Current and Future Opportunities and Challenges in Continuing Pharmacy Education

PubMed Central

Wadelin, Jeffrey W.; Janke, Kristin K.; Zellmer, William A.; Vlasses, Peter H.

2017-01-01

The Accreditation Council for Pharmacy Education (ACPE) convened a consensus-seeking invitational conference on October 29-30, 2015, in Chicago, Ill. ACPE’s desire to have stakeholder guidance on its role in the future of continuing pharmacy education and continuing professional development led to the convening of the conference. The purpose of this article is to summarize the proceedings of the conference, including the recommendations from the stakeholders. PMID:28496264

Diabetes Technology-Continuous Subcutaneous Insulin Infusion Therapy and Continuous Glucose Monitoring in Adults: An Endocrine Society Clinical Practice Guideline.

PubMed

Peters, Anne L; Ahmann, Andrew J; Battelino, Tadej; Evert, Alison; Hirsch, Irl B; Murad, M Hassan; Winter, William E; Wolpert, Howard

2016-11-01

To formulate clinical practice guidelines for the use of continuous glucose monitoring and continuous subcutaneous insulin infusion in adults with diabetes. The participants include an Endocrine Society-appointed Task Force of seven experts, a methodologist, and a medical writer. The American Association for Clinical Chemistry, the American Association of Diabetes Educators, and the European Society of Endocrinology co-sponsored this guideline. The Task Force developed this evidence-based guideline using the Grading of Recommendations, Assessment, Development, and Evaluation system to describe the strength of recommendations and the quality of evidence. The Task Force commissioned one systematic review and used the best available evidence from other published systematic reviews and individual studies. One group meeting, several conference calls, and e-mail communications enabled consensus. Committees and members of the Endocrine Society, the American Association for Clinical Chemistry, the American Association of Diabetes Educators, and the European Society of Endocrinology reviewed and commented on preliminary drafts of these guidelines. Continuous subcutaneous insulin infusion and continuous glucose monitoring have an important role in the treatment of diabetes. Data from randomized controlled trials are limited on the use of medical devices, but existing studies support the use of diabetes technology for a wide variety of indications. This guideline presents a review of the literature and practice recommendations for appropriate device use.

2017 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations Summary.

PubMed

Olasveengen, Theresa M; de Caen, Allan R; Mancini, Mary E; Maconochie, Ian K; Aickin, Richard; Atkins, Dianne L; Berg, Robert A; Bingham, Robert M; Brooks, Steven C; Castrén, Maaret; Chung, Sung Phil; Considine, Julie; Couto, Thomaz Bittencourt; Escalante, Raffo; Gazmuri, Raúl J; Guerguerian, Anne-Marie; Hatanaka, Tetsuo; Koster, Rudolph W; Kudenchuk, Peter J; Lang, Eddy; Lim, Swee Han; Løfgren, Bo; Meaney, Peter A; Montgomery, William H; Morley, Peter T; Morrison, Laurie J; Nation, Kevin J; Ng, Kee-Chong; Nadkarni, Vinay M; Nishiyama, Chika; Nuthall, Gabrielle; Ong, Gene Yong-Kwang; Perkins, Gavin D; Reis, Amelia G; Ristagno, Giuseppe; Sakamoto, Tetsuya; Sayre, Michael R; Schexnayder, Stephen M; Sierra, Alfredo F; Singletary, Eunice M; Shimizu, Naoki; Smyth, Michael A; Stanton, David; Tijssen, Janice A; Travers, Andrew; Vaillancourt, Christian; Van de Voorde, Patrick; Hazinski, Mary Fran; Nolan, Jerry P

2017-12-01

The International Liaison Committee on Resuscitation has initiated a near-continuous review of cardiopulmonary resuscitation science that replaces the previous 5-year cyclic batch-and-queue approach process. This is the first of an annual series of International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations summary articles that will include the cardiopulmonary resuscitation science reviewed by the International Liaison Committee on Resuscitation in the previous year. The review this year includes 5 basic life support and 1 paediatric Consensuses on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Each of these includes a summary of the science and its quality based on Grading of Recommendations, Assessment, Development, and Evaluation criteria and treatment recommendations. Insights into the deliberations of the International Liaison Committee on Resuscitation task force members are provided in Values and Preferences sections. Finally, the task force members have prioritised and listed the top 3 knowledge gaps for each population, intervention, comparator, and outcome question. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

2017 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations Summary.

PubMed

Olasveengen, Theresa M; de Caen, Allan R; Mancini, Mary E; Maconochie, Ian K; Aickin, Richard; Atkins, Dianne L; Berg, Robert A; Bingham, Robert M; Brooks, Steven C; Castrén, Maaret; Chung, Sung Phil; Considine, Julie; Couto, Thomaz Bittencourt; Escalante, Raffo; Gazmuri, Raúl J; Guerguerian, Anne-Marie; Hatanaka, Tetsuo; Koster, Rudolph W; Kudenchuk, Peter J; Lang, Eddy; Lim, Swee Han; Løfgren, Bo; Meaney, Peter A; Montgomery, William H; Morley, Peter T; Morrison, Laurie J; Nation, Kevin J; Ng, Kee-Chong; Nadkarni, Vinay M; Nishiyama, Chika; Nuthall, Gabrielle; Ong, Gene Yong-Kwang; Perkins, Gavin D; Reis, Amelia G; Ristagno, Giuseppe; Sakamoto, Tetsuya; Sayre, Michael R; Schexnayder, Stephen M; Sierra, Alfredo F; Singletary, Eunice M; Shimizu, Naoki; Smyth, Michael A; Stanton, David; Tijssen, Janice A; Travers, Andrew; Vaillancourt, Christian; Van de Voorde, Patrick; Hazinski, Mary Fran; Nolan, Jerry P

2017-12-05

The International Liaison Committee on Resuscitation has initiated a near-continuous review of cardiopulmonary resuscitation science that replaces the previous 5-year cyclic batch-and-queue approach process. This is the first of an annual series of International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations summary articles that will include the cardiopulmonary resuscitation science reviewed by the International Liaison Committee on Resuscitation in the previous year. The review this year includes 5 basic life support and 1 pediatric Consensuses on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Each of these includes a summary of the science and its quality based on Grading of Recommendations, Assessment, Development, and Evaluation criteria and treatment recommendations. Insights into the deliberations of the International Liaison Committee on Resuscitation task force members are provided in Values and Preferences sections. Finally, the task force members have prioritized and listed the top 3 knowledge gaps for each population, intervention, comparator, and outcome question. © 2017 American Heart Association, Inc., and European Resuscitation Council.

The Associate Degree in Hong Kong. Final Report of a Consultancy Study Commissioned by the Education and Manpower Bureau and Undertaken by the Federation for Continuing Education in Teaching Institutions.

ERIC Educational Resources Information Center

2001

In an effort to increase access to education and set up a comprehensive qualification framework, Hong Kong's Education Commission made key recommendations to the government in May 2000. Those recommendations included the development of a diversified, multi-channel, multi-layer higher education system. Three of Hong Kong's higher education…

Extracorporeal treatment for carbamazepine poisoning: Systematic review and recommendations from the EXTRIP workgroup

PubMed Central

Ghannoum, Marc; Yates, Christopher; Galvao, Tais F.; Sowinski, Kevin M.; Vo, Thi Hai Vân; Coogan, Andrew; Gosselin, Sophie; Lavergne, Valery; Nolin, Thomas D.; Hoffman, Robert S.

2014-01-01

Abstract Context. The Extracorporeal Treatments in Poisoning (EXTRIP) workgroup was created to provide evidence and consensus-based recommendations on the use of extracorporeal treatments (ECTRs) in poisoning. Objectives. To perform a systematic review and provide clinical recommendations for ECTR in carbamazepine poisoning. Methods. After a systematic literature search, the subgroup extracted the data and summarized the findings following a pre-determined format. The entire workgroup voted via a two-round modified Delphi method to reach a consensus on voting statements, using a RAND/UCLA Appropriateness Method to quantify disagreement. Anonymous votes were compiled, returned, and discussed in person. A second vote determined the final recommendations. Results. Seventy-four articles met inclusion criteria. Articles included case reports, case series, descriptive cohorts, pharmacokinetic studies, and in-vitro studies; two poor-quality observational studies were identified, yielding a very low quality of evidence for all recommendations. Data on 173 patients, including 6 fatalities, were reviewed. The workgroup concluded that carbamazepine is moderately dialyzable and made the following recommendations: ECTR is suggested in severe carbamazepine poisoning (2D). ECTR is recommended if multiple seizures occur and are refractory to treatment (1D), or if life-threatening dysrhythmias occur (1D). ECTR is suggested if prolonged coma or respiratory depression requiring mechanical ventilation are present (2D) or if significant toxicity persists, particularly when carbamazepine concentrations rise or remain elevated, despite using multiple-dose activated charcoal (MDAC) and supportive measures (2D). ECTR should be continued until clinical improvement is apparent (1D) or the serum carbamazepine concentration is below 10 mg/L (42 the μ in μmol/L looks weird.) (2D). Intermittent hemodialysis is the preferred ECTR (1D), but both intermittent hemoperfusion (1D) or continuous renal replacement therapies (3D) are alternatives if hemodialysis is not available. MDAC therapy should be continued during ECTR (1D). Conclusion. Despite the low quality of the available clinical evidence and the high protein binding capacity of carbamazepine, the workgroup suggested extracorporeal removal in cases of severe carbamazepine poisoning. PMID:25355482

Gamma ray astrophysics to the year 2000. Report of the NASA Gamma Ray Program Working Group

NASA Technical Reports Server (NTRS)

1988-01-01

Important developments in gamma-ray astrophysics up to energies of 100 GeV during the last decade are reviewed. Also, the report seeks to define the major current scientific goals of the field and proposes a vigorous program to pursue them, extending to the year 2000. The goals of gamma-ray astronomy include the study of gamma rays which provide the most direct means of studying many important problems in high energy astrophysics including explosive nucleosynthesis, accelerated particle interactions and sources, and high-energy processes around compact objects. The current research program in gamma-ray astronomy in the U.S. including the space program, balloon program and foreign programs in gamma-ray astronomy is described. The high priority recommendations for future study include an Explorer-class high resolution gamma-ray spectroscopy mission and a Get Away Special cannister (GAS-can) or Scout class multiwavelength experiment for the study of gamma-ray bursts. Continuing programs include an extended Gamma Ray Observatory mission, continuation of the vigorous program of balloon observations of the nearby Supernova 1987A, augmentation of the balloon program to provide for new instruments and rapid scientific results, and continuation of support for theoretical research. Long term recommendations include new space missions using advanced detectors to better study gamma-ray sources, the development of these detectors, continued study for the assembly of large detectors in space, collaboration with the gamma-ray astronomy missions initiated by other countries, and consideration of the Space Station attached payloads for gamma-ray experiments.

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.

Twenty-five years since the Shearman Report: How far have we come? Are we there yet?

PubMed

Catling, Christine J; Homer, Caroline S E

2016-02-01

In 1989, the first major state-wide report into maternity services, known as the Shearman Report after its author, was released in New South Wales, the most populous state in Australia. This paper reflects upon the report and tracks the progress of five of its key recommendations. The recommendations are still some of the major issues facing maternity services across the country. These are: community-based maternity care, rural maternity services, hospital visiting rights for privately practising midwives, obstetric intervention, and midwifery continuity of maternity care. In some ways, much has changed in 25 years including the terminology used in the report, the importance of midwifery continuity of care and the woman-centred nature of many services. However, in other ways, there is still a long way to go to address these major issues. Despite more than a quarter of a century, many recommendations have not been fulfilled, especially access to care in rural areas, rates of obstetric intervention, and the issue of visiting rights for privately practising midwives which has gone backwards. A continued and renewed effort is needed to ensure that the forward thinking recommendations of the Shearman Report are ultimately realised for all women and their families. Crown Copyright © 2015. Published by Elsevier Ltd. All rights reserved.

DOD Financial Management: Continued Actions Needed to Address Congressional Committee Panel Recommendations

DTIC Science & Technology

2015-09-01

which was intended to fundamentally transform DOD’s financial management operations and achieve clean financial 12GAO-15-290. 13GAO-15-290. 14Pub...Actions to Implement the Panel on Defense Financial Management and Auditability Reform Recommendations valuations for these assets. For example, DOD’s...governance, the department is managing its business systems, including ERP systems, as portfolios of investments . The goal is to aggregate data from

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

PubMed

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

2014-09-01

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

New Jersey Children's Behavioral Healthcare System: cross service delivery planning for transitional population of youth (ages 16 and 18+ years).

PubMed

McGill, Kenneth; McGill, Scott A

2011-08-01

The continued need for improvement within a 'system of care' is essential as the need for mental health services by those 'youth' within the child welfare system continually grows. This article outlines the statewide reform of New Jersey's Children's Behavioral Healthcare System, which began in 2000, as well as including the recommendations of the University of South Florida as part of their 'Final Report: Independent Assessment of New Jersey's Child Behavioral Health Services' on continued changes within the system of care. Successful outcomes have resulted from this welfare reform initiative, which include most notably the significant caseload decrease of the Division of Youth and Family Services (DYFS) and the creation of a new cabinet entity, the Department of Children and Families (DCF). This article specifically outlines systemic recommendations to best serve the target population of 'transitional' youth between the ages of 16 to 18+ years utilizing interagency cooperation based upon 'theory of change' and Total Clinical Outcomes Management (TCOM) strategies. Copyright © 2010 Elsevier Ltd. All rights reserved.

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

PubMed Central

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

2018-01-01

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

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

PubMed

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

2018-04-01

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

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.

7 CFR 1200.13 - Administrator's recommended decision.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 1200.13 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (MARKETING AGREEMENTS AND ORDERS; MISCELLANEOUS COMMODITIES), DEPARTMENT OF AGRICULTURE RULES OF... decision shall include: (1) a preliminary statement containing a description of the history of the...

Management of newborn infant born to mother suffering from tuberculosis: current recommendations & gaps in knowledge.

PubMed

Mittal, Hema; Das, Saurabhi; Faridi, M M A

2014-07-01

Tuberculosis (TB) is a global disease with increase in concern with growing morbidity and mortality after drug resistance and co-infection with HIV. Mother to neonatal transmission of disease is well known. Current recommendations regarding management of newborns of mothers with tuberculosis are variable in different countries and have large gaps in the knowledge and practices. We compare and summarize here current recommendations on management of infants born to mothers with tuberculosis. Congenital tuberculosis is diagnosed by Cantwell criteria and treatment includes three or four anti-tubercular drug regimen. Prophylaxis with isoniazid (3-6 months) is recommended in neonates born to mother with TB who are infectious. Breastfeeding should be continued in these neonates and isolation is recommended only till mother is infectious, has multidrug resistant tuberculosis or non adherent to treatment. BCG vaccine is recommended at birth or after completion of prophylaxis (3-6 months) in all neonates.

Preparing for Infectious Disease: Department of Education Recommendations to Ensure the Continuity of Teaching and Learning for Schools (K-12) during Extended Student Absence or School Dismissal

ERIC Educational Resources Information Center

US Department of Education, 2014

2014-01-01

The U.S. Department of Education (ED) wishes to remind states, districts, schools, students, staff, families, and guardians as well as communities about the importance of: (1) addressing the prevention of infectious disease in schools, including the seasonal flu, viral meningitis, enterovirus, and Ebola; and (2) ensuring the continuity of teaching…

Annual report to Congress. Department of Energy activities relating to the Defense Nuclear Facilities Safety Board, calendar year 2000

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

None

2001-03-01

This Annual Report to the Congress describes the Department of Energy's activities in response to formal recommendations and other interactions with the Defense Nuclear Facilities Safety Board. During 2000, the Department completed its implementation and proposed closure of one Board recommendation and completed all implementation plan milestones associated with two additional Board recommendations. Also in 2000, the Department formally accepted two new Board recommendations and developed implementation plans in response to those recommendations. The Department also made significant progress with a number of broad-based safety initiatives. These include initial implementation of integrated safety management at field sites and within headquartersmore » program offices, issuance of a nuclear safety rule, and continued progress on stabilizing excess nuclear materials to achieve significant risk reduction.« less

Role of passive remote sensors. Sensor System Panel report

NASA Astrophysics Data System (ADS)

1982-06-01

Capabilities of present passive systems are described and the development of passive remote sensing systems for the more abundant tropospheric trace species is recommended. The combination of nadir-viewing spectrometers and solar occultation for tropospheric measurement of those gases having large stratospheric burdens is discussed. Development of a nadir-viewing instrument capable of obtaining continuous spectra in narrower bands is recommended. Gas filter radiometers for species specific measurements and development of a spectral survey instrument are discussed. Further development of aerosol retrieval algorithms, including polarization techniques, for obtaining aerosol thickness and size distributions is advised. Recommendations of specific investigations to be pursued are presented.

Role of passive remote sensors. Sensor System Panel report

NASA Technical Reports Server (NTRS)

1982-01-01

Capabilities of present passive systems are described and the development of passive remote sensing systems for the more abundant tropospheric trace species is recommended. The combination of nadir-viewing spectrometers and solar occultation for tropospheric measurement of those gases having large stratospheric burdens is discussed. Development of a nadir-viewing instrument capable of obtaining continuous spectra in narrower bands is recommended. Gas filter radiometers for species specific measurements and development of a spectral survey instrument are discussed. Further development of aerosol retrieval algorithms, including polarization techniques, for obtaining aerosol thickness and size distributions is advised. Recommendations of specific investigations to be pursued are presented.

The Haiti Medical Education Project: development and analysis of a competency based continuing medical education course in Haiti through distance learning.

PubMed

Battat, Robert; Jhonson, Marc; Wiseblatt, Lorne; Renard, Cruff; Habib, Laura; Normil, Manouchka; Remillard, Brian; Brewer, Timothy F; Sacajiu, Galit

2016-10-19

Recent calls for reform in healthcare training emphasize using competency-based curricula and information technology-empowered learning. Continuing Medical Education programs are essential in maintaining physician accreditation. Haitian physicians have expressed a lack access to these activities. The Haiti Medical Education Project works in alliance with Haitian medical leadership, faculty and students to support the Country's medical education system. We present the creation, delivery and evaluation of a competency-based continuing medical education curriculum for physicians in rural Haiti. Real time lectures from local and international institutions were teleconferenced to physicians in remote Haitian sites using VidyoConferencing™ technology. With American Academy of Family Physicians (AAFP) and College of Family Physicians Canada (CFPC) guidelines as references, a competency-derived syllabus was created for a Haitian continuing medical education program. The resulting educational goals were reviewed by a committee of Haitian and North American physician/medical education practitioners to reflect local needs. All authors reviewed lectures and then conferred to establish agreement on competencies presented for each lecture. Sixty-seven lectures were delivered. Human immunodeficiency virus/Acquired Immunodeficiency Syndrome, ophthalmologic, infectious diseases, renal and endocrine competencies were well-represented, with more than 50 % of the joint AAFP and CFPC recommended competencies outlined. Areas under-represented included allergy and immunology, cardiology, surgery, pain management, gastroenterology, neurology, pulmonology, men's health and rheumatology; these topics accounted for less than 25 % of AAFP/CFPC recommended competencies. Areas not covered included geriatrics, nutrition, occupational health and women's health. Within practice-based lectures, only disaster medicine, health promotion and information management were included, but only partially covered. We identified teaching goals covered and competencies that were missing from a CME program for rural Haitian physicians. We aim to use this analysis to provide a competency-based CME lecture series that proportionally meets local needs while following recommendations of recognized national family medicine organizations.

Diuretics.

ERIC Educational Resources Information Center

Plummer, Nancy; Michael, Nancy, Ed.

This module on diuretics is intended for use in inservice or continuing education programs for persons who administer medications in long-term care facilities. Instructor information, including teaching suggestions, and a listing of recommended audiovisual materials and their sources appear first. The module goal and objectives are then provided.…

Administering Eye Medications.

ERIC Educational Resources Information Center

Morris, Sara; Michael, Nancy, Ed.

This module on administering eye medications is intended for use in inservice or continuing education programs for persons who administer medications in long-term care facilities. Instructor information, including teaching suggestions, and a listing of recommended audiovisual materials and their sources appear first. A brief discussion follows of…

Antidiabetic Agents.

ERIC Educational Resources Information Center

Plummer, Nancy; Michael, Nancy, Ed.

This module on antidiabetic agents is intended for use in inservice or continuing education programs for persons who administer medications in long-term care facilities. Instructor information, including teaching suggestions, and a listing of recommended audiovisual materials and their sources appear first. The module goal and objectives are then…

Multiple Sclerosis.

ERIC Educational Resources Information Center

Plummer, Nancy; Michael, Nancy, Ed.

This module on multiple sclerosis is intended for use in inservice or continuing education programs for persons who administer medications in long-term care facilities. Instructor information, including teaching suggestions, and a listing of recommended audiovisual materials and their sources appear first. The module goal and objectives are then…

Antineoplastic Drugs.

ERIC Educational Resources Information Center

Morris, Sara; Michael, Nancy, Ed.

This module on antineoplastic drugs is intended for use in inservice or continuing education programs for persons who administer medications in long-term care facilities. Instructor information, including teaching suggestions, and a listing of recommended audiovisual materials and their sources appear first. The module goal and objectives are then…

THE GLOBAL ZERO MOVEMENT: A ROAD TO NOWHERE

DTIC Science & Technology

2016-02-08

Agency ( IAEA ) to ensure continued compliance.  Sixth recommendation: The United States must not adopt the concept of de- alerting its nuclear...nuclear weapons or moving fissile material in violation of NPT. These discussions should include intelligence community, law enforcement, and IAEA as

Concurrent Associations between Physical Activity, Screen Time, and Sleep Duration with Childhood Obesity.

PubMed

Laurson, Kelly R; Lee, Joey A; Gentile, Douglas A; Walsh, David A; Eisenmann, Joey C

2014-01-01

Aim. To examine the simultaneous influence of physical activity, screen time, and sleep duration recommendations on the odds of childhood obesity (including overweight). Methods. Physical activity was assessed via pedometer and screen time, and sleep duration were assessed via survey in a cross sectional sample of 674 children (aged 7-12 years) from two Midwestern communities in the fall of 2005. Participants were cross tabulated into four groups depending on how many recommendations were being met (0, 1, 2, or all 3). Linear and logistic regression were used to examine the influence of physical activity, screen time and sleep duration on obesity and interactions among the three variables. Results. Children achieving all three recommendations simultaneously (9.2% of total sample) were the least likely to be obese. Approximately 16% of boys and 9% of girls achieving all recommendations were overweight or obese compared to 53% of boys and 42.5% of girls not achieving any. Conclusions. The odds of obesity increased in a graded manner for each recommendation which was not met. Meeting all three recommendations appears to have a protective effect against obesity. Continued efforts are warranted to promote healthy lifestyle behaviors that include meeting physical activity, screen time, and sleep duration recommendations concurrently.

Concurrent Associations between Physical Activity, Screen Time, and Sleep Duration with Childhood Obesity

PubMed Central

Laurson, Kelly R.; Lee, Joey A.; Gentile, Douglas A.; Walsh, David A.; Eisenmann, Joey C.

2014-01-01

Aim. To examine the simultaneous influence of physical activity, screen time, and sleep duration recommendations on the odds of childhood obesity (including overweight). Methods. Physical activity was assessed via pedometer and screen time, and sleep duration were assessed via survey in a cross sectional sample of 674 children (aged 7–12 years) from two Midwestern communities in the fall of 2005. Participants were cross tabulated into four groups depending on how many recommendations were being met (0, 1, 2, or all 3). Linear and logistic regression were used to examine the influence of physical activity, screen time and sleep duration on obesity and interactions among the three variables. Results. Children achieving all three recommendations simultaneously (9.2% of total sample) were the least likely to be obese. Approximately 16% of boys and 9% of girls achieving all recommendations were overweight or obese compared to 53% of boys and 42.5% of girls not achieving any. Conclusions. The odds of obesity increased in a graded manner for each recommendation which was not met. Meeting all three recommendations appears to have a protective effect against obesity. Continued efforts are warranted to promote healthy lifestyle behaviors that include meeting physical activity, screen time, and sleep duration recommendations concurrently. PMID:24734210

Brown continues crusade against earmarking

NASA Astrophysics Data System (ADS)

Leath, Audrey T.

House Science Committee Chairman George Brown (D-Calif.), a crusader against earmarking of academic research and facilities, continues his efforts to raise the subject's visibility with a new report that was released on August 9."Academic Earmarks: An Interim Report by the Chairman of the Committee on Science, Space, and Technology" includes preliminary results of a survey of about fifty institutions receiving recent earmarks and offers a trio of recommendations to help stem the flood of unauthorized projects.

40 CFR 57.811 - Recommended decision.

Code of Federal Regulations, 2010 CFR

2010-07-01

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

Urinary Tract Infections.

ERIC Educational Resources Information Center

Plummer, Nancy; Michael, Nancy, Ed.

This module on urinary tract infections is intended for use in inservice or continuing education programs for persons who administer medications in long-term care facilities. Instructor information, including teaching suggestions, and a listing of recommended audiovisual materials and their sources appear first. The module goal and objectives are…

Drugs Used in COPD.

ERIC Educational Resources Information Center

Plummer, Nancy; Michael, Nancy, Ed.

This module on drugs used in chronic obstructive pulmonary disease (COPD) is intended for use in inservice or continuing education programs for persons who administer medications in long-term care facilities. Instructor information, including teaching suggestions, and a listing of recommended audiovisual materials and their sources appear first.…

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

PubMed Central

Volberding, Paul A.

2017-01-01

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

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.

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

Federal Register 2010, 2011, 2012, 2013, 2014

2013-10-31

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

Developing Mathematical Habits of Mind

ERIC Educational Resources Information Center

Mark, June; Cuoco, Al; Goldenberg, E. Paul; Sword, Sarah

2010-01-01

"Mathematical habits of mind" include reasoning by continuity, looking at extreme cases, performing thought experiments, and using abstraction that mathematicians use in their work. Current recommendations emphasize the critical nature of developing these habits of mind: "Once this kind of thinking is established, students can apply it in the…

Tube Feedings.

ERIC Educational Resources Information Center

Plummer, Nancy

This module on tube feedings is intended for use in inservice or continuing education programs for persons who work in long-term care. Instructor information, including teaching suggestions and a listing of recommended audiovisual materials and their sources appear first. The module goal and objectives are then provided. A brief discussion follows…

7 CFR 1942.5 - Application review and approval.

Code of Federal Regulations, 2010 CFR

2010-01-01

... Public Law 103-354 by written amendment to this letter. Any changes not approved by FmHA or its successor... Agriculture Regulations of the Department of Agriculture (Continued) RURAL HOUSING SERVICE, RURAL BUSINESS... complete the project summary, including written analysis and recommendations, and will prepare a draft...

Review: Malaria Chemoprophylaxis for Travelers to Latin America

PubMed Central

Steinhardt, Laura C.; Magill, Alan J.; Arguin, Paul M.

2011-01-01

Because of recent declining malaria transmission in Latin America, some authorities have recommended against chemoprophylaxis for most travelers to this region. However, the predominant parasite species in Latin America, Plasmodium vivax, can form hypnozoites sequestered in the liver, causing malaria relapses. Additionally, new evidence shows the potential severity of vivax infections, warranting continued consideration of prophylaxis for travel to Latin America. Individualized travel risk assessments are recommended and should consider travel locations, type, length, and season, as well as probability of itinerary changes. Travel recommendations might include no precautions, mosquito avoidance only, or mosquito avoidance and chemoprophylaxis. There are a range of good options for chemoprophylaxis in Latin America, including atovaquone-proguanil, doxycycline, mefloquine, and—in selected areas—chloroquine. Primaquine should be strongly considered for nonpregnant, G6PD-nondeficient patients traveling to vivax-endemic areas of Latin America, and it has the added benefit of being the only drug to protect against malaria relapses. PMID:22144437

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

ERIC Educational Resources Information Center

Granville, Arthur; And Others

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

The elements of a commercial human spaceflight safety reporting system

NASA Astrophysics Data System (ADS)

Christensen, Ian

2017-10-01

In its report on the SpaceShipTwo accident the National Transportation Safety Board (NTSB) included in its recommendations that the Federal Aviation Administration (FAA) ;in collaboration with the commercial spaceflight industry, continue work to implement a database of lessons learned from commercial space mishap investigations and encourage commercial space industry members to voluntarily submit lessons learned.; In its official response to the NTSB the FAA supported this recommendation and indicated it has initiated an iterative process to put into place a framework for a cooperative safety data sharing process including the sharing of lessons learned, and trends analysis. Such a framework is an important element of an overall commercial human spaceflight safety system.

Brown continues crusade against earmarking

NASA Astrophysics Data System (ADS)

Leath, Audrey T.

House Science Committee Chairman George Brown (D-Calif.), a crusader against earmarking of academic research and facilities, continues his efforts to raise the subject's visibility with a new report that was released on August 9.“Academic Earmarks: An Interim Report by the Chairman of the Committee on Science, Space, and Technology” includes preliminary results of a survey of about fifty institutions receiving recent earmarks and offers a trio of recommendations to help stem the flood of unauthorized projects.

2017 American College of Rheumatology/American Association of Hip and Knee Surgeons Guideline for the Perioperative Management of Antirheumatic Medication in Patients With Rheumatic Diseases Undergoing Elective Total Hip or Total Knee Arthroplasty.

PubMed

Goodman, Susan M; Springer, Bryan; Guyatt, Gordon; Abdel, Matthew P; Dasa, Vinod; George, Michael; Gewurz-Singer, Ora; Giles, Jon T; Johnson, Beverly; Lee, Steve; Mandl, Lisa A; Mont, Michael A; Sculco, Peter; Sporer, Scott; Stryker, Louis; Turgunbaev, Marat; Brause, Barry; Chen, Antonia F; Gililland, Jeremy; Goodman, Mark; Hurley-Rosenblatt, Arlene; Kirou, Kyriakos; Losina, Elena; MacKenzie, Ronald; Michaud, Kaleb; Mikuls, Ted; Russell, Linda; Sah, Alexander; Miller, Amy S; Singh, Jasvinder A; Yates, Adolph

2017-08-01

This collaboration between the American College of Rheumatology and the American Association of Hip and Knee Surgeons developed an evidence-based guideline for the perioperative management of antirheumatic drug therapy for adults with rheumatoid arthritis (RA), spondyloarthritis (SpA) including ankylosing spondylitis and psoriatic arthritis, juvenile idiopathic arthritis (JIA), or systemic lupus erythematosus (SLE) undergoing elective total hip (THA) or total knee arthroplasty (TKA). A panel of rheumatologists, orthopedic surgeons specializing in hip and knee arthroplasty, and methodologists was convened to construct the key clinical questions to be answered in the guideline. A multi-step systematic literature review was then conducted, from which evidence was synthesized for continuing versus withholding antirheumatic drug therapy and for optimal glucocorticoid management in the perioperative period. A Patient Panel was convened to determine patient values and preferences, and the Grading of Recommendations Assessment, Development and Evaluation methodology was used to rate the quality of evidence and the strength of recommendations, using a group consensus process through a convened Voting Panel of rheumatologists and orthopedic surgeons. The strength of the recommendation reflects the degree of certainty that benefits outweigh harms of the intervention, or vice versa, considering the quality of available evidence and the variability in patient values and preferences. The guideline addresses the perioperative use of antirheumatic drug therapy including traditional disease-modifying antirheumatic drugs, biologic agents, tofacitinib, and glucocorticoids in adults with RA, SpA, JIA, or SLE who are undergoing elective THA or TKA. It provides recommendations regarding when to continue, when to withhold, and when to restart these medications, and the optimal perioperative dosing of glucocorticoids. The guideline includes 7 recommendations, all of which are conditional and based on low- or moderate-quality evidence. This guideline should help decision-making by clinicians and patients regarding perioperative antirheumatic medication management at the time of elective THA or TKA. These conditional recommendations reflect the paucity of high-quality direct randomized controlled trial data. © 2017, American College of Rheumatology.

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 Future of Postgraduate Medical Education in Canada.

PubMed

Busing, Nick; Harris, Ken; MacLellan, Anne-Marie; Moineau, Geneviève; Oandasan, Ivy; Rourke, James; Saxena, Anurag

2015-09-01

The Future of Medical Education in Canada Postgraduate (FMEC PG) Project was launched in 2010 by a consortium of four organizations: the Association of Faculties of Medicine of Canada, the Collège des Médecins du Québec, the College of Family Physicians of Canada, and the Royal College of Physicians and Surgeons of Canada. The FMEC PG study set out to review the state of the Canadian postgraduate medical education (PGME) system and make recommendations for improvements and changes. The extensive process included literature reviews, commissioned papers, stakeholder interviews, international consultations, and dialogue with the public and learners. The resulting key findings and 10 recommendations, published in a report in 2012, represent the collective vision of the consortium partner organizations for PGME in Canada. Implementation of the recommendations began in 2013 and will continue beyond 2016.In this article, the authors describe the complex process of developing the recommendations, highlight several recommendations, consider implementation processes and issues, and share lessons learned to date. They reflect on the ways in which the transformation of a very complex and complicated PGME system has required many stakeholders to work together on multiple interventions simultaneously. Notwithstanding the challenges for the participating organizations, changes have been introduced and sustainability is being forged. Throughout this process, the consortium partners and other stakeholders have continued to address the social accountability role of all physicians with respect to the public they serve.

Australian health professionals' health website recommendation trends.

PubMed

Usher, Wayne T

2011-08-01

This study was concerned with indentifying motivations and trends associated with a health website recommendation from eight of Australia's major health professions to the health consumer. Health professions included in this study are: psychiatrists, general practitioners, social workers, dietitians, chiropractors, physiotherapists, optometrists and pharmacists. An online survey (www.limesurvey.org) was developed from a common set of questions negotiated between all eight health professions. Survey questions were constructed in an attempt to identify participants' reasons for or against recommending a health website to a patient. A 5-point scale (not, slightly, neutral, moderately, strongly) to measure influence was used throughout the question set. This study indicates that Australian general practitioners (GPs) were the highest Australian health professionals to undertake a health website recommendation (86%), followed by psychiatrists (80%), with the lowest being physiotherapists (42%) and optometrists (33%). A profile of the Australian health professional who recommends a health website is identified as male, aged above 50 years, has had more than 10 years experience, works in a major city, is in private practice and has patient numbers exceeding 500 in a 12-month period (2009). Recommendations from this study include the need to develop mechanisms that identify high-quality online medical information and the development and implementation of Continuing Professional Development (CPD) courses which up-skill health professionals concerning the recommendation of health websites for health care delivery.

Status Report to the Governor and General Assembly, 2001.

ERIC Educational Resources Information Center

Kentucky Council on Postsecondary Education, Frankfort.

The Kentucky Council on Postsecondary Education reports on its activities and achievements in 2001. The Council describes some of its activities, including: developing funding recommendations for Kentucky's college and universities for the 2002-2004 biennium; (2) continuing the startup of the Kentucky Virtual University, a consortium online…

Higher Education Cooperation Act: Fiscal Year 1998 Grant Allocations.

ERIC Educational Resources Information Center

Illinois State Board of Higher Education, Springfield.

This report describes fiscal year 1998 grant allocations made under the Illinois Higher Education Cooperation Act (HECA) to support programs and projects involving cooperation among higher education institutions. A total of $16.59 million was allocated. Projects recommended for grant funds include 3 new and 12 continuing interinstitutional…

40 CFR 1051.125 - What maintenance instructions must I give to buyers?

Code of Federal Regulations, 2013 CFR

2013-07-01

... necessary. This might include adding engine oil, changing air, fuel, or oil filters, servicing engine... (CONTINUED) AIR POLLUTION CONTROLS CONTROL OF EMISSIONS FROM RECREATIONAL ENGINES AND VEHICLES Emission... the maintenance will be done at the recommended interval on in-use engines. In considering your...

40 CFR 1051.125 - What maintenance instructions must I give to buyers?

Code of Federal Regulations, 2012 CFR

2012-07-01

... necessary. This might include adding engine oil, changing air, fuel, or oil filters, servicing engine... (CONTINUED) AIR POLLUTION CONTROLS CONTROL OF EMISSIONS FROM RECREATIONAL ENGINES AND VEHICLES Emission... the maintenance will be done at the recommended interval on in-use engines. In considering your...

40 CFR 1051.125 - What maintenance instructions must I give to buyers?

Code of Federal Regulations, 2011 CFR

2011-07-01

... necessary. This might include adding engine oil, changing air, fuel, or oil filters, servicing engine... (CONTINUED) AIR POLLUTION CONTROLS CONTROL OF EMISSIONS FROM RECREATIONAL ENGINES AND VEHICLES Emission... the maintenance will be done at the recommended interval on in-use engines. In considering your...

40 CFR 1051.125 - What maintenance instructions must I give to buyers?

Code of Federal Regulations, 2014 CFR

2014-07-01

... necessary. This might include adding engine oil, changing air, fuel, or oil filters, servicing engine... (CONTINUED) AIR POLLUTION CONTROLS CONTROL OF EMISSIONS FROM RECREATIONAL ENGINES AND VEHICLES Emission... the maintenance will be done at the recommended interval on in-use engines. In considering your...

Helping Soldiers Leverage Army Knowledge, Skills, and Abilities in Civilian Jobs

DTIC Science & Technology

2017-01-01

44,100 High school diploma 4 Wind turbine service technicians 3,710 $48,800 High school diploma 4 Table D.1—Continued 139 Lists of Figures and Tables...servicing automotive electrical systems, including wiring harnesses and starting and charging systems; and Table 3.40 Civilian Occupations Recommended

National Policy and The Great Tuition Debate--Does This Man Have the Solution?

ERIC Educational Resources Information Center

Shaw, Jane S.

1974-01-01

Describes the 6 recommendations of the National Commission on the Financing of Postsecondary Education, including federal funding of undergraduate education through grants and loans, increase in tuition charges, full utilization of institutional resources, and continuation of tax incentives for voluntary support of higher education. (Author/PG)

Medications Used in the Treatment of Ischemic Heart Disease.

ERIC Educational Resources Information Center

Plummer, Nancy; Michael, Nancy, Ed.

This module on medications used in the treatment of ischemic heart disease is intended for use in inservice or continuing education programs for persons who administer medications in long-term care facilities. Instructor information, including teaching suggestions, and a listing of recommended audiovisual materials and their sources appear first.…

40 CFR 1051.125 - What maintenance instructions must I give to buyers?

Code of Federal Regulations, 2010 CFR

2010-07-01

... maintenance steps to address engine operation that is not atypical, or that the maintenance is unlikely to... (CONTINUED) AIR POLLUTION CONTROLS CONTROL OF EMISSIONS FROM RECREATIONAL ENGINES AND VEHICLES Emission... maintenance step, recommend the maximum feasible interval for this maintenance, include your rationale with...

Promoting Educational Equity through School Libraries. Module 3: Sex-Fair Instructional Materials.

ERIC Educational Resources Information Center

Nilsen, Alleen Pace; Tyler, Karen Beyard

The sex-fair characteristics which school librarians and media specialists should look for in the content, language, and illustrations when selecting instructional materials are described in this third learning module of an inservice continuing education program. Recommended criteria for selection include the portrayal of approximately equal…

Education et Formation des Adultes en France. (Adult Education in France.)

ERIC Educational Resources Information Center

National Inst. for Adult Education, Nancy (France).

This report on a national seminar attended by over 100 French adult educators from universities, industry, government agencies, and voluntary agencies is divided into three parts. Part I summarizes conclusions and recommendations made by nine commissions on conditions (including needs and objectives, obstacles to continuing education, educational…

Quality and Variability of Online Available Physical Therapy Protocols From Academic Orthopaedic Surgery Programs for Anterior Cruciate Ligament Reconstruction.

PubMed

Makhni, Eric C; Crump, Erica K; Steinhaus, Michael E; Verma, Nikhil N; Ahmad, Christopher S; Cole, Brian J; Bach, Bernard R

2016-08-01

To assess the quality and variability found across anterior cruciate ligament (ACL) rehabilitation protocols published online by academic orthopaedic programs. Web-based ACL physical therapy protocols from United States academic orthopaedic programs available online were included for review. Main exclusion criteria included concomitant meniscus repair, protocols aimed at pediatric patients, and failure to provide time points for the commencement or recommended completion of any protocol components. A comprehensive, custom scoring rubric was created that was used to assess each protocol for the presence or absence of various rehabilitation components, as well as when those activities were allowed to be initiated in each protocol. Forty-two protocols were included for review from 155 U.S. academic orthopaedic programs. Only 13 protocols (31%) recommended a prehabilitation program. Five protocols (12%) recommended continuous passive motion postoperatively. Eleven protocols (26%) recommended routine partial or non-weight bearing immediately postoperatively. Ten protocols (24%) mentioned utilization of a secondary/functional brace. There was considerable variation in range of desired full-weight-bearing initiation (9 weeks), as well as in the types of strength and proprioception exercises specifically recommended. Only 8 different protocols (19%) recommended return to sport after achieving certain strength and activity criteria. Many ACL rehabilitation protocols recommend treatment modalities not supported by current reports. Moreover, high variability in the composition and time ranges of rehabilitation components may lead to confusion among patients and therapists. Level II. Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

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

PubMed

Tam, Theresa W S

2018-02-01

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

Primary and Secondary Prevention of Cardiovascular Disease

PubMed Central

Vandvik, Per Olav; Lincoff, A. Michael; Gore, Joel M.; Gutterman, David D.; Sonnenberg, Frank A.; Alonso-Coello, Pablo; Akl, Elie A.; Lansberg, Maarten G.; Guyatt, Gordon H.

2012-01-01

Background: This guideline focuses on long-term administration of antithrombotic drugs designed for primary and secondary prevention of cardiovascular disease, including two new antiplatelet therapies. Methods: The methods of this guideline follow those described in Methodology for the Development of Antithrombotic Therapy and Prevention of Thrombosis Guidelines: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines in this supplement. Results: We present 23 recommendations for pertinent clinical questions. For primary prevention of cardiovascular disease, we suggest low-dose aspirin (75-100 mg/d) in patients aged > 50 years over no aspirin therapy (Grade 2B). For patients with established coronary artery disease, defined as patients 1-year post-acute coronary syndrome, with prior revascularization, coronary stenoses > 50% by coronary angiogram, and/or evidence for cardiac ischemia on diagnostic testing, we recommend long-term low-dose aspirin or clopidogrel (75 mg/d) (Grade 1A). For patients with acute coronary syndromes who undergo percutaneous coronary intervention (PCI) with stent placement, we recommend for the first year dual antiplatelet therapy with low-dose aspirin in combination with ticagrelor 90 mg bid, clopidogrel 75 mg/d, or prasugrel 10 mg/d over single antiplatelet therapy (Grade 1B). For patients undergoing elective PCI with stent placement, we recommend aspirin (75-325 mg/d) and clopidogrel for a minimum duration of 1 month (bare-metal stents) or 3 to 6 months (drug-eluting stents) (Grade 1A). We suggest continuing low-dose aspirin plus clopidogrel for 12 months for all stents (Grade 2C). Thereafter, we recommend single antiplatelet therapy over continuation of dual antiplatelet therapy (Grade 1B). Conclusions: Recommendations continue to favor single antiplatelet therapy for patients with established coronary artery disease. For patients with acute coronary syndromes or undergoing elective PCI with stent placement, dual antiplatelet therapy for up to 1 year is warranted. PMID:22315274

Continuing education needs for fishery professionals: a survey of North American fisheries administrators

USGS Publications Warehouse

Rassam, G.N.; Eisler, R.

2001-01-01

North American fishery professionals? continuing education needs were investigated in an American Fisheries Society questionnaire sent to 111 senior fishery officials in winter 2000. Based on a response rate of 52.2% (N = 58), a minimum of 2,967 individuals would benefit from additional training, especially in the areas of statistics and analysis (83% endorsement rate), restoration and enhancement (81%), population dynamics (81%), multi-species interactions (79%), and technical writing (79%). Other skills and techniques recommended by respondents included computer skills (72%), fishery modeling (69%), habitat modification (67%), watershed processes (66%), fishery management (64%), riparian and stream ecology (62%), habitat management (62%), public administration (62%), nonindigenous species (57%), and age and growth (55%). Additional comments by respondents recommended new technical courses, training in various communications skills, and courses to more effectively manage workloads.

[Treatment of typical trigeminus neuralgias. Overview of the current state of drug and surgical therapy].

PubMed

Möbius, E; Leopold, H C; Paulus, W M

1984-10-11

Carbamazepine continues to be the most useful drug in the treatment of trigeminal neuralgia. Diphenylhydantoin may be given in addition to or instead of Carbamazepine. Refractory cases may benefit from combination with Baclofen or Chlorphenesin. In cases of persistent pain the concomitant use of tricyclic antidepressant drugs is recommended. If pain continues in spite of multiple medical therapies or if serious side effects develop, then surgical procedures such as percutaneous controlled thermocoagulation or microvascular decompression are indicated. Percutaneous thermocoagulation is associated with the lowest mortality and morbidity rate and can easily be repeated. Microvascular decompression should especially be offered to young patients, who want to avoid any sensory disturbance of the face, and recommended for other patients for whom all other forms of therapy including percutaneous thermocoagulation have failed.

Quality of cancer care in Spain: recommendations of a patients' jury.

PubMed

Arrighi, E; Blancafort, S; Jovell, A J; Navarro Rubio, M D

2015-05-01

The aim of the study was to evaluate quality of cancer care in Spain through patient's views, experiences and perceptions; with the purpose of making recommendations to improve cancer care. A modified citizen's jury was organised with the participation of 30 members and four experts as witnesses. For 1 day jurors representing 13 of 17 Spanish Autonomous Communities were met to make recommendations for improving the quality of cancer care in Spain. Concerns were identified regarding care fragmentation, test delays, duplications and poor social and emotional support. Some recommendations highlighted the need to improve the access to psycho-oncology care as well as support in social care and counselling, addressing patients to specific care. Some strategies proposed by the jury included a 24-h call centre, continuity in palliative care and appropriate follow-up and support after the end of therapy. In conclusion, the experience of cancer should include access to multiple specialists, effective coordination of care, accurate information about the disease and treatment options, and timely attention to symptoms and psychosocial needs. © 2014 John Wiley & Sons Ltd.

A Retrospective Management Perspective on Nearly 20 Years of the Savannah River Site Citizen Advisory Board - 13078

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

Belencan, Helen L.; Guevara, Karen C.; Spears, Terrel J.

2013-07-01

The Department of Energy, Office of Environmental Management (DOE EM) program has invested in site specific advisory boards since 1994. These boards have served as a portal to the communities surrounding the DOE sites, provided a key avenue for public involvement, and have actively engaged in providing input and feedback that has informed clean up and priority decisions made by EM. Although the EM program has made considerable progress in completing its mission, work will continue for decades, including work at the Savannah River Site (SRS). It is reasonable to assume the advisory boards will continue in their role providingmore » input and feedback to EM. The SRS Citizen Advisory Board (CAB) formed in 1994 and has issued 298 recommendations through September 2012. Although the effectiveness of the board is not measured by the number of recommendations issued, the recommendations themselves serve to illustrate the areas in which the CAB is particularly interested, and offer insight to the overall effectiveness of the CAB as a means for public participation in the EM decision making process. (authors)« less

Health effects models for nuclear power plant accident consequence analysis: Low LET radiation

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

Evans, J.S.

