Science.gov

Sample records for recommended target values

  1. Meeting "Valuing People" Health Targets: Recommendations from a Research Workshop

    ERIC Educational Resources Information Center

    Mir, Ghazala

    2007-01-01

    Research at the University of Leeds has evaluated how well changes to healthcare proposed in the Government White Paper "Valuing People" (Department of Health 2001) were being implemented in one locality and their impact on people with learning disabilities. The project had a developmental aspect and incorporated two workshops over the…

  2. Achievement of NKF/K-DOQI recommended target values for bone and mineral metabolism in incident hemodialysis patients: results of the FARO-2 cohort.

    PubMed

    Cozzolino, Mario; Messa, Piergiorgio; Brancaccio, Diego; Cannella, Giuseppe; Bolasco, Piergiorgio; Di Luca, Marina; Costanzo, Anna Maria; Paparatti, Umberto di Luzio; Festa, Vincenzo; Gualberti, Giuliana; Mazzaferro, Sandro

    2014-01-01

    Mineral Bone Disorders (MBD) is prevalent in hemodialysis (HD) patients and associated with increased cardiovascular mortality. The FARO-2 study evaluated the achievement of the NKF/K-DOQI guidelines on recommended target values for serum calcium (Ca), phosphorous (P) and intact parathyroid hormone (PTH) levels on survival in incident HD patients. Data were collected by questionnaire from 568 incident HD patients followed prospectively over a 3-year period from 26 Italian dialysis units. The cumulative probability of time-to-death for CKD-MBD treatment characteristics was determined by the Kaplan-Meier curves. Serum PTH levels (median values at 6 months vs. 36 months; 225 vs. 254 pg/ml), Ca (8.8 vs. 8.9 g/dl) and P (5.1 vs. 4.8 mg/dl) were not significantly different at 6 months versus follow-up. The majority of incident HD patients (60-70%) who were followed up for 36 months did not achieve the NKF/K-DOQI recommended target values. Survival rates were higher in patients on target for three parameters versus patients off target (survival at 24 months: at target 95.7% (95% CI: 84.0-98.9) versus not on target 71.1% (95% CI: 66.3-75.4, p < 0.01)). The 30.1% of patients on target for three MBD parameters at least once during the follow-up period had better survival rates compared to those not reaching these targets (survival at 24 months: at least once 88.0% (95% CI: 81.9-92.1); 67.7% (95% CI: 61.9-72.8, p < 0.01)). Our findings indicate that incident HD patients who achieved target levels (for three MBD parameters) for at least one visit have a lower risk of mortality. © 2014 S. Karger AG, Basel.

  3. Implementing Target Value Design.

    PubMed

    Alves, Thais da C L; Lichtig, Will; Rybkowski, Zofia K

    2017-04-01

    An alternative to the traditional way of designing projects is the process of target value design (TVD), which takes different departure points to start the design process. The TVD process starts with the client defining an allowable cost that needs to be met by the design and construction teams. An expected cost in the TVD process is defined through multiple interactions between multiple stakeholders who define wishes and others who define ways of achieving these wishes. Finally, a target cost is defined based on the expected profit the design and construction teams are expecting to make. TVD follows a series of continuous improvement efforts aimed at reaching the desired goals for the project and its associated target value cost. The process takes advantage of rapid cycles of suggestions, analyses, and implementation that starts with the definition of value for the client. In the traditional design process, the goal is to identify user preferences and find solutions that meet the needs of the client's expressed preferences. In the lean design process, the goal is to educate users about their values and advocate for a better facility over the long run; this way owners can help contractors and designers to identify better solutions. This article aims to inform the healthcare community about tools and techniques commonly used during the TVD process and how they can be used to educate and support project participants in developing better solutions to meet their needs now as well as in the future.

  4. Recommending a value for the Newtonian gravitational constant.

    PubMed

    Wood, Barry M

    2014-10-13

    The primary objective of the CODATA Task Group on Fundamental Constants is 'to periodically provide the scientific and technological communities with a self-consistent set of internationally recommended values of the basic constants and conversion factors of physics and chemistry based on all of the relevant data available at a given point in time'. I discuss why the availability of these recommended values is important and how it simplifies and improves science. I outline the process of determining the recommended values and introduce the principles that are used to deal with discrepant results. In particular, I discuss the specific challenges posed by the present situation of gravitational constant experimental results and how these principles were applied to the most recent 2010 recommended value. Finally, I speculate about what may be expected for the next recommended value of the gravitational constant scheduled for evaluation in 2014.

  5. CODATA recommended values of the fundamental physical constants: 2014*

    NASA Astrophysics Data System (ADS)

    Mohr, Peter J.; Newell, David B.; Taylor, Barry N.

    2016-07-01

    This paper gives the 2014 self-consistent set of values of the constants and conversion factors of physics and chemistry recommended by the Committee on Data for Science and Technology (CODATA). These values are based on a least-squares adjustment that takes into account all data available up to 31 December 2014. Details of the data selection and methodology of the adjustment are described. The recommended values may also be found at physics.nist.gov/constants.

  6. CODATA Recommended Values of the Fundamental Physical Constants: 2014*

    NASA Astrophysics Data System (ADS)

    Mohr, Peter J.; Newell, David B.; Taylor, Barry N.

    2016-12-01

    This paper gives the 2014 self-consistent set of values of the constants and conversion factors of physics and chemistry recommended by the Committee on Data for Science and Technology (CODATA). These values are based on a least-squares adjustment that takes into account all data available up to 31 December 2014. Details of the data selection and methodology of the adjustment are described. The recommended values may also be found at http://physics.nist.gov/constants.

  7. Recommended Values of the Fundamental Physical Constants: A Status Report

    PubMed Central

    Taylor, Barry N.; Cohen, E. Richard

    1990-01-01

    We summarize the principal advances made in the fundamental physical constants field since the completion of the 1986 CODATA least-squares adjustment of the constants and discuss their implications for both the 1986 set of recommended values and the next least-squares adjustment. In general, the new results lead to values of the constants with uncertainties 5 to 7 times smaller than the uncertainties assigned the 1986 values. However, the changes in the values themselves are less than twice the 1986 assigned one-standard-deviation uncertainties and thus are not highly significant. Although much new data has become available since 1986, three new results dominate the analysis: a value of the Planck constant obtained from a realization of the watt; a value of the fine-structure constant obtained from the magnetic moment anomaly of the electron; and a value of the molar gas constant obtained from the speed of sound in argon. Because of their dominant role in determining the values and uncertainties of many of the constants, it is highly desirable that additional results of comparable uncertainty that corroborate these three data items be obtained before the next adjustment is carried out. Until then, the 1986 CODATA set of recommended values will remain the set of choice. PMID:28179787

  8. Treat-to-target (T2T) recommendations for gout.

    PubMed

    Kiltz, U; Smolen, J; Bardin, T; Cohen Solal, A; Dalbeth, N; Doherty, M; Engel, B; Flader, C; Kay, J; Matsuoka, M; Perez-Ruiz, F; da Rocha Castelar-Pinheiro, G; Saag, K; So, A; Vazquez Mellado, J; Weisman, M; Westhoff, T H; Yamanaka, H; Braun, J

    2017-04-01

    The treat-to-target (T2T) concept has been applied successfully in several inflammatory rheumatic diseases. Gout is a chronic disease with a high burden of pain and inflammation. Because the pathogenesis of gout is strongly related to serum urate levels, gout may be an ideal disease in which to apply a T2T approach. Our aim was to develop international T2T recommendations for patients with gout. A committee of experts with experience in gout agreed upon potential targets and outcomes, which was the basis for the systematic literature search. Eleven rheumatologists, one cardiologist, one nephrologist, one general practitioner and one patient met in October 2015 to develop T2T recommendations based on the available scientific evidence. Levels of evidence, strength of recommendations and levels of agreement were derived. Although no randomised trial was identified in which a comparison with standard treatment or an evaluation of a T2T approach had been performed in patients with gout, indirect evidence was provided to focus on targets such as normalisation of serum urate levels. The expert group developed four overarching principles and nine T2T recommendations. They considered dissolution of crystals and prevention of flares to be fundamental; patient education, ensuring adherence to medications and monitoring of serum urate levels were also considered to be of major importance. This is the first application of the T2T approach developed for gout. Since no publication reports a trial comparing treatment strategies for gout, highly credible overarching principles and level D expert recommendations were created and agreed upon. 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/.

  9. Recommended values of clean metal surface work functions

    SciTech Connect

    Derry, Gregory N. Kern, Megan E.; Worth, Eli H.

    2015-11-15

    A critical review of the experimental literature for measurements of the work functions of clean metal surfaces of single-crystals is presented. The tables presented include all results found for low-index crystal faces except cases that were known to be contaminated surfaces. These results are used to construct a recommended value of the work function for each surface examined, along with an uncertainty estimate for that value. The uncertainties are based in part on the error distribution for all measured work functions in the literature, which is included here. The metals included in this review are silver (Ag), aluminum (Al), gold (Au), copper (Cu), iron (Fe), iridium (Ir), molybdenum (Mo), niobium (Nb), nickel (Ni), palladium (Pd), platinum (Pt), rhodium (Rh), ruthenium (Ru), tantalum (Ta), and tungsten (W)

  10. Nutrient intake values (NIVs): a recommended terminology and framework for the derivation of values.

    PubMed

    King, Janet C; Vorster, Hester H; Tome, Daniel G

    2007-03-01

    Although most countries and regions around the world set recommended nutrient intake values for their populations, there is no standardized terminology or framework for establishing these standards. Different terms used for various components of a set of dietary standards are described in this paper and a common set of terminology is proposed. The recommended terminology suggests that the set of values be called nutrient intake values (NIVs) and that the set be composed of three different values. The average nutrient requirement (ANR) reflects the median requirement for a nutrient in a specific population. The individual nutrient level (INLx) is the recommended level of nutrient intake for all healthy people in the population, which is set at a certain level x above the mean requirement. For example, a value set at 2 standard deviations above the mean requirement would cover the needs of 98% of the population and would be INL98. The third component of the NIVs is an upper nutrient level (UNL), which is the highest level of daily nutrient intake that is likely to pose no risk of adverse health effects for almost all individuals in a specified life-stage group. The proposed framework for deriving a set of NIVs is based on a statistical approach for determining the midpoint of a distribution of requirements for a set of nutrients in a population (the ANR), the standard deviation of the requirements, and an individual nutrient level that assures health at some point above the mean, e.g., 2 standard deviations. Ideally, a second set of distributions of risk of excessive intakes is used as the basis for a UNL.

  11. Diet and inflammatory bowel disease: review of patient-targeted recommendations.

    PubMed

    Hou, Jason K; Lee, Dale; Lewis, James

    2014-10-01

    Patients have strong beliefs about the role of diet in the cause of inflammatory bowel disease (IBD) and in exacerbating or alleviating ongoing symptoms from IBD. The rapid increase in the incidence and prevalence of IBD in recent decades strongly suggests an environmental trigger for IBD, one of which may be dietary patterns. There are several pathways where diet may influence intestinal inflammation, such as direct dietary antigens, altering the gut microbiome, and affecting gastrointestinal permeability. However, data that altering diet can change the natural history of IBD are scarce, and evidence-based dietary guidelines for patients with IBD are lacking. Patients, therefore, seek nonmedical resources for dietary guidance, such as patient support groups and unverified sources on the Internet. The aim of this review is to identify patient-targeted dietary recommendations for IBD and to critically appraise the nutritional value of these recommendations. We review patient-targeted dietary information for IBD from structured Internet searches and popular defined diets. Patient-targeted dietary recommendations focus on food restrictions and are highly conflicting. High-quality dietary intervention studies are needed to facilitate creation of evidence-based dietary guidelines for patients with IBD. Copyright © 2014 AGA Institute. Published by Elsevier Inc. All rights reserved.

  12. Diet and Inflammatory Bowel Disease: Review of Patient-Targeted Recommendations

    PubMed Central

    Hou, Jason K.; Lee, Dale; Lewis, James

    2014-01-01

    Patients have strong beliefs about the role of diet in the cause of inflammatory bowel disease (IBD) and in exacerbating or alleviating ongoing symptoms from IBD. The rapid increase in the incidence and prevalence of IBD in the past several decades strongly suggests an environmental trigger for IBD, one of which may be dietary patterns. There are several pathways where diet may influence intestinal inflammation such as direct dietary antigens, altering the gut microbiome, and affecting gastrointestinal permeability. However, data that altering diet can change the natural history of IBD are scarce and evidence based dietary guidelines for patients with IBD are lacking. Patients therefore seek non-medical resources for dietary guidance such as patient support groups and unverified sources on the internet. The aim of this review is to identify patient-targeted dietary recommendations for IBD and to critically appraise the nutritional value of these recommendations. We review patient-targeted dietary information for IBD from structured internet searches and popular defined diets. Patient-targeted dietary recommendations focus on food restrictions and are highly conflicting. High quality dietary intervention studies are needed to facilitate creation of evidence-based dietary guidelines for patients with IBD. PMID:24107394

  13. Targeting Net Zero Energy at Fort Carson: Assessment and Recommendations

    SciTech Connect

    Anderson, K.; Markel, T.; Simpson, M.; Leahey, J.; Rockenbaugh, C.; Lisell, L.; Burman, K.; Singer, M.

    2011-10-01

    The U.S. Army's Fort Carson installation was selected to serve as a prototype for net zero energy assessment and planning. NREL performed the comprehensive assessment to appraise the potential of Fort Carson to achieve net zero energy status through energy efficiency, renewable energy, and electric vehicle integration. This report summarizes the results of the assessment and provides energy recommendations. This study is part of a larger cross-laboratory effort that also includes an assessment of renewable opportunities at seven other DoD Front Range installations, a microgrid design for Fort Carson critical loads and an assessment of regulatory and market-based barriers to a regional secure smart grid.

  14. The Value of Targeted Comic Book Readers

    ERIC Educational Resources Information Center

    Hammond, Kay; Danaher, Katherine

    2012-01-01

    A limitation of extensive reading programmes is the time required for progress in vocabulary acquisition. This paper reports on a qualitative exploration of student perceptions of the value of non-compulsory comic books in ESL elementary and upper-intermediate level courses at a tertiary institution. We aimed to develop supplementary materials…

  15. The Value of Targeted Comic Book Readers

    ERIC Educational Resources Information Center

    Hammond, Kay; Danaher, Katherine

    2012-01-01

    A limitation of extensive reading programmes is the time required for progress in vocabulary acquisition. This paper reports on a qualitative exploration of student perceptions of the value of non-compulsory comic books in ESL elementary and upper-intermediate level courses at a tertiary institution. We aimed to develop supplementary materials…

  16. Recommended Dietary Allowances should be used to set Daily Values for nutrition labeling.

    PubMed

    Murphy, Suzanne P; Barr, Susan I

    2006-05-01

    Guiding principles were recently suggested for revising the Daily Values (DVs) used for nutrition labels on foods and dietary supplements. These principles incorporate the new Dietary Reference Intakes, which are nutrient standards issued between 1997 and 2005 by the Institute of Medicine. Most of the principles are likely to lead to a more accurate basis for the DVs. However, the recommendation to use the Estimated Average Requirement (EAR) rather than the Recommended Dietary Allowance (RDA) should be reconsidered. Traditional public health messages to American and Canadian consumers have focused on nutrient intake levels with a high probability of being adequate. The RDA, with a 98% probability of adequacy, is designed to be the target nutrient intake for individuals; in contrast, the EAR has only a 50% probability of adequacy. Three considerations should lead to a preference for using the RDA rather than the EAR for the DVs: 1) consumers are likely to expect that a product (or a diet) with 100% of the DV has a high probability of nutrient adequacy; 2) use of the RDA for the DV will be consistent with other types of dietary guidance, such as the Dietary Guidelines for Americans 2005 and US food guides; and 3) use of the RDA as a standard for nutrient intake, rather than the EAR, has a potential benefit (a higher prevalence of adequate intakes) that exceeds potential risk (a higher prevalence of excessive intakes).

  17. Targeted and comprehensive space-environment sensors: description and recommendations

    SciTech Connect

    Reeves, Geoffrey; O'Brien, Paul; Mazur, Joe; Ginet, Gregory

    2009-01-01

    We discuss the roles of the two classes of space-environment sensors on operational space systems: (1) Targeted sensors capable of measuring the environment and effects at a level sufficient for providing situational awareness for the host spacecraft and (2) Comprehensive sensors capable of providing detailed environment measurements that can be mapped to a broad region of near-Earth space, providing global situational awareness and quantitative characterization of the environment. Our purpose is to show the usefulness of a heterogeneous architecture with both classes of sensors for the near-term and long-term needs of National Security Space

  18. Recommended Partition Coefficient (Kd) Values for Nuclide Partitioning in the Presence of Cellulose Degradation Products

    SciTech Connect

    Serkiz, S.M.

    2001-02-23

    This report documents the data analysis of the results of the described laboratory studies in order to recommend Kd values for use in Performance Assessment modeling of nuclide transport in the presence of CDP.

  19. Recommendations

    ERIC Educational Resources Information Center

    Brazelton, G. Blue; Renn, Kristen A.; Stewart, Dafina-Lazarus

    2015-01-01

    In this chapter, the editors provide a summary of the information shared in this sourcebook about the success of students who have minoritized identities of sexuality or gender and offer recommendations for policy, practice, and further research.

  20. Recommendations

    ERIC Educational Resources Information Center

    Brazelton, G. Blue; Renn, Kristen A.; Stewart, Dafina-Lazarus

    2015-01-01

    In this chapter, the editors provide a summary of the information shared in this sourcebook about the success of students who have minoritized identities of sexuality or gender and offer recommendations for policy, practice, and further research.

  1. Recommendations to improve wildlife exposure estimation for development of soil screening and cleanup values.

    PubMed

    Sample, Bradley E; Schlekat, Chris; Spurgeon, David J; Menzie, Charlie; Rauscher, Jon; Adams, Bill

    2014-07-01

    recommendations for application of these improved models to the development of site-specific remedial goals protective of wildlife. Although the focus is on metals contamination, many of the methods and tools discussed are also applicable to organic contaminants. The conclusion of this workgroup was that existing exposure estimation models are generally appropriate when fully expanded and that methods are generally available to develop more robust site-specific exposure estimates. Improved realism in site-specific wildlife Eco-SCVs could be achieved by obtaining more realistic estimates for diet composition, bioaccumulation, bioavailability and/or bioaccessibility, soil ingestion, spatial aspects of exposure, and target organ exposure. These components of wildlife exposure estimation should be developed on a site-, species-, and analyte-specific basis to the extent that the expense for their derivation is justified by the value they add to Eco-SCV development.

