Eliminating Inappropriate Telemetry Monitoring: An Evidence-Based Implementation Guide.

PubMed

Yeow, Raymond Y; Strohbehn, Garth W; Kagan, Calvin M; Petrilli, Christopher M; Krishnan, Jamuna K; Edholm, Karli; Sussman, L Scott; Blanck, Jaime F; Popa, Remus I; Pahwa, Amit K

2018-06-04

In-hospital continuous electrocardiographic monitoring, commonly referred to as telemetry, has allowed for rapid recognition of life-threatening conditions, including complex arrhythmias and myocardial ischemia. However, inappropriate use can lead to unnecessary downstream testing from "false alarms," which in turn affects clinician efficiency and increases health care costs without benefiting patients. For these reasons, the Society of Hospital Medicine's Choosing Wisely campaign recommended use of a protocol-driven discontinuation of telemetry. The American Heart Association (AHA) developed a set of Practice Standards for the appropriate use of telemetry monitoring in 2004, which they updated in 2017. Unfortunately, the AHA Practice Standards have not been widely adopted-with as many as 43% of monitored patients lacking a recommended indication for monitoring. Thus, we created an overview discussing the safety and efficacy of incorporating the AHA Practice Standards and a review of studies highlighting their successful incorporation within patient care workflow. We conclude by outlining an "implementation blueprint" for health system professionals and administrators seeking to change their institution's culture of telemetry use. As the health care landscape continues to shift, enacting high-value initiatives that improve patient safety and efficiency of care will be critical.

Improving the development, monitoring and reporting of stroke rehabilitation research: Consensus-based core recommendations from the Stroke Recovery and Rehabilitation Roundtable.

PubMed

Walker, Marion F; Hoffmann, Tammy C; Brady, Marian C; Dean, Catherine M; Eng, Janice J; Farrin, Amanda J; Felix, Cynthia; Forster, Anne; Langhorne, Peter; Lynch, Elizabeth A; Radford, Kathryn A; Sunnerhagen, Katharina S; Watkins, Caroline L

2017-07-01

Recent reviews have demonstrated that the quality of stroke rehabilitation research has continued to improve over the last four decades but despite this progress, there are still many barriers in moving the field forward. Rigorous development, monitoring and complete reporting of interventions in stroke trials are essential in providing rehabilitation evidence that is robust, meaningful and implementable. An international partnership of stroke rehabilitation experts committed to develop consensus-based core recommendations with a remit of addressing the issues identified as limiting stroke rehabilitation research in the areas of developing, monitoring and reporting stroke rehabilitation interventions. Work exploring each of the three areas took place via multiple teleconferences and a two-day meeting in Philadelphia in May 2016. A total of 15 recommendations were made. To validate the need for the recommendations, the group reviewed all stroke rehabilitation trials published in 2015 (n = 182 papers). Our review highlighted that the majority of publications did not clearly describe how interventions were developed or monitored during the trial. In particular, under-reporting of the theoretical rationale for the intervention and the components of the intervention call into question many interventions that have been evaluated for efficacy. More trials were found to have addressed the reporting of interventions recommendations than those related to development or monitoring. Nonetheless, the majority of reporting recommendations were still not adequately described. To progress the field of stroke rehabilitation research and to ensure stroke patients receive optimal evidence-based clinical care, we urge the research community to endorse and adopt our recommendations.

Internal quality control indicators of cervical cytopathology exams performed in laboratories monitored by the External Quality Control Laboratory.

PubMed

Ázara, Cinara Zago Silveira; Manrique, Edna Joana Cláudio; Tavares, Suelene Brito do Nascimento; de Souza, Nadja Lindany Alves; Amaral, Rita Goreti

2014-09-01

To evaluate the impact of continued education provided by an external quality control laboratory on the indicators of internal quality control of cytopathology exams. The internal quality assurance indicators for cytopathology exams from 12 laboratories monitored by the External Quality Control Laboratory were evaluated. Overall, 185,194 exams were included, 98,133 of which referred to the period preceding implementation of a continued education program, while 87,061 referred to the period following this intervention. Data were obtained from the Cervical Cancer Database of the Brazilian National Health Service. Following implementation of the continued education program, the positivity index (PI) remained within recommended limits in four laboratories. In another four laboratories, the PI progressed from below the limits to within the recommended standards. In one laboratory, the PI remained low, in two laboratories, it remained very low, and in one, it increased from very low to low. The percentage of exams compatible with a high-grade squamous intraepithelial lesion (HSIL) remained within the recommended limits in five laboratories, while in three laboratories it progressed from below the recommended levels to >0.4% of the total number of satisfactory exams, and in four laboratories it remained below the standard limit. Both the percentage of atypical squamous cells of undetermined significance (ASC-US) in relation to abnormal exams, and the ratio between ASC-US and intraepithelial lesions remained within recommended levels in all the laboratories investigated. An improvement was found in the indicators represented by the positivity index and the percentage of exams compatible with a high-grade squamous intraepithelial lesion, showing that the role played by the external quality control laboratory in providing continued education contributed towards improving laboratory staff skills in detecting cervical cancer precursor lesions.

Continuing oversight through site monitoring: experiences of an institutional ethics committee in an Indian tertiary-care hospital.

PubMed

Shetty, Yashashri C; Marathe, Padmaja; Kamat, Sandhya; Thatte, Urmila

2012-01-01

WHO-TDR and the Indian Council of Medical Research recommend site visits by institutional ethics committees (IECs) for continued oversight, to ensure the ethical conduct of research. Our IEC conducted seven site visits in 2008-2009 using a standardised format to monitor adherence to protocol and the informed consent process. The study identified issues related to informed consent (6/7), deviation from protocol (5/7), reporting of study progress to the IEC (3/7), recruiting additional participants without IEC approval (2/7), reporting of serious adverse events (1/7), investigator's lack of awareness of protocol and the informed consent document (2/7) and other findings. Investigators were informed about the findings and were asked to submit an explanation. The IEC issued warnings about not repeating such lapses in the future (5/7), restricted enrollment of new participants (2/7), recommended continued good clinical practice training to the study team (4/7), advised the recruitment of additional study coordinators (2/7), and requested the submission of adverse event reports (2/7) or sponsors' audit reports (2/7). Our study showed that the ethical conduct of studies can be ensured by conducting routine site monitoring.

Nutrition recommendations and the Children's Food and Beverage Advertising Initiative's 2014 approved food and beverage product list.

PubMed

Schermbeck, Rebecca M; Powell, Lisa M

2015-04-23

We compare the Children's Food and Beverage Advertising Initiative's (CFBAI's) April 2014 list of food and beverage products approved to be advertised on children's television programs with the federal Interagency Working Group's nutrition recommendations for such advertised products. Products were assessed by using the nutrients to limit (saturated fat, trans fat, sugar, and sodium) component of the Interagency Working Group's recommendations. Fifty-three percent of the listed products did not meet the nutrition recommendations and, therefore, were ineligible to be advertised. We recommend continued monitoring of food and beverage products marketed to children.

40 CFR 62.14690 - What monitoring equipment must I install and what parameters must I monitor?

Code of Federal Regulations, 2010 CFR

2010-07-01

... subpart, you must install, calibrate, maintain, and continuously operate a bag leak detection system as... detection system for each exhaust stack of the fabric filter. (2) Each bag leak detection system must be... specifications and recommendations. (3) The bag leak detection system must be certified by the manufacturer to be...

Preventing extravasation injuries in neonates.

PubMed

Tong, Rachael

2007-10-01

Sick and preterm neonates are particularly vulnerable to extravasation injury but many of these injuries could be prevented if a 'hyper-vigilant' approach to monitoring of the intravenous access is adopted. A number of barriers exist that may prevent rigorous and continuous monitoring of intravenous access sites in neonatal units. Several themes were identified in the literature as supporting quality nursing practice in this area, including: staffing and skill mix, preceptorship of newly qualified staff, continuing professional development, record keeping and communication. These themes are explored and recommendations made to help reduce the incidence of extravasation injury.

Three decades of the WHO code and marketing of infant formulas.

PubMed

Forsyth, Stewart

2012-05-01

The International Code of Marketing of Breast Milk Substitutes states that governments, non-governmental organizations, experts, consumers and industry need to cooperate in activities aimed at improving infant nutrition. However, the evidence from the last three decades is that of a series of disputes, legal proceedings and boycotts. The purpose of this review is to assess the overall progress in the implementation of the Code and to examine the problematic areas of monitoring, compliance and governance. There are continuing issues of implementation, monitoring and compliance which predominantly reflect weak governance. Many Member States have yet to fully implement the Code recommendations and most States do not have adequate monitoring and reporting mechanisms. Application of the Code in developed countries may be undermined by a lack of consensus on the WHO recommendation of 6 months exclusive breastfeeding. There is evidence of continuing conflict and acrimony, especially between non-government organizations and industry. Measures need to be taken to encourage the Member States to implement the Code and to establish the governance systems that will not only ensure effective implementation and monitoring of the Code, but also deliver the Code within a spirit of participation, collaboration and trust.

Adherence to guidelines for creatinine and potassium monitoring and discontinuation following renin–angiotensin system blockade: a UK general practice-based cohort study

PubMed Central

Schmidt, Morten; Bhaskaran, Krishnan; Nitsch, Dorothea; Sørensen, Henrik Toft; Smeeth, Liam; Tomlinson, Laurie A

2017-01-01

Objectives To examine adherence to serum creatinine and potassium monitoring and discontinuation guidelines following initiation of treatment with ACE inhibitors (ACEI) or angiotensin receptor blockers (ARBs); and whether high-risk patients are monitored. Design A general practice-based cohort study using electronic health records from the UK Clinical Practice Research Datalink and Hospital Episode Statistics. Setting UK primary care, 2004–2014. Subjects 223 814 new ACEI/ARB users. Main outcome measures Proportion of patients with renal function monitoring before and after ACEI/ARB initiation; creatinine increase ≥30% or potassium levels >6 mmol/L at first follow-up monitoring; and treatment discontinuation after such changes. Using logistic regression models, we also examined patient characteristics associated with these biochemical changes, and with follow-up monitoring within the guideline recommendation of 2 weeks after treatment initiation. Results 10% of patients had neither baseline nor follow-up monitoring of creatinine within 12 months before and 2 months after initiation of an ACEI/ARB, 28% had monitoring only at baseline, 15% only at follow-up, and 47% both at baseline and follow-up. The median period between the most recent baseline monitoring and drug initiation was 40 days (IQR 12–125 days). 34% of patients had baseline creatinine monitoring within 1 month before initiating therapy, but <10% also had the guideline-recommended follow-up test recorded within 2 weeks. Among patients experiencing a creatinine increase ≥30% (n=567, 1.2%) or potassium level >6 mmol/L (n=191, 0.4%), 80% continued treatment. Although patients with prior myocardial infarction, hypertension or baseline potassium >5 mmol/L were at high risk of ≥30% increase in creatinine after ACEI/ARB initiation, there was no evidence that they were more frequently monitored. Conclusions Only one-tenth of patients initiating ACEI/ARB therapy receive the guideline-recommended creatinine monitoring. Moreover, the vast majority of the patients fulfilling postinitiation discontinuation criteria for creatinine and potassium increases continue on treatment. PMID:28069618

Recommendations for data monitoring committees from the Clinical Trials Transformation Initiative.

PubMed

Calis, Karim A; Archdeacon, Patrick; Bain, Raymond; DeMets, David; Donohue, Miriam; Elzarrad, M Khair; Forrest, Annemarie; McEachern, John; Pencina, Michael J; Perlmutter, Jane; Lewis, Roger J

2017-08-01

Background/aims Use of data monitoring committees to oversee clinical trials was first proposed nearly 50 years ago. Since then, data monitoring committee use in clinical trials has increased and evolved. Nonetheless, there are no well-defined criteria for determining the need for a data monitoring committee, and considerable variability exists in data monitoring committee composition and conduct. To understand and describe the role and function of data monitoring committees, and establish best practices for data monitoring committee trial oversight, the Clinical Trials Transformation Initiative-a public-private partnership to improve clinical trials-launched a multi-stakeholder project. Methods The data monitoring committee project team included 16 individuals charged with (1) clarifying the purpose of data monitoring committees, (2) identifying best practices for independent data monitoring committee conduct, (3) describing effective communication practices, and (4) developing strategies for training data monitoring committee members. Evidence gathering included a survey, a series of focus group discussions, and a 2-day expert meeting aimed at achieving consensus opinions that form the foundation of our data monitoring committee recommendations. Results We define the role of the data monitoring committee as an advisor to the research sponsor on whether to continue, modify, or terminate a trial based on periodic assessment of trial data. Data monitoring committees should remain independent from the sponsor and be composed of members with no relevant conflicts of interest. Representation on a data monitoring committee generally should include at least one clinician with expertise in the therapeutic area being studied, a biostatistician, and a designated chairperson who has experience with clinical trials and data monitoring. Data monitoring committee meetings are held periodically to evaluate the unmasked data from ongoing trials, but the content and conduct of meetings may vary depending on specific goals or topics for deliberation. To guide data monitoring committee conduct and communication plans, a charter consistent with the protocol's research design and statistical analysis plan should be developed and agreed upon by the sponsor and the data monitoring committee prior to patient enrollment. We recommend concise and flexible charters that explain roles, responsibilities, operational issues, and how data monitoring committee recommendations are generated and communicated. The demand for data monitoring committee members appears to exceed the current pool of qualified individuals. To prepare a new generation of trained data monitoring committee members, we encourage a combination of didactic educational programs, practical experience, and skill development through apprenticeships and mentoring by experienced data monitoring committee members. Conclusion Our recommendations address data monitoring committee use, conduct, communication practices, and member preparation and training. Furthermore recommendations form the foundation for ongoing efforts to improve clinical trial oversight and enhance the safety and integrity of clinical research. These recommendations serve as a call to action for implementation of best practices that benefit study participants, study sponsors, and society.

Update to Practice Standards for Electrocardiographic Monitoring in Hospital Settings: A Scientific Statement From the American Heart Association.

PubMed

Sandau, Kristin E; Funk, Marjorie; Auerbach, Andrew; Barsness, Gregory W; Blum, Kay; Cvach, Maria; Lampert, Rachel; May, Jeanine L; McDaniel, George M; Perez, Marco V; Sendelbach, Sue; Sommargren, Claire E; Wang, Paul J

2017-11-07

This scientific statement provides an interprofessional, comprehensive review of evidence and recommendations for indications, duration, and implementation of continuous electro cardiographic monitoring of hospitalized patients. Since the original practice standards were published in 2004, new issues have emerged that need to be addressed: overuse of arrhythmia monitoring among a variety of patient populations, appropriate use of ischemia and QT-interval monitoring among select populations, alarm management, and documentation in electronic health records. Authors were commissioned by the American Heart Association and included experts from general cardiology, electrophysiology (adult and pediatric), and interventional cardiology, as well as a hospitalist and experts in alarm management. Strict adherence to the American Heart Association conflict of interest policy was maintained throughout the consensus process. Authors were assigned topics relevant to their areas of expertise, reviewed the literature with an emphasis on publications since the prior practice standards, and drafted recommendations on indications and duration for electrocardiographic monitoring in accordance with the American Heart Association Level of Evidence grading algorithm that was in place at the time of commissioning. The comprehensive document is grouped into 5 sections: (1) Overview of Arrhythmia, Ischemia, and QTc Monitoring; (2) Recommendations for Indication and Duration of Electrocardiographic Monitoring presented by patient population; (3) Organizational Aspects: Alarm Management, Education of Staff, and Documentation; (4) Implementation of Practice Standards; and (5) Call for Research. Many of the recommendations are based on limited data, so authors conclude with specific questions for further research. © 2017 American Heart Association, Inc.

Experiences and recommendations in deploying a real-time, water quality monitoring system

NASA Astrophysics Data System (ADS)

O'Flynn, B.; Regan, F.; Lawlor, A.; Wallace, J.; Torres, J.; O'Mathuna, C.

2010-12-01

Monitoring of water quality at a river basin level to meet the requirements of the Water Framework Directive (WFD) using conventional sampling and laboratory-based techniques poses a significant financial burden. Wireless sensing systems offer the potential to reduce these costs considerably, as well as provide more useful, continuous monitoring capabilities by giving an accurate idea of the changing environmental and water quality in real time. It is unlikely that the traditional spot/grab sampling will provide a reasonable estimate of the true maximum and/or mean concentration for a particular physicochemical variable in a water body with marked temporal variability. When persistent fluctuations occur, it is likely only to be detected through continuous measurements, which have the capability of detecting sporadic peaks of concentration. Thus, in situ sensors capable of continuous sampling of parameters required under the WFD would therefore provide more up-to-date information, cut monitoring costs and provide better coverage representing long-term trends in fluctuations of pollutant concentrations. DEPLOY is a technology demonstration project, which began planning and station selection and design in August 2008 aiming to show how state-of-the-art technology could be implemented for cost-effective, continuous and real-time monitoring of a river catchment. The DEPLOY project is seen as an important building block in the realization of a wide area autonomous network of sensors capable of monitoring the spatial and temporal distribution of important water quality and environmental target parameters. The demonstration sites chosen are based in the River Lee, which flows through Ireland's second largest city, Cork, and were designed to include monitoring stations in five zones considered typical of significant river systems--these monitor water quality parameters such as pH, temperature, depth, conductivity, turbidity and dissolved oxygen. Over one million data points have been collected since the multi-sensor system was deployed in May 2009. Extreme meteorological events have occurred during the period of deployment and the collection of real-time water quality data as well as the knowledge, experience and recommendations for future deployments are discussed.

Nutrition Recommendations and the Children’s Food and Beverage Advertising Initiative’s 2014 Approved Food and Beverage Product List

PubMed Central

Powell, Lisa M.

2015-01-01

We compare the Children’s Food and Beverage Advertising Initiative’s (CFBAI’s) April 2014 list of food and beverage products approved to be advertised on children’s television programs with the federal Interagency Working Group’s nutrition recommendations for such advertised products. Products were assessed by using the nutrients to limit (saturated fat, trans fat, sugar, and sodium) component of the Interagency Working Group’s recommendations. Fifty-three percent of the listed products did not meet the nutrition recommendations and, therefore, were ineligible to be advertised. We recommend continued monitoring of food and beverage products marketed to children. PMID:25906434

Web-based credential monitoring instantly flags health professionals with fraudulent licenses or criminal backgrounds.

PubMed

Haddad, Matthew

2009-01-01

An alarming number of practicing medical professionals and healthcare staffers across the nation may have criminal backgrounds, jeopardizing the health of hundreds of millions of patients and compromising the integrity of healthcare in this country. An investigation conducted by The Los Angeles Times found that an extraordinary number of nurses in California with criminal backgrounds had been allowed to continue working in healthcare facilities for years--their crimes virtually swept under the rug. This article suggests that continuous monitoring of healthcare credentials can mitigate the potential harm posed by credentialing fraud, recommending 24/7 monitoring in real-time as opposed to once every year or two as is the current practice. This would include verification of provider licenses, Drug Enforcement Administration certification, Office of Inspector General status, and criminal offenses. Automatic and continuous monitoring of licenses and other databases for changes and lapses, and reports on issues that are uncovered, help to prevent harmful acts on the part of healthcare providers with questionable backgrounds.

Solar wind and magnetosphere interactions

NASA Technical Reports Server (NTRS)

Russell, C. T.; Allen, J. H.; Cauffman, D. P.; Feynman, J.; Greenstadt, E. W.; Holzer, R. E.; Kaye, S. M.; Slavin, J. A.; Manka, R. H.; Rostoker, G.

1979-01-01

The relationship between the magnetosphere and the solar wind is addressed. It is noted that this interface determines how much of the solar plasma and field energy is transferred to the Earth's environment, and that this coupling not only varies in time, responding to major solar disturbances, but also to small changes in solar wind conditions and interplanetary field directions. It is recommended that the conditions of the solar wind and interplanetary medium be continuously monitored, as well as the state of the magnetosphere. Other recommendations include further study of the geomagnetic tail, tests of Pc 3,4 magnetic pulsations as diagnostics of the solar wind, and tests of kilometric radiation as a remote monitor of the auroral electrojet.

Less or more hemodynamic monitoring in critically ill patients.

PubMed

Jozwiak, Mathieu; Monnet, Xavier; Teboul, Jean-Louis

2018-06-07

Hemodynamic investigations are required in patients with shock to identify the type of shock, to select the most appropriate treatments and to assess the patient's response to the selected therapy. We discuss how to select the most appropriate hemodynamic monitoring techniques in patients with shock as well as the future of hemodynamic monitoring. Over the last decades, the hemodynamic monitoring techniques have evolved from intermittent toward continuous and real-time measurements and from invasive toward less-invasive approaches. In patients with shock, current guidelines recommend the echocardiography as the preferred modality for the initial hemodynamic evaluation. In patients with shock nonresponsive to initial therapy and/or in the most complex patients, it is recommended to monitor the cardiac output and to use advanced hemodynamic monitoring techniques. They also provide other useful variables that are useful for managing the most complex cases. Uncalibrated and noninvasive cardiac output monitors are not reliable enough in the intensive care setting. The use of echocardiography should be initially encouraged in patients with shock to identify the type of shock and to select the most appropriate therapy. The use of more invasive hemodynamic monitoring techniques should be discussed on an individualized basis.

Adherence to guidelines for creatinine and potassium monitoring and discontinuation following renin-angiotensin system blockade: a UK general practice-based cohort study.

PubMed

Schmidt, Morten; Mansfield, Kathryn E; Bhaskaran, Krishnan; Nitsch, Dorothea; Sørensen, Henrik Toft; Smeeth, Liam; Tomlinson, Laurie A

2017-01-09

To examine adherence to serum creatinine and potassium monitoring and discontinuation guidelines following initiation of treatment with ACE inhibitors (ACEI) or angiotensin receptor blockers (ARBs); and whether high-risk patients are monitored. A general practice-based cohort study using electronic health records from the UK Clinical Practice Research Datalink and Hospital Episode Statistics. UK primary care, 2004-2014. 223 814 new ACEI/ARB users. Proportion of patients with renal function monitoring before and after ACEI/ARB initiation; creatinine increase ≥30% or potassium levels >6 mmol/L at first follow-up monitoring; and treatment discontinuation after such changes. Using logistic regression models, we also examined patient characteristics associated with these biochemical changes, and with follow-up monitoring within the guideline recommendation of 2 weeks after treatment initiation. 10% of patients had neither baseline nor follow-up monitoring of creatinine within 12 months before and 2 months after initiation of an ACEI/ARB, 28% had monitoring only at baseline, 15% only at follow-up, and 47% both at baseline and follow-up. The median period between the most recent baseline monitoring and drug initiation was 40 days (IQR 12-125 days). 34% of patients had baseline creatinine monitoring within 1 month before initiating therapy, but <10% also had the guideline-recommended follow-up test recorded within 2 weeks. Among patients experiencing a creatinine increase ≥30% (n=567, 1.2%) or potassium level >6 mmol/L (n=191, 0.4%), 80% continued treatment. Although patients with prior myocardial infarction, hypertension or baseline potassium >5 mmol/L were at high risk of ≥30% increase in creatinine after ACEI/ARB initiation, there was no evidence that they were more frequently monitored. Only one-tenth of patients initiating ACEI/ARB therapy receive the guideline-recommended creatinine monitoring. Moreover, the vast majority of the patients fulfilling postinitiation discontinuation criteria for creatinine and potassium increases continue on treatment. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

DOD and VA Health Care: Actions Needed to Help Ensure Appropriate Medication Continuation and Prescribing Practices

DTIC Science & Technology

2016-01-01

and Polytrauma System of Care at the Richmond, Virginia VA Medical Center (VAMC). We interviewed pharmacists , psychiatrists, and other providers who...2We interviewed pharmacists about recommended medication practices and related monitoring because pharmacists are responsible for...differences may have affected medication continuation.6 We also obtained the perspectives of providers and pharmacists from our selected VAMCs and Army MTFs

78 FR 65322 - Proposed Data Collections Submitted for Public Comment and Recommendations

Federal Register 2010, 2011, 2012, 2013, 2014

2013-10-31

... days of this notice. Proposed Project Clostridium difficile Infection (CDI) Surveillance (0920-0892... rate and severity of Clostridium difficile infection (CDI) indicate a clear need to conduct longitudinal assessments to continue to monitor changes in CDI epidemiology, including changes in risk factors...

Coordinated bird monitoring: Technical recommendations for military lands

USGS Publications Warehouse

Bart, Jonathan; Manning, Ann; Fischer, Richard; Eberly, Chris

2012-01-01

The Department of Defense (DoD) is subject to several rules and regulations establishing responsibilities for monitoring migratory birds. The Sikes Act requires all military installations with significant natural resources to prepare and implement Integrated Natural Resources Management Plans (INRMPs). These plans guide the conservation and long-term management of natural resources on military lands in a manner that is compatible with and sustains the military mission. An INRMP also supports compliance with all legal requirements and guides the military in fulfilling its obligation to be a good steward of public land.The management and conservation of migratory birds is addressed in installation INRMPs. The National Environmental Policy Act (NEPA) requires federal agencies to evaluate and disclose the potential environmental impacts of their proposed actions. More recently, DoD signed an MOU (http://www.dodpif.org/downloads/EO13186_MOU-DoD.pdf) for migratory birds, under Executive Order 13186, with the US Fish and Wildlife Service (USFWS) in July 2006 and a Migratory Bird Rule (http://www.dodpif.org/downloads/MigBirdFINALRule_FRFeb2007.pdf) was passed by Congress in February 2007. The Migratory Bird Rule addresses the potential impacts of military readiness activities on populations of migratory birds and establishes a process to implement conservation measures if and when a military readiness activity is expected to have a significant adverse impact on a population of migratory bird species (as determined through the NEPA process). The MOU states that for nonmilitary readiness activities, prior to initiating any activity likely to affect populations of migratory birds DoD shall (1) identify the migratory bird species likely to occur in the area of the proposed action and determine if any species of concern could be affected by the activity, and (2) assess and document, using NEPA when applicable, the effect of the proposed action on species of concern. By following these procedures, DoD will minimize the possibility for a proposed action to unintentionally take migratory birds at a level that would violate any of the migratory bird treaties and potentially impact mission activities. In addition, implementing conservation and monitoring programs for migratory birds supports the ecosystem integrity necessary to sustain DoD's natural resources for the military mission.Non-compliance with the procedural requirements of the MBTA could result in a private party lawsuit under the Administrative Procedures Act (APA). A lawsuit filed under APA involving a Navy bombing range is the basis for a court ruling that unintentional take of migratory birds applies to federal actions. Ensuring the necessary data is available to adequately assess impacts of a proposed action will help avoid lawsuits or help ensure such lawsuits have no grounds. The data gathered in a bird monitoring program will provide the best scientific data available to assess the expected impacts of a proposed action on migratory bird species through the NEPA process. This report presents recommendations developed by the U.S. Geological Survey (USGS) for the Department of Defense (DoD) on establishing a "Coordinated Bird Monitoring (CBM) Plan." The CBM Plan is intended to ensure that DoD meets its conservation and regulatory responsibilities for monitoring birds (Chapter 1). The report relies heavily on recommendations in the report, "Opportunities for improving avian monitoring" (http://www.nabci-us.org/aboutnabci/monitoringreportfinal0307.pdf), by the U.S. North American Bird Conservation Initiative (U.S. NABCI Monitoring Subcommittee, 2007) and on a review of 358 current DoD bird monitoring programs carried out as part of this project (Chapter 2). This report contains 12 recommendations which, if followed, would result in a comprehensive, efficient, and useful approach to bird monitoring. The recommendations are based on the entire report but are presented together at the end of Chapter 1. DoD has agreed to consider implementing these recommendations; however, final decisions will be based upon such factors as the availability of resources and military mission considerations. These recommendations from USGS can be summarized into 6 major themes: A major report on monitoring was released in 2007 by the U.S. North American Bird Conservation Initiative (http://www.nabci-us.org/main2.html). DoD can be consistent with this report by establishing policy that monitoring will be explicitly acknowledged as an integral element of bird management and conservation (Recommendation 1). The design of monitoring and assessment programs for birds should include the following steps: Preparation of a document describing the program's goals, objectives, and methods similar to a format we provide (Recommendation 2, Chapter 4). Selection of field methods using an "expert system" developed in this project (Recommendation 3, Chapter 5) or another well-documented system. Preparation and storage of metadata describing the monitoring program in the Natural Resources Monitoring Partnership (NRMP), and other appropriate databases Recommendation 4, Chapter 6). Entry of the survey data using eBird (http://ebird.org/content/dod) or the Coordinated Bird Monitoring Database (CBMD) and long-term storage of the data in the CBMD and the Avian Knowledge Network (AKN; Recommendation 5, Chapter 6; http://www.avianknowledge.net/). Submission of major results from the monitoring program for publication in a peer reviewed journal (Recommendation 6). The DoD Legacy Resource Management Program (Legacy; https://www.dodlegacy.org), Environmental Security Technology Certification Program (ESTCP; http://www.serdp.org/), and Strategic Environmental Research and Development Program (SERDP; http://www.serdp.org/) should be encouraged to continue their significant contributions to the foundations of bird monitoring (Recommendation 7, Chapters 1 and 3). Appropriate monitoring should be conducted to identify species of concern on installations. A year-round, one-time survey of birds on installations with habitat for migratory birds would provide the most information to assist compliance with the MOU, the Final Rule, and the NEPA analyses of proposed actions. However, less intensive survey efforts can still be conducted to yield useful information. We describe how various levels of survey effort might be organized and conducted. In addition, continuing surveys, as feasible, would further assist in documenting effects of military readiness and non-readiness activities on species of concern (SOC) (Recommendation 8, Chapter 7). Participation in well-designed, large-scale surveys [(e.g., North American Breeding Bird Survey (BBS; http://www.pwrc.usgs.gov/bbs/), Monitoring Avian Productivity and Survivorship (MAPS; http://www.birdpop.org/maps.htm)] on land that DoD manages or on lands where the results will be of high interest to DoD, will provide DoD and other NABCI members with information important to bird conservation (Recommendation 9, Chapter 8). Review and implementation of the CBM Plan should involve both higher level management and installation-level natural resources managers (Recommendation 11), be implemented through cooperative partnerships (Recommendation 12), and be followed on U.S territory lands and Army Corps of Engineers projects (Recommendation 10).Additional recommendations that pertain to implementing the DoD CBM Plan are discussed in Chapter 9.

[Current status and recommendations on the use of continuous blood glucose monitoring systems in children and adolescents with type 1 diabetes mellitus].

PubMed

Torres Lacruz, M; Barrio Castellanos, R; García Cuartero, B; Gómez Gila, A; González Casado, I; Hermoso López, F; Luzuriaga Tomás, C; Oyarzabal Irigoyen, M; Rica Etxebarria, I; Rodríguez Rigual, M

2011-08-01

Glucose monitoring methods have made great advances in the last decade with the appearance of the continuous glucose monitoring systems (CGMS) that measure the glucose levels in the interstitial liquid, providing information about glucose patterns and trends, but do not replace the self-monitoring of capillary glucose. Improvement in diabetes control using the CGMS depends on the motivation and training received by the patient and family and on the continuity in its use. Due to the development and widespread use of these systems in clinical practice, the diabetes group of the Sociedad Española de Endocrinología Pediátrica has drafted a document of consensus for their indication and use in children and adolescents. Only a limited number of trials have been performed in children and adolescent populations. More data are needed on the use of this technology in order to define the impact on metabolic control. Copyright © 2010 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.

Quarterly report on Defense Nuclear Facilities Safety Board Recommendation 90-7 for the period ending December 31, 1992

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

Cash, R.J.; Dukelow, G.T.; Forbes, C.J.

1993-03-01

This is the seventh quarterly report on the progress of activities addressing safety issues associated with Hanford Site high-level radioactive waste tanks that contain ferrocyanide compounds. In the presence of oxidizing materials, such as nitrates or nitrites, ferrocyanide can be made to explode in the laboratory by heating it to high temperatures [above 285{degrees}C (545{degrees}F)]. In the mid 1950s approximately 140 metric tons of ferrocyanide were added to 24 underground high-level radioactive waste tanks. An implementation plan (Cash 1991) responding to the Defense Nuclear Facilities Safety Board Recommendation 90-7 (FR 1990) was issued in March 1991 describing the activities thatmore » were planned and underway to address each of the six parts of Recommendation 90-7. A revision to the original plan was transmitted to US Department of Energy by Westinghouse Hanford Company in December 1992. Milestones completed this quarter are described in this report. Contents of this report include: Introduction; Defense Nuclear Facilities Safety Board Implementation Plan Task Activities (Defense Nuclear Facilities Safety Board Recommendation for enhanced temperature measurement, Recommendation for continuous temperature monitoring, Recommendation for cover gas monitoring, Recommendation for ferrocyanide waste characterization, Recommendation for chemical reaction studies, and Recommendation for emergency response planning); Schedules; and References. All actions recommended by the Defense Nuclear Facilities Safety Board for emergency planning by Hanford Site emergency preparedness organizations have been completed.« less

Recommendations on the choice of gas analysis equipment for systems of continuous monitoring and accounting of emissions from thermal power plants

NASA Astrophysics Data System (ADS)

Kondrat'eva, O. E.; Roslyakov, P. V.; Burdyukov, D. A.; Khudolei, O. D.; Loktionov, O. A.

2017-10-01

According to Federal Law no. 219-FZ, dated July 21, 2014, all enterprises that have a significant negative impact on the environment shall continuously monitor and account emissions of harmful substances into the atmospheric air. The choice of measuring equipment that is included in continuous emission monitoring and accounting systems (CEM&ASs) is a complex technical problem; in particular, its solution requires a comparative analysis of gas analysis systems; each of these systems has its advantages and disadvantages. In addition, the choice of gas analysis systems for CEM&ASs should be maximally objective and not depend on preferences of separate experts and specialists. The technique of choosing gas analysis equipment that was developed in previous years at Moscow Power Engineering Institute (MPEI) has been analyzed and the applicability of the mathematical tool of a multiple criteria analysis to choose measuring equipment for the continuous emission monitoring and accounting system have been estimated. New approaches to the optimal choice of gas analysis equipment for systems of the continuous monitoring and accounting of harmful emissions from thermal power plants have been proposed, new criteria of evaluation of gas analysis systems have been introduced, and weight coefficients have been determined for these criteria. The results of this study served as a basis for the Preliminary National Standard of the Russian Federation "Best Available Technologies. Automated Systems of Continuous Monitoring and Accounting of Emissions of Harmful (Polluting) Substances from Thermal Power Plants into the Atmospheric Air. Basic Requirements," which was developed by the Moscow Power Engineering Institute, National Research University, in cooperation with the Council of Power Producers and Strategic Electric Power Investors Association and the All-Russia Research Institute for Materials and Technology Standardization.

The strategy for improving water-quality monitoring in the United States; final report of the Intergovernmental Task Force on Monitoring Water Quality; technical appendices

USGS Publications Warehouse

,

1995-01-01

The Intergovernmental Task Force on Monitoring Water Quality (ITFM) prepared this report in collaboration with representatives of all levels of government and the private sector. The report recommends a strategy for nationwide water-quality monitoring and technical monitoring improvements to support sound water-quality decisionmaking. The strategy is intended to achieve a better return on public and private investments in monitoring, environmental protection, and natural resources management. It is also designed to expand the base of information useful to a variety of users at multiple geographic scales. Institutional and technical changes are needed to improve water-quality monitoring and to meet the full range of monitoring requirements. Monitoring must be incorporated as a critical element of program planning, implementation, and evaluation. The strategy includes recommendations in many key elements, such as the development of goal-oriented monitoring and indicators, institutional collaboration, and methods comparability. Initial actions have been taken to implement the strategy. Several Federal agencies have jointly purchased and shared remotely sensed land-cover information needed for water assessment. Major agency data systems are using common data-element names and reference tables that will ensure easy sharing of data. A number of States have held meetings with collectors of water information to initiate statewide monitoring strategies. New monitoring guidance has been developed for Federal water-quality grants to States. Many State offices have changed monitoring programs to place emphasis on priority watersheds and to improve assessment of water quality. As the competition increases for adequate supplies of clean water, concerns about public health and the environment escalate, and more demands are placed on the water information infrastructure. To meet these demands, the collaborative approach has already produced benefits, which will continue to grow as the recommendations are implemented

Clinical Practice Guidelines for Sustained Neuromuscular Blockade in the Adult Critically Ill Patient.

PubMed

Murray, Michael J; DeBlock, Heidi; Erstad, Brian; Gray, Anthony; Jacobi, Judi; Jordan, Che; McGee, William; McManus, Claire; Meade, Maureen; Nix, Sean; Patterson, Andrew; Sands, M Karen; Pino, Richard; Tescher, Ann; Arbour, Richard; Rochwerg, Bram; Murray, Catherine Friederich; Mehta, Sangeeta

2016-11-01

To update the 2002 version of "Clinical practice guidelines for sustained neuromuscular blockade in the adult critically ill patient." A Task Force comprising 17 members of the Society of Critical Medicine with particular expertise in the use of neuromuscular-blocking agents; a Grading of Recommendations Assessment, Development, and Evaluation expert; and a medical writer met via teleconference and three face-to-face meetings and communicated via e-mail to examine the evidence and develop these practice guidelines. Annually, all members completed conflict of interest statements; no conflicts were identified. This activity was funded by the Society for Critical Care Medicine, and no industry support was provided. Using the Grading of Recommendations Assessment, Development, and Evaluation system, the Grading of Recommendations Assessment, Development, and Evaluation expert on the Task Force created profiles for the evidence related to six of the 21 questions and assigned quality-of-evidence scores to these and the additional 15 questions for which insufficient evidence was available to create a profile. Task Force members reviewed this material and all available evidence and provided recommendations, suggestions, or good practice statements for these 21 questions. The Task Force developed a single strong recommendation: we recommend scheduled eye care that includes lubricating drops or gel and eyelid closure for patients receiving continuous infusions of neuromuscular-blocking agents. The Task Force developed 10 weak recommendations. 1) We suggest that a neuromuscular-blocking agent be administered by continuous intravenous infusion early in the course of acute respiratory distress syndrome for patients with a PaO2/FIO2 less than 150. 2) We suggest against the routine administration of an neuromuscular-blocking agents to mechanically ventilated patients with status asthmaticus. 3) We suggest a trial of a neuromuscular-blocking agents in life-threatening situations associated with profound hypoxemia, respiratory acidosis, or hemodynamic compromise. 4) We suggest that neuromuscular-blocking agents may be used to manage overt shivering in therapeutic hypothermia. 5) We suggest that peripheral nerve stimulation with train-of-four monitoring may be a useful tool for monitoring the depth of neuromuscular blockade but only if it is incorporated into a more inclusive assessment of the patient that includes clinical assessment. 6) We suggest against the use of peripheral nerve stimulation with train of four alone for monitoring the depth of neuromuscular blockade in patients receiving continuous infusion of neuromuscular-blocking agents. 7) We suggest that patients receiving a continuous infusion of neuromuscular-blocking agent receive a structured physiotherapy regimen. 8) We suggest that clinicians target a blood glucose level of less than 180 mg/dL in patients receiving neuromuscular-blocking agents. 9) We suggest that clinicians not use actual body weight and instead use a consistent weight (ideal body weight or adjusted body weight) when calculating neuromuscular-blocking agents doses for obese patients. 10) We suggest that neuromuscular-blocking agents be discontinued at the end of life or when life support is withdrawn. In situations in which evidence was lacking or insufficient and the study results were equivocal or optimal clinical practice varies, the Task Force made no recommendations for nine of the topics. 1) We make no recommendation as to whether neuromuscular blockade is beneficial or harmful when used in patients with acute brain injury and raised intracranial pressure. 2) We make no recommendation on the routine use of neuromuscular-blocking agents for patients undergoing therapeutic hypothermia following cardiac arrest. 3) We make no recommendation on the use of peripheral nerve stimulation to monitor degree of block in patients undergoing therapeutic hypothermia. 4) We make no recommendation on the use of neuromuscular blockade to improve the accuracy of intravascular-volume assessment in mechanically ventilated patients. 5) We make no recommendation concerning the use of electroencephalogram-derived parameters as a measure of sedation during continuous administration of neuromuscular-blocking agents. 6) We make no recommendation regarding nutritional requirements specific to patients receiving infusions of neuromuscular-blocking agents. 7) We make no recommendation concerning the use of one measure of consistent weight over another when calculating neuromuscular-blocking agent doses in obese patients. 8) We make no recommendation on the use of neuromuscular-blocking agents in pregnant patients. 9) We make no recommendation on which muscle group should be monitored in patients with myasthenia gravis receiving neuromuscular-blocking agents. Finally, in situations in which evidence was lacking or insufficient but expert consensus was unanimous, the Task Force developed six good practice statements. 1) If peripheral nerve stimulation is used, optimal clinical practice suggests that it should be done in conjunction with assessment of other clinical findings (e.g., triggering of the ventilator and degree of shivering) to assess the degree of neuromuscular blockade in patients undergoing therapeutic hypothermia. 2) Optimal clinical practice suggests that a protocol should include guidance on neuromuscular-blocking agent administration in patients undergoing therapeutic hypothermia. 3) Optimal clinical practice suggests that analgesic and sedative drugs should be used prior to and during neuromuscular blockade, with the goal of achieving deep sedation. 4) Optimal clinical practice suggests that clinicians at the bedside implement measure to attenuate the risk of unintended extubation in patients receiving neuromuscular-blocking agents. 5) Optimal clinical practice suggests that a reduced dose of an neuromuscular-blocking agent be used for patients with myasthenia gravis and that the dose should be based on peripheral nerve stimulation with train-of-four monitoring. 6) Optimal clinical practice suggests that neuromuscular-blocking agents be discontinued prior to the clinical determination of brain death.

Addressing Dropout Related Factors at the Local Level: Recommendations for Teachers

ERIC Educational Resources Information Center

Smith, Sandra Covington

2008-01-01

As educators and practitioners continue to seek effective interventions to prevent dropout, they must focus on identifying, monitoring, and addressing risk factors that are influenced by teachers (e.g., academic performance, peer and adult interactions, attendance, and behavior). As a result, teachers' roles in dropout prevention are critical.…

76 FR 12648 - Lowering Miners' Exposure to Respirable Coal Mine Dust, Including Continuous Personal Dust Monitors

Federal Register 2010, 2011, 2012, 2013, 2014

2011-03-08

... be appropriate to use on a short-term basis. 13. The proposed rule addresses (1) which occupations... for respirable coal mine dust, provide for full- shift sampling, redefine the term ``normal production... respect to their availability. If shorter or longer timeframes are recommended, please provide the...

Current and Emerging Uses of Insertable Cardiac Monitors: Evaluation of Syncope and Monitoring for Atrial Fibrillation.

PubMed

Tomson, Todd T; Passman, Rod

Insertable cardiac monitors (ICMs) have provided clinicians with a superb tool for assessing infrequent or potentially asymptomatic arrhythmias. ICMs have shown their usefulness in the evaluation of unexplained syncope, providing high diagnostic yields in a cost-effective manner. While unexplained syncope continues to be the most common reason for their use, ICMs are increasingly being used for the monitoring of atrial fibrillation (AF). Recent trials have demonstrated that a substantial proportion of patients with cryptogenic stroke have AF detected only by the prolonged monitoring provided by ICMs. A particularly promising and emerging use for ICMs is in the management of anticoagulation in patients with known paroxysmal AF. The introduction in recent years of ICMs with automatic AF detection algorithms and continuous remote monitoring in combination with novel oral anticoagulants have opened the door for targeted anticoagulation guided by remote monitoring, a strategy that has recently shown promise in pilot studies of this technique. While further research is needed before official recommendations can be given, this use of ICMs opens exciting new possibilities for personalized medicine that could potentially reduce bleeding risk and improve quality of life in patients with atrial fibrillation.

A review of the outcomes of the recommendations made during paediatric telepsychiatry consultations.

PubMed

Boydell, Katherine M; Volpe, Tiziana; Kertes, Angela; Greenberg, Natasha

2007-01-01

Little is known about whether the recommendations made during telepsychiatry are actually implemented. We reviewed 100 telepsychiatry consultations, chosen randomly from a paediatric telepsychiatry programme serving rural communities in Ontario. Treatment recommendations had been made for each case reviewed and up to nine recommendations had been made for a single case. Twenty-seven percent of recommendations revolved around monitoring (10%), changing (9%), starting (4%), continuing (3%) and stopping (1%) medication. Case managers associated with 54 of the cases were interviewed to determine whether the recommendations had been implemented and to examine the barriers and facilitators to implementation. The results indicated that cooperation of both child and parent, clear communication of recommendations, involvement of the school and local health providers, stability of the agencies and availability of services were key components in the successful implementation of recommendations. The matter of technology or technological difficulties acting as a barrier to telepsychiatric consultations was not mentioned by case managers, suggesting that it was not a problem.

Evaluation of EDR-3 vibration, shock, temperature, and humidity recording unit

NASA Technical Reports Server (NTRS)

Rees, Kevin G.; Mondale, C. F.

1990-01-01

The purpose of this evaluation was to determine if the self-contained, off-the-shelf, Environmental Data Recorder 3 (EDR-3) could be qualified to monitor shock, vibration, and temperature during rail transportation of space shuttle solid rocket components. The evaluation testing started in November 1989 and continued until June 1990. Two EDR-3 units were used to monitor both on- and off-plant shipments of shuttle components. In addition, extensive testing was performed at Thiokol's Vibration Test facility, T-53. Testing demonstrated that the EDR-3 is capable of successfully monitoring actual shipments of solid rocket hardware. Thiokol metrology has verified the accuracy of temperature monitoring. In addition, calibrated shock/vibration testing demonstrated that the EDR-3 does accurately record acceleration. It is recommended that the vendor modify the EDR-3 data recovery system to allow remote communication via a 30-foot cable. This would permit communication with the unit mounted on a case segment after a rail car cover is installed. The vendor will make this change and produce a new model, designated EDR-3-10. It is further recommended that Thiokol qualify the EDR-3-10 for transportation monitoring of redesigned solid rocket motor (RSRM) components.

Long-Term Continuous Ambulatory ECG Monitors and External Cardiac Loop Recorders for Cardiac Arrhythmia: A Health Technology Assessment

PubMed Central

Kabali, Conrad; Xie, Xuanqian; Higgins, Caroline

2017-01-01

Background Ambulatory electrocardiography (ECG) monitors are often used to detect cardiac arrhythmia. For patients with symptoms, an external cardiac loop recorder will often be recommended. The improved recording capacity of newer Holter monitors and similar devices, collectively known as longterm continuous ambulatory ECG monitors, suggests that they will perform just as well as, or better than, external loop recorders. This health technology assessment aimed to evaluate the effectiveness, cost-effectiveness, and budget impact of longterm continuous ECG monitors compared with external loop recorders in detecting symptoms of cardiac arrhythmia. Methods Based on our systematic search for studies published up to January 15, 2016, we did not identify any studies directly comparing the clinical effectiveness of longterm continuous ECG monitors and external loop recorders. Therefore, we conducted an indirect comparison, using a 24-hour Holter monitor as a common comparator. We used a meta-regression model to control for bias due to variation in device-wearing time and baseline syncope rate across studies. We conducted a similar systematic search for cost-utility and cost-effectiveness studies comparing the two types of devices; none were found. Finally, we used historical claims data (2006–2014) to estimate the future 5-year budget impact in Ontario, Canada, of continued public funding for both types of longterm ambulatory ECG monitors. Results Our clinical literature search yielded 7,815 non-duplicate citations, of which 12 cohort studies were eligible for indirect comparison. Seven studies assessed the effectiveness of longterm continuous monitors and five assessed external loop recorders. Both types of devices were more effective than a 24-hour Holter monitor, and we found no substantial difference between them in their ability to detect symptoms (risk difference 0.01; 95% confidence interval −0.18, 0.20). Using GRADE for network meta-analysis, we evaluated the quality of the evidence as low. Our budget impact analysis showed that use of the longterm continuous monitors has grown steadily in Ontario since they became publicly funded in 2006, particularly since 2011 when monitors that can record for 14 days or longer became funded, and the use of external cardiac loop recorders has correspondingly declined. The analysis suggests that, with these trends, continued public funding of both types of longterm ambulatory ECG testing will result in additional costs ranging from $130,000 to $370,000 per year over the next 5 years. Conclusions Although both longterm continuous ambulatory ECG monitors and external cardiac loop recorders were more effective than a 24-hour Holter monitor in detecting symptoms of cardiac arrhythmia, we found no evidence to suggest that these two devices differ in effectiveness. Assuming that the use of longterm continuous monitors will continue to increase in the next 5 years, the public health care system in Ontario can expect to see added costs of $130,000 to $370,000 per year. PMID:28194254

Barriers to Implementation of Recommendations for Transport of Children in Ground Ambulances.

PubMed

Woods, Rashida H; Shah, Manish; Doughty, Cara; Gilchrest, Anthony

2017-10-16

The National Highway Traffic Safety Administration (NHTSA) released draft recommendations in 2010 on the safe transport of children in ground ambulances. The purpose of this study was to assess awareness of these guidelines among emergency medical service (EMS) agencies and to identify implementation barriers. We conducted a cross-sectional, anonymous online survey of 911-responding, ground transport EMS agencies in Texas. Demographics, modes of transport based on case scenarios, and barriers to implementation were assessed. Of 62 eligible EMS agencies that took the survey, 35.7% were aware of the NHTSA guidelines, 62.5% agreed they would improve safety, and 41.1% planned to implement them. Seventy-five percent of EMS agencies used the ideal or acceptable alternative to transport children requiring continuous monitoring, and 69.5% chose ideal or acceptable alternatives for children requiring spinal immobilization. The ideal or acceptable alternative was not chosen for children who were not injured or ill (93.2%), ill or injured but not requiring continuous monitoring (53.3%), and situations when multiple patients required transport (57.6%). The main requirements for implementation were provider education, ambulance interior modifications, new guidelines in the EMS agency, and purchase of new equipment. Few EMS agencies are aware of the NHTSA guidelines on safe transport of children in ground ambulances. Although most agencies appropriately transport children who require monitoring, interventions, or spinal immobilization, they use inappropriate means to transport children in situations with multiple patients, lack of injury or illness, or lack of need for monitoring.

A continuous process for the development of Kodak Aerochrome Infrared Film 2443 as a negative

NASA Astrophysics Data System (ADS)

Klimes, D.; Ross, D. I.

1993-02-01

A process for the continuous dry-to-dry development of Kodak Aerochrome Infrared Film 2443 as a negative (CIR-neg) is described. The process is well suited for production processing of long film lengths. Chemicals from three commercial film processes are used with modifications. Sensitometric procedures are recommended for the monitoring of processing quality control. Sensitometric data and operational aerial exposures indicate that films developed in this process have approximately the same effective aerial film speed as films processed in the reversal process recommended by the manufacturer (Kodak EA-5). The CIR-neg process is useful when aerial photography is acquired for resources management applications which require print reproductions. Originals can be readily reproduced using conventional production equipment (electronic dodging) in black and white or color (color compensation).

[From insulin pump and continuous glucose monitoring to the artificial pancreas].

PubMed

Apablaza, Pamela; Soto, Néstor; Codner, Ethel

2017-05-01

Technology for diabetes care has undergone major development during recent decades. These technological advances include continuous subcutaneous insulin infusion (CSII), also known as insulin pumps, and real-time continuous glucose monitoring system (RT-CGMS). The integration of CSII and RT-CGMS into a single device has led to sensor-augmented pump therapy and more recently, a technology that has automated delivery of basal insulin therapy, known as hybrid system. These new technologies have led to benefits in attaining better metabolic control and decreasing the incidence of severe hypoglycemia, especially in patients with type 1 diabetes. This review describes the types of technologies currently available or under investigation for these purposes, their benefits and disadvantages, recommendations and the appropriate patient selection for their use. The clinical use of the hybrid system and artificial pancreas seem to be possible in the near future.

Change detection technique for muscle tone during static stretching by continuous muscle viscoelasticity monitoring using wearable indentation tester.

PubMed

Okamura, Naomi; Kobayashi, Yo; Sugano, Shigeki; Fujie, Masakatsu G

2017-07-01

Static stretching is widely performed to decrease muscle tone as a part of rehabilitation protocols. Finding out the optimal duration of static stretching is important to minimize the time required for rehabilitation therapy and it would be helpful for maintaining the patient's motivation towards daily rehabilitation tasks. Several studies have been conducted for the evaluation of static stretching; however, the recommended duration of static stretching varies widely between 15-30 s in general, because the traditional methods for the assessment of muscle tone do not monitor the continuous change in the target muscle's state. We have developed a method to monitor the viscoelasticity of one muscle continuously during static stretching, using a wearable indentation tester. In this study, we investigated a suitable signal processing method to detect the time required to change the muscle tone, utilizing the data collected using a wearable indentation tester. By calculating a viscoelastic index with a certain time window, we confirmed that the stretching duration required to bring about a decrease in muscle tone could be obtained with an accuracy in the order of 1 s.

The future of nursing: monitoring the progress of recommended change in hospitals, nurse-led clinics, and home health and hospice agencies.

PubMed

Pittman, Patricia; Bass, Emily; Hargraves, John; Herrera, Carolina; Thompson, Pamela

2015-02-01

The objective of this study was to assess the implementation of recommendations of the Institute of Medicine (IOM) report, The Future of Nursing: Leading Change, Advancing Health. In 2010, the IOM made a series of recommendations aimed at transforming the role of nurses in healthcare delivery. We conducted a multiyear survey, in 2011 and 2013, with nurse leaders who were members of the American Organization of Nurse Executives, the National Nursing Centers Consortium, or the Visiting Nurses Association of America. When comparing 2013 to 2011, we find progress in instituting the IOM's recommendations in 3 areas: (1) raising the proportion of employed RNs with at least a bachelor's degree; (2) expanding the proportion of healthcare institutions with nurse residency programs; and (3) offering opportunities for continuing nurse education Our findings suggest that healthcare organizations are transforming to support the recommendations of the IOM.

HIV Treatment and Prevention: An Overview of Recommendations From the 2016 IAS–USA Antiretroviral Guidelines Panel

PubMed Central

Volberding, Paul A.

2017-01-01

Updated recommendations from the IAS–USA Antiretroviral Guidelines Panel on antiretroviral therapy for the treatment and prevention of HIV infection in adults were published in the Journal of the American Medical Association in 2016. The updated, evidence-based recommendations address when to initiate antiretroviral therapy, recommended initial antiretroviral regimens, including integrase strand transfer inhibitor (InSTI)-based regimens, recommended regimens for persons in whom an InSTI is not an option, and special treatment considerations. The interface between antiretroviral therapy and opportunistic infections, when and how to switch antiretroviral therapy, laboratory monitoring, engagement in care, adherence to antiretroviral therapy, and use of antiretroviral therapy as HIV prevention are also discussed, as well as future directions in HIV treatment. This article summarizes an IAS–USA continuing education webinar presented by Paul A. Volberding, MD, in August 2016. PMID:28402930

World Health Organization-World Federation of Societies of Anaesthesiologists (WHO-WFSA) International Standards for a Safe Practice of Anesthesia.

PubMed

Gelb, Adrian W; Morriss, Wayne W; Johnson, Walter; Merry, Alan F; Abayadeera, Anuja; Belîi, Natalia; Brull, Sorin J; Chibana, Aline; Evans, Faye; Goddia, Cyril; Haylock-Loor, Carolina; Khan, Fauzia; Leal, Sandra; Lin, Nan; Merchant, Richard; Newton, Mark W; Rowles, Jackie S; Sanusi, Arinola; Wilson, Iain; Velazquez Berumen, Adriana

2018-06-01

The International Standards for a Safe Practice of Anesthesia were developed on behalf of the World Federation of Societies of Anaesthesiologists (WFSA), a nonprofit organization representing anesthesiologists in 150 countries, and the World Health Organization (WHO). The recommendations have been approved by WHO and the membership of WFSA. These Standards are applicable to all anesthesia providers throughout the world. They are intended to provide guidance and assistance to anesthesia providers, their professional organizations, hospital and facility administrators, and governments for maintaining and improving the quality and safety of anesthesia care. The Standards cover professional aspects; facilities and equipment; medications and intravenous fluids; monitoring; and the conduct of anesthesia. HIGHLY RECOMMENDED standards, the functional equivalent of mandatory standards, include (amongst other things): the continuous presence of a trained and vigilant anesthesia provider; continuous monitoring of tissue oxygenation and perfusion by clinical observation and a pulse oximeter; intermittent monitoring of blood pressure; confirmation of correct placement of an endotracheal tube (if used) by auscultation and carbon dioxide detection; the use of the WHO Safe Surgery Checklist; and a system for transfer of care at the end of an anesthetic. The International Standards represent minimum standards and the goal should always be to practice to the highest possible standards, preferably exceeding the standards outlined in this document.

World Health Organization-World Federation of Societies of Anaesthesiologists (WHO-WFSA) International Standards for a Safe Practice of Anesthesia.

PubMed

Gelb, Adrian W; Morriss, Wayne W; Johnson, Walter; Merry, Alan F

2018-05-07

The International Standards for a Safe Practice of Anesthesia were developed on behalf of the World Federation of Societies of Anaesthesiologists (WFSA), a non-profit organization representing anesthesiologists in 150 countries, and the World Health Organization (WHO). The recommendations have been approved by WHO and the membership of WFSA. These Standards are applicable to all anesthesia providers throughout the world. They are intended to provide guidance and assistance to anesthesia providers, their professional organizations, hospital and facility administrators, and governments for maintaining and improving the quality and safety of anesthesia care. The Standards cover professional aspects; facilities and equipment; medications and intravenous fluids; monitoring; and the conduct of anesthesia. HIGHLY RECOMMENDED standards, the functional equivalent of mandatory standards, include (amongst other things): the continuous presence of a trained and vigilant anesthesia provider; continuous monitoring of tissue oxygenation and perfusion by clinical observation and a pulse oximeter; intermittent monitoring of blood pressure; confirmation of correct placement of an endotracheal tube (if used) by auscultation and carbon dioxide detection; the use of the WHO Safe Surgery Checklist; and a system for transfer of care at the end of an anesthetic. The International Standards represent minimum standards and the goal should always be to practice to the highest possible standards, preferably exceeding the standards outlined in this document.

Continuous Glucose Monitoring vs Conventional Therapy for Glycemic Control in Adults With Type 1 Diabetes Treated With Multiple Daily Insulin Injections: The GOLD Randomized Clinical Trial.

PubMed

Lind, Marcus; Polonsky, William; Hirsch, Irl B; Heise, Tim; Bolinder, Jan; Dahlqvist, Sofia; Schwarz, Erik; Ólafsdóttir, Arndís Finna; Frid, Anders; Wedel, Hans; Ahlén, Elsa; Nyström, Thomas; Hellman, Jarl

2017-01-24

The majority of individuals with type 1 diabetes do not meet recommended glycemic targets. To evaluate the effects of continuous glucose monitoring in adults with type 1 diabetes treated with multiple daily insulin injections. Open-label crossover randomized clinical trial conducted in 15 diabetes outpatient clinics in Sweden between February 24, 2014, and June 1, 2016 that included 161 individuals with type 1 diabetes and hemoglobin A1c (HbA1c) of at least 7.5% (58 mmol/mol) treated with multiple daily insulin injections. Participants were randomized to receive treatment using a continuous glucose monitoring system or conventional treatment for 26 weeks, separated by a washout period of 17 weeks. Difference in HbA1c between weeks 26 and 69 for the 2 treatments. Adverse events including severe hypoglycemia were also studied. Among 161 randomized participants, mean age was 43.7 years, 45.3% were women, and mean HbA1c was 8.6% (70 mmol/mol). A total of 142 participants had follow-up data in both treatment periods. Mean HbA1c was 7.92% (63 mmol/mol) during continuous glucose monitoring use and 8.35% (68 mmol/mol) during conventional treatment (mean difference, -0.43% [95% CI, -0.57% to -0.29%] or -4.7 [-6.3 to -3.1 mmol/mol]; P < .001). Of 19 secondary end points comprising psychosocial and various glycemic measures, 6 met the hierarchical testing criteria of statistical significance, favoring continuous glucose monitoring compared with conventional treatment. Five patients in the conventional treatment group and 1 patient in the continuous glucose monitoring group had severe hypoglycemia. During washout when patients used conventional therapy, 7 patients had severe hypoglycemia. Among patients with inadequately controlled type 1 diabetes treated with multiple daily insulin injections, the use of continuous glucose monitoring compared with conventional treatment for 26 weeks resulted in lower HbA1c. Further research is needed to assess clinical outcomes and longer-term adverse effects. clinicaltrials.gov Identifier: NCT02092051.

Planning Risk-Based SQC Schedules for Bracketed Operation of Continuous Production Analyzers.

PubMed

Westgard, James O; Bayat, Hassan; Westgard, Sten A

2018-02-01

To minimize patient risk, "bracketed" statistical quality control (SQC) is recommended in the new CLSI guidelines for SQC (C24-Ed4). Bracketed SQC requires that a QC event both precedes and follows (brackets) a group of patient samples. In optimizing a QC schedule, the frequency of QC or run size becomes an important planning consideration to maintain quality and also facilitate responsive reporting of results from continuous operation of high production analytic systems. Different plans for optimizing a bracketed SQC schedule were investigated on the basis of Parvin's model for patient risk and CLSI C24-Ed4's recommendations for establishing QC schedules. A Sigma-metric run size nomogram was used to evaluate different QC schedules for processes of different sigma performance. For high Sigma performance, an effective SQC approach is to employ a multistage QC procedure utilizing a "startup" design at the beginning of production and a "monitor" design periodically throughout production. Example QC schedules are illustrated for applications with measurement procedures having 6-σ, 5-σ, and 4-σ performance. Continuous production analyzers that demonstrate high σ performance can be effectively controlled with multistage SQC designs that employ a startup QC event followed by periodic monitoring or bracketing QC events. Such designs can be optimized to minimize the risk of harm to patients. © 2017 American Association for Clinical Chemistry.