1990-01-01

This report describes dose-response models intended to be used in estimating the radiological health effects of nuclear power plant accidents. Models of early and continuing effects, cancers and thyroid nodules, and genetic effects are provided. Weibull dose-response functions are recommended for evaluating the risks of early and continuing health effects. Three potentially lethal early effects -- the hematopoietic, pulmonary, and gastrointestinal syndromes -- are considered. In addition, models are included for assessing the risks of several nonlethal early and continuing effects -- including prodromal vomiting and diarrhea, hypothyroidism and radiation thyroiditis, skin burns, reproductive effects, and pregnancy losses. Linear andmore » linear-quadratic models are recommended for estimating cancer risks. Parameters are given for analyzing the risks of seven types of cancer in adults -- leukemia, bone, lung, breast, gastrointestinal, thyroid, and other.'' The category, other'' cancers, is intended to reflect the combined risks of multiple myeloma, lymphoma, and cancers of the bladder, kidney, brain, ovary, uterus and cervix. Models of childhood cancers due to in utero exposure are also developed. For most cancers, both incidence and mortality are addressed. The models of cancer risk are derived largely from information summarized in BEIR III -- with some adjustment to reflect more recent studies. 64 refs., 18 figs., 46 tabs.« less

Review and Implementation Status of Prior Defense Business Board Recommendations

DTIC Science & Technology

2007-04-01

Resource Management • Support unified models for shared services , and be prepared to adjust forward approaches for a Unified Medical Command...models for shared services – including by and between Veterans Affairs and Defense, electronic information exchange, disease treatment and prevention...www.dod.mil/dbb/pdf/DBB- Report-on-the-Military.pdf. • Continue to support unified models for shared services – including by and between Veterans Affairs

A Process Evaluation of Project Developmental Continuity. Interim Report II, Part B: Recommendations for Measuring Program Impact.

ERIC Educational Resources Information Center

Love, John M.; And Others

This report presents recommendations for measures to be used in assessing the impact of Project Developmental Continuity (PDC). Chapter I reviews the purpose of the impact study and presents the basic considerations guiding the selection of measures. Chapter II describes the review process that led to the final recommendations. Chapter III…

National Institutes of Health Pathways to Prevention Workshop: Methods for Evaluating Natural Experiments in Obesity.

PubMed

Emmons, Karen M; Doubeni, Chyke A; Fernandez, Maria E; Miglioretti, Diana L; Samet, Jonathan M

2018-06-05

On 5 and 6 December 2017, the National Institutes of Health (NIH) convened the Pathways to Prevention Workshop: Methods for Evaluating Natural Experiments in Obesity to identify the status of methods for assessing natural experiments to reduce obesity, areas in which these methods could be improved, and research needs for advancing the field. This article considers findings from a systematic evidence review on methods for evaluating natural experiments in obesity, workshop presentations by experts and stakeholders, and public comment. Research gaps are identified, and recommendations related to 4 key issues are provided. Recommendations on population-based data sources and data integration include maximizing use and sharing of existing surveillance and research databases and ensuring significant effort to integrate and link databases. Recommendations on measurement include use of standardized and validated measures of obesity-related outcomes and exposures, systematic measurement of co-benefits and unintended consequences, and expanded use of validated technologies for measurement. Study design recommendations include improving guidance, documentation, and communication about methods used; increasing use of designs that minimize bias in natural experiments; and more carefully selecting control groups. Cross-cutting recommendations target activities that the NIH and other funders might undertake to improve the rigor of natural experiments in obesity, including training and collaboration on modeling and causal inference, promoting the importance of community engagement in the conduct of natural experiments, ensuring maintenance of relevant surveillance systems, and supporting extended follow-up assessments for exemplar natural experiments. To combat the significant public health threat posed by obesity, researchers should continue to take advantage of natural experiments. The recommendations in this report aim to strengthen evidence from such studies.

78 FR 12756 - Proposed Data Collections Submitted for Public Comment and Recommendations

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-25

... strategies, including self- report pre-and post-test instruments for assessing trainee reaction and measuring... Knowledge Test. Mine Escape/Continuous Mining Pre/Post- 30 1 6/60 3 participants. Training Knowledge Test. Mine Rescue/Longwall Mining Pre/Post- 30 1 6/60 3 participants. Training Knowledge Test. Mine Rescue...

Novels for Class Study in Junior High School: Some Recommendations.

ERIC Educational Resources Information Center

Flanigan, Jean Culp

This thesis examines opinions of recognized authorities in the teaching of literature regarding the goals of the literature curriculum in achieving the end of producing students who continue to read for pleasure and enrichment once their formal education is completed. Criteria for selecting novels for adolescents include: (1) readability,…

77 FR 61411 - Proposed Data Collections Submitted for Public Comment and Recommendations

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-09

... three-year clearance request for the National Hospital Care Survey includes data collection from... Bill (UB-04) administrative claims data as well as facility level data. This activity continues in 2013... sector, foundations, and a variety of users in the print media. Data collected through NHCS are essential...

Student Financial Aid. Agenda Item 3.

ERIC Educational Resources Information Center

Farland, Ronn; Tarrer, Rod

A staff report on the availability of financial aid funds to students in California was presented to the Board of Governors of California Community Colleges and includes 13 recommendations for action. The report indicates a continuing increase in federal aid funds since 1955, with over $8 billion available in 1978-79. A review of federal and state…

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

Federal Register 2010, 2011, 2012, 2013, 2014

2011-03-08

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

Historical Overview of Transitional Feeding Recommendations and Vegetable Feeding Practices for Infants and Young Children

PubMed Central

Kleinman, Ronald E.; Coletta, Frances A.

2016-01-01

Although recommendations for introducing solid foods to infants and young children have changed significantly since the beginning of the 20th century, vegetable consumption recommendations have always been an important part of the child-feeding repertoire. In 1958, the first report of the American Academy of Pediatrics (AAP) Committee on Nutrition stated that developmental maturity of the gut and neuromuscular system, growth rate, and activity level were good indicators for determining when to introduce solid foods to infants than age. All 7 editions of the AAP Pediatric Nutrition Handbook use an evidence-based model for recommendations concerning the complementary feeding of infants and young children. The model includes developmental readiness principles, feeding practices, and age-appropriate nutrient requirements. Dietary patterns and nutrient consumption among infants and young children have been analyzed using data from the 2002 and 2008 Feeding Infants and Toddlers Study (FITS). The 2008 FITS also collected information concerning participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Since 1972, WIC has been a cost-effective means of improving the diets and health of infants and young children from low-income families. Data from the 2008 FITS showed that many young children did not consume recommended amounts of fiber or potassium, and vegetable and fruit intakes continued to be lower than recommended. Low vegetable consumption and limited variety were also seen among WIC participants and nonparticipants aged 6 months to 4 years prior to changes in the WIC food package. Increasing children’s consumption of all vegetables should continue to be a focus going forward. PMID:27003950

[Vaccination schedule of the Spanish Association of Pediatrics: recommendations 2006].

PubMed

2006-01-01

Based on the evidence available, the Vaccines Advisory Committee (VAC) of the Spanish Association of Pediatrics reports and comments on the new developments in vaccines that have taken place in 2005 and recommends some modifications to the vaccination schedule for 2006. In agreement with changes in the product monographs for the meningococcal C vaccine, the VAC recommends two doses for the three commercially available preparations with a booster dose in the second year of life. The European Medicines Evaluation Agency (EMEA) has temporarily suspended the sale of the Hexavac vaccine due to doubts about its long-term protection against hepatitis B. The VAC continues to support the use of these combined vaccines. Currently only Infranrix Hexa is available in Spain. The recommendation of vaccinating adolescents with a booster dose of pertussis vaccine via the administration of an acellular preparation of low antigenic load together with the adult diphtheria and tetanus vaccine remains valid. Vaccination against chickenpox in susceptible children aged more than 12 months old continues to be recommended. There is wide coverage for the 7-valent pneumococcal conjugate vaccine in many areas of Spain. In view of the studies published, the VAC reiterates the need for universal immunization by introducing this vaccine in the official vaccination schedule. Finally, other vaccines not included in this schedule are discussed, with special mention of the advisability of influenza vaccination in children, according to the recommendations of the VAC available at the beginning of each season on the web site of the Spanish Association of Pediatrics www.aeped.es; www. vacunasaep.org.

Do nurses provide a safe sleep environment for infants in the hospital setting? An integrative review.

PubMed

Patton, Carla; Stiltner, Denise; Wright, Kelly Barnhardt; Kautz, Donald D

2015-02-01

Sudden infant death syndrome (SIDS) may be the most preventable cause of death for infants 0 to 6 months of age. The American Academy of Pediatrics (AAP) first published safe sleep recommendations for parents and healthcare professionals in 1992. In 1994, new guidelines were published and they became known as the "Back to Sleep" campaign. After this, a noticeable decline occurred in infant deaths from SIDS. However, this number seems to have plateaued with no continuing significant improvements in infant deaths. The objective of this review was to determine whether nurses provide a safe sleep environment for infants in the hospital setting. Research studies that dealt with nursing behaviors and nursing knowledge in the hospital setting were included in the review. A search was conducted of Google Scholar, CINAHL, PubMed, and Cochrane, using the key words "NICU," "newborn," "SIDS," "safe sleep environment," "nurse," "education," "supine sleep," "prone sleep," "safe sleep," "special care nursery," "hospital policy for safe sleep," "research," "premature," "knowledge," "practice," "health care professionals," and "parents." The review included research reports on nursing knowledge and behaviors as well as parental knowledge obtained through education and role modeling of nursing staff. Only research studies were included to ensure that our analysis was based on rigorous research-based findings. Several international studies were included because they mirrored findings noted in the United States. All studies were published between 1999 and 2012. Healthcare professionals and parents were included in the studies. They were primarily self-report surveys, designed to determine what nurses, other healthcare professionals, and parents knew or had been taught about SIDS. Integrative review. Thirteen of the 16 studies included in the review found that some nurses and some mothers continued to use nonsupine positioning. Four of the 16 studies discussed nursing knowledge and noncompliance with AAP safe sleep recommendations. Eleven of the 16 studies found that some nurses were recommending incorrect sleep positions to mothers. Five of the 16 studies noted that some nurses and mothers gave fear of aspiration as the reason they chose to use a nonsupine sleep position. In the majority of the studies, the information was self-reported, which could impact the validity of the findings. Also, the studies used convenience sampling, which makes study findings difficult to generalize. The research indicates that there has been a plateau in safe sleeping practices in the hospital setting. Some infants continue to be placed in positions that increase the risk for SIDS. The research also shows that some nurses are not following the 2011 AAP recommendations for a safe sleep environment. Clearly, nurses need additional education on SIDS prevention and the safe sleep environment, and additional measures need to be adopted to ensure that all nurses and all families understand the research supporting the AAP recommendation that supine sleep is best. Further work is needed to promote evidence-based practice among healthcare professionals and families.

Problems with the 2015 Dietary Guidelines for Americans: An Alternative.

PubMed

DiNicolantonio, James J; Harcombe, Zoë; O'Keefe, James H

2016-01-01

Abstract The updated 2015 Dietary Guidelines for Americans, published in January 2016, have stirred much controversy since the advisory report first appeared. Several important changes have been made, with some recommendations having greater scientific evidence for their support than others. The focus of this review is to discuss specific recommendations from the 2015 Dietary Guidelines for Americans that lack sound scientific evidence; these include: 1) Allowing approximately half of all grains to be refined; 2) The continued recommendations for fat-free or low-fat dairy and limitation of saturated fat intake to < 10% of calories; 3) Sodium intake < 2,300 mg/day; and 4) Consumption of up to 27 grams/day of "oils" (high in polyunsaturated fat or monounsaturated fat). Based on our review, the aforementioned recommendations found in the updated 2015 Dietary Guideline for Americans may increase the incidence of cardiometabolic disease, diabetes, obesity, dyslipidemia, cardiovascular disease, and possibly cancer.

An ICON Overview on Physical Modalities for Neck Pain and Associated Disorders

PubMed Central

Graham, Nadine; Gross, Anita R; Carlesso, Lisa C; Santaguida, P. Lina; MacDermid, Joy C; Walton, Dave; Ho, Enoch

2013-01-01

Introduction: Neck pain is common, can be disabling and is costly to society. Physical modalities are often included in neck rehabilitation programs. Interventions may include thermal, electrotherapy, ultrasound, mechanical traction, laser and acupuncture. Definitive knowledge regarding optimal modalities and dosage for neck pain management is limited. Purpose: To systematically review existing literature to establish the evidence-base for recommendations on physical modalities for acute to chronic neck pain. Methods: A comprehensive computerized and manual search strategy from January 2000 to July 2012, systematic review methodological quality assessment using AMSTAR, qualitative assessment using a GRADE approach and recommendation presentation was included. Systematic or meta-analyses of studies evaluating physical modalities were eligible. Independent assessment by at least two review team members was conducted. Data extraction was performed by one reviewer and checked by a second. Disagreements were resolved by consensus. Results: Of 103 reviews eligible, 20 were included and 83 were excluded. Short term pain relief - Moderate evidence of benefit: acupuncture, intermittent traction and laser were shown to be better than placebo for chronic neck pain. Moderate evidence of no benefit: pulsed ultrasound, infrared light or continuous traction was no better than placebo for acute whiplash associated disorder, chronic myofascial neck pain or subacute to chronic neck pain. There was no added benefit when hot packs were combined with mobilization, manipulation or electrical muscle stimulation for chronic neck pain, function or patient satisfaction at six month follow-up. Conclusions: The current state of the evidence favours acupuncture, laser and intermittent traction for chronic neck pain. Some electrotherapies show little benefit for chronic neck pain. Consistent dosage, improved design and long term follow-up continue to be the recommendations for future research. PMID:24155804

Evaluating and Evolving Metadata in Multiple Dialects

NASA Technical Reports Server (NTRS)

Kozimore, John; Habermann, Ted; Gordon, Sean; Powers, Lindsay

2016-01-01

Despite many long-term homogenization efforts, communities continue to develop focused metadata standards along with related recommendations and (typically) XML representations (aka dialects) for sharing metadata content. Different representations easily become obstacles to sharing information because each representation generally requires a set of tools and skills that are designed, built, and maintained specifically for that representation. In contrast, community recommendations are generally described, at least initially, at a more conceptual level and are more easily shared. For example, most communities agree that dataset titles should be included in metadata records although they write the titles in different ways.

Wireless Instrumentation Use on Launch Vehicles

NASA Technical Reports Server (NTRS)

Sherman, Aaron

2010-01-01

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

Dealing with Time in Health Economic Evaluation: Methodological Issues and Recommendations for Practice.

PubMed

O'Mahony, James F; Newall, Anthony T; van Rosmalen, Joost

2015-12-01

Time is an important aspect of health economic evaluation, as the timing and duration of clinical events, healthcare interventions and their consequences all affect estimated costs and effects. These issues should be reflected in the design of health economic models. This article considers three important aspects of time in modelling: (1) which cohorts to simulate and how far into the future to extend the analysis; (2) the simulation of time, including the difference between discrete-time and continuous-time models, cycle lengths, and converting rates and probabilities; and (3) discounting future costs and effects to their present values. We provide a methodological overview of these issues and make recommendations to help inform both the conduct of cost-effectiveness analyses and the interpretation of their results. For choosing which cohorts to simulate and how many, we suggest analysts carefully assess potential reasons for variation in cost effectiveness between cohorts and the feasibility of subgroup-specific recommendations. For the simulation of time, we recommend using short cycles or continuous-time models to avoid biases and the need for half-cycle corrections, and provide advice on the correct conversion of transition probabilities in state transition models. Finally, for discounting, analysts should not only follow current guidance and report how discounting was conducted, especially in the case of differential discounting, but also seek to develop an understanding of its rationale. Our overall recommendations are that analysts explicitly state and justify their modelling choices regarding time and consider how alternative choices may impact on results.

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

241-AY Double Shell Tanks (DST) Integrity Assessment Report

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

JENSEN, C.E.

1999-09-21

This report presents the results of the integrity assessment of the 241-AY double-shell tank farm facility located in the 200 East Area of the Hanford Site. The assessment included the design evaluation and integrity examinations of the tanks and concluded that the facility is adequately designed, is compatible with the waste, and is fit for use. Recommendations including subsequent examinations. are made to ensure the continued safe operation of the tanks.

Integrating palliative care into disease management guidelines.

PubMed

Emanuel, Linda; Alexander, Carla; Arnold, Robert M; Bernstein, Richard; Dart, Richard; Dellasantina, Christopher; Dykstra, Lee; Tulsky, James

2004-12-01

Palliative care should not be reserved for those who are close to dying; as a comprehensive approach to minimizing illness-related suffering, it is appropriate for patients with significant illness from the time of diagnosis on. The American Hospice Foundation Guidelines Committee's initiative aims to provide a practical approach for guideline writers and others to integrate palliative care into disease management and care services whenever it is relevant. A consensus approach was used to design recommendations for upgrading existing disease management and service guidelines to include palliative care. A template is described for identifying stages in disease management guidelines when integration of palliative care is appropriate: (1) Introductory sections to disease management guidelines should include prognosis and other disease consequences; (2) Diagnostic sections should include recommendations for conducting a whole patient assessment; (3) Treatment sections should include discernment of patient goals for care, continuous goal reassessment, palliative care interventions to reduce suffering as needed, and treatment decisions should include discussion of the type of expected improvement. Service guidelines should note the role of interdisciplinary team care as well as palliative care consultative or care services; (4) Sections that conclude the care provided to incurable patients should not end without recommendations on grief and bereavement care, and care during the last hours of living. The American Hospice Foundation Guidelines Committee recommends integration of relevant aspects of palliative care in introductory, diagnostic, treatment, and closing sections of management guidelines for all significant illnesses.

EULAR/PReS standards and recommendations for the transitional care of young people with juvenile-onset rheumatic diseases.

PubMed

Foster, Helen E; Minden, Kirsten; Clemente, Daniel; Leon, Leticia; McDonagh, Janet E; Kamphuis, Sylvia; Berggren, Karin; van Pelt, Philomine; Wouters, Carine; Waite-Jones, Jennifer; Tattersall, Rachel; Wyllie, Ruth; Stones, Simon R; Martini, Alberto; Constantin, Tamas; Schalm, Susanne; Fidanci, Berna; Erer, Burak; Demirkaya, Erkan; Ozen, Seza; Carmona, Loreto

2017-04-01

To develop standards and recommendations for transitional care for young people (YP) with juvenile-onset rheumatic and musculoskeletal diseases (jRMD). The consensus process involved the following: (1) establishing an international expert panel to include patients and representatives from multidisciplinary teams in adult and paediatric rheumatology; (2) a systematic review of published models of transitional care in jRMDs, potential standards and recommendations, strategies for implementation and tools to evaluate services and outcomes; (3) setting the framework, developing the process map and generating a first draft of standards and recommendations; (4) further iteration of recommendations; (5) establishing consensus recommendations with Delphi methodology and (6) establishing standards and quality indicators. The final consensus derived 12 specific recommendations for YP with jRMD focused on transitional care. These included: high-quality, multidisciplinary care starting in early adolescence; the integral role of a transition co-ordinator; transition policies and protocols; efficient communications; transfer documentation; an open electronic-based platform to access resources; appropriate training for paediatric and adult healthcare teams; secure funding to continue treatments and services into adult rheumatology and the need for increased evidence to inform best practice. These consensus-based recommendations inform strategies to reach optimal outcomes in transitional care for YP with jRMD based on available evidence and expert opinion. They need to be implemented in the context of individual countries, healthcare systems and regulatory frameworks. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Standardized Effect Sizes for Moderated Conditional Fixed Effects with Continuous Moderator Variables

PubMed Central

Bodner, Todd E.

2017-01-01

Wilkinson and Task Force on Statistical Inference (1999) recommended that researchers include information on the practical magnitude of effects (e.g., using standardized effect sizes) to distinguish between the statistical and practical significance of research results. To date, however, researchers have not widely incorporated this recommendation into the interpretation and communication of the conditional effects and differences in conditional effects underlying statistical interactions involving a continuous moderator variable where at least one of the involved variables has an arbitrary metric. This article presents a descriptive approach to investigate two-way statistical interactions involving continuous moderator variables where the conditional effects underlying these interactions are expressed in standardized effect size metrics (i.e., standardized mean differences and semi-partial correlations). This approach permits researchers to evaluate and communicate the practical magnitude of particular conditional effects and differences in conditional effects using conventional and proposed guidelines, respectively, for the standardized effect size and therefore provides the researcher important supplementary information lacking under current approaches. The utility of this approach is demonstrated with two real data examples and important assumptions underlying the standardization process are highlighted. PMID:28484404

Planning continuing training.

PubMed

Nacef, T; Argellies, J L

1982-01-01

Suggests new direction in the approach to planning continued training of medical personnel. Under this new scheme, health problems themselves will be the sole basis for the planning of the continuing training program. This approach assures the involvement of health professionals at various levels and fosters a multiprofessional involvement in continuing training. It is also recommended that the preventive aspects of medicine be stressed far more than is typical of traditional hospital services. The method for decision making in program planning includes 6 steps: 1) choice of health problem to be solved (includes considerations of severity of the problems and the degree to which continuing training will be of value); 2) analysis of the number and type of health personnel needed; 3) determination of desired skill acquisition; 4) analysis of teaching/educational requirements; 5) inventory of resources (time, facilities, staff, instructional materials) available; 6) evaluation. Coordination at different levels, both national and regional, ensures the cohesion of the multiprofessional continuing training system. Regional cell groups, composed of 2 paramedicals and a doctor administer continuing training sessions under policy established at a national level by a national advisory committee. This approach makes continuing training an important and immediate component of health policy aimed at delivering basic health services to the entire population.

Exclusive breastfeeding for six months: the WHO six months recommendation in the Asia Pacific Region.

PubMed

Binns, Colin W; Lee, Mi Kyung

2014-01-01

In 2001 the World Health Assembly adopted the infant feeding strategy which included the recommendation for exclusive breastfeeding until 6 months of age with continued breastfeeding while complementary foods are introduced. This recommendation has been endorsed by many national authorities, professional organisations and most countries in the Asia Pacific Region. Reviews by WHO, the US Surgeon General, Agency for Healthcare Research and Quality, US Department of Health and Human Services and others have documented the many benefits of breastfeeding. The introduction of solid foods before six months of age is associated with increased rates of infection, reduced breastmilk production, disruption to the microbiome and possibly obesity. If solids are introduced at around six months (by 26 weeks) there is no evidence of increases in allergic diseases.

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

NASA Technical Reports Server (NTRS)

Hirshorn, Steven; Jefferies, Sharon

2016-01-01

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

Preventing extravasation injuries in neonates.

PubMed

Tong, Rachael

2007-10-01

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

Investigation of test methods, material properties, and processes for solar cell encapsulants

NASA Technical Reports Server (NTRS)

Willis, P. B.

1983-01-01

A study of potentially useful low cost encapsulation materials for the Flat-Plate Solar Array project is discussed. The goal is to identify, evaluate, test and recommend encapsulant materials and processes for the production of cost-effective, long life solar cell modules. Technical investigations included studies of aging and degradation of candidate encapsulation materials, continued identification of primers for durable bonding of module interfaces, continued evaluation of soil resistant treatments for the sunlit surface of the module and testing of corrosion protective coatings for use low cost mild steel substrates.

Software Engineering Laboratory Series: Proceedings of the Twentieth Annual Software Engineering Workshop

NASA Technical Reports Server (NTRS)

1995-01-01

The Software Engineering Laboratory (SEL) is an organization sponsored by NASA/GSFC and created to investigate the effectiveness of software engineering technologies when applied to the development of application software. The activities, findings, and recommendations of the SEL are recorded in the Software Engineering Laboratory Series, a continuing series of reports that includes this document.

Software Engineering Laboratory Series: Collected Software Engineering Papers. Volume 15

NASA Technical Reports Server (NTRS)

1997-01-01

The Software Engineering Laboratory (SEL) is an organization sponsored by NASA/GSFC and created to investigate the effectiveness of software engineering technologies when applied to the development of application software. The activities, findings, and recommendations of the SEL are recorded in the Software Engineering Laboratory Series, a continuing series of reports that includes this document.

ESEA Reauthorization Principles and Recommendations: A Policy Statement of the Council of Chief State School Officers

ERIC Educational Resources Information Center

Council of Chief State School Officers, 2010

2010-01-01

This policy statement presents a vision for a "new deal" to guide reauthorization of the Elementary & Secondary Education Act (ESEA). First, states must continue to lead the way with bold, thoughtful education reforms to ensure that all students graduate from high school ready for college and career. This includes developing and…

Software Engineering Laboratory Series: Collected Software Engineering Papers. Volume 14

NASA Technical Reports Server (NTRS)

1996-01-01

The Software Engineering Laboratory (SEL) is an organization sponsored by NASA/GSFC and created to investigate the effectiveness of software engineering technologies when applied to the development of application software. The activities, findings, and recommendations of the SEL are recorded in the Software Engineering Laboratory Series, a continuing series of reports that includes this document.

Software Engineering Laboratory Series: Collected Software Engineering Papers. Volume 13

NASA Technical Reports Server (NTRS)

1995-01-01

The Software Engineering Laboratory (SEL) is an organization sponsored by NASA/GSFC and created to investigate the effectiveness of software engineering technologies when applied to the development of application software. The activities, findings, and recommendations of the SEL are recorded in the Software Engineering Laboratory Series, a continuing series of reports that includes this document.

The Collaborative Career Adjustment Project (CCAP): A Model to Recruit and Retain Speech-Language Pathologists in Rural Communities.

ERIC Educational Resources Information Center

Farmer, Stephen S.

1994-01-01

Describes the Collaborative Career Adjustment Project, a program that allows licensed teachers in rural New Mexico to continue teaching while taking weekend, summer, or distance education courses to obtain a master's degree in speech-language pathology. Includes recommendations for the recruitment and retention of rural students in communication…

Planning for chronic disease medications in disaster: perspectives from patients, physicians, pharmacists, and insurers.

PubMed

Carameli, Kelley A; Eisenman, David P; Blevins, Joy; d'Angona, Brian; Glik, Deborah C

2013-06-01

Recent US disasters highlight the current imbalance between the high proportion of chronically ill Americans who depend on prescription medications and their lack of medication reserves for disaster preparedness. We examined barriers that Los Angeles County residents with chronic illness experience within the prescription drug procurement system to achieve recommended medication reserves. A mixed methods design included evaluation of insurance pharmacy benefits, focus group interviews with patients, and key informant interviews with physicians, pharmacists, and insurers. Most prescriptions are dispensed as 30-day units through retail pharmacies with refills available after 75% of use, leaving a monthly medication reserve of 7 days. For patients to acquire 14- to 30-day disaster medication reserves, health professionals interviewed supported 60- to 100-day dispensing units. Barriers included restrictive insurance benefits, patients' resistance to mail order, and higher copay-ments. Physicians, pharmacists, and insurers also varied widely in their preparedness planning and collective mutual-aid plans, and most believed pharmacists had the primary responsibility for patients' medication continuity during a disaster. To strengthen prescription drug continuity in disasters, recommendations include the following: (1) creating flexible drug-dispensing policies to help patients build reserves, (2) training professionals to inform patients about disaster planning, and (3) building collaborative partnerships among system stakeholders.

Sodium and Its Role in Cardiovascular Disease – The Debate Continues

PubMed Central

Kong, Yee Wen; Baqar, Sara; Jerums, George; Ekinci, Elif I.

2016-01-01

Guidelines have recommended significant reductions in dietary sodium intake to improve cardiovascular health. However, these dietary sodium intake recommendations have been questioned as emerging evidence has shown that there is a higher risk of cardiovascular disease with a low sodium diet, including in individuals with type 2 diabetes. This may be related to the other pleotropic effects of dietary sodium intake. Therefore, despite recent review of dietary sodium intake guidelines by multiple organizations, including the dietary guidelines for Americans, American Diabetes Association, and American Heart Association, concerns about the impact of the degree of sodium restriction on cardiovascular health continue to be raised. This literature review examines the effects of dietary sodium intake on factors contributing to cardiovascular health, including left ventricular hypertrophy, heart rate, albuminuria, rennin–angiotensin–aldosterone system activation, serum lipids, insulin sensitivity, sympathetic nervous system activation, endothelial function, and immune function. In the last part of this review, the association between dietary sodium intake and cardiovascular outcomes, especially in individuals with diabetes, is explored. Given the increased risk of cardiovascular disease in individuals with diabetes and the increasing incidence of diabetes worldwide, this review is important in summarizing the recent evidence regarding the effects of dietary sodium intake on cardiovascular health, especially in this population. PMID:28066329

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...

The understandings and meanings eight seventh and eighth grade Latinas gave to science

NASA Astrophysics Data System (ADS)

Parker, Carolyn Ann

My study examined the experiences of eight seventh and eighth grade girls of Central American descent, in and out of the science classroom. The study was interpretive in design and explored the question, "How did the eight participants understand and make meaning of science?" Guided by a sociocultural perspective and a socially critical stance, I explored issues of educational access, particularly to science, mediated by the relationships and experiences formed by families, peers, science classrooms, schools, and society. Data sources included monthly individual interviews, regular focus group meetings, school observations, and interviews with teachers and family members. Findings include the importance of school science experiences that emphasize hands-on activities and the study of topics relevant to students' everyday lives. School influences that I discuss include English-as-a-Second Language learning, English language ability and its effect on classroom interactions, ability grouping, standardized testing, and teachers' instructional practices. Out-of-school influences I examine include the national science education reform movement, familial expectations, and society and the media's portrayal of science and the scientist. The implications and recommendations of the study are particularly germane to practice. Recommendations for the science classroom include a continued emphasis on hands-on science experiences that incorporate high academic expectations for all students, including second-language learners. Moreover, curriculum should be connected and relevant to students' everyday experiences. Recommendations for outside-the-science classroom include a thoughtful examination of the educational environment created by a school's tracking policy and continued support of meaningful professional development experiences for teachers. Future research and the subsequent development of theory should include a further analysis of the influence of gender, ethnicity, science, and recently immigrated students. A study of the influence of English-language ability on students' educational experiences would be especially informative. Studies like this can assist the science education community to implement gender and culturally-equitable curricula, instructional materials, and assessment strategies that could better meet the needs of students who have historically been underrepresented in the discipline, including, but not limited to, second-language learners and recent immigrants to the United States.

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)

Polycystic ovary syndrome: a review for dermatologists: Part II. Treatment.

PubMed

Buzney, Elizabeth; Sheu, Johanna; Buzney, Catherine; Reynolds, Rachel V

2014-11-01

Dermatologists are in a key position to treat the manifestations of polycystic ovary syndrome (PCOS). The management of PCOS should be tailored to each woman's specific goals, reproductive interests, and particular constellation of symptoms. Therefore, a multidisciplinary approach is recommended. In part II of this continuing medical education article, we present the available safety and efficacy data regarding treatments for women with acne, hirsutism, and androgenetic alopecia. Therapies discussed include lifestyle modification, topical therapies, combined oral contraceptives, antiandrogen agents, and insulin-sensitizing drugs. Treatment recommendations are made based on the current available evidence. Copyright © 2014 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

Policy Perspective: Ensuring Comprehensive Care and Support for Gender Nonconforming Children and Adolescents

PubMed Central

Dowshen, Nadia; Meadows, Rachel; Byrnes, Maureen; Hawkins, Linda; Eder, Jennifer; Noonan, Kathleen

2016-01-01

Abstract Despite recent notable advances in societal equality for lesbian, gay, bisexual, and transgender (LGBT) individuals, youth who identify as trans* or gender nonconforming, in particular, continue to experience significant challenges accessing the services they need to grow into healthy adults. This policy perspective first offers background information describing this population, their unique healthcare needs, and obstacles when seeking care, including case study examples. The authors then provide recommendations for medical education, health systems, and insurance payers, as well as recommendations for school systems and broader public policy changes to improve the health and well-being of gender nonconforming youth. PMID:28861528

A qualitative exploration of the major challenges facing pharmacovigilance in Saudi Arabia.

PubMed

Aljadhey, Hisham; Mahmoud, Mansour A; Alshammari, Thamir M; Al-Dhaeefi, Mohammed; Le Louet, Herve; Perez-Gutthann, Susana; Pitts, Peter J

2015-09-01

To explore the challenges facing pharmacovigilance in Saudi Arabia and formulate recommendations to improve it from the perspective of healthcare professionals in Saudi Arabia. This was a qualitative study of 4 focus group discussions with pharmacists, physicians, and academicians held under the auspices of the King Saud University School of Pharmacy and the Center for Medicine in the Public Interest, Riyadh, Saudi Arabia. A total of 29 eligible healthcare professionals were invited to participate in the discussion. The predefined themes of the study were the current practice and major challenges facing pharmacovigilance in regulatory bodies, hospitals, the community, and academia, as well as recommendations to improve pharmacovigilance practice.  Of the 29 participants invited, 27 attended the discussion. Challenges facing regulatory bodies included complicated adverse drug reactions (ADR) reporting forms, lack of feedback on ADRs submitted to the Saudi Food and Drug Authority, lack of decisions from the local authority to withdraw medications, and lack of data on pharmacovigilance. The challenges to pharmacovigilance in hospitals included the lack of knowledge of the significance of ADR reporting, workload, blaming culture, and lack of collaboration between regulatory bodies and hospitals. However, challenges facing pharmaceutical industries included the lack of drug manufacturers in Saudi Arabia and lack of interest in pharmacovigilance. Recommendations to improve pharmacovigilance included the need for communication, stronger regulatory requirements, the need for research, the need for unified ADRs reporting, and continuous education and training.  The study has identified the challenges facing pharmacovigilance in Saudi Arabia and made certain recommendations to overcome them. These recommendations might be helpful for regulatory bodies to enhance spontaneous reporting and promote pharmacovigilance.

Software Engineering Laboratory Series: Proceedings of the Twenty-First Annual Software Engineering Workshop

NASA Technical Reports Server (NTRS)

1996-01-01

The Software Engineering Laboratory (SEL) is an organization sponsored by NASA/GSFC and created to investigate the effectiveness of software engineering technologies when applied to the development of application software. The activities, findings, and recommendations of the SEL are recorded in the Software Engineering Laboratory Series, a continuing series of reports that includes this document.

OSTA data systems planning workshop recommendations

NASA Technical Reports Server (NTRS)

Desjardins, R.

1981-01-01

The Integrated Discipline Requirements are presented, including the following needs: (1) quality data sets, (2) a systematic treatment of problems with present data, (3) a single integrated catalog or master directory, (4) continuity of data formats, (5) a standard geographic and time basis, (6) data delivery in terms of easy rather than immediate accessibility, (7) data archives, and (8) cooperation with user agencies.

Software Engineering Laboratory Series: Proceedings of the Twenty-Second Annual Software Engineering Workshop

NASA Technical Reports Server (NTRS)

1997-01-01

The Software Engineering Laboratory (SEL) is an organization sponsored by NASA/GSFC and created to investigate the effectiveness of software engineering technologies when applied to the development of application software. The activities, findings, and recommendations of the SEL are recorded in the Software Engineering Laboratory Series, a continuing series of reports that includes this document.

RECOMMENDED OPERATING PROCEDURE NO. 2.3: SAMPLING AND ANALYSIS OF TOTAL HYDROCARBONS FROM SOURCES BY CONTINUOUS EMISSION MONITOR

EPA Science Inventory

The report is a recommended operating procedure (ROP) prepared for use in research activities conducted by EPA's Air and Energy Engineering Research Laboratory (AEERL). he described method is applicable to the continuous measurement of total hydrocarbons (THCs), also known as tot...

29 CFR 1912a.5 - Advice and recommendations.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 29 Labor 7 2013-07-01 2013-07-01 false Advice and recommendations. 1912a.5 Section 1912a.5 Labor Regulations Relating to Labor (Continued) OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR (CONTINUED) NATIONAL ADVISORY COMMITTEE ON OCCUPATIONAL SAFETY AND HEALTH § 1912a.5 Advice and...

29 CFR 1912a.5 - Advice and recommendations.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 29 Labor 7 2014-07-01 2014-07-01 false Advice and recommendations. 1912a.5 Section 1912a.5 Labor Regulations Relating to Labor (Continued) OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR (CONTINUED) NATIONAL ADVISORY COMMITTEE ON OCCUPATIONAL SAFETY AND HEALTH § 1912a.5 Advice and...

Evaluation of performance and maximum length of continuous decks in bridges : part 1.

DOT National Transportation Integrated Search

2011-06-01

The purpose of this research was to evaluate the performance history of continuous bridge decks in the State of Georgia, to determine why the current design detail works, to recommend a new design detail, and to recommend the maximum and/or optimum l...

Management of rhinosinusitis during pregnancy: systematic review and expert panel recommendations.

PubMed

Lal, Devyani; Jategaonkar, Ameya A; Borish, Larry; Chambliss, Linda R; Gnagi, Sharon H; Hwang, Peter H; Rank, Matthew A; Stankiewicz, James A; Lund, Valerie J

2016-06-01

Management of rhinosinusitis during pregnancy requires special considerations. 1. Conduct a systematic literature review for acute and chronic rhinosinusitis (CRS) management during pregnancy. 2. Make evidence-based recommendations. The systematic review was conducted using MEDLINE and EMBASE databases and relevant search terms. Title, abstract and full manuscript review were conducted by two authors independently. A multispecialty panel with expertise in management of Rhinological disorders, Allergy-Immunology, and Obstetrics-Gynecology was invited to review the systematic review. Recommendations were sought on use of following for CRS management during pregnancy: oral corticosteroids; antibiotics; leukotrienes; topical corticosteroid spray/irrigations/drops; aspirin desensitization; elective surgery for CRS with polyps prior to planned pregnancy; vaginal birth versus planned Caesarian for skull base erosions/ prior CSF rhinorrhea. Eighty-eight manuscripts underwent full review after screening 3052 abstracts. No relevant level 1, 2, or 3 studies were found. Expert panel recommendations for rhinosinusitis management during pregnancy included continuing nasal corticosteroid sprays for CRS maintenance, using pregnancy-safe antibiotics for acute rhinosinusitis and CRS exacerbations, and discontinuing aspirin desensitization for aspirin exacerbated respiratory disease. The manuscript presents detailed recommendations. The lack of evidence pertinent to managing rhinosinusitis during pregnancy warrants future trials. Expert recommendations constitute the current best available evidence.

Urinary incontinence in frail elderly persons: Report from the 5th International Consultation on Incontinence.

PubMed

Wagg, Adrian; Gibson, William; Ostaszkiewicz, Joan; Johnson, Theodore; Markland, Alayne; Palmer, Mary H; Kuchel, George; Szonyi, George; Kirschner-Hermanns, Ruth

2015-06-01

Evidence based guidelines for the management of frail older persons with urinary incontinence are rare. Those produced by the International Consultation on Incontinence represent an authoritative set of recommendations spanning all aspects of management. To update the recommendations of the 4th ICI. A series of systematic reviews and evidence updates were performed by members of the working group in order to update the 2009 recommendations. The resulting guidelines were presented at the 2012 meeting of the European Associatioon of Urology. Along with the revision of the treatment algorithm and accompanying text. There have been significant advances in several areas including pharmacological treatment of overactive bladder. The committee continue to notes the relative paucity of data concerning frail older persons and draw attention to knowledge gaps in this area. © 2014 Wiley Periodicals, Inc.

Neonatal physical therapy. Part II: Practice frameworks and evidence-based practice guidelines.

PubMed

Sweeney, Jane K; Heriza, Carolyn B; Blanchard, Yvette; Dusing, Stacey C

2010-01-01

(1) To outline frameworks for neonatal physical therapy based on 3 theoretical models, (2) to describe emerging literature supporting neonatal physical therapy practice, and (3) to identify evidence-based practice recommendations. Three models are presented as a framework for neonatal practice: (1) dynamic systems theory including synactive theory and the theory of neuronal group selection, (2) the International Classification of Functioning, Disability and Health, and (3) family-centered care. Literature is summarized to support neonatal physical therapists in the areas of examination, developmental care, intervention, and parent education. Practice recommendations are offered with levels of evidence identified. Neonatal physical therapy practice has a theoretical and evidence-based structure, and evidence is emerging for selected clinical procedures. Continued research to expand the science of neonatal physical therapy is critical to elevate the evidence and support practice recommendations.

Improving immunization in Afghanistan: results from a cross-sectional community-based survey to assess routine immunization coverage.

PubMed

Mugali, Raveesha R; Mansoor, Farooq; Parwiz, Sardar; Ahmad, Fazil; Safi, Najibullah; Higgins-Steele, Ariel; Varkey, Sherin

2017-04-04

Despite progress in recent years, Afghanistan is lagging behind in realizing the full potential of immunization. The country is still endemic for polio transmission and measles outbreaks continue to occur. In spite of significant reductions over the past decade, the mortality rate of children under 5 years of age continues to remain high at 91 per 1000 live births. The study was a descriptive community-based cross sectional household survey. The survey aimed to estimate the levels of immunization coverage at national and province levels. Specific objectives are to: establish valid baseline information to monitor progress of the immunization program; identify reasons why children are not immunized; and make recommendations to enhance access and quality of immunization services in Afghanistan. The survey was carried out in all 34 provinces of the country, with a sample of 6125 mothers of children aged 12-23 months. Nationally, 51% of children participating in the survey received all doses of each antigen irrespective of the recommended date of immunization or recommended interval between doses. About 31% of children were found to be partially vaccinated. Reasons for partial vaccination included: place to vaccinate child too far (23%), not aware of the need of vaccination (17%), no faith in vaccination (16%), mother was too busy (15%), and fear of side effects (11%). The innovative mechanism of contracting out delivery of primary health care services in Afghanistan, including immunization, to non-governmental organizations is showing some positive results in quickly increasing coverage of essential interventions, including routine immunization. Much ground still needs to be covered with proper planning and management of resources in order to improve the immunization coverage in Afghanistan and increase survival and health status of its children.

Liver enzyme monitoring in patients treated with troglitazone.

PubMed

Graham, D J; Drinkard, C R; Shatin, D; Tsong, Y; Burgess, M J

2001-08-15

Soon after initial marketing in March 1997, troglitazone, the first thiazolidinedione antidiabetic agent, was found to cause life-threatening acute liver failure. The drug was removed from the market in March 2000. To evaluate the effect of US Food and Drug Administration (FDA) risk management efforts, including repeated labeling changes and "Dear Healthcare Professional" letters, on periodic liver enzyme monitoring of patients taking troglitazone. Claims data from a large, multistate managed care organization were used to establish 4 cohorts of patients (N = 7603) with at least 90 days of health plan enrollment before first troglitazone prescription during 4 consecutive periods spanning April 1997 to September 1999 and representing 4 progressively stringent liver monitoring recommendations. Percentage of eligible troglitazone users in each cohort with baseline, monthly (for up to 6 months of continuous use), and complete (baseline and monthly) enzyme monitoring, based on computerized records of laboratory claims. Baseline testing increased from 15% before any FDA monitoring recommendations (cohort 1) to 44.6% following 4 separate FDA interventions (cohort 4; P<.001). In cohort 4, 33.4% of users had follow-up testing after 1 month of therapy, falling to 13% after 5 months of continuous use. In all cohorts, less than 5% received all recommended liver enzyme tests by the third month of continuous use. The FDA risk management efforts did not achieve meaningful or sustained improvement in liver enzyme testing. Evaluation of the impact of regulatory actions is needed before such actions can be regarded as effective or sufficient.

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 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...

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...

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...

Social security financing.

PubMed

1980-05-01

After nearly 2 years of study, the 1979 Advisory Council on Social Security submitted its findings and recommendations in December. In February the Bulletin published the Executive Summary of the Council's report. Because of the continuing wide public interest in the future of social security financing, the Council's detailed findings and recommendations on that subject are published below. The Council unanimously reports that all current and future beneficiaries can count on receiving the payments to which they are entitled. Among the recommendations it calls for are partial financing with nonpayroll-tax revenues. Suggested changes include hospital insurance (HI) financed through portins of personal and corporate income taxes and a part of the HI insurance payroll tax diverted to cash benefits with the balance of this tax repealed. The Council also recommends that the social security cash benefits program be brought into long-run actuarial balance--with a payroll-tax rate increase in the year 2005. It rejects the idea of a value-added tax as being inflationary. Parenthetical remarks represent additional views of the Council members cited.

Resistance to discontinuing breast cancer screening in older women: A qualitative study.

PubMed

Housten, Ashley J; Pappadis, Monique R; Krishnan, Shilpa; Weller, Susan C; Giordano, Sharon H; Bevers, Therese B; Volk, Robert J; Hoover, Diana S

2018-06-01

Screening mammography is associated with reduced breast cancer-specific mortality; however, among older women, evidence suggests that the potential harms of screening may outweigh the benefits. We used a qualitative approach to examine the willingness of older women from different racial/ethnic groups to discontinue breast cancer screening. Women ≥70 years of age who reported having a screening mammogram in the past 3 years and/or reported that they intended to continue screening in the future were recruited for in-depth interviews. Participants who intended to continue screening were asked to describe how the following hypothetical scenarios would impact a decision to discontinue screening: health concerns or limited life expectancy, a physician's recommendation to discontinue, reluctance to undergo treatment, and recommendations from experts or governmental panels to stop screening. Semi-structured, face-to-face interviews were audio-recorded. Data coding and analysis followed inductive and deductive approaches. Regardless of the scenario, participants (n = 29) expressed a strong intention to continue screening. Based on the hypothetical physician recommendations, intentions to continue screening appeared to remain strong. They did not envision a change in their health status that would lead them to discontinue screening and were skeptical of expert/government recommendations. There were no differences observed according to age, race/ethnicity, or education. Among older women who planned to continue screening, intentions to continue breast cancer screening appear to be highly resilient and resistant to recommendations from physicians or expert/government panels. Copyright © 2018 John Wiley & Sons, Ltd.

First Italian consensus statement on diagnosis, prevention and treatment of cardiovascular complications in HIV-infected patients in the HAART era (2006).

PubMed

Carosi, G; Quiros-Roldan, E; Torti, C; Antinori, A; Bevilacqua, M; Bonadonna, R C; Bonfanti, P; Castagna, A; Cauda, R; d'Arminio-Monforte, A; Di Gregorio, P; Di Perri, G; Esposito, R; Fatuzzo, F; Gervasoni, C; Giannattasio, C; Guaraldi, G; Lazzarin, A; Lo Caputo, S; Maggi, P; Mazzotta, F; Moroni, M; Prestileo, T; Ranieri, R; Rizzardini, G; Russo, R; Galli, M

2007-06-01

The present document contains recommendations for assessment, prevention and treatment of cardiovascular risk for HIV-infected patients. All recommendations were graded according to the strength and quality of the evidence and were voted on by 73 members of the Italian Cardiovascular Risk Guidelines Working Group which includes both experts in HIV/AIDS care and in cardiovascular and metabolic medicine. Since antiretroviral drug exposure represents only one risk factor, continued emphasis on an integrated management is given. This should include prevention and treatment of known cardiovascular risk factors (such as dyslipidaemia, diabetes, insulin resistance, healthy diet, physical activity, avoidance of smoking), but also rational switch of antiretroviral drugs. A rational switch strategy should consider both metabolic and anthropometric disturbances and effectiveness of antiretroviral regimens.

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

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...

Recommender engine for continuous-time quantum Monte Carlo methods

NASA Astrophysics Data System (ADS)

Huang, Li; Yang, Yi-feng; Wang, Lei

2017-03-01

Recommender systems play an essential role in the modern business world. They recommend favorable items such as books, movies, and search queries to users based on their past preferences. Applying similar ideas and techniques to Monte Carlo simulations of physical systems boosts their efficiency without sacrificing accuracy. Exploiting the quantum to classical mapping inherent in the continuous-time quantum Monte Carlo methods, we construct a classical molecular gas model to reproduce the quantum distributions. We then utilize powerful molecular simulation techniques to propose efficient quantum Monte Carlo updates. The recommender engine approach provides a general way to speed up the quantum impurity solvers.

Systemic Therapy for Stage IV Non–Small-Cell Lung Cancer: American Society of Clinical Oncology Clinical Practice Guideline Update

PubMed Central

Masters, Gregory A.; Temin, Sarah; Azzoli, Christopher G.; Giaccone, Giuseppe; Baker, Sherman; Brahmer, Julie R.; Ellis, Peter M.; Gajra, Ajeet; Rackear, Nancy; Schiller, Joan H.; Smith, Thomas J.; Strawn, John R.; Trent, David; Johnson, David H.

