Characterizing Safety-net Providers’ HPV Vaccine Recommendations to Undecided Parents: A Pilot Study

PubMed Central

Shay, L. Aubree; Street, Richard L.; Baldwin, Austin S.; Marks, Emily G.; Lee, Simon Craddock; Higashi, Robin T.; Skinner, Celette Sugg; Fuller, Sobha; Persaud, Donna; Tiro, Jasmin A.

2016-01-01

Objective Although provider recommendation is a key predictor of HPV vaccination, how providers verbalize recommendations particularly strong ones is unknown. We developed a tool to describe strength and content of provider recommendations. Methods We used electronic health records to identify unvaccinated adolescents with appointments at six safety-net clinics in Dallas, Texas. Clinic visit audio-recordings were qualitatively analyzed to identify provider recommendation types (presumptive vs. participatory introduction; strong vs. weak), describe content communicated, and explore patterns between recommendation type and vaccination. Results We analyzed 43 audio-recorded discussions between parents and 12 providers. Most providers used a participatory introduction (42 discussions) and made weak recommendations (24 discussions) by using passive voice or adding a qualification (e.g., not school required). Few providers (11 discussions) gave strong recommendations (clear, personally-owned endorsement). HPV vaccination was lowest for those receiving only weak recommendations and highest when providers coupled the recommendation with an adjacent rationale. Conclusion Our new tool provides initial evidence of how providers undercut their recommendations through qualifications or support them with a rationale. Most providers gave weak HPV vaccine recommendations and used a participatory introduction. Practice Implications Providers would benefit from communication skills training on how to make explicit recommendations with an evidence-based rationale. PMID:27401828

Recommendations to minimize diagnostic nuclear medicine exposure to the embryo, fetus, and infant; availability of final recommendations--FDA. Notice.

PubMed

1986-02-19

Food and Drug Administration (FDA) is announcing the availability of final recommendations to minimize diagnostic nuclear medicine exposure to the embryo, fetus, and breastfeeding infant. The final recommendations, prepared by FDA's Center for Devices and Radiological Health (CDRH), include the agency's rationale for the recommendations as well as the endorsement of the recommendations by several professional organizations. The final recommendations are being published in a pamphlet that is being made available to interested persons.

Current micronutrient recommendations in Europe: towards understanding their differences and similarities.

PubMed

Doets, Esmée L; de Wit, Liesbeth S; Dhonukshe-Rutten, Rosalie A M; Cavelaars, Adriënne E J M; Raats, Monique M; Timotijevic, Lada; Brzozowska, Anna; Wijnhoven, Trudy M A; Pavlovic, Mirjana; Totland, Torunn Holm; Andersen, Lene F; Ruprich, Jiri; Pijls, Loek T J; Ashwell, Margaret; Lambert, Janet P; van 't Veer, Pieter; de Groot, Lisette C P G M

2008-04-01

Nowadays most countries in Europe have established their own nutrient recommendations to assess the adequacy of dietary intakes and to plan desirable dietary intakes. As yet there is no standard approach for deriving nutrient recommendations, they may vary from country to country. This results in different national recommendations causing confusion for policy-makers, health professionals, industry, and consumers within Europe. EURRECA (EURopean micronutrient RECommendations Aligned) is a network of excellence funded by the European Commission (EC), and established to identify and address the problem of differences between countries in micronutrient recommendations. The objective of this paper is to give an overview of the available micronutrient recommendations in Europe, and to provide information on their origin, concepts and definitions. Furthermore this paper aims to illustrate the diversity in European recommendations on vitamin A and vitamin D, and to explore differences and commonalities in approaches that could possibly explain variations observed. A questionnaire was developed to get information on the process of establishing micronutrient recommendations. These questionnaires were sent to key informants in the field of micronutrient recommendations to cover all European countries/regions. Also the latest reports on nutrient recommendations in Europe were collected. Standardisation procedures were defined to enable comparison of the recommendations. Recommendations for vitamin A and vitamin D were compared per sex at the ages 3, 9 months and 5, 10, 15, 25, 50 and 70 years. Information extracted from the questionnaires and reports was compared focusing on: (1) The concept of recommendation (recommended daily allowance (RDA), adequate intake (AI) or acceptable range), (2) The year of publication of the report (proxy for available evidence), (3) Population groups defined, (4) Other methodological issues such as selected criteria of adequacy, the type of evidence used, and assumptions made. Twenty-two countries, the World Health Organization (WHO)/the Food and Agriculture Organization of the United Nations (FAO) and the EC have their own reports on nutrient recommendations. Thirteen countries based their micronutrient recommendations on those from other countries or organisations. Five countries, WHO/FAO and the EC defined their own recommendations. The DACH-countries (Germany, Austria and Switzerland) as well as the Nordic countries (Norway, Sweden, Finland, Denmark and Iceland) cooperated in setting recommendations. Greece and Portugal use the EC and the WHO/FAO recommendations, respectively and Slovenia adopted the recommendations from the DACH-countries. Rather than by concepts, definitions, and defined population groups, variability appears to emerge from differences in criteria for adequacy, assumptions made and type of evidence used to establish micronutrient recommendations. The large variation in current micronutrient recommendations for population groups as illustrated for vitamin A and vitamin D strengthens the need for guidance on setting evidence based, up-to-date European recommendations. Differences in endpoints, type of evidence used to set recommendations, experts' opinions and assumptions are all likely to contribute to the identified variation. So far, background information was not sufficient transparent to disentangle the relative contribution of these different aspects. EURRECA has an excellent opportunity to develop tools to improve transparency on the approaches used in setting micronutrient recommendations, including the selection of criteria for adequacy, weighing of evidence, and interpretation of data.

A Retrospective Analysis Comparing the New Standardized Letter of Recommendation in Dermatology with the Classic Narrative Letter of Recommendation

PubMed Central

Mosser, Joy; Lee, Grace; Pootrakul, Llana; Harfmann, Katya; Fabbro, Stephanie; Faith, Esteban Fernandez; Carr, David; Plotner, Alisha; Zirwas, Matthew; Kaffenberger, Benjamin H.

2016-01-01

Background: In an effort to avoid numerous problems associated with narrative letters of recommendation, a dermatology standardized letter of recommendation was utilized in the 2014–2015 resident application cycle. Objective: A comparison of the standardized letter of recommendation and narrative letters of recommendation from a single institution and application cycle to determine if the standardized letter of recommendation met its original goals of efficiency, applicant stratification, and validity. Methods: Eight dermatologists assessed all standardized letters of recommendation/narrative letters of recommendation pairs received during the 2014–2015 application cycle. Five readers repeated the analysis two months later. Each letter of recommendation was evaluated based on a seven question survey. Letter analysis and survey completion for each letter was timed. Results: Compared to the narrative letters of recommendation, the standardized letter of recommendation is easier to interpret (p<0.0001), has less exaggeration of applicants’ positive traits (p<0.001), and has higher inter-rater and intrarater reliability for determining applicant traits including personality, reliability, work-ethic, and global score. Standardized letters of recommendation are also faster to interpret (p<0.0001) and provide more information about the writer’s background or writer-applicant relationship than narrative letters of recommendation (p<0.001). Limitations: This study was completed at a single institution. Conclusions: The standardized letter of recommendation appears to be meeting its initial goals of 1) efficiency, 2) applicant stratification, and 3) validity. (J Clin Aesthet Dermatol. 2016;9(9):36–2.) PMID:27878060

Characteristics of knowledge content in a curated online evidence library.

PubMed

Varada, Sowmya; Lacson, Ronilda; Raja, Ali S; Ip, Ivan K; Schneider, Louise; Osterbur, David; Bain, Paul; Vetrano, Nicole; Cellini, Jacqueline; Mita, Carol; Coletti, Margaret; Whelan, Julia; Khorasani, Ramin

2018-05-01

To describe types of recommendations represented in a curated online evidence library, report on the quality of evidence-based recommendations pertaining to diagnostic imaging exams, and assess underlying knowledge representation. The evidence library is populated with clinical decision rules, professional society guidelines, and locally developed best practice guidelines. Individual recommendations were graded based on a standard methodology and compared using chi-square test. Strength of evidence ranged from grade 1 (systematic review) through grade 5 (recommendations based on expert opinion). Finally, variations in the underlying representation of these recommendations were identified. The library contains 546 individual imaging-related recommendations. Only 15% (16/106) of recommendations from clinical decision rules were grade 5 vs 83% (526/636) from professional society practice guidelines and local best practice guidelines that cited grade 5 studies (P < .0001). Minor head trauma, pulmonary embolism, and appendicitis were topic areas supported by the highest quality of evidence. Three main variations in underlying representations of recommendations were "single-decision," "branching," and "score-based." Most recommendations were grade 5, largely because studies to test and validate many recommendations were absent. Recommendation types vary in amount and complexity and, accordingly, the structure and syntax of statements they generate. However, they can be represented in single-decision, branching, and score-based representations. In a curated evidence library with graded imaging-based recommendations, evidence quality varied widely, with decision rules providing the highest-quality recommendations. The library may be helpful in highlighting evidence gaps, comparing recommendations from varied sources on similar clinical topics, and prioritizing imaging recommendations to inform clinical decision support implementation.

48 CFR 19.505 - Rejecting Small Business Administration recommendations.

Code of Federal Regulations, 2011 CFR

2011-10-01

... Administration recommendations. 19.505 Section 19.505 Federal Acquisition Regulations System FEDERAL ACQUISITION... Small Business Administration recommendations. (a) If the contracting officer rejects a recommendation... the recommendation. (b) The SBA procurement center representative (or, if a procurement center...

Hybrid employment recommendation algorithm based on Spark

NASA Astrophysics Data System (ADS)

Li, Zuoquan; Lin, Yubei; Zhang, Xingming

2017-08-01

Aiming at the real-time application of collaborative filtering employment recommendation algorithm (CF), a clustering collaborative filtering recommendation algorithm (CCF) is developed, which applies hierarchical clustering to CF and narrows the query range of neighbour items. In addition, to solve the cold-start problem of content-based recommendation algorithm (CB), a content-based algorithm with users’ information (CBUI) is introduced for job recommendation. Furthermore, a hybrid recommendation algorithm (HRA) which combines CCF and CBUI algorithms is proposed, and implemented on Spark platform. The experimental results show that HRA can overcome the problems of cold start and data sparsity, and achieve good recommendation accuracy and scalability for employment recommendation.

Recommender systems in knowledge-mining

NASA Astrophysics Data System (ADS)

Volna, Eva

2017-07-01

The subject of the paper is to analyse the possibilities of application of recommender systems in the field of data mining. The work focuses on three basic types of recommender systems (collaborative, content-based and hybrid). The goal of the article is to evaluate which of these three concepts of recommender systems provides forecast with the lowest error rate in the domain of recommending movies. This target is fulfilled by the practical part of the work - at first, the own recommender system was designed and created, capable of obtaining movies recommendation from the database based on the user's preferences. Next, we verified experimentally which recommender system produces more accurate results.

Recommendations and offers for adult influenza vaccination, 2011-2012 season, United States.

PubMed

Benedict, Katharine M; Santibanez, Tammy A; Black, Carla L; Ding, Helen; Graitcer, Samuel B; Bridges, Carolyn B; Kennedy, Erin D

2017-03-01

Provider recommendations and offers for influenza vaccination improve adult influenza vaccination coverage. Analysis was performed to describe receipt of influenza vaccination recommendations and offers among adults who visited a healthcare provider (HCP) during the 2011-2012 influenza season and describe differences between those receiving and not receiving recommendations and offers for influenza vaccination. Associations between influenza vaccination and receipt of recommendations and offers were examined. Respondents to a random digit dial telephone survey who had visited a HCP since July 1, 2011 were asked if they had received a recommendation for influenza vaccination. Those receiving a recommendation were asked if they received an offer for vaccination. Participants were characterized by demographic and access to health care variables. Logistic regression was used to examine the relationships between participant characteristics and recommendation alone, between participant characteristics and recommendation and offer, and between influenza vaccination and recommendation and offer. Of those who reported visiting a HCP, 43.8% reported receiving a recommendation for influenza vaccination. Of those who reported receiving a recommendation, 76.6% reported receiving an offer for influenza vaccination. Persons with high-risk conditions and persons over 65 years were more likely to receive recommendations for influenza vaccination when compared to those without high-risk conditions and 18-49 year olds, respectively. Those reporting receipt of a recommendation and offer for influenza vaccination were 1.76 times more likely and those reporting receipt of a recommendation but no offer were 1.72 times more likely to report being vaccinated for influenza controlling for all patient characteristics. Less than half of respondents reported receipt of recommendations and offers of influenza vaccination during the 2011-2012 influenza season and disparities exist between groups. All healthcare providers seeing adults should recommend or offer influenza vaccination for all patients at every visit during the influenza season. Copyright © 2016. Published by Elsevier Ltd.

World Health Organization strong recommendations based on low-quality evidence (study quality) are frequent and often inconsistent with GRADE guidance.

PubMed

Alexander, Paul E; Brito, Juan P; Neumann, Ignacio; Gionfriddo, Michael R; Bero, Lisa; Djulbegovic, Benjamin; Stoltzfus, Rebecca; Montori, Victor M; Norris, Susan L; Schünemann, Holger J; Guyatt, Gordon H

2016-04-01

In 2007 the World Health Organization (WHO) adopted the GRADE system for development of public health guidelines. Previously we found that many strong recommendations issued by WHO are based on evidence for which there is only low or very low confidence in the estimates of effect (discordant recommendations). GRADE guidance indicates that such discordant recommendations are rarely appropriate but suggests five paradigmatic situations in which discordant recommendations may be warranted. We sought to provide insight into the many discordant recommendations in WHO guidelines. We examined all guidelines that used the GRADE method and were approved by the WHO Guideline Review Committee between 2007 and 2012. Teams of reviewers independently abstracted data from eligible guidelines and classified recommendations either into one of the five paradigms for appropriately-formulated discordant recommendations or into three additional categories in which discordant recommendations were inconsistent with GRADE guidance: 1) the evidence warranted moderate or high confidence (a misclassification of evidence) rather than low or very low confidence; 2) good practice statements; or 3) uncertainty in the estimates of effect would best lead to a conditional (weak) recommendation. The 33 eligible guidelines included 160 discordant recommendations, of which 98 (61.3%) addressed drug interventions and 132 (82.5%) provided some rationale (though not entirely explicit at times) for the strong recommendation. Of 160 discordant recommendations, 25 (15.6%) were judged consistent with one of the five paradigms for appropriate recommendations; 33 (21%) were based on evidence warranting moderate or high confidence in the estimates of effect; 29 (18%) were good practice statements; and 73 (46%) warranted a conditional, rather than a strong recommendation. WHO discordant recommendations are often inconsistent with GRADE guidance, possibly threatening the integrity of the process. Further training in GRADE methods for WHO guideline development group members may be necessary, along with further research on what motivates the formulation of such recommendations. Copyright © 2016 Elsevier Inc. All rights reserved.

Recommendations and offers for adult influenza vaccination, 2011–2012 season, United States

PubMed Central

Benedict, Katharine M.; Santibanez, Tammy A.; Black, Carla L.; Ding, Helen; Graitcer, Samuel B.; Bridges, Carolyn B.; Kennedy, Erin D.

2017-01-01

Background Provider recommendations and offers for influenza vaccination improve adult influenza vaccination coverage. Analysis was performed to describe receipt of influenza vaccination recommendations and offers among adults who visited a healthcare provider (HCP) during the 2011–2012 influenza season and describe differences between those receiving and not receiving recommendations and offers for influenza vaccination. Associations between influenza vaccination and receipt of recommendations and offers were examined. Methods Respondents to a random digit dial telephone survey who had visited a HCP since July 1, 2011 were asked if they had received a recommendation for influenza vaccination. Those receiving a recommendation were asked if they received an offer for vaccination. Participants were characterized by demographic and access to health care variables. Logistic regression was used to examine the relationships between participant characteristics and recommendation alone, between participant characteristics and recommendation and offer, and between influenza vaccination and recommendation and offer. Results Of those who reported visiting a HCP, 43.8% reported receiving a recommendation for influenza vaccination. Of those who reported receiving a recommendation, 76.6% reported receiving an offer for influenza vaccination. Persons with high-risk conditions and persons over 65 years were more likely to receive recommendations for influenza vaccination when compared to those without high-risk conditions and 18–49 year olds, respectively. Those reporting receipt of a recommendation and offer for influenza vaccination were 1.76 times more likely and those reporting receipt of a recommendation but no offer were 1.72 times more likely to report being vaccinated for influenza controlling for all patient characteristics. Conclusions Less than half of respondents reported receipt of recommendations and offers of influenza vaccination during the 2011–2012 influenza season and disparities exist between groups. All healthcare providers seeing adults should recommend or offer influenza vaccination for all patients at every visit during the influenza season. PMID:27137099

Choosing Wisely: assessment of current US top five list recommendations’ trustworthiness using a pragmatic approach

PubMed Central

Horvath, Karl; Semlitsch, Thomas; Jeitler, Klaus; Abuzahra, Muna E; Posch, Nicole; Domke, Andreas; Siebenhofer, Andrea

2016-01-01

Objectives Identification of sufficiently trustworthy top 5 list recommendations from the US Choosing Wisely campaign. Setting Not applicable. Participants All top 5 list recommendations available from the American Board of Internal Medicine Foundation website. Main outcome measures/interventions Compilation of US top 5 lists and search for current German highly trustworthy (S3) guidelines. Extraction of guideline recommendations, including grade of recommendation (GoR), for suggestions comparable to top 5 list recommendations. For recommendations without guideline equivalents, the methodological quality of the top 5 list development process was assessed using criteria similar to that used to judge guidelines, and relevant meta-literature was identified in cited references. Judgement of sufficient trustworthiness of top 5 list recommendations was based either on an ‘A’ GoR of guideline equivalents or on high methodological quality and citation of relevant meta-literature. Results 412 top 5 list recommendations were identified. For 75 (18%), equivalents were found in current German S3 guidelines. 44 of these recommendations were associated with an ‘A’ GoR, or a strong recommendation based on strong evidence, and 26 had a ‘B’ or a ‘C’ GoR. No GoR was provided for 5 recommendations. 337 recommendations had no equivalent in the German S3 guidelines. The methodological quality of the development process was high and relevant meta-literature was cited for 87 top 5 list recommendations. For a further 36, either the methodological quality was high without any meta-literature citations or meta-literature citations existed but the methodological quality was lacking. For the remaining 214 recommendations, either the methodological quality was lacking and no literature was cited or the methodological quality was generally unsatisfactory. Conclusions 131 of current US top 5 list recommendations were found to be sufficiently trustworthy. For a substantial number of current US top 5 list recommendations, their trustworthiness remains unclear. Methodological requirements for developing top 5 lists are recommended. PMID:27855098

The dynamical modeling and simulation analysis of the recommendation on the user-movie network

NASA Astrophysics Data System (ADS)

Zhang, Shujuan; Jin, Zhen; Zhang, Juan

2016-12-01

At present, most research about the recommender system is based on graph theory and algebraic methods, but these methods cannot predict the evolution of the system with time under the recommendation method, and cannot dynamically analyze the long-term utility of the recommendation method. However, these two aspects can be studied by the dynamical method, which essentially investigates the intrinsic evolution mechanism of things, and is widely used to study a variety of actual problems. So, in this paper, network dynamics is used to study the recommendation on the user-movie network, which consists of users and movies, and the movies are watched either by the personal search or through the recommendation. Firstly, dynamical models are established to characterize the personal search and the system recommendation mechanism: the personal search model, the random recommendation model, the preference recommendation model, the degree recommendation model and the hybrid recommendation model. The rationality of the models established is verified by comparing the stochastic simulation with the numerical simulation. Moreover, the validity of the recommendation methods is evaluated by studying the movie degree, which is defined as the number of the movie that has been watched. Finally, we combine the personal search and the recommendation to establish a more general model. The change of the average degree of all the movies is given with the strength of the recommendation. Results show that for each recommendation method, the change of the movie degree is different, and is related to the initial degree of movies, the adjacency matrix A representing the relation between users and movies, the time t. Additionally, we find that in a long time, the degree recommendation is not as good as that in a short time, which fully demonstrates the advantage of the dynamical method. For the whole user-movie system, the preference recommendation is the best.

A framework for diversifying recommendation lists by user interest expansion.

PubMed

Zhang, Zhu; Zheng, Xiaolong; Zeng, Daniel Dajun

2016-08-01

Recommender systems have been widely used to discover users' preferences and recommend interesting items to users during this age of information load. Researchers in the field of recommender systems have realized that the quality of a top-N recommendation list involves not only relevance but also diversity. Most traditional recommendation algorithms are difficult to generate a diverse item list that can cover most of his/her interests for each user, since they mainly focus on predicting accurate items similar to the dominant interests of users. Additionally, they seldom exploit semantic information such as item tags and users' interest labels to improve recommendation diversity. In this paper, we propose a novel recommendation framework which mainly adopts an expansion strategy of user interests based on social tagging information. The framework enhances the diversity of users' preferences by expanding the sizes and categories of the original user-item interaction records, and then adopts traditional recommendation models to generate recommendation lists. Empirical evaluations on three real-world data sets show that our method can effectively improve the accuracy and diversity of item recommendation.

A framework for diversifying recommendation lists by user interest expansion

PubMed Central

Zhang, Zhu; Zeng, Daniel Dajun

2017-01-01

Recommender systems have been widely used to discover users’ preferences and recommend interesting items to users during this age of information load. Researchers in the field of recommender systems have realized that the quality of a top-N recommendation list involves not only relevance but also diversity. Most traditional recommendation algorithms are difficult to generate a diverse item list that can cover most of his/her interests for each user, since they mainly focus on predicting accurate items similar to the dominant interests of users. Additionally, they seldom exploit semantic information such as item tags and users’ interest labels to improve recommendation diversity. In this paper, we propose a novel recommendation framework which mainly adopts an expansion strategy of user interests based on social tagging information. The framework enhances the diversity of users’ preferences by expanding the sizes and categories of the original user-item interaction records, and then adopts traditional recommendation models to generate recommendation lists. Empirical evaluations on three real-world data sets show that our method can effectively improve the accuracy and diversity of item recommendation. PMID:28959089

Recommended system of application and development

NASA Astrophysics Data System (ADS)

Wang, Wei

2018-04-01

A recommender system is a project that helps users identify their wishes and needs. The recommender system has been successfully applied to many e-commerce environments, such as news, film, music, books and other areas of recommendation. This paper mainly discusses the application of recommendation technology in software engineering, data and knowledge engineering, configurable projects and persuasion technology, and summarizes the development trend of recommendation technology in the future.

Lost in translation? How adults living with Cystic Fibrosis understand treatment recommendations from their healthcare providers, and the impact on adherence to therapy.

PubMed

Pakhale, S; Baron, J; Armstrong, M; Tasca, G; Gaudet, E; Aaron, S D; Cameron, W; Balfour, L

2016-08-01

This study builds on the limited research documenting Cystic Fibrosis (CF) patients' understanding of treatment recommendations and how this may impact adherence to therapy. We surveyed adults with CF and their healthcare professional (HCP) to capture treatment recommendations provided by the HCP, and patients' knowledge, and frequency of performance, of these recommendations. We classified CF participants' understanding of treatment recommendations (correct/incorrect) as compared to the actual recommendations made by the HCP. We computed CF participants' adherence in relation to HCP treatment recommendations and to their own understanding of treatment recommendations (adherent/non-adherent). Complete HCP and patient data were available for 42 participants. The recommended treatment frequency was correctly understood by 0%-87.8% of CF participants. Adherence to HCP treatment recommendations ranged from 0 to 68.3% (mean 45.4%±21.5), and rates were low (<33%) for acapella, percussion/postural drainage, tobramycin nebulization and insulin. Participants' adherence was greater when calculated in relation to participants' understanding of treatment recommendations (62.4%±25.1) than when calculated in relation to actual HCP treatment recommendations (45.4%±21.5%) (p=0.009). Adults with CF misunderstand treatment recommendations; this likely affects treatment adherence. Interventions to ensure HCPs use effective communication strategies are needed. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Do recommender systems benefit users? a modeling approach

NASA Astrophysics Data System (ADS)

Yeung, Chi Ho

2016-04-01

Recommender systems are present in many web applications to guide purchase choices. They increase sales and benefit sellers, but whether they benefit customers by providing relevant products remains less explored. While in many cases the recommended products are relevant to users, in other cases customers may be tempted to purchase the products only because they are recommended. Here we introduce a model to examine the benefit of recommender systems for users, and find that recommendations from the system can be equivalent to random draws if one always follows the recommendations and seldom purchases according to his or her own preference. Nevertheless, with sufficient information about user preferences, recommendations become accurate and an abrupt transition to this accurate regime is observed for some of the studied algorithms. On the other hand, we find that high estimated accuracy indicated by common accuracy metrics is not necessarily equivalent to high real accuracy in matching users with products. This disagreement between estimated and real accuracy serves as an alarm for operators and researchers who evaluate recommender systems merely with accuracy metrics. We tested our model with a real dataset and observed similar behaviors. Finally, a recommendation approach with improved accuracy is suggested. These results imply that recommender systems can benefit users, but the more frequently a user purchases the recommended products, the less relevant the recommended products are in matching user taste.

28 CFR 0.36 - Recommendations.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 28 Judicial Administration 1 2010-07-01 2010-07-01 false Recommendations. 0.36 Section 0.36... Pardon Attorney § 0.36 Recommendations. The Pardon Attorney shall submit all recommendations in clemency... recommendations to the President. [Order No. 1012-83, 48 FR 22290, May 18, 1983] ...

28 CFR 0.36 - Recommendations.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 28 Judicial Administration 1 2011-07-01 2011-07-01 false Recommendations. 0.36 Section 0.36... Pardon Attorney § 0.36 Recommendations. The Pardon Attorney shall submit all recommendations in clemency... recommendations to the President. [Order No. 1012-83, 48 FR 22290, May 18, 1983] ...

16 CFR 1702.2 - Procedural requirements and recommendations.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 16 Commercial Practices 2 2010-01-01 2010-01-01 false Procedural requirements and recommendations...; PETITION PROCEDURES AND REQUIREMENTS § 1702.2 Procedural requirements and recommendations. (a) Requirements... recommendations. The following are procedural recommendations to help the Commission in its consideration of...

16 CFR 1702.2 - Procedural requirements and recommendations.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 16 Commercial Practices 2 2011-01-01 2011-01-01 false Procedural requirements and recommendations...; PETITION PROCEDURES AND REQUIREMENTS § 1702.2 Procedural requirements and recommendations. (a) Requirements... recommendations. The following are procedural recommendations to help the Commission in its consideration of...

48 CFR 32.409-1 - Recommendation for approval.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 48 Federal Acquisition Regulations System 1 2011-10-01 2011-10-01 false Recommendation for... Recommendation for approval. If recommending approval, the contracting officer shall transmit the following... authorization (see 32.410). (g) The recommendation for approval of the advance payment request. (h...

The Physician Recommendation Coding System (PhyReCS): A Reliable and Valid Method to Quantify the Strength of Physician Recommendations During Clinical Encounters

PubMed Central

Scherr, Karen A.; Fagerlin, Angela; Williamson, Lillie D.; Davis, J. Kelly; Fridman, Ilona; Atyeo, Natalie; Ubel, Peter A.

2016-01-01

Background Physicians’ recommendations affect patients’ treatment choices. However, most research relies on physicians’ or patients’ retrospective reports of recommendations, which offer a limited perspective and have limitations such as recall bias. Objective To develop a reliable and valid method to measure the strength of physician recommendations using direct observation of clinical encounters. Methods Clinical encounters (n = 257) were recorded as part of a larger study of prostate cancer decision making. We used an iterative process to create the 5-point Physician Recommendation Coding System (PhyReCS). To determine reliability, research assistants double-coded 50 transcripts. To establish content validity, we used one-way ANOVAs to determine whether relative treatment recommendation scores differed as a function of which treatment patients received. To establish concurrent validity, we examined whether patients’ perceived treatment recommendations matched our coded recommendations. Results The PhyReCS was highly reliable (Krippendorf’s alpha =. 89, 95% CI [.86, .91]). The average relative treatment recommendation score for each treatment was higher for individuals who received that particular treatment. For example, the average relative surgery recommendation score was higher for individuals who received surgery versus radiation (mean difference = .98, SE = .18, p < .001) or active surveillance (mean difference = 1.10, SE = .14, p < .001). Patients’ perceived recommendations matched coded recommendations 81% of the time. Conclusion The PhyReCS is a reliable and valid way to capture the strength of physician recommendations. We believe that the PhyReCS would be helpful for other researchers who wish to study physician recommendations, an important part of patient decision making. PMID:27343015

The Physician Recommendation Coding System (PhyReCS): A Reliable and Valid Method to Quantify the Strength of Physician Recommendations During Clinical Encounters.

PubMed

Scherr, Karen A; Fagerlin, Angela; Williamson, Lillie D; Davis, J Kelly; Fridman, Ilona; Atyeo, Natalie; Ubel, Peter A

2017-01-01

Physicians' recommendations affect patients' treatment choices. However, most research relies on physicians' or patients' retrospective reports of recommendations, which offer a limited perspective and have limitations such as recall bias. To develop a reliable and valid method to measure the strength of physician recommendations using direct observation of clinical encounters. Clinical encounters (n = 257) were recorded as part of a larger study of prostate cancer decision making. We used an iterative process to create the 5-point Physician Recommendation Coding System (PhyReCS). To determine reliability, research assistants double-coded 50 transcripts. To establish content validity, we used 1-way analyses of variance to determine whether relative treatment recommendation scores differed as a function of which treatment patients received. To establish concurrent validity, we examined whether patients' perceived treatment recommendations matched our coded recommendations. The PhyReCS was highly reliable (Krippendorf's alpha = 0.89, 95% CI [0.86, 0.91]). The average relative treatment recommendation score for each treatment was higher for individuals who received that particular treatment. For example, the average relative surgery recommendation score was higher for individuals who received surgery versus radiation (mean difference = 0.98, SE = 0.18, P < 0.001) or active surveillance (mean difference = 1.10, SE = 0.14, P < 0.001). Patients' perceived recommendations matched coded recommendations 81% of the time. The PhyReCS is a reliable and valid way to capture the strength of physician recommendations. We believe that the PhyReCS would be helpful for other researchers who wish to study physician recommendations, an important part of patient decision making. © The Author(s) 2016.

Research on personalized recommendation algorithm based on spark

NASA Astrophysics Data System (ADS)

Li, Zeng; Liu, Yu

2018-04-01

With the increasing amount of data in the past years, the traditional recommendation algorithm has been unable to meet people's needs. Therefore, how to better recommend their products to users of interest, become the opportunities and challenges of the era of big data development. At present, each platform enterprise has its own recommendation algorithm, but how to make efficient and accurate push information is still an urgent problem for personalized recommendation system. In this paper, a hybrid algorithm based on user collaborative filtering and content-based recommendation algorithm is proposed on Spark to improve the efficiency and accuracy of recommendation by weighted processing. The experiment shows that the recommendation under this scheme is more efficient and accurate.

7 CFR 906.39 - Recommendations for regulations.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 8 2011-01-01 2011-01-01 false Recommendations for regulations. 906.39 Section 906.39... LOWER RIO GRANDE VALLEY IN TEXAS Order Regulating Handling Regulation § 906.39 Recommendations for... recommendation at the same time such recommendation is submitted to the Secretary. ...

7 CFR 906.39 - Recommendations for regulations.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 8 2010-01-01 2010-01-01 false Recommendations for regulations. 906.39 Section 906.39... LOWER RIO GRANDE VALLEY IN TEXAS Order Regulating Handling Regulation § 906.39 Recommendations for... recommendation at the same time such recommendation is submitted to the Secretary. ...

8 CFR 342.7 - Report and recommendation.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 8 Aliens and Nationality 1 2011-01-01 2011-01-01 false Report and recommendation. 342.7 Section... CANCELLATION OF CERTIFICATES, DOCUMENTS, OR RECORDS § 342.7 Report and recommendation. The naturalization... findings and recommendations. The record, including the report and recommendation, shall be forwarded to...

8 CFR 342.7 - Report and recommendation.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 8 Aliens and Nationality 1 2010-01-01 2010-01-01 false Report and recommendation. 342.7 Section... CANCELLATION OF CERTIFICATES, DOCUMENTS, OR RECORDS § 342.7 Report and recommendation. The naturalization... findings and recommendations. The record, including the report and recommendation, shall be forwarded to...

21 CFR 14.174 - Advice and recommendations in writing.

Code of Federal Regulations, 2011 CFR

2011-04-01

... § 14.174 Advice and recommendations in writing. Advice and recommendations given by a committee on a... 21 Food and Drugs 1 2011-04-01 2011-04-01 false Advice and recommendations in writing. 14.174... of the advice and recommendations of the committee. ...

21 CFR 14.174 - Advice and recommendations in writing.

Code of Federal Regulations, 2010 CFR

2010-04-01

... § 14.174 Advice and recommendations in writing. Advice and recommendations given by a committee on a... 21 Food and Drugs 1 2010-04-01 2010-04-01 false Advice and recommendations in writing. 14.174... of the advice and recommendations of the committee. ...

Uncovering the information core in recommender systems

NASA Astrophysics Data System (ADS)

Zeng, Wei; Zeng, An; Liu, Hao; Shang, Ming-Sheng; Zhou, Tao

2014-08-01

With the rapid growth of the Internet and overwhelming amount of information that people are confronted with, recommender systems have been developed to effectively support users' decision-making process in online systems. So far, much attention has been paid to designing new recommendation algorithms and improving existent ones. However, few works considered the different contributions from different users to the performance of a recommender system. Such studies can help us improve the recommendation efficiency by excluding irrelevant users. In this paper, we argue that in each online system there exists a group of core users who carry most of the information for recommendation. With them, the recommender systems can already generate satisfactory recommendation. Our core user extraction method enables the recommender systems to achieve 90% of the accuracy of the top-L recommendation by taking only 20% of the users into account. A detailed investigation reveals that these core users are not necessarily the large-degree users. Moreover, they tend to select high quality objects and their selections are well diversified.

Acute diarrhea's recommendations on oral rehydration therapy and feeding.

PubMed

Chongbanyatcharoen, Pairoj

2005-06-01

Oral rehydration therapy and feeding for patients with diarrhea recommended by physicians who had attended the short course "Practical Approach to Common GI Problems" were compared with The Royal College of Pediatricians of Thailand Expert Committee on Gastrointestinal System's (RCPedT) Recommendations. A questionnaire was sent to physicians who had attended the short course. Physicians recommended a variety of oral rehydration solutions (ORS) which were different from RCPedT's recommendations. 42.6% of physicians recommended WHO/ORS, 54.1% recommended commercial ORS and 3.3% recommended any form of ORS. The other form of ORS, 59.0% of physicians recommended was carbonated drinks (nonphysiologic ORS) and 40.9% recommended home mixing of ORS. 55.7% of respondents recommended ORT for mild or moderate dehydration and 29.5% for mild or no dehydration only 14.8% of the physicians followed the guidelines. Although RCPedT WHO and American Academy of Pediatrics (AAP) Committee on Nutrition stated that vomiting was not a contraindication to successful use of ORT but vomiting was the most common reason (86.9%) given by respondents for failure of ORT and vomiting was the reason for starvation as well (11.5%). Early feeding of appropriate food 80.3% of respondents followed the guidelines but only 50.7% of respondents recommended breast feeding for children younger than 1 year old.

Primary Care Physicians' Struggle with Current Adult Pneumococcal Vaccine Recommendations.

PubMed

Hurley, Laura P; Allison, Mandy A; Pilishvili, Tamara; O'Leary, Sean T; Crane, Lori A; Brtnikova, Michaela; Beaty, Brenda L; Lindley, Megan C; Bridges, Carolyn B; Kempe, Allison

2018-01-01

In 2012, the Advisory Committee on Immunization Practices recommended 13-valent pneumococcal conjugate vaccine (PCV13) in series with 23-valent pneumococcal polysaccharide vaccine (PPSV23) for at-risk adults ≥19; in 2014, it expanded this recommendation to adults ≥65. Primary care physicians' practice, knowledge, attitudes, and beliefs regarding these recommendations are unknown. Primary care physicians throughout the U.S. were surveyed by E-mail and post from December 2015 to January 2016. Response rate was 66% (617 of 935). Over 95% of respondents reported routinely assessing adults' vaccination status and recommending both vaccines. A majority found the current recommendations to be clear (50% "very clear," 38% "somewhat clear"). Twenty percent found the upfront cost of purchasing PCV13, lack of insurance coverage, inadequate reimbursement, and difficulty determining vaccination history to be "major barriers" to giving these vaccines. Knowledge of recommendations varied, with 83% identifying the PCV13 recommendation for adults ≥65 and only 21% identifying the recommended interval between PCV13 and PPSV23 in an individual <65 at increased risk. Almost all surveyed physicians reported recommending both pneumococcal vaccines, but a disconnect seems to exist between perceived clarity and knowledge of the recommendations. Optimal implementation of these recommendations will require addressing knowledge gaps and reported barriers. © Copyright 2018 by the American Board of Family Medicine.

Recommended dietary reference intakes, nutritional goals and dietary guidelines for fat and fatty acids: a systematic review.

PubMed

Aranceta, Javier; Pérez-Rodrigo, Carmen

2012-06-01

Dietary fat and its effects on health and disease has attracted interest for research and Public Health. Since the 1980s many bodies and organizations have published recommendations regarding fat intake. In this paper different sets of recommendations are analyzed following a systematic review process to examine dietary reference intakes, nutritional goals and dietary guidelines for fat and fatty acids. A literature search was conducted in relevant literature databases along a search for suitable grey literature reports. Documents were included if they reported information on either recommended intake levels or dietary reference values or nutritional objectives or dietary guidelines regarding fat and/or fatty acids and/or cholesterol intake or if reported background information on the process followed to produce the recommendations. There is no standard approach for deriving nutrient recommendations. Recommendations vary between countries regarding the levels of intake advised, the process followed to set the recommendations. Recommendations on fat intake share similar figures regarding total fat intake, saturated fats and trans fats. Many sets do not include a recommendation about cholesterol intake. Most recent documents provide advice regarding specific n-3 fatty acids. Despite efforts to develop evidence based nutrient recommendations and dietary guidelines that may contribute to enhance health, there are still many gaps in research. It would be desirable that all bodies concerned remain transparent about the development of dietary recommendations. In order to achieve this, the type of evidence selected to base the recommendations should be specified and ranked. Regular updates of such recommendations should be planned.

Comparing the Maryland Comprehensive Cancer Control Plan With Federal Cancer Prevention and Control Recommendations.

PubMed

Fowler, Stephanie L; Platz, Elizabeth A; Diener-West, Marie; Hokenmaier, Sarah; Truss, Meredith; Lewis, Courtney; Kanarek, Norma F

2015-10-01

Since the introduction of the Affordable Care Act (ACA) in 2012, 11 million more Americans now have access to preventive services via health care coverage. Several prevention-related recommendations issued by the US Preventive Services Task Force (USPSTF), Centers for Disease Control and Prevention (CDC), and Advisory Committee on Immunization Practices (ACIP) are covered under the ACA. State cancer plans often provide prevention strategies, but whether these strategies correspond to federal evidence-based recommendations is unclear. The objective of this article is to assess whether federal evidence-based recommendations, including those covered under the ACA, are included in the Maryland Comprehensive Cancer Control Plan (MCCCP). A total of 19 federal recommendations pertaining to cancer prevention and control were identified. Inclusion of federal cancer-related recommendations by USPSTF, CDC, and ACIP in the MCCCP's goals, objectives, and strategies was examined. Nine of the federal recommendations were issued after the MCCCP's publication. MCCCP recommendations corresponded completely with 4 federal recommendations and corresponded only partially with 3. Reasons for partial correspondence included specification of less restrictive at-risk populations or different intervention implementers. Three federal recommendations were not mentioned in the MCCCP's goals, objectives, and strategies. Many cancer-related federal recommendations were released after the MCCCP's publication and therefore do not appear in the most current version. We recommend that the results of this analysis be considered in the update of the MCCCP. Our findings underscore the need for a periodic scan for changes to federal recommendations and for adjusting state policies and programs to correspond with federal recommendations, as appropriate for Marylanders.

Coroners' recommendations for prevention of resident deaths in aged care: The role of primary care providers

PubMed

Aitken, Georgia; Demosthenous, Athena; Bugeja, Lyndal; Willoughby, Melissa; Young, Carmel; E Ibrahim, Joseph

2018-05-01

Currently, very little is known about how coroners consider a role for general practitioners (GPs) and registered nurses (RNs) in recommendations for the prevention of premature death. Involving these professions in recommendations generally directed towards government organisations or residential aged care providers and management may contribute to more successful broader policy changes. The aim of this article was to examine whether coroners' recommendations describe a specific role for GPs and RNs in the prevention of premature death in residential aged care settings and, if so, what domains of practice were considered. This study was part of a larger retrospective cohort study. The National Coronial Information System (NCIS) was used to extract coroners' reports that included recommendations directed towards GPs and RNs. The following information was extracted: mechanism of death, incident location, text of coroners' recommendations. Of 162 unique recommendations, 14 (8.6%) were relevant to GPs and 10 (6.2%) were relevant to RNs. Most recommendations were made in the domains of 'applied professional knowledge and skills', 'organisations and legal dimensions' and 'provision and coordination of care'. Recommendations were primarily made in response to natural cause deaths and complications of clinical care. Coroners' recommendations have a limited focus directed towards GPs and RNs, and recommendations focus on their roles in application of skills and knowledge, legal domains, and provision and coordination of care. Recommendations were mainly made in response to deaths due to suboptimal care or from 'complications of clinical care'. Formulating recommendations for these health professions may increase accountability and the likelihood of a recommendation being effectively implemented.

48 CFR 32.409-2 - Recommendation for disapproval.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 48 Federal Acquisition Regulations System 1 2011-10-01 2011-10-01 false Recommendation for... Recommendation for disapproval. If recommending disapproval, the contracting officer shall, under agency procedures, transmit— (a) The items prescribed in 32.409-1(a), (b), and (c); and (b) The recommendation for...

21 CFR 316.12 - Providing written recommendations.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 5 2010-04-01 2010-04-01 false Providing written recommendations. 316.12 Section...) DRUGS FOR HUMAN USE ORPHAN DRUGS Written Recommendations for Investigations of Orphan Drugs § 316.12 Providing written recommendations. (a) FDA will provide the sponsor with written recommendations concerning...

17 CFR 229.1012 - (Item 1012) The solicitation or recommendation.

Code of Federal Regulations, 2010 CFR

2010-04-01

... or recommendation. 229.1012 Section 229.1012 Commodity and Securities Exchanges SECURITIES AND... (Regulation M-A) § 229.1012 (Item 1012) The solicitation or recommendation. (a) Solicitation or recommendation. State the nature of the solicitation or the recommendation. If this statement relates to a...

22 CFR 1203.735-213 - Recommendations for employment.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 22 Foreign Relations 2 2011-04-01 2009-04-01 true Recommendations for employment. 1203.735-213... Recommendations for employment. (a) Making recommendations in official capacity. In general, an employee shall not, in the employee's official capacity, make any recommendations in connection with the employment of...

21 CFR 316.12 - Providing written recommendations.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 5 2011-04-01 2011-04-01 false Providing written recommendations. 316.12 Section...) DRUGS FOR HUMAN USE ORPHAN DRUGS Written Recommendations for Investigations of Orphan Drugs § 316.12 Providing written recommendations. (a) FDA will provide the sponsor with written recommendations concerning...

33 CFR 62.63 - Recommendations.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 33 Navigation and Navigable Waters 1 2011-07-01 2011-07-01 false Recommendations. 62.63 Section 62... Recommendations. (a) The public may recommend changes to existing aids to navigation, request new aids or the discontinuation of existing aids, and report aids no longer necessary for maritime safety. These recommendations...

22 CFR 1203.735-213 - Recommendations for employment.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 22 Foreign Relations 2 2010-04-01 2010-04-01 true Recommendations for employment. 1203.735-213... Recommendations for employment. (a) Making recommendations in official capacity. In general, an employee shall not, in the employee's official capacity, make any recommendations in connection with the employment of...

12 CFR 19.38 - Recommended decision and filing of record.

Code of Federal Regulations, 2010 CFR

2010-01-01

... PRACTICE AND PROCEDURE Uniform Rules of Practice and Procedure § 19.38 Recommended decision and filing of... allowed for filing reply briefs under § 19.37(b), the administrative law judge shall file with and certify... administrative law judge's recommended decision, recommended findings of fact, recommended conclusions of law...

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...

8 CFR 341.5 - Report and recommendation.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 8 Aliens and Nationality 1 2010-01-01 2010-01-01 false Report and recommendation. 341.5 Section... CITIZENSHIP § 341.5 Report and recommendation. The officer assigned to act on the application shall report his/her findings and recommendation by completing the Report and Recommendation section of the Form N-600...

7 CFR 920.51 - Recommendations for regulation.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 8 2010-01-01 2010-01-01 false Recommendations for regulation. 920.51 Section 920.51... Regulations § 920.51 Recommendations for regulation. (a) Whenever the committee deems it advisable to regulate... recommend to the Secretary. (b) In arriving at its recommendations for regulation pursuant to paragraph (a...

33 CFR 403.11 - Findings and recommendations. [Rule 11

Code of Federal Regulations, 2011 CFR

2011-07-01

... 33 Navigation and Navigable Waters 3 2011-07-01 2011-07-01 false Findings and recommendations... and recommendations. [Rule 11] The Board shall report its findings and recommendations in writing to... indicate whether the recommendations represent the unanimous agreement of the members of the Board and, if...

8 CFR 341.5 - Report and recommendation.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 8 Aliens and Nationality 1 2011-01-01 2011-01-01 false Report and recommendation. 341.5 Section... CITIZENSHIP § 341.5 Report and recommendation. The officer assigned to act on the application shall report his/her findings and recommendation by completing the Report and Recommendation section of the Form N-600...

7 CFR 920.51 - Recommendations for regulation.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 8 2011-01-01 2011-01-01 false Recommendations for regulation. 920.51 Section 920.51... Regulations § 920.51 Recommendations for regulation. (a) Whenever the committee deems it advisable to regulate... recommend to the Secretary. (b) In arriving at its recommendations for regulation pursuant to paragraph (a...

12 CFR 368.4 - Recommendations to customers.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 12 Banks and Banking 4 2011-01-01 2011-01-01 false Recommendations to customers. 368.4 Section 368... POLICY GOVERNMENT SECURITIES SALES PRACTICES § 368.4 Recommendations to customers. In recommending to a... broker or dealer shall have reasonable grounds for believing that the recommendation is suitable for the...

33 CFR 403.11 - Findings and recommendations. [Rule 11

Code of Federal Regulations, 2010 CFR

2010-07-01

... 33 Navigation and Navigable Waters 3 2010-07-01 2010-07-01 false Findings and recommendations... and recommendations. [Rule 11] The Board shall report its findings and recommendations in writing to... indicate whether the recommendations represent the unanimous agreement of the members of the Board and, if...

21 CFR 1000.60 - Recommendation on administratively required dental x-ray examinations.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Recommendation on administratively required dental... Recommendations § 1000.60 Recommendation on administratively required dental x-ray examinations. (a) The Food and Drug Administration recommends that dental x-ray examinations be performed only after careful...

21 CFR 1000.60 - Recommendation on administratively required dental x-ray examinations.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Recommendation on administratively required dental... Recommendations § 1000.60 Recommendation on administratively required dental x-ray examinations. (a) The Food and Drug Administration recommends that dental x-ray examinations be performed only after careful...

21 CFR 1000.60 - Recommendation on administratively required dental x-ray examinations.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Recommendation on administratively required dental... Recommendations § 1000.60 Recommendation on administratively required dental x-ray examinations. (a) The Food and Drug Administration recommends that dental x-ray examinations be performed only after careful...

21 CFR 1000.60 - Recommendation on administratively required dental x-ray examinations.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Recommendation on administratively required dental... Recommendations § 1000.60 Recommendation on administratively required dental x-ray examinations. (a) The Food and Drug Administration recommends that dental x-ray examinations be performed only after careful...

21 CFR 1000.60 - Recommendation on administratively required dental x-ray examinations.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Recommendation on administratively required dental... Recommendations § 1000.60 Recommendation on administratively required dental x-ray examinations. (a) The Food and Drug Administration recommends that dental x-ray examinations be performed only after careful...

Fiscal Year 1999 Higher Education Budget Recommendations. Operations and Grants.

ERIC Educational Resources Information Center

Illinois State Board of Higher Education, Springfield.

This report presents staff recommendations of the Illinois Board of Higher Education concerning budget recommendations for higher education operations and grants for fiscal year 1999. General funds recommendations total $2,207.1 million, an increase of 6.1 percent over 1998 appropriations. Recommendations are also included for locally-held…

Research on Long Tail Recommendation Algorithm

NASA Astrophysics Data System (ADS)

Hu, Xuezhi; Zhang, Chuang; Wu, Ming; Zeng, Yang

2017-10-01

Most recommendation systems in the major electronic commerce platforms are influenced by the long tail effect more or less. There are sufficient researches of how to assess recommendation effect while no criteria to evaluate long tail recommendation rate. In this study, we first discussed the existing problems of recommending long tail products through specific experiments. Then we proposed a long tail evaluation criteria and compared the performance in long tail recommendation between different models.

A Group Recommender System for Tourist Activities

NASA Astrophysics Data System (ADS)

Garcia, Inma; Sebastia, Laura; Onaindia, Eva; Guzman, Cesar

This paper introduces a method for giving recommendations of tourist activities to a group of users. This method makes recommendations based on the group tastes, their demographic classification and the places visited by the users in former trips. The group recommendation is computed from individual personal recommendations through the use of techniques such as aggregation, intersection or incremental intersection. This method is implemented as an extension of the e-Tourism tool, which is a user-adapted tourism and leisure application, whose main component is the Generalist Recommender System Kernel (GRSK), a domain-independent taxonomy-driven search engine that manages the group recommendation.

The impact of fear appeals on processing and acceptance of action recommendations.

PubMed

de Hoog, Natascha; Stroebe, Wolfgang; de Wit, John B F

2005-01-01

A stage model of processing of fear-arousing communications was tested in an experiment that examined the impact of vulnerability to a severe health risk, the quality of the arguments supporting a protective action recommendation, and the source to which the recommendation was attributed, on processing and acceptance of the recommendation. Argument quality influenced attitudes toward the recommendation (but not intention to act), and this effect was mediated by negative thoughts about the recommendation. Vulnerability influenced intention to act (but not attitudes), and this effect was mediated by perceived threat and positive thoughts about the recommendation. The pattern of findings suggests that although vulnerability to a severe health risk induces biased processing of the recommendation, biased processing is restricted to intentions and does not compromise the evaluation of the recommendation. The theoretical and practical implications of these findings are discussed.

A method for evaluating discoverability and navigability of recommendation algorithms.

PubMed

Lamprecht, Daniel; Strohmaier, Markus; Helic, Denis

2017-01-01

Recommendations are increasingly used to support and enable discovery, browsing, and exploration of items. This is especially true for entertainment platforms such as Netflix or YouTube, where frequently, no clear categorization of items exists. Yet, the suitability of a recommendation algorithm to support these use cases cannot be comprehensively evaluated by any recommendation evaluation measures proposed so far. In this paper, we propose a method to expand the repertoire of existing recommendation evaluation techniques with a method to evaluate the discoverability and navigability of recommendation algorithms. The proposed method tackles this by means of first evaluating the discoverability of recommendation algorithms by investigating structural properties of the resulting recommender systems in terms of bow tie structure, and path lengths. Second, the method evaluates navigability by simulating three different models of information seeking scenarios and measuring the success rates. We show the feasibility of our method by applying it to four non-personalized recommendation algorithms on three data sets and also illustrate its applicability to personalized algorithms. Our work expands the arsenal of evaluation techniques for recommendation algorithms, extends from a one-click-based evaluation towards multi-click analysis, and presents a general, comprehensive method to evaluating navigability of arbitrary recommendation algorithms.

Evidence-based review of interventions for medically at-risk older drivers.

PubMed

Classen, Sherrilene; Monahan, Miriam; Auten, Beth; Yarney, Abraham

2014-01-01

OBJECTIVE. To conduct an evidence-based review of intervention studies of older drivers with medical conditions. METHOD. We used the American Occupational Therapy Association's classification criteria (Levels I-V, I = highest level of evidence) to identify driving interventions. We classified studies using letters to represent the strength of recommendations: A = strongly recommend the intervention; B = recommend intervention is provided routinely; C = weak evidence that the intervention can improve outcomes; D = recommend not to provide the intervention; I = insufficient evidence to recommend for or against the intervention. RESULTS. For clients with stroke, we recommend a graded simulator intervention (A) and multimodal training in traffic theory knowledge and on-road interventions (B); we make no recommendation for or against Dynavision, Useful Field of View, or visual-perceptual interventions (I). For clients with visual deficits, we recommend educational intervention (A) and bioptic training (B); we make no recommendation for or against prism lenses (I). For clients with dementia, we recommend driving restriction interventions (C) and make no recommendation for or against use of compensatory driving strategies (I). CONCLUSION. Level I studies are needed to identify effective interventions for medically at-risk older drivers. Copyright © 2014 by the American Occupational Therapy Association, Inc.

International Variation in Asthma and Bronchiolitis Guidelines.

PubMed

Bakel, Leigh Anne; Hamid, Jemila; Ewusie, Joycelyne; Liu, Kai; Mussa, Joseph; Straus, Sharon; Parkin, Patricia; Cohen, Eyal

2017-11-01

Guideline recommendations for the same clinical condition may vary. The purpose of this study was to determine the degree of agreement among comparable asthma and bronchiolitis treatment recommendations from guidelines. National and international guidelines were searched by using guideline databases (eg, National Guidelines Clearinghouse: December 16-17, 2014, and January 9, 2015). Guideline recommendations were categorized as (1) recommend, (2) optionally recommend, (3) abstain from recommending, (4) recommend against a treatment, and (5) not addressed by the guideline. The degree of agreement between recommendations was evaluated by using an unweighted and weighted κ score. Pairwise comparisons of the guidelines were evaluated similarly. There were 7 guidelines for asthma and 4 guidelines for bronchiolitis. For asthma, there were 166 recommendation topics, with 69 recommendation topics given in ≥2 guidelines. For bronchiolitis, there were 46 recommendation topics, with 21 recommendation topics provided in ≥2 guidelines. The overall κ for asthma was 0.03, both unweighted (95% confidence interval [CI]: -0.01 to 0.07) and weighted (95% CI: -0.01 to 0.10); for bronchiolitis, it was 0.32 unweighted (95% CI: 0.16 to 0.52) and 0.15 weighted (95% CI: -0.01 to 0.5). Less agreement was found in national and international guidelines for asthma than for bronchiolitis. Additional studies are needed to determine if differences are based on patient preferences and values and economic considerations or if other recommendation-level, guideline-level, and condition-level factors are driving these differences. Copyright © 2017 by the American Academy of Pediatrics.

Oncology drug health technology assessment recommendations: Canadian versus UK experiences

PubMed Central

Chabot, Isabelle; Rocchi, Angela

2014-01-01

Background Canada has two health technology assessment (HTA) agencies responsible for oncology drug funding recommendations: the Institut National d’Excellence en Santé et Services Sociaux (INESSS) for the province of Québec and the pan-Canadian Oncology Drug Review for the rest of Canada. The objective of the research was to review and compare the recommendations of these two agencies alongside an international comparator – the National Institute for Health and Care Excellence (NICE) in the United Kingdom – with respect to their recommendations records and the influence of clinical and cost-effectiveness evidence on the recommendations. Methods Recommendations were identified from the three agencies from January 1, 2002 to June 1, 2013. Recommendations were limited to five cancer sites (lung, breast, colon, kidney, blood) and to metastatic/advanced settings. Descriptive analyses examined the frequency of positive recommendations and factors related to a positive recommendation. For each recommendation, only publicly available information posted on the agency website was used to abstract data. Results There was a wide variation in the rate of positive recommendations, ranging from 48% for NICE to 95% for Canada’s national process (among the 74% of its recommendations that were publicly posted). Interagency agreement was low, with full agreement for only six of the 14 drugs commonly reviewed by all three agencies. Evidence of a survival gain was not necessary for a positive recommendation; progression-free survival was acceptable. Different approaches were taken when addressing unacceptable cost-effectiveness. NICE was most likely to yield a negative recommendation on these grounds, whereas Canada’s national process was most likely to yield a positive recommendation with a required pricing arrangement. Conclusion In this analysis, the primary reason for the observed divergence between agency recommendations appeared to be the availability of mechanisms in each jurisdiction to address cost-effectiveness subsequent to the HTA assessment process. Furthermore, caution is needed when interpreting cross-agency comparisons between HTA agencies, as recommendations may not correspond directly to subsequent funding decisions and actual patient access. This may be a concern, given the high international profile of assessments conducted by the reviewed HTA agencies. PMID:25075196

Clinical practice guidelines from the French College of Gynecologists and Obstetricians (CNGOF): benign breast tumors - short text.