Interindividual and intraindividual variations in postprandial glycemia peak time complicate precise recommendations for self-monitoring of glucose in persons with type 1 diabetes mellitus.

PubMed

Johansen, Mette Dencker; Gjerløv, Irene; Christiansen, Jens Sandahl; Hejlesen, Ole K

2012-03-01

In glycemic control, postprandial glycemia may be important to monitor and optimize as it reveals glycemic control quality, and postprandial hyperglycemia partly predicts late diabetic complications. Self-monitoring of blood glucose (SMBG) may be an appropriate technology to use, but recommendations on measurement time are crucial. We retrospectively analyzed interindividual and intraindividual variations in postprandial glycemic peak time. Continuous glucose monitoring (CGM) and carbohydrate intake were collected in 22 patients with type 1 diabetes mellitus. Meals were identified from carbohydrate intake data. For each meal, peak time was identified as time from meal to CGM zenith within 40-150 min after meal start. Interindividual (one-way Anova) and intraindividual (intraclass correlation coefficient) variation was calculated. Nineteen patients were included with sufficient meal data quality. Mean peak time was 87 ± 29 min. Mean peak time differed significantly between patients (p = 0.02). Intraclass correlation coefficient was 0.29. Significant interindividual and intraindividual variations exist in postprandial glycemia peak time, thus hindering simple and general advice regarding postprandial SMBG for detection of maximum values. © 2012 Diabetes Technology Society.

Wireless Instrumentation Use on Launch Vehicles

NASA Technical Reports Server (NTRS)

Sherman, Aaron

2010-01-01

This slide presentation reviews the results of a study on the use of wireless instrumentation and sensors on future launch vehicles. The use of wireless technologies would if feasible would allow for fewer wires, and allow for more flexibility. However, it was generally concluded that wireless solutions are not currently ready to replace wired technologies for launch vehicles. The recommendations of the study were to continue to use wired sensors as the primary choice for vehicle instrumentation, and to continue to assess needs and use wireless instrumentation where appropriate. The future work includes support efforts for wireless technologies, and continue to monitor the development of wireless solutions.

Recommending blood glucose monitors, a pharmacy perspective.

PubMed

Carter, Alan

2007-03-01

Selection of what blood glucose monitoring system to utilize has become an issue for physicians, diabetes educators, pharmacists, and patients. The field of competing makes and models of blood glucose monitoring systems has become crowded, with manufacturers touting improvements in accuracy, ease of use/alternate site options, stored results capacity, software evaluation tools, and/or price point. Personal interviews of 12 pharmacists from community and academic practice settings about monitor preference, as well as results from a national survey of pharmacist recommendations, were compared to actual wholesale sales data to estimate the impact of such recommendations on final monitor selection by the patient. Accu-Chek monitors were recommended 34.65% of the time and represented 28.58% of sales, with a success rate of 82.48% of being the monitor selected. OneTouch monitors had 27.72% of recommendations but represented 31.43% of sales, indicating possible patient brand loyalty or formulary preference for that product. FreeStyle(R) monitors came in third for pharmacist recommendations and were selected by the patient 61.68% of the time when recommended. The category of "other monitor" choices was selected 60.89% of the time by patients given those suggestions. Included in the "other monitor" category was the new disposable monitor marketed as the Sidekick. Based on sales data provided, the Sidekick made up 2.87% of "other monitor" category sales, representing 68% of the "other monitor" segment. While patients frequently follow pharmacist monitoring system suggestions, the ultimate deciding factor is most often the final out-of-pocket cost to the patient. As a result, cost of supplies often becomes the most important determining factor in final monitor selection at the patient level. If the patient cannot afford to perform the recommended daily testing intervals, all other determining factors and suggestions become moot.

Nurse adoption of continuous patient monitoring on acute post-surgical units: managing technology implementation.

PubMed

Jeskey, Mary; Card, Elizabeth; Nelson, Donna; Mercaldo, Nathaniel D; Sanders, Neal; Higgins, Michael S; Shi, Yaping; Michaels, Damon; Miller, Anne

2011-10-01

To report an exploratory action-research process used during the implementation of continuous patient monitoring in acute post-surgical nursing units. Substantial US Federal funding has been committed to implementing new health care technology, but failure to manage implementation processes may limit successful adoption and the realisation of proposed benefits. Effective approaches for managing barriers to new technology implementation are needed. Continuous patient monitoring was implemented in three of 13 medical/surgical units. An exploratory action-feedback approach, using time-series nurse surveys, was used to identify barriers and develop and evaluate responses. Post-hoc interviews and document analysis were used to describe the change implementation process. Significant differences were identified in night- and dayshift nurses' perceptions of technology benefits. Research nurses' facilitated the change process by evolving 'clinical nurse implementation specialist' expertise. Health information technology (HIT)-related patient outcomes are mediated through nurses' acting on new information but HIT designed for critical care may not transfer to acute care settings. Exploratory action-feedback approaches can assist nurse managers in assessing and mitigating the real-world effects of HIT implementations. It is strongly recommended that nurse managers identify stakeholders and develop comprehensive plans for monitoring the effects of HIT in their units. © 2011 Blackwell Publishing Ltd.

Putting intelligent structured intermittent auscultation (ISIA) into practice.

PubMed

Maude, Robyn M; Skinner, Joan P; Foureur, Maralyn J

2016-06-01

Fetal monitoring guidelines recommend intermittent auscultation for the monitoring of fetal wellbeing during labour for low-risk women. However, these guidelines are not being translated into practice and low-risk women birthing in institutional maternity units are increasingly exposed to continuous cardiotocographic monitoring, both on admission to hospital and during labour. When continuous fetal monitoring becomes routinised, midwives and obstetricians lose practical skills around intermittent auscultation. To support clinical practice and decision-making around auscultation modality, the intelligent structured intermittent auscultation (ISIA) framework was developed. The purpose of this discussion paper is to describe the application of intelligent structured intermittent auscultation in practice. The intelligent structured intermittent auscultation decision-making framework is a knowledge translation tool that supports the implementation of evidence into practice around the use of intermittent auscultation for fetal heart monitoring for low-risk women during labour. An understanding of the physiology of the materno-utero-placental unit and control of the fetal heart underpin the development of the framework. Intelligent structured intermittent auscultation provides midwives with a robust means of demonstrating their critical thinking and clinical reasoning and supports their understanding of normal physiological birth. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

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

PubMed

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

2015-09-18

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

Status of Insecticide Resistance in Papua New Guinea: An Update from Nation-Wide Monitoring of Anopheles Mosquitoes.

PubMed

Koimbu, Gussy; Czeher, Cyrille; Katusele, Michelle; Sakur, Muker; Kilepak, Lemen; Tandrapah, Anthony; Hetzel, Manuel W; Pulford, Justin; Robinson, Leanne; Karl, Stephan

2018-01-01

Insecticide resistance (IR) monitoring is an important component of vector-borne disease control. The last assessment of IR in Papua New Guinea (PNG) was conducted in 2010. Since then, vector populations have been exposed to higher levels of pyrethroids with the continued nation-wide distribution of insecticide-treated nets. Here, we provide an update on phenotypic IR in four highly malaria-endemic areas of PNG. IR against deltamethrin, lambda-cyhalothrin, and dichlorodiphenyltrichloroethane was assessed using World Health Organization bioassays. A total of 108 bioassays for each insecticide were conducted screening 2,290 adult female anopheline mosquitoes. No phenotypic resistance was observed. Bioassay parameters agreed well with those observed in other studies that used the same assays and insecticides. These results indicate that the three tested insecticides are still universally effective in PNG. Continued IR monitoring (every 1-2 years) in PNG is recommended to detect reduced susceptibility early and adjust guidelines to prevent widespread resistance.

Is freezing in the vaccine cold chain an ongoing issue? A literature review.

PubMed

Hanson, Celina M; George, Anupa M; Sawadogo, Adama; Schreiber, Benjamin

2017-04-19

Vaccine exposure to temperatures below recommended ranges in the cold chain may decrease vaccine potency of freeze-sensitive vaccines leading to a loss of vaccine investments and potentially places children at risk of contracting vaccine preventable illnesses. This literature review is an update to one previously published in 2007 (Matthias et al., 2007), analyzing the prevalence of vaccine exposure to temperatures below recommendations throughout various segments of the cold chain. Overall, 45 studies included in this review assess temperature monitoring, of which 29 specifically assess 'too cold' temperatures. The storage segments alone were evaluated in 41 articles, 15 articles examined the transport segment and 4 studied outreach sessions. The sample size of the studies varied, ranging from one to 103 shipments and from three to 440 storage units. Among reviewed articles, the percentage of vaccine exposure to temperatures below recommended ranges during storage was 33% in wealthier countries and 37.1% in lower income countries. Vaccine exposure to temperatures below recommended ranges occurred during shipments in 38% of studies from higher income countries and 19.3% in lower income countries. This review highlights continuing issues of vaccine exposure to temperatures below recommended ranges during various segments of the cold chain. Studies monitoring the number of events vaccines are exposed to 'too cold' temperatures as well as the duration of these events are needed. Many reviewed studies emphasize the lack of knowledge of health workers regarding freeze damage of vaccines and how this has an effect on temperature monitoring. It is important to address this issue by educating vaccinators and cold chain staff to improve temperature maintenance and supply chain management, which will facilitate the distribution of potent vaccines to children. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

Parental preference and perspectives on continuous pulse oximetry in infants and children with bronchiolitis

PubMed Central

Hendaus, Mohamed A; Nassar, Suzan; Leghrouz, Bassil A; Alhammadi, Ahmed H; Alamri, Mohammed

2018-01-01

Objective The purpose of the study was to investigate parental preference of continuous pulse oximetry in infants and children with bronchiolitis. Materials and methods A cross-sectional prospective study was conducted at Hamad Medical Corporation in Qatar. Parents of infants and children <24 months old and hospitalized with bronchiolitis were offered an interview survey. Results A total of 132 questionnaires were completed (response rate 100%). Approximately 90% of participants were 20–40 years of age, and 85% were females. The mean age of children was 7.2±5.8 months. Approximately eight in ten parents supported the idea of continuous pulse oximetry in children with bronchiolitis. Almost 43% of parents believed that continuous pulse-oximetry monitoring would delay their children’s hospital discharge. Interestingly, approximately 85% of caregivers agreed that continuous pulse oximetry had a good impact on their children’s health. In addition, around one in two of the participants stated that good bedside examinations can obviate the need for continuous pulse oximetry. Furthermore, 80% of parents believed that continuous pulse-oximetry monitoring would give the health-care provider a good sense of security regarding the child’s health. Finally, being a male parent was associated with significantly increased risk of reporting unnecessary fatigue, attributed to the sound of continuous pulse oximetry (P=0.031). Conclusion Continuous pulse-oximetry monitoring in children with bronchiolitis was perceived as reassuring for parents. Involving parents in decision-making is considered essential in the better management of children with bronchiolitis or any other disease. The first step to decrease continuous pulse oximetry will require provider education and change as well. Furthermore, we recommend proper counseling for parents, emphasizing that medical technology is not always essential, but is a complementary mode of managing a disease. PMID:29662305

Analysis of Elements of the Continuous Monitoring Program

DTIC Science & Technology

2009-12-01

reasons for differences in financial reporting between the CMP and BOR and provide COMNAVSURFOR the opportunity to increase financial reporting timeliness...accuracy, and completeness of the surface fleet. A methodology was developed to analyze financial reporting within the cruiser and frigate classes...the different groupings. A Beta Test was run on six ships for two months, which tested the recommended alternatives to financial reporting and

Final Report of the NASA Technology Readiness Assessment (TRA) Study Team

NASA Technical Reports Server (NTRS)

Hirshorn, Steven; Jefferies, Sharon

2016-01-01

The material in this report covers the results on the NASA-wide TRA team, who are responsible for ascertaining the full extent of issues and ambiguities pertaining to TRATRL and to provide recommendations for mitigation. The team worked for approximately 6 months to become knowledgeable on the current TRATRL process and guidance and to derive recommendations for improvement.The team reviewed the TRA processes of other government agencies (OGA), including international agencies, and found that while the high-level processes are similar, the NASA process has a greater level of detail. Finally, NASA’s HQ OCT continues to monitor the GAO’s efforts to produce a TRA Best Practices Guide, a draft of which was received in February 2016. This Guide could impact the recommendations of this report.

Measuring sports injuries on the pitch: a guide to use in practice

PubMed Central

Hespanhol, Luiz C.; Barboza, Saulo D.; van Mechelen, Willem; Verhagen, Evert

2015-01-01

Sports participation is a major ally for the promotion of physical activity. However, sports injuries are important adverse effects of sports participation and should be monitored in sports populations. The purpose of this paper is to review the basic concepts of injury monitoring and discuss the implementation of these concepts in practice. The aspects discussed are: (1) sports injury definition; (2) classification of sports injuries; (3) population at risk, prevalence, and incidence; (4) severity measures; (5) economic costs; (6) systems developed to monitor sports injuries; and (7) online technology. Only with reliable monitoring systems applied in a continuous and long-term manner will it be possible to identify the burden of injuries, to identify the possible cases at an early stage, to implement early interventions, and to generate data for sports injury prevention. The implementation of sports injuries monitoring systems in practice is strongly recommended. PMID:26537807

Don't forget the learner: an essential aspect for developing effective hypermedia online learning in continuing medical education.

PubMed

Sandars, John; Homer, Matthew; Walsh, Kieran; Rutherford, Alaster

2012-03-01

There is increasing use of hypermedia online learning in continuing medical education (CME) that presents the learner with a wide range of different learning resources, requiring the learner to use self-regulated learning (SRL) skills. This study is the first to apply an SRL perspective to understand how learners engage with hypermedia online learning in CME. We found that the main SRL skills used by learners were use of strategies and monitoring. The increasing use of strategies was associated with increasing interest in the topic and with increasing satisfaction with the learning experience. Further research is recommended to understand SRL processes and its impact on learning in other aspects of hypermedia online learning across the different phases of medical education. Research is also recommended to implement and evaluate the learning impact of a variety of approaches to develop the SRL skills of hypermedia online learners in CME.

Recommendations for new monitoring wells at Everest, Kansas.

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

LaFreniere, L. M.

2007-05-03

On February 15, 2007, the Commodity Credit Corporation of the U.S. Department of Agriculture (CCC/USDA) submitted Recommendations for Remedial Action at Everest, Kansas. Those Recommendations were accepted by the Kansas Department of Health and Environment (KDHE) in a letter to the CCC/USDA dated March 5, 2007. The approved Recommendations document outlines a plan for systematic groundwater sampling and monitoring at Everest to provide data necessary for the critical evaluation of remedial options - including a phytoremediation alternative - for restoration of the groundwater and protection of the surface waters of the intermittent creek at this site. Phase I of themore » KDHE-approved monitoring plan includes the following activities: (1) Groundwater sampling at existing monitoring wells, with analyses for volatile organic compounds (VOCs) and selected biodegradation parameters; (2) Sampling of surface waters along the intermittent creek for VOCs analyses; and (3) Periodic manual measurement and automated recording of groundwater and surface water levels in the vicinity of the intermittent creek. The locations selected for groundwater and surface water sampling and analyses under the approved monitoring program were determined in consultation with the KDHE. As a result of subsequent discussions among representatives of the KDHE, the CCC/USDA, and Argonne regarding the technical program at Everest, the CCC/USDA seeks KDHE approval for the installation of up to four new permanent monitoring wells along the upper reach of the intermittent creek west of the Nigh property, as shown in Figure 1. The proposed new well locations lie progressively downgradient in the anticipated direction of future groundwater and contaminant movement; all of the recommended points lie at least 2,000 ft upgradient, however, of the confirmed area of groundwater discharge to the creek identified near Highway 73. The proposed new wells will supplement the existing network of groundwater and surface water monitoring points identified in the KDHE-approved monitoring plan. The new wells will be sampled in accord with the schedules outlined in the approved plan. The new wells are recommended to address specific investigation needs, as follows: (1) The proposed borings will provide data on the lithologic and hydrogeologic characteristics - and the relative continuity - of the Everest aquifer unit along the upgradient reach of the intermittent creek, where possible implementation of a phytoremediation remedy is under consideration. (2) Installation of the borings will permit the collection of sediments from the aquifer unit for possible physical or hydraulic property analyses. The completed monitoring wells will also facilitate possible future in situ estimation of the aquifer unit's hydraulic properties in this area, as part of the remedy evaluation and development process. (3) The completed new wells will be used to determine the depths to groundwater and the pattern(s) of groundwater flow near the intermittent creek, and hence to predict more accurately the locations of possible groundwater (and contaminant) discharge and the extent of the area amenable to possible phytoremediation. (4) The use of automated groundwater level recorders at the new locations will provide data on the potential range and variability of groundwater levels to be expected in the area near the intermittent creek. (5) Periodic sampling of the recommended wells for VOCs analyses will help to constrain (1) the rate(s) and pathway(s) of contaminant approach toward the intermittent creek (and the area amenable to possible phytoremediation) and (2) the areal extent of the plume as it continues to evolve. The resulting 'early warning' data obtained from this sampling will therefore help to ensure that remedial action can be taken, if necessary, in sufficient time to prevent unacceptable levels of carbon tetrachloride contamination from threatening the identified surface waters of the creek. The well locations shown in Figure 1 were chosen to satisfy the technical objectives above, as well as to minimize disruption (to the extent possible) of the normal agricultural activities in the required investigation area. To accommodate these somewhat conflicting goals, the recommended monitoring points include one new well (PZ1) along the existing waterways west of the Nigh property, one new well (PZ3) along the margin of the farm field southwest of existing well SB63 and northeast of well SB64, and two new wells (PZ2, PZ4) in the fields east of the intermittent creek. The CCC/USDA has contacted the potentially affected landowner and is attempting to negotiate access to the desired well locations. If the necessary access cannot be obtained, a modified distribution of three new monitoring wells, to be located entirely along the existing waterways west and southwest of the Nigh property, is proposed as a possible alternate configuration.« less

NIOSH comments to DOL on the Mine Safety and Health Administration's proposed rule on air quality, chemical substances, and respiratory protection standards by J. D. Millar, March 1, 1990

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

Not Available

The testimony concerns the views of NIOSH regarding the Mine Safety and Health Administration (MSHA) proposed rule on permissible exposure limits; exposure monitoring, abrasive blasting; drill dust control; dangerous atmospheres; and prohibited areas for food and beverages. NIOSH continues to endorse the recommended exposure limit of 1 part per million (ppm) as a 15 minute short term exposure limit for nitrogen-dioxide (10102440). NIOSH supports MSHA in proposing an 8 hour time weighted average of 25ppm for nitric-oxide (10102439). NIOSH supports MSHA in proposing a limit of 35ppm as an 8 hour time weighted average (TWA) for carbon-monoxide (630080) and recommendsmore » that sulfur-dioxide (7446095) exposure be limited to 0.5ppm as an 8 hour TWA. NIOSH recommends that routine air monitoring be required on a periodic basis. NIOSH recommends that mine operators be required to establish a written exposure monitoring plan for each facility that outlines where area and personal samples should be taken, how many samples should be taken, and the implementation of the remaining portions of the proposed rule change. NIOSH supports the rules for abrasive blasting for both coal and metal/nonmetal mines and has identified several substitutive materials for silica sand that could be used in abrasive blasting.« less

[Cumulative effect of Coriolis acceleration on coronary hemodynamics].

PubMed

Lapaev, E V; Bednenko, V S

1985-01-01

Time-course variations in coronary circulation and cardiac output were measured in 29 healthy test subjects who performed tests with a continuous cumulation of Coriolis accelerations and in 12 healthy test subjects who were exposed to Coriolis accelerations combined with acute hypoxia. Adaptive changes in coronary circulation were seen. It is recommended to monitor coronary circulation during vestibulometric tests as part of medical expertise of the flying personnel.

Laser safety: regulations, standards, and recommendations

NASA Astrophysics Data System (ADS)

Smalley, Penny J.

1993-07-01

All healthcare professionals involved in the delivery of laser technology to patients, must develop and monitor clinical laser safety programs that ensure compliance with national, state, and local regulations, professional standards of practice, and national consensus standards. Laser safe treatment environments for patients and for personnel can be established and maintained through understanding the impact of both regulatory and advisory guidelines, comprehensive program planning, appropriate continuing education, and routine safety audits.

2014 ICHLNRRA intercomparison of radon/thoron gas and radon short-lived decay products measuring instruments in the NRPI Prague.

PubMed

Jílek, K; Timková, J

2015-06-01

During the Eighth International Conference on High Levels of Natural Radiation and Radon Areas held in autumn 2014 at Prague, the third intercomparison of radon/thoron gas and radon short-lived decay products measurement instruments was organised by and held at the Natural Radiation Division of the National Radiation Protection Institute (NRPI; SÚRO v.v.i.) in Prague. The intercomparison was newly focussed also on continuous monitors with active sampling adapters capable to distinguish radon/thoron gas in their mix field.The results of radon gas measurements carried out in the big NRPI radon chamber indicated very well an average deviation of up to 5 % from the reference NRPI value for 80 % of all the exposed instruments. The results of equilibrium equivalent concentration continuous monitors indicated an average deviation of up to 5 % from the reference NRPI value for 40 % of all the exposed instruments and their ~8-10 % shift compared with the NRPI. The results of investigated ambient conditions upon response of exposed continuous monitors indicated influence of aerosol changes upon response of radon monitors with an active air sampling adapters through the filter, only. The exposures of both radon/thoron gas discriminative continuous monitors and passive detectors have been indicated inconsistent results: on one hand, their excellent agreement up to several per cent for both the gases, and on the other hand, systematic unsatisfactory differences up to 40 %. Additional radon/thoron exercises are recommended to improve both the instruments themselves and quality of their operators. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

International Consensus on Use of Continuous Glucose Monitoring.

PubMed

Danne, Thomas; Nimri, Revital; Battelino, Tadej; Bergenstal, Richard M; Close, Kelly L; DeVries, J Hans; Garg, Satish; Heinemann, Lutz; Hirsch, Irl; Amiel, Stephanie A; Beck, Roy; Bosi, Emanuele; Buckingham, Bruce; Cobelli, Claudio; Dassau, Eyal; Doyle, Francis J; Heller, Simon; Hovorka, Roman; Jia, Weiping; Jones, Tim; Kordonouri, Olga; Kovatchev, Boris; Kowalski, Aaron; Laffel, Lori; Maahs, David; Murphy, Helen R; Nørgaard, Kirsten; Parkin, Christopher G; Renard, Eric; Saboo, Banshi; Scharf, Mauro; Tamborlane, William V; Weinzimer, Stuart A; Phillip, Moshe

2017-12-01

Measurement of glycated hemoglobin (HbA 1c ) has been the traditional method for assessing glycemic control. However, it does not reflect intra- and interday glycemic excursions that may lead to acute events (such as hypoglycemia) or postprandial hyperglycemia, which have been linked to both microvascular and macrovascular complications. Continuous glucose monitoring (CGM), either from real-time use (rtCGM) or intermittently viewed (iCGM), addresses many of the limitations inherent in HbA 1c testing and self-monitoring of blood glucose. Although both provide the means to move beyond the HbA 1c measurement as the sole marker of glycemic control, standardized metrics for analyzing CGM data are lacking. Moreover, clear criteria for matching people with diabetes to the most appropriate glucose monitoring methodologies, as well as standardized advice about how best to use the new information they provide, have yet to be established. In February 2017, the Advanced Technologies & Treatments for Diabetes (ATTD) Congress convened an international panel of physicians, researchers, and individuals with diabetes who are expert in CGM technologies to address these issues. This article summarizes the ATTD consensus recommendations and represents the current understanding of how CGM results can affect outcomes. © 2017 by the American Diabetes Association.

Integrated intelligent systems in advanced reactor control rooms

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

Beckmeyer, R.R.

1989-01-01

An intelligent, reactor control room, information system is designed to be an integral part of an advanced control room and will assist the reactor operator's decision making process by continuously monitoring the current plant state and providing recommended operator actions to improve that state. This intelligent system is an integral part of, as well as an extension to, the plant protection and control systems. This paper describes the interaction of several functional components (intelligent information data display, technical specifications monitoring, and dynamic procedures) of the overall system and the artificial intelligence laboratory environment assembled for testing the prototype. 10 refs.,more » 5 figs.« less

Actual issues of introduction of continuous emission monitoring systems for control of negative impact of TPP to atmospheric air

NASA Astrophysics Data System (ADS)

Kondrateva, O. E.; Roslyakov, P. V.; Borovkova, A. M.; Loktionov, O. A.

2017-11-01

Over the past 3 years there have been significant changes in Russian environmental legislation related to the transition to technological regulation based on the principles of the best available technologies (BAT). These changes also imply control and accounting of the harmful impact of industrial enterprises on the environment. Therefore, a mandatory requirement for equipping automatic continuous emission monitoring systems (ACEMS) is established for all large TPPs. For a successful practical solution of the problem of introducing such systems in the whole country there is an urgent need to develop the governing regulatory document for the design and operation of systems for continuous monitoring of TPP emissions into the air, allowing within reasonable limits to unify these systems for their work with the state data fund of state environmental monitoring and make easier the process of their implementation at operating facilities for industrial enterprises. Based on the large amount of research in the field of creation of ACEMS, which conducted in National Research University “MPEI”, a draft guidance document was developed, which includes the following regulatory provisions: goals and objectives of ACEMS, the stages of their introduction rules of carrying out preliminary inspection of energy facilities, requirements to develop technical specifications, general requirements for the operation of ACEMS, requirements to the structure and elements of ACEMS, recommendations on selection of places of measuring equipment installation, rules for execution, commissioning and acceptance testing, continuous measurement method, method for determination of the current gross and specific emissions. The draft guidance document, developed by the National Research University “MPEI”, formed the basis of the Preliminary national standards PNST 187-2017 “Automatic systems for continuous control and metering of contaminants emissions from thermal electric power stations into the atmospheric air. General requirements”. [1

Recommendations for strengthening the infrared technology component of any condition monitoring program

NASA Astrophysics Data System (ADS)

Nicholas, Jack R., Jr.; Young, R. K.

1999-03-01

This presentation provides insights of a long term 'champion' of many condition monitoring technologies and a Level III infra red thermographer. The co-authors present recommendations based on their observations of infra red and other components of predictive, condition monitoring programs in manufacturing, utility and government defense and energy activities. As predictive maintenance service providers, trainers, informal observers and formal auditors of such programs, the co-authors provide a unique perspective that can be useful to practitioners, managers and customers of advanced programs. Each has over 30 years experience in the field of machinery operation, maintenance, and support the origins of which can be traced to and through the demanding requirements of the U.S. Navy nuclear submarine forces. They have over 10 years each of experience with programs in many different countries on 3 continents. Recommendations are provided on the following: (1) Leadership and Management Support (For survival); (2) Life Cycle View (For establishment of a firm and stable foundation for a program); (3) Training and Orientation (For thermographers as well as operators, managers and others); (4) Analyst Flexibility (To innovate, explore and develop their understanding of machinery condition); (5) Reports and Program Justification (For program visibility and continued expansion); (6) Commitment to Continuous Improvement of Capability and Productivity (Through application of updated hardware and software); (7) Mutual Support by Analysts (By those inside and outside of the immediate organization); (8) Use of Multiple Technologies and System Experts to Help Define Problems (Through the use of correlation analysis of data from up to 15 technologies. An example correlation analysis table for AC and DC motors is provided.); (9) Root Cause Analysis (Allows a shift from reactive to proactive stance for a program); (10) Master Equipment Identification and Technology Application (To place the condition monitoring program in perspective); (11) Use of procedures for Predictive, Condition Monitoring and maintenance in general (To get consistent results); (12) Developing a scheme for predictive, condition monitoring personnel qualification and certification (To provide a career path and incentive to advance skill level and value to the company); (13) Analyst Assignment to Technologies and Related Duties (To make intelligent use of the skills of individuals assigned); (14) Condition Monitoring Analyst Selection Criteria (Key attributes for success are mentioned.); (15) Design and Modification to Support Monitoring (For old and new machinery to facilitate data acquisition); (16) Establishment of a Museum of Components and Samples Pulled from Service for Cause (For orientation and awareness training of operators and managers and exchange of information between analysts); (17) Goals (To promote a proactive program approach for machinery condition improvement).

The Sustainable Development Goal for Urban Sanitation: Africa's Statistical Tragedy Continues?

PubMed

Buckley, Robert M; Kallergis, Achilles

2018-06-01

Sanitation delivery in the urban areas of sub-Saharan African countries has been a chronic issue, particularly difficult to tackle. Under the Millennium Development Goals, the sanitation target in urban sub-Saharan Africa was missed by a wide margin and witnessed almost no improvement. After 2 years of review, the WHO/UNICEF Joint Monitoring Programme published a new measure of access to sanitation as a baseline for the Sustainable Development Goals. There are a number of improvements in the new measure. However, despite the improvements, the new measure continues to be characterized by an important flaw: it continues to disregard how shared toilet facilities contribute towards the SDG sanitation target. As a result, the new measure does not indicate whether progress is being made in low-income urban areas where a large number of households rely on shared sanitation; nor does it provide a goal that can be achieved in cities of the poorest countries over the measurement period. But, its most egregious failing is that it directs resources towards investments which will often fail cost/benefit tests. In sum, it is not a surprise that a Working Group recommended that the measure should be changed to include some shared facilities. Following the Working Group's recommendation would have avoided the adverse consequences of continued reliance on a key component of the methodology used for monitoring sanitation improvements under the Millennium Development Goals. The paper discusses the limitations of this methodology in the context of urban sub-Saharan Africa, where current sanitation conditions are seriously lacking, and the significant future urban population growth will add more pressure for the delivery of vital sanitation services.

Pipeline monitoring with unmanned aerial vehicles

NASA Astrophysics Data System (ADS)

Kochetkova, L. I.

2018-05-01

Pipeline leakage during transportation of combustible substances leads to explosion and fire thus causing death of people and destruction of production and accommodation facilities. Continuous pipeline monitoring allows identifying leaks in due time and quickly taking measures for their elimination. The paper describes the solution of identification of pipeline leakage using unmanned aerial vehicles. It is recommended to apply the spectral analysis with input RGB signal to identify pipeline damages. The application of multi-zone digital images allows defining potential spill of oil hydrocarbons as well as possible soil pollution. The method of multi-temporal digital images within the visible region makes it possible to define changes in soil morphology for its subsequent analysis. The given solution is cost efficient and reliable thus allowing reducing timing and labor resources in comparison with other methods of pipeline monitoring.

High phenobarbital clearance during continuous renal replacement therapy: a case report and pharmacokinetic analysis.

PubMed

Rosenborg, Staffan; Saraste, Lars; Wide, Katarina

2014-08-01

Phenobarbital is an old antiepileptic drug used in severe epilepsy. Despite this, little is written about the need for dose adjustments in renal replacement therapy. Most sources recommend a moderately increased dose guided by therapeutic drug monitoring.A 14 year old boy with nonketotic hyperglycinemia, a rare inborn error of metabolism, characterized by high levels of glycine, epilepsy, spasticity, and cognitive impairment, was admitted to the emergency department with respiratory failure after a few days of fever and cough. The boy was unconscious at admittance and had acute renal and hepatic failure.Due to the acute respiratory infection, hypoxic hepatic and renal failure occurred and the patient had a status epilepticus.The patient was intubated and mechanically ventilated. Continuous renal replacement therapy was initiated. Despite increased phenobarbital doses, therapeutic levels were not reached until the dose was increased to 500 mg twice daily. Therapeutic drug monitoring was performed in plasma and dialysate. Calculations revealed that phenobarbital was almost freely dialyzed.Correct dosing of drugs in patients on renal replacement therapy may need a multidisciplinary approach and guidance by therapeutic drug monitoring.

High Phenobarbital Clearance During Continuous Renal Replacement Therapy

PubMed Central

Rosenborg, Staffan; Saraste, Lars; Wide, Katarina

2014-01-01

Abstract Phenobarbital is an old antiepileptic drug used in severe epilepsy. Despite this, little is written about the need for dose adjustments in renal replacement therapy. Most sources recommend a moderately increased dose guided by therapeutic drug monitoring. A 14 year old boy with nonketotic hyperglycinemia, a rare inborn error of metabolism, characterized by high levels of glycine, epilepsy, spasticity, and cognitive impairment, was admitted to the emergency department with respiratory failure after a few days of fever and cough. The boy was unconscious at admittance and had acute renal and hepatic failure. Due to the acute respiratory infection, hypoxic hepatic and renal failure occurred and the patient had a status epilepticus. The patient was intubated and mechanically ventilated. Continuous renal replacement therapy was initiated. Despite increased phenobarbital doses, therapeutic levels were not reached until the dose was increased to 500 mg twice daily. Therapeutic drug monitoring was performed in plasma and dialysate. Calculations revealed that phenobarbital was almost freely dialyzed. Correct dosing of drugs in patients on renal replacement therapy may need a multidisciplinary approach and guidance by therapeutic drug monitoring. PMID:25101986

Continuous water quality monitoring for the hard clam industry in Florida, USA.

PubMed

Bergquist, Derk C; Heuberger, David; Sturmer, Leslie N; Baker, Shirley M

2009-01-01

In 2000, Florida's fast-growing hard clam aquaculture industry became eligible for federal agricultural crop insurance through the US Department of Agriculture, but the responsibility for identifying the cause of mortality remained with the grower. Here we describe the continuous water quality monitoring system used to monitor hard clam aquaculture areas in Florida and show examples of the data collected with the system. Systems recording temperature, salinity, dissolved oxygen, water depth, turbidity and chlorophyll at 30 min intervals were installed at 10 aquaculture lease areas along Florida's Gulf and Atlantic coasts. Six of these systems sent data in real-time to a public website, and all 10 systems provided data for web-accessible archives. The systems documented environmental conditions that could negatively impact clam survival and productivity and identified biologically relevant water quality differences among clam aquaculture areas. Both the real-time and archived data were used widely by clam growers and nursery managers to make management decisions and in filing crop loss insurance claims. While the systems were labor and time intensive, we recommend adjustments that could reduce costs and staff time requirements.

Effects of staff training and electronic event monitoring on long-term adherence to lung-protective ventilation recommendations.

PubMed

Castellanos, Ixchel; Martin, Marcus; Kraus, Stefan; Bürkle, Thomas; Prokosch, Hans-Ulrich; Schüttler, Jürgen; Toddenroth, Dennis

2018-02-01

To investigate long-term effects of staff training and electronic clinical decision support (CDS) on adherence to lung-protective ventilation recommendations. In 2012, group instructions and workshops at two surgical intensive care units (ICUs) started, focusing on standardized protocols for mechanical ventilation and volutrauma prevention. Subsequently implemented CDS functions continuously monitor ventilation parameters, and from 2015 triggered graphical notifications when tidal volume (V T ) violated individual thresholds. To estimate the effects of these educational and technical interventions, we retrospectively analyzed nine years of V T records from routine care. As outcome measures, we calculated relative frequencies of settings that conform to recommendations, case-specific mean excess V T , and total ICU survival. Assessing 571,478 V T records from 10,241 ICU cases indicated that adherence during pressure-controlled ventilation improved significantly after both interventions; the share of conforming V T records increased from 61.6% to 83.0% and then 86.0%. Despite increasing case severity, ICU survival remained nearly constant over time. Staff training effectively improves adherence to lung-protective ventilation strategies. The observed CDS effect seemed less pronounced, although it can easily be adapted to new recommendations. Both interventions, which futures studies could deploy in combination, promise to improve the precision of mechanical ventilation. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

A circumpolar monitoring framework for polar bears

USGS Publications Warehouse

Vongraven, Dag; Aars, Jon; Amstrup, Steven C.; Atkinson, Stephen N.; Belikov, Stanislav; Born, Erik W.; DeBruyn, T.D.; Derocher, Andrew E.; Durner, George M.; Gill, Michael J.; Lunn, Nicholas J.; Obbard, Martyn E.; Omelak, Jack; Ovsyanikov, Nikita; Peacock, Elizabeth; Richardson, E.E.; Sahanatien, Vicki; Stirling, Ian; Wiig, Øystein

2012-01-01

Polar bears (Ursus maritimus) occupy remote regions that are characterized by harsh weather and limited access. Polar bear populations can only persist where temporal and spatial availability of sea ice provides adequate access to their marine mammal prey. Observed declines in sea ice availability will continue as long as greenhouse gas concentrations rise. At the same time, human intrusion and pollution levels in the Arctic are expected to increase. A circumpolar understanding of the cumulative impacts of current and future stressors is lacking, long-term trends are known from only a few subpopulations, and there is no globally coordinated effort to monitor effects of stressors. Here, we describe a framework for an integrated circumpolar monitoring plan to detect ongoing patterns, predict future trends, and identify the most vulnerable polar bear subpopulations. We recommend strategies for monitoring subpopulation abundance and trends, reproduction, survival, ecosystem change, human-caused mortality, human–bear conflict, prey availability, health, stature, distribution, behavioral change, and the effects that monitoring itself may have on polar bears. We assign monitoring intensity for each subpopulation through adaptive assessment of the quality of existing baseline data and research accessibility. A global perspective is achieved by recommending high intensity monitoring for at least one subpopulation in each of four major polar bear ecoregions. Collection of data on harvest, where it occurs, and remote sensing of habitat, should occur with the same intensity for all subpopulations. We outline how local traditional knowledge may most effectively be combined with the best scientific methods to provide comparable and complementary lines of evidence. We also outline how previously collected intensive monitoring data may be sub-sampled to guide future sampling frequencies and develop indirect estimates or indices of subpopulation status. Adoption of this framework will inform management and policy responses to changing worldwide polar bear status and trends.

Continuous glucose monitoring reveals different glycemic responses of moderate- vs high-carbohydrate lunch meals in people with type 2 diabetes.

PubMed

Powers, Margaret A; Cuddihy, Robert M; Wesley, David; Morgan, Blaine

2010-12-01

This single-center, meal-intervention, crossover study was conducted to determine the glycemic response to fixed meals with varying carbohydrate content. Continuous glucose monitoring was used to document the glycemic response. Participants were 14 people with type 2 diabetes on metformin only. On 4 consecutive days in March or July 2008, study participants consumed a fixed breakfast and one of two test meals (lunch) provided in random order. The two lunch types varied only in carbohydrate content; the protein, fat, fiber, and glycemic index were similar. They consumed no caloric food or beverages for 4 hours after each meal. Consuming double the carbohydrate content did not double the glycemic response variables, yet most were substantially different in glucose value (mg/dL) or minutes. General linear model analyses revealed substantial differences for peak glucose, change from baseline glucose to peak, time to return to preprandial glucose, 4-hour glucose area under the curve, and 4-hour mean glucose. Continuous glucose monitoring data provided a robust description of the glycemic response to the two meals. Such data can help improve postprandial glucose levels through more informed nutrition recommendations and synchronization of food intake, diabetes medication, and/or physical activity. Copyright © 2010 American Dietetic Association. Published by Elsevier Inc. All rights reserved.

Recommendations for the use of ultrasound in rheumatoid arthritis: literature review and SONAR score experience.

PubMed

Zufferey, Pascal; Tamborrini, Giorgio; Gabay, Cem; Krebs, Andreas; Kyburz, Diego; Michel, Beat; Moser, Urs; Villiger, Peter M; So, Alexander; Ziswiler, Hans Rudolf

2013-12-20

Ultrasound (US) has become a useful tool in the detection of early disease, differential diagnosis, guidance of treatment decisions and treatment monitoring of rheumatoid arthritis (RA). In 2008, the Swiss Sonography in Arthritis and Rheumatism (SONAR) group was established to promote the use of US in inflammatory arthritis in clinical practice. A scoring system was developed and taught to a large number of Swiss rheumatologists who already contributed to the Swiss Clinical Quality Management (SCQM) database, a national patient register. This paper intends to give a Swiss consensus about best clinical practice recommendations for the use of US in RA on the basis of the current literature knowledge and experience with the Swiss SONAR score. Literature research was performed to collect data on current evidence. The results were discussed among specialists of the Swiss university centres and private practice, following a structured procedure. Musculoskelatal US was found to be very helpful in establishing the diagnosis and monitoring the evolution of RA, and to be a reliable tool if used by experienced examiners. It influences treatment decisions such as continuing, intensifying or stepping down therapy. The definite modalities of integrating US into the diagnosis and monitoring of RA treatments will be defined within a few years. There are, however, strong arguments to use US findings as of today in daily clinical care. Some practical recommendations about the use of US in RA, focusing on the diagnosis and the use of the SONAR score, are proposed.

40 CFR 141.605 - Subpart V compliance monitoring location recommendations.

Code of Federal Regulations, 2011 CFR

2011-07-01

... location recommendations. 141.605 Section 141.605 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY... System Evaluations § 141.605 Subpart V compliance monitoring location recommendations. (a) Your IDSE report must include your recommendations and justification for where and during what month(s) TTHM and...

40 CFR 141.605 - Subpart V compliance monitoring location recommendations.

Code of Federal Regulations, 2010 CFR

2010-07-01

... System Evaluations § 141.605 Subpart V compliance monitoring location recommendations. (a) Your IDSE report must include your recommendations and justification for where and during what month(s) TTHM and... location recommendations. 141.605 Section 141.605 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY...

Kidney function monitoring and nonvitamin K oral anticoagulant dosage in atrial fibrillation.

PubMed

Andreu Cayuelas, Jose Manuel; Caro Martínez, Cesar; Flores Blanco, Pedro Jose; Elvira Ruiz, Gines; Albendin Iglesias, Helena; Cerezo Manchado, Juan Jose; Bailen Lorenzo, Jose Luis; Januzzi, James L; García Alberola, Arcadio; Manzano-Fernández, Sergio

2018-06-01

Clinical practice guidelines recommend regular kidney function monitoring in atrial fibrillation patients on nonvitamin K oral anticoagulants (NOAC); however, information regarding compliance with these recommendations in daily life conditions is scarce. We sought to determine the compliance with kidney function monitoring recommendations in nonvalvular atrial fibrillation (NVAF) patients starting NOAC and its implication on the appropriateness of NOAC dosage. This study involves the retrospective analysis of a multicentre registry including consecutive NVAF patients who started NOAC (n = 692). Drug dosage changes and serum creatinine determinations were recorded during 1-year follow-up. European Heart Rhythm Association criteria were used to define the appropriateness of kidney function monitoring as well as adequate NOAC dosage. During the follow-up (334 ± 89 days), the compliance with kidney function monitoring recommendations was 61% (n = 425). After multivariate adjustment, age (OR × year: 0.92 (CI 95%: 0.89-0.95) P < .001), creatinine clearance (OR × mL/min: 1.02 (CI 95%: 1.01-1.03) P < .001) and adequate NOAC dosage at baseline (OR: 1.54 (CI 95%: 1.06-2.23), P = .024) were independent predictors of appropriate kidney function monitoring. Compliance with kidney function monitoring recommendations was independently associated with change to appropriate NOAC dose after 1 year (OR: 2.80 (CI 95%: 1.01-7.80), P = .049). Noncompliance with kidney function monitoring recommendations is common in NVAF patients starting NOAC, especially in elderly patients with kidney dysfunction. Compliance with kidney function monitoring recommendations was associated with adequate NOAC dosage at 1-year follow-up. Further studies are warranted to evaluate the implication of kidney function monitoring on prognosis. © 2018 Stichting European Society for Clinical Investigation Journal Foundation.

Antimicrobial resistance and Neisseria gonorrhoeae multiantigen sequence typing (NG-MAST) genotypes in N. gonorrhoeae during 2012-2014 in Karachi, Pakistan.

PubMed

Jabeen, Kauser; Bhawan Mal, Pushpa; Khan, Erum; Chandio, Saeeda; Jacobsson, Susanne; Unemo, Magnus

2016-07-22

Globally, increasing antimicrobial resistance (AMR) in Neisseria gonorrhoea has led to decreased treatment options for gonorrhoea. Continuous monitoring of resistance is crucial to determine evolving resistance trends in Neisseria gonorrhoea and to suggest treatment recommendations. Quality assured gonococcal AMR data from Pakistan are mainly lacking. This study was performed to determine prevalence and trends of gonococcal AMR and molecular epidemiology of local strains during 2012-2014 in Karachi, Pakistan. Gonococcal isolates (n = 100) were obtained from urogenital specimens submitted to the Aga Khan University Laboratory, Karachi, Pakistan. Antimicrobial susceptibility was determined using Etest and molecular epidemiology was assessed by N. gonorrhoeae multiantigen sequence typing (NG-MAST). Quality control was performed using N. gonorrhoeae WHO reference strains C, F, G, K, L, M, N, O, and P, and ATCC 49226. Susceptibility to spectinomycin, ceftriaxone and cefixime was 100 % and to azithromycin was 99 %. All isolates had low ceftriaxone MICs, i.e., ≤0.032 mg/L. Resistance to ciprofloxacin, tetracycline and penicillin G were 86 %, 51 % and 43 %, respectively. NG-MAST analysis identified 74 different sequence types (STs). A highly diversified gonococcal population, 74 NG-MAST STs (62 novel STs) with an increased resistance to penicillin G, ciprofloxacin and tetracycline circulated in Karachi, Pakistan. Fortunately, no resistance to ceftriaxone was detected. Accordingly, ceftriaxone can continuously be recommended as the treatment of choice. However it is recommended to increase the dose of ceftriaxone from 125 mg intramuscularly to 250 mg intramuscularly due to ceftriaxone MIC creep and emerging resistance reported in the region. Furthermore, due to the high level of resistance to ciprofloxacin (86 %) it is essential to exclude ciprofloxacin from the recommended first-line therapy. It is imperative to significantly broaden the gonococcal AMR monitoring with participation from other laboratories and cities in Pakistan.

The Technology Boom

PubMed Central

Gilmore, L. Anne; Duhé, Abby F.; Frost, Elizabeth A.

2014-01-01

As technology continues to develop rapidly, the incidence of obesity also continues to climb at an alarming rate. The increase in available technology is thought to be a contributor in the obesogenic environment, yet at the same time technology can also be used to intervene and improve health and health behaviors. This article reviews the components of effective weight management programs and the novel role that technology, such as SMS, websites, and smartphone apps, is playing to improve the success of such programs. Use of these modern technologies can now allow for individualized treatment recommendations to be delivered to individuals remotely, increased self-monitoring/tracking of health-related data, broader and more rapid dissemination of health information/recommendations, and increased patient–dietician/physician contact. The use of technology in weight management programs results in improved long-term weight management, and in most cases improved cost-effectiveness. Rather than blaming increased food intake and sedentary lifestyle on technology, rapidly developing and innovative technologies should be used to our advantage and deployed to combat the obesity epidemic. PMID:24876625

Applicability of NASQAN data for ecosystem assessments on the Missouri River

USGS Publications Warehouse

Blevins, Dale W.; Fairchild, James

2001-01-01

The effectiveness of ecological restoration efforts on large developed rivers is often unknown because comprehensive ecological monitoring programs are often absent. Although Eulerian water-quality monitoring programs, such as the National Stream Quality Accounting Network (NASQAN) program, are more common, they are usually not designed for ecological assessment. Therefore, this paper addresses the value of NASQAN for ecological assessments on the Missouri River and identifies potential program additions and modifications to assess certain ecological changes in physical habitat, biological structure and function, and ecotoxicity. Five additional sites: The analysis of chlorophyll, mercury, ATP, potential endocrine disruptors, total trace elements, and selected total hydrophobic organics; and the hourly measurement of dissolved oxygen, turbidity, and temperature are recommended. Hourly measurements would require an entirely new operational aspect to NASQAN. However, the presence of data loggers and satellite transmitters in the gauging stations at all NASQAN sites substantially improves the feasibility of continuous water-quality monitoring. The use of semipermeable membrane devices (SPMDs) to monitor dissolved bioaccumulating organics and trace elements, identification and enumeration of zooplankton, and characterization of the bioavailability of organic matter are also recommended. The effect of biological processes on the conservative assumptions that are used in flux and source determinations of NASQAN constituents are also evaluated. Organic carbon, organic nitrogen, dissolved phosphate, and dissolved inorganic nitrogen are the NASQAN constituents most vulnerable to biological processes and thus violation of conservative assumptions.

Oversight role of the Independent Monitoring Board of the Global Polio Eradication Initiative.

PubMed

Rutter, Paul D; Donaldson, Liam J

2014-11-01

The Global Polio Eradication Initiative (GPEI) established its Independent Monitoring Board (IMB) in 2010 to monitor and guide its progress toward stopping polio transmission globally. The concept of an IMB is innovative, with no clear analogue in the history of the GPEI or in any other global health program. The IMB meets with senior program officials every 3-6 months. Its reports provide analysis and recommendations about individual polio-affected countries. The IMB also examines issues affecting the global program as a whole. Its areas of focus have included escalating the level of priority afforded to polio eradication (particularly by recommending a World Health Assembly resolution to declare polio eradication a programmatic emergency, which was enacted in May 2012), placing greater emphasis on people factors in the delivery of the program, encouraging innovation, strengthening focus on the small number of so-called sanctuaries where polio persists, and continuous quality improvement to reach every missed child with vaccination. The IMB's true independence from the agencies and countries delivering the program has enabled it to raise difficult issues that others cannot. Other global health programs might benefit from establishing similar independent monitoring mechanisms. © The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

Defense Infrastructure: DOD has Made Limited Progress in Assessing Foreign Encroachment Risks on Federally Managed Land

DTIC Science & Technology

2016-04-13

ordnance and munitions components; endangered species habitat; and protected marine resources.1 More recently, DOD stated in its 2014 Sustainable Ranges...House Report 113-446 accompanying a bill for the National Defense Authorization Act for Fiscal Year 2015 directed DOD to submit a report assessing... act on our 2014 recommendations, and we will continue to monitor DOD actions in this area. Page 4 GAO-16-381R Defense Infrastructure DOD Has

Management and protection protocols for the threatened Piping Plover (Charadrius Melodus) on Cape Hatteras National Seashore, North Carolina

USGS Publications Warehouse

Cohen, J.B.

2005-01-01

Executive Summary 1. The breeding population of the piping plover (Charadrius melodus), a federally-threatened shorebird, at Cape Hatteras National Seashore (CAHA) declined from 15 pairs/yr to 3 pairs/yr from 1989-2004. A population of this size may face immediate risk of extirpation from several sources. At several former breeding sites at CAHA, there have been no nesting pairs in recent years. 2. Only one plover chick has survived to fledging at CAHA, 2001-2004. While survival of eggs has often been moderate to high since 1989, survival of chicks has generally been low. Reproductive rate improved in 2005, with 6 chicks fledging from 2 pairs in conjunction with more actively managed closures in brood-rearing areas. 3. Inclement weather, predation, and recreational disturbance may negatively impact reproductive success of piping plovers at CAHA. Recreational disturbance and habitat loss caused by ORVs may discourage pairs from attempting to nest. 4. To recover the breeding plover population at CAHA, it will be necessary to create disturbance-free areas containing high-quality nesting and foraging habitat from the territory-establishment phase to the brood-rearing phase of the breeding cycle. We provide three management options to reduce risk of disturbance and mortality. They entail full closure of the seashore to recreation, closure of historical breeding sites to ORVs, or restriction of recreation to an oceanside corridor. 5. To reduce the risk of egg and chick mortality, we recommend continued efforts to trap and remove mammalian predators from all aforementioned sites and the continued use of predator exclosures around nests. We further recommend intensive monitoring and surveillance of protected areas to determine the extent and timing of threats to nests and broods, including nest overwash, predation, and disturbance or vandalism by humans. 6. Even if reproductive success improves under our recommendations, however, a population of this size will take several years to recover in the absence of immigrants from other sites, and there may not be a noticeable increase in population size in the short term. We recommend using an Adaptive Management approach, combining research, monitoring and management to assess the effectiveness of management actions in achieving our goals to recovery this threatened species at Cape Hatteras. 7. The size of nonbreeding flocks, their habitat use, their site tenacity, and sources of disturbance and mortality are not known with high precision. We recommend monitoring standards and research to address this problem, while at the same time restricting recreation adjacent to important migration and wintering sites to afford nonbreeding birds increased protection.

Level monitoring system with pulsating sensor—Application to online level monitoring of dashpots in a fast breeder reactor

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

Malathi, N.; Sahoo, P., E-mail: sahoop@igcar.gov.in; Ananthanarayanan, R.

2015-02-15

An innovative continuous type liquid level monitoring system constructed by using a new class of sensor, viz., pulsating sensor, is presented. This device is of industrial grade and it is exclusively used for level monitoring of any non conducting liquid. This instrument of unique design is suitable for high resolution online monitoring of oil level in dashpots of a sodium-cooled fast breeder reactor. The sensing probe is of capacitance type robust probe consisting of a number of rectangular mirror polished stainless steel (SS-304) plates separated with uniform gaps. The performance of this novel instrument has been thoroughly investigated. The precision,more » sensitivity, response time, and the lowest detection limit in measurement using this device are <0.01 mm, ∼100 Hz/mm, ∼1 s, and ∼0.03 mm, respectively. The influence of temperature on liquid level is studied and the temperature compensation is provided in the instrument. The instrument qualified all recommended tests, such as environmental, electromagnetic interference and electromagnetic compatibility, and seismic tests prior to its deployment in nuclear reactor. With the evolution of this level measurement approach, it is possible to provide dashpot oil level sensors in fast breeder reactor for the first time for continuous measurement of oil level in dashpots of Control and Safety Rod Drive Mechanism during reactor operation.« less

[Maternal discharge: conditions and organization for mothers and newborns returning home. The French National Authority for Health recommendations update].

PubMed

Hascoët, J-M; Petitprez, K

2014-09-01

In light of changes in both medical practices and the organization of medical care, the French National Authority for Health (Haute Autorité de santé, HAS) proposed new recommendations on the discharge of mothers and newborns, updating its 2004 recommendations on early discharge of mothers and newborns. This decision in turn made it necessary to define optimal discharge conditions and accompanying measures for mothers and infants returning home. The problem was approached by adopting the usual HAS methodology for drafting good practice recommendations. This involved establishing a working group bringing together representatives of all medical and care fields related to perinatology as well as patient representatives. This working group submitted draft recommendations, based on updated published references, to a committee. The committee then proposed amendments to the recommendations, which the working group was free to accept or reject. The updated recommendations that emerged from this process apply four essential principles : first, preparing for discharge as early as the prenatal period, ideally during the third trimester of pregnancy, in particular by providing expectant mothers with information on how the discharge will be organized and anticipating problems that might arise; second, ensuring care continuity between hospitalization, discharge to home, and follow-up; third, ensuring optimal conditions for discharge after a maternity stay of 72-96 h for normal delivery or 96-120 h in case of caesarean section (this hospital stay duration allows for neonatal screening); and fourth, defining how mothers and children are to be accompanied during the first postnatal month. In conclusion, these recommendations resulted in an increase in the duration of as well as an improvement in routine newborn surveillance, whether in hospital or after discharge, in what is a critical phase of infant development. They encourage ambulatory postnatal monitoring. The new recommendations ensure continuity of care while taking into account mothers' and couples' wish to take responsibility for organizing their own healthcare. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

Management and protection protocols for nesting sea turtles on Cape Hatteras National Seashore, North Carolina

USGS Publications Warehouse

Cohen, J.B.

2005-01-01

Executive Summary 1. The southeast U.S. population of the loggerhead turtle (Caretta caretta) has increased since the species was listed as federally threatened in 1978. Since standardized monitoring began in North Carolina in 1995, the number of nests at Cape Hatteras National Seashore (CAHA) fluctuated from year to year, and was lowest in 1996 and 1997 (39 nests) and highest in 2003 (101 nests). Green turtles (Chelonia mydas) and leatherback turtles (Dermochelys coriacea) have nested in small numbers at CAHA, sporadically over time. 2. Hatching success of sea turtle nests typically approaches 80%. At CAHA hatching success from 1999-2003 was low when hurricanes hit during the nesting season (30%-38%), and ranged from 52%-70% otherwise. Hatching success at CAHA is usually correlated with hatching success in the surrounding subpopulation (north Florida to North Carolina). 3. Inclement weather, predation, and human recreation can negatively impact nesting rate and hatching success. 4. Currently there is little protection from recreation at CAHA for nesting females and nests that have not been found by monitors. We propose three management options to provide such protection, and to increase protection for known nests and hatchlings. We propose an adaptive management framework for assessing the effectiveness of these management options in improving sea turtle nesting rate and nest and hatchling survival. 5. We recommend continued efforts to trap and remove mammalian predators from all sea turtle habitat. We further recommend intensive monitoring and surveillance of protected areas to determine the extent and timing of threats to nests and broods, including nest overwash, predation, and disturbance or vandalism by humans. 6. Continue to relocate nests and assist stranded turtles according to North Carolina Wildlife Resources Commission guidelines. 7. Artificial light sources pose a serious threat to sea turtles in some parts of CAHA, which must be remedied immediately. We recommend that CAHA enact turtle-friendly lighting regulations and work with the communities within its borders to reduce light pollution and to eliminate artificial light sources that are directly visible from sea turtle nesting areas. 8. We recommend increased education and outreach to CAHA visitors, including requiring participation in an educational program before being granted nighttime beach access. The long-term success of sea turtle recovery will depend on public cooperation and positive public attitudes toward sea turtles and turtle management actions.

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

Fondeur, F.; Taylor-Pashow, K.

SRNL received two sets of SHT samples (MCU-14-667-672, pulled 8/27/2014 and MCU-14-846-847, pulled on 9/22/2014) for analysis. The samples were analyzed for composition. It is recommended that the solvent receives Isopar® L and TiDG trimming at this time. Analysis of sample MCU-14-846-847 indicates the solvent has evaporated Isopar®L and has lost TiDG to a level below the recommended minimum 1 mM level. Since the addition of MaxCalix to the SHT in early July 2014, the MaxCalix concentration in the solvent has reached nominal values. The laboratory will continue to monitor the quality of the solvent in particular for any newmore » impurity or degradation of the solvent components.« less

Extracorporeal treatment for theophylline poisoning: systematic review and recommendations from the EXTRIP workgroup.

PubMed

Ghannoum, Marc; Wiegand, Timothy J; Liu, Kathleen D; Calello, Diane P; Godin, Melanie; Lavergne, Valery; Gosselin, Sophie; Nolin, Thomas D; Hoffman, Robert S

2015-05-01

The Extracorporeal Treatments in Poisoning workgroup was created to provide evidence-based recommendations on the use of extracorporeal treatments (ECTRs) in poisoning. Here, the workgroup presents its systematic review and recommendations for theophylline. After a systematic review of the literature, a subgroup reviewed articles, extracted data, summarized findings, and proposed structured voting statements following a pre-determined format. A two-round modified Delphi method was chosen to reach a consensus on voting statements and the RAND/UCLA Appropriateness Method was used to quantify disagreement. Anonymous votes were compiled, returned, and discussed. A second vote determined the final recommendations. 141 articles were included: 6 in vitro studies, 4 animal studies, 101 case reports/case series, 7 descriptive cohorts, 4 observational studies, and 19 pharmacokinetic studies, yielding a low-to-very-low quality of evidence for all recommendations. Data on 143 patients were reviewed, including 10 deaths. The workgroup concluded that theophylline is dialyzable (level of evidence = A) and made the following recommendations: ECTR is recommended in severe theophylline poisoning (1C). Specific recommendations for ECTR include a theophylline concentration [theophylline] > 100 mg/L (555 μmol/L) in acute exposure (1C), the presence of seizures (1D), life-threatening dysrhythmias (1D) or shock (1D), a rising [theophylline] despite optimal therapy (1D), and clinical deterioration despite optimal care (1D). In chronic poisoning, ECTR is suggested if [theophylline] > 60 mg/L (333 μmol/L) (2D) or if the [theophylline] > 50 mg/L (278 μmol/L) and the patient is either less than 6 months of age or older than 60 years of age (2D). ECTR is also suggested if gastrointestinal decontamination cannot be administered (2D). ECTR should be continued until clinical improvement is apparent or the [theophylline] is < 15 mg/L (83 μmol/L) (1D). Following the cessation of ECTR, patients should be closely monitored. Intermittent hemodialysis is the preferred method of ECTR (1C). If intermittent hemodialysis is unavailable, hemoperfusion (1C) or continuous renal replacement therapies may be considered (3D). Exchange transfusion is an adequate alternative to hemodialysis in neonates (2D). Multi-dose activated charcoal should be continued during ECTR (1D). Theophylline poisoning is amenable to ECTRs. The workgroup recommended extracorporeal removal in the case of severe theophylline poisoning.

Overview of systematic reviews of therapeutic ranges: methodologies and recommendations for practice.

