Roadwaste management : a tool for developing district plans.

DOT National Transportation Integrated Search

2000-10-01

The Oregon Department of Transportation (ODOT) conducted a study to examine roadwaste management options. Phase 1 consisted of a thorough review of regulations and standards, roadwaste characterization, current management practices, and new technolog...

40 CFR 63.3493 - What work practice standards must I meet?

Code of Federal Regulations, 2010 CFR

2010-07-01

... or the control efficiency/outlet concentration option to comply with the emission limitations, you... materials, and waste materials must be conveyed from one location to another in closed containers or pipes...

Development of clinical practice guidelines.

PubMed

Hollon, Steven D; Areán, Patricia A; Craske, Michelle G; Crawford, Kermit A; Kivlahan, Daniel R; Magnavita, Jeffrey J; Ollendick, Thomas H; Sexton, Thomas L; Spring, Bonnie; Bufka, Lynn F; Galper, Daniel I; Kurtzman, Howard

2014-01-01

Clinical practice guidelines (CPGs) are intended to improve mental, behavioral, and physical health by promoting clinical practices that are based on the best available evidence. The American Psychological Association (APA) is committed to generating patient-focused CPGs that are scientifically sound, clinically useful, and informative for psychologists, other health professionals, training programs, policy makers, and the public. The Institute of Medicine (IOM) 2011 standards for generating CPGs represent current best practices in the field. These standards involve multidisciplinary guideline development panels charged with generating recommendations based on comprehensive systematic reviews of the evidence. The IOM standards will guide the APA as it generates CPGs that can be used to inform the general public and the practice community regarding the benefits and harms of various treatment options. CPG recommendations are advisory rather than compulsory. When used appropriately, high-quality guidelines can facilitate shared decision making and identify gaps in knowledge.

Practice Parameters for the Respiratory Indications for Polysomnography in Children

PubMed Central

Aurora, R. Nisha; Zak, Rochelle S.; Karippot, Anoop; Lamm, Carin I.; Morgenthaler, Timothy I.; Auerbach, Sanford H.; Bista, Sabin R.; Casey, Kenneth R.; Chowdhuri, Susmita; Kristo, David A.; Ramar, Kannan

2011-01-01

Background: There has been marked expansion in the literature and practice of pediatric sleep medicine; however, no recent evidence-based practice parameters have been reported. These practice parameters are the first of 2 papers that assess indications for polysomnography in children. This paper addresses indications for polysomnography in children with suspected sleep related breathing disorders. These recommendations were reviewed and approved by the Board of Directors of the American Academy of Sleep Medicine. Methods: A systematic review of the literature was performed, and the American Academy of Neurology grading system was used to assess the quality of evidence. Recommendations for PSG Use: Polysomnography in children should be performed and interpreted in accordance with the recommendations of the AASM Manual for the Scoring of Sleep and Associated Events. (Standard) Polysomnography is indicated when the clinical assessment suggests the diagnosis of obstructive sleep apnea syndrome (OSAS) in children. (Standard) Children with mild OSAS preoperatively should have clinical evaluation following adenotonsillectomy to assess for residual symptoms. If there are residual symptoms of OSAS, polysomnography should be performed. (Standard) Polysomnography is indicated following adenotonsillectomy to assess for residual OSAS in children with preoperative evidence for moderate to severe OSAS, obesity, craniofacial anomalies that obstruct the upper airway, and neurologic disorders (e.g., Down syndrome, Prader-Willi syndrome, and myelomeningocele). (Standard) Polysomnography is indicated for positive airway pressure (PAP) titration in children with obstructive sleep apnea syndrome. (Standard) Polysomnography is indicated when the clinical assessment suggests the diagnosis of congenital central alveolar hypoventilation syndrome or sleep related hypoventilation due to neuromuscular disorders or chest wall deformities. It is indicated in selected cases of primary sleep apnea of infancy. (Guideline) Polysomnography is indicated when there is clinical evidence of a sleep related breathing disorder in infants who have experienced an apparent life-threatening event (ALTE). (Guideline) Polysomnography is indicated in children being considered for adenotonsillectomy to treat obstructive sleep apnea syndrome. (Guideline) Follow-up PSG in children on chronic PAP support is indicated to determine whether pressure requirements have changed as a result of the child's growth and development, if symptoms recur while on PAP, or if additional or alternate treatment is instituted. (Guideline) Polysomnography is indicated after treatment of children for OSAS with rapid maxillary expansion to assess for the level of residual disease and to determine whether additional treatment is necessary. (Option) Children with OSAS treated with an oral appliance should have clinical follow-up and polysomnography to assess response to treatment. (Option) Polysomnography is indicated for noninvasive positive pressure ventilation (NIPPV) titration in children with other sleep related breathing disorders. (Option) Children treated with mechanical ventilation may benefit from periodic evaluation with polysomnography to adjust ventilator settings. (Option) Children treated with tracheostomy for sleep related breathing disorders benefit from polysomnography as part of the evaluation prior to decannulation. These children should be followed clinically after decannulation to assess for recurrence of symptoms of sleep related breathing disorders. (Option) Polysomnography is indicated in the following respiratory disorders only if there is a clinical suspicion for an accompanying sleep related breathing disorder: chronic asthma, cystic fibrosis, pulmonary hypertension, bronchopulmonary dysplasia, or chest wall abnormality such as kyphoscoliosis. (Option) Recommendations against PSG Use: 16. Nap (abbreviated) polysomnography is not recommended for the evaluation of obstructive sleep apnea syndrome in children. (Option) 17. Children considered for treatment with supplemental oxygen do not routinely require polysomnography for management of oxygen therapy. (Option) Conclusions: Current evidence in the field of pediatric sleep medicine indicates that PSG has clinical utility in the diagnosis and management of sleep related breathing disorders. The accurate diagnosis of SRBD in the pediatric population is best accomplished by integration of polysomnographic findings with clinical evaluation. Citation: Aurora RN; Zak RS; Karippot A; Lamm CI; Morgenthaler TI; Auerbach SH; Bista SR; Casey KR; Chowdhuri S; Kristo DA; Ramar K. Practice parameters for the respiratory indications for polysomnography in children. SLEEP 2011;34(3):379-388. PMID:21359087

Balance and Gait Impairment: Sensor-Based Assessment for Patients With Peripheral Neuropathy.

PubMed

Campbell, Grace; Skubic, Marjorie A

2018-06-01

Individuals with peripheral neuropathy (PN) frequently experience balance and gait impairments that can lead to poor physical function, falls, and injury. Nurses are aware that patients with cancer experience balance and gait impairments but are unsure of optimal assessment and management strategies. This article reviews options for balance and gait assessment for patients diagnosed with cancer experiencing PN, describes advantages and limitations of the various options, and highlights innovative, clinically feasible technologies to improve clinical assessment and management. The literature was reviewed to identify and assess the gold standard quantitative measures for assessing balance and gait. Gold standard quantitative measures are burdensome for patients and not often used in clinical practice. Sensor-based technologies improve balance and gait assessment options by calculating precise impairment measures during performance of simple clinical tests at the point of care.

Practice parameters for the treatment of colonic diverticular disease: Italian Society of Colon and Rectal Surgery (SICCR) guidelines.

PubMed

Binda, G A; Cuomo, R; Laghi, A; Nascimbeni, R; Serventi, A; Bellini, D; Gervaz, P; Annibale, B

2015-10-01

The mission of the Italian Society of Colorectal Surgery (SICCR) is to optimize patient care. Providing evidence-based practice guidelines is therefore of key importance. About the present report it concernes the SICCR practice guidelines for the diagnosis and treatment of diverticular disease of the colon. The guidelines are not intended to define the sole standard of care but to provide evidence-based recommendations regarding the available therapeutic options.

78 FR 67881 - Nondiscrimination on the Basis of Disability in Air Travel: Accessibility of Web Sites and...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-11-12

... corresponding accessible pages on a mobile Web site by one year after the final rule's effective date; and (3... Mobile Web site conformant with any of the following standards: WCAG 1.0, WCAG 2.0 at Level A, existing Section 508 standards, or Mobile Web Best Practices (MWBP) 1.0 (if applicable). Two of the options they...

Practice parameters for the surgical modifications of the upper airway for obstructive sleep apnea in adults.

PubMed

Aurora, R Nisha; Casey, Kenneth R; Kristo, David; Auerbach, Sanford; Bista, Sabin R; Chowdhuri, Susmita; Karippot, Anoop; Lamm, Carin; Ramar, Kannan; Zak, Rochelle; Morgenthaler, Timothy I

2010-10-01

Practice parameters for the treatment of obstructive sleep apnea syndrome (OSAS) in adults by surgical modification of the upper airway were first published in 1996 by the American Academy of Sleep Medicine (formerly ASDA). The following practice parameters update the previous practice parameters. These recommendations were reviewed and approved by the Board of Directors of the American Academy of Sleep Medicine. A systematic review of the literature was performed, and the GRADE system was used to assess the quality of evidence. The findings from this evaluation are provided in the accompanying review paper, and the subsequent recommendations have been developed from this review. The following procedures have been included: tracheostomy, maxillo-mandibular advancement (MMA), laser assisted uvulopalatoplasty (LAUP), uvulopalatopharyngoplasty (UPPP), radiofrequency ablation (RFA), and palatal implants. The presence and severity of obstructive sleep apnea must be determined before initiating surgical therapy (Standard). The patient should be advised about potential surgical success rates and complications, the availability of alternative treatment options such as nasal positive airway pressure and oral appliances, and the levels of effectiveness and success rates of these alternative treatments (Standard). The desired outcomes of treatment include resolution of the clinical signs and symptoms of obstructive sleep apnea and the normalization of sleep quality, the apnea-hypopnea index, and oxyhemoglobin saturation levels (Standard). Tracheostomy has been shown to be an effective single intervention to treat obstructive sleep apnea. This operation should be considered only when other options do not exist, have failed, are refused, or when this operation is deemed necessary by clinical urgency (Option). MMA is indicated for surgical treatment of severe OSA in patients who cannot tolerate or who are unwilling to adhere to positive airway pressure therapy, or in whom oral appliances, which are more often appropriate in mild and moderate OSA patients, have been considered and found ineffective or undesirable (Option). UPPP as a sole procedure, with or without tonsillectomy, does not reliably normalize the AHI when treating moderate to severe obstructive sleep apnea syndrome. Therefore, patients with severe OSA should initially be offered positive airway pressure therapy, while those with moderate OSA should initially be offered either PAP therapy or oral appliances (Option). Use of multi-level or stepwise surgery (MLS), as a combined procedure or as stepwise multiple operations, is acceptable in patients with narrowing of multiple sites in the upper airway, particularly if they have failed UPPP as a sole treatment (Option). LAUP is not routinely recommended as a treatment for obstructive sleep apnea syndrome (Standard). RFA can be considered as a treatment in patients with mild to moderate obstructive sleep apnea who cannot tolerate or who are unwilling to adhere to positive airway pressure therapy, or in whom oral appliances have been considered and found ineffective or undesirable (Option). Palatal implants may be effective in some patients with mild obstructive sleep apnea who cannot tolerate or who are unwilling to adhere to positive airway pressure therapy, or in whom oral appliances have been considered and found ineffective or undesirable (Option). Postoperatively, after an appropriate period of healing, patients should undergo follow-up evaluation including an objective measure of the presence and severity of sleep-disordered breathing and oxygen saturation, as well as clinical assessment for residual symptoms. Additionally, patients should be followed over time to detect the recurrence of disease (Standard). While there has been significant progress made in surgical techniques for the treatment of OSA, there is a lack of rigorous data evaluating surgical modifications of the upper airway. Systematic and methodical investigations are needed to improve the quality of evidence, assess additional outcome measures, determine which populations are most likely to benefit from a particular procedure or procedures, and optimize perioperative care.

The Treatment of Central Sleep Apnea Syndromes in Adults: Practice Parameters with an Evidence-Based Literature Review and Meta-Analyses

PubMed Central

Aurora, R. Nisha; Chowdhuri, Susmita; Ramar, Kannan; Bista, Sabin R.; Casey, Kenneth R.; Lamm, Carin I.; Kristo, David A.; Mallea, Jorge M.; Rowley, James A.; Zak, Rochelle S.; Tracy, Sharon L.

2012-01-01

The International Classification of Sleep Disorders, Second Edition (ICSD-2) distinguishes 5 subtypes of central sleep apnea syndromes (CSAS) in adults. Review of the literature suggests that there are two basic mechanisms that trigger central respiratory events: (1) post-hyperventilation central apnea, which may be triggered by a variety of clinical conditions, and (2) central apnea secondary to hypoventilation, which has been described with opioid use. The preponderance of evidence on the treatment of CSAS supports the use of continuous positive airway pressure (CPAP). Much of the evidence comes from investigations on CSAS related to congestive heart failure (CHF), but other subtypes of CSAS appear to respond to CPAP as well. Limited evidence is available to support alternative therapies in CSAS subtypes. The recommendations for treatment of CSAS are summarized as follows: CPAP therapy targeted to normalize the apnea-hypopnea index (AHI) is indicated for the initial treatment of CSAS related to CHF. (STANDARD)Nocturnal oxygen therapy is indicated for the treatment of CSAS related to CHF. (STANDARD)Adaptive Servo-Ventilation (ASV) targeted to normalize the apnea-hypopnea index (AHI) is indicated for the treatment of CSAS related to CHF. (STANDARD)BPAP therapy in a spontaneous timed (ST) mode targeted to normalize the apnea-hypopnea index (AHI) may be considered for the treatment of CSAS related to CHF only if there is no response to adequate trials of CPAP, ASV, and oxygen therapies. (OPTION)The following therapies have limited supporting evidence but may be considered for the treatment of CSAS related to CHF after optimization of standard medical therapy, if PAP therapy is not tolerated, and if accompanied by close clinical follow-up: acetazolamide and theophylline. (OPTION)Positive airway pressure therapy may be considered for the treatment of primary CSAS. (OPTION)Acetazolamide has limited supporting evidence but may be considered for the treatment of primary CSAS. (OPTION)The use of zolpidem and triazolam may be considered for the treatment of primary CSAS only if the patient does not have underlying risk factors for respiratory depression. (OPTION)The following possible treatment options for CSAS related to end-stage renal disease may be considered: CPAP, supplemental oxygen, bicarbonate buffer use during dialysis, and nocturnal dialysis. (OPTION) Citation: Aurora RN; Chowdhuri S; Ramar K; Bista SR; Casey KR; Lamm CI; Kristo DA; Mallea JM; Rowley JA; Zak RS; Tracy SL. The treatment of central sleep apnea syndromes in adults: practice parameters with an evidence-based literature review and meta-analyses. SLEEP 2012;35(1):17-40. PMID:22215916

Practice parameters for the clinical evaluation and treatment of circadian rhythm sleep disorders. An American Academy of Sleep Medicine report.

PubMed

Morgenthaler, Timothy I; Lee-Chiong, Teofilo; Alessi, Cathy; Friedman, Leah; Aurora, R Nisha; Boehlecke, Brian; Brown, Terry; Chesson, Andrew L; Kapur, Vishesh; Maganti, Rama; Owens, Judith; Pancer, Jeffrey; Swick, Todd J; Zak, Rochelle

2007-11-01

The expanding science of circadian rhythm biology and a growing literature in human clinical research on circadian rhythm sleep disorders (CRSDs) prompted the American Academy of Sleep Medicine (AASM) to convene a task force of experts to write a review of this important topic. Due to the extensive nature of the disorders covered, the review was written in two sections. The first review paper, in addition to providing a general introduction to circadian biology, addresses "exogenous" circadian rhythm sleep disorders, including shift work disorder (SWD) and jet lag disorder (JLD). The second review paper addresses the "endogenous" circadian rhythm sleep disorders, including advanced sleep phase disorder (ASPD), delayed sleep phase disorder (DSPD), irregular sleep-wake rhythm (ISWR), and the non-24-hour sleep-wake syndrome (nonentrained type) or free-running disorder (FRD). These practice parameters were developed by the Standards of Practice Committee and reviewed and approved by the Board of Directors of the AASM to present recommendations for the assessment and treatment of CRSDs based on the two accompanying comprehensive reviews. The main diagnostic tools considered include sleep logs, actigraphy, the Morningness-Eveningness Questionnaire (MEQ), circadian phase markers, and polysomnography. Use of a sleep log or diary is indicated in the assessment of patients with a suspected circadian rhythm sleep disorder (Guideline). Actigraphy is indicated to assist in evaluation of patients suspected of circadian rhythm disorders (strength of recommendation varies from "Option" to "Guideline," depending on the suspected CRSD). Polysomnography is not routinely indicated for the diagnosis of CRSDs, but may be indicated to rule out another primary sleep disorder (Standard). There is insufficient evidence to justify the use of MEQ for the routine clinical evaluation of CRSDs (Option). Circadian phase markers are useful to determine circadian phase and confirm the diagnosis of FRD in sighted and unsighted patients but there is insufficient evidence to recommend their routine use in the diagnosis of SWD, JLD, ASPD, DSPD, or ISWR (Option). Additionally, actigraphy is useful as an outcome measure in evaluating the response to treatment for CRSDs (Guideline). A range of therapeutic interventions were considered including planned sleep schedules, timed light exposure, timed melatonin doses, hypnotics, stimulants, and alerting agents. Planned or prescribed sleep schedules are indicated in SWD (Standard) and in JLD, DSPD, ASPD, ISWR (excluding elderly-demented/nursing home residents), and FRD (Option). Specifically dosed and timed light exposure is indicated for each of the circadian disorders with variable success (Option). Timed melatonin administration is indicated for JLD (Standard); SWD, DSPD, and FRD in unsighted persons (Guideline); and for ASPD, FRD in sighted individuals, and for ISWR in children with moderate to severe psychomotor retardation (Option). Hypnotic medications may be indicated to promote or improve daytime sleep among night shift workers (Guideline) and to treat jet lag-induced insomnia (Option). Stimulants may be indicated to improve alertness in JLD and SWD (Option) but may have risks that must be weighed prior to use. Modafinil may be indicated to improve alertness during the night shift for patients with SWD (Guideline).

MIUS community conceptual design study

NASA Technical Reports Server (NTRS)

Fulbright, B. E.

1976-01-01

The feasibility, practicality, and applicability of the modular integrated utility systems (MIUS) concept to a satellite new-community development with a population of approximately 100,000 were analyzed. Two MIUS design options, the 29-MIUS-unit (option 1) and the 8-MIUS-unit (option 2) facilities were considered. Each resulted in considerable resource savings when compared to a conventional utility system. Economic analyses indicated that the total cash outlay and operations and maintenance costs for these two options were considerably less than for a conventional system. Computer analyses performed in support of this study provided corroborative data for the study group. An environmental impact assessment was performed to determine whether the MIUS meets or will meet necessary environmental standards. The MIUS can provide improved efficiency in the conservation of natural resources while not adversely affecting the physical environment.

Practice Parameters for the Surgical Modifications of the Upper Airway for Obstructive Sleep Apnea in Adults

PubMed Central

Aurora, R. Nisha; Casey, Kenneth R.; Kristo, David; Auerbach, Sanford; Bista, Sabin R.; Chowdhuri, Susmita; Karippot, Anoop; Lamm, Carin; Ramar, Kannan; Zak, Rochelle; Morgenthaler, Timothy I.

2010-01-01

Background: Practice parameters for the treatment of obstructive sleep apnea syndrome (OSAS) in adults by surgical modification of the upper airway were first published in 1996 by the American Academy of Sleep Medicine (formerly ASDA). The following practice parameters update the previous practice parameters. These recommendations were reviewed and approved by the Board of Directors of the American Academy of Sleep Medicine. Methods: A systematic review of the literature was performed, and the GRADE system was used to assess the quality of evidence. The findings from this evaluation are provided in the accompanying review paper, and the subsequent recommendations have been developed from this review. The following procedures have been included: tracheostomy, maxillo-mandibular advancement (MMA), laser assisted uvulopalatoplasty (LAUP), uvulopalatopharyngoplasty (UPPP),radiofrequency ablation (RFA), and palatal implants. Recommendations: The presence and severity of obstructive sleep apnea must be determined before initiating surgical therapy (Standard). The patient should be advised about potential surgical success rates and complications, the availability of alternative treatment options such as nasal positive airway pressure and oral appliances, and the levels of effectiveness and success rates of these alternative treatments (Standard). The desired outcomes of treatment include resolution of the clinical signs and symptoms of obstructive sleep apnea and the normalization of sleep quality, the apnea-hypopnea index, and oxyhemoglobin saturation levels (Standard). Tracheostomy has been shown to be an effective single intervention to treat obstructive sleep apnea. This operation should be considered only when other options do not exist, have failed, are refused, or when this operation is deemed necessary by clinical urgency (Option). MMA is indicated for surgical treatment of severe OSA in patients who cannot tolerate or who are unwilling to adhere to positive airway pressure therapy, or in whom oral appliances, which are more often appropriate in mild and moderate OSA patients, have been considered and found ineffective or undesirable (Option). UPPP as a sole procedure, with or without tonsillectomy, does not reliably normalize the AHI when treating moderate to severe obstructive sleep apnea syndrome. Therefore, patients with severe OSA should initially be offered positive airway pressure therapy, while those with moderate OSA should initially be offered either PAP therapy or oral appliances (Option). Use of multi-level or stepwise surgery (MLS), as a combined procedure or as stepwise multiple operations, is acceptable in patients with narrowing of multiple sites in the upper airway, particularly if they have failed UPPP as a sole treatment (Option). LAUP is not routinely recommended as a treatment for obstructive sleep apnea syndrome (Standard). RFA can be considered as a treatment in patients with mild to moderate obstructive sleep apnea who cannot tolerate or who are unwilling to adhere to positive airway pressure therapy, or in whom oral appliances have been considered and found ineffective or undesirable (Option). Palatal implants may be effective in some patients with mild obstructive sleep apnea who cannot tolerate or who are unwilling to adhere to positive airway pressure therapy, or in whom oral appliances have been considered and found ineffective or undesirable (Option). Postoperatively, after an appropriate period of healing, patients should undergo follow-up evaluation including an objective measure of the presence and severity of sleep-disordered breathing and oxygen saturation, as well as clinical assessment for residual symptoms. Additionally, patients should be followed over time to detect the recurrence of disease (Standard). Conclusions: While there has been significant progress made in surgical techniques for the treatment of OSA, there is a lack of rigorous data evaluating surgical modifications of the upper airway. Systematic and methodical investigations are needed to improve the quality of evidence, assess additional outcome measures, determine which populations are most likely to benefit from a particular procedure or procedures, and optimize perioperative care. Citation: Aurora RN; Casey KR; Kristo D; Auerbach S; Bista SR; Chowdhuri S; Karippot A; Lamm C; Ramar K; Zak R; Morgenthaler TI. Practice parameters for the surgical modifications of the upper airway for obstructive sleep apnea in adults. SLEEP 2010;33(10):1408-1413. PMID:21061864

The Forgotten: Formal Assessment of the Adult Writer

ERIC Educational Resources Information Center

McNair, Daniel J.; Curry, Toi L.

2013-01-01

This review of current writing assessment practices focuses upon the adult population, an area significantly underrepresented within psychoeducational literature. As compared to other populations, such as K-12 students, there are few options for the practitioner wishing to evaluate adult writers by means of standardized assessment instruments.…

76 FR 13851 - National Emission Standards for Hazardous Air Pollutants: Mercury Emissions From Mercury Cell...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-03-14

...This action proposes amendments to the national emission standards for hazardous air pollutants (NESHAP) for mercury emissions from mercury cell chlor-alkali plants (Mercury Cell NESHAP). On June 11, 2008, EPA proposed amendments to this NESHAP in response to a petition for reconsideration filed by the Natural Resources Defense Council (NRDC). This action is a supplement to the June 11, 2008, proposal. Specifically, this action proposes two options for amending the NESHAP for mercury emissions from mercury cell chlor-alkali plants. The first option would require the elimination of mercury emissions and thus encourage the conversion to non-mercury technology. The second option would require the measures proposed in 2008. These measures, which included significant improvements in the work practices to reduce fugitive emissions from the cell room, would result in near-zero levels of mercury emissions while still allowing the mercury cell facilities to continue to operate. We are specifically requesting comment on which of these options is more appropriate, and may finalize either option or a combination of elements from them. In addition, this action proposes several amendments that would apply regardless of which option we select. These proposed amendments are provisions of the existing NESHAP that would apply to periods of startup, shutdown, and malfunction (SSM), and corrections to compliance errors in the currently effective rule.

Counseling and choosing between infant-feeding options: overall limits and local interpretations by health care providers and women living with HIV in resource-poor countries (Burkina Faso, Cambodia, Cameroon).

PubMed

Desclaux, Alice; Alfieri, Chiara

2009-09-01

As part of prevention of HIV mother-to-child transmission (PMTCT) strategies, HIV-positive women are asked to choose between two options regarding infant feeding: replacement feeding or exclusive breastfeeding with early weaning. Health services must offer women counseling, guidance, and support to enable them to make an informed choice. This article aims to shed light on the content of counseling and its adaptation to local situations, including women's perceptions, in three resource-poor countries with different infant feeding patterns (Burkina Faso, Cambodia, and Cameroon). The qualitative study included observations in health facilities and interviews with HIV-positive mothers and health workers. The results show that counseling practices vary, including prescriptive counseling proposing only one option to all women, an option based on the mother's economic level assessed by health care providers, and the choice between options. While health workers consider economic aspects first, women mostly consider social aspects related to the risk of being stigmatized as a "bad mother'" or as HIV-positive. Overall trends identify some limits to counseling effectiveness when considering women's perceptions and needs, such as: the content of information provided by health care providers, duration and timing of counseling, discrepancies between information provided during counseling and from the health system, and ranking of preventive options by health workers. Women's agency for feeding choices is related to local practices and local authorities' abilities to provide more or less comprehensive counseling based on the organization of the health and aid system. Local practices also depend on institutions' interpretations of international recommendations based on public health considerations regarding standard of care and women's and the health system's respective responsibilities. Beyond structural constraints that hinder the adoption of preventive infant feeding patterns, addressing these issues may help improve counseling practices.

[Standards, options, and recommendations for initial management of patients with malignant ovarian epithelial tumors].

PubMed

Kerbrat, P; Lhommé, C; Fervers, B; Guastalla, J P; Thomas, L; Basuyau, J P; Duvillard, P; Cohen-Solal, C; Dauplat, J; Tournemaine, N

2000-12-09

Suprapubic and transvaginal pelvic ultrasound exploration is indicated for suspected ovarian tumor (standard). Diagnosis and search for extension require surgery and pathology examination. Systematic preoperative computed tomography is not recommended (standard). Surgery for cancer of the ovary is a specialized procedure requiring skill in cancer, gynecology, visceral surgery and laparoscopic surgery. If the patient is referred to a specialized center after a primary procedure considered to be inadequate, a new procedure is recommended for staging. Residual tumor volume after the primary procedure has prognostic value. Systematic second look procedures are not recommended for routine practice (standard). For patients with grade IA G1 tumors, there is no indication for complementary treatment (standard). For patients with grade IA G2-3 or clear cell tumors, IB, IC, IIA, there is no standard. no complementary treatment, complementary chemotherapy using platinum, complementary external abdominopelvic radiotherapy. A complementary treatment is recommended for grades IC and IIA. Complementary treatment for grades IIB (no residual tissue), IIC (with residual tissue), III (no residual tissue), is based on: complementary chemotherapy with platinium, complementary external abdominopelvic radiotherapy (options). Complementary treatment for advanced forms (IIB (with residual tissue), IIC (with residual tissue), III (with residual tissue) and IV) is based on polychemotherapy with platinium (standard). platinium combined with paclitaxel (intravenous), platinium combined with cyclophosphamide and/or doxorubicin (intravenous) or intraperitoneal cisplatin combined with cyclophosphamide (intravenous). The chemotherapy work-up includes physical examination, assay of serum markers (particularly CA125) and abdominopelvic computed tomography (proof level B) (standard). Physical examination is recommended for monitoring patients in complete remission with no sign of suspected recurrence (standard). This document was reviewed in April 1977. The working group again validated the Standards, OPTIONS and Recommendations, without modifications in June 1999.

Management of scars: updated practical guidelines and use of silicones.

PubMed

Meaume, Sylvie; Le Pillouer-Prost, Anne; Richert, Bertrand; Roseeuw, Diane; Vadoud, Javid

2014-01-01

Hypertrophic scars and keloids resulting from surgery, burns, trauma and infection can be associated with substantial physical and psychological distress. Various non-invasive and invasive options are currently available for the prevention and treatment of these scars. Recently, an international multidisciplinary group of 24 experts on scar management (dermatologists; plastic and reconstructive surgeons; general surgeons; physical medicine, rehabilitation and burns specialists; psychosocial and behavioural researchers; epidemiologists; beauticians) convened to update a set of practical guidelines for the prevention and treatment of hypertrophic and keloid scars on the basis of the latest published clinical evidence on existing scar management options. Silicone-based products such as sheets and gels are recommended as the gold standard, first-line, non-invasive option for both the prevention and treatment of scars. Other general scar preventative measures include avoiding sun exposure, compression therapy, taping and the use of moisturisers. Invasive treatment options include intralesional injections of corticosteroids and/or 5-fluorouracil, cryotherapy, radiotherapy, laser therapy and surgical excision. All of these options may be used alone or as part of combination therapy. Of utmost importance is the regular re-evaluation of patients every four to eight weeks to evaluate whether additional treatment is warranted. The amount of scar management measures that are applied to each wound depends on the patient's risk of developing a scar and their level of concern about the scar's appearance. The practical advice presented in the current guidelines should be combined with clinical judgement when deciding on the most appropriate scar management measures for an individual patient.

Food and Drug Administration upscheduling of hydrocodone and the effects on nurse practitioner pain management practices.

PubMed

Mack, Rachel

2018-06-01

In 2013, the Advisory Committee of the Food and Drug Administration determined hydrocodone combination medications (HCMs) needed tighter regulation due to high abuse potential; they recommended upscheduling HCMs from Schedule III to II. The purpose of this study was to examine the effect of upscheduling of HCMs on pain management practices of advanced practiced registered nurses (APRNs) in Oklahoma. In this qualitative study, 25 participants described their primary care experiences after the upscheduling. A thematic analysis was used to understand the effects on APRN pain management practices. The upscheduling of HCMs has greatly affected the pain management practices of APRNs in a state where Schedule II narcotic prescribing is forbidden. Findings will assist APRNs with improving patient access to care, implementing practice regulations, and exploring options for alternative pain therapies in primary care. Upscheduling of HCMs has had a severe impact on APRNs, affecting their prescribing practices and leading to increased referrals. They noted limited treatment options, increased health care costs, and decreased access to care. The APRNs understand the problem of prescription opioid abuse, diversion, and misuse. A consensus model could standardize the regulatory process for APRNs, increase interstate mobility for practice, and increase access to APRN care nationwide.

Variation in assessment and standard setting practices across UK undergraduate medicine and the need for a benchmark.

PubMed

MacDougall, Margaret

2015-10-31

The principal aim of this study is to provide an account of variation in UK undergraduate medical assessment styles and corresponding standard setting approaches with a view to highlighting the importance of a UK national licensing exam in recognizing a common standard. Using a secure online survey system, response data were collected during the period 13 - 30 January 2014 from selected specialists in medical education assessment, who served as representatives for their respective medical schools. Assessment styles and corresponding choices of standard setting methods vary markedly across UK medical schools. While there is considerable consensus on the application of compensatory approaches, individual schools display their own nuances through use of hybrid assessment and standard setting styles, uptake of less popular standard setting techniques and divided views on norm referencing. The extent of variation in assessment and standard setting practices across UK medical schools validates the concern that there is a lack of evidence that UK medical students achieve a common standard on graduation. A national licensing exam is therefore a viable option for benchmarking the performance of all UK undergraduate medical students.

Dyadic OPTION: Measuring perceptions of shared decision-making in practice.

PubMed

Melbourne, Emma; Roberts, Stephen; Durand, Marie-Anne; Newcombe, Robert; Légaré, France; Elwyn, Glyn

2011-04-01

Current models of the medical consultation emphasize shared decision-making (SDM), whereby the expertise of both the doctor and the patient are recognised and seen to equally contribute to the consultation. The evidence regarding the desirability and effectiveness of the SDM approach is often conflicting. It is proposed that the conflicts are due to the nature of assessment, with current assessments from the perspective of an outside observer. To empirically assess perceived involvement in the medical consultation using the dyadic OPTION instrument. 36 simulated medical consultations were organised between general practitioners and standardized- patients, using the observer OPTION and the newly developed dyadic OPTION instruments. SDM behaviours observed in the consultations were seen to depend on both members of the doctor and patient dyad, rather than each in isolation. Thus a dyadic approach to measurement is supported. This current study highlights the necessity for a dyadic approach to assessment and introduces a novel research instrument: the dyadic OPTION instrument. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

78 FR 27271 - Self-Regulatory Organizations; BOX Options Exchange LLC; Order Granting Approval of Proposed Rule...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-09

... symbols (SPYJ) than the corresponding standard options on SPY.\\8\\ In addition, the Exchange proposes to list Jumbo SPY Options for all expirations applicable to standard options on SPY,\\9\\ and proposes that strike prices for Jumbo SPY Options be set at the same level as standard options on SPY.\\10\\ Bids and...

Interview with Brian Kearsey about the Founding of Crossroads School, Brewster, NY.

ERIC Educational Resources Information Center

Kearsey, Brian; Kearsey, Kathy

2000-01-01

A husband and wife team of Montessori-trained teachers started a private school in Brewster (New York) that also serves as a home school resource center. Their practices include mixed-age grouping, learner-centered instruction, optional standardized tests, parents in the classrooms, and frequent field trips. They endured 3 years of dealing with…

The safety of bone allografts used in dentistry: a review.

PubMed

Holtzclaw, Dan; Toscano, Nicholas; Eisenlohr, Lisa; Callan, Don

2008-09-01

Recent media reports concerning "stolen body parts" have shaken the public's trust in the safety of and the use of ethical practices involving human allografts. The authors provide a comprehensive review of the safety aspects of human bone allografts. The authors reviewed U.S. government regulations, industry standards, independent industry association guidelines, company guidelines and scientific articles related to the use of human bone allografts in the practice of dentistry published in the English language. The use of human bone allografts in the practice of dentistry involves the steps of procurement, processing, use and tracking. Rigorous donor screening and aseptic proprietary processing programs have rendered the use of human bone allografts safe and effective as a treatment option. When purchasing human bone allografts for the practice of dentistry, one should choose products accredited by the American Association of Tissue Banks for meeting uniformly high safety and quality control measures. Knowledge of human bone allograft procurement, processing, use and tracking procedures may allow dental clinicians to better educate their patients and address concerns about this valuable treatment option.

41 CFR 102-194.5 - What is the Standard and Optional Forms Management Program?

Code of Federal Regulations, 2010 CFR

2010-07-01

... 41 Public Contracts and Property Management 3 2010-07-01 2010-07-01 false What is the Standard and Optional Forms Management Program? 102-194.5 Section 102-194.5 Public Contracts and Property Management... PROGRAMS 194-STANDARD AND OPTIONAL FORMS MANAGEMENT PROGRAM § 102-194.5 What is the Standard and Optional...

The development of a highly constrained health level 7 implementation guide to facilitate electronic laboratory reporting to ambulatory electronic health record systems.

PubMed

Sujansky, Walter V; Overhage, J Marc; Chang, Sophia; Frohlich, Jonah; Faus, Samuel A

2009-01-01

Electronic laboratory interfaces can significantly increase the value of ambulatory electronic health record (EHR) systems by providing laboratory result data automatically and in a computable form. However, many ambulatory EHRs cannot implement electronic laboratory interfaces despite the existence of messaging standards, such as Health Level 7, version 2 (HL7). Among several barriers to implementing laboratory interfaces is the extensive optionality within the HL7 message standard. This paper describes the rationale for and development of an HL7 implementation guide that seeks to eliminate most of the optionality inherent in HL7, but retain the information content required for reporting outpatient laboratory results. A work group of heterogeneous stakeholders developed the implementation guide based on a set of design principles that emphasized parsimony, practical requirements, and near-term adoption. The resulting implementation guide contains 93% fewer optional data elements than HL7. This guide was successfully implemented by 15 organizations during an initial testing phase and has been approved by the HL7 standards body as an implementation guide for outpatient laboratory reporting. Further testing is required to determine whether widespread adoption of the implementation guide by laboratories and EHR systems can facilitate the implementation of electronic laboratory interfaces.

Evaluation of Unix-Based Integrated Office Automation Products.

DTIC Science & Technology

1994-04-01

recipient preferences of networked UNIX users. An e-mail directory contains the preferred applications (e.g., FrameMaker , Excel) for each user, and e...Future Not Available (B) FrameMaker (UNIX) E-Optional I/E-Standard Future* (B) Interleaf (UNIX) I/E-Optional I/E-Standard Future* (B) IslandWrite Not...Optional Future Not Available DXF I-Optional Future Not Available (B) EPSI I-Standard Not Available Future (B) FrameMaker (MIF) E-Optional I/E-Standard Not

Using simulation to study difficult clinical issues: prenatal counseling at the threshold of viability across American and Dutch cultures.

PubMed

Geurtzen, Rosa; Hogeveen, Marije; Rajani, Anand K; Chitkara, Ritu; Antonius, Timothy; van Heijst, Arno; Draaisma, Jos; Halamek, Louis P

2014-06-01

Prenatal counseling at the threshold of viability is a challenging yet critically important activity, and care guidelines differ across cultures. Studying how this task is performed in the actual clinical environment is extremely difficult. In this pilot study, we used simulation as a methodology with 2 aims as follows: first, to explore the use of simulation incorporating a standardized pregnant patient as an investigative methodology and, second, to determine similarities and differences in content and style of prenatal counseling between American and Dutch neonatologists. We compared counseling practice between 11 American and 11 Dutch neonatologists, using a simulation-based investigative methodology. All subjects performed prenatal counseling with a simulated pregnant patient carrying a fetus at the limits of viability. The following elements of scenario design were standardized across all scenarios: layout of the physical environment, details of the maternal and fetal histories, questions and responses of the standardized pregnant patient, and the time allowed for consultation. American subjects typically presented several treatment options without bias, whereas Dutch subjects were more likely to explicitly advise a specific course of treatment (emphasis on partial life support). American subjects offered comfort care more frequently than the Dutch subjects and also discussed options for maximal life support more often than their Dutch colleagues. Simulation is a useful research methodology for studying activities difficult to assess in the actual clinical environment such as prenatal counseling at the limits of viability. Dutch subjects were more directive in their approach than their American counterparts, offering fewer options for care and advocating for less invasive interventions. American subjects were more likely to offer a wider range of therapeutic options without providing a recommendation for any specific option.

17 CFR 230.238 - Exemption for standardized options.

Code of Federal Regulations, 2010 CFR

2010-04-01

... options. 230.238 Section 230.238 Commodity and Securities Exchanges SECURITIES AND EXCHANGE COMMISSION... Exemption for standardized options. (a) Exemption. Except as expressly provided in paragraphs (b) and (c) of this section, the Act does not apply to any standardized option, as that term is defined by section 240...

Determining a sustainable and economically optimal wastewater treatment and discharge strategy.

PubMed

Hardisty, Paul E; Sivapalan, Mayuran; Humphries, Robert

2013-01-15

Options for treatment and discharge of wastewater in regional Western Australia (WA) are examined from the perspective of overall sustainability and social net benefit. Current practice in the state has typically involved a basic standard of treatment deemed to be protective of human health, followed by discharge to surface water bodies. Community and regulatory pressure to move to higher standards of treatment is based on the presumption that a higher standard of treatment is more protective of the environment and society, and thus is more sustainable. This analysis tests that hypothesis for Western Australian conditions. The merits of various wastewater treatment and discharge strategies are examined by quantifying financial costs (capital and operations), and by monetising the wider environmental and social costs and benefits of each option over an expanded planning horizon (30 years). Six technical treatment-disposal options were assessed at a test site, all of which met the fundamental criterion of protecting human health. From a financial perspective, the current business-as-usual option is preferred - it is the least cost solution. However, valuing externalities such as water, greenhouse gases, ecological impacts and community amenity, the status quo is revealed as sub-optimal. Advanced secondary treatment with stream disposal improves water quality and provides overall net benefit to society. All of the other options were net present value (NPV) negative. Sensitivity analysis shows that the favoured option outperforms all of the others under a wide range of financial and externality values and assumptions. Expanding the findings across the state reveals that moving from the identified socially optimal level of treatment to higher (tertiary) levels of treatment would result in a net loss to society equivalent to several hundred million dollars. In other words, everyone benefits from improving treatment to the optimum point. But society, the environment, and the Corporation are all worse off when treatment levels are pushed beyond what is economic and sustainable. Copyright © 2012 Elsevier Ltd. All rights reserved.

Variation in assessment and standard setting practices across UK undergraduate medicine and the need for a benchmark

PubMed Central

2015-01-01

Objectives The principal aim of this study is to provide an account of variation in UK undergraduate medical assessment styles and corresponding standard setting approaches with a view to highlighting the importance of a UK national licensing exam in recognizing a common standard. Methods Using a secure online survey system, response data were collected during the period 13 - 30 January 2014 from selected specialists in medical education assessment, who served as representatives for their respective medical schools. Results Assessment styles and corresponding choices of standard setting methods vary markedly across UK medical schools. While there is considerable consensus on the application of compensatory approaches, individual schools display their own nuances through use of hybrid assessment and standard setting styles, uptake of less popular standard setting techniques and divided views on norm referencing. Conclusions The extent of variation in assessment and standard setting practices across UK medical schools validates the concern that there is a lack of evidence that UK medical students achieve a common standard on graduation. A national licensing exam is therefore a viable option for benchmarking the performance of all UK undergraduate medical students. PMID:26520472

Current Opinion and Knowledge on Peritoneal Carcinomatosis: A Survey among a Swiss Oncology Network.

PubMed

Grass, Fabian; Martin, David; Montemurro, Michael; Mathevet, Patrice; Wolfer, Anita; Coukos, George; Demartines, Nicolas; Hübner, Martin

2018-06-13

The present survey aimed to evaluate current opinion and practice regarding peritoneal metastasis (PM), satisfaction with available treatment options, and need for new therapeutic approaches. This was a qualitative study conducted between October 2016 and October 2017 in the Réseau Suisse Romand d'Oncologie including 101 members of various oncological specialties. Participants' demographics, current practice, knowledge, and satisfaction regarding available treatment options and need for new treatment options were assessed by semantic differential scales through 33 closed questions with automatic reminders at 4-, 8-, 12-, and 16-week intervals. Twenty-seven participants (27%) completed the survey. Participants were gastrointestinal or gynecologic oncologists and surgeons. Most participants (67%) evaluated their knowledge on PM as moderate, while 22% considered themselves as experts. Clinical usefulness of systemic chemotherapy and hyperthermic intraperitoneal chemotherapy was judged to be moderate to high for PM of ovarian and colorectal origin and moderate to poor for gastric origin. Satisfaction with available treatment options was 6/10 (interquartile range [IQR] 4-7) for ovarian, 5/10 (IQR 3-7) for colorectal, and 3/10 (IQR 1-3) for gastric PM. Treatment strategies varied widely for typical case vignettes. The need for new treatment modalities was rated as 8/10 (IQR 6-10). Usefulness of and satisfaction with available treatment options for PM were rated as moderate at best by oncological experts, and treatment strategies differed importantly among participants. There appears to be a clear need for standardization and new treatment modalities. © 2018 S. Karger AG, Basel.

Management of urinary incontinence in residential care.

PubMed

Lim, David S

2016-07-01

Urinary incontinence is prevalent in residential care and rates are expected to increase with the ageing population in Australia. It contributes to poor quality of life (QoL), functional impairments in activities of daily living, and deterioration of mental and sexual health. Management depends on the type of incontinence, its aetiology, the severity of symptoms, the effects on QoL, and patient factors. Treatment options include active treatment and passive containment. However, not all active treatment options are feasible in residential care. There is little evidence to advise on standard best practice. The aims of this article are to review treatment options for urinary incontinence in residential care, feasibility of service delivery and challenges associated with this. A greater understanding of the issues surrounding the management of urinary incontinence in residential care is required to deliver satisfactory patient-centred care on a consistent basis.

Sound therapy for tinnitus management: practicable options.

PubMed

Hoare, Derek J; Searchfield, Grant D; El Refaie, Amr; Henry, James A

2014-01-01

The authors reviewed practicable options of sound therapy for tinnitus, the evidence base for each option, and the implications of each option for the patient and for clinical practice. To provide a general guide to selecting sound therapy options in clinical practice. Practicable sound therapy options. Where available, peer-reviewed empirical studies, conference proceedings, and review studies were examined. Material relevant to the purpose was summarized in a narrative. The number of peer-reviewed publications pertaining to each sound therapy option reviewed varied significantly (from none to over 10). Overall there is currently insufficient evidence to support or refute the routine use of individual sound therapy options. It is likely, however, that sound therapy combined with education and counseling is generally helpful to patients. Clinicians need to be guided by the patient's point of care, patient motivation and expectations of sound therapy, and the acceptability of the intervention both in terms of the sound stimuli they are to use and whether they are willing to use sound extensively or intermittently. Clinicians should also clarify to patients the role sound therapy is expected to play in the management plan. American Academy of Audiology.

[Report from the CFEF seminar on fetal biometry (June 2017)].

PubMed

Collège Français d'échographie Fœtale Cfef

2017-10-01

This article reports the conclusions and recommendations resulting from the seminar organized in Paris on June 15, 2017 by the scientific committee of the French College of Fetal Ultrasound (CFEF). The purpose of this meeting was to audit the practices in screening for SGA and IUGR fetuses in France and to discuss ways to improve ultrasound screening. A review of charts, references, standards and common practices was performed. The potential new biometric tools applicable in France were reviewed and analyzed. Eventually, options and recommendations for improvement are proposed. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Defense Standardization Program Journal. October/December 2011

DTIC Science & Technology

2011-12-01

34 tends to yield a negative con - notation, because some people may believe that a mistake or failure has occurred. But, in fact, lessons learned are...to further refine processes or pro - cedures. In order for coalition partners and al- lies to meet the demands of a changing global environment...other things, those stakeholders conducted a SWOT (strengths, weak- nesses, opportunities, threats) analysis to help identify practicable options. The

24 CFR 3285.503 - Optional appliances.

Code of Federal Regulations, 2011 CFR

2011-04-01

... URBAN DEVELOPMENT MODEL MANUFACTURED HOME INSTALLATION STANDARDS Optional Features § 3285.503 Optional... Manufactured Home Construction and Safety Standards in this chapter. (3) When the vent exhausts through the...

24 CFR 3285.503 - Optional appliances.

Code of Federal Regulations, 2010 CFR

2010-04-01

... URBAN DEVELOPMENT MODEL MANUFACTURED HOME INSTALLATION STANDARDS Optional Features § 3285.503 Optional... Manufactured Home Construction and Safety Standards in this chapter. (3) When the vent exhausts through the...

24 CFR 3285.503 - Optional appliances.

Code of Federal Regulations, 2012 CFR

2012-04-01

... URBAN DEVELOPMENT MODEL MANUFACTURED HOME INSTALLATION STANDARDS Optional Features § 3285.503 Optional... Manufactured Home Construction and Safety Standards in this chapter. (3) When the vent exhausts through the...

Thermal comfort: research and practice.

PubMed

van Hoof, Joost; Mazej, Mitja; Hensen, Jan L M

2010-01-01

Thermal comfort--the state of mind, which expresses satisfaction with the thermal environment--is an important aspect of the building design process as modern man spends most of the day indoors. This paper reviews the developments in indoor thermal comfort research and practice since the second half of the 1990s, and groups these developments around two main themes; (i) thermal comfort models and standards, and (ii) advances in computerization. Within the first theme, the PMV-model (Predicted Mean Vote), created by Fanger in the late 1960s is discussed in the light of the emergence of models of adaptive thermal comfort. The adaptive models are based on adaptive opportunities of occupants and are related to options of personal control of the indoor climate and psychology and performance. Both models have been considered in the latest round of thermal comfort standard revisions. The second theme focuses on the ever increasing role played by computerization in thermal comfort research and practice, including sophisticated multi-segmental modeling and building performance simulation, transient thermal conditions and interactions, thermal manikins.

Alternative Test Methods for Electronic Parts

NASA Technical Reports Server (NTRS)

Plante, Jeannette

2004-01-01

It is common practice within NASA to test electronic parts at the manufacturing lot level to demonstrate, statistically, that parts from the lot tested will not fail in service using generic application conditions. The test methods and the generic application conditions used have been developed over the years through cooperation between NASA, DoD, and industry in order to establish a common set of standard practices. These common practices, found in MIL-STD-883, MIL-STD-750, military part specifications, EEE-INST-002, and other guidelines are preferred because they are considered to be effective and repeatable and their results are usually straightforward to interpret. These practices can sometimes be unavailable to some NASA projects due to special application conditions that must be addressed, such as schedule constraints, cost constraints, logistical constraints, or advances in the technology that make the historical standards an inappropriate choice for establishing part performance and reliability. Alternate methods have begun to emerge and to be used by NASA programs to test parts individually or as part of a system, especially when standard lot tests cannot be applied. Four alternate screening methods will be discussed in this paper: Highly accelerated life test (HALT), forward voltage drop tests for evaluating wire-bond integrity, burn-in options during or after highly accelerated stress test (HAST), and board-level qualification.

Advancing educational diversity: antifragility, standardization, democracy, and a multitude of education options

NASA Astrophysics Data System (ADS)

Fortunato, Michael W. P.

2017-03-01

This essay is a response to a paper by Avery and Hains that raises questions about the often unintended effects of knowledge standardization in an educational setting. While many K-12 schools are implementing common core standards, and many institutions of higher education are implementing their own standardized educational practices, the question is raised about what is lost in this effort to ensure regularity and consistency in educational outcomes. One such casualty may be local knowledge, which in a rural context includes ancestral knowledge about land, society, and cultural meaning. This essay explores whether or not efforts to standardize crowd out such knowledge, and decrease the diversity of knowledge within our society's complex ecosystem—thus making the ecosystem weaker. Using antifragility as a useful idea for examining system complexity, the essay considers the impact of standardization on innovation, democracy, and the valuation of some forms of knowledge (and its bearers) above others.

41 CFR 101-39.4901 - Obtaining standard and optional forms.

Code of Federal Regulations, 2010 CFR

2010-07-01

... VEHICLES 39-INTERAGENCY FLEET MANAGEMENT SYSTEMS 39.49-Forms § 101-39.4901 Obtaining standard and optional... 41 Public Contracts and Property Management 2 2010-07-01 2010-07-01 true Obtaining standard and optional forms. 101-39.4901 Section 101-39.4901 Public Contracts and Property Management Federal Property...

Assessing Option Grid® practicability and feasibility for facilitating shared decision making: An exploratory study.

PubMed

Tsulukidze, Maka; Grande, Stuart W; Gionfriddo, Michael R

2015-07-01

To assess the feasibility of Option Grids(®)for facilitating shared decision making (SDM) in simulated clinical consultations and explore clinicians' views on their practicability. We used mixed methods approach to analyze clinical consultations using the Observer OPTION instrument and thematic analysis for follow-up interviews with clinicians. Clinicians achieved high scores on information sharing and low scores on preference elicitation and integration. Four themes were identified: (1) Barriers affect practicability of Option Grids(®); (2) Option Grids(®) facilitate the SDM process; (3) Clinicians are aware of the gaps in their practice of SDM; (4) Training and ongoing feedback on the optimal use of Option Grids(®) are necessary. Use of Option Grids(®) by clinicians with background knowledge in SDM did not facilitate optimal levels of competency on the SDM core concepts of preference elicitation and integration. Future research must evaluate the impact of training on the use of Option Grids(®), and explore how best to help clinicians bridge the gap between knowledge and action. Clinicians proficiently imparting information in simulations struggled to elicit and integrate patient preferences - understanding this gap and developing strategies to close it are the next steps for implementing SDM into clinical practice. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Justifying Clinical Nudges.

PubMed

Gorin, Moti; Joffe, Steven; Dickert, Neal; Halpern, Scott

2017-03-01

The shift away from paternalistic decision-making and toward patient-centered, shared decision-making has stemmed from the recognition that in order to practice medicine ethically, health care professionals must take seriously the values and preferences of their patients. At the same time, there is growing recognition that minor and seemingly irrelevant features of how choices are presented can substantially influence the decisions people make. Behavioral economists have identified striking ways in which trivial differences in the presentation of options can powerfully and predictably affect people's choices. Choice-affecting features of the decision environment that do not restrict the range of choices or significantly alter the incentives have come to be known as "nudges." Although some have criticized conscious efforts to influence choice, we believe that clinical nudges may often be morally justified. The most straightforward justification for nudge interventions is that they help people bypass their cognitive limitations-for example, the tendency to choose the first option presented even when that option is not the best for them-thereby allowing people to make choices that best align with their rational preferences or deeply held values. However, we argue that this justification is problematic. We argue that, if physicians wish to use nudges to shape their patients' choices, the justification for doing so must appeal to an ethical and professional standard, not to patients' preferences. We demonstrate how a standard with which clinicians and bioethicists already are quite familiar-the best-interest standard-offers a robust justification for the use of nudges. © 2017 The Hastings Center.