PubMed

Lavoué, Vincent; Fritel, Xavier; Antoine, Martine; Beltjens, Françoise; Bendifallah, Sofiane; Boisserie-Lacroix, Martine; Boulanger, Loic; Canlorbe, Geoffroy; Catteau-Jonard, Sophie; Chabbert-Buffet, Nathalie; Chamming's, Foucauld; Chéreau, Elisabeth; Chopier, Jocelyne; Coutant, Charles; Demetz, Julie; Guilhen, Nicolas; Fauvet, Raffaele; Kerdraon, Olivier; Laas, Enora; Legendre, Guillaume; Mathelin, Carole; Nadeau, Cédric; Naggara, Isabelle Thomassin; Ngô, Charlotte; Ouldamer, Lobna; Rafii, Arash; Roedlich, Marie-Noelle; Seror, Jérémy; Séror, Jean-Yves; Touboul, Cyril; Uzan, Catherine; Daraï, Emile

2016-05-01

Screening with breast ultrasound in combination with mammography is needed to investigate a clinical breast mass (Grade B), colored single-pore breast nipple discharge (Grade C), or mastitis (Grade C). The BI-RADS system is recommended for describing and classifying abnormal breast imaging findings. For a breast abscess, a percutaneous biopsy is recommended in the case of a mass or persistent symptoms (Grade C). For mastalgia, when breast imaging is normal, no MRI or breast biopsy is recommended (Grade C). Percutaneous biopsy is recommended for a BI-RADS category 4-5 mass (Grade B). For persistent erythematous nipple or atypical eczema lesions, a nipple biopsy is recommended (Grade C). For distortion and asymmetry, a vacuum core-needle biopsy is recommended due to the risk of underestimation by simple core-needle biopsy (Grade C). For BI-RADS category 4-5 microcalcifications without any ultrasound signal, a minimum 11-G vacuum core-needle biopsy is recommended (Grade B). In the absence of microcalcifications on radiography cores additional samples are recommended (Grade B). For atypical ductal hyperplasia, atypical lobular hyperplasia, lobular carcinoma in situ, flat epithelial atypia, radial scar and mucocele with atypia, surgical excision is commonly recommended (Grade C). Expectant management is feasible after multidisciplinary consensus. For these lesions, when excision margins are not clear, no new excision is recommended except for LCIS characterized as pleomorphic or with necrosis (Grade C). For grade 1 phyllodes tumor, surgical resection with clear margins is recommended. For grade 2 phyllodes tumor, 10mm margins are recommended (Grade C). For papillary breast lesions without atypia, complete disappearance of the radiological signal is recommended (Grade C). For papillary breast lesions with atypia, complete surgical excision is recommended (Grade C). Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Comparing the Maryland Comprehensive Cancer Control Plan With Federal Cancer Prevention and Control Recommendations

PubMed Central

Platz, Elizabeth A.; Diener-West, Marie; Hokenmaier, Sarah; Truss, Meredith; Lewis, Courtney; Kanarek, Norma F.

2015-01-01

Introduction Since the introduction of the Affordable Care Act (ACA) in 2012, 11 million more Americans now have access to preventive services via health care coverage. Several prevention-related recommendations issued by the US Preventive Services Task Force (USPSTF), Centers for Disease Control and Prevention (CDC), and Advisory Committee on Immunization Practices (ACIP) are covered under the ACA. State cancer plans often provide prevention strategies, but whether these strategies correspond to federal evidence-based recommendations is unclear. The objective of this article is to assess whether federal evidence-based recommendations, including those covered under the ACA, are included in the Maryland Comprehensive Cancer Control Plan (MCCCP). Methods A total of 19 federal recommendations pertaining to cancer prevention and control were identified. Inclusion of federal cancer-related recommendations by USPSTF, CDC, and ACIP in the MCCCP’s goals, objectives, and strategies was examined. Results Nine of the federal recommendations were issued after the MCCCP’s publication. MCCCP recommendations corresponded completely with 4 federal recommendations and corresponded only partially with 3. Reasons for partial correspondence included specification of less restrictive at-risk populations or different intervention implementers. Three federal recommendations were not mentioned in the MCCCP’s goals, objectives, and strategies. Conclusion Many cancer-related federal recommendations were released after the MCCCP’s publication and therefore do not appear in the most current version. We recommend that the results of this analysis be considered in the update of the MCCCP. Our findings underscore the need for a periodic scan for changes to federal recommendations and for adjusting state policies and programs to correspond with federal recommendations, as appropriate for Marylanders. PMID:26425867

Conflicting national recommendations and the use of screening mammography: does the physician's recommendation matter?

PubMed

Taplin, S H; Urban, N; Taylor, V M; Savarino, J

1997-01-01

This study evaluated whether women's perceptions of the conflicting recommendations for breast cancer screening were associated with decreased use of mammography. We conducted a random-digit-dial telephone survey of 1024 women in four communities of western Washington State. In addition to collecting data for demographics, beliefs about mammography, and insurance coverage, we inquired whether the respondents were aware of any conflicting recommendations about when to begin or how frequently to perform screening mammography, whether their physicians had recommended a mammogram, and whether they were likely to do what their physicians recommended. After grouping women according to whether they perceived conflicting recommendations, we used chi-square statistics to compare the distribution of proportions of women by age, race, household income, education, and insurance coverage. To estimate the odds of their having a mammogram in the previous 2 years (yes or no), we used multivariate logistic regression and included the above variables as covariates. Sixty-two percent of eligible women completed the survey, and 49 percent (479 of 985) perceived conflicting recommendations. The association between perceiving conflict and mammography use was not significant. Eighty-three percent of women who perceived conflicting recommendations reported being more comfortable using their own judgment about getting the procedure. After controlling for whether women perceived conflicting recommendations and all other factors, women who said they followed their physician's advice but did not recall their physician recommending mammography were 71 percent less likely to have received a recent mammogram than were women who reported their physician did recommend it (odds ratio 0.29, confidence interval 0.16-0.51). The conflicting recommendations surrounding breast cancer screening are not influencing women's choices about mammography. The physician recommendation and women's self-reported likeliness to follow it are the most important factors associated with mammography use.

Moving from evidence to developing recommendations in guidelines: article 11 in Integrating and coordinating efforts in COPD guideline development. An official ATS/ERS workshop report.

PubMed

Schünemann, Holger J; Oxman, Andy D; Akl, Elie A; Brozek, Jan L; Montori, Victor M; Heffner, John; Hill, Suzanne; Woodhead, Mark; Campos-Outcalt, Doug; Alderson, Phil; Woitalla, Thomas; Puhan, Milo A; Falck-Ytter, Yngve; Bousquet, Jean; Guyatt, Gordon

2012-12-01

Professional societies, like many other organizations around the world, have recognized the need to use more rigorous processes to ensure that healthcare recommendations are informed by the best available research evidence. This is the 11th of a series of 14 articles that methodologists and researchers from around the world prepared to advise guideline developers for respiratory and other diseases on how to achieve this goal. For this article, we developed five key questions and updated a review of the literature on moving from evidence to recommendations. We addressed the following specific questions.What is the strength of a recommendation and what determines the strength? What are the implications of strong and weak recommendations for patients, clinicians, and policy makers? Should guideline panels make recommendations in the face of very low-quality evidence? Under which circumstances should guideline panels make research recommendations? How should recommendations be formulated and presented? We searched PubMed and other databases of methodological studies for existing systematic reviews and relevant methodological research. We did not conduct systematic reviews ourselves. Our conclusions are based on available evidence, consideration of what guideline developers are doing, and pre- and postworkshop discussions. The strength of a recommendation reflects the extent to which guideline developers can, across the range of patients for whom the recommendations are intended, be confident that the desirable effects of following the recommendation outweigh the undesirable effects. Four factors influence the strength of a recommendation: the quality of evidence supporting the recommendation, the balance between desirable and undesirable effects, the uncertainty or variability of patient values and preferences, and costs. Strong and weak (also called "conditional") recommendations have distinct implications for patients, clinicians, and policy makers. Adherence to strong recommendations or, in the case of weak (conditional) recommendations, documentation of discussion or shared decision making with a patient, might be used as quality measures or performance indicators. Clinicians desire guidance regardless of the quality of the underlying evidence. Very low-quality evidence should ideally result in either appropriately labeled recommendations (i.e., as based on very low-quality evidence) or a statement that the guideline panel did not reach consensus on the recommendation due to the lack of confidence in the effect estimates. However, guideline panels often have more resources, time, and information than practicing clinicians. Therefore, they may be in a position to use their best judgments to make recommendations even when there is very low-quality evidence, although some guideline developers disagree with this approach and prefer a general approach of not making recommendations in the face of very low-quality evidence. Guideline panels should consider making research recommendations when there is important uncertainty about the desirable and undesirable effects of an intervention, further research could reduce that uncertainty, and the potential benefits and savings of reducing the uncertainty outweigh the potential harms of not making the research recommendation. Recommendations for additional research should be as precise and specific as possible.

10 CFR 10.31 - Actions on the recommendations.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 10 Energy 1 2010-01-01 2010-01-01 false Actions on the recommendations. 10.31 Section 10.31 Energy... recommendations. (a) Upon receipt of the findings and recommendation from the Hearing Examiner, and the record... Services and Administration and Chief Information Officer. (b)(1) In the event of a recommendation by the...

10 CFR 10.31 - Actions on the recommendations.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 10 Energy 1 2011-01-01 2011-01-01 false Actions on the recommendations. 10.31 Section 10.31 Energy... recommendations. (a) Upon receipt of the findings and recommendation from the Hearing Examiner, and the record... Services and Administration and Chief Information Officer. (b)(1) In the event of a recommendation by the...

45 CFR 1801.23 - Recommendation by panel.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 45 Public Welfare 4 2010-10-01 2010-10-01 false Recommendation by panel. 1801.23 Section 1801.23... HARRY S. TRUMAN SCHOLARSHIP PROGRAM The Competition § 1801.23 Recommendation by panel. (a) Each Panel is... recommend additional Scholars from the States in its region. (b) A panel's recommendations are based on the...

12 CFR 13.4 - Recommendations to customers.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 12 Banks and Banking 1 2011-01-01 2011-01-01 false Recommendations to customers. 13.4 Section 13.4... PRACTICES § 13.4 Recommendations to customers. In recommending to a customer the purchase, sale or exchange... reasonable grounds for believing that the recommendation is suitable for the customer upon the basis of the...

10 CFR 10.29 - Recommendation of the Hearing Examiner.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 10 Energy 1 2010-01-01 2010-01-01 false Recommendation of the Hearing Examiner. 10.29 Section 10... Recommendation of the Hearing Examiner. (a) The Hearing Examiner's findings and recommendation shall be based... for his or her findings, and shall make a recommendation as to the action which should be taken in the...

10 CFR 10.29 - Recommendation of the Hearing Examiner.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 10 Energy 1 2011-01-01 2011-01-01 false Recommendation of the Hearing Examiner. 10.29 Section 10... Recommendation of the Hearing Examiner. (a) The Hearing Examiner's findings and recommendation shall be based... for his or her findings, and shall make a recommendation as to the action which should be taken in the...

45 CFR 1801.23 - Recommendation by panel.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 45 Public Welfare 4 2011-10-01 2011-10-01 false Recommendation by panel. 1801.23 Section 1801.23... HARRY S. TRUMAN SCHOLARSHIP PROGRAM The Competition § 1801.23 Recommendation by panel. (a) Each Panel is... recommend additional Scholars from the States in its region. (b) A panel's recommendations are based on the...

21 CFR 1000.55 - Recommendation for quality assurance programs in diagnostic radiology facilities.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Recommendation for quality assurance programs in... Recommendations § 1000.55 Recommendation for quality assurance programs in diagnostic radiology facilities. (a) Applicability. Quality assurance programs as described in paragraph (c) of this section are recommended for all...

21 CFR 1000.55 - Recommendation for quality assurance programs in diagnostic radiology facilities.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Recommendation for quality assurance programs in... Recommendations § 1000.55 Recommendation for quality assurance programs in diagnostic radiology facilities. (a) Applicability. Quality assurance programs as described in paragraph (c) of this section are recommended for all...

21 CFR 1000.55 - Recommendation for quality assurance programs in diagnostic radiology facilities.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Recommendation for quality assurance programs in... Recommendations § 1000.55 Recommendation for quality assurance programs in diagnostic radiology facilities. (a) Applicability. Quality assurance programs as described in paragraph (c) of this section are recommended for all...

Illinois Public School Finance Project: State Superintendent's Preliminary School Finance Reform Recommendations. Resource and Background Materials.

ERIC Educational Resources Information Center

Illinois State Board of Education, Springfield.

Preliminary recommendations of the state superintendent's office are presented in part I of this report on Illinois school finance reform. The recommendations are grouped under four areas: (1) distribution of state funds (with eight recommendations), (2) generation of revenues (with six recommendations), (3) management resources (with six…

12 CFR 13.4 - Recommendations to customers.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 12 Banks and Banking 1 2010-01-01 2010-01-01 false Recommendations to customers. 13.4 Section 13.4... PRACTICES § 13.4 Recommendations to customers. In recommending to a customer the purchase, sale or exchange... reasonable grounds for believing that the recommendation is suitable for the customer upon the basis of the...

Course Recommendation as a Construct in Student Evaluations: Will Students Recommend Your Course?

ERIC Educational Resources Information Center

Ang, Lawrence; Breyer, Yvonne Alexandra; Pitt, Joseph

2018-01-01

"Recommendation" is a highly credible and powerful construct in marketing. This article investigates the construct "intention to recommend" in the context of student evaluations of teaching. Motivated by changes in the sector, the study explores what factors drive course recommendation and their relationship with each other. A…

40 CFR 246.201-3 - Recommended procedures: Glass, can, and mixed paper separation.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 24 2010-07-01 2010-07-01 false Recommended procedures: Glass, can... and Recommended Procedures § 246.201-3 Recommended procedures: Glass, can, and mixed paper separation. In areas where markets are available, it is recommended that glass, cans, and mixed paper be...

40 CFR 246.201-3 - Recommended procedures: Glass, can, and mixed paper separation.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 25 2011-07-01 2011-07-01 false Recommended procedures: Glass, can... and Recommended Procedures § 246.201-3 Recommended procedures: Glass, can, and mixed paper separation. In areas where markets are available, it is recommended that glass, cans, and mixed paper be...

A Collaborative Recommend Algorithm Based on Bipartite Community

PubMed Central

Fu, Yuchen; Liu, Quan; Cui, Zhiming

2014-01-01

The recommendation algorithm based on bipartite network is superior to traditional methods on accuracy and diversity, which proves that considering the network topology of recommendation systems could help us to improve recommendation results. However, existing algorithms mainly focus on the overall topology structure and those local characteristics could also play an important role in collaborative recommend processing. Therefore, on account of data characteristics and application requirements of collaborative recommend systems, we proposed a link community partitioning algorithm based on the label propagation and a collaborative recommendation algorithm based on the bipartite community. Then we designed numerical experiments to verify the algorithm validity under benchmark and real database. PMID:24955393

The application of mixed recommendation algorithm with user clustering in the microblog advertisements promotion

NASA Astrophysics Data System (ADS)

Gong, Lina; Xu, Tao; Zhang, Wei; Li, Xuhong; Wang, Xia; Pan, Wenwen

2017-03-01

The traditional microblog recommendation algorithm has the problems of low efficiency and modest effect in the era of big data. In the aim of solving these issues, this paper proposed a mixed recommendation algorithm with user clustering. This paper first introduced the situation of microblog marketing industry. Then, this paper elaborates the user interest modeling process and detailed advertisement recommendation methods. Finally, this paper compared the mixed recommendation algorithm with the traditional classification algorithm and mixed recommendation algorithm without user clustering. The results show that the mixed recommendation algorithm with user clustering has good accuracy and recall rate in the microblog advertisements promotion.

Verbal and numerical consumer recommendations: switching between recommendation formats leads to preference inconsistencies.

PubMed

Maciejovsky, Boris; Budescu, David V

2013-06-01

Many Web sites provide consumers with product recommendations, which are typically presented by a sequence of verbal reviews and numerical ratings. In three experiments, we demonstrate that when participants switch between formats (e.g., from verbal to numerical), they are more prone to preference inconsistencies than when they aggregate the recommendations within the same format (e.g., verbal). When evaluating recommendations, participants rely primarily on central-location measures (e.g., mean) and less on other distribution characteristics (e.g., variance). We explain our findings within the theoretical framework of stimulus-response compatibility and we make practical recommendations for the design of recommendation systems and Web portals.

Eighteen years of recommendations to prevent industrial chemical incidents: results and lessons learned of the US Chemical Safety Board.

PubMed

Tinney, V A; Anenberg, S C; Kaszniak, M; Robinson, B

2016-10-01

The US Chemical Safety Board (CSB), a federal agency that investigates significant chemical incidents and hazards, is interested in determining the impact of the recommendations resulting from its investigations, and how to better more effective recommendations to prevent chemical incidents. This is a descriptive study of the US Chemical Safety Board's safety recommendations. The CSB coded and analysed its safety recommendations according to potential impact on reducing incidents, implementation status, purpose and recipient type. As of March 31, 2015, the CSB has issued 733 recommendations, 75% (548) of which are closed and 25% (185) of which remain open. For recommendations categorised as having high, medium, and low impact, 38% (78), 76% (160), and 78% (245) were implemented, respectively. CSB recommendations have led to important and lasting safety changes through regulations, industry guidance and voluntary consensus standards, and individual companies; however, coding recommendations by potential impact do not fully capture the influence of CSB recommendations. While this methodology serves as a preliminary way to determine the effect of recommendations, further data are needed to determine the extent to which these safety changes have reduced the frequency or severity of industrial accidents. Copyright © 2016 The Royal Society for Public Health. All rights reserved.

n-3 fatty acid dietary recommendations and food sources to achieve essentiality and cardiovascular benefits.

PubMed

Gebauer, Sarah K; Psota, Tricia L; Harris, William S; Kris-Etherton, Penny M

2006-06-01

Dietary recommendations have been made for n-3 fatty acids, including alpha-linolenic acid (ALA), eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA) to achieve nutrient adequacy and to prevent and treat cardiovascular disease. These recommendations are based on a large body of evidence from epidemiologic and controlled clinical studies. The n-3 fatty acid recommendation to achieve nutritional adequacy, defined as the amount necessary to prevent deficiency symptoms, is 0.6-1.2% of energy for ALA; up to 10% of this can be provided by EPA or DHA. To achieve recommended ALA intakes, food sources including flaxseed and flaxseed oil, walnuts and walnut oil, and canola oil are recommended. The evidence base supports a dietary recommendation of approximately 500 mg/d of EPA and DHA for cardiovascular disease risk reduction. For treatment of existing cardiovascular disease, 1 g/d is recommended. These recommendations have been embraced by many health agencies worldwide. A dietary strategy for achieving the 500-mg/d recommendation is to consume 2 fish meals per week (preferably fatty fish). Foods enriched with EPA and DHA or fish oil supplements are a suitable alternate to achieve recommended intakes and may be necessary to achieve intakes of 1 g/d.

Solving the stability-accuracy-diversity dilemma of recommender systems

NASA Astrophysics Data System (ADS)

Hou, Lei; Liu, Kecheng; Liu, Jianguo; Zhang, Runtong

2017-02-01

Recommender systems are of great significance in predicting the potential interesting items based on the target user's historical selections. However, the recommendation list for a specific user has been found changing vastly when the system changes, due to the unstable quantification of item similarities, which is defined as the recommendation stability problem. To improve the similarity stability and recommendation stability is crucial for the user experience enhancement and the better understanding of user interests. While the stability as well as accuracy of recommendation could be guaranteed by recommending only popular items, studies have been addressing the necessity of diversity which requires the system to recommend unpopular items. By ranking the similarities in terms of stability and considering only the most stable ones, we present a top- n-stability method based on the Heat Conduction algorithm (denoted as TNS-HC henceforth) for solving the stability-accuracy-diversity dilemma. Experiments on four benchmark data sets indicate that the TNS-HC algorithm could significantly improve the recommendation stability and accuracy simultaneously and still retain the high-diversity nature of the Heat Conduction algorithm. Furthermore, we compare the performance of the TNS-HC algorithm with a number of benchmark recommendation algorithms. The result suggests that the TNS-HC algorithm is more efficient in solving the stability-accuracy-diversity triple dilemma of recommender systems.

Stakeholder views of ethical guidance regarding prevention and care in HIV vaccine trials.

PubMed

Moorhouse, Rika; Slack, Catherine; Quayle, Michael; Essack, Zaynab; Lindegger, Graham

2014-06-30

South Africa is a major hub of HIV prevention trials, with plans for a licensure trial to start in 2015. The appropriate standards of care and of prevention in HIV vaccine trials are complex and debated issues and ethical guidelines offer some direction. However, there has been limited empirical exploration of South African stakeholders' perspectives on ethical guidance related to prevention and care in HIV vaccine trials. Site staff, Community Advisory Board members and Research Ethics Committee members involved with current HIV vaccine trials in South Africa were invited to participate in an exploration of their views. A questionnaire listed 10 care and 10 prevention recommendations drawn from two widely available sets of ethical guidelines for biomedical HIV prevention trials. Respondents (n = 98) rated each recommendation on five dimensions: "Familiarity with", "Ease of Understanding", "Ease of Implementing", "Perceived Protection", and "Agreement with" each ethical recommendation. The ratings were used to describe stakeholder perspectives on dimensions for each recommendation. Dimension ratings were averaged across the five dimensions and used as an indication of overall merit for each recommendation. Differences were explored across dimensions, between care-oriented and prevention-oriented recommendations, and between stakeholder groups. Both care and prevention recommendations were rated highly overall, with median ratings well above the scale midpoint. In general, informed consent recommendations were most positively rated. Care-related recommendations were rated significantly more positively than prevention-related recommendations, with the five lowest-rated recommendations being prevention-related. The most problematic dimension across all recommendations was "Ease of Implementing," and the least problematic was "Agreement with," suggesting the most pressing stakeholder concerns are practical rather than theoretical; that is, respondents agree with but see barriers to the attainment of these recommendations. We propose that prevention recommendations be prioritized for refinement, especially those assigned bottom-ranking scores for "Ease of Implementing", and/ or "Ease of Understanding" in order to assist vaccine stakeholders to better comprehend and implement these recommendations. Further qualitative research could also assist to better understand nuances in stakeholder reservations about implementing such recommendations.

Stakeholder views of ethical guidance regarding prevention and care in HIV vaccine trials

PubMed Central

2014-01-01

Background South Africa is a major hub of HIV prevention trials, with plans for a licensure trial to start in 2015. The appropriate standards of care and of prevention in HIV vaccine trials are complex and debated issues and ethical guidelines offer some direction. However, there has been limited empirical exploration of South African stakeholders’ perspectives on ethical guidance related to prevention and care in HIV vaccine trials. Methods Site staff, Community Advisory Board members and Research Ethics Committee members involved with current HIV vaccine trials in South Africa were invited to participate in an exploration of their views. A questionnaire listed 10 care and 10 prevention recommendations drawn from two widely available sets of ethical guidelines for biomedical HIV prevention trials. Respondents (n = 98) rated each recommendation on five dimensions: “Familiarity with”, “Ease of Understanding”, “Ease of Implementing”, “Perceived Protection”, and “Agreement with” each ethical recommendation. The ratings were used to describe stakeholder perspectives on dimensions for each recommendation. Dimension ratings were averaged across the five dimensions and used as an indication of overall merit for each recommendation. Differences were explored across dimensions, between care-oriented and prevention-oriented recommendations, and between stakeholder groups. Results Both care and prevention recommendations were rated highly overall, with median ratings well above the scale midpoint. In general, informed consent recommendations were most positively rated. Care-related recommendations were rated significantly more positively than prevention-related recommendations, with the five lowest-rated recommendations being prevention-related. The most problematic dimension across all recommendations was “Ease of Implementing,” and the least problematic was “Agreement with,” suggesting the most pressing stakeholder concerns are practical rather than theoretical; that is, respondents agree with but see barriers to the attainment of these recommendations. Conclusions We propose that prevention recommendations be prioritized for refinement, especially those assigned bottom-ranking scores for “Ease of Implementing”, and/ or “Ease of Understanding” in order to assist vaccine stakeholders to better comprehend and implement these recommendations. Further qualitative research could also assist to better understand nuances in stakeholder reservations about implementing such recommendations. PMID:24981027

32 CFR 724.813 - The recommendation of the NDRB president.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 32 National Defense 5 2010-07-01 2010-07-01 false The recommendation of the NDRB president. 724... recommendation of the NDRB president. (a) General. The president of the NDRB may forward cases for consideration... recommendation when a case is forwarded to the SRA. If the president makes a recommendation with respect to the...

32 CFR 724.813 - The recommendation of the NDRB president.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 32 National Defense 5 2011-07-01 2011-07-01 false The recommendation of the NDRB president. 724... recommendation of the NDRB president. (a) General. The president of the NDRB may forward cases for consideration... recommendation when a case is forwarded to the SRA. If the president makes a recommendation with respect to the...

Designing and Developing a Novel Hybrid Adaptive Learning Path Recommendation System (ALPRS) for Gamification Mathematics Geometry Course

ERIC Educational Resources Information Center

Su, Chung-Ho

2017-01-01

Since recommendation systems possess the advantage of adaptive recommendation, they have gradually been applied to e-learning systems to recommend subsequent learning content for learners. However, problems exist in current learning recommender systems available to students in that they are often general learning content and unable to offer…

Can Dissimilar Users Contribute to Accuracy and Diversity of Personalized Recommendation?

NASA Astrophysics Data System (ADS)

Zeng, Wei; Shang, Ming-Sheng; Zhang, Qian-Ming; Lü, Linyuan; Zhou, Tao

Recommender systems are becoming a popular and important set of personalization techniques that assist individual users with navigating through the rapidly growing amount of information. A good recommender system should be able to not only find out the objects preferred by users, but also help users in discovering their personalized tastes. The former corresponds to high accuracy of the recommendation, while the latter to high diversity. A big challenge is to design an algorithm that provides both highly accurate and diverse recommendation. Traditional recommendation algorithms only take into account the contributions of similar users, thus, they tend to recommend popular items for users ignoring the diversity of recommendations. In this paper, we propose a recommendation algorithm by considering both the effects of similar and dissimilar users under the framework of collaborative filtering. Extensive analyses on three datasets, namely MovieLens, Netflix and Amazon, show that our method performs much better than the standard collaborative filtering algorithm for both accuracy and diversity.

Do Community Recommendations Improve Metadata?

NASA Astrophysics Data System (ADS)

Gordon, S.; Habermann, T.; Jones, M. B.; Leinfelder, B.; Mecum, B.; Powers, L. A.; Slaughter, P.

2016-12-01

Complete documentation of scientific data is the surest way to facilitate discovery and reuse. What is complete metadata? There are many metadata recommendations from communities like the OGC, FGDC, NASA, and LTER, that can provide data documentation guidance for discovery, access, use and understanding. Often, the recommendations that communities develop are for a particular metadata dialect. Two examples of this are the LTER Completeness recommendation for EML and the FGDC Data Discovery recommendation for CSDGM. Can community adoption of a recommendation ensure that what is included in the metadata is understandable to the scientific community and beyond? By applying quantitative analysis to different LTER and USGS metadata collections in DataOne and ScienceBase, we show that community recommendations can improve the completeness of collections over time. Additionally, by comparing communities in DataOne that use the EML and CSDGM dialects, but have not adopted the recommendations to the communities that have, the positive effects of recommendation adoption on documentation completeness can be measured.

Aggregation Trade Offs in Family Based Recommendations

NASA Astrophysics Data System (ADS)

Berkovsky, Shlomo; Freyne, Jill; Coombe, Mac

Personalized information access tools are frequently based on collaborative filtering recommendation algorithms. Collaborative filtering recommender systems typically suffer from a data sparsity problem, where systems do not have sufficient user data to generate accurate and reliable predictions. Prior research suggested using group-based user data in the collaborative filtering recommendation process to generate group-based predictions and partially resolve the sparsity problem. Although group recommendations are less accurate than personalized recommendations, they are more accurate than general non-personalized recommendations, which are the natural fall back when personalized recommendations cannot be generated. In this work we present initial results of a study that exploits the browsing logs of real families of users gathered in an eHealth portal. The browsing logs allowed us to experimentally compare the accuracy of two group-based recommendation strategies: aggregated group models and aggregated predictions. Our results showed that aggregating individual models into group models resulted in more accurate predictions than aggregating individual predictions into group predictions.

Personalized recommendation via an improved NBI algorithm and user influence model in a Microblog network

NASA Astrophysics Data System (ADS)

Lian, Jie; Liu, Yun; Zhang, Zhen-jiang; Gui, Chang-ni

2013-10-01

Bipartite network based recommendations have attracted extensive attentions in recent years. Differing from traditional object-oriented recommendations, the recommendation in a Microblog network has two crucial differences. One is high authority users or one’s special friends usually play a very active role in tweet-oriented recommendation. The other is that the object in a Microblog network corresponds to a set of tweets on same topic instead of an actual and single entity, e.g. goods or movies in traditional networks. Thus repeat recommendations of the tweets in one’s collected topics are indispensable. Therefore, this paper improves network based inference (NBI) algorithm by original link matrix and link weight on resource allocation processes. This paper finally proposes the Microblog recommendation model based on the factors of improved network based inference and user influence model. Adjusting the weights of these two factors could generate the best recommendation results in algorithm accuracy and recommendation personalization.

The influence of evaluation recommendations on instrumental and conceptual uses: A preliminary analysis.

PubMed

Bourgeois, Isabelle; Whynot, Jane

2018-06-01

Evaluation recommendations are sometimes included in evaluation reports to highlight specific actions to be taken to improve a program or to make other changes to its operational context. This preliminary study sought to examine evaluation recommendations drawn from 25 evaluation reports published by Canadian federal government departments and agencies, in order to examine the evaluation issues covered and the focus of the recommendations. Our results show that in keeping with policy requirements, the evaluation recommendations focused on program relevance, effectiveness and efficiency and economy. Furthermore, a significant number of recommendations also focused on the implementation of more rigorous performance measurement strategies. The focus of the recommendations did not vary by publication date, recommendation type, and organizational sector. The findings also show that for the most part, the management responses produced as part of the broader evaluation process support the recommendations included in the report and identify specific timelines for implementation. Copyright © 2018 Elsevier Ltd. All rights reserved.

Creating More Credible and Persuasive Recommender Systems: The Influence of Source Characteristics on Recommender System Evaluations

NASA Astrophysics Data System (ADS)

Yoo, Kyung-Hyan; Gretzel, Ulrike

Whether users are likely to accept the recommendations provided by a recommender system is of utmost importance to system designers and the marketers who implement them. By conceptualizing the advice seeking and giving relationship as a fundamentally social process, important avenues for understanding the persuasiveness of recommender systems open up. Specifically, research regarding the influence of source characteristics, which is abundant in the context of humanhuman relationships, can provide an important framework for identifying potential influence factors. This chapter reviews the existing literature on source characteristics in the context of human-human, human-computer, and human-recommender system interactions. It concludes that many social cues that have been identified as influential in other contexts have yet to be implemented and tested with respect to recommender systems. Implications for recommender system research and design are discussed.

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

PubMed

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

2011-10-01

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

The 2014 International Pressure Ulcer Guideline: methods and development.

PubMed

Haesler, Emily; Kottner, Jan; Cuddigan, Janet

2017-06-01

A discussion of the methodology used to develop the Prevention and Treatment of Pressure Ulcers: Clinical Practice Guideline. (2014). International experts representing National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel and Pan Pacific Pressure Injury Alliance developed the second edition of this clinical guideline. Discussion paper - methodology. A comprehensive search for papers published up to July 2013 was conducted in 11 databases and identified 4286 studies. After critical appraisal, 356 studies were included and assigned a level of evidence. Guideline recommendations provide guidance on best practice in pressure ulcer prevention and treatment. Understanding the development process of a guideline increases the meaningfulness of recommendations to clinicians. Five hundred and seventy five recommendations arose from the research and its interpretation. The body of evidence supporting each recommendation was assigned a strength of evidence. A strength of recommendation was assigned to recommendation statements using the GRADE system. Recommendations are primarily supported by a body of evidence rated as C (87% of recommendations), representing low quality and/or indirect evidence (30%) and expert opinion (57%). Two hundred and forty seven recommendations (43%) received a strong recommendation ('Do it'). Recommendations were developed with consideration to research of the highest methodological quality evidence and studies that add to clinical insight and provide guidance for areas of care where minimal research has been conducted. Recommendations in the guideline reflect best practice and should be implemented with consideration to local context and resources and the individual's preferences and needs. © 2016 John Wiley & Sons Ltd.

Never enough sleep: a brief history of sleep recommendations for children.

PubMed

Matricciani, Lisa Anne; Olds, Tim S; Blunden, Sarah; Rigney, Gabrielle; Williams, Marie T

2012-03-01

There is a common belief that children are not getting enough sleep and that children's total sleep time has been declining. Over the century, many authors have proposed sleep recommendations. The aim of this study was to describe historical trends in recommended and actual sleep durations for children and adolescents, and to explore the rationale of sleep recommendations. A systematic literature review was conducted to identify recommendations for children's sleep requirements and data reporting children's actual total sleep time. For each recommendation identified, children's actual sleep time was determined by identifying studies reporting the sleep duration of children of the same age, gender, and country in the same years. Historical trends in age-adjusted recommended sleep times and trends in children's actual sleep time were calculated. A thematic analysis was conducted to determine the rationale and evidence-base for recommendations. Thirty-two sets of recommendations were located dating from 1897 to 2009. On average, age-specific recommended sleep decreased at the rate of -0.71 minute per year. This rate of decline was almost identical to the decline in the actual sleep duration of children (-0.73 minute per year). Recommended sleep was consistently ∼37 minutes greater than actual sleep, although both declined over time. A lack of empirical evidence for sleep recommendations was universally acknowledged. Inadequate sleep was seen as a consequence of "modern life," associated with technologies of the time. No matter how much sleep children are getting, it has always been assumed that they need more.

The Comparison of Personalization Recommendation for E-Commerce

NASA Astrophysics Data System (ADS)

Ya, Luo

Personalization recommendation is the key technology in E-commerce, which affects the performance of E-commerce system. This paper mainly introduces personalization recommendation system and its role, and several widely used recommendation technology. Through comparing and analyzing on the strengths and weaknesses of recommendation technology, it concludes that the combined application for a variety of techniques should satisfy the actual needs better.

Occupational therapy-based and evidence-supported recommendations for assessment and exercises in hand osteoarthritis.

PubMed

Kjeken, Ingvild

2011-12-01

The aims of this study were to develop recommendations for occupational therapy assessment and design of hand exercise programmes in patients with hand osteoarthritis. An expert group followed a Delphi procedure to reach consensus for up to 10 recommendations for assessment and exercises, respectively. Thereafter, an evidence-based approach was used to identify and appraise research evidence supporting each recommendation, before the recommendations were validated by the expert group. The process resulted in 10 recommendations for assessment and eight for design of exercise programmes. The literature search revealed that there is a paucity of clinical trials to guide recommendations for hand osteoarthritis, and the evidence for the majority of the recommendations was based on expert opinions. Also, even if a systematic review demonstrates some evidence for the efficacy of strength training exercises in hand OA, the evidence for any specific exercise is limited to expert opinions. A first set of recommendations for assessment and exercise in hand osteoarthritis has been developed. For many of the recommendations there is a paucity of research evidence. High-quality studies are therefore needed to establish a high level of evidence concerning functional assessment and the effect of hand exercises in hand osteoarthritis.

An Ontology-Based Tourism Recommender System Based on Spreading Activation Model

NASA Astrophysics Data System (ADS)

Bahramian, Z.; Abbaspour, R. Ali

2015-12-01

A tourist has time and budget limitations; hence, he needs to select points of interest (POIs) optimally. Since the available information about POIs is overloading, it is difficult for a tourist to select the most appreciate ones considering preferences. In this paper, a new travel recommender system is proposed to overcome information overload problem. A recommender system (RS) evaluates the overwhelming number of POIs and provides personalized recommendations to users based on their preferences. A content-based recommendation system is proposed, which uses the information about the user's preferences and POIs and calculates a degree of similarity between them. It selects POIs, which have highest similarity with the user's preferences. The proposed content-based recommender system is enhanced using the ontological information about tourism domain to represent both the user profile and the recommendable POIs. The proposed ontology-based recommendation process is performed in three steps including: ontology-based content analyzer, ontology-based profile learner, and ontology-based filtering component. User's feedback adapts the user's preferences using Spreading Activation (SA) strategy. It shows the proposed recommender system is effective and improves the overall performance of the traditional content-based recommender systems.

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.

Missing the Target for Routine Human Papillomavirus Vaccination: Consistent and Strong Physician Recommendations Are Lacking for 11- to 12-Year-Old Males.

PubMed

Vadaparampil, Susan T; Malo, Teri L; Sutton, Steven K; Ali, Karla N; Kahn, Jessica A; Casler, Alix; Salmon, Daniel; Walkosz, Barbara; Roetzheim, Richard G; Zimet, Gregory D; Giuliano, Anna R

2016-10-01

Rates of routine human papillomavirus (HPV) vaccination of adolescent males in the United States are low. Leading health organizations advocate consistent and strong physician recommendations to improve HPV vaccine dissemination. This study describes the prevalence and correlates of consistent and strong physician recommendations for HPV vaccination of adolescent males. We surveyed pediatric and family medicine physicians in Florida about their HPV vaccine recommendations for male vaccine-eligible age groups (11-12, 13-17, 18-21 years). Descriptive statistics compared consistency and strength of HPV recommendations across age groups. Multivariable logistic regression examined factors associated with consistent and strong recommendations for 11- to 12-year-olds. We received 367 completed surveys (51% response rate). Physicians most often consistently and strongly recommended HPV vaccine to males ages 13 to 17 (39%) compared with ages 11 to 12 (31%) and 18 to 21 (31%). Consistent and strong recommendation for 11- to 12-year-old males was more likely to be delivered by Vaccine for Children providers and less likely among physicians who reported more personal barriers to vaccination, particularly concerns about vaccine safety, concerns about adding vaccines to the vaccine schedule, and difficulty in remembering to discuss HPV vaccination. Physicians' current consistency and strength of HPV vaccine recommendations do not align with national recommendations. Interventions to improve HPV vaccine recommendations must also consider the influence of physicians' personal barriers to HPV vaccine delivery. As one of the first studies to examine both consistency and strength of physicians' HPV vaccine recommendations for males, our findings can inform future interventions focused on facilitating physicians' recommendations. Cancer Epidemiol Biomarkers Prev; 25(10); 1435-46. ©2016 AACR. ©2016 American Association for Cancer Research.

Frequency and level of evidence used in recommendations by the National Comprehensive Cancer Network guidelines beyond approvals of the US Food and Drug Administration: retrospective observational study.

PubMed

Wagner, Jeffrey; Marquart, John; Ruby, Julia; Lammers, Austin; Mailankody, Sham; Kaestner, Victoria; Prasad, Vinay

2018-03-07

To determine the differences between recommendations by the National Comprehensive Cancer Network (NCNN) guidelines and Food and Drug Administration approvals of anticancer drugs, and the evidence cited by the NCCN to justify recommendations where differences exist. Retrospective observational study. National Comprehensive Cancer Network and FDA. 47 new molecular entities approved by the FDA between 2011 and 2015. Comparison of all FDA approved indications (new and supplemental) with all NCCN recommendations as of 25 March 2016. When the NCCN made recommendations beyond the FDA's approvals, the recommendation was classified and the cited evidence noted. 47 drugs initially approved by the FDA between 2011 and 2015 for adult hematologic or solid cancers were examined. These 47 drugs were authorized for 69 FDA approved indications, whereas the NCCN recommended these drugs for 113 indications, of which 69 (62%) overlapped with the 69 FDA approved indications and 44 (39%) were additional recommendations. The average number of recommendations beyond the FDA approved indications was 0.92. 23% (n=10) of the additional recommendations were based on evidence from randomized controlled trials, and 16% (n=7) were based on evidence from phase III studies. During 21 months of follow-up, the FDA granted approval to 14% (n=6) of the additional recommendations. The NCCN frequently recommends beyond the FDA approved indications even for newer, branded drugs. The strength of the evidence cited by the NCCN supporting such recommendations is weak. Our findings raise concern that the NCCN justifies the coverage of costly, toxic cancer drugs based on weak evidence. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Guideline recommendations for post-acute postoperative physiotherapy in total hip and knee arthroplasty: are they used in daily clinical practice?

PubMed

Peter, W F; Nelissen, R G H H; Vlieland, T P M Vliet

2014-09-01

In a Dutch guideline on physiotherapy (PT) in hip and knee osteoarthritis, a number of recommendations on post-acute (i.e. after discharge from hospital) PT following total hip (THA) and total knee (TKA) arthroplasty were included. Little is known about the uptake of these recommendations in daily clinical practice. The aim of the present study was to determine the extent to which the guideline recommendations regarding post-acute PT after THA and TKA are followed in daily clinical practice. An online pilot survey on the delivery of post-acute, postoperative PT was sent to a random sample of 957 Dutch physiotherapists. The survey included questions on the application of recommended, neither recommended nor advised against, and advised against treatment modalities and various treatment modalities for which there were no formulated recommendations. A total of 219 physiotherapists completed the questionnaire, with a mean age of 40 years (standard deviation 12.6), 55% female and 95% working in primary care. The vast majority reported the use of the recommended exercise modalities (muscle strengthening exercises (96%), and functional exercises (99%). Continuous passive motion, which was neither recommended nor advised against, and electrical muscle stimulation, which was not recommended, were provided by 1%. Reported treatment modalities for which there were no formulated recommendations included patient education (99%), gait training (95%), active range of motion (ROM) exercises (93%), balance exercises (86%), passive ROM exercises (58%), aerobic exercises (50%), massage (18%) and cold therapy (11%). The vast majority of physiotherapists reported adhering to recommendations on post-acute postoperative PT in THA and TKA patients after discharge from hospital. Although yet to be confirmed in a larger nationwide survey, the relatively high frequency of use of many other treatment modalities, for which there were no formulated recommendations, suggests the need to extend the current set of recommendations to include evidence-based statements on additional treatment modalities. Copyright © 2014 John Wiley & Sons, Ltd.

Dietary recommendations for infants and toddlers among pediatric dentists in North Carolina.

PubMed

Sim, Chien J; Iida, Hiroko; Vann, William F; Quinonez, Rocio B; Steiner, Michael J

2014-01-01

The purposes of this study were to: describe practice patterns, knowledge, and attitudes of pediatric dentists in North Carolina (N.C.) in delivering dietary recommendations to the parents/caregivers of infants and toddlers; and identify barriers that limit the implementation of related recommendations. Our survey instrument included 30 questions covering eight domains of barriers to guideline adherence. Surveys were mailed to 150 practicing pediatric dentists in N.C. Descriptive and bivariate analyses were performed. Exploratory factor analysis was used to identify subscales and inform the multivariable model. The response rate was 57 percent (86/150), 80 percent of whom reported providing infant and toddler feeding recommendations routinely. Knowledge of and agreement with the recommendation regarding breast-feeding duration was lower than that for bottle-feeding recommendations. Stepwise logistic regression analysis indicated that survey respondents were less likely to provide dietary recommendations regularly to the parents/caregivers of infants and toddlers when they have practice constraints and the respondents disagree with American Academy of Pediatrics (AAP) and American Academy of Pediatric Dentistry (AAPD) recommendations on bottle and juice consumption. Most respondents routinely provide dietary recommendations to the parents/caregivers of infants and toddlers. Disagreement with AAP and AAPD recommendations on bottle, and juice consumption as well as practice constraints impedes practitioners from providing dietary recommendations regularly to the parents/caregivers of infants and toddlers.

World Health Organization recommendations are often strong based on low confidence in effect estimates.

PubMed

Alexander, Paul E; Bero, Lisa; Montori, Victor M; Brito, Juan Pablo; Stoltzfus, Rebecca; Djulbegovic, Benjamin; Neumann, Ignacio; Rave, Supriya; Guyatt, Gordon

2014-06-01

Expert guideline panelists are sometimes reluctant to offer weak/conditional/contingent recommendations. Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidance warns against strong recommendations when confidence in effect estimates is low or very low, suggesting that such recommendations may seldom be justified. We aim to characterize the classification of strength of recommendations and confidence in estimates in World Health Organization (WHO) guidelines that used the GRADE approach and graded both strength and confidence (GRADEd). We reviewed all WHO guidelines (January 2007 to December 2012), identified those that were GRADEd, and, in these, examined the classifications of strong and weak and associated confidence in estimates (high, moderate, low, and very low). We identified 116 WHO guidelines in which 43 (37%) were GRADEd and had 456 recommendations, of which 289 (63.4%) were strong and 167 (36.6%) were conditional/weak. Of the 289 strong recommendations, 95 (33.0%) were based on evidence warranting low confidence in estimates and 65 (22.5%) on evidence warranting very low confidence in estimates (55.5% strong recommendations overall based on low or very low confidence in estimates). Strong recommendations based on low or very low confidence estimates are very frequently made in WHO guidelines. Further study to determine the reasons for such high uncertainty recommendations is warranted. Copyright © 2014 Elsevier Inc. All rights reserved.

Communication about colorectal cancer screening in Britain: public preferences for an expert recommendation.

PubMed

Waller, J; Macedo, A; von Wagner, C; Simon, A E; Jones, C; Hammersley, V; Weller, D; Wardle, J; Campbell, C

2012-12-04

Informed decision-making approaches to cancer screening emphasise the importance of decisions being determined by individuals' own values and preferences. However, advice from a trusted source may also contribute to autonomous decision-making. This study examined preferences regarding a recommendation from the NHS and information provision in the context of colorectal cancer (CRC) screening. In face-to-face interviews, a population-based sample of adults across Britain (n=1964; age 50-80 years) indicated their preference between: (1) a strong recommendation to participate in CRC screening, (2) a recommendation alongside advice to make an individual decision, and (3) no recommendation but advice to make an individual decision. Other measures included trust in the NHS and preferences for information on benefits and risks. Most respondents (84%) preferred a recommendation (47% strong recommendation, 37% recommendation plus individual decision-making advice), but the majority also wanted full information on risks (77%) and benefits (78%). Men were more in favour of a recommendation than women (86% vs 81%). Trust in the NHS was high overall, but the minority who expressed low trust were less likely to want a recommendation. Most British adults want full information on risks and benefits of screening but they also want a recommendation from an authoritative source. An 'expert' view may be an important part of autonomous health decision-making.

43 CFR 3.8 - Applications referred for recommendation.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 43 Public Lands: Interior 1 2010-10-01 2010-10-01 false Applications referred for recommendation... AMERICAN ANTIQUITIES § 3.8 Applications referred for recommendation. Applications for permits shall be referred to the Smithsonian Institution for recommendation. ...

43 CFR 3.8 - Applications referred for recommendation.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 43 Public Lands: Interior 1 2011-10-01 2011-10-01 false Applications referred for recommendation... AMERICAN ANTIQUITIES § 3.8 Applications referred for recommendation. Applications for permits shall be referred to the Smithsonian Institution for recommendation. ...

Evidence-based medicine in obstetrics: can levels B and C recommendations be elevated to level A recommendations?

PubMed Central

Chauhan, Suneet P; Chang, Eugene; Brost, Brian; Assel, Barbara; Baxter, Jason; Smith, James A; Grobman, Robert; Berghella, Vincenzo; Scardo, James A; Magann, Everett F; Morrison, John C

2009-01-01

In this study, 65% (132/195) of level B/C obstetric recommendations are amenable to randomized clinical trials (RCTs) and seven were identified as most needed. The purpose of the survey was to evaluate levels B and C recommendations in obstetric practice bulletins (PBs) regarding the feasibility of performing RCT to elevate each subject to level A evidence. Eleven geographically dispersed physicians with experience in research reviewed levels B and C recommendations for the ethical and logistical feasibility of performing an RCT. In the 35 obstetric PBs, 195 level B/C recommendations were reviewed. The majority considered 47 (24%) topics unethical for an RCT and thought 16 (11%) did not need an RCT, thus leaving 132 (67%) levels B and C recommendations available for an RCT. Two-thirds of levels B and C recommendations in obstetric PB are amenable to RCTs and potentially becoming level A evidence. PMID:27582813

Modeling mutual feedback between users and recommender systems

NASA Astrophysics Data System (ADS)

Zeng, An; Yeung, Chi Ho; Medo, Matúš; Zhang, Yi-Cheng

2015-07-01

Recommender systems daily influence our decisions on the Internet. While considerable attention has been given to issues such as recommendation accuracy and user privacy, the long-term mutual feedback between a recommender system and the decisions of its users has been neglected so far. We propose here a model of network evolution which allows us to study the complex dynamics induced by this feedback, including the hysteresis effect which is typical for systems with non-linear dynamics. Despite the popular belief that recommendation helps users to discover new things, we find that the long-term use of recommendation can contribute to the rise of extremely popular items and thus ultimately narrow the user choice. These results are supported by measurements of the time evolution of item popularity inequality in real systems. We show that this adverse effect of recommendation can be tamed by sacrificing part of short-term recommendation accuracy.

Hybrid recommendation methods in complex networks.

PubMed

Fiasconaro, A; Tumminello, M; Nicosia, V; Latora, V; Mantegna, R N

2015-07-01

We propose two recommendation methods, based on the appropriate normalization of already existing similarity measures, and on the convex combination of the recommendation scores derived from similarity between users and between objects. We validate the proposed measures on three data sets, and we compare the performance of our methods to other recommendation systems recently proposed in the literature. We show that the proposed similarity measures allow us to attain an improvement of performances of up to 20% with respect to existing nonparametric methods, and that the accuracy of a recommendation can vary widely from one specific bipartite network to another, which suggests that a careful choice of the most suitable method is highly relevant for an effective recommendation on a given system. Finally, we study how an increasing presence of random links in the network affects the recommendation scores, finding that one of the two recommendation algorithms introduced here can systematically outperform the others in noisy data sets.

Diagnosis and management of nonvariceal upper gastrointestinal hemorrhage: European Society of Gastrointestinal Endoscopy (ESGE) Guideline.

PubMed

Gralnek, Ian M; Dumonceau, Jean-Marc; Kuipers, Ernst J; Lanas, Angel; Sanders, David S; Kurien, Matthew; Rotondano, Gianluca; Hucl, Tomas; Dinis-Ribeiro, Mario; Marmo, Riccardo; Racz, Istvan; Arezzo, Alberto; Hoffmann, Ralf-Thorsten; Lesur, Gilles; de Franchis, Roberto; Aabakken, Lars; Veitch, Andrew; Radaelli, Franco; Salgueiro, Paulo; Cardoso, Ricardo; Maia, Luís; Zullo, Angelo; Cipolletta, Livio; Hassan, Cesare

2015-10-01

This Guideline is an official statement of the European Society of Gastrointestinal Endoscopy (ESGE). It addresses the diagnosis and management of nonvariceal upper gastrointestinal hemorrhage (NVUGIH). Main Recommendations MR1. ESGE recommends immediate assessment of hemodynamic status in patients who present with acute upper gastrointestinal hemorrhage (UGIH), with prompt intravascular volume replacement initially using crystalloid fluids if hemodynamic instability exists (strong recommendation, moderate quality evidence). MR2. ESGE recommends a restrictive red blood cell transfusion strategy that aims for a target hemoglobin between 7 g/dL and 9 g/dL. A higher target hemoglobin should be considered in patients with significant co-morbidity (e. g., ischemic cardiovascular disease) (strong recommendation, moderate quality evidence). MR3. ESGE recommends the use of the Glasgow-Blatchford Score (GBS) for pre-endoscopy risk stratification. Outpatients determined to be at very low risk, based upon a GBS score of 0 - 1, do not require early endoscopy nor hospital admission. Discharged patients should be informed of the risk of recurrent bleeding and be advised to maintain contact with the discharging hospital (strong recommendation, moderate quality evidence). MR4. ESGE recommends initiating high dose intravenous proton pump inhibitors (PPI), intravenous bolus followed by continuous infusion (80 mg then 8 mg/hour), in patients presenting with acute UGIH awaiting upper endoscopy. However, PPI infusion should not delay the performance of early endoscopy (strong recommendation, high quality evidence). MR5. ESGE does not recommend the routine use of nasogastric or orogastric aspiration/lavage in patients presenting with acute UGIH (strong recommendation, moderate quality evidence). MR6. ESGE recommends intravenous erythromycin (single dose, 250 mg given 30 - 120 minutes prior to upper gastrointestinal [GI] endoscopy) in patients with clinically severe or ongoing active UGIH. In selected patients, pre-endoscopic infusion of erythromycin significantly improves endoscopic visualization, reduces the need for second-look endoscopy, decreases the number of units of blood transfused, and reduces duration of hospital stay (strong recommendation, high quality evidence). MR7. Following hemodynamic resuscitation, ESGE recommends early (≤ 24 hours) upper GI endoscopy. Very early (< 12 hours) upper GI endoscopy may be considered in patients with high risk clinical features, namely: hemodynamic instability (tachycardia, hypotension) that persists despite ongoing attempts at volume resuscitation; in-hospital bloody emesis/nasogastric aspirate; or contraindication to the interruption of anticoagulation (strong recommendation, moderate quality evidence). MR8. ESGE recommends that peptic ulcers with spurting or oozing bleeding (Forrest classification Ia and Ib, respectively) or with a nonbleeding visible vessel (Forrest classification IIa) receive endoscopic hemostasis because these lesions are at high risk for persistent bleeding or rebleeding (strong recommendation, high quality evidence). MR9. ESGE recommends that peptic ulcers with an adherent clot (Forrest classification IIb) be considered for endoscopic clot removal. Once the clot is removed, any identified underlying active bleeding (Forrest classification Ia or Ib) or nonbleeding visible vessel (Forrest classification IIa) should receive endoscopic hemostasis (weak recommendation, moderate quality evidence). MR10. In patients with peptic ulcers having a flat pigmented spot (Forrest classification IIc) or clean base (Forrest classification III), ESGE does not recommend endoscopic hemostasis as these stigmata present a low risk of recurrent bleeding. In selected clinical settings, these patients may be discharged to home on standard PPI therapy, e. g., oral PPI once-daily (strong recommendation, moderate quality evidence). MR11. ESGE recommends that epinephrine injection therapy not be used as endoscopic monotherapy. If used, it should be combined with a second endoscopic hemostasis modality (strong recommendation, high quality evidence). MR12. ESGE recommends PPI therapy for patients who receive endoscopic hemostasis and for patients with adherent clot not receiving endoscopic hemostasis. PPI therapy should be high dose and administered as an intravenous bolus followed by continuous infusion (80 mg then 8 mg/hour) for 72 hours post endoscopy (strong recommendation, high quality evidence). MR13. ESGE does not recommend routine second-look endoscopy as part of the management of nonvariceal upper gastrointestinal hemorrhage (NVUGIH). However, in patients with clinical evidence of rebleeding following successful initial endoscopic hemostasis, ESGE recommends repeat upper endoscopy with hemostasis if indicated. In the case of failure of this second attempt at hemostasis, transcatheter angiographic embolization (TAE) or surgery should be considered (strong recommendation, high quality evidence). MR14. In patients with NVUGIH secondary to peptic ulcer, ESGE recommends investigating for the presence of Helicobacter pylori in the acute setting with initiation of appropriate antibiotic therapy when H. pylori is detected. Re-testing for H. pylori should be performed in those patients with a negative test in the acute setting. Documentation of successful H. pylori eradication is recommended (strong recommendation, high quality evidence). MR15. In patients receiving low dose aspirin for secondary cardiovascular prophylaxis who develop peptic ulcer bleeding, ESGE recommends aspirin be resumed immediately following index endoscopy if the risk of rebleeding is low (e. g., FIIc, FIII). In patients with high risk peptic ulcer (FIa, FIb, FIIa, FIIb), early reintroduction of aspirin by day 3 after index endoscopy is recommended, provided that adequate hemostasis has been established (strong recommendation, moderate quality evidence). © Georg Thieme Verlag KG Stuttgart · New York.

