Quality Measurement Recommendations Relevant to Clinical Guidelines in Germany and the United Kingdom: (What) Can We Learn From Each Other?

PubMed Central

Petzold, Thomas; Deckert, Stefanie; Williamson, Paula R.; Schmitt, Jochen

2018-01-01

We conducted a systematic review of clinical guidelines (CGs) to examine the methodological approaches of quality indicator derivation in CGs, the frequency of quality indicators to check CG recommendations in routine care, and clinimetric properties of quality indicators. We analyzed the publicly available CG databases of the Association of the Scientific Medical Societies in Germany (AWMF) and National Institute for Health and Care Excellence (NICE). Data on the methodology of subsequent quality indicator derivation, the content and definition of recommended quality indicators, and clinimetric properties of measurement instruments were extracted. In Germany, no explicit methodological guidance exists, but 3 different approaches are used. For NICE, a general approach is used for the derivation of quality indicators out of quality standards. Quality indicators were defined in 34 out of 87 CGs (39%) in Germany and for 58 out of 133 (43%) NICE CGs. Statements regarding measurement properties of instruments for quality indicator assessment were missing in German and NICE documents. Thirteen pairs of CGs (32%) have associated quality indicators. Thirty-four quality indicators refer to the same aspect of the quality of care, which corresponds to 27% of the German and 7% of NICE quality indicators. The development of a standardized and internationally accepted methodology for the derivation of quality indicators relevant to CGs is needed to measure and compare quality of care in health care systems. PMID:29591538

The diagnostic test accuracy of rectal examination for prostate cancer diagnosis in symptomatic patients: a systematic review.

PubMed

Jones, Daniel; Friend, Charlotte; Dreher, Andreas; Allgar, Victoria; Macleod, Una

2018-06-02

Prostate cancer is the most common cancer in men in the UK. NICE guidelines on recognition and referral of suspected cancer, recommend performing digital rectal examination (DRE) on patients with urinary symptoms and urgently referring if the prostate feels malignant. However, this is based on the results of one case control study, so it is not known if DRE performed in primary care is an accurate method of detecting prostate cancer. The aim of this review is to ascertain the sensitivity, specificity, positive and negative predictive value of DRE for the detection of prostate cancer in symptomatic patients in primary care. CENTRAL, MEDLINE, EMBASE and CINAHL databases were searched in august 2015 for studies in which a DRE was performed in primary care on symptomatic patients and compared against a reference diagnostic procedure. Four studies were included with a total of 3225 patients. The sensitivity and specificity for DRE as a predictor of prostate cancer in symptomatic patients was 28.6 and 90.7%, respectively. The positive and negative predictive values were 42.3 and 84.2%, respectively. This review found that DRE performed in general practice is accurate, and supports the UK NICE guidelines that patients with a malignant prostate on examination are referred urgently for suspected prostate cancer. Abnormal DRE carried a 42.3% chance of malignancy, above the 3% risk threshold which NICE guidance suggests warrants an urgent referral. However this review questions the benefit of performing a DRE in primary care in the first instance, suggesting that a patient's risk of prostate cancer based on symptoms alone would warrant urgent referral even if the DRE feels normal.

Coastal Amplification Laws for the French Tsunami Warning Center: Numerical Modeling and Fast Estimate of Tsunami Wave Heights Along the French Riviera

NASA Astrophysics Data System (ADS)

Gailler, A.; Hébert, H.; Schindelé, F.; Reymond, D.

2017-11-01

Tsunami modeling tools in the French tsunami Warning Center operational context provide rapidly derived warning levels with a dimensionless variable at basin scale. A new forecast method based on coastal amplification laws has been tested to estimate the tsunami onshore height, with a focus on the French Riviera test-site (Nice area). This fast prediction tool provides a coastal tsunami height distribution, calculated from the numerical simulation of the deep ocean tsunami amplitude and using a transfer function derived from the Green's law. Due to a lack of tsunami observations in the western Mediterranean basin, coastal amplification parameters are here defined regarding high resolution nested grids simulations. The preliminary results for the Nice test site on the basis of nine historical and synthetic sources show a good agreement with the time-consuming high resolution modeling: the linear approximation is obtained within 1 min in general and provides estimates within a factor of two in amplitude, although the resonance effects in harbors and bays are not reproduced. In Nice harbor especially, variation in tsunami amplitude is something that cannot be really assessed because of the magnitude range and maximum energy azimuth of possible events to account for. However, this method is well suited for a fast first estimate of the coastal tsunami threat forecast.

Coastal amplification laws for the French tsunami Warning Center: numerical modeling and fast estimate of tsunami wave heights along the French Riviera

NASA Astrophysics Data System (ADS)

Gailler, A.; Schindelé, F.; Hebert, H.; Reymond, D.

2017-12-01

Tsunami modeling tools in the French tsunami Warning Center operational context provide for now warning levels with a no dimension scale, and at basin scale. A new forecast method based on coastal amplification laws has been tested to estimate the tsunami onshore height, with a focus on the French Riviera test-site (Nice area). This fast prediction tool provides a coastal tsunami height distribution, calculated from the numerical simulation of the deep ocean tsunami amplitude and using a transfer function derived from the Green's law. Due to a lack of tsunami observation in the western Mediterranean basin, coastal amplification parameters are here defined regarding high resolution nested grids simulations. The first encouraging results for the Nice test site on the basis of 9 historical and fake sources show a good agreement with the time-consuming high resolution modeling: the linear approximation provides within in general 1 minute estimates less a factor of 2 in amplitude, although the resonance effects in harbors and bays are not reproduced. In Nice harbor especially, variation in tsunami amplitude is something that cannot be really appreciated because of the magnitude range and maximum energy azimuth of possible events to account for. However, this method suits well for a fast first estimate of the coastal tsunami threat forecast.

Coastal Amplification Laws for the French Tsunami Warning Center: Numerical Modeling and Fast Estimate of Tsunami Wave Heights Along the French Riviera

NASA Astrophysics Data System (ADS)

Gailler, A.; Hébert, H.; Schindelé, F.; Reymond, D.

2018-04-01

Tsunami modeling tools in the French tsunami Warning Center operational context provide rapidly derived warning levels with a dimensionless variable at basin scale. A new forecast method based on coastal amplification laws has been tested to estimate the tsunami onshore height, with a focus on the French Riviera test-site (Nice area). This fast prediction tool provides a coastal tsunami height distribution, calculated from the numerical simulation of the deep ocean tsunami amplitude and using a transfer function derived from the Green's law. Due to a lack of tsunami observations in the western Mediterranean basin, coastal amplification parameters are here defined regarding high resolution nested grids simulations. The preliminary results for the Nice test site on the basis of nine historical and synthetic sources show a good agreement with the time-consuming high resolution modeling: the linear approximation is obtained within 1 min in general and provides estimates within a factor of two in amplitude, although the resonance effects in harbors and bays are not reproduced. In Nice harbor especially, variation in tsunami amplitude is something that cannot be really assessed because of the magnitude range and maximum energy azimuth of possible events to account for. However, this method is well suited for a fast first estimate of the coastal tsunami threat forecast.

What and How Are We Evaluating? Meta-Evaluation Study of the NASA Innovations in Climate Education (NICE) Portfolio

NASA Astrophysics Data System (ADS)

Martin, A. M.; Barnes, M. H.; Chambers, L. H.; Pippin, M. R.

2011-12-01

As part of NASA's Minority University Research and Education Program (MUREP), the NASA Innovations in Climate Education (NICE) project at Langley Research Center has funded 71 climate education initiatives since 2008. The funded initiatives span across the nation and contribute to the development of a climate-literate public and the preparation of a climate-related STEM workforce through research experiences, professional development opportunities, development of data access and modeling tools, and educational opportunities in both K-12 and higher education. Each of the funded projects proposes and carries out its own evaluation plan, in collaboration with external or internal evaluation experts. Using this portfolio as an exemplar case, NICE has undertaken a systematic meta-evaluation of these plans, focused primarily on evaluation questions, approaches, and methods. This meta-evaluation study seeks to understand the range of evaluations represented in the NICE portfolio, including descriptive information (what evaluations, questions, designs, approaches, and methods are applied?) and questions of value (do these evaluations meet the needs of projects and their staff, and of NASA/NICE?). In the current climate, as federal funders of climate change and STEM education projects seek to better understand and incorporate evaluation into their decisions, evaluators and project leaders are also seeking to build robust understanding of program effectiveness. Meta-evaluations like this provide some baseline understanding of the current status quo and the kinds of evaluations carried out within such funding portfolios. These explorations are needed to understand the common ground between evaluative best practices, limited resources, and agencies' desires, capacity, and requirements. When NASA asks for evaluation of funded projects, what happens? Which questions are asked and answered, using which tools? To what extent do the evaluations meet the needs of projects and program officers? How do they contribute to best practices in climate science education? These questions are important to ask about STEM and climate literacy work more generally; the NICE portfolio provides a broad test case for thinking strategically, critically, and progressively about evaluation in our community. Our findings can inform the STEM education, communication, and public outreach communities, and prompt us to consider a broad range of informative evaluation options. During this presentation, we will consider the breadth, depth and utility of evaluations conducted through a NASA climate education funding opportunity. We will examine the relationship between what we want to know about education programs, what we want to achieve with our interventions, and what we ask in our evaluations.

What and How Are We Evaluating? Meta-Evaluation Study of the NASA Innovations in Climate Education (NICE) Portfolio

NASA Astrophysics Data System (ADS)

Martin, A. M.; Barnes, M. H.; Chambers, L. H.; Pippin, M. R.

2013-12-01

As part of NASA's Minority University Research and Education Program (MUREP), the NASA Innovations in Climate Education (NICE) project at Langley Research Center has funded 71 climate education initiatives since 2008. The funded initiatives span across the nation and contribute to the development of a climate-literate public and the preparation of a climate-related STEM workforce through research experiences, professional development opportunities, development of data access and modeling tools, and educational opportunities in both K-12 and higher education. Each of the funded projects proposes and carries out its own evaluation plan, in collaboration with external or internal evaluation experts. Using this portfolio as an exemplar case, NICE has undertaken a systematic meta-evaluation of these plans, focused primarily on evaluation questions, approaches, and methods. This meta-evaluation study seeks to understand the range of evaluations represented in the NICE portfolio, including descriptive information (what evaluations, questions, designs, approaches, and methods are applied?) and questions of value (do these evaluations meet the needs of projects and their staff, and of NASA/NICE?). In the current climate, as federal funders of climate change and STEM education projects seek to better understand and incorporate evaluation into their decisions, evaluators and project leaders are also seeking to build robust understanding of program effectiveness. Meta-evaluations like this provide some baseline understanding of the current status quo and the kinds of evaluations carried out within such funding portfolios. These explorations are needed to understand the common ground between evaluative best practices, limited resources, and agencies' desires, capacity, and requirements. When NASA asks for evaluation of funded projects, what happens? Which questions are asked and answered, using which tools? To what extent do the evaluations meet the needs of projects and program officers? How do they contribute to best practices in climate science education? These questions are important to ask about STEM and climate literacy work more generally; the NICE portfolio provides a broad test case for thinking strategically, critically, and progressively about evaluation in our community. Our findings can inform the STEM education, communication, and public outreach communities, and prompt us to consider a broad range of informative evaluation options. During this presentation, we will consider the breadth, depth and utility of evaluations conducted through a NASA climate education funding opportunity. We will examine the relationship between what we want to know about education programs, what we want to achieve with our interventions, and what we ask in our evaluations.

Say No to Speed Bumps!

ERIC Educational Resources Information Center

Brannon, Sian

2010-01-01

No matter how cutting edge (and nicely funded) one's library is, there is always something cooler and more efficient on the horizon. Granted, not all new technology may be necessary in the library. But chances are one is going to want to get something--RFID (radio frequency identification), text reference, downloadable content, gaming,…

Noise-immune cavity-enhanced analytical atomic spectrometry - NICE-AAS - A technique for detection of elements down to zeptogram amounts

NASA Astrophysics Data System (ADS)

Axner, Ove; Ehlers, Patrick; Hausmaninger, Thomas; Silander, Isak; Ma, Weiguang

2014-10-01

Noise-immune cavity-enhanced optical heterodyne molecular spectroscopy (NICE-OHMS) is a powerful technique for detection of molecular compounds in gas phase that is based on a combination of two important concepts: frequency modulation spectroscopy (FMS) for reduction of noise, and cavity enhancement, for prolongation of the interaction length between the light and the sample. Due to its unique properties, it has demonstrated unparalleled detection sensitivity when it comes to detection of molecular constituents in the gas phase. However, despite these, it has so far not been used for detection of atoms, i.e. for elemental analysis. The present work presents an assessment of the expected performance of Doppler-broadened (Db) NICE-OHMS for analytical atomic spectrometry, then referred to as noise-immune cavity-enhanced analytical atomic spectrometry (NICE-AAS). After a description of the basic principles of Db-NICE-OHMS, the modulation and detection conditions for optimum performance are identified. Based on a previous demonstrated detection sensitivity of Db-NICE-OHMS of 5 × 10- 12 cm- 1 Hz- 1/2 (corresponding to a single-pass absorbance of 7 × 10- 11 over 10 s), the expected limits of detection (LODs) of Hg and Na by NICE-AAS are estimated. Hg is assumed to be detected in gas phase directly while Na is considered to be atomized in a graphite furnace (GF) prior to detection. It is shown that in the absence of spectral interferences, contaminated sample compartments, and optical saturation, it should be feasible to detect Hg down to 10 zg/cm3 (10 fg/m3 or 10- 5 ng/m3), which corresponds to 25 atoms/cm3, and Na down to 0.5 zg (zg = zeptogram = 10- 21 g), representing 50 zg/mL (parts-per-sextillion, pps, 1:1021) in liquid solution (assuming a sample of 10 μL) or solely 15 atoms injected into the GF, respectively. These LODs are several orders of magnitude lower (better) than any previous laser-based absorption technique previously demonstrated under atmospheric pressure conditions. It is prophesied that NICE-AAS could provide such high detection sensitivity that the instrumentation should not, by itself, be the limiting factor of an assessment of elemental abundance; the accuracy of an assessment would then instead be limited by concomitant species, e.g. originating from the handling procedures of the sample or the environment.

Tailor systemic therapy to the patient with severe psoriasis.

PubMed

Van de Velde, Vanessa; Tidman, Michael J

2016-02-01

There is no standard definition regarding the severity of psoriasis, and a number of factors should be considered, including the extent and stability of skin disease, involvement of joints, response to treatment, and impact on quality of life. Erythrodermic psoriasis and pustular psoriasis are severe conditions and the patient may be systemically unwell and febrile. NICE recommends that four key areas should be evaluated and recorded when assessing patients: severity, using the static Physician's Global Assessment (sPGA); disease impact on physical, psychological and social wellbeing using the Dermatology Life Quality Index (DLQI); the presence of psoriatic arthritis; and comorbidities. Ideally, patients should be assessed annually for psoriatic arthritis: the Psoriasis Epidemiology Screening Tool is a validated tool to screen for psoriatic arthritis in primary and secondary care. Patients with severe psoriasis should undergo cardiovascular risk assessment at presentation and every five years, or more frequently if indicated. Referral to secondary care should be made for patients with any type of psoriasis with poor response to topical therapy (after 2 or 3 months according to SIGN) and for extensive psoriasis. Cases where the psoriasis is having a significant physical or psychological impact on an individual's quality of life warrant early referral, as do those where the diagnosis is uncertain. Patients with generalised pustular psoriasis or erythroderma should be referred urgently for same-day specialist input. Patients with acute guttate psoriasis who may require phototherapy should also be referred. Children and adolescents with any type of psoriasis should be referred to a specialist at initial presentation.

Construction of two Lactococcus lactis expression vectors combining the Gateway and the NIsin Controlled Expression systems.

PubMed

Douillard, François P; Mahony, Jennifer; Campanacci, Valérie; Cambillau, Christian; van Sinderen, Douwe

2011-09-01

Over the last 10 years, the NIsin Controlled Expression (NICE) system has been extensively used in the food-grade bacterium Lactococcus lactis subsp. cremoris to produce homologous and heterologous proteins for academic and biotechnological purposes. Although various L. lactis molecular tools have been developed, no expression vectors harboring the popular Gateway recombination system are currently available for this widely used cloning host. In this study, we constructed two expression vectors that combine the NICE and the Gateway recombination systems and we tested their applicability by recombining and over-expressing genes encoding structural proteins of lactococcal phages Tuc2009 and TP901-1. Over-expressed phage proteins were analyzed by immunoblotting and purified by His-tag affinity chromatography with protein productions yielding 2.8-3.7 mg/l of culture. This therefore is the first description of L. lactis NICE expression vectors which integrate the Gateway cloning technology and which are suitable for the production of sufficient amounts of proteins to facilitate subsequent structural and functional analyses. Copyright © 2011 Elsevier Inc. All rights reserved.

Cost-effective public health guidance: asking questions from the decision-maker's viewpoint.

PubMed

Chalkidou, Kalipso; Culyer, Anthony; Naidoo, Bhash; Littlejohns, Peter

2008-03-01

In February 2004, in his assessment of the long-term financial viability of the NHS, Derek Wanless recommended the use of 'a consistent framework, such as the methodology developed by NICE, to evaluate the cost-effectiveness of interventions and initiatives across health care and public health'. One year later public health was added to NICE's remit and the new National Institute for Health and Clinical Excellence (NICE) was established, with amended statutory instruments to permit consideration of broader public sector costs when developing cost-effective guidance for public health. With the principle of 'a consistent framework' put forward by Wanless as the starting point, this paper provides an insight into the most challenging aspects of applying the principles of cost-effectiveness analysis in the public health context from the policymaker's perspective. It reflects on the long-term consequences of taking on responsibility for producing public health guidance on the Institute's overall approach to guidance development and describes the tension between striving for consistency and cross-evaluation comparability while ensuring that the methodological tools used are fit for the purpose of developing public health guidance.

The National Institute for Health and Clinical Excellence (NICE) guidelines for early detection of ovarian cancer: the pivotal role of the clinical laboratory.

PubMed

Sturgeon, Catharine M; Duffy, Michael J; Walker, Graeme

2011-07-01

The National Institute for Health and Clinical Excellence (NICE) has recently reviewed optimal means of early recognition and initial management of ovarian cancer, the leading cause of gynaecological death in the UK. The NICE guidelines state that general practitioners should measure serum CA125 in women presenting with persistent and continuous symptoms suggestive of ovarian cancer (e.g. abdominal distension, early satiety and loss of appetite or pelvic pain). If CA125 is ≥35 kU/L, the general practitioner should arrange an ultrasound scan of the abdomen and pelvis to enable calculation of the risk of malignancy score (RMI). Women with an RMI score of ≥250 should then be referred to a specialist multidisciplinary team. Successful implementation of these guidelines requires close liaison between primary care and laboratory medicine to ensure that CA125 is requested as a diagnostic aid only for women meeting the criteria stated in the guidelines. Preanalytical criteria must also be met and it is essential that both requestors and patients be aware of other possible causes of increases in CA125, as well as the fact that it is not raised in all patients with ovarian cancer. Guidance is being prepared to enable appropriate interpretation and implementation of the NICE guidelines. Continuous audit of the outcomes will also be essential to determine the effectiveness of this approach to early detection of ovarian cancer.

Doppler-broadened NICE-OHMS beyond the cavity-limited weak absorption condition - II: Experimental verification

NASA Astrophysics Data System (ADS)

Hausmaninger, Thomas; Silander, Isak; Ma, Weiguang; Axner, Ove

2016-01-01

Doppler-broadened (Db) noise-immune cavity-enhanced optical heterodyne molecular spectrometry (NICE-OHMS) is normally described by an expression, here termed the conventional (CONV) description, that is restricted to the conventional cavity-limited weak absorption condition (CCLWA), i.e. when the single pass absorbance is significantly smaller than the empty cavity losses, i.e. when α0 L < < π / F. To describe NICE-OHMS signals beyond this limit two simplified extended descriptions (termed the extended locking and extended transmission description, ELET, and the extended locking and full transmission description, ELFT), which are assumed to be valid under the relaxed cavity-limited weak absorption condition (RCLWA), i.e. when α0 L < π / F, and a full description (denoted FULL), presumed to be valid also when the α0 L < π / F condition does not hold, have recently been derived in an accompanying work (Ma W, et al. Doppler-broadened NICE-OHMS beyond the cavity-limited weak absorption condition - I. Theoretical Description. J Quant Spectrosc Radiat Transfer, 2015, http://dx.doi.org/10.1016/j.jqsrt.2015.09.007). The present work constitutes an experimental verification and assessment of the validity of these, performed in the Doppler limit for a set of Fα0 L / π values (up to 3.5); it is shown under which conditions the various descriptions are valid. It is concluded that for samples with Fα0 L / π up to 0.01, all descriptions replicate the data well. It is shown that the CONV description is adequate and provides accurate assessments of the signal strength (and thereby the analyte concentration) up to Fα0 L / π of around 0.1, while the ELET is accurate for Fα0 L / π up to around 0.3. The ELFT description mimics the Db NICE-OHMS signal well for Fα0 L / π up to around unity, while the FULL description is adequate for all Fα0 L / π values investigated. Access to these descriptions both increases considerably the dynamic range of the technique and facilitates calibration using certified reference gases, which thereby significantly broadens the applicability of the Db NICE-OHMS technique.

Current strategies for monitoring men with localised prostate cancer lack a strong evidence base: observational longitudinal study.

PubMed

Metcalfe, C; Tilling, K; Davis, M; Lane, J A; Martin, R M; Kynaston, H; Powell, P; Neal, D E; Hamdy, F; Donovan, J L

2009-08-04

The UK National Institute for Health and Clinical Excellence (NICE) guidance recommends conservative management of men with 'low-risk' localised prostate cancer, monitoring the disease using prostate-specific antigen (PSA) kinetics and re-biopsy. However, there is little evidence of the changes in PSA level that should alert to the need for clinical re-assessment. This study compares the alerts resulting from PSA kinetics and a novel longitudinal reference range approach, which incorporates age-related changes, during the monitoring of 408 men with localised prostate cancer. Men were monitored by regular PSA tests over a mean of 2.9 years, recording when a man's PSA doubling time fell below 2 years, PSA velocity exceeded 2 ng ml(-1) per year, or when his upper 10% reference range was exceeded. Prostate-specific antigen doubling time and PSA velocity alerted a high proportion of men initially but became unresponsive to changes with successive tests. Calculating doubling time using recent PSA measurements reduced the decline in response. The reference range method maintained responsiveness to changes in PSA level throughout the monitoring. The increasing unresponsiveness of PSA kinetics is a consequence of the underlying regression model. Novel methods are needed for evaluation in cohorts currently being managed by monitoring. Meanwhile, the NICE guidance should be cautious.

Silent Starters

ERIC Educational Resources Information Center

Morris, Emma

2011-01-01

The "silent starter" is an idea that the author was reminded of during Christopher Martin's session at the ATM conference in 2011, entitled "Big Ideas". This was a nice idea for introducing, or practising mappings, but it was not the first time the author had encountered this powerful teaching tool. The idea is best explained…

Clinical guidelines in pediatric headache: evaluation of quality using the AGREE II instrument

PubMed Central

2014-01-01

Background The Appraisal of Guidelines for Research and Evaluation (AGREE II) tool is a validated questionnaire used to assess the methodological quality of clinical guidelines (CGs). We used the AGREE II tool to assess the development process, the methodological quality, and the quality of reporting of available pediatric CGs for the management of headache in children. We also studied the variability in responses related to the characteristics of eleven Italian neuropediatric centers, showing similarities and differences in the main recommendations reported in CGs. Methods A systematic literature search was conducted from January 2002 to June 2013 on Mediline, the Cochrane database, the National Guideline Clearinghouse website and the NHS evidence search tool, using the following terms: headache, cephalalgia, guidelines and children (MESH or text words). Six CGs providing information on the diagnosis and management of headache and specific recommendations for children were selected. Eleven neuropediatric centers assessed the overall quality and the appropriateness of all available CGs using of the AGREE II instrument. Results Six CGs meeting the inclusion and exclusion criteria were identified and assessed by 11 reviewers. Our study showed that the NICE CGs was “strongly recommended” while the French and Danish CGs were mainly “not recommended”. The comparison between the overall quality score of the French CGs and the NICE CGs was statistically significant (6.54 ± 0.69 vs 4.18 ± 1.08; p =0.001). The correlation analysis between quality domain score and guideline publication date showed a statistically significant association only for the “editorial independence” domain (r = 0.842 p = 0.035). The intra-class coefficients showed that the 11 reviewers had the highest agreement for the Lewis CGs (r = 0.857), and the lowest one for the NICE CGs (r = 0.656). Statistical analyses showed that professionals from outpatient services dedicated pediatric headache assigned a higher overall quality score to the NICE CGs as compared to professionals from non-outpatient services (6.86 ± 0.38 vs 6.0 ± 0.82; p = 0.038). Conclusions CGs resulted definitely of low-moderate quality and non “homogeneous”. Further major efforts are needed to update the existing CGs according to the principles of evidence based medicine. PMID:25178699

NICE guidance: a comparative study of the introduction of the single technology appraisal process and comparison with guidance from Scottish Medicines Consortium

PubMed Central

Waugh, Norman; Sharma, Pawana; Sculpher, Mark; Walker, Andrew

2012-01-01

Objectives To compare the timelines and recommendations of the Scottish Medicines Consortium (SMC) and National Institute of Health and Clinical Excellence (NICE), in particular since the single technology assessment (STA) process was introduced in 2005. Design Comparative study of drug appraisals published by NICE and SMC. Setting NICE and SMC. Participants All drugs appraised by SMC and NICE, from establishment of each organisation until August 2010, were included. Data were gathered from published reports on the NICE website, SMC annual reports and European Medicines Agency website. Primary and secondary outcome measures Primary outcome was time from marketing authorisation until publication of first guidance. The final outcome for each drug was documented. Drug appraisals by NICE (before and after the introduction of the STA process) and SMC were compared. Results NICE and SMC appraised 140 drugs, 415 were appraised by SMC alone and 102 by NICE alone. NICE recommended, with or without restriction, 90% of drugs and SMC 80%. SMC published guidance more quickly than NICE (median 7.4 compared with 21.4 months). Overall, the STA process reduced the average time to publication compared with multiple technology assessments (median 16.1 compared with 22.8 months). However, for cancer medications, the STA process took longer than multiple technology assessment (25.2 compared with 20.0 months). Conclusions Proportions of drugs recommended for NHS use by SMC and NICE are similar. SMC publishes guidance more quickly than NICE. The STA process has improved the time to publication but not for cancer drugs. The lengthier time for NICE guidance is partly due to measures to provide transparency and the widespread consultation during the NICE process. PMID:22290398

Reducing the overuse of βhCG measurements in the emergency gynaecology clinic.

PubMed

Frost, Lucy

2016-01-01

Serial βhCG testing can be a helpful tool in deciding how to manage pregnancy of unknown location. Its use in emergency gynaecology clinics can prevent unnecessary admission and intervention. However, despite NICE Guidelines on when it is safe to opt for conservative management, it was identified that there was a problem with over-testing of βhCG when patients could be discharged with instructions to repeat a urinary pregnancy test in two weeks. Two PDSA cycles were undertaken to improve the awareness of NICE guidelines: the first involved formal and informal educational sessions and the second involved the inclusion of a guideline summary on the front of patients' notes when they were having serial βhCG tests for doctors to refer to. Case notes were reviewed for 157 women who had βhCG tests at baseline and 48 hours. Of these, 139 were suitable for serial βhCG testing, and 83 of these were suitable for discharge after 48 hours. Of the 83 patients that were eligible for discharge, there were 31 unnecessary βhCG tests done, 23 of which were prior to intervention. A significant improvement was noted, with between 4-10 unnecessary βhCG tests per fortnight prior to intervention, 0-3 following the first intervention, and 0-2 following the second. Reduction in unnecessary βhCG testing has positive implications for patients, who do not have to take unnecessary time off work, prolong an already very distressing period, and have unnecessary blood tests. There are also cost and time saving implications for the hospital.

Challenging current views on bile acid diarrhoea and malabsorption.

PubMed

Kurien, Matthew; Thurgar, Elizabeth; Davies, Ashley; Akehurst, Ron; Andreyev, Jervoise

2018-04-01

In 2012, the National Institute for Health and Care Excellence (NICE) assessed guidance (DG7) on the use of tauroselcholic ( 75 selenium) acid (also known as SeHCAT) for the investigation of diarrhoea due to bile acid malabsorption (BAM) in patients with IBS-D and in patients with Crohn's disease who have not had an ileal resection. NICE concluded that tauroselcholic ( 75 selenium) acid was recommended for use in research only. NICE will be reviewing the decision to update the guidance for tauroselcholic ( 75 selenium) acid, for these populations, in March 2017. Our aim is to summarise advances in BAM, also known as bile acid diarrhoea (BAD), and encourage clinicians to re-evaluate their understanding of this disorder. We review the prevalence, diagnosis and treatment of BAD/BAM. We describe the new evidence available since the original NICE review in 2012, and discuss the economic issues associated with failure to diagnose or to treat BAD/BAM accurately. There is new and compelling evidence available since DG7, which shows that tauroselcholic ( 75 selenium) acid scanning is a powerful tool in the diagnosis of BAD/BAM. We summarise published prevalence data (approximately 1% prevalence in the UK, as suggested by clinical practice diagnosis rates), and highlight that the true prevalence of BAD/BAM could be far greater than this. We present evidence that challenges current opinion about this disorder, and we commend both clinicians and health technology assessment (HTA) agencies for being open to arguments and new evidence in any future HTAs.

"How to Be Nice 'and' Get What You Want": Structural Referents of "Self" and "Other" in Experiential Education as (Un)Democratic Practice

ERIC Educational Resources Information Center

Vernon, Franklin

2015-01-01

This critical ethnography explores a social justice program utilizing nontraditional, democratic, "experiential" education practices. The author posits a historical legacy of pedagogy of self obscures its emancipatory, democratic potential while simultaneously expanding on contemporary discourses of self and other as aspects of the…

Diagnosis of gestational diabetes mellitus: falling through the net.

PubMed

Meek, Claire L; Lewis, Hannah B; Patient, Charlotte; Murphy, Helen R; Simmons, David

2015-09-01

Gestational diabetes mellitus (GDM) is associated with increased risks to mother and child, but globally agreed diagnostic criteria remain elusive. Identification of women with GDM is important, as treatment reduces adverse outcomes such as perinatal death, shoulder dystocia and neonatal hypoglycaemia. Recently, the UK's National Institute for Health and Care Excellence (NICE) recommended new diagnostic thresholds for GDM which are different from the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) criteria endorsed by the WHO. The study aim was to assess neonatal and obstetric outcomes among women who would test positive for the IADPSG criteria but negative for the NICE 2015 criteria. Data from 25,543 consecutive singleton live births (2004-2008) were obtained retrospectively from hospital records. Women were screened with a random plasma glucose (RPG; 12-16 weeks) and a 50 g glucose challenge test (GCT; 26-28 weeks). If RPG >7.0 mmol/l, GCT >7.7 mmol/l or symptoms were present, a 75 g OGTT was offered (n = 3,848). In this study, GDM prevalence was 4.13% (NICE 2015) and 4.62% (IADPSG). Women who 'fell through the net', testing NICE-negative but IADPSG-positive (n = 387), had a higher risk of having a large-for-gestational-age (LGA) infant (birthweight >90th percentile for gestational age; adjusted OR [95% CI] 3.12 [2.44, 3.98]), Caesarean delivery (1.44 [1.15, 1.81]) and polyhydramnios (6.90 [3.94, 12.08]) compared with women with negative screening results and no OGTT (n = 21,695). LGA risk was highest among women with fasting plasma glucose 5.1-5.5 mmol/l (n = 167): the mean birthweight was 350 g above that of the reference population and 37.7% of infants were LGA. The IADPSG criteria identify women at substantial risk of complications who would not be identified by the NICE 2015 criteria.

Priming methods in semantics and pragmatics.

PubMed

Maldonado, Mora; Spector, Benjamin; Chemla, Emmanuel

2017-01-01

Structural priming is a powerful method to inform linguistic theories. We argue that this method extends nicely beyond syntax to theories of meaning. Priming, however, should still be seen as only one of the tools available for linguistic data collection. Specifically, because priming can occur at different, potentially conflicting levels, it cannot detect every aspect of linguistic representations.

Differences in cancer drug assessment between Spain and the United Kingdom.

PubMed

Lozano-Blázquez, Ana; Dickson, Rumona; Fraga-Fuentes, María-Dolores; Martínez-Martínez, Fernando; Calleja-Hernández, Miguel-Ángel

2015-09-01

There is no Spanish Government agency resembling the National Institute for Health and Care Excellence (NICE) in the United Kingdom (UK) that carries out a centralised evaluation and makes decisions about funding. Therefore, we aim to assess the differences between NICE and the Spanish bodies in terms of their respective processes. We compare the decisions concerning cancer drugs in the assessments made by NICE/Single Technology Appraisal with assessments made by MADRE methodology. We included all cancer drugs assessed by NICE and all MADRE reports made using a shared reports process (GENESIS) and reports from Catalonia (CAMDHA) and Andalucía (GFTHA). We compared the number of drugs assessed, the decisions taken by NICE and Spanish organizations and timelines. Between January 2011 and December 2013 NICE appraised 24 cancer drugs. In Spain, 44 reports were produced using MADRE methodology. For the 14 drugs assessed by both NICE and Spanish bodies, NICE rejected a high proportion of the drugs (50% versus 26%). GENESIS, with a median of 8 months, made decisions more quickly than NICE (13.5 months) and GFTHA (17 months). The slowest organisation was CAMDHA (24.5 months). More drugs are assessed in Spain than by NICE because there are more organisations in Spain doing this work and their processes are simpler. NICE rejects more drugs as it uses cost-effectiveness thresholds that lead to a 'not-recommended' decision, and Spanish bodies recommend cancer drugs for subgroups of patients where better results can be obtained. Timelines are better for Spanish Committees, probably because of the greater number of steps in the appraisal process by NICE. Copyright © 2015 Elsevier Ltd. All rights reserved.

The Management of Patients with Depression In Primary Care: an Audit Review.

PubMed

Henfrey, Helen

2015-09-01

The IAPT scheme was introduced in 2007 to implement the recommendations from NICE guidelines regarding psychological therapy for depression. This retrospective audit carried out across two General Practice Surgeries evaluates the care being given in relation to the standards of NICE guidelines. Initial audit found variable concordance, however after discussion of this at a local audit meeting and the displaying of posters and leaflets detailing the IAPT scheme this was improved on re-audit. Training should be provided to General Practitioners regarding the standards of care for patients with low mood or depression. In this training there should be an emphasis on the role of psychological therapy and details given of local resources. Posters and leaflets should be clearly displayed to allow patients to self-refer to IAPT. A close watch must be given to waiting times for the IAPT service as demands increase.

Resource Planning in Glaucoma: A Tool to Evaluate Glaucoma Service Capacity.

PubMed

Batra, Ruchika; Sharma, Hannah E; Elaraoud, Ibrahim; Mohamed, Shabbir

2017-12-28

The National Patient Safety Agency (2009) publication advising timely follow-up of patients with established glaucoma followed several reported instances of visual loss due to postponed appointments and patients lost to follow-up. The Royal College of Ophthalmologists Quality Standards Development Group stated that all hospital appointments should occur within 15% of the intended follow-up period. To determine whether: 1. Glaucoma follow-up appointments at a teaching hospital occur within the requested time 2. Appointments are requested at appropriate intervals based on the NICE Guidelines 3. The capacity of the glaucoma service is adequate Methods: A two-part audit was undertaken of 98 and 99 consecutive patients respectively attending specialist glaucoma clinics. In the first part, the reasons for delayed appointments were recorded. In the second part the requested follow-up was compared with NICE guidelines where applicable. Based on the findings, changes were implemented and a re-audit of 100 patients was carried out. The initial audit found that although clinical decisions regarding follow-up intervals were 100% compliant with NICE guidelines where applicable, 24% of appointments were delayed beyond 15% of the requested period, due to administrative errors and inadequate capacity, leading to significant clinical deterioration in two patients. Following the introduction of an electronic appointment tracker and increased clinical capacity created by extra clinics and clinicians, the re-audit found a marked decrease in the percentage of appointments being delayed (9%). This audit is a useful tool to evaluate glaucoma service provision, assist in resource planning for the service and bring about change in a non-confrontational way. It can be widely applied and adapted for use in other medical specialities.

A prospective audit of the impact of additional staff on the care of diabetic patients in a community podiatry service

PubMed Central

Ryan, Alexandra; Uppal, Meenakshi; Cunning, Imelda; Buckley, Claire M.

2015-01-01

Objective The purpose of this study was to evaluate the impact of the employment of additional podiatry staff on patients with diabetes attending a community-based podiatry service. Methods An audit was conducted to evaluate the intervention of two additional podiatry staff. All patients with diabetes referred to and attending community podiatry services in a specified area in the Republic of Ireland between June 2011 and June 2012 were included. The service was benchmarked against the UK gold standard outlined in the ‘Guidelines on prevention & management of foot problems in Type 2 Diabetes’ by the National Institute of Clinical Excellence (NICE). Process of care measures addressed were the number of patients with diabetes receiving treatment and the waiting times of patients with diabetes from referral to initial review. Results An increase in the number of patients with diabetes receiving treatment was seen in all risk categories (ranging from low risk to the emergency foot). Waiting times for patients with diabetes decreased post-intervention but did not reach the targets outlined in the NICE guidelines. The average time from referral to initial review of patients with an emergency diabetic foot was 37 weeks post-intervention. NICE guidelines recommend that these patients are seen within 24 hours. Discussion During the life cycle of this audit, increased numbers of patients were treated and waiting times for patients with diabetes were reduced. An internal re-organisation of the services coincided with the commencement of the additional staff. The improvements observed were due to the effects of a combination of additional staff and service re-organisation. Efficient organisation of services is key to optimal performance. Continued efforts to improve services are required to reach the standards outlined in the NICE guidelines. PMID:26048860

A prospective audit of the impact of additional staff on the care of diabetic patients in a community podiatry service.

PubMed

Ryan, Alexandra; Uppal, Meenakshi; Cunning, Imelda; Buckley, Claire M

2015-01-01

The purpose of this study was to evaluate the impact of the employment of additional podiatry staff on patients with diabetes attending a community-based podiatry service. An audit was conducted to evaluate the intervention of two additional podiatry staff. All patients with diabetes referred to and attending community podiatry services in a specified area in the Republic of Ireland between June 2011 and June 2012 were included. The service was benchmarked against the UK gold standard outlined in the 'Guidelines on prevention & management of foot problems in Type 2 Diabetes' by the National Institute of Clinical Excellence (NICE). Process of care measures addressed were the number of patients with diabetes receiving treatment and the waiting times of patients with diabetes from referral to initial review. An increase in the number of patients with diabetes receiving treatment was seen in all risk categories (ranging from low risk to the emergency foot). Waiting times for patients with diabetes decreased post-intervention but did not reach the targets outlined in the NICE guidelines. The average time from referral to initial review of patients with an emergency diabetic foot was 37 weeks post-intervention. NICE guidelines recommend that these patients are seen within 24 hours. During the life cycle of this audit, increased numbers of patients were treated and waiting times for patients with diabetes were reduced. An internal re-organisation of the services coincided with the commencement of the additional staff. The improvements observed were due to the effects of a combination of additional staff and service re-organisation. Efficient organisation of services is key to optimal performance. Continued efforts to improve services are required to reach the standards outlined in the NICE guidelines.

Age-related references in national public health, technology appraisal and clinical guidelines and guidance: documentary analysis.

PubMed

Forrest, Lynne F; Adams, Jean; Ben-Shlomo, Yoav; Buckner, Stefanie; Payne, Nick; Rimmer, Melanie; Salway, Sarah; Sowden, Sarah; Walters, Kate; White, Martin

2017-05-01

older people may be less likely to receive interventions than younger people. Age bias in national guidance may influence entire public health and health care systems. We examined how English National Institute for Health & Care Excellence (NICE) guidance and guidelines consider age. we undertook a documentary analysis of NICE public health (n = 33) and clinical (n = 114) guidelines and technology appraisals (n = 212). We systematically searched for age-related terms, and conducted thematic analysis of the paragraphs in which these occurred ('age-extracts'). Quantitative analysis explored frequency of age-extracts between and within document types. Illustrative quotes were used to elaborate and explain quantitative findings. 2,314 age-extracts were identified within three themes: age documented as an a-priori consideration at scope-setting (518 age-extracts, 22.4%); documentation of differential effectiveness, cost-effectiveness or other outcomes by age (937 age-extracts, 40.5%); and documentation of age-specific recommendations (859 age-extracts, 37.1%). Public health guidelines considered age most comprehensively. There were clear examples of older-age being considered in both evidence searching and in making recommendations, suggesting that this can be achieved within current processes. we found inconsistencies in how age is considered in NICE guidance and guidelines. More effort may be required to ensure age is consistently considered. Future NICE committees should search for and document evidence of age-related differences in receipt of interventions. Where evidence relating to effectiveness and cost-effectiveness in older populations is available, more explicit age-related recommendations should be made. Where there is a lack of evidence, it should be stated what new research is needed. © The Author 2016. Published by Oxford University Press on behalf of the British Geriatrics Society.

Nice and Kind, Smart and Funny: What Children Like and Want to Emulate in Their Teachers

ERIC Educational Resources Information Center

Hutchings, Merryn; Carrington, Bruce; Francis, Becky; Skelton, Christine; Read, Barbara; Hall, Ian

2008-01-01

In many western countries, government statements about the need to recruit more men to primary teaching are frequently supported by references to the importance of male teachers as role models for boys. The suggestion is that boys will both achieve better and behave better when taught by male teachers, because they will identify with them and want…

"What Is Critical Whiteness Doing in Our Nice Field Like Critical Race Theory?" Applying CRT and CWS to Understand the White Imaginations of White Teacher Candidates

ERIC Educational Resources Information Center

Matias, Cheryl E.; Viesca, Kara Mitchell; Garrison-Wade, Dorothy F.; Tandon, Madhavi; Galindo, Rene

2014-01-01

Critical Race Theory (CRT) revolutionized how we investigate race in education. Centralizing counter-stories from people of color becomes essential for decentralizing white normative discourse--a process we refer to as realities within the Black imagination. Yet, few studies examine how whites respond to centering the Black imagination, especially…

How To Write a Business Letter. Power of the Printed Word.

ERIC Educational Resources Information Center

Forbes, Malcolm

Business letters should turn people on rather than turning them off. To write a good business letter, know what the goal is before starting to write, call the reader by name, tell what the letter is about in the first paragraph, refer to dates when answering letters, and write from the reader's point of view. Be positive, be nice, and be natural.…

Improving outcomes for people in mental health crisis: a rapid synthesis of the evidence for available models of care.

PubMed

Paton, Fiona; Wright, Kath; Ayre, Nigel; Dare, Ceri; Johnson, Sonia; Lloyd-Evans, Brynmor; Simpson, Alan; Webber, Martin; Meader, Nick

2016-01-01

Crisis Concordat was established to improve outcomes for people experiencing a mental health crisis. The Crisis Concordat sets out four stages of the crisis care pathway: (1) access to support before crisis point; (2) urgent and emergency access to crisis care; (3) quality treatment and care in crisis; and (4) promoting recovery. To evaluate the clinical effectiveness and cost-effectiveness of the models of care for improving outcomes at each stage of the care pathway. Electronic databases were searched for guidelines, reviews and, where necessary, primary studies. The searches were performed on 25 and 26 June 2014 for NHS Evidence, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, NHS Economic Evaluation Database, and the Health Technology Assessment (HTA) and PROSPERO databases, and on 11 November 2014 for MEDLINE, PsycINFO and the Criminal Justice Abstracts databases. Relevant reports and reference lists of retrieved articles were scanned to identify additional studies. When guidelines covered a topic comprehensively, further literature was not assessed; however, where there were gaps, systematic reviews and then primary studies were assessed in order of priority. Systematic reviews were critically appraised using the Risk Of Bias In Systematic reviews assessment tool, trials were assessed using the Cochrane risk-of-bias tool, studies without a control group were assessed using the National Institute for Health and Care Excellence (NICE) prognostic studies tool and qualitative studies were assessed using the Critical Appraisal Skills Programme quality assessment tool. A narrative synthesis was conducted for each stage of the care pathway structured according to the type of care model assessed. The type and range of evidence identified precluded the use of meta-analysis. One review of reviews, six systematic reviews, nine guidelines and 15 primary studies were included. There was very limited evidence for access to support before crisis point. There was evidence of benefits for liaison psychiatry teams in improving service-related outcomes in emergency departments, but this was often limited by potential confounding in most studies. There was limited evidence regarding models to improve urgent and emergency access to crisis care to guide police officers in their Mental Health Act responsibilities. There was positive evidence on clinical effectiveness and cost-effectiveness of crisis resolution teams but variability in implementation. Current work from the Crisis resolution team Optimisation and RElapse prevention study aims to improve fidelity in delivering these models. Crisis houses and acute day hospital care are also currently recommended by NICE. There was a large evidence base on promoting recovery with a range of interventions recommended by NICE likely to be important in helping people stay well. Most evidence was rated as low or very low quality, but this partly reflects the difficulty of conducting research into complex interventions for people in a mental health crisis and does not imply that all research was poorly conducted. However, there are currently important gaps in research for a number of stages of the crisis care pathway. Particular gaps in research on access to support before crisis point and urgent and emergency access to crisis care were found. In addition, more high-quality research is needed on the clinical effectiveness and cost-effectiveness of mental health crisis care, including effective components of inpatient care, post-discharge transitional care and Community Mental Health Teams/intensive case management teams. This study is registered as PROSPERO CRD42014013279. The National Institute for Health Research HTA programme.

The U.K. service level audit of insulin pump therapy in adults.

PubMed

White, H D; Goenka, N; Furlong, N J; Saunders, S; Morrison, G; Langridge, P; Paul, P; Ghatak, A; Weston, P J

2014-04-01

The National Institute for Health and Clinical Excellence (NICE) published guidelines for the use of continuous subcutaneous insulin infusion in 2008 (technology appraisal 151). The first U.K.-wide insulin pump audit took place in 2012 with the aim of determining adherence to the guidance issued in NICE technology appraisal 151. The results of the adult service level audit are reported here. All centres providing continuous subcutaneous insulin infusion services to adults with diabetes in the U.K. were invited to participate. Audit metrics were aligned to technology appraisal 151. Data entry took place online using a DiabetesE formatted data collection tool. One hundred and eighty-three centres were identified as delivering adult continuous subcutaneous insulin infusion services in the U.K., of which 178 (97.3%) participated in the audit. At the time of the audit, 13 428 adults were using insulin pump therapy, giving an estimated prevalence of use of 6%. Ninety-three per cent of centres did not report any barriers in obtaining funding for patients who fulfilled NICE criteria. The mean number of consultant programmed activities dedicated to continuous subcutaneous insulin infusion services was 0.96 (range 0-8), mean whole-time equivalent diabetes specialist nurses was 0.62 (range 0-3) and mean whole-time equivalent dietitian services was 0.3 (range 0-2), of which 39, 61 and 60%, respectively, were not formally funded. The prevalence of continuous subcutaneous insulin infusion use in the U.K. falls well below the expectation of NICE (15-20%) and that of other European countries (> 15%) and the U.S.A. (40%). This may be attributable, in part, to lack of healthcare professional time needed for identification and training of new pump therapy users. © 2013 The Authors. Diabetic Medicine © 2013 Diabetes UK.

UK service level audit of insulin pump therapy in paediatrics.

PubMed

Ghatak, A; Paul, P; Hawcutt, D B; White, H D; Furlong, N J; Saunders, S; Morrison, G; Langridge, P; Weston, P J

2015-12-01

To conduct an audit of insulin pump therapy in the UK after the issue of guidelines for the use of continuous subcutaneous insulin infusion by NICE in 2008 (Technology Appraisal 151). All centres in the UK, providing pump services to children and young people were invited to participate in an online audit. Audit metrics were aligned to NICE Technology Appraisal 151 and an electronic data collection tool was used. Of the 176 UK centres identified as providing pump services, 166 (94.3%) participated in the study. A total of 5094 children and young people were identified as using continuous subcutaneous insulin infusion (19% of all paediatric patients with Type 1 diabetes), with a median (range) of 16.9 (0.67-69.4)% per centre. Units had a median of 0.58 consultant sessions, 0.43 full-time equivalent diabetic specialist nurses, and 0.1 full-time equivalent dieticians delivering the pump service. The majority of this time was not formally funded. Families could access 24-h clinical and technical support (83% units), although the delivery varied between consultant, diabetic specialist nurse and company representatives. Only 53% of units ran, or accessed, structured education programmes for continuous subcutaneous insulin infusion use. Most units (86%) allowed continuous subcutaneous insulin infusion use for paediatric inpatients, but only 56% had written guidelines for this scenario. Nine percent of units had encountered funding refusal for a patient fulfilling NICE (Technology Appraisal 151) criteria. The number of children and young people on continuous subcutaneous insulin infusion therapy is consistent with numbers estimated by NICE. There is a worrying lack of funded healthcare professional time. The audit also identified gaps in the provision of structured education and absence of written inpatient guidelines. © 2015 The Authors. Diabetic Medicine © 2015 Diabetes UK.

MICE or NICE? An economic evaluation of clinical decision rules in the diagnosis of heart failure in primary care.

PubMed

Monahan, Mark; Barton, Pelham; Taylor, Clare J; Roalfe, Andrea K; Hobbs, F D Richard; Cowie, Martin; Davis, Russell; Deeks, Jon; Mant, Jonathan; McCahon, Deborah; McDonagh, Theresa; Sutton, George; Tait, Lynda

2017-08-15

Detection and treatment of heart failure (HF) can improve quality of life and reduce premature mortality. However, symptoms such as breathlessness are common in primary care, have a variety of causes and not all patients require cardiac imaging. In systems where healthcare resources are limited, ensuring those patients who are likely to have HF undergo appropriate and timely investigation is vital. A decision tree was developed to assess the cost-effectiveness of using the MICE (Male, Infarction, Crepitations, Edema) decision rule compared to other diagnostic strategies to identify HF patients presenting to primary care. Data from REFER (REFer for EchocaRdiogram), a HF diagnostic accuracy study, was used to determine which patients received the correct diagnosis decision. The model adopted a UK National Health Service (NHS) perspective. The current recommended National Institute for Health and Care Excellence (NICE) guidelines for identifying patients with HF was the most cost-effective option with a cost of £4400 per quality adjusted life year (QALY) gained compared to a "do nothing" strategy. That is, patients presenting with symptoms suggestive of HF should be referred straight for echocardiography if they had a history of myocardial infarction or if their NT-proBNP level was ≥400pg/ml. The MICE rule was more expensive and less effective than the other comparators. Base-case results were robust to sensitivity analyses. This represents the first cost-utility analysis comparing HF diagnostic strategies for symptomatic patients. Current guidelines in England were the most cost-effective option for identifying patients for confirmatory HF diagnosis. The low number of HF with Reduced Ejection Fraction patients (12%) in the REFER patient population limited the benefits of early detection. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

I See What You Mean: Visual Literacy, K-8. Second Edition

ERIC Educational Resources Information Center

Moline, Steve

2011-01-01

Some educators may view diagrams, pictures, and charts as nice add-on tools for students who are visual thinkers. But Steve Moline sees visual literacy as fundamental to learning and to what it means to be human. In Moline's view, we are all bilingual. Our second language, which we do not speak but which we read and write every day, is visual.…

Longing for clinical excellence: a critical outlook into the NICE recommendations on hypertension management--is nice always good?

PubMed

Zanchetti, Alberto; Mancia, Giuseppe

2012-04-01

The European Society of Hypertension and the European Society of Cardiology have started the preparation of the third edition of their joint guidelines on the management of arterial hypertension. The authors have focused on the new edition of the UK NICE guidelines to learn about the difficulties of disentangling evidence from wisdom when preparing recommendations. The two areas where the NICE guidelines have changed more importantly are the use of ambulatory blood pressure in the diagnosis of hypertension and the choices of antihypertensive agents to initiate treatment (less frequent use of diuretics and preference given to chlorthalidone and indapamide). NICE recommendations on these topics appear more based on opinion than evidence. Strenuous longing for evidence and clinical excellence is certainly meritorious, but such a nice approach is not always good.

Comparing patient access to pharmaceuticals in the UK and US.

PubMed

Cohen, Joshua; Cairns, Catherine; Paquette, Cherie; Faden, Laura

2006-01-01

The debate on access to new drugs has focused on the time lag between applications for approval and granting of marketing authorisation. This delay was identified as the first barrier with respect to patient access to new drugs, encompassing the hurdles of safety, efficacy and quality. Additional barriers have since been identified. These pertain to reimbursement and pricing of approved drugs, the so-called fourth and fifth hurdles. We reviewed 38 National Institute for Health and Clinical Excellence (NICE) guidance appraisals carried out between April 1999 and April 2005. These appraisals included 71 recently approved drugs considered to have either high clinical or cost impact. For each drug we first determined its marketing approval date by the British Medicines Healthcare Products Agency (MHRA) or European Medicines Evaluation Agency (EMEA). Secondly, we determined if each drug was approved by the US FDA for marketing and, if so, the date when it was approved. Thirdly, we considered whether and when each drug was recommended for reimbursement and use by NICE, and whether conditions of reimbursement applied. Fourthly, for the subset of FDA-approved drugs, we examined formulary placement, cost sharing and conditions of reimbursement on three-tier formularies used by seven leading US third-party payers serving Medicare beneficiaries. Fifthly, we reviewed each NICE recommendation to determine if cost-effectiveness data were referred to either in the appraisal documentation or in the final recommendation. Sixthly, we asked a spokesperson from each US payer whether cost-effectiveness assessments or rebates played a role in determining formulary placement of drugs in our sample, and whether there was a lag between marketing approval and reimbursement for any of the covered drugs. Of the 71 drugs contained in 38 NICE guidance appraisals, the US FDA approved 64. On average, the subset of 64 drugs received marketing authorisation in the US prior to the UK. On average, US plans covered 87% of the 64 drugs, the same percentage of drugs recommended for NHS reimbursement and use. Cost sharing in the US was significantly higher than in the UK, with wider variation across plans. On average, drugs covered in the US had fewer conditions of reimbursement (15%) than the percentage of drugs given conditions by NICE (46%). US plans were quicker to decide to reimburse drugs following marketing approval than NICE. The US provides faster, more flexible access to most, but not all, of the UK-approved pharmaceuticals in our sample. However, US patients have higher cost sharing than the UK and coverage is less evenly spread across the population. From a policy perspective, our study findings confirm the need to bolster the NICE fast-track initiative to decrease the amount of time it takes to appraise certain new pharmaceuticals. Also, the study findings point to the need in the US for careful monitoring of plan compliance with regulations pertaining to the Medicare drug benefit, particularly with respect to formulary restrictions and limits on cost sharing.

CERN alerter—RSS based system for information broadcast to all CERN offices

NASA Astrophysics Data System (ADS)

Otto, R.

2008-07-01

Nearly every large organization uses a tool to broadcast messages and information across the internal campus (messages like alerts announcing interruption in services or just information about upcoming events). These tools typically allow administrators (operators) to send 'targeted' messages which are sent only to specific groups of users or computers, e/g only those located in a specified building or connected to a particular computing service. CERN has a long history of such tools: CERNVMS's SPM_quotMESSAGE command, Zephyr [2] and the most recent the NICE Alerter based on the NNTP protocol. The NICE Alerter used on all Windows-based computers had to be phased out as a consequence of phasing out NNTP at CERN. The new solution to broadcast information messages on the CERN campus continues to provide the service based on cross-platform technologies, hence minimizing custom developments and relying on commercial software as much as possible. The new system, called CERN Alerter, is based on RSS (Really Simple Syndication) [9] for the transport protocol and uses Microsoft SharePoint as the backend for database and posting interface. The windows-based client relies on Internet Explorer 7.0 with custom code to trigger the window pop-ups and the notifications for new events. Linux and Mac OS X clients could also rely on any RSS readers to subscribe to targeted notifications. The paper covers the architecture and implementation aspects of the new system.

Investigating the use of NICE guidelines and IAPT services in the treatment of depression

PubMed Central

2012-01-01

Background There is evidence that the National Institute for Health and Clinical Excellence (NICE) guidelines for mental health disorders are used to varying degrees in primary care. A lack of access to cognitive–behavioural therapy (CBT) has been found to be a barrier to their implementation. The Improving Access to Psychological Therapies (IAPT) initiative was created in 2007 to increase the availability of NICE-recommended psychological treatments for depression and anxiety disorders within the National Health Service in England. Aim This study aims to investigate whether general practitioners (GPs) who have access to IAPT services and use NICE guidelines are more likely to use NICE concordant treatments for depression than those who do not. Depression was chosen as it is the most common mental health problem facing primary care physicians. Method Questionnaires were sent to 830 GPs in southeast England and six GPs were interviewed. The response rate to the questionnaires was 27% (n = 222). Results Ninety-five per cent of GPs were aware of the NICE guidelines for depression, and 76% had read them. Concordance with the guidelines was significantly higher when GPs had access to a local IAPT service or had read the NICE guidelines. Conclusions The interviews revealed favourable views to IAPT services when used, although access to treatments was still a common barrier to the implementation of the NICE guidelines for depression. PMID:23997821

Achievement of NICE quality standards for patients with new presentation of inflammatory arthritis: observations from the National Clinical Audit for Rheumatoid and Early Inflammatory Arthritis.

PubMed

Ledingham, Joanna M; Snowden, Neil; Rivett, Ali; Galloway, James; Ide, Zoe; Firth, Jill; MacPhie, Elizabeth; Kandala, Ngianga; Dennison, Elaine M; Rowe, Ian

2017-02-01

A national audit was performed assessing the early management of suspected inflammatory arthritis by English and Welsh rheumatology units. The aim of this audit was to measure the performance of rheumatology services against National Institute for Health and Care Excellence (NICE) quality standards (QSs) for the management of early inflammatory arthritis benchmarked to regional and national comparators for the first time in the UK. All individuals >16 years of age presenting to rheumatology services in England and Wales with suspected new-onset inflammatory arthritis were included in the audit. Information was collected against six NICE QSs that pertain to early inflammatory arthritis management. We present national data for the 6354 patients recruited from 1 February 2014 to 31 January 2015; 97% of trusts and health boards in England and Wales participated in this audit. Only 17% of patients were referred by their general practitioner within 3 days of first presentation. Specialist rheumatology assessment occurred within 3 weeks of referral in 38% of patients. The target of DMARD initiation within 6 weeks of referral was achieved in 53% of RA patients; 36% were treated with combination DMARDs and 82% with steroids within the first 3 months of specialist care. Fifty-nine per cent of patients received structured education on their arthritis within 1 month of diagnosis. In total, 91% of patients had a treatment target set; the agreed target was achieved within 3 months of specialist review in only 27% of patients. Access to urgent advice via a telephone helpline was reported to be available in 96% of trusts. The audit has highlighted gaps between NICE standards and delivery of care, as well as substantial geographic variability. © The Author 2016. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

What is the quality of economic evaluations of non-drug therapies? A systematic review and critical appraisal of economic evaluations of radiotherapy for cancer.

PubMed

Barbieri, M; Weatherly, H L A; Ara, R; Basarir, H; Sculpher, M; Adams, R; Ahmed, H; Coles, C; Guerrero-Urbano, T; Nutting, C; Powell, M

2014-10-01

Breast, cervical and colorectal cancers are the three most frequent cancers in women, while lung, prostate and colorectal cancers are the most frequent in men. Much attention has been given to the economic evaluation of pharmaceuticals for treatment of cancer by the National Institute for Health and Care Excellence (NICE) in the UK and similar authorities internationally, while economic analysis developed for other types of anti-cancer interventions, including radiotherapy and surgery, are less common. Our objective was to review methods used in published cost-effectiveness studies evaluating radiotherapy for breast, cervical, colorectal, head and neck and prostate cancer, and to compare the economic evaluation methods applied with those defined in the guidelines used by the NICE technology appraisal programme. A systematic search of seven databases (MEDLINE, EMBASE, CDSR, NHSEED, HTA, DARE, EconLit) as well as research registers, the NICE website and conference proceedings was conducted in July 2012. Only economic evaluations of radiotherapy interventions in individuals diagnosed with cancer that included quality-adjusted life-years (QALYs) or life-years (LYs) were included. Included studies were appraised on the basis of satisfying essential, preferred and UK-specific methods requirements, building on the NICE Reference Case for economic evaluations and on other methods guidelines. A total of 29 studies satisfied the inclusion criteria (breast 14, colorectal 2, prostate 10, cervical 0, head and neck 3). Only two studies were conducted in the UK (13 in the USA). Among essential methods criteria, the main issue was that only three (10%) of the studies used clinical-effectiveness estimates identified through systematic review of the literature. Similarly, only eight (28%) studies sourced health-related quality-of-life data directly from patients with the condition of interest. Other essential criteria (e.g. clear description of comparators, patient group indication and appropriate time horizon) were generally fulfilled, while most of the UK-specific requirements were not met. Based on this review there is a dearth of up-to-date, robust evidence on the cost effectiveness of radiotherapy in cancer suitable to support decision making in the UK. Studies selected did not fully satisfy essential method standards currently recommended by NICE.

An audit of growth hormone replacement for GH-deficient adults in Scotland.

PubMed

Philip, Sam; Howat, Isobel; Carson, Maggie; Booth, Anne; Campbell, Karen; Grant, Donna; Patterson, Catherine; Schofield, Christopher; Bevan, John; Patrick, Alan; Leese, Graham; Connell, John

2013-04-01

Guidelines on the clinical use of growth hormone therapy in adults were issued by the UK National Institute for Clinical Excellence (NICE) in August 2003. We conducted a retrospective clinical audit on the use of growth hormone (GH) in Scotland to evaluate the use of these guidelines and their impact on clinical practice. The audit had two phases. In phase I, the impact of NICE criteria on specialist endocrine practice in starting and continuing GH replacement was assessed. In phase II, the reasons why some adults in Scotland with growth hormone deficiency were not on replacement therapy were evaluated. A retrospective cross-sectional case note review was carried out of all adult patients being followed up for growth hormone deficiency during the study period (1 March 2005 to 31 March 2008). Phase I of the audit included 208 patients and phase II 108 patients. Sellar tumours were the main cause of GH deficiency in both phases of the audit. In phase I, 53 patients (77%) had an AGHDA-QoL score >11 documented before commencing GH post-NICE guidance, compared with 35 (25%) pre-NICE guidance. Overall, only 39 patients (18%) met the full NICE criteria for starting and continuing GH (pre-NICE, 11%; post-NICE, 35%). Phase II indicated that the main reasons for not starting GH included perceived satisfactory quality of life (n = 47, 43%), patient reluctance (16, 15%) or a medical contraindication (16, 15%). Although the use of quality of life assessments has increased following publication of the NICE guidelines, most adults on GH in Scotland did not fulfil the complete set of NICE criteria. The main reason for not starting GH therapy in adult GH-deficient patients was perceived satisfactory quality of life. © 2012 Blackwell Publishing Ltd.

To what extent are national guidelines for the management of urinary incontinence in women adhered? Data from a national audit.

PubMed

Wagg, A; Duckett, J; McClurg, D; Harari, D; Lowe, D

2011-12-01

OBJECTIVE  To assess the degree of adherence to the current National Institute for Health and Clinical Excellence (NICE) guidelines on the management of urinary incontinence (UI) in women. Retrospective survey of consecutive female inpatients and outpatients with UI as part of a national audit. NHS hospital and primary care (PC) trusts. Twenty-five women <65 years old and 25 women ≥ 65 years old from each participating site. All NHS trusts in England, Wales and Northern Ireland were eligible to participate. A web-based data collection form aligned to the NICE guidelines was constructed for the study. All data submitted to the audit were anonymous and access to the web-tool was password-protected for confidentiality. Data were returned by 128 acute and 75 PC trusts on 7846 women. No diagnosis was documented in 6.8% (153/2254) of younger and 28% (571/2011) of older women in hospitals (P < 0.001), and by 8.6% (123/1435) of younger and 21% (380/1786) of older women in PC trusts. In hospitals, 26% (396/1524) of younger women and 15% (182/1231) of older women (P < 0.001) and in PC trusts 8.2% (77/934) of younger and 4.7% (46/975) of older women underwent multichannel cystometry before conservative therapy. Documentation of discussion of causes and treatment of UI occurred in 76% (1717/2254) of younger and 44% (884/2011) of older women in hospitals (P < 0.001) and in 75% (1080/1435) of younger and 53% (948/1786) of older women in PC trusts (P < 0.001). CONCLUSION Older women are less likely to receive NICE compliant management. Adherence varies according to recommendation. There needs to be concentration on evidence-based community provision of care by competent and interested clinicians before the aims of the NICE guidelines are met. © 2011 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2011 RCOG.

Can the NICE "end-of-life premium" be given a coherent ethical justification?

PubMed

Cookson, Richard

2013-12-01

In 2009 the UK National Institute for Health and Clinical Excellence (NICE) announced that its health technology appraisal committees would henceforth give special additional weight to health gains from life-extending end-of-life treatments. This was a response to mounting concern from NICE's stakeholders that effective new drugs for end-stage cancer often fail NICE's standard test of cost effectiveness. This change of policy may be justifiable on procedural grounds as the result of a democratic political process responding to stakeholder concerns. However, according to the "accountability for reasonableness" framework proposed by the philosopher Norman Daniels and endorsed by NICE, there also needs to be transparency about the substantive ethical grounds for public health care resource allocation decisions. In that spirit, I analyze eleven potentially relevant justifications for the NICE "end-of-life premium," drawn from the economics and philosophy literature: (1) rule of rescue, (2) fair chances, (3) ex post willingness to pay, (4) caring externality, (5) financial protection, (6) symbolic value, (7) diminishing marginal value of future life years, (8) concentration of benefits, (9) dread, (10) time to set your affairs in order, and (11) severity of illness. I conclude that none of them yields a coherent ethical justification for the NICE end-of-life premium.

An Update on Improvements to NiCE Support for RELAP-7

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

McCaskey, Alex; Wojtowicz, Anna; Deyton, Jordan H.

The Multiphysics Object-Oriented Simulation Environment (MOOSE) is a framework that facilitates the development of applications that rely on finite-element analysis to solve a coupled, nonlinear system of partial differential equations. RELAP-7 represents an update to the venerable RELAP-5 simulator that is built upon this framework and attempts to model the balance-of-plant concerns in a full nuclear plant. This report details the continued support and integration of RELAP-7 and the NEAMS Integrated Computational Environment (NiCE). RELAP-7 is fully supported by the NiCE due to on-going work to tightly integrate NiCE with the MOOSE framework, and subsequently the applications built upon it.more » NiCE development throughout the first quarter of FY15 has focused on improvements, bug fixes, and feature additions to existing MOOSE-based application support. Specifically, this report will focus on improvements to the NiCE MOOSE Model Builder, the MOOSE application job launcher, and the 3D Nuclear Plant Viewer. This report also includes a comprehensive tutorial that guides RELAP-7 users through the basic NiCE workflow: from input generation and 3D Plant modeling, to massively parallel job launch and post-simulation data visualization.« less

A critical review of recent clinical practice guidelines on the diagnosis and treatment of non-neurogenic male lower urinary tract symptoms

PubMed Central

Chua, Michael Erlano; Mendoza, Jonathan; See, Manuel; Esmena, Ednalyn; Aguila, Dean; Silangcruz, Jan Michael; Reyes, Buenaventura Jose; Luna, Saturnino; Morales, Marcelino

2015-01-01

Introduction: We provide an overview of the quality of recent clinical clinical practice guidelines (CPGs) for non-neurogenic male lower urinary tract symptoms (LUTS) and summarize the recommendations for their diagnosis, assessment, and treatment. Methods: We systematically searched recent (2008–2013) CPGs for non-neurogenic male LUTS. Eligible CPGs were assessed and appraised using Appraisal of Guidelines, Research and Evaluation II (AGREE II) tool by a CPG-appraisal group. The appraisal scores for each guideline were summarized according to each domain and in total. A recommendation summary was made across the guidelines for diagnostics, conservative management, medical, minimally invasive therapy, and surgical management. Results: A total of 8 guidelines were considered. According to AGREE II appraisal of guidelines, the National Institute for Health and Clinical Excellence (NICE), American Urological Association (AUA) and European Association of Urology (EAU) consistently scored high on the guideline domains assessed. Recommendations on diagnostics, conservative management, medical, and surgical management were consistent among the top 3 guidelines. However, we noted a discrepancy in recommending minimally invasive therapy as an alternative management of moderate to severe or bothersome non-neurogenic male LUTS secondary to benign prostatic enlargement (BPE); the NICE guideline, in particular, does not recommend using minimally invasive therapy. Conclusion: The quality of recent CPGs on non-neurogenic male LUTS was appraised and summarized. The guidelines from NICE, AUA and EAU were considered highly compliant to the AGREE II proposition for guideline formation and development. PMID:26279717

A critical review of recent clinical practice guidelines on the diagnosis and treatment of non-neurogenic male lower urinary tract symptoms.

PubMed

Chua, Michael Erlano; Mendoza, Jonathan; See, Manuel; Esmena, Ednalyn; Aguila, Dean; Silangcruz, Jan Michael; Reyes, Buenaventura Jose; Luna, Saturnino; Morales, Marcelino

2015-01-01

We provide an overview of the quality of recent clinical clinical practice guidelines (CPGs) for non-neurogenic male lower urinary tract symptoms (LUTS) and summarize the recommendations for their diagnosis, assessment, and treatment. We systematically searched recent (2008-2013) CPGs for non-neurogenic male LUTS. Eligible CPGs were assessed and appraised using Appraisal of Guidelines, Research and Evaluation II (AGREE II) tool by a CPG-appraisal group. The appraisal scores for each guideline were summarized according to each domain and in total. A recommendation summary was made across the guidelines for diagnostics, conservative management, medical, minimally invasive therapy, and surgical management. A total of 8 guidelines were considered. According to AGREE II appraisal of guidelines, the National Institute for Health and Clinical Excellence (NICE), American Urological Association (AUA) and European Association of Urology (EAU) consistently scored high on the guideline domains assessed. Recommendations on diagnostics, conservative management, medical, and surgical management were consistent among the top 3 guidelines. However, we noted a discrepancy in recommending minimally invasive therapy as an alternative management of moderate to severe or bothersome non-neurogenic male LUTS secondary to benign prostatic enlargement (BPE); the NICE guideline, in particular, does not recommend using minimally invasive therapy. The quality of recent CPGs on non-neurogenic male LUTS was appraised and summarized. The guidelines from NICE, AUA and EAU were considered highly compliant to the AGREE II proposition for guideline formation and development.

Is Group Therapy Democratic? Enduring Consequences of Outward Bound's Alignment with the Human Potential Movement. A Response to "How to Be Nice and Get What You Want: Structural Referents of "Self" and "Other" in Experiential Education as (Un)Democratic Practice."

ERIC Educational Resources Information Center

Seaman, Jayson

2016-01-01

Franklin Vernon provided an example of how programs viewing themselves as "cultural islands" are in fact embedded within historical capitalist relations, through the discourses of "self" that they promote. In this response, I expand on Vernon's argument to situate the quasi-therapeutic practices he identified in the history of…

NICE recommendations for the assessment of stable chest pain: assessing the early economic and service impact in the rapid-access chest pain service.

PubMed

Ashrafi, Reza; Raga, Santosh; Abdool, Ali; Disney, Andrew; Wong, Peter; Davis, Gershan K

2013-05-01

In 2010, guidelines published by the National Institute for Clinical Excellence (NICE) suggested a change in the way patients with stable chest pain of suspected cardiac origin were investigated. These guidelines removed exercise treadmill testing from routine use and introduced cardiac CT to regular use. To investigate whether these guidelines had improved our service provision by reducing the number of further investigations required to make a diagnosis, and to see if our costs had increased now that the less expensive exercise treadmill tests were not recommended. Clinic letters were used to assess patients pretest likelihood of coronary artery disease for two six-month cohorts of consecutive patients seen in the rapid access chest pain clinic (January-June 2010 and July-December 2011) using NICE published methodology, and to ascertain which investigations patients had. Using NICE modelled costs, we generated comparative hypothetical costs for each cohort and an average cost per patient. In the January-June 2010 cohort, 435 patients with chest pain were seen, and in July-December 2011, 334 patients were seen. In the pre-NICE guidelines cohort, 23% of patients required two investigations as compared with 11.4% in the post-NICE guidelines cohort, with no patient requiring three investigations as compared with 3% in the original cohort. There was no significant increase in costs per patient in the post-NICE guidance group. Implementing NICE guidance reduced the number of investigations needed per patient, and did not prove more expensive for our department in the short term.

Neutron Star Interior Composition Explorer (NICE)

NASA Technical Reports Server (NTRS)

Gendreau, Keith C.; Arzoumanian, Zaven

2008-01-01

This viewgraph presentation contains an overview of the mission of the Neutron Star Interior Composition Explorer (NICE), a proposed International Space Station (ISS) payload dedicated ot the study of neutron stars. There are also reviews of the Science Objectives of the payload,the science measurements, the design and the expected performance for the instruments for NICE,

(Non-adiabatic) string creation on nice slices in Schwarzschild black holes

NASA Astrophysics Data System (ADS)

Puhm, Andrea; Rojas, Francisco; Ugajin, Tomonori

2017-04-01

Nice slices have played a pivotal role in the discussion of the black hole information paradox as they avoid regions of strong spacetime curvature and yet smoothly cut through the infalling matter and the outgoing Hawking radiation, thus, justifying the use of low energy field theory. To avoid information loss it has been argued recently, however, that local effective field theory has to break down at the horizon. To assess the extent of this breakdown in a UV complete framework we study string-theoretic effects on nice slices in Schwarzschild black holes. Our purpose is two-fold. First, we use nice slices to address various open questions and caveats of [1] where it was argued that boost-enhanced non-adiabatic string-theoretic effects at the horizon could provide a dynamical mechanism for the firewall. Second, we identify two non-adiabatic effects on nice slices in Schwarzschild black holes: pair production of open strings near the horizon enhanced by the presence of the infinite tower of highly excited string states and a late-time non-adiabatic effect intrinsic to nice slices.

Examining the implementation of NICE guidance: cross-sectional survey of the use of NICE interventional procedures guidance by NHS Trusts.

PubMed

Lowson, Karin; Jenks, Michelle; Filby, Alexandra; Carr, Louise; Campbell, Bruce; Powell, John

2015-06-30

In the UK, NHS hospitals receive large amounts of evidence-based recommendations for care delivery from the National Institute for Health and Care Excellence (NICE) and other organisations. Little is known about how NHS organisations implement such guidance and best practice for doing so. This study was therefore designed to examine the dissemination, decision-making, and monitoring processes for NICE interventional procedures (IP) guidance and to investigate the barriers and enablers to the implementation of such guidance. A cross-sectional survey questionnaire was developed and distributed to individuals responsible for managing the processes around NICE guidance in all 181 acute NHS hospitals in England, Scotland, Wales and Northern Ireland. A review of acute NHS hospital policies for implementing NICE guidance was also undertaken using information available in the public domain and from organisations' websites. The response rate to the survey was 75 % with 135 completed surveys received. Additionally, policies from 25 % of acute NHS hospitals were identified and analysed. NHS acute hospitals typically had detailed processes in place to implement NICE guidance, although organisations recognised barriers to implementation including organisational process barriers, clinical engagement and poor targeting with a large number of guidance issued. Examples of enablers to, and good practice for, implementation of guidance were found, most notably the value of shared learning experiences between NHS hospitals. Implications for NICE were also identified. These included making improvements to the layout of guidance, signposting on the website and making better use of their shared learning platform. Most organisations have robust processes in place to deal with implementing guidance. However, resource limitations and the scope of guidance received by organisations create barriers relating to organisational processes, clinician engagement and financing of new procedures. Guidance implementation can be facilitated through encouragement of shared learning by organisations such as NICE and open knowledge transfer between organisations.

Preserving the Family Woods: tools to help guide transfer to the next generation of landowners

Treesearch

US FS Northeastern Area State and Private Forestry; John Becker; Michael Jacobson

2008-01-01

Hello, Woodland Owner! Looking forward to a nice conversation with your family about estate planning? If so, you're one of a fairly small number. Estate planning may not be a fun or easy topic, but this is an area where failing to plan can mean planning to fail. This guide is designed to help make the process a little easier. If it helps to know, you're not...