  2. Treating spondyloarthritis, including ankylosing spondylitis and psoriatic arthritis, to target: recommendations of an international task force

    PubMed Central

    Smolen, Josef S; Braun, Jürgen; Dougados, Maxime; Emery, Paul; FitzGerald, Oliver; Helliwell, Philip; Kavanaugh, Arthur; Kvien, Tore K; Landewé, Robert; Luger, Thomas; Mease, Philip; Olivieri, Ignazio; Reveille, John; Ritchlin, Christopher; Rudwaleit, Martin; Schoels, Monika; Sieper, Joachim; de Wit, Martinus; Baraliakos, Xenofon; Betteridge, Neil; Burgos-Vargas, Ruben; Collantes-Estevez, Eduardo; Deodhar, Atul; Elewaut, Dirk; Gossec, Laure; Jongkees, Merryn; Maccarone, Mara; Redlich, Kurt; van den Bosch, Filip; Wei, James Cheng-Chung; Winthrop, Kevin; van der Heijde, Désirée

    2014-01-01

    Background Therapeutic targets have been defined for diseases like diabetes, hypertension or rheumatoid arthritis and adhering to them has improved outcomes. Such targets are just emerging for spondyloarthritis (SpA). Objective To define the treatment target for SpA including ankylosing spondylitis and psoriatic arthritis (PsA) and develop recommendations for achieving the target, including a treat-to-target management strategy. Methods Based on results of a systematic literature review and expert opinion, a task force of expert physicians and patients developed recommendations which were broadly discussed and voted upon in a Delphi-like process. Level of evidence, grade and strength of the recommendations were derived by respective means. The commonalities between axial SpA, peripheral SpA and PsA were discussed in detail. Results Although the literature review did not reveal trials comparing a treat-to-target approach with another or no strategy, it provided indirect evidence regarding an optimised approach to therapy that facilitated the development of recommendations. The group agreed on 5 overarching principles and 11 recommendations; 9 of these recommendations related commonly to the whole spectrum of SpA and PsA, and only 2 were designed separately for axial SpA, peripheral SpA and PsA. The main treatment target, which should be based on a shared decision with the patient, was defined as remission, with the alternative target of low disease activity. Follow-up examinations at regular intervals that depend on the patient's status should safeguard the evolution of disease activity towards the targeted goal. Additional recommendations relate to extra-articular and extramusculoskeletal aspects and other important factors, such as comorbidity. While the level of evidence was generally quite low, the mean strength of recommendation was 9–10 (10: maximum agreement) for all recommendations. A research agenda was formulated. Conclusions The task force defined the

  3. Treat-to-target in systemic lupus erythematosus: recommendations from an international task force.

    PubMed

    van Vollenhoven, Ronald F; Mosca, Marta; Bertsias, George; Isenberg, David; Kuhn, Annegret; Lerstrøm, Kirsten; Aringer, Martin; Bootsma, Hendrika; Boumpas, Dimitrios; Bruce, Ian N; Cervera, Ricard; Clarke, Ann; Costedoat-Chalumeau, Nathalie; Czirják, László; Derksen, Ronald; Dörner, Thomas; Gordon, Caroline; Graninger, Winfried; Houssiau, Frédéric; Inanc, Murat; Jacobsen, Søren; Jayne, David; Jedryka-Goral, Anna; Levitsky, Adrian; Levy, Roger; Mariette, Xavier; Morand, Eric; Navarra, Sandra; Neumann, Irmgard; Rahman, Anisur; Rovensky, Jozef; Smolen, Josef; Vasconcelos, Carlos; Voskuyl, Alexandre; Voss, Anne; Zakharova, Helena; Zoma, Asad; Schneider, Matthias

    2014-06-01

    The principle of treating-to-target has been successfully applied to many diseases outside rheumatology and more recently to rheumatoid arthritis. Identifying appropriate therapeutic targets and pursuing these systematically has led to improved care for patients with these diseases and useful guidance for healthcare providers and administrators. Thus, an initiative to evaluate possible therapeutic targets and develop treat-to-target guidance was believed to be highly appropriate in the management of systemic lupus erythematosus (SLE) patients as well. Specialists in rheumatology, nephrology, dermatology, internal medicine and clinical immunology, and a patient representative, contributed to this initiative. The majority convened on three occasions in 2012-2013. Twelve topics of critical importance were identified and a systematic literature review was performed. The results were condensed and reformulated as recommendations, discussed, modified and voted upon. The finalised bullet points were analysed for degree of agreement among the task force. The Oxford Centre level of evidence (LoE, corresponding to the research questions) and grade of recommendation (GoR) were determined for each recommendation. The 12 systematic literature searches and their summaries led to 11 recommendations. Prominent features of these recommendations are targeting remission, preventing damage and improving quality of life. LoE and GoR of the recommendations were variable but agreement was >0.9 in each case. An extensive research agenda was identified, and four overarching principles were also agreed upon. Treat-to-target-in-SLE (T2T/SLE) recommendations were developed by a large task force of multispecialty experts and a patient representative. It is anticipated that 'treating-to-target' can and will be applicable to the care of patients with SLE.

  4. Average and recommended half-life values for two neutrino double beta decay: Upgrade-2013

    SciTech Connect

    Barabash, A. S.

    2013-12-30

    All existing positive results on two neutrino double beta decay in different nuclei were analyzed. Using the procedure recommended by the Particle Data Group, weighted average values for half-lives of {sup 48}Ca, {sup 76}Ge, {sup 82}Se, {sup 96}Zr, {sup 100}Mo, {sup 100}Mo−{sup 100}Ru (0{sub 1}{sup +}), {sup 116}Cd, {sup 130}Te, {sup 136}Xe, {sup 150}Nd, {sup 150}Nd−{sup 150}Sm (0{sub 1}{sup +}) and {sup 238}U were obtained. Existing geochemical data were analyzed and recommended values for half-lives of {sup 128}Te and {sup 130}Ba are proposed. I recommend the use of these results as the most currently reliable values for half-lives.

  5. Precision Modeling Of Targets Using The VALUE Computer Program

    NASA Astrophysics Data System (ADS)

    Hoffman, George A.; Patton, Ronald; Akerman, Alexander

    1989-08-01

    The 1976-vintage LASERX computer code has been augmented to produce realistic electro-optical images of targets. Capabilities lacking in LASERX but recently incorporated into its VALUE successor include: •Shadows cast onto the ground •Shadows cast onto parts of the target •See-through transparencies (e.g.,canopies) •Apparent images due both to atmospheric scattering and turbulence •Surfaces characterized by multiple bi-directional reflectance functions VALUE provides not only realistic target modeling by its precise and comprehensive representation of all target attributes, but additionally VALUE is very user friendly. Specifically, setup of runs is accomplished by screen prompting menus in a sequence of queries that is logical to the user. VALUE also incorporates the Optical Encounter (OPEC) software developed by Tricor Systems,Inc., Elgin, IL.

  6. Treating rheumatoid arthritis to target: recommendations of an international task force

    PubMed Central

    Smolen, Josef S; Aletaha, Daniel; Bijlsma, Johannes W J; Breedveld, Ferdinand C; Boumpas, Dimitrios; Burmester, Gerd; Combe, Bernard; Cutolo, Maurizio; de Wit, Maarten; Dougados, Maxime; Emery, Paul; Gibofsky, Alan; Gomez-Reino, Juan Jesus; Haraoui, Boulos; Kalden, Joachim; Keystone, Edward C; Kvien, Tore K; McInnes, Iain; Martin-Mola, Emilio; Montecucco, Carlomaurizio; Schoels, Monika; van der Heijde, Desirée

    2010-01-01

    Background Aiming at therapeutic targets has reduced the risk of organ failure in many diseases such as diabetes or hypertension. Such targets have not been defined for rheumatoid arthritis (RA). Objective To develop recommendations for achieving optimal therapeutic outcomes in RA. Methods A task force of rheumatologists and a patient developed a set of recommendations on the basis of evidence derived from a systematic literature review and expert opinion; these were subsequently discussed, amended and voted upon by >60 experts from various regions of the world in a Delphi-like procedure. Levels of evidence, strength of recommendations and levels of agreement were derived. Results The treat-to-target activity resulted in 10 recommendations. The treatment aim was defined as remission with low disease activity being an alternative goal in patients with long-standing disease. Regular follow-up (every 1–3 months during active disease) with appropriate therapeutic adaptation to reach the desired state within 3 to a maximum of 6 months was recommended. Follow-up examinations ought to employ composite measures of disease activity which include joint counts. Additional items provide further details for particular aspects of the disease. Levels of agreement were very high for many of these recommendations (≥9/10). Conclusion The 10 recommendations are supposed to inform patients, rheumatologists and other stakeholders about strategies to reach optimal outcomes of RA based on evidence and expert opinion. PMID:20215140

  7. SU-E-I-27: Establishing Target Exposure Index Values for Computed Radiography

    SciTech Connect

    Murphy, N; Tchou, P; Belcher, K; Scott, A

    2014-06-01

    Purpose: To develop a standard set of target exposure index (TEI) values to be applied to Agfa Computed Radiography (CR) readers in accordance with International Electrotechnical Committee 62494-1 (ed. 1.0). Methods: A large data cohort was collected from six USAF Medical Treatment Facilities that exclusively use Agfa CR Readers. Dose monitoring statistics were collected from each reader. The data was analyzed based on anatomic region, view, and processing speed class. The Agfa specific exposure metric, logarithmic mean (LGM), was converted to exposure index (EI) for each data set. The optimum TEI value was determined by minimizing the number of studies that fell outside the acceptable deviation index (DI) range of +/− 2 for phototimed techniques or a range of +/−3 for fixed techniques. An anthropomorphic radiographic phantom was used to corroborate the TEI recommendations. Images were acquired of several anatomic regions and views using standard techniques. The images were then evaluated by two radiologists as either acceptable or unacceptable. The acceptable image with the lowest exposure and EI value was compared to the recommended TEI values using a passing DI range. Results: Target EI values were determined for a comprehensive list of anatomic regions and views. Conclusion: Target EI values must be established on each CR unit in order to provide a positive feedback system for the technologist. This system will serve as a mechanism to prevent under or overexposures of patients. The TEI recommendations are a first attempt at a large scale process improvement with the goal of setting reasonable and standardized TEI values. The implementation and effectiveness of the recommended TEI values should be monitored and adjustments made as necessary.

  8. Evaluation of the 235U resonance parameters to fit the standard recommended values

    NASA Astrophysics Data System (ADS)

    Leal, Luiz; Noguere, Gilles; Paradela, Carlos; Durán, Ignacio; Tassan-Got, Laurent; Danon, Yaron; Jandel, Marian

    2017-09-01

    A great deal of effort has been dedicated to the revision of the standard values in connection with the neutron interaction for some actinides. While standard data compilation are available for decades nuclear data evaluations included in existing nuclear data libraries (ENDF, JEFF, JENDL, etc.) do not follow the standard recommended values. Indeed, the majority of evaluations for major actinides do not conform to the standards whatsoever. In particular, for the n + 235U interaction the only value in agreement with the standard is the thermal fission cross section. A resonance re-evaluation of the n + 235U interaction has been performed to address the issues regarding standard values in the energy range from 10-5 eV to 2250 eV. Recently, 235U fission cross-section measurements have been performed at the CERN Neutron Time-of-Flight facility (TOF), known as n_TOF, in the energy range from 0.7 eV to 10 keV. The data were normalized according to the recommended standard of the fission integral in the energy range 7.8 eV to 11 eV. As a result, the n_TOF averaged fission cross sections above 100 eV are in good agreement with the standard recommended values. The n_TOF data were included in the 235U resonance analysis that was performed with the code SAMMY. In addition to the average standard values related to the fission cross section, standard thermal values for fission, capture, and elastic cross sections were also included in the evaluation. This paper presents the procedure used for re-evaluating the 235U resonance parameters including the recommended standard values as well as new cross section measurements.

  9. AUI&GIV: Recommendation with Asymmetric User Influence and Global Importance Value.

    PubMed

    Zhao, Zhi-Lin; Wang, Chang-Dong; Lai, Jian-Huang

    2016-01-01

    The user-based collaborative filtering (CF) algorithm is one of the most popular approaches for making recommendation. Despite its success, the traditional user-based CF algorithm suffers one serious problem that it only measures the influence between two users based on their symmetric similarities calculated by their consumption histories. It means that, for a pair of users, the influences on each other are the same, which however may not be true. Intuitively, an expert may have an impact on a novice user but a novice user may not affect an expert at all. Besides, each user may possess a global importance factor that affects his/her influence to the remaining users. To this end, in this paper, we propose an asymmetric user influence model to measure the directed influence between two users and adopt the PageRank algorithm to calculate the global importance value of each user. And then the directed influence values and the global importance values are integrated to deduce the final influence values between two users. Finally, we use the final influence values to improve the performance of the traditional user-based CF algorithm. Extensive experiments have been conducted, the results of which have confirmed that both the asymmetric user influence model and global importance value play key roles in improving recommendation accuracy, and hence the proposed method significantly outperforms the existing recommendation algorithms, in particular the user-based CF algorithm on the datasets of high rating density.

  10. AUI&GIV: Recommendation with Asymmetric User Influence and Global Importance Value

    PubMed Central

    Zhao, Zhi-Lin; Wang, Chang-Dong; Lai, Jian-Huang

    2016-01-01

    The user-based collaborative filtering (CF) algorithm is one of the most popular approaches for making recommendation. Despite its success, the traditional user-based CF algorithm suffers one serious problem that it only measures the influence between two users based on their symmetric similarities calculated by their consumption histories. It means that, for a pair of users, the influences on each other are the same, which however may not be true. Intuitively, an expert may have an impact on a novice user but a novice user may not affect an expert at all. Besides, each user may possess a global importance factor that affects his/her influence to the remaining users. To this end, in this paper, we propose an asymmetric user influence model to measure the directed influence between two users and adopt the PageRank algorithm to calculate the global importance value of each user. And then the directed influence values and the global importance values are integrated to deduce the final influence values between two users. Finally, we use the final influence values to improve the performance of the traditional user-based CF algorithm. Extensive experiments have been conducted, the results of which have confirmed that both the asymmetric user influence model and global importance value play key roles in improving recommendation accuracy, and hence the proposed method significantly outperforms the existing recommendation algorithms, in particular the user-based CF algorithm on the datasets of high rating density. PMID:26828803

  11. Treating rheumatoid arthritis to target: 2014 update of the recommendations of an international task force

    PubMed Central

    Smolen, Josef S; Breedveld, Ferdinand C; Burmester, Gerd R; Bykerk, Vivian; Dougados, Maxime; Emery, Paul; Kvien, Tore K; Navarro-Compán, M Victoria; Oliver, Susan; Schoels, Monika; Scholte-Voshaar, Marieke; Stamm, Tanja; Stoffer, Michaela; Takeuchi, Tsutomu; Aletaha, Daniel; Andreu, Jose Louis; Aringer, Martin; Bergman, Martin; Betteridge, Neil; Bijlsma, Hans; Burkhardt, Harald; Combe, Bernard; Durez, Patrick; Fonseca, Joao Eurico; Gibofsky, Alan; Gomez-Reino, Juan J; Graninger, Winfried; Hannonen, Pekka; Haraoui, Boulos; Kouloumas, Marios; Landewe, Robert; Martin-Mola, Emilio; Nash, Peter; Ostergaard, Mikkel; Östör, Andrew; Richards, Pam; Sokka-Isler, Tuulikki; Thorne, Carter; Tzioufas, Athanasios G; van Vollenhoven, Ronald; de Wit, Martinus

    2016-01-01

    Background Reaching the therapeutic target of remission or low-disease activity has improved outcomes in patients with rheumatoid arthritis (RA) significantly. The treat-to-target recommendations, formulated in 2010, have provided a basis for implementation of a strategic approach towards this therapeutic goal in routine clinical practice, but these recommendations need to be re-evaluated for appropriateness and practicability in the light of new insights. Objective To update the 2010 treat-to-target recommendations based on systematic literature reviews (SLR) and expert opinion. Methods A task force of rheumatologists, patients and a nurse specialist assessed the SLR results and evaluated the individual items of the 2010 recommendations accordingly, reformulating many of the items. These were subsequently discussed, amended and voted upon by >40 experts, including 5 patients, from various regions of the world. Levels of evidence, strengths of recommendations and levels of agreement were derived. Results The update resulted in 4 overarching principles and 10 recommendations. The previous recommendations were partly adapted and their order changed as deemed appropriate in terms of importance in the view of the experts. The SLR had now provided also data for the effectiveness of targeting low-disease activity or remission in established rather than only early disease. The role of comorbidities, including their potential to preclude treatment intensification, was highlighted more strongly than before. The treatment aim was again defined as remission with low-disease activity being an alternative goal especially in patients with long-standing disease. Regular follow-up (every 1–3 months during active disease) with according therapeutic adaptations to reach the desired state was recommended. Follow-up examinations ought to employ composite measures of disease activity that include joint counts. Additional items provide further details for particular aspects of the

  12. Optimal blood pressure targets in 2014 - Does the guideline recommendation match the evidence base?

    PubMed

    Alviar, C L; Bangalore, S; Messerli, F H

    2015-01-01

    Various scientific societies have recently published practice guidelines for the diagnosis and management of arterial hypertension with no clear consensus on a blood pressure target. This article reviews those recommendations and critically examines if they are based on sound evidence. Copyright © 2015 SEHLELHA. Published by Elsevier Espana. All rights reserved.

  13. Recommendations from Friends Anytime and Anywhere: Toward a Model of Contextual Offer and Consumption Values

    PubMed Central

    Shen, Xiao-Liang; Wang, Nan

    2013-01-01

    Abstract The ubiquity and portability of mobile devices provide additional opportunities for information retrieval. People can easily access mobile applications anytime and anywhere when they need to acquire specific context-aware recommendations (contextual offer) from their friends. This study, thus, represents an initial attempt to understand users' acceptance of a mobile-based social reviews platform, where recommendations from friends can be obtained with mobile devices. Based on the consumption value theory, a theoretical model is proposed and empirically examined using survey data from 218 mobile users. The findings demonstrate that contextual offers based on users' profiles, access time, and geographic positions significantly predict their value perceptions (utilitarian, hedonic, and social), which, in turn, affect their intention to use a mobile social reviews platform. This study is also believed to provide some useful insights to both research and practice. PMID:23530548

  14. Recommendations from friends anytime and anywhere: toward a model of contextual offer and consumption values.

    PubMed

    Shen, Xiao-Liang; Sun, Yongqiang; Wang, Nan

    2013-05-01

    The ubiquity and portability of mobile devices provide additional opportunities for information retrieval. People can easily access mobile applications anytime and anywhere when they need to acquire specific context-aware recommendations (contextual offer) from their friends. This study, thus, represents an initial attempt to understand users' acceptance of a mobile-based social reviews platform, where recommendations from friends can be obtained with mobile devices. Based on the consumption value theory, a theoretical model is proposed and empirically examined using survey data from 218 mobile users. The findings demonstrate that contextual offers based on users' profiles, access time, and geographic positions significantly predict their value perceptions (utilitarian, hedonic, and social), which, in turn, affect their intention to use a mobile social reviews platform. This study is also believed to provide some useful insights to both research and practice.

  15. History of the recommended atomic-weight values from 1882 to 1997: A comparision of differences from current values to the estimated uncertainties of earlier values.

    USGS Publications Warehouse

    Coplen, T.B.; Peiser, H.S.

    1998-01-01

    International commissions and national committees for atomic weights (mean relative atomic masses) have recommended regularly updated, best values for these atomic weights as applicable to terrestrial sources of the chemical elements. Presented here is a historically complete listing starting with the values in F. W. Clarke's 1882 recalculation, followed by the recommended values in the annual reports of the American Chemical Society's Atomic Weights Commission. From 1903, an International Commission published such reports and its values (scaled to an atomic weight of 16 for oxygen) are here used in preference to those of national committees of Britain, Germany, Spain, Switzerland, and the U.S.A. We have, however, made scaling adjustments from Ar(16O) to Ar(12C) where not negligible. From 1920, this International Commission constituted itself under the International Union of Pure and Applied Chemistry (IUPAC). Since then, IUPAC has published reports (mostly biennially) listing the recommended atomic weights, which are reproduced here. Since 1979, these values have been called the "standard atomic weights" and, since 1969, all values have been published, with their estimated uncertainties. Few of the earlier values were published with uncertainties. Nevertheless, we assessed such uncertainties on the basis of our understanding of the likely contemporary judgement of the values' reliability. While neglecting remaining uncertainties of 1997 values, we derive "differences" and a retrospective index of reliability of atomic-weight values in relation to assessments of uncertainties at the time of their publication. A striking improvement in reliability appears to have been achieved since the commissions have imposed upon themselves the rule of recording estimated uncertainties from all recognized sources of error.

  16. Recommended Parameter Values for INEEL Subsurface Disposal Area Source Release Modeling

    SciTech Connect

    Riley, Robert G.; Lopresti, Charles A.

    2004-06-23

    The purpose of this report is to summarize 1) associated information and values for key release model parameters (i.e., best estimate, minimum and maximum) obtained where possible from published experimental data, 2) a structure for selection of sensitivity tests cases that can be used to identify test cases, and 3) recommended test cases for selected contaminants of potential concern to assess remedy effectiveness against a no-treatment base case.