Implementation of NATO Guidelines on Intellectual Property Rights. Revision

DTIC Science & Technology

1979-01-01

RECOMMENDED CHANGES IN DoD POLICY .............. ................ 3- 1 Recommendations for NATO IP Policy ..... ........... . 3- 1 Recommendation 1’ Commit...4- 6 Effects of Recommended IP Policy ......... .. .. 4- 9 5. RECOMMENDED CHANGES IN THE ASPR/DAR ..... ......... ...... .... 5- 1 APPENDICES I... changes to the guide- lines for re-presentation to CNAD, but no important modifications are antici- pated. Accordingly, we have assumed that the guidelines

Presence and Accuracy of Drug Dosage Recommendations for Continuous Renal Replacement Therapy in Tertiary Drug Information References

PubMed Central

Gorman, Sean K; Slavik, Richard S; Lam, Stefanie

2012-01-01

Background: Clinicians commonly rely on tertiary drug information references to guide drug dosages for patients who are receiving continuous renal replacement therapy (CRRT). It is unknown whether the dosage recommendations in these frequently used references reflect the most current evidence. Objective: To determine the presence and accuracy of drug dosage recommendations for patients undergoing CRRT in 4 drug information references. Methods: Medications commonly prescribed during CRRT were identified from an institutional medication inventory database, and evidence-based dosage recommendations for this setting were developed from the primary and secondary literature. The American Hospital Formulary System—Drug Information (AHFS–DI), Micromedex 2.0 (specifically the DRUGDEX and Martindale databases), and the 5th edition of Drug Prescribing in Renal Failure (DPRF5) were assessed for the presence of drug dosage recommendations in the CRRT setting. The dosage recommendations in these tertiary references were compared with the recommendations derived from the primary and secondary literature to determine concordance. Results: Evidence-based drug dosage recommendations were developed for 33 medications administered in patients undergoing CRRT. The AHFS–DI provided no dosage recommendations specific to CRRT, whereas the DPRF5 provided recommendations for 27 (82%) of the medications and the Micromedex 2.0 application for 20 (61%) (13 [39%] in the DRUGDEX database and 16 [48%] in the Martindale database, with 9 medications covered by both). The dosage recommendations were in concordance with evidence-based recommendations for 12 (92%) of the 13 medications in the DRUGDEX database, 26 (96%) of the 27 in the DPRF5, and all 16 (100%) of those in the Martindale database. Conclusions: One prominent tertiary drug information resource provided no drug dosage recommendations for patients undergoing CRRT. However, 2 of the databases in an Internet-based medical information application and the latest edition of a renal specialty drug information resource provided recommendations for a majority of the medications investigated. Most dosage recommendations were similar to those derived from the primary and secondary literature. The most recent edition of the DPRF is the preferred source of information when prescribing dosage regimens for patients receiving CRRT. PMID:22783029

Use of anthrax vaccine in the United States: recommendations of the Advisory Committee on Immunization Practices (ACIP), 2009.

PubMed

Wright, Jennifer Gordon; Quinn, Conrad P; Shadomy, Sean; Messonnier, Nancy

2010-07-23

These recommendations from the Advisory Committee on Immunization Practices (ACIP) update the previous recommendations for anthrax vaccine adsorbed (AVA) (CDC. Use of anthrax vaccine in the United States: Recommendations of the Advisory Committee on Immunization Practices [ACIP]. MMWR 2000;49:1-20; CDC. Use of anthrax vaccine in response to terrorism: supplemental recommendations of the Advisory Committee on Immunization Practices [ACIP]. MMWR 2002;51:1024-6) and reflect the status of anthrax vaccine supplies in the United States. This statement 1) provides updated information on anthrax epidemiology; 2) summarizes the evidence regarding the effectiveness and efficacy, immunogenicity, and safety of AVA; 3) provides recommendations for pre-event and preexposure use of AVA; and 4) provides recommendations for postexposure use of AVA. In certain instances, recommendations that did not change were clarified. No new licensed anthrax vaccines are presented. Substantial changes to these recommendations include the following: 1) reducing the number of doses required to complete the pre-event and preexposure primary series from 6 doses to 5 doses, 2) recommending intramuscular rather than subcutaneous AVA administration for preexposure use, 3) recommending AVA as a component of postexposure prophylaxis in pregnant women exposed to aerosolized Bacillus anthracis spores, 4) providing guidance regarding preexposure vaccination of emergency and other responder organizations under the direction of an occupational health program, and 5) recommending 60 days of antimicrobial prophylaxis in conjunction with 3 doses of AVA for optimal protection of previously unvaccinated persons after exposure to aerosolized B. anthracis spores.

The Canadian National EMS Research Agenda: Impact and Feasibility of Implementation of Previously Generated Recommendations.

PubMed

Jensen, J L; Blanchard, I E; Bigham, B L; Carter, Aje; Brown, R; Socha, D; Brown, L H; Travers, A H; Craig, A M; Morrison, L J

2015-09-01

A recent mixed-methods study on the state of emergency medical services (EMS) research in Canada led to the generation of nineteen actionable recommendations. As part of the dissemination plan, a survey was distributed to EMS stakeholders to determine the anticipated impact and feasibility of implementing these recommendations in Canadian systems. An online survey explored both the implementation impact and feasibility for each recommendation using a five-point scale. The sample consisted of participants from the Canadian National EMS Research Agenda study (published in 2013) and additional EMS research stakeholders identified through snowball sampling. Responses were analysed descriptively using median and plotted on a matrix. Participants reported any planned or ongoing initiatives related to the recommendations, and required or anticipated resources. Free text responses were analysed with simple content analysis, collated by recommendation. The survey was sent to 131 people, 94 (71.8%) of whom responded: 30 EMS managers/regulators (31.9%), 22 researchers (23.4%), 15 physicians (16.0%), 13 educators (13.8%), and 5 EMS providers (5.3%). Two recommendations (11%) had a median impact score of 4 (of 5) and feasibility score of 4 (of 5). Eight recommendations (42%) had an impact score of 5, with a feasibility score of 3. Nine recommendations (47%) had an impact score of 4 and a feasibility score of 3. For most recommendations, participants scored the anticipated impact higher than the feasibility to implement. Ongoing or planned initiatives exist pertaining to all recommendations except one. All of the recommendations will require additional resources to implement.

Latin American Consensus for Pediatric Cardiopulmonary Resuscitation 2017: Latin American Pediatric Critical Care Society Pediatric Cardiopulmonary Resuscitation Committee.

PubMed

López-Herce, Jesús; Almonte, Enma; Alvarado, Manuel; Bogado, Norma Beatriz; Cyunel, Mariana; Escalante, Raffo; Finardi, Christiane; Guzmán, Gustavo; Jaramillo-Bustamante, Juan C; Madrid, Claudia C; Matamoros, Martha; Moya, Luis Augusto; Obando, Grania; Reboredo, Gaspar; López, Lissette R; Scheu, Christian; Valenzuela, Alejandro; Yerovi, Rocío; Yock-Corrales, Adriana

2018-03-01

To develop a Latin American Consensus about Pediatric Cardiopulmonary Resuscitation. To clarify, reinforce, and adapt some specific recommendations for pediatric patients and to stimulate the implementation of these recommendations in clinical practice. Expert consensus recommendations with Delphi methodology. Latin American countries. Experts in pediatric cardiopulmonary resuscitation from 19 Latin American countries. Delphi methodology for expert consensus. The goal was to reach consensus with all the participating experts for every recommendation. An agreement of at least 80% of the participating experts had to exist in order to deliver a recommendation. Two Delphi voting rounds were sent out electronically. The experts were asked to score between 1 and 9 their level of agreement for each recommendation. The score was then classified into three groups: strong agreement (score 7-9), moderate agreement (score 4-6), and disagreement (score 1-3). Nineteen experts from 19 countries participated in both voting rounds and in the whole process of drafting the recommendations. Sixteen recommendations about organization of cardiopulmonary resuscitation, prevention, basic resuscitation, advanced resuscitation, and postresuscitation measures were approved. Ten of them had a consensus of 100%. Four of them were agreed by all the participants except one (94.7% consensus). One recommendation was agreed by all except two experts (89.4%), and finally, one was agreed by all except three experts (84.2%). All the recommendations reached a level of agreement. This consensus adapts 16 international recommendations to Latin America in order to improve the practice of cardiopulmonary resuscitation in children. Studies should be conducted to analyze the effectiveness of the implementation of these recommendations.

Do clinicians want recommendations? A multi-center study comparing evidence summaries with and without GRADE recommendations.

PubMed

Neumann, Ignacio; Alonso-Coello, Pablo; Vandvik, Per Olav; Agoritsas, Thomas; Mas, Gemma; Akl, Elie A; Brignardello-Petersen, Romina; Emparanza, Jose; McCullagh, Lauren; De Sitio, Catherine; McGinn, Thomas; Almodaimegh, Hind; Almodaimegh, Khalid; Rivera, Solange; Rojas, Luis; Stirnemann, Jérôme; Irani, Jihad; Hlais, Sani; Mustafa, Reem; Bdair, Fadi; Aly, Abdelrahman; Kristiansen, Annette; Izcovich, Ariel; Ramirez, Anggie; Brozek, Jan; Guyatt, Gordon; Schünemann, Holger J

2018-03-09

Evidence-based clinical practice guidelines provide recommendations to assist clinicians in decision-making and to reduce the gap between best current research evidence and clinical practice. However, some argue that providing pre-appraised evidence summaries alone, rather than recommendations, is more appropriate. To evaluate clinicians' preferences, understanding of the evidence and intended course of action in response to evidence summaries with and without recommendations. We included practicing clinicians attending educational sessions across 10 countries. Clinicians were randomized to receive relevant clinical scenarios supported by research evidence of low or very-low certainty, and accompanied by either strong or weak recommendations developed with the GRADE system. Within each group, participants were further randomized to receive the recommendation plus the corresponding evidence summary or the evidence summary alone. We evaluated participants' preferences and understanding for the presentation strategy as well as their intended course of action. 189/219 (86%) and 201/248 (81%) participants preferred having recommendations accompanying evidence summaries for both strong and weak recommendations, respectively. Across all scenarios less than half of participants correctly interpreted information provided in the evidences summaries (e.g. estimates of effect, certainty in the research evidence). Presence of a recommendation resulted in a more appropriate intended course of action for two scenarios involving strong recommendations. Evidence summaries alone are not enough to impact clinicians' course of action. Clinicians clearly prefer having recommendations accompanying evidence summaries in the context of low or very-low certainty of evidence (Trial registration NCT02006017). Copyright © 2018 Elsevier Inc. All rights reserved.

Improving the recommender algorithms with the detected communities in bipartite networks

NASA Astrophysics Data System (ADS)

Zhang, Peng; Wang, Duo; Xiao, Jinghua

2017-04-01

Recommender system offers a powerful tool to make information overload problem well solved and thus gains wide concerns of scholars and engineers. A key challenge is how to make recommendations more accurate and personalized. We notice that community structures widely exist in many real networks, which could significantly affect the recommendation results. By incorporating the information of detected communities in the recommendation algorithms, an improved recommendation approach for the networks with communities is proposed. The approach is examined in both artificial and real networks, the results show that the improvement on accuracy and diversity can be 20% and 7%, respectively. This reveals that it is beneficial to classify the nodes based on the inherent properties in recommender systems.

78 FR 4145 - Proposed Recommendations Regarding Money Market Mutual Fund Reform

Federal Register 2010, 2011, 2012, 2013, 2014

2013-01-18

... FINANCIAL STABILITY OVERSIGHT COUNCIL Proposed Recommendations Regarding Money Market Mutual Fund Reform AGENCY: Financial Stability Oversight Council. ACTION: Proposed recommendation; extension of...'') published in the Federal Register proposed recommendations regarding money market mutual funds (``MMFs...

[Food and beverages available in automatic food dispensers in health care facilities of the Portugal North Health Region].

PubMed

Rodrigues, Filipa Gomes; Ramos, Elisabete; Freitas, Mário; Neto, Maria

2010-01-01

Patients and health staff frequently need to stay in health care facilities for quite a long time. Therefore, it's necessary to create the conditions that allow the ingestion of food during those periods, namely through the existence of automatic food dispensers. However, the available food and beverages might not always be compatible with a healthy diet. The aim of this work was to evaluate if the food and beverages available in automatic food dispensers in public Ambulatory Care Facilities (ACF) and Hospitals of the Portugal North Health Region were contributing to a healthy diet, during the year of 2007. A questionnaire was elaborated and sent to the Coordinators of the Health Sub-Regions and to the Hospital Administrators. The questionnaire requested information about the existence of automatic food dispensers in the several departments of each health care facility, as well as which food and beverages were available and most sold. Afterwards, the pre-processing of the results involved the classification of the food and beverages in three categories: recommended, sometimes recommended and not recommended. The questionnaire reply ratio was 71% in ACF and 83% in Hospitals. Automatic food dispensers were available in all the Hospitals and 86.5% of ACF. It wasn't possible to acquire food in 37% of the health facility departments. These departments were all located in ACF. The more frequently available beverages in departments with automatic food dispensers were coffee, still water, tea, juices and nectars and soft drinks. Still water, coffee, yogurt, juices and nectars and soft drinks were reported as the most sold. The more frequently avaliable food items were chocolate, recommended cookies, not recommended cakes, recommended sandwiches and sometimes recommended croissants. The food items reported as being the most sold were recommended sandwiches, chocolate, recommended cookies, sometimes recommended croissants and not recommended cookies. The beverages in the recommended and sometimes recommended groups were the most frequently available and sold. The not recommended food items were reported as being the most available, while both the recommended and not recommended food items were equally reported as being the most sold. Results show that unhealthy food and beverages are widely available in public health care facilities of the Portugal North Health Region.

[Analysis of characteristics shown in self introduction letter and professor's recommendation letter].

PubMed

Kim, Sang Hyun

2013-09-01

The purpose of this study was to investigate applicants' behavioral characteristics based on the evaluation of cognitive, affective and social domain shown in self introduction letter and professor's recommendation letter. Self introduction letters and professor's recommendation letters of 109 applicants students who applied to medical school were collected. Frequency analysis and simple correlation were done in self introduction letter and professor's recommendation letter. Frequency analysis showed affective characteristics were most often mentioned in self introduction letter, and cognitive characteristics were most frequently described in professor's recommendation letter. There was a strong correlation between cognitive domains of self introduction letter and cognitive domain of professor's recommendation letter. There was a strong correlation between affective domain of self introduction letter and cognitive domain professor's recommendation letter. It is very important to make full use of self introduction letter and professor's recommendation letter for selecting medical students. Through the frequency analysis and simple correlation, more specific guidelines need to be suggested in order to secure fairness and objectivity in the evaluation of self-introduction letter and professor's recommendation letter.

On Deep Learning for Trust-Aware Recommendations in Social Networks.

PubMed

Deng, Shuiguang; Huang, Longtao; Xu, Guandong; Wu, Xindong; Wu, Zhaohui

2017-05-01

With the emergence of online social networks, the social network-based recommendation approach is popularly used. The major benefit of this approach is the ability of dealing with the problems with cold-start users. In addition to social networks, user trust information also plays an important role to obtain reliable recommendations. Although matrix factorization (MF) becomes dominant in recommender systems, the recommendation largely relies on the initialization of the user and item latent feature vectors. Aiming at addressing these challenges, we develop a novel trust-based approach for recommendation in social networks. In particular, we attempt to leverage deep learning to determinate the initialization in MF for trust-aware social recommendations and to differentiate the community effect in user's trusted friendships. A two-phase recommendation process is proposed to utilize deep learning in initialization and to synthesize the users' interests and their trusted friends' interests together with the impact of community effect for recommendations. We perform extensive experiments on real-world social network data to demonstrate the accuracy and effectiveness of our proposed approach in comparison with other state-of-the-art methods.

Recommendations for Third Molar Removal: A Practice-Based Cohort Study

PubMed Central

Rothen, Marilynn; Spiekerman, Charles; Drangsholt, Mark; McClellan, Lyle; Huang, Greg J.

2014-01-01

Objectives. We investigated general dentists’ reasons for recommending removal or retention of third molars and whether patients adhered to dentists’ recommendations. Methods. In a 2-year prospective cohort study (2009–2011) in the Pacific Northwest, we followed 801 patients aged 16 to 22 years from 50 general dental practices. Generalized estimating equations logistic regressions related patient and dentist characteristics to dentists' recommendations to remove third molars and to patient adherence. Results. General dentists recommended removal of 1683 third molars from 469 (59%) participants, mainly to prevent future problems (79%) or because a third molar had an unfavorable orientation or was unlikely to erupt (57%). Dentists recommended retention and monitoring of 1244 third molars from 366 (46%) participants, because it was too early to decide (73%), eruption path was favorable (39%), or space for eruption was sufficient (26%). When dentists recommended removal, 55% of participants adhered to this recommendation during follow-up, and the main reason was availability of insurance (88%). Conclusions. General dentists frequently recommended removal of third molars for reasons not related to symptoms or pathology, but rather to prevent future problems. PMID:24524519

Context-Awareness Based Personalized Recommendation of Anti-Hypertension Drugs.

PubMed

Chen, Dexin; Jin, Dawei; Goh, Tiong-Thye; Li, Na; Wei, Leiru

2016-09-01

The World Health Organization estimates that almost one-third of the world's adult population are suffering from hypertension which has gradually become a "silent killer". Due to the varieties of anti-hypertensive drugs, patients are interested in how these drugs can be selected to match their respective conditions. This study provides a personalized recommendation service system of anti-hypertensive drugs based on context-awareness and designs a context ontology framework of the service. In addition, this paper introduces a Semantic Web Rule Language (SWRL)-based rule to provide high-level context reasoning and information recommendation and to overcome the limitation of ontology reasoning. To make the information recommendation of the drugs more personalized, this study also devises three categories of information recommendation rules that match different priority levels and uses a ranking algorithm to optimize the recommendation. The experiment conducted shows that combining the anti-hypertensive drugs personalized recommendation service context ontology (HyRCO) with the optimized rule reasoning can achieve a higher-quality personalized drug recommendation service. Accordingly this exploratory study of the personalized recommendation service for hypertensive drugs and its method can be easily adopted for other diseases.

Context-Aware Recommender Systems

NASA Astrophysics Data System (ADS)

Adomavicius, Gediminas; Tuzhilin, Alexander

The importance of contextual information has been recognized by researchers and practitioners in many disciplines, including e-commerce personalization, information retrieval, ubiquitous and mobile computing, data mining, marketing, and management. While a substantial amount of research has already been performed in the area of recommender systems, most existing approaches focus on recommending the most relevant items to users without taking into account any additional contextual information, such as time, location, or the company of other people (e.g., for watching movies or dining out). In this chapter we argue that relevant contextual information does matter in recommender systems and that it is important to take this information into account when providing recommendations. We discuss the general notion of context and how it can be modeled in recommender systems. Furthermore, we introduce three different algorithmic paradigms - contextual prefiltering, post-filtering, and modeling - for incorporating contextual information into the recommendation process, discuss the possibilities of combining several contextaware recommendation techniques into a single unifying approach, and provide a case study of one such combined approach. Finally, we present additional capabilities for context-aware recommenders and discuss important and promising directions for future research.

Modifications in endoscopic practice for pediatric patients.

PubMed

Lightdale, Jenifer R; Acosta, Ruben; Shergill, Amandeep K; Chandrasekhara, Vinay; Chathadi, Krishnavel; Early, Dayna; Evans, John A; Fanelli, Robert D; Fisher, Deborah A; Fonkalsrud, Lisa; Hwang, Joo Ha; Kashab, Mouen; Muthusamy, V Raman; Pasha, Shabana; Saltzman, John R; Cash, Brooks D

2014-05-01

We recommend that endoscopy in children be performed by pediatric-trained endoscopists whenever possible. We recommend that adult-trained endoscopists coordinate their services with pediatricians and pediatric specialists when they are needed to perform endoscopic procedures in children. We recommend that endoscopy be performed within 24 hours in symptomatic pediatric patients with known or suspected ingestion of caustic substances. We recommend emergent foreign-body removal of esophageal button batteries, as well as 2 or more rare-earth neodymium magnets. We recommend that procedural and resuscitative equipment appropriate for pediatric use should be readily available during endoscopic procedures. We recommend that personnel trained specifically in pediatric life support and airway management be readily available during sedated procedures in children. We recommend the use of endoscopes smaller than 6 mm in diameter in infants and children weighing less than 10 kg. We recommend the use of standard adult duodenoscopes for performing ERCP in children who weigh at least 10 kg. We recommend the placement of 12F or 16F percutaneous endoscopic gastrostomy tubes in children who weigh less than 50 kg.

Endoscopic management of acute necrotizing pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) evidence-based multidisciplinary guidelines.

PubMed

Arvanitakis, Marianna; Dumonceau, Jean-Marc; Albert, Jörg; Badaoui, Abdenor; Bali, Maria Antonietta; Barthet, Marc; Besselink, Marc; Deviere, Jacques; Oliveira Ferreira, Alexandre; Gyökeres, Tibor; Hritz, Istvan; Hucl, Tomas; Milashka, Marianna; Papanikolaou, Ioannis S; Poley, Jan-Werner; Seewald, Stefan; Vanbiervliet, Geoffroy; van Lienden, Krijn; van Santvoort, Hjalmar; Voermans, Rogier; Delhaye, Myriam; van Hooft, Jeanin

2018-05-01

1:  ESGE suggests using contrast-enhanced computed tomography (CT) as the first-line imaging modality on admission when indicated and up to the 4th week from onset in the absence of contraindications. Magnetic resonance imaging (MRI) may be used instead of CT in patients with contraindications to contrast-enhanced CT, and after the 4th week from onset when invasive intervention is considered because the contents (liquid vs. solid) of pancreatic collections are better characterized by MRI and evaluation of pancreatic duct integrity is possible. Weak recommendation, low quality evidence. 2:  ESGE recommends against routine percutaneous fine needle aspiration (FNA) of (peri)pancreatic collections. Strong recommendation, moderate quality evidence. FNA should be performed only if there is suspicion of infection and clinical/imaging signs are unclear. Weak recommendation, low quality evidence. 3:  ESGE recommends initial goal-directed intravenous fluid therapy with Ringer's lactate (e. g. 5 - 10 mL/kg/h) at onset. Fluid requirements should be patient-tailored and reassessed at frequent intervals. Strong recommendation, moderate quality evidence. 4:  ESGE recommends against antibiotic or probiotic prophylaxis of infectious complications in acute necrotizing pancreatitis. Strong recommendation, high quality evidence. 5:  ESGE recommends invasive intervention for patients with acute necrotizing pancreatitis and clinically suspected or proven infected necrosis. Strong recommendation, low quality evidence.ESGE suggests that the first intervention for infected necrosis should be delayed for 4 weeks if tolerated by the patient. Weak recommendation, low quality evidence. 6:  ESGE recommends performing endoscopic or percutaneous drainage of (suspected) infected walled-off necrosis as the first interventional method, taking into account the location of the walled-off necrosis and local expertise. Strong recommendation, moderate quality evidence. 7:  ESGE suggests that, in the absence of improvement following endoscopic transmural drainage of walled-off necrosis, endoscopic necrosectomy or minimally invasive surgery (if percutaneous drainage has already been performed) is to be preferred over open surgery as the next therapeutic step, taking into account the location of the walled-off necrosis and local expertise. Weak recommendation, low quality evidence. 8:  ESGE recommends long-term indwelling of transluminal plastic stents in patients with disconnected pancreatic duct syndrome. Strong recommendation, low quality evidence. Lumen-apposing metal stents should be retrieved within 4 weeks to avoid stent-related adverse effects.Strong recommendation, low quality evidence. © Georg Thieme Verlag KG Stuttgart · New York.

46 CFR 387.5 - Surplus property assignment recommendation.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 46 Shipping 8 2011-10-01 2011-10-01 false Surplus property assignment recommendation. 387.5 Section 387.5 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION MISCELLANEOUS UTILIZATION AND... property assignment recommendation. Before any assignment recommendation is submitted to the Disposal...

46 CFR 387.5 - Surplus property assignment recommendation.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 46 Shipping 8 2010-10-01 2010-10-01 false Surplus property assignment recommendation. 387.5 Section 387.5 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION MISCELLANEOUS UTILIZATION AND... property assignment recommendation. Before any assignment recommendation is submitted to the Disposal...

5 CFR 9001.108 - Prohibited recommendations.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 5 Administrative Personnel 3 2011-01-01 2011-01-01 false Prohibited recommendations. 9001.108... CONDUCT FOR EMPLOYEES OF THE FEDERAL HOUSING FINANCE AGENCY § 9001.108 Prohibited recommendations. Employees shall not make any recommendation or suggestion, directly or indirectly, concerning the...

78 FR 55263 - Draft Guidance for Industry on Bioequivalence Recommendations for Fluticasone Propionate...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-09-10

...] Draft Guidance for Industry on Bioequivalence Recommendations for Fluticasone Propionate; Salmeterol... ``Bioequivalence Recommendations for Fluticasone Propionate; Salmeterol Xinafoate.'' The recommendations provide specific guidance on the design of bioequivalence (BE) studies to support abbreviated new drug applications...

Variability in State-Based Recommendations for Management of Alpha Thalassemia Trait and Silent Carrier Detected on the Newborn Screen.

PubMed

Fogel, Benjamin N; Nguyen, Hong Loan T; Smink, Gayle; Sekhar, Deepa L

2018-04-01

We conducted an inventory of state-based recommendations for follow-up of alpha thalassemia silent carrier and trait identified on newborn screen. We found wide variability in the nature and timing of these recommendations. We recommend a standardized recommendation to guide pediatricians in evidenced-based care for this population. Copyright © 2017 Elsevier Inc. All rights reserved.

Advanced subsonic long-haul transport terminal area compatibility study. Volume 2: Research and technology recommendations

NASA Technical Reports Server (NTRS)

1974-01-01

The Terminal Area Compatibility (TAC) study is briefly summarized for background information. The most important research items for the areas of noise congestion, and emissions are identified. Other key research areas are also discussed. The 50 recommended research items are categorized by flight phase, technology, and compatibility benefits. The relationship of the TAC recommendations to the previous ATT recommendations is discussed. The bulk of the document contains the 50 recommended research items. For each item, the potential payoff, state of readiness, recommended action and estimated cost and schedule are given.

Quality assurance in nuclear medicine facilities; availability of final recommendations--FDA. Notice.

PubMed

1985-05-13

The Food and Drug Administration (FDA) is announcing the availability of final recommendations prepared by its Center for Devices and Radiological Health (CDRH) on quality assurance programs in nuclear medicine facilities. The final recommendations include the agency's rationale for the recommendations as well as references that can be used as well as references that can be used as guides in conducting quality control monitoring. These final recommendations are available as a technical report in CDRH's radiation recommendations series. They are intended to encourage and promote the development of voluntary quality assurance programs in nuclear medicine facilities.

Use of Simulators to Explore Specialty Recommendation for a Palpable Breast Mass

PubMed Central

Laufer, Shlomi; Ray, Rebecca D.; D'Angelo, Anne-Lise D.; Jones, Grace F.; Pugh, Carla M.

2015-01-01

Background The study aim was to evaluate recommendation patterns of different specialties for the work-up of a palpable breast mass using simulated scenarios and clinical breast examination (CBE) models. Methods Study participants were a convenience sample of physicians (n=318) attending annual surgical, family practice and obstetrics and gynecology (OB/GYN) conferences. Two different silicone-based breast models (superficial mass vs chest wall mass) were used to test CBE skills and recommendation patterns (imaging, tissue sampling, and follow-up). Results Participants were more likely to recommend mammography (p<.001) and core biopsy (p<.0001) and less likely to recommend needle aspiration (p<.043) and 1-month follow up (p<.001) for the chest wall mass compared to the superficial mass. Family practitioners were less likely to recommend ultrasound (p<.001) and OB/GYNs were less likely to recommend mammogram (p<.006) across models. Surgeons were more likely to recommend core biopsy and less likely to recommend needle aspiration across models (p<.001) Conclusions Recommendation patterns differed across the two models in line with existing practice guidelines. Additionally, differences in practice patterns between primary care and specialty providers may represent varying clinician capabilities, health care resources, and individual preferences. Our work shows that simulation may be used to track adherence to practice guidelines for breast masses. PMID:26198334

Developing a policy guidance for financing dental care in Iran using the RAND Appropriateness Method.

PubMed

Jadidfard, M P; Yazdani, S; Khoshnevisan, M H

2013-12-01

This study aimed to provide recommendations on health care financing with special emphasis on dental care. The RAND Appropriateness Method was employed to obtain the collective opinion of a multidisciplinary panel of experts on a set of recommendation statements regarding Iranian dental care financing. An initial set of recommendations were identified from a literature review. Panel members, selected purposively and by peer nomination, each rated the appropriateness and necessity of the recommendations in a structured process of two rounds. Each recommendation was classified as inappropriate, uncertain, appropriate but not necessary, or appropriate and necessary according to the median rating score and the level of disagreement among the panellists. Of 28 initial recommendations, 25 were agreed on as appropriate, of which 22 were considered as necessary. Altogether, these recommendations provide a holistic picture of an oral health system's financing in three domains: revenue collection, pooling of revenues and purchasing of dental services. The policy guidance recommendations are intended to provide the Iranian oral health authorities with an evidence-base for financing dental care. The recommendations may be transferrable, at least in part, particularly to developing countries with similar hybrid health system structures. Finally, the method used to develop the recommendations can serve as a model for use elsewhere.

Management of Acute and Recurrent Gout: A Clinical Practice Guideline From the American College of Physicians.

PubMed

Qaseem, Amir; Harris, Russell P; Forciea, Mary Ann

2017-01-03

The American College of Physicians (ACP) developed this guideline to present the evidence and provide clinical recommendations on the management of gout. Using the ACP grading system, the committee based these recommendations on a systematic review of randomized, controlled trials; systematic reviews; and large observational studies published between January 2010 and March 2016. Clinical outcomes evaluated included pain, joint swelling and tenderness, activities of daily living, patient global assessment, recurrence, intermediate outcomes of serum urate levels, and harms. The target audience for this guideline includes all clinicians, and the target patient population includes adults with acute or recurrent gout. ACP recommends that clinicians choose corticosteroids, nonsteroidal anti-inflammatory drugs (NSAIDs), or colchicine to treat patients with acute gout. (Grade: strong recommendation, high-quality evidence). ACP recommends that clinicians use low-dose colchicine when using colchicine to treat acute gout. (Grade: strong recommendation, moderate-quality evidence). ACP recommends against initiating long-term urate-lowering therapy in most patients after a first gout attack or in patients with infrequent attacks. (Grade: strong recommendation, moderate-quality evidence). ACP recommends that clinicians discuss benefits, harms, costs, and individual preferences with patients before initiating urate-lowering therapy, including concomitant prophylaxis, in patients with recurrent gout attacks. (Grade: strong recommendation, moderate-quality evidence).

Barriers and facilitators in the implementation of recommendations for hand eczema prevention among healthcare workers.

PubMed

van der Meer, Esther W C; van der Gulden, Joost W J; van Dongen, Diana; Boot, Cécile R L; Anema, Johannes R

2015-05-01

Evidence-based recommendations are available for the prevention of hand eczema among healthcare workers. However, the implementation of these recommendations is not always successful. To identify barriers and facilitators in the implementation of recommendations for the prevention of hand eczema among healthcare workers alongside a randomized controlled trial. A qualitative study was performed in which 19 healthcare workers were interviewed. The interview transcripts were open coded and also coded by means of a template by two researchers to identify relevant barriers and facilitators. Most barriers and facilitators reported for the recommendations were found at the level of the innovation (e.g. the recommendations), whereas for the guideline as a whole, multiple levels (socio-political, organization, user, and facilities) were identified. To enhance the implementation of recommendations for the prevention of hand eczema in a healthcare setting, having knowledge about these recommendations seems to be an important first step. In addition, maintaining the attention of the subject, testing the products beforehand and close collaboration with the infection control department might enhance implementation. Furthermore, it is important that the recommendations fit in with the work of the healthcare workers. When the implementation of the recommendations is prepared, these points should be taken into account. © 2015 The Authors. Contact Dermatitis published by John Wiley & Sons Ltd.

Use of Social Networking Sites and Adherence to Physical Activity and Screen Time Recommendations in Adolescents.

PubMed

Sampasa-Kanyinga, Hugues; Chaput, Jean-Philippe

2016-05-01

Adolescents are recommended to achieve ≥ 60 min/day of moderate-to-vigorous physical activity (PA) and ≤2 h/day of screen time (ST). This study examined the relationships between the use of social networking sites (SNSs) and adherence to PA and ST recommendations in a large sample of Canadian adolescents. This cross-sectional school-based survey included a representative sample of 9388 students in grades 7 to 12 across Ontario, Canada. After adjustment for several confounding variables, results showed that male adolescents who use SNSs for fewer hours (≤ 1 h/day) had greater odds of adherence to PA and to both PA and ST recommendations concurrently, while those who use it for more hours (≥ 3 h/day) had lower odds of adherence to the ST recommendation. Female adolescents who use SNSs for more hours had lower odds of adherence to the ST recommendation (use of SNSs ≥ 2 h/day) and to both PA and ST recommendations concurrently (use of SNSs ≥ 5 h/day). Heavy use of SNSs has a negative influence on the adherence to the ST recommendation in both males and females; however, infrequent use of SNSs was related to the adherence to the PA recommendation and concurrent adherence to both recommendations in males only.

Adherence to vitamin D recommendations among US infants.

PubMed

Perrine, Cria G; Sharma, Andrea J; Jefferds, Maria Elena D; Serdula, Mary K; Scanlon, Kelley S

2010-04-01

In November 2008, the American Academy of Pediatrics (AAP) doubled the recommended daily intake of vitamin D for infants and children, from 200 IU/day (2003 recommendation) to 400 IU/day. We aimed to assess the prevalence of infants meeting the AAP recommended intake of vitamin D during their first year of life. Using data from the Infant Feeding Practices Study II, conducted from 2005 to 2007, we estimated the percentage of infants who met vitamin D recommendations at ages 1, 2, 3, 4, 5, 6, 7.5, 9, and 10.5 months (n = 1952-1633). The use of oral vitamin D supplements was low, regardless of whether infants were consuming breast milk or formula, ranging from 1% to 13%, varying by age. Among infants who consumed breast milk but no formula, only 5% to 13% met either recommendation. Among mixed-fed infants, 28% to 35% met the 2003 recommendation, but only 9% to 14% would have met the 2008 recommendation. Among those who consumed formula but no breast milk, 81% to 98% met the 2003 recommendation, but only 20% to 37% would have met the 2008 recommendation. Our findings suggest that most US infants are not consuming adequate amounts of vitamin D according to the 2008 AAP recommendation. Pediatricians and health care providers should encourage parents of infants who are either breastfed or consuming <1 L/day of infant formula to give their infants an oral vitamin D supplement.

Customized Clinical Practice Guidelines for Management of Adult Cataract in Iran

PubMed Central

Rajavi, Zhaleh; Javadi, Mohammad Ali; Daftarian, Narsis; Safi, Sare; Nejat, Farhad; Shirvani, Armin; Ahmadieh, Hamid; Shahraz, Saeid; Ziaei, Hossein; Moein, Hamidreza; Motlagh, Behzad Fallahi; Feizi, Sepehr; Foroutan, Alireza; Hashemi, Hassan; Hashemian, Seyed Javad; Jabbarvand, Mahmoud; Jafarinasab, Mohammad Reza; Karimian, Farid; Mohammad-Rabei, Hossein; Mohammadpour, Mehrdad; Nassiri, Nader; Panahi-Bazaz, Mahmoodreza; Rohani, Mohammad Reza; Sedaghat, Mohammad Reza; Sheibani, Kourosh

2015-01-01

Purpose: To customize clinical practice guidelines (CPGs) for cataract management in the Iranian population. Methods: First, four CPGs (American Academy of Ophthalmology 2006 and 2011, Royal College of Ophthalmologists 2010, and Canadian Ophthalmological Society 2008) were selected from a number of available CPGs in the literature for cataract management. All recommendations of these guidelines, together with their references, were studied. Each recommendation was summarized in 4 tables. The first table showed the recommendation itself in clinical question components format along with its level of evidence. The second table contained structured abstracts of supporting articles related to the clinical question with their levels of evidence. The third table included the customized recommendation of the internal group respecting its clinical advantage, cost, and complications. In the fourth table, the internal group their recommendations from 1 to 9 based on the customizing capability of the recommendation (applicability, acceptability, external validity). Finally, customized recommendations were sent one month prior to a consensus session to faculty members of all universities across the country asking for their comments on recommendations. Results: The agreed recommendations were accepted as conclusive while those with no agreement were discussed at the consensus session. Finally, all customized recommendations were codified as 80 recommendations along with their sources and levels of evidence for the Iranian population. Conclusion: Customization of CPGs for management of adult cataract for the Iranian population seems to be useful for standardization of referral, diagnosis and treatment of patients. PMID:27051491

Barriers of and facilitators to physician recommendation of colorectal cancer screening.

PubMed

Guerra, Carmen E; Schwartz, J Sanford; Armstrong, Katrina; Brown, Jamin S; Halbert, Chanita Hughes; Shea, Judy A

2007-12-01

Colorectal cancer screening (CRCS) has been demonstrated to be effective and is consistently recommended by clinical practice guidelines. However, only slightly over half of all Americans have ever been screened. Patients cite physician recommendation as the most important motivator of screening. This study explored the barriers of and facilitators to physician recommendation of CRCS. A 3-component qualitative study to explore the barriers of and facilitators to physician recommendation of CRCS: in-depth, semistructured interviews with 29 purposively sampled, community- and academic-based primary care physicians; chart-stimulated recall, a technique that utilizes patient charts to probe physician recall and provide context about the barriers of and facilitators to physician recommendation of CRCS during actual clinic encounters; and focus groups with 18 academic primary care physicians. Grounded theory techniques of analysis were used. All the participating physicians were aware of and recommended CRCS. The overwhelmingly preferred test was colonoscopy. Barriers of physician recommendation of CRCS included patient comorbidities, prior patient refusal of screening, physician forgetfulness, acute care visits, lack of time, and lack of reminder systems and test tracking systems. Facilitators to physician recommendation of CRCS included patient request, patient age 50-59, physician positive attitudes about CRCS, physician prioritization of screening, visits devoted to preventive health, reminders, and incentives. There are multiple physician, patient, and system barriers to recommending CRCS. Thus, interventions may need to target barriers at multiple levels to successfully increase physician recommendation of CRCS.

Knowledge and practices regarding iodine supplementation: A national survey of healthcare providers.

PubMed

Guess, Kimberly; Malek, Lenka; Anderson, Amanda; Makrides, Maria; Zhou, Shao J

2017-02-01

Little is known of healthcare providers' awareness and implementation of the National Health and Medical Research Council's recommendation regarding iodine supplementation during pre-conception, pregnancy and lactation. To assess knowledge and practices of Australian healthcare providers in relation to the National Health and Medical Research Council's iodine supplement recommendation. Obstetricians, gynaecologists, general practitioners, dietitians and midwives were recruited through their relevant professional bodies to participate in an online survey. The survey was completed by 396 healthcare providers Australia-wide. While 71% of healthcare providers' were aware of the National Health and Medical Research Council's recommendation for iodine supplementation, fewer were aware of the recommended dose (38%) or duration (44%). Seventy-three percent of healthcare providers recommended iodine supplements in pregnancy, 56% when planning pregnancy and 52% during lactation. The main reasons for not recommending iodine supplements included belief there was no need for iodine supplements due to mandatory iodine fortification of food (28%) and unawareness of the recommendation (25%). Awareness of the recommendation was positively associated with recommending iodine supplements while length of practice, time spent per consultation, age or area of practice were not associated with recommending iodine supplements. There is a need to improve healthcare providers' knowledge of and adherence to the National Health and Medical Research Council's iodine supplement recommendation. Strategies within antenatal and postnatal services, as well as public health initiatives, are required to improve the knowledge and practices of healthcare providers. Copyright © 2016 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

Design Recommendations for Concrete Tunnel Linings : Volume II. Summary of Research and Proposed Recommendations.

DOT National Transportation Integrated Search

1983-11-01

The report presents design recommendations for concrete tunnel linings for transportation tunnels. The recommendations developed as a result of in-depth analysis and model testing of the behavior of concrete tunnel linings. The research addressed pro...

77 FR 25226 - Proposed Recommendations on Obstructive Sleep Apnea

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-27

...] Proposed Recommendations on Obstructive Sleep Apnea AGENCY: Federal Motor Carrier Safety Administration... Agency is still in the process of carefully reviewing the recommendations submitted by the Motor Carrier... anticipate requesting public comment on the recommendations later this year. DATES: This withdrawal is...

A Review of Recommendations for Sequencing Receptive and Expressive Language Instruction

ERIC Educational Resources Information Center

Petursdottir, Anna Ingeborg; Carr, James E.

2011-01-01

We review recommendations for sequencing instruction in receptive and expressive language objectives in early and intensive behavioral intervention (EIBI) programs. Several books recommend completing receptive protocols before introducing corresponding expressive protocols. However, this recommendation has little empirical support, and some…

48 CFR 32.409-2 - Recommendation for disapproval.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Recommendation for disapproval. 32.409-2 Section 32.409-2 Federal Acquisition Regulations System FEDERAL ACQUISITION REGULATION... Recommendation for disapproval. If recommending disapproval, the contracting officer shall, under agency...

48 CFR 32.409-1 - Recommendation for approval.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Recommendation for approval. 32.409-1 Section 32.409-1 Federal Acquisition Regulations System FEDERAL ACQUISITION REGULATION... Recommendation for approval. If recommending approval, the contracting officer shall transmit the following...

What Influences Recommendations Issued by the Agency for Health Technology Assessment in Poland? A Glimpse Into Decision Makers' Preferences.

PubMed

Niewada, Maciej; Polkowska, Małgorzata; Jakubczyk, Michał; Golicki, Dominik

This study aimed to evaluate the factors that are associated with positive (supporting public funding) and negative recommendations of the Agency for Health Technology Assessment in Poland. Two independent analysts reviewed all the recommendations publicly available online before October 7, 2011. For each recommendation, predefined decision rationales, that is, clinical efficacy, safety, cost-effectiveness, and formal aspects, were sought, either advocating or discouraging the public financing. In the analysis, we used descriptive statistics and a logistic regression model so as to identify the association between predefined criteria and the recommendation being positive. We identified 344 recommendations-218 positive (62.8%) and 126 negative (37.2%). Negative recommendations were better justified and also the comments were less ambiguous in accordance with the recommendation (except for clinical efficacy). In general, the specified criteria supported the decision (either positive or negative) in 209 (60.8%), 107 (31.1%), 124 (36.0%), 96 (27.9%), and 61 (17.7%) recommendations, respectively, and ran contrary to the actual decision in the remaining ones. Threshold values for either cost-effectiveness or budget impact distinguishing positive from negative recommendations could not be specified. The following parameters reached statistical significance in logistic regression: clinical efficacy (both explicitly positive and explicitly negative evaluations impacted in opposite directions), lack of impact on hard end points, unfavorable safety profile, cost-effectiveness results, and formal shortcomings (all reduced the probability of a positive recommendation). Decision making of the Agency for Health Technology Assessment in Poland is multicriterial, and its results cannot be easily decomposed into simple associations or easily predicted. Still, efficacy and safety seem to contribute most to final recommendations. Copyright © 2013, International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc.

Philadelphia chromosome-negative classical myeloproliferative neoplasms: revised management recommendations from European LeukemiaNet.

PubMed

Barbui, Tiziano; Tefferi, Ayalew; Vannucchi, Alessandro M; Passamonti, Francesco; Silver, Richard T; Hoffman, Ronald; Verstovsek, Srdan; Mesa, Ruben; Kiladjian, Jean-Jacques; Hehlmann, Rȕdiger; Reiter, Andreas; Cervantes, Francisco; Harrison, Claire; Mc Mullin, Mary Frances; Hasselbalch, Hans Carl; Koschmieder, Steffen; Marchetti, Monia; Bacigalupo, Andrea; Finazzi, Guido; Kroeger, Nicolaus; Griesshammer, Martin; Birgegard, Gunnar; Barosi, Giovanni

2018-05-01

This document updates the recommendations on the management of Philadelphia chromosome-negative myeloproliferative neoplasms (Ph-neg MPNs) published in 2011 by the European LeukemiaNet (ELN) consortium. Recommendations were produced by multiple-step formalized procedures of group discussion. A critical appraisal of evidence by using Grades of Recommendation, Assessment, Development and Evaluation (GRADE) methodology was performed in the areas where at least one randomized clinical trial was published. Seven randomized controlled trials provided the evidence base; earlier phase trials also informed recommendation development. Key differences from the 2011 diagnostic recommendations included: lower threshold values for hemoglobin and hematocrit and bone marrow examination for diagnosis of polycythemia vera (PV), according to the revised WHO criteria; the search for complementary clonal markers, such as ASXL1, EZH2, IDH1/IDH2, and SRSF2 for the diagnosis of myelofibrosis (MF) in patients who test negative for JAK2V617, CALR or MPL driver mutations. Regarding key differences of therapy recommendations, both recombinant interferon alpha and the JAK1/JAK2 inhibitor ruxolitinib are recommended as second-line therapies for PV patients who are intolerant or have inadequate response to hydroxyurea. Ruxolitinib is recommended as first-line approach for MF-associated splenomegaly in patients with intermediate-2 or high-risk disease; in case of intermediate-1 disease, ruxolitinib is recommended in highly symptomatic splenomegaly. Allogeneic stem cell transplantation is recommended for transplant-eligible MF patients with high or intermediate-2 risk score. Allogeneic stem cell transplantation is also recommended for transplant-eligible MF patients with intermediate-1 risk score who present with either refractory, transfusion-dependent anemia, blasts in peripheral blood > 2%, adverse cytogenetics, or high-risk mutations. In these situations, the transplant procedure should be performed in a controlled setting.

Do patients discussed at a lung cancer multidisciplinary team meeting receive guideline-recommended treatment?

PubMed

Boxer, Miriam M; Duggan, Kirsten J; Descallar, Joseph; Vinod, Shalini K

2016-03-01

Clinical guidelines provide evidence-based management recommendations to guide practice. This study aimed to evaluate whether patients discussed at a lung cancer multidisciplinary team meeting received guideline-recommended treatment and determine reasons for not receiving guideline-recommended treatment. All new lung cancer patients discussed at the Liverpool/Macarthur lung cancer multidisciplinary team meeting between 1 December 2005 and 31 December 2010 were included. Guideline-recommended treatment was assigned according to pathology, stage and ECOG (Eastern Co-operative Oncology Group) performance status as per the 2004 Australian Lung Cancer Guidelines. This was compared with actual treatment received to determine adherence to guidelines. For those patients who did not receive guideline-recommended treatment, the medical record was reviewed to determine the reason(s) for this. Survival was compared between those who did and did not receive guideline-recommended treatment. 808 new patients were discussed at the multidisciplinary team meeting. Guideline-recommended treatment could not be assigned in 2% of patients due to missing data. 435 patients (54%) received guideline-recommended treatment, and 356 (44%) did not. The most common reasons for not receiving guideline-recommended treatment were a decline in ECOG performance status (24%), large tumor volume precluding radical radiotherapy (17%), comorbidities (15%) and patient preference (13%). Patients less than 70 years who received guideline-recommended treatment had improved survival compared with those who did not. A significant proportion of lung cancer patients did not receive guideline-recommended treatment due to legitimate reasons. Alternative guidelines are needed for patients not suitable for current best practice. Treatment according to guidelines was a predictor for survival. © 2015 Wiley Publishing Asia Pty Ltd.

Adherence to the World Cancer Research Fund/American Institute for Cancer Research recommendations and breast cancer risk.

PubMed

Harris, Holly R; Bergkvist, Leif; Wolk, Alicja

2016-06-01

The World Cancer Research Fund/American Association for Cancer Research (WCRF/AICR) has published eight nutrition-related recommendations for the prevention of cancer. However, few prospective studies have examined these recommendations by breast cancer hormone receptor subtype and only one case-control study has included the dietary supplements recommendation in their evaluation. We investigated whether adherence to the WCRF/AICR cancer prevention recommendations was associated with breast cancer incidence, overall and by hormone receptor subtype, in the Swedish Mammography Cohort. Among 31,514 primarily postmenopausal women diet and lifestyle factors were assessed with a self-administered food frequency questionnaire. A score was constructed based on adherence to the recommendations for body fatness, physical activity, energy density, plant foods, animal foods, alcoholic drinks and dietary supplements (score range 0-7). Cox proportional hazard models were used to calculate hazard ratios (HRs) and 95% confidence intervals (95% CIs). During 15 years of follow-up 1,388 cases of breast cancer were identified. Women who met six to seven recommendations had a 51% decreased risk of breast cancer compared to women meeting only zero to two recommendations (95% CI = 0.35-0.70). The association between each additional recommendation met and breast cancer risk was strongest for the ER-positive/PR-positive subtype (HR = 0.86; 95% CI = 0.79-0.94), while for the ER-negative/PR-negative subtype the individual recommendations regarding plant and animal foods were most strongly associated with reduced risk. Our findings support that adherence to the WCRF/AICR recommendations reduces breast cancer risk in a population of primarily postmenopausal women. Promoting these recommendations to the public could help reduce breast cancer incidence. © 2016 UICC.

An investigation of the validity of the Work Assessment Triage Tool clinical decision support tool for selecting optimal rehabilitation interventions for workers with musculoskeletal injuries.

PubMed

Qin, Ziling; Armijo-Olivo, Susan; Woodhouse, Linda J; Gross, Douglas P

2016-03-01

To evaluate the concurrent validity of a clinical decision support tool (Work Assessment Triage Tool (WATT)) developed to select rehabilitation treatments for injured workers with musculoskeletal conditions. Methodological study with cross-sectional and prospective components. Data were obtained from the Workers' Compensation Board of Alberta rehabilitation facility in Edmonton, Canada. A total of 432 workers' compensation claimants evaluated between November 2011 and June 2012. Percentage agreement between the Work Assessment Triage Tool and clinician recommendations was used to determine concurrent validity. In claimants returning to work, frequencies of matching were calculated and compared between clinician and Work Assessment Triage Tool recommendations and the actual programs undertaken by claimants. The frequency of each intervention recommended by clinicians, Work Assessment Triage Tool, and case managers were also calculated and compared. Percentage agreement between clinician and Work Assessment Triage Tool recommendations was poor (19%) to moderate (46%) and Kappa = 0.37 (95% CI -0.02, 0.76). The Work Assessment Triage Tool did not improve upon clinician recommendations as only 14 out of 31 claimants returning to work had programs that contradicted clinician recommendations, but were consistent with Work Assessment Triage Tool recommendations. Clinicians and case managers were inclined to recommend functional restoration, physical therapy, or no rehabilitation while the Work Assessment Triage Tool recommended additional evidence-based interventions, such as workplace-based interventions. Our findings do not provide evidence of concurrent validity for the Work Assessment Triage Tool compared with clinician recommendations. Based on these results, we cannot recommend further implementation of the Work Assessment Triage Tool. However, the Work Assessment Triage Tool appeared more likely than clinicians to recommend interventions supported by evidence; thus warranting further research. © The Author(s) 2015.

Impact of United States Preventive Services Task Force Recommendations on Utilization of Prostate-specific Antigen Screening in Medicare Beneficiaries.

PubMed

Khairnar, Rahul; Mishra, Mark V; Onukwugha, Eberechukwu

2018-02-16

Previous studies assessing the impact of United States Preventive Services Task Force (USPSTF) recommendations on utilization of prostate-specific antigen (PSA) screening have not investigated longer-term impacts of 2008 recommendations nor have they investigated the impact of 2012 recommendations in the Medicare population. This study aimed to evaluate change in utilization of PSA screening, post-2008 and 2012 USPSTF recommendations, and assessed trends and determinants of receipt of PSA screening in the Medicare population. This retrospective study of male Medicare beneficiaries utilized Medicare Current Beneficiary Survey data and linked administrative claims from 2006 to 2013. Beneficiaries aged ≥65 years, with continuous enrollment in parts A and B for each year they were surveyed were included in the study. Beneficiaries with self-reported/claims-based diagnosis of prostate cancer were excluded. The primary outcome was receipt of PSA screening. Other measures included age groups (65 to 74 and ≥75), time periods (pre-2008/post-2008 and 2012 recommendations), and sociodemographic variables. The study cohort consisted of 11,028 beneficiaries, who were predominantly white (87.56%), married (69.25%), and unemployed (84.4%); 52.21% beneficiaries were aged ≥75. Declining utilization trends for PSA screening were observed in men aged ≥75 after 2008 recommendations and in both age groups after 2012 recommendations. The odds of receiving PSA screening declined by 17% in men aged ≥75 after 2008 recommendations and by 29% in men aged ≥65 after 2012 recommendations. The 2008 and 2012 USPSTF recommendations against PSA screening were associated with declines in utilization of PSA screening during the study period. USPSTF recommendations play a significant role in affecting utilization patterns of health services.

The Immediate Impact of the 2009 USPSTF Screening Guideline Change on Physician Recommendation of a Screening Mammogram: Findings from a National Ambulatory and Medical Care Survey-Based Study.

PubMed

Rajan, Suja S; Suryavanshi, Manasi S; Karanth, Siddharth; Lairson, David R

2017-04-01

Regular screening is considered the most effective method to reduce the mortality and morbidity associated with breast cancer. Nevertheless, contradictory evidence about screening mammograms has led to periodic changes and considerable variations among different screening guidelines. This study is the first to examine the immediate impact of the 2009 US Preventive Services Task Force (USPSTF) guideline modification on physician recommendation of mammograms. The study included visits by women aged 40 years and older without prior breast cancer from the National Ambulatory and Medical Care Survey 2008-2010. Bivariate and multiple logistic regressions were used to determine the factors associated with mammography recommendation. Approximately 29,395 visits were included and mammography was recommended during 1350 visits; 50-64-year-old women had 72% higher odds, and 65-74-year-old women had twice the odds of getting a mammogram recommendation compared with 40-49-year-old women in 2009. However, there was no difference in recommendation by age groups in 2008 and 2010. Obstetricians and gynecologists did not modify their recommendation behavior in 2009, unlike all other specialists who reduced their recommendation for 40-49-year-old women in 2009. Other characteristics associated with mammogram recommendations were certain patient comorbidities, physician specialty and primary care physician status, health maintenance organization status of the clinic, and certain visit characteristics. This study demonstrated a temporary effect of the USPSTF screening guideline change on mammogram recommendation. However, in light of conflicting recommendations by different guidelines, the physicians erred toward the more rigorous guidelines and did not permanently reduce their mammogram recommendation for women aged 40-49 years.

Physical Therapists Make Accurate and Appropriate Discharge Recommendations for Patients Who Are Acutely Ill

PubMed Central

Fields, Christina J.; Fernandez, Natalia

2010-01-01

Background Acute care physical therapists contribute to the complex process of patient discharge planning. As physical therapists are experts at evaluating functional abilities and are able to incorporate various other factors relevant to discharge planning, it was expected that physical therapists’ recommendations of patient discharge location would be both accurate and appropriate. Objective This study determined how often the therapists’ recommendations for patient discharge location and services were implemented, representing the accuracy of the recommendations. The impact of unimplemented recommendations on readmission rate was examined, reflecting the appropriateness of the recommendations. Design This retrospective study included the discharge recommendations of 40 acute care physical therapists for 762 patients in a large academic medical center. The frequency of mismatch between the physical therapist's recommendation and the patient's actual discharge location and services was calculated. The mismatch variable had 3 levels: match, mismatch with services lacking, or mismatch with different services. Regression analysis was used to test whether mismatch status, patient age, length of admission, or discharge location predicted patient readmittance. Results Overall, physical therapists’ discharge recommendations were implemented 83% of the time. Patients were 2.9 times more likely to be readmitted when the therapist's discharge recommendation was not implemented and recommended follow-up services were lacking (mismatch with services lacking) compared with patients with a match. Limitations This study was limited to one facility. Limited information about the patients was collected, and data on patient readmission to other facilities were not collected. Conclusions This study supports the role of physical therapists in discharge planning in the acute care setting. Physical therapists demonstrated the ability to make accurate and appropriate discharge recommendations for patients who are acutely ill. PMID:20299410

Between forwarding and mentoring: a qualitative study of recommending medical doctors for international postdoctoral research positions.

PubMed

Sambunjak, Dario; Marušić, Matko

2011-06-09

Young scientists rarely have extensive international connections that could facilitate their mobility. They often rely on their doctoral supervisors and other senior academics, who use their networks to generate opportunities for young scientists to gain international experience and provide the initial trigger for an outward move. To explore the process of informal recommending of young physicians from a small country for postdoctoral research positions in foreign countries, we conducted in-depth interviews with eight senior academics who acted as recommenders and eight physicians who, based on the recommendations of senior academics, spent at least a year working in a laboratory abroad. Interviews were transcribed and analyzed by using the framework approach. The findings showed that recommending can take four distinct forms: 1) forwarding information, 2) passive recommending, 3) active recommending, and 4) mentor recommending. These forms differ in their level of commitment and mutual trust among actors, and possible control over the success of the process. Two groups of recommendees--'naive' and 'experienced'--can be distinguished based on their previous scientific experience and research collaboration with the recommender. Crucial for the success of the process is an adequate preparation of recommendees' stay abroad, as well as their return and reintegration. The benefits of recommending extend beyond the individual participants to the scientific community and broader society of the sending country. With a sufficient level of commitment by the actors, informal recommending can be a part of or grow into an all-encompassing developmental relationship equal to mentoring. The importance of senior academics' informal contacts and recommendations in promoting junior scientists' mobility should be acknowledged and encouraged by the research institutions and universities, particularly in developing countries.

Explaining the variability in recommended intakes of folate, vitamin B12, iron and zinc for adults and elderly people.

PubMed

Doets, Esmée L; Cavelaars, Adrienne E J M; Dhonukshe-Rutten, Rosalie A M; van 't Veer, Pieter; de Groot, Lisette C P G M

2012-05-01

To signal key issues for harmonising approaches for establishing micronutrient recommendations by explaining observed variation in recommended intakes of folate, vitamin B12, Fe and Zn for adults and elderly people. We explored differences in recommended intakes of folate, vitamin B12, Fe and Zn for adults between nine reports on micronutrient recommendations. Approaches used for setting recommendations were compared as well as eminence-based decisions regarding the selection of health indicators indicating adequacy of intakes and the consulted evidence base. In nearly all reports, recommendations were based on the average nutrient requirement. Variation in recommended folate intakes (200-400 μg/d) was related to differences in the consulted evidence base, whereas variation in vitamin B12 recommendations (1.4-3.0 μg/d) was due to the selection of different CV (10-20 %) and health indicators (maintenance of haematological status or basal losses). Variation in recommended Fe intakes (men 8-10 mg/d, premenopausal women 14.8-19.6 mg/d, postmenopausal women 7.5-10.0 mg/d) was explained by different assumed reference weights and bioavailability factors (10-18 %). Variation in Zn recommendations (men 7-14 mg/d, women 4.9-9.0 mg/d) was also explained by different bioavailability factors (24-48 %) as well as differences in the consulted evidence base. For the harmonisation of approaches for setting recommended intakes of folate, vitamin B12, Fe and Zn across European countries, standardised methods are needed to (i) select health indicators and define adequate biomarker concentrations, (ii) make assumptions about inter-individual variation in requirements, (iii) derive bioavailability factors and (iv) collate, select, interpret and integrate evidence on requirements.