78 FR 26413 - Self-Regulatory Organizations; The Options Clearing Corporation; Notice of Filing of Proposed...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-06

... Contracts from Saturday to Friday night. Eliminating Saturday expirations will allow OCC to streamline the... expiration date for Standard Expiration Contracts is moved to Friday night, expiration processing for standard options, quarterly options, and weekly options will all occur on the same day and will be a single...

Comparison of nutrition standards and other recommended procurement practices for improving institutional food offerings in Los Angeles County, 2010-2012.

PubMed

Robles, Brenda; Wood, Michelle; Kimmons, Joel; Kuo, Tony

2013-03-01

National, state, and local institutions that procure, distribute, sell, and/or serve food to employees, students, and the public are increasingly capitalizing on existing operational infrastructures to create healthier food environments. Integration of healthy nutrition standards and other recommended practices [e.g., energy (kilocalories) postings at point-of-purchase, portion size restrictions, product placement guidelines, and signage] into new or renewing food service and vending contracts codifies an institution's commitment to increasing the availability of healthful food options in their food service venues and vending machines. These procurement requirements, in turn, have the potential to positively influence consumers' food-purchasing behaviors. Although these strategies are becoming increasingly popular, much remains unknown about their context, the processes required to implement them effectively, and the factors that facilitate their sustainability, especially in such broad and diverse settings as schools, county government facilities, and cities. To contribute to this gap in information, we reviewed and compared nutrition standards and other best practices implemented recently in a large school district, in a large county government, and across 10 municipalities in Los Angeles County. We report lessons learned from these efforts.

Comparison of Nutrition Standards and Other Recommended Procurement Practices for Improving Institutional Food Offerings in Los Angeles County, 2010–2012123

PubMed Central

Robles, Brenda; Wood, Michelle; Kimmons, Joel; Kuo, Tony

2013-01-01

National, state, and local institutions that procure, distribute, sell, and/or serve food to employees, students, and the public are increasingly capitalizing on existing operational infrastructures to create healthier food environments. Integration of healthy nutrition standards and other recommended practices [e.g., energy (kilocalories) postings at point-of-purchase, portion size restrictions, product placement guidelines, and signage] into new or renewing food service and vending contracts codifies an institution’s commitment to increasing the availability of healthful food options in their food service venues and vending machines. These procurement requirements, in turn, have the potential to positively influence consumers’ food-purchasing behaviors. Although these strategies are becoming increasingly popular, much remains unknown about their context, the processes required to implement them effectively, and the factors that facilitate their sustainability, especially in such broad and diverse settings as schools, county government facilities, and cities. To contribute to this gap in information, we reviewed and compared nutrition standards and other best practices implemented recently in a large school district, in a large county government, and across 10 municipalities in Los Angeles County. We report lessons learned from these efforts. PMID:23493535

42 CFR 23.23 - Who is eligible to receive a private practice option loan?

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 1 2012-10-01 2012-10-01 false Who is eligible to receive a private practice option loan? 23.23 Section 23.23 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN... § 23.23 Who is eligible to receive a private practice option loan? (a) Eligibility for loans is limited...

42 CFR 23.23 - Who is eligible to receive a private practice option loan?

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 1 2011-10-01 2011-10-01 false Who is eligible to receive a private practice option loan? 23.23 Section 23.23 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN... § 23.23 Who is eligible to receive a private practice option loan? (a) Eligibility for loans is limited...

42 CFR 23.23 - Who is eligible to receive a private practice option loan?

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 1 2014-10-01 2014-10-01 false Who is eligible to receive a private practice option loan? 23.23 Section 23.23 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN... § 23.23 Who is eligible to receive a private practice option loan? (a) Eligibility for loans is limited...

42 CFR 23.23 - Who is eligible to receive a private practice option loan?

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 1 2010-10-01 2010-10-01 false Who is eligible to receive a private practice option loan? 23.23 Section 23.23 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN... § 23.23 Who is eligible to receive a private practice option loan? (a) Eligibility for loans is limited...

42 CFR 23.23 - Who is eligible to receive a private practice option loan?

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 1 2013-10-01 2013-10-01 false Who is eligible to receive a private practice option loan? 23.23 Section 23.23 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN... § 23.23 Who is eligible to receive a private practice option loan? (a) Eligibility for loans is limited...

48 CFR 52.222-43 - Fair Labor Standards Act and Service Contract Act-Price Adjustment (Multiple Year and Option...

Code of Federal Regulations, 2010 CFR

2010-10-01

... and Service Contract Act-Price Adjustment (Multiple Year and Option Contracts). 52.222-43 Section 52... Standards Act and Service Contract Act—Price Adjustment (Multiple Year and Option Contracts). As prescribed...—Price Adjustment (Multiple Year and Option Contracts) (SEP 2009) (a) This clause applies to both...

Setting a national minimum standard for health benefits: how do state benefit mandates compare with benefits in large-group plans?

PubMed

Frey, Allison; Mika, Stephanie; Nuzum, Rachel; Schoen, Cathy

2009-06-01

Many proposed health insurance reforms would establish a federal minimum benefit standard--a baseline set of benefits to ensure that people have adequate coverage and financial protection when they purchase insurance. Currently, benefit mandates are set at the state level; these vary greatly across states and generally target specific areas rather than set an overall standard for what qualifies as health insurance. This issue brief considers what a broad federal minimum standard might look like by comparing existing state benefit mandates with the services and providers covered under the Federal Employees Health Benefits Program (FEHBP) Blue Cross and Blue Shield standard benefit package, an example of minimum creditable coverage that reflects current standard practice among employer-sponsored health plans. With few exceptions, benefits in the FEHBP standard option either meet or exceed those that state mandates require-indicating that a broad-based national benefit standard would include most existing state benefit mandates.

Pay-for-virtue: an option to improve pay-for-performance?

PubMed

Buetow, Stephen; Entwistle, Vikki

2011-10-01

Pay-for-performance schemes reward standardized professional behaviours associated with effective care. However, they neglect the significance of virtue and devalue and erode professional motivation based on virtue. Pay for training to cultivate virtue, and/or pay-for-virtue, may mitigate these dangers. Although virtue is typically considered its own reward, and the assessment of virtue is problematic, pay-for-virtue could involve (1) stringent checks on the appropriateness of the standardized care currently rewarded by pay-for-performance for individual patients or (2) pay for indicators of virtue. These indicators could be based on virtues identified from a framework of universal virtues and through logical inferences from features of practice. It is possible that pay-for-virtue could ultimately strengthen health professionals' intrinsic motivation for good practice, but this and the broader effects of pay-for-virtue would need careful investigation. © 2011 Blackwell Publishing Ltd.

16 CFR 432.4 - Optional disclosures.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 16 Commercial Practices 1 2011-01-01 2011-01-01 false Optional disclosures. 432.4 Section 432.4 Commercial Practices FEDERAL TRADE COMMISSION TRADE REGULATION RULES POWER OUTPUT CLAIMS FOR AMPLIFIERS UTILIZED IN HOME ENTERTAINMENT PRODUCTS § 432.4 Optional disclosures. Other operating characteristics and...

16 CFR 432.4 - Optional disclosures.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 16 Commercial Practices 1 2012-01-01 2012-01-01 false Optional disclosures. 432.4 Section 432.4 Commercial Practices FEDERAL TRADE COMMISSION TRADE REGULATION RULES POWER OUTPUT CLAIMS FOR AMPLIFIERS UTILIZED IN HOME ENTERTAINMENT PRODUCTS § 432.4 Optional disclosures. Other operating characteristics and...

16 CFR 432.4 - Optional disclosures.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 16 Commercial Practices 1 2014-01-01 2014-01-01 false Optional disclosures. 432.4 Section 432.4 Commercial Practices FEDERAL TRADE COMMISSION TRADE REGULATION RULES POWER OUTPUT CLAIMS FOR AMPLIFIERS UTILIZED IN HOME ENTERTAINMENT PRODUCTS § 432.4 Optional disclosures. Other operating characteristics and...

16 CFR 432.4 - Optional disclosures.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 16 Commercial Practices 1 2013-01-01 2013-01-01 false Optional disclosures. 432.4 Section 432.4 Commercial Practices FEDERAL TRADE COMMISSION TRADE REGULATION RULES POWER OUTPUT CLAIMS FOR AMPLIFIERS UTILIZED IN HOME ENTERTAINMENT PRODUCTS § 432.4 Optional disclosures. Other operating characteristics and...

A Delphi study and ranking exercise to support commissioning services: future delivery of Thrombectomy services in England.

PubMed

Halvorsrud, Kristoffer; Flynn, Darren; Ford, Gary A; McMeekin, Peter; Bhalla, Ajay; Balami, Joyce; Craig, Dawn; White, Phil

2018-02-22

Intra-arterial thrombectomy is the gold standard treatment for large artery occlusive stroke. However, the evidence of its benefits is almost entirely based on trials delivered by experienced neurointerventionists working in established teams in neuroscience centres. Those responsible for the design and prospective reconfiguration of services need access to a comprehensive and complementary array of information on which to base their decisions. This will help to ensure the demonstrated effects from trials may be realised in practice and account for regional/local variations in resources and skill-sets. One approach to elucidate the implementation preferences and considerations of key experts is a Delphi survey. In order to support commissioning decisions, we aimed using an electronic Delphi survey to establish consensus on the options for future organisation of thrombectomy services among physicians with clinical experience in managing large artery occlusive stroke. A Delphi survey was developed with 12 options for future organisation of thrombectomy services in England. A purposive sampling strategy established an expert panel of stroke physicians from the British Association of Stroke Physicians (BASP) Clinical Standards and/or Executive Membership that deliver 24/7 intravenous thrombolysis. Options with aggregate scores falling within the lowest quartile were removed from the subsequent Delphi round. Options reaching consensus following the two Delphi rounds were then ranked in a final exercise by both the wider BASP membership and the British Society of Neuroradiologists (BSNR). Eleven stroke physicians from BASP completed the initial two Delphi rounds. Three options achieved consensus, with subsequently wider BASP (97%, n = 43) and BSNR members (86%, n = 21) assigning the highest approval rankings in the final exercise for transferring large artery occlusive stroke patients to nearest neuroscience centre for thrombectomy based on local CT/CT Angiography. The initial Delphi rounds ensured optimal reduction of options by an expert panel of stroke physicians, while subsequent ranking exercises allowed remaining options to be ranked by a wider group of experts within stroke to reach consensus. The preferred implementation option for thrombectomy is investigating suspected acute stroke patients by CT/CT Angiography and secondary transfer of large artery occlusive stroke patients to the nearest neuroscience (thrombectomy) centre.

40 CFR 63.5820 - What are my options for meeting the standards for continuous lamination/casting operations?

Code of Federal Regulations, 2010 CFR

2010-07-01

...: Reinforced Plastic Composites Production Options for Meeting Standards § 63.5820 What are my options for... weight percent organic HAP emissions reduction limit in Table 3 to this subpart, you have the option of demonstrating that you achieve 95 percent reduction of all wet-out area organic HAP emissions. (d) Combination...

To create a cleanroom controlled environment using a mobile air decontamination unit for the preparation of antineoplastic drugs.

PubMed

Lecordier, Julien; Plivard, Claire; Gardeux, Michel; Daouadi, Karim; Lahet, Jean-Jacques

2016-02-01

To use a mobile air decontamination unit (MADU) for a microbial destruction and decreased particle burden making a cleanroom controlled environment in a Centralized Chemotherapy Preparation Unit (CCPU). Good manufacturing practices (GMP) in France specify that the ambient air in the vicinity of a class III biosafety cabinet (isolator) complies with air cleanliness ISO 8 level in CCPU. This guideline has a significant impact because implementing a dedicated air handling unit (AHU) brings some engineering constraints and generates substantial additional costs. Authors have previously studied some technical and economical aspects to evaluate the feasibility of the MADU option. Using a MADU was the chosen option. Qualification of the CCPU showed that results were in compliance with the French GMP. After one year of use, the efficiency of the MADU was confirmed. According to these results, using a MADU constitutes a beneficial option for CCPU previously equipped with an isolator when compared to renovation work involving a standard built-in AHU. © The Author(s) 2014.

Regulating riparian forests for aquatic productivity in the Pacific Northwest, USA: addressing a paradox.

PubMed

Newton, Michael; Ice, George

2016-01-01

Forested riparian buffers isolate streams from the influence of harvesting operations that can lead to water temperature increases. Only forest cover between the sun and stream limits stream warming, but that cover also reduces in-stream photosynthesis, aquatic insect production, and fish productivity. Water temperature increases that occur as streams flow through canopy openings decrease rapidly downstream, in as little as 150 m. Limiting management options in riparian forests restricts maintenance and optimization of various buffer contributions to beneficial uses, including forest products, fish, and their food supply. Some riparian disturbance, especially along cold streams, appears to benefit fish productivity. Options for enhancing environmental investments in buffers should include flexibility in application of water quality standards to address the general biological needs of fish and temporary nature of clearing induced warming. Local prescriptions for optimizing riparian buffers and practices that address long-term habitat needs deserve attention. Options and incentives are needed to entice landowners to actively manage for desirable riparian forest conditions.

Some practical universal noiseless coding techniques, part 3, module PSl14,K+

NASA Technical Reports Server (NTRS)

Rice, Robert F.

1991-01-01

The algorithmic definitions, performance characterizations, and application notes for a high-performance adaptive noiseless coding module are provided. Subsets of these algorithms are currently under development in custom very large scale integration (VLSI) at three NASA centers. The generality of coding algorithms recently reported is extended. The module incorporates a powerful adaptive noiseless coder for Standard Data Sources (i.e., sources whose symbols can be represented by uncorrelated non-negative integers, where smaller integers are more likely than the larger ones). Coders can be specified to provide performance close to the data entropy over any desired dynamic range (of entropy) above 0.75 bit/sample. This is accomplished by adaptively choosing the best of many efficient variable-length coding options to use on each short block of data (e.g., 16 samples) All code options used for entropies above 1.5 bits/sample are 'Huffman Equivalent', but they require no table lookups to implement. The coding can be performed directly on data that have been preprocessed to exhibit the characteristics of a standard source. Alternatively, a built-in predictive preprocessor can be used where applicable. This built-in preprocessor includes the familiar 1-D predictor followed by a function that maps the prediction error sequences into the desired standard form. Additionally, an external prediction can be substituted if desired. A broad range of issues dealing with the interface between the coding module and the data systems it might serve are further addressed. These issues include: multidimensional prediction, archival access, sensor noise, rate control, code rate improvements outside the module, and the optimality of certain internal code options.

A real options approach to clinical faculty salary structure.

PubMed

Kahn, Marc J; Long, Hugh W

2012-01-01

One can use the option theory model originally developed to price financial opportunities in security markets to analyze many other economic arrangements such as the salary structures of clinical faculty in an academic medical center practice plan. If one views the underlying asset to be the portion (labeled "salary") of the economic value of the collections made for the care provided patients by the physician, then a salary guarantee can be considered a put option provided the physician, the guarantee having value to the physician only when the actual salary earned is less than the salary guarantee. Similarly, within an incentive plan, a salary cap can be thought of as a call option provided to the practice plan since a salary cap only has value to the practice plan when a physician's earnings exceed the cap. Further, based on analysis of prior earnings, the Black-Scholes options pricing model can be used both to price each option and to determine a financially neutral balance between a salary guarantee and a salary cap by equating the prices of the implied put and call options. We suggest that such analysis is superior to empirical methods for setting clinical faculty salary structure in the academic practice plan setting.

Get ready for the new asbestos standard

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

Onderick, W.A.

On October 1, OSHA`s revised asbestos rules became law, and with them are many changes from the previous 1986 standard. The presumed asbestos-containing material (PACM) rule is one of the bigger changes in the revised standard. OSHA has declared that owners must presume that there are certain high-risk asbestos-containing materials (ACM) in facilities built prior to 1981, unless bulk sample results prove them to be nonasbestos. The impact of this provision forces companies to think carefully before presuming where asbestos is or where it is not. Companies must also heed the EPA Asbestos National Emission Standards for Hazardous Air Pollutantsmore » (NESHAP), which require inspections and bulk sampling to identify materials prior to renovation or demolition. Short and long term needs should be examined when analyzing how to comply with the PACM provision. There are four options available. Option 1: Ignore the standard and face potential enforcement fines. Option 2: Presume all materials in pre-1981 buildings contain asbestos and simply post additional warning signs. Option 3: Survey or resurvey the facilities to be in compliance with the PACM ruling. Option 4: Conduct more comprehensive surveys. Option 3 is discussed in some detail.« less

Implementation of a real option in a sustainable supply chain: an empirical study of alkaline battery recycling

NASA Astrophysics Data System (ADS)

Cucchiella, Federica; D'Adamo, Idiano; Gastaldi, Massimo; Lenny Koh, S. C.

2014-06-01

Green supply chain management (GSCM) has emerged as a key approach for enterprises seeking to become environmentally sustainable. This paper aims to evaluate and describe the advantages of a GSCM approach by analysing practices and performance consequences in the battery recycling sector. It seeks to integrate works in supply chain management (SCM), environmental management, performance management and real option (RO) theory into one framework. In particular, life cycle assessment (LCA) is applied to evaluate the environmental impact of a battery recycling plant project, and life cycle costing (LCC) is applied to evaluate its economic impact. Firms, also understanding the relevance of GSCM, have often avoided applying the green principles because of the elevated costs that such management involved. Such costs could also seem superior to the potential advantages since standard performance measurement systems are internally and business focused; for these reasons, we consider all the possible value deriving also by uncertainty associated to a green project using the RO theory. This work is one of the few and pioneering efforts to investigate GSCM practices in the battery recycling sector.

77 FR 37617 - Updating OSHA Standards Based on National Consensus Standards; Head Protection

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-22

... provisions in the 2009 edition permitting optional testing for helmets worn in the backwards position (``reverse wearing''), optional testing for helmets at colder temperatures than provided in previous editions, and optional testing for the high- visibility coloring of helmets. If manufacturers choose to evaluate...

Manatee County government's commitment to Florida's water resources

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

Hunsicker, C.

1998-07-01

With ever increasing development demands in coastal areas and subsequent declines in natural resources, especially water, coastal communities must identify creative options for sustaining remaining water resources and an accepted standard of living. The Manatee County agricultural reuse project, using reclaimed wastewater is part of a water resource program, is designed to meet these challenges. The reuse system works in concert with consumer conservation practices and efficiency of use measures which are being implemented by all public and private sector water users in this southwest Florida community.

Learning Together; part 2: training costs and health gain - a cost analysis.

PubMed

Cullen, Katherine; Riches, Wendy; Macaulay, Chloe; Spicer, John

2017-01-01

Learning Together is a complex educational intervention aimed at improving health outcomes for children and young people. There is an additional cost as two doctors are seeing patients together for a longer appointment than a standard general practice (GP) appointment. Our approach combines the impact of the training clinics on activity in South London in 2014-15 with health gain, using NICE guidance and standards to allow comparison of training options. Activity data was collected from Training Practices hosting Learning Together. A computer based model was developed to analyse the costs of the Learning Together intervention compared to usual training in a partial economic evaluation. The results of the model were used to value the health gain required to make the intervention cost effective. Data were returned for 363 patients booked into 61 clinics across 16 Training Practices. Learning Together clinics resulted in an increase in costs of £37 per clinic. Threshold analysis illustrated one child with a common illness like constipation needs to be well for two weeks, in one Practice hosting four training clinics for the clinics to be considered cost effective. Learning Together is of minimal training cost. Our threshold analysis produced a rubric that can be used locally to test cost effectiveness at a Practice or Programme level.

Spray-on-skin cells in burns: a common practice with no agreed protocol.

PubMed

Allouni, Ammar; Papini, Remo; Lewis, Darren

2013-11-01

Cultured epithelial autograft (CEA) has been used for skin coverage after burn wound excision since 1981. It is used in burn units and centres throughout the U.K.; however, there appears to be no agreed standards of practice. We aimed to investigate the experience and current practice with its usage in the management of acute burn injury. An online survey was sent to twenty-five burns consultants in the U.K., who are members of the British Burn Association. We received 14 responses. Rarely have the responders agreed to the same practice in most of the questions. Different choices were given by responders with regards the indications for cell culture, techniques used, primary and secondary dressings used, first wound review timing, and measures used to evaluate outcomes. In the current economic environment, the NHS needs to rationalize services on the basis of cost effectiveness. CEA is an expensive procedure that requires an adequately sterile laboratory, special equipments and highly experienced dedicated staff. When dealing with expensive management options, it is important to have an agreed protocol that can form the standard that can be referred to when auditing practices and results to improve burn management and patients' care. Crown Copyright © 2013. Published by Elsevier Ltd. All rights reserved.

The prompted optional randomization trial: a new design for comparative effectiveness research.

PubMed

Flory, James; Karlawish, Jason

2012-12-01

Randomized controlled trials are the gold standard for medical evidence because randomization provides the best-known protection against confounding of results. Randomization has practical and ethical problems that limit the number of trials that can be conducted, however. A different method for collecting clinical data retains the statistically useful properties of randomization without incurring its practical and ethical challenges. A computerized prompt introduces a random element into clinical decision-making that can be instantly overridden if it conflicts with optimal patient care. This creates a weak form of randomization that still eliminates the effect of all confounders, can be carried out without disturbing routine clinical care, and arguably will not require research-grade informed consent.

Choosing a New Telephone System for Your Medical Practice.

PubMed

Metherell, Brian

2016-01-01

E-mail may rule the world in other types of businesses, but for medical practices, the telephone remains the primary mode of communication with patients, specialists, and pharmacies. From making appointments to calling in prescriptions, telephones are essential to patient care. With technology changing very quickly and new capabilities coming into the medical practice, such as telemedicine and Skype, you need to know your options when choosing a new telephone system. The possibilities include on-site, cloud, and hybrid networked solutions. A wide variety of features and capabilities are available, from dozens of vendors. Of course, no matter what telephone solution you choose, you must meet regulatory compliance, particularly HIPAA, and Payment Card Industry Data Security Standard if you take credit cards. And it has to be affordable, reliable, and long lasting. This article explores what medical practices need to know when choosing a new business telephone system in order to find the right solutions for their businesses.

Practical Considerations for Clinical PET/MR Imaging.

PubMed

Galgano, Samuel; Viets, Zachary; Fowler, Kathryn; Gore, Lael; Thomas, John V; McNamara, Michelle; McConathy, Jonathan

2018-01-01

Clinical PET/MR imaging is currently performed at a number of centers around the world as part of routine standard of care. This article focuses on issues and considerations for a clinical PET/MR imaging program, focusing on routine standard-of-care studies. Although local factors influence how clinical PET/MR imaging is implemented, the approaches and considerations described here intend to apply to most clinical programs. PET/MR imaging provides many more options than PET/computed tomography with diagnostic advantages for certain clinical applications but with added complexity. A recurring theme is matching the PET/MR imaging protocol to the clinical application to balance diagnostic accuracy with efficiency. Copyright © 2017 Elsevier Inc. All rights reserved.

Practical Considerations for Clinical PET/MR Imaging.

PubMed

Galgano, Samuel; Viets, Zachary; Fowler, Kathryn; Gore, Lael; Thomas, John V; McNamara, Michelle; McConathy, Jonathan

2017-05-01

Clinical PET/MR imaging is currently performed at a number of centers around the world as part of routine standard of care. This article focuses on issues and considerations for a clinical PET/MR imaging program, focusing on routine standard-of-care studies. Although local factors influence how clinical PET/MR imaging is implemented, the approaches and considerations described here intend to apply to most clinical programs. PET/MR imaging provides many more options than PET/computed tomography with diagnostic advantages for certain clinical applications but with added complexity. A recurring theme is matching the PET/MR imaging protocol to the clinical application to balance diagnostic accuracy with efficiency. Copyright © 2016 Elsevier Inc. All rights reserved.

Quality standards for bone conduction implants.

PubMed

Gavilan, Javier; Adunka, Oliver; Agrawal, Sumit; Atlas, Marcus; Baumgartner, Wolf-Dieter; Brill, Stefan; Bruce, Iain; Buchman, Craig; Caversaccio, Marco; De Bodt, Marc T; Dillon, Meg; Godey, Benoit; Green, Kevin; Gstoettner, Wolfgang; Hagen, Rudolf; Hagr, Abdulrahman; Han, Demin; Kameswaran, Mohan; Karltorp, Eva; Kompis, Martin; Kuzovkov, Vlad; Lassaletta, Luis; Li, Yongxin; Lorens, Artur; Martin, Jane; Manoj, Manikoth; Mertens, Griet; Mlynski, Robert; Mueller, Joachim; O'Driscoll, Martin; Parnes, Lorne; Pulibalathingal, Sasidharan; Radeloff, Andreas; Raine, Christopher H; Rajan, Gunesh; Rajeswaran, Ranjith; Schmutzhard, Joachim; Skarzynski, Henryk; Skarzynski, Piotr; Sprinzl, Georg; Staecker, Hinrich; Stephan, Kurt; Sugarova, Serafima; Tavora, Dayse; Usami, Shin-Ichi; Yanov, Yuri; Zernotti, Mario; Zorowka, Patrick; de Heyning, Paul Van

2015-01-01

Bone conduction implants are useful in patients with conductive and mixed hearing loss for whom conventional surgery or hearing aids are no longer an option. They may also be used in patients affected by single-sided deafness. To establish a consensus on the quality standards required for centers willing to create a bone conduction implant program. To ensure a consistently high level of service and to provide patients with the best possible solution the members of the HEARRING network have established a set of quality standards for bone conduction implants. These standards constitute a realistic minimum attainable by all implant clinics and should be employed alongside current best practice guidelines. Fifteen items are thoroughly analyzed. They include team structure, accommodation and clinical facilities, selection criteria, evaluation process, complete preoperative and surgical information, postoperative fitting and assessment, follow-up, device failure, clinical management, transfer of care and patient complaints.

NHS Dentistry: Options for Change in context--a personal overview of a landmark document and what it could mean for the future of dental services.

PubMed

Pitts, N B

2003-12-06

The aims of this paper are to provide an impartial overview of the proposals and agenda for the future brought together in the NHS Dentistry: Options for Change document in the context of previous dental service delivery in primary care, and to start to explore what Options for Change could mean for the future of NHS dental services. Options has been described as perhaps the most radical and ground breaking opportunity for NHS dentistry to finally move forward after prolonged periods of stagnation and disharmony. The Options agenda has the potential to bring in a new style of NHS practice for dentistry, providing a way to finally get off the current 'treadmill' and to develop new NHS dental services where prevention is a priority and providing high quality dental treatment, tailored to the long term needs of the 21st century patient, is the driving aim. However, the difficulties on all sides of leaving behind decades of disputes and overcoming real access, workforce and funding issues must not be underestimated or dismissed. The report was prepared by a working group comprising representatives from the profession, of patient groups and various sections of the Department of Health in England which was brought together by the then Chief Dental Officer. The key themes and priorities for action identified in Options include: local commissioning and funding, methods of remuneration for general dental practitioners, prevention and an oral health assessment for patients, clinical pathways, information and communication technology, practice structure, development of the dental team and the patient experience. The document also contains comprehensive reports of the three Options for Change task groups making recommendations for: 1) a new deal for patients - national standards, 2) systems of delivery of dental care and 3) education, training and development of the dental team. Ways forward for delivering improved, modern, effective, preventive, patient-centred dental care have been identified. This potential can, however, only be realised if viable and sustainable agreements can be achieved to operationalise the best choices.

40 CFR 63.5810 - What are my options for meeting the standards for open molding and centrifugal casting operations...

Code of Federal Regulations, 2013 CFR

2013-07-01

... standards for open molding and centrifugal casting operations at new and existing sources? 63.5810 Section... Meeting Standards § 63.5810 What are my options for meeting the standards for open molding and centrifugal...) through (d) of this section to meet the standards for open molding or centrifugal casting operations in...

Recommendations for genetic testing to reduce the incidence of anthracycline-induced cardiotoxicity.

PubMed

Aminkeng, Folefac; Ross, Colin J D; Rassekh, Shahrad R; Hwang, Soomi; Rieder, Michael J; Bhavsar, Amit P; Smith, Anne; Sanatani, Shubhayan; Gelmon, Karen A; Bernstein, Daniel; Hayden, Michael R; Amstutz, Ursula; Carleton, Bruce C

2016-09-01

Anthracycline-induced cardiotoxicity (ACT) occurs in 57% of treated patients and remains an important limitation of anthracycline-based chemotherapy. In various genetic association studies, potential genetic risk markers for ACT have been identified. Therefore, we developed evidence-based clinical practice recommendations for pharmacogenomic testing to further individualize therapy based on ACT risk. We followed a standard guideline development process, including a systematic literature search, evidence synthesis and critical appraisal, and the development of clinical practice recommendations with an international expert group. RARG rs2229774, SLC28A3 rs7853758 and UGT1A6 rs17863783 variants currently have the strongest and the most consistent evidence for association with ACT. Genetic variants in ABCC1, ABCC2, ABCC5, ABCB1, ABCB4, CBR3, RAC2, NCF4, CYBA, GSTP1, CAT, SULT2B1, POR, HAS3, SLC22A7, SCL22A17, HFE and NOS3 have also been associated with ACT, but require additional validation. We recommend pharmacogenomic testing for the RARG rs2229774 (S427L), SLC28A3 rs7853758 (L461L) and UGT1A6*4 rs17863783 (V209V) variants in childhood cancer patients with an indication for doxorubicin or daunorubicin therapy (Level B - moderate). Based on an overall risk stratification, taking into account genetic and clinical risk factors, we recommend a number of management options including increased frequency of echocardiogram monitoring, follow-up, as well as therapeutic options within the current standard of clinical practice. Existing evidence demonstrates that genetic factors have the potential to improve the discrimination between individuals at higher and lower risk of ACT. Genetic testing may therefore support both patient care decisions and evidence development for an improved prevention of ACT. © 2016 The British Pharmacological Society.

Recommendations for genetic testing to reduce the incidence of anthracycline‐induced cardiotoxicity

PubMed Central

Aminkeng, Folefac; Ross, Colin J. D.; Rassekh, Shahrad R.; Hwang, Soomi; Rieder, Michael J.; Bhavsar, Amit P.; Smith, Anne; Sanatani, Shubhayan; Gelmon, Karen A.; Bernstein, Daniel; Hayden, Michael R.; Amstutz, Ursula

2016-01-01

Aims Anthracycline‐induced cardiotoxicity (ACT) occurs in 57% of treated patients and remains an important limitation of anthracycline‐based chemotherapy. In various genetic association studies, potential genetic risk markers for ACT have been identified. Therefore, we developed evidence‐based clinical practice recommendations for pharmacogenomic testing to further individualize therapy based on ACT risk. Methods We followed a standard guideline development process, including a systematic literature search, evidence synthesis and critical appraisal, and the development of clinical practice recommendations with an international expert group. Results RARG rs2229774, SLC28A3 rs7853758 and UGT1A6 rs17863783 variants currently have the strongest and the most consistent evidence for association with ACT. Genetic variants in ABCC1, ABCC2, ABCC5, ABCB1, ABCB4, CBR3, RAC2, NCF4, CYBA, GSTP1, CAT, SULT2B1, POR, HAS3, SLC22A7, SCL22A17, HFE and NOS3 have also been associated with ACT, but require additional validation. We recommend pharmacogenomic testing for the RARG rs2229774 (S427L), SLC28A3 rs7853758 (L461L) and UGT1A6*4 rs17863783 (V209V) variants in childhood cancer patients with an indication for doxorubicin or daunorubicin therapy (Level B – moderate). Based on an overall risk stratification, taking into account genetic and clinical risk factors, we recommend a number of management options including increased frequency of echocardiogram monitoring, follow‐up, as well as therapeutic options within the current standard of clinical practice. Conclusions Existing evidence demonstrates that genetic factors have the potential to improve the discrimination between individuals at higher and lower risk of ACT. Genetic testing may therefore support both patient care decisions and evidence development for an improved prevention of ACT. PMID:27197003

Telelearning standards and their application in medical education.

PubMed

Duplaga, Mariusz; Juszkiewicz, Krzysztof; Leszczuk, Mikolaj

2004-01-01

Medial education, both on the graduate and postgraduate levels, has become a real challenge nowadays. The volume of information in medical sciences grows so rapidly that many health professionals experience essential problems in keeping track of the state of the art in this domain. e-learning offers important advantages to medical education continuation due to its universal availability and opportunity for implementation of flexible patterns of training. An important trace of medical education is developing practical skills. Some examples of standardization efforts include: the CEN/ISSS Workshop on Learning Technology (WSLT), the Advanced Learning Infrastructure Consortium (ALIC), Education Network Australia (EdNA) and PROmoting Multimedia access to Education and Training in European Society (PROMETEUS). Sun Microsystems' support (Sun ONE, iPlanetTM ) for many of the above-mentioned standards is described as well. Development of a medical digital video library with recordings of invasive procedures incorporating additional information and commentary may improve the efficiency of the training process in interventional medicine. A digital video library enabling access to videos of interventional procedures performed in the area of thoracic medicine may be a valuable element for developing practical skills. The library has been filled with video resources recorded at the Department of Interventional Pulmonology; it enhances training options for pulmonologists and thoracic surgeons. The main focus was put on demonstration of bronchofiberoscopic and videothoracoscopic procedures. The opportunity to browse video recordings of procedures performed in the specific field also considerably enhances the options for training in other medical specialties. In the era of growing health consumer awareness, patients are also perceived as the target audience for medical digital libraries. As a case study of Computer-Based Training systems, the Medical Digital Video Library is presented.

76 FR 39143 - Self-Regulatory Organizations; International Securities Exchange, LLC; Notice of Filing and...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-05

... Rule Change To Increase the Position and Exercise Limit for Options on the Standard & Poor's[supreg... exercise limit applicable to options on the Standard and Poor's[supreg] Depositary Receipts (``SPDRs[supreg... increase the position and exercise limit applicable to options on SPDRs[supreg], which are trading under...

78 FR 36005 - Self-Regulatory Organizations; The Options Clearing Corporation; Notice of Filing and Immediate...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-14

... Clear Over-the-Counter Index Options on Underlying Indices Published by Standard & Poor's Financial... publishing this notice to solicit comments on the proposed rule change from interested persons. \\1\\ 15 U.S.C...-counter (``OTC'') index options on underlying indices published by Standard & Poor's Financial Services...

78 FR 70961 - Agency Information Collection Activities; Submission for OMB Review; Comment Request; Notice to...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-11-27

... for OMB Review; Comment Request; Notice to Employees of Coverage Options Under Fair Labor Standards... Employees of Coverage Options Under Fair Labor Standards Act Section 18B,'' to the Office of Management and... and a related model notice of healthcare coverage options available under the Patient Protection and...

Management and marketing for the general practice dental office.

PubMed

Clarkson, Earl; Bhatia, Sanjeev

2008-07-01

This article reviews trends in the dental marketplace. Marketing is an essential element of dentistry. Communicating treatment options with patients is one aspect of marketing. Treatment planning helps patients understand the relationships between oral health, occlusion, temporomandibular joint function, and systemic health. Through marketing, dental practice owners inform patients of ever-changing treatment modalities. Understanding treatment options allows patients to make better, informed choices. More options leads to a higher level of care and more comprehensive dental treatment. Managing a practice requires tracking its financial health. Economic statistics measure the effect of management decisions that mark the direction of a dental practice.

31 CFR 344.2 - What general provisions apply to SLGS securities?

Code of Federal Regulations, 2014 CFR

2014-07-01

..., 2005, it is impermissible: (i) To use the SLGS program to create a cost-free option; (ii) To purchase a... a cost-free option. In addition, this practice is prohibited under paragraph (f)(1)(i) of this... would result in the SLGS program being used to create a cost-free option. In addition, this practice is...

Trying to optimise the German version of the OPTION scale regarding the dyadic aspect of shared decision making.

PubMed

Keller, H; Hirsch, O; Müller-Engelmann, M; Heinzel-Gutenbrunner, M; Krones, T; Donner-Banzhoff, N

2013-01-01

The OPTION scale ("observing patient involvement in decision making") assesses the extent to which clinicians involve patients in decisions across a range of situations in clinical practice. It so far just covers physician behavior. We intended to modify the scoring of the OPTION scale to incorporate active patient behavior in consultations. Modification was done on scoring level, attempting a dyadic, relationship-centred approach in that high ratings can be evoked also by the behaviour of active patients. The German version of the OPTION scale was compared with a modified version by analysing video recordings of primary care consultations dealing with cardiovascular prevention. Fifteen general practitioners provided 40 videotaped consultations. Videos were analysed by two rater pairs and two experts in shared decision making (SDM). Reliability measures of the modified version were lower than those of the original scale. Significant associations of the dichotomised scale with the expert SDM rating as well as with physicians' expertise in SDM were only found for the modified OPTION scale. Receiver Operating Characteristic (ROC) analyses confirmed a valid differentiation between the presence of SDM (yes/no) on total score level, even though the cut-off point was quite low. Standard deviations of the single items in the modified version were higher compared to the original OPTION scale, while the means of total scores were similar. The original OPTION scale is physician-centered and neglects the activity and a possible self-involvement of the patient. Our modified instruction was able to capture the dyadic element partially. The development of a separate dyadic instrument might be more promising.

Development of shared decision-making resources to help inform difficult healthcare decisions: An example focused on dysvascular partial foot and transtibial amputations.

PubMed

Quigley, Matthew; Dillon, Michael P; Fatone, Stefania

2018-02-01

Shared decision making is a consultative process designed to encourage patient participation in decision making by providing accurate information about the treatment options and supporting deliberation with the clinicians about treatment options. The process can be supported by resources such as decision aids and discussion guides designed to inform and facilitate often difficult conversations. As this process increases in use, there is opportunity to raise awareness of shared decision making and the international standards used to guide the development of quality resources for use in areas of prosthetic/orthotic care. To describe the process used to develop shared decision-making resources, using an illustrative example focused on decisions about the level of dysvascular partial foot amputation or transtibial amputation. Development process: The International Patient Decision Aid Standards were used to guide the development of the decision aid and discussion guide focused on decisions about the level of dysvascular partial foot amputation or transtibial amputation. Examples from these shared decision-making resources help illuminate the stages of development including scoping and design, research synthesis, iterative development of a prototype, and preliminary testing with patients and clinicians not involved in the development process. Lessons learnt through the process, such as using the International Patient Decision Aid Standards checklist and development guidelines, may help inform others wanting to develop similar shared decision-making resources given the applicability of shared decision making to many areas of prosthetic-/orthotic-related practice. Clinical relevance Shared decision making is a process designed to guide conversations that help patients make an informed decision about their healthcare. Raising awareness of shared decision making and the international standards for development of high-quality decision aids and discussion guides is important as the approach is introduced in prosthetic-/orthotic-related practice.

Management of immune thrombocytopenia: Korean experts recommendation in 2017.

PubMed

Jang, Jun Ho; Kim, Ji Yoon; Mun, Yeung-Chul; Bang, Soo-Mee; Lim, Yeon Jung; Shin, Dong-Yeop; Choi, Young Bae; Yhim, Ho-Young; Lee, Jong Wook; Kook, Hoon

2017-12-01

Management options for patients with immune thrombocytopenia (ITP) have evolved substantially over the past decades. The American Society of Hematology published a treatment guideline for clinicians referring to the management of ITP in 2011. This evidence-based practice guideline for ITP enables the appropriate treatment of a larger proportion of patients and the maintenance of normal platelet counts. Korean authority operates a unified mandatory national health insurance system. Even though we have a uniform standard guideline enforced by insurance reimbursement, there are several unsolved issues in real practice in ITP treatment. To optimize the management of Korean ITP patients, the Korean Society of Hematology Aplastic Anemia Working Party (KSHAAWP) reviewed the consensus and the Korean data on the clinical practices of ITP therapy. Here, we report a Korean expert recommendation guide for the management of ITP.

[A practical guide for the management of gliomas].

PubMed

Stupp, Roger; Pica, Alessia; Mirimanoff, René O; Michielin, Olivier

2007-09-01

The management of gliomas in daily clinical practice is challenging. It requires a multidisciplinary and coordinated approach involving neurosurgery, radiotherapy and, finally, chemotherapy. Important progress has been made during the last years with the introduction of a combined treatment associating standard radiotherapy with concomitant chemotherapy using temozolomide, a novel alkylating agent. For the first time in many years a new treatment strategy translated into a significant prolongation of survival. In parallel, molecular markers (e.g. loss of heterozygosity on chromosomes 1p and 19q or methylation of the methyl-guanine methyl transferase [MGMT] gene promoter) allowed for identification of distinct subtypes of glioma or prediction of treatment response. In this "Practical Guide", we describe the daily practice and aim at answering some common questions in the management of patients suffering from glioblastoma, astrocytoma, oligodendroglioma and low grade glioma. The therapeutic options presented here are based on evidences from the literature. In the absence of documented evidence, the empirical choices from our local practice are explained and justified.

Patient and Clinician Openness to Including a Broader Range of Healing Options in Primary Care

PubMed Central

Hsu, Clarissa; Cherkin, Daniel C.; Hoffmeyer, Sylvia; Sherman, Karen J.; Phillips, William R.

2011-01-01

PURPOSE We studied the openness of patients and clinicians to introducing a broader range of healing options into primary care. METHODS Focus groups were conducted with primary care patients (4 groups) and clinicians (3 groups) from an integrated medical care system in 2008. Transcripts of discussions were analyzed using an immersion/crystallization approach. RESULTS Both patients (n = 44) and clinicians (n = 32) were open to including a wider variety of healing options in primary care. Patients desired some evidence of effectiveness, although there was wide variation in the type of evidence required. Many patients believed that the clinician’s personal and practice experience was an important form of evidence. Patients wanted to share in the decision to refer and the choice of options. Clinicians were most concerned with safety of specific treatments, including some of the herbs and dietary supplements. They also believed they lacked adequate information about the nature, benefits, and risks of many alternatives, and they were not aware of local practitioners and resources to whom they could confidently refer their patients. Both patients and clinicians were concerned that services recommended be covered by insurance or be affordable to patients. CONCLUSIONS Integrating additional healing options into primary care may be feasible and desirable, as well as help meet the needs of patients with conditions that have not been responsive to standard medical treatments. PMID:21911764

Practical issues surrounding the explosion of tyrosine kinase inhibitors for the management of chronic myeloid leukemia.

PubMed

Mathisen, Michael S; Kantarjian, Hagop M; Cortes, Jorge; Jabbour, Elias J

2014-09-01

The advent of tyrosine kinase inhibitors (TKIs) has drastically changed the treatment outcome of chronic myeloid leukemia (CML). Imatinib was the first TKI approved, and has been considered the standard of care for more than a decade. Second generation compounds, namely dasatinib and nilotinib, are highly effective in newly diagnosed patients as well as those who fail imatinib. Bosutinib and ponatinib have also become available as second line options. With five agents from which to choose, selecting a TKI has become a challenge. Multiple tests are now available to determine a patient's disease status, making the ideal monitoring strategy unclear. The gold standard for response to TKI therapy remains the achievement of complete cytogenetic response. This review will discuss the practical aspects of selecting a TKI and monitoring a patient once on therapy, including when to consider a treatment change. Other relevant issues, including cost, compliance, role of allogeneic hematopoietic cell transplantation, and discontinuation of TKIs will also be covered. Copyright © 2014. Published by Elsevier Ltd.

Fracture healing: A review of clinical, imaging and laboratory diagnostic options.

PubMed

Cunningham, Brian P; Brazina, Sloane; Morshed, Saam; Miclau, Theodore

2017-06-01

A fundamental issue in clinical orthopaedics is the determination of when a fracture is united. However, there are no established "gold standards," nor standardized methods for assessing union, which has resulted in significant disagreement among orthopaedic surgeons in both clinical practice and research. A great deal of investigative work has been directed to addressing this problem, with a number of exciting new techniques described. This review provides a brief summary of the burden of nonunion fractures and addresses some of the challenges related to the assessment of fracture healing. The tools currently available to determine union are discussed, including various imaging modalities, biomechanical testing methods, and laboratory and clinical assessments. The evaluation of fracture healing in the setting of both patient care and clinical research is integral to the orthopaedic practice. Weighted integration of several available metrics must be considered to create a composite outcome measure of patient prognosis. Copyright © 2017 Elsevier Ltd. All rights reserved.

41 CFR 102-194.25 - What is an automated Standard or Optional format?

Code of Federal Regulations, 2010 CFR

2010-07-01

... Property Management Regulations System (Continued) FEDERAL MANAGEMENT REGULATION ADMINISTRATIVE PROGRAMS 194-STANDARD AND OPTIONAL FORMS MANAGEMENT PROGRAM § 102-194.25 What is an automated Standard or... 41 Public Contracts and Property Management 3 2010-07-01 2010-07-01 false What is an automated...

40 CFR 63.5810 - What are my options for meeting the standards for open molding and centrifugal casting operations...

Code of Federal Regulations, 2011 CFR

2011-07-01

... standards for open molding and centrifugal casting operations at new and existing sources? 63.5810 Section... § 63.5810 What are my options for meeting the standards for open molding and centrifugal casting... (d) of this section to meet the standards for open molding or centrifugal casting operations in Table...

40 CFR 63.5810 - What are my options for meeting the standards for open molding and centrifugal casting operations...

Code of Federal Regulations, 2010 CFR

2010-07-01

... standards for open molding and centrifugal casting operations at new and existing sources? 63.5810 Section... § 63.5810 What are my options for meeting the standards for open molding and centrifugal casting... (d) of this section to meet the standards for open molding or centrifugal casting operations in Table...

48 CFR 2917.207 - Exercising options.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 7 2010-10-01 2010-10-01 false Exercising options. 2917... AND CONTRACT TYPES SPECIAL CONTRACTING METHODS Options 2917.207 Exercising options. The contracting officer must use a standardized determination and finding before exercising an option in accordance with...

Oncologists' attitudes and practices regarding banking sperm before cancer treatment.

PubMed

Schover, Leslie R; Brey, Kimberly; Lichtin, Alan; Lipshultz, Larry I; Jeha, Sima

2002-04-01

The goal of this study was to survey oncologists in three different practice settings to determine their knowledge, attitudes, and practices regarding referring patients to bank sperm before cancer treatment. A postal survey about knowledge, attitudes, and practices regarding banking sperm before cancer treatment was sent to 718 oncology staff physicians and fellows at two cancer centers and at sites in a Community Clinical Oncology Program. The return rate was 24% and did not differ by institution, oncologic specialty, or sex. Fellows were significantly more likely to participate (37%) than staff physicians (20%). Ninety-one percent of respondents agreed that sperm banking should be offered to all men at risk of infertility as a result of cancer treatment, but 48% either never bring up the topic or mention it to less than a quarter of eligible men. Neither greater knowledge about sperm banking nor seeing large numbers of eligible men yearly increased the likelihood of discussing the option. Barriers cited included lack of time for the discussion, perceived high cost, and lack of convenient facilities. Oncologists reported they would be less likely to offer sperm banking to men who were homosexual, HIV-positive, had a poor prognosis, or had aggressive tumors. Oncologists overestimated the costs of sperm banking and the number of samples needed to make cryopreservation worthwhile. Sperm banking should be offered as an option to all men at risk of infertility because of their cancer treatment. Clearer practice standards could help oncologists increase their knowledge about sperm banking and avoid dependence on biased patient selection criteria.

Erectile dysfunction management options in Nigeria.

PubMed

Afolayan, Anthony Jide; Yakubu, Musa Toyin

2009-04-01

In Nigeria, the prevalence of erectile dysfunction (ED) among patients attending primary care clinics, age-standardized to the U.S. population in 2000 is 57.4%. This is considered high enough to warrant the attention of scientist for critical studies and analysis. The high ED prevalence is associated with etiologies such as psychosexual factors, chronic medical conditions, and some lifestyles. ED constitutes a major public health problem, influencing the patient's well-being and quality of life. It also leads to broken homes and marriages, psychological, social, and physical morbidity. To give an account of various ED management options in Nigeria. Review of peer-reviewed literature, questionnaire, and ethnobotanical survey to some indigenous herb sellers and herbalists. Cross cultural perspectives of ED management in Nigeria. The review suggests that traditional (phytotherapy, zootherapy, and occultism) and nontraditional, orthodox practice (drug therapy, psychological, and behavioral counseling) are applicable to ED management in Nigeria. This review should help in creating awareness into various options available for managing ED in the country, but does not recommend self medication of any form, be it the use of orthodox or herbal remedy.

The commercial sector: marketing diet and fitness responsibly.

PubMed

Conley, R

1998-08-01

The commercial sector, through a range of products and services, is already heavily involved in the weight loss industry. Because of its capability to access millions of people, it has great potential for promoting public health through dietary and exercise practices. However, an absence of controls or advertising standards, safety and quality, currently threatens its credibility. This paper draws from my own experience developing a now well-established diet and fitness organisation. It makes the case that the best quality products and practice arise from close collaboration with scientific experts in the field. Effectiveness is increased through the distribution of sound educational messages, through an array of commercial options that include books, magazines, videos, television and diet and exercise clubs.

Metrological challenges for measurements of key climatological observables Part 2: oceanic salinity

NASA Astrophysics Data System (ADS)

Pawlowicz, R.; Feistel, R.; McDougall, T. J.; Ridout, P.; Seitz, S.; Wolf, H.

2016-02-01

Salinity is a key variable in the modelling and observation of ocean circulation and ocean-atmosphere fluxes of heat and water. In this paper, we examine the climatological relevance of ocean salinity, noting fundamental deficiencies in the definition of this key observable, and its lack of a secure foundation in the International System of Units, the SI. The metrological history of salinity is reviewed, problems with its current definitions and measurement practices are analysed, and options for future improvements are discussed in conjunction with the recent seawater standard TEOS-10.

41 CFR 102-194.40 - For what Standard or Optional forms should an electronic version not be made available?

Code of Federal Regulations, 2010 CFR

2010-07-01

... 41 Public Contracts and Property Management 3 2010-07-01 2010-07-01 false For what Standard or... Contracts and Property Management Federal Property Management Regulations System (Continued) FEDERAL MANAGEMENT REGULATION ADMINISTRATIVE PROGRAMS 194-STANDARD AND OPTIONAL FORMS MANAGEMENT PROGRAM § 102-194.40...

76 FR 58061 - Self-Regulatory Organizations; Options Clearing Corporation; Notice of Filing of Proposed Rule...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-19

... Organizations; Options Clearing Corporation; Notice of Filing of Proposed Rule Change To Adopt Fitness Standards... purpose of the proposed rule change is to establish fitness standards for directors, clearing members, and... Core Principle O requires DCOs to establish fitness standards for directors, clearing members and...

40 CFR 63.5830 - What are my options for meeting the standards for pultrusion operations subject to the 60 weight...

Code of Federal Regulations, 2010 CFR

2010-07-01

... standards for pultrusion operations subject to the 60 weight percent organic HAP emissions reductions... National Emissions Standards for Hazardous Air Pollutants: Reinforced Plastic Composites Production Options... operations subject to the 60 weight percent organic HAP emissions reductions requirement? You must use one or...

Opinion and Special Articles: Loan forgiveness options for young neurologists: Current landscape and practice implications.

PubMed

George, Benjamin P; Dorsey, E Ray; Grischkan, Justin A

2017-04-11

Increasing education debt has led to the availability of a variety of loan forgiveness options including the Department of Education's Public Service Loan Forgiveness (PSLF) program. This article discusses the current landscape of loan forgiveness options including trends in PSLF for rising neurology trainees, and implications for choices in specialization, employment, practice location, and the pursuit of an academic career. We further provide guidance on how to navigate the various loan forgiveness options that neurology residents and fellows may consider. © 2017 American Academy of Neurology.

Joint BAP NAPICU evidence-based consensus guidelines for the clinical management of acute disturbance: De-escalation and rapid tranquillisation.