2015-01-01

Purpose To provide evidence-based recommendations to update the American Society of Clinical Oncology guideline on systemic therapy for stage IV non–small-cell lung cancer (NSCLC). Methods An Update Committee of the American Society of Clinical Oncology NSCLC Expert Panel based recommendations on a systematic review of randomized controlled trials from January 2007 to February 2014. Results This guideline update reflects changes in evidence since the previous guideline. Recommendations There is no cure for patients with stage IV NSCLC. For patients with performance status (PS) 0 to 1 (and appropriate patient cases with PS 2) and without an EGFR-sensitizing mutation or ALK gene rearrangement, combination cytotoxic chemotherapy is recommended, guided by histology, with early concurrent palliative care. Recommendations for patients in the first-line setting include platinum-doublet therapy for those with PS 0 to 1 (bevacizumab may be added to carboplatin plus paclitaxel if no contraindications); combination or single-agent chemotherapy or palliative care alone for those with PS 2; afatinib, erlotinib, or gefitinib for those with sensitizing EGFR mutations; crizotinib for those with ALK or ROS1 gene rearrangement; and following first-line recommendations or using platinum plus etoposide for those with large-cell neuroendocrine carcinoma. Maintenance therapy includes pemetrexed continuation for patients with stable disease or response to first-line pemetrexed-containing regimens, alternative chemotherapy, or a chemotherapy break. In the second-line setting, recommendations include docetaxel, erlotinib, gefitinib, or pemetrexed for patients with nonsquamous cell carcinoma; docetaxel, erlotinib, or gefitinib for those with squamous cell carcinoma; and chemotherapy or ceritinib for those with ALK rearrangement who experience progression after crizotinib. In the third-line setting, for patients who have not received erlotinib or gefitinib, treatment with erlotinib is recommended. There are insufficient data to recommend routine third-line cytotoxic therapy. Decisions regarding systemic therapy should not be made based on age alone. Additional information can be found at http://www.asco.org/guidelines/nsclc and http://www.asco.org/guidelineswiki. PMID:26324367

Transcultural Diabetes Nutrition Algorithm: A Malaysian Application

PubMed Central

Hamdy, Osama; Chin Chia, Yook; Lin Lim, Shueh; Kumari Natkunam, Santha; Yeong Tan, Ming; Sulaiman, Ridzoni; Nisak, Barakatun; Chee, Winnie Siew Swee; Marchetti, Albert; Hegazi, Refaat A.; Mechanick, Jeffrey I.

2013-01-01

Glycemic control among patients with prediabetes and type 2 diabetes mellitus (T2D) in Malaysia is suboptimal, especially after the continuous worsening over the past decade. Improved glycemic control may be achieved through a comprehensive management strategy that includes medical nutrition therapy (MNT). Evidence-based recommendations for diabetes-specific therapeutic diets are available internationally. However, Asian patients with T2D, including Malaysians, have unique disease characteristics and risk factors, as well as cultural and lifestyle dissimilarities, which may render international guidelines and recommendations less applicable and/or difficult to implement. With these thoughts in mind, a transcultural Diabetes Nutrition Algorithm (tDNA) was developed by an international task force of diabetes and nutrition experts through the restructuring of international guidelines for the nutritional management of prediabetes and T2D to account for cultural differences in lifestyle, diet, and genetic factors. The initial evidence-based global tDNA template was designed for simplicity, flexibility, and cultural modification. This paper reports the Malaysian adaptation of the tDNA, which takes into account the epidemiologic, physiologic, cultural, and lifestyle factors unique to Malaysia, as well as the local guidelines recommendations. PMID:24385984

Transcultural diabetes nutrition algorithm: a malaysian application.

PubMed

Hussein, Zanariah; Hamdy, Osama; Chin Chia, Yook; Lin Lim, Shueh; Kumari Natkunam, Santha; Hussain, Husni; Yeong Tan, Ming; Sulaiman, Ridzoni; Nisak, Barakatun; Chee, Winnie Siew Swee; Marchetti, Albert; Hegazi, Refaat A; Mechanick, Jeffrey I

2013-01-01

Glycemic control among patients with prediabetes and type 2 diabetes mellitus (T2D) in Malaysia is suboptimal, especially after the continuous worsening over the past decade. Improved glycemic control may be achieved through a comprehensive management strategy that includes medical nutrition therapy (MNT). Evidence-based recommendations for diabetes-specific therapeutic diets are available internationally. However, Asian patients with T2D, including Malaysians, have unique disease characteristics and risk factors, as well as cultural and lifestyle dissimilarities, which may render international guidelines and recommendations less applicable and/or difficult to implement. With these thoughts in mind, a transcultural Diabetes Nutrition Algorithm (tDNA) was developed by an international task force of diabetes and nutrition experts through the restructuring of international guidelines for the nutritional management of prediabetes and T2D to account for cultural differences in lifestyle, diet, and genetic factors. The initial evidence-based global tDNA template was designed for simplicity, flexibility, and cultural modification. This paper reports the Malaysian adaptation of the tDNA, which takes into account the epidemiologic, physiologic, cultural, and lifestyle factors unique to Malaysia, as well as the local guidelines recommendations.

Measurement Properties of Questionnaires Measuring Continuity of Care: A Systematic Review

PubMed Central

Uijen, Annemarie A.; Heinst, Claire W.; Schellevis, Francois G.; van den Bosch, Wil J.H.M.; van de Laar, Floris A.; Terwee, Caroline B.; Schers, Henk J.

2012-01-01

Background Continuity of care is widely acknowledged as a core value in family medicine. In this systematic review, we aimed to identify the instruments measuring continuity of care and to assess the quality of their measurement properties. Methods We did a systematic review using the PubMed, Embase and PsycINFO databases, with an extensive search strategy including ‘continuity of care’, ‘coordination of care’, ‘integration of care’, ‘patient centered care’, ‘case management’ and its linguistic variations. We searched from 1995 to October 2011 and included articles describing the development and/or evaluation of the measurement properties of instruments measuring one or more dimensions of continuity of care (1) care from the same provider who knows and follows the patient (personal continuity), (2) communication and cooperation between care providers in one care setting (team continuity), and (3) communication and cooperation between care providers in different care settings (cross-boundary continuity). We assessed the methodological quality of the measurement properties of each instrument using the COSMIN checklist. Results We included 24 articles describing the development and/or evaluation of 21 instruments. Ten instruments measured all three dimensions of continuity of care. Instruments were developed for different groups of patients or providers. For most instruments, three or four of the six measurement properties were assessed (mostly internal consistency, content validity, structural validity and construct validity). Six instruments scored positive on the quality of at least three of six measurement properties. Conclusions Most included instruments have problems with either the number or quality of its assessed measurement properties or the ability to measure all three dimensions of continuity of care. Based on the results of this review, we recommend the use of one of the four most promising instruments, depending on the target population Diabetes Continuity of Care Questionnaire, Alberta Continuity of Services Scale-Mental Health, Heart Continuity of Care Questionnaire, and Nijmegen Continuity Questionnaire. PMID:22860100

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

PubMed

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

2016-11-01

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

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...

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...

Consultancy on Large-Scale Submerged Aerobic Cultivation Process Design - Final Technical Report: February 1, 2016 -- June 30, 2016

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

Crater, Jason; Galleher, Connor; Lievense, Jeff

NREL is developing an advanced aerobic bubble column model using Aspen Custom Modeler (ACM). The objective of this work is to integrate the new fermentor model with existing techno-economic models in Aspen Plus and Excel to establish a new methodology for guiding process design. To assist this effort, NREL has contracted Genomatica to critique and make recommendations for improving NREL's bioreactor model and large scale aerobic bioreactor design for biologically producing lipids at commercial scale. Genomatica has highlighted a few areas for improving the functionality and effectiveness of the model. Genomatica recommends using a compartment model approach with an integratedmore » black-box kinetic model of the production microbe. We also suggest including calculations for stirred tank reactors to extend the models functionality and adaptability for future process designs. Genomatica also suggests making several modifications to NREL's large-scale lipid production process design. The recommended process modifications are based on Genomatica's internal techno-economic assessment experience and are focused primarily on minimizing capital and operating costs. These recommendations include selecting/engineering a thermotolerant yeast strain with lipid excretion; using bubble column fermentors; increasing the size of production fermentors; reducing the number of vessels; employing semi-continuous operation; and recycling cell mass.« less

The Continuous Quality Improvement Book Club: Developing a Book Club to Promote Praxis

ERIC Educational Resources Information Center

Lyons, Becky; Ray, Chris

2014-01-01

This article poses a model for developing a book club to promote praxis. This model is built upon a basic four step framework for developing book clubs and includes specific recommendations to focus the book club on reflection of theory and how to incorporate it into practice. This model will be used to start a book club examining Continuous…

Continuous Positive Airway Pressure Strategies with Bubble Nasal Continuous Positive Airway Pressure: Not All Bubbling Is the Same: The Seattle Positive Airway Pressure System.

PubMed

Welty, Stephen E

2016-12-01

Premature neonates are predisposed to complications, including bronchopulmonary dysplasia (BPD). BPD is associated with long-term pulmonary and neurodevelopmental consequences. Noninvasive respiratory support with nasal continuous positive airway pressure (CPAP) has been recommended strongly by the American Academy of Pediatrics. However, CPAP implementation has shown at least a 50% failure rate. Enhancing nasal CPAP effectiveness may decrease the need for mechanical ventilation and reduce the incidence of BPD. Bubble nasal CPAP is better than nasal CPAP using mechanical devices and the bubbling provides air exchange in distal respiratory units. The Seattle PAP system reduces parameters that assess work of breathing. Copyright © 2016 Elsevier Inc. All rights reserved.

Glucose Biosensors: An Overview of Use in Clinical Practice

PubMed Central

Yoo, Eun-Hyung; Lee, Soo-Youn

2010-01-01

Blood glucose monitoring has been established as a valuable tool in the management of diabetes. Since maintaining normal blood glucose levels is recommended, a series of suitable glucose biosensors have been developed. During the last 50 years, glucose biosensor technology including point-of-care devices, continuous glucose monitoring systems and noninvasive glucose monitoring systems has been significantly improved. However, there continues to be several challenges related to the achievement of accurate and reliable glucose monitoring. Further technical improvements in glucose biosensors, standardization of the analytical goals for their performance, and continuously assessing and training lay users are required. This article reviews the brief history, basic principles, analytical performance, and the present status of glucose biosensors in the clinical practice. PMID:22399892

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.

Do Studies Evaluating QT/QTc Interval Prolongation with Dietary Supplements Meet FDA Standards: A Systematic Review.

PubMed

Nguyen, Tinh An; Kurian, Amy; Leong, Jessica; Patel, Umang M; Shah, Sachin A

2017-07-04

Dietary supplement use is continuously increasing, but the safety evaluation of these products remains partial. While dietary supplements have no mandate for assessing cardiovascular safety, all new drug entities (NDE) are required to undergo a thorough QT/corrected QT (QTc) assessment to determine their propensity to impact cardiac repolarization. Independent investigators and manufacturers of dietary supplements voluntarily initiate safety studies; however, the quality of these studies is controversial. We sought to compare studies evaluating the QT/QTc effects of dietary supplements based on the International Conference of Harmonization (ICH)-E14 recommendations for NDE. Twenty-six published dietary supplement studies assessed QT/QTc interval prolongation. Sample sizes ranged from nine subjects to 206 among the 15 crossover studies, six parallel design studies, and five observational studies. A plan to account for electrocardiogram (ECG) morphological abnormalities was included in 10 studies, and two studies reported cardiovascular adverse events. Eight studies found a significant change in QT/QTc intervals. The majority of studies included in this review contained many of the critical elements recommended by the ICH E14, which includes the U.S. Food and Drug Administration guidance document for QT/QTc interval assessment. Compared with the thorough QT (TQT) standards, studies are typically well performed but can be bolstered by some study design changes. More than 30% of the included studies showed some degree of ECG changes, suggesting the need for continued cardiovascular safety assessment of dietary supplements.

Implications for paediatric shock management in resource-limited settings: a perspective from the FEAST trial.

PubMed

Houston, Kirsty Anne; George, Elizabeth C; Maitland, Kathryn

2018-05-04

Although the African "Fluid Expansion as Supportive therapy" (FEAST) trial showed fluid resuscitation was harmful in children with severe febrile illness managed in resource-limited hospitals, the most recent evidence reviewed World Health Organization (WHO) guidelines continue to recommend fluid boluses in children with shock according to WHO criteria "WHO shock", arguing that the numbers included in the FEAST trial were too small to provide reasonable certainty. We re-analysed the FEAST trial results for all international definitions for paediatric shock including hypotensive (or decompensated shock) and the WHO criteria. In addition, we examined the clinical relevance of the WHO criteria to published and unpublished observational studies reporting shock in resource-limited settings. We established that hypotension was rare in children with severe febrile illness complicating only 29/3170 trial participants (0.9%). We confirmed that fluid boluses were harmful irrespective of the definitions of shock including the very small number with WHO shock (n = 65). In this subgroup 48% of bolus recipients died at 48 h compared to 20% of the non-bolus control group, an increased absolute risk of 28%, but translating to an increased relative risk of 240% (p = 0.07 (two-sided Fisher's exact test)). Examining studies describing the prevalence of the stringent WHO shock criteria in children presenting to hospital we found this was rare (~ 0.1%) and in these children mortality was very high (41.5-100%). The updated WHO guidelines continue to recommend boluses for a very limited number of children presenting at hospital with the strict definition of WHO shock. Nevertheless, the 3% increased mortality from boluses seen across FEAST trial participants would also include this subgroup of children receiving boluses. Recommendations aiming to differentiate WHO shock from other definitions will invariably lead to "slippage" at the bedside, with the potential of exposing a wider group of children to the harm of fluid-bolus therapy.

Solar wind and magnetosphere interactions

NASA Technical Reports Server (NTRS)

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

1979-01-01

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

Electronic Systems for Spacecraft Vehicles: Required EDA Tools

NASA Technical Reports Server (NTRS)

Bachnak, Rafic

1999-01-01

The continuous increase in complexity of electronic systems is making the design and manufacturing of such systems more challenging than ever before. As a result, designers are finding it impossible to design efficient systems without the use of sophisticated Electronic Design Automation (EDA) tools. These tools offer integrated simulation of the electrical, mechanical, and manufacturing functions and lead to a correct by design methodology. This report identifies the EDA tools that would be needed to design, analyze, simulate, and evaluate electronic systems for spacecraft vehicles. In addition, the report presents recommendations to enhance the current JSC electronic design capabilities. This includes cost information and a discussion as to the impact, both positive and negative, of implementing the recommendations.

The Provision of Interventional Radiology Services in Europe: CIRSE Recommendations.

PubMed

Tsetis, Dimitrios; Uberoi, Raman; Fanelli, Fabrizio; Roberston, Iain; Krokidis, Miltiadis; van Delden, Otto; Radeleff, Boris; Müller-Hülsbeck, Stefan; Szerbo-Trojanowska, Malgorzata; Lee, Michael; Morgan, Robert; Brountzos, Elias; Belli, Anna Maria

2016-04-01

Interventional Radiology (IR) is an essential part of modern medicine, delivering minimally invasive patient-focused care, which has been proven to be safe and effective in both elective and emergency settings. The aim of this document is to outline the core requirements and standards for the provision of Interventional Radiological services, including training, certification, manpower, and accreditation. The ultimate challenge will be the adoption of these recommendations by different countries and health economies around the world, in turn ensuring equal access to IR treatments for all patients, the appropriate distribution of resources for IR service provision as well as the continued development of safe and high-quality IR services in Europe and beyond.

Child passenger safety.

PubMed

Durbin, Dennis R

2011-04-01

Despite significant reductions in the number of children killed in motor vehicle crashes over the past decade, crashes continue to be the leading cause of death for children 4 years and older. Therefore, the American Academy of Pediatrics continues to recommend inclusion of child passenger safety anticipatory guidance at every health-supervision visit. This technical report provides a summary of the evidence in support of 5 recommendations for best practices to optimize safety in passenger vehicles for children from birth through adolescence that all pediatricians should know and promote in their routine practice. These recommendations are presented in the revised policy statement on child passenger safety in the form of an algorithm that is intended to facilitate their implementation by pediatricians with their patients and families. The algorithm is designed to cover the majority of situations that pediatricians will encounter in practice. In addition, a summary of evidence on a number of additional issues that affect the safety of children in motor vehicles, including the proper use and installation of child restraints, exposure to air bags, travel in pickup trucks, children left in or around vehicles, and the importance of restraint laws, is provided. Finally, this technical report provides pediatricians with a number of resources for additional information to use when providing anticipatory guidance to families.

Statistical methods for meta-analyses including information from studies without any events-add nothing to nothing and succeed nevertheless.

PubMed

Kuss, O

2015-03-30

Meta-analyses with rare events, especially those that include studies with no event in one ('single-zero') or even both ('double-zero') treatment arms, are still a statistical challenge. In the case of double-zero studies, researchers in general delete these studies or use continuity corrections to avoid them. A number of arguments against both options has been given, and statistical methods that use the information from double-zero studies without using continuity corrections have been proposed. In this paper, we collect them and compare them by simulation. This simulation study tries to mirror real-life situations as completely as possible by deriving true underlying parameters from empirical data on actually performed meta-analyses. It is shown that for each of the commonly encountered effect estimators valid statistical methods are available that use the information from double-zero studies without using continuity corrections. Interestingly, all of them are truly random effects models, and so also the current standard method for very sparse data as recommended from the Cochrane collaboration, the Yusuf-Peto odds ratio, can be improved on. For actual analysis, we recommend to use beta-binomial regression methods to arrive at summary estimates for the odds ratio, the relative risk, or the risk difference. Methods that ignore information from double-zero studies or use continuity corrections should no longer be used. We illustrate the situation with an example where the original analysis ignores 35 double-zero studies, and a superior analysis discovers a clinically relevant advantage of off-pump surgery in coronary artery bypass grafting. Copyright © 2014 John Wiley & Sons, Ltd.

Colorectal cancer screening for average-risk adults: 2018 guideline update from the American Cancer Society.

PubMed

Wolf, Andrew M D; Fontham, Elizabeth T H; Church, Timothy R; Flowers, Christopher R; Guerra, Carmen E; LaMonte, Samuel J; Etzioni, Ruth; McKenna, Matthew T; Oeffinger, Kevin C; Shih, Ya-Chen Tina; Walter, Louise C; Andrews, Kimberly S; Brawley, Otis W; Brooks, Durado; Fedewa, Stacey A; Manassaram-Baptiste, Deana; Siegel, Rebecca L; Wender, Richard C; Smith, Robert A

2018-05-30

In the United States, colorectal cancer (CRC) is the fourth most common cancer diagnosed among adults and the second leading cause of death from cancer. For this guideline update, the American Cancer Society (ACS) used an existing systematic evidence review of the CRC screening literature and microsimulation modeling analyses, including a new evaluation of the age to begin screening by race and sex and additional modeling that incorporates changes in US CRC incidence. Screening with any one of multiple options is associated with a significant reduction in CRC incidence through the detection and removal of adenomatous polyps and other precancerous lesions and with a reduction in mortality through incidence reduction and early detection of CRC. Results from modeling analyses identified efficient and model-recommendable strategies that started screening at age 45 years. The ACS Guideline Development Group applied the Grades of Recommendations, Assessment, Development, and Evaluation (GRADE) criteria in developing and rating the recommendations. The ACS recommends that adults aged 45 years and older with an average risk of CRC undergo regular screening with either a high-sensitivity stool-based test or a structural (visual) examination, depending on patient preference and test availability. As a part of the screening process, all positive results on noncolonoscopy screening tests should be followed up with timely colonoscopy. The recommendation to begin screening at age 45 years is a qualified recommendation. The recommendation for regular screening in adults aged 50 years and older is a strong recommendation. The ACS recommends (qualified recommendations) that: 1) average-risk adults in good health with a life expectancy of more than 10 years continue CRC screening through the age of 75 years; 2) clinicians individualize CRC screening decisions for individuals aged 76 through 85 years based on patient preferences, life expectancy, health status, and prior screening history; and 3) clinicians discourage individuals older than 85 years from continuing CRC screening. The options for CRC screening are: fecal immunochemical test annually; high-sensitivity, guaiac-based fecal occult blood test annually; multitarget stool DNA test every 3 years; colonoscopy every 10 years; computed tomography colonography every 5 years; and flexible sigmoidoscopy every 5 years. CA Cancer J Clin 2018;000:000-000. © 2018 American Cancer Society. © 2018 American Cancer Society.

Vaccine recommendations for children and youth for the 2017/2018 influenza season.

PubMed

Moore, Dorothy L

2018-02-01

The Canadian Paediatric Society continues to encourage annual influenza vaccination for ALL children and youth ≥6 months of age. Recommendations from the National Advisory Committee on Immunization (NACI) for the 2017/2018 influenza season are not substantially changed from those of last season. NACI has conducted a review of all available vaccine effectiveness data concerning live attenuated influenza vaccine (LAIV) and concludes that current evidence supports the continued use of LAIV in Canada, although use is not currently recommended in the USA because of concern about efficacy.

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...

Implementing business continuity effectively within the UK National Health Service.

PubMed

Roberts, Patrick; Molyneux, Helen

2010-11-01

Whereas major incident planning is very well established within National Health Service (NHS) organisations in the UK, business continuity management (BCM) planning, in many cases, is a relatively new activity; however, a combination of factors including the emergence of H1N1 influenza, has led to growing interest in the subject. This paper draws on both the personal experience of the authors and published research in relevant fields to make a number of specific recommendations about the effective implementation of BCM within NHS organisations. These include the need to define the BCM project properly; conduct a thorough business impact analysis considering 'back office' as well as clinical activities; define suitable command and control arrangements with clear delegated authority; and support plan development with appropriate training.

The World Hypertension League: where now and where to in salt reduction

PubMed Central

Lackland, Daniel T.; Lisheng, Liu; Zhang, Xin-Hua; Nilsson, Peter M.; Niebylski, Mark L.

2015-01-01

High dietary salt is a leading risk for death and disability largely by causing increased blood pressure. Other associated health risks include gastric and renal cell cancers, osteoporosis, renal stones, and increased disease activity in multiple sclerosis, headache, increased body fat and Meniere’s disease. The World Hypertension League (WHL) has prioritized advocacy for salt reduction. WHL resources and actions include a non-governmental organization policy statement, dietary salt fact sheet, development of standardized nomenclature, call for quality research, collaboration in a weekly salt science update, development of a process to set recommended dietary salt research standards and regular literature reviews, development of adoptable power point slide sets to support WHL positions and resources, and critic of weak research studies on dietary salt. The WHL plans to continue to work with multiple governmental and non-governmental organizations to promote dietary salt reduction towards the World Health Organization (WHO) recommendations. PMID:26090335

Best practices for health and safety technology transfer in construction.

PubMed

Welch, Laura S; Russell, Dustin; Weinstock, Deborah; Betit, Eileen

2015-08-01

Construction continues to be a dangerous industry, yet solutions that would prevent injury and illness do exist. Prevention of injury and illness among construction workers requires dissemination, adoption, and implementation of these effective interventions, or "research to practice" (r2p). CPWR recruited participants with experience and insight into effective methods for diffusion of health and safety technologies in this industry for a symposium with 3 group sessions and 3 breakout groups. The organizers reviewed session notes and identified 141 recommendations, which were then assigned to 13 over-arching themes. Recommendations included a guide for researchers on patenting and licensing, a business case model, and in-depth case studies including development, testing, manufacturing, marketing, and diffusion. A more comprehensive understanding of the health and safety technology transfer landscape, the various actors, and their motivators and goals will help to foster the successful commercialization and diffusion of health and safety innovations. © 2015 Wiley Periodicals, Inc.

Obstetrician practice patterns and recommendations for physical activity during pregnancy.

PubMed

Evenson, Kelly R; Pompeii, Lisa A

2010-09-01

Many women do not attain minimum American College of Obstetricians and Gynecologists (ACOG) recommendations for physical activity during pregnancy. This study assessed the self-reported practice patterns and recommendations of 384 obstetricians working in Texas through a mailed survey on physical activity during pregnancy. The most common exercise elements routinely collected from pregnant women included types of exercise (81%), history of exercise before pregnancy (79%), and frequency of exercise (76%). Fewer obstetricians collected duration (68%) or intensity (69%) of exercise. The percentage of obstetricians recommending avoidance of nine household activities and exercises (including lifting groceries, starting a new exercise program, or participating in walking, jogging, or bicycling) was significantly higher with each successive trimester. Most obstetricians agreed that pregnant women would gain some benefit from mild exercise (99.5%), but fewer agreed that moderate (74%) or vigorous exercise (6%) would be beneficial. Sixty-two percent of obstetricians reported that women who have never exercised could begin an exercise program during pregnancy. Almost all participants agreed that physical activity might make a woman feel more energetic (98%) and improve her labor and delivery (89%), but fewer agreed that exercise during pregnancy causes lower weight babies (23%) or could trigger labor (18%). Dissemination of current recommendations and discussion about the benefits and risks of physical activity during pregnancy, such as through continuing education, appear warranted. Future research could address the causes of disparities between self-reported practice patterns and current ACOG guidelines.

Guidelines for diagnosis, prevention and treatment of hand eczema--short version.

PubMed

Diepgen, Thomas L; Andersen, Klaus E; Chosidow, Oliver; Coenraads, Peter Jan; Elsner, Peter; English, John; Fartasch, Manigé; Gimenez-Arnau, Ana; Nixon, Rosemary; Sasseville, Denis; Agner, Tove

2015-01-01

The guidelines aim to provide advice on the management of hand eczema (HE), using an evidence- and consensus-based approach. The guidelines consider a systematic Cochrane review on interventions for HE, which is based on a systematic search of the published literature (including hand-searching). In addition to the evidence- and consensus-based recommendation on the treatment of HE, the guidelines cover mainly consensus-based diagnostic aspects and preventive measures (primary and secondary prevention). Treatment recommendations include non-pharmacological interventions, topical, physical and systemic treatments. Topical corticosteroids are recommended as first line treatment in the management of HE, however continuous long-term treatment beyond six weeks only when necessary and under careful medical supervision. Alitretinoin is recommended as a second line treatment (relative to topical corticosteroids) for patients with severe chronic HE. Randomized control trials (RCT) are missing for other used systemic treatments and comparison of systemic drugs in "head-to-head" RCTs are needed. The guidelines development group is a working group of the European Society of Contact Dermatitis (ESCD) and has carefully tried to reconcile opposite views, define current optimal practice and provide specific recommendations, and meetings have been chaired by a professional moderator of the AWMF (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften; Association of the Scientific Medical Societies in Germany). No financial support was given by any medical company. The guidelines are expected to be valid until December 2017 at the latest. © 2014 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

Management of rhinosinusitis during pregnancy: systematic review and expert panel recommendations

PubMed Central

Lal, Devyani; Jategaonkar, Ameya A.; Borish, Larry; Chambliss, Linda R.; Gnagi, Sharon H.; Hwang, Peter H.; Rank, Matthew A.; Stankiewicz, James A.; Lund, Valerie J.

2018-01-01

Background Management of rhinosinusitis during pregnancy requires special considerations. Objectives 1. Conduct a systematic literature review for acute and chronic rhinosinusitis (CRS) management during pregnancy. 2. Make evidence-based recommendations. Methods The systematic review was conducted using MEDLINE and EMBASE databases and relevant search terms. Title, abstract and full manuscript review were conducted by two authors independently. A multispecialty panel with expertise in management of Rhinological disorders, Allergy-Immunology, and Obstetrics-Gynecology was invited to review the systematic review. Recommendations were sought on use of following for CRS management during pregnancy: oral corticosteroids; antibiotics; leukotrienes; topical corticosteroid spray/irrigations/drops; aspirin desensitization; elective surgery for CRS with polyps prior to planned pregnancy; vaginal birth versus planned Caesarian for skull base erosions/ prior CSF rhinorrhea. Results Eighty-eight manuscripts underwent full review after screening 3052 abstracts. No relevant level 1, 2, or 3 studies were found. Expert panel recommendations for rhinosinusitis management during pregnancy included continuing nasal corticosteroid sprays for CRS maintenance, using pregnancy-safe antibiotics for acute rhinosinusitis and CRS exacerbations, and discontinuing aspirin desensitization for aspirin exacerbated respiratory disease. The manuscript presents detailed recommendations. Conclusions The lack of evidence pertinent to managing rhinosinusitis during pregnancy warrants future trials. Expert recommendations constitute the current best available evidence. PMID:26800862

Annual report to Congress: Department of Energy activities relating to the Defense Nuclear Facilities Safety Board, Calendar Year 1999

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

None

2000-02-01

This is the tenth Annual Report to the Congress describing Department of Energy activities in response to formal recommendations and other interactions with the Defense Nuclear Facilities Safety Board (Board). The Board, an independent executive-branch agency established in 1988, provides advice and recommendations to the Secretary of Energy regarding public health and safety issues at the Department's defense nuclear facilities. The Board also reviews and evaluates the content and implementation of health and safety standards, as well as other requirements, relating to the design, construction, operation, and decommissioning of the Department's defense nuclear facilities. During 1999, Departmental activities resulted inmore » the closure of nine Board recommendations. In addition, the Department has completed all implementation plan milestones associated with three Board recommendations. One new Board recommendation was received and accepted by the Department in 1999, and a new implementation plan is being developed to address this recommendation. The Department has also made significant progress with a number of broad-based initiatives to improve safety. These include expanded implementation of integrated safety management at field sites, opening of a repository for long-term storage of transuranic wastes, and continued progress on stabilizing excess nuclear materials to achieve significant risk reduction.« less

Vaccine recommendations for children and youth for the 2014/2015 influenza season.

PubMed

Moore, Dorothy L

2014-10-01

The Canadian Paediatric Society continues to encourage annual influenza vaccination for ALL children and youth ≥6 months of age. Recommendations from the National Advisory Committee on Immunization for the 2014/2015 influenza season include some important changes: Influenza vaccination is recommended for ALL individuals ≥6 months of age, with particular focus on those at high risk of influenza-related complications and their close contacts. Definitions of high-risk conditions and close contacts have not changed from those of 2013/2014.The preference for intranasal, live attenuated influenza vaccine (LAIV) over trivalent inactivated influenza vaccines for healthy children is restricted to individuals two to six years of age. There is insufficient evidence to recommend LAIV over trivalent inactivated influenza vaccines in older children or in children with chronic health conditions; either vaccine may be used unless there are specific contraindications.Quadrivalent influenza vaccines are expected to be available for the 2014/2015 season and may be used interchangeably with trivalent vaccines. They may offer improved protection.Trivalent or quadrivalent inactivated vaccines may be used in individuals with egg allergy; LAIV has not yet been evaluated in this population and is not recommended at this time.

STATEMENT OF GEORGE W. FELLENDORF BEFORE THE MARYLAND COMMISSION TO STUDY EDUCATIONAL NEEDS OF HANDICAPPED CHILDREN.

ERIC Educational Resources Information Center

FELLENDORF, GEORGE W.

THE EXECUTIVE DIRECTOR OF THE ALEXANDER GRAHAM BELL ASSOCIATION FOR THE DEAF URGED THAT THE STATE OF MARYLAND CONTINUE TO INVESTIGATE NEW DEVELOPMENTS IN THE AREA OF EDUCATION OF THE HANDICAPPED. HE RECOMMENDED THAT CONTINUAL REVIEW AND RECOMMENDATIONS OF NEEDS BE MADE BY REGIONAL SUBCOMMITTEES, PROGRAMS BE COORDINATED BY AN ADMINISTRATOR AT THE…

Continuous Energy Improvement in Motor Driven Systems - A Guidebook for Industry

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

Gilbert A. McCoy and John G. Douglass

2014-02-01

This guidebook provides a step-by-step approach to developing a motor system energy-improvement action plan. An action plan includes which motors should be repaired or replaced with higher efficiency models, recommendations on maintaining a spares inventory, and discussion of improvements in maintenance practices. The guidebook is the successor to DOE’s 1997 Energy Management for Motor Driven Systems. It builds on its predecessor publication by including topics such as power transmission systems and matching driven equipment to process requirements in addition to motors.

Installation Restoration Program. Phase I: Records Search Goodfellow Air Force Base, Texas.

DTIC Science & Technology

1985-03-01

CHDRO - ARSENIC SARIUM, CADMIUM MIUM. COPPER. IRON, DIS- DIS- DIS- DIS- DIS- DIS- SOLVED SOLVED SOLVED SOLVED SOLVED SOLVED TIME (UOIL (UCIL (UGIL (UG/L... cadmium , chromium, copper, iron, lead, manganese, mercury, nickel, silver, and zinc. The recommended parameters include those compounds known or...8217. ... . . -. * -:,-..’... .... ’.... ...’. .’..".-... ... -......- . ..............-............... . ..... .. APPENDIX A (Continued, Page 2 of 7) Cadmium A metal used in batteries and other industrial

Aviation Security-Related Findings and Recommendations of the 9/11 Commission

DTIC Science & Technology

2005-03-30

The 9/11 Commission found that al Qaeda operatives exploited known weaknesses in U.S. aviation security to carry out the terrorist attacks of...September 11, 2001. While legislation and administration actions after September 11, 2001 were implemented to strengthen aviation security , the 9/11...Commission concluded that several weaknesses continue to exist. These include perceived vulnerabilities in cargo and general aviation security as well as

Community pharmacists’ services for women during pregnancy and breast feeding in Kuwait: a cross-sectional study

PubMed Central

Albassam, Abdullah

2018-01-01

Objectives This study was designed to identify the services provided by community pharmacists in Kuwait and their views regarding self-care in pregnancy and lactation. In addition, it determined the pharmacists’ recommendations for treatment of pregnancy-related and breast feeding-related ailments. Design Cross-sectional questionnaire-based survey. Setting Community pharmacies in Kuwait. Participants 207 pharmacies were randomly selected from the Ministry of Health database. One registered pharmacist was approached from each pharmacy. One hundred and ninety-two (92.8%) pharmacists agreed to participate and completed a self-administered questionnaire. Outcomes The proportions of pharmacists offering particular advice for health conditions in pregnancy and lactation, pharmacists’ recommendations for common and specific ailments during pregnancy and breast feeding, and pharmacists’ views about self-care in pregnancy and breast feeding. Results The top services provided to pregnant and lactating women were recommending vitamins and food supplements (89.8%) and contraception advice (83.4%), respectively. More than half of participants indicated that they would recommend medications for headache, constipation, cough, runny nose, sore throat, nausea/vomiting, indigestion, sore or cracked nipple and insufficient milk. Diarrhoea, haemorrhoids, insomnia, varicose vein, swelling of the feet and legs, vaginal itching, back pain, fever, mastitis and engorgement were frequently referred to the physician. Recommendations on medication use were occasionally inappropriate in terms of unneeded drug therapy, off-label use and safety. In relation to offering advice and solving medication and health problems of pregnant and lactating women, more than half of pharmacists indicated that they have sufficient knowledge (61.5%; 50.5%) and confidence (58.3%; 53.1%), respectively. Most of the respondents (88.5%) agreed that a continuing education programme on this topic would be of value for their practice. Conclusion The present findings show that respondents had different recommendations for treatment of pregnancy-related and lactation-related ailments; and also highlight the need for interventions, including continuing professional development and revision of the undergraduate pharmacy curriculum. PMID:29306891

7 CFR 948.21 - 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. 948.21 Section 948.21 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Marketing... Order Regulating Handling Regulation § 948.21 Recommendations for regulations. An area committee upon...

7 CFR 946.51 - Recommendation for regulations.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 8 2011-01-01 2011-01-01 false Recommendation for regulations. 946.51 Section 946.51 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Marketing... WASHINGTON Order Regulating Handling Regulation § 946.51 Recommendation for regulations. The committee shall...

7 CFR 959.51 - 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. 959.51 Section 959.51 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Marketing... Regulating Handling Regulations § 959.51 Recommendations for regulations. Upon complying with the...

7 CFR 946.51 - Recommendation for regulations.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 8 2010-01-01 2010-01-01 false Recommendation for regulations. 946.51 Section 946.51 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Marketing... WASHINGTON Order Regulating Handling Regulation § 946.51 Recommendation for regulations. The committee shall...

7 CFR 966.51 - 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. 966.51 Section 966.51 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Marketing... Regulating Handling Regulation § 966.51 Recommendations for regulations. The committee, upon complying with...

40 CFR 256.11 - Recommendations.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 25 2011-07-01 2011-07-01 false Recommendations. 256.11 Section 256.11 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES GUIDELINES FOR DEVELOPMENT...; Distribution of Funding § 256.11 Recommendations. (a) Responsibilities should be identified for each of the...

40 CFR 256.11 - Recommendations.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 24 2010-07-01 2010-07-01 false Recommendations. 256.11 Section 256.11 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES GUIDELINES FOR DEVELOPMENT...; Distribution of Funding § 256.11 Recommendations. (a) Responsibilities should be identified for each of the...

7 CFR 966.51 - 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. 966.51 Section 966.51 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Marketing... Regulating Handling Regulation § 966.51 Recommendations for regulations. The committee, upon complying with...

7 CFR 948.21 - 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. 948.21 Section 948.21 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Marketing... Order Regulating Handling Regulation § 948.21 Recommendations for regulations. An area committee upon...

7 CFR 959.51 - 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. 959.51 Section 959.51 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Marketing... Regulating Handling Regulations § 959.51 Recommendations for regulations. Upon complying with the...

46 CFR 121.510 - Recommended emergency broadcast instructions.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 46 Shipping 4 2012-10-01 2012-10-01 false Recommended emergency broadcast instructions. 121.510 Section 121.510 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) SMALL PASSENGER VESSELS... CONTROL AND MISCELLANEOUS SYSTEMS AND EQUIPMENT Radio § 121.510 Recommended emergency broadcast...

46 CFR 121.510 - Recommended emergency broadcast instructions.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 46 Shipping 4 2014-10-01 2014-10-01 false Recommended emergency broadcast instructions. 121.510 Section 121.510 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) SMALL PASSENGER VESSELS... CONTROL AND MISCELLANEOUS SYSTEMS AND EQUIPMENT Radio § 121.510 Recommended emergency broadcast...

40 CFR 231.5 - Recommended determination.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 40 Protection of Environment 25 2014-07-01 2014-07-01 false Recommended determination. 231.5 Section 231.5 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) OCEAN DUMPING SECTION 404(c) PROCEDURES § 231.5 Recommended determination. (a) The Regional Administrator or his designee...

40 CFR 108.6 - Recommendations.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 40 Protection of Environment 23 2012-07-01 2012-07-01 false Recommendations. 108.6 Section 108.6 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) WATER PROGRAMS EMPLOYEE PROTECTION HEARINGS § 108.6 Recommendations. At the conclusion of any hearing under this part, the Administrative Law...

40 CFR 240.209-2 - Recommended procedures: Design.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 24 2010-07-01 2010-07-01 false Recommended procedures: Design. 240.209-2 Section 240.209-2 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES GUIDELINES FOR THE THERMAL PROCESSING OF SOLID WASTES Requirements and Recommended Procedures...

40 CFR 240.208-3 - Recommended procedures: Operations.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 24 2010-07-01 2010-07-01 false Recommended procedures: Operations. 240.208-3 Section 240.208-3 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES GUIDELINES FOR THE THERMAL PROCESSING OF SOLID WASTES Requirements and Recommended...

40 CFR 240.210-3 - Recommended procedures: Operations.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 24 2010-07-01 2010-07-01 false Recommended procedures: Operations. 240.210-3 Section 240.210-3 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES GUIDELINES FOR THE THERMAL PROCESSING OF SOLID WASTES Requirements and Recommended...

40 CFR 240.202-3 - Recommended procedures: Operations.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 24 2010-07-01 2010-07-01 false Recommended procedures: Operations. 240.202-3 Section 240.202-3 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES GUIDELINES FOR THE THERMAL PROCESSING OF SOLID WASTES Requirements and Recommended...

40 CFR 240.202-2 - Recommended procedures: Design.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 24 2010-07-01 2010-07-01 false Recommended procedures: Design. 240.202-2 Section 240.202-2 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES GUIDELINES FOR THE THERMAL PROCESSING OF SOLID WASTES Requirements and Recommended Procedures...

40 CFR 240.210-2 - Recommended procedures: Design.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 24 2010-07-01 2010-07-01 false Recommended procedures: Design. 240.210-2 Section 240.210-2 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES GUIDELINES FOR THE THERMAL PROCESSING OF SOLID WASTES Requirements and Recommended Procedures...

40 CFR 240.203-3 - Recommended procedures: Operations.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 24 2010-07-01 2010-07-01 false Recommended procedures: Operations. 240.203-3 Section 240.203-3 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES GUIDELINES FOR THE THERMAL PROCESSING OF SOLID WASTES Requirements and Recommended...

40 CFR 240.206-2 - Recommended procedures: Design.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 24 2010-07-01 2010-07-01 false Recommended procedures: Design. 240.206-2 Section 240.206-2 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES GUIDELINES FOR THE THERMAL PROCESSING OF SOLID WASTES Requirements and Recommended Procedures...

40 CFR 240.202-2 - Recommended procedures: Design.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 25 2011-07-01 2011-07-01 false Recommended procedures: Design. 240.202-2 Section 240.202-2 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES GUIDELINES FOR THE THERMAL PROCESSING OF SOLID WASTES Requirements and Recommended Procedures...

40 CFR 240.211-2 - Recommended procedures: Design.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 24 2010-07-01 2010-07-01 false Recommended procedures: Design. 240.211-2 Section 240.211-2 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES GUIDELINES FOR THE THERMAL PROCESSING OF SOLID WASTES Requirements and Recommended Procedures...

40 CFR 240.200-2 - Recommended procedures: Design.

Code of Federal Regulations, 2011 CFR

2011-07-01

....200-2 Section 240.200-2 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES GUIDELINES FOR THE THERMAL PROCESSING OF SOLID WASTES Requirements and Recommended Procedures § 240.200-2 Recommended procedures: Design. (a) In addition to the residential and commercial wastes...

40 CFR 240.200-2 - Recommended procedures: Design.

Code of Federal Regulations, 2010 CFR

2010-07-01

....200-2 Section 240.200-2 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES GUIDELINES FOR THE THERMAL PROCESSING OF SOLID WASTES Requirements and Recommended Procedures § 240.200-2 Recommended procedures: Design. (a) In addition to the residential and commercial wastes...

40 CFR 108.6 - Recommendations.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 21 2010-07-01 2010-07-01 false Recommendations. 108.6 Section 108.6 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) WATER PROGRAMS EMPLOYEE PROTECTION HEARINGS § 108.6 Recommendations. At the conclusion of any hearing under this part, the Administrative Law...

40 CFR 231.5 - Recommended determination.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 24 2010-07-01 2010-07-01 false Recommended determination. 231.5 Section 231.5 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) OCEAN DUMPING SECTION 404(c) PROCEDURES § 231.5 Recommended determination. (a) The Regional Administrator or his designee...

48 CFR 53.108 - Recommendations concerning forms.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 2 2010-10-01 2010-10-01 false Recommendations concerning forms. 53.108 Section 53.108 Federal Acquisition Regulations System FEDERAL ACQUISITION REGULATION (CONTINUED) CLAUSES AND FORMS FORMS General 53.108 Recommendations concerning forms. Users of this regulation...

Continued study of NAVSTAR/GPS for general aviation

NASA Technical Reports Server (NTRS)

Alberts, R. D.; Ruedger, W. H.

1979-01-01

A conceptual approach for examining the full potential of Global Positioning Systems (GPS) for the general aviation community is presented. Aspects of an experimental program to demonstrate these concepts are discussed. The report concludes with the observation that the true potential of GPS can only be exploited by utilization in concert with a data link. The capability afforded by the combination of position location and reporting stimulates the concept of GPS providing the auxiliary functions of collision avoidance, and approach and landing guidance. A series of general recommendations for future NASA and civil community efforts in order to continue to support GPS for general aviation are included.

Advance care planning in dementia: recommendations for healthcare professionals.

PubMed

Piers, Ruth; Albers, Gwenda; Gilissen, Joni; De Lepeleire, Jan; Steyaert, Jan; Van Mechelen, Wouter; Steeman, Els; Dillen, Let; Vanden Berghe, Paul; Van den Block, Lieve

2018-06-21

Advance care planning (ACP) is a continuous, dynamic process of reflection and dialogue between an individual, those close to them and their healthcare professionals, concerning the individual's preferences and values concerning future treatment and care, including end-of-life care. Despite universal recognition of the importance of ACP for people with dementia, who gradually lose their ability to make informed decisions themselves, ACP still only happens infrequently, and evidence-based recommendations on when and how to perform this complex process are lacking. We aimed to develop evidence-based clinical recommendations to guide professionals across settings in the practical application of ACP in dementia care. Following the Belgian Centre for Evidence-Based Medicine's procedures, we 1) performed an extensive literature search to identify international guidelines, articles reporting heterogeneous study designs and grey literature, 2) developed recommendations based on the available evidence and expert opinion of the author group, and 3) performed a validation process using written feedback from experts, a survey for end users (healthcare professionals across settings), and two peer-review groups (with geriatricians and general practitioners). Based on 67 publications and validation from ten experts, 51 end users and two peer-review groups (24 participants) we developed 32 recommendations covering eight domains: initiation of ACP, evaluation of mental capacity, holding ACP conversations, the role and importance of those close to the person with dementia, ACP with people who find it difficult or impossible to communicate verbally, documentation of wishes and preferences, including information transfer, end-of-life decision-making, and preconditions for optimal implementation of ACP. Almost all recommendations received a grading representing low to very low-quality evidence. No high-quality guidelines are available for ACP in dementia care. By combining evidence with expert and user opinions, we have defined a unique set of recommendations for ACP in people living with dementia. These recommendations form a valuable tool for educating healthcare professionals on how to perform ACP across settings.

7 CFR 945.51 - Recommendation for regulations.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 8 2011-01-01 2011-01-01 false Recommendation for regulations. 945.51 Section 945.51 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Marketing... Recommendation for regulations. Whenever the committee deems it advisable that the handling of potatoes be...

7 CFR 945.51 - Recommendation for regulations.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 8 2010-01-01 2010-01-01 false Recommendation for regulations. 945.51 Section 945.51 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Marketing... Recommendation for regulations. Whenever the committee deems it advisable that the handling of potatoes be...

40 CFR Appendix to Part 243 - Recommended Bibliography

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 25 2011-07-01 2011-07-01 false Recommended Bibliography Appendix to Part 243 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES GUIDELINES.... Appendix to Part 243—Recommended Bibliography 1. American National Standard Z245.1. Safety standard for...

45 CFR 1801.23 - Recommendation by panel.

Code of Federal Regulations, 2013 CFR

2013-10-01

... Public Welfare Regulations Relating to Public Welfare (Continued) HARRY S. TRUMAN SCHOLARSHIP FOUNDATION HARRY S. TRUMAN SCHOLARSHIP PROGRAM The Competition § 1801.23 Recommendation by panel. (a) Each Panel is..., it does not provide a recommendation. The Foundation will carry over the Scholarship for that state...

45 CFR 1801.23 - Recommendation by panel.

Code of Federal Regulations, 2012 CFR

2012-10-01

... Public Welfare Regulations Relating to Public Welfare (Continued) HARRY S. TRUMAN SCHOLARSHIP FOUNDATION HARRY S. TRUMAN SCHOLARSHIP PROGRAM The Competition § 1801.23 Recommendation by panel. (a) Each Panel is..., it does not provide a recommendation. The Foundation will carry over the Scholarship for that state...

45 CFR 1801.23 - Recommendation by panel.

Code of Federal Regulations, 2014 CFR

2014-10-01

... Public Welfare Regulations Relating to Public Welfare (Continued) HARRY S. TRUMAN SCHOLARSHIP FOUNDATION HARRY S. TRUMAN SCHOLARSHIP PROGRAM The Competition § 1801.23 Recommendation by panel. (a) Each Panel is..., it does not provide a recommendation. The Foundation will carry over the Scholarship for that state...