Treatment recommendations for schizophrenia, major depression and alcohol dependence and stigmatizing attitudes of the public: results from a German population survey.

PubMed

Speerforck, Sven; Schomerus, Georg; Matschinger, Herbert; Angermeyer, Matthias C

2017-06-01

In addition to mental health literacy, several potentially conflicting emotions and attitudes among the public are hypothesized to guide their recommendations for specific mental health treatments. It is unclear whether evidence-based treatment strategies are guided by pro-social or stigmatizing attitudes and emotions. In a representative population survey in Germany (n = 3642), we asked respondents to what extent they would recommend psychotropic medication, psychotherapy and relaxation techniques for a person with mental illness described in an unlabelled vignette. For each treatment recommendation, we used multinomial logistic regression analyses to obtain predicted probabilities. Predictors comprised illness recognition, vignette condition, causal beliefs (current stress, childhood adversities, biogenetic), emotions (fear, anger, pro-social reactions), social distance, age, gender and education. Fear predicted greater probability for recommending psychotropic drugs in all investigated illnesses (p < 0.001), whereas associations of fear with recommending psychotherapy were generally lower and no associations with the recommendation for relaxation techniques were found. Anger was related to fewer recommendations for psychotherapy in all illnesses (p < 0.01). Pro-social reactions were predominantly related to the recommendation of relaxation techniques for a person with schizophrenia or major depression (p < 0.001). Higher desire for social distance predicted fewer recommendations for relaxation techniques in all three vignette conditions (p < 0.05). Our study corroborates findings that treatment recommendations are not necessarily linked to pro-social reactions or mental health literacy. The recommendation for a treatment modality like psychotropic medication or psychotherapy can be linked to underlying fear, possibly reflecting a public desire for protection against people with mental illness.

Layout Study and Application of Mobile App Recommendation Approach Based On Spark Streaming Framework

NASA Astrophysics Data System (ADS)

Wang, H. T.; Chen, T. T.; Yan, C.; Pan, H.

2018-05-01

For App recommended areas of mobile phone software, made while using conduct App application recommended combined weighted Slope One algorithm collaborative filtering algorithm items based on further improvement of the traditional collaborative filtering algorithm in cold start, data matrix sparseness and other issues, will recommend Spark stasis parallel algorithm platform, the introduction of real-time streaming streaming real-time computing framework to improve real-time software applications recommended.

High adherence to the ‘Wise List’ treatment recommendations in Stockholm: a 15-year retrospective review of a multifaceted approach promoting rational use of medicines

PubMed Central

Gustafsson, Lars L; Ateva, Kristina; Bastholm-Rahmner, Pia; Ovesjö, Marie-Louise; Jirlow, Malena; Juhasz-Haverinen, Maria; Lärfars, Gerd; Malmström, Rickard E; Wettermark, Björn; Andersén-Karlsson, Eva

2017-01-01

Objectives To present the ‘Wise List’ (a formulary of essential medicines for primary and specialised care in Stockholm Healthcare Region) and assess adherence to the recommendations over a 15-year period. Design Retrospective analysis of all prescription data in the Stockholm Healthcare Region between 2000 and 2015 in relation to the Wise List recommendations during the same time period. Setting All outpatient care in the Stockholm Healthcare Region. Participants All prescribers in the Stockholm Healthcare Region. Main outcome measures The number of core and complementary substances included in the Wise List, the adherence to recommendations by Anatomic Therapeutic Chemical (ATC) 1st level using defined daily doses (DDDs) adjusted to the DDD for 2015, adherence to recommendations over time measured by dispensed prescriptions yearly between 2002 and 2015. Results The number of recommended core substances was stable (175–212). Overall adherence to the recommendations for core medicines for all prescribers increased from 75% to 84% (2000 to 2015). The adherence to recommendations in primary care for core medicines increased from 80% to 90% (2005 to 2015) with decreasing range in practice variation (32% to 13%). Hospital prescriber adherence to core medicine recommendations was stable but increased for the combination core and complementary medicines from 77% to 88% (2007 to 2015). Adherence varied between the 4 therapeutic areas studied. Conclusions High and increasing adherence to the Wise List recommendations was seen for all prescriber categories. The transparent process for developing recommendations involving respected experts and clinicians using strict criteria for handling potential conflicts of interests, feedback to prescribers, continuous medical education and financial incentives are possible contributing factors. High-quality evidence-based recommendations to prescribers, such as the Wise List, disseminated through a multifaceted approach, will become increasingly important and should be developed further to include recommendations and introduction protocols for new expensive medicines. PMID:28465306

Evidence-informed recommendations for rehabilitation with older adults living with HIV: a knowledge synthesis

PubMed Central

O'Brien, Kelly K; Solomon, Patricia; Trentham, Barry; MacLachlan, Duncan; MacDermid, Joy; Tynan, Anne-Marie; Baxter, Larry; Casey, Alan; Chegwidden, William; Robinson, Greg; Tran, Todd; Wu, Janet; Zack, Elisse

2014-01-01

Objective Our aim was to develop evidence-informed recommendations for rehabilitation with older adults living with HIV. Design We conducted a knowledge synthesis, combining research evidence specific to HIV, rehabilitation and ageing, with evidence on rehabilitation interventions for common comorbidities experienced by older adults with HIV. Methods We included highly relevant HIV-specific research addressing rehabilitation and ageing (stream A) and high-quality evidence on the effectiveness of rehabilitation interventions for common comorbidities experienced by older adults ageing with HIV (stream B). We extracted and synthesised relevant data from the evidence to draft evidence-informed recommendations for rehabilitation. Draft recommendations were refined based on people living with HIV (PLHIV) and clinician experience, values and preferences, reviewed by an interprofessional team for Grading of Recommendations Assessment, Development, and Evaluation (GRADE) (quality) rating and revision and then circulated to PLHIV and clinicians for external endorsement and final refinement. We then devised overarching recommendations to broadly guide rehabilitation with older adults living with HIV. Results This synthesis yielded 8 overarching and 52 specific recommendations. Thirty-six specific recommendations were derived from 108 moderate-level or high-level research articles (meta-analyses and systematic reviews) that described the effectiveness of rehabilitation interventions for comorbidities that may be experienced by older adults with HIV. Recommendations addressed rehabilitation interventions across eight health conditions: bone and joint disorders, cancer, stroke, cardiovascular disease, mental health challenges, cognitive impairments, chronic obstructive pulmonary disease and diabetes. Sixteen specific recommendations were derived from 42 research articles specific to rehabilitation with older adults with HIV. The quality of evidence from which these recommendations were derived was either low or very low, consisting primarily of narrative reviews or descriptive studies with small sample sizes. Recommendations addressed approaches to rehabilitation assessment and interventions, and contextual factors to consider for rehabilitation with older adults living with HIV. Conclusions These evidence-informed recommendations provide a guide for rehabilitation with older adults living with HIV. PMID:24833687

7 CFR 916.51 - Recommendations for regulation.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 8 2011-01-01 2011-01-01 false Recommendations for regulation. 916.51 Section 916.51... Order Regulating Handling Regulations § 916.51 Recommendations for regulation. (a) Whenever the... recommendations for regulation pursuant to paragraph (a) of this section, the committee shall give consideration...

78 FR 36547 - Technological Advisory Council Recommendation for Improving Receiver Performance

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-18

... Council Recommendation for Improving Receiver Performance AGENCY: Federal Communications Commission... of receivers in ensuring the efficient use of spectrum and to provide recommendations on avoiding... Advisory Council (``TAC'') White Paper. OET invited comment on the TAC white paper and its recommendations...

45 CFR 1616.4 - Recommendations.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 45 Public Welfare 4 2010-10-01 2010-10-01 false Recommendations. 1616.4 Section 1616.4 Public... § 1616.4 Recommendations. (a) Before filling an attorney position, a recipient shall notify the organized... seek recommendations for attorneys who meet the qualifications established for the position. (b) A...

16 CFR 1.43 - Recommendations.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 16 Commercial Practices 1 2010-01-01 2010-01-01 false Recommendations. 1.43 Section 1.43... PROCEDURES Export Trade Associations § 1.43 Recommendations. Whenever the Commission has reason to believe... association recommendations for the readjustment of its business. If the association fails to comply with the...

7 CFR 947.51 - Recommendations for regulations.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 8 2010-01-01 2010-01-01 false Recommendations for regulations. 947.51 Section 947.51 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Marketing... Regulation § 947.51 Recommendations for regulations. The committee shall recommend to the Secretary grade...

7 CFR 923.51 - Recommendations for regulation.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 8 2010-01-01 2010-01-01 false Recommendations for regulation. 923.51 Section 923.51... DESIGNATED COUNTIES IN WASHINGTON Order Regulating Handling Regulations § 923.51 Recommendations for... arriving at its recommendations for regulation pursuant to paragraph (a) of this section, the committee...

7 CFR 923.51 - Recommendations for regulation.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 8 2011-01-01 2011-01-01 false Recommendations for regulation. 923.51 Section 923.51... DESIGNATED COUNTIES IN WASHINGTON Order Regulating Handling Regulations § 923.51 Recommendations for... arriving at its recommendations for regulation pursuant to paragraph (a) of this section, the committee...

7 CFR 915.50 - Recommendations for regulation.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 8 2011-01-01 2011-01-01 false Recommendations for regulation. 915.50 Section 915.50... Order Regulating Handling Regulations § 915.50 Recommendations for regulation. (a) Whenever the... arriving at its recommendations pursuant to paragraph (a) of this section, the committee shall give...

7 CFR 916.51 - Recommendations for regulation.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 8 2010-01-01 2010-01-01 false Recommendations for regulation. 916.51 Section 916.51... Order Regulating Handling Regulations § 916.51 Recommendations for regulation. (a) Whenever the... recommendations for regulation pursuant to paragraph (a) of this section, the committee shall give consideration...

45 CFR 1616.4 - Recommendations.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 45 Public Welfare 4 2011-10-01 2011-10-01 false Recommendations. 1616.4 Section 1616.4 Public... § 1616.4 Recommendations. (a) Before filling an attorney position, a recipient shall notify the organized... seek recommendations for attorneys who meet the qualifications established for the position. (b) A...

7 CFR 915.50 - Recommendations for regulation.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 8 2010-01-01 2010-01-01 false Recommendations for regulation. 915.50 Section 915.50... Order Regulating Handling Regulations § 915.50 Recommendations for regulation. (a) Whenever the... arriving at its recommendations pursuant to paragraph (a) of this section, the committee shall give...

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...

5 CFR 2638.506 - Director's recommendation.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 5 Administrative Personnel 3 2011-01-01 2011-01-01 false Director's recommendation. 2638.506... Cases Involving Individual Executive Agency Employees § 2638.506 Director's recommendation. (a) Where... employee is the head of an agency, the Director shall make any such recommendation to the President and the...

7 CFR 958.51 - Recommendations for regulations.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 8 2010-01-01 2010-01-01 false Recommendations for regulations. 958.51 Section 958.51 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Marketing... Recommendations for regulations. The committee shall recommend regulations to the Secretary whenever it finds that...

16 CFR 1.43 - Recommendations.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 16 Commercial Practices 1 2011-01-01 2011-01-01 false Recommendations. 1.43 Section 1.43... PROCEDURES Export Trade Associations § 1.43 Recommendations. Whenever the Commission has reason to believe... association recommendations for the readjustment of its business. If the association fails to comply with the...

7 CFR 958.51 - Recommendations for regulations.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 8 2011-01-01 2011-01-01 false Recommendations for regulations. 958.51 Section 958.51 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Marketing... Recommendations for regulations. The committee shall recommend regulations to the Secretary whenever it finds that...

5 CFR 2638.506 - Director's recommendation.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 5 Administrative Personnel 3 2010-01-01 2010-01-01 false Director's recommendation. 2638.506... Cases Involving Individual Executive Agency Employees § 2638.506 Director's recommendation. (a) Where... employee is the head of an agency, the Director shall make any such recommendation to the President and the...

7 CFR 947.51 - Recommendations for regulations.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 8 2011-01-01 2011-01-01 false Recommendations for regulations. 947.51 Section 947.51 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Marketing... Regulation § 947.51 Recommendations for regulations. The committee shall recommend to the Secretary grade...

48 CFR 53.108 - Recommendations concerning forms.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 48 Federal Acquisition Regulations System 2 2011-10-01 2011-10-01 false Recommendations concerning... (CONTINUED) CLAUSES AND FORMS FORMS General 53.108 Recommendations concerning forms. Users of this regulation... referenced in this regulation. Recommendations from within an executive agency shall be submitted to the...

41 CFR 102-75.655 - What does the assignment recommendation contain?

Code of Federal Regulations, 2010 CFR

2010-07-01

... recommendation contain? 102-75.655 Section 102-75.655 Public Contracts and Property Management Federal Property Management Regulations System (Continued) FEDERAL MANAGEMENT REGULATION REAL PROPERTY 75-REAL PROPERTY... What does the assignment recommendation contain? Any recommendation submitted by DOI must provide...

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...

Constructing compact and effective graphs for recommender systems via node and edge aggregations

DOE PAGES

Lee, Sangkeun; Kahng, Minsuk; Lee, Sang-goo

2014-12-10

Exploiting graphs for recommender systems has great potential to flexibly incorporate heterogeneous information for producing better recommendation results. As our baseline approach, we first introduce a naive graph-based recommendation method, which operates with a heterogeneous log-metadata graph constructed from user log and content metadata databases. Although the na ve graph-based recommendation method is simple, it allows us to take advantages of heterogeneous information and shows promising flexibility and recommendation accuracy. However, it often leads to extensive processing time due to the sheer size of the graphs constructed from entire user log and content metadata databases. In this paper, we proposemore » node and edge aggregation approaches to constructing compact and e ective graphs called Factor-Item bipartite graphs by aggregating nodes and edges of a log-metadata graph. Furthermore, experimental results using real world datasets indicate that our approach can significantly reduce the size of graphs exploited for recommender systems without sacrificing the recommendation quality.« less

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.

Alleviating bias leads to accurate and personalized recommendation

NASA Astrophysics Data System (ADS)

Qiu, Tian; Wang, Tian-Tian; Zhang, Zi-Ke; Zhong, Li-Xin; Chen, Guang

2013-11-01

Recommendation bias towards objects has been found to have an impact on personalized recommendation, since objects present heterogeneous characteristics in some network-based recommender systems. In this article, based on a biased heat conduction recommendation algorithm (BHC) which considers the heterogeneity of the target objects, we propose a heterogeneous heat conduction algorithm (HHC), by further taking the heterogeneity of the source objects into account. Tested on three real datasets, the Netflix, RYM and MovieLens, the HHC algorithm is found to present better recommendation in both the accuracy and diversity than two benchmark algorithms, i.e., the original BHC and a hybrid algorithm of heat conduction and mass diffusion (HHM), while not requiring any other accessorial information or parameter. Moreover, the HHC algorithm also elevates the recommendation accuracy on cold objects, referring to the so-called cold-start problem. Eigenvalue analyses show that, the HHC algorithm effectively alleviates the recommendation bias towards objects with different level of popularity, which is beneficial to solving the accuracy-diversity dilemma.

Improving information filtering via network manipulation

NASA Astrophysics Data System (ADS)

Zhang, Fuguo; Zeng, An

2012-12-01

The recommender system is a very promising way to address the problem of overabundant information for online users. Although the information filtering for the online commercial systems has received much attention recently, almost all of the previous works are dedicated to design new algorithms and consider the user-item bipartite networks as given and constant information. However, many problems for recommender systems such as the cold-start problem (i.e., low recommendation accuracy for the small-degree items) are actually due to the limitation of the underlying user-item bipartite networks. In this letter, we propose a strategy to enhance the performance of the already existing recommendation algorithms by directly manipulating the user-item bipartite networks, namely adding some virtual connections to the networks. Numerical analyses on two benchmark data sets, MovieLens and Netflix, show that our method can remarkably improves the recommendation performance. Specifically, it not only improves the recommendations accuracy (especially for the small-degree items), but also helps the recommender systems generate more diverse and novel recommendations.

AAPT Lab Recommendations: Past, Present, and Future

NASA Astrophysics Data System (ADS)

Kozminski, Joseph

The ``AAPT Recommendations for the Undergraduate Physics Laboratory Curriculum'' was endorsed by the American Association of Physics Teachers Executive Board in November 2014. This set of curriculum recommendations focuses on developing skills and competencies that will prepare students for research in graduate school and for jobs in the STEM sector, education, and many other employment sectors. The recommendations can be used to guide changes in laboratory curricula, to assess department laboratory curricula during program reviews, and to educate university officials about the importance of laboratory experiences. The recommendations offer many potential opportunities for collaboration between physics education researchers and laboratory instructors in studying skill development in the lab and how various elements of the laboratory curriculum can best be assessed. There are also discussions underway to create an online resource for laboratory instructors to share implementation ideas and resources. This presentation provides an overview of these recommendations and their development, how the recommendations are currently being used, and opportunities for expanded use of the recommendations going forward.

[Schools meals in French secondary state schools: compliance to national recommendations and schools catering patterns].

PubMed

Bertin, M; Lafay, L; Calamassi-Tran, G; Volatier, J-L; Dubuisson, C

2011-02-01

Recent reports on the lack of nutritional quality of meals served in schools have led public authorities to draft, in 1999, recommendations for restoring a balanced food supply. Following the survey carried out by the French food safety Agency in 2005-2006, which highlighted gaps in the implementation of these recommendations, a law passed in July 2010 plans to make these recommendations mandatory, as their 2007 revised version. Thus, the objective of this study was to assess initial school compliance with regard to this last revised version of the recommendations and to identify school patterns through their catering management and implication in a dietary project. Seven hundred and seven secondary state schools were questioned (570 were administrated by the Ministry of Education and 137 by the Ministry of Agriculture) on their catering practices. Twenty consecutive menus from each school were also analyzed with a specific coding system to establish its nutritional composition for comparison with the 2007 recommendations. On average, schools complied with half of the recommendations. Good compliance was observed with the 2007 recommendations concerning fried products, starchy foods, fruits, and dairy products whereas very few schools were in compliance with recommendations concerning fish, cheeses and sweetened desserts containing less than 15 % fat and more than 20 g of sugar per portion. Furthermore, compliance with recommendations was significantly better for lunch meals, and even better for agricultural establishments. A 5-component meal was also associated with greater compliance with the recommendations. In addition, four school patterns were identified based on catering management practices. The first two categories of establishments had knowledge of the recommendations but exhibited different levels of application. The last two types of establishments had no knowledge of the recommendations and differed in their catering management practices. Compliance with recommendations was contrasted, with high adequacy for some guidelines and low for others. Nevertheless, application of the current guidelines and real implication of the school in a dietary project did improve the dietary offer in such schools. Copyright © 2010 Elsevier Masson SAS. All rights reserved.

Enhanced surveillance of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccines in pregnancy in the Vaccine Adverse Event Reporting System (VAERS), 2011-2015.

PubMed

Moro, Pedro L; Cragan, Janet; Tepper, Naomi; Zheteyeva, Yenlik; Museru, Oidda; Lewis, Paige; Broder, Karen

2016-04-29

In October 2011, the Advisory Committee on Immunization Practices (ACIP) issued updated recommendations that all pregnant women routinely receive a dose of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine. We characterized reports to the Vaccine Adverse Event Reporting System (VAERS) in pregnant women who received Tdap after this updated recommendation (2011-2015) and compared the pattern of adverse events (AEs) with the period before the updated recommendation (2005-2010). We searched the VAERS database for reports of AEs in pregnant women who received Tdap vaccine after the routine recommendation (11/01/2011-6/30/2015) and compared it to published data before the routine Tdap recommendation (01/01/2005-06/30/2010). We conducted clinical review of reports and available medical records. The clinical pattern of reports in the post-recommendation period was compared with the pattern before the routine Tdap recommendation. We found 392 reports of Tdap vaccination after the routine recommendation. One neonatal death but no maternal deaths were reported. No maternal or neonatal deaths were reported before the recommendation. We observed an increase in proportion of reports for stillbirths (1.5-2.8%) and injection site reactions/arm pain (4.5-11.9%) after the recommendation compared to the period before the routine recommendation for Tdap during pregnancy. We noted a decrease in reports of spontaneous abortion (16.7-1%). After the 2011 Tdap recommendation, in most reports, vaccination (79%) occurred during the third trimester compared to 4% before the 2011 Tdap recommendation. Twenty-six reports of repeat Tdap were received in VAERS; 13 did not report an AE. One medical facility accounted for 27% of all submitted reports. No new or unexpected vaccine AEs were noted among pregnant women who received Tdap after routine recommendations for maternal Tdap vaccination. Changes in reporting patterns would be expected, given the broader use of Tdap in pregnant women in the third trimester. Published by Elsevier Ltd.

Dental health professional recommendation and consumer habits in denture cleansing.

PubMed

Axe, Alyson S; Varghese, Roshan; Bosma, MaryLynn; Kitson, Nicola; Bradshaw, David J

2016-02-01

Regular cleaning of dentures is essential to the oral and general health of denture wearers. Only limited systematic data are available on the recommendations that dental health care professionals (DHCPs) make to patients for denture cleaning. Data on denture wearers' cleaning regimens are also lacking. The purpose of this study was to provide data on recommendations that DHCPs make to patients for denture cleaning and on the cleaning regimens of denture wearers. DHCPs (n=613), including dentists and hygienists, were surveyed in developed (Japan, USA, Italy) and developing (Brazil, India) countries. A questionnaire assessing a range of denture cleaning recommendations was used. The questions addressed products, frequency, how to use remedies, the suggested dilution and duration of cleansing treatment, the location of dentures while cleaning, and the reasoning behind the recommendation of particular products or modes of treatment. Denture cleansing methods and the routine of denture wearers in developed and developing countries were also surveyed with a questionnaire (n=2862) and a 1-week diary (n=1462). An average of more than 2 treatments was recommended by DHCPs. Specialist denture cleanser tablets, "regular" toothpaste, mouthwash, soap and water, denture paste, foam or liquid denture cleanser, and dishwashing detergents were most commonly recommended; other product recommendations included baking soda, vinegar, salt water, and bleach. More than 10% of DHCPs made no primary recommendation on cleaning. Denture tablets were more commonly recommended in developed countries, whereas toothpaste was the most common recommendation in developing countries. Denture wearers used products and methods similar to those recommended by DHCPs. Toothpaste, water, and mouthwash were used more frequently than denture tablets. More than 75% of denture wearers reported using denture cleanser tablets for more than 5 minutes, whereas soap and toothpaste were typically used for less than 2 minutes. DHCP recommendations and denture wearer habits are diverse, with no consensus on the most appropriate denture cleaning methods. This reflects a lack of clear, systematic evidence upon which to base recommendations. Copyright © 2016 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.

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

PubMed Central

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

2009-01-01

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

A bottom-up approach to MEDLINE indexing recommendations.

PubMed

Jimeno-Yepes, Antonio; Wilkowski, Bartłomiej; Mork, James G; Van Lenten, Elizabeth; Fushman, Dina Demner; Aronson, Alan R

2011-01-01

MEDLINE indexing performed by the US National Library of Medicine staff describes the essence of a biomedical publication in about 14 Medical Subject Headings (MeSH). Since 2002, this task is assisted by the Medical Text Indexer (MTI) program. We present a bottom-up approach to MEDLINE indexing in which the abstract is searched for indicators for a specific MeSH recommendation in a two-step process. Supervised machine learning combined with triage rules improves sensitivity of recommendations while keeping the number of recommended terms relatively small. Improvement in recommendations observed in this work warrants further exploration of this approach to MTI recommendations on a larger set of MeSH headings.

A proposed configurable approach for recommendation systems via data mining techniques

NASA Astrophysics Data System (ADS)

Khedr, Ayman E.; Idrees, Amira M.; Hegazy, Abd El-Fatah; El-Shewy, Samir

2018-02-01

This study presents a configurable approach for recommendations which determines the suitable recommendation method for each field based on the characteristics of its data, the method includes determining the suitable technique for selecting a representative sample of the provided data. Then selecting the suitable feature weighting measure to provide a correct weight for each feature based on its effect on the recommendations. Finally, selecting the suitable algorithm to provide the required recommendations. The proposed configurable approach could be applied on different domains. The experiments have revealed that the approach is able to provide recommendations with only 0.89 error rate percentage.

Brief report: Service implementation and maternal distress surrounding evaluation recommendations for young children diagnosed with autism

PubMed Central

Warren, Zachary; Vehorn, Alison; Dohrmann, Elizabeth; Newsom, Cassandra; Taylor, Julie Lounds

2014-01-01

There is limited evidence surrounding the ability of families of children with autism spectrum disorders to access and implement recommended interventions following diagnosis. The distress a family may encounter with regard to inability to access recommended services is also poorly understood. In this study, we present preliminary data regarding implementation of clinical recommendations following autism spectrum disorder diagnosis as well as associations of implementation with maternal functioning. In total, 75 mothers of young children diagnosed with autism spectrum disorder through a university-based preschool autism clinic returned surveys regarding access to recommended services as well as maternal mental health and distress. Results indicate that while families were able to implement numerous recommendations, specific categories of intervention were less likely to be received. Challenges implementing recommended services were not related to increased maternal distress. These results suggest that despite potential barriers toward accessing some specific recommended services following diagnosis of autism spectrum disorder, many families may be quite successful in implementing many other core recommended services and that failure to access such services may not necessarily negatively impact maternal mental health and distress. PMID:23045221

[Inpatient pain consultation service at a university hospital: a retrospective analysis of patient characteristics and the rate of the implementation of recommendations].

PubMed

Lassen, C L; Sommer, M; Meyer, N; Klier, T W; Graf, B M; Pawlik, M T; Wiese, C H R

2012-08-01

The aim of this study was to conduct an audit of a university inpatient pain consultation service and to examine the quality and the implementation of the recommended therapeutic measures. Factors that influenced the implementation should be identified. All inpatients treated by the consultation service in the years 2009 and 2010 were analyzed retrospectively. Demographic patient characteristics as well as quality parameters of the consultation service and pharmacological and non-pharmacological recommendations and their implementation were analyzed. In total 1,048 requests for the consultation service were processed of which 39.7% of the requests were for patients with acute pain, 33.8% with chronic and 19.9% with tumor-associated pain. Measures recommended most were medication, physiotherapy and psychological treatment. Recommended medications were actually prescribed in more than 80%, physiotherapy recommended in about 75% and psychological treatment recommended in 47% of the cases. Only a few influencing factors for the implementation of the recommended measures could be identified. Many different pain states are seen in an inpatient pain consultation service. The recommendations given are implemented in most cases especially concerning the medication.

Prevention of Pertussis, Tetanus, and Diphtheria with Vaccines in the United States: Recommendations of the Advisory Committee on Immunization Practices (ACIP)

PubMed Central

Tiwari, Tejpratap; Moro, Pedro; Messonnier, Nancy E.; Reingold, Arthur; Sawyer, Mark; Clark, Thomas A.

2018-01-01

Summary This report compiles and summarizes all recommendations from CDC's Advisory Committee on Immunization Practices (ACIP) regarding prevention and control of tetanus, diphtheria, and pertussis in the United States. As a comprehensive summary of previously published recommendations, this report does not contain any new recommendations and replaces all previously published reports and policy notes; it is intended for use by clinicians and public health providers as a resource. ACIP recommends routine vaccination for tetanus, diphtheria, and pertussis. Infants and young children are recommended to receive a 5-dose series of diphtheria and tetanus toxoids and acellular pertussis (DTaP) vaccines, with one adolescent booster dose of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine. Adults who have never received Tdap also are recommended to receive a booster dose of Tdap. Women are recommended to receive a dose of Tdap during each pregnancy, which should be administered from 27 through 36 weeks’ gestation, regardless of previous receipt of Tdap. After receipt of Tdap, adolescents and adults are recommended to receive a booster tetanus and diphtheria toxoids (Td) vaccine every 10 years to assure ongoing protection against tetanus and diphtheria. PMID:29702631

Endoscopic submucosal dissection: European Society of Gastrointestinal Endoscopy (ESGE) Guideline.

PubMed

Pimentel-Nunes, Pedro; Dinis-Ribeiro, Mário; Ponchon, Thierry; Repici, Alessandro; Vieth, Michael; De Ceglie, Antonella; Amato, Arnaldo; Berr, Frieder; Bhandari, Pradeep; Bialek, Andrzej; Conio, Massimo; Haringsma, Jelle; Langner, Cord; Meisner, Søren; Messmann, Helmut; Morino, Mario; Neuhaus, Horst; Piessevaux, Hubert; Rugge, Massimo; Saunders, Brian P; Robaszkiewicz, Michel; Seewald, Stefan; Kashin, Sergey; Dumonceau, Jean-Marc; Hassan, Cesare; Deprez, Pierre H

2015-09-01

This Guideline is an official statement of the European Society of Gastrointestinal Endoscopy (ESGE). The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system 1 2 was adopted to define the strength of recommendations and the quality of evidence. 1 ESGE recommends endoscopic en bloc resection for superficial esophageal squamous cell cancers (SCCs), excluding those with obvious submucosal involvement (strong recommendation, moderate quality evidence). Endoscopic mucosal resection (EMR) may be considered in such lesions when they are smaller than 10 mm if en bloc resection can be assured. However, ESGE recommends endoscopic submucosal dissection (ESD) as the first option, mainly to provide an en bloc resection with accurate pathology staging and to avoid missing important histological features (strong recommendation, moderate quality evidence). 2 ESGE recommends endoscopic resection with a curative intent for visible lesions in Barrett's esophagus (strong recommendation, moderate quality evidence). ESD has not been shown to be superior to EMR for excision of mucosal cancer, and for that reason EMR should be preferred. ESD may be considered in selected cases, such as lesions larger than 15 mm, poorly lifting tumors, and lesions at risk for submucosal invasion (strong recommendation, moderate quality evidence). 3 ESGE recommends endoscopic resection for the treatment of gastric superficial neoplastic lesions that possess a very low risk of lymph node metastasis (strong recommendation, high quality evidence). EMR is an acceptable option for lesions smaller than 10 - 15 mm with a very low probability of advanced histology (Paris 0-IIa). However, ESGE recommends ESD as treatment of choice for most gastric superficial neoplastic lesions (strong recommendation, moderate quality evidence). 4 ESGE states that the majority of colonic and rectal superficial lesions can be effectively removed in a curative way by standard polypectomy and/or by EMR (strong recommendation, moderate quality evidence). ESD can be considered for removal of colonic and rectal lesions with high suspicion of limited submucosal invasion that is based on two main criteria of depressed morphology and irregular or nongranular surface pattern, particularly if the lesions are larger than 20 mm; or ESD can be considered for colorectal lesions that otherwise cannot be optimally and radically removed by snare-based techniques (strong recommendation, moderate quality evidence). © Georg Thieme Verlag KG Stuttgart · New York.

Treatment of Low Bone Density or Osteoporosis to Prevent Fractures in Men and Women: A Clinical Practice Guideline Update From the American College of Physicians.

PubMed

Qaseem, Amir; Forciea, Mary Ann; McLean, Robert M; Denberg, Thomas D

2017-06-06

This guideline updates the 2008 American College of Physicians (ACP) recommendations on treatment of low bone density and osteoporosis to prevent fractures in men and women. This guideline is endorsed by the American Academy of Family Physicians. The ACP Clinical Guidelines Committee based these recommendations on a systematic review of randomized controlled trials; systematic reviews; large observational studies (for adverse events); and case reports (for rare events) that were published between 2 January 2005 and 3 June 2011. The review was updated to July 2016 by using a machine-learning method, and a limited update to October 2016 was done. Clinical outcomes evaluated were fractures and adverse events. This guideline focuses on the comparative benefits and risks of short- and long-term pharmacologic treatments for low bone density, including pharmaceutical prescriptions, calcium, vitamin D, and estrogen. Evidence was graded according to the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system. The target audience for this guideline includes all clinicians. The target patient population includes men and women with low bone density and osteoporosis. ACP recommends that clinicians offer pharmacologic treatment with alendronate, risedronate, zoledronic acid, or denosumab to reduce the risk for hip and vertebral fractures in women who have known osteoporosis. (Grade: strong recommendation; high-quality evidence). ACP recommends that clinicians treat osteoporotic women with pharmacologic therapy for 5 years. (Grade: weak recommendation; low-quality evidence). ACP recommends that clinicians offer pharmacologic treatment with bisphosphonates to reduce the risk for vertebral fracture in men who have clinically recognized osteoporosis. (Grade: weak recommendation; low-quality evidence). ACP recommends against bone density monitoring during the 5-year pharmacologic treatment period for osteoporosis in women. (Grade: weak recommendation; low-quality evidence). ACP recommends against using menopausal estrogen therapy or menopausal estrogen plus progestogen therapy or raloxifene for the treatment of osteoporosis in women. (Grade: strong recommendation; moderate-quality evidence). ACP recommends that clinicians should make the decision whether to treat osteopenic women 65 years of age or older who are at a high risk for fracture based on a discussion of patient preferences, fracture risk profile, and benefits, harms, and costs of medications. (Grade: weak recommendation; low-quality evidence).

Secondary Prevention of Cervical Cancer: ASCO Resource-Stratified Clinical Practice Guideline

PubMed Central

Jeronimo, Jose; Castle, Philip E.; Temin, Sarah; Denny, Lynette; Gupta, Vandana; Kim, Jane J.; Luciani, Silvana; Murokora, Daniel; Ngoma, Twalib; Qiao, Youlin; Quinn, Michael; Sankaranarayanan, Rengaswamy; Sasieni, Peter; Schmeler, Kathleen M.; Shastri, Surendra S.

2017-01-01

Purpose To provide resource-stratified, evidence-based recommendations on the secondary prevention of cervical cancer globally. Methods ASCO convened a multidisciplinary, multinational panel of oncology, primary care, epidemiology, health economic, cancer control, public health, and patient advocacy experts to produce recommendations reflecting four resource-tiered settings. A review of existing guidelines, a formal consensus-based process, and a modified ADAPTE process to adapt existing guidelines were conducted. Other experts participated in formal consensus. Results Seven existing guidelines were identified and reviewed, and adapted recommendations form the evidence base. Four systematic reviews plus cost-effectiveness analyses provided indirect evidence to inform consensus, which resulted in ≥ 75% agreement. Recommendations Human papillomavirus (HPV) DNA testing is recommended in all resource settings; visual inspection with acetic acid may be used in basic settings. Recommended age ranges and frequencies by setting are as follows: maximal: ages 25 to 65, every 5 years; enhanced: ages 30 to 65, if two consecutive negative tests at 5-year intervals, then every 10 years; limited: ages 30 to 49, every 10 years; and basic: ages 30 to 49, one to three times per lifetime. For basic settings, visual assessment is recommended as triage; in other settings, genotyping and/or cytology are recommended. For basic settings, treatment is recommended if abnormal triage results are present; in other settings, colposcopy is recommended for abnormal triage results. For basic settings, treatment options are cryotherapy or loop electrosurgical excision procedure; for other settings, loop electrosurgical excision procedure (or ablation) is recommended. Twelve-month post-treatment follow-up is recommended in all settings. Women who are HIV positive should be screened with HPV testing after diagnosis and screened twice as many times per lifetime as the general population. Screening is recommended at 6 weeks postpartum in basic settings; in other settings, screening is recommended at 6 months. In basic settings without mass screening, infrastructure for HPV testing, diagnosis, and treatment should be developed. Additional information can be found at www.asco.org/rs-cervical-cancer-secondary-prev-guideline and www.asco.org/guidelineswiki. It is the view of of ASCO that health care providers and health care system decision makers should be guided by the recommendations for the highest stratum of resources available. The guideline is intended to complement, but not replace, local guidelines. PMID:29094101

Sequencing the threat and recommendation components of persuasive messages differentially improves the effectiveness of high- and low-distressing imagery in an anti-alcohol message in students.

PubMed

Brown, Stephen L; West, Charlotte

2015-05-01

Distressing imagery is often used to improve the persuasiveness of mass-reach health promotion messages, but its effectiveness may be limited because audiences avoid attending to content. Prior self-affirmation or self-efficacy inductions have been shown to reduce avoidance and improve audience responsiveness to distressing messages, but these are difficult to introduce into a mass-reach context. Reasoning that a behavioural recommendation may have a similar effect, we reversed the traditional threat-behavioural recommendation health promotion message sequence. 2 × 2 experimental design: Factor 1, high- and low-distress images; Factor 2, threat-recommendation and recommendation-threat sequences. Ninety-one students were exposed to an identical text message accompanied by high- or low-distress imagery presented in threat-recommendation and recommendation-threat sequences. For the high-distress message, greater persuasion was observed for the recommendation-threat than the threat-recommendation sequence. This was partially mediated by participants' greater self-exposure to the threat component of the message, which we attribute to the effect of sequence in reducing attentional avoidance. For the low-distress message, greater persuasion was observed for the threat-recommendation sequence, which was not mediated by reading time allocated to the threat. Tailoring message sequence to suit the degree of distress that message developers wish to induce provides a tool that could improve persuasive messages. These findings provide a first step in this process and discuss further steps needed to consolidate and expand these findings. Statement of contribution What is already known on this subject? Health promotion messages accompanied by distressing imagery might, under some circumstances, persuade individuals to engage in healthier behaviour. Audiences can respond defensively to distressing imagery, but may be less inclined to do so when an easily followed behavioural recommendation is presented before imagery. Current literature is divided on whether presenting a behavioural recommendation before a threat component accompanied by distressing images will improve the persuasiveness of messages. What does this study add? We show that, when a behavioural recommendation precedes a threat containing distressing images, persuasiveness of a threatening message is stronger than a threat-recommendation sequence. We show that a recommendation-threat sequence improves persuasiveness of distressing imagery because it reduces attentional avoidance. © 2014 The British Psychological Society.

7 CFR 905.51 - Recommendations for regulation.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 8 2010-01-01 2010-01-01 false Recommendations for regulation. 905.51 Section 905.51..., AND TANGELOS GROWN IN FLORIDA Order Regulating Handling Regulations § 905.51 Recommendations for... and trend in consumer income. The committee shall submit to the Secretary its recommendations and...

5 CFR 2471.9 - Report and recommendations.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 5 Administrative Personnel 3 2011-01-01 2011-01-01 false Report and recommendations. 2471.9... OF THE PANEL § 2471.9 Report and recommendations. (a) When a report is issued after a factfinding... by the Panel, shall contain recommendations. (b) A report of the designated representative containing...

7 CFR 905.51 - Recommendations for regulation.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 8 2011-01-01 2011-01-01 false Recommendations for regulation. 905.51 Section 905.51..., AND TANGELOS GROWN IN FLORIDA Order Regulating Handling Regulations § 905.51 Recommendations for... and trend in consumer income. The committee shall submit to the Secretary its recommendations and...

14 CFR 1240.110 - Recommendation to the Administrator.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 14 Aeronautics and Space 5 2010-01-01 2010-01-01 false Recommendation to the Administrator. 1240... AND CONTRIBUTIONS Awards for Scientific and Technical Contributions § 1240.110 Recommendation to the... specific amount and distribution thereof for any multiple contributors. The recommendation of the Board to...

40 CFR 256.65 - Recommendations for public participation.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 25 2011-07-01 2011-07-01 false Recommendations for public... Participation § 256.65 Recommendations for public participation. (a) State and substate planning agencies should establish an advisory group, or utilize an existing group, to provide recommendations on major policy and...

14 CFR 1240.110 - Recommendation to the Administrator.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 14 Aeronautics and Space 5 2011-01-01 2010-01-01 true Recommendation to the Administrator. 1240... AND CONTRIBUTIONS Awards for Scientific and Technical Contributions § 1240.110 Recommendation to the... specific amount and distribution thereof for any multiple contributors. The recommendation of the Board to...

7 CFR 922.51 - Recommendations for regulation.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 8 2010-01-01 2010-01-01 false Recommendations for regulation. 922.51 Section 922.51... COUNTIES IN WASHINGTON Order Regulating Handling Regulations § 922.51 Recommendations for regulation. (a... recommendations for regulation pursuant to paragraph (a) of this section, the committee shall give consideration...

48 CFR 453.108 - Recommendations concerning forms.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 48 Federal Acquisition Regulations System 4 2011-10-01 2011-10-01 false Recommendations concerning... AND FORMS FORMS General 453.108 Recommendations concerning forms. Contracting officers shall submit recommendations for new forms or to revise, eliminate, or consolidate forms prescribed by FAR part 53 and part 453...

20 CFR 702.272 - Informal recommendation by district director.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false Informal recommendation by district director... Procedures Discrimination § 702.272 Informal recommendation by district director. (a) If the district... employee accept the district director's recommendation, it will be incorporated in an order and mailed to...

49 CFR 216.23 - Consideration of recommendation.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 49 Transportation 4 2011-10-01 2011-10-01 false Consideration of recommendation. 216.23 Section..., LOCOMOTIVE AND EQUIPMENT Emergency Order-Track § 216.23 Consideration of recommendation. Upon receipt of a... recommendation to the Administrator concerning the issuance of an Emergency order removing the affected track...

49 CFR 216.23 - Consideration of recommendation.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 49 Transportation 4 2010-10-01 2010-10-01 false Consideration of recommendation. 216.23 Section..., LOCOMOTIVE AND EQUIPMENT Emergency Order-Track § 216.23 Consideration of recommendation. Upon receipt of a... recommendation to the Administrator concerning the issuance of an Emergency order removing the affected track...

5 CFR 2471.9 - Report and recommendations.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 5 Administrative Personnel 3 2010-01-01 2010-01-01 false Report and recommendations. 2471.9... OF THE PANEL § 2471.9 Report and recommendations. (a) When a report is issued after a factfinding... by the Panel, shall contain recommendations. (b) A report of the designated representative containing...

7 CFR 917.40 - Recommendations for regulations.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 8 2011-01-01 2011-01-01 false Recommendations for regulations. 917.40 Section 917.40... CALIFORNIA Order Regulating Handling Regulations § 917.40 Recommendations for regulations. (a) Whenever a... recommendations for regulation pursuant to paragraph (a) of this section, the commodity committee shall give...

77 FR 47847 - Proposed Data Collections Submitted for Public Comment and Recommendations

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-10

...] Proposed Data Collections Submitted for Public Comment and Recommendations In compliance with the... investigation and the usefulness of recommendations; data are collected from 100 state and local health... on both the timeliness and the practical utility of the recommendations from the investigation by...

48 CFR 1419.505 - Rejecting Small Business Administration recommendations.

Code of Federal Regulations, 2011 CFR

2011-10-01

... Administration recommendations. 1419.505 Section 1419.505 Federal Acquisition Regulations System DEPARTMENT OF... Rejecting Small Business Administration recommendations. (a) A written justification in support of the CO's decision to reject the set-aside recommendation shall be approved by the HCA. It shall then be forwarded...

7 CFR 922.51 - Recommendations for regulation.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 8 2011-01-01 2011-01-01 false Recommendations for regulation. 922.51 Section 922.51... COUNTIES IN WASHINGTON Order Regulating Handling Regulations § 922.51 Recommendations for regulation. (a... recommendations for regulation pursuant to paragraph (a) of this section, the committee shall give consideration...

20 CFR 702.272 - Informal recommendation by district director.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 20 Employees' Benefits 3 2011-04-01 2011-04-01 false Informal recommendation by district director... PROCEDURE Claims Procedures Discrimination § 702.272 Informal recommendation by district director. (a) If... employer and employee accept the district director's recommendation, it will be incorporated in an order...

43 CFR 417.3 - Notice of recommendations and determinations.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 43 Public Lands: Interior 1 2011-10-01 2011-10-01 false Notice of recommendations and... MEASURES WITH LOWER BASIN CONTRACTORS AND OTHERS § 417.3 Notice of recommendations and determinations... advanced by the Contractors in such consultations, the Regional Director will formulate his recommendations...

40 CFR 108.6 - Recommendations.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 22 2011-07-01 2011-07-01 false Recommendations. 108.6 Section 108.6... HEARINGS § 108.6 Recommendations. At the conclusion of any hearing under this part, the Administrative Law Judge shall, based on the record, issue tentative findings of fact and recommendations concerning the...

7 CFR 917.40 - Recommendations for regulations.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 8 2010-01-01 2010-01-01 false Recommendations for regulations. 917.40 Section 917.40... CALIFORNIA Order Regulating Handling Regulations § 917.40 Recommendations for regulations. (a) Whenever a... recommendations for regulation pursuant to paragraph (a) of this section, the commodity committee shall give...

[Recommendations in neonatal resuscitation].

PubMed

2004-01-01

The recommendations for neonatal resuscitation are not always based on sufficient scientific evidence and thus expert consensus based on current research, knowledge, and experience are useful for formulating practical protocols that are easy to follow. The latest recommendations, in 2000, modified previously published recommendations and are included in the present text.

77 FR 18827 - Draft Guidance for Industry on Bioequivalence Recommendations for Iron Sucrose Injection...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-28

...] Draft Guidance for Industry on Bioequivalence Recommendations for Iron Sucrose Injection; Availability... Recommendations for Iron Sucrose.'' The recommendations provide specific guidance on the design of bioequivalence (BE) studies to support abbreviated new drug applications (ANDAs) for iron sucrose injection. DATES...

5 CFR 2638.502 - Recommendations and advice.

Code of Federal Regulations, 2010 CFR

2010-01-01

... recommendation may be made or the advice given either orally or in writing. In addition, the Director shall... 5 Administrative Personnel 3 2010-01-01 2010-01-01 false Recommendations and advice. 2638.502... Cases Involving Individual Executive Agency Employees § 2638.502 Recommendations and advice. The...

5 CFR 2638.502 - Recommendations and advice.

Code of Federal Regulations, 2011 CFR

2011-01-01

... recommendation may be made or the advice given either orally or in writing. In addition, the Director shall... 5 Administrative Personnel 3 2011-01-01 2011-01-01 false Recommendations and advice. 2638.502... Cases Involving Individual Executive Agency Employees § 2638.502 Recommendations and advice. The...

Decision-Guided Recommenders with Composite Alternatives

ERIC Educational Resources Information Center

Alodhaibi, Khalid

2011-01-01

Recommender systems aim to support users in their decision-making process while interacting with large information spaces and recommend items of interest to users based on preferences they have expressed, either explicitly or implicitly. Recommender systems are increasingly used with product and service selection over the Internet. Although…

Fiscal Year 1998 Higher Education Budget Recommendations. Operations and Grants.

ERIC Educational Resources Information Center

Illinois State Board of Higher Education, Springfield.

This report summarizes staff recommendations of the Illinois Board of Higher Education concerning budget recommendations for higher education operations and grants for fiscal year 1998. The report also includes recommendations for state appropriated revolving funds, locally held university income funds, and other appropriated funds. Specific…

41 CFR 102-75.590 - What does the assignment recommendation contain?

Code of Federal Regulations, 2010 CFR

2010-07-01

... recommendation contain? 102-75.590 Section 102-75.590 Public Contracts and Property Management Federal Property Management Regulations System (Continued) FEDERAL MANAGEMENT REGULATION REAL PROPERTY 75-REAL PROPERTY... § 102-75.590 What does the assignment recommendation contain? Any assignment recommendation that HUD...

43 CFR 417.3 - Notice of recommendations and determinations.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 43 Public Lands: Interior 1 2010-10-01 2010-10-01 false Notice of recommendations and... MEASURES WITH LOWER BASIN CONTRACTORS AND OTHERS § 417.3 Notice of recommendations and determinations... advanced by the Contractors in such consultations, the Regional Director will formulate his recommendations...

Semantically Enhanced Recommender Systems

NASA Astrophysics Data System (ADS)

Ruiz-Montiel, Manuela; Aldana-Montes, José F.

Recommender Systems have become a significant area in the context of web personalization, given the large amount of available data. Ontologies can be widely taken advantage of in recommender systems, since they provide a means of classifying and discovering of new information about the items to recommend, about user profiles and even about their context. We have developed a semantically enhanced recommender system based on this kind of ontologies. In this paper we present a description of the proposed 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.

Information filtering via preferential diffusion.

PubMed

Lü, Linyuan; Liu, Weiping

2011-06-01

Recommender systems have shown great potential in addressing the information overload problem, namely helping users in finding interesting and relevant objects within a huge information space. Some physical dynamics, including the heat conduction process and mass or energy diffusion on networks, have recently found applications in personalized recommendation. Most of the previous studies focus overwhelmingly on recommendation accuracy as the only important factor, while overlooking the significance of diversity and novelty that indeed provide the vitality of the system. In this paper, we propose a recommendation algorithm based on the preferential diffusion process on a user-object bipartite network. Numerical analyses on two benchmark data sets, MovieLens and Netflix, indicate that our method outperforms the state-of-the-art methods. Specifically, it can not only provide more accurate recommendations, but also generate more diverse and novel recommendations by accurately recommending unpopular objects.

Information filtering via preferential diffusion

NASA Astrophysics Data System (ADS)

Lü, Linyuan; Liu, Weiping

2011-06-01

Recommender systems have shown great potential in addressing the information overload problem, namely helping users in finding interesting and relevant objects within a huge information space. Some physical dynamics, including the heat conduction process and mass or energy diffusion on networks, have recently found applications in personalized recommendation. Most of the previous studies focus overwhelmingly on recommendation accuracy as the only important factor, while overlooking the significance of diversity and novelty that indeed provide the vitality of the system. In this paper, we propose a recommendation algorithm based on the preferential diffusion process on a user-object bipartite network. Numerical analyses on two benchmark data sets, MovieLens and Netflix, indicate that our method outperforms the state-of-the-art methods. Specifically, it can not only provide more accurate recommendations, but also generate more diverse and novel recommendations by accurately recommending unpopular objects.

Network-based recommendation algorithms: A review

NASA Astrophysics Data System (ADS)

Yu, Fei; Zeng, An; Gillard, Sébastien; Medo, Matúš

2016-06-01

Recommender systems are a vital tool that helps us to overcome the information overload problem. They are being used by most e-commerce web sites and attract the interest of a broad scientific community. A recommender system uses data on users' past preferences to choose new items that might be appreciated by a given individual user. While many approaches to recommendation exist, the approach based on a network representation of the input data has gained considerable attention in the past. We review here a broad range of network-based recommendation algorithms and for the first time compare their performance on three distinct real datasets. We present recommendation topics that go beyond the mere question of which algorithm to use-such as the possible influence of recommendation on the evolution of systems that use it-and finally discuss open research directions and challenges.

Treatment Recommendations for Single-Unit Crowns: Findings from The National Dental Practice-Based Research Network

PubMed Central

McCracken, Michael S.; Louis, David R.; Litaker, Mark S.; Minyé, Helena M.; Mungia, Rahma; Gordan, Valeria V.; Marshall, Don G.; Gilbert, Gregg H.

2016-01-01

Background Objectives were to: (1) quantify practitioner variation in likelihood to recommend a crown; and (2) test whether certain dentist, practice, and clinical factors are significantly associated with this likelihood. Methods Dentists in the National Dental Practice-Based Research Network completed a questionnaire about indications for single-unit crowns. In four clinical scenarios, practitioners ranked their likelihood of recommending a single-unit crown. These responses were used to calculate a dentist-specific “Crown Factor” (CF; range 0–12). A higher score implies a higher likelihood to recommend a crown. Certain characteristics were tested for statistically significant associations with the CF. Results 1,777 of 2,132 eligible dentists responded (83%). Practitioners were most likely to recommend crowns for teeth that were fractured, cracked, endodontically-treated, or had a broken restoration. Practitioners overwhelmingly recommended crowns for posterior teeth treated endodontically (94%). Practice owners, Southwest practitioners, and practitioners with a balanced work load were more likely to recommend crowns, as were practitioners who use optical scanners for digital impressions. Conclusions There is substantial variation in the likelihood of recommending a crown. While consensus exists in some areas (posterior endodontic treatment), variation dominates in others (size of an existing restoration). Recommendations varied by type of practice, network region, practice busyness, patient insurance status, and use of optical scanners. Practical Implications Recommendations for crowns may be influenced by factors unrelated to tooth and patient variables. A concern for tooth fracture -- whether from endodontic treatment, fractured teeth, or large restorations -- prompted many clinicians to recommend crowns. PMID:27492046

Implications of current recommendations for third-generation cephalosporin use in the WHO Western Pacific Region following the emergence of multiresistant gonococci.

PubMed

Tapsall, J W

2009-08-01

To ascertain recommendations for the treatment of gonorrhoea in the WHO Western Pacific Region (WPR) following the emergence of "cephalosporin-resistant" Neisseria gonorrhoeae and to relate these to clinical and laboratory measures directed towards disease and antibiotic resistance control. WHO WPR Gonococcal Antimicrobial Resistance Programme members provided data on the type, dose and source of third-generation cephalosporins recommended for the treatment of gonorrhoea. Ceftriaxone was recommended more widely (11/15 respondents) than cefixime (five centres). No cephalosporins were recommended in three jurisdictions. One other oral (ceftibuten) and injectable (cefodizime) agent was recommended. Uniform (400 mg) doses of cefixime were recommended but ceftriaxone regimens ranged between 125 mg and 1 g, with nine of 11 respondents using a 250 mg dose. Both generic and proprietary preparations were widely used. Third-generation cephalosporins are widely recommended for the treatment of gonorrhoea in the WPR, with injectable ceftriaxone more extensively so than oral cefixime and in an expanded dose range. Few other cephalosporins were recommended. Current knowledge suggests that the trend towards ceftriaxone treatment in higher doses may decrease the impact of the circulation of "cephalosporin-resistant" gonococci in the WPR. These recommendations represent public sector practice only and of themselves are unlikely to contain the further spread of "cephalosporin-resistant" gonococci because of the general clinical use of cephalosporins. Optimisation of strategies for laboratory detection of third-generation cephalosporin resistance can be simplified in the WPR because of the restricted spectrum of cephalosporins recommended. Additional efforts are urgently required for both disease and antibiotic resistance control in gonorrhoea.

Quality of physician communication about human papillomavirus vaccine: findings from a national survey.

PubMed

Gilkey, Melissa B; Malo, Teri L; Shah, Parth D; Hall, Megan E; Brewer, Noel T

2015-11-01

Improving the quality of physicians' recommendations for human papillomavirus (HPV) vaccination is critical to addressing low coverage. Thus, we sought to describe HPV vaccine communication practices among primary care physicians. Pediatricians and family physicians (n = 776) completed our national online survey in 2014. We assessed the quality of their HPV vaccine recommendations on strength of endorsement (i.e., saying the vaccine is important), timeliness (recommending it by ages 11-12), consistency (recommending it routinely vs. using a risk-based approach), and urgency (recommending same-day vaccination). A sizeable minority of physicians reported that they do not strongly endorse HPV vaccine (27%) or deliver timely recommendations for girls (26%) or boys (39%). Many physicians (59%) used a risk-based approach to recommending HPV vaccine, and only half (51%) usually recommended same-day vaccination. Overall recommendation quality was lower among physicians who were uncomfortable talking about HPV vaccine or who believed parents did not value it. Quality was higher among physicians who began discussions by saying the child was due for HPV vaccine versus giving information or eliciting questions. Many physicians in our national sample reported recommending HPV vaccine inconsistently, behind schedule, or without urgency. These practices likely contribute to under-immunization among adolescents, and may convey ambivalence to parents. As one of the first studies to assess multiple aspects of recommendation quality, these findings can inform the many state and national initiatives that aim to improve communication about HPV vaccine so as to address the persistent underuse of a powerful tool for cancer prevention. ©2015 American Association for Cancer Research.

12 CFR 263.38 - Recommended decision and filing of record.

Code of Federal Regulations, 2010 CFR

2010-01-01

... FEDERAL RESERVE SYSTEM RULES OF PRACTICE FOR HEARINGS Uniform Rules of Practice and Procedure § 263.38... expiration of the time allowed for filing reply briefs under § 263.37(b), the administrative law judge shall... the administrative law judge's recommended decision, recommended findings of fact, recommended...

22 CFR 1471.8 - Report and recommendations.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 22 Foreign Relations 2 2011-04-01 2009-04-01 true Report and recommendations. 1471.8 Section 1471... FOREIGN SERVICE IMPASSE DISPUTES PANEL PROCEDURES OF THE PANEL § 1471.8 Report and recommendations. (a... be in writing and, when authorized by the Panel, shall contain recommendations. (b) A report of the...

22 CFR 908.3 - Board recommendations.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 22 Foreign Relations 2 2010-04-01 2010-04-01 true Board recommendations. 908.3 Section 908.3 Foreign Relations FOREIGN SERVICE GRIEVANCE BOARD REMEDIES § 908.3 Board recommendations. (a) If the Board... disciplinary action against any employee of an Agency, it shall make an appropriate recommendation to the head...