  17. A value-based practice model of rehabilitation: consumers' recommendations in action.

    PubMed

    Yoshida, Karen K; Self, Hazel M; Renwick, Rebecca M; Forma, Laura L; King, Audrey J; Fell, Leslie A

    2015-01-01

    The purpose of this paper is to present a model of rehabilitation practice that is based on the recommendations of consumers who used rehabilitation services and have a life-changing physical impairment (spinal cord injury - SCI). This value-based practice model is based on two qualitative studies. The first study developed the framework (social adaptation) for a new practice model based on values. The second study, described in this paper, used the framework to learn about recommendations for change in the rehabilitation process. Participants in the second study were 80 volunteers who live with a SCI in the community, across the province of Ontario, Canada. A snowball strategy was used to recruit interested participants. Participants were involved in face-to-face interviews which included questions on what helped and hindered their initial rehabilitation process, and their recommendations for change. In this paper, we described a model that demonstrates how consumer input is essential in shaping a comprehensive rehabilitation process. The model is based on overarching value statements that express the worthiness of all individuals, the value of the lived experience of disability and the responsibility of the rehabilitation process to enable client autonomy. Four "values in action" are articulated: caring and respect for the individual and his/her personhood; applying the lived experience of disability; fostering autonomy; and promoting hopefulness. These values have been initially described in another paper based on a specific subset of 15 women living with SCI related to body issues during rehabilitation. This paper builds on this value work and we develop key practices for a progressive rehabilitation culture and model, based on the larger study group of 80 participants (men and women with SCI). This value-based model, when integrated with traditional, physical improvement-focused rehabilitation, has the potential to create a more effective process by offering

  18. Advancing Earth System Science using Quantified Objectives: An Overview of the NRC Recommended Value Framework

    NASA Astrophysics Data System (ADS)

    Friedl, R.

    2016-12-01

    The successful application of the value-based framework recommended in the recent National Academy study to measurement prioritization depends, first and foremost, on the establishment of an adequate working definition of an Earth science "objective". The sought-after definition should readily lend itself to formulation of quantified objectives for use in advancing observations of the Earth system. This presentation will provide an overview of the National Academy study on measurement continuity with particular emphasis on the committee's perspective on overcoming the challenges of establishing useful quantified objectives.

  19. Improved automatic target recognition (ATR) value through enhancements and accommodations

    NASA Astrophysics Data System (ADS)

    Ross, Timothy D.; Goodwon, Lloyd C.

    2006-05-01

    There is a strong and growing need for automatic target recognition (ATR) technologies. Those technologies have made great strides; however, there is a general sense that they are not having the full impact desired. This paper develops a value-based framework for considering how ATR technology can be made more relevant and then introduces and expands on two elements within that framework: 'enhancements' and 'accommodations'. Value is used here as the degree to which a technology's benefits exceed the technology's costs. Value may be improved by increasing benefits or decreasing costs; but it may be as important that the uncertainty about benefits and costs be reduced. Enhancements and accommodations are distinguished here from the 'core ATR'. While it is generally appreciated that improved core ATR performance could improve value, enhancements and accommodations might be overlooked by those focused on ATRs. Enhancements are ways of making the overall system, inclusive of a core ATR, more capable. Accommodations are ways of making the problem easier for the core ATR. An example enhancement is technology to fuse the output of the core ATR with other sources. An example accommodation is for the user to agree to limit the target set to large, and therefore more easily recognized, objects. This paper encourages the consideration of this framework and outlines a number of candidates for enhancements and accommodations for synthetic aperture radar (SAR) ATR, including humans-in-the-loop, change detection, fusion, modeling confusers, group detection, adaptive algorithms, class make-up, and scene-based decisions.

  20. Assessment of structural computer code implementation of PVRC recommended piping damping values. [Pressure Vessel Research Committee

    SciTech Connect

    Ware, A.G.

    1984-03-01

    A task group of the Pressure Vessel Research Committee of the Welding Research Council has recommended that structural damping for seismic analyses of piping systmes be modified from the present constant damping to allow higher damping values at low response frequencies. This Technical Development Program project evaluates the implementation of the proposed change on the INEL structural computer codes. For response spectrum analyses and time history modal superposition analyses, the most commonly used seismic techniques, the proposed changes can be easily carried out. Appropriate methods are described in this report. For the time history direct integration method of solution, exact implementation is impossible, and choosing the appropriate Rayleigh constants in order to avoid excessive over- or underconservatism in damping values will be difficult. However, this type of solution method is rarely used in seismic structural analyses.

  1. Target value design: applications to newborn intensive care units.

    PubMed

    Rybkowski, Zofia K; Shepley, Mardelle McCuskey; Ballard, H Glenn

    2012-01-01

    There is a need for greater understanding of the health impact of various design elements in neonatal intensive care units (NICUs) as well as cost-benefit information to make informed decisions about the long-term value of design decisions. This is particularly evident when design teams are considering the transition from open-bay NICUs to single-family-room (SFR) units. This paper introduces the guiding principles behind target value design (TVD)-a price-led design methodology that is gaining acceptance in healthcare facility design within the Lean construction methodology. The paper also discusses the role that set-based design plays in TVD and its application to NICUs.

  2. Recommended Values of the Thermophysical Properties of Eight Alloys, Major Constituents and Their Oxides

    DTIC Science & Technology

    1966-01-01

    Shvidkovskii, E.G. (7); (g) Tresh, H.R.,r8). Other Values: (h) Polyak , E. V., and Sergueiev, S. V. ( 9), f 10); (i) Yao. T.P., andKondic, V. (11); (j...Sergueiev and Polyak (l0);(q) Navarro, J.M., .-Mid Kondic, V. (12); (r) Sato, T., and Munahata, S. (6). T(0K) Mcp) T(0K) 505( m. p.) 2.04 1150 550...i".^» I ■^■^■^■i-f<- lV ŕ^;* ■*,’-’ ■■"’.■ll» ’,’ ’’ ■ ",7’!’ ? « >«« > ■■ ii .» .■ m p; . 117 TABLE n-8. VISCOSITY OF ZINC RECOMMENDED

  3. Targeted yield concept and a framework of fertilizer recommendation in irrigated rice domains of subtropical India*

    PubMed Central

    Bera, R.; Seal, A.; Bhattacharyya, P.; Das, T.H.; Sarkar, D.; Kangjoo, K.

    2006-01-01

    Soil test crop response (STCR) correlation studies were carried out in Vindhyan alluvial plain during 2001 to 2004 taking IR-36 as test crop to quantify rice production in the context of the variability of soil properties and use of balanced fertilizers based on targeted yield concept. The soils were developed on gently sloping alluvial plain with different physiographic settings and notable variation in drainage condition. Soil properties show moderate variation in texture (loamy to clay), organic carbon content (4.4 to 9.8 g/kg), cation exchange capacity (10.2 to 22.4 cmol (p+)/kg) and pH (5.3 to 6.4). Soil fertility status for N is low to medium (224 to 348 kg/ha), P is medium to high (87 to 320 kg/ha) and K ranges from medium to high (158 to 678 kg/ha). Database regarding nutrient requirement in kg/t of grain produce (NR), the percent contribution from the soil available nutrients [CS (%)] and the percent contribution from the applied fertilizer nutrients [CF (%)] were computed for calibrating and formulating fertilizer recommendations. Validity of the yield target for 7 and 8 t/ha was tested in farmers’ fields and yields targets varied at less than 10%. The percent achievement of targets aimed at different level was more than 90%, indicating soil test based fertilizer recommendation approach was economically viable within the agro-ecological zone with relatively uniform cropping practices and socio-economic conditions. PMID:17111464

  4. Shilling Attacks Detection in Recommender Systems Based on Target Item Analysis

    PubMed Central

    Zhou, Wei; Wen, Junhao; Koh, Yun Sing; Xiong, Qingyu; Gao, Min; Dobbie, Gillian; Alam, Shafiq

    2015-01-01

    Recommender systems are highly vulnerable to shilling attacks, both by individuals and groups. Attackers who introduce biased ratings in order to affect recommendations, have been shown to negatively affect collaborative filtering (CF) algorithms. Previous research focuses only on the differences between genuine profiles and attack profiles, ignoring the group characteristics in attack profiles. In this paper, we study the use of statistical metrics to detect rating patterns of attackers and group characteristics in attack profiles. Another question is that most existing detecting methods are model specific. Two metrics, Rating Deviation from Mean Agreement (RDMA) and Degree of Similarity with Top Neighbors (DegSim), are used for analyzing rating patterns between malicious profiles and genuine profiles in attack models. Building upon this, we also propose and evaluate a detection structure called RD-TIA for detecting shilling attacks in recommender systems using a statistical approach. In order to detect more complicated attack models, we propose a novel metric called DegSim’ based on DegSim. The experimental results show that our detection model based on target item analysis is an effective approach for detecting shilling attacks. PMID:26222882

  5. Recommended Values of Meteorological Factors to Be Considered in the Design of Aircraft Ice-Prevention Equipment

    NASA Technical Reports Server (NTRS)

    Jones, Alun R; Lewis, William

    1949-01-01

    Meteorological conditions conducive to aircraft icing are arranged in four classifications: three are associated with cloud structure and the fourth with freezing rain. The range of possible meteorological factors for each classification is discussed and specific values recommended for consideration in the design of ice-prevention equipment for aircraft are selected and tabulated. The values selected are based upon a study of the available observational data and theoretical considerations where observations are lacking. Recommendations for future research in the field are presented.

  6. Interests and values in the Recommended Dietary Allowances and nutritional guidelines for Americans.

    PubMed

    Kunkel, H O

    1996-09-01

    Evidence is provided showing that interests, values and belief systems have affected the development of Recommended Dietary Allowances (RDAs) and nutrition guidelines for Americans in the past and can be expected to do so in the future. The conflicts of the 1980s relative to the nutritional guidelines for Americans and the RDAs illustrate the tension among values that can parallel a conflict of interests. In the conflicts of the 1980s, we saw an apparent conflict between those policies that attempt to optimize outcomes for a large class of affected parties and those policies that attempt to establish constraints on actions which appear to threaten individual autonomy and freedom of choice. The former approach derives from utilitarian, consequential moral philosophy which evaluates policies by evaluating costs and harms, and weighing them against benefits to all parties. The latter has its strongest advocates in contemporary libertarianism which takes individual freedom to be the bottom line. Ethical vegetarianism, a belief system which would limit RDAs and guidelines to those that can be translated to vegan and other vegetarian diets, has been a more recent entry into the discussions. Such human value issues suggest that a set of RDAs or of nutrition guidelines is analogous to and may be considered to be an ethic. An ethic is a theory reached via the method of reflective equilibrium that is a coherent ordered triple set of beliefs: a set of considered moral judgments, a set of moral principles, and a set of relevant scientific background theories. The reasoning, however, can become circular and unsound when the considered moral judgments, moral principles and relevant background are not independent sources of information. If they are mixed or, for example, an intuition is mistaken for a scientific conclusion, the reasoning can be flawed.

  7. 2014 Eighth Joint National Committee Panel Recommendation for Blood Pressure Targets Revisited

    PubMed Central

    Bangalore, Sripal; Gong, Yan; Cooper-DeHoff, Rhonda M.; Pepine, Carl J.; Messerli, Franz H.

    2014-01-01

    BACKGROUND The 2014 Eighth Joint National Committee panel recommendations for management of high blood pressure (BP) recommend a systolic BP threshold for initiation of drug therapy and a therapeutic target of <150 mm Hg in those ≥60 years of age, a departure from prior recommendations of <140 mm Hg. However, it is not known whether this is an optimal choice, especially for the large population with coronary artery disease (CAD). OBJECTIVES This study sought to evaluate optimal BP in patients ≥60 years of age. METHODS Patients 60 years of age or older with CAD and baseline systolic BP >150 mm Hg randomized to a treatment strategy on the basis of either atenolol/hydrochlorothiazide or verapamil-SR (sustained release)/trandolapril in INVEST (INternational VErapamil SR Trandolapril STudy) were categorized into 3 groups on the basis of achieved on-treatment systolic BP: group 1, <140 mm Hg; group 2, 140 to <150 mm Hg; and group 3, ≥150 mm Hg. Primary outcome was first occurrence of all-cause death, nonfatal myocardial infarction (MI), or nonfatal stroke. Secondary outcomes were all-cause mortality, cardiovascular mortality, total MI, nonfatal MI, total stroke, nonfatal stroke, heart failure, or revascularization, tabulated separately. Outcomes for each group were compared in unadjusted and multiple propensity score–adjusted models. RESULTS Among 8,354 patients included in this analysis with an accumulated 22,308 patient-years of follow-up, 4,787 (57%) achieved systolic BP of <140 mm Hg (group 1), 1,747 (21%) achieved systolic BP of 140 to <150 mm Hg (group 2), and 1,820 (22%) achieved systolic BP of ≥150 mm Hg (group 3). In unadjusted models, group 1 had the lowest rates of the primary outcome (9.36% vs. 12.71% vs. 21.32%; p < 0.0001), all-cause mortality (7.92% vs. 10.07% vs. 16.81%; p < 0.0001), cardiovascular mortality (3.26% vs. 4.58% vs. 7.80%; p < 0.0001), MI (1.07% vs. 1.03% vs. 2.91%; p < 0.0001), total stroke (1.19% vs. 2.63% vs. 3.85%; p <0

  8. Navigating the internet safely: recommendations for residential programs targeting at-risk adolescents.

    PubMed

    Pridgen, Bryan

    2010-01-01

    Adolescence is a period during human development characterized by a variety of biological, psychological, and social changes. Navigating these changes can be a stressful experience for both adolescents and their families. To complicate matters further, the Internet has altered the landscape of human interaction in a way that may accentuate deficits in the capacity for self-sustaining, reciprocal peer relationships. Adolescents suffering from emotional and behavioral disorders may be especially prone to this influence, as evidenced by our observation of the growing clinical trend of adolescents admitted to inpatient and residential psychiatric units who present with a history of risky cyber-behaviors. Within these settings, education for adolescents and their families around appropriate use of the Internet, as well as social training for the online management of the impulsivity and poor judgment that is so often characteristic of adolescence, is vital. Milieu models employed in the treatment of emotionally troubled adolescents must adapt so as to incorporate the identification of problematic attachment behaviors not only in real-time relationships, but also as those behaviors inevitably occur in more troubling and potentially destructive ways over the Internet. The article addresses this need by offering recommendations for the creation of a skills-based, Internet-focused curriculum for inpatient and residential programs targeting at-risk adolescents. Evaluating the association between online communication habits and the evolution of disturbances in attachment systems is an important future direction for research aimed at safeguarding the emotional and physical well-being of all adolescents.

  9. A lipidologist perspective of global lipid guidelines and recommendations, part 1: Lipid treatment targets and risk assessment.

    PubMed

    Bays, Harold E

    2016-01-01

    Having knowledge of worldwide lipid guidelines and recommendations may provide clinicians a more global perspective on lipid management. This perspective reviews 8 international scientific and/or medical organizations' lipid guidelines, recommendations, and position papers: the National Lipid Association (2014), National Institute for Health and Care Excellence (2014), International Atherosclerosis Society (2013), American College of Cardiology/American Heart Association (2013), Canadian Cardiovascular Society (2013), Japan Atherosclerosis Society (2012), European Society of Cardiology/European Atherosclerosis Society (2012), and Adult Treatment Panel III (2001/2004). Part 1 of this perspective focuses on sentinel components of these lipid guidelines and recommendations as applied to the role of atherogenic lipoprotein cholesterol levels, primary lipid target of therapy, other primary and secondary lipid treatment targets, and assessment of atherosclerotic cardiovascular disease (ASCVD) risk. Part 2 examines goals of lipid-altering therapy to reduce ASCVD events. Both parts 1 and 2 include the author's perspective on sentinel topics. In general, some guidelines and recommendations differ with regard to ASCVD risk assessment and lipid treatment goals. However, lipid guidelines and recommendations have significant concordance regarding the need to reduce atherogenic lipoprotein cholesterol levels, and are in general agreement on the primary lipid treatment targets. Finally, a substantial degree of agreement exists among guidelines and recommendations in their emphasis on the need for aggressive treatment of hypercholesterolemia, for which the predominance of ASCVD outcomes studies suggests statins as the first-line treatment of choice. Copyright © 2016 National Lipid Association. Published by Elsevier Inc. All rights reserved.

  10. The therapeutic value of targeting inflammation in gastrointestinal cancers

    PubMed Central

    Sun, Beicheng; Karin, Michael

    2014-01-01

    Inflammation has been implicated in the initiation and progression of gastrointestinal (GI) cancers. Inflammation also plays important roles in subverting immune tolerance, escape from immune surveillance, and conferring resistance to chemotherapeutic agents. Targeting key regulators and mediators of inflammation represents an attractive strategy for GI cancer prevention and treatment. However, the targeting of inflammation in GI cancer is not straight-forward and sometimes inflammation may contribute to tumor regression. We discuss the origins and effects of inflammation in GI cancer and how to target it successfully. PMID:24881011

  11. Weighted feature value based Drug Target Protein prediction.

    PubMed

    Hyun, Bo-ra; Jung, Hwiesung; Jang, Woo-Hyuk; Jung, Suk Hoon; Han, Dong-Soo

    2008-01-01

    Drug discovery is a long process in which only a few successful new therapeutic discoveries are made and identification of drug target candidate proteins requires considerable time and efforts. However, the accumulation of information on drugs has made it possible to devise new computational methods for classifying drug target candidates. In this paper, we devise a Drug Target Protein (DT-P) classification method by the summation of weighted features which is extracted from known DT-P. The method is validated using Bayesian decision theory and SVM, and it was revealed to achieve high specificity of 89.5% with 88% accuracy.

  12. The Recommendations of the National Commission on Excellence in Education: A Case Study of Their Value.

    ERIC Educational Resources Information Center

    Cohn, Marilyn M.; Distefano, Anna

    1984-01-01

    Examines the report of the National Commission on Excellence in Education, assesses the applicability of the commission's findings to one high school, identifies problems in implementing the commission's recommendations in the high school studied, and, on the basis of this analysis, considers a national commission's role in generating local…

  13. Values.

    ERIC Educational Resources Information Center

    Chapel Hill City Schools, NC.

    GRADES OR AGES: Grades 1-12. SUBJECT MATTER: Values. ORGANIZATION AND PHYSICAL APPEARANCE: The guide is intended to define the development of the valuing process and contains ideas for classroom teachers. It is not a conventional curriculum guide but is recommended for use with the guide on drug education (SP 007 318). It contains the following…

  14. Standards of reporting for MRI-targeted biopsy studies (START) of the prostate: recommendations from an International Working Group.