40 CFR 246.202-5 - Recommended procedures: Transportation.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 40 Protection of Environment 26 2012-07-01 2011-07-01 true Recommended procedures: Transportation. 246.202-5 Section 246.202-5 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED... § 246.202-5 Recommended procedures: Transportation. Transportation to market may be supplied by either...

40 CFR 246.202-5 - Recommended procedures: Transportation.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 25 2011-07-01 2011-07-01 false Recommended procedures: Transportation. 246.202-5 Section 246.202-5 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED... § 246.202-5 Recommended procedures: Transportation. Transportation to market may be supplied by either...

40 CFR 246.202-5 - Recommended procedures: Transportation.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 40 Protection of Environment 25 2014-07-01 2014-07-01 false Recommended procedures: Transportation. 246.202-5 Section 246.202-5 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED... § 246.202-5 Recommended procedures: Transportation. Transportation to market may be supplied by either...

40 CFR 246.200-7 - Recommended procedures: Transportation.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 40 Protection of Environment 25 2014-07-01 2014-07-01 false Recommended procedures: Transportation. 246.200-7 Section 246.200-7 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED... § 246.200-7 Recommended procedures: Transportation. Transportation to market may be supplied by the...

40 CFR 246.202-5 - Recommended procedures: Transportation.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 40 Protection of Environment 26 2013-07-01 2013-07-01 false Recommended procedures: Transportation. 246.202-5 Section 246.202-5 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED... § 246.202-5 Recommended procedures: Transportation. Transportation to market may be supplied by either...

40 CFR 246.200-7 - Recommended procedures: Transportation.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 40 Protection of Environment 26 2012-07-01 2011-07-01 true Recommended procedures: Transportation. 246.200-7 Section 246.200-7 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED... § 246.200-7 Recommended procedures: Transportation. Transportation to market may be supplied by the...

40 CFR 246.200-7 - Recommended procedures: Transportation.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 25 2011-07-01 2011-07-01 false Recommended procedures: Transportation. 246.200-7 Section 246.200-7 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED... § 246.200-7 Recommended procedures: Transportation. Transportation to market may be supplied by the...

40 CFR 246.200-7 - Recommended procedures: Transportation.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 40 Protection of Environment 26 2013-07-01 2013-07-01 false Recommended procedures: Transportation. 246.200-7 Section 246.200-7 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED... § 246.200-7 Recommended procedures: Transportation. Transportation to market may be supplied by the...

Clinical Practice Guidelines From the AABB: Red Blood Cell Transfusion Thresholds and Storage.

PubMed

Carson, Jeffrey L; Guyatt, Gordon; Heddle, Nancy M; Grossman, Brenda J; Cohn, Claudia S; Fung, Mark K; Gernsheimer, Terry; Holcomb, John B; Kaplan, Lewis J; Katz, Louis M; Peterson, Nikki; Ramsey, Glenn; Rao, Sunil V; Roback, John D; Shander, Aryeh; Tobian, Aaron A R

2016-11-15

More than 100 million units of blood are collected worldwide each year, yet the indication for red blood cell (RBC) transfusion and the optimal length of RBC storage prior to transfusion are uncertain. To provide recommendations for the target hemoglobin level for RBC transfusion among hospitalized adult patients who are hemodynamically stable and the length of time RBCs should be stored prior to transfusion. Reference librarians conducted a literature search for randomized clinical trials (RCTs) evaluating hemoglobin thresholds for RBC transfusion (1950-May 2016) and RBC storage duration (1948-May 2016) without language restrictions. The results were summarized using the Grading of Recommendations Assessment, Development and Evaluation method. For RBC transfusion thresholds, 31 RCTs included 12 587 participants and compared restrictive thresholds (transfusion not indicated until the hemoglobin level is 7-8 g/dL) with liberal thresholds (transfusion not indicated until the hemoglobin level is 9-10 g/dL). The summary estimates across trials demonstrated that restrictive RBC transfusion thresholds were not associated with higher rates of adverse clinical outcomes, including 30-day mortality, myocardial infarction, cerebrovascular accident, rebleeding, pneumonia, or thromboembolism. For RBC storage duration, 13 RCTs included 5515 participants randomly allocated to receive fresher blood or standard-issue blood. These RCTs demonstrated that fresher blood did not improve clinical outcomes. It is good practice to consider the hemoglobin level, the overall clinical context, patient preferences, and alternative therapies when making transfusion decisions regarding an individual patient. Recommendation 1: a restrictive RBC transfusion threshold in which the transfusion is not indicated until the hemoglobin level is 7 g/dL is recommended for hospitalized adult patients who are hemodynamically stable, including critically ill patients, rather than when the hemoglobin level is 10 g/dL (strong recommendation, moderate quality evidence). A restrictive RBC transfusion threshold of 8 g/dL is recommended for patients undergoing orthopedic surgery, cardiac surgery, and those with preexisting cardiovascular disease (strong recommendation, moderate quality evidence). The restrictive transfusion threshold of 7 g/dL is likely comparable with 8 g/dL, but RCT evidence is not available for all patient categories. These recommendations do not apply to patients with acute coronary syndrome, severe thrombocytopenia (patients treated for hematological or oncological reasons who are at risk of bleeding), and chronic transfusion-dependent anemia (not recommended due to insufficient evidence). Recommendation 2: patients, including neonates, should receive RBC units selected at any point within their licensed dating period (standard issue) rather than limiting patients to transfusion of only fresh (storage length: <10 days) RBC units (strong recommendation, moderate quality evidence). Research in RBC transfusion medicine has significantly advanced the science in recent years and provides high-quality evidence to inform guidelines. A restrictive transfusion threshold is safe in most clinical settings and the current blood banking practices of using standard-issue blood should be continued.

KDIGO Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors.

PubMed

Lentine, Krista L; Kasiske, Bertram L; Levey, Andrew S; Adams, Patricia L; Alberú, Josefina; Bakr, Mohamed A; Gallon, Lorenzo; Garvey, Catherine A; Guleria, Sandeep; Li, Philip Kam-Tao; Segev, Dorry L; Taler, Sandra J; Tanabe, Kazunari; Wright, Linda; Zeier, Martin G; Cheung, Michael; Garg, Amit X

2017-08-01

The 2017 Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors is intended to assist medical professionals who evaluate living kidney donor candidates and provide care before, during and after donation. The guideline development process followed the Grades of Recommendation Assessment, Development, and Evaluation (GRADE) approach and guideline recommendations are based on systematic reviews of relevant studies that included critical appraisal of the quality of the evidence and the strength of recommendations. However, many recommendations, for which there was no evidence or no systematic search for evidence was undertaken by the Evidence Review Team, were issued as ungraded expert opinion recommendations. The guideline work group concluded that a comprehensive approach to risk assessment should replace decisions based on assessments of single risk factors in isolation. Original data analyses were undertaken to produce a "proof-in-concept" risk-prediction model for kidney failure to support a framework for quantitative risk assessment in the donor candidate evaluation and defensible shared decision making. This framework is grounded in the simultaneous consideration of each candidate's profile of demographic and health characteristics. The processes and framework for the donor candidate evaluation are presented, along with recommendations for optimal care before, during, and after donation. Limitations of the evidence are discussed, especially regarding the lack of definitive prospective studies and clinical outcome trials. Suggestions for future research, including the need for continued refinement of long-term risk prediction and novel approaches to estimating donation-attributable risks, are also provided.In citing this document, the following format should be used: Kidney Disease: Improving Global Outcomes (KDIGO) Living Kidney Donor Work Group. KDIGO Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors. Transplantation. 2017;101(Suppl 8S):S1-S109.

A decentralized and onsite wastewater management course: bringing together global concerns and practical pedagogy.

PubMed

Gaulke, L S; Borgford-Parnell, J L; Stensel, H D

2008-01-01

This paper reports on the design, implementation, and results of a course focused on decentralized and onsite wastewater treatment in global contexts. Problem-based learning was the primary pedagogical method, with which students tackled real-world problems and designed systems to meet the needs of diverse populations. Both learning and course evaluations demonstrated that the course was successful in fulfilling learning objectives, increasing student design skills, and raising awareness of global applications. Based on this experience a list of recommendations was created for co-developing and team-teaching multidisciplinary design courses. These recommendations include ideas for aligning student and teacher goals, overcoming barriers to effective group-work, and imbedding continuous course assessments. Copyright IWA Publishing 2008.

Meet AAPT's new President, Steve Iona

NASA Astrophysics Data System (ADS)

Willis, Courtney

2014-02-01

I first met Steve Iona 40 years ago at a Denver Area Physics Teachers meeting. Steve had recently completed bachelor's and master's degrees in mathematics from the University of Chicago. Being a Colorado native, he was interested in returning to Colorado to teach. Steve had some rather high-powered recommendations, including one from a Nobel laureate. As Steve is fond of saying, because the recommendations were secret, he never knew if they were positive or not, but at least they were good enough for him to get a job teaching junior high school! Within a couple of years Steve had moved to the high school and was teaching Project Physics, astronomy, and general science. Steve continued to teach high school for over 25 years.

Female Reproductive Health After Childhood, Adolescent, and Young Adult Cancers: Guidelines for the Assessment and Management of Female Reproductive Complications

PubMed Central

Metzger, Monika L.; Meacham, Lillian R.; Patterson, Briana; Casillas, Jacqueline S.; Constine, Louis S.; Hijiya, Nobuko; Kenney, Lisa B.; Leonard, Marcia; Lockart, Barbara A.; Likes, Wendy; Green, Daniel M.

2013-01-01

Purpose As more young female patients with cancer survive their primary disease, concerns about reproductive health related to primary therapy gain relevance. Cancer therapy can often affect reproductive organs, leading to impaired pubertal development, hormonal regulation, fertility, and sexual function, affecting quality of life. Methods The Children's Oncology Group Long-Term Follow-Up Guidelines for Survivors of Childhood, Adolescent, and Young Adult Cancer (COG-LTFU Guidelines) are evidence-based recommendations for screening and management of late effects of therapeutic exposures. The guidelines are updated every 2 years by a multidisciplinary panel based on current literature review and expert consensus. Results This review summarizes the current task force recommendations for the assessment and management of female reproductive complications after treatment for childhood, adolescent, and young adult cancers. Experimental pretreatment as well as post-treatment fertility preservation strategies, including barriers and ethical considerations, which are not included in the COG-LTFU Guidelines, are also discussed. Conclusion Ongoing research will continue to inform COG-LTFU Guideline recommendations for follow-up care of female survivors of childhood cancer to improve their health and quality of life. PMID:23382474

Flight service evaluation of an advanced composite empennage component on commercial transport aircraft

NASA Technical Reports Server (NTRS)

1976-01-01

The development and flight evaluation of an advanced composite empennage component is presented. The recommended concept for the covers is graphite-epoxy hats bonded to a graphite-epoxy skin. The hat flare-out has been eliminated, instead the hat is continuous into the joint. The recommended concept for the spars is graphite-epoxy caps and a hybrid of Kevlar-49 and graphite-epoxy in the spar web. The spar cap, spar web stiffeners for attaching the ribs, and intermediate stiffeners are planned to be fabricated as a unit. Access hole in the web will be reinforced with a donut type, zero degree graphite-epoxy wound reinforcement. The miniwich design concept in the upper three ribs originally proposed is changed to a graphite-epoxy stiffened solid laminate design concept. The recommended configuration for the lower seven ribs remains as graphite-epoxy caps with aluminum cruciform diagonals. The indicated weight saving for the current advanced composite vertical fin configuration is 20.2% including a 24 lb growth allowance. The project production cost saving is approximately 1% based on a cumulative average of 250 aircraft and including only material, production labor, and quality assurance costs.

Assessment of the status of resources for essential trauma care in Hanoi and Khanh Hoa, Vietnam.

PubMed

Son, Nguyen Thai; Thu, Nguyen Hoai; Tu, Nguyen Thi Hong; Mock, Charles

2007-09-01

The World Health Organization and the International Association for Trauma Surgery and Intensive Care have published the Guidelines for Essential Trauma Care. This provides recommendations for the human and physical resources needed to provide an adequate, essential level of trauma care services in countries at all economic levels worldwide. We sought to use this set of recommendations as a basis to assess the trauma care capabilities in two locations in Vietnam and thus to identify affordable and sustainable methods to strengthen trauma care nationwide. A needs assessment tool was created that incorporated the recommendations of the Guidelines. This was used to conduct in-depth, onsite evaluations of 11 health care facilities in Hanoi and Khanh Hoa Province, including commune health stations, district hospitals, provincial hospitals, and a central hospital. Resources for trauma care were mostly adequate at provincial and central hospitals. There were several deficiencies at the district hospitals and especially at commune health stations. These included low level of trauma related training and shortages of supplies and equipment. In many cases these shortages were of low-cost items. However, in general, capabilities had improved compared with prior evaluations. This study has identified several low-cost ways in which to strengthen trauma care in Vietnam. These include greater use of continuing education courses for trauma care and more attention to trauma related curriculum in schools of medicine and nursing. These also include defining and assuring the availability of a core set of essential trauma related equipment and supplies. A policy recommendation that follows from the above findings is the need for programs to strengthen the organization and planning for trauma care.

40 CFR 256.42 - Recommendations for assuring facility development.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 25 2011-07-01 2011-07-01 false Recommendations for assuring facility development. 256.42 Section 256.42 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID... Planning and Implementation § 256.42 Recommendations for assuring facility development. (a) The State plan...

7 CFR 1540.5 - Submission of recommendations.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 10 2010-01-01 2010-01-01 false Submission of recommendations. 1540.5 Section 1540.5 Agriculture Regulations of the Department of Agriculture (Continued) FOREIGN AGRICULTURAL SERVICE, DEPARTMENT... Products § 1540.5 Submission of recommendations. If the Secretary has reason to believe that the perishable...

7 CFR 1540.5 - Submission of recommendations.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 10 2011-01-01 2011-01-01 false Submission of recommendations. 1540.5 Section 1540.5 Agriculture Regulations of the Department of Agriculture (Continued) FOREIGN AGRICULTURAL SERVICE, DEPARTMENT... Products § 1540.5 Submission of recommendations. If the Secretary has reason to believe that the perishable...

46 CFR 184.510 - Recommended emergency broadcast instructions.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 46 Shipping 7 2012-10-01 2012-10-01 false Recommended emergency broadcast instructions. 184.510 Section 184.510 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) SMALL PASSENGER VESSELS (UNDER 100 GROSS TONS) VESSEL CONTROL AND MISCELLANEOUS SYSTEMS AND EQUIPMENT Radio § 184.510 Recommended...

46 CFR 184.510 - Recommended emergency broadcast instructions.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 46 Shipping 7 2014-10-01 2014-10-01 false Recommended emergency broadcast instructions. 184.510 Section 184.510 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) SMALL PASSENGER VESSELS (UNDER 100 GROSS TONS) VESSEL CONTROL AND MISCELLANEOUS SYSTEMS AND EQUIPMENT Radio § 184.510 Recommended...

40 CFR 57.816 - Effect of negative recommendation.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 5 2010-07-01 2010-07-01 false Effect of negative recommendation. 57.816 Section 57.816 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS... Reduction Technology § 57.816 Effect of negative recommendation. No waiver of the interim requirement for...

An acoustic energy framework for predicting combustion-driven acoustic instabilities in premixed gas-turbines

NASA Astrophysics Data System (ADS)

Ibrahim, Zuhair M. A.

The purpose of this study was to discover and assess student financial services delivered to students enrolled at East Tennessee State University. The research was undertaken for institutional self-improvement. The research explored changes that have occurred in student financial services in the dynamic higher education market. The research revealed universities pursued best practices for the delivery of student financial services through expanded employee knowledge, restructured organizations, and integrated information technologies. The research was conducted during October and November, 2006. The data were gathered from an online student survey of student financial services. The areas researched included: the Bursar office, the Financial Aid office, and online services. The results of the data analysis revealed problems with the students' perceived quality of existing financial services and the additional services students desire. The research focused on student perceptions of the quality of financial services by age and gender classifications and response categories. Although no statistically significant difference was found between the age-gender classifications on the perception of the quality of the financial services studied, the research adds to our understanding of student financial services at East Tennessee State University. Recommendation for continued research included annual surveys of segmented student populations that include ethnicity, age, gender, and educational level. The research would be used for continuous improvement efforts and student relationship management. Also additional research was recommended for employee learning in relation to the institution's mission, goals, and values.

The Variance between Recommended and Nursing Staff Levels at Womack Army Medical Center

DTIC Science & Technology

2007-06-07

beneficiaries a vast array of services ranging from primary care to bariatric surgery and vascular surgery to intensive care including neonatal intensive care...over 700 radiological procedures. WAMC also averages 94 inpatients, 30 admissions, 21 surgeries , and 9 births during that same workday (WAMC, 2006a...number of observation patients l=one patient Continuous 24-hour Nursing (obsvpt) 2=two patients Report and 3--three patients Surgery etc... Staffing

The transfer of safety training in work organizations: a systems perspective to continuous learning.

PubMed

Ford, J K; Fisher, S

1994-01-01

The effectiveness of safety and health programs can be evaluated from a "transfer" perspective, which evaluates the effectiveness of training in individual programs, and from a "systems" perspective that contends that a safety training program cannot be isolated from the organizational system of which it is a part. This chapter explores the effectiveness of training from a systems perspective and includes recommendations for improving safety and health training.

Financing the American Consumer: A Business Report on Consumer Credit. Part I--Summary Report. Report of the Sub-Council on Credit and Related Terms of Sale of the National Business Council for Consumer Affairs.

ERIC Educational Resources Information Center

National Business Council for Consumer Affairs, Washington, DC.

Individuals and organizations administering consumer credit services are urged to adopt the following recommendations and the Code of Billing and Collection Practices (also included): (1) Credit grantors should support continuing educational programs at national and local levels on the nature of the consumer credit system. (2) Whenever possible,…

Recommendations on the Use of Diagnostic Devices in Far-Forward Military Operations

DTIC Science & Technology

2016-10-01

any other aspect of this collection of information, including suggestions for reducing this burden to Department of Defense , Washington Headquarters... Department of Defense (DoD). A consistent theme that emerged during the workshop was that even if technology that could provide detailed patient care...of military operations in which the Department of Defense (DoD) operates. DoD members achieve continuity of care and treatment by moving patients

An Exploratory Analysis of Projected Navy Officer Inventory Strength Using Data Farming

DTIC Science & Technology

2016-09-01

model’s run-time. 3. Base Case In addition to the experimental design, this study includes a base case scenario to serve as a baseline for comparison...47 3. SWO Operating Strength Deviation-Base Case One objective of this study is to determine the risk in operating strength deviation presented by...ANSWERS TO RESEARCH QUESTIONS ................................... 71  B.  RECOMMENDATIONS FOR FUTURE STUDIES ......................... 73  1.  Continuous

Report of the Defense Science Board Task Force on Defense Nuclear Agency

DTIC Science & Technology

1993-04-01

capability . including an adequate body of technically-qualifted people? ...................................................... ilI 3) What happens f...operational or warfighting capabilities ; no established way of providing support to CINCs: and in any event. DNA’s technology programs are broader than DOE’s...success of the major primes and their subcontractors (who are part of the DNA core capability ). We recommend that DNA continue to be the primary focal

The association between a journal’s source of revenue and the drug recommendations made in the articles it publishes

PubMed Central

Becker, Annette; Dörter, Fatma; Eckhardt, Kirsten; Viniol, Annika; Baum, Erika; Kochen, Michael M.; Lexchin, Joel; Wegscheider, Karl; Donner-Banzhoff, Norbert

2011-01-01

Background There is evidence to suggest that pharmaceutical companies influence the publication and content of research papers. Most German physicians rely on journals for their continuing medical education. We studied the influence of pharmaceutical advertising on the drug recommendations made in articles published in 11 German journals that focus on continuing medical education. Methods We conducted a cross-sectional study of all of the issues of 11 journals published in 2007. Only journals frequently read by general practitioners were chosen. Issues were screened for pharmaceutical advertisements and recommendations made in the editorial content for a specified selection of drugs. Each journal was rated on a five-point scale according to the strength with which it either recommended or discouraged the use of these drugs. We looked for differences in these ratings between free journals (i.e., those financed entirely by pharmaceutical advertising), journals with mixed sources of revenue and journals financed solely by subscription fees. The journals were also screened for the simultaneous appearance of advertisements and recommendations for the same drug within a certain period, which was adjusted for both journal and class of drug. Results We identified 313 issues containing at least one advertisement for the selected drugs and 412 articles in which drug recommendations were made. Free journals were more likely to recommend the specified drugs than journals with sources of revenue that were mixed or based solely on subscriptions. The simultaneous appearance of advertisements and recommendations for the same drug in the same issue of a journal showed an inconsistent association. Interpretation Free journals almost exclusively recommended the use of the specified drugs, whereas journals financed entirely with subscription fees tended to recommend against the use of the same drugs. Doctors should be aware of this bias in their use of material published in medical journals that focus on continuing medical education. PMID:21398223

The association between a journal's source of revenue and the drug recommendations made in the articles it publishes.

PubMed

Becker, Annette; Dörter, Fatma; Eckhardt, Kirsten; Viniol, Annika; Baum, Erika; Kochen, Michael M; Lexchin, Joel; Wegscheider, Karl; Donner-Banzhoff, Norbert

2011-03-22

There is evidence to suggest that pharmaceutical companies influence the publication and content of research papers. Most German physicians rely on journals for their continuing medical education. We studied the influence of pharmaceutical advertising on the drug recommendations made in articles published in 11 German journals that focus on continuing medical education. We conducted a cross-sectional study of all of the issues of 11 journals published in 2007. Only journals frequently read by general practitioners were chosen. Issues were screened for pharmaceutical advertisements and recommendations made in the editorial content for a specified selection of drugs. Each journal was rated on a five-point scale according to the strength with which it either recommended or discouraged the use of these drugs. We looked for differences in these ratings between free journals (i.e., those financed entirely by pharmaceutical advertising), journals with mixed sources of revenue and journals financed solely by subscription fees. The journals were also screened for the simultaneous appearance of advertisements and recommendations for the same drug within a certain period, which was adjusted for both journal and class of drug. We identified 313 issues containing at least one advertisement for the selected drugs and 412 articles in which drug recommendations were made. Free journals were more likely to recommend the specified drugs than journals with sources of revenue that were mixed or based solely on subscriptions. The simultaneous appearance of advertisements and recommendations for the same drug in the same issue of a journal showed an inconsistent association. Free journals almost exclusively recommended the use of the specified drugs, whereas journals financed entirely with subscription fees tended to recommend against the use of the same drugs. Doctors should be aware of this bias in their use of material published in medical journals that focus on continuing medical education.

40 CFR 246.202-3 - Recommended procedures: Market study.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 25 2011-07-01 2011-07-01 false Recommended procedures: Market study. 246.202-3 Section 246.202-3 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED... § 246.202-3 Recommended procedures: Market study. An investigation of markets should be made by the...

40 CFR 246.201-4 - Recommended procedures: Market study.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 25 2011-07-01 2011-07-01 false Recommended procedures: Market study. 246.201-4 Section 246.201-4 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED... § 246.201-4 Recommended procedures: Market study. An investigation of markets should be made for each...

40 CFR 246.201-4 - Recommended procedures: Market study.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 24 2010-07-01 2010-07-01 false Recommended procedures: Market study. 246.201-4 Section 246.201-4 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED... § 246.201-4 Recommended procedures: Market study. An investigation of markets should be made for each...

40 CFR 246.202-3 - Recommended procedures: Market study.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 24 2010-07-01 2010-07-01 false Recommended procedures: Market study. 246.202-3 Section 246.202-3 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED... § 246.202-3 Recommended procedures: Market study. An investigation of markets should be made by the...

40 CFR 246.200-3 - Recommended procedures: Market study.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 24 2010-07-01 2010-07-01 false Recommended procedures: Market study. 246.200-3 Section 246.200-3 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED... § 246.200-3 Recommended procedures: Market study. An investigation of markets should be made by the...

40 CFR 246.200-3 - Recommended procedures: Market study.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 25 2011-07-01 2011-07-01 false Recommended procedures: Market study. 246.200-3 Section 246.200-3 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED... § 246.200-3 Recommended procedures: Market study. An investigation of markets should be made by the...

40 CFR 57.812 - Appeal from or review of recommended decision.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 5 2010-07-01 2010-07-01 false Appeal from or review of recommended decision. 57.812 Section 57.812 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR... Emission Reduction Technology § 57.812 Appeal from or review of recommended decision. (a) Exceptions. (1...

41 CFR 102-75.855 - What happens if DOT does not submit an assignment recommendation?

Code of Federal Regulations, 2010 CFR

2010-07-01

... not submit an assignment recommendation? 102-75.855 Section 102-75.855 Public Contracts and Property Management Federal Property Management Regulations System (Continued) FEDERAL MANAGEMENT REGULATION REAL....855 What happens if DOT does not submit an assignment recommendation? If DOT does not submit an...

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

Code of Federal Regulations, 2010 CFR

2010-07-01

... disposal agency receives the assignment recommendation from DOI? 102-75.665 Section 102-75.665 Public Contracts and Property Management Federal Property Management Regulations System (Continued) FEDERAL... assignment recommendation from DOI? If, after considering other uses for the property, the disposal agency...

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

PubMed

Ghannoum, Marc; Laliberté, Martin; Nolin, Thomas D; MacTier, Robert; Lavergne, Valery; Hoffman, Robert S; Gosselin, Sophie

2015-06-01

The EXtracorporeal TReatments In Poisoning (EXTRIP) workgroup presents its systematic review and clinical recommendations on the use of extracorporeal treatment (ECTR) in valproic acid (VPA) poisoning. The lead authors reviewed all of the articles from a systematic literature search, extracted the data, summarized the key findings, and proposed structured voting statements following a predetermined format. A two-round modified Delphi method was chosen to reach a consensus on voting statements and the RAND/UCLA Appropriateness Method was used to quantify disagreement. Anonymous votes were compiled, returned, and discussed in person. A second vote was conducted to determine the final workgroup recommendations. The latest literature search conducted in November 2014 retrieved a total of 79 articles for final qualitative analysis, including one observational study, one uncontrolled cohort study with aggregate analysis, 70 case reports and case series, and 7 pharmacokinetic studies, yielding a very low quality of evidence for all recommendations. Clinical data were reported for 82 overdose patients while pharmaco/toxicokinetic grading was performed in 55 patients. The workgroup concluded that VPA is moderately dialyzable (level of evidence = B) and made the following recommendations: ECTR is recommended in severe VPA poisoning (1D); recommendations for ECTR include a VPA concentration > 1300 mg/L (9000 μmol/L)(1D), the presence of cerebral edema (1D) or shock (1D); suggestions for ECTR include a VPA concentration > 900 mg/L (6250 μmol/L)(2D), coma or respiratory depression requiring mechanical ventilation (2D), acute hyperammonemia (2D), or pH ≤ 7.10 (2D). Cessation of ECTR is indicated when clinical improvement is apparent (1D) or the serum VPA concentration is between 50 and 100 mg/L (350-700 μmol/L)(2D). Intermittent hemodialysis is the preferred ECTR in VPA poisoning (1D). If hemodialysis is not available, then intermittent hemoperfusion (1D) or continuous renal replacement therapy (2D) is an acceptable alternative. VPA is moderately dialyzable in the setting of overdose. ECTR is indicated for VPA poisoning if at least one of the above criteria is present. Intermittent hemodialysis is the preferred ECTR modality in VPA poisoning.

Canadian Cardiovascular Society consensus conference recommendations on heart failure 2006: Diagnosis and management

PubMed Central

Arnold, J Malcolm O; Liu, Peter; Demers, Catherine; Dorian, Paul; Giannetti, Nadia; Haddad, Haissam; Heckman, George A; Howlett, Jonathan G; Ignaszewski, Andrew; Johnstone, David E; Jong, Philip; McKelvie, Robert S; Moe, Gordon W; Parker, John D; Rao, Vivek; Ross, Heather J; Sequeira, Errol J; Svendsen, Anna M; Teo, Koon; Tsuyuki, Ross T; White, Michel

2006-01-01

Heart failure remains a common diagnosis, especially in older individuals. It continues to be associated with significant morbidity and mortality, but major advances in both diagnosis and management have occurred and will continue to improve symptoms and other outcomes in patients. The Canadian Cardiovascular Society published its first consensus conference recommendations on the diagnosis and management of heart failure in 1994, followed by two brief updates, and reconvened this consensus conference to provide a comprehensive review of current knowledge and management strategies. New clinical trial evidence and meta-analyses were critically reviewed by a multidisciplinary primary panel who developed both recommendations and practical tips, which were reviewed by a secondary panel. The resulting document is intended to provide practical advice for specialists, family physicians, nurses, pharmacists and others who are involved in the care of heart failure patients. Management of heart failure begins with an accurate diagnosis, and requires rational combination drug therapy, individualization of care for each patient (based on their symptoms, clinical presentation and disease severity), appropriate mechanical interventions including revascularization and devices, collaborative efforts among health care professionals, and education and cooperation of the patient and their immediate caregivers. The goal is to translate best evidence-based therapies into clinical practice with a measureable impact on the health of heart failure patients in Canada. PMID:16450016

National resource for computation in chemistry, phase I: evaluation and recommendations

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

Not Available

1980-05-01

The National Resource for Computation in Chemistry (NRCC) was inaugurated at the Lawrence Berkeley Laboratory (LBL) in October 1977, with joint funding by the Department of Energy (DOE) and the National Science Foundation (NSF). The chief activities of the NRCC include: assembling a staff of eight postdoctoral computational chemists, establishing an office complex at LBL, purchasing a midi-computer and graphics display system, administering grants of computer time, conducting nine workshops in selected areas of computational chemistry, compiling a library of computer programs with adaptations and improvements, initiating a software distribution system, providing user assistance and consultation on request. This reportmore » presents assessments and recommendations of an Ad Hoc Review Committee appointed by the DOE and NSF in January 1980. The recommendations are that NRCC should: (1) not fund grants for computing time or research but leave that to the relevant agencies, (2) continue the Workshop Program in a mode similar to Phase I, (3) abandon in-house program development and establish instead a competitive external postdoctoral program in chemistry software development administered by the Policy Board and Director, and (4) not attempt a software distribution system (leaving that function to the QCPE). Furthermore, (5) DOE should continue to make its computational facilities available to outside users (at normal cost rates) and should find some way to allow the chemical community to gain occasional access to a CRAY-level computer.« less

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

PubMed

2012-04-06

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

Evaluation of an online family history tool for identifying hereditary and familial colorectal cancer.

PubMed

Kallenberg, F G J; Aalfs, C M; The, F O; Wientjes, C A; Depla, A C; Mundt, M W; Bossuyt, P M M; Dekker, E

2017-09-21

Identifying a hereditary colorectal cancer (CRC) syndrome or familial CRC (FCC) in a CRC patient may enable the patient and relatives to enroll in surveillance protocols. As these individuals are insufficiently recognized, we evaluated an online family history tool, consisting of a patient-administered family history questionnaire and an automated genetic referral recommendation, to facilitate the identification of patients with hereditary CRC or FCC. Between 2015 and 2016, all newly diagnosed CRC patients in five Dutch outpatient clinics, were included in a trial with a stepped-wedge design, when first visiting the clinic. Each hospital continued standard procedures for identifying patients at risk (control strategy) and then, after a predetermined period, switched to offering the family history tool to included patients (intervention strategy). After considering the tool-based recommendation, the health care provider could decide on and arrange the referral. Primary outcome was the relative number of CRC patients who received screening or surveillance recommendations for themselves or relatives because of hereditary CRC or FCC, provided by genetic counseling. The intervention effect was evaluated using a logit-linear model. With the tool, 46/489 (9.4%) patients received a screening or surveillance recommendation, compared to 35/292 (12.0%) in the control group. In the intention-to-treat-analysis, accounting for time trends and hospital effects, this difference was not statistically significant (p = 0.58). A family history tool does not necessarily assist in increasing the number of CRC patients and relatives enrolled in screening or surveillance recommendations for hereditary CRC or FCC. Other interventions should be considered.

Applications of asymptotic confidence intervals with continuity corrections for asymmetric comparisons in noninferiority trials.

PubMed

Soulakova, Julia N; Bright, Brianna C

2013-01-01

A large-sample problem of illustrating noninferiority of an experimental treatment over a referent treatment for binary outcomes is considered. The methods of illustrating noninferiority involve constructing the lower two-sided confidence bound for the difference between binomial proportions corresponding to the experimental and referent treatments and comparing it with the negative value of the noninferiority margin. The three considered methods, Anbar, Falk-Koch, and Reduced Falk-Koch, handle the comparison in an asymmetric way, that is, only the referent proportion out of the two, experimental and referent, is directly involved in the expression for the variance of the difference between two sample proportions. Five continuity corrections (including zero) are considered with respect to each approach. The key properties of the corresponding methods are evaluated via simulations. First, the uncorrected two-sided confidence intervals can, potentially, have smaller coverage probability than the nominal level even for moderately large sample sizes, for example, 150 per group. Next, the 15 testing methods are discussed in terms of their Type I error rate and power. In the settings with a relatively small referent proportion (about 0.4 or smaller), the Anbar approach with Yates' continuity correction is recommended for balanced designs and the Falk-Koch method with Yates' correction is recommended for unbalanced designs. For relatively moderate (about 0.6) and large (about 0.8 or greater) referent proportion, the uncorrected Reduced Falk-Koch method is recommended, although in this case, all methods tend to be over-conservative. These results are expected to be used in the design stage of a noninferiority study when asymmetric comparisons are envisioned. Copyright © 2013 John Wiley & Sons, Ltd.

Report of the IAU Working Group on Cartographic Coordinates and Rotational Elements: 2015

NASA Astrophysics Data System (ADS)

Archinal, B. A.; Acton, C. H.; A'Hearn, M. F.; Conrad, A.; Consolmagno, G. J.; Duxbury, T.; Hestroffer, D.; Hilton, J. L.; Kirk, R. L.; Klioner, S. A.; McCarthy, D.; Meech, K.; Oberst, J.; Ping, J.; Seidelmann, P. K.; Tholen, D. J.; Thomas, P. C.; Williams, I. P.

2018-03-01

This report continues the practice where the IAU Working Group on Cartographic Coordinates and Rotational Elements revises recommendations regarding those topics for the planets, satellites, minor planets, and comets approximately every 3 years. The Working Group has now become a "functional working group" of the IAU, and its membership is open to anyone interested in participating. We describe the procedure for submitting questions about the recommendations given here or the application of these recommendations for creating a new or updated coordinate system for a given body. Regarding body orientation, the following bodies have been updated: Mercury, based on MESSENGER results; Mars, along with a refined longitude definition; Phobos; Deimos; (1) Ceres; (52) Europa; (243) Ida; (2867) Šteins; Neptune; (134340) Pluto and its satellite Charon; comets 9P/Tempel 1, 19P/Borrelly, 67P/Churyumov-Gerasimenko, and 103P/Hartley 2, noting that such information is valid only between specific epochs. The special challenges related to mapping 67P/Churyumov-Gerasimenko are also discussed. Approximate expressions for the Earth have been removed in order to avoid confusion, and the low precision series expression for the Moon's orientation has been removed. The previously online only recommended orientation model for (4) Vesta is repeated with an explanation of how it was updated. Regarding body shape, text has been included to explain the expected uses of such information, and the relevance of the cited uncertainty information. The size of the Sun has been updated, and notation added that the size and the ellipsoidal axes for the Earth and Jupiter have been recommended by an IAU Resolution. The distinction of a reference radius for a body (here, the Moon and Titan) is made between cartographic uses, and for orthoprojection and geophysical uses. The recommended radius for Mercury has been updated based on MESSENGER results. The recommended radius for Titan is returned to its previous value. Size information has been updated for 13 other Saturnian satellites and added for Aegaeon. The sizes of Pluto and Charon have been updated. Size information has been updated for (1) Ceres and given for (16) Psyche and (52) Europa. The size of (25143) Itokawa has been corrected. In addition, the discussion of terminology for the poles (hemispheres) of small bodies has been modified and a discussion on cardinal directions added. Although they continue to be used for planets and their satellites, it is assumed that the planetographic and planetocentric coordinate system definitions do not apply to small bodies. However, planetocentric and planetodetic latitudes and longitudes may be used on such bodies, following the right-hand rule. We repeat our previous recommendations that planning and efforts be made to make controlled cartographic products; newly recommend that common formulations should be used for orientation and size; continue to recommend that a community consensus be developed for the orientation models of Jupiter and Saturn; newly recommend that historical summaries of the coordinate systems for given bodies should be developed, and point out that for planets and satellites planetographic systems have generally been historically preferred over planetocentric systems, and that in cases when planetographic coordinates have been widely used in the past, there is no obvious advantage to switching to the use of planetocentric coordinates. The Working Group also requests community input on the question submitting process, posting of updates to the Working Group website, and on whether recommendations should be made regarding exoplanet coordinate systems.

Aerospace Safety Advisory Panel

NASA Technical Reports Server (NTRS)

1992-01-01

The results of the Panel's activities are presented in a set of findings and recommendations. Highlighted here are both improvements in NASA's safety and reliability activities and specific areas where additional gains might be realized. One area of particular concern involves the curtailment or elimination of Space Shuttle safety and reliability enhancements. Several findings and recommendations address this area of concern, reflecting the opinion that safety and reliability enhancements are essential to the continued successful operation of the Space Shuttle. It is recommended that a comprehensive and continuing program of safety and reliability improvements in all areas of Space Shuttle hardware/software be considered an inherent component of ongoing Space Shuttle operations.

The Schizophrenia Patient Outcomes Research Team (PORT): updated treatment recommendations 2009.

PubMed

Kreyenbuhl, Julie; Buchanan, Robert W; Dickerson, Faith B; Dixon, Lisa B

2010-01-01

The Schizophrenia Patient Outcomes Research Team (PORT) project has played a significant role in the development and dissemination of evidence-based practices for schizophrenia. In contrast to other clinical guidelines, the Schizophrenia PORT Treatment Recommendations, initially published in 1998 and first revised in 2003, are based primarily on empirical data. Over the last 5 years, research on psychopharmacologic and psychosocial treatments for schizophrenia has continued to evolve, warranting an update of the PORT recommendations. In consultation with expert advisors, 2 Evidence Review Groups (ERGs) identified 41 treatment areas for review and conducted electronic literature searches to identify all clinical studies published since the last PORT literature review. The ERGs also reviewed studies preceding 2002 in areas not covered by previous PORT reviews, including smoking cessation, substance abuse, and weight loss. The ERGs reviewed over 600 studies and synthesized the research evidence, producing recommendations for those treatments for which the evidence was sufficiently strong to merit recommendation status. For those treatments lacking empirical support, the ERGs produced parallel summary statements. An Expert Panel consisting of 39 schizophrenia researchers, clinicians, and consumers attended a conference in November 2008 in which consensus was reached on the state of the evidence for each of the treatment areas reviewed. The methods and outcomes of the update process are presented here and resulted in recommendations for 16 psychopharmacologic and 8 psychosocial treatments for schizophrenia. Another 13 psychopharmacologic and 4 psychosocial treatments had insufficient evidence to support a recommendation, representing significant unmet needs in important treatment domains.

Extracorporeal treatment for thallium poisoning: recommendations from the EXTRIP Workgroup.

PubMed

Ghannoum, Marc; Nolin, Thomas D; Goldfarb, David S; Roberts, Darren M; Mactier, Robert; Mowry, James B; Dargan, Paul I; Maclaren, Robert; Hoegberg, Lotte C; Laliberté, Martin; Calello, Diane; Kielstein, Jan T; Anseeuw, Kurt; Winchester, James F; Burdmann, Emmanuel A; Bunchman, Timothy E; Li, Yi; Juurlink, David N; Lavergne, Valery; Megarbane, Bruno; Gosselin, Sophie; Liu, Kathleen D; Hoffman, Robert S

2012-10-01

The EXtracorporeal TReatments In Poisoning (EXTRIP) workgroup was formed to provide recommendations on the use of extracorporeal treatment (ECTR) in poisoning. To test and validate its methods, the workgroup reviewed data for thallium (Tl). After an extensive search, the co-chairs reviewed the articles, extracted the data, summarized findings, and proposed structured voting statements following a predetermined format. A two-round modified Delphi method was chosen to reach a consensus on voting statements and RAND/UCLA Appropriateness Method to quantify disagreement. Blinded votes were compiled, returned, and discussed during a conference call. A second vote determined the final recommendations. Forty-five articles met inclusion criteria. Only case reports and case series were identified, yielding a very low quality of evidence for all recommendations. Data on 74 patients, including 11 who died, were abstracted. The workgroup concluded that Tl is slightly dialyzable and made the following recommendations: ECTR is recommended in severe Tl poisoning (1D). ECTR is indicated if Tl exposure is highly suspected on the basis of history or clinical features (2D) or if the serum Tl concentration is >1.0 mg/L (2D). ECTR should be initiated as soon as possible, ideally within 24-48 hours of Tl exposure (1D), and be continued until the serum Tl concentration is <0.1 mg/L for a minimal duration of 72 hours (2D). Despite Tl's low dialyzability and the limited evidence, the workgroup strongly recommended extracorporeal removal in the case of severe Tl poisoning.

Surveying Lactation Professionals Regarding Marijuana Use and Breastfeeding.

PubMed

Bergeria, Cecilia L; Heil, Sarah H

2015-09-01

Breastfeeding is associated with substantial benefits for both the child and mother. Most guidelines state that women who use illicit drugs should not breastfeed. Although this recommendation has traditionally included marijuana, this drug's changing legal status and the limited scientific research regarding marijuana's effect on breastfeeding and the nursing child may lead to varying recommendations made by lactation professionals to clients who use marijuana. Additionally, to our knowledge, there are no data estimating the prevalence of marijuana use among breastfeeding women, making it unclear how common it is. This study assessed recommendations around breastfeeding and marijuana use and estimated the prevalence of marijuana use among breastfeeding women. A convenience sample of lactation professionals who practice throughout New England and were attending the 2014 Vermont Lactation Consultant Association conference was offered the opportunity to complete a five-item survey. Of 120 conference attendees, 74 completed the survey. Forty-four percent reported their recommendations around breastfeeding and marijuana use depended on factors like the severity of maternal use. Another 41% reported recommending continued breastfeeding because the benefits outweigh the harms. The remaining 15% reported recommending that a woman should stop breastfeeding if she cannot stop using marijuana. Survey completers estimated that 15% (1,203/7,843) of their breastfeeding clients in the past year used marijuana. Lactation professionals vary widely in their recommendations to breastfeeding clients who use marijuana. The estimate of prevalence also suggests this is a relatively common issue. More research is needed to assess the generalizability of these findings.

Chapter 4. Manpower. Recommendations and standard operating procedures for intensive care unit and hospital preparations for an influenza epidemic or mass disaster.

PubMed

Sandrock, Christian

2010-04-01

To provide recommendations and standard operating procedures (SOPs) for intensive care unit (ICU) and hospital preparations for an influenza pandemic or mass disaster with a specific focus on manpower. Based on a literature review and expert opinion, a Delphi process was used to define the essential topics including manpower. Key recommendations include: (1) plan to access, coordinate and increase labor resources for continued and expanded ICU care including increasing critical care specialists and expanded practice for non-critical care personnel; (2) develop an education, awareness, preparation and communication program to ensure a well-protected and prepared workforce with coordinated rapid manpower expansion; (3) maintain a central inventory of all clinical and non-clinical staff with their current roles along with possible emergency re-training possibilities; (4) coordinate all clinical and non-clinical staffing requirements and determine the hospital's daily needs including a sick and no-show list together with ICU requirements; (5) provide clinical care to patients only with clinical staff and not with non-clinical staff; (6) delegate duties not within the scope of workers' practice under crisis conditions with proper supervision and support from experienced clinicians to ensure patient safety; (7) intensivists should supervise nonintensivist physicians to expand the workforce if patient surge exceeds the number of available ICU-trained specialists. Judicious planning and adoption of protocols for providing adequate manpower are necessary to optimize outcomes during a pandemic.

Many Mobile Health Apps Target High-Need, High-Cost Populations, But Gaps Remain.

PubMed

Singh, Karandeep; Drouin, Kaitlin; Newmark, Lisa P; Lee, JaeHo; Faxvaag, Arild; Rozenblum, Ronen; Pabo, Erika A; Landman, Adam; Klinger, Elissa; Bates, David W

2016-12-01

With rising smartphone ownership, mobile health applications (mHealth apps) have the potential to support high-need, high-cost populations in managing their health. While the number of available mHealth apps has grown substantially, no clear strategy has emerged on how providers should evaluate and recommend such apps to patients. Key stakeholders, including medical professional societies, insurers, and policy makers, have largely avoided formally recommending apps, which forces patients to obtain recommendations from other sources. To help stakeholders overcome barriers to reviewing and recommending apps, we evaluated 137 patient-facing mHealth apps-those intended for use by patients to manage their health-that were highly rated by consumers and recommended by experts and that targeted high-need, high-cost populations. We found that there is a wide variety of apps in the marketplace but that few apps address the needs of the patients who could benefit the most. We also found that consumers' ratings were poor indications of apps' clinical utility or usability and that most apps did not respond appropriately when a user entered potentially dangerous health information. Going forward, data privacy and security will continue to be major concerns in the dissemination of mHealth apps. Project HOPE—The People-to-People Health Foundation, Inc.

Proceedings of the AMCP Partnership Forum: Breaking the Link Between Pain Management and Opioid Use Disorder.

PubMed

2015-12-01

Prescription drug misuse and abuse, especially with opioid analgesics, is the fastest growing drug problem in the United States. Addressing this public health crisis demands the coordinated efforts and actions of all stakeholders to establish a process of improving patient care and decreasing misuse and abuse. On September 9, 2014, the Academy of Managed Care Pharmacy (AMCP) convened a meeting of multiple stakeholders to recommend activities and programs that AMCP can promote to improve pain management, prevent opioid use disorder (OUD), and improve medication-assisted treatment outcomes. The speakers and panelists recommended that efforts to improve pain management outcomes and reduce the potential for OUD should rely on demonstrated evidence and best practices. It was recommended that AMCP promote a more holistic and evidence-based approach to pain management and OUD treatment that actively engages the patient in the decision-making process and includes care coordination with medical, pharmacy, behavioral, and mental health aspects of organizations, all of which is seamlessly supported by a technology infrastructure. To accomplish this, it was recommended that AMCP work to collaborate with organizations representing these stakeholders. Additionally, it was recommended that AMCP conduct continuing pharmacy education programs, develop a best practices toolkit on pain management, and actively promote quality standards for OUD prevention and treatment.

Improved sexual history taking in the 2012 BASHH asymptomatic screening re-audit.

PubMed

Menon-Johansson, A S; McClean, H; Carne, C A; Estreich, S; Knapper, C; Sethi, G; Smith, A; Sullivan, A K

2014-04-01

Effective asymptomatic screening for sexually transmitted infections is an important public health service because a significant proportion of sexually transmitted infections do not present with symptoms. In 2009, the National Audit Group of the British Association of Sexual Health and HIV (BASHH) audited the management of asymptomatic patients and recommended increased documentation about oral and anal sex, regional strategies for nucleic acid amplification test (NAAT) use for gonorrhoea, improved screening for hepatitis B in men who have sex with men and an increase in screening for HIV. The 2012 audit used web-based forms to collect submissions from 180 consultant-led centres (65% response rate) that included episodes of care from 6669 asymptomatic patients. An improvement was demonstrated for all the areas measured during the 2009 audit. A doubling of gonorrhoea testing using NAATs was seen and yet 10% of asymptomatic patients continued to have microscopy despite these tests not being recommended by BASHH guidelines. This audit recommends universal adoption of gonorrhoea NAATs across the United Kingdom.