18 CFR 16.14 - Departmental recommendation for takeover.

Code of Federal Regulations, 2011 CFR

2011-04-01

... recommendation for takeover. 16.14 Section 16.14 Conservation of Power and Water Resources FEDERAL ENERGY... 15 of the Federal Power Act § 16.14 Departmental recommendation for takeover. (a) A Federal department or agency may file a recommendation that the United States exercise its right to take over a...

33 CFR 13.01-15 - Applications and recommendations.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 33 Navigation and Navigable Waters 1 2011-07-01 2011-07-01 false Applications and recommendations..., and Miniatures § 13.01-15 Applications and recommendations. (a) All administrative details pertaining... recommendations for the award of a Lifesaving Medal may be filed by or in behalf of the person making or...

7 CFR 924.51 - Recommendations for regulation.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 8 2010-01-01 2010-01-01 false Recommendations for regulation. 924.51 Section 924.51... Recommendations for regulation. (a) Whenever the committee deems it advisable to regulate the handling of any.... (b) In arriving at its recommendations for regulation pursuant to paragraph (a) of this section, the...

22 CFR 1471.8 - Report and recommendations.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 22 Foreign Relations 2 2010-04-01 2010-04-01 true Report and recommendations. 1471.8 Section 1471... FOREIGN SERVICE IMPASSE DISPUTES PANEL PROCEDURES OF THE PANEL § 1471.8 Report and recommendations. (a... be in writing and, when authorized by the Panel, shall contain recommendations. (b) A report of the...

22 CFR 908.3 - Board recommendations.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 22 Foreign Relations 2 2011-04-01 2009-04-01 true Board recommendations. 908.3 Section 908.3 Foreign Relations FOREIGN SERVICE GRIEVANCE BOARD REMEDIES § 908.3 Board recommendations. (a) If the Board... disciplinary action against any employee of an Agency, it shall make an appropriate recommendation to the head...

22 CFR 909.3 - Board recommendation.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 22 Foreign Relations 2 2011-04-01 2009-04-01 true Board recommendation. 909.3 Section 909.3 Foreign Relations FOREIGN SERVICE GRIEVANCE BOARD DECISIONMAKING § 909.3 Board recommendation. Where the Board's decision is a recommendation, it shall be directed to the head of the Agency. A copy of the...

32 CFR 700.304 - Recommendations to Congress.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 32 National Defense 5 2011-07-01 2011-07-01 false Recommendations to Congress. 700.304 Section 700... The Secretary of the Navy § 700.304 Recommendations to Congress. After first informing the Secretary of Defense, the Secretary of the Navy may make such recommendations to Congress relating to the...

7 CFR 714.44 - Recommendation by State committee.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 7 2011-01-01 2011-01-01 false Recommendation by State committee. 714.44 Section 714... PENALTIES ERRONEOUSLY, ILLEGALLY, OR WRONGFULLY COLLECTED § 714.44 Recommendation by State committee. A... recommendation as provided in § 714.43 prior to action being taken by the State committee. Any necessary...

7 CFR 929.51 - Recommendations for regulation.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 8 2011-01-01 2011-01-01 false Recommendations for regulation. 929.51 Section 929.51... LONG ISLAND IN THE STATE OF NEW YORK Order Regulating Handling Regulations § 929.51 Recommendations for... August 31. Such recommendation shall include the free and restricted percentages for the crop year; (3...

7 CFR 714.44 - Recommendation by State committee.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 7 2010-01-01 2010-01-01 false Recommendation by State committee. 714.44 Section 714... PENALTIES ERRONEOUSLY, ILLEGALLY, OR WRONGFULLY COLLECTED § 714.44 Recommendation by State committee. A... recommendation as provided in § 714.43 prior to action being taken by the State committee. Any necessary...

41 CFR 60-30.36 - Exceptions to recommendations.

Code of Federal Regulations, 2010 CFR

2010-07-01

... recommendations. 60-30.36 Section 60-30.36 Public Contracts and Property Management Other Provisions Relating to... EXECUTIVE ORDER 11246 Expedited Hearing Procedures § 60-30.36 Exceptions to recommendations. Within 10 days... said recommendations. Exceptions may be responded to by other parties within 7 days after receipt by...

46 CFR 4.07-15 - Recommendations, action on.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 46 Shipping 1 2010-10-01 2010-10-01 false Recommendations, action on. 4.07-15 Section 4.07-15 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY PROCEDURES APPLICABLE TO THE PUBLIC MARINE CASUALTIES AND INVESTIGATIONS Investigations § 4.07-15 Recommendations, action on. Where the recommendations of...

7 CFR 953.41 - Recommendations for regulations.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 8 2011-01-01 2011-01-01 false Recommendations for regulations. 953.41 Section 953.41... SOUTHEASTERN STATES Order Regulating Handling Regulations § 953.41 Recommendations for regulations. (a) It... effect at the time of recommendation. (b) In determining the grades, sizes, and qualities of potatoes or...

33 CFR 13.01-15 - Applications and recommendations.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 33 Navigation and Navigable Waters 1 2010-07-01 2010-07-01 false Applications and recommendations..., and Miniatures § 13.01-15 Applications and recommendations. (a) All administrative details pertaining... recommendations for the award of a Lifesaving Medal may be filed by or in behalf of the person making or...

7 CFR 714.43 - Recommendation by county committee.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 7 2011-01-01 2011-01-01 false Recommendation by county committee. 714.43 Section 714... PENALTIES ERRONEOUSLY, ILLEGALLY, OR WRONGFULLY COLLECTED § 714.43 Recommendation by county committee.... After the recommendation of approval or disapproval is made by the county committee, the claim shall be...

49 CFR 91.5 - Findings and recommendations.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 49 Transportation 1 2011-10-01 2011-10-01 false Findings and recommendations. 91.5 Section 91.5... PRACTICES § 91.5 Findings and recommendations. (a) Upon finding that a foreign government or entity imposes... review of the report and recommendations made under paragraph (b) of this section, that unreasonably...

7 CFR 953.41 - Recommendations for regulations.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 8 2010-01-01 2010-01-01 false Recommendations for regulations. 953.41 Section 953.41... SOUTHEASTERN STATES Order Regulating Handling Regulations § 953.41 Recommendations for regulations. (a) It... effect at the time of recommendation. (b) In determining the grades, sizes, and qualities of potatoes or...

40 CFR 57.816 - Effect of negative recommendation.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 5 2011-07-01 2011-07-01 false Effect of negative recommendation. 57... Reduction Technology § 57.816 Effect of negative recommendation. No waiver of the interim requirement for... or a State first takes into account the Administrator's report, findings, and recommendations as to...

14 CFR 169.3 - Application for recommendation and certification.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 14 Aeronautics and Space 3 2010-01-01 2010-01-01 false Application for recommendation and... FACILITIES THEREON § 169.3 Application for recommendation and certification. (a) Any interested person may apply to the Administrator for a recommendation and certification with respect to a proposed project for...

18 CFR 16.15 - Commission recommendation to Congress.

Code of Federal Regulations, 2011 CFR

2011-04-01

... recommendation to Congress. 16.15 Section 16.15 Conservation of Power and Water Resources FEDERAL ENERGY... 15 of the Federal Power Act § 16.15 Commission recommendation to Congress. Upon receipt of a recommendation from any Federal department or agency, a proposal of any party, or on the Commission's own motion...

14 CFR 169.3 - Application for recommendation and certification.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 14 Aeronautics and Space 3 2011-01-01 2011-01-01 false Application for recommendation and... FACILITIES THEREON § 169.3 Application for recommendation and certification. (a) Any interested person may apply to the Administrator for a recommendation and certification with respect to a proposed project for...

41 CFR 60-30.36 - Exceptions to recommendations.

Code of Federal Regulations, 2011 CFR

2011-07-01

... recommendations. 60-30.36 Section 60-30.36 Public Contracts and Property Management Other Provisions Relating to... EXECUTIVE ORDER 11246 Expedited Hearing Procedures § 60-30.36 Exceptions to recommendations. Within 10 days... said recommendations. Exceptions may be responded to by other parties within 7 days after receipt by...

7 CFR 714.43 - Recommendation by county committee.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 7 2010-01-01 2010-01-01 false Recommendation by county committee. 714.43 Section 714... PENALTIES ERRONEOUSLY, ILLEGALLY, OR WRONGFULLY COLLECTED § 714.43 Recommendation by county committee.... After the recommendation of approval or disapproval is made by the county committee, the claim shall be...

14 CFR 77.65 - Recommendations by parties.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 14 Aeronautics and Space 2 2010-01-01 2010-01-01 false Recommendations by parties. 77.65 Section... Recommendations by parties. Within 20 days after the mailing of the record of hearing by the official reporter, or... copies of his recommendations for a final decision to be made by the Administrator. ...

46 CFR 4.07-15 - Recommendations, action on.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 46 Shipping 1 2011-10-01 2011-10-01 false Recommendations, action on. 4.07-15 Section 4.07-15 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY PROCEDURES APPLICABLE TO THE PUBLIC MARINE CASUALTIES AND INVESTIGATIONS Investigations § 4.07-15 Recommendations, action on. Where the recommendations of...

7 CFR 927.52 - Prerequisites to recommendations.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 8 2011-01-01 2011-01-01 false Prerequisites to recommendations. 927.52 Section 927... recommendations. (a) Decisions of the Fresh Pear Committee or the Processed Pear Committee with respect to any recommendations to the Secretary pursuant to the establishment or modification of a supplemental rate of...

40 CFR 222.8 - Recommendations of Presiding Officer.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 25 2011-07-01 2011-07-01 false Recommendations of Presiding Officer... DUMPING ACTION ON OCEAN DUMPING PERMIT APPLICATIONS UNDER SECTION 102 OF THE ACT § 222.8 Recommendations... Administrator or to the Regional Administrator, as the case may be, written recommendations relating to the...

7 CFR 929.51 - Recommendations for regulation.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 8 2010-01-01 2010-01-01 false Recommendations for regulation. 929.51 Section 929.51... LONG ISLAND IN THE STATE OF NEW YORK Order Regulating Handling Regulations § 929.51 Recommendations for... August 31. Such recommendation shall include the free and restricted percentages for the crop year; (3...

7 CFR 924.51 - Recommendations for regulation.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 8 2011-01-01 2011-01-01 false Recommendations for regulation. 924.51 Section 924.51... Recommendations for regulation. (a) Whenever the committee deems it advisable to regulate the handling of any.... (b) In arriving at its recommendations for regulation pursuant to paragraph (a) of this section, the...

40 CFR 222.8 - Recommendations of Presiding Officer.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 24 2010-07-01 2010-07-01 false Recommendations of Presiding Officer... DUMPING ACTION ON OCEAN DUMPING PERMIT APPLICATIONS UNDER SECTION 102 OF THE ACT § 222.8 Recommendations... Administrator or to the Regional Administrator, as the case may be, written recommendations relating to the...

32 CFR 700.304 - Recommendations to Congress.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 32 National Defense 5 2010-07-01 2010-07-01 false Recommendations to Congress. 700.304 Section 700... The Secretary of the Navy § 700.304 Recommendations to Congress. After first informing the Secretary of Defense, the Secretary of the Navy may make such recommendations to Congress relating to the...

18 CFR 16.14 - Departmental recommendation for takeover.

Code of Federal Regulations, 2010 CFR

2010-04-01

... recommendation for takeover. 16.14 Section 16.14 Conservation of Power and Water Resources FEDERAL ENERGY... 15 of the Federal Power Act § 16.14 Departmental recommendation for takeover. (a) A Federal department or agency may file a recommendation that the United States exercise its right to take over a...

18 CFR 16.15 - Commission recommendation to Congress.

Code of Federal Regulations, 2010 CFR

2010-04-01

... recommendation to Congress. 16.15 Section 16.15 Conservation of Power and Water Resources FEDERAL ENERGY... 15 of the Federal Power Act § 16.15 Commission recommendation to Congress. Upon receipt of a recommendation from any Federal department or agency, a proposal of any party, or on the Commission's own motion...

7 CFR 985.51 - Recommendations for volume regulation.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 8 2011-01-01 2011-01-01 false Recommendations for volume regulation. 985.51 Section... Limitations § 985.51 Recommendations for volume regulation. (a) If the Committee's marketing policy... recommendations shall be made prior to February 15, or such other date as the Committee, with the approval of the...

7 CFR 927.52 - Prerequisites to recommendations.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 8 2010-01-01 2010-01-01 false Prerequisites to recommendations. 927.52 Section 927... recommendations. (a) Decisions of the Fresh Pear Committee or the Processed Pear Committee with respect to any recommendations to the Secretary pursuant to the establishment or modification of a supplemental rate of...

22 CFR 909.3 - Board recommendation.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 22 Foreign Relations 2 2010-04-01 2010-04-01 true Board recommendation. 909.3 Section 909.3 Foreign Relations FOREIGN SERVICE GRIEVANCE BOARD DECISIONMAKING § 909.3 Board recommendation. Where the Board's decision is a recommendation, it shall be directed to the head of the Agency. A copy of the...

40 CFR 246.201-3 - Recommended procedures: Glass, can, and mixed paper separation.

Code of Federal Regulations, 2014 CFR

2014-07-01

..., and mixed paper separation. 246.201-3 Section 246.201-3 Protection of Environment ENVIRONMENTAL... and Recommended Procedures § 246.201-3 Recommended procedures: Glass, can, and mixed paper separation. In areas where markets are available, it is recommended that glass, cans, and mixed paper be...

40 CFR 246.201-3 - Recommended procedures: Glass, can, and mixed paper separation.

Code of Federal Regulations, 2013 CFR

2013-07-01

..., and mixed paper separation. 246.201-3 Section 246.201-3 Protection of Environment ENVIRONMENTAL... and Recommended Procedures § 246.201-3 Recommended procedures: Glass, can, and mixed paper separation. In areas where markets are available, it is recommended that glass, cans, and mixed paper be...

12 CFR 368.4 - Recommendations to customers.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 12 Banks and Banking 4 2010-01-01 2010-01-01 false Recommendations to customers. 368.4 Section 368... POLICY GOVERNMENT SECURITIES SALES PRACTICES § 368.4 Recommendations to customers. In recommending to a customer the purchase, sale or exchange of a government security, a bank that is a government securities...

Computational Techniques for More Accurate and Diverse Recommendations

ERIC Educational Resources Information Center

Kwon, YoungOk

2011-01-01

Recommender systems are becoming an increasingly important research area due to the growing demand for personalized recommendations. The volume of information available to each user and the number of products carried in e-commerce marketplaces have grown tremendously. Thus, recommender systems are needed to help individual users find the most…

77 FR 7585 - Draft Guidance for Industry on Bioequivalence Recommendations for Rifaximin Tablets; Availability

Federal Register 2010, 2011, 2012, 2013, 2014

2012-02-13

... (rifaximin-550). The recommendations provide specific guidance on the design of bioequivalence (BE) studies... studies to support ANDAs for rifaximin-200 (Draft Rifaximin-200 BE Recommendations). FDA is now issuing a...] Draft Guidance for Industry on Bioequivalence Recommendations for Rifaximin Tablets; Availability AGENCY...

75 FR 33311 - Guidance for Industry on Bioequivalence Recommendations for Specific Products; Availability

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-11

... available recommendations on how to design product- specific bioequivalence (BE) studies to support... meaningful opportunity for the public to consider and comment on product-specific BE study recommendations... available recommendations on how to design product-specific BE studies to support ANDAs. Under this process...

21 CFR 316.10 - Content and format of a request for written recommendations.

Code of Federal Regulations, 2011 CFR

2011-04-01

... its recommendations for nonclinical laboratory studies and clinical investigations. [57 FR 62085, Dec... recommendations. 316.10 Section 316.10 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) DRUGS FOR HUMAN USE ORPHAN DRUGS Written Recommendations for Investigations of Orphan...

40 CFR 246.200-4 - Recommended procedures: Levels of separation.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 24 2010-07-01 2010-07-01 false Recommended procedures: Levels of... § 246.200-4 Recommended procedures: Levels of separation. A two-level separation is recommended for most... separate category cost effective may choose to implement three levels of separation: (1) Computer papers...

Evaluating Recommender Systems for Technology Enhanced Learning: A Quantitative Survey

ERIC Educational Resources Information Center

Erdt, Mojisola; Fernandez, Alejandro; Rensing, Christoph

2015-01-01

The increasing number of publications on recommender systems for Technology Enhanced Learning (TEL) evidence a growing interest in their development and deployment. In order to support learning, recommender systems for TEL need to consider specific requirements, which differ from the requirements for recommender systems in other domains like…

41 CFR 102-75.570 - What happens if the disposal agency does not approve the assignment recommendation?

Code of Federal Regulations, 2010 CFR

2010-07-01

... disposal agency does not approve the assignment recommendation? 102-75.570 Section 102-75.570 Public Contracts and Property Management Federal Property Management Regulations System (Continued) FEDERAL... approve the assignment recommendation? If the recommendation is not approved, the disposal agency must...

Personalized Recommendation of Learning Material Using Sequential Pattern Mining and Attribute Based Collaborative Filtering

ERIC Educational Resources Information Center

Salehi, Mojtaba; Nakhai Kamalabadi, Isa; Ghaznavi Ghoushchi, Mohammad Bagher

2014-01-01

Material recommender system is a significant part of e-learning systems for personalization and recommendation of appropriate materials to learners. However, in the existing recommendation algorithms, dynamic interests and multi-preference of learners and multidimensional-attribute of materials are not fully considered simultaneously. Moreover,…

33 CFR 62.63 - Recommendations.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 33 Navigation and Navigable Waters 1 2010-07-01 2010-07-01 false Recommendations. 62.63 Section 62... UNITED STATES AIDS TO NAVIGATION SYSTEM Public Participation in the Aids to Navigation System § 62.63 Recommendations. (a) The public may recommend changes to existing aids to navigation, request new aids or the...

78 FR 55727 - Draft Guidance for Industry on Recommendations for Preparation and Submission of Animal Food...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-09-11

...] Draft Guidance for Industry on Recommendations for Preparation and Submission of Animal Food Additive...) entitled ``Recommendations for Preparation and Submission of Animal Food Additive Petitions.'' This draft... guidance for industry (GFI 221) entitled ``Recommendations for Preparation and Submission of Animal Food...

INTERNATIONAL REPORT: Practical realization of the definition of the metre, including recommended radiations of other optical frequency standards (2003)

NASA Astrophysics Data System (ADS)

Felder, R.

2005-08-01

In 2003, the International Committee for Weights and Measures (CIPM) recommended updated values of the frequency for certain optical frequency standards recommended for the practical realization of the definition of the metre. The text of this CIPM Recommendation and details of the updated radiations are given here. The complete updated set of recommended radiations, including frequencies, wavelengths, uncertainties and operating conditions where appropriate, is available on the BIPM website.

Comparing Drug-Disease Associations in Clinical Practice Guideline Recommendations and Drug Product Label Indications.

PubMed

Leung, Tiffany I; Dumontier, Michel

2015-01-01

Clinical practice guidelines (CPGs) and structured product labels (SPLs) are both intended to promote evidence-based medical practices and guide clinicians' prescribing decisions. However, it is unclear how well CPG recommendations about pharmacologic therapies for certain diseases match SPL indications for recommended drugs. In this study, we use publicly available data and text mining methods to examine drug-disease associations in CPG recommendations and SPL treatment indications for 15 common chronic conditions. Preliminary results suggest that there is a mismatch between guideline-recommended pharmacologic therapies and SPL indications. Conflicting or inconsistent recommendations and indications may complicate clinical decision making and implementation or measurement of best practices.

Recommendations for field measurements of aircraft noise

NASA Technical Reports Server (NTRS)

Marsh, A. H.

1982-01-01

Specific recommendations for environmental test criteria, data acquisition procedures, and instrument performance requirements for measurement of noise levels produced by aircraft in flight are provided. Recommendations are also given for measurement of associated airplane and engine parameters and atmospheric conditions. Recommendations are based on capabilities which were available commercially in 1981; they are applicable to field tests of aircraft flying subsonically past microphones located near the surface of the ground either directly under or to the side of a flight path. Aircraft types covered by the recommendations include fixed-wing airplanes powered by turbojet or turbofan engines or by propellers. The recommended field-measurement procedures are consistent with assumed requirements for data processing and analysis.

Treatment Recommendation Actions, Contingencies, and Responses: An Introduction.

PubMed

Stivers, Tanya; Barnes, Rebecca K

2017-08-21

In the era of patient participation in health care decision making, we know surprisingly little about the ways in which treatment recommendations are made, the contexts that shape their formulation, and the consequences of these formulations. In this article, we introduce a systematic collective investigation of how recommendations for medications are responded to and made in primary versus secondary care, in the US versus the UK, and in contexts where the medication was over the counter versus by prescription. This article provides an overview of the coding system that was used in this project including describing what constitutes a recommendation, the primary action types clinicians use for recommendations, and the types of responses provided by patients to recommendations.

Matrix- and tensor-based recommender systems for the discovery of currently unknown inorganic compounds

NASA Astrophysics Data System (ADS)

Seko, Atsuto; Hayashi, Hiroyuki; Kashima, Hisashi; Tanaka, Isao

2018-01-01

Chemically relevant compositions (CRCs) and atomic arrangements of inorganic compounds have been collected as inorganic crystal structure databases. Machine learning is a unique approach to search for currently unknown CRCs from vast candidates. Herein we propose matrix- and tensor-based recommender system approaches to predict currently unknown CRCs from database entries of CRCs. Firstly, the performance of the recommender system approaches to discover currently unknown CRCs is examined. A Tucker decomposition recommender system shows the best discovery rate of CRCs as the majority of the top 100 recommended ternary and quaternary compositions correspond to CRCs. Secondly, systematic density functional theory (DFT) calculations are performed to investigate the phase stability of the recommended compositions. The phase stability of the 27 compositions reveals that 23 currently unknown compounds are newly found to be stable. These results indicate that the recommender system has great potential to accelerate the discovery of new compounds.

Does a Simple Intervention Enhance Memory and Adherence for Neuropsychological Recommendations?

PubMed

Meth, Molly; Calamia, Matthew; Tranel, Daniel

2016-01-01

The variables that influence the extent to which patients and their families remember and follow neuropsychological recommendations after their appointments are unclear. There has been limited research on this topic. The current study was designed to address this knowledge gap. Patients (n = 79) and caregivers (n = 36) were randomized into 1 of 2 groups, letter or no-letter, to investigate whether providing a supplemental written reminder of the recommendations given (in addition to routine feedback procedures in our clinic) would improve memory for and adherence to recommendations. We found that recall of recommendations was better in the letter condition, although this effect was observed in the caregivers and not in the patients. Adherence to recommendations did not differ significantly between the letter and no-letter conditions. These findings show that a simple intervention can improve caregiver memory for recommendations. Future research could help determine how to translate improvements in memory into greater adherence.

User Evaluation of the NASA Technical Report Server Recommendation Service

NASA Technical Reports Server (NTRS)

Nelson, Michael L.; Bollen, Johan; Calhoun, JoAnne R.; Mackey, Calvin E.

2004-01-01

We present the user evaluation of two recommendation server methodologies implemented for the NASA Technical Report Server (NTRS). One methodology for generating recommendations uses log analysis to identify co-retrieval events on full-text documents. For comparison, we used the Vector Space Model (VSM) as the second methodology. We calculated cosine similarities and used the top 10 most similar documents (based on metadata) as recommendations . We then ran an experiment with NASA Langley Research Center (LaRC) staff members to gather their feedback on which method produced the most quality recommendations. We found that in most cases VSM outperformed log analysis of co-retrievals. However, analyzing the data revealed the evaluations may have been structurally biased in favor of the VSM generated recommendations. We explore some possible methods for combining log analysis and VSM generated recommendations and suggest areas of future work.

User Evaluation of the NASA Technical Report Server Recommendation Service

NASA Technical Reports Server (NTRS)

Nelson, Michael L.; Bollen, Johan; Calhoun, JoAnne R.; Mackey, Calvin E.

2004-01-01

We present the user evaluation of two recommendation server methodologies implemented for the NASA Technical Report Server (NTRS). One methodology for generating recommendations uses log analysis to identify co-retrieval events on full-text documents. For comparison, we used the Vector Space Model (VSM) as the second methodology. We calculated cosine similarities and used the top 10 most similar documents (based on metadata) as 'recommendations'. We then ran an experiment with NASA Langley Research Center (LaRC) staff members to gather their feedback on which method produced the most 'quality' recommendations. We found that in most cases VSM outperformed log analysis of co-retrievals. However, analyzing the data revealed the evaluations may have been structurally biased in favor of the VSM generated recommendations. We explore some possible methods for combining log analysis and VSM generated recommendations and suggest areas of future work.

Introduction on health recommender systems.

PubMed

Sanchez-Bocanegra, C L; Sanchez-Laguna, F; Sevillano, J L

2015-01-01

People are looking for appropriate health information which they are concerned about. The Internet is a great resource of this kind of information, but we have to be careful if we don't want to get harmful info. Health recommender systems are becoming a new wave for apt health information as systems suggest the best data according to the patients' needs.The main goals of health recommender systems are to retrieve trusted health information from the Internet, to analyse which is suitable for the user profile and select the best that can be recommended, to adapt their selection methods according to the knowledge domain and to learn from the best recommendations.A brief definition of recommender systems will be given and an explanation of how are they incorporated in the health sector. A description of the main elementary recommender methods as well as their most important problems will also be made. And, to finish, the state of the art will be described.

Position statement: hypoglycemia management in patients with diabetes mellitus. Diabetes Mellitus Working Group of the Spanish Society of Endocrinology and Nutrition.

PubMed

Mezquita-Raya, Pedro; Reyes-García, Rebeca; Moreno-Pérez, Óscar; Muñoz-Torres, Manuel; Merino-Torres, Juan Francisco; Gorgojo-Martínez, Juan José; Jódar-Gimeno, Esteban; Escalada San Martín, Javier; Gargallo-Fernández, Manuel; Soto-Gonzalez, Alfonso; González Pérez de Villar, Noemí; Becerra Fernández, Antonio; Bellido Guerrero, Diego; Botella-Serrano, Marta; Gómez-Peralta, Fernando; López de la Torre Casares, Martín

2013-11-01

To provide practical recommendations for evaluation and management of hypoglycemia in patients with diabetes mellitus. Members of the Diabetes Mellitus Working Group of the Spanish Society of Endocrinology and Nutrition. Recommendations were formulated according to the Grading of Recommendations, Assessment, Development, and Evaluation system to describe both the strength of recommendations and the quality of evidence. A systematic search was made in MEDLINE (PubMed). Papers in English and Spanish with publication date before 15 February 2013 were included. For recommendations about drugs only those approved by the European Medicines Agency were included. After formulation of recommendations, they were discussed by the Working Group. The document provides evidence-based practical recommendations for evaluation and management of hypoglycemia in patients with diabetes mellitus. Copyright © 2013 SEEN. Published by Elsevier Espana. All rights reserved.

Adherence to the food guide pyramid recommendations among African Americans and Latinos: results from the Multiethnic Cohort.

PubMed

Sharma, Sangita; Murphy, Suzanne P; Wilkens, Lynne R; Shen, Lucy; Hankin, Jean H; Monroe, Kristine R; Henderson, Brian; Kolonel, Laurence N

2004-12-01

The objective of the study was to determine the degree of adherence to the Food Guide Pyramid recommendations among African Americans, Latinos born in the United States, and Latinos born in Mexico. Subjects were from the Multiethnic Cohort Study in Hawaii and Los Angeles, and completed a self-administered quantitative food frequency questionnaire at baseline in 1993-1996. Dairy recommendations were the least likely of all the food group recommendations to be followed, with 61% to 99% of individuals in the three ethnic groups not consuming the recommended number of servings. African Americans were less likely to adhere to all of the food group recommendations compared to the two Latino groups. A greater percentage of Latinos born in the United States did not adhere to the food group recommendations compared to Latinos born in Mexico. All three groups would benefit from interventions designed to promote healthy food choices.

Recommender system based on scarce information mining.

PubMed

Lu, Wei; Chung, Fu-Lai; Lai, Kunfeng; Zhang, Liang

2017-09-01

Guessing what user may like is now a typical interface for video recommendation. Nowadays, the highly popular user generated content sites provide various sources of information such as tags for recommendation tasks. Motivated by a real world online video recommendation problem, this work targets at the long tail phenomena of user behavior and the sparsity of item features. A personalized compound recommendation framework for online video recommendation called Dirichlet mixture probit model for information scarcity (DPIS) is hence proposed. Assuming that each clicking sample is generated from a representation of user preferences, DPIS models the sample level topic proportions as a multinomial item vector, and utilizes topical clustering on the user part for recommendation through a probit classifier. As demonstrated by the real-world application, the proposed DPIS achieves better performance in accuracy, perplexity as well as diversity in coverage than traditional methods. Copyright © 2017 Elsevier Ltd. All rights reserved.

Recommended procedures for measuring aircraft noise and associated parameters

NASA Technical Reports Server (NTRS)

Marsh, A. H.

1977-01-01

Procedures are recommended for obtaining experimental values of aircraft flyover noise levels (and associated parameters). Specific recommendations are made for test criteria, instrumentation performance requirements, data-acquisition procedures, and test operations. The recommendations are based on state-of-the-art measurement capabilities available in 1976 and are consistent with the measurement objectives of the NASA Aircraft Noise Prediction Program. The recommendations are applicable to measurements of the noise produced by an airplane flying subsonically over (or past) microphones located near the surface of the ground. Aircraft types covered by the recommendations are fixed-wing airplanes powered by turbojet or turbofan engines and using conventional aerodynamic means for takeoff and landing. Various assumptions with respect to subsequent data processing and analysis were made (and are described) and the recommended measurement procedures are compatible with the assumptions. Some areas where additional research is needed relative to aircraft flyover noise measurement techniques are also discussed.

I should not recommend it to you even if you will like it: the ethics of recommender systems

NASA Astrophysics Data System (ADS)

Tang, Tiffany Ya; Winoto, Pinata

2016-01-01

In this paper, we extend the current research in the recommendation system community by showing that users did attach ethical consideration to items. In an experiment (N = 111) that manipulated several moral factors regarding the potentially harmful content in movies, books, and games, users were asked to evaluate the appropriateness of recommending these items to teenagers and adult couples. Results agreed with previous studies in that gender plays a key role in making moral judgment, especially regarding the ethical appropriateness of an item. The pilot study further identifies degrees of aversion regarding the appeal of these elements in media for ethical recommendations. Based on the study, we propose a user-initiated ethical recommender system to help users pick up morally appropriate items during the post-recommendation process. We believe that the ethical appropriateness of items perceived by end users could predict the trust and credibility of the system.

Trust-aware recommendation for improving aggregate diversity

NASA Astrophysics Data System (ADS)

Liu, Haifeng; Bai, Xiaomei; Yang, Zhuo; Tolba, Amr; Xia, Feng

2015-10-01

Recommender systems are becoming increasingly important and prevalent because of the ability of solving information overload. In recent years, researchers are paying increasing attention to aggregate diversity as a key metric beyond accuracy, because improving aggregate recommendation diversity may increase long tails and sales diversity. Trust is often used to improve recommendation accuracy. However, how to utilize trust to improve aggregate recommendation diversity is unexplored. In this paper, we focus on solving this problem and propose a novel trust-aware recommendation method by incorporating time factor into similarity computation. The rationale underlying the proposed method is that, trustees with later creation time of trust relation can bring more diverse items to recommend to their trustors than other trustees with earlier creation time of trust relation. Through relevant experiments on publicly available dataset, we demonstrate that the proposed method outperforms the baseline method in terms of aggregate diversity while maintaining almost the same recall.

Improved collaborative filtering recommendation algorithm of similarity measure

NASA Astrophysics Data System (ADS)

Zhang, Baofu; Yuan, Baoping

2017-05-01

The Collaborative filtering recommendation algorithm is one of the most widely used recommendation algorithm in personalized recommender systems. The key is to find the nearest neighbor set of the active user by using similarity measure. However, the methods of traditional similarity measure mainly focus on the similarity of user common rating items, but ignore the relationship between the user common rating items and all items the user rates. And because rating matrix is very sparse, traditional collaborative filtering recommendation algorithm is not high efficiency. In order to obtain better accuracy, based on the consideration of common preference between users, the difference of rating scale and score of common items, this paper presents an improved similarity measure method, and based on this method, a collaborative filtering recommendation algorithm based on similarity improvement is proposed. Experimental results show that the algorithm can effectively improve the quality of recommendation, thus alleviate the impact of data sparseness.

75 FR 984 - Draft Recommended Interim Preliminary Remediation Goals for Dioxin in Soil at CERCLA and RCRA Sites

Federal Register 2010, 2011, 2012, 2013, 2014

2010-01-07

... Recommended Interim Preliminary Remediation Goals for Dioxin in Soil at CERCLA and RCRA Sites AGENCY... Recommended Interim Preliminary Remediation Goals for Dioxin in Soil at Comprehensive Environmental Response... interim PRGs for dioxin in soil. These draft recommended interim PRGs were calculated using existing, peer...

Advanced Dental Education: Recommendations for the 80's. Issues in Dental Health Policy.

ERIC Educational Resources Information Center

American Association of Dental Schools, Washington, DC.

Six statements of working principles and 11 major recommendations falling within those areas, as established by the Task Force on Advanced Dental Education, are presented. Supporting recommendations are also provided. The six principles include: (1) no change is recommended in the present goal of predoctoral education, to prepare students for…

14 CFR 77.65 - Recommendations by parties.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 14 Aeronautics and Space 2 2011-01-01 2011-01-01 false Recommendations by parties. 77.65 Section... Subpart D § 77.65 Recommendations by parties. Within 20 days after the mailing of the record of hearing by... presiding officer five copies of his recommendations for a final decision to be made by the Administrator. ...

10 CFR 960.3-2-3 - Recommendation of sites for characterization.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 10 Energy 4 2011-01-01 2011-01-01 false Recommendation of sites for characterization. 960.3-2-3... POTENTIAL SITES FOR A NUCLEAR WASTE REPOSITORY Implementation Guidelines § 960.3-2-3 Recommendation of sites... President not less than three candidate sites for such characterization. The recommendation decision shall...

7 CFR 981.49 - Board estimates and recommendations.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 8 2011-01-01 2011-01-01 false Board estimates and recommendations. 981.49 Section... recommendations. To aid the Secretary in fixing the salable and reserve percentages, the Board shall furnish to... recommendations for the crop year, each of which, or any later revisions thereof, shall be adopted by the...

7 CFR 1.420 - Consent recommendation.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 1 2010-01-01 2010-01-01 false Consent recommendation. 1.420 Section 1.420... Conservation and Shortage Relief Act of 1990 (16 U.S.C. 620 et seq.) § 1.420 Consent recommendation. Any time before the Judge files the decision, the parties of record may enter a consent recommendation. Such...

7 CFR 981.49 - Board estimates and recommendations.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 8 2010-01-01 2010-01-01 false Board estimates and recommendations. 981.49 Section... recommendations. To aid the Secretary in fixing the salable and reserve percentages, the Board shall furnish to... recommendations for the crop year, each of which, or any later revisions thereof, shall be adopted by the...

10 CFR 960.3-1-4-3 - Site recommendation for characterization.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 10 Energy 4 2011-01-01 2011-01-01 false Site recommendation for characterization. 960.3-1-4-3... POTENTIAL SITES FOR A NUCLEAR WASTE REPOSITORY Implementation Guidelines § 960.3-1-4-3 Site recommendation for characterization. The evidence required to support the recommendation of a site as a candidate...

Improved Personalized Recommendation Based on Causal Association Rule and Collaborative Filtering

ERIC Educational Resources Information Center

Lei, Wu; Qing, Fang; Zhou, Jin

2016-01-01

There are usually limited user evaluation of resources on a recommender system, which caused an extremely sparse user rating matrix, and this greatly reduce the accuracy of personalized recommendation, especially for new users or new items. This paper presents a recommendation method based on rating prediction using causal association rules.…

48 CFR 1419.202-70 - Acquisition screening and BUDS recommendations.

Code of Federal Regulations, 2011 CFR

2011-10-01

... BUDS recommendations. 1419.202-70 Section 1419.202-70 Federal Acquisition Regulations System DEPARTMENT... screening and BUDS recommendations. (a) For open market acquisitions estimated to exceed the SAT, the DI... document the rationale for not accepting a SBS recommendation on DI Form 1886, under “Notes.” (See FAR 19...

7 CFR 1.420 - Consent recommendation.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 1 2011-01-01 2011-01-01 false Consent recommendation. 1.420 Section 1.420... Conservation and Shortage Relief Act of 1990 (16 U.S.C. 620 et seq.) § 1.420 Consent recommendation. Any time before the Judge files the decision, the parties of record may enter a consent recommendation. Such...

48 CFR 1419.202-70 - Acquisition screening and BUDS recommendations.

Code of Federal Regulations, 2010 CFR

2010-10-01

... BUDS recommendations. 1419.202-70 Section 1419.202-70 Federal Acquisition Regulations System DEPARTMENT... screening and BUDS recommendations. (a) For open market acquisitions estimated to exceed the SAT, the DI... document the rationale for not accepting a BUDS recommendation on DI Form 1886, under “Notes.” (See FAR 19...

40 CFR 246.201-3 - Recommended procedures: Glass, can, and mixed paper separation.

Code of Federal Regulations, 2012 CFR

2012-07-01

... mixed paper separation. 246.201-3 Section 246.201-3 Protection of Environment ENVIRONMENTAL PROTECTION... Recommended Procedures § 246.201-3 Recommended procedures: Glass, can, and mixed paper separation. In areas where markets are available, it is recommended that glass, cans, and mixed paper be separated at the...

Automated Analysis of Text in Graduate School Recommendations. Research Report. ETS RR-15-23

ERIC Educational Resources Information Center

Heilman, Michael; Breyer, F. Jay; Williams, Frank; Klieger, David; Flor, Michael

2015-01-01

Graduate school recommendations are an important part of admissions in higher education, and natural language processing may be able to provide objective and consistent analyses of recommendation texts to complement readings by faculty and admissions staff. However, these sorts of high-stakes, personal recommendations are different from the…

9 CFR 72.16 - Designated dipping stations to be approved by the Administrator, APHIS on recommendations of...

Code of Federal Regulations, 2010 CFR

2010-01-01

... approved by the Administrator, APHIS on recommendations of State authorities; facilities. 72.16 Section 72... CATTLE § 72.16 Designated dipping stations to be approved by the Administrator, APHIS on recommendations of State authorities; facilities. When deemed advisable and upon recommendation by the proper...

Recommending Peers for Learning: Matching on Dissimilarity in Interpretations to Provoke Breakdown

ERIC Educational Resources Information Center

Rajagopal, Kamakshi; van Bruggen, Jan M.; Sloep, Peter B.

2017-01-01

People recommenders are a widespread feature of social networking sites and educational social learning platforms alike. However, when these systems are used to extend learners' Personal Learning Networks, they often fall short of providing recommendations of learning value to their users. This paper proposes a design of a people recommender based…

29 CFR 1912a.5 - Advice and recommendations.

Code of Federal Regulations, 2011 CFR

2011-07-01

... (CONTINUED) NATIONAL ADVISORY COMMITTEE ON OCCUPATIONAL SAFETY AND HEALTH § 1912a.5 Advice and recommendations. Any advice or recommendations of the Committee shall be given or made with approval of a majority... 29 Labor 7 2011-07-01 2011-07-01 false Advice and recommendations. 1912a.5 Section 1912a.5 Labor...

29 CFR 1912a.5 - Advice and recommendations.

Code of Federal Regulations, 2010 CFR

2010-07-01

... (CONTINUED) NATIONAL ADVISORY COMMITTEE ON OCCUPATIONAL SAFETY AND HEALTH § 1912a.5 Advice and recommendations. Any advice or recommendations of the Committee shall be given or made with approval of a majority... 29 Labor 7 2010-07-01 2010-07-01 false Advice and recommendations. 1912a.5 Section 1912a.5 Labor...

Career Goal-Based E-Learning Recommendation Using Enhanced Collaborative Filtering and PrefixSpan

ERIC Educational Resources Information Center

Ma, Xueying; Ye, Lu

2018-01-01

This article describes how e-learning recommender systems nowadays have applied different kinds of techniques to recommend personalized learning content for users based on their preference, goals, interests and background information. However, the cold-start problem which exists in traditional recommendation algorithms are still left over in…

Behavioral Recommendations in Health Research News as Cues to Action: Self-Relevancy and Self-Efficacy Processes.

PubMed

Chang, Chingching

2016-08-01

This study argues that behavioral recommendations in health news function as cues to action. A proposed self-oriented model seeks to explore the impacts of behavioral recommendations in health research news as cues to action through their influences on self-relevancy and self-efficacy. A content analysis (Study 1) first establishes that health research news commonly features behavioral recommendations. A message experiment (Study 2) then explores the utility of behavioral recommendations as cues to action by demonstrating a self-relevancy effect: Health research news with, as opposed to without, behavioral recommendations increases the self-relevancy of advocated health behaviors, which then improve people's attitudes toward and intentions to adopt those behaviors. A second message experiment (Study 3) tests whether varying presentations of behavioral recommendations alter their effectiveness as cues to action and thus people's behavioral intentions through a dual effect process. In addition to the previously demonstrated self-relevancy effect, this experiment shows that concrete, as opposed to abstract, behavioral recommendations trigger a self-efficacy effect, increasing perceived self-efficacy and further improving behavioral intentions.

The omni-relevance of surgery: how medical specialization shapes orthopedic surgeons' treatment recommendations.

PubMed

Hudak, Pamela L; Clark, Shannon J; Raymond, Geoffrey

2013-01-01

This article examines treatment recommendations in orthopedic surgery consultations and shows how surgery is treated as "omni-relevant" within this activity, providing a context within which the broad range of treatment recommendations proposed by surgeons is offered. Using conversation analysis to analyse audiotaped encounters between orthopedic surgeons and patients, we highlight how surgeons treat surgery as having a special, privileged status relative to other treatment options by (1) invoking surgery (whether or not it is actually being recommended) and (2) presenting surgery as the "last best resort" (in relation to which other treatment options are calibrated, described and considered). This privileged status surfaces in the design and delivery of recommendations as a clear asymmetry: Recommendations for surgery are proposed early, in relatively simple and unmitigated form. In contrast, recommendations not for surgery tend to be delayed and involve significantly more interactional work in their delivery. Possible implications of these findings, including how surgeons' structuring of recommendations may shape patient expectations (whether for surgery or some alternative), and potentially influence the distribution of orthopedic surgery procedures arising from these consultations, are considered.

Promoting Cold-Start Items in Recommender Systems

PubMed Central

Liu, Jin-Hu; Zhou, Tao; Zhang, Zi-Ke; Yang, Zimo; Liu, Chuang; Li, Wei-Min

2014-01-01

As one of the major challenges, cold-start problem plagues nearly all recommender systems. In particular, new items will be overlooked, impeding the development of new products online. Given limited resources, how to utilize the knowledge of recommender systems and design efficient marketing strategy for new items is extremely important. In this paper, we convert this ticklish issue into a clear mathematical problem based on a bipartite network representation. Under the most widely used algorithm in real e-commerce recommender systems, the so-called item-based collaborative filtering, we show that to simply push new items to active users is not a good strategy. Interestingly, experiments on real recommender systems indicate that to connect new items with some less active users will statistically yield better performance, namely, these new items will have more chance to appear in other users' recommendation lists. Further analysis suggests that the disassortative nature of recommender systems contributes to such observation. In a word, getting in-depth understanding on recommender systems could pave the way for the owners to popularize their cold-start products with low costs. PMID:25479013

Promoting cold-start items in recommender systems.

PubMed

Liu, Jin-Hu; Zhou, Tao; Zhang, Zi-Ke; Yang, Zimo; Liu, Chuang; Li, Wei-Min

2014-01-01

As one of the major challenges, cold-start problem plagues nearly all recommender systems. In particular, new items will be overlooked, impeding the development of new products online. Given limited resources, how to utilize the knowledge of recommender systems and design efficient marketing strategy for new items is extremely important. In this paper, we convert this ticklish issue into a clear mathematical problem based on a bipartite network representation. Under the most widely used algorithm in real e-commerce recommender systems, the so-called item-based collaborative filtering, we show that to simply push new items to active users is not a good strategy. Interestingly, experiments on real recommender systems indicate that to connect new items with some less active users will statistically yield better performance, namely, these new items will have more chance to appear in other users' recommendation lists. Further analysis suggests that the disassortative nature of recommender systems contributes to such observation. In a word, getting in-depth understanding on recommender systems could pave the way for the owners to popularize their cold-start products with low costs.

The APOSTEL recommendations for reporting quantitative optical coherence tomography studies.

PubMed

Cruz-Herranz, Andrés; Balk, Lisanne J; Oberwahrenbrock, Timm; Saidha, Shiv; Martinez-Lapiscina, Elena H; Lagreze, Wolf A; Schuman, Joel S; Villoslada, Pablo; Calabresi, Peter; Balcer, Laura; Petzold, Axel; Green, Ari J; Paul, Friedemann; Brandt, Alexander U; Albrecht, Philipp

2016-06-14

To develop consensus recommendations for reporting of quantitative optical coherence tomography (OCT) study results. A panel of experienced OCT researchers (including 11 neurologists, 2 ophthalmologists, and 2 neuroscientists) discussed requirements for performing and reporting quantitative analyses of retinal morphology and developed a list of initial recommendations based on experience and previous studies. The list of recommendations was subsequently revised during several meetings of the coordinating group. We provide a 9-point checklist encompassing aspects deemed relevant when reporting quantitative OCT studies. The areas covered are study protocol, acquisition device, acquisition settings, scanning protocol, funduscopic imaging, postacquisition data selection, postacquisition data analysis, recommended nomenclature, and statistical analysis. The Advised Protocol for OCT Study Terminology and Elements recommendations include core items to standardize and improve quality of reporting in quantitative OCT studies. The recommendations will make reporting of quantitative OCT studies more consistent and in line with existing standards for reporting research in other biomedical areas. The recommendations originated from expert consensus and thus represent Class IV evidence. They will need to be regularly adjusted according to new insights and practices. © 2016 American Academy of Neurology.

Effects of the bipartite structure of a network on performance of recommenders

NASA Astrophysics Data System (ADS)

Wang, Qing-Xian; Li, Jian; Luo, Xin; Xu, Jian-Jun; Shang, Ming-Sheng

2018-02-01

Recommender systems aim to predict people's preferences for online items by analyzing their historical behaviors. A recommender can be modeled as a high-dimensional and sparse bipartite network, where the key issue is to understand the relation between the network structure and a recommender's performance. To address this issue, we choose three network characteristics, clustering coefficient, network density and user-item ratio, as the analyzing targets. For the cluster coefficient, we adopt the Degree-preserving rewiring algorithm to obtain a series of bipartite network with varying cluster coefficient, while the degree of user and item keep unchanged. Furthermore, five state-of-the-art recommenders are applied on two real datasets. The performances of recommenders are measured by both numerical and physical metrics. These results show that a recommender's performance is positively related to the clustering coefficient of a bipartite network. Meanwhile, higher density of a bipartite network can provide more accurate but less diverse or novel recommendations. Furthermore, the user-item ratio is positively correlated with the accuracy metrics but negatively correlated with the diverse and novel metrics.

Factors Explaining Racial/Ethnic Disparities in Rates of Physician Recommendation for Colorectal Cancer Screening

PubMed Central

Pelletier, Valerie; Winter, Kelly; Albatineh, Ahmed N.

2013-01-01

Objectives. Physician recommendation plays a crucial role in receiving endoscopic screening for colorectal cancer (CRC). This study explored factors associated with racial/ethnic differences in rates of screening recommendation. Methods. Data on 5900 adults eligible for endoscopic screening were obtained from the National Health Interview Survey. Odds ratios of receiving an endoscopy recommendation were calculated for selected variables. Planned, sequenced logistic regressions were conducted to examine the extent to which socioeconomic and health care variables account for racial/ethnic disparities in recommendation rates. Results. Differential rates were observed for CRC screening and screening recommendations among racial/ethnic groups. Compared with Whites, Hispanics were 34% less likely (P < .01) and Blacks were 26% less likely (P < .05) to receive this recommendation. The main predictors that emerged in sequenced analysis were education for Hispanics and Blacks and income for Blacks. After accounting for the effects of usual source of care, insurance coverage, and education, the disparity reduced and became statistically insignificant. Conclusions. Socioeconomic status and access to health care may explain major racial/ethnic disparities in CRC screening recommendation rates. PMID:23678899

[Explorations of breast microcalcifications: Guidelines].

PubMed

Chamming's, F; Chopier, J; Mathelin, C; Chéreau, E

2015-12-01

To assess imaging performances for the detection, characterization and biopsy of breast microcalcifications and make recommendations. French and English publications were searched using PubMed, Cochrane Library and international learned societies recommendations. Digital mammography (DR [Direct Radiography] and CR [Computed Radiography]) and screen-film mammography demonstrate good performances for the detection and the characterization of breast microcalcifications. Systematic use of the 2013 edition of the BI-RADS lexicon is recommended for description and characterization of microcalcifications. Faced with BI-RADS 4 or 5 microcalcifications, breast ultrasound is recommended but a normal result does not eliminate the diagnosis of cancer and other examination should be performed. Literature review does not allow recommending digital breast tomosynthesis, elastography or MRI to analyze microcalcifications. In case of probably benign microcalcifications (BI-RADS 3), six months, one year and at least two years follow-up are recommended. In case a biopsy is indicated, it is recommended to use a vacuum-assisted macrobiopsy system with 11-gauges needles or bigger. If no calcification is visible on the radiography of the specimen, it is recommended to obtain additional samples. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Soft Regulation with Crowd Recommendation: Coordinating Self-Interested Agents in Sociotechnical Systems under Imperfect Information.

PubMed

Luo, Yu; Iyengar, Garud; Venkatasubramanian, Venkat

2016-01-01

Regulating emerging industries is challenging, even controversial at times. Under-regulation can result in safety threats to plant personnel, surrounding communities, and the environment. Over-regulation may hinder innovation, progress, and economic growth. Since one typically has limited understanding of, and experience with, the novel technology in practice, it is difficult to accomplish a properly balanced regulation. In this work, we propose a control and coordination policy called soft regulation that attempts to strike the right balance and create a collective learning environment. In soft regulation mechanism, individual agents can accept, reject, or partially accept the regulator's recommendation. This non-intrusive coordination does not interrupt normal operations. The extent to which an agent accepts the recommendation is mediated by a confidence level (from 0 to 100%). Among all possible recommendation methods, we investigate two in particular: the best recommendation wherein the regulator is completely informed and the crowd recommendation wherein the regulator collects the crowd's average and recommends that value. We show by analysis and simulations that soft regulation with crowd recommendation performs well. It converges to optimum, and is as good as the best recommendation for a wide range of confidence levels. This work sheds a new theoretical perspective on the concept of the wisdom of crowds.

Dietary behaviors related to cancer prevention among pre-adolescents and adolescents: the gap between recommendations and reality.

PubMed

Holman, Dawn M; White, Mary C

2011-06-01

Diet is thought to play an important role in cancer risk. This paper summarizes dietary recommendations for cancer prevention and compares these recommendations to the dietary behaviors of U.S. youth ages 8-18. We identified cancer prevention-related dietary recommendations from key health organizations and assessed dietary consumption patterns among youth using published statistics from the National Health and Nutrition Examination Survey, the national Youth Risk Behavior Survey, and other supplemental sources. Cancer prevention guidelines recommend a diet rich in fruits, vegetables, and whole grains, recommend limiting sugary foods and beverages, red and processed meats, sodium, and alcohol, and recommend avoiding foods contaminated with carcinogens. However, youth typically do not meet the daily recommendations for fruit, vegetable, or whole grain consumption and are over-consuming energy-dense, sugary and salty foods. A large discrepancy exists between expert recommendations about diet and cancer and actual dietary practices among young people and points to the need for more research to better promote the translation of science into practice. Future research should focus on developing and evaluating policies and interventions at the community, state and national levels for aligning the diets of youth with the evolving scientific evidence regarding cancer prevention.

A Hybrid Approach using Collaborative filtering and Content based Filtering for Recommender System

NASA Astrophysics Data System (ADS)

Geetha, G.; Safa, M.; Fancy, C.; Saranya, D.

2018-04-01

In today’s digital world, it has become an irksome task to find the content of one's liking in an endless variety of content that are being consumed like books, videos, articles, movies, etc. On the other hand there has been an emerging growth among the digital content providers who want to engage as many users on their service as possible for the maximum time. This gave birth to the recommender system comes wherein the content providers recommend users the content according to the users’ taste and liking. In this paper we have proposed a movie recommendation system. A movie recommendation is important in our social life due to its features such as suggesting a set of movies to users based on their interest, or the popularities of the movies. In this paper we are proposing a movie recommendation system that has the ability to recommend movies to a new user as well as the other existing users. It mines movie databases to collect all the important information, such as, popularity and attractiveness, which are required for recommendation. We use content-based and collaborative filtering and also hybrid filtering, which is a combination of the results of these two techniques, to construct a system that provides more precise recommendations concerning movies.

Soft Regulation with Crowd Recommendation: Coordinating Self-Interested Agents in Sociotechnical Systems under Imperfect Information

PubMed Central

2016-01-01

Regulating emerging industries is challenging, even controversial at times. Under-regulation can result in safety threats to plant personnel, surrounding communities, and the environment. Over-regulation may hinder innovation, progress, and economic growth. Since one typically has limited understanding of, and experience with, the novel technology in practice, it is difficult to accomplish a properly balanced regulation. In this work, we propose a control and coordination policy called soft regulation that attempts to strike the right balance and create a collective learning environment. In soft regulation mechanism, individual agents can accept, reject, or partially accept the regulator’s recommendation. This non-intrusive coordination does not interrupt normal operations. The extent to which an agent accepts the recommendation is mediated by a confidence level (from 0 to 100%). Among all possible recommendation methods, we investigate two in particular: the best recommendation wherein the regulator is completely informed and the crowd recommendation wherein the regulator collects the crowd’s average and recommends that value. We show by analysis and simulations that soft regulation with crowd recommendation performs well. It converges to optimum, and is as good as the best recommendation for a wide range of confidence levels. This work sheds a new theoretical perspective on the concept of the wisdom of crowds. PMID:26977699

OARSI Clinical Trials Recommendations: Design, conduct, and reporting of clinical trials for knee osteoarthritis.

PubMed

McAlindon, T E; Driban, J B; Henrotin, Y; Hunter, D J; Jiang, G-L; Skou, S T; Wang, S; Schnitzer, T

2015-05-01

The goal of this document is to update the original OARSI recommendations specifically for the design, conduct, and reporting of clinical trials that target symptom or structure modification among individuals with knee osteoarthritis (OA). To develop recommendations for the design, conduct, and reporting of clinical trials for knee OA we initially drafted recommendations through an iterative process. Members of the working group included representatives from industry and academia. After the working group members reviewed a final draft, they scored the appropriateness for recommendations. After the members voted we calculated the median score among the nine members of the working group who completed the score. The document includes 25 recommendations regarding randomization, blocking and stratification, blinding, enhancing accuracy of patient-reported outcomes (PRO), selecting a study population and index knee, describing interventions, patient-reported and physical performance measures, structural outcome measures, biochemical biomarkers, and reporting recommendations. In summary, the working group identified 25 recommendations that represent the current best practices regarding clinical trials that target symptom or structure modification among individuals with knee OA. These updated recommendations incorporate novel technologies (e.g., magnetic resonance imaging (MRI)) and strategies to address the heterogeneity of knee OA. Copyright © 2015 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

The cumulative impact of physical activity, sleep duration, and television time on adolescent obesity: 2011 Youth Risk Behavior Survey.

PubMed

Laurson, Kelly R; Lee, Joey A; Eisenmann, Joey C

2015-03-01

Physical activity (PA), television time (TV), and sleep duration (SLP) are considered individual risk factors for adolescent obesity. Our aim was to investigate the concurrent influence of meeting PA, SLP, and TV recommendations on adolescent obesity utilizing 2011 Youth Risk Behavior Surveillance Survey (YRBSS) data. Subjects included 9589 (4874 females) high school students. PA, SLP, and TV were categorized utilizing established national recommendations and youth were cross-tabulated into 1 of 8 groups based on meeting or not meeting each recommendation. Logistic models were used to examine the odds of obesity for each group. Youth meeting the PA recommendation were not at increased odds of obesity, regardless of SLP or TV status. However, not meeting any single recommendation, in general, led to increased odds of not meeting the other two. In boys, 11.8% met all recommendations while 14.1% met 0 recommendations. In girls, only 5.0% met all recommendations while 17.8% met none. Boys and girls not meeting any of the recommendations were 4.0 and 3.8 times more likely to be obese compared with their respective referent groups. Further research considering the simultaneous influence these risk factors may have on obesity and on one another is warranted.

Objective consensus from decision trees.