PubMed

Cooney, Lewis; Loke, Yoon K; Golder, Su; Kirkham, Jamie; Jorgensen, Andrea; Sinha, Ian; Hawcutt, Daniel

2017-06-02

Many medicines are dosed to achieve a particular therapeutic range, and monitored using therapeutic drug monitoring (TDM). The evidence base for a therapeutic range can be evaluated using systematic reviews, to ensure it continues to reflect current indications, doses, routes and formulations, as well as updated adverse effect data. There is no consensus on the optimal methodology for systematic reviews of therapeutic ranges. An overview of systematic reviews of therapeutic ranges was undertaken. The following databases were used: Cochrane Database of Systematic Reviews (CDSR), Database of Abstracts and Reviews of Effects (DARE) and MEDLINE. The published methodologies used when systematically reviewing the therapeutic range of a drug were analyzed. Step by step recommendations to optimize such systematic reviews are proposed. Ten systematic reviews that investigated the correlation between serum concentrations and clinical outcomes encompassing a variety of medicines and indications were assessed. There were significant variations in the methodologies used (including the search terms used, data extraction methods, assessment of bias, and statistical analyses undertaken). Therapeutic ranges should be population and indication specific and based on clinically relevant outcomes. Recommendations for future systematic reviews based on these findings have been developed. Evidence based therapeutic ranges have the potential to improve TDM practice. Current systematic reviews investigating therapeutic ranges have highly variable methodologies and there is no consensus of best practice when undertaking systematic reviews in this field. These recommendations meet a need not addressed by standard protocols.

Use of epoetin and darbepoetin in patients with cancer: 2007 American Society of Clinical Oncology/American Society of Hematology clinical practice guideline update.

PubMed

Rizzo, J Douglas; Somerfield, Mark R; Hagerty, Karen L; Seidenfeld, Jerome; Bohlius, Julia; Bennett, Charles L; Cella, David F; Djulbegovic, Benjamin; Goode, Matthew J; Jakubowski, Ann A; Rarick, Mark U; Regan, David H; Lichtin, Alan E

2008-01-01

To update the American Society of Clinical Oncology/American Society of Hematology (ASCO/ASH) recommendations for the use of epoetin. The guideline was expanded to address use of darbepoetin and thromboembolic risk associated with these agents. An Update Committee ("Committee") reviewed and analyzed data published since 2002 through July 2007. MEDLINE and the Cochrane Collaboration Library databases were searched. For patients with chemotherapy-associated anemia, the Committee continues to recommend initiating an erythropoiesis-stimulating agent (ESA) as hemoglobin (Hb) approaches, or falls below, 10 g/dL, to increase Hb and decrease transfusions. ESA treatment continues to be recommended for patients with low-risk myelodysplasia for similar reasons. There is no evidence showing increased survival as a result of ESA treatment. Conclusive evidence is lacking that, absent clinical circumstances necessitating earlier treatment, initiating ESAs at Hb levels greater than 10 g/dL either spares more patients from transfusion or substantially improves their quality of life. Starting doses and dose modifications based on response or lack thereof should follow the package insert. Continuing ESAs beyond 6 to 8 weeks in the absence of response, assuming appropriate dose increase has been attempted in nonresponders as per US Food and Drug Administration-approved labeling, does not seem to be beneficial, and ESA therapy should be discontinued. The Committee recommends monitoring iron stores and supplementing iron intake for ESA-treated patients. ESAs should be used cautiously with chemotherapy, or in clinical states, associated with elevated risk for thromboembolic complications. The Committee also cautions against ESA use for patients with cancer who are not receiving chemotherapy, since recent trials report increased thromboembolic risks and decreased survival under these circumstances.

Use of epoetin and darbepoetin in patients with cancer: 2007 American Society of Hematology/American Society of Clinical Oncology clinical practice guideline update.

PubMed

Rizzo, J Douglas; Somerfield, Mark R; Hagerty, Karen L; Seidenfeld, Jerome; Bohlius, Julia; Bennett, Charles L; Cella, David F; Djulbegovic, Benjamin; Goode, Matthew J; Jakubowski, Ann A; Rarick, Mark U; Regan, David H; Lichtin, Alan E

2008-01-01

To update the American Society of Clinical Oncology/American Society of Hematology (ASCO/ASH) recommendations for the use of epoetin. The guideline was expanded to address use of darbepoetin and thromboembolic risk associated with these agents. An Update Committee ("Committee") reviewed and analyzed data published since 2002 through July 2007. MEDLINE and the Cochrane Collaboration Library databases were searched. For patients with chemotherapy-associated anemia, the Committee continues to recommend initiating an erythropoiesis-stimulating agent (ESA) as hemoglobin (Hb) approaches, or falls below, 10 g/dL, to increase Hb and decrease transfusions. ESA treatment continues to be recommended for patients with low-risk myelodysplasia for similar reasons. There is no evidence showing increased survival as a result of ESA treatment. Conclusive evidence is lacking that, absent clinical circumstances necessitating earlier treatment, initiating ESAs at Hb levels greater than 10 g/dL either spares more patients from transfusion or substantially improves their quality of life. Starting doses and dose modifications based on response or lack thereof should follow the package insert. Continuing ESAs beyond 6 to 8 weeks in the absence of response, assuming appropriate dose increase has been attempted in nonresponders as per US Food and Drug Administration-approved label, does not seem to be beneficial, and ESA therapy should be discontinued. The Committee recommends monitoring iron stores and supplementing iron intake for ESA-treated patients. ESAs should be used cautiously with chemotherapy, or in clinical states, associated with elevated risk for thromo-embolic complications. The Committee also cautions against ESA use for patients with cancer who are not receiving chemotherapy, since recent trials report increased thromboembolic risks and decreased survival under these circumstances.

American Society of Interventional Pain Physicians (ASIPP) guidelines for responsible opioid prescribing in chronic non-cancer pain: Part 2--guidance.

PubMed

Manchikanti, Laxmaiah; Abdi, Salahadin; Atluri, Sairam; Balog, Carl C; Benyamin, Ramsin M; Boswell, Mark V; Brown, Keith R; Bruel, Brian M; Bryce, David A; Burks, Patricia A; Burton, Allen W; Calodney, Aaron K; Caraway, David L; Cash, Kimberly A; Christo, Paul J; Damron, Kim S; Datta, Sukdeb; Deer, Timothy R; Diwan, Sudhir; Eriator, Ike; Falco, Frank J E; Fellows, Bert; Geffert, Stephanie; Gharibo, Christopher G; Glaser, Scott E; Grider, Jay S; Hameed, Haroon; Hameed, Mariam; Hansen, Hans; Harned, Michael E; Hayek, Salim M; Helm, Standiford; Hirsch, Joshua A; Janata, Jeffrey W; Kaye, Alan D; Kaye, Adam M; Kloth, David S; Koyyalagunta, Dhanalakshmi; Lee, Marion; Malla, Yogesh; Manchikanti, Kavita N; McManus, Carla D; Pampati, Vidyasagar; Parr, Allan T; Pasupuleti, Ramarao; Patel, Vikram B; Sehgal, Nalini; Silverman, Sanford M; Singh, Vijay; Smith, Howard S; Snook, Lee T; Solanki, Daneshvari R; Tracy, Deborah H; Vallejo, Ricardo; Wargo, Bradley W

2012-07-01

Part 2 of the guidelines on responsible opioid prescribing provides the following recommendations for initiating and maintaining chronic opioid therapy of 90 days or longer. 1. A) Comprehensive assessment and documentation is recommended before initiating opioid therapy, including documentation of comprehensive history, general medical condition, psychosocial history, psychiatric status, and substance use history. ( good) B) Despite limited evidence for reliability and accuracy, screening for opioid use is recommended, as it will identify opioid abusers and reduce opioid abuse. ( limited) C) Prescription monitoring programs must be implemented, as they provide data on patterns of prescription usage, reduce prescription drug abuse or doctor shopping. ( good to fair) D) Urine drug testing (UDT) must be implemented from initiation along with subsequent adherence monitoring to decrease prescription drug abuse or illicit drug use when patients are in chronic pain management therapy. ( good) 2. A) Establish appropriate physical diagnosis and psychological diagnosis if available prior to initiating opioid therapy. ( good) B) Caution must be exercised in ordering various imaging and other evaluations, interpretation and communication with the patient, to avoid increased fear, activity restriction, requests for increased opioids, and maladaptive behaviors. ( good) C) Stratify patients into one of the 3 risk categories - low, medium, or high risk. D) A pain management consultation, may assist non-pain physicians, if high-dose opioid therapy is utilized. ( fair) 3. Essential to establish medical necessity prior to initiation or maintenance of opioid therapy. ( good) 4. Establish treatment goals of opioid therapy with regard to pain relief and improvement in function. ( good) 5. A) Long-acting opioids in high doses are recommended only in specific circumstances with severe intractable pain that is not amenable to short-acting or moderate doses of long-acting opioids, as there is no significant difference between long-acting and short-acting opioids for their effectiveness or adverse effects. ( fair) B) The relative and absolute contraindications to opioid use in chronic non-cancer pain must be evaluated including respiratory instability, acute psychiatric instability, uncontrolled suicide risk, active or history of alcohol or substance abuse, confirmed allergy to opioid agents, coadministration of drugs capable of inducing life-limiting drug interaction, concomitant use of benzodiazepines, active diversion of controlled substances, and concomitant use of heavy doses of central nervous system depressants. ( fair to limited) 6. A robust agreement which is followed by all parties is essential in initiating and maintaining opioid therapy as such agreements reduce overuse, misuse, abuse, and diversion. ( fair) 7. A) Once medical necessity is established, opioid therapy may be initiated with low doses and short-acting drugs with appropriate monitoring to provide effective relief and avoid side effects. ( fair for short-term effectiveness, limited for long-term effectiveness) B) Up to 40 mg of morphine equivalent is considered as low dose, 41 to 90 mg of morphine equivalent as a moderate dose, and greater than 91 mg of morphine equivalence as high dose. ( fair) C) In reference to long-acting opioids, titration must be carried out with caution and overdose and misuse must be avoided. ( good) 8. A) Methadone is recommended for use in late stages after failure of other opioid therapy and only by clinicians with specific training in the risks and uses. ( limited) B) Monitoring recommendation for methadone prescription is that an electrocardiogram should be obtained prior to initiation, at 30 days and yearly thereafter. ( fair) 9. In order to reduce prescription drug abuse and doctor shopping, adherence monitoring by UDT and PMDPs provide evidence that is essential to the identification of those patients who are non-compliant or abusing prescription drugs or illicit drugs. ( fair) 10. Constipation must be closely monitored and a bowel regimen be initiated as soon as deemed necessary. ( good) 11. Chronic opioid therapy may be continued, with continuous adherence monitoring, in well-selected populations, in conjunction with or after failure of other modalities of treatments with improvement in physical and functional status and minimal adverse effects. ( fair). The guidelines are based on the best available evidence and do not constitute inflexible treatment recommendations. Due to the changing body of evidence, this document is not intended to be a "standard of care."

A performance evaluation model for the Stock Point Logistics Integrated Communication Environment (SPLICE)

NASA Astrophysics Data System (ADS)

Schmidt, J. B.

1985-09-01

This thesis investigates ways of improving the real-time performance of the Stockpoint Logistics Integrated Communication Environment (SPLICE). Performance evaluation through continuous monitoring activities and performance studies are the principle vehicles discussed. The method for implementing this performance evaluation process is the measurement of predefined performance indexes. Performance indexes for SPLICE are offered that would measure these areas. Existing SPLICE capability to carry out performance evaluation is explored, and recommendations are made to enhance that capability.

Head of the bed elevation angle recorder for intensive care unit

NASA Astrophysics Data System (ADS)

Krefft, Maciej; Zamaro-Michalska, Aleksandra; Zabołotny, Wojciech M.; Zaworski, Wojciech; Grzanka, Antoni; Łazowski, Tomasz; Tavola, Mario; Siewiera, Jacek; Mikaszewska-Sokolewicz, Małgorzata

2013-10-01

This paper presents a recording system optimized for long term measurement of bed headrest elevation angle in the Intensive Care Unit. The continuous monitoring of this parameter allows to find the correlation between the patient's position in bed and the risk of the Ventilator Associated Pneumonia (VAP), a very serious problem in therapy of critically ill patients. Recorder might be be an important tool to evaluate the "care bundles" - sets of preventive procedures recommended for treatment of patients in the ICU.

Safety measures associated with the use of organophosphate insecticides in the Haitian malaria control programme*

PubMed Central

Warren, McWilson; Ruebush, Trenton K.; Hobbs, Jesse H.; Hippolyte, Robert; Miller, Steve

1985-01-01

A programme emphasizing intensive training, use of protective equipment and uniforms, daily supervision of safety measures at work, and weekly monitoring of blood cholinesterase levels by the tintometric method was instituted to prevent toxicity in Haitian malaria workers during spraying with the organophosphate insecticides fenitrothion and malathion. The programme functioned well, depressed cholinesterase activity (≤ 50% of normal) being detected rapidly prior to the development of serious symptoms. Evidence of fenitrothion overexposure appeared in spraymen early in the first spray cycle, and was associated with faulty protective clothing and a failure to observe strictly the recommended safety measures at work. After these deficiencies were corrected, insecticide application continued without serious incidents or interruption of the programme. No serious reduction of cholinesterase activity was seen in a more limited study of spraymen using malathion. It is strongly recommended that similar training and monitoring programmes should be instituted whenever organophosphate pesticides are used as residual sprays for malaria control. This is particularly important in areas where the more toxic compound, fenitrothion, is to be used. PMID:3874715

Aerospace Safety Advisory Panel

NASA Technical Reports Server (NTRS)

1998-01-01

During 1997, the Aerospace Safety Advisory Panel (ASAP) continued its safety reviews of NASA's human space flight and aeronautics programs. Efforts were focused on those areas that the Panel believed held the greatest potential to impact safety. Continuing safe Space Shuttle operations and progress in the manufacture and testing of primary components for the International Space Station (ISS) were noteworthy. The Panel has continued to monitor the safety implications of the transition of Space Shuttle operations to the United Space Alliance (USA). One area being watched closely relates to the staffing levels and skill mix in both NASA and USA. Therefore, a section of this report is devoted to personnel and other related issues that are a result of this change in NASA's way of doing business for the Space Shuttle. Attention will continue to be paid to this important topic in subsequent reports. Even though the Panel's activities for 1997 were extensive, fewer specific recommendations were formulated than has been the case in recent years. This is indicative of the current generally good state of safety of NASA programs. The Panel does, however, have several longer term concerns that have yet to develop to the level of a specific recommendation. These are covered in the introductory material for each topic area in Section 11. In another departure from past submissions, this report does not contain individual findings and recommendations for the aeronautics programs. While the Panel devoted its usual efforts to examining NASA's aeronautic centers and programs, no specific recommendations were identified for inclusion in this report. In lieu of recommendations, a summary of the Panel's observations of NASA's safety efforts in aeronautics and future Panel areas of emphasis is provided. With profound sadness the Panel notes the passing of our Chairman, Paul M. Johnstone, on December 17, 1997, and our Staff Assistant, Ms. Patricia M. Harman, on October 5, 1997. Other changes to the Panel composition during the past year were: the resignation of Mr. Dennis E. Fitch as a Consultant; the appointment of Mr. Roger D. Schaufele as a Consultant; and the assignment of Ms. Susan M. Smith as Staff Assistant.

International recommendations for glucose control in adult non diabetic critically ill patients.

PubMed

Ichai, Carole; Preiser, Jean-Charles

2010-01-01

The purpose of this research is to provide recommendations for the management of glycemic control in critically ill patients. Twenty-one experts issued recommendations related to one of the five pre-defined categories (glucose target, hypoglycemia, carbohydrate intake, monitoring of glycemia, algorithms and protocols), that were scored on a scale to obtain a strong or weak agreement. The GRADE (Grade of Recommendation, Assessment, Development and Evaluation) system was used, with a strong recommendation indicating a clear advantage for an intervention and a weak recommendation indicating that the balance between desirable and undesirable effects of an intervention is not clearly defined. A glucose target of less than 10 mmol/L is strongly suggested, using intravenous insulin following a standard protocol, when spontaneous food intake is not possible. Definition of the severe hypoglycemia threshold of 2.2 mmol/L is recommended, regardless of the clinical signs. A general, unique amount of glucose (enteral/parenteral) to administer for any patient cannot be suggested. Glucose measurements should be performed on arterial rather than venous or capillary samples, using central lab or blood gas analysers rather than point-of-care glucose readers. Thirty recommendations were obtained with a strong (21) and a weak (9) agreement. Among them, only 15 were graded with a high level of quality of evidence, underlying the necessity to continue clinical studies in order to improve the risk-to-benefit ratio of glucose control.

Renal function monitoring in patients prescribed dabigatran in the Compass Health Primary Health Organisation: a quality improvement audit.

PubMed

McBain, Lynn; Kyle, Anna

2018-03-09

To assess annual renal function monitoring and clinical indications for use in patients prescribed dabigatran. A quality improvement activity included all patients in the Compass Health Primary Health Organisation (PHO) prescribed dabigatran. Information recorded: demographics; indication for use; daily dose; height; weight; serum creatinine; and estimated glomerular filtration rate (eGFR). The first audit occurred during July 2013 - May 2014, the second during May 2014 - October 2016. Across the PHO, all patients prescribed dabigatran were reviewed: 941 patients and 1,564 respectively. At the time of the second pass audit, renal function monitoring improved from 88% to 90%, and 96% were prescribed dabigatran for an approved indication. Results showed a continuing high level of renal function monitoring across the PHO in 90% of patients prescribed dabigatran. Practitioners were reminded to use creatinine clearance as a marker of renal function. Dabigatran was prescribed for an approved indication in 96% of patients. Our results are in line with recommended best practice and clinical guidelines.

Definition of air quality measurements for monitoring space shuttle launches

NASA Technical Reports Server (NTRS)

Thorpe, R. D.

1978-01-01

A description of a recommended air quality monitoring network to characterize the impact on ambient air quality in the Kennedy Space Center (KSC) (area) of space shuttle launch operations is given. Analysis of ground cloud processes and prevalent meteorological conditions indicates that transient HCl depositions can be a cause for concern. The system designed to monitor HCl employs an extensive network of inexpensive detectors combined with a central analysis device. An acid rain network is also recommended. A quantitative measure of projected minimal long-term impact involves the limited monitoring of NOx and particulates. All recommended monitoring is confined ti KSC property.

Validation of the Somnotouch-NIBP noninvasive continuous blood pressure monitor according to the European Society of Hypertension International Protocol revision 2010.

PubMed

Bilo, Grzegorz; Zorzi, Cristina; Ochoa Munera, Juan E; Torlasco, Camilla; Giuli, Valentina; Parati, Gianfranco

2015-10-01

The present study aimed to evaluate the accuracy of the Somnotouch-NIBP noninvasive continuous blood pressure monitor according to the European Society of Hypertension International Protocol revision 2010. Systolic and diastolic blood pressures were sequentially measured in 33 adults (11 women, mean age 63.5±11.9 years) using a mercury sphygmomanometer (two observers) and the Somnotouch-NIBP device (one supervisor). A total of 99 pairs of comparisons were obtained from 33 participants for judgments in two parts with three grading phases. All the validation requirements were fulfilled. The Somnotouch-NIBP device fulfilled the requirements of the part 1 of the validation study. The number of absolute differences between device and observers within 5, 10, and 15 mmHg was 75/99, 90/99, and 96/99, respectively, for systolic blood pressure and 90/99, 99/99, and 99/99, respectively, for diastolic blood pressure. The device also fulfilled the criteria in part 2 of the validation study. Twenty-seven and 31 participants had at least two of the three device-observers differences less than or equal to 5 mmHg for systolic and diastolic blood pressure, respectively. All three device-observer differences were greater than 5 mmHg in two participants for systolic and in one participant for diastolic blood pressure. The Somnotouch-NIBP noninvasive continuous blood pressure monitor has passed the requirements of the International Protocol revision 2010, and hence can be recommended for blood pressure monitoring in adults, at least under conditions corresponding to those investigated in our study.

An Assessment of Long-Term Compliance with Performance Standards in Compensatory Mitigation Wetlands.

PubMed

Van den Bosch, Kyle; Matthews, Jeffrey W

2017-04-01

Under the US Clean Water Act, wetland restoration is used to compensate for adverse impacts to wetlands. Following construction, compensation wetlands are monitored for approximately 5 years to determine if they comply with project-specific performance standards. Once a compensation site complies with performance standards, it is assumed that the site will continue to meet standards indefinitely. However, there have been few assessments of long-term compliance. We surveyed, in 2012, 30 compensation sites 8-20 years after restoration to determine whether projects continued to meet performance standards. Additionally, we compared floristic quality of compensation sites to the quality of adjacent natural wetlands to determine whether wetland condition in compensation sites could be predicted based on the condition of nearby wetlands. Compensation sites met, on average, 65% of standards during the final year of monitoring and 53% of standards in 2012, a significant decrease in compliance. Although forested wetlands often failed to meet standards for planted tree survival, the temporal decrease in compliance was driven by increasing dominance by invasive plants in emergent wetlands. The presumption of continued compliance with performance standards after a 5-year monitoring period was not supported. Wetlands restored near better quality natural wetlands achieved and maintained greater floristic quality, suggesting that landscape context was an important determinant of long-term restoration outcomes. Based on our findings, we recommend that compensation wetlands should be monitored for longer time periods, and we suggest that nearby or adjacent natural wetlands provide good examples of reasonably achievable restoration outcomes in a particular landscape.

Methods and techniques for measuring gas emissions from agricultural and animal feeding operations.

PubMed

Hu, Enzhu; Babcock, Esther L; Bialkowski, Stephen E; Jones, Scott B; Tuller, Markus

2014-01-01

Emissions of gases from agricultural and animal feeding operations contribute to climate change, produce odors, degrade sensitive ecosystems, and pose a threat to public health. The complexity of processes and environmental variables affecting these emissions complicate accurate and reliable quantification of gas fluxes and production rates. Although a plethora of measurement technologies exist, each method has its limitations that exacerbate accurate quantification of gas fluxes. Despite a growing interest in gas emission measurements, only a few available technologies include real-time, continuous monitoring capabilities. Commonly applied state-of-the-art measurement frameworks and technologies were critically examined and discussed, and recommendations for future research to address real-time monitoring requirements for forthcoming regulation and management needs are provided.

[Monitoring of environmental pollution in Armenia and certain issues on reproductive health and cytogenetic status of organism].

PubMed

Tadevosian, N S; Muradian, S A; Tadevosian, A E; Khachatrian, B G; Dzhandzhapanian, A N; Parsadanian, G G; Pogosian, S B; Gevorkian, N B; Guloian, A A

2012-01-01

Investigations aimed at the study on the state of environment from the point of pollution by organochlorine pesticides and their metabolites (HCH, DDT, DDE and DDD), as well as on possible unfavorable impact due to carriage of mentioned persistent organic pollutants (POPs) towards reproductive health and cytogenetic status of organism were done. In parallel, monitoring of possible mutagenic components of the environment was also conducted. As to obtained data, residues of organochlorine pesticides are continually determined with high frequency both in environmental media, agricultural foodstuffs and biomedia of rural population of observed region (Aragatsotn marz, Armenia). No changes in mutagenic background were registered. The represented results of the study make fragment of complex social-hygienic, monitoring investigations on environmental quality that would further serve as a platform for working out the recommendations on reduction of environmental pollution and improvement of health protection issues in Armenia.

Toward implementation of a national ground water monitoring network

USGS Publications Warehouse

Schreiber, Robert P.; Cunningham, William L.; Copeland, Rick; Frederick, Kevin D.

2008-01-01

The Federal Advisory Committee on Water Information's (ACWI) Subcommittee on Ground Water (SOGW) has been working steadily to develop and encourage implementation of a nationwide, long-term ground-water quantity and quality monitoring framework. Significant progress includes the planned submission this fall of a draft framework document to the full committee. The document will include recommendations for implementation of the network and continued acknowledgment at the federal and state level of ACWI's potential role in national monitoring toward an improved assessment of the nation's water reserves. The SOGW mission includes addressing several issues regarding network design, as well as developing plans for concept testing, evaluation of costs and benefits, and encouraging the movement from pilot-test results to full-scale implementation within a reasonable time period. With the recent attention to water resource sustainability driven by severe droughts, concerns over global warming effects, and persistent water supply problems, the SOGW mission is now even more critical.

A Brief Review of Non-invasive Monitoring of Respiratory Condition for Extubated Patients with or at Risk for Obstructive Sleep Apnea after Surgery

PubMed Central

Zhang, Xuezheng; Kassem, Mahmoud Attia Mohamed; Zhou, Ying; Shabsigh, Muhammad; Wang, Quanguang; Xu, Xuzhong

2017-01-01

Obstructive sleep apnea (OSA) is one of the important risk factors contributing to postoperative airway complications. OSA alters the respiratory physiology and increases the sensitivity of muscle tone of the upper airway after surgery to residual anesthetic medication. In addition, the prevalence of OSA was reported to be much higher among surgical patients than the general population. Therefore, appropriate monitoring to detect early respiratory impairment in postoperative extubated patients with possible OSA is challenging. Based on the comprehensive clinical observation, several equipment have been used for monitoring the respiratory conditions of OSA patients after surgery, including the continuous pulse oximetry, capnography, photoplethysmography (PPG), and respiratory volume monitor (RVM). To date, there has been no consensus on the most suitable device as a recommended standard of care. In this review, we describe the advantages and disadvantages of some possible monitoring strategies under certain clinical conditions. According to the literature, the continuous pulse oximetry, with its high sensitivity, is still the most widely used device. It is also cost-effective and convenient to use but has low specificity and does not reflect ventilation. Capnography is the most widely used device for detection of hypoventilation, but it may not provide reliable data for extubated patients. Even normal capnography cannot exclude the existence of hypoxia. PPG shows the state of both ventilation and oxygenation, but its sensitivity needs further improvement. RVM provides real-time detection of hypoventilation, quantitative precise demonstration of respiratory rate, tidal volume, and MV for extubated patients, but no reflection of oxygenation. Altogether, the sole use of any of these devices is not ideal for monitoring of extubated patients with or at risk for OSA after surgery. However, we expect that the combined use of continuous pulse oximetry and RVM may be promising for these patients due to their complementary function, which need further study. PMID:28337439

Hemodialysis and Water Quality

PubMed Central

Coulliette, Angela D.; Arduino, Matthew J.

2015-01-01

Over 383,900 individuals in the U.S. undergo maintenance hemodialysis that exposes them to water, primarily in the form of dialysate. The quality of water and associated dialysis solutions have been implicated in adverse patient outcomes and is therefore critical. The Association for the Advancement of Medical Instrumentation has published both standards and recommended practices that address both water and the dialyzing solutions. Some of these recommendations have been adopted into Federal Regulations by the Centers for Medicare and Medicaid Services as part of the Conditions for Coverage, which includes limits on specific contaminants within water used for dialysis, dialysate, and substitution fluids. Chemical, bacterial, and endotoxin contaminants are health threats to dialysis patients, as shown by the continued episodic nature of outbreaks since the 1960s causing at least 592 cases and 16 deaths in the U.S. The importance of the dialysis water distribution system, current standards and recommendations, acceptable monitoring methods, a review of chemical, bacterial, and endotoxin outbreaks, and infection control programs are discussed. PMID:23859187

Laboratory Safety Monitoring of Chronic Medications in Ambulatory Care Settings

PubMed Central

Hurley, Judith S; Roberts, Melissa; Solberg, Leif I; Gunter, Margaret J; Nelson, Winnie W; Young, Linda; Frost, Floyd J

2005-01-01

OBJECTIVE To evaluate laboratory safety monitoring in patients taking selected chronic prescription drugs. DESIGN Retrospective study using 1999–2001 claims data to calculate rates of missed laboratory tests (potential laboratory monitoring errors). Eleven drugs/drug groups and 64 laboratory tests were evaluated. SETTING Two staff/network model health maintenance organizations. PATIENTS Continuously enrolled health plan members age≥19 years taking ≥1 chronic medications. MEASUREMENTS AND MAIN RESULTS Among patients taking chronic medications (N=29,823 in 1999, N=32,423 in 2000, and N=36,811 in 2001), 47.1% in 1999, 45.0% in 2000, and 44.0% in 2001 did not receive ≥1 test recommended for safety monitoring. Taking into account that patients were sometimes missing more than 1 test for a given drug and that patients were frequently taking multiple drugs, the rate of all potential laboratory monitoring errors was 849/1,000 patients/year in 1999, 810/1,000 patients/year in 2000, and 797/1,000 patients/year in 2001. Rates of potential laboratory monitoring errors varied considerably across individual drugs and laboratory tests. CONCLUSIONS Lapses in laboratory monitoring of patients taking selected chronic medications were common. Further research is needed to determine whether, and to what extent, this failure to monitor patients is associated with adverse clinical outcomes. PMID:15857489

Changing the use of electronic fetal monitoring and labor support: a case study of barriers and facilitators.

PubMed

Graham, Ian D; Logan, Jo; Davies, Barbara; Nimrod, Carl

2004-12-01

Decreasing the use of continuous electronic fetal monitoring and increasing professional labor support for low-risk pregnancies are recommended by the Society of Obstetricians and Gynecologists of Canada. This study explored factors influencing the successful (and unsuccessful) introduction of an evidence-based fetal health surveillance guideline. This qualitative case study was conducted at two tertiary and one community hospital. Data were collected in 14 clinician focus groups (51 nurses), followed by 8 interviews with nurse administrators and educators. Analysis of verbatim transcripts and unit records included coding and categorizing data to form profiles that were compared across hospitals. Implementation of the guideline recommendations in the hospital settings was affected by many different factors originating in the practice environment, with the potential adopters, and related to the characteristics of the guideline. The influences of these diverse factors interacted sometimes to magnify or counteract each other's effect. The physical setting, adopter concerns, and the medicolegal issues surrounding the guideline played critical roles in uptake. In addition, changes preceding the introduction of the recommendations, the institution's agenda, and nursing and medical leadership influenced the uptake of guideline recommendations. The number and experience of nurses in each setting and availability of equipment also affected guideline acceptance and use. When implementing best practice, it is important to identify organizational barriers to the change that will need managing by the appropriate level of administration in the organization. Careful tailoring of implementation interventions to the barriers originating with the potential adopters is also necessary. Be prepared for unanticipated effects.

Domestic water service delivery indicators and frameworks for monitoring, evaluation, policy and planning: a review.

PubMed

Kayser, Georgia L; Moriarty, Patrick; Fonseca, Catarina; Bartram, Jamie

2013-10-11

Monitoring of water services informs policy and planning for national governments and the international community. Currently, the international monitoring system measures the type of drinking water source that households use. There have been calls for improved monitoring systems over several decades, some advocating use of multiple indicators. We review the literature on water service indicators and frameworks with a view to informing debate on their relevance to national and international monitoring. We describe the evidence concerning the relevance of each identified indicator to public health, economic development and human rights. We analyze the benefits and challenges of using these indicators separately and combined in an index as tools for planning, monitoring, and evaluating water services. We find substantial evidence on the importance of each commonly recommended indicator--service type, safety, quantity, accessibility, reliability or continuity of service, equity, and affordability. Several frameworks have been proposed that give structure to the relationships among individual indicators and some combine multiple indicator scores into a single index but few have been rigorously tested. More research is needed to understand if employing a composite metric of indicators is advantageous and how each indicator might be scored and scaled.

Domestic Water Service Delivery Indicators and Frameworks for Monitoring, Evaluation, Policy and Planning: A Review

PubMed Central

Kayser, Georgia L.; Moriarty, Patrick; Fonseca, Catarina; Bartram, Jamie

2013-01-01

Monitoring of water services informs policy and planning for national governments and the international community. Currently, the international monitoring system measures the type of drinking water source that households use. There have been calls for improved monitoring systems over several decades, some advocating use of multiple indicators. We review the literature on water service indicators and frameworks with a view to informing debate on their relevance to national and international monitoring. We describe the evidence concerning the relevance of each identified indicator to public health, economic development and human rights. We analyze the benefits and challenges of using these indicators separately and combined in an index as tools for planning, monitoring, and evaluating water services. We find substantial evidence on the importance of each commonly recommended indicator—service type, safety, quantity, accessibility, reliability or continuity of service, equity, and affordability. Several frameworks have been proposed that give structure to the relationships among individual indicators and some combine multiple indicator scores into a single index but few have been rigorously tested. More research is needed to understand if employing a composite metric of indicators is advantageous and how each indicator might be scored and scaled. PMID:24157507

A Device for Fetal Monitoring by Means of Control Over Cardiovascular Parameters Based on Acoustic Data

NASA Astrophysics Data System (ADS)

Khokhlova, L. A.; Seleznev, A. I.; Zhdanov, D. S.; Zemlyakov, I. Yu; Kiseleva, E. Yu

2016-01-01

The problem of monitoring fetal health is topical at the moment taking into account a reduction in the level of fertile-age women's health and changes in the concept of perinatal medicine with reconsideration of live birth criteria. Fetal heart rate monitoring is a valuable means of assessing fetal health during pregnancy. The routine clinical measurements are usually carried out by the means of ultrasound cardiotocography. Although the cardiotocography monitoring provides valuable information on the fetal health status, the high quality ultrasound devices are expensive, they are not available for home care use. The recommended number of measurement is also limited. The passive and fully non-invasive acoustic recording provides an alternative low-cost measurement method. The article describes a device for fetal and maternal health monitoring by analyzing the frequency and periodicity of heart beats by means of acoustic signal received on the maternal abdomen. Based on the usage of this device a phonocardiographic fetal telemedicine system, which will allow to reduce the antenatal fetal mortality rate significantly due to continuous monitoring over the state of fetus regardless of mother's location, can be built.

The use of individualized contract plans as a method of performance evaluation for allied health faculty.

PubMed

Mitcham, M D; Vericella, B J

1985-11-01

Results from a two-year study of the individualized contract plan (ICP) approach to faculty evaluation indicate this is a workable method of performance evaluation for allied health faculty. The ICP was found to be individualized, systematic, flexible, and objective. Faculty members and department chairpersons differed in their perception of the effectiveness of the ICP, but both groups supported its continued use. Five major recommendations were made regarding the continued use of the ICP as a method of faculty performance evaluation: (1) separate evaluation and professional development aspects, (2) link results to the institutional reward structure, (3) administer the ICP uniformly among departments, (4) develop a monitoring mechanism, and (5) foster open communication among all participants in the system.

Recommendations for the use of medications with continuous enteral nutrition.

PubMed

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

2009-08-15

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

Noise assessment of unsuppressed TF-34-GE-100A engine at Warfield ANG, Baltimore, Maryland

NASA Astrophysics Data System (ADS)

Shaffer, Winston J., II; Ellis, John C., II

1987-12-01

This report presents the results of noise data measurements of an unsuppressed TF34-GE-100A engine and a community noise survey of the local area around the engine. Three recommendations were made. A two barrier design should be installed as an interim noise control measure. Justification and installation of a noise suppressor, as a long term solution, should be pursued. Day-night sound levels should continue to be monitored until adequate characterization of the airport noise environment is obtained.

[Implementation of performance indicators in the Czech Breast Cancer Screening Programme -  results of the regular monitoring].

PubMed

Májek, O; Bartoňková, H; Daneš, J; Skovajsová, M; Dušek, L

2014-01-01

The Czech organised breast cancer screening programme was initiated in 2002. Collection of data on screening mammography examinations, subsequent diagnostic procedures, and final dia-gnosis is an indispensable part of the programme. Data collection is obligatory for all accredited centres, in accordance with regulations issued by the Czech Ministry of Health. This contribution aims to demonstrate the recent results of quality monitoring of the accredited centres. Quality indicators, whose definition complies with international standards, involve the women's participation, the volume of performed examinations, the accuracy of screening mammography, the use of preoperative diagnostics, and the proportion of early detected tumours. Our evaluation documents a continuous improvement in quality of the Czech mammography screening programme, which is thereby in full agreement with international recommendations on quality assurance.

Intercomparison of an Aerosol Chemical Speciation Monitor (ACSM) with ambient fine aerosol measurements in downtown Atlanta, Georgia

NASA Astrophysics Data System (ADS)

Budisulistiorini, S. H.; Canagaratna, M. R.; Croteau, P. L.; Baumann, K.; Edgerton, E. S.; Kollman, M. S.; Ng, N. L.; Verma, V.; Shaw, S. L.; Knipping, E. M.; Worsnop, D. R.; Jayne, J. T.; Weber, R. J.; Surratt, J. D.

2014-07-01

Currently, there are a limited number of field studies that evaluate the long-term performance of the Aerodyne Aerosol Chemical Speciation Monitor (ACSM) against established monitoring networks. In this study, we present seasonal intercomparisons of the ACSM with collocated fine aerosol (PM2.5) measurements at the Southeastern Aerosol Research and Characterization (SEARCH) Jefferson Street (JST) site near downtown Atlanta, GA, during 2011-2012. Intercomparison of two collocated ACSMs resulted in strong correlations (r2 > 0.8) for all chemical species, except chloride (r2 = 0.21) indicating that ACSM instruments are capable of stable and reproducible operation. In general, speciated ACSM mass concentrations correlate well (r2 > 0.7) with the filter-adjusted continuous measurements from JST, although the correlation for nitrate is weaker (r2 = 0.55) in summer. Correlations of the ACSM NR-PM1 (non-refractory particulate matter with aerodynamic diameter less than or equal to 1 μm) plus elemental carbon (EC) with tapered element oscillating microbalance (TEOM) PM2.5 and Federal Reference Method (FRM) PM1 mass are strong with r2 > 0.7 and r2 > 0.8, respectively. Discrepancies might be attributed to evaporative losses of semi-volatile species from the filter measurements used to adjust the collocated continuous measurements. This suggests that adjusting the ambient aerosol continuous measurements with results from filter analysis introduced additional bias to the measurements. We also recommend to calibrate the ambient aerosol monitoring instruments using aerosol standards rather than gas-phase standards. The fitting approach for ACSM relative ionization for sulfate was shown to improve the comparisons between ACSM and collocated measurements in the absence of calibrated values, suggesting the importance of adding sulfate calibration into the ACSM calibration routine.

Practical implementation, education and interpretation guidelines for continuous glucose monitoring: A French position statement.

PubMed

Borot, S; Benhamou, P Y; Atlan, C; Bismuth, E; Bonnemaison, E; Catargi, B; Charpentier, G; Farret, A; Filhol, N; Franc, S; Gouet, D; Guerci, B; Guilhem, I; Guillot, C; Jeandidier, N; Joubert, M; Melki, V; Merlen, E; Penfornis, A; Picard, S; Renard, E; Reznik, Y; Riveline, J P; Rudoni, S; Schaepelynck, P; Sola-Gazagnes, A; Tubiana-Rufi, N; Verier-Mine, O; Hanaire, H

2018-02-01

The use by diabetes patients of real-time continuous interstitial glucose monitoring (CGM) or the FreeStyle Libre ® (FSL) flash glucose monitoring (FGM) system is becoming widespread and has changed diabetic practice. The working group bringing together a number of French experts has proposed the present practical consensus. Training of professionals and patient education are crucial for the success of CGM. Also, institutional recommendations must pay particular attention to the indications for and reimbursement of CGM devices in populations at risk of hypoglycaemia. The rules of good practice for CGM are the precursors of those that need to be enacted, given the oncoming emergence of artificial pancreas devices. It is necessary to have software combining user-friendliness, multiplatform usage and average glucose profile (AGP) presentation, while integrating glucose and insulin data as well as events. Expression of CGM data must strive for standardization that facilitates patient phenotyping and their follow-up, while integrating indicators of variability. The introduction of CGM involves a transformation of treatment support, rendering it longer and more complex as it also includes specific educational and technical dimensions. This complexity must be taken into account in discussions of organization of diabetes care. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Continuous pulse oximeter monitoring for inapparent hypoxemia after long bone fractures.

PubMed

Wong, Margaret Wan Nar; Tsui, Hon For; Yung, Shu Heng; Chan, Kai Ming; Cheng, Jack Chun Yiu

2004-02-01

Continuous pulse oximeter monitoring (CPOM) and daily intermittent arterial blood gas (ABG) were used to define the incidence, pattern, and severity of inapparent hypoxemia after long bone fractures. Twenty long bone fracture patients and 19 normal control patients were studied. CPOM, daily ABG, hypoxic symptoms, and features of fat embolism syndrome were monitored for 72 hours after fractures and after surgical interventions. CPOM trend curves showed that all fracture patients except one had recurrent desaturations below 90% Sao2 of varying duration and depth. The lowest Sao2 was down to 60% and the longest episode lasted for 1.47 hours. ABG analysis could not show the recurrent phenomena and never detected the corresponding desaturation episodes. Long bone fracture patients had more desaturation episodes, longer total desaturation duration, and larger total area under desaturation curves in both the postfracture and postoperative periods (p < 0.05). The mean Sao2 was significantly lower in the postfracture period. Although most patients remained asymptomatic and recovered spontaneously, two required transient oxygen therapy and one progressed to fat embolism syndrome. Inapparent hypoxia with profound desaturation is common after long bone fractures. CPOM of all patients admitted with long bone fractures is recommended for early detection. In patients who develop inapparent hypoxia, additional pulmonary insult should be avoided or undertaken with care and well timed.

Good laboratory practices for biochemical genetic testing and newborn screening for inherited metabolic disorders.

PubMed

2012-04-06

Biochemical genetic testing and newborn screening are essential laboratory services for the screening, detection, diagnosis, and monitoring of inborn errors of metabolism or inherited metabolic disorders. Under the Clinical Laboratory Improvement Amendments of 1988 (CLIA) regulations, laboratory testing is categorized on the basis of the level of testing complexity as either waived (i.e., from routine regulatory oversight) or nonwaived testing (which includes tests of moderate and high complexity). Laboratories that perform biochemical genetic testing are required by CLIA regulations to meet the general quality systems requirements for nonwaived testing and the personnel requirements for high-complexity testing. Laboratories that perform public health newborn screening are subject to the same CLIA regulations and applicable state requirements. As the number of inherited metabolic diseases that are included in state-based newborn screening programs continues to increase, ensuring the quality of performance and delivery of testing services remains a continuous challenge not only for public health laboratories and other newborn screening facilities but also for biochemical genetic testing laboratories. To help ensure the quality of laboratory testing, CDC collaborated with the Centers for Medicare & Medicaid Services, the Food and Drug Administration, the Health Resources and Services Administration, and the National Institutes of Health to develop guidelines for laboratories to meet CLIA requirements and apply additional quality assurance measures for these areas of genetic testing. This report provides recommendations for good laboratory practices that were developed based on recommendations from the Clinical Laboratory Improvement Advisory Committee, with additional input from the Secretary's Advisory Committee on Genetics, Health, and Society; the Secretary's Advisory Committee on Heritable Disorders in Newborns and Children; and representatives of newborn screening laboratories. The recommended practices address the benefits of using a quality management system approach, factors to consider before introducing new tests, establishment and verification of test performance specifications, the total laboratory testing process (which consists of the preanalytic, analytic, and postanalytic phases), confidentiality of patient information and test results, and personnel qualifications and responsibilities for laboratory testing for inherited metabolic diseases. These recommendations are intended for laboratories that perform biochemical genetic testing to improve the quality of laboratory services and for newborn screening laboratories to ensure the quality of laboratory practices for inherited metabolic disorders. These recommendations also are intended as a resource for medical and public health professionals who evaluate laboratory practices, for users of laboratory services to facilitate their collaboration with newborn screening systems and use of biochemical genetic tests, and for standard-setting organizations and professional societies in developing future laboratory quality standards and practice recommendations. This report complements Good Laboratory Practices for Molecular Genetic Testing for Heritable Diseases and Conditions (CDC. Good laboratory practices for molecular genetic testing for heritable diseases and conditions. MMWR 2009;58 [No. RR-6]) to provide guidance for ensuring and improving the quality of genetic laboratory services and public health outcomes. Future recommendations for additional areas of genetic testing will be considered on the basis of continued monitoring and evaluation of laboratory practices, technology advancements, and the development of laboratory standards and guidelines.

Climate Suite Study for the National Polar-Orbiting Operational Environmental Satellite System Internal Concepts Study. Part A; Ozone Sensors

NASA Technical Reports Server (NTRS)

Lucke, R. L.; Planet, Walter G.; Hudson, R. D.

1995-01-01

Our recommendations to NPOESS for the sensors it should adopt to meet threshold requirements for global monitoring of ozone and, to some extent, of aerosols and of atmospheric temperature, pressure, and water vapor content are summarized in this report. The degree to which these sensors fulfill other NPOESS requirements than ozone is also summarized. The number of sensors that should be in the constellation is discussed in terms of desired reliability, continuity of coverage, and the ability to cross-calibrate successive sensors. Our recommendations for specific ozone measurement requirements, IORD item 4.1.6.2.28, are given. We make the case that the monitoring of three minor constituents in the upper atmosphere (N20, ClO or ClONO2, and HNO3) should be added to the list of NPOESS requirements because of their importance to long-term ozone studies and the small additional cost required (ozone sensors are already designed to measure them). Specific measurement requirements, which should be regarded as supplementary to the ozone requirement, are given here. The necessity of using two types of sensors, nadir-viewers and limb-scanners, for atmospheric studies is discussed.

Standardization versus customization of glucose reporting.

PubMed

Rodbard, David

2013-05-01

Bergenstal et al. (Diabetes Technol Ther 2013;15:198-211) described an important approach toward standardization of reporting and analysis of continuous glucose monitoring and self-monitoring of blood glucose (SMBG) data. The ambulatory glucose profile (AGP), a composite display of glucose by time of day that superimposes data from multiple days, is perhaps the most informative and useful of the many graphical approaches to display glucose data. However, the AGP has limitations; some variations are desirable and useful. Synchronization with respect to meals, traditionally used in glucose profiles for SMBG data, can improve characterization of postprandial glucose excursions. Several other types of graphical display are available, and recently developed ones can augment the information provided by the AGP. There is a need to standardize the parameters describing glycemic variability and cross-validate the available computer programs that calculate glycemic variability. Clinical decision support software can identify and prioritize clinical problems, make recommendations for modifications of therapy, and explain its justification for those recommendations. The goal of standardization is challenging in view of the diversity of clinical situations and of computing and display platforms and software. Standardization is desirable but must be done in a manner that permits flexibility and fosters innovation.

Monitoring strategies and scale-appropriate hydrologic and biogeochemical modelling for natural resource management: Conclusions and recommendations from a session held at the iEMSs 2008

USDA-ARS?s Scientific Manuscript database

This short communication paper presents recommendations for developing scale-appropriate monitoring and modelling strategies to assist decision making in natural resource management. These ideas presented here were discussed in the session (S5) ‘Monitoring strategies and scale-appropriate hydrologic...

An equity dashboard to monitor vaccination coverage.

PubMed

Arsenault, Catherine; Harper, Sam; Nandi, Arijit; Rodríguez, José M Mendoza; Hansen, Peter M; Johri, Mira

2017-02-01

Equity monitoring is a priority for Gavi, the Vaccine Alliance, and for those implementing The 2030 agenda for sustainable development . For its new phase of operations, Gavi reassessed its approach to monitoring equity in vaccination coverage. To help inform this effort, we made a systematic analysis of inequalities in vaccination coverage across 45 Gavi-supported countries and compared results from different measurement approaches. Based on our findings, we formulated recommendations for Gavi's equity monitoring approach. The approach involved defining the vulnerable populations, choosing appropriate measures to quantify inequalities, and defining equity benchmarks that reflect the ambitions of the sustainable development agenda. In this article, we explain the rationale for the recommendations and for the development of an improved equity monitoring tool. Gavi's previous approach to measuring equity was the difference in vaccination coverage between a country's richest and poorest wealth quintiles. In addition to the wealth index, we recommend monitoring other dimensions of vulnerability (maternal education, place of residence, child sex and the multidimensional poverty index). For dimensions with multiple subgroups, measures of inequality that consider information on all subgroups should be used. We also recommend that both absolute and relative measures of inequality be tracked over time. Finally, we propose that equity benchmarks target complete elimination of inequalities. To facilitate equity monitoring, we recommend the use of a data display tool - the equity dashboard - to support decision-making in the sustainable development period. We highlight its key advantages using data from Côte d'Ivoire and Haiti.

An equity dashboard to monitor vaccination coverage

PubMed Central

Harper, Sam; Nandi, Arijit; Rodríguez, José M Mendoza; Hansen, Peter M; Johri, Mira

2017-01-01

Abstract Equity monitoring is a priority for Gavi, the Vaccine Alliance, and for those implementing The 2030 agenda for sustainable development. For its new phase of operations, Gavi reassessed its approach to monitoring equity in vaccination coverage. To help inform this effort, we made a systematic analysis of inequalities in vaccination coverage across 45 Gavi-supported countries and compared results from different measurement approaches. Based on our findings, we formulated recommendations for Gavi’s equity monitoring approach. The approach involved defining the vulnerable populations, choosing appropriate measures to quantify inequalities, and defining equity benchmarks that reflect the ambitions of the sustainable development agenda. In this article, we explain the rationale for the recommendations and for the development of an improved equity monitoring tool. Gavi’s previous approach to measuring equity was the difference in vaccination coverage between a country’s richest and poorest wealth quintiles. In addition to the wealth index, we recommend monitoring other dimensions of vulnerability (maternal education, place of residence, child sex and the multidimensional poverty index). For dimensions with multiple subgroups, measures of inequality that consider information on all subgroups should be used. We also recommend that both absolute and relative measures of inequality be tracked over time. Finally, we propose that equity benchmarks target complete elimination of inequalities. To facilitate equity monitoring, we recommend the use of a data display tool – the equity dashboard – to support decision-making in the sustainable development period. We highlight its key advantages using data from Côte d’Ivoire and Haiti. PMID:28250513

Intelligent Structured Intermittent Auscultation (ISIA): evaluation of a decision-making framework for fetal heart monitoring of low-risk women

PubMed Central

2014-01-01

Background Research-informed fetal monitoring guidelines recommend intermittent auscultation (IA) for fetal heart monitoring for low-risk women. However, the use of cardiotocography (CTG) continues to dominate many institutional maternity settings. Methods A mixed methods intervention study with before and after measurement was undertaken in one secondary level health service to facilitate the implementation of an initiative to encourage the use of IA. The intervention initiative was a decision-making framework called Intelligent Structured Intermittent Auscultation (ISIA) introduced through an education session. Results Following the intervention, medical records review revealed an increase in the use of IA during labour represented by a relative change of 12%, with improved documentation of clinical findings from assessments, and a significant reduction in the risk of receiving an admission CTG (RR 0.75, 95% CI, 0.60 – 0.95, p = 0.016). Conclusion The ISIA informed decision-making framework transformed the practice of IA and provided a mechanism for knowledge translation that enabled midwives to implement evidence-based fetal heart monitoring for low risk women. PMID:24884597

Monitoring-Based Model for Personalizing the Clinical Process of Crohn’s Disease

PubMed Central

de Ramón-Fernández, Alberto; Ruiz-Fernández, Daniel; Vives-Boix, Víctor

2017-01-01

Crohn’s disease is a chronic pathology belonging to the group of inflammatory bowel diseases. Patients suffering from Crohn’s disease must be supervised by a medical specialist for the rest of their lives; furthermore, each patient has its own characteristics and is affected by the disease in a different way, so health recommendations and treatments cannot be generalized and should be individualized for a specific patient. To achieve this personalization in a cost-effective way using technology, we propose a model based on different information flows: control, personalization, and monitoring. As a result of the model and to perform a functional validation, an architecture based on services and a prototype of the system has been defined. In this prototype, a set of different devices and technologies to monitor variables from patients and their environment has been integrated. Artificial intelligence algorithms are also included to reduce the workload related to the review and analysis of the information gathered. Due to the continuous and automated monitoring of the Crohn’s patient, this proposal can help in the personalization of the Crohn’s disease clinical process. PMID:28678162

Unobtrusive Monitoring of Neonatal Brain Temperature Using a Zero-Heat-Flux Sensor Matrix.

PubMed

Atallah, Louis; Bongers, Edwin; Lamichhane, Bishal; Bambang-Oetomo, Sidarto

2016-01-01

The temperature of preterm neonates must be maintained within a narrow window to ensure their survival. Continuously measuring their core temperature provides an optimal means of monitoring their thermoregulation and their response to environmental changes. However, existing methods of measuring core temperature can be very obtrusive, such as rectal probes, or inaccurate/lagging, such as skin temperature sensors and spot-checks using tympanic temperature sensors. This study investigates an unobtrusive method of measuring brain temperature continuously using an embedded zero-heat-flux (ZHF) sensor matrix placed under the head of the neonate. The measured temperature profile is used to segment areas of motion and incorrect positioning, where the neonate's head is not above the sensors. We compare our measurements during low motion/stable periods to esophageal temperatures for 12 preterm neonates, measured for an average of 5 h per neonate. The method we propose shows good correlation with the reference temperature for most of the neonates. The unobtrusive embedding of the matrix in the neonate's environment poses no harm or disturbance to the care work-flow, while measuring core temperature. To address the effect of motion on the ZHF measurements in the current embodiment, we recommend a more ergonomic embedding ensuring the sensors are continuously placed under the neonate's head.

Adherence to Biobehavioral Recommendations in Pediatric Migraine as Measured by Electronic Monitoring: The Adherence in Migraine (AIM) Study.

PubMed

Kroon Van Diest, Ashley M; Ramsey, Rachelle; Aylward, Brandon; Kroner, John W; Sullivan, Stephanie M; Nause, Katie; Allen, Janelle R; Chamberlin, Leigh A; Slater, Shalonda; Hommel, Kevin; LeCates, Susan L; Kabbouche, Marielle A; O'Brien, Hope L; Kacperski, Joanne; Hershey, Andrew D; Powers, Scott W

2016-07-01

The purpose of this investigation was to examine treatment adherence to medication and lifestyle recommendations among pediatric migraine patients using electronic monitoring systems. Nonadherence to medical treatment is a significant public health concern, and can result in poorer treatment outcomes, decreased cost-effectiveness of medical care, and increased morbidity. No studies have systematically examined adherence to medication and lifestyle recommendations in adolescents with migraine outside of a clinical trial. Participants included 56 adolescents ages 11-17 who were presenting for clinical care. All were diagnosed with migraine with or without aura or chronic migraine and had at least 4 headache days per month. Medication adherence was objectively measured using electronic monitoring systems (Medication Event Monitoring Systems technology) and daily, prospective self-report via personal electronic devices. Adherence to lifestyle recommendations of regular exercise, eating, and fluid intake were also assessed using daily self-report on personal electronic devices. Electronic monitoring indicates that adolescents adhere to their medication 75% of the time, which was significantly higher than self-reported rates of medication adherence (64%). Use of electronic monitoring of medication detected rates of adherence that were significantly higher for participants taking once daily medication (85%) versus participants taking twice daily medication (59%). Average reported adherence to lifestyle recommendations of consistent noncaffeinated fluid intake (M = 5 cups per day) was below recommended levels of a minimum of 8 cups per day. Participants on average also reported skipping 1 meal per week despite recommendations of consistently eating three meals per day. Results suggest that intervention focused on adherence to preventive treatments (such as medication) and lifestyle recommendations may provide more optimal outcomes for children and adolescents with migraine and their families. Once daily dosing of medication may be preferred to twice daily medication for increased medication adherence among children and adolescents. © 2016 American Headache Society.

40 CFR 62.15220 - What additional requirements must I meet for the operation of my continuous emission monitoring...

Code of Federal Regulations, 2011 CFR

2011-07-01

... meet for the operation of my continuous emission monitoring systems and continuous opacity monitoring system? 62.15220 Section 62.15220 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED... the operation of my continuous emission monitoring systems and continuous opacity monitoring system...

40 CFR 62.15220 - What additional requirements must I meet for the operation of my continuous emission monitoring...

Code of Federal Regulations, 2010 CFR

2010-07-01

... meet for the operation of my continuous emission monitoring systems and continuous opacity monitoring system? 62.15220 Section 62.15220 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED... the operation of my continuous emission monitoring systems and continuous opacity monitoring system...

Updated US Public Health Service guidelines for the management of occupational exposures to human immunodeficiency virus and recommendations for postexposure prophylaxis.

PubMed

Kuhar, David T; Henderson, David K; Struble, Kimberly A; Heneine, Walid; Thomas, Vasavi; Cheever, Laura W; Gomaa, Ahmed; Panlilio, Adelisa L

2013-09-01

This report updates US Public Health Service recommendations for the management of healthcare personnel (HCP) who experience occupational exposure to blood and/or other body fluids that might contain human immunodeficiency virus (HIV). Although the principles of exposure management remain unchanged, recommended HIV postexposure prophylaxis (PEP) regimens and the duration of HIV follow-up testing for exposed personnel have been updated. This report emphasizes the importance of primary prevention strategies, the prompt reporting and management of occupational exposures, adherence to recommended HIV PEP regimens when indicated for an exposure, expert consultation in management of exposures, follow-up of exposed HCP to improve adherence to PEP, and careful monitoring for adverse events related to treatment, as well as for virologic, immunologic, and serologic signs of infection. To ensure timely postexposure management and administration of HIV PEP, clinicians should consider occupational exposures as urgent medical concerns, and institutions should take steps to ensure that staff are aware of both the importance of and the institutional mechanisms available for reporting and seeking care for such exposures. The following is a summary of recommendations: (1) PEP is recommended when occupational exposures to HIV occur; (2) the HIV status of the exposure source patient should be determined, if possible, to guide need for HIV PEP; (3) PEP medication regimens should be started as soon as possible after occupational exposure to HIV, and they should be continued for a 4-week duration; (4) new recommendation-PEP medication regimens should contain 3 (or more) antiretroviral drugs (listed in Appendix A ) for all occupational exposures to HIV; (5) expert consultation is recommended for any occupational exposures to HIV and at a minimum for situations described in Box 1 ; (6) close follow-up for exposed personnel ( Box 2 ) should be provided that includes counseling, baseline and follow-up HIV testing, and monitoring for drug toxicity; follow-up appointments should begin within 72 hours of an HIV exposure; and (7) new recommendation-if a newer fourth-generation combination HIV p24 antigen-HIV antibody test is utilized for follow-up HIV testing of exposed HCP, HIV testing may be concluded 4 months after exposure ( Box 2 ); if a newer testing platform is not available, follow-up HIV testing is typically concluded 6 months after an HIV exposure.

A Survey of Restraint Methods for the Safe Transport of Children in Ground Ambulances.

PubMed

Woods, Rashida H; Shah, Manish; Doughty, Cara; Gilchrest, Anthony

2018-03-01

The National Highway Traffic Safety Administration (NHTSA) released draft recommendations in 2010 on the safe transport of children in ground ambulances. The purpose of this study was to assess awareness of these guidelines among emergency medical service (EMS) agencies and to identify implementation barriers. We conducted a cross-sectional, anonymous online survey of 911-responding, ground transport EMS agencies in Texas. Demographics, modes of transport based on case scenarios, and barriers to implementation were assessed. Of 62 eligible EMS agencies that took the survey, 35.7% were aware of the NHTSA guidelines, 62.5% agreed they would improve safety, and 41.1% planned to implement them. Seventy-five percent of EMS agencies used the ideal or acceptable alternative to transport children requiring continuous monitoring, and 69.5% chose ideal or acceptable alternatives for children requiring spinal immobilization. The ideal or acceptable alternative was not chosen for children who were not injured or ill (93.2%), ill or injured but not requiring continuous monitoring (53.3%), and situations when multiple patients required transport (57.6%). The main requirements for implementation were provider education, ambulance interior modifications, new guidelines in the EMS agency, and purchase of new equipment. Few EMS agencies are aware of the NHTSA guidelines on safe transport of children in ground ambulances. Although most agencies appropriately transport children who require monitoring, interventions, or spinal immobilization, they use inappropriate means to transport children in situations with multiple patients, lack of injury or illness, or lack of need for monitoring.

Chronobiologically Interpreted Ambulatory Blood Pressure Monitoring in Health and Disease

PubMed Central

Cornélissen, Germaine; Hillman, Dewayne; Beaty, Larry A.; Hong, Shiyu; Schwartzkopff, Othild; Watanabe, Yoshihiko; Otsuka, Kuniaki; Siegelova, Jarmila

2012-01-01

To detect vascular variability anomalies (VVAs), a blood pressure and heart rate profile around the clock for at least 7 days is a start. As a minimum, measurement every 60 or preferably 30 minutes for a week is needed, to be continued if abnormality is found, to assess the about 24-hour (circadian) variability that exists in all individuals. As a first dividend, one then also obtains a glimpse of 2 of the very many longer-than-circadian periodicities, the biological half-week and week. Certainly if we can have sensors and computer chips in our cars that continuously monitor the pressure over a tire's life, we should be able to do the same job for ourselves for diagnostic and therapeutic decisions. Healthcare today emphasizes wellness with recommendations for exercise and a proper diet, yet these evaluations may not be adequate. BP may be measured at a visit to the doctor or before an exercise session, along with measuring body weight and performing a physical exam. The seeds of disease are planted long before they are visible, and what appears to be normal from a conventional point of view may in fact be abnormal. Hidden alterations of physiological function, masked by the body's remarkable adaptive capabilities, may become visible through a new diagnostic and therapeutic realm—chronobiology—that reveals hitherto unseen abnormalities. The tools of chronobiology may yield additional dividends, such as the detection of physiological “loads” related to stress and stress relief and the undesirable effects of space weather upon personal events such as sudden cardiac death, societal events like terrorism and war, and natural disasters. Chronobiologically interpreted automatic ambulatory BP and heart rate (HR) monitoring (C-ABPM) may detect the antecedents of these types of events. C-ABPM is of interest in preventive cardiology, since it reveals new diagnoses as vascular variability anomalies (VVAs) and renders previous conventional diagnoses more reliable, such as that of an elevated BP. These VVAs include MESOR (midline-estimating statistic of rhythm)-hypertension, an elevation of the MESOR, which is diagnosed, like all other VVAs, only after 1 or preferably several replications of 7-day around-the-clock BP monitoring with available, affordable, and unobtrusive instrumentation. The recommendation for continuous C-ABPM recognizes several principles that constitute inseparably intertwined contributors to severe cardio-, cerebro- and renovascular diesase. C-ABPM gauges wear and tear of genetics, physical loads, and in particular mental stress placed upon individuals from “womb to tomb” by daily life, including weather in extraterrestrial space as well as that on earth, as a continuous surveillance paradigm preventing us from flying blind to a change from less than 5% to near 100% in the risk of a stroke within 6 years. PMID:23710422

Chronobiologically Interpreted Ambulatory Blood Pressure Monitoring in Health and Disease.