Hemodialysis and Water Quality

PubMed Central

Coulliette, Angela D.; Arduino, Matthew J.

2015-01-01

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

Standard operating procedures for female orgasmic disorder: consensus of the International Society for Sexual Medicine.

PubMed

Laan, Ellen; Rellini, Alessandra H; Barnes, Tricia

2013-01-01

As the field of sexual medicine evolves, it is important to continually improve patient care by developing contemporary "standard operating procedures" (SOPs), reflecting the consensus view of experts in sexual medicine. Few, if any, consensus SOPs have been developed for the diagnosis and treatment of Female Orgasmic Disorder (FOD). The objective is to provide standard operating procedures for FOD. The SOP Committee was composed of a chair, selected by the International Society for the Study of Sexual Medicine, and two additional experts. To inform its key recommendations, the Committee used systematic reviews of available evidence and discussions during a group meeting, conference calls and e-mail communications. The Committee received no corporate funding or remuneration. A total of 12 recommendations for the assessment and treatment of FOD were generated, including suggestions for further research. Evidence-based, practice recommendations for the treatment of FOD are provided that will hopefully inform clinical decision making for those treating this common condition. © 2012 International Society for Sexual Medicine.

[Vaccination schedule of the Spanish Association of Pediatrics: recommendations 2005].

PubMed

2005-02-01

The Advisory Committee on Vaccines of the Spanish Association of Pediatrics provides information and comments on the new developments in vaccines that have taken place in 2004 and recommends a few modifications to the Immunization Schedule for 2005. Concerning the meningococcal C vaccine, no change is made to the possibility of administering two doses for the first vaccination with one of the available formulations. The existence of immunization failure in children who have received a first vaccination with three vaccine doses before the age of 12 months is discussed, and the health authorities will probably include a booster dose in the second year of life throughout 2005. The recommendations of the European Medicines Evaluation Agency (EMEA) on hexavalent vaccines continue to be valid and consequently the use of these vaccines should not be stopped. This year the need for adolescents to receive a booster dose of the pertussis vaccine, with administration of an acellular, low antigenic load preparation together with the adult diphtheria and tetanus vaccine is stressed.

Changing therapeutic paradigms in CMV retinitis in AIDS.

PubMed

Piper, H; Ciulla, T A; Danis, R P; Pratt, L M

2000-12-01

Cytomegalovirus (CMV) retinitis is a common ocular complication of immunosuppression. The management of CMV retinitis has been continuously evolving over the last decade. The mainstay of therapy remains ganciclovir and foscarnet. However, increasing resistance and ongoing toxicities to these agents remain a challenge. Additional frequently utilised agents include cidofovir and fomivirsen. The advent of highly active antiretroviral therapy (HAART) has allowed the restoration of immunocompetency to many patients previously challenged by CMV infection. In some circumstances, HAART has even eliminated the need for ongoing antiviral therapy. This paper reviews the current treatment modalities, including their toxicities and dosing recommendations.

Society of Behavioral Medicine (SBM) position statement: SBM urges Congress to preserve and extend funding for Medicaid services.

PubMed

Behrman, Pamela; Demirci, Jill; Yanez, Betina; Beharie, Nisha; Laroche, Helena

2018-05-08

In May 2017, the Trump administration proposed steep cuts to Medicaid funding. This proposal was met with bipartisan criticism, as this program provides vital healthcare coverage for vulnerable children, adults, and families, including those living below the federal poverty line. In addition to the proposed funding cuts, federally authorized state restrictions to Medicaid access (e.g., work requirements) have been proposed, putting the Medicaid coverage of scores of enrollees at risk. Overwhelming health costs from inadequate or absent insurance are found to contribute to financial problems, including bankruptcy. Financial strain, in turn, is related to serious and life-threatening health problems in both children and adults. Given these impacts, the Society of Behavioral Medicine (SBM) urges Congress to protect and extend Medicaid funding. To maintain subscriber access, SBM recommends that Congress continue to use percentage rather than block funding determinants and eliminate states' authority to enforce program qualification requirements, including work provisions and stipulations for locking out subscribers who do not pay their premiums on time. It is also recommended that Congress increase and improve the scope and quality of reporting Medicaid's evidence base. This could be achieved through regular evaluations, focusing on Medicaid's impact on the health and economic well-being of its participants. SBM further recommends efforts to increase the public's awareness of and participation in Medicaid for eligible individuals, children, and families.

Developing dimensions for a multicomponent multidisciplinary approach to obesity management: a qualitative study.

PubMed

Cochrane, Anita J; Dick, Bob; King, Neil A; Hills, Andrew P; Kavanagh, David J

2017-10-16

There have been consistent recommendations for multicomponent and multidisciplinary approaches for obesity management. However, there is no clear agreement on the components, disciplines or processes to be considered within such an approach. In this study, we explored multicomponent and multidisciplinary approaches through an examination of knowledge, skills, beliefs, and recommendations of stakeholders involved in obesity management. These stakeholders included researchers, practitioners, educators, and patients. We used qualitative action research methods, including convergent interviewing and observation, to assist the process of inquiry. The consensus was that a multicomponent and multidisciplinary approach should be based on four central meta-components (patient, practitioner, process, and environmental factors), and specific components of these factors were identified. Psychologists, dieticians, exercise physiologists and general practitioners were nominated as key practitioners to be included. A complex condition like obesity requires that multiple components be addressed, and that both patients and multiple disciplines are involved in developing solutions. Implementing cycles of continuous improvement to deal with complexity, instead of trying to control for it, offers an effective way to deal with complex, changing multisystem problems like obesity.

41 CFR 102-83.45 - Where may Executive agencies find guidance on appealing GSA's decisions and recommendations...

Code of Federal Regulations, 2010 CFR

2010-07-01

... agencies find guidance on appealing GSA's decisions and recommendations concerning delineated areas? 102-83... System (Continued) FEDERAL MANAGEMENT REGULATION REAL PROPERTY 83-LOCATION OF SPACE Location of Space... recommendations concerning delineated areas? GSA's PBS provides guidance in its Customer Guide to Real Property on...

41 CFR 102-75.860 - What happens after the disposal agency receives the assignment recommendation from DOT?

Code of Federal Regulations, 2010 CFR

2010-07-01

... disposal agency receives the assignment recommendation from DOT? 102-75.860 Section 102-75.860 Public Contracts and Property Management Federal Property Management Regulations System (Continued) FEDERAL... recommendation from DOT? If, after considering other uses for the property, the disposal agency approves the...

50 CFR 18.90 - Recommended decision, certification of the transcript and submission of comments on the...

Code of Federal Regulations, 2010 CFR

2010-10-01

... 50 Wildlife and Fisheries 6 2010-10-01 2010-10-01 false Recommended decision, certification of the transcript and submission of comments on the recommended decision. 18.90 Section 18.90 Wildlife and Fisheries..., TRANSPORTATION, SALE, PURCHASE, BARTER, EXPORTATION, AND IMPORTATION OF WILDLIFE AND PLANTS (CONTINUED) MARINE...

Decrease in varicella incidence after implementation of the 2-dose recommendation for varicella vaccine in New Hampshire.

PubMed

Daly, Elizabeth R; Anderson, Ludmila; Dreisig, John; Dionne-Odom, Jodie

2013-09-01

Varicella is a common infectious disease, for which 2-dose vaccination was recommended in 2006. Varicella case and vaccination data in New Hampshire were analyzed to assess impact of this recommendation on disease incidence and clinical characteristics. Varicella incidence decreased after the 2-dose recommendation, with greatest reductions in ages 5-19 years. Continued vaccination efforts should further reduce disease.

Full Spectrum Information Operations and the Information Professional Officer Intermediate Qualification Process: Filling the Gap to Ensure the Continued Leadership of the Information Professional Community in the Area of Information Dominance

DTIC Science & Technology

2005-09-01

information dominance . This thesis provides recommended line items for injection into the IP IQ in the appropriate format with discussions and definitions that address the specific line items. The thesis also provides further recommendations for the continuing improvement and refinement of the IP qualification process, especially in the area of

Recommendations and Ongoing Efforts within the NASA Data Quality Working Group

NASA Astrophysics Data System (ADS)

Moroni, D. F.; Ramapriyan, H.; Bagwell, R.; Downs, R. R.

2015-12-01

Since its inception in March 2014, the NASA Data Quality Working Group (DQWG) has procured a set of 12 high level recommendations which had been sifted from and aggregated from a prioritized subset of nearly 100 unique recommendations spanning four unique data quality management phases and distributed between two actionable categories. The four data quality management phases as identified by the DQWG are: 1. Capturing (i.e., deriving, collecting and organizing the information), 2. Describing (i.e., documenting and procuring the information for public consumption), 3. Facilitating Discovery (i.e., publishing and providing access to the information), and 4. Enabling Use (i.e., enhancing the utility of the information). Mapping each of our recommendations to one or more of the above management phases is intended to enable improved assessment of cost, feasibility, and relevancy to the entities responsible for implementing such recommendations. The DQWG further defined two distinct actionable categories: 1) Data Systems and 2) Science. The purpose of these actionable categories is to define specifically who is responsible for the implementation and adherence toward these recommendations; we refer to the responsible entities as the "actionees". Here we will summarize each of the high level recommendations along with their corresponding management phases and actionees. We will present what has recently been identified as our set of "low-hanging fruit" recommendations, which are intended for near-term implementation. Finally, we will present the status and motivation for continuing and future planned activities, which include but are not limited to: engaging inter-agency and international communities, more direct feedback from Earth observation missions, and mapping of "low-hanging fruit" recommendations to existing solutions.

Still Searching: A Meta-Synthesis of a Good Death from the Bereaved Family Member Perspective

PubMed Central

Tenzek, Kelly E.; Depner, Rachel

2017-01-01

The concept of a good death continues to receive attention in end-of-life (EOL) scholarship. We sought to continue this line of inquiry related to a good death by conducting a meta-synthesis of published qualitative research studies that examined a good death from the bereaved family member’s perspective. Results of the meta-synthesis included 14 articles with 368 participants. Based on analysis, we present a conceptual model called The Opportunity Model for Presence during the EOL Process. The model is framed in socio-cultural factors, and major themes include EOL process engagement with categories of healthcare participants, communication and practical issues. The second theme, (dis)continuity of care, includes categories of place of care, knowledge of family member dying and moment of death. Both of these themes lead to perceptions of either a good or bad death, which influences the bereavement process. We argue the main contribution of the model is the ability to identify moments throughout the interaction where family members can be present to the EOL process. Recommendations for healthcare participants, including patients, family members and clinical care providers are offered to improve the quality of experience throughout the EOL process and limitations of the study are discussed. PMID:28441339

A Quality Model to Select Patients in Cupping Therapy Clinics: A New Tool for Ensuring Safety in Clinical Practice.

PubMed

Aboushanab, Tamer; AlSanad, Saud

2018-06-08

Cupping therapy is a popular treatment in various countries and regions, including Saudi Arabia. Cupping therapy is regulated in Saudi Arabia by the National Center for Complementary and Alternative Medicine (NCCAM), Ministry of Health. The authors recommend that this quality model for selecting patients in cupping clinics - first version (QMSPCC-1) - be used routinely as part of clinical practice and quality management in cupping clinics. The aim of the quality model is to ensure the safety of patients and to introduce and facilitate quality and auditing processes in cupping therapy clinics. Clinical evaluation of this tool is recommended. Continued development, re-evaluation and reassessment of this tool are important. Copyright © 2018. Published by Elsevier B.V.

Policy considerations for improving influenza vaccination rates among pregnant women.

PubMed

Mollard, Elizabeth K; Guenzel, Nicholas; Brown, Peggy A; Keeler, Heidi J; Cramer, Mary E

2014-01-01

Influenza exposure during pregnancy can cause severe health problems for both the mother and her offspring, including an increased risk of mortality. Influenza vaccination during all trimesters of pregnancy is safe and effective, and recommended by professional organizations such as the American College of Obstetrics and Gynecology. Despite these recommendations, the U.S. vaccination rates remain low in this high-risk population. A policy analysis based on the five-part method identified by Teitelbaum and Wilensky () addresses factors to consider in identifying the best voluntary policy options to improve the vaccination rates. The authors provide discussion of the background, landscape, and stakeholder interests and the pros and cons of two voluntary policy options to increase vaccination. The policy options include: (a) financial incentives for providers and (b) an education emphasis for providers and staff. The authors conclude that based on considerations of cost, provider preference, and practicality of implementation, a continuing educational intervention is the preferred policy venue to increase vaccination rates. © 2014 Wiley Periodicals, Inc.

Children's need for favorable acoustics in schools

NASA Astrophysics Data System (ADS)

Nelson, Peggy B.

2003-10-01

Children continue to improve their understanding of speech in noise and reverberation throughout childhood and adolescence. They do not typically achieve adult performance levels until their late teenage years. As a result, schools that are designed to be acoustically adequate for adult understanding may be insufficient for full understanding by young children. In addition, children with hearing loss, those with attention problems, and those learning in a non-native language require even more favorable signal-to-noise ratios. This tutorial will review the literature gathered by the ANSl/ASA working group on classroom acoustics that shaped the recommendations of the working group. Special topics will include speech perception data from typically developing infants and children, from children with hearing loss, and from adults and children listening in a non-native language. In addition, the tutorial will overview recommendations contained within ANSI standard 12.60-2002: Acoustical Performance Criteria, Design Requirements, and Guidelines for Schools. The discussion will also include issues related to designing quiet classrooms and working with local schools and professionals.

Environmental parameters of the Tennessee River in Alabama. 1: Thermal stratification

NASA Technical Reports Server (NTRS)

Rosing, L. M.

1976-01-01

Thermal stratification data of a transect across Wheeler Reservoir are correlated with the climatological data at the time of sampling. This portion of the Tennessee River is used as a heat sink for the effluent from the three reactor Browns Ferry Nuclear Power Plant. The transect sampling line is 1.3 miles below this point of effluence. Data are presented by weekly samplings for one year prior to plant operations. Post-operational data are presented with one reactor in operation and with two reactors in partial operation. Data gathering was terminated when the plant ceased operations. The results indicate that the effluent for partial plant operation were inconclusive. As a result, recommendations include continuing the sampling when the plant resumes operation at full capacity. Recommendations also include developing math models with the presented thermal and climatological data to be used for predicting the effluent impact in the river with varying climatological conditions and also to predict the effectiveness of the cooling towers.

MIDAS: Lessons learned from the first spaceborne atomic force microscope

NASA Astrophysics Data System (ADS)

Bentley, Mark Stephen; Arends, Herman; Butler, Bart; Gavira, Jose; Jeszenszky, Harald; Mannel, Thurid; Romstedt, Jens; Schmied, Roland; Torkar, Klaus

2016-08-01

The Micro-Imaging Dust Analysis System (MIDAS) atomic force microscope (AFM) onboard the Rosetta orbiter was the first such instrument launched into space in 2004. Designed only a few years after the technique was invented, MIDAS is currently orbiting comet 67P Churyumov-Gerasimenko and producing the highest resolution 3D images of cometary dust ever made in situ. After more than a year of continuous operation much experience has been gained with this novel instrument. Coupled with operations of the Flight Spare and advances in terrestrial AFM a set of "lessons learned" has been produced, cumulating in recommendations for future spaceborne atomic force microscopes. The majority of the design could be reused as-is, or with incremental upgrades to include more modern components (e.g. the processor). Key additional recommendations are to incorporate an optical microscope to aid the search for particles and image registration, to include a variety of cantilevers (with different spring constants) and a variety of tip geometries.

A Recommendation on SLR Ranging to Future Global Navigation Satellite Systems

NASA Astrophysics Data System (ADS)

Labrecque, J. L.; Miller, J. J.; Pearlman, M.

2008-12-01

The multi-agency US Geodetic Requirements Working Group has recommended that Satellite Laser Retro- reflectors be installed on GPS III satellites as a principal component of the Positioning, Navigation, and Timing mandate of the Global Positioning System. The Working Group, which includes NASA, NGA, NOAA, NRL, USGS, and the USNO, echoes the Global Geodetic Observing System recommendation that SLR retro- reflectors be installed on all GNSS satellites. It is further recommended that the retro-reflectors conform to and hopefully exceed the minimum standard of the International Laser Ranging Service for retro-reflector cross sections of 100 million square meters for the HEO GNSS satellites to insure sufficiently accurate ranging by the global network of satellite laser ranging systems. The objective of this recommendation is to contribute to the improvement in the International Terrestrial Reference Frame, and its derivative the WGS84 reference frame, through continuing improvements in the characterization of the GPS orbits and clocks. Another objective is to provide an independent means of assessing the interoperability and accuracy of the GNSS systems and regional augmentation systems. The ranging to GNSS-mounted retro-reflectors will constitute a significant new means of space-based collocation to constrain the tie between the GPS and SLR networks that constitute over 50% of the data from which the ITRF is derived. The recommendation for the installation of SLR retro-reflectors aboard future GPS satellites is one of a number of efforts aimed at improving the accuracy and stability of ITRF. These steps are being coordinated with and supportive of the efforts of the GGOS and its services such at the VLBI2010 initiative, developing a next generation geodetic network, near real-time GPS positioning and EOP determination, and numerous efforts in the improvement of geodetic algorithms for GPS, SLR, VLBI, DORIS, and the determination of the ITRF. If past is prologue, the requirements of accuracy placed upon GNSS systems will continue to evolve at a factor of ten per decade for the lifetime of the GPS III, extending to 2025 and beyond. Global societal priorities such as sea level change measurement already require a factor of ten or more improvement in the accuracy and stability of the ITRF. Increasing accuracy requirements by civilian users for precision positioning and time keeping will certainly continue to grow at an exponential rate. The PNT accuracy of our GNSS systems will keep pace with these societal needs only if we equip the GNSS systems with the capability to identify and further reduce systematic errors.

Proceedings of second Indian GAME conference, Mumbai, February, 2016.

PubMed

Srivastava, Vaibhav; Stevenson, Robin; Sanghvi, Shwetal

2016-01-01

The second Indian Global Alliance for Medical Education (GAME) conference on continuing medical education-continuing professional development (CME-CPD) was held in Mumbai in February 2016. The main aim of the meeting was to create a blueprint for further development of CME in India based on best practices from around the world. To that end, delegates had been invited from the USA, the UK and Australasia, who engaged in productive discussions with the major stakeholders of the CME community in India. The latter included clinicians, medical communications representatives and delegates from the pharmaceutical industry. The mandatory CME system already established in Maharashtra was described as an example, which could be exported to other states. The various types of accreditation were discussed, including provider and activity accreditation along with hybrid systems. Recommendations for future development were proposed from workshops comprising clinicians, industry representatives and medical communications agencies.

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

PubMed

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

2015-09-18

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

International Parkinson and movement disorder society evidence-based medicine review: Update on treatments for the motor symptoms of Parkinson's disease.

PubMed

Fox, Susan H; Katzenschlager, Regina; Lim, Shen-Yang; Barton, Brandon; de Bie, Rob M A; Seppi, Klaus; Coelho, Miguel; Sampaio, Cristina

2018-03-23

The objective of this review was to update evidence-based medicine recommendations for treating motor symptoms of Parkinson's disease (PD). The Movement Disorder Society Evidence-Based Medicine Committee recommendations for treatments of PD were first published in 2002 and updated in 2011, and we continued the review to December 31, 2016. Level I studies of interventions for motor symptoms were reviewed. Criteria for inclusion and quality scoring were as previously reported. Five clinical indications were considered, and conclusions regarding the implications for clinical practice are reported. A total of 143 new studies qualified. There are no clinically useful interventions to prevent/delay disease progression. For monotherapy of early PD, nonergot dopamine agonists, oral levodopa preparations, selegiline, and rasagiline are clinically useful. For adjunct therapy in early/stable PD, nonergot dopamine agonists, rasagiline, and zonisamide are clinically useful. For adjunct therapy in optimized PD for general or specific motor symptoms including gait, rivastigmine is possibly useful and physiotherapy is clinically useful; exercise-based movement strategy training and formalized patterned exercises are possibly useful. There are no new studies and no changes in the conclusions for the prevention/delay of motor complications. For treating motor fluctuations, most nonergot dopamine agonists, pergolide, levodopa ER, levodopa intestinal infusion, entacapone, opicapone, rasagiline, zonisamide, safinamide, and bilateral STN and GPi DBS are clinically useful. For dyskinesia, amantadine, clozapine, and bilateral STN DBS and GPi DBS are clinically useful. The options for treating PD symptoms continues to expand. These recommendations allow the treating physician to determine which intervention to recommend to an individual patient. © 2018 International Parkinson and Movement Disorder Society. © 2018 International Parkinson and Movement Disorder Society.

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

PubMed

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

2015-08-01

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

EPA guidance on building trust in mental health services.

PubMed

Gaebel, W; Muijen, M; Baumann, A E; Bhugra, D; Wasserman, D; van der Gaag, R J; Heun, R; Zielasek, J

2014-02-01

To advance mental health care use by developing recommendations to increase trust from the general public and patients, those who have been in contact with services, those who have never been in contact and those who care for their families in the mental health care system. We performed a systematic literature search and the retrieved documents were evaluated by two independent reviewers. Evidence tables were generated and recommendations were developed in an expert and stakeholder consensus process. We developed five recommendations which may increase trust in mental health care services and advance mental health care service utilization. Trust is a mutual, complex, multidimensional and dynamic interrelationship of a multitude of factors. Its components may vary between individuals and over time. They may include, among others, age, place of residence, ethnicity, culture, experiences as a service user, and type of disorder. For mental health care services, issues of knowledge about mental health services, confidentiality, continuity of treatment, dignity, safety and avoidance of stigma and coercion are central elements to increase trust. Evidence-based recommendations to increase mutual trust of service users and psychiatrists have been developed and may help to increase mental health care service utilization. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

CONTINUOUS AND SEMI-CONTINUOUS METHODS FOR PM MASS AND COMPOSITION

EPA Science Inventory

This article is a review of the status of continuous and semi-continuous methods for PM mass and composition based on results from EPA's PM Supersites Program and related studies. It summarizes recommendations suggested by Solomon and Sioutas (2006 submitted to the J. Air and Wa...

Membrane Transport Phenomena (MTP)

NASA Technical Reports Server (NTRS)

Mason, Larry W.

1997-01-01

The activities during the fourth semi-annual period of the MTP project have involved the completion of the Science Concept Review (SCR) presentation and peer review, continuation of analyses for the mass transfer coefficients measured from MTA experiment data, and development of the second generation (MTP-II) instrument. The SCR panel members were generated several recommendations for the MTP project recommendations are : Table 1 Summary of Primary SCR Panel Recommendations (1) Continue and refine development of mass transfer coefficient analyses (2) Refine and upgrade analytical modeling associated with the MTP experiment. (3) Increase resolution of measurements in proximity of the membrane interface. (4) Shift emphasis to measurement of coupled transport effects (i.e., development of MTP phase II experiment concept).

Improving the Financial Aid Delivery Process and the Federal Family Education Loan Program: Program Recommendations.

ERIC Educational Resources Information Center

Coalition for Student Loan Reform, Washington, DC.

This publication presents a set of eight recommended reforms and improvements for delivering financial aid to postsecondary students especially the Federal Family Education Loan Program (FFELP). The recommendations are: (1) make applying for student aid simpler for students; (2) assure the continued availability of a dependable, reliable source of…

Building Leadership Skills and Promoting Workforce Development: Evaluation Data Collected from Public Health Professionals in the Field of Maternal and Child Health

PubMed Central

Kasehagen, Laurin; Barradas, Danielle T.; ‘Ali, Zarinah

2015-01-01

Professional development, including training and leadership skill building, is important for maternal and child health (MCH) epidemiologists. Current workforce development and training opportunities vary, but lack an emphasis on linking leadership competencies with MCH epidemiology. This paper describes efforts at the annual MCH Epidemiology Conference (the “Conference”) to promote leadership activities and workforce development, and recommendations to enhance professional development. An evaluation of attendee opinions on Conference workforce development activities was conducted during the 2009 and 2010 Conferences (70 and 66 % response rates, respectively). Frequencies and percentages were calculated overall and by attendee profession. Qualitative responses to questions regarding workforce and professional development were classified by theme in 2009, and a categorical question was developed for the 2010 evaluation. A combined 38 % of Conference attendees in 2009 and 2010 were MCH epidemiologists and 62 % were other MCH professionals. Attendees recommended more support and access to training, mentoring, and resources including job opportunities. Continuing education (41 %), special knowledge and skills-building training (51 %), and development of online resources for training (57 %) were highly recommended by attendees. Career (47 %) and leadership (49 %) mentoring by senior-level professionals in the field were also highly recommended. Promotion of leadership can be achieved by integrating the concept of leadership into the Conference itself; by publishing and disseminating MCH epidemiologic research in scientific, program, and policy settings; and by communicating the importance of epidemiologic findings to stakeholders and other non-scientific audiences. PMID:22923283

Geosynchronous Microwave Atmospheric Sounding Radiometer (MASR) feasibility studies. Volume 1: Management summary

NASA Technical Reports Server (NTRS)

1978-01-01

The mission of the microwave atmospheric sounding radiometer (MASR) is to collect data to aid in the observation and prediction of severe storms. The geosynchronous orbit allows the continuous atmospheric measurement needed to resolve mesoscale dynamics. The instrument may operate in conjunction with this document, Volume 1 - Management, which summarizes the highlights of final reports on both the radiometer instrument and antenna studies. The radiometer instrument summary includes a synopsis of Volume 2 - Radiometer Receiver Feasibility, including design, recommended configuration, performance estimates, and weight and power estimates. The summary of the antenna study includes a synopsis of Volume 3 - Antenna Feasibility, including preliminary design tradeoffs, performance of selected design, and details of the mechanical/thermal design.

Veterans Health Administration's Disaster Emergency Medical Personnel System (DEMPS) Training Evaluation: Potential Implications for Disaster Health Care Volunteers.

PubMed

Schmitz, Susan; Radcliff, Tiffany A; Chu, Karen; Smith, Robert E; Dobalian, Aram

2018-02-20

The US Veterans Health Administration's Disaster Emergency Medical Personnel System (DEMPS) is a team of employee disaster response volunteers who provide clinical and non-clinical staffing assistance when local systems are overwhelmed. This study evaluated attitudes and recommendations of the DEMPS program to understand the impact of multi-modal training on volunteer perceptions. DEMPS volunteers completed an electronic survey in 2012 (n=2120). Three training modes were evaluated: online, field exercise, and face-to-face. Measures included: "Training Satisfaction," "Attitudes about Training," "Continued Engagement in DEMPS." Data were analyzed using χ2 and logistic regression. Open-ended questions were evaluated in a manner consistent with grounded theory methodology. Most respondents participated in DEMPS training (80%). Volunteers with multi-modal training who completed all 3 modes (14%) were significantly more likely to have positive attitudes about training, plan to continue as volunteers, and would recommend DEMPS to others (P-value<0.001). Some respondents requested additional interactive activities and suggested increased availability of training may improve volunteer engagement. A blended learning environment using multi-modal training methods, could enhance satisfaction and attitudes and possibly encourage continued engagement in DEMPS or similar programs. DEMPS training program modifications in 2015 expanded this blended learning approach through new interactive online learning opportunities. (Disaster Med Public Health Preparedness. 2018; page 1 of 8).

Community pharmacists' services for women during pregnancy and breast feeding in Kuwait: a cross-sectional study.

PubMed

Albassam, Abdullah; Awad, Abdelmoneim

2018-01-05

This study was designed to identify the services provided by community pharmacists in Kuwait and their views regarding self-care in pregnancy and lactation. In addition, it determined the pharmacists' recommendations for treatment of pregnancy-related and breast feeding-related ailments. Cross-sectional questionnaire-based survey. Community pharmacies in Kuwait. 207 pharmacies were randomly selected from the Ministry of Health database. One registered pharmacist was approached from each pharmacy. One hundred and ninety-two (92.8%) pharmacists agreed to participate and completed a self-administered questionnaire. The proportions of pharmacists offering particular advice for health conditions in pregnancy and lactation, pharmacists' recommendations for common and specific ailments during pregnancy and breast feeding, and pharmacists' views about self-care in pregnancy and breast feeding. The top services provided to pregnant and lactating women were recommending vitamins and food supplements (89.8%) and contraception advice (83.4%), respectively. More than half of participants indicated that they would recommend medications for headache, constipation, cough, runny nose, sore throat, nausea/vomiting, indigestion, sore or cracked nipple and insufficient milk. Diarrhoea, haemorrhoids, insomnia, varicose vein, swelling of the feet and legs, vaginal itching, back pain, fever, mastitis and engorgement were frequently referred to the physician. Recommendations on medication use were occasionally inappropriate in terms of unneeded drug therapy, off-label use and safety. In relation to offering advice and solving medication and health problems of pregnant and lactating women, more than half of pharmacists indicated that they have sufficient knowledge (61.5%; 50.5%) and confidence (58.3%; 53.1%), respectively. Most of the respondents (88.5%) agreed that a continuing education programme on this topic would be of value for their practice. The present findings show that respondents had different recommendations for treatment of pregnancy-related and lactation-related ailments; and also highlight the need for interventions, including continuing professional development and revision of the undergraduate pharmacy curriculum. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Treating pain on skin graft donor sites: Review and clinical recommendations.

PubMed

Sinha, Sarthak; Schreiner, Amanda J; Biernaskie, Jeff; Nickerson, Duncan; Gabriel, Vincent A

2017-11-01

Split-thickness skin grafting is the most common reconstructive procedure in managing burn injuries. Harvesting split-thickness skin creates a new partial thickness wound referred to as the donor site. Pain at the donor site is reported to be one of the most distressing symptoms during the early postoperative period. Here, we (a) identify strategies for managing donor site pain, (b) assess the quality of individual studies, and (c) formulate evidence-based recommendations based on the amount and consistency of evidence. Our analysis revealed five distinct approaches to minimize donor site pain. These include: continuous subcutaneous local anesthetic infusion (three studies), subcutaneous anesthetic injection (five studies), topical agents (six studies), nonpharmacological interventions (three studies), and wound dressings (18 studies). Available randomized control trials typically evaluated pain on standardized scales (i.e. Visual Analog Scale, Numerical Rating Scale), and compared the experimental group with standard care. Recommended treatments include: (a) subcutaneous anesthetic injection of adrenaline-lidocaine; (b) ice application; (c) topical agents, such as lidocaine and bupivacaine; and (d) hydrocolloid- and polyurethane-based wound dressings accompanied with fibrin sealant. Methodologically sound randomized control trials examining the efficacy of modified tumescent solution, ropivacaine, plasma therapy, noncontact ultrasound, and morphine gels are lacking and should be a priority for future research.

7 CFR 987.71 - Expenses.

Code of Federal Regulations, 2010 CFR

2010-01-01

... Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Marketing Agreements..., together with all data supporting such recommendation, shall be submitted to the Secretary within a reasonable time after the marketing policy for each crop year is recommended. ...

40 CFR 256.27 - Recommendation for schedules leading to compliance with the prohibition of open dumping.

Code of Federal Regulations, 2010 CFR

2010-07-01

... ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES GUIDELINES FOR DEVELOPMENT AND IMPLEMENTATION OF STATE SOLID WASTE MANAGEMENT PLANS Solid Waste Disposal Programs § 256.27 Recommendation for schedules leading...

40 CFR 256.27 - Recommendation for schedules leading to compliance with the prohibition of open dumping.

Code of Federal Regulations, 2011 CFR

2011-07-01

... ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES GUIDELINES FOR DEVELOPMENT AND IMPLEMENTATION OF STATE SOLID WASTE MANAGEMENT PLANS Solid Waste Disposal Programs § 256.27 Recommendation for schedules leading...

77 FR 68802 - Advisory Committee on Commercial Operations of Customs and Border Protection (COAC)

Federal Register 2010, 2011, 2012, 2013, 2014

2012-11-16

...: Recommendations and resolutions on CBP's Trade Transformation initiatives, recommendations on the role of the... initiative in the area of continuing education should be pursued, requirements for brokers to obtain bona...

Contemporary Dietary Practices: FODMAPs and Beyond.

PubMed

Dharmapuri, Sadhana; Hettich, Kyndal; Goday, Praveen S

2016-01-01

There is no diet that is recommended for all individuals. Some special diets (eg, gluten-free for celiac disease) are necessary for health and quality of life. Other diets may be recommended for a short period of time to aid in symptom relief but may not be recommended for the long- term (eg, LFD). Popular diets continue to come and go with varying levels of success. When considering adolescents, continued growth and development are most important, and restrictive diets can lead to nutrient inadequacies and poor growth. Before making any recommendation, it is important to consider the goal of the diet and the cost versus benefits associated with following the diet. Adherence is always a challenge, regardless of the type of diet implemented. If a special diet is not warranted for the health, safety, and desired quality of life of the individual, it should not be implemented.

Coming to terms about describing Golden Eagle reproduction

USGS Publications Warehouse

Steenhof, Karen; Kochert, Michael N.; McIntyre, Carol L.; Brown, Jessi L.

2017-01-01

Clearly defined terms are essential for reporting and understanding research findings, and inconsistent terminology can complicate efforts to compare findings from different studies. In this article, we reiterate and clarify recommended terms for describing Golden Eagle (Aquila chrysaetos) territory occupancy and reproduction. Several authors have provided recommendations for reporting data on raptor reproduction, but our literature review showed that authors continue to use different, often ambiguous and undefined, terms. The inconsistent use of terminology by researchers has been continued and expanded by lawmakers, regulators, and managers, perpetuating confusion. We recommend that authors clearly define and reference all terminology that they use, and we caution against use of the term “active” to describe a nest or nesting territory, because it is tainted with a history of inconsistent use. We provide a glossary of recommended terms for Golden Eagles and other large, long-lived raptors.

Opioid Therapy for Chronic Pain: Overview of the 2017 US Department of Veterans Affairs and US Department of Defense Clinical Practice Guideline.

PubMed

Rosenberg, Jack M; Bilka, Brandon M; Wilson, Sara M; Spevak, Christopher

2018-05-01

The US Department of Veterans Affairs (VA) and US Department of Defense (DoD) revised the 2010 clinical practice guideline (CPG) for the management of opioid therapy for chronic pain, considering the specific needs of the VA and DoD and new evidence regarding prescribing opioid medication for non-end-of-life-related chronic pain. This paper summarizes the major recommendations and compares them with the US Centers for Disease Control and Prevention (CDC) guideline for prescribing opioids. This Opioid Therapy CPG was developed for VA-DoD service members, veterans, and their families. The VA/DoD Evidence-Based Practice Work Group convened a VA/DoD guideline renewal development effort and conformed to the guidelines established by the VA/DoD Joint Executive Council (JEC) and VA/DoD Health Executive Council (HEC). The panel developed questions, searched and evaluated the literature, developed recommendations using GRADE methodology, and developed algorithms. Passage of the CARA Act by Congress compelled consideration and comparison with the CDC opioid therapy guideline mid-development. There were 18 recommendations made. This article focuses on guideline development and key recommendations with CDC comparisons taken from four major areas, including: initiation and continuation of opioids;type, dose, follow-up, and taper of opioids;risk mitigation;acute pain. Guideline development and recommendations are presented. There was substantial overlap with the CDC opioid guideline. Additionally, there were items particularly relevant to the VA-DoD, including risk mitigation, suicide prevention, and preventing opioid use disorder in young patients. Our guideline highlights avoiding opioid therapy longer than 90 days as a critical juncture.

Recommendations for selecting drug-drug interactions for clinical decision support.

PubMed

Tilson, Hugh; Hines, Lisa E; McEvoy, Gerald; Weinstein, David M; Hansten, Philip D; Matuszewski, Karl; le Comte, Marianne; Higby-Baker, Stefanie; Hanlon, Joseph T; Pezzullo, Lynn; Vieson, Kathleen; Helwig, Amy L; Huang, Shiew-Mei; Perre, Anthony; Bates, David W; Poikonen, John; Wittie, Michael A; Grizzle, Amy J; Brown, Mary; Malone, Daniel C

2016-04-15

Recommendations for including drug-drug interactions (DDIs) in clinical decision support (CDS) are presented. A conference series was conducted to improve CDS for DDIs. A work group consisting of 20 experts in pharmacology, drug information, and CDS from academia, government agencies, health information vendors, and healthcare organizations was convened to address (1) the process to use for developing and maintaining a standard set of DDIs, (2) the information that should be included in a knowledge base of standard DDIs, (3) whether a list of contraindicated drug pairs can or should be established, and (4) how to more intelligently filter DDI alerts. We recommend a transparent, systematic, and evidence-driven process with graded recommendations by a consensus panel of experts and oversight by a national organization. We outline key DDI information needed to help guide clinician decision-making. We recommend judicious classification of DDIs as contraindicated and more research to identify methods to safely reduce repetitive and less-relevant alerts. An expert panel with a centralized organizer or convener should be established to develop and maintain a standard set of DDIs for CDS in the United States. The process should be evidence driven, transparent, and systematic, with feedback from multiple stakeholders for continuous improvement. The scope of the expert panel's work should be carefully managed to ensure that the process is sustainable. Support for research to improve DDI alerting in the future is also needed. Adoption of these steps may lead to consistent and clinically relevant content for interruptive DDIs, thus reducing alert fatigue and improving patient safety. Copyright © 2016 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

DNA commission of the International Society of Forensic Genetics: Recommendations on the evaluation of STR typing results that may include drop-out and/or drop-in using probabilistic methods

PubMed Central

Gill, P.; Gusmão, L.; Haned, H.; Mayr, W.R.; Morling, N.; Parson, W.; Prieto, L.; Prinz, M.; Schneider, H.; Schneider, P.M.; Weir, B.S.

2015-01-01

DNA profiling of biological material from scenes of crimes is often complicated because the amount of DNA is limited and the quality of the DNA may be compromised. Furthermore, the sensitivity of STR typing kits has been continuously improved to detect low level DNA traces. This may lead to (1) partial DNA profiles and (2) detection of additional alleles. There are two key phenomena to consider: allelic or locus ‘drop-out’, i.e. ‘missing’ alleles at one or more genetic loci, while ‘drop-in’ may explain alleles in the DNA profile that are additional to the assumed main contributor(s). The drop-in phenomenon is restricted to 1 or 2 alleles per profile. If multiple alleles are observed at more than two loci then these are considered as alleles from an extra contributor and analysis can proceed as a mixture of two or more contributors. Here, we give recommendations on how to estimate probabilities considering drop-out, Pr(D), and drop-in, Pr(C). For reasons of clarity, we have deliberately restricted the current recommendations considering drop-out and/or drop-in at only one locus. Furthermore, we offer recommendations on how to use Pr(D) and Pr(C) with the likelihood ratio principles that are generally recommended by the International Society of Forensic Genetics (ISFG) as measure of the weight of the evidence in forensic genetics. Examples of calculations are included. An Excel spreadsheet is provided so that scientists and laboratories may explore the models and input their own data. PMID:22864188

The European guideline on management of major bleeding and coagulopathy following trauma: fourth edition.

PubMed

Rossaint, Rolf; Bouillon, Bertil; Cerny, Vladimir; Coats, Timothy J; Duranteau, Jacques; Fernández-Mondéjar, Enrique; Filipescu, Daniela; Hunt, Beverley J; Komadina, Radko; Nardi, Giuseppe; Neugebauer, Edmund A M; Ozier, Yves; Riddez, Louis; Schultz, Arthur; Vincent, Jean-Louis; Spahn, Donat R

2016-04-12

Severe trauma continues to represent a global public health issue and mortality and morbidity in trauma patients remains substantial. A number of initiatives have aimed to provide guidance on the management of trauma patients. This document focuses on the management of major bleeding and coagulopathy following trauma and encourages adaptation of the guiding principles to each local situation and implementation within each institution. The pan-European, multidisciplinary Task Force for Advanced Bleeding Care in Trauma was founded in 2004 and included representatives of six relevant European professional societies. The group used a structured, evidence-based consensus approach to address scientific queries that served as the basis for each recommendation and supporting rationale. Expert opinion and current clinical practice were also considered, particularly in areas in which randomised clinical trials have not or cannot be performed. Existing recommendations were reconsidered and revised based on new scientific evidence and observed shifts in clinical practice; new recommendations were formulated to reflect current clinical concerns and areas in which new research data have been generated. This guideline represents the fourth edition of a document first published in 2007 and updated in 2010 and 2013. The guideline now recommends that patients be transferred directly to an appropriate trauma treatment centre and encourages use of a restricted volume replacement strategy during initial resuscitation. Best-practice use of blood products during further resuscitation continues to evolve and should be guided by a goal-directed strategy. The identification and management of patients pre-treated with anticoagulant agents continues to pose a real challenge, despite accumulating experience and awareness. The present guideline should be viewed as an educational aid to improve and standardise the care of the bleeding trauma patients across Europe and beyond. This document may also serve as a basis for local implementation. Furthermore, local quality and safety management systems need to be established to specifically assess key measures of bleeding control and outcome. A multidisciplinary approach and adherence to evidence-based guidance are key to improving patient outcomes. The implementation of locally adapted treatment algorithms should strive to achieve measureable improvements in patient outcome.

Continuing Experiments on the Receptivity of Transient Disturbances to Surface Roughness and Freestream Turbulence

DTIC Science & Technology

2008-09-28

rotating the spindle of the angle controller with a precision of 0.2°. The multiple-hotwire holder is designed to carry four hotwires. One hotwire is a...section and a maximum operating speed of 25 m/s. The tunnel’s design follows the recommendations of Reshotko et al. (1997) for flow quality. Operating at...This sting assembly includes a shaft that rotates in a streamlined casing and allows angular calibration of slanted hotwires. Outside the test

National study of public spending for mental retardation and developmental disabilities.

PubMed

Braddock, D; Hemp, R; Fujiura, G

1987-09-01

Results of a nationwide study of public mental retardation/developmental disabilities (MR/DD) spending in the states during Fiscal Years 1977 through 1986 were summarized. Trends identified included: (a) continuing growth in spending for community services, (b) contraction of total spending for institutional operations, and (c) predominance of ICF/MR support in large (16+ beds) congregate care settings. Periodic replication of the study was recommended as was additional research to identify the political and economic determinants of state MR/DD spending.

Collateral Damage and Critical Turning Points: Public Health Implications of HPV Vaccine News Coverage for Boys and Men in 2011.

PubMed

Krakow, Melinda; Rogers, Brian

2016-09-01

In 2009, the Food and Drug Administration (FDA) officially expanded approval of the Gardasil vaccine to include human papillomavirus (HPV) vaccination for boys and men, and in 2011, the Centers for Disease Control and Prevention (CDC) issued a formal recommendation for routine vaccination for this population. Despite these efforts, HPV vaccination rates for boys and men continue to fall short of public health targets. While news was breaking about the benefits of the HPV vaccine for boys and men, public attention shifted as a result of political debates concerning the vaccine. This study examines a pivotal time period for public health in which the vaccine became officially recommended for boys and men and at the same time became the center of political controversies in the lead-up to the 2012 presidential campaign. The current study extends previous research and presents a content analysis of newspaper articles (N = 154) about the HPV vaccine for the year 2011. Results indicate that the lack of comprehensive coverage of HPV and the HPV vaccine found in previous studies continued in this year. Results shed light on key political events that may have functioned to overshadow the recommendation of the HPV vaccine for boys and men. The implications of this pattern of news coverage can inform public health efforts to address low rates of HPV vaccination uptake among boys and men in present day.

Monitoring of Recommended Metabolic Laboratory Parameters Among Medicaid Recipients on Second-Generation Antipsychotics in Federally Qualified Health Centers.

PubMed

Uzal, Natalia E; Chavez, Benjamin; Kosirog, Emily R; Billups, Sarah J; Saseen, Joseph J

2018-02-01

In 2004, a consensus statement outlining recommended metabolic monitoring for patients prescribed second-generation antipsychotics (SGAs) was published. More than a decade later, suboptimal adherence rates to these recommendations continue to be reported, which could lead to long-term and costly complications. To define the prevalence of appropriately monitored Medicaid patients receiving care at federally qualified health centers (FQHCs) prescribed SGAs. This was a retrospective study examining electronic health record and Medicaid claims data to assess the rates of glucose and lipid monitoring for patients prescribed SGAs from January 2014 to August 2016 in a FQHC. Prescription and laboratory claims for patients receiving care at 4 FQHCs were reviewed. Descriptive statistics were used to evaluate the primary outcome. A total of 235 patients were included in the analysis. Patients initiated on SGA therapy (n = 92) had baseline glucose and lipid monitoring rates of 50% and 23%, respectively. The 3-month monitoring rates were 37% for glucose and 26% for lipids, whereas annual rates were 71% and 40%, respectively. Patients continuing SGA therapy (n = 143) had annual glucose and lipid monitoring rates of 67% and 44%. Medicaid patients at FQHCs initially prescribed SGAs have low baseline and 3-month metabolic monitoring, whereas annual monitoring was comparable to previously published studies. Adults receiving chronic care at a FQHC were more likely to receive glucose monitoring. Those with type 2 diabetes mellitus and/or hyperlipidemia were more likely to receive glucose and lipid monitoring.

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

PubMed

Apablaza, Pamela; Soto, Néstor; Codner, Ethel

2017-05-01

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

HealthRecSys: A semantic content-based recommender system to complement health videos.

PubMed

Sanchez Bocanegra, Carlos Luis; Sevillano Ramos, Jose Luis; Rizo, Carlos; Civit, Anton; Fernandez-Luque, Luis

2017-05-15

The Internet, and its popularity, continues to grow at an unprecedented pace. Watching videos online is very popular; it is estimated that 500 h of video are uploaded onto YouTube, a video-sharing service, every minute and that, by 2019, video formats will comprise more than 80% of Internet traffic. Health-related videos are very popular on YouTube, but their quality is always a matter of concern. One approach to enhancing the quality of online videos is to provide additional educational health content, such as websites, to support health consumers. This study investigates the feasibility of building a content-based recommender system that links health consumers to reputable health educational websites from MedlinePlus for a given health video from YouTube. The dataset for this study includes a collection of health-related videos and their available metadata. Semantic technologies (such as SNOMED-CT and Bio-ontology) were used to recommend health websites from MedlinePlus. A total of 26 healths professionals participated in evaluating 253 recommended links for a total of 53 videos about general health, hypertension, or diabetes. The relevance of the recommended health websites from MedlinePlus to the videos was measured using information retrieval metrics such as the normalized discounted cumulative gain and precision at K. The majority of websites recommended by our system for health videos were relevant, based on ratings by health professionals. The normalized discounted cumulative gain was between 46% and 90% for the different topics. Our study demonstrates the feasibility of using a semantic content-based recommender system to enrich YouTube health videos. Evaluation with end-users, in addition to healthcare professionals, will be required to identify the acceptance of these recommendations in a nonsimulated information-seeking context.

CAEP 2015 Academic Symposium: Current State and Recommendations to Achieve Adequate and Sustainable Funding for Emergency Medicine Academic Units.

PubMed

Lang, Eddy S; Artz, Jennifer D; Wilkie, Ryan D; Stiell, Ian G; Topping, Claude; Belanger, François P; Afilalo, Marc; Renouf, Tia; Crocco, Anthony; Wyatt, Kelly; Christenson, Jim

2016-05-01

To describe the current state of academic emergency medicine (EM) funding in Canada and develop recommendations to grow and establish sustainable funding. A panel of eight leaders from different EM academic units was assembled. Using mixed methods (including a literature review, sharing of professional experiences, a survey of current EM academic heads, and data previously collected from an environmental scan), 10 recommendations were drafted and presented at an academic symposium. Attendee feedback was incorporated, and the second set of draft recommendations was further distributed to the Canadian Association Emergency Physicians (CAEP) Academic Section for additional comments before being finalized. Recommendations were developed around the funding challenges identified and solutions developed by academic EM university-based units across Canada. A strategic plan was seen as integral to achieving strong funding of an EM unit, especially when it aligned with departmental and institutional priorities. A business plan, although occasionally overlooked, was deemed an important component for planning and sustaining the academic mission. A number of recommendations surrounding philanthropy consisted of creating partnerships with existing foundations and engaging multiple stakeholders and communities. Synergy between academic and clinical EM departments was also viewed as an opportunity to ensure integration of common missions. Education and networking for current and future leaders were also viewed as invaluable to ensure that opportunities are optimized through strong leadership development and shared experiences to further the EM academic missions across the country. These recommendations were designed to improve the financial circumstances for many Canadian EM units. There is a considerable wealth of resources that can contribute to financial stability for an academic unit, and an annual networking meeting and continuing education on these issues will facilitate more rapid implementation of these recommendations.