PubMed

Putora, Paul Martin; Panje, Cedric M; Papachristofilou, Alexandros; Dal Pra, Alan; Hundsberger, Thomas; Plasswilm, Ludwig

2014-12-05

Consensus-based approaches provide an alternative to evidence-based decision making, especially in situations where high-level evidence is limited. Our aim was to demonstrate a novel source of information, objective consensus based on recommendations in decision tree format from multiple sources. Based on nine sample recommendations in decision tree format a representative analysis was performed. The most common (mode) recommendations for each eventuality (each permutation of parameters) were determined. The same procedure was applied to real clinical recommendations for primary radiotherapy for prostate cancer. Data was collected from 16 radiation oncology centres, converted into decision tree format and analyzed in order to determine the objective consensus. Based on information from multiple sources in decision tree format, treatment recommendations can be assessed for every parameter combination. An objective consensus can be determined by means of mode recommendations without compromise or confrontation among the parties. In the clinical example involving prostate cancer therapy, three parameters were used with two cut-off values each (Gleason score, PSA, T-stage) resulting in a total of 27 possible combinations per decision tree. Despite significant variations among the recommendations, a mode recommendation could be found for specific combinations of parameters. Recommendations represented as decision trees can serve as a basis for objective consensus among multiple parties.

[Prevention of infections in adults and adolescents with systemic lupus erythematosus: Guidelines for the clinical practice based on the literature and expert opinion].

PubMed

Mathian, A; Arnaud, L; Adoue, D; Agard, C; Bader-Meunier, B; Baudouin, V; Belizna, C; Bonnotte, B; Boumedine, F; Chaib, A; Chauchard, M; Chiche, L; Daugas, E; Ghali, A; Gobert, P; Gondran, G; Guettrot-Imbert, G; Hachulla, E; Hamidou, M; Haroche, J; Hervier, B; Hummel, A; Jourde-Chiche, N; Korganow, A-S; Kwon, T; Le Guern, V; Le Quellec, A; Limal, N; Magy-Bertrand, N; Marianetti-Guingel, P; Martin, T; Martin Silva, N; Meyer, O; Miyara, M; Morell-Dubois, S; Ninet, J; Pennaforte, J-L; Polomat, K; Pourrat, J; Queyrel, V; Raymond, I; Remy, P; Sacre, K; Sibilia, J; Viallard, J-F; Viau Brabant, A; Hanslik, T; Amoura, Z

2016-05-01

To develop French recommendations about the management of vaccinations, the screening of cervical cancer and the prevention of pneumocystis pneumonia in systemic lupus erythematosus (SLE). Thirty-seven experts qualified in internal medicine, rheumatology, dermatology, nephrology and pediatrics have selected recommendations from a list of proposition based on available data from the literature. For each recommendation, the level of evidence and the level of agreement among the experts were specified. Inactivated vaccines do not cause significant harm in SLE patients. Experts recommend that lupus patient should receive vaccinations accordingly to the recommendations and the schedules for the general public. Pneumococcal vaccination is recommended for all SLE patients. Influenza vaccination is recommended for immunosuppressed SLE patients. Live attenuated vaccines should be avoided in immunosuppressed patients. Yet, recent works suggest that they can be considered in mildly immunosuppressed patients. Experts have recommended a cervical cytology every year for immunosuppressed patients. No consensus was obtained for the prevention of pneumocystis pneumonia. These recommendations can be expected to improve clinical practice uniformity and, in the longer term, to optimize the management of SLE patients. Copyright © 2016 Société nationale française de médecine interne (SNFMI). Published by Elsevier SAS. All rights reserved.

[Recommendations for psychotherapy in psychiatric inpatient treatment : Results of the PAKT Study Part I].

PubMed

Uhlmann, C; Flammer, E; Pfiffner, C; Grempler, J; Längle, G; Eschweiler, G-W; Spießl, H; Steinert, T

2017-03-01

In the S3 treatment guidelines psychotherapy is recommended in all psychological disorders. Therefore, outpatient or inpatient psychotherapy should be recommended by therapists in most cases. On the other hand, it is well known that waiting periods for psychotherapeutic treatment are considerable, which raises the question how the recommendation for psychotherapy is presented in psychiatric hospitals in Germany. The article deals with the question of how frequent the recommendation of psychotherapeutic treatment is made after psychiatric inpatient stay or day care, and if there are differences between hospitals and patient groups. In four psychiatric hospitals in southern Germany the frequency of recommendation for psychotherapy in psychiatric patients was registered and compared to the number of all patients treated in the equivalent time. For this purpose, we analyzed data of the basic documentation in the four participating hospitals. Overall, 9.6 % of the patients received a recommendation of psychotherapeutic treatment. In the psychiatric university hospital a subsequent psychotherapeutic treatment was recommended somewhat more often. Differences between hospitals were present but marginal. Over all participating hospitals, psychotherapy was recommended markedly less frequently in patients with an F2 diagnosis in comparison with patients with F3 or F4 diagnoses. Psychotherapeutic treatment after psychiatric inpatient stay is recommended cautiously. Probably therapists anticipate the fact that the growing demand for psychotherapeutic treatment in general reduces the chances for persons after psychiatric inpatient treatment.

GRADE Evidence to Decision (EtD) frameworks for adoption, adaptation, and de novo development of trustworthy recommendations: GRADE-ADOLOPMENT.

PubMed

Schünemann, Holger J; Wiercioch, Wojtek; Brozek, Jan; Etxeandia-Ikobaltzeta, Itziar; Mustafa, Reem A; Manja, Veena; Brignardello-Petersen, Romina; Neumann, Ignacio; Falavigna, Maicon; Alhazzani, Waleed; Santesso, Nancy; Zhang, Yuan; Meerpohl, Jörg J; Morgan, Rebecca L; Rochwerg, Bram; Darzi, Andrea; Rojas, Maria Ximenas; Carrasco-Labra, Alonso; Adi, Yaser; AlRayees, Zulfa; Riva, John; Bollig, Claudia; Moore, Ainsley; Yepes-Nuñez, Juan José; Cuello, Carlos; Waziry, Reem; Akl, Elie A

2017-01-01

Guideline developers can: (1) adopt existing recommendations from others; (2) adapt existing recommendations to their own context; or (3) create recommendations de novo. Monetary and nonmonetary resources, credibility, maximization of uptake, as well as logical arguments should guide the choice of the approach and processes. To describe a potentially efficient model for guideline production based on adoption, adaptation, and/or de novo development of recommendations utilizing the Grading of Recommendations Assessment, Development and Evaluation (GRADE) Evidence to Decision (EtD) frameworks. We applied the model in a new national guideline program producing 22 practice guidelines. We searched for relevant evidence that informs the direction and strength of a recommendation. We then produced GRADE EtDs for guideline panels to develop recommendations. We produced a total of 80 EtD frameworks in approximately 4 months and 146 EtDs in approximately 6 months in two waves. Use of the EtD frameworks allowed panel members understand judgments of others about the criteria that bear on guideline recommendations and then make their own judgments about those criteria in a systematic approach. The "GRADE-ADOLOPMENT" approach to guideline production combines adoption, adaptation, and, as needed, de novo development of recommendations. If developers of guidelines follow EtD criteria more widely and make their work publically available, this approach should prove even more useful. Copyright © 2016 The Author(s). Published by Elsevier Inc. All rights reserved.

[Assessment of the sonographer's knowledge on the second trimester ultrasound recommendations of the National Technical Committee of Ultrasound].

PubMed

Matar, M; Picone, O; Dalmon, C; Ayoubi, J-M

2013-09-01

To evaluate the sonographers' knowledge of the National Technical Committee of Ultrasound's recommendations concerning second trimester ultrasound. Anonymous questionnaire was sent by e-mails containing 25 questions about demographic elements, the practice of second trimester ultrasound and the recommendations of the National Technical Committee of Ultrasound about second trimester ultrasound. Six hundred and eighty-four responses were obtained. Six hundred and fifty-three upon 684 (95%) of respondents practice second trimester ultrasound and 635 upon 653 (97%) know about the existence of the report of the National Technical Committee of Ultrasound. The rates of correct answers concerning recommended biometrical images vary between 97% for the biparietal diameter and head circumference, 98% for abdominal circumference and 100% for the femur length. While for morphological images, rates vary between 52% and 100%. A subgroup analysis (whether the respondents have already read the recommendations or not) showed that those who had read the recommendations have significantly better results than those who did not. Those who have already read the recommendations have better knowledge and global knowledge can be improved. National recommendations serve to promote a policy of quality assurance of ultrasound and may be used in medicolegal issues. The societies that make recommendations should more diffuse their work and practitioners should make effort to pursue the continuing medical education and to implement the recommendations. Copyright © 2013 Elsevier Masson SAS. 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

The Endocrine Society guidelines: when the confidence cart goes before the evidence horse.

PubMed

Brito, Juan P; Domecq, Juan P; Murad, Mohammed H; Guyatt, Gordon H; Montori, Victor M

2013-08-01

In 2005, the Endocrine Society (TES) adopted the GRADE system of developing clinical practice guidelines. Grading of Recommendations, Assessment, Development, and Evaluation working group guidance suggests that strong recommendations based on low or very low (L/VL) confidence may often be inappropriate, and has offered a taxonomy of paradigmatic situations in which strong recommendations based on L/VL confidence estimates may be appropriate. We sought to characterize strong recommendations of TES based on L/VL confidence evidence. We identified all strong recommendations based on L/VL confidence evidence published in TES guidelines between 2005 and 2011. We identified those consistent with one of the paradigmatic situations in the taxonomy. Two hundred six of 357 (58%) of the recommendations of TES were strong; of these, 121 (59%) were based on L/VL confidence evidence. Of these 121, 35 (29%) were consistent with one of the paradigmatic situations. The most common situation (13, 11%) was of a strong recommendation against the intervention because of low confidence evidence for benefit and high confidence evidence for harm. The remaining 86 (71%) comprised 43 (36%) "best practice" statements for which sensible alternatives do not exist; 5 (4%) in which recommendations were for "additional research"; 5 (4%) in which greater confidence in the estimates was warranted; and 33 (27%) for which we could not find a compelling explanation for the incongruence. Guideline panels should beware of formulating strong recommendations when confidence in estimates is low. Our taxonomy when such recommendations are appropriate may be helpful.

Adherence to dietary recommendations for Swedish adults across categories of greenhouse gas emissions from food.

PubMed

Sjörs, Camilla; Hedenus, Fredrik; Sjölander, Arvid; Tillander, Annika; Bälter, Katarina

2017-12-01

To explore associations between diet-related greenhouse gas emissions (GHGE), nutrient intakes and adherence to the Nordic Nutrition Recommendations among Swedish adults. Diet was assessed by 4d food records in the Swedish National Dietary Survey. GHGE was estimated by linking all foods to carbon dioxide equivalents, using data from life cycle assessment studies. Participants were categorized into quartiles of energy-adjusted GHGE and differences between GHGE groups regarding nutrient intakes and adherence to nutrient recommendations were explored. Sweden. Women (n 840) and men (n 627) aged 18-80 years. Differences in nutrient intakes and adherence to nutrient recommendations between GHGE groups were generally small. The dietary intake of participants with the lowest emissions was more in line with recommendations regarding protein, carbohydrates, dietary fibre and vitamin D, but further from recommendations regarding added sugar, compared with the highest GHGE group. The overall adherence to recommendations was found to be better among participants with lower emissions compared with higher emissions. Among women, 27 % in the lowest GHGE group adhered to at least twenty-three recommendations compared with only 12 % in the highest emission group. For men, the corresponding figures were 17 and 10 %, respectively. The study compared nutrient intakes as well as adherence to dietary recommendations for diets with different levels of GHGE from a national dietary survey. We found that participants with low-emission diets, despite higher intake of added sugar, adhered to a larger number of dietary recommendations than those with high emissions.

Are root cause analyses recommendations effective and sustainable? An observational study.

PubMed

Hibbert, Peter D; Thomas, Matthew J W; Deakin, Anita; Runciman, William B; Braithwaite, Jeffrey; Lomax, Stephanie; Prescott, Jonathan; Gorrie, Glenda; Szczygielski, Amy; Surwald, Tanja; Fraser, Catherine

2018-03-01

To assess the strength of root cause analysis (RCA) recommendations and their perceived levels of effectiveness and sustainability. All RCAs related to sentinel events (SEs) undertaken between the years 2010 and 2015 in the public health system in Victoria, Australia were analysed. The type and strength of each recommendation in the RCA reports were coded by an expert patient safety classifier using the US Department of Veteran Affairs type and strength criteria. Thirty-six public health services. The proportion of RCA recommendations which were classified as 'strong' (more likely to be effective and sustainable), 'medium' (possibly effective and sustainable) or 'weak' (less likely to be effective and sustainable). There were 227 RCAs in the period of study. In these RCAs, 1137 recommendations were made. Of these 8% were 'strong', 44% 'medium' and 48% were 'weak'. In 31 RCAs, or nearly 15%, only weak recommendations were made. In 24 (11%) RCAs five or more weak recommendations were made. In 165 (72%) RCAs no strong recommendations were made. The most frequent recommendation types were reviewing or enhancing a policy/guideline/documentation, and training and education. Only a small proportion of recommendations arising from RCAs in Victoria are 'strong'. This suggests that insights from the majority of RCAs are not likely to inform practice or process improvements. Suggested improvements include more human factors expertise and independence in investigations, more extensive application of existing tools that assist teams to prioritize recommendations that are likely to be effective, and greater use of observational and simulation techniques to understand the underlying systems factors. Time spent in repeatedly investigating similar incidents may be better spent aggregating and thematically analysing existing sources of information about patient safety.

['Third day intervention': an analysis of the factors associated with following the recommendations on the prescribing of antibiotics].

PubMed

García-San Miguel, Lucía; Cobo, Javier; Martínez, José Antonio; Arnau, Josep Maria; Murillas, Javier; Peña, Carmen; Segura, Ferran; Gurguí, Montserrat; Gálvez, Juan; Giménez, Montserrat; Gudiol, Francesc

2014-12-01

Stewardship programs on the use of antibiotics usually include interventions based on non-compulsory recommendations for the prescribers. Factors related to the adherence to expert recommendations, and the implementation of these programmes in daily practice, are of interest. A randomized, controlled, multicentre intervention study was performed in 32 hospitalization units. Antibiotic prescriptions were evaluated by an infectious disease specialist on the third day. We describe the implementation of the intervention, the factors associated with adherence to recommendations, and the impact of the intervention. A total of 3,192 interventions were carried out. Information sources used to prepare the recommendations varied significantly between centres. A modification was recommended in 65% of cases: withdrawal (47%), change in administration route (26%), change of drugs or number of antibiotics (27%), and change in dose (5%). Simplification of treatment accounted for 75% of all recommendations. Adherence was 68%, with significant differences between hospitals, and higher when the recommendations consisted of a dose adjustment or change of route, during the first intervention period, and also when recommendations were personally commented on, in addition to writing a note in the clinical chart. We did not find any reduction in antibiotic consumption or variation in the incidence of resistant pathogens. An important proportion of antibiotic prescriptions may be susceptible to improvement, most of them towards simplification. The adherence to the intervention was high, but significant variations at different centres were observed, depending on the type of recommendation, and the study period. Those recommendations that were personally commented on were more followed more than those only written. Copyright © 2013 Elsevier España, S.L.U. y Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.

American Society of Clinical Oncology Clinical Practice Guideline Update on Chemotherapy for Stage IV Non–Small-Cell Lung Cancer

PubMed Central

Azzoli, Christopher G.; Baker, Sherman; Temin, Sarah; Pao, William; Aliff, Timothy; Brahmer, Julie; Johnson, David H.; Laskin, Janessa L.; Masters, Gregory; Milton, Daniel; Nordquist, Luke; Pfister, David G.; Piantadosi, Steven; Schiller, Joan H.; Smith, Reily; Smith, Thomas J.; Strawn, John R.; Trent, David; Giaccone, Giuseppe

2009-01-01

The purpose of this article is to provide updated recommendations for the treatment of patients with stage IV non–small-cell lung cancer. A literature search identified relevant randomized trials published since 2002. The scope of the guideline was narrowed to chemotherapy and biologic therapy. An Update Committee reviewed the literature and made updated recommendations. One hundred sixty-two publications met the inclusion criteria. Recommendations were based on treatment strategies that improve overall survival. Treatments that improve only progression-free survival prompted scrutiny of toxicity and quality of life. For first-line therapy in patients with performance status of 0 or 1, a platinum-based two-drug combination of cytotoxic drugs is recommended. Nonplatinum cytotoxic doublets are acceptable for patients with contraindications to platinum therapy. For patients with performance status of 2, a single cytotoxic drug is sufficient. Stop first-line cytotoxic chemotherapy at disease progression or after four cycles in patients who are not responding to treatment. Stop two-drug cytotoxic chemotherapy at six cycles even in patients who are responding to therapy. The first-line use of gefitinib may be recommended for patients with known epidermal growth factor receptor (EGFR) mutation; for negative or unknown EGFR mutation status, cytotoxic chemotherapy is preferred. Bevacizumab is recommended with carboplatin-paclitaxel, except for patients with certain clinical characteristics. Cetuximab is recommended with cisplatin-vinorelbine for patients with EGFR-positive tumors by immunohistochemistry. Docetaxel, erlotinib, gefitinib, or pemetrexed is recommended as second-line therapy. Erlotinib is recommended as third-line therapy for patients who have not received prior erlotinib or gefitinib. Data are insufficient to recommend the routine third-line use of cytotoxic drugs. Data are insufficient to recommend routine use of molecular markers to select chemotherapy. PMID:19917871

The 2009 schizophrenia PORT psychosocial treatment recommendations and summary statements.

PubMed

Dixon, Lisa B; Dickerson, Faith; Bellack, Alan S; Bennett, Melanie; Dickinson, Dwight; Goldberg, Richard W; Lehman, Anthony; Tenhula, Wendy N; Calmes, Christine; Pasillas, Rebecca M; Peer, Jason; Kreyenbuhl, Julie

2010-01-01

The Schizophrenia Patient Outcomes Research Team (PORT) psychosocial treatment recommendations provide a comprehensive summary of current evidence-based psychosocial treatment interventions for persons with schizophrenia. There have been 2 previous sets of psychosocial treatment recommendations (Lehman AF, Steinwachs DM. Translating research into practice: the Schizophrenia Patient Outcomes Research Team (PORT) treatment recommendations. Schizophr Bull. 1998;24:1-10 and Lehman AF, Kreyenbuhl J, Buchanan RW, et al. The Schizophrenia Patient Outcomes Research Team (PORT): updated treatment recommendations 2003. Schizophr Bull. 2004;30:193-217). This article reports the third set of PORT recommendations that includes updated reviews in 7 areas as well as adding 5 new areas of review. Members of the psychosocial Evidence Review Group conducted reviews of the literature in each intervention area and drafted the recommendation or summary statement with supporting discussion. A Psychosocial Advisory Committee was consulted in all aspects of the review, and an expert panel commented on draft recommendations and summary statements. Our review process produced 8 treatment recommendations in the following areas: assertive community treatment, supported employment, cognitive behavioral therapy, family-based services, token economy, skills training, psychosocial interventions for alcohol and substance use disorders, and psychosocial interventions for weight management. Reviews of treatments focused on medication adherence, cognitive remediation, psychosocial treatments for recent onset schizophrenia, and peer support and peer-delivered services indicated that none of these treatment areas yet have enough evidence to merit a treatment recommendation, though each is an emerging area of interest. This update of PORT psychosocial treatment recommendations underscores both the expansion of knowledge regarding psychosocial treatments for persons with schizophrenia at the same time as the limitations in their implementation in clinical practice settings.

Growth, yield and tuber quality of Solanum tuberosum L. under supplemental ultraviolet-B radiation at different NPK levels.

PubMed

Singh, S; Kumari, R; Agrawal, M; Agrawal, S B

2011-05-01

In many areas, decreases in the stratospheric ozone layer have resulted in an increase in ultraviolet-B (UV-B, 280-315 nm) radiation reaching the Earth's surface. The present study was conducted to evaluate the interactive effects of supplemental UV-B (sUV-B) and mineral nutrients on a tuber crop, potato (Solanum tuberosum L. var Kufri Badshah), under natural field conditions in a dry tropical environment. The nutrient treatments were the recommended dose of NPK (F(o)), 1.5 times the recommended dose of NPK (F(1)), 1.5 times the recommended dose of N (F(2)) and 1.5 times the recommended dose of K (F(3)). The response of potato plants to sUV-B varied with nutrient treatment and concentration. sUV-B adversely affected growth, yield and quality of tubers, causing an increase in reducing sugars in the tubers and thus reducing the economic value. Growth and fresh weight of tubers was maximal with sUV-B at 1.5 times recommended NPK, but the dry weight of tubers were highest with the recommended NPK dose. Reducing sugar content was lower in potato plants treated with sUV-B and the recommended NPK than with sUV-B and 1.5 times the recommended NPK. This study thus clearly shows that growing potato with 1.5 times the recommended NPK or 1.5 times the recommended dose of N/K does not alleviate the sUV-B induced changes in yield and quality of tubers compared to the recommended NPK dose. © 2010 German Botanical Society and The Royal Botanical Society of the Netherlands.

Youth injury prevention in Canada: use of the Delphi method to develop recommendations.

PubMed

Pike, Ian; Piedt, Shannon; Davison, Colleen M; Russell, Kelly; Macpherson, Alison K; Pickett, William

2015-12-22

The Health Behaviour in School-aged Children Survey is one of very few cross-national health surveys that includes information on injury occurrence and prevention within adolescent populations. A collaboration to develop a Canadian youth injury report using these data resulted in, Injury among Young Canadians: A national study of contextual determinants. The objective of this study was to develop specific evidence-based, policy-oriented recommendations arising from the national report, using a modified-Delphi process with a panel of expert stakeholders. Eight injury prevention experts and a 3-person youth advisory team associated with a Canadian injury prevention organization (Parachute Canada) reviewed, edited and commented on report recommendations through a three-stage iterative modified-Delphi process. From an initial list of 27 draft recommendations, the modified-Delphi process resulted in a final list of 19 specific recommendations, worded to resonate with the group(s) responsible to lead or take the recommended action. Two recommendations were rated as "extremely important" or "very important" by 100 % of the expert panel, two were deleted, a further two recommendations were deleted but the content included as text in the report, and four were merged with other existing recommendations. The modified-Delphi process was an appropriate method to achieve agreement on 19 specific evidence-based, policy-oriented recommendations to complement the national youth injury report. In providing their input, it is noted that the injury stakeholders each acted as individual experts, unattached to any organizational position or policy. These recommendations will require multidisciplinary collaborations in order to support the proposed policy development, additional research, programming and clear decision-making for youth injury prevention.

The Impact of Consumer-Directed Health Plans and Patient Socioeconomic Status on Physician Recommendations for Colorectal Cancer Screening

PubMed Central

Mallya, Giridhar; Polsky, Daniel

2008-01-01

Background Consumer-directed health plans are increasingly common, yet little is known about their impact on physician decision-making and preventive service use. Objective To determine how patients’ deductible levels and socioeconomic status may affect primary care physicians’ recommendations for colorectal cancer screening. Design, Setting, and Participants Screening recommendations were elicited using hypothetical vignettes from a national sample of 1,500 primary care physicians. Physicians were randomized to one of four vignettes describing a patient with either low or high socioeconomic status (SES) and either low- or high-deductible plan. Bivariate and multivariate analyses were used to examine how recommendations varied as a function of SES and deductible. Outcome Measures Rates of recommendation for home fecal occult blood testing, sigmoidoscopy, colonoscopy, and inappropriate screening, defined as no screening or office-based fecal occult blood testing. Results A total of 528 (49%) eligible physicians responded. Overall, 7.2% of physicians recommended inappropriate screening; 3.2% of patients with high SES in low-deductible plans received inappropriate screening recommendations and 11.4% of patients with low SES in high-deductible plans for an adjusted odds ratio of 0.22 (0.05–0.89). The odds of a colonoscopy recommendation were over ten times higher (AOR 11.46, 5.26–24.94) for patients with high SES in low-deductible plans compared to patients with low SES in high-deductible plans. Funds in medical savings accounts eliminated differences in inappropriate screening recommendations. Conclusions Patient SES and deductible-level affect physician recommendations for preventive care. Coverage of preventive services and funds in medical savings accounts may help to mitigate the impact of high-deductibles and SES on inappropriate recommendations. PMID:18629590

Food group and micronutrient intake adequacy among children, adults and elderly women in Greece.

PubMed

Manios, Yannis; Moschonis, George; Grammatikaki, Evangelia; Mavrogianni, Christina; van den Heuvel, Ellen G H M; Bos, Rolf; Singh-Povel, Cecile

2015-03-11

The aim of the present study was to record the percentage of children, adults and elderly women in Greece meeting food and micronutrient intake recommendations. Additionally, the present study was aiming to identify the main food contributors of micronutrient intakes and assess the degree up to which meeting food intake recommendations also ensures micronutrient intake adequacy. Dietary intake data from three studies conducted in Greece (on 9-13-year-old children; 40-60-year-old adults; and 50-75-year-old women) were used to estimate mean intakes, the percentages of subjects meeting food and nutrient intake recommendations and the contribution of six core food groups to nutrient intake adequacy. The present study showed that more than 50% of children, adults and elderly women were failing to consume the recommended portions of vegetables, dairy and grains. Furthermore, children and adults consuming the recommended portions of individual core food groups had significantly lower percentages of inadequate micronutrient intakes compared to their counterparts not meeting food intake recommendations (p < 0.05). Nevertheless, even among those consuming the recommended portions from a specific core food group, the recommended intake of the corresponding micronutrient (for which this food group is the main contributor) was not always met. Indicatively, 18.2%-44.1% and 4.2%-7.0% of the populations under study were not meeting calcium and vitamin C intake recommendations, although they were consuming the recommended portions of dairy and fruits, respectively. In conclusion, these findings highlight the importance for public health policy makers to take all necessary initiatives to support the population in achieving the recommended intakes from all core food groups, but also emphasize on food variety to ensure adequate intake for all micronutrients.

Food Group and Micronutrient Intake Adequacy among Children, Adults and Elderly Women in Greece

PubMed Central

Manios, Yannis; Moschonis, George; Grammatikaki, Evangelia; Mavrogianni, Christina; van den Heuvel, Ellen GHM; Bos, Rolf; Singh-Povel, Cecile

2015-01-01

The aim of the present study was to record the percentage of children, adults and elderly women in Greece meeting food and micronutrient intake recommendations. Additionally, the present study was aiming to identify the main food contributors of micronutrient intakes and assess the degree up to which meeting food intake recommendations also ensures micronutrient intake adequacy. Dietary intake data from three studies conducted in Greece (on 9–13-year-old children; 40–60-year-old adults; and 50–75-year-old women) were used to estimate mean intakes, the percentages of subjects meeting food and nutrient intake recommendations and the contribution of six core food groups to nutrient intake adequacy. The present study showed that more than 50% of children, adults and elderly women were failing to consume the recommended portions of vegetables, dairy and grains. Furthermore, children and adults consuming the recommended portions of individual core food groups had significantly lower percentages of inadequate micronutrient intakes compared to their counterparts not meeting food intake recommendations (p < 0.05). Nevertheless, even among those consuming the recommended portions from a specific core food group, the recommended intake of the corresponding micronutrient (for which this food group is the main contributor) was not always met. Indicatively, 18.2%–44.1% and 4.2%–7.0% of the populations under study were not meeting calcium and vitamin C intake recommendations, although they were consuming the recommended portions of dairy and fruits, respectively. In conclusion, these findings highlight the importance for public health policy makers to take all necessary initiatives to support the population in achieving the recommended intakes from all core food groups, but also emphasize on food variety to ensure adequate intake for all micronutrients. PMID:25768954

Treatment Recommendations for Locally Advanced, Non-Small-Cell Lung Cancer: The Influence of Physician and Patient Factors

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

Lee, Irwin H.; Hayman, James A.; Landrum, Mary Beth

2009-08-01

Purpose: To determine the impact of patient age, comorbidity, and physician factors on treatment recommendations for locally advanced, unresectable non-small-cell lung cancer (NSCLC). Methods and Materials: We surveyed radiation oncologists regarding their recommendations for treatment (chemoradiation, radiation alone, chemotherapy alone, or no therapy) for hypothetical patients with Stage IIIB NSCLC who varied by age (55 vs. 80 years) and comorbid illness (none, moderate, or severe chronic obstructive pulmonary disease [COPD]). Multinomial logistic regression was used to assess the impact of physician and practice characteristics on radiation oncologists' treatment recommendations for three scenarios with the least agreement. Results: Of 214 radiationmore » oncologists, nearly all (99%) recommended chemoradiation for a healthy 55 year old. However, there was substantial variability in recommendations for a 55 year old with severe COPD, an 80-year-old with moderate COPD, and an 80-year-old with severe COPD. Physicians seeing a lower volume of lung cancer patients were statistically less likely to recommend radiotherapy for younger or older patients with severe COPD (both p < 0.05), but the impact was modest. Conclusions: Nearly all radiation oncologists report following the evidence-based recommendation of chemoradiation for young, otherwise healthy patients with locally advanced, unresectable NSCLC, but there is substantial variability in treatment recommendations for older or sicker patients, probably related to the lack of clinical trial data for such patients. The physician and practice characteristics we examined only weakly affected treatment recommendations. Additional clinical trial data are necessary to guide recommendations for treatment of elderly patients and patients with poor pulmonary function to optimize their management.« less

Comparison of current recommended regimens of atropinization in organophosphate poisoning.

PubMed

Connors, Nicholas J; Harnett, Zachary H; Hoffman, Robert S

2014-06-01

Atropine is the mainstay of therapy in organophosphate (OP) toxicity, though research and consensus on dosing is lacking. In 2004, as reported by Eddleston et al. (J Toxicol Clin Toxicol 42(6):865-75, 2004), they noted variation in recommended regimens. We assessed revisions of original references, additional citations, and electronic sources to determine the current variability in atropine dosing recommendations. Updated editions of references from Eddleston et al.'s work, texts of Internal and Emergency Medicine, and electronic resources were reviewed for atropine dosing recommendations. For comparison, recommendations were assessed using the same mean dose (23.4 mg) and the highest dose (75 mg) of atropine as used in the original paper. Recommendations were also compared with the dosing regimen from the World Health Organization (WHO). Thirteen of the original recommendations were updated and 15 additional references were added giving a convenience sample of 28. Sufficient information to calculate time to targeted dose was provided by 24 of these samples. Compared to 2004, current recommendations have greatly increased the speed of atropinization with 13/24 able to reach the mean and high atropine dose within 30 min compared to 1/36 in 2004. In 2004, there were 13 regimens where the maximum time to reach 75 mg was over 18 h, whereas now, there are 2. While only one recommendation called for doubling the dose for faster escalation in 2004, 15 of the 24 current works include dose doubling. In 2004, Eddleston et al. called for an evidence-based guideline for the treatment of OP poisoning that could be disseminated worldwide. Many current recommendations can adequately treat patients within 1 h. While the WHO recommendations remain slow to treat patients with OP poisoning, other authorities are close to a consensus on rapid atropinization.

Low proportion of high school senior athletes receiving recommended immunizations.

PubMed

Karpinos, Ashley Rowatt; Rizzone, Katherine H; Cribbs, Sarah P; Roumie, Christianne L

2014-05-01

The preparticipation physical evaluation (PPE) often serves as the only preventive health care visit for athletes, but immunization status is not uniformly addressed in such visits. Thus, athletes may not be receiving recommended immunizations. Our aim was to determine the proportion of high school senior athletes who received all recommended immunizations. Our hypothesis was that females would be less likely than males to receive all recommended immunizations given suboptimal human papillomavirus (HPV) vaccine uptake. We conducted a cross-sectional survey evaluation of the immunization status of high school senior athletes in Davidson County, TN. The primary composite outcome was receipt of recommended immunizations for tetanus, meningococcal, and seasonal influenza. For females, the primary outcome also included completion of the HPV series. A total of 162 participants, 104 males and 58 females, were included. More males than females received all recommended immunizations (15.4% vs 3.5%; P = 0.02). When HPV immunization was excluded from the composite outcome, there was no difference in the proportion of males and females who received all recommended immunizations (15.4% vs 15.5%; P = 0.98). The odds of receiving all recommended immunizations was 0.14 (95% CI, 0.03-0.72) for females compared with males when adjusted for covariates. Athletes seen at retail-based clinics for their PPE were less likely to receive all recommended immunizations compared with athletes seen in primary care (OR, 0.13; 95% CI, 0.02-0.69). Only 1 in 6 high school senior athletes received the recommended tetanus, meningococcal, and influenza immunizations. A lower proportion of females, only 1 in 28, received all recommended immunizations due to the HPV series. Policy changes requiring a review of immunizations at the PPE would benefit many high school athletes.

Beyond Wishful Thinking: Integrating Consumer Preferences in the Assessment of Dietary Recommendations

PubMed Central

2016-01-01

Convenience, taste, and prices are the main determinants of food choices. Complying with dietary recommendations therefore imposes a “taste cost” on consumers, potentially hindering adoption of those recommendations. The study presents and applies a new methodology, based on economic theory, to quantify this taste cost and assess the health and welfare effects of different dietary recommendations. Then, by comparison of those effects, we identify socially desirable recommendations that are most compatible with consumer preferences (i.e., that best balance health benefits against”taste cost”) and should be prioritized for promotion. The methodology proceeds in three-steps: first, an economic-behavioral model simulates how whole diets would change if consumers complied with dietary recommendations; second, an epidemiological model estimates the number of deaths avoided (DA) due to the dietary change; third, an efficiency analysis weighs the health benefits against the taste and policy costs of each recommendation. The empirical model is calibrated using French data. We find that recommendations to reduce consumption of red meat and soft-drinks, or raise consumption of milk products and fish/seafood impose relatively moderate taste costs. By comparison, recommendations related to F&V consumption and, to a lesser extent, butter/cream/cheese, snacks, and all meats impose larger taste costs on consumers. The F&V recommendation is the costliest for consumers to comply with, but it also reduces diet-related mortality the most, so that a large budget could be allocated to promoting F&V consumption while keeping this policy cost-beneficial. We conclude that promotion of most dietary recommendations improves social welfare. Our framework complements the programming models available in nutrition and public health: those models are best used to identify dietary targets, following which our framework identifies cost-beneficial ways of moving towards those targets. PMID:27362764

Beyond Wishful Thinking: Integrating Consumer Preferences in the Assessment of Dietary Recommendations.

PubMed

Irz, Xavier; Leroy, Pascal; Réquillart, Vincent; Soler, Louis-Georges

2016-01-01

Convenience, taste, and prices are the main determinants of food choices. Complying with dietary recommendations therefore imposes a "taste cost" on consumers, potentially hindering adoption of those recommendations. The study presents and applies a new methodology, based on economic theory, to quantify this taste cost and assess the health and welfare effects of different dietary recommendations. Then, by comparison of those effects, we identify socially desirable recommendations that are most compatible with consumer preferences (i.e., that best balance health benefits against"taste cost") and should be prioritized for promotion. The methodology proceeds in three-steps: first, an economic-behavioral model simulates how whole diets would change if consumers complied with dietary recommendations; second, an epidemiological model estimates the number of deaths avoided (DA) due to the dietary change; third, an efficiency analysis weighs the health benefits against the taste and policy costs of each recommendation. The empirical model is calibrated using French data. We find that recommendations to reduce consumption of red meat and soft-drinks, or raise consumption of milk products and fish/seafood impose relatively moderate taste costs. By comparison, recommendations related to F&V consumption and, to a lesser extent, butter/cream/cheese, snacks, and all meats impose larger taste costs on consumers. The F&V recommendation is the costliest for consumers to comply with, but it also reduces diet-related mortality the most, so that a large budget could be allocated to promoting F&V consumption while keeping this policy cost-beneficial. We conclude that promotion of most dietary recommendations improves social welfare. Our framework complements the programming models available in nutrition and public health: those models are best used to identify dietary targets, following which our framework identifies cost-beneficial ways of moving towards those targets.

Comparison between Complementary Dietary Treatment of Alzheimer Disease in Iranian Traditional Medicine and Modern Medicine

PubMed Central

AHMADIAN-ATTARI, Mohammad Mahdi; MOSADDEGH, Mahmoud; KAZEMNEJAD, Anooshiravan; NOORBALA, Ahmad Ali

2013-01-01

Abstract Background Dietary notifications have been introduced recently for Alzheimer Disease (AD). In Iranian old medical manuscripts, there are some nutritional recommendations related to Nesyan (AD equivalent). The aim of this article was to compare dietary recommendations of Iranian traditional medicine (ITM) with novel medical outcomes. Methods 1) Searching for dietary recommendations and abstinences described in ITM credible manuscripts; 2) Extracting fatty components of ITM diet according to the database of the Department of Agriculture of the USA; 3) Statistical analysis of fatty elements of traditionally recommended foods via Mann-Whitney Test in comparison with elements of the abstinent ones; 4) Searching for AD dietary recommendations and abstinences which currently published in medical journals; 5) Comparing traditional and new dietary suggestions with each other. Results 1) Traditionally recommended foods are fattier than abstinent ones (P<0.001). There are meaningful differences between unsaturated fatty acids (UFAs) (P<0.001), saturated fatty acids (P<0.001), and cholesterol (P<0.05) of recommended foods and abstinent ones. 2) Traditionally recommended diet is also fattier than the abstinent diet (4.5 times); UFAs of the recommended diet is 11 times more than that of the abstinent one; it is the same story for cholesterol (1.4 times); 3) Recent studies show that diets with high amounts of UFAs have positive effects on AD; a considerable number of papers emphasizes on probable positive role of cholesterol on AD; 4) Traditional recommended diet is in agreement with recent studies. Conclusion ITM recommended diet which is full of unsaturated fatty acids and cholesterol can be utilized for complementary treatment of AD. PMID:26060643

Guideline recommendations and antimicrobial resistance: the need for a change.

PubMed

Elias, Christelle; Moja, Lorenzo; Mertz, Dominik; Loeb, Mark; Forte, Gilles; Magrini, Nicola

2017-07-26

Antimicrobial resistance has become a global burden for which inappropriate antimicrobial use is an important contributing factor. Any decisions on the selection of antibiotics use should consider their effects on antimicrobial resistance. The objective of this study was to assess the extent to which antibiotic prescribing guidelines have considered resistance patterns when making recommendations for five highly prevalent infectious syndromes. We used Medline searches complemented with extensive use of Web engine to identify guidelines on empirical treatment of community-acquired pneumonia, urinary tract infections, acute otitis media, rhinosinusitis and pharyngitis. We collected data on microbiology and resistance patterns and identified discrete pattern categories. We assessed the extent to which recommendations considered resistance, in addition to efficacy and safety, when recommending antibiotics. We identified 135 guidelines, which reported a total of 251 recommendations. Most (103/135, 79%) were from developed countries. Community-acquired pneumonia was the syndrome mostly represented (51, 39%). In only 16 (6.4%) recommendations, selection of empirical antibiotic was discussed in relation to resistance and specific microbiological data. In a further 69 (27.5%) recommendations, references were made in relation to resistance, but the attempt was inconsistent. Across syndromes, 12 patterns of resistance with implications on recommendations were observed. 50% to 75% of recommendations did not attempt to set recommendation in the context of these patterns. There is consistent evidence that guidelines on empirical antibiotic use did not routinely consider resistance in their recommendations. Decision-makers should analyse and report the extent of local resistance patterns to allow better decision-making. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

2017 update of the Turkish League Against Rheumatism (TLAR) evidence-based recommendations for the management of knee osteoarthritis.

PubMed

Tuncer, Tiraje; Cay, Fatih Hasan; Altan, Lale; Gurer, Gulcan; Kacar, Cahit; Ozcakir, Suheda; Atik, Sahap; Ayhan, Figen; Durmaz, Berrin; Eskiyurt, Nurten; Genc, Hakan; GokceKutsal, Yesim; Gunaydin, Rezzan; Hepguler, Simin; Hizmetli, Sami; Kaya, Taciser; Kurtais, Yesim; Saridogan, Merih; Sindel, Dilsad; Sutbeyaz, Serap; Sendur, Omer Faruk; Ugurlu, Hatice; Unlu, Zeliha

2018-05-17

In a Turkish League Against Rheumatism (TLAR) project, evidence-based recommendations for the management of knee osteoarthritis (OA) was developed for the first time in our country in 2012 (TLAR-2012). In accordance with developing medical knowledge and scientific evidence, recommendations were updated. The committee was composed of 22 physical medicine and rehabilitation specialists (4 have rheumatology subspeciality also) and an orthopaedic surgeon. Systematic literature search were applied on Pubmed, Embase, Cochrane and Turkish Medical Index for the dates between January the 1st 2012 and January the 29th of 2015. The articles were assessed for quality and classified according to hierarchy for the level of evidence, and the selected ones sent to committee members electronically. They were asked to develop new recommendations. In the meeting in 2015, the format of the recommendations was decided to be patient-based and considering the grade and the severity of the disease. By the discussion of the each item under the light of new evidences, the final recommendations were developed. Each item was voted electronically on a 10-cm visual analogue scale (VAS) and the strength of recommendation (SoR) was calculated. In the light of evidences, totally 11 titles of recommendations were developed; the first 7 were applicable to each patient in every stages of the disease, remaining were for defined specific clinical situations. The mean SoR value of the recommendations was between 7.44 and 9.93. TLAR-2012 recommendations were updated in a new format. We think that, present recommendations will be beneficial for the physicians who manage, as well as the patients who suffer from the disease.

Allergy-immunology practice parameters and strength of recommendation data: an evolutionary perspective.

PubMed

Park, Matthew H; Banks, Taylor A; Nelson, Michael R

2016-03-01

The practice parameters for allergy and immunology (A/I) are a valuable tool guiding practitioners' clinical practice. The A/I practice parameters have evolved over time in the context of evidence-based medicine milestones. To identify evolutionary trends in the character, scope, and evidence underlying recommendations in the A/I practice parameters. Practice parameters that have guided A/I from 1995 through 2014 were analyzed. Statements and recommendations with strength of recommendation categories A and B were considered to have a basis in evidence from controlled trials. Forty-three publications and updates covering 25 unique topics were identified. There was great variability in the number of recommendations made and the proportion of statements with controlled trial evidence. The mean number of recommendations made per practice parameter has decreased significantly, from 95.8 to a mean of 38.3. There also is a trend toward an increased proportion of recommendations based on controlled trial evidence in practice parameters with fewer recommendations, with a mean of 30.7% in practice parameters with at least 100 recommendations based on controlled trial evidence compared with 48.3% in practice parameters with 30 to 100 recommendations and 51.0% in those with fewer than 30 recommendations. The A/I practice parameters have evolved significantly over time. Encouragingly, greater controlled trial evidence is associated with updated practice parameters and a recent trend of more narrowly focused topics. These findings should only bolster and inspire confidence in the utility of the A/I practice parameters in assisting practitioners to navigate through the uncertainty that is intrinsic to medicine in making informed decisions with patients. Published by Elsevier Inc.

Association between meeting the WCRF/AICR cancer prevention recommendations and colorectal cancer incidence: results from the VITAL cohort.

PubMed

Hastert, Theresa A; White, Emily

2016-11-01

In 2007, the World Cancer Research Fund (WCRF) and American Institute for Cancer Research (AICR) published eight recommendations regarding body weight, physical activity, and dietary behaviors aimed at reducing cancer incidence worldwide. In this paper, we assess whether meeting the WCRF/AICR recommendations is associated with lower colorectal cancer (CRC) incidence; evaluate whether particular recommendations are most strongly associated with lower CRC incidence; and assess whether associations differ by sex. We operationalized six of the recommendations (related to body weight, physical activity, energy density, plant foods, red and processed meat, and alcohol) and examined their association with CRC incidence over 7.6 years of follow-up in the prospective VITamins And Lifestyle Study cohort. Participants included 66,920 adults aged 50-76 years at baseline (2000-2002) with no history of CRC and with complete data for the recommendations evaluated. Incident colorectal cancers (n = 546) were tracked through 2009. Compared with meeting no recommendations, meeting 1-3 recommendations was associated with 34-45 % lower CRC incidence, and meeting 4-6 was associated with 58 % lower incidence (95 % CI 34 %, 74 %) in fully adjusted analyses. The recommendations most strongly associated with lower CRC risk for women were related to body fatness and red and processed meat, while for men these were alcohol intake and red and processed meat. Differences by sex were statistically significant (p < 0.05) for the recommendations related to body weight and to alcohol. Meeting the WCRF/AICR recommendations, particularly those related to alcohol, body weight, and red and processed meat, could substantially reduce CRC incidence; however, associations differ by sex.

Summary of the NACI Statement on Seasonal Influenza Vaccine for 2017-2018.

PubMed

Vaudry, W; Stirling, R

2017-05-04

Influenza is a respiratory infection caused primarily by influenza A and B viruses. Vaccination is the most effective way to prevent influenza and its complications. The National Advisory Committee on Immunization (NACI) provides recommendations regarding seasonal influenza vaccines annually to the Public Health Agency of Canada (PHAC). To summarize the NACI recommendations regarding the use of seasonal influenza vaccines for the 2017-2018 influenza season. Annual influenza vaccine recommendations are developed by NACI's Influenza Working Group for consideration and approval by NACI, based on NACI's evidence-based process for developing recommendations. The recommendations include a consideration of the burden of influenza illness and the target populations for vaccination; efficacy and effectiveness, immunogenicity and safety of influenza vaccines; vaccine schedules; and other aspects of influenza immunization. These recommendations are published annually on the Agency's website in the NACI Advisory Committee Statement: Canadian Immunization Guide Chapter on Influenza and Statement on Seasonal Influenza Vaccine (the Statement). The annual statement has been updated for the 2017-2018 influenza season to incorporate recommendations for the use of live attenuated influenza vaccine (LAIV) that were contained in two addenda published after the 2016-2017 statement. These recommendations were 1) that egg-allergic individuals may be vaccinated against influenza using the low ovalbumin-containing LAIV licensed for use in Canada and 2) to continue to recommend the use of LAIV in children and adolescents 2-17 years of age, but to remove the preferential recommendation for its use. NACI continues to recommend annual influenza vaccination for all individuals aged six months and older, with particular focus on people at high risk of influenza-related complications or hospitalization, people capable of transmitting influenza to those at high risk, and others as indicated.

Training and Practices of Cannabis Dispensary Staff.

PubMed

Haug, Nancy A; Kieschnick, Dustin; Sottile, James E; Babson, Kimberly A; Vandrey, Ryan; Bonn-Miller, Marcel O

2016-01-01

Introduction: The proliferation of cannabis dispensaries within the United States has emerged from patient demand for the legalization of cannabis as an alternative treatment for a number of conditions and symptoms. Unfortunately, nothing is known about the practices of dispensary staff with respect to recommendation of cannabis strains/concentrations for specific patient ailments. To address this limitation, the present study assessed the training and practices of cannabis dispensary staff. Materials and Methods: Medical and nonmedical dispensary staff ( n =55) were recruited via e-mail and social media to complete an online survey assessing their demographic characteristics, dispensary features, patient characteristics, formal training, and cannabis recommendation practices. Results: Fifty-five percent of dispensary staff reported some formal training for their position, with 20% reporting medical/scientific training. A majority (94%) indicated that they provide specific cannabis advice to patients. In terms of strains, dispensary staff trended toward recommendations of Indica for anxiety, chronic pain, insomnia, nightmares, and Tourette's syndrome. They were more likely to recommend Indica and hybrid plants for post-traumatic stress disorder (PTSD)/trauma and muscle spasms. In contrast, staff were less likely to recommend Indica for depression; hybrid strains were most often recommended for amyotrophic lateral sclerosis (ALS). In terms of cannabinoid concentrations, dispensary staff were most likely to recommend a 1:1 ratio of delta-9-tetrahydrocannabinol (THC):cannabidiol (CBD) for patients suffering from anxiety, Crohn's disease, hepatitis C, and PTSD/trauma, while patients seeking appetite stimulation were most likely to be recommended THC. Staff recommended high CBD for arthritis and Alzheimer's disease and a high CBD or 1:1 ratio for ALS, epilepsy, and muscle spasms. Conclusions: Although many dispensary staff are making recommendations consistent with current evidence, some are recommending cannabis that has either not been shown effective for, or could exacerbate, a patient's condition. Findings underscore the importance of consistent, evidence-based, training of dispensary staff who provide specific recommendations for patient medical conditions.

Association between use of systematic reviews and national policy recommendations on screening newborn babies for rare diseases: systematic review and meta-analysis.

PubMed

Taylor-Phillips, Sian; Stinton, Chris; Ferrante di Ruffano, Lavinia; Seedat, Farah; Clarke, Aileen; Deeks, Jonathan J

2018-05-09

To understand whether international differences in recommendations of whether to screen for rare diseases using the newborn blood spot test might in part be explained by use of systematic review methods. Systematic review and meta-analysis. Website searches of 26 national screening organisations. Journal articles, papers, legal documents, presentations, conference abstracts, or reports relating to a national recommendation on whether to screen for any condition using the newborn blood spot test, with no restrictions on date or language. Two reviewers independently assessed whether the recommendation for or against screening included systematic reviews, and data on test accuracy, benefits of early detection, and potential harms of overdiagnosis. The odds of recommending screening according to the use of systematic review methods was estimated across conditions using meta-analysis. 93 reports were included that assessed 104 conditions across 14 countries, totalling 276 recommendations (units of analysis). Screening was favoured in 159 (58%) recommendations, not favoured in 98 (36%), and not recommended either way in 19 (7%). Only 60 (22%) of the recommendations included a systematic review. Use of a systematic review was associated with a reduced probability of screening being recommended (23/60 (38%) v 136/216 (63%), odds ratio 0.17, 95% confidence interval 0.07 to 0.43). Of the recommendations, evidence for test accuracy, benefits of early detection, and overdiagnosis was not considered in 115 (42%), 83 (30%), and 211 (76%), respectively. Using systematic review methods is associated with a reduced probability of screening being recommended. Many national policy reviews of screening for rare conditions using the newborn blood spot test do not assess the evidence on the key benefits and harms of screening. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Automated detection using natural language processing of radiologists recommendations for additional imaging of incidental findings.

PubMed

Dutta, Sayon; Long, William J; Brown, David F M; Reisner, Andrew T

2013-08-01

As use of radiology studies increases, there is a concurrent increase in incidental findings (eg, lung nodules) for which the radiologist issues recommendations for additional imaging for follow-up. Busy emergency physicians may be challenged to carefully communicate recommendations for additional imaging not relevant to the patient's primary evaluation. The emergence of electronic health records and natural language processing algorithms may help address this quality gap. We seek to describe recommendations for additional imaging from our institution and develop and validate an automated natural language processing algorithm to reliably identify recommendations for additional imaging. We developed a natural language processing algorithm to detect recommendations for additional imaging, using 3 iterative cycles of training and validation. The third cycle used 3,235 radiology reports (1,600 for algorithm training and 1,635 for validation) of discharged emergency department (ED) patients from which we determined the incidence of discharge-relevant recommendations for additional imaging and the frequency of appropriate discharge documentation. The test characteristics of the 3 natural language processing algorithm iterations were compared, using blinded chart review as the criterion standard. Discharge-relevant recommendations for additional imaging were found in 4.5% (95% confidence interval [CI] 3.5% to 5.5%) of ED radiology reports, but 51% (95% CI 43% to 59%) of discharge instructions failed to note those findings. The final natural language processing algorithm had 89% (95% CI 82% to 94%) sensitivity and 98% (95% CI 97% to 98%) specificity for detecting recommendations for additional imaging. For discharge-relevant recommendations for additional imaging, sensitivity improved to 97% (95% CI 89% to 100%). Recommendations for additional imaging are common, and failure to document relevant recommendations for additional imaging in ED discharge instructions occurs frequently. The natural language processing algorithm's performance improved with each iteration and offers a promising error-prevention tool. Copyright © 2013 American College of Emergency Physicians. Published by Mosby, Inc. All rights reserved.

Training and Practices of Cannabis Dispensary Staff

PubMed Central

Haug, Nancy A.; Kieschnick, Dustin; Sottile, James E.; Babson, Kimberly A.; Vandrey, Ryan; Bonn-Miller, Marcel O.

2016-01-01

Abstract Introduction: The proliferation of cannabis dispensaries within the United States has emerged from patient demand for the legalization of cannabis as an alternative treatment for a number of conditions and symptoms. Unfortunately, nothing is known about the practices of dispensary staff with respect to recommendation of cannabis strains/concentrations for specific patient ailments. To address this limitation, the present study assessed the training and practices of cannabis dispensary staff. Materials and Methods: Medical and nonmedical dispensary staff (n=55) were recruited via e-mail and social media to complete an online survey assessing their demographic characteristics, dispensary features, patient characteristics, formal training, and cannabis recommendation practices. Results: Fifty-five percent of dispensary staff reported some formal training for their position, with 20% reporting medical/scientific training. A majority (94%) indicated that they provide specific cannabis advice to patients. In terms of strains, dispensary staff trended toward recommendations of Indica for anxiety, chronic pain, insomnia, nightmares, and Tourette's syndrome. They were more likely to recommend Indica and hybrid plants for post-traumatic stress disorder (PTSD)/trauma and muscle spasms. In contrast, staff were less likely to recommend Indica for depression; hybrid strains were most often recommended for amyotrophic lateral sclerosis (ALS). In terms of cannabinoid concentrations, dispensary staff were most likely to recommend a 1:1 ratio of delta-9-tetrahydrocannabinol (THC):cannabidiol (CBD) for patients suffering from anxiety, Crohn's disease, hepatitis C, and PTSD/trauma, while patients seeking appetite stimulation were most likely to be recommended THC. Staff recommended high CBD for arthritis and Alzheimer's disease and a high CBD or 1:1 ratio for ALS, epilepsy, and muscle spasms. Conclusions: Although many dispensary staff are making recommendations consistent with current evidence, some are recommending cannabis that has either not been shown effective for, or could exacerbate, a patient's condition. Findings underscore the importance of consistent, evidence-based, training of dispensary staff who provide specific recommendations for patient medical conditions. PMID:28861496

Summary of the National Advisory Committee on Immunization (NACI) Statement on Seasonal Influenza Vaccine for 2016-2017.

PubMed

Gemmill, I; Zhao, L; Cochrane, L

2016-09-01

Influenza is a respiratory infection caused primarily by influenza A and B viruses. Vaccination is the most effective way to prevent influenza and its complications. The National Advisory Committee on Immunization (NACI) provides recommendations regarding seasonal influenza vaccines annually to the Public Health Agency of Canada (the Agency). To summarize the NACI recommendations regarding the use of seasonal influenza vaccines for the 2016-2017 influenza season. Annual influenza vaccine recommendations are developed by NACI's Influenza Working Group for consideration and approval by NACI, based on NACI's evidence-based process for developing recommendations, and include a consideration of the burden of influenza illness and the target populations for vaccination; efficacy and effectiveness, immunogenicity and safety of influenza vaccines; vaccine schedules; and other aspects of influenza immunization. These recommendations are published annually on the Agency's website in the NACI Advisory Committee Statement: Canadian Immunization Guide Chapter on Influenza and Statement on Seasonal Influenza Vaccine (the Statement). The annual NACI seasonal influenza vaccine recommendations have been updated for the 2016-2017 influenza season to include adults with neurologic or neurodevelopment conditions among the groups for whom influenza vaccination is particularly recommended; to include the new high-dose, trivalent inactivated influenza vaccine for use in adults 65 years of age and over; to recommend that egg-allergic individuals may also be vaccinated against influenza using the low ovalbumin-containing live attenuated influenza vaccine (LAIV) licensed for use in Canada (NACI has previously recommended that egg-allergic individuals may be vaccinated using inactivated influenza vaccines); and to remove the preferential recommendation for the use of LAIV in children 2-17 years of age. Two addenda to the 2016-2017 Statement address these new LAIV recommendations. NACI continues to recommend annual influenza vaccination for all individuals aged six months and older, with particular focus on people at high risk of influenza-related complications or hospitalization, people capable of transmitting influenza to those at high risk and others as indicated.

European guideline for the diagnosis and treatment of insomnia.

PubMed

Riemann, Dieter; Baglioni, Chiara; Bassetti, Claudio; Bjorvatn, Bjørn; Dolenc Groselj, Leja; Ellis, Jason G; Espie, Colin A; Garcia-Borreguero, Diego; Gjerstad, Michaela; Gonçalves, Marta; Hertenstein, Elisabeth; Jansson-Fröjmark, Markus; Jennum, Poul J; Leger, Damien; Nissen, Christoph; Parrino, Liborio; Paunio, Tiina; Pevernagie, Dirk; Verbraecken, Johan; Weeß, Hans-Günter; Wichniak, Adam; Zavalko, Irina; Arnardottir, Erna S; Deleanu, Oana-Claudia; Strazisar, Barbara; Zoetmulder, Marielle; Spiegelhalder, Kai

2017-12-01

This European guideline for the diagnosis and treatment of insomnia was developed by a task force of the European Sleep Research Society, with the aim of providing clinical recommendations for the management of adult patients with insomnia. The guideline is based on a systematic review of relevant meta-analyses published till June 2016. The target audience for this guideline includes all clinicians involved in the management of insomnia, and the target patient population includes adults with chronic insomnia disorder. The GRADE (Grading of Recommendations Assessment, Development and Evaluation) system was used to grade the evidence and guide recommendations. The diagnostic procedure for insomnia, and its co-morbidities, should include a clinical interview consisting of a sleep history (sleep habits, sleep environment, work schedules, circadian factors), the use of sleep questionnaires and sleep diaries, questions about somatic and mental health, a physical examination and additional measures if indicated (i.e. blood tests, electrocardiogram, electroencephalogram; strong recommendation, moderate- to high-quality evidence). Polysomnography can be used to evaluate other sleep disorders if suspected (i.e. periodic limb movement disorder, sleep-related breathing disorders), in treatment-resistant insomnia, for professional at-risk populations and when substantial sleep state misperception is suspected (strong recommendation, high-quality evidence). Cognitive behavioural therapy for insomnia is recommended as the first-line treatment for chronic insomnia in adults of any age (strong recommendation, high-quality evidence). A pharmacological intervention can be offered if cognitive behavioural therapy for insomnia is not sufficiently effective or not available. Benzodiazepines, benzodiazepine receptor agonists and some antidepressants are effective in the short-term treatment of insomnia (≤4 weeks; weak recommendation, moderate-quality evidence). Antihistamines, antipsychotics, melatonin and phytotherapeutics are not recommended for insomnia treatment (strong to weak recommendations, low- to very-low-quality evidence). Light therapy and exercise need to be further evaluated to judge their usefulness in the treatment of insomnia (weak recommendation, low-quality evidence). Complementary and alternative treatments (e.g. homeopathy, acupuncture) are not recommended for insomnia treatment (weak recommendation, very-low-quality evidence). © 2017 European Sleep Research Society.