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

Rohe, Daniel Peter

Sandia National Laboratories has recently purchased a Polytec 3D Scanning Laser Doppler Vibrometer for vibration measurement. This device has proven to be a very nice tool for making vibration measurements, and has a number of advantages over traditional sensors such as accelerometers. The non-contact nature of the laser vibrometer means there is no mass loading due to measuring the response. Additionally, the laser scanning heads can position the laser spot much more quickly and accurately than placing an accelerometer or performing a roving hammer impact. The disadvantage of the system is that a significant amount of time must be investedmore » to align the lasers with each other and the part so that the laser spots can be accurately positioned. The Polytec software includes a number of nice tools to aid in this procedure; however, certain portions are still tedious. Luckily, the Polytec software is readily extensible by programming macros for the system, so tedious portions of the procedure can be made easier by automating the process. The Polytec Software includes a WinWrap (similar to Visual Basic) editor and interface to run macros written in that programming language. The author, however, is much more proficient in Python, and the latter also has a much larger set of libraries that can be used to create very complex macros, while taking advantage of Python’s inherent readability and maintainability.« less

The Nice model can explain the dispersion of the prograde Himalia family of irregular satellites at Jupiter

NASA Astrophysics Data System (ADS)

Li, Daohai; Christou, Apostolos

2017-10-01

More than 50 irregular satellites revolve around Jupiter in which at least three distinct collisional families are identified. Among them, the Himalia family is unique in the large velocity dispersion--several hundred m/s--among its members, inconsistent with a purely collisional origin.We explore this puzzle in the context of the Nice scenario of early solar system evolution. There, the giant planets migrated significant distances due to interactions with a primordial planetesimal disk. We generate a synthetic, collisionally-produced Himalia family and follow its evolution through principal events of the Nice model. Two situations are considered: (i) The planetesimal disk is solely composed of large, moon-sized objects. In this case, the family is dramatically scattered, especially in semimajor axis and eccentricity, as the planetesimals fly by Jupiter. The velocity dispersion of $\\sim60\\%$ of family members is raised to several hundred m/s, satisfactorily explaining the observed dispersion. However, this situation is not likely as the considered planetesimals seem unphysically massive. We now consider the alternative case (ii) within the so-called ``Jumping Jupiter’’ where planetary, rather than planetesimal encounters are responsible for the observed dispersion. Here, ice giants encounter Jupiter up to a few hundred times (Nesvorn\\'{y} \\& Morbidelli 2012). We find $\\lesssim20$ such planetary encounters disperse the synthetic family to the observed degree. We also find that the family cannot survive $\\sim100$ such fly-bys as the satellites become too widely dispersed.Reference: Nesvorn\\'{y}, D., \\& Morbidelli, A. 2012, AJ, 144, 117.

Implementing NICE obesity guidance for staff: an NHS trust audit.

PubMed

Dalton, M B

2015-01-01

The UK National Institute of Health and Clinical Excellence (NICE) has produced guidelines (CG43) on preventing and managing overweight and obesity, which apply to the National Health Service (NHS) as an employer. To record in an NHS trust baseline assessment and management of obesity by its occupational health (OH) service staff, with reference to the standards in CG43, enabling deficiencies to be identified and improvements to be recommended as a benchmark for future measurement. Criteria relevant to OH in CG43 were identified and data were collected from trust policies, interviews with managers, questionnaires to OH staff, examination of OH resources and case notes of staff attending OH. Results were checked for compliance with CG43 standards. Although the trust met NICE standards as an employer, significant lack of compliance was found in its OH service. Only 53% of staff attending medical examinations had weight recorded, OH resources were inadequate and 75% of its staff had received no training. Problems identified included lack of written guidance, time and care pathways. The resulting action plan included a consultant-led working party liaising with the trust's health and well-being committee, training, enhanced OH resources, an obesity protocol, a database and weight management clinics. We found not only a lack of OH policy guidance but apparent inertia in dealing with obesity. The action plan demonstrated how OH clinical practice can draw upon CG43 to combat obesity in an NHS workforce. © The Author 2015. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Radiological assessment of paediatric cervical spine injury in blunt trauma: the potential impact of new NICE guidelines on the use of CT.

PubMed

Davies, J; Cross, S; Evanson, J

2016-09-01

To determine the potential effect of changes to the National Institute for Health and Care Excellence (NICE) guidelines to the use of computed tomography (CT) in the assessment of suspected paediatric cervical spine (c-spine) injury. A 5 year retrospective study was conducted of c-spine imaging in paediatric (<10 years) patients presenting following blunt trauma at a Level 1 trauma centre in London. All patients under the age of 10 years who underwent any imaging of the c-spine following blunt trauma were included. Clinical data relating to the presenting signs and symptoms were obtained from the retrospective review of electronic records and paper notes. This was then applied to the previous NICE guideline (CG56) and to the new NICE guideline (CG176). Patients with incomplete data were excluded. Two hundred and seventy-eight patients <10 years underwent imaging of the c-spine following blunt trauma. Two hundred and seventy (97.12%) examinations had complete data and were included in further analysis. One hundred and forty-nine (55.19%) met the criteria for a CT of the c-spine under NICE CG56, whereas 252 (93.33%) met the updated NICE CG176 criteria for c-spine CT. Five (1.85%) patients had a c-spine injury and met the criteria under both CG56 and CG176 NICE guidelines. Recent changes to NICE Head Injury Guidelines relating to radiological assessment of paediatric c-spine following blunt trauma are likely to result in an increased usage of CT as the initial radiological investigation over plain radiographs, without an apparent increase in specificity in the present series. Copyright © 2016 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

Heat-transfer resistance at solid-liquid interfaces: a tool for the detection of single-nucleotide polymorphisms in DNA.

PubMed

van Grinsven, Bart; Vanden Bon, Natalie; Strauven, Hannelore; Grieten, Lars; Murib, Mohammed; Monroy, Kathia L Jiménez; Janssens, Stoffel D; Haenen, Ken; Schöning, Michael J; Vermeeren, Veronique; Ameloot, Marcel; Michiels, Luc; Thoelen, Ronald; De Ceuninck, Ward; Wagner, Patrick

2012-03-27

In this article, we report on the heat-transfer resistance at interfaces as a novel, denaturation-based method to detect single-nucleotide polymorphisms in DNA. We observed that a molecular brush of double-stranded DNA grafted onto synthetic diamond surfaces does not notably affect the heat-transfer resistance at the solid-to-liquid interface. In contrast to this, molecular brushes of single-stranded DNA cause, surprisingly, a substantially higher heat-transfer resistance and behave like a thermally insulating layer. This effect can be utilized to identify ds-DNA melting temperatures via the switching from low- to high heat-transfer resistance. The melting temperatures identified with this method for different DNA duplexes (29 base pairs without and with built-in mutations) correlate nicely with data calculated by modeling. The method is fast, label-free (without the need for fluorescent or radioactive markers), allows for repetitive measurements, and can also be extended toward array formats. Reference measurements by confocal fluorescence microscopy and impedance spectroscopy confirm that the switching of heat-transfer resistance upon denaturation is indeed related to the thermal on-chip denaturation of DNA. © 2012 American Chemical Society

Does the cancer drugs fund lead to faster uptake of cost-effective drugs? A time-trend analysis comparing England and Wales.

PubMed

Chamberlain, C; Collin, S M; Stephens, P; Donovan, J; Bahl, A; Hollingworth, W

2014-10-28

The Cancer Drugs Fund (CDF) provides £200 million annually in England for 'anti-cancer' drugs. We used a controlled pre-/post-intervention design to compare IMS Health dispensing data for 15 cancer drugs (2007-2012) in England vs Wales, stratified by pre-CDF NICE drug approval status (rejected, mixed recommendations, recommended, not appraised). The CDF was associated with increased prescribing in England for three of five drugs rejected or with mixed NICE recommendations. The prescribing volume ratios (PVR) ranged from 1.29 (95% CI 1.00, 1.67) for sorafenib to 3.28 (2.59, 4.14) for bevacizumab (NICE rejected) and 0.93 (0.81, 1.06) and 1.35 (1.21, 1.49) for sunitinib and imatinib respectively (mixed recommendations). Post CDF prescribing in England increased for both drugs awaiting NICE appraisal pre-CDF (lapatinib PVR=7.44 (5.81, 9.54), panitumumab PVR=5.40 (1.20, 24.42)) and subsequently rejected. The CDF was not associated with increased prescribing in England of NICE-recommended drugs. The three most recently launched, subsequently recommended drugs were adopted faster in Wales (from pazopanib PVR=0.51 (0.28, 0.96) to abiraterone PVR=0.78 (0.61-0.99)). These data indicate that the CDF is used to access drugs deemed not cost-effective by NICE. The CDF did not expedite access to new cost-effective cancer agents prior to NICE approval.

Elucidating the Complex Lineshapes Resulting from the Highly Sensitive, Ion Selective, Technique Nice-Ohvms

NASA Astrophysics Data System (ADS)

Hodges, James N.; Siller, Brian; McCall, Benjamin J.

2015-06-01

The technique Noise Immune Cavity Enhanced Optical Heterodyne Velocity Modulation Spectroscopy, or NICE-OHVMS, has been used to great effect to precisely and accurately measure a variety of molecular ion transitions from species such as H_3^+, CH_5^+, HeH^+, and HCO^+, achieving MHz or in some cases sub-MHz uncertainty. It is a powerful technique, but a complete theoretical understanding of the complex NICE-OHVMS lineshape is needed to fully unlock its potential. NICE-OHVMS is the direct result of the combination of the highly sensitive spectroscopic technique Noise Immune Cavity Enhanced Optical Heterodyne Molecular Spectroscopy(NICE-OHMS) with Velocity Modulation Spectroscopy(VMS), applying the most sensitive optical detection method with ion species selectivity. The theoretical underpinnings of NICE-OHMS lineshapes are well established, as are those of VMS. This presentation is the logical extension of those two preceding bodies of work. Simulations of NICE-OHVMS lineshapes under a variety of conditions and fits of experimental data to the model are presented. The significance and accuracy of the various inferred parameters, along with the prospect of using them to extract additional information from observed transitions, are discussed. J.~N. Hodges, et al. J. Chem. Phys. (2013), 139, 164201. A.~J. Perry, et al. J. Chem. Phys. (2014), 141, 101101. K.~N. Crabtree, et al. Chem. Phys. Lett. (2012), 551, 1-6. F.~M. Schmidt, et al. J. Opt. Soc. Amer. A (2008), 24, 1392--1405. J.~W. Farley, J. Chem. Phys. (1991), 95, 5590--5602.

The LivePhoto Physics videos and video analysis site

NASA Astrophysics Data System (ADS)

Abbott, David

2009-09-01

The LivePhoto site is similar to an archive of short films for video analysis. Some videos have Flash tools for analyzing the video embedded in the movie. Most of the videos address mechanics topics with titles like Rolling Pencil (check this one out for pedagogy and content knowledge—nicely done!), Juggler, Yo-yo, Puck and Bar (this one is an inelastic collision with rotation), but there are a few titles in other areas (E&M, waves, thermo, etc.).

British Thoracic Society community acquired pneumonia guideline and the NICE pneumonia guideline: how they fit together

PubMed Central

Lim, W S; Smith, D L; Wise, M P; Welham, S A

2015-01-01

The British Thoracic Society (BTS) guideline for the management of adults with community acquired pneumonia (CAP) published in 2009 was compared with the 2014 National Institute for Health and Care Excellence (NICE) Pneumonia Guideline. Of the 36 BTS recommendations that overlapped with NICE recommendations, no major differences were found in 31, including those covering key aspects of CAP management: timeliness of diagnosis and treatment, severity assessment and empirical antibiotic choice. Of the five BTS recommendations where major differences with NICE were identified, one related to antibiotic duration in low and moderate severity CAP, two to the timing of review of patients and two to legionella urinary antigen testing. PMID:25977290

One-Step Generation of Multifunctional Polyelectrolyte Microcapsules via Nanoscale Interfacial Complexation in Emulsion (NICE)

DOE PAGES

Kim, Miju; Yeo, Seon Ju; Highley, Christopher B.; ...

2015-07-14

Polyelectrolyte microcapsules represent versatile stimuli-responsive structures that enable the encapsulation, protection, and release of active agents. Their conventional preparation methods, however, tend to be time-consuming, yield low encapsulation efficiency, and seldom allow for the dual incorporation of hydrophilic and hydrophobic materials, limiting their widespread utilization. In this work, we present a method to fabricate stimuli-responsive polyelectrolyte microcapsules in one step based on nanoscale interfacial complexation in emulsions (NICE) followed by spontaneous droplet hatching. NICE microcapsules can incorporate both hydrophilic and hydrophobic materials and also can be induced to trigger the release of encapsulated materials by changes in the solution pHmore » or ionic strength. We also show that NICE microcapsules can be functionalized with nanomaterials to exhibit useful functionality, such as response to a magnetic field and disassembly in response to light. NICE represents a potentially transformative method to prepare multifunctional nanoengineered polyelectrolyte microcapsules for various applications such as drug delivery and cell mimicry.« less

One-Step Generation of Multifunctional Polyelectrolyte Microcapsules via Nanoscale Interfacial Complexation in Emulsion (NICE).

PubMed

Kim, Miju; Yeo, Seon Ju; Highley, Christopher B; Burdick, Jason A; Yoo, Pil J; Doh, Junsang; Lee, Daeyeon

2015-08-25

Polyelectrolyte microcapsules represent versatile stimuli-responsive structures that enable the encapsulation, protection, and release of active agents. Their conventional preparation methods, however, tend to be time-consuming, yield low encapsulation efficiency, and seldom allow for the dual incorporation of hydrophilic and hydrophobic materials, limiting their widespread utilization. In this work, we present a method to fabricate stimuli-responsive polyelectrolyte microcapsules in one step based on nanoscale interfacial complexation in emulsions (NICE) followed by spontaneous droplet hatching. NICE microcapsules can incorporate both hydrophilic and hydrophobic materials and also can be induced to trigger the release of encapsulated materials by changes in the solution pH or ionic strength. We also show that NICE microcapsules can be functionalized with nanomaterials to exhibit useful functionality, such as response to a magnetic field and disassembly in response to light. NICE represents a potentially transformative method to prepare multifunctional nanoengineered polyelectrolyte microcapsules for various applications such as drug delivery and cell mimicry.

One-Step Generation of Multifunctional Polyelectrolyte Microcapsules via Nanoscale Interfacial Complexation in Emulsion (NICE)

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

Kim, Miju; Yeo, Seon Ju; Highley, Christopher B.

Polyelectrolyte microcapsules represent versatile stimuli-responsive structures that enable the encapsulation, protection, and release of active agents. Their conventional preparation methods, however, tend to be time-consuming, yield low encapsulation efficiency, and seldom allow for the dual incorporation of hydrophilic and hydrophobic materials, limiting their widespread utilization. In this work, we present a method to fabricate stimuli-responsive polyelectrolyte microcapsules in one step based on nanoscale interfacial complexation in emulsions (NICE) followed by spontaneous droplet hatching. NICE microcapsules can incorporate both hydrophilic and hydrophobic materials and also can be induced to trigger the release of encapsulated materials by changes in the solution pHmore » or ionic strength. We also show that NICE microcapsules can be functionalized with nanomaterials to exhibit useful functionality, such as response to a magnetic field and disassembly in response to light. NICE represents a potentially transformative method to prepare multifunctional nanoengineered polyelectrolyte microcapsules for various applications such as drug delivery and cell mimicry.« less

"Patients with amyotrophic lateral sclerosis (ALS) are usually nice persons"-How physicians experienced in ALS see the personality characteristics of their patients.

PubMed

Mehl, Theresa; Jordan, Berit; Zierz, Stephan

2017-01-01

Physicians experienced in the treatment of patients with amyotrophic lateral sclerosis (ALS) occasionally describe these patients as "nice" persons. ALS experienced physicians ( n  =   36) were asked to assess the personality characteristics of ALS patients using a multidimensional personality questionnaire based on the five-factor model of personality. Control groups consisted of physicians experienced in Myasthenia gravis (MG) ( n  =   21) and lung cancer (LC) ( n  =   36). In the dimension Agreeableness ALS patients were rated significantly higher than the other groups ( p  <   .001). This was mainly due to the high scores for converse adjective pairs "stubborn-compliant" and "selfish-helpful". The dimension Agreeableness is very similar to "niceness". Results support the anecdotal description of ALS patients as "nice" persons. Personality characteristics of ALS patients differentiate them from other patient groups. It remains open whether the "nice" personality structure is linked to the susceptibility to the disease.

Towards an Integrated Approach to Sexual Health Services: The Contribution of NICE Guidance on One-to-One Interventions to Prevent STIs and under 18 Conceptions

ERIC Educational Resources Information Center

Killoran, Amanda; McCormick, Geraldine

2010-01-01

Objective: To describe the development of the National Institute for Health and Clinical Excellence (NICE) evidence-based guidance on one-to-one interventions for prevention of STIs and under 18 conceptions, as a focus for an integrated approach to sexual health services. Method: Documentation of the process for developing NICE guidance that is…

Applicability and accuracy of pretest probability calculations implemented in the NICE clinical guideline for decision making about imaging in patients with chest pain of recent onset.

PubMed

Roehle, Robert; Wieske, Viktoria; Schuetz, Georg M; Gueret, Pascal; Andreini, Daniele; Meijboom, Willem Bob; Pontone, Gianluca; Garcia, Mario; Alkadhi, Hatem; Honoris, Lily; Hausleiter, Jörg; Bettencourt, Nuno; Zimmermann, Elke; Leschka, Sebastian; Gerber, Bernhard; Rochitte, Carlos; Schoepf, U Joseph; Shabestari, Abbas Arjmand; Nørgaard, Bjarne; Sato, Akira; Knuuti, Juhani; Meijs, Matthijs F L; Brodoefel, Harald; Jenkins, Shona M M; Øvrehus, Kristian Altern; Diederichsen, Axel Cosmus Pyndt; Hamdan, Ashraf; Halvorsen, Bjørn Arild; Mendoza Rodriguez, Vladimir; Wan, Yung Liang; Rixe, Johannes; Sheikh, Mehraj; Langer, Christoph; Ghostine, Said; Martuscelli, Eugenio; Niinuma, Hiroyuki; Scholte, Arthur; Nikolaou, Konstantin; Ulimoen, Geir; Zhang, Zhaoqi; Mickley, Hans; Nieman, Koen; Kaufmann, Philipp A; Buechel, Ronny Ralf; Herzog, Bernhard A; Clouse, Melvin; Halon, David A; Leipsic, Jonathan; Bush, David; Jakamy, Reda; Sun, Kai; Yang, Lin; Johnson, Thorsten; Laissy, Jean-Pierre; Marcus, Roy; Muraglia, Simone; Tardif, Jean-Claude; Chow, Benjamin; Paul, Narinder; Maintz, David; Hoe, John; de Roos, Albert; Haase, Robert; Laule, Michael; Schlattmann, Peter; Dewey, Marc

2018-03-19

To analyse the implementation, applicability and accuracy of the pretest probability calculation provided by NICE clinical guideline 95 for decision making about imaging in patients with chest pain of recent onset. The definitions for pretest probability calculation in the original Duke clinical score and the NICE guideline were compared. We also calculated the agreement and disagreement in pretest probability and the resulting imaging and management groups based on individual patient data from the Collaborative Meta-Analysis of Cardiac CT (CoMe-CCT). 4,673 individual patient data from the CoMe-CCT Consortium were analysed. Major differences in definitions in the Duke clinical score and NICE guideline were found for the predictors age and number of risk factors. Pretest probability calculation using guideline criteria was only possible for 30.8 % (1,439/4,673) of patients despite availability of all required data due to ambiguity in guideline definitions for risk factors and age groups. Agreement regarding patient management groups was found in only 70 % (366/523) of patients in whom pretest probability calculation was possible according to both models. Our results suggest that pretest probability calculation for clinical decision making about cardiac imaging as implemented in the NICE clinical guideline for patients has relevant limitations. • Duke clinical score is not implemented correctly in NICE guideline 95. • Pretest probability assessment in NICE guideline 95 is impossible for most patients. • Improved clinical decision making requires accurate pretest probability calculation. • These refinements are essential for appropriate use of cardiac CT.

Site-specific mutagenesis of the nodule-infected cell expression (NICE) element and the AT-rich element ATRE-BS2* of the Sesbania rostrata leghemoglobin glb3 promoter.

PubMed Central

Szczyglowski, K; Szabados, L; Fujimoto, S Y; Silver, D; de Bruijn, F J

1994-01-01

Sesbania rostrata leghemoglobin glb3 (Srglb3) promoter sequences responsible for expression in infected cells of transgenic Lotus corniculatus nodules were delimited to a 78-bp Dral-Hinfl fragment. This region, which is located between coordinates -194 to -116 relative to the start codon of the Srglb3 gene, was named the nodule-infected cell expression (NICE) element. Insertion of the NICE element into the truncated nopaline synthase promoter was found to confer a nodule-specific expression pattern on this normally root-enhanced promoter. Within the NICE element, three distinct motifs ([A]AAAGAT, TTGTCTCTT, and CACCC[T]) were identified; they are highly conserved in the promoter regions of a variety of plant (leg)hemoglobin genes. The NICE element and the adjacent AT-rich element (ATRE-BS2*) were subjected to site-directed mutagenesis. The expression patterns of nine selected Srglb3 promoter fragments carrying mutations in ATRE-BS2* and 19 with mutations in the NICE element were examined. Mutations in ATRE-BS2* had varying effects on Srglb3 promoter activity, ranging from a two- to threefold reduction to a slight stimulation of activity. Mutations in the highly conserved (A)AAAGAT motif of the NICE element reduced Srglb3 promoter activity two- to fourfold, whereas mutations in the TCTT portion of the TTGTCTCTT motif virtually abolished promoter activity, demonstrating the essential nature of these motifs for Srglb3 gene expression. An A-to-T substitution in the CACCC(T) motif of the NICE element also abolished Srglb3 promoter activity, while a C-to-T mutation at position 4 resulted in a threefold reduction of promoter strength. The latter phenotypes resemble the effect of similar mutations in the conserved CACCC motif located in the promoter region of mammalian beta-globin genes. The possible analogies between these two systems will be discussed. PMID:8180496

Trends in procedures for infertility and caesarean sections: was NICE disinvestment guidance implemented? NICE recommendation reminders.

PubMed

Chamberlain, Charlotte A; Martin, Richard M; Busby, John; Gilbert, Rebecca; Cahill, David J; Hollingworth, William

2013-02-06

National Institute for Health and Clinical Excellence (NICE) clinical guidelines and subsequent NICE issued 'recommendation reminders' advocate discontinuing two fertility procedures and caesarean sections in women with hepatitis. We assess whether NICE guidance in 2004 and recommendation reminders were associated with a change in the rate of clinical procedures performed. Routine inpatient Hospital Episode Statistics (HES) data were extracted from the HES database for 1st April 1998 to 31st March 2010 using OPCS procedure codes for varicocele operations in infertile men, endometrial biopsies in infertile women and caesarean sections in women with hepatitis B or C. We used Joinpoint regression to identify points in time when the trend in procedure rates changed markedly, to identify any influence of the release of NICE guidance. Between 1998-2010, planned caesarean sections in women with and without hepatitis B or C increased yearly (annual percentage change (APC) 4.9%, 95% CI 2.1% to 7.7%) in women with hepatitis, compared with women without (APC 4.0% [95% CI 2.7% to 5.3%] up to 2001, APC -0.6% [95% CI -2.8% to 1.8%] up to 2004 and 1.3% [95% CI 0.8% to 1.8%] up to 2010). In infertile women under 40 years of age, endometrial biopsies for investigation of infertility increased, APC 6.0% (95% CI 3.6% to 8.4%) up to 2003, APC 1.5% (95% CI -4.3% to 7.7%) to 2007 followed by APC 12.8% (95% CI 1.0% to 26.0%) to 2010. Varicocele procedures remained relatively static between 1998 and 2010 (APC -0.5%, 95% CI -2.3% to 1.3%). There was no decline in use of the three studied procedures, contrary to NICE guidance, and no change in uptake associated with the timing of NICE guidance or recommendation reminders. 'Do not do' recommendation reminders may be ineffective at improving clinical practice or achieving disinvestment.

ViibraTip for Testing Vibration Perception to Detect Diabetic Peripheral Neuropathy: A NICE Medical Technology Guidance.

PubMed

Willits, Iain; Cole, Helen; Jones, Roseanne; Dimmock, Paul; Arber, Mick; Craig, Joyce; Sims, Andrew

2015-08-01

VibraTip™ was selected by the Medical Technologies Advisory Committee (MTAC) to undergo evaluation through the National Institute for Health and Care Excellence (NICE). VibraTip™ provides a vibratory stimulus for the purpose of detecting diabetic peripheral neuropathy (DPN) in patients with type 1 or 2 diabetes mellitus, and is intended to replace the current practice of using the 128 Hz tuning fork or 10 g monofilament (comparators). The sponsor (McCallan Medical) provided clinical and economic submissions which were evaluated by an External Assessment Centre (EAC). Of six diagnostic studies identified, the EAC considered that only one was directly relevant to the assessment. This study indicated VibraTip™ had a sensitivity of 0.79 (95 % CI 0.69-0.90) and specificity of 0.82 (95 % CI 0.74-0.90) for DPN using a neurothesiometer at 25 V as a reference standard. This was non-inferior to the comparators, but the sample size (n = 141) was too small to draw unequivocal conclusions and it is unclear how generalisable results were to clinical practice. The sponsor presented a de facto cost-minimisation model that in the base case showed minimal cost savings and, in sensitivity analysis which assumed diagnostic superiority of VibraTip™, showed large savings. The EAC appraised this model and concluded it was flawed as it was not evidence based and costs were likely to be unrealistic. The MTAC considered that the technology showed promise but decided the case for adoption was not proven, and therefore made a research recommendation as is reflected in NICE Medical Technology Guidance 22.

How well do vital signs identify children with serious infections in paediatric emergency care?

PubMed

Thompson, M; Coad, N; Harnden, A; Mayon-White, R; Perera, R; Mant, D

2009-11-01

To determine whether vital signs identify children with serious infections, and to compare their diagnostic value with that of the Manchester triage score (MTS) and National Institute for Health and Clinical Excellence (NICE) traffic light system of clinical risk factors. Prospective cohort of children presenting with suspected acute infection. We recorded vital signs, level of consciousness, activity level, respiratory distress, hydration and MTS category. Paediatric assessment unit at a teaching hospital in England. 700 children (median age 3 years), of whom 357 (51.0%) were referred from primary care, 198 (28.3%) self-referrals and 116 (16.6%) emergency ambulance transfers. Just over half (383 or 54.7%) were admitted. Severity of infection categorised as serious, intermediate, minor or not infection. Children with serious or intermediate infections (n = 313) were significantly more likely than those with minor or no infection (n = 387) to have a temperature >or=39 degrees C, tachycardia, saturations 2 seconds. Having one or more of temperature >or=39 degrees C, saturations

Impact of the National Institute for Health and Care Excellence (NICE) guidance on medical technology uptake: analysis of the uptake of spinal cord stimulation in England 2008–2012

PubMed Central

Vyawahare, Bharati; Hallas, Natalie; Brookes, Morag; Taylor, Rod S; Eldabe, Sam

2014-01-01

Background The National Institute for Health and Care Excellence (NICE) Technology Appraisal Guidance on spinal cord stimulation (SCS) was published in 2008 and updated in 2012 with no change. This guidance recommends SCS as a cost-effective treatment for patients with neuropathic pain. Objective To assess the impact of NICE guidance by comparing SCS uptake in England pre-NICE (2008–2009) and post-NICE (2009–2012) guidance. We also compared the English SCS uptake rate with that of Belgium, the Netherlands, France and Germany. Design SCS implant data for England was obtained from the Hospital Episode Statistics (HES) database and compared with other European countries where comparable data were available. Results The HES data showed small increases in SCS implantation and replacement/revision procedures, and a large increase in SCS trials between 2008 and 2012. The increase in the total number of SCS procedures per million of population in England is driven primarily by revision/replacements and increased trial activity. Marked variability in SCS uptake at both health regions and primary care trust level was observed. Conclusions Despite the positive NICE recommendation for the routine use of SCS, we found no evidence of a significant impact on SCS uptake in England. Rates of SCS implantation in England are lower than many other European countries. PMID:24398364

Urgent revision required of NICE guidance relating to prevention of spread of vCJD through neurosurgical instruments.

PubMed

George, Kuriakose

2014-04-01

In 2006, NICE brought out guidance relating to prevention of vCJD through contaminated surgical instruments. This was with the aim of protecting patients born after 1997 who did not have any risk of developing vCJD through eating beef contaminated with BSE through the food chain. Many adult neurosurgical units did not pay much attention to this until 2013 when they were suddenly faced with these children who were now 16 and being admitted to the adult neurosurgical service rather than pediatric. The NICE guidance requires that most patients born after 1997 be operated on using a separate set of neurosurgical instruments than those born before this. This is proving to be a huge financial, as well as logistical, challenge and also a clinical risk as attention is being diverted to searching for the right kit when it should be spent on saving lives. It is now clear in 2013 that the risks that NICE feared were perhaps overstated as there is nowhere near the number of deaths from vCJD that NICE had feared would happen. Worldwide there have been only five cases whereby CJD was transmitted through contaminated neurosurgical instruments and the last case was in 1976. There have been no cases of vCJD transmission attributed to use of contaminated neurosurgical instruments. NICE should revisit this guidance urgently in view of these circumstances.

(Non-adiabatic) string creation on nice slices in Schwarzschild black holes

DOE PAGES

Puhm, Andrea; Rojas, Francisco; Ugajin, Tomonori

2017-04-27

Nice slices have played a pivotal role in the discussion of the black hole information paradox as they avoid regions of strong spacetime curvature and yet smoothly cut through the infalling matter and the outgoing Hawking radiation, thus, justifying the use of low energy field theory. To avoid information loss it has been argued recently, however, that local effective field theory has to break down at the horizon. To assess the extent of this breakdown in a UV complete framework we study string-theoretic effects on nice slices in Schwarzschild black holes. Here, our purpose is two-fold. First, we use nicemore » slices to address various open questions and caveats of [1] where it was argued that boost-enhanced non-adiabatic string-theoretic effects at the horizon could provide a dynamical mechanism for the firewall. Second, we identify two non-adiabatic effects on nice slices in Schwarzschild black holes: pair production of open strings near the horizon enhanced by the presence of the infinite tower of highly excited string states and a late-time non-adiabatic effect intrinsic to nice slices.« less

(Non-adiabatic) string creation on nice slices in Schwarzschild black holes

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

Puhm, Andrea; Rojas, Francisco; Ugajin, Tomonori

Nice slices have played a pivotal role in the discussion of the black hole information paradox as they avoid regions of strong spacetime curvature and yet smoothly cut through the infalling matter and the outgoing Hawking radiation, thus, justifying the use of low energy field theory. To avoid information loss it has been argued recently, however, that local effective field theory has to break down at the horizon. To assess the extent of this breakdown in a UV complete framework we study string-theoretic effects on nice slices in Schwarzschild black holes. Here, our purpose is two-fold. First, we use nicemore » slices to address various open questions and caveats of [1] where it was argued that boost-enhanced non-adiabatic string-theoretic effects at the horizon could provide a dynamical mechanism for the firewall. Second, we identify two non-adiabatic effects on nice slices in Schwarzschild black holes: pair production of open strings near the horizon enhanced by the presence of the infinite tower of highly excited string states and a late-time non-adiabatic effect intrinsic to nice slices.« less

Nanoengineered Ionic-Covalent Entanglement (NICE) Bioinks for 3D Bioprinting.

PubMed

Chimene, David; Peak, Charles W; Gentry, James L; Carrow, James K; Cross, Lauren M; Mondragon, Eli; Cardoso, Guinea B; Kaunas, Roland; Gaharwar, Akhilesh K

2018-03-28

We introduce an enhanced nanoengineered ionic-covalent entanglement (NICE) bioink for the fabrication of mechanically stiff and elastomeric 3D biostructures. NICE bioink formulations combine nanocomposite and ionic-covalent entanglement (ICE) strengthening mechanisms to print customizable cell-laden constructs for tissue engineering with high structural fidelity and mechanical stiffness. Nanocomposite and ICE strengthening mechanisms complement each other through synergistic interactions, improving mechanical strength, elasticity, toughness, and flow properties beyond the sum of the effects of either reinforcement technique alone. Herschel-Bulkley flow behavior shields encapsulated cells from excessive shear stresses during extrusion. The encapsulated cells readily proliferate and maintain high cell viability over 120 days within the 3D-printed structure, which is vital for long-term tissue regeneration. A unique aspect of the NICE bioink is its ability to print much taller structures, with higher aspect ratios, than can be achieved with conventional bioinks without requiring secondary supports. We envision that NICE bioinks can be used to bioprint complex, large-scale, cell-laden constructs for tissue engineering with high structural fidelity and mechanical stiffness for applications in custom bioprinted scaffolds and tissue engineered implants.

Lens ray diagrams with a spreadsheet

NASA Astrophysics Data System (ADS)

González, Manuel I.

2018-05-01

Physicists create spreadsheets customarily to carry out numerical calculations and to display their results in a meaningful, nice-looking way. Spreadsheets can also be used to display a vivid geometrical model of a physical system. This statement is illustrated with an example taken from geometrical optics: images formed by a thin lens. A careful mixture of standard Excel functions allows to display a realistic automated ray diagram. The suggested spreadsheet is intended as an auxiliary didactic tool for instructors who wish to teach their students to create their own ray diagrams.

NASA Innovations in Climate Education Connects Audiences Coast-to-Coast for Climate Literacy via the NASA Digital Learning Network

NASA Astrophysics Data System (ADS)

Murray, B.; Barnes, M. H.; Chambers, L. H.; Pippin, M. R.; Martin, A. M.; Geyer, A. J.; Leber, M.; Joyner, E.; Small, C.; Dublin, D.

2013-12-01

The Minority University Research and Education Program (MUREP) NASA Innovations in Climate Education (NICE) project advances NASA's Office of Education's strategic initiative to improve the quality of the nation's Science, Technology, Engineering and Mathematics (STEM) education and enhance literacy about climate and other Earth systems environmental changes. NICE also strategically supports the United States' progressive initiative to enhance the science and technology enterprise for successful competition in the 21st century global community. To extend to wider networks in 2013, MUREP NICE partnered with the NASA Digital Learning Network (DLNTM) in a unique, non-traditional collaborative model to significantly increase the impact and connection with formal and informal educators, curriculum developers, science education specialists, and researchers regarding climate literacy. DLN offers an expansive distance learning capability that bridges presenters with education audiences for interactive, web-based, synchronous and asynchronous Educator Professional Development (EPD). DLN services over 10,000 educators each year. In 3rd quarter FY13 alone DLN totaled 3,361 connections with educators. The DLN allows for cost effective (no travel) engagement of multiple geographically dispersed audiences with presenters from remote locations. This facilitates interactive communication among participants through distance education, allowing them to share local experiences with one another. A comprehensive four-part EPD workshop, featuring several NICE Principal Investigators (PI) and NASA subject matter experts was developed for NICE in April 2013. Topics covered in the workshop progressed from a simple introduction of Earth's energy budget, through explanation of temperature data collection and evidence of temperature rise, impacts on phenology, and finally consequences for bugs and birds. This event was an innovative hybrid workshop, connecting onsite teachers interactively with remotely connected participants and presenters across the nation. In addition to the 19 educators who participated live, 298 watched the sessions via a webcast. A similar workshop series experienced 300% growth in 2 years indicating the potential for comparable growth of NICE events. Due to unanimous requests for more information on these and other topics, beginning Fall 2013, NICE will reach into additional educators' classrooms via the DLN to deliver continued EPD from NICE PIs and other NASA researchers. With DLN capability, hundreds of additional unique viewers have been exposed to NICE via the DLN this year. This large-scale effort allows for long term, sustained engagement of the global community. We intend to take advantage of capabilities of the DLN as we continue to scale NICE events to wider audiences. The use of distance education allows for immediate release of new information and more frequent connections, resulting in sustained engagement of participants. This presentation will explore the various successes and future opportunities for expanding the impact of climate literacy via the NASA DLN, a large-scale collaborative network.

[How it should be enabled network cooperation on healthcare services. Towards an HispaNICE?

PubMed

Abellán Perpiñán, José María; Martínez Pérez, Jorge Eduardo

2016-11-01

Although the Spanish Network of Health Technology Assessment was founded in 2012, it is true that its actual influence on the rationalization of the National Health System's healthcare basket is scarce. The main argument of this article is that the Spanish Network of HTA should work "as if" it was an HispaNICE. That is to say, transferring the NICE's advantages to Spanish context. Copyright © 2016. Publicado por Elsevier España, S.L.U.

Trends in procedures for infertility and caesarean sections: was NICE disinvestment guidance implemented? NICE recommendation reminders

PubMed Central

2013-01-01

Background National Institute for Health and Clinical Excellence (NICE) clinical guidelines and subsequent NICE issued ‘recommendation reminders’ advocate discontinuing two fertility procedures and caesarean sections in women with hepatitis. We assess whether NICE guidance in 2004 and recommendation reminders were associated with a change in the rate of clinical procedures performed. Methods Routine inpatient Hospital Episode Statistics (HES) data were extracted from the HES database for 1st April 1998 to 31st March 2010 using OPCS procedure codes for varicocele operations in infertile men, endometrial biopsies in infertile women and caesarean sections in women with hepatitis B or C. We used Joinpoint regression to identify points in time when the trend in procedure rates changed markedly, to identify any influence of the release of NICE guidance. Results Between 1998-2010, planned caesarean sections in women with and without hepatitis B or C increased yearly (annual percentage change (APC) 4.9%, 95% CI 2.1% to 7.7%) in women with hepatitis, compared with women without (APC 4.0% [95% CI 2.7% to 5.3%] up to 2001, APC -0.6% [95% CI -2.8% to 1.8%] up to 2004 and 1.3% [95% CI 0.8% to 1.8%] up to 2010). In infertile women under 40 years of age, endometrial biopsies for investigation of infertility increased, APC 6.0% (95% CI 3.6% to 8.4%) up to 2003, APC 1.5% (95% CI -4.3% to 7.7%) to 2007 followed by APC 12.8% (95% CI 1.0% to 26.0%) to 2010. Varicocele procedures remained relatively static between 1998 and 2010 (APC -0.5%, 95% CI -2.3% to 1.3%). Conclusions There was no decline in use of the three studied procedures, contrary to NICE guidance, and no change in uptake associated with the timing of NICE guidance or recommendation reminders. ‘Do not do’ recommendation reminders may be ineffective at improving clinical practice or achieving disinvestment. PMID:23388377

BOOK REVIEW: Solitons, Instantons, and Twistors Solitons, Instantons, and Twistors

NASA Astrophysics Data System (ADS)

Witt, Donald M.

2011-04-01

Solitons and instantons play important roles both in pure and applied mathematics as well as in theoretical physics where they are related to the topological structure of the vacuum. Twistors are a useful tool for solving nonlinear differential equations and are useful for the study of the antiself-dual Yang-Mills equations and the Einstein equations. Many books and more advanced monographs have been written on these topics. However, this new book by Maciej Dunajski is a complete first introduction to all of the topics in the title. Moreover, it covers them in a very unique way, through integrable systems. The approach taken in this book is that of mathematical physics à la field theory. The book starts by giving an introduction to integrable systems of ordinary and partial differential equations and proceeds from there. Gauge theories are not covered until chapter 6 which means the reader learning the material for the first time can build up confidence with simpler models of solitons and instantons before encountering them in gauge theories. The book also has an extremely clear introduction to twistor theory useful to both mathematicians and physicists. In particular, the twistor theory presentation may be of interest to string theorists wanting understand twistors. There are many useful connections to research into general relativity. Chapter 9 on gravitational instantons is great treatment useful to anyone doing research in classical or quantum gravity. There is also a nice discussion of Kaluza-Klein monopoles. The three appendices A-C cover the necessary background material of basic differential geometry, complex manifolds, and partial differential equations needed to fully understand the subject. The reader who has some level of expertise in any of the topics covered can jump right into that material without necessarily reading all of the earlier chapters because of the extremely clear writing style of the author. This makes the book an excellent reference on instantons, solitons and twistors. However, I found it useful to read the whole book because the author has a beautiful perspective on and presentation of the material. Maciej Dunajski developed the book out of notes from a series of lecture courses he taught on these subjects over a five year period at Cambridge University. This fact makes the book an excellent choice for a textbook on the subject with each of the 10 chapters containing nice problems and exercises. Additionally, the wealth of information contained in the book makes it a great reference book for any theoretical physicist or mathematician to own. As an introduction to an exciting area of research, this book is excellent because it is not only accessible but self contained. A wonderful feature of the book is the clear and informative explanation of the topics and the wealth of examples. The presentation style of the book means that it is accessible to readers ranging from advanced undergraduates doing research to experts. It would be an excellent textbook for a course at the advanced undergraduate level or graduate level in either mathematics or physics. This book will become a standard on the subject. The typesetting of the book is very clean, with nicely sized fonts and clean uniform notation. It includes 35 illustrations which helpfully illustrated text. It is my pleasure to highly recommend it to anyone from an advanced undergraduate to a researcher in the fields covered.

The Toulmin Argument Model in Artificial Intelligence

NASA Astrophysics Data System (ADS)

Verheij, Bart

In 1958, Toulmin published The Uses of Argument. Although this anti-formalistic monograph initially received mixed reviews (see section 2 of [20] for Toulmin’s own recounting of the reception of his book), it has become a classical text on argumentation, and the number of references to the book (when writing these words1 —by a nice numerological coincidence—1958) continues to grow (see [7] and the special issue of Argumentation 2005; Vol. 19, No. 3). Also the field of Artificial Intelligence has discovered Toulmin’s work. Especially four of Toulmin’s themes have found follow-up in Artificial Intelligence.

A Randomized Controlled Trial Comparing the Low FODMAP Diet vs. Modified NICE Guidelines in US Adults with IBS-D.

PubMed

Eswaran, Shanti L; Chey, William D; Han-Markey, Theresa; Ball, Sarah; Jackson, Kenya

2016-12-01

There has been an increasing interest in the role of fermentable oligo-, di-, and monosaccharides and polyols (FODMAPs) in irritable bowel syndrome (IBS). We report results from the first randomized controlled trial of the low FODMAP diet in US adults with IBS and diarrhea (IBS-D). The objectives were to compare the efficacy of the low FODMAP diet vs. a diet based upon modified National Institute for Health and Care Excellence guidelines (mNICE) on overall and individual symptoms in IBS-D patients. This was a single-center, randomized-controlled trial of adult patients with IBS-D (Rome III) which compared 2 diet interventions. After a 2-week screening period, eligible patients were randomized to a low FODMAP or mNICE diet for 4 weeks. The primary end point was the proportion of patients reporting adequate relief of IBS-D symptoms ≥50% of intervention weeks 3-4. Secondary outcomes included a composite end point which required response in both abdominal pain (≥30% reduction in mean daily pain score compared with baseline) and stool consistency (decrease in mean daily Bristol Stool Form of ≥1 compared with baseline), abdominal pain and stool consistency responders, and other key individual IBS symptoms assessed using daily questionnaires. After screening, 92 subjects (65 women, median age 42.6 years) were randomized. Eighty-four patients completed the study (45 low FODMAP, 39 mNICE). Baseline demographics, symptom severity, and nutrient intake were similar between groups. Fifty-two percent of the low FODMAP vs. 41% of the mNICE group reported adequate relief of their IBS-D symptoms (P=0.31). Though there was no significant difference in the proportion of composite end point responders (P=0.13), the low FODMAP diet resulted in a higher proportion of abdominal pain responders compared with the mNICE group (51% vs. 23%, P=0.008). Compared with baseline scores, the low FODMAP diet led to greater reductions in average daily scores of abdominal pain, bloating, consistency, frequency, and urgency than the mNICE diet. In this US trial, 40-50% of patients reported adequate relief of their IBS-D symptoms with the low FODMAP diet or a diet based on modified NICE guidelines. The low FODMAP diet led to significantly greater improvement in individual IBS symptoms, particularly pain and bloating, compared with the mNICE diet.

NICE guidelines for imaging studies in children with UTI adequate only in boys under the age of 6 months.

PubMed

Ristola, Marko Tapani; Hurme, Timo

2013-03-01

The purpose of this study was to evaluate the applicability of the National Institute for Health and Clinical Excellence (NICE) guidelines for imaging studies in children under the age of three with first urinary tract infection (UTI). In our cohort of 112 patients, we gathered data regarding the occurrence of indications for ultrasonography (US) and voiding cystourethrography (VCUG) according to the NICE guidelines, dimercaptosuccinic acid (DMSA) scintigraphy examinations, UTI recurrence, antimicrobial prophylaxis (AMP), anti-reflux procedures, and other urological procedures. If the NICE guidelines had been applied, 13 of the 25 patients (52 %) with vesicoureteral reflux (VUR), including 6 of the 12 patients (50 %) with dilating VUR and 3 of the 4 patients who underwent endoscopic anti-reflux treatment, would have been missed, and a negative VCUG would have been avoided in 25 of the 42 patients (60 %) with no VUR. None of the missed diagnoses occurred in the younger boys' group. Based on these preliminary analyses, we feel that the NICE guidelines for imaging studies in children under 3 years old with UTI may be applicable to clinical use only in boys under 6 months of age. For other patients the guidelines were unsuccessful.

Noise-Immune Cavity-Enhanced Optical Frequency Comb Spectroscopy

NASA Astrophysics Data System (ADS)

Rutkowski, Lucile; Khodabakhsh, Amir; Johanssson, Alexandra C.; Foltynowicz, Aleksandra

2015-06-01

We present noise-immune cavity-enhanced optical frequency comb spectroscopy (NICE-OFCS), a recently developed technique for sensitive, broadband, and high resolution spectroscopy. In NICE-OFCS an optical frequency comb (OFC) is locked to a high finesse cavity and phase-modulated at a frequency precisely equal to (a multiple of) the cavity free spectral range. Since each comb line and sideband is transmitted through a separate cavity mode in exactly the same way, any residual frequency noise on the OFC relative to the cavity affects each component in an identical manner. The transmitted intensity contains a beat signal at the modulation frequency that is immune to frequency-to-amplitude noise conversion by the cavity, in a way similar to continuous wave noise-immune cavity-enhanced optical heterodyne molecular spectroscopy (NICE-OHMS). The light transmitted through the cavity is detected with a fast-scanning Fourier-transform spectrometer (FTS) and the NICE-OFCS signal is obtained by fast Fourier transform of the synchronously demodulated interferogram. Our NICE-OFCS system is based on an Er:fiber femtosecond laser locked to a cavity with a finesse of ˜9000 and a fast-scanning FTS equipped with a high-bandwidth commercial detector. We measured NICE-OFCS signals from the 3νb{1}+νb{3} overtone band of CO_2 around 1.57 μm and achieved absorption sensitivity 6.4×10-11cm-1 Hz-1/2 per spectral element, corresponding to a minimum detectable CO_2 concentration of 25 ppb after 330 s integration time. We will describe the principles of the technique and its technical implementation, and discuss the spectral lineshapes of the NICE-OFCS signals. A. Khodabakhsh, C. Abd Alrahman, and A. Foltynowicz, Opt. Lett. 39, 5034-5037 (2014). J. Ye, L. S. Ma, and J. L. Hall, J. Opt. Soc. Am. B 15, 6-15 (1998). A. Khodabakhsh, A. C. Johansson, and A. Foltynowicz, Appl. Phys. B (2015) doi:10.1007/s00340-015-6010-7.

Spot protein-creatinine ratio and spot albumin-creatinine ratio in the assessment of pre-eclampsia: a diagnostic accuracy study with decision-analytic model-based economic evaluation and acceptability analysis.

PubMed

Waugh, Jason; Hooper, Richard; Lamb, Edmund; Robson, Stephen; Shennan, Andrew; Milne, Fiona; Price, Christopher; Thangaratinam, Shakila; Berdunov, Vladislav; Bingham, Jenn

2017-10-01

The National Institute for Health and Care Excellence (NICE) guidelines highlighted the need for 'large, high-quality prospective studies comparing the various methods of measuring proteinuria in women with new-onset hypertensive disorders during pregnancy'. The primary objective was to evaluate quantitative assessments of spot protein-creatinine ratio (SPCR) and spot albumin-creatinine ratio (SACR) in predicting severe pre-eclampsia (PE) compared with 24-hour urine protein measurement. The secondary objectives were to investigate interlaboratory assay variation, to evaluate SPCR and SACR thresholds in predicting adverse maternal and fetal outcomes and to assess the cost-effectiveness of these models. This was a prospective diagnostic accuracy cohort study, with decision-analytic modelling and a cost-effectiveness analysis. The setting was 36 obstetric units in England, UK. Pregnant women (aged ≥ 16 years), who were at > 20 weeks' gestation with confirmed gestational hypertension and trace or more proteinuria on an automated dipstick urinalysis. Women provided a spot urine sample for protein analysis (the recruitment sample) and were asked to collect a 24-hour urine sample, which was stored for secondary analysis. A further spot sample of urine was taken immediately before delivery. Outcome data were collected from hospital records. There were four index tests on a spot sample of urine: (1) SPCR test (conducted at the local laboratory); (2) SPCR test [conducted at the central laboratory using the benzethonium chloride (BZC) assay]; (3) SPCR test [conducted at the central laboratory using the pyrogallol red (PGR) assay]; and (4) SACR test (conducted at the central laboratory using an automated chemistry analyser). The comparator tests on 24-hour urine collection were a central test using the BZC assay and a central test using the PGR assay. The primary reference standard was the NICE definition of severe PE. Secondary reference standards were a clinician diagnosis of severe PE, which is defined as treatment with magnesium sulphate or with severe PE protocol; adverse perinatal outcome; one or more of perinatal or infant mortality, bronchopulmonary dysplasia, necrotising enterocolitis or grade III/IV intraventricular haemorrhage; and economic cost and outcomes. Health service data on service use and costs followed published economic models. In total, 959 women were available for primary analysis and 417 of them had severe PE. The diagnostic accuracy of the four assays on spot urine samples against the reference standards was similar. The three SPCR tests had sensitivities in excess of 90% at prespecified thresholds, with poor specificities and negative likelihood ratios of ≥ 0.1. The SACR test had a significantly higher sensitivity of 99% (confidence interval 98% to 100%) and lower specificity. Receiver operating characteristic (ROC) curves were similar (area under ROC curve between 0.87 and 0.89); the area under the central laboratory's SACR curve was significantly higher ( p  = 0.004). The central laboratory's SACR test was the most cost-effective option, generating an additional 0.03 quality-adjusted life-years at an additional cost of £45.07 compared with the local laboratory's SPCR test. The probabilistic analysis showed it to have a 100% probability of being cost-effective at the standard willingness-to-pay threshold recommended by NICE. Implementation of NICE guidelines has led to an increased intervention rate in the study population that affected recruitment rates and led to revised sample size calculations. Evidence from this clinical study does not support the recommendation of 24-hour urine sample collection in hypertensive pregnant women. The SACR test had better diagnostic performance when predicting severe pre-eclampsia. All four tests could potentially be used as rule-out tests for the NICE definition of severe PE. Testing SACR at a threshold of 8 mg/mmol should be studied as a 'rule-out' test of proteinuria. Current Controlled Trials ISRCTN82607486. This project was funded by the National Institute Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment ; Vol. 21, No. 61. See the NIHR Journals Library website for further project information.

Developing the revised NICE appraisal technical guidance to manufacturers and sponsors: opportunity or threat?

PubMed

Taylor, Rod S; Hutton, John; Culyer, Anthony J

2002-01-01

One of the principal roles of the National Institute for Clinical Excellence (NICE) is to appraise selected existing and emerging healthcare technologies and, as a result, produce guidance for the National Health Service (NHS) in England and Wales. A central part of this appraisal is the potential for manufacturers and sponsors to make a data submission. This paper describes the process of development of the second edition of technical guidance to manufacturers and sponsors for submission to NICE. The revision process took place during the period May 2000 and January 2001 and involved a number of key steps -- establishment of a guidance steering committee, review of current international guidelines of clinical and cost effectiveness, drafting of the guidance, detailed consultation with stakeholders, revision of the guidance and, finally, publication. The lessons learnt from revision of the NICE guidance for manufacturers and sponsors and some main issues for its future development are discussed.

Drug reimbursement recommendations by the National Institute for Health and Clinical Excellence: have they impacted the National Health Service budget?

PubMed

Mauskopf, Josephine; Chirila, Costel; Birt, Julie; Boye, Kristina S; Bowman, Lee

2013-04-01

Determine whether reimbursement restrictions recommended by the National Institute for Health and Clinical Excellence (NICE) have impacted the United Kingdom (UK) National Health Service (NHS) budget. Data were abstracted from NICE guidance documents and costing statements through March 2011. Estimated maximum and adjusted potential budget impact (PBI) on the NHS was derived using estimates of the UK marketing-approved population and the annual cost for the new drug. Descriptive and logistic analyses were used to estimate the correlation between the degree of restrictions on reimbursement recommended by NICE for each new drug indication and the PBI controlling for clinical effectiveness and cost-effectiveness. PBI was significantly correlated with the degree of reimbursement restrictions. In descriptive analysis, the adjusted PBI for drugs that were recommended without restrictions was £20.3 million (SD = 22.2) compared with £49.8 million (SD = 90.8) for those recommended with restrictions and £71.1 million (SE = 99.9) for those not recommended. In logistic analysis, the odds ratio for less restrictive reimbursement was 0.848 (95% CI, 0.762-0.945) for each £20 million increase in the adjusted PBI. Results were similar using the maximum PBI. After controlling for clinical effectiveness and cost-effectiveness, the degree of reimbursement restriction recommended by NICE remains significantly correlated with the PBI, despite that fact that the NICE decision process does not consider budget impact. This correlation might be due to NICE consideration of effectiveness and cost-effectiveness for subgroups of the approved population. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

A Review of Ruxolitinib for the Treatment of Myelofibrosis: A Critique of the Evidence.

PubMed

Wade, Ros; Hodgson, Robert; Biswas, Mousumi; Harden, Melissa; Woolacott, Nerys

2017-02-01

As part of the National Institute for Health and Care Excellence's (NICE) Single Technology Appraisal (STA) process, ruxolitinib was assessed to determine the clinical and cost effectiveness of its use in the treatment of disease-related splenomegaly or symptoms in adults with myelofibrosis. Ruxolitinib had previously been assessed as part of the STA process and was not recommended in NICE guidance issued in June 2013 (TA289). A review of TA289 was commissioned following the availability of new longer-term survival data; a price discount patient access scheme (PAS) was also introduced. The Centre for Reviews and Dissemination (CRD) and Centre for Health Economics (CHE) Technology Appraisal Group at the University of York was commissioned to act as the independent Evidence Review Group (ERG). This article provides a summary of the manufacturer or sponsor of the technology's (referred to as the company) submission, the ERG review and the resulting NICE guidance issued in March 2016. The main clinical effectiveness data were derived from two good-quality multicentre randomised controlled trials (RCTs): COMFORT-II compared ruxolitinib with best available therapy (BAT) and COMFORT-I compared ruxolitinib with placebo. Both RCTs demonstrated a statistically significant reduction in splenomegaly and its associated symptoms in intermediate-2 and high-risk myelofibrosis patients. Overall survival was statistically significantly improved with ruxolitinib compared with BAT at 3.5 years of follow-up in the COMFORT-II trial (hazard ratio 0.58, 95 % CI 0.36-0.93). Grade 3-4 adverse events were more frequent in the ruxolitinib group than in the BAT group; 42 % compared with 25 %. Evidence relating to patients with lower-risk disease or low platelet counts (50-100 × 10 9 /L) was less robust. The company's economic model was well-presented and had an appropriate model structure. The base-case incremental cost-effectiveness ratio (ICER) was estimated to be around £45,000 per quality-adjusted life-year (QALY) gained (including the PAS discount). Extensive sensitivity and scenario analyses were presented, demonstrating that the estimated ICER was robust to a range of input values and assumptions made in the model. Alternative scenarios presented by the ERG showed only modest increases in the estimated ICER, primarily as a result of including an element of drug wastage within the model. Alternative scenarios resulted in estimated ICERs ranging from around £45,000 to £49,000 per QALY gained (including the PAS discount). At the first appraisal meeting, the NICE Appraisal Committee concluded that ruxolitinib was clinically effective and was a cost effective use of National Health Service (NHS) resources for patients with high-risk myelofibrosis who meet NICE's end-of-life criteria. Following the consultation, the company offered a revised PAS, resulting in a revised base-case ICER of £31,229 per QALY gained. The company also presented new evidence on the cost effectiveness of ruxolitinib in intermediate-2 and high-risk subgroups and a revised version of the model. The NICE Appraisal Committee considered the new evidence and recommended ruxolitinib for the treatment of patients with intermediate-2-risk disease as well as patients with high-risk disease, based on International Prognostic Scoring System (IPSS) prognostic factors.

Peer teaching and information retrieval: the role of the NICE Evidence search student champion scheme in enhancing students' confidence.

PubMed

Sbaffi, Laura; Hallsworth, Elaine; Weist, Anne

2018-03-01

This research reports on the NICE Evidence search (ES) student champion scheme (SCS) first five years of activity (2011-2016) in terms of its impact on health care undergraduate students' information search skills and search confidence. A review of students' evaluation of the scheme was carried out to chart the changes in attitude towards NICE Evidence search as an online health care information source and to monitor students' approach to information seeking. This study is based on the results of questionnaires distributed to students before and after attending a training session on NICE Evidence search delivered by their own peers. The exercise was implemented in health related universities in England over a period of five consecutive academic years. (i) Students' search confidence improved considerably after the training; (ii) ES was perceived as being an increasingly useful resource of evidence based information for their studies; (iii) the training helped students develop discerning search skills and use evidence based information sources more consistently and critically. The NICE SCS improves confidence in approaching information tasks amongst health care undergraduate students. Future developments could involve offering the training at the onset of a course of study and adopting online delivery formats to expand its geographical reach. © 2018 Health Libraries Group.

Here Comes the Bride... and Her Teeth Are Nice and Bright

MedlinePlus

FOR THE DENTAL PATIENT ... Here comes the bride … … and her teeth are nice and bright! P lanning a wedding? There will ... SMILE Professional cleaning. A professional cleaning in a dental office before your wedding can help remove stains ...

Vertical thermodynamic structure of the troposphere during the Norwegian young sea ICE expedition (N-ICE2015)

NASA Astrophysics Data System (ADS)

Kayser, Markus; Maturilli, Marion; Graham, Robert M.; Hudson, Stephen R.; Rinke, Annette; Cohen, Lana; Kim, Joo-Hong; Park, Sang-Jong; Moon, Woosok; Granskog, Mats A.

2017-10-01

The Norwegian young sea ICE (N-ICE2015) expedition was designed to investigate the atmosphere-snow-ice-ocean interactions in the young and thin sea ice regime north of Svalbard. Radiosondes were launched twice daily during the expedition from January to June 2015. Here we use these upper air measurements to study the multiple cyclonic events observed during N-ICE2015 with respect to changes in the vertical thermodynamic structure, moisture content, and boundary layer characteristics. We provide statistics of temperature inversion characteristics, static stability, and boundary layer extent. During winter, when radiative cooling is most effective, we find the strongest impact of synoptic cyclones. Changes to thermodynamic characteristics of the boundary layer are associated with transitions between the radiatively "clear" and "opaque" atmospheric states. In spring, radiative fluxes warm the surface leading to lifted temperature inversions and a statically unstable boundary layer. Further, we compare the N-ICE2015 static stability distributions to corresponding profiles from ERA-Interim reanalysis, from the closest land station in the Arctic North Atlantic sector, Ny-Ålesund, and to soundings from the SHEBA expedition (1997/1998). We find similar stability characteristics for N-ICE2015 and SHEBA throughout the troposphere, despite differences in location, sea ice thickness, and snow cover. For Ny-Ålesund, we observe similar characteristics above 1000 m, while the topography and ice-free fjord surrounding Ny-Ålesund generate great differences below. The long-term radiosonde record (1993-2014) from Ny-Ålesund indicates that during the N-ICE2015 spring period, temperatures were close to the climatological mean, while the lowest 3000 m were 1-3°C warmer than the climatology during winter.

Dietetic practice in refeeding syndrome.

PubMed

Wagstaff, G

2011-10-01

The physiology and consequences of refeeding syndrome have long been recognised, although its management continues to be debated, despite the recommendations made by The National Institute for Health and Clinical Excellence (NICE) in their guideline 'Nutrition Support in Adults' (2006). The present study aims to assess current dietetic opinion and practice in this area, as well as whether the NICE recommendations have been adopted. An anonymous, self-completed Internet survey was designed investigating current practice and opinions on the NICE (2006) guidance on this subject. A link to the questionnaire was distributed with a covering letter via e-mail to the heads of department of National Health Service Trusts in the London region, UK, requesting that it be disseminated to all dietitians working with adults. After the closing date, all responses were collated and analysed. The survey elicited a 30.8% response rate. Some 89.8% of respondents have read the NICE guidance on Nutrition Support in Adults (2006) and 66.9% have changed their practice regarding refeeding syndrome management as a result. Sixty-two percent do not wait for biochemistry to normalise before commencing nutrition. Ninety-two percent of respondents completed the mini case studies indicating that current practice is inconsistent among dietitians. Neither NICE criteria for recognising patients at risk of refeeding, nor the recommended starting rates are universally followed. Seventy-five percent continue to supplement electrolytes reactively. Although limited by a small sample size, the findings of the present study suggest that dietetic practice regarding refeeding syndrome management remains inconsistent with the recommendations made by NICE, although some aspects have been adopted. © 2011 The Author. Journal of Human Nutrition and Dietetics © 2011 The British Dietetic Association Ltd.

"Taking the problem to the people": traffic safety from public relations to political theory, 1937-1954.

PubMed

Bernardin, Stève

2015-04-01

The slogan "taking the problem to the people" nicely summarizes U.S. traffic safety campaigns of the 1950s. It refers to the goal of awareness and self-discipline for drivers through education and law enforcement. A detailed analysis of the campaigns, however, shows a subtler objective of the motor interests that promoted it. They wanted to overcome political indifference through a civic mobilization of drivers as citizens, persuading drivers to lobby for traffic control. The analysis of their efforts leads us to question the role-or lack of role-of politicians in scientific and technological controversies.

A Successful Senior Seminar: Unsolved Problems in Number Theory

ERIC Educational Resources Information Center

Styer, Robert

2014-01-01

The "Unsolved Problems in Number Theory" book by Richard Guy provides nice problems suitable for a typical math major. We give examples of problems that have worked well in our senior seminar course and some nice results that senior math majors can obtain.

Bringing Global Climate Change Education to Alabama Middle School and High School Classrooms

NASA Astrophysics Data System (ADS)

Lee, M.; Mitra, C.; Percival, E.; Thomas, A.; Lucy, T.; Hickman, E.; Cox, J.; Chaudhury, S. R.; Rodger, C.

2013-12-01

A NASA-funded Innovations in Climate Education (NICE) Program has been launched in Alabama to improve high school and middle school education in climate change science. The overarching goal is to generate a better informed public that understands the consequences of climate change and can contribute to sound decision making on related issues. Inquiry based NICE modules have been incorporated into the existing course of study for 9-12 grade biology, chemistry, and physics classes. In addition, new modules in three major content areas (earth and space science, physical science, and biological science) have been introduced to selected 6-8 grade science teachers in the summer of 2013. The NICE modules employ five E's of the learning cycle: Engage, Explore, Explain, Extend and Evaluate. Modules learning activities include field data collection, laboratory measurements, and data visualization and interpretation. Teachers are trained in the use of these modules for their classroom through unique partnership with Alabama Science in Motion (ASIM) and the Alabama Math Science Technology Initiative (AMSTI). Certified AMSTI teachers attend summer professional development workshops taught by ASIM and AMSTI specialists to learn to use NICE modules. During the school year, the specialists in turn deliver the needed equipment to conduct NICE classroom exercises and serve as an in-classroom resource for teachers and their students. Scientists are partnered with learning and teaching specialists and lead teachers to implement and test efficacy of instructional materials, models, and NASA data used in classroom. The assessment by professional evaluators after the development of the modules and the training of teachers indicates that the modules are complete, clear, and user-friendly. The overall teacher satisfaction from the teacher training was 4.88/5.00. After completing the module teacher training, the teachers reported a strong agreement that the content developed in the NICE modules should be included in the Alabama secondary curriculum. Eventually, the NICE program has the potential to reach over 200,000 students when the modules are fully implemented in every school in the state of Alabama. The project can give these students access to expertise and equipment, thereby strengthening the connections between the universities, state education administrators, and the community.

They're NICE and Neat, but Are They Useful? A Grounded Theory of Clinical Psychologists' Beliefs About and Use of NICE Guidelines.

PubMed

Court, Alex John; Cooke, Anne; Scrivener, Amanda

2017-07-01

Guidelines are ubiquitous but inconsistently used in UK mental health services. Clinical psychologists are often influential in guideline development and implementation, but opinion within the profession is divided. This study utilized grounded theory methodology to examine clinical psychologists' beliefs about and use of NICE guidelines. Eleven clinical psychologists working in the NHS were interviewed. The overall emerging theme was; NICE guidelines are considered to have benefits but to be fraught with dangers. Participants were concerned that guidelines can create an unhelpful illusion of neatness. They managed the tension between the helpful and unhelpful aspects of guidelines by relating to them in a flexible manner. The participants reported drawing on specialist skills such as idiosyncratic formulation and integration. However, due to the pressures and dominant discourses within services they tended to practice in ways that prevent these skills from being recognized. This led to fears that their professional identity was threatened, which impacted upon perceptions of the guidelines. To our knowledge, the theoretical framework presented in this paper is the first that attempts to explain why NICE guidelines are not consistently utilized in UK mental health services. The current need for services to demonstrate 'NICE compliance' may be leading to a perverse incentive for clinical psychologists in particular to do one thing but say another and for specialist skills to be obscured. If borne out by future studies, this represents a threat to continued quality improvement and also to the profession. Copyright © 2016 John Wiley & Sons, Ltd. Guidelines have many benefits, but the current pressure for services to be 'NICE compliant' may be having unintended negative as well as positive effects. Lack of implementation may be partly the result of active choice by clinicians concerned to use the full range of professional skills and to offer flexibility and choice to service users. The current context is creating a perverse incentive for clinicians to say one thing but do another. This is problematic for services and a potential threat to the profession of clinical psychology. Copyright © 2016 John Wiley & Sons, Ltd.

Screen Study Guides.

ERIC Educational Resources Information Center

Duncan, Barry

1969-01-01

This study guide for Arthur Lipsett's film "Very Nice, Very Nice" is in four parts. First, it describes and evaluates the film, discusses Lipsett's unusual juxtapositions, fast cutting, and fragmented speeches as indications of his satirical intent, and suggests that the only meaningful summation of the film's content is through pattern…

Tropospheric characteristics over sea ice during N-ICE2015

NASA Astrophysics Data System (ADS)

Kayser, Markus; Maturilli, Marion; Graham, Robert; Hudson, Stephen; Cohen, Lana; Rinke, Annette; Kim, Joo-Hong; Park, Sang-Jong; Moon, Woosok; Granskog, Mats

2017-04-01

Over recent years, the Arctic Ocean region has shifted towards a younger and thinner sea-ice regime. The Norwegian young sea ICE (N-ICE2015) expedition was designed to investigate the atmosphere-snow-ice-ocean interactions in this new ice regime north of Svalbard. Here we analyze upper-air measurements made by radiosondes launched twice daily together with surface meteorology observations during N-ICE2015 from January to June 2015. We study the multiple cyclonic events observed during N-ICE2015 with respect to changes in the vertical thermodynamic structure, sudden increases in moisture content and temperature, temperature inversions and boundary layer dynamics. The influence of synoptic cyclones is strongest under polar night conditions, when radiative cooling is most effective and the moisture content is low. We find that transitions between the radiatively clear and opaque state are the largest drivers of changes to temperature inversion and stability characteristics in the boundary layer during winter. In spring radiative fluxes warm the surface leading to lifted temperature inversions and a statically unstable boundary layer. The unique N-ICE2015 dataset is used for case studies investigating changes in the vertical structure of the atmosphere under varying synoptic conditions. The goal is to deepen our understanding of synoptic interactions within the Arctic climate system, to improve model performance, as well as to identify gaps in instrumentation, which precludes further investigations.

Sensitivity analysis in economic evaluation: an audit of NICE current practice and a review of its use and value in decision-making.

PubMed

Andronis, L; Barton, P; Bryan, S

2009-06-01

To determine how we define good practice in sensitivity analysis in general and probabilistic sensitivity analysis (PSA) in particular, and to what extent it has been adhered to in the independent economic evaluations undertaken for the National Institute for Health and Clinical Excellence (NICE) over recent years; to establish what policy impact sensitivity analysis has in the context of NICE, and policy-makers' views on sensitivity analysis and uncertainty, and what use is made of sensitivity analysis in policy decision-making. Three major electronic databases, MEDLINE, EMBASE and the NHS Economic Evaluation Database, were searched from inception to February 2008. The meaning of 'good practice' in the broad area of sensitivity analysis was explored through a review of the literature. An audit was undertaken of the 15 most recent NICE multiple technology appraisal judgements and their related reports to assess how sensitivity analysis has been undertaken by independent academic teams for NICE. A review of the policy and guidance documents issued by NICE aimed to assess the policy impact of the sensitivity analysis and the PSA in particular. Qualitative interview data from NICE Technology Appraisal Committee members, collected as part of an earlier study, were also analysed to assess the value attached to the sensitivity analysis components of the economic analyses conducted for NICE. All forms of sensitivity analysis, notably both deterministic and probabilistic approaches, have their supporters and their detractors. Practice in relation to univariate sensitivity analysis is highly variable, with considerable lack of clarity in relation to the methods used and the basis of the ranges employed. In relation to PSA, there is a high level of variability in the form of distribution used for similar parameters, and the justification for such choices is rarely given. Virtually all analyses failed to consider correlations within the PSA, and this is an area of concern. Uncertainty is considered explicitly in the process of arriving at a decision by the NICE Technology Appraisal Committee, and a correlation between high levels of uncertainty and negative decisions was indicated. The findings suggest considerable value in deterministic sensitivity analysis. Such analyses serve to highlight which model parameters are critical to driving a decision. Strong support was expressed for PSA, principally because it provides an indication of the parameter uncertainty around the incremental cost-effectiveness ratio. The review and the policy impact assessment focused exclusively on documentary evidence, excluding other sources that might have revealed further insights on this issue. In seeking to address parameter uncertainty, both deterministic and probabilistic sensitivity analyses should be used. It is evident that some cost-effectiveness work, especially around the sensitivity analysis components, represents a challenge in making it accessible to those making decisions. This speaks to the training agenda for those sitting on such decision-making bodies, and to the importance of clear presentation of analyses by the academic community.

Children's Sociolinguistic Evaluations of Nice Foreigners and Mean Americans

ERIC Educational Resources Information Center

Kinzler, Katherine D.; DeJesus, Jasmine M.

2013-01-01

Three experiments investigated 5- to 6-year-old monolingual English-speaking American children's sociolinguistic evaluations of others based on their accent (native, foreign) and social actions (nice, mean, neutral). In Experiment 1, children expressed social preferences for native-accented English speakers over foreign-accented speakers, and they…

In-Situ Sampling and Characterization of Naturally Occurring Marine Methane Hydrate Using the D/V JOIDES Resolution

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

Rack, Frank

2003-06-30

The primary accomplishments of the JOI Cooperative Agreement with DOE/NETL in this quarter were that: (1) Frank Rack, Anne Trehu, and Tim Collett presented preliminary results and operational outcomes of ODP Leg 204 at the American Association of Petroleum Geologists annual meeting in Salt Lake City, UT; (2) several Leg 204 scientists participated in special hydrate sessions at the international EGS/AGU/EUG meeting in Nice, France and presented initial science results from the cruise, which included outcomes arising from this cooperative agreement; and, (3) postcruise evaluation of the data, tools and measurement systems that were used during ODP Leg 204 continuedmore » in the preparation of deliverables under this agreement. At the EGS/EUG/AGU meeting in Nice, France in April, Leg 204 Co-chiefs Anne Trehu and Gerhard Bohrmann, as well as ODP scientists Charlie Paull, Erwin Suess, and Jim Kennett, participated in a press conference on hydrates. The well-attended press conference entitled ''Gas Hydrates: Free methane found and controversy over the 'hydrate gun''' led to stories in Nature on-line and BBC radio, among others. There were six (6) oral and fifteen (15) poster presentations on ODP Leg 204 hydrate science at the EGS/AGU/EUG Meeting in Nice, France on April 6-11, 2003. This was a very strong showing at a meeting just over six month following the completion of the drilling cruise and highlighted many of the results of the leg, including the results obtained with instruments and equipment funded under this cooperative agreement. At the AAPG annual meeting in Salt Lake City, UT on May 11-14, 2003, Anne Trehu gave an oral presentation about the scientific results of Leg 204, and Frank Rack presented a poster outlining the operational and technical accomplishments. Work continued on analyzing data collected during ODP Leg 204 and preparing reports on the outcomes of Phase 1 projects as well as developing plans for Phase 2.« less

Assessment of the Accuracy of the Bethe-Salpeter (BSE/GW) Oscillator Strengths.

PubMed

Jacquemin, Denis; Duchemin, Ivan; Blondel, Aymeric; Blase, Xavier

2016-08-09

Aiming to assess the accuracy of the oscillator strengths determined at the BSE/GW level, we performed benchmark calculations using three complementary sets of molecules. In the first, we considered ∼80 states in Thiel's set of compounds and compared the BSE/GW oscillator strengths to recently determined ADC(3/2) and CC3 reference values. The second set includes the oscillator strengths of the low-lying states of 80 medium to large dyes for which we have determined CC2/aug-cc-pVTZ values. The third set contains 30 anthraquinones for which experimental oscillator strengths are available. We find that BSE/GW accurately reproduces the trends for all series with excellent correlation coefficients to the benchmark data and generally very small errors. Indeed, for Thiel's sets, the BSE/GW values are more accurate (using CC3 references) than both CC2 and ADC(3/2) values on both absolute and relative scales. For all three sets, BSE/GW errors also tend to be nicely spread with almost equal numbers of positive and negative deviations as compared to reference values.

Analysis of the NMI01 marker for a population database of cannabis seeds.

PubMed

Shirley, Nicholas; Allgeier, Lindsay; Lanier, Tommy; Coyle, Heather Miller

2013-01-01

We have analyzed the distribution of genotypes at a single hexanucleotide short tandem repeat (STR) locus in a Cannabis sativa seed database along with seed-packaging information. This STR locus is defined by the polymerase chain reaction amplification primers CS1F and CS1R and is referred to as NMI01 (for National Marijuana Initiative) in our study. The population database consists of seed seizures of two categories: seed samples from labeled and unlabeled packages regarding seed bank source. Of a population database of 93 processed seeds including 12 labeled Cannabis varieties, the observed genotypes generated from single seeds exhibited between one and three peaks (potentially six alleles if in homozygous state). The total number of observed genotypes was 54 making this marker highly specific and highly individualizing even among seeds of common lineage. Cluster analysis associated many but not all of the handwritten labeled seed varieties tested to date as well as the National Park seizure to our known reference database containing Mr. Nice Seedbank and Sensi Seeds commercially packaged reference samples. © 2012 American Academy of Forensic Sciences.

An overview of NICE guidance: acute kidney injury.

PubMed

Ellis, Peter; Jenkins, Karen

Acute Kidney Injury (AKI) as a financial, resource and human burden on both the NHS and people with AKI. Clearly if AKI is the cause of much morbidity and mortality and significant amounts of it can be prevented and/or detected earlier, this could only be a good thing. In part, the problem with AKI is that it has historically been regarded as little more than a sequal to other more pressing physical illnesses and therefore not taken as seriously as it might. The 2013 guidance from NICE-clinical guideline 169-and the accompanying pathway, seek to address this with an emphasis on assessment and prevention, identification of disease, management and subsequent chronic disease management ( NICE, 2013a ).

Wind shear over the Nice Côte d'Azur airport: case studies

NASA Astrophysics Data System (ADS)

Boilley, A.; Mahfouf, J.-F.

2013-09-01

The Nice Côte d'Azur international airport is subject to horizontal low-level wind shears. Detecting and predicting these hazards is a major concern for aircraft security. A measurement campaign took place over the Nice airport in 2009 including 4 anemometers, 1 wind lidar and 1 wind profiler. Two wind shear events were observed during this measurement campaign. Numerical simulations were carried out with Meso-NH in a configuration compatible with near-real time applications to determine the ability of the numerical model to predict these events and to study the meteorological situations generating an horizontal wind shear. A comparison between numerical simulation and the observation dataset is conducted in this paper.

Wind shear over the Nice Côte d'Azur airport: case studies

NASA Astrophysics Data System (ADS)

Boilley, A.; Mahfouf, J.-F.

2013-04-01

The Nice Côte d'Azur international airport is subject to horizontal low-level wind shears. Detecting and predicting these hazards is a major concern for aircraft security. A measurement campaign took place over the Nice airport in 2009 including 4 anemometers, 1 wind lidar and 1 wind profiler. Two wind shear events were observed during this measurement campaign. Numerical simulations were carried out with Meso-NH in a configuration compatible with near-real time applications to determine the ability of the numerical model to predict these events and to study the meteorological situations generating a horizontal wind shear. A comparison between numerical simulation and the observation dataset is conducted in this paper.

Western municipal water conservation policy: The case of disaggregated demand

NASA Astrophysics Data System (ADS)

Burness, Stuart; Chermak, Janie; Krause, Kate

2005-03-01

We investigate aspects of the felicity of both incentive-based and command and control policies in effecting municipal water conservation goals. When demand can be disaggregated according to uses or users, our results suggest that policy efforts be focused on the submarket wherein demand is more elastic. Under plausible consumer parameters, a household production function approach to water utilization prescribes the nature of demand elasticities in alternative uses and squares nicely with empirical results from the literature. An empirical example illustrates. Overall, given data and other informational limitations, extant institutional structures, and in situ technology, our analysis suggests a predisposition for command and control policies over incentive-based tools.

Being "Nice" or Being "Normal": Girls Resisting Discourses of "Coolness"

ERIC Educational Resources Information Center

Paechter, Carrie; Clark, Sheryl

2016-01-01

In this paper we consider discourses of friendship and belonging mobilised by girls who are not part of the dominant "cool" group in one English primary school. We explore how, by investing in alternative and, at times, resistant, discourses of "being nice" and "being normal" these "non-cool" girls were able…

Risk Reduction and Training using Simulation Based Tools - 12180

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

Hall, Irin P.