PubMed

Halberg, Franz; Mult, Hc; Cornélissen, Germaine; Hillman, Dewayne; Beaty, Larry A; Hong, Shiyu; Schwartzkopff, Othild; Watanabe, Yoshihiko; Otsuka, Kuniaki; Siegelova, Jarmila

2012-05-01

To detect vascular variability anomalies (VVAs), a blood pressure and heart rate profile around the clock for at least 7 days is a start. As a minimum, measurement every 60 or preferably 30 minutes for a week is needed, to be continued if abnormality is found, to assess the about 24-hour (circadian) variability that exists in all individuals. As a first dividend, one then also obtains a glimpse of 2 of the very many longer-than-circadian periodicities, the biological half-week and week. Certainly if we can have sensors and computer chips in our cars that continuously monitor the pressure over a tire's life, we should be able to do the same job for ourselves for diagnostic and therapeutic decisions. Healthcare today emphasizes wellness with recommendations for exercise and a proper diet, yet these evaluations may not be adequate. BP may be measured at a visit to the doctor or before an exercise session, along with measuring body weight and performing a physical exam. The seeds of disease are planted long before they are visible, and what appears to be normal from a conventional point of view may in fact actually be abnormal. Hidden alterations of physiological function, masked by the body's remarkable adaptive capabilities, may become visible through a new diagnostic and therapeutic realm-chronobiology-that reveals hitherto unseen abnormalities. The tools of chronobiology may yield additional dividends, such as the detection of physiological "loads" related to stress and stress relief and the undesirable effcts of space weather upon personal events such as sudden cardiac death, societal events like terrorism and war, and natural disasters. Chronobiologi cally interpreted automatic ambulatory BP and heart rate (HR) monitoring (C-ABPM) may detect the antecedents of these types of events. C-ABPM is of interest in preventive cardiology, since it reveals new diagnoses as vascular variability anomalies (VVAs) and renders previous conventional diagnoses more reliable, such as that of an elevated BP. These VVAs include MESOR (midline-estimating statistic of rhythm)-hypertension, an elevation of the MESOR, which is diagnosed, like all other VVAs, only after I or preferably several replications of 7-day around-the-clock BP monitoring with available, affordable, and unobtrusive instrumentation. The recommendation for continuous C-ABPM recognizes several principles that constitute inseparably intertwined contributors to severe cardio-, cerebro- and renovascular diease. C-ABPM gauges wear and tear of genetics, physical loads, and in particular mental stress placed upon individuals from "womb to tomb" by daily life, including weather in extraterrestrial space as well as that on earth, as a continuous surveillance paradigm preventing us from flying blind to a change from less than 5% to near 100% in the risk of a stroke within 6 years.

[Noninvasive total hemoglobin monitoring based on multiwave spectrophotometry in obstetrics and gynecology].

PubMed

Pyregov, A V; Ovechkin, A Iu; Petrov, S V

2012-01-01

Results of prospective randomized comparative research of 2 total hemoglobin estimation methods are presented. There were laboratory tests and continuous noninvasive technique with multiwave spectrophotometry on the Masimo Rainbow SET. Research was carried out in two stages. At the 1st stage (gynecology)--67 patients were included and in second stage (obstetrics)--44 patients during and after Cesarean section. The standard deviation of noninvasive total hemoglobin estimation from absolute values (invasive) was 7.2 and 4.1%, an standard deviation in a sample--5.2 and 2.7 % in gynecologic operations and surgical delivery respectively, that confirms lack of reliable indicators differences. The method of continuous noninvasive total hemoglobin estimation with multiwave spectrophotometry on the Masimo Rainbow SET technology can be recommended for use in obstetrics and gynecology.

40 CFR 60.1765 - What additional requirements must I meet for the operation of my continuous emission monitoring...

Code of Federal Regulations, 2011 CFR

2011-07-01

... meet for the operation of my continuous emission monitoring systems and continuous opacity monitoring system? 60.1765 Section 60.1765 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR... continuous emission monitoring systems and continuous opacity monitoring system? Use the required span values...

40 CFR 60.1765 - What additional requirements must I meet for the operation of my continuous emission monitoring...

Code of Federal Regulations, 2010 CFR

2010-07-01

... meet for the operation of my continuous emission monitoring systems and continuous opacity monitoring system? 60.1765 Section 60.1765 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR... continuous emission monitoring systems and continuous opacity monitoring system? Use the required span values...

From the Children’s Oncology Group: Evidence-based recommendations for PEG-asparaginase nurse monitoring, hypersensitivity reaction management, and patient/family education

PubMed Central

Woods, Deborah; Winchester, Kari; Towerman, Alison; Gettinger, Katie; Carey, Christina; Timmermann, Karen; Langley, Rachel; Browne, Emily

2017-01-01

PEG-aspariginase is a backbone chemotherapy agent in pediatric acute lymphoblastic leukemia and in some non-Hodgkin lymphoma therapies. Nurses lack standardized guidelines for monitoring patients receiving PEG-asparaginase and for educating patients/families about hypersensitivity reaction risks. An electronic search of six databases using publication years 2000–2015 and multiple professional organizations and clinical resources was conducted. Evidence sources were reviewed for topic applicability. Each of the final 23 sources was appraised by two team members. The GRADE system was used to assign a quality and strength rating for each recommendation. Multiple recommendations were developed: four relating to nurse monitoring of patients during and after drug administration, eight guiding hypersensitivity reaction management, and four concerning patient/family educational content. These strong recommendations were based on moderate, low, or very-low quality evidence. Several recommendations relied upon generalized drug hypersensitivity guidelines. Additional research is needed to safely guide PEG-asparaginase monitoring, hypersensitivity reaction management and patient/family education. Nurses administering PEG-asparaginase play a critical role in the early identification and management of hypersensitivity reactions. PMID:28602129

Space Station Induced Monitoring

NASA Technical Reports Server (NTRS)

Spann, James F. (Editor); Torr, Marsha R. (Editor)

1988-01-01

This report contains the results of a conference convened May 10-11, 1988, to review plans for monitoring the Space Station induced environment, to recommend primary components of an induced environment monitoring package, and to make recommendations pertaining to suggested modifications of the Space Station External Contamination Control Requirements Document JSC 30426. The contents of this report are divided as Follows: Monitoring Induced Environment - Space Station Work Packages Requirements, Neutral Environment, Photon Emission Environment, Particulate Environment, Surface Deposition/Contamination; and Contamination Control Requirements.

Industrial wind turbine post-construction bird and bat monitoring: A policy framework for Canada.

PubMed

Parisé, Jason; Walker, Tony R

2017-10-01

Electricity generation from wind energy has proliferated throughout North America and will continue to grow. Given Canada's expected increase in wind energy capacity, consideration of the potential adverse impacts to bird and bat populations is prudent given their sensitivity to these projects. The province of Ontario, Canada is currently the leading jurisdiction for wind energy development, and for provincial guidance on pre- and post-construction monitoring. With uniform monitoring guidance in Ontario, wind energy proponents, and third-party consultants, have developed post-construction monitoring protocols that meet provincial guidance, while also providing standardized reporting. In Atlantic Canada, post-construction guidelines vary between provinces, depending mostly on guidance from the Environment Canada Canadian Wildlife Service and relevant provincial agencies. To ensure quality post-construction monitoring results in Atlantic Canada and other provinces, it is imperative that all Canadian provinces adopt similar approaches to those employed in Ontario. This paper reviews major causes of bird and bat mortalities; reviews Canadian federal and Ontario provincial bird and bat monitoring guidelines to elucidate gaps between environmental assessment (EA) theory and application; summarizes post-construction monitoring protocols from eight bird and bat post-construction monitoring programs used in Ontario; and, proposes recommendations to support future wind development opportunities across Canada and specifically in Atlantic Canada. Copyright © 2017 Elsevier Ltd. All rights reserved.

EEG Monitoring Technique Influences the Management of Hypoxic-Ischemic Seizures in Neonates Undergoing Therapeutic Hypothermia.

PubMed

Jan, Saber; Northington, Frances J; Parkinson, Charlamaine M; Stafstrom, Carl E

2017-01-01

Electroencephalogram (EEG) monitoring techniques for neonatal hypoxia-ischemia (HI) are evolving over time, and the specific type of EEG utilized could influence seizure diagnosis and management. We examined whether the type of EEG performed affected seizure treatment decisions (e.g., the choice and number of antiseizure drugs [ASDs]) in therapeutic hypothermia-treated neonates with HI from 2007 to 2015 in the Johns Hopkins Hospital Neonatal Intensive Care Unit. During this period, 3 different EEG monitoring protocols were utilized: Period 1 (2007-2009), single, brief conventional EEG (1 h duration) at a variable time during therapeutic hypothermia treatment, i.e., ordered when a seizure was suspected; Period 2 (2009-2013), single, brief conventional EEG followed by amplitude-integrated EEG for the duration of therapeutic hypothermia treatment and another brief conventional EEG after rewarming; and Period 3 (2014-2015), continuous video-EEG (cEEG) for the duration of therapeutic hypothermia treatment (72 h) plus for an additional 12 h during and after rewarming. One hundred and sixty-two newborns were included in this retrospective cohort study. As a function of the type and duration of EEG monitoring, we assessed the risk (likelihood) of receiving no ASD, at least 1 ASD, or ≥2 ASDs. We found that the risk of a neonate being prescribed an ASD was 46% less during Period 3 (cEEG) than during Period 1 (brief conventional EEG only) (95% CI 6-69%, p = 0.03). After adjusting for initial EEG and MRI results, compared with Period 1, there was a 38% lower risk of receiving an ASD during Period 2 (95% CI: 9-58%, p = 0.02) and a 67% lower risk during Period 3 (95% CI: 23-86%, p = 0.01). The risk ratio of receiving ≥2 ASDs was not significantly different across the 3 periods. In conclusion, in addition to the higher sensitivity and specificity of continuous video-EEG monitoring, fewer infants are prescribed an ASD when undergoing continuous forms of EEG monitoring (aEEG or cEEG) than those receiving conventional EEG. We recommend that use of continuous video-EEG be considered whenever possible, both to treat seizures more specifically and to avoid overtreatment. © 2017 S. Karger AG, Basel.

Deriving a GPS Monitoring Time Recommendation for Physical Activity Studies of Adults.

PubMed

Holliday, Katelyn M; Howard, Annie Green; Emch, Michael; Rodríguez, Daniel A; Rosamond, Wayne D; Evenson, Kelly R

2017-05-01

Determining locations of physical activity (PA) is important for surveillance and intervention development, yet recommendations for using location recording tools like global positioning system (GPS) units are lacking. Specifically, no recommendation exists for the number of days study participants should wear a GPS to reliably estimate PA time spent in locations. This study used data from participants (N = 224, age = 18-85 yr) in five states who concurrently wore an ActiGraph GT1M accelerometer and a Qstarz BT-Q1000X GPS for three consecutive weeks to construct monitoring day recommendations through variance partitioning methods. PA bouts ≥10 min were constructed from accelerometer counts, and the location of GPS points was determined using a hand-coding protocol. Monitoring day recommendations varied by the type of location (e.g., participant homes vs parks) and the intensity of PA bouts considered (low and medium cut point moderate to vigorous PA [MVPA] bouts or high cut point vigorous PA [VPA] bouts). In general, minutes of all PA intensities spent in a given location could be measured with ≥80% reliability using 1-3 d of GPS monitoring for fitness facilities, schools, and footpaths. MVPA bout minutes in parks and roads required longer monitoring periods of 5-12 d. PA in homes and commercial areas required >19 d of monitoring. Twelve days of monitoring was found to reliably estimate minutes in both low and medium threshold MVPA as well as VPA bouts for many important built environment locations that can be targeted to increase PA at the population level. Minutes of PA in the home environment and commercial locations may be best assessed through other means given the lengthy estimated monitoring time required.

40 CFR 63.7747 - How do I apply for alternative monitoring requirements for a continuous emissions monitoring system?

Code of Federal Regulations, 2011 CFR

2011-07-01

... monitoring requirements for a continuous emissions monitoring system? 63.7747 Section 63.7747 Protection of... apply for alternative monitoring requirements for a continuous emissions monitoring system? (a) You may... prevention technique, a description of the continuous monitoring system or method including appropriate...

40 CFR 63.7747 - How do I apply for alternative monitoring requirements for a continuous emissions monitoring system?

Code of Federal Regulations, 2010 CFR

2010-07-01

... monitoring requirements for a continuous emissions monitoring system? 63.7747 Section 63.7747 Protection of... apply for alternative monitoring requirements for a continuous emissions monitoring system? (a) You may... prevention technique, a description of the continuous monitoring system or method including appropriate...

Monitoring inflammation (including fever) in acute brain injury.

PubMed

Provencio, J Javier; Badjatia, Neeraj

2014-12-01

Inflammation is an important part of the normal physiologic response to acute brain injury (ABI). How inflammation is manifest determines if it augments or hinders the resolution of ABI. Monitoring body temperature, the cellular arm of the inflammatory cascade, and inflammatory proteins may help guide therapy. This summary will address the utility of inflammation monitoring in brain-injured adults. An electronic literature search was conducted for English language articles describing the testing, utility, and optimal methods to measure inflammation in ABI. Ninety-four articles were included in this review. Current evidence suggests that control of inflammation after ABI may hold promise for advances in good outcomes. However, our understanding of how much inflammation is good and how much is deleterious is not yet clear. Several important concepts emerge form our review. First, while continuous temperature monitoring of core body temperature is recommended, temperature pattern alone is not useful in distinguishing infectious from noninfectious fever. Second, when targeted temperature management is used, shivering should be monitored at least hourly. Finally, white blood cell levels and protein markers of inflammation may have a limited role in distinguishing infectious from noninfectious fever. Our understanding of optimal use of inflammation monitoring after ABI is limited currently but is an area of active investigation.

Best Practices for Robotic Surgery Programs

PubMed Central

Goldenberg, David; Winder, Joshua S.; Juza, Ryan M.; Lyn-Sue, Jerome R.

2017-01-01

Background and Objectives: Robotic surgical programs are increasing in number. Efficient methods by which to monitor and evaluate robotic surgery teams are needed. Methods: Best practices for an academic university medical center were created and instituted in 2009 and continue to the present. These practices have led to programmatic development that has resulted in a process that effectively monitors leadership team members; attending, resident, fellow, and staff training; credentialing; safety metrics; efficiency; and case volume recommendations. Results: Guidelines for hospitals and robotic directors that can be applied to one's own robotic surgical services are included with examples of management of all aspects of a multispecialty robotic surgery program. Conclusion: The use of these best practices will ensure a robotic surgery program that is successful and well positioned for a safe and productive environment for current clinical practice. PMID:28729780

40 CFR 60.1250 - What is my schedule for evaluating continuous emission monitoring systems?

Code of Federal Regulations, 2011 CFR

2011-07-01

... continuous emission monitoring systems? 60.1250 Section 60.1250 Protection of Environment ENVIRONMENTAL... Continuous Emission Monitoring § 60.1250 What is my schedule for evaluating continuous emission monitoring systems? (a) Conduct annual evaluations of your continuous emission monitoring systems no more than 13...

Equity-Oriented Monitoring in the Context of Universal Health Coverage

PubMed Central

Hosseinpoor, Ahmad Reza; Bergen, Nicole; Koller, Theadora; Prasad, Amit; Schlotheuber, Anne; Valentine, Nicole; Lynch, John; Vega, Jeanette

2014-01-01

Monitoring inequalities in health is fundamental to the equitable and progressive realization of universal health coverage (UHC). A successful approach to global inequality monitoring must be intuitive enough for widespread adoption, yet maintain technical credibility. This article discusses methodological considerations for equity-oriented monitoring of UHC, and proposes recommendations for monitoring and target setting. Inequality is multidimensional, such that the extent of inequality may vary considerably across different dimensions such as economic status, education, sex, and urban/rural residence. Hence, global monitoring should include complementary dimensions of inequality (such as economic status and urban/rural residence) as well as sex. For a given dimension of inequality, subgroups for monitoring must be formulated taking into consideration applicability of the criteria across countries and subgroup heterogeneity. For economic-related inequality, we recommend forming subgroups as quintiles, and for urban/rural inequality we recommend a binary categorization. Inequality spans populations, thus appropriate approaches to monitoring should be based on comparisons between two subgroups (gap approach) or across multiple subgroups (whole spectrum approach). When measuring inequality absolute and relative measures should be reported together, along with disaggregated data; inequality should be reported alongside the national average. We recommend targets based on proportional reductions in absolute inequality across populations. Building capacity for health inequality monitoring is timely, relevant, and important. The development of high-quality health information systems, including data collection, analysis, interpretation, and reporting practices that are linked to review and evaluation cycles across health systems, will enable effective global and national health inequality monitoring. These actions will support equity-oriented progressive realization of UHC. PMID:25243463

[Equity-oriented monitoring in the context of universal health coverage].

PubMed

Hosseinpoor, Ahmad Reza; Bergen, Nicole; Koller, Theadora; Prasad, Amit; Schlotheuber, Anne; Valentine, Nicole; Lynch, John; Vega, Jeanette

2015-07-01

Monitoring inequalities in health is fundamental to the equitable and progressive realization of universal health coverage (UHC). A successful approach to global inequality monitoring must be intuitive enough for widespread adoption, yet maintain technical credibility. This article discusses methodological considerations for equity-oriented monitoring of UHC, and proposes recommendations for monitoring and target setting. Inequality is multidimensional, such that the extent of inequality may vary considerably across different dimensions such as economic status, education, sex, and urban/rural residence. Hence, global monitoring should include complementary dimensions of inequality (such as economic status and urban/rural residence) as well as sex. For a given dimension of inequality, subgroups for monitoring must be formulated taking into consideration applicability of the criteria across countries and subgroup heterogeneity. For economic-related inequality, we recommend forming subgroups as quintiles, and for urban/rural inequality we recommend a binary categorization. Inequality spans populations, thus appropriate approaches to monitoring should be based on comparisons between two subgroups (gap approach) or across multiple subgroups (whole spectrum approach). When measuring inequality absolute and relative measures should be reported together, along with disaggregated data; inequality should be reported alongside the national average. We recommend targets based on proportional reductions in absolute inequality across populations. Building capacity for health inequality monitoring is timely, relevant, and important. The development of high-quality health information systems, including data collection, analysis, interpretation, and reporting practices that are linked to review and evaluation cycles across health systems, will enable effective global and national health inequality monitoring. These actions will support equity-oriented progressive realization of UHC.

The U.S. Department of Veterans' Affairs depleted uranium exposed cohort at 25 Years: Longitudinal surveillance results

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

McDiarmid, Melissa A.; Gaitens, Joanna M.; Hines,

Background: A small group of Gulf War I veterans wounded in depleted uranium (DU) friendly-fire incidents have been monitored for health changes in a clinical surveillance program at the Veterans Affairs Medical Center, Baltimore since 1994. Methods: During the spring of 2015, an in-patient clinical surveillance protocol was performed on 36 members of the cohort, including exposure monitoring for total and isotopic uranium concentrations in urine and a comprehensive assessment of health outcomes. Results: On-going mobilization of U from embedded fragments is evidenced by elevated urine U concentrations. The DU isotopic signature is observed principally in participants possessing embedded fragments.more » Those with only an inhalation exposure have lower urine U concentration and a natural isotopic signature. Conclusions: At 25 years since first exposure to DU, an aging cohort of military veterans continues to show no U-related health effects in known target organs of U toxicity. As U body burden continues to accrue from in-situ mobilization from metal fragment depots, and increases with exposure duration, critical tissue-specific U concentration thresholds may be reached, thus recommending on-going surveillance of this veteran cohort. - Highlights: • Gulf War I veterans wounded with depleted uranium are monitored for health changes. • In 2015 in-patient clinical surveillance was performed on 36 members of the cohort. • Mobilization of U from embedded fragments is evidenced by elevated U in urine. • This cohort of continues to show no U-related health effects.« less

40 CFR 60.3040 - What is my schedule for evaluating continuous emission monitoring systems?

Code of Federal Regulations, 2010 CFR

2010-07-01

... continuous emission monitoring systems? 60.3040 Section 60.3040 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) STANDARDS OF PERFORMANCE FOR NEW STATIONARY SOURCES... continuous emission monitoring systems? (a) Conduct annual evaluations of your continuous emission monitoring...

These Shoes Are Made for Walking: Sensitivity Performance Evaluation of Commercial Activity Monitors under the Expected Conditions and Circumstances Required to Achieve the International Daily Step Goal of 10,000 Steps

PubMed Central

O’Connell, Sandra; ÓLaighin, Gearóid; Kelly, Lisa; Murphy, Elaine; Beirne, Sorcha; Burke, Niall; Kilgannon, Orlaith; Quinlan, Leo R.

2016-01-01

Introduction Physical activity is a vitally important part of a healthy lifestyle, and is of major benefit to both physical and mental health. A daily step count of 10,000 steps is recommended globally to achieve an appropriate level of physical activity. Accurate quantification of physical activity during conditions reflecting those needed to achieve the recommended daily step count of 10,000 steps is essential. As such, we aimed to assess four commercial activity monitors for their sensitivity/accuracy in a prescribed walking route that reflects a range of surfaces that would typically be used to achieve the recommended daily step count, in two types of footwear expected to be used throughout the day when aiming to achieve the recommended daily step count, and in a timeframe required to do so. Methods Four commercial activity monitors were worn simultaneously by participants (n = 15) during a prescribed walking route reflective of surfaces typically encountered while achieving the daily recommended 10,000 steps. Activity monitors tested were the Garmin Vivofit ™, New Lifestyles’ NL-2000 ™ pedometer, Withings Smart Activity Monitor Tracker (Pulse O2) ™, and Fitbit One ™. Results All activity monitors tested were accurate in their step detection over the variety of different surfaces tested (natural lawn grass, gravel, ceramic tile, tarmacadam/asphalt, linoleum), when wearing both running shoes and hard-soled dress shoes. Conclusion All activity monitors tested were accurate in their step detection sensitivity and are valid monitors for physical activity quantification over the variety of different surfaces tested, when wearing both running shoes and hard-soled dress shoes, and over a timeframe necessary for accumulating the recommended daily step count of 10,000 steps. However, it is important to consider the accuracy of activity monitors, particularly when physical activity in the form of stepping activities is prescribed as an intervention in the treatment or prevention of a disease state. PMID:27167121

Postnatal hypothermia and cold stress among newborn infants in Nepal monitored by continuous ambulatory recording.

PubMed

Ellis, M; Manandhar, N; Shakya, U; Manandhar, D S; Fawdry, A; Costello, A M

1996-07-01

To describe the pattern of hypothermia and cold stress after delivery among a normal neonatal population in Nepal; to provide practical advice for improving thermal care in a resource limited maternity hospital. The principal government funded maternity hospital in Kathmandu, Nepal, with an annual delivery rate of 15,000 (constituting 40% of all Kathmandu Valley deliveries), severe resource limitations (annual budget Pounds 250,000), and a cold winter climate provided the setting. Thirty five healthy term neonates not requiring special care were enrolled for study within 90 minutes of birth. Continuous ambulatory temperature monitoring, using microthermistor skin probes for forehead and axilla, a flexible rectal probe, and a black ball probe placed next to the infant for ambient temperature, was carried out. All probes were connected to a compact battery powered Squirrel Memory Logger, giving a temperature reading to 0.2 degree C at five minute intervals for 24 hours. Severity and duration of hypothermia, using cutoff values of core temperature less than 36 degrees C, 34 degrees C, and 32 degrees C; and cold stress, using cutoff values of skin-core (forehead-axilla) temperature difference greater than 3 degrees C and 4 degrees C were the main outcome measures. Twenty four hour mean ambient temperatures were generally lower than the WHO recommended level of 25 degrees C (median 22.3 degrees C, range 15.1-27.5 degrees C). Postnatal hypothermia was prolonged, with axillary core temperatures only reaching 36 degrees C after a mean of 6.4 hours (range 0-21.1; SD 4.6). There was persistent and increasing cold stress over the first 24 hours with the core-skin (axillary-forehead) temperature gap exceeding 3 degrees C for more than half of the first 24 hours. Continuous ambulatory recording identifies weak links in the "warm chain" for neonates. The severity and duration of thermal problems was greater than expected even in a hospital setting where some of the WHO recommendations had already been implemented.

Radiation exposure to the operator performing cardiac angiography with U-arm systems

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

Balter, S.; Sones, F.M. Jr.; Brancato, R.

The radiation exposure received by a group of operators performing 700 coronary angiograms was measured using the brachial artery approach and the Philips Cardio Diagnost. Nineteen sites were monitored on each operator, using lithium fluoride thermoluminescent dosimeters. Four hundred examinations were performed with a table-mounted protective shield in place. Three hundred were performed without the shield. The average exposures (in mR per study) with and without the shield were 1.9/6 for the eyes and 1.4/8.3 for the thyroid. The resulting operator exposure with the shield in place is low enough so that an operator performing 25 procedures per week onmore » a continuous basis will not exceed the recommendations of the National Commission on Radiological Protection and Units. We therefore strongly recommend the use of properly designed and appropriately positioned shield with all U-arm systems.« less

Radiation exposure to the operator performing cardiac angiography with U-arm systems

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

Balter, S.; Sones, F.M. Jr.; Brancato, R.

We measured the radiation exposure received by a group of operators performing 700 coronary angiograms. All studies were performed using the brachial artery approach and the Philips Cardio Diagnost. Nineteen sites were monitored on each operator, using lithium fluoride thermoluminescent dosimeters. Four hundred examinations were performed with a table-mounted protective shield in place. Three hundred were performed without the shield. The averge exposures (in mR per study) with and without the shield were 1.9/6 for the eyes and 1.4/8.3 for the thyroid. The resulting operator exposure with the shield in place is low enough so that an operator performing 25more » procedures per week on a continuous basis will not exceed the recommendations of the National Commission on Radiological Protection and Units. We therefore strongly recommend the use of properly designed and appropriately positioned shield with all U-arm systems.« less

Hemodialysis and water quality.

PubMed

Coulliette, Angela D; Arduino, Matthew J

2013-01-01

Over 383,900 individuals in the U.S. undergo maintenance hemodialysis that exposes them to water, primarily in the form of dialysate. The quality of water and associated dialysis solutions have been implicated in adverse patient outcomes and is therefore critical. The Association for the Advancement of Medical Instrumentation has published both standards and recommended practices that address both water and the dialyzing solutions. Some of these recommendations have been adopted into Federal Regulations by the Centers for Medicare and Medicaid Services as part of the Conditions for Coverage, which includes limits on specific contaminants within water used for dialysis, dialysate, and substitution fluids. Chemical, bacterial, and endotoxin contaminants are health threats to dialysis patients, as shown by the continued episodic nature of outbreaks since the 1960s causing at least 592 cases and 16 deaths in the U.S. The importance of the dialysis water distribution system, current standards and recommendations, acceptable monitoring methods, a review of chemical, bacterial, and endotoxin outbreaks, and infection control programs are discussed. Published 2013. This article is a U.S. Government work and is in the public domain in the USA.

Anesthesia for fetal surgery.

PubMed

Hoagland, Monica A; Chatterjee, Debnath

2017-04-01

Fetal therapy is an exciting and growing field of medicine. Advances in prenatal imaging and continued innovations in surgical and anesthetic techniques have resulted in a wide range of fetal interventions including minimally invasive, open mid-gestation, and ex-utero intrapartum treatment procedures. The potential for maternal morbidity is significant and must be carefully weighed against claimed benefits to the fetus. Appropriate patient selection is critical, and a multidisciplinary team-based approach is strongly recommended. The anesthetic management should focus on maintaining uteroplacental circulation, achieving profound uterine relaxation, optimizing surgical conditions, monitoring fetal hemodynamics, and minimizing maternal and fetal risk. © 2017 John Wiley & Sons Ltd.

Tight glycemic control in the ICU - is the earth flat?

PubMed

Steil, Garry M; Agus, Michael S D

2014-06-27

Tight glycemic control in the ICU has been shown to reduce mortality in some but not all prospective randomized control trials. Confounding the interpretation of these studies are differences in how the control was achieved and underlying incidence of hypoglycemia, which can be expected to be affected by the introduction of continuous glucose monitoring (CGM). In this issue of Critical Care, a consensus panel provides a list of the research priorities they believe are needed for CGM to become routine practice in the ICU. We reflect on these recommendations and consider the implications for using CGM today.

Development and Evaluation of a Mobile Personalized Blood Glucose Prediction System for Patients With Gestational Diabetes Mellitus.

PubMed

Pustozerov, Evgenii; Popova, Polina; Tkachuk, Aleksandra; Bolotko, Yana; Yuldashev, Zafar; Grineva, Elena

2018-01-09

Personalized blood glucose (BG) prediction for diabetes patients is an important goal that is pursued by many researchers worldwide. Despite many proposals, only a few projects are dedicated to the development of complete recommender system infrastructures that incorporate BG prediction algorithms for diabetes patients. The development and implementation of such a system aided by mobile technology is of particular interest to patients with gestational diabetes mellitus (GDM), especially considering the significant importance of quickly achieving adequate BG control for these patients in a short period (ie, during pregnancy) and a typically higher acceptance rate for mobile health (mHealth) solutions for short- to midterm usage. This study was conducted with the objective of developing infrastructure comprising data processing algorithms, BG prediction models, and an appropriate mobile app for patients' electronic record management to guide BG prediction-based personalized recommendations for patients with GDM. A mobile app for electronic diary management was developed along with data exchange and continuous BG signal processing software. Both components were coupled to obtain the necessary data for use in the personalized BG prediction system. Necessary data on meals, BG measurements, and other events were collected via the implemented mobile app and continuous glucose monitoring (CGM) system processing software. These data were used to tune and evaluate the BG prediction model, which included an algorithm for dynamic coefficients tuning. In the clinical study, 62 participants (GDM: n=49; control: n=13) took part in a 1-week monitoring trial during which they used the mobile app to track their meals and self-measurements of BG and CGM system for continuous BG monitoring. The data on 909 food intakes and corresponding postprandial BG curves as well as the set of patients' characteristics (eg, glycated hemoglobin, body mass index [BMI], age, and lifestyle parameters) were selected as inputs for the BG prediction models. The prediction results by the models for BG levels 1 hour after food intake were root mean square error=0.87 mmol/L, mean absolute error=0.69 mmol/L, and mean absolute percentage error=12.8%, which correspond to an adequate prediction accuracy for BG control decisions. The mobile app for the collection and processing of relevant data, appropriate software for CGM system signals processing, and BG prediction models were developed for a recommender system. The developed system may help improve BG control in patients with GDM; this will be the subject of evaluation in a subsequent study. ©Evgenii Pustozerov, Polina Popova, Aleksandra Tkachuk, Yana Bolotko, Zafar Yuldashev, Elena Grineva. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 09.01.2018.

40 CFR 60.1275 - What additional requirements must I meet for the operation of my continuous emission monitoring...

Code of Federal Regulations, 2010 CFR

2010-07-01

... meet for the operation of my continuous emission monitoring systems and continuous opacity monitoring... additional requirements must I meet for the operation of my continuous emission monitoring systems and continuous opacity monitoring system? Use the required span values and applicable performance specifications...

40 CFR 60.1275 - What additional requirements must I meet for the operation of my continuous emission monitoring...

Code of Federal Regulations, 2011 CFR

2011-07-01

... meet for the operation of my continuous emission monitoring systems and continuous opacity monitoring... additional requirements must I meet for the operation of my continuous emission monitoring systems and continuous opacity monitoring system? Use the required span values and applicable performance specifications...

Aerospace safety advisory panel

NASA Technical Reports Server (NTRS)

1995-01-01

The Aerospace Safety Advisory Panel (ASAP) monitored NASA's activities and provided feedback to the NASA Administrator, other NASA officials and Congress throughout the year. Particular attention was paid to the Space Shuttle, its launch processing and planned and potential safety improvements. The Panel monitored Space Shuttle processing at the Kennedy Space Center (KSC) and will continue to follow it as personnel reductions are implemented. There is particular concern that upgrades in hardware, software, and operations with the potential for significant risk reduction not be overlooked due to the extraordinary budget pressures facing the agency. The authorization of all of the Space Shuttle Main Engine (SSME) Block II components portends future Space Shuttle operations at lower risk levels and with greater margins for handling unplanned ascent events. Throughout the year, the Panel attempted to monitor the safety activities related to the Russian involvement in both space and aeronautics programs. This proved difficult as the working relationships between NASA and the Russians were still being defined as the year unfolded. NASA's concern for the unique safety problems inherent in a multi-national endeavor appears appropriate. Actions are underway or contemplated which should be capable of identifying and rectifying problem areas. The balance of this report presents 'Findings and Recommendations' (Section 2), 'Information in Support of Findings and Recommendations' (Section 3) and Appendices describing Panel membership, the NASA response to the March 1994 ASAP report, and a chronology of the panel's activities during the reporting period (Section 4).

Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines on Intraoperative Cranial Nerve Monitoring in Vestibular Schwannoma Surgery.

PubMed

Vivas, Esther X; Carlson, Matthew L; Neff, Brian A; Shepard, Neil T; McCracken, D Jay; Sweeney, Alex D; Olson, Jeffrey J

2018-02-01

Does intraoperative facial nerve monitoring during vestibular schwannoma surgery lead to better long-term facial nerve function? This recommendation applies to adult patients undergoing vestibular schwannoma surgery regardless of tumor characteristics. Level 3: It is recommended that intraoperative facial nerve monitoring be routinely utilized during vestibular schwannoma surgery to improve long-term facial nerve function. Can intraoperative facial nerve monitoring be used to accurately predict favorable long-term facial nerve function after vestibular schwannoma surgery? This recommendation applies to adult patients undergoing vestibular schwannoma surgery. Level 3: Intraoperative facial nerve can be used to accurately predict favorable long-term facial nerve function after vestibular schwannoma surgery. Specifically, the presence of favorable testing reliably portends a good long-term facial nerve outcome. However, the absence of favorable testing in the setting of an anatomically intact facial nerve does not reliably predict poor long-term function and therefore cannot be used to direct decision-making regarding the need for early reinnervation procedures. Does an anatomically intact facial nerve with poor electromyogram (EMG) electrical responses during intraoperative testing reliably predict poor long-term facial nerve function? This recommendation applies to adult patients undergoing vestibular schwannoma surgery. Level 3: Poor intraoperative EMG electrical response of the facial nerve should not be used as a reliable predictor of poor long-term facial nerve function. Should intraoperative eighth cranial nerve monitoring be used during vestibular schwannoma surgery? This recommendation applies to adult patients undergoing vestibular schwannoma surgery with measurable preoperative hearing levels and tumors smaller than 1.5 cm. Level 3: Intraoperative eighth cranial nerve monitoring should be used during vestibular schwannoma surgery when hearing preservation is attempted. Is direct monitoring of the eighth cranial nerve superior to the use of far-field auditory brain stem responses? This recommendation applies to adult patients undergoing vestibular schwannoma surgery with measurable preoperative hearing levels and tumors smaller than 1.5 cm. Level 3: There is insufficient evidence to make a definitive recommendation.  The full guideline can be found at: https://www.cns.org/guidelines/guidelines-manage-ment-patients-vestibular-schwannoma/chapter_4. Copyright © 2017 by the Congress of Neurological Surgeons

The Value of Continuous ST-Segment Monitoring in the Emergency Department.

PubMed

Bovino, Leonie Rose; Funk, Marjorie; Pelter, Michele M; Desai, Mayur M; Jefferson, Vanessa; Andrews, Laura Kierol; Forte, Kenneth

2015-01-01

Practice standards for electrocardiographic monitoring recommend continuous ST-segment monitoring (C-STM) in patients presenting to the emergency department (ED) with signs and/or symptoms of acute coronary syndrome (ACS), but few studies have evaluated its use in the ED. We compared time to diagnosis and 30-day adverse events before and after implementation of C-STM. We also evaluated the diagnostic accuracy of C-STM in detecting ischemia and infarction. We prospectively studied 163 adults (preintervention: n = 78; intervention: n = 85) in a single ED and stratified them into low (n = 51), intermediate (n = 100), or high (n = 12) risk using History, ECG, Age, Risk factors, and Troponin (HEART) scores. The principal investigator monitored participants, activating C-STM on bedside monitors in the intervention phase. We used likelihood ratios (LRs) as the measure of diagnostic accuracy. Overall, 9% of participants were diagnosed with ACS. Median time to diagnosis did not differ before and after implementation of C-STM (5.55 vs. 5.98 hr; p = 0.43). In risk-stratified analyses, no significant pre-/postdifference in time to diagnosis was found in low-, intermediate-, or high-risk participants. There was no difference in the rate of 30-day adverse events before versus after C-STM implementation (11.5% vs. 10.6%; p = 0.85). The +LR and -LR of C-STM for ischemia were 24.0 (95% confidence interval [CI]: 1.4, 412.0) and 0.3 (95% CI: 0.02, 2.9), respectively, and for infarction were 13.7 (95% CI: 1.7, 112.3) and 0.7 (95% CI: 0.3, 1.5), respectively. Use of C-STM did not provide added diagnostic benefit for patients with signs and/or symptoms of myocardial ischemia in the ED.

Knowledge-Acquisition Tool For Expert System

NASA Technical Reports Server (NTRS)

Disbrow, James D.; Duke, Eugene L.; Regenie, Victoria A.

1988-01-01

Digital flight-control systems monitored by computer program that evaluates and recommends. Flight-systems engineers for advanced, high-performance aircraft use knowlege-acquisition tool for expert-system flight-status monitor suppling interpretative data. Interpretative function especially important in time-critical, high-stress situations because it facilitates problem identification and corrective strategy. Conditions evaluated and recommendations made by ground-based engineers having essential knowledge for analysis and monitoring of performances of advanced aircraft systems.

Combining malaria control with house electrification: adherence to recommended behaviours for proper deployment of solar-powered mosquito trapping systems, Rusinga Island, western Kenya.

PubMed

Oria, Prisca A; Alaii, Jane; Ayugi, Margaret; Takken, Willem; Leeuwis, Cees

2015-08-01

To investigate community adherence to recommended behaviours for proper deployment of solar-powered mosquito trapping systems (SMoTS) after 3- to 10-week use. Solar-powered mosquito trapping system, which also provided power for room lighting and charging mobile phones, were installed in houses in Rusinga Island, western Kenya. We used a structured checklist for observations and a semi-structured questionnaire for interviews in 24 homesteads. We also analysed the subject of 224 community calls to the project team for technical maintenance of SMoTS. Most respondents cared for SMoTS by fencing, emptying and cleaning the trap. Our observations revealed that most traps were fenced, clean and in good working condition. A significantly higher proportion of community calls was lighting-related. Lighting was the main reason respondents liked SMoTS because it reduced or eliminated expenditure on kerosene. However, some respondents observed they no longer heard sounds of mosquitoes inside their houses. All respondents reportedly slept under insecticide-treated nets (ITNs) before receiving SMoTS. After receiving SMoTS, most respondents reportedly continued to use ITNs citing that the project advised them to do so. Some beach residents stopped using ITNs because they no longer heard mosquitoes or due to heat discomfort caused by lights. Electricity-related incentives played a greater role in encouraging adherence to recommended behaviours for proper deployment of SMoTS than the potential health benefits in the early stages of the intervention. Although energy-related financial incentives may play a role, they are insufficient to ensure adherence to health advice, even in the short term. Ongoing community engagement and research monitors and addresses adherence to recommended behaviours including continuation of current malaria control strategies. © 2015 John Wiley & Sons Ltd.

Recommendations on the diagnosis, treatment and monitoring of late-onset hypogonadism in men - a suggested update.

PubMed

Lunenfeld, Bruno; Mskhalaya, George; Kalinchenko, Svetlana; Tishova, Yulia

2013-12-01

Recommendations on the diagnosis, treatment and monitoring of late-onset hypogonadism (LOH) in men were first published by ISSAM in 2002 In 2005, and, in 2008, updated recommendations were published in the International Journal of Andrology, the Journal of Andrology, the Aging Male and European Urology. Towards discussions at the next ISSAM/ESSAM meeting in Moscow, 29 November 2013, we suggest the following update.

PROTECTING HEALTH WITH SAME DAY WATER QUALITY MONITORING RESULTS FOR BATHING BEACHES

EPA Science Inventory

Current US Environmental Protection Agency guidelines recommend the use of cultural methods for E. coli and enterococci to monitor beach water quality. The guidelines recommend a single sample value or a geometric mean value from at least five samples. The single sample guideli...

40 CFR 60.2941 - What is my schedule for evaluating continuous emission monitoring systems?

Code of Federal Regulations, 2010 CFR

2010-07-01

... continuous emission monitoring systems? 60.2941 Section 60.2941 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) STANDARDS OF PERFORMANCE FOR NEW STATIONARY SOURCES... emission monitoring systems? (a) Conduct annual evaluations of your continuous emission monitoring systems...

40 CFR 60.3040 - What is my schedule for evaluating continuous emission monitoring systems?

Code of Federal Regulations, 2011 CFR

2011-07-01

... continuous emission monitoring systems? 60.3040 Section 60.3040 Protection of Environment ENVIRONMENTAL... continuous emission monitoring systems? (a) Conduct annual evaluations of your continuous emission monitoring... emission monitoring systems daily and quarterly as specified in appendix F of this part. ...

40 CFR 60.2939 - What continuous emission monitoring systems must I install?

Code of Federal Regulations, 2010 CFR

2010-07-01

... and Qualification Monitoring § 60.2939 What continuous emission monitoring systems must I install? (a) You must install, calibrate, maintain, and operate continuous emission monitoring systems for carbon... carbon monoxide. (b) You must install, evaluate, and operate each continuous emission monitoring system...

40 CFR 60.2939 - What continuous emission monitoring systems must I install?

Code of Federal Regulations, 2011 CFR

2011-07-01

... and Qualification Monitoring § 60.2939 What continuous emission monitoring systems must I install? (a) You must install, calibrate, maintain, and operate continuous emission monitoring systems for carbon... carbon monoxide. (b) You must install, evaluate, and operate each continuous emission monitoring system...

Monitoring guidance for patients with hypophosphatasia treated with asfotase alfa.

PubMed

Kishnani, Priya S; Rush, Eric T; Arundel, Paul; Bishop, Nick; Dahir, Kathryn; Fraser, William; Harmatz, Paul; Linglart, Agnès; Munns, Craig F; Nunes, Mark E; Saal, Howard M; Seefried, Lothar; Ozono, Keiichi

2017-09-01

Hypophosphatasia (HPP) is a rare, inherited, systemic, metabolic disorder caused by autosomal recessive mutations or a single dominant-negative mutation in the gene encoding tissue-nonspecific alkaline phosphatase (TNSALP). The disease is associated with a broad range of signs, symptoms, and complications, including impaired skeletal mineralization, altered calcium and phosphate metabolism, recurrent fractures, pain, respiratory problems, impaired growth and mobility, premature tooth loss, developmental delay, and seizures. Asfotase alfa is a human, recombinant enzyme replacement therapy that is approved in many countries for the treatment of patients with HPP. To address the unmet need for guidance in the monitoring of patients receiving asfotase alfa, an international panel of physicians with experience in diagnosing and managing HPP convened in May 2016 to discuss treatment monitoring parameters. The panel discussions focused on recommendations for assessing and monitoring patients after the decision to treat with asfotase alfa had been made and did not include recommendations for whom to treat. Based on the consensus of panel members, this review provides guidance on the monitoring of patients with HPP during treatment with asfotase alfa, including recommendations for laboratory, efficacy, and safety assessments and the frequency with which these should be performed during the course of treatment. Recommended assessments are based on patient age and include regular monitoring of biochemistry, skeletal radiographs, respiratory function, growth, pain, mobility and motor function, and quality of life. Because of the systemic presentation of HPP, a coordinated, multidisciplinary, team-based, patient-focused approach is recommended in the management of patients receiving asfotase alfa. Monitoring of efficacy and safety outcomes must be tailored to the individual patient, depending on medical history, clinical manifestations, availability of resources in the clinical setting, and the clinician's professional judgment. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

Assessing the availability of LLINs for continuous distribution through routine antenatal care and the Expanded Programme on Immunizations in sub-Saharan Africa.

PubMed

Theiss-Nyland, Katherine; Lynch, Michael; Lines, Jo

2016-05-04

In addition to mass distribution campaigns, the World Health Organization (WHO) recommends the continuous distribution of long-lasting insecticidal nets (LLINs) to all pregnant women attending antenatal care (ANC) and all infants attending the Expanded Programme on Immunization (EPI) services in countries implementing mosquito nets for malaria control. Countries report LLIN distribution data to the WHO annually. For this analysis, these data were used to assess policy and practice in implementing these recommendations and to compare the numbers of LLINs available through ANC and EPI services with the numbers of women and children attending these services. For each reporting country in sub-Saharan Africa, the presence of a reported policy for LLIN distribution through ANC and EPI was reviewed. Prior to inclusion in the analysis the completeness of data was assessed in terms of the numbers of LLINs distributed through all channels (campaigns, EPI, ANC, other). For each country with adequate data, the numbers of LLINs reportedly distributed by national programmes to ANC was compared to the number of women reportedly attending ANC at least once; the ratio between these two numbers was used as an indicator of LLIN availability at ANC services. The same calculations were repeated for LLINs distributed through EPI to produce the corresponding LLIN availability through this distribution channel. Among 48 malaria-endemic countries in Africa, 33 malaria programmes reported adopting policies of ANC-based continuous distribution of LLINs, and 25 reported adopting policies of EPI-based distribution. Over a 3-year period through 2012, distribution through ANC accounted for 9 % of LLINs distributed, and LLINs distributed through EPI accounted for 4 %. The LLIN availability ratios achieved were 55 % through ANC and 34 % through EPI. For 38 country programmes reporting on LLIN distribution, data to calculate LLIN availability through ANC and EPI was available for 17 and 16, respectively. These continuous LLIN distribution channels appear to be under-utilized, especially EPI-based distribution. However, quality data from more countries are needed for consistent and reliable programme performance monitoring. A greater focus on routine data collection, monitoring and reporting on LLINs distributed through both ANC and EPI can provide insight into both strengths and weaknesses of continuous distribution, and improve the effectiveness of these delivery channels.

40 CFR 60.1235 - How are the data from the continuous emission monitoring systems used?

Code of Federal Regulations, 2010 CFR

2010-07-01

... emission monitoring systems used? 60.1235 Section 60.1235 Protection of Environment ENVIRONMENTAL... Continuous Emission Monitoring § 60.1235 How are the data from the continuous emission monitoring systems used? You must use data from the continuous emission monitoring systems for sulfur dioxide, nitrogen...

40 CFR 60.1235 - How are the data from the continuous emission monitoring systems used?

Code of Federal Regulations, 2011 CFR

2011-07-01

... emission monitoring systems used? 60.1235 Section 60.1235 Protection of Environment ENVIRONMENTAL... Continuous Emission Monitoring § 60.1235 How are the data from the continuous emission monitoring systems used? You must use data from the continuous emission monitoring systems for sulfur dioxide, nitrogen...

Using smart card technology to monitor the eating habits of children in a school cafeteria: 2. The nutrient contents of all meals chosen by a group of 8- to 11-year-old boys over 78 days.

PubMed

Lambert, N; Plumb, J; Looise, B; Johnson, I T; Harvey, I; Wheeler, C; Robinson, M; Rolfe, P

2005-08-01

The aim of the study was to test the abilities of the newly created smart card system to track the nutrient contents of foods chosen over several months by individual diners in a school cafeteria. From the food choice and composition of food data sets, an Access database was created encompassing 30 diners (aged 8-11 years), 78 days and eight nutrients. Data were available for a total of 1909 meals. Based upon population mean values the cohort were clearly choosing meals containing higher than the recommended maximum amounts for sugar and lower than the recommended minimum amounts of fibre, iron and vitamin A. Protein and vitamin C contents of meals chosen were well above minimum requirements. Over the 1909 meals, nutrient requirements were met 41% of the time. The system created was very effective at continually monitoring food choices of individual diners over limitless time. The data generated raised questions on the common practice of presenting nutrient intakes as population mean values calculated over a few days. The impact of heavily fortified foods on such studies in general is discussed.

Surveillance, health promotion and control of Chagas disease in the Amazon Region - Medical attention in the Brazilian Amazon Region: a proposal

PubMed Central

Coura, José Rodrigues; Junqueira, Angela CV

2015-01-01

We refer to Oswaldo Cruz's reports dating from 1913 about the necessities of a healthcare system for the Brazilian Amazon Region and about the journey of Carlos Chagas to 27 locations in this region and the measures that would need to be adopted. We discuss the risks of endemicity of Chagas disease in the Amazon Region. We recommend that epidemiological surveillance of Chagas disease in the Brazilian Amazon Region and Pan-Amazon region should be implemented through continuous monitoring of the human population that lives in the area, their housing, the environment and the presence of triatomines. The monitoring should be performed with periodic seroepidemiological surveys, semi-annual visits to homes by health agents and the training of malaria microscopists and healthcare technicians to identify Trypanosoma cruzi from patients' samples and T. cruzi infection rates among the triatomines caught. We recommend health promotion and control of Chagas disease through public health policies, especially through sanitary education regarding the risk factors for Chagas disease. Finally, we propose a healthcare system through base hospitals, intermediate-level units in the areas of the Brazilian Amazon Region and air transportation, considering the distances to be covered for medical care. PMID:26560976

Continuous Seismic Threshold Monitoring

DTIC Science & Technology

1992-05-31

Continuous threshold monitoring is a technique for using a seismic network to monitor a geographical area continuously in time. The method provides...area. Two approaches are presented. Site-specific monitoring: By focusing a seismic network on a specific target site, continuous threshold monitoring...recorded events at the site. We define the threshold trace for the network as the continuous time trace of computed upper magnitude limits of seismic

Climate Change and Vector Borne Diseases on NASA Langley Research Center

NASA Technical Reports Server (NTRS)

Cole, Stuart K.; DeYoung, Russell J.; Shepanek, Marc A.; Kamel, Ahmed

2014-01-01

Increasing global temperature, weather patterns with above average storm intensities, and higher sea levels have been identified as phenomena associated with global climate change. As a causal system, climate change could contribute to vector borne diseases in humans. Vectors of concern originate from the vicinity of Langley Research Center include mosquitos and ticks that transmit disease that originate regionally, nationwide, or from outside the US. Recognizing changing conditions, vector borne diseases propagate under climate change conditions, and understanding the conditions in which they may exist or propagate, presents opportunities for monitoring their progress and mitigating their potential impacts through communication, continued monitoring, and adaptation. Personnel comprise a direct and fundamental support to NASA mission success, continuous and improved understanding of climatic conditions, and the resulting consequence of disease from these conditions, helps to reduce risk in terrestrial space technologies, ground operations, and space research. This research addresses conditions which are attributed to climatic conditions which promote environmental conditions conducive to the increase of disease vectors. This investigation includes evaluation of local mosquito population count and rainfall data for statistical correlation and identification of planning recommendations unique to LaRC, other NASA Centers to assess adaptation approaches, Center-level planning strategies.

Recommendations for a wind profiling network to support Space Shuttle launches

NASA Technical Reports Server (NTRS)

Zamora, R. J.

1992-01-01

The feasibility is examined of a network of clear air radar wind profilers to forecast wind conditions before Space Shuttle launches during winter. Currently, winds are measured only in the vicinity of the shuttle launch site and wind loads on the launch vehicle are estimated using these measurements. Wind conditions upstream of the Cape are not monitored. Since large changes in the wind shear profile can be associated with weather systems moving over the Cape, it may be possible to improve wind forecasts over the launch site if wind measurements are made upstream. A radar wind profiling system is in use at the Space Shuttle launch site. This system can monitor the wind profile continuously. The existing profiler could be combined with a number of radars located upstream of the launch site. Thus, continuous wind measurements would be available upstream and at the Cape. NASA-Marshall representatives have set the requirements for radar wind profiling network. The minimum vertical resolution of the network must be set so that the wind shears over the depths greater than or = 1 km will be detected. The network should allow scientists and engineers to predict the wind profile over the Cape 6 hours before a Space Shuttle launch.

A Recommender System in the Cyber Defense Domain

DTIC Science & Technology

2014-03-27

monitoring software is a java based program sending updates to the database on the sensor machine. The host monitoring program gathers information about...3.2.2 Database. A MySQL database located on the sensor machine acts as the storage for the sensors on the network. Snort, Nmap, vulnerability scores, and...machine with the IDS and the recommender is labeled “sensor”. The recommender system code is written in java and compiled using java version 1.6.024

Recommendations Service for Chronic Disease Patient in Multimodel Sensors Home Environment

PubMed Central

Hussain, Maqbool; Ali, Taqdir; Khan, Wajahat Ali; Afzal, Muhammad; Latif, Khalid

2015-01-01

Abstract With advanced technologies in hand, there exist potential applications and services built around monitoring activities of daily living (ADL) of elderly people at nursing homes. Most of the elderly people in these facilities are suffering from different chronic diseases such as dementia. Existing technologies are mainly focusing on non-medication interventions and monitoring of ADL for addressing loss of autonomy or well-being. Monitoring and managing ADL related to cognitive behaviors for non-medication intervention are very effective in improving dementia patients' conditions. However, cognitive functions of patients can be improved if appropriate recommendations of medications are delivered at a particular time. Previously we developed the Secured Wireless Sensor Network Integrated Cloud Computing for Ubiquitous-Life Care (SC3). SC3 services were limited to monitoring ADL of elderly people with Alzheimer's disease and providing non-medication recommendations to the patient. In this article, we propose a system called the Smart Clinical Decision Support System (CDSS) as an integral part of the SC3 platform. Using the Smart CDSS, patients are provided with access to medication recommendations of expert physicians. Physicians are provided with an interface to create clinical knowledge for medication recommendations and to observe the patient's condition. The clinical knowledge created by physicians as the knowledge base of the Smart CDSS produces recommendations to the caregiver for medications based on each patient's symptoms. PMID:25559934

Recommendations service for chronic disease patient in multimodel sensors home environment.

PubMed

Hussain, Maqbool; Ali, Taqdir; Khan, Wajahat Ali; Afzal, Muhammad; Lee, Sungyoung; Latif, Khalid

2015-03-01

With advanced technologies in hand, there exist potential applications and services built around monitoring activities of daily living (ADL) of elderly people at nursing homes. Most of the elderly people in these facilities are suffering from different chronic diseases such as dementia. Existing technologies are mainly focusing on non-medication interventions and monitoring of ADL for addressing loss of autonomy or well-being. Monitoring and managing ADL related to cognitive behaviors for non-medication intervention are very effective in improving dementia patients' conditions. However, cognitive functions of patients can be improved if appropriate recommendations of medications are delivered at a particular time. Previously we developed the Secured Wireless Sensor Network Integrated Cloud Computing for Ubiquitous-Life Care (SC(3)). SC(3) services were limited to monitoring ADL of elderly people with Alzheimer's disease and providing non-medication recommendations to the patient. In this article, we propose a system called the Smart Clinical Decision Support System (CDSS) as an integral part of the SC(3) platform. Using the Smart CDSS, patients are provided with access to medication recommendations of expert physicians. Physicians are provided with an interface to create clinical knowledge for medication recommendations and to observe the patient's condition. The clinical knowledge created by physicians as the knowledge base of the Smart CDSS produces recommendations to the caregiver for medications based on each patient's symptoms.

Continuous ultrasound-assisted extraction of hexavalent chromium from soil with or without on-line preconcentration prior to photometric monitoring.

PubMed

Luque-García, J L; Luque de Castro, M D

2002-08-01

A continuous ultrasound-assisted extractor was coupled to a photometric detector in order to obtain a fully automated approach for the determination of CrVI in soil. The use of a flow injection (FI) manifold as interface between the extractor and the photometric detector allowed the monitoring of CrVI after extraction in a continuous manner. The coloured complex formed between 1,5-diphenylcarbazide (DPC) and CrVI was used as recommended in EPA method 7196A because it is one of the most sensitive and selective reactions for CrVI determination. A preconcentration minicolumn packed with a strong anion-exchange resin was placed between the extractor and the detector, providing a more sensitive method. The linear dynamic ranges were 1-10 and 0.25-7.5 mg l-1 for the methods without (method A) and with preconcentration (method B), respectively. The limits of detection were 4.52 ng for method A and 1.23 ng for method B. Both methods were applied to a natural contaminated soil and the results obtained agreed well with those obtained by the reference EPA method 3060A. The influence of different amounts of CrIII in the samples was also studied and the results showed that the proposed methods did not disturb the original species distribution.

40 CFR 62.15180 - How are the data from the continuous emission monitoring systems used?

Code of Federal Regulations, 2010 CFR

2010-07-01

... emission monitoring systems used? 62.15180 Section 62.15180 Protection of Environment ENVIRONMENTAL... Constructed on or Before August 30, 1999 Continuous Emission Monitoring § 62.15180 How are the data from the continuous emission monitoring systems used? You must use data from the continuous emission monitoring...

40 CFR 62.15205 - What minimum amount of monitoring data must I collect with my continuous emission monitoring...

Code of Federal Regulations, 2010 CFR

2010-07-01

... must I collect with my continuous emission monitoring systems and is this requirement enforceable? 62... with my continuous emission monitoring systems and is this requirement enforceable? (a) Where continuous emission monitoring systems are required, obtain 1-hour arithmetic averages. Make sure the...

40 CFR 62.15205 - What minimum amount of monitoring data must I collect with my continuous emission monitoring...

Code of Federal Regulations, 2011 CFR

2011-07-01

... must I collect with my continuous emission monitoring systems and is this requirement enforceable? 62... with my continuous emission monitoring systems and is this requirement enforceable? (a) Where continuous emission monitoring systems are required, obtain 1-hour arithmetic averages. Make sure the...

40 CFR 60.1725 - How are the data from the continuous emission monitoring systems used?

Code of Federal Regulations, 2011 CFR

2011-07-01

... emission monitoring systems used? 60.1725 Section 60.1725 Protection of Environment ENVIRONMENTAL... Before August 30, 1999 Model Rule-Continuous Emission Monitoring § 60.1725 How are the data from the continuous emission monitoring systems used? You must use data from the continuous emission monitoring...

40 CFR 60.2942 - What is the minimum amount of monitoring data I must collect with my continuous emission...

Code of Federal Regulations, 2010 CFR

2010-07-01

... monitoring data I must collect with my continuous emission monitoring systems, and is the data collection... with my continuous emission monitoring systems, and is the data collection requirement enforceable? (a) Where continuous emission monitoring systems are required, obtain 1-hour arithmetic averages. Make sure...

40 CFR 60.3041 - What is the minimum amount of monitoring data I must collect with my continuous emission...

Code of Federal Regulations, 2010 CFR

2010-07-01

... monitoring data I must collect with my continuous emission monitoring systems, and is the data collection... collect with my continuous emission monitoring systems, and is the data collection requirement enforceable? (a) Where continuous emission monitoring systems are required, obtain 1-hour arithmetic averages...

40 CFR 60.3041 - What is the minimum amount of monitoring data I must collect with my continuous emission...

Code of Federal Regulations, 2011 CFR

2011-07-01

... monitoring data I must collect with my continuous emission monitoring systems, and is the data collection... collect with my continuous emission monitoring systems, and is the data collection requirement enforceable? (a) Where continuous emission monitoring systems are required, obtain 1-hour arithmetic averages...

40 CFR 62.15280 - What minimum amount of monitoring data must I collect with my continuous parameter monitoring...

Code of Federal Regulations, 2010 CFR

2010-07-01

... must I collect with my continuous parameter monitoring systems and is this requirement enforceable? 62... with my continuous parameter monitoring systems and is this requirement enforceable? (a) Where continuous parameter monitoring systems are used, obtain 1-hour arithmetic averages for three parameters: (1...

40 CFR 62.15280 - What minimum amount of monitoring data must I collect with my continuous parameter monitoring...

Code of Federal Regulations, 2011 CFR

2011-07-01

... must I collect with my continuous parameter monitoring systems and is this requirement enforceable? 62... with my continuous parameter monitoring systems and is this requirement enforceable? (a) Where continuous parameter monitoring systems are used, obtain 1-hour arithmetic averages for three parameters: (1...

40 CFR 62.15180 - How are the data from the continuous emission monitoring systems used?

Code of Federal Regulations, 2011 CFR

2011-07-01

... emission monitoring systems used? 62.15180 Section 62.15180 Protection of Environment ENVIRONMENTAL... Constructed on or Before August 30, 1999 Continuous Emission Monitoring § 62.15180 How are the data from the continuous emission monitoring systems used? You must use data from the continuous emission monitoring...