PubMed

Patel, Maxine X; Sethi, Faisil N; Barnes, Thomas Re; Dix, Roland; Dratcu, Luiz; Fox, Bernard; Garriga, Marina; Haste, Julie C; Kahl, Kai G; Lingford-Hughes, Anne; McAllister-Williams, Hamish; O'Brien, Aileen; Parker, Caroline; Paterson, Brodie; Paton, Carol; Posporelis, Sotiris; Taylor, David M; Vieta, Eduard; Völlm, Birgit; Wilson-Jones, Charlotte; Woods, Laura

2018-06-01

The British Association for Psychopharmacology and the National Association of Psychiatric Intensive Care and Low Secure Units developed this joint evidence-based consensus guideline for the clinical management of acute disturbance. It includes recommendations for clinical practice and an algorithm to guide treatment by healthcare professionals with various options outlined according to their route of administration and category of evidence. Fundamental overarching principles are included and highlight the importance of treating the underlying disorder. There is a focus on three key interventions: de-escalation, pharmacological interventions pre-rapid tranquillisation and rapid tranquillisation (intramuscular and intravenous). Most of the evidence reviewed relates to emergency psychiatric care or acute psychiatric adult inpatient care, although we also sought evidence relevant to other common clinical settings including the general acute hospital and forensic psychiatry. We conclude that the variety of options available for the management of acute disturbance goes beyond the standard choices of lorazepam, haloperidol and promethazine and includes oral-inhaled loxapine, buccal midazolam, as well as a number of oral antipsychotics in addition to parenteral options of intramuscular aripiprazole, intramuscular droperidol and intramuscular olanzapine. Intravenous options, for settings where resuscitation equipment and trained staff are available to manage medical emergencies, are also included.

The indications for polysomnography and related procedures.

PubMed

Chesson, A L; Ferber, R A; Fry, J M; Grigg-Damberger, M; Hartse, K M; Hurwitz, T D; Johnson, S; Kader, G A; Littner, M; Rosen, G; Sangal, R B; Schmidt-Nowara, W; Sher, A

1997-06-01

This paper is a review of the literature on the use of polysomnography in the diagnosis of sleep disorders in the adult. It is based on a search of MEDLINE from January 1966 through April 1996. It has been reviewed and approved by the Board of Directors of the American Sleep Disorders Association and provides the background for the accompanying ASDA Standards of Practice Committee's Parameters for the Practice of Sleep Medicine in North America. The diagnostic categories reviewed are: sleep-related breathing disorders; other respiratory disorders; narcolepsy; parasomnias and sleep-related epilepsy; restless legs syndrome and periodic limb movement disorders: insomnia; and circadian rhythm sleep disorders. Where appropriate, previously published practice parameters papers are cited and discussed. The relevant published peer-reviewed literature used as the basis for critical decisions was compiled into accompanying evidence tables and is analyzed in the text. In the section on the assessment of sleep apnea syndrome, options for estimating pretest probability to select high risk patients are also reviewed. Sleep-testing procedures other than standard polysomnography are also addressed (daytime polysomnography, split-night studies, oximetry, limited full respiratory recordings, and less-than-full respiratory recording) and treatment-related follow-up studies are discussed.

Analyzing Two-Phase Single-Case Data with Non-overlap and Mean Difference Indices: Illustration, Software Tools, and Alternatives.

PubMed

Manolov, Rumen; Losada, José L; Chacón-Moscoso, Salvador; Sanduvete-Chaves, Susana

2016-01-01

Two-phase single-case designs, including baseline evaluation followed by an intervention, represent the most clinically straightforward option for combining professional practice and research. However, unless they are part of a multiple-baseline schedule, such designs do not allow demonstrating a causal relation between the intervention and the behavior. Although the statistical options reviewed here cannot help overcoming this methodological limitation, we aim to make practitioners and applied researchers aware of the available appropriate options for extracting maximum information from the data. In the current paper, we suggest that the evaluation of behavioral change should include visual and quantitative analyses, complementing the substantive criteria regarding the practical importance of the behavioral change. Specifically, we emphasize the need to use structured criteria for visual analysis, such as the ones summarized in the What Works Clearinghouse Standards, especially if such criteria are complemented by visual aids, as illustrated here. For quantitative analysis, we focus on the non-overlap of all pairs and the slope and level change procedure, as they offer straightforward information and have shown reasonable performance. An illustration is provided of the use of these three pieces of information: visual, quantitative, and substantive. To make the use of visual and quantitative analysis feasible, open source software is referred to and demonstrated. In order to provide practitioners and applied researchers with a more complete guide, several analytical alternatives are commented on pointing out the situations (aims, data patterns) for which these are potentially useful.

Analyzing Two-Phase Single-Case Data with Non-overlap and Mean Difference Indices: Illustration, Software Tools, and Alternatives

PubMed Central

Manolov, Rumen; Losada, José L.; Chacón-Moscoso, Salvador; Sanduvete-Chaves, Susana

2016-01-01

Two-phase single-case designs, including baseline evaluation followed by an intervention, represent the most clinically straightforward option for combining professional practice and research. However, unless they are part of a multiple-baseline schedule, such designs do not allow demonstrating a causal relation between the intervention and the behavior. Although the statistical options reviewed here cannot help overcoming this methodological limitation, we aim to make practitioners and applied researchers aware of the available appropriate options for extracting maximum information from the data. In the current paper, we suggest that the evaluation of behavioral change should include visual and quantitative analyses, complementing the substantive criteria regarding the practical importance of the behavioral change. Specifically, we emphasize the need to use structured criteria for visual analysis, such as the ones summarized in the What Works Clearinghouse Standards, especially if such criteria are complemented by visual aids, as illustrated here. For quantitative analysis, we focus on the non-overlap of all pairs and the slope and level change procedure, as they offer straightforward information and have shown reasonable performance. An illustration is provided of the use of these three pieces of information: visual, quantitative, and substantive. To make the use of visual and quantitative analysis feasible, open source software is referred to and demonstrated. In order to provide practitioners and applied researchers with a more complete guide, several analytical alternatives are commented on pointing out the situations (aims, data patterns) for which these are potentially useful. PMID:26834691

Benefits and Limitations of Real Options Analysis for the Practice of River Flood Risk Management

NASA Astrophysics Data System (ADS)

Kind, Jarl M.; Baayen, Jorn H.; Botzen, W. J. Wouter

2018-04-01

Decisions on long-lived flood risk management (FRM) investments are complex because the future is uncertain. Flexibility and robustness can be used to deal with future uncertainty. Real options analysis (ROA) provides a welfare-economics framework to design and evaluate robust and flexible FRM strategies under risk or uncertainty. Although its potential benefits are large, ROA is hardly used in todays' FRM practice. In this paper, we investigate benefits and limitations of a ROA, by applying it to a realistic FRM case study for an entire river branch. We illustrate how ROA identifies optimal short-term investments and values future options. We develop robust dike investment strategies and value the flexibility offered by additional room for the river measures. We benchmark the results of ROA against those of a standard cost-benefit analysis and show ROA's potential policy implications. The ROA for a realistic case requires a high level of geographical detail, a large ensemble of scenarios, and the inclusion of stakeholders' preferences. We found several limitations of applying the ROA. It is complex. In particular, relevant sources of uncertainty need to be recognized, quantified, integrated, and discretized in scenarios, requiring subjective choices and expert judgment. Decision trees have to be generated and stakeholders' preferences have to be translated into decision rules. On basis of this study, we give general recommendations to use high discharge scenarios for the design of measures with high fixed costs and few alternatives. Lower scenarios may be used when alternatives offer future flexibility.

Pollution prevention options to meet impending MACT standards: A compendium

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

Berglund, R.L.; Pickron, J.S.

1997-12-31

Under the Clean Air Act Amendments of 1990, the EPA was charged with developing MACT standards for a large group of operations representing a variety of different industry categories. While pollution prevention opportunities for meeting the requirements of the HON standards for the synthetic organic chemical manufacturing industry (SOCMI) and similar standards for the refining industry have drawn significant discussion and attention, little guidance for considering pollution prevention options for meeting other MACT standards have been provided. Yet, in working with companies to meet the requirements of proposed MACT standards for the shipbuilding, wood processing, plastics and gas processing industries,more » a number of pollution prevention opportunities for meeting these requirements were identified in early compliance strategies. This paper will provide a compendium of pollution prevention options for meeting these and other proposed and promulgated MACT standards.« less

Molecular diagnosis of bloodstream infections: planning to (physically) reach the bedside.

PubMed

Leggieri, N; Rida, A; François, P; Schrenzel, Jacques

2010-08-01

Faster identification of infecting microorganisms and treatment options is a first-ranking priority in the infectious disease area, in order to prevent inappropriate treatment and overuse of broad-spectrum antibiotics. Standard bacterial identification is intrinsically time-consuming, and very recently there has been a burst in the number of commercially available nonphenotype-based techniques and in the documentation of a possible clinical impact of these techniques. Matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS) is now a standard diagnostic procedure on cultures and hold promises on spiked blood. Meanwhile, commercial PCR-based techniques have improved with the use of bacterial DNA enrichment methods, the diversity of amplicon analysis techniques (melting curve analysis, microarrays, gel electrophoresis, sequencing and analysis by mass spectrometry) leading to the ability to challenge bacterial culture as the gold standard for providing earlier diagnosis with a better 'clinical' sensitivity and additional prognostic information. Laboratory practice has already changed with MALDI-TOF MS, but a change in clinical practice, driven by emergent nucleic acid-based techniques, will need the demonstration of real-life applicability as well as robust clinical-impact-oriented studies.

Management options of non-syndromic sagittal craniosynostosis.

PubMed

Lee, Bryan S; Hwang, Lee S; Doumit, Gaby D; Wooley, Joseph; Papay, Francis A; Luciano, Mark G; Recinos, Violette M

2017-05-01

There have been various effective surgical procedures for the treatment of non-syndromic sagittal craniosynostosis, but no definitive guidelines for management have been established. We conducted a study to elucidate the current state of practice and establish a warranted standard of care. An Internet-based study was sent to 180 pediatric neurosurgeons across the country and 102 craniofacial plastic surgeons in fourteen different countries, to collect data for primary indication for surgical management, preference for timing and choice of surgery, and pre-, peri-, and post-operative management options. The overall response rate from both groups was 32% (n=90/284). Skull deformity was the primary indication for surgical treatment in patients without signs of hydrocephalus for both neurosurgeons and craniofacial surgeons (80% and 63%, respectively). Open surgical management was most commonly performed at six months of age by neurosurgeons (46%) and also by craniofacial surgeons (35%). Open surgical approach was favored for patients younger than four months of age by neurosurgeons (50%), but endoscopic approach was favored by craniofacial surgeons (35%). When performing an open surgical intervention, most neurosurgeons preferred pi or reversed pi procedure (27%), whereas total cranial vault remodeling was the most commonly performed procedure by craniofacial surgeons (37%). The data demonstrated a discrepancy in the treatment options for non-syndromic sagittal craniosynostosis. By conducting/comparing a wide survey to collect consolidative data from both groups of pediatric neurosurgeons and craniofacial plastic surgeons, we can attempt to facilitate the establishment of standard of care. Copyright © 2017 Elsevier Ltd. All rights reserved.

Summary of Propagation Cases of the Second AIAA Sonic Boom Prediction Workshop

NASA Technical Reports Server (NTRS)

Rallabhandi, Sriram; Loubeau, Alexandra

2017-01-01

A summary is provided for the propagation portion of the second AIAA Sonic Boom Workshop held January 8, 2017 in conjunction with the AIAA SciTech 2017 conference. Near-field pressure waveforms for two cases were supplied and ground signatures at multiple azimuthal angles as well as their corresponding loudness metrics were requested from 10 participants, representing 3 countries. Each case had some required runs, as well as some optional runs. The required cases included atmospheric profiles with measured data including winds, using Radiosonde balloon data at multiple geographically spread locations, while the optional cases included temperature and pressure profiles from the US Standard atmosphere. The humidity profiles provided for the optional cases were taken from ANSI guidance, as the authors were unaware of an accepted standard at the time the cases were released to the participants. Participants provided ground signatures along with the requested data, including some loudness metrics using their best practices, which included lossy as well as lossless schemes. All the participants' submissions, for each case, are compared and discussed. Noise or loudness measures are calculated and detailed comparisons and statistical analyses are performed and presented. It has been observed that the variation in the loudness measures and spread between participants' submissions increased as the computation proceeded from under-track locations towards the lateral cut-off. Lessons learned during this workshop are discussed and recommendations are made for potential improvements and possible subsequent workshops as we collectively attempt to refine our analysis methods.

Decoding Dynamic Brain Patterns from Evoked Responses: A Tutorial on Multivariate Pattern Analysis Applied to Time Series Neuroimaging Data.

PubMed

Grootswagers, Tijl; Wardle, Susan G; Carlson, Thomas A

2017-04-01

Multivariate pattern analysis (MVPA) or brain decoding methods have become standard practice in analyzing fMRI data. Although decoding methods have been extensively applied in brain-computer interfaces, these methods have only recently been applied to time series neuroimaging data such as MEG and EEG to address experimental questions in cognitive neuroscience. In a tutorial style review, we describe a broad set of options to inform future time series decoding studies from a cognitive neuroscience perspective. Using example MEG data, we illustrate the effects that different options in the decoding analysis pipeline can have on experimental results where the aim is to "decode" different perceptual stimuli or cognitive states over time from dynamic brain activation patterns. We show that decisions made at both preprocessing (e.g., dimensionality reduction, subsampling, trial averaging) and decoding (e.g., classifier selection, cross-validation design) stages of the analysis can significantly affect the results. In addition to standard decoding, we describe extensions to MVPA for time-varying neuroimaging data including representational similarity analysis, temporal generalization, and the interpretation of classifier weight maps. Finally, we outline important caveats in the design and interpretation of time series decoding experiments.

Systemic therapy in muscle-invasive and metastatic bladder cancer: current trends and future promises.

PubMed

Aragon-Ching, Jeanny B; Trump, Donald L

2016-09-01

Bladder urothelial cancers remain an important urologic cancer with limited treatment options in the locally advanced and metastatic setting. While neoadjuvant chemotherapy for locally advanced muscle-invasive cancers has shown overall survival benefit, clinical uptake in practice have lagged behind. Controversies surrounding adjuvant chemotherapy use are also ongoing. Systemic therapies for metastatic bladder cancer have largely used platinum-based therapies without effective standard second-line therapy options for those who fail, although vinflunine is approved in Europe as a second-line therapy based on a Phase III trial, and most recently, atezolizumab, a checkpoint inhibitor, was approved by the US FDA. Given increasing recognition of mutational signatures expressed in urothelial carcinomas, several promising agents with use of VEGF-targeted therapies, HER2-directed agents and immunotherapies with PD-1/PD-L1 antibodies in various settings are discussed herein.

Statin-related myotoxicity.

PubMed

Fernandes, Vera; Santos, Maria Joana; Pérez, Antonio

2016-05-01

Statin therapy has a very important role in decreasing cardiovascular risk, and treatment non-compliance may therefore be a concern in high cardiovascular risk patients. Myotoxicity is a frequent side effect of statin therapy and one of the main causes of statin discontinuation, which limits effective treatment of patients at risk of or with cardiovascular disease. Because of the high proportion of patients on statin treatment and the frequency of statin-related myotoxicity, this is a subject of concern in clinical practice. However, statin-related myotoxicity is probably underestimated because there is not a gold standard definition, and its diagnosis is challenging. Moreover, information about pathophysiology and optimal therapeutic options is scarce. Therefore, this paper reviews the knowledge about the definition, pathophysiology and predisposing conditions, diagnosis and management of statin-related myotoxicity, and provides a practical scheme for its management in clinical practice. Copyright © 2016 SEEN. Published by Elsevier España, S.L.U. All rights reserved.

Managing the risks of disease transmission through trade: a commodities-based approach?

PubMed

Brückner, G K

2011-04-01

Since its founding in 1924, the World Organisation for Animal Health (OIE) has facilitated safe trade in animals and animal products by developing effective standards to prevent the spread of animal diseases across the globe. A protocol for recognising the disease-free status of countries is an integral part of this process and has been adopted and advanced through the years to assist OIE Member Countries in placing disease-free animals and their products on the international market. Options such as trade from disease-free zones and disease-free compartments are now available to Members and have proven to be a positive mechanism for facilitating trade. A further option is trading in safe commodities, i.e. animals and animal products that have been identified as safe to trade even in the presence of disease, either with or without applying risk mitigation measures before export. Although most Members have incorporated the acceptance of disease-free countries or zones into their animal health policies and sanitary measures, there still appears to be a reluctance to trade in commodities from infected countries, despite clear, scientifically based risk management standards that can be applied if needed. This paper offers some examples reflecting the apparent reluctance to trade in commodities and discusses how the standards in the OIE's Terrestrial Animal Health Code could be used to apply scientifically based risk management practices to review outdated policies.

17 CFR 155.2 - Trading standards for floor brokers.

Code of Federal Regulations, 2013 CFR

2013-04-01

... TRADING STANDARDS § 155.2 Trading standards for floor brokers. Each contract market shall adopt rules which shall, at a minimum, with respect to each member of the contract market acting as a floor broker... option, or (3) sale of any put option, in the same commodity which is executable at the market price or...

17 CFR 155.2 - Trading standards for floor brokers.

Code of Federal Regulations, 2014 CFR

2014-04-01

... (CONTINUED) TRADING STANDARDS § 155.2 Trading standards for floor brokers. Each contract market shall adopt rules which shall, at a minimum, with respect to each member of the contract market acting as a floor... option, or (3) sale of any put option, in the same commodity which is executable at the market price or...

Pragmatic characteristics of patient-reported outcome measures are important for use in clinical practice.

PubMed

Kroenke, Kurt; Monahan, Patrick O; Kean, Jacob

2015-09-01

Measures for assessing patient-reported outcomes (PROs) that may have initially been developed for research are increasingly being recommended for use in clinical practice as well. Although psychometric rigor is essential, this article focuses on pragmatic characteristics of PROs that may enhance uptake into clinical practice. Three sources were drawn on in identifying pragmatic criteria for PROs: (1) selected literature review including recommendations by other expert groups; (2) key features of several model public domain PROs; and (3) the authors' experience in developing practical PROs. Eight characteristics of a practical PRO include: (1) actionability (i.e., scores guide diagnostic or therapeutic actions/decision making); (2) appropriateness for the relevant clinical setting; (3) universality (i.e., for screening, severity assessment, and monitoring across multiple conditions); (4) self-administration; (5) item features (number of items and bundling issues); (6) response options (option number and dimensions, uniform vs. varying options, time frame, intervals between options); (7) scoring (simplicity and interpretability); and (8) accessibility (nonproprietary, downloadable, available in different languages and for vulnerable groups, and incorporated into electronic health records). Balancing psychometric and pragmatic factors in the development of PROs is important for accelerating the incorporation of PROs into clinical practice. Published by Elsevier Inc.

78 FR 17741 - Self-Regulatory Organizations; BOX Options Exchange LLC; Notice of Filing and Immediate...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-22

... Organizations; BOX Options Exchange LLC; Notice of Filing and Immediate Effectiveness of Proposed Rule Change To Permit the Minimum Price Variation for Mini Options To Be the Same as Permitted for Standard Options on... Options Exchange LLC (the ``Exchange'') filed with the Securities and Exchange Commission (``Commission...

78 FR 28912 - Self-Regulatory Organizations; The NASDAQ Stock Market LLC; Notice of Filing and Immediate...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-16

... Proposed Rule Change Relating to Penny Pilot Options and Non-Penny Pilot Options May 10, 2013. Pursuant to... ``Options Pricing,'' at Section 2 governing pricing for NASDAQ members using the NASDAQ Options Market (``NOM''), NASDAQ's facility for executing and routing standardized equity and index options...

78 FR 35338 - Self-Regulatory Organizations; BOX Options Exchange LLC; Notice of Filing and Immediate...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-12

... trading option contracts overlying 1,000 SPDR[supreg] S&P 500[supreg] exchange-traded fund shares (``SPY''),\\3\\ or (``Jumbo SPY Options'').\\4\\ Whereas standard options contracts represent a deliverable of 100... the number of deliverable shares, Jumbo SPY Options have the same terms and contract characteristics...

[Internet presence of neurologists, psychiatrists and medical psychotherapists in private practice].

PubMed

Kuhnigk, Olaf; Ramuschkat, Meike; Schreiner, Julia; Anger, Anina; Reimer, Jens

2014-04-01

The world wide web provides new options to physicians in terms practice marketing, information brokerage, and process optimization. This study explores prevalence and content of homepages of neurologists, psychiatrists and medical psychotherapists in private practice. Through the legal bodies of physicians in private practice in six northern German states neurologists, psychiatrists and medical psychotherapists were identified. According to a standardized and operationalized criteria catalogue, homepages were rated. 1804 physicians were identified, 352 (19.5 %) had operated a homepage. Higher frequencies of homepages found for male physicians (vs. female physicians), practice centres (vs. single practices) and urban practices (vs. rural practices). In average, practices reached 18.8 (± 5.3) of 42 points; contact data and accessibility information were generally available; information as to qualification and specialization was provided more infrequently. Legal specifications were not considered in more than every second homepage, interactive elements like online appointment of follow-up prescription were only rarely offered. Only every fifth neurological or psychiatric practice operates an own homepage, higher competition (urban area) and higher professionalization (practice centres) seem to act as promotors. The legal framework has to be focused, and patient needs should be taken into account. © Georg Thieme Verlag KG Stuttgart · New York.

21 CFR 131.110 - Milk.

Code of Federal Regulations, 2014 CFR

2014-04-01

... nonfat dry milk. Milk may be homogenized. (b) Vitamin addition (Optional). (1) If added, vitamin A shall... Units thereof within limits of good manufacturing practice. (2) If added, vitamin D shall be present in... good manufacturing practice. (c) Optional ingredients. The following safe and suitable ingredients may...

Profile development for the spatial data transfer standard

USGS Publications Warehouse

Szemraj, John A.; Fegeas, Robin G.; Tolar, Billy R.

1994-01-01

The Spatial Data Transfer Standard (SDTS), or Federal Information Processing Standard (FIPS) 173, is designed to support all types of spatial data. Implementing all of the standard's options at one time is impractical. Therefore, implementation of the SDTS is being accomplished through the use of profiles. Profiles are clearly defined, limited subsets of the SDTS created for use with a specific type or model of data and designed with as few options as possible. When a profile is proposed, specific choices are made for encoding possibilities that were not addressed, left optional, or left with numerous choices within the SDTS. Profile development is coordinated by the U.S. Geological Survey's SDTS Task Force. When completed, profiles are submitted to the National Institute of Standards and Technology (NIST) for approval as official amendments to the SDTS. The first profile, the Topological Vector Profile (TVP), has been completed. A Raster Profile has been tested and is being finalized for submission to the NIST. Other vector profiles, such as those for network and nontopological data, are also being considered as future implementation options for the SDTS.

Protocol: the effect of 12 weeks of Tai Chi practice on anxiety in healthy but stressed people compared to exercise and wait-list comparison groups: a randomized controlled trial.

PubMed

Zheng, Shuai; Lal, Sara; Meier, Peter; Sibbritt, David; Zaslawski, Chris

2014-06-01

Stress is a major problem in today's fast-paced society and can lead to serious psychosomatic complications. The ancient Chinese mind-body exercise of Tai Chi may provide an alternative and self-sustaining option to pharmaceutical medication for stressed individuals to improve their coping mechanisms. The protocol of this study is designed to evaluate whether Tai Chi practice is equivalent to standard exercise and whether the Tai Chi group is superior to a wait-list control group in improving stress coping levels. This study is a 6-week, three-arm, parallel, randomized, clinical trial designed to evaluate Tai Chi practice against standard exercise and a Tai Chi group against a nonactive control group over a period of 6 weeks with a 6-week follow-up. A total of 72 healthy adult participants (aged 18-60 years) who are either Tai Chi naïve or have not practiced Tai Chi in the past 12 months will be randomized into a Tai Chi group (n = 24), an exercise group (n = 24) or a wait-list group (n = 24). The primary outcome measure will be the State Trait Anxiety Inventory with secondary outcome measures being the Perceived Stress Scale 14, heart rate variability, blood pressure, Short Form 36 and a visual analog scale. The protocol is reported using the appropriate Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) items. Copyright © 2014. Published by Elsevier B.V.

Ada Compiler Validation Summary Report. Certificate Number: 920918S1. 11274 U.S. Navy Ada/M, Version 4.5 (/NO OPTIMIZE) VAX 8550/8600/8650 (Cluster) = Enhanced Processor (EP) AN/UYK-44 (Bare Board)

DTIC Science & Technology

1992-10-27

Institute of Standards and Technology Gaithersburg, MD USA 1 ELECTE I= 7 . PERFORMING ORGANIZATION NAME(S) AND ADDRESS(E JUN 3 1993U . , PERFORMING...Standard [Ada83) using the current Ada Compiler Validation Capability (ACVC). This Validation Summary Report ( VSR ) gives an account of the testing of... 7 - Control Part (Redirection) Options F.14 Compiler Options F-59 LINKER OPTIONS The linker options of this Ada implementation, as described inl this

Facility Systems, Ground Support Systems, and Ground Support Equipment General Design Requirements

NASA Technical Reports Server (NTRS)

Thaxton, Eric A.

2014-01-01

KSC-DE-512-SM establishes overall requirements and best design practices to be used at the John F. Kennedy Space Center (KSC) for the development of ground systems (GS) in support of operations at launch, landing, and retrieval sites. These requirements apply to the design and development of hardware and software for ground support equipment (GSE), ground support systems (GSS), and facility ground support systems (F-GSS) used to support the KSC mission for transportation, receiving, handling, assembly, test, checkout, servicing, and launch of space vehicles and payloads and selected flight hardware items for retrieval. This standards manual supplements NASA-STD-5005 by including KSC-site-specific and local environment requirements. These requirements and practices are optional for equipment used at manufacturing, development, and test sites.

Sharing organs with foreign nationals.

PubMed

Bruni, Rebecca; Wright, Linda

2011-03-01

Organs for transplantation are an absolute scarcity throughout the world, and many countries do not offer transplantation. Developed countries with transplant programs receive requests to list foreign nationals for transplantation. Any national standard deserves justification by a thorough exploration of the issues. In this article, the issues regarding organ transplantation for foreign nationals in Canada are explored. Currently Canada has no policy on listing foreign nationals for transplantation. Three topics are reviewed: (1) arguments for and against the transplantation of organs from deceased donors to foreign nationals, (2) relevant legislation and position statements, and (3) relevant practices in other countries. Finally, practical policy options are suggested. This article's analysis of the issues will provide guidance for health care professionals and policy makers in Canada and developed countries exploring listing foreign nationals for transplantation.

Regenerative medicine blueprint.

PubMed

Terzic, Andre; Harper, C Michel; Gores, Gregory J; Pfenning, Michael A

2013-12-01

Regenerative medicine, a paragon of future healthcare, holds unprecedented potential in extending the reach of treatment modalities for individuals across diseases and lifespan. Emerging regenerative technologies, focused on structural repair and functional restoration, signal a radical transformation in medical and surgical practice. Regenerative medicine is poised to provide innovative solutions in addressing major unmet needs for patients, ranging from congenital disease and trauma to degenerative conditions. Realization of the regenerative model of care predicates a stringent interdisciplinary paradigm that will drive validated science into standardized clinical options. Designed as a catalyst in advancing rigorous new knowledge on disease causes and cures into informed delivery of quality care, the Mayo Clinic regenerative medicine blueprint offers a patient-centered, team-based strategy that optimizes the discovery-translation-application roadmap for the express purpose of science-supported practice advancement.

Consent process for US-based family reference DNA samples.

PubMed

Katsanis, Sara H; Snyder, Lindsey; Arnholt, Kelly; Mundorff, Amy Z

2018-01-01

DNA collection from family members of the missing is a tenet for missing persons' and mass fatality investigations. Procedures for consenting family members are disparate, depending on the context supporting the reason for sample collection. While guidelines and best practices have been developed for handling mass fatalities and for identification of the missing, these guidelines do not address standard consent practices for living family members of potential victims. We examined the relevant U.S. laws, international guidelines and best practices, sampled consent forms currently used for DNA collection of family members, and drafted model language for a consent form to communicate the required and recommended information. We modeled the consent form on biobank consenting practices and tested the consent language among students and the general population for constructive feedback and readability. We also asked respondents to consider the options for DNA collection and either hypothetically agree or disagree. The model language presented here highlights information important to relay in consent processes and can serve as a foundation for future consent practices in mass fatalities and missing persons' investigations. Copyright © 2017 Elsevier B.V. All rights reserved.

30 CFR 90.103 - Compensation.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Resources MINE SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR COAL MINE SAFETY AND HEALTH MANDATORY HEALTH STANDARDS-COAL MINERS WHO HAVE EVIDENCE OF THE DEVELOPMENT OF PNEUMOCONIOSIS Dust Standards... under § 90.3 (Part 90 option; notice of eligibility; exercise of option). (b) Whenever a Part 90 miner...

40 CFR 63.4341 - How do I demonstrate initial compliance?

Code of Federal Regulations, 2013 CFR

2013-07-01

... PROGRAMS (CONTINUED) NATIONAL EMISSION STANDARDS FOR HAZARDOUS AIR POLLUTANTS FOR SOURCE CATEGORIES (CONTINUED) National Emission Standards for Hazardous Air Pollutants: Printing, Coating, and Dyeing of... option, or the oxidizer outlet organic HAP concentration option. You do not need to redetermine the mass...

40 CFR 63.4341 - How do I demonstrate initial compliance?

Code of Federal Regulations, 2014 CFR

2014-07-01

... PROGRAMS (CONTINUED) NATIONAL EMISSION STANDARDS FOR HAZARDOUS AIR POLLUTANTS FOR SOURCE CATEGORIES (CONTINUED) National Emission Standards for Hazardous Air Pollutants: Printing, Coating, and Dyeing of... option, or the oxidizer outlet organic HAP concentration option. You do not need to redetermine the mass...

40 CFR 63.4341 - How do I demonstrate initial compliance?

Code of Federal Regulations, 2012 CFR

2012-07-01

... PROGRAMS (CONTINUED) NATIONAL EMISSION STANDARDS FOR HAZARDOUS AIR POLLUTANTS FOR SOURCE CATEGORIES (CONTINUED) National Emission Standards for Hazardous Air Pollutants: Printing, Coating, and Dyeing of... option, or the oxidizer outlet organic HAP concentration option. You do not need to redetermine the mass...

Roadwaste : Issues and Options : appendices.

DOT National Transportation Integrated Search

1998-06-01

The appendices belong to "Roadwaste : Issues and Options". : The Oregon Department of Transportation (ODOT) is conducting a study to determine roadwaste management options. Phase 1 consisted of a thorough review of regulations and standards, roadwast...

7 CFR 457.133 - Prune crop insurance provisions.

Code of Federal Regulations, 2012 CFR

2012-01-01

... Provisions that allow optional units by irrigated and non-irrigated practices are not applicable. Instead of establishing optional units by section, section equivalent, or FSA farm serial number optional units may be established if each optional unit is located on non-contiguous land. 3. Insurance Guarantees, Coverage Levels...

7 CFR 457.133 - Prune crop insurance provisions.

Code of Federal Regulations, 2011 CFR

2011-01-01

... Provisions that allow optional units by irrigated and non-irrigated practices are not applicable. Instead of establishing optional units by section, section equivalent, or FSA farm serial number optional units may be established if each optional unit is located on non-contiguous land. 3. Insurance Guarantees, Coverage Levels...

Cost-effectiveness analysis of Option B+ for HIV prevention and treatment of mothers and children in Malawi.

PubMed

Fasawe, Olufunke; Avila, Carlos; Shaffer, Nathan; Schouten, Erik; Chimbwandira, Frank; Hoos, David; Nakakeeto, Olive; De Lay, Paul

2013-01-01

The Ministry of Health in Malawi is implementing a pragmatic and innovative approach for the management of all HIV-infected pregnant women, termed Option B+, which consists of providing life-long antiretroviral treatment, regardless of their CD4 count or clinical stage. Our objective was to determine if Option B+ represents a cost-effective option. A decision model simulates the disease progression of a cohort of HIV-infected pregnant women receiving prophylaxis and antiretroviral therapy, and estimates the number of paediatric infections averted and maternal life years gained over a ten-year time horizon. We assess the cost-effectiveness from the Ministry of Health perspective while taking into account the practical realities of implementing ART services in Malawi. If implemented as recommended by the World Health Organization, options A, B and B+ are equivalent in preventing new infant infections, yielding cost effectiveness ratios between US$ 37 and US$ 69 per disability adjusted life year averted in children. However, when the three options are compared to the current practice, the provision of antiretroviral therapy to all mothers (Option B+) not only prevents infant infections, but also improves the ten-year survival in mothers more than four-fold. This translates into saving more than 250,000 maternal life years, as compared to mothers receiving only Option A or B, with savings of 153,000 and 172,000 life years respectively. Option B+ also yields favourable incremental cost effectiveness ratios (ICER) of US$ 455 per life year gained over the current practice. In Malawi, Option B+ represents a favorable policy option from a cost-effectiveness perspective to prevent future infant infections, save mothers' lives and reduce orphanhood. Although Option B+ would require more financial resources initially, it would save societal resources in the long-term and represents a strategic option to simplify and integrate HIV services into maternal, newborn and child health programmes.

Integrating Research and Practice: Distractions, Controversies, and Options for Moving Forward

ERIC Educational Resources Information Center

Gambrill, Eileen

2015-01-01

Integrating practice and research is vital in all helping professions in order to offer the most ethical, evidence-informed interventions to clients. This article describes some avoidable distractions that hinder integration, discusses controversies related to integration, and describes options for moving forward, including making wasted resources…

41 CFR 101-26.302 - Standard and optional forms.

Code of Federal Regulations, 2013 CFR

2013-07-01

... forms. 101-26.302 Section 101-26.302 Public Contracts and Property Management Federal Property Management Regulations System FEDERAL PROPERTY MANAGEMENT REGULATIONS SUPPLY AND PROCUREMENT 26-PROCUREMENT SOURCES AND PROGRAM 26.3-Procurement of GSA Stock Items § 101-26.302 Standard and optional forms. Agencies...

41 CFR 101-26.302 - Standard and optional forms.

Code of Federal Regulations, 2011 CFR

2011-07-01

... forms. 101-26.302 Section 101-26.302 Public Contracts and Property Management Federal Property Management Regulations System FEDERAL PROPERTY MANAGEMENT REGULATIONS SUPPLY AND PROCUREMENT 26-PROCUREMENT SOURCES AND PROGRAM 26.3-Procurement of GSA Stock Items § 101-26.302 Standard and optional forms. Agencies...

41 CFR 101-26.302 - Standard and optional forms.

Code of Federal Regulations, 2012 CFR

2012-07-01

... forms. 101-26.302 Section 101-26.302 Public Contracts and Property Management Federal Property Management Regulations System FEDERAL PROPERTY MANAGEMENT REGULATIONS SUPPLY AND PROCUREMENT 26-PROCUREMENT SOURCES AND PROGRAM 26.3-Procurement of GSA Stock Items § 101-26.302 Standard and optional forms. Agencies...

41 CFR 101-26.302 - Standard and optional forms.

Code of Federal Regulations, 2010 CFR

2010-07-01

... forms. 101-26.302 Section 101-26.302 Public Contracts and Property Management Federal Property Management Regulations System FEDERAL PROPERTY MANAGEMENT REGULATIONS SUPPLY AND PROCUREMENT 26-PROCUREMENT SOURCES AND PROGRAM 26.3-Procurement of GSA Stock Items § 101-26.302 Standard and optional forms. Agencies...

41 CFR 101-26.302 - Standard and optional forms.

Code of Federal Regulations, 2014 CFR

2014-07-01

... forms. 101-26.302 Section 101-26.302 Public Contracts and Property Management Federal Property Management Regulations System FEDERAL PROPERTY MANAGEMENT REGULATIONS SUPPLY AND PROCUREMENT 26-PROCUREMENT SOURCES AND PROGRAM 26.3-Procurement of GSA Stock Items § 101-26.302 Standard and optional forms. Agencies...

Perceptions and misconceptions regarding the Joint Commission's view of quality monitoring.

PubMed

Patterson, C H

1989-10-01

The Joint Commission recently has revised its hospital standards for infection control to reflect more accurately current state-of-the-art practices. In addition, the Joint Commission's Agenda for Change initiatives include the development of clinical indicators; one of the topics that will be included in those clinical indicator sets will be infection control. How the hospital chooses to organize itself to conduct the historically required monitoring and evaluation of clinical patient care currently required by the standards of the Joint Commission is at the option of the hospital. How the hospital will organize and collect data specific to infection control indicators yet to be developed by the Joint Commission has not been determined and will not be defined until specific research and development projects are completed. The hospital is expected to have in place infection prevention, surveillance, and control programs; it also is expected to have in place a quality assurance program that focuses not only on solving identified problems but also on the improvement of patient care quality. How the hospitals organize and/or integrate these activities is also at its option. It is expected that qualified professionals will direct and enforce infection prevention, surveillance, and control practices; indicators for infection control can provide data that will help assess the relative success of those practices and activities. The Joint Commission is not developing the capability to judge, on its own part, the actual quality of care provided by an organization seeking accreditation. Rather, the Joint Commission is committed to developing more accurate means to evaluate the structures, processes, and outcomes of diagnosis and treatment activities, as well as their interrelationships. Clinical excellence is supported by quality in the organizational environment and the managerial and leadership contexts within which patient care is delivered. Both clinical and organizational excellence are essential components of quality, and the Joint Commission is convinced that it is appropriate and timely to undertake more direct assessments of both.

Stress urinary incontinence in women: Current and emerging therapeutic options

PubMed Central

Shamout, Samer; Campeau, Lysanne

2017-01-01

Surgical management of stress urinary incontinence (SUI) is most commonly achieved by midurethral synthetic sling (MUS) insertion as a first-line surgical option. A great deal of research continues to evolve new management strategies to reach an optimal balance of high efficacy and minimal adverse events. This expert opinion review provides a brief and comprehensive discussion of recent advances and ongoing research in the management of SUI, with an emphasis on single-incision mini-slings, vaginal laser treatment, and cell-based therapy. It is based on data obtained from numerous published meta-analyses and original studies identified through literature search. Single-incision mini-slings appear equally effective initially compared with standard MUS (retropubic or transobturator) for the treatment of female SUI; however, this efficacy lacks durability evidence beyond one-year followup. There is a lack of sufficient clinical evidence to currently confirm long-term safety and effectiveness of cell-therapy and non-ablative vaginal laser therapy, besides suggestion of apparent initial safety. There are still significant challenges to overcome before widespread clinical practice of the latter two modalities. Future research should be aimed at identifying groups of patients who might benefit from these minimally invasive therapeutic options. PMID:28616118

A Review of Shared Decision-Making and Patient Decision Aids in Radiation Oncology.

PubMed

Woodhouse, Kristina Demas; Tremont, Katie; Vachani, Anil; Schapira, Marilyn M; Vapiwala, Neha; Simone, Charles B; Berman, Abigail T

2017-06-01

Cancer treatment decisions are complex and may be challenging for patients, as multiple treatment options can often be reasonably considered. As a result, decisional support tools have been developed to assist patients in the decision-making process. A commonly used intervention to facilitate shared decision-making is a decision aid, which provides evidence-based outcomes information and guides patients towards choosing the treatment option that best aligns with their preferences and values. To ensure high quality, systematic frameworks and standards have been proposed for the development of an optimal aid for decision making. Studies have examined the impact of these tools on facilitating treatment decisions and improving decision-related outcomes. In radiation oncology, randomized controlled trials have demonstrated that decision aids have the potential to improve patient outcomes, including increased knowledge about treatment options and decreased decisional conflict with decision-making. This article provides an overview of the shared-decision making process and summarizes the development, validation, and implementation of decision aids as patient educational tools in radiation oncology. Finally, this article reviews the findings from decision aid studies in radiation oncology and offers various strategies to effectively implement shared decision-making into clinical practice.

24 CFR 35.120 - Options.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 24 Housing and Urban Development 1 2010-04-01 2010-04-01 false Options. 35.120 Section 35.120... and Definitions for All Programs. § 35.120 Options. (a) Standard treatments. Where interim controls are required by this part, the designated party has the option to presume that lead-based paint or...

30 CFR 90.104 - Waiver of rights; re-exercise of option.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 30 Mineral Resources 1 2014-07-01 2014-07-01 false Waiver of rights; re-exercise of option. 90.104... PNEUMOCONIOSIS Dust Standards, Rights of Part 90 Miners § 90.104 Waiver of rights; re-exercise of option. (a) A... under Part 90 until the miner re-exercises the option in accordance with § 90.3(e) (Part 90 option...

30 CFR 90.104 - Waiver of rights; re-exercise of option.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 30 Mineral Resources 1 2013-07-01 2013-07-01 false Waiver of rights; re-exercise of option. 90.104... PNEUMOCONIOSIS Dust Standards, Rights of Part 90 Miners § 90.104 Waiver of rights; re-exercise of option. (a) A... under Part 90 until the miner re-exercises the option in accordance with § 90.3(e) (Part 90 option...

30 CFR 90.104 - Waiver of rights; re-exercise of option.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 30 Mineral Resources 1 2012-07-01 2012-07-01 false Waiver of rights; re-exercise of option. 90.104... PNEUMOCONIOSIS Dust Standards, Rights of Part 90 Miners § 90.104 Waiver of rights; re-exercise of option. (a) A... under Part 90 until the miner re-exercises the option in accordance with § 90.3(e) (Part 90 option...

30 CFR 90.104 - Waiver of rights; re-exercise of option.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 30 Mineral Resources 1 2011-07-01 2011-07-01 false Waiver of rights; re-exercise of option. 90.104... PNEUMOCONIOSIS Dust Standards, Rights of Part 90 Miners § 90.104 Waiver of rights; re-exercise of option. (a) A... under Part 90 until the miner re-exercises the option in accordance with § 90.3(e) (Part 90 option...

30 CFR 90.104 - Waiver of rights; re-exercise of option.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Waiver of rights; re-exercise of option. 90.104... PNEUMOCONIOSIS Dust Standards, Rights of Part 90 Miners § 90.104 Waiver of rights; re-exercise of option. (a) A... under Part 90 until the miner re-exercises the option in accordance with § 90.3(e) (Part 90 option...

Maintenance of Certification Part IV Quality-Improvement Project for Hypertension Control: A Preliminary Retrospective Analysis

PubMed Central

Kolasinski, Vallerie A; Price, David W

2015-01-01

Context: A Maintenance of Certification Part IV project was created on the basis of an existing, multifaceted hypertension improvement program. Objective: To evaluate the impact of the Maintenance of Certification project, the effects of the improvement options on blood pressure control in hypertensive patients, and the participants’ perception of the workload related to participation in the project. Design: Nonexperimental retrospective analysis. Setting: Kaiser Permanente hospitals and medical office buildings in Northern California. Intervention: Participants used one or more options from a defined menu of strategies to attempt to increase the percentage of hypertensive patients on their patient panels who had controlled blood pressure. Main Outcome Measure: Proportion of hypertensive patients with blood pressure ≤ 139/89 mm Hg. Results: Fifty-two American Board of Family Medicine and 19 American Board of Internal Medicine certified physicians completed projects. Mean panel blood pressure control improved from 79.49% (standard deviation [SD] = 11.32) to 84.64% (SD = 7.80). The choice of improvement option was not associated with the level of improvement or with the participants’ perception of the workload related to completing the project. Conclusion: Project participants improved the care of their patients without an increased perceived burden to their practice. We found no association between the choice of improvement option and either the level of improvement or the perception of workload. PMID:25785642

Investing in deliberation: a definition and classification of decision support interventions for people facing difficult health decisions.

PubMed

Elwyn, Glyn; Frosch, Dominick; Volandes, Angelo E; Edwards, Adrian; Montori, Victor M

2010-01-01

This article provides an analysis of 'decision aids', interventions to support patients facing tough decisions. Interest has increased since the concept of shared decision making has become widely considered to be a means of achieving desirable clinical outcomes. We consider the aims of these interventions and examine assumptions about their use. We propose three categories, interventions that are used in face-to-face encounters, those designed for use outside clinical encounters and those which are mediated, using telephone or other communication media. We propose the following definition: decision support interventions help people think about choices they face; they describe where and why choice exists; they provide information about options, including, where reasonable, the option of taking no action. These interventions help people to deliberate, independently or in collaboration with others, about options, by considering relevantattributes; they support people to forecast how they might feel about short, intermediate and long-term outcomes which have relevant consequences, in ways which help the process of constructing preferences and eventual decision making, appropriate to their individual situation. Although quality standards have been published for these interventions, we are also cautious about premature closure and consider that the need for short versions for use inside clinical encounters and long versions for external use requires further research. More work is also needed on the use of narrative formats and the translation of theory into practical designs. The interest in decision support interventions for patients heralds a transformation in clinical practice although many important areas remain unresolved.

77 FR 37587 - Updating OSHA Standards Based on National Consensus Standards; Head Protection

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-22

... testing for helmets worn in the backwards position (``reverse wearing''), optional testing for helmets at colder temperatures than provided in previous editions, and optional testing for the high- visibility coloring of helmets. If manufacturers choose to evaluate their helmets using any of these three testing...

48 CFR 22.404-12 - Labor standards for contracts containing construction requirements and option provisions that...

Code of Federal Regulations, 2011 CFR

2011-10-01

... contract price adjustment. An example of a contract pricing method that the contracting officer might... contracts containing construction requirements and option provisions that extend the term of the contract... SOCIOECONOMIC PROGRAMS APPLICATION OF LABOR LAWS TO GOVERNMENT ACQUISITIONS Labor Standards for Contracts...

Early pregnancy failure management among family physicians.

PubMed

Wallace, Robin; Dehlendorf, Christine; Vittinghoff, Eric; Gold, Katherine J; Dalton, Vanessa K

2013-03-01

Family physicians, as primary care providers for reproductive-aged women, frequently initiate or refer patients for management of early pregnancy failure (EPF). Safe and effective options for EPF treatment include expectant management, medical management with misoprostol, and aspiration in the office or operating room. Current practice does not appear to reflect patient preferences or to utilize the most cost-effective treatments. We compared characteristics and practice patterns among family physicians who do and do not provide multiple options for EPF care. We performed a secondary analysis of a national survey of women's health providers to describe demographic and practice characteristics among family physicians who care for women with EPF. We used multivariate logistic regression to identify correlates of providing more than one option for EPF management. The majority of family physicians provide only one option for EPF; expectant management was most frequently used among our survey respondents. Misoprostol and office-based aspiration were rarely used. Providing more than one option for EPF management was associated with more years in practice, smaller county population, larger proportions of Medicaid patients, intrauterine contraception provision, and prior training in office-based aspiration. Family physicians are capable of providing a comprehensive range of options for EPF management in the outpatient setting but few providers currently do so. To create a more patient-centered and cost-effective model of care for EPF, additional resources should be directed at education, skills training, and system change initiatives to prepare family physicians to offer misoprostol and office-based aspiration to women with EPF.

A proposed protocol for acceptance and constancy control of computed tomography systems: a Nordic Association for Clinical Physics (NACP) work group report.

PubMed

Kuttner, Samuel; Bujila, Robert; Kortesniemi, Mika; Andersson, Henrik; Kull, Love; Østerås, Bjørn Helge; Thygesen, Jesper; Tarp, Ivanka Sojat

2013-03-01

Quality assurance (QA) of computed tomography (CT) systems is one of the routine tasks for medical physicists in the Nordic countries. However, standardized QA protocols do not yet exist and the QA methods, as well as the applied tolerance levels, vary in scope and extent at different hospitals. To propose a standardized protocol for acceptance and constancy testing of CT scanners in the Nordic Region. Following a Nordic Association for Clinical Physics (NACP) initiative, a group of medical physicists, with representatives from four Nordic countries, was formed. Based on international literature and practical experience within the group, a comprehensive standardized test protocol was developed. The proposed protocol includes tests related to the mechanical functionality, X-ray tube, detector, and image quality for CT scanners. For each test, recommendations regarding the purpose, equipment needed, an outline of the test method, the measured parameter, tolerance levels, and the testing frequency are stated. In addition, a number of optional tests are briefly discussed that may provide further information about the CT system. Based on international references and medical physicists' practical experiences, a comprehensive QA protocol for CT systems is proposed, including both acceptance and constancy tests. The protocol may serve as a reference for medical physicists in the Nordic countries.

Counseling women with early pregnancy failure: utilizing evidence, preserving preference.

PubMed

Wallace, Robin R; Goodman, Suzan; Freedman, Lori R; Dalton, Vanessa K; Harris, Lisa H

2010-12-01

To apply principles of shared decision-making to EPF management counseling. To present a patient treatment priority checklist developed from review of available literature on patient priorities for EPF management. Review of evidence for patient preferences; personal, emotional, physical and clinical factors that may influence patient priorities for EPF management; and the clinical factors, resources, and provider bias that may influence current practice. Women have strong and diverse preferences for EPF management and report higher satisfaction when treated according to these preferences. However, estimates of actual treatment patterns suggest that current practice does not reflect the evidence for safety and acceptability of all options, or patient preferences. Multiple practice barriers and biases exist that may be influencing provider counseling about options for EPF management. Choosing management for EPF is a preference-sensitive decision. A patient-centered approach to EPF management should incorporate counseling about all treatment options. Providers can integrate a counseling model into EPF management practice that utilizes principles of shared decision-making and an organized method for eliciting patient preferences, priorities, and concerns about treatment options. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

78 FR 17738 - Self-Regulatory Organizations; NASDAQ OMX PHLX LLC; Notice of Filing and Immediate Effectiveness...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-22

... customer bases of potential product users have indicated a preference that premium pricing for Mini Options... market participants clarity as to the minimum pricing increments for Mini Options, the filing would harmonize penny pricing between Mini Options and standard options on the same security. \\4\\ See Securities...

78 FR 17970 - Self-Regulatory Organizations; Miami International Securities Exchange LLC; Notice of Filing and...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-25

... product users and they have indicated a preference that premium pricing for mini-options match what is... market participants clarity as to the minimum pricing increments for mini-options, the filing would harmonize penny pricing between mini-options and standard options on the same security. \\3\\ See Securities...

17 CFR 155.4 - Trading standards for introducing brokers.

Code of Federal Regulations, 2010 CFR

2010-04-01

... the extent possible, that each order received from a customer or from an option customer which is... of the customer or option customer before any order in any future or in any commodity option in the... consent of the account owner, if the affiliated person has gained knowledge of the customer's or option...

77 FR 38362 - Self-Regulatory Organizations; NYSE Arca, Inc.; Notice of Withdrawal of Proposed Rule Change To...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-27

... Option Contracts Overlying 10 Shares of a Security (``Mini-Options Contracts'') and Implement Rule Text... Contracts and implement rule text necessary to distinguish Mini-Options Contracts from Standard Contracts...

47 CFR 1.2103 - Competitive bidding design options.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 47 Telecommunication 1 2010-10-01 2010-10-01 false Competitive bidding design options. 1.2103 Section 1.2103 Telecommunication FEDERAL COMMUNICATIONS COMMISSION GENERAL PRACTICE AND PROCEDURE Competitive Bidding Proceedings General Procedures § 1.2103 Competitive bidding design options. (a) The...

Bioremediation of oil-contaminated soils: A recipe for success

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

Wittenbach, S.A.

1995-12-31

Bioremediation of land crude oil and lube oil spills is an effective and economical option. Other options include road spreading (where permitted), thermal desorption, and off-site disposal. The challenge for environment and operations managers is to select the best approach for each remediation site. Costs and liability for off-site disposal are ever increasing. Kerr-McGee`s extensive field research in eastern and western Texas provides the data to support bioremediation as a legitimate and valid option. Both practical and economical bioremediation as a legitimate and valid option. Both practical and economical, bioremediation also offers a lower risk of, for example, Superfund clean-upmore » exposure than off-site disposal.« less

Optional part-time and longer GP training modules in GP practices associated with more trainees becoming GPs - a cohort study in Switzerland.

PubMed

Studerus, Lara; Ahrens, Regina; Häuptle, Christian; Goeldlin, Adrian; Streit, Sven

2018-01-05

Switzerland, like many other countries, has a shortage of General Practitioners (GPs). Optional GP training modules in GP practices were offered during the at least 5-year GP training program to increase student and trainee interest in becoming a GP. The training modules had not yet been evaluated. We determined how many Swiss GP trainees became practicing GPs after they completed optional training modules, and if longer modules were associated with higher rates of GP specialization. In this population-based cohort study, we included GP trainees who chose an optional GP training module in GP practice, provided by the Foundation to Promote Training in General Practice (WHM) between 2006 and 2015. GP trainees were invited to complete an online survey to assess the primary outcome (becoming a practicing GP by 2016). Data on non-responders was collected via an internet search. We calculated univariate time-to-event curves to become a practicing GP, stratified by trainee's gender, length, part-time training, and number of years after graduation until training modules were completed. We used a multivariate model to adjust for characteristics of participants, training, and satisfaction with training modules. We assessed primary outcome for 351 (92.1%) of 381 former GP trainees who participated in a WHM program between 2006 and 2015. Of these 218 (57%) were practicing GPs by 2016. When focusing on the trainees who had completed training between 2006 and 2010, the rate of practicing GPs was even 73%. Longer (p = 0.018) and part-time training modules (p = 0.003) were associated with higher rates of being a practicing GP. Most (81%) practicing GPs thought their optional GP training module was (very) important in their choice of specialty. GP trainees who spent more time training in a GP practice, or who trained part-time were more likely to become practicing GPs. Most (80%) rated their training module as (very) important in their choice of career, highlighting that these modules effectively encourage the interests of those already inclined towards the GP specialty. Longer GP training modules and more opportunities for part-time training may attract and retain more interested trainees, and possibly increase the number of practicing GPs.