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

NASA Astrophysics Data System (ADS)

Casadevall, T. J.

2009-12-01

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

The pharmacologic management of nausea and vomiting of pregnancy.

PubMed

Niebyl, Jennifer R; Briggs, Gerald G

2014-02-01

Nausea and vomiting are common in early pregnancy. Forty percent or more of pregnant women may continue to suffer beyond the first trimester and 10% beyond the second trimester. A focus of the assessment is to confirm that the nausea and vomiting is due to the pregnancy and not some other cause. Nonpharmacologic options, particularly dietary modification, are a mainstay of treatment. For those who continue to experience symptoms, pharmacologic management can be employed. The combination of doxylamine succinate/pyridoxine hydrochloride was reintroduced in the United States following FDA approval in early 2013. The product was given a pregnancy safety rating of A and is recommended as first-line pharmacologic treatment for NVP. Other options include antihistamines, metoclopramide, ondansetron, phenothiazines, and after the first trimester, corticosteroids.

40 CFR 256.25 - Recommendation for inactive facilities.

Code of Federal Regulations, 2014 CFR

2014-07-01

... notification of agencies responsible for public health and safety. ... 40 Protection of Environment 25 2014-07-01 2014-07-01 false Recommendation for inactive facilities. 256.25 Section 256.25 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID...

40 CFR 256.25 - Recommendation for inactive facilities.

Code of Federal Regulations, 2012 CFR

2012-07-01

... notification of agencies responsible for public health and safety. ... 40 Protection of Environment 26 2012-07-01 2011-07-01 true Recommendation for inactive facilities. 256.25 Section 256.25 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID...

40 CFR 256.25 - Recommendation for inactive facilities.

Code of Federal Regulations, 2013 CFR

2013-07-01

... notification of agencies responsible for public health and safety. ... 40 Protection of Environment 26 2013-07-01 2013-07-01 false Recommendation for inactive facilities. 256.25 Section 256.25 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID...

7 CFR 985.51 - Recommendations for volume regulation.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 985.51 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Marketing Agreements and Orders; Fruits, Vegetables, Nuts), DEPARTMENT OF AGRICULTURE MARKETING... Limitations § 985.51 Recommendations for volume regulation. (a) If the Committee's marketing policy...

Principles for consistent value assessment and sustainable funding of orphan drugs in Europe.

PubMed

Gutierrez, Laura; Patris, Julien; Hutchings, Adam; Cowell, Warren

2015-05-03

The European Orphan Medicinal Products (OMP) Regulation has successfully encouraged research to develop treatments for rare diseases resulting in the authorisation of new OMPs in Europe. While decisions on OMP designation and marketing authorisation are made at the European Union level, reimbursement decisions are made at the national level. OMP value and affordability are high priority issues for policymakers and decisions regarding their pricing and funding are highly complex. There is currently no European consensus on how OMP value should be assessed and inequalities of access to OMPs have previously been observed. Against this background, policy makers in many countries are considering reforms to improve access to OMPs. This paper proposes ten principles to be considered when undertaking such reforms, from the perspective of an OMP manufacturer. We recommend the continued prioritisation of rare diseases by policymakers, an increased alignment between payer and regulatory frameworks, pricing centred on OMP value, and mechanisms to ensure long-term financial sustainability allowing a continuous and virtuous development of OMPs. Our recommendations support the development of more consistent frameworks and encourage collaboration between all stakeholders, including research-based industry, payers, clinicians, and patients.

Disparities in Treatment and Service Utilization among Hispanics and Non-Hispanic Whites with Bipolar Disorder

PubMed Central

Salcedo, Stephanie; McMaster, Kaja J.; Johnson, Sheri L.

2016-01-01

Objectives Due to the serious and recurrent nature of bipolar disorder, continuous long-term medication treatment is typically recommended. Little is known about whether these treatment recommendations are effectively implemented for Hispanics. This study examined differences in mood stabilizer use and mental health service utilization between adult English-speaking Hispanic and non-Hispanic white respondents with bipolar disorder. Methods The sample included 163 participants with lifetime bipolar I and II disorders in the National Comorbidity Survey Replication. Demographics, symptom presentation, and acculturation were examined as covariates. Results None of the 26 Hispanic respondents were taking mood-stabilizing medication, compared to 21% of non-Hispanic whites, and Hispanics were less likely to receive medications for emotional problems, see a professional for manic episodes, or attend psychotherapy. Even after accounting for differences in symptom profiles and sociodemographics, ethnicity continued to be a significant predictor of mood stabilizer use and psychotherapy attendance. There was a nonsignificant trend towards lower acculturation among Hispanics being associated with even poorer service utilization. Conclusions No Hispanics were receiving minimally adequate treatment for their bipolar disorder. Future research should focus on identifying the barriers that lead to these stark ethnic disparities in treatment. PMID:27129856

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

PubMed

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

2018-06-04

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

Recommended Patient-Reported Core Set of Symptoms to Measure in Adult Cancer Treatment Trials

PubMed Central

Mitchell, Sandra A.; Dueck, Amylou C.; Basch, Ethan; Cella, David; Reilly, Carolyn Miller; Minasian, Lori M.; Denicoff, Andrea M.; O’Mara, Ann M.; Fisch, Michael J.; Chauhan, Cynthia; Aaronson, Neil K.; Coens, Corneel; Bruner, Deborah Watkins

2014-01-01

Background The National Cancer Institute’s Symptom Management and Health-Related Quality of Life Steering Committee held a clinical trials planning meeting (September 2011) to identify a core symptom set to be assessed across oncology trials for the purposes of better understanding treatment efficacy and toxicity and to facilitate cross-study comparisons. We report the results of an evidence-synthesis and consensus-building effort that culminated in recommendations for core symptoms to be measured in adult cancer clinical trials that include a patient-reported outcome (PRO). Methods We used a data-driven, consensus-building process. A panel of experts, including patient representatives, conducted a systematic review of the literature (2001–2011) and analyzed six large datasets. Results were reviewed at a multistakeholder meeting, and a final set was derived emphasizing symptom prevalence across diverse cancer populations, impact on health outcomes and quality of life, and attribution to either disease or anticancer treatment. Results We recommend that a core set of 12 symptoms—specifically fatigue, insomnia, pain, anorexia (appetite loss), dyspnea, cognitive problems, anxiety (includes worry), nausea, depression (includes sadness), sensory neuropathy, constipation, and diarrhea—be considered for inclusion in clinical trials where a PRO is measured. Inclusion of symptoms and other patient-reported endpoints should be well justified, hypothesis driven, and meaningful to patients. Conclusions This core set will promote consistent assessment of common and clinically relevant disease- and treatment-related symptoms across cancer trials. As such, it provides a foundation to support data harmonization and continued efforts to enhance measurement of patient-centered outcomes in cancer clinical trials and observational studies. PMID:25006191

LAMMR: A new generation satellite microwave radiometer - Its concepts and capabilities. [Large Antenna Multichannel Microwave Radiometer

NASA Technical Reports Server (NTRS)

Walton, W. T.; Wilheit, T. T.

1981-01-01

Definition studies and baseline design are summarized for the proposed, and now discontinued, LAMMR. The instrument is an offset parabolic reflector with Cassegrain feeds. The three-meter aperture reflector, to be constructed using graphite-epoxy technology, rotates continuously at 0.833 rps. The scan drive subsystem includes momentum compensation for the rotating mass which includes the reflector, the support arm and Cassegrain subreflector, feed horns and radiometer. Two total power radiometers are recommended for each frequency, one each for horizontal and vertical polarizations. The selection plan, definition study specifications, LAMMR performance specifications, and predicted accuracies and resolutions after processing are shown.

Exercise in the healthy older adult.

PubMed

Karani, R; McLaughlin, M A; Cassel, C K

2001-01-01

Habitual exercise provides numerous health benefits to the older adult. While dynamic aerobic activities increase stamina and lung capacity, isometric or resistance training improves muscle strength and endurance. Long-term benefits of continued exercise include a decreased risk of death from heart disease, enhanced balance and mobility, a decreased risk of diabetes, and an improvement in depressive symptoms. While the hazards of exercise relate predominantly to extremes of intensity and duration, all older adults should consult with a physician before beginning a new activity program. A prescription for exercise should include both aerobic and resistance training components, and frequent follow-up to improve adherence is highly recommended. (c)2001 CVRR, Inc.

Brazil's National Program for Improving Primary Care Access and Quality (PMAQ)

PubMed Central

Harris, Matthew J.; Rocha, Marcia Gomes

2017-01-01

Despite some remarkable achievements, there are several challenges facing Brazil's Family Health Strategy (FHS), including expanding access to primary care and improving its quality. These concerns motivated the development of the National Program for Improving Primary Care Access and Quality (PMAQ). Although voluntary, the program now includes nearly 39 000 FHS teams in the country and has led to a near doubling of the federal investment in primary care in its first 2 rounds. In this article, we introduce the PMAQ and advance several recommendations to ensure that it continues to improve primary care access and quality in Brazil. PMID:28252498

Recommendations for safety planning, data collection, evaluation and reporting during drug, biologic and vaccine development: a report of the safety planning, evaluation, and reporting team.

PubMed

Crowe, Brenda J; Xia, H Amy; Berlin, Jesse A; Watson, Douglas J; Shi, Hongliang; Lin, Stephen L; Kuebler, Juergen; Schriver, Robert C; Santanello, Nancy C; Rochester, George; Porter, Jane B; Oster, Manfred; Mehrotra, Devan V; Li, Zhengqing; King, Eileen C; Harpur, Ernest S; Hall, David B

2009-10-01

The Safety Planning, Evaluation and Reporting Team (SPERT) was formed in 2006 by the Pharmaceutical Research and Manufacturers of America. SPERT's goal was to propose a pharmaceutical industry standard for safety planning, data collection, evaluation, and reporting, beginning with planning first-in-human studies and continuing through the planning of the post-product-approval period. SPERT's recommendations are based on our review of relevant literature and on consensus reached in our discussions. An important recommendation is that sponsors create a Program Safety Analysis Plan early in development. We also give recommendations for the planning of repeated, cumulative meta-analyses of the safety data obtained from the studies conducted within the development program. These include clear definitions of adverse events of special interest and standardization of many aspects of data collection and study design. We describe a 3-tier system for signal detection and analysis of adverse events and highlight proposals for reducing "false positive" safety findings. We recommend that sponsors review the aggregated safety data on a regular and ongoing basis throughout the development program, rather than waiting until the time of submission. We recognize that there may be other valid approaches. The proactive approach we advocate has the potential to benefit patients and health care providers by providing more comprehensive safety information at the time of new product marketing and beyond.

Earth Observing System, Conclusions and Recommendations

NASA Technical Reports Server (NTRS)

1984-01-01

The following Earth Observing Systems (E.O.S.) recommendations were suggested: (1) a program must be initiated to ensure that present time series of Earth science data are maintained and continued. (2) A data system that provides easy, integrated, and complete access to past, present, and future data must be developed as soon as possible. (3) A long term research effort must be sustained to study and understand these time series of Earth observations. (4) The E.O.S. should be established as an information system to carry out those aspects of the above recommendations which go beyond existing and currently planned activities. (5) The scientific direction of the E.O.S. should be established and continued through an international scientific steering committee.

Design recommendations for the optimized continuity diaphragm for prestressed concrete bulb-T beams.

DOT National Transportation Integrated Search

2008-01-01

This research focused on prestressed concrete bulb-T (PCBT) beams made composite with a cast-in-place concrete deck and continuous over several spans through the use of continuity diaphragms. The current design procedure in AASHTO states that a conti...

KDIGO Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors

PubMed Central

Lentine, Krista L.; Kasiske, Bertram L.; Levey, Andrew S.; Adams, Patricia L.; Alberú, Josefina; Bakr, Mohamed A.; Gallon, Lorenzo; Garvey, Catherine A.; Guleria, Sandeep; Li, Philip Kam-Tao; Segev, Dorry L.; Taler, Sandra J.; Tanabe, Kazunari; Wright, Linda; Zeier, Martin G.; Cheung, Michael; Garg, Amit X.

2017-01-01

Abstract The 2017 Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors is intended to assist medical professionals who evaluate living kidney donor candidates and provide care before, during and after donation. The guideline development process followed the Grades of Recommendation Assessment, Development, and Evaluation (GRADE) approach and guideline recommendations are based on systematic reviews of relevant studies that included critical appraisal of the quality of the evidence and the strength of recommendations. However, many recommendations, for which there was no evidence or no systematic search for evidence was undertaken by the Evidence Review Team, were issued as ungraded expert opinion recommendations. The guideline work group concluded that a comprehensive approach to risk assessment should replace decisions based on assessments of single risk factors in isolation. Original data analyses were undertaken to produce a “proof-in-concept” risk-prediction model for kidney failure to support a framework for quantitative risk assessment in the donor candidate evaluation and defensible shared decision making. This framework is grounded in the simultaneous consideration of each candidate's profile of demographic and health characteristics. The processes and framework for the donor candidate evaluation are presented, along with recommendations for optimal care before, during, and after donation. Limitations of the evidence are discussed, especially regarding the lack of definitive prospective studies and clinical outcome trials. Suggestions for future research, including the need for continued refinement of long-term risk prediction and novel approaches to estimating donation-attributable risks, are also provided. In citing this document, the following format should be used: Kidney Disease: Improving Global Outcomes (KDIGO) Living Kidney Donor Work Group. KDIGO Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors. Transplantation. 2017;101(Suppl 8S):S1–S109. PMID:28742762

When can immunotherapy for insect sting allergy be stopped?

PubMed

Müller, Ulrich R; Ring, Johannes

2015-01-01

Stings by Hymenoptera (honey bees, vespids, ants) can cause systemic allergic reactions (SARs). Venom immunotherapy (VIT) is highly effective and reduces an allergic patient's risk of a recurrent SAR to less than 5-20%. The risk of a recurrent SAR to a re-sting decreases the longer VIT is continued. The recommended duration of VIT is at least 3 to 5 years. Risk factors for recurrent SARs to a sting after stopping VIT have been identified and discussed: Recommendations concerning stopping VIT: For patients without any of the identified risk factors, VIT should be continued for 5 rather than 3 years. In patients with definite risk factors, a longer duration of VIT has to be discussed before stopping it. In mast cell disorders, VIT for life is recommended. Because of the residual risk of SARs after VIT, all patients are advised to carry an epinephrine autoinjector indefinitely and to continue to take measures to avoid Hymenoptera stings. Copyright © 2015 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

ACR Appropriateness Criteria®  Resectable Rectal Cancer

PubMed Central

2012-01-01

The management of resectable rectal cancer continues to be guided by clinical trials and advances in technique. Although surgical advances including total mesorectal excision continue to decrease rates of local recurrence, the management of locally advanced disease (T3-T4 or N+) benefits from a multimodality approach including neoadjuvant concomitant chemotherapy and radiation. Circumferential resection margin, which can be determined preoperatively via MRI, is prognostic. Toxicity associated with radiation therapy is decreased by placing the patient in the prone position on a belly board, however for patients who cannot tolerate prone positioning, IMRT decreases the volume of normal tissue irradiated. The use of IMRT requires knowledge of the patterns of spreads and anatomy. Clinical trials demonstrate high variability in target delineation without specific guidance demonstrating the need for peer review and the use of a consensus atlas. Concomitant with radiation, fluorouracil based chemotherapy remains the standard, and although toxicity is decreased with continuous infusion fluorouracil, oral capecitabine is non-inferior to the continuous infusion regimen. Additional chemotherapeutic agents, including oxaliplatin, continue to be investigated, however currently should only be utilized on clinical trials as increased toxicity and no definitive benefit has been demonstrated in clinical trials. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every two years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. PMID:23006527

Occupational exposure to blood and body fluids: new postexposure prophylaxis recommendations. United States Occupational Safety and Health Administration.

PubMed

Cuny, E; Carpenter, W M

1998-04-01

Dental health care professionals continue to suffer exposure incidents from instruments contaminated with blood and/or body fluids from patients. Each of these cases requires that a rigid protocol be followed for their evaluation. New information regarding the risk factors for HIV-seroconversion following an exposure incident have been identified. Recent data has demonstrated that a 79 percent reduction in disease transmission may be possible with a new combination drug therapy. The anti-retroviral drugs included in this new regimen are now standard in the management of occupational exposure to HIV. Several factors set dentistry apart from other health care occupations, and these differences appear to have an effect on the risks associated with occupational exposures. This article explores these risk factors and the new recommendations for postexposure care.

The Department of Energy Nuclear Criticality Safety Program

NASA Astrophysics Data System (ADS)

Felty, James R.

2005-05-01

This paper broadly covers key events and activities from which the Department of Energy Nuclear Criticality Safety Program (NCSP) evolved. The NCSP maintains fundamental infrastructure that supports operational criticality safety programs. This infrastructure includes continued development and maintenance of key calculational tools, differential and integral data measurements, benchmark compilation, development of training resources, hands-on training, and web-based systems to enhance information preservation and dissemination. The NCSP was initiated in response to Defense Nuclear Facilities Safety Board Recommendation 97-2, Criticality Safety, and evolved from a predecessor program, the Nuclear Criticality Predictability Program, that was initiated in response to Defense Nuclear Facilities Safety Board Recommendation 93-2, The Need for Critical Experiment Capability. This paper also discusses the role Dr. Sol Pearlstein played in helping the Department of Energy lay the foundation for a robust and enduring criticality safety infrastructure.

Preconception care for women with type 2 diabetes mellitus: A mixed-methods study of provider knowledge and practice.

PubMed

Klein, J; Boyle, J A; Kirkham, R; Connors, C; Whitbread, C; Oats, J; Barzi, F; McIntyre, D; Lee, I; Luey, M; Shaw, J; Brown, A D H; Maple-Brown, L J

2017-07-01

Preconception care may decrease adverse pregnancy outcomes associated with pre-existing diabetes mellitus. Aboriginal Australians are at high risk of type 2 diabetes mellitus (T2DM), with earlier onset. We explored practitioner views on preconception care delivery for women with T2DM in the Northern Territory, where 31% of births are to Aboriginal women. Mixed-methods study including cross-sectional survey of 156 health practitioners and 11 semi-structured interviews. Practitioners reported low attendance for preconception care however, 51% provided counselling on an opportunistic basis. Rural/remote practitioners were most likely to find counselling feasible. The majority (69%) utilised appropriate guidelines and addressed lifestyle modifications including smoking (81%), weight management (79%), and change medications appropriately such as ceasing ACE inhibitors (69%). Fewer (40%) prescribed the recommended dose of folate (5mg) or felt comfortable recommending delaying pregnancy to achieve optimal preconception glucose control (42%). Themes identified as barriers to care included the complexity of care setting and infrequent preconception consultations. There was a focus on motivation of women to make informed choices about conception, including birth spacing, timing and contraception. Preconception care enablers included cross-cultural communication, a multi-disciplinary care team and strong client-based relationships. Health practitioners are keen to provide preconception counselling and reported knowledge of evidence-based guidelines. Improvements are needed in recommending high dose folate and optimising glucose control. Cross-cultural communication and team-based care were reported as fundamental to successful preconception care in women with T2DM. Continued education and policy changes are required to support practitioners in opportunities to enhance pregnancy planning. Copyright © 2017 Elsevier B.V. All rights reserved.

Recommended Implementation of Arterial Spin Labeled Perfusion MRI for Clinical Applications: A consensus of the ISMRM Perfusion Study Group and the European Consortium for ASL in Dementia

PubMed Central

Alsop, David C.; Detre, John A.; Golay, Xavier; Günther, Matthias; Hendrikse, Jeroen; Hernandez-Garcia, Luis; Lu, Hanzhang; MacIntosh, Bradley J.; Parkes, Laura M.; Smits, Marion; van Osch, Matthias J. P.; Wang, Danny JJ; Wong, Eric C.; Zaharchuk, Greg

2014-01-01

This article provides a summary statement of recommended implementations of arterial spin labeling (ASL) for clinical applications. It is a consensus of the ISMRM Perfusion Study Group and the European ‘ASL in Dementia’ consortium, both of whom met to reach this consensus in October 2012 in Amsterdam. Although ASL continues to undergo rapid technical development, we believe that current ASL methods are robust and ready to provide useful clinical information, and that a consensus statement on recommended implementations will help the clinical community to adopt a standardized approach. In this article we describe the major considerations and tradeoffs in implementing an ASL protocol, and provide specific recommendations for a standard approach. Our conclusions are that, as an optimal default implementation we recommend: pseudo-continuous labeling, background suppression, a segmented 3D readout without vascular crushing gradients, and calculation and presentation of both label/control difference images and cerebral blood flow in absolute units using a simplified model. PMID:24715426

7 CFR 984.48 - Marketing estimates and recommendations.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 8 2010-01-01 2010-01-01 false Marketing estimates and recommendations. 984.48 Section 984.48 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Marketing Agreements and Orders; Fruits, Vegetables, Nuts), DEPARTMENT OF AGRICULTURE WALNUTS...

7 CFR 984.48 - Marketing estimates and recommendations.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 7 Agriculture 8 2014-01-01 2014-01-01 false Marketing estimates and recommendations. 984.48 Section 984.48 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (MARKETING AGREEMENTS AND ORDERS; FRUITS, VEGETABLES, NUTS), DEPARTMENT OF AGRICULTURE WALNUTS...

7 CFR 984.48 - Marketing estimates and recommendations.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 7 Agriculture 8 2013-01-01 2013-01-01 false Marketing estimates and recommendations. 984.48 Section 984.48 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (MARKETING AGREEMENTS AND ORDERS; FRUITS, VEGETABLES, NUTS), DEPARTMENT OF AGRICULTURE WALNUTS...

7 CFR 984.48 - Marketing estimates and recommendations.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 8 2011-01-01 2011-01-01 false Marketing estimates and recommendations. 984.48 Section 984.48 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Marketing Agreements and Orders; Fruits, Vegetables, Nuts), DEPARTMENT OF AGRICULTURE WALNUTS...

Course Development Cycle Time: A Framework for Continuous Process Improvement.

ERIC Educational Resources Information Center

Lake, Erinn

2003-01-01

Details Edinboro University's efforts to reduce the extended cycle time required to develop new courses and programs. Describes a collaborative process improvement framework, illustrated data findings, the team's recommendations for improvement, and the outcomes of those recommendations. (EV)

Funding priorities in animal reproduction at the United States Department of Agriculture's Cooperative State Research, Education, and Extension Service.

PubMed

Mirando, Mark A; Hamernik, Debora L

2006-03-01

The National Research Initiative (NRI) Competitive Grants Program is the U.S. Department of Agriculture's major competitive grants program and is administered by the Cooperative State Research, Education, and Extension Service (CSREES). Since its inception in 1991, the NRI has funded competitive grants in the discipline of animal reproduction. Previously, this program provided funding for a broad range of projects encompassing almost every subdiscipline in reproductive biology of farm animals, including aquatic species important to the aquaculture industry. During fiscal year 2004, the NRI Animal Reproduction Program narrowed the focus of funding priorities to the topics of infertility, basic mechanisms regulating fertility, cryopreservation of gametes, reducing the postpartum interval to conception, and sterilization methods or development of monosex populations. In response to a directive to further narrow the focus of funding priorities for fiscal year 2005 and beyond, CSREES conducted a Stakeholder Workshop on Funding Priorities in Animal Reproduction at the 37th Annual Meeting of the Society for the Study of Reproduction in Vancouver, Canada. More than 75 stakeholder scientists from a cross section of federal, public, and private institutions from across the United States participated in the workshop and provided recommendations to CSREES for future NRI-funding priorities in Animal Reproduction. The recommendations provided by stakeholders included continuing efforts to focus funding priorities into fewer high-impact areas relevant to animal agriculture and aquaculture. Recommendations also included movement back toward subdisciplines of animal reproduction that cut across all applicable species. The three funding priorities that consistently emerged as recommendations from the workshop participants were 1) gonadal function and production of gametes, 2) pituitary-hypothalamic function, and 3) embryo and conceptus development, including interaction between the conceptus and uterus. These funding priorities were considered when preparing the fiscal year 2006 NRI Request for Applications.

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

ERIC Educational Resources Information Center

Granville, Arthur C.; Love, John M.

This brief report summarizes the analysis and conclusions presented in detail in Interim Report VI regarding the feasibility of conducting a longitudinal study of Project Developmental Continuity (PDC). This project is a Head Start demonstration program aimed at providing educational and developmental continuity between children's Head Start and…

Effectiveness of implementation interventions in improving physician adherence to guideline recommendations in heart failure: a systematic review

PubMed Central

Shanbhag, Deepti; Graham, Ian D; Harlos, Karen; Haynes, R. Brian; Gabizon, Itzhak; Connolly, Stuart J; Van Spall, Harriette Gillian Christine

2018-01-01

Background The uptake of guideline recommendations that improve heart failure (HF) outcomes remains suboptimal. We reviewed implementation interventions that improve physician adherence to these recommendations, and identified contextual factors associated with implementation success. Methods We searched databases from January 1990 to November 2017 for studies testing interventions to improve uptake of class I HF guidelines. We used the Cochrane Effective Practice and Organisation of Care and Process Redesign frameworks for data extraction. Primary outcomes included: proportion of eligible patients offered guideline-recommended pharmacotherapy, self-care education, left ventricular function assessment and/or intracardiac devices. We reported clinical outcomes when available. Results We included 38 studies. Provider-level interventions (n=13 studies) included audit and feedback, reminders and education. Organisation-level interventions (n=18) included medical records system changes, multidisciplinary teams, clinical pathways and continuity of care. System-level interventions (n=3) included provider/institutional incentives. Four studies assessed multi-level interventions. We could not perform meta-analyses due to statistical/conceptual heterogeneity. Thirty-two studies reported significant improvements in at least one primary outcome. Clinical pathways, multidisciplinary teams and multifaceted interventions were most consistently successful in increasing physician uptake of guidelines. Among randomised controlled trials (RCT) (n=10), pharmacist and nurse-led interventions improved target dose prescriptions. Eleven studies reported clinical outcomes; significant improvements were reported in three, including a clinical pathway, a multidisciplinary team and a multifaceted intervention. Baseline assessment of barriers, staff training, iterative intervention development, leadership commitment and policy/financial incentives were associated with intervention effectiveness. Most studies (n=20) had medium risk of bias; nine RCTs had low risk of bias. Conclusion Our study is limited by the quality and heterogeneity of the primary studies. Clinical pathways, multidisciplinary teams and multifaceted interventions appear to be most consistent in increasing guideline uptake. However, improvements in process outcomes were rarely accompanied by improvements in clinical outcomes. Our work highlights the need for improved research methodology to reliably assess the effectiveness of implementation interventions. PMID:29511005

Effectiveness of implementation interventions in improving physician adherence to guideline recommendations in heart failure: a systematic review.

PubMed

Shanbhag, Deepti; Graham, Ian D; Harlos, Karen; Haynes, R Brian; Gabizon, Itzhak; Connolly, Stuart J; Van Spall, Harriette Gillian Christine

2018-03-06

The uptake of guideline recommendations that improve heart failure (HF) outcomes remains suboptimal. We reviewed implementation interventions that improve physician adherence to these recommendations, and identified contextual factors associated with implementation success. We searched databases from January 1990 to November 2017 for studies testing interventions to improve uptake of class I HF guidelines. We used the Cochrane Effective Practice and Organisation of Care and Process Redesign frameworks for data extraction. Primary outcomes included: proportion of eligible patients offered guideline-recommended pharmacotherapy, self-care education, left ventricular function assessment and/or intracardiac devices. We reported clinical outcomes when available. We included 38 studies. Provider-level interventions (n=13 studies) included audit and feedback, reminders and education. Organisation-level interventions (n=18) included medical records system changes, multidisciplinary teams, clinical pathways and continuity of care. System-level interventions (n=3) included provider/institutional incentives. Four studies assessed multi-level interventions. We could not perform meta-analyses due to statistical/conceptual heterogeneity. Thirty-two studies reported significant improvements in at least one primary outcome. Clinical pathways, multidisciplinary teams and multifaceted interventions were most consistently successful in increasing physician uptake of guidelines. Among randomised controlled trials (RCT) (n=10), pharmacist and nurse-led interventions improved target dose prescriptions. Eleven studies reported clinical outcomes; significant improvements were reported in three, including a clinical pathway, a multidisciplinary team and a multifaceted intervention. Baseline assessment of barriers, staff training, iterative intervention development, leadership commitment and policy/financial incentives were associated with intervention effectiveness. Most studies (n=20) had medium risk of bias; nine RCTs had low risk of bias. Our study is limited by the quality and heterogeneity of the primary studies. Clinical pathways, multidisciplinary teams and multifaceted interventions appear to be most consistent in increasing guideline uptake. However, improvements in process outcomes were rarely accompanied by improvements in clinical outcomes. Our work highlights the need for improved research methodology to reliably assess the effectiveness of implementation interventions. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Defense Commissaries: DOD Needs to Improve Business Processes to Ensure Patron Benefits and Achieve Operational Efficiencies

DTIC Science & Technology

2017-03-01

sales, leverage efficiencies, and achieve savings in commissary operations. Second, DeCA has not conducted cost - benefit analyses for costs ...conduct comprehensive cost - benefit analyses for service contracts and distribution options. DOD concurred with GAO’s first two recommendations and...partially concurred with the third recommendation. GAO continues to believe the cost - benefit analysis recommendation is valid

Marijuana as medicine?

PubMed

Grodeck, B

1997-01-01

Recent laws in California and Arizona allow doctors to legally recommend marijuana for the pain and discomfort associated with AIDS and other serious illnesses. Federal authorities continue to oppose this legislation, and promise to prosecute physicians who recommend or prescribe the drug. A 1990 survey of cancer specialists showed that 54 percent were in favor of the law, and 44 percent had already broken the law by recommending marijuana to their patients.

A Strategy for Sourcing Continuing Engineering Education

ERIC Educational Resources Information Center

Baukal, Charles E., Jr.

2012-01-01

Many are calling for increased continuing education for engineers, but few details are provided as to how to source that education. This paper recommends a strategy for sourcing continuing engineering education (CEE). Providers of CEE are categorized here as internal (the organization itself), external (universities, professional/trade…

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.

Toward a Strategy in Continuing Education: Proceedings of the Consultation on Continuing Education for Ministers of the United Methodist Church (University of Chicago, October 20-23, 1968).

ERIC Educational Resources Information Center

Rouch, Mark A., Ed.

A representative group from The United Methodist Church met to consider continuing education of the ordained pastor and to formulate recommendations for the church's strategy in ministerial continuing education. After a paper on continuing professional education, another described the minister as a professional--educated, expert, institutional,…

The U.S. Geological Survey Bird Banding Laboratory: an integrated scientific program supporting research and conservation of North American birds

USGS Publications Warehouse

Smith, Gregory J.

2013-01-01

The U.S. Geological Survey (USGS) Bird Banding Laboratory (BBL) was established in 1920 after ratification of the Migratory Bird Treaty Act with the United Kingdom in 1918. During World War II, the BBL was moved from Washington, D.C., to what is now the USGS Patuxent Wildlife Research Center (PWRC). The BBL issues permits and bands to permittees to band birds, records bird band recoveries or encounters primarily through telephone and Internet reporting, and manages more than 72 million banding records and more than 4.5 million records of encounters using state-of-the-art technologies. Moreover, the BBL also issues bands and manages banding and encounter data for the Canadian Bird Banding Office (BBO). Each year approximately 1 million bands are shipped from the BBL to banders in the United States and Canada, and nearly 100,000 encounter reports are entered into the BBL systems. Banding data are essential for regulatory programs, especially migratory waterfowl harvest regulations. The USGS BBL works closely with the U.S. Fish and Wildlife Service (USFWS) to develop regulations for the capture, handling, banding, and marking of birds. These regulations are published in the Code of Federal Regulations (CFR). In 2006, the BBL and the USFWS Division of Migratory Bird Management (DMBM) began a comprehensive revision of the banding regulations. The bird banding community has three major constituencies: Federal and State agency personnel involved in the management and conservation of bird populations that include the Flyway Councils, ornithological research scientists, and avocational banders. With increased demand for banding activities and relatively constant funding, a Federal Advisory Committee (Committee) was chartered and reviewed the BBL program in 2005. The final report of the Committee included six major goals and 58 specific recommendations, 47 of which have been addressed by the BBL. Specifically, the Committee recommended the BBL continue to support science, conservation, and management of birds through the use of banding and banding data and that the BBL be managed by the USGS and located at the USGS Patuxent Wildlife Research Center (PWRC) in Laurel, Maryland. Recommendations that have not been implemented include those already addressed by other organizations, as well as lower priority, such as developing a BBL business plan. The comprehensive review and recommendations of the Committee, the response of the BBL to address the Committee’s recommendations, and other improvements to its operations have positioned the BBL to provide a high level of service to the banding community. As new technologies are developed and incorporated into BBL operations, further efficiencies are expected to enable the BBL to continue to meet emerging scientific needs.

The development and regulation of occupational exposure limits in Taiwan.

PubMed

Shih, Tung-Sheng; Wu, Kuen-Yuh; Chen, Hong-I; Chang, Cheng-Ping; Chang, Ho-Yuan; Huang, Yi-Shiao; Liou, Saou-Hsing

2006-11-01

The occupational exposure limits (OELs) in Taiwan was promulgated in 1974 and has been revised five times since then. Many of the OELs were adopted from the most recent ACGIH TLVs and US OSHA PELs. A total of 483 chemicals were listed in the current Taiwan OELs Standard. The procedures of OELs development in Taiwan include the IOSH organized a recommended exposure limits (RELs) Committee to select the target chemicals and to recommend the RELs through literature review based on the health effects in the first stage, then, the CLA put policy needs, economical and technical feasibility into consideration and set up the final OELs at the second stage. A standard operation manual of RELs Committee has been developed. Based on our experience, several issues including the participation of representatives from a comprehensive spectrum, communication/education and training/enforcement, continuous collection of the local exposure data and health hazard information, use of health risk assessment, consideration of economic, and technical feasibility, as well as the globalization and information and experience sharing are critical in developing the appropriate OELs. Three examples including benzene, crystalline silica, and 2-methoxy ethanol are given to demonstrate the operation of system.

International Council for Standardization in Haematology (ICSH) Recommendations for Laboratory Measurement of Direct Oral Anticoagulants.

PubMed

Gosselin, Robert C; Adcock, Dorothy M; Bates, Shannon M; Douxfils, Jonathan; Favaloro, Emmanuel J; Gouin-Thibault, Isabelle; Guillermo, Cecilia; Kawai, Yohko; Lindhoff-Last, Edelgard; Kitchen, Steve

2018-03-01

This guidance document was prepared on behalf of the International Council for Standardization in Haematology (ICSH) for providing haemostasis-related guidance documents for clinical laboratories. This inaugural coagulation ICSH document was developed by an ad hoc committee, comprised of international clinical and laboratory direct acting oral anticoagulant (DOAC) experts. The committee developed consensus recommendations for laboratory measurement of DOACs (dabigatran, rivaroxaban, apixaban and edoxaban), which would be germane for laboratories assessing DOAC anticoagulation. This guidance document addresses all phases of laboratory DOAC measurements, including pre-analytical (e.g. preferred time sample collection, preferred sample type, sample stability), analytical (gold standard method, screening and quantifying methods) and post analytical (e.g. reporting units, quality assurance). The committee addressed the use and limitations of screening tests such as prothrombin time, activated partial thromboplastin time as well as viscoelastic measurements of clotting blood and point of care methods. Additionally, the committee provided recommendations for the proper validation or verification of performance of laboratory assays prior to implementation for clinical use, and external quality assurance to provide continuous assessment of testing and reporting method. Schattauer GmbH Stuttgart.

Hemodialysis and water quality.

PubMed

Coulliette, Angela D; Arduino, Matthew J

2013-01-01

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

40 CFR 63.2997 - What are the requirements for monitoring devices?

Code of Federal Regulations, 2011 CFR

2011-07-01

... continuously the thermal oxidizer temperature at the exit of the combustion zone before any substantial heat exchange occurs or at the location consistent with the manufacturer's recommendations. (2) Continuously...

40 CFR 63.2997 - What are the requirements for monitoring devices?

Code of Federal Regulations, 2010 CFR

2010-07-01

... continuously the thermal oxidizer temperature at the exit of the combustion zone before any substantial heat exchange occurs or at the location consistent with the manufacturer's recommendations. (2) Continuously...

40 CFR 68.56 - Maintenance.

Code of Federal Regulations, 2011 CFR

2011-07-01

... Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) CHEMICAL... testing procedures shall follow recognized and generally accepted good engineering practices. The...' recommendations, industry standards or codes, good engineering practices, and prior operating experience. ...

40 CFR 68.56 - Maintenance.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) CHEMICAL... testing procedures shall follow recognized and generally accepted good engineering practices. The...' recommendations, industry standards or codes, good engineering practices, and prior operating experience. ...

40 CFR 68.56 - Maintenance.

Code of Federal Regulations, 2012 CFR

2012-07-01

... Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) CHEMICAL... testing procedures shall follow recognized and generally accepted good engineering practices. The...' recommendations, industry standards or codes, good engineering practices, and prior operating experience. ...

40 CFR 68.56 - Maintenance.

Code of Federal Regulations, 2014 CFR

2014-07-01

... Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) CHEMICAL... testing procedures shall follow recognized and generally accepted good engineering practices. The...' recommendations, industry standards or codes, good engineering practices, and prior operating experience. ...

40 CFR 68.56 - Maintenance.

Code of Federal Regulations, 2013 CFR

2013-07-01

... Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) CHEMICAL... testing procedures shall follow recognized and generally accepted good engineering practices. The...' recommendations, industry standards or codes, good engineering practices, and prior operating experience. ...

7 CFR 920.51 - Recommendations for regulation.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 7 Agriculture 8 2014-01-01 2014-01-01 false Recommendations for regulation. 920.51 Section 920.51 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (MARKETING AGREEMENTS AND ORDERS; FRUITS, VEGETABLES, NUTS), DEPARTMENT OF AGRICULTURE KIWIFRUIT GROWN IN CALIFORNIA...

7 CFR 920.51 - Recommendations for regulation.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 7 Agriculture 8 2013-01-01 2013-01-01 false Recommendations for regulation. 920.51 Section 920.51 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (MARKETING AGREEMENTS AND ORDERS; FRUITS, VEGETABLES, NUTS), DEPARTMENT OF AGRICULTURE KIWIFRUIT GROWN IN CALIFORNIA...

7 CFR 920.51 - Recommendations for regulation.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 7 Agriculture 8 2012-01-01 2012-01-01 false Recommendations for regulation. 920.51 Section 920.51 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Marketing Agreements and Orders; Fruits, Vegetables, Nuts), DEPARTMENT OF AGRICULTURE KIWIFRUIT GROWN IN CALIFORNIA...

40 CFR 243.201-2 - Recommended procedures: Operations.

Code of Federal Regulations, 2014 CFR

2014-07-01

... equipment should meet the applicable provisions of the Occupational Safety and Health Administration... 40 Protection of Environment 25 2014-07-01 2014-07-01 false Recommended procedures: Operations. 243.201-2 Section 243.201-2 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED...

40 CFR 240.209-3 - Recommended procedures: Operations.

Code of Federal Regulations, 2011 CFR

2011-07-01

... Occupational Respiratory Disease, National Institute for Occupational Safety and Health, Morgantown, W. Va. (c... 40 Protection of Environment 25 2011-07-01 2011-07-01 false Recommended procedures: Operations. 240.209-3 Section 240.209-3 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED...

40 CFR 240.209-3 - Recommended procedures: Operations.

Code of Federal Regulations, 2013 CFR

2013-07-01

... Occupational Respiratory Disease, National Institute for Occupational Safety and Health, Morgantown, W. Va. (c... 40 Protection of Environment 26 2013-07-01 2013-07-01 false Recommended procedures: Operations. 240.209-3 Section 240.209-3 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED...

40 CFR 240.209-3 - Recommended procedures: Operations.

Code of Federal Regulations, 2014 CFR

2014-07-01

... Occupational Respiratory Disease, National Institute for Occupational Safety and Health, Morgantown, W. Va. (c... 40 Protection of Environment 25 2014-07-01 2014-07-01 false Recommended procedures: Operations. 240.209-3 Section 240.209-3 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED...

40 CFR 243.203-2 - Recommended procedures: Operations.

Code of Federal Regulations, 2013 CFR

2013-07-01

...) The minimum collection frequency consistent with public health and safety should be adopted to... 40 Protection of Environment 26 2013-07-01 2013-07-01 false Recommended procedures: Operations. 243.203-2 Section 243.203-2 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED...

40 CFR 243.203-2 - Recommended procedures: Operations.

Code of Federal Regulations, 2014 CFR

2014-07-01

...) The minimum collection frequency consistent with public health and safety should be adopted to... 40 Protection of Environment 25 2014-07-01 2014-07-01 false Recommended procedures: Operations. 243.203-2 Section 243.203-2 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED...

40 CFR 243.203-2 - Recommended procedures: Operations.

Code of Federal Regulations, 2011 CFR

2011-07-01

...) The minimum collection frequency consistent with public health and safety should be adopted to... 40 Protection of Environment 25 2011-07-01 2011-07-01 false Recommended procedures: Operations. 243.203-2 Section 243.203-2 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED...

40 CFR 240.204-2 - Recommended procedures: Design.

Code of Federal Regulations, 2010 CFR

2010-07-01

....204-2 Section 240.204-2 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES GUIDELINES FOR THE THERMAL PROCESSING OF SOLID WASTES Requirements and Recommended Procedures... indiscriminately. Consideration should be given to onsite treatment of process and waste waters before discharge...

40 CFR 240.207-2 - Recommended procedures: Design.

Code of Federal Regulations, 2010 CFR

2010-07-01

....207-2 Section 240.207-2 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES GUIDELINES FOR THE THERMAL PROCESSING OF SOLID WASTES Requirements and Recommended Procedures... attractive. The tipping, residue discharge, and waste salvage areas should be screened from public view, and...

40 CFR 240.201-2 - Recommended procedures: Design.

Code of Federal Regulations, 2011 CFR

2011-07-01

....201-2 Section 240.201-2 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES GUIDELINES FOR THE THERMAL PROCESSING OF SOLID WASTES Requirements and Recommended Procedures... or excluded wastes inadvertently left at the facility should be considered in design. (b) Examples of...

40 CFR 256.25 - Recommendation for inactive facilities.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 24 2010-07-01 2010-07-01 false Recommendation for inactive facilities. 256.25 Section 256.25 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES GUIDELINES FOR DEVELOPMENT AND IMPLEMENTATION OF STATE SOLID WASTE MANAGEMENT PLANS Solid Waste...

40 CFR 256.25 - Recommendation for inactive facilities.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 25 2011-07-01 2011-07-01 false Recommendation for inactive facilities. 256.25 Section 256.25 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES GUIDELINES FOR DEVELOPMENT AND IMPLEMENTATION OF STATE SOLID WASTE MANAGEMENT PLANS Solid Waste...

Recommendations for Institutional Prematriculation Immunizations

ERIC Educational Resources Information Center

Journal of American College Health, 2011

2011-01-01

The recommendations presented in this article are provided to colleges and universities to facilitate the implementation of a comprehensive institutional prematriculation immunization policy. Vaccine-preventable diseases continue to occur on American campuses. In response to changing epidemiology and the introduction of new vaccines, the ACHA…

Building leadership skills and promoting workforce development: evaluation data collected from public health professionals in the field of maternal and child health.

PubMed

Kroelinger, Charlan D; Kasehagen, Laurin; Barradas, Danielle T; 'Ali, Zarinah

2012-12-01

Professional development, including training and leadership skill building, is important for maternal and child health (MCH) epidemiologists. Current workforce development and training opportunities vary, but lack an emphasis on linking leadership competencies with MCH epidemiology. This paper describes efforts at the annual MCH Epidemiology Conference (the "Conference") to promote leadership activities and workforce development, and recommendations to enhance professional development. An evaluation of attendee opinions on Conference workforce development activities was conducted during the 2009 and 2010 Conferences (70 and 66 % response rates, respectively). Frequencies and percentages were calculated overall and by attendee profession. Qualitative responses to questions regarding workforce and professional development were classified by theme in 2009, and a categorical question was developed for the 2010 evaluation. A combined 38 % of Conference attendees in 2009 and 2010 were MCH epidemiologists and 62 % were other MCH professionals. Attendees recommended more support and access to training, mentoring, and resources including job opportunities. Continuing education (41 %), special knowledge and skills-building training (51 %), and development of online resources for training (57 %) were highly recommended by attendees. Career (47 %) and leadership (49 %) mentoring by senior-level professionals in the field were also highly recommended. Promotion of leadership can be achieved by integrating the concept of leadership into the Conference itself; by publishing and disseminating MCH epidemiologic research in scientific, program, and policy settings; and by communicating the importance of epidemiologic findings to stakeholders and other non-scientific audiences.

The Rules of Engagement: CTTI Recommendations for Successful Collaborations Between Sponsors and Patient Groups Around Clinical Trials.

PubMed

Bloom, Diane; Beetsch, Joel; Harker, Matthew; Hesterlee, Sharon; Moreira, Paulo; Patrick-Lake, Bray; Selig, Wendy; Sherman, Jeffrey; Smith, Sophia K; Valentine, James E; Roberts, Jamie N

2018-03-01

To identify the elements necessary for successful collaboration between patient groups and academic and industry sponsors of clinical trials, in order to develop recommendations for best practices for effective patient group engagement. In-depth interviews, informed by a previously reported survey, were conducted to identify the fundamentals of successful patient group engagement. Thirty-two respondents from 3 sectors participated: patient groups, academic researchers, and industry. The findings were presented to a multistakeholder group of experts in January 2015. The expert group came to consensus on a set of actionable recommendations for best practices for patient groups and research sponsors. Interview respondents acknowledged that not all patient groups are created equal in terms of what they can contribute to a clinical trial. The most important elements for effective patient group engagement include establishing meaningful partnerships, demonstrating mutual benefits, and collaborating as partners from the planning stage forward. Although there is a growing appreciation by sponsors about the benefits of patient group engagement, there remains some resistance and some uncertainty about how best to engage. Barriers include mismatched expectations and a perception that patient groups lack scientific sophistication and that "wishful thinking" may cloud their recommendations. Patient groups are developing diverse skillsets and acquiring assets to leverage in order to become collaborators with industry and academia on clinical trials. Growing numbers of research sponsors across the clinical trials enterprise are recognizing the benefits of continuous and meaningful patient group engagement, but there are still mindsets to change, and stakeholders need further guidance on operationalizing a new model of clinical trial conduct.

A Global Capacity Building Vision for Societal Applications of Earth Observing Systems and Data: Key Questions and Recommendations

NASA Technical Reports Server (NTRS)

Hossain, Faisal; Serrat-Capdevila, Aleix; Granger, Stephanie; Thomas, Amy; Saah, David; Ganz, David; Mugo, Robinson; Murthy, M. S. R.; Ramos, Victor Hugo; Kirschbaum, Dalia;

Risk of tuberculosis in patients treated with tumor necrosis factor antagonists due to incomplete prevention of reactivation of latent infection.