2012-07-01

Process Modeling and Simulation (M and S) has been used for many years in manufacturing and similar domains, as part of an industrial engineer's tool box. Traditionally, however, this technique has been employed in small, isolated projects where models were created from scratch, often making it time and cost prohibitive. Newport News Shipbuilding (NNS) has recognized the value of this predictive technique and what it offers in terms of risk reduction, cost avoidance and on-schedule performance of highly complex work. To facilitate implementation, NNS has been maturing a process and the software to rapidly deploy and reuse M and Smore » based decision support tools in a variety of environments. Some examples of successful applications by NNS of this technique in the nuclear domain are a reactor refueling simulation based tool, a fuel handling facility simulation based tool and a tool for dynamic radiation exposure tracking. The next generation of M and S applications include expanding simulation based tools into immersive and interactive training. The applications discussed here take a tool box approach to creating simulation based decision support tools for maximum utility and return on investment. This approach involves creating a collection of simulation tools that can be used individually or integrated together for a larger application. The refueling simulation integrates with the fuel handling facility simulation to understand every aspect and dependency of the fuel handling evolutions. This approach translates nicely to other complex domains where real system experimentation is not feasible, such as nuclear fuel lifecycle and waste management. Similar concepts can also be applied to different types of simulation techniques. For example, a process simulation of liquid waste operations may be useful to streamline and plan operations, while a chemical model of the liquid waste composition is an important tool for making decisions with respect to waste disposition. Integrating these tools into a larger virtual system provides a tool for making larger strategic decisions. The key to integrating and creating these virtual environments is the software and the process used to build them. Although important steps in the direction of using simulation based tools for nuclear domain, the applications described here represent only a small cross section of possible benefits. The next generation of applications will, likely, focus on situational awareness and adaptive planning. Situational awareness refers to the ability to visualize in real time the state of operations. Some useful tools in this area are Geographic Information Systems (GIS), which help monitor and analyze geographically referenced information. Combined with such situational awareness capability, simulation tools can serve as the platform for adaptive planning tools. These are the tools that allow the decision maker to react to the changing environment in real time by synthesizing massive amounts of data into easily understood information. For the nuclear domains, this may mean creation of Virtual Nuclear Systems, from Virtual Waste Processing Plants to Virtual Nuclear Reactors. (authors)« less

Quality of data collected for severity of illness scores in the Dutch National Intensive Care Evaluation (NICE) registry.

PubMed

Arts, Daniëlle; de Keizer, Nicolette; Scheffer, Gert-Jan; de Jonge, Evert

2002-05-01

To analyse the quality of data used to measure severity of illness in the Dutch National Intensive Care Evaluation (NICE) registry, after implementation of quality improving procedures. Data were re-abstracted from the paper records of patients or the Patient Data Management System and compared to the data contained in the registry. The re-abstracted data were considered to be the gold standard. ICUs of nine Dutch hospitals that had been collecting data for the NICE registry for at least 1 year. The mean percentages of inaccurate and incomplete data, per hospital, over all variables, were 6.1%+/-4.4 (SD) and 2.7%+/-4.4 (SD), respectively. The mean difference in severity of illness scores between registry data and re-abstracted data was 0.2 points for APACHE II and 0.4 points for SAPS II. The mean difference in predicted mortality according to APACHE II and SAPS II between registry data and re-abstracted data was 0.4% and 0.02%, respectively. The current data quality of the NICE registry is good and justifies evaluative research. These positive results might be explained by the implementation of several quality assurance procedures in the NICE registry, such as training and automatic data checks. Electronic supplementary material to this paper can be obtained by using the Springer LINK server located at http://dx.doi.org/10.1007/s00134-002-1272-z

DECISION-COMPONENTS OF NICE'S TECHNOLOGY APPRAISALS ASSESSMENT FRAMEWORK.

PubMed

de Folter, Joost; Trusheim, Mark; Jonsson, Pall; Garner, Sarah

2018-01-01

Value assessment frameworks have gained prominence recently in the context of U.S. healthcare. Such frameworks set out a series of factors that are considered in funding decisions. The UK's National Institute of Health and Care Excellence (NICE) is an established health technology assessment (HTA) agency. We present a novel application of text analysis that characterizes NICE's Technology Appraisals in the context of the newer assessment frameworks and present the results in a visual way. A total of 243 documents of NICE's medicines guidance from 2007 to 2016 were analyzed. Text analysis was used to identify a hierarchical set of decision factors considered in the assessments. The frequency of decision factors stated in the documents was determined and their association with terms related to uncertainty. The results were incorporated into visual representations of hierarchical factors. We identified 125 decision factors, and hierarchically grouped these into eight domains: Clinical Effectiveness, Cost Effectiveness, Condition, Current Practice, Clinical Need, New Treatment, Studies, and Other Factors. Textual analysis showed all domains appeared consistently in the guidance documents. Many factors were commonly associated with terms relating to uncertainty. A series of visual representations was created. This study reveals the complexity and consistency of NICE's decision-making processes and demonstrates that cost effectiveness is not the only decision-criteria. The study highlights the importance of processes and methodology that can take both quantitative and qualitative information into account. Visualizations can help effectively communicate this complex information during the decision-making process and subsequently to stakeholders.

In Vitro Assessment of the Antimicrobial Efficacy of Optimized Nitroglycerin-Citrate-Ethanol as a Nonantibiotic, Antimicrobial Catheter Lock Solution for Prevention of Central Line-Associated Bloodstream Infections

PubMed Central

Reitzel, Ruth A.; Hirsh-Ginsberg, Cheryl; Murray, Kimberly; Chaftari, Anne-Marie; Hachem, Ray; Raad, Issam

2016-01-01

The rapid, broad-spectrum, biofilm-eradicating activity of the combination of 0.01% nitroglycerin, 7% citrate, and 20% ethanol and its potential as a nonantibiotic, antimicrobial catheter lock solution (ACLS) were previously reported. Here, a nitroglycerin-citrate-ethanol (NiCE) ACLS optimized for clinical assessment was developed by reducing the nitroglycerin and citrate concentrations and increasing the ethanol concentration. Biofilm-eradicating activity was sustained when the ethanol concentration was increased from 20 to 22% which fully compensated for reducing the citrate concentration from 7% to 4% as well as the nitroglycerin concentration from 0.01% to 0.0015% or 0.003%. The optimized formulations demonstrated complete and rapid (2 h) eradication of methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-intermediate Staphylococcus aureus (VISA), methicillin-resistant Staphylococcus epidermidis (MRSE), vancomycin-resistant enterococci (VRE), multidrug-resistant (MDR) Pseudomonas aeruginosa, MDR Klebsiella pneumoniae, MDR Enterobacter cloacae, MDR Acinetobacter baumannii, MDR Escherichia coli, MDR Stenotrophomonas maltophilia, Candida albicans, and Candida glabrata biofilms. The optimized NiCE lock solutions demonstrated anticoagulant activities comparable to those of heparin lock solutions. NiCE lock solution was significantly more effective than taurolidine-citrate-heparin lock solution in eradicating biofilms of Staphylococcus aureus and Candida glabrata. The optimized, nonantibiotic, heparin-free NiCE lock solution demonstrates rapid broad-spectrum biofilm eradication as well as effective anticoagulant activity, making NiCE a high-quality ACLS candidate for clinical assessment. PMID:27297475

National Cycle Program (NCP) Common Analysis Tool for Aeropropulsion

NASA Technical Reports Server (NTRS)

Follen, G.; Naiman, C.; Evans, A.

1999-01-01

Through the NASA/Industry Cooperative Effort (NICE) agreement, NASA Lewis and industry partners are developing a new engine simulation, called the National Cycle Program (NCP), which is the initial framework of NPSS. NCP is the first phase toward achieving the goal of NPSS. This new software supports the aerothermodynamic system simulation process for the full life cycle of an engine. The National Cycle Program (NCP) was written following the Object Oriented Paradigm (C++, CORBA). The software development process used was also based on the Object Oriented paradigm. Software reviews, configuration management, test plans, requirements, design were all apart of the process used in developing NCP. Due to the many contributors to NCP, the stated software process was mandatory for building a common tool intended for use by so many organizations. The U.S. aircraft and airframe companies recognize NCP as the future industry standard for propulsion system modeling.

Cost-effectiveness modeling for neuropathic pain treatments: investigating the relative importance of parameters using an open-source model.

PubMed

Hirst, Matthew; Bending, Matthew W; Baio, Gianluca; Yesufu-Udechuku, Amina; Dunlop, William C N

2018-06-08

The study objective was to develop an open-source replicate of a cost-effectiveness model developed by National Institute for Health and Care (NICE) in order to explore uncertainties in health economic modeling of novel pharmacological neuropathic pain treatments. The NICE model, consisting of a decision tree with branches for discrete levels of pain relief and adverse event (AE) severities, was replicated using R and used to compare a hypothetical neuropathic pain drug to pregabalin. Model parameters were sourced from NICE's clinical guidelines and associated with probability distributions to account for underlying uncertainty. A simulation-based scenario analysis was conducted to assess how uncertainty in efficacy and AEs affected the net monetary benefit (NMB) for the hypothetical treatment at a cost-effectiveness threshold of £20,000 per QALY. Relative to pregabalin, an increase in efficacy was associated with greater NMB than an improvement in tolerability. A greater NMB was observed when efficacy was marginally higher than that of pregabalin while maintaining the same level of AEs than when efficacy was equivalent to pregabalin but with a more substantial reduction in AEs. In the latter scenario, the NMB was only positive at a low cost-effectiveness threshold. The replicate model shares the limitations described in the NICE guidelines. There is a lack of support in scientific literature for the assumption that increased efficacy is associated with a greater reduction in tolerability. The replicate model also included a single comparator, unlike the NICE model. Pain relief is a stronger driver of NMB than tolerability at a cost-effectiveness threshold of £20,000 per QALY. Health technology assessment decisions which are influenced by NICE's model may reward efficacy gains even if they are associated with more severe AEs. This contrasts with recommendations from clinical guidelines for neuropathic pain which place more equal weighting on improvements in efficacy and tolerability as value drivers.

The U.K. NICE 2014 Guidelines for Osteoarthritis of the Knee: Lessons Learned in a Narrative Review Addressing Inadvertent Limitations and Bias.

PubMed

Birch, Stephen; Lee, Myeong Soo; Robinson, Nicola; Alraek, Terje

2017-04-01

Several systematic reviews suggest that acupuncture is effective for knee osteoarthritis (OA), and furthermore a safe and cost-effective treatment for this condition. A recent clinical practice guideline (CPG) from the National Institute for Health and Care Excellence (NICE), in the United Kingdom, recommended against the use of acupuncture on the grounds that the effect size (ES) in comparison with sham acupuncture is too small. Safety data were not considered in the review, in addition the levels of evidence for acupuncture against other recommended therapies were not compared. Consequently, it is argued that this NICE guideline has limitations that lead to several potential biases in its evaluation of acupuncture, which were not addressed correctly: (1) NICE's prior scoping process limited its review. (2) NICE introduced the method of developing recommendations based on the consideration of which interventions make "minimal important differences" of an ES of 0.5 or greater, rather than the statistical significance of the effect of an intervention when compared with an appropriate comparison. (3) Evidence that sham acupuncture is not physiologically inert and has some level of beneficial effect, hence artificially reducing the magnitude of the ES in comparison with sham. (4) The low adverse effects profile of acupuncture. (5) Evidence from trials comparing acupuncture with usual or standard care was not considered, nor was cost-effectiveness data. (6) Lack of the usual CPG "head-to-head" comparisons between interventions. If the same criteria and methods that have been applied to acupuncture were applied to other NICE-recommended therapies for knee OA, including patient centeredness, patient education, self-management and weight loss, nonsteroidal anti-inflammatory drug (NSAIDs), and cyclooxygenase-2 inhibitor (COX-2 inhibitors), these too would no longer be recommended and opiates would become the first line of drug prescription. Given the problems with sham acupuncture, perhaps now is the time to embrace pragmatic studies and employ comparative effectiveness studies instead.

Techniques in Organic Chemistry: Miniscale, Standard Taper Microscale, and Williamson Microscale (Jerry R. Mohrig, Christina Noring Hammond, Paul F. Schatz, and Terence C. Morrill)

NASA Astrophysics Data System (ADS)

Pagni, Richard M.

2003-04-01

I am uncertain exactly how this experiment-free book is supposed to be used. I can suggest a few possibilities, however. It could be used as a primary text if the experiments are presented separately, perhaps to an honors class. It could supplement the authors’ more traditional lab manual or any other lab manual. It could also serve as an instructional manual for inexperienced, and often insecure, students, helping them get confidence and skill in carrying out the myriad activities in the organic laboratory. I will use this very nice book as a reference the next time I teach the laboratory course.

Application developer's tutorial for the CSM testbed architecture

NASA Technical Reports Server (NTRS)

Underwood, Phillip; Felippa, Carlos A.

1988-01-01

This tutorial serves as an illustration of the use of the programmer interface on the CSM Testbed Architecture (NICE). It presents a complete, but simple, introduction to using both the GAL-DBM (Global Access Library-Database Manager) and CLIP (Command Language Interface Program) to write a NICE processor. Familiarity with the CSM Testbed architecture is required.

When Nice Won't Suffice: Honest Discourse Is Key to Shifting School Culture

ERIC Educational Resources Information Center

MacDonald, Elisa

2011-01-01

The "culture of nice" is the underlying culture that inhibits a team of teachers from reaching a level of rigorous collaborative discourse where teachers are challenging each other's and their own thinking, beliefs, assumptions, and practice. This article discusses how honest discourse can be the key to shifting school culture. The act of…

Nice to Your Heart: A Pilot Community-Based Intervention to Improve Heart Health Behaviours in Urban Residents

ERIC Educational Resources Information Center

Carter, Stephanie R.; Walker, Alia; Abdul-Latif, Safiyah; Maurer, Laurie; Masunungure, Daniel; Tedaldi, Ellen; Patterson, Freda

2016-01-01

Objective: Efforts to improve cardiovascular health among adult African American populations, particularly through organised physical activity, have met with limited success. This study pilot-tested a novel soul line dancing and nutrition education programme ("Nice to Your Heart") that was designed and implemented as part of an academic…

Generating Nice Linear Systems for Matrix Gaussian Elimination

ERIC Educational Resources Information Center

Homewood, L. James

2004-01-01

In this article an augmented matrix that represents a system of linear equations is called nice if a sequence of elementary row operations that reduces the matrix to row-echelon form, through matrix Gaussian elimination, does so by restricting all entries to integers in every step. Many instructors wish to use the example of matrix Gaussian…

Collaboration Promotes Proportional Reasoning about Resource Distribution in Young Children

ERIC Educational Resources Information Center

Ng, Rowena; Heyman, Gail D.; Barner, David

2011-01-01

The authors investigated how children and adults evaluate the "niceness" of individuals who engage in resource distribution, with a focus on their sensitivity to the proportion of resources given. Across 3 experiments, subjects evaluated the niceness of a child who gave a quantity of pennies to another child. In Study 1 (N = 30), adults showed…

Children's behaviour problems: a NICE mess.

PubMed

Timimi, S

2014-09-01

The potential harms of medicalisation are well known. A good illustration comes from the medicalisation of children's behaviour problems. National Institute for health and Clinical Excellence (NICE) guidelines on conditions such as Attention Deficit Hyperactivity Disorder (ADHD), Autistic Spectrum Disorder (ASD) and Conduct Disorder (CD) reflect how attempts to regulate medical practice in this area has spawned guidelines based more on wish fulfilment (that getting kids to behave themselves can be accomplished by simple technological interventions that exist independent of context) than scientific evidence. In this perspective piece, I explain why these NICE guidelines are more a reflection of cultural confusion about how to deal with children, than the outcome of sound scientific understanding in this area. © 2014 John Wiley & Sons Ltd.

The Type and Impact of Evidence Review Group Exploratory Analyses in the NICE Single Technology Appraisal Process.

PubMed

Carroll, Christopher; Kaltenthaler, Eva; Hill-McManus, Daniel; Scope, Alison; Holmes, Michael; Rice, Stephen; Rose, Micah; Tappenden, Paul; Woolacott, Nerys

2017-06-01

As part of the UK National Institute for Health and Care Excellence (NICE) single technology appraisal process, independent evidence review groups (ERGs) critically appraise a company's submission relating to a specific technology and indication. To explore the type of additional exploratory analyses conducted by ERGs and their impact on the recommendations made by NICE. The 100 most recently completed single technology appraisals with published guidance were selected for inclusion. A content analysis of relevant documents was undertaken to identify and extract relevant data, and narrative synthesis was used to rationalize and present these data. The types of exploratory analysis conducted in relation to companies' models were fixing errors, addressing violations, addressing matters of judgment, and the provision of a new, ERG-preferred base case. Ninety-three of the 100 ERG reports contained at least one of these analyses. The most frequently reported type of analysis in these 93 ERG reports related to the category "Matters of judgment," which was reported in 83 reports (89%). At least one of the exploratory analyses conducted and reported by an ERG is mentioned in 97% of NICE appraisal consultation documents and 94% of NICE final appraisal determinations, and had a clear influence on recommendations in 72% of appraisal consultation documents and 47% of final appraisal determinations. These results suggest that the additional analyses undertaken by ERGs in the appraisal of company submissions are highly influential in the policy-making and decision-making process. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Opening the black box: a study of the process of NICE guidelines implementation.

PubMed

Spyridonidis, Dimitrios; Calnan, Michael

2011-10-01

This study informs 'evidence-based' implementation by using an innovative methodology to provide further understanding of the implementation process in the English NHS using two distinctly different NICE clinical guidelines as exemplars. The implementation process was tracked retrospectively and prospectively using a comparative case-study and longitudinal design. 74 unstructured interviews were carried out with 48 key informants (managers and clinicians) between 2007 and 2009. This study has shown that the NICE guidelines implementation process has both planned and emergent components, which was well illustrated by the use of the prospective longitudinal design in this study. The implementation process might be characterised as strategic and planned to begin with but became uncontrolled and subject to negotiation as it moved from the planning phase to adoption in everyday practice. The variations in the implementation process could be best accounted for in terms of differences in the structure and nature of the local organisational context. The latter pointed to the importance of managers as well as clinicians in decision-making about implementation. While national priorities determine the context for implementation the shape of the process is influenced by the interactions between doctors and managers, which influence the way they respond to external policy initiatives such as NICE guidelines. NICE and other national health policy-makers need to recognise that the introduction of planned change 'initiatives' in clinical practice are subject to social and political influences at the micro level as well as the macro level. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

What is the actual cost of providing the intrauterine system for contraception in a UK community sexual and reproductive health setting?

PubMed

Cook, Louise; Fleming, Charlotte

2014-01-01

The anticipated increase in uptake of intrauterine system (IUS) fittings is slower than predicted by the National Institute for Health and Clinical Excellence (NICE). There is evidence to suggest that this is because of a high perceived cost of providing this contraceptive method. Whereas studies to date have all guessed at these costs, we calculated the actual costs of providing the IUS. We tracked the notes of 283 women who had an IUS fitted in our community sexual and reproductive health service for 5 years. We recorded duration of use, measured the actual cost of all appointments and interventions over the lifespan of the device, and compared our findings with NICE predicted costs. With 70% complete follow-up, the average duration of use of the IUS was 3.44 years compared to NICE's prediction of 3.32. The average annual cost of providing an IUS for contraception in community clinics was £54.55 per woman; this compares with £70.49 modelled by NICE for provision in primary care. Most (80%) of the cost is incurred in the first year. The cost of managing problems is small. Providing the IUS for contraception was 23% cheaper in the present study than that predicted by NICE and cheaper than providing combined oral contraception in our service. Fitting IUSs in community clinics may be cheaper than in primary care. Streamlining the patient pathway will reduce costs further. Restricting access to the IUS because of initial cost is a false economy.

What's the evidence that NICE guidance has been implemented? Results from a national evaluation using time series analysis, audit of patients' notes, and interviews.

PubMed

Sheldon, Trevor A; Cullum, Nicky; Dawson, Diane; Lankshear, Annette; Lowson, Karin; Watt, Ian; West, Peter; Wright, Dianne; Wright, John

2004-10-30

To assess the extent and pattern of implementation of guidance issued by the National Institute for Clinical Excellence (NICE). Interrupted time series analysis, review of case notes, survey, and interviews. Acute and primary care trusts in England and Wales. All primary care prescribing, hospital pharmacies; a random sample of 20 acute trusts, 17 mental health trusts, and 21 primary care trusts; and senior clinicians and managers from five acute trusts. Rates of prescribing and use of procedures and medical devices relative to evidence based guidance. 6308 usable patient audit forms were returned. Implementation of NICE guidance varied by trust and by topic. Prescribing of some taxanes for cancer (P < 0.002) and orlistat for obesity (P < 0.001) significantly increased in line with guidance. Prescribing of drugs for Alzheimer's disease and prophylactic extraction of wisdom teeth showed trends consistent with, but not obviously a consequence of, the guidance. Prescribing practice often did not accord with the details of the guidance. No change was apparent in the use of hearing aids, hip prostheses, implantable cardioverter defibrillators, laparoscopic hernia repair, and laparoscopic colorectal cancer surgery after NICE guidance had been issued. Implementation of NICE guidance has been variable. Guidance seems more likely to be adopted when there is strong professional support, a stable and convincing evidence base, and no increased or unfunded costs, in organisations that have established good systems for tracking guidance implementation and where the professionals involved are not isolated. Guidance needs to be clear and reflect the clinical context.

In Vitro Assessment of the Antimicrobial Efficacy of Optimized Nitroglycerin-Citrate-Ethanol as a Nonantibiotic, Antimicrobial Catheter Lock Solution for Prevention of Central Line-Associated Bloodstream Infections.

PubMed

Reitzel, Ruth A; Rosenblatt, Joel; Hirsh-Ginsberg, Cheryl; Murray, Kimberly; Chaftari, Anne-Marie; Hachem, Ray; Raad, Issam

2016-09-01

The rapid, broad-spectrum, biofilm-eradicating activity of the combination of 0.01% nitroglycerin, 7% citrate, and 20% ethanol and its potential as a nonantibiotic, antimicrobial catheter lock solution (ACLS) were previously reported. Here, a nitroglycerin-citrate-ethanol (NiCE) ACLS optimized for clinical assessment was developed by reducing the nitroglycerin and citrate concentrations and increasing the ethanol concentration. Biofilm-eradicating activity was sustained when the ethanol concentration was increased from 20 to 22% which fully compensated for reducing the citrate concentration from 7% to 4% as well as the nitroglycerin concentration from 0.01% to 0.0015% or 0.003%. The optimized formulations demonstrated complete and rapid (2 h) eradication of methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-intermediate Staphylococcus aureus (VISA), methicillin-resistant Staphylococcus epidermidis (MRSE), vancomycin-resistant enterococci (VRE), multidrug-resistant (MDR) Pseudomonas aeruginosa, MDR Klebsiella pneumoniae, MDR Enterobacter cloacae, MDR Acinetobacter baumannii, MDR Escherichia coli, MDR Stenotrophomonas maltophilia, Candida albicans, and Candida glabrata biofilms. The optimized NiCE lock solutions demonstrated anticoagulant activities comparable to those of heparin lock solutions. NiCE lock solution was significantly more effective than taurolidine-citrate-heparin lock solution in eradicating biofilms of Staphylococcus aureus and Candida glabrata The optimized, nonantibiotic, heparin-free NiCE lock solution demonstrates rapid broad-spectrum biofilm eradication as well as effective anticoagulant activity, making NiCE a high-quality ACLS candidate for clinical assessment. Copyright © 2016, American Society for Microbiology. All Rights Reserved.

Managing conflicts of interest in the UK National Institute for Health and Care Excellence (NICE) clinical guidelines programme: qualitative study.

PubMed

Graham, Tanya; Alderson, Phil; Stokes, Tim

2015-01-01

There is international concern that conflicts of interest (COI) may bias clinical guideline development and render it untrustworthy. Guideline COI policies exist with the aim of reducing this bias but it is not known how such policies are interpreted and used by guideline producing organisations. This study sought to determine how conflicts of interest (COIs) are disclosed and managed by a national clinical guideline developer (NICE: the UK National Institute for Health and Care Excellence). Qualitative study using semi-structured telephone interviews with 14 key informants: 8 senior staff of NICE's guideline development centres and 6 chairs of guideline development groups (GDGs). We conducted a thematic analysis. Participants regard the NICE COI policy as comprehensive leading to transparent and independent guidance. The application of the NICE COI policy is, however, not straightforward and clarity could be improved. Disclosure of COI relies on self reporting and guideline developers have to take "on trust" the information they receive, certain types of COI (non-financial) are difficult to categorise and manage and disclosed COI can impact on the ability to recruit clinical experts to GDGs. Participants considered it both disruptive and stressful to exclude members from GDG meetings when required by the COI policy. Nonetheless the impact of this disruption can be minimised with good group chairing skills. We consider that the successful implementation of a COI policy in clinical guideline development requires clear policies and procedures, appropriate training of GDG chairs and an evaluation of how the policy is used in practice.

Deep brain stimulation: a return journey from psychiatry to neurology.

PubMed

Ashkan, Keyoumars; Shotbolt, Paul; David, Anthony S; Samuel, Michael

2013-06-01

Deep brain stimulation (DBS) has emerged as an effective neurosurgical tool to treat a range of conditions. Its use in movement disorders such as Parkinson's disease, tremor and dystonia is now well established and has been approved by the National Institute of Clinical Excellence (NICE). The NICE does, however, emphasise the need for a multidisciplinary team to manage these patients. Such a team is traditionally composed of neurologists, neurosurgeons and neuropsychologists. Neuropsychiatrists, however, are increasingly recognised as essential members given many psychiatric considerations that may arise in patients undergoing DBS. Patient selection, assessment of competence to consent and treatment of postoperative psychiatric disease are just a few areas where neuropsychiatric input is invaluable. Partly driven by this close team working and partly based on the early history of DBS for psychiatric disorders, there is increasing interest in re-exploring the potential of neurosurgery to treat patients with psychiatric disease, such as depression and obsessive-compulsive disorder. Although the clinical experience and evidence with DBS in this group of patients are steadily increasing, many questions remain unanswered. Yet, the characteristics of optimal surgical candidates, the best choice of DBS target, the most effective stimulating parameters and the extent of postoperative improvement are not clear for most psychiatric conditions. Further research is therefore required to define how DBS can be best utilised to improve the quality of life of patients with psychiatric disease.

A Mw 6.3 earthquake scenario in the city of Nice (southeast France): ground motion simulations

NASA Astrophysics Data System (ADS)

Salichon, Jérome; Kohrs-Sansorny, Carine; Bertrand, Etienne; Courboulex, Françoise

2010-07-01

The southern Alps-Ligurian basin junction is one of the most seismically active zone of the western Europe. A constant microseismicity and moderate size events (3.5 < M < 5) are regularly recorded. The last reported historical event took place in February 1887 and reached an estimated magnitude between 6 and 6.5, causing human losses and extensive damages (intensity X, Medvedev-Sponheuer-Karnik). Such an event, occurring nowadays, could have critical consequences given the high density of population living on the French and Italian Riviera. We study the case of an offshore Mw 6.3 earthquake located at the place where two moderate size events (Mw 4.5) occurred recently and where a morphotectonic feature has been detected by a bathymetric survey. We used a stochastic empirical Green’s functions (EGFs) summation method to produce a population of realistic accelerograms on rock and soil sites in the city of Nice. The ground motion simulations are calibrated on a rock site with a set of ground motion prediction equations (GMPEs) in order to estimate a reasonable stress-drop ratio between the February 25th, 2001, Mw 4.5, event taken as an EGF and the target earthquake. Our results show that the combination of the GMPEs and EGF techniques is an interesting tool for site-specific strong ground motion estimation.

The Role of Nice and Nasty Theory of Mind in Teacher-Selected Peer Models for Adolescents with Autism Spectrum Disorders

ERIC Educational Resources Information Center

Laghi, Fiorenzo; Lonigro, Antonia; Levanto, Simona; Ferraro, Maurizio; Baumgartner, Emma; Baiocco, Roberto

2016-01-01

The study aimed at verifying if nice and nasty theory of mind behaviors, in association with teachers' peer buddy nomination, could be used to correctly select peer models for adolescents with autism spectrum disorder. Mentalizing abilities and emotional and behavioral characteristics of 601 adolescents were assessed. Results suggest that teachers…

Graduate Students Rate Institutional Websites: The Must Have, Nice to Have, and Delighted to Have Services

ERIC Educational Resources Information Center

Meyer, Katrina A.; Jones, Stephanie J.

2012-01-01

The graduate students admitted to the online and blended programs in higher education at Texas Tech University and the University of Memphis were surveyed about their respective university websites, or the institution's "virtual face." A total of 42 students rated 30 web-based services as "must have," "nice to have," "delighted to have (but not…

Compliance with NICE guidance on the use of anti-TNFalpha agents in ankylosing spondylitis: an east and west Midlands regional audit.

PubMed

Rees, Frances; Peffers, Gillian; Bell, Carolyn; Obrenovic, Karen; Sandhu, Ravinder; Packham, Jonathan; Erb, Nicola

2012-08-01

Here we report on an audit performed to examine compliance with National Institute for Health and Clinical Excellence (NICE) guidelines for the use of anti-tumour necrosis factor alpha (anti-TNFalpha) in treating patients with ankylosing spondylitis (AS). Data from 17 rheumatology centres across the Midlands were collected prospectively from patients with AS attending outpatient clinics and retrospectively in patients receiving anti-TNFalpha but not attending outpatient clinics during the audit. In total, 80% of the 416 patients for whom data were collected were male. Of the 238 patients recruited prospectively, 41% were receiving anti-TNFalpha. Reviewing all patients on anti-TNFalpha (N=275), pre-treatment assessments 12 weeks apart were documented in 55% of patients. After anti-TNFalpha treatment had started, regular 12-weekly assessments occurred in 46% of patients. Therefore, compliance with NICE guidance was found to vary among centres. Based on our audit, clinical capacity, and clinical or patient choice might be influencing the suboptimal adherence seen in assessment timing suggested by NICE guidelines relating to the use of anti-TNFalpha in treating patients with AS.

Substructure analysis using NICE/SPAR and applications of force to linear and nonlinear structures. [spacecraft masts

NASA Technical Reports Server (NTRS)

Razzaq, Zia; Prasad, Venkatesh; Darbhamulla, Siva Prasad; Bhati, Ravinder; Lin, Cai

1987-01-01

Parallel computing studies are presented for a variety of structural analysis problems. Included are the substructure planar analysis of rectangular panels with and without a hole, the static analysis of space mast, using NICE/SPAR and FORCE, and substructure analysis of plane rigid-jointed frames using FORCE. The computations are carried out on the Flex/32 MultiComputer using one to eighteen processors. The NICE/SPAR runstream samples are documented for the panel problem. For the substructure analysis of plane frames, a computer program is developed to demonstrate the effectiveness of a substructuring technique when FORCE is enforced. Ongoing research activities for an elasto-plastic stability analysis problem using FORCE, and stability analysis of the focus problem using NICE/SPAR are briefly summarized. Speedup curves for the panel, the mast, and the frame problems provide a basic understanding of the effectiveness of parallel computing procedures utilized or developed, within the domain of the parameters considered. Although the speedup curves obtained exhibit various levels of computational efficiency, they clearly demonstrate the excellent promise which parallel computing holds for the structural analysis problem. Source code is given for the elasto-plastic stability problem and the FORCE program.

The EBI SRS server-new features.

PubMed

Zdobnov, Evgeny M; Lopez, Rodrigo; Apweiler, Rolf; Etzold, Thure

2002-08-01

Here we report on recent developments at the EBI SRS server (http://srs.ebi.ac.uk). SRS has become an integration system for both data retrieval and sequence analysis applications. The EBI SRS server is a primary gateway to major databases in the field of molecular biology produced and supported at EBI as well as European public access point to the MEDLINE database provided by US National Library of Medicine (NLM). It is a reference server for latest developments in data and application integration. The new additions include: concept of virtual databases, integration of XML databases like the Integrated Resource of Protein Domains and Functional Sites (InterPro), Gene Ontology (GO), MEDLINE, Metabolic pathways, etc., user friendly data representation in 'Nice views', SRSQuickSearch bookmarklets. SRS6 is a licensed product of LION Bioscience AG freely available for academics. The EBI SRS server (http://srs.ebi.ac.uk) is a free central resource for molecular biology data as well as a reference server for the latest developments in data integration.

Design and Research of the Sewage Treatment Control System

NASA Astrophysics Data System (ADS)

Chu, J.; Hu, W. W.

Due to the rapid development of China's economy, the water pollution has become a problem that we have to face. In particular, how to deal with industrial wastewater has become a top priority. In wastewater treatment, the control system based on PLC has met the design requirement in real-time, reliability, precision and so on. The integration of sequence control and process control in PLC, has the characteristics of high reliability, simple network, convenient and flexible use. PLC is a powerful tool for small and medium-sized industrial automation. Therefore, the sewage treatment control system take PLC as the core of control system, can nicely solve the problem of industrial wastewater in a certain extent.

[The acceptability of the NICE recommendations for schizophrenia in the Italian Departments of Mental Health. The SIEP-DIRECT'S Project on the discrepancy between routine practice and evidence].

PubMed

Semisa, Domenico; Lasalvia, Antonio; Miceli, Maurizio; Dall'Agnola, Rosa Bruna; Pucci, Cristina; Bissoli, Sarah; Visani, Enrico; Pismataro, Carmine Pasquale; Vanetti, Michele; Pioli, Rosaria; Ruggeri, Mirella; Lora, Antonio

2008-01-01

This paper aims at presenting the most significant results emerging from the work carried out by the focus groups of the multi-centre Project SIEP-DIRECT'S. The Project is aimed at assessing the existing discrepancies between the evidence-based NICE guidelines for schizophrenia and the usual practices of care given by Italian mental health services. Each focus group was requested to give an evaluation on: (a) appropriateness of the English NICE guidelines in the context of the Italian mental health services; (b) clarity and usefulness of the 103 indicators developed on the basis of the NICE recommendations to measure their level of application within the services. In each of the 19 mental health departments or psychiatric services participating in the Project there were organized "multidisciplinary" focus groups and "specialistic" focus groups. The former included, amongst others, professional operators of the mental health services, patients, their relatives, representatives of patient organizations and general practitioners. They examined the recommendations and indicators upon which the participants could express their opinion or judgment based on their knowledge, experience or information in their possession. The latter group, composed only of psychiatrists, examined the recommendations and indicators relative to pharmacological treatments that regarded the specific competences of their professional category. Most NICE recommendations seemed appropriate to the working context of the Italian services. However, some perplexity emerged as regards specific organizational models of the services, such as the specific services for psychotic onsets or the assertive outreach teams, which were believed not to be strictly pertinent to the traditional organization of mental health care in our Country. There were also some criticisms regarding the cognitive-behavioural treatments which the NICE Guidelines recommend as the principle psychotherapeutic option for patients with schizophrenia, since in many Italian services, when the use of psychological interventions are needed, the tendency is to prefer interventions based on psychodynamic theories. The SIEP indicators were generally held to be clear and acceptable. In the view of the focus groups, the NICE guidelines are on the whole useful and suitable for orientating the services in the choice of more efficacious practices in the treatment of patients with schizophrenia. Moreover, the results obtained legitimate the use of the set of SIEP indicators for the evaluation of good practices and the quality of care offered by Italian services. Finally, the use of focus groups delines to a different context as well as the verification of the comprehensibility and applicability of SIEP indicators.

NICE recommendations for psychotherapy in depression: Of limited clinical utility.

PubMed

McQueen, D; Smith, P St John

2015-01-01

In 2009/10 NICE partially updated its guidelines on the treatment and management of depression in adults. Due to methodological shortcomings the recommendations for psychotherapy must be treated with caution. Despite recognising the heterogeneous and comorbid nature of depression, and the limitations of depression as a unitary diagnostic category, NICE treats depression as if it were a unitary entity differentiated only by severity. The guidance ignores important aetiological factors such as trauma, loss and maltreatment, personality and interpersonal difficulties. It excludes the largest naturalistic studies on clinical populations treated in the National Health Service on the grounds that they are observational studies conducted in heterogeneous groups with mixed neurotic disorders. It unquestioningly accepts that the "brand" of psychotherapy has construct validity, and ignores psychotherapy process research indicating significant commonalities, and overlap, between treatment modalities and evidence that individual practitioner effects are larger than the differences between treatment modalities. It fails to consider patient differences and preferences, which are known to influence uptake, completion and response. It takes an exclusively short-term perspective on a chronic relapsing disorder. It does not consider the evidence for longer-term treatments. It is of special concern that NICE misrepresents the findings of its own systematic review by implying that CBT and IPT are superior treatments. NICE's systematic review actually found no evidence of superiority between CBT, IPT, psychodynamic psychotherapy, or counselling. Based on the exclusion of much clinically relevant research demonstrating the effectiveness of psychodynamic psychotherapy and counselling many commentators have alleged a bias towards CBT in the guidance. With regard to service delivery NICE proposes the replacement of psychiatric assessment and individualised treatment plans, with an unproven stepped-care model. These clinical and theoretical limitations, perceived bias in the selection of studies, neglect of patient differences, preferences and values, misrepresentation of results of the systematic review, and the proposal for an unproven service delivery model together seriously undermine the validity of the guidance. The guidance, lacking validity is of questionable use, it undermines patient autonomy, professional expertise and, ultimately, patient welfare.

A Diet Low in Fermentable Oligo-, Di-, and Monosaccharides and Polyols Improves Quality of Life and Reduces Activity Impairment in Patients With Irritable Bowel Syndrome and Diarrhea.

PubMed

Eswaran, Shanti; Chey, William D; Jackson, Kenya; Pillai, Sivaram; Chey, Samuel W; Han-Markey, Theresa

2017-12-01

We investigated the effects of a diet low in fermentable oligo-, di-, and monosaccharides and polyols (FODMAPs) vs traditional dietary recommendations on health-related quality of life (QOL), anxiety and depression, work productivity, and sleep quality in patients with irritable bowel syndrome and diarrhea (IBS-D). We conducted a prospective, single-center, single-blind trial of 92 adult patients with IBS-D (65 women; median age, 42.6 years) randomly assigned to groups placed on a diet low in FODMAPs or a modified diet recommended by the National Institute for Health and Care Excellence (mNICE) for 4 weeks. IBS-associated QOL (IBS-QOL), psychosocial distress (based on the Hospital Anxiety and Depression Scale), work productivity (based on the Work Productivity and Activity Impairment), and sleep quality were assessed before and after diet periods. Eighty-four patients completed the study (45 in the low-FODMAP group and 39 in the mNICE group). At 4 weeks, patients on the diet low in FODMAPs had a larger mean increase in IBS-QOL score than did patients on the mNICE diet (15.0 vs 5.0; 95% CI, -17.4 to -4.3). A significantly higher proportion of patients in the low-FODMAP diet group had a meaningful clinical response, based on IBS-QOL score, than in the mNICE group (52% vs 21%; 95% CI, -0.52 to -0.08). Anxiety scores decreased in the low-FODMAP diet group compared with the mNICE group (95% CI, 0.46-2.80). Activity impairment was significantly reduced with the low-FODMAP diet (-22.89) compared with the mNICE diet (-9.44; 95% CI, 2.72-24.20). In a randomized, controlled trial, a diet low in FODMAPs led to significantly greater improvements in health-related QOL, anxiety, and activity impairment compared with a diet based on traditional recommendations for patients with IBS-D. ClinicalTrials.gov, number NCT01624610. Copyright © 2017 AGA Institute. Published by Elsevier Inc. All rights reserved.

Mandatory implementation of NICE Guidelines for the care of bipolar disorder and other conditions in England and Wales.

PubMed

Morriss, Richard

2015-09-30

Bipolar disorder is a common long-term mental health condition characterised by episodes of mania or hypomania and depression resulting in disability, early death, and high health and society costs. Public money funds the National Institute of Healthcare and Clinical Excellence (NICE) to produce clinical guidelines by systematically identifying the most up to date research evidence and costing its main recommendations for healthcare organisations and professionals to follow in England and Wales. Most governments, including those of England and Wales, need to improve healthcare but at reduced cost. There is evidence, particularly in bipolar disorder, that systematically following clinical guidelines achieves these outcomes. NICE clinical guidelines, including those regarding bipolar disorder, remain variably implemented. They give clinicians and patients a non-prescriptive basis for deciding their care. Despite the passing of the Health and Social Care Act in 2012 in England requiring all healthcare organisations to consider NICE clinical guidelines in commissioning, delivering, and inspecting healthcare services, healthcare organisations in the National Health Service may ignore them with little accountability and few consequences. There is no mechanism to ensure that healthcare professionals know or consider them. Barriers to their implementation include the lack of political and professional leadership, the complexity of the organisation of care and policy, mistrust of some processes and recommendations of clinical guidelines, and a lack of a clear implementation model, strategy, responsibility, or accountability. Mitigation to these barriers is presented herein. The variability, safety, and quality of healthcare might be improved and its cost reduced if the implementation of NICE clinical guidelines, such as those for bipolar disorder, were made the minimum starting point for clinical decision-making and mandatory responsibilities of all healthcare organisations and professionals.

Antibiotic prophylaxis in dentistry: part II. A qualitative study of patient perspectives and understanding of the NICE guideline.

PubMed

Soheilipour, S; Scambler, S; Dickinson, C; Dunne, S M; Burke, M; Jabbarifar, S E; Newton, J T

2011-07-08

The National Institute for Health and Clinical Excellence (NICE) recommendations in 2008 for antibiotic prophylaxis before dental treatment contradict previous practice. There is a potential difficulty in explaining the new guidance to patients who have long believed that they must receive antibiotics before their dental treatment. This study investigated the patient-related barriers and facilitating factors in implementation of the NICE guidance. In-depth interviews were conducted with nine patients concerning their views about barriers and factors that could influence the implementation of the NICE guidance on antibiotic prophylaxis before dental treatment. Data were analysed using framework analysis. For patients the rationale for the NICE guidance was unclear. They understood that at the population level the risk of infective endocarditis was less than the risk of adverse reaction to antibiotics. However, on an individual level they felt that the latter risk was negligible given their previous experience of antibiotics. They were aware that standards of care change over time but were concerned that this may be an example where a mistake had been made. Patients felt that the characteristics of the person advising them about the new guidance were important in whether or not they would accept them - they wished to be advised by a clinician that they knew and trusted, and who was perceived as having appropriate expertise. Patients generally felt that they would be most reassured by information provided by a clinician who they felt they could trust and who was qualified to comment on the issue by respecting their autonomy. The implications of the findings for the development of patient information are discussed.

What's the evidence that NICE guidance has been implemented? Results from a national evaluation using time series analysis, audit of patients' notes, and interviews

PubMed Central

Sheldon, Trevor A; Cullum, Nicky; Dawson, Diane; Lankshear, Annette; Lowson, Karin; Watt, Ian; West, Peter; Wright, Dianne; Wright, John

2004-01-01

Objectives To assess the extent and pattern of implementation of guidance issued by the National Institute for Clinical Excellence (NICE). Design Interrupted time series analysis, review of case notes, survey, and interviews. Setting Acute and primary care trusts in England and Wales. Participants All primary care prescribing, hospital pharmacies; a random sample of 20 acute trusts, 17 mental health trusts, and 21 primary care trusts; and senior clinicians and managers from five acute trusts. Main outcome measures Rates of prescribing and use of procedures and medical devices relative to evidence based guidance. Results 6308 usable patient audit forms were returned. Implementation of NICE guidance varied by trust and by topic. Prescribing of some taxanes for cancer (P < 0.002) and orlistat for obesity (P < 0.001) significantly increased in line with guidance. Prescribing of drugs for Alzheimer's disease and prophylactic extraction of wisdom teeth showed trends consistent with, but not obviously a consequence of, the guidance. Prescribing practice often did not accord with the details of the guidance. No change was apparent in the use of hearing aids, hip prostheses, implantable cardioverter defibrillators, laparoscopic hernia repair, and laparoscopic colorectal cancer surgery after NICE guidance had been issued. Conclusions Implementation of NICE guidance has been variable. Guidance seems more likely to be adopted when there is strong professional support, a stable and convincing evidence base, and no increased or unfunded costs, in organisations that have established good systems for tracking guidance implementation and where the professionals involved are not isolated. Guidance needs to be clear and reflect the clinical context. PMID:15514342

Likelihood of cesarean delivery after applying leading active labor diagnostic guidelines.

PubMed

Neal, Jeremy L; Lowe, Nancy K; Phillippi, Julia C; Ryan, Sharon L; Knupp, Amy M; Dietrich, Mary S; Thung, Stephen F

2017-06-01

Friedman, the United Kingdom's National Institute for Health and Care Excellence (NICE), and the American College of Obstetricians and Gynecologists/Society for Maternal-Fetal Medicine (ACOG/SMFM) support different active labor diagnostic guidelines. Our aims were to compare likelihoods for cesarean delivery among women admitted before vs in active labor by diagnostic guideline (within-guideline comparisons) and between women admitted in active labor per one or more of the guidelines (between-guideline comparisons). Active labor diagnostic guidelines were retrospectively applied to cervical examination data from nulliparous women with spontaneous labor onset (n = 2573). Generalized linear models were used to determine outcome likelihoods within- and between-guideline groups. At admission, 15.7%, 48.3%, and 10.1% of nulliparous women were in active labor per Friedman, NICE, and ACOG/SMFM diagnostic guidelines, respectively. Cesarean delivery was more likely among women admitted before vs in active labor per the Friedman (AOR 1.75 [95% CI 1.08-2.82] or NICE guideline (AOR 2.55 [95% CI 1.84-3.53]). Between guidelines, cesarean delivery was less likely among women admitted in active labor per the NICE guideline, as compared with the ACOG/SMFM guideline (AOR 0.55 [95% CI 0.35-0.88]). Many nulliparous women are admitted to the hospital before active labor onset. These women are significantly more likely to have a cesarean delivery. Diagnosing active labor before admission or before intervention to speed labor may be one component of a multi-faceted approach to decreasing the primary cesarean rate in the United States. The NICE diagnostic guideline is more inclusive than Friedman or ACOG/SMFM guidelines and its use may be the most clinically useful for safely lowering cesarean rates. © 2017 Wiley Periodicals, Inc.

Impact of the QOF and the NICE guideline in the diagnosis andmanagement of depression: a qualitative study

PubMed Central

Mitchell, Caroline; Dwyer, Rachel; Hagan, Teresa; Mathers, Nigel

2011-01-01

Background The National Institute for Health and clinical Excellence (NICE) depression guideline (2004) and the updated Quality and Outcomes Framework (QOF) ( 2006) in general practice have introduced the concepts of screening severity assessment, for example using the Patient Health Questionnaire 9 (PHQ-9), and ‘stepped care’ for depression. Aim To explore primary care practitioner perspectives on the clinical utility of the NICE guideline and the impact of the QOF on diagnosis and management of depression in routine practice. Design and setting Qualitative study using focus groups from four multidisciplinary practice teams with diverse populations in south Yorkshire. Method Four focus groups were conducted, using a topic guide and audiotaping. There were 38 participants: GPs, nurses, doctors in training, mental health workers, and a manager. Data analysis was iterative and thematic. Results The NICE guideline, with its embedded principles of holism and evidence-based practice, was viewed positively but its impact was compromised by resource and practitioner barriers to implementation. The perceived imposition of the screening questions and severity assessments (PHQ-9) with no responsive training had required practitioners to work hard to minimise negative impacts on their work, for example: constantly adapting consultations to tick boxes; avoiding triggering open displays of distress without the time to offer appropriate care; positively managing how their patients were labelled. Further confusion was experienced around the evolving content of psychological interventions for depression. Conclusion Organisational barriers to the implementation of the NICE guideline and the limited scope of the QOF highlight the need for policy makers to work more effectively with the complex realities of general practice in order to systematically improve the quality and delivery of ‘managed’ care for depression. PMID:21619752

Health benefit assessment of pharmaceuticals: An international comparison of decisions from Germany, England, Scotland and Australia.

PubMed

Fischer, Katharina Elisabeth; Heisser, Thomas; Stargardt, Tom

2016-10-01

Little is known on the performance of the newly introduced health benefit assessment process, AMNOG, in Germany compared to other health technology assessment agencies. We analysed whether decisions of the German Federal Joint Committee (FJC) deviate from decisions of the UK National Institute for Health and Care Excellence (NICE), the Scottish Medicines Consortium (SMC) and the Australian Pharmaceutical Benefits Advisory Committee (PBAC). We analysed decisions made for comparable patient subgroups by the four agencies between 2011 and 2014. First, decisions were compared (a) by their final outcome, i.e. whether a health benefit was identified, and (b) by the agencies' judgement on comparative effectiveness. Subsequently, we partially explored reasons for differences between HTA agencies. From the 192 FJC decisions, we identified 55 that overlapped with NICE, 166 with SMC and 119 with PBAC. FJC agreed with NICE in 40% in final outcome (Cohen's Kappa=-0.13). Similar results were obtained for FJC and SMC (47.6%, kappa=0.03) and FJC and PBAC (48.7%, kappa=0.07). Agreement increased when comparing judgements based on comparative effectiveness only. However, the FJC's final decision was positive only in 43.6%, 39.2% and 44.5% of the patient subgroups, as opposed to 74.5% (NICE), 68.7% (SMC), and 68.9% (PBAC), respectively. We show that the FJC - an agency relatively new in structurally assessing the health benefit of pharmaceuticals - deviates considerably in decisions compared to other HTA agencies. Our study also reveals that the FJC tends to appraise stricter than NICE. Copyright © 2016 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

Implementing core NICE guidelines for osteoarthritis in primary care with a model consultation (MOSAICS): a cluster randomised controlled trial.

PubMed

Dziedzic, K S; Healey, E L; Porcheret, M; Afolabi, E K; Lewis, M; Morden, A; Jinks, C; McHugh, G A; Ryan, S; Finney, A; Main, C; Edwards, J J; Paskins, Z; Pushpa-Rajah, A; Hay, E M

2018-01-01

To determine the effectiveness of a model osteoarthritis consultation, compared with usual care, on physical function and uptake of National Institute for Health and Care Excellence (NICE) osteoarthritis recommendations, in adults ≥45 years consulting with peripheral joint pain in UK general practice. Two-arm cluster-randomised controlled trial with baseline health survey. Eight general practices in England. 525 adults ≥45 years consulting for peripheral joint pain, amongst 28,443 population survey recipients. Four intervention practices delivered the model osteoarthritis consultation to patients consulting with peripheral joint pain; four control practices continued usual care. The primary clinical outcome of the trial was the SF-12 physical component score (PCS) at 6 months; the main secondary outcome was uptake of NICE core recommendations by 6 months, measured by osteoarthritis quality indicators. A Linear Mixed Model was used to analyse clinical outcome data (SF-12 PCS). Differences in quality indicator outcomes were assessed using logistic regression. 525 eligible participants were enrolled (mean age 67.3 years, SD 10.5; 59.6% female): 288 from intervention and 237 from control practices. There were no statistically significant differences in SF-12 PCS: mean difference at the 6-month primary endpoint was -0.37 (95% CI -2.32, 1.57). Uptake of core NICE recommendations by 6 months was statistically significantly higher in the intervention arm compared with control: e.g., increased written exercise information, 20.5% (7.9, 28.3). Whilst uptake of core NICE recommendations was increased, there was no evidence of benefit of this intervention, as delivered in this pragmatic randomised trial, on the primary outcome of physical functioning at 6 months. ISRCTN06984617. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

Targeting the initial investigation and management in cases of acute pulmonary embolism.

PubMed

Moore, Nicholas; Hawkins, Peter

2013-01-01

It was noted by consultants in our hospital that the early investigation of suspected pulmonary embolism (PE) lacked structure. This was causing delays in definitive diagnosis and early management. The resulting unnecessary use of investigation was also wasting resources. In particular, the inappropriate use of serum d-dimer tests was causing concern. The National Institute of Clinical Excellence (NICE) guidelines recommend use of the 2-level Well's score to target investigation in suspected PE. A baseline audit against the NICE guideline revealed that Well's scores were rarely used (only calculated in 12% of cases) and confirmed the suspicion that early investigation was poorly targeted. This project intervened using educational talks promoting the use of Well's scores in cases of suspected PE. Well's score proformas were placed in the emergency department and emergency assessment unit for reference. Their availability was advertised. This significantly increased the use of Well's scores (46% vs 11%, p<0.001). Fewer patients underwent unnecessary d-dimer measurements in cases of likely PE (65% vs 86%). Initial investigation was more targeted in cases where a Well's score had been calculated than in cases without a Well's score. For example, significantly fewer unnecessary d-dimer tests were performed in these cases (45% vs 100%, p<0.05). The cost of unnecessary investigation in suspected PE is not only significant financially but also in the resulting delay in definitive diagnosis and management for the patient. The simple intervention used here was effective in addressing this problem.

Comparing discriminant analysis and neural network for the determination of sex using femur head measurements.

PubMed

Alunni, Véronique; Jardin, Philippe du; Nogueira, Luisa; Buchet, Luc; Quatrehomme, Gérald

2015-08-01

The measurement of the femoral head is usually considered an interesting variable for the sex determination of skeletal remains. To date, there are few published reference measurements of the femoral head in a modern European population for the purpose of sex determination. In this study, 116 femurs from 58 individuals of the South of France (Nice Bone Collection, Nice, France) were studied. Three measurements of the femoral head were taken: the vertical head diameter (VHD), the transversal head diameter (THD) and the head circumference (HC). The results show that: (i) there is no statistical difference between the right and left femurs for each of the three measurements (VHD, THD and HC). Therefore we arbitrarily chose to use the measures from the right femurs (N=58) to pursue our experiments; (ii) the measurements of the femoral head are similar to those of contemporary American populations; (iii) the dimensions of the femoral head place the measurements of the French population somewhere between Germany or Croatia, and Spain; (iv) there is no significant secular trend (in contrast with the femoral neck diameter); (v) the femoral head measurement as a single variable is useful for sex determination: a 96.5% rate of accuracy was obtained using THD and HC measurements with the artificial neural network; and a 94.8% rate of accuracy using VHD, both with the discriminant analysis and the neural network. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

The 2015 and 2016 terrorist attacks in France: was there a short-term impact on hospitalizations for cardiovascular disease?

PubMed

Chatignoux, Edouard; Gabet, Amélie; Moutengou, Elodie; Pirard, Philippe; Motreff, Yvon; Bonaldi, Christophe; Olié, Valérie

2018-01-01

The terrorist attacks in Paris and Nice in 2015 and 2016 generated widespread emotional stress in France. Given that acute emotional stress is a well-known trigger for cardiovascular disease, we investigated whether these attacks had any short-term impact on hospitalizations for acute cardiovascular disease in France. Annual hospital discharge data from 2009 to 2016 were extracted from the French Hospital Discharge Database. All hospitalizations with a primary diagnosis of acute coronary syndrome, heart failure, or stroke were selected. Generalized additive Poisson models were used to differentiate "unusual" variations in daily hospitalization numbers in the 15 days following the attacks from the expected background hospitalization rate. The average daily number of hospitalizations was 396.4 for acute coronary syndrome, 598.6 for heart failure, and 334.6 for stroke. The daily mean number of hospitalizations for heart failure and stroke was higher in the 15 days following each attack compared with the reference periods. However, multivariate analysis showed no significant variation in the risk of hospitalization in the days following the attacks. Watching events unfold on television, no matter how dramatic, was not a sufficiently potent trigger for cardiovascular disease, although it may have led to an increase in hospitalizations for stress or anxiety. The 2015 and 2016 terrorist attacks do not seem to have had any measurable short-term impact on hospitalizations for cardiovascular disease either in the Paris and Nice regions or in the rest of France.

The social and cultural construction of psychiatric knowledge: an analysis of NICE guidelines on depression and ADHD

PubMed Central

Moncrieff, Joanna; Timimi, Sami

2013-01-01

The current paper presents an analysis of the NICE guidelines on depression and attention deficit hyperactivity disorder (ADHD) from the perspective of the philosophy of science, guided particularly by Foucault's notion of the symbiosis of knowledge and power. It examines how data that challenged the orthodox position on the validity and drug treatment of these conditions was managed in the process of guideline development. The depression guideline briefly considered the complexity and heterogeneity of depression, and numerous methodological problems with evaluating treatments, including antidepressants. However, the guideline recommendations made no reference to these issues and ignored evidence that questioned the analysis of antidepressant trials. The guideline on ADHD reviewed validity, but did not consider evidence from the critical literature, and overlooked inconsistencies in the data. The guideline identified that drug trials have shown no long-term benefit in ADHD, but still recommended treatment with stimulant drugs for children with severe symptoms and for all adults claiming consensus for this position. Both guidelines demonstrate how contradictory data are managed so as not to jeopardise the currently predominant view that ADHD and depression are valid and un-contentious medical conditions that should be treated with drugs. The subjective nature of guideline formation that is revealed illustrates Foucault's suggestion that the authority of medicine operates to promote a technological view of the nature of certain human problems, which in turn strengthens medical hegemony over these areas. PMID:23496174

The computational structural mechanics testbed architecture. Volume 4: The global-database manager GAL-DBM

NASA Technical Reports Server (NTRS)

Wright, Mary A.; Regelbrugge, Marc E.; Felippa, Carlos A.

1989-01-01

This is the fourth of a set of five volumes which describe the software architecture for the Computational Structural Mechanics Testbed. Derived from NICE, an integrated software system developed at Lockheed Palo Alto Research Laboratory, the architecture is composed of the command language CLAMP, the command language interpreter CLIP, and the data manager GAL. Volumes 1, 2, and 3 (NASA CR's 178384, 178385, and 178386, respectively) describe CLAMP and CLIP and the CLIP-processor interface. Volumes 4 and 5 (NASA CR's 178387 and 178388, respectively) describe GAL and its low-level I/O. CLAMP, an acronym for Command Language for Applied Mechanics Processors, is designed to control the flow of execution of processors written for NICE. Volume 4 describes the nominal-record data management component of the NICE software. It is intended for all users.

A time-series study of percutaneous closure of patent foramen ovale: premature adoption?

PubMed Central

Lew, Kian Nian; Angelini, Gianni D; Hollingworth, William

2016-01-01

Objectives To evaluate the impact of National Institute for Health and Care Excellence (NICE) guidance in January 2005 and subsequent trial evidence on the adoption of percutaneous closure of patent foramen ovale (PCPFO). Methods A retrospective time series study was conducted using the Inpatient Hospital Episode Statistics (HES) England. A total of 3801 patients, aged ≥18 and ≤60 years, who had PCPFO from 1 April 2006 to 31 March 2012 in England. Percentage change annualised (PCA) in PCPFO procedure rates between initial NICE guidance and publication of trial results was analysed. Results Between Quarter 2, 2006 and Quarter 4, 2009, 2163 PCPFO procedures were performed, with an increasing PCA of 48.4%. The procedure rate peaked before the presentation of equivocal results from the first randomised controlled trial (RCT) in late 2010, and declined between Quarter 4, 2009 and Quarter 4, 2011 (PCA=−15.3%). Of more than 2300 patients recruited to three RCTs, only 71 were recruited in English hospitals. Conclusions PCPFO was rapidly adopted after the publication of initial NICE guidance despite the absence of RCT evidence of efficacy. Very few English patients participated in international RCTs of PCPFO, suggesting that NICE recommendations also failed to encourage the generation of RCT evidence. PMID:26835140

Transparency in practice: Evidence from 'verification analyses' issued by the Polish Agency for Health Technology Assessment in 2012-2015.

PubMed

Ozierański, Piotr; Löblová, Olga; Nicholls, Natalia; Csanádi, Marcell; Kaló, Zoltán; McKee, Martin; King, Lawrence

2018-01-08

Transparency is recognised to be a key underpinning of the work of health technology assessment (HTA) agencies, yet it has only recently become a subject of systematic inquiry. We contribute to this research field by considering the Polish Agency for Health Technology Assessment (AHTAPol). We situate the AHTAPol in a broader context by comparing it with the National Institute for Health and Care Excellence (NICE) in England. To this end, we analyse all 332 assessment reports, called verification analyses, that the AHTAPol issued from 2012 to 2015, and a stratified sample of 22 Evidence Review Group reports published by NICE in the same period. Overall, by increasingly presenting its key conclusions in assessment reports, the AHTAPol has reached the transparency standards set out by NICE in transparency of HTA outputs. The AHTAPol is more transparent than NICE in certain aspects of the HTA process, such as providing rationales for redacting assessment reports and providing summaries of expert opinions. Nevertheless, it is less transparent in other areas of the HTA process, such as including information on expert conflicts of interest. Our findings have important implications for understanding HTA in Poland and more broadly. We use them to formulate recommendations for policymakers.

NICE technology appraisals: working with multiple levels of uncertainty and the potential for bias.

PubMed

Brown, Patrick; Calnan, Michael

2013-05-01

One of the key roles of the English National Institute for Health and Clinical Excellence (NICE) is technology appraisal. This essentially involves evaluating the cost effectiveness of pharmaceutical products and other technologies for use within the National Health Service. Based on a content analysis of key documents which shed light on the nature of appraisals, this paper draws attention to the multiple layers of uncertainty and complexity which are latent within the appraisal process, and the often socially constructed mechanisms for tackling these. Epistemic assumptions, bounded rationality and more explicitly relational forms of managing knowledge are applied to this end. These findings are discussed in the context of the literature highlighting the inherently social process of regulation. A framework is developed which posits the various forms of uncertainty, and responses to these, as potential conduits of regulatory bias-in need of further research. That NICE's authority is itself regulated by other actors within the regulatory regime, particularly the pharmaceutical industry, exposes it to the threat of regulatory capture. Following Lehoux, it is concluded that a more transparent and reflexive format for technological appraisals is necessary. This would enable a more robust, defensible form of decision-making and moreover enable NICE to preserve its legitimacy in the midst of pressures which threaten this.

Seeing the NICE side of cost-effectiveness analysis: a qualitative investigation of the use of CEA in NICE technology appraisals.

PubMed

Bryan, Stirling; Williams, Iestyn; McIver, Shirley

2007-02-01

Resource scarcity is the raison d'être for the discipline of economics. Thus, the primary purpose of economic analysis is to help decision-makers when addressing problems arising due to the scarcity problem. The research reported here was concerned with how cost-effectiveness information is used by the National Institute for Health & Clinical Excellence (NICE) in national technology coverage decisions in the UK, and how its impact might be increased. The research followed a qualitative case study methodology with semi-structured interviews, supported by observation and analysis of secondary sources. Our research highlights that the technology appraisal function of NICE represents an important progression for the UK health economics community: new cost-effectiveness work is commissioned for each technology and that work directly informs national health policy. However, accountability in policy decisions necessitates that the information upon which decisions are based (including cost-effectiveness analysis, CEA) is accessible. This was found to be a serious problem and represents one of the main ongoing challenges. Other issues highlighted include perceived weaknesses in analysis methods and the poor alignment between the health maximisation objectives assumed in economic analyses and the range of other objectives facing decision-makers in reality. Copyright (c) 2006 John Wiley & Sons, Ltd.

Meta-analysis of trials of streptococcal throat treatment programs to prevent rheumatic fever.

PubMed

Lennon, Diana; Kerdemelidis, Melissa; Arroll, Bruce

2009-07-01

Rheumatic fever (RF) is the commonest cause of pediatric heart disease globally. Penicillin for streptococcal pharyngitis prevents RF. Inequitable access to health care persists. To investigate RF prevention by treating streptococcal pharyngitis in school- and/or community-based programs. Medline, Old Medline, the Cochrane Library, DARE, Central, NHS, EED, NICE, NRMC, Clinical Evidence, CDC website, PubMed, and reference lists of retrieved articles. Known researchers in the field were contacted where possible. Randomized, controlled trials or trials of before/after design examining treatment of sore throats in schools or communities with RF as an outcome where data were able to be pooled for analysis. Two authors examined titles, abstracts, selected articles, and extracted data. Disagreements were resolved by consensus. QUANTITATIVE ANALYSIS TOOL: Review Manager version 4.2 to assess pooled relative risks and 95% confidence intervals. Six studies (of 677 screened) which met the criteria and could be pooled were included. Meta-analysis of these trials for RF control produced a relative risk of 0.41 (95% CI: 0.23-0.70). There was statistical heterogeneity (I = 70.5%). Hence a random effects analysis was conducted. Many studies were poor quality. Title and available abstracts of non-English studies were checked. There may be publication bias. This is the best available evidence in an area with imperfect information. It is expected acute RF cases would diminish by about 60% using a school or community clinic to treat streptococcal pharyngitis. This should be considered in high-risk populations.

An audit of NICE guidelines on antenatal pelvic floor exercises.

PubMed

Ismail, Sharif I M F

2009-12-01

The National Institute for Health and Clinical Excellence (NICE) recommends antenatal pelvic floor exercises during first pregnancy to reduce postpartum stress incontinence. The aim of this audit was to assess patient awareness and compliance with this guideline. An anonymous self-constructed questionnaire was given to patients after their first delivery. A total of 223 questionnaires were returned over a 6-month period. Although 95% of patients were aware of the importance of pelvic floor exercises, only a limited proportion of them had the right information and a minority practised them. Printed material seemed to be very influential in getting the message across. The importance of giving information early in pregnancy and national awareness was shown in the suggestions for improvement. Patient awareness and actual practise of antenatal pelvic floor exercises did not meet NICE guidelines, calling for strategies to improve awareness and adherence.

The computational structural mechanics testbed architecture. Volume 5: The Input-Output Manager DMGASP

NASA Technical Reports Server (NTRS)

Felippa, Carlos A.

1989-01-01

This is the fifth of a set of five volumes which describe the software architecture for the Computational Structural Mechanics Testbed. Derived from NICE, an integrated software system developed at Lockheed Palo Alto Research Laboratory, the architecture is composed of the command language (CLAMP), the command language interpreter (CLIP), and the data manager (GAL). Volumes 1, 2, and 3 (NASA CR's 178384, 178385, and 178386, respectively) describe CLAMP and CLIP and the CLIP-processor interface. Volumes 4 and 5 (NASA CR's 178387 and 178388, respectively) describe GAL and its low-level I/O. CLAMP, an acronym for Command Language for Applied Mechanics Processors, is designed to control the flow of execution of processors written for NICE. Volume 5 describes the low-level data management component of the NICE software. It is intended only for advanced programmers involved in maintenance of the software.

Do NICE and CHI have no interest in safety? Opinion of the book NICE, CHI and the NHS reforms. Enabling excellence or imposing control?

PubMed

Fletcher, P

2000-08-01

Seventeen eminent and experienced people have contributed to this most valuable review of NICE and CHI and their potential impact on clinical practice in the UK. There is essentially 100% agreement that the basic concept is a good one; we all want to have the highest possible quality of clinical practice and improvements in health care. This is all motherhood and apple-pie stuff which goes without question but the problem is how it is put into effect. The contributors are also in agreement and fear that central desire for control will outweigh the benefits. The most recent NICE action, which was leaked to the media as a 'preliminary opinion', concerned the use of beta-interferon for the treatment of multiple sclerosis (MS). The opinion seems to be that beta-interferon is very expensive, that, yes, it does help some sufferers but, no, it does not help others and because it costs more than the NHS can afford no one can have it. This seems to me to be a most unsatisfactory outcome. Surely what clinical excellence demands is the refinement of diagnostic capabilities so that those who will benefit may be distinguished from those who will not. In the meantime we do the best we can even if it does mean that the NHS has to pay for some patients who do not respond. This is the inevitable consequence of the belief that a 'free' and comprehensive health service can be provided out of general taxation. Beta-interferon for the treatment of MS is an example of the observable fact that medical science is advancing at a rate considerably in excess of possible increases in funding. Possibly the most important problem identified in this book is the absence of a relevant, high quality data source for the preparation of the numerous guidelines that NICE is expected to produce each year. In a fully grown science a starting point for a quantitative procedure is the establishment of a baseline and, having done that, the scientist's next step is to produce a standard curve for use in the measurement of further investigations. I have said previously that medicine is not a fully grown science (which is one of the problems) but that does not mean that basic scientific method can be abandoned. What is the baseline for the evaluation of clinical practice? The best would be records of the progression of a disease-state in untreated patients. That, for obvious reasons, is clearly not possible so a compromise is unavoidable. Unfortunately we do not even have that compromise baseline so how do we know what is better and what is worse? In simple, single disease states and within the limits of RCTs that is sometimes possible but in a population composed of many elderly people with multiple pathology it is greatly more difficult. If NICE is to produce authoritative guidelines then its first task is to define a (compromise) baseline. For the readers of this journal the absence of safety as one of the measures of clinical excellence must be a matter of concern. All clinical interventions may be casually related to adverse reactions which may, on occasion, be serious or even fatal. Perhaps excluding safety was a conscious decision by those who created NICE. At the time of market approval information on safety is almost always limited to events occurring more frequently than 1 in 1000 exposures which is far below the desirable level of precision. If NICE is to provide advice at the time of market authorization or shortly after then it will never be in a position to include an acceptable evaluation of safety. So why give a hostage to fortune by mentioning it in NICE's remit? Time alone will tell whether NICE and CHI achieve health improvement or whether they prove to be no more than a political gesture.

Completing the cycle: The use of audit to develop a mental health service in times of austerity.

PubMed

Shah, Nisha; Donaldson, Lucinda; Giridhar, Ramya

2013-12-01

A published audit demonstrated that a pilot psychiatric clinic failed to capture predicted numbers of women with severe and enduring mental illness. On the basis of recommendations from this audit, along with those from the Royal College of Psychiatrists and NICE guidelines, a more comprehensive psychiatric service was developed to meet this demand and therefore manage risk more effectively. Over the course of a year, the new service attracted a higher rate of referrals of pregnant women with severe and enduring mental illness. The majority referral source continued to be midwifery-led. Audit is a useful tool for evaluating and informing service development and helped us identify further improvements needed to deliver an effective mental health service.

[Adaptations of psychotropic drugs in patients aged 75 years and older in a departement of geriatric internal medecine: report of 100 cases].

PubMed

Couderc, Anne-Laure; Bailly-Agaledes, Cindy; Camalet, Joëlle; Capriz-Ribière, Françoise; Gary, André; Robert, Philippe; Brocker, Patrice; Guérin, Olivier

2011-06-01

The elderly often with multiple diseases are particularly at risk from adverse drug reactions. Nearly half of iatrogenic drug in the elderly are preventable. Some medications such as psychotropic drugs are particularly involved in iatrogenic accidents. We wanted to know if the tools of the comprehensive geriatric assessment or other factors could influence the changes of psychotropic drugs in a geriatric departement. Our prospective study of four months in 100 patients aged 75 years and older hospitalized in the Geriatric Internal Medecine Departement of University Hospital of Nice investigated what were the clinical or biological reasons and tools used during changes of psychotropic drugs. We compared these changes according to the comprehensive geriatric assessment tools and we analyzed the changes based on lists of potentially inappropriate medications by Laroche et al. and from the instrument STOPP/START. The Mini Mental State Examination (MMSE) was the tool that has most influenced the changes in psychotropic including a tendency to increase and the introduction of anxiolytics when MMSE < 20 (p = 0.007) while neuroleptics instead arrested and decreased (p = 0.012). The comprehensive geriatric assessment has its place in decision support during the potentially iatrogenic prescriptions of drugs such as psychotropic and new tools such as STOPP/START can also be a help to the prescriber informed.

Venous thromboembolism prophylaxis risk assessment in a general surgery cohort: a closed-loop audit.

PubMed

McGoldrick, D M; Redmond, H P

2017-08-01

Venous thromboembolism (VTE) is a potential source of morbidity and mortality in surgical in-patients. A number of guidelines exist that advise on prophylactic measures. We aimed to assess VTE prophylaxis prescribing practices and compliance with a kardex-based risk assessment tool in a general surgery population. Data on general surgery in-patients were collected on two separate wards on two separate days. Drug kardexes were assessed for VTE prophylaxis measures and use of the risk assessment tool. NICE and SIGN guidelines were adopted as a gold standard. The audit results and information on the risk assessment tool were presented as an educational intervention at two separate departmental teaching sessions. A re-audit was completed after 3 months. In Audit A, 74 patients were assessed. 70% were emergency admissions. The risk assessment tool was completed in 2.7%. 75 and 97% of patients were correctly prescribed anti-embolic stockings (AES) and low-molecular weight heparin (LMWH), respectively. 30 patients were included in Audit B, 56% of whom were emergency admissions. 66% had a risk assessment performed, a statistically significant improvement (p < 0.0001). Rates of LMWH prescribing were similar (96%), but AES prescribing was lower (36%). Rates of LMWH prescribing are high in this general surgical population, although AES prescribing rates vary. Use of the VTE risk assessment tool increased following the initial audit and intervention.

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.

Preparing Brigade Combat Team Soldiers for Mission Readiness Through Research on Intangible Psychological Constructs and their Applications: Validation and Pilot

DTIC Science & Technology

2015-01-01

and their Applications: Validation and Pilot Steven N. Aude Kenneth Nicely Michael A. Lodato ICF International Christopher L. Vowels...CONTRACT OR GRANT NUMBER W5J9CQ-11-0009 5b. PROGRAM ELEMENT NUMBER 622785 6. AUTHOR(S) Steven N. Aude, Kenneth Nicely, Michael A... Michael A. Lodato ICF International Christopher L. Vowels U.S. Army Research Institute Fort Hood Research Unit Brian T. Crabb

What is the current NHS service provision for patients severely affected by chronic fatigue syndrome/myalgic encephalomyelitis? A national scoping exercise

PubMed Central

McDermott, Clare; Al Haddabi, Atheer; Akagi, Hiroko; Selby, Michelle; Cox, Diane; Lewith, George

2014-01-01

Background Chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME), in its most severe clinical presentation, can result in patients becoming housebound and bedbound so unable to access most available specialist services. This presents particular clinical risks and treatment needs for which the National Institute for Health and Care Excellence (NICE) advises specialist medical care and monitoring. The extent of National Health Service (NHS) specialist provision in England for severe CFS/ME is currently unknown. Objectives To establish the current NHS provision for patients with severe CFS/ME in England. Setting and participants All 49 English NHS specialist CFS/ME adult services in England, in 2013. Method Cross-sectional survey by email questionnaire. Primary outcome measures Adherence to NICE guidelines for severe CFS/ME. Results All 49 services replied (100%). 33% (16/49) of specialist CFS/ME services provided no service for housebound patients. 55% (27/49) services did treat patients with severe CFS/ME and their interventions followed the NICE guidelines. The remaining services (12%, 6/49) offered occasional or minimal support where funding allowed. There was one NHS unit providing specialist inpatient CFS/ME provision in England. Conclusions Study findings highlight substantial variation in access to specialist care for patients with severe presentation of CFS/ME. Where treatment was provided, this appeared to comply with NICE recommendations for this patient group. PMID:24984956

Audit of Helicobacter pylori Testing in Microbiology Laboratories in England: To Inform Compliance with NICE Guidance and the Feasibility of Routine Antimicrobial Resistance Surveillance

PubMed Central

Allison, Rosalie; Lecky, Donna M.; Bull, Megan; Turner, Kim; Godbole, Gauri

2016-01-01

Introduction. The National Institute for Health and Clinical Excellence (NICE) guidance recommends that dyspeptic patients are tested for Helicobacter pylori using a urea breath test, stool antigen test, or serology. Antibiotic resistance in H. pylori is globally increasing, but treatment in England is rarely guided by susceptibility testing or surveillance. Aims. To determine compliance of microbiology laboratories in England with NICE guidance and whether laboratories perform culture and antibiotic susceptibility testing (AST). Methods. In 2015, 170 accredited English microbiology laboratories were surveyed, by email. Results. 121/170 (71%) laboratories responded; 96% provided H. pylori testing (78% on site). 94% provided H. pylori diagnosis using stool antigen; only four provided serology as their noninvasive test; 3/4 of these encouraged urea breath tests in their acute trusts. Only 22/94 (23%) of the laboratories performed H. pylori cultures from gastric biopsies on site; 9/22 performed AST, but the vast majority processed less than one specimen/week. Conclusions. Only five laboratories in England do not comply with NICE guidance; these will need the guidance reinforced. National surveillance needs to be implemented; culture-based AST would need to be centralised. Moving forward, detection of resistance in H. pylori from stool specimens using molecular methods (PCR) needs to be explored. PMID:27829836

Doing Pre-operative Investigations in Emergency Department; a Clinical Audit.

PubMed

Rafiq, Muhammad Salman; Rafiq, Maria; Rafiq, Muhammad Imran; Salman, Seema Gul; Hafeez, Sania

2017-01-01

Pre-operative investigations for emergency surgical patients differ between centers. Following established guidelines can reduce unnecessary investigation, cost of treatment and hospital stay. The present audit was carried out to evaluate the condition of doing pre-operative investigations for three common surgical emergencies compared to National Institute for Health and Care Excellence (NICE) guidelines and local criteria. A retrospective clinical audit of acute-appendicitis, abscess and hernia patients admitted to the emergency department was carried out over a one-year period from July 2014 to July 2015. Data of laboratory investigations, their indication, cost and duration of hospital stay was collected and compared with NICE-guidelines. A total of 201 patients were admitted to the emergency department during the audit period. These included 77(38.3%) cases of acute-appendicitis, 112 (55.7%) cases of abscesses, and 12 (6%) cases of hernia. Investigations not indicated by NICE-guidelines included 42 (20.9%) full blood counts, 29 (14.4%) random blood sugars, 26 (12.9%) urea tests, 4 (2%) chest x-rays, 13 (6.5%) electrocardiographs, and 58 (28.9%) urine analyses. These cost 25,675 Rupees (245.46 Dollars) in unnecessary investigation costs and 65.7 days of additional hospital stay. Unnecessary investigations for emergency surgical patients can be reduced by following NICE-guidelines. This will reduce workload on emergency services, treatment costs and the length of hospital stay.