Physiotherapists use a great variety of motor learning options in neurological rehabilitation, from which they choose through an iterative process: a retrospective think-aloud study.

PubMed

Kleynen, Melanie; Moser, Albine; Haarsma, Frederike A; Beurskens, Anna J; Braun, Susy M

2017-08-01

The goal of this study was to examine which motor learning options are applied by experienced physiotherapists in neurological rehabilitation, and how they choose between the different options. A descriptive qualitative approach was used. A purposive sample of five expert physiotherapists from the neurological ward of a rehabilitation center participated. Data were collected using nine videotaped therapy situations. During retrospective think-aloud interviews, the physiotherapists were instructed to constantly "think aloud" while they were watching their own videos. Five "operators" were identified: "act", "know", "observe", "assess" and "argue". The "act" operator consisted of 34 motor learning options, which were clustered into "instruction", "feedback" and "organization". The "know", "observe", "assess" and "argue" operators explained how therapists chose one of these options. The four operators seem to be interrelated and together lead to a decision to apply a particular motor learning option. Results show that the participating physiotherapists used a great variety of motor learning options in their treatment sessions. Further, the decision-making process with regard to these motor learning options was identified. Results may support future intervention studies that match the content and process of therapy in daily practice. The study should be repeated with other physiotherapists. Implications for Rehabilitation The study provided insight into the way experienced therapist handle the great variety of possible motor learning options, including concrete ideas on how to operationalize these options in specific situations. Despite differences in patients' abilities, it seems that therapists use the same underlying clinical reasoning process when choosing a particular motor learning option. Participating physiotherapists used more than the in guidelines suggested motor learning options and considered more than the suggested factors, hence adding practice based options of motor learning to the recommended ones in the guidelines. A think-aloud approach can be considered for peer-to-peer and student coaching to enhance discussion on the motor learning options applied and the underlying choices and to encourage research by practicing clinicians.

[Quality assurance and quality management in intensive care].

PubMed

Notz, K; Dubb, R; Kaltwasser, A; Hermes, C; Pfeffer, S

2015-11-01

Treatment success in hospitals, particularly in intensive care units, is directly tied to quality of structure, process, and outcomes. Technological and medical advancements lead to ever more complex treatment situations with highly specialized tasks in intensive care nursing. Quality criteria that can be used to describe and correctly measure those highly complex multiprofessional situations have only been recently developed and put into practice.In this article, it will be shown how quality in multiprofessional teams can be definded and assessed in daily clinical practice. Core aspects are the choice of a nursing theory, quality assurance measures, and quality management. One possible option of quality assurance is the use of standard operating procedures (SOPs). Quality can ultimately only be achieved if professional groups think beyond their boundaries, minimize errors, and establish and live out instructions and SOPs.

[Physical treatment modalities for chronic leg ulcers].

PubMed

Dissemond, J

2010-05-01

An increasing numbers of physical treatment options are available for chronic leg ulcer. In this review article, compression therapy, therapeutic ultrasound, negative pressure therapy, extracorporeal shock wave therapy, electrostimulation therapy, electromagnetic therapy, photodynamic therapy, water-filtered infrared-A-radiation and hydrotherapy are discussed in terms of their practical applications and the underlying evidence. With the exception of compression therapy for most of these treatments, good scientific data are not available. However this is a widespread problem in the treatment of chronic wounds. Nevertheless, several of the described methods such as negative pressure therapy represent one of the gold standards in practical treatment of patients with chronic leg ulcers. Although the use of physical treatment modalities may improve healing in patients with chronic leg ulcers, the diagnosis and treatment of the underlying causes are essential for long-lasting success.

[Minimally invasive interventional techniques involving the urogenital tract in dogs and cats].

PubMed

Heilmann, R M

2016-01-01

Minimally invasive interventional techniques are advancing fast in small animal medicine. These techniques utilize state-of-the-art diagnostic methods, including fluoroscopy, ultrasonography, endoscopy, and laparoscopy. Minimally invasive procedures are particularly attractive in the field of small animal urology because, in the past, treatment options for diseases of the urogenital tract were rather limited or associated with a high rate of complications. Most endourological interventions have a steep learning curve. With the appropriate equipment and practical training some of these procedures can be performed in most veterinary practices. However, most interventions require referral to a specialty clinic. This article summarizes the standard endourological equipment and materials as well as the different endourological interventions performed in dogs and cats with diseases of the kidneys/renal pelves, ureters, or lower urinary tract (urinary bladder and urethra).

Bringing social standards into project evaluation under dynamic uncertainty.

PubMed

Knudsen, Odin K; Scandizzo, Pasquale L

2005-04-01

Society often sets social standards that define thresholds of damage to society or the environment above which compensation must be paid to the state or other parties. In this article, we analyze the interdependence between the use of social standards and investment evaluation under dynamic uncertainty where a negative externality above a threshold established by society requires an assessment and payment of damages. Under uncertainty, the party considering implementing a project or new technology must not only assess when the project is economically efficient to implement but when to abandon a project that could potentially exceed the social standard. Using real-option theory and simple models, we demonstrate how such a social standard can be integrated into cost-benefit analysis through the use of a development option and a liability option coupled with a damage function. Uncertainty, in fact, implies that both parties interpret the social standard as a target for safety rather than an inflexible barrier that cannot be overcome. The larger is the uncertainty, in fact, the greater will be the tolerance for damages in excess of the social standard from both parties.

University Examinations and Standardized Testing: Principles, Experience, and Policy Options. World Bank Technical Paper Number 78. Proceedings of a Seminar on the Uses of Standardized Tests and Selection Examinations (Beijing, China, April 1985).

ERIC Educational Resources Information Center

Heyneman, Stephen P., Ed.; Fagerlind, Ingemar, Ed.

In September 1984, the Chinese government asked the Economic Development Institute of the World Bank to assist the officials of the Chinese Ministry of Education in thinking through some policy options for examinations and standardized testing. This document summarizes the descriptions of testing programs and advice provided to these Chinese…

76 FR 68236 - Self-Regulatory Organizations; Options Clearing Corporation; Order Approving Proposed Rule Change...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-03

... Organizations; Options Clearing Corporation; Order Approving Proposed Rule Change To Adopt Fitness Standards for... amended by the Dodd-Frank Act. In particular, new DCO Core Principle O requires DCOs to establish fitness...) establish and enforce appropriate fitness standards for (I) directors, (II) members of any disciplinary...

40 CFR 63.5701 - What are my options for complying with the open molding emission limit?

Code of Federal Regulations, 2010 CFR

2010-07-01

... the open molding emission limit? 63.5701 Section 63.5701 Protection of Environment ENVIRONMENTAL... POLLUTANTS FOR SOURCE CATEGORIES National Emission Standards for Hazardous Air Pollutants for Boat Manufacturing Standards for Open Molding Resin and Gel Coat Operations § 63.5701 What are my options for...

46 CFR 308.520 - Standard optional endorsement No. 3, Form MA-300-C.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 46 Shipping 8 2014-10-01 2014-10-01 false Standard optional endorsement No. 3, Form MA-300-C. 308.520 Section 308.520 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE War Risk Cargo Insurance Open Policy War Risk Cargo Insurance § 308.520...

46 CFR 308.519 - Standard optional endorsement No. 2, Form MA-300-B.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 46 Shipping 8 2014-10-01 2014-10-01 false Standard optional endorsement No. 2, Form MA-300-B. 308.519 Section 308.519 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE War Risk Cargo Insurance Open Policy War Risk Cargo Insurance § 308.519...

46 CFR 308.546 - Standard optional endorsement No. 1-A, Form MA-316-A.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 46 Shipping 8 2014-10-01 2014-10-01 false Standard optional endorsement No. 1-A, Form MA-316-A. 308.546 Section 308.546 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE War Risk Cargo Insurance Facultative War Risk Cargo Insurance § 308.546...

46 CFR 308.518 - Standard optional endorsement No. 1, Form MA-300-A.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 46 Shipping 8 2014-10-01 2014-10-01 false Standard optional endorsement No. 1, Form MA-300-A. 308.518 Section 308.518 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE War Risk Cargo Insurance Open Policy War Risk Cargo Insurance § 308.518...

Negotiating behavioural change: therapists' proposal turns in Cognitive Behavioural Therapy.

PubMed

Ekberg, Katie; Lecouteur, Amanda

2012-01-01

Cognitive behavioural therapy (CBT) is an internationally recognised method for treating depression. However, many of the techniques involved in CBT are accomplished within the therapy interaction in diverse ways, and with varying consequences for the trajectory of therapy session. This paper uses conversation analysis to examine some standard ways in which therapists propose suggestions for behavioural change to clients attending CBT sessions for depression in Australia. Therapists' proposal turns displayed their subordinate epistemic authority over the matter at hand, and emphasised a high degree of optionality on behalf of the client in accepting their suggestions. This practice was routinely accomplished via three standard proposal turns: (1) hedged recommendations; (2) interrogatives; and (3) information-giving. These proposal turns will be examined in relation to the negotiation of behavioural change, and the implications for CBT interactions between therapist and client will be discussed.

Medicare Advantage: options for standardizing benefits and information to improve consumer choice.

PubMed

O'Brien, Ellen; Hoadley, Jack

2008-04-01

The Medicare Advantage (MA) program offers beneficiaries a choice of private health plans as alternatives to the traditional fee-for-service Medicare program. MA plans potentially provide additional value, but as plan choices have proliferated, consumers contemplating their options have had difficulty understanding how they differ. Through "standardization" more consistent types of information and a limited number of dimensions along which plans vary--MA plans could reduce complexity and improve beneficiaries' ability to make informed choices. Such standardization steps would offer more meaningful variation in the health coverage options available to beneficiaries, Medicare officials and their community partners would find it far easier to educate beneficiaries about their health plan choices, and beneficiaries would better understand what they were buying. Standardization might also strengthen the ability of the market-based Medicare Advantage program to incorporate beneficiary preferences.

Underreporting of high-risk water and sanitation practices undermines progress on global targets.

PubMed

Vedachalam, Sridhar; MacDonald, Luke H; Shiferaw, Solomon; Seme, Assefa; Schwab, Kellogg J

2017-01-01

Water and sanitation indicators under the Millennium Development Goals failed to capture high-risk practices undertaken on a regular basis. In conjunction with local partners, fourteen rounds of household surveys using mobile phones with a customized open-source application were conducted across nine study geographies in Asia and Africa. In addition to the main water and sanitation facilities, interviewees (n = 245,054) identified all water and sanitation options regularly used for at least one season of the year. Unimproved water consumption and open defecation were targeted as high-risk practices. We defined underreporting as the difference between the regular and main use of high-risk practices. Our estimates of high-risk practices as the main option matched the widely accepted Demographic and Health Surveys (DHS) estimates within the 95% confidence interval. However, estimates of these practices as a regular option was far higher than the DHS estimates. Across the nine geographies, median underreporting of unimproved water use was 5.5%, with a range of 0.5% to 13.9%. Median underreporting of open defecation was much higher at 9.9%, with a range of 2.7% to 11.5%. This resulted in an underreported population of 25 million regularly consuming unimproved water and 50 million regularly practicing open defecation. Further examination of data from Ethiopia suggested that location and socio-economic factors were significant drivers of underreporting. Current global monitoring relies on a framework that considers the availability and use of a single option to meet drinking water and sanitation needs. Our analysis demonstrates the use of multiple options and widespread underreporting of high-risk practices. Policies based on current monitoring data, therefore, fail to consider the range of challenges and solutions to meeting water and sanitation needs, and result in an inflated sense of progress. Mobile surveys offer a cost-effective and innovative platform to rapidly and repeatedly monitor critical development metrics.

Underreporting of high-risk water and sanitation practices undermines progress on global targets

PubMed Central

Vedachalam, Sridhar; MacDonald, Luke H.; Shiferaw, Solomon; Seme, Assefa; Schwab, Kellogg J.

2017-01-01

Water and sanitation indicators under the Millennium Development Goals failed to capture high-risk practices undertaken on a regular basis. In conjunction with local partners, fourteen rounds of household surveys using mobile phones with a customized open-source application were conducted across nine study geographies in Asia and Africa. In addition to the main water and sanitation facilities, interviewees (n = 245,054) identified all water and sanitation options regularly used for at least one season of the year. Unimproved water consumption and open defecation were targeted as high-risk practices. We defined underreporting as the difference between the regular and main use of high-risk practices. Our estimates of high-risk practices as the main option matched the widely accepted Demographic and Health Surveys (DHS) estimates within the 95% confidence interval. However, estimates of these practices as a regular option was far higher than the DHS estimates. Across the nine geographies, median underreporting of unimproved water use was 5.5%, with a range of 0.5% to 13.9%. Median underreporting of open defecation was much higher at 9.9%, with a range of 2.7% to 11.5%. This resulted in an underreported population of 25 million regularly consuming unimproved water and 50 million regularly practicing open defecation. Further examination of data from Ethiopia suggested that location and socio-economic factors were significant drivers of underreporting. Current global monitoring relies on a framework that considers the availability and use of a single option to meet drinking water and sanitation needs. Our analysis demonstrates the use of multiple options and widespread underreporting of high-risk practices. Policies based on current monitoring data, therefore, fail to consider the range of challenges and solutions to meeting water and sanitation needs, and result in an inflated sense of progress. Mobile surveys offer a cost-effective and innovative platform to rapidly and repeatedly monitor critical development metrics. PMID:28489904

21 CFR 131.115 - Concentrated milk.

Code of Federal Regulations, 2014 CFR

2014-04-01

... be homogenized. (b) Vitamin addition (Optional). If added, vitamin D shall be present in such... manufacturing practice. (c) Optional ingredients. The following safe and suitable optional ingredients may be used: (1) Carrier for vitamin D. (2) Characterizing flavoring ingredients, with or without coloring, as...

78 FR 10671 - Self-Regulatory Organizations; Chicago Board Options Exchange, Incorporated; Notice of Filing of...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-14

...-Regulatory Organizations; Chicago Board Options Exchange, Incorporated; Notice of Filing of Proposed Rule Change To Permit the Minimum Price Variation for Mini-Options To Be the Same as Permitted for Standard Options on the Same Security February 8, 2013. Pursuant to Section 19(b)(1) of the Securities Exchange Act...

78 FR 28692 - Self-Regulatory Organizations; BOX Options Exchange LLC; Notice of Filing and Immediate...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-15

... standard SPY options, (2) codify the minimum contract threshold requirement for the execution of Jumbo SPY... Fund (``IWM''). QQQQ, SPY and IWM are quoted in $0.01 increments for all options series. This proposed... Exchange believes that by reducing the minimum trading increments for Jumbo SPY Options to $0.01, the...

Group Health's participation in a shared decision-making demonstration yielded lessons, such as role of culture change.

PubMed

King, Jaime; Moulton, Benjamin

2013-02-01

In 2007 Washington State became the first state to enact legislation encouraging the use of shared decision making and decision aids to address deficiencies in the informed-consent process. Group Health volunteered to fulfill a legislated mandate to study the costs and benefits of integrating these shared decision-making processes into clinical practice across a range of conditions for which multiple treatment options are available. The Group Health Demonstration Project, conducted during 2009-11, yielded five key lessons for successful implementation, including the synergy between efforts to reduce practice variation and increase shared decision making; the need to support modifications in practice with changes in physician training and culture; and the value of identifying best implementation methods through constant evaluation and iterative improvement. These lessons, and the legislated provisions that supported successful implementation, can guide other states and health care institutions moving toward informed patient choice as the standard of care for medical decision making.

Redefining the Practice of Peer Review Through Intelligent Automation Part 2: Data-Driven Peer Review Selection and Assignment.

PubMed

Reiner, Bruce I

2017-12-01

In conventional radiology peer review practice, a small number of exams (routinely 5% of the total volume) is randomly selected, which may significantly underestimate the true error rate within a given radiology practice. An alternative and preferable approach would be to create a data-driven model which mathematically quantifies a peer review risk score for each individual exam and uses this data to identify high risk exams and readers, and selectively target these exams for peer review. An analogous model can also be created to assist in the assignment of these peer review cases in keeping with specific priorities of the service provider. An additional option to enhance the peer review process would be to assign the peer review cases in a truly blinded fashion. In addition to eliminating traditional peer review bias, this approach has the potential to better define exam-specific standard of care, particularly when multiple readers participate in the peer review process.

American Society for Radiation Oncology (ASTRO) and American College of Radiology (ACR) Practice Guideline for the Performance of High-Dose-Rate Brachytherapy

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

Erickson, Beth A.; Demanes, D. Jeffrey; Ibbott, Geoffrey S.

2011-03-01

High-Dose-Rate (HDR) brachytherapy is a safe and efficacious treatment option for patients with a variety of different malignancies. Careful adherence to established standards has been shown to improve the likelihood of procedural success and reduce the incidence of treatment-related morbidity. A collaborative effort of the American College of Radiology (ACR) and American Society for Therapeutic Radiation Oncology (ASTRO) has produced a practice guideline for HDR brachytherapy. The guideline defines the qualifications and responsibilities of all the involved personnel, including the radiation oncologist, physicist and dosimetrists. Review of the leading indications for HDR brachytherapy in the management of gynecologic, thoracic, gastrointestinal,more » breast, urologic, head and neck, and soft tissue tumors is presented. Logistics with respect to the brachytherapy implant procedures and attention to radiation safety procedures and documentation are presented. Adherence to these practice guidelines can be part of ensuring quality and safety in a successful HDR brachytherapy program.« less

Facial palsy: what can the multidisciplinary team do?

PubMed Central

Butler, Daniel P; Grobbelaar, Adriaan O

2017-01-01

The functional and psychosocial impact of facial paralysis on the patient is significant. In response, a broad spectrum of treatment options exist and are provided by a multitude of health care practitioners. The cause and duration of the facial weakness can vary widely and the optimal care pathway varies. To optimize patient outcome, those involved in the care of patients with facial palsy should collaborate within comprehensive multidisciplinary teams (MDTs). At an international level, those involved in the care of patients with facial paralysis should aim to create standardized guidelines on which outcome domains matter most to patients to aid the identification of high quality care. This review summarizes the causes and treatment options for facial paralysis and discusses the subsequent importance of multidisciplinary care in the management of patients with this condition. Further discussion is given to the extended role of the MDT in determining what constitutes quality in facial palsy care to aid the creation of accepted care pathways and delineate best practice. PMID:29026314

Wildlife habitats in managed rangelands—the Great Basin of southeastern Oregon: management practices and options.

Treesearch

Frederick C. Hall

1985-01-01

Management practices and options to provide habitat for wildlife in the Great Basin of southeastern Oregon deal with both vegetation treatment and protection, livestock management, maintenance or distribution of water developments, protection of wildlife areas through road closures or fencing, and direct manipulation of wildlife through hunting, trapping, or other...

Clinical nurse specialist subroles: foundations for entrepreneurship.

PubMed

Hazelton, J H; Boyum, C M; Frost, M H

1993-01-01

Entrepreneurship is a career option for nurses seeking autonomy in their practice. The six subroles of the CNS--researcher, consultant, advanced clinician, educator, leader/manager, and collaborator--provide the framework for discussion of the functional aspects of this new option. Examples demonstrate how these subroles have been used by various nurse entrepreneurs. Implications for practice and recommendations are provided.

Methodological aspects of clinical trials in tinnitus: A proposal for an international standard

PubMed Central

Landgrebe, Michael; Azevedo, Andréia; Baguley, David; Bauer, Carol; Cacace, Anthony; Coelho, Claudia; Dornhoffer, John; Figueiredo, Ricardo; Flor, Herta; Hajak, Goeran; van de Heyning, Paul; Hiller, Wolfgang; Khedr, Eman; Kleinjung, Tobias; Koller, Michael; Lainez, Jose Miguel; Londero, Alain; Martin, William H.; Mennemeier, Mark; Piccirillo, Jay; De Ridder, Dirk; Rupprecht, Rainer; Searchfield, Grant; Vanneste, Sven; Zeman, Florian; Langguth, Berthold

2013-01-01

Chronic tinnitus is a common condition with a high burden of disease. While many different treatments are used in clinical practice, the evidence for the efficacy of these treatments is low and the variance of treatment response between individuals is high. This is most likely due to the great heterogeneity of tinnitus with respect to clinical features as well as underlying pathophysiological mechanisms. There is a clear need to find effective treatment options in tinnitus, however, clinical trials differ substantially with respect to methodological quality and design. Consequently, the conclusions that can be derived from these studies are limited and jeopardize comparison between studies. Here, we discuss our view of the most important aspects of trial design in clinical studies in tinnitus and make suggestions for an international methodological standard in tinnitus trials. We hope that the proposed methodological standard will stimulate scientific discussion and will help to improve the quality of trials in tinnitus. PMID:22789414

Childhood Arthritis and Rheumatology Research Alliance consensus treatment plans for juvenile idiopathic arthritis-associated and idiopathic chronic anterior uveitis.

PubMed

Angeles-Han, Sheila T; Lo, Mindy S; Henderson, Lauren A; Lerman, Melissa A; Abramson, Leslie; Cooper, Ashley M; Parsa, Miriam F; Zemel, Lawrence S; Ronis, Tova; Beukelman, Timothy; Cox, Erika; Sen, H Nida; Holland, Gary N; Brunner, Hermine I; Lasky, Andrew; Rabinovich, C Egla

2018-05-28

Systemic immunosuppressive treatment of pediatric chronic anterior uveitis (CAU), both juvenile idiopathic arthritis (JIA)-associated and idiopathic varies, making it difficult to identify best treatments. The Childhood Arthritis and Rheumatology Research Alliance (CARRA) developed consensus treatment plans (CTPs) for CAU for the purpose of reducing practice variability and allowing future comparison of treatments by comparative effectiveness analysis techniques. A core group of pediatric rheumatologists, ophthalmologists with uveitis expertise, and a lay advisor comprised the CARRA uveitis workgroup who performed literature review on pharmacologic treatments, held teleconferences, and developed a case-based survey administered to the CARRA membership to delineate treatment practices. We utilized 3 face-to-face consensus meetings using nominal group technique to develop CTPs. The survey identified areas of treatment practice variability. We developed 2 CTPs for the treatment of CAU, case definitions, and monitoring parameters. The first CTP is directed at children naïve to steroid-sparing medication, and the second at children initiating biologic therapy with options for methotrexate, adalimumab and infliximab. We defined a core dataset and outcome measures with data collection at 3 and 6 months after therapy initiation. The CARRA membership voted acceptance of the CTPs with a >95% (N = 233) approval. Using consensus methodology, two standardized CTPs were developed for systemic immunosuppressive treatment of CAU. These CTPs are not meant as treatment guidelines, but are designed for further pragmatic research within the CARRA research network. Use of these CTPs in a prospective comparison effectiveness study should improve outcomes by identifying best practice options. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Option Grids to facilitate shared decision making for patients with Osteoarthritis of the knee: protocol for a single site, efficacy trial.

PubMed

Marrin, Katy; Wood, Fiona; Firth, Jill; Kinsey, Katharine; Edwards, Adrian; Brain, Kate E; Newcombe, Robert G; Nye, Alan; Pickles, Timothy; Hawthorne, Kamila; Elwyn, Glyn

2014-04-07

Despite policy interest, an ethical imperative, and evidence of the benefits of patient decision support tools, the adoption of shared decision making (SDM) in day-to-day clinical practice remains slow and is inhibited by barriers that include culture and attitudes; resources and time pressures. Patient decision support tools often require high levels of health and computer literacy. Option Grids are one-page evidence-based summaries of the available condition-specific treatment options, listing patients' frequently asked questions. They are designed to be sufficiently brief and accessible enough to support a better dialogue between patients and clinicians during routine consultations. This paper describes a study to assess whether an Option Grid for osteoarthritis of the knee (OA of the knee) facilitates SDM, and explores the use of Option Grids by patients disadvantaged by language or poor health literacy. This will be a stepped wedge exploratory trial involving 72 patients with OA of the knee referred from primary medical care to a specialist musculoskeletal service in Oldham. Six physiotherapists will sequentially join the trial and consult with six patients using usual care procedures. After a period of brief training in using the Option Grid, the same six physiotherapists will consult with six further patients using an Option Grid in the consultation. The primary outcome will be efficacy of the Option Grid in facilitating SDM as measured by observational scores using the OPTION scale. Comparisons will be made between patients who have received the Option Grid and those who received usual care. A Decision Quality Measure (DQM) will assess quality of decision making. The health literacy of patients will be measured using the REALM-R instrument. Consultations will be observed and audio-recorded. Interviews will be conducted with the physiotherapists, patients and any interpreters present to explore their views of using the Option Grid. Option Grids offer a potential solution to the barriers to implementing traditional decision aids into routine clinical practice. The study will assess whether Option Grids can facilitate SDM in day-to-day clinical practice and explore their use with patients disadvantaged by language or poor health literacy. Current Controlled Trials ISRCTN94871417.

77 FR 28455 - National Standards for Traffic Control Devices; the Manual on Uniform Traffic Control Devices for...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-14

... Options for design and applications of traffic control devices, this Manual should not be considered a... application of traffic control devices, as well as in the location and design of roads and streets that the..., while this Manual provides Standards, Guidance, and Options for design and applications of traffic...

40 CFR Table 10 to Subpart G of... - Wastewater-Compliance Options for Wastewater Tanks

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 9 2011-07-01 2011-07-01 false Wastewater-Compliance Options for Wastewater Tanks 10 Table 10 to Subpart G of Part 63 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) NATIONAL EMISSION STANDARDS FOR HAZARDOUS AIR POLLUTANTS FOR SOURCE CATEGORIES National Emission Standards...

40 CFR Table 10 to Subpart G of... - Wastewater-Compliance Options for Wastewater Tanks

Code of Federal Regulations, 2012 CFR

2012-07-01

... 40 Protection of Environment 10 2012-07-01 2012-07-01 false Wastewater-Compliance Options for Wastewater Tanks 10 Table 10 to Subpart G of Part 63 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) NATIONAL EMISSION STANDARDS FOR HAZARDOUS AIR POLLUTANTS FOR SOURCE CATEGORIES National Emission Standard...

40 CFR Table 10 to Subpart G of... - Wastewater-Compliance Options for Wastewater Tanks

Code of Federal Regulations, 2014 CFR

2014-07-01

... 40 Protection of Environment 10 2014-07-01 2014-07-01 false Wastewater-Compliance Options for Wastewater Tanks 10 Table 10 to Subpart G of Part 63 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) NATIONAL EMISSION STANDARDS FOR HAZARDOUS AIR POLLUTANTS FOR SOURCE CATEGORIES National Emission Standard...

40 CFR Table 10 to Subpart G of... - Wastewater-Compliance Options for Wastewater Tanks

Code of Federal Regulations, 2013 CFR

2013-07-01

... 40 Protection of Environment 10 2013-07-01 2013-07-01 false Wastewater-Compliance Options for Wastewater Tanks 10 Table 10 to Subpart G of Part 63 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) NATIONAL EMISSION STANDARDS FOR HAZARDOUS AIR POLLUTANTS FOR SOURCE CATEGORIES National Emission Standard...

40 CFR Table 10 to Subpart G of... - Wastewater-Compliance Options for Wastewater Tanks

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 9 2010-07-01 2010-07-01 false Wastewater-Compliance Options for Wastewater Tanks 10 Table 10 to Subpart G of Part 63 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) NATIONAL EMISSION STANDARDS FOR HAZARDOUS AIR POLLUTANTS FOR SOURCE CATEGORIES National Emission Standards...

Is the Cognitive Complexity of Commitment-to-Change Statements Associated With Change in Clinical Practice? An Application of Bloom's Taxonomy.

PubMed

Armson, Heather; Elmslie, Tom; Roder, Stefanie; Wakefield, Jacqueline

2015-01-01

This study categorizes 4 practice change options, including commitment-to-change (CTC) statements using Bloom's taxonomy to explore the relationship between a hierarchy of CTC statements and implementation of changes in practice. Our hypothesis was that deeper learning would be positively associated with implementation of planned practice changes. Thirty-five family physicians were recruited from existing practice-based small learning groups. They were asked to use their usual small-group process while exploring an educational module on peripheral neuropathy. Part of this process included the completion of a practice reflection tool (PRT) that incorporates CTC statements containing a broader set of practice change options-considering change, confirmation of practice, and not convinced a change is needed ("enhanced" CTC). The statements were categorized using Bloom's taxonomy and then compared to reported practice implementation after 3 months. Nearly all participants made a CTC statement and successful practice implementation at 3 months. By using the "enhanced" CTC options, additional components that contribute to practice change were captured. Unanticipated changes accounted for one-third of all successful changes. Categorizing statements on the PRT using Bloom's taxonomy highlighted the progression from knowledge/comprehension to application/analysis to synthesis/evaluation. All PRT statements were classified in the upper 2 levels of the taxonomy, and these higher-level (deep learning) statements were related to higher levels of practice implementation. The "enhanced" CTC options captured changes that would not otherwise be identified and may be worthy of further exploration in other CME activities. Using Bloom's taxonomy to code the PRT statements proved useful in highlighting the progression through increasing levels of cognitive complexity-reflecting deep learning. © 2015 The Alliance for Continuing Education in the Health Professions, the Society for Academic Continuing Medical Education, and the Council on Continuing Medical Education, Association for Hospital Medical Education.

78 FR 59076 - Self-Regulatory Organizations; NASDAQ OMX PHLX LLC; Notice of Filing and Immediate Effectiveness...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-09-25

... contracts (Rule 1057) and PHLX FOREX option contracts (Rules 1000C-1009C). Standard expiration contracts... apply only to series of option contracts opened for trading after the effective date of the OCC rule... trading of options in order to change the expiration date for most option contracts to the third Friday of...

Implementing Best Practices and Validation of Cryopreservation Techniques for Microorganisms

PubMed Central

Smith, David; Ryan, Matthew

2012-01-01

Authentic, well preserved living organisms are basic elements for research in the life sciences and biotechnology. They are grown and utilized in laboratories around the world and are key to many research programmes, industrial processes and training courses. They are vouchers for publications and must be available for confirmation of results, further study or reinvestigation when new technologies become available. These biological resources must be maintained without change in biological resource collections. In order to achieve best practice in the maintenance and provision of biological materials for industry, research and education the appropriate standards must be followed. Cryopreservation is often the best preservation method available to achieve these aims, allowing long term, stable storage of important microorganisms. To promulgate best practice the Organisation for Economic Development and Co-operation (OECD published the best practice guidelines for BRCs. The OECD best practice consolidated the efforts of the UK National Culture Collections, the European Common Access to Biological Resources and Information (CABRI) project consortium and the World Federation for Culture Collections. The paper discusses quality management options and reviews cryopreservation of fungi, describing how the reproducibility and quality of the technique is maintained in order to retain the full potential of fungi. PMID:22629202

Managing caries: the need to close the gap between the evidence base and current practice.

PubMed

Schwendicke, F; Doméjean, S; Ricketts, D; Peters, M

2015-11-13

Underpinned by a changing knowledge of the aetiology of caries and its sequelae, and assisted by established and advancing dental materials, there is growing evidence supporting less invasive management of dental caries based on the principles of minimal intervention dentistry. This narrative review assesses both the evidence and the adoption of less invasive caries management strategies and describes ways in which the gap between evidence and practice might be overcome. While there is increasing data supporting less invasive management of carious lesions, these are not standard in most dental practices worldwide. Usually, clinical studies focused on efficacy as outcome, and did not take into consideration the views and priorities of other stakeholders, such as primary care dentists, educators, patients and those financing services. Involving these stakeholders into study design and demonstrating the broader advantages of new management strategies might improve translation of research into practice. In theory, clinical dentists can rely on a growing evidence in cariology regarding less invasive management options. In practice, further factors seem to impede adoption of these strategies. Future research should address these factors by involving major stakeholders and investigating their prioritised outcomes to narrow or close the evidence gap.

Management/Technical Interaction in Integrated Information System Development.

ERIC Educational Resources Information Center

Bagley, Clarence H.; Gardner, Don E.

The integrated information system element of the management information system concept has practical applications for management in the areas of both information analysis and decision-model building. Four basic options for achieving integration in operational data systems are: a default option, the coordinated file option, the distributed…

Selection of a Non-ODC Solvent for Rubber Processing Equipment Cleaning

NASA Technical Reports Server (NTRS)

Morgan, R. E.; Thornton, T. N.; Semmel, L.; Selvidge, S. A.; Cash, Steve (Technical Monitor)

2002-01-01

NASA/MSFC has recently acquired new equipment for the manufacture and processing of rubber and rubber containing items that are used in the RSRM (Reusable Solid Rocket Motor) system. Work with a previous generation of rubber equipment at MSFC (Marshall Space Flight Center) in the 1970's had involved the use of ODC's such as 1,1,1-Trichloroethane or VOC's such as Toluene as the solvents of choice in cleaning the equipment. Neither of these options is practical today. This paper addresses the selection and screening of candidate cleaning solvents that are not only effective, but also meet the new environmental standards.

Selection of a Non-ODC Solvent for Rubber Processing Equipment Cleaning

NASA Technical Reports Server (NTRS)

Morgan, R. E.; Thornton, T. N.; Semmel, L.; Selvidge, S. A.

2003-01-01

NASA/MSFC has recently acquired new equipment for the manufacture and processing of rubber and rubber containing items that are used in the Redesigned Solid Rocket Motor (RSRM) system. Work with a previous generation of rubber equipment at MSFC in the 1970's had involved the use of Oxygen Deficient Center (ODC's) such as 1,1,1-Trichloroethane or VOC's such as Toluene as the solvents of choice in cleaning the equipment. Neither of these options is practical today. This paper addresses the selection and screening of candidate cleaning solvents that are not only effective, but also meet the new environmental standards.

The Treatment of Restless Legs Syndrome and Periodic Limb Movement Disorder in Adults—An Update for 2012: Practice Parameters with an Evidence-Based Systematic Review and Meta-Analyses

PubMed Central

Aurora, R. Nisha; Kristo, David A.; Bista, Sabin R.; Rowley, James A.; Zak, Rochelle S.; Casey, Kenneth R.; Lamm, Carin I.; Tracy, Sharon L.; Rosenberg, Richard S.

2012-01-01

A systematic literature review and meta-analyses (where appropriate) were performed to update the previous AASM practice parameters on the treatments, both dopaminergic and other, of RLS and PLMD. A considerable amount of literature has been published since these previous reviews were performed, necessitating an update of the corresponding practice parameters. Therapies with a STANDARD level of recommendation include pramipexole and ropinirole. Therapies with a GUIDELINE level of recommendation include levodopa with dopa decarboxylase inhibitor, opioids, gabapentin enacarbil, and cabergoline (which has additional caveats for use). Therapies with an OPTION level of recommendation include carbamazepine, gabapentin, pregabalin, clonidine, and for patients with low ferritin levels, iron supplementation. The committee recommends a STANDARD AGAINST the use of pergolide because of the risks of heart valve damage. Therapies for RLS secondary to ESRD, neuropathy, and superficial venous insufficiency are discussed. Lastly, therapies for PLMD are reviewed. However, it should be mentioned that because PLMD therapy typically mimics RLS therapy, the primary focus of this review is therapy for idiopathic RLS. Citation: Aurora RN; Kristo DA; Bista SR; Rowley JA: Zak RS; Casey KR; Lamm CI; Tracy SL; Rosenberg RS. The treatment of restless legs syndrome and periodic limb movement disorder in adults—an update for 2012: practice parameters with an evidence-based systematic review and meta-analyses. SLEEP 2012;35(8):1039-1062. PMID:22851801

40 CFR 63.2241 - What are the work practice requirements and how must I meet them?

Code of Federal Regulations, 2010 CFR

2010-07-01

... Products Compliance Options, Operating Requirements, and Work Practice Requirements § 63.2241 What are the...) If you have a dry rotary dryer, you may choose to designate your dry rotary dryer as a green rotary dryer and meet the more stringent compliance options and operating requirements in § 63.2240 for green...

Dental practice websites: creating a Web presence.

PubMed

Miller, Syrene A; Forrest, Jane L

2002-07-01

Web technology provides an opportunity for dentists to showcase their practice philosophy, quality of care, office setting, and staff in a creative manner. Having a Website provides a practice with innovative and cost-effective communications and marketing tools for current and potential patients who use the Internet. The main benefits of using a Website to promote one's practice are: Making office time more productive, tasks more timely, follow-up less necessary Engaging patients in an interactive and visual learning process Providing online forms and procedure examples for patients Projecting a competent and current image Tracking the usage of Web pages. Several options are available when considering the development of a Website. These options range in cost based on customization of the site and ongoing support services, such as site updates, technical assistance, and Web usage statistics. In most cases, Websites are less expensive than advertising in the phone book. Options in creating a Website include building one's own, employing a company that offers Website templates, and employing a company that offers customized sites. These development options and benefits will continue to grow as individuals access the Web and more information and sites become available.

Impact of dentists' years since graduation on management of temporomandibular disorders.

PubMed

Reissmann, Daniel R; Behn, Alexandra; Schierz, Oliver; List, Thomas; Heydecke, Guido

2015-12-01

The aims were to assess the impact of the number of years since dentists' graduation on appraisement of diagnostic needs and utilization of treatment options for temporomandibular disorders (TMD) and to investigate whether increased knowledge in TMD is sufficiently considered in today's dentist's undergraduate curricula and, therefore, represented in more evidence-based TMD management in dentists with less years since graduation. A questionnaire regarding knowledge and management of TMD was developed and was subsequently applied in a random sample of 400 dentists in a region in Northern Germany. Of the 222 dentists (response rate 55.6 %), participating in the study, the frequency of TMD treatment need in the general population was estimated at 21.5 %, with lower values in dentists with more years passed since graduation. Measures regarding utilization of standardized examination forms, perceptions of insufficient specialization, and referrals of patients to TMD specialists indicated a lower quality and certainty in TMD management in participants with less time since graduation. While the provision of splints was a well-established treatment option in initial TMD management of all participants, additional TMD treatment options were mentioned less often, with lower proportions of participants making use of these options within the first decade since graduation. Evidence-based TMD management is not fully represented in dental practitioners in Germany. This might be due to an insufficient consideration of TMD management in the dentist's undergraduate curricula. Effective interventions to increase dentists' knowledge and to change dentists' practices in TMD management are required.

The Differences among Three-, Four-, and Five-Option-Item Formats in the Context of a High-Stakes English-Language Listening Test

ERIC Educational Resources Information Center

Lee, HyeSun; Winke, Paula

2013-01-01

We adapted three practice College Scholastic Ability Tests (CSAT) of English listening, each with five-option items, to create four- and three-option versions by asking 73 Korean speakers or learners of English to eliminate the least plausible options in two rounds. Two hundred and sixty-four Korean high school English-language learners formed…

75 FR 29893 - Business Reply Mail Online Application Option

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-28

... POSTAL SERVICE 39 CFR Part 111 Business Reply Mail Online Application Option AGENCY: Postal Service TM . ACTION: Final rule. SUMMARY: The Postal Service TM will revise the Mailing Standards of the... option to obtain a Business Reply Mail[supreg] (BRM) permit online. Additionally, the electronic version...

77 FR 48580 - Self-Regulatory Organizations; Chicago Board Options Exchange, Incorporated; Order Granting...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-14

.... Description of the Proposal FLEX Options, unlike traditional standardized options, allow investors to..., settling, processing information with respect to, and facilitating transactions in securities, to remove... general, to protect investors and the public interest; and not be designed to permit unfair discrimination...

40 CFR 89.102 - Effective dates, optional inclusion, flexibility for equipment manufacturers.

Code of Federal Regulations, 2011 CFR

2011-07-01

... COMPRESSION-IGNITION ENGINES Emission Standards and Certification Provisions § 89.102 Effective dates, optional inclusion, flexibility for equipment manufacturers. (a) This subpart applies to all engines... manufactured on or after January 1, 2000. (b) A manufacturer can optionally certify engines manufactured up to...

40 CFR 89.102 - Effective dates, optional inclusion, flexibility for equipment manufacturers.

Code of Federal Regulations, 2014 CFR

2014-07-01

... COMPRESSION-IGNITION ENGINES Emission Standards and Certification Provisions § 89.102 Effective dates, optional inclusion, flexibility for equipment manufacturers. (a) This subpart applies to all engines... manufactured on or after January 1, 2000. (b) A manufacturer can optionally certify engines manufactured up to...

Identifying patients and clinical scenarios for use of long-acting injectable antipsychotics - expert consensus survey part 1.

PubMed

Sajatovic, Martha; Ross, Ruth; Legacy, Susan N; Correll, Christoph U; Kane, John M; DiBiasi, Faith; Fitzgerald, Heather; Byerly, Matthew

2018-01-01

To assess expert consensus on barriers and facilitators for long-acting injectable antipsychotic (LAI) use and provide clinical recommendations on issues where clinical evidence is lacking, including identifying appropriate clinical situations for LAI use. A 50-question survey comprising 916 response options was distributed to 42 research experts and high prescribers with extensive LAI experience. Respondents rated options on relative appropriateness/importance using a 9-point scale. Consensus was determined using chi-square test of score distributions. Mean (standard deviation) ratings were calculated. Responses to 29 questions (577 options) relating to appropriate patients and clinical scenarios for LAI use are reported. Recommendations aligned with research on risk factors for nonadherence and poor outcomes for patients with schizophrenia/schizoaffective or bipolar disorder. Findings suggested, contrary to general practice patterns, that LAI use may be appropriate earlier in the disease course and in younger patients. Results for bipolar disorder were similar to those for schizophrenia but with less consensus. Numerous facilitators of LAI prescribing were considered important, particularly that LAIs may reduce relapses and improve outcomes. Findings support wider use of LAIs in patients with schizophrenia/schizoaffective and bipolar disorders beyond the setting of poor adherence and earlier use in the disease course.

Study design options in evaluating gene-environment interactions: practical considerations for a planned case-control study of pediatric leukemia.

PubMed

Goodman, Michael; Dana Flanders, W

2007-04-01

We compare methodological approaches for evaluating gene-environment interaction using a planned study of pediatric leukemia as a practical example. We considered three design options: a full case-control study (Option I), a case-only study (Option II), and a partial case-control study (Option III), in which information on controls is limited to environmental exposure only. For each design option we determined its ability to measure the main effects of environmental factor E and genetic factor G, and the interaction between E and G. Using the leukemia study example, we calculated sample sizes required to detect and odds ratio (OR) of 2.0 for E alone, an OR of 10 for G alone and an interaction G x E of 3. Option I allows measuring both main effects and interaction, but requires a total sample size of 1,500 cases and 1,500 controls. Option II allows measuring only interaction, but requires just 121 cases. Option III allows calculating the main effect of E, and interaction, but not the main effect of G, and requires a total of 156 cases and 133 controls. In this case, the partial case-control study (Option III) appears to be more efficient with respect to its ability to answer the research questions for the amount of resources required. The design options considered in this example are not limited to observational epidemiology and may be applicable in studies of pharmacogenomics, survivorship, and other areas of pediatric ALL research.

75 FR 51668 - Optional Mail Preparation Standards for Flat-Size Mailpieces in FSS Zones

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-23

... bundles of six or more addressed pieces each, subject to these standards: * * * * * [Revise item b of 13.2... combination. Mailers will then prepare bundles of uniform size from the pieces in the pool. Bundles must be... this option may be applied to the top piece of each bundle, unless otherwise required to be placed on...

Hyperhidrosis: review of recent advances and new therapeutic options for primary hyperhidrosis.

PubMed

Brown, Ashley L; Gordon, Jennifer; Hill, Samantha

2014-08-01

Primary focal hyperhidrosis is a common condition that negatively impacts quality of life for many pediatric patients and can be challenging to treat. Standard treatments for hyperhidrosis can be used with success in many patients, and newer therapies and techniques offer options that have demonstrated efficacy and safety. This review highlights standard therapies for primary focal hyperhidrosis as well as the most recent technique advancements and alternative treatment options. The standard approach to treating primary focal hyperhidrosis remains initiation of topical preparations, followed by advancement to systemic medications, local administration of medication and/or surgical procedures. Recent studies focus on enhancing tolerability of topical preparations as well as evaluating the efficacy of neuromodulator injections, oral anticholinergic medications and laser therapy. Microwave technology has also been introduced for the treatment of focal hyperhidrosis with promising results. Many therapies exist for hyperhidrosis, and each treatment plan must be evaluated on a patient-by-patient basis. Advances in standard therapies and emergence of new treatment techniques are the main emphases of current published literature on hyperhidrosis. This article presents recent therapeutic options as well as updates on more established strategies to help practitioners treat this challenging condition.

Other Remedy Options Evaluated

EPA Pesticide Factsheets

EPA considered several remedy options for reducing emissions from electric generating units (EGUs) that contribute significantly to nonattainment or interfere with maintenance of the air quality standards by downwind states.

Is different better?: models of teaching and their influence on the net financial outcome for general practice teaching posts.

PubMed

Laurence, Caroline O; Black, Linda E; Cheah, Carolyn; Karnon, Jonathan

2011-07-12

In Australia, training for general practice (GP) occurs within private practices and their involvement in teaching can have significant financial costs. At the same time there are growing demands for clinical places for all disciplines and for GP there is concern that there are insufficient teaching practices to meet the demand at the medical student, prevocational and vocational training levels. One option to address this may be to change how teaching occurs in the practice. A question that arises in posing such an option is whether different models of teaching change the costs for a teaching practice. The aim of this study is to determine the net financial outcome of teaching models in private GP. Modelling the financial implications for a range of teaching options using a costing framework developed from a survey of teaching practices in South Australia. Each option was compared with the traditional model of teaching where one GP supervisor is singularly responsible for one learner. The main outcome measure was net financial outcome per week. Decisions on the model cost parameters were made by the study's Steering Group which comprised of experienced GP supervisors. Four teaching models are presented. Model 1 investigates the gains from teaching multiple same level learners, Models 2 and 3, the benefits of vertically integrated teaching using different permutations, and Model 4 the concept of a GP teacher who undertakes all the teaching. There was a significant increase in net benefits of Aus$547 per week (95% confidence intervals $459, $668) to the practice when a GP taught two same level learners (Model 1) and when a senior registrar participated in teaching a prevocational doctor (Model 3, Aus$263, 95% confidence intervals $80, $570). For Model 2, a practice could significantly reduce the loss if a registrar was involved in vertically integrated teaching which included the training of a medical student (Aus$551, 95% confidence intervals $419, $718). The GP teacher model resulted in a net remuneration of Aus$207,335 per year, sourced predominantly from the GP teacher activities, with no loss to the practice. Our study costed teaching options that can maximise the financial outcomes from teaching. The inclusion of GP registrars in the teaching model or the supervisor teaching more than one same level learner results in a greater financial benefit. This gain was achieved through a reduction in supervisor teaching time and the sharing of administrative and teaching activities with GP registrars. We also show that a GP teacher who carries a minimal patient load can be a sustainable option for a practice. Further, the costing framework used for the teaching models presented in this study has the ability to be applied to any number of teaching model permutations.

Preparing Physicians for Rural-Based Primary Care Practice: A Preliminary Evaluation of Rural Training Initiatives at OSU-COM.

PubMed

Wheeler, Denna L; Hackler, Jeffrey B

2017-05-01

The physician shortage in Oklahoma coupled with geographic maldistribution of primary care physicians limits access to care in rural and underserved areas. One of the most effective strategies to recruit and retain physicians in rural areas is to create undergraduate and graduate medical education training sites in these locations. Oklahoma State University Center for Health Sciences College of Osteopathic Medicine has implemented a rural training program that begins with early recruitment of rural high school students, introduces medical students to rural practice options through rural clinical training opportunities, and provides opportunities to remain in rural Oklahoma for residency training through ongoing graduate medical education development. The purpose of this article is to provide a case study of the development of the college's Rural Medical Track. Preliminary findings indicate that rural-based clinical training for third- and fourth-year students strengthens performance on standardized tests.

Moral consensus theory: paradigm cases of abortion and orthothanasia in Brazil.

PubMed

Miziara, Ivan Dieb; Miziara, Carmen Silvia Molleis Galego

2013-01-01

Bioethics is a relatively new way of thinking about relationships in medical practice. It enables reflection on ethical conflicts, and opens up management options without dictating rules. Despite this historical context, medical ethics has been sidelined in the course of the development of bioethics. Bioethical reflection does not automatically result in changes to conflict resolution in daily doctor-patient relationships. However, these reflections are important because they promote the search for a "moral consensus" that establishes new ethical rules for day-to-day medical practice. We suggest that there is no conflict between bioethics and medical ethics; rather, these areas interact to establish new standards of behaviour among physicians. The legalisation of orthothanasia in Brazil is one example of how this theory of moral consensus might operate. On the other hand, the legal battle on abortion illustrates how the law cannot change without such a moral consensus.

Individualisation of Lean Concept in Companies Dealing with Mass Production

NASA Astrophysics Data System (ADS)

Bednár, Roman

2012-12-01

The methods of lean manufacturing primarily designed for businesses dealing with serial production, are also used in other types of production. However the concept of lean production was not designed for these types of businesses, they are utilized only partially. Paper focuses on applying methods of lean concept in companies which are dealing with mass production and their options of exchange for other methods in the event of disagreement. Basis of the article is a list of lean methods with its description and its utilization in practice. The questionnaire was utilized to identify information from the practice. Based on this survey were identified the critical methods that are no longer appropriate for companies dealing with mass production. However, there are alternative methods of describing the problem. It is possible to say that companies are trying to get closer to their goal by modification of the basic concepts. And the concept of Lean Enterprise serves as a standard.

42 CFR 435.4 - Definitions and use of terms.

Code of Federal Regulations, 2010 CFR

2010-10-01

... disabled individual; Optional targeted low-income child means a child under age 19 who meets the financial and categorical standards described below. (1) Financial need. An optional targeted low-income child... optional targeted low-income child is not covered under a group health plan or health insurance coverage...

The struggle for equality in healthcare continues.

PubMed

Rutledge, E O

2001-01-01

All healthcare providers, both institutional and individual, must make every effort to ensure that every person who seeks their medical care is offered competent, sincere, and equal treatment options. Unfortunately, this ideal scenario does not take into account the lack of diversity among care providers and the lack of culturally competent policies within healthcare delivery settings. As a result, many care providers continue to follow racially biased treatment practices and many organizations continue to ignore their public trust of providing fair treatment to everyone, regardless of skin color, gender, economic capabilities, etc. Although developing and implementing a diversity plan and culturally competent policies is very complex practically, politically, and programmatically for traditional institutional care providers, it must be done. The key ingredient to this effort is the absolute commitment and support of the organization's governing bodies and executive management. Institutions can certainly volunteer and begin to develop such programs that foster recruitment, selection, and retention of culturally competent care providers to ensure that equal healthcare is received by their patient populations. However, many institutions are already besieged by too many healthcare challenges to volunteer for such an effort. The Joint Commission on Accreditation of Healthcare Organizations and the National Council of Quality Assurance can certainly help jumpstart this effort by establishing an accreditation standard that requires all healthcare providers to establish and practice culturally competent care within their organizations. Providers must also embrace the diversity that is a part of our society and must not let race or ethnicity be a determining factor in offering treatment options.

[Innovative teleradiology network: concept and experience report].

PubMed

Kämmerer, M; Bethge, O T; Antoch, G

2014-04-01

(DICOM E-MAIL provides a standardized way for exchanging DICOM objects (Digital Imaging and Communications in Medicine) and further relevant patient data for the treatment context reliably and securely via encrypted e-mails. The current version of the DICOM E-MAIL standard recommendations of the"Deutsche Röntgengesellschaft" (DRG, German Röntgen Society) defines for the first time options for setting up a special directory service for the provision and distribution of communication data of all participants in a network. By using such"telephone books", networks of any size can be operated independent of the provider. Compared to a Cross-Enterprise Document Sharing (XDS) scenario, the required infrastructure is considerably less complex and quicker to realize. Critical success factors are, in addition to the technology and an effective support, that the participants themselves contribute to the further development of the network and in this way, the network approach can be practiced.