40 CFR 60.2942 - What is the minimum amount of monitoring data I must collect with my continuous emission...

Code of Federal Regulations, 2011 CFR

2011-07-01

... monitoring data I must collect with my continuous emission monitoring systems, and is the data collection... with my continuous emission monitoring systems, and is the data collection requirement enforceable? (a) Where continuous emission monitoring systems are required, obtain 1-hour arithmetic averages. Make sure...

40 CFR 60.1725 - How are the data from the continuous emission monitoring systems used?

Code of Federal Regulations, 2010 CFR

2010-07-01

... emission monitoring systems used? 60.1725 Section 60.1725 Protection of Environment ENVIRONMENTAL... Before August 30, 1999 Model Rule-Continuous Emission Monitoring § 60.1725 How are the data from the continuous emission monitoring systems used? You must use data from the continuous emission monitoring...

Detection of sub micro Gray dose levels using OSL phosphor LiMgPO4:Tb,B

NASA Astrophysics Data System (ADS)

Rawat, N. S.; Dhabekar, Bhushan; Muthe, K. P.; Koul, D. K.; Datta, D.

2017-04-01

Detection of sub micro Gray doses finds application in personnel and environmental monitoring, and nuclear forensics. Recently developed LiMgPO4:Tb,B (LMP) is highly sensitive Optically Stimulated Luminescence (OSL) phosphor with excellent dosimetric properties. The OSL emission spectrum of LMP consists of several peaks attributed to characteristic Tb3+ emission. The OSL emission peak at 380 nm is favorable for bi-alkali PMT used in RISO reader system. It is demonstrated that significant improvement in dose detection threshold can be realized for LMP by optimization of continuous wave (CW-) OSL parameters like stimulation intensity and readout time. The minimum measurable dose (MMD) as low as 0.49 μGy in readout time of less than 1 s at stimulation intensity of 32 mW/cm2 has been achieved using this phosphor. The recommendations for choice of parameters for personnel and environmental monitoring are also discussed.

Nonylphenol: Properties, legislation, toxicity and determination.

PubMed

Araujo, Frederico G DE; Bauerfeldt, Glauco F; Cid, Yara Peluso

2017-08-07

This paper aims to gather and discuss important information about nonylphenol, such as physical chemistry properties, toxicity and analytical methods in various matrices. As a degradation product of ethoxylated alkylphenols, nonylphenol presents a higher degree of reactivity than its precursor. Due to its harmful effects on the environment, use and production of nonylphenol has been banned in European Union countries, alongside their precursors. The guide on quality of drinking water (USEPA) recommends a maximum concentration of 28 µg L-1 for fresh water. In Brazil, there is no clear legislation containing values ​​of maximum concentration of nonylphenol. Due to this lack of regulation, a continuous monitoring is necessary of this pollutant in environmental samples. This paper aims to encourage further studies on nonylphenol, seen as a critical environmental pollutant. For proper monitoring is necessary to have reliable analytical methods and easy to perform in routine analysis.

Harms to Consumers of Inpatient Psychiatric Facilities in the United States: An Analysis of News Articles.

PubMed

Shields, Morgan C; Reneau, Hailey; Albert, Sasha M; Siegel, Leeann; Trinh, Nhi-Ha

2018-05-30

Inpatient psychiatric facilities in the United States lack systematic regulation and monitoring of a variety of patient safety concerns. We conducted a qualitative analysis of 61 news articles to identify common causes and types of harms within inpatient psychiatric facilities, with a focus on physical harm. The news articles reported on patient self-harm, patient-patient violence, and violence between patients and staff, noting that youth, older adults, and veterans were especially vulnerable. Harms occurred throughout the care continuum - at admission, during the inpatient stay, and at discharge - and retaliation towards whistleblowers deterred facility accountability. We recommend 1) addressing staffing shortages, 2) instituting systematic monitoring of critical incidents and the experiences of consumers and staff, 3) improving both inpatient safety and post-discharge community supports, and 4) continued journalistic coverage of harms within inpatient psychiatric facilities.

Biofouling detection monitoring devices: status assessment. Final report

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

Hillman, R.E.; Anson, D.; Corliss, J.M.

1985-03-01

An inventory of devices to detect and monitor biofouling in power plant condenser systems was prepared. The inventory was developed through a review of manufacturers' product information brochures, a general literature review, and limited personal contact with users and manufacturers. Two macrofouling and seventeen microfouling detection devices were reviewed. A summary analysis of the principal features of each device was prepared. Macrofouling devices are generally simple devices located at or near cooling water intakes. They monitor the growth of larger organisms such as mussels, barnacles, and large seaweeds. Microfouling detectors are usually located in or near the condenser tubes. Theymore » detect and monitor the growth of slime films on the tubes. Some of the devices measure changes in heat transfer or pressure drop in the condenser tubes. Other types include condenser simulators, biofilm samplers, or devices that measure the acoustic properties of the fouling films. Most devices are still in the development stage. Of the few available for general use, the type that measures heat transfer and/or pressure drop are developed to a greater degree than the other types. Recommendations for further research into development of a biofouling detection and monitoring devices include a side-by-side field comparison of selected devices, and the continued development of an effective acoustic device.« less

The 'wise list'- a comprehensive concept to select, communicate and achieve adherence to recommendations of essential drugs in ambulatory care in Stockholm.

PubMed

Gustafsson, Lars L; Wettermark, Björn; Godman, Brian; Andersén-Karlsson, Eva; Bergman, Ulf; Hasselström, Jan; Hensjö, Lars-Olof; Hjemdahl, Paul; Jägre, Ingrid; Julander, Margaretha; Ringertz, Bo; Schmidt, Daniel; Sjöberg, Susan; Sjöqvist, Folke; Stiller, Carl-Olav; Törnqvist, Elisabeth; Tryselius, Rolf; Vitols, Sigurd; von Bahr, Christer

2011-04-01

The aim was to present and evaluate the impact of a comprehensive strategy over 10 years to select, communicate and achieve adherence to essential drug recommendations (EDR) in ambulatory care in a metropolitan healthcare region. EDRs were issued and launched as a 'Wise List' by the regional Drug and Therapeutics Committee in Stockholm. This study presents the concept by: (i) documenting the process for selecting, communicating and monitoring the impact of the 'Wise List'; (ii) analysing the variation in the number of drug substances recommended between 2000 and 2010; (iii) assessing the attitudes to the 'Wise List' among prescribers and the public; (iv) evaluating the adherence to recommendations between 2003 and 2009. The 'Wise List' consistently contained 200 drug substances for treating common diseases. The drugs were selected based on their efficacy, safety, suitability and cost-effectiveness. The 'Wise List' was known among one-third of a surveyed sample of the public in 2002 after initial marketing campaigns. All surveyed prescribers knew about the concept and 81% found the recommendations trustworthy in 2005. Adherence to recommendations increased from 69% in 1999 to 77% in 2009. In primary care, adherence increased from 83% to 87% from 2003 to 2009. The coefficient of variation (CV%) decreased from 6.1% to 3.8% for 156 healthcare centres between these years. The acceptance of the 'Wise List' in terms of trust among physicians and among the public and increased adherence may be explained by clear criteria for drug recommendations, a comprehensive communication strategy, electronic access to recommendations, continuous medical education and involvement of professional networks and patients.

Adherence to recommended electronic health record safety practices across eight health care organizations.

PubMed

Sittig, Dean F; Salimi, Mandana; Aiyagari, Ranjit; Banas, Colin; Clay, Brian; Gibson, Kathryn A; Goel, Ashutosh; Hines, Robert; Longhurst, Christopher A; Mishra, Vimal; Sirajuddin, Anwar M; Satterly, Tyler; Singh, Hardeep

2018-04-26

The Safety Assurance Factors for EHR Resilience (SAFER) guides were released in 2014 to help health systems conduct proactive risk assessment of electronic health record (EHR)- safety related policies, processes, procedures, and configurations. The extent to which SAFER recommendations are followed is unknown. We conducted risk assessments of 8 organizations of varying size, complexity, EHR, and EHR adoption maturity. Each organization self-assessed adherence to all 140 unique SAFER recommendations contained within 9 guides (range 10-29 recommendations per guide). In each guide, recommendations were organized into 3 broad domains: "safe health IT" (total 45 recommendations); "using health IT safely" (total 80 recommendations); and "monitoring health IT" (total 15 recommendations). The 8 sites fully implemented 25 of 140 (18%) SAFER recommendations. Mean number of "fully implemented" recommendations per guide ranged from 94% (System Interfaces-18 recommendations) to 63% (Clinical Communication-12 recommendations). Adherence was higher for "safe health IT" domain (82.1%) vs "using health IT safely" (72.5%) and "monitoring health IT" (67.3%). Despite availability of recommendations on how to improve use of EHRs, most recommendations were not fully implemented. New national policy initiatives are needed to stimulate implementation of these best practices.

Brain Resuscitation in the Drowning Victim

PubMed Central

Topjian, Alexis A.; Berg, Robert A.; Bierens, Joost J. L. M.; Branche, Christine M.; Clark, Robert S.; Friberg, Hans; Hoedemaekers, Cornelia W. E.; Holzer, Michael; Katz, Laurence M.; Knape, Johannes T. A.; Kochanek, Patrick M.; Nadkarni, Vinay; van der Hoeven, Johannes G.

2013-01-01

Drowning is a leading cause of accidental death. Survivors may sustain severe neurologic morbidity. There is negligible research specific to brain injury in drowning making current clinical management non-specific to this disorder. This review represents an evidence-based consensus effort to provide recommendations for management and investigation of the drowning victim. Epidemiology, brain-oriented prehospital and intensive care, therapeutic hypothermia, neuroimaging/monitoring, biomarkers, and neuroresuscitative pharmacology are addressed. When cardiac arrest is present, chest compressions with rescue breathing are recommended due to the asphyxial insult. In the comatose patient with restoration of spontaneous circulation, hypoxemia and hyperoxemia should be avoided, hyperthermia treated, and induced hypothermia (32–34 °C) considered. Arterial hypotension/hypertension should be recognized and treated. Prevent hypoglycemia and treat hyperglycemia. Treat clinical seizures and consider treating non-convulsive status epilepticus. Serial neurologic examinations should be provided. Brain imaging and serial biomarker measurement may aid prognostication. Continuous electroencephalography and N20 somatosensory evoked potential monitoring may be considered. Serial biomarker measurement (e.g., neuron specific enolase) may aid prognostication. There is insufficient evidence to recommend use of any specific brain-oriented neuroresuscitative pharmacologic therapy other than that required to restore and maintain normal physiology. Following initial stabilization, victims should be transferred to centers with expertise in age-specific post-resuscitation neurocritical care. Care should be documented, reviewed, and quality improvement assessment performed. Preclinical research should focus on models of asphyxial cardiac arrest. Clinical research should focus on improved cardiopulmonary resuscitation, re-oxygenation/reperfusion strategies, therapeutic hypothermia, neuroprotection, neurorehabilitation, and consideration of drowning in advances made in treatment of other central nervous system disorders. PMID:22956050

40 CFR 60.1825 - What is the minimum amount of monitoring data I must collect with my continuous parameter...

Code of Federal Regulations, 2010 CFR

2010-07-01

... monitoring data I must collect with my continuous parameter monitoring systems and is the data collection... must collect with my continuous parameter monitoring systems and is the data collection requirement enforceable? (a) Where continuous parameter monitoring systems are used, obtain 1-hour arithmetic averages for...

40 CFR 60.1750 - What is the minimum amount of monitoring data I must collect with my continuous emission...

Code of Federal Regulations, 2011 CFR

2011-07-01

... monitoring data I must collect with my continuous emission monitoring systems and is the data collection... I must collect with my continuous emission monitoring systems and is the data collection requirement enforceable? (a) Where continuous emission monitoring systems are required, obtain 1-hour arithmetic averages...

40 CFR 60.1825 - What is the minimum amount of monitoring data I must collect with my continuous parameter...

Code of Federal Regulations, 2011 CFR

2011-07-01

... monitoring data I must collect with my continuous parameter monitoring systems and is the data collection... must collect with my continuous parameter monitoring systems and is the data collection requirement enforceable? (a) Where continuous parameter monitoring systems are used, obtain 1-hour arithmetic averages for...

40 CFR 60.1750 - What is the minimum amount of monitoring data I must collect with my continuous emission...

Code of Federal Regulations, 2010 CFR

2010-07-01

... monitoring data I must collect with my continuous emission monitoring systems and is the data collection... I must collect with my continuous emission monitoring systems and is the data collection requirement enforceable? (a) Where continuous emission monitoring systems are required, obtain 1-hour arithmetic averages...

Neuromonitoring after major neurosurgical procedures.

PubMed

Messerer, M; Daniel, R T; Oddo, M

2012-07-01

Postoperative care of major neurosurgical procedures is aimed at the prevention, detection and treatment of secondary brain injury. This consists of a series of pathological events (i.e. brain edema and intracranial hypertension, cerebral hypoxia/ischemia, brain energy dysfunction, non-convulsive seizures) that occur early after the initial insult and surgical intervention and may add further burden to primary brain injury and thus impact functional recovery. Management of secondary brain injury requires specialized neuroscience intensive care units (ICU) and continuous advanced monitoring of brain physiology. Monitoring of intracranial pressure (ICP) is a mainstay of care and is recommended by international guidelines. However, ICP monitoring alone may be insufficient to detect all episodes of secondary brain insults. Additional invasive (i.e. brain tissue PO2, cerebral microdialysis, regional cerebral blood flow) and non-invasive (i.e. transcranial doppler, near-infrared spectroscopy, EEG) brain monitoring devices might complement ICP monitoring and help clinicians to target therapeutic interventions (e.g. management of cerebral perfusion pressure, blood transfusion, glucose control) to patient-specific pathophysiology. Several independent studies demonstrate such multimodal approach may optimize patient care after major neurosurgical procedures. The aim of this review is to evaluate some of the available monitoring systems and summarize recent important data showing the clinical utility of multimodal neuromonitoring for the management of main acute neurosurgical conditions, including traumatic brain injury, subarachnoid hemorrhage and stroke.

77 FR 59000 - Guidance for Industry: Pre-Storage Leukocyte Reduction of Whole Blood and Blood Components...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-09-25

... intended for transfusion, including recommendations for validation and quality control monitoring of the... intended for transfusion, including recommendations for validation and quality control monitoring of the... control number 0910-0052; the collections of information in 21 CFR 606.100(b), 606.100(c), 606.121, and...

76 FR 5386 - Draft Guidance for Industry: Pre-Storage Leukocyte Reduction of Whole Blood and Blood Components...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-01-31

... intended for transfusion, including recommendations for validation and quality control monitoring of the..., including recommendations for validation and quality control monitoring of the leukocyte reduction process... control number 0910-0052; the collections of information in 21 CFR 606.100(b), 606.100(c), and 606.121...

50 CFR 648.160 - Catch quotas and other restrictions.

Code of Federal Regulations, 2011 CFR

2011-10-01

... Limit (ACL). (a) The Bluefish Monitoring Committee shall recommend to the MAFMC an ACL for the bluefish fishery, which shall be equal to the ABC recommended by the SSC. (1) Periodicity. The bluefish fishery ACL... Monitoring Committee shall conduct a detailed review of fishery performance relative to the ACL at least...

Mood and Ambulatory Monitoring of Physical Activity Patterns in Youth with Polycystic Ovary Syndrome.

PubMed

Michael, Julie C; El Nokali, Nermeen E; Black, Jessica J; Rofey, Dana L

2015-10-01

To provide initial insight into physical activity patterns and predictors of moderate to vigorous physical activity (MVPA) in youth with polycystic ovary syndrome (PCOS) by using a multisensor activity monitor. Cross-sectional study analyzing baseline MVPA data using real-time continuous monitoring of physical activity. Body mass index (BMI) and depressive symptoms were examined as predictors of MVPA. A large, urban children's hospital in the United States. Thirty-five youth (aged 12 to 21 years) previously diagnosed with PCOS (mean BMI = 38.0 kg/m(2); mean age = 15.4 years, 79% white) who were participants in a behavioral lifestyle intervention. Total steps, total MVPA, longest continuous bout of MVPA, and frequency of MVPA bouts lasting for 5 to 9 minutes and 10 or more minutes. Sixty percent of youth averaged at least 1 daily MVPA bout lasting 10 or more minutes, and 14% averaged a daily MVPA bout lasting 30 or more minutes. BMI was negatively correlated with MVPA bout duration (P = .04). Parental ratings of depression, but not self-report ratings, were predictive of participants' total MVPA (β = -.46; P = .01), number of 5- to 9-minute bouts (β = -.39; P = .03), and bouts of 10 or more minutes (β = -.35; P = .05). Youth with PCOS may benefit from being prescribed multiple bouts of MVPA lasting less than 30 continuous minutes to meet national recommendations and achieve health benefits. BMI and parental endorsement of child's depression symptoms may be important to consider when assessing and prescribing MVPA to youth with PCOS. Copyright © 2015 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

Metabolic regulation during constant moderate physical exertion in extreme conditions in Type 1 diabetes.

PubMed

Valletta, J J; Chipperfield, A J; Clough, G F; Byrne, C D

2012-06-01

Constant moderate intensity physical exertion in humid environments at altitude poses a considerable challenge to maintaining euglycaemia with Type 1 diabetes. Blood glucose concentrations and energy expenditure were continuously recorded in a person trekking at altitude in a tropical climate to quantify changes in glucose concentrations in relation to energy expenditure. Blood glucose concentrations and energy expenditure were continuously monitored with a Guardian® real-time continuous glucose monitoring system (CGMS) and a SenseWear® Pro3 armband (BodyMedia Inc., USA), in a 27-year-old woman with Type 1 diabetes, during her climb up Mount Kinabalu in Borneo (c. 4095 m). Comparative control data from the same person was collected in the UK (temperate climate at sea level) and Singapore (tropical climate at sea level). Maximum physical effort during the climb was < 60% VO(2MAX) (maximal oxygen consumption). Mean daily calorific intakes were 2300 kcal (UK), 2370 kcal (Singapore) and 2274 kcal (Mount Kinabalu), and mean daily insulin doses were 54 U (UK), 40 U (Singapore) and 47 U (Mount Kinabalu). Despite markedly increased energy expenditure during the climb [4202 kcal (Mount Kinabalu) vs. 2948 kcal (UK) and 2662 kcal (Singapore)], mean blood glucose was considerably higher during the trek up Mount Kinabalu [13.2 ± 5.9 mmol/l, vs. 7.9 ± 3.8 mmol/l (UK) and 8.6 ± 4.0 mmol/l (Singapore)]. Marked unexpected hyperglycaemia occurred while trekking on Mount Kinabalu, despite similar calorie consumption and insulin doses to control conditions. Because of the risk of unexpected hyperglycaemia in these conditions, we recommend that patients embarking on similar activity holidays undertake frequent blood glucose monitoring. © 2011 The Authors. Diabetic Medicine © 2011 Diabetes UK.

Measuring Progress Toward Universal Health Coverage: Does the Monitoring Framework of Bangladesh Need Further Improvement?

PubMed

Gupta, Rajat Das; Shahabuddin, Asm

2018-01-08

This review aimed to compare Bangladesh's Universal Health Coverage (UHC) monitoring framework with the global-level recommendations and to find out the existing gaps of Bangladesh's UHC monitoring framework compared to the global recommendations. In order to reach the aims of the review, we systematically searched two electronic databases - PubMed and Google Scholar - by using appropriate keywords to select articles that describe issues related to UHC and the monitoring framework of UHC applied globally and particularly in Bangladesh. Four relevant documents were found and synthesized. The review found that Bangladesh incorporated all of the recommendations suggested by the global monitoring framework regarding mentoring the financial risk protection and equity perspective. However, a significant gap in the monitoring framework related to service coverage was observed. Although Bangladesh has a significant burden of mental illnesses, cataract, and neglected tropical diseases, indicators related to these issues were absent in Bangladesh's UHC framework. Moreover, palliative-care-related indicators were completely missing in the framework. The results of this review suggest that Bangladesh should incorporate these indicators in their UHC monitoring framework in order to track the progress of the country toward UHC more efficiently and in a robust way.

77 FR 18709 - Quality Assurance Requirements for Continuous Opacity Monitoring Systems at Stationary Sources

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-28

... Quality Assurance Requirements for Continuous Opacity Monitoring Systems at Stationary Sources AGENCY... direct final rule titled ``Quality Assurance Requirements for Continuous Opacity Monitoring Systems at...--Quality Assurance Requirements for Continuous Opacity Monitoring Systems at Stationary Sources Docket, EPA...

40 CFR 60.1740 - What is my schedule for evaluating continuous emission monitoring systems?

Code of Federal Regulations, 2010 CFR

2010-07-01

... continuous emission monitoring systems? 60.1740 Section 60.1740 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) STANDARDS OF PERFORMANCE FOR NEW STATIONARY SOURCES... evaluating continuous emission monitoring systems? (a) Conduct annual evaluations of your continuous emission...

40 CFR 60.1270 - What is required for my continuous opacity monitoring system and how are the data used?

Code of Federal Regulations, 2011 CFR

2011-07-01

... opacity monitoring system and how are the data used? 60.1270 Section 60.1270 Protection of Environment... Continuous Emission Monitoring § 60.1270 What is required for my continuous opacity monitoring system and how... system. (b) Install, evaluate, and operate each continuous opacity monitoring system according to § 60.13...

Milrinone in advanced heart failure: dose and therapeutic monitor outside intensive care unit.

PubMed

Charisopoulou, Dafni; Leaver, Neil; Banner, Nicholas R

2014-04-01

Advanced chronic heart failure (ACHF) patients often require inotropes before transplantation or ventricular assist device implantation. Milrinone, an inotrope and vasodilator, may accumulate in cardiorenal syndrome with serious adverse effects. We investigated the potential for therapeutic drug monitoring of milrinone levels using High Performance Liquid Chromatography Mass Spectrometry (HPLC-MS). 22 ACHF patients (15 males, 49±9 years) received milrinone 50 µg/kg intravenously (i.v.) during heart catheterization. Milrinone levels were 216±71 ng/ml (within the reported therapeutic range: 100-300 ng/ml), followed by improvements in cardiac index, pulmonary artery and wedge pressures (p < 0.005). 18 ACHF patients (17 males, 50±12 years, 13 had renal dysfunction) received continuous i.v. milrinone (5-26 days) at 0.1-0.2 µg/kg/min, titrated according to plasma milrinone levels. No adverse events occurred. Therapeutic levels were achieved with doses of 0.2±0.06 µg/Kg/min, below those recommended in Summary of Product Characteristics. Milrinone therapy can be noninvasively monitored by HPLC-MS, while avoiding toxicity in ACHF.

Human Research Program (HRP) Exploration Medical Capability (ExMC) Standing Review Panel (SRP)

NASA Technical Reports Server (NTRS)

Cintron, Nitza; Dutson, Eric; Friedl, Karl; Hyman, William; Jemison, Mae; Klonoff, David

2009-01-01

The SRP believes strongly that regularly performed in-flight crew assessments are needed in order to identify a change in health status before a medical condition becomes clinically apparent. It is this early recognition in change that constitutes the foundation of the "occupational health model" expounded in the HRP Requirements Document as a key component of the HRP risk mitigation strategy that will enable its objective of "prevention and mitigation of human health and performance risks". A regular crew status examination of physiological and clinical performance is needed. This can be accomplished through instrumented monitoring of routine embedded tasks. The SRP recommends addition of a new gap to address this action under Category 3.0 Mitigate the Risk. This new gap is closely associated with Task 4.19 which addresses the lack of adequate biomedical monitoring capabilities for performing periodic clinical status evaluations and contingency medical monitoring. A corollary to these gaps is the critical emphasis on preventive medicine, not only during pre- and post-flight phases of a mission as is the current practice, but continued into the in-flight phases of exploration class missions.

Front-end Electronics for Unattended Measurement (FEUM). Results of Prototype Evaluation

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

Conrad, Ryan C.; Keller, Daniel T.; Morris, Scott J.

2015-07-01

The International Atomic Energy Agency (IAEA) deploys unattended monitoring systems to provide continuous monitoring of nuclear material within safeguarded facilities around the world. As the number of unattended monitoring instruments increases, the IAEA is challenged to become more efficient in the implementation of those systems. In 2010, the IAEA initiated the Front-End Electronics for Unattended Measurement (FEUM) project with the goals of greater flexibility in the interfaces to various sensors and data acquisition systems, and improved capabilities for remotely located sensors (e.g., where sensor and front-end electronics might be separated by tens of meters). In consultation with the IAEA, amore » technical evaluation of a candidate FEUM device produced by a commercial vendor has been performed. This evaluation assessed the device against the IAEA’s original technical specifications and a broad range of important parameters that include sensor types, cable lengths and types, industrial electromagnetic noise that can degrade signals from remotely located detectors, and high radiation fields. Testing data, interpretation, findings and recommendations are provided.« less

[Continuous glucose monitoring using the Glucoday system, in children and adolescents who have type one diabetes].

PubMed

López Gutiérrez, Sònia; Pavía Sesma, Carlos

2010-10-01

At present times, Continuous Glucose Monitoring is a recommended method to detect glucemia fluctuations in patients who have diabetes, due to the fine correlation between interstitial glucose and capillary glucemia. The objective of this project is obtain a glucose register during a 48 hour period in a group of Type I diabetes patients who have an irregular metabolic control and to evaluate effectiveness of treatment employed, as well as evaluating compliance of the therapeutic norms established for each patient. At the same time, the authors plan to test the usefulness of a graphical register for diabetic education. After applying an anesthetic cream in the lateral umbilical zone, a subcutaneous catheter connected to a GLUCODAY, Menarini Diagnostics glucose sensor is inserted which, by means of a continuous sequence taking measures in interstitial liquid, registers a value every three minutes for as long as this connection is maintained. After a maximum 48 hour period, data are transferred to a computer and by means of the corresponding computer program, a graphic register for each patient is produced. Informed consent has been obtained from each patient. There were 23 patients in this study group, each diagnosed to have Type I diabetes; eight of these patients, two girls and six boys, were pre-puberty aged while 15, six girls and nine boys, were adolescents. Two of the pre-puberty patients had pathological antecedents, in one case celiac and the other thyroid disease. Two of the puberty aged patients had a history of chronic lymphocytic thyroid disease under opo-therapeutic treatment. Individual analysis of each case permits health professionals to detect a series of facts: it is difficult to comply with glucemic objectives in this group of adolescents having diabetes, with insulin treatment installed and researchers detect postprandial hyper-glucemia which do not appear when using capillary glucemias carried out by habitual methods. Study observations manifest a lack of compliance in indicated agreed upon schedules and researchers detect dietary transgressions. Continuous Glucose Monitoring makes it possible to obtain a graphic which can include those incidences which have occurred, facilitate commenting on the errors detected with adolescent patients and permit proposing a series of therapeutic modifications based on concrete, real data. Continuous Glucose Monitoring promises to be a useful tool to educate patients about diabetes.

Understanding the positive benefit:risk profile of alemtuzumab in relapsing multiple sclerosis: perspectives from the Alemtuzumab Clinical Development Program.

PubMed

Havrdova, Eva; Cohen, Jeffrey A; Horakova, Dana; Kovarova, Ivana; Meluzinova, Eva

2017-01-01

The introduction of high-efficacy therapies for relapsing-remitting multiple sclerosis has driven re-evaluation of treatment goals and benefit:risk considerations in treatment choice. In the alemtuzumab Phase II and III clinical trials, patients treated with alemtuzumab 12 mg versus subcutaneous interferon beta-1a demonstrated significantly reduced annualized relapse rates and improved magnetic resonance imaging outcomes, and were significantly more likely to achieve no evidence of disease activity and reduction in brain volume loss. In two of the studies, alemtuzumab-treated patients had a significantly reduced risk of 6-month confirmed disease worsening, compared with subcutaneous interferon beta-1a. Benefits were maintained throughout 5 years, with a majority of patients receiving no alemtuzumab retreatment or other disease-modifying therapy. Trial results support alemtuzumab's manageable, consistent safety profile in relapsing-remitting multiple sclerosis. Infusion-associated reactions, the most frequent adverse events (AEs), can be minimized by corticosteroid pretreatment, monitoring, and symptomatic management. Other AEs include infections and autoimmune events. Oral anti-herpes prophylaxis should be initiated on the first day of each alemtuzumab treatment course and continued according to local guidelines. Overall cancer risk was lower in the alemtuzumab clinical trials than in a reference population; however, continuing surveillance will determine if alemtuzumab may be associated with certain malignancies such as thyroid papillary carcinoma and melanoma, which are currently identified as potential risks. The post-approval risk management strategy includes a safety monitoring program. Autoimmune AEs (thyroid events, immune thrombocytopenia, nephropathies) can be detected in a timely manner with the monitoring program, which includes physician and patient education about the signs and symptoms, monthly renal and hematologic monitoring, and quarterly thyroid function monitoring for 48 months after the last alemtuzumab course. Education, vigilance by physicians and patients, and monthly laboratory monitoring are recommended to maintain alemtuzumab's positive benefit:risk profile.

Monitoring of the stability of underground workings in Polish copper mines conditions

NASA Astrophysics Data System (ADS)

Fuławka, Krzysztof; Mertuszka, Piotr; Pytel, Witold

2018-01-01

One of the problems associated with the excavation of deposit in underground mines is the local disturbance in a state of unstable equilibrium results in the sudden release of energy, mainly in the form of roof falls. The scale and intensity of this type of events depends on a number of factors. To minimize the risk of instability occurrence, continuous observations of the roof strata condition are recommended. Different roof strata observation methods used in the Polish copper mines have been analysed within the framework of presented paper. In addition, selected prospective methods, which could significantly increase efficiency of rock fall prevention are presented.

A phased approach to induced seismicity risk management

DOE PAGES

White, Joshua A.; Foxall, William

2014-01-01

This work describes strategies for assessing and managing induced seismicity risk during each phase of a carbon storage project. We consider both nuisance and damage potential from induced earthquakes, as well as the indirect risk of enhancing fault leakage pathways. A phased approach to seismicity management is proposed, in which operations are continuously adapted based on available information and an on-going estimate of risk. At each project stage, specific recommendations are made for (a) monitoring and characterization, (b) modeling and analysis, and (c) site operations. The resulting methodology can help lower seismic risk while ensuring site operations remain practical andmore » cost-effective.« less

Transforming care delivery through health information technology.

PubMed

Wheatley, Benjamin

2013-01-01

The slow but progressive adoption of health information technology (IT) nationwide promises to usher in a new era in health care. Electronic health record systems provide a complete patient record at the point of care and can help to alleviate some of the challenges of a fragmented delivery system, such as drug-drug interactions. Moreover, health IT promotes evidence-based practice by identifying gaps in recommended treatment and providing clinical decision-support tools. In addition, the data collected through digital records can be used to monitor patient outcomes and identify potential improvements in care protocols. Kaiser Permanente continues to advance its capability in each of these areas.

Report of the panel on international programs

NASA Technical Reports Server (NTRS)

Anderson, Allen Joel; Fuchs, Karl W.; Ganeka, Yasuhiro; Gaur, Vinod; Green, Andrew A.; Siegfried, W.; Lambert, Anthony; Rais, Jacub; Reighber, Christopher; Seeger, Herman

1991-01-01

The panel recommends that NASA participate and take an active role in the continuous monitoring of existing regional networks, the realization of high resolution geopotential and topographic missions, the establishment of interconnection of the reference frames as defined by different space techniques, the development and implementation of automation for all ground-to-space observing systems, calibration and validation experiments for measuring techniques and data, the establishment of international space-based networks for real-time transmission of high density space data in standardized formats, tracking and support for non-NASA missions, and the extension of state-of-the art observing and analysis techniques to developing nations.

Reducing the loss of vaccines from accidental freezing in the cold chain: the experience of continuous temperature monitoring in Tunisia.

PubMed

Lloyd, John; Lydon, Patrick; Ouhichi, Ramzi; Zaffran, Michel

2015-02-11

Accidental freezing of vaccines is a growing threat and a real risk for national immunization programs when the potency of many vaccines can be compromised if these are exposed to sub-zero temperatures in the cold chain. In Tunisia, this issue is compounded by using sub-standard domestic cold chain equipment instead of equipping the program with medical refrigerators designed specifically for storing vaccines and temperature sensitive pharmaceuticals. Against this backdrop, this paper presents the findings of a demonstration project conducted in Tunisia in 2012 that tested the impact of introducing several freeze prevention solutions to mitigate the risk of accidental freezing of vaccines. The main finding is that, despite the continued use of underperforming domestic refrigerators, continuous temperature monitoring using new technologies combined with other technological interventions significantly reduced the prevalence of accidental exposure to freezing temperatures. These improvements were noticed for cold chain storage at regional, district and health center levels, and during the transport legs that were part of the demonstration conducted in the regions of Kasserine in the South-Eastern part of Tunisia. Subsequent to introducing these freeze prevention solutions, the incidence of freeze alarms was reduced and the percent of time the temperatures dropped below the 2 °C recommended threshold. The incidence of freeze alarms at health center level was reduced by 40%. Lastly, the solutions implemented reduced risk of freezing during transport from 13.8% to 1.7%. Although the solution implemented is not optimal in the longer term because domestic refrigerators are used extensively in district stores and health centers, the risk of accidental freezing is significantly reduced by introducing the practice of continuous temperature monitoring as a standard. The management of the cold chain equipment was strengthened as a result which helps protect the potency of vaccines to the areas of most difficult access. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

Wireless Vital Sign Monitoring in Pregnant Women: A Functionality and Acceptability Study.

PubMed

Boatin, Adeline Adwoa; Wylie, Blair Johnson; Goldfarb, Ilona; Azevedo, Robin; Pittel, Elena; Ng, Courtney; Haberer, Jessica Elizabeth

2016-07-01

To test the functionality and acceptability of a wireless vital sign monitor in an inpatient obstetric unit. Pregnant women at a U.S. tertiary-care hospital wore a wireless vital sign sensor that captures heart rate, respiratory rate, and temperature. Measurements were compared with vital signs obtained by standard devices. We defined continuous capture of vital signs for 30 min with wireless data transfer to a central monitor as functional success. Acceptability was assessed per the pregnant women and nurses observing the device. Bland-Altman plots were constructed to assess agreement between the wireless sensor and standard measurements. Thirty of 32 enrolled pregnant women had successful monitoring; 2 cases were stopped early for non-study-related reasons. Comparing wireless sensor and standard measurements, the mean difference (limits of agreement) values at the 25th and 75th percentiles were 1.6 (±13.2) and 4.2 (±18.6) heartbeats/min, 4.2 (±6.1) and 0.7 (±5.4) respirations/min, and 0.02°C (±1.5) and 0.5°C (±1.8), respectively. Most pregnant women found the device comfortable, likeable, and useful (78%, 81%, and 97%, respectively); 80% of nurses found the monitor easy to use, and 84% would recommend it to a patient. We successfully obtained maternal vital signs using a simple wireless monitor with high acceptability. Well-validated monitors of this nature could significantly alleviate the human resource burden of monitoring during labor and confer greatly desired mobility to laboring pregnant women, although incorporation of blood pressure monitoring will be critical.

30 CFR 77.211-1 - Continuous methane monitoring device; installation and operation; automatic deenergization of...

Code of Federal Regulations, 2010 CFR

2010-07-01

... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Continuous methane monitoring device... Installations § 77.211-1 Continuous methane monitoring device; installation and operation; automatic deenergization of electric equipment. Continuous methane monitoring devices shall be set to deenergize...

40 CFR 60.1235 - How are the data from the continuous emission monitoring systems used?

Code of Federal Regulations, 2013 CFR

2013-07-01

... emission monitoring systems used? 60.1235 Section 60.1235 Protection of Environment ENVIRONMENTAL... Continuous Emission Monitoring § 60.1235 How are the data from the continuous emission monitoring systems... oxides, and carbon monoxide to demonstrate continuous compliance with the emission limits specified in...

40 CFR 60.1235 - How are the data from the continuous emission monitoring systems used?

Code of Federal Regulations, 2014 CFR

2014-07-01

... emission monitoring systems used? 60.1235 Section 60.1235 Protection of Environment ENVIRONMENTAL... Continuous Emission Monitoring § 60.1235 How are the data from the continuous emission monitoring systems... oxides, and carbon monoxide to demonstrate continuous compliance with the emission limits specified in...

40 CFR 60.1235 - How are the data from the continuous emission monitoring systems used?

Code of Federal Regulations, 2012 CFR

2012-07-01

... emission monitoring systems used? 60.1235 Section 60.1235 Protection of Environment ENVIRONMENTAL... Continuous Emission Monitoring § 60.1235 How are the data from the continuous emission monitoring systems... oxides, and carbon monoxide to demonstrate continuous compliance with the emission limits specified in...

30 CFR 77.211-1 - Continuous methane monitoring device; installation and operation; automatic deenergization of...

Code of Federal Regulations, 2011 CFR

2011-07-01

... 30 Mineral Resources 1 2011-07-01 2011-07-01 false Continuous methane monitoring device... Installations § 77.211-1 Continuous methane monitoring device; installation and operation; automatic deenergization of electric equipment. Continuous methane monitoring devices shall be set to deenergize...

40 CFR 60.1740 - What is my schedule for evaluating continuous emission monitoring systems?

Code of Federal Regulations, 2011 CFR

2011-07-01

... continuous emission monitoring systems? 60.1740 Section 60.1740 Protection of Environment ENVIRONMENTAL... evaluating continuous emission monitoring systems? (a) Conduct annual evaluations of your continuous emission monitoring systems no more than 13 months after the previous evaluation was conducted. (b) Evaluate your...

40 CFR 62.15195 - What is my schedule for evaluating continuous emission monitoring systems?

Code of Federal Regulations, 2010 CFR

2010-07-01

... continuous emission monitoring systems? 62.15195 Section 62.15195 Protection of Environment ENVIRONMENTAL... evaluating continuous emission monitoring systems? (a) Conduct annual evaluations of your continuous emission monitoring systems no more than 13 months after the previous evaluation was conducted. (b) Evaluate your...

40 CFR 62.15195 - What is my schedule for evaluating continuous emission monitoring systems?

Code of Federal Regulations, 2011 CFR

2011-07-01

... continuous emission monitoring systems? 62.15195 Section 62.15195 Protection of Environment ENVIRONMENTAL... evaluating continuous emission monitoring systems? (a) Conduct annual evaluations of your continuous emission monitoring systems no more than 13 months after the previous evaluation was conducted. (b) Evaluate your...

40 CFR 60.3038 - What continuous emission monitoring systems must I install?

Code of Federal Regulations, 2011 CFR

2011-07-01

... December 9, 2004 Model Rule-Monitoring § 60.3038 What continuous emission monitoring systems must I install? (a) You must install, calibrate, maintain, and operate continuous emission monitoring systems for... system according to the “Monitoring Requirements” in § 60.13. ...

40 CFR 60.3038 - What continuous emission monitoring systems must I install?

Code of Federal Regulations, 2010 CFR

2010-07-01

... December 9, 2004 Model Rule-Monitoring § 60.3038 What continuous emission monitoring systems must I install? (a) You must install, calibrate, maintain, and operate continuous emission monitoring systems for... system according to the “Monitoring Requirements” in § 60.13. ...

40 CFR 57.811 - Recommended decision.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 5 2010-07-01 2010-07-01 false Recommended decision. 57.811 Section 57.811 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED... Technology § 57.811 Recommended decision. As soon as practicable after the conclusion of the hearing, one or...

Strategies to prevent ventilation-associated pneumonia: the effect of cuff pressure monitoring techniques and tracheal tube type on aspiration of subglottic secretions: an in-vitro study.

PubMed

Carter, Eleanor L; Duguid, Alasdair; Ercole, Ari; Matta, Basil; Burnstein, Rowan M; Veenith, Tonny

2014-03-01

Ventilation-associated pneumonia (VAP) is the commonest nosocomial infection in intensive care. Implementation of a VAP prevention care bundle is a proven method to reduce its incidence. The UK care bundle recommends maintenance of the tracheal tube cuff pressure at 20 to 30  cmH₂O with 4-hourly pressure checks and use of tracheal tubes with subglottic aspiration ports in patients admitted for more than 72  h. To evaluate the effects of tracheal tube type and cuff pressure monitoring technique on leakage of subglottic secretions past the tracheal tube cuff. Bench-top study. Laboratory. A model adult trachea with simulated subglottic secretions was intubated with a tracheal tube with the cuff inflated to 25  cmH₂O. Experiments were conducted using a Portex Profile Soft Seal tracheal tube with three cuff pressure monitoring strategies and using a Portex SACETT tracheal tube with intermittent cuff pressure checks. Rate of simulated secretion leakage past the tracheal tube cuff. Mean ± SD leakage of fluid past the Profile Soft Seal tracheal tube cuff was 2.25 ± 1.49  ml  min⁻¹ with no monitoring of cuff pressure, 2.98 ± 1.63  ml  min⁻¹ with intermittent cuff pressure monitoring and 3.83 ± 2.17  ml  min⁻¹ with continuous cuff pressure monitoring (P <0.001). Using a SACETT tracheal tube with a subglottic aspiration port and aspirating the simulated secretions prior to intermittent cuff pressure checks reduced the leakage rate to 0.50 ± 0.48  ml  min⁻¹ (P <0.001). Subglottic secretions leaked past the tracheal tube cuff with all tube types and cuff pressure monitoring strategies in this model. Significantly higher rates were observed with continuous cuff pressure monitoring and significantly lower rates were observed when using a tracheal tube with a subglottic aspiration port. Further evaluation of medical device performance is needed in order to design more effective VAP prevention strategies.

Indicators for Universal Health Coverage: can Kenya comply with the proposed post-2015 monitoring recommendations?

PubMed

Obare, Valerie; Brolan, Claire E; Hill, Peter S

2014-12-20

Universal Health Coverage (UHC), referring to access to healthcare without financial burden, has received renewed attention in global health spheres. UHC is a potential goal in the post-2015 development agenda. Monitoring of progress towards achieving UHC is thus critical at both country and global level, and a monitoring framework for UHC was proposed by a joint WHO/World Bank discussion paper in December 2013. The aim of this study was to determine the feasibility of the framework proposed by WHO/World Bank for global UHC monitoring framework in Kenya. The study utilised three documents--the joint WHO/World Bank UHC monitoring framework and its update, and the Bellagio meeting report sponsored by WHO and the Rockefeller Foundation--to conduct the research. These documents informed the list of potential indicators that were used to determine the feasibility of the framework. A purposive literature search was undertaken to identify key government policy documents and relevant scholarly articles. A desk review of the literature was undertaken to answer the research objectives of this study. Kenya has yet to establish an official policy on UHC that provides a clear mandate on the goals, targets and monitoring and evaluation of performance. However, a significant majority of Kenyans continue to have limited access to health services as well as limited financial risk protection. The country has the capacity to reasonably report on five out of the seven proposed UHC indicators. However, there was very limited capacity to report on the two service coverage indicators for the chronic condition and injuries (CCIs) interventions. Out of the potential tracer indicators (n = 27) for aggregate CCI-related measures, four tracer indicators were available. Moreover the country experiences some wider challenges that may impact on the implementation and feasibility of the WHO/World Bank framework. The proposed global framework for monitoring UHC will only be feasible in Kenya if systemic challenges are addressed. While the infrastructure for reporting the MDG related indicators is in place, Kenya will require continued international investment to extend its capacity to meet the data requirements of the proposed UHC monitoring framework, particularly for the CCI-related indicators.

Titration effectiveness of two autoadjustable continuous positive airway pressure devices driven by different algorithms in patients with obstructive sleep apnoea.

PubMed

Damiani, Mario Francesco; Quaranta, Vitaliano Nicola; Tedeschi, Ersilia; Drigo, Riccardo; Ranieri, Teresa; Carratù, Pierluigi; Resta, Onofrio

2013-08-01

Nocturnal application of continuous positive airway pressure (CPAP) is the standard treatment for patients with obstructive sleep apnoea (OSA). Determination of the therapeutic pressure (CPAP titration) is usually performed by a technician in the sleep laboratory during attended polysomnography. One possible alternative to manual titration is automated titration. Indeed, during the last 15 years, devices have been developed that deliver autoadjustable CPAP (A-CPAP). The aim of the present study was to compare the titration effectiveness of two A-CPAP devices using different flow-based algorithms in patients with OSA. This is a randomized study; 79 subjects underwent two consecutive unattended home A-CPAP titration nights with two different devices (Autoset Resmed; Remstar Auto Respironics); during the third and the fourth night, patients underwent portable monitoring in the sleep laboratory during fixed CPAP at the A-CPAP recommended pressure. Bland Altman plots showed good agreement between the recommended median and maximal pressure levels obtained with the two devices. A significant improvement was observed in all the sleep parameters by both A-CPAP machines to a similar degree. It was observed that the two A-CPAP devices using different algorithms are equally effective in initial titration of CPAP. © 2013 The Authors. Respirology © 2013 Asian Pacific Society of Respirology.

Contamination during production of heater-cooler units by Mycobacterium chimaera potential cause for invasive cardiovascular infections: results of an outbreak investigation in Germany, April 2015 to February 2016.

PubMed

Haller, Sebastian; Höller, Christiane; Jacobshagen, Anja; Hamouda, Osamah; Abu Sin, Muna; Monnet, Dominique L; Plachouras, Diamantis; Eckmanns, Tim

2016-04-28

Invasive infections with Mycobacterium chimaera were reported in patients with previous open chest surgery and exposure to contaminated heater-cooler units (HCUs). We present results of the surveillance of clinical cases and of contaminated HCUs as well as environmental investigations in Germany up until February 2016. Clinical infections occurred in five male German cases over 50 years of age (range 53-80). Cases had been exposed to HCUs from one single manufacturer during open chest surgery up to five years prior to onset of symptoms. During environmental investigations, M. chimaera was detected in samples from used HCUs from three different countries and samples from new HCUs as well as in the environment at the manufacturing site of one manufacturer in Germany. Our investigation suggests that at least some of the M. chimaera infections may have been caused by contamination of HCUs at manufacturing site. We recommend that until sustainable measures for safe use of HCUs in operation theatres are implemented, users continue to adhere to instructions for use of HCUs and Field Safety Notices issued by the manufacturer, implement local monitoring for bacterial contamination and continuously check the websites of national and European authorities for current recommendations for the safe operation of HCUs.

Acknowleding attributes that enable the career academic nurse to thrive in the tertiary education sector: A qualitative systematic review.

PubMed

Wyllie, Aileen; DiGiacomo, Michelle; Jackson, Debra; Davidson, Patricia; Phillips, Jane

2016-10-01

To optimise the career development in early career academic nurses by providing an overview of the attributes necessary for success. Evidence of early prospective career planning is necessary to optimise success in the tertiary sector. This is particularly important for nurse academics given the profession's later entry into academia, the ageing nursing workforce and the continuing global shortage of nurses. A qualitative systematic review. Academic Search Complete, CINAHL, Medline, ERIC, Professional Development Collection and Google Scholar databases were searched; resulting in the inclusion of nine qualitative nurse-only focussed studies published between 2004 and 2014. The studies were critically appraised and the data thematically analysed. Three abilities were identified as important to the early career academic nurse: a willingness to adapt to change, an intention to pursue support and embodying resilience. These abilities give rise to attributes that are recommended as key to successful academic career development for those employed on a continuing academic basis. The capacity to rely on one's own capabilities is becoming seen as increasingly important. It is proposed that recognition of these attributes, their skilful application and monitoring outlined in the review are recommended for a successful career in academia. Crown Copyright © 2016. Published by Elsevier Ltd. All rights reserved.

Changes among US Cancer Survivors: Comparing Demographic, Diagnostic, and Health Care Findings from the 1992 and 2010 National Health Interview Surveys.

PubMed

Buchanan, Natasha D; King, Jessica B; Rodriguez, Juan L; White, Arica; Trivers, Katrina F; Forsythe, Laura P; Kent, Erin E; Rowland, Julia H; Sabatino, Susan A

2013-01-01

Background. Differences in healthcare and cancer treatment for cancer survivors in the United States (US) have not been routinely examined in nationally representative samples or studied before and after important Institute of Medicine (IOM) recommendations calling for higher quality care provision and attention to comprehensive cancer care for cancer survivors. Methods. To assess differences between survivor characteristics in 1992 and 2010, we conducted descriptive analyses of 1992 and 2010 National Health Interview Survey (NHIS) data. Our study sample consisted of 1018 self-reported cancer survivors from the 1992 NHIS and 1718 self-reported cancer survivors from the 2010 NHIS who completed the Cancer Control (CCS) and Cancer Epidemiology (CES) Supplements. Results. The prevalence of reported survivors increased from 1992 to 2010 (4.2% versus 6.3%). From 1992 to 2010, there was an increase in long-term cancer survivors and a drop in multiple malignancies, and surgery remained the most widely used treatment. Significantly fewer survivors (<10 years after diagnosis) were denied insurance coverage. Survivors continue to report low participation in counseling or support groups. Conclusions. As the prevalence of cancer survivors continues to grow, monitoring differences in survivor characteristics can be useful in evaluating the effects of policy recommendations and the quality of clinical care.

Patient attitudes towards remote continuous vital signs monitoring on general surgery wards: An interview study.

PubMed

Downey, C L; Brown, J M; Jayne, D G; Randell, R

2018-06-01

Vital signs monitoring is used to identify deteriorating patients in hospital. The most common tool for vital signs monitoring is an early warning score, although emerging technologies allow for remote, continuous patient monitoring. A number of reviews have examined the impact of continuous monitoring on patient outcomes, but little is known about the patient experience. This study aims to discover what patients think of monitoring in hospital, with a particular emphasis on intermittent early warning scores versus remote continuous monitoring, in order to inform future implementations of continuous monitoring technology. Semi-structured interviews were undertaken with 12 surgical inpatients as part of a study testing a remote continuous monitoring device. All patients were monitored with both an early warning score and the new device. Interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis. Patients can see the value in remote, continuous monitoring, particularly overnight. However, patients appreciate the face-to-face aspect of early warning score monitoring as it allows for reassurance, social interaction, and gives them further opportunity to ask questions about their medical care. Early warning score systems are widely used to facilitate detection of the deteriorating patient. Continuous monitoring technologies may provide added reassurance. However, patients value personal contact with their healthcare professionals and remote monitoring should not replace this. We suggest that remote monitoring is best introduced in a phased manner, and initially as an adjunct to usual care, with careful consideration of the patient experience throughout. Copyright © 2018 Elsevier B.V. All rights reserved.

Heart Rhythm Monitoring in the Constellation Lunar and Launch/Landing EVA Suit: Recommendations from an Expert Panel

NASA Technical Reports Server (NTRS)

Scheuring, Richard A.; Hamilton, Doug; Jones, Jeffrey A.; Alexander, David

2009-01-01

There are currently several physiological monitoring requirements for EVA in the Human-Systems Interface Requirements (HSIR) document. There are questions as to whether the capability to monitor heart rhythm in the lunar surface space suit is a necessary capability for lunar surface operations. Similarly, there are questions as to whether the capability to monitor heart rhythm during a cabin depressurization scenario in the launch/landing space suit is necessary. This presentation seeks to inform space medicine personnel of recommendations made by an expert panel of cardiovascular medicine specialists regarding in-suit ECG heart rhythm monitoring requirements during lunar surface operations. After a review of demographic information and clinical cases and panel discussion, the panel recommended that ECG monitoring capability as a clinical tool was not essential in the lunar space suit; ECG monitoring was not essential in the launch/landing space suit for contingency scenarios; the current hear rate monitoring capability requirement for both launch/landing and lunar space suits should be maintained; lunar vehicles should be required to have ECG monitoring capability with a minimum of 5-lead ECG for IVA medical assessments; and, exercise stress testing for astronaut selection and retention should be changed from the current 85% maximum heart rate limit to maximal, exhaustive 'symptom-limited' testing to maximize diagnostic utility as a screening tool for evaluating the functional capacity of astronauts and their cardiovascular health.

Heart Rhythm Monitoring in the Constellation Lunar and Launch/Landing EVA Suit: Recommendations from an Expert Panel

NASA Technical Reports Server (NTRS)

Scheuring, Richard A.; Hamilton, D.; Jones, J. A.; Alexander, D.

2008-01-01

Currently there are several physiological monitoring requirements for Extravehicular Activity (EVA) in the Human-Systems Interface Requirements (HSIR) document, including continuous heart rhythm monitoring. However, it is not known whether heart rhythm monitoring in the lunar surface space suit is a necessary capability for lunar surface operations or in launch/landing suit the event of a cabin depressurization enroute to or from the moon. Methods: Current US astronaut corps demographic information was provided to an expert panel of cardiovascular medicine experts, including specialists in electrophysiology, exercise physiology, interventional cardiology and arrhythmia. This information included averages for male/female age, body mass index (BMI), blood pressure, cholesterol, inflammatory markers, echocardiogram, ranges for coronary artery calcium (CAC) scores for long duration astronauts, and ranges for heart rate (HR) and metabolic (MET) rates obtained during microgravity and lunar EVA. Results: The panel determined that no uncontrolled hazard was likely to occur in the suit during lunar surface or contingency microgravity ops that would require ECG monitoring in the highly screened US astronaut population. However having the capability for rhythm monitoring inside the vehicle (IVA) was considered critical to manage an astronaut in distress. Discussion: Heart rate (HR) monitoring alone allows effective monitoring of astronaut health and function. Consequently, electrocardiographic (ECG) monitoring capability as a clinical tool is not essential in the lunar or launch/landing space suit. However, the panel considered that rhythm monitoring could be useful in certain clinical situations, it was not considered required for safe operations. Also, lunar vehicles should be required to have ECG monitoring capability with a minimum of 5-lead ECG (derived 12- lead) for IVA medical assessments.

Accolades and Recommendations: A Longitudinal Analysis of Monitoring Reports for Two Charter Schools Serving Native American Students

ERIC Educational Resources Information Center

Anderson, Derek L.; Holder, K. C.

2012-01-01

This longitudinal case study examines 10 years' worth of annual monitoring reports for two rural Native American Charter Schools. Using data from multiple sources including interviews, site visits, and document analyses, the authors used provisional coding and constant comparison analysis to categorize the accolades and recommendations embedded in…

40 CFR 60.2941 - What is my schedule for evaluating continuous emission monitoring systems?

Code of Federal Regulations, 2011 CFR

2011-07-01

... continuous emission monitoring systems? 60.2941 Section 60.2941 Protection of Environment ENVIRONMENTAL... emission monitoring systems? (a) Conduct annual evaluations of your continuous emission monitoring systems... emission monitoring systems daily and quarterly as specified in appendix F of this part. ...

Diplomacy Through Earth Sciences: An Overview of US Geological Survey Technical Assistance Regarding the Ongoing LUSI Mud Eruption, East Java, Indonesia

NASA Astrophysics Data System (ADS)

Casadevall, T. J.

2009-12-01

In June 2007, the US Department of State (DOS) requested assistance from the USGS to provide technical guidance and advice to the US Mission in Indonesia regarding the Lumpur Sidoarjo (LUSI) mud crisis. In May 2006, LUSI began as a mud eruption from a series of mud springs adjacent to an oil and gas exploration well being drilled near Surabaya, East Java, Indonesia. The production of mud and waters from the LUSI crater area has now continued for more than 3 years with no significant change in mud production rate (~110,000 cubic meters per day) nor in temperature of the mud (70-80 degrees C). Engineers suggest that mud production will continue at these rates for years to decades to come. Regardless of future activity at LUSI, the current mud accumulation of more than 100 million cubic meters poses a physical and environmental hazard which requires continuous monitoring and observation. The first response to the 2007 DOS request involved a site visit to Indonesia in September 2007. The result of that visit was to recommend to the Government of Indonesia (GOI) that they focus on long-term management of the mud rather than focus on the controversy as to the cause of the eruption or the debate about stopping the flow. Other recommendations from the initial 2007 technical visit included contracting for a US scientist to be co-located with engineers of the Sidoarjo Mud Management Board (BPLS) in Surabaya, East Java, to advise and consult on day-to-day developments at the site of the mud eruption. A second technical team visit by USGS scientists and an engineer from the US Army Corps of Engineers in October-November 2008 made additional recommendations on the long-term management of the mud and was followed in December by the start of a 6 month contract for the US mud adviser. From the start of activity in mid-2006 through late-2008, there was a clear sense of urgency at the US Mission in Indonesia to provide guidance and advice and included the personal intervention of the new US Ambassador. The USGS has completed the requests made in the June 2007 DOS cable, including an initial characterization of the mud and fluids; an analysis of land surface changes using the INSAR method; and an assessment of the seismic hazards in East Java. In the coming year, USGS will assist DOI agencies in the geophysical monitoring of the LUSI area and in the continued characterization of mud and fluids produced by the eruption.

Changes in the immune system during and after spaceflight

NASA Technical Reports Server (NTRS)

Taylor, G. R.; Konstantinova, I.; Sonnenfeld, G.; Jennings, R.

1997-01-01

The results of immunological analyses before, during and after spaceflight, have established the fact that spaceflight can result in a blunting of the immune mechanisms of human crew members and animal test species. There is some evidence that the immune function changes in short-term flights resemble those occurring after acute stress, while the changes during long-term flights resemble those caused by chronic stress. In addition, this blunting of the immune function occurs concomitant with a relative increase in potentially infectious microorganisms in the space cabin environment. This combination of events results in an increased probability of inflight infectious events. The realization of this probability has been shown to be partially negated by the judicious use of a preflight health stabilization program and other operational countermeasures. The continuation of these countermeasures, as well as microbial and immunological monitoring, are recommended for continued spaceflight safety.

Continuous Monitoring of Glucose for Type 1 Diabetes: A Health Technology Assessment.

PubMed

2018-01-01

Type 1 diabetes is a condition in which the pancreas produces little or no insulin. People with type 1 diabetes must manage their blood glucose levels by monitoring the amount of glucose in their blood and administering appropriate amounts of insulin via injection or an insulin pump. Continuous glucose monitoring may be beneficial compared to self-monitoring of blood glucose using a blood glucose meter. It provides insight into a person's blood glucose levels on a continuous basis, and can identify whether blood glucose levels are trending up or down. We conducted a health technology assessment, which included an evaluation of clinical benefit, value for money, and patient preferences related to continuous glucose monitoring. We compared continuous glucose monitoring with self-monitoring of blood glucose using a finger-prick and a blood glucose meter. We performed a systematic literature search for studies published since January 1, 2010. We created a Markov model projecting the lifetime horizon of adults with type 1 diabetes, and performed a budget impact analysis from the perspective of the health care payer. We also conducted interviews and focus group discussions with people who self-manage their type 1 diabetes or support the management of a child with type 1 diabetes. Twenty studies were included in the clinical evidence review. Compared with self-monitoring of blood glucose, continuous glucose monitoring improved the percentage of time patients spent in the target glycemic range by 9.6% (95% confidence interval 8.0-11.2) to 10.0% (95% confidence interval 6.75-13.25) and decreased the number of severe hypoglycemic events.Continuous glucose monitoring was associated with higher costs and small increases in health benefits (quality-adjusted life-years). Incremental cost-effectiveness ratios (ICERs) ranged from $592,206 to $1,108,812 per quality-adjusted life-year gained in analyses comparing four continuous glucose monitoring interventions to usual care. However, the uncertainty around the ICERs was large. The net budget impact of publicly funding continuous glucose monitoring assuming a 20% annual increase in adoption of continuous glucose monitoring would range from $8.5 million in year 1 to $16.2 million in year 5.Patient engagement surrounding the topic of continuous glucose monitoring was robust. Patients perceived that these devices provided important social, emotional, and medical and safety benefits in managing type 1 diabetes, especially in children. Continuous glucose monitoring was more effective than self-monitoring of blood glucose in managing type 1 diabetes for some outcomes, such as time spent in the target glucose range and time spent outside the target glucose range (moderate certainty in this evidence). We were less certain that continuous glucose monitoring would reduce the number of severe hypoglycemic events. Compared with self-monitoring of blood glucose, the costs of continuous glucose monitoring were higher, with only small increases in health benefits. Publicly funding continuous glucose monitoring for the type 1 diabetes population in Ontario would result in additional costs to the health system over the next 5 years. Adult patients and parents of children with type 1 diabetes reported very positive experiences with continuous glucose monitoring. The high ongoing cost of continuous glucose monitoring devices was seen as the greatest barrier to their widespread use.