Probabilistic sensitivity analysis for NICE technology assessment: not an optional extra.

PubMed

Claxton, Karl; Sculpher, Mark; McCabe, Chris; Briggs, Andrew; Akehurst, Ron; Buxton, Martin; Brazier, John; O'Hagan, Tony

2005-04-01

Recently the National Institute for Clinical Excellence (NICE) updated its methods guidance for technology assessment. One aspect of the new guidance is to require the use of probabilistic sensitivity analysis with all cost-effectiveness models submitted to the Institute. The purpose of this paper is to place the NICE guidance on dealing with uncertainty into a broader context of the requirements for decision making; to explain the general approach that was taken in its development; and to address each of the issues which have been raised in the debate about the role of probabilistic sensitivity analysis in general. The most appropriate starting point for developing guidance is to establish what is required for decision making. On the basis of these requirements, the methods and framework of analysis which can best meet these needs can then be identified. It will be argued that the guidance on dealing with uncertainty and, in particular, the requirement for probabilistic sensitivity analysis, is justified by the requirements of the type of decisions that NICE is asked to make. Given this foundation, the main issues and criticisms raised during and after the consultation process are reviewed. Finally, some of the methodological challenges posed by the need fully to characterise decision uncertainty and to inform the research agenda will be identified and discussed. Copyright (c) 2005 John Wiley & Sons, Ltd.

A comparison of neuromuscular electrical stimulation and traditional therapy, versus traditional therapy in patients with longstanding dysphagia.

PubMed

Frost, Jo; Robinson, H Fiona; Hibberd, Judi

2018-06-01

Dysphagia in adults arises from a range of causes including acquired neurological disorders and some cancers. Previous research has suggested that treatment using neuromuscular electrical stimulation (NMES) when used in conjunction with conventional therapy is effective. This review describes the recent literature and a small prospective case series carried out in the United Kingdom. This study contributed to support National Institute of Clinical Excellence (NICE) guidance for clinicians who wish to include NMES in a rehabilitation programme for dysphagic patients, specifically with reference to safety and the impact on swallowing function of this intervention. In 2014, the UK NICE issued guidelines enabling UK therapists to trial the use of NMES, but the guidelines also sought additional evidence on the impact on swallowing function of NMES and the incidence of side effects. This small prospective case series investigated both of these aspects with a group of patients with dysphagia of neurological origin who had not achieved adequate swallowing function with traditional therapy alone. This study recruited 10 adult patients with dysphagia of neurological origin. All had previously received traditional swallowing therapy for at least 6 months but only achieved a Functional Oral Intake Scale of 4 or less (a scale for amounts and types of oral intake). The total study period was 10 weeks for each subject comprising 5 weeks of traditional therapy delivered three times a week followed by 5 weeks of NMES concurrent with traditional therapy (NMES + traditional therapy) delivered three times a week using the VitalStim stimulator (VitalStim Therapy, UK). In addition, the Quality of Life in Swallowing and Eating Assessment Tool 10 (quality of life scales) were determined to allow comparison between studies. Nine subjects achieved an improvement in swallowing function after NMES + traditional therapy was measured using the Functional Oral Intake Scale, giving a statistically significant improvement (P < 0.001) when NMES + traditional therapy was compared with traditional therapy. In addition, there was a low incidence of adverse effects with only minor adverse events occurring in 1.3% of electrode pair placements. The current preliminary study suggests that NMES + traditional therapy has a good safety record and may improve oral intake and patient reported swallowing outcomes for subjects with long-standing dysphagia of neurological cause, which has not responded to traditional therapy. Provided care is taken with skin preparation and electrode placement the risk of adverse effects from the treatment was minimal. Significantly, in 30% of the subjects, an improvement in voice quality was found.

Low-dose-rate brachytherapy for the treatment of localised prostate cancer in men with a high risk of disease relapse.

PubMed

Laing, Robert; Uribe, Jennifer; Uribe-Lewis, Santiago; Money-Kyrle, Julian; Perna, Carla; Chintzoglou, Stylianos; Khaksar, Sara; Langley, Stephen E M

2018-04-01

To report clinical outcomes of 125 I low-dose-rate prostate brachytherapy (LDR-PB) as monotherapy or combined with androgen-deprivation therapy (ADT) and/or external beam radiotherapy (EBRT) in high-risk localised prostate cancer. Analysis of clinical outcomes from a prospective cohort of patients treated with LDR-PB alone or combined treatment in a single institution. Men with a high risk of disease relapse were identified by the National Institute for Health and Care Excellence (NICE) criteria or by the National Comprehensive Cancer Network (NCCN) criteria. Relapse-free survival (RFS), overall survival (OS), prostate cancer-specific survival (PCSS), and metastases-free survival (MFS), were analysed together with patient-reported symptom scores and physician-reported adverse events. The NICE and NCCN criteria identified 267 and 202 high-risk patients, respectively. NICE-defined patients had significantly lower pre-treatment PSA levels, Gleason scores <7, and a greater proportion of patients who received LDR-PB monotherapy. At 9 years after implantation RFS was 89% and 87% in the NICE and NCCN groups, respectively (log-rank P = 0.637), and OS 93% and 94%, respectively (log-rank P = 0.481). All of the survival estimates were similar between LDR-PB monotherapy and combined therapies. Cox proportional hazards regression confirmed RFS was similar between the treatment types. Treatment-related toxicity was also similar between the treatment methods. LDR-PB is effective at controlling localised prostate cancer in patients with a high risk of disease relapse. As the present study was not randomised, it is not possible to define those patients who need the addition of ADT and/or EBRT. However, the NICE criteria appear suitable to define treatment options where patients could benefit from LDR-PB as monotherapy or combined treatment. This choice should be discussed with the patient taking into account comorbidities and presence of multiple high-risk factors. © 2018 The Authors BJU International © 2018 BJU International Published by John Wiley & Sons Ltd.

Are current UK National Institute for Health and Clinical Excellence (NICE) obesity risk guidelines useful? Cross-sectional associations with cardiovascular disease risk factors in a large, representative English population.

PubMed

Tabassum, Faiza; Batty, G David

2013-01-01

The National Institute for Health and Clinical Excellence (NICE) has recently released obesity guidelines for health risk. For the first time in the UK, we estimate the utility of these guidelines by relating them to the established cardiovascular disease (CVD) risk factors. Health Survey for England (HSE) 2006, a population-based cross-sectional study in England was used with a sample size of 7225 men and women aged ≥35 years (age range: 35-97 years). The following CVD risk factor outcomes were used: hypertension, diabetes, total and high density lipoprotein cholesterol, glycated haemoglobin, fibrinogen, C-reactive protein and Framingham risk score. Four NICE categories of obesity were created based on body mass index (BMI) and waist circumference (WC): no risk (up to normal BMI and low/high WC); increased risk (normal BMI & very high WC, or obese & low WC); high risk (overweight & very high WC, or obese & high WC); and very high risk (obese I & very high WC or obese II/III with any levels of WC. Men and women in the very high risk category had the highest odds ratios (OR) of having unfavourable CVD risk factors compared to those in the no risk category. For example, the OR of having hypertension for those in the very high risk category of the NICE obesity groupings was 2.57 (95% confidence interval 2.06 to 3.21) in men, and 2.15 (1.75 to 2.64) in women. Moreover, a dose-response association between the adiposity groups and most of the CVD risk factors was observed except total cholesterol in men and low HDL in women. Similar results were apparent when the Framingham risk score was the outcome of interest. In conclusion, the current NICE definitions of obesity show utility for a range of CVD risk factors and CVD risk in both men and women.

Are Current UK National Institute for Health and Clinical Excellence (NICE) Obesity Risk Guidelines Useful? Cross-Sectional Associations with Cardiovascular Disease Risk Factors in a Large, Representative English Population

PubMed Central

Tabassum, Faiza; Batty, G. David

2013-01-01

The National Institute for Health and Clinical Excellence (NICE) has recently released obesity guidelines for health risk. For the first time in the UK, we estimate the utility of these guidelines by relating them to the established cardiovascular disease (CVD) risk factors. Health Survey for England (HSE) 2006, a population-based cross-sectional study in England was used with a sample size of 7225 men and women aged ≥35 years (age range: 35–97 years). The following CVD risk factor outcomes were used: hypertension, diabetes, total and high density lipoprotein cholesterol, glycated haemoglobin, fibrinogen, C-reactive protein and Framingham risk score. Four NICE categories of obesity were created based on body mass index (BMI) and waist circumference (WC): no risk (up to normal BMI and low/high WC); increased risk (normal BMI & very high WC, or obese & low WC); high risk (overweight & very high WC, or obese & high WC); and very high risk (obese I & very high WC or obese II/III with any levels of WC. Men and women in the very high risk category had the highest odds ratios (OR) of having unfavourable CVD risk factors compared to those in the no risk category. For example, the OR of having hypertension for those in the very high risk category of the NICE obesity groupings was 2.57 (95% confidence interval 2.06 to 3.21) in men, and 2.15 (1.75 to 2.64) in women. Moreover, a dose-response association between the adiposity groups and most of the CVD risk factors was observed except total cholesterol in men and low HDL in women. Similar results were apparent when the Framingham risk score was the outcome of interest. In conclusion, the current NICE definitions of obesity show utility for a range of CVD risk factors and CVD risk in both men and women. PMID:23844088

Vedolizumab for the Treatment of Adults with Moderate-to-Severe Active Ulcerative Colitis: An Evidence Review Group Perspective of a NICE Single Technology Appraisal.

PubMed

Essat, Munira; Tappenden, Paul; Ren, Shijie; Bessey, Alice; Archer, Rachel; Wong, Ruth; Lobo, Alan; Hoque, Sami

2016-03-01

As part of its single technology appraisal (STA) process, the National Institute for Health and Care Excellence (NICE) invited the manufacturer of vedolizumab (Takeda UK) to submit evidence of the clinical effectiveness and cost effectiveness of vedolizumab for the treatment of patients with moderate-to-severe active ulcerative colitis (UC). The Evidence Review Group (ERG) produced a critical review of the evidence for the clinical effectiveness and cost effectiveness of the technology, based upon the company's submission to NICE. The evidence was derived mainly from GEMINI 1, a Phase 3, multicentre, randomised, double-blinded, placebo-controlled study of the induction and maintenance of clinical response and remission by vedolizumab (MLN0002) in patients with moderate-to-severe active UC with an inadequate response to, loss of response to or intolerance of conventional therapy or anti-tumour necrosis factor (TNF)-α. The clinical evidence showed that vedolizumab performed significantly better than placebo in both the induction and maintenance phases. In the post hoc subgroup analyses in patients with or without prior anti-TNF-α therapy, vedolizumab performed better then placebo (p value not reported). In addition, a greater improvement in health-related quality of life was observed in patients treated with vedolizumab, and the frequency and types of adverse events were similar in the vedolizumab and placebo groups, but the evidence was limited to short-term follow-up. There were a number of limitations and uncertainties in the clinical evidence base, which warrants caution in its interpretation--in particular, the post hoc subgroup analyses and high dropout rates in the maintenance phase of GEMINI 1. The company also presented a network meta-analysis of vedolizumab versus other biologic therapies indicated for moderate-to-severe UC. However, the ERG considered that the results presented may have underestimated the uncertainty in treatment effects, since fixed-effects models were used, despite clear evidence of heterogeneity among the trials included in the network. Results from the company's economic evaluation (which included price reductions to reflect the proposed patient access scheme for vedolizumab) suggested that vedolizumab is the most effective option compared with surgery and conventional therapy in the following three populations: (1) a mixed intention-to-treat population, including patients who have previously received anti-TNF-α therapy and those who are anti-TNF-α naïve; (2) patients who are anti-TNF-α naïve only; and (3) patients who have previously failed anti-TNF-α therapy only. The ERG concluded that the results of the company's economic evaluation could not be considered robust, because of errors in model implementation, omission of relevant comparators, deviations from the NICE reference case and questionable model assumptions. The ERG amended the company's model and demonstrated that vedolizumab is expected to be dominated by surgery in all three populations.

High Precision Spectroscopy of CH_5^+ Using Nice-Ohvms

NASA Astrophysics Data System (ADS)

Hodges, James N.; Perry, Adam J.; McCall, Benjamin J.

2013-06-01

The elusive methonium ion, CH_5^+, is of great interest due to its highly fluxional nature. The only published high-resolution infrared spectrum remains completely unassigned to this date. The primary challenge in understanding the CH_5^+ spectrum is that traditional spectroscopic approaches rely on a molecule having only small (or even large) amplitude motions about a well-defined reference geometry, and this is not the case with CH_5^+. We are in the process of re-scanning Oka's spectrum, in the original Black Widow discharge cell, using the new technique of Noise Immune Cavity Enhanced Optical Heterodyne Velocity Modulation Spectroscopy (NICE-OHVMS). The high precision afforded by optical saturation in conjunction with a frequency comb allows transition line centers to be determined with sub-MHz accuracy and precision -- a substantial improvement over the 90 MHz precision of Oka's work. With a high-precision linelist in hand, we plan to search for four line combination differences to directly determine the spacings between rotational energy levels. Such a search is currently infeasible due to the large number of false positives resulting from the relatively low precision and high spectral density of Oka's spectrum. The resulting combination differences, in conjunction with state-of-the-art theoretical calculations from Tucker Carrington, may provide the first insight into the rotational structure of this unique molecular system. E. T. White, J. Tang, T. Oka, Science (1999) 284, 135--137. B. M. Siller, et al. Opt. Express (2011), 19, 24822--24827. K. N. Crabtree, et al. Chem. Phys. Lett. (2012), 551, 1--6. X. Wang, T. Carrington, J. Chem. Phys., (2008), 129, 234102.

Severe Weather Guide - Mediterranean Ports. 11. Nice

DTIC Science & Technology

1988-03-01

CAPTAIN’S SUMMARY Nice is located on the south coast of France in the region known as the French Riviera (Figure 2-1), about 12 n mi west of the Italian...southern coast of France in the region known as the French Riviera approximately 12 n mi west of the Italian border. High mountains back the coastline...CA 93943-5006 9. PROCUREMENT INSTRUMENT IDENTIFICATION NUMBER N00228-84-D-3187 10. SOURCE OF FUNDING NUMBERS PROGRAM ELEMENT NO. PROJECT NO

The Gordon Conference on Inorganic Chemistry Held in Wolfboro, New Hampshire on 30 July-3 August 1990

DTIC Science & Technology

1991-06-01

Amgerst, MA 01002 Facultad De Ciencias Exactas Y Naturales Pabellon 1 - C Universitaria Dissado, Leonard N4 Buenos Aires 1428 Kings College Argentina...Laboratories 6 Universitatstrasse 2nd Floor B-2 Zurich Switzerland CH-8092 Rochester NY 14652-3208 Diebold, Michael P. Dunham, Stephen Dupont De Nemours...Laboratoire De Chimie Moleculaire Univ. of Paris-Sud URAAU CNRS Laboratoire De Chimie Theorique Univ. De Nice, Parc Vairose Batiment 490 Nice France 06034

An online model composition tool for system biology models

PubMed Central

2013-01-01

Background There are multiple representation formats for Systems Biology computational models, and the Systems Biology Markup Language (SBML) is one of the most widely used. SBML is used to capture, store, and distribute computational models by Systems Biology data sources (e.g., the BioModels Database) and researchers. Therefore, there is a need for all-in-one web-based solutions that support advance SBML functionalities such as uploading, editing, composing, visualizing, simulating, querying, and browsing computational models. Results We present the design and implementation of the Model Composition Tool (Interface) within the PathCase-SB (PathCase Systems Biology) web portal. The tool helps users compose systems biology models to facilitate the complex process of merging systems biology models. We also present three tools that support the model composition tool, namely, (1) Model Simulation Interface that generates a visual plot of the simulation according to user’s input, (2) iModel Tool as a platform for users to upload their own models to compose, and (3) SimCom Tool that provides a side by side comparison of models being composed in the same pathway. Finally, we provide a web site that hosts BioModels Database models and a separate web site that hosts SBML Test Suite models. Conclusions Model composition tool (and the other three tools) can be used with little or no knowledge of the SBML document structure. For this reason, students or anyone who wants to learn about systems biology will benefit from the described functionalities. SBML Test Suite models will be a nice starting point for beginners. And, for more advanced purposes, users will able to access and employ models of the BioModels Database as well. PMID:24006914

A Theoretically Based Behavioral Nutrition Intervention for Community Elders at High Risk: The B-NICE Randomized Controlled Clinical Trial

PubMed Central

LOCHER, JULIE L.; BALES, CONNIE W.; ELLIS, AMY C.; LAWRENCE, JEANNINE C.; NEWTON, LAURA; RITCHIE, CHRISTINE S.; ROTH, DAVID L.; BUYS, DAVID L.; VICKERS, KRISTIN S.

2012-01-01

We conducted a study designed to evaluate the efficacy and feasibility of a multilevel self-management intervention to improve nutritional intake in a group of older adults receiving Medicare home health services who were at especially high risk for experiencing undernutrition. The Behavioral Nutrition Intervention for Community Elders (B-NICE) trial used a prospective randomized controlled design to determine whether individually tailored counseling focused on social and behavioral aspects of eating resulted in increased caloric intake and improved nutrition-related health outcomes in a high-risk population of older adults. The study was guided by the theoretical approaches of the Ecological Model and Social Cognitive Theory. The development and implementation of the B-NICE protocol, including the theoretical framework, methodology, specific elements of the behavioral intervention, and assurances of the treatment fidelity, as well as the health policy implications of the trial results, are presented in this article. PMID:22098180

Do children go for the nice guys? The influence of speaker benevolence and certainty on selective word learning.

PubMed

Bergstra, Myrthe; DE Mulder, Hannah N M; Coopmans, Peter

2018-04-06

This study investigated how speaker certainty (a rational cue) and speaker benevolence (an emotional cue) influence children's willingness to learn words in a selective learning paradigm. In two experiments four- to six-year-olds learnt novel labels from two speakers and, after a week, their memory for these labels was reassessed. Results demonstrated that children retained the label-object pairings for at least a week. Furthermore, children preferred to learn from certain over uncertain speakers, but they had no significant preference for nice over nasty speakers. When the cues were combined, children followed certain speakers, even if they were nasty. However, children did prefer to learn from nice and certain speakers over nasty and certain speakers. These results suggest that rational cues regarding a speaker's linguistic competence trump emotional cues regarding a speaker's affective status in word learning. However, emotional cues were found to have a subtle influence on this process.

The topography of generosity: asymmetric evaluations of prosocial actions.

PubMed

Klein, Nadav; Epley, Nicholas

2014-12-01

Prosociality is considered a virtue. Those who care for others are admired, whereas those who care only for themselves are despised. For one's reputation, it pays to be nice. Does it pay to be even nicer? Four experiments assess reputational inferences across the entire range of prosocial outcomes in zero-sum interactions, from completely selfish to completely selfless actions. We observed consistent nonlinear evaluations: Participants evaluated selfish actions more negatively than equitable actions, but they did not evaluate selfless actions markedly more favorably than equitable actions. This asymptotic pattern reflected monotonic evaluations for increasingly selfish actions and insensitivity to increasingly selfless actions. It pays to be nice but not to be really nice. Additional experiments suggest that this pattern stems partly from failing to make spontaneous comparisons between varying degrees of selflessness. We suggest that these reputational incentives could guide social norms, encouraging equitable actions but discouraging extremely selfless actions. PsycINFO Database Record (c) 2014 APA, all rights reserved.

Alcohol and sexual health in young people: the role of PSHE.

PubMed

Rowlinson, Louise

2014-12-01

This paper explores the relationship between sexual health and alcohol in young people in contemporary society, and the role of personal, social and health and economic education (PSHE). This research was prompted by the decision of the Department of Health (DH) not to publish National Institute for Health and Care Excellence (NICE) guidance on PSHE in January 2011. The guidance was requested following a Department for Education internal review into PSHE education. This paper will review qualitative and quantitative research, and data pertaining to the issue of sexual health behaviour and alcohol use among young people in the UK and the role of PSHE education. NICE guidance remains the 'gold standard' for evidence-based healthcare service provision and its implications for sexually transmitted infection and teenage pregnancy rates remains a high priority. Equally, research supports that addressing the issue of alcohol is an increasing priority in young people. This paper will argue that the NICE PSHE review findings should be updated, published and implemented.

Memories of good deeds past: The reinforcing power of prosocial behavior in children.

PubMed

Tasimi, Arber; Young, Liane

2016-07-01

Does considering one's past prosociality affect future behavior? Prior research has revealed instances in which adults engage in additional prosocial behavior-moral reinforcement-as well as instances in which adults engage in worse behavior-moral licensing. The current study examined the developmental origins of these effects by testing whether 6- to 8-year-old children (N=225) are more or less generous after recalling their own good deeds. Children were asked to recount a time when they were nice, were mean, or watched a movie. Children behaved more generously after recalling a time when they were nice. We show that this boost in generosity was not simply the result of instructing children to consider nice behavior; children's giving did not increase after recalling others' good deeds. We also show that, even after recounting multiple instances of their past goodness, children continue to behave more generously. These findings suggest that doing good leads to more good in children. Copyright © 2016 Elsevier Inc. All rights reserved.

Tool calibration system for micromachining system

DOEpatents

Miller, Donald M.

1979-03-06

A tool calibration system including a tool calibration fixture and a tool height and offset calibration insert for calibrating the position of a tool bit in a micromachining tool system. The tool calibration fixture comprises a yokelike structure having a triangular head, a cavity in the triangular head, and a port which communicates a side of the triangular head with the cavity. Yoke arms integral with the triangular head extend along each side of a tool bar and a tool head of the micromachining tool system. The yoke arms are secured to the tool bar to place the cavity around a tool bit which may be mounted to the end of the tool head. Three linear variable differential transformer's (LVDT) are adjustably mounted in the triangular head along an X axis, a Y axis, and a Z axis. The calibration insert comprises a main base which can be mounted in the tool head of the micromachining tool system in place of a tool holder and a reference projection extending from a front surface of the main base. Reference surfaces of the calibration insert and a reference surface on a tool bar standard length are used to set the three LVDT's of the calibration fixture to the tool reference position. These positions are transferred permanently to a mastering station. The tool calibration fixture is then used to transfer the tool reference position of the mastering station to the tool bit.

Blood transfusion practice in the UK and Ireland: a survey of palliative care physicians.

PubMed

Neoh, Karen; Stanworth, Simon; Bennett, Michael I

2018-03-23

Red cell (blood) transfusions are used in palliative care to manage patients with symptomatic anaemia or when patients have lost blood. We aimed to understand current blood transfusion practice among palliative medicine doctors and compare this with National Institute for Health and Care Excellence (NICE) guidance. NICE guidance advocates more restrictive transfusion practice but is based on clinical trials in non-palliative care contexts; the extent to which these findings should be applied to palliative care remains unclear. Four clinical vignettes of common clinical palliative care scenarios were developed. Members of the Association for Palliative Medicine were invited to complete the survey. Results were compared with acceptable responses based on current NICE recommendations and analysed to determine the influence of respondents' gender, experience or work setting. 27% of 1070 members responded. Overall, ideal or acceptable responses were selected by less than half of doctors to all four vignettes. Doctors were more liberal in prescribing blood transfusions than NICE guidance would advocate. Senior doctors were less likely to choose an acceptable response than junior colleagues. Palliative care practice is varied and not consistent with a restrictive blood transfusion policy. More recently trained doctors follow less liberal practices than senior colleagues. More direct evidence of benefits and harms of blood transfusion is needed in palliative care to inform practice. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Deliberating Tarceva: A case study of how British NHS managers decide whether to purchase a high-cost drug in the shadow of NICE guidance.

PubMed

Hughes, David; Doheny, Shane

2011-11-01

This paper examines audio-recorded data from meetings in which NHS managers decide whether to fund high-cost drugs for individual patients. It investigates the work of a Welsh individual patient commissioning (IPC) panel responsible for sanctioning the purchase of 'un-commissioned' treatments for exceptional cases. The case study presented highlights the changing rationales used for approving or denying a cancer drug, Tarceva, during a period when NICE first suggested it was not cost effective, but then changed its position in a final technology appraisal recommending use when the cost did not exceed that of an alternative product. Our data show how decisions taken in the shadow of NICE guidance remain complex and subject to local discretion. Guidance that takes time to prepare, is released in stages, and relates to particular disease stages, must be interpreted in the context of particular cases. The case-based IPC panel discourse stands in tension with the standardised population-based recommendations in guidance. Panel members, who based their decisions on the central notions of 'efficacy' and 'exceptionality', often struggled to apply NICE information on cost-effectiveness to their deliberations on efficacy (clinical effectiveness). The case study suggests that the complex nature of decision making makes standardization of outcomes very difficult to achieve, so that local professional judgement is likely to remain central to health care rationing at this level. Copyright © 2011 Elsevier Ltd. All rights reserved.

Walking Through the Impulse-Momentum Theorem

NASA Astrophysics Data System (ADS)

Haugland, Ole Anton

2013-02-01

Modern force platforms are handy tools for investigating forces during human motion. Earlier they were very expensive and were mostly used in research laboratories. But now even platforms that can measure in two directions are quite affordable. In this work we used the PASCO 2-Axis Force Platform. The analysis of the data can serve as a nice illustration of qualitative or quantitative use of the impulse-momentum theorem p - p0 = ∫t0t Fdt = I. The most common use of force platforms is to study the force from the base during the push-off period of a vertical jump. I think this is an activity of great value, and I would recommend it. The use of force platforms in teaching is well documented in research literature.1-4

Validation of the large-scale Lagrangian cirrus model CLaMS-Ice by in-situ measurements

NASA Astrophysics Data System (ADS)

Costa, Anja; Rolf, Christian; Grooß, Jens-Uwe; Afchine, Armin; Spelten, Nicole; Dreiling, Volker; Zöger, Martin; Krämer, Martina

2015-04-01

Cirrus clouds are an element of uncertainty in the climate system and have received increasing attention since the last IPCC reports. The interaction of varying freezing meachanisms, sedimentation rates, temperature and updraft velocity fluctuations and other factors that lead to the formation of those clouds is still not fully understood. During the ML-Cirrus campaign 2014 (Germany), the new cirrus cloud model CLaMS-Ice (see Rolf et al., EGU 2015) has been used for flight planning to direct the research aircraft HALO into interesting cirrus cloud regions. Now, after the campaign, we use our in-situ aircraft measurements to validate and improve this model - with the long-term goal to enable it to simulate cirrus cloud cover globally, with reasonable computing times and sufficient accuracy. CLaMS-Ice consists of a two-moment bulk model established by Spichtinger and Gierens (2009a, 2009b), which simulates cirrus clouds along trajectories that the Lagrangian model CLaMS (McKenna et al., 2002 and Konopka et al. 2007) derived from ECMWF data. The model output covers temperature, pressure, relative humidity, ice water content (IWC), and ice crystal numbers (Nice). These parameters were measured on board of HALO by the following instruments: temperature and pressure by BAHAMAS, total and gas phase water by the hygrometers FISH and SHARC (see Meyer et al 2014, submitted to ACP), and Nice as well as ice crystal size distributions by the cloud spectrometer NIXE-CAPS (see also Krämer et al., EGU 2015). Comparisons of the model results with the measurements yield that cirrus clouds can be successfully simulated by CLaMS-Ice. However, there are sections in which the model's relative humidity and Nice deviate considerably from the measured values. This can be traced back to e.g. the initialization of total water from ECMWF data. The simulations are therefore reinitiated with the total water content measured by FISH. Other possible sources of uncertainties are investigated, as imposed temperature fluctuations, numbers and efficencies of heterogeneous ice nuclei or assumptions concerning the sedimentation rates. This contribution sums up the results of these investigations and outlines future work on CLaMS-Ice, that will lead to a tool helping to understand the cirrus clouds under the different environmental conditions during ML-Cirrus.

[An increase of infective endocarditis cases in England seen with concomitant reduction in antibiotic prophylaxis since the implementation of NICE guidelines in 2008: possible explanations].

PubMed

Tiberi, Simon; Pink, Frederick; Jayakumar, Angelina; Arioli, Francesco

2015-01-01

Dayer and colleagues recently reported in The Lancet an increased incidence of infective endocarditis in England since 2008, year of NICE guideline on the restriction of antibiotic prophylaxis. They observed a concomitant decrease in the use of antibiotic prophylaxis. The temporal link between reduction of prophylaxis prescribing and increase of infective endocarditis raises the question of whether there is a causal association. In view of this observation, should we rethink antibiotic prophylaxis to prevent infective endocarditis?

External cavity diode laser-based detection of trace gases with NICE-OHMS using current modulation.

PubMed

Centeno, R; Mandon, J; Cristescu, S M; Axner, O; Harren, F J M

2015-03-09

We combine an external cavity diode laser with noise-immune cavity-enhanced optical heterodyne molecular spectroscopy (NICE-OHMS) using current modulation. With a finesse of 1600, we demonstrate noise equivalent absorption sensitivities of 4.1 x 10(-10) cm(-1) Hz(-1/2), resulting in sub-ppbv detection limits for Doppler-broadened transitions of CH(4) at 6132.3 cm(-1), C(2)H(2) at 6578.5 cm(-1) and HCN at 6541.7 cm(-1). The system is used for hydrogen cyanide detection from sweet almonds.

BOOK REVIEW: String Theory in a Nutshell

NASA Astrophysics Data System (ADS)

Skenderis, Kostas

2007-11-01

The book 'String Theory in a Nutshell' by Elias Kiritsis provides a comprehensive introduction to modern string theory. String theory is the leading candidate for a theory that successfully unifies all fundamental forces of nature, including gravity. The subject has been continuously developing since the early 1970s, with classic textbooks on the subject being those of Green, Schwarz and Witten (1987) and Polchinski (1998). Since the latter was published there have been substantial developments, in particular in understanding black holes and gravity/gauge theory dualities. A textbook treatment of this important material is clearly needed, both by students and researchers in string theory and by mathematicians and physicists working in related fields. This book has a good selection of material, starting from basics and moving into classic and modern topics. In particular, Kiritsis' presentation of the basic material is complementary to that of the earlier textbooks and he includes a number of topics which are not easily found or covered adequately elsewhere, for example, loop corrections to string effective couplings. Overall the book nicely covers the major advances of the last ten years, including (non-perturbative) string dualities, black hole physics, AdS/CFT and matrix models. It provides a concise but fairly complete introduction to these subjects which can be used both by students and by researchers. Moreover the emphasis is on results that are reasonably established, as is appropriate for a textbook; concise summaries are given for subjects which are still in flux, with references to relevant reviews and papers. A positive feature of the book is that the bibliography sections at the end of each chapter provide a comprehensive guide to the literature. The bibliographies point to reviews and pedagogical papers on subjects covered in this book as well as those that were omitted. It is rare for a textbook to contain such a self-contained and detailed guide to the literature. In all, the book contains nearly five hundred exercises for the graduate-level student, which are useful both in teaching courses on string theory and for those who are studying by themselves. A nice feature of this book is that references are made to specific pages earlier in the book, rather than to chapters, which is helpful for students working through the book on their own. In summary,'String Theory in a Nutshell'is a valuable addition to the existing string theory textbooks; it is complementary to the previous books and gives a good treatment of subsequent developments. It is likely to become a staple reference on the subject, used both by students and researchers.

Ciliary heterogeneity within a single cell: the Paramecium model.

PubMed

Aubusson-Fleury, Anne; Cohen, Jean; Lemullois, Michel

2015-01-01

Paramecium is a single cell able to divide in its morphologically differentiated stage that has many cilia anchored at its cell surface. Many thousands of cilia are thus assembled in a short period of time during division to duplicate the cell pattern while the cell continues swimming. Most, but not all, of these sensory cilia are motile and involved in two main functions: prey capture and cell locomotion. These cilia display heterogeneity, both in their length and their biochemical properties. Thanks to these properties, as well as to the availability of many postgenomic tools and the possibility to follow the regrowth of cilia after deciliation, Paramecium offers a nice opportunity to study the assembly of the cilia, as well as the genesis of their diversity within a single cell. In this paper, after a brief survey of Paramecium morphology and cilia properties, we describe the tools and the protocols currently used for immunofluorescence, transmission electron microscopy, and ultrastructural immunocytochemistry to analyze cilia, with special recommendations to overcome the problem raised by cilium diversity. Copyright © 2015. Published by Elsevier Inc.

The implementation of nice guidance on venous thromboembolism risk assessment and prophylaxis: a before-after observational study to assess the impact on patient safety across four hospitals in England

PubMed Central

2013-01-01

Background Venous thromboembolism (VTE) is a major cause of morbidity and mortality in hospitalised patients. VTE prevention has been identified as a major health need internationally to improve patient safety. A National Institute for Health and Clinical Excellence (NICE) guideline was issued in February 2010. Its key priorities were to assess patients for risk of VTE on admission to hospital, assess patients for bleeding risk and evaluate the risks and benefits of prescribing VTE prophylaxis. The aim of this study was to evaluate the implementation of NICE guidance and its impact on patient safety. Methods A before-after observational design was used to investigate changes in VTE risk assessment documentation and inappropriate prescribing of prophylaxis between the year prior to (2009) and the year following (2010) the implementation of NICE guidance, using data from a 3-week period during each year. A total of 408 patients were sampled in each year across four hospitals in the NHS South region. Results Implementation strategies such as audit, education and training were used. The percentage of patients for whom a VTE risk assessment was documented increased from 51.5% (210/408) in 2009 to 79.2% (323/408) in 2010; difference 27.7% (95% CI: 21.4% to 33.9%; p < 0.001). There was little evidence of change in the percentage who were prescribed prophylaxis amongst patients without a risk assessment (71.7% (142/198) in 2009 and 68.2% (58/85) in 2010; difference −3.5% (95% CI: -15.2% to 8.2%; p =0.56) nor the percentage who were prescribed low molecular weight heparin amongst patients with a contraindication (14% (4/28) in 2009 and 15% (6/41) in 2010; RD = 0.3% (95% CI: -16.5% to 17.2%; p =0.97). Conclusions The documentation of risk assessment improved following the implementation of NICE guidance; it is questionable, however, whether this led to improved patient safety with respect to prescribing appropriate prophylaxis. PMID:23734903

Comparing the costs of three prostate cancer follow-up strategies: a cost minimisation analysis.

PubMed

Pearce, Alison M; Ryan, Fay; Drummond, Frances J; Thomas, Audrey Alforque; Timmons, Aileen; Sharp, Linda

2016-02-01

Prostate cancer follow-up is traditionally provided by clinicians in a hospital setting. Growing numbers of prostate cancer survivors mean that this model of care may not be economically sustainable, and a number of alternative approaches have been suggested. The aim of this study was to develop an economic model to compare the costs of three alternative strategies for prostate cancer follow-up in Ireland-the European Association of Urology (EAU) guidelines, the National Institute of Health Care Excellence (NICE) guidelines and current practice. A cost minimisation analysis was performed using a Markov model with three arms (EAU guidelines, NICE guidelines and current practice) comparing follow-up for men with prostate cancer treated with curative intent. The model took a health care payer's perspective over a 10-year time horizon. Current practice was the least cost efficient arm of the model, the NICE guidelines were most cost efficient (74 % of current practice costs) and the EAU guidelines intermediate (92 % of current practice costs). For the 2562 new cases of prostate cancer diagnosed in 2009, the Irish health care system could have saved €760,000 over a 10-year period if the NICE guidelines were adopted. This is the first study investigating costs of prostate cancer follow-up in the Irish setting. While economic models are designed as a simplification of complex real-world situations, these results suggest potential for significant savings within the Irish health care system associated with implementation of alternative models of prostate cancer follow-up care.

Peer-teaching of evidence-based medicine.

PubMed

Rees, Eliot; Sinha, Yashashwi; Chitnis, Abhishek; Archer, James; Fotheringham, Victoria; Renwick, Stephen

2014-07-01

Many medical schools teach the principles of evidence-based medicine (EBM) as part of their undergraduate curriculum. Medical students perceive that EBM is valuable to their undergraduate and postgraduate career. Students may experience barriers to applying EBM principles, especially when searching for evidence or identifying high-quality resources. The UK National Institute for Health and Care Excellence (NICE) Evidence Search is a service that enables access to authoritative clinical and non-clinical evidence and best practice through a web-based portal. Evidence-based medicine workshops were organised and delivered by fourth-year medical students, having first received training from NICE to become NICE student champions. The workshops covered the basic principles of EBM and focused on retrieving EBM resources for study through the NICE Evidence Search portal. The scheme was evaluated using a pre-workshop survey and an 8-12 week post-workshop survey. Self-reported confidence in searching for evidence-based resources increased from 29 per cent before the workshop to 87 per cent after the workshop. Only 1 per cent of students rated evidence-based resources as their first preference pre-workshop, compared with 31 per cent post-workshop. The results show that although many students were aware of evidence-based resources, they tended not to use them as their preferred resource. Despite appreciating the value of evidence-based resources, few students were confident in accessing and using such resources for pre-clinical study. A peer-taught workshop in EBM improved students' confidence with, and use of, evidence-based resources. © 2014 John Wiley & Sons Ltd.

Having your cake and eating it: office of fair trading proposal for funding new drugs to benefit patients and innovative companies.

PubMed

Godman, Brian; Haycox, Alan; Schwabe, Ulrich; Joppi, Roberta; Garattini, Silvio

2008-01-01

There are insufficient resources in the UK to fund all new technologies and new indications approved by the National Institute for Health and Clinical Excellence (NICE). Diverting funding from existing sources will have a detrimental effect on the provision of other priority services. The UK Office of Fair Trading (OFT) recently suggested a value-based pricing approach that appears workable but has generated considerable debate. Their proposal of a 25% premium for the originator product once generics are available is more generous than seen in a number of other European countries, where typically only the lowest priced product is reimbursed. The OFT proposal for a maximum 50% premium for patent-protected products, versus the prices of generics in a class or related classes, is also more generous than the proposed reforms for the pricing of proton pump inhibitors in Sweden or current reforms in Germany. In our opinion, the OFT proposals are persuasive and in accordance with the reforms seen in other European countries, and therefore should be adopted. The alternatives to fully funding new drugs or new indications as approved by NICE are either tightening the cost per QALY threshold, giving NICE an annual national budget to fund its advice alongside suggested areas for disinvestment, proactively switching patients from high-cost brand-name drugs to generics, or further delaying funding for new drugs and new indications approved by NICE. The majority of these suggestions are not in the best interests of patients or innovative pharmaceutical companies seeking to reap the rewards of their efforts.

Using Nice-Ohvms Lineshapes to Study Relaxation Rates and Transition Dipole Moments

NASA Astrophysics Data System (ADS)

Hodges, James N.; McCall, Benjamin J.

2016-06-01

Noise Immune Cavity Enhanced Optical Heterodyne Velocity Modulation Spectroscopy (NICE-OHVMS) is a successful technique that we have developed to sensitively, precisely, and accurately record transitions of molecular ions. It has been used exclusively as a method for precise transition frequency measurement via saturation and fitting of the resultant Lamb dips. NICE-OHVMS has been employed to improve the uncertainties on H_3^+, CH_5^+, HeH^+, and OH^+, reducing the transition frequency uncertainties by two orders of magnitude. Because NICE-OHVMS is a saturation technique, this provides a unique opportunity to access information about the ratio of the transition dipole moment to the relaxation rate of the transition. This can be done in two ways, either through comparison of Lamb dip depth to the transition profile or comparison of the absorption intensity and dispersion intensity. Due to the complexity of the modulation scheme, there are many parameters that affect the apparent intensity of the recorded lineshape. A complete understanding of the lineshape is required to make the measurements of interest. Here we present a model that accounts for the heterodyne modulation and velocity modulation, assuming that the fundamental lineshape is represented by a Voigt profile. Fits to data are made and interpreted in order to extract the saturation parameter. K.N. Crabtree et al., Chem. Phys. Lett. 551, 1 (2012). J.N. Hodges et al., J. Chem. Phys. 139, 164201 (2013). A.J. Perry et al., J. Mol. Spectrosc. 317, 71 (2015). A.J. Perry et al., J. Chem. Phys. 141, 101101 (2014). C.R. Marcus et al., Astrophys. J. 817, 138 (2016).

Non-ischemic cerebral enhancing lesions secondary to endovascular aneurysm therapy: nickel allergy or foreign body reaction? Case series and review of the literature.

PubMed

Shotar, Eimad; Law-Ye, Bruno; Baronnet-Chauvet, Flore; Zeidan, Sinead; Psimaras, Dimitri; Bielle, Franck; Pecquet, Catherine; Navarro, Soledad; Rosso, Charlotte; Cohen, Fleur; Chiras, Jacques; Di Maria, Federico; Sourour, Nader; Clarençon, Frédéric

2016-09-01

Delayed onset of non-ischemic cerebral enhancing (NICE) lesions is a rare complication of intracranial aneurysms' endovascular therapy (EVT). The purpose of this study is to report this rare complication and its potential pathophysiology in a single-center case series and review the relevant literature. After retrospective review of all patients managed by EVT at our institution from January 1, 2012 to December 31, 2014, 2 out of 374 patients (0.5 %) with such a complication were identified. Skin patch testing was performed with all endovascular devices used in the two patients and with the European baseline series, including nickel. All previously published cases in the English literature were reviewed based on exhaustive PubMed and Embase research. Patient no. 1 developed NICE lesions 1 month after balloon-assisted coiling of a ruptured anterior communicating artery aneurysm. Patient no. 2 developed NICE lesions 12 months (the longest delay reported to date for such a complication) after the treatment of a right carotid-ophthalmic aneurysm by loose coiling and flow diversion. Patient no. 2 demonstrated nickel skin reactivity, but none of the two patients presented allergic reaction to the devices used during interventions. Based on our observations and review of the literature, we hypothesize that delayed non-ischemic cerebral enhancing lesions after EVT are more likely related to foreign body emboli rather than nickel allergy. The two presented cases demonstrate the potential for recurrence and prolonged fluctuation of NICE lesions, warranting long-term follow-up for all patients presenting this complication.

Nutritional rehabilitation after ICU - does it happen: a qualitative interview and observational study.

PubMed

Merriweather, Judith; Smith, Pam; Walsh, Timothy

2014-03-01

To compare and contrast current nutritional rehabilitation practices against recommendations from National Institute for Health and Excellence guideline Rehabilitation after critical illness (NICE) (2009, http://www.nice.org.uk/cg83). Recovery from critical illness has gained increasing prominence over the last decade but there is remarkably little research relating to nutritional rehabilitation. The study is a qualitative study based on patient interviews and observations of ward practice. Seventeen patients were recruited into the study at discharge from the intensive care unit (ICU) of a large teaching hospital in central Scotland in 2011. Semi-structured interviews were conducted on transfer to the ward and weekly thereafter. Fourteen of these patients were followed up at three months post-ICU discharge, and a semi-structured interview was carried out. Observations of ward practice were carried out twice weekly for the duration of the ward stay. Current nutritional practice for post-intensive care patients did not reflect the recommendations from the NICE guideline. A number of organisational issues were identified as influencing nutritional care. These issues were categorised as ward culture, service-centred delivery of care and disjointed discharge planning. Their influence on nutritional care was compounded by the complex problems associated with critical illness. The NICE guideline provides few nutrition-specific recommendations for rehabilitation; however, current practice does not reflect the nutritional recommendations that are detailed in the rehabilitation care pathway. Nutritional care of post-ICU patients is problematic and strategies to overcome these issues need to be addressed in order to improve nutritional intake. © 2013 John Wiley & Sons Ltd.

Searching for Chips of Kuiper Belt Objects in Meteorites

NASA Technical Reports Server (NTRS)

Zolensky, M. E.; Ohsumi, K.; Briani, G.; Gounelle, M.; Mikouchi, T.; Satake, W.; Kurihara, T.; Weisberg, M. K.; Le, L.

2009-01-01

The Nice model [1&2] describes a scenario whereby the Jovian planets experienced a violent reshuffling event approx.3:9 Ga the giant planets moved, existing small body reservoirs were depleted or eliminated, and new reservoirs were created in particular locations. The Nice model quantitatively explains the orbits of the Jovian planets and Neptune [1], the orbits of bodies in several different small body reservoirs in the outer solar system (e.g., Trojans of Jupiter [2], the Kuiper belt and scattered disk [3], the irregular satellites of the giant planets [4], and the late heavy bombardment on the terrestrial planets approx.3:9 Ga [5]. This model is unique in plausibly explaining all of these phenomena. One issue with the Nice model is that it predicts that transported Kuiper Belt Objects (KBOs) (things looking like D class asteroids) should predominate in the outer asteroid belt, but we know only about 10% of the objects in the outer main asteroid belt appear to be D-class objects [6]. However based upon collisional modeling, Bottke et al. [6] argue that more than 90% of the objects captured in the outer main belt could have been eliminated by impacts if they had been weakly-indurated objects. These disrupted objects should have left behind pieces in the ancient regoliths of other, presumably stronger asteroids. Thus, a derived prediction of the Nice model is that ancient regolith samples (regolith-bearing meteorites) should contain fragments of collisionally-destroyed Kuiper belt objects. In fact KBO pieces might be expected to be present in most ancient regolith- bearing meteorites [7&8].

The MAGEC system for spinal lengthening in children with scoliosis: A NICE Medical Technology Guidance.

PubMed

Jenks, Michelle; Craig, Joyce; Higgins, Joanne; Willits, Iain; Barata, Teresa; Wood, Hannah; Kimpton, Christine; Sims, Andrew

2014-12-01

Scoliosis-structural lateral curvature of the spine-affects around four children per 1,000. The MAGEC system comprises a magnetically distractible spinal rod implant and an external remote controller, which lengthens the rod; this system avoids repeated surgical lengthening. Rod implants brace the spine internally and are lengthened as the child grows, preventing worsening of scoliosis and delaying the need for spinal fusion. The Medical Technologies Advisory Committee at the National Institute for Health and Care Excellence (NICE) selected the MAGEC system for evaluation in a NICE medical technologies guidance. Six studies were identified by the sponsor (Ellipse Technologies Inc.) as being relevant to the decision problem. Meta-analysis was used to compare the clinical evidence results with those of one conventional growth rod study, and equal efficacy of the two devices was concluded. The key weakness was selection of a single comparator study. The External Assessment Centre (EAC) identified 16 conventional growth rod studies and undertook meta-analyses of relevant outcomes. Its critique highlighted limitations around study heterogeneity and variations in baseline characteristics and follow-up duration, precluding the ability to draw firm conclusions. The sponsor constructed a de novo costing model showing that MAGEC rods generated cost savings of £9,946 per patient after 6 years, compared with conventional rods. The EAC critiqued and updated the model structure and inputs, calculating robust cost savings of £12,077 per patient with MAGEC rods compared with conventional rods over 6 years. The year of valuation was 2012. NICE issued a positive recommendation as supported by the evidence (Medical Technologies Guidance 18).

Time-efficient simulations of tight-binding electronic structures with Intel Xeon PhiTM many-core processors

NASA Astrophysics Data System (ADS)

Ryu, Hoon; Jeong, Yosang; Kang, Ji-Hoon; Cho, Kyu Nam

2016-12-01

Modelling of multi-million atomic semiconductor structures is important as it not only predicts properties of physically realizable novel materials, but can accelerate advanced device designs. This work elaborates a new Technology-Computer-Aided-Design (TCAD) tool for nanoelectronics modelling, which uses a sp3d5s∗ tight-binding approach to describe multi-million atomic structures, and simulate electronic structures with high performance computing (HPC), including atomic effects such as alloy and dopant disorders. Being named as Quantum simulation tool for Advanced Nanoscale Devices (Q-AND), the tool shows nice scalability on traditional multi-core HPC clusters implying the strong capability of large-scale electronic structure simulations, particularly with remarkable performance enhancement on latest clusters of Intel Xeon PhiTM coprocessors. A review of the recent modelling study conducted to understand an experimental work of highly phosphorus-doped silicon nanowires, is presented to demonstrate the utility of Q-AND. Having been developed via Intel Parallel Computing Center project, Q-AND will be open to public to establish a sound framework of nanoelectronics modelling with advanced HPC clusters of a many-core base. With details of the development methodology and exemplary study of dopant electronics, this work will present a practical guideline for TCAD development to researchers in the field of computational nanoelectronics.

Decreasing Caregivers' Positive Attitudes Toward Spanking.

PubMed

Burkhart, Kimberly; Knox, Michele; Hunter, Kimberly; Pennewitt, Deanna; Schrouder, Karyssa

2018-02-19

The Play Nicely program is a multimedia training program designed to teach caregivers and health care professionals how to manage early childhood aggression and to use positive parenting practices. The aim of this article is to help the practicing clinician determine whether the Play Nicely program should be incorporated into his/her practice and to evaluate whether the program is effective at decreasing positive attitudes toward spanking in a socioeconomically disadvantaged population in both a resident pediatric clinic and a community center. Thirty-three caregivers of children aged 2 to 5 years viewed the Play Nicely program and completed pre- and post-training questionnaires. Decreased positive attitudes toward spanking were reported after training. Favorable attitudes toward spanking were associated with increased use of harsher discipline and higher child externalizing behavior. This study provides support that this brief intervention is effective in a socioeconomically disadvantaged population, is portable, and can be used in a group setting. This program may serve as a prevention and population-based approach to addressing the adverse childhood experience of spanking. Copyright © 2017 National Association of Pediatric Nurse Practitioners. Published by Elsevier Inc. All rights reserved.

The role of health economics in the evaluation of surgery and operative technologies.

PubMed

Taylor, Matthew

2017-02-01

Dr Matthew Taylor is the director of York Health Economics Consortium and leads the Consortium's health technology assessment program. The work of York Health Economics Consortium involves empirical research in health economics for both the private and public sectors. Dr Taylor is the scientific lead for the National Institute for Health and Care Excellence (NICE) Economic and Methodological Unit and a former member of NICE's Public Health Advisory Committee. He is also managing director (Europe) of Minerva, an international network of health economics consultancies. Copyright © 2016 Elsevier Inc. All rights reserved.

A primary care audit of familial risk in patients with a personal history of breast cancer.

PubMed

Nathan, Paul; Ahluwalia, Aneeta; Chorley, Wendy

2014-12-01

Breast cancer is the most common cancer diagnosed in women, both in the UK and worldwide. A small proportion of women are at very high risk of breast cancer, having a particularly strong family history. The National Institute for Health and Clinical Excellence (NICE) has advised that practitioners should not, in most instances, actively seek to identify women with a family history of breast cancer. An audit was undertaken at an urban primary care practice of 15,000 patients, using a paper-based, self-administered questionnaire sent to patients identified with a personal history of breast cancer. The aim of this audit was to determine whether using targeted screening of relatives of patients with breast cancer to identify familial cancer risk is worthwhile in primary care. Since these patients might already expected to have been risk assessed following their initial diagnosis, this audit acts as a quality improvement exercise. The audit used a validated family history questionnaire and risk assessment tool as a screening approach for identifying and grading familial risk in line with the NICE guidelines, to guide referral to the familial cancer screening service. The response rate to family history questionnaires was 54 % and the majority of patients responded positively to their practitioner seeking to identify familial cancer risks in their family. Of the 57 returned questionnaires, over a half (54 %) contained pedigrees with individuals eligible for referral. Patients and their relatives who are often registered with the practice welcome the discussion. An appropriate referral can therefore be made. The findings suggest a role for primary care practitioners in the identification of those at higher familial risk. However integrated systems and processes need designing to facilitate this work.

The effects of the NICE Technology Appraisal 121 (gliadel and temozolomide) on survival in high-grade glioma.

PubMed

Barr, James Geoffrey; Grundy, Paul L

2012-12-01

The prognosis of high-grade glioma (HGG) is poor with a median survival of about 1 year for glioblastoma. In 2007, NICE published a technology appraisal (TA121) recommending the use of carmustine wafers (Gliadel) and systemic therapy with temozolomide for selected patients with HGG. Outcomes for HGG surgery in the United Kingdom with these combined treatments have not been published. Retrospective audit of consecutive patients in a single unit with carmustine wafer implantation. Fifty-nine patients had carmustine wafers implanted at primary surgery, between October 2005 and October 2010 at Wessex Neurological Centre, Southampton, UK. Patients were given chemotherapeutic treatments strictly according to NICE TA121. Survival was calculated using Kaplan-Meier method. Fifty-five patients had WHO grade IV tumours and four had grade III. Median age was 61 years. At follow-up, 39 patients had died. Median survival was 15.3 months. Eight patients (13.5%) experienced post-operative complications (including five infections) for which four had the carmustine wafers removed. Forty-seven (80%) patients were treated with radical radiotherapy (55-60 Gy) and six (10%) patients received palliative radiotherapy (30 Gy). Thirty-seven patients (63%) received concomitant temozolomide chemotherapy. In the subset of 37 patients receiving multimodal treatment with radical radiotherapy and concomitant temozolomide, median survival was 15.8 months compared with 7.4 months in those not receiving multimodal treatment. Carmustine wafers for primary HGG surgery in accordance with the NICE TA121 were associated with a median survival of 15.3 months; this is improved compared with previously reported randomised trials. Multimodal treatment with carmustine wafers, radical radiotherapy and concomitant temozolomide was associated with improved survival. Increased incidence of infections was observed in cases receiving carmustine wafers.

Development of Advanced Eco-hydrologic and Biogeochemical Coupling Model to Constrain Missing Role of Inland Waters on Boundless Biogeochemical Cycle

NASA Astrophysics Data System (ADS)

Nakayama, T.; Maksyutov, S. S.

2016-12-01

Inland waters including rivers, lakes, and groundwater are suggested to act as a transport pathway for water and dissolved substances, and play some role in continental biogeochemical cycling (Cole et al., 2007; Battin et al., 2009). The authors have developed process-based National Integrated Catchment-based Eco-hydrology (NICE) model (Nakayama, 2014, 2015, etc.), which includes feedback between hydrologic-geomorphic-ecological processes. In this study, NICE was further developed to couple with various biogeochemical cycle models in biosphere, those for water quality in aquatic ecosystems, and those for carbon weathering, etc. (NICE-BGC) (Nakayama, accepted). The new model incorporates connectivity of the biogeochemical cycle accompanied by hydrologic cycle between surface water and groundwater, hillslopes and river networks, and other intermediate regions. The model also includes reaction between inorganic and organic carbons, and its relation to nitrogen and phosphorus in terrestrial-aquatic continuum. The model results of CO2 evasion to the atmosphere, sediment storage, and carbon transport to the ocean (DOC, POC, and DIC flux) were reasonably in good agreement with previous compiled data. The model also showed carbon budget in major river basins and in each continent in global scale. In order to decrease uncertainty about carbon cycle, it became clear the previous empirical estimation by compiled data should be extended to this process-oriented model and higher resolution data to further clarify mechanistic interplay between inorganic and organic carbon and its relationship to nitrogen and phosphorus in terrestrial-aquatic linkages. NICE-BGC would play important role to re-evaluate greenhouse gas budget of the biosphere, and to bridge gap between top-down and bottom-up approaches (Battin et al., 2009; Regnier et al., 2013).

The structure of the distant Kuiper belt in a Nice model scenario

NASA Astrophysics Data System (ADS)

Pike, Rosemary E.; Lawler, Samantha; Brasser, Ramon; Shankman, Cory; Alexandersen, Mike; Kavelaars, J. J.

2016-10-01

By utilizing a well-sampled migration model and characterized survey detections, we demonstrate that the Nice-model scenario results in consistent populations of scattering trans-Neptunian objects (TNOs) and several resonant TNO populations, but fails to reproduce the large population of 5:1 resonators discovered in surveys. We examine in detail the TNO populations implanted by the Nice model simulation from Brasser and Morbidelli (2013, B&M). This analysis focuses on the region from 25-155 AU, probing the classical, scattering, detached, and major resonant populations. Additional integrations were necessary to classify the test particles and determine population sizes and characteristics. The classified simulation objects are compared to the real TNOs from the Canada-France Ecliptic Plane Survey (CFEPS), CFEPS high latitude fields, and the Alexandersen (2016) survey. These surveys all include a detailed characterization of survey depth, pointing, and tracking efficiency, which allows detailed testing of this independently produced model of TNO populations. In the B&M model, the regions of the outer Solar System populated via capture of scattering objects are consistent with survey constraints. The scattering TNOs and most n:1 resonant populations have consistent orbital distributions and population sizes with the real detections, as well as a starting disk mass consistent with expectations. The B&M 5:1 resonators have a consistent orbital distribution with the real detections and previous models. However, the B&M 5:1 Neptune resonance is underpopulated by a factor of ~100 and would require a starting proto-planetesimal disk with a mass of ~100 Earth masses. The large population in the 5:1 Neptune resonance is unexplained by scattering capture in a Nice-model scenario, however this model accurately produces the TNO subpopulations that result from scattering object capture and provides additional insight into sub-population orbital distributions.

Genetic testing for BRCA1: effects of a randomised study of knowledge provision on interest in testing and long term test uptake; implications for the NICE guidelines.

PubMed

Hall, Julia; Gray, Susan; A'Hern, Roger; Shanley, Susan; Watson, Maggie; Kash, Kathryn; Croyle, Robert; Eeles, Rosalind

2009-01-01

Interest in searching for mutations in BRCA1 and BRCA2 is high. Knowledge regarding these genes and the advantages and limitations of genetic testing is limited. It is unknown whether increasing knowledge about breast cancer genetic testing alters interest in testing. Three hundred and seventy nine women (260 with a family history of breast cancer; 119 with breast cancer) from The Royal Marsden NHS Foundation Trust were randomised to receive or not receive written educational information on cancer genetics. A questionnaire was completed assessing interest in BRCA1 testing and knowledge on breast cancer genetics and screening. Actual uptake of BRCA1 testing is reported with a six year follow-up. Eighty nine percent of women at risk of breast cancer and 76% of women with breast cancer were interested in BRCA1 testing (P < 0.0001). Provision of educational information did not affect level of interest. Knowledge about breast cancer susceptibility genes was poor. According to the NICE guidelines regarding eligibility for BRCA1 and BRCA2 testing, the families of 66% of the at risk group and 13% of the women with breast cancer would be eligible for testing (probability of BRCA1 mutation >or=20%). Within six years of randomisation, genetic testing was actually undertaken on 12 women, only 10 of whom would now be eligible, on the NICE guidelines. There is strong interest in BRCA1 testing. Despite considerable ignorance of factors affecting the inheritance of breast cancer, education neither reduced nor increased interest to undergo testing. The NICE guidelines successfully triage those with a high breast cancer risk to be managed in cancer genetics clinics.

National Survey of Neurosurgeons and Stroke Physicians on Decompressive Hemicraniectomy for Malignant Middle Cerebral Artery Infarction.

PubMed

Basu, Pallavi; Jenkins, Harri; Tsang, Kevin; Vakharia, Vejay N

2017-06-01

Several studies have evaluated the use of decompressive hemicraniectomy (DHC) in malignant middle cerebral artery infarction (MMCAI). In the United Kingdom, the National Institute for Health and Care Excellence (NICE) has set criteria for selection of patients for DHC in MMCAI. We set out to survey the attitudes and practice of neurosurgeons and stroke physicians within the United Kingdom towards DHC in MMCAI. An electronic survey of questions on management of MMCAI in various clinical scenarios was submitted to the academic committees of the Society of British Neurological Surgeons and the British Association of Stroke Physicians for approval before dissemination through the consultant members. Responses were collected over 2 months. A total of 78 responses, from 51 neurosurgeons and 27 stroke physicians, were included in final analysis. A total of 54% and 24% of all respondents would recommend DHC in patients aged 60-70 and 70-80 years, respectively; 60% would advocate surgery between 48 and 72 hours and 27% beyond 72 hours. A total of 36% indicated DHC with preoperative Glasgow Coma Scale 15/15. These findings do not conform to current NICE guidelines. Stroke physicians were statistically more likely to recommend DHC in patients older than 60 years (P = 0.032) and in those with dominant multiterritorial infarcts (P = 0.042) and accept a greater postoperative modified Rankin Scale (P = 0.034) compared with neurosurgeons. In view of evidence from recent trials and differences in NICE guidelines and current clinical practice within the United Kingdom, based on our survey results, it is important to reevaluate NICE guidelines. Crown Copyright © 2017. Published by Elsevier Inc. All rights reserved.

Health technology adoption and the politics of governance in the UK.

PubMed

Milewa, Timothy

2006-12-01

The manner in which clinical and cost-effectiveness data are used to inform decisions about the funding and availability of drugs, therapies and medical devices is inherently politicised within collectively financed systems of health care. The National Institute for Health and Clinical Excellence (NICE) was established by the British government in 1999 to reach evidence-based decisions on whether selected health technologies should be made available by the National Health Service in England and Wales. But NICE is also required to involve a broad range of interested parties in the decision-making process, provide detailed rationales for its rulings and defend appeals from aggrieved parties. Debates about the emergence of "deliberative" forms of policy governance--based upon participation by a broad range of stakeholders rather than reliance on scientific, bureaucratic or political expertise alone--are thus particularly apposite. This article draws on a study of decision-making within NICE by focusing upon the tenor and orientation of deliberation about the adoption of health technologies. Does such deliberation take place upon a level playing field for different interests? Or do implicit parameters and understandings in the deliberative process tend to privilege some interests by structuring debate and attendant outcomes? Findings suggest that deliberative assumptions and parameters pertaining to fluid and contestable ideas of transparent reasoning and domain competence both reflect and shape relationships of influence and marginality among participants. Broader analytical implications centre on a distinction between "deliberative democracy" and "democratic deliberation". The extent to which this distinction is acknowledged and addressed in policy and practise will have marked implications for the substantive nature of attempts to broaden involvement in decision-making within public sector bodies such as NICE.

Application of the Canadian CT head rules in managing minor head injuries in a UK emergency department: implications for the implementation of the NICE guidelines

PubMed Central

Sultan, H; Boyle, A; Pereira, M; Antoun, N; Maimaris, C

2004-01-01

Objective: : In 2002 a new protocol was introduced based on the Canadian CT rules. Before this the Royal College of Surgeons "Galasko" report guidelines had been followed. This study evaluates the effects of the protocol and discusses the impact of the implementation of the NICE head injury guidelines—also based on the Canadian CT rules. Methods: A "before and after" study was undertaken, using data from accident and emergency cards and hospital notes of adult patients with head injuries presenting to the emergency department over seven months in 2001 and nine months in 2002. The two groups were compared to see how rates of computed tomography (CT), admission for observation, discharge, and skull radiography had changed after introduction of the protocol. Results: : Head CT rates in patients with minor head injuries (MHI) increased significantly from 47 of 330 (14%) to 58 of 267 (20%) (p<0.05). There were also significantly increased rates of admission for observation, from 111 (34%) to 119 (45%). Skull radiography rates fell considerably from 33% of all patients with head injuries in 2001 to 1.6% in 2002, without any adverse effect. Conclusions: This study shows that it is possible to replace the current practice in the UK of risk stratification of adult MHI based on skull radiography, with slightly modified versions of the Canadian CT rule/NICE guidelines. This will result in a large reduction in skull radiography and will be associated with modest increases in CT and admissions rates. If introduction of the NICE guideline is to be realistic, the study suggests that it will not be cost neutral. PMID:15208222

[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.

Achieving high-quality care: a view from NICE.

PubMed

Leng, Gillian; Partridge, Gemma

2018-01-01

The National Institute for Health and Care Excellence (NICE) was established in 1999 to provide evidence-based guidance. The task of producing guidance by reviewing primary research data and using an advisory committee to develop evidence-based recommendations, is not straightforward. Guidance production is, however, less challenging than the task of putting evidence-based recommendations into practice.NICE is very sensitive to this challenge as, since 1999, over 1500 pieces of NICE guidance have been published. A number of pieces of guidance relate to heart disease, including pharmaceutical agents, new medical technologies and clinical guidelines. Examples include guidelines on acute heart failure and atrial fibrillation, and advice on technologies including edoxaban and implantable cardioverter defibrillators.The research evidence is clear that a change in practice rarely comes about as a result of simply disseminating guidance on best practice. Simple dissemination is particularly ineffective if the guidance has not been produced by a well-respected, credible organisation. It is also clear from the literature that implementation is more successful when more than one approach is taken, and when there is alignment between efforts at organisational, local and national levels.At an organisational level, there should be support from the Board for quality improvement, with ongoing measurement of progress. Resources should be provided for targeted change programmes, particularly where new guidance suggests improvements are required. A systematic process for putting change in place should include identifying barriers to change, agreeing interventions to overcome the barriers and drive forward improvement and planning for implementation and evaluation. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Comparative study of fluvial lakes in floodplains of the Elbe, Lužnice and Svratka Rivers based on hydrochemical and biological approach.

PubMed

Havlíková, Petra; Chuman, Tomáš; Janský, Bohumír

2017-11-17

The aim of the thesis was to specify key differences in chemistry and biota (zooplankton communities) among fluvial lakes in three regions of the Czech Republic: the central part of the Elbe River, the upper part of the Lužnice River and the upper part of the Svratka River. The ten studied lakes of the three regions differ in size, geology, shading, connection with the river and the level of anthropogenic impact. The following hypotheses were tested: (1) The water chemistry of fluvial lakes significantly differs in different floodplains. In the central Elbe River floodplain, there are the highest values of conductivity and concentrations of organic matter and nutrients. Fluvial lakes of the Svratka River floodplain show the lowest level of these parameters, and fluvial lakes of the upper Lužnice River have levels intermediate between the two previous regions. (2) The chemistry of fluvial lakes that have contact with the river through surface connection is significantly influenced by the river. (3) The structure of zooplankton differs in different lakes due to the geographical distance between locations, their different altitude and water chemistry. The PCA analysis of selected parameters of the water chemistry revealed a close relationship of locations in the central Elbe River floodplain on the one side and close relationship of the locations in the upper Lužnice River and Svratka River on the other. However, the amount of organic matter, nitrogen (with the exception of nitrates) and phosphorus was independent of the region. The relationship between the extent of the lake-river connection and the water chemistry was not significant. The hypothesis that the zooplankton differ in different lakes was not proved-the species composition was similar in all the lakes.

Integrating health technology assessment requirements in the clinical development of medicines: the experience from NICE scientific advice.

PubMed

Maignen, François; Osipenko, Leeza; Pinilla-Dominguez, Pilar; Crowe, Emily

2017-03-01

The primary objective of the study was to analyse the proposed clinical development and economic evaluation plans for investigational medicinal products for which pharmaceutical companies have sought health technology assessment (HTA) scientific advice (SA). We have selected and analysed all the scientific advice procedures undertaken by National Institute for Health and Care Excellence (NICE) SA between 1 January 2009 and 3 December 2015 for investigational medicinal products. We have mapped the questions asked by the companies and the areas of advice highlighted in the advice reports to the sections of the NICE methods guide to the technology appraisals (2013). An overwhelming proportion of SA procedures have addressed questions related to the clinical development and specifically the main pivotal efficacy studies. Approximately a quarter of the questions relate to the approaches to economic evaluation. Questions raised in European Medicines Agency-HTA procedures generally focus on clinical efficacy issues whereas cost-effectiveness ones tend to dominate in NICE-only procedures. Our analysis shows that the issues mostly discussed in the HTA SA are the choice of comparator, the generalisability of the clinical trial evidence to the NHS practice and the impact of the clinical trial outcomes on quality of life and survival. Less disagreement with the developers' plans was seen in the choice of clinical endpoints, population definition, position of the technology in the treatment pathway and study design. Scientific advice is designed to improve the quality of evidence and approaches to evidence generation for future regulatory approval and HTA evaluation. Our experience to date suggests that payer requirements are inconsistently integrated in the clinical development programmes. More efforts should be dedicated to demonstrating the clinical value of new medicinal products to patients and key decision-makers.

Use of economic evaluation in local health care decision-making in England: a qualitative investigation.

PubMed

Eddama, Oya; Coast, Joanna

2009-03-01

To explore decision-making and the use of economic evaluation at the local health care decision-making level in England (UK). Data collection was over a 16-month period (January 2003 to April 2004). Data collection comprised 29 in-depth interviews with a range of decision makers, 13 observations of decision-making meetings, and analysis of documents produced at meetings. A constant comparative approach was used to identify broad themes and sub-themes arising from the data. Data were analysed using Microsoft Word. National Institute for Health and Clinical Excellence (NICE) guidance provides the main way in which economic evaluation is used at a local level in the UK, although following NICE guidance is often regarded as detrimental to pursuing local priorities. Other than through NICE, economic evaluation is not considered at the local level; we found no evidence for use at the meeting group (by individuals). Although decision makers appear to understand notions of scarcity, with some also referring to value for money, the process of decision-making departs from these principles in practice. Disinvestment decisions are not made nor are decisions weighted against pre-defined criteria. Options appraisal is conducted, but it does not embody the principles of economic evaluation, since options are not considered in terms of their costs and benefits and opportunity cost is not accounted for. There appear to be two reasons why economic evaluation is not used at the local level: (1) the nature of management decisions concerned with the employment of extra staff and new equipment, rather than the choice of medicines or specific interventions usually assessed in published economic evaluation; (2) lack of awareness of the economic evaluation approach to decision-making. These two factors point to a lack of freedom in decision-making at the local level and a lack of understanding of how priority setting can be achieved in practice. A more detailed and rigorous approach to prioritisation at the local level is required. Whilst, PCTs have been given greater responsibility for priority setting, they lack the necessary power and understanding of the ways in which long term solutions to problems in health care can be achieved. Economics can be a valuable asset to priority setting and has already filtered into the jargon used by decision makers. Whilst most concepts are understood, the leap to adopting these concepts into the practice of decision-making needs to be made.

Working Together, Before We're all at Sea

NASA Astrophysics Data System (ADS)

Bricher, P.; Newman, L.; Diggs, S. C.

2016-02-01

Wouldn't it be nice to know who is going to be sailing where next summer? There have been many attempts to build a portal to share information about future field plans in the Southern Ocean, and these have thus far met with limited success in terms of capacity and and take-up. There is, however, considerable optimism about the future potential for such a tool, with at least a dozen multi-nation research and field initiatives planning to develop such tools for their own research communities. There is a clear appetite among researchers for a tool to spark conversations well in advance of field seasons that lead to better use of scarce field resources. Ironically though, one of the biggest challenges to the successful development of such a tool is a lack of communication among the groups that are trying to develop such portals. A second major challenge is a lack of resources to properly develop, test, and maintain such portals. The Southern Ocean Observing System (SOOS) is holding conversations among data managers and multi-nation research initiatives to develop a tool of maximum utility for all. We propose a common backbone, in the form of a single integrated database based on open-source code, that meets the needs of oceanographers, biologists, other researchers, and program managers. Customised data entry forms and web visualisations can then be built off this to better target it to the needs of individual groups, without sacrificing interoperability. A further advantage of this approach is that we can marshal the resources of all groups to produce the best field planning tool possible. In this presentation, we will share the lessons learned so far, and invite further collaboration.

Preset pivotal tool holder

DOEpatents

Asmanes, Charles

1979-01-01

A tool fixture is provided for precise pre-alignment of a radiused edge cutting tool in a tool holder relative to a fixed reference pivot point established on said holder about which the tool holder may be selectively pivoted relative to the fixture base member to change the contact point of the tool cutting edge with a workpiece while maintaining the precise same tool cutting radius relative to the reference pivot point.

Characteristics and use of urban health indicator tools by municipal built environment policy and decision-makers: a systematic review protocol.

PubMed

Pineo, Helen; Glonti, Ketevan; Rutter, Harry; Zimmermann, Nicole; Wilkinson, Paul; Davies, Michael

2017-01-13

There is wide agreement that there is a lack of attention to health in municipal environmental policy-making, such as urban planning and regeneration. Explanations for this include differing professional norms between health and urban environment professionals, system complexity and limited evidence for causality between attributes of the built environment and health outcomes. Data from urban health indicator (UHI) tools are potentially a valuable form of evidence for local government policy and decision-makers. Although many UHI tools have been specifically developed to inform policy, there is poor understanding of how they are used. This study aims to identify the nature and characteristics of UHI tools and their use by municipal built environment policy and decision-makers. Health and social sciences databases (ASSIA, Campbell Library, EMBASE, MEDLINE, Scopus, Social Policy and Practice and Web of Science Core Collection) will be searched for studies using UHI tools alongside hand-searching of key journals and citation searches of included studies. Advanced searches of practitioner websites and Google will also be used to find grey literature. Search results will be screened for UHI tools, and for studies which report on or evaluate the use of such tools. Data about UHI tools will be extracted to compile a census and taxonomy of existing tools based on their specific characteristics and purpose. In addition, qualitative and quantitative studies about the use of these tools will be appraised using quality appraisal tools produced by the UK National Institute for Health and Care Excellence (NICE) and synthesised in order to gain insight into the perceptions, value and use of UHI tools in the municipal built environment policy and decision-making process. This review is not registered with PROSPERO. This systematic review focuses specifically on UHI tools that assess the physical environment's impact on health (such as transport, housing, air quality and greenspace). This study will help indicator producers understand whether this form of evidence is of value to built environment policy and decision-makers and how such tools should be tailored for this audience. N/A.

Looking beyond satisfaction: evaluating the value and impact of information skills training.

PubMed

Raynor, Michael; Craven, Jenny

2015-03-01

In this feature guest writers Michael Raynor and Jenny Craven from the National Institute for Health and Care Excellence (NICE) present an overview of their evaluative research study on the value and impact of the information skills training courses they provide at NICE. In particular, this small study used a combination of qualitative and quantitative data to look beyond satisfaction and confidence levels and identify whether learning had actually taken place as a result of attending the sessions, and how new skills were used by the attendees in their day-to-day work. H.S. © 2015 Health Libraries Journal.

Reshaping policy to deliver holistic care for adolescents with Crohn's disease.

PubMed

Smith, Claudia; Gettings, Sheryl

2016-12-08

The number of adolescents with Crohn's disease (CD) is rising, with one third of cases diagnosed before turning 21 years old. Evidence shows that long-term medical intervention, school absence and the physical toll of CD on the growing adolescent also have a psychological effect on patients. In addition, poorly defined transition pathways are extending these problems into adulthood. The National Institute for Health and Care Excellence (NICE) guidelines are important in shaping service delivery and distribution. However, analysis of the full 2012 NICE CD management guidelines indicates they fall short of providing adequate recommendations for holistic management of the disease in young populations. An update in 2016 added a new clinical recommendation to the guidelines, but no further exploration of the psychosocial aspects of the impact of the disease. The authors of this article used a critical review of literature and concluded that service provision for adolescents with CD could be made better by improving CD support networks, involving young people in the development of policy centred on their care, as well as incorporating other (non-NICE) well-researched CD guidelines in national policy. These changes would improve quality of life for this vulnerable population.

Impact of NICE guidance on rates of haemorrhage after tonsillectomy: an evaluation of guidance issued during an ongoing national tonsillectomy audit.

PubMed

Audit, National Prospective Tonsillectomy

2008-08-01

The National Institute for Health and Clinical Excellence (NICE) issued guidance on surgical techniques for tonsillectomy during a national audit of surgical practice and postoperative complications. To assess the impact of the guidance on tonsillectomy practice and outcomes. An interrupted time-series analysis of routinely collected Hospital Episodes Statistics data, and an analysis of longitudinal trends in surgical technique using data from the National Prospective Tonsillectomy Audit. Patients undergoing tonsillectomy in English NHS hospitals between January 2002 and December 2004. Postoperative haemorrhage within 28 days. The rate of haemorrhage increased by 0.5% per year from 2002, reaching 6.4% when the guidance was published. After publication, the rate of haemorrhage fell immediately to 5.7% (difference 0.7%: 95% CI -1.3% to 0.0%) and the rate of increase appeared to have stopped. Data from the National Prospective Tonsillectomy Audit showed that the fall coincided with a shift in surgical techniques, which was consistent with the guidance. NICE guidance influenced surgical tonsillectomy technique and in turn produced an immediate fall in postoperative haemorrhage. The ongoing national audit and strong support from the surgical specialist association may have aided its implementation.

ICP-MS determination of trace elements in aerosols using a dynamic reaction cell: first results in PM10 comparing road and aerial traffic in Nice area (France).

PubMed

Fabretti, Jean-François; Sauret, Nathalie; Gal, Jean-François; Maria, Pierre-Charles; Schärer, Urs

2007-09-01

An analytical methodology was developed for the determination of 21 trace elements in suspended particulate matter (PM) using a microwave digestion procedure associated with an inductively coupled plasma mass spectrometry (ICP-MS). The dynamic reaction cell (DRC) of the instrument was carefully optimized to eliminate polyatomic species causing spectral interferences for three specified elements (Cr, Fe, Mn). With this method, the detection limits based on the analysis of seven quartz fibre filters (QFF) considering a one-week sample (250 m3) varied between 0.2 and 650 pg m(-3) for trace elements and between 2.1 and 5.6 ng m(-3) for major elements (Fe, Ti, Zn). The recovery of the analytes was tested with NIST SRM 1648 urban dust within 10% of the certified values only for 3-4 mg of material. The first results were discussed for a field campaign which was carried out simultaneously in the heaviest traffic road tunnel of the centre of Nice and near the landing-taking-off runways in the international airport of Nice Côte d'Azur. The behaviour of some combustion tracers was especially studied.

Do English NHS Microbiology laboratories offer adequate services for the diagnosis of UTI in children? Healthcare Quality Improvement Partnership (HQIP) Audit of Standard Operational Procedures.