PubMed

Gómez-Reino, Juan J; Carmona, Loreto; Angel Descalzo, Miguel

2007-06-15

To evaluate the causes of new cases of active tuberculosis (ATB) in patients treated with tumor necrosis factor (TNF) antagonists included in the national registry BIOBADASER (Base de Datos de Productos Biológicos de la Sociedad Española de Reumatología) after the dissemination of recommendations to prevent reactivation of latent tuberculosis infection (LTBI). Incidence rate of ATB per 100,000 patient-years and 95% confidence intervals (95% CIs) were calculated in patients entering BIOBADASER after March 2002 and were stratified by compliance with recommendations (complete or incomplete). ATB rates in BIOBADASER were compared with the background rate and the rate in the rheumatoid arthritis cohort EMECAR (Estudio de la Morbilidad y Expresión Clínica de la Artritis Reumatoide) not treated with TNF antagonists. In addition, rates of ATB among patients treated with adalimumab, etanercept, and infliximab were estimated and compared only for treatments started after September 2003, when all 3 drugs became fully available. Following March 2002, a total of 5,198 patients treated with a TNF antagonist were registered in BIOBADASER. Fifteen ATB cases were noted (rate 172 per 100,000 patient-years, 95% CI 103-285). Recommendations were fully followed in 2,655 treatments. The probability of developing ATB was 7 times higher when recommendations were not followed (incidence rate ratio 7.09, 95% CI 1.60-64.69). Two-step tuberculosis skin test for LTBI was the major failure in complying with recommendations. New cases of ATB still occur in patients treated with all available TNF antagonists due to lack of compliance with recommendations to prevent reactivation of LTBI. Continuous evaluation of recommendations is required to improve clinical practice.

The Ferris Educational Mission: A Continuing Study by the Ferris Educational Planning Committee, Part II: Continuing Education.

ERIC Educational Resources Information Center

Ferris State Coll., Big Rapids, MI.

This document, the second of a two-part study, focuses on the area of continuing and adult education at Ferris State College (FSC), Michigan. An overview of the status of adult and continuing education and recommendations are provided by the schools of allied health, business, general education, education, pharmacy, technical and applied arts, and…

40 CFR 256.22 - Recommendations for State regulatory powers.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 40 Protection of Environment 25 2014-07-01 2014-07-01 false Recommendations for State regulatory powers. 256.22 Section 256.22 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES GUIDELINES FOR DEVELOPMENT AND IMPLEMENTATION OF STATE SOLID WASTE MANAGEMENT PLANS Solid Waste...

40 CFR 256.22 - Recommendations for State regulatory powers.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 40 Protection of Environment 26 2013-07-01 2013-07-01 false Recommendations for State regulatory powers. 256.22 Section 256.22 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES GUIDELINES FOR DEVELOPMENT AND IMPLEMENTATION OF STATE SOLID WASTE MANAGEMENT PLANS Solid Waste...

40 CFR 256.22 - Recommendations for State regulatory powers.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 40 Protection of Environment 26 2012-07-01 2011-07-01 true Recommendations for State regulatory powers. 256.22 Section 256.22 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES GUIDELINES FOR DEVELOPMENT AND IMPLEMENTATION OF STATE SOLID WASTE MANAGEMENT PLANS Solid Waste...

40 CFR 243.201-2 - Recommended procedures: Operations.

Code of Federal Regulations, 2012 CFR

2012-07-01

... should meet the applicable provisions of the Occupational Safety and Health Administration Standards for... 40 Protection of Environment 26 2012-07-01 2011-07-01 true Recommended procedures: Operations. 243.201-2 Section 243.201-2 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID...

40 CFR 240.209-3 - Recommended procedures: Operations.

Code of Federal Regulations, 2012 CFR

2012-07-01

... Occupational Respiratory Disease, National Institute for Occupational Safety and Health, Morgantown, W. Va. (c... 40 Protection of Environment 26 2012-07-01 2011-07-01 true Recommended procedures: Operations. 240.209-3 Section 240.209-3 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID...

40 CFR 243.203-2 - Recommended procedures: Operations.

Code of Federal Regulations, 2012 CFR

2012-07-01

... minimum collection frequency consistent with public health and safety should be adopted to minimize... 40 Protection of Environment 26 2012-07-01 2011-07-01 true Recommended procedures: Operations. 243.203-2 Section 243.203-2 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID...

40 CFR 240.208-2 - Recommended procedures: Design.

Code of Federal Regulations, 2010 CFR

2010-07-01

....208-2 Section 240.208-2 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES GUIDELINES FOR THE THERMAL PROCESSING OF SOLID WASTES Requirements and Recommended Procedures... allow for removal from the site of residue or other solids in a manner that protects the environment. ...

41 CFR 102-3.145 - What policies apply to subcommittee meetings?

Code of Federal Regulations, 2010 CFR

2010-07-01

... Management Regulations System (Continued) FEDERAL MANAGEMENT REGULATION GENERAL 3-FEDERAL ADVISORY COMMITTEE... subcommittee meetings? If a subcommittee makes recommendations directly to a Federal officer or agency, or if its recommendations will be adopted by the parent advisory committee without further deliberations by...

50 CFR 18.83 - Determination to cancel the hearing.

Code of Federal Regulations, 2010 CFR

2010-10-01

... (CONTINUED) TAKING, POSSESSION, TRANSPORTATION, SALE, PURCHASE, BARTER, EXPORTATION, AND IMPORTATION OF...) Promptly after oral argument, if any, the presiding officer shall make a recommended decision based on the... shall transmit to the Director his recommended decision, the record and a certificate stating that the...

Drug resistance in B and non-B subtypes amongst subjects recently diagnosed as primary/recent or chronic HIV-infected over the period 2013-2016: Impact on susceptibility to first-line strategies including integrase strand-transfer inhibitors.

PubMed

Andreis, Samantha; Basso, Monica; Scaggiante, Renzo; Cruciani, Mario; Ferretto, Roberto; Manfrin, Vinicio; Panese, Sandro; Rossi, Maria Cristina; Francavilla, Ermenegildo; Boldrin, Caterina; Alvarez, Mario; Dal Bello, Federico; Mengoli, Carlo; Turriziani, Ombretta; Sarmati, Loredana; Antonelli, Guido; Andreoni, Massimo; Palù, Giorgio; Parisi, Saverio Giuseppe

2017-09-01

To characterize the prevalence of transmitted drug resistance mutations (TDRMs) by plasma analysis of 750 patients at the time of HIV diagnosis from January 1, 2013 to November 16, 2016 in the Veneto region (Italy), where all drugs included in the recommended first line therapies were prescribed, included integrase strand transfer inhibitors (InNSTI). TDRMs were defined according to the Stanford HIV database algorithm. Subtype B was the most prevalent HIV clade (67.3%). A total of 92 patients (12.3%) were expected to be resistant to one drug at least, most with a single class mutation (60/68-88.2% in subtype B infected subjectsand 23/24-95.8% in non-B subjects) and affecting mainly NNRTIs. No significant differences were observed between the prevalence rates of TDRMs involving one or more drugs, except for the presence of E138A quite only in patients with B subtype and other NNRTI in subjects with non-B infection. The diagnosis of primary/recent infection was made in 73 patients (9.7%): they had almost only TDRMs involving a single class. Resistance to InSTI was studied in 484 subjects (53 with primary-recent infection), one patient had 143C in 2016, a total of thirteen 157Q mutations were detected (only one in primary/recent infection). Only one major InSTI-TDRM was identified but monitoring of TDRMs should continue in the light of continuing presence of NNRTI-related mutation amongst newly diagnosed subjects, sometime impacting also to modern NNRTI drugs recommended in first-line therapy. Copyright © 2017 International Society for Chemotherapy of Infection and Cancer. Published by Elsevier Ltd. All rights reserved.

Recommendations concerning satellite-acquired earth resource data: 1982 report of the Data Management Subcommittee of the GEOSAT Committee, Incorporated

NASA Technical Reports Server (NTRS)

1982-01-01

End user concerns about the content and accessibility of libraries of remote sensing data in general are addressed. Recommendations pertaining to the United States' satellite remote sensing programs urge: (1) the continuation of the NASA/EROS Data Center program to convert pre-1979 scenes to computer readable tapes and create a historical archive of this valuable data; (2) improving the EROS archive by adding geologically interesting scenes, data from other agencies (including previously classified data), and by adopting a policy to retire data from the archive; (3) establishing a computer data base inquiry system that includes remote sensing data from all publically available sources; (4) capability for prepurchase review and evaluation; (5) a flexible price structure; and (6) adoption of standard digital data products format. Information about LANDSAT 4, the status of worldwide LANDSAT receiving stations, future non-U.S. remote sensing satellites, a list of sources for LANDSAT data, and the results of a survey of GEOSAT members' remote sensing data processing systems are also considered.

Stress and burnout in forensic mental health nursing: a literature review.

PubMed

Dickinson, Tommy; Wright, Karen M

Forensic mental health nurses who work with patients who have severe and enduring mental health needs have been identified as at risk of suffering from occupational stress, and even developing burnout syndrome. Therefore, this article reviews the available literature on stress and burnout in inpatient forensic mental health nursing to identify the stressors and to highlight recommendations. From the review, the main stressors placed on forensic nurses are identified as interprofessional conflicts, workload, and lack of involvement in decision-making. Recommendations to reduce stress and burnout for nurses within this specialty are highlighted. These are identified as follows: staff should have easy access to support systems including clinical supervision; managers should foster an open and honest culture to enable staff members to express their feelings openly or in confidence and learn how to deal with their frustrations; and staff should be encouraged to rotate wards to increase personal and professional development and reduce boredom and apathy. Furthermore, staff should be provided with, and encouraged to undertake, continuing professional development which may include psychosocial interventions training.

Women's sexual pain disorders.

PubMed

van Lankveld, Jacques J D M; Granot, Michal; Weijmar Schultz, Willibrord C M; Binik, Yitzchak M; Wesselmann, Ursula; Pukall, Caroline F; Bohm-Starke, Nina; Achtrari, Chahin

2010-01-01

Women's sexual pain disorders include dyspareunia and vaginismus and there is need for state-of-the-art information in this area. To update the scientific evidence published in 2004, from the 2nd International Consultation on Sexual Medicine pertaining to the diagnosis and treatment of women's sexual pain disorders. An expert committee, invited from six countries by the 3rd International Consultation, was comprised of eight researchers and clinicians from biological and social science disciplines, for the purpose of reviewing and grading the scientific evidence on nosology, etiology, diagnosis, and treatment of women's sexual pain disorders. Expert opinion was based on grading of evidence-based medical literature, extensive internal committee discussion, public presentation, and debate. Results. A comprehensive assessment of medical, sexual, and psychosocial history is recommended for diagnosis and management. Indications for general and focused pelvic genital examination are identified. Evidence-based recommendations for assessment of women's sexual pain disorders are reviewed. An evidence-based approach to management of these disorders is provided. Continued efforts are warranted to conduct research and scientific reporting on the optimal assessment and management of women's sexual pain disorders, including multidisciplinary approaches.

Should OCD be classified as an anxiety disorder in DSM-V?

PubMed

Stein, Dan J; Fineberg, Naomi A; Bienvenu, O Joseph; Denys, Damiaan; Lochner, Christine; Nestadt, Gerald; Leckman, James F; Rauch, Scott L; Phillips, Katharine A

2010-06-01

In DSM-III, DSM-III-R, and DSM-IV, obsessive-compulsive disorder (OCD) was classified as an anxiety disorder. In ICD-10, OCD is classified separately from the anxiety disorders, although within the same larger category as anxiety disorders (as one of the "neurotic, stress-related, and somatoform disorders"). Ongoing advances in our understanding of OCD and other anxiety disorders have raised the question of whether OCD should continue to be classified with the anxiety disorders in DSM-V. This review presents a number of options and preliminary recommendations to be considered for DSM-V. Evidence is reviewed for retaining OCD in the category of anxiety disorders, and for moving OCD to a separate category of obsessive-compulsive (OC)-spectrum disorders, if such a category is included in DSM-V. Our preliminary recommendation is that OCD be retained in the category of anxiety disorders but that this category also includes OC-spectrum disorders along with OCD. If this change is made, the name of this category should be changed to reflect this proposed change. (c) 2010 Wiley-Liss, Inc.

Understanding How Clinician-Patient Relationships and Relational Continuity of Care Affect Recovery from Serious Mental Illness: STARS Study Results

PubMed Central

Green, Carla A.; Polen, Michael R.; Janoff, Shannon L.; Castleton, David K.; Wisdom, Jennifer P.; Vuckovic, Nancy; Perrin, Nancy A.; Paulson, Robert I.; Oken, Stuart L.

2008-01-01

Objective Recommendations for improving care include increased patient-clinician collaboration, patient empowerment, and greater relational continuity of care. All rely upon good clinician-patient relationships, yet little is known about how relational continuity and clinician-patient relationships interact, or their effects on recovery from mental illness. Methods Individuals (92 women, 85 men) with schizophrenia, schizoaffective disorder, affective psychosis, or bipolar disorder participated in this observational study. Participants completed in-depth interviews detailing personal and mental health histories. Questionnaires included quality of life and recovery assessments and were linked to records of services used. Qualitative analyses yielded a hypothesized model of the effects of relational continuity and clinician-patient relationships on recovery and quality of life, tested using covariance structure modeling. Results Qualitative data showed that positive, trusting relationships with clinicians, developed over time, aid recovery. When “fit” with clinicians was good, long-term relational continuity of care allowed development of close, collaborative relationships, fostered good illness and medication management, and supported patient-directed decisions. Most valued were competent, caring, trustworthy, and trusting clinicians who treated clinical encounters “like friendships,” increasing willingness to seek help and continue care when treatments were not effective and supporting “normal” rather than “mentally ill” identities. Statistical models showed positive relationships between recovery-oriented patient-driven care and satisfaction with clinicians, medication satisfaction, and recovery. Relational continuity indirectly affected quality of life via satisfaction with clinicians; medication satisfaction was associated with fewer symptoms; fewer symptoms were associated with recovery and better quality of life. Conclusions Strong clinician-patient relationships, relational continuity, and a caring, collaborative approach facilitate recovery from mental illness and improved quality of life. PMID:18614445

Understanding how clinician-patient relationships and relational continuity of care affect recovery from serious mental illness: STARS study results.

PubMed

Green, Carla A; Polen, Michael R; Janoff, Shannon L; Castleton, David K; Wisdom, Jennifer P; Vuckovic, Nancy; Perrin, Nancy A; Paulson, Robert I; Oken, Stuart L

2008-01-01

Recommendations for improving care include increased patient-clinician collaboration, patient empowerment, and greater relational continuity of care. All rely upon good clinician-patient relationships, yet little is known about how relational continuity and clinician-patient relationships interact, or their effects on recovery from mental illness. Individuals (92 women, 85 men) with schizophrenia, schizoaffective disorder, affective psychosis, or bipolar disorder participated in this observational study. Participants completed in-depth interviews detailing personal and mental health histories. Questionnaires included quality of life and recovery assessments and were linked to records of services used. Qualitative analyses yielded a hypothesized model of the effects of relational continuity and clinician-patient relationships on recovery and quality of life, tested using covariance structure modeling. Qualitative data showed that positive, trusting relationships with clinicians, developed over time, aid recovery. When "fit" with clinicians was good, long-term relational continuity of care allowed development of close, collaborative relationships, fostered good illness and medication management, and supported patient-directed decisions. Most valued were competent, caring, trustworthy, and trusting clinicians who treated clinical encounters "like friendships," increasing willingness to seek help and continue care when treatments were not effective and supporting "normal" rather than "mentally ill" identities. Statistical models showed positive relationships between recovery-oriented patient-driven care and satisfaction with clinicians, medication satisfaction, and recovery. Relational continuity indirectly affected quality of life via satisfaction with clinicians; medication satisfaction was associated with fewer symptoms; fewer symptoms were associated with recovery and better quality of life. Strong clinician-patient relationships, relational continuity, and a caring, collaborative approach facilitate recovery from mental illness and improved quality of life.

Expanding the recommendations for annual influenza vaccination to school-age children in the United States.

PubMed

Fiore, Anthony E; Epperson, Scott; Perrotta, Dennis; Bernstein, Henry; Neuzil, Kathleen

2012-03-01

Despite long-standing recommendations to vaccinate children who have underlying chronic medical conditions or who are contacts of high-risk persons, vaccination coverage among school-age children remains low. Community studies have indicated that school-age children have the highest incidence of influenza and are an important source of amplifying and sustaining community transmission that affects all age groups. A consultation to discuss the advantages and disadvantages of a universal recommendation for annual influenza vaccination of all children age ≥6 months was held in Atlanta, Georgia, in September 2007. Consultants provided summaries of current data on vaccine effectiveness, safety, supply, successful program implementation, and economics studies and discussed challenges associated with continuing a risk- and contact-based vaccination strategy compared with a universal vaccination recommendation. Consultants noted that school-age children had a substantial illness burden caused by influenza, that vaccine was safe and effective for children aged 6 months through 18 years, and that evidence suggested that vaccinating school-age children would provide benefits to both the vaccinated children and their unvaccinated household and community contacts. However, implementation of an annual recommendation for all school-age children would pose major challenges to parents, medical providers and health care systems. Alternative vaccination venues were needed, and of these school-located vaccination programs might offer the most promise as an alternative vaccination site for school-age children. Expansion of recommendations to include all school-age children will require additional development of an infrastructure to support implementation and methods to adequately evaluate impact.

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

PubMed

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

2012-01-01

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

Assessment of phthalates/phthalate alternatives in children's toys and childcare articles: Review of the report including conclusions and recommendation of the Chronic Hazard Advisory Panel of the Consumer Product Safety Commission.

PubMed

Lioy, Paul J; Hauser, Russ; Gennings, Chris; Koch, Holger M; Mirkes, Philip E; Schwetz, Bernard A; Kortenkamp, Andreas

2015-01-01

The Consumer Product Safety Commission (CPSC) convened a Chronic Hazard Advisory Panel (CHAP) on Phthalates found in children's toys, and childcare products, and in products used by women of childbearing age. The CHAP conducted a risk assessment on phthalates and phthalate substitutes, and made recommendations to either ban, impose an interim ban, or allow the continued use of phthalates and phthalate substitutes in the above products. After a review of the literature, the evaluation included toxic end points of primary concern, biomonitoring results, extant exposure reconstruction, and epidemiological results. The health end points chosen were associated with the rat phthalate syndrome, which is characterized by malformations of the epididymis, vas deferens, seminal vesicles, prostate, external genitalia (hypospadias), and by cryptorchidism (undescended testes), retention of nipples/areolae, and demasculinization (~incomplete masculinization) of the perineum, resulting in reduced anogenital distance. Risk assessment demonstrated that some phthalates should be permanently banned, removed from the banned list, or remain interim banned. Biomonitoring and toxicology data provided the strongest basis for a mixture risk assessment. In contrast, external exposure data were the weakest and need to be upgraded for epidemiological studies and risk assessments. Such studies would focus on routes and sources. The review presents recommendations and uncertainties.

Trampoline-related injuries in childhood.

PubMed

Eberl, Robert; Schalamon, Johannes; Singer, Georg; Huber, Sarah S; Spitzer, Peter; Höllwarth, Michael E

2009-10-01

Recommendations to prevent trampoline injuries were given since the 1970s. However, despite these educational efforts, safety recommendations seem to be ignored and the number of trampoline injuries is increasing. All children referred to our department for injuries related to trampolines over a period of 3 years were included. The patients' records were reviewed and a questionnaire was sent out in order to gain additional information. Injuries were classified as severe and mild. A total of 265 children (46% m, 54% f) with a median age of 8.2 years (range 1 to 14) were included. The injury rate was continuously growing from the year 2005 (10.6%) to 2007 (58.1%). Most of the injuries were recorded between April and September with a peak of injuries in August. Seventy-five percent of all accidents happened in the afternoon; 40% of the injuries were classified as severe, 60% as mild. Nets or equal security devices were used in 56.6%. Trampolining is associated with a significant risk for bodily harm at any age and results in severe injuries in 40% of cases. Though there may be still room for improvement in safety recommendations, all attempts over a period of more than 30 years to reduce the number of trampoline-related backyard injuries failed and the incidence is still increasing. At present, trampolines cannot be made safe for recreational activities and are of an unacceptable risk even under supervision.

S3-Guideline on allergy prevention: 2014 update: Guideline of the German Society for Allergology and Clinical Immunology (DGAKI) and the German Society for Pediatric and Adolescent Medicine (DGKJ).

PubMed

Schäfer, Torsten; Bauer, Carl-Peter; Beyer, Kirsten; Bufe, Albrecht; Friedrichs, Frank; Gieler, Uwe; Gronke, Gerald; Hamelmann, Eckard; Hellermann, Mechthild; Kleinheinz, Andreas; Klimek, Ludger; Koletzko, Sibylle; Kopp, Matthias; Lau, Susanne; Müsken, Horst; Reese, Imke; Schmidt, Sabine; Schnadt, Sabine; Sitter, Helmut; Strömer, Klaus; Vagts, Jennifer; Vogelberg, Christian; Wahn, Ulrich; Werfel, Thomas; Worm, Margitta; Muche-Borowski, Cathleen

The continued high prevalence of allergic diseases in Western industrialized nations combined with the limited options for causal therapy make evidence-based primary prevention necessary. The recommendations last published in the S3-guideline on allergy prevention in 2009 have been revised and a consensus reached on the basis of an up-to-date systematic literature search. Evidence was sought for the period between May 2008 and May 2013 in the Cochrane and MEDLINE electronic databases, as well as in the reference lists of recent review articles. In addition, experts were surveyed for their opinions. The relevance of retrieved literature was checked by means of two filter processes: firstly according to title and abstract, and secondly based on the full text of the articles. Included studies were given an evidence grade, and a bias potential (low/high) was specified for study quality. A formal consensus on the revised recommendations was reached by representatives of the relevant specialist societies and (self-help) organizations (nominal group process). Of 3,284 hits, 165 studies (one meta-analysis, 15 systematic reviews, 31 randomized controlled trials, 65 cohort studies, 12 case-control studies and 41 cross-sectional studies) were included and evaluated. Recommendations on the following remain largely unaltered: full breastfeeding for 4 months as a means of allergy prevention (hypoallergenic infant formula in the case of infants at risk); avoidance of overweight; fish consumption (during pregnancy/lactation and in the introduction of solid foods for infants); vaccination according to the recommendations of the German Standing Committee on Vaccination (Ständige Impfkommission, STIKO); avoidance of air pollutants and tobacco exposure and avoidance of indoor conditions conducive to the development of mold. The assertion that a reduction in house-dust mite allergen content as a primary preventive measure is not recommended also remains unchanged. The introduction of solid foods into infant diet should not be delayed. In the case of children at risk cats should not be acquired as domestic pets. Keeping dogs is not associated with an increased risk of allergy. The updated guideline includes a new recommendation to consider the increased risk of asthma following delivery by cesarean section. Additional statements have been formulated on pre- and probiotic agents, psychosocial factors, medications, and various nutritional components. Revising the guideline by using an extensive evidence base has resulted not only in an endorsement of the existing recommendations, but also in modifications and in the addition of new recommendations. The updated guideline enables evidence-based and up-to-date recommendations to be made on allergy prevention. Supplementary material is available for this article at 10.1007/s40629-014-0022-4 and is accessible for authorized users.

Developing a minimum dataset for nursing team leader handover in the intensive care unit: A focus group study.

PubMed

Spooner, Amy J; Aitken, Leanne M; Corley, Amanda; Chaboyer, Wendy

2018-01-01

Despite increasing demand for structured processes to guide clinical handover, nursing handover tools are limited in the intensive care unit. The study aim was to identify key items to include in a minimum dataset for intensive care nursing team leader shift-to-shift handover. This focus group study was conducted in a 21-bed medical/surgical intensive care unit in Australia. Senior registered nurses involved in team leader handovers were recruited. Focus groups were conducted using a nominal group technique to generate and prioritise minimum dataset items. Nurses were presented with content from previous team leader handovers and asked to select which content items to include in a minimum dataset. Participant responses were summarised as frequencies and percentages. Seventeen senior nurses participated in three focus groups. Participants agreed that ISBAR (Identify-Situation-Background-Assessment-Recommendations) was a useful tool to guide clinical handover. Items recommended to be included in the minimum dataset (≥65% agreement) included Identify (name, age, days in intensive care), Situation (diagnosis, surgical procedure), Background (significant event(s), management of significant event(s)) and Recommendations (patient plan for next shift, tasks to follow up for next shift). Overall, 30 of the 67 (45%) items in the Assessment category were considered important to include in the minimum dataset and focused on relevant observations and treatment within each body system. Other non-ISBAR items considered important to include related to the ICU (admissions to ICU, staffing/skill mix, theatre cases) and patients (infectious status, site of infection, end of life plan). Items were further categorised into those to include in all handovers and those to discuss only when relevant to the patient. The findings suggest a minimum dataset for intensive care nursing team leader shift-to-shift handover should contain items within ISBAR along with unit and patient specific information to maintain continuity of care and patient safety across shift changes. Copyright © 2017 Australian College of Critical Care Nurses Ltd. All rights reserved.

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

PubMed

Buckley, Robert M; Kallergis, Achilles

2018-06-01

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

Pacemaker or defibrillator surgery without interruption of anticoagulation.

PubMed

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

2013-05-30

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

A repeated measures model for analysis of continuous outcomes in sequential parallel comparison design studies.

PubMed

Doros, Gheorghe; Pencina, Michael; Rybin, Denis; Meisner, Allison; Fava, Maurizio

2013-07-20

Previous authors have proposed the sequential parallel comparison design (SPCD) to address the issue of high placebo response rate in clinical trials. The original use of SPCD focused on binary outcomes, but recent use has since been extended to continuous outcomes that arise more naturally in many fields, including psychiatry. Analytic methods proposed to date for analysis of SPCD trial continuous data included methods based on seemingly unrelated regression and ordinary least squares. Here, we propose a repeated measures linear model that uses all outcome data collected in the trial and accounts for data that are missing at random. An appropriate contrast formulated after the model has been fit can be used to test the primary hypothesis of no difference in treatment effects between study arms. Our extensive simulations show that when compared with the other methods, our approach preserves the type I error even for small sample sizes and offers adequate power and the smallest mean squared error under a wide variety of assumptions. We recommend consideration of our approach for analysis of data coming from SPCD trials. Copyright © 2013 John Wiley & Sons, Ltd.

1992 NASA Life Support Systems Analysis workshop

NASA Technical Reports Server (NTRS)

Evanich, Peggy L.; Crabb, Thomas M.; Gartrell, Charles F.

1992-01-01

The 1992 Life Support Systems Analysis Workshop was sponsored by NASA's Office of Aeronautics and Space Technology (OAST) to integrate the inputs from, disseminate information to, and foster communication among NASA, industry, and academic specialists. The workshop continued discussion and definition of key issues identified in the 1991 workshop, including: (1) modeling and experimental validation; (2) definition of systems analysis evaluation criteria; (3) integration of modeling at multiple levels; and (4) assessment of process control modeling approaches. Through both the 1991 and 1992 workshops, NASA has continued to seek input from industry and university chemical process modeling and analysis experts, and to introduce and apply new systems analysis approaches to life support systems. The workshop included technical presentations, discussions, and interactive planning, with sufficient time allocated for discussion of both technology status and technology development recommendations. Key personnel currently involved with life support technology developments from NASA, industry, and academia provided input to the status and priorities of current and future systems analysis methods and requirements.

Management strategies in the treatment of neonatal and pediatric gastroenteritis

PubMed Central

Ciccarelli, Simona; Stolfi, Ilaria; Caramia, Giuseppe

2013-01-01

Acute gastroenteritis, characterized by the onset of diarrhea with or without vomiting, continues to be a major cause of morbidity and mortality in children in mostly resource-constrained nations. Although generally a mild and self-limiting disease, gastroenteritis is one of the most common causes of hospitalization and is associated with a substantial disease burden. Worldwide, up to 40% of children aged less than 5 years with diarrhea are hospitalized with rotavirus. Also, some microorganisms have been found predominantly in resource-constrained nations, including Shigella spp, Vibrio cholerae, and the protozoan infections. Prevention remains essential, and the rotavirus vaccines have demonstrated good safety and efficacy profiles in large clinical trials. Because dehydration is the major complication associated with gastroenteritis, appropriate fluid management (oral or intravenous) is an effective and safe strategy for rehydration. Continuation of breastfeeding is strongly recommended. New treatments such as antiemetics (ondansetron), some antidiarrheal agents (racecadotril), and chemotherapeutic agents are often proposed, but not yet universally recommended. Probiotics, also known as “food supplement,” seem to improve intestinal microbial balance, reducing the duration and the severity of acute infectious diarrhea. The European Society for Paediatric Gastroenterology, Hepatology and Nutrition and the European Society of Paediatric Infectious Diseases guidelines make a stronger recommendation for the use of probiotics for the management of acute gastroenteritis, particularly those with documented efficacy such as Lactobacillus rhamnosus GG, Lactobacillus reuteri, and Saccharomyces boulardii. To date, the management of acute gastroenteritis has been based on the option of “doing the least”: oral rehydration-solution administration, early refeeding, no testing, no unnecessary drugs. PMID:24194646

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

40 CFR 255.24 - Procedure for identifying interstate regions.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 24 2010-07-01 2010-07-01 false Procedure for identifying interstate regions. 255.24 Section 255.24 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID... recommendation, the local consensus, or a neighboring Governor's recommendation is that an interstate region be...

40 CFR 256.24 - Recommendations for closing or upgrading open dumps.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 40 Protection of Environment 26 2013-07-01 2013-07-01 false Recommendations for closing or upgrading open dumps. 256.24 Section 256.24 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES GUIDELINES FOR DEVELOPMENT AND IMPLEMENTATION OF STATE SOLID WASTE MANAGEMENT PLANS...

40 CFR 256.24 - Recommendations for closing or upgrading open dumps.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 40 Protection of Environment 26 2012-07-01 2011-07-01 true Recommendations for closing or upgrading open dumps. 256.24 Section 256.24 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES GUIDELINES FOR DEVELOPMENT AND IMPLEMENTATION OF STATE SOLID WASTE MANAGEMENT PLANS...

40 CFR 256.24 - Recommendations for closing or upgrading open dumps.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 40 Protection of Environment 25 2014-07-01 2014-07-01 false Recommendations for closing or upgrading open dumps. 256.24 Section 256.24 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES GUIDELINES FOR DEVELOPMENT AND IMPLEMENTATION OF STATE SOLID WASTE MANAGEMENT PLANS...

7 CFR 1540.44 - Submission of recommendations by the Secretary of Agriculture.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 10 2011-01-01 2011-01-01 false Submission of recommendations by the Secretary of Agriculture. 1540.44 Section 1540.44 Agriculture Regulations of the Department of Agriculture (Continued) FOREIGN AGRICULTURAL SERVICE, DEPARTMENT OF AGRICULTURE INTERNATIONAL AGRICULTURAL TRADE Emergency Relief...

7 CFR 1540.44 - Submission of recommendations by the Secretary of Agriculture.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 7 Agriculture 10 2012-01-01 2012-01-01 false Submission of recommendations by the Secretary of Agriculture. 1540.44 Section 1540.44 Agriculture Regulations of the Department of Agriculture (Continued) FOREIGN AGRICULTURAL SERVICE, DEPARTMENT OF AGRICULTURE INTERNATIONAL AGRICULTURAL TRADE Emergency Relief...

7 CFR 1540.44 - Submission of recommendations by the Secretary of Agriculture.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 7 Agriculture 10 2014-01-01 2014-01-01 false Submission of recommendations by the Secretary of Agriculture. 1540.44 Section 1540.44 Agriculture Regulations of the Department of Agriculture (Continued) FOREIGN AGRICULTURAL SERVICE, DEPARTMENT OF AGRICULTURE INTERNATIONAL AGRICULTURAL TRADE Emergency Relief...

7 CFR 1540.44 - Submission of recommendations by the Secretary of Agriculture.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 7 Agriculture 10 2013-01-01 2013-01-01 false Submission of recommendations by the Secretary of Agriculture. 1540.44 Section 1540.44 Agriculture Regulations of the Department of Agriculture (Continued) FOREIGN AGRICULTURAL SERVICE, DEPARTMENT OF AGRICULTURE INTERNATIONAL AGRICULTURAL TRADE Emergency Relief...

7 CFR 1540.44 - Submission of recommendations by the Secretary of Agriculture.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 10 2010-01-01 2010-01-01 false Submission of recommendations by the Secretary of Agriculture. 1540.44 Section 1540.44 Agriculture Regulations of the Department of Agriculture (Continued) FOREIGN AGRICULTURAL SERVICE, DEPARTMENT OF AGRICULTURE INTERNATIONAL AGRICULTURAL TRADE Emergency Relief...

47 CFR 87.137 - Types of emission.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) SAFETY AND SPECIAL RADIO SERVICES AVIATION SERVICES... to use A3 and at new radiobeacon stations unless specifically recommended by the FAA for safety..., 1990, unless specificallly recommended by the FAA for safety purposes. 3 In the band 117.975-136 MHz...

Select Committee on Public Education. Recommendations.

ERIC Educational Resources Information Center

Texas State Legislature, Austin. Select Committee on Public Education.

Texas' Select Committee on Public Education, created in 1983 by resolution of the Texas Legislature, was directed "to study the issues and continuing concerns relating to public education in Texas, particularly school finance and each of its components." The committee's recommendations, presented in this report, are intended to provide…

Preliminary guidelines and recommendations for the development of material and process specifications for carbon fiber-reinforced liquid resin molded materials.

DOT National Transportation Integrated Search

2007-05-01

This document recommends guidance and criteria for the development of material and process specifications and material acceptance documents for liquid resins and continuous carbon fiber reinforcement materials used in liquid molding processes to manu...

34 CFR 602.35 - Responding to the Advisory Committee's recommendation.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 34 Education 3 2010-07-01 2010-07-01 false Responding to the Advisory Committee's recommendation. 602.35 Section 602.35 Education Regulations of the Offices of the Department of Education (Continued) OFFICE OF POSTSECONDARY EDUCATION, DEPARTMENT OF EDUCATION THE SECRETARY'S RECOGNITION OF ACCREDITING...

40 CFR 141.803 - Coliform sampling.

Code of Federal Regulations, 2013 CFR

2013-07-01

... the disinfection and flushing frequency recommended by the aircraft water system manufacturer, when... of the aircraft water system is unrestricted. (e) Post disinfection and flushing follow-up sampling....803 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) WATER PROGRAMS (CONTINUED...

40 CFR 141.803 - Coliform sampling.

Code of Federal Regulations, 2014 CFR

2014-07-01

... the disinfection and flushing frequency recommended by the aircraft water system manufacturer, when... of the aircraft water system is unrestricted. (e) Post disinfection and flushing follow-up sampling....803 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) WATER PROGRAMS (CONTINUED...

Automated Diagnosis Of Conditions In A Plant-Growth Chamber

NASA Technical Reports Server (NTRS)

Clinger, Barry R.; Damiano, Alfred L.

1995-01-01

Biomass Production Chamber Operations Assistant software and hardware constitute expert system that diagnoses mechanical failures in controlled-environment hydroponic plant-growth chamber and recommends corrective actions to be taken by technicians. Subjects of continuing research directed toward development of highly automated closed life-support systems aboard spacecraft to process animal (including human) and plant wastes into food and oxygen. Uses Microsoft Windows interface to give technicians intuitive, efficient access to critical data. In diagnostic mode, system prompts technician for information. When expert system has enough information, it generates recovery plan.

Tobacco cessation with patients recovering from alcohol and other substance abuse.

PubMed

McIlvain, H E; Bobo, J K

1999-09-01

This article focuses on the problem of tobacco cessation in the patient recovering from alcohol or other substance abuse. The authors review the epidemiology of the problem, specific health risks to this population from continued tobacco use, and recent research findings that address previous treatment concerns. Recommendations for counseling by physicians are made. These include an algorithm for determining the patient's stage of readiness for making a quit attempt, specific counseling tasks based on the patients stage, and motivational counseling strategies aimed at increasing the patients motivation to quit.

Time well spent? Assessing nursing-supply chain activities.

PubMed

Ferenc, Jeff

2010-02-01

The amount of time nurses spend providing direct patient care seems to be continually eroding. So it's little wonder a survey conducted last year of critical care, OR nurses and nurse executives found that half of the 1600 respondents feel they spend too much time on supply chain duties. Most also said their supply chain duties impact patient safe ty and their ability to provide bedside care. Experts interviewed for this report believe it's time for supply chain leaders and nurses to develop a closer working partnership. Included are their recommendations to improve performance.

Large Area X-Ray Spectroscopy Mission

NASA Technical Reports Server (NTRS)

Tananbaum, H.

1997-01-01

The Large Area X-ray Spectroscopy (LAXS) mission concept study continues to evolve strongly following the merging of the LAXS mission with the Next Generation X-ray Observatory (NGXO, PI: Nick White) into the re-named High Throughput X-ray Spectroscopy (HTXS) Mission. HTXS retains key elements of the LAXS proposal, including the use of multiple satellites for risk-reduction and cost savings. A key achievement of the program has been the recommendation by the Structure and Evolution of the Universe (SEUS) (April 1997) for a new start for the HTXS mission in the 2000-2004 timeframe.

Tonsillary carcinoma after temozolomide treatment for glioblastoma multiforme: treatment-related or dual-pathology?

PubMed

Binello, E; Germano, I M

2009-08-01

Glioblastoma multiforme is a primary malignant brain tumor with a prognosis of typically less than 2 years. Standard treatment paradigms include surgery, radiation therapy and temozolomide. Little data exists for temozolomide recommendations after the first 6 months. We present a case of a patient with glioblastoma multiforme treated with surgery, radiation and chronic temozolomide for 6 years. He continues to survive glioblastoma-recurrence-free, but developed tonsillary carcinoma. This case raises the question of whether this secondary solid-organ malignancy is treatment-related or dual pathology.

Multiple perspectives on groupwork with children of battered women.

PubMed

Peled, E; Edleson, J L

1992-01-01

As this century ends there continues to be little public attention devoted to child witnesses of woman abuse and few social programs exist to meet their needs. This article presents the findings of a qualitative evaluation of a group program for children of battered women. Interviews were conducted with 16 mothers, 5 fathers, 9 group leaders, and 30 children who participated in 8 groups. Data also included observations of one complete group process (10 groups and 3 family sessions). Both intended and unintended results are presented and recommendations for practice are discussed.

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

NONE

Preliminary Assessment/Site Inspection Report of Areas Of concern (AOC) A thru F at WK Kellogg, Battle Creek, MI. A Preliminary Assessment/Site Inspection was performed on 6 AOC`s at WK Kellogg to confirm or deny the presence of contamination a the AOC`s. The AOC`s involved in this investigation include. AOC A, Waste Accumulation Area; AOC B, Motor Pool Drainage Ditch; AOC C, Fire Training Area South; AOC D, Fire Training Area West; AOC E, Old Hanger (Building 6900); AOC F, New Hanger (Building 6901). The recommendation is for AOC`s A and B continue to the RI/FS stage.

Thermal infrared remote sensing of surface features for renewable resource applications

NASA Technical Reports Server (NTRS)

Welker, J. E.

1981-01-01

The subjects of infrared remote sensing of surface features for renewable resource applications is reviewed with respect to the basic physical concepts involved at the Earth's surface and up through the atmosphere, as well as the historical development of satellite systems which produce such data at increasingly greater spatial resolution. With this general background in hand, the growth of a variety of specific renewable resource applications using the developing thermal infrared technology are discussed, including data from HCMM investigators. Recommendations are made for continued growth in this field of applications.

Extending FDA guidance to include consumer medication information (CMI) delivery on mobile devices.

PubMed

Sage, Adam; Blalock, Susan J; Carpenter, Delesha

This paper describes the current state of consumer-focused mobile health application use and the current U.S. Food and Drug Administration (FDA) guidance on the distribution of consumer medication information (CMI), and discusses recommendations and considerations for the FDA to expand CMI guidance to include CMI in mobile applications. Smartphone-based health interventions have been linked to increased medication adherence and improved health outcomes. Trends in smartphone ownership present opportunities to more effectively communicate and disseminate medication information; however, current FDA guidance for CMI does not outline how to effectively communicate CMI on a mobile platform, particularly in regards to user-centered design and information sourcing. As evidence supporting the potential effectiveness of mobile communication in health care continues to increase, CMI developers, regulating entities, and researchers should take note. Although mobile-based CMI offers an innovative mechanism to deliver medication information, caution should be exercised. Specifically, considerations for developing mobile CMI include consumers' digital literacy, user experience (e.g., usability), and the quality and accuracy of new widely used sources of information (e.g., crowd-sourced reviews and ratings). Recommended changes to FDA guidance for CMI include altering the language about scientific accuracy to address more novel methods of information gathering (e.g., anecdotal experiences and Google Consumer Surveys) and including guidance for usability testing of mobile health applications. Copyright © 2016 Elsevier Inc. All rights reserved.

Strategy for exploration of the outer planets: 1986-1996

NASA Technical Reports Server (NTRS)

1986-01-01

Over the past decade COMPLEX has published three strategy reports which, taken together, encompass the entire planetary system and recommend a coherent program of planetary exploration. The highest priority for outer planet exploration during the next decade is intensive study of Saturn (the planet, satellites, rings, and magnetosphere) as a system. The Committee additionally recommends that NASA engage in the following supporting activities: increased support of laboratory and theoretical studies; pursuit of earth-based and earth-orbital observations; commitment to continued operation of productive spacecraft; implementation of the instrument development plan as appropriate for the outer solar system; studies of deep atmospheric probes; development of penetrators or other hard landers; development of radiation-hardened spacecraft; and development of low-thrust propulsion systems. Longer-term objectives include exploration and intensive study of: the Uranus and Neptune systems; planetology of the Galilean satellites and Titan; and the inner Jovian system.

Breastfeeding Trends and Determinants: Implications and recommendations for Gulf Cooperation Council countries.

PubMed

Al-Nuaimi, Nisreen; Katende, Godfrey; Arulappan, Judie

2017-05-01

Optimal breastfeeding practices entail the early initiation of breastfeeding soon after delivery of the baby, exclusive breastfeeding for the first six months of life and the continuation of breastfeeding complemented by solid food up until two years of age. Breastfeeding has wide-ranging health benefits for both the mother and her child; however, many factors contribute to low rates of exclusive breastfeeding. This article highlights the benefits of optimal breastfeeding as well as trends and determinants associated with breastfeeding both worldwide and in Gulf Cooperation Council (GCC) countries. Strategies to optimise breastfeeding and overcome breastfeeding barriers in the GCC region are recommended, including community health and education programmes and 'baby-friendly' hospital initiatives. Advocates of breastfeeding are needed at the national, community and family levels. In addition, more systematic research should be conducted to examine breastfeeding practices and the best strategies to promote breastfeeding in this region.

Coronary heart disease in women: highlights of the past 2 years--stepping stones, milestones and obstructing boulders.

PubMed

Wenger, Nanette K

2006-04-01

Emerging data continue to highlight important sex-based differences in coronary heart disease (CHD) prevention and diagnostic testing, in the management of acute coronary syndromes and in the outcomes of CHD therapies. Evidence-based guidelines have been developed that offer specific recommendations for clinicians and information for women. These guidelines are buttressed by results that have become available from randomized, controlled clinical trials in women, and data from CHD registries and clinical trials involving both sexes but including adequate numbers of women to enable the reporting of sex-specific results. Underuse of guideline-based preventive and therapeutic strategies for women probably contributes to their less favorable CHD outcomes. Adherence to recommendations offers the promise of improving the heart health of women. In this article, I summarize new information to guide the preventive, diagnostic and therapeutic management of CHD in women.

Improving Graduate Education to Support a Branching Career Pipeline: Recommendations Based on a Survey of Doctoral Students in the Basic Biomedical Sciences

PubMed Central

Fuhrmann, C. N.; Halme, D. G.; O’Sullivan, P. S.; Lindstaedt, B.

2011-01-01

Today's doctoral programs continue to prepare students for a traditional academic career path despite the inadequate supply of research-focused faculty positions. We advocate for a broader doctoral curriculum that prepares trainees for a wide range of science-related career paths. In support of this argument, we describe data from our survey of doctoral students in the basic biomedical sciences at University of California, San Francisco (UCSF). Midway through graduate training, UCSF students are already considering a broad range of career options, with one-third intending to pursue a non–research career path. To better support this branching career pipeline, we recommend that national standards for training and mentoring include emphasis on career planning and professional skills development to ensure the success of PhD-level scientists as they contribute to a broadly defined global scientific enterprise. PMID:21885820

Providing care for critically ill surgical patients: challenges and recommendations.

PubMed

Tisherman, Samuel A; Kaplan, Lewis; Gracias, Vicente H; Beilman, Gregory J; Toevs, Christine; Byrnes, Matthew C; Coopersmith, Craig M

2013-07-01

Providing optimal care for critically ill and injured surgical patients will become more challenging with staff shortages for surgeons and intensivists. This white paper addresses the historical issues behind the present situation, the need for all intensivists to engage in dedicated critical care per the intensivist model, and the recognition that intensivists from all specialties can provide optimal care for the critically ill surgical patient, particularly with continuing involvement by the surgeon of record. The new acute care surgery training paradigm (including trauma, surgical critical care, and emergency general surgery) has been developed to increase interest in trauma and surgical critical care, but the number of interested trainees remains too few. Recommendations are made for broadening the multidisciplinary training and practice opportunities in surgical critical care for intensivists from all base specialties and for maintaining the intensivist model within acute care surgery practice. Support from academic and administrative leadership, as well as national organizations, will be needed.

Preventing tobacco-caused cancer: a call to action.

PubMed

Orleans, C T

1995-11-01

Nicotine addiction is the most common serious medical problem in the country. Tobacco use is responsible for 30% of cancer deaths in the United States and 90% of all lung cancer deaths. The physical addiction to nicotine explains why over 30% of Americans continue to smoke or use tobacco despite their desires and efforts to quit. The testimony summarized in this paper recommends four broad strategies for preventing tobacco-caused cancers in the United States: a) mandating and reimbursing effective treatments for nicotine addiction; b) increasing Federal and state tobacco excise taxes and earmarking a fraction of tax revenues for tobacco prevention and cessation; c) enacting other policy changes to prevent tobacco use and addiction among children, including expanded clean indoor air legislation, comprehensive youth tobacco access legislation, and the regulation of tobacco products and their advertising and promotion; and d) expanding tobacco control research and critical Federal research support. Specific recommendations are given for each broad strategy.

Engaging Girls in STEM: How to Plan or Revamp Your EPO Resources or Activities to be More Effective for Girls

NASA Technical Reports Server (NTRS)

Bleacher, Lora V.; Peterson, Karen A.; Sharma, Mangala; Smith, Denise

2012-01-01

This two-hour workshop, which was held as a follow-on to the plenary session "Engaging Girls in STEM: A Discussion of Foundational and Current Research on What Works," offered research-based insights, resources, and tips to help participants plan or revamp programs and resources aimed at encouraging girls in science. Led by Karen Peterson, PI for the National Girls Collaborative Project,1 the workshop included: a brief discussion about effective strategies recommended for encouraging girls in STEM; hands-on experience, where participants-availing of the expert's guidance-applied the recommended strategies to alter or tailor an existing or planned program/resource to be more girl-friendly; and a sharing out, where the participants reflected on the results of the hands-on exercise and developed action items to continue carrying out the girl-friendly best practices in science, technology, engineering, and math education and public outreach.

Perceived discontinuities and continuities in transdisciplinary scientific working groups.

PubMed

Crowston, Kevin; Specht, Alison; Hoover, Carol; Chudoba, Katherine M; Watson-Manheim, Mary Beth

2015-11-15

We examine the DataONE (Data Observation Network for Earth) project, a transdisciplinary organization tasked with creating a cyberinfrastructure platform to ensure preservation of and access to environmental science and biological science data. Its objective was a difficult one to achieve, requiring innovative solutions. The DataONE project used a working group structure to organize its members. We use organizational discontinuity theory as our lens to understand the factors associated with success in such projects. Based on quantitative and qualitative data collected from DataONE members, we offer recommendations for the use of working groups in transdisciplinary synthesis. Recommendations include welcome diverse opinions and world views, establish shared communication practices, schedule periodic synchronous face-to-face meetings, and ensure the active participation of bridge builders or knowledge brokers such as librarians who know how to ask questions about disciplines not their own. Copyright © 2015 Elsevier B.V. All rights reserved.