Pre-Pregnancy Body Mass Index, Gestational Weight Gain, and Birth Weight: A Cohort Study in China.

PubMed

Yang, Shaoping; Peng, Anna; Wei, Sheng; Wu, Jing; Zhao, Jinzhu; Zhang, Yiming; Wang, Jing; Lu, Yuan; Yu, Yuzhen; Zhang, Bin

2015-01-01

To assess whether pre-pregnancy body mass index (BMI) modify the relationship between gestational weight gain (GWG) and child birth weight (specifically, presence or absence of low birth weight (LBW) or presence of absence of macrosomia), and estimates of the relative risk of macrosomia and LBW based on pre-pregnancy BMI were controlled in Wuhan, China. From June 30, 2011 to June 30, 2013. All data was collected and available from the perinatal health care system. Logistic regression models were used to estimate the independent association among pregnancy weight gain, LBW, normal birth weight, and macrosomia within different pre-pregnancy BMI groups. We built different logistic models for the 2009 Institute of Medicine (IOM) Guidelines and Chinese-recommended GWG which was made from this sample. The Chinese-recommended GWG was derived from the quartile values (25th-75th percentiles) of weight gain at the time of delivery in the subjects which comprised our sample. For LBW children, using the recommended weight gain of the IOM and Chinese women as a reference, the OR for a pregnancy weight gain below recommendations resulted in a positive relationship for lean and normal weight women, but not for overweight and obese women. For macrosomia, considering the IOM's recommended weight gain as a reference, the OR magnitude for pregnancy weight gain above recommendations resulted in a positive correlation for all women. The OR for a pregnancy weight gain below recommendations resulted in a negative relationship for normal BMI and lean women, but not for overweight and obese women based on the IOM recommendations, significant based on the recommended pregnancy weight gain for Chinese women. Of normal weight children, 56.6% were above the GWG based on IOM recommendations, but 26.97% of normal weight children were above the GWG based on Chinese recommendations. A GWG above IOM recommendations might not be helpful for Chinese women. We need unified criteria to classify adult BMI and to expand the sample size to improve representation and to elucidate the relationship between GWG and related outcomes for developing a Chinese GWG recommendation.

Pre-Pregnancy Body Mass Index, Gestational Weight Gain, and Birth Weight: A Cohort Study in China

PubMed Central

Wei, Sheng; Wu, Jing; Zhao, Jinzhu; Zhang, Yiming; Wang, Jing; Lu, Yuan; Yu, Yuzhen; Zhang, Bin

2015-01-01

Objective To assess whether pre-pregnancy body mass index (BMI) modify the relationship between gestational weight gain (GWG) and child birth weight (specifically, presence or absence of low birth weight (LBW) or presence of absence of macrosomia), and estimates of the relative risk of macrosomia and LBW based on pre-pregnancy BMI were controlled in Wuhan, China. Methods From June 30, 2011 to June 30, 2013. All data was collected and available from the perinatal health care system. Logistic regression models were used to estimate the independent association among pregnancy weight gain, LBW, normal birth weight, and macrosomia within different pre-pregnancy BMI groups. We built different logistic models for the 2009 Institute of Medicine (IOM) Guidelines and Chinese-recommended GWG which was made from this sample. The Chinese-recommended GWG was derived from the quartile values (25th-75th percentiles) of weight gain at the time of delivery in the subjects which comprised our sample. Results For LBW children, using the recommended weight gain of the IOM and Chinese women as a reference, the OR for a pregnancy weight gain below recommendations resulted in a positive relationship for lean and normal weight women, but not for overweight and obese women. For macrosomia, considering the IOM’s recommended weight gain as a reference, the OR magnitude for pregnancy weight gain above recommendations resulted in a positive correlation for all women. The OR for a pregnancy weight gain below recommendations resulted in a negative relationship for normal BMI and lean women, but not for overweight and obese women based on the IOM recommendations, significant based on the recommended pregnancy weight gain for Chinese women. Of normal weight children, 56.6% were above the GWG based on IOM recommendations, but 26.97% of normal weight children were above the GWG based on Chinese recommendations. Conclusions A GWG above IOM recommendations might not be helpful for Chinese women. We need unified criteria to classify adult BMI and to expand the sample size to improve representation and to elucidate the relationship between GWG and related outcomes for developing a Chinese GWG recommendation. PMID:26115015

Use of Vital Pulp Therapies in Primary Teeth with Deep Caries Lesions.

PubMed

Dhar, Vineet; Marghalani, Abdullah A; Crystal, Yasmi O; Kumar, Ashok; Ritwik, Priyanshi; Tulunoglu, Ozlem; Graham, Laurel

2017-09-15

This manuscript presents evidence-based guidance on the use of vital pulp therapies for treatment of deep caries lesions in children. A guideline panel convened by the American Academy of Pediatric Dentistry formulated evidence-based recommendations on three vital pulp therapies: indirect pulp treatment (IPT; also known as indirect pulp cap), direct pulp cap (DPC), and pulpotomy. The basis of the guideline's recommendations was evidence from "Primary Tooth Vital Pulp Therapy: A Systematic Review and Meta-Analysis." (Pediatr Dent 2017;15;39[1]:16-23.) A systematic search was conducted in PubMed®/MEDLINE, Embase®, Cochrane Central Register of Controlled Trials, and trial databases to identify randomized controlled trials and systematic reviews addressing peripheral issues of vital pulp therapies such as patient preferences of treatment and impact of cost. Quality of the evidence was assessed through the Grading of Recommendations Assessment, Development, and Evaluation approach; the evidence-to-decision framework was used to formulate a recommendation. The panel was unable to make a recommendation on superiority of any particular type of vital pulp therapy owing to lack of studies directly comparing these interventions. The panel recommends use of mineral trioxide aggregate (MTA) and formocresol in pulpotomy treatments; these are recommendations based on moderate-quality evidence at 24 months. The panel made weak recommendations regarding choice of medicament in both IPT (moderate-quality evidence [24 months], low quality evidence [48 months]) and DPC (very-low quality evidence [24 months]). Success of both treatments was independent of type of medicament used. The panel also recommends use of ferric sulfate (low-quality evidence), lasers (low-quality evidence), sodium hypochlorite (very low-quality evidence), and tricalcium silicate (very low-quality evidence) in pulpotomies; these are weak recommendations based on low-quality evidence. The panel recommended against the use of calcium hydroxide as pulpotomy medicament in primary teeth with deep caries lesions. Conclusions and practical implications: The guideline intends to inform the clinical practices with evidence-based recommendations on vital pulp therapies in primary teeth with deep caries lesions. These recommendations are based upon the best available evidence to-date.

Secondary Prevention of Cervical Cancer: ASCO Resource-Stratified Clinical Practice Guideline.

PubMed

Jeronimo, Jose; Castle, Philip E; Temin, Sarah; Denny, Lynette; Gupta, Vandana; Kim, Jane J; Luciani, Silvana; Murokora, Daniel; Ngoma, Twalib; Qiao, Youlin; Quinn, Michael; Sankaranarayanan, Rengaswamy; Sasieni, Peter; Schmeler, Kathleen M; Shastri, Surendra S

2017-10-01

To provide resource-stratified, evidence-based recommendations on the secondary prevention of cervical cancer globally. ASCO convened a multidisciplinary, multinational panel of oncology, primary care, epidemiology, health economic, cancer control, public health, and patient advocacy experts to produce recommendations reflecting four resource-tiered settings. A review of existing guidelines, a formal consensus-based process, and a modified ADAPTE process to adapt existing guidelines were conducted. Other experts participated in formal consensus. Seven existing guidelines were identified and reviewed, and adapted recommendations form the evidence base. Four systematic reviews plus cost-effectiveness analyses provided indirect evidence to inform consensus, which resulted in ≥ 75% agreement. Human papillomavirus (HPV) DNA testing is recommended in all resource settings; visual inspection with acetic acid may be used in basic settings. Recommended age ranges and frequencies by setting are as follows: maximal: ages 25 to 65, every 5 years; enhanced: ages 30 to 65, if two consecutive negative tests at 5-year intervals, then every 10 years; limited: ages 30 to 49, every 10 years; and basic: ages 30 to 49, one to three times per lifetime. For basic settings, visual assessment is recommended as triage; in other settings, genotyping and/or cytology are recommended. For basic settings, treatment is recommended if abnormal triage results are present; in other settings, colposcopy is recommended for abnormal triage results. For basic settings, treatment options are cryotherapy or loop electrosurgical excision procedure; for other settings, loop electrosurgical excision procedure (or ablation) is recommended. Twelve-month post-treatment follow-up is recommended in all settings. Women who are HIV positive should be screened with HPV testing after diagnosis and screened twice as many times per lifetime as the general population. Screening is recommended at 6 weeks postpartum in basic settings; in other settings, screening is recommended at 6 months. In basic settings without mass screening, infrastructure for HPV testing, diagnosis, and treatment should be developed.Additional information can be found at www.asco.org/rs-cervical-cancer-secondary-prev-guideline and www.asco.org/guidelineswiki.It is the view of of ASCO that health care providers and health care system decision makers should be guided by the recommendations for the highest stratum of resources available. The guideline is intended to complement, but not replace, local guidelines.

General recommendations on immunization --- recommendations of the Advisory Committee on Immunization Practices (ACIP).

PubMed

2011-01-28

This report is a revision of the General Recommendations on Immunization and updates the 2006 statement by the Advisory Committee on Immunization Practices (ACIP) (CDC. General recommendations on immunization: recommendations of the Advisory Committee on Immunization Practices [ACIP]. MMWR 2006;55[No. RR-15]). The report also includes revised content from previous ACIP recommendations on the following topics: adult vaccination (CDC. Update on adult immunization recommendations of the immunization practices Advisory Committee [ACIP]. MMWR 1991;40[No. RR-12]); the assessment and feedback strategy to increase vaccination rates (CDC. Recommendations of the Advisory Committee on Immunization Practices: programmatic strategies to increase vaccination rates-assessment and feedback of provider-based vaccination coverage information. MMWR 1996;45:219-20); linkage of vaccination services and those of the Supplemental Nutrition Program for Women, Infants, and Children (WIC program) (CDC. Recommendations of the Advisory Committee on Immunization Practices: programmatic strategies to increase vaccination coverage by age 2 years-linkage of vaccination and WIC services. MMWR 1996;45:217-8); adolescent immunization (CDC. Immunization of adolescents: recommendations of the Advisory Committee on Immunization Practices, the American Academy of Pediatrics, the American Academy of Family Physicians, and the American Medical Association. MMWR 1996;45[No. RR-13]); and combination vaccines (CDC. Combination vaccines for childhood immunization: recommendations of the Advisory Committee on Immunization Practices [ACIP], the American Academy of Pediatrics [AAP], and the American Academy of Family Physicians [AAFP]. MMWR 1999;48[No. RR-5]). Notable revisions to the 2006 recommendations include 1) revisions to the tables of contraindications and precautions to vaccination, as well as a separate table of conditions that are commonly misperceived as contraindications and precautions; 2) reordering of the report content, with vaccine risk-benefit screening, managing adverse reactions, reporting of adverse events, and the vaccine injury compensation program presented immediately after the discussion of contraindications and precautions; 3) stricter criteria for selecting an appropriate storage unit for vaccines; 4) additional guidance for maintaining the cold chain in the event of unavoidable temperature deviations; and 5) updated revisions for vaccination of patients who have received a hematopoietic cell transplant. The most recent ACIP recommendations for each specific vaccine should be consulted for comprehensive details. This report, ACIP recommendations for each vaccine, and additional information about vaccinations are available from CDC at http://www.cdc.gov/vaccines.

Antiretroviral Drugs for Treatment and Prevention of HIV Infection in Adults: 2016 Recommendations of the International Antiviral Society-USA Panel.

PubMed

Günthard, Huldrych F; Saag, Michael S; Benson, Constance A; del Rio, Carlos; Eron, Joseph J; Gallant, Joel E; Hoy, Jennifer F; Mugavero, Michael J; Sax, Paul E; Thompson, Melanie A; Gandhi, Rajesh T; Landovitz, Raphael J; Smith, Davey M; Jacobsen, Donna M; Volberding, Paul A

2016-07-12

New data and therapeutic options warrant updated recommendations for the use of antiretroviral drugs (ARVs) to treat or to prevent HIV infection in adults. To provide updated recommendations for the use of antiretroviral therapy in adults (aged ≥18 years) with established HIV infection, including when to start treatment, initial regimens, and changing regimens, along with recommendations for using ARVs for preventing HIV among those at risk, including preexposure and postexposure prophylaxis. A panel of experts in HIV research and patient care convened by the International Antiviral Society-USA reviewed data published in peer-reviewed journals, presented by regulatory agencies, or presented as conference abstracts at peer-reviewed scientific conferences since the 2014 report, for new data or evidence that would change previous recommendations or their ratings. Comprehensive literature searches were conducted in the PubMed and EMBASE databases through April 2016. Recommendations were by consensus, and each recommendation was rated by strength and quality of the evidence. Newer data support the widely accepted recommendation that antiretroviral therapy should be started in all individuals with HIV infection with detectable viremia regardless of CD4 cell count. Recommended optimal initial regimens for most patients are 2 nucleoside reverse transcriptase inhibitors (NRTIs) plus an integrase strand transfer inhibitor (InSTI). Other effective regimens include nonnucleoside reverse transcriptase inhibitors or boosted protease inhibitors with 2 NRTIs. Recommendations for special populations and in the settings of opportunistic infections and concomitant conditions are provided. Reasons for switching therapy include convenience, tolerability, simplification, anticipation of potential new drug interactions, pregnancy or plans for pregnancy, elimination of food restrictions, virologic failure, or drug toxicities. Laboratory assessments are recommended before treatment, and monitoring during treatment is recommended to assess response, adverse effects, and adherence. Approaches are recommended to improve linkage to and retention in care are provided. Daily tenofovir disoproxil fumarate/emtricitabine is recommended for use as preexposure prophylaxis to prevent HIV infection in persons at high risk. When indicated, postexposure prophylaxis should be started as soon as possible after exposure. Antiretroviral agents remain the cornerstone of HIV treatment and prevention. All HIV-infected individuals with detectable plasma virus should receive treatment with recommended initial regimens consisting of an InSTI plus 2 NRTIs. Preexposure prophylaxis should be considered as part of an HIV prevention strategy for at-risk individuals. When used effectively, currently available ARVs can sustain HIV suppression and can prevent new HIV infection. With these treatment regimens, survival rates among HIV-infected adults who are retained in care can approach those of uninfected adults.

American College of Rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee.

PubMed

Hochberg, Marc C; Altman, Roy D; April, Karine Toupin; Benkhalti, Maria; Guyatt, Gordon; McGowan, Jessie; Towheed, Tanveer; Welch, Vivian; Wells, George; Tugwell, Peter

2012-04-01

To update the American College of Rheumatology (ACR) 2000 recommendations for hip and knee osteoarthritis (OA) and develop new recommendations for hand OA. A list of pharmacologic and nonpharmacologic modalities commonly used to manage knee, hip, and hand OA as well as clinical scenarios representing patients with symptomatic hand, hip, and knee OA were generated. Systematic evidence-based literature reviews were conducted by a working group at the Institute of Population Health, University of Ottawa, and updated by ACR staff to include additions to bibliographic databases through December 31, 2010. The Grading of Recommendations Assessment, Development and Evaluation approach, a formal process to rate scientific evidence and to develop recommendations that are as evidence based as possible, was used by a Technical Expert Panel comprised of various stakeholders to formulate the recommendations for the use of nonpharmacologic and pharmacologic modalities for OA of the hand, hip, and knee. Both “strong” and “conditional” recommendations were made for OA management. Modalities conditionally recommended for the management of hand OA include instruction in joint protection techniques, provision of assistive devices, use of thermal modalities and trapeziometacarpal joint splints, and use of oral and topical nonsteroidal antiinflammatory drugs (NSAIDs), tramadol, and topical capsaicin. Nonpharmacologic modalities strongly recommended for the management of knee OA were aerobic, aquatic, and/or resistance exercises as well as weight loss for overweight patients. Nonpharmacologic modalities conditionally recommended for knee OA included medial wedge insoles for valgus knee OA, subtalar strapped lateral insoles for varus knee OA, medially directed patellar taping, manual therapy, walking aids, thermal agents, tai chi, self management programs, and psychosocial interventions. Pharmacologic modalities conditionally recommended for the initial management of patients with knee OA included acetaminophen, oral and topical NSAIDs, tramadol, and intraarticular corticosteroid injections; intraarticular hyaluronate injections, duloxetine, and opioids were conditionally recommended in patients who had an inadequate response to initial therapy. Opioid analgesics were strongly recommended in patients who were either not willing to undergo or had contraindications for total joint arthroplasty after having failed medical therapy. Recommendations for hip OA were similar to those for the management of knee OA. These recommendations are based on the consensus judgment of clinical experts from a wide range of disciplines, informed by available evidence, balancing the benefits and harms of both nonpharmacologic and pharmacologic modalities, and incorporating their preferences and values. It is hoped that these recommendations will be utilized by health care providers involved in the management of patients with OA. Copyright © 2012 by the American College of Rheumatology.

Writing Recommendation Letters: A Measure of Your Character, Too

ERIC Educational Resources Information Center

Weldy Boyd, Amanda C.

2011-01-01

The author considers how to approach a request for a personal recommendation from someone whom the author does not wish to advocate. Ultimately, the author proposes that those asked to write recommendations have a right to say "no," should they feel hesitant to recommend the candidate, and a responsibility to suggest that someone else might be a…

33 CFR 127.009 - Letter of recommendation.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 33 Navigation and Navigable Waters 2 2011-07-01 2011-07-01 false Letter of recommendation. 127.009... General § 127.009 Letter of recommendation. After the COTP receives the Letter of Intent under § 127.007(a) or (b), the COTP issues a Letter of Recommendation as to the suitability of the waterway for LNG or...

33 CFR 127.009 - Letter of recommendation.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 33 Navigation and Navigable Waters 2 2010-07-01 2010-07-01 false Letter of recommendation. 127.009... General § 127.009 Letter of recommendation. After the COTP receives the Letter of Intent under § 127.007(a) or (b), the COTP issues a Letter of Recommendation as to the suitability of the waterway for LNG or...

Diagnostic Yield of Chromosomal Microarray Analysis in an Autism Primary Care Practice: Which Guidelines to Implement?

ERIC Educational Resources Information Center

McGrew, Susan G.; Peters, Brittany R.; Crittendon, Julie A.; Veenstra-VanderWeele, Jeremy

2012-01-01

Genetic testing is recommended for patients with ASD; however specific recommendations vary by specialty. American Academy of Pediatrics and American Academy of Neurology guidelines recommend G-banded karyotype and Fragile X DNA. The American College of Medical Genetics recommends Chromosomal Microarray Analysis (CMA). We determined the yield of…

Recommendations for Promoting E-learning in Higher Education Institutions: A Case Study of Iran

ERIC Educational Resources Information Center

Hanafizadeh, Payam; Khodabakhshi, Mohsen; Hanafizadeh, Mohammad Reza

2011-01-01

This paper intends to offer recommendations for promoting e-learning in higher education institutions in developing countries in general, and in Iran in particular. For this, 279 recommendations were extracted through the investigation of 11 countries and 5 regions. Using content analysis, 23 recommendations were selected and then categorized into…

The Strategic Study Group on the Status of Women: Report to the President and the Commission for Women--Recommendation Package #4.

ERIC Educational Resources Information Center

Pennsylvania State Univ., University Park.

The document presents partial recommendations of a Pennsylvania State University Study Group on the Status of Women at the University. Recommendations concern: special populations, sexual harassment in the workplace, sexual violence against women, women's athletics, and health services for women students. Among specific recommendations are the…

Recommendations for snag retention in southwestern mixed-conifer and ponderosa pine forests: History and current status

Treesearch

Joseph L. Ganey

2016-01-01

Snags provide habitat for numerous species of wildlife. Several authors have provided recommendations for snag retention in southwestern mixed-conifer and ponderosa pine (Pinus ponderosa) forests. Most recommendations were presented in terms of minimum snag density and/or size. I summarized the history of recommendations for snag retention in these forest...

Treatment of Childhood and Adolescent Obesity: An Integrative Review of Recent Recommendations from Five Expert Groups

ERIC Educational Resources Information Center

Kirschenbaum, Daniel S.; Gierut, Kristen

2013-01-01

Objective: To compare and contrast 5 sets of expert recommendations about the treatment of childhood and adolescent obesity. Method: We reviewed 5 sets of recent expert recommendations: 2007 health care organizations' four stage model, 2007 Canadian clinical practice guidelines, 2008 Endocrine Society recommendations, 2009 seven step model, and…

77 FR 35481 - Subsistence Management Regulations for Public Lands in Alaska-2012-13 and 2013-14 Subsistence...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-13

... recommended for rejection by one or more of the Regional Councils unless noted below. Statewide The Board took... action was contrary to one council recommendation and consistent with the recommendation of another. The... methods on State and private lands. This action was contrary to the one Council's recommendation, one...

5 CFR Appendix A to Subpart I of... - Recommended Language for Court Orders Awarding Former Spouse Survivor Annuities

Code of Federal Regulations, 2011 CFR

2011-01-01

... 5 Administrative Personnel 2 2011-01-01 2011-01-01 false Recommended Language for Court Orders.... I, App. A Appendix A to Subpart I of Part 838—Recommended Language for Court Orders Awarding Former Spouse Survivor Annuities This appendix provides recommended language for use in court orders awarding...

5 CFR Appendix A to Subpart I of... - Recommended Language for Court Orders Awarding Former Spouse Survivor Annuities

Code of Federal Regulations, 2010 CFR

2010-01-01

... 5 Administrative Personnel 2 2010-01-01 2010-01-01 false Recommended Language for Court Orders.... I, App. A Appendix A to Subpart I of Part 838—Recommended Language for Court Orders Awarding Former Spouse Survivor Annuities This appendix provides recommended language for use in court orders awarding...

77 FR 5262 - Notice of Adjustment of Statewide Per Capita Indicator for Recommending a Cost Share Adjustment

Federal Register 2010, 2011, 2012, 2013, 2014

2012-02-02

...] Notice of Adjustment of Statewide Per Capita Indicator for Recommending a Cost Share Adjustment AGENCY... per capita indicator for recommending cost share adjustments for major disasters declared on or after... INFORMATION: Pursuant to 44 CFR 206.47, the statewide per capita indicator that is used to recommend an...

78 FR 9935 - Notice of Adjustment of Statewide Per Capita Indicator for Recommending a Cost Share Adjustment

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-12

...] Notice of Adjustment of Statewide Per Capita Indicator for Recommending a Cost Share Adjustment AGENCY... per capita indicator for recommending cost share adjustments for major disasters declared on or after... INFORMATION: Pursuant to 44 CFR 206.47, the statewide per capita indicator that is used to recommend an...

41 CFR 102-75.665 - What happens after the disposal agency receives the assignment recommendation from DOI?

Code of Federal Regulations, 2011 CFR

2011-01-01

... disposal agency receives the assignment recommendation from DOI? 102-75.665 Section 102-75.665 Public... assignment recommendation from DOI? If, after considering other uses for the property, the disposal agency approves the assignment recommendation from DOI, it must assign the property by letter or other document to...

Friend suggestion in social network based on user log

NASA Astrophysics Data System (ADS)

Kaviya, R.; Vanitha, M.; Sumaiya Thaseen, I.; Mangaiyarkarasi, R.

2017-11-01

Simple friend recommendation algorithms such as similarity, popularity and social aspects is the basic requirement to be explored to methodically form high-performance social friend recommendation. Suggestion of friends is followed. No tags of character were followed. In the proposed system, we use an algorithm for network correlation-based social friend recommendation (NC-based SFR).It includes user activities like where one lives and works. A new friend recommendation method, based on network correlation, by considering the effect of different social roles. To model the correlation between different networks, we develop a method that aligns these networks through important feature selection. We consider by preserving the network structure for a more better recommendations so that it significantly improves the accuracy for better friend-recommendation.

Fruit and vegetable consumption and sports participation among UK Youth.

PubMed

McAloney, Kareena; Graham, Hilary; Law, Catherine; Platt, Lucinda; Wardle, Heather; Hall, Julia

2014-02-01

UK guidelines for youth recommend daily physical activity and five portions of fruit and vegetables per day. This study examined the prevalence and clustering of meeting recommendations among 10- to 15-year old. Data for 3,914 youth, from the first wave of Understanding Society: the UK Household Longitudinal Study, were analysed. Clustering was assessed using the observed/expected ratio method. A minority of youth met both recommendations, and these behaviours were clustered. The odds of meeting both recommendations were lower for older youth and for Pakistani and Bangladeshi youth; boys in lower income households were less likely to meet both recommendations. Most youth met neither recommendation and the behaviours clustered with variations by ethnicity and socioeconomic conditions.

Implementing AORN recommended practices for prevention of transmissible infections.

PubMed

Patrick, Marcia R; Hicks, Rodney W

2013-12-01

Preventing infection in the perioperative setting is a critical element of patient and health care worker safety. This article reviews the recommendations in the AORN "Recommended practices for prevention of transmissible infections in the perioperative practice setting." The recommended practices are intended to help perioperative nurses implement standard and transmission-based precautions (ie, contact, droplet, airborne), including use of personal protective equipment as well as interventions to prevent surgical site infections and exposure to bloodborne pathogens. Additional recommendations cover vaccination programs and how to manage personnel who require work restrictions. Hospital and ambulatory patient scenarios are included to help perioperative nurses apply the recommendations in daily practice. Copyright © 2013 AORN, Inc. Published by Elsevier Inc. All rights reserved.

International survey on the management of skin stigmata and suspected tethered cord.

PubMed

Ponger, Penina; Ben-Sira, Liat; Beni-Adani, Liana; Steinbok, Paul; Constantini, Shlomi

2010-12-01

We designed a survey to investigate current international management trends of neonates with lumbar midline skin stigmata suspicious of tethered cord, among pediatric neurosurgeons, focusing on the lower risk stigmata, simple dimples, deviated gluteal folds, and discolorations. Our findings will enable physicians to assess their current diagnosis routine and aid in clarifying management controversies. A questionnaire on the proposed diagnostic evaluation of seven case reports, each accompanied by relevant imaging, was distributed by e-mail to members of the International Society for Pediatric Neurosurgery, the European Society for Pediatric Neurosurgery, and via the PEDS server list between March and August 2008. Sixty-two questionnaires, completed by experienced professionals with a rather uniform distribution of experience levels, were analyzed. Forty-eight percent do not recommend any imaging of simple dimples, 30% recommend US screening and 22% recommend MR. Seventy-nine percent recommend imaging of deviated gluteal fold with 30% recommending MR. Ninety-two percent recommend imaging infants with hemangiomas with 74% recommending MR. MR for sinus tracts is recommended by 90% if sacral and by 98% if lumber. Eighty-four percent recommend MR for filar cyst. Our survey demonstrates that management of low-risk skin stigmata, simple dimple, deviated gluteal fold, and discolorations lacks consensus. In addition, a significant sector of the professional community proposes a work-up of simple dimples, sacral tracts, and filar cysts that contradicts established recommendations. A simple classification system is needed to attain a better approach, enabling correct diagnosis of tethered cord without exposing neonates to unnecessary examinations.

Recommendations for the management of cardiovascular risk in patients with rheumatoid arthritis: scientific evidence and expert opinion.

PubMed

Martín-Martínez, María A; González-Juanatey, Carlos; Castañeda, Santos; Llorca, Javier; Ferraz-Amaro, Iván; Fernández-Gutiérrez, Benjamín; Díaz-González, Federico; González-Gay, Miguel A

2014-08-01

Last recommendations regarding cardiovascular risk (CVR) in rheumatoid arthritis (RA) patients were developed by the EULAR group in 2010. The aim is to update evidence-based recommendations about this worrying health problem. We assembled a multidisciplinary workgroup (rheumatologists, endocrinologist, cardiologist, and epidemiologist) and a panel of 28 expert rheumatologists. The study was carried out in two big phases: identifying key areas in the prevention and management of CVR and developing a set of recommendations based on a review of the available scientific evidence and use of the Delphi consensus technique. All this has been developed according to an updating process of evidence-based recommendations. Overall, 25 recommendations were made addressing three complementary areas: CVR assessment tools, patient eligibility for assessment, and treatment strategies for control of CVR. The grade of the recommendations was not substantially modified compared to the original EULAR recommendations, except in two of them, which were upgraded from C to B. These two recommendations are the ones related to the use of corticosteroids and smoking cessation. The new developed recommendations address these two areas: CVR assessment and treatment strategies for control of CVR. There are substantial gaps in the current knowledge that do not allow classifying properly RA patients based on their actual CVR and to accurately identify those patients who would benefit from CVR assessment. Consequently, studies designed to determine the causal effects of RA disease characteristics on cardiovascular morbidity/mortality and to identify patients at high risk of cardiovascular disease are still needed. Copyright © 2014 Elsevier Inc. All rights reserved.

Improving Physician Recommendations for Human Papillomavirus Vaccination: The Role of Professional Organizations.

PubMed

Hswen, Yulin; Gilkey, Melissa B; Rimer, Barbara K; Brewer, Noel T

2017-01-01

To address low human papillomavirus (HPV) vaccination coverage, the American Academy of Family Physicians (AAFP) and the American Academy of Pediatrics (AAP) have launched national campaigns encouraging physicians to deliver strong HPV vaccine recommendations. We surveyed family physicians and pediatricians to examine the impact of these efforts on physicians' recommendation practices. A national sample of family physicians and pediatricians (n = 776) completed our online survey in 2014. The survey assessed reach, content, and influence of AAFP and AAP communications about HPV vaccination. The survey also assessed quality of physicians' communication practices for recommending HPV vaccination. Forty-seven percent of family physicians reported receiving information on HPV vaccination from AAFP, whereas 62% of pediatricians reported receiving information from AAP. Among physicians reached by AAFP or AAP, most reported receiving the message to give strong recommendations to adolescent boys (71%) and girls (78%). Although receiving information was not associated with HPV vaccine recommendation quality, receiving the message to give strong recommendations correlated with delivering higher-quality recommendations for boys (odds ratio, 4.19, 95% confidence interval, 2.64-6.64) and girls (odds ratio, 3.15, 95% confidence interval, 1.91-5.18). Over half of physicians reported improving their HPV vaccine communication after receiving information from AAFP (69%) or AAP (53%). Our findings suggest that it is important for AAFP and AAP to communicate the need for strong HPV vaccine recommendations. Given that many physicians reported improving their recommendation practices, professional organizations stand to contribute to increasing HPV vaccination coverage, but they will likely need to increase the intensity of quality improvement efforts to do so.

Is adherence to diet, physical activity, and body weight cancer prevention recommendations associated with colorectal cancer incidence in African American women?

PubMed

Nomura, Sarah J O; Dash, Chiranjeev; Rosenberg, Lynn; Yu, Jeffrey; Palmer, Julie R; Adams-Campbell, Lucile L

2016-07-01

The purpose of this study was to evaluate whether adherence to the World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) cancer prevention recommendations was associated with colorectal cancer incidence in the Black Women's Health Study (BWHS). In this ongoing prospective cohort of African American women (analytic cohort n = 49,103), 354 incident colorectal cancers were diagnosed between baseline (1995) and 2011. Adherence scores for seven WCRF/AICR recommendations (adherent = 1 point, non-adherent level 1 = 0.5 points, non-adherent level 2 = 0 points) were created using questionnaire data and summed to an overall adherence score (maximum = 7). Recommendation adherence and colorectal cancer incidence were evaluated using baseline and time-varying data in Cox regression models. At baseline, 8.5 % of women adhered >4 recommendations. In time-varying analyses, the HR was 0.98 (95 % CI 0.84-1.15) per 0.5 point higher score and 0.51 (95 % CI 0.23-1.10) for adherence to >4 compared to <3 recommendations. Adherence to individual recommendations was not associated with colorectal cancer risk. Results were similar in models that considered baseline exposures only. Adherence to cancer prevention recommendations was low and not associated with colorectal cancer risk among women in the BWHS. Research in diverse populations is essential to evaluate the validity of existing recommendations, and assess whether there are alternative recommendations that are more beneficial for cancer prevention in specific populations.

Use of systematic reviews in clinical practice guidelines: case study of smoking cessation

PubMed Central

Silagy, C A; Stead, L F; Lancaster, T

2001-01-01

Objective To examine the extent to which recommendations in the national guidelines for the cessation of smoking are based on evidence from systematic reviews of controlled trials. Design Retrospective analysis of recommendations for the national guidelines for the cessation of smoking. Materials National guidelines in clinical practice on smoking cessation published in English. Main outcome measures The type of evidence (systematic review of controlled trials, individual trials, other studies, expert opinion) used to support each recommendation. We also assessed whether a Cochrane systematic review was available and could have been used in formulating the recommendation. Results Four national smoking cessation guidelines (from Canada, New Zealand, the United Kingdom, and the United States) covering 105 recommendations were identified. An explicit evidence base for 100%, 89%, 68%, and 98% of recommendations, respectively, was detected, of which 60%, 56%, 59%, and 47% were based on systematic reviews of controlled studies. Cochrane systematic reviews could have been used to develop between 39% and 73% of recommendations but were actually used in 0% to 36% of recommendations. The UK guidelines had the highest proportion of recommendations based on Cochrane systematic reviews. Conclusions Use of systematic reviews in guidelines is a measure of the “payback” on investment in research synthesis. Systematic reviews commonly underpinned recommendations in guidelines on smoking cessation. The extent to which they were used varied by country and there was evidence of duplication of effort in some areas. Greater international collaboration in developing and maintaining an evidence base of systematic reviews can improve the efficiency of use of research resources. PMID:11597966

Adapting heart failure guidelines for nursing care in home health settings: challenges and solutions.

PubMed

Radhakrishnan, Kavita; Topaz, Maxim; Masterson Creber, Ruth

2014-07-01

Nurses provide most of home health services for patients with heart failure, and yet there are no evidence-based practice guidelines developed for home health nurses. The purpose of this article was to review the challenges and solutions for adapting generally available HF clinical practice guidelines to home health nursing. Appropriate HF guidelines were identified and home health nursing-relevant guidelines were extracted by the research team. In addition, a team of nursing academic and practice experts evaluated the extracted guidelines and reached consensus through Delphi rounds. We identified 172 recommendations relevant to home health nursing from the American Heart Association and Heart Failure Society of America guidelines. The recommendations were divided into 5 groups (generic, minority populations, normal ejection fraction, reduced ejection fraction, and comorbidities) and further subgroups. Experts agreed that 87% of the recommendations selected by the research team were relevant to home health nursing and rejected 6% of the selected recommendations. Experts' opinions were split on 7% of guideline recommendations. Experts mostly disagreed on recommendations related to HF medication and laboratory prescription as well as HF patient assessment. These disagreements were due to lack of patient information available to home health nurses as well as unclear understanding of scope of practice regulations for home health nursing. After 2 Delphi rounds over 8 months, we achieved 100% agreement on the recommendations. The finalized guideline included 153 recommendations. Guideline adaptation projects should include a broad scope of nursing practice recommendations from which home health agencies can customize relevant recommendations in accordance with available information and state and agency regulations.

Evidence-based advances in transfusion practice in neonatal intensive care units.

PubMed

Christensen, Robert D; Carroll, Patrick D; Josephson, Cassandra D

2014-01-01

Transfusions to neonates convey both benefits and risks, and evidence is needed to guide wise use. Such evidence is accumulating, but more information is needed to generate sound evidence-based practices. We sought to analyze published information on nine aspects of transfusion practice in neonatal intensive care units. We assigned 'categories of evidence' and 'recommendations' using the format of the United States Preventive Services Task Force of the Agency for Healthcare Research and Quality. The nine practices studied were: (1) delayed clamping or milking of the umbilical cord at preterm delivery - recommended, high/substantial A; (2) drawing the initial blood tests from cord/placental blood from very low birth weight (VLBW, <1,500 g) infants at delivery - recommended, moderate/moderate B; (3) limiting phlebotomy losses of VLBW infants - recommended, moderate/substantial B; (4) selected use of erythropoiesis-stimulating agents to prevent transfusions - recommended, moderate/moderate-moderate/small B, C; (5) using platelet mass, rather than platelet count, in platelet transfusion decisions - recommended, moderate/small C; (6) permitting the platelet count to fall to <20,000/µl in 'stable' neonates before transfusing platelets - recommended, low/small I; (8) permitting the platelet count to fall to <50,000/µl in 'unstable' neonates before transfusing platelets - recommended, moderate/small C, and (9) not performing routine coagulation test screening on every VLBW infant - recommended, moderate/small C. We view these recommendations as dynamic, to be revised as additional evidence becomes available. We predict this list will expand as new studies provide more information to guide best transfusion practices. © 2014 S. Karger AG, Basel.

Multinational evidence-based recommendations for the diagnosis and management of gout: integrating systematic literature review and expert opinion of a broad panel of rheumatologists in the 3e initiative

PubMed Central

Sivera, Francisca; Andrés, Mariano; Carmona, Loreto; Kydd, Alison S R; Moi, John; Seth, Rakhi; Sriranganathan, Melonie; van Durme, Caroline; van Echteld, Irene; Vinik, Ophir; Wechalekar, Mihir D; Aletaha, Daniel; Bombardier, Claire; Buchbinder, Rachelle; Edwards, Christopher J; Landewé, Robert B; Bijlsma, Johannes W; Branco, Jaime C; Burgos-Vargas, Rubén; Catrina, Anca I; Elewaut, Dirk; Ferrari, Antonio J L; Kiely, Patrick; Leeb, Burkhard F; Montecucco, Carlomaurizio; Müller-Ladner, Ulf; Østergaard, Mikkel; Zochling, Jane; Falzon, Louise; van der Heijde, Désirée M

2014-01-01

We aimed to develop evidence-based multinational recommendations for the diagnosis and management of gout. Using a formal voting process, a panel of 78 international rheumatologists developed 10 key clinical questions pertinent to the diagnosis and management of gout. Each question was investigated with a systematic literature review. Medline, Embase, Cochrane CENTRAL and abstracts from 2010–2011 European League Against Rheumatism and American College of Rheumatology meetings were searched in each review. Relevant studies were independently reviewed by two individuals for data extraction and synthesis and risk of bias assessment. Using this evidence, rheumatologists from 14 countries (Europe, South America and Australasia) developed national recommendations. After rounds of discussion and voting, multinational recommendations were formulated. Each recommendation was graded according to the level of evidence. Agreement and potential impact on clinical practice were assessed. Combining evidence and clinical expertise, 10 recommendations were produced. One recommendation referred to the diagnosis of gout, two referred to cardiovascular and renal comorbidities, six focused on different aspects of the management of gout (including drug treatment and monitoring), and the last recommendation referred to the management of asymptomatic hyperuricaemia. The level of agreement with the recommendations ranged from 8.1 to 9.2 (mean 8.7) on a 1–10 scale, with 10 representing full agreement. Ten recommendations on the diagnosis and management of gout were established. They are evidence-based and supported by a large panel of rheumatologists from 14 countries, enhancing their utility in clinical practice. PMID:23868909

Multinational evidence-based recommendations on how to investigate and follow-up undifferentiated peripheral inflammatory arthritis: integrating systematic literature research and expert opinion of a broad international panel of rheumatologists in the 3E Initiative.

PubMed

Machado, P; Castrejon, I; Katchamart, W; Koevoets, R; Kuriya, B; Schoels, M; Silva-Fernández, L; Thevissen, K; Vercoutere, W; Villeneuve, E; Aletaha, D; Carmona, L; Landewé, R; van der Heijde, D; Bijlsma, J W J; Bykerk, V; Canhão, H; Catrina, A I; Durez, P; Edwards, C J; Mjaavatten, M D; Leeb, B F; Losada, B; Martín-Mola, E M; Martinez-Osuna, P; Montecucco, C; Müller-Ladner, U; Østergaard, M; Sheane, B; Xavier, R M; Zochling, J; Bombardier, C

2011-01-01

To develop evidence-based recommendations on how to investigate and follow-up undifferentiated peripheral inflammatory arthritis (UPIA). 697 rheumatologists from 17 countries participated in the 3E (Evidence, Expertise, Exchange) Initiative of 2008-9 consisting of three separate rounds of discussions and modified Delphi votes. In the first round 10 clinical questions were selected. A bibliographic team systematically searched Medline, Embase, the Cochrane Library and ACR/EULAR 2007-2008 meeting abstracts. Relevant articles were reviewed for quality assessment, data extraction and synthesis. In the second round each country elaborated a set of national recommendations. Finally, multinational recommendations were formulated and agreement among the participants and the potential impact on their clinical practice was assessed. A total of 39,756 references were identified, of which 250 were systematically reviewed. Ten multinational key recommendations about the investigation and follow-up of UPIA were formulated. One recommendation addressed differential diagnosis and investigations prior to establishing the operational diagnosis of UPIA, seven recommendations related to the diagnostic and prognostic value of clinical and laboratory assessments in established UPIA (history and physical examination, acute phase reactants, autoantibodies, radiographs, MRI and ultrasound, genetic markers and synovial biopsy), one recommendation highlighted predictors of persistence (chronicity) and the final recommendation addressed monitoring of clinical disease activity in UPIA. Ten recommendations on how to investigate and follow-up UPIA in the clinical setting were developed. They are evidence-based and supported by a large panel of rheumatologists, thus enhancing their validity and practical use.

Preventive services recommendations for adults in primary care settings: agreement between Canada, France and the USA--a systematic review.

PubMed

Gelly, Julien; Mentre, France; Nougairede, Michel; Duval, Xavier

2013-07-01

To analyze the level of agreement between recommendations on preventive services developed by Canada, France and the USA. We gathered recommendations on primary and secondary preventive services to adults up to November 3rd, 2011 from Canadian and US Task Forces, and equivalent French agencies. We excluded recommendations on immunization, long-term diseases or pregnancy. Among 250 recommendations, 84 (34%) issued by a single country could not be compared; 43 (26%) of the remaining 166 were in strong agreement (strictly identical grades between advising countries); 25 of 43 resulted in a proposal to be implemented in clinical practice, two others not to be implemented in clinical practice and 16 were indeterminate about implementation. Strong agreement was more frequent for recommendations concerning history-taking and physical examination than for those concerning interventions (odds ratio (OR)=11.3, 95%CI: 1.6-241.2; p=0.04), and for recommendations concerning a high-risk population than for those concerning the general population (OR=3.1, 95%CI: 1.4-7.0; p=0.006). Agreement did not differ either according to maximum time range between recommendations' publication or according to the advising country. Agreement between recommendations is low particularly on those concerning non-clinical preventive services or non-high-risk individuals. Copyright © 2013 Elsevier Inc. All rights reserved.

Associated factors for recommending HBV vaccination to children among Georgian health care workers.

PubMed

Butsashvili, Maia; Kamkamidze, George; Topuridze, Marina; Morse, Dale; Triner, Wayne; DeHovitz, Jack; Nelson, Kenrad; McNutt, Louise-Anne

2012-12-20

Most cases of hepatitis B virus (HBV) infection and subsequent liver diseases can be prevented with universal newborn HBV vaccination. The attitudes of health care workers about HBV vaccination and their willingness to recommend vaccine have been shown to impact HBV vaccination coverage and the prevention of vertical transmission of HBV. The purpose of this study was to ascertain the factors associated with health care worker recommendations regarding newborn HBV vaccination. A cross-sectional study of prevalence and awareness of hepatitis B and hepatitis B vaccine was conducted among randomly selected physicians and nurses employed in seven hospitals in Georgia in 2006 and 2007. Self-administered questionnaires included a module on recommendations for HBV, HCV and HIV. Of the 1328 participants included in this analysis, 36% reported recommending against hepatitis B vaccination for children, including 33% of paediatricians. Among the 70.6% who provided a reason for not recommending HBV vaccine, the most common concern was an adverse vaccine event. Unvaccinated physicians and nurses were more likely to recommend against HBV vaccine (40.4% vs 11.4%, PR 3.54; 95% CI: 2.38, 5.29). Additionally, health care worker age was inversely correlated with recommendations for HBV vaccine with older workers less likely to recommend it. Vaccinating health care workers against HBV may provide a dual benefit by boosting occupational safety as well as strengthening universal coverage programs for newborns.

Online Tonsillectomy Resources: Are Parents Getting Consistent and Readable Recommendations?

PubMed

Wozney, Lori; Chorney, Jill; Huguet, Anna; Song, Jin Soo; Boss, Emily F; Hong, Paul

2017-05-01

Objective Parents frequently refer to information on the Internet to confirm or broaden their understanding of surgical procedures and to research postoperative care practices. Our study evaluated the readability, comprehensiveness, and consistency around online recommendations directed at parents of children undergoing tonsillectomy. Study Design A cross-sectional study design was employed. Setting Thirty English-language Internet websites. Subjects and Methods Three validated measures of readability were applied and content analysis was employed to evaluate the comprehensiveness of information in domains of perioperative education. Frequency effect sizes and percentile ranks were calculated to measure dispersion of recommendations across sites. Results The mean readability level of all sites was above a grade 10 level with fewer than half of the sites (n = 14, 47%) scoring at or below the eight-grade level. Provided information was often incomplete with a noted lack of psychosocial support and skills-training recommendations. Content analysis showed 67 unique recommendations spanning the full perioperative period. Most recommendations had low consensus, being reported in 5 or fewer sites (frequency effect size <16%). Conclusion Many online parent-focused resources do not meet readability recommendations, portray incomplete education about perioperative care and expectations, and provide recommendations with low levels of consensus. Up-to-date mapping of the research evidence around recommendations is needed as well as improved efforts to make online information easier to read.

Variation in Treatment Recommendations for Dupuytren Disease.

PubMed

McMillan, Catherine; Yeung, Celine; Binhammer, Paul

2017-12-01

To examine agreement on Dupuytren disease (DD) treatment recommendations in an international sample of hand surgeons. A survey was developed to determine expertise in needle aponeurotomy, surgery, and collagenase injection to treat DD and to examine treatment recommendations for 16 case scenarios. Case scenarios were predeveloped using expert input. Each case represented a unique combination of 4 dichotomous variables including cord thickness, contracture severity, patient age, and joint involvement. Interrater reliability statistics were calculated and multinomial logistic regression modeling and analysis of variance were used to examine the impact of surgeon- and case-related variables on treatment recommendations. A total of 36 hand surgeons from 9 countries (mean experience, 17 years) participated. Average pairwise percent agreement and Krippendorff's alpha were 26% and .012, respectively. Predictors of a recommendation for surgery over multiple options were a total contracture of greater than 70°, a thick precentral cord, involvement of the metacarpophalangeal and proximal interphalangeal joints, and greater years in practice. A greater number of years in practice predicted recommendation for collagenase injection and the presence of a thick precentral cord predicted a recommendation for needle aponeurotomy. Little agreement exists on treatment recommendations for common presentations of DD in this sample. Further investigation into the sources of potential widespread discrepancies in the management of DD may improve the capacity to make evidence-based recommendations. Copyright © 2017 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

Evaluating the role of public health in implementation of genomics-related recommendations: a case study of hereditary cancers using the CDC Science Impact Framework.

PubMed

Green, Ridgely Fisk; Ari, Mary; Kolor, Katherine; Dotson, W David; Bowen, Scott; Habarta, Nancy; Rodriguez, Juan L; Richardson, Lisa C; Khoury, Muin J

2018-06-15

Public health plays an important role in ensuring access to interventions that can prevent disease, including the implementation of evidence-based genomic recommendations. We used the Centers for Disease Control and Prevention (CDC) Science Impact Framework to trace the impact of public health activities and partnerships on the implementation of the 2009 Evaluation of Genomic Applications in Practice and Prevention (EGAPP) Lynch Syndrome screening recommendation and the 2005 and 2013 United States Preventive Services Task Force (USPSTF) BRCA1 and BRCA2 testing recommendations.The EGAPP and USPSTF recommendations have each been cited by >300 peer-reviewed publications. CDC funds selected states to build capacity to integrate these recommendations into public health programs, through education, policy, surveillance, and partnerships. Most state cancer control plans include genomics-related goals, objectives, or strategies. Since the EGAPP recommendation, major public and private payers now provide coverage for Lynch Syndrome screening for all newly diagnosed colorectal cancers. National guidelines and initiatives, including Healthy People 2020, included similar recommendations and cited the EGAPP and USPSTF recommendations. However, disparities in implementation based on race, ethnicity, and rural residence remain challenges. Public health achievements in promoting the evidence-based use of genomics for the prevention of hereditary cancers can inform future applications of genomics in public health.

Physical activity and health-related quality of life among older men: an examination of current physical activity recommendations.

PubMed

Vallance, Jeff K; Eurich, Dean T; Lavallee, Celeste M; Johnson, Steven T

2012-01-01

To determine differences in health-related quality of life (HRQoL) between older men achieving versus not achieving American College of Sports Medicine (ACSM) and the United States Department of Health and Human Services recommendations (USDHHS) physical activity (PA) recommendations. Older-aged men (≥ 55 years) completed a mailed survey that assessed self-reported PA and HRQoL. Data were collected between September and October of 2010. 387 older men (Mean age=65) completed the survey. Under half (48%) reported achieving the ACSM recommendation while 64% reported achieving the USDHHS recommendation. Older men achieving the ACSM recommendation reported significantly higher scores in physical health (Δ=3.5, p<0.001), mental health (Δ=4.4, p<0.001), and global health (Δ=4.3, p<0.001) component scores compared to those not achieving the recommendation. Those achieving the higher dose recommended by the USDHHS (≥ 300 min per week of moderate-intensity activity) reported significantly higher scores on the PHC (Δ=2.1, p=0.029) and GHC (Δ=2.3, p=0.027) scales compared to those achieving the USDHHS base recommendation (150-299.9 min per week of moderate-intensity activity). Self-reported PA was significantly and positively associated with higher HRQoL scores among older men. Associations were stronger for those achieving a higher volume of PA. Copyright © 2012 Elsevier Inc. All rights reserved.

Do we need personalized recommendations for infants at risk of developing disease?

PubMed

Hernell, Olle; West, Christina

2008-01-01

Current nutrition recommendations, directed towards populations, are based on estimated average nutrient requirements for a target population and intend to meet the needs of most individuals within that population. They also aim at preventing common diseases such as obesity, diabetes and cardiovascular disease. For infants with specific genetic polymorphisms, e.g. some inborn errors of metabolism, adherence to current recommendations will cause disease symptoms and they need personalized nutrition recommendations. Some other monogenic polymorphisms, e.g. adult hypolactasia, are common but with varying prevalence between ethnic groups and within populations. Ages at onset as well as the degree of the resulting lactose intolerance also vary, making population-based as well as personalized recommendations difficult. The tolerable intake is best set by each individual based on symptoms. For polygenetic diseases such as celiac disease, type-1 diabetes and allergic disease, current knowledge is insufficient to suggest personalized recommendations aiming at primary prevention for all high-risk infants, although it may be justified to provide such recommendations on an individual level should the parents ask for them. New technologies such as nutrigenetics and nutrigenomics are promising tools with which current nutrition recommendations can possibly be refined and the potential of individualized nutrition be explored. It seems likely that in the future it will be possible to offer more subgroups within a population personalized recommendations.

U.S. Preventive Services Task Force recommendations and cancer screening among female Medicare beneficiaries.

PubMed

Salloum, Ramzi G; Kohler, Racquel E; Jensen, Gail A; Sheridan, Stacey L; Carpenter, William R; Biddle, Andrea K

2014-03-01

Medicare covers several cancer screening tests not currently recommended by the U.S. Preventive Services Task Force (Task Force). In September 2002, the Task Force relaxed the upper age limit of 70 years for breast cancer screening recommendations, and in March 2003 an upper age limit of 65 years was introduced for cervical cancer screening recommendations. We assessed whether mammogram and Pap test utilization among women with Medicare coverage is influenced by changes in the Task Force's recommendations for screening. We identified female Medicare beneficiaries aged 66-80 years and used bivariate probit regression to examine the receipt of breast (mammogram) and cervical (Pap test) cancer screening reflecting changes in the Task Force recommendations. We analyzed 9,760 Medicare Current Beneficiary Survey responses from 2001 to 2007. More than two-thirds reported receiving a mammogram and more than one-third a Pap test in the previous 2 years. Lack of recommendation was given as a reason for not getting screened among the majority (51% for mammogram and 75% for Pap). After controlling for beneficiary-level socioeconomic characteristics and access to care factors, we did not observe a significant change in breast and cervical cancer screening patterns following the changes in Task Force recommendations. Although there is evidence that many Medicare beneficiaries adhere to screening guidelines, some women may be receiving non-recommended screening services covered by Medicare.

Hand hygiene--comparison of international recommendations.

PubMed

Wendt, C

2001-08-01

The value of hand hygiene for the prevention of cross-infection was first observed in the middle of the 19th century. Since then, which procedure is the most suitable for hand hygiene has been repeatedly discussed and several different guidelines and recommendations have been published. The aim of this review is to compare different recommendations for hand hygiene regarding technique and indication. Medline, the internet and a personal library were searched to obtain as many written recommendations as possible. In addition, a small questionnaire was sent by e-mail to 20 international colleagues. As a result, written recommendations from 10 countries could be compared. Recommended methods of hand hygiene include handwashing (washing hands with plain soap), hygienic handwash (washing hands with medicated soap) and hygienic hand-rub (use of antiseptic rubs). In most countries handwashing and hygienic handwash are the methods of choice and only in central European countries is hygienic hand-rub the preferred technique. Situations in which performance of hand hygiene is recommended are comparable. However, no single indication is recommended in all guidelines. Hand hygiene is most often recommended before performing invasive procedures and after microbial contamination. Guidelines should be clear and easy to follow for them to become standard of care. Thus, guidelines are needed that do not leave to the health care worker a decision as to whether hand hygiene is indicated.

Impact of patient outcomes and cost aspects on reimbursement recommendations in Poland in 2012-2014.

PubMed

Malinowski, Krzysztof Piotr; Kawalec, Paweł; Trąbka, Wojciech

2016-11-01

The aim of this study was to assess the influence of different factors on the final reimbursement recommendations for drugs in Poland and to identify the correlation between these factors and the probability of a positive reimbursement recommendation for an applicant drug issued by the President of the Agency for Health Technology Assessment and Tariff System (AOTMiT). We analysed all recommendations for the period of 2012-2014 in Poland, three years following the launch of the new Reimbursement Act of Medicines, Foodstuffs Intended for Particular Nutritional Uses and Medical Devices. For each recommendation we collected data on efficacy, safety, cost of therapy, cost-effectiveness, quality of evidence, orphan drug status and others. Logistic regression was used to identify factors that increase the odds of a positive reimbursement recommendation. We analysed 221 recommendations for drugs, of which 78% were positive. We observed significant associations of all selected factors with positive recommendations. Proven efficacy and safety were associated with much greater odds for a positive reimbursement recommendation (123.5 and 42.6, respectively) than cost factors, which may suggest that patient outcome is much more important than the results of the cost-effectiveness analysis (odds ratio of 3.5) and the general cost of therapy (odds ratio of 3) in the analysed period. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

15 CFR 10.7 - Procedure when a recommended standard is not supported by a consensus.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 15 Commerce and Foreign Trade 1 2010-01-01 2010-01-01 false Procedure when a recommended standard is not supported by a consensus. 10.7 Section 10.7 Commerce and Foreign Trade Office of the Secretary... recommended standard is not supported by a consensus. If the Department determines that a recommended standard...