    PubMed

    Moore, Caroline M; Kasivisvanathan, Veeru; Eggener, Scott; Emberton, Mark; Fütterer, Jurgen J; Gill, Inderbir S; Grubb Iii, Robert L; Hadaschik, Boris; Klotz, Laurence; Margolis, Daniel J A; Marks, Leonard S; Melamed, Jonathan; Oto, Aytekin; Palmer, Suzanne L; Pinto, Peter; Puech, Philippe; Punwani, Shonit; Rosenkrantz, Andrew B; Schoots, Ivo G; Simon, Richard; Taneja, Samir S; Turkbey, Baris; Ukimura, Osamu; van der Meulen, Jan; Villers, Arnauld; Watanabe, Yuji

    2013-10-01

    A systematic literature review of magnetic resonance imaging (MRI)-targeted prostate biopsy demonstrates poor adherence to the Standards for the Reporting of Diagnostic Accuracy (STARD) recommendations for the full and transparent reporting of diagnostic studies. To define and recommend Standards of Reporting for MRI-targeted Biopsy Studies (START). Each member of a panel of 23 experts in urology, radiology, histopathology, and methodology used the RAND/UCLA appropriateness methodology to score a 258-statement premeeting questionnaire. The collated responses were presented at a face-to-face meeting, and each statement was rescored after group discussion. Measures of agreement and consensus were calculated for each statement. The most important statements, based on group median score, the degree of group consensus, and the content of the group discussion, were used to create a checklist of reporting criteria (the START checklist). The strongest recommendations were to report histologic results of standard and targeted cores separately using Gleason score and maximum cancer core length. A table comparing detection rates of clinically significant and clinically insignificant disease by targeted and standard approaches should also be used. It was recommended to report the recruitment criteria for MRI-targeted biopsy, prior biopsy status of the population, a brief description of the MRI sequences, MRI reporting method, radiologist experience, and image registration technique. There was uncertainty about which histologic criteria constitute clinically significant cancer when the prostate is sampled using MRI-targeted biopsy, and it was agreed that a new definition of clinical significance in this setting needed to be derived in future studies. Use of the START checklist would improve the quality of reporting in MRI-targeted biopsy studies and facilitate a comparison between standard and MRI-targeted approaches. Copyright © 2013 European Association of Urology. All

  15. Diagnosis and Management of Late-Onset Spondyloarthritis: Implications of Treat-to-Target Recommendations.

    PubMed

    Toussirot, Éric

    2015-07-01

    Spondyloarthritis (SpA) is usually observed in young patients while onset in the elderly is less common. Late-onset forms of SpA may become more common due to longer life expectancy. The clinical spectrum of late-onset SpA is as broad as in young people, with a predominance of peripheral SpA over pure axial disease. The Assessment of SpondyloArthritis international Society (ASAS) has developed new criteria for axial or peripheral SpA that allow patients aged under 45 years at the time of disease onset to be identified. These criteria are not theoretically adapted for the classification of patients with late-onset disease but they are useful for the diagnosis. Similarly, magnetic resonance imaging (MRI) is now widely used for the early recognition of sacroiliitis or spinal inflammation in SpA, and sacroiliitis as evidenced by MRI is included in the ASAS criteria for axial SpA. Nevertheless, the utility of sacroiliac joint and/or spine inflammation as detected by MRI has mostly been described in young patients with ankylosing spondylitis, SpA, or inflammatory back pain, but not in the elderly. The management of SpA is now more focused on remission or, alternatively, low disease activity, according to the treat-to-target recommendations. Such an optimized approach to therapy is thought to improve patient outcomes and ultimately long-term quality of life. The same principles of treatment should apply in the elderly, but require certain adjustments, especially with biological agents. Tumor necrosis factor-α blocking agents are very effective in SpA, but seem slightly less effective in the elderly and are associated with an increased risk of infection in this population. A careful and rigorous evaluation is thus required before initiating these agents in elderly subjects.

  16. What's the Regulatory Value of a Target Product Profile?

    PubMed

    Breder, Christopher D; Du, Wenny; Tyndall, Adria

    2017-07-01

    Target product profiles (TPPs) are used as a regulatory tool for dialog on clinical development or manufacturing plans. Drugs and biologics approved by the FDA that mention TPPs are associated with more efficient regulatory review times, perhaps as a result of increased planning or because the TPP promotes well-organized regulatory dialog. Published by Elsevier Ltd.

  17. Recommendations for the design of laboratory studies on non-target arthropods for risk assessment of genetically engineered plants

    USDA-ARS?s Scientific Manuscript database

    This paper provides recommendations on experimental design for early-tier laboratory studies used in the risk assessment process to evaluate potential adverse impacts of arthropod-resistant genetically-engineered plants on non-target arthropods. While we rely heavily on the currently used proteins f...

  18. Pursuing optimal thresholds to recommend breast biopsy by quantifying the value of tomosynthesis

    NASA Astrophysics Data System (ADS)

    Wu, Yirong; Alagoz, Oguzhan; Vanness, David J.; Trentham-Dietz, Amy; Burnside, Elizabeth S.

    2014-03-01

    A 2% threshold has been traditionally used to recommend breast biopsy in mammography. We aim to characterize how the biopsy threshold varies to achieve the maximum expected utility (MEU) of tomosynthesis for breast cancer diagnosis. A cohort of 312 patients, imaged with standard full field digital mammography (FFDM) and digital breast tomosynthesis (DBT), was selected for a reader study. Fifteen readers interpreted each patient's images and estimated the probability of malignancy using two modes: FFDM versus FFDM + DBT. We generated receiver operator characteristic (ROC) curves with the probabilities for all readers combined. We found that FFDM+DBT provided improved accuracy and MEU compared with FFDM alone. When DBT was included in the diagnosis along with FFDM, the optimal biopsy threshold increased to 2.7% as compared with the 2% threshold for FFDM alone. While understanding the optimal threshold from a decision analytic standpoint will not help physicians improve their performance without additional guidance (e.g. decision support to reinforce this threshold), the discovery of this level does demonstrate the potential clinical improvements attainable with DBT. Specifically, DBT has the potential to lead to substantial improvements in breast cancer diagnosis since it could reduce the number of patients recommended for biopsy while preserving the maximal expected utility.

  19. [The recommended reference values for anaemia in the elderly are of limited usefulness].

    PubMed

    Olde Rikkert, M G M

    2006-05-06

    Recent epidemiological findings on the risk factors for mortality and functional impairment do not support lower cut-off values than the official WHO reference values for the definition of anaemia in the elderly, and even suggest higher limits. However, wide-scale application of such high Hb values for a full investigation of the causes of anaemia in clinical practice requires data on the effectiveness in terms of a net increase in quality of life at acceptable costs. At present, there are no evidence-based Hb limits for the elderly because such data are lacking. As a pragmatic way out, the WHO limits can be taken for a simple and non-invasive biochemical analysis of anaemia, but individual considerations, taking into account co-morbidity, life expectation and patients' preferences, are necessary for further diagnostic investigations such as colonoscopy or sternum puncture.

  20. RECOMMENDATIONS FOR AND DOCUMENTATION OF BIOLOGICAL VALUES FOR USE IN RISK ASSESSMENT

    EPA Science Inventory

    The document was prepared by the Office of Health and Environmental Assessment, Environmental Criteria and Assessment Office, Cincinnati, OH for the Office of Solid Waste and Emergency Response. The document consists of an extensive compliation of values gleaned from published li...

  1. RECOMMENDATIONS FOR AND DOCUMENTATION OF BIOLOGICAL VALUES FOR USE IN RISK ASSESSMENT

    EPA Science Inventory

    The document was prepared by the Office of Health and Environmental Assessment, Environmental Criteria and Assessment Office, Cincinnati, OH for the Office of Solid Waste and Emergency Response. The document consists of an extensive compliation of values gleaned from published li...

  2. Target hematologic values in the management of essential thrombocythemia and polycythemia vera.

    PubMed

    Hernández-Boluda, Juan Carlos; Gómez, Montse

    2015-01-01

    Treatment of essential thrombocythemia (ET) and polycythemia vera (PV) is aimed at preventing vascular complications, which are the main cause of morbidity and mortality in these diseases. Over the years, clinical trials have demonstrated that the incidence of thrombosis and bleeding can be reduced by controlling the blood cell counts, but the target hematological levels have varied across the studies. In this article, we review the evidence supporting the use of predefined target hematologic values for the management of ET and PV in routine clinical practice. At present, the recommended target hematocrit in PV is below 45%, regardless of the patients' risk profile. Concerning platelet counts, no direct correlation has been demonstrated with thrombotic risk in either ET or PV. Thus, although cytoreductive treatment reduces the rate of vascular complications in high-risk patients, no particular threshold of the platelet counts has been shown to be more protective against thrombosis. Extreme thrombocytosis is a risk factor for bleeding, particularly when aspirin or anagrelide are given. Leukocytosis at baseline or during follow-up appears to be a risk factor for thrombosis, mostly in high-risk patients. However, the clinical benefit of strictly controlling this parameter is not yet established. Finally, standardized definitions of response to cytoreductive treatment in ET and PV have recently been published. Nevertheless, they have been produced to compare the efficacy of new therapies in clinical trials, whereas its relevance in clinical practice has been questioned in retrospective studies showing that such response definitions do not correlate with the patients' clinical outcome. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  3. Treating axial spondyloarthritis and peripheral spondyloarthritis, especially psoriatic arthritis, to target: 2017 update of recommendations by an international task force.

    PubMed

    Smolen, Josef S; Schöls, Monika; Braun, Jürgen; Dougados, Maxime; FitzGerald, Oliver; Gladman, Dafna D; Kavanaugh, Arthur; Landewé, Robert; Mease, Philip; Sieper, Joachim; Stamm, Tanja; Wit, Maarten de; Aletaha, Daniel; Baraliakos, Xenofon; Betteridge, Neil; Bosch, Filip van den; Coates, Laura C; Emery, Paul; Gensler, Lianne S; Gossec, Laure; Helliwell, Philip; Jongkees, Merryn; Kvien, Tore K; Inman, Robert D; McInnes, Iain B; Maccarone, Mara; Machado, Pedro M; Molto, Anna; Ogdie, Alexis; Poddubnyy, Denis; Ritchlin, Christopher; Rudwaleit, Martin; Tanew, Adrian; Thio, Bing; Veale, Douglas; Vlam, Kurt de; Heijde, Désirée van der

    2017-07-06

    Therapeutic targets have been defined for axial and peripheral spondyloarthritis (SpA) in 2012, but the evidence for these recommendations was only of indirect nature. These recommendations were re-evaluated in light of new insights. Based on the results of a systematic literature review and expert opinion, a task force of rheumatologists, dermatologists, patients and a health professional developed an update of the 2012 recommendations. These underwent intensive discussions, on site voting and subsequent anonymous electronic voting on levels of agreement with each item. A set of 5 overarching principles and 11 recommendations were developed and voted on. Some items were present in the previous recommendations, while others were significantly changed or newly formulated. The 2017 task force arrived at a single set of recommendations for axial and peripheral SpA, including psoriatic arthritis (PsA). The most exhaustive discussions related to whether PsA should be assessed using unidimensional composite scores for its different domains or multidimensional scores that comprise multiple domains. This question was not resolved and constitutes an important research agenda. There was broad agreement, now better supported by data than in 2012, that remission/inactive disease and, alternatively, low/minimal disease activity are the principal targets for the treatment of PsA. As instruments to assess the patients on the path to the target, the Ankylosing Spondylitis Disease Activity Score (ASDAS) for axial SpA and the Disease Activity index for PSoriatic Arthritis (DAPSA) and Minimal Disease Activity (MDA) for PsA were recommended, although not supported by all. Shared decision-making between the clinician and the patient was seen as pivotal to the process. The task force defined the treatment target for SpA as remission or low disease activity and developed a large research agenda to further advance the field. © Article author(s) (or their employer(s) unless otherwise

  4. Same drugs, valued differently? Comparing comparators and methods used in reimbursement recommendations in Australia, Canada, and Korea.

    PubMed

    Bae, Green; Bae, Eun Young; Bae, SeungJin

    2015-05-01

    To investigate whether the value of the same drug is evaluated differently across jurisdictions, publicly available reimbursement recommendation data from the Health Insurance Review and Assessment Service (HIRA, Korea) from January 2007 until July 2012 were compared with reimbursement recommendation data from the Pharmaceutical Benefit Advisory Committee (PBAC) of Australia, and the Common Drug Review (CDR) and the pan-Canadian Oncology Drug review (pCODR) of Canada. The most recent guidelines from the three agencies regarding the recommended methods of economic evaluation and comparator selection were also compared. During the observation period, 25 products were evaluated by all three countries. No significant differences in the comparator(s)' selection or methods of economic evaluation were found, but the CDR was significantly less likely to positively recommend products compared with the other agencies (p=0.023). The agreement between agencies on selected comparator(s) was moderate to significant (kappa statistics=0.590-0.669), whereas the reimbursement decisions (kappa statistics=0.042-0.296) and the methods of economic evaluation (kappa statistics=0.138-0.525) showed slight to fair agreement. We illustrated that the divergence in reimbursement decisions across jurisdictions is less related to comparator selection or the level of clinical evidence considered and more related to country-specific issues.

  5. Recommended Parameter Values for GENII Modeling of Radionuclides in Routine Air and Water Releases

    SciTech Connect

    Snyder, Sandra F.; Arimescu, Carmen; Napier, Bruce A.; Hay, Tristan R.

    2012-11-01

    The GENII v2 code is used to estimate dose to individuals or populations from the release of radioactive materials into air or water. Numerous parameter values are required for input into this code. User-defined parameters cover the spectrum from chemical data, meteorological data, agricultural data, and behavioral data. This document is a summary of parameter values that reflect conditions in the United States. Reasonable regional and age-dependent data is summarized. Data availability and quality varies. The set of parameters described address scenarios for chronic air emissions or chronic releases to public waterways. Considerations for the special tritium and carbon-14 models are briefly addressed. GENIIv2.10.0 is the current software version that this document supports.

  6. [Clinic structure and timely management of emergency cesarean section--reference values and recommendations].

    PubMed

    Roemer, V M; Heger-Römermann, G

    1993-01-01

    This retrospective clinical study was performed to analyze the relationship between the time course of an emergency Cesarean Section and the structural, logistic and circadian aspects of the clinical environment. Statistical analysis was based on architectural and structural data from 132 Departments of Obstetrics in the region of Northrhine-Westfalia, Germany. Hospitals were compared in four groups of equal size defined by the number of deliveries per year. Data were available on 207 emergency C-Sections from 66 participating hospitals. The time of the day of each delivery was rounded to full hours. The size of the hospital was a highly significant predictor (p < 0.001) of the time elapsing between decision making and delivery (DD-interval) and of the preparation time required prior to the start of the operation: With increasing number of yearly deliveries the DD interval decreased from 31 minutes (SD = 15) to 19 minutes (SD = 7) with respective set-up times of 26 minutes (SD = 15) and 15 minutes (SD = 7) respectively. The time of the day had a significant influence on both variables (p < 0.05) with emergency C-Sections being slowest between 1:00 a.m. and 7:00 a.m. The mean time intervals observed may serve as a reference for the individual hospital situation: A preparation time of 15 minutes, time from start of surgery until delivery of 4 minutes and a DD interval of 19 minutes. The data presented in this study underline the importance of the immediate availability of a complete emergency team consisting of midwife, obstetrician, anesthesiologist, OR nursing staff and pediatrician. While not necessarily arguing in favor of a concentration of obstetrical practice in specialized centers, the following recommendations might be worth considering for any given clinical setting: 1. Immediate availability of a complete team is essential, especially during the night. 2. Well defined steps of urgency in agreement between all disciplines involved improve communication and

  7. Is the recommended target of 4 hours from head injury to emergency craniotomy achievable?

    PubMed

    Sergides, I G; Whiting, G; Howarth, S; Hutchinson, P J

    2006-10-01

    Guidelines recommend that head-injured patients who require life-saving decompressive surgery should undergo surgery within 4 h. To assess the compliance with this recommendation 100 consecutive head-injured patients admitted to a regional neurosurgical unit (RNU) were studied. Time points from head injury to craniotomy were documented and analysed. Twenty-four patients underwent emergency craniotomy, only one being operated on within 4 h. In this cohort of patients there was no relationship between timing of surgery and outcome. In order to investigate whether it is possible to reduce delays in transportation time, theoretical models were created to determine whether direct transfer to the RNU would be faster by land or air ambulance.

  8. Evidence-based recommendations for the development of obesity prevention programs targeted at preschool children.

    PubMed

    Summerbell, C D; Moore, H J; Vögele, C; Kreichauf, S; Wildgruber, A; Manios, Y; Douthwaite, W; Nixon, C A; Gibson, E L

    2012-03-01

    The ToyBox intervention was developed using an evidence-based approach, using the findings of four reviews. These reviews included three critical and narrative reviews of educational strategies and psychological approaches explaining young children's acquisition and formation of energy-balance related behaviours, and the management of these behaviours, and also a systematic review of behavioural models underpinning school-based interventions in preschool and school settings for the prevention of obesity in children aged 4-6 years. This paper summarises and translates the findings from these reviews into practical evidence based recommendations for researchers and policy-makers to consider when developing and implementing interventions for the prevention of overweight and obesity in young (aged 4-6 years) children. The recommendations focus on two behaviours, physical activity and sedentary behaviour, and healthy eating, and include general recommendations, intervention approaches, interventions content, and simple messages. The review also briefly examines the role that the commercial sector plays in hindering or facilitating attempts to create healthy food environments for children. This paper also recognises that childhood obesity is not an issue for the education sector alone; it needs to be tackled at a multi sectoral level, recognizing the particularly important role of local governments, nongovernment organizations and the media.

  9. Recommendations for the measurement of FIV(1) values in chronic obstructive pulmonary disease.

    PubMed

    Visser, Frank J; Ramlal, Sunil; Dekhuijzen, P N Richard; Heijdra, Yvonne F

    2008-01-01

    In contrast to static inspiratory parameters such as vital capacity and inspiratory capacity, information on forced inspiratory volume in 1 s (FIV(1)) in patients with chronic obstructive pulmonary disease (COPD) is limited. It was the aim of this study to investigate the influence of the preceding expiratory manoeuvre and the optimal number of manoeuvres on FIV(1) values. In 169 patients with COPD, FIV(1) manoeuvres were performed after a forced (FIV(1)-Fe) and a slow (FIV(1)-Se) expiration. To investigate the optimal number of the FIV(1)-Se manoeuvres, 8 attempts were performed. The variability of FIV(1)-Fe was greater than that of FIV(1)-Se. The mean difference between FIV(1)-Se and FIV(1)-Fe was 0.21 litres (p < 0.01) and dependent on the Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage. The higher the GOLD stage, the greater the difference between the 2 techniques. The correlation coefficient between FIV(1)-Se and FIV(1)-Fe was high (r = 0.89, p = 0.01), but there was a poor agreement between these parameters (limits of agreement -0.52 to 0.94 litres). Five manoeuvres were needed to obtain an optimal FIV(1)-Se. There was no association with the GOLD stage. In COPD patients, FIV(1)-Se are less variable than FIV(1)-Fe, the agreement between the 2 manoeuvres is poor, and at least 5 FIV(1)-Se manoeuvres are needed to get an acceptable FIV(1). This holds for all GOLD stages. 2007 S. Karger AG, Basel.

  10. Targeting Net Zero Energy at Marine Corps Base Kaneohe Bay, Hawaii: Assessment and Recommendations

    SciTech Connect

    Burman, K.; Kandt, A.; Lisell, L.; Booth, S.; Walker, A.; Roberts, J.; Falcey, J.

    2011-11-01

    DOD's U.S. Pacific Command has partnered with the U.S. Department of Energy's (DOE) National Renewable Energy Laboratory (NREL) to assess opportunities for increasing energy security through renewable energy and energy efficiency in Hawaii installations. NREL selected Marine Corps Base Hawaii (MCBH), Kaneohe Bay to receive technical support for net zero energy assessment and planning funded through the Hawaii Clean Energy Initiative (HCEI). NREL performed a comprehensive assessment to appraise the potential of MCBH Kaneohe Bay to achieve net zero energy status through energy efficiency, renewable energy, and electric vehicle integration. This report summarizes the results of the assessment and provides energy recommendations.