Continuous Monitoring of Glucose for Type 1 Diabetes: A Health Technology Assessment

PubMed Central

Vandersluis, Stacey; Kabali, Conrad; Djalalov, Sandjar; Gajic-Veljanoski, Olga; Wells, David; Holubowich, Corinne

2018-01-01

Background Type 1 diabetes is a condition in which the pancreas produces little or no insulin. People with type 1 diabetes must manage their blood glucose levels by monitoring the amount of glucose in their blood and administering appropriate amounts of insulin via injection or an insulin pump. Continuous glucose monitoring may be beneficial compared to self-monitoring of blood glucose using a blood glucose meter. It provides insight into a person's blood glucose levels on a continuous basis, and can identify whether blood glucose levels are trending up or down. Methods We conducted a health technology assessment, which included an evaluation of clinical benefit, value for money, and patient preferences related to continuous glucose monitoring. We compared continuous glucose monitoring with self-monitoring of blood glucose using a finger-prick and a blood glucose meter. We performed a systematic literature search for studies published since January 1, 2010. We created a Markov model projecting the lifetime horizon of adults with type 1 diabetes, and performed a budget impact analysis from the perspective of the health care payer. We also conducted interviews and focus group discussions with people who self-manage their type 1 diabetes or support the management of a child with type 1 diabetes. Results Twenty studies were included in the clinical evidence review. Compared with self-monitoring of blood glucose, continuous glucose monitoring improved the percentage of time patients spent in the target glycemic range by 9.6% (95% confidence interval 8.0–11.2) to 10.0% (95% confidence interval 6.75–13.25) and decreased the number of severe hypoglycemic events. Continuous glucose monitoring was associated with higher costs and small increases in health benefits (quality-adjusted life-years). Incremental cost-effectiveness ratios (ICERs) ranged from $592,206 to $1,108,812 per quality-adjusted life-year gained in analyses comparing four continuous glucose monitoring interventions to usual care. However, the uncertainty around the ICERs was large. The net budget impact of publicly funding continuous glucose monitoring assuming a 20% annual increase in adoption of continuous glucose monitoring would range from $8.5 million in year 1 to $16.2 million in year 5. Patient engagement surrounding the topic of continuous glucose monitoring was robust. Patients perceived that these devices provided important social, emotional, and medical and safety benefits in managing type 1 diabetes, especially in children. Conclusions Continuous glucose monitoring was more effective than self-monitoring of blood glucose in managing type 1 diabetes for some outcomes, such as time spent in the target glucose range and time spent outside the target glucose range (moderate certainty in this evidence). We were less certain that continuous glucose monitoring would reduce the number of severe hypoglycemic events. Compared with self-monitoring of blood glucose, the costs of continuous glucose monitoring were higher, with only small increases in health benefits. Publicly funding continuous glucose monitoring for the type 1 diabetes population in Ontario would result in additional costs to the health system over the next 5 years. Adult patients and parents of children with type 1 diabetes reported very positive experiences with continuous glucose monitoring. The high ongoing cost of continuous glucose monitoring devices was seen as the greatest barrier to their widespread use. PMID:29541282

40 CFR Table 4 to Subpart Hhhhhhh... - Applicability of the General Provisions to Part 63

Code of Federal Regulations, 2014 CFR

2014-07-01

... SSM plan for continuous monitoring systems No. § 63.8(c)(5) Continuous opacity monitoring system...) Written procedures for continuous monitoring systems Yes, except for last sentence, which refers to an SSM plan. SSM plans are not required § 63.8(e) Continuous monitoring systems performance evaluation Yes...

40 CFR 60.1240 - How do I make sure my continuous emission monitoring systems are operating correctly?

Code of Federal Regulations, 2010 CFR

2010-07-01

... emission monitoring systems are operating correctly? 60.1240 Section 60.1240 Protection of Environment... Continuous Emission Monitoring § 60.1240 How do I make sure my continuous emission monitoring systems are operating correctly? (a) Conduct initial, daily, quarterly, and annual evaluations of your continuous...

40 CFR 60.1240 - How do I make sure my continuous emission monitoring systems are operating correctly?

Code of Federal Regulations, 2013 CFR

2013-07-01

... emission monitoring systems are operating correctly? 60.1240 Section 60.1240 Protection of Environment... Continuous Emission Monitoring § 60.1240 How do I make sure my continuous emission monitoring systems are operating correctly? (a) Conduct initial, daily, quarterly, and annual evaluations of your continuous...

40 CFR 60.1240 - How do I make sure my continuous emission monitoring systems are operating correctly?

Code of Federal Regulations, 2012 CFR

2012-07-01

... emission monitoring systems are operating correctly? 60.1240 Section 60.1240 Protection of Environment... Continuous Emission Monitoring § 60.1240 How do I make sure my continuous emission monitoring systems are operating correctly? (a) Conduct initial, daily, quarterly, and annual evaluations of your continuous...

40 CFR 60.1240 - How do I make sure my continuous emission monitoring systems are operating correctly?

Code of Federal Regulations, 2014 CFR

2014-07-01

... emission monitoring systems are operating correctly? 60.1240 Section 60.1240 Protection of Environment... Continuous Emission Monitoring § 60.1240 How do I make sure my continuous emission monitoring systems are operating correctly? (a) Conduct initial, daily, quarterly, and annual evaluations of your continuous...

40 CFR 60.1240 - How do I make sure my continuous emission monitoring systems are operating correctly?

Code of Federal Regulations, 2011 CFR

2011-07-01

... emission monitoring systems are operating correctly? 60.1240 Section 60.1240 Protection of Environment... Continuous Emission Monitoring § 60.1240 How do I make sure my continuous emission monitoring systems are operating correctly? (a) Conduct initial, daily, quarterly, and annual evaluations of your continuous...

40 CFR Table 3 of Subpart Aaaa to... - Requirements for Validating Continuous Emission Monitoring Systems (CEMS)

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 6 2010-07-01 2010-07-01 false Requirements for Validating Continuous Emission Monitoring Systems (CEMS) 3 Table 3 of Subpart AAAA to Part 60 Protection of Environment... Continuous Emission Monitoring Systems (CEMS) For the following continuous emission monitoring systems Use...

40 CFR Table 3 of Subpart Aaaa to... - Requirements for Validating Continuous Emission Monitoring Systems (CEMS)

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 6 2011-07-01 2011-07-01 false Requirements for Validating Continuous Emission Monitoring Systems (CEMS) 3 Table 3 of Subpart AAAA to Part 60 Protection of Environment... Continuous Emission Monitoring Systems (CEMS) For the following continuous emission monitoring systems Use...

Field observations of display placement requirements and character size for presbyopic and prepresbyopic computer users.

PubMed

Bartha, Michael C; Allie, Paul; Kokot, Douglas; Roe, Cynthia Purvis

2015-01-01

Computer users continue to report eye and upper body discomfort even as workstation flexibility has improved. Research shows a relationship between character size, viewing distance, and reading performance. Few reports exist regarding text height viewed under normal office work conditions and eye discomfort. This paper reports self-selected computer display placement, text characteristics, and subjective comfort for older and younger computer workers under real-world conditions. Computer workers were provided with monitors and adjustable display support(s). In Study 1, older workers wearing progressive-addition lenses (PALs) were observed. In study 2, older workers wearing multifocal lenses and younger workers were observed. Workers wearing PALs experienced less eye and body discomfort with adjustable displays, and less eye and neck discomfort for text visual angles near or greater than ergonomic recommendations. Older workers wearing multifocal correction positioned displays much lower than younger workers. In general, computer users did not adjust character size to ensure that fovial images of text fell within the recommended range. Ergonomic display placement recommendations should be different for computer users wearing multifocal correction for presbyopia. Ergonomic training should emphasize adjusting text size for user comfort.

HPV Vaccination among Adolescent Males: Results from the National Immunization Survey-Teen

PubMed Central

Reiter, Paul L.; Gilkey, Melissa B.; Brewer, Noel T.

2013-01-01

US guidelines provided a permissive recommendation forHPV vaccine for males in 2009, with an updated recommendation for routine vaccination in 2011. Dataon vaccine uptake among males, however, remain sparse. We analyzed 2010–2011 data (collected mostlyprior to the recommendation for routine vaccination) from the National Immunization Survey-Teen for a nationally representative sample of adolescent males ages 13–17 (n=22,365). We examined HPV vaccine initiation( receipt of at least one doseba sed on healthcare provider records) as the primary outcome. Analyses used weighted logistic regression. HPV vaccine initiation increased from 1.4% in 2010 to 8.3% in 2011. Parents who reported receiving a healthcare provider recommendation to get their sons HPV vaccine were much more likely to have vaccinated sons (OR=19.02, 95% CI: 14.36–25.19). Initiation was also higher among sons who were Hispanic (OR=1.83, 95% CI: 1.24–2.71) or who were eligible for the Vaccines for Children program (OR=1.53, 95% CI: 1.01–2.31). Only31.0% of parents with unvaccinated sons indicatedtheir sons were “somewhat likely” or “very likely” to receive HPV vaccine in the next year. The most common main reasons for parents not intending to vaccinate were believing vaccination is not needed or not necessary (24.5%), not having received a provider recommendation (22.1%), and lack of knowledge (15.9%). HPV vaccination is low among adolescent males in the US, and provider recommendation for vaccination is likely keyto improv ingvaccine uptake. Given the updated recommendation for routine vaccination and the changes in health insurance coverage that are likely to follow, continued efforts are needed to monitor HPV vaccination among males. PMID:23602667

COCONet enhancements to circum-Caribbean tsunami warning, tidal, and sea-level monitoring: update on tide gauge installations

NASA Astrophysics Data System (ADS)

Dausz, K.; Dittmann, S. T.; Feaux, K.; von Hillebrandt-Andrade, C.; Mattioli, G. S.; Normandeau, J.

2014-12-01

The Continually Operating Caribbean GPS Observational Network (COCONet) is a National Science Foundation (NSF) funded multi-hazard geodetic and meteorological network distributed throughout the Caribbean, which provides infrastructure and capacity building for a broad range of earth science questions. The network is a multi-national collaboration consisting of 46 newly constructed continuous Global Positioning Systems (cGPS) and 21 refurbished existing GPS stations, all co-located with meteorological sensors. One recommendation of the COCONet working group was to improve the vertical reference frame for long-term sea level monitoring. A COCONet supplement was awarded by the NSF to further address this particular objective through the co-location of GPS and tide gauges. This COCOnet infrastructure, along with the new tide gauges, will have broad scientific implications for hazards mitigation, solid earth, and atmospheric science research. UNAVCO engineers have meet with members of the Caribbean tide gauge community to establish target locations and design station layout. Allocated NSF funds allow for the construction of two complete new tide gauge systems each with two complimentary cGPS. Following the recommendations of NOAA and the sea level monitoring community, the two "new" locales will be Port Royal, Jamaica and Puerto Morelos, Mexico. Both locations had previously existing, but currently non-operational tide gauges. UNAVCO engineers will install a Sutron Radar Level Recorder and a backup pressure sensor tide gauge with GOES satellite telemetry. Tide data will be freely available by the Intergovernmental Oceanographic Commission (www.ioc-sealevelmonitoring.org). The NSF supplement also provided funds for adding cGPS to two additional locations where currently functioning tide gauge systems exist. Proposed locations for this additional infrastructure are Barahona, Dominican Republic and Bocas del Toro, Panama. All four locations will feature two standard COCONet cGPS systems consisting of a Trimble Choke Ring GNSS antenna, Trimble NetR9 GPS receiver, and a Vaisala meteorological sensor. All GPS data will be collected, processed and distributed via standard COCONet archiving and processing along with raw meteorological data at coconet.unavco.org.

C-B3-03: Development and Pilot Testing of Guidelines to Monitor High-Risk Medications in the Ambulatory Setting

PubMed Central

Tjia, Jennifer; Field, Terry; Garber, Lawrence; Raebel, Marsha; Donovan, Jennifer; Kanaan, Abir; Fischer, Shira; Gagne, Shawn; Zhao, Yanfang; Fuller, Jackie; Gurwitz, Jerry

2010-01-01

Background: Inadequate laboratory monitoring of high-risk medications contributes to preventable adverse drug events. One barrier to appropriate monitoring is lack of standardized monitoring guidelines. The study aims were to develop guidelines to monitor high-risk medications and to assess the prevalence of laboratory testing for these medications in a multispecialty group practice. Methods: We developed guidelines for laboratory monitoring of high-risk medications as part of a patient safety intervention trial. An advisory committee of national experts and local leaders (clinicians, pharmacists, pharmacoepidemiologists, and patient safety experts) used a two-round, internet-based Delphi process to select guideline medications based on the importance of monitoring for efficacy, safety, and drug-drug interactions. Test frequency recommendations were developed by academic pharmacists based on literature review and local interdisciplinary consensus. To estimate the potential impact of the intervention, we determined the prevalence of high-risk drug dispensings and laboratory testing for guideline medications between January 1, 2008 and July 31, 2008. Results: Consensus on medications to include in the guidelines was achieved in two rounds. Final guidelines included 35 drugs/drug classes and 61 laboratory tests. The prevalence of monitoring ranged from <50% to >90%, with infrequently prescribed drugs having a lower prevalence of recommended testing. When more than one test was recommended for a selected medication, monitoring within a medication sometimes differed by > 50%. Conclusions: Even among drugs where there is general consensus that laboratory monitoring is important, prevalence of monitoring is highly variable. Further, infrequently prescribed medications are at higher risk for poor monitoring.

Implementation of a nutrition education program in a handball team; consequences on nutritional status.

PubMed

Molina-López, Jorge; Molina, José Manuel; Chirosa, Luis Javier; Florea, Daniela; Sáez, Laura; Jiménez, Jorge; Planells, Paloma; Pérez de la Cruz, Antonio; Planells, Elena

2013-01-01

To evaluate nutritional status and dietary habits after implementation of a nutritional education program in professional handball players. Longitudinal study of 14 handball players evaluated with 72-h recall, a questionnaire on food consumption and anthropometric measures during 4 months. The intervention consisted of a nutrition education program. Energy intake was consistently below the recommended allowances. Macronutrient intakes as a percentage of total energy intake were below the recommended allowances for carbohydrates, and above recommended allowances for fats. Nutritional education was followed by a significant increase (p < 0.01) in total energy and macronutrient intakes, with no significant changes in macronutrient or micronutrient intakes after adjustment for energy intake. The imbalance in nutrient intake in handball players suggests that detailed re-analysis is needed to determine specific recommendations for this population. Nutritional education with continuous follow-up to monitor athletes' dietary habits may lead them to adopt appropriate nutritional habits to optimize dietary intakes. The lack of specific recommendations for micronutrient intakes in athletes leads to confusion regarding appropriate intakes; biochemical tests that yield normal values (albeit approaching cut-off values for deficiency) may disguise deficient status for some nutrients when strenuous exercise is involved. In-depth studies with nutrition education programs that include long-term follow-up are advisable to avoid deficiencies that can lead to irreversible damage in competitive athletes. Copyright © AULA MEDICA EDICIONES 2013. Published by AULA MEDICA. All rights reserved.

Accuracy of continuous noninvasive arterial pressure monitoring in living-liver donors during transplantation.

PubMed

Araz, Coskun; Zeyneloglu, Pinar; Pirat, Arash; Veziroglu, Nukhet; Camkiran Firat, Aynur; Arslan, Gulnaz

2015-04-01

Hemodynamic monitoring is vital during liver transplant surgeries because distinct hemodynamic changes are expected. The continuous noninvasive arterial pressure (CNAP) monitor is a noninvasive device for continuous arterial pressure measurement by a tonometric method. This study compared continuous noninvasive arterial pressure monitoring with invasive direct arterial pressure monitoring in living-liver donors during transplant. There were 40 patients analyzed while undergoing hepatic lobectomy for liver transplant. Invasive pressure monitoring was established at the radial artery and continuous noninvasive arterial pressure monitoring using a finger sensor was recorded simultaneously from the contralateral arm. Systolic, diastolic, and mean arterial pressures from the 2 methods were compared. Correlation between the 2 methods was calculated. A total of 5433 simultaneous measurements were obtained. For systolic arterial blood pressure, 55% continuous noninvasive arterial pressure measurements were within 10% direct arterial measurement; the correlation was 0.479, continuous noninvasive arterial pressure bias was -0.3 mm Hg, and limits of agreement were 32.0 mm Hg. For diastolic arterial blood pressure, 50% continuous noninvasive arterial pressure measurements were within 10% direct arterial measurement; the correlation was 0.630, continuous noninvasive arterial pressure bias was -0.4 mm Hg, and limits of agreement were 21.1 mm Hg. For mean arterial blood pressure, 60% continuous noninvasive arterial pressure measurements were within 10% direct arterial measurement; the correlation was 0.692, continuous noninvasive arterial pressure bias was +0.4 mm Hg, and limits of agreement were 20.8 mm Hg. The 2 monitoring techniques did not show acceptable agreement. Our results suggest that continuous noninvasive arterial pressure monitoring is not equivalent to invasive arterial pressure monitoring in donors during living-donor liver transplant.

Monitoring the tobacco use epidemic II. The Agent: Current and Emerging Tobacco Products

PubMed Central

Stellman, Steven D.; Djordjevic, Mirjana V.

2009-01-01

Objective This Agent paper summarizes the findings and recommendations of the Agent (product) Working Group of the November, 2002, National Tobacco Monitoring, Research and Evaluation Workshop. Methods The Agent Working Group evaluated the need to develop new surveillance systems for quantifying ingredients and emissions of tobacco and tobacco smoke and to improve methods to assess uptake and metabolism of these constituents taking into account variability in human smoking behavior. Results The toxic properties of numerous tobacco and tobacco smoke constituents are well known, yet systematic monitoring of tobacco products has historically been limited to tar, nicotine, and CO in mainstream cigarette smoke using a machine-smoking protocol that does not reflect human smoking behavior. Toxicity of smokeless tobacco products has not been regularly monitored. Tobacco products are constantly changing and untested products are introduced into the marketplace with great frequency, including potential reduced-exposure products (PREPs). The public health impact of new or modified tobacco products is unknown. Conclusions Systematic surveillance is recommended for mainstream smoke constituents such as polycyclic aromatic hydrocarbons (PAH), tobacco-specific nitrosamines (TSNA), total and free-base nicotine, volatile organic compounds, aromatic amines, and metals; and design attributes including tobacco blend, additives, and filter ventilation. Research on smoking topography is recommended to help define machine-smoking protocols for monitoring emissions reflective of human smoking behavior. Recommendations are made for marketplace product sampling and for population monitoring of smoking topography, emissions of toxic constituents, biomarkers of exposure and, eventually, risk of tobacco-related diseases. PMID:18848577

Care of girls and women with Turner syndrome: a guideline of the Turner Syndrome Study Group.

PubMed

Bondy, Carolyn A

2007-01-01

The objective of this work is to provide updated guidelines for the evaluation and treatment of girls and women with Turner syndrome (TS). The Turner Syndrome Consensus Study Group is a multidisciplinary panel of experts with relevant clinical and research experience with TS that met in Bethesda, Maryland, April 2006. The meeting was supported by the National Institute of Child Health and unrestricted educational grants from pharmaceutical companies. The study group used peer-reviewed published information to form its principal recommendations. Expert opinion was used where good evidence was lacking. The study group met for 3 d to discuss key issues. Breakout groups focused on genetic, cardiological, auxological, psychological, gynecological, and general medical concerns and drafted recommendations for presentation to the whole group. Draft reports were available for additional comment on the meeting web site. Synthesis of the section reports and final revisions were reviewed by e-mail and approved by whole-group consensus. We suggest that parents receiving a prenatal diagnosis of TS be advised of the broad phenotypic spectrum and the good quality of life observed in TS in recent years. We recommend that magnetic resonance angiography be used in addition to echocardiography to evaluate the cardiovascular system and suggest that patients with defined cardiovascular defects be cautioned in regard to pregnancy and certain types of exercise. We recommend that puberty should not be delayed to promote statural growth. We suggest a comprehensive educational evaluation in early childhood to identify potential attention-deficit or nonverbal learning disorders. We suggest that caregivers address the prospect of premature ovarian failure in an open and sensitive manner and emphasize the critical importance of estrogen treatment for feminization and for bone health during the adult years. All individuals with TS require continued monitoring of hearing and thyroid function throughout the lifespan. We suggest that adults with TS be monitored for aortic enlargement, hypertension, diabetes, and dyslipidemia.

Management and prevention of refeeding syndrome in medical inpatients: An evidence-based and consensus-supported algorithm.

PubMed

Friedli, Natalie; Stanga, Zeno; Culkin, Alison; Crook, Martin; Laviano, Alessandro; Sobotka, Lubos; Kressig, Reto W; Kondrup, Jens; Mueller, Beat; Schuetz, Philipp

2018-03-01

Refeeding syndrome (RFS) can be a life-threatening metabolic condition after nutritional replenishment if not recognized early and treated adequately. There is a lack of evidence-based treatment and monitoring algorithm for daily clinical practice. The aim of the study was to propose an expert consensus guideline for RFS for the medical inpatient (not including anorexic patients) regarding risk factors, diagnostic criteria, and preventive and therapeutic measures based on a previous systematic literature search. Based on a recent qualitative systematic review on the topic, we developed clinically relevant recommendations as well as a treatment and monitoring algorithm for the clinical management of inpatients regarding RFS. With international experts, these recommendations were discussed and agreement with the recommendation was rated. Upon hospital admission, we recommend the use of specific screening criteria (i.e., low body mass index, large unintentional weight loss, little or no nutritional intake, history of alcohol or drug abuse) for risk assessment regarding the occurrence of RFS. According to the patient's individual risk for RFS, a careful start of nutritional therapy with a stepwise increase in energy and fluids goals and supplementation of electrolyte and vitamins, as well as close clinical monitoring, is recommended. We also propose criteria for the diagnosis of imminent and manifest RFS with practical treatment recommendations with adoption of the nutritional therapy. Based on the available evidence, we developed a practical algorithm for risk assessment, treatment, and monitoring of RFS in medical inpatients. In daily routine clinical care, this may help to optimize and standardize the management of this vulnerable patient population. We encourage future quality studies to further refine these recommendations. Copyright © 2017 Elsevier Inc. All rights reserved.

40 CFR 60.1760 - What is required for my continuous opacity monitoring system and how are the data used?

Code of Federal Regulations, 2011 CFR

2011-07-01

... opacity monitoring system and how are the data used? 60.1760 Section 60.1760 Protection of Environment... continuous opacity monitoring system and how are the data used? (a) Install, calibrate, maintain, and operate a continuous opacity monitoring system. (b) Install, evaluate, and operate each continuous opacity...

40 CFR Table 6 to Subpart Bbbb of... - Model Rule-Requirements for Validating Continuous Emission Monitoring Systems (CEMS)

Code of Federal Regulations, 2010 CFR

2010-07-01

... Continuous Emission Monitoring Systems (CEMS) 6 Table 6 to Subpart BBBB of Part 60 Protection of Environment...—Requirements for Validating Continuous Emission Monitoring Systems (CEMS) For the following continuous emission monitoring systems Use the following methods in appendix A of this part to validate poollutant concentratin...

40 CFR Table 6 to Subpart Bbbb of... - Model Rule-Requirements for Validating Continuous Emission Monitoring Systems (CEMS)

Code of Federal Regulations, 2011 CFR

2011-07-01

... Continuous Emission Monitoring Systems (CEMS) 6 Table 6 to Subpart BBBB of Part 60 Protection of Environment...—Requirements for Validating Continuous Emission Monitoring Systems (CEMS) For the following continuous emission monitoring systems Use the following methods in appendix A of this part to validate poollutant concentratin...

Pacemaker or defibrillator surgery without interruption of anticoagulation.

PubMed

Birnie, David H; Healey, Jeff S; Wells, George A; Verma, Atul; Tang, Anthony S; Krahn, Andrew D; Simpson, Christopher S; Ayala-Paredes, Felix; Coutu, Benoit; Leiria, Tiago L L; Essebag, Vidal

2013-05-30

Many patients requiring pacemaker or implantable cardioverter-defibrillator (ICD) surgery are taking warfarin. For patients at high risk for thromboembolic events, guidelines recommend bridging therapy with heparin; however, case series suggest that it may be safe to perform surgery without interrupting warfarin treatment. There have been few results from clinical trials to support the safety and efficacy of this approach. We randomly assigned patients with an annual risk of thromboembolic events of 5% or more to continued warfarin treatment or to bridging therapy with heparin. The primary outcome was clinically significant device-pocket hematoma, which was defined as device-pocket hematoma that necessitated prolonged hospitalization, interruption of anticoagulation therapy, or further surgery (e.g., hematoma evacuation). The data and safety monitoring board recommended termination of the trial after the second prespecified interim analysis. Clinically significant device-pocket hematoma occurred in 12 of 343 patients (3.5%) in the continued-warfarin group, as compared with 54 of 338 (16.0%) in the heparin-bridging group (relative risk, 0.19; 95% confidence interval, 0.10 to 0.36; P<0.001). Major surgical and thromboembolic complications were rare and did not differ significantly between the study groups. They included one episode of cardiac tamponade and one myocardial infarction in the heparin-bridging group and one stroke and one transient ischemic attack in the continued-warfarin group. As compared with bridging therapy with heparin, a strategy of continued warfarin treatment at the time of pacemaker or ICD surgery markedly reduced the incidence of clinically significant device-pocket hematoma. (Funded by the Canadian Institutes of Health Research and the Ministry of Health and Long-Term Care of Ontario; BRUISE CONTROL ClinicalTrials.gov number, NCT00800137.).

Monitoring the tobacco use epidemic V: The environment: factors that influence tobacco use.

PubMed

Farrelly, Matthew C

2009-01-01

This environment paper (V of V) summarizes important surveillance and evaluation systems that monitor influences on tobacco use such as smoke-free laws and other legislation, excise taxes, mass media, and a broad range of tobacco control activities, discusses their strengths and weaknesses, and makes recommendations for enhancement. We summarize and expand on the recommendations from the Environment Working Group of the National Tobacco Monitoring, Research, and Evaluation Workshop prioritized surveillance needs. This group rank-ordered surveillance needs various environmental influences, considering both the perceived importance of each environmental influence and the adequacy of the current surveillance systems. Based on this ranking and subsequent discussion, the group identified key priorities for enhancement. The group arrived at two key priorities: (1) develop and implement a national system for local tobacco control ordinance surveillance, and (2) develop and implement a comprehensive program monitoring system that is used by all states and supported by all funding agencies. Other environmental influences recommended for priority monitoring include cigarette prices and tobacco countermarketing. Systematic surveillance and monitoring of key program inputs and outputs and environmental influences is central to understand the effectiveness and cost-effectiveness of tobacco control efforts.

Measuring Progress Toward Universal Health Coverage: Does the Monitoring Framework of Bangladesh Need Further Improvement?

PubMed Central

Shahabuddin, ASM

2018-01-01

This review aimed to compare Bangladesh’s Universal Health Coverage (UHC) monitoring framework with the global-level recommendations and to find out the existing gaps of Bangladesh’s UHC monitoring framework compared to the global recommendations. In order to reach the aims of the review, we systematically searched two electronic databases - PubMed and Google Scholar - by using appropriate keywords to select articles that describe issues related to UHC and the monitoring framework of UHC applied globally and particularly in Bangladesh. Four relevant documents were found and synthesized. The review found that Bangladesh incorporated all of the recommendations suggested by the global monitoring framework regarding mentoring the financial risk protection and equity perspective. However, a significant gap in the monitoring framework related to service coverage was observed. Although Bangladesh has a significant burden of mental illnesses, cataract, and neglected tropical diseases, indicators related to these issues were absent in Bangladesh’s UHC framework. Moreover, palliative-care-related indicators were completely missing in the framework. The results of this review suggest that Bangladesh should incorporate these indicators in their UHC monitoring framework in order to track the progress of the country toward UHC more efficiently and in a robust way. PMID:29541562

2014 CODEPEH recommendations: Early detection of late onset deafness, audiological diagnosis, hearing aid fitting and early intervention.

PubMed

Núñez-Batalla, Faustino; Jáudenes-Casaubón, Carmen; Sequí-Canet, Jose Miguel; Vivanco-Allende, Ana; Zubicaray-Ugarteche, Jose

2016-01-01

The latest scientific literature considers early diagnosis of deafness as the key element to define the educational and inclusive prognosis of the deaf child, because it allows taking advantage of the critical period of development (0-4 years). Highly significant differences exist between deaf people who have been stimulated early and those who have received late or improper intervention. Early identification of late-onset disorders requires special attention and knowledge on the part of every childcare professional. Programs and additional actions beyond neonatal screening should be designed and planed to ensure that every child with a significant hearing loss is detected early. For this purpose, the CODEPEH would like to highlight the need for continuous monitoring of children's auditory health. Consequently, CODEPEH has drafted the recommendations included in the present document. Copyright © 2015 Elsevier España, S.L.U. and Sociedad Española de Otorrinolaringología y Patología Cérvico-Facial. All rights reserved.

[CODEPEH 2014 recommendations for the early detection of delayed hearing loss].

PubMed

Núñez-Batalla, Faustino; Jáudenes-Casaubón, Carmen; Sequí-Canet, José Miguel; Vivanco-Allende, Ana; Zubicaray-Ugarteche, José

2016-10-01

The latest scientific literature considers early diagnosis of deafness as key element to define the educational prognosis and inclusion of the deaf child, as advantage can be taken in the critical period of development (0-4 years). Highly significant differences exist between those deaf persons who have been stimulated early and those who have received late or inappropriate intervention. Early identification of late-onset disorders requires special attention and knowledge of all childcare professionals. Programs and additional actions beyond neonatal screening should be designed and planned in order to ensure that every child with a significant hearing loss is detected early. For this purpose, the Committee for the Early Detection of Deafness (CODEPEH) would like to highlight the need for continuous monitoring on the hearing health of children. And, for this reason, CODEPEH drafts the recommendations included in the present document. Copyright © 2015 Asociación Española de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.

[The NHG guidelines 'Adult asthma' and 'COPD'].

PubMed

Geijer, Roeland M M; Tuut, Mariska K; in't Veen, Johannes C C M; Broekhuizen, Berna D L; Chavannes, Niels H; Smeele, Ivo J M

2015-01-01

The Dutch College of General Practitioners (NHG) guidelines 'Adult asthma' and 'COPD' have been revised. New spirometry reference values from the Global Lung Function Initiative are recommended. Airway obstruction is defined as a FEV1/FVC ratio below the 5th percentile for the reference population. Spirometry for diagnosis takes place without use of patients' inhaled medication and consists of measurements before and after standardized bronchodilation. In monitoring spirometry, patients continue using inhaled medication and standardized bronchodilation is not indicated. The goal of asthma management is optimal asthma control, tailored to individual goals. The most important non-drug intervention in asthma and COPD is to recommend stopping smoking. The goal of COPD management is to limit symptoms, improve exercise capacity and quality of life, and reduce the burden of disease. Inhaled corticosteroids are usually not indicated in COPD treatment. Patients with comorbid asthma and COPD are treated with non-drug interventions according to the COPD guideline and with medication according to the asthma guideline.

A survey of whitewater recreation impacts along five West Virginia rivers

USGS Publications Warehouse

Leung, Y.-F.; Marion, J.L.

1998-01-01

Results are reported from an assessment of whitewater river recreation impacts at river accesses and recreation sites along five West Virginia rivers: the New, Gauley, Cheat, Tygart, and Shenandoah. Procedures were developed and applied to assess resource conditions on 24 river access roads, 68 river accesses, and 151 recreation sites. The majority of river accesses and recreation sites are located on the New and Gauley rivers, which account for most of the state?s whitewater recreation use. Site conditions are variable. While some river accesses and sites are situated on resistant rocky substrates, many are poorly designed and/or located on erodible soil and sand substrates. Recreation site sizes and other areal measures of site disturbance are quite large, coincident with the large group sizes associated with commercially outfitted whitewater rafting trips. Recommendations are offered for managing river accesses and sites and whitewater visitation and the selection of indicators and standards as part of a Limits of Acceptable Change management process. Procedures and recommendations for continued visitor impact monitoring are also offered.

Ethical issues related to professional exposure of pregnant women in the medical field: monitoring and limiting effective dose.

PubMed

Santos, J A M; Nunes, R

2011-03-01

The International Commission on Radiological Protection recommendations for occupational exposed pregnant women do not imply necessarily the complete avoidance of work with radiation or radioactive materials. Instead, a careful review of the exposure conditions, once the pregnancy is declared, as part of the exercise of the ICRP optimisation principle (based in a teleological ethics point of view) is suggested. The dose limitation (following a deontological ethics point of view) of the fetus/embryo is, however, not clearly well established as happens in the case of workers or members of the public. Also, the justification of practices (to continue to work or not with radiation or radioactive materials) is not clearly addressed in most national or international recommendations. An analysis of this justification (bearing in mind both teleological and deontological ethics) is examined in this work having in mind the best interest of the child-to-be as well as other existing social and economical factors.

40 CFR 60.1335 - What is the minimum amount of monitoring data I must collect with my continuous parameter...

Code of Federal Regulations, 2011 CFR

2011-07-01

... monitoring data I must collect with my continuous parameter monitoring systems and is the data collection... parameter monitoring systems and is the data collection requirement enforceable? (a) Where continuous parameter monitoring systems are used, obtain 1-hour arithmetic averages for three parameters: (1) Load...

40 CFR 60.1335 - What is the minimum amount of monitoring data I must collect with my continuous parameter...

Code of Federal Regulations, 2010 CFR

2010-07-01

... monitoring data I must collect with my continuous parameter monitoring systems and is the data collection... parameter monitoring systems and is the data collection requirement enforceable? (a) Where continuous parameter monitoring systems are used, obtain 1-hour arithmetic averages for three parameters: (1) Load...

Diagnostic Yield of Extended Cardiac Patch Monitoring in Patients with Stroke or TIA.

PubMed

Tung, Christie E; Su, Derek; Turakhia, Mintu P; Lansberg, Maarten G

2014-01-01

It is important to evaluate patients with transient ischemic attack (TIA) or stroke for atrial fibrillation (AF) because the detection of AF changes the recommended anti-thrombotic regimen from treatment with an antiplatelet agent to oral anticoagulation. This study describes the diagnostic yield of a patch-based, single-use, and water-resistant 14-day continuous cardiac rhythm monitor (ZIO Patch) in patients with stroke or TIA. We obtained data from the manufacturer and servicer of the ZIO Patch (iRhythm Technologies). Patients who were monitored between January 2012 and June 2013 and whose indication for monitoring was TIA or stroke were included. The duration of monitoring, the number and type of arrhythmias, and the time to first arrhythmia were documented. One thousand one hundred seventy-one monitoring reports were analyzed. The mean monitor wear time was 10.9 days and the median wear time was 13.0 days (interquartile range 7.2-14.0). The median analyzable time relative to the total wear time was 98.7% (IQR 96.0-99.5%). AF was present in 5.0% of all reports. The mean duration before the first episode of paroxysmal AF (PAF) was 1.5 days and the median duration was 0.4 days. 14.3% of first PAF episodes occurred after 48 h. The mean PAF burden was 12.7% of the total monitoring duration. Excellent quality of the recordings and very good patient compliance coupled with a substantial proportion of AF detection beyond the first 48 h of monitoring suggest that the cardiac patch is superior to conventional 48-h Holter monitors for AF detection in patients with stroke or TIA.

ECLSS Integration Analysis: Advanced ECLSS Subsystem and Instrumentation Technology Study for the Space Exploration Initiative

NASA Technical Reports Server (NTRS)

1990-01-01

In his July 1989 space policy speech, President Bush proposed a long range continuing commitment to space exploration and development. Included in his goals were the establishment of permanent lunar and Mars habitats and the development of extended duration space transportation. In both cases, a major issue is the availability of qualified sensor technologies for use in real-time monitoring and control of integrated physical/chemical/biological (p/c/b) Environmental Control and Life Support Systems (ECLSS). The purpose of this study is to determine the most promising instrumentation technologies for future ECLSS applications. The study approach is as follows: 1. Precursor ECLSS Subsystem Technology Trade Study - A database of existing and advanced Atmosphere Revitalization (AR) and Water Recovery and Management (WRM) ECLSS subsystem technologies was created. A trade study was performed to recommend AR and WRM subsystem technologies for future lunar and Mars mission scenarios. The purpose of this trade study was to begin defining future ECLSS instrumentation requirements as a precursor to determining the instrumentation technologies that will be applicable to future ECLS systems. 2. Instrumentation Survey - An instrumentation database of Chemical, Microbial, Conductivity, Humidity, Flowrate, Pressure, and Temperature sensors was created. Each page of the sensor database report contains information for one type of sensor, including a description of the operating principles, specifications, and the reference(s) from which the information was obtained. This section includes a cursory look at the history of instrumentation on U.S. spacecraft. 3. Results and Recommendations - Instrumentation technologies were recommended for further research and optimization based on a consideration of both of the above sections. A sensor or monitor technology was recommended based on its applicability to future ECLS systems, as defined by the ECLSS Trade Study (1), and on whether its characteristics were considered favorable relative to similar instrumentation technologies (competitors), as determined from the Instrumentation Survey (2). The instrumentation technologies recommended by this study show considerable potential for development and promise significant returns if research efforts are invested.

A Process Evaluation of Project Developmental Continuity, Interim Report VI: Recommendations for Continuing the Impact Study.

ERIC Educational Resources Information Center

Granville, Arthur; And Others

This interim report re-examines data on instrument suitability, comparability of groups, and adequacy of sample size in Year III of the process evaluation of Project Developmental Continuity (PDC) and offers preliminary recommendations concerning the feasibility of continuing the impact study. PDC is a Head Start demonstration program aimed at…

Overview of human health in the Arctic: conclusions and recommendations.

PubMed

Donaldson, Shawn; Adlard, Bryan; Odland, Jon Øyvind

2016-01-01

This article is intended to provide an overview of the key conclusions, knowledge gaps and key recommendations based on the recent 2015 Arctic human health assessment under the Arctic Monitoring and Assessment Program. This assessment was based primarily on data from human health monitoring and research studies and peer-reviewed literature published since the last assessment in 2009.

Report from the NOAA workshops to standardize protocols for monitoring toxic Pfiesteria species and associated environmental conditions.

PubMed

Luttenberg, D; Turgeon, D; Higgins, J

2001-10-01

Long-term monitoring of water quality, fish health, and plankton communities in susceptible bodies of water is crucial to identify the environmental factors that contribute to outbreaks of toxic Pfiesteria complex (TPC) species. In the aftermath of the 1997 toxic Pfiesteria outbreaks in North Carolina and Maryland, federal and several state agencies agreed that there was a need to standardize monitoring protocols. The National Oceanic & Atmospheric Administration convened two workshops that brought together state, federal, and academic resource managers and scientific experts to a) seek consensus on responding to and monitoring potential toxic Pfiesteria outbreaks; b) recommend standard parameters and protocols to characterize water quality, fish health, and plankton at historical event sites and potentially susceptible sites; and c) discuss options for integrating monitoring data sets from different states into regional and national assessments. Workshop recommendations included the development of a three-tiered TPC monitoring strategy: Tier 1, rapid event response; Tier 2, comprehensive assessment; and Tier 3, routine monitoring. These tiers correspond to varying levels of water quality, fish health, and plankton monitoring frequency and intensity. Under the strategy, sites are prioritized, depending upon their history and susceptibility to TPC events, and assigned an appropriate level of monitoring activity. Participants also agreed upon a suite of water quality parameters that should be monitored. These recommendations provide guidance to state and federal agencies conducting rapid-response and assessment activities at sites of suspected toxic Pfiesteria outbreaks, as well as to states that are developing such monitoring programs for the first time.

21 CFR 26.45 - Monitoring continued equivalence.

Code of Federal Regulations, 2013 CFR

2013-04-01

... COMMUNITY Specific Sector Provisions for Medical Devices § 26.45 Monitoring continued equivalence. Monitoring activities will be carried out in accordance with § 26.69. ... 21 Food and Drugs 1 2013-04-01 2013-04-01 false Monitoring continued equivalence. 26.45 Section 26...

21 CFR 26.45 - Monitoring continued equivalence.

Code of Federal Regulations, 2012 CFR

2012-04-01

... COMMUNITY Specific Sector Provisions for Medical Devices § 26.45 Monitoring continued equivalence. Monitoring activities will be carried out in accordance with § 26.69. ... 21 Food and Drugs 1 2012-04-01 2012-04-01 false Monitoring continued equivalence. 26.45 Section 26...

21 CFR 26.45 - Monitoring continued equivalence.

Code of Federal Regulations, 2014 CFR

2014-04-01

... COMMUNITY Specific Sector Provisions for Medical Devices § 26.45 Monitoring continued equivalence. Monitoring activities will be carried out in accordance with § 26.69. ... 21 Food and Drugs 1 2014-04-01 2014-04-01 false Monitoring continued equivalence. 26.45 Section 26...

21 CFR 26.45 - Monitoring continued equivalence.

Code of Federal Regulations, 2011 CFR

2011-04-01

... COMMUNITY Specific Sector Provisions for Medical Devices § 26.45 Monitoring continued equivalence. Monitoring activities will be carried out in accordance with § 26.69. ... 21 Food and Drugs 1 2011-04-01 2011-04-01 false Monitoring continued equivalence. 26.45 Section 26...

40 CFR 75.40 - General demonstration requirements.

Code of Federal Regulations, 2011 CFR

2011-07-01

... (CONTINUED) CONTINUOUS EMISSION MONITORING Alternative Monitoring Systems § 75.40 General demonstration... continuous emission monitoring system may apply to the Administrator for approval of an alternative monitoring system (or system component) to determine average hourly emission data for SO2, NOX, and/or...

Recommendations for standards of monitoring during anaesthesia and recovery 2015: Association of Anaesthetists of Great Britain and Ireland.

PubMed

Checketts, M R; Alladi, R; Ferguson, K; Gemmell, L; Handy, J M; Klein, A A; Love, N J; Misra, U; Morris, C; Nathanson, M H; Rodney, G E; Verma, R; Pandit, J J

2016-01-01

This guideline updates and replaces the 4th edition of the AAGBI Standards of Monitoring published in 2007. The aim of this document is to provide guidance on the minimum standards for physiological monitoring of any patient undergoing anaesthesia or sedation under the care of an anaesthetist. The recommendations are primarily aimed at anaesthetists practising in the United Kingdom and Ireland. Minimum standards for monitoring patients during anaesthesia and in the recovery phase are included. There is also guidance on monitoring patients undergoing sedation and also during transfer of anaesthetised or sedated patients. There are new sections discussing the role of monitoring depth of anaesthesia, neuromuscular blockade and cardiac output. The indications for end-tidal carbon dioxide monitoring have been updated. © 2015 The Authors. Anaesthesia published by John Wiley & Sons Ltd on behalf of Association of Anaesthetists of Great Britain and Ireland.

[Contraception and pregnancy after liver transplantation: an update overview].

PubMed

Parolin, Mônica Beatriz; Coelho, Júlio Cezar Uili; Urbanetz, Almir Antônio; Pampuch, Melina

2009-01-01

Successful liver transplantation not only treats the underlying liver disease but also restores libido and fertility in female recipients. Although reports of successful pregnancy after liver transplantation continue to increase, these pregnancies are considered of high-risk because they are associated with increase maternofetal morbidity. A MEDLINE search (1978-2007) was conducted using the terms 'liver transplantation', 'pregnancy', 'immunosuppressive agents', 'sexual function'. Reviews, retrospective series, long-term clinical follow-up of case series and original articles containing basic scientific observations were included. Although no formal guidelines have been established there are some 'golden rules' to improve the probability of favorable maternal and fetal outcome. Most transplant centers recommend to delay pregnancy for at least 1-year after transplantation. The recipient should be on a stable immunosuppression regimen, with good graft function and no evidence of renal dysfunction or uncontrolled arterial hypertension. Considering the increased incidence of prematurity, low birth weight, hypertension and preeclampsia reported during pregnancy post-LT, these high-risk patients should be managed by a multidisciplinary team, including an obstetrician specialized in high-risk pregnancies. Carefully monitoring of immunosuppressive drugs serum level is prudent to avoid graft rejection episodes and drugs with teratogenic potential should be discontinued. Breastfeeding is usually not recommended. Successful pregnancies are the rule after liver transplantation. A carefully monitoring by an experience multidisciplinary team increases the chances of favorable maternofetal outcome.

European LeukemiaNet recommendations for the management of chronic myeloid leukemia: 2013

PubMed Central

Deininger, Michael W.; Rosti, Gianantonio; Hochhaus, Andreas; Soverini, Simona; Apperley, Jane F.; Cervantes, Francisco; Clark, Richard E.; Cortes, Jorge E.; Guilhot, François; Hjorth-Hansen, Henrik; Hughes, Timothy P.; Kantarjian, Hagop M.; Kim, Dong-Wook; Larson, Richard A.; Lipton, Jeffrey H.; Mahon, François-Xavier; Martinelli, Giovanni; Mayer, Jiri; Müller, Martin C.; Niederwieser, Dietger; Pane, Fabrizio; Radich, Jerald P.; Rousselot, Philippe; Saglio, Giuseppe; Saußele, Susanne; Schiffer, Charles; Silver, Richard; Simonsson, Bengt; Steegmann, Juan-Luis; Goldman, John M.; Hehlmann, Rüdiger

2013-01-01

Advances in chronic myeloid leukemia treatment, particularly regarding tyrosine kinase inhibitors, mandate regular updating of concepts and management. A European LeukemiaNet expert panel reviewed prior and new studies to update recommendations made in 2009. We recommend as initial treatment imatinib, nilotinib, or dasatinib. Response is assessed with standardized real quantitative polymerase chain reaction and/or cytogenetics at 3, 6, and 12 months. BCR-ABL1 transcript levels ≤10% at 3 months, <1% at 6 months, and ≤0.1% from 12 months onward define optimal response, whereas >10% at 6 months and >1% from 12 months onward define failure, mandating a change in treatment. Similarly, partial cytogenetic response (PCyR) at 3 months and complete cytogenetic response (CCyR) from 6 months onward define optimal response, whereas no CyR (Philadelphia chromosome–positive [Ph+] >95%) at 3 months, less than PCyR at 6 months, and less than CCyR from 12 months onward define failure. Between optimal and failure, there is an intermediate warning zone requiring more frequent monitoring. Similar definitions are provided for response to second-line therapy. Specific recommendations are made for patients in the accelerated and blastic phases, and for allogeneic stem cell transplantation. Optimal responders should continue therapy indefinitely, with careful surveillance, or they can be enrolled in controlled studies of treatment discontinuation once a deeper molecular response is achieved. PMID:23803709

Role of self-monitoring of blood glucose in glycemic control.

PubMed

Karter, Andrew J

2006-01-01

To examine the role of self-monitoring of blood glucose (SMBG) in the management of diabetes mellitus. Current trends and published evidence are reviewed. Despite the widespread evidence that lowering glycemic levels reduces the risks of complications in patients with diabetes, little improvement in glycemic control has been noted among patients in the United States and Europe in recent years. Although SMBG has been widely used, considerable controversy surrounds its role in achieving glycemic control. The high cost of test strips has made considerations regarding appropriate recommendations for SMBG a priority, especially in light of the current climate of health-care cost-containment. Existing clinical recommendations lack specific guidance to patients and clinicians regarding SMBG practice intensity and frequency, particularly for those patients not treated with insulin. Previous studies of the association between SMBG and glycemic control often found weak and conflicting results. A reexamination of the role of SMBG is needed, with special attention to the unique needs of patients using different diabetes treatments, within special clinical subpopulations, and during initiation of SMBG versus its ongoing use. Further understanding of the intensity and frequency of SMBG needed to reflect the variability in glycemic patterns would facilitate more specific guideline development. Educational programs that focus on teaching patients the recommended SMBG practice, specific glycemic targets, and appropriate responses to various blood glucose readings would be beneficial. Continuing medical education programs for health-care providers should suggest ways to analyze patient SMBG records to tailor medication regimens. For transfer or communication of SMBG reports to the clinical staff, a standardized format that extracts key data elements and allows quick review by health-care providers would be useful. Because the practice of SMBG is expensive, the cost-effectiveness of SMBG needs to be carefully assessed.

40 CFR 60.1230 - What continuous emission monitoring systems must I install for gaseous pollutants?

Code of Federal Regulations, 2012 CFR

2012-07-01

... according to the “Monitoring Requirements” in § 60.13. (c) You must monitor the oxygen (or carbon dioxide... systems must I install for gaseous pollutants? 60.1230 Section 60.1230 Protection of Environment... Continuous Emission Monitoring § 60.1230 What continuous emission monitoring systems must I install for...

40 CFR 60.1230 - What continuous emission monitoring systems must I install for gaseous pollutants?

Code of Federal Regulations, 2014 CFR

2014-07-01

... according to the “Monitoring Requirements” in § 60.13. (c) You must monitor the oxygen (or carbon dioxide... systems must I install for gaseous pollutants? 60.1230 Section 60.1230 Protection of Environment... Continuous Emission Monitoring § 60.1230 What continuous emission monitoring systems must I install for...

40 CFR 60.1230 - What continuous emission monitoring systems must I install for gaseous pollutants?

Code of Federal Regulations, 2013 CFR

2013-07-01

... according to the “Monitoring Requirements” in § 60.13. (c) You must monitor the oxygen (or carbon dioxide... systems must I install for gaseous pollutants? 60.1230 Section 60.1230 Protection of Environment... Continuous Emission Monitoring § 60.1230 What continuous emission monitoring systems must I install for...

40 CFR 60.1260 - What is the minimum amount of monitoring data I must collect with my continuous emission...

Code of Federal Regulations, 2010 CFR

2010-07-01

... monitoring data I must collect with my continuous emission monitoring systems and is the data collection... monitoring systems and is the data collection requirement enforceable? (a) Where continuous emission monitoring systems are required, obtain 1-hour arithmetic averages. Make sure the averages for sulfur dioxide...

40 CFR 60.1260 - What is the minimum amount of monitoring data I must collect with my continuous emission...

Code of Federal Regulations, 2011 CFR

2011-07-01

... monitoring data I must collect with my continuous emission monitoring systems and is the data collection... monitoring systems and is the data collection requirement enforceable? (a) Where continuous emission monitoring systems are required, obtain 1-hour arithmetic averages. Make sure the averages for sulfur dioxide...

21 CFR 26.15 - Monitoring continued equivalence.

Code of Federal Regulations, 2014 CFR

2014-04-01

... COMMUNITY Specific Sector Provisions for Pharmaceutical Good Manufacturing Practices § 26.15 Monitoring continued equivalence. Monitoring activities for the purpose of maintaining equivalence shall include review... 21 Food and Drugs 1 2014-04-01 2014-04-01 false Monitoring continued equivalence. 26.15 Section 26...

21 CFR 26.15 - Monitoring continued equivalence.

Code of Federal Regulations, 2013 CFR

2013-04-01

... COMMUNITY Specific Sector Provisions for Pharmaceutical Good Manufacturing Practices § 26.15 Monitoring continued equivalence. Monitoring activities for the purpose of maintaining equivalence shall include review... 21 Food and Drugs 1 2013-04-01 2013-04-01 false Monitoring continued equivalence. 26.15 Section 26...

21 CFR 26.15 - Monitoring continued equivalence.

Code of Federal Regulations, 2012 CFR

2012-04-01

... COMMUNITY Specific Sector Provisions for Pharmaceutical Good Manufacturing Practices § 26.15 Monitoring continued equivalence. Monitoring activities for the purpose of maintaining equivalence shall include review... 21 Food and Drugs 1 2012-04-01 2012-04-01 false Monitoring continued equivalence. 26.15 Section 26...

75 FR 47780 - New England Fishery Management Council; Public Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-09

...; observer coverage and portside sampling; and measures to require electronic monitoring. 2. Provide AP... follows: 1. Review and provide AP recommendations regarding catch monitoring alternatives under...: quota monitoring and reporting; measures to confirm the accuracy of self-reporting; catch monitoring and...

In-situ strain monitoring in liquid containers of LNG transporting carriers

NASA Astrophysics Data System (ADS)

Oh, Min-Cheol; Seo, Jun-Kyu; Kim, Kyung-Jo; Lee, Sang-Min; Kim, Myung-Hyun

2008-08-01

Liquefied natural gas (LNG) transport carriers are exposed to a risk by the repeated bump in the LNG container during the vessel traveling over the wave in ocean. The liquid inside the container, especially when it was not fully contained, make a strong bump onto the insulation panel of the tank wall. The insulation panel consists of several layers of thick polyurethane foam (PUF) to maintain the LNG below the cryogenic temperature, -162°C. Due to the repeated shock on the PUF, a crack could be developed on the tank wall causing a tremendous disaster for LNG carriers. To prevent the accidental crack on the tank, a continuous monitoring of the strain imposed on the PUF is recommended. In this work, a fiber-optic Bragg grating was imbedded inside the PUF for monitoring the strain parallel to the impact direction. The optical fiber sensor with a small diameter of 125 μm was suitable to be inserted in the PUF through a small hole drilled after the PUF was cured. In-situ monitoring of the strain producing the change of Bragg reflection wavelength, a high speed wavelength interrogation method was employed by using an arrayed waveguide grating. By dropping a heavy mass on the PUF, we measured the strain imposed on the insulation panel.

Home oxygen therapy: re-thinking the role of devices.

PubMed

Melani, Andrea S; Sestini, Piersante; Rottoli, Paola

2018-03-01

A range of devices are available for delivering and monitoring home oxygen therapy (HOT). Guidelines do not give indications for the choice of the delivery device but recommend the use of an ambulatory system in subjects on HOT whilst walking. Areas covered: We provide a clinical overview of HOT and review traditional and newer delivery and monitoring devices for HOT. Despite relevant technology advancements, clinicians, faced with many challenges when they prescribe oxygen therapy, often remain familiar to traditional devices and continuous flow delivery of oxygen. Some self-filling delivery-less devices could increase the users' level of independence with ecological advantage and, perhaps, reduced cost. Some newer portable oxygen concentrators are being available, but more work is needed to understand their performances in different diseases and clinical settings. Pulse oximetry has gained large diffusion worldwide and some models permit long-term monitoring. Some closed-loop portable monitoring devices are also able to adjust oxygen flow automatically in accordance with the different needs of everyday life. This might help to improve adherence and the practice of proper oxygen titration that has often been omitted because difficult to perform and time-consuming. Expert commentary: The prescribing physicians should know the characteristics of newer devices and use technological advancements to improve the practice of HOT.

Intranasal influenza vaccine: Why does Canada have different recommendations from the USA on its use?

PubMed

Tam, Theresa W S

2018-02-01

Canada and the USA differ in their recommendations for the use of live attenuated influenza vaccine (LAIV). The Canadian National Advisory Committee on Immunization (NACI) continues to recommend LAIV as one of the influenza vaccines available for use in children 2 to 17 years of age. The US Advisory Committee on Immunization Practices (ACIP) made an interim recommendation against the use of LAIV for the 2016 to 2017 influenza season in response to low LAIV effectiveness observed in the USA during the 2013 to 2014 to 2015 to 2016 seasons. The recommendation has been continued for the 2017 to 2018 season. In response, NACI undertook a review of available LAIV effectiveness data in children and adolescents from Canada, the USA and a number of European countries. This commentary by Canada's Chief Public Health Officer summarizes the findings of that review and provides the rationale for Canada's current continued recommendation for LAIV use.

Monitoring oral temperature, heart rate, and respiration rate of West Indian manatees (Trichechus manatus) during capture and handling in the field

USGS Publications Warehouse

Wong, Arthur W.; Bonde, Robert K.; Siegal-Willott, Jessica; Stamper, M. Andrew; Colee, James; Powell, James A.; Reid, James P.; Deutsch, Charles J.; Harr, Kendal E.

2012-01-01

West Indian manatees (Trichechus manatus) are captured, handled, and transported to facilitate conservation, research, and rehabilitation efforts. Monitoring manatee oral temperature (OT), heart rate (HR), and respiration rate (RR) during out-of-water handling can assist efforts to maintain animal well-being and improve medical response to evidence of declining health. To determine effects of capture on manatee vital signs, we monitored OT, HR, and RR continuously for a 50-min period in 38 healthy, awake, juvenile and adult Florida manatees (T. m. latirostris) and 48 similar Antillean manatees (T. m. manatus). We examined creatine kinase (CK), potassium (K+), serum amyloid A (SAA), and lactate values for each animal to assess possible systemic inflammation and muscular trauma. OT range was 29.5 to 36.2° C, HR range was 32 to 88 beats/min, and RR range was 0 to 17 breaths/5 min. Antillean manatees had higher initial OT, HR, and RR than Florida manatees (p < 0.001). As monitoring time progressed, mean differences between the subspecies were no longer significant. High RR over monitoring time was associated with high lactate concentration. Antillean manatees had higher overall lactate values ([mean ± SD] 20.6 ± 7.8 mmol/L) than Florida manatees (13.7 ± 6.7 mmol/L; p < 0.001). We recommend monitoring manatee OT, HR, and RR during capture and handling in the field or in a captive care setting.

Weight-bearing recommendations after operative fracture treatment-fact or fiction? Gait results with and feasibility of a dynamic, continuous pedobarography insole.

PubMed

Braun, Benedikt J; Veith, Nils T; Rollmann, Mika; Orth, Marcel; Fritz, Tobias; Herath, Steven C; Holstein, Jörg H; Pohlemann, Tim

2017-08-01

Rehabilitation after lower-extremity fractures is based on the physicians' recommendation for non-, partial-, or full weight-bearing. Clinical studies rely on this assumption, but continuous compliance or objective loading rates are unknown. The purpose of this study was to determine the compliance to weight-bearing recommendations by introducing a novel, pedobarography system continuously registering postoperative ground forces into ankle, tibial shaft and proximal femur fracture aftercare and test its feasibility for this purpose. In this prospective, observational study, a continuously measuring pedobarography insole was placed in the patients shoe during the immediate post-operative aftercare after ankle, tibial shaft and intertrochanteric femur fractures. Weight-bearing was ordered as per the institutional standard and controlled by physical therapy. The insole was retrieved after a maximum of six weeks (28 days [range 5-42 days]). Non-compliance was defined as a failure to maintain, or reach the ordered weight-bearing within 30%. Overall 30 patients were included in the study. Fourteen (47%) of the patients were compliant to the weight-bearing recommendations. Within two weeks after surgery patients deviated from the recommendation by over 50%. Sex, age and weight did not influence the performance (p > 0.05). Ankle fracture patients (partial weight-bearing) showed a significantly increased deviation from the recommendation (p = 0.01). Our study results show that, despite physical therapy training, weight-bearing compliance to recommended limits was low. Adherence to the partial weight-bearing task was further decreased over time. Uncontrolled weight-bearing recommendations should thus be viewed with caution and carefully considered as fiction. The presented insole is feasible to determine weight bearing continuously, could immediately help define real-time patient behaviour and establish realistic, individual weight-bearing recommendations.

40 CFR 60.2939 - What continuous emission monitoring systems must I install?

Code of Federal Regulations, 2012 CFR

2012-07-01

... systems must I install? 60.2939 Section 60.2939 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY... and Qualification Monitoring § 60.2939 What continuous emission monitoring systems must I install? (a) You must install, calibrate, maintain, and operate continuous emission monitoring systems for carbon...

Transmission of hepatitis B virus among persons undergoing blood glucose monitoring in long-term-care facilities--Mississippi, North Carolina, and Los Angeles County, California, 2003-2004.

PubMed

2005-03-11

Regular monitoring of blood glucose levels is an important component of routine diabetes care. Capillary blood is typically sampled with the use of a fingerstick device and tested with a portable glucometer. Because of outbreaks of hepatitis B virus (HBV) infections associated with glucose monitoring, CDC and the Food and Drug Administration (FDA) have recommended since 1990 that fingerstick devices be restricted to individual use. This report describes three recent outbreaks of HBV infection among residents in long-term-care (LTC) facilities that were attributed to shared devices and other breaks in infection-control practices related to blood glucose monitoring. Findings from these investigations and previous reports suggest that recommendations concerning standard precautions and the reuse of fingerstick devices have not been adhered to or enforced consistently in LTC settings. The findings underscore the need for education, training, adherence to standard precautions, and specific infection-control recommendations targeting diabetes-care procedures in LTC settings.

Reevaluation of air surveillance station siting

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

Abbott, K.; Jannik, T.

2016-07-06

DOE Technical Standard HDBK-1216-2015 (DOE 2015) recommends evaluating air-monitoring station placement using the analytical method developed by Waite. The technique utilizes wind rose and population distribution data in order to determine a weighting factor for each directional sector surrounding a nuclear facility. Based on the available resources (number of stations) and a scaling factor, this weighting factor is used to determine the number of stations recommended to be placed in each sector considered. An assessment utilizing this method was performed in 2003 to evaluate the effectiveness of the existing SRS air-monitoring program. The resulting recommended distribution of air-monitoring stations wasmore » then compared to that of the existing site perimeter surveillance program. The assessment demonstrated that the distribution of air-monitoring stations at the time generally agreed with the results obtained using the Waite method; however, at the time new stations were established in Barnwell and in Williston in order to meet requirements of DOE guidance document EH-0173T.« less

Recommendations for the use of mist nets for inventory and monitoring of bird populations

Treesearch

C. John Ralph; Erica H. Dunn; Will J. Peach; Colleen M. Handel

2004-01-01

We provide recommendations on the best practices for mist netting for the purposes of monitoring population parameters such as abundance and demography. Studies should be carefully thought out before nets are set up, to ensure that sampling design and estimated sample size will allow study objectives to be met. Station location, number of nets, type of nets, net...

40 CFR 62.15190 - Am I exempt from any 40 CFR part 60 appendix B or appendix F requirements to evaluate continuous...

Code of Federal Regulations, 2010 CFR

2010-07-01

... appendix B or appendix F requirements to evaluate continuous emission monitoring systems? 62.15190 Section... evaluate continuous emission monitoring systems? Yes, the accuracy tests for your sulfur dioxide continuous emission monitoring system require you to also evaluate your oxygen (or carbon dioxide) continuous emission...

40 CFR 62.15190 - Am I exempt from any 40 CFR part 60 appendix B or appendix F requirements to evaluate continuous...

Code of Federal Regulations, 2011 CFR

2011-07-01

... appendix B or appendix F requirements to evaluate continuous emission monitoring systems? 62.15190 Section... evaluate continuous emission monitoring systems? Yes, the accuracy tests for your sulfur dioxide continuous emission monitoring system require you to also evaluate your oxygen (or carbon dioxide) continuous emission...