The Effect of Incorporating Good Learners' Ratings in e-Learning Content-Based Recommender System

ERIC Educational Resources Information Center

Ghauth, Khairil Imran; Abdullah, Nor Aniza

2011-01-01

One of the anticipated challenges of today's e-learning is to solve the problem of recommending from a large number of learning materials. In this study, we introduce a novel architecture for an e-learning recommender system. More specifically, this paper comprises the following phases i) to propose an e-learning recommender system based on…

Interim Canadian recommendations for the use of a fractional dose of yellow fever vaccine during a vaccine shortage

PubMed Central

2016-01-01

Summary This statement outlines interim recommendations intended for use during yellow fever vaccine shortages only. The recommendations differ from the standard recommendations for yellow fever vaccination in the Canadian Immunization Guide and in the Committee to Advise on Tropical Medicine and Travel (CATMAT) Statement for Travellers and Yellow Fever. PMID:29770023

43 CFR 404.44 - What criteria will Reclamation apply to determine whether it is appropriate to recommend that a...

Code of Federal Regulations, 2011 CFR

2011-10-01

... formulated and evaluated; (b) Whether the recommendation for further study of one or more alternatives is... determine whether it is appropriate to recommend that a feasibility study be conducted? 404.44 Section 404... will Reclamation apply to determine whether it is appropriate to recommend that a feasibility study be...

29 CFR 458.88 - Submission of the Administrative Law Judge's recommended decision and order to the Assistant...

Code of Federal Regulations, 2011 CFR

2011-07-01

... Administrative Law Judge shall cause his recommended decision and order to be served promptly on all parties to... parties. (c) Exceptions to the Administrative Law Judge's recommended decision and order may be filed by... 29 Labor 2 2011-07-01 2011-07-01 false Submission of the Administrative Law Judge's recommended...

29 CFR 458.88 - Submission of the Administrative Law Judge's recommended decision and order to the Assistant...

Code of Federal Regulations, 2012 CFR

2012-07-01

... Administrative Law Judge shall cause his recommended decision and order to be served promptly on all parties to... parties. (c) Exceptions to the Administrative Law Judge's recommended decision and order may be filed by... 29 Labor 2 2012-07-01 2012-07-01 false Submission of the Administrative Law Judge's recommended...

Marine Corps Installations National Capital RegionRegional Contracting Office Generally Implemented Recommendations

DTIC Science & Technology

2016-07-29

Corps Installations National Capital Region–Regional Contracting Office Generally Implemented Recommendations J U LY 2 9 , 2 0 1 6 Report No...Installations National Capital Region–Regional Contracting Office Generally Implemented Recommendations Objective We determined whether the Marine...Corps Regional Contracting Office–National Capital Region implemented the recommendations in Report No. DODIG-2015-095, “Small Business Contracting

Hot Spots on the Web for Teacher Librarians: A Selection of Recommended Web Sites for TLs To Visit.

ERIC Educational Resources Information Center

1996

Six papers review and recommend sites on the Web as resources for teacher librarians include: "Just Do It: A Guide to Getting Out There and Doing It Yourself" (Catherine Ryan); "A Selection of Recommended Web Sites for TLs To Visit" (Karen Bonanno); "A Selection of Recommended Web Sites for TLs To Visit" (Sandra…

Recommendations for Changes in Laws, Resources and Programs Related to Drug Law Enforcement. Discussion Paper 89-2.

ERIC Educational Resources Information Center

Matthias, Mary

This document lists recommendations for changes in laws, resources and programs relating to drug law enforcement made to the Wisconsin Special Committee on Drug Law Enforcement, as of August 25, 1989. Some of the recommendations are based on comments of Committee members, rather than persons testifying to the Committee. Each recommendation is…

WIA Reauthorization Recommendations [and] Side-by-Side Comparison of Title I Provisions in Recent WIA Reauthorization Proposals (June 25, 2003 Update).

ERIC Educational Resources Information Center

Patel, Nisha; Strawn, Julie; Greenberg, Mark

This publication on reauthorization recommendations for the Workforce Investment Act of 1998 (WIA) comprises three documents. The first is a short summary of reauthorization recommendations for Title I and II. Title I recommendations are to eliminate sequential eligibility; promote greater access to training; improve adjustment of performance…

Probiotics for gastrointestinal disorders: Proposed recommendations for children of the Asia-Pacific region.

PubMed

Cameron, Donald; Hock, Quak Seng; Kadim, Musal; Mohan, Neelam; Ryoo, Eell; Sandhu, Bhupinder; Yamashiro, Yuichiro; Jie, Chen; Hoekstra, Hans; Guarino, Alfredo

2017-12-07

Recommendations for probiotics are available in several regions. This paper proposes recommendations for probiotics in pediatric gastrointestinal diseases in the Asia-Pacific region. Epidemiology and clinical patterns of intestinal diseases in Asia-Pacific countries were discussed. Evidence-based recommendations and randomized controlled trials in the region were revised. Cultural aspects, health management issues and economic factors were also considered. Final recommendations were approved by applying the Likert scale and rated using the GRADE system. Saccharomyces boulardii CNCM I-745 (Sb) and Lactobacillus rhamnosus GG ( LGG ) were strongly recommended as adjunct treatment to oral rehydration therapy for gastroenteritis. Lactobacillus reuteri could also be considered. Probiotics may be considered for prevention of (with the indicated strains): antibiotic-associated diarrhea (LGG or Sb); Clostridium difficile -induced diarrhea (Sb); nosocomial diarrhea (LGG); infantile colic ( L reuteri ) and as adjunct treatment of Helicobacter pylori (Sb and others). Specific probiotics with a history of safe use in preterm and term infants may be considered in infants for prevention of necrotizing enterocolitis. There is insufficient evidence for recommendations in other conditions. Despite a diversity of epidemiological, socioeconomical and health system conditions, similar recommendations apply well to Asia pacific countries. These need to be validated with local randomized-controlled trials.

Diabetic Retinopathy Clinical Practice Guidelines: Customized for Iranian Population

PubMed Central

Rajavi, Zhale; Safi, Sare; Javadi, Mohammad Ali; Azarmina, Mohsen; Moradian, Siamak; Entezari, Morteza; Nourinia, Ramin; Ahmadieh, Hamid; Shirvani, Armin; Shahraz, Saeid; Ramezani, Alireza; Dehghan, Mohammad Hossein; Shahsavari, Mohsen; Soheilian, Masoud; Nikkhah, Homayoun; Ziaei, Hossein; Behboudi, Hasan; Farrahi, Fereydoun; Falavarjani, Khalil Ghasemi; Parvaresh, Mohammad Mehdi; Fesharaki, Hamid; Abrishami, Majid; Shoeibi, Nasser; Rahimi, Mansour; Javadzadeh, Alireza; Karkhaneh, Reza; Riazi-Esfahani, Mohammad; Manaviat, Masoud Reza; Maleki, Alireza; Kheiri, Bahareh; Golbafian, Faegheh

2016-01-01

Purpose: To customize clinical practice guidelines (CPGs) for management of diabetic retinopathy (DR) in the Iranian population. Methods: Three DR CPGs (The Royal College of Ophthalmologists 2013, American Academy of Ophthalmology [Preferred Practice Pattern 2012], and Australian Diabetes Society 2008) were selected from the literature using the AGREE tool. Clinical questions were designed and summarized into four tables by the customization team. The components of the clinical questions along with pertinent recommendations extracted from the above-mentioned CPGs; details of the supporting articles and their levels of evidence; clinical recommendations considering clinical benefits, cost and side effects; and revised recommendations based on customization capability (applicability, acceptability, external validity) were recorded in 4 tables, respectively. Customized recommendations were sent to the faculty members of all universities across the country to score the recommendations from 1 to 9. Results: Agreed recommendations were accepted as the final recommendations while the non-agreed ones were approved after revision. Eventually, 29 customized recommendations under three major categories consisting of screening, diagnosis and treatment of DR were developed along with their sources and levels of evidence. Conclusion: This customized CPGs for management of DR can be used to standardize the referral pathway, diagnosis and treatment of patients with diabetic retinopathy. PMID:27994809

A collaborative approach for research paper recommender system.

PubMed

Haruna, Khalid; Akmar Ismail, Maizatul; Damiasih, Damiasih; Sutopo, Joko; Herawan, Tutut

2017-01-01

Research paper recommenders emerged over the last decade to ease finding publications relating to researchers' area of interest. The challenge was not just to provide researchers with very rich publications at any time, any place and in any form but to also offer the right publication to the right researcher in the right way. Several approaches exist in handling paper recommender systems. However, these approaches assumed the availability of the whole contents of the recommending papers to be freely accessible, which is not always true due to factors such as copyright restrictions. This paper presents a collaborative approach for research paper recommender system. By leveraging the advantages of collaborative filtering approach, we utilize the publicly available contextual metadata to infer the hidden associations that exist between research papers in order to personalize recommendations. The novelty of our proposed approach is that it provides personalized recommendations regardless of the research field and regardless of the user's expertise. Using a publicly available dataset, our proposed approach has recorded a significant improvement over other baseline methods in measuring both the overall performance and the ability to return relevant and useful publications at the top of the recommendation list.

A collaborative approach for research paper recommender system

PubMed Central

Akmar Ismail, Maizatul; Damiasih, Damiasih; Sutopo, Joko; Herawan, Tutut

2017-01-01

Research paper recommenders emerged over the last decade to ease finding publications relating to researchers’ area of interest. The challenge was not just to provide researchers with very rich publications at any time, any place and in any form but to also offer the right publication to the right researcher in the right way. Several approaches exist in handling paper recommender systems. However, these approaches assumed the availability of the whole contents of the recommending papers to be freely accessible, which is not always true due to factors such as copyright restrictions. This paper presents a collaborative approach for research paper recommender system. By leveraging the advantages of collaborative filtering approach, we utilize the publicly available contextual metadata to infer the hidden associations that exist between research papers in order to personalize recommendations. The novelty of our proposed approach is that it provides personalized recommendations regardless of the research field and regardless of the user’s expertise. Using a publicly available dataset, our proposed approach has recorded a significant improvement over other baseline methods in measuring both the overall performance and the ability to return relevant and useful publications at the top of the recommendation list. PMID:28981512

Exercise recommendations for childhood cancer survivors exposed to cardiotoxic therapies: an institutional clinical practice initiative.

PubMed

Okada, Maki; Meeske, Kathleen A; Menteer, Jondavid; Freyer, David R

2012-01-01

Childhood cancer survivors who have received treatment with anthracyclines are at risk for developing cardiomyopathy in dose-dependent fashion. Historically, restrictions on certain types of physical activity that were intended to preserve cardiac function have been recommended, based on a mixture of evidence-based and consensus-based recommendations. In the LIFE Cancer Survivorship & Transition Program at Children's Hospital Los Angeles, the authors reevaluated their recommendations for exercise in survivors who were exposed to anthracyclines, with or without irradiation in proximity to the myocardium. The primary goal was to develop consistent, specific, practical, safe, and (where possible) evidence-based recommendations for at-risk survivors in the program. To accomplish this, the authors referred to current exercise guidelines for childhood cancer survivors, consulted recent literature for relevant populations, and obtained input from the program's pediatric cardiology consultant. The resulting risk-based exercise recommendations are designed to complement current published guidelines, maximize safe exercise, and help childhood cancer survivors return to a normal life that emphasizes overall wellness and physical activity. This article describes a single institution's experience in modifying exercise recommendations for at-risk childhood survivors and includes the methods, findings, and current institutional practice recommendations along with sample education materials.

Developing a semantic web model for medical differential diagnosis recommendation.

PubMed

Mohammed, Osama; Benlamri, Rachid

2014-10-01

In this paper we describe a novel model for differential diagnosis designed to make recommendations by utilizing semantic web technologies. The model is a response to a number of requirements, ranging from incorporating essential clinical diagnostic semantics to the integration of data mining for the process of identifying candidate diseases that best explain a set of clinical features. We introduce two major components, which we find essential to the construction of an integral differential diagnosis recommendation model: the evidence-based recommender component and the proximity-based recommender component. Both approaches are driven by disease diagnosis ontologies designed specifically to enable the process of generating diagnostic recommendations. These ontologies are the disease symptom ontology and the patient ontology. The evidence-based diagnosis process develops dynamic rules based on standardized clinical pathways. The proximity-based component employs data mining to provide clinicians with diagnosis predictions, as well as generates new diagnosis rules from provided training datasets. This article describes the integration between these two components along with the developed diagnosis ontologies to form a novel medical differential diagnosis recommendation model. This article also provides test cases from the implementation of the overall model, which shows quite promising diagnostic recommendation results.

Official ERS/ATS clinical practice guidelines: noninvasive ventilation for acute respiratory failure

PubMed Central

Brochard, Laurent; Elliott, Mark W.; Hess, Dean; Hill, Nicholas S.; Navalesi, Paolo; Antonelli, Massimo; Brozek, Jan; Conti, Giorgio; Ferrer, Miquel; Guntupalli, Kalpalatha; Jaber, Samir; Keenan, Sean; Mancebo, Jordi; Mehta, Sangeeta; Raoof, Suhail

2017-01-01

Noninvasive mechanical ventilation (NIV) is widely used in the acute care setting for acute respiratory failure (ARF) across a variety of aetiologies. This document provides European Respiratory Society/American Thoracic Society recommendations for the clinical application of NIV based on the most current literature. The guideline committee was composed of clinicians, methodologists and experts in the field of NIV. The committee developed recommendations based on the GRADE (Grading, Recommendation, Assessment, Development and Evaluation) methodology for each actionable question. The GRADE Evidence to Decision framework in the guideline development tool was used to generate recommendations. A number of topics were addressed using technical summaries without recommendations and these are discussed in the supplementary material. This guideline committee developed recommendations for 11 actionable questions in a PICO (population–intervention–comparison–outcome) format, all addressing the use of NIV for various aetiologies of ARF. The specific conditions where recommendations were made include exacerbation of chronic obstructive pulmonary disease, cardiogenic pulmonary oedema, de novo hypoxaemic respiratory failure, immunocompromised patients, chest trauma, palliation, post-operative care, weaning and post-extubation. This document summarises the current state of knowledge regarding the role of NIV in ARF. Evidence-based recommendations provide guidance to relevant stakeholders. PMID:28860265

Recommendations for reducing ambiguity in written procedures.

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

Matzen, Laura E.

Previous studies in the nuclear weapons complex have shown that ambiguous work instructions (WIs) and operating procedures (OPs) can lead to human error, which is a major cause for concern. This report outlines some of the sources of ambiguity in written English and describes three recommendations for reducing ambiguity in WIs and OPs. The recommendations are based on commonly used research techniques in the fields of linguistics and cognitive psychology. The first recommendation is to gather empirical data that can be used to improve the recommended word lists that are provided to technical writers. The second recommendation is to havemore » a review in which new WIs and OPs and checked for ambiguities and clarity. The third recommendation is to use self-paced reading time studies to identify any remaining ambiguities before the new WIs and OPs are put into use. If these three steps are followed for new WIs and OPs, the likelihood of human errors related to ambiguity could be greatly reduced.« less

A Dynamic Recommender System for Improved Web Usage Mining and CRM Using Swarm Intelligence.

PubMed

Alphy, Anna; Prabakaran, S

2015-01-01

In modern days, to enrich e-business, the websites are personalized for each user by understanding their interests and behavior. The main challenges of online usage data are information overload and their dynamic nature. In this paper, to address these issues, a WebBluegillRecom-annealing dynamic recommender system that uses web usage mining techniques in tandem with software agents developed for providing dynamic recommendations to users that can be used for customizing a website is proposed. The proposed WebBluegillRecom-annealing dynamic recommender uses swarm intelligence from the foraging behavior of a bluegill fish. It overcomes the information overload by handling dynamic behaviors of users. Our dynamic recommender system was compared against traditional collaborative filtering systems. The results show that the proposed system has higher precision, coverage, F1 measure, and scalability than the traditional collaborative filtering systems. Moreover, the recommendations given by our system overcome the overspecialization problem by including variety in recommendations.

Evidence-Based Consensus Recommendations for Colposcopy Practice for Cervical Cancer Prevention in the United States.

PubMed

Wentzensen, Nicolas; Massad, L Stewart; Mayeaux, Edward J; Khan, Michelle J; Waxman, Alan G; Einstein, Mark H; Conageski, Christine; Schiffman, Mark H; Gold, Michael A; Apgar, Barbara S; Chelmow, David; Choma, Kim K; Darragh, Teresa M; Gage, Julia C; Garcia, Francisco A R; Guido, Richard S; Jeronimo, Jose A; Liu, Angela; Mathews, Cara A; Mitchell, Martha M; Moscicki, Anna-Barbara; Novetsky, Akiva P; Papasozomenos, Theognosia; Perkins, Rebecca B; Silver, Michelle I; Smith, Katie M; Stier, Elizabeth A; Tedeschi, Candice A; Werner, Claudia L; Huh, Warner K

2017-10-01

The American Society for Colposcopy and Cervical Pathology (ASCCP) Colposcopy Standards recommendations address the role of colposcopy and directed biopsy for cervical cancer prevention in the United States (US). The recommendations were developed by an expert working group appointed by ASCCP's Board of Directors. An extensive literature review was conducted and supplemented by a systematic review and meta-analysis of unpublished data. In addition, a survey of practicing colposcopists was conducted to assess current colposcopy practice in the US. Recommendations were approved by the working group members, and the final revisions were made based on comments received from the public. The recommendations cover terminology, risk-based colposcopy, colposcopy procedures, and colposcopy adjuncts. The ASCCP Colposcopy Standards recommendations are an important step toward raising the standard of colposcopy services delivered to women in the US. Because cervical cancer screening programs are currently undergoing important changes that may affect colposcopy performance, updates to some of the current recommendations may be necessary in the future.

A Dynamic Recommender System for Improved Web Usage Mining and CRM Using Swarm Intelligence

PubMed Central

Alphy, Anna; Prabakaran, S.

2015-01-01

In modern days, to enrich e-business, the websites are personalized for each user by understanding their interests and behavior. The main challenges of online usage data are information overload and their dynamic nature. In this paper, to address these issues, a WebBluegillRecom-annealing dynamic recommender system that uses web usage mining techniques in tandem with software agents developed for providing dynamic recommendations to users that can be used for customizing a website is proposed. The proposed WebBluegillRecom-annealing dynamic recommender uses swarm intelligence from the foraging behavior of a bluegill fish. It overcomes the information overload by handling dynamic behaviors of users. Our dynamic recommender system was compared against traditional collaborative filtering systems. The results show that the proposed system has higher precision, coverage, F1 measure, and scalability than the traditional collaborative filtering systems. Moreover, the recommendations given by our system overcome the overspecialization problem by including variety in recommendations. PMID:26229978

The physician as disability advisor for patients with musculoskeletal complaints.

PubMed

Rainville, James; Pransky, Glenn; Indahl, Aage; Mayer, Eric K

2005-11-15

Literature review. To review the literature about the performance of physicians as mediators of temporary and permanent disability for patients with chronic musculoskeletal complaints. To assess specifically the nature and variance of recommendations from physicians, factors influencing physician performance, and efforts to influence physician behavior in this area. While caring for patients with musculoskeletal injuries, physicians are often asked to recommend appropriate levels of activity and work. These recommendations have significant consequences for patients' general health, employment, and financial well-being. Medical literature search. Physician recommendations limiting activity and work after injury are highly variable, often reflecting their own pain attitudes and beliefs. Patients' desires strongly predict disability recommendations (i.e., physicians often acquiesce to patients' requests). Other influences include jurisdiction, employer, insurer, and medical system factors. The most successful efforts to influence physician recommendations have used mass communication to influence public attitudes, while reinforcing the current standard of practice for physicians. Physician recommendations for work and activity have important health and financial implications. Systemic, multidimensional approaches are necessary to improve performance.

Improved personalized recommendation based on a similarity network

NASA Astrophysics Data System (ADS)

Wang, Ximeng; Liu, Yun; Xiong, Fei

2016-08-01

A recommender system helps individual users find the preferred items rapidly and has attracted extensive attention in recent years. Many successful recommendation algorithms are designed on bipartite networks, such as network-based inference or heat conduction. However, most of these algorithms define the resource-allocation methods for an average allocation. That is not reasonable because average allocation cannot indicate the user choice preference and the influence between users which leads to a series of non-personalized recommendation results. We propose a personalized recommendation approach that combines the similarity function and bipartite network to generate a similarity network that improves the resource-allocation process. Our model introduces user influence into the recommender system and states that the user influence can make the resource-allocation process more reasonable. We use four different metrics to evaluate our algorithms for three benchmark data sets. Experimental results show that the improved recommendation on a similarity network can obtain better accuracy and diversity than some competing approaches.

Hybrid context aware recommender systems

NASA Astrophysics Data System (ADS)

Jain, Rajshree; Tyagi, Jaya; Singh, Sandeep Kumar; Alam, Taj

2017-10-01

Recommender systems and context awareness is currently a vital field of research. Most hybrid recommendation systems implement content based and collaborative filtering techniques whereas this work combines context and collaborative filtering. The paper presents a hybrid context aware recommender system for books and movies that gives recommendations based on the user context as well as user or item similarity. It also addresses the issue of dimensionality reduction using weighted pre filtering based on dynamically entered user context and preference of context. This unique step helps to reduce the size of dataset for collaborative filtering. Bias subtracted collaborative filtering is used so as to consider the relative rating of a particular user and not the absolute values. Cosine similarity is used as a metric to determine the similarity between users or items. The unknown ratings are calculated and evaluated using MSE (Mean Squared Error) in test and train datasets. The overall process of recommendation has helped to personalize recommendations and give more accurate results with reduced complexity in collaborative filtering.

Accommodation Decision Making for Postsecondary Students With Learning Disabilities: Individually Tailored or One Size Fits All?

PubMed

Weis, Robert; Dean, Emily L; Osborne, Karen J

2016-09-01

Clinicians uniformly recommend accommodations for college students with learning disabilities; however, we know very little about which accommodations they select and the validity of their recommendations. We examined the assessment documentation of a large sample of community college students receiving academic accommodations for learning disabilities to determine (a) which accommodations their clinicians recommended and (b) whether clinicians' recommendations were supported by objective data gathered during the assessment process. In addition to test and instructional accommodations, many clinicians recommended that students with learning disabilities should have different educational expectations, standards, and methods of evaluation (i.e., grading) than their nondisabled classmates. Many of their recommendations for accommodations were not supported by objective evidence from students' history, diagnosis, test data, and current functioning. Furthermore, clinicians often recommended accommodations that were not specific to the student's diagnosis or area of disability. Our findings highlight the need for individually selected accommodations matched to students' needs and academic contexts. © Hammill Institute on Disabilities 2014.

Evaluation of physiological, growth and yield responses of a tropical oil crop (Brassica campestris L. var. Kranti) under ambient ozone pollution at varying NPK levels.

PubMed

Singh, Poonam; Agrawal, Madhoolika; Agrawal, Shashi Bhushan

2009-03-01

A field study was conducted to evaluate the impact of ambient ozone on mustard (Brassica campestris L. var. Kranti) plants grown under recommended and 1.5 times recommended NPK doses at a rural site of India using filtered (FCs) and non-filtered open top chambers (NFCs). Ambient mean O(3) concentration varied from 41.65 to 54.2ppb during the experiment. Plants growing in FCs showed higher photosynthetic rate at both NPK levels, but higher stomatal conductance only at recommended NPK. There were improvements in growth parameters and biomass of plants in FCs as compared to NFCs at both NPK levels with higher increments at 1.5 times recommended. Seed yield and harvest index decreased significantly only at recommended NPK in NFCs. Seed quality in terms of nutrients, protein and oil contents reduced in NFCs at recommended NPK. The application of 1.5 times recommended NPK provided protection against yield loss due to ambient O(3).

International short-term medical missions: a systematic review of recommended practices.

PubMed

Roche, Stephanie D; Ketheeswaran, Pavinarmatha; Wirtz, Veronika J

2017-01-01

To identify practices for conducting international short-term medical missions (STMMs) recommended in the literature and examine how these link STMMs to recipient countries' existing health systems. Systematic review of PubMed-indexed articles on STMMs and their bibliographies using preferred reporting items for systematic reviews and meta-analyses guidelines. Recommendations were organized using the World Health Organization Health Systems Framework. In 92 publications, 67 % offered at least one recommendation that would link STMMs to the recipient country's health system. Among these recommendations, most focused on service delivery and few on health financing and governance. There is a lack of consensus around a proper standard of care, patient selection, and trip duration. Comprehensive global standards are needed for STMM work to ensure that services are beneficial both to patients and to the broader healthcare systems of recipient countries. By providing an overview of the current recommendations and important gaps where practice recommendations are needed, this study can provide relevant input into the development of global standards for STMMs.

The Relationship Between Guideline-Recommended Initiation of Therapy, Outcomes, and Cost for Patients with Metastatic Non-Small Cell Lung Cancer.

PubMed

Casebeer, Adrianne; Antol, Dana Drzayich; DeClue, Richard W; Hopson, Sari; Li, Yong; Khoury, Raya; Michael, Todd; Sehman, Marina; Parikh, Aparna; Stemkowski, Stephen; Bunce, Mikele

2018-06-01

Guideline-recommended therapy for metastatic non-small cell lung cancer (mNSCLC) encourages evidence-based treatment; however, there is a knowledge gap regarding the influence of guideline-recommended initiation of therapy on outcomes and cost. To investigate if lack of guideline-recommended initiation of first-line systemic therapy was associated with worse patient outcomes and increased costs for patients with mNSCLC. In this retrospective analysis, 1,344 Medicare patients with mNSCLC were identified from Humana data. Performance status (PS) was imputed using procedure, diagnosis, and durable medical equipment codes pre-index. Guideline-recommended initiation of therapy was defined as ≥1 cycle of National Comprehensive Cancer Network-recommended first-line therapy based on age and PS or targeted therapies regardless of age and PS. Demographics and clinical characteristics were compared by guideline-recommended initiation of therapy. A Cox model assessed factors associated with 6-month mortality. End-of-life quality of care indicators included hospital admission and oncology infusions 30 days preceding death and were evaluated using logistic regression models. A generalized linear model assessed the relationship between guideline-recommended initiation of therapy and total health care costs in the 6 months post-index controlling for clinical, demographic, and treatment characteristics. Logistic models for inpatient stays and emergency department visits were also evaluated. Guideline-recommended therapy initiation was observed in 75.5% of patients. Patients not initiating guideline-recommended therapy were older, with a mean (SD) age of 72.5 (6.7) versus 71.2 (6.2) years (P = 0.001), and more frequently identified as having a low-income subsidy (30.0% vs. 16.4%; P < 0.001). Among the 24.6% of patients who died ≤ 6 months post-index, a greater percentage had not initiated guideline-recommended therapy (28.8% vs. 23.2%; P = 0.040). In adjusted models, PS (not initiation of guideline-recommended therapy) was predictive of mortality (patients with poor PS had an 84% higher probability of death [P = 0.014]). Among decedents, 64.2% were hospitalized, and 33.9% had an oncology-related infusion within 30 days of death, with no differences by guideline-recommended initiation of therapy. These end-of-life quality indicators were not associated with guideline-recommended initiation of therapy in adjusted models. Overall, 47.5% of patients who initiated guideline-recommended therapy were hospitalized compared with 55.0% of patients who did not (P = 0.026). Patients initiating guideline-recommended therapy had higher post-index total and oncology-related health care costs and fewer hospitalizations. In models, these differences in costs and hospitalizations were not associated with initiation of guideline-recommended therapy. Most patients initiated guideline-recommended therapy, with no differences in mortality and quality of care at the end of life by guideline-recommended initiation of therapy, though adherence beyond treatment initiation was not assessed. Unadjusted hospitalization rates were lower and costs were higher for patients who initiated guideline-recommended therapy. These differences were no longer observed after risk adjustment, suggesting that they may have been influenced by patient characteristics, disease progression, and subsequent treatment decisions. This study was sponsored by Genentech. Khoury, Michael, Parikh, and Bunce are employed by Genentech. Casebeer, Drzayich Antol, DeClue, Hopson, Li, and Stemkowski are employed by Comprehensive Health Insights, Humana, which was contracted by Genentech to conduct this study. Sehman is employed by Humana. Based on this research, 2 posters were presented at the Academy of Managed Care Pharmacy Nexus 2017 on October 16-19, 2017, in Dallas, Texas. Another poster was also presented at the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) Annual European Congress on October 29-November 2, 2016, in Vienna, Austria.

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)

What Vaccines Do You Need?

MedlinePlus

... Recommendations Why Immunize? Vaccines: The Basics The Adult Vaccine Quiz Language: English Español (Spanish) Recommend on Facebook Tweet Share Compartir Vaccines are recommended for adults based on age, health ...

Automatic Generation of Conditional Diagnostic Guidelines.

PubMed

Baldwin, Tyler; Guo, Yufan; Syeda-Mahmood, Tanveer

2016-01-01

The diagnostic workup for many diseases can be extraordinarily nuanced, and as such reference material text often contains extensive information regarding when it is appropriate to have a patient undergo a given procedure. In this work we employ a three task pipeline for the extraction of statements indicating the conditions under which a procedure should be performed, given a suspected diagnosis. First, we identify each instance in the text where a procedure is being recommended. Next we examine the context around these recommendations to extract conditional statements that dictate the conditions under which the recommendation holds. Finally, corefering recommendations across the document are linked to produce a full recommendation summary. Results indicate that each underlying task can be performed with above baseline performance, and the output can be used to produce concise recommendation summaries.

Research on the Application of Persona in Book Recommendation System

NASA Astrophysics Data System (ADS)

Gao, Baozhong; Du, Shouyan; Li, Xinzhi; Liu, Fangai

2017-10-01

Currently, there still exists a host of problems in the book recommendation system, such as low accuracy, weak correlation and poor pertinence. Aiming to unravel these problems, this paper based on the theory of big data and data mining technology, through analyzing internet user behavior and the “5C” model of personal credit evaluation, combined with joint impact weight calculation method, which involves user grade, borrowing credit, book friend recommendation degree, book friend recommended adoption degree, borrowing frequency, borrowing number, and borrowing time interval. User activity and credit are also taken into account in the process of establishing user tagging system so as to build classified book recommendation service. This method is of universal meaning to the book recommendation service of smart campus with user as the core under big data environment.

Converting the unconverted: the effect of inclination and opportunity to discount health-related fear appeals.

PubMed

Keller, P A

1999-06-01

Two experiments indicated that the conventional wisdom for designing fear appeals, higher fear arousal, and a consequences-recommendations ordering, was more persuasive for adherents, or those who were already following the advocated recommendations. Instead, lowering the level of fear arousal and reversing the order of the consequences and recommendations were more effective for persuading the unconverted. The unconverted were more persuaded by the latter message format because it reduced the level of message discounting. Specifically, unconverted participants who received either a low fear appeal or recommendations preceding consequences perceived themselves to be more susceptible, perceived the consequences as more severe, regarded the recommendations as more efficacious, believed they were more able to follow the recommendations, and were less likely to refute the message claims.

MOTIVATING ACTION AND MAINTAINING CHANGE: THE TIME-VARYING ROLE OF HOMEWORK FOLLOWING A BRIEF COUPLES INTERVENTION

PubMed Central

Hawrilenko, Matt; Fleming, CJ Eubanks; Goldstein, Alana; Cordova, James V.

2015-01-01

Studies regarding the effectiveness of homework assignments in cognitive-behavioral treatments have demonstrated mixed results. This study investigated predictors of compliance with homework recommendations and the time-varying relationship of recommendation completion with treatment response in a brief couples intervention (N=108). More satisfied couples and couples with more motivation to change completed more recommendations, whereas couples with children completed fewer. The association between recommendation completion and treatment response varied with the passage of time, with the strongest effect observed six-months after the intervention, but no discernible differences at one year post-intervention. Couples that completed more recommendations experienced more rapid treatment gains, but even those couples doing substantially fewer recommendations ultimately realized equivalent treatment effects, although they progressed more slowly. Implications are discussed. PMID:26456167

Recommender systems

NASA Astrophysics Data System (ADS)

Lü, Linyuan; Medo, Matúš; Yeung, Chi Ho; Zhang, Yi-Cheng; Zhang, Zi-Ke; Zhou, Tao

2012-10-01

The ongoing rapid expansion of the Internet greatly increases the necessity of effective recommender systems for filtering the abundant information. Extensive research for recommender systems is conducted by a broad range of communities including social and computer scientists, physicists, and interdisciplinary researchers. Despite substantial theoretical and practical achievements, unification and comparison of different approaches are lacking, which impedes further advances. In this article, we review recent developments in recommender systems and discuss the major challenges. We compare and evaluate available algorithms and examine their roles in the future developments. In addition to algorithms, physical aspects are described to illustrate macroscopic behavior of recommender systems. Potential impacts and future directions are discussed. We emphasize that recommendation has great scientific depth and combines diverse research fields which makes it interesting for physicists as well as interdisciplinary researchers.

[GRADE Evidence to Decision (EtD) frameworks: a systematic and transparent approach to making well informed healthcare choices. 2: Clinical practice guidelines.

PubMed

Morgano, Gian Paolo; Parmelli, Elena; Amato, Laura; Iannone, Primiano; Marchetti, Marco; Moja, Lorenzo; Davoli, Marina; Schünemann, Holger

2018-05-01

In the first article in this series we described the GRADE (Grading of Recommendations Assessment, Development and Evaluation) Evidence to Decision (EtD) frameworks and their rationale for different types of decisions. In this second article, we describe the use of EtD frameworks for clinical recommendations and how it can help clinicians and patients who use those recommendations. EtD frameworks for clinical practice recommendations provide a structured and transparent approach for guideline panels. The framework helps ensure consideration of key criteria that determine whether an intervention should be recommended and that judgments are informed by the best available evidence. Frameworks are also a way for panels to make guideline users aware of the rationale (justification) for their recommendations.

Ancillary Care in South African HIV Vaccine Trials: Addressing Needs, Drafting Protocols, and Engaging Community

PubMed Central

Slack, Catherine M.

2014-01-01

There has been debate about sponsor-investigator ethical responsibilities to address participants’ medical needs in trials in resource-constrained contexts. Certain ethical guidelines make detailed recommendations. This study explored whether ethical guideline recommendations for care in HIV vaccine trials were being met, and whether stakeholders were facing difficulties addressed by guidelines. It sampled key stakeholders involved in two trials across five sites in South Africa, and reviewed relevant documentation. It concluded that sites were largely meeting guideline recommendations for addressing needs, with some exceeding these. Recommendations for writing protocols were only partially achieved. Recommendations for engaging participating community were mostly met, except for “moral negotiation” recommendations. Suggestions are made to strengthen practices, and to improve guidelines so they address empirical concerns. PMID:24572086

Impact of Gender-Specific Human Papillomavirus Vaccine Recommendations on Uptake of Other Adolescent Vaccines: Analysis of the NIS-Teen (2008-2012).

PubMed

Bednarczyk, Robert A; Orenstein, Walter A; Omer, Saad B

In the United States, human papillomavirus vaccination was routinely recommended for adolescent females in 2006 and provisionally recommended for adolescent males in 2009. We evaluated the hypothesis that gender-specific human papillomavirus vaccination recommendations would impact gender-specific uptake of other vaccines using National Immunization Survey-Teen public use data sets (2008-2012). Female adolescents had higher coverage than males of at least 1 other adolescent vaccine in 2008 (3.0% higher) and 2009 (4.3% higher). Gender differences abated in 2010, 2011, and 2012 (0.2%, 0.9%, and 0.4%, respectively). To evaluate unintended consequences of gender-based recommendations, countries with female-only human papillomavirus vaccination recommendations should evaluate gender-specific uptake of other adolescent vaccines.

Association Rule Analysis for Tour Route Recommendation and Application to Wctsnop

NASA Astrophysics Data System (ADS)

Fang, H.; Chen, C.; Lin, J.; Liu, X.; Fang, D.

2017-09-01

The increasing E-tourism systems provide intelligent tour recommendation for tourists. In this sense, recommender system can make personalized suggestions and provide satisfied information associated with their tour cycle. Data mining is a proper tool that extracting potential information from large database for making strategic decisions. In the study, association rule analysis based on FP-growth algorithm is applied to find the association relationship among scenic spots in different cities as tour route recommendation. In order to figure out valuable rules, Kulczynski interestingness measure is adopted and imbalance ratio is computed. The proposed scheme was evaluated on Wangluzhe cultural tourism service network operation platform (WCTSNOP), where it could verify that it is able to quick recommend tour route and to rapidly enhance the recommendation quality.

Personalized recommendation via unbalance full-connectivity inference

NASA Astrophysics Data System (ADS)

Ma, Wenping; Ren, Chen; Wu, Yue; Wang, Shanfeng; Feng, Xiang

2017-10-01

Recommender systems play an important role to help us to find useful information. They are widely used by most e-commerce web sites to push the potential items to individual user according to purchase history. Network-based recommendation algorithms are popular and effective in recommendation, which use two types of elements to represent users and items respectively. In this paper, based on consistence-based inference (CBI) algorithm, we propose a novel network-based algorithm, in which users and items are recognized with no difference. The proposed algorithm also uses information diffusion to find the relationship between users and items. Different from traditional network-based recommendation algorithms, information diffusion initializes from users and items, respectively. Experiments show that the proposed algorithm is effective compared with traditional network-based recommendation algorithms.

Ancillary care in South African HIV vaccine trials: addressing needs, drafting protocols, and engaging community.

PubMed

Slack, Catherine M

2014-02-01

There has been debate about sponsor-investigator ethical responsibilities to address participants' medical needs in trials in resource-constrained contexts. Certain ethical guidelines make detailed recommendations. This study explored whether ethical guideline recommendations for care in HIV vaccine trials were being met, and whether stakeholders were facing difficulties addressed by guidelines. It sampled key stakeholders involved in two trials across five sites in South Africa, and reviewed relevant documentation. It concluded that sites were largely meeting guideline recommendations for addressing needs, with some exceeding these. Recommendations for writing protocols were only partially achieved. Recommendations for engaging participating community were mostly met, except for "moral negotiation" recommendations. Suggestions are made to strengthen practices, and to improve guidelines so they address empirical concerns.

Blue Ribbon Committee on Bloodborne Parasitic Diseases.

PubMed

2002-09-01

In summary, the A1 recommendations are related to: developing a network (epidemiologic and demographic aspects); undertaking activities within the network; providing support for parasite research testing; developing new policies, and; preparing a Memorandum to Cabinet for submission by September 1, 2001, for funding from April 2002 over 5 years. The A recommendations deal with sustaining the network and addressing existing needs, including Public and professional education Review of current policies Business plan Development of a contribution program to meet operational needs. The B recommendation(s) will be dealt with by the future Treasury Board submission. The group identified no C recommendations.

The politics of prostate cancer screening.

PubMed

Kaffenberger, Samuel D; Penson, David F

2014-05-01

The controversial recent recommendation by the United States Preventive Services Task Force (USPSTF) against prostate-specific antigen (PSA) screening for early-stage prostate cancer has caused much debate. Whereas USPSTF recommendations against routine screening mammography in younger women resulted in fierce public outcry and eventual alteration in the language of the recommendation, the same public and political response has not been seen with PSA screening for prostate cancer. It is of paramount importance to ensure improved efficiency and transparency of the USPSTF recommendation process, and resolution of concerns with the current USPSTF recommendation against PSA screening for all ages. Published by Elsevier Inc.

Process, not product: investigating recommendations for improving citizen science "success".

PubMed

Freitag, Amy; Pfeffer, Max J

2013-01-01

Citizen science programs are increasingly popular for a variety of reasons, from public education to new opportunities for data collection. The literature published in scientific journals resulting from these projects represents a particular perspective on the process. These articles often conclude with recommendations for increasing "success". This study compared these recommendations to those elicited during interviews with program coordinators for programs within the United States. From this comparison, success cannot be unilaterally defined and therefore recommendations vary by perspective on success. Program coordinators tended to have more locally-tailored recommendations specific to particular aspects of their program mission.

Shield materials recommended for space power nuclear reactors

NASA Technical Reports Server (NTRS)

Kaszubinski, L. J.

1973-01-01

Lithium hydride is recommended for neutron attenuation and depleted uranium is recommended for gamma ray attenuation. For minimum shield weights these materials must be arranged in alternate layers to attenuate the secondary gamma rays efficiently. In the regions of the shield near the reactor, where excessive fissioning occurs in the uranium, a tungsten alloy is used instead. Alloys of uranium such as either the U-0.5Ti or U-8Mo are available to accommodate structural requirements. The zone-cooled casting process is recommended for lithium hydride fabrication. Internal honeycomb reinforcement to control cracks in the lithium hydride is recommended.

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.

Consensus recommendations for improvement of unmet clinical needs--the example of chronic graft-versus-host disease: a systematic review and meta-analysis.

PubMed

Olivieri, Jacopo; Manfredi, Lucia; Postacchini, Laura; Tedesco, Silvia; Leoni, Pietro; Gabrielli, Armando; Rambaldi, Alessandro; Bacigalupo, Andrea; Olivieri, Attilio; Pomponio, Giovanni

2015-07-01

Consensus recommendations are used to improve the methodology of research about rare disorders, but their uptake is unknown. We studied the uptake of consensus recommendations in steroid-refractory chronic graft-versus-host disease (SR-cGVHD). Although in 2006 the National Institutes of Health (NIH) cGVHD consensus project produced recommendations for clinical trials, guidelines have emphasised the scarcity of valuable evidence for all tested interventions. We searched Medline (PubMed) between Jan 1, 1998, and Oct 1, 2013, for non-randomised studies of systemic treatment for SR-cGVHD. To measure adherence to NIH recommendations, we applied a 61 item checklist derived from the NIH consensus document. We did a meta-analysis to measure pooled effect size for overall response rate (ORR) and meta-regression analyses to measure the effect of deviations from NIH recommendations on pooled effect size. We included 82 studies related to nine interventions. Conformity to NIH recommendations was evenly low across the analysed timeframe (1998-2013), and did not change significantly after publication of NIH recommendations. The pooled effect size for ORR for systemic treatment of SR-cGVHD was 0.66 (95% CI 0.62-0.70). Increased adherence to NIH recommendations in a score of items defining correct response assessment was associated with a significant reduction in ORR (-4.2%, 95% CI -6.6 to -1.9; p=0.001). We recorded no significant association between ORR and sets of items related to correct diagnostic definition of SR-cGVHD (change in ORR -3.1%, 95% CI -7.7 to 1.5), specification of primary intervention (0, -3.8 to 3.6), or concomitant treatments (-1.6%, -5.4 to 2.3). The score of items defining correct response assessment increased after publication of NIH recommendations. Our findings show evidence of bias in the reported efficacy of treatment of SR-cGVHD. The overall effect of NIH recommendations in scientific literature is scarce; however, NIH recommendations improved assessment of response, possibly reducing the overestimation bias. Better implementation of NIH recommendations might reduce false expectations about new interventions, and thus prevent clinical studies with ineffective treatments. None. Copyright © 2015 Elsevier Ltd. All rights reserved.

Comparison of Recommended Eligibility for Primary Prevention Statin Therapy Based on the US Preventive Services Task Force Recommendations vs the ACC/AHA Guidelines.

PubMed

Pagidipati, Neha J; Navar, Ann Marie; Mulder, Hillary; Sniderman, Allan D; Peterson, Eric D; Pencina, Michael J

2017-04-18

There are important differences among guideline recommendations for using statin therapy in primary prevention. New recommendations from the US Preventive Services Task Force (USPSTF) emphasize therapy based on the presence of 1 or more cardiovascular disease (CVD) risk factors and a 10-year global CVD risk of 10% or greater. To determine the difference in eligibility for primary prevention statin treatment among US adults, assuming full application of USPSTF recommendations compared with the American College of Cardiology/American Heart Association (ACC/AHA) guidelines. National Health and Nutrition Examination Survey (NHANES) data (2009-2014) were used to assess statin eligibility under the 2016 USPSTF recommendations vs the 2013 ACC/AHA cholesterol guidelines among a nationally representative sample of 3416 US adults aged 40 to 75 years with fasting lipid data and triglyceride levels of 400 mg/dL or less, without prior CVD. The 2016 USPSTF recommendations vs 2013 ACC/AHA guidelines. Eligibility for primary prevention statin therapy. Among the US primary prevention population represented by 3416 individuals in NHANES, the median weighted age was 53 years (interquartile range, 46-61), and 53% (95% CI, 52%-55%) were women. Along with the 21.5% (95% CI, 19.3%-23.7%) of patients who reported currently taking lipid-lowering medication, full implementation of the USPSTF recommendations would be associated with initiation of statin therapy in an additional 15.8% (95% CI, 14.0%-17.5%) of patients, compared with an additional 24.3% (95% CI, 22.3%-26.3%) of patients who would be recommended for statin initiation under full implementation of the 2013 ACC/AHA guidelines. Among the 8.9% of individuals in the primary prevention population who would be recommended for statins by ACC/AHA guidelines but not by USPSTF recommendations, 55% would be adults aged 40 to 59 years with a mean 30-year cardiovascular risk greater than 30%, and 28% would have diabetes. In this sample of US adults from 2009-2014, adherence to the 2016 USPSTF recommendations for statin therapy, compared with the 2013 ACC/AHA guidelines, could lead to a lower number of individuals recommended for primary prevention statin therapy, including many younger adults with high mean long-term CVD risk.

International and multidisciplinary expert recommendations for the use of biologics in systemic lupus erythematosus.

PubMed

Kleinmann, Jean-François; Tubach, Florence; Le Guern, Véronique; Mathian, Alexis; Richez, Christophe; Saadoun, David; Sacre, Karim; Sellam, Jérémie; Seror, Raphaèle; Amoura, Zahir; Andres, Emmanuel; Audia, Sylvain; Bader-Meunier, Brigitte; Blaison, Gilles; Bonnotte, Bernard; Cacoub, Patrice; Caillard, Sophie; Chiche, Laurent; Chosidow, Olivier; Costedoat-Chalumeau, Nathalie; Daien, Claire; Daugas, Eric; Derdèche, Nairouz; Doria, Andrea; Fain, Olivier; Fakhouri, Fadi; Farge, Dominique; Gabay, Cem; Guillo, Sylvie; Hachulla, Eric; Hajjaj-Hassouni, Najia; Hamidou, Mohamed; Houssiau, Frédéric A; Jourde-Chiche, Noémie; Koné-Paut, Isabelle; Ladjouz-Rezig, Aïcha; Lambotte, Olivier; Lipsker, Dan; Mariette, Xavier; Martin-Silva, Nicolas; Martin, Thierry; Maurier, François; Meckenstock, Roderich; Mékinian, Arsène; Meyer, Olivier; Mohamed, Shirine; Morel, Jacques; Moulin, Bruno; Mulleman, Denis; Papo, Thomas; Poindron, Vincent; Puéchal, Xavier; Punzi, Leonardo; Quartier, Pierre; Sailler, Laurent; Smail, Amar; Soubrier, Martin; Sparsa, Agnès; Tazi-Mezalek, Zoubida; Zakraoui, Leith; Zuily, Stéphane; Sibilia, Jean; Gottenberg, Jacques-Eric

2017-06-01

Despite conventional immunosuppressants, active and steroid-dependent systemic lupus erythematosus (SLE) represents a therapeutic challenge. Only one biologic, belimumab, has been approved, but other biologics are sometimes used off-label. Given the lack of evidence-based data in some clinical situations encountered in real life, we developed expert recommendations for the use of biologics for SLE. The recommendations were developed by a formal consensus method. This method aims to formalize the degree of agreement among experts by identifying, through iterative ratings with feedback, the points on which experts agree, disagree or are undecided. Hence, the recommendations are based on the agreed-upon points. We gathered the opinion of 59 French-speaking SLE experts from 3 clinical networks dedicated to systemic autoimmune diseases (FLEUR, IMIDIATE, FAI2R) from Algeria, Belgium, France, Italy, Morocco, Switzerland and Tunisia. Represented medical specialities were internal medicine (49%), rheumatology (34%), nephrology (7%), dermatology (5%), pediatrics (3%) and cardiology (2%). Two methodologists and 3 strictly independent SLE expert groups contributed to developing these recommendations: a steering group (SG) (n=9), an evaluation group (EG) (n=28) and a reading group (RG) (n=22). Preliminary recommendations were drafted by the SG, then proposed to the EG. Each EG member rated the degree of agreement from 1 to 9 (1: lowest; 9: strongest) for each recommendation. After 2 rating rounds, the SG submitted a new version of the recommendations to the RG. With comments from the RG, the SG finalised the recommendations. A total of 17 final recommendations were formulated by the SG, considering all agreement scores and comments by the EG and RG members and the two methodologists. These recommendations define the subset of patients who require a biologic; the type of biologics to use (belimumab, rituximab, etc.) depending on the organ involvement and associated co-treatments; what information should be given to patients; and how to evaluate treatment efficacy and when to consider discontinuation. Overall, 17 recommendations for the good use of biologics in SLE were formulated by a large panel of SLE experts to provide guidance for clinicians in daily practice. These recommendations will be regularly updated according to the results of new randomized trials and increasing real life experience. Copyright © 2017 Elsevier B.V. All rights reserved.

Creating adaptive web recommendation system based on user behavior

NASA Astrophysics Data System (ADS)

Walek, Bogdan

2018-01-01

The paper proposes adaptive web recommendation system based on user behavior. The proposed system uses expert system to evaluating and recommending suitable items of content. Relevant items are subsequently evaluated and filtered based on history of visited items and user´s preferred categories of items. Main parts of the proposed system are presented and described. The proposed recommendation system is verified on specific example.

Methods of international health technology assessment agencies for economic evaluations--a comparative analysis.

PubMed

Mathes, Tim; Jacobs, Esther; Morfeld, Jana-Carina; Pieper, Dawid

2013-09-30

The number of Health Technology Assessment (HTA) agencies increases. One component of HTAs are economic aspects. To incorporate economic aspects commonly economic evaluations are performed. A convergence of recommendations for methods of health economic evaluations between international HTA agencies would facilitate the adaption of results to different settings and avoid unnecessary expense. A first step in this direction is a detailed analysis of existing similarities and differences in recommendations to identify potential for harmonization. The objective is to provide an overview and comparison of the methodological recommendations of international HTA agencies for economic evaluations. The webpages of 127 international HTA agencies were searched for guidelines containing recommendations on methods for the preparation of economic evaluations. Additionally, the HTA agencies were requested information on methods for economic evaluations. Recommendations of the included guidelines were extracted in standardized tables according to 13 methodological aspects. All process steps were performed independently by two reviewers. Finally 25 publications of 14 HTA agencies were included in the analysis. Methods for economic evaluations vary widely. The greatest accordance could be found for the type of analysis and comparator. Cost-utility-analyses or cost-effectiveness-analyses are recommended. The comparator should continuously be usual care. Again the greatest differences were shown in the recommendations on the measurement/sources of effects, discounting and in the analysis of sensitivity. The main difference regarding effects is the focus either on efficacy or effectiveness. Recommended discounting rates range from 1.5%-5% for effects and 3%-5% for costs whereby it is mostly recommended to use the same rate for costs and effects. With respect to the analysis of sensitivity the main difference is that oftentimes the probabilistic or deterministic approach is recommended exclusively. Methods for modeling are only described vaguely and mainly with the rational that the "appropriate model" depends on the decision problem. Considering all other aspects a comparison is challenging as recommendations vary regarding detailedness and addressed issues. There is a considerable unexplainable variance in recommendations. Further effort is needed to harmonize methods for preparing economic evaluations.

Association of both consistency and strength of self-reported clinician recommendation for HPV vaccination and HPV vaccine uptake among 11- to 12-year-old children.

PubMed

Finney Rutten, Lila J; St Sauver, Jennifer L; Beebe, Timothy J; Wilson, Patrick M; Jacobson, Debra J; Fan, Chun; Breitkopf, Carmen Radecki; Vadaparampil, Susan T; MacLaughlin, Kathy L; Jacobson, Robert M

2017-10-27

We tested the hypotheses that consistency and strength of clinician recommendation of the human papillomavirus (HPV) vaccination would be associated with vaccine delivery rates. From October 2015 through January 2016, we conducted a survey of primary care clinicians (n=227) in Southeastern Minnesota to evaluate clinician behaviors regarding HPV vaccination. The survey response rate was 41.0% (51 clinical sites). We used the Rochester Epidemiology Project, a clinical data linkage infrastructure, to ascertain clinical site-level HPV vaccination rates. We examined associations of clinician self-reports of both the consistency and strength of their recommendations for HPV vaccination for patients aged 11-12years (n=14,406) with site-level vaccination rates. The majority of clinicians reported consistently (always or usually) recommending the HPV vaccine to females (79.0%) and to males (62.2%); 71.9% of clinicians reported strongly recommending the vaccine to females while 58.6% reported strongly recommending to males. Consistency and strength of recommending the HPV vaccine was significantly higher among those practicing in pediatrics and board certified in pediatrics compared to family medicine. Higher rates of initiation (1 dose) [Incidence Rate Ratio (IRR)=1.05; 95% CI (1.01-1.09)] and completion (3 doses) [IRR=1.08; 95% CI (1.02-1.13)] were observed among clinical sites where, on average, clinicians more frequently reported always or usually recommending the vaccine for females compared to sites where, on average, clinicians reported recommending the vaccine less frequently. Similarly, higher rates of initiation [IRR=1.03; 95% CI (1.00-1.06)] and completion [IRR=1.04; CI (1.00, 1.08)] were observed among sites where clinicians reported strongly recommending the vaccine to females more frequently compared to sites where, on average, clinicians reported strongly recommending the HPV vaccine less frequently; similar associations were observed for male initiation [IRR=1.05; CI (1.02,1.08)] and completion [IRR=1.05; 95% CI (1.01, 1.09)]. Consistency and strength of HPV vaccination recommendation was associated with higher vaccination rates. Copyright © 2017 Elsevier Ltd. All rights reserved.

Answering medical questions at the point of care: a cross-sectional study comparing rapid decisions based on PubMed and Epistemonikos searches with evidence-based recommendations developed with the GRADE approach.

PubMed

Izcovich, Ariel; Criniti, Juan Martín; Popoff, Federico; Ragusa, Martín Alberto; Gigler, Cristel; Gonzalez Malla, Carlos; Clavijo, Manuela; Manzotti, Matias; Diaz, Martín; Catalano, Hugo Norberto; Neumann, Ignacio; Guyatt, Gordon

2017-08-07

Using the best current evidence to inform clinical decisions remains a challenge for clinicians. Given the scarcity of trustworthy clinical practice guidelines providing recommendations to answer clinicians' daily questions, clinical decision support systems (ie, assistance in question identification and answering) emerge as an attractive alternative. The trustworthiness of the recommendations achieved by such systems is unknown. To evaluate the trustworthiness of a question identification and answering system that delivers timely recommendations. Cross-sectional study. We compared the responses to 100 clinical questions related to inpatient management provided by two rapid response methods with 'Gold Standard' recommendations. One of the rapid methods was based on PubMed and the other on Epistemonikos database. We defined our 'Gold Standard' as trustworthy published evidence-based recommendations or, when unavailable, recommendations developed locally by a panel of six clinicians following the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Recommendations provided by the rapid strategies were classified as potentially misleading or reasonable. We also determined if the potentially misleading recommendations could have been avoided with the appropriate implementation of searching and evidence summary tools. We were able to answer all of the 100 questions with both rapid methods. Of the 200 recommendations obtained, 6.5% (95% CI 3% to 9.9%) were classified as potentially misleading and 93.5% (95% CI 90% to 96.9%) as reasonable. 6 of the 13 potentially misleading recommendations could have been avoided by the appropriate usage of the Epistemonikos matrix tool or by constructing summary of findings tables. No significant differences were observed between the evaluated rapid response methods. A question answering service based on the GRADE approach proved feasible to implement and provided appropriate guidance for most identified questions. Our approach could help stakeholders in charge of managing resources and defining policies for patient care to improve evidence-based decision-making in an efficient and feasible manner. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

NCBO Ontology Recommender 2.0: an enhanced approach for biomedical ontology recommendation.

PubMed

Martínez-Romero, Marcos; Jonquet, Clement; O'Connor, Martin J; Graybeal, John; Pazos, Alejandro; Musen, Mark A

2017-06-07

Ontologies and controlled terminologies have become increasingly important in biomedical research. Researchers use ontologies to annotate their data with ontology terms, enabling better data integration and interoperability across disparate datasets. However, the number, variety and complexity of current biomedical ontologies make it cumbersome for researchers to determine which ones to reuse for their specific needs. To overcome this problem, in 2010 the National Center for Biomedical Ontology (NCBO) released the Ontology Recommender, which is a service that receives a biomedical text corpus or a list of keywords and suggests ontologies appropriate for referencing the indicated terms. We developed a new version of the NCBO Ontology Recommender. Called Ontology Recommender 2.0, it uses a novel recommendation approach that evaluates the relevance of an ontology to biomedical text data according to four different criteria: (1) the extent to which the ontology covers the input data; (2) the acceptance of the ontology in the biomedical community; (3) the level of detail of the ontology classes that cover the input data; and (4) the specialization of the ontology to the domain of the input data. Our evaluation shows that the enhanced recommender provides higher quality suggestions than the original approach, providing better coverage of the input data, more detailed information about their concepts, increased specialization for the domain of the input data, and greater acceptance and use in the community. In addition, it provides users with more explanatory information, along with suggestions of not only individual ontologies but also groups of ontologies to use together. It also can be customized to fit the needs of different ontology recommendation scenarios. Ontology Recommender 2.0 suggests relevant ontologies for annotating biomedical text data. It combines the strengths of its predecessor with a range of adjustments and new features that improve its reliability and usefulness. Ontology Recommender 2.0 recommends over 500 biomedical ontologies from the NCBO BioPortal platform, where it is openly available (both via the user interface at http://bioportal.bioontology.org/recommender , and via a Web service API).