  11. Limited uptake of ulcerative colitis 'treat to target' recommendations in real-world practice.

    PubMed

    Bryant, Robert V; Costello, Samuel P; Schoeman, Scott; Sathananthan, Dharshan; Knight, Emma; Lau, Su-Yin; Schoeman, Mark N; Mountifield, Reme; Tee, Derrick; Travis, Simon P L; Andrews, Jane M

    2017-08-14

    A 'Treat to Target' (T2T) approach has been proposed for ulcerative colitis (UC), with a target of combined clinical and endoscopic remission. The aim of the study was evaluate the extent to which proposed targets are achieved in real-world care, along with clinician perceptions and potential challenges. A multicentre, retrospective, cross-sectional review of patients with UC attending outpatient services in South Australia was conducted. Clinical and objective assessment of disease activity (endoscopy, histology, and/or biomarkers) was recorded. A survey evaluated Gastroenterologists' perceptions of T2T in UC. Statistical analysis included logistic regression and Fisher's exact tests. Of 246 patients with UC, 61% were in clinical remission (normal bowel habit and no rectal bleeding), 35% in clinical and endoscopic remission (Mayo endoscopic sub-score ≤1), and 16% in concordant clinical, endoscopic and histological (Truelove and Richards' Index) remission. Rather than disease-related factors (extent/activity), clinician-related factors dominated outcome. Hospital location and the choice of therapy predicted combined clinical and endoscopic remission (OR 3.6, 95% CI 1.6-8.7, p<0.001; OR 3.3, 95% CI 1.1-12.5, p=0.04, respectively). Clinicians used C-reactive protein (CRP) more often than endoscopy as a biomarker for disease activity (75% vs. 47%, p<0.001). In the survey, 45/61 Gastroenterologists responded, with significant disparity between clinician estimates of targets achieved in practice and real-world data (p<0.001 for clinical and endoscopic remission). Most patients with UC do not achieve composite clinical and endoscopic remission in 'real-world' practice. Clinician uptake of proposed 'Treat to Target' guidelines is a challenge to their implementation. This article is protected by copyright. All rights reserved.

  12. Sailing From the Seas of Chaos Into the Corridor of Stability: Practical Recommendations to Increase the Informational Value of Studies.

    PubMed

    Lakens, Daniël; Evers, Ellen R K

    2014-05-01

    Recent events have led psychologists to acknowledge that the inherent uncertainty encapsulated in an inductive science is amplified by problematic research practices. In this article, we provide a practical introduction to recently developed statistical tools that can be used to deal with these uncertainties when performing and evaluating research. In Part 1, we discuss the importance of accurate and stable effect size estimates as well as how to design studies to reach a corridor of stability around effect size estimates. In Part 2, we explain how, given uncertain effect size estimates, well-powered studies can be designed with sequential analyses. In Part 3, we (a) explain what p values convey about the likelihood that an effect is true, (b) illustrate how the v statistic can be used to evaluate the accuracy of individual studies, and (c) show how the evidential value of multiple studies can be examined with a p-curve analysis. We end by discussing the consequences of incorporating our recommendations in terms of a reduced quantity, but increased quality, of the research output. We hope that the practical recommendations discussed in this article will provide researchers with the tools to make important steps toward a psychological science that allows researchers to differentiate among all possible truths on the basis of their likelihood.

  13. Crossing the health IT chasm: considerations and policy recommendations to overcome current challenges and enable value-based care.

    PubMed

    Adler-Milstein, Julia; Embi, Peter J; Middleton, Blackford; Sarkar, Indra Neil; Smith, Jeff

    2017-03-15

    While great progress has been made in digitizing the US health care system, today's health information technology (IT) infrastructure remains largely a collection of systems that are not designed to support a transition to value-based care. In addition, the pursuit of value-based care, in which we deliver better care with better outcomes at lower cost, places new demands on the health care system that our IT infrastructure needs to be able to support. Provider organizations pursuing new models of health care delivery and payment are finding that their electronic systems lack the capabilities needed to succeed. The result is a chasm between the current health IT ecosystem and the health IT ecosystem that is desperately needed.In this paper, we identify a set of focal goals and associated near-term achievable actions that are critical to pursue in order to enable the health IT ecosystem to meet the acute needs of modern health care delivery. These ideas emerged from discussions that occurred during the 2015 American Medical Informatics Association Policy Invitational Meeting. To illustrate the chasm and motivate our recommendations, we created a vignette from the multistakeholder perspectives of a patient, his provider, and researchers/innovators. It describes an idealized scenario in which each stakeholder's needs are supported by an integrated health IT environment. We identify the gaps preventing such a reality today and present associated policy recommendations that serve as a blueprint for critical actions that would enable us to cross the current health IT chasm by leveraging systems and information to routinely deliver high-value care.

  14. Recommendations from the European Working Group for Value Assessment and Funding Processes in Rare Diseases (ORPH-VAL).

    PubMed

    Annemans, Lieven; Aymé, Ségolène; Le Cam, Yann; Facey, Karen; Gunther, Penilla; Nicod, Elena; Reni, Michele; Roux, Jean-Louis; Schlander, Michael; Taylor, David; Tomino, Carlo; Torrent-Farnell, Josep; Upadhyaya, Sheela; Hutchings, Adam; Le Dez, Lugdivine

    2017-03-10

    Rare diseases are an important public health issue with high unmet need. The introduction of the EU Regulation on orphan medicinal products (OMP) has been successful in stimulating investment in the research and development of OMPs. Despite this advancement, patients do not have universal access to these new medicines. There are many factors that affect OMP uptake, but one of the most important is the difficulty of making pricing and reimbursement (P&R) decisions in rare diseases. Until now, there has been little consensus on the most appropriate assessment criteria, perspective or appraisal process. This paper proposes nine principles to help improve the consistency of OMP P&R assessment in Europe and ensure that value assessment, pricing and funding processes reflect the specificities of rare diseases and contribute to both the sustainability of healthcare systems and the sustainability of innovation in this field. These recommendations are the output of the European Working Group for Value Assessment and Funding Processes in Rare Diseases (ORPH-VAL), a collaboration between rare disease experts, patient representatives, academics, health technology assessment (HTA) practitioners, politicians and industry representatives. ORPH-VAL reached its recommendations through careful consideration of existing OMP P&R literature and through a wide consultation with expert stakeholders, including payers, regulators and patients. The principles cover four areas: OMP decision criteria, OMP decision process, OMP sustainable funding systems and European co-ordination. This paper also presents a guide to the core elements of value relevant to OMPs that should be consistently considered in all OMP appraisals. The principles outlined in this paper may be helpful in drawing together an emerging consensus on this topic and identifying areas where consistency in payer approach could be achievable and beneficial. All stakeholders have an obligation to work together to ensure

  15. Geographically-weighted regression of knowledge and behaviour determinants to anti-malarial recommending and dispensing practice among medicine retailers in western Kenya: capacitating targeted interventions.

    PubMed

    Rusk, Andria; Highfield, Linda; Wilkerson, J Michael; Harrell, Melissa; Obala, Andrew; Amick, Benjamin

    2016-11-21

    Most patients with malaria seek treatment first in retail drug shops. Myriad studies have examined retailer behaviours and characteristics to understand the determinants to these behaviours. Geospatial methods are helpful in discovering if geographic location plays a role in the relationship between determinants and outcomes. This study aimed to discover if spatial autocorrelation exists in the relationship between determinants and retailer behaviours, and to provide specific geographic locations and target behaviours for tailoring future interventions. Retailer behaviours and characteristics captured from a survey deployed to medicine retailers in the Webuye Demographic and Health Surveillance Site were analysed using geographic weighted regression to create prediction models for three separate outcomes: recommending the first-line anti-malarial therapy to adults, recommending the first-line anti-malarial therapy to children, and selling that therapy more than other anti-malarials. The estimated regression coefficients for each determinant, as well as the pseudo R(2) values for each final model, were then mapped to assess spatial variability and local areas of best model fit. The relationships explored were found to be non-stationary, indicating that spatial heterogeneity exist in the data. The association between having a pharmacy-related health training and recommending the first-line anti-malarial treatment to adults was strongest around the peri-urban centre: comparing those with training in pharmacy to those without training (OR = 5.75, p = 0.021). The association between knowing the first-line anti-malarial and recommending it to children was strongest in the north of the study area compared to those who did not know the MOH-recommended anti-malarial (OR = 2.34, p = 0.070). This is also the area with the strongest association between attending a malaria workshop and selling the MOH-recommended anti-malarial more than other anti-malarials, compared to

  16. Developing clinical practice guidelines: types of evidence and outcomes; values and economics, synthesis, grading, and presentation and deriving recommendations

    PubMed Central

    2012-01-01

    Clinical practice guidelines are one of the foundations of efforts to improve healthcare. In 1999, we authored a paper about methods to develop guidelines. Since it was published, the methods of guideline development have progressed both in terms of methods and necessary procedures and the context for guideline development has changed with the emergence of guideline clearinghouses and large scale guideline production organisations (such as the UK National Institute for Health and Clinical Excellence). It therefore seems timely to, in a series of three articles, update and extend our earlier paper. In this second paper, we discuss issues of identifying and synthesizing evidence: deciding what type of evidence and outcomes to include in guidelines; integrating values into a guideline; incorporating economic considerations; synthesis, grading, and presentation of evidence; and moving from evidence to recommendations. PMID:22762158

  17. Developing clinical practice guidelines: types of evidence and outcomes; values and economics, synthesis, grading, and presentation and deriving recommendations.

    PubMed

    Woolf, Steven; Schünemann, Holger J; Eccles, Martin P; Grimshaw, Jeremy M; Shekelle, Paul

    2012-07-04

    Clinical practice guidelines are one of the foundations of efforts to improve healthcare. In 1999, we authored a paper about methods to develop guidelines. Since it was published, the methods of guideline development have progressed both in terms of methods and necessary procedures and the context for guideline development has changed with the emergence of guideline clearinghouses and large scale guideline production organisations (such as the UK National Institute for Health and Clinical Excellence). It therefore seems timely to, in a series of three articles, update and extend our earlier paper. In this second paper, we discuss issues of identifying and synthesizing evidence: deciding what type of evidence and outcomes to include in guidelines; integrating values into a guideline; incorporating economic considerations; synthesis, grading, and presentation of evidence; and moving from evidence to recommendations.

  18. Methodological recommendations for cognition trials in bipolar disorder by the International Society for Bipolar Disorders Targeting Cognition Task Force.

    PubMed

    Miskowiak, K W; Burdick, K E; Martinez-Aran, A; Bonnin, C M; Bowie, C R; Carvalho, A F; Gallagher, P; Lafer, B; López-Jaramillo, C; Sumiyoshi, T; McIntyre, R S; Schaffer, A; Porter, R J; Torres, I J; Yatham, L N; Young, A H; Kessing, L V; Vieta, E

    2017-09-12

    To aid the development of treatment for cognitive impairment in bipolar disorder, the International Society for Bipolar Disorders (ISBD) convened a task force to create a consensus-based guidance paper for the methodology and design of cognition trials in bipolar disorder. The task force was launched in September 2016, consisting of 18 international experts from nine countries. A series of methodological issues were identified based on literature review and expert opinion. The issues were discussed and expanded upon in an initial face-to-face meeting, telephone conference call and email exchanges. Based upon these exchanges, recommendations were achieved. Key methodological challenges are: lack of consensus on how to screen for entry into cognitive treatment trials, define cognitive impairment, track efficacy, assess functional implications, and manage mood symptoms and concomitant medication. Task force recommendations are to: (i) enrich trials with objectively measured cognitively impaired patients; (ii) generally select a broad cognitive composite score as the primary outcome and a functional measure as a key secondary outcome; and (iii) include remitted or partly remitted patients. It is strongly encouraged that trials exclude patients with current substance or alcohol use disorders, neurological disease or unstable medical illness, and keep non-study medications stable. Additional methodological considerations include neuroimaging assessments, targeting of treatments to illness stage and using a multimodal approach. This ISBD task force guidance paper provides the first consensus-based recommendations for cognition trials in bipolar disorder. Adherence to these recommendations will likely improve the sensitivity in detecting treatment efficacy in future trials and increase comparability between studies. © 2017 The Authors Bipolar Disorders Published by John Wiley & Sons Ltd.

  19. Are Doses and Schedules of Small-Molecule Targeted Anticancer Drugs Recommended by Phase I Studies Realistic?

    PubMed

    Roda, Desamparados; Jimenez, Begoña; Banerji, Udai

    2016-05-01

    Tolerability of molecularly targeted agents (MTA) used in cancer therapeutics is determined in phase I trials. We reviewed the reported incidence of toxicity in phase III trials at doses and schedules recommended by phase I trials to evaluate whether these recommendations are realistic when drugs are used in larger populations of patients. We systematically reviewed a safety profile of small molecule (SM-MTA) and mAb MTA (MA-MTA) approved by the FDA in the last 12 years. There was a significantly increased percentage of grade 3 or 4 adverse events reported with SM-MTA compared with MA-MTA [40% vs. 27%; RR 1.5; 95% confidence interval (CI), 1.10-2.25, P = 0.038] in phase III studies. Importantly, a substantial proportion of patients (45%) treated with SM-MTA required dose modifications due to drug-related toxicity in phase III trials. However, this toxicity was associated to a definitive study drug discontinuation in only 9%. Overall, 25% of SM-MTA declared recommended phase II doses below MTD based on pharmacokinetic-pharmacodynamic data and these trials were associated with a significantly reduced number of dose modifications in registration trials (32% vs. 50%; RR 0.64; 95% CI, 0.43-0.88, P = 0.01). Tolerability is going to come into further focus due to the need for combinations of SM-MTA and other anticancer agents. There was a higher incidence of grade 3-4 toxicity in phase III trials in combinations versus single-agent SM-MTAs (64% vs. 37%; RR 1.73; 95% CI, 1.3-2.3, P = 0.001). These results indicate that phase I studies underestimate toxicity while recommending doses of SM-MTA. Clin Cancer Res; 22(9); 2127-32. ©2015 AACR.

  20. Current HER2 Testing Recommendations and Clinical Relevance as a Predictor of Response to Targeted Therapy.

    PubMed

    Ballinger, Tarah J; Sanders, Melinda E; Abramson, Vandana G

    2015-06-01

    Clinical decision-making in the treatment of breast cancer depends on an accurate determination and understanding of human epidermal growth factor receptor 2 (HER2) status. The guidelines for HER2 testing were recently updated in late 2013, but limitations continue to exist in the interpretation and clinical application of results when the tumor specimens do not fall neatly into positive or negative categories with immunohistochemistry and fluorescence in situ hybridization testing. The issues, including discordance between pathologists or laboratories, polysomy, and genetic heterogeneity, present challenging situations that are difficult to translate into clinical significance. The present review discussed the changes in the updated American Society of Clinical Oncology/College of American Pathologists guidelines, the clinical relevance of complex issues in HER2 testing, and the implications of the results on the response to HER2-targeted therapies. Great advances have been made in the treatment of HER2-positive breast cancer; however, the challenge remains to determine the best testing analysis that will identify patients who will benefit the most from these therapies.

  1. Baseline and Target Values for PV Forecasts: Toward Improved Solar Power Forecasting

    SciTech Connect

    Zhang, Jie; Hodge, Bri-Mathias; Lu, Siyuan; Hamann, Hendrik F.; Lehman, Brad; Simmons, Joseph; Campos, Edwin; Banunarayanan, Venkat

    2015-10-05

    Accurate solar power forecasting allows utilities to get the most out of the solar resources on their systems. To truly measure the improvements that any new solar forecasting methods can provide, it is important to first develop (or determine) baseline and target solar forecasting at different spatial and temporal scales. This paper aims to develop baseline and target values for solar forecasting metrics. These were informed by close collaboration with utility and independent system operator partners. The baseline values are established based on state-of-the-art numerical weather prediction models and persistence models. The target values are determined based on the reduction in the amount of reserves that must be held to accommodate the uncertainty of solar power output.

  2. Targeting Neuroblastoma Cell Surface Proteins: Recommendations for Homology Modeling of hNET, ALK, and TrkB

    PubMed Central

    Haddad, Yazan; Heger, Zbyněk; Adam, Vojtech

    2017-01-01

    Targeted therapy is a promising approach for treatment of neuroblastoma as evident from the large number of targeting agents employed in clinical practice today. In the absence of known crystal structures, researchers rely on homology modeling to construct template-based theoretical structures for drug design and testing. Here, we discuss three candidate cell surface proteins that are suitable for homology modeling: human norepinephrine transporter (hNET), anaplastic lymphoma kinase (ALK), and neurotrophic tyrosine kinase receptor 2 (NTRK2 or TrkB). When choosing templates, both sequence identity and structure quality are important for homology modeling and pose the first of many challenges in the modeling process. Homology modeling of hNET can be improved using template models of dopamine and serotonin transporters instead of the leucine transporter (LeuT). The extracellular domains of ALK and TrkB are yet to be exploited by homology modeling. There are several idiosyncrasies that require direct attention throughout the process of model construction, evaluation and refinement. Shifts/gaps in the alignment between the template and target, backbone outliers and side-chain rotamer outliers are among the main sources of physical errors in the structures. Low-conserved regions can be refined with loop modeling method. Residue hydrophobicity, accessibility to bound metals or glycosylation can aid in model refinement. We recommend resolving these idiosyncrasies as part of “good modeling practice” to obtain highest quality model. Decreasing physical errors in protein structures plays major role in the development of targeting agents and understanding of chemical interactions at the molecular level. PMID:28163672

  3. Targeting Neuroblastoma Cell Surface Proteins: Recommendations for Homology Modeling of hNET, ALK, and TrkB.

    PubMed

    Haddad, Yazan; Heger, Zbyněk; Adam, Vojtech

    2017-01-01

    Targeted therapy is a promising approach for treatment of neuroblastoma as evident from the large number of targeting agents employed in clinical practice today. In the absence of known crystal structures, researchers rely on homology modeling to construct template-based theoretical structures for drug design and testing. Here, we discuss three candidate cell surface proteins that are suitable for homology modeling: human norepinephrine transporter (hNET), anaplastic lymphoma kinase (ALK), and neurotrophic tyrosine kinase receptor 2 (NTRK2 or TrkB). When choosing templates, both sequence identity and structure quality are important for homology modeling and pose the first of many challenges in the modeling process. Homology modeling of hNET can be improved using template models of dopamine and serotonin transporters instead of the leucine transporter (LeuT). The extracellular domains of ALK and TrkB are yet to be exploited by homology modeling. There are several idiosyncrasies that require direct attention throughout the process of model construction, evaluation and refinement. Shifts/gaps in the alignment between the template and target, backbone outliers and side-chain rotamer outliers are among the main sources of physical errors in the structures. Low-conserved regions can be refined with loop modeling method. Residue hydrophobicity, accessibility to bound metals or glycosylation can aid in model refinement. We recommend resolving these idiosyncrasies as part of "good modeling practice" to obtain highest quality model. Decreasing physical errors in protein structures plays major role in the development of targeting agents and understanding of chemical interactions at the molecular level.

  4. The ciprofloxacin target AUC : MIC ratio is not reached in hospitalized patients with the recommended dosing regimens

    PubMed Central

    Haeseker, Michiel; Stolk, Leo; Nieman, Fred; Hoebe, Christian; Neef, Cees; Bruggeman, Cathrien; Verbon, Annelies

    2013-01-01

    AIM The aim of this study was to determine the ciprofloxacin serum concentrations in hospitalized patients and to determine which percentage reached the efficacy target of AUC : MIC > 125. Additionally, the influence of demographic anthropomorphic and clinical parameters on the pharmacokinetics and pharmacodynamics of ciprofloxacin were investigated. METHODS In serum of 80 hospitalized patients ciprofloxacin concentrations were measured with reverse phase high performance liquid chromatography with fluorescence detection. The ciprofloxacin dose was 400–1200 mg day−1 i.v. in two or three doses depending on renal function and causative bacteria. Pharmacokinetic parameters were calculated with maximum a posteriori Bayesian estimation (MW\\PHARM 3.60). A two compartment open model was used. RESULTS Mean (± SD) age was 66 (± 17) years, the mean clearance corrected for bodyweight was 0.24 l h−1 kg−1 and the mean AUC was 49 mg l−1 h. Ciprofloxacin clearance and thus AUC were associated with both age and serum creatinine. Of all patients, 21% and 75% of the patients, did not reach the proposed ciprofloxacin AUC : MIC > 125 target with MICs of 0.25 and 0.5 mg l−1, respectively. A computer simulated increase in the daily dose from 800 mg to 1200 mg, decreased these percentages to 1% and 37%, respectively. CONCLUSION A substantial proportion of the hospitalized patients did not reach the target ciprofloxacin AUC : MIC and are suboptimally dosed with recommended doses. Taking into account the increasing resistance to ciprofloxacin worldwide, a ciprofloxacin dose of 1200 mg i.v. daily in patients with normal renal function is necessary to reach the targeted AUC : MIC > 125. PMID:22616681

  5. Directional support value of Gaussian transformation for infrared small target detection.

    PubMed

    Yang, Changcai; Ma, Jiayi; Qi, Shengxiang; Tian, Jinwen; Zheng, Sheng; Tian, Xin

    2015-03-20

    Robust small target detection is one of the key techniques in IR search and tracking systems for self-defense or attacks. In this paper we present a robust solution for small target detection in a single IR image. The key ideas of the proposed method are to use the directional support value of Gaussian transform (DSVoGT) to enhance the targets, and use the multiscale representation provided by DSVoGT to reduce the false alarm rate. The original image is decomposed into sub-bands in different orientations by convolving the image with the directional support value filters, which are deduced from the weighted mapped least-squares-support vector machines (LS-SVMs). Based on the sub-band images, a support value of Gaussian matrix is constructed, and the trace of this matrix is then defined as the target measure. The corresponding multiscale correlations of the target measures are computed for enhancing target signal while suppressing the background clutter. We demonstrate the advantages of the proposed method on real IR images and compare the results against those obtained from standard detection approaches, including the top-hat filter, max-mean filter, max-median filter, min-local-Laplacian of Gaussian (LoG) filter, as well as LS-SVM. The experimental results on various cluttered background images show that the proposed method outperforms other detectors.