PubMed

McNulty, Cliodna A M; Verlander, Neville Q; Moore, Philippa C L; Larcombe, James; Dudley, Jan; Banerjee, Jaydip; Jadresic, Lyda

2015-09-01

The National Institute of Care Excellence (NICE) 2007 guidance CG54, on urinary tract infection (UTI) in children, states that clinicians should use urgent microscopy and culture as the preferred method for diagnosing UTI in the hospital setting for severe illness in children under 3 years old and from the GP setting in children under 3 years old with intermediate risk of severe illness. NICE also recommends that all 'infants and children with atypical UTI (including non-Escherichia coli infections) should have renal imaging after a first infection'. We surveyed all microbiology laboratories in England with Clinical Pathology Accreditation to determine standard operating procedures (SOPs) for urgent microscopy, culture and reporting of children's urine and to ascertain whether the SOPs facilitate compliance with NICE guidance. We undertook a computer search in six microbiology laboratories in south-west England to determine urine submissions and urine reports in children under 3 years. Seventy-three per cent of laboratories (110/150) participated. Enterobacteriaceae that were not E. coli were reported only as coliforms (rather than non-E. coli coliforms) by 61% (67/110) of laboratories. Eighty-eight per cent of laboratories (97/110) provided urgent microscopy for hospital and 54% for general practice (GP) paediatric urines; 61% of laboratories (confidence interval 52-70%) cultured 1 μl volume of urine, which equates to one colony if the bacterial load is 106 c.f.u. l(-1). Only 22% (24/110) of laboratories reported non-E. coli coliforms and provided urgent microscopy for both hospital and GP childhood urines; only three laboratories also cultured a 5 μl volume of urine. Only one of six laboratories in our submission audit had a significant increase in urine submissions and urines reported from children less than 3 years old between the predicted pre-2007 level in the absence of guidance and the 2008 level following publication of the NICE guidance. Less than a quarter of laboratories were providing a service that would allow clinicians to fully comply with the first line recommendations in the 2007 NICE UTI in children guidance. Laboratory urine submission report figures suggest that the guidance has not led to an increase in diagnosis of UTI in children under 3 years old.

Implementing the NICE osteoarthritis guidelines: a mixed methods study and cluster randomised trial of a model osteoarthritis consultation in primary care--the Management of OsteoArthritis In Consultations (MOSAICS) study protocol.

PubMed

Dziedzic, Krysia S; Healey, Emma L; Porcheret, Mark; Ong, Bie Nio; Main, Chris J; Jordan, Kelvin P; Lewis, Martyn; Edwards, John J; Jinks, Clare; Morden, Andrew; McHugh, Gretl A; Ryan, Sarah; Finney, Andrew; Jowett, Sue; Oppong, Raymond; Afolabi, Ebenezer; Pushpa-Rajah, Angela; Handy, June; Clarkson, Kris; Mason, Elizabeth; Whitehurst, Tracy; Hughes, Rhian W; Croft, Peter R; Hay, Elaine M

2014-08-27

There is as yet no evidence on the feasibility of implementing recommendations from the National Institute of Health and Care Excellence (NICE) osteoarthritis (OA) guidelines in primary care, or of the effect these recommendations have on the condition. The primary aim of this study is to determine the clinical and cost effectiveness of a model OA consultation (MOAC), implementing the core recommendations from the NICE OA guidelines in primary care. Secondary aims are to investigate the impact, feasibility and acceptability of the MOAC intervention; to develop and evaluate a training package for management of OA by general practitioners (GPs) and practice nurses; test the feasibility of deriving 'quality markers' of OA management using a new consultation template and medical record review; and describe the uptake of core NICE OA recommendations in participants aged 45 years and over with joint pain. A mixed methods study with a nested cluster randomised controlled trial. This study was developed according to a defined theoretical framework (the Whole System Informing Self-management Engagement). An overarching model (the Normalisation Process Theory) will be employed to undertake a comprehensive 'whole-system' evaluation of the processes and outcomes of implementing the MOAC intervention. The primary outcome is general physical health (Short Form-12 Physical component score [PCS]) (Ware 1996). The impact, acceptability and feasibility of the MOAC intervention at practice level will be assessed by comparing intervention and control practices using a Quality Indicators template and medical record review. Impact and acceptability of the intervention for patients will be assessed via self-completed outcome measures and semi-structured interviews. The impact, acceptability and feasibility of the MOAC intervention and training for GPs and practice nurses will be evaluated using a variety of methods including questionnaires, semi-structured interviews, and observations. The main output from the study will be to determine whether the MOAC intervention is clinically and cost effective. Additional outputs will be the development of the MOAC for patients consulting with joint pain in primary care, training and educational materials, and resources for patients and professionals regarding supported self-management and uptake of NICE guidance. ISRCTN number: ISRCTN06984617.

Exploring hyperspectral imaging data sets with topological data analysis.

PubMed

Duponchel, Ludovic

2018-02-13

Analytical chemistry is rapidly changing. Indeed we acquire always more data in order to go ever further in the exploration of complex samples. Hyperspectral imaging has not escaped this trend. It quickly became a tool of choice for molecular characterisation of complex samples in many scientific domains. The main reason is that it simultaneously provides spectral and spatial information. As a result, chemometrics has provided many exploration tools (PCA, clustering, MCR-ALS …) well-suited for such data structure at early stage. However we are today facing a new challenge considering the always increasing number of pixels in the data cubes we have to manage. The idea is therefore to introduce a new paradigm of Topological Data Analysis in order explore hyperspectral imaging data sets highlighting its nice properties and specific features. With this paper, we shall also point out the fact that conventional chemometric methods are often based on variance analysis or simply impose a data model which implicitly defines the geometry of the data set. Thus we will show that it is not always appropriate in the framework of hyperspectral imaging data sets exploration. Copyright © 2017 Elsevier B.V. All rights reserved.

[Suicide Risk Assessment in the Clinical Practice Guidelines for the Diagnosis and Management of Depression in Colombia].

PubMed

Gómez Restrepo, Carlos; Bohórquez Peñaranda, Adriana Patricia; Gil Lemus, Laura Marcela; Jaramillo, Luis Eduardo; García Valencia, Jenny; Bravo Narváez, Eliana; de la Hoz Bradford, Ana María; Palacio, Carlos

2013-01-01

Suicide is the most serious complications of depression. It has high associated health costs and causes millions of deaths worldwide per year. Given its implications, it is important to know the factors that increase the risk of its occurrence and the most useful tools for addressing it. To identify the signs and symptoms that indicate an increased risk of suicide, and factors that increase the risk in patients diagnosed with depression. To establish the tools best fitted to identify suicide risk in people with depression. Clinical practice guidelines were developed, following those of the methodmethodological guidelines of the Ministry of Social Protection, to collect evidence and to adjust recommendations. Recommendations from the NICE90 and CANMAT guidelines were adopted and updated for questions found in these guidelines, while new recommendations were developed for questions not found in them. Basic points and recommendations are presented from a chapter of the clinical practice guidelines on depressive episodes and recurrent depressive disorder related to suicide risk assessment. Their corresponding recommendation levels are included. Copyright © 2013 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España. All rights reserved.

Reviews

NASA Astrophysics Data System (ADS)

2007-07-01

WE RECOMMEND God: The Failed Hypothesis A book that applies scientific logic to the search for a creator Go with the Flow This CD-ROM proves a great resource for teaching fluids Collins GCSE Student Book for EdExcel 360 Additional Science An attractive update that will sit well in modern classrooms The Rough Guide to Climate Change This book contains a thorough study of the must-teach subject InspireData Presentation software ideal for analysing data in the field WORTH A LOOK Uncertain Science...Uncertain World A book to persuade the public that unanswered questions are not a failure of science or scientists Fisher Space Pen An interesting teaching resource and a nice bit of stationery HANDLE WITH CARE Russian Space Pen A joke gift at best—no physics here IGCSE Physics for EdExcel Dull, old-fashioned approach to teaching the new qualification WEB WATCH How news headlines can prove a valuable tool to get pupils interested in a subject

Simulations of Scatterometry Down to 22 nm Structure Sizes and Beyond with Special Emphasis on LER

NASA Astrophysics Data System (ADS)

Osten, W.; Ferreras Paz, V.; Frenner, K.; Schuster, T.; Bloess, H.

2009-09-01

In recent years, scatterometry has become one of the most commonly used methods for CD metrology. With decreasing structure size for future technology nodes, the search for optimized scatterometry measurement configurations gets more important to exploit maximum sensitivity. As widespread industrial scatterometry tools mainly still use a pre-set measurement configuration, there are still free parameters to improve sensitivity. Our current work uses a simulation based approach to predict and optimize sensitivity of future technology nodes. Since line edge roughness is getting important for such small structures, these imperfections of the periodic continuation cannot be neglected. Using fourier methods like e.g. rigorous coupled wave approach (RCWA) for diffraction calculus, nonperiodic features are hard to reach. We show that in this field certain types of fieldstitching methods show nice numerical behaviour and lead to useful results.

Handheld tools assess medical necessity at the point of care.

PubMed

Pollard, Dan

2002-01-01

An emerging strategy to manage financial risk in clinical practice is to involve the physician at the point of care. Using handheld technology, encounter-specific information along with medical necessity policy can be presented to physicians allowing them to integrate it into their medical decision-making process. Three different strategies are discussed: reference books or paper encounter forms, electronic reference tools, and integrated process tools. The electronic reference tool strategy was evaluated and showed a return on investment exceeding 1200% due to reduced overhead costs associated with rework of claim errors.

Machine tool locator

DOEpatents

Hanlon, John A.; Gill, Timothy J.

2001-01-01

Machine tools can be accurately measured and positioned on manufacturing machines within very small tolerances by use of an autocollimator on a 3-axis mount on a manufacturing machine and positioned so as to focus on a reference tooling ball or a machine tool, a digital camera connected to the viewing end of the autocollimator, and a marker and measure generator for receiving digital images from the camera, then displaying or measuring distances between the projection reticle and the reference reticle on the monitoring screen, and relating the distances to the actual position of the autocollimator relative to the reference tooling ball. The images and measurements are used to set the position of the machine tool and to measure the size and shape of the machine tool tip, and examine cutting edge wear. patent

Fingerprint chromatogram analysis of Pseudostellaria heterophylla (Miq.) Pax root by high performance liquid chromatography.

PubMed

Han, Chao; Chen, Junhui; Chen, Bo; Lee, Frank Sen-Chun; Wang, Xiaoru

2006-09-01

A simple and reliable high performance liquid chromatographic (HPLC) method has been developed and validated for the fingerprinting of extracts from the root of Pseudostellaria heterophylla (Miq.) Pax. HPLC with gradient elution was performed on an authentic reference standard of powdered P. heterophylla (Miq.) Pax root and 11 plant samples of the root were collected from different geographic locations. The HPLC chromatograms have been standardized through the selection and identification of reference peaks and the normalization of retention times and peak intensities of all the common peaks. The standardized HPLC fingerprints show high stability and reproducibility, and thus can be used effectively for the screening analysis or quality assessment of the root or its derived products. Similarity index calculations based on cosine angle values or correlation methods have been performed on the HPLC fingerprints. As a group, the fingerprints of the P. heterophylla (Miq.) Pax samples studied are highly correlated with closely similar fingerprints. Within the group, the samples can be further divided into subgroups based on hierarchical clustering analysis (HCA). Sample grouping based on HCA coincides nicely with those based on the geographical origins of the samples. The HPLC fingerprinting techniques thus have high potential in authentication or source-tracing types of applications.

Direct and indirect reputation formation in nonhuman great apes (Pan paniscus, Pan troglodytes, Gorilla gorilla, Pongo pygmaeus) and human children (Homo sapiens).

PubMed

Herrmann, Esther; Keupp, Stefanie; Hare, Brian; Vaish, Amrisha; Tomasello, Michael

2013-02-01

Humans make decisions about when and with whom to cooperate based on their reputations. People either learn about others by direct interaction or by observing third-party interactions or gossip. An important question is whether other animal species, especially our closest living relatives, the nonhuman great apes, also form reputations of others. In Study 1, chimpanzees, bonobos, orangutans, and 2.5-year-old human children experienced a nice experimenter who tried to give food/toys to the subject and a mean experimenter who interrupted the food/toy giving. In studies 2 and 3, nonhuman great apes and human children could only passively observe a similar interaction, in which a nice experimenter and a mean experimenter interacted with a third party. Orangutans and 2.5-year-old human children preferred to approach the nice experimenter rather than the mean one after having directly experienced their respective behaviors. Orangutans, chimpanzees, and 2.5-year-old human children also took into account experimenter actions toward third parties in forming reputations. These studies show that the human ability to form direct and indirect reputation judgment is already present in young children and shared with at least some of the other great apes. PsycINFO Database Record (c) 2013 APA, all rights reserved

PAQ: Partition Analysis of Quasispecies.

PubMed

Baccam, P; Thompson, R J; Fedrigo, O; Carpenter, S; Cornette, J L

2001-01-01

The complexities of genetic data may not be accurately described by any single analytical tool. Phylogenetic analysis is often used to study the genetic relationship among different sequences. Evolutionary models and assumptions are invoked to reconstruct trees that describe the phylogenetic relationship among sequences. Genetic databases are rapidly accumulating large amounts of sequences. Newly acquired sequences, which have not yet been characterized, may require preliminary genetic exploration in order to build models describing the evolutionary relationship among sequences. There are clustering techniques that rely less on models of evolution, and thus may provide nice exploratory tools for identifying genetic similarities. Some of the more commonly used clustering methods perform better when data can be grouped into mutually exclusive groups. Genetic data from viral quasispecies, which consist of closely related variants that differ by small changes, however, may best be partitioned by overlapping groups. We have developed an intuitive exploratory program, Partition Analysis of Quasispecies (PAQ), which utilizes a non-hierarchical technique to partition sequences that are genetically similar. PAQ was used to analyze a data set of human immunodeficiency virus type 1 (HIV-1) envelope sequences isolated from different regions of the brain and another data set consisting of the equine infectious anemia virus (EIAV) regulatory gene rev. Analysis of the HIV-1 data set by PAQ was consistent with phylogenetic analysis of the same data, and the EIAV rev variants were partitioned into two overlapping groups. PAQ provides an additional tool which can be used to glean information from genetic data and can be used in conjunction with other tools to study genetic similarities and genetic evolution of viral quasispecies.

Predictors of fever-related admissions to a paediatric assessment unit, ward and reattendances in a South London emergency department: the CABIN 2 study.

PubMed

Bustinduy, Amaya L; Chis Ster, Irina; Shaw, Rebecca; Irwin, Adam; Thiagarajan, Jaiganesh; Beynon, Rhys; Ladhani, Shamez; Sharland, Mike

2017-01-01

To explore the risk factors for ward and paediatric assessment unit (PAU) admissions from the emergency department (ED). Prospective observational study. Febrile children attending a large tertiary care ED during the winter of 2014-2015. Ward and PAU admissions, National Institute for Health and Care Excellence (NICE) guidelines classification, reattendance to the ED within 28 days and antibiotic use. A total of 1097 children attending the children's ED with fever were analysed. Risk factors for PAU admission were tachycardia (RR=1.1, 95% CI (1 to 1.1)), ill-appearance (RR=2.2, 95% CI (1.2 to 4.2)), abnormal chest findings (RR=2.1, 95% CI (1.2 to 4.3)), categorised as NICE amber (RR 1.7 95% CI (1.2 to 2.5)). There was a 30% discordance between NICE categorisation at triage and statistical internal validation. Predictors of ward admission were a systemic (RR=6.9, 95% CI (2.4 to 19.8)) or gastrointestinal illness (RR=3.8, 95% (1.4 to 10.4)) and categorised as NICE Red (RR=5.9, 95% CI (2.2 to 15.3)). Only 51 children had probable bacterial pneumonia (4.6%), 52 children had a proven urinary tract infection (4.2%), with just 2 (0.2%) positive blood cultures out of 485 (44%) children who received an antibiotic. 15% of all children reattended by 28 days and were more likely to have been categorised as Amber and had investigations on initial visit. Risk factors for PAU and ward admissions are different in this setting with high reattendance rates and very low proportion of confirmed/probable serious bacterial infections. Future studies need to focus on reducing avoidable admissions and antibiotic treatment. 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/.

Iceless Icy Moons: Is the Nice Model In Trouble?

NASA Astrophysics Data System (ADS)

Dones, Henry C. Luke; Levison, H. F.

2012-05-01

Nimmo and Korycansky (2012; henceforth NK12) stated that if the outer Solar System underwent a Late Heavy Bombardment (LHB) in the Nice model, the mass striking the icy satellites at speeds up to tens of km/s would have vaporized so much ice that moons such as Mimas, Enceladus, and Miranda would have been devolatilized. NK12's possible explanations of this apparent discrepancy with observations include (1) the mass influx was a factor of 10 less than that in the Nice model; (2) the mass distribution of the impactors was top-heavy, so that luck might have saved some of the moons from suffering large, vapor-removing impacts; or (3) the inner moons formed after the LHB. NK12 calculated the mass influx onto the satellites from the lunar impact rate estimated by Gomes et al. (2005) and scaling factors calculated by Zahnle et al. (1998, 2003; also see Barr and Canup 2010). Production of vapor in hypervelocity impacts is calculated from Kraus et al. (2011). Our preliminary results show that there is about an order-of-magnitude uncertainty in the mass striking the satellites during the LHB, with NK12's estimate at the upper end of the range. We will discuss how the mass influx depends on the velocity and mass distributions of the impactors. The Nice model lives. We thank the NASA Lunar Science Institute (http://lunarscience.nasa.gov/) for support. Barr, A.C., Canup, R.M., Nature Geoscience 3, 164-167 (2010). Gomes, R., Levison, H.F., Tsiganis, K., Morbidelli, A., Nature 435, 466-469 (2005). Kraus, R.G., Senft, L.E., Stewart, S.T., Icarus 214, 724-738 (2011). Nimmo, F., Korycansky, D.G., Icarus, in press, http://www.sciencedirect.com/science/article/pii/S0019103512000310 (2012). Zahnle, K., Dones, L., Levison, H.F., Icarus 136, 202-222 (1998). Zahnle, K., Schenk, P., Levison, H.F., Dones, L., Icarus 163, 263-289 (2003).

N-ICE2015: Multi-disciplinary study of the young sea ice system north of Svalbard from winter to summer.

NASA Astrophysics Data System (ADS)

Steen, Harald; Granskog, Mats; Assmy, Philipp; Duarte, Pedro; Hudson, Stephen; Gerland, Sebastian; Spreen, Gunnar; Smedsrud, Lars H.

2016-04-01

The Arctic Ocean is shifting to a new regime with a thinner and smaller sea-ice area cover. Until now, winter sea ice extent has changed less than during summer, as the heat loss to the atmosphere during autumn and winter is large enough form an ice cover in most regions. The insulating snow cover also heavily influences the winter ice growth. Consequently, the older, thicker multi-year sea ice has been replace by a younger and thinner sea. These large changes in the sea ice cover may have dramatic consequences for ecosystems, energy fluxes and ultimately atmospheric circulation and the Northern Hemisphere climate. To study the effects of the changing Arctic the Norwegian Polar Institute, together with national and international partners, launched from January 11 to June 24, 2015 the Norwegian Young Sea ICE cruise 2015 (N-ICE2015). N-ICE2015 was a multi-disciplinary cruise aimed at simultaneously studying the effect of the Arctic Ocean changes in the sea ice, the atmosphere, in radiation, in ecosystems. as well as water chemistry. R/V Lance was frozen into the drift ice north of Svalbard at about N83 E25 and drifted passively southwards with the ice until she was broken loose. When she was loose, R/V Lance was brought back north to a similar starting position. While fast in the ice, she served as a living and working platform for 100 scientist and engineers from 11 countries. One aim of N-ICE2015 is to present a comprehensive data-set on the first year ice dominated system available for the scientific community describing the state and changes of the Arctic sea ice system from freezing to melt. Analyzing the data is progressing and some first results will be presented.

Impact of investigations in general practice on timeliness of referral for patients subsequently diagnosed with cancer: analysis of national primary care audit data.

PubMed

Rubin, G P; Saunders, C L; Abel, G A; McPhail, S; Lyratzopoulos, G; Neal, R D

2015-02-17

For patients with symptoms of possible cancer who do not fulfil the criteria for urgent referral, initial investigation in primary care has been advocated in the United Kingdom and supported by additional resources. The consequence of this strategy for the timeliness of diagnosis is unknown. We analysed data from the English National Audit of Cancer Diagnosis in Primary Care on patients with lung (1494), colorectal (2111), stomach (246), oesophagus (513), pancreas (327), and ovarian (345) cancer relating to the ordering of investigations by the General Practitioner and their nature. Presenting symptoms were categorised according to National Institute for Health and Care Excellence (NICE) guidance on referral for suspected cancer. We used linear regression to estimate the mean difference in primary-care interval by cancer, after adjustment for age, gender, and the symptomatic presentation category. Primary-care investigations were undertaken in 3198/5036 (64%) of cases. The median primary-care interval was 16 days (IQR 5-45) for patients undergoing investigation and 0 days (IQR 0-10) for those not investigated. Among patients whose symptoms mandated urgent referral to secondary care according to NICE guidelines, between 37% (oesophagus) and 75% (pancreas) were first investigated in primary care. In multivariable linear regression analyses stratified by cancer site, adjustment for age, sex, and NICE referral category explained little of the observed prolongation associated with investigation. For six specified cancers, investigation in primary care was associated with later referral for specialist assessment. This effect was independent of the nature of symptoms. Some patients for whom urgent referral is mandated by NICE guidance are nevertheless investigated before referral. Reducing the intervals between test order, test performance, and reporting can help reduce the prolongation of primary-care intervals associated with investigation use. Alternative models of assessment should be considered.

Impact of investigations in general practice on timeliness of referral for patients subsequently diagnosed with cancer: analysis of national primary care audit data

PubMed Central

Rubin, G P; Saunders, C L; Abel, G A; McPhail, S; Lyratzopoulos, G; Neal, R D

2015-01-01

Background: For patients with symptoms of possible cancer who do not fulfil the criteria for urgent referral, initial investigation in primary care has been advocated in the United Kingdom and supported by additional resources. The consequence of this strategy for the timeliness of diagnosis is unknown. Methods: We analysed data from the English National Audit of Cancer Diagnosis in Primary Care on patients with lung (1494), colorectal (2111), stomach (246), oesophagus (513), pancreas (327), and ovarian (345) cancer relating to the ordering of investigations by the General Practitioner and their nature. Presenting symptoms were categorised according to National Institute for Health and Care Excellence (NICE) guidance on referral for suspected cancer. We used linear regression to estimate the mean difference in primary-care interval by cancer, after adjustment for age, gender, and the symptomatic presentation category. Results: Primary-care investigations were undertaken in 3198/5036 (64%) of cases. The median primary-care interval was 16 days (IQR 5–45) for patients undergoing investigation and 0 days (IQR 0–10) for those not investigated. Among patients whose symptoms mandated urgent referral to secondary care according to NICE guidelines, between 37% (oesophagus) and 75% (pancreas) were first investigated in primary care. In multivariable linear regression analyses stratified by cancer site, adjustment for age, sex, and NICE referral category explained little of the observed prolongation associated with investigation. Interpretation: For six specified cancers, investigation in primary care was associated with later referral for specialist assessment. This effect was independent of the nature of symptoms. Some patients for whom urgent referral is mandated by NICE guidance are nevertheless investigated before referral. Reducing the intervals between test order, test performance, and reporting can help reduce the prolongation of primary-care intervals associated with investigation use. Alternative models of assessment should be considered. PMID:25602963

Do English NHS Microbiology laboratories offer adequate services for the diagnosis of UTI in children? Healthcare Quality Improvement Partnership (HQIP) Audit of Standard Operational Procedures

PubMed Central

Verlander, Neville Q.; Moore, Philippa C. L.; Larcombe, James; Dudley, Jan; Banerjee, Jaydip; Jadresic, Lyda

2015-01-01

The National Institute of Care Excellence (NICE) 2007 guidance CG54, on urinary tract infection (UTI) in children, states that clinicians should use urgent microscopy and culture as the preferred method for diagnosing UTI in the hospital setting for severe illness in children under 3 years old and from the GP setting in children under 3 years old with intermediate risk of severe illness. NICE also recommends that all ‘infants and children with atypical UTI (including non-Escherichia coli infections) should have renal imaging after a first infection’. We surveyed all microbiology laboratories in England with Clinical Pathology Accreditation to determine standard operating procedures (SOPs) for urgent microscopy, culture and reporting of children's urine and to ascertain whether the SOPs facilitate compliance with NICE guidance. We undertook a computer search in six microbiology laboratories in south-west England to determine urine submissions and urine reports in children under 3 years. Seventy-three per cent of laboratories (110/150) participated. Enterobacteriaceae that were not E. coli were reported only as coliforms (rather than non-E. coli coliforms) by 61 % (67/110) of laboratories. Eighty-eight per cent of laboratories (97/110) provided urgent microscopy for hospital and 54 % for general practice (GP) paediatric urines; 61 % of laboratories (confidence interval 52–70 %) cultured 1 μl volume of urine, which equates to one colony if the bacterial load is 106 c.f.u. l− 1. Only 22 % (24/110) of laboratories reported non-E. coli coliforms and provided urgent microscopy for both hospital and GP childhood urines; only three laboratories also cultured a 5 μl volume of urine. Only one of six laboratories in our submission audit had a significant increase in urine submissions and urines reported from children less than 3 years old between the predicted pre-2007 level in the absence of guidance and the 2008 level following publication of the NICE guidance. Less than a quarter of laboratories were providing a service that would allow clinicians to fully comply with the first line recommendations in the 2007 NICE UTI in children guidance. Laboratory urine submission report figures suggest that the guidance has not led to an increase in diagnosis of UTI in children under 3 years old. PMID:26297550

A regional audit of the use of COX-2 selective non-steroidal anti-inflammatory drugs (NSAIDs) in rheumatology clinics in the West Midlands, in relation to NICE guidelines.

PubMed

Price-Forbes, A N; Callaghan, R; Allen, M E; Rowe, I F

2005-07-01

Whilst all non-steroidal anti-inflammatory drugs (NSAIDs) can cause adverse gastrointestinal events, COX-2-selective inhibitors (COX-2) may have improved gastrointestinal safety compared with non-selective NSAIDs (NSNSAIDs). In 2001, the National Institute for Clinical Excellence (NICE) published guidance on the use of the COX-2 agents celecoxib, rofecoxib, meloxicam and etodolac for rheumatoid arthritis (RA) and osteoarthritis (OA). This study aimed to audit the appropriateness of NSAID use in relation to NICE guidance in rheumatology out-patients. Questionnaires were completed for all patients attending clinics in 18 rheumatology units in the West Midlands over a 2-week period. Data collected included patient demographics, NSAID type, indications, duration of use (> or =3 months was considered prolonged), and concomitant prescription of corticosteroids, warfarin and gastroprotective agents. Data were collected on 2846 patients; 1164 (41%) were taking NSAIDs (791 NSNSAIDs, 373 COX-2). Of the 1164 NSAID users, 753 (65%) had a diagnosis of RA or OA (483 NSNSAIDs, 270 COX-2). Overall, 37% of NSAID prescriptions were appropriate. Of the NSNSAID users, 92% had at least one risk factor for adverse gastrointestinal events and were therefore inappropriately treated. Prolonged use (in 89%) and age > or =65 yr (in 23%) were the most frequent risk factors identified. Of the COX-2 users, 97% had one or more risk factors and were appropriately treated. Analysis of the RA/OA subgroup revealed similar findings. Thirty-six per cent were taking NSAIDs appropriately; 97% of NSNSAID use was inappropriate and 97% of COX-2 use was appropriate treatment. In the whole cohort, gastroprotective agents were used in 26% of NSNSAID users, 56% of gastroprotective agents being proton pump inhibitors. Ninety-two per cent of patients attending rheumatology clinics who were taking NSNSAIDs should have been prescribed a COX-2-selective agent in relation to NICE guidance. Duration of use and age > or =65 yr emerged numerically as the most important risk factors. Significant numbers of patients taking NSNSAIDs may be at risk from adverse gastrointestinal events and clinicians may wish to review their prescribing patterns. Conversely, 97% of patients taking COX-2 agents were treated appropriately. Although practice overall conformed poorly with NICE guidance, NSAID prescribing also needs to be considered in the context of recent concerns regarding the cardiovascular risks of COX-2 agents.

Ledipasvir-Sofosbuvir for Treating Chronic Hepatitis C: A NICE Single Technology Appraisal-An Evidence Review Group Perspective.

PubMed

Thokala, P; Simpson, E L; Tappenden, P; Stevens, J W; Dickinson, K; Ryder, S; Harrison, P

2016-08-01

The National Institute for Health and Care Excellence (NICE) invited Gilead, the company manufacturing ledipasvir-sofosbuvir (LDV/SOF), to submit evidence for the clinical effectiveness and cost effectiveness of LDV/SOF for treating chronic hepatitis C. The School of Health and Related Research (ScHARR) Technology Assessment Group was commissioned as the Evidence Review Group (ERG). This paper describes the company's submission (CS), the ERG review and the subsequent decision of the NICE Appraisal Committee (AC). The ERG produced a critical review of the clinical effectiveness and cost-effectiveness evidence of LDV/SOF based upon the CS. The clinical effectiveness data for LDV/SOF were taken from ten trials: three phase III trials and seven phase II trials. Trials compared different durations of LDV/SOF, with and without ribavirin (RBV). There were no head-to-head trials comparing LDV/SOF with any comparator listed in the NICE scope. Data from the trials were mostly from populations with genotype 1 (GT1) disease, although some limited data were available for populations with genotypes 3 and 4. For GT1 treatment-naïve patients, sustained viral response for 12 weeks (SVR12) rates for LDV/SOF ranged from 93.1 to 99.4 % for subgroups of patients with non-cirrhotic disease, whilst SVR rates of 94.1 to 100 % were reported for subgroups of patients with compensated cirrhosis. For GT1 treatment-experienced patients, SVR12 rates ranging from 95.4 to 100 % were reported for subgroups of non-cirrhotic patients, and SVR rates ranging from 81.8 to 100 % were reported within subgroups of patients with compensated cirrhosis. Comparator data were not searched systematically as part of the submission, but were based on the company's previous NICE submission of sofosbuvir, with additional targeted searches. The ERG's critical appraisal of the company's economic evaluation highlighted a number of concerns. The ERG's base case analyses suggested that the incremental cost-effectiveness ratios (ICERs) for LDV/SOF (+RBV) are dependent on (a) treatment durations, (b) whether patients have been previously treated and (c) whether patients have liver cirrhosis or not. The AC concluded that it was appropriate to use the approach taken in the ERG's exploratory analyses, in line with the marketing authorisation, which considered people with and without cirrhosis separately, and estimated the cost effectiveness for each recommended treatment duration of LDV/SOF.

Hydrological modelling in sandstone rocks watershed

NASA Astrophysics Data System (ADS)

Ponížilová, Iva; Unucka, Jan

2015-04-01

The contribution is focused on the modelling of surface and subsurface runoff in the Ploučnice basin. The used rainfall-runoff model is HEC-HMS comprising of the method of SCS CN curves and a recession method. The geological subsurface consisting of sandstone is characterised by reduced surface runoff and, on the contrary, it contributes to subsurface runoff. The aim of this paper is comparison of the rate of influence of sandstone on reducing surface runoff. The recession method for subsurface runoff was used to determine the subsurface runoff. The HEC-HMS model allows semi- and fully distributed approaches to schematisation of the watershed and rainfall situations. To determine the volume of runoff the method of SCS CN curves is used, which results depend on hydrological conditions of the soils. The rainfall-runoff model assuming selection of so-called methods of event of the SCS-CN type is used to determine the hydrograph and peak flow rate based on simulation of surface runoff in precipitation exceeding the infiltration capacity of the soil. The recession method is used to solve the baseflow (subsurface) runoff. The method is based on the separation of hydrograph to direct runoff and subsurface or baseflow runoff. The study area for the simulation of runoff using the method of SCS CN curves to determine the hydrological transformation is the Ploučnice basin. The Ploučnice is a hydrologically significant river in the northern part of the Czech Republic, it is a right tributary of the Elbe river with a total basin area of 1.194 km2. The average value of CN curves for the Ploučnice basin is 72. The geological structure of the Ploučnice basin is predominantly formed by Mesozoic sandstone. Despite significant initial loss of rainfall the basin response to the causal rainfall was demonstrated by a rapid rise of the surface runoff from the watershed and reached culmination flow. Basically, only surface runoff occures in the catchment during the initial phase of this extreme event. The increase of the baseflow runoff is slower and remains constant after reaching a certain level. The rise of the baseflow runoff is showed in a descending part of the hydrograph. The recession method in this case shows almost 20 hours delay. Results from the HEC-HMS prove availability of both methods for the runoff modeling in this type of catchment. When simulating extreme short-term rainfall-runoff episodes, the influence of geological subsurface is not significant, but it is manifested. Using more relevant rainfall events would bring more satisfactory results.

Crizotinib for Untreated Anaplastic Lymphoma Kinase-Positive Non-Small-Cell Lung Cancer: An Evidence Review Group Perspective of a NICE Single Technology Appraisal.

PubMed

Morgan, Philip; Woolacott, Nerys; Biswas, Mousumi; Mebrahtu, Teumzghi; Harden, Melissa; Hodgson, Robert

2017-09-01

As part of the National Institute for Health and Care Excellence (NICE) single technology appraisal process, the manufacturer of crizotinib submitted evidence on the clinical and cost effectiveness of crizotinib in untreated anaplastic lymphoma kinase-positive (ALK-positive) non-small-cell lung cancer (NSCLC). Crizotinib has previously been assessed by NICE for patients with previously treated ALK-positive NSCLC (TA 296). It was not approved in this previous appraisal, but had been made available through the cancer drugs fund. As part of this new appraisal, the company included a price discount patient access scheme (PAS). The Centre for Reviews and Dissemination and Centre for Health Economics Technology Appraisal Group at the University of York was commissioned to act as the independent Evidence Review Group (ERG). This article provides a description of the company's submission and the ERG's review and summarises the resulting NICE guidance issued in August 2016. The main clinical-effectiveness data were derived from a multicentre randomised controlled trial-PROFILE 1014-that compared crizotinib with pemetrexed chemotherapy in combination with carboplatin or cisplatin in patients with untreated non-squamous ALK-positive NSCLC. In the trial, crizotinib demonstrated improvements in progression-free survival (PFS) and overall survival (OS). The company's economic model was a three-state 'area under the curve' Markov model. The base-case incremental cost-effectiveness ratio (ICER) was estimated to be greater than £50,000 per quality-adjusted life-year (QALY) gained (excluding the PAS discount). The ERG assessment of the evidence submitted by the company raised a number of concerns. In terms of the clinical evidence, the OS benefit was highly uncertain due to the cross-over permitted in the trial and the immaturity of the data; only 26% of events had occurred by the data cut-off point. In the economic modelling, the most significant concerns related to the analysis of OS and assumptions made regarding the duration of therapy. The ERG exploratory re-analysis of the OS data relaxed the assumption of proportional hazards made in the company submission, which demonstrated significant uncertainty regarding the OS gains from crizotinib. The ERG reconfigured the economic model so that duration of therapy was based on the area under the curve analysis of the PROFILE 1014 trial, dramatically increasing the cost associated with implementing crizotinib and consequently, substantially increasing the ICER. At the first appraisal meeting, the NICE Appraisal Committee concluded that crizotinib, while clinically effective, was not sufficiently cost effective for use in the UK NHS. Following the consultation, the company offered a revised PAS and conducted extensive re-analysis, resulting in a revised base-case ICER of £47,291 per QALY gained. The NICE Appraisal Committee concluded that crizotinib was likely to be a cost-effective use of NHS resources, despite the uncertainty that persisted around a number of factors, namely the long-term survival benefit of crizotinib. Crizotinib was therefore recommended as an option for untreated ALK-positive advanced NSCLC in adults.

Oh! Web 2.0, Virtual Reference Service 2.0, Tools & Techniques (II)

ERIC Educational Resources Information Center

Arya, Harsh Bardhan; Mishra, J. K.

2012-01-01

The paper describes the theory and definition of the practice of librarianship, specifically addressing how Web 2.0 technologies (tools) such as synchronous messaging, collaborative reference service and streaming media, blogs, wikis, social networks, social bookmarking tools, tagging, RSS feeds, and mashups might intimate changes and how…

Comparison of Performance Predictions for New Low-Thrust Trajectory Tools

NASA Technical Reports Server (NTRS)

Polsgrove, Tara; Kos, Larry; Hopkins, Randall; Crane, Tracie

2006-01-01

Several low thrust trajectory optimization tools have been developed over the last 3% years by the Low Thrust Trajectory Tools development team. This toolset includes both low-medium fidelity and high fidelity tools which allow the analyst to quickly research a wide mission trade space and perform advanced mission design. These tools were tested using a set of reference trajectories that exercised each tool s unique capabilities. This paper compares the performance predictions of the various tools against several of the reference trajectories. The intent is to verify agreement between the high fidelity tools and to quantify the performance prediction differences between tools of different fidelity levels.

Changing Health Care Professionals' Attitudes Toward Spanking.

PubMed

Burkhart, Kimberly; Knox, Michele; Hunter, Kimberly

2016-10-01

Twenty-two pediatric residents and 31 medical students viewed the Play Nicely program. The Play Nicely program is a multimedia program that teaches health care professionals how to counsel parents to use positive parenting and disciplining strategies in response to early childhood aggression. Health care professionals completed pre- and posttraining questionnaires to assess changes in comfort with counseling, parenting knowledge, and attitudes toward spanking. Results indicated at posttraining that health care professionals were significantly more comfortable with counseling parents, had increased parenting knowledge, and decreased positive attitudes toward spanking. Findings suggest that this program holds promise for educating health care professionals on how to counsel parents on positive parenting strategies and positively change attitudes toward spanking. © The Author(s) 2016.

Atmosphere-Ice-Ocean-Ecosystem Processes in a Thinner Arctic Sea Ice Regime: The Norwegian Young Sea ICE (N-ICE2015) Expedition

NASA Astrophysics Data System (ADS)

Granskog, Mats A.; Fer, Ilker; Rinke, Annette; Steen, Harald

2018-03-01

Arctic sea ice has been in rapid decline the last decade and the Norwegian young sea ICE (N-ICE2015) expedition sought to investigate key processes in a thin Arctic sea ice regime, with emphasis on atmosphere-snow-ice-ocean dynamics and sea ice associated ecosystem. The main findings from a half-year long campaign are collected into this special section spanning the Journal of Geophysical Research: Atmospheres, Journal of Geophysical Research: Oceans, and Journal of Geophysical Research: Biogeosciences and provide a basis for a better understanding of processes in a thin sea ice regime in the high Arctic. All data from the campaign are made freely available to the research community.

Provision of smoking cessation support for pregnant women in England: results from an online survey of NHS stop smoking services for pregnant women

PubMed Central

2014-01-01

Background Smoking during pregnancy is a major public health concern and an NHS priority. In 2010, 26% of UK women smoked immediately before or during their pregnancy and 12% smoked continuously. Smoking cessation support is provided through free at the point of use Stop Smoking Services for Pregnant women (SSSP). However, to date, little is known of how these services provide support across England. The aim of this study was to describe the key elements of support provided through English SSSP. Methods SSSP managers were invited to participate in this survey by email. Data were then collected via an online questionnaire; one survey was completed for each SSSP. Up to four reminder emails were sent over a two month period. Results 86% (121 of 141) of services completed the survey. Responding services were, on average, larger than non-responding services in terms of the number of pregnant women setting quit dates and successfully quitting (p < 0.01). In line with the 2010 NICE guidelines, Stop Smoking in Pregnancy and following Childbirth, one in five SSSP identified pregnant smokers using carbon monoxide (CO) testing and refer via an opt-out pathway. All services offered nicotine replacement therapy (NRT) to pregnant women and 87% of services also offered dual therapy NRT, i.e. combination of a patch and short acting NRT product.. The 2010 NICE guidelines note that services should be flexible and client-centred. Consistent with this, SSSP offer pregnant women a range of support types (median 4) including couple/family, group (open or closed) or one-to-one. These are available in a number of locations (median 5), including in community venues, clinics and women’s homes. Conclusions English Stop Smoking Services offer behavioural support and pharmacotherapy to pregnant women motivated to quit smoking. Interventions provided are generally evidence-based and delivered in a variety of both social and health care settings. PMID:24593130

Proton Beam Radiotherapy for Uveal Melanomas at Nice Teaching Hospital: 16 Years' Experience

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

Caujolle, Jean-Pierre, E-mail: ncaujolle@aol.co; Mammar, Hamid; Chamorey, Emmanuel Phar

2010-09-01

Purpose: To present the results of uveal melanomas treated at Nice Teaching Hospital. Methods and Materials: This retrospective study included 886 consecutive patients referred to our clinic for the treatment of uveal melanomas by proton beam radiotherapy from June 1991 to December 2007. Survival rates were determined by using Kaplan-Meier estimates, and prognostic factors were evaluated using the log-rank test or Cox model. Results: The number (percent total) of subjects staged according to the TNM classification system (6th edition) of malignant tumors included 39 stage T1 (4.4%), 420 stage T2 (47.40%), 409 stage T3 (46.16%), and 18 stage T4 (2.03%)more » patients. The median follow-up was 63.7 months. The Kaplan-Meier overall survival rate at 5 years according to the sixth edition TNM classification was 92% for T1, 89% for T2, 67% for T3, and 62% for T4; and at 10 years, 86% for T1, 78% for T2, 43% for T3, and 41% for T4. Five factors were found to be associated with an increased death rate: advanced age, tumor thickness, largest tumor basal diameter, tumor volume, and tumor volume-to-eyeball volume ratio. The metastasis-free survival rates were 88.3 % at 5 years and 76.4 % at 10 years. The local control rates were 93.9% at 5 years and 92.1% at 10 years. The ocular conservation rates were 91.1% at 5 years and 87.3% at 10 years. Conclusions: We report the results of a large series of patients treated for uveal melanomas with a very long follow-up. Despite the large tumor volume treated, our results were similar to previously published findings relating to proton beam therapy.« less

Detection and estimation trends linked to air quality and mortality on French Riviera over the 1990-2005 period to develop a prediction model of an aggregate risk index

NASA Astrophysics Data System (ADS)

Sicard, P.; Mangin, A.; Hebel, P.; Lesne, O.; Malléa, P.

2009-04-01

There is a profound relation between human health and well being from the one side and air pollution levels from the other. Air quality in South of France and more specifically in Nice, is known to be bad, especially in summer. The main objectives are to establish correlations between air pollution, exposure of people and reactivity of these people to this aggression, to validate a risk index built from air quality and pollen data in the area of Nice and to construct a prediction model of this sanitary index. The spatial extent of the experiment will be mainly the territory of "Alpes Maritimes". All the tasks are performed in collaboration with the "Heath-Environment Network" of the "Centre Hospitalier Universitaire" of Nice. The development of an adequate tool for observation (health index and/or indices per pathology) to understand impacts of pollution levels in an area is of utmost importance. These indexes should take into account the possible adverse effects associated with the coexistence of all the pollutants and environmental parameters. This tool must be able to inform the citizens about the levels of pollution in an adequate and understandable way but also to be used by relevant authorities to take a series of predetermined measures to protect the health of the population. This paper describes the first step to construct a prediction model of this sanitary index with a confidence interval 99% (and 95%): detection and estimation trends observed in concentrations of pollutants, emissions and mortality over the 1990-2005 period in the "Alpes Maritimes" area. The non-parametric Mann-Kendall test has been developed for detecting and estimating monotonic trends in the time series and applied in our study at annual values of pollutants air concentrations. An important objective of many environmental monitoring programs is to detect changes or trends in pollution levels over time. Over the period 1990-2005, concerning the emissions of the main pollutants, we obtained significant decreasing trends. Between 1994 and 2005, from the SO2 concentrations, decreasing trends of 1.2 %.year-1 (urban stations) and of 5.4 %.year-1 (traffic stations) were calculated. Over the same period, we obtained a decreasing trend of 1.3 %.year-1 for the NO2 concentrations (urban stations) and of 3.1 %.year-1 for the traffic stations. In addition, a decreasing trend of 0.5 %.year-1 was calculated for the suburban stations over the 1998-2005 period. Globally, the concentration of the major pollutants showed a clear downward trend and those main reductions have reflected the reduction policy of the emissions over twenty years. By considering the ozone mean values in urban areas over the 1997-2005 period, an increasing of 3.0 %.year-1 was obtained with annual averages and 3.9 %.year-1 with median values. Over the 1990-2005 period, we obtained significant decreasing trends concerning the "ischemic heart diseases" (- 1.20 %.year-1) and "asthma" (- 4.03 %.year-1) categories. No significant sex-related difference was identified for these groups. An annual change rate of + 0.31 %.year-1 for the "airway diseases" and of + 2.50%.year-1 for the "unknown causes" were identified. For these categories, we noted a sex-related difference. In fact, we obtained for males a decreasing trend contrary to females.

BOOK REVIEW: Vortex Methods: Theory and Practice

NASA Astrophysics Data System (ADS)

Cottet, G.-H.; Koumoutsakos, P. D.

2001-03-01

The book Vortex Methods: Theory and Practice presents a comprehensive account of the numerical technique for solving fluid flow problems. It provides a very nice balance between the theoretical development and analysis of the various techniques and their practical implementation. In fact, the presentation of the rigorous mathematical analysis of these methods instills confidence in their implementation. The book goes into some detail on the more recent developments that attempt to account for viscous effects, in particular the presence of viscous boundary layers in some flows of interest. The presentation is very readable, with most points illustrated with well-chosen examples, some quite sophisticated. It is a very worthy reference book that should appeal to a large body of readers, from those interested in the mathematical analysis of the methods to practitioners of computational fluid dynamics. The use of the book as a text is compromised by its lack of exercises for students, but it could form the basis of a graduate special topics course. Juan Lopez

Nicolas Donitch. Solved enigmas. (Nicolae Donici. Enigme descifrate)

NASA Astrophysics Data System (ADS)

Stavinschi, Magda

2015-12-01

The book is the most complete historical -scientific biography of the astronomer N.N. Donitch (1874, Chisinau, Bessarabia- 1960, Nice, France). It include many photographs, recollections on him by astronomers from many countries, archive documents. Main scientific interests and results has been described in detail. The activity of the astronomer in Astronomical Societies and IAU over the time has been described also. A list of publications has been given with a list of references on his personalty. The book is designed for a large circle of readers - from scientific researchers to students and non-astronomers yet. A number of contributions from philologist Haralambie Corbu, writer Iurie Colesnic, Director of the Odessa Astronomical Observatory S.M. Andrievskii, French astronomers Auduin Charles Dollfus, Gualtiero Olivieri, Paul Danjon, Romanian researchers Mircea Herovanu, Vladimir Boico, Gh. Teodoreanu, Gheorghe Rascu, Zoe Donici in the connection with the biography of N.N. Donitch has been included also. The book is richly illustrated by photographs and documents from archives.

Reviews Book: Extended Project Student Guide Book: My Inventions Book: ASE Guide to Research in Science Education Classroom Video: The Science of Starlight Software: SPARKvue Book: The Geek Manifesto Ebook: A Big Ball of Fire Apps

NASA Astrophysics Data System (ADS)

2014-05-01

WE RECOMMEND Level 3 Extended Project Student Guide A non-specialist, generally useful and nicely put together guide to project work ASE Guide to Research in Science Education Few words wasted in this handy introduction and reference The Science of Starlight Slow but steady DVD covers useful ground SPARKvue Impressive software now available as an app WORTH A LOOK My Inventions and Other Writings Science, engineering, autobiography, visions and psychic phenomena mixed in a strange but revealing concoction The Geek Manifesto: Why Science Matters More enthusiasm than science, but a good motivator and interesting A Big Ball of Fire: Your questions about the Sun answered Free iTunes download made by and for students goes down well APPS Collider visualises LHC experiments ... Science Museum app enhances school trips ... useful information for the Cambridge Science Festival

Determination of quality factors by microdosimetry

NASA Astrophysics Data System (ADS)

Al-Affan, I. A. M.; Watt, D. E.

1987-03-01

The application of microdose parameters for the specification of a revised scale of quality factors which would be applicable at low doses and dose rates is examined in terms of an original proposal by Rossi. Two important modifications are suggested to enable an absolute scale of quality factors to be constructed. Allowance should be made to allow for the dependence of the saturation threshold of lineal energy on the type of heavy charged particle. Also, an artificial saturation threshold should be introduced for electron tracks as a mean of modifying the measurements made in the microdosimeter to the more realistic site sizes of nanometer dimensions. The proposed absolute scale of quality factors nicely encompasses the high RBEs of around 3 observed at low doses for tritium β rays and is consistent with the recent recommendation of the ICRP that the quality factor for fast neutrons be increased by a factor of two, assuming that there is no biological repair for the reference radiation.

Positional reference system for ultraprecision machining

DOEpatents

Arnold, Jones B.; Burleson, Robert R.; Pardue, Robert M.

1982-01-01

A stable positional reference system for use in improving the cutting tool-to-part contour position in numerical controlled-multiaxis metal turning machines is provided. The reference system employs a plurality of interferometers referenced to orthogonally disposed metering bars which are substantially isolated from machine strain induced position errors for monitoring the part and tool positions relative to the metering bars. A microprocessor-based control system is employed in conjunction with the plurality of position interferometers and part contour description data inputs to calculate error components for each axis of movement and output them to corresponding axis drives with appropriate scaling and error compensation. Real-time position control, operating in combination with the reference system, makes possible the positioning of the cutting points of a tool along a part locus with a substantially greater degree of accuracy than has been attained previously in the art by referencing and then monitoring only the tool motion relative to a reference position located on the machine base.

Positional reference system for ultraprecision machining

DOEpatents

Arnold, J.B.; Burleson, R.R.; Pardue, R.M.

1980-09-12

A stable positional reference system for use in improving the cutting tool-to-part contour position in numerical controlled-multiaxis metal turning machines is provided. The reference system employs a plurality of interferometers referenced to orthogonally disposed metering bars which are substantially isolated from machine strain induced position errors for monitoring the part and tool positions relative to the metering bars. A microprocessor-based control system is employed in conjunction with the plurality of positions interferometers and part contour description data input to calculate error components for each axis of movement and output them to corresponding axis driven with appropriate scaling and error compensation. Real-time position control, operating in combination with the reference system, makes possible the positioning of the cutting points of a tool along a part locus with a substantially greater degree of accuracy than has been attained previously in the art by referencing and then monitoring only the tool motion relative to a reference position located on the machine base.

CAR: contig assembly of prokaryotic draft genomes using rearrangements.

PubMed

Lu, Chin Lung; Chen, Kun-Tze; Huang, Shih-Yuan; Chiu, Hsien-Tai

2014-11-28

Next generation sequencing technology has allowed efficient production of draft genomes for many organisms of interest. However, most draft genomes are just collections of independent contigs, whose relative positions and orientations along the genome being sequenced are unknown. Although several tools have been developed to order and orient the contigs of draft genomes, more accurate tools are still needed. In this study, we present a novel reference-based contig assembly (or scaffolding) tool, named as CAR, that can efficiently and more accurately order and orient the contigs of a prokaryotic draft genome based on a reference genome of a related organism. Given a set of contigs in multi-FASTA format and a reference genome in FASTA format, CAR can output a list of scaffolds, each of which is a set of ordered and oriented contigs. For validation, we have tested CAR on a real dataset composed of several prokaryotic genomes and also compared its performance with several other reference-based contig assembly tools. Consequently, our experimental results have shown that CAR indeed performs better than all these other reference-based contig assembly tools in terms of sensitivity, precision and genome coverage. CAR serves as an efficient tool that can more accurately order and orient the contigs of a prokaryotic draft genome based on a reference genome. The web server of CAR is freely available at http://genome.cs.nthu.edu.tw/CAR/ and its stand-alone program can also be downloaded from the same website.

The methodological quality assessment tools for preclinical and clinical studies, systematic review and meta-analysis, and clinical practice guideline: a systematic review.

PubMed

Zeng, Xiantao; Zhang, Yonggang; Kwong, Joey S W; Zhang, Chao; Li, Sheng; Sun, Feng; Niu, Yuming; Du, Liang

2015-02-01

To systematically review the methodological assessment tools for pre-clinical and clinical studies, systematic review and meta-analysis, and clinical practice guideline. We searched PubMed, the Cochrane Handbook for Systematic Reviews of Interventions, Joanna Briggs Institute (JBI) Reviewers Manual, Centre for Reviews and Dissemination, Critical Appraisal Skills Programme (CASP), Scottish Intercollegiate Guidelines Network (SIGN), and the National Institute for Clinical Excellence (NICE) up to May 20th, 2014. Two authors selected studies and extracted data; quantitative analysis was performed to summarize the characteristics of included tools. We included a total of 21 assessment tools for analysis. A number of tools were developed by academic organizations, and some were developed by only a small group of researchers. The JBI developed the highest number of methodological assessment tools, with CASP coming second. Tools for assessing the methodological quality of randomized controlled studies were most abundant. The Cochrane Collaboration's tool for assessing risk of bias is the best available tool for assessing RCTs. For cohort and case-control studies, we recommend the use of the Newcastle-Ottawa Scale. The Methodological Index for Non-Randomized Studies (MINORS) is an excellent tool for assessing non-randomized interventional studies, and the Agency for Healthcare Research and Quality (ARHQ) methodology checklist is applicable for cross-sectional studies. For diagnostic accuracy test studies, the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool is recommended; the SYstematic Review Centre for Laboratory animal Experimentation (SYRCLE) risk of bias tool is available for assessing animal studies; Assessment of Multiple Systematic Reviews (AMSTAR) is a measurement tool for systematic reviews/meta-analyses; an 18-item tool has been developed for appraising case series studies, and the Appraisal of Guidelines, Research and Evaluation (AGREE)-II instrument is widely used to evaluate clinical practice guidelines. We have successfully identified a variety of methodological assessment tools for different types of study design. However, further efforts in the development of critical appraisal tools are warranted since there is currently a lack of such tools for other fields, e.g. genetic studies, and some existing tools (nested case-control studies and case reports, for example) are in need of updating to be in line with current research practice and rigor. In addition, it is very important that all critical appraisal tools remain subjective and performance bias is effectively avoided. © 2015 Chinese Cochrane Center, West China Hospital of Sichuan University and Wiley Publishing Asia Pty Ltd.

Societal views on NICE, cancer drugs fund and value-based pricing criteria for prioritising medicines: a cross-sectional survey of 4118 adults in Great Britain.

PubMed

Linley, Warren G; Hughes, Dyfrig A

2013-08-01

The criteria used by the National Institute for Health and Clinical Excellence (NICE) for accepting higher incremental cost-effectiveness ratios for some medicines over others, and the recent introduction of the Cancer Drugs Fund (CDF) in England, are assumed to reflect societal preferences for National Health Service resource allocation. Robust empirical evidence to this effect is lacking. To explore societal preferences for these and other criteria, including those proposed for rewarding new medicines under the future value-based pricing (VBP) system, we conducted a choice-based experiment in 4118 UK adults via web-based surveys. Preferences were determined by asking respondents to allocate fixed funds between different patient and disease types reflecting nine specific prioritisation criteria. Respondents supported the criteria proposed under the VBP system (for severe diseases, address unmet needs, are innovative--provided they offered substantial health benefits, and have wider societal benefits) but did not support the end-of-life premium or the prioritisation of children or disadvantaged populations as specified by NICE, nor the special funding status for treatments of rare diseases, nor the CDF. Policies introduced on the basis of perceived--and not actual--societal values may lead to inappropriate resource allocation decisions with the potential for significant population health and economic consequences. Copyright © 2012 John Wiley & Sons, Ltd.

Current UK dental sedation practice and the 'National Institute for Health and Care Excellence' (NICE) guideline 112: sedation in children and young people.

PubMed

Coulthard, P; Craig, D; Holden, C; Robb, N D; Sury, M; Chopra, S; Holroyd, I

2015-04-24

Describe current dental sedation practice for under 19-year-olds in the UK and compare it with the recommendations of NICE guidance 112. Members of the Society for the Advancement of Anaesthesia in Dentistry and members of the Dental Sedation Teachers Group were invited to participate in an online survey. Two hundred and sixty-six dentists and doctors completed the survey. Eighty-two percent were operator and sedationist (operator-sedationist). Ninety-five percent provided written information and 94% obtained written consent. Eighty-four percent kept a written or electronic sedation record. Eighty-six percent complied with life support training expectations. Eighty-six percent had immediate access to resuscitation equipment. Sixty-seven percent of sedationists reported that treatment could not be completed under sedation for <10% of cases during the previous year. When sedation was unsuccessful, 61% said they would schedule general anaesthesia and 54.5% would schedule advanced sedation care. Forty-nine percent believed that a dentist was an appropriate person to provide advanced sedation for 12-18 years. Only 24% thought a dentist should provide advanced sedation for children<12 years, with 75% preferring an anaesthetist. The appropriate setting for advanced sedation was thought to be primary care by 33% and secondary care by 68%. We found good agreement between the current practice of sedation and the recommendations of the NICE guidance 112.

Apremilast for the Treatment of Moderate to Severe Plaque Psoriasis: A Critique of the Evidence.

PubMed

Hinde, Sebastian; Wade, Ros; Palmer, Stephen; Woolacott, Nerys; Spackman, Eldon

2016-06-01

As part of the National Institute for Health and Care Excellence's (NICE) single technology appraisal (STA) process, apremilast was assessed to determine the clinical and cost effectiveness of its use in the treatment of moderate to severe plaque psoriasis in two patient populations, differentiated by the severity of the patient's Psoriasis Area Severity Index (PASI) score. The Centre for Reviews and Dissemination (CRD) and the Centre for Health Economics (CHE) Technology Appraisal Group at the University of York was commissioned to act as the evidence review group (ERG). This article provides a summary of the company's submission, the ERG report and NICE's subsequent guidance. In the company's initial submission, a sequence of treatments including apremilast was found to be both more effective and cheaper than a comparator sequence without it in both populations considered. However, this result was found to be highly sensitive to a series of assumptions made by the company, primarily reflecting the costs of best supportive care once no further treatments are available, and the source of utility estimates. A re-estimation of the cost effectiveness of apremilast by the ERG suggested that the apremilast sequence in the two populations was more effective, but due to high additional costs was not indicative of a cost-effective use of NHS resources. As such, in the final appraisal decision NICE concluded that apremilast was not cost effective in either population.

Noise-immune cavity-enhanced optical frequency comb spectroscopy: a sensitive technique for high-resolution broadband molecular detection

NASA Astrophysics Data System (ADS)

Khodabakhsh, Amir; Johansson, Alexandra C.; Foltynowicz, Aleksandra

2015-04-01

Noise-immune cavity-enhanced optical frequency comb spectroscopy (NICE-OFCS) is a recently developed technique that utilizes phase modulation to obtain immunity to frequency-to-amplitude noise conversion by the cavity modes and yields high absorption sensitivity over a broad spectral range. We describe the principles of the technique and discuss possible comb-cavity matching solutions. We present a theoretical description of NICE-OFCS signals detected with a Fourier transform spectrometer (FTS) and validate the model by comparing it to experimental CO2 spectra around 1,575 nm. Our system is based on an Er:fiber femtosecond laser locked to a cavity and phase-modulated at a frequency equal to a multiple of the cavity free spectral range (FSR). The NICE-OFCS signal is detected by a fast-scanning FTS equipped with a high-bandwidth commercial detector. We demonstrate a simple method of passive locking of the modulation frequency to the cavity FSR that significantly improves the long-term stability of the system, allowing averaging times on the order of minutes. Using a cavity with a finesse of ~9,000, we obtain absorption sensitivity of 6.4 × 10-11 cm-1 Hz-1/2 per spectral element and concentration detection limit for CO2 of 450 ppb Hz-1/2, determined by multiline fitting.

Winter snow conditions on Arctic sea ice north of Svalbard during the Norwegian young sea ICE (N-ICE2015) expedition

NASA Astrophysics Data System (ADS)

Merkouriadi, Ioanna; Gallet, Jean-Charles; Graham, Robert M.; Liston, Glen E.; Polashenski, Chris; Rösel, Anja; Gerland, Sebastian

2017-10-01

Snow is a crucial component of the Arctic sea ice system. Its thickness and thermal properties control heat conduction and radiative fluxes across the ocean, ice, and atmosphere interfaces. Hence, observations of the evolution of snow depth, density, thermal conductivity, and stratigraphy are crucial for the development of detailed snow numerical models predicting energy transfer through the snow pack. Snow depth is also a major uncertainty in predicting ice thickness using remote sensing algorithms. Here we examine the winter spatial and temporal evolution of snow physical properties on first-year (FYI) and second-year ice (SYI) in the Atlantic sector of the Arctic Ocean, during the Norwegian young sea ICE (N-ICE2015) expedition (January to March 2015). During N-ICE2015, the snow pack consisted of faceted grains (47%), depth hoar (28%), and wind slab (13%), indicating very different snow stratigraphy compared to what was observed in the Pacific sector of the Arctic Ocean during the SHEBA campaign (1997-1998). Average snow bulk density was 345 kg m-3 and it varied with ice type. Snow depth was 41 ± 19 cm in January and 56 ± 17 cm in February, which is significantly greater than earlier suggestions for this region. The snow water equivalent was 14.5 ± 5.3 cm over first-year ice and 19 ± 5.4 cm over second-year ice.

A Rainfall- and Temperature-Driven Abundance Model for Aedes albopictus Populations

PubMed Central

Tran, Annelise; L’Ambert, Grégory; Lacour, Guillaume; Benoît, Romain; Demarchi, Marie; Cros, Myriam; Cailly, Priscilla; Aubry-Kientz, Mélaine; Balenghien, Thomas; Ezanno, Pauline

2013-01-01

The mosquito Aedes (Stegomyia) albopictus (Skuse) (Diptera: Culicidae) is an invasive species which has colonized Southern Europe in the last two decades. As it is a competent vector for several arboviruses, its spread is of increasing public health concern, and there is a need for appropriate monitoring tools. In this paper, we have developed a modelling approach to predict mosquito abundance over time, and identify the main determinants of mosquito population dynamics. The model is temperature- and rainfall-driven, takes into account egg diapause during unfavourable periods, and was used to model the population dynamics of Ae. albopictus in the French Riviera since 2008. Entomological collections of egg stage from six locations in Nice conurbation were used for model validation. We performed a sensitivity analysis to identify the key parameters of the mosquito population dynamics. Results showed that the model correctly predicted entomological field data (Pearson r correlation coefficient values range from 0.73 to 0.93). The model’s main control points were related to adult’s mortality rates, the carrying capacity in pupae of the environment, and the beginning of the unfavourable period. The proposed model can be efficiently used as a tool to predict Ae. albopictus population dynamics, and to assess the efficiency of different control strategies. PMID:23624579

The centrality of meta-programming in the ES-DOC eco-system

NASA Astrophysics Data System (ADS)

Greenslade, Mark

2017-04-01

The Earth System Documentation (ES-DOC) project is an international effort aiming to deliver a robust earth system model inter-comparison project documentation infrastructure. Such infrastructure both simplifies & standardizes the process of documenting (in detail) projects, experiments, models, forcings & simulations. In support of CMIP6, ES-DOC has upgraded its eco-system of tools, web-services & web-sites. The upgrade consolidates the existing infrastructure (built for CMIP5) and extends it with the introduction of new capabilities. The strategic focus of the upgrade is improvements in the documentation experience and broadening the range of scientific use-cases that the archived documentation may help deliver. Whether it is highlighting dataset errors, exploring experimental protocols, comparing forcings across ensemble runs, understanding MIP objectives, reviewing citations, exploring component properties of configured models, visualising inter-model relationships, scientists involved in CMIP6 will find the ES-DOC infrastructure helpful. This presentation underlines the centrality of meta-programming within the ES-DOC eco-system. We will demonstrate how agility is greatly enhanced by taking a meta-programming approach to representing data models and controlled vocabularies. Such an approach nicely decouples representations from encodings. Meta-models will be presented along with the associated tooling chain that forward engineers artefacts as diverse as: class hierarchies, IPython notebooks, mindmaps, configuration files, OWL & SKOS documents, spreadsheets …etc.

Delivering Electronic Resources with Web OPACs and Other Web-based Tools: Needs of Reference Librarians.

ERIC Educational Resources Information Center

Bordeianu, Sever; Carter, Christina E.; Dennis, Nancy K.

2000-01-01

Describes Web-based online public access catalogs (Web OPACs) and other Web-based tools as gateway methods for providing access to library collections. Addresses solutions for overcoming barriers to information, such as through the implementation of proxy servers and other authentication tools for remote users. (Contains 18 references.)…

Micturating cystourethrogram as a tool for investigating UTI in children - An institutional audit.

PubMed

Hua, L; Linke, R J; Boucaut, H A P; Khurana, S

2016-10-01

Micturating cystourethrograms (MCUG) are the gold standard for evaluating vesicoureteric reflux (VUR). There is a growing consensus for increasing the threshold for performing MCUGs following urinary tract infections (UTI) in children. There are several varying guidelines. It is important to detect high-grade reflux in the setting of an UTI because of potential long-term complications. This audit aimed to retrospectively: (1) identify the conformance rate of local guidelines at the Women's and Children's Hospital (WCH); (2) assess predictors for an abnormal MCUG; and (3) compare local guidelines against the Royal Children's Hospital, Melbourne (RCH), National Institute for Healthcare and Excellence (NICE), and American Academy of Pediatrics (AAP) guidelines for selectively detecting high-grade reflux. The number of MCUGs performed from 2008 to 2012 at the WCH radiology department was collected. Patients undergoing MCUG during the 2012 calendar year were identified. Only children having an initial MCUG as part of an UTI investigation with prerequisite imaging as per guidelines were included. Each child's age, sex, referral source, reason, renal ultrasound (RUS) prior to the MCUG, MCUG result and VUR grade were recorded. The WCH guidelines were applied to determine conformance, to evaluate predictors for an abnormal MCUG, and compared against other retrospectively applied guidelines (RCH, NICE, AAP). There was complete data for 168 children who underwent MCUG as part of an UTI investigation (median age 0.79 years, range 0.12-8.74, male:female 67:101). There were 67/168 abnormal MCUGs (62 children with VUR, five bladder diverticulum), and 97 refluxing renal units (43 high-grade VUR units). No posterior urethral valves (PUV) were identified as part of the UTI investigation. A total of 143/168 patients had prior RUS (normal:abnormal 67:76). The WCH guidelines had 82% conformance. There was no statistically significant association between an abnormal MCUG and age, sex, referral source, reason, or prior RUS result. The WCH guidelines may have missed five children with high-grade VUR (four children had surgery), compared with RCH, APP and NICE, with 8, 15, and 17 children, respectively, having high-grade VUR (two, five, and five children had surgery, respectively) show in the Summary Table. The retrospective study had limitations and possible selection bias (children with UTI without a MCUG). There were no standard treatment approaches for VUR; hence establishing a MCUG guideline is difficult. An alternative is the top-down approach. Current institutional guidelines for considering MCUG following UTI in children vary considerably. The MCUG guidelines at any institution must take into account the local management guidelines for high-grade VUR. Crown Copyright © 2016. Published by Elsevier Ltd. All rights reserved.

Lack of proportionality. Seven specifications of public interest that override post-approval commercial interests on limited access to clinical data.

PubMed

Strech, Daniel; Littmann, Jasper

2012-07-02

For the protection of commercial interests, licensing bodies such as the EMA and health technology assessment institutions such as NICE restrict full access to unpublished evidence. Their respective policies on data transparency, however, lack a systematic account of (1) what kinds of commercial interests remain relevant after market approval has been granted, (2) what the specific types of public interest are that may override these commercial interests post approval, and, most importantly, (3) what criteria guide the trade-off between public interest and legitimate measures for the protection of commercial interest. Comparing potential commercial interests with seven specifications of relevant public interest reveals the lack of proportionality inherent in the current practices of EMA and NICE.

The computational structural mechanics testbed architecture. Volume 2: The interface

NASA Technical Reports Server (NTRS)

Felippa, Carlos A.

1988-01-01

This is the third set of five volumes which describe the software architecture for the Computational Structural Mechanics Testbed. Derived from NICE, an integrated software system developed at Lockheed Palo Alto Research Laboratory, the architecture is composed of the command language CLAMP, the command language interpreter CLIP, and the data manager GAL. Volumes 1, 2, and 3 (NASA CR's 178384, 178385, and 178386, respectively) describe CLAMP and CLIP and the CLIP-processor interface. Volumes 4 and 5 (NASA CR's 178387 and 178388, respectively) describe GAL and its low-level I/O. CLAMP, an acronym for Command Language for Applied Mechanics Processors, is designed to control the flow of execution of processors written for NICE. Volume 3 describes the CLIP-Processor interface and related topics. It is intended only for processor developers.

The computational structural mechanics testbed architecture. Volume 1: The language

NASA Technical Reports Server (NTRS)

Felippa, Carlos A.

1988-01-01

This is the first set of five volumes which describe the software architecture for the Computational Structural Mechanics Testbed. Derived from NICE, an integrated software system developed at Lockheed Palo Alto Research Laboratory, the architecture is composed of the command language CLAMP, the command language interpreter CLIP, and the data manager GAL. Volumes 1, 2, and 3 (NASA CR's 178384, 178385, and 178386, respectively) describe CLAMP and CLIP, and the CLIP-processor interface. Volumes 4 and 5 (NASA CR's 178387 and 178388, respectively) describe GAL and its low-level I/O. CLAMP, an acronym for Command Language for Applied Mechanics Processors, is designed to control the flow of execution of processors written for NICE. Volume 1 presents the basic elements of the CLAMP language and is intended for all users.

Access to aidable residual hearing in adult candidates for cochlear implantation in the UK.

PubMed

Fielden, Claire A; Hampton, Rosa; Smith, Sandra; Kitterick, Pádraig T

2016-04-01

Guidance from the National Institute for Health and Care Excellence (NICE) permits candidates to receive a cochlear implant provided they only hear sounds louder than 90 dB HL at 2 and 4 kHz. In some patients, their level of residual hearing may be sufficient to warrant the use of a hearing aid in their non-implanted ear. A survey of unilaterally implanted adults indicated that those implanted since the publication of NICE guidance were almost seven times more likely to use a hearing aid than those implanted prior to this. If contralateral hearing aid use provides additional benefits over implant use alone, it may be appropriate to consider the capacity to use residual hearing following implantation when determining candidacy.

Fluctuating asymmetry, sociosexuality, and intrasexual competitive tactics.

PubMed

Simpson, J A; Gangestad, S W; Christensen, P N; Leck, K

1999-01-01

Heterosexual men and women were told they were competing with another same-sex individual for a date with an attractive opposite-sex interviewer. After answering 6 questions, participants were asked to tell the competitor why the interviewer should choose them over the competitor. Participants' videotaped behavior was coded for different behavioral tactics. Men who were more symmetrical and who had a more unrestricted sociosexual orientation were more likely to use direct competition tactics than were less symmetrical and restricted men. Restricted men accentuated their positive personal qualities, presenting themselves as "nice guys." Structural equation modeling revealed that fluctuating asymmetry (FA) was directly associated with the use of direct competition tactics. However, the link between FA and presenting oneself as a nice guy was mediated through sociosexuality. No effects were found for women.

The computational structural mechanics testbed architecture. Volume 2: Directives

NASA Technical Reports Server (NTRS)

Felippa, Carlos A.

1989-01-01

This is the second of a set of five volumes which describe the software architecture for the Computational Structural Mechanics Testbed. Derived from NICE, an integrated software system developed at Lockheed Palo Alto Research Laboratory, the architecture is composed of the command language (CLAMP), the command language interpreter (CLIP), and the data manager (GAL). Volumes 1, 2, and 3 (NASA CR's 178384, 178385, and 178386, respectively) describe CLAMP and CLIP and the CLIP-processor interface. Volumes 4 and 5 (NASA CR's 178387 and 178388, respectively) describe GAL and its low-level I/O. CLAMP, an acronym for Command Language for Applied Mechanics Processors, is designed to control the flow of execution of processors written for NICE. Volume 2 describes the CLIP directives in detail. It is intended for intermediate and advanced users.

Azacitidine for Treating Acute Myeloid Leukaemia with More Than 30 % Bone Marrow Blasts: An Evidence Review Group Perspective of a National Institute for Health and Care Excellence Single Technology Appraisal.

PubMed

Tikhonova, Irina A; Hoyle, Martin W; Snowsill, Tristan M; Cooper, Chris; Varley-Campbell, Joanna L; Rudin, Claudius E; Mujica Mota, Ruben E

2017-03-01

The National Institute for Health and Care Excellence (NICE) invited the manufacturer of azacitidine (Celgene) to submit evidence for the clinical and cost effectiveness of this drug for the treatment of acute myeloid leukaemia with more than 30 % bone marrow blasts in adults who are not eligible for haematopoietic stem cell transplantation, as part of the NICE's Single Technology Appraisal process. The Peninsula Technology Assessment Group was commissioned to act as the Evidence Review Group (ERG). The ERG produced a critical review of the evidence contained within the company's submission to NICE. The clinical effectiveness data used in the company's economic analysis were derived from a single randomised controlled trial, AZA-AML-001. It was an international, multicentre, controlled, phase III study with an open-label, parallel-group design conducted to determine the efficacy and safety of azacitidine against a conventional care regimen (CCR). The CCR was a composite comparator of acute myeloid leukaemia treatments currently available in the National Health Service: intensive chemotherapy followed by best supportive care (BSC) upon disease relapse or progression, non-intensive chemotherapy followed by BSC and BSC only. In AZA-AML-001, the primary endpoint was overall survival. Azacitidine appeared to be superior to the CCR, with median overall survival of 10.4 and 6.5 months, respectively. However, in the intention-to-treat analysis, the survival advantage associated with azacitidine was not statistically significant. The company submitted a de novo economic evaluation based on a partitioned survival model with four health states: "Remission", "Non-remission", "Relapse/Progressive disease" and "Death". The model time horizon was 10 years. The perspective was the National Health Service and Personal Social Services. Costs and health effects were discounted at the rate of 3.5 % per year. The base-case incremental cost-effectiveness ratio (ICER) of azacitidine compared with the CCR was £20,648 per quality-adjusted life-year (QALY) gained. In the probabilistic sensitivity analysis, the mean ICER was £17,423 per QALY. At the willingness-to-pay of £20,000, £30,000 and £50,000 per QALY, the probability of azacitidine being cost effective was 0.699, 0.908 and 0.996, respectively. The ERG identified a number of errors in Celgene's model and concluded that the results of the company's economic evaluation could not be considered robust. After amendments to Celgene's model, the base-case ICER was £273,308 per QALY gained. In the probabilistic sensitivity analysis, the mean ICER was £277,123 per QALY. At a willingness-to-pay of £100,000 per QALY, the probability of azacitidine being cost effective was less than 5 %. In all exploratory analyses conducted by the ERG, the ICER exceeded the NICE's cost-effectiveness threshold range of £20,000-30,000 per QALY. Given the evidence provided in the submission, azacitidine did not fulfil NICE's end-of-life criteria. After considering the analyses performed by the ERG and submissions from clinician and patient experts, the NICE Appraisal Committee did not recommend azacitidine for this indication.

Cetuximab for recurrent and/or metastatic squamous cell carcinoma of the head and neck: a NICE single technology appraisal.

PubMed

Bagust, Adrian; Greenhalgh, Janette; Boland, Angela; Fleeman, Nigel; McLeod, Claire; Dickson, Rumona; Dundar, Yenal; Proudlove, Christine; Shaw, Richard

2010-01-01

The National Institute for Health and Clinical Excellence (NICE) invited the manufacturer of cetuximab (Merck Serono) to submit evidence for the clinical and cost effectiveness of cetuximab in combination with platinum-based chemotherapy (CTX) for the treatment of patients with recurrent and/or metastatic squamous cell cancer of the head and neck (SCCHN) according to the Institute's Single Technology Appraisal (STA) process. The Liverpool Reviews and Implementation Group at the University of Liverpool was commissioned to act as the Evidence Review Group (ERG). This article summarizes the ERG's review of the evidence submitted by the manufacturer. A summary of the Appraisal Committee (AC) decision is provided. The ERG reviewed the clinical evidence in accordance with the decision problem defined by NICE. The analysis of the submitted model assessed the appropriateness of the manufacturer's approach to modelling the decision problem, the reliability of model implementation and the extent of conformity to published standards and prevailing norms of practice within the health economics modelling community. Particular attention was paid to issues likely to impact substantially on the base-case cost-effectiveness results. Clinical-effectiveness evidence was derived from a single randomized controlled trial (RCT). Results presented for clinical outcomes were strongly supportive of benefits resulting from the use of cetuximab. Cetuximab + platinum-based CTX with 5 fluorouracil (5-FU) extended median overall survival (OS) from 7.4 months in the CTX group to 10.1 months in the cetuximab + CTX group. Median progression-free survival rose from 3.3 months to 5.6 months, best overall response to therapy increased from 19.5% to 35.6%, disease control rate rose from 60% to 81.1% and median time to treatment failure was 4.8 months compared with 3.0 months. Exploratory subgroup analyses indicated significant OS benefits in 11 of 16 pre-planned analyses. The ERG identified a number of issues relating to the clinical-effectiveness results: consideration was limited to first-line use of cetuximab; patients in the trial were younger and fitter than those presenting in UK clinical practice; there was no evidence of survival advantage for patients with metastatic disease; there was no evidence of effectiveness in patients not cetuximab-naive; and the quality-of-life data were poor. The submitted incremental cost-effectiveness ratio was considerably above the NICE threshold. The ERG questioned the submitted economic model on a number of grounds: the rationale for creating an economic model rather than direct analysis of trial data; the use of Weibull functions for survival models; inaccurate CTX costs; selection of health state utilities; inaccurate unit costs; and lack of mid-cycle correction. After amending the model, the ERG considered the use of cetuximab to be not cost effective for NICE at any price. The AC concluded that cetuximab in combination with platinum-based CTX should not be recommended for the treatment of patients with recurrent and/or metastatic SCCHN. Patients already receiving this treatment for this indication should have the option to continue treatment until they and their clinician consider it appropriate to stop. This was the first appraisal to consider the end-of-life medicines criteria introduced by NICE in January 2009.