40 CFR 60.1730 - How do I make sure my continuous emission monitoring systems are operating correctly?

Code of Federal Regulations, 2010 CFR

2010-07-01

... emission monitoring systems are operating correctly? 60.1730 Section 60.1730 Protection of Environment... continuous emission monitoring systems are operating correctly? (a) Conduct initial, daily, quarterly, and annual evaluations of your continuous emission monitoring systems that measure oxygen (or carbon dioxide...

40 CFR 60.1730 - How do I make sure my continuous emission monitoring systems are operating correctly?

Code of Federal Regulations, 2014 CFR

2014-07-01

... emission monitoring systems are operating correctly? 60.1730 Section 60.1730 Protection of Environment... continuous emission monitoring systems are operating correctly? (a) Conduct initial, daily, quarterly, and annual evaluations of your continuous emission monitoring systems that measure oxygen (or carbon dioxide...

40 CFR 62.15185 - How do I make sure my continuous emission monitoring systems are operating correctly?

Code of Federal Regulations, 2010 CFR

2010-07-01

... emission monitoring systems are operating correctly? 62.15185 Section 62.15185 Protection of Environment... make sure my continuous emission monitoring systems are operating correctly? (a) Conduct initial, daily, quarterly, and annual evaluations of your continuous emission monitoring systems that measure oxygen (or...

40 CFR 60.1730 - How do I make sure my continuous emission monitoring systems are operating correctly?

Code of Federal Regulations, 2012 CFR

2012-07-01

... emission monitoring systems are operating correctly? 60.1730 Section 60.1730 Protection of Environment... continuous emission monitoring systems are operating correctly? (a) Conduct initial, daily, quarterly, and annual evaluations of your continuous emission monitoring systems that measure oxygen (or carbon dioxide...

40 CFR 60.1730 - How do I make sure my continuous emission monitoring systems are operating correctly?

Code of Federal Regulations, 2013 CFR

2013-07-01

... emission monitoring systems are operating correctly? 60.1730 Section 60.1730 Protection of Environment... continuous emission monitoring systems are operating correctly? (a) Conduct initial, daily, quarterly, and annual evaluations of your continuous emission monitoring systems that measure oxygen (or carbon dioxide...

40 CFR 62.15185 - How do I make sure my continuous emission monitoring systems are operating correctly?

Code of Federal Regulations, 2014 CFR

2014-07-01

... emission monitoring systems are operating correctly? 62.15185 Section 62.15185 Protection of Environment... make sure my continuous emission monitoring systems are operating correctly? (a) Conduct initial, daily, quarterly, and annual evaluations of your continuous emission monitoring systems that measure oxygen (or...

40 CFR 60.1730 - How do I make sure my continuous emission monitoring systems are operating correctly?

Code of Federal Regulations, 2011 CFR

2011-07-01

... emission monitoring systems are operating correctly? 60.1730 Section 60.1730 Protection of Environment... continuous emission monitoring systems are operating correctly? (a) Conduct initial, daily, quarterly, and annual evaluations of your continuous emission monitoring systems that measure oxygen (or carbon dioxide...

40 CFR 62.15185 - How do I make sure my continuous emission monitoring systems are operating correctly?

Code of Federal Regulations, 2012 CFR

2012-07-01

... emission monitoring systems are operating correctly? 62.15185 Section 62.15185 Protection of Environment... make sure my continuous emission monitoring systems are operating correctly? (a) Conduct initial, daily, quarterly, and annual evaluations of your continuous emission monitoring systems that measure oxygen (or...

40 CFR 62.15185 - How do I make sure my continuous emission monitoring systems are operating correctly?

Code of Federal Regulations, 2011 CFR

2011-07-01

... emission monitoring systems are operating correctly? 62.15185 Section 62.15185 Protection of Environment... make sure my continuous emission monitoring systems are operating correctly? (a) Conduct initial, daily, quarterly, and annual evaluations of your continuous emission monitoring systems that measure oxygen (or...

40 CFR 62.15185 - How do I make sure my continuous emission monitoring systems are operating correctly?

Code of Federal Regulations, 2013 CFR

2013-07-01

... emission monitoring systems are operating correctly? 62.15185 Section 62.15185 Protection of Environment... make sure my continuous emission monitoring systems are operating correctly? (a) Conduct initial, daily, quarterly, and annual evaluations of your continuous emission monitoring systems that measure oxygen (or...

40 CFR 60.1315 - Must I meet other requirements for continuous monitoring?

Code of Federal Regulations, 2012 CFR

2012-07-01

... continuous monitoring? 60.1315 Section 60.1315 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY... Requirements § 60.1315 Must I meet other requirements for continuous monitoring? You must also monitor three... at the inlet of your particulate matter air pollution control device. (c) Carbon feed rate if...

40 CFR 60.1315 - Must I meet other requirements for continuous monitoring?

Code of Federal Regulations, 2010 CFR

2010-07-01

... continuous monitoring? 60.1315 Section 60.1315 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY... Requirements § 60.1315 Must I meet other requirements for continuous monitoring? You must also monitor three... at the inlet of your particulate matter air pollution control device. (c) Carbon feed rate if...

40 CFR 60.1315 - Must I meet other requirements for continuous monitoring?

Code of Federal Regulations, 2014 CFR

2014-07-01

... continuous monitoring? 60.1315 Section 60.1315 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY... Requirements § 60.1315 Must I meet other requirements for continuous monitoring? You must also monitor three... at the inlet of your particulate matter air pollution control device. (c) Carbon feed rate if...

40 CFR 60.1315 - Must I meet other requirements for continuous monitoring?

Code of Federal Regulations, 2013 CFR

2013-07-01

... continuous monitoring? 60.1315 Section 60.1315 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY... Requirements § 60.1315 Must I meet other requirements for continuous monitoring? You must also monitor three... at the inlet of your particulate matter air pollution control device. (c) Carbon feed rate if...

40 CFR 60.1315 - Must I meet other requirements for continuous monitoring?

Code of Federal Regulations, 2011 CFR

2011-07-01

... continuous monitoring? 60.1315 Section 60.1315 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY... Requirements § 60.1315 Must I meet other requirements for continuous monitoring? You must also monitor three... at the inlet of your particulate matter air pollution control device. (c) Carbon feed rate if...

Environmental Technology Verification Report for Applikon MARGA Semi-Continuous Ambient Air Monitoring System

EPA Science Inventory

The verification test was conducted oer a period of 30 days (October 1 to October 31, 2008) and involved the continuous operation of duplicate semi-continuous monitoring technologies at the Burdens Creek Air Monitoring Site, an existing ambient-air monitoring station located near...

Ambulatory reflux monitoring for diagnosis of gastro-esophageal reflux disease: Update of the Porto consensus and recommendations from an international consensus group.

PubMed

Roman, S; Gyawali, C P; Savarino, E; Yadlapati, R; Zerbib, F; Wu, J; Vela, M; Tutuian, R; Tatum, R; Sifrim, D; Keller, J; Fox, M; Pandolfino, J E; Bredenoord, A J

2017-10-01

An international group of experts evaluated and revised recommendations for ambulatory reflux monitoring for the diagnosis of gastro-esophageal reflux disease (GERD). Literature search was focused on indications and technical recommendations for GERD testing and phenotypes definitions. Statements were proposed and discussed during several structured meetings. Reflux testing should be performed after cessation of acid suppressive medication in patients with a low likelihood of GERD. In this setting, testing can be either catheter-based or wireless pH-monitoring or pH-impedance monitoring. In patients with a high probability of GERD (esophagitis grade C and D, histology proven Barrett's mucosa >1 cm, peptic stricture, previous positive pH monitoring) and persistent symptoms, pH-impedance monitoring should be performed on treatment. Recommendations are provided for data acquisition and analysis. Esophageal acid exposure is considered as pathological if acid exposure time (AET) is greater than 6% on pH testing. Number of reflux episodes and baseline impedance are exploratory metrics that may complement AET. Positive symptom reflux association is defined as symptom index (SI) >50% or symptom association probability (SAP) >95%. A positive symptom-reflux association in the absence of pathological AET defines hypersensitivity to reflux. The consensus group determined that grade C or D esophagitis, peptic stricture, histology proven Barrett's mucosa >1 cm, and esophageal acid exposure greater >6% are sufficient to define pathological GERD. Further testing should be considered when none of these criteria are fulfilled. © 2017 John Wiley & Sons Ltd.

Skylab technology electrical power system

NASA Technical Reports Server (NTRS)

Woosley, A. P.; Smith, O. B.; Nassen, H. S.

1974-01-01

The solar array/battery power systems for the Skylab vehicle were designed to operate in a solar inertial pointing mode to provide power continuously to the Skylab. Questions of power management are considered, taking into account difficulties caused by the reduction in power system performance due to the effects of structural failure occurring during the launching process. The performance of the solar array of the Apollo Telescope Mount Power System is discussed along with the Orbital Workshop solar array performance and the Airlock Module power conditioning group performance. A list is presented of a number of items which have been identified during mission monitoring and are recommended for electrical power system concepts, designs, and operation for future spacecraft.

Use of ECT in the presence of acute bilateral posterior vitreous detachmanet.

PubMed

Taye, Tesema; Dobranici, Letitia; Fisher, Mark; Cullum, Sarah

2018-04-01

We describe a case of acute bilateral posterior vitreous detachment (PVD) in a 71-year-old female, which developed during a course of electroconvulsive therapy (ECT) for treatment-resistant depression. The risks and benefits of continuing ECT were assessed and the patient completed the full course of 16 ECT treatments without further ophthalmic complications. As the incidence of PVD increases with age, and ECT is used more frequently in elderly people with depression, we recommend paying attention to ophthalmic symptoms as part of the routine clinical monitoring of ECT side effects. If ophthalmic symptoms occur, the risks and benefits of ECT need to be weighed up including consultation with an ophthalmologist.

Survivors of childhood cancer in South Australia attending a late-effects clinic: a descriptive report of psychological, cognitive, and academic late-effects.

PubMed

Roberts, Rachel M; Robins, Tamara; Gannoni, Anne F; Tapp, Heather

2014-01-01

This study provides a description of psychological late effects among a heterogeneous cohort of pediatric cancer survivors (N = 70) attending the South Australian Late-effects Clinic. Survivors reported more problems on the Strengths and Difficulties Questionnaire and the Child Behavior Checklist compared to normative data but no differences in Sluggish Cognitive Tempo scores. Forty-six percent of the sample reported school difficulties, and 12% of the sample age older than 15 reported smoking. Late-effects clinics should continue to monitor psychological well-being and health behaviors. Further research is recommended to determine whether sluggish cognitive tempo is a useful concept for the assessment of survivors.

Free-living monitoring of Parkinson's disease: Lessons from the field.

PubMed

Del Din, Silvia; Godfrey, Alan; Mazzà, Claudia; Lord, Sue; Rochester, Lynn

2016-09-01

Wearable technology comprises miniaturized sensors (eg, accelerometers) worn on the body and/or paired with mobile devices (eg, smart phones) allowing continuous patient monitoring in unsupervised, habitual environments (termed free-living). Wearable technologies are revolutionizing approaches to health care as a result of their utility, accessibility, and affordability. They are positioned to transform Parkinson's disease (PD) management through the provision of individualized, comprehensive, and representative data. This is particularly relevant in PD where symptoms are often triggered by task and free-living environmental challenges that cannot be replicated with sufficient veracity elsewhere. This review concerns use of wearable technology in free-living environments for people with PD. It outlines the potential advantages of wearable technologies and evidence for these to accurately detect and measure clinically relevant features including motor symptoms, falls risk, freezing of gait, gait, functional mobility, and physical activity. Technological limitations and challenges are highlighted, and advances concerning broader aspects are discussed. Recommendations to overcome key challenges are made. To date there is no fully validated system to monitor clinical features or activities in free-living environments. Robust accuracy and validity metrics for some features have been reported, and wearable technology may be used in these cases with a degree of confidence. Utility and acceptability appears reasonable, although testing has largely been informal. Key recommendations include adopting a multidisciplinary approach for standardizing definitions, protocols, and outcomes. Robust validation of developed algorithms and sensor-based metrics is required along with testing of utility. These advances are required before widespread clinical adoption of wearable technology can be realized. © 2016 International Parkinson and Movement Disorder Society. © 2016 International Parkinson and Movement Disorder Society.

Monitor for detecting and assessing exposure to airborne nanoparticles

NASA Astrophysics Data System (ADS)

Marra, Johan; Voetz, Matthias; Kiesling, Heinz-Jürgen

2010-01-01

An important safety aspect of the workplace environment concerns the severity of its air pollution with nanoparticles (NP; <100 nm) and ultrafine particles (UFP; <300 nm). Depending on their size and chemical nature, exposure to these particles through inhalation can be hazardous because of their intrinsic ability to deposit in the deep lung regions and the possibility to subsequently pass into the blood stream. Recommended safety measures in the nanomaterials industry are pragmatic, aiming at exposure minimization in general, and advocating continuous control by monitoring both the workplace air pollution level and the personal exposure to airborne NPs. This article describes the design and operation of the Aerasense NP monitor that enables intelligence gathering in particular with respect to airborne particles in the 10-300 nm size range. The NP monitor provides real time information about their number concentration, average size, and surface areas per unit volume of inhaled air that deposit in the various compartments of the respiratory tract. The monitor's functionality relies on electrical charging of airborne particles and subsequent measurements of the total particle charge concentration under various conditions. Information obtained with the NP monitor in a typical workplace environment has been compared with simultaneously recorded data from a Scanning Mobility Particle Sizer (SMPS) capable of measuring the particle size distribution in the 11-1086 nm size range. When the toxicological properties of the engineered and/or released particles in the workplace are known, personal exposure monitoring allows a risk assessment to be made for a worker during each workday, when the workplace-produced particles can be distinguished from other (ambient) particles.

76 FR 25277 - Lowering Miners' Exposure to Respirable Coal Mine Dust, Including Continuous Personal Dust Monitors

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-04

... 1219-AB64 Lowering Miners' Exposure to Respirable Coal Mine Dust, Including Continuous Personal Dust... to Respirable Coal Mine Dust, Including Continuous Personal Dust Monitors. This extension gives... Miners' Exposure to Respirable Coal Mine Dust, Including Continuous Personal Dust Monitors. In response...

40 CFR 60.1720 - What continuous emission monitoring systems must I install for gaseous pollutants?

Code of Federal Regulations, 2014 CFR

2014-07-01

... systems must I install for gaseous pollutants? 60.1720 Section 60.1720 Protection of Environment... or Before August 30, 1999 Model Rule-Continuous Emission Monitoring § 60.1720 What continuous..., maintain, and operate continuous emission monitoring systems for oxygen (or carbon dioxide), sulfur dioxide...

40 CFR 60.1720 - What continuous emission monitoring systems must I install for gaseous pollutants?

Code of Federal Regulations, 2012 CFR

2012-07-01

... systems must I install for gaseous pollutants? 60.1720 Section 60.1720 Protection of Environment... or Before August 30, 1999 Model Rule-Continuous Emission Monitoring § 60.1720 What continuous..., maintain, and operate continuous emission monitoring systems for oxygen (or carbon dioxide), sulfur dioxide...

40 CFR 60.1720 - What continuous emission monitoring systems must I install for gaseous pollutants?

Code of Federal Regulations, 2013 CFR

2013-07-01

... systems must I install for gaseous pollutants? 60.1720 Section 60.1720 Protection of Environment... or Before August 30, 1999 Model Rule-Continuous Emission Monitoring § 60.1720 What continuous..., maintain, and operate continuous emission monitoring systems for oxygen (or carbon dioxide), sulfur dioxide...

Impact of a risk management plan on Legionella contamination of dental unit water.

PubMed

Leoni, Erica; Dallolio, Laura; Stagni, Francesca; Sanna, Tiziana; D'Alessandro, Giovanni; Piana, Gabriela

2015-02-23

The study aimed to assess the prevalence of Legionella spp. in dental unit waterlines of a dental clinic and to verify whether the microbiological parameters used as indicators of water quality were correlated with Legionella contamination. A risk management plan was subsequently implemented in the dental health care setting, in order to verify whether the adopted disinfection protocols were effective in preventing Legionella colonization. The water delivered from syringes and turbines of 63 dental units operating in a dental clinic, was monitored for counts of the heterotrophic bacteria P. aeruginosa and Legionella spp. (22 °C and 37 °C). At baseline, output water from dental units continuously treated with disinfection products was more compliant with the recommended standards than untreated and periodically treated water. However, continuous disinfection was still not able to prevent contamination by Legionella and P. aeruginosa. Legionella was isolated from 36.4%, 24.3% and 53.3% of samples from untreated, periodically and continuously treated waterlines, respectively. The standard microbiological parameters used as indicators of water quality proved to be unreliable as predictors of the presence of Legionella, whose source was identified as the tap water used to supply the dental units. The adoption of control measures, including the use of deionized water in supplying the dental unit waterlines and the application of a combined protocol of continuous and periodic disinfection, with different active products for the different devices, resulted in good control of Legionella contamination. The efficacy of the measures adopted was mainly linked to the strict adherence to the planned protocols, which placed particular stress on staff training and ongoing environmental monitoring.

Assessment of cerebral blood flow autoregulation (CBF AR) with rheoencephalography (REG): studies in animals

NASA Astrophysics Data System (ADS)

Popovic, Djordje; Bodo, Michael; Pearce, Frederick; van Albert, Stephen; Garcia, Alison; Settle, Tim; Armonda, Rocco

2013-04-01

The ability of cerebral vasculature to regulate cerebral blood flow (CBF) in the face of changes in arterial blood pressure (SAP) or intracranial pressure (ICP) is an important guard against secondary ischemia in acute brain injuries, and official guidelines recommend that therapeutic decisions be guided by continuous monitoring of CBF autoregulation (AR). The common method for CBF AR monitoring, which rests on real-time derivation of the correlation coefficient (PRx) between slow oscillations in SAP and ICP is, however, rarely used in clinical practice because it requires invasive ICP measurements. This study investigated whether the correlation coefficient between SAP and the pulsatile component of the non-invasive transcranial bioimpedance signal (rheoencephalography, REG) could be used to assess the state and lower limit of CBF AR. The results from pigs and rhesus macaques affirm the utility of REG; however, additional animal and clinical studies are warranted to assess selectivity of automatic REG-based evaluation of CBF AR.

Traumatic brain injury: preferred methods and targets for resuscitation.

PubMed

Scaife, Eric R; Statler, Kimberly D

2010-06-01

Severe traumatic brain injury (TBI) is the most common cause of death and disability in pediatric trauma. This review looks at the strategies to treat TBI in a temporal fashion. We examine the targets for resuscitation from field triage to definitive care in the pediatric ICU. Guidelines for the management of pediatric TBI exist. The themes of contemporary clinical research have been compliance with these guidelines and refinement of treatment recommendations developing a more sophisticated understanding of the pathophysiology of the injured brain. In the field, the aim has been to achieve routine compliance with the resuscitation goals. In the hospital, efforts have been directed at improving our ability to monitor the injured brain, developing techniques that limit brain swelling, and customizing brain perfusion. As our understanding of pediatric TBI evolves, the ambition is that age-specific and perhaps individual brain injury strategies based upon feedback from continuous monitors will be defined. In addition, vogue methods such as hypothermia, hypertonic saline, and aggressive surgical decompression may prove to impact brain swelling and outcomes.

Geothermal Gases--Community Experiences, Perceptions, and Exposures in Northern California.

PubMed

Chiu, Cindy H; Lozier, Matthew J; Bayleyegn, Tesfaye; Tait, Karen; Barreau, Tracy; Copan, Lori; Roisman, Rachel; Jackson, Rebecca; Smorodinsky, Svetlana; Kreutzer, Richard A; Yip, Fuyuen; Wolkin, Amy

2015-12-01

Lake County, California, is in a high geothermal-activity area. Over the past 30 years, the city of Clearlake has reported health effects and building evacuations related to geothermal venting. Previous investigations in Clearlake revealed hydrogen sulfide at levels known to cause health effects and methane at levels that can cause explosion risks. The authors conducted an investigation in multiple cities and towns in Lake County to understand better the risk of geothermal venting to the community. They conducted household surveys and outdoor air sampling of hydrogen sulfide and methane and found community members were aware of geothermal venting and some expressed concerns. The authors did not, however, find hydrogen sulfide above the California Environmental Protection Agency air quality standard of 30 parts per billion over one hour or methane above explosive thresholds. The authors recommend improving risk communication, continuing to monitor geothermal gas effects on the community, and using community reports and complaints to monitor and document geothermal venting incidents.

Avian influenza vaccines and vaccination in birds.

PubMed

Capua, Ilaria; Alexander, Dennis J

2008-09-12

Although the use of vaccines against avian influenza viruses in birds has been discouraged over the years, the unprecedented occurrence of outbreaks caused by avian influenza (AI) viruses in recent times has required review of this policy. A variety of products are now available on the market, ranging from inactivated conventional to live recombinant products. The general consensus on the use of vaccination is that if complying to GMP standards and properly administered, birds will be more resistant to field challenge and will exhibit reduced shedding levels in case of infection. However, viral circulation may still occur in a clinically healthy vaccinated population. This may result in an endemic situation and in the emergence of antigenic variants. In order to limit these risks, monitoring programmes enabling the detection of field exposure in vaccinated populations are recommended by international organisations and are essential to allow the continuation of international trade. Adequate management of a vaccination campaign, including monitoring, improved biosecurity and restriction is essential for the success of any control program for AI.

Behaviours of overweight and obese women during pregnancy who achieve and exceed recommended gestational weight gain

PubMed Central

Chuang, Cynthia H.; Stengel, Michael R.; Hwang, Sandra W.; Velott, Diana; Kjerulff, Kristen H.; Kraschnewski, Jennifer L.

2014-01-01

Summary Background Excessive gestational weight gain (GWG) is associated with increased risk of pregnancy-related complications, postpartum weight retention, and long-term obesity. Little is known about the behavioural habits of pregnant women who achieve and exceed recommended GWG. Method In 2011, qualitative interviews were conducted in Pennsylvania with post-partum women who were overweight or obese prior to pregnancy to ascertain their behaviours and attitudes regarding dietary habits, physical activity, and self-monitoring during pregnancy. Thematic analysis identified the habits of women who achieved and exceeded recommended GWG guidelines. Results Of the 29 women interviewed, 11 had appropriate GWG and 18 had excessive GWG. Women achieving appropriate GWG reported modest increases in caloric intake if at all, with deliberate meal and snack planning, while women with excessive GWG described “eating-for-two.” Nearly all women with excessive GWG reported exercising less during pregnancy (or remaining sedentary), while women with appropriate GWG largely increased or maintained pre-pregnancy physical activity levels. About half of the sample reported self-monitoring weight gain during pregnancy, but women achieving recommended GWG tied their weight monitoring with GWG goals consistent with recommended guidelines. Conclusions Women who achieved appropriate GWG reported deliberate dietary habits and physical activity planning, with appropriate GWG goals during pregnancy. Women exceeding recommended GWG described “eating-for-two,” were sedentary, and either had no goals for GWG or intended to gain more weight than recommended. PMID:25434913

40 CFR 60.2940 - How do I make sure my continuous emission monitoring systems are operating correctly?

Code of Federal Regulations, 2013 CFR

2013-07-01

... emission monitoring systems are operating correctly? 60.2940 Section 60.2940 Protection of Environment... 16, 2006 Monitoring § 60.2940 How do I make sure my continuous emission monitoring systems are operating correctly? (a) Conduct initial, daily, quarterly, and annual evaluations of your continuous...

40 CFR 60.2940 - How do I make sure my continuous emission monitoring systems are operating correctly?

Code of Federal Regulations, 2014 CFR

2014-07-01

... emission monitoring systems are operating correctly? 60.2940 Section 60.2940 Protection of Environment... 16, 2006 Monitoring § 60.2940 How do I make sure my continuous emission monitoring systems are operating correctly? (a) Conduct initial, daily, quarterly, and annual evaluations of your continuous...

Eye lens monitoring for interventional radiology personnel: dosemeters, calibration and practical aspects of H p (3) monitoring. A 2015 review.

PubMed

Carinou, Eleftheria; Ferrari, Paolo; Bjelac, Olivera Ciraj; Gingaume, Merce; Merce, Marta Sans; O'Connor, Una

2015-09-01

A thorough literature review about the current situation on the implementation of eye lens monitoring has been performed in order to provide recommendations regarding dosemeter types, calibration procedures and practical aspects of eye lens monitoring for interventional radiology personnel. Most relevant data and recommendations from about 100 papers have been analysed and classified in the following topics: challenges of today in eye lens monitoring; conversion coefficients, phantoms and calibration procedures for eye lens dose evaluation; correction factors and dosemeters for eye lens dose measurements; dosemeter position and influence of protective devices. The major findings of the review can be summarised as follows: the recommended operational quantity for the eye lens monitoring is H p (3). At present, several dosemeters are available for eye lens monitoring and calibration procedures are being developed. However, in practice, very often, alternative methods are used to assess the dose to the eye lens. A summary of correction factors found in the literature for the assessment of the eye lens dose is provided. These factors can give an estimation of the eye lens dose when alternative methods, such as the use of a whole body dosemeter, are used. A wide range of values is found, thus indicating the large uncertainty associated with these simplified methods. Reduction factors from most common protective devices obtained experimentally and using Monte Carlo calculations are presented. The paper concludes that the use of a dosemeter placed at collar level outside the lead apron can provide a useful first estimate of the eye lens exposure. However, for workplaces with estimated annual equivalent dose to the eye lens close to the dose limit, specific eye lens monitoring should be performed. Finally, training of the involved medical staff on the risks of ionising radiation for the eye lens and on the correct use of protective systems is strongly recommended.

Wildlife and habitat damage assessment from Hurricane Charley: recommendations for recovery of the J. N. "Ding" Darling National Wildlife Refuge Complex. [Final report to U.S. Fish and Wildlife Service

USGS Publications Warehouse

Meyers, J.M.; Langtimm, C.A.; Smith, T. J.; Pednault-Willett, K.

2005-01-01

On 13 August 2004, the first of four hurricanes to strike Florida in 50% and sometimes 90% of their vegetation severely damaged (dead, broken tree stems, and tipped trees). Shell Mound Trail of JNDDNWR sustained catastrophic damage to its old growth mangrove forests. Direct storm mortality and injury to manatees in the area was probably slight. Because seagrass beads and manatee habitat extend beyond refuge boundaries, we recommended a regional approach with partner agencies to more thoroughly assess storm impacts and monitor recovery of seagrass and manatees. Besides intensive monitoring of waterbirds and their nesting habitat (pre- and post-storm), we recommend that the Mangrove Cuckoo be used as an indicator species for recovery of mangrove forests and also for monitoring songbirds at risk. Black-whiskered Vireo may be another potential indicator species to monitor in mangrove forests. Damaged vegetation should be monitored for recovery (permanent or long-term plots), especially where previous study plots have been established and with additional plots in mangrove forests of waterbird nesting islands and freshwater wetlands. Potential loss of wetlands may be prevented by water level monitoring, locating the positions (GPS-GIS) and maintaining existing water control structures, creating a GIS map of refuge with accurate vertical data, and monitoring and eradicating invasive plants. Invasive species, including Brazilian pepper (Schinus terebinthifolius) and air potato (Dioscorea bulbifora), were common in a very limited survey. As an important monitoring goal, we recommend that species presence-absence data analysis (with probability of detection) be used to determine changes in animal communities. This could be accomplished possibly with comparison to other storm-damaged and undamaged refuges in the Region. This information may be helpful to refuge managers when storms return in the future.

Preprototype vapor compression distillation subsystem. [recovering potable water from wastewater

NASA Technical Reports Server (NTRS)

Ellis, G. S.; Wynveen, R. A.; Schubert, F. H.

1979-01-01

A three-person capacity preprototype vapor compression distillation subsystem for recovering potable water from wastewater aboard spacecraft was designed, assembled, and tested. The major components of the subsystem are: (1) a distillation unit which includes a compressor, centrifuge, central shaft, and outer shell; (2) a purge pump; (3) a liquids pump; (4) a post-treat cartridge; (5) a recycle/filter tank; (6) an evaporator high liquid level sensor; and (7) the product water conductivity monitor. A computer based control monitor instrumentation carries out operating mode change sequences, monitors and displays subsystem parameters, maintains intramode controls, and stores and displays fault detection information. The mechanical hardware occupies 0.467 m3, requires 171 W of electrical power, and has a dry weight of 143 kg. The subsystem recovers potable water at a rate of 1.59 kg/hr, which is equivalent to a duty cycle of approximately 30% for a crew of three. The product water has no foul taste or odor. Continued development of the subsystem is recommended for reclaiming water for human consumption as well as for flash evaporator heat rejection, urinal flushing, washing, and other on-board water requirements.

Application of ERTS-1 data to the protection and management of New Jersey's coastal environment

NASA Technical Reports Server (NTRS)

Yunghans, R. S.; Feinberg, E. B.; Wobber, F. J.; Mairs, R. L. (Principal Investigator); Macomber, R. T.; Stanczuk, D.; Stitt, J. A.

1974-01-01

The author has identified the following significant results. Rapid access to ERTS data was provided by NASA GSFC for the February 26, 1974 overpass of the New Jersey test site. Forty-seven hours following the overpass computer-compatible tapes were ready for processing at EarthSat. The finished product was ready just 60 hours following the overpass and delivered to the New Jersey Department of Environmental Protection. This operational demonstration has been successful in convincing NJDEP as to the worth of ERTS as an operational monitoring and enforcement tool of significant value to the State. An erosion/ accretion severity index has been developed for the New Jersey shore case study area. Computerized analysis techniques have been used for monitoring offshore waste disposal dumping locations, drift vectors, and dispersion rates in the New York Bight area. A computer shade print of the area was used to identify intensity levels of acid waste. A Litton intensity slice print was made to provide graphic presentation of dispersion characteristics and the dump extent. Continued monitoring will lead to the recommendation and justification of permanent dumping sites which pose no threat to water quality in nearshore environments.

Estimated energy expenditure of nursing assistants in long term care.

PubMed

Olson, Darcie L; King, Phyllis M

2012-01-01

Ergonomic research on nursing work has focused primarily on the biomechanical analysis of patient handling tasks. Few studies have addressed the intensity of a full day of nursing work as measured by changes in heart rate and energy expenditure. A pilot study was conducted between August 2009 and May 2010 to examine the intensity of performing nursing assistant work in long term care settings and to assess the usefulness of heart rate monitoring as a measure of work intensity. The residents of the facilities were physically dependent adults. The settings had floor-based mechanical lifting devices available and no-lift policies that restricted workers from lifting. Eight women between the ages of 19 and 54 from two facilities participated in this study. A wearable recorder allowed unobtrusive heart rate monitoring while nursing assistants worked their usual shift. Continuous heart rate monitoring for a full shift provided an estimation of energy expenditure. The data suggest that the nursing assistants worked at a moderate level yet were within the safe work intensity level recommended by NIOSH [32]. The information provides preliminary baseline data for nursing assistants who work with physically dependent adults using floor-based lifts in a no-lift environment.

A Process Evaluation of Project Developmental Continuity. Interim Report II, Part B: Recommendations for Measuring Program Impact.

ERIC Educational Resources Information Center

Love, John M.; And Others

This report presents recommendations for measures to be used in assessing the impact of Project Developmental Continuity (PDC). Chapter I reviews the purpose of the impact study and presents the basic considerations guiding the selection of measures. Chapter II describes the review process that led to the final recommendations. Chapter III…

Monitoring black-footed ferrets during reestablishment of free-ranging populations: Discussion of alternative methods and recommended minimum standards

USGS Publications Warehouse

Biggins, Dean E.; Godbey, Jerry L.; Matchett, Marc R.; Hanebury, Louis R.; Livieri, Travis M.; Marinari, Paul E.

2006-01-01

Although the monitoring of black-footed ferret (Mustela nigripes) populations following reintroductions has not been haphazard, several ferret recovery groups since 1994 have recommended development of uniform standards prescribing minimum methods, intensities, and frequencies of monitoring that would provide data on population size, mortality rates, and recruitment. Such standards would promote comparability of data among sites, document expectations for those who will attempt to establish new populations, and allow the U.S. Fish and Wildlife Service and other responsible groups to better assess progress made toward achieving recovery objectives. Our recommendations are based on methods that have been successfully used to monitor natural and reintroduced populations of ferrets and are an attempt to balance needs and costs. We suggest a combination of marking ferrets with passive integrated transponder (PIT) tags and annual spotlight searches coupled with automated transponder readers to individually identify survivors. Unmarked ferrets should be captured and implanted with PIT tags whenever possible. These and other methods are detailed. Circumstances that may dictate other methods or more intensive monitoring (e.g., high rates of loss or low recruitment) also are discussed.

Professionals' views of fetal-monitoring support the development of devices to provide objective longer-term assessment of fetal wellbeing.

PubMed

Brown, Rebecca; Johnstone, Edward D; Heazell, Alexander E P

2016-01-01

Continuous longer-term fetal monitoring has been proposed to address limitations of current technologies in the detection of fetal compromise. We aimed to assess professionals' views regarding current fetal-monitoring techniques and proposed longer-term continuous fetal monitoring. A questionnaire was designed and validated to assess obstetricians' and midwives' use of current fetal-monitoring techniques and their views towards continuous monitoring. 125 of 173 received responses (72% obstetricians, 28% midwives) were analysed. Professionals had the strongest views about supporting evidence for the most commonly employed fetal-monitoring techniques (maternal awareness of fetal movements, ultrasound assessment of fetal growth and umbilical artery Doppler). 45.1% of professionals agreed that a continuous monitoring device would be beneficial (versus 28.7% who disagreed); this perceived benefit was not influenced by professionals' views regarding current techniques or professional background. Professionals have limited experience of continuous fetal monitoring, but most respondents believed that it would increase maternal anxiety (64.3%) and would have concerns with its use in clinical practice (81.7%). Continuous fetal monitoring would be acceptable to the majority of professionals. However, development of these technologies must be accompanied by extended examination of professionals' and women's views to determine barriers to its introduction.

40 CFR 60.1735 - Am I exempt from any appendix B or appendix F requirements to evaluate continuous emission...

Code of Federal Regulations, 2012 CFR

2012-07-01

... appendix F requirements to evaluate continuous emission monitoring systems? 60.1735 Section 60.1735... Combustion Units Constructed on or Before August 30, 1999 Model Rule-Continuous Emission Monitoring § 60.1735... to also evaluate your oxygen (or carbon dioxide) continuous emission monitoring system. Therefore...

40 CFR 60.1760 - What is required for my continuous opacity monitoring system and how are the data used?

Code of Federal Regulations, 2010 CFR

2010-07-01

... ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) STANDARDS OF PERFORMANCE FOR NEW STATIONARY... monitoring system according to § 60.13. (c) Complete an initial evaluation of your continuous opacity monitoring system according to Performance Specification 1 in appendix B of this part. Complete the...

40 CFR 60.1245 - Am I exempt from any appendix B or appendix F requirements to evaluate continuous emission...

Code of Federal Regulations, 2011 CFR

2011-07-01

... appendix F requirements to evaluate continuous emission monitoring systems? 60.1245 Section 60.1245... appendix F requirements to evaluate continuous emission monitoring systems? Yes, the accuracy tests for your sulfur dioxide continuous emission monitoring system require you to also evaluate your oxygen (or...

40 CFR 60.1735 - Am I exempt from any appendix B or appendix F requirements to evaluate continuous emission...

Code of Federal Regulations, 2011 CFR

2011-07-01

... appendix F requirements to evaluate continuous emission monitoring systems? 60.1735 Section 60.1735... systems? Yes, the accuracy tests for your sulfur dioxide continuous emission monitoring system require you to also evaluate your oxygen (or carbon dioxide) continuous emission monitoring system. Therefore...

40 CFR 60.1735 - Am I exempt from any appendix B or appendix F requirements to evaluate continuous emission...

Code of Federal Regulations, 2010 CFR

2010-07-01

... appendix F requirements to evaluate continuous emission monitoring systems? 60.1735 Section 60.1735... systems? Yes, the accuracy tests for your sulfur dioxide continuous emission monitoring system require you to also evaluate your oxygen (or carbon dioxide) continuous emission monitoring system. Therefore...

40 CFR 60.1245 - Am I exempt from any appendix B or appendix F requirements to evaluate continuous emission...

Code of Federal Regulations, 2010 CFR

2010-07-01

... appendix F requirements to evaluate continuous emission monitoring systems? 60.1245 Section 60.1245... appendix F requirements to evaluate continuous emission monitoring systems? Yes, the accuracy tests for your sulfur dioxide continuous emission monitoring system require you to also evaluate your oxygen (or...

40 CFR 60.1715 - What types of continuous emission monitoring must I perform?

Code of Federal Regulations, 2010 CFR

2010-07-01

... (CONTINUED) AIR PROGRAMS (CONTINUED) STANDARDS OF PERFORMANCE FOR NEW STATIONARY SOURCES Emission Guidelines... must I perform? To continuously monitor emissions, you must perform four tasks: (a) Install continuous...

Improving immunization in Afghanistan: results from a cross-sectional community-based survey to assess routine immunization coverage.

PubMed

Mugali, Raveesha R; Mansoor, Farooq; Parwiz, Sardar; Ahmad, Fazil; Safi, Najibullah; Higgins-Steele, Ariel; Varkey, Sherin

2017-04-04

Despite progress in recent years, Afghanistan is lagging behind in realizing the full potential of immunization. The country is still endemic for polio transmission and measles outbreaks continue to occur. In spite of significant reductions over the past decade, the mortality rate of children under 5 years of age continues to remain high at 91 per 1000 live births. The study was a descriptive community-based cross sectional household survey. The survey aimed to estimate the levels of immunization coverage at national and province levels. Specific objectives are to: establish valid baseline information to monitor progress of the immunization program; identify reasons why children are not immunized; and make recommendations to enhance access and quality of immunization services in Afghanistan. The survey was carried out in all 34 provinces of the country, with a sample of 6125 mothers of children aged 12-23 months. Nationally, 51% of children participating in the survey received all doses of each antigen irrespective of the recommended date of immunization or recommended interval between doses. About 31% of children were found to be partially vaccinated. Reasons for partial vaccination included: place to vaccinate child too far (23%), not aware of the need of vaccination (17%), no faith in vaccination (16%), mother was too busy (15%), and fear of side effects (11%). The innovative mechanism of contracting out delivery of primary health care services in Afghanistan, including immunization, to non-governmental organizations is showing some positive results in quickly increasing coverage of essential interventions, including routine immunization. Much ground still needs to be covered with proper planning and management of resources in order to improve the immunization coverage in Afghanistan and increase survival and health status of its children.

Evidence based communication for health promotion: Indian lessons of last decade.

PubMed

Suresh, K

2011-01-01

Good health promotion programs which help achieve public health goals are derived from using a mix of epidemiological and social and behavioral science research information. Social data informed by behavioral theories provides a lens of understanding how recommended behaviors are adopted by different individuals within the population over a period of time. In addition to social and epidemiological data, evidence based and scientifically planned and monitored strategic communication interventions have to be linked to available service components of the program. Communication is increasingly understood as an enabler of individual and social level change to achieve established developmental goals including health. Democratization movements and the advent of the internet have changed the environment around any program communication from top-down, expert-to-consumer (vertical) communication towards non-hierarchical, dialogue-based (horizontal) communication, through which the public increasingly questions recommendations of experts and public institutions on the basis of their own, often web based, research. The amount of information available has increased greatly, including scientifically valid data and evidence-based recommendations alongside poor quality data, personal opinions, and misinformation. Evidence-based approaches include engagement with and listening to stakeholders, and being transparent about decision making, and honest and open about uncertainty and risks. Decision and policy makers cannot assume what the public wants without undertaking social science and decision science research. The Global Polio Eradication Initiative and Integrated Disease Surveillance Projects (IDSP) in India haves shown that monitoring of public concerns needs to be continuous and responsive, and hand in hand with the monitoring of technical strategies and appropriate Information Technology support for, not only data transmission but also for videoconferencing and community involvement through toll free 24 × 7 call service with universal access. This article elucidates the vital role of Health Promotion, a research based communication process, in achieving developmental, particularly health goals. It underscores that communication is as much a science as an art, as much process as it is about outcomes. It advocates for increased linkages between epidemiological research and social science research in planning effective health promotion interventions with quality service delivery.

[The Jena Anxiety Monitoring List (JAMoL) - a tool for the evidence-based treatment of panic disorder with or without agoraphobia in primary care].

PubMed

Hiller, Thomas Stephan; Freytag, Antje; Breitbart, Jörg; Teismann, Tobias; Schöne, Elisabeth; Blank, Wolfgang; Schelle, Mercedes; Vollmar, Horst Christian; Margraf, Jürgen; Gensichen, Jochen

2018-04-01

Behavior therapy-oriented methods are recommended for treating anxiety disorders in primary care. The treatment of patients with long-term conditions can be improved by case management and structured clinical monitoring. The present paper describes the rationale, design and application of the 'Jena Anxiety Monitoring List' (JAMoL), a monitoring tool for the treatment of patients with panic disorder, with or without agoraphobia, in primary care. JAMoL's design was based on established clinical measures, the rationale of exposure-based anxiety treatment, and research on family practice-based case management. After piloting, the JAMoL was used in the clinical study 'Jena-PARADISE' (ISRCTN64669297), where non-physician practice staff monitored patients with panic disorder by telephone. Using semi-structured interviews in concomitant studies, study participants were asked about the instrument's functionality. The JAMoL assesses the severity of anxiety symptoms (6 items) as well as the patient's adherence to therapy (4 items) and fosters the case management-related information exchange (3 items). An integrated traffic light scheme facilitates the evaluation of monitoring results. Within the clinical study, non-physician practice staff carried out a total of 1,525 JAMoL-supported monitoring calls on 177 patients from 30 primary care practices (median calls per patient: 10 [interquartile range, 9-10]). Qualitative analyses revealed that most practice teams and patients rated the JAMoL as a practicable and treatment-relevant tool. The JAMoL enables primary care practice teams to continuously monitor anxiety symptoms and treatment adherence in patients with panic disorder with or without agoraphobia. Within the behavior therapy-oriented treatment program 'Jena-PARADISE', the JAMoL constitutes an important case management tool. Copyright © 2018. Published by Elsevier GmbH.

40 CFR 60.4345 - What are the requirements for the continuous emission monitoring system equipment, if I choose to...

Code of Federal Regulations, 2010 CFR

2010-07-01

... continuous emission monitoring system equipment, if I choose to use this option? 60.4345 Section 60.4345... PERFORMANCE FOR NEW STATIONARY SOURCES Standards of Performance for Stationary Combustion Turbines Monitoring § 60.4345 What are the requirements for the continuous emission monitoring system equipment, if I...

40 CFR 60.1280 - What must I do if any of my continuous emission monitoring systems are temporarily unavailable to...

Code of Federal Regulations, 2011 CFR

2011-07-01

... emission monitoring systems are temporarily unavailable to meet the data collection requirements? 60.1280... Modification or Reconstruction is Commenced After June 6, 2001 Continuous Emission Monitoring § 60.1280 What must I do if any of my continuous emission monitoring systems are temporarily unavailable to meet the...

40 CFR 62.15215 - What is required for my continuous opacity monitoring system and how are the data used?

Code of Federal Regulations, 2011 CFR

2011-07-01

... opacity monitoring system and how are the data used? 62.15215 Section 62.15215 Protection of Environment... required for my continuous opacity monitoring system and how are the data used? (a) Install, calibrate, maintain, and operate a continuous opacity monitoring system. (b) Install, evaluate, and operate each...

40 CFR 60.4345 - What are the requirements for the continuous emission monitoring system equipment, if I choose to...

Code of Federal Regulations, 2011 CFR

2011-07-01

... continuous emission monitoring system equipment, if I choose to use this option? 60.4345 Section 60.4345... PERFORMANCE FOR NEW STATIONARY SOURCES Standards of Performance for Stationary Combustion Turbines Monitoring § 60.4345 What are the requirements for the continuous emission monitoring system equipment, if I...

40 CFR 60.1280 - What must I do if any of my continuous emission monitoring systems are temporarily unavailable to...

Code of Federal Regulations, 2010 CFR

2010-07-01

... emission monitoring systems are temporarily unavailable to meet the data collection requirements? 60.1280... Modification or Reconstruction is Commenced After June 6, 2001 Continuous Emission Monitoring § 60.1280 What must I do if any of my continuous emission monitoring systems are temporarily unavailable to meet the...

Comparing methods suitable for monitoring marine mammals in low visibility conditions during seismic surveys.

PubMed

Verfuss, Ursula K; Gillespie, Douglas; Gordon, Jonathan; Marques, Tiago A; Miller, Brianne; Plunkett, Rachael; Theriault, James A; Tollit, Dominic J; Zitterbart, Daniel P; Hubert, Philippe; Thomas, Len

2018-01-01

Loud sound emitted during offshore industrial activities can impact marine mammals. Regulations typically prescribe marine mammal monitoring before and/or during these activities to implement mitigation measures that minimise potential acoustic impacts. Using seismic surveys under low visibility conditions as a case study, we review which monitoring methods are suitable and compare their relative strengths and weaknesses. Passive acoustic monitoring has been implemented as either a complementary or alternative method to visual monitoring in low visibility conditions. Other methods such as RADAR, active sonar and thermal infrared have also been tested, but are rarely recommended by regulatory bodies. The efficiency of the monitoring method(s) will depend on the animal behaviour and environmental conditions, however, using a combination of complementary systems generally improves the overall detection performance. We recommend that the performance of monitoring systems, over a range of conditions, is explored in a modelling framework for a variety of species. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

Improving nurses' knowledge of continuous ST-segment monitoring.

PubMed

Chronister, Connie

2014-01-01

Continuous ST-segment monitoring can result in detection of myocardial ischemia, but in clinical practice, continuous ST-segment monitoring is conducted incorrectly and underused by many registered nurses (RNs). Many RNs are unable to correctly institute ST-segment monitoring guidelines because of a lack of education. To evaluate whether an educational intervention, provided to 32 RNs, increases knowledge and correct clinical decision making (CDM) for the use of continuous ST-segment monitoring. At a single institution, an ST-segment monitoring class was provided to RNs in 2 cardiovascular units. Knowledge and correct CDM instruments were used for a baseline pretest and subsequent posttest after ST-segment monitoring education. Statistical significance between pretest and posttest scores for knowledge and correct CDM practice was noted with dependent t tests (P = .0001). Many RNs responsible for electrocardiographic monitoring are not aware of evidence-based ST-segment monitoring practice guidelines and cannot properly place precordial leads needed for ST-segment monitoring. Knowledge and correct CDM with ST-segment monitoring can be improved with focused education.

Subsidence monitoring network: an Italian example aimed at a sustainable hydrocarbon E&P activity

NASA Astrophysics Data System (ADS)

Dacome, M. C.; Miandro, R.; Vettorel, M.; Roncari, G.

2015-11-01

According to the Italian law in order to start-up any new hydrocarbon exploitation activity, an Environmental Impact Assessment study has to be presented, including a monitoring plan, addressed to foresee, measure and analyze in real time any possible impact of the project on the coastal areas and on those ones in the close inland located. The occurrence of subsidence, that could partly be related to hydrocarbon production, both on-shore and off-shore, can generate great concern in those areas where its occurrence may have impacts on the local environment. ENI, following the international scientific community recommendations on the matter, since the beginning of 90's years, implemented a cutting-edge monitoring network, with the aim to prevent, mitigate and control geodynamics phenomena generated in the activity areas, with a particular attention to conservation and protection of environmental and territorial equilibrium, taking care of what is known as "sustainable development". The current ENI implemented monitoring surveys can be divided as: - Shallow monitoring: spirit levelling surveys, continuous GPS surveys in permanent stations, SAR surveys, assestimeter subsurface compaction monitoring, ground water level monitoring, LiDAR surveys, bathymetrical surveys. - Deep monitoring: reservoir deep compaction trough radioactive markers, reservoir static (bottom hole) pressure monitoring. All the information, gathered through the monitoring network, allow: 1. to verify if the produced subsidence is evolving accordingly with the simulated forecast. 2. to provide data to revise and adjust the prediction compaction models 3. to put in place the remedial actions if the impact exceeds the threshold magnitude originally agreed among the involved parties. ENI monitoring plan to measure and monitor the subsidence process, during field production and also after the field closure, is therefore intended to support a sustainable field development and an acceptable exploitation programme in which the actual risk connected with the field production is evaluated in advance, shared and agreed among all the involved subjects: oil company, stakeholders and local community (with interests in the affected area).

PROFESSIONAL FLASH CONTINUOUS GLUCOSE MONITORING WITH AMBULATORY GLUCOSE PROFILE REPORTING TO SUPPLEMENT A1C: RATIONALE AND PRACTICAL IMPLEMENTATION.

PubMed

Hirsch, Irl B; Verderese, Carol A

2017-11-01

Recent consensus statements strongly advocate downloading and interpreting continuous glucose data for diabetes management in patients with type 1 or 2 diabetes. Supplementing periodic glycated hemoglobin (A1C) testing with intermittent continuous glucose monitoring (CGM) using a standardized report form known as the ambulatory glucose profile (AGP) is an evolving standard of care. The rationale for this approach and its implementation with a recently approved novel monitoring technology are explored. Search of the medical literature, professional guidelines, and real-world evidence guided this introduction of an integrative practice framework that uses AGP in conjunction with intermittent flash continuous glucose monitoring (FCGM) as a supplement to A1C testing. The combination of intermittent continuous glucose pattern analysis, standardized glucose metrics, and a readily interpretable data report has the potential to practically extend the recognized benefits of CGM to more patients and clarify the relationship between A1C and average glucose levels in individual cases. Novel FCGM technologies portend greater use of continuous forms of glucose monitoring and wider adoption of AGP report analysis. Additional formal and empirical evidence is needed to more fully characterize best practice. A1C = glycated hemoglobin; AGP = ambulatory glucose profile; CGM = continuous glucose monitoring; FCGM = flash continuous glucose monitoring; IQR = interquartile range; SMBG = self-monitoring of blood glucose.

Recommendations for Health Monitoring and Reporting for Zebrafish Research Facilities

PubMed Central

Crim, Marcus J.; Lieggi, Christine

2016-01-01

Abstract The presence of subclinical infection or clinical disease in laboratory zebrafish may have a significant impact on research results, animal health and welfare, and transfer of animals between institutions. As use of zebrafish as a model of disease increases, a harmonized method for monitoring and reporting the health status of animals will facilitate the transfer of animals, allow institutions to exclude diseases that may negatively impact their research programs, and improve animal health and welfare. All zebrafish facilities should implement a health monitoring program. In this study, we review important aspects of a health monitoring program, including choice of agents, samples for testing, available testing methodologies, housing and husbandry, cost, test subjects, and a harmonized method for reporting results. Facilities may use these recommendations to implement their own health monitoring program. PMID:26991393

Recommendations for standardizing validation procedures assessing physical activity of older persons by monitoring body postures and movements.

PubMed

Lindemann, Ulrich; Zijlstra, Wiebren; Aminian, Kamiar; Chastin, Sebastien F M; de Bruin, Eling D; Helbostad, Jorunn L; Bussmann, Johannes B J

2014-01-10

Physical activity is an important determinant of health and well-being in older persons and contributes to their social participation and quality of life. Hence, assessment tools are needed to study this physical activity in free-living conditions. Wearable motion sensing technology is used to assess physical activity. However, there is a lack of harmonisation of validation protocols and applied statistics, which make it hard to compare available and future studies. Therefore, the aim of this paper is to formulate recommendations for assessing the validity of sensor-based activity monitoring in older persons with focus on the measurement of body postures and movements. Validation studies of body-worn devices providing parameters on body postures and movements were identified and summarized and an extensive inter-active process between authors resulted in recommendations about: information on the assessed persons, the technical system, and the analysis of relevant parameters of physical activity, based on a standardized and semi-structured protocol. The recommended protocols can be regarded as a first attempt to standardize validity studies in the area of monitoring physical activity.

Development of an In-Situ Decommissioning Sensor Network Test Bed for Structural Condition Monitoring - 12156

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

Zeigler, Kristine E.; Ferguson, Blythe A.

2012-07-01

The Savannah River National Laboratory (SRNL) has established an In Situ Decommissioning (ISD) Sensor Network Test Bed, a unique, small scale, configurable environment, for the assessment of prospective sensors on actual ISD system material, at minimal cost. The Department of Energy (DOE) is presently implementing permanent entombment of contaminated, large nuclear structures via ISD. The ISD end state consists of a grout-filled concrete civil structure within the concrete frame of the original building. Validation of ISD system performance models and verification of actual system conditions can be achieved through the development a system of sensors to monitor the materials andmore » condition of the structure. The ISD Sensor Network Test Bed has been designed and deployed to addresses the DOE-Environmental Management Technology Need to develop a remote monitoring system to determine and verify ISD system performance. Commercial off-the-shelf sensors have been installed on concrete blocks taken from walls of the P Reactor Building at the Savannah River Site. Deployment of this low-cost structural monitoring system provides hands-on experience with sensor networks. The initial sensor system consists of groutable thermistors for temperature and moisture monitoring, strain gauges for crack growth monitoring, tilt-meters for settlement monitoring, and a communication system for data collection. Baseline data and lessons learned from system design and installation and initial field testing will be utilized for future ISD sensor network development and deployment. The Sensor Network Test Bed at SRNL uses COTS sensors on concrete blocks from the outer wall of the P Reactor Building to measure conditions expected to occur in ISD structures. Knowledge and lessons learned gained from installation, testing, and monitoring of the equipment will be applied to sensor installation in a meso-scale test bed at FIU and in future ISD structures. The initial data collected from the sensors installed on the P Reactor Building blocks define the baseline materials condition of the P Reactor ISD external concrete structure. Continued monitoring of the blocks will enable evaluation of the effects of aging on the P Reactor ISD structure. The collected data will support validation of the material degradation model and assessment of the condition of the ISD structure over time. The following are recommendations for continued development of the ISD Sensor Network Test Bed: - Establish a long-term monitoring program using the concrete blocks with existing sensor and/or additional sensors for trending the concrete materials and structural condition; - Continue development of a stand-alone test bed sensor system that is self-powered and provides wireless transmission of data to a user-accessible dashboard; - Develop and implement periodic NDE/DE characterization of the concrete blocks to provide verification and validation for the measurements obtained through the sensor system and concrete degradation model(s). (authors)« less

[Current status and recommendations for intrapartum monitoring of fetal heart rate].

PubMed

Měchurová, A; Velebil, P; Hruban, L; Janků, P

2016-04-01

Monitoring of fetal heart rate is one of the basic components of obstetrical care, in which the cardiotocography remains the gold standard and screening method in early diagnosis of fetal hypoxia, even after introduction of other selective methods of intrauterine monitoring of fetal well-being. The review article is divided into several parts: pathophysiology of fetal oxygenation, fetal heart rate and changes of fetal hemodynamics, and rules for fetal heart rate auscultation. The main principles of cardiotocographic monitoring and evaluation of ante- and intrapartrum recordings according to the FIGO criteria from 1986 and evaluation of intrapartum recordings according to the 2015 FIGO recommendations are mentioned. At the end a comparative table of 1986 FIGO and 2015 FIGO criteria is presented. Review.

Adjusting insulin doses in patients with type 1 diabetes that use insulin pump and continuous glucose monitoring - Variations among countries and physicians.

PubMed

Nimri, Revital; Dassau, Eyal; Segall, Tomer; Muller, Ido; Bratina, Natasa; Kordonouri, Olga; Bello, Rachel; Biester, Torben; Dovc, Klemen; Tenenbaum, Ariel; Brener, Avivit; Šimunović, Marko; Sakka, Sophia D; Nevo Shenker, Michal; Passone, Caroline Gb; Rutigliano, Irene; Tinti, Davide; Bonura, Clara; Caiulo, Silvana; Ruszala, Anna; Piccini, Barbara; Giri, Dinesh; Stein, Ronnie; Rabbone, Ivana; Bruzzi, Patrizia; Omladič, Jasna Šuput; Steele, Caroline; Beccuti, Guglielmo; Yackobovitch-Gavan, Michal; Battelino, Tadej; Danne, Thomas; Atlas, Eran; Phillip, Moshe

2018-06-08

To evaluate physicians' adjustments of insulin pump settings based on continuous glucose monitoring (CGM) for patients with type 1 diabetes and to compare physicians' to automated insulin dose adjustments. 26 physicians from 16 centers in Europe, Israel and South-America participated in the study. All were asked to adjust insulin dosing based on insulin pump, CGM and glucometer downloads of 15 patients (mean age 16.2 ± 4.3 y, 6 females, mean A1c 8.3 ± 0.9%) gathered over a 3-week period. Recommendations were compared for the relative changes in the basal, carbohydrate-ratio (CR) and correction-factor (CF) plans among physicians, among centers and between the physicians and an automated algorithm (DreaMed Advisor Pro). Study endpoints were the percentage of comparison points for which there was full agreement on the trend of insulin dose adjustments (same trend), partial agreement (increase/decrease vs. no change) and full disagreement (opposite trend). Percentage of full agreement between physicians on the trend of insulin adjustments of the basal, CR and CF plans was 41±9%, 45±11% and 45.5±13%, and of complete disagreement was 12±7%, 9.5±7% and 10±8%, respectively. Significantly similar results were found between the physicians and the DreaMed Advisor Pro. The Advisor magnitude of insulin dose change was at least equal or less than proposed by the physicians. Physicians provide different insulin dose recommendations based on the same data sets. The automated advice of the DreaMed Advisor Pro didn't differ significantly from the advice given by the physicians in the direction or magnitude of the insulin dosing. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

[Blood cultures in the paediatric emergency department. Guidelines and recommendations on their indications, collection, processing and interpretation].

PubMed

Hernández-Bou, S; Álvarez Álvarez, C; Campo Fernández, M N; García Herrero, M A; Gené Giralt, A; Giménez Pérez, M; Piñeiro Pérez, R; Gómez Cortés, B; Velasco, R; Menasalvas Ruiz, A I; García García, J J; Rodrigo Gonzalo de Liria, C

2016-05-01

Blood culture (BC) is the gold standard when a bacteraemia is suspected, and is one of the most requested microbiological tests in paediatrics. Some changes have occurred in recent years: the introduction of new vaccines, the increasing number of patients with central vascular catheters, as well as the introduction of continuous monitoring BC systems. These changes have led to the review and update of different factors related to this technique in order to optimise its use. A practice guideline is presented with recommendations on BC, established by the Spanish Society of Paediatric Emergency Care and the Spanish Society for Paediatric Infectious Diseases. After reviewing the available scientific evidence, several recommendations for each of the following aspects are presented: BC indications in the Emergency Department, how to obtain, transport and process cultures, special situations (indications and interpretation of results in immunosuppressed patients and/or central vascular catheter carriers, indications for anaerobic BC), differentiation between bacteraemia and contamination when a BC shows bacterial growth and actions to take with a positive BC in patients with fever of unknown origin. Copyright © 2015 Asociación Española de Pediatría. Published by Elsevier España, S.L.U. All rights reserved.

Recommendations for Assessment of the Reliability, Sensitivity, and Validity of Data Provided by Wearable Sensors Designed for Monitoring Physical Activity

PubMed Central

2018-01-01

Although it is becoming increasingly popular to monitor parameters related to training, recovery, and health with wearable sensor technology (wearables), scientific evaluation of the reliability, sensitivity, and validity of such data is limited and, where available, has involved a wide variety of approaches. To improve the trustworthiness of data collected by wearables and facilitate comparisons, we have outlined recommendations for standardized evaluation. We discuss the wearable devices themselves, as well as experimental and statistical considerations. Adherence to these recommendations should be beneficial not only for the individual, but also for regulatory organizations and insurance companies. PMID:29712629

Submittal of Final Post-Closure Inspection Letter Report for Corrective Action Unit 112: Area 23 Hazardous Waste Trenches, Nevada Test Site, Nevada, Revision 0, December 2007; DOE/NV--1103

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

NSTec Environmental Restoration

This letter serves as the post-closure monitoring letter report for the above Corrective Action Unit (CAU) for the period October 2006-September 2007. Quarterly inspections were conducted on December 20,2006; March 29,2007; June 13,2007; and September 27, 2007, to observe the condition of the gate, use restriction warning signs, monuments, fencing, trenches, soil covers, and monitoring well covers. The first inspection was conducted on December 20,2006. Signs, fencing, riprap, monuments, and monitoring well covers were in excellent condition. No cracking, erosion, or subsidence was observed on the covers. No issues or concerns were identified, and no corrective actions were recommended. Themore » second inspection was conducted on March 29,2007. Signs, fencing, riprap, monuments, and monitoring well covers were in excellent condition. No cracking, erosion, or subsidence was observed on the covers. Vegetation that was observed to be growing in several locations on the cover was the only identified concern, for which removal was recommended. Vegetation was removed on May 24,2007. The third inspection was conducted on June 13,2007. Signs, fencing, riprap, monuments, and monitoring well covers were in excellent condition. No cracking, erosion, or subsidence was observed on the covers. No issues or concerns were identified, and no corrective actions were recommended. The fourth inspection was conducted on September 27,2007. Signs, fencing, riprap, monuments, and monitoring well covers were in excellent condition. No cracking, erosion, or subsidence was observed on the covers. No issues or concerns were identified, and no corrective actions were recommended. The post-closure inspection checklists for CAU 112 are attached. Photographs and field notes taken during site inspections are maintained in the project files.« less

40 CFR 60.1245 - Am I exempt from any appendix B or appendix F requirements to evaluate continuous emission...

Code of Federal Regulations, 2012 CFR

2012-07-01

... appendix F requirements to evaluate continuous emission monitoring systems? 60.1245 Section 60.1245... Commenced After June 6, 2001 Continuous Emission Monitoring § 60.1245 Am I exempt from any appendix B or... carbon dioxide) continuous emission monitoring system. Therefore, your oxygen (or carbon dioxide...