  6. An infrared target detection algorithm based on lateral inhibition and singular value decomposition

    NASA Astrophysics Data System (ADS)

    Li, Yun; Song, Yong; Zhao, Yufei; Zhao, Shangnan; Li, Xu; Li, Lin; Tang, Songyuan

    2017-09-01

    This paper proposes an infrared target detection algorithm based on lateral inhibition (LI) and singular value decomposition (SVD). Firstly, a local structure descriptor based on SVD of gradient domain is constructed, which reflects basic structures of the local regions of an infrared image. Then, LI network is modified by combining LI with the local structure descriptor for enhancing target and suppressing background. Meanwhile, to calculate lateral inhibition coefficients adaptively, the direction parameters are determined by the dominant orientations obtained from SVD. Experimental results show that, compared with the typical algorithms, the proposed algorithm not only can detect small target or area target under complex backgrounds, but also has excellent abilities of background suppression and target enhancement.

  7. Baseline and target values for regional and point PV power forecasts: Toward improved solar forecasting

    DOE PAGES

    Zhang, Jie; Hodge, Bri -Mathias; Lu, Siyuan; ...

    2015-11-10

    Accurate solar photovoltaic (PV) power forecasting allows utilities to reliably utilize solar resources on their systems. However, to truly measure the improvements that any new solar forecasting methods provide, it is important to develop a methodology for determining baseline and target values for the accuracy of solar forecasting at different spatial and temporal scales. This paper aims at developing a framework to derive baseline and target values for a suite of generally applicable, value-based, and custom-designed solar forecasting metrics. The work was informed by close collaboration with utility and independent system operator partners. The baseline values are established based onmore » state-of-the-art numerical weather prediction models and persistence models in combination with a radiative transfer model. The target values are determined based on the reduction in the amount of reserves that must be held to accommodate the uncertainty of PV power output. The proposed reserve-based methodology is a reasonable and practical approach that can be used to assess the economic benefits gained from improvements in accuracy of solar forecasting. Lastly, the financial baseline and targets can be translated back to forecasting accuracy metrics and requirements, which will guide research on solar forecasting improvements toward the areas that are most beneficial to power systems operations.« less

  8. Baseline and target values for regional and point PV power forecasts: Toward improved solar forecasting

    SciTech Connect

    Zhang, Jie; Hodge, Bri -Mathias; Lu, Siyuan; Hamann, Hendrik F.; Lehman, Brad; Simmons, Joseph; Campos, Edwin; Banunarayanan, Venkat; Black, Jon; Tedesco, John

    2015-11-10

    Accurate solar photovoltaic (PV) power forecasting allows utilities to reliably utilize solar resources on their systems. However, to truly measure the improvements that any new solar forecasting methods provide, it is important to develop a methodology for determining baseline and target values for the accuracy of solar forecasting at different spatial and temporal scales. This paper aims at developing a framework to derive baseline and target values for a suite of generally applicable, value-based, and custom-designed solar forecasting metrics. The work was informed by close collaboration with utility and independent system operator partners. The baseline values are established based on state-of-the-art numerical weather prediction models and persistence models in combination with a radiative transfer model. The target values are determined based on the reduction in the amount of reserves that must be held to accommodate the uncertainty of PV power output. The proposed reserve-based methodology is a reasonable and practical approach that can be used to assess the economic benefits gained from improvements in accuracy of solar forecasting. Lastly, the financial baseline and targets can be translated back to forecasting accuracy metrics and requirements, which will guide research on solar forecasting improvements toward the areas that are most beneficial to power systems operations.

  9. Baseline and Target Values for PV Forecasts: Toward Improved Solar Power Forecasting: Preprint

    SciTech Connect

    Zhang, Jie; Hodge, Bri-Mathias; Lu, Siyuan; Hamann, Hendrik F.; Lehman, Brad; Simmons, Joseph; Campos, Edwin; Banunarayanan, Venkat

    2015-08-05

    Accurate solar power forecasting allows utilities to get the most out of the solar resources on their systems. To truly measure the improvements that any new solar forecasting methods can provide, it is important to first develop (or determine) baseline and target solar forecasting at different spatial and temporal scales. This paper aims to develop baseline and target values for solar forecasting metrics. These were informed by close collaboration with utility and independent system operator partners. The baseline values are established based on state-of-the-art numerical weather prediction models and persistence models. The target values are determined based on the reduction in the amount of reserves that must be held to accommodate the uncertainty of solar power output. forecasting metrics. These were informed by close collaboration with utility and independent system operator partners. The baseline values are established based on state-of-the-art numerical weather prediction models and persistence models. The target values are determined based on the reduction in the amount of reserves that must be held to accommodate the uncertainty of solar power output.

  10. Valuing the scholarship of integration and the scholarship of application in the academy for health sciences scholars: recommended methods

    PubMed Central

    Hofmeyer, Anne; Newton, Mandi; Scott, Cathie

    2007-01-01

    In the landmark 1990 publication Scholarship Reconsidered, Boyer challenged the 'teaching verses research debates' by advocating for the scholarship of discovery, teaching, integration, and application. The scholarship of discovery considers publications and research as the yardstick in the merit, promotion and tenure system the world over. But this narrow view of scholarship does not fully support the obligations of universities to serve global societies and to improve health and health equity. Mechanisms to report the scholarship of teaching have been developed and adopted by some universities. In this article, we contribute to the less developed areas of scholarship, i.e. integration and application. We firstly situate the scholarship of discovery, teaching, integration and application within the interprofessional and knowledge exchange debates. Second, we propose a means for health science scholars to report the process and outcomes of the scholarship of integration and application with other disciplines, decision-makers and communities. We conclude with recommendations for structural and process change in faculty merit, tenure, and promotion systems so that health science scholars with varied academic portfolios are valued and many forms of academic scholarship are sustained. It is vital academic institutions remain relevant in an era when the production of knowledge is increasingly recognized as a social collaborative activity. PMID:17535436

  11. Valuing the scholarship of integration and the scholarship of application in the academy for health sciences scholars: recommended methods.

    PubMed

    Hofmeyer, Anne; Newton, Mandi; Scott, Cathie

    2007-05-29

    In the landmark 1990 publication Scholarship Reconsidered, Boyer challenged the 'teaching verses research debates' by advocating for the scholarship of discovery, teaching, integration, and application. The scholarship of discovery considers publications and research as the yardstick in the merit, promotion and tenure system the world over. But this narrow view of scholarship does not fully support the obligations of universities to serve global societies and to improve health and health equity. Mechanisms to report the scholarship of teaching have been developed and adopted by some universities. In this article, we contribute to the less developed areas of scholarship, i.e. integration and application. We firstly situate the scholarship of discovery, teaching, integration and application within the interprofessional and knowledge exchange debates. Second, we propose a means for health science scholars to report the process and outcomes of the scholarship of integration and application with other disciplines, decision-makers and communities. We conclude with recommendations for structural and process change in faculty merit, tenure, and promotion systems so that health science scholars with varied academic portfolios are valued and many forms of academic scholarship are sustained. It is vital academic institutions remain relevant in an era when the production of knowledge is increasingly recognized as a social collaborative activity.

  12. Recommendations for the design of laboratory studies on non-target arthropods for risk assessment of genetically engineered plants

    PubMed Central

    Hellmich, Richard L.; Candolfi, Marco P.; Carstens, Keri; De Schrijver, Adinda; Gatehouse, Angharad M. R.; Herman, Rod A.; Huesing, Joseph E.; McLean, Morven A.; Raybould, Alan; Shelton, Anthony M.; Waggoner, Annabel

    2010-01-01

    This paper provides recommendations on experimental design for early-tier laboratory studies used in risk assessments to evaluate potential adverse impacts of arthropod-resistant genetically engineered (GE) plants on non-target arthropods (NTAs). While we rely heavily on the currently used proteins from Bacillus thuringiensis (Bt) in this discussion, the concepts apply to other arthropod-active proteins. A risk may exist if the newly acquired trait of the GE plant has adverse effects on NTAs when they are exposed to the arthropod-active protein. Typically, the risk assessment follows a tiered approach that starts with laboratory studies under worst-case exposure conditions; such studies have a high ability to detect adverse effects on non-target species. Clear guidance on how such data are produced in laboratory studies assists the product developers and risk assessors. The studies should be reproducible and test clearly defined risk hypotheses. These properties contribute to the robustness of, and confidence in, environmental risk assessments for GE plants. Data from NTA studies, collected during the analysis phase of an environmental risk assessment, are critical to the outcome of the assessment and ultimately the decision taken by regulatory authorities on the release of a GE plant. Confidence in the results of early-tier laboratory studies is a precondition for the acceptance of data across regulatory jurisdictions and should encourage agencies to share useful information and thus avoid redundant testing. PMID:20938806

  13. Reaching recommended lipid and blood pressure targets with amlodipine/atorvastatin combination in patients with coronary heart disease.

    PubMed

    Dorval, Jean-Francois; Anderson, Todd; Buithieu, Jean; Chan, Sammy; Hutchison, Stuart; Huynh, Thao; Jobin, Jean; Lonn, Eva; Poirier, Paul; Title, Lawrence; Walling, Ann; Tran, Thang; Boudreau, Ghyslain; Charbonneau, Francois; Genest, Jacques

    2005-01-15

    The effects of combined atorvastatin and amlodipine on blood pressure (BP) and low-density lipoprotein (LDL) cholesterol levels were investigated in 134 patients with documented coronary heart disease treated for 1 year. BP at baseline was 128 +/- 15/79 +/- 9 mm Hg and was controlled by the treating physician; no calcium channel blockers were allowed. Baseline means for plasma cholesterol were 6.4 +/- 1.1 mmol/L (147 +/- 39 mg/dl), triglycerides 2.0 +/- 0.9 mmol/L (177 +/- 88 mg/dl), LDL cholesterol 4.4 +/- 1.0 mmol/L (170 +/- 39 mg/dl), and high-density lipoprotein cholesterol 1.2 +/- 0.3 mmol/L (46 +/- 12 mg/dl). Patients were all given atorvastatin 10 mg, then increased to 80 mg if the LDL cholesterol was <2.5 mmol/L (100 mg/dl). At 3 months, patients were randomized to amlodipine 10 mg or placebo. Plasma LDL cholesterol was decreased by 50%, and the LDL cholesterol target of <2.5 mmol/L was achieved in 81% of the patients. BP targets were achieved in 69% of the atorvastatin + placebo group, versus 96% in the atorvastatin + amlodipine group (p = 0.0002). With use of combination atorvastatin + amlodipine at doses ranging from 10 to 80 mg and 5 to 10 mg, respectively, recommended therapeutic goals were reached in most select subjects with coronary artery disease who were concomitantly receiving aspirin and antihypertensive therapy.

  14. Recommendations for the design of laboratory studies on non-target arthropods for risk assessment of genetically engineered plants.

    PubMed

    Romeis, Jörg; Hellmich, Richard L; Candolfi, Marco P; Carstens, Keri; De Schrijver, Adinda; Gatehouse, Angharad M R; Herman, Rod A; Huesing, Joseph E; McLean, Morven A; Raybould, Alan; Shelton, Anthony M; Waggoner, Annabel

    2011-02-01

    This paper provides recommendations on experimental design for early-tier laboratory studies used in risk assessments to evaluate potential adverse impacts of arthropod-resistant genetically engineered (GE) plants on non-target arthropods (NTAs). While we rely heavily on the currently used proteins from Bacillus thuringiensis (Bt) in this discussion, the concepts apply to other arthropod-active proteins. A risk may exist if the newly acquired trait of the GE plant has adverse effects on NTAs when they are exposed to the arthropod-active protein. Typically, the risk assessment follows a tiered approach that starts with laboratory studies under worst-case exposure conditions; such studies have a high ability to detect adverse effects on non-target species. Clear guidance on how such data are produced in laboratory studies assists the product developers and risk assessors. The studies should be reproducible and test clearly defined risk hypotheses. These properties contribute to the robustness of, and confidence in, environmental risk assessments for GE plants. Data from NTA studies, collected during the analysis phase of an environmental risk assessment, are critical to the outcome of the assessment and ultimately the decision taken by regulatory authorities on the release of a GE plant. Confidence in the results of early-tier laboratory studies is a precondition for the acceptance of data across regulatory jurisdictions and should encourage agencies to share useful information and thus avoid redundant testing.

  15. Targeted Human Factors and Ergonomics Recommendations for Materiel and Concept Developers from the 2013 US Army Capabilities Integration Center Dismounted Non-network-Enabled Limited Objective Experiment (ARCIC DNNE LOE)

    DTIC Science & Technology

    2014-11-01

    Targeted Human Factors and Ergonomics Recommendations for Materiel and Concept Developers from the 2013 US Army Capabilities Integration...Laboratory Aberdeen Proving Ground, MD 21005-5425 ARL-TN-0645 November 2014 Targeted Human Factors and Ergonomics Recommendations for...To) 1 January–31 December 2013 4. TITLE AND SUBTITLE Targeted Human Factors and Ergonomics Recommendations for Materiel and Concept Developers from

  16. Infrared dim-small target tracking via singular value decomposition and improved Kernelized correlation filter

    NASA Astrophysics Data System (ADS)

    Qian, Kun; Zhou, Huixin; Rong, Shenghui; Wang, Bingjian; Cheng, Kuanhong

    2017-05-01

    Infrared small target tracking plays an important role in applications including military reconnaissance, early warning and terminal guidance. In this paper, an effective algorithm based on the Singular Value Decomposition (SVD) and the improved Kernelized Correlation Filter (KCF) is presented for infrared small target tracking. Firstly, the super performance of the SVD-based algorithm is that it takes advantage of the target's global information and obtains a background estimation of an infrared image. A dim target is enhanced by subtracting the corresponding estimated background with update from the original image. Secondly, the KCF algorithm is combined with Gaussian Curvature Filter (GCF) to eliminate the excursion problem. The GCF technology is adopted to preserve the edge and eliminate the noise of the base sample in the KCF algorithm, helping to calculate the classifier parameter for a small target. At last, the target position is estimated with a response map, which is obtained via the kernelized classifier. Experimental results demonstrate that the presented algorithm performs favorably in terms of efficiency and accuracy, compared with several state-of-the-art algorithms.

  17. Achievement of recommended glucose and blood pressure targets in patients with type 2 diabetes and hypertension in clinical practice – study rationale and protocol of DIALOGUE

    PubMed Central

    2012-01-01

    Background Patients with type 2 diabetes have 2–4 times greater risk for cardiovascular morbidity and mortality than those without, and this is even further aggravated if they also suffer from hypertension. Unfortunately, less than one third of hypertensive diabetic patients meet blood pressure targets, and more than half fail to achieve target HbA1c values. Thus, appropriate blood pressure and glucose control are of utmost importance. Since treatment sometimes fails in clinical practice while clinical trials generally suggest good efficacy, data from daily clinical practice, especially with regard to the use of newly developed anti-diabetic and anti-hypertensive compounds in unselected patient populations, are essential. The DIALOGUE registry aims to close this important gap by evaluating different treatment approaches in hypertensive type 2 diabetic patients with respect to their effectiveness and tolerability and their impact on outcomes. In addition, DIALOGUE is the first registry to determine treatment success based on the new individualized treatment targets recommended by the ADA and the EASD. Methods DIALOGUE is a prospective observational German multicentre registry and will enrol 10,000 patients with both diabetes and hypertension in up to 700 sites. After a baseline visit, further documentations are scheduled at 6, 12 and 24 months. There are two co-primary objectives referring to the most recent guidelines for the treatment of diabetes and hypertension: 1) individual HbA1c goal achievement with respect to anti-diabetic pharmacotherapy and 2) individual blood pressure goal achievement with different antihypertensive treatments. Among the secondary objectives the rate of major cardio-vascular and cerebro-vascular events (MACCE) and the rate of hospitalizations are the most important. Conclusion The registry will be able to gain insights into the reasons for the obvious gap between the demonstrated efficacy and safety of anti-diabetic and anti

  18. Value-focused framework for defining landscape-scale conservation targets

    USGS Publications Warehouse

    Romanach, Stephanie; Benscoter, Allison M.; Brandt, Laura A.

    2016-01-01

    Conservation of natural resources can be challenging in a rapidly changing world and require collaborative efforts for success. Conservation planning is the process of deciding how to protect, conserve, and enhance or minimize loss of natural and cultural resources. Establishing conservation targets (also called indicators or endpoints), the measurable expressions of desired resource conditions, can help with site-specific up to landscape-scale conservation planning. Using conservation targets and tracking them through time can deliver benefits such as insight into ecosystem health and providing early warnings about undesirable trends. We describe an approach using value-focused thinking to develop statewide conservation targets for Florida. Using such an approach allowed us to first identify stakeholder objectives and then define conservation targets to meet those objectives. Stakeholders were able to see how their shared efforts fit into the broader conservation context, and also anticipate the benefits of multi-agency and -organization collaboration. We developed an iterative process for large-scale conservation planning that included defining a shared framework for the process, defining the conservation targets themselves, as well as developing management and monitoring strategies for evaluation of their effectiveness. The process we describe is applicable to other geographies where multiple parties are seeking to implement collaborative, large-scale biological planning.