Collaborative Systems and Multi-user Interfaces: Computer-based Tools for Cooperative Problem Solving

DTIC Science & Technology

1986-10-31

Reference Card Given to Participants) Cognoter Reference Select = LeftButton Menu = MiddleButton TitleBar menu for tool operations Item menu for item...collaborative tools and their uses, the Colab system and the Cognoter presentation tool were implemented and used for both real and posed idea organization...tasks. To test the system design and its effect on structured problem-solving, many early Colab/ Cognoter meetings were monitored and a series of

77 FR 26183 - Technical Revisions To Update Reference to the Required Assessment Tool for State Nursing Homes...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-03

... Reference to the Required Assessment Tool for State Nursing Homes Receiving Per Diem Payments From VA AGENCY... resident assessment tool for State homes that receive per diem from VA for providing nursing home care to veterans. It requires State nursing homes receiving per diem from VA to use the most recent version of the...

High flow rate development: process optimization using megasonic immersion development (MID)

NASA Astrophysics Data System (ADS)

Courboin, Daniel; Choi, Jong Woo; Jung, Sang Hyun; Baek, Seung Hee; Kim, Lee Ju

2004-12-01

In previous study the high impact of development by-products on Critical Dimension (CD) through the microloading effect has been demonstrated for a Novolak resist. In this paper, through further tests involving Chemically Amplified Resist (CAR) and Novolak resist, the microloading effect of development is characterized and tentative mechanism is presented. Megasonic Immersion Development (MID), a high flow rate development technique similar to the Proximity Gap Suction Development (PGSD), was used and compared with spin spray development and puddle development. On TOK IP3600, a Novolak resist, we have explored a wide range of process conditions with MID. Developer temperature was varied from 5°C to 40°C with TMAH developer concentration of 1.9% and 2.38% resulting in an isofocal dose range of 90mJ to 190mJ. Exposure Focus Matrix (EFM) with a specific microloading pattern and resist cross sections were performed. The best conditions are quite far from the standard process advised by the resist supplier. Very nice standing wave profile was obtained at high temperature development. On CAR, JEOL 9000MVII, a 50kV e-beam vector scan tool, and ETEC ALTA 4300, a DUV raster scan tool, were used with different develop process techniques including MID. FujiFilm Arch FEP-171 positive CAR and Sumitomo NEB-22 negative CAR were used on 50kV writing tool. Sumitomo PEK-130 was used on DUV writing tool. FEP-171 and PEK-1300 show microloading effect on high density patterns but not NEB-22. MID shows also improved reproduction of develop features in the chrome and a 20% improvement of CD uniformity. The results of this study seem to indicate that a closer look in their development process is needed for 90nm and 65nm technologies.

Learning Photogrammetry with Interactive Software Tool PhoX

NASA Astrophysics Data System (ADS)

Luhmann, T.

2016-06-01

Photogrammetry is a complex topic in high-level university teaching, especially in the fields of geodesy, geoinformatics and metrology where high quality results are demanded. In addition, more and more black-box solutions for 3D image processing and point cloud generation are available that generate nice results easily, e.g. by structure-from-motion approaches. Within this context, the classical approach of teaching photogrammetry (e.g. focusing on aerial stereophotogrammetry) has to be reformed in order to educate students and professionals with new topics and provide them with more information behind the scene. Since around 20 years photogrammetry courses at the Jade University of Applied Sciences in Oldenburg, Germany, include the use of digital photogrammetry software that provide individual exercises, deep analysis of calculation results and a wide range of visualization tools for almost all standard tasks in photogrammetry. During the last years the software package PhoX has been developed that is part of a new didactic concept in photogrammetry and related subjects. It also serves as analysis tool in recent research projects. PhoX consists of a project-oriented data structure for images, image data, measured points and features and 3D objects. It allows for almost all basic photogrammetric measurement tools, image processing, calculation methods, graphical analysis functions, simulations and much more. Students use the program in order to conduct predefined exercises where they have the opportunity to analyse results in a high level of detail. This includes the analysis of statistical quality parameters but also the meaning of transformation parameters, rotation matrices, calibration and orientation data. As one specific advantage, PhoX allows for the interactive modification of single parameters and the direct view of the resulting effect in image or object space.

Ruxolitinib for the treatment of myelofibrosis: a NICE single technology appraisal.

PubMed

Wade, Ros; Rose, Micah; Neilson, Aileen Rae; Stirk, Lisa; Rodriguez-Lopez, Rocio; Bowen, David; Craig, Dawn; Woolacott, Nerys

2013-10-01

The National Institute for Health and Care Excellence (NICE) invited the manufacturer of ruxolitinib (Novartis) to submit clinical and cost-effectiveness evidence for ruxolitinib within its licensed indication (the treatment of disease-related splenomegaly or symptoms in adult patients with myelofibrosis), according to the Institute's Single Technology Appraisal process. The Centre for Reviews and Dissemination and Centre for Health Economics at the University of York were commissioned to act as the independent Evidence Review Group (ERG). This article provides a description of the company submission, the ERG review and the resulting NICE guidance TA289 issued in June 2013. The ERG critically reviewed the evidence presented in the manufacturer's submission and identified areas requiring clarification, for which the manufacturer provided additional evidence. The main clinical effectiveness data were derived from two phase III, multicentre, randomised controlled trials (RCTs): Controlled myelofibrosis study with oral JAK inhibitor treatment (COMFORT)-II compared ruxolitinib with best available therapy (BAT), and COMFORT-I compared ruxolitinib with placebo. These RCTs demonstrated that ruxolitinib confers significant benefits in terms of spleen size reduction and improvement in symptom burden. In the COMFORT-II trial, a reduction in spleen volume of ≥35 % was achieved in 28 % of ruxolitinib-treated patients compared with 0 % of patients in the BAT group (p < 0.001) at 48 weeks, and there was a mean change in spleen volume of -30.1 versus +7.3 % (p < 0.001). Ruxolitinib also provided significant improvements in myelofibrosis-associated symptoms and health-related quality-of-life compared with BAT and placebo. The ERG concluded that ruxolitinib appears to reduce splenomegaly and its associated symptoms, but that there was considerable uncertainty surrounding the manufacturer's cost-effectiveness estimates due to limitations in the manufacturer's model. The manufacturer's model did not allow for disease progression, did not accurately capture symptomatic relief, had several implausible or unjustified assumptions, and there were several parameter choices that the ERG found sub-optimal. ERG sensitivity analyses found that nearly all plausible adjustments to the model reduced the cost effectiveness of ruxolitinib. It is very likely that the base-case incremental cost-effectiveness ratio of £73,980/quality-adjusted life-year presented by the manufacturer represents a best-case scenario. The NICE Appraisal Committee concluded that ruxolitinib was clinically effective, but could not be considered a cost effective use of National Health Service (NHS) resources for treating disease-related splenomegaly or symptoms in adults with myelofibrosis. Ruxolitinib is not recommended for the treatment of disease-related splenomegaly or symptoms in adult patients with primary myelofibrosis (also known as chronic idiopathic myelofibrosis), post-polycythaemia vera myelofibrosis and post-essential thrombocythaemia myelofibrosis in NICE TA289.

Lenalidomide for the Treatment of Low- or Intermediate-1-Risk Myelodysplastic Syndromes Associated with Deletion 5q Cytogenetic Abnormality: An Evidence Review of the NICE Submission from Celgene.

PubMed

Blommestein, Hedwig M; Armstrong, Nigel; Ryder, Steve; Deshpande, Sohan; Worthy, Gill; Noake, Caro; Riemsma, Rob; Kleijnen, Jos; Severens, Johan L; Al, Maiwenn J

2016-01-01

The National Institute for Health and Care Excellence (NICE) invited the manufacturer of lenalidomide (Celgene) to submit evidence of the clinical and cost effectiveness of the drug for treating adults with myelodysplastic syndromes (MDS) associated with deletion 5q cytogenetic abnormality, as part of the Institute's single technology appraisal (STA) process. Kleijnen Systematic Reviews Ltd (KSR), in collaboration with Erasmus University Rotterdam, was commissioned to act as the Evidence Review Group (ERG). This paper describes the company's submission, the ERG review, and the NICE's subsequent decisions. The ERG reviewed the evidence for clinical and cost effectiveness of the technology, as submitted by the manufacturer to the NICE. The ERG searched for relevant additional evidence and validated the manufacturer's decision analytic model to examine the robustness of the cost-effectiveness results. Clinical effectiveness was obtained from a three-arm, European, randomized, phase III trial among red blood cell (RBC) transfusion-dependent patients with low-/intermediate-1-risk del5q31 MDS. The primary endpoint was RBC independence for ≥26 weeks, and was reached by a higher proportion of patients in the lenalidomide 10 and 5 mg groups compared with placebo (56.1 and 42.6 vs 5.9 %, respectively; both p < 0.001). The option of dose adjustments after 16 weeks due to dose-limiting toxicities or lack of response made long-term effectiveness estimates unreliable, e.g. overall survival (OS). The de novo model of the manufacturer included a Markov state-transition cost-utility model implemented in Microsoft Excel. The base-case incremental cost-effectiveness ratio (ICER) of the manufacturer was £56,965. The ERG assessment indicated that the modeling structure represented the course of the disease; however, a few errors were identified and some of the input parameters were challenged. In response to the appraisal documentation, the company revised the economic model, which increased the ICER to £68,125 per quality-adjusted life-year. The NICE Appraisal Committee (AC) did not recommend lenalidomide as a cost-effective treatment. Subsequently, the manufacturer submitted a Patient Access Scheme (PAS) that provided lenalidomide free of charge for patients who remained on treatment after 26 cycles. This PAS improved the ICER to £25,300, although the AC considered the proportion of patients who received treatment beyond 26 cycles, and hence the ICER, to be uncertain. Nevertheless, the AC accepted a commitment from the manufacturer to publish, once available, data on the proportion of patients eligible for the PAS, and believed this provided reassurance that lenalidomide was a cost-effective treatment for low- or intermediate-1-risk MDS patients.

Degarelix for Treating Advanced Hormone-Dependent Prostate Cancer: An Evidence Review Group Perspective of a NICE Single Technology Appraisal.

PubMed

Uttley, Lesley; Whyte, Sophie; Gomersall, Timothy; Ren, Shijie; Wong, Ruth; Chambers, Duncan; Tappenden, Paul

2017-07-01

As part of its Single Technology Appraisal Process, the National Institute for Health and Care Excellence (NICE) invited the manufacturer of degarelix (Ferring Pharmaceuticals) to submit evidence for the clinical and cost effectiveness of degarelix for the treatment of advanced hormone-dependent prostate cancer. The School of Health and Related Research Technology Appraisal Group at the University of Sheffield was commissioned to act as the independent Evidence Review Group (ERG). The ERG produced a critical review of the evidence contained within the company's submission to NICE. The evidence, which included a randomised controlled trial (RCT) of degarelix versus leuprorelin, found that degarelix was non-inferior to leuprorelin for reduction of testosterone levels and that degarelix achieved a more rapid suppression of prostate-specific antigen levels and subsequently decreased incidences of testosterone flare associated with luteinising hormone releasing-hormone (LHRH) agonists. However, protection against testosterone flare for the comparators in the clinical trials was not employed in line with UK clinical practice. Further claims surrounding overall survival, cardiovascular adverse events and clinical equivalence of the comparator drugs from six RCTs of degarelix should be regarded with caution because of flaws and inconsistencies in the pooling of trial data to draw conclusions. The cost-effectiveness evidence included a de novo economic model. Based on the ERG's preferred base case, the deterministic incremental cost-effectiveness analysis (ICER) for degarelix versus 3-monthly triptorelin was £14,798 per quality-adjusted life-year (QALY) gained. Additional scenario analyses undertaken by the ERG resulted in ICERs for degarelix versus 3-monthly triptorelin ranging from £17,067 to £35,589 per QALY gained. Subgroup analyses undertaken using the Appraisal Committee's preferred assumptions suggested that degarelix was not cost effective for the subgroup with metastatic disease but could be cost effective for the subgroup with spinal metastases. The company submitted further evidence to NICE following an initial negative Appraisal Committee decision. Further analyses from the Decision Support Unit found that that, whilst some evidence indicated that degarelix could be cost effective for a small subgroup of people with spinal cord compression (SCC), data on the potential size of this subgroup and the rate of SCC were insufficient to estimate an ICER based on the evidence submitted by the company and a separately commissioned systematic review. NICE recommended degarelix as an option for treating advanced hormone-dependent prostate cancer in people with spinal metastases, only if the commissioner can achieve at least the same discounted drug cost as that available to the UK NHS in June 2016.

SEER Abstracting Tool (SEER*Abs)

Cancer.gov

With this customizable tool, registrars can collect and store data abstracted from medical records. Download the software and find technical support and reference manuals. SEER*Abs has features for creating records, managing abstracting work and data, accessing reference data, and integrating edits.

Editors' note

NASA Astrophysics Data System (ADS)

2007-03-01

This issue of Astronomische Nachrichten is a collection of original papers on local helioseismology, which covers topics discussed at the first HELAS local helioseismology workshop held on 2006 September 25-27 at Nice Observatory, France.

Overview Of Impedance Sensors

NASA Astrophysics Data System (ADS)

Abele, John E.

1989-08-01

Electrical impedance has been one of the many "tools of great promise" that physicians have employed in their quest to measure and/or monitor body function or physiologic events. So far, the expectations for its success have always exceeded its performance. In simplistic terms, physiologic impedance is a measure of the resistance in the volume between electrodes which changes as a function of changes in that volume, the relative impedance of that volume, or a combination of these two. The history and principles of electrical impedance are very nicely reviewed by Geddes and Baker in their textbook "Principles of Applied Biomedical Instrumentation". It is humbling, however, to note that Cremer recorded variations in electrical impedance in frog hearts as early as 1907. The list of potential applications includes the measurement of thyroid function, estrogen activity, galvanic skin reflex, respiration, blood flow by conductivity dilution, nervous activity and eye movement. Commercial devices employing impedance have been and are being used to measure respiration (pneumographs and apneamonitors), pulse volume (impedance phlebographs) and even noninvasive cardiac output.

New robotics: design principles for intelligent systems.

PubMed

Pfeifer, Rolf; Iida, Fumiya; Bongard, Josh

2005-01-01

New robotics is an approach to robotics that, in contrast to traditional robotics, employs ideas and principles from biology. While in the traditional approach there are generally accepted methods (e. g., from control theory), designing agents in the new robotics approach is still largely considered an art. In recent years, we have been developing a set of heuristics, or design principles, that on the one hand capture theoretical insights about intelligent (adaptive) behavior, and on the other provide guidance in actually designing and building systems. In this article we provide an overview of all the principles but focus on the principles of ecological balance, which concerns the relation between environment, morphology, materials, and control, and sensory-motor coordination, which concerns self-generated sensory stimulation as the agent interacts with the environment and which is a key to the development of high-level intelligence. As we argue, artificial evolution together with morphogenesis is not only "nice to have" but is in fact a necessary tool for designing embodied agents.

The medline UK filter: development and validation of a geographic search filter to retrieve research about the UK from OVID medline.

PubMed

Ayiku, Lynda; Levay, Paul; Hudson, Tom; Craven, Jenny; Barrett, Elizabeth; Finnegan, Amy; Adams, Rachel

2017-07-13

A validated geographic search filter for the retrieval of research about the United Kingdom (UK) from bibliographic databases had not previously been published. To develop and validate a geographic search filter to retrieve research about the UK from OVID medline with high recall and precision. Three gold standard sets of references were generated using the relative recall method. The sets contained references to studies about the UK which had informed National Institute for Health and Care Excellence (NICE) guidance. The first and second sets were used to develop and refine the medline UK filter. The third set was used to validate the filter. Recall, precision and number-needed-to-read (NNR) were calculated using a case study. The validated medline UK filter demonstrated 87.6% relative recall against the third gold standard set. In the case study, the medline UK filter demonstrated 100% recall, 11.4% precision and a NNR of nine. A validated geographic search filter to retrieve research about the UK with high recall and precision has been developed. The medline UK filter can be applied to systematic literature searches in OVID medline for topics with a UK focus. © 2017 Crown copyright. Health Information and Libraries Journal © 2017 Health Libraries GroupThis article is published with the permission of the Controller of HMSO and the Queen's Printer for Scotland.

Precision displacement reference system

DOEpatents

Bieg, Lothar F.; Dubois, Robert R.; Strother, Jerry D.

2000-02-22

A precision displacement reference system is described, which enables real time accountability over the applied displacement feedback system to precision machine tools, positioning mechanisms, motion devices, and related operations. As independent measurements of tool location is taken by a displacement feedback system, a rotating reference disk compares feedback counts with performed motion. These measurements are compared to characterize and analyze real time mechanical and control performance during operation.

Will the implementation of the 2007 National Institute for Health and Clinical Excellence (NICE) guidelines on childhood urinary tract infection (UTI) in the UK miss significant urinary tract pathology?

PubMed

Deader, Rafia; Tiboni, Sonia G; Malone, Padraig S J; Fairhurst, Joanna

2012-08-01

• To investigate whether the implementation of the August 2007 National Institute for Health and Clinical Excellence (NICE) guidelines would miss significant urinary tract pathology in children with urinary tract infection (UTI). • All ultrasound (US) performed in children aged >6 months, during the year 1 August 2006 to 31 July 2007 for UTI, were retrospectively studied. • Each US scan in the study population of 346 was categorised dependent on whether it was appropriate or inappropriate to have been performed under the new guidelines and whether the US scan was normal or abnormal. • The records of each patient with an inappropriate abnormal US scan were re-analysed to see if patient management was affected by the US scan. • In 2011 patients with an original inappropriate abnormal US scan were re-evaluated to identify if any had presented with further urinary pathology. • In accordance with the NICE guidelines patients were divided by age. • Children aged 0.5-3 years: 78/95 (82%) US scans were inappropriate of which 12 (15%) were abnormal and four of these had a further documented UTI. After careful assessment of the US abnormalities it was judged that only one would have benefited from the initial US scan. • Children aged >3 years: 146/251 (58%) US scans were inappropriate of which 21(14%) were abnormal and six of these (29%) had a further documented UTI. After careful assessment of the US abnormalities it was judged that only three of 21 (14%) would have benefited from the initial US scan. • The vast majority of anomalies detected on the inappropriate US scans were of little clinical significance. • It is difficult to identify any patient who would have been truly disadvantaged if the US scan had not been performed after the initial UTI. • The NICE guidelines are safe to follow. © 2011 THE AUTHORS. BJU INTERNATIONAL © 2011 BJU INTERNATIONAL.

A change in the trend in dosulepin usage following the introduction of a prescribing indicator but not after two national safety warnings.

PubMed

Deslandes, P N; Jenkins, K S L; Haines, K E; Hutchings, S; Cannings-John, R; Lewis, T L; Bracchi, R C; Routledge, P A

2016-04-01

The tricyclic antidepressant dosulepin has been associated with an increased risk of toxicity in overdose compared with other antidepressants. In the UK, the MHRA and NICE have issued advice on the prescribing of dosulepin, and a National Prescribing Indicator (NPI) to monitor usage was introduced in Wales in 2011. The aim of this study was to assess whether trends in dosulepin usage in Wales and NE England changed following the two pieces of safety guidance and the introduction of the National Prescribing Indicator in Wales. Primary care dosulepin usage in the 12 months prior to and following MHRA safety advice (in 2007), NICE guideline CG90 (in 2009) and the introduction of the NPI (in 2011) was obtained. Usage was measured using defined daily doses (DDDs) per 1000 prescribing units (PUs). The trends in the 12 months prior to and following the introduction of prescribing advice and the NPI were compared using an autoregressive integrated moving average (ARIMA) model. In Wales, the trend in dosulepin usage did not change significantly prior to and following the MHRA advice: -0·18 and -0·43 DDDs/1000PUs per month, respectively (P = 0·07), or prior to and following NICE CG90: -0·30 and -0·49 DDDs/1000PUs per month, respectively (P = 0·35). In the 12 months prior to and following the introduction of the NPI, the trend was -0·45 and -0·98 DDDs/1000PUs per month, respectively (P = 0·001). In NE England, the trend did not alter significantly following the NICE advice or the introduction of the NPI in Wales. The trend in dosulepin usage in Wales altered significantly following the introduction of the NPI, but not after the other prescribing advice. This association, coupled with the absence of a significant change in NE England over the same period, provided some evidence of the effectiveness of the NPI in prompting a change in prescribing behaviour in Wales. © 2016 John Wiley & Sons Ltd.

The Role of Noncomparative Evidence in Health Technology Assessment Decisions.

PubMed

Griffiths, Elizabeth A; Macaulay, Richard; Vadlamudi, Nirma K; Uddin, Jasim; Samuels, Ebony R

2017-12-01

Many health technology assessment (HTA) agencies express a preference for randomized controlled trial evidence when appraising health technologies; nevertheless, it is not always feasible or ethical to conduct such comparative trials. To assess the role of noncomparative evidence in HTA decision making. The Web sites of the National Institute for Health and Care Excellence (NICE) in the United Kingdom, the Canadian Agency for Drugs and Technologies in Health (CADTH) in Canada, and the Institute for Quality and Efficiency in Health Care (Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen [IQWiG]) in Germany were searched for single HTA reports (published between January 2010 and December 2015). The product, indication, outcome, and clinical evidence presented (comparative/noncomparative) were double-extracted, with any discrepancies reconciled. A noncomparative study was defined as any study not presenting results against another treatment (including placebo or best supportive care), regardless of phase or setting, including dose-ranging studies. A total of 549 appraisals were extracted. Noncomparative evidence was considered in 38% (45 of 118) of NICE submissions, 13% (34 of 262) of CADTH submissions, and 12% (20 of 169) of IQWiG submissions. Evidence submissions based exclusively on noncomparative evidence were presented in only 4% (5 of 118) of NICE appraisals, 6% (16 of 262) of CADTH appraisals, and 4% (6 of 169) of IQWiG appraisals. Most drugs appraised solely on the basis of noncomparative evidence were indicated for cancer or hepatitis C. Positive outcome rates (encompassing recommended/restricted/added-benefit decisions) for submissions presenting only noncomparative evidence were similar to overall recommendation rates for CADTH (69% vs. 68%, respectively), but were numerically lower for NICE (60% vs. 84%, respectively) and IQWiG (17% vs. 38%, respectively) (P > 0.05 for all). Noncomparative studies can be viewed as acceptable clinical evidence by HTA agencies when these study designs are justifiable and when treatment effect can be convincingly demonstrated, but their use is currently limited. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Are life-extending treatments for terminal illnesses a special case? Exploring choices and societal viewpoints.

PubMed

McHugh, Neil; van Exel, Job; Mason, Helen; Godwin, Jon; Collins, Marissa; Donaldson, Cam; Baker, Rachel

2018-02-01

Criteria used by the National Institute for Health and Care Excellence (NICE) to assess life-extending, end-of-life (EoL) treatments imply that health gains from such treatments are valued more than other health gains. Despite claims that the policy is supported by societal values, evidence from preference elicitation studies is mixed and in-depth research has shown there are different societal viewpoints. Few studies elicit preferences for policies directly or combine different approaches to understand preferences. Survey questions were designed to investigate support for NICE EoL guidance at national and regional levels. These 'Decision Rule' and 'Treatment Choice' questions were administered to an online sample of 1496 UK respondents in May 2014. The same respondents answered questions designed to elicit their agreement with three viewpoints (previously identified and described) in relation to provision of EoL treatments for terminally ill patients. We report the findings of these choice questions and examine how they relate to each other and respondents' viewpoints. The Decision Rule questions described three policies: DA - a standard 'value for money' test, applied to all health technologies; DB - giving special consideration to all treatments for terminal illnesses; and DC - giving special consideration to specific categories of treatments for terminal illnesses e.g. life extension (as in NICE EoL guidance) or those that improve quality-of-life (QoL). Three Treatment Choices were presented: TA - improving QoL for patients with a non-terminal illness; TB - extending life for EoL patients; and TC - improving QoL at the EoL. DC received most support (45%) with most respondents giving special consideration to EoL only when treatments improved QoL. The most commonly preferred treatment choices were TA (51%) and TC (43%). Overall, this study challenges claims about public support for NICE's EoL guidance and the focus on life extension at EoL and substantiates existing evidence of plurality in societal values. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

Achieving Excellence in Library Instruction.

ERIC Educational Resources Information Center

Gilbert, Betty; And Others

The materials included in this document supporting library instruction are divided into two chapters. The first chapter contains bibliographies of instructional materials, professional periodicals, general reference tools, and religious reference tools. Throughout the bibliographies, the approximate cost of the materials is indicated by dollar…

Tool setting device

DOEpatents

Brown, Raymond J.

1977-01-01

The present invention relates to a tool setting device for use with numerically controlled machine tools, such as lathes and milling machines. A reference position of the machine tool relative to the workpiece along both the X and Y axes is utilized by the control circuit for driving the tool through its program. This reference position is determined for both axes by displacing a single linear variable displacement transducer (LVDT) with the machine tool through a T-shaped pivotal bar. The use of the T-shaped bar allows the cutting tool to be moved sequentially in the X or Y direction for indicating the actual position of the machine tool relative to the predetermined desired position in the numerical control circuit by using a single LVDT.

Lice Aren't So Nice

MedlinePlus

... much scratching can lead to scalp infections. Lice Love Everyone Because lice are parasites, they will set ... lice are dirty doesn't know that lice love everyone and that includes the cleanest kid in ...

A Combined Approach of Infrared Spectroscopy and Multivariate Analysis for the Simultaneous Determination of Sugars and Fructans in Strawberry Juices During Storage.

PubMed

Cassani, Lucía; Santos, Mauricio; Gerbino, Esteban; Del Rosario Moreira, María; Gómez-Zavaglia, Andrea

2018-03-01

In this work, a Fourier transform mid-infrared spectroscopy (FTIR)-based method was developed for simultaneously quantifying simple sugars and exogenously added fructooligosaccharides (FOS) in strawberry juices preserved for up to 14 d using nonthermal techniques (geraniol and vanillin+ultrasound). The main spectral differences were observed in the 1200 to 900 cm -1 region. The presence of FOS was identified by the typical bands at 1134, 1034, and 935 cm -1 . During storage, a significant decrease of sucrose was concomitant to an increase of glucose and fructose in juices stored without any previous preservation treatment, as determined by high-performance liquid chromatography (HPLC). A principal component analysis was performed on the FTIR spectra corresponding to the different treatments. The groups observed explained more than 94% of the variance and were related to changes in the carbohydrate composition during storage. Then, different partial least square models (PLS) were defined to determine the concentrations of glucose, sucrose, fructose, and those of exogenously added FOS with degrees of polymerization within 3 and 5. The carbohydrates' concentrations determined by HPLC were used as reference method. The models were validated with independent sets of data. The mean of predicted values fitted nicely those obtained by HPLC (correlation and R 2  > 0.97), thus supporting the use of the PLS models to monitor the quality of strawberry juices in unknown samples. In conclusion, FTIR spectroscopy appears as an adequate analytical tool to quick assess whether juice formulations meet specifications in terms of authenticity, contamination and/or deterioration. FTIR spectroscopy provided a method potentially transferable to the food industry when associated with the multivariate analysis. The robust 21 PLS models defined in this work provided reliable tools for the rapid monitoring of juices' authenticity and/or deterioration. In this regard, FTIR associated to multivariate analysis enabled the determination of different sugars in a single measurement without the need of pure sugars as standards. This experimental simplicity supports the use of FTIR at the production line, and also contributes to save time in determining carbohydrates' composition and stability, in an environmentally friendly way. © 2017 Institute of Food Technologists®.

Clio's Workshop: Resources for Historical Studies in American Librarianship.

ERIC Educational Resources Information Center

Tucker, John Mark

2000-01-01

Identifies tools most useful in the library historian's workshop, particularly those of a bibliographic, reference, or documentary nature. Highlights include bibliographic tools and the formative years of librarianship; sources of current scholarship; reference sources, including minority voices; documentary materials; and historians in…

Human populations: houses for spouses.

PubMed

Balaresque, Patricia; Jobling, Mark A

2007-01-09

Patterns of genetic variability in human populations are profoundly influenced by social organisation, including lifestyle, language, religion and social status. A nice illustration is seen among societies that have specific rules about who can marry whom.

Nearly Nice Right Triangles.

ERIC Educational Resources Information Center

Reid, Bob

1989-01-01

Relationships among the sides are developed for right triangles whose sides are in the ratios 1:3, 1:4, and 1:5. The golden ratio appears in the results which can be used in secondary mathematics. (DC)

Sexual conflict: nice guys finish last.

PubMed

Emery Thompson, Melissa

2014-12-01

Male chimpanzees are often aggressive towards females. A new study from Gombe National Park in Tanzania reports that persistent attacks increase a male's probability of siring offspring. Copyright © 2014 Elsevier Ltd. All rights reserved.

Grouping diabetes checks could confuse score and reward process.

PubMed

Kleebauer, Alistair

2014-08-19

Diabetes nurses have questioned whether GP practices will have the staff capacity to carry out eight health checks on diabetes patients recommended by the National Institute for Care and Health Excellence (NICE).

Depoliticisation, Resilience and the Herceptin Post-Code Lottery Crisis: Holding Back the Tide

PubMed Central

2015-01-01

Research Highlights and Abstract This article: Covers new empirical terrain in the study of depoliticisation, with an in-depth case study of health technology regulation; Analyses depoliticisation from a novel analytical perspective, examining how depoliticised institutions are resilient to external pressure for politicisation; Posits a distinctive framework for analysing resilience, drawing on cognate literatures on policy networks and agencification; Raises interesting and distinctive questions about the nature of depoliticisation in advanced liberal democracies, arguing it is more contested than commonly acknowledged. Depoliticisation as a concept offers distinctive insights into how governments attempt to relieve political pressures in liberal democracies. Analysis has examined the effects of depoliticisation tactics on the public, but not how those tactics are sustained during moments of political tension. Drawing on policy networks and agencification literatures, this article examines how these tactics are resilient against pressure for politicisation. Using an in-depth case study of the controversial appraisal of cancer drug Herceptin in 2005/6 by the National Institute for Health and Clinical Excellence (NICE), the article examines how ‘resilient’ NICE was to external politicisation. It is argued that NICE was resilient because it was effectively ‘insulated’ by formal procedures and informal norms of deference to scientific expertise. This mechanism is termed ‘institutional double glazing’. The conclusion suggests developments to the conceptual and methodological framework of depoliticisation, and highlights theoretical insights into the nature of ‘anti-politics’ in contemporary democracies. PMID:27904418

Rationale and design of a double-blind, placebo-controlled, randomized trial to evaluate the safety and efficacy of nimodipine in preventing cognitive impairment in ischemic cerebrovascular events (NICE)

PubMed Central

2012-01-01

Background Stroke is the second most common cause of mortality and the leading cause of neurological disability, cognitive impairment and dementia worldwide. Nimodipine is a dihydropyridinic calcium antagonist with a role in neuroprotection, making it a promising therapy for vascular cognitive impairment and dementia. Methods/design The NICE study is a multicenter, randomized, double-blind, placebo-controlled study being carried out in 23 centers in China. The study population includes patients aged 30–80 who have suffered an ischemic stroke (≤7 days). Participants are randomly allocated to nimodipine (90 mg/d) or placebo (90 mg/d). The primary efficacy is to evaluate the level of mild cognitive impairment following treatment of an ischemic stroke with nimodipine or placebo for 6 months. Safety is being assessed by observing side effects of nimodipine. Assuming a relative risk reduction of 22%, at least 656 patients are required in this study to obtain statistical power of 90%. The first patient was recruited in November 2010. Discussion Previous studies suggested that nimodipine could improve cognitive function in vascular dementia and Alzheimer’s disease dementia. It is unclear that at which time-point intervention with nimodipine should occur. Therefore, the NICE study is designed to evaluate the benefits and safety of nimodipine, which was adminstered within seven days, in preventing/treating mild cognitive impairment following ischemic stroke. PMID:22950711

Children's colour choices for completing drawings of affectively characterised topics.

PubMed

Burkitt, Esther; Barrett, Martyn; Davis, Alyson

2003-03-01

This study was designed to explore whether or not children systematically use particular colours when completing drawings of affectively characterised topics. Three hundred and thirty 4-11-year-old children were subdivided into three conditions, colouring in a drawing of a man, a dog, or a tree, respectively. The children completed two test sessions in counterbalanced order. In one session, children rated and ranked ten colours in order of preference. In the other session, children completed three colouring tasks in which they had to colour in three identical figures but which had been given different affective characterisations: a neutrally characterised figure, a figure characterised as nasty, and a figure characterised as nice. It was found that, in all age groups and for all topics, the children used their more preferred colours for the nice figures, their least preferred colours for the nasty figures, and colours rated intermediately for the neutral figures. It was also found that, in all age groups and for all topics, black tended to be the most frequently chosen colour for colouring in the drawings of the negatively characterised figures. By contrast, primary colours were predominantly selected for the neutral figure, while a wide range of mainly primary and secondary colours were chosen for colouring in the nice figure. These results suggest that children are able to alter systematically their use of colour during picture completion tasks in response to differential affective topic characterisations, and that even very young children are able to use colours symbolically.

The NHS: assessing new technologies, NICE and value for money.

PubMed

Stevens, A; Chalkidou, K; Littlejohns, P

2011-06-01

The healthcare system in the UK, essentially the NHS, is an open economic system subject to the same pressures as any other economic system. The pressures concern limited resources coupled with powerful drivers for increasing spending: invention, demography and inflation. There have only ever been three types of economic system: steady state (everything, as in a feudal system, stays as it was the year before), market capitalism (supply and demand are allowed to find their own equilibrium) and some version of central planning. In healthcare, most advanced countries favour the last of the three. This is for three reasons: distribution (not only are the poor less able to pay for sickness, but sickness exacerbates poverty), information (markets operate poorly when providers can easily outsmart customers) and externalities (it is in the interest of everyone that infectious diseases and the other knock-on consequences of ill health are ameliorated). So in the UK, the state, with a good deal of cross-party consensus, directs most of health service supply. This system has become more complex over the decades since the formation of the NHS in 1948. A notable element of the complexity is the regulation of the introduction of new technologies. A key element of the regulatory system has been the National Institute for Health and Clinical Excellence (NICE), and a key aspect of NICE's decisions has been not just value, but also value for money. This has not been without controversy.

Strategies for Sustainable Cancer Care.

PubMed

Kerr, David J; Jani, Anant; Gray, Sir Muir

2016-01-01

There is an increasing focus on the relative cost-effectiveness and sustainability of delivering high-quality cancer care, with most emphasis, debatably, given to cost control of innovative treatments. It is difficult to calculate all the direct and indirect contributors to the total cost of cancer treatment, but it is estimated that cancer drugs constitute 10% to 30% of the total cost of cancer care. A 2007 study in France showed the contribution of drug costs was less than 20%, with approximately 70% of the total expenditure on cancer accounted for by health care resource use, such as hospitalization. The U.K. government established the National Institute for Health and Care Excellence (NICE)-the dominant function of which is technology appraisal-to assess the clinical and cost-effectiveness of new pharmaceutical and biopharmaceutical products. This is to ensure that all National Health Service (NHS) patients have equitable access to the most clinically effective and cost-effective treatments that are viable. NICE has developed a transparent, public process to judge incremental cost-effectiveness using the quality-adjusted life year (QALY), which allows comparisons of cost-effectiveness across medical specialties. NICE has been both lauded and criticized-especially when it passes judgment on marginally effective but expensive anticancer drugs-but it provides a route to "rational rationing" and, therefore, may contribute to sustainable cancer care by highlighting the issue of affordable medicine. This implies a challenge to the wider oncology community as to how we might cooperate to introduce the concept of value-driven cancer care.

Smartphones - the Geophysics Lab in Your Students' Pocket

NASA Astrophysics Data System (ADS)

Salaree, A.; Stein, S.; Saloor, N.; Elling, R. P.

2017-12-01

Many interesting topics are hard to demonstrate in geophysics classes without costly equipment and logistic hassles. For instance, the speed of P-waves in the Earth's crust is usually calculated using printed seismic sections from published studies, giving students little insight into the recording process. This is mainly due to the complex, costly, and weather-dependent logistics of conducting seismic reflection experiments using arrays of - either purchased or borrowed - expensive seismometers and recording units. Smartphones, which students own and are (perhaps unduly) comfortable with, have many otherwise expensive instruments as built-in sensors. These instruments are nifty tools that make labs easier, faster, and more fun. We use smartphones in several labs in an introductory geophysics class. In one, students use their phones to measure the latitude and longitude of a point on campus. Combining the data shows a nice spread of positions illustrating the precision of measurements, spatial trends in the scatter, and even differences between Android and iPhone data. Hence concepts about data that are often presented with ideal theoretical examples emerge from the students' measurements. Another uses the phones' accelerometers and available software to measure the speed of P-waves using a linear array of smartphones/seismometers along a table, similar to the procedure used in reflection seismology. In a third, students used their smartphones in an elevator to measure the acceleration of gravity in a moving reference frame, and thus explore key concepts that arise in many geophysical applications. These three applications illustrate the potential for using smartphones in a wide variety of geophysics teaching, much as their value is being increasingly recognized in other educational applications. Here are some links to an instructions document and a video from the seismic experiment: Instructions: http://www.earth.northwestern.edu/ amir/202/smartphone_array.pdf Video: https://youtu.be/SL5dr4o5oTI

Atrial fibrillation: stroke prevention in focus.

PubMed

Ferguson, Caleb; Inglis, Sally C; Newton, Phillip J; Middleton, Sandy; Macdonald, Peter S; Davidson, Patricia M

2014-05-01

Atrial fibrillation (AF) is a common arrhythmia and a risk factor for stroke and other, adverse events. Internationally there have been recent advancements in the therapies available for, stroke prevention in AF. Nurses will care for individuals with AF across a variety of primary and acute, care settings and should be familiar with evidence based therapies. This paper provides a review of the epidemiology of AF and stroke, stroke and bleeding risk, assessment tools and evidence based treatments for the prevention of stroke in AF including the use of, novel anti-thrombin agents. A review of key databases was conducted from 2002 to 2012 using the key search terms 'atrial, fibrillation' 'anticoagulation' 'risk assessment' and 'clinical management'. The following electronic, databases were searched: CINAHL, Medline, Scopus, the Cochrane Library and Google Scholar., Reference lists were manually hand searched. Key clinical guidelines from National Institute for, Clinical Excellence (NICE, UK), American Heart Association (AHA, USA), American College of Cardiology, (ACC, USA) and the European Society of Cardiology (ESC) and key government policy documents were, also included. Articles were included in the review if they addressed nursing management with a focus, on Australia. Many treatment options exist for AF. Best practice guidelines make a variety of, recommendations which include cardioversion, ablation, pulmonary vein isolation, pharmacological, agents for rate or rhythm control approaches, and antithrombotic therapy (including anticoagulation, and antiplatelet therapy). Treatment should be patient centred and individualised based upon, persistency of the rhythm, causal nature, risk and co-morbid conditions. AF is a common and burdensome condition where treatment is complex and not without, risk. Nurses will encounter individuals with AF across a variety of primary and acute care areas, understanding the risk of AF and appropriate therapies is important across all care settings. Treatment, must be individually tailored to the needs of the patient and balanced with the best available evidence. Copyright © 2013 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.

Enterprise Reference Library

NASA Technical Reports Server (NTRS)

Bickham, Grandin; Saile, Lynn; Havelka, Jacque; Fitts, Mary

2011-01-01

Introduction: Johnson Space Center (JSC) offers two extensive libraries that contain journals, research literature and electronic resources. Searching capabilities are available to those individuals residing onsite or through a librarian s search. Many individuals have rich collections of references, but no mechanisms to share reference libraries across researchers, projects, or directorates exist. Likewise, information regarding which references are provided to which individuals is not available, resulting in duplicate requests, redundant labor costs and associated copying fees. In addition, this tends to limit collaboration between colleagues and promotes the establishment of individual, unshared silos of information The Integrated Medical Model (IMM) team has utilized a centralized reference management tool during the development, test, and operational phases of this project. The Enterprise Reference Library project expands the capabilities developed for IMM to address the above issues and enhance collaboration across JSC. Method: After significant market analysis for a multi-user reference management tool, no available commercial tool was found to meet this need, so a software program was built around a commercial tool, Reference Manager 12 by The Thomson Corporation. A use case approach guided the requirements development phase. The premise of the design is that individuals use their own reference management software and export to SharePoint when their library is incorporated into the Enterprise Reference Library. This results in a searchable user-specific library application. An accompanying share folder will warehouse the electronic full-text articles, which allows the global user community to access full -text articles. Discussion: An enterprise reference library solution can provide a multidisciplinary collection of full text articles. This approach improves efficiency in obtaining and storing reference material while greatly reducing labor, purchasing and duplication costs. Most importantly, increasing collaboration across research groups provides unprecedented access to information relevant to NASA s mission. Conclusion: This project is an expansion and cost-effective leveraging of the existing JSC centralized library. Adding key word and author search capabilities and an alert function for notifications about new articles, based on users profiles, represent examples of future enhancements.

Evaluation of French version of the Vulnerability to abuse screen scale (VASS), a elder abuse screening tool.

PubMed

Grenier, Florian; Capriz, Françoise; Lacroix-Hugues, Virginie; Paysant, François; Pradier, Christian; Franco, Alain

2016-06-01

The elder abuse is a major public health problem. In the world, almost 4 to 10% of people of more than 65 years would be abuse. The generalist practitioners report only 2% of the elder abuse. Furthermore, the evaluations of elder abuse screenings test found in the scientist literature were unsatisfactory. Evaluate the elder abuse screening capacities of the Vulnerability to abuse screen scale (VASS) in order to propose it to the doctors. VASS was translated in French. It's a quantitative and a forward-looking study whose the answers of people of more than 65 years old were analysed and compared in blind way to the answers of socials workers. 200 patients were included between March and May 2012 in the CHU of Cimiez, Nice. We found 104 patients in danger of abuse, 40 cases of abuse revealed by the socials workers, so 20% of abuses were reported by the gold standard. It means a sensibility of 90,9%, a specificity of 49,7% and a predictive value of 96,1% to a score of 1 to the test. The screening test VASS shown it useful to detect elder people in danger of abuse but a few discriminants and not adapted to patients who have cognitive pathologies. It's a screening tool usable by default, more sensitive than others tests in the scientist literature. However, these results ask the question of the useful of these tools of elder abuse screening in comparison with the education of doctors which made proofs of success in this subject.

E-KIT: An Electronic-Knowledge Information Tool for Organizing Site Information and Improving Technical Communication with Stakeholders - 13082

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

Kautsky, Mark; Findlay, Richard C.; Hodges, Rex A.

2013-07-01

Managing technical references for projects that have long histories is hampered by the large collection of documents, each of which might contain discrete pieces of information relevant to the site conceptual model. A database application has been designed to improve the efficiency of retrieving technical information for a project. Although many databases are currently used for accessing analytical and geo-referenced data, applications designed specifically to manage technical reference material for projects are scarce. Retrieving site data from the array of available references becomes an increasingly inefficient use of labor. The electronic-Knowledge Information Tool (e-KIT) is designed as a project-level resourcemore » to access and communicate technical information. The e-KIT is a living tool that grows as new information becomes available, and its value to the project increases as the volume of site information increases. Having all references assembled in one location with complete reference citations and links to elements of the site conceptual model offers a way to enhance communication with outside groups. The published and unpublished references are incorporated into the e-KIT, while the compendium of references serves as a complete bibliography for the project. (authors)« less

Bevacizumab for metastatic colorectal cancer: a NICE single technology appraisal.

PubMed

Whyte, Sophie; Pandor, Abdullah; Stevenson, Matt

2012-12-01

The National Institute for Health and Clinical Excellence (NICE) invited the manufacturer of bevacizumab (Roche Products) to submit evidence for the clinical and cost effectiveness of this drug for the treatment of patients with metastatic colorectal cancer (mCRC), as part of the Institute's Single Technology Appraisal (STA) process. The School of Health and Related Research (ScHARR) at the University of Sheffield was commissioned to act as the Evidence Review Group (ERG). This paper provides a description of the company submission, the ERG review and NICE's subsequent decisions. The ERG produced a critical review of the evidence for the clinical and cost effectiveness of the technology provided within the manufacturer's submission to NICE. The ERG also independently searched for relevant evidence and modified the manufacturer's decision analytic model to examine the impact of altering some of the key assumptions. The main clinical effectiveness data were derived from a phase III, multicentre, multinational, two-arm, randomized, open-label study with the primary objective of confirming the non-inferiority of oxaliplatin plus capecitabine (XELOX) compared with oxaliplatin plus 5-fluorouracil and folinic acid (FOLFOX-4) in adult patients with histologically confirmed mCRC who had not previously been treated. The ERG considered that the NO16966 trial was of reasonable methodological quality and demonstrated a significant improvement in both progression-free and overall survival when bevacizumab is added to either XELOX or FOLFOX-4. The ERG considered that the size of the actual treatment effect of bevacizumab was uncertain due to trial design limitations, imbalance of a known prognostic factor, relatively short treatment duration compared with that allowed within the trial protocol, and interpretation of the statistical analyses. The manufacturer's submission included a de novo economic evaluation using a cost-effectiveness model built in Microsoft® Excel. The ERG believed that the modelling structure employed was appropriate but highlighted several areas of uncertainty that had the potential to have a significant impact on the resulting incremental cost-effectiveness ratios (ICERs). The areas of uncertainty identified by the ERG included whether chemotherapy would be administered continuously or intermittently, patient access scheme (PAS) costs and uptake, survival that was dependent on the statistical analyses used, and the likely duration of continued treatment with bevacizumab after cessation of oxaliplatin and the efficacy associated with continuation. The STA described here highlighted the challenges in appraising interventions with a complex PAS. Based on the analyses that include a discount to the list price of oxaliplatin, the ERG concluded that the ICERs for the addition of bevacizumab to XELOX or FOLFOX were both over £50 000. The NICE Appraisal Committee concluded that bevacizumab in combination with oxaliplatin and either 5-fluorouracil plus folinic acid or capecitabine (i.e. FOLFOX or XELOX) was not recommended for the treatment of mCRC.

BOOK REVIEW: Symmetry and the Monster: One of the Greatest Quests of Mathematics

NASA Astrophysics Data System (ADS)

Szabo, R. J.

2007-04-01

The book Symmetry and the Monster: One of the Greatest Quests of Mathematics describes historical events leading up to the discovery of the Monster sporadic group, the largest simple sporadic group. It also expounds the significance and deep relationships between this group and other areas of mathematics and theoretical physics. It begins, in the prologue, with a nice overview of some of the mathematical drama surrounding the discovery of the Monster and its subsequent relationship to number theory (the so-called Moonshine conjectures). From a historical perspective, the book traces back to the roots of group theory, Galois theory, and steadily runs through time through the many famous mathematicians who contributed to group theory, including Lie, Killing and Cartan. Throughout, the author has provided a very nice and deep insight into the sociological and scientific problems at the time, and gives the reader a very prominent inside view of the real people behind the mathematics. The book should be an enjoyable read to anyone with an interest in the history of mathematics. For the non-mathematician the book makes a good, and mostly successful, attempt at being non-technical. Technical mathematical jargon is replaced with more heuristic, intuitive terminology, making the mathematical descriptions in the book fairly easy going. A glossary\\hspace{0.25pc} of\\hspace{0.25pc} terminology for noindent the more scientifically inclined is included in various footnotes throughout the book and in a comprehensive listing at the end of the book. Some more technical material is also included in the form of appendices at the end of the book. Some aspects of physics are also explained in a simple, intuitive way. The author further attempts at various places to give the non-specialist a glimpse into what mathematical proof is all about, and explains the difficulties and technicalities involved in this very nicely (for instance, he mentions the various 100+ page articles that appeared in the hey-day of finite group theory, indicating the enormous technical nature of the subject). The book nicely paints a dramatic landscape leading up to the discovery of the Monster group, and the problems that remain to this day in trying to understand its significance. One can really take from this book a feel of the mathematics leading up to its appearance, and the importance of the classification problem which was responsible for this. One also really gets an appreciation of the efforts and commitments of the mathematicians who contributed to the subject. All in all, this book achieves a nice balance between providing a beautiful historical account of group theory, and explaining the classification problem for finite groups in a way that is accessible to non-scientists. This should prove to be a good read for both the layperson interested in mathematics or mathematical physics, and also both mathematicians and physicists alike.

Benford's law and continuous dependent random variables

NASA Astrophysics Data System (ADS)

Becker, Thealexa; Burt, David; Corcoran, Taylor C.; Greaves-Tunnell, Alec; Iafrate, Joseph R.; Jing, Joy; Miller, Steven J.; Porfilio, Jaclyn D.; Ronan, Ryan; Samranvedhya, Jirapat; Strauch, Frederick W.; Talbut, Blaine

2018-01-01

Many mathematical, man-made and natural systems exhibit a leading-digit bias, where a first digit (base 10) of 1 occurs not 11% of the time, as one would expect if all digits were equally likely, but rather 30%. This phenomenon is known as Benford's Law. Analyzing which datasets adhere to Benford's Law and how quickly Benford behavior sets in are the two most important problems in the field. Most previous work studied systems of independent random variables, and relied on the independence in their analyses. Inspired by natural processes such as particle decay, we study the dependent random variables that emerge from models of decomposition of conserved quantities. We prove that in many instances the distribution of lengths of the resulting pieces converges to Benford behavior as the number of divisions grow, and give several conjectures for other fragmentation processes. The main difficulty is that the resulting random variables are dependent. We handle this by using tools from Fourier analysis and irrationality exponents to obtain quantified convergence rates as well as introducing and developing techniques to measure and control the dependencies. The construction of these tools is one of the major motivations of this work, as our approach can be applied to many other dependent systems. As an example, we show that the n ! entries in the determinant expansions of n × n matrices with entries independently drawn from nice random variables converges to Benford's Law.

magHD: a new approach to multi-dimensional data storage, analysis, display and exploitation

NASA Astrophysics Data System (ADS)

Angleraud, Christophe

2014-06-01

The ever increasing amount of data and processing capabilities - following the well- known Moore's law - is challenging the way scientists and engineers are currently exploiting large datasets. The scientific visualization tools, although quite powerful, are often too generic and provide abstract views of phenomena, thus preventing cross disciplines fertilization. On the other end, Geographic information Systems allow nice and visually appealing maps to be built but they often get very confused as more layers are added. Moreover, the introduction of time as a fourth analysis dimension to allow analysis of time dependent phenomena such as meteorological or climate models, is encouraging real-time data exploration techniques that allow spatial-temporal points of interests to be detected by integration of moving images by the human brain. Magellium is involved in high performance image processing chains for satellite image processing as well as scientific signal analysis and geographic information management since its creation (2003). We believe that recent work on big data, GPU and peer-to-peer collaborative processing can open a new breakthrough in data analysis and display that will serve many new applications in collaborative scientific computing, environment mapping and understanding. The magHD (for Magellium Hyper-Dimension) project aims at developing software solutions that will bring highly interactive tools for complex datasets analysis and exploration commodity hardware, targeting small to medium scale clusters with expansion capabilities to large cloud based clusters.

Delay-based signal shapers and acfa 2020 blended wing body flight control system

NASA Astrophysics Data System (ADS)

Kucera, V.; Hromčík, M.

2013-12-01

The purpose of this paper is twofold. First: results related to application of signal shapers, imposed on pilot's commands, in cooperation with feedback flight control system (FCS) are reported for the case of ACFA2020 (Active Control for Flexible 2020 Aircraft) blended-wingbody (BWB) design. The results suggest that signal shapers can cooperate nicely both with FCS focused on the rigid-body dynamics only, as well as with an implemented and properly working active damping system. In both cases, the amount of vibrations due to pilot's inputs (manoeuvres) can be substantially reduced. Second: combination of signal shapers and rate-limiters is discussed in detail. Rate-limiters, representing finite achievable rates of servos for control surfaces, deteriorate considerably performance of the delay-based shapers. Configuration proposes only open-loop response of the free aircraft (without controller) for shaped reference respect to nonlinearities at action surface. Standard versions of the shapers cannot be therefore directly applied, especially for higher control surfaces deflections. Instead, two efficient alternatives can be used, suggested in the paper, that take the rate limitations into account at the design stage already.

Supramolecular inorganic species: An expedition into a fascinating, rather unknown land mesoscopia with interdisciplinary expectations and discoveries

NASA Astrophysics Data System (ADS)

Müller, A.

1994-09-01

One of the basic problems in science is the understanding of the potentialities of material systems, a topic which is of relevance for disciplines ranging from natural philosophy over topology and/or structural chemistry, and biology ( morphogenesis) to materials science. Information on this problem can be obtained by studying the different types of linking of basic fragments in self-assembly processes, a type of reaction which has proved to be one of the most important in the biological and material world. The outlined problem can be nicely studied in the case of polyoxometalates with reference to basic organizing principles of material systems like conservative self-organization ( self-assembly), host—guest interactions, complementarity, molecular recognition, emergence vs. reduction ( as a dialectic unit), template-direction, exchange-interactions and, in general, the mesoscopic material world with its unusual properties as well as its topological and/or structural diversity. Science will lose in significance as an interdisciplinary unit — as outlined or maybe predicted here — should not more importance be attached to general aspects in the future.

75 FR 12809 - Federal Aviation Administration

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-17

... DEPARTMENT OF TRANSPORTATION Federal Aviation Administration Notice of Intent To Rule on Request...: Federal Aviation Administration (FAA), DOT. ACTION: Notice of Request to Release Airport Property. SUMMARY... Nicely, Manager, Federal Aviation Administration, Southwest Region, Airports Division, Texas Airports...

[Anatomical and artistic breast considerations].

PubMed

Moufarrège, R

2005-10-01

The author presents the golden ratios of the breast. Out of these ratios, the breast will lack harmony and beauty. Starting there, he gives his advices and rules to follow in order to obtain nice shapes in augmentation mammaplasties.

Orienteering: A Thinging Man's Sport or It's Not Nice to Fool Mother Nature

ERIC Educational Resources Information Center

August, Irwin

1974-01-01

Orienteering is land navigation through unknown countryside with map and compass. This article describes an orienteering program in the Action Education Curriculum, State University of New York, College at Purchase. (KM)

A review of the cost-effectiveness of vedolizumab for treating moderate- to severely active ulcerative colitis.

PubMed

Tsai, Her Hsin; Black, Christopher

2016-12-01

Vedolizumab is a novel humanised monoclonal IgG1 antibody gut selective anti-integrin specifically targeting α4β7 integrins in the gut and found to be efficacious in the treatment of ulcerative colitis. Areas covered: Research investigating the cost-effectiveness of vedolizumab is limited. This review considers data from the manufacturers, the evidence research group commissioned by NICE to conduct a single technology appraisal, and the decision of NICE itself to appraise what is currently known about the cost-effectiveness of vedolizumab for moderately to severely active ulcerative from a UK perspective. Expert commentary: Based on the very limited data currently available, it can be concluded that vedolizumab is a cost-effective option for those with moderately to severely active ulcerative colitis who are anti-TNFa naive; however, there is a need for further research comparing vedolizumab with other biologic therapies which may alter perceptions of cost-effectiveness.

The relationship between moral judgment and cooperation in children with high-functioning autism

PubMed Central

Li, Jing; Zhu, Liqi; Gummerum, Michaela

2014-01-01

This study investigated moral judgment in children with high-functioning autism and their cooperation in prisoner's dilemma game with partners of different moralities. Thirty-eight 6- to 12-year-old high-functioning autistic (HFA) children and 31 typically developing (TD) children were recruited. Children were asked to judge story protagonists' morality. After making this moral judgment correctly, they were asked to play with the morally nice and the morally naughty child in a repeated prisoner's dilemma game. Results showed that both HFA and TD children made correct moral judgments, and that HFA children might even have more rigid criteria for what constitutes morally naughty acts. HFA children's cooperation did not differ depending on the morality of the interaction partner, while TD children showed higher cooperation when interacting with the morally nice than the morally naughty child did. Thus, partner's morality did influence TD children's but not HFA children's subsequent cooperation. PMID:24603775

NICE-Accredited Commissioning Guidance for Weight Assessment and Management Clinics: a Model for a Specialist Multidisciplinary Team Approach for People with Severe Obesity.

PubMed

Welbourn, Richard; Dixon, John; Barth, Julian H; Finer, Nicholas; Hughes, Carly A; le Roux, Carel W; Wass, John

2016-03-01

Despite increasing prevalence of obesity, no country has successfully implemented comprehensive pathways to provide advice to all the severely obese patients that seek treatment. We aimed to formulate pathways for referral into and out of weight assessment and management clinics (WAMCs) that include internal medicine/primary care physicians as part of a multidisciplinary team that could provide specialist advice and interventions, including referral for bariatric surgery. Using a National Institute of Health and Care Excellence (NICE)-accredited process, a Guidance Development Group conducted a literature search identifying existing WAMCs. As very few examples of effective structures and clinical pathways existed, the current evidence base for optimal assessment and management of bariatric surgery patients was used to reach a consensus. The model we describe could be adopted internationally by health services to manage severely obese patients.

Multiband product rule and consonant identification.

PubMed

Li, Feipeng; Allen, Jont B

2009-07-01

The multiband product rule, also known as band-independence, is a basic assumption of articulation index and its extension, the speech intelligibility index. Previously Fletcher showed its validity for a balanced mix of 20% consonant-vowel (CV), 20% vowel-consonant (VC), and 60% consonant-vowel-consonant (CVC) sounds. This study repeats Miller and Nicely's version of the hi-/lo-pass experiment with minor changes to study band-independence for the 16 Miller-Nicely consonants. The cut-off frequencies are chosen such that the basilar membrane is evenly divided into 12 segments from 250 to 8000 Hz with the high-pass and low-pass filters sharing the same six cut-off frequencies in the middle. Results show that the multiband product rule is statistically valid for consonants on average. It also applies to subgroups of consonants, such as stops and fricatives, which are characterized by a flat distribution of speech cues along the frequency. It fails for individual consonants.

Microcomputer-Based Access to Machine-Readable Numeric Databases.

ERIC Educational Resources Information Center

Wenzel, Patrick

1988-01-01

Describes the use of microcomputers and relational database management systems to improve access to numeric databases by the Data and Program Library Service at the University of Wisconsin. The internal records management system, in-house reference tools, and plans to extend these tools to the entire campus are discussed. (3 references) (CLB)

BOOK REVIEW: Tribology on the Small Scale: A Bottom Up Approach to Friction, Lubrication, and Wear Tribology on the Small Scale: A Bottom Up Approach to Friction, Lubrication, and Wear

NASA Astrophysics Data System (ADS)

Hainsworth, S.

2008-11-01

Friction, lubrication and wear interactions between materials make considerable differences to how efficient our engines are, whether or not we ski downhill faster than others, or whether the shoes that we are wearing give us sufficient grip to successfully navigate the marble floors of buildings. Traditionally, tribologists have focussed on the macroscopic issues of tribological problems, looking at the design of components, the viscosity of oils and the mechanical properties of surfaces to understand how components interact to give the desired friction and wear properties. However, in the last twenty years there has been an increasing realization that the processes that are controlling these macroscopic interactions are determined by what happens on the atomic and microscopic scale. Further, with the advent of nano- and micro-electro mechanical systems (NEMs and MEMs), macroscopic scale tribological interactions do not influence the tribology of these devices in the same way, and capillary forces and van der Waal's forces play an increased role in determining whether these devices function successfully. This book aims to fill a gap in the area of tribology textbooks by addressing the important advances that have been made in our understanding of the science of nano- and micro-scale tribological interactions. The book is aimed at advanced undergraduate and graduate level students on engineering programmes, academics and scientists interested in atomic and microscopic scale tribological interactions, and engineers and scientists who are not tribologists per se but work in technologies (such as NEMs/MEMs) where tribology is of importance. Whilst the target audience appears to be largely engineers, the book should have wider appeal to physicists, chemists and modellers with interests in tribological interactions. The book consists of twelve chapters with an introduction to the general significance of tribology and a brief history of modern tribology, followed by more detailed coverage of characterization and quantification of surface roughness. There is then a discussion of the mechanical properties of surfaces, and an introduction to contact mechanics. This follows a similar structure to traditional tribology textbooks but there are some nice examples and illustrations of how this relates to small scale tribology, with reference to recording heads on laser textured disk surfaces for example. The origins of friction are then discussed, with a detailed section on stick-slip interactions which are particularly significant in tribological interactions at the small scale. Chapters 5-8 then deviate from the more traditional tribology textbooks and cover surface energies and capillary forces, surface forces and their physical origins, and the measurement of these forces by the surface force apparatus and atomic force microscope. Surface forces at the small scale and capillary forces are extremely important in the successful functioning of small scale nano- or micro-electro mechanical systems, and there is a good discussion of the origin of these forces and how they can be understood, measured and controlled. The final chapters are devoted to lubrication, and atomistic origins of friction and wear. Traditional lubrication theories are initially outlined followed by detailed examples of boundary lubrication and capillary forces in tribology at the micro-scale. There are some nice examples of the importance of lubricant chemistry on sliding forces. Overall I found this book to be well-written and very readable with some very nice examples of why all this fundamental background is of importance in practical applications. The book is well-presented and it should be accessible to its target audience, particularly since the cost is reasonable. Each chapter ends with a set of selected references to allow more detailed study of particular topics if desired. There is a comprehensive index at the end of the book. I will recommend it to my students on courses on tribology and surface engineering.

Responses to gestational weight management guidance: a thematic analysis of comments made by women in online parenting forums

PubMed Central

2014-01-01

Background The National Institute for Health and Clinical Excellence (NICE) published guidance on weight management in pregnancy in July 2010 (NICE public health guidance 27: 2010), and this received considerable press coverage across a range of media. This offered an opportunity to examine how gestational weight management guidance was received by UK women. Methods A thematic analysis was conducted of 400 posts made in UK-based parenting internet forums in the week following the publication of the NICE guidance. This allowed us to examine the naturally occurring comments from 202 women who posted about the guidance on public forums. Results Three main themes were identified and explored: i) Perceived control/responsibility ii) Risk perception iii) Confused messages. Conclusions Women differed in their perceptions of the level of control that they had over being overweight with some feeling responsible and motivated to maintain a healthy lifestyle. Others felt there were multiple factors influencing their weight issues beyond their control. There were reports of feeling guilty about the impact of weight on the growing baby and experiencing significant obesity stigma from the public and health professionals. Information about the risks of overweight and obesity in pregnancy were difficult messages for women to hear, and for health professionals to deliver. Women reported being confused by the messages that they received. Health messages need to be delivered sensitively to women, and health professionals need support and training to do this. Risk information should always be accompanied with clear advice and support to help women to manage their weight in pregnancy. PMID:24981024

Norwegian Young Sea Ice Experiment (N-ICE) Field Campaign Report

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

Walden, V. P.; Hudson, S. R.; Cohen, L.

The Norwegian Young Sea Ice (N-ICE) experiment was conducted aboard the R/V Lance research vessel from January through June 2015. The primary purpose of the experiment was to better understand thin, first-year sea ice. This includes understanding of how different components of the Arctic system affect sea ice, but also how changing sea ice affects the system. A major part of this effort is to characterize the atmospheric conditions throughout the experiment. A micropulse lidar (MPL) (S/N: 108) was deployed from the U.S. Department of Energy’s (DOE) Atmospheric Radiation Measurement (ARM) Climate Research Facility as part of the atmospheric suitemore » of instruments. The MPL operated successfully throughout the entire experiment, acquiring data from 21 January 2015 through 23 June 2015. The MPL was the essential instrument for determining the phase (water, ice or mixed) of the lower-level clouds over the sea ice. Data obtained from the MPL during the N-ICE experiment show large cloud fractions over young, thin Arctic sea ice from January through June 2015 (north of Svalbard). The winter season was characterized by frequent synoptic storms and large fluctuations in the near-surface temperature. There was much less synoptic activity in spring and summer as the near-surface temperature rose to 0 C. The cloud fraction was lower in winter (60%) than in the spring and summer (80%). Supercooled liquid clouds were observed for most of the deployment, appearing first in mid-February. Spring and summer clouds were characterized by low, thick, uniform clouds.« less

Responses to gestational weight management guidance: a thematic analysis of comments made by women in online parenting forums.

PubMed

Arden, Madelynne A; Duxbury, Alexandra M S; Soltani, Hora

2014-06-30

The National Institute for Health and Clinical Excellence (NICE) published guidance on weight management in pregnancy in July 2010 (NICE public health guidance 27: 2010), and this received considerable press coverage across a range of media. This offered an opportunity to examine how gestational weight management guidance was received by UK women. A thematic analysis was conducted of 400 posts made in UK-based parenting internet forums in the week following the publication of the NICE guidance. This allowed us to examine the naturally occurring comments from 202 women who posted about the guidance on public forums. Three main themes were identified and explored: i) Perceived control/responsibility ii) Risk perception iii) Confused messages. Women differed in their perceptions of the level of control that they had over being overweight with some feeling responsible and motivated to maintain a healthy lifestyle. Others felt there were multiple factors influencing their weight issues beyond their control. There were reports of feeling guilty about the impact of weight on the growing baby and experiencing significant obesity stigma from the public and health professionals. Information about the risks of overweight and obesity in pregnancy were difficult messages for women to hear, and for health professionals to deliver. Women reported being confused by the messages that they received. Health messages need to be delivered sensitively to women, and health professionals need support and training to do this. Risk information should always be accompanied with clear advice and support to help women to manage their weight in pregnancy.

A prescription survey of antipsychotic use in England and Wales following the introduction of NICE guidance.

PubMed

MacE, Shubhra; Taylor, David

2005-01-01

Objective : In the United Kingdom (UK) the National Institute for Clinical Excellence (NICE) has recommended the use of atypical antipsychotics for the treatment of schizophrenia. As part of its guidance it discourages the concurrent use of typical and atypical antipsychotics. In previous prescribing surveys antipsychotic polypharmacy has been noted to be widespread. We sought to evaluate atypical antipsychotic prescribing after the publication of NICE guidance. Method : We invited psychiatric centres in England and Wales to participate, in March 2004, in an atypical antipsychotic prescribing survey of hospital in-patients. Results : Thirty-six in-patient units submitted data for 2012 patients. After exclusions, 1092 patients were eligible. Of these, 28.6% (312) were prescribed a typical alongside an atypical antipsychotic and 19.3% (211) were prescribed high-dose antipsychotics. Co-prescription was more prevalent in patients aged 40 years and above (32.0 vs. 25.3%; P=0.018). It was also noted that in centres employing senior pharmacists, co-prescription was more common (28.6 vs. 14.3%; P=0.03). High-dose treatment was more commonly observed in patients of a white ethnic background (20.6 vs. 13.9%; P=0.02) as well as in patients aged 40 years and above (24.4 vs. 15.0%; P<0.001). Prescription of anticholinergics was significantly more prevalent in those receiving atypical and typical combinations than atypicals alone (26.0 vs. 12.0%; P<0.001). Conclusions : Antipsychotic polypharmacy remains commonplace. Similarly the prescription of high-dose antipsychotics is also widespread.

Enhancing recovery rates: lessons from year one of IAPT.

PubMed

Gyani, Alex; Shafran, Roz; Layard, Richard; Clark, David M

2013-09-01

The English Improving Access to Psychological Therapies (IAPT) initiative aims to make evidence-based psychological therapies for depression and anxiety disorder more widely available in the National Health Service (NHS). 32 IAPT services based on a stepped care model were established in the first year of the programme. We report on the reliable recovery rates achieved by patients treated in the services and identify predictors of recovery at patient level, service level, and as a function of compliance with National Institute of Health and Care Excellence (NICE) Treatment Guidelines. Data from 19,395 patients who were clinical cases at intake, attended at least two sessions, had at least two outcomes scores and had completed their treatment during the period were analysed. Outcome was assessed with the patient health questionnaire depression scale (PHQ-9) and the anxiety scale (GAD-7). Data completeness was high for a routine cohort study. Over 91% of treated patients had paired (pre-post) outcome scores. Overall, 40.3% of patients were reliably recovered at post-treatment, 63.7% showed reliable improvement and 6.6% showed reliable deterioration. Most patients received treatments that were recommended by NICE. When a treatment not recommended by NICE was provided, recovery rates were reduced. Service characteristics that predicted higher reliable recovery rates were: high average number of therapy sessions; higher step-up rates among individuals who started with low intensity treatment; larger services; and a larger proportion of experienced staff. Compliance with the IAPT clinical model is associated with enhanced rates of reliable recovery. Copyright © 2013 The Authors. Published by Elsevier Ltd.. All rights reserved.

Utah obstetricians' opinions of planned home birth and conflicting NICE/ACOG guidelines: A qualitative study.

PubMed

Rainey, Emily; Simonsen, Sara; Stanford, Joseph; Shoaf, Kimberley; Baayd, Jami

2017-06-01

The United Kingdom's National Institute for Health and Care Excellence (NICE) recently published recommendations that support planned home birth for low-risk women. The American College of Obstetricians and Gynecologists (ACOG) remains wary of planned home birth, asserting that hospitals and birthing centers are the safest birth settings. Our objective was to examine opinions of obstetricians in Salt Lake City, Utah about home birth in the context of rising home birth rates and conflicting guidelines. Participants were recruited through online searches of Salt Lake City obstetricians and through snowball sampling. We conducted individual interviews exploring experiences with and attitudes toward planned home birth and the ACOG/NICE guidelines. Fifteen obstetricians who varied according to years of experience, location of medical training, sex, and subspecialty (resident, OB/GYN, maternal-fetal medicine specialist) were interviewed. Participants did not recommend home birth but supported a woman's right to choose her birth setting. Obstetrician opinions about planned home birth were shaped by misconceptions of home birth benefits, confusion surrounding the scope of care at home and among home birth providers, and negative transfer experiences. Participants were unfamiliar with the literature on planned home birth and/or viewed the evidence as unreliable. Support for ACOG guidelines was high, particularly in the context of the United States health care setting. Physician objectivity may be limited by biases against home birth, which stem from limited familiarity with published evidence, negative experiences with home-to-hospital transfers, and distrust of home birth providers in a health care system not designed to support home birth. © 2017 Wiley Periodicals, Inc.

High catalytic activity and stability of Ni/CexZr1-xO2/MSU-H for CH4/CO2 reforming reaction

NASA Astrophysics Data System (ADS)

Chang, Xiaoqian; Liu, Bingsi; Xia, Hong; Amin, Roohul

2018-06-01

How to reduce emission of CO2 as greenhouse gases, which resulted in global warming, is of very important significance. A series of Ni/CexZr1-xO2/MSU-H catalysts was prepared by means of hexagonally ordered mesoporous MSU-H with thermal and hydrothermal stabilities, which is cheap and can be synthesized in the large scale. The 10%Ni/Ce0.75Zr0.25O2/MSU-H catalyst presents high catalytic activity, stability and the ability of coke-resistance for CH4/CO2 reforming reaction due to high SBET (428 m2/g) and smaller Nio nanoparticle size (3.14 nm). The high dispersed Nio nanoparticles over MSU-H promoted the decomposition of CH4 and the carbon species accumulated on active Nio sites reacting with crystal lattice oxygen in Ce0.75Zr0.25O2 to form CO molecules. In the meantime, the remained oxygen vacancies on the interface between Nio and Ce0.75Zr0.25O2 could be supplemented via CO2. HRTEM images and XRD results of Ni/Ce0.75Zr0.25O2/MSU-H verified that high dispersion of Ni nanoparticles over Ni/Ce0.75Zr0.25O2/MSU-H correlated closely with the synergistic action between Ce0.75Zr0.25O2 and MSU-H as well as hexagonally ordered structure of MSU-H, which can provide effectively the oxygen storage capacity and inhibit the formation of coke.

Forensic answers to the 14th of July 2016 terrorist attack in Nice.

PubMed

Quatrehomme, Gérald; Toupenay, Steve; Delabarde, Tania; Padovani, Bernard; Alunni, Véronique

2018-04-17

The terrorist attack of July 14, 2016 in Nice (France) was a devastating event. A man voluntarily drove a truck into a crowd gathered for the fireworks display on the seaside "Promenade des Anglais," plowing pedestrians down over more than 2 km before being shot dead. At the time of this report, a total of 86 casualties and more than 1200 formal complaints for physical and psychological injuries have been recorded. The aim of this work is to describe the forensic management of this event and its immediate aftermath. This paper reaffirms the basic tenets of disaster management: a single place of work, teamwork in times of crisis, a single communication channel with families and the media, and the validation of the identifications by a multidisciplinary commission. This paper highlights other essential aspects of the organization of the forensic effort put in place after the Nice attack: the contribution of the police at the crime scene, the cooperation between the disaster victim identification (DVI) team, and the forensic pathologists at the morgue, applying the identification (ID) process to unconscious victims in the intensive care unit, the input of volunteers, and the logistics associated with the management of the aftermath of the event. All of the victims were positively identified within 4 and a half days. For the first time in such a paper, the central role of medical students in the immediate aftermath of the disaster is outlined. The need to address the possible psychological trauma of the non-medical and even the medical staff taking part in the forensic effort is also reaffirmed.

Noise-Immune Cavity-Enhanced Optical Heterodyne Molecular Spectrometry Modelling Under Saturated Absorption

NASA Astrophysics Data System (ADS)

Dupré, Patrick

2015-06-01

The Noise-Immune Cavity-Enhanced Optical Heterodyne Molecular Spectrometry (NICE-OHMS) is a modern technique renowned for its ultimate sensitivity, because it combines long equivalent absorption length provided by a high finesse cavity, and a detection theoretically limited by the sole photon-shot-noise. One fallout of the high finesse is the possibility to accumulating strong intracavity electromagnetic fields (EMF). Under this condition, molecular transitions can be easy saturated giving rise to the usual Lamb dips (or hole burning). However, the unusual shape of the basically trichromatic EMF (due to the RF lateral sidebands) induces nonlinear couplings, i.e., new crossover transitions. An analytical methodology will be presented to calculate spectra provided by NICE-OHMS experiments. It is based on the solutions of the equations of motion of an open two-blocked-level system performed in the frequency-domain (optically thin medium). Knowing the transition dipole moment, the NICE-OHMS signals (``absorption-like'' and ``dispersion-like'') can be simulated by integration over the Doppler shifts and by paying attention to the molecular Zeeman sublevels and to the EMF polarization The approach has been validated by discussion experimental data obtained on two transitions of {C2H2} in the near-infrared under moderated saturation. One of the applications of the saturated absorption is to be able to simultaneously determine the transition intensity and the density number while only one these 2 quantities can only be assessed in nonlinear absorption. J. Opt. Soc. Am. B 32, 838 (2015) Optics Express 16, 14689 (2008)

Evaluation of the NICE mini-GRACE risk scores for acute myocardial infarction using the Myocardial Ischaemia National Audit Project (MINAP) 2003-2009: National Institute for Cardiovascular Outcomes Research (NICOR).

PubMed

Simms, Alexander D; Reynolds, Stephanie; Pieper, Karen; Baxter, Paul D; Cattle, Brian A; Batin, Phillip D; Wilson, John I; Deanfield, John E; West, Robert M; Fox, Keith A A; Hall, Alistair S; Gale, Christopher P

2013-01-01

To evaluate the performance of the National Institute for Health and Clinical Excellence (NICE) mini-Global Registry of Acute Coronary Events (GRACE) (MG) and adjusted mini-GRACE (AMG) risk scores. Retrospective observational study. 215 acute hospitals in England and Wales. 137 084 patients discharged from hospital with a diagnosis of acute myocardial infarction (AMI) between 2003 and 2009, as recorded in the Myocardial Ischaemia National Audit Project (MINAP). Model performance indices of calibration accuracy, discriminative and explanatory performance, including net reclassification index (NRI) and integrated discrimination improvement. Of 495 263 index patients hospitalised with AMI, there were 53 196 ST elevation myocardial infarction and 83 888 non-ST elevation myocardial infarction (NSTEMI) (27.7%) cases with complete data for all AMG variables. For AMI, AMG calibration was better than MG calibration (Hosmer-Lemeshow goodness of fit test: p=0.33 vs p<0.05). MG and AMG predictive accuracy and discriminative ability were good (Brier score: 0.10 vs 0.09; C statistic: 0.82 and 0.84, respectively). The NRI of AMG over MG was 8.1% (p<0.05). Model performance was reduced in patients with NSTEMI, chronic heart failure, chronic renal failure and in patients aged ≥85 years. The AMG and MG risk scores, utilised by NICE, demonstrated good performance across a range of indices using MINAP data, but performed less well in higher risk subgroups. Although indices were better for AMG, its application may be constrained by missing predictors.

Validation of two algorithms for managing children with a non-blanching rash.

PubMed

Riordan, F Andrew I; Jones, Laura; Clark, Julia

2016-08-01

Paediatricians are concerned that children who present with a non-blanching rash (NBR) may have meningococcal disease (MCD). Two algorithms have been devised to help identify which children with an NBR have MCD. To evaluate the NBR algorithms' ability to identify children with MCD. The Newcastle-Birmingham-Liverpool (NBL) algorithm was applied retrospectively to three cohorts of children who had presented with NBRs. This algorithm was also piloted in four hospitals, and then used prospectively for 12 months in one hospital. The National Institute for Health and Care Excellence (NICE) algorithm was validated retrospectively using data from all cohorts. The cohorts included 625 children, 145 (23%) of whom had confirmed or probable MCD. Paediatricians empirically treated 324 (52%) children with antibiotics. The NBL algorithm identified all children with MCD and suggested treatment for a further 86 children (sensitivity 100%, specificity 82%). One child with MCD did not receive immediate antibiotic treatment, despite this being suggested by the algorithm. The NICE algorithm suggested 382 children (61%) who should be treated with antibiotics. This included 141 of the 145 children with MCD (sensitivity 97%, specificity 50%). These algorithms may help paediatricians identify children with MCD who present with NBRs. The NBL algorithm may be more specific than the NICE algorithm as it includes fewer features suggesting MCD. The only significant delay in treatment of MCD occurred when the algorithms were not followed. 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/

Prioritising public health guidance topics in the National Institute for Health and Care Excellence using the Analytic Hierarchy Process.