24 CFR 1000.530 - What corrective and remedial actions will HUD request or recommend to address performance...

Code of Federal Regulations, 2012 CFR

2012-04-01

..., DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT NATIVE AMERICAN HOUSING ACTIVITIES Recipient Monitoring... for completing activities or complying with the requirements of this part; (3) Recommend that the recipient suspend, discontinue, or not incur costs for the affected activity; (4) Recommend that the...

24 CFR 1000.530 - What corrective and remedial actions will HUD request or recommend to address performance...

Code of Federal Regulations, 2010 CFR

2010-04-01

..., DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT NATIVE AMERICAN HOUSING ACTIVITIES Recipient Monitoring... for completing activities or complying with the requirements of this part; (3) Recommend that the recipient suspend, discontinue, or not incur costs for the affected activity; (4) Recommend that the...

24 CFR 1000.530 - What corrective and remedial actions will HUD request or recommend to address performance...

Code of Federal Regulations, 2011 CFR

2011-04-01

..., DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT NATIVE AMERICAN HOUSING ACTIVITIES Recipient Monitoring... for completing activities or complying with the requirements of this part; (3) Recommend that the recipient suspend, discontinue, or not incur costs for the affected activity; (4) Recommend that the...

40 CFR 63.7947 - What are my monitoring alternatives?

Code of Federal Regulations, 2014 CFR

2014-07-01

... 40 Protection of Environment 14 2014-07-01 2014-07-01 false What are my monitoring alternatives? 63.7947 Section 63.7947 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR... (CONTINUED) National Emission Standards for Hazardous Air Pollutants: Site Remediation Continuous Monitoring...

40 CFR 63.7947 - What are my monitoring alternatives?

Code of Federal Regulations, 2013 CFR

2013-07-01

... 40 Protection of Environment 14 2013-07-01 2013-07-01 false What are my monitoring alternatives? 63.7947 Section 63.7947 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR... (CONTINUED) National Emission Standards for Hazardous Air Pollutants: Site Remediation Continuous Monitoring...

40 CFR 63.7947 - What are my monitoring alternatives?

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 13 2011-07-01 2011-07-01 false What are my monitoring alternatives? 63.7947 Section 63.7947 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR... (CONTINUED) National Emission Standards for Hazardous Air Pollutants: Site Remediation Continuous Monitoring...

40 CFR 75.13 - Specific provisions for monitoring CO 2 emissions.

Code of Federal Regulations, 2013 CFR

2013-07-01

... the general operating requirements in § 75.10 for a CO2 continuous emission monitoring system and flow... specified in §§ 75.11(a) through (e) or § 75.16, except that the phrase “CO2 continuous emission monitoring system” shall apply rather than “SO2 continuous emission monitoring system,” the phrase “CO2...

40 CFR 75.13 - Specific provisions for monitoring CO 2 emissions.

Code of Federal Regulations, 2014 CFR

2014-07-01

... the general operating requirements in § 75.10 for a CO2 continuous emission monitoring system and flow... specified in §§ 75.11(a) through (e) or § 75.16, except that the phrase “CO2 continuous emission monitoring system” shall apply rather than “SO2 continuous emission monitoring system,” the phrase “CO2...

Perspectives of patients with non-insulin-treated type 2 diabetes on self-monitoring of blood glucose: A qualitative study.

PubMed

Chen, Chen-Mei; Hung, Li-Chen; Chen, Yang-Lin; Yeh, Mei Chang

2018-04-01

To explore experiences of self-monitoring of blood glucose among patients with non-insulin-treated type 2 diabetes. Self-monitoring of blood glucose is essential to diabetes care and facilitates glycaemic control. Patients' perspectives of self-monitoring of blood glucose have seldom been discussed in the literature, and engagement in self-monitoring of blood glucose is consistently low. The descriptive phenomenological method was used. Purposive sampling was conducted to recruit participants from the endocrinology departments of medical institutions in Taiwan based on the following criteria: (i) having a medical diagnosis of type 2 diabetes, (ii) not being treated with insulin, (iii) having engaged in self-monitoring of blood glucose at least once within the preceding 6 months, (iv) being at least 20 years old and (v) not having any major mental or cognitive disorders. Data were collected in outpatient consultation rooms, the participants' homes and other settings where the participants felt secure and comfortable. In-depth interviews were conducted to collect data from 16 patients with diabetes. The participants perceived that lifestyle affected blood glucose levels and did not know how to handle high or low blood glucose levels. Their willingness to continue self-monitoring of blood glucose depended on whether healthcare professionals checked or discussed their blood glucose levels with them. The patients' knowledge regarding blood glucose variation and healthcare professionals' attitudes affected the patients' self-monitoring of blood glucose behaviours. The empirical findings illustrated self-monitoring of blood glucose experiences and recommended that healthcare professionals' closely attend to patients' requirements and responses to diabetes and incorporate the self-monitoring of blood glucose into therapy plans. Healthcare professionals should reinforce patients' knowledge on appropriate responses to high and low blood glucose levels, intervene appropriately, discuss self-monitoring of blood glucose results with patients and track these results. © 2017 John Wiley & Sons Ltd.

Recommendation 87/567/EEC on vocational training for women, 24 November 1987.

PubMed

1987-01-01

This document contains the text of a 1987 Recommendation of the Commission of the European Communities on vocational training for women. Article 1 recommends that Member States adopt a policy to encourage participation of women in training schemes, especially those relevant to occupations of the future and in areas where women are under-represented. Article 2 recommends that Member States: 1) integrate training for women within a broad framework of cooperation between all parties involved; 2) staff such services with personnel trained to deal with the specific problems faced by women; 3) promote outreach activities on the part of such services; 4) provide more decentralized and widely distributed educational and training facilities; 5) promote images of women engaged in nontraditional activities; 6) encourage female participation in higher education, especially in technological areas; 7) encourage female participation in nontraditional apprenticeships; 8) encourage female entrepreneurs by offering appropriate training; 9) develop measures to promote participation of women in continuous training activities; 10) provide underprivileged women and women returning to work with specific courses designed to meet their needs; 11) provide flexible child care arrangements and financial incentives for women to participate in training activities; 12) recognize skills acquired in running a household and looking after a family; and 13) monitor the progress of women taking part in training schemes. Member States are to inform the Commission of their activities in these areas within three years to enable the Commission to create a report on such measures.

Comprehensive in-hospital monitoring in acute heart failure: applications for clinical practice and future directions for research. A statement from the Acute Heart Failure Committee of the Heart Failure Association (HFA) of the European Society of Cardiology (ESC).

PubMed

Harjola, Veli-Pekka; Parissis, John; Brunner-La Rocca, Hans-Peter; Čelutkienė, Jelena; Chioncel, Ovidiu; Collins, Sean P; De Backer, Daniel; Filippatos, Gerasimos S; Gayat, Etienne; Hill, Loreena; Lainscak, Mitja; Lassus, Johan; Masip, Josep; Mebazaa, Alexandre; Miró, Òscar; Mortara, Andrea; Mueller, Christian; Mullens, Wilfried; Nieminen, Markku S; Rudiger, Alain; Ruschitzka, Frank; Seferovic, Petar M; Sionis, Alessandro; Vieillard-Baron, Antoine; Weinstein, Jean Marc; de Boer, Rudolf A; Crespo Leiro, Maria G; Piepoli, Massimo; Riley, Jillian P

2018-04-30

This paper provides a practical clinical application of guideline recommendations relating to the inpatient monitoring of patients with acute heart failure, through the evaluation of various clinical, biomarker, imaging, invasive and non-invasive approaches. Comprehensive inpatient monitoring is crucial to the optimal management of acute heart failure patients. The European Society of Cardiology heart failure guidelines provide recommendations for the inpatient monitoring of acute heart failure, but the level of evidence underpinning most recommendations is limited. Many tools are available for the in-hospital monitoring of patients with acute heart failure, and each plays a role at various points throughout the patient's treatment course, including the emergency department, intensive care or coronary care unit, and the general ward. Clinical judgment is the preeminent factor guiding application of inpatient monitoring tools, as the various techniques have different patient population targets. When applied appropriately, these techniques enable decision making. However, there is limited evidence demonstrating that implementation of these tools improves patient outcome. Research priorities are identified to address these gaps in evidence. Future research initiatives should aim to identify the optimal in-hospital monitoring strategies that decrease morbidity and prolong survival in patients with acute heart failure. © 2018 The Authors. European Journal of Heart Failure © 2018 European Society of Cardiology.

40 CFR 75.16 - Special provisions for monitoring emissions from common, bypass, and multiple stacks for SO2...

Code of Federal Regulations, 2010 CFR

2010-07-01

... maintain an SO2 continuous emission monitoring system and flow monitoring system in the duct to the common... emission monitoring system and flow monitoring system in the common stack and combine emissions for the... continuous emission monitoring system and flow monitoring system in the duct to the common stack from each...

30 CFR 74.11 - Tests of the continuous personal dust monitor.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Tests of the continuous personal dust monitor. 74.11 Section 74.11 Mineral Resources MINE SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR COAL MINE SAFETY AND HEALTH COAL MINE DUST SAMPLING DEVICES Requirements for Continuous Personal Dust Monitors § 74.11 Tests of the continuous personal...

30 CFR 74.11 - Tests of the continuous personal dust monitor.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 30 Mineral Resources 1 2011-07-01 2011-07-01 false Tests of the continuous personal dust monitor. 74.11 Section 74.11 Mineral Resources MINE SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR COAL MINE SAFETY AND HEALTH COAL MINE DUST SAMPLING DEVICES Requirements for Continuous Personal Dust Monitors § 74.11 Tests of the continuous personal...

Real-time earthquake monitoring: Early warning and rapid response

NASA Technical Reports Server (NTRS)

1991-01-01

A panel was established to investigate the subject of real-time earthquake monitoring (RTEM) and suggest recommendations on the feasibility of using a real-time earthquake warning system to mitigate earthquake damage in regions of the United States. The findings of the investigation and the related recommendations are described in this report. A brief review of existing real-time seismic systems is presented with particular emphasis given to the current California seismic networks. Specific applications of a real-time monitoring system are discussed along with issues related to system deployment and technical feasibility. In addition, several non-technical considerations are addressed including cost-benefit analysis, public perceptions, safety, and liability.

A quantitative method for optimized placement of continuous air monitors.

PubMed

Whicker, Jeffrey J; Rodgers, John C; Moxley, John S

2003-11-01

Alarming continuous air monitors (CAMs) are a critical component for worker protection in facilities that handle large amounts of hazardous materials. In nuclear facilities, continuous air monitors alarm when levels of airborne radioactive materials exceed alarm thresholds, thus prompting workers to exit the room to reduce inhalation exposures. To maintain a high level of worker protection, continuous air monitors are required to detect radioactive aerosol clouds quickly and with good sensitivity. This requires that there are sufficient numbers of continuous air monitors in a room and that they are well positioned. Yet there are no published methodologies to quantitatively determine the optimal number and placement of continuous air monitors in a room. The goal of this study was to develop and test an approach to quantitatively determine optimal number and placement of continuous air monitors in a room. The method we have developed uses tracer aerosol releases (to simulate accidental releases) and the measurement of the temporal and spatial aspects of the dispersion of the tracer aerosol through the room. The aerosol dispersion data is then analyzed to optimize continuous air monitor utilization based on simulated worker exposure. This method was tested in a room within a Department of Energy operated plutonium facility at the Savannah River Site in South Carolina, U.S. Results from this study show that the value of quantitative airflow and aerosol dispersion studies is significant and that worker protection can be significantly improved while balancing the costs associated with CAM programs.

Lithium Clinics in Berlin and Dresden: a 50-Year Experience.

PubMed

Felber, Werner; Bauer, Michael; Lewitzka, Ute; Müller-Oerlinghausen, Bruno

2018-06-14

Although lithium's serendipitous discovery as a medication for depression dates back more than 200 years, the first scientific evidence that it prevents mania and depression arose only in the 1960s. However, at that time there was a lack of knowledge about how to administer and monitor lithium therapy safely and properly. The lithium clinics in Dresden and Berlin were remarkably similar in their beginnings in the late 1960s regarding patient numbers and scientific expertise without being aware of one another due to the Iron Curtain separating Germany into a western and eastern part until 1990. In what were initially lithium-care programs run independently from one another, the lithium clinics embedded in academic settings in Dresden and Berlin represent a milestone in the history of psychopharmacological treatment of affective disorders in Germany and trailblazers for today's lithium therapy. Nowadays, lithium's clinical applications are unquestioned, such as its use in strategies to prevent mood episodes and suicide, and to treat depression. The extensively documented knowledge of lithium treatment is the fruit of more than 50 years of observing disease courses and of studying side effects and influencing factors of lithium prophylaxis. Its safe and proper administration-in determining the correct indication, baseline and follow-up examinations, recommended dosages, monitoring, or the management of side effects-is well established. Subsequently, both national and international guidelines continue recommending lithium as the gold standard in treating patients with unipolar and bipolar disorders. © Georg Thieme Verlag KG Stuttgart · New York.

Early Evaluation of the VIIRS Calibration, Cloud Mask and Surface Reflectance Earth Data Records

NASA Technical Reports Server (NTRS)

Vermote, Eric; Justice, Chris; Csiszar, Ivan

2014-01-01

Surface reflectance is one of the key products fromVIIRS and as withMODIS, is used in developing several higherorder land products. The VIIRS Surface Reflectance (SR) Intermediate Product (IP) is based on the heritageMODIS Collection 5 product (Vermote, El Saleous, & Justice, 2002). The quality and character of surface reflectance depend on the accuracy of the VIIRS Cloud Mask (VCM), the aerosol algorithms and the adequate calibration of the sensor. The focus of this paper is the early evaluation of the VIIRS SR product in the context of the maturity of the operational processing system, the Interface Data Processing System (IDPS). After a brief introduction, the paper presents the calibration performance and the role of the surface reflectance in calibration monitoring. The analysis of the performance of the cloud mask with a focus on vegetation monitoring (no snow conditions) shows typical problems over bright surfaces and high elevation sites. Also discussed is the performance of the aerosol input used in the atmospheric correction and in particular the artifacts generated by the use of the Navy Aerosol Analysis and Prediction System. Early quantitative results of the performance of the SR product over the AERONET sites showthatwith the fewadjustments recommended, the accuracy iswithin the threshold specifications. The analysis of the adequacy of the SR product (Land PEATE adjusted version) in applications of societal benefits is then presented. We conclude with a set of recommendations to ensure consistency and continuity of the JPSS mission with the MODIS Land Climate Data Record.

Self-monitoring of blood glucose in diabetes mellitus: arguments for an individualized approach.

PubMed

Nauck, Michael A; El-Ouaghlidi, Andrea; Vardarli, Irfan

2009-09-01

The utility of glucose self-monitoring in different types and stages of diabetes is controversial, as there is only sparse relevant evidence from randomized controlled clinical trials. In this analysis, the authors aim to develop individualized recommendations based on clinical needs and the available literature. The PubMed database was searched for articles that appeared up to 30 September 2008 containing the terms "measurement," "control","monitoring," and "hypoglycemia"; the retrieved articles were supplemented by other articles that were cited in them. A directed search was also made for the recommendations of the German, European, American, and international diabetological societies. Conclusions were then drawn about the useful modalities and extent of glucose self-monitoring on the basis of the clinical features of the major types of diabetes and the main treatment strategies for them. With the exception of intensified treatment strategies (which rely on blood-sugar regulation with insulin), only a few evidence-based recommendations can be derived from randomized clinical trials and meta-analyses. Nonetheless, a strategy for self-monitoring according to the patient's individual needs can be derived from the characteristics of therapeutic regimens: depending on the type of diabetes from which the patient suffers, the predicted number of glucometer strips required for self-monitoring will vary from almost none to roughly 400 per month. The decision to use glucose self-monitoring, as well as the type and extent of self-monitoring that will be used, should be based on the individual patient's type of diabetes, treatment regimen, and clinical characteristics. Like any other type of therapeutic intervention, self-monitoring should have a well-documented, rational justification.

Women's experiences of continuous fetal monitoring - a mixed-methods systematic review.

PubMed

Crawford, Alexandra; Hayes, Dexter; Johnstone, Edward D; Heazell, Alexander E P

2017-12-01

Antepartum stillbirth is often preceded by detectable signs of fetal compromise, including changes in fetal heart rate and movement. It is hypothesized that continuous fetal monitoring could detect these signs more accurately and objectively than current forms of fetal monitoring and allow for timely intervention. This systematic review aimed to explore available evidence on women's experiences of continuous fetal monitoring to investigate its acceptability before clinical implementation and to inform clinical studies. Systematic searching of four electronic databases (Embase, PsycINFO, MEDLINE and CINAHL), using key terms defined by initial scoping searches, identified a total of 35 studies. Following title and abstract screening by two independent researchers, five studies met the inclusion criteria. Studies were not excluded based on language, methodology or quality assessment. An integrative methodology was used to synthesize qualitative and quantitative data together. Forms of continuous fetal monitoring used included Monica AN24 monitors (n = 4) and phonocardiography (n = 1). Four main themes were identified: practical limitations of the device, negative emotions, positive perceptions, and device implementation. Continuous fetal monitoring was reported to have high levels of participant satisfaction and was preferred by women to intermittent cardiotocography. This review suggests that continuous fetal monitoring is accepted by women. However, it has also highlighted both the paucity and heterogeneity of current studies and suggests that further research should be conducted into women's experiences of continuous fetal monitoring before such devices can be used clinically. © 2017 Nordic Federation of Societies of Obstetrics and Gynecology.

Usefulness of continuous glucose monitoring for the diagnosis of hypoglycemia after a gastric bypass in a patient previously treated for type 2 diabetes.

PubMed

Hanaire, Hélène; Dubet, Audrey; Chauveau, Marie-Emilie; Anduze, Yves; Fernandes, Martine; Melki, Vincent; Ritz, Patrick

2010-01-01

Hypoglycemia is rare after a gastric bypass and can be taken for a dumping syndrome. There is no report in the literature of the contribution of continuous glucose monitoring to the diagnosis of hypoglycemia in these circumstances. The present case report shows that continuous glucose monitoring can be a useful tool for the diagnosis and the management of such episodes. Continuous glucose monitoring revealed hypoglycemic episodes in free living circumstances that were not present during 72-h fasting. These episodes followed wide hyperglycemic swings. No such episode resumed over 8 months after specific dietary advices and treatment by 50 mg TID of acarbose. Because hypoglycemia can be difficult to diagnose from dumping syndrome, continuous glucose monitoring is a very useful tool revealing the episodes in free living circumstances and can be used to monitor the treatment success.

49 CFR 220.39 - Continuous radio monitoring.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 49 Transportation 4 2010-10-01 2010-10-01 false Continuous radio monitoring. 220.39 Section 220.39..., DEPARTMENT OF TRANSPORTATION RAILROAD COMMUNICATIONS Radio and Wireless Communication Procedures § 220.39 Continuous radio monitoring. Each radio used in a railroad operation shall be turned on to the appropriate...

49 CFR 220.39 - Continuous radio monitoring.

Code of Federal Regulations, 2014 CFR

2014-10-01

..., DEPARTMENT OF TRANSPORTATION RAILROAD COMMUNICATIONS Radio and Wireless Communication Procedures § 220.39 Continuous radio monitoring. Each radio used in a railroad operation shall be turned on to the appropriate... 49 Transportation 4 2014-10-01 2014-10-01 false Continuous radio monitoring. 220.39 Section 220.39...

49 CFR 220.39 - Continuous radio monitoring.

Code of Federal Regulations, 2013 CFR

2013-10-01

..., DEPARTMENT OF TRANSPORTATION RAILROAD COMMUNICATIONS Radio and Wireless Communication Procedures § 220.39 Continuous radio monitoring. Each radio used in a railroad operation shall be turned on to the appropriate... 49 Transportation 4 2013-10-01 2013-10-01 false Continuous radio monitoring. 220.39 Section 220.39...

40 CFR 75.32 - Determination of monitor data availability for standard missing data procedures.

Code of Federal Regulations, 2011 CFR

2011-07-01

... availability for standard missing data procedures. 75.32 Section 75.32 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) CONTINUOUS EMISSION MONITORING Missing Data Substitution Procedures § 75.32 Determination of monitor data availability for standard missing data procedures...

40 CFR 75.32 - Determination of monitor data availability for standard missing data procedures.

Code of Federal Regulations, 2014 CFR

2014-07-01

... availability for standard missing data procedures. 75.32 Section 75.32 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) CONTINUOUS EMISSION MONITORING Missing Data Substitution Procedures § 75.32 Determination of monitor data availability for standard missing data procedures...

40 CFR 75.32 - Determination of monitor data availability for standard missing data procedures.

Code of Federal Regulations, 2013 CFR

2013-07-01

... availability for standard missing data procedures. 75.32 Section 75.32 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) CONTINUOUS EMISSION MONITORING Missing Data Substitution Procedures § 75.32 Determination of monitor data availability for standard missing data procedures...

40 CFR 75.32 - Determination of monitor data availability for standard missing data procedures.

Code of Federal Regulations, 2010 CFR

2010-07-01

... availability for standard missing data procedures. 75.32 Section 75.32 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) CONTINUOUS EMISSION MONITORING Missing Data Substitution Procedures § 75.32 Determination of monitor data availability for standard missing data procedures...

40 CFR 75.32 - Determination of monitor data availability for standard missing data procedures.

Code of Federal Regulations, 2012 CFR

2012-07-01

... availability for standard missing data procedures. 75.32 Section 75.32 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) CONTINUOUS EMISSION MONITORING Missing Data Substitution Procedures § 75.32 Determination of monitor data availability for standard missing data procedures...

Test/QA Plan (TQAP) for Verification of Semi-Continuous Ambient Air Monitoring Systems

EPA Science Inventory

The purpose of the semi-continuous ambient air monitoring technology (or MARGA) test and quality assurance plan is to specify procedures for a verification test applicable to commercial semi-continuous ambient air monitoring technologies. The purpose of the verification test is ...

40 CFR 75.13 - Specific provisions for monitoring CO2 emissions.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 16 2010-07-01 2010-07-01 false Specific provisions for monitoring CO2... monitoring CO2 emissions. (a) CO 2 continuous emission monitoring system. If the owner or operator chooses to... operating requirements in § 75.10 for a CO2 continuous emission monitoring system and flow monitoring system...

40 CFR 75.13 - Specific provisions for monitoring CO2 emissions.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 16 2011-07-01 2011-07-01 false Specific provisions for monitoring CO2... monitoring CO2 emissions. (a) CO 2 continuous emission monitoring system. If the owner or operator chooses to... operating requirements in § 75.10 for a CO2 continuous emission monitoring system and flow monitoring system...

40 CFR 75.13 - Specific provisions for monitoring CO2 emissions.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 40 Protection of Environment 17 2012-07-01 2012-07-01 false Specific provisions for monitoring CO2... monitoring CO2 emissions. (a) CO 2 continuous emission monitoring system. If the owner or operator chooses to... operating requirements in § 75.10 for a CO2 continuous emission monitoring system and flow monitoring system...

40 CFR 75.12 - Specific provisions for monitoring NOX emission rate.

Code of Federal Regulations, 2010 CFR

2010-07-01

...) AIR PROGRAMS (CONTINUED) CONTINUOUS EMISSION MONITORING Monitoring Provisions § 75.12 Specific provisions for monitoring NOX emission rate. (a) Coal-fired units, gas-fired nonpeaking units or oil-fired... 40 Protection of Environment 16 2010-07-01 2010-07-01 false Specific provisions for monitoring NOX...

40 CFR 75.11 - Specific provisions for monitoring SO2 emissions.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 40 Protection of Environment 17 2014-07-01 2014-07-01 false Specific provisions for monitoring SO2... PROGRAMS (CONTINUED) CONTINUOUS EMISSION MONITORING Monitoring Provisions § 75.11 Specific provisions for monitoring SO2 emissions. (a) Coal-fired units. The owner or operator shall meet the general operating...

40 CFR 75.12 - Specific provisions for monitoring NOX emission rate.

Code of Federal Regulations, 2013 CFR

2013-07-01

...) AIR PROGRAMS (CONTINUED) CONTINUOUS EMISSION MONITORING Monitoring Provisions § 75.12 Specific provisions for monitoring NOX emission rate. (a) Coal-fired units, gas-fired nonpeaking units or oil-fired... 40 Protection of Environment 17 2013-07-01 2013-07-01 false Specific provisions for monitoring NOX...

40 CFR 75.11 - Specific provisions for monitoring SO2 emissions.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 40 Protection of Environment 17 2012-07-01 2012-07-01 false Specific provisions for monitoring SO2... PROGRAMS (CONTINUED) CONTINUOUS EMISSION MONITORING Monitoring Provisions § 75.11 Specific provisions for monitoring SO2 emissions. (a) Coal-fired units. The owner or operator shall meet the general operating...

40 CFR 75.12 - Specific provisions for monitoring NOX emission rate.

Code of Federal Regulations, 2014 CFR

2014-07-01

...) AIR PROGRAMS (CONTINUED) CONTINUOUS EMISSION MONITORING Monitoring Provisions § 75.12 Specific provisions for monitoring NOX emission rate. (a) Coal-fired units, gas-fired nonpeaking units or oil-fired... 40 Protection of Environment 17 2014-07-01 2014-07-01 false Specific provisions for monitoring NOX...

40 CFR 75.14 - Specific provisions for monitoring opacity.

Code of Federal Regulations, 2010 CFR

2010-07-01

... PROGRAMS (CONTINUED) CONTINUOUS EMISSION MONITORING Monitoring Provisions § 75.14 Specific provisions for monitoring opacity. (a) Coal-fired units and oil-fired units. The owner or operator shall meet the general... 40 Protection of Environment 16 2010-07-01 2010-07-01 false Specific provisions for monitoring...

40 CFR 75.14 - Specific provisions for monitoring opacity.

Code of Federal Regulations, 2014 CFR

2014-07-01

... PROGRAMS (CONTINUED) CONTINUOUS EMISSION MONITORING Monitoring Provisions § 75.14 Specific provisions for monitoring opacity. (a) Coal-fired units and oil-fired units. The owner or operator shall meet the general... 40 Protection of Environment 17 2014-07-01 2014-07-01 false Specific provisions for monitoring...

40 CFR 75.12 - Specific provisions for monitoring NOX emission rate.

Code of Federal Regulations, 2011 CFR

2011-07-01

...) AIR PROGRAMS (CONTINUED) CONTINUOUS EMISSION MONITORING Monitoring Provisions § 75.12 Specific provisions for monitoring NOX emission rate. (a) Coal-fired units, gas-fired nonpeaking units or oil-fired... 40 Protection of Environment 16 2011-07-01 2011-07-01 false Specific provisions for monitoring NOX...

40 CFR 75.14 - Specific provisions for monitoring opacity.

Code of Federal Regulations, 2011 CFR

2011-07-01

... PROGRAMS (CONTINUED) CONTINUOUS EMISSION MONITORING Monitoring Provisions § 75.14 Specific provisions for monitoring opacity. (a) Coal-fired units and oil-fired units. The owner or operator shall meet the general... 40 Protection of Environment 16 2011-07-01 2011-07-01 false Specific provisions for monitoring...

40 CFR 75.12 - Specific provisions for monitoring NOX emission rate.

Code of Federal Regulations, 2012 CFR

2012-07-01

...) AIR PROGRAMS (CONTINUED) CONTINUOUS EMISSION MONITORING Monitoring Provisions § 75.12 Specific provisions for monitoring NOX emission rate. (a) Coal-fired units, gas-fired nonpeaking units or oil-fired... 40 Protection of Environment 17 2012-07-01 2012-07-01 false Specific provisions for monitoring NOX...

40 CFR 75.11 - Specific provisions for monitoring SO2 emissions.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 40 Protection of Environment 17 2013-07-01 2013-07-01 false Specific provisions for monitoring SO2... PROGRAMS (CONTINUED) CONTINUOUS EMISSION MONITORING Monitoring Provisions § 75.11 Specific provisions for monitoring SO2 emissions. (a) Coal-fired units. The owner or operator shall meet the general operating...

40 CFR 75.14 - Specific provisions for monitoring opacity.

Code of Federal Regulations, 2012 CFR

2012-07-01

... PROGRAMS (CONTINUED) CONTINUOUS EMISSION MONITORING Monitoring Provisions § 75.14 Specific provisions for monitoring opacity. (a) Coal-fired units and oil-fired units. The owner or operator shall meet the general... 40 Protection of Environment 17 2012-07-01 2012-07-01 false Specific provisions for monitoring...

40 CFR 75.14 - Specific provisions for monitoring opacity.

Code of Federal Regulations, 2013 CFR

2013-07-01

... PROGRAMS (CONTINUED) CONTINUOUS EMISSION MONITORING Monitoring Provisions § 75.14 Specific provisions for monitoring opacity. (a) Coal-fired units and oil-fired units. The owner or operator shall meet the general... 40 Protection of Environment 17 2013-07-01 2013-07-01 false Specific provisions for monitoring...

Continuing education: online monitoring of haemodialysis dose.

PubMed

Vartia, Aarne

2018-01-25

Kt/V urea reflects the efficacy of haemodialysis scaled to patient size (urea distribution volume). The guidelines recommend monthly Kt/V measurements based on blood samples. Modern haemodialysis machines are equipped with accessories monitoring the dose online at every session without extra costs, blood samples and computers. To describe the principles, devices, benefits and shortcomings of online monitoring of haemodialysis dose. A critical literature overview and discussion. UV absorbance methods measure Kt/V, ionic dialysance Kt (product of clearance and treatment time; cleared volume without scaling). Both are easy and useful methods, but comparison is difficult due to problems in scaling of the dialysis dose to the patient's size. The best dose estimation method is the one which predicts the quality of life and survival most accurately. There is some evidence on the predictive value of ionic dialysance Kt, but more documentation is required on the UV method. Online monitoring is a useful tool in everyday quality assurance, but blood samples are still required for more accurate kinetic modelling. After reading this article the reader should be able to: Understand the elements of the Kt/V equation for dialysis dose. Compare and contrast different methods of measurement of dialysis dose. Reflect on the importance of adequate dialysis dose for patient survival and life quality. © 2018 European Dialysis and Transplant Nurses Association/European Renal Care Association.

Overnight non-contact continuous vital signs monitoring using an intelligent automatic beam-steering Doppler sensor at 2.4 GHz.

PubMed

Batchu, S; Narasimhachar, H; Mayeda, J C; Hall, T; Lopez, J; Nguyen, T; Banister, R E; Lie, D Y C

2017-07-01

Doppler-based non-contact vital signs (NCVS) sensors can monitor heart rates, respiration rates, and motions of patients without physically touching them. We have developed a novel single-board Doppler-based phased-array antenna NCVS biosensor system that can perform robust overnight continuous NCVS monitoring with intelligent automatic subject tracking and optimal beam steering algorithms. Our NCVS sensor achieved overnight continuous vital signs monitoring with an impressive heart-rate monitoring accuracy of over 94% (i.e., within ±5 Beats-Per-Minute vs. a reference sensor), analyzed from over 400,000 data points collected during each overnight monitoring period of ~ 6 hours at a distance of 1.75 meters. The data suggests our intelligent phased-array NCVS sensor can be very attractive for continuous monitoring of low-acuity patients.

Oral lichen planus.

PubMed

Olson, Meredith A; Rogers, Roy S; Bruce, Alison J

2016-01-01

Lichen planus is an inflammatory mucocutaneous disease that can affect the skin, hair, nails, and mucosal surfaces. Mucosal sites of involvement include oral, genital, ocular, otic, esophageal, and, less commonly, bladder, nasal, laryngeal, and anal surfaces. Oral lichen planus is a mucosal variant of lichen planus, which tends to affect women more often than men, with a typically more chronic course and potential for significant morbidity. Treatment can be challenging, and there is potentially a low risk of malignant transformation; however, therapeutic benefits can be obtained with various topical and systemic medications. Clinical monitoring is recommended to ensure symptomatic control. Increasing awareness and recognition of this entity have continued to fuel advances in therapy and in our understanding of the disease. Copyright © 2016 Elsevier Inc. All rights reserved.

Health hazard evaluation report HETA 96-0137-2607, Yankee Atomic Electric Company, Rowe, Massachusetts

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

Sylvain, D.C.

1996-10-01

In response to a request from the Health and Safety Supervisor at the Yankee Nuclear Power Station (SIC-4911), Rowe, Massachusetts, an investigation was begun into ozone (10028156) exposure during plasma arc cutting and welding. Welders had reported chest tightness, dry cough, and throat and bronchial irritation. The nuclear power station was in the process of being decommissioned, and workers were dismantling components using welding and cutting methods. Of the operations observed during the site visit, the highest ozone concentrations were generated during plasma arc cutting, followed by metal inert gas (MIG) welding and arc welding. During plasma arc cutting themore » average and peak concentrations exceeded the NIOSH ceiling recommended exposure limit of 0.1 part per million. The author concludes that ozone exposure during plasma arc cutting and MIG welding presented a health hazard to welders. The author recommends that improvements be made in the local exhaust ventilation, that nitrogen-dioxide levels be monitored during hot work, and that many exposed workers wear protective clothing, use ultraviolet blocking lotion, and continue the use appropriate shade of eye protection.« less

ENVIRONMENTAL MONITORING FOR PUBLIC ACCESS AND COMMUNITY TRACKING (EMPACT) PROGRAM MICROBIOLOGICAL MONITORING OF RECREATIONAL WATER

EPA Science Inventory

Current Environmental Protection Agency (EPA) recommended microbiological monitoring practices for bathing beach water quality were suggested in 1968, as a part of the fecal coliform guideline developed by the Federal Water Pollution Control Administration. The guideline stated ...

Reference Cross Sections for Charged-particle Monitor Reactions

NASA Astrophysics Data System (ADS)

Hermanne, A.; Ignatyuk, A. V.; Capote, R.; Carlson, B. V.; Engle, J. W.; Kellett, M. A.; Kibédi, T.; Kim, G.; Kondev, F. G.; Hussain, M.; Lebeda, O.; Luca, A.; Nagai, Y.; Naik, H.; Nichols, A. L.; Nortier, F. M.; Suryanarayana, S. V.; Takács, S.; Tárkányi, F. T.; Verpelli, M.

2018-02-01

Evaluated cross sections of beam-monitor reactions are expected to become the de-facto standard for cross-section measurements that are performed over a very broad energy range in accelerators in order to produce particular radionuclides for industrial and medical applications. The requirements for such data need to be addressed in a timely manner, and therefore an IAEA coordinated research project was launched in December 2012 to establish or improve the nuclear data required to characterise charged-particle monitor reactions. An international team was assembled to recommend more accurate cross-section data over a wide range of targets and projectiles, undertaken in conjunction with a limited number of measurements and more extensive evaluations of the decay data of specific radionuclides. Least-square evaluations of monitor-reaction cross sections including uncertainty quantification have been undertaken for charged-particle beams of protons, deuterons, 3He- and 4He-particles. Recommended beam monitor reaction data with their uncertainties are available at the IAEA-NDS medical portal http://www-nds.iaea.org/medical/monitor_reactions.html.

Maintaining routine despite ongoing exposure to terrorism: a healthy strategy for adolescents?

PubMed

Pat-Horenczyk, Ruth; Schiff, Miriam; Doppelt, Osnat

2006-08-01

To examine the association between ongoing terrorism and Israeli adolescents' routine activities. A total of 1336 junior high and high school students from Jerusalem (46.9% boys and 53.1% girls) self-reported on measures of maintaining or reducing their level of routine activities, perceived parental monitoring, posttraumatic symptoms (PTS) and functional impairment. We used linear regressions to explore possible associations between decreasing (or maintaining) level of routine activities, parental monitoring, and PTS and functional impairment. A majority of the adolescents reported that under the recurrent threat of terrorism they maintained their routine (i.e., 65.8% continued using public transportation). Similarly, more than half the students perceived their parents as encouraging them to maintain their routine activities. Furthermore, greater exposure to terrorism was associated with more PTS symptoms and functional impairment. Nonetheless, a reduced level of routine activities was a significant predictor for higher PTS and functional impairment, even after controlling for level of exposure to terrorism, gender and age. Similarly, perceived parental limiting of routine activities was a significant predictor for higher PTS and functional impairment, even after controlling for gender, age and the level of exposure to terrorism. Our results support practitioners' recommendations to encourage continuity in daily routine. Disruption of routine activities may result in the development of avoidance reactions that can lead to posttraumatic stress disorder.

Trastuzumab-induced cardiotoxicity.

PubMed

Moss, Lisa Stegall; Starbuck, Mandy Fields; Mayer, Deborah K; Harwood, Elaine Brooks; Glotzer, Jana

2009-11-01

To review trastuzumab-related cardiotoxic effects in the breast cancer adjuvant setting, present a system for pretreatment screening for cardiovascular risk factors, describe monitoring recommendations, provide a tool to facilitate adherence to monitoring guidelines, and discuss implications for patient education. Literature regarding cardiotoxicity and trastuzumab in breast cancer. Trastuzumab was approved in 2006 for use in the adjuvant setting. A small percentage of women (approximately 4%) developed heart failure during or after treatment. However, the trials excluded women with cardiac disease. Current screening for cardiotoxicity relies on sequential left ventricular function measurements with either echocardiography or multigated acquisition scanning at baseline and every three months. Treatment modifications are recommended if changes from baseline are detected. Long-term and late effects have yet to be determined. Although a small number of women experienced cardiotoxicity in the adjuvant setting, an increase may be seen because women with preexisting heart disease receive this treatment. Guidelines and tools will be helpful for appropriate and consistent screening of cardiac risk factors and disease prior to initiation of trastuzumab and for monitoring during and after administration. Nurses are instrumental in assessing, monitoring, and treating women receiving trastuzumab. Implementing guidelines to promote adherence to recommended monitoring is important in the early detection of cardiotoxicity in this population. Educating women about their treatment and side effects is an important aspect of care.

NREL Patents Method for Continuous Monitoring of Materials During

Science.gov Websites

Manufacturing | News | NREL NREL Patents Method for Continuous Monitoring of Materials During Manufacturing News Release: NREL Patents Method for Continuous Monitoring of Materials During Manufacturing patent for a novel method that rapidly characterizes specialized materials during the manufacturing

40 CFR 75.39 - Missing data procedures for sorbent trap monitoring systems.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 16 2010-07-01 2010-07-01 false Missing data procedures for sorbent... (CONTINUED) AIR PROGRAMS (CONTINUED) CONTINUOUS EMISSION MONITORING Missing Data Substitution Procedures § 75.39 Missing data procedures for sorbent trap monitoring systems. (a) If a primary sorbent trap...

40 CFR 60.1805 - Must I meet other requirements for continuous monitoring?

Code of Federal Regulations, 2010 CFR

2010-07-01

... continuous monitoring? 60.1805 Section 60.1805 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY..., 1999 Model Rule-Other Monitoring Requirements § 60.1805 Must I meet other requirements for continuous... device. (c) Carbon feed rate if activated carbon is used to control dioxins/furans or mercury emissions. ...

40 CFR 60.2939 - What continuous emission monitoring systems must I install?

Code of Federal Regulations, 2013 CFR

2013-07-01

... systems must I install? 60.2939 Section 60.2939 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY... § 60.2939 What continuous emission monitoring systems must I install? (a) You must install, calibrate, maintain, and operate continuous emission monitoring systems for carbon monoxide and for oxygen. You must...

40 CFR 60.1805 - Must I meet other requirements for continuous monitoring?

Code of Federal Regulations, 2014 CFR

2014-07-01

... continuous monitoring? 60.1805 Section 60.1805 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY..., 1999 Model Rule-Other Monitoring Requirements § 60.1805 Must I meet other requirements for continuous... device. (c) Carbon feed rate if activated carbon is used to control dioxins/furans or mercury emissions. ...

40 CFR 60.2939 - What continuous emission monitoring systems must I install?

Code of Federal Regulations, 2014 CFR

2014-07-01

... systems must I install? 60.2939 Section 60.2939 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY... § 60.2939 What continuous emission monitoring systems must I install? (a) You must install, calibrate, maintain, and operate continuous emission monitoring systems for carbon monoxide and for oxygen. You must...

40 CFR 60.1805 - Must I meet other requirements for continuous monitoring?

Code of Federal Regulations, 2012 CFR

2012-07-01

... continuous monitoring? 60.1805 Section 60.1805 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY..., 1999 Model Rule-Other Monitoring Requirements § 60.1805 Must I meet other requirements for continuous... device. (c) Carbon feed rate if activated carbon is used to control dioxins/furans or mercury emissions. ...

40 CFR 60.1805 - Must I meet other requirements for continuous monitoring?

Code of Federal Regulations, 2013 CFR

2013-07-01

... continuous monitoring? 60.1805 Section 60.1805 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY..., 1999 Model Rule-Other Monitoring Requirements § 60.1805 Must I meet other requirements for continuous... device. (c) Carbon feed rate if activated carbon is used to control dioxins/furans or mercury emissions. ...

40 CFR 60.1805 - Must I meet other requirements for continuous monitoring?

Code of Federal Regulations, 2011 CFR

2011-07-01

... continuous monitoring? 60.1805 Section 60.1805 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY..., 1999 Model Rule-Other Monitoring Requirements § 60.1805 Must I meet other requirements for continuous... device. (c) Carbon feed rate if activated carbon is used to control dioxins/furans or mercury emissions. ...

Alpha-environmental continuous air monitor inlet

DOEpatents

Rodgers, John C.

2003-01-01

A wind deceleration and protective shroud that provides representative samples of ambient aerosols to an environmental continuous air monitor (ECAM) has a cylindrical enclosure mounted to an input on the continuous air monitor, the cylindrical enclosure having shrouded nozzles located radially about its periphery. Ambient air flows, often along with rainwater flows into the nozzles in a sampling flow generated by a pump in the continuous air monitor. The sampling flow of air creates a cyclonic flow in the enclosure that flows up through the cylindrical enclosure until the flow of air reaches the top of the cylindrical enclosure and then is directed downward to the continuous air monitor. A sloped platform located inside the cylindrical enclosure supports the nozzles and causes any moisture entering through the nozzle to drain out through the nozzles.

[Design and implementation of real-time continuous glucose monitoring instrument].

PubMed

Huang, Yonghong; Liu, Hongying; Tian, Senfu; Jia, Ziru; Wang, Zi; Pi, Xitian

2017-12-01

Real-time continuous glucose monitoring can help diabetics to control blood sugar levels within the normal range. However, in the process of practical monitoring, the output of real-time continuous glucose monitoring system is susceptible to glucose sensor and environment noise, which will influence the measurement accuracy of the system. Aiming at this problem, a dual-calibration algorithm for the moving-window double-layer filtering algorithm combined with real-time self-compensation calibration algorithm is proposed in this paper, which can realize the signal drift compensation for current data. And a real-time continuous glucose monitoring instrument based on this study was designed. This real-time continuous glucose monitoring instrument consisted of an adjustable excitation voltage module, a current-voltage converter module, a microprocessor and a wireless transceiver module. For portability, the size of the device was only 40 mm × 30 mm × 5 mm and its weight was only 30 g. In addition, a communication command code algorithm was designed to ensure the security and integrity of data transmission in this study. Results of experiments in vitro showed that current detection of the device worked effectively. A 5-hour monitoring of blood glucose level in vivo showed that the device could continuously monitor blood glucose in real time. The relative error of monitoring results of the designed device ranged from 2.22% to 7.17% when comparing to a portable blood meter.

Evaluation and prioritization of stream habitat monitoring in the Lower Columbia Salmon and Steelhead Recovery Domain as related to the habitat monitoring needs of ESA recovery plans

USGS Publications Warehouse

Puls, Amy L.; Anlauf Dunn, Kara; Graham Hudson, Bernadette

2014-01-01

The lower Columbia River and its tributaries once supported abundant runs of salmon and steelhead; however, there are five species currently listed under the federal Endangered Species Act (ESA). The National Marine Fisheries Service has completed, and is proposing for adoption, a comprehensive ESA Recovery Plan for the Lower Columbia Evolutionarily Significant Units (ESUs) based on the recovery plans developed by Oregon and Washington. One of the primary factors attributed to the decline of these species is habitat degradation. There are numerous entities conducting status and/or trends monitoring of instream habitat in the lower Columbia River Basin, but because the programs were developed for agency specific reasons, the existing monitoring efforts are not well coordinated, and often lack the spatial coverage, certainty, or species coverage necessary to answer questions related to status and trends of the ESA listed populations. The Pacific Northwest Aquatic Monitoring Partnership’s Integrated Status and Trends Monitoring (ISTM) project was initiated to improve integration of existing and new monitoring efforts by developing recommendations for sampling frames, protocols, and data sharing. In an effort to meet the ISTM project goals, five objectives were identified: (1) identify and prioritize decisions, questions, and monitoring objectives, (2) evaluate how existing programs align with these management decisions, questions, and objectives, (3) identify the most appropriate monitoring design to inform priority management decisions, questions, and objectives, (4) use trade-off analysis to develop specific recommendations for monitoring based on outcomes of Objectives 1-3 and (5) recommend implementation and reporting mechanisms. This report summarizes the effort to address Objectives 1 and 2, detailing the commonalities among the habitat characteristics that all entities measure and monitor, and how the metrics align with the priorities listed in the comprehensive recovery plan for the Lower Columbia ESUs.

The Effects of Continuous Vs. Intermittent Self-Monitoring on the Duration and Magnitude of Behavior Change.

ERIC Educational Resources Information Center

Schayer, Laurel L.; Schroeder, Harold E.

Continuous self-monitoring (CSM) was compared with a demand characteristics control condition (non self-monitoring), with intermittent self-monitoring (ISM) and with another control condition. It was predicted that both self-monitoring conditions would produce effects over and above the demand characteristics inherent in the self-monitoring…

21 CFR 316.14 - Refusal to provide written recommendations.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 5 2011-04-01 2011-04-01 false Refusal to provide written recommendations. 316.14... (CONTINUED) DRUGS FOR HUMAN USE ORPHAN DRUGS Written Recommendations for Investigations of Orphan Drugs § 316.14 Refusal to provide written recommendations. (a) FDA may refuse to provide written recommendations...

49 CFR 195.573 - What must I do to monitor external corrosion control?

Code of Federal Regulations, 2013 CFR

2013-10-01

... operation and maintenance of the system are in accordance with API Recommended Practice 651. However, this...) why compliance with all or certain operation and maintenance provisions of API Recommended Practice...

49 CFR 195.573 - What must I do to monitor external corrosion control?

Code of Federal Regulations, 2014 CFR

2014-10-01

... operation and maintenance of the system are in accordance with API Recommended Practice 651. However, this...) why compliance with all or certain operation and maintenance provisions of API Recommended Practice...

Pollution monitoring system. [photographic laboratory by-products

NASA Technical Reports Server (NTRS)

Goodding, R. A.

1973-01-01

An investigation was undertaken to identify those photographic laboratory by-products which can produce harmful reactions if released untreated. After identification of these by-products, specific monitoring systems for each of the offending ions were investigated and recommendations for implementation are presented. Appropriate monitoring systems are discussed.

40 CFR 58.61 - Monitoring other pollutants.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 5 2010-07-01 2010-07-01 false Monitoring other pollutants. 58.61 Section 58.61 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) AMBIENT AIR QUALITY SURVEILLANCE Federal Monitoring § 58.61 Monitoring other pollutants. The...

40 CFR 58.13 - Monitoring network completion.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 40 Protection of Environment 6 2012-07-01 2012-07-01 false Monitoring network completion. 58.13 Section 58.13 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) AMBIENT AIR QUALITY SURVEILLANCE Monitoring Network § 58.13 Monitoring network completion. (a...

40 CFR 58.13 - Monitoring network completion.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 40 Protection of Environment 6 2014-07-01 2014-07-01 false Monitoring network completion. 58.13 Section 58.13 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) AMBIENT AIR QUALITY SURVEILLANCE Monitoring Network § 58.13 Monitoring network completion. (a...

40 CFR 58.13 - Monitoring network completion.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 40 Protection of Environment 6 2013-07-01 2013-07-01 false Monitoring network completion. 58.13 Section 58.13 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) AMBIENT AIR QUALITY SURVEILLANCE Monitoring Network § 58.13 Monitoring network completion. (a...

Endoscopy in patients on antiplatelet or anticoagulant therapy, including direct oral anticoagulants: British Society of Gastroenterology (BSG) and European Society of Gastrointestinal Endoscopy (ESGE) guidelines.

PubMed

Veitch, Andrew M; Vanbiervliet, Geoffroy; Gershlick, Anthony H; Boustiere, Christian; Baglin, Trevor P; Smith, Lesley-Ann; Radaelli, Franco; Knight, Evelyn; Gralnek, Ian M; Hassan, Cesare; Dumonceau, Jean-Marc

2016-04-01

The risk of endoscopy in patients on antithrombotics depends on the risks of procedural haemorrhage vs. thrombosis due to discontinuation of therapy. P2Y12 receptor antagonists (clopidogrel, prasugrel, ticagrelor): For low-risk endoscopic procedures we recommend continuing P2Y12 receptor antagonists as single or dual antiplatelet therapy (low quality evidence, strong recommendation);For high-risk endoscopic procedures in patients at low thrombotic risk, we recommend discontinuing P2Y12 receptor antagonists five days before the procedure (moderate quality evidence, strong recommendation). In patients on dual antiplatelet therapy, we suggest continuing aspirin (low quality evidence, weak recommendation).For high-risk endoscopic procedures in patients at high thrombotic risk, we recommend continuing aspirin and liaising with a cardiologist about the risk/benefit of discontinuation of P2Y12 receptor antagonists (high quality evidence, strong recommendation). Warfarin: The advice for warfarin is fundamentally unchanged from BSG 2008 guidance. Direct Oral Anticoagulants (DOAC): For low-risk endoscopic procedures we suggest omitting the morning dose of DOAC on the day of the procedure (very low quality evidence, weak recommendation). For high-risk endoscopic procedures, we recommend that the last dose of DOAC be taken ≥ 48 hours before the procedure (very low quality evidence, strong recommendation). For patients on dabigatran with CrCl (or estimated glomerular filtration rate, eGFR) of 30 - 50 mL/min we recommend that the last dose of DOAC be taken 72 hours before the procedure (very low quality evidence, strong recommendation). In any patient with rapidly deteriorating renal function a haematologist should be consulted (low quality evidence, strong recommendation). © Georg Thieme Verlag KG Stuttgart · New York.

The President's Panel Recommendations - Today

ERIC Educational Resources Information Center

Luckey, Robert E.; Neman, Ronald S.

1975-01-01

State mental retardation program coordinators were surveyed regarding their opinions with respect to progress in achieving the President's Panel recommendations of 1962, and the continuing relevance of these recommendations today. (Author)

Clinical outcome of continuous facial nerve monitoring during primary parotidectomy.

PubMed

Terrell, J E; Kileny, P R; Yian, C; Esclamado, R M; Bradford, C R; Pillsbury, M S; Wolf, G T

1997-10-01

To assess whether continuous facial nerve monitoring during parotidectomy is associated with a lower incidence of facial nerve paresis or paralysis compared with parotidectomy without monitoring and to assess the cost of such monitoring. A retrospective analysis of outcomes for patients who underwent parotidectomy with or without continuous facial nerve monitoring. University medical center. Fifty-six patients undergoing parotidectomy in whom continuous electromyographic monitoring was used and 61 patients in whom it was not used. (1) The incidence of early and persistent facial nerve paresis or paralysis and (2) the cost associated with facial nerve monitoring. Early, unintentional facial weakness was significantly lower in the group monitored by electromyograpy (43.6%) than in the unmonitored group (62.3%) (P=.04). In the subgroup of patients without comorbid conditions or surgeries, early weakness in the monitored group (33.3%) remained statistically lower than the rate of early weakness in the unmonitored group (57.5%) (P=.03). There was no statistical difference in the final facial nerve function or incidence of permanent nerve injury between the groups or subgroups. After multivariate analysis, nonmonitored status (odds ratio [OR], 3.22), advancing age (OR, 1.47 per 10 years), and longer operative times (OR, 1.3 per hour) were the only significant independent predictive variables significantly associated with early postoperative facial weakness. The incremental cost of facial nerve monitoring was $379. The results suggest that continuous electromyographic monitoring of facial muscle during primary parotidectomy reduces the incidence of short-term postoperative facial paresis. Advantages and disadvantages of this technique need to be considered together with the additional costs in deciding whether routine use of continuous monitoring is a useful, cost-effective adjunct to parotid surgery.

A guide to treating gait impairment with prolonged-release fampridine (Fampyra®) in patients with multiple sclerosis.

PubMed

Ramió-Torrentà, L; Álvarez-Cermeño, J C; Arroyo, R; Casanova-Estruch, B; Fernández, O; García-Merino, J A; Hernández, M A; Izquierdo, G; Martínez-Yélamos, S; Meca, J; Moral, E; Olascoaga, J; Prieto, J M; Saiz, A

2018-06-01

Gait impairment, a frequent sign in multiple sclerosis (MS), places a major burden on patients since it results in progressive loss of personal and social autonomy, along with work productivity. This guide aims to provide recommendations on how to evaluate gait impairment and use prolonged-release fampridine (PR-fampridine) as treatment for MS patients with gait impairment in Spain. PR-fampridine dosed at 10mg every 12hours is currently the only drug approved to treat gait impairment in adults with MS. Additionally, PR-fampridine has been shown in clinical practice to significantly improve quality of life (QoL) in patients who respond to treatment. Treatment response can be assessed with the Timed 25-Foot Walk (T25FW) or the 12-item MS Walking Scale (MSWS-12); tests should be completed before and after starting treatment. The minimum time recommended for evaluating treatment response is 2 weeks after treatment onset. Patients are considered responders and permitted to continue the treatment when they demonstrate a decrease in their T25FW time or an increase in MSWS-12 scores. A re-evaluation is recommended at least every 6 months. The SF-36 (Short Form-36) and the MSIS-29 (MS Impact Scale-29) tests are recommended for clinicians interested in performing a detailed QoL assessment. This drug is generally well-tolerated and has a good safety profile. It should be taken on an empty stomach and renal function must be monitored regularly. These recommendations will help ensure safer and more efficient prescription practices and easier management of PR-fampridine as treatment for gait impairment in Spanish adults with MS. Copyright © 2015 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.

40 CFR Table 1 to Subpart Llllll... - Applicability of General Provisions to Subpart LLLLLL

Code of Federal Regulations, 2011 CFR

2011-07-01

... Modacrylic Fibers Production Area Sources Pt. 63, Subpt. LLLLLL, Table 1 Table 1 to Subpart LLLLLL of Part 63... not include opacity or visible emissions standards or require a continuous opacity monitoring system... does not require a continuous opacity monitoring system or continuous emissions monitoring system. 63.9...

40 CFR Table 1 to Subpart Llllll... - Applicability of General Provisions to Subpart LLLLLL

Code of Federal Regulations, 2010 CFR

2010-07-01

... Modacrylic Fibers Production Area Sources Pt. 63, Subpt. LLLLLL, Table 1 Table 1 to Subpart LLLLLL of Part 63... not include opacity or visible emissions standards or require a continuous opacity monitoring system... does not require a continuous opacity monitoring system or continuous emissions monitoring system. 63.9...

78 FR 65306 - Best Practices for Continuous Monitoring of Temperature and Flow in Wadeable Streams

Federal Register 2010, 2011, 2012, 2013, 2014

2013-10-31

... Practices for Continuous Monitoring of Temperature and Flow in Wadeable Streams AGENCY: Environmental... Monitoring of Temperature and Flow in Wadeable Streams'' (EPA/600/R-13/170). The EPA also is announcing that... Development. The report describes best practices for the deployment of continuous temperature and flow sensors...

40 CFR 60.1725 - How are the data from the continuous emission monitoring systems used?

Code of Federal Regulations, 2013 CFR

2013-07-01

... emission monitoring systems used? 60.1725 Section 60.1725 Protection of Environment ENVIRONMENTAL... Before August 30, 1999 Model Rule-Continuous Emission Monitoring § 60.1725 How are the data from the... systems for sulfur dioxide, nitrogen oxides, and carbon monoxide to demonstrate continuous compliance with...

40 CFR 60.1725 - How are the data from the continuous emission monitoring systems used?

Code of Federal Regulations, 2014 CFR

2014-07-01

... emission monitoring systems used? 60.1725 Section 60.1725 Protection of Environment ENVIRONMENTAL... Before August 30, 1999 Model Rule-Continuous Emission Monitoring § 60.1725 How are the data from the... systems for sulfur dioxide, nitrogen oxides, and carbon monoxide to demonstrate continuous compliance with...

40 CFR 60.1365 - What records must I keep for continuously monitored pollutants or parameters?

Code of Federal Regulations, 2010 CFR

2010-07-01

... diluent gas, document the relationship between oxygen and carbon dioxide, as specified in § 60.1255. (h... continuously monitored pollutants or parameters? 60.1365 Section 60.1365 Protection of Environment... Recordkeeping § 60.1365 What records must I keep for continuously monitored pollutants or parameters? You must...

40 CFR 60.1365 - What records must I keep for continuously monitored pollutants or parameters?

Code of Federal Regulations, 2011 CFR

2011-07-01

... diluent gas, document the relationship between oxygen and carbon dioxide, as specified in § 60.1255. (h... continuously monitored pollutants or parameters? 60.1365 Section 60.1365 Protection of Environment... Recordkeeping § 60.1365 What records must I keep for continuously monitored pollutants or parameters? You must...

40 CFR 60.1365 - What records must I keep for continuously monitored pollutants or parameters?

Code of Federal Regulations, 2013 CFR

2013-07-01

... diluent gas, document the relationship between oxygen and carbon dioxide, as specified in § 60.1255. (h... continuously monitored pollutants or parameters? 60.1365 Section 60.1365 Protection of Environment... Recordkeeping § 60.1365 What records must I keep for continuously monitored pollutants or parameters? You must...

40 CFR 60.1365 - What records must I keep for continuously monitored pollutants or parameters?

Code of Federal Regulations, 2012 CFR

2012-07-01

... diluent gas, document the relationship between oxygen and carbon dioxide, as specified in § 60.1255. (h... continuously monitored pollutants or parameters? 60.1365 Section 60.1365 Protection of Environment... Recordkeeping § 60.1365 What records must I keep for continuously monitored pollutants or parameters? You must...

40 CFR 60.1365 - What records must I keep for continuously monitored pollutants or parameters?

Code of Federal Regulations, 2014 CFR

2014-07-01

... diluent gas, document the relationship between oxygen and carbon dioxide, as specified in § 60.1255. (h... continuously monitored pollutants or parameters? 60.1365 Section 60.1365 Protection of Environment... Recordkeeping § 60.1365 What records must I keep for continuously monitored pollutants or parameters? You must...

40 CFR 60.1725 - How are the data from the continuous emission monitoring systems used?

Code of Federal Regulations, 2012 CFR

2012-07-01

... emission monitoring systems used? 60.1725 Section 60.1725 Protection of Environment ENVIRONMENTAL... Before August 30, 1999 Model Rule-Continuous Emission Monitoring § 60.1725 How are the data from the... systems for sulfur dioxide, nitrogen oxides, and carbon monoxide to demonstrate continuous compliance with...

40 CFR Table 7 to Subpart Jjj of... - Requirements for Continuous Emission Monitoring Systems (CEMS) a

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 8 2011-07-01 2011-07-01 false Requirements for Continuous Emission Monitoring Systems (CEMS) a 7 Table 7 to Subpart JJJ of Part 62 Protection of Environment ENVIRONMENTAL...—Requirements for Continuous Emission Monitoring Systems (CEMS) a ER31JA03.013 ...

40 CFR Table 7 to Subpart Jjj of... - Requirements for Continuous Emission Monitoring Systems (CEMS) a

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 8 2010-07-01 2010-07-01 false Requirements for Continuous Emission Monitoring Systems (CEMS) a 7 Table 7 to Subpart JJJ of Part 62 Protection of Environment ENVIRONMENTAL...—Requirements for Continuous Emission Monitoring Systems (CEMS) a ER31JA03.013 ...

Evaluation of continuous air monitor placement in a plutonium facility.

PubMed

Whicker, J J; Rodgers, J C; Fairchild, C I; Scripsick, R C; Lopez, R C

1997-05-01

Department of Energy appraisers found continuous air monitors at Department of Energy plutonium facilities alarmed less than 30% of the time when integrated room plutonium air concentrations exceeded 500 DAC-hours. Without other interventions, this alarm percentage suggests the possibility that workers could be exposed to high airborne concentrations without continuous air monitor alarms. Past research has shown that placement of continuous air monitors is a critical component in rapid and reliable detection of airborne releases. At Los Alamos National Laboratory and many other Department of Energy plutonium facilities, continuous air monitors have been primarily placed at ventilation exhaust points. The purpose of this study was to evaluate and compare the effectiveness of exhaust register placement of workplace continuous air monitors with other sampling locations. Polydisperse oil aerosols were released from multiple locations in two plutonium laboratories at Los Alamos National Laboratory. An array of laser particle counters positioned in the rooms measured time-resolved aerosol dispersion. Results showed alternative placement of air samplers generally resulted in aerosol detection that was faster, often more sensitive, and equally reliable compared with samplers at exhaust registers.