  19. Value of Time Saved for Use in Corps Planning Studies: A Review of the Literature and Recommendations

    DTIC Science & Technology

    1991-10-01

    The value of time saved is an important component in water resources planning studies. It is used to evaluating benefits of projects that reduce the...construction of a project may incur, via increasing travel time through traffic delays. Public use of the value of time in transportation studies dates...attempting to estimate the value of time intensified with the growing use of both the automobile and with economic analysis as a tool in the project

  20. Theranostic Value of Multimers: Lessons Learned from Trimerization of Neurotensin Receptor Ligands and Other Targeting Vectors

    PubMed Central

    Maschauer, Simone; Einsiedel, Jürgen; Reich, Dominik; Hübner, Harald; Gmeiner, Peter; Wester, Hans-Jürgen; Prante, Olaf; Notni, Johannes

    2017-01-01

    Neurotensin receptor 1 (NTS1) is overexpressed on a variety of cancer entities; for example, prostate cancer, ductal pancreatic adenocarcinoma, and breast cancer. Therefore, it represents an interesting target for the diagnosis of these cancers types by positron emission tomography (PET). The metabolically-stabilized neurotensin (NT) derivative peptide Nlys8-Lys9-Pro10-Tyr11-Tle12-Leu13-OH was elongated at the N-terminus with 6-azido norleucine and coupled with the 1,4,7-triazacyclononane-1,4,7-tris[(2-carboxyethyl)methylenephosphinic acid] (TRAP) chelator TRAP(alkyne)3 in order to synthesize a NT trimer with subnanomolar affinity and high stability. The 68Ga-labeled peptide [68Ga]Ga-TRAP(NT4)3 was characterized in vitro using the NTS1-expressing human colorectal adenocarcinoma cell line HT29. It displayed fast and high internalization rates of >90%, but also fast efflux rates of 50% over 15 min. In vivo, [68Ga]Ga-TRAP(NT4)3 showed moderate HT29 tumor uptake values of 1.7 %ID/g at 60 min post-injection (p.i.), but also high uptake and retention in the kidneys and liver. A comparison of data for trimer/monomer pairs of NT ligands and other targeting vectors (peptides and peptoids targeting integrins αvβ3, α5β1, and αvβ6, the PSMA-ligand DUPA (2-[3-(1,3-dicarboxypropyl)-ureido]pentanedioic acid), and nitroimidazoles targeting hypoxia) revealed that multimers always exhibit higher target affinities and tumor uptake, but not necessarily improved tumor-to-tissue ratios. Thus, although in vitro data are not suitable for prediction of in vivo performance, multimers are potentially superior to monomers, particularly for applications where high tumor accumulation is crucial. PMID:28287433

  1. Interventional value of total flavonoids from Rhizoma Drynariae on Cathepsin K, a potential target of osteoporosis.

    PubMed

    Shi, Xiao-Lin; Liu, Kang; Wu, Lian-Guo

    2011-07-01

    Osteoporosis, the sixth most common disease in the world, is bringing increasingly serious harm to people's health. Cathepsin K, which plays an important role in bone resorption, is a potential target in the treatment of osteoporosis. Total flavonoids, the active ingredients in Rhizoma Drynariae, have shown obvious, therapeutic effect on osteoporosis. In previous studies, it was presumed that the mechanism for the therapeutic effect was through inhibiting the expression of Cathepsin K. However, there are still no detailed reports on some key issues such as the specific inhibitory results of total flavonoids on Cathepsin K and the pathway of inhibition and so on. Based on previous studies on total flavonoids from Rhizoma Drynariae, the pathway for the effect of, total flavonoids inhibiting Cathepsin K and their interventional value on Cathepsin K were analyzed in this paper, so as to explore the interventional feasibility and value of total flavonoids in Rhizoma Drynariae on Cathepsin K.

  2. Stabilization of prescribed values and periodic orbits with regular and pulse target oriented control

    NASA Astrophysics Data System (ADS)

    Braverman, E.; Chan, B.

    2014-03-01

    Investigating a method of chaos control for one-dimensional maps, where the intervention is proportional to the difference between a fixed value and a current state, we demonstrate that stabilization is possible in one of the two following cases: (1) for small values, the map is increasing and the slope of the line connecting the points on the line with the origin is decreasing; (2) the chaotic map is locally Lipschitz. Moreover, in the latter case we prove that any point of the map can be stabilized. In addition, we study pulse stabilization when the intervention occurs each m-th step and illustrate that stabilization is possible for the first type of maps. In the context of population dynamics, we notice that control with a positive target, even if stabilization is not achieved, leads to persistent solutions and prevents extinction in models which experience the Allee effect.

  3. Stabilization of prescribed values and periodic orbits with regular and pulse target oriented control

    SciTech Connect

    Braverman, E. Chan, B.

    2014-03-15

    Investigating a method of chaos control for one-dimensional maps, where the intervention is proportional to the difference between a fixed value and a current state, we demonstrate that stabilization is possible in one of the two following cases: (1) for small values, the map is increasing and the slope of the line connecting the points on the line with the origin is decreasing; (2) the chaotic map is locally Lipschitz. Moreover, in the latter case we prove that any point of the map can be stabilized. In addition, we study pulse stabilization when the intervention occurs each m-th step and illustrate that stabilization is possible for the first type of maps. In the context of population dynamics, we notice that control with a positive target, even if stabilization is not achieved, leads to persistent solutions and prevents extinction in models which experience the Allee effect.

  4. Stabilization of prescribed values and periodic orbits with regular and pulse target oriented control.

    PubMed

    Braverman, E; Chan, B

    2014-03-01

    Investigating a method of chaos control for one-dimensional maps, where the intervention is proportional to the difference between a fixed value and a current state, we demonstrate that stabilization is possible in one of the two following cases: (1) for small values, the map is increasing and the slope of the line connecting the points on the line with the origin is decreasing; (2) the chaotic map is locally Lipschitz. Moreover, in the latter case we prove that any point of the map can be stabilized. In addition, we study pulse stabilization when the intervention occurs each m-th step and illustrate that stabilization is possible for the first type of maps. In the context of population dynamics, we notice that control with a positive target, even if stabilization is not achieved, leads to persistent solutions and prevents extinction in models which experience the Allee effect.

  5. Defining competencies for education in health care value: recommendations from the University of California, San Francisco Center for Healthcare Value Training Initiative.

    PubMed

    Moriates, Christopher; Dohan, Daniel; Spetz, Joanne; Sawaya, George F

    2015-04-01

    Leaders in medical education have increasingly called for the incorporation of cost awareness and health care value into health professions curricula. Emerging efforts have thus far focused on physicians, but foundational competencies need to be defined related to health care value that span all health professions and stages of training. The University of California, San Francisco (UCSF) Center for Healthcare Value launched an initiative in 2012 that engaged a group of educators from all four health professions schools at UCSF: Dentistry, Medicine, Nursing, and Pharmacy. This group created and agreed on a multidisciplinary set of comprehensive competencies related to health care value. The term "competency" was used to describe components within the larger domain of providing high-value care. The group then classified the competencies as beginner, proficient, or expert level through an iterative process and group consensus. The group articulated 21 competencies. The beginner competencies include basic principles of health policy, health care delivery, health costs, and insurance. Proficient competencies include real-world applications of concepts to clinical situations, primarily related to the care of individual patients. The expert competencies focus primarily on systems-level design, advocacy, mentorship, and policy. These competencies aim to identify a standard that may help inform the development of curricula across health professions training. These competencies could be translated into the learning objectives and evaluation methods of resources to teach health care value, and they should be considered in educational settings for health care professionals at all levels of training and across a variety of specialties.

  6. Action to Support Practices Implement Research Evidence (ASPIRE): protocol for a cluster-randomised evaluation of adaptable implementation packages targeting 'high impact' clinical practice recommendations in general practice.

    PubMed

    Willis, Thomas A; Hartley, Suzanne; Glidewell, Liz; Farrin, Amanda J; Lawton, Rebecca; McEachan, Rosemary R C; Ingleson, Emma; Heudtlass, Peter; Collinson, Michelle; Clamp, Susan; Hunter, Cheryl; Ward, Vicky; Hulme, Claire; Meads, David; Bregantini, Daniele; Carder, Paul; Foy, Robbie

    2016-02-29

    There are recognised gaps between evidence and practice in general practice, a setting which provides particular challenges for implementation. We earlier screened clinical guideline recommendations to derive a set of 'high impact' indicators based upon criteria including potential for significant patient benefit, scope for improved practice and amenability to measurement using routinely collected data. We aim to evaluate the effectiveness and cost-effectiveness of a multifaceted, adaptable intervention package to implement four targeted, high impact recommendations in general practice. The research programme Action to Support Practice Implement Research Evidence (ASPIRE) includes a pair of pragmatic cluster-randomised trials which use a balanced incomplete block design. Clusters are general practices in West Yorkshire, United Kingdom (UK), recruited using an 'opt-out' recruitment process. The intervention package adapted to each recommendation includes combinations of audit and feedback, educational outreach visits and computerised prompts with embedded behaviour change techniques selected on the basis of identified needs and barriers to change. In trial 1, practices are randomised to adapted interventions targeting either diabetes control or risky prescribing and those in trial 2 to adapted interventions targeting either blood pressure control in patients at risk of cardiovascular events or anticoagulation in atrial fibrillation. The respective primary endpoints comprise achievement of all recommended target levels of haemoglobin A1c (HbA1c), blood pressure and cholesterol in patients with type 2 diabetes, a composite indicator of risky prescribing, achievement of recommended blood pressure targets for specific patient groups and anticoagulation prescribing in patients with atrial fibrillation. We are also randomising practices to a fifth, non-intervention control group to further assess Hawthorne effects. Outcomes will be assessed using routinely collected data

  7. A user-targeted synthesis of the VALUE perfect predictor experiment

    NASA Astrophysics Data System (ADS)

    Maraun, Douglas; Widmann, Martin; Gutierrez, Jose; Kotlarski, Sven; Hertig, Elke; Wibig, Joanna; Rössler, Ole; Huth, Radan

    2016-04-01

    VALUE is an open European network to validate and compare downscaling methods for climate change research. A key deliverable of VALUE is the development of a systematic validation framework to enable the assessment and comparison of both dynamical and statistical downscaling methods. VALUE's main approach to validation is user-focused: starting from a specific user problem, a validation tree guides the selection of relevant validation indices and performance measures. We consider different aspects: (1) marginal aspects such as mean, variance and extremes; (2) temporal aspects such as spell length characteristics; (3) spatial aspects such as the de-correlation length of precipitation extremes; and multi-variate aspects such as the interplay of temperature and precipitation or scale-interactions. Several experiments have been designed to isolate specific points in the downscaling procedure where problems may occur. Experiment 1 (perfect predictors): what is the isolated downscaling skill? How do statistical and dynamical methods compare? How do methods perform at different spatial scales? Experiment 2 (Global climate model predictors): how is the overall representation of regional climate, including errors inherited from global climate models? Experiment 3 (pseudo reality): do methods fail in representing regional climate change? Here, we present a user-targeted synthesis of the results of the first VALUE experiment. In this experiment, downscaling methods are driven with ERA-Interim reanalysis data to eliminate global climate model errors, over the period 1979-2008. As reference data we use, depending on the question addressed, (1) observations from 86 meteorological stations distributed across Europe; (2) gridded observations at the corresponding 86 locations or (3) gridded spatially extended observations for selected European regions. With more than 40 contributing methods, this study is the most comprehensive downscaling inter-comparison project so far. The

  8. The Value of Energy Performance and Green Attributes in Buildings: A Review of Existing Literature and Recommendations for Future Research

    SciTech Connect

    Stuart, Elizabeth

    2011-09-07

    Labels, certifications, and rating systems for energy efficiency performance and “green” attributes of buildings have been available in the U.S. for over 10 years, and used extensively in the European Union and Australia for longer. Such certifications and ratings can make energy efficiency more visible, and could help spur demand for energy efficiency if these designations are shown to have a positive impact on sales or rental prices. This policy brief discusses the findings and methodologies from recent studies on this topic, and suggests recommendations for future research. Although there have been just a handful of studies within the last 10 years that have investigated these effects, a few key findings emerge: To maximize sales price impact, label or rating information must be disclosed early and visibly in the sales process; The approach to evaluating energy efficiency labels (e.g., ENERGY STAR) and general “green” certifications (e.g., LEED or GreenPoint Rated) may need to be different, depending on the type, vintage and market penetration of the label; Collaborative efforts to promote label adoption and build a large dataset of labeled buildings will be required to produce reliable study results.

  9. The stroke offspring study: is parental stroke history of value in targeted risk factor screening?

    PubMed

    Hart, Nigel D; Cupples, Margaret E; Wiggam, M Ivan; Patterson, Christopher C; Yarnell, John W G

    2011-01-01

    This study aimed to compare the prevalence of stroke risk factors among people with a parental history of stroke to those in a control group of individuals, of similar age, gender and social class, with no parental stroke history. Parental stroke increases an individual's risk of stroke, but little is known of the potential value of using this information in targeted screening for primary prevention in general practice. We sent questionnaires to 300 randomly selected individuals aged 40-65 years, in each of 11 different general practices in Northern Ireland. Among 1061 responses received within six weeks, 332 reported a parental history of stroke (31.3%). We matched respondents with (cases) and without (controls) a parental history of stroke on characteristics of age, gender and socioeconomic status. Matched pairs were invited to attend a consultation at which their diet and exercise habits were assessed using validated questionnaires and height, weight, blood pressure and serum lipids and glucose were measured. Matched data were available for 199 case-control pairs (398 individuals). Mean systolic and diastolic blood pressures were significantly higher in cases than in paired controls (systolic 146.3 versus 140.6 mmHg (P < 0.01); diastolic 87.7 versus 85.0 mmHg (P = 0.014)). Cases consumed more alcohol than their paired controls (13.8 versus 10.1 U/week (P < 0.01)), but their measures of body mass index, lipids, diabetes, diet and exercise did not differ significantly. The results of this study suggest that screening offspring of patients with stroke in respect of blood pressure has potential value in identifying people likely to benefit from primary prevention, but do not support the adoption of a targeted screening strategy for other commonly cited stroke risk factors.

  10. Multicomponent targeted intervention to prevent delirium in hospitalized older patients: what is the economic value?

    PubMed

    Rizzo, J A; Bogardus, S T; Leo-Summers, L; Williams, C S; Acampora, D; Inouye, S K

    2001-07-01

    Delirium, or acute confusional state, is a common and serious occurrence among hospitalized older persons. Current estimates suggest that delirium complicates hospital stays for more than 2.3 million older persons each year, involving more than 17.5 million hospital days and accounting for more than $4 billion (1994 dollars) of Medicare expenditures. A 40% reduction was recently reported in the risk for delirium among hospitalized older persons receiving a multicomponent targeted risk factor intervention (MTI) strategy to prevent delirium, compared with subjects receiving usual hospital care.1 Before recommending that this preventive strategy be implemented in clinical practice, however, the cost implications must be thoroughly examined as well. The present analysis performs net cost evaluations of the MTI for the prevention of delirium among hospitalized patients. Hospital charge and cost-to-charge ratio data are linked to a database of 852 subjects, who were treated with MTI or usual care. Multivariable regression methods were used to help isolate the impact of MTI on hospital costs. These results were then combined with our earlier work on the impact of the MTI on delirium prevention to assess the cost effectiveness of this intervention. The MTI significantly reduced nonintervention costs among subjects at intermediate risk for developing delirium, but not among subjects at high risk. When MTI intervention costs were included, MTI had no significant effect on overall health care costs in the intermediate risk cohort, but raised overall costs in the high risk group. Because the MTI prevented delirium in the intermediate risk group without raising costs, the conclusion reached is that it is a cost effective treatment option for patients at intermediate risk for developing delirium. In contrast, the results suggest that the MTI is not cost effective for subjects at high risk.

  11. Targeting triglycerides as prognostic indicators and determining lowest values for patient benefit.

    PubMed

    Sprecher, D L

    2001-09-01

    A number of reports demonstrate the importance of serum triglyceride values in predicting the clinical onset of vascular disease. However, adjustment for measurements highly correlated with triglyceride (TG) levels, such as history of diabetes, body mass index, and high-density lipoprotein cholesterol (HDL-C), lessen if not remove the TG contribution to outcomes. More recently, improved analytic approaches have more persuasively implicated triglycerides as independently relevant to the onset of cardiovascular disease. Elevated TG values are the consequence of larger TG-rich particles, including very low density lipoprotein and atherogenic intermediate particles, which are in turn associated with dense low-density lipoprotein. It has been observed that a reduction in TG concentrations often proceeds in parallel with improved clinical outcomes; however, direct correlation between the two has been elusive. This has been demonstrated in multiple pharmacologic trials. However, an improvement in these relationships has been observed when TG-correlated measurements of intermediate particles, low-density lipoprotein density, and HDL-C have been made. National guidelines for cholesterol treatment have now incorporated a TG greater than 200 mg/dL as a secondary treatment trigger, which targets apolipoprotein B-related particles, represented by non-HDL-C (total cholesterol minus HDL-C), as the suggested goal of therapy.

  12. The value of ProMED-mail for the Early Warning Committee in the Netherlands: more specific approach recommended.

    PubMed

    Zeldenrust, M E; Rahamat-Langendoen, J C; Postma, M J; van Vliet, J A

    2008-02-07

    This article describes a retrospective and descriptive study into the added value of ProMED-mail--the global electronic reporting system for outbreaks of emerging infectious diseases and toxins maintained by the International Society for Infectious Diseases--as an early warning system for The Netherlands Early Warning Committee (NEWC). Information about infectious disease events in foreign countries originating from ProMED-mail was retrieved from the reports of the NEWC between May 2006 and June 2007. Each event was analysed in depth in order to determine if it could have been a possible threat to public health in The Netherlands. It was determined whether these events were mentioned in other sources of information used by the NEWC besides ProMED-mail. In addition, we assessed the possible consequences of missing an event when not reading ProMED-mail or of being informed of the event with a time delay. Semi-structured interviews with stakeholders were conducted to explore other functions of ProMED-mail besides early warning. Five out of 25 events reported in ProMED-mail were assessed as a potential threat to The Netherlands, mainly because of the known vulnerability of The Netherlands for vaccine preventable diseases: an outbreak of measles in the United Kingdom and Japan, a case of poliomyelitis in Kenya, and two events concerning Highly Pathogenic Avian Influenza (HPAI) H5N1. The outbreak of measles in Japan and one case of HPAI H5N1 infection in a bird in Germany were only reported by ProMED-mail; the other potential threats were mentioned in other sources with a time delay. ProMED-mail has a limited but real added value over other sources in the early warning of threats. A more specific approach of using ProMED-mail by defining vulnerabilities of a country would be useful and efficient. ProMED-mail is appreciated for providing background and preliminary outbreak information.

  13. Interval MULTIMOORA method with target values of attributes based on interval distance and preference degree: biomaterials selection

    NASA Astrophysics Data System (ADS)

    Hafezalkotob, Arian; Hafezalkotob, Ashkan

    2016-12-01

    A target-based MADM method covers beneficial and non-beneficial attributes besides target values for some attributes. Such techniques are considered as the comprehensive forms of MADM approaches. Target-based MADM methods can also be used in traditional decision-making problems in which beneficial and non-beneficial attributes only exist. In many practical selection problems, some attributes have given target values. The values of decision matrix and target-based attributes can be provided as intervals in some of such problems. Some target-based decision-making methods have recently been developed; however, a research gap exists in the area of MADM techniques with target-based attributes under uncertainty of information. We extend the MULTIMOORA method for solving practical material selection problems in which material properties and their target values are given as interval numbers. We employ various concepts of interval computations to reduce degeneration of uncertain data. In this regard, we use interval arithmetic and introduce innovative formula for interval distance of interval numbers to create interval target-based normalization technique. Furthermore, we use a pairwise preference matrix based on the concept of degree of preference of interval numbers to calculate the maximum, minimum, and ranking of these numbers. Two decision-making problems regarding biomaterials selection of hip and knee prostheses are discussed. Preference degree-based ranking lists for subordinate parts of the extended MULTIMOORA method are generated by calculating the relative degrees of preference for the arranged assessment values of the biomaterials. The resultant rankings for the problem are compared with the outcomes of other target-based models in the literature.

  14. Specimen materials, target values and commutability for external quality assessment (proficiency testing) schemes.

    PubMed

    Miller, W Greg

    2003-01-01

    The objective of external quality assessment is to evaluate clinical acceptability of laboratory results. It is desirable to evaluate intermethod harmonization and traceability to a reference system. Conventional matrix-modified processed materials are used in most programs, because they can be produced in large quantities, can have multiple abnormal analytes in the same vial and have excellent stability. The principal limitation of these materials is non-commutability which makes them unsuitable for traceability or harmonization evaluation. Peer group evaluation is used which allows an individual laboratory to confirm appropriate use of a measurement technology and a manufacturer to monitor uniformity in their calibration transfer process. Authentic clinical specimen pools provide commutability but are limited by the quantity available and number of analytes at pathologic levels in the same vial. Hybrid approaches have used authentic clinical specimen pools in conjunction with non-commutable processed materials to determine method-specific matrix-corrected target values which have enabled evaluation of traceability to reference methods. Conventional processed materials are limited by non-commutability. Pooled clinical specimens are limited by availability. When used together, external quality assessment can evaluate traceability to reference systems and harmonization between test procedures.