PubMed

Reddy, B P; Kelly, M P; Thokala, P; Walters, S J; Duenas, A

2014-10-01

The Centre for Public Health (CPH), at the United Kingdom's National Institute for Health and Care Excellence (NICE) is responsible for producing national guidance relating to the promotion of good health and the prevention and treatment of disease. Given the challenges of developing guidance in this area, choosing the most appropriate topics for further study is of fundamental importance. This paper explores the current prioritisation process and describes how the Analytic Hierarchy Process (AHP), a multi criteria decision analysis (MCDA) technique, might be used to do so. A proposed approach is outlined, which was tested in a proof of concept pilot. This consisted of eight participants with experience of related NICE committees building scores for each topic together in a 'decision conference' setting. Criteria were identified and subsequently weighted to indicate the relative importance of each. Participants then collaboratively estimated the performance of each topic on each criterion. Total scores for each topic were calculated, which could be ranked and used as the basis for better informed discussion for prioritising topics to recommend to the Minister for future guidance. Sensitivity analyses of the dataset found it to be robust. Choosing the right topics for guidance at the earliest possible time is of fundamental importance to public health guidance, and judgement is likely to play an important part in doing so. MCDA techniques offer a potentially useful approach to structuring the problem in a rational and transparent way. NICE should consider carefully whether such an approach might be worth pursuing in the future.

The Health Technology Assessment of companion diagnostics: experience of NICE.

PubMed

Byron, Sarah K; Crabb, Nick; George, Elisabeth; Marlow, Mirella; Newland, Adrian

2014-03-15

Companion diagnostics are used to aid clinical decision making to identify patients who are most likely to respond to treatment. They are becoming increasingly important as more new pharmaceuticals receive licensed indications that require the use of a companion diagnostic to identify the appropriate patient subgroup for treatment. These pharmaceuticals have proven benefit in the treatment of some cancers and other diseases, and also have potential to precisely tailor treatments to the individual in the future. However, the increasing use of companion diagnostics could place a substantial burden on health system resources to provide potentially high volumes of testing. This situation, in part, has led policy makers and Health Technology Assessment (HTA) bodies to review the policies and methods used to make reimbursement decisions for pharmaceuticals requiring companion diagnostics. The assessment of a pharmaceutical alongside the companion diagnostic used in the clinical trials may be relatively straightforward, although there are a number of challenges associated with assessing pharmaceuticals where a range of alternative companion diagnostics are available for use in routine clinical practice. The UK HTA body, the National Institute for Health and Care Excellence (NICE), has developed policy for considering companion diagnostics using its Technology Appraisal and Diagnostics Assessment Programs. Some HTA bodies in other countries have also adapted their policies and methods to accommodate the assessment of companion diagnostics. Here, we provide insight into the HTA of companion diagnostics for reimbursement decisions and how the associated challenges are being addressed, in particular by NICE. See all articles in this CCR Focus section, "The Precision Medicine Conundrum: Approaches to Companion Diagnostic Co-development." ©2014 AACR.

Adherence to exercise referral schemes by participants - what do providers and commissioners need to know? A systematic review of barriers and facilitators.

PubMed

Morgan, Fiona; Battersby, Alysia; Weightman, Alison L; Searchfield, Lydia; Turley, Ruth; Morgan, Helen; Jagroo, James; Ellis, Simon

2016-03-05

Physical inactivity levels are rising worldwide with major implications for the health of the population and the prevalence of non-communicable diseases. Exercise referral schemes (ERS) continue to be a popular intervention utilised by healthcare practitioners to increase physical activity. We undertook a systematic review of views studies in order to inform guidance from the UK National Institute of Health and Care Excellence (NICE) on exercise referral schemes to promote physical activity. This paper reports on the participant views identified, to inform those seeking to refine schemes to increase attendance and adherence. Fifteen databases and a wide range of websites and grey literature sources were searched systematically for publications from 1995 to June 2013. In addition, a range of supplementary methods including, a call for evidence by NICE, contacting authors, reference list checking and citation tracking were utilised to identify additional research. Studies were included where they detailed schemes for adults aged 19 years or older who were 'inactive' (i.e. they are not currently meeting UK physical activity guidelines). Study selection was conducted independently in duplicate. Quality assessment was undertaken by one reviewer and checked by a second, with 20 % of papers being considered independently in duplicate. Papers were coded in qualitative data analysis software Atlas.ti. This review was reported in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement). Evidence from 33 UK-relevant studies identified that support from providers, other attendees and family was an important facilitator of adherence and 'making exercise a habit' post programme, as was the variety and personalised nature of sessions offered. Barriers to attendance included the inconvenient timing of sessions, their cost and location. An intimidating gym atmosphere, a dislike of the music and TV and a lack of confidence in operating gym equipment were frequently reported. These findings provide valuable insights that commissioners and providers should consider. The main themes were consistent across a large number of studies and further research should concentrate on programmes that reflect these findings.

An Overview of Global Observing Systems Relevant to GODAE

DTIC Science & Technology

2009-10-29

GODAE Paper presented1 at the Final GODAE Symposium. Nice. France. November 12-15, 2008. Abstract available at: http-V/www.gouac. •wg/2.1 SW-abstract html (accessed lune 2, 2009). Oceanography September 2009 33

Incidence of infective endocarditis in England, 2000-13: a secular trend, interrupted time-series analysis.

PubMed

Dayer, Mark J; Jones, Simon; Prendergast, Bernard; Baddour, Larry M; Lockhart, Peter B; Thornhill, Martin H

2015-03-28

Antibiotic prophylaxis given before invasive dental procedures in patients at risk of developing infective endocarditis has historically been the focus of infective endocarditis prevention. Recent changes in antibiotic prophylaxis guidelines in the USA and Europe have substantially reduced the number of patients for whom antibiotic prophylaxis is recommended. In the UK, guidelines from the National Institute for Health and Clinical Excellence (NICE) recommended complete cessation of antibiotic prophylaxis for prevention of infective endocarditis in March, 2008. We aimed to investigate changes in the prescribing of antibiotic prophylaxis and the incidence of infective endocarditis since the introduction of these guidelines. We did a retrospective secular trend study, analysed as an interrupted time series, to investigate the effect of antibiotic prophylaxis versus no prophylaxis on the incidence of infective endocarditis in England. We analysed data for the prescription of antibiotic prophylaxis from Jan 1, 2004, to March 31, 2013, and hospital discharge episode statistics for patients with a primary diagnosis of infective endocarditis from Jan 1, 2000, to March 31, 2013. We compared the incidence of infective endocarditis before and after the introduction of the NICE guidelines using segmented regression analysis of the interrupted time series. Prescriptions of antibiotic prophylaxis for the prevention of infective endocarditis fell substantially after introduction of the NICE guidance (mean 10,900 prescriptions per month [Jan 1, 2004, to March 31, 2008] vs 2236 prescriptions per month [April 1, 2008, to March 31, 2013], p<0·0001). Starting in March, 2008, the number of cases of infective endocarditis increased significantly above the projected historical trend, by 0·11 cases per 10 million people per month (95% CI 0·05-0·16, p<0·0001). By March, 2013, 35 more cases per month were reported than would have been expected had the previous trend continued. This increase in the incidence of infective endocarditis was significant for both individuals at high risk of infective endocarditis and those at lower risk. Although our data do not establish a causal association, prescriptions of antibiotic prophylaxis have fallen substantially and the incidence of infective endocarditis has increased significantly in England since introduction of the 2008 NICE guidelines. Heart Research UK, Simplyhealth, and US National Institutes of Health. Copyright © 2015 Elsevier Ltd. All rights reserved.

Retrospective examination of lipid-lowering treatment patterns in a real-world high-risk cohort in the UK in 2014: comparison with the National Institute for Health and Care Excellence (NICE) 2014 lipid modification guidelines.

PubMed

Steen, Dylan L; Khan, Irfan; Ansell, David; Sanchez, Robert J; Ray, Kausik K

2017-02-17

In 2014, guidelines from the National Institute for Health and Care Excellence (NICE) provided updated recommendations on lipid-modifying therapy (LMT). We assessed clinical practice contemporaneous to release of these guidelines in a UK general practice setting for secondary and high-risk primary-prevention populations, and extrapolated the findings to UK nation level. Patients from The Health Improvement Network database with the following criteria were included: lipid profile in 2014 (index date); ≥20 years of age; ≥2 years representation in database prior to index; ≥1 statin indication either for atherosclerotic cardiovascular disease (ASCVD) or the non-ASCVD conditions high-risk diabetes mellitus and/or chronic kidney disease. Overall, 183 565 patients met the inclusion criteria (n=91 479 for ASCVD, 92 086 for non-ASCVD). In those with ASCVD, 79% received statin treatment and 31% received high-intensity statin. In the non-ASCVD group, 62% were on a statin and 57% received medium-intensity or high-intensity statin. In the ASCVD and non-ASCVD cohorts, 6% and 15%, respectively, were already treated according to dosing recommendations as per updated NICE guidelines. Extrapolation to the 2014 UK population indicated that, of the 3.3 million individuals with ASCVD, 2.4 million would require statin uptitration and 680 000 would require statin initiation (31% de novo initiation, 60% reinitiation, 9% addition to non-statin LMT) to achieve full concordance with updated guidelines. Of the 3.5 million high-risk non-ASCVD individuals, 1.6 million would require statin uptitration and 1.4 million would require statin initiation (59% de novo initiation, 36% reinitiation, 5% addition to non-statin LMT). A large proportion of UK individuals with ASCVD and high-risk non-ASCVD received statin treatment (79% and 62%, respectively) during the year of NICE 2014 guidelines release. Up to 94% of patients with ASCVD and 85% of high-risk non-ASCVD individuals, representing ∼3 million individuals in each group, would require statin uptitration or initiation to achieve full concordance with updated guidelines. 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/.

Drug-disease and drug-drug interactions: systematic examination of recommendations in 12 UK national clinical guidelines.

PubMed

Dumbreck, Siobhan; Flynn, Angela; Nairn, Moray; Wilson, Martin; Treweek, Shaun; Mercer, Stewart W; Alderson, Phil; Thompson, Alex; Payne, Katherine; Guthrie, Bruce

2015-03-11

To identify the number of drug-disease and drug-drug interactions for exemplar index conditions within National Institute of Health and Care Excellence (NICE) clinical guidelines. Systematic identification, quantification, and classification of potentially serious drug-disease and drug-drug interactions for drugs recommended by NICE clinical guidelines for type 2 diabetes, heart failure, and depression in relation to 11 other common conditions and drugs recommended by NICE guidelines for those conditions. NICE clinical guidelines for type 2 diabetes, heart failure, and depression Potentially serious drug-disease and drug-drug interactions. Following recommendations for prescription in 12 national clinical guidelines would result in several potentially serious drug interactions. There were 32 potentially serious drug-disease interactions between drugs recommended in the guideline for type 2 diabetes and the 11 other conditions compared with six for drugs recommended in the guideline for depression and 10 for drugs recommended in the guideline for heart failure. Of these drug-disease interactions, 27 (84%) in the type 2 diabetes guideline and all of those in the two other guidelines were between the recommended drug and chronic kidney disease. More potentially serious drug-drug interactions were identified between drugs recommended by guidelines for each of the three index conditions and drugs recommended by the guidelines for the 11 other conditions: 133 drug-drug interactions for drugs recommended in the type 2 diabetes guideline, 89 for depression, and 111 for heart failure. Few of these drug-disease or drug-drug interactions were highlighted in the guidelines for the three index conditions. Drug-disease interactions were relatively uncommon with the exception of interactions when a patient also has chronic kidney disease. Guideline developers could consider a more systematic approach regarding the potential for drug-disease interactions, based on epidemiological knowledge of the comorbidities of people with the disease the guideline is focused on, and should particularly consider whether chronic kidney disease is common in the target population. In contrast, potentially serious drug-drug interactions between recommended drugs for different conditions were common. The extensive number of potentially serious interactions requires innovative interactive approaches to the production and dissemination of guidelines to allow clinicians and patients with multimorbidity to make informed decisions about drug selection. © Dumbreck et al 2015.

FOREWORD: Workshop on "Very Hot Astrophysical Plasmas"

NASA Astrophysics Data System (ADS)

Koch-Miramond, Lydie; Montemerie, Thierry

1984-01-01

A Workshop on "Very Hot Astrophysical Plasmas" was held in Nice, France, on 8-10 November 1982. Dedicated mostly to theoretical, observational, and experimental aspects of X-ray astronomy and related atomic physics, it was the first of its kind to be held in France. The Workshop was "European" in the sense that one of its goals (apart from pure science) was to gather the European astronomical community in view of the forthcoming presentation of the "X-80" project for final selection to be the next scientific satellite of the European Space Agency. We now know that the Infrared Space Observatory has been chosen instead, but the recent successful launch of EXOSAT still keeps X-ray astronomy alive, and should be able to transfer, at least for a time, the leadership in this field from the U.S. to Europe, keeping in mind the competitive level of our Japanese colleagues. (With respect to the selection of ISO, one should also keep in mind that observations in the infrared often bring material relevant to the study of X-ray sources!) On a longer time scale, the Workshop also put emphasis on several interesting projects for the late eighties-early nineties, showing the vitality of the field in Europe. Some proposals have already taken a good start, like XMM, the X-ray Multi-Mirror project, selected by ESA last December for an assessment study in 1983. The present proceedings contain most of the papers that were presented at the Workshop. Only the invited papers were presented orally, contributed papers being presented in the form of posters but summarized orally by rapporteurs. To make up this volume, the written versions of these papers were either cross-reviewed by the Invited Speakers, or refereed by the Rapporteurs (for contributed papers) and edited by us, when necessary. Note, however, that the conclusions of the Workshop, which were kindly presented by Richard McCray, have already appeared in the "News and Views" section of Nature (301, 372, 1983). Altogether, the present proceedings aim at giving an up-to-date overview of X-ray astronomy, and may be taken also as a kind of "status report" on European projects in the field. As such, it should hopefully be useful to the astronomical community at large. But it is certainly worthwhile to recall that the Workshop (hence, this volume) would not have been possible without the help of many people, especially on location, in the city of Nice. The organizers received a competent and dedicated help from the Observatoire de Nice (interesting absorption effects could be seen while ascending the Mont-Gros in the fog — and also during the lunch under the Grande Coupole!), from the "Mutuelle Générale de l'Education Nationale", which provided a convenient and modern building to hold the Workshop, and from the City of Nice, which arranged a magnificent — if rainy — cocktail party at the Villa Massha. Thanks are also due to all our sponsors for financial help. We want to thank more particularly Pr Raymond Michard, Director of the Observatoire de Nice, and several other people there: Françoise Bely-Dubau, Danièle Benotto, Renata Feldmann, Paul Faucher. In Saclay and during the Workshop, we all appreciated the efficient collaboration of Claudine Belin and Raymonde Boschiero, while after the Workshop, Nils Robert Nilsson was of great help as Manuscript Editor for these proceedings. In spite of the poor weather, already alluded to — and which turned out to be the worst over all France for decades — and thanks to the cooperation of all, we do think it was really...— a Nice Workshop.

Putting "Reference" in the Publications Reference File.

ERIC Educational Resources Information Center

Zink, Steven D.

1980-01-01

Argues for more widespread utilization of the U.S. Government Printing Office's Publications Reference File, a reference tool in microfiche format used to answer questions about current U.S. government documents and their availability. Ways to accomplish this task are suggested. (Author/JD)

Social Question and Answer Services versus Library Virtual Reference: Evaluation and Comparison from the Users' Perspective

ERIC Educational Resources Information Center

Zhang, Yin; Deng, Shengli

2014-01-01

Introduction: In recent years, the introduction of social question and answer services and other Internet tools have expanded the ways in which people have their questions answered. There has been speculation and debate over whether such services and other Internet tools are replacing library virtual reference services. Method: Most previous…

Assessing ecological departure from reference conditions with the Fire Regime Condition Class (FRCC) Mapping Tool

Treesearch

Stephen W. Barrett; Thomas DeMeo; Jeffrey L. Jones; J.D. Zeiler; Lee C. Hutter

2006-01-01

Knowledge of ecological departure from a range of reference conditions provides a critical context for managing sustainable ecosystems. Fire Regime Condition Class (FRCC) is a qualitative measure characterizing possible departure from historical fire regimes. The FRCC Mapping Tool was developed as an ArcMap extension utilizing the protocol identified by the Interagency...

Nice Work if You Can Get Them To Do It.

ERIC Educational Resources Information Center

Fish, Stanley

2000-01-01

Discusses the value for administrators of guidance offered by (1) the tenets of poststructuralism; (2) the book "An Uncertain Glory: Letters of Cautious but Sound Advice to Stanley, a Dean-in-Waiting"; and (3) Machiavelli's "Il Principe." (NH)

The right to try.

PubMed

Pearce, Lynne

2015-01-20

Many clinical commissioning groups have ignored 2013 national guidelines requiring them to make IVF available. NICE has recently issued a quality standard to tackle this postcode lottery. Nurses can help by alerting local decision makers to the human and fi nancial cost of infertility.

The Physics of Soaring.

ERIC Educational Resources Information Center

Ford, Kenneth W.

2000-01-01

Discusses the nature and orientation of the forces that allow an engineless airplane (a glider or sailplane) to fly. A glider flying at constant velocity provides a nice example of an object moving under the action of several forces that add to zero. (WRM)

Summary of the Conference "The Physics of Evolved Stars"

NASA Astrophysics Data System (ADS)

De Marco, O.

2015-12-01

Olivier Chesneau was an astronomer of many talents. His expertise was on optical and infrared interferometry. Olivier*s tool of choice, the Very Large Telescope Interferometer (VLTI), allowed him to see solutions to open questions in stellar astrophysics. These visions led to collaborations with experts in each of the fields where VLTI observations could be useful. As a result Olivier was a man in the middle of a phenomenal network of astronomers, collaborators and friends. I am fortunate to have been one of them. In this contribution I summarise the conference "Physics of Evolved Stars", held in Nice in June 2015 in memory of Olivier. The conference neatly showcased the science that Olivier had been involved with during his life and laid out the advancements that were made thanks in great part to him and to the collaborations he started. Without doubt his bubbly, happy personality, child-like in a way, made him the perfect connector bringing the technique, the questions and the experts in diverse fields together. Dear to all who worked with him, he was truly the little prince of Astronomy. We shall miss him every day.

Systematic review and meta-analysis of the role of mental training in the acquisition of technical skills in surgery.

PubMed

Rao, Ahsan; Tait, Ian; Alijani, Afshin

2015-09-01

Mental training is rehearsal of mental imagery without physically performing the task. The aim of the study was to perform systematic review and meta-analysis on all the available data to evaluate the role of mental training in the acquisition of surgical technical skills. The following search databases were used: EMBASE, MEDLINE, Web of Science, Clinicaltrials.gov.uk, SIGN guidelines, NICE guidelines, and Cochrane review register. Meta-analysis was performed using Revman 5.2 statistical software. There were a total of 9 randomized controlled trials with 474 participants, of which 189 participants received mental training. Five randomized controlled trials concluded positive impact of mental training. Mental training group did not show any significant improvement in overall performance of the task carried in each study (P = .06). Mental training can be used as an important supplementary tool in learning surgical skills when run in parallel with physical training and applied to trainees with some experience of the skill. Copyright © 2015 Elsevier Inc. All rights reserved.

Genes on B chromosomes: old questions revisited with new tools.

PubMed

Banaei-Moghaddam, Ali M; Martis, Mihaela M; Macas, Jiří; Gundlach, Heidrun; Himmelbach, Axel; Altschmied, Lothar; Mayer, Klaus F X; Houben, Andreas

2015-01-01

B chromosomes are supernumerary dispensable parts of the karyotype which appear in some individuals of some populations in some species. Often, they have been considered as 'junk DNA' or genomic parasites without functional genes. Due to recent advances in sequencing technologies, it became possible to investigate their DNA composition, transcriptional activity and effects on the host transcriptome profile in detail. Here, we review the most recent findings regarding the gene content of B chromosomes and their transcriptional activities and discuss these findings in the context of comparable biological phenomena, like sex chromosomes, aneuploidy and pseudogenes. Recent data suggest that B chromosomes carry transcriptionally active genic sequences which could affect the transcriptome profile of their host genome. These findings are gradually changing our view that B chromosomes are solely genetically inert selfish elements without any functional genes. This at one side could partly explain the deleterious effects which are associated with their presence. On the other hand it makes B chromosome a nice model for studying regulatory mechanisms of duplicated genes and their evolutionary consequences. Copyright © 2014 Elsevier B.V. All rights reserved.

Switching Fields in Physics: Finding the Right Job

NASA Astrophysics Data System (ADS)

Dowell, Marla

2004-05-01

The Bad News: fewer than one in ten recent Physics PhDs will land a faculty position in physics. The Good News: non-academic career opportunities for Physics PhDs are in abundance. The trick is finding the right job. With the explosion of web-based resume sites, identifying these opportunities and getting your resume seen by the right people can be both difficult and frustrating. Tough times call for creative solutions. My presentation, based on experience as both a job seeker and potential employer, will include recent data on the physics job market. I will discuss non-academic job opportunities and practical tools for finding and landing the right job, such as career guidance tests and networking methods. A word of warning, most serious job hunts are extremely time-consuming. If you're looking for opportunities outside your physics discipline, be prepared for a lot of rejection letters. The trick is to make the most out of those contacts since you never know where they may lead. Remember, while a plethora of job offers is nice, only the right one is necessary.

Absolute configuration in 4-alkyl- and 4-aryl-3,4-dihydro-2(1H)-pyrimidones: a combined theoretical and experimental investigation.

PubMed

Uray, G; Verdino, P; Belaj, F; Kappe, C O; Fabian, W M

2001-10-05

Structural features (orientation of the carboxyl group, ring puckering), electronic absorption, and circular dichroism spectra of 4-alkyl- and 4-aryl-dihydropyrimidones 1-5 are calculated by semiempirical (AM1, INDO/S), ab initio (HF/6-31G, CIS/6-31G, RPA/6-31G), and density functional theory (B3LYP/6-31G) methods. These calculations allow an assignment of the absolute configuration by comparison of simulated and experimental CD spectra. Although the ab initio methods greatly overestimate electronic transition energies, the general appearance of the experimental CD spectra is quite nicely reproduced by these calculations. Thus, comparison of experimental with calculated CD spectra is a reliable tool for the assignment of the absolute configuration. For 4-methyl derivatives 1, the first enantiopure DHPM examples with no additional aromatic substituent, the stereochemistry at C4 provided by the theoretical results is confirmed by X-ray structure determination of the diastereomeric salt 6. Additional support is the consistent HPLC elution order found for all investigated DHPMs on a cellulose-derived chiral stationary phase.

Analysis of the effects of the global financial crisis on the Turkish economy, using hierarchical methods

NASA Astrophysics Data System (ADS)

Kantar, Ersin; Keskin, Mustafa; Deviren, Bayram

2012-04-01

We have analyzed the topology of 50 important Turkish companies for the period 2006-2010 using the concept of hierarchical methods (the minimal spanning tree (MST) and hierarchical tree (HT)). We investigated the statistical reliability of links between companies in the MST by using the bootstrap technique. We also used the average linkage cluster analysis (ALCA) technique to observe the cluster structures much better. The MST and HT are known as useful tools to perceive and detect global structure, taxonomy, and hierarchy in financial data. We obtained four clusters of companies according to their proximity. We also observed that the Banks and Holdings cluster always forms in the centre of the MSTs for the periods 2006-2007, 2008, and 2009-2010. The clusters match nicely with their common production activities or their strong interrelationship. The effects of the Automobile sector increased after the global financial crisis due to the temporary incentives provided by the Turkish government. We find that Turkish companies were not very affected by the global financial crisis.

Make Movies out of Your Dynamical Simulations with OGRE!

NASA Astrophysics Data System (ADS)

Tamayo, Daniel; Douglas, R. W.; Ge, H. W.; Burns, J. A.

2013-10-01

We have developed OGRE, the Orbital GRaphics Environment, an open-source project comprising a graphical user interface that allows the user to view the output from several dynamical integrators (e.g., SWIFT) that are commonly used for academic work. One can interactively vary the display speed, rotate the view and zoom the camera. This makes OGRE a great tool for students or the general public to explore accurate orbital histories that may display interesting dynamical features, e.g. the destabilization of Solar System orbits under the Nice model, or interacting pairs of exoplanets. Furthermore, OGRE allows the user to choreograph sequences of transformations as the simulation is played to generate movies for use in public talks or professional presentations. The graphical user interface is coded using Qt to ensure portability across different operating systems. OGRE will run on Linux and Mac OS X. The program is available as a self-contained executable, or as source code that the user can compile. We are continually updating the code, and hope that people who find it useful will contribute to the development of new features.

Make Movies out of Your Dynamical Simulations with OGRE!

NASA Astrophysics Data System (ADS)

Tamayo, Daniel; Douglas, R. W.; Ge, H. W.; Burns, J. A.

2014-01-01

We have developed OGRE, the Orbital GRaphics Environment, an open-source project comprising a graphical user interface that allows the user to view the output from several dynamical integrators (e.g., SWIFT) that are commonly used for academic work. One can interactively vary the display speed, rotate the view and zoom the camera. This makes OGRE a great tool for students or the general public to explore accurate orbital histories that may display interesting dynamical features, e.g. the destabilization of Solar System orbits under the Nice model, or interacting pairs of exoplanets. Furthermore, OGRE allows the user to choreograph sequences of transformations as the simulation is played to generate movies for use in public talks or professional presentations. The graphical user interface is coded using Qt to ensure portability across different operating systems. OGRE will run on Linux and Mac OS X. The program is available as a self-contained executable, or as source code that the user can compile. We are continually updating the code, and hope that people who find it useful will contribute to the development of new features.

[Supplementary services used as marketing tools in the competition among private practice doctors].

PubMed

Meurers, Horst

2009-01-01

What is the relation between additional healthcare services, marketing and competition among office-based physicians? The best and truly effective marketing strategy is a satisfied patient recommending his doctor's services to others. Hence, good marketing starts with a convincing service concept, not just with advertising. More and more frequently patients ask for supplementary health service offerings. Additional services tailored to individual practices--e.g., in the field of nutrition, sports, fitness, wellness, aesthetics--meet the patients' demands, but at the same time they provide a competitive advantage over the ordinary medical practice. And what is more, these additional healthcare services have a nice side effect: they earn an additional income which is not unwelcome in times of decreasing revenues from the public healthcare system. The much sought-after potential for additional services and income can be achieved by offering commercial medical services, e.g., the sale of healthcare products. The coexistence of the doctor's commercial and non-commercial medical services is admissible as long as certain rules of professional conduct and tax laws are followed.

Promising Practices in Instruction of Discovery Tools

ERIC Educational Resources Information Center

Buck, Stefanie; Steffy, Christina

2013-01-01

Libraries are continually changing to meet the needs of users; this includes implementing discovery tools, also referred to as web-scale discovery tools, to make searching library resources easier. Because these tools are so new, it is difficult to establish definitive best practices for teaching these tools; however, promising practices are…

Multisurface fixture permits easy grinding of tool bit angles

NASA Technical Reports Server (NTRS)

Jones, C. R.

1966-01-01

Multisurface fixture with a tool holder permits accurate grinding and finishing of right and left hand single point threading tools. All angles are ground by changing the fixture position to rest at various references angles without removing the tool from the holder.

Ramucirumab for Treating Advanced Gastric Cancer or Gastro-Oesophageal Junction Adenocarcinoma Previously Treated with Chemotherapy: An Evidence Review Group Perspective of a NICE Single Technology Appraisal.

PubMed

Büyükkaramikli, Nasuh C; Blommestein, Hedwig M; Riemsma, Rob; Armstrong, Nigel; Clay, Fiona J; Ross, Janine; Worthy, Gill; Severens, Johan; Kleijnen, Jos; Al, Maiwenn J

2017-12-01

The National Institute for Health and Care Excellence (NICE) invited the company that manufactures ramucirumab (Cyramza ® , Eli Lilly and Company) to submit evidence of the clinical and cost effectiveness of the drug administered alone (monotherapy) or with paclitaxel (combination therapy) for treating adults with advanced gastric cancer or gastro-oesophageal junction (GC/GOJ) adenocarcinoma that were previously treated with chemotherapy, as part of the Institute's single technology appraisal (STA) process. Kleijnen Systematic Reviews Ltd (KSR), in collaboration with Erasmus University Rotterdam, was commissioned to act as the Evidence Review Group (ERG). This paper describes the company's submission, the ERG review, and NICE's subsequent decisions. Clinical effectiveness evidence for ramucirumab monotherapy (RAM), compared with best supportive care (BSC), was based on data from the REGARD trial. Clinical effectiveness evidence for ramucirumab combination therapy (RAM + PAC), compared with paclitaxel monotherapy (PAC), was based on data from the RAINBOW trial. In addition, the company undertook a network meta-analysis (NMA) to compare RAM + PAC with BSC and docetaxel. Cost-effectiveness evidence of monotherapy and combination therapy relied on partitioned survival, cost-utility models. The base-case incremental cost-effectiveness ratio (ICER) of the company was £188,640 (vs BSC) per quality-adjusted life-year (QALY) gained for monotherapy and £118,209 (vs BSC) per QALY gained for combination therapy. The ERG assessment indicated that the modelling structure represented the course of the disease; however, a few errors were identified and some of the input parameters were challenged. The ERG provided a new base case, with ICERs (vs BSC) of £188,100 (monotherapy) per QALY gained and £129,400 (combination therapy) per QALY gained and conducted additional exploratory analyses. The NICE Appraisal Committee (AC), considered the company's decision problem was in line with the NICE scope, with the exception of the choice of comparators for the combination therapy model. The most plausible ICER for ramucirumab monotherapy compared with BSC was £188,100 per QALY gained. The Committee considered that the ERG's exploratory analysis in which RAM + PAC was compared with PAC by using the direct head-to-head data (including utilities) from the RAINBOW trial, provided the most plausible ICER (i.e. £408,200 per QALY gained) for ramucirumab combination therapy. The Committee concluded that end-of-life considerations cannot be applied for either case, since neither failed to offer an extension to life of at least 3 months. The company did not submit a patient access scheme (PAS). After consideration of the evidence, the Committee concluded that ramucirumab alone or with paclitaxel could not be considered a cost-effective use of National Health Service resources for treating advanced GC/GOJ patients that were previously treated with chemotherapy, and therefore its use could not be recommended. We might wonder if a complete STA process is necessary for treatments without a PAS, which are, according to the company's submission, already associated with ICERs far above the currently accepted threshold in all (base-case, sensitivity and scenario) analyses.

76 FR 70076 - Technical Revisions To Update Reference to the Required Assessment Tool for State Nursing Homes...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-10

... Reference to the Required Assessment Tool for State Nursing Homes Receiving Per Diem Payments From VA AGENCY... State homes that receive per diem from VA for providing nursing home care to veterans. The proposed rule would require State nursing homes receiving per diem from VA to use the most recent version of the...

What's a Nice Biology Teacher Like You Doing Teaching Humanities?

ERIC Educational Resources Information Center

Biermann, Carol A.

1990-01-01

Described is the College Success Program designed to enhance retention of at-risk individuals. The goals, bioethics course offerings at various colleges, course outline for a bioethics course taught in the humanities, and evaluation of the course are discussed. (CW)

Psychology in the Classroom.

ERIC Educational Resources Information Center

Jennings, Gretchen; Craig, Michelle L.

1997-01-01

Describes an exhibition-based activity set that teaches important psychological processes such as attention (Interference), communication (Pattern Talk), and cooperation versus competition (Do Nice Guys Finish Last?). Activities follow the scientific method, and teachers can observe varying levels of skill and cognitive development in students of…

Organ and tissue donation in a regional paediatric intensive care unit: evaluation of practice.

PubMed

Carone, Laura; Alurkar, Shrirang; Kigozi, Phoebe; Vyas, Harish

2018-05-01

Approximately 2% of those on the organ transplant list in the UK are children. Early identification of donors and referral to organ donation teams (ODT) has proven to increase both the success rate of gaining consent and the number of organs actually retrieved. To evaluate the practice relating to organ donation for children receiving end-of-life care on a paediatric intensive care unit (PICU) measured against the National Guidelines. All children 0-18 who received their end-of-life care and died on the PICU. A retrospective cohort study of organ donation patterns including referral, approach, consent and donation. This involved a review of case notes on PICU between the years 2009 and 2014. One hundred five deaths were identified and 100 notes were examined and data analysed to ascertain if religion, age and length of stay on PICU impacted on practice. Eighty-six children met the early identification criteria for potential donors, 40 (46.5%) children were referred to the ODT and 33 (38.3%) families were approached regarding donation. Twenty-one (24.4%) families consented to donation. Seventeen donations took place with a total of 41 sets of organs/tissues retrieved. Despite the majority of children meeting early identification for potential donors, many were not being referred. All children on end-of-life care should be referred for potential organ donation. Organ donation needs to be seen as a priority for hospitals as a part of routine end-of-life care to help increase referral rates and give families the opportunity to donate. Many paediatric deaths are not referred for consideration of organ donation, despite guidelines stating that this process should be standard of care. Further optimization of referral rates may aid in increasing the number of organs available for donation. What is Known: • Shortage of organs continues to be a national problem. • NICE guidelines state that all patients who are on end-of-life care should have the option of organ donation explored. • Required referral both increases the number of donors and organs donated. What is New: • The process of identifying and referring children for paediatric organ donation. • Identifies that children are still not being referred for organ donation. • Organ donation is still not a priority for hospitals.

EQUIPT: protocol of a comparative effectiveness research study evaluating cross-context transferability of economic evidence on tobacco control

PubMed Central

Pokhrel, Subhash; Evers, Silvia; Leidl, Reiner; Trapero-Bertran, Marta; Kalo, Zoltan; de Vries, Hein; Crossfield, Andrea; Andrews, Fiona; Rutter, Ailsa; Coyle, Kathryn; Lester-George, Adam; West, Robert; Owen, Lesley; Jones, Teresa; Vogl, Matthias; Radu-Loghin, Cornel; Voko, Zoltan; Huic, Mirjana; Coyle, Doug

2014-01-01

Introduction Tobacco smoking claims 700 000 lives every year in Europe and the cost of tobacco smoking in the EU is estimated between €98 and €130 billion annually; direct medical care costs and indirect costs such as workday losses each represent half of this amount. Policymakers all across Europe are in need of bespoke information on the economic and wider returns of investing in evidence-based tobacco control, including smoking cessation agendas. EQUIPT is designed to test the transferability of one such economic evidence base—the English Tobacco Return on Investment (ROI) tool—to other EU member states. Methods and analysis EQUIPT is a multicentre, interdisciplinary comparative effectiveness research study in public health. The Tobacco ROI tool already developed in England by the National Institute for Health and Care Excellence (NICE) will be adapted to meet the needs of European decision-makers, following transferability criteria. Stakeholders' needs and intention to use ROI tools in sample countries (Germany, Hungary, Spain and the Netherlands) will be analysed through interviews and surveys and complemented by secondary analysis of the contextual and other factors. Informed by this contextual analysis, the next phase will develop country-specific ROI tools in sample countries using a mix of economic modelling and Visual Basic programming. The results from the country-specific ROI models will then be compared to derive policy proposals that are transferable to other EU states, from which a centralised web tool will be developed. This will then be made available to stakeholders to cater for different decision-making contexts across Europe. Ethics and dissemination The Brunel University Ethics Committee and relevant authorities in each of the participating countries approved the protocol. EQUIPT has a dedicated work package on dissemination, focusing on stakeholders’ communication needs. Results will be disseminated via peer-reviewed publications, e-learning resources and policy briefs. PMID:25421342

Child Safety Reference Frameworks: a Policy Tool for Child Injury Prevention at the Sub-national Level.

PubMed

Scholtes, Beatrice; Schröder-Bäck, Peter; Mackay, Morag; Vincenten, Joanne; Brand, Helmut

2017-06-01

The aim of this paper is to present the Child Safety Reference Frameworks (CSRF), a policy advice tool that places evidence-based child safety interventions, applicable at the sub-national level, into a framework resembling the Haddon Matrix. The CSRF is based on work done in previous EU funded projects, which we have adapted to the field of child safety. The CSRF were populated following a literature review. Four CSRF were developed for four domains of child safety: road, water and home safety, and intentional injury prevention. The CSRF can be used as a reference, assessment and comparative tool by child safety practitioners and policy makers working at the sub-national level. Copyright© by the National Institute of Public Health, Prague 2017

Meteorological conditions in a thinner Arctic sea ice regime from winter to summer during the Norwegian Young Sea Ice expedition (N-ICE2015)

NASA Astrophysics Data System (ADS)

Cohen, Lana; Hudson, Stephen R.; Walden, Von P.; Graham, Robert M.; Granskog, Mats A.

2017-07-01

Atmospheric measurements were made over Arctic sea ice north of Svalbard from winter to early summer (January-June) 2015 during the Norwegian Young Sea Ice (N-ICE2015) expedition. These measurements, which are available publicly, represent a comprehensive meteorological data set covering the seasonal transition in the Arctic Basin over the new, thinner sea ice regime. Winter was characterized by a succession of storms that produced short-lived (less than 48 h) temperature increases of 20 to 30 K at the surface. These storms were driven by the hemispheric scale circulation pattern with a large meridional component of the polar jet stream steering North Atlantic storms into the high Arctic. Nonstorm periods during winter were characterized by strong surface temperature inversions due to strong radiative cooling ("radiatively clear state"). The strength and depth of these inversions were similar to those during the Surface Heat Budget of the Arctic Ocean (SHEBA) campaign. In contrast, atmospheric profiles during the "opaquely cloudy state" were different to those from SHEBA due to differences in the synoptic conditions and location within the ice pack. Storm events observed during spring/summer were the result of synoptic systems located in the Barents Sea and the Arctic Basin rather than passing directly over N-ICE2015. These synoptic systems were driven by a large-scale circulation pattern typical of recent years, with an Arctic Dipole pattern developing during June. Surface temperatures became near-constant 0°C on 1 June marking the beginning of summer. Atmospheric profiles during the spring and early summer show persistent lifted temperature and moisture inversions that are indicative of clouds and cloud processes.

Summary of the consultation on a strategy for services for chronic obstructive pulmonary disease (COPD) in England.

PubMed

Jones, Rupert; Gruffydd-Jones, Kevin; Pinnock, Hilary; Peffers, Sarah-Jane; Lawrence, Judith; Scullion, Jane; White, Patrick; Holmes, Steve

2010-12-01

The Consultation on a Strategy for Services for COPD in England is the culmination of five years' work by respiratory specialists from all disciplines, as well as representatives from the voluntary sector, patients, carers and planners. It has been led by the Department of Health in England and the joint National Directors for the programme, Professor Sue Hill and Dr Robert Winter. The Strategy outlines service standards for providers of COPD care and is complementary to the UK National Institute for Health and Clinical Excellence (NICE) guidelines on the management of COPD. Its key elements are: • preventing the development and progression of COPD • diagnosing COPD accurately and at an early stage • developing structured care based on national guidance • promoting self-management education • reducing the number of people admitted to hospital • improving access to end-of-life care • promoting good asthma services. In essence this is an aspirational strategy which aims to change the way that the NHS in England delivers care for people with COPD by identifying them earlier and managing them optimally in order to reduce the likelihood of progression to the more severe stages of the disease. An economic impact assessment shows that implementing the Strategy will save approximately £1billion over 10 years as well as sparing many people from a debilitating illness. This supplement is based on the Strategy Consultation document as well as the NICE guidelines for COPD management. It aims to elucidate practical implementation of the COPD Strategy, and includes verbatim the Strategy recommendations as well as highly relevant clinical information from the NICE guidelines. Implementation of the Strategy recommendations should lead to optimum care for patients with COPD.

Selecting children for head CT following head injury

PubMed Central

Kemp, A; Nickerson, E; Trefan, L; Houston, R; Hyde, P; Pearson, G; Edwards, R; Parslow, RC; Maconochie, I

2016-01-01

Objective Indicators for head CT scan defined by the 2007 National Institute for Health and Care Excellence (NICE) guidelines were analysed to identify CT uptake, influential variables and yield. Design Cross-sectional study. Setting Hospital inpatient units: England, Wales, Northern Ireland and the Channel Islands. Patients Children (<15 years) admitted to hospital for more than 4 h following a head injury (September 2009 to February 2010). Interventions CT scan. Main outcome measures Number of children who had CT, extent to which NICE guidelines were followed and diagnostic yield. Results Data on 5700 children were returned by 90% of eligible hospitals, 84% of whom were admitted to a general hospital. CT scans were performed on 30.4% of children (1734), with a higher diagnostic yield in infants (56.5% (144/255)) than children aged 1 to 14 years (26.5% (391/1476)). Overall, only 40.4% (984 of 2437 children) fulfilling at least one of the four NICE criteria for CT actually underwent one. These children were much less likely to receive CT if admitted to a general hospital than to a specialist centre (OR 0.52 (95% CI 0.45 to 0.59)); there was considerable variation between healthcare regions. When indicated, children >3 years were much more likely to have CT than those <3 years (OR 2.35 (95% CI 2.08 to 2.65)). Conclusion Compliance with guidelines and diagnostic yield was variable across age groups, the type of hospital and region where children were admitted. With this pattern of clinical practice the risks of both missing intracranial injury and overuse of CT are considerable. PMID:27449674

Selecting children for head CT following head injury.

PubMed

Kemp, A; Nickerson, E; Trefan, L; Houston, R; Hyde, P; Pearson, G; Edwards, R; Parslow, R C; Maconochie, I

2016-10-01

Indicators for head CT scan defined by the 2007 National Institute for Health and Care Excellence (NICE) guidelines were analysed to identify CT uptake, influential variables and yield. Cross-sectional study. Hospital inpatient units: England, Wales, Northern Ireland and the Channel Islands. Children (<15 years) admitted to hospital for more than 4 h following a head injury (September 2009 to February 2010). CT scan. Number of children who had CT, extent to which NICE guidelines were followed and diagnostic yield. Data on 5700 children were returned by 90% of eligible hospitals, 84% of whom were admitted to a general hospital. CT scans were performed on 30.4% of children (1734), with a higher diagnostic yield in infants (56.5% (144/255)) than children aged 1 to 14 years (26.5% (391/1476)). Overall, only 40.4% (984 of 2437 children) fulfilling at least one of the four NICE criteria for CT actually underwent one. These children were much less likely to receive CT if admitted to a general hospital than to a specialist centre (OR 0.52 (95% CI 0.45 to 0.59)); there was considerable variation between healthcare regions. When indicated, children >3 years were much more likely to have CT than those <3 years (OR 2.35 (95% CI 2.08 to 2.65)). Compliance with guidelines and diagnostic yield was variable across age groups, the type of hospital and region where children were admitted. With this pattern of clinical practice the risks of both missing intracranial injury and overuse of CT are considerable. 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/

A UK survey of rehabilitation following critical illness: implementation of NICE Clinical Guidance 83 (CG83) following hospital discharge.

PubMed

Connolly, Bronwen; Douiri, A; Steier, J; Moxham, J; Denehy, L; Hart, N

2014-05-15

To determine the implementation of National Institute for Health and Care Excellence guidance (NICE CG83) for posthospital discharge critical illness follow-up and rehabilitation programmes. Closed-question postal survey. Adult intensive care units (ICUs) across the UK, identified from national databases of organisations. Specialist-only and private ICUs were not included. Senior respiratory critical care physiotherapy clinicians. A representative sample of 182 surveys was returned from the 240 distributed (75.8% (95% CI 70.4 to 81.2)). Only 48 organisations (27.3% (95% CI 20.7 to 33.9)) offered a follow-up service 2-3 months following hospital discharge, the majority (n=39, 84.8%) in clinic format. 12 organisations reported posthospital discharge rehabilitation programmes (6.8% (95% CI 3.1 to 10.5)), albeit only 10 of these operated on a regular basis. Lack of funding was reported as the most frequent (n=149/164, 90%) and main barrier (n=99/156, 63.5%) to providing services. Insufficient resources (n=71/164, 43.3%) and lack of priority by the clinical management team (n=66/164, 40.2%) were also highly cited barriers to service delivery. NICE CG83 has been successful in profiling the importance of rehabilitation for survivors of critical illness. However, 4 years following publication of CG83 there has been limited development of this clinical service across the UK. Strategies to support delivery of such quality improvement programmes are urgently required to enhance patient care. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Cost-effectiveness analysis of hypertension treatment: controlled release nifedipine and candesartan low-dose combination therapy in patients with essential hypertension--the Nifedipine and Candesartan Combination (NICE-Combi) Study.

PubMed

Fujikawa, Keita; Hasebe, Naoyuki; Kikuchi, Kenjiro

2005-07-01

Societal interest in pharmaco-economic analysis is increasing in Japan. In this study, the cost-effectiveness of low-dose combination therapy with controlled release nifedipine plus candesartan and up-titrated monotherapy with candesartan was estimated, based on the results of the NICE-Combi study. The NICE-Combi study was a double-blind, parallel arm, randomized clinical trial to compare the efficacy of low-dose combination therapy of controlled release nifedipine (20 mg/day) plus candesartan (8 mg/day) vs. up-titrated monotherapy of candesartan (12 mg/day) on blood pressure control in Japanese patients with mild to severe essential hypertension who were not sufficiently controlled by the conventional dose of candesartan (8 mg/ day). The incremental cost effectiveness of each cohort during the 8-week randomization period was compared, from the perspective of a third-party payer (i.e., insurers). The average total cost per patient was 29,943 Japanese yen for the combination therapy group and 33,182 Japanese yen for the candesartan monotherapy group, while the rate of achievement of the target blood pressure was significantly higher in the combination therapy group than in the up-titrated monotherapy group. In the combination therapy group, higher efficacy and lower incremental treatment cost ("Dominance") were observed when compared to the monotherapy group. The sensitivity analyses also supported the results. In conclusion, these results suggest that combination therapy with controlled release nifedipine and low-dose candesartan (8 mg) is "dominant" to up-titrated candesartan monotherapy for the management of essential hypertension. This conclusion was robust to sensitivity analysis.

Vision Amniotic Leak Detector (ALD) to Eliminate Amniotic Fluid Leakage as a Cause of Vaginal Wetness in Pregnancy: A NICE Medical Technology Guidance.

PubMed

Ray, A F; Peirce, S C; Wilkes, A R; Carolan-Rees, G

2015-10-01

In prelabour rupture of membranes (PROM) or preterm PROM the amniotic membranes rupture prior to labour. Where this is not overt a speculum examination is undertaken to confirm diagnosis. The Vision Amniotic Leak Detector (ALD) is a panty liner that can diagnose amniotic fluid as a cause of vaginal wetness. It was evaluated by the UK National Institute for Health and Care Excellence (NICE) as part of the Medical Technologies Evaluation Programme. The sponsor (CommonSense Ltd) identified five studies, of which three were deemed within scope by the External Assessment Centre (EAC). Two of these three used an inappropriate comparator. The EAC recalculated the diagnostic accuracy of Vision ALD using speculum examination as the comparator: sensitivity of 97% (95% CI 93-99%), negative predictive value of 96% (95% CI 92-98%). A negative result would therefore allow patients to be discharged with confidence. In the sponsor's cost-consequence model only patients with a positive Vision ALD result would have a speculum examination, producing a cost saving of around £10 per patient. The EAC felt that some costs were unjustified and the model did not include infection outcomes or use in a community setting. The EAC revised the sponsor's model and found the results were most sensitive to clinician costs. Vision ALD was associated with savings of around £15-£25 per patient when administration in lower-cost community healthcare avoided a referral to a higher-cost secondary-care centre. NICE published guidance MTG15 in July 2013 recommending that the case for adopting Vision ALD was supported by the evidence.

Issues Related to the Frequency of Exploratory Analyses by Evidence Review Groups in the NICE Single Technology Appraisal Process.

PubMed

Kaltenthaler, Eva; Carroll, Christopher; Hill-McManus, Daniel; Scope, Alison; Holmes, Michael; Rice, Stephen; Rose, Micah; Tappenden, Paul; Woolacott, Nerys

2017-06-01

Evidence Review Groups (ERGs) critically appraise company submissions as part of the National Institute for Health and Care Excellence (NICE) Single Technology Appraisal (STA) process. As part of their critique of the evidence submitted by companies, the ERGs undertake exploratory analyses to explore uncertainties in the company's model. The aim of this study was to explore pre-defined factors that might influence or predict the extent of ERG exploratory analyses. The aim of this study was to explore predefined factors that might influence or predict the extent of ERG exploratory analyses. We undertook content analysis of over 400 documents, including ERG reports and related documentation for the 100 most recent STAs (2009-2014) for which guidance has been published. Relevant data were extracted from the documents and narrative synthesis was used to summarise the extracted data. All data were extracted and checked by two researchers. Forty different companies submitted documents as part of the NICE STA process. The most common disease area covered by the STAs was cancer (44%), and most ERG reports (n = 93) contained at least one exploratory analysis. The incidence and frequency of ERG exploratory analyses does not appear to be related to any developments in the appraisal process, the disease area covered by the STA, or the company's base-case incremental cost-effectiveness ratio (ICER). However, there does appear to be a pattern in the mean number of analyses conducted by particular ERGs, but the reasons for this are unclear and potentially complex. No clear patterns were identified regarding the presence or frequency of exploratory analyses, apart from the mean number conducted by individual ERGs. More research is needed to understand this relationship.

A feasibility study examining the effect on lung cancer diagnosis of offering a chest X-ray to higher-risk patients with chest symptoms: protocol for a randomized controlled trial

PubMed Central

2013-01-01

Background In order to improve lung cancer survival in the UK, a greater proportion of resectable cancers must be diagnosed. It is likely that resectability rates would be increased by more timely diagnosis. Aside from screening, the only way of achieving this is to reduce the time to diagnosis in symptomatic cancers. Currently, lung cancers are mainly diagnosed by general practitioners (GPs) using the National Institute for Health and Clinical Excellence (NICE) guidelines for urgent referral for chest X-ray, which recommend urgent imaging or referral for patients who have one of a number of chest symptoms for more than 3 weeks. We are proposing to expand this recommendation to include one of a number of chest symptoms of any duration in higher-risk patients. Methods/Design We intend to conduct a trial of imaging in these higher-risk patients and compare it with NICE guidelines to see if imaging improves stage at diagnosis and resection rates. This trial would have to be large (and consequently resource-intensive) because most of these patients will not have lung cancer, making optimal design crucial. We are therefore conducting a pilot trial that will ascertain the feasibility of running a full trial and provide key information that will be required in order to design the full trial. Discussion This trial will assess the feasibility and inform the design of a large, UK-wide, clinical trial of a change to the NICE guidelines for urgent referral for chest X-ray for suspected lung cancer. It utilizes a combination of workshop, health economic, quality of life, qualitative, and quantitative methods in order to fully assess feasibility. Trial registration Clinicaltrials.gov NCT01344005 PMID:24279296

Evolution of the evidence on the effectiveness and cost-effectiveness of acetylcholinesterase inhibitors and memantine for Alzheimer's disease: systematic review and economic model.

PubMed

Hyde, Christopher; Peters, Jaime; Bond, Mary; Rogers, Gabriel; Hoyle, Martin; Anderson, Rob; Jeffreys, Mike; Davis, Sarah; Thokala, Praveen; Moxham, Tiffany

2013-01-01

in 2007 the National Institute of Health and Clinical Excellence (NICE) restricted the use of acetylcholinesterase inhibitors and memantine. we conducted a health technology assessment (HTA) of the effectiveness and cost-effectiveness of donepezil, galantamine, rivastigmine and memantine for the treatment of AD to re-consider and up-date the evidence base used to inform the 2007 NICE decision. The systematic review of effectiveness targeted randomised controlled trials. A comprehensive search, including MEDLINE, Embase and the Cochrane Library, was conducted from January 2004 to March 2010. All key review steps were done by two reviewers. Random effects meta-analysis was conducted. The cost-effectiveness was assessed using a cohort-based model with three health states: pre-institutionalised, institutionalised and dead. The perspective was NHS and Personal Social Services and the cost year 2009. confidence about the size and statistical significance of the estimates of effect of galantamine, rivastigmine and memantine improved on function and global impact in particular. Cost-effectiveness also changed. For donepezil, galantamine and rivastigmine, the incremental cost per quality-adjusted life year (QALY) in 2004 was above £50,000; in 2010 the same drugs 'dominated' best supportive care (improved clinical outcome at reduced cost). This was primarily because of changes in the modelled costs of introducing the drugs. For memantine, the cost-effectiveness also improved from a range of £37-53,000 per QALY gained to a base-case of £32,000. there has been a change in the evidence base between 2004 and 2010 consistent with the change in NICE guidance. Further evolution in cost-effectiveness estimates is possible particularly if there are changes in drug prices.

Prescribing tamoxifen in primary care for the prevention of breast cancer: a national online survey of GPs' attitudes.

PubMed

Smith, Samuel G; Foy, Robbie; McGowan, Jennifer A; Kobayashi, Lindsay C; DeCensi, Andrea; Brown, Karen; Side, Lucy; Cuzick, Jack

2017-06-01

The cancer strategy for England (2015-2020) recommends GPs prescribe tamoxifen for breast cancer primary prevention among women at increased risk. To investigate GPs' attitudes towards prescribing tamoxifen. In an online survey, GPs in England, Northern Ireland, and Wales ( n = 928) were randomised using a 2 × 2 between-subjects design to read one of four vignettes describing a healthy patient seeking a tamoxifen prescription. In the vignette, the hypothetical patient's breast cancer risk (moderate versus high) and the clinician initiating the prescription (GP prescriber versus secondary care clinician [SCC] prescriber) were manipulated in a 1:1:1:1 ratio. Outcomes were willingness to prescribe, comfort discussing harms and benefits, comfort managing the patient, factors affecting the prescribing decision, and awareness of tamoxifen and the National Institute for Health and Care Excellence (NICE) guideline CG164. Half (51.7%) of the GPs knew tamoxifen can reduce breast cancer risk, and one-quarter (24.1%) were aware of NICE guideline CG164. Responders asked to initiate prescribing (GP prescriber) were less willing to prescribe tamoxifen than those continuing a prescription initiated in secondary care (SCC prescriber) (68.9% versus 84.6%, P <0.001). The GP prescribers reported less comfort discussing tamoxifen (53.4% versus 62.5%, P = 0.01). GPs willing to prescribe were more likely to be aware of the NICE guideline ( P = 0.039) and to have acknowledged the benefits of tamoxifen ( P <0.001), and were less likely to have considered its off-licence status ( P <0.001). Initiating tamoxifen prescriptions for preventive therapy in secondary care before asking GPs to continue the patient's care may overcome some prescribing barriers. © British Journal of General Practice 2017.

A NEW HEALTH TECHNOLOGY ASSESSMENT SYSTEM FOR DEVICES: THE FIRST FIVE YEARS.

PubMed

Campbell, Bruce; Dobson, Lee; Higgins, Joanne; Dillon, Bernice; Marlow, Mirella; Pomfrett, Chris

2017-01-01

The aim of this study was to review 5 years of activity from a new system devised by the National Institute for Health and Care Excellence (NICE), for assessing medical devices and diagnostics aimed at identifying and speeding adoption of technologies with clinical and cost advantages, compared with current practice in the United Kingdom healthcare system. All eligible notified technologies were classified using the Food and Drug Administration and Global Medical Device Nomenclature nomenclatures. Decisions about selecting technologies for full assessment to produce NICE recommendations were reviewed, along with the reasons given to companies for not selecting products. Between 2009 and 2014, 186 technologies were notified (46 percent therapeutic and 54 percent diagnostic). Thirty-nine were judged ineligible (no regulatory approval), and 147 were considered by an independent committee. Of these, eighty (54 percent) were not selected for full assessment, most commonly because of insufficient evidence (86 percent): there were uncertainties specifically about benefits to the health service (54 percent), to patients (39 percent), and about cost (24 percent). The remaining 67 were selected and assessed for Medical Technology guidance (52 percent) (noninferior and/or lower cost consequences than current practice), for Diagnostics guidance (43 percent) or other NICE recommendations about adoption and use. Classifying technologies by two different systems showed no selection bias for any technology type or disease area. Identifying new or under-used devices and diagnostics with potential benefits and promoting their adoption is important to health services in the United Kingdom and worldwide. This new system offers a means of fostering both uptake and further research. Lack of research data on new products is a major obstacle to evaluation.

[Introduction of British guidelines in perinatal mental healthcare--towards enhancing the function of perinatal mental healthcare in Japan].

PubMed

Suzuki, Toshihito

2014-01-01

Professionals in many different occupations, from psychiatrists, obstetricians, and pediatricians to nurses, midwives, pharmacists, clinical psychologists, public health nurses, and psychiatric social workers, are involved in perinatal mental healthcare. In order to enhance the function of such healthcare, it is necessary both to provide specialized training in each occupation and form a system and to smoothly conduct medical collaboration between different occupations. A deficiency in the medical function of perinatal mental healthcare greatly influences the mother and child's health, mental hygiene, and social life later in life. Therefore, a demand is seen for specialized staff and system formation capable of the following: 1) responding with appropriate perinatal management of female patients taking psychotropic drugs; 2) providing support and pregnancy consultation to female patients who wish to have children; and 3) properly handling postpartum mental disorder management, possibility of breastfeeding, and various issues that arise in mother-child relationships during upbringing. In the UK, the clinical guideline (NICE Clinical Guideline 45) for perinatal mental healthcare, which was created by the National Institute for Clinical Excellence (NICE), provides important guidelines on how to handle perinatal mental health. Aside from the NICE guideline, the Maudsley Prescribing Guidelines in Psychiatry indicates basic guidelines on prescribing perinatal drug therapy. In Japan, however, the current situation of perinatal mental healthcare is such that it has yet to be systemically developed. In this paper, we introduce the basic content in these British guidelines that should be noted. In addition, we consider the current status and future disposition of Japan's perinatal mental healthcare, with consideration for the differences in healthcare circumstances between Japan and the UK.

Value based pricing, research and development, and patient access schemes. Will the United Kingdom get it right or wrong?

PubMed Central

Towse, Adrian

2010-01-01

The National Health Service (NHS) should reward innovation it values. This will enable the NHS and the United Kingdom (UK) economy to benefit and impact positively on the Research and Development (R&D) decision making of companies. The National Institute for Health and Clinical Excellence (NICE) currently seeks to do this on behalf of the NHS. Yet the Office of Fair Trading proposals for Value Based Pricing add price setting powers – initially for the Department of Health (DH) and then for NICE. This introduces an additional substantial uncertainty that will impact on R&D and, conditional on R&D proceeding, on launch (or not) in the UK. Instead of adding to uncertainty the institutional arrangements for assessing value should seek to be predictable and science based, building on NICE's current arrangements. The real challenge is to increase understanding of the underlying cost-effectiveness of the technology itself by collecting evidence alongside use. The 2009 Pharmaceutical Price Regulation Scheme sought to help do this with Flexible Pricing (FP) and Patient Access Schemes (PASs). The PASs to date have increased access to medicines, but no schemes proposed to date have yet helped to tackle outcomes uncertainty. The 2010 Innovation Pass can also be seen as a form of ‘coverage with evidence development.’ The NHS is understandably concerned about the costs of running such evidence collection schemes. Enabling the NHS to deliver on such schemes will impact favourably on R&D decisions. Increasing the uncertainty in the UK NHS market through government price setting will reduce incentives for R&D and for early UK launch. PMID:20716236

A comparison of the treatment recommendations for neurogenic lower urinary tract dysfunction in the national institute for health and care excellence, European Association of Urology and international consultations on incontinence guidelines.

PubMed

Jaggi, Ashley; Drake, Marcus; Siddiqui, Emad; Fatoye, Francis

2018-04-17

Healthcare guidelines are an important vehicle in establishing up-to-date evidence based medicine (EBM) in clinical practice. Due to varying development processes, clinical guidelines created by different institutions can often contain contrasting recommendations. This can have implications for optimal and standardized patient care across management settings. The similarities and differences of treatment recommendations made in the National Institute for Health and Care Excellence (NICE), The European Association of Urology (EAU), and the International Consultation on Continence (ICI) guidelines for neurogenic lower urinary tract dysfunction (NLUTD) were assessed. The guidelines generally agree on their approach to conservative management, including behavioral therapies, and catheterization techniques. There was discrepancy on the benefit of using an alpha blocker in NLUTD and bladder outlet obstruction (BOO) and administering Botulinum toxin A (Onabotulinum-A) in NLUTD. The highest degree of divergence was seen in recommendations for surgical treatments, where the EAU made gender-specific recommendations, and gave continent urinary diversion higher preference than given in the NICE and ICI guidelines. In the absence of high-quality clinical evidence, many of the recommendations made across all three guidelines are based on expert opinion. NICE, the EAU and ICI have similarities but they place differing emphasis on costs and expert opinion, which translated in notably different recommendations. It is evident that increased research efforts, possibly in the form of prospective registries, pragmatic trials, and resource utilization studies are necessary to improve the underlying evidence base for NLUTD, and subsequently the strength and concordance of recommendations across guidelines. © 2018 Wiley Periodicals, Inc.

Value based pricing, research and development, and patient access schemes. Will the United Kingdom get it right or wrong?

PubMed

Towse, Adrian

2010-09-01

The National Health Service (NHS) should reward innovation it values. This will enable the NHS and the United Kingdom (UK) economy to benefit and impact positively on the Research and Development (R&D) decision making of companies. The National Institute for Health and Clinical Excellence (NICE) currently seeks to do this on behalf of the NHS. Yet the Office of Fair Trading proposals for Value Based Pricing add price setting powers--initially for the Department of Health (DH) and then for NICE. This introduces an additional substantial uncertainty that will impact on R&D and, conditional on R&D proceeding, on launch (or not) in the UK. Instead of adding to uncertainty the institutional arrangements for assessing value should seek to be predictable and science based, building on NICE's current arrangements. The real challenge is to increase understanding of the underlying cost-effectiveness of the technology itself by collecting evidence alongside use. The 2009 Pharmaceutical Price Regulation Scheme sought to help do this with Flexible Pricing (FP) and Patient Access Schemes (PASs). The PASs to date have increased access to medicines, but no schemes proposed to date have yet helped to tackle outcomes uncertainty. The 2010 Innovation Pass can also be seen as a form of 'coverage with evidence development.' The NHS is understandably concerned about the costs of running such evidence collection schemes. Enabling the NHS to deliver on such schemes will impact favourably on R&D decisions. Increasing the uncertainty in the UK NHS market through government price setting will reduce incentives for R&D and for early UK launch.

Improving the implementation of NICE public health workplace guidance: an evaluation of the effectiveness of action-planning workshops in NHS trusts in England.

PubMed

Jones, Sarah; Sloan, David; Evans, Hannah E R; Williams, Sian

2015-08-01

There is evidence that health and well-being of the National Health Service (NHS) workforce affects organizational and patient outcomes. A Cochrane review of the effectiveness of clinical audit to improve quality of care has shown great variation between studies, depending on the design and intensity of support offered. This study evaluates the effectiveness of an organizational audit methodology with (1) action-planning workshops and follow-up and (2) audit feedback alone, to support the implementation of the National Institute for Health and Care Excellence (NICE) workplace guidance. Two rounds of audit using a self-administered online questionnaire were conducted. An overall implementation score was devised for each trust. Following round 1, interviews were conducted with a cohort of trusts with high scores. The interviews used a theory-based framework to identify predictors of and barriers to successful implementation. From this, the content for action-planning workshops was devised and workshops held with lower scoring trusts. The remaining trusts received only written feedback on their audit results. Changes in the implementation score between rounds 1 and 2 were compared within and between cohorts. The median improvement in scores between rounds 1 and 2 was statistically significant except where baseline score was high. The improvement for trusts who received workshops was very much better than those who did not (P < 0.001). This difference remained after adjustment using stratification by baseline score (P = 0.001). Audit, combined with action-planning workshops and follow-up, appears to be more effective in improving implementation of NICE workplace health and well-being guidance than audit with feedback alone. © 2015 John Wiley & Sons, Ltd.

[Applicability of "do not do recommendations" from the National Institute for Health and Care Excellence in a quaternary care hospital].

PubMed

Martin, S; Miñarro, R; Cano, P; Aranda, J M

2015-01-01

To qualitatively and quantitatively identify the level of agreement between the clinical staff of a quaternary care hospital and the National Institute for Health and Care Excellence (NICE) "do not do" recommendations, and to submit a strategic alternative for effective implementation. An ad hoc form was designed to evaluate level of clinical disagreement from the experience and knowledge of the clinical staff, as well as the applicability, usefulness, effectivity and efficiency of all the NICE "do not do" recommendations that had been published up to June 2012, checking their stability up to the July 2014 update. Description of the process of design and implementation of the strategic alternative to improve compliance is presented. The great majority (90%) of Clinical Unit directors agree with the NICE recommendations, with 64% finding them useful or very useful, 52% finding them applicable, and 32% and 34% thinking they are of high effectivity and efficiency, respectively. However, 20% of the efficient ones are not being applied. Moreover, knowledge discordances that might lead to clinical disagreements were detected. A strategic intervention, combining culture and incentives for good clinical practices, has been implemented. The improvement in the use of the good clinical practice recommendations is directly related to the agreement of its definition and evidence. An evaluation strategy of its application by the health professionals is essential to achieve an impact in avoidable costs. Moreover, to control for harmful effects of the economic impact on patient safety, it will be necessary to simultaneously evaluate clinical/health outcome indicators tightly linked to the applied recommendations. Copyright © 2015 SECA. Published by Elsevier Espana. All rights reserved.

MSeqDR mvTool: A mitochondrial DNA Web and API resource for comprehensive variant annotation, universal nomenclature collation, and reference genome conversion.

PubMed

Shen, Lishuang; Attimonelli, Marcella; Bai, Renkui; Lott, Marie T; Wallace, Douglas C; Falk, Marni J; Gai, Xiaowu

2018-06-01

Accurate mitochondrial DNA (mtDNA) variant annotation is essential for the clinical diagnosis of diverse human diseases. Substantial challenges to this process include the inconsistency in mtDNA nomenclatures, the existence of multiple reference genomes, and a lack of reference population frequency data. Clinicians need a simple bioinformatics tool that is user-friendly, and bioinformaticians need a powerful informatics resource for programmatic usage. Here, we report the development and functionality of the MSeqDR mtDNA Variant Tool set (mvTool), a one-stop mtDNA variant annotation and analysis Web service. mvTool is built upon the MSeqDR infrastructure (https://mseqdr.org), with contributions of expert curated data from MITOMAP (https://www.mitomap.org) and HmtDB (https://www.hmtdb.uniba.it/hmdb). mvTool supports all mtDNA nomenclatures, converts variants to standard rCRS- and HGVS-based nomenclatures, and annotates novel mtDNA variants. Besides generic annotations from dbNSFP and Variant Effect Predictor (VEP), mvTool provides allele frequencies in more than 47,000 germline mitogenomes, and disease and pathogenicity classifications from MSeqDR, Mitomap, HmtDB and ClinVar (Landrum et al., 2013). mvTools also provides mtDNA somatic variants annotations. "mvTool API" is implemented for programmatic access using inputs in VCF, HGVS, or classical mtDNA variant nomenclatures. The results are reported as hyperlinked html tables, JSON, Excel, and VCF formats. MSeqDR mvTool is freely accessible at https://mseqdr.org/mvtool.php. © 2018 Wiley Periodicals, Inc.

Chapter 4 - The LANDFIRE Prototype Project reference database

Treesearch

John F. Caratti

2006-01-01

This chapter describes the data compilation process for the Landscape Fire and Resource Management Planning Tools Prototype Project (LANDFIRE Prototype Project) reference database (LFRDB) and explains the reference data applications for LANDFIRE Prototype maps and models. The reference database formed the foundation for all LANDFIRE tasks. All products generated by the...

Implementation and Use of the Reference Analytics Module of LibAnswers

ERIC Educational Resources Information Center

Flatley, Robert; Jensen, Robert Bruce

2012-01-01

Academic libraries have traditionally collected reference statistics using hash marks on paper. Although efficient and simple, this method is not an effective way to capture the complexity of reference transactions. Several electronic tools are now available to assist libraries with collecting often elusive reference data--among them homegrown…

Hole-Center Locating Tool

NASA Technical Reports Server (NTRS)

Senter, H. F.

1984-01-01

Tool alines center of new hold with existing hole. Tool marks center of new hole drilled while workpiece is in place. Secured with bolts while hole center marked with punch. Used for field installations where reference points unavailable or work area cramped and not easily accessible with conventional tools.

The role of standards in the development and implementation of clinical laboratory tests: a domestic and global perspective.

PubMed

Michaud, Ginette Y

2005-01-01

In the field of clinical laboratory medicine, standardization is aimed at increasing the trueness and reliability of measured values. Standardization relies on the use of written standards, reference measurement procedures and reference materials. These are important tools for the design and validation of new tests, and for establishing the metrological traceability of diagnostic assays. Their use supports the translation of research technologies into new diagnostic assays and leads to more rapid advances in science and medicine, as well as improvements in the quality of patient care. The various standardization tools are described, as are the procedures by which written standards, reference procedures and reference materials are developed. Recent efforts to develop standards for use in the field of molecular diagnostics are discussed. The recognition of standardization tools by the FDA and other regulatory authorities is noted as evidence of their important role in ensuring the safety and performance of in vitro diagnostic devices.

User`s and reference guide to the INEL RML/analytical radiochemistry sample tracking database version 1.00

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

Femec, D.A.

This report discusses the sample tracking database in use at the Idaho National Engineering Laboratory (INEL) by the Radiation Measurements Laboratory (RML) and Analytical Radiochemistry. The database was designed in-house to meet the specific needs of the RML and Analytical Radiochemistry. The report consists of two parts, a user`s guide and a reference guide. The user`s guide presents some of the fundamentals needed by anyone who will be using the database via its user interface. The reference guide describes the design of both the database and the user interface. Briefly mentioned in the reference guide are the code-generating tools, CREATE-SCHEMAmore » and BUILD-SCREEN, written to automatically generate code for the database and its user interface. The appendices contain the input files used by the these tools to create code for the sample tracking database. The output files generated by these tools are also included in the appendices.« less

DUK - A Fast and Efficient Kmer Based Sequence Matching Tool

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

Li, Mingkun; Copeland, Alex; Han, James

2011-03-21

A new tool, DUK, is developed to perform matching task. Matching is to find whether a query sequence partially or totally matches given reference sequences or not. Matching is similar to alignment. Indeed many traditional analysis tasks like contaminant removal use alignment tools. But for matching, there is no need to know which bases of a query sequence matches which position of a reference sequence, it only need know whether there exists a match or not. This subtle difference can make matching task much faster than alignment. DUK is accurate, versatile, fast, and has efficient memory usage. It uses Kmermore » hashing method to index reference sequences and Poisson model to calculate p-value. DUK is carefully implemented in C++ in object oriented design. The resulted classes can also be used to develop other tools quickly. DUK have been widely used in JGI for a wide range of applications such as contaminant removal, organelle genome separation, and assembly refinement. Many real applications and simulated dataset demonstrate its power.« less

What helps and hinders midwives in engaging with pregnant women about stopping smoking? A cross-sectional survey of perceived implementation difficulties among midwives in the North East of England.

PubMed

Beenstock, Jane; Sniehotta, Falko F; White, Martin; Bell, Ruth; Milne, Eugene Mg; Araujo-Soares, Vera

2012-04-24

Around 5,000 miscarriages and 300 perinatal deaths per year result from maternal smoking in the United Kingdom. In the northeast of England, 22% of women smoke at delivery compared to 14% nationally. Midwives have designated responsibilities to help pregnant women stop smoking. We aimed to assess perceived implementation difficulties regarding midwives' roles in smoking cessation in pregnancy. A self-completed, anonymous survey was sent to all midwives in northeast England (n = 1,358) that explores the theoretical explanations for implementation difficulties of four behaviours recommended in the National Institute for Health and Clinical Excellence (NICE) guidance: (a) asking a pregnant woman about her smoking behaviour, (b) referring to the stop-smoking service, (c) giving advice about smoking behaviour, and (d) using a carbon monoxide monitor. Questions covering Michie et al.'s theoretical domain framework (TDF), describing 11 domains of hypothesised behavioural determinants (i.e., 'knowledge', 'skills', 'social/professional role/identity', 'beliefs about capabilities', 'beliefs about consequences', 'motivation and goals', 'memory', 'attention and decision processes', 'environmental context and resources', 'social influences', 'emotion', and 'self-regulation/action planning'), were used to describe perceived implementation difficulties, predict self-reported implementation behaviours, and explore relationships with demographic and professional variables. The overall response rate was 43% (n = 589). The number of questionnaires analysed was 364, following removal of the delivery-unit midwives, who are not directly involved in providing smoking-cessation services. Participants reported few implementation difficulties, high levels of motivation for all four behaviours and identified smoking-cessation work with their role. Midwives were less certain about the consequences of, and the environmental context and resources available for, engaging in this work relative to other TDF domains. All domains were highly correlated. A principal component analysis showed that a single factor ('propensity to act'), derived from all domains, explained 66% of variance in theoretical domain measures. The 'propensity to act' was predictive of the self-reported behaviour 'Refer all women who smoke……to NHS Stop Smoking Services' and mediated the relationship between demographic variables, such as midwives' main place of work, and behaviour. Our findings advance understanding of what facilitates and inhibits midwives' guideline implementation behaviours in relation to smoking cessation and will inform the development of current practice and new interventions. Using the TDF as a self-completion questionnaire is innovative, and this study supports previous research that the TDF is an appropriate tool to understand the behaviour of healthcare professionals.

ARC-2010-ACD10-0047-002

NASA Image and Video Library

2010-03-09

ARC Sculpture by Peter Gutkin 'Nice Ice in New York' circa 1970's. This sculputre was donated to Ames Research Center by the artist. Peter Gutkin has designed special interiors, exhibits, and display furniture for Ames since 1979. He currently maintains an office in San Francisco, CA.

Play Nice Across Time Space

NASA Technical Reports Server (NTRS)

Conroy, Michael P.

2015-01-01

Lecture is an overview of Simulation technologies, methods and practices, as applied to current and past NASA programs. Focus is on sharing experience and the overall benefits to programs and projects of having appropriate simulation and analysis capabilities available at the correct point in a system lifecycle.

Teardrop and heart orbits of a swinging Atwood's machine

NASA Astrophysics Data System (ADS)

Tufillaro, Nicholas B.

1994-03-01

An exact solution is presented for a swinging Atwood's machine. This teardrop-heart orbit is constructed using Hamilton-Jacobi theory. The example nicely illustrates the utility of the Hamilton-Jacobi method for finding solutions to nonlinear mechanical systems when more elementary techniques fail.

Stratigraphy of the pedogenic manganese nodules in the Carletonville area, North West Province of South Africa: A case study of the General Nice Manganese Mine

NASA Astrophysics Data System (ADS)

Pharoe, Benedict Kinshasa; Liu, Kuiwu

2018-07-01

The lithostratigraphy of pedogenic manganese (Mn) nodules in the Carletonville area is similar to the Klipkuil, Ryedale, Wes Wits, and Houtkoppies deposits in the West Rand region of the Gauteng and North West Provinces and to a lesser extent the Bronkhorstfontein manganese deposit in the Limpopo Province of South Africa. The lithostratigraphy of the ore deposit at the General Nice Manganese Mine consists of a basal manganese wad, preserved in a typical karst setting on top of the underlying Malmani stromatolitic dolomites and Tertiary fluvial and secondary mineral deposits consisting of manganese nodules of variable size in a finer-grained soil matrix. At the top of the deposit is a Mn-depleted Quaternary sand cover. The Tertiary alluvial succession hosting Mn nodules was informally subdivided into A, B, C, D, E, F, G and H zones on the basis of geochemical analyses (XRD, XRF and SEM) of bulk zone samples and the manganese nodule size and concentration.

Identifying types and causes of errors in mortality data in a clinical registry using multiple information systems.

PubMed

Koetsier, Antonie; Peek, Niels; de Keizer, Nicolette

2012-01-01

Errors may occur in the registration of in-hospital mortality, making it less reliable as a quality indicator. We assessed the types of errors made in in-hospital mortality registration in the clinical quality registry National Intensive Care Evaluation (NICE) by comparing its mortality data to data from a national insurance claims database. Subsequently, we performed site visits at eleven Intensive Care Units (ICUs) to investigate the number, types and causes of errors made in in-hospital mortality registration. A total of 255 errors were found in the NICE registry. Two different types of software malfunction accounted for almost 80% of the errors. The remaining 20% were five types of manual transcription errors and human failures to record outcome data. Clinical registries should be aware of the possible existence of errors in recorded outcome data and understand their causes. In order to prevent errors, we recommend to thoroughly verify the software that is used in the registration process.