Obesity Prevention at the Point of Purchase

PubMed Central

Cohen, Deborah A.; Lesser, Lenard I.

2017-01-01

The point of purchase is when people may make poor and impulsive decisions about what and how much to buy and consume. Since point of purchase strategies frequently work through non-cognitive processes, people are often unable to recognize and resist them. Because people lack insight into how marketing practices interfere with their ability to routinely eat healthy, balanced diets, public health entities should protect consumers from point of purchase strategies. We describe four point of purchase policy options including standardized portion sizes; standards for meals that are sold as a bundle, e.g. “combo meals”; placement and marketing restrictions on highly processed low-nutrient foods; and explicit warning labels. Adoption of such policies could contribute significantly to the prevention of obesity and diet-related chronic diseases. We also discuss how the policies could be implemented, along with who might favor or oppose them. Many of the policies can be implemented locally, while preserving consumer choice. PMID:26910361

Remuneration of hematopoietic stem cell donors: principles and perspective of the World Marrow Donor Association.

PubMed

Boo, Michael; van Walraven, Suzanna M; Chapman, Jeremy; Lindberg, Brian; Schmidt, Alexander H; Shaw, Bronwen E; Switzer, Galen E; Yang, Edward; Egeland, Torstein

2011-01-06

Hematopoietic stem cell transplantation is a curative procedure for life-threatening hematologic diseases. Donation of hematopoietic stem cells (HSCs) from an unrelated donor, frequently residing in another country, may be the only option for 70% of those in need of unrelated hematopoietic stem cell transplantation. To maximize the opportunity to find the best available donor, individual donor registries collaborate internationally. To provide homogeneity of practice among registries, the World Marrow Donor Association (WMDA) sets standards against which registries are accredited and provides guidance and regulations about unrelated donor safety and care. A basic tenet of the donor registries is that unrelated HSC donation is an altruistic act; nonpayment of donors is entrenched in the WMDA standards and in international practice. In the United States, the prohibition against remuneration of donors has recently been challenged. Here, we describe the reasons that the WMDA continues to believe that HSC donors should not be paid because of ethical concerns raised by remuneration, potential to damage the public will to act altruistically, the potential for coercion and exploitation of donors, increased risk to patients, harm to local transplantation programs and international stem cell exchange, and the possibility of benefiting some patients while disadvantaging others.

Standardized Patients versus Volunteer Patients for Physical Therapy Students' Interviewing Practice: A Pilot Study.

PubMed

Murphy, Sue; Imam, Bita; MacIntyre, Donna L

2015-01-01

To compare the use of standardized patients (SPs) and volunteer patients (VPs) for physical therapy students' interviewing practice in terms of students' perception and overall costs. Students in the Master of Physical Therapy programme (n=80) at a Canadian university were divided into 20 groups of 4 and were randomly assigned to interview either an SP (10 groups) or a VP (10 groups). Students completed a survey about their perception of the usefulness of the activity and the ease and depth of information extraction. Survey responses as well as costs of the interview exercise were compared between SP and VP groups. No statistically significant between-groups difference was found for the majority of survey items. The cost of using an SP was $148, versus $50 for a VP. Students' perceptions of the usefulness of the activity in helping them to develop their interview skills and of the ease and depth of extracting information were similar for both SPs and VPs. Because the cost of using an SP is about three times that of using a VP, using VPs seem to be a more cost-effective option.

Systematic Review of Hydrotherapy Research: Does a Warm Bath in Labor Promote Normal Physiologic Childbirth?

PubMed

Shaw-Battista, Jenna

Health sciences research was systematically reviewed to assess randomized controlled trials of standard care versus immersion hydrotherapy in labor before conventional childbirth. Seven studies of 2615 women were included. Six trials examined hydrotherapy in midwifery care and found an effect of pain relief; of these, 2 examined analgesia and found reduced use among women who bathed in labor. One study each found that hydrotherapy reduced maternal anxiety and fetal malpresentation, increased maternal satisfaction with movement and privacy, and resulted in cervical dilation progress equivalent to standard labor augmentation practices. Studies examined more than 30 fetal and neonatal outcomes, and no benefit or harm of hydrotherapy was identified. Two trials had anomalous findings of increased newborn resuscitation or nursery admission after hydrotherapy, which were not supported by additional results in the same or other studies. Review findings demonstrate that intrapartum immersion hydrotherapy is a helpful and benign practice. Hydrotherapy facilitates physiologic childbirth and may increase satisfaction with care. Maternity care providers are recommended to include hydrotherapy among routine labor pain management options and consider immersion to promote progress of normal or protracted labor, particularly among women with preferences to avoid obstetric medications and procedures.

Enrichment options for African painted dogs (Lycaon pictus).

PubMed

Cloutier, Tammy L; Packard, Jane M

2014-01-01

Best practices for carnivore enrichment encourage the diversity of species-typical behaviors, increased activity, and reduced stereotypic behavior; ideally considering the life-history and behavior of each species. African wild dogs (Lycaon pictus), or painted dogs, are social carnivores that have large home ranges and complex pack dynamics (e.g., variation in group size, relatedness, etc.). As there are relatively few studies on painted dog enrichment, the goal of this study was to compile a list of enrichment options used by institutions participating in the species survival plan (SSP). Representatives were asked to describe social groups (n = 45), enclosures (n = 21), enrichment practices (options, delivery frequency, perceived success), and overall best practices. Respondents (61%, n = 23) reported using options for all six enrichment categories recommended by the Canid Taxon Advisory Group: environmental enrichment devices, habitat, sensory, food, behavioral, and social. Perceived success was significantly higher for the food category, followed by the sensory and behavioral categories. All respondents reported delivering enrichment at least multiple times a month, and most reported multiple times per week. Enclosure size did not differ significantly for mixed-sex groups (n = 28) compared to single-sex groups (n = 17). We discuss respondents' suggestions for best practices and the need to record data to compare perceived success with actual behavioral effects, controlling for variation in group size and composition. Overall, respondents recommended a flexible approach, since not all painted dogs and groups respond in the same way to the enrichment options. © 2014 Wiley Periodicals, Inc.

Numerical Algorithm for Delta of Asian Option

PubMed Central

Zhang, Boxiang; Yu, Yang; Wang, Weiguo

2015-01-01

We study the numerical solution of the Greeks of Asian options. In particular, we derive a close form solution of Δ of Asian geometric option and use this analytical form as a control to numerically calculate Δ of Asian arithmetic option, which is known to have no explicit close form solution. We implement our proposed numerical method and compare the standard error with other classical variance reduction methods. Our method provides an efficient solution to the hedging strategy with Asian options. PMID:26266271

Legal standard of care: a shift from the traditional Bolam test.

PubMed

Samanta, Ash; Samanta, Jo

2003-01-01

An essential component of an action in negligence against a doctor is proof that the doctor failed to provide the required standard of care under the circumstances. Traditionally the standard of care in law has been determined according to the Bolam test. This is based on the principle that a doctor does not breach the legal standard of care, and is therefore not negligent, if the practice is supported by a responsible body of similar professionals. The Bolam principle, however, has been perceived as being excessively reliant upon medical testimony supporting the defendant. The judgment given by the House of Lords in the recent case of Bolitho imposes a requirement that the standard proclaimed must be justified on a logical basis and must have considered the risks and benefits of competing options. The effect of Bolitho is that the court will take a more enquiring stance to test the medical evidence offered by both parties in litigation, in order to reach its own conclusions. Recent case law shows how the court has applied the Bolitho approach in determining the standard of care in cases of clinical negligence. An understanding of this approach and of the shift from the traditional Bolam test is relevant to all medical practitioners, particularly in a climate that is increasingly litigious.

7 CFR 457.122 - Walnut crop insurance provisions.

Code of Federal Regulations, 2013 CFR

2013-01-01

... optional units by section, section equivalent, or FSA farm serial number and by irrigated and non-irrigated practices are not applicable. Optional units may be established only if each optional unit is located on non... group, in which case you may select one price election for each walnut variety or varietal group...

7 CFR 457.122 - Walnut crop insurance provisions.

Code of Federal Regulations, 2012 CFR

2012-01-01

... optional units by section, section equivalent, or FSA farm serial number and by irrigated and non-irrigated practices are not applicable. Optional units may be established only if each optional unit is located on non... group, in which case you may select one price election for each walnut variety or varietal group...

7 CFR 457.122 - Walnut crop insurance provisions.

Code of Federal Regulations, 2011 CFR

2011-01-01

... optional units by section, section equivalent, or FSA farm serial number and by irrigated and non-irrigated practices are not applicable. Optional units may be established only if each optional unit is located on non... group, in which case you may select one price election for each walnut variety or varietal group...

Caring for Pregnant Women with Opioid Use Disorder in the USA: Expanding and Improving Treatment.

PubMed

Saia, Kelley A; Schiff, Davida; Wachman, Elisha M; Mehta, Pooja; Vilkins, Annmarie; Sia, Michelle; Price, Jordana; Samura, Tirah; DeAngelis, Justin; Jackson, Clark V; Emmer, Sawyer F; Shaw, Daniel; Bagley, Sarah

Opioid use disorder in the USA is rising at an alarming rate, particularly among women of childbearing age. Pregnant women with opioid use disorder face numerous barriers to care, including limited access to treatment, stigma, and fear of legal consequences. This review of opioid use disorder in pregnancy is designed to assist health care providers caring for pregnant and postpartum women with the goal of expanding evidence-based treatment practices for this vulnerable population. We review current literature on opioid use disorder among US women, existing legislation surrounding substance use in pregnancy, and available treatment options for pregnant women with opioid use disorder. Opioid agonist treatment (OAT) remains the standard of care for treating opioid use disorder in pregnancy. Medically assisted opioid withdrawal ("detoxification") is not recommended in pregnancy and is associated with high maternal relapse rates. Extended release naltrexone may confer benefit for carefully selected patients. Histories of trauma and mental health disorders are prevalent in this population; and best practice recommendations incorporate gender-specific, trauma-informed, mental health services. Breastfeeding with OAT is safe and beneficial for the mother-infant dyad. Further research investigating options of OAT and the efficacy of opioid antagonists in pregnancy is needed. The US health care system can adapt to provide quality care for these mother-infant dyads by expanding comprehensive treatment services and improving access to care.

The patient-centered medical home in oncology: from concept to reality.

PubMed

Page, Ray D; Newcomer, Lee N; Sprandio, John D; McAneny, Barbara L

2015-01-01

In recent years, the cost of providing quality cancer care has been subject to an epic escalation causing concerns on the verge of a health care crisis. Innovative patient-management models in oncology based on patient-centered medical home (PCMH) principles, coupled with alternative payments to traditional fee for service (FFS), such as bundled and episodes payment are now showing evidence of effectiveness. These efforts have the potential to bend the cost curve while also improving quality of care and patient satisfaction. However, going forward with FFS alternatives, there are several performance-based payment options with an array of financial risks and rewards. Most novel payment options convey a greater financial risk and accountability on the provider. Therefore, the oncology medical home (OMH) can be a way to mitigate some financial risks by sharing savings with the payer through better global care of the patient, proactively preventing complications, emergency department (ED) visits, and hospitalizations. However, much of the medical home infrastructure that is required to reduced total costs of cancer care comes as an added expense to the provider. As best-of-practice quality standards are being elucidated and refined, we are now at a juncture where payers, providers, policymakers, and other stakeholders should work in concert to expand and implement the OMH framework into the variety of oncology practice environments to better equip them to assimilate into the new payment reform configurations of the future.

Extracorporeal shockwaves as regenerative therapy in orthopedic traumatology: a narrative review from basic research to clinical practice.

PubMed

D Agostino, M C; Frairia, R; Romeo, P; Amelio, E; Berta, L; Bosco, V; Gigliotti, S; Guerra, C; Messina, S; Messuri, L; Moretti, B; Notarnicola, A; Maccagnano, G; Russo, S; Saggini, R; Vulpiani, M C; Buselli, P

2016-01-01

Extracorporeal Shock Wave Therapy (ESWT), after its first medical application in the urological field for lithotripsy, nowadays represents a valid therapeutical tool also for many musculoskeletal diseases, as well as for regenerative medicine applications. This is possible thanks to its mechanisms of action, which in the non-urological field are not related to mechanical disruption (as for renal stones), but rather to the capacity, by mechanotransduction, to induce neoangiogenesis, osteogenesis and to improve local tissue trophism, regeneration and remodeling, through stem cell stimulation. On the basis of these biological assumptions, it becomes clear that ESWT can represent a valid therapeutic tool also for all those pathological conditions that derive from musculoskeletal trauma, and are characterized by tissue loss and/or delayed healing and regeneration (mainly bone and skin, but not only). As a safe, repeatable and non–invasive therapy, in many cases it can represent a first–line therapeutic option, as an alternative to surgery (for example, in bone and skin healing disorders), or in combination with some other treatment options. It is hoped that with its use in daily practice also the muscle–skeletal field will grow, not only for standard indications, but also in post–traumatic sequelae, in order to improve recovery and shorten healing time, with undoubted advantages for the patients and lower health service expenses.

Options in Education, Transcript for November 3, 1975: College Enrollment, Standardized Testing, Hyperactive Children, Teacher Strikes, and Training to Be a Professional Golfer.

ERIC Educational Resources Information Center

George Washington Univ., Washington, DC. Inst. for Educational Leadership.

"Options in Education" is a radio news program which focuses on issues and developments in education. This transcript of the first show contains discussions of college enrollment, the controversy over standardized testing, hyperactivity in school children, the rash of teacher strikes, and how to become a professional golfer. Participants…

Army Contracting: Training and Guidance Needed to Ensure Appropriate Use of the Option to Extend Services Clause

DTIC Science & Technology

2016-01-28

reproduce this material separately. The Government Accountability Office, the audit , evaluation, and investigative arm of...Executive Director Army Contracting Command-Redstone Arsenal Army Contracting: Training and Guidance Needed to Ensure Appropriate Use of the Option to...which this report is based in accordance with generally accepted government auditing standards. Those standards require that we plan and perform the

Options in Education, Transcript for November 10, 1975: College Enrollment, Standardized Testing, Hyperactive School Children, Sex Discrimination in Education, Telephone Installation, and Adult Functional Competence.

ERIC Educational Resources Information Center

George Washington Univ., Washington, DC. Inst. for Educational Leadership.

"Options in Education" is a radio news program which focuses on issues and developments in education. This transcript of the show contains discussions of college enrollment; standardized testing; hyperactivity in school children, the drugs given to these children, and the biochemical effects of artificial flavors and colors on…

Effect of novel patient interaction on students’ performance of pregnancy options counseling

PubMed Central

Shaddeau, Angela; Nimz, Abigail; Sheeder, Jeanelle; Tocce, Kristina

2015-01-01

Background Although options counseling is a fundamental skill for medical providers, previous research has identified gaps in medical school reproductive health education. Purpose To determine if a 1-h novel patient interaction (NPI) improves student performance when caring for a standardized patient with an unintended pregnancy. Methods From September 2012 to June 2013 we randomized third-year medical students at the University of Colorado School of Medicine to the standard curriculum plus an NPI, or the standard curriculum only. The NPI consisted of a 1-h small-group session with a patient who discussed her experiences with options counseling and her decision to terminate her pregnancy. Students completed an Objective Structured Clinical Examination (OSCE) at the rotation's end, which included options counseling. The primary outcome was the proportion of participants achieving ‘excellence’ on the OSCE checklist. ‘Excellence’ was defined as a score ≥90%. Examinations were flagged as ‘unsatisfactory encounters’ if core competencies were not addressed. OSCE standardized patients and evaluators were blinded to group assignment. Results In total, 135 students were eligible and randomized: 75 to NPI; 60 to control. During the OSCE, few students achieved ‘excellence’ (24% NPI vs. 28% control, p=0.57). There were no differences between scores for components of options counseling. More students in the control group ‘appeared somewhat uncomfortable’ delivering the pregnancy test results (5% NPI vs. 18% control, p=0.006). More than half (54%) of the intervention group and 67% of controls had ‘unsatisfactory encounters’ (p=0.16), almost exclusively due to omission of adoption. Most students addressed abortion (96% NPI vs. 92% control, p=0.29). Conclusions A 1-h NPI does not improve medical students’ performance of pregnancy options counseling and the option of adoption is routinely omitted. Adoption is clearly an area that needs greater attention when designing comprehensive reproductive health curriculum for medical students. PMID:26654215

Effect of novel patient interaction on students' performance of pregnancy options counseling.

PubMed

Shaddeau, Angela; Nimz, Abigail; Sheeder, Jeanelle; Tocce, Kristina

2015-01-01

Although options counseling is a fundamental skill for medical providers, previous research has identified gaps in medical school reproductive health education. To determine if a 1-h novel patient interaction (NPI) improves student performance when caring for a standardized patient with an unintended pregnancy. From September 2012 to June 2013 we randomized third-year medical students at the University of Colorado School of Medicine to the standard curriculum plus an NPI, or the standard curriculum only. The NPI consisted of a 1-h small-group session with a patient who discussed her experiences with options counseling and her decision to terminate her pregnancy. Students completed an Objective Structured Clinical Examination (OSCE) at the rotation's end, which included options counseling. The primary outcome was the proportion of participants achieving 'excellence' on the OSCE checklist. 'Excellence' was defined as a score ≥90%. Examinations were flagged as 'unsatisfactory encounters' if core competencies were not addressed. OSCE standardized patients and evaluators were blinded to group assignment. In total, 135 students were eligible and randomized: 75 to NPI; 60 to control. During the OSCE, few students achieved 'excellence' (24% NPI vs. 28% control, p=0.57).There were no differences between scores for components of options counseling. More students in the control group 'appeared somewhat uncomfortable' delivering the pregnancy test results (5% NPI vs. 18% control, p=0.006). More than half (54%) of the intervention group and 67% of controls had 'unsatisfactory encounters' (p=0.16), almost exclusively due to omission of adoption. Most students addressed abortion (96% NPI vs. 92% control, p=0.29). A 1-h NPI does not improve medical students' performance of pregnancy options counseling and the option of adoption is routinely omitted. Adoption is clearly an area that needs greater attention when designing comprehensive reproductive health curriculum for medical students.

Using Option Grids: steps toward shared decision-making for neonatal circumcision.

PubMed

Fay, Mary; Grande, Stuart W; Donnelly, Kyla; Elwyn, Glyn

2016-02-01

To assess the impact, acceptability and feasibility of a short encounter tool designed to enhance the process of shared decision-making and parental engagement. We analyzed video-recordings of clinical encounters, half undertaken before and half after a brief intervention that trained four clinicians how to use Option Grids, using an observer-based measure of shared decision-making. We also analyzed semi-structured interviews conducted with the clinicians four weeks after their exposure to the intervention. Observer OPTION(5) scores were higher at post-intervention, with a mean of 33.9 (SD=23.5) compared to a mean of 16.1 (SD=7.1) for pre-intervention, a significant difference of 17.8 (95% CI: 2.4, 33.2). Prior to using the intervention, clinicians used a consent document to frame circumcision as a default practice. Encounters with the Option Grid conferred agency to both parents and clinicians, and facilitated shared decision-making. Clinician reported recognizing the tool's positive effect on their communication process. Tools such as Option Grids have the potential to make it easier for clinicians to achieve shared decision-making. Encounter tools have the potential to change practice. More research is needed to test their feasibility in routine practice. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

77 FR 21120 - Self-Regulatory Organizations; NYSE Arca, Inc.; Notice of Filing of Proposed Rule Change to List...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-09

... Contracts Overlying 10 Shares of a Security (``Mini-Options Contracts'') and Implementing Rule Text... contracts'') and implement rule text necessary to distinguish mini-options contracts from option contracts overlying 100 shares of a security (``standard contracts''). The text of the proposed rule change is...

78 FR 17985 - Self-Regulatory Organizations; The NASDAQ Stock Market LLC; Notice of Filing and Immediate...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-25

... with customer bases of potential product users have indicated a preference that premium pricing for... options on the same security. In addition to giving market participants clarity as to the minimum pricing increments for Mini Options, the filing would harmonize penny pricing between Mini Options and standard...

76 FR 9696 - Equipment Price Forecasting in Energy Conservation Standards Analysis

Federal Register 2010, 2011, 2012, 2013, 2014

2011-02-22

... for particular efficiency design options, an empirical experience curve fit to the available data may be used to forecast future costs of such design option technologies. If a statistical evaluation indicates a low level of confidence in estimates of the design option cost trend, this method should not be...

7 CFR 51.3418 - Optional test for fry color.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 7 Agriculture 2 2014-01-01 2014-01-01 false Optional test for fry color. 51.3418 Section 51.3418... § 51.3418 Optional test for fry color. Fry color may be determined in accordance with contract specifications by using the Munsell Color Standards for Frozen French Fried Potatoes, Third Edition, 1972, 64-1...

7 CFR 51.3418 - Optional test for fry color.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 7 Agriculture 2 2013-01-01 2013-01-01 false Optional test for fry color. 51.3418 Section 51.3418... § 51.3418 Optional test for fry color. Fry color may be determined in accordance with contract specifications by using the Munsell Color Standards for Frozen French Fried Potatoes, Third Edition, 1972, 64-1...

76 FR 79748 - Self-Regulatory Organizations; NASDAQ OMX PHLX LLC; Notice of Filing of Proposed Rule Change...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-22

..., confirming that ``iShares[supreg]'' is a registered trademark of BlackRock Institutional Trust Company, N.A...''), NYSEArca (``Arca''), BATS Global Markets (``BATS''), Boston Options Exchange (``BOX''), Chicago Board... to the applicable ETF option interval standards of other options markets.\\6\\ \\6\\ See, for example...

Reducing the number of options on multiple-choice questions: response time, psychometrics and standard setting.

PubMed

Schneid, Stephen D; Armour, Chris; Park, Yoon Soo; Yudkowsky, Rachel; Bordage, Georges

2014-10-01

Despite significant evidence supporting the use of three-option multiple-choice questions (MCQs), these are rarely used in written examinations for health professions students. The purpose of this study was to examine the effects of reducing four- and five-option MCQs to three-option MCQs on response times, psychometric characteristics, and absolute standard setting judgements in a pharmacology examination administered to health professions students. We administered two versions of a computerised examination containing 98 MCQs to 38 Year 2 medical students and 39 Year 3 pharmacy students. Four- and five-option MCQs were converted into three-option MCQs to create two versions of the examination. Differences in response time, item difficulty and discrimination, and reliability were evaluated. Medical and pharmacy faculty judges provided three-level Angoff (TLA) ratings for all MCQs for both versions of the examination to allow the assessment of differences in cut scores. Students answered three-option MCQs an average of 5 seconds faster than they answered four- and five-option MCQs (36 seconds versus 41 seconds; p = 0.008). There were no significant differences in item difficulty and discrimination, or test reliability. Overall, the cut scores generated for three-option MCQs using the TLA ratings were 8 percentage points higher (p = 0.04). The use of three-option MCQs in a health professions examination resulted in a time saving equivalent to the completion of 16% more MCQs per 1-hour testing period, which may increase content validity and test score reliability, and minimise construct under-representation. The higher cut scores may result in higher failure rates if an absolute standard setting method, such as the TLA method, is used. The results from this study provide a cautious indication to health professions educators that using three-option MCQs does not threaten validity and may strengthen it by allowing additional MCQs to be tested in a fixed amount of testing time with no deleterious effect on the reliability of the test scores. © 2014 John Wiley & Sons Ltd.

Selecting Treatments and Monitoring Outcomes: The Circle of Evidence-Based Practice and Client-Centered Care in Treating a Preschool Child Who Stutters

ERIC Educational Resources Information Center

Ratner, Nan Bernstein

2018-01-01

Purpose: The purpose of the present clinical forum is to compare how 2 clinicians might select among therapy options for a preschool-aged child who presents with stuttering close to onset. Method: I discuss approaches to full evaluation of the child's profile, advisement of evidence-based practice options open to the family, the need for…

Best Development Practices: A Primer for Smart Growth

EPA Pesticide Factsheets

Best Development Practices: A Primer for Smart Growth lists specific practices to achieve development principles that mix land uses, support transportation options, protect natural systems, and provide housing choices.

7 CFR 1468.6 - Practice eligibility provisions.

Code of Federal Regulations, 2010 CFR

2010-01-01

..., DEPARTMENT OF AGRICULTURE LOANS, PURCHASES, AND OTHER OPERATIONS CONSERVATION FARM OPTION General Provisions... conservation practice specified in the conservation farm plan is determined to be an eligible practice, as... practices that are eligible under CRP; (2) 7 CFR part 1467 for wetland restoration or protection practices...

Understanding the financial impact of robotics in gynecologic surgery.

PubMed

Swan, Kimberly; Advincula, Arnold P

2011-09-01

As surgical innovation and technological advancements evolve, the associated costs cannot be overlooked. Currently, the United States health care system is undergoing an attempted overhaul with technology such as robotics sitting front and center of the financial debate. As patient demand for less invasive surgical options increases and standards of practice change, patient outcomes must be carefully evaluated to justify the costs increase from traditional, often more invasive treatments. The collection of financial data is quite varied among hospital systems and so is the models used to determine the costs of robotics. Although limited thus far, various cost data have been ascertained in the areas of reproductive surgery, hysterectomy (both benign and oncologic), and pelvic reconstructive surgery.

Module Architecture for in Situ Space Laboratories

NASA Technical Reports Server (NTRS)

Sherwood, Brent

2010-01-01

The paper analyzes internal outfitting architectures for space exploration laboratory modules. ISS laboratory architecture is examined as a baseline for comparison; applicable insights are derived. Laboratory functional programs are defined for seven planet-surface knowledge domains. Necessary and value-added departures from the ISS architecture standard are defined, and three sectional interior architecture options are assessed for practicality and potential performance. Contemporary guidelines for terrestrial analytical laboratory design are found to be applicable to the in-space functional program. Densepacked racks of system equipment, and high module volume packing ratios, should not be assumed as the default solution for exploration laboratories whose primary activities include un-scriptable investigations and experimentation on the system equipment itself.

From randomized controlled trials to observational studies.

PubMed

Silverman, Stuart L

2009-02-01

Randomized controlled trials are considered the gold standard in the hierarchy of research designs for evaluating the efficacy and safety of a treatment intervention. However, their results can have limited applicability to patients in clinical settings. Observational studies using large health care databases can complement findings from randomized controlled trials by assessing treatment effectiveness in patients encountered in day-to-day clinical practice. Results from these designs can expand upon outcomes of randomized controlled trials because of the use of larger and more diverse patient populations with common comorbidities and longer follow-up periods. Furthermore, well-designed observational studies can identify clinically important differences among therapeutic options and provide data on long-term drug effectiveness and safety.

Exponential model for option prices: Application to the Brazilian market

NASA Astrophysics Data System (ADS)

Ramos, Antônio M. T.; Carvalho, J. A.; Vasconcelos, G. L.

2016-03-01

In this paper we report an empirical analysis of the Ibovespa index of the São Paulo Stock Exchange and its respective option contracts. We compare the empirical data on the Ibovespa options with two option pricing models, namely the standard Black-Scholes model and an empirical model that assumes that the returns are exponentially distributed. It is found that at times near the option expiration date the exponential model performs better than the Black-Scholes model, in the sense that it fits the empirical data better than does the latter model.

Architecture for Survivable System Processing (ASSP)

NASA Astrophysics Data System (ADS)

Wood, Richard J.

1991-11-01

The Architecture for Survivable System Processing (ASSP) Program is a multi-phase effort to implement Department of Defense (DOD) and commercially developed high-tech hardware, software, and architectures for reliable space avionics and ground based systems. System configuration options provide processing capabilities to address Time Dependent Processing (TDP), Object Dependent Processing (ODP), and Mission Dependent Processing (MDP) requirements through Open System Architecture (OSA) alternatives that allow for the enhancement, incorporation, and capitalization of a broad range of development assets. High technology developments in hardware, software, and networking models, address technology challenges of long processor life times, fault tolerance, reliability, throughput, memories, radiation hardening, size, weight, power (SWAP) and security. Hardware and software design, development, and implementation focus on the interconnectivity/interoperability of an open system architecture and is being developed to apply new technology into practical OSA components. To insure for widely acceptable architecture capable of interfacing with various commercial and military components, this program provides for regular interactions with standardization working groups (e.g.) the International Standards Organization (ISO), American National Standards Institute (ANSI), Society of Automotive Engineers (SAE), and Institute of Electrical and Electronic Engineers (IEEE). Selection of a viable open architecture is based on the widely accepted standards that implement the ISO/OSI Reference Model.

Architecture for Survivable System Processing (ASSP)

NASA Technical Reports Server (NTRS)

Wood, Richard J.

1991-01-01

The Architecture for Survivable System Processing (ASSP) Program is a multi-phase effort to implement Department of Defense (DOD) and commercially developed high-tech hardware, software, and architectures for reliable space avionics and ground based systems. System configuration options provide processing capabilities to address Time Dependent Processing (TDP), Object Dependent Processing (ODP), and Mission Dependent Processing (MDP) requirements through Open System Architecture (OSA) alternatives that allow for the enhancement, incorporation, and capitalization of a broad range of development assets. High technology developments in hardware, software, and networking models, address technology challenges of long processor life times, fault tolerance, reliability, throughput, memories, radiation hardening, size, weight, power (SWAP) and security. Hardware and software design, development, and implementation focus on the interconnectivity/interoperability of an open system architecture and is being developed to apply new technology into practical OSA components. To insure for widely acceptable architecture capable of interfacing with various commercial and military components, this program provides for regular interactions with standardization working groups (e.g.) the International Standards Organization (ISO), American National Standards Institute (ANSI), Society of Automotive Engineers (SAE), and Institute of Electrical and Electronic Engineers (IEEE). Selection of a viable open architecture is based on the widely accepted standards that implement the ISO/OSI Reference Model.

Is different better? Models of teaching and their influence on the net financial outcome for general practice teaching posts

PubMed Central

2011-01-01

Background In Australia, training for general practice (GP) occurs within private practices and their involvement in teaching can have significant financial costs. At the same time there are growing demands for clinical places for all disciplines and for GP there is concern that there are insufficient teaching practices to meet the demand at the medical student, prevocational and vocational training levels. One option to address this may be to change how teaching occurs in the practice. A question that arises in posing such an option is whether different models of teaching change the costs for a teaching practice. The aim of this study is to determine the net financial outcome of teaching models in private GP. Methods Modelling the financial implications for a range of teaching options using a costing framework developed from a survey of teaching practices in South Australia. Each option was compared with the traditional model of teaching where one GP supervisor is singularly responsible for one learner. The main outcome measure was net financial outcome per week. Decisions on the model cost parameters were made by the study's Steering Group which comprised of experienced GP supervisors. Four teaching models are presented. Model 1 investigates the gains from teaching multiple same level learners, Models 2 and 3, the benefits of vertically integrated teaching using different permutations, and Model 4 the concept of a GP teacher who undertakes all the teaching. Results There was a significant increase in net benefits of Aus$547 per week (95% confidence intervals $459, $668) to the practice when a GP taught two same level learners (Model 1) and when a senior registrar participated in teaching a prevocational doctor (Model 3, Aus$263, 95% confidence intervals $80, $570). For Model 2, a practice could significantly reduce the loss if a registrar was involved in vertically integrated teaching which included the training of a medical student (Aus$551, 95% confidence intervals $419, $718). The GP teacher model resulted in a net remuneration of Aus$207,335 per year, sourced predominantly from the GP teacher activities, with no loss to the practice. Conclusions Our study costed teaching options that can maximise the financial outcomes from teaching. The inclusion of GP registrars in the teaching model or the supervisor teaching more than one same level learner results in a greater financial benefit. This gain was achieved through a reduction in supervisor teaching time and the sharing of administrative and teaching activities with GP registrars. We also show that a GP teacher who carries a minimal patient load can be a sustainable option for a practice. Further, the costing framework used for the teaching models presented in this study has the ability to be applied to any number of teaching model permutations. PMID:21749692

Technical proficiency in cytopathology: assessment through external quality assurance.

PubMed

Cummings, M C; Greaves, J; Shukor, R A; Perkins, G; Ross, J

2017-04-01

To assess both the feasibility and value of conducting an external quality assurance programme concerning technical aspects of cytopathology laboratory practice, and the interest by laboratories in enrolling in such a programme. Six technical surveys, comprising staining exercises and questionnaires relating to laboratory practice, were distributed over a 4-year period to the approximately 220 laboratories enrolled in the RCPAQAP Cytopathology slide survey modules. Staining exercises using the Papanicolaou and Romanowsky techniques, the preparation of urine and body fluid specimens and immunocytochemistry on the cell block material were assessed. Accompanying relevant questionnaires were included, and one survey comprised a questionnaire alone concerning the collection of urinary tract and body fluid samples. Provision of an external cytopathology technical module was feasible for the RCPAQAP and participation rates (maximum of 87% per survey; average 68% for stained slides and 66% for questionnaires) were commendable, particularly considering these were optional undertakings with some exercises not applicable to all laboratories. The great majority of submitted slides were scored as satisfactory, and there was an especially high standard for the immunocytochemical staining exercise with 95% considered satisfactory, including 50.6% with a perfect score. Reasons for suboptimal scores were provided for potential quality improvement for interested laboratories. A wealth of information relating to laboratory practice was provided to the RCPAQAP which was collated and summarised for laboratory use. The provision of a technical module in cytopathology is both a feasible and valuable undertaking of interest to laboratories which should become standard practice for cytopathology external quality assurance providers. © 2016 John Wiley & Sons Ltd.

78 FR 66796 - Self-Regulatory Organizations: Miami International Securities Exchange LLC; Notice of Filing and...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-11-06

... transaction fee for executions in standard option contracts and $0.008 transaction fee for Mini Option... Exchange for purposes of the transaction fee and Section 1(a)(i) of the Fee Schedule include: (i... (``DPLMM''). See MIAX Options Fee Schedule, Section 1(a)(i)--Market Maker Transaction Fees. The current...

78 FR 42577 - Self-Regulatory Organizations; BOX Options Exchange LLC; Notice of Filing and Immediate...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-16

... for institutional investors. Trading in Jumbo SPY Options is entirely voluntary and Participants can... contracts. While there are no position limit requirements for Jumbo SPY, Mini SPY or standard SPY options,\\6... believes that the proposal is consistent with the requirements of Section 6(b) of the Securities Exchange...

17 CFR 240.19c-5 - Governing the multiple listing of options on national securities exchanges.

Code of Federal Regulations, 2010 CFR

2010-04-01

... of options on national securities exchanges. 240.19c-5 Section 240.19c-5 Commodity and Securities... of Exchange Members § 240.19c-5 Governing the multiple listing of options on national securities exchanges. (a) The rules of each national securities exchange that provides a trading market in standardized...

The ADA's practice parameters.

PubMed

Ellek, Donalda M

2005-01-01

The ADA parameters of care have served the needs of practicing dentists for fifteen years. Their purpose is to describe a range of treatment options that dentists will want to consider, in combination with particular clinical conditions and patient preferences. These options have been developed based on available evidence and a consensus of professional judgment. The ADA has exercised concern that parameters not be used, out of the context of individual professional judgment, for policy purposes.

Use of the Generating Options for Active Risk Control (GO-ARC) Technique can lead to more robust risk control options.

PubMed

Card, Alan J; Simsekler, Mecit Can Emre; Clark, Michael; Ward, James R; Clarkson, P John

2014-01-01

Risk assessment is widely used to improve patient safety, but healthcare workers are not trained to design robust solutions to the risks they uncover. This leads to an overreliance on the weakest category of risk control recommendations: administrative controls. Increasing the proportion of non-administrative risk control options (NARCOs) generated would enable (though not ensure) the adoption of more robust solutions. Experimentally assess a method for generating stronger risk controls: The Generating Options for Active Risk Control (GO-ARC) Technique. Participants generated risk control options in response to two patient safety scenarios. Scenario 1 (baseline): All participants used current practice (unstructured brainstorming). Scenario 2: Control group used current practice; intervention group used the GO-ARC Technique. To control for individual differences between participants, analysis focused on the change in the proportion of NARCOs for each group. Proportion of NARCOs decreased from 0.18 at baseline to 0.12. Intervention group: Proportion increased from 0.10 at baseline to 0.29 using the GO-ARC Technique. Results were statistically significant. There was no decrease in the number of administrative controls generated by the intervention group. The Generating Options for Active Risk Control (GO-ARC) Technique appears to lead to more robust risk control options.

Options for lowering U.S. carbon dioxide emissions

NASA Astrophysics Data System (ADS)

Bierbaum, Rosina M.; Friedman, Robert M.; Levenson, Howard; Rapoport, Richard D.; Sundt, Nick

1992-03-01

The United States can decrease its emissions of carbon dioxide (CO2) to as much as 35 percent below 1987 levels within the next 25 years by adopting an aggressive package of policies crossing all sectors of the economy. Such emissions reductions will be difficult to achieve and may be costly, but no major technological breakthroughs are needed. In this paper, we identify a ``Tough'' package of energy conservation, energy supply, and forest managment practices to accomplish this level of emissions reductions. We also present a package of cost-effective, ``Moderate'' technical options, which if adopted, would hold CO2 emissions to about 15-percent increase over 1987 levels by 2015. In constrast, if the United State takes not new actions to curb energy use, CO2 emissions will likely rise 50 percent during that time. A variety of Federal policy initiatives will be required to achieve large reductions in U.S. CO2 emissions. Such policy actions will have to include both regulatory ``push'' and market ``pull'' mechanisms--including performance standards, tax incentive programs, carbon-emission or energy taxes, labeling and efficiency ratings, and research, development, and demostration activities.

Monitoring Detrusor Oxygenation and Hemodynamics Noninvasively during Dysfunctional Voiding

PubMed Central

Macnab, Andrew J.; Stothers, Lynn S.; Shadgan, Babak

2012-01-01

The current literature indicates that lower urinary tract symptoms (LUTSs) related to benign prostatic hyperplasia (BPH) have a heterogeneous pathophysiology. Pressure flow studies (UDSs) remain the gold standard evaluation methodology for such patients. However, as the function of the detrusor muscle depends on its vasculature and perfusion, the underlying causes of LUTS likely include abnormalities of detrusor oxygenation and hemodynamics, and available treatment options include agents thought to act on the detrusor smooth muscle and/or vasculature. Hence, near infrared spectroscopy (NIRS), an established optical methodology for monitoring changes in tissue oxygenation and hemodynamics, has relevance as a means of expanding knowledge related to the pathophysiology of BPH and potential treatment options. This methodological report describes how to conduct simultaneous NIRS monitoring of detrusor oxygenation and hemodynamics during UDS, outlines the clinical implications and practical applications of NIRS, explains the principles of physiologic interpretation of NIRS voiding data, and proposes an exploratory hypothesis that the pathophysiological causes underlying LUTS include detrusor dysfunction due to an abnormal hemodynamic response or the onset of oxygen debt during voiding. PMID:23019422

Hemobilia: An Uncommon But Notable Cause of Upper Gastrointestinal Bleeding.

PubMed

Cathcart, Scott; Birk, John W; Tadros, Michael; Schuster, Micheal

2017-10-01

A literature review to improve practitioners' knowledge and performance concerning the epidemiology, diagnosis, and management of hemobilia. A search of Pubmed, Google Scholar, and Medline was conducted using the keyword hemobilia and relevant articles were reviewed and analyzed. The findings pertaining to hemobilia etiology, investigation, and management techniques were considered and organized by clinicians practiced in hemobilia. The majority of current hemobilia cases have an iatrogenic cause from either bile duct or liver manipulation. Blunt trauma is also a significant cause of hemobilia. The classic triad presentation of right upper quadrant pain, jaundice, and upper gastrointestinal bleeding is rarely seen. Computed tomography and magnetic resonance imaging are the preferred diagnostic modalities, and the preferred therapeutic management includes interventional radiology and endoscopic retrograde cholangiopancreatography. Surgery is rarely a therapeutic option. With advances in computed tomography and magnetic resonance imaging technology, diagnosis with these less invasive investigations are the favored option. However, traditional catheter angiography is still the gold standard. The management of significant hemobilia is still centered on arterial embolization, but arterial and biliary stents have become accepted alternative therapies.

Ultrasound-guided peripheral nerve blockade.

PubMed

Chin, Ki Jinn; Chan, Vincent

2008-10-01

The use of ultrasound for peripheral nerve blockade is becoming popular. Although the feasibility of ultrasound-guided nerve blockade is now clear, it is uncertain at this time whether it represents the new standard for regional anesthesia in terms of efficacy and safety. The ability to visualize nerve location, needle advancement, needle-nerve interaction, and local anesthetic spread makes ultrasound-guided nerve block an attractive option. Study results indicate that these advantages can improve the ease of block performance, block success rates, and complications. At the same time there is evidence that ultrasound-guided regional anesthesia is a unique skill in its own right, and that proficiency in it requires training and experience. Ultrasound is a valuable tool that is now available to the regional anesthesiologist, and it is fast becoming a standard part of practice. It promises to be of especial value to the less experienced practitioner. Ultrasound does not in itself, however, guarantee the efficacy and safety of peripheral nerve blockade. Proper training in its use is required and we can expect to see the development of formal standards and guidelines in this regard.

Pregnancy Options Counseling and Abortion Referrals Among US Primary Care Physicians: Results From a National Survey.

PubMed

Holt, Kelsey; Janiak, Elizabeth; McCormick, Marie C; Lieberman, Ellice; Dehlendorf, Christine; Kajeepeta, Sandhya; Caglia, Jacquelyn M; Langer, Ana

2017-07-01

Primary care physicians (PCPs) can play a critical role in addressing unintended pregnancy through high-quality options counseling and referrals. We surveyed a nationally representative sample of 3,000 PCPs in general, family, and internal medicine on practices and opinions related to options counseling for unintended pregnancy. We assessed predictors of physician practices using multivariable logistic regression weighted for sampling design and differential non-response. Response rate was 29%. Seventy-one percent believed residency training in options counseling should be required, and 69% believed PCPs have an obligation to provide abortion referrals even in the presence of a personal objection to abortion. However, only 26% reported routine options counseling when caring for women with unintended pregnancy compared to 60% who routinely discuss prenatal care. Among physicians who see women seeking abortion, 62% routinely provide referrals, while 14% routinely attempt to dissuade women. Family physicians were more likely to provide routine options counseling when seeing patients with unintended pregnancy than internal medicine physicians (32% vs 21%, P=0.002). In multivariable analyses, factors associated with higher odds of routine abortion referrals were more years in practice (OR=1.03 for each additional year, 95% CI: 1.00-1.05), identifying as a woman vs a man (OR=2.11, 95% CI: 1.31-3.40), practicing in a hospital vs private primary care/multispecialty setting (OR=3.17, 95% CI: 1.10-9.15), and no religious affiliation of practice vs religious affiliation (OR for Catholic affiliation=0.27, 95% CI: 0.11-0.66; OR for other religious affiliation=0.36, 95% CI: 0.15-0.83). Personal Christian religious affiliation among physicians who regularly attend religious services vs no religious affiliation was associated with lower odds of counseling (OR=0.48, 95% CI: 0.26-0.90) and referrals (OR=0.31, 95% CI: 0.15-0.62), and higher odds of abortion dissuasion (OR=4.03, 95% CI: 1.46-11.14). Findings reveal the need to support fuller integration of options counseling and abortion referrals in primary care, particularly through institutional and professional society guidelines and training opportunities to impart skills and highlight the professional obligation to provide non-directive information and support to women with unintended pregnancy.

Patterns of Care for Craniopharyngioma: Survey of members of the American Association of Neurological Surgeons

PubMed Central

Hankinson, Todd C.; Palmeri, Nicholas O.; Williams, Sarah A.; Torok, Michelle R.; Serrano, Cesar A.; Foreman, Nicholas K.; Handler, Michael H.; Liu, Arthur K.

2014-01-01

Background/Significance Initial therapy for craniopharyngioma remains controversial. Population-based datasets indicate that traditional algorithms (GTR versus STR +/− XRT) are often not employed. We investigated neurosurgical practice patterns. Methods A ten-question survey was electronically distributed to members of the American Association of Neurological Surgeons. Responses were analyzed using standard statistical techniques. Results One hundred-two responses were collected, with a median 25 craniopharyngiomas managed per respondent. 36% estimated their practice included ≥75% pediatrics and 61% had an academic practice. 36% would recommend observation or radiation therapy for a suspected craniopharyngioma in the absence of a tissue diagnosis, with 46% of these indicating this recommendation in ≥10% of cases. Following STR, 35% always recommend XRT and 59% recommend it in over half of cases. However, following STR or biopsy alone, 18% and 11% never recommend XRT. There was no association between type of practice (i.e. academic or ≥75% pediatrics) and practice patterns. Conclusions This survey verifies that deviation from established algorithms is common, underscoring the clinical complexity of these patients and recent secondary data analyses This should influence clinical researchers to investigate outcomes for patients treated using alternative methods. This will lend insight into appropriate treatment options and contribute to quality of life outcomes studies for craniopharyngioma. PMID:24577430

The role of community pharmacy-based vaccination in the USA: current practice and future directions

PubMed Central

Bach, Albert T; Goad, Jeffery A

2015-01-01

Community pharmacy-based provision of immunizations in the USA has become commonplace in the last few decades, with success in increasing rates of immunizations. Community pharmacy-based vaccination services are provided by pharmacists educated in the practice of immunization delivery and provide a convenient and accessible option for receiving immunizations. The pharmacist’s role in immunization practice has been described as serving in the roles of educator, facilitator, and immunizer. With a majority of pharmacist-provided vaccinations occurring in the community pharmacy setting, there are many examples of community pharmacists serving in these immunization roles with successful outcomes. Different community pharmacies employ a number of different models and workflow practices that usually consist of a year-round in-house service staffed by their own immunizing pharmacist. Challenges that currently exist in this setting are variability in scopes of immunization practice for pharmacists across states, inconsistent reimbursement mechanisms, and barriers in technology. Many of these challenges can be alleviated by continual education; working with legislators, state boards of pharmacy, stakeholders, and payers to standardize laws; and reimbursement design. Other challenges that may need to be addressed are improvements in communication and continuity of care between community pharmacists and the patient centered medical home. PMID:29354521

17 CFR 3.13 - Registration of agricultural trade option merchants and their associated persons.

Code of Federal Regulations, 2010 CFR

2010-04-01

... accepted accounting principles; (ii) The agricultural trade option merchant must identify each of the... accepted auditing standards prepared within the prior 12 months. (3) These applications must be...

New options for optical quality tolerances

NASA Astrophysics Data System (ADS)

Aikens, Dave

2017-11-01

The optics community has long recognized the problems of misinterpretation of the surface quality specification and the potential for conflict1-2. Finally in 2017 there are new versions of the ISO and ANSI standards for surface imperfection tolerances which provide vastly improved alternatives to the existing options, especially the use of the US Military standard for specifying optical quality tolerances. This paper will review the existing standards in common use for specifying surface imperfections, and then describe in detail the new versions of the ISO and ANSI standards which are available in 2017. The details of the notations and inspection methods for each of the optics specifications will be provided, and the differences between the various alternatives will be discussed.

77 FR 44291 - Self-Regulatory Organizations; NYSE Arca, Inc.; Order Granting Approval of Proposed Rule Change...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-07-27

... volatility. On the day of the monthly expiration of VIX call options, previously purchased VIX call options are cash-settled, and new VIX call options are purchased at the 10 a.m., Central Time asking price... Index. \\9\\ Tail hedging, in the context used by the Index Provider, is the practice of trying to hedge...

Do continuing medical education articles foster shared decision making?

PubMed

Labrecque, Michel; Lafortune, Valérie; Lajeunesse, Judith; Lambert-Perrault, Anne-Marie; Manrique, Hermes; Blais, Johanne; Légaré, France

2010-01-01

Defined as reviews of clinical aspects of a specific health problem published in peer-reviewed and non-peer-reviewed medical journals, offered without charge, continuing medical education (CME) articles form a key strategy for translating knowledge into practice. This study assessed CME articles for mention of evidence-based information on benefits and harms of available treatment and/or preventive options that are deemed essential for shared decision making (SDM) to occur in clinical practice. Articles were selected from 5 medical journals that publish CME articles and are provided free of charge to primary-care physicians of the Province of Quebec, Canada. Two individuals independently scored each article with the use of a 10-item checklist based on the International Patient Decision Aid Standards. In case of discrepancy, the item score was established by team consensus. Scores were added to produce a total article score ranging from 0 (no item present) to 10 (all items present). Thirty articles (6 articles per journal) were selected. Total article scores ranged from 1 to 9, with a mean (+/- SD) of 3.1 +/- 2.0 (95% confidence interval 2.8-4.3). Health conditions and treatment options were the items most frequently discussed in the articles; next came treatment benefits. Possible harms, the use of the same denominators for benefits and harms, and methods to facilitate the communication of benefits and harms to patients were almost never described. No significant differences between journals were observed. The CME articles evaluated did not include the evidence-based information necessary to foster SDM in clinical practice. Peer-reviewed and non-peer-reviewed medical journals should require CME articles to include this type of information.

An analysis of UK waste minimization clubs: key requirements for future cost effective developments.

PubMed

Phillips, P S; Pratt, R M; Pike, K

2001-01-01

The UK waste strategy is based upon use of the best practicable environmental option (BPEO), by those making waste management decisions. BPEO is supported by the use of the waste hierarchy, with its range of preferable options for dealing with waste, and the proximity principle, where waste is treated/disposed of as close to its point of origin as possible. The national waste strategy emphasizes the key role of waste minimization and encourages industry, commerce and the public to move towards sustainable waste management practice for economic and environmental reasons. Waste minimization clubs have been used, since the early 1990s, to demonstrate to industry/commerce that reducing waste production can lead to significant financial savings. There have been around 75 such clubs in the UK and they receive support from a wide range of agencies, including the Environmental Technology Best Practice Program. The early Demonstration Clubs had significant savings to cost ratios, e.g. Aire and Calder at 8.4, but had very high costs, e.g. Aire and Calder at 400,000 pounds. It is acknowledged that the number of clubs will have to be approximately doubled in the next few years so as to have an adequate coverage of the UK. There are at present, marked regional variations in club development and cognizance needs to be taken, by facilitators, of the need for extensive coverage of the UK. Future clubs will probably have to operate in a financially constrained climate and they need to be designed to deliver significant savings and waste reduction at low cost. To aid future club design, final reports of all projects should report in a standard manner so that cost benefit analysis can be used to inform facilitators about the most effective club type. rights reserved.

A Review of Marine Growth Protection System (MGPS) Options for the Royal Australian Navy

DTIC Science & Technology

2011-12-01

in practice, complete prevention of all fouling is rarely practical and as such, MGPS are often used in a dual capacity . Remediation of existing...alloys may behave quite differently with respect to their seawater-chlorine corrosion potential [29, 30]. Numerous environmental and physical factors can...considered a viable option for application by the RAN there are a number of criteria which must be met by the system. These factors are equally important

Initiating decision-making in neurology consultations: 'recommending' versus 'option-listing' and the implications for medical authority.

PubMed

Toerien, Merran; Shaw, Rebecca; Reuber, Markus

2013-07-01

This article compares two practices for initiating treatment decision-making, evident in audio-recorded consultations between a neurologist and 13 patients in two hospital clinics in the UK. We call these 'recommending' and 'option-listing'. The former entails making a proposal to do something; the latter entails the construction of a list of options. Using conversation analysis (CA), we illustrate each, showing that the distinction between these two practices matters to participants. Our analysis centres on two distinctions between the practices: epistemic differences and differences in the slots each creates for the patient's response. Considering the implications of our findings for understanding medical authority, we argue that option-listing - relative to recommending - is a practice whereby clinicians work to relinquish a little of their authority. This article contributes, then, to a growing body of CA work that offers a more nuanced, tempered account of medical authority than is typically portrayed in the sociological literature. We argue that future CA studies should map out the range of ways - in addition to recommending - in which treatment decision-making is initiated by clinicians. This will allow for further evidence-based contributions to debates on the related concepts of patient participation, choice, shared decision-making and medical authority. © 2013 The Authors. Sociology of Health & Illness © 2013 Foundation for the Sociology of Health & Illness/John Wiley & Sons Ltd.

Should Title 24 Ventilation Requirements Be Amended to include an Indoor Air Quality Procedure?

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

Dutton, Spencer M.; Mendell, Mark J.; Chan, Wanyu R.