Position paper: Rationale for the treatment of Wilms tumour in the UMBRELLA SIOP-RTSG 2016 protocol.

PubMed

van den Heuvel-Eibrink, Marry M; Hol, Janna A; Pritchard-Jones, Kathy; van Tinteren, Harm; Furtwängler, Rhoikos; Verschuur, Arnauld C; Vujanic, Gordan M; Leuschner, Ivo; Brok, Jesper; Rübe, Christian; Smets, Anne M; Janssens, Geert O; Godzinski, Jan; Ramírez-Villar, Gema L; de Camargo, Beatriz; Segers, Heidi; Collini, Paola; Gessler, Manfred; Bergeron, Christophe; Spreafico, Filippo; Graf, Norbert

2017-12-01

The Renal Tumour Study Group of the International Society of Paediatric Oncology (SIOP-RTSG) has developed a new protocol for the diagnosis and treatment of childhood renal tumours, the UMBRELLA SIOP-RTSG 2016 (the UMBRELLA protocol), to continue international collaboration in the treatment of childhood renal tumours. This protocol will support integrated biomarker and imaging research, focussing on assessing the independent prognostic value of genomic changes within the tumour and the volume of the blastemal component that survives preoperative chemotherapy. Treatment guidelines for Wilms tumours in the UMBRELLA protocol include recommendations for localized, metastatic, and bilateral disease, for all age groups, and for relapsed disease. These recommendations have been established by a multidisciplinary panel of leading experts on renal tumours within the SIOP-RTSG. The UMBRELLA protocol should promote international collaboration and research and serve as the SIOP-RTSG best available treatment standard.

Complexity of Exercise Behavior Among Older African American Women.

PubMed

Kosma, Maria; Buchanan, David; Hondzinski, Jan

2017-07-01

Despite the exercise benefits, disparities among diverse older adults continue to exist, where African American women have the lowest percentage of any population group in meeting national recommended activity guidelines. Drawing on the philosophical tradition of phronesis (practical reasoning) introduced by Aristotle, we studied perceptions of the exercise value among 14 older African American women. Three themes included: (1) exercise goals (e.g., effort exerted), (2) exercise reasons (e.g., health benefits, enjoyment and convenience, and activity recommendation), and (3) inactivity reasons (e.g., health issues, lack of motivation, and family responsibilities/priorities). Although most women reported being active, only three participants met the Healthy People 2020 guidelines for aerobic and muscle-strengthening activities, while two individuals were inactive. Exercise promoters should consider the values that motivate older African American women to exercise, such as the provision of accessible, nondiscriminatory exercise facilities, and not to exercise, such as concerns about neighborhood safety, in designing programs.

Aerial drone misadventure: A novel case of trauma resulting in ocular globe rupture.

PubMed

Moskowitz, Eliza E; Siegel-Richman, Yonaton M; Hertner, George; Schroeppel, Thomas

2018-06-01

The purpose of this case report is to present the novel findings of a drone causing such a traumatic ocular injury and provide recommendations for how it might be prevented. We report on a recent case where a child presented to our Emergency Department after incurring a blow to the face by the propeller of a remote controlled drone. The patient suffered significant trauma including rupture of the right globe. As drone sales continue to rise, it is important that physicians be prepared to treat the potential injuries that may result from using these devices. Furthermore, in an attempt to reduce the number of visits associated with remote controlled drones, physicians should be prepared to provide advice as to how patients can reduce the risks of injury. We hope that the framework and recommendations below will help physicians decrease adverse outcomes related to this unusual injury pattern.

The need to advance nutrition education in the training of health care professionals and recommended research to evaluate implementation and effectiveness1234

PubMed Central

Kris-Etherton, Penny M; Akabas, Sharon R; Bales, Connie W; Bistrian, Bruce; Braun, Lynne; Edwards, Marilyn S; Laur, Celia; Lenders, Carine M; Levy, Matthew D; Palmer, Carole A; Pratt, Charlotte A; Ray, Sumantra; Rock, Cheryl L; Saltzman, Edward; Seidner, Douglas L; Van Horn, Linda

2014-01-01

Nutrition is a recognized determinant in 3 (ie, diseases of the heart, malignant neoplasms, cerebrovascular diseases) of the top 4 leading causes of death in the United States. However, many health care providers are not adequately trained to address lifestyle recommendations that include nutrition and physical activity behaviors in a manner that could mitigate disease development or progression. This contributes to a compelling need to markedly improve nutrition education for health care professionals and to establish curricular standards and requisite nutrition and physical activity competencies in the education, training, and continuing education for health care professionals. This article reports the present status of nutrition and physical activity education for health care professionals, evaluates the current pedagogic models, and underscores the urgent need to realign and synergize these models to reflect evidence-based and outcomes-focused education. PMID:24717343

Improving graduate education to support a branching career pipeline: recommendations based on a survey of doctoral students in the basic biomedical sciences.

PubMed

Fuhrmann, C N; Halme, D G; O'Sullivan, P S; Lindstaedt, B

2011-01-01

Today's doctoral programs continue to prepare students for a traditional academic career path despite the inadequate supply of research-focused faculty positions. We advocate for a broader doctoral curriculum that prepares trainees for a wide range of science-related career paths. In support of this argument, we describe data from our survey of doctoral students in the basic biomedical sciences at University of California, San Francisco (UCSF). Midway through graduate training, UCSF students are already considering a broad range of career options, with one-third intending to pursue a non-research career path. To better support this branching career pipeline, we recommend that national standards for training and mentoring include emphasis on career planning and professional skills development to ensure the success of PhD-level scientists as they contribute to a broadly defined global scientific enterprise.

Domestic Minor Sex Trafficking: Medical Follow-up for Victimized and High-Risk Youth.

PubMed

Kaplan, Dana M; Moore, Jessica L; Barron, Christine E; Goldberg, Amy P

2018-05-01

Domestic minor sex trafficking (DMST) has become an increasingly recognized issue associated with both immediate and long-term physical and mental health consequences. Guidelines have focused on potential risk factors, recruitment practices, and health consequences for these youth assisting in identification and intervention efforts. However, recommendations have not been established for continuous medical intervention and follow-up for this vulnerable patient population that includes both patients involved in and at high risk for DMST. Our goal is to highlight preliminary recommendations for and the importance of medical visits for these youth. A comprehensive physical examination, STI testing and treatment, and pregnancy prevention options are important to address the patients' concerns for their body and identify acute and chronic injuries. Further, collaborating with other medical and non-medical providers can provide essential resources for the multifaceted needs of DMST patients. [Full article available at http://rimed.org/rimedicaljournal-2018-05.asp].

Consultant Input in Acute Medical Admissions and Patient Outcomes in Hospitals in England: A Multivariate Analysis

PubMed Central

Bell, Derek; Lambourne, Adrian; Percival, Frances; Laverty, Anthony A.; Ward, David K.

2013-01-01

Recent recommendations for physicians in the UK outline key aspects of care that should improve patient outcomes and experience in acute hospital care. Included in these recommendations are Consultant patterns of work to improve timeliness of clinical review and improve continuity of care. This study used a contemporaneous validated survey compared with clinical outcomes derived from Hospital Episode Statistics, between April 2009 and March 2010 from 91 acute hospital sites in England to evaluate systems of consultant cover for acute medical admissions. Clinical outcomes studied included adjusted case fatality rates (aCFR), including the ratio of weekend to weekday mortality, length of stay and readmission rates. Hospitals that had an admitting Consultant presence within the Acute Medicine Unit (AMU, or equivalent) for a minimum of 4 hours per day (65% of study group) had a lower aCFR compared with hospitals that had Consultant presence for less than 4 hours per day (p<0.01) and also had a lower 28 day re-admission rate (p<0.01). An ‘all inclusive’ pattern of Consultant working, incorporating all the guideline recommendations and which included the minimum Consultant presence of 4 hours per day (29%) was associated with reduced excess weekend mortality (p<0.05). Hospitals with >40 acute medical admissions per day had a lower aCFR compared to hospitals with fewer than 40 admissions per day (p<0.03) and had a lower 7 day re-admission rate (p<0.02). This study is the first large study to explore the potential relationships between systems of providing acute medical care and clinical outcomes. The results show an association between well-designed systems of Consultant working practices, which promote increased patient contact, and improved patient outcomes in the acute hospital setting. PMID:23613858

Consultant input in acute medical admissions and patient outcomes in hospitals in England: a multivariate analysis.

PubMed

Bell, Derek; Lambourne, Adrian; Percival, Frances; Laverty, Anthony A; Ward, David K

2013-01-01

Recent recommendations for physicians in the UK outline key aspects of care that should improve patient outcomes and experience in acute hospital care. Included in these recommendations are Consultant patterns of work to improve timeliness of clinical review and improve continuity of care. This study used a contemporaneous validated survey compared with clinical outcomes derived from Hospital Episode Statistics, between April 2009 and March 2010 from 91 acute hospital sites in England to evaluate systems of consultant cover for acute medical admissions. Clinical outcomes studied included adjusted case fatality rates (aCFR), including the ratio of weekend to weekday mortality, length of stay and readmission rates. Hospitals that had an admitting Consultant presence within the Acute Medicine Unit (AMU, or equivalent) for a minimum of 4 hours per day (65% of study group) had a lower aCFR compared with hospitals that had Consultant presence for less than 4 hours per day (p<0.01) and also had a lower 28 day re-admission rate (p<0.01). An 'all inclusive' pattern of Consultant working, incorporating all the guideline recommendations and which included the minimum Consultant presence of 4 hours per day (29%) was associated with reduced excess weekend mortality (p<0.05). Hospitals with >40 acute medical admissions per day had a lower aCFR compared to hospitals with fewer than 40 admissions per day (p<0.03) and had a lower 7 day re-admission rate (p<0.02). This study is the first large study to explore the potential relationships between systems of providing acute medical care and clinical outcomes. The results show an association between well-designed systems of Consultant working practices, which promote increased patient contact, and improved patient outcomes in the acute hospital setting.

Antithrombotic therapy in atrial fibrillation: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition).

PubMed

Singer, Daniel E; Albers, Gregory W; Dalen, James E; Fang, Margaret C; Go, Alan S; Halperin, Jonathan L; Lip, Gregory Y H; Manning, Warren J

2008-06-01

This chapter about antithrombotic therapy in atrial fibrillation (AF) is part of the American College of Chest Physicians Evidence-Based Guidelines Clinical Practice Guidelines (8th Edition). Grade 1 recommendations indicate that most patients would make the same choice and Grade 2 suggests that individual patient's values may lead to different choices (for a full understanding of the grading see Guyatt et al, CHEST 2008; 133[suppl]:123S-131S). Among the key recommendations in this chapter are the following (all vitamin K antagonist [VKA] recommendations have a target international normalized ratio [INR] of 2.5; range 2.0-3.0, unless otherwise noted). In patients with AF, including those with paroxysmal AF, who have had a prior ischemic stroke, transient ischemic attack (TIA), or systemic embolism, we recommend long-term anticoagulation with an oral VKA, such as warfarin, because of the high risk of future ischemic stroke faced by this set of patients (Grade 1A). In patients with AF, including those with paroxysmal AF, who have two or more of the risk factors for future ischemic stroke listed immediately below, we recommend long-term anticoagulation with an oral VKA (Grade 1A). Two or more of the following risk factors apply: age >75 years, history of hypertension, diabetes mellitus, moderately or severely impaired left ventricular systolic function and/or heart failure. In patients with AF, including those with paroxysmal AF, with only one of the risk factors listed immediately above, we recommend long-term antithrombotic therapy (Grade 1A), either as anticoagulation with an oral VKA, such as warfarin (Grade 1A), or as aspirin, at a dose of 75-325 mg/d (Grade 1B). In these patients at intermediate risk of ischemic stroke we suggest a VKA rather than aspirin (Grade 2A). In patients with AF, including those with paroxysmal AF, age < or =75 years and with none of the other risk factors listed above, we recommend long-term aspirin therapy at a dose of 75-325 mg/d (Grade 1B), because of their low risk of ischemic stroke. For patients with atrial flutter, we recommend that antithrombotic therapy decisions follow the same risk-based recommendations as for AF (Grade 1C). For patients with AF and mitral stenosis, we recommend long-term anticoagulation with an oral VKA (Grade 1B). For patients with AF and prosthetic heart valves we recommend long-term anticoagulation with an oral VKA at an intensity appropriate for the specific type of prosthesis (Grade 1B). See CHEST 2008; 133(suppl):593S-629S. For patients with AF of > or =48 h or of unknown duration for whom pharmacologic or electrical cardioversion is planned, we recommend anticoagulation with an oral VKA, such as warfarin, for 3 weeks before elective cardioversion and for at least 4 weeks after sinus rhythm has been maintained (Grade 1C). For patients with AF of > or = 48 h or of unknown duration undergoing pharmacological or electrical cardioversion, we also recommend either immediate anticoagulation with unfractionated IV heparin, or low-molecular-weight heparin (LMWH), or at least 5 days of warfarin by the time of cardioversion (achieving an INR of 2.0-3.0) as well as a screening multiplane transesophageal echocardiography (TEE). If no thrombus is seen, cardioversion is successful, and sinus rhythm is maintained, we recommend anticoagulation for at least 4 weeks. If a thrombus is seen on TEE, then cardioversion should be postponed and anticoagulation should be continued indefinitely. We recommend obtaining a repeat TEE before attempting later cardioversion (Grade 1B addressing the equivalence of TEE-guided vs non-TEE-guided cardioversion). For patients with AF of known duration <48 h, we suggest cardioversion without prolonged anticoagulation (Grade 2C). However, in patients without contraindications to anticoagulation, we suggest beginning IV heparin or LMWH at presentation (Grade 2C).

Tobacco use among adolescents. Strategies for prevention.

PubMed

Epps, R P; Manley, M W; Glynn, T J

1995-04-01

Tobacco use is a major public health problem that has its onset during childhood and adolescence. To prevent the onset, physicians can reach children and their parents in their offices beginning in the prenatal period and continuing through adulthood. For pediatricians and other physicians who care for children, NCI recommends five office-based activities that begin with the letter A. The 5 As include anticipatory guidance, ask, advise, assist, and arrange follow-up visits. Elimination of tobacco use requires a comprehensive strategy that includes health professional interventions, policy changes, advertising restrictions, comprehensive school-based programs, community activities, and advocacy approaches. Physicians and health professionals have major roles to play in each of these interventions.

Guide for inservice inspection of ground-based pressure vessels and systems

NASA Technical Reports Server (NTRS)

1976-01-01

This guide includes recommendations for inservice inspection and recertification of ground based, unfired pressure vessels and all pressurized systems including those served by fired pressure vessels hereinafter referred to as pressure vessels, systems and components of systems. It covers the vast array of pound based industrial and special purpose pressurized components and systems used at NASA field installations for research and development and those utility systems and components that require more than routine maintenance to insure continued structural integrity for their useful life. Through surveillance and correction of inservice deterioration, NASA will maintain a safe working environment for their own and contractor personnel, safety for the public sector and protection against loss of capital investment.

Transactive Systems Simulation and Valuation Platform Trial Analysis

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

Widergren, Steven E.; Hammerstrom, Donald J.; Huang, Qiuhua

Transactive energy systems use principles of value to coordinate responsive supply and demand in energy systems. Work continues within the Transactive Systems Program, which is funded by the U.S. Department of Energy at Pacific Northwest National Laboratory, to understand the value of, understand the theory behind, and simulate the behaviors of transactive energy systems. This report summarizes recent advances made by this program. The main capability advances include a more comprehensive valuation model, including recommended documentation that should make valuation studies of all sorts more transparent, definition of economic metrics with which transactive mechanisms can be evaluated, and multiple improvementsmore » to the time-simulation environment that is being used to evaluate transactive scenarios.« less

Extracorporeal Treatment for Lithium Poisoning: Systematic Review and Recommendations from the EXTRIP Workgroup

PubMed Central

Decker, Brian S.; Goldfarb, David S.; Dargan, Paul I.; Friesen, Marjorie; Gosselin, Sophie; Hoffman, Robert S.; Lavergne, Valéry; Nolin, Thomas D.

2015-01-01

The Extracorporeal Treatments in Poisoning Workgroup was created to provide evidence-based recommendations on the use of extracorporeal treatments in poisoning. Here, the EXTRIP workgroup presents its recommendations for lithium poisoning. After a systematic literature search, clinical and toxicokinetic data were extracted and summarized following a predetermined format. The entire workgroup voted through a two-round modified Delphi method to reach a consensus on voting statements. A RAND/UCLA Appropriateness Method was used to quantify disagreement, and anonymous votes were compiled and discussed in person. A second vote was conducted to determine the final workgroup recommendations. In total, 166 articles met inclusion criteria, which were mostly case reports, yielding a very low quality of evidence for all recommendations. A total of 418 patients were reviewed, 228 of which allowed extraction of patient-level data. The workgroup concluded that lithium is dialyzable (Level of evidence=A) and made the following recommendations: Extracorporeal treatment is recommended in severe lithium poisoning (1D). Extracorporeal treatment is recommended if kidney function is impaired and the [Li+] is >4.0 mEq/L, or in the presence of a decreased level of consciousness, seizures, or life-threatening dysrhythmias irrespective of the [Li+] (1D). Extracorporeal treatment is suggested if the [Li+] is >5.0 mEq/L, significant confusion is present, or the expected time to reduce the [Li+] to <1.0 mEq/L is >36 hours (2D). Extracorporeal treatment should be continued until clinical improvement is apparent or [Li+] is <1.0 mEq/L (1D). Extracorporeal treatments should be continued for a minimum of 6 hours if the [Li+] is not readily measurable (1D). Hemodialysis is the preferred extracorporeal treatment (1D), but continuous RRT is an acceptable alternative (1D). The workgroup supported the use of extracorporeal treatment in severe lithium poisoning. Clinical decisions on when to use extracorporeal treatment should take into account the [Li+], kidney function, pattern of lithium toxicity, patient’s clinical status, and availability of extracorporeal treatments. PMID:25583292

Neuromodulators for Functional Gastrointestinal Disorders (Disorders of Gut-Brain Interaction): A Rome Foundation Working Team Report.

PubMed

Drossman, Douglas A; Tack, Jan; Ford, Alexander C; Szigethy, Eva; Törnblom, Hans; Van Oudenhove, Lukas

2018-03-01

Central neuromodulators (antidepressants, antipsychotics, and other central nervous system-targeted medications) are increasingly used for treatment of functional gastrointestinal disorders (FGIDs), now recognized as disorders of gut-brain interaction. However, the available evidence and guidance for the use of central neuromodulators in these conditions is scanty and incomplete. In this Rome Foundation Working Team report, a multidisciplinary team summarized available research evidence and clinical experience to provide guidance and treatment recommendations. The working team summarized the literature on the pharmacology of central neuromodulators and their effects on gastrointestinal sensorimotor function and conducted an evidence-based review on their use for treating FGID syndromes. Because of the paucity of data for FGIDs, we included data for non-gastrointestinal painful disorders and specific symptoms of pain, nausea, and vomiting. This information was combined into a final document comprising a synthesis of available evidence and recommendations for clinical use guided by the research and clinical experience of the experts on the committee. The evidence-based review on neuromodulators in FGID, restricted by the limited available controlled trials, was integrated with open-label studies and case series, along with the experience of experts to create recommendations using a consensus (Delphi) approach. Due to the diversity of conditions and complexity of treatment options, specific recommendations were generated for different FGIDs. However, some general recommendations include: (1) low to modest dosages of tricyclic antidepressants provide the most convincing evidence of benefit for treating chronic gastrointestinal pain and painful FGIDs and serotonin noradrenergic reuptake inhibitors can also be recommended, though further studies are needed; (2) augmentation, that is, adding a second treatment (adding quetiapine, aripiprazole, buspirone α2δ ligand agents) is recommended when a single medication is unsuccessful or produces side effects at higher dosages; (3) treatment should be continued for 6-12 months to potentially prevent relapse; and (4) implementation of successful treatment requires effective communication skills to improve patient acceptance and adherence, and to optimize the patient-provider relationship. Based on systematic and selectively focused review and the consensus of a multidisciplinary panel, we have provided summary information and guidelines for the use of central neuromodulators in the treatment of chronic gastrointestinal symptoms and FGIDs. Further studies are needed to confirm and refine these recommendations. Copyright © 2018 AGA Institute. Published by Elsevier Inc. All rights reserved.

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

PubMed

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

2013-01-01

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

The National Cancer Institute-American Society of Clinical Oncology Cancer Trial Accrual Symposium: summary and recommendations.

PubMed

Denicoff, Andrea M; McCaskill-Stevens, Worta; Grubbs, Stephen S; Bruinooge, Suanna S; Comis, Robert L; Devine, Peggy; Dilts, David M; Duff, Michelle E; Ford, Jean G; Joffe, Steven; Schapira, Lidia; Weinfurt, Kevin P; Michaels, Margo; Raghavan, Derek; Richmond, Ellen S; Zon, Robin; Albrecht, Terrance L; Bookman, Michael A; Dowlati, Afshin; Enos, Rebecca A; Fouad, Mona N; Good, Marjorie; Hicks, William J; Loehrer, Patrick J; Lyss, Alan P; Wolff, Steven N; Wujcik, Debra M; Meropol, Neal J

2013-11-01

Many challenges to clinical trial accrual exist, resulting in studies with inadequate enrollment and potentially delaying answers to important scientific and clinical questions. The National Cancer Institute (NCI) and the American Society of Clinical Oncology (ASCO) cosponsored the Cancer Trial Accrual Symposium: Science and Solutions on April 29-30, 2010 to examine the state of accrual science related to patient/community, physician/provider, and site/organizational influences, and identify new interventions to facilitate clinical trial enrollment. The symposium featured breakout sessions, plenary sessions, and a poster session including 100 abstracts. Among the 358 attendees were clinical investigators, researchers of accrual strategies, research administrators, nurses, research coordinators, patient advocates, and educators. A bibliography of the accrual literature in these three major areas was provided to participants in advance of the meeting. After the symposium, the literature in these areas was revisited to determine if the symposium recommendations remained relevant within the context of the current literature. Few rigorously conducted studies have tested interventions to address challenges to clinical trials accrual. Attendees developed recommendations for improving accrual and identified priority areas for future accrual research at the patient/community, physician/provider, and site/organizational levels. Current literature continues to support the symposium recommendations. A combination of approaches addressing both the multifactorial nature of accrual challenges and the characteristics of the target population may be needed to improve accrual to cancer clinical trials. Recommendations for best practices and for future research developed from the symposium are provided.

40 CFR 40.150 - Evaluation of applications.

Code of Federal Regulations, 2011 CFR

2011-07-01

.... Relevancy, coupled with the results of technical review, will provide the basis for funding recommendations... will be reviewed for technical merit by at least one reviewer within EPA and at least two reviewers.... Recommendations for continuation of funding will be based on progress toward the accomplishment of the goals set...

40 CFR Appendix to Part 240 - Recommended Bibliography

Code of Federal Regulations, 2014 CFR

2014-07-01

... Safety and Health Act of 1970; Pub. L. 91-596, 91st Cong., S. 2193, Dec. 29, 1970. Washington, U.S... 40 Protection of Environment 25 2014-07-01 2014-07-01 false Recommended Bibliography Appendix to Part 240 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES GUIDELINES...

40 CFR 57.810 - Filing of briefs, proposed findings, and proposed recommendations.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 5 2010-07-01 2010-07-01 false Filing of briefs, proposed findings, and proposed recommendations. 57.810 Section 57.810 Protection of Environment ENVIRONMENTAL PROTECTION... Requirement for Use of Continuous Emission Reduction Technology § 57.810 Filing of briefs, proposed findings...

40 CFR Appendix to Part 240 - Recommended Bibliography

Code of Federal Regulations, 2011 CFR

2011-07-01

... Part 240 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES GUIDELINES FOR THE THERMAL PROCESSING OF SOLID WASTES Pt. 240, App. Appendix to Part 240—Recommended Bibliography 1. The Solid Waste Disposal Act as amended; Title II of Pub. L. 89-272, 89th Cong., S. 306, Oct. 20...

40 CFR 256.24 - Recommendations for closing or upgrading open dumps.

Code of Federal Regulations, 2010 CFR

2010-07-01

... (CONTINUED) SOLID WASTES GUIDELINES FOR DEVELOPMENT AND IMPLEMENTATION OF STATE SOLID WASTE MANAGEMENT PLANS Solid Waste Disposal Programs § 256.24 Recommendations for closing or upgrading open dumps. (a) All... feasibility of resource recovery or resource conservation to reduce the solid waste volume entering a facility...

40 CFR 256.24 - Recommendations for closing or upgrading open dumps.

Code of Federal Regulations, 2011 CFR

2011-07-01

... (CONTINUED) SOLID WASTES GUIDELINES FOR DEVELOPMENT AND IMPLEMENTATION OF STATE SOLID WASTE MANAGEMENT PLANS Solid Waste Disposal Programs § 256.24 Recommendations for closing or upgrading open dumps. (a) All... feasibility of resource recovery or resource conservation to reduce the solid waste volume entering a facility...

What Do Adolescents Exposed to Alcoholic Anonymous Think about 12-Step Groups?

ERIC Educational Resources Information Center

Kelly, John F.; Myers, Mark G.; Rodolico, John

2008-01-01

Objectives: Referral to Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) is a common continuing care recommendation. Evidence suggests some youth benefit, yet, despite referrals, youth participation is low. Little is known about adolescents' experiences of AA/NA. Greater knowledge would inform and help tailor aftercare recommendations.…

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

NASA Technical Reports Server (NTRS)

1990-01-01

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

Theory-based development of an implementation intervention to increase HPV vaccination in pediatric primary care practices.

PubMed

Garbutt, Jane M; Dodd, Sherry; Walling, Emily; Lee, Amanda A; Kulka, Katharine; Lobb, Rebecca

2018-03-13

The national guideline for use of the vaccine targeting oncogenic strains of the human papillomavirus (HPV) is an evidence-based practice that is poorly implemented in primary care. Recommendations include completion of the vaccine series before the 13th birthday for girls and boys, giving the first dose at the 11- to 12-year-old check-up visit, concurrent with other recommended vaccines. Interventions to increase implementation of this guideline have had little impact, and opportunities to prevent cancer continue to be missed. We used a theory-informed approach to develop a pragmatic intervention for use in primary care settings to increase implementation of the HPV vaccine guideline recommendation. Using a concurrent mixed methods design in 10 primary care practices, we applied the Consolidated Framework for Implementation Research (CFIR) to systematically investigate and characterize factors strongly influencing vaccine use. We then used the Behavior Change Wheel (BCW) and the Theoretical Domains Framework (TDF) to analyze provider behavior and identify behaviors to target for change and behavioral change strategies to include in the intervention. We identified facilitators and barriers to guideline use across the five CFIR domains: most distinguishing factors related to provider characteristics, their perception of the intervention, and their process to deliver the vaccine. Targeted behaviors were for the provider to recommend the HPV vaccine the same way and at the same time as the other adolescent vaccines, to answer parents' questions with confidence, and to implement a vaccine delivery system. To this end, the intervention targeted improving provider's capability (knowledge, communication skills) and motivation (action planning, belief about consequences, social influences) regarding implementing guideline recommendations, and increasing their opportunity to do so (vaccine delivery system). Behavior change strategies included providing information and communication skill training with graded tasks and modeling, feedback of coverage rates, goal setting, and social support. These strategies were combined in an implementation intervention to be delivered using practice facilitation, educational outreach visits, and cyclical small tests of change. Using CFIR, the BCW and the TDF facilitated the development of a pragmatic, multi-component implementation intervention to increase use of the HPV vaccine in the primary care setting.

29 CFR 1960.78 - Purpose and scope.

Code of Federal Regulations, 2010 CFR

2010-07-01

... agency progress and problems in correcting unsafe and unhealthful working conditions, and recommendations... Regulations Relating to Labor (Continued) OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR (CONTINUED) BASIC PROGRAM ELEMENTS FOR FEDERAL EMPLOYEE OCCUPATIONAL SAFETY AND HEALTH PROGRAMS AND RELATED...

[CGM-continuous glucose monitoring - statement of the Austrian Diabetes Association].

PubMed

Schütz-Fuhrmann, Ingrid; Schober, Edith; Rami, Birgit; Stadler, Marietta; Bischof, Martin; Fortunat, Sandra; Laimer, Markus; Weitgasser, Raimund; Prager, Rudolf

2012-12-01

This position statement represents the recommendations of the Austrian Diabetes Association regarding the clinical diagnostic and therapeutic application, safety and benefits of continuous subcutaneous glucose monitoring systems in patients with diabetes mellitus, based on current evidence.

[CGM-Continuous Glucose Monitoring--Statement of the Austrian Diabetes Association].

PubMed

Schütz-Fuhrmann, Ingrid; Rami-Merhar, Birgit; Hofer, Sabine; Stadler, Marietta; Bischof, Martin; Zlamal-Fortunat, Sandra; Laimer, Markus; Weitgasser, Raimund; Prager, Rudolf

2016-04-01

This position statement represents the recommendations of the Austrian Diabetes Association regarding the clinical diagnostic and therapeutic application, safety and benefits of continuous subcutaneous glucose monitoring systems in patients with diabetes mellitus, based on current evidence.

Development of environmentally friendly messages to promote longer durations of breastfeeding for already breastfeeding mothers.

PubMed

Hamilton, Amanda E

2015-01-01

Durations of breastfeeding activity in the United States fall short of established recommendations by leading public health institutions. In response to this problem, this study sought to develop environmentally friendly messages to promote continued breastfeeding for moms already breastfeeding in order to help them reach recommended breastfeeding durations. Messages were successfully cultivated to encourage moms already breastfeeding to meet recommended breastfeeding durations. In addition, this study cultivated strategies by which to use environmentally friendly messages to urge mothers who still need to decide whether to breastfeed or formula feed to breastfeed, although this was not the purpose of the research. Avenues for future communication-based breastfeeding research were also elucidated. The Elaboration Likelihood Model serves as useful theory to assess the role of environmentally friendly messages in the promotion of continued breastfeeding.

Fracture liaison services for osteoporosis in the Asia-Pacific region: current unmet needs and systematic literature review.

PubMed

Chang, Y -F; Huang, C -F; Hwang, J -S; Kuo, J -F; Lin, K -M; Huang, H -C; Bagga, S; Kumar, A; Chen, F -P; Wu, C -H

2018-04-01

The analysis aimed to identify the treatment gaps in current fracture liaison services (FLS) and to provide recommendations for best practice establishment of future FLS across the Asia-Pacific region. The findings emphasize the unmet need for the implementation of new programs and provide recommendations for the refinement of existing ones. The study's objectives were to evaluate fracture liaison service (FLS) programs in the Asia-Pacific region and provide recommendations for establishment of future FLS programs. A systematic literature review (SLR) of Medline, PubMed, EMBASE, and Cochrane Library (2000-2017 inclusive) was performed using the following keywords: osteoporosis, fractures, liaison, and service. Inclusion criteria included the following: patients ≥ 50 years with osteoporosis-related fractures; randomized controlled trials or observational studies with control groups (prospective or retrospective), pre-post, cross-sectional and economic evaluation studies. Success of direct or indirect interventions was assessed based on patients' understanding of risk, bone mineral density assessment, calcium intake, osteoporosis treatment, re-fracture rates, adherence, and mortality, in addition to cost-effectiveness. Overall, 5663 unique citations were identified and the SLR identified 159 publications, reporting 37 studies in Asia-Pacific. These studies revealed the unmet need for public health education, adequate funding, and staff resourcing, along with greater cooperation between departments and physicians. These actions can help to overcome therapeutic inertia with sufficient follow-up to ensure adherence to recommendations and compliance with treatment. The findings also emphasize the importance of primary care physicians continuing to prescribe treatment and ensure service remains convenient. These findings highlight the limited evidence supporting FLS across the Asia-Pacific region, emphasizing the unmet need for new programs and/or refinement of existing ones to improve outcomes. With the continued increase in burden of fractures in Asia-Pacific, establishment of new FLS and assessment of existing services are warranted to determine the impact of FLS for healthcare professionals, patients, family/caregivers, and society.

Adherence of Low-income Women to Cancer Screening Recommendations

PubMed Central

O'Malley, Ann S; Forrest, Christopher B; Mandelblatt, Jeanne

2002-01-01

BACKGROUND African-American and low-income women have lower rates of cancer screening and higher rates of late-stage disease than do their counterparts. OBJECTIVE To examine the effects of primary care, health insurance, and HMO participation on adherence to regular breast, cervical, and colorectal cancer screening. DESIGN Random-digit-dial and targeted household telephone survey of a population-based sample. SETTING Washington, D.C. census tracts with ≥30% of households below 200% of federal poverty threshold. PARTICIPANTS Included in the survey were 1,205 women over age 40, 82% of whom were African American. MAIN OUTCOME MEASURES Adherence was defined as reported receipt of the last 2 screening tests within recommended intervals for age. RESULTS The survey completion rate was 85%. Overall, 75% of respondents were adherent to regular Pap smears, 66% to clinical breast exams, 65% to mammography, and 29% to fecal occult blood test recommendations. Continuity with a single primary care practitioner, comprehensive service delivery, and higher patient satisfaction with the relationships with primary care practitioners were associated with higher adherence across the 4 screening tests, after considering other factors. Coordination of care also was associated with screening adherence for women age 65 and over, but not for the younger women. Compared with counterparts in non-HMO plans, women enrolled in health maintenance organizations were also more likely to be adherent to regular screening (e.g., Pap, odds ratio [OR] 1.89, 95% confidence interval [CI] 1.11 to 3.17; clinical breast exam, OR 2.04, 95% CI 1.21 to 3.44; mammogram, OR 1.95, 95% CI 1.15 to 3.31; fecal occult blood test, OR 1.70, 95% CI 1.01 to 2.83.) CONCLUSIONS Organizing healthcare services to promote continuity with a specific primary care clinician, a comprehensive array of services available at the primary care delivery site, coordination among providers, and better patient-practitioner relationships are likely to improve inner-city, low-income women's adherence to cancer screening recommendations. PMID:11841530

Moving forward by looking back: reflecting on a decade of CDC's work in sexual violence prevention, 2000-2010.

PubMed

DeGue, Sarah; Simon, Thomas R; Basile, Kathleen C; Yee, Sue Lin; Lang, Karen; Spivak, Howard

2012-12-01

In 2011, the Division of Violence Prevention (DVP) within CDC's Injury Center engaged an external panel of experts to review and evaluate its research and programmatic portfolio for sexual violence (SV) prevention from 2000 to 2010. This article summarizes findings from the review by highlighting DVP's key activities and accomplishments during this period and identifying remaining gaps in the field and future directions for SV prevention. DVP's SV prevention work in the 2000s included (1) raising the profile of SV as a public health problem, (2) shifting the field toward a focus on the primary prevention of SV perpetration, and (3) applying the public health model to SV research and programmatic activities. The panel recommended that DVP continue to draw attention to the importance of sexual violence prevention as a public health issue, build on prior investments in the Rape Prevention and Education Program, support high-quality surveillance and research activities, and enhance communication to improve the link between research and practice. Current DVP projects and priorities provide a foundation to actively address these recommendations. In addition, DVP continues to provide leadership and guidance to the research and practice fields, with the goal of achieving significant reductions in SV perpetration and allowing individuals to live to their full potential.

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

USGS Publications Warehouse

Cohen, J.B.

2005-01-01

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

Continuing evolution of equine influenza virus in Central Asia, 2007-2012.

PubMed

Karamendin, Kobey; Kydyrmanov, A; Kasymbekov, Y; Khan, E; Daulbayeva, K; Asanova, S; Zhumatov, K; Seidalina, A; Sayatov, M; Fereidouni, S R

2014-09-01

Equine influenza (EI) continues to be an important respiratory pathogen of horses worldwide. Since 2007 several outbreaks of EI have occurred in Central Asian countries, including Kazakhstan, western Mongolia, India and western China. Phylogenetic analysis showed that two H3N8 equine influenza virus (EIV) isolates from Kazakhstan, A/equine/Almaty/26/2007 and A/equine/South Kazakhstan/236/12, were related to Florida sublineage 2, with high similarity to EIVs circulating in the same period in neighbouring countries. New outbreaks of EI during 2011 and 2012 in Kazakhstan and other Central Asian countries were caused by viruses of the same lineage. Genetic characterization of the viruses showed formation of a small EIV cluster with specific genetic signatures and continued evolution of this lineage in Central Asia between 2007 and 2012. The main genetic changes were observed in hemagglutinin gene without any antigenic drift. Although no vaccination policy was carried out in Kazakhstan, application of Florida clade 2-based vaccines is recommended.

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

PubMed

Haddad, Matthew

2009-01-01

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

An architecture for a continuous, user-driven, and data-driven application of clinical guidelines and its evaluation.

PubMed

Shalom, Erez; Shahar, Yuval; Lunenfeld, Eitan

2016-02-01

Design, implement, and evaluate a new architecture for realistic continuous guideline (GL)-based decision support, based on a series of requirements that we have identified, such as support for continuous care, for multiple task types, and for data-driven and user-driven modes. We designed and implemented a new continuous GL-based support architecture, PICARD, which accesses a temporal reasoning engine, and provides several different types of application interfaces. We present the new architecture in detail in the current paper. To evaluate the architecture, we first performed a technical evaluation of the PICARD architecture, using 19 simulated scenarios in the preeclampsia/toxemia domain. We then performed a functional evaluation with the help of two domain experts, by generating patient records that simulate 60 decision points from six clinical guideline-based scenarios, lasting from two days to four weeks. Finally, 36 clinicians made manual decisions in half of the scenarios, and had access to the automated GL-based support in the other half. The measures used in all three experiments were correctness and completeness of the decisions relative to the GL. Mean correctness and completeness in the technical evaluation were 1±0.0 and 0.96±0.03 respectively. The functional evaluation produced only several minor comments from the two experts, mostly regarding the output's style; otherwise the system's recommendations were validated. In the clinically oriented evaluation, the 36 clinicians applied manually approximately 41% of the GL's recommended actions. Completeness increased to approximately 93% when using PICARD. Manual correctness was approximately 94.5%, and remained similar when using PICARD; but while 68% of the manual decisions included correct but redundant actions, only 3% of the actions included in decisions made when using PICARD were redundant. The PICARD architecture is technically feasible and is functionally valid, and addresses the realistic continuous GL-based application requirements that we have defined; in particular, the requirement for care over significant time frames. The use of the PICARD architecture in the domain we examined resulted in enhanced completeness and in reduction of redundancies, and is potentially beneficial for general GL-based management of chronic patients. Copyright © 2015 Elsevier Inc. All rights reserved.

The Need for Specialty Curricula Based on Core Competencies: A White Paper of the Conjoint Committee on Continuing Medical Education

ERIC Educational Resources Information Center

Jackson, Marcia J.; Gallis, Harry A.; Gilman, Stuart C.; Grossman, Michael; Holzman, Gerald B.; Marquis, Damon; Trusky, Sandra K.

2007-01-01

At present there is no curriculum to guide physician lifelong learning in a prescribed, deliberate manner. The Conjoint Committee on Continuing Medical Education, a group representing 16 major stakeholder organizations in continuing medical education, recommends that each specialty society and corresponding board reach consensus on the…

[Recommendations for the evaluation and follow-up of the continuous quality improvement].

PubMed

Maurellet-Evrard, S; Daunizeau, A

2013-06-01

Continual improvement of the quality in a medical laboratory is based on the implementation of tools for systematically evaluate the quality management system and its ability to meet the objectives defined. Monitoring through audit and management review, addressing complaints and nonconformities and performing client satisfaction survey are the key for the continual improvement.

Continuity of Care, Caregiver-Child Interactions, and Toddler Social Competence and Problem Behaviors

ERIC Educational Resources Information Center

Ruprecht, Karen; Elicker, James; Choi, Ji Young

2016-01-01

Research Findings: Continuity of care is a recommended practice in child care intended to promote secure and supportive relationships between infants and toddlers and their caregivers. Toddlers (N = 115) between 12 and 24 months were observed in 30 continuity and 29 noncontinuity classrooms. The average duration of care for toddlers with…

SURGICAL REMOVAL OF DENSE POSTERIOR CAPSULE OPACIFICATION AND VITREOUS FLOATERS IN ADULTS BY POSTERIOR CONTINUOUS CURVILINEAR CAPSULORHEXIS THROUGH THE PARS PLANA AND 23-GAUGE VITRECTOMY.

PubMed

Lin, Jijian; Su, Zhitao; Huang, Xiaodan; Ji, Xian; Yao, Ke

2016-11-01

To evaluate the safety and efficacy of posterior continuous curvilinear capsulorhexis through the pars plana and 23-gauge vitrectomy in surgical management of dense posterior capsule opacification and vitreous floaters. Fifteen pseudophakic eyes of 15 patients with dense posterior capsule opacification and vitreous floaters between September 2012 and June 2014 were included; after vitrectomy, posterior continuous curvilinear capsulorhexis through the pars plana was performed. Data were collected, including baseline preoperative characteristics, postoperative outcomes, complications, and a modified quality-of-life survey that patients completed. No intraoperative or postoperative complications were encountered in any of the 15 cases. Mean Snellen best-corrected visual acuity was 20/250 preoperatively and improved to 20/32 postoperatively (P < 0.001). All patients showed normal intraocular pressure 7 days after the procedure. The mean overall corneal endothelial cell loss at postoperative Month 3 was 1.2%. Approximately 80% of the patients had no complaint of vitreous floaters after the procedure. Except for 1 patient (7%) diagnosed with age-related macular degeneration, the rest of the patients (93%) were satisfied with the procedure and would recommend it to friends with dense posterior capsule opacification and vitreous floaters. Posterior continuous curvilinear capsulorhexis through the pars plana combined with 23-gauge vitrectomy may be used to remove dense posterior capsule opacification and vitreous floaters in pseudophakic eyes.

Texas Solar Collaboration DOE Rooftop Solar Challenge City of Houston Project Summary

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

Ronk, Jennifer

2013-02-14

The City of Houston is committed to achieving a sustainable solar infrastructure. In 2008, Houston was named a United States Department of Energy (DOE) Solar America City. As a Solar America City, Houston teamed with the Houston Advanced Research Center (HARC), Sandia National Laboratory (Sandia), industry, and academia, to implement the Solar Houston Initiative and prepare the Solar Houston Plan. The Solar Houston initiative was focused on identifying and overcoming barriers associated with establishing a solar infrastructure that is incorporated into the City of Houston’s overall energy plan. A broad group of Houston area stakeholders, facilitated by HARC, came togethermore » to develop a comprehensive solar plan that went beyond technology to address barriers and establish demonstrations, public outreach, education programs and other activities. The plan included proposed scopes of work in four program areas: policies, solar integration, public outreach, and education. Through the support of the DOE SunShot Rooftop Solar Challenge (RSC) grant to the Texas Collaboration (San Antonio, Austin, and Hosuton), Houston has been able to implement several of the recommendations of the Solar Houston Plan. Specific recommendations that this project was able to support include; Working with the other Texas Solar America Cities (San Antonio and Austin), to harmonize permitting and inspection processes to simplify for installers and lower soft costs of installation; Participating in state level solar policy groups such as the Texas Renewable Energy Industries Association (TRIEA); Continued coordination with the local transmission and distribution utility (CenterPoint) and retail electric providers (REP); Identification of opportunities to improve permitting and interconnection; Providing training on PV systems to City inspectors; Educating the public by continuing outreach, training, and workshops, particularly using the the Green Building Resources Center; Evaluating methods of addressing financial barriers to residential solar; Maintaining www.solarhoustontx.org; and Continuing meetings with stakeholders to get ongoing feedback from the solar community on their needs. The following sections provide a brief summary of the activities completed under each of the nine tasks specifically related to the RSC grant. Reports and other backup information are included in the appendices.« less

Breastfeeding practices, beliefs, and social norms in low-resource communities in Mexico: Insights for how to improve future promotion strategies

PubMed Central

Swigart, Tessa M.; Bonvecchio, Anabelle; Théodore, Florence L.; Zamudio-Haas, Sophia; Villanueva-Borbolla, Maria Angeles; Thrasher, James F.

2017-01-01

Introduction Breastfeeding is recommended exclusively for the first 6 months after birth, with continued breastfeeding for at least 2 years. Yet prevalence of these recommendations is low globally, although it is an effective and cost-effective way to prevent serious infections and chronic illness. Previous studies have reported that social support greatly influences breastfeeding, but there is little evidence on perceived social norms in Mexico and how they affect actual behavior. Objective Our objective was to investigate breastfeeding intention, practices, attitudes, and beliefs, particularly normative, among low-resource communities in central and southern Mexico. Methods We performed a secondary analysis using the theory of planned behavior with cross-sectional data, which included semi-structured individual interviews with fathers (n 10), 8 focus groups with mothers (n 50), and 8 focus groups with women community leaders (n 44) with a total of 104 participants. Our data also included a quantitative survey among pregnant women and mothers (n 321). Results Women reported supplementing breast milk with water and teas soon after birth, as well as introducing small bites of solid food a few months after birth. Social norms appeared to support breastfeeding, but not exclusive breastfeeding or breastfeeding for periods longer than about a year. This may be partially explained by: a) behavioral beliefs that for the first 6 months breast milk alone is insufficient for the baby, and that water in addition to breast milk is necessary to hydrate an infant and b) normative beliefs related to the appropriateness of breastfeeding in public and as the child gets older. Conclusions Future strategies should focus on positively influencing social norms to support recommended practices, and emphasize the specific reasons behind the recommendations. Future efforts should take a multi-pronged approach using a variety of influences, not only directed at healthcare providers but close family members, including fathers. PMID:28671954

GOSPEL 3: Management of gout by primary-care physicians and office-based rheumatologists in France in the early 21st century - comparison with 2006 EULAR Recommendations.

PubMed

Goossens, Julia; Lancrenon, Sylvie; Lanz, Sabine; Ea, Hang-Korng; Lambert, Charles; Guggenbuhl, Pascal; Saraux, Alain; Delva, Catherine; Sahbane, Samy; Lioté, Frédéric

2017-07-01

In 2006, recommendations about the management of gout were issued by the European League Against Rheumatism (EULAR). The objective of this work was to compare these recommendations to practice patterns of physicians working in private practices in France. In a prospective multicenter nationwide study conducted in France, a random sample of primary-care physicians (PCPs) and private-practice rheumatologists (PPRs) was taken in 2009. Each physician included 2 consecutive patients with gout. Each patient was evaluated twice at an interval of 3-6months. Information on EULAR 2006 management modalities were collected in a standardized manner. Of 1003 patients, 771 were evaluated twice. Allopurinol was prescribed to 75.1% of patients in all and was initiated at the first study visit in 44 patients, among whom 19 (43.2%) 19 patients received the recommended starting dosage of 100mg/day. Colchicine therapy to prevent flares was prescribed to 74.3% of patients. Of the 522 patients on allopurinol therapy at the first visit, only 34.5% had serum uric acid levels≤360μmoL/L (mean dosage, 173 mg/day). Excessive dietary intake by patients who were overweight or obese was recorded in 31.5% of patients seen by PCPs and in 19.7% of those seen by OBRs. This finding prompted the delivery of nutritional advice to 45.8% of patients. Discontinuation of excessive alcohol intake was recommended to only 10% of patients. Diuretic therapy discontinuation was feasible in 175 patients but was recommended in only 7 patients. Differences between practice patterns and 2006 EULAR recommendations were identified. Simplifying the recommendations and teaching them during medical training and continued medical education may deserve consideration. Copyright © 2017. Published by Elsevier SAS.