High Efficient Photo-Fenton Catalyst of α-Fe2O3/MoS2 Hierarchical Nanoheterostructures: Reutilization for Supercapacitors

NASA Astrophysics Data System (ADS)

Yang, Xijia; Sun, Haiming; Zhang, Lishu; Zhao, Lijun; Lian, Jianshe; Jiang, Qing

2016-08-01

A novel three-dimensional (3D) α-Fe2O3/MoS2 hierarchical nanoheterostructure is effectively synthesized via a facile hydrothermal method. The zero-dimensional (0D) Fe2O3 nanoparticles guide the growth of two-dimensional (2D) MoS2 nanosheets and formed 3D flower-like structures, while MoS2 facilitates the good dispersion of porous Fe2O3 with abundant oxygen vacancies. This charming 3D-structure with perfect match of non-equal dimension exhibits high recyclable photo-Fenton catalytic activity for Methyl orange pollutant and nice specific capacity in reusing as supercapacitor after catalysis. The synergistic effect between Fe2O3 and MoS2, the intermediate nanointerfaces, the 3D porous structures, and the abundant oxygen vacancies both contribute to highly active catalysis, nice electrochemical performance and stable cycling. This strategy is simple, cheap, and feasible for maximizing the value of the materials, as well as eliminating the secondary pollution.

High Efficient Photo-Fenton Catalyst of α-Fe2O3/MoS2 Hierarchical Nanoheterostructures: Reutilization for Supercapacitors.

PubMed

Yang, Xijia; Sun, Haiming; Zhang, Lishu; Zhao, Lijun; Lian, Jianshe; Jiang, Qing

2016-08-16

A novel three-dimensional (3D) α-Fe2O3/MoS2 hierarchical nanoheterostructure is effectively synthesized via a facile hydrothermal method. The zero-dimensional (0D) Fe2O3 nanoparticles guide the growth of two-dimensional (2D) MoS2 nanosheets and formed 3D flower-like structures, while MoS2 facilitates the good dispersion of porous Fe2O3 with abundant oxygen vacancies. This charming 3D-structure with perfect match of non-equal dimension exhibits high recyclable photo-Fenton catalytic activity for Methyl orange pollutant and nice specific capacity in reusing as supercapacitor after catalysis. The synergistic effect between Fe2O3 and MoS2, the intermediate nanointerfaces, the 3D porous structures, and the abundant oxygen vacancies both contribute to highly active catalysis, nice electrochemical performance and stable cycling. This strategy is simple, cheap, and feasible for maximizing the value of the materials, as well as eliminating the secondary pollution.

Cardiovascular risk assessment in rheumatoid arthritis – controversies and the new approach

PubMed Central

Głuszko, Piotr

2016-01-01

The current methods of cardiovascular (CV) risk assessment in the course of inflammatory connective tissue diseases are a subject of considerable controversy. Comparing different methods of CV risk assessment in current rheumatoid arthritis (RA) guidelines, only a few of them recommend the use of formal risk calculators. These are the EULAR guidelines suggesting the use of SCORE and the British Society for Rheumatology guidelines performed in collaboration with NICE preferring the use of QRISK-2. Analyzing the latest American and British reports, two main concepts could be identified. The first one is to focus on risk calculators developed for the general population taking into account RA, and the calculator that might fulfill this role is the new QRISK-2 presented by NICE in 2014. The second concept is to create RA-specific risk calculators, such as the Expanded Cardiovascular Risk Prediction Score for RA. In this review we also discuss the efficiency of a new Pooled Cohort Equation and other calculators in the general and RA population. PMID:27504023

Changing the Publication Culture From "Nice to Do" to "Need to Do": Implications for Nurse Leaders in Acute Care Settings.

PubMed

Tyndall, Deborah E; Caswell, Nicole I

2017-01-01

Nurses in clinical settings often generate innovative practice ideas to inform their practice and improve patient outcomes. Yet, few publish and share these innovations with a wider audience. Barriers impeding clinical nurses from writing for publication include discomfort with writing, lack of time, and scarce resources. A qualitative study was designed to determine obstacles and facilitators to writing for publication. Interviews were conducted with five clinical nurses who had recently published in peer-reviewed journals. Three themes emerged from the data: culture of "nice to do," personal motivation, and writing experiences. Findings from the study offer implications for nurse leaders to help increase publication efforts by clinical nurses in acute care settings. Nurse leaders can promote publication by clinical nurses through three main strategies: create a culture that supports publication, offer incentives to motivate nurses to publish and reward those who do publish, and provide writing experiences that facilitate writing for publication. © 2016 Wiley Periodicals, Inc.

Isolation, spectroscopic and density functional theory studies of 7-(4-methoxyphenyl)-9H-furo[2,3-f]chromen-9-one: a new flavonoid from the bark of Millettia ovalifolia.

PubMed

Taj Ur Rahman; Arfan, Mohammad; Mahmood, Tariq; Liaqat, Wajiha; Gilani, Mazhar Amjad; Uddin, Ghias; Ludwig, Ralf; Zaman, Khair; Choudhary, M Iqbal; Khattak, Khanzadi Fatima; Ayub, Khurshid

2015-07-05

The phytochemical examination of chloroform soluble fraction (FX2) of methanolic extract of bark of Millettia ovalifolia yielded a new flavonoid; 7-(4-methoxyphenyl)-9H-furo [2,3-f]chromen-9-one (1). Compound 1 is characterized by spectroscopic analytical techniques such as UV, IR, 1D, 2D NMR spectroscopy, and mass spectrometry. A theoretical model is also developed for obtaining geometric, electronic and spectroscopic properties of 1. The geometry optimization and harmonic vibration simulations have been carried out at B3LYP/6-31G(d,p). The vibrational spectrum of compound 1 shows nice correlation with the experimental IR spectrum, through a scaling factor of 0.9613. (1)H and (13)C NMR chemical shifts are simulated using Cramer's re-parameterized function WP04 at 6-31G(d,p) basis set, and correlate nicely with the experimental chemical shifts. Copyright © 2015 Elsevier B.V. All rights reserved.

Selected contributions from the 11th Gas in Marine Sediments International Conference of September 2012, Nice: an introduction

NASA Astrophysics Data System (ADS)

Pierre, Catherine; Imbert, Patrice; Mascle, Jean

2014-06-01

This Introduction presents an overview of selected contributions from the 11th Gas in Marine Sediments International Conference held on the 4-7 September 2012 in Nice, France, and published in this special issue of Geo-Marine Letters under the guest editorship of Catherine Pierre, Patrice Imbert and Jean Mascle. These cover fluid seepage dynamics at widely varying spatiotemporal scales in a giant buried caldera of the Caspian Sea, mud volcanoes and pockmarks in the Mediterranean and adjoining Gulf of Cadiz, as well as Lake Baikal, pockmarks of shallower waters along the Atlantic French coast and in Baltic Sea lagoons, deepwater pockmarks and cold seeps on the Norwegian margin and the Hikurangi Margin of New Zealand, asphalt seepage sites offshore southern California, and the tectonically controlled southern Chile forearc. We look forward to meeting all again at the 12th Gas in Marine Sediments conference scheduled for 1-6 September 2014 in Taipei, Taiwan.

Isolation, spectroscopic and density functional theory studies of 7-(4-methoxyphenyl)-9H-furo[2,3-f]chromen-9-one: A new flavonoid from the bark of Millettia ovalifolia

NASA Astrophysics Data System (ADS)

Rahman, Taj Ur; Arfan, Mohammad; Mahmood, Tariq; Liaqat, Wajiha; Gilani, Mazhar Amjad; Uddin, Ghias; Ludwig, Ralf; Zaman, Khair; Choudhary, M. Iqbal; Khattak, Khanzadi Fatima; Ayub, Khurshid

2015-07-01

The phytochemical examination of chloroform soluble fraction (FX2) of methanolic extract of bark of Millettia ovalifolia yielded a new flavonoid; 7-(4-methoxyphenyl)-9H-furo [2,3-f]chromen-9-one (1). Compound 1 is characterized by spectroscopic analytical techniques such as UV, IR, 1D, 2D NMR spectroscopy, and mass spectrometry. A theoretical model is also developed for obtaining geometric, electronic and spectroscopic properties of 1. The geometry optimization and harmonic vibration simulations have been carried out at B3LYP/6-31G(d,p). The vibrational spectrum of compound 1 shows nice correlation with the experimental IR spectrum, through a scaling factor of 0.9613. 1H and 13C NMR chemical shifts are simulated using Cramer's re-parameterized function WP04 at 6-31G(d,p) basis set, and correlate nicely with the experimental chemical shifts.

Nice Guys and Gals Finish Last? Not in Early Adolescence When Empathic, Accepted, and Popular Peers are Desirable.

PubMed

Bower, Andrew R; Nishina, Adrienne; Witkow, Melissa R; Bellmore, Amy

2015-12-01

Little is known about attributes that elicit romantic desirability in early adolescence. The current study, with a sample of 531 sixth-grade students (45% boys) attending ethnically diverse middle schools, used a resource control framework to explore which self-reported behaviors (e.g., empathy and aggression) and peer-reported status (e.g., acceptance and perceived popularity) predict the likelihood of being considered romantically desirable (i.e., receiving at least one "crush" nomination from an opposite sex grademate). Self-reported empathy was positively associated with students' romantic desirability (primarily for those with high peer acceptance), whereas self-reported aggression on its own did not. Both peer-acceptance and popularity also were positively associated with students' romantic desirability, and aggressive behavior reduced popularity's effect. Although aggression may be integral for obtaining high peer status across cultures, prosocial behaviors were romantically valued. Our findings suggest that peer-vetted social status elicits romantic interest and during early adolescence, nice guys and gals really do not finish last.

[A comparative study of coding and information systems for the evaluation of medical and social conditions: the case of addictive disorders].

PubMed

Bourdais-Mannone, Claire; Cherikh, Faredj; Gicquel, Nathalie; Gelsi, Eve; Jove, Frédérique; Staccini, Pascal

2011-01-01

The purpose of this study was to conduct a descriptive and comparative analysis of the tools used by healthcare professionals specializing in addictive disorders to promote a rapprochement of information systems. The evaluation guide used to assess the compensation needs of disabled persons treated in "Maisons Départementales des Personnes Handicapées" (centres for disabled people) organizes information in different areas, including a psychological component. The guide includes social and environmental information in the "Recueil Commun sur les Addictions et les Prises en charges" (Joint Report on Drug Addiction and Drug Treatment). While the program for the medicalization of information systems includes care data, the current information about social situations remains inadequate. The international classification of diseases provides synthetic diagnostic codes to describe substance use, etiologic factors and the somatic and psychological complications inherent to addictive disorders. The current system could be radically simplified and harmonized and would benefit from adopting a more individualized approach to non-substance behavioral addictions. The international classification of disabilities provides tools for evaluating the psychological component included in the recent definition of addictive disorders. Legal information should play an integral role in the structure of the information system and in international classifications. The prevalence of episodes of care and treatment of addictive and psychological disorders was assessed at Nice University Hospital in all disciplines. Except in addiction treatment units, very few patients were found to have a RECAP file.

Wikipedia Chemical Structure Explorer: substructure and similarity searching of molecules from Wikipedia.

PubMed

Ertl, Peter; Patiny, Luc; Sander, Thomas; Rufener, Christian; Zasso, Michaël

2015-01-01

Wikipedia, the world's largest and most popular encyclopedia is an indispensable source of chemistry information. It contains among others also entries for over 15,000 chemicals including metabolites, drugs, agrochemicals and industrial chemicals. To provide an easy access to this wealth of information we decided to develop a substructure and similarity search tool for chemical structures referenced in Wikipedia. We extracted chemical structures from entries in Wikipedia and implemented a web system allowing structure and similarity searching on these data. The whole search as well as visualization system is written in JavaScript and therefore can run locally within a web page and does not require a central server. The Wikipedia Chemical Structure Explorer is accessible on-line at www.cheminfo.org/wikipedia and is available also as an open source project from GitHub for local installation. The web-based Wikipedia Chemical Structure Explorer provides a useful resource for research as well as for chemical education enabling both researchers and students easy and user friendly chemistry searching and identification of relevant information in Wikipedia. The tool can also help to improve quality of chemical entries in Wikipedia by providing potential contributors regularly updated list of entries with problematic structures. And last but not least this search system is a nice example of how the modern web technology can be applied in the field of cheminformatics. Graphical abstractWikipedia Chemical Structure Explorer allows substructure and similarity searches on molecules referenced in Wikipedia.

Structured syncope care pathways based on lean six sigma methodology optimises resource use with shorter time to diagnosis and increased diagnostic yield.

PubMed

Martens, Leon; Goode, Grahame; Wold, Johan F H; Beck, Lionel; Martin, Georgina; Perings, Christian; Stolt, Pelle; Baggerman, Lucas

2014-01-01

To conduct a pilot study on the potential to optimise care pathways in syncope/Transient Loss of Consciousness management by using Lean Six Sigma methodology while maintaining compliance with ESC and/or NICE guidelines. Five hospitals in four European countries took part. The Lean Six Sigma methodology consisted of 3 phases: 1) Assessment phase, in which baseline performance was mapped in each centre, processes were evaluated and a new operational model was developed with an improvement plan that included best practices and change management; 2) Improvement phase, in which optimisation pathways and standardised best practice tools and forms were developed and implemented. Staff were trained on new processes and change-management support provided; 3) Sustaining phase, which included support, refinement of tools and metrics. The impact of the implementation of new pathways was evaluated on number of tests performed, diagnostic yield, time to diagnosis and compliance with guidelines. One hospital with focus on geriatric populations was analysed separately from the other four. With the new pathways, there was a 59% reduction in the average time to diagnosis (p = 0.048) and a 75% increase in diagnostic yield (p = 0.007). There was a marked reduction in repetitions of diagnostic tests and improved prioritisation of indicated tests. Applying a structured Lean Six Sigma based methodology to pathways for syncope management has the potential to improve time to diagnosis and diagnostic yield.

Structured Syncope Care Pathways Based on Lean Six Sigma Methodology Optimises Resource Use with Shorter Time to Diagnosis and Increased Diagnostic Yield

PubMed Central

Martens, Leon; Goode, Grahame; Wold, Johan F. H.; Beck, Lionel; Martin, Georgina; Perings, Christian; Stolt, Pelle; Baggerman, Lucas

2014-01-01

Aims To conduct a pilot study on the potential to optimise care pathways in syncope/Transient Loss of Consciousness management by using Lean Six Sigma methodology while maintaining compliance with ESC and/or NICE guidelines. Methods Five hospitals in four European countries took part. The Lean Six Sigma methodology consisted of 3 phases: 1) Assessment phase, in which baseline performance was mapped in each centre, processes were evaluated and a new operational model was developed with an improvement plan that included best practices and change management; 2) Improvement phase, in which optimisation pathways and standardised best practice tools and forms were developed and implemented. Staff were trained on new processes and change-management support provided; 3) Sustaining phase, which included support, refinement of tools and metrics. The impact of the implementation of new pathways was evaluated on number of tests performed, diagnostic yield, time to diagnosis and compliance with guidelines. One hospital with focus on geriatric populations was analysed separately from the other four. Results With the new pathways, there was a 59% reduction in the average time to diagnosis (p = 0.048) and a 75% increase in diagnostic yield (p = 0.007). There was a marked reduction in repetitions of diagnostic tests and improved prioritisation of indicated tests. Conclusions Applying a structured Lean Six Sigma based methodology to pathways for syncope management has the potential to improve time to diagnosis and diagnostic yield. PMID:24927475

We need a NICE for global development spending

PubMed Central

Chalkidou, Kalipso; Culyer, Anthony J.; Glassman, Amanda; Li, Ryan

2017-01-01

With aid budgets shrinking in richer countries and more money for healthcare becoming available from domestic sources in poorer ones, the rhetoric of value for money or improved efficiency of aid spending is increasing. Taking healthcare as one example, we discuss the need for and potential benefits of (and obstacles to) the establishment of a national institute for aid effectiveness. In the case of the UK, such an institute would help improve development spending decisions made by DFID, the country’s aid agency, as well as by the various multilaterals, such as the Global Fund, through which British aid monies is channelled. It could and should also help countries becoming increasingly independent from aid build their own capacity to make sure their own resources go further in terms of health outcomes and more equitable distribution. Such an undertaking will not be easy given deep suspicion amongst development experts towards economists and arguments for improving efficiency. We argue that it is exactly because needs matter that those who make spending decisions must consider the needs not being met when a priority requires that finite resources are diverted elsewhere. These chosen unmet needs are the true costs; they are lost health. They must be considered, and should be minimised and must therefore be measured. Such exposition of the trade-offs of competing investment options can help inform an array of old and newer development tools, from strategic purchasing and pricing negotiations for healthcare products to performance based contracts and innovative financing tools for programmatic interventions. PMID:28868141

An online paradigm for exploring the self-reference effect

PubMed Central

Bentley, Sarah V.; Greenaway, Katharine H.; Haslam, S. Alexander

2017-01-01

People reliably encode information more effectively when it is related in some way to the self—a phenomenon known as the self-reference effect. This effect has been recognized in psychological research for almost 40 years, and its scope as a tool for investigating the self-concept is still expanding. The self-reference effect has been used within a broad range of psychological research, from cultural to neuroscientific, cognitive to clinical. Traditionally, the self-reference effect has been investigated in a laboratory context, which limits its applicability in non-laboratory samples. This paper introduces an online version of the self-referential encoding paradigm that yields reliable effects in an easy-to-administer procedure. Across four studies (total N = 658), this new online tool reliably replicated the traditional self-reference effect: in all studies self-referentially encoded words were recalled significantly more than semantically encoded words (d = 0.63). Moreover, the effect sizes obtained with this online tool are similar to those obtained in laboratory samples, and are robust to experimental variations in encoding time (Studies 1 and 2) and recall procedure (Studies 3 and 4), and persist independent of primacy and recency effects (all studies). PMID:28472160

SPARTA: Simple Program for Automated reference-based bacterial RNA-seq Transcriptome Analysis.

PubMed

Johnson, Benjamin K; Scholz, Matthew B; Teal, Tracy K; Abramovitch, Robert B

2016-02-04

Many tools exist in the analysis of bacterial RNA sequencing (RNA-seq) transcriptional profiling experiments to identify differentially expressed genes between experimental conditions. Generally, the workflow includes quality control of reads, mapping to a reference, counting transcript abundance, and statistical tests for differentially expressed genes. In spite of the numerous tools developed for each component of an RNA-seq analysis workflow, easy-to-use bacterially oriented workflow applications to combine multiple tools and automate the process are lacking. With many tools to choose from for each step, the task of identifying a specific tool, adapting the input/output options to the specific use-case, and integrating the tools into a coherent analysis pipeline is not a trivial endeavor, particularly for microbiologists with limited bioinformatics experience. To make bacterial RNA-seq data analysis more accessible, we developed a Simple Program for Automated reference-based bacterial RNA-seq Transcriptome Analysis (SPARTA). SPARTA is a reference-based bacterial RNA-seq analysis workflow application for single-end Illumina reads. SPARTA is turnkey software that simplifies the process of analyzing RNA-seq data sets, making bacterial RNA-seq analysis a routine process that can be undertaken on a personal computer or in the classroom. The easy-to-install, complete workflow processes whole transcriptome shotgun sequencing data files by trimming reads and removing adapters, mapping reads to a reference, counting gene features, calculating differential gene expression, and, importantly, checking for potential batch effects within the data set. SPARTA outputs quality analysis reports, gene feature counts and differential gene expression tables and scatterplots. SPARTA provides an easy-to-use bacterial RNA-seq transcriptional profiling workflow to identify differentially expressed genes between experimental conditions. This software will enable microbiologists with limited bioinformatics experience to analyze their data and integrate next generation sequencing (NGS) technologies into the classroom. The SPARTA software and tutorial are available at sparta.readthedocs.org.

Reference Readiness for AV Questions.

ERIC Educational Resources Information Center

Drolet, Leon L., Jr.

1981-01-01

Reviews 50 reference tools which librarians can use to answer almost any audiovisual question including queries on trivia, equipment selection, biographical information, and motion picture ratings. (LLS)

Spreadsheet-based engine data analysis tool - user's guide.

DOT National Transportation Integrated Search

2016-07-01

This record refers to both the spreadsheet tool - Fleet Equipment Performance Measurement Preventive Maintenance Model: Spreadsheet-Based Engine Data Analysis Tool, http://ntl.bts.gov/lib/60000/60000/60007/0-6626-P1_Final.xlsm - and its accompanying ...

Stage 2 tool user’s manual.

DOT National Transportation Integrated Search

2017-08-01

The purpose of the Permitted Overweight Truck Corridor Analysis Tool (referred to in this document as the Stage 2 Tool) is to evaluate existing or to create new proposed overweight (OW) truck corridors to estimate the permitted OW truck, pavement, br...

Diamagnetic Anisotropy: Two Iron Complexes as Laboratory Examples

ERIC Educational Resources Information Center

Fernandez, Ignacio; Sanchez, Jorge Fernando Fernandez

2010-01-01

There are relatively few experiments describing the NMR properties of bis(amine) iron(II) phthalocyanine complexes. Several features make this experiment attractive: First, it nicely illustrates the diamagnetic anisotropy phenomena, providing both students and teachers an opportunity to gain insight into aspects such as phase correction and…

Survey of Biochemical Separation Techniques

ERIC Educational Resources Information Center

Nilsson, Melanie R.

2007-01-01

A simple laboratory exercise is illustrated that exposes students to wide range of separation techniques in one laboratory program and provides a nice complement to a project-oriented program. Students have learned the basic principles of syringe filtration, centricon, dialysis, gel filtration and solid-phase extraction methodologies and have got…

Hey! A Louse Bit Me!

MedlinePlus

... Staying Safe Videos for Educators Search English Español Hey! A Louse Bit Me! KidsHealth / For Kids / Hey! A Louse Bit Me! Print en español ¡Ay! ¡ ... topic for: Kids Lice Aren't So Nice Hey! A Gnat Bit Me! Hey! A Flea Bit ...

78 FR 51803 - Culturally Significant Objects Imported for Exhibition Determinations: “Nice: Luc Tuymans”

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-21

.... 2681, et seq.; 22 U.S.C. 6501 note, et seq.), Delegation of Authority No. 234 of October 1, 1999.... Department of State, SA-5, L/PD, Fifth Floor (Suite 5H03), Washington, DC 20522-0505. Dated: August 14, 2013...

The Analysis, Numerical Simulation, and Diagnosis of Extratropical Weather Systems

DTIC Science & Technology

2000-09-30

MRY) and I developed a collaboration with the NRL/SSMIS Lower-Atmospheric Sounding Capability program; Gene Poe (NRL, Team Leader). The effort is...Geophysical Society Annual Meeting (Nice, Fance ; April 2000), the Extratropical Cyclone Workshop (Monterey, CA; Sept. 2000), and in seminars at NCAR

The TURis System for Transurethral Resection of the Prostate: A NICE Medical Technology Guidance.

PubMed

Cleves, Andrew; Dimmock, Paul; Hewitt, Neil; Carolan-Rees, Grace

2016-06-01

The transurethral resection in saline (TURis) system was notified by the company Olympus Medical to the National Institute of Health and Care Excellence's (NICE's) Medical Technologies Evaluation Programme. Following selection for medical technologies guidance, the company developed a submission of clinical and economic evidence for evaluation. TURis is a bipolar surgical system for treating men with lower urinary tract symptoms due to benign prostatic enlargement. The comparator is any monopolar transurethral resection of the prostate (mTURP) system. Cedar, a collaboration between Cardiff and Vale University Health Board, Cardiff University and Swansea University in the UK, acted as an External Assessment Centre (EAC) for NICE to independently critique the company's submission of evidence. Eight randomised trials provided evidence for TURis, demonstrating efficacy equivalent to that of mTURP for improvement of symptoms. The company presented meta-analyses of key outcome measures, and the EAC made methodological modifications in response to the heterogeneity of the trial data. The EAC analysis found that TURis substantially reduced the relative risks of transurethral resection syndrome (relative risk 0.18 [95 % confidence interval 0.05-0.62]) and blood transfusion (relative risk 0.35 [95 % confidence interval 0.19-0.65]). The company provided a de novo economic model comparing TURis with mTURP. The EAC critiqued the model methodology and made modifications. This found TURis to be cost saving at £70.55 per case for existing Olympus customers and cost incurring at £19.80 per case for non-Olympus customers. When an additional scenario based on the only available data on readmission (due to any cause) from a single trial was modelled, the estimated cost saving per case was £375.02 for existing users of Olympus electrosurgery equipment and £284.66 per case when new Olympus equipment would need to be purchased. Meta-analysis of eight randomised trials showed that TURis is associated with a statistically significantly reduced risk of transurethral resection syndrome and a reduced need for blood transfusion-two factors that may drive cost saving for the National Health Service. The clinical data are equivocal as to whether TURis shortens the hospital stay. Limited data from a single study suggest that TURis may reduce the rate of readmission after surgery. The NICE guidance supports adoption of the TURis technology for performing transurethral resection of the prostate in men with lower urinary tract symptoms due to benign prostatic enlargement.

Statistical analysis of the extreme values of dynamic sea level by spatial interpolation for a beach of the Mediterranean French coast

NASA Astrophysics Data System (ADS)

Kergadallan, X.; Metzler, N., Sr.

2016-12-01

The knowledge of sea levels along the coastline is of the utmost importance for characterization of flood risks in coastal areas, with a particular interest devoted to extreme values because they may induce the most dramatic consequences.The Cerema is a new French public body in support of national and local authorities in the field of sustainable development. At the request of French authorities, the Cerema has studied with a statistical approach the extreme values of the dynamic sea levels for one beach of the Mediterranean coast in Southern France.The beach is located at Saint-Aygulf, between Toulon and Nice. This site is critical because it's a tourist place with some buildings closed to the sea.The dynamic sea level studied includes a predictive part, the tidal level with about 40 cm of tidal range, and a non predictive part due to meteorological effect (difference of atmospheric pressures, wind effect) and breaking wave (wave run-up).There is no data of sea level measurement or numerical simulation at Saint-Aygulf. The development of a model to compute numerical simulations is out of the scope of this study.The closest tide gauges are located at more 50 km from Saint-Aygulf, in Toulon and Nice, with more than 15 years of observations.The originality of this work is to transform data from Toulon and Nice, so that the estimations of the dynamic sea level with these transformed data are representative of Saint-Aygulf. The final result is a weighted mean of both estimations (weight inversely proportional of the distance).The wave run-up is computed with the Stockdon et al. [2006] formula. Wave data come from ANEMOC2 data base (hindcast simulations from Cerema and EDF R&D). The dependence between offshore sea-states and tide gauge measurement is modelled by a Gumbel copula. Data transformation of Toulon and Nice takes into account the specific conditions of wave climate at Saint-Aygulf (exposure and energy loss during the propagation).As specified by the theory, the dependence model (Gumbel copula) is defined if and only if values of wave and still water level (tide-gauge record) are simultaneously extreme. It's why we introduce a low and a high limit in order to border the final result.At the end we discuss about the limits of the method and we give some ideas to improve it.

Trastuzumab Emtansine for Treating HER2-Positive, Unresectable, Locally Advanced or Metastatic Breast Cancer After Treatment with Trastuzumab and a Taxane: An Evidence Review Group Perspective of a NICE Single Technology Appraisal.

PubMed

Squires, Hazel; Stevenson, Matt; Simpson, Emma; Harvey, Rebecca; Stevens, John

2016-07-01

The National Institute for Health and Care Excellence (NICE) invited the manufacturer of trastuzumab emtansine (T-DM1) (Kadcyla(®); Roche) to submit evidence of its clinical and cost-effectiveness for treating human epidermal growth factor receptor 2 (HER2)-positive, unresectable, locally advanced or metastatic breast cancer after treatment with trastuzumab and a taxane. The School of Health and Related Research Technology Appraisal Group (ScHARR-TAG) at the University of Sheffield were the independent Evidence Review Group (ERG) who produced a critical review of the company's submission to NICE. The ERG also independently searched for relevant evidence and modified the submitted decision analytic model to produce a revised estimate of cost-effectiveness and examine the impact of altering some of the key assumptions. The clinical effectiveness data were taken from two randomised controlled trials that reported a significant advantage in progression-free survival (PFS) for T-DM1 over lapatinib in combination with capecitabine (EMILIA trial), and over the treatment of physician's choice (TH3RESA trial). A network meta-analysis suggested T-DM1 was the best treatment in terms of both overall survival and PFS compared with lapatinib in combination with capecitabine; trastuzumab in combination with capecitabine; and capecitabine monotherapy. Adverse event (AE) data were taken from a pooled analysis of additional trials of T-DM1 as a single agent. The most common grade 3 or greater AEs for T-DM1 were thrombocytopenia and hepatotoxicity. Following the clarification process, the manufacturer reported a deterministic incremental cost-effectiveness ratio (ICER) for T-DM1 compared with lapatinib in combination with capecitabine of £167,236, the latter of which was estimated to have an ICER of £49,798 compared with capecitabine monotherapy. The ERG produced similar values of £166,429 and £50,620 respectively. All other comparators were dominated. During the appraisal, the manufacturer offered an analysis of a patient access scheme (PAS), which suggested that T-DM1 had a 0 % probability of being cost-effective at an ICER of £30,000 per QALY gained. The NICE Appraisal Committee concluded that while the clinical effectiveness of T-DM1 had been proven, it was not likely to represent a cost-effective use of National Health Service resources and therefore its use could not be recommended.

Nouns referring to tools and natural objects differentially modulate the motor system.

PubMed

Gough, Patricia M; Riggio, Lucia; Chersi, Fabian; Sato, Marc; Fogassi, Leonardo; Buccino, Giovanni

2012-01-01

While increasing evidence points to a critical role for the motor system in language processing, the focus of previous work has been on the linguistic category of verbs. Here we tested whether nouns are effective in modulating the motor system and further whether different kinds of nouns - those referring to artifacts or natural items, and items that are graspable or ungraspable - would differentially modulate the system. A Transcranial Magnetic Stimulation (TMS) study was carried out to compare modulation of the motor system when subjects read nouns referring to objects which are Artificial or Natural and which are Graspable or Ungraspable. TMS was applied to the primary motor cortex representation of the first dorsal interosseous (FDI) muscle of the right hand at 150 ms after noun presentation. Analyses of Motor Evoked Potentials (MEPs) revealed that across the duration of the task, nouns referring to graspable artifacts (tools) were associated with significantly greater MEP areas. Analyses of the initial presentation of items revealed a main effect of graspability. The findings are in line with an embodied view of nouns, with MEP measures modulated according to whether nouns referred to natural objects or artifacts (tools), confirming tools as a special class of items in motor terms. Additionally our data support a difference for graspable versus non graspable objects, an effect which for natural objects is restricted to initial presentation of items. Copyright © 2011 Elsevier Ltd. All rights reserved.

Capturing Fine Details Involving Low-Cost Sensors -a Comparative Study

NASA Astrophysics Data System (ADS)

Rehany, N.; Barsi, A.; Lovas, T.

2017-11-01

Capturing the fine details on the surface of small objects is a real challenge to many conventional surveying methods. Our paper discusses the investigation of several data acquisition technologies, such as arm scanner, structured light scanner, terrestrial laser scanner, object line-scanner, DSLR camera, and mobile phone camera. A palm-sized embossed sculpture reproduction was used as a test object; it has been surveyed by all the instruments. The result point clouds and meshes were then analyzed, using the arm scanner's dataset as reference. In addition to general statistics, the results have been evaluated based both on 3D deviation maps and 2D deviation graphs; the latter allows even more accurate analysis of the characteristics of the different data acquisition approaches. Additionally, own-developed local minimum maps were created that nicely visualize the potential level of detail provided by the applied technologies. Besides the usual geometric assessment, the paper discusses the different resource needs (cost, time, expertise) of the discussed techniques. Our results proved that even amateur sensors operated by amateur users can provide high quality datasets that enable engineering analysis. Based on the results, the paper contains an outlook to potential future investigations in this field.

Children's sensitivity to ulterior motives when evaluating prosocial behavior.

PubMed

Heyman, Gail; Barner, David; Heumann, Jennifer; Schenck, Lauren

2014-01-01

Reasoning about ulterior motives was investigated among children ages 6-10 years (total N = 119). In each of two studies, participants were told about children who offered gifts to peers who needed help. Each giver chose to present a gift in either a public setting, which is consistent with having an ulterior motive to enhance one's reputation, or in a private setting, which is not consistent with having an ulterior motive. In each study, the 6- to 7-year olds showed no evidence of understanding that the public givers might have ulterior motives, but the 8- to 10-year olds rated the private givers more favorably. In , the older children were more likely than the younger children to refer to impression management when explaining their judgments of the givers. The younger children who mentioned impression management did so to justify a preference for public givers (e.g., by explaining that public givers are nicer because more of their peers will know that they are nice). Results from suggest that developmental change in children's reasoning about intentions and social outcomes contributes to their understanding of ulterior motives. Copyright © 2013 Cognitive Science Society, Inc.

Operational test results of the passive final approach spacing tool

DOT National Transportation Integrated Search

1997-06-01

A prototype decision support tool for terminal area air traffic controllers, : referred to as the Final Approach Spacing Tool (FAST), was recently evaluated in : operation with live air traffic at the Dallas/Fort Worth, Texas Airport, : Controllers u...

Macro Analysis Tool - MAT

EPA Science Inventory

This product is an easy-to-use Excel-based macro analysis tool (MAT) for performing comparisons of air sensor data with reference data and interpreting the results. This tool tackles one of the biggest hurdles in citizen-led community air monitoring projects – working with ...

Diagnosis and treatment of ectopic pregnancy.

PubMed

Epee-Bekima, Mathias; Overton, Caroline

2013-03-01

The most common site of localisation of an ectopic pregnancy is the fallopian tube. Rarely an ectopic pregnancy can be found in the ovary, a caesarean section scar, the abdomen or the cervix. Risk factors are previous ectopic pregnancy, PID, endometriosis, previous pelvic surgery, the presence of a coil and infertility. However, a third of women with an ectopic pregnancy have no known risk factors. NICE recommends a low threshold for offering a pregnancy test to women of childbearing age when they attend the surgery. Symptoms and signs appear when the tube starts to tear. When the tube ruptures, the woman will quickly become unwell and haemodynamically unstable because of rapid intra-abdominal blood loss. The most common symptoms of ectopic pregnancy are pelvic or abdominal pain, amenorrhoea, missed period or abnormal period and vaginal bleeding. A positive diagnosis of a urinary tract infection or gastroenteritis does not exclude an ectopic pregnancy. Signs of suspected ectopic pregnancy include pelvic, abdominal, adnexal or cervical motion tenderness, rebound tenderness and abdominal distension. Women who are haemodynamically unstable, or in whom there is significant concern about the degree of pain or bleeding, should be referred directly to A&E, irrespective of the result of the pregnancy test. Stable patients with bleeding who have pain or a pregnancy of six weeks gestation or more or a pregnancy of uncertain gestation should be referred immediately to an early pregnancy assessment (EPA) service, or out-of-hours gynaecology service if the EPA service is not available. Diagnosis is confirmed by transvaginal ultrasound scan to identify the location of the pregnancy.

Applying rapid 'de-facto' HTA in resource-limited settings: experience from Romania.

PubMed

Lopert, Ruth; Ruiz, Francis; Chalkidou, Kalipso

2013-10-01

In attempting to constrain healthcare expenditure growth, health technology assessment (HTA) can enable policy-makers to look beyond budget impact and facilitate more rational decision-making. However lack of technical capacity and poor governance can limit use in some countries. Undertaking de facto HTA by adapting decisions taken in countries with established processes is a method that may be applied while building domestic HTA capacity. We explored the potential for applying this approach in Romania. As part of a review of the basic health benefits available to insured Romanians we examined the listing process and content of the Romanian drug reimbursement formulary. We assessed value for money indirectly by drawing on appraisals by UK's NICE, and for products considered cost effective in the UK, adjusting prices by the ratio of Romanian per capita GDP to UK per capita GDP. We found more than 30 of the top 50 medicines on the Romanian formulary unlikely to be cost-effective, suggesting that existing external reference pricing mechanisms may not be delivering good value for money. While not taking into account local costs or treatment patterns, absent local considerations of value for money, this method offers a guide for both drug selection and pricing. Until robust local HTA processes are established this approach could support further analysis of existing prices and pricing mechanisms. Applied more generally, it is arguably preferable to external reference pricing, product delisting or arbitrary price cuts, and may support the future development of more rigorous, evidence-based decision-making. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Browsing the Virtual Stacks: Making Electronic Reference Tools More Visible to Users

ERIC Educational Resources Information Center

Peterson, Elizabeth

2008-01-01

Electronic reference resources are expanding traditional print reference collections far beyond the walls of the library building. While the library literature has seen a debate rage about the various merits and pitfalls of electronic reference sources, no one disputes they are here to stay. As more of the library content becomes available through…

The Reference Statistic Shuffle: Finding a Tool That Not Only Adds Stuff up but Improves Results

ERIC Educational Resources Information Center

Northam, Sarah H.

2012-01-01

Reference librarians are constantly balancing their reference duties against other duties, for example, collection development and departmental liaison. The author works as a reference librarian at Texas A&M University-Commerce Libraries in Commerce, Texas. The university has approximately 11,000 students, a large number of whom are…

EFL Students' Perceptions of Corpus-Tools as Writing References

ERIC Educational Resources Information Center

Lai, Shu-Li

2015-01-01

A number of studies have suggested the potentials of corpus tools in vocabulary learning. However, there are still some concerns. Corpus tools might be too complicated to use; example sentences retrieved from corpus tools might be too difficult to understand; processing large number of sample sentences could be challenging and time-consuming;…

Writing a Dissertation: Tools for Success

ERIC Educational Resources Information Center

Montgomery, Anne E.

2017-01-01

Plenty of material exists to help with the writing process, but sometimes the writer needs tools to help organize the process. This paper reviews some of the tools needed to organize articles and other references. A discussion of keywords, note taking, and document organization provides examples on the choice use of technology tools to support the…

LinkEHR-Ed: a multi-reference model archetype editor based on formal semantics.

PubMed

Maldonado, José A; Moner, David; Boscá, Diego; Fernández-Breis, Jesualdo T; Angulo, Carlos; Robles, Montserrat

2009-08-01

To develop a powerful archetype editing framework capable of handling multiple reference models and oriented towards the semantic description and standardization of legacy data. The main prerequisite for implementing tools providing enhanced support for archetypes is the clear specification of archetype semantics. We propose a formalization of the definition section of archetypes based on types over tree-structured data. It covers the specialization of archetypes, the relationship between reference models and archetypes and conformance of data instances to archetypes. LinkEHR-Ed, a visual archetype editor based on the former formalization with advanced processing capabilities that supports multiple reference models, the editing and semantic validation of archetypes, the specification of mappings to data sources, and the automatic generation of data transformation scripts, is developed. LinkEHR-Ed is a useful tool for building, processing and validating archetypes based on any reference model.

CD-ROM Stress.

ERIC Educational Resources Information Center

Bunge, Charles A.

1991-01-01

Discussion of stress in library reference departments focuses on stress caused by CD-ROM reference tools. Topics discussed include work overload; nonreference duties; patron attitudes and behavior; staff attitudes; the need for proper staff training; and the need for library administrators to be sensitive to reference staff needs. (LRW)

Dual Analyses Examining Proving Process: Grounded Theory and Knowledge Analysis

ERIC Educational Resources Information Center

Adiredja, Aditya P.; Smith Karunakaran, Shiv

2016-01-01

This report presents dual analyses of an undergraduate student, Cassie, whose work provides nice contrasts between Grounded Theory (GT) analysis and Knowledge Analysis (KA). The analyses highlight particular methodological differences, such as grain size of findings, positioning of novices and more general implications about expert-novice studies.…

Here's Another Nice Mess: Using Video in Reflective Dialogue Research Method

ERIC Educational Resources Information Center

Hepplewhite, K.

2014-01-01

This account discusses "reflective dialogues", a process utilising video to re-examine in-action decision-making with theatre practitioners who operate in community contexts. The reflexive discussions combine with observation, text and digital documentation to offer a sometimes "messy" (from Schön 1987) dynamic to the research…

International Monetary Policy Coordination in a New Keynesian Model with NICE Features

ERIC Educational Resources Information Center

Poutineau, Jean-Christophe; Vermandel, Gauthier

2018-01-01

The authors provide a static two-country new Keynesian model to teach two related questions in international macroeconomics: the international transmission of unilateral monetary policy decisions and the gains coming from the coordination monetary rules. They concentrate on "normal times" and use a thoroughly graphical approach to…

Speaking Their Language

ERIC Educational Resources Information Center

Butler, Kevin

2009-01-01

Tapping into technology for foreign language learning is important, given that such learning is seen as vital to the nation's economic and cultural well-being. The development of technology has dovetailed nicely with a new paradigm of foreign language education, says Marty Abbott, director of education for the American Council on the Teaching of…

What Leads to Sex? Adolescent Preferred Partners and Reasons for Sex.

ERIC Educational Resources Information Center

Eyre, Stephen L.; Millstein, Susan G.

1999-01-01

Examined perceived antecedents of sex and preferred partner qualities in African-American and White late adolescents. Found that African Americans mentioned "nice body" as criterion for partner attractiveness; Whites did not. Males identified sexual arousal as a reason for sex; females did not. African-American males associated sexual…

Your Best Summer Ever

ERIC Educational Resources Information Center

Cleaver, Samantha

2012-01-01

"It must be nice to have summers off." Only other teachers know just how short summer is, with much of August devoted to planning for the new school year. This article offers 17 fresh ideas for exploring, making money, and preparing for next year. Plus, a reading list that hits all the marks!

Making Molecular Borromean Rings

ERIC Educational Resources Information Center

Pentecost, Cari D.; Tangchaivang, Nichol; Cantrill, Stuart J.; Chichak, Kelly S.; Peters, Andrea J.; Stoddart, Fraser J.

2007-01-01

A procedure that requires seven 4-hour blocks of time to allow undergraduate students to prepare the molecular Borromean rings (BRs) on a gram-scale in 90% yield is described. The experiment would serve as a nice capstone project to culminate any comprehensive organic laboratory course and expose students to fundamental concepts, symmetry point…

Sharing Command of the Co-Teaching Ship: How to Play Nicely with Others

ERIC Educational Resources Information Center

Sims, Emily

2008-01-01

High school teacher Emily Sims shares her experiences co-teaching inclusive classes as a first-year teacher. She imparts practical advice for successful co-teaching relationships between the content teacher and the special education teacher, from which both students and teachers can thrive. (Contains 1 figure.)

FlexMod Scheduling Redux

ERIC Educational Resources Information Center

Murray, Shannon

2008-01-01

Flexible modular scheduling (flex mod)--a schedule philosophy and system that has been in place at Wausau West High School in Wausau, Wisconsin, for the last 35 years and aligns nicely with current research on student learning--is getting more and more attention from high school administrators across the country. Flexible modular scheduling was…

Carbon Dioxide Fountain

ERIC Educational Resources Information Center

Kang, Seong-Joo; Ryu, Eun-Hee

2007-01-01

This article presents the development of a carbon dioxide fountain. The advantages of the carbon dioxide fountain are that it is odorless and uses consumer chemicals. This experiment also is a nice visual experiment that allows students to see evidence of a gaseous reagent being consumed when a pressure sensor is available. (Contains 3 figures.)…

Nice Voices Are a Dime a Dozen.

ERIC Educational Resources Information Center

Hollahan, Patricia Welting

1979-01-01

To succeed in today's competitive opera world, a singer needs--in addition to a good voice--personality, acting ability, good appearance, musicianship, language facility, versatility, and experience. Especially important are sight reading skills, care of the voice, and the ability to express emotion. Part of a theme issue on opera. (Author/SJL)

Statistical Analysis Experiment for Freshman Chemistry Lab.

ERIC Educational Resources Information Center

Salzsieder, John C.

1995-01-01

Describes a laboratory experiment dissolving zinc from galvanized nails in which data can be gathered very quickly for statistical analysis. The data have sufficient significant figures and the experiment yields a nice distribution of random errors. Freshman students can gain an appreciation of the relationships between random error, number of…

The EMC Informationist Chair: 2009 A Year in Review

DTIC Science & Technology

2010-01-31

the right level or at the right volume: Is the information necessary or nice to have? Is it value added? Current political ‘ cloak & dagger ’ (an...their efforts to systematically attack these challenges and continue to work within our own government channels to simplify our processes to reduce

Let's Get Fiscal

ERIC Educational Resources Information Center

Barbour, Andrew

2013-01-01

With the US economy continuing its weak recovery, it's tempting to think that IT budgets in higher education might begin to rebound especially in light of the increased focus on online learning. Nice thought, but no. Education costs are rising even faster than those for healthcare, and the public outcry over the cost of higher education…

Teaching Diffraction with Hands-On Optical Spectrometry

ERIC Educational Resources Information Center

Fischer, Robert

2012-01-01

Although the observation of optical spectra is common practice in physics classes, students are usually limited to a passive, qualitative observation of nice colours. This paper discusses a diffraction-based spectrometer that allows students to take quantitative measurements of spectral bands. Students can build it within minutes from generic…

Personal Competence of Institutionalized Adult Males with or without Down Syndrome.

ERIC Educational Resources Information Center

Greenspan, Stephen; Delaney, Karen

1983-01-01

The Personal Competence Profile was administered to 30 male adults with Down syndrome and 30 without Down syndrome matched on age, IQ, and years of instituionalization. Down syndrome subjects rated higher on attention, calmness, and niceness but lower on sensation, language, and boldness. (Author/CL)

Children Show Heightened Memory for Threatening Social Actions

ERIC Educational Resources Information Center

Baltazar, Nicole C.; Shutts, Kristin; Kinzler, Katherine D.

2012-01-01

Three experiments investigated whether a negativity bias in social perception extends to preschool-aged children's memory for the details of others' social actions and experiences. After learning about individuals who committed nice or mean social actions, children in Experiment 1 were more accurate at remembering who was mean compared with who…

Using a Simple Optical Rangefinder To Teach Similar Triangles.

ERIC Educational Resources Information Center

Cuicchi, Paul M.; Hutchison, Paul S.

2003-01-01

Describes how the concept of similar triangles was taught using an optical method of estimating large distances as a corresponding activity. Includes the derivation of a formula to calculate one source of measurement error and is a nice exercise in the use of the properties of similar triangles. (Author/NB)

Some Nice Relations between Right-Angled Triangles and the Golden Section

ERIC Educational Resources Information Center

Scimone, Aldo

2011-01-01

The international debate about experimental approaches to the teaching and learning mathematics is very current. While number theory lends itself naturally to such approaches, elementary geometry can also provide interesting starting points for creative work in class. This article shows how simple considerations about right triangles and the…

Nature by Default in Early Childhood Education for Sustainability

ERIC Educational Resources Information Center

Elliott, Sue; Young, Tracy

2016-01-01

This essay critiques the relevance of historical antecedents about children's play in nature and how these historical and political mechanisms create cultural rovoked by Taylor's (2013) exploration of the pervasive influence of romanticised images of innocent children in nature and our own experiences of never-ending "nice" stories about…

Creation of an Open Framework for Point-of-Care Computer-Assisted Reporting and Decision Support Tools for Radiologists.

PubMed

Alkasab, Tarik K; Bizzo, Bernardo C; Berland, Lincoln L; Nair, Sujith; Pandharipande, Pari V; Harvey, H Benjamin

2017-09-01

Decreasing unnecessary variation in radiology reporting and producing guideline-concordant reports is fundamental to radiology's success in value-based payment models and good for patient care. In this article, we present an open authoring system for point-of-care clinical decision support tools integrated into the radiologist reporting environment referred to as the computer-assisted reporting and decision support (CAR/DS) framework. The CAR/DS authoring system, described herein, includes: (1) a definition format for representing radiology clinical guidelines as structured, machine-readable Extensible Markup Language documents and (2) a user-friendly reference implementation to test the fidelity of the created definition files with the clinical guideline. The proposed definition format and reference implementation will enable content creators to develop CAR/DS tools that voice recognition software (VRS) vendors can use to extend the commercial tools currently in use. In making the definition format and reference implementation software freely available, we hope to empower individual radiologists, expert groups such as the ACR, and VRS vendors to develop a robust ecosystem of CAR/DS tools that can further improve the quality and efficiency of the patient care that our field provides. We hope that this initial effort can serve as the basis for a community-owned open standard for guideline definition that the imaging informatics and VRS vendor communities will embrace and strengthen. To this end, the ACR Assist™ initiative is intended to make the College's clinical content, including the Incidental Findings Committee White Papers, available for decision support tool creation based upon the herein described CAR/DS framework. Copyright © 2017 American College of Radiology. Published by Elsevier Inc. All rights reserved.

Bivalirudin for the treatment of ST-segment elevation myocardial infarction: a NICE single technology appraisal.

PubMed

Simpson, E L; Fitzgerald, P; Evans, P; Tappenden, P; Kalita, N; Reckless, J P D; Bakhai, A

2013-04-01

The National Institute for Health and Clinical Excellence (NICE) invited the manufacturer (The Medicines Company) of bivalirudin to submit evidence for its clinical and cost effectiveness within its licensed indication for the treatment of adults with ST-segment elevation myocardial infarction (STEMI) intended for primary percutaneous coronary intervention (PPCI), as part of NICE's single technology appraisal (STA) process. The School of Health and Related Research (ScHARR) at the University of Sheffield was commissioned to act as the Evidence Review Group (ERG), which produced a review of the evidence within the manufacturer's submission to NICE. This article describes the manufacturer's submission, the ERG review and NICE's subsequent decisions. The main evidence was derived from one randomized controlled trial (RCT) of STEMI patients intended for PPCI, comparing bivalirudin with unfractionated heparin plus glycoprotein IIb/IIIa inhibitors (GPIs). Bivalirudin was associated with a significant reduction in cardiac mortality at 30 days (p = 0.03) and at 1-year follow-up (p = 0.005), and a significant reduction in major bleeding at 30 days (p < 0.001) and 1 year (p < 0.0001), compared with heparin plus GPI. Stent thrombosis up to 24 hours following PPCI was significantly (p < 0.001) more common with bivalirudin. However, there was no significant treatment effect for stent thrombosis from 1 to 30 days (p = 0.28), or at 1-year follow-up (p = 0.53). There were no significant treatment group differences at 30 days and at 1 year in stroke (p = 0.68 and p = 0.99, respectively), in myocardial infarction [MI] (p = 0.90 and p = 0.22, respectively), or in the need for the revascularization of the target vessel for ischaemia (p = 0.18 and p = 0.12, respectively). There were two decision-analytic models: the base-case scenario used 1-year follow-up data from the RCT; and a sensitivity analysis used 3-year follow-up data. Resource use was primarily drawn from this RCT. Health-related quality-of-life (HR-QOL) estimates were drawn from a UK cohort study. Both models evaluated the incremental costs and outcomes of bivalirudin compared with heparin plus GPI for patients with STEMI intended for PPCI. The analysis adopted a UK NHS perspective over a lifetime horizon. Unit costs were based on year 2009-2010 prices. The model adopted a decision-tree structure to reflect initial events for the initial period (stroke, repeat MI, minor/major bleeding events, repeat revascularization and death) and a two-state Markov component to simulate longer-term survival. The economic analysis suggested that bivalirudin is expected to dominate the heparin plus GPI strategy. This finding was consistent across the probabilistic sensitivity analysis and the vast majority of deterministic sensitivity analyses undertaken. Three exceptions to this finding were observed for the following sensitivity analyses: (1) the exclusive use of eptifibatide as the GPI (incremental cost-effectiveness ratio [ICER] = £1,764); (2) the combination of 100 % eptifibatide use, 100 % radial arterial access and no differential length between strategies for initial hospital stay (ICER = £4,106); and (3) a longer length of ward stay (increase of 0.33 days) for the initial hospitalization (ICER = £415). The Appraisal Committee (AC) gave a positive recommendation for bivalirudin for the treatment of adults with STEMI undergoing PPCI.

Dabigatran for the prevention of stroke and systemic embolism in atrial fibrillation: A NICE single technology appraisal.

PubMed

Faria, Rita; Spackman, Eldon; Burch, Jane; Corbacho, Belen; Todd, Derick; Pepper, Chris; Woolacott, Nerys; Palmer, Stephen

2013-07-01

The National Institute for Health and Clinical Excellence (NICE) invited the manufacturer of dabigatran etexilate (Boehringer Ingelheim Ltd, UK) to submit evidence for the clinical and cost-effectiveness of this drug for the prevention of stroke and systemic embolism in patients with non-valvular atrial fibrillation (AF) as part of the NICE single technology appraisal process. The Centre for Reviews and Dissemination and the Centre for Health Economics at the University of York were commissioned to act as the evidence review group (ERG). This article presents a summary of the manufacturer's submission, the ERG report and the subsequent development of NICE guidance for the use of dabigatran within the UK National Health Service. Dabigatran was granted marketing authorisation by the European Medicines Agency for a sequential dosing regimen (DBG sequential), in which patients under 80 years are treated with dabigatran 150 mg twice daily (DBG150) and patients 80 years and over are given dabigatran 110 mg twice daily (DBG110). NICE decisions are bound by the marketing authorisation; therefore, the decision problem faced by the committee was whether the DBG sequential regimen was effective and cost-effective compared with warfarin or aspirin for patients with non-valvular AF and one or more risk factors. The RE-LY trial, a large multi-centre non-inferiority randomised clinical trial, was the primary source of clinical evidence. DBG150 was shown to be non-inferior, and subsequently superior to warfarin, for the primary outcome of all stroke/systemic embolism. DBG110 was found to be non-inferior to warfarin. Results were presented for a post hoc subgroup analysis for patients under and over 80 years of age, where DBG110 showed a statistically significant reduction of haemorrhagic stroke and intracranial haemorrhage in comparison to warfarin in patients over 80 years of age. This post hoc subgroup analysis by age was the basis for the licensed DBG sequential regimen. The economic evaluation compared the costs and outcomes of DBG110, DBG150 and DBG sequential against warfarin, aspirin, and aspirin plus clopidogrel. Across the three dosing regimens, dabigatran was associated with greater costs and better health outcomes than warfarin; however, DBG150 offered the most benefits and dominated DBG110 and DBG sequential (i.e. less costly and more effective). The cost-effectiveness of DBG150 was less favourable for patients well controlled on warfarin. In the first appraisal meeting, the committee issued a 'minded no' decision until additional analyses on the licensed DBG sequential regimen were presented by the manufacturer. These additional analyses indicated that the incremental cost-effectiveness ratio (ICER) of the DBG sequential regimen compared with warfarin ranged from £8,388 to £18,987 per quality-adjusted life year (QALY) gained depending on the level of monitoring costs assumed for warfarin. Patients on warfarin would need to be within therapeutic range 83-85 % of the time for the ICER to exceed £30,000 per additional QALY. Following consideration of the additional evidence and the responses from a large number of consultees and commentators, the committee recommended dabigatran as DBG sequential as an option for the prevention of stroke and systemic embolism in people with non-valvular AF with one or more risk factors for ischaemic stroke.

Talimogene Laherparepvec for Treating Metastatic Melanoma: An Evidence Review Group Perspective of a NICE Single Technology Appraisal.

PubMed

Fleeman, Nigel; Bagust, Adrian; Boland, Angela; Beale, Sophie; Richardson, Marty; Krishan, Ashma; Stainthorpe, Angela; Abdulla, Ahmed; Kotas, Eleanor; Banks, Lindsay; Payne, Miranda

2017-10-01

The National Institute for Health and Care Excellence (NICE) invited the manufacturer (Amgen) of talimogene laherparepvec (T-VEC) to submit clinical and cost-effectiveness evidence for previously untreated advanced (unresectable or metastatic) melanoma as part of the Institute's Single Technology Appraisal process. The Liverpool Reviews and Implementation Group (LRiG) at the University of Liverpool was commissioned to act as the Evidence Review Group (ERG). This article presents a summary of the company's submission of T-VEC, the ERG review and the resulting NICE guidance (TA410), issued in September 2016. T-VEC is an oncolytic virus therapy granted a marketing authorisation by the European Commission for the treatment of adults with unresectable melanoma that is regionally or distantly metastatic (stage IIIB, IIIC and IVM1a) with no bone, brain, lung or other visceral disease. Clinical evidence for T-VEC versus granulocyte-macrophage colony-stimulating factor (GM-CSF) was derived from the multinational, open-label randomised controlled OPTiM trial [Oncovex (GM-CSF) Pivotal Trial in Melanoma]. In accordance with T-VEC's marketing authorisation, the company's submission focused primarily on 249 patients with stage IIIB to stage IV/M1a disease who constituted 57% of the overall trial population (T-VEC, n = 163 and GM-CSF, n = 86). Results from analyses of durable response rate, objective response rate, time to treatment failure and overall survival all showed marked and statistically significant improvements for patients treated with T-VEC compared with those treated with GM-CSF. However, GM-CSF is not used to treat melanoma in clinical practice. It was not possible to compare treatment with T-VEC with an appropriate comparator using conventionally accepted methods due to the absence of comparative head-to-head data or trials with sufficient common comparators. Therefore, the company compared T-VEC with ipilimumab using what it described as modified Korn and two-step Korn methods. Results from these analyses suggested that treatment with T-VEC was at least as effective as treatment with ipilimumab. Using the discounted patient access scheme (PAS) price for T-VEC and list price for ipilimumab, the company reported incremental cost-effectiveness ratios (ICERs) per quality-adjusted life-year (QALY) gained. For the comparison of treatment with T-VEC versus ipilimumab, the ICER per QALY gained was -£16,367 using the modified Korn method and -£60,271 using the two-step Korn method. The NICE Appraisal Committee (AC) agreed with the ERG that the company's methods for estimating clinical effectiveness of T-VEC versus ipilimumab were flawed and therefore produced unreliable results for modelling progression in stage IIIB to stage IVM1a melanoma. The AC concluded that the clinical and cost effectiveness of treatment with T-VEC compared with ipilimumab is unknown in patients with stage IIIB to stage IV/M1a disease. However, the AC considered that T-VEC may be a reasonable option for treating patients who are unsuitable for treatment with systemically administered immunotherapies (such as ipilimumab). T-VEC was therefore recommended by NICE as a treatment option for adults with unresectable, regionally or distantly metastatic (stage IIIB to stage IVM1a) melanoma that has not spread to bone, brain, lung or other internal organs, only if treatment with systemically administered immunotherapies is not suitable and the company provides T-VEC at the agreed discounted PAS price.

Ipilimumab for Previously Untreated Unresectable Malignant Melanoma: A Critique of the Evidence.

PubMed

Giannopoulou, Christina; Sideris, Eleftherios; Wade, Ros; Moe-Byrne, Thirimon; Eastwood, Alison; McKenna, Claire

2015-12-01

The National Institute for Health and Care Excellence (NICE) invited the manufacturer of ipilimumab (Bristol-Myers Squibb Pharmaceuticals Limited) to submit clinical and cost-effectiveness evidence for previously untreated advanced (unresectable or metastatic) melanoma as part of the Institute's Single Technology Appraisal process. The Centre for Reviews and Dissemination and Centre for Health Economics at the University of York were commissioned to act as the independent Evidence Review Group (ERG). This article presents a summary of the manufacturer's submission of ipilimumab, the ERG review and the resulting NICE guidance TA319, issued in July 2014. Ipilimumab at a recommended dose of 3 mg/kg monotherapy was previously granted marketing authorisation by the European Medicines Agency in adult patients who had received prior therapy and was recommended by NICE in guidance TA268. In October 2013, the EMA approved the extension of this indication to previously untreated advanced melanoma patients. NICE decisions are bound by the marketing authorisation; therefore, the decision problem faced by the NICE Appraisal Committee was whether ipilimumab at a recommended dose of 3 mg/kg monotherapy was effective and cost effective compared with first-line standard of care involving dacarbazine (DTIC) and vemurafenib (for BRAF V600 mutation-positive patients). The CA184-024 trial was the primary source of clinical evidence for ipilimumab. However, this was based on a dose of 10 mg/kg with concomitant DTIC. The results over a 5-year period indicated that ipilimumab 10 mg/kg plus DTIC demonstrated a significant increase in median overall survival (OS) of 2.1 months compared with DTIC plus placebo (11.2 vs. 9.1 months). The BRIM-3 trial, which was an open-label randomised controlled trial (RCT) in BRAF V600 mutation-positive patients, was the primary source of evidence for an indirect comparison with vemurafenib. The results showed that vemurafenib increased median OS by 3.6 months compared with DTIC (13.2 vs. 9.6 months). The economic evaluation compared the costs and outcomes of ipilimumab by assuming that the 3 mg/kg dosing regimen was clinically equivalent in efficacy to an ipilimumab 10 mg/kg dosing regimen plus DTIC and by using a treatment sequencing approach that incorporated second-line active therapy and third-line best supportive care (BSC). In the first appraisal meeting, the committee recommended ipilimumab only in the context of research as part of a clinical study. This was primarily based on the lack of robust evidence to support the assumption of clinical equivalence between dosages and the absence of evidence available to inform the sequential use of treatments. Following the consultation, the manufacturer submitted additional analyses and evidence to support the cost effectiveness of ipilimumab at first line. The manufacturer's response was based on concerns relating to uncertainty surrounding the relative efficacy of ipilimumab 3 mg/kg monotherapy compared with DTIC and vemurafenib, comparability of the patient populations at first and second line, and the effects of concomitant DTIC. These additional analyses indicated that the incremental cost-effectiveness ratio (ICER) was £ 47,900 per quality-adjusted life-year (QALY) gained for ipilimumab compared with DTIC and £ 28,600 per QALY gained for ipilimumab compared with vemurafenib. Following consideration of the additional evidence and the responses from a large number of consultees and commentators, the committee recommended ipilimumab as an option for adults with previously untreated advanced melanoma.

Development of a PubMed Based Search Tool for Identifying Sex and Gender Specific Health Literature.

PubMed

Song, Michael M; Simonsen, Cheryl K; Wilson, Joanna D; Jenkins, Marjorie R

2016-02-01

An effective literature search strategy is critical to achieving the aims of Sex and Gender Specific Health (SGSH): to understand sex and gender differences through research and to effectively incorporate the new knowledge into the clinical decision making process to benefit both male and female patients. The goal of this project was to develop and validate an SGSH literature search tool that is readily and freely available to clinical researchers and practitioners. PubMed, a freely available search engine for the Medline database, was selected as the platform to build the SGSH literature search tool. Combinations of Medical Subject Heading terms, text words, and title words were evaluated for optimal specificity and sensitivity. The search tool was then validated against reference bases compiled for two disease states, diabetes and stroke. Key sex and gender terms and limits were bundled to create a search tool to facilitate PubMed SGSH literature searches. During validation, the search tool retrieved 50 of 94 (53.2%) stroke and 62 of 95 (65.3%) diabetes reference articles selected for validation. A general keyword search of stroke or diabetes combined with sex difference retrieved 33 of 94 (35.1%) stroke and 22 of 95 (23.2%) diabetes reference base articles, with lower sensitivity and specificity for SGSH content. The Texas Tech University Health Sciences Center SGSH PubMed Search Tool provides higher sensitivity and specificity to sex and gender specific health literature. The tool will facilitate research, clinical decision-making, and guideline development relevant to SGSH.

Development of a PubMed Based Search Tool for Identifying Sex and Gender Specific Health Literature

PubMed Central

Song, Michael M.; Simonsen, Cheryl K.; Wilson, Joanna D.

2016-01-01

Abstract Background: An effective literature search strategy is critical to achieving the aims of Sex and Gender Specific Health (SGSH): to understand sex and gender differences through research and to effectively incorporate the new knowledge into the clinical decision making process to benefit both male and female patients. The goal of this project was to develop and validate an SGSH literature search tool that is readily and freely available to clinical researchers and practitioners. Methods: PubMed, a freely available search engine for the Medline database, was selected as the platform to build the SGSH literature search tool. Combinations of Medical Subject Heading terms, text words, and title words were evaluated for optimal specificity and sensitivity. The search tool was then validated against reference bases compiled for two disease states, diabetes and stroke. Results: Key sex and gender terms and limits were bundled to create a search tool to facilitate PubMed SGSH literature searches. During validation, the search tool retrieved 50 of 94 (53.2%) stroke and 62 of 95 (65.3%) diabetes reference articles selected for validation. A general keyword search of stroke or diabetes combined with sex difference retrieved 33 of 94 (35.1%) stroke and 22 of 95 (23.2%) diabetes reference base articles, with lower sensitivity and specificity for SGSH content. Conclusions: The Texas Tech University Health Sciences Center SGSH PubMed Search Tool provides higher sensitivity and specificity to sex and gender specific health literature. The tool will facilitate research, clinical decision-making, and guideline development relevant to SGSH. PMID:26555409

The PDA as a reference tool: libraries' role in enhancing nursing education.

PubMed

Scollin, Patrick; Callahan, John; Mehta, Apurva; Garcia, Elizabeth

2006-01-01

"The PDA as a Reference Tool: The Libraries' Role in Enhancing Nursing Education" is a pilot project funded by the University of Massachusetts President's Office Information Technology Council through their Professional Development Grant program in 2004. The project's goal is to offer faculty and students in nursing programs at two University of Massachusetts campuses access to an array of medical reference information, such as handbooks, dictionaries, calculators, and diagnostic tools, on small handheld computers called personal digital assistants. Through exposure to the variety of information resources in this digital format, participants can discover and explore these resources at no personal financial cost. Participants borrow handhelds from the University Library's circulation desks. The libraries provide support in routine resynchronizing of handhelds to update information. This report will discuss how the projects were administered, what we learned about what did and did not work, the problems and solutions, and where we hope to go from here.

Event-Driven Process Chains (EPC)

NASA Astrophysics Data System (ADS)

Mendling, Jan

This chapter provides a comprehensive overview of Event-driven Process Chains (EPCs) and introduces a novel definition of EPC semantics. EPCs became popular in the 1990s as a conceptual business process modeling language in the context of reference modeling. Reference modeling refers to the documentation of generic business operations in a model such as service processes in the telecommunications sector, for example. It is claimed that reference models can be reused and adapted as best-practice recommendations in individual companies (see [230, 168, 229, 131, 400, 401, 446, 127, 362, 126]). The roots of reference modeling can be traced back to the Kölner Integrationsmodell (KIM) [146, 147] that was developed in the 1960s and 1970s. In the 1990s, the Institute of Information Systems (IWi) in Saarbrücken worked on a project with SAP to define a suitable business process modeling language to document the processes of the SAP R/3 enterprise resource planning system. There were two results from this joint effort: the definition of EPCs [210] and the documentation of the SAP system in the SAP Reference Model (see [92, 211]). The extensive database of this reference model contains almost 10,000 sub-models: 604 of them non-trivial EPC business process models. The SAP Reference model had a huge impact with several researchers referring to it in their publications (see [473, 235, 127, 362, 281, 427, 415]) as well as motivating the creation of EPC reference models in further domains including computer integrated manufacturing [377, 379], logistics [229] or retail [52]. The wide-spread application of EPCs in business process modeling theory and practice is supported by their coverage in seminal text books for business process management and information systems in general (see [378, 380, 49, 384, 167, 240]). EPCs are frequently used in practice due to a high user acceptance [376] and extensive tool support. Some examples of tools that support EPCs are ARIS Toolset by IDS Scheer AG, AENEIS by ATOSS Software AG, ADONIS by BOC GmbH, Visio by Microsoft Corp., Nautilus by Gedilan Consulting GmbH, and Bonapart by Pikos GmbH. In order to facilitate the interchange of EPC business process models between these tools, there is a tool neutral interchange format called EPC Markup Language (EPML) [283, 285, 286, 287, 289, 290, 291].

Critical care providers refer to information tools less during communication tasks after a critical care clinical information system introduction.

PubMed

Ballermann, Mark; Shaw, Nicola T; Mayes, Damon C; Gibney, R T Noel

2011-01-01

Electronic documentation methods may assist critical care providers with information management tasks in Intensive Care Units (ICUs). We conducted a quasi-experimental observational study to investigate patterns of information tool use by ICU physicians, nurses, and respiratory therapists during verbal communication tasks. Critical care providers used tools less at 3 months after the CCIS introduction. At 12 months, care providers referred to paper and permanent records, especially during shift changes. The results suggest potential areas of improvement for clinical information systems in assisting critical care providers in ensuring informational continuity around their patients.

Unobtrusive Evaluation of Reference Service and Individual Responsibility: The Canadian Experience. Contemporary Studies in Information Management, Policies, and Services.

ERIC Educational Resources Information Center

Dilevko, Juris

Long a controversial topic in the specialized world of reference librarianship, unobtrusive evaluation is a useful tool in gauging the degree to which reference librarians are effectively performing their jobs. Based on a nationwide survey of government documents reference service in Canada, This book examines the broad philosophical implications…

Screening of healthcare workers for tuberculosis: development and validation of a new health economic model to inform practice

PubMed Central

Eralp, Merve Nazli; Scholtes, Stefan; Martell, Geraldine; Winter, Robert

2012-01-01

Background Methods for determining cost-effectiveness of different treatments are well established, unlike appraisal of non-drug interventions, including novel diagnostics and biomarkers. Objective The authors develop and validate a new health economic model by comparing cost-effectiveness of tuberculin skin test (TST); blood test, interferon-gamma release assay (IGRA) and TST followed by IGRA in conditional sequence, in screening healthcare workers for latent or active tuberculosis (TB). Design The authors focus on healthy life years gained as the benefit metric, rather than quality-adjusted life years given limited data to estimate quality adjustments of life years with TB and complications of treatment, like hepatitis. Healthy life years gained refer to the number of TB or hepatitis cases avoided and the increase in life expectancy. The authors incorporate disease and test parameters informed by systematic meta-analyses and clinical practice. Health and economic outcomes of each strategy are modelled as a decision tree in Markov chains, representing different health states informed by epidemiology. Cost and effectiveness values are generated as the individual is cycled through 20 years of the model. Key parameters undergo one-way and Monte Carlo probabilistic sensitivity analyses. Setting Screening healthcare workers in secondary and tertiary care. Results IGRA is the most effective strategy, with incremental costs per healthy life year gained of £10 614–£20 929, base case, £8021–£18 348, market costs TST £45, IGRA £90, IGRA specificities of 99%–97%; mean (5%, 95%), £12 060 (£4137–£38 418) by Monte Carlo analysis. Conclusions Incremental costs per healthy life year gained, a conservative estimate of benefit, are comparable to the £20 000–£30 000 NICE band for IGRA alone, across wide differences in disease and test parameters. Health gains justify IGRA costs, even if IGRA tests cost three times TST. This health economic model offers a powerful tool for appraising non-drug interventions in the market and under development. PMID:22382118

Toolkit of Available EPA Green Infrastructure Modeling ...

EPA Pesticide Factsheets

This webinar will present a toolkit consisting of five EPA green infrastructure models and tools, along with communication material. This toolkit can be used as a teaching and quick reference resource for use by planners and developers when making green infrastructure implementation decisions. It can also be used for low impact development design competitions. Models and tools included: Green Infrastructure Wizard (GIWiz), Watershed Management Optimization Support Tool (WMOST), Visualizing Ecosystem Land Management Assessments (VELMA) Model, Storm Water Management Model (SWMM), and the National Stormwater Calculator (SWC). This webinar will present a toolkit consisting of five EPA green infrastructure models and tools, along with communication material. This toolkit can be used as a teaching and quick reference resource for use by planners and developers when making green infrastructure implementation decisions. It can also be used for low impact development design competitions. Models and tools included: Green Infrastructure Wizard (GIWiz), Watershed Management Optimization Support Tool (WMOST), Visualizing Ecosystem Land Management Assessments (VELMA) Model, Storm Water Management Model (SWMM), and the National Stormwater Calculator (SWC).

The Behavior of Regular Satellites During the Planetary Migration

NASA Astrophysics Data System (ADS)

Nogueira, Erica Cristina; Gomes, R. S.; Brasser, R.

2013-05-01

Abstract (2,250 Maximum Characters): The behavior of the regular satellites of the giant planets during the instability phase of the Nice model needs to be better understood. In order to explain this behavior, we used numerical simulations to investigate the evolution of the regular satellite systems of the ice giants when these two planets experienced encounters with the gas giants. For the initial conditions we placed an ice planet in between Jupiter and Saturn, according to the evolution of Nice model simulations in a ‘jumping Jupiter’ scenario (Brasser et al. 2009). We used the MERCURY integrator (Chambers 1999) and cloned simulations by slightly modifying the Hybrid integrator changeover parameter. We obtained 101 successful runs which kept all planets, of which 24 were jumping Jupiter cases. Subsequently we performed additional numerical integrations in which the ice giant that encountered a gas giant was started on the same orbit but with its regular satellites included. This is done as follows: For each of the 101 basic runs, we save the orbital elements of all objects in the integration at all close encounter events. Then we performed a backward integration to start the system 100 years before the encounter and re-enacted the forward integration with the regular satellites around the ice giant. These integrations ran for 1000 years. The final orbital elements of the satellites with respect to the ice planet were used to restart the integration for the next planetary encounter (if any). If we assume that Uranus is the ice planet that had encounters with a gas giant, we considered the satellites Miranda, Ariel, Umbriel, Titania and Oberon with their present orbits around the planet. For Neptune we introduced Triton with an orbit with a 15% larger than the actual semi-major axis to account for the tidal decay from the LHB to present time. We also assume that Triton was captured through binary disruption (Agnor and Hamilton 2006, Nogueira et al. 2011) and its orbit was circularized by tides during the ~500 million years before the LHB. References: Agnor & Hamilton 2006, Nature 441, 192 Brasser et al. 2009, A&A 507, 1053 Chambers 1999, Mon. Not. R. Astron. Soc. 304, 793 Nogueira et al. 2011, Icarus 214, 113

A structured review of health utility measures and elicitation in advanced/metastatic breast cancer.

PubMed

Hao, Yanni; Wolfram, Verena; Cook, Jennifer

2016-01-01

Health utilities are increasingly incorporated in health economic evaluations. Different elicitation methods, direct and indirect, have been established in the past. This study examined the evidence on health utility elicitation previously reported in advanced/metastatic breast cancer and aimed to link these results to requirements of reimbursement bodies. Searches were conducted using a detailed search strategy across several electronic databases (MEDLINE, EMBASE, Cochrane Library, and EconLit databases), online sources (Cost-effectiveness Analysis Registry and the Health Economics Research Center), and web sites of health technology assessment (HTA) bodies. Publications were selected based on the search strategy and the overall study objectives. A total of 768 publications were identified in the searches, and 26 publications, comprising 18 journal articles and eight submissions to HTA bodies, were included in the evidence review. Most journal articles derived utilities from the European Quality of Life Five-Dimensions questionnaire (EQ-5D). Other utility measures, such as the direct methods standard gamble (SG), time trade-off (TTO), and visual analog scale (VAS), were less frequently used. Several studies described mapping algorithms to generate utilities from disease-specific health-related quality of life (HRQOL) instruments such as European Organization for Research and Treatment of Cancer Quality of Life Questionnaire - Core 30 (EORTC QLQ-C30), European Organization for Research and Treatment of Cancer Quality of Life Questionnaire - Breast Cancer 23 (EORTC QLQ-BR23), Functional Assessment of Cancer Therapy - General questionnaire (FACT-G), and Utility-Based Questionnaire-Cancer (UBQ-C); most used EQ-5D as the reference. Sociodemographic factors that affect health utilities, such as age, sex, income, and education, as well as disease progression, choice of utility elicitation method, and country settings, were identified within the journal articles. Most submissions to HTA bodies obtained utility values from the literature rather than exploring the HRQOL data obtained during clinical development. This was critiqued by the National Institute for Health and Clinical Excellence (NICE). Furthermore, the impact of age on utilities was highlighted by NICE and it was suggested that an age match of the study population should be attempted. Health utilities are recorded across the globe to varying extents and using differing elicitation methods. Manufacturers seeking reimbursement need to be aware of the country-specific requirements for elicitation of health utilities.

A structured review of health utility measures and elicitation in advanced/metastatic breast cancer

PubMed Central

Hao, Yanni; Wolfram, Verena; Cook, Jennifer

2016-01-01

Background Health utilities are increasingly incorporated in health economic evaluations. Different elicitation methods, direct and indirect, have been established in the past. This study examined the evidence on health utility elicitation previously reported in advanced/metastatic breast cancer and aimed to link these results to requirements of reimbursement bodies. Methods Searches were conducted using a detailed search strategy across several electronic databases (MEDLINE, EMBASE, Cochrane Library, and EconLit databases), online sources (Cost-effectiveness Analysis Registry and the Health Economics Research Center), and web sites of health technology assessment (HTA) bodies. Publications were selected based on the search strategy and the overall study objectives. Results A total of 768 publications were identified in the searches, and 26 publications, comprising 18 journal articles and eight submissions to HTA bodies, were included in the evidence review. Most journal articles derived utilities from the European Quality of Life Five-Dimensions questionnaire (EQ-5D). Other utility measures, such as the direct methods standard gamble (SG), time trade-off (TTO), and visual analog scale (VAS), were less frequently used. Several studies described mapping algorithms to generate utilities from disease-specific health-related quality of life (HRQOL) instruments such as European Organization for Research and Treatment of Cancer Quality of Life Questionnaire – Core 30 (EORTC QLQ-C30), European Organization for Research and Treatment of Cancer Quality of Life Questionnaire – Breast Cancer 23 (EORTC QLQ-BR23), Functional Assessment of Cancer Therapy – General questionnaire (FACT-G), and Utility-Based Questionnaire-Cancer (UBQ-C); most used EQ-5D as the reference. Sociodemographic factors that affect health utilities, such as age, sex, income, and education, as well as disease progression, choice of utility elicitation method, and country settings, were identified within the journal articles. Most submissions to HTA bodies obtained utility values from the literature rather than exploring the HRQOL data obtained during clinical development. This was critiqued by the National Institute for Health and Clinical Excellence (NICE). Furthermore, the impact of age on utilities was highlighted by NICE and it was suggested that an age match of the study population should be attempted. Conclusion Health utilities are recorded across the globe to varying extents and using differing elicitation methods. Manufacturers seeking reimbursement need to be aware of the country-specific requirements for elicitation of health utilities. PMID:27382319