Minimum outdoor air ventilation rates (VRs) for buildings are specified in standards, including California?s Title 24 standards. The ASHRAE ventilation standard includes two options for mechanically-ventilated buildings ? a prescriptive ventilation rate procedure (VRP) that specifies minimum VRs that vary among occupancy classes, and a performance-based indoor air quality procedure (IAQP) that may result in lower VRs than the VRP, with associated energy savings, if IAQ meeting specified criteria can be demonstrated. The California Energy Commission has been considering the addition of an IAQP to the Title 24 standards. This paper, based on a review of prior data and newmore » analyses of the IAQP, evaluates four future options for Title 24: no IAQP; adding an alternate VRP, adding an equivalent indoor air quality procedure (EIAQP), and adding an improved ASHRAE-like IAQP. Criteria were established for selecting among options, and feedback was obtained in a workshop of stakeholders. Based on this review, the addition of an alternate VRP is recommended. This procedure would allow lower minimum VRs if a specified set of actions were taken to maintain acceptable IAQ. An alternate VRP could also be a valuable supplement to ASHRAE?s ventilation standard.« less

Confidence limits for data mining models of options prices

NASA Astrophysics Data System (ADS)

Healy, J. V.; Dixon, M.; Read, B. J.; Cai, F. F.

2004-12-01

Non-parametric methods such as artificial neural nets can successfully model prices of financial options, out-performing the Black-Scholes analytic model (Eur. Phys. J. B 27 (2002) 219). However, the accuracy of such approaches is usually expressed only by a global fitting/error measure. This paper describes a robust method for determining prediction intervals for models derived by non-linear regression. We have demonstrated it by application to a standard synthetic example (29th Annual Conference of the IEEE Industrial Electronics Society, Special Session on Intelligent Systems, pp. 1926-1931). The method is used here to obtain prediction intervals for option prices using market data for LIFFE “ESX” FTSE 100 index options ( http://www.liffe.com/liffedata/contracts/month_onmonth.xls). We avoid special neural net architectures and use standard regression procedures to determine local error bars. The method is appropriate for target data with non constant variance (or volatility).

Cost effectiveness analysis of effluent limitations guidelines and standards for the centralized waste treament industry

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

Wheeler, W.

1998-12-01

EPA has proposed effluent limitations guidelines and standards for the centralized waste treatment (CWT) industry. This report investigates the cost-effectiveness of all possible combinations of proposed control options for the three subcategories of CWT operations. EPA considered three control options for metals, two for oils and two for organics, with 12 possible combinations of these options. The report measures cost-effectiveness through a comparison of compliance costs to the quantity of pollutants removed under each combination of control options. The effectiveness of the regulations is measured in terms of reductions in the pounds of pollutants discharged to surface waters, weighted tomore » account for the pollutants` toxicity. Some pollutants removed are specifically addressed by the regulation, while others and not directly regulated but are removed incidentally as a result of controlling for other pollutants.« less

MODELING CONCEPTS FOR BMP/LID SIMULATION

EPA Science Inventory

Enhancement of simulation options for stormwater best management practices (BMPs) and hydrologic source control is discussed in the context of the EPA Storm Water Management Model (SWMM). Options for improvement of various BMP representations are presented, with emphasis on inco...

45 CFR 155.730 - Application standards for SHOP.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 155.730 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS EXCHANGE ESTABLISHMENT STANDARDS AND OTHER RELATED STANDARDS UNDER THE AFFORDABLE CARE ACT Exchange Functions: Small Business Health Options Program (SHOP) § 155.730 Application standards for SHOP...

45 CFR 155.710 - Eligibility standards for SHOP.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 155.710 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS EXCHANGE ESTABLISHMENT STANDARDS AND OTHER RELATED STANDARDS UNDER THE AFFORDABLE CARE ACT Exchange Functions: Small Business Health Options Program (SHOP) § 155.710 Eligibility standards for SHOP...

45 CFR 155.710 - Eligibility standards for SHOP.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 155.710 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS EXCHANGE ESTABLISHMENT STANDARDS AND OTHER RELATED STANDARDS UNDER THE AFFORDABLE CARE ACT Exchange Functions: Small Business Health Options Program (SHOP) § 155.710 Eligibility standards for SHOP...

Surgical treatment of Bell's palsy: current attitudes.

PubMed

Smouha, Eric; Toh, Elizabeth; Schaitkin, Barry M

2011-09-01

To learn the current management of Bell's palsy among practicing otologists and neurotologists and to better define the role of surgical decompression of the facial nerve in the treatment of Bell's palsy. Survey questionnaire. We conducted a survey of members of the American Otological Society and the American Neurotology Society to learn their current practices in the treatment of Bell's palsy. Eighty-six neurotologists responded out of 334 surveys (26%). The majority of respondents obtain magnetic resonance imaging and electrical testing for new patients and treat with a combination of steroids and antiviral agents. More than two thirds of respondents would recommend surgery to patients who met the established electrophysiologic criteria (electroneuronography <10% normal, no spontaneous motor unit action potentials on electromyography within 10 days of onset of complete paralysis). However, only half believe that surgical decompression should be the standard of care, and only half would use a standard middle fossa approach. Lack of evidence was the most commonly cited reason for not recommending surgery. Several respondents wrote that they would leave the option of surgery to the patient. Most important, one third of neurotologists have not performed a surgical decompression for Bell's palsy in the last 10 years, and 95% perform less than one procedure per year. Disagreement persists among practicing otologists about the role of surgical decompression for Bell's palsy. More convincing clinical evidence will be needed before there is widespread consensus regarding the surgical treatment of this condition. Copyright © 2011 The American Laryngological, Rhinological, and Otological Society, Inc.

77 FR 20472 - Self-Regulatory Organizations; The Options Clearing Corporation; Notice of Filing of Proposed...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-04

... ``Fitness Standards for Directors, Clearing Members and Others'' (``Fitness Standards'') to bring such standards into conformity with the proposed amendments to OCC's By-Laws. The Fitness Standards were... regulations, OCC's Fitness Standards, as described above, were constructed in part to comply with core...

Management Options for Control of a Stunt and Needle Nematode in Southern Forest Nurseries

Treesearch

Michelle M. Cram; Stephen W. Fraedrich

2005-01-01

Crop rotation and fallow are management options that can be used to control plant parasitic nematodes in forest tree nurseries. Before these options can be put into practice, it is important to determine the host range and survivability under fallow of the parasitic nematode to be controlled. The results of host range tests on a needle nematode (Longidorus...

Does availability of AIR insulin increase insulin use and improve glycemic control in patients with type 2 diabetes?

PubMed

Bergenstal, Richard M; Freemantle, Nick; Leyk, Malgorzata; Cutler, Gordon B; Hayes, Risa P; Muchmore, Douglas B

2009-09-01

In the concordance model, physician and patient discuss treatment options, explore the impact of treatment decisions from the patient's perspective, and make treatment choices together. We tested, in a concordance setting, whether the availability of AIR inhaled insulin (developed by Alkermes, Inc. [Cambridge, MA] and Eli Lilly and Company [Indianapolis, IN]; AIR is a registered trademark of Alkermes, Inc.), as compared with existing treatment options alone, leads to greater initiation and maintenance of insulin therapy and improves glycemic control in patients with type 2 diabetes. This was a 9-month, multicenter, parallel, open-label study in adult, nonsmoking patients with diabetes not optimally controlled by two or more oral antihyperglycemic medications. Patients were randomized to the Standard Options group (n = 516), in which patients chose a regimen from drugs in each major treatment class excluding inhaled insulin, or the Standard Options + AIR insulin group (n = 505), in which patients had the same choices plus AIR insulin. The primary end points were the proportion of patients in each group using insulin at end point and change in hemoglobin A1C (A1C) from baseline to end point. At end point, 53% of patients in the Standard Options group and 59% in the Standard Options + AIR insulin group were using insulin (P = 0.07). Both groups reduced A1C by about 1.2% and reported increased well-being and treatment satisfaction. The most common adverse event with AIR insulin was transient cough. The opportunity to choose AIR insulin did not affect overall use of insulin at end point or A1C outcomes. Regardless of group assignment, utilizing a shared decision-making approach to treatment choices (concordance model), resulted in improved treatment satisfaction and A1C values at end point. Therefore, increasing patient involvement in treatment decisions may improve outcomes.

Compliance Options Diagrams for the Paper and Other Web Coating National Emission Standards for Hazardous Air Pollutants (NESHAP)

EPA Pesticide Factsheets

This January 2004 document contains 14 diagrams illustrating the different compliance options available for those facilities that fall under the Paper and Web Coating Maximum Achievable control Technology (MACT).

Assessing Window Replacement Options | Efficient Windows Collaborative

Science.gov Websites

Foundry Foundry New Construction Windows Window Selection Tool Selection Process Design Guidance Installation Replacement Windows Window Selection Tool Assessing Options Selection Process Design Guidance Installation Understanding Windows Benefits Design Considerations Measuring Performance Performance Standards

Summary of Texas highway funding options and alternatives.

DOT National Transportation Integrated Search

2013-07-01

During the 20122013 academic year, The University of : Texas at Austins Lyndon B. Johnson School of Public : Affairs offered a Policy Research Project (PRP) course : on Texas highway funding options. PRPs are a standard : course in the LBJ Scho...

First on-line survey of an international multidisciplinary working group (MightyMedic) on current practice in diagnosis, therapy and follow-up of dyslipidemias.

PubMed

Stefanutti, C; D'Alessandri, G; Petta, A; Harada-Shiba, M; Julius, U; Soran, H; Moriarty, P M; Romeo, S; Drogari, E; Jaeger, B R

2015-05-01

The MightyMedic (Multidisciplinary International Group for Hemapheresis TherapY and MEtabolic DIsturbances Contrast) Working Group has been founded in 2013. The leading idea was to establish an international network of interdisciplinary nature aimed at working to cross national borders research projects, clinical trials, educational initiatives (meetings, workshops, summer schools) in the field of metabolic diseases, namely hyperlipidemias, and diabetes, preventive cardiology, and atherosclerosis. Therapeutic apheresis, its indications and techniques, is a parallel field of investigation. The first on-line survey of the Group has been completed in the first half of 2014. The survey included # 24 Centers in Italy, Germany, Greece, UK, Sweden, Japan and USA. Relevant data have been collected on current practice in diagnosis, therapy and follow-up of dyslipidemias. 240 subjects with hyperlipidemia and treated with lipoprotein apheresis have been reported in the survey, but a large percentage of patients (35%) who could benefit from this therapeutic option are still treated by conventional drug approach. Genetic molecular diagnosis is performed in only 33% of patients while Lipoprotein(a) (Lp(a)) is included in cardiovascular disease risk assessment in 71% of participating Centers. New detailed investigations and prospective multicenter studies are needed to evaluate changes induced by the impact of updated indications and strategies, as well as new treatment options, targeting standardization of therapeutic and diagnostic approaches. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Physicians' shared decision-making behaviors in depression care.

PubMed

Young, Henry N; Bell, Robert A; Epstein, Ronald M; Feldman, Mitchell D; Kravitz, Richard L

2008-07-14

Although shared decision making (SDM) has been reported to facilitate quality care, few studies have explored the extent to which SDM is implemented in primary care and factors that influence its application. This study assesses the extent to which physicians enact SDM behaviors and describes factors associated with physicians' SDM behaviors within the context of depression care. In a secondary analysis of data from a randomized experiment, we coded 287 audiorecorded interactions between physicians and standardized patients (SPs) using the Observing Patient Involvement (OPTION) system to assess physician SDM behaviors. We performed a series of generalized linear mixed model analyses to examine physician and patient characteristics associated with SDM behavior. The mean (SD) OPTION score was 11.4 (3.3) of 48 possible points. Older physicians (partial correlation coefficient = -0.29; beta = -0.09; P < .01) and physicians who practiced in a health maintenance organization setting (beta = -1.60; P < .01) performed fewer SDM behaviors. Longer visit duration was associated with more SDM behaviors (partial correlation coefficient = 0.31; beta = 0.08; P < .01). In addition, physicians enacted more SDM behaviors with SPs who made general (beta = 2.46; P < .01) and brand-specific (beta = 2.21; P < .01) medication requests compared with those who made no request. In the context of new visits for depressive symptoms, primary care physicians performed few SDM behaviors. However, physician SDM behaviors are influenced by practice setting and patient-initiated requests for medication. Additional research is needed to identify interventions that encourage SDM when indicated.

Flexible phosphor sensors: a digital supplement or option to rigid sensors.

PubMed

Glazer, Howard S

2014-01-01

An increasing number of dental practices are upgrading from film radiography to digital radiography, for reasons that include faster image processing, easier image access, better patient education, enhanced data storage, and improved office productivity. Most practices that have converted to digital technology use rigid, or direct, sensors. Another digital option is flexible phosphor sensors, also called indirect sensors or phosphor storage plates (PSPs). Flexible phosphor sensors can be advantageous for use with certain patients who may be averse to direct sensors, and they can deliver a larger image area. Additionally, sensor cost for replacement PSPs is considerably lower than for hard sensors. As such, flexible phosphor sensors appear to be a viable supplement or option to direct sensors.

78 FR 62722 - Self-Regulatory Organizations; Financial Industry Regulatory Authority, Inc.; Order Granting...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-10-22

... proposed rule change is intended to apply to any OCC Cleared OTC Option.\\7\\ \\5\\ See Securities Exchange Act... standardized index option.\\38\\ FINRA Rule 2330(b)(5)(A)(i)(b) generally requires only those members that are... FINRA, as is the case for all conventional options.\\40\\ \\37\\ Id. \\38\\ Id. See also FINRA Rule 2360(b)(5...

78 FR 36812 - Self-Regulatory Organizations; International Securities Exchange, LLC; Notice of Filing and...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-19

... are not discussed below, are and shall continue to be \\1/10\\th of the fees for standard options.\\4\\ \\3... charge fees for regular orders in mini options at a rate that is \\1/10\\th the rate of fees the Exchange... light of the fact that mini options have a smaller exercise and assignment value, specifically \\1/ 10\\th...

An Evaluation of the Wake County Public School System Alternative Educational Options, 2009-10. E&R Report No. 10.15

ERIC Educational Resources Information Center

Rhea, Anisa

2010-01-01

The purpose of this study is to evaluate the Wake County Public School System (WCPSS) alternative educational options. The WCPSS options are similar to those in other North Carolina districts. WCPSS student outcomes based on state assessments and federal standards are also equivalent or higher than other districts, although the capacity for WCPSS…

Confronting the realities of implementing contextual learning ideas in a biology classroom

NASA Astrophysics Data System (ADS)

Akers, Julia B.

1999-10-01

The purpose of this study was to describe the implementation of contextual learning practices in a biology class. Research contends that contextual learning classrooms are active learning environments where students are involved in "hands-on" team projects and the teacher assumes a facilitator role. In this student-centered classroom, students take ownership and responsibility for their own learning. This study examined these assertions and other factors that emerged as the study developed. The research methods used were qualitative. The subject for this study was a biology teacher with twenty-six years of experience who implemented contextual learning practices in two of her biology classes in the 1997--98 school year. As the teacher confronted contextual learning, we engaged in collaborative research that included fourteen interviews transcribed verbatim for analysis, classroom observations and the teacher's written reports. Throughout the study, factors developed that adversely affected contextual learning practices. These factors were discipline, curriculum, and administrative decisions over which the teacher had no control. These are examined along with their consequences for implementing a contextual classroom. Successful practices that worked in the teacher's classroom were also determined and included the teacher's "failure is not an option" policy, mandatory tutoring, behavior contracts, high expectations and teamed projects. Besides contextual learning, a key component of the study was the collaborative research process and its meaning to the subject, the researcher and future researchers who attempt this collaborative approach. The study's conclusion indicate that scheduling, multiple repeaters, discipline and the state Standards of Learning moved the teacher away from contextual learning practices to a more teacher-directed classroom. Two recommendations of this study are that further research is needed to study how the state Standards of Learning have affected instructional practices and the effect of administrative decisions that influence the level of teacher success in the classroom.

Iron dosing in kidney disease: inconsistency of evidence and clinical practice

PubMed Central

Gaweda, Adam E.; Ginzburg, Yelena Z.; Chait, Yossi; Germain, Michael J.; Aronoff, George R.; Rachmilewitz, Eliezer

2015-01-01

The management of anemia in patients with chronic kidney disease (CKD) is difficult. The availability of erythropoiesis-stimulating agents (ESAs) has increased treatment options for previously transfusion-requiring patients, but the recent evidence of ESA side effects has prompted the search for complementary or alternative approaches. Next to ESA, parenteral iron supplementation is the second main form of anemia treatment. However, as of now, no systematic approach has been proposed to balance the concurrent administration of both agents according to individual patient's needs. Furthermore, the potential risks of excessive iron dosing remain a topic of controversy. How, when and whether to monitor CKD patients for potential iron overload remain to be elucidated. This review addresses the question of risk and benefit of iron administration in CKD, highlights the evidence supporting current practice, provides an overview of standard and potential new markers of iron status and outlines a new pharmacometric approach to physiologically compatible individualized dosing of ESA and iron in CKD patients. PMID:24821751

Managing waste from confined animal feeding operations in the United States: the need for sanitary reform.

PubMed

Graham, Jay P; Nachman, Keeve E

2010-12-01

Confined food-animal operations in the United States produce more than 40 times the amount of waste than human biosolids generated from US wastewater treatment plants. Unlike biosolids, which must meet regulatory standards for pathogen levels, vector attraction reduction and metal content, no treatment is required of waste from animal agriculture. This omission is of concern based on dramatic changes in livestock production over the past 50 years, which have resulted in large increases in animal waste and a high degree of geographic concentration of waste associated with the regional growth of industrial food-animal production. Regulatory measures have not kept pace with these changes. The purpose of this paper is to: 1) review trends that affect food-animal waste production in the United States, 2) assess risks associated with food-animal wastes, 3) contrast food-animal waste management practices to management practices for biosolids and 4) make recommendations based on existing and potential policy options to improve management of food-animal waste.

Shared decision making for patients living with inflammatory arthritis.

PubMed

Palmer, Deborah; El Miedany, Yasser

Providing adequate care for people with inflammatory arthritis is an ongoing challenge. In recent years significant progress has been made in the treatment of inflammatory arthritic conditions. The availability of a wide range of disease-modifying anti-rheumatic drugs as well as biologic therapies has not only improved treatment, but also made treatment decisions much more complex. This wider range of improved treatment options happened at the same time as a clear move towards patient-centred care and implementing shared decision making for both medical and surgical conditions. Implementing shared decision making has been reported to be associated with higher satisfaction and better adherence to therapy. Electronic shared decision making has more recently been suggested as a tool for clinical practice. The aim of this article is to look at further integrating shared decision making in standard rheumatology practice in view of the available evidence and the outcomes of a study looking at a recently developed patient shared decision guide.

77 FR 35944 - Renewal of the Global Markets Advisory Committee

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-15

... international standards for regulating futures, swaps, options, and derivatives markets, as well as..., competitive, and financially sound futures and options markets. Meetings of the Global Markets Advisory... COMMODITY FUTURES TRADING COMMISSION Renewal of the Global Markets Advisory Committee AGENCY...

40 CFR 80.1342 - What compliance options are available to small refiners under this subpart?

Code of Federal Regulations, 2014 CFR

2014-07-01

... Benzene Small Refiner Provisions § 80.1342 What compliance options are available to small refiners under... this section must comply with the applicable benzene standards at § 80.1230 beginning with the first...

40 CFR 80.1342 - What compliance options are available to small refiners under this subpart?

Code of Federal Regulations, 2011 CFR

2011-07-01

... Benzene Small Refiner Provisions § 80.1342 What compliance options are available to small refiners under... this section must comply with the applicable benzene standards at § 80.1230 beginning with the first...

40 CFR 80.1342 - What compliance options are available to small refiners under this subpart?

Code of Federal Regulations, 2013 CFR

2013-07-01

... Benzene Small Refiner Provisions § 80.1342 What compliance options are available to small refiners under... this section must comply with the applicable benzene standards at § 80.1230 beginning with the first...

Licensing of Generic Medicines: Are There Any Challenges Left? A Pharmaceutical Regulatory Perspective.

PubMed

Borg, John Joseph; Tomasi, Paolo; Pani, Luca; Aislaitner, George; Pirozynski, Michal; Leufkens, Hubert; Melchiorri, Daniela

2014-01-01

When an innovative product (innovator) is not covered anymore by intellectual property rights, cheaper equivalent medicinal products (generic products) may be marketed and used in clinical practice. The regulation of generic products is well-established, and is primarily based on standard rules for quality, therapeutic equivalence requirements (the latter in most instances proven through a bioequivalence study), and safety data for the innovator. The extensive experience from bringing generic products to the market over the last decades allows the conclusion that they are well-accepted and provide a useful alternative option for cost-effective pharmacotherapy. While supporting this conclusion, there are a number of issues to be considered during the assessment of a generic product application. Six scenarios are described in total, from an efficacy and a safety perspective, where potential concerns with the current regulatory standards could arise in the approval of generic products. We also propose solutions to these scenarios in order to foster debate on these issues.

International Myeloma Working Group Consensus Statement for the Management, Treatment, and Supportive Care of Patients With Myeloma Not Eligible for Standard Autologous Stem-Cell Transplantation

PubMed Central

Palumbo, Antonio; Rajkumar, S. Vincent; San Miguel, Jesus F.; Larocca, Alessandra; Niesvizky, Ruben; Morgan, Gareth; Landgren, Ola; Hajek, Roman; Einsele, Hermann; Anderson, Kenneth C.; Dimopoulos, Meletios A.; Richardson, Paul G.; Cavo, Michele; Spencer, Andrew; Stewart, A. Keith; Shimizu, Kazuyuki; Lonial, Sagar; Sonneveld, Pieter; Durie, Brian G.M.; Moreau, Philippe; Orlowski, Robert Z.

2014-01-01

Purpose To provide an update on recent advances in the management of patients with multiple myeloma who are not eligible for autologous stem-cell transplantation. Methods A comprehensive review of the literature on diagnostic criteria is provided, and treatment options and management of adverse events are summarized. Results Patients with symptomatic disease and organ damage (ie, hypercalcemia, renal failure, anemia, or bone lesions) require immediate treatment. The International Staging System and chromosomal abnormalities identify high- and standard-risk patients. Proteasome inhibitors, immunomodulatory drugs, corticosteroids, and alkylating agents are the most active agents. The presence of concomitant diseases, frailty, or disability should be assessed and, if present, treated with reduced-dose approaches. Bone disease, renal damage, hematologic toxicities, infections, thromboembolism, and peripheral neuropathy are the most frequent disabling events requiring prompt and active supportive care. Conclusion These recommendations will help clinicians ensure the most appropriate care for patients with myeloma in everyday clinical practice. PMID:24419113

Using aggregate data to estimate the standard error of a treatment-covariate interaction in an individual patient data meta-analysis.

PubMed

Kovalchik, Stephanie A; Cumberland, William G

2012-05-01

Subgroup analyses are important to medical research because they shed light on the heterogeneity of treatment effectts. A treatment-covariate interaction in an individual patient data (IPD) meta-analysis is the most reliable means to estimate how a subgroup factor modifies a treatment's effectiveness. However, owing to the challenges in collecting participant data, an approach based on aggregate data might be the only option. In these circumstances, it would be useful to assess the relative efficiency and power loss of a subgroup analysis without patient-level data. We present methods that use aggregate data to estimate the standard error of an IPD meta-analysis' treatment-covariate interaction for regression models of a continuous or dichotomous patient outcome. Numerical studies indicate that the estimators have good accuracy. An application to a previously published meta-regression illustrates the practical utility of the methodology. © 2012 Wiley-VCH Verlag GmbH & Co. KGaA, Weinheim.

Cost-Effectiveness of Fecal Microbiota Transplantation in the Treatment of Recurrent Clostridium Difficile Infection: A Literature Review.

PubMed

Arbel, Leor T; Hsu, Edmund; McNally, Keegan

2017-08-23

Clostridium difficile ( C. difficile ) is a common cause of antibiotic--associated diarrhea (AAD), being responsible for 15--25% of all AAD cases. The purpose of this literature review is to determine the cost-effectiveness of fecal microbiota transplantation (FMT) and how it compares in this regard to the standard treatments of choice for recurrent C. difficile infection (CDI). The review of the literature along with the evaluation of three comparative cost effective analyses yielded findings consistent with the view that FMT is the most cost-effective option in treating recurrent CDI. There are some (but considerably less) data indicating that FMT may be a cost effective strategy in treating initial CDI, as well. The superior cost-effectiveness of FMT as compared to the preferred standards of treatment for recurrent CDI suggest FMT use should become more integrated in routine clinical practice. Increased utilization of FMTs would allow for better control of this increasingly problematic disease as well as lower costs associated with its management.

Obesity prevention at the point of purchase.

PubMed

Cohen, D A; Lesser, L I

2016-05-01

The point of purchase is when people may make poor and impulsive decisions about what and how much to buy and consume. Because point of purchase strategies frequently work through non-cognitive processes, people are often unable to recognize and resist them. Because people lack insight into how marketing practices interfere with their ability to routinely eat healthy, balanced diets, public health entities should protect consumers from potentially harmful point of purchase strategies. We describe four point of purchase policy options including standardized portion sizes; standards for meals that are sold as a bundle, e.g. 'combo meals'; placement and marketing restrictions on highly processed low-nutrient foods; and explicit warning labels. Adoption of such policies could contribute significantly to the prevention of obesity and diet-related chronic diseases. We also discuss how the policies could be implemented, along with who might favour or oppose them. Many of the policies can be implemented locally, while preserving consumer choice. © 2016 World Obesity.

Development of short-form measures to assess four types of elder mistreatment: Findings from an evidence-based study of APS elder abuse substantiation decisions.

PubMed

Beach, Scott R; Liu, Pi-Ju; DeLiema, Marguerite; Iris, Madelyn; Howe, Melissa J K; Conrad, Kendon J

2017-01-01

Improving the standardization and efficiency of adult protective services (APS) investigations is a top priority in APS practice. Using data from the Elder Abuse Decision Support System (EADSS), we developed short-form measures of four types of elder abuse: financial, emotional/psychological, physical, and neglect. The EADSS data set contains 948 elder abuse cases (age 60+) with yes/no abuse substantiation decisions for each abuse type following a 30-day investigation. Item sensitivity/specificity analyses were conducted on long-form items with the substantiation decision for each abuse type as the criterion. Validity was further tested using receiver-operator characteristic (ROC) curve analysis, correlation with long forms and internal consistency. The four resulting short-form measures, containing 36 of the 82 original items, have validity similar to the original long forms. These short forms can be used to standardize and increase efficiency of APS investigations, and may also offer researchers new options for brief elder abuse assessments.

Development of short-form measures to assess four types of elder mistreatment: Findings from an evidence-based study of APS elder abuse substantiation decisions

PubMed Central

Beach, Scott R.; Liu, Pi-Ju; DeLiema, Marguerite; Iris, Madelyn; Howe, Melissa J.K.; Conrad, Kendon J.

2018-01-01

Improving the standardization and efficiency of adult protective services (APS) investigations is a top priority in APS practice. Using data from the Elder Abuse Decision Support System (EADSS), we developed short-form measures of four types of elder abuse: financial, emotional/psychological, physical, and neglect. The EADSS data set contains 948 elder abuse cases (age 60+) with yes/no abuse substantiation decisions for each abuse type following a 30-day investigation. Item sensitivity/specificity analyses were conducted on long-form items with the substantiation decision for each abuse type as the criterion. Validity was further tested using receiver–operator characteristic (ROC) curve analysis, correlation with long forms and internal consistency. The four resulting short-form measures, containing 36 of the 82 original items, have validity similar to the original long forms. These short forms can be used to standardize and increase efficiency of APS investigations, and may also offer researchers new options for brief elder abuse assessments. PMID:28590799

Technical Options for Energy Conservation in Buildings. National Conference of States on Building Codes and Standards and National Bureau of Standards Joint Emergency Workshop on Energy Conservation in Buildings. (Washington, D.C., June 19, 1973) NBS Technical Note 789.

ERIC Educational Resources Information Center

National Bureau of Standards (DOC), Washington, DC. Inst. for Applied Technology.

The purpose of this report is to provide reference material on the technical options for energy conservation in buildings. Actions pertinent to existing buildings and new buildings are considered separately. Regarding existing buildings, principal topics include summer cooling, winter heating, and other energy-related features such as insulation,…

POLICY OPTIONS TO REVERSE THE DECLINE OF WILD PACIFIC SALMON

EPA Science Inventory

The primary goal of the Salmon 2100 Project was to identify practical options that have a high probability of maintaining biologically significant, sustainable populations of wild salmon in the Pacific Northwest and California. Wild salmon recovery efforts in western North Americ...

Emerging Minimally Invasive Treatment Options for Male Lower Urinary Tract Symptoms.

PubMed

Magistro, Giuseppe; Chapple, Christopher R; Elhilali, Mostafa; Gilling, Peter; McVary, Kevin T; Roehrborn, Claus G; Stief, Christian G; Woo, Henry H; Gratzke, Christian

2017-12-01

Lower urinary tract symptoms (LUTS) are one of the most common and troublesome nonmalignant conditions affecting quality of life in aging men. A spectrum of established medical and surgical options is available to provide relief of bothersome LUTS. Both the adverse events of medication and the morbidity with surgical treatment modalities have to be counterbalanced against efficacy. Novel minimally invasive treatment options aim to be effective, ideally to be performed in an ambulatory setting under local anaesthesia and to offer a more favourable safety profile than existing reference techniques. A comprehensive, narrative review of novel minimally invasive treatment modalities for the management of male LUTS due to benign prostatic enlargement is presented. Medline, PubMed, Cochrane database, and Embase were screened for randomised controlled trials (RCTs), clinical trials, and reviews on novel minimally invasive treatment options for male LUTS due to benign prostatic enlargement. With regard to newly devised intraprostatic injectables (botulinum neurotoxin A, NX1207, PRX302), PRX302 is currently the only substance that was superior to placebo in a phase 3 RCT providing proof of efficacy and safety. The prostatic urethral lift technique has been evaluated in several phase 3 trials showing rapid and durable relief of LUTS without compromising sexual function in carefully selected patients without a prominent median lobe. The first clinical experience of the temporary implantable nitinol device demonstrated that implantation of this novel device is a safe procedure, easy, and fast to perform. Further studies are required to evaluate efficacy, durability, and to define appropriate patient selection. New ablative approaches like the image guided robotic waterjet ablation (AquaBeam) or procedures based on convective water vapour energy (Rezūm) are in the early stages of development. Prostatic artery embolization performed by interventional radiologists at specialised centres shows a high technical success rate in the treatment of bothersome LUTS. However, a substantial clinical failure rate and a particular spectrum of complications not commonly seen after urologic interventions do occur and need to be critically evaluated. Initial promising clinical results on novel minimally invasive treatment options indicate efficacy comparable to standard techniques, often associated with a more favourable safety profile, in particular with preservation of sexual function. Many of these techniques are in their infancy and based on experience of new developments in the past. Further RCTs are required to evaluate efficacy, safety, and durability of novel techniques with long-term follow-up and careful evaluation of the selection criteria, which have been applied in clinical trials. The prostatic urethral lift is the only procedure with Level 1 evidence data and that can therefore be recommended for treatment of male LUTS in clinical practice for selected patients. Minimally invasive treatment options have been developed to provide relief of lower urinary tract symptoms comparable to standard surgical techniques with a more favourable safety profile. However, long-term clinical evaluation is still needed for most of these innovations before they can be recommended to be an effective replacement for standard surgical treatment. Copyright © 2017 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Standardization Documents

DTIC Science & Technology

2011-08-01

Specifications and Standards; Guide Specifications; CIDs; and NGSs . Learn. Perform. Succeed. STANDARDIZATION DOCUMENTS Federal Specifications Commercial...national or international standardization document developed by a private sector association, organization, or technical society that plans ...Maintain lessons learned • Examples: Guidance for application of a technology; Lists of options Learn. Perform. Succeed. DEFENSE HANDBOOK

45 CFR 155.700 - Standards for the establishment of a SHOP.

Code of Federal Regulations, 2013 CFR

2013-10-01

... Section 155.700 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS EXCHANGE ESTABLISHMENT STANDARDS AND OTHER RELATED STANDARDS UNDER THE AFFORDABLE CARE ACT Exchange Functions: Small Business Health Options Program (SHOP) § 155.700 Standards for the establishment...

45 CFR 155.700 - Standards for the establishment of a SHOP.

Code of Federal Regulations, 2012 CFR

2012-10-01

... Section 155.700 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS EXCHANGE ESTABLISHMENT STANDARDS AND OTHER RELATED STANDARDS UNDER THE AFFORDABLE CARE ACT Exchange Functions: Small Business Health Options Program (SHOP) § 155.700 Standards for the establishment...

Ablative skin resurfacing.

PubMed

Agrawal, Nidhi; Smith, Greg; Heffelfinger, Ryan

2014-02-01

Ablative laser resurfacing has evolved as a safe and effective treatment for skin rejuvenation. Although traditional lasers were associated with significant thermal damage and lengthy recovery, advances in laser technology have improved safety profiles and reduced social downtime. CO2 lasers remain the gold standard of treatment, and fractional ablative devices capable of achieving remarkable clinical improvement with fewer side effects and shorter recovery times have made it a more practical option for patients. Although ablative resurfacing has become safer, careful patient selection and choice of suitable laser parameters are essential to minimize complications and optimize outcomes. This article describes the current modalities used in ablative laser skin resurfacing and examines their efficacy, indications, and possible side effects. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Fibrinolysis and Beyond: Bridging the Gap between Local and Systemic Clot Removal

PubMed Central

Knauer, K.; Huber, Roman

2011-01-01

Recanalization methods in ischemic stroke have been progressively expanded over the past years. In addition the continuous development of specialized mechanical devices for thrombectomy a broad spectrum of new drugs has been tested: Both options, novel drugs as well as new devices, can be employed independently of each other, but in most cases a combination of the two with the standard treatment of intravenous fibrinolysis is applied. Until recently, a large number of case series have been performed to investigate the effects of various drugs and interventions, but only a few trials have been conducted to determine the optimal conditions for combining both procedures. This review surveys the different systemic and endovascular vessel reopening practices and their major bridging techniques. PMID:21373206

Conservative care as a treatment option for patients aged 75 years and older with CKD stage V: a National survey in the Netherlands.

PubMed

Susanto, Christopher; Kooman, J; Courtens, A M; Konings, C J A M

2018-01-01

Conservative care for patients aged 75 years and older with CKD stage 5 as a treatment option besides dialysis was proposed officially in the Netherlands in October 2016. This national survey showed the current implementation of this option in Netherlands nephrology departments. A web-based survey was sent to medical managers of 60 nephrology departments in the Netherlands in August 2016. Twenty-one medical managers (35%) completed the survey. The term "conservative care" is frequently used and well known. The estimated number of patients in whom the decision for maximal conservative care was made in 2015 was 310 of 2249 patients with CKD stage 5 age 75 years and older (range 5-50 patients per department). 164 patients became symptomatic and received no dialysis. There is no official registration for this treatment option and patient category. The practice patterns vary widely. Only one of 21 respondents reported a conservative care outpatient clinic. Formal training or education regarding conservative care is not available in most of departments. 95% of respondents discussed this treatment option with their patients. General practitioners are always being informed about their patient's decision. Their main role is providing or organizing palliative care support at the end of life and discussing advance care planning. Most respondents (86%) considered to include their patients in a prospective multicentre observational study, conservative care versus dialysis. Conservative care as a treatment option for patients with CKD stage 5 aged 75 years and older is well established. The practice patterns are varied in the Netherlands. Follow-up studies are needed to see whether the new multidisciplinary guideline facilitates harmonization of practice pattern. Funding is needed to optimize the implementation of conservative care.

Reconstructive microsurgical approach for the treatment of pyoderma gangrenosum.

PubMed

Schwaiger, Karl; Russe, Elisabeth; Kholosy, Hassan; Hladik, Michaela; Heinrich, Klemens; Weitgasser, Laurenz; Schoeller, Thomas; Wechselberger, Gottfried

2018-01-01

Pyoderma gangrenosum (PG) is a rare type of autoimmune disease that results in progressive ulcers with or without previous trauma. However, PG is not well understood to date, and its treatment therefore remains a challenge. Because of the disease's systemic characteristic and the unpredictability of the clinical course, no gold standard treatment is available, especially concerning the surgical procedures to treat pyodermic lesions. Often, PG is not recognized during routine clinical practice, and standard ulcer treatment (conservative wound care, debridement, skin grafting, and local flap coverage) is initiated; this induces an autoinflammatory response, resulting in disastrous ulcers, thereby making free flap coverage necessary. The purpose of this study was to assess the outcome of microvascular free-tissue transfer as a treatment option for extended soft-tissue defects resulting from PG. We retrospectively evaluated 8 cases in 5 patients suffering from PG of the lower extremity who received defect closure with a microvascular free-tissue transfer under immunosuppressive and corticosteroid therapy. The average patient age was 60 years; three were male, and two were female. Seven defects were covered with free gracilis muscle flap. One patient received an anterolateral thigh flap. The average defect size was 93 cm 2 . No flap loss was observed during follow-up. All patients received broad-spectrum antibiotic treatment and corticosteroids. Two patients also received infliximab. PG once diagnosed is not a contraindication for microvascular free-tissue transfer. Multidisciplinary evaluation of each case is fundamental. All surgical treatments should be performed only with sufficient protective immunosuppression therapy. If the defect requires free flap coverage, it should be considered as a surgical option despite the potential risk of a pathergic response in PG and was a safe treatment option in all our cases. In conclusion, we share our experience regarding preoperative, intraoperative, and postoperative care of patients with PG receiving free flap surgery. Copyright © 2017 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Job sharing as an employment alternative in group medical practice.

PubMed

Vanek, E P; Vanek, J A

2001-01-01

Although physicians discuss quality-of-life and employment issues with their patients, they often fail to consider flexible scheduling and reduced employment options to lessen their own job stress. We examined one of these options by surveying two community-based, private practice groups with a combined 13-year experience with job sharing. We found that a majority of respondents rated job sharing as successful, and most wanted it to continue. Job sharers derived considerable personal benefit from the arrangement and had significantly more positive attitudes toward work than full-time physicians. Job sharing appeared to have little impact on practice parameters. Dependability, flexibility and willingness to cooperate were the most important attributes in choosing a job-sharing partner. Job sharing is an employment alternative worth exploring to retain physicians in medical group practice.

Five different types of framing effects in medical situation: a preliminary exploration.

PubMed

Peng, Jiaxi; Li, Hongzheng; Miao, Danmin; Feng, Xi; Xiao, Wei

2013-02-01

Considerable reports concerned the framing effect in medical situations. But quite few of them noticed to explore the differences among the various kinds of framing effects. In the present study, five different types of framing effects were examined and the effect sizes of them were compared. Medical decision making problems concerning medicine effect evaluation, patient's compliance, treatment and doctor options selection were established. All the problems were described in both positive and negative frames. 500 undergraduates as participants were randomly divided into ten groups. Participants from each group were asked to finish one decision making task. ALL THE FRAMES THAT WERE EXAMINED LEADED TO SIGNIFICANT FRAMING EFFECTS: When the Asia Disease Problem was described in a positive frame, the participants preferred the conservative frame than the risky one, while if in a negative frame, the preference reversed (P < 0.01). If the drug effect was described as "of 100 patients taking this kind of medicine, 70 patients became better", people tended to make more positive evaluations, compared with described as "of 100 patients taking this kind of medicine, 30 patients didn't become better" (P < 0.01). Doctors' advices were respectively described in a baneful or beneficial frame and the former one resulted in a better compliance (P < 0.05). If treatment options were described with a survival rate, people tended to choose risky option, while if described with a mortality rate, people tended to choose conservative option (P < 0.05). The number sized framing effect was also tested to be significant (P < 0.01). The five types of framing effects were small to big in effect size. Medical decision making can be affected by frame descriptions. Attentions should be paid on the standardization of description in medical practice.

24 CFR 3285.501 - Home installation manual supplements.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 24 Housing and Urban Development 5 2014-04-01 2014-04-01 false Home installation manual... HOUSING AND URBAN DEVELOPMENT MODEL MANUFACTURED HOME INSTALLATION STANDARDS Optional Features § 3285.501 Home installation manual supplements. Supplemental instructions for optional equipment or features must...

24 CFR 3285.501 - Home installation manual supplements.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 24 Housing and Urban Development 5 2013-04-01 2013-04-01 false Home installation manual... HOUSING AND URBAN DEVELOPMENT MODEL MANUFACTURED HOME INSTALLATION STANDARDS Optional Features § 3285.501 Home installation manual supplements. Supplemental instructions for optional equipment or features must...

24 CFR 3285.501 - Home installation manual supplements.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 24 Housing and Urban Development 5 2010-04-01 2010-04-01 false Home installation manual... HOUSING AND URBAN DEVELOPMENT MODEL MANUFACTURED HOME INSTALLATION STANDARDS Optional Features § 3285.501 Home installation manual supplements. Supplemental instructions for optional equipment or features must...

24 CFR 3285.501 - Home installation manual supplements.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 24 Housing and Urban Development 5 2011-04-01 2011-04-01 false Home installation manual... HOUSING AND URBAN DEVELOPMENT MODEL MANUFACTURED HOME INSTALLATION STANDARDS Optional Features § 3285.501 Home installation manual supplements. Supplemental instructions for optional equipment or features must...

24 CFR 3285.501 - Home installation manual supplements.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 24 Housing and Urban Development 5 2012-04-01 2012-04-01 false Home installation manual... HOUSING AND URBAN DEVELOPMENT MODEL MANUFACTURED HOME INSTALLATION STANDARDS Optional Features § 3285.501 Home installation manual supplements. Supplemental instructions for optional equipment or features must...

NOX EMISSION CONTROL OPTIONS FOR COAL-FIRED ELECTRIC UTILITY BOILERS

EPA Science Inventory

The paper reviews NOx control options for coal-fired electric utility boilers. (NOTE: Acid Rain NOx regulations, the Ozone Transport Commission's NOx Budget Program, revision of the New Source Performance Standards (NSPS) for NOx emissions from utility sources, and Ozone Transpor...

Project HELP: a study protocol to pilot test a shared decision-making tool about treatment options for patients with hepatitis C and chronic kidney disease.

PubMed

Politi, M C; George, N; Li, T; Korenblat, K M; Fowler, K J; Ho, C; Liapakis, A; Roth, D; Yee, J

2018-01-01

Recent advances in treatment have given patients with chronic kidney disease (CKD) access to safer and more effective medications to treat comorbid hepatitis C virus (HCV) infection. Given the variety and complexity of treatment options that depend on patients' clinical characteristics and personal preferences, education and decision support are needed to prepare patients better to discuss treatment options with their clinicians. Drawing on International Patient Decision Aids Standards guidelines, literature reviews, and guidance from a diverse expert advisory group of nephrologists, hepatologists, and patients, we will develop and test a HCV and CKD decision support tool. Named Project HELP ( Helping Empower Liver and kidney Patients ), this tool will support patients with HCV and CKD during decisions about whether, when, and how to treat each illness. The tool will (1) explain information using plain language and graphics; (2) provide a step-by-step process for thinking about treating HCV and CKD; (3) tailor relevant information to each user by asking about the individual's stage of CKD, stage of fibrosis, prior treatment, and comorbidities; (4) assess user knowledge and values for treatment choices; and (5) help individuals use and consider information appropriate to their values and needs to discuss with a clinician. A pilot study including 70 individuals will evaluate the tool's efficacy, usability, and likelihood of using it in clinical practice. Eligibility criteria will include individuals who understand and read English, who are at least 18 years old, have a diagnosis of HCV (any genotype) and CKD (any stage), and are considering treatment options. This study can identify particular characteristics of individuals or groups that might experience challenges initiating treatment for HCV in the CKD population. This tool could provide a resource to facilitate patient-clinician discussions regarding HCV and CKD treatment options.

77 FR 31048 - Self-Regulatory Organizations; the Options Clearing Corporation; Order Approving Proposed Rule...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-24

... made changes to OCC's ``Fitness Standard for Directors, Clearing Members and Others'' to conform it to... to statutory disqualifications. The proposed rule change will amend OCC's ``Fitness Standards for Directors, Clearing Members and Others'' (``Fitness Standards'') to bring such standards into conformity...

Music Education Suites

ERIC Educational Resources Information Center

Kemp, Wayne

2009-01-01

This publication describes options for designing and equipping middle and high school music education suites, and suggests ways of gaining community support for including full service music suites in new and renovated school facilities. In addition to basic music suites, and practice rooms, other options detailed include: (1) small ensemble…

Comparison of the Josephson Voltage Standards of the NIMT and the BIPM (part of the ongoing BIPM key comparison BIPM.EM-K10.b)

NASA Astrophysics Data System (ADS)

Solve, S.; Chayramy, R.; Stock, M.; Pimsut, S.; Rujirat, N.

2016-01-01

A comparison of the Josephson array voltage standards of the Bureau International des Poids et Mesures (BIPM) and the National Institute of Metrology - (Thailand), NIMT, was carried out in November 2015 at the level of 10 V. For this exercise, options A and B of the BIPM.EM-K10.b comparison protocol were applied. Option B required the BIPM to provide a reference voltage for measurement by the NIMT using its Josephson standard with its own measuring device. Option A required the NIMT to provide a reference voltage with its Josephson voltage standard for measurement by the BIPM using an analogue nanovoltmeter and associated measurement loop. In all cases the BIPM array was kept floating from ground. The final results were in good agreement within the combined relative standard uncertainty of 2.6 parts in 1010 for the nominal voltage of 10 V. Main text To reach the main text of this paper, click on Final Report. Note that this text is that which appears in Appendix B of the BIPM key comparison database kcdb.bipm.org/. The final report has been peer-reviewed and approved for publication by the CCEM, according to the provisions of the CIPM Mutual Recognition Arrangement (CIPM MRA).

Medication monitoring and drug testing ethics project.

PubMed

Payne, Richard; Moe, Jeffrey L; Sevier, Catherine Harvey; Sevier, David; Waitzkin, Michael

2015-01-01

In 2012, Duke University initiated a research project, funded by an unrestricted research grant from Millennium Laboratories, a drug testing company. The project focused on assessing the frequency and nature of questionable, unethical, and illegal business practices in the clinical drug testing industry and assessing the potential for establishing a business code of ethics. Laboratory leaders, clinicians, industry attorneys, ethicists, and consultants participated in the survey, were interviewed, and attended two face-to-face meetings to discuss a way forward. The study demonstrated broad acknowledgment of variations in the legal and regulatory environment, resulting in inconsistent enforcement of industry practices. Study participants expressed agreement that overtly illegal practices sometimes exist, particularly when laboratory representatives and clinicians discuss reimbursement, extent of testing, and potential business incentives with medical practitioners. Most respondents reported directly observing probable violations involving marketing materials, contracts, or, in the case of some individuals, directly soliciting people with offers of clinical supplies and other "freebies." While many study respondents were skeptical that voluntary standards alone would eliminate questionable business practices, most viewed ethics codes and credentialing as an important first step that could potentially mitigate uneven enforcement, while improving quality of care and facilitating preferred payment options for credentialed parties. Many were willing to participate in future discussions and industry-wide initiatives to improve the environment.

Assessing the integrated pest management practices of southeastern US ornamental nursery operations.

PubMed

LeBude, Anthony V; White, Sarah A; Fulcher, Amy F; Frank, Steve; Klingeman Iii, William E; Chong, Juang-Horng; Chappell, Matthew R; Windham, Alan; Braman, Kris; Hale, Frank; Dunwell, Winston; Williams-Woodward, Jean; Ivors, Kelly; Adkins, Craig; Neal, Joe

2012-09-01

The Southern Nursery Integrated Pest Management (SNIPM) working group surveyed ornamental nursery crop growers in the southeastern United States to determine their pest management practices. Respondents answered questions about monitoring practices for insects, diseases and weeds, prevention techniques, intervention decisions, concerns about IPM and educational opportunities. Survey respondents were categorized into three groups based on IPM knowledge and pest management practices adopted. The three groups differed in the use of standardized sampling plans for scouting pests, in monitoring techniques, e.g. sticky cards, phenology and growing degree days, in record-keeping, in the use of spot-spraying and in the number of samples sent to a diagnostic clinic for identification and management recommendation. Stronger emphasis is needed on deliberate scouting techniques and tools to monitor pest populations to provide earlier pest detection and greater flexibility of management options. Most respondents thought that IPM was effective and beneficial for both the environment and employees, but had concerns about the ability of natural enemies to control insect pests, and about the availability and effectiveness of alternatives to chemical controls. Research and field demonstration is needed for selecting appropriate natural enemies for augmentative biological control. Two groups utilized cooperative extension almost exclusively, which would be an avenue for educating those respondents. Copyright © 2012 Society of Chemical Industry.

Feynman perturbation expansion for the price of coupon bond options and swaptions in quantum finance. I. Theory

NASA Astrophysics Data System (ADS)

Baaquie, Belal E.

2007-01-01

European options on coupon bonds are studied in a quantum field theory model of forward interest rates. Swaptions are briefly reviewed. An approximation scheme for the coupon bond option price is developed based on the fact that the volatility of the forward interest rates is a small quantity. The field theory for the forward interest rates is Gaussian, but when the payoff function for the coupon bond option is included it makes the field theory nonlocal and nonlinear. A perturbation expansion using Feynman diagrams gives a closed form approximation for the price of coupon bond option. A special case of the approximate bond option is shown to yield the industry standard one-factor HJM formula with exponential volatility.

Feynman perturbation expansion for the price of coupon bond options and swaptions in quantum finance. I. Theory.

PubMed

Baaquie, Belal E

2007-01-01

European options on coupon bonds are studied in a quantum field theory model of forward interest rates. Swaptions are briefly reviewed. An approximation scheme for the coupon bond option price is developed based on the fact that the volatility of the forward interest rates is a small quantity. The field theory for the forward interest rates is Gaussian, but when the payoff function for the coupon bond option is included it makes the field theory nonlocal and nonlinear. A perturbation expansion using Feynman diagrams gives a closed form approximation for the price of coupon bond option. A special case of the approximate bond option is shown to yield the industry standard one-factor HJM formula with exponential volatility.

Factors influencing postnatal Option B+ participation and breastfeeding duration among HIV-positive women in Lilongwe District, Malawi: A qualitative study.

PubMed

Flax, Valerie L; Hamela, Gloria; Mofolo, Innocent; Hosseinipour, Mina C; Hoffman, Irving F; Maman, Suzanne

2017-01-01

To ensure the health of mothers and children, prevention of mother-to-child HIV transmission (PMTCT) programs test women for HIV, engage HIV-positive women in care, and promote recommended breastfeeding practices. Under Malawi's Option B+ PMTCT program, ~20% of women are lost-to-follow-up (LTFU) and little is known about their breastfeeding practices. The purpose of this study is to describe facilitators and barriers to Option B+ participation and how participation influences breastfeeding duration. We conducted in-depth interviews with HIV-positive women in Option B+ (n = 32) or LTFU from Option B+ (n = 32). They were recruited from four government clinics in Lilongwe District and had a child aged 0-23 months. Women in Option B+ had better disclosure experiences and more social support than LTFU women. The most common reasons for LTFU were fear of HIV disclosure, anticipated or experienced stigma, and insufficient social support. Other reasons included: non-acceptance of HIV status, antiretroviral therapy (ART) side effects, lack of funds for transport, and negative experiences with clinic staff. Worries about possible transmission, even while on ART, influenced timing of weaning for some women in Option B+. Despite their knowledge of the risk of HIV transmission to the child, most LTFU women continued to breastfeed after stopping ART because they considered breastmilk to be an important source of nutrients for the child. Given that HIV-positive Malawian women LTFU from Option B+ breastfeed in the absence of ART, efforts are needed to use evidence-based strategies to address the barriers to Option B+ participation and avert preventable transmission through breastmilk.

Philanthropy as a source of funding for nursing initiatives.

PubMed

Kleinpell, Ruth M; Start, Rachel; McIntosh, Erik; Worobec, Sophia; Llewellyn, Jane

2014-01-01

Nurse leaders are challenged with ensuring that research and evidence-based practices are being integrated into clinical care. Initiatives such as the Magnet Recognition Program have helped reinforce the importance of advancing nursing practices to integrate best practices, conduct quality improvement initiatives, improve performance metrics, and involve bedside nurses in conducting research and evidence-based practice projects. While seeking research funding is an option for some initiatives, other strategies such as seeking funding from grateful patients or from philanthropic resources are becoming important options for nurse leaders to pursue, as the availability of funding from traditional sources such as professional organizations or federal funding becomes more limited. In addition, more institutions are seeking and applying for funding, increasing the pool of candidates who are vying for existing funding. Seeking alternative sources of funding, such as through philanthropy, becomes a viable option. This article reviews important considerations in seeking funding from philanthropic sources for nursing initiatives. Examples from a multiyear project that focused on promoting a healthy work environment and improving nursing morale are used to highlight strategies that were used to solicit, obtain, and secure extension funding from private foundation funding to support the initiative.