  15. Guidance for a personal target value of F(E)NO in allergic asthma: case report and theoretical example.

    PubMed

    Högman, Marieann; Meriläinen, Pekka

    2013-03-01

    In clinically stable asthma the exhaled NO values (F(E)NO) are generally higher than in control subjects. Therefore, reference values are of limited importance in clinical practice. This is demonstrated in this case report, but it is also shown that NO parameters from non-linear modelling do have a clinical value. A subject with asthma was treated with inhaled corticosteroids for 1 week. The non-linear NO model was used to measure the response to treatment. The NO parameters from subjects with atopic rhinitis and asthma were fed into a computer program to generate theoretical F(E)NO₀.₀₅ values, i.e. target values. There was a dramatic decrease in F(E)NO₀.₀₅ due to treatment, from 82 to 34 ppb, but it remained higher than in healthy controls. This is due to the elevated diffusion rate of NO, unchanged by treatment. When the NO parameters are known, a personal best value of F(E)NO₀.₀₅ (fractional concentration of exhaled NO in the gas phase, 0.05 L/s) can be calculated, which can be the target value when only F(E)NO₀.₀₅ can be monitored. In conclusion, reference values for NO parameters are shown to be clinically useful. It is essential that every patient receives his/her target value of F(E)NO₀.₀₅, when only a single NO measurement is available. In our opinion, this is the reason why there are few successful studies of trying to target the NO value with inhaled corticosteroids.

  16. Recommendations for high-risk clinical target volume definition with computed tomography for three-dimensional image-guided brachytherapy in cervical cancer patients.

    PubMed

    Ohno, Tatsuya; Wakatsuki, Masaru; Toita, Takafumi; Kaneyasu, Yuko; Yoshida, Ken; Kato, Shingo; Li, Noriko; Tokumaru, Sunao; Ikushima, Hitoshi; Uno, Takashi; Noda, Shin-Ei; Kazumoto, Tomoko; Harima, Yoko

    2016-11-10

    Our purpose was to develop recommendations for contouring the computed tomography (CT)-based high-risk clinical target volume (CTVHR) for 3D image-guided brachytherapy (3D-IGBT) for cervical cancer. A 15-member Japanese Radiation Oncology Study Group (JROSG) committee with expertise in gynecological radiation oncology initiated guideline development for CT-based CTVHR (based on a comprehensive literature review as well as clinical experience) in July 2014. Extensive discussions occurred during four face-to-face meetings and frequent email communication until a consensus was reached. The CT-based CTVHR boundaries were defined by each anatomical plane (cranial-caudal, lateral, or anterior-posterior) with or without tumor progression beyond the uterine cervix at diagnosis. Since the availability of magnetic resonance imaging (MRI) with applicator insertion for 3D planning is currently limited, T2-weighted MRI obtained at diagnosis and just before brachytherapy without applicator insertion was used as a reference for accurately estimating the tumor size and topography. Furthermore, utilizing information from clinical examinations performed both at diagnosis and brachytherapy is strongly recommended. In conclusion, these recommendations will serve as a brachytherapy protocol to be used at institutions with limited availability of MRI for 3D treatment planning.

  17. Memo to the FDA and ICH: appeal for in vivo drug target identification and target pharmacokinetics Recommendations for improved procedures and requirements.

    PubMed

    Stumpf, Walter E

    2007-08-01

    This memorandum is addressed to members of regulatory agencies, as well as managers of pharmaceutical companies. Pharmacokineticists and toxicologists may consider this proposal, weigh its merits, and provide input for implementation. Experience from academic research and ADME experiments during drug development has prompted this appeal for improved drug target recognition. Similar demands have been made repeatedly in the literature. Such efforts are not new, but a renewed urgency has come from comparing results obtained with methods of different resolution and sensitivity, namely high-resolution receptor microscopic autoradiography compared and viewed in parallel to conventional low-resolution 'cut-and-count' radioassays and whole body autoradiography. Conflicting results reveal astounding deficiencies of current ADME approaches. False negatives and false positives of favored 'expedient' procedures allow drugs to reach the market with misleading and inaccurate information about the total drug effect.

  18. Sex, Prescribing Practices and Guideline Recommended, Blood Pressure, and LDL Cholesterol Targets at Baseline in the BARI 2D Trial

    PubMed Central

    Magee, Michelle F.; Tamis-Holland, Jacqueline E.; Lu, Jiang; Bittner, Vera A.; Brooks, Maria Mori; Lopes, Neuza; Jacobs, Alice K.; Study Group, BARI 2D

    2015-01-01

    Background. Research has shown less aggressive treatment and poorer control of cardiovascular disease (CVD) risk factors in women than men. Methods. We analyzed sex differences in pharmacotherapy strategies and attainment of goals for hemoglobin A1c (HbA1c), blood pressure (BP), and low density lipoprotein cholesterol (LDL-C) in patients with type 2 diabetes and established coronary artery disease enrolled into the BARI 2D trial. Results. Similar numbers of drugs were prescribed in both women and men. Women were less frequent on metformin or sulfonylurea and more likely to take insulin and to be on higher doses of hydroxymethylglutaryl-CoA reductase inhibitors (statins) than men. After adjusting for baseline differences and treatment prescribed, women were less likely to achieve goals for HbA1c (OR = 0.71, 95% CI 0.57, 0.88) and LDL-C (OR = 0.64, 95% CI 0.53, 0.78). More antihypertensives were prescribed to women, and yet BP ≤ 130/80 mmHg did not differ by sex. Conclusions. Women entering the BARI 2D trial were as aggressively treated with drugs as men. Despite equivalent treatment, women less frequently met targets for HbA1c and LDL-C. Our findings suggest that there may be sex differences in response to drug therapies used to treat diabetes, hypertension, and hyperlipidemia. PMID:25873955

  19. Target Selection Recommendations Based on Impact of Deep Brain Stimulation Surgeries on Nonmotor Symptoms of Parkinson's Disease

    PubMed Central

    Wang, Xiao-Hong; Zhang, Lin; Sperry, Laura; Olichney, John; Farias, Sarah Tomaszewski; Shahlaie, Kiarash; Chang, Norika Malhado; Liu, Ying; Wang, Su-Ping; Wang, Cui

    2015-01-01

    Objective: This review examines the evidence that deep brain stimulation (DBS) has extensive impact on nonmotor symptoms (NMSs) of patients with Parkinson's disease (PD). Data Sources: We retrieved information from the PubMed database up to September, 2015, using various search terms and their combinations including PD, NMSs, DBS, globus pallidus internus (GPi), subthalamic nucleus (STN), and ventral intermediate thalamic nucleus. Study Selection: We included data from peer-reviewed journals on impacts of DBS on neuropsychological profiles, sensory function, autonomic symptoms, weight changes, and sleep disturbances. For psychological symptoms and cognitive impairment, we tried to use more reliable proofs: Random, control, multicenter, large sample sizes, and long period follow-up clinical studies. We categorized the NMSs into four groups: those that would improve definitively following DBS; those that are not significantly affected by DBS; those that remain controversial on their surgical benefit; and those that can be worsened by DBS. Results: In general, it seems to be an overall beneficial effect of DBS on NMSs, such as sensory, sleep, gastrointestinal, sweating, cardiovascular, odor, urological symptoms, and sexual dysfunction, GPi-DBS may produce similar results; Both STN and Gpi-DBS are safe with regard to cognition and psychology over long-term follow-up, though verbal fluency decline is related to DBS; The impact of DBS on behavioral addictions and dysphagia is still uncertain. Conclusions: As the motor effects of STN-DBS and GPi-DBS are similar, NMSs may determine the target choice in surgery of future patients. PMID:26668154

  20. Impact of Age and Target-Organ Damage on Prognostic Value of 24-Hour Ambulatory Blood Pressure.

    PubMed

    Olesen, Thomas B; Stidsen, Jacob V; Blicher, Marie K; Pareek, Manan; Rasmussen, Susanne; Vishram-Nielsen, Julie K K; Olsen, Michael H

    2017-09-11

    Markers of target-organ damage and 24-hour ambulatory blood pressure (BP) measurement improve cardiovascular risk stratification. The prevalence of target-organ damage and raised BP increases with aging. The study aim was to evaluate the impact of age and target-organ damage on the prognostic value of ambulatory BP. Markers of target-organ damage and ambulatory BP were measured in 1408 healthy people aged 41 or 51 (middle-aged group), and 61 or 71 (older group) years. The primary outcome was cardiovascular events after 16 years of follow-up, with data obtained from national registries. The prognostic value of BP was evaluated with Cox regression models, adjusted for traditional risk factors and target-organ damage, including left ventricular mass, pulse wave velocity, carotid plaques, and urine albumin/creatinine ratio. A total of 323 events were observed. In comparison with traditional risk factors, adding systolic BP and presence of target-organ damage improved risk stratification by increasing concordance index from 0.711 to 0.728 (P=0.01). In middle-aged subjects with target-organ damage, increment in pulse pressure (hazard ratio, 1.70; 95% confidence interval, 1.31-2.21; P<0.01) and increment in average real variability (hazard ratio, 1.29; 95% confidence interval, 1.05-1.59; P=0.02) were associated with a greater risk of cardiovascular disease compared with subjects without target-organ damage: hazard ratio, 1.04 (95% confidence interval, 0.74-1.46; P=0.81); P for interaction, 0.02; and hazard ratio, 0.89 (95% confidence interval, 0.69-1.14; P=0.36); P for interaction, 0.01. Target-organ damage may be a marker of individual susceptibility to the harmful effects of pulse pressure and BP variability on the cardiovascular system in middle-aged individuals. © 2017 American Heart Association, Inc.

  1. Target Values in the History Course Curricula during the Republican Period

    ERIC Educational Resources Information Center

    Ulusoy, Kadir

    2017-01-01

    No matter what the era is, history lesson is one of the leading of the courses that will provide the nations to comprehend the awareness of being a nation. For that reason, history education and teaching is permanently essential. History is the lesson that provide the nations to adapt the values they have, sustain these values through the…

  2. Targeted prostate biopsy: value of multiparametric magnetic resonance imaging in detection of localized cancer

    PubMed Central

    Le, Jesse D; Huang, Jiaoti; Marks, Leonard S

    2014-01-01

    Prostate cancer is the second most common cancer in men, with 1.1 million new cases worldwide reported by the World Health Organization in one recent year. Transrectal ultrasound (TRUS)-guided biopsy has been used for the diagnosis of prostate cancer for over 2 decades, but the technique is usually blind to cancer location. Moreover, the false negative rate of TRUS biopsy has been reported to be as high as 47%. Multiparametric magnetic resonance imaging (mp-MRI) includes T1- and T2-weighted imaging as well as dynamic contrast-enhanced (DCE) and diffusion-weighted imaging (DWI). mp-MRI is a major advance in the imaging of prostate cancer, enabling targeted biopsy of suspicious lesions. Evolving targeted biopsy techniques—including direct in-bore biopsy, cognitive fusion and software-based MRI-ultrasound (MRI-US) fusion—have led to a several-fold improvement in cancer detection compared to the earlier method. Importantly, the detection of clinically significant cancers has been greatly facilitated by targeting, compared to systematic biopsy alone. Targeted biopsy via MRI-US fusion may dramatically alter the way prostate cancer is diagnosed and managed. PMID:24589455

  3. Manhunts: A Policy Maker’s Guide to High-Value Targeting

    DTIC Science & Technology

    2013-06-01

    must be consistent with the nation’s values. Last, any strategy must be continually evaluated for its effectiveness and revised when needed. This... effectiveness and revised when needed. This thesis analyzes several operations conducted by Israel between 1960 and 1973. Israel provides United States...Mission(s) .......................................................... 94  5.  Assess the Effects

  4. Targeted and efficient transfer of multiple value-added genes into wheat varieties

    USDA-ARS?s Scientific Manuscript database

    With an objective to optimize an approach to transfer multiple value added genes to a wheat variety while maintaining and improving agronomic performance, two alleles with mutations in the acetolactate synthase (ALS) gene located on wheat chromosomes 6B and 6D providing tolerance to imidazolinone (I...

  5. Use of the Threshold of Toxicological Concern (TTC) approach for deriving target values for drinking water contaminants.

    PubMed

    Mons, M N; Heringa, M B; van Genderen, J; Puijker, L M; Brand, W; van Leeuwen, C J; Stoks, P; van der Hoek, J P; van der Kooij, D

    2013-03-15

    Ongoing pollution and improving analytical techniques reveal more and more anthropogenic substances in drinking water sources, and incidentally in treated water as well. In fact, complete absence of any trace pollutant in treated drinking water is an illusion as current analytical techniques are capable of detecting very low concentrations. Most of the substances detected lack toxicity data to derive safe levels and have not yet been regulated. Although the concentrations in treated water usually do not have adverse health effects, their presence is still undesired because of customer perception. This leads to the question how sensitive analytical methods need to become for water quality screening, at what levels water suppliers need to take action and how effective treatment methods need to be designed to remove contaminants sufficiently. Therefore, in the Netherlands a clear and consistent approach called 'Drinking Water Quality for the 21st century (Q21)' has been developed within the joint research program of the drinking water companies. Target values for anthropogenic drinking water contaminants were derived by using the recently introduced Threshold of Toxicological Concern (TTC) approach. The target values for individual genotoxic and steroid endocrine chemicals were set at 0.01 μg/L. For all other organic chemicals the target values were set at 0.1 μg/L. The target value for the total sum of genotoxic chemicals, the total sum of steroid hormones and the total sum of all other organic compounds were set at 0.01, 0.01 and 1.0 μg/L, respectively. The Dutch Q21 approach is further supplemented by the standstill-principle and effect-directed testing. The approach is helpful in defining the goals and limits of future treatment process designs and of analytical methods to further improve and ensure the quality of drinking water, without going to unnecessary extents. Copyright © 2013 Elsevier Ltd. All rights reserved.

  6. The value of prevention: managing the risks associated with targeted violence and active shooters.

    PubMed

    Doherty, Matthew

    2016-01-01

    Every time we turn on the news, or open our Internet browsers, a story about an active shooter--at a school, house of worship, public place and even in our workplace--spills onto the page, the author reports. In this article he focuses on how we can prevent these incidents from occurring. What exactly is "targeted violence"--and why is what experts call "behavioral threat assessment" one of the single most effective ways to prevent the next active shooter incident in any organization?

  7. Non-negative infrared patch-image model: Robust target-background separation via partial sum minimization of singular values

    NASA Astrophysics Data System (ADS)

    Dai, Yimian; Wu, Yiquan; Song, Yu; Guo, Jun

    2017-03-01

    To further enhance the small targets and suppress the heavy clutters simultaneously, a robust non-negative infrared patch-image model via partial sum minimization of singular values is proposed. First, the intrinsic reason behind the undesirable performance of the state-of-the-art infrared patch-image (IPI) model when facing extremely complex backgrounds is analyzed. We point out that it lies in the mismatching of IPI model's implicit assumption of a large number of observations with the reality of deficient observations of strong edges. To fix this problem, instead of the nuclear norm, we adopt the partial sum of singular values to constrain the low-rank background patch-image, which could provide a more accurate background estimation and almost eliminate all the salient residuals in the decomposed target image. In addition, considering the fact that the infrared small target is always brighter than its adjacent background, we propose an additional non-negative constraint to the sparse target patch-image, which could not only wipe off more undesirable components ulteriorly but also accelerate the convergence rate. Finally, an algorithm based on inexact augmented Lagrange multiplier method is developed to solve the proposed model. A large number of experiments are conducted demonstrating that the proposed model has a significant improvement over the other nine competitive methods in terms of both clutter suppressing performance and convergence rate.

  8. The impact of the draft 2005 recommendations of ICRP on secondary derived regulatory values being considered by the US Department of Energy.

    PubMed

    O'Connell, P

    2006-01-01

    The US Department of Energy, Office of Environment, Safety and Health, Office of Health is responsible for maintaining the Department of Energy's occupational radiation protection rule, Title 10 Code of Federal Regulations, Part 835, Occupational Radiation Protection. The Department of Energy is evaluating amending its rule to include the dose assessment methodology recommended in International Commission on Radiological Protection (ICRP) Publications 60 and 68. On 21 June 2004 the ICRP posted their draft, Recommendations of the International Commission on Radiological Protection 2005, which included revisions to the recommended dose assessment methodology. The Department of Energy compared the draft recommendations to determine their effect on the changes the Department of Energy is currently considering.

  9. The Value of Advanced Technology in Meeting 2050 Greenhouse Gas Emissions Targets in the United States

    SciTech Connect

    Kyle, G. Page; Clarke, Leon E.; Pugh, Graham; Wise, Marshall A.; Calvin, Katherine V.; Edmonds, James A.; Kim, Son H.

    2009-12-01

    This paper, a contribution to the EMF 22 subgroup on Transition Scenarios, examines the relationship between technology evolution over the next forty years and the cost, energy, and greenhouse gas emissions consequences of possible U.S. mitigation goals. The paper explores these issues within the context of cumulative emissions targets based on linear reductions in CO2-e emissions of 50 percent and 80 percent below 1990 levels by 2050. Six technology futures were constructed within the MiniCAM integrated assessment model and then applied to the emissions targets. The paper explores the influence of technology availability and expectations of future technology availability on the economic consequences of emissions mitigation, on the time path of emissions mitigation, and on the evolution of the U.S. energy system over time. One of the strongest themes to emerge from the scenarios in this study is that near-term decision-making depends on the availability of technology decades into the future, when deep emissions reductions are required to meet the cumulative emissions goals. In the scenarios in this paper, it is expectations about future technology that have the most dramatic effect on greenhouse gas emissions prices and emissions reductions in 2020, as opposed to near-term technology availability. Moreover, it is the nature of technology 20, 30, and 40 years out, rather than availability and deployment of technology in the next decade, that will largely determine the character of the mid-century energy system.

  10. Targets for antibiotic and healthcare resource stewardship in inpatient community-acquired pneumonia: a comparison of management practices with National Guideline Recommendations.

    PubMed

    Jenkins, T C; Stella, S A; Cervantes, L; Knepper, B C; Sabel, A L; Price, C S; Shockley, L; Hanley, M E; Mehler, P S; Burman, W J

    2013-02-01

    Community-acquired pneumonia (CAP) is the most common infection leading to hospitalization in the USA. The objective of this study was to evaluate management practices for inpatient CAP in relation to Infectious Diseases Society of America/American Thoracic Society (IDSA/ATS) guidelines to identify opportunities for antibiotic and health care resource stewardship. This was a retrospective cohort study of adults hospitalized for CAP at a single institution from 15 April 2008 to 31 May 2009. Of the 209 patients with CAP who presented to Denver Health Medical Center during the study period and were hospitalized, 166 (79 %) and 43 (21 %) were admitted to a medical ward and the intensive care unit (ICU), respectively. Sixty-one (29 %) patients were candidates for outpatient therapy per IDSA/ATS guidance with a CURB-65 score of 0 or 1 and absence of hypoxemia. Sputum cultures were ordered for 110 specimens; however, an evaluable sample was obtained in only 49 (45 %) cases. Median time from antibiotic initiation to specimen collection was 11 [interquartile range (IQR) 6-19] h, and a potential pathogen was identified in only 18 (16 %) cultures. Blood cultures were routinely obtained for both non-ICU (81 %) and ICU (95 %) cases, but 15 of 36 (42 %) positive cultures were false-positive results. The most common antibiotic regimen was ceftriaxone + azithromycin (182, 87 % cases). Discordant with IDSA/ATS recommendations, oral step-down therapy consisted of a new antibiotic class in 120 (66 %), most commonly levofloxacin (101, 55 %). Treatment durations were typically longer than suggested with a median of 10 (IQR 8-12) days. In this cohort of patients hospitalized for CAP, management was frequently inconsistent with IDSA/ATS guideline recommendations, revealing potential targets to reduce unnecessary antibiotic and healthcare resource utilization.

  11. Targets for Antibiotic and Health Care Resource Stewardship in Inpatient Community-Acquired Pneumonia: A Comparison of Management