Systematic Review of Decision Aids for Newly Diagnosed Patients with Prostate Cancer Making Treatment Decisions.

PubMed

Adsul, Prajakta; Wray, Ricardo; Spradling, Kyle; Darwish, Oussama; Weaver, Nancy; Siddiqui, Sameer

2015-11-01

Despite established evidence for using patient decision aids, use with newly diagnosed patients with prostate cancer remains limited partly due to variability in aid characteristics. We systematically reviewed decision aids for newly diagnosed patients with prostate cancer. Published peer reviewed journal articles, unpublished literature on the Internet and the Ottawa decision aids web repository were searched to identify decision aids designed for patients with prostate cancer facing treatment decisions. A total of 14 aids were included in study. Supplementary materials on aid development and published studies evaluating the aids were also included. We studied aids designed to help patients make specific choices among options and outcomes relevant to health status that were specific to prostate cancer treatment and in English only. Aids were reviewed for IPDAS (International Patient Decision Aid Standards) and additional standards deemed relevant to prostate cancer treatment decisions. They were also reviewed for novel criteria on the potential for implementation. Acceptable interrater reliability was achieved at Krippendorff α = 0.82. Eight of the 14 decision aids (57.1%) were developed in the United States, 6 (42.8%) were print based, 5 (35.7%) were web or print based and only 4 (28.5%) had been updated since 2013. Ten aids (71.4%) were targeted to prostate cancer stage. All discussed radiation and surgery, 10 (71.4%) discussed active surveillance and/or watchful waiting and 8 (57.1%) discussed hormonal therapy. Of the aids 64.2% presented balanced perspectives on treatment benefits and risks, and/or outcome probabilities associated with each option. Ten aids (71.4%) presented value clarification prompts for patients and steps to make treatment decisions. No aid was tested with physicians and only 4 (28.6%) were tested with patients. Nine aids (64.2%) provided details on data appraisal and 4 (28.6%) commented on the quality of evidence used. Seven of the 8 web or computer based aids (87.5%) provided patients with the opportunity to interact with the aid. All except 1 aid scored above the 9th grade reading level. No evidence on aid implementation in routine practice was available. As physicians look to adopt decision aids in practice, they may base the choice of aid on characteristics that correlate with patient socioeconomic and educational status, personal practice style and practice setting. Copyright © 2015 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Validity of the toddler feeding questionnaire for measuring parent authoritative and indulgent feeding practices which are associated with stress and health literacy among Latino parents of preschool children.

PubMed

Heerman, William J; Lounds-Taylor, Julie; Mitchell, Stephanie; Barkin, Shari L

2018-01-01

Understanding the contribution of parental feeding practices to childhood obesity among Latino children is a solution-oriented approach that can lead to interventions supporting healthy childhood growth and lowering rates of obesity. The purpose of this study was to confirm the reliability and validity of the Toddler Feeding Questionnaire (TFQ) to measure parental feeding practices among a sample of Spanish-speaking parent-preschool child pairs (n = 529), and to test the hypothesis that parent characteristics of body mass index (BMI), stress, and health literacy are associated with more indulgent and less authoritative feeding practices. Standardized parent-report questionnaires were completed during baseline interviews in a randomized controlled trial of an obesity prevention intervention. The TFQ includes subscales for indulgent practices (11 items), authoritative practices (7 items), and environmental influences (6 items) with response options scored on a 5-point Likert scale and averaged. Factor analysis confirmed a three-factor structure. Internal consistency was good for indulgent (α = 0.66) and authoritative (α = 0.65) practices but lower for environmental (α = 0.48). Spearman correlation showed indulgent practices and environmental influences were associated with unhealthy child diet patterns, whereas authoritative practices were associated with a healthier child diet. Multivariate linear regression showed higher parent stress was associated with higher indulgent and lower authoritative scores; higher parent health literacy was positively associated with indulgent scores. These results indicate the TFQ is a valid measure of authoritative and indulgent parent feeding practices among Spanish-speaking parents of preschool-age children and that stress and health literacy, potentially modifiable parent characteristics, could be targeted to support healthy feeding practices. Copyright © 2017 Elsevier Inc. All rights reserved.

MENU OF NOX EMISSION CONTROL OPTIONS FOR COAL-FIRED ELECTRIC UTILITY BOILERS

EPA Science Inventory

The paper reviews NOx control options for coal-fired electric utility boilers. (NOTE: Acid Rain NOx regulations, the Ozone Transport Commission's NOx Budget Program, revision of the New Source Performance Standards (NSPS) for NOx emissions from utility sources, and Ozone Transpor...

Helping Dental Students Make Informed Decisions About Private Practice Employment Options in a Changing Landscape.

PubMed

Badger, Gary R; Fryer, Cheryl E S; Giannini, Peter J; Townsend, Janice A; Huja, Sarandeep

2015-12-01

According to the 2014 American Dental Education Association (ADEA) Survey of Dental School Seniors, 45.3% of new graduates planned to enter private practice immediately after graduation; of those, while 65% planned to become an associate dentist in a private practice, 28.3% intended to enter a corporate group practice-the only category that saw an increase over the previous year. Current trends indicate that the number of new graduates choosing to enter some form of private practice without further education will continue to remain high, due in large part to the need to repay educational debt. In light of these trends, the question that must be asked is whether dental schools are optimally preparing students to make informed decisions regarding future employment options in the changing dental practice landscape. This article argues that dental schools should review their curricula to ensure graduates are being prepared for this changing environment and the increased business pressures associated with dental practice. Important considerations in preparing dental students to be successful in the process of selecting a practice model are identified.

Management Options for Biochemically Recurrent Prostate Cancer.

PubMed

Fakhrejahani, Farhad; Madan, Ravi A; Dahut, William L

2017-05-01

Prostate cancer is the most common solid tumor malignancy in men worldwide. Treatment with surgery and radiation can be curative in organ-confined disease. Unfortunately, about one third of men develop biochemically recurrent disease based only on rising prostate-specific antigen (PSA) in the absence of visible disease on conventional imaging. For these patients with biochemical recurrent prostate cancer, there is no uniform guideline for subsequent management. Based on available data, it seems prudent that biochemical recurrent prostate cancer should initially be evaluated for salvage radiation or prostatectomy, with curative intent. In selected cases, high-intensity focused ultrasound and cryotherapy may be considered in patients that meet very narrow criteria as defined by non-randomized trials. If salvage options are not practical or unsuccessful, androgen deprivation therapy (ADT) is a standard option for disease control. While some patients prefer ADT to manage the disease immediately, others defer treatment because of the associated toxicity. In the absence of definitive randomized data, patients may be followed using PSA doubling time as a trigger to initiate ADT. Based on retrospective data, a PSA doubling time of less than 3-6 months has been associated with near-term development of metastasis and thus could be used signal to initiate ADT. Once treatment is begun, patients and their providers can choose between an intermittent and continuous ADT strategy. The intermittent approach may limit side effects but in patients with metastatic disease studies could not exclude a 20% greater risk of death. In men with biochemical recurrence, large studies have shown that intermittent therapy is non-inferior to continuous therapy, thus making this a reasonable option. Since biochemically recurrent prostate cancer is defined by technological limitations of radiographic detection, as new imaging (i.e., PSMA) strategies are developed, it may alter how the disease is monitored and perhaps managed. Furthermore, patients have no symptoms related to their disease and thus many prefer options that minimize toxicity. For this reason, herbal agents and immunotherapy are under investigation as potential alternatives to ADT and its accompanying side effects. New therapeutic options combined with improved imaging to evaluate the disease may markedly change how biochemically recurrent prostate cancer is managed in the future.

On a learning curve for shared decision making: Interviews with clinicians using the knee osteoarthritis Option Grid.

PubMed

Elwyn, Glyn; Rasmussen, Julie; Kinsey, Katharine; Firth, Jill; Marrin, Katy; Edwards, Adrian; Wood, Fiona

2018-02-01

Tools used in clinical encounters to illustrate to patients the risks and benefits of treatment options have been shown to increase shared decision making. However, we do not have good information about how these tools are viewed by clinicians and how clinicians think patients would react to their use. Our aim was to examine clinicians' views about the possible and actual use of tools designed to support patients and clinicians to collaborate and deliberate about treatment options, namely, Option Grid decision aids. We conducted a thematic analysis of qualitative interviews embedded in the intervention phase of a trial of an Option Grid decision aid for osteoarthritis of the knee. Interviews were conducted with 6 participating clinicians before they used the tool and again after clinicians had used the tool with 6 patients. In the first interview, clinicians voiced concerns that the tool would lead to an increase in encounter duration, patient resistance regarding involvement in decision making, and potential information overload. At the second interview, after minimal training, the clinicians reported that the tool had changed their usual way of communicating, and it was generally acceptable and helpful to integrate it into practice. After experiencing the use of Option Grids, clinicians became more willing to use the tools in their clinical encounters with patients. How best to introduce Option Grids to clinicians and adopt their use into practice will need careful consideration of context, workflow, and clinical pathways. © 2016 John Wiley & Sons, Ltd.

Scleral Lenses in the Management of Corneal Irregularity and Ocular Surface Disease.

PubMed

Shorter, Ellen; Harthan, Jennifer; Nau, Cherie B; Nau, Amy; Barr, Joseph T; Hodge, David O; Schornack, Muriel M

2017-09-29

To describe current practice patterns regarding the use of scleral lens therapy in the management of corneal irregularity and ocular surface disease among eye care providers who fit scleral lenses. The Scleral Lenses in Current Ophthalmic Practice: an Evaluation (SCOPE) study group conducted an electronic survey of eye care providers from January 15 to March 31, 2015. Respondents ranked management options for corneal irregularity in the order in which they would generally consider their use. Respondents also ranked options for the management of ocular surface disease in the order in which they would use each of the treatments. Results for each option were analyzed as percentage first-place ranking; percentage first-, second-, or third-place ranking; and mean rank score. Survey responses were obtained from 723 providers who had fit 5 or more scleral lenses. Of these respondents, 629 ranked options for management of corneal irregularity and 612 ranked options for management of ocular surface disease. Corneal rigid gas-permeable lenses were the first option for management of corneal irregularity for 44% of respondents, and scleral lenses were the first option for 34% of respondents. Lubricant drops were the first therapeutic recommendation for ocular surface disease for 84% of respondents, and scleral lenses were ranked first by 6% of respondents. Scleral lenses rank second only to corneal rigid gas-permeable lenses for management of corneal irregularity. Scleral lenses are generally considered after other medical intervention and before surgery for the management of ocular surface disease.

24 CFR 3285.504 - Skirting.

Code of Federal Regulations, 2010 CFR

2010-04-01

... MODEL MANUFACTURED HOME INSTALLATION STANDARDS Optional Features § 3285.504 Skirting. (a) Skirting, if... skirting within 6 inches of the ground must be pressure-treated in accordance with AWPA Standard U1...

24 CFR 3285.504 - Skirting.

Code of Federal Regulations, 2012 CFR

2012-04-01

... MODEL MANUFACTURED HOME INSTALLATION STANDARDS Optional Features § 3285.504 Skirting. (a) Skirting, if... skirting within 6 inches of the ground must be pressure-treated in accordance with AWPA Standard U1...

24 CFR 3285.504 - Skirting.

Code of Federal Regulations, 2011 CFR

2011-04-01

... MODEL MANUFACTURED HOME INSTALLATION STANDARDS Optional Features § 3285.504 Skirting. (a) Skirting, if... skirting within 6 inches of the ground must be pressure-treated in accordance with AWPA Standard U1...

Medical emergencies in the dermatology office: incidence and options for crisis preparedness.

PubMed

Hazen, Paul G; Daoud, Shaza; Hazen, Brent P; Engstrom, Conley W; Turgeon, Karen L; Reep, Michael D; Tanphaichitr, Arthapol; Styron, Brandie T

2014-05-01

Medical emergencies may occur in any setting, including dermatology offices. We examined the incidence of medical emergencies in a survey of 34 dermatologists northeast Ohio. Fifty-five events occurred over 565 combined years of clinical practice, an incidence of 1 episode every 10.3 years. We also review options for better preparedness for medical emergencies in dermatology practices, ranging from an emergency action plan for emergency personnel, basic life support (BLS) certification, advanced cardiac life support (ACLS) certification, and on-site automatic electronic defibrillators (AEDs).

Cannabinoid Hyperemesis Syndrome and the Consulting Psychiatrist: A Case Study of Diagnosis and Treatment for an Emerging Disorder in Psychiatric Practice.

PubMed

Kast, Kristopher A; Gershengoren, Liliya

2018-01-01

The increasing prevalence of cannabis use in the United States requires awareness of cannabis-related disorders and familiarity with treatment options. We present a case of cannabinoid hyperemesis syndrome that required psychiatric consultation for diagnostic clarification and effective treatment with intravenous haloperidol. Literature from emergency medicine, toxicology, and gastroenterology is reviewed, including proposed diagnostic criteria for cannabinoid hyperemesis syndrome and reported off-label treatment options, with a specific focus on clinical questions facing the practicing psychiatrist regarding this emerging disorder.

Astrobiological relevance and feasibility of a sample collection mission to the atmosphere of Venus

NASA Astrophysics Data System (ADS)

Schulze-Makuch, Dirk; Irwin, Louis N.; Irwin, Troy

2002-11-01

The lower cloud level of the Venusian atmosphere is an environmental niche that could harbor microbial life. Particularly the mode 3 particles that are enriched in this atmospheric layer are of astrobiological interest. We propose here a sample collection mission to the atmosphere of Venus and evaluate three mission options. The first option is a Stardust-type spacecraft used for sample collection, the second option is a Rotating Probe Tether System, and the third option is a Parachute Drop - Balloon Floatation System. Given the current state of technology, the result of our preliminary analysis is that the Parachute Drop - Balloon Floatation Mission is the most feasible and practical option.

Music therapy services for individuals with autism spectrum disorder: a survey of clinical practices and training needs.

PubMed

Kern, Petra; Rivera, Nicole R; Chandler, Alie; Humpal, Marcia

2013-01-01

Over the past decade, the definitions, diagnoses, prevalence rates, theories about the causes, evidence-based treatment options, and practice guidelines pertaining to Autism Spectrum Disorder (ASD) have undergone numerous changes. While several recent studies evaluate the effects of music therapy interventions for individuals with ASD, no current review reflects the latest music therapy practices and trends. The purpose of this study was to evaluate the status of music therapy practices for serving clients with ASD, the implementation of national ASD standards and guidelines, the awareness of recent developments, and training needs of music therapists. Professional members of the American Music Therapy Association who are working with individuals with ASD served as the sample for this national cross-sectional survey study (N = 328). A 45-item online questionnaire was designed and distributed through email and social media. Participants accessed the online survey through SurveyMonkey®. Findings suggest music therapy practices and services for individuals with ASD have shifted and now reflect a slightly higher percentage of caseload, a broader age range of clients, and a trend to serve clients in home and community settings. Most therapeutic processes align with recommended practices for ASD and incorporate several of the recognized evidence-based practices. Less understood or recognized are inclusion practices and latest developments in the field of ASD. Music therapists have a solid understanding of providing services for individuals with ASD, but would benefit from advanced online training and improved information dissemination to stay current with the rapidly changing aspects pertinent to this population. © 2013 by the American Music Therapy Association.

How much dentists are ethically concerned about overtreatment; a vignette-based survey in Switzerland.

PubMed

Kazemian, Ali; Berg, Isabelle; Finkel, Christina; Yazdani, Shahram; Zeilhofer, Hans-Florian; Juergens, Philipp; Reiter-Theil, Stella

2015-06-19

Overtreatment (or unnecessary treatment) is when medical or dental services are provided with a higher volume or cost than is appropriate. This study aimed to investigate how a group of dentists in Switzerland, a wealthy country known to have high standards of healthcare including dentistry, evaluated the meaning of unnecessary treatments from an ethical perspective and, assessed the expected frequency of different possible behaviors among their peers. A vignette describing a situation that is susceptible for overtreatment of a patient was presented to a group of dentists. The vignette was followed by five options. A questionnaire including the vignette was posted to 2482 dentists in the German-speaking areas of Switzerland. The respondents were asked to rate each option according to their estimation about its prevalence and their judgment about the degree to which the behavior is ethically sound. 732 completed questionnaires were returned. According to the responses, the most ethical and the most unethical options are considered to be the most and the least prevalent behaviors among dentists practicing in Switzerland, respectively. Suggesting unnecessary treatments to patients seems to be an ethically unacceptable conduct in the eyes of a sample of dentists in Switzerland. Although the respondents believed their colleagues were very likely to behave in an ethical way in response to a situation that is susceptible to overtreatment, they still seemed to be concerned about the prevalence of unethical behaviors in this regard.

Diagnosis of Helicobacter pylori infection: Current options and developments

PubMed Central

Wang, Yao-Kuang; Kuo, Fu-Chen; Liu, Chung-Jung; Wu, Meng-Chieh; Shih, Hsiang-Yao; Wang, Sophie SW; Wu, Jeng-Yih; Kuo, Chao-Hung; Huang, Yao-Kang; Wu, Deng-Chyang

2015-01-01

Accurate diagnosis of Helicobacter pylori (H. pylori) infection is a crucial part in the effective management of many gastroduodenal diseases. Several invasive and non-invasive diagnostic tests are available for the detection of H. pylori and each test has its usefulness and limitations in different clinical situations. Although none can be considered as a single gold standard in clinical practice, several techniques have been developed to give the more reliable results. Invasive tests are performed via endoscopic biopsy specimens and these tests include histology, culture, rapid urease test as well as molecular methods. Developments of endoscopic equipment also contribute to the real-time diagnosis of H. pylori during endoscopy. Urea breathing test and stool antigen test are most widely used non-invasive tests, whereas serology is useful in screening and epidemiological studies. Molecular methods have been used in variable specimens other than gastric mucosa. More than detection of H. pylori infection, several tests are introduced into the evaluation of virulence factors and antibiotic sensitivity of H. pylori, as well as screening precancerous lesions and gastric cancer. The aim of this article is to review the current options and novel developments of diagnostic tests and their applications in different clinical conditions or for specific purposes. PMID:26523098

Use of a birth plan within woman-held maternity records: a qualitative study with women and staff in northeast Scotland.

PubMed

Whitford, Heather M; Entwistle, Vikki A; van Teijlingen, Edwin; Aitchison, Patricia E; Davidson, Tracey; Humphrey, Tracy; Tucker, Janet S

2014-09-01

Birth plans are written preferences for labor and birth which women prepare in advance. Most studies have examined them as a novel intervention or "outside" formal care provision. This study considered use of a standard birth plan section within a national, woman-held maternity record. Exploratory qualitative interviews were conducted with women (42) and maternity service staff (24) in northeast Scotland. Data were analyzed thematically. Staff and women were generally positive about the provision of the birth plan section within the record. Perceived benefits included the opportunity to highlight preferences, enhance communication, stimulate discussions, and address anxieties. However, not all women experienced these benefits or understood the birth plan's purpose. Some were unaware of the opportunity to complete it or could not access the support they needed from staff to discuss or be confident about their options. Some were reluctant to plan too much. Staff recognized the need to support women with birth plan completion but noted practical challenges to this. A supportive antenatal opportunity to allow discussion of options may be needed to realize the potential benefits of routine inclusion of birth plans in maternity notes. © 2014 Wiley Periodicals, Inc.

Anemia and iron deficiency in gastrointestinal and liver conditions

PubMed Central

Stein, Jürgen; Connor, Susan; Virgin, Garth; Ong, David Eng Hui; Pereyra, Lisandro

2016-01-01

Iron deficiency anemia (IDA) is associated with a number of pathological gastrointestinal conditions other than inflammatory bowel disease, and also with liver disorders. Different factors such as chronic bleeding, malabsorption and inflammation may contribute to IDA. Although patients with symptoms of anemia are frequently referred to gastroenterologists, the approach to diagnosis and selection of treatment as well as follow-up measures is not standardized and suboptimal. Iron deficiency, even without anemia, can substantially impact physical and cognitive function and reduce quality of life. Therefore, regular iron status assessment and awareness of the clinical consequences of impaired iron status are critical. While the range of options for treatment of IDA is increasing due to the availability of effective and well-tolerated parenteral iron preparations, a comprehensive overview of IDA and its therapy in patients with gastrointestinal conditions is currently lacking. Furthermore, definitions and assessment of iron status lack harmonization and there is a paucity of expert guidelines on this topic. This review summarizes current thinking concerning IDA as a common co-morbidity in specific gastrointestinal and liver disorders, and thus encourages a more unified treatment approach to anemia and iron deficiency, while offering gastroenterologists guidance on treatment options for IDA in everyday clinical practice. PMID:27672287

Identifying Underlying Emotional Instability and Utilizing a Combined Intervention in the Treatment of Childhood Constipation and Encopresis-A Case Report.

PubMed

Davis, Jamie L

2016-06-01

Childhood constipation is a common ailment that in certain cases can lead to encopresis or fecal incontinence. The literature suggests that standard care varies in effectiveness, especially in the long term. Fecal incontinence can lead to frustration, guilt, and shame for both the child and family and has untold long-term psychological and physical consequences. To address alternative treatment options for pediatric constipation and encopresis by using acupuncture and Chinese medicine. Patient and Setting: This is a case study of a 6-year-old girl seen in a private practice acupuncture clinic in the northwestern United States. Treatment involved acupuncture, massage, and Chinese herbal medicine. The patient in this study began to have regular bowel movements on her own, from a type 5 on the modified Bristol Stool Form Scale for Children to a type 3, with no laxative use and few to no fecal accidents. Emotional stability and support seem to play an important role in pediatric constipation and encopresis. Acupuncture may be an effective treatment option in the integrative care model to address both the emotional and physical components of childhood constipation.

The interaction between equipoise and logistics in clinical trials: A case study.

PubMed

Warshaw, Meredith G; Carey, Vincent J; McFarland, Elizabeth J; Dawson, Liza; Abrams, Elaine; Melvin, Ann; Fairlie, Lee; Spiegel, Hans; Jay, Jonathan; Agwu, Allison L

2017-06-01

Equipoise is usually discussed as an ethical issue in clinical trials. However, it also has practical implications. Clinical equipoise is usually construed to mean uncertainty or disagreement among the expert clinician community. However, an individual physician's sense of equipoise may vary by location, based on the local standard of care or availability of specific treatment options, and these differences can affect providers' willingness to enroll participants into clinical trials. There are also logistical barriers to enrollment in international trials due to prolonged timelines for approvals by government agencies and ethical review boards. A multinational clinical trial of bridging strategies for treatment of non-adherent HIV-infected youth, experienced differing perceptions of equipoise due to disparities in availability of treatment options by country. Unfortunately, the countries with most demand for the trial were those where the approval process was most delayed, and the study was closed early due to slow accrual. When planning multicenter clinical trials, it is important to take into account heterogeneity among research sites and try to anticipate differences in equipoise and logistical factors between sites, in order to plan to address these issues at the design stage.

Anemia and iron deficiency in gastrointestinal and liver conditions.

PubMed

Stein, Jürgen; Connor, Susan; Virgin, Garth; Ong, David Eng Hui; Pereyra, Lisandro

2016-09-21

Iron deficiency anemia (IDA) is associated with a number of pathological gastrointestinal conditions other than inflammatory bowel disease, and also with liver disorders. Different factors such as chronic bleeding, malabsorption and inflammation may contribute to IDA. Although patients with symptoms of anemia are frequently referred to gastroenterologists, the approach to diagnosis and selection of treatment as well as follow-up measures is not standardized and suboptimal. Iron deficiency, even without anemia, can substantially impact physical and cognitive function and reduce quality of life. Therefore, regular iron status assessment and awareness of the clinical consequences of impaired iron status are critical. While the range of options for treatment of IDA is increasing due to the availability of effective and well-tolerated parenteral iron preparations, a comprehensive overview of IDA and its therapy in patients with gastrointestinal conditions is currently lacking. Furthermore, definitions and assessment of iron status lack harmonization and there is a paucity of expert guidelines on this topic. This review summarizes current thinking concerning IDA as a common co-morbidity in specific gastrointestinal and liver disorders, and thus encourages a more unified treatment approach to anemia and iron deficiency, while offering gastroenterologists guidance on treatment options for IDA in everyday clinical practice.

Fertility preservation options in breast cancer patients.

PubMed

Kasum, Miro; von Wolff, Michael; Franulić, Daniela; Čehić, Ermin; Klepac-Pulanić, Tajana; Orešković, Slavko; Juras, Josip

2015-01-01

The purpose of this review is to analyse current options for fertility preservation in young women with breast cancer (BC). Considering an increasing number of BC survivors, owing to improvements in cancer treatment and delaying of childbearing, fertility preservation appears to be an important issue. Current fertility preservation options in BC survivors range from well-established standard techniques to experimental or investigational interventions. Among the standard options, random-start ovarian stimulation protocol represents a new technique, which significantly decreases the total time of the in vitro fertilisation cycle. However, in patients with oestrogen-sensitive tumours, stimulation protocols using aromatase inhibitors are currently preferred over tamoxifen regimens. Cryopreservation of embryos and oocytes are nowadays deemed the most successful techniques for fertility preservation in BC patients. GnRH agonists during chemotherapy represent an experimental method for fertility preservation due to conflicting long-term outcome results regarding its safety and efficacy. Cryopreservation of ovarian tissue, in vitro maturation of immature oocytes and other strategies are considered experimental and should only be offered within the context of a clinical trial. An early pretreatment referral to reproductive endocrinologists and oncologists should be suggested to young BC women at risk of infertility, concerning the risks and benefits of fertility preservation options.

Default Options In Advance Directives Influence How Patients Set Goals For End-Of-Life Care

PubMed Central

Halpern, Scott D.; Loewenstein, George; Volpp, Kevin G.; Cooney, Elizabeth; Vranas, Kelly; Quill, Caroline M.; Mckenzie, Mary S.; Harhay, Michael O.; Gabler, Nicole B.; Silva, Tatiana; Arnold, Robert; Angus, Derek C.; Bryce, Cindy

2015-01-01

Although decisions regarding end-of-life care are personal and important, they may be influenced by the ways in which options are presented. To test this hypothesis, we randomly assigned 132 seriously ill patients to complete one of three types of advance directives. Two types had end-of-life care options already checked—a default choice—but one of these favored comfort-oriented care, and the other, life-extending care. The third type was a standard advance directive with no options checked. We found that most patients preferred comfort-oriented care, but the defaults influenced those choices. For example, 77 percent of patients in the comfort-oriented group retained that choice, while 43 percent of those in the life-extending group rejected the default choice and selected comfort-oriented care instead. Among the standard advance directive group, 61 percent of patients selected comfort-oriented care. Our findings suggest that patients may not hold deep-seated preferences regarding end-of-life care. The findings provide motivation for future research examining whether using default options in advance directives may improve important outcomes, including patients’ receipt of wanted and unwanted services, resource use, survival, and quality of life. PMID:23381535

21 CFR 164.110 - Mixed nuts.

Code of Federal Regulations, 2010 CFR

2010-04-01

... CONSUMPTION TREE NUT AND PEANUT PRODUCTS Requirements for Specific Standardized Tree Nut and Peanut Products... shelled tree nut ingredients, with or without one or more of the optional shelled peanut ingredients, of... is packed in transparent containers, three or more of the optional tree nut ingredients shall be...

Fast Track Option: An Accelerated Associate's Degree Program.

ERIC Educational Resources Information Center

Price, J. Randall

1998-01-01

Alternative instructional delivery options such as self-paced and flexible enrollment courses are designed to increase enrollment, promote retention, and encourage student success without lowering academic standards. The Fast Track Associate's Degree Program, developed by a team of faculty, staff, and administrators at Richland Community College,…

24 CFR 965.505 - Standards for allowances for utilities.

Code of Federal Regulations, 2010 CFR

2010-04-01

... PHA installs air conditioning, it shall provide, to the maximum extent economically feasible, systems... systems that offer each resident the option to choose air conditioning shall include retail meters or... allowances. For systems that offer residents the option to choose air conditioning but cannot be checkmetered...

Longleaf Pine: Natural Regeneration and Management

Treesearch

William D. Boyer

1999-01-01

Longleaf pine has long been recognized as a high-quality timber tree providing a number of valuable products. It is a versatile species with characteristics allowing the use of several silvicultural options. Both natural and artificial regeneration of longleaf pine are now practical management options. Natural regeneration is a lowcost alternative whenever sufficient...

THE SALMON 2100 PROJECT: OPTIONS TO PROTECT, RESTORE, ANE ENHANCE SALMON ALONG THE WEST COAST OF NORTH AMERICA

EPA Science Inventory

The primary goal of the Salmon 2100 Project is to identify practical options that have a high probability of maintaining biologically significant, sustainable populations of wild salmon in California, Oregon, Washington, Idaho, and British Columbia. The Project does not support o...

Evaluation of a Sustainable Remediation Option: Beneficial Reuse of Petroleum-Contaminated Sediment as an Energy Source

EPA Science Inventory

The characteristics of petroleum-contaminated sediment (PCS) have been evaluated to assess whether the practice of its beneficial reuse as a sole or supplemental energy source is sustainable relative to other sediment remediation options such as monitored natural recovery (MNR), ...

Vocational Education: Options and Directions. Working Paper 18.

ERIC Educational Resources Information Center

Stokes, Helen; Holdsworth, Roger

This paper presents practical options for school development in relation to vocational education ranging from small and specific steps to larger whole school change. Chapter 1 describes the context. Chapter 2 highlights three interlocked imperatives to attain this objective: a comprehensive and well-structured educational program that deals…

75 FR 46916 - Proposal for Minor Adjustments to Optional Alternative Site Framework

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-04

... DEPARTMENT OF COMMERCE Foreign-Trade Zones Board Proposal for Minor Adjustments to Optional Alternative Site Framework The Foreign-Trade Zones (FTZ) Board is inviting public comment on a staff proposal to make minor adjustments to the Board's practice regarding the alternative site framework (ASF...

Treatment Option Overview (Prostate Cancer)

MedlinePlus

... from making testosterone. However, estrogens are seldom used today in the treatment of prostate cancer because of ... or better than the standard treatment . Many of today's standard treatments for cancer are based on earlier ...

Evaluation of Policy Options for Increasing the Availability of Primary Care Services in Rural Washington State.

PubMed

Friedberg, Mark W; Martsolf, Grant R; White, Chapin; Auerbach, David I; Kandrack, Ryan; Reid, Rachel O; Butcher, Emily; Yu, Hao; Hollands, Simon; Nie, Xiaoyu

2017-01-01

The Washington State legislature has recently considered several policy options to address a perceived shortage of primary care physicians in rural Washington. These policy options include opening the new Elson S. Floyd College of Medicine at Washington State University in 2017; increasing the number of primary care residency positions in the state; expanding educational loan-repayment incentives to encourage primary care physicians to practice in rural Washington; increasing Medicaid payment rates for primary care physicians in rural Washington; and encouraging the adoption of alternative models of primary care, such as medical homes and nurse-managed health centers, that reallocate work from physicians to nurse practitioners (NPs) and physician assistants (PAs). RAND Corporation researchers projected the effects that these and other policy options could have on the state's rural primary care workforce through 2025. They project a 7-percent decrease in the number of rural primary care physicians and a 5-percent decrease in the number of urban ones. None of the policy options modeled in this study, on its own, will offset this expected decrease by relying on physicians alone. However, combinations of these strategies or partial reallocation of rural primary care services to NPs and PAs via such new practice models as medical homes and nurse-managed health centers are plausible options for preserving the overall availability of primary care services in rural Washington through 2025.

Environmental and economic analyses of waste disposal options for traditional markets in Indonesia.

PubMed

Aye, Lu; Widjaya, E R

2006-01-01

Waste from traditional markets in Indonesia is the second largest stream of municipal solid waste after household waste. It has a higher organic fraction and may have greater potential to be managed on a business scale compared to household wastes. The attributed reason is that in general the wastes generated from traditional markets are more uniform, more concentrated and less hazardous than waste from other sources. This paper presents the results of environmental and economic assessments to compare the options available for traditional market waste disposal in Indonesia. The options compared were composting in labour intensive plants, composting in a centralised plant that utilised a simple wheel loader, centralised biogas production and landfill for electricity production. The current open dumping practice was included as the baseline case. A life cycle assessment (LCA) was used for environmental analysis. All options compared have lower environmental impacts than the current practice of open dumping. The biogas production option has the lowest environmental impacts. A cost-benefit analysis, which considered greenhouse gas savings, was used for the economic assessment. It was found that composting at a centralised plant is the most economically feasible option under the present Indonesian conditions. The approach reported in this study could be applied for 'a pre-feasibility first cut comparison' that includes environmental aspects in a decision-making framework for developing countries even though European emission factors were used.

Early community-based family practice elective positively influences medical students' career considerations--a pre-post-comparison.

PubMed

Deutsch, Tobias; Hönigschmid, Petra; Frese, Thomas; Sandholzer, Hagen

2013-02-21

Demographic change and recruitment problems in family practice are increasingly threatening an adequate primary care workforce in many countries. Thus, it is important to attract young physicians to the field. The purpose of the present study was to examine the effect of an early community-based 28-h family practice elective with one-to-one mentoring on medical students' consideration of family practice as a career option, their interest in working office-based, and several perceptions with regard to specific aspects of a family physician's work. First- and second-year medical students completed questionnaires before and after a short community-based family practice elective, consisting of a preparatory course and a community-based practical experience with one-to-one mentoring by trained family physicians. We found a significantly higher rate of students favoring family practice as a career option after the elective (32.7% vs. 26.0%, p = 0.039). Furthermore, the ranking of family practice among other considered career options improved (p = 0.002). Considerations to work office-based in the future did not change significantly. Perceptions regarding a family physician's job changed positively with regard to the possibility of long-term doctor-patient relationships and treatment of complex disease patterns. The majority of the students described identification with the respective family physician tutor as a professional role model and an increased interest in the specialty. Our results indicate that a short community-based family practice elective early in medical education may positively influence medical students' considerations of a career in family practice. Furthermore, perceptions regarding the specialty with significant impact on its attractiveness may be positively adjusted. Further research is needed to evaluate the influence of different components of a family practice curriculum on the de facto career decisions of young physicians after graduation.

Wake Forest U. Joins Ranks of Test-Optional Colleges

ERIC Educational Resources Information Center

Hoover, Eric; Supiano, Beckie

2008-01-01

Wake Forest University will no longer require applicants to submit standardized test scores, the university announced last week. The move makes Wake Forest, in Winston-Salem, North Carolina, one of the most prominent institutions with a "test optional" admissions policy. The university's decision reveals the increasing complexity of the…

Effects of Employing Ridge Regression in Structural Equation Models.

ERIC Educational Resources Information Center

McQuitty, Shaun

1997-01-01

LISREL 8 invokes a ridge option when maximum likelihood or generalized least squares are used to estimate a structural equation model with a nonpositive definite covariance or correlation matrix. Implications of the ridge option for model fit, parameter estimates, and standard errors are explored through two examples. (SLD)

Treatment Options by Stage (Prostate Cancer)

MedlinePlus

... from making testosterone. However, estrogens are seldom used today in the treatment of prostate cancer because of ... or better than the standard treatment . Many of today's standard treatments for cancer are based on earlier ...

Fertility Preservation for Patients With Cancer: American Society of Clinical Oncology Clinical Practice Guideline Update

PubMed Central

Loren, Alison W.; Mangu, Pamela B.; Beck, Lindsay Nohr; Brennan, Lawrence; Magdalinski, Anthony J.; Partridge, Ann H.; Quinn, Gwendolyn; Wallace, W. Hamish; Oktay, Kutluk

2013-01-01

Purpose To update guidance for health care providers about fertility preservation for adults and children with cancer. Methods A systematic review of the literature published from March 2006 through January 2013 was completed using MEDLINE and the Cochrane Collaboration Library. An Update Panel reviewed the evidence and updated the recommendation language. Results There were 222 new publications that met inclusion criteria. A majority were observational studies, cohort studies, and case series or reports, with few randomized clinical trials. After review of the new evidence, the Update Panel concluded that no major, substantive revisions to the 2006 American Society of Clinical Oncology recommendations were warranted, but clarifications were added. Recommendations As part of education and informed consent before cancer therapy, health care providers (including medical oncologists, radiation oncologists, gynecologic oncologists, urologists, hematologists, pediatric oncologists, and surgeons) should address the possibility of infertility with patients treated during their reproductive years (or with parents or guardians of children) and be prepared to discuss fertility preservation options and/or to refer all potential patients to appropriate reproductive specialists. Although patients may be focused initially on their cancer diagnosis, the Update Panel encourages providers to advise patients regarding potential threats to fertility as early as possible in the treatment process so as to allow for the widest array of options for fertility preservation. The discussion should be documented. Sperm and embryo cryopreservation as well as oocyte cryopreservation are considered standard practice and are widely available. Other fertility preservation methods should be considered investigational and should be performed by providers with the necessary expertise. PMID:23715580

Juvenile idiopathic arthritis.

PubMed

Boros, Christina; Whitehead, Ben

2010-09-01

Juvenile idiopathic arthritis is the most common rheumatic disease in childhood, occurring in approximately 1:500 children. Despite a recent expansion in treatment options and improvement of outcomes, significant morbidity still occurs. This article outlines the clinical manifestations, assessment, detection of complications, treatment options and monitoring requirements, with the aid of guidelines recently published by The Royal Australian College of General Practitioners, which provide practical support for general practitioners to ensure best practice care and to prevent lifelong disability in patients with juvenile idiopathic arthritis. General practice plays an important role in the early detection, initial management and ongoing monitoring of children with juvenile idiopathic arthritis. Early detection involves understanding the classification framework for subtypes of juvenile idiopathic arthritis, and being aware of the clinical manifestations and how to look for them, through history, examination and appropriate investigation. The major extra-articular manifestations of juvenile idiopathic arthritis are uveitis and growth disturbance. Treatment options include nonsteroidal anti-inflammatory drugs, methotrexate, biologic agents, and corticosteroids. Management using a multidisciplinary approach can prevent long term sequelae. Unfortunately, approximately 50% of children will have active disease as adults.

A Guide to Faculty Development: Practical Advice, Examples, and Resources.

ERIC Educational Resources Information Center

Gillespie, Kay Herr, Ed.

Chapters in this guide provide practical guidance and useful information and resources relating to important aspects of faculty development, from setting up a faculty development program to assessing teaching practices. The chapters are: (1) "Faculty, Instructional, and Organizational Development: Options and Choices" (Robert M. Diamond); (2) "Ten…

45 CFR 155.710 - Eligibility standards for SHOP.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 45 Public Welfare 1 2014-10-01 2014-10-01 false Eligibility standards for SHOP. 155.710 Section... Exchange Functions: Small Business Health Options Program (SHOP) § 155.710 Eligibility standards for SHOP. (a) General requirement. The SHOP must permit qualified employers to purchase coverage for qualified...

Alternative Fuels Data Center: E85 Codes and Standards

Science.gov Websites

Development Equipment Options Equipment Installation Codes, Standards, & Safety Vehicles Laws & ; Incentives Ethanol Codes, Standards, and Safety The U.S. Environmental Protection Agency's (EPA) Office of -Gasoline Blends. The Occupational Safety and Health Administration (OSHA) regulates some fuel-dispensing

Comparison of the Josephson Voltage Standards of the DMDM and the BIPM (part of the ongoing BIPM key comparison BIPM.EM-K10.b)

NASA Astrophysics Data System (ADS)

Solve, S.; Chayramy, R.; Stock, M.; Pantelic-Babic, J.; Sofranac, Z.; Cincar Vujovic, T.

2016-01-01

A comparison of the Josephson array voltage standards of the Bureau International des Poids et Mesures (BIPM) and the Directorate of Measures and Precious Metals (DMDM), Belgrade, Serbia, was carried out in June 2015 at the level of 10 V. For this exercise, options A and B of the BIPM.EM-K10.b comparison protocol were applied. Option B required the BIPM to provide a reference voltage for measurement by the DMDM using its Josephson standard with its own measuring device. Option A required the DMDM to provide a reference voltage with its Josephson voltage standard for measurement by the BIPM using an analogue nanovoltmeter and associated measurement loop. Since no sufficiently stable voltage could be achieved in this configuration, a digital detector was used. In all cases the BIPM array was kept floating from ground. The final results were in good agreement within the combined relative standard uncertainty of 1.5 parts in 1010 for the nominal voltage of 10 V. Main text To reach the main text of this paper, click on Final Report. Note that this text is that which appears in Appendix B of the BIPM key comparison database kcdb.bipm.org/. The final report has been peer-reviewed and approved for publication by the CCEM, according to the provisions of the CIPM Mutual Recognition Arrangement (CIPM MRA).

Trazodone Addition to Paroxetine and Mirtazapine in a Patient with Treatment-Resistant Depression: The Pros and Cons of Combining Three Antidepressants

PubMed Central

Alves, José Carlos; Rego, Raquel Garcia

2016-01-01

Dual antidepressant combination for treatment-resistant depression is a strategy well supported by literature and accepted in clinical practice. Rather, the usefulness of the combination of more than two antidepressants is controversial. This may be related to the possibility of higher side-effect burden and to doubts about its pharmacological effectiveness and therapeutic advantage compared to other standard treatment options. We report a relapse of moderate-to-severe depressive symptoms with insomnia that successfully remitted after the addition of trazodone to a dual combination of paroxetine and mirtazapine (in standard effective doses) in a patient with treatment-resistant depression. We also review the literature and discuss the utility of triple antidepressant combination in treatment-resistant depression. This clinical case highlights the utility of combining trazodone as a third antidepressant for the relapse of depressive symptoms after the failure of a dual antidepressant combination. Trazodone may be advantageous in patients presenting recurrence of moderate-to-severe depressive symptoms that include sleep problems and/or insomnia and may be particularly useful when benzodiazepines are not recommended. Although its use may be controversial and associated with higher risk of side-effects, more investigation is needed to determine the efficacy and safety for triple antidepressant combinations as reliable strategies for treatment-resistant depression in clinical practice. PMID:27807450

Active Surveillance of Prostate Cancer: Use, Outcomes, Imaging, and Diagnostic Tools

PubMed Central

Tosoian, Jeffrey J; Loeb, Stacy; Epstein, Jonathan I; Turkbey, Baris; Choyke, Peter; Schaeffer, Edward M

2016-01-01

Active surveillance (AS) has emerged as a standard management option for men with very low-risk and low-risk prostate cancer, and contemporary data indicate that use of AS is increasing in the United States and abroad. In the favorable-risk population, reports from multiple prospective cohorts indicate a less than 1% likelihood of metastatic disease and prostate cancer-specific mortality over intermediate-term follow-up (median 5 to 6 years). Higher-risk men participating in AS appear to be at increased risk of adverse outcomes, but these populations have not been adequately studied to this point. Although monitoring on AS largely relies on serial prostate biopsy, a procedure associated with significant morbidity, there is a need for improved diagnostic tools for patient selection and monitoring. Revisions from the 2014 International Society of Urologic Pathology consensus conference have yielded a more intuitive reporting system and detailed reporting of low-intermediate grade tumors, which should facilitate the practice of AS. Meanwhile, emerging modalities such as multiparametric magnetic resonance imaging and tissue-based molecular testing have shown prognostic value in some populations. At this time, however, these instruments have not been sufficiently studied to consider their routine, standardized use in the AS setting. Future studies should seek to identify those platforms most informative in the AS population and propose a strategy by which promising diagnostic tools can be safely and efficiently incorporated into clinical practice. PMID:27249729

Development of a Curricular Framework for Pediatric Hospital Medicine Fellowships.

PubMed

Jerardi, Karen E; Fisher, Erin; Rassbach, Caroline; Maniscalco, Jennifer; Blankenburg, Rebecca; Chase, Lindsay; Shah, Neha

2017-07-01

Pediatric Hospital Medicine (PHM) is an emerging field in pediatrics and one that has experienced immense growth and maturation in a short period of time. Evolution and rapid expansion of the field invigorated the goal of standardizing PHM fellowship curricula, which naturally aligned with the field's evolving pursuit of a defined identity and consideration of certification options. The national group of PHM fellowship program directors sought to establish curricular standards that would more accurately reflect the competencies needed to practice pediatric hospital medicine and meet future board certification needs. In this manuscript, we describe the method by which we reached consensus on a 2-year curricular framework for PHM fellowship programs, detail the current model for this framework, and provide examples of how this curricular framework may be applied to meet the needs of a variety of fellows and fellowship programs. The 2-year PHM fellowship curricular framework was developed over a number of years through an iterative process and with the input of PHM fellowship program directors (PDs), PHM fellowship graduates, PHM leaders, pediatric hospitalists practicing in a variety of clinical settings, and other educators outside the field. We have developed a curricular framework for PHM Fellowships that consists of 8 education units (defined as 4 weeks each) in 3 areas: clinical care, systems and scholarship, and individualized curriculum. Copyright © 2017 by the American Academy of Pediatrics.

Reducing environmental risk associated with laboratory decommissioning and property transfer.

PubMed

Dufault, R; Abelquist, E; Crooks, S; Demers, D; DiBerardinis, L; Franklin, T; Horowitz, M; Petullo, C; Sturchio, G

2000-12-01

The need for more or less space is a common laboratory problem. Solutions may include renovating existing space, leaving or demolishing old space, or acquiring new space or property for building. All of these options carry potential environmental risk. Such risk can be the result of activities related to the laboratory facility or property (e.g., asbestos, underground storage tanks, lead paint), or the research associated with it (e.g., radioactive, microbiological, and chemical contamination). Regardless of the option chosen to solve the space problem, the potential environmental risk must be mitigated and the laboratory space and/or property must be decommissioned or rendered safe prior to any renovation, demolition, or property transfer activities. Not mitigating the environmental risk through a decommissioning process can incur significant financial liability for any costs associated with future decommissioning cleanup activities. Out of necessity, a functioning system, environmental due diligence auditing, has evolved over time to assess environmental risk and reduce associated financial liability. This system involves a 4-phase approach to identify, document, manage, and clean up areas of environmental concern or liability, including contamination. Environmental due diligence auditing includes a) historical site assessment, b) characterization assessment, c) remedial effort and d) final status survey. General practice standards from the American Society for Testing and Materials are available for conducting the first two phases. However, standards have not yet been developed for conducting the third and final phases of the environmental due diligence auditing process. Individuals involved in laboratory decommissioning work in the biomedical research industry consider this a key weakness.

Reducing environmental risk associated with laboratory decommissioning and property transfer.

PubMed Central

Dufault, R; Abelquist, E; Crooks, S; Demers, D; DiBerardinis, L; Franklin, T; Horowitz, M; Petullo, C; Sturchio, G

2000-01-01

The need for more or less space is a common laboratory problem. Solutions may include renovating existing space, leaving or demolishing old space, or acquiring new space or property for building. All of these options carry potential environmental risk. Such risk can be the result of activities related to the laboratory facility or property (e.g., asbestos, underground storage tanks, lead paint), or the research associated with it (e.g., radioactive, microbiological, and chemical contamination). Regardless of the option chosen to solve the space problem, the potential environmental risk must be mitigated and the laboratory space and/or property must be decommissioned or rendered safe prior to any renovation, demolition, or property transfer activities. Not mitigating the environmental risk through a decommissioning process can incur significant financial liability for any costs associated with future decommissioning cleanup activities. Out of necessity, a functioning system, environmental due diligence auditing, has evolved over time to assess environmental risk and reduce associated financial liability. This system involves a 4-phase approach to identify, document, manage, and clean up areas of environmental concern or liability, including contamination. Environmental due diligence auditing includes a) historical site assessment, b) characterization assessment, c) remedial effort and d) final status survey. General practice standards from the American Society for Testing and Materials are available for conducting the first two phases. However, standards have not yet been developed for conducting the third and final phases of the environmental due diligence auditing process. Individuals involved in laboratory decommissioning work in the biomedical research industry consider this a key weakness. PMID:11121365

An improved procedure for integrated behavioral z-scoring illustrated with modified Hole Board behavior of male inbred laboratory mice.

PubMed

Labots, M Maaike; Laarakker, M C Marijke; Schetters, D Dustin; Arndt, S S Saskia; van Lith, H A Hein

2018-01-01

Guilloux et al. introduced: integrated behavioral z-scoring, a method for behavioral phenotyping of mice. Using this method multiple ethological variables can be combined to show an overall description of a certain behavioral dimension or motivational system. However, a problem may occur when the control group used for the calculation has a standard deviation of zero or when no control group is present to act as a reference group. In order to solve these problems, an improved procedure is suggested: taking the pooled data as reference. For this purpose a behavioral study with male mice from three inbred strains was carried out. The integrated behavioral z-scoring methodology was applied, thereby taking five different reference group options. The outcome regarding statistical significance and practical importance was compared. Significant effects and effect sizes were influenced by the choice of the reference group. In some cases it was impossible to use a certain population and condition, because one or more behavioral variables in question had a standard deviation of zero. Based on the improved method, male mice from the three inbred strains differed regarding activity and anxiety. Taking the method described by Guilloux et al. as basis, the present procedure improved the generalizability to all types of experimental designs in animal behavioral research. To solve the aforementioned problems and to avoid getting the diagnosis of data manipulation, the pooled data (combining the data from all experimental groups in a study) as reference option is recommended. Copyright © 2017 Elsevier B.V. All rights reserved.

An innovative approach to capability-based emergency operations planning

PubMed Central

Keim, Mark E

2013-01-01

This paper describes the innovative use information technology for assisting disaster planners with an easily-accessible method for writing and improving evidence-based emergency operations plans. This process is used to identify all key objectives of the emergency response according to capabilities of the institution, community or society. The approach then uses a standardized, objective-based format, along with a consensus-based method for drafting capability-based operational-level plans. This information is then integrated within a relational database to allow for ease of access and enhanced functionality to search, sort and filter and emergency operations plan according to user need and technological capacity. This integrated approach is offered as an effective option for integrating best practices of planning with the efficiency, scalability and flexibility of modern information and communication technology. PMID:28228987

An innovative approach to capability-based emergency operations planning.

PubMed

Keim, Mark E

2013-01-01

This paper describes the innovative use information technology for assisting disaster planners with an easily-accessible method for writing and improving evidence-based emergency operations plans. This process is used to identify all key objectives of the emergency response according to capabilities of the institution, community or society. The approach then uses a standardized, objective-based format, along with a consensus-based method for drafting capability-based operational-level plans. This information is then integrated within a relational database to allow for ease of access and enhanced functionality to search, sort and filter and emergency operations plan according to user need and technological capacity. This integrated approach is offered as an effective option for integrating best practices of planning with the efficiency, scalability and flexibility of modern information and communication technology.

Endoscopic ultrasound-guided biliary drainage

PubMed Central

Chavalitdhamrong, Disaya; Draganov, Peter V

2012-01-01

Endoscopic ultrasound (EUS)-guided biliary drainage has emerged as a minimally invasive alternative to percutaneous and surgical interventions for patients with biliary obstruction who had failed endoscopic retrograde cholangiopancreatography (ERCP). EUS-guided biliary drainage has become feasible due to the development of large channel curvilinear therapeutic echo-endoscopes and the use of real-time ultrasound and fluoroscopy imaging in addition to standard ERCP devices and techniques. EUS-guided biliary drainage is an attractive option because of its minimally invasive, single step procedure which provides internal biliary decompression. Multiple investigators have reported high success and low complication rates. Unfortunately, high quality prospective data are still lacking. We provide detailed review of the use of EUS for biliary drainage from the perspective of practicing endoscopists with specific focus on the technical aspects of the procedure. PMID:22363114

Developments in the safe design of LNG tanks

NASA Astrophysics Data System (ADS)

Fulford, N. J.; Slatter, M. D.

The objective of this paper is to discuss how the gradual development of design concepts for liquefied natural gas (LNG) storage systems has helped to enhance storage safety and economy. The experience in the UK is compared with practice in other countries with similar LNG storage requirements. Emphasis is placed on the excellent record of safety and reliability exhibited by tanks with a primary metal container designed and constructed to approved standards. The work carried out to promote the development of new materials, fire protection, and monitoring systems for use in LNG storage is also summarized, and specific examples described from British Gas experience. Finally, the trends in storage tank design world-wide and options for future design concepts are discussed, bearing in mind planned legislation and design codes governing hazardous installations.

[A new challenge in clinical practice: resistance to directly acting antivirals in hepatitis C treatment].

PubMed

Chen, Z W; Hu, P; Ren, H

2016-03-20

Directly acting antivirals (DAAs) is a major treatment of hepatitis C virus (HCV) overseas. But DAAs resistance is getting more and more clinicians' attention. DAAs have not been approved in China to date, even though some of them are in clinical trials. However, a good knowledge of DAAs resistance is important on optimizing HCV treatment regimens, increasing sustained virological response (SVR) and decreasing treatment failure in clinical. In this review, DAAs resistance mechanism and virologic barrier to resistance, the prevalence of pre-existing DAAs resistance-associated variants (RAVs), the impact of RAVs on treatment outcome, the options of treatment regimens after resistance and drug resistance testing are discussed, hoping to provide some help for DAAs' standardized treatment in China in the future.

Enhancing Response Rates in Physician Surveys: The Limited Utility of Electronic Options

PubMed Central

Nicholls, Keith; Chapman, Kathryn; Shaw, Thomas; Perkins, Allen; Sullivan, Margaret Murray; Crutchfield, Susan; Reed, Eddie

2011-01-01

Objective To evaluate the utility of offering physicians electronic options as alternatives to completing mail questionnaires. Data Source A survey of colorectal cancer screening practices of Alabama primary care physicians, conducted May–June 2010. Study Design In the follow-up to a mail questionnaire, physicians were offered options of completing surveys by telephone, fax, email, or online. Data Collection Method Detailed records were kept on the timing and mode of completion of surveys. Principal Findings Eighty-eight percent of surveys were returned by mail, 10 percent were returned by fax, and only 2 percent were completed online; none were completed by telephone or email. Conclusions Offering fax options increases response rates, but providing other electronic options does not. PMID:21492157

76 FR 79609 - Federal Acquisition Regulation; Clarification of Standards for Computer Generation of Forms

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-22

... Regulation; Clarification of Standards for Computer Generation of Forms AGENCY: Department of Defense (DoD... American National Standards Institute X12, as the valid standard to use for computer-generated forms. FAR... optional forms on their computers. In addition to clarifying that FIPS 161 is no longer in use, public...

Punching loan sharks on the nose: effective interventions to reduce financial hardship in New Zealand.

PubMed

Signal, Louise; Lanumata, Tolotea; Bowers, Sharron

2012-08-01

Growth in the high-cost, unregulated fringe lender market (with these lenders commonly referred to as loan sharks) has occurred both internationally and in New Zealand in recent years. The credit practices of loan sharks create financial hardship for many people including Māori, Pacific and low-income New Zealanders. This paper reports on research that explored strategies for reducing the impact of the fringe lender market on Māori, Pacific and low-income New Zealanders. A narrative literature review and 10 key informant interviews were conducted to provide information on how best to intervene to reduce the impact of the fringe lender market for these people. The main interventions identified were: two regulatory approaches, one for capping interest rates and another to create codes of responsible lending; access to safe affordable micro-finance options; financial literacy education; and Pacific cultural change around fa'alavelave, which are the 'obligations' of giving. Protecting consumers from the unsafe practices of fringe lenders requires a combined approach of discouraging the undesirable practices of fringe lenders through regulation and encouraging the growth of safe, affordable micro-finance options. Financial literacy education is a valuable activity for directing consumer attention to the safest options, but in isolation will have limited effect if options are limited. Health promoters have a valuable role to play in implementing these interventions.

How federalism shapes public health financing, policy, and program options.

PubMed

Ogden, Lydia L

2012-01-01

In the United States, fiscal and functional federalism strongly shape public health policy and programs. Federalism has implications for public health practice: it molds financing and disbursement options, including funding formulas, which affect allocations and program goals, and shapes how funding decisions are operationalized in a political context. This article explores how American federalism, both fiscal and functional, structures public health funding, policy, and program options, investigating the effects of intergovernmental transfers on public health finance and programs.

Are food and drink retailers within NHS venues adhering to NICE Quality standard 94 guidance on childhood obesity? A cross-sectional study of two large secondary care NHS hospitals in England

PubMed Central

James, Alice; Birch, Laura; Fletcher, Peter; Pearson, Sally; Boyce, Catherine; Ness, Andy R; Hamilton-Shield, Julian P; Lithander, Fiona E

2017-01-01

Objective To assess whether the food and drink retail outlets in two major National Health Service (NHS) district general hospitals in England adhere to quality statements 1–3 of the UK National Institute for Health and Care Excellence (NICE) quality standard 94. Design Cross-sectional, descriptive study to assess the food and drink options available in vending machines, restaurants, cafes and shops in two secondary care hospitals. Main outcome measures Adherence to quality statement 1 whereby the food and drink items available in the vending machines were classified as either healthy or less healthy using the Nutrient Profiling Model (NPM). Compliance with quality statements 2 and 3 was assessed through the measurement of how clearly the shops, cafes and restaurants displayed nutrition information on menus, and the availability and prominent display of healthy food and drink options in retail outlets, respectively. Results Adherence to quality statement 1 was poor. Of the 18 vending machines assessed, only 7 (39%) served both a healthy food and a healthy drink option. Neither hospital was compliant with quality statement 2 wherein nutritional information was not available on menus of food providers in either hospital. There was inconsistent compliance with quality standard 3 whereby healthy food and drink options were prominently displayed in the two main hospital restaurants, but all shops and cafes prioritised the display of unhealthy items. Conclusions Neither hospital was consistently compliant with quality statements 1–3 of the NICE quality standard 94. Improving the availability of healthy foods and drinks while reducing the display and accessibility to less healthy options in NHS venues may improve family awareness of healthy alternatives. Making it easier for parents to direct their children to healthier choices is an ostensibly central component of our healthcare system. PMID:29150472

A new system for understanding modes of mechanical ventilation.

PubMed

Chatburn, R L; Primiano, F P

2001-06-01

Numerous ventilation modes and ventilation options have become available as new mechanical ventilators have reached the market. Ventilator manufacturers have no standardized terminology for ventilator modes and ventilation options, and ventilator operator's manuals do not help the clinician compare the modes of ventilators from different manufacturers. This article proposes a standardized system for classifying ventilation modes, based on general engineering principles and a small set of explicit definitions. Though there may be resistance by ventilator manufacturers to a standardized system of ventilation terminology, clinicians and health care equipment purchasers should adopt such a system in the interest of clear communication--the lack of which prevents clinicians from fully understanding the therapies they administer and could compromise the quality of patient care.

21 CFR 137.170 - Instantized flours.

Code of Federal Regulations, 2012 CFR

2012-04-01

.... standard sieve (840-micron opening), and not more than 20 percent will pass through a 200 mesh U.S standard sieve (74-micron opening). (b) The optional procedures referred to in paragraph (a) of this section are...

21 CFR 137.170 - Instantized flours.

Code of Federal Regulations, 2014 CFR

2014-04-01

.... standard sieve (840-micron opening), and not more than 20 percent will pass through a 200 mesh U.S standard sieve (74-micron opening). (b) The optional procedures referred to in paragraph (a) of this section are...

21 CFR 137.170 - Instantized flours.

Code of Federal Regulations, 2013 CFR

2013-04-01

.... standard sieve (840-micron opening), and not more than 20 percent will pass through a 200 mesh U.S standard sieve (74-micron opening). (b) The optional procedures referred to in paragraph (a) of this section are...

21 CFR 137.170 - Instantized flours.

Code of Federal Regulations, 2011 CFR

2011-04-01

.... standard sieve (840-micron opening), and not more than 20 percent will pass through a 200 mesh U.S standard sieve (74-micron opening). (b) The optional procedures referred to in paragraph (a) of this section are...

21 CFR 137.170 - Instantized flours.

Code of Federal Regulations, 2010 CFR

2010-04-01

.... standard sieve (840-micron opening), and not more than 20 percent will pass through a 200 mesh U.S standard sieve (74-micron opening). (b) The optional procedures referred to in paragraph (a) of this section are...

Life or Death of Severely Disabled Infants: A Counseling Issue.

ERIC Educational Resources Information Center

Head, David W.; And Others

1985-01-01

Presents dimensions that serve as a background for counselors to assist families in considering options related to disabled infants. Dimensions include the meaning of life, cost to benefit ratio, medical options, legal precedent, and a theological perspective. This issue is related to counseling practice through counselor ethics and values.…

Logic of Accounting: The Case of Reporting Previous Options in Norwegian Activation Encounters

ERIC Educational Resources Information Center

Solberg, Janne

2017-01-01

The article deals with the enactment of client resistance in Norwegian vocational rehabilitation encounters. More specific, a practice here called "reporting previous options" is analyzed by using the resources of ethnomethodological conversation analysis (CA) in five instances as doing some sort of accounting. In response to the…

Preparing Students for Multiple Options beyond High School. Best Practices Newsletter

ERIC Educational Resources Information Center

Southern Regional Education Board (SREB), 2015

2015-01-01

Too often school leaders, teachers and counselors invest their energies into preparing students for college. In today's society, that's not enough. Students must be prepared for multiple options after high school including gainful employment. This newsletter looks at ways schools can ensure more students are college and career-ready by creating…

Study of the Alsys implementation of the Catalogue of Interface Features and Options for the Ada language for 80386 Unix

NASA Technical Reports Server (NTRS)

Gibson, James S.; Barnes, Michael J.; Ostermiller, Daniel L.

1993-01-01

A set of programs was written to test the functionality and performance of the Alsys Ada implementation of the Catalogue of Interface Features and Options (CIFO), a set of optional Ada packages for real-time applications. No problems were found with the task id, preemption control, or shared-data packages. Minor problems were found with the dispatching control, dynamic priority, events, non-waiting entry call, semaphore, and scheduling packages. The Alsys implementation is derived mostly from Release 2 of the CIFO standard, but includes some of the features of Release 3 and some modifications unique to Alsys. Performance measurements show that the semaphore and shared-data features are an order-of-magnitude faster than the same mechanisms using an Ada rendezvous. The non-waiting entry call is slightly faster than a standard rendezvous. The existence of errors in the implementation, the incompleteness of the documentation from the published standard impair the usefulness of this implementation. Despite those short-comings, the Alsys CIFO implementation might be of value in the development of real-time applications.

Evaluating Mobile Survey Tools (MSTs) for Field-Level Monitoring and Data Collection: Development of a Novel Evaluation Framework, and Application to MSTs for Rural Water and Sanitation Monitoring

PubMed Central

Fisher, Michael B.; Mann, Benjamin H.; Cronk, Ryan D.; Shields, Katherine F.; Klug, Tori L.; Ramaswamy, Rohit

2016-01-01

Information and communications technologies (ICTs) such as mobile survey tools (MSTs) can facilitate field-level data collection to drive improvements in national and international development programs. MSTs allow users to gather and transmit field data in real time, standardize data storage and management, automate routine analyses, and visualize data. Dozens of diverse MST options are available, and users may struggle to select suitable options. We developed a systematic MST Evaluation Framework (EF), based on International Organization for Standardization/International Electrotechnical Commission (ISO/IEC) software quality modeling standards, to objectively assess MSTs and assist program implementers in identifying suitable MST options. The EF is applicable to MSTs for a broad variety of applications. We also conducted an MST user survey to elucidate needs and priorities of current MST users. Finally, the EF was used to assess seven MSTs currently used for water and sanitation monitoring, as a validation exercise. The results suggest that the EF is a promising method for evaluating MSTs. PMID:27563916

Evaluating Mobile Survey Tools (MSTs) for Field-Level Monitoring and Data Collection: Development of a Novel Evaluation Framework, and Application to MSTs for Rural Water and Sanitation Monitoring.

PubMed

Fisher, Michael B; Mann, Benjamin H; Cronk, Ryan D; Shields, Katherine F; Klug, Tori L; Ramaswamy, Rohit

2016-08-23

Information and communications technologies (ICTs) such as mobile survey tools (MSTs) can facilitate field-level data collection to drive improvements in national and international development programs. MSTs allow users to gather and transmit field data in real time, standardize data storage and management, automate routine analyses, and visualize data. Dozens of diverse MST options are available, and users may struggle to select suitable options. We developed a systematic MST Evaluation Framework (EF), based on International Organization for Standardization/International Electrotechnical Commission (ISO/IEC) software quality modeling standards, to objectively assess MSTs and assist program implementers in identifying suitable MST options. The EF is applicable to MSTs for a broad variety of applications. We also conducted an MST user survey to elucidate needs and priorities of current MST users. Finally, the EF was used to assess seven MSTs currently used for water and sanitation monitoring, as a validation exercise. The results suggest that the EF is a promising method for evaluating MSTs.

7 CFR 28.105 - Practical forms of cotton standards.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 7 Agriculture 2 2012-01-01 2012-01-01 false Practical forms of cotton standards. 28.105 Section 28... REGULATIONS COTTON CLASSING, TESTING, AND STANDARDS Regulations Under the United States Cotton Standards Act Practical Forms of Cotton Standards § 28.105 Practical forms of cotton standards. (a) Practical forms of the...

7 CFR 28.105 - Practical forms of cotton standards.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 7 Agriculture 2 2013-01-01 2013-01-01 false Practical forms of cotton standards. 28.105 Section 28... REGULATIONS COTTON CLASSING, TESTING, AND STANDARDS Regulations Under the United States Cotton Standards Act Practical Forms of Cotton Standards § 28.105 Practical forms of cotton standards. (a) Practical forms of the...

7 CFR 28.105 - Practical forms of cotton standards.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 2 2010-01-01 2010-01-01 false Practical forms of cotton standards. 28.105 Section 28... REGULATIONS COTTON CLASSING, TESTING, AND STANDARDS Regulations Under the United States Cotton Standards Act Practical Forms of Cotton Standards § 28.105 Practical forms of cotton standards. (a) Practical forms of the...

7 CFR 28.105 - Practical forms of cotton standards.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 7 Agriculture 2 2014-01-01 2014-01-01 false Practical forms of cotton standards. 28.105 Section 28... REGULATIONS COTTON CLASSING, TESTING, AND STANDARDS Regulations Under the United States Cotton Standards Act Practical Forms of Cotton Standards § 28.105 Practical forms of cotton standards. (a) Practical forms of the...

7 CFR 28.105 - Practical forms of cotton standards.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 2 2011-01-01 2011-01-01 false Practical forms of cotton standards. 28.105 Section 28... REGULATIONS COTTON CLASSING, TESTING, AND STANDARDS Regulations Under the United States Cotton Standards Act Practical Forms of Cotton Standards § 28.105 Practical forms of cotton standards. (a) Practical forms of the...

45 CFR 155.730 - Application standards for SHOP.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 45 Public Welfare 1 2013-10-01 2013-10-01 false Application standards for SHOP. 155.730 Section... Exchange Functions: Small Business Health Options Program (SHOP) § 155.730 Application standards for SHOP. (a) General requirements. Application forms used by the SHOP must meet the requirements set forth in...

45 CFR 155.730 - Application standards for SHOP.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 45 Public Welfare 1 2014-10-01 2014-10-01 false Application standards for SHOP. 155.730 Section... Exchange Functions: Small Business Health Options Program (SHOP) § 155.730 Application standards for SHOP. (a) General requirements. Application forms used by the SHOP must meet the requirements set forth in...

DIFFERENTIATING PASSENGER VEHICLES BY FUEL ECONOMY: STRATEGIC INCENTIVES AND THE COST-EFFECTIVENESS OF TRADABLE CAFE STANDARDS

EPA Science Inventory

The welfare and distributional effects of alternative fuel economy regulations will be compared, including an increase in existing CAFE standards, allowing for tradable credits, and implementing other design options in a trading scheme, such as sliding standards based on ve...

A randomised controlled trial of caseload midwifery care: M@NGO (Midwives @ New Group practice Options).

PubMed

Tracy, Sally K; Hartz, Donna; Hall, Bev; Allen, Jyai; Forti, Amanda; Lainchbury, Anne; White, Jan; Welsh, Alec; Tracy, Mark; Kildea, Sue

2011-10-26

Australia has an enviable record of safety for women in childbirth. There is nevertheless growing concern at the increasing level of intervention and consequent morbidity amongst childbearing women. Not only do interventions impact on the cost of services, they carry with them the potential for serious morbidities for mother and infant.Models of midwifery have proliferated in an attempt to offer women less fragmented hospital care. One of these models that is gaining widespread consumer, disciplinary and political support is caseload midwifery care. Caseload midwives manage the care of approximately 35-40 a year within a small Midwifery Group Practice (usually 4-6 midwives who plan their on call and leave within the Group Practice.) We propose to compare the outcomes and costs of caseload midwifery care compared to standard or routine hospital care through a randomised controlled trial. A two-arm RCT design will be used. Women will be recruited from tertiary women's hospitals in Sydney and Brisbane, Australia. Women allocated to the caseload intervention will receive care from a named caseload midwife within a Midwifery Group Practice. Control women will be allocated to standard or routine hospital care. Women allocated to standard care will receive their care from hospital rostered midwives, public hospital obstetric care and community based general medical practitioner care. All midwives will collaborate with obstetricians and other health professionals as necessary according to the woman's needs. Data will be collected at recruitment, 36 weeks antenatally, six weeks and six months postpartum by web based or postal survey. With 750 women or more in each of the intervention and control arms the study is powered (based on 80% power; alpha 0.05) to detect a difference in caesarean section rates of 29.4 to 22.9%; instrumental birth rates from 11.0% to 6.8%; and rates of admission to neonatal intensive care of all neonates from 9.9% to 5.8% (requires 721 in each arm). The study is not powered to detect infant or maternal mortality, however all deaths will be reported. Other significant findings will be reported, including a comprehensive process and economic evaluation. Australian New Zealand Clinical Trials Registry ACTRN12609000349246.

Looking for Skeletons in the Data Centre `Cupboard': How Repository Certification Can Help

NASA Astrophysics Data System (ADS)

Sorvari, S.; Glaves, H.

2017-12-01

There has been a national geoscience repository at the British Geological Survey (or one of its previous incarnations) almost since its inception in 1835. This longevity has resulted in vast amounts of analogue material and, more recently, digital data some of which has been collected by our scientists but much more has been acquired either through various legislative obligations or donated from various sources. However, the role and operation of the UK National Geoscience Data Centre (NGDC) in the 21st Century is very different to that of the past, with new systems and procedures dealing with predominantly digital data. A web-based ingestion portal allows users to submit their data directly to the NGDC while online services provide discovery and access to data and derived products. Increasingly we are also required to implement an array of standards e.g. ISO, OGC, W3C, best practices e.g. FAIR and legislation e.g. EU INSPIRE Directive; whilst at the same time needing to justifying our very existence to our funding agency and hosting organisation. External pressures to demonstrate that we can be recognised as a trusted repository by researchers, various funding agencies, publishers and other related entities have forced us to look at how we function, and to benchmark our operations against those of other organisations and current relevant standards such as those laid down by different repository certification processes. Following an assessment of the various options, the WDS/DSA certification process was selected as the most appropriate route for accreditation of NGDC as a trustworthy repository. It provided a suitable framework for reviewing the current systems, procedures and best practices. Undertaking this process allowed us to identify where the NGDC already has robust systems in place and where there were gaps and deficiencies in current practices. The WDS/DSA assessment process also helped to reinforce best practice throughout the NGDC and demonstrated that many of the recognised and required procedures and standards for recognition as a trusted repository were already in place, even if they were not always followed!

17 CFR 155.3 - Trading standards for futures commission merchants.

Code of Federal Regulations, 2010 CFR

2010-04-01

...) Insure, to the extent possible, that each order received from a customer or from an option customer which... the affiliated person has gained knowledge of the customer's or option customer's order prior to the... merchant or any of its affiliated persons by reason of their relationship to such other person, except with...

77 FR 74043 - Self-Regulatory Organizations; The Options Clearing Corporation; Order Granting Approval of...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-12-12

... (``OCC'') submitted to the Securities and Exchange Commission (``Commission''), pursuant to Rule 9b-1... of trading standardized options. In September 2012, the Commission approved proposed rule changes...\\ The Commission recently approved a proposed rule change by the OCC to make similar changes to its By...

40 CFR 86.1832-01 - Optional equipment and air conditioning for test vehicles.

Code of Federal Regulations, 2010 CFR

2010-07-01

... PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) CONTROL OF EMISSIONS FROM NEW AND IN-USE HIGHWAY VEHICLES AND ENGINES (CONTINUED) General Compliance Provisions for Control of Air Pollution From New and In... group, will be equipped with an item (whether that item is standard equipment or an option), the full...

40 CFR 86.1832-01 - Optional equipment and air conditioning for test vehicles.

Code of Federal Regulations, 2012 CFR

2012-07-01

... PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) CONTROL OF EMISSIONS FROM NEW AND IN-USE HIGHWAY VEHICLES AND ENGINES (CONTINUED) General Compliance Provisions for Control of Air Pollution From New and In... group, will be equipped with an item (whether that item is standard equipment or an option), the full...

40 CFR 63.138 - Process wastewater provisions-performance standards for treatment processes managing Group 1...

Code of Federal Regulations, 2012 CFR

2012-07-01

... each treatment process. (b) Control options: Group 1 wastewater streams for Table 9 compounds. The... section. (c) Control options: Group 1 wastewater streams for Table 8 compounds. The owner or operator...) Residuals. For each residual removed from a Group 1 wastewater stream, the owner or operator shall control...

40 CFR 86.1832-01 - Optional equipment and air conditioning for test vehicles.

Code of Federal Regulations, 2011 CFR

2011-07-01

... PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) CONTROL OF EMISSIONS FROM NEW AND IN-USE HIGHWAY VEHICLES AND ENGINES (CONTINUED) General Compliance Provisions for Control of Air Pollution From New and In... group, will be equipped with an item (whether that item is standard equipment or an option), the full...

40 CFR 86.1832-01 - Optional equipment and air conditioning for test vehicles.

Code of Federal Regulations, 2013 CFR

2013-07-01

... PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) CONTROL OF EMISSIONS FROM NEW AND IN-USE HIGHWAY VEHICLES AND ENGINES (CONTINUED) General Compliance Provisions for Control of Air Pollution From New and In... group, will be equipped with an item (whether that item is standard equipment or an option), the full...

40 CFR 63.138 - Process wastewater provisions-performance standards for treatment processes managing Group 1...

Code of Federal Regulations, 2013 CFR

2013-07-01

... each treatment process. (b) Control options: Group 1 wastewater streams for Table 9 compounds. The... section. (c) Control options: Group 1 wastewater streams for Table 8 compounds. The owner or operator...) Residuals. For each residual removed from a Group 1 wastewater stream, the owner or operator shall control...

40 CFR 63.138 - Process wastewater provisions-performance standards for treatment processes managing Group 1...

Code of Federal Regulations, 2011 CFR

2011-07-01

... each treatment process. (b) Control options: Group 1 wastewater streams for Table 9 compounds. The... section. (c) Control options: Group 1 wastewater streams for Table 8 compounds. The owner or operator...) Residuals. For each residual removed from a Group 1 wastewater stream, the owner or operator shall control...

76 FR 64174 - Public Input on the Report to Congress on How To Modernize and Improve the System of Insurance...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-10-17

... examples, supporting any opinions or conclusions; (2) approaches and options toward improvement or... out such approaches or options. FOR FURTHER INFORMATION CONTACT: Federal Insurance Office, Department... submit views on: 1. Systemic risk regulation with respect to insurance; 2. Capital standards and the...

17 CFR 155.3 - Trading standards for futures commission merchants.

Code of Federal Regulations, 2011 CFR

2011-04-01

...) Insure, to the extent possible, that each order received from a customer or from an option customer which... the affiliated person has gained knowledge of the customer's or option customer's order prior to the... merchant or any of its affiliated persons by reason of their relationship to such other person, except with...

17 CFR 155.3 - Trading standards for futures commission merchants.

Code of Federal Regulations, 2012 CFR

2012-04-01

...) Insure, to the extent possible, that each order received from a customer or from an option customer which... the affiliated person has gained knowledge of the customer's or option customer's order prior to the... merchant or any of its affiliated persons by reason of their relationship to such other person, except with...

Alternative Compliance: Guidelines for Preparing and Submitting a Waiver Request Application and Other Documentation Requirements

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

Not Available

2013-03-01

This document is designed to assist covered fleets interested in taking advantage of more flexible compliance options and to facilitate the transition from Standard Compliance to Alternative Compliance. It is designed to help fleets better understand the Alternative Compliance option and successfully complete the waiver application process.

Alternative Compliance: Guidelines for Preparing and Submitting a Waiver Request Application and Other Documentation Requirements (Brochure)

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

Not Available

2014-06-01

This document is designed to assist covered fleets interested in taking advantage of more flexible compliance options and to facilitate the transition from Standard Compliance to Alternative Compliance. It is designed to help fleets better understand the Alternative Compliance option and successfully complete the waiver application process.

Alternative Compliance: Guidelines for Preparing and Submitting a Waiver Request Application and Other Documentation Requirements

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

Sears, Ted

2014-06-01

This document is designed to assist covered fleets interested in taking advantage of more flexible compliance options and to facilitate the transition from Standard Compliance to Alternative Compliance. It is designed to help fleets better understand the Alternative Compliance option and successfully complete the waiver application process.

Alternative Compliance: Guidelines for Preparing and Submitting a Waiver Request Application and Other Documentation Requirements (Book)

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

Not Available

2010-11-01

This document is designed to assist covered fleets interested in taking advantage of more flexible compliance options and to facilitate the transition from Standard Compliance to Alternative Compliance. It is designed to help fleets better understand the Alternative Compliance option and successfully complete the waiver application process.

40 CFR 270.235 - Options for incinerators, cement kilns, lightweight aggregate kilns, solid fuel boilers, liquid...

Code of Federal Regulations, 2010 CFR

2010-07-01

... Technology (MACT) Standards § 270.235 Options for incinerators, cement kilns, lightweight aggregate kilns... malfunction plan, design, and operating history. (2) Retain or add these permit requirements to the permit to... information including the source's startup, shutdown, and malfunction plan, design, and operating history; and...

Environmental issues in operations management

NASA Astrophysics Data System (ADS)

Muthulingam, Suresh

Adoption of sustainable operating practices is becoming an increasingly important issue for many organizations in the world today. In this dissertation, I use empirical methods to investigate factors that influence the adoption of sustainable practices and also identify issues that may hinder the adoption of such practices. I explore these issues in two diverse settings. In Chapter 1, I investigate the adoption and non-adoption of energy efficiency initiatives using a database of over 100,000 recommendations provided to more than 13,000 small and medium sized manufacturing firms. Even though the average payback across all recommendations is just over one year, many of these profitable opportunities are not implemented. Using a probit instrumental variable model, I identify four biases in the adoption of these recommendations. First, managers are myopic as they miss out on many profitable opportunities. Second, managers are more influenced by upfront costs than by net benefits when evaluating such initiatives. Third, adoption of a recommendation depends not only on its characteristics but also on the sequence in which the recommendations are presented. Adoption rates are higher for initiatives appearing early in a list of recommendations. Finally, adoption is not influenced by the number of options provided to decision makers. This contributes to the debate about whether or not choice overload occurs. We highlight decision biases previously unobserved in the Operations Management literature using field data rather than experimental data. We draw implications for enhancing adoption of energy efficiency initiatives and for other decision contexts where a collection of process improvement recommendations are made to firms. In Chapter 2, I examine the depth of adoption of the voluntary LEED (Leadership in Energy and Environmental Design) standards for green buildings. Depth of adoption refers to the extent to which the buildings adopt practices related to the standard. The LEED standard is based on a point system where buildings are awarded different certification levels based on the number of points they achieve. We use a database of 721 buildings certified to the LEED standard to investigate four issues related to the depth of adoption. First, I find that depth of adoption is influenced by the various certification levels (certified, silver, gold, platinum) incorporated into the LEED standards. In the distribution of points achieved by buildings, this results in large "spikes" at the cutoffs for the various certification levels. Second, we find that the depth of adoption of the LEED standard increases over time as the standard becomes more widely accepted. Third, we find that among organizations that adopt the LEED standard, nonprofit organizations adopt it more deeply than other types of organizations. Finally, we find that deeper adoption is associated with longer project completion times, consistent with the greater complexity involved. Our study contributes to the literature by highlighting that the structure of a standard can influence depth of adoption, that depth of adoption can evolve over time, and that depth of adoption is influenced by organization type. We draw implications for the design and future development of similar voluntary standards.

Space station data system analysis/architecture study. Task 2: Options development, DR-5. Volume 3: Programmatic options

NASA Technical Reports Server (NTRS)

1985-01-01

Task 2 in the Space Station Data System (SSDS) Analysis/Architecture Study is the development of an information base that will support the conduct of trade studies and provide sufficient data to make design/programmatic decisions. This volume identifies the preferred options in the programmatic category and characterizes these options with respect to performance attributes, constraints, costs, and risks. The programmatic category includes methods used to administrate/manage the development, operation and maintenance of the SSDS. The specific areas discussed include standardization/commonality; systems management; and systems development, including hardware procurement, software development and system integration, test and verification.

Attraction Effect in Risky Choice Can Be Explained by Subjective Distance Between Choice Alternatives.

PubMed

Mohr, Peter N C; Heekeren, Hauke R; Rieskamp, Jörg

2017-08-21

Individuals make decisions under risk throughout daily life. Standard models of economic decision making typically assume that people evaluate choice options independently. There is, however, substantial evidence showing that this independence assumption is frequently violated in decision making without risk. The present study extends these findings to the domain of decision making under risk. To explain the independence violations, we adapted a sequential sampling model, namely Multialternative Decision Field Theory (MDFT), to decision making under risk and showed how this model can account for the observed preference shifts. MDFT not only better predicts choices compared with the standard Expected Utility Theory, but it also explains individual differences in the size of the observed context effect. Evidence in favor of the chosen option, as predicted by MDFT, was positively correlated with brain activity in the medial orbitofrontal cortex (mOFC) and negatively correlated with brain activity in the anterior insula (aINS). From a neuroscience perspective, the results of the present study show that specific brain regions, such as the mOFC and aINS, not only code the value or risk of a single choice option but also code the evidence in favor of the best option compared with other available choice options.

Expanding your gay and lesbian patient base: what savvy medical practices know.

PubMed

Kahn, Ellen; Sullivan, Tom

2008-01-01

Many medical practices are looking at options to reach out to the gay, lesbian, bisexual, and transgender community as a means of expanding business and improving quality of care. This article sets out steps that any practice can take to market to this community and improve its cultural competence.

Guidelines for project-level traffic forecasting for Hawaii Department of Transportation.

DOT National Transportation Integrated Search

2015-12-01

These guidelines describe both best practice and acceptable practice for performing project-level traffic : forecasts for the State of Hawaii. The guidelines describe a number of techniques and options that are all : acceptable within their intended ...

Hormone Therapy in Clinical Equine Practice.

PubMed

McCue, Patrick M

2016-12-01

A wide variety of hormone therapies are used in clinical practice in the reproductive management of horses. The goal of this article is to review therapeutic options for a variety of clinical indications. Copyright © 2016 Elsevier Inc. All rights reserved.

Practice Options and Decision Making for Dental Students.

ERIC Educational Resources Information Center

Manski, Richard J.

1987-01-01

One dental school implemented in its fourth-year curriculum an intensive simulation exercise to teach students the application of fundamental economic concepts such as capital costs, leasehold improvements, operating expenses, working capital, and financial risk in dental practice. (MSE)

Environmental and economic analyses of waste disposal options for traditional markets in Indonesia

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

Aye, Lu; Widjaya, E.R.

2006-07-01

Waste from traditional markets in Indonesia is the second largest stream of municipal solid waste after household waste. It has a higher organic fraction and may have greater potential to be managed on a business scale compared to household wastes. The attributed reason is that in general the wastes generated from traditional markets are more uniform, more concentrated and less hazardous than waste from other sources. This paper presents the results of environmental and economic assessments to compare the options available for traditional market waste disposal in Indonesia. The options compared were composting in labour intensive plants, composting in amore » centralised plant that utilised a simple wheel loader, centralised biogas production and landfill for electricity production. The current open dumping practice was included as the baseline case. A life cycle assessment (LCA) was used for environmental analysis. All options compared have lower environmental impacts than the current practice of open dumping. The biogas production option has the lowest environmental impacts. A cost-benefit analysis, which considered greenhouse gas savings, was used for the economic assessment. It was found that composting at a centralised plant is the most economically feasible option under the present Indonesian conditions. The approach reported in this study could be applied for 'a pre-feasibility first cut comparison' that includes environmental aspects in a decision-making framework for developing countries even though European emission factors were used.« less

Neurostimulation options for failed back surgery syndrome: The need for rational and objective measurements. Proposal of an international clinical network using an integrated database and health economic analysis: the PROBACK network.

PubMed

Rigoard, P; Slavin, K

2015-03-01

In the context of failed back surgery syndrome (FBSS) treatment, the current practice in neurostimulation varies from center-to-center and most clinical decisions are based on an individual diagnosis. Neurostimulation evaluation tools and pain relief assessment are of major concern, as they now constitute one of the main biases of clinical trials. Moreover, the proliferation of technological devices, in a fertile and unsatisfied market, fosters and only furthers the confusion. There are three options available to apply scientific debates to our daily neurostimulation practice: intentional ignorance, standardized evidence-based practice or alternative data mining approach. In view of the impossibility of conducting multiple randomized clinical trials comparing various devices, one by one, the proposed concept would be to redefine the indications and the respective roles of the various spinal cord and peripheral nerve stimulation devices with large-scale computational modeling/data mining approach, by conducting a multicenter prospective database registry, supported by a clinician's global network called "PROBACK". We chose to specifically analyze 6 parameters: device coverage performance/coverage selectivity/persistence of the long-term electrical response (technical criteria) and comparative mapping of patient pain relief/persistence of the long-term clinical response/safety and complications occurrence (clinical criteria). Two types of analysis will be performed: immediate analysis (including cost analysis) and computational analysis, i.e. demonstration of the robustness of certain correlations of variables, in order to extract response predictors. By creating an international prospective database, the purpose of the PROBACK project was to set up a process of extraction and comparative analysis of data derived from the selection, implantation and follow-up of FBSS patients candidates for implanted neurostimulation. This evaluation strategy should help to change the opinions of each implanter and each health system towards a more rational decision-making approach subtended by mathematical reality. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

Training in reproductive endocrinology and infertility and assisted reproductive technologies: options and worldwide needs.

PubMed

de Ziegler, Dominique; de Ziegler, Nathalie; Sean, Sokteang; Bajouh, Osama; Meldrum, David R

2015-07-01

Standardized, high-quality training in reproductive endocrinology, infertility, and assisted reproductive technologies (REI-ART) faces challenges owing to the high-tech nature of ART and the important country-to-country differences in clinical practice and regulations overseeing training. Moreover, while the training capacity of the classical by-fellowship training platforms is shrinking, an increasing demand for REI-ART specialists is coming from emerging countries. To meet this expanding need for REI-ART specialists, we propose a novel by-network model linking a reference training center to satellite practical training sites. Simulation should be used more extensively to achieve competency before initiating live clinical experience, analogous to the highly effective training systems that have been used in aviation for decades. Large ART databases that exist because of obligations to report ART activity and results constitute unique yet so far untapped sources for developing by-scenario simulation training models. Online training materials incorporating these state-of-the-art information technology tools could be developed as a means of fulfilling training needs worldwide. Copyright © 2015. Published by Elsevier Inc.

Cost-Effectiveness of Fecal Microbiota Transplantation in the Treatment of Recurrent Clostridium Difficile Infection: A Literature Review

PubMed Central

Arbel, Leor T; McNally, Keegan

2017-01-01

Clostridium difficile (C. difficile) is a common cause of antibiotic-­associated diarrhea (AAD), being responsible for 15­-25% of all AAD cases. The purpose of this literature review is to determine the cost-effectiveness of fecal microbiota transplantation (FMT) and how it compares in this regard to the standard treatments of choice for recurrent C. difficile infection (CDI). The review of the literature along with the evaluation of three comparative cost effective analyses yielded findings consistent with the view that FMT is the most cost-effective option in treating recurrent CDI. There are some (but considerably less) data indicating that FMT may be a cost effective strategy in treating initial CDI, as well. The superior cost-effectiveness of FMT as compared to the preferred standards of treatment for recurrent CDI suggest FMT use should become more integrated in routine clinical practice. Increased utilization of FMTs would allow for better control of this increasingly problematic disease as well as lower costs associated with its management. PMID:29067223

Mental health literacy: A cross-cultural study of American and Chinese bachelor of nursing students.

PubMed

Liu, W; Li, Y-M; Peng, Y

2018-03-01

WHAT IS KNOWN ON THE SUBJECT?: Many nursing students have inadequate preparation for practice in mental health nursing in the United States and China. The concept of mental illness has different connotations in different cultures. Studies differ from country to country concerning the influence of nursing education on students' knowledge about and attitudes towards mental disorders. There is a lack of cross-cultural research that takes a broad perspective to explore how nursing students' knowledge and beliefs about mental disorders are influenced by the culture within education and healthcare systems. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Nursing students in the United States and China shared similar views on a broad range of intervention options including professional help, psychotropic medications and activity interventions for managing depression and schizophrenia. The major difference between the two nursing student groups was that the Chinese students showed more preference to occasional alcohol consumption and specialized therapies including cognitive-behavioural therapy and electroconvulsive therapy and the US students held less skepticism towards traditional and religious practices as possible treatment options for depression and schizophrenia. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The Chinese nursing students need to be educated about safe alcohol consumption guidelines adopted by the National Health and Family Planning Commission. The US nursing students need to increase their awareness of national practice guidelines for managing mental disorders, particularly with respect to the use of specialized therapies such as cognitive-behavioural therapy and electroconvulsive therapy. We support professional and psychosocial interventions in caring for patients with mental disorders. INTRODUCTION Nursing students in the United States and China have reported inadequate preparedness for practice in mental health nursing. It is important to investigate nursing students' mental health literacy levels for a better understanding of their practice readiness in mental health field upon completion of their education. Aim This study was aimed at developing an understanding of American and Chinese nursing students' mental health literacy regarding the effectiveness of specific interventions for managing depression and schizophrenia. Method The "Australian National Mental Health Literacy Survey" was completed by a group of 310 nursing students including 152 Americans and 158 Chinese between April 2016 and April 2017 to compare students' rated intervention options on two provided vignettes. Results The two student groups reached consensus on many intervention options. However, the Chinese students showed more preference to occasional alcohol consumption and specialized therapies and the US students held less skepticism towards traditional practices as treatment options for depression and schizophrenia. Discussion and implications for practice The findings support professional and psychosocial interventions in caring for patients with mental disorders. There is a significant need for specific education on safe alcohol consumption guidelines for Chinese nursing students and clinical practice guidelines for managing mental disorders for American nursing students. © 2017 John Wiley & Sons Ltd.

Alternative skid trail retirement options for steep terrain logging

Treesearch

Mathew F. Smidt; Randall K. Kolka

2001-01-01

In winter 1999-2000 trials of deep tillage and recontouring of skid trails were implemented on three sites in northeastern Kentucky, USA to examine their potential as skid trail retirement options. While effective, current Best Management Practices (BMPs) for trail retirement do not address two potential benefits of retirement: recovery of normal hill slope hydrology...

Alternative skid trail retirement options for steep terrain logging

Treesearch

Mathew F. Smidt; Randall K. Kelka

2001-01-01

In winter 1999-2000 trials of deep tillage and recontouring of skid trails were implemented on three sites in northeastern Kentucky, USA to examine their potential as skid trail retirement options. While effective, current Best Management Practices (BMPs) for trail retirement do not address two potential benefits of retirement: recovery of normal hill slope\\r\\...

Identifying wood utilization options for ecosystem management : summary of a national research project

Treesearch

K. E. Skog; R. J. Barbour; J. E. Baumgras; A. Clark

1997-01-01

Using an ecosystem approach to forest management will change silvicultural practices, thus requiring utilization options to provide revenue and to help offset the costs of the silviculture treatments. The Forest Service, university cooperators, and several industry mills in the southern, western, and northeastern United States have been involved in a national...

Options in Education, Transcript for February 23, 1976: Conflict in Theory, Conflict in Research, and Conflict in Practice.

ERIC Educational Resources Information Center

George Washington Univ., Washington, DC. Inst. for Educational Leadership.

"Options in Education" is a radio news program which focuses on issues and developments in education. This transcript contains discussions of conflict in theory--education in America, difficulties in dramatizing today's racism, and children's relationships in a predominately black school; conflict in research--marijuana and sexual…

Toward Best Practices in Analyzing Datasets with Missing Data: Comparisons and Recommendations

ERIC Educational Resources Information Center

Johnson, David R.; Young, Rebekah

2011-01-01

Although several methods have been developed to allow for the analysis of data in the presence of missing values, no clear guide exists to help family researchers in choosing among the many options and procedures available. We delineate these options and examine the sensitivity of the findings in a regression model estimated in three random…

45 CFR 155.700 - Standards for the establishment of a SHOP.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 45 Public Welfare 1 2014-10-01 2014-10-01 false Standards for the establishment of a SHOP. 155.700... Exchange Functions: Small Business Health Options Program (SHOP) § 155.700 Standards for the establishment of a SHOP. (a) General requirement. An Exchange must provide for the establishment of a SHOP that...

48 CFR 53.105 - Computer generation.

Code of Federal Regulations, 2013 CFR

2013-10-01

... Data Interchange or a format that can be translated into one of those standards. (b) The standards listed in paragraph (a)(2) of this section may also be used for submission of data set forth in other..., content, or sequence of the data elements, and the form carries the Standard or Optional Form number and...

48 CFR 53.105 - Computer generation.

Code of Federal Regulations, 2012 CFR

2012-10-01

... Data Interchange or a format that can be translated into one of those standards. (b) The standards listed in paragraph (a)(2) of this section may also be used for submission of data set forth in other..., content, or sequence of the data elements, and the form carries the Standard or Optional Form number and...

48 CFR 53.105 - Computer generation.

Code of Federal Regulations, 2014 CFR

2014-10-01

... Data Interchange or a format that can be translated into one of those standards. (b) The standards listed in paragraph (a)(2) of this section may also be used for submission of data set forth in other..., content, or sequence of the data elements, and the form carries the Standard or Optional Form number and...

Acceptance Factors Influencing Adoption of National Institute of Standards and Technology Information Security Standards: A Quantitative Study

ERIC Educational Resources Information Center

Kiriakou, Charles M.

2012-01-01

Adoption of a comprehensive information security governance model and security controls is the best option organizations may have to protect their information assets and comply with regulatory requirements. Understanding acceptance factors of the National Institute of Standards and Technology (NIST) Risk Management Framework (RMF) comprehensive…

Performance Standards for Windows | Efficient Windows Collaborative

Science.gov Websites

Foundry Foundry New Construction Windows Window Selection Tool Selection Process Design Guidance Installation Replacement Windows Window Selection Tool Assessing Options Selection Process Design Guidance Installation Understanding Windows Benefits Design Considerations Measuring Performance Performance Standards

Learning relative values in the striatum induces violations of normative decision making

PubMed Central

Klein, Tilmann A.; Ullsperger, Markus; Jocham, Gerhard

2017-01-01

To decide optimally between available options, organisms need to learn the values associated with these options. Reinforcement learning models offer a powerful explanation of how these values are learnt from experience. However, human choices often violate normative principles. We suggest that seemingly counterintuitive decisions may arise as a natural consequence of the learning mechanisms deployed by humans. Here, using fMRI and a novel behavioural task, we show that, when suddenly switched to novel choice contexts, participants’ choices are incongruent with values learnt by standard learning algorithms. Instead, behaviour is compatible with the decisions of an agent learning how good an option is relative to an option with which it had previously been paired. Striatal activity exhibits the characteristics of a prediction error used to update such relative option values. Our data suggest that choices can be biased by a tendency to learn option values with reference to the available alternatives. PMID:28631734

SGLT2 inhibitors provide an effective therapeutic option for diabetes complicated with insulin antibodies.

PubMed

Hayashi, Akinori; Takano, Koji; Kawai, Sayuki; Shichiri, Masayoshi

2016-01-01

Diabetes mellitus complicated with insulin antibodies is rare in clinical practice but usually difficult to control. A high amount of insulin antibodies, especially with low affinity and high binding capacity, leads to unstable glycemic control characterized by hyperglycemia unresponsive to large volume of insulin and unanticipated hypoglycemia. There are several treatment options, such as changing insulin preparation, immunosupression with glucocorticoids, and plasmapheresis, most of which are of limited efficacy. Sodium-glucose cotransporter 2 (SGLT2) inhibitors are a novel class of drug which decrease renal glucose reabsorption and lowers plasma glucose level independent of insulin action. We report here a case with diabetes complicated with insulin antibodies who was effectively controlled by an SGLT2 inhibitor. A 47-year-old man with type 2 diabetes treated with insulin had very poor glycemic control characterized by postprandial hyperglycemia unresponsive to insulin therapy and repetitive hypoglycemia due to insulin antibodies. Treatment with ipragliflozin, an SGLT2 inhibitor, improved HbA1c from 8.4% to 6.0% and glycated albumin from 29.4% to 17.9%. Continuous glucose monitoring revealed improvement of glycemic profile (average glucose level from 212 mg/dL to 99 mg/dL and glycemic standard deviation from 92 mg/dL to 14 mg/dL) with disappearance of hypoglycemic events. This treatment further ameliorated the characteristics of insulin antibodies and resulted in reduced insulin requirement. SGLT2 inhibitors may offer an effective treatment option for managing the poor glycemic control in diabetes complicated with insulin antibodies.

The role of basal insulin and GLP-1 receptor agonist combination products in the management of type 2 diabetes

PubMed Central

Inman, Taylor R.; Plyushko, Erika; Austin, Nicholas P.; Johnson, Jeremy L.

2018-01-01

The prevalence of type 2 diabetes necessitates the development of new treatment options to individualize therapy. Basal insulin has been a standard treatment option for years, while glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have grown in use over the past decade due to glucose-lowering efficacy and weight loss potential. There are two new combination injectable products that have recently been approved combining basal insulins with GLP-1 RAs in single pen-injector devices. United States guidelines recently emphasize the option to use combination injectable therapy with GLP-1 RAs and basal insulin once the basal insulin has been optimally titrated as a second- or third-line agent in addition to metformin without reaching the goal A1c. Insulin glargine/lixisenatide 100/33 (IGlarLixi) can be dosed between 15 and 60 units once daily from a single pen-injector device. Insulin degludec/liraglutide 100/3.6 (IDegLira) can be dosed between 10 and 50 units once daily, also from a single pen-injector device. Maximum doses, while measured in units, correspond to limits defined by each individual GLP-1 RA. The dual use of basal insulin plus GLP-1 RA is non-inferior compared with basal insulin plus a single injection of prandial insulin at the largest meal and compared with twice daily-dosed premixed insulins; and this combination is associated with weight loss and less hypoglycemia. These new combination products could help providers effectively and efficiently follow clinical practice guidelines while enhancing patient adherence with injectable medications. PMID:29796245

Evaluation of transcranial surgical decompression of the optic canal as a treatment option for traumatic optic neuropathy.

PubMed

He, Zhenhua; Li, Qiang; Yuan, Jingmin; Zhang, Xinding; Gao, Ruiping; Han, Yanming; Yang, Wenzhen; Shi, Xuefeng; Lan, Zhengbo

2015-07-01

Traumatic optic neuropathy (TON) is a serious complication of head trauma, with the incidence rate ranging from 0.5% to 5%. The two treatment options widely practiced for TON are: (i) high-dose corticosteroid therapy and (ii) surgical decompression. However, till date, there is no consensus on the treatment protocol. This study aimed to evaluate the therapeutic efficacy of transcranial decompression of optic canal in TON patients. A total of 39 patients with visual loss resulting from TON between January 2005 and June 2013 were retrospectively reviewed for preoperative vision, preoperative image, visual evoked potential (VEP), surgical approach, postoperative visual acuity, complications, and follow-up results. All these patients underwent transcranial decompression of optic canal. During the three-month follow-up period, among the 39 patients, 21 showed an improvement in their eyesight, 6 recovered to standard logarithmic visual acuity chart "visible," 10 could count fingers, 2 could see hand movement, and 3 regained light sensation. Visual evoked potential could be used as an important preoperative and prognostic evaluation parameter for TON patients. Once TON was diagnosed, surgery is a promising therapeutic option, especially when a VEP wave is detected, irrespective of the HRCT scan findings. Operative time between trauma and operation is not necessary reference to assess the therapeutic effect of surgical decompression. The poor results of this procedure may be related to the severity of optic nerve injury. The patient's age is an important factor affecting the surgical outcomes. Copyright © 2015 Elsevier B.V. All rights reserved.

Development and pilot testing of a Decision Aid (DA) for women with early-stage breast cancer considering contralateral prophylactic mastectomy.

PubMed

Ager, B; Jansen, J; Porter, D; Phillips, K A; Glassey, R; Butow, P

2018-05-22

Describe the development, acceptability and feasibility of a Decision Aid (DA) for women with early-stage breast cancer (BC) at average contralateral breast cancer (CBC) risk considering contralateral prophylactic mastectomy (CPM). The DA was developed using the International Patient Decision Aid Standards (IPDAS) and the Ottawa Decision Support Framework. It provides evidence-based information about CPM in a booklet format combining text, graphs and images of surgical options. Twenty-three women with a history of early-stage breast cancer were interviewed in person or over the phone using a 'think aloud approach'. Framework analysis was used to code and analyse data. Twenty-three women participated in the study. Mean age of participants was 58.6 years and time since diagnosis ranged from 14 months to 21 years. Five women had CPM and eighteen had not. Women strongly endorsed the DA. Many felt validated by a section on appearance and found information on average risk of recurrence and metastases helpful, however, noted the importance of discussing personal risk with their surgeon. Many requested more information on surgery details (time taken, recovery) and costs of the different options. The DA was acceptable to women, including the format, content and proposed implementation strategies. Practical and financial issues are important to women in considering treatment options. Women appreciate information about CPM at diagnosis and emphasised the importance of discussing potential downsides of the procedure in addition to benefits. The DA was considered acceptable to facilitate such discussions. Copyright © 2018 Elsevier Ltd. All rights reserved.

The role of basal insulin and GLP-1 receptor agonist combination products in the management of type 2 diabetes.

PubMed

Inman, Taylor R; Plyushko, Erika; Austin, Nicholas P; Johnson, Jeremy L

2018-05-01

The prevalence of type 2 diabetes necessitates the development of new treatment options to individualize therapy. Basal insulin has been a standard treatment option for years, while glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have grown in use over the past decade due to glucose-lowering efficacy and weight loss potential. There are two new combination injectable products that have recently been approved combining basal insulins with GLP-1 RAs in single pen-injector devices. United States guidelines recently emphasize the option to use combination injectable therapy with GLP-1 RAs and basal insulin once the basal insulin has been optimally titrated as a second- or third-line agent in addition to metformin without reaching the goal A1c. Insulin glargine/lixisenatide 100/33 (IGlarLixi) can be dosed between 15 and 60 units once daily from a single pen-injector device. Insulin degludec/liraglutide 100/3.6 (IDegLira) can be dosed between 10 and 50 units once daily, also from a single pen-injector device. Maximum doses, while measured in units, correspond to limits defined by each individual GLP-1 RA. The dual use of basal insulin plus GLP-1 RA is non-inferior compared with basal insulin plus a single injection of prandial insulin at the largest meal and compared with twice daily-dosed premixed insulins; and this combination is associated with weight loss and less hypoglycemia. These new combination products could help providers effectively and efficiently follow clinical practice guidelines while enhancing patient adherence with injectable medications.

Chapter 29: Unproved and controversial methods and theories in allergy-immunology.

PubMed

Shah, Rachna; Greenberger, Paul A

2012-01-01

Unproved methods and controversial theories in the diagnosis and management of allergy-immunology are those that lack scientific credibility. Some definitions are provided for perspective because in chronic medical conditions, frequently, nonscientifically based treatments are developed that can have a very positive psychological effect on the patients in the absence of objective physical benefit. Standard practice can be described as "the methods of diagnosis and treatment used by reputable physicians in a particular subspecialty or primary care practice" with the understanding that diagnosis and treatment options are consistent with established mechanisms of conditions or diseases.(3) Conventional medicine (Western or allopathic medicine) is that which is practiced by the majority of MDs, DOs, psychologists, RNs, and physical therapists. Complementary medicine uses the practice of conventional medicine with complementary and alternative medicine such as using acupuncture for pain relief in addition to opioids. Alternative medicine implies use of complementary and alternative practices in place of conventional medicine. Unproved and controversial methods and theories do not have supporting data, validation, and sufficient scientific scrutiny, and they should not be used in the practice of allergy-immunology. Some examples of unproven theories about allergic immunologic conditions include allergic toxemia, idiopathic environmental intolerance, association with childhood vaccinations, and adrenal fatigue. Unconventional (unproved) diagnostic methods for allergic-immunologic conditions include cytotoxic tests, provocation-neutralization, electrodermal diagnosis, applied kinesiology assessments, and serum IgG or IgG(4) testing. Unproven treatments and intervention methods for allergic-immunologic conditions include acupuncture, homeopathy ("likes cure likes"), halotherapy, and autologous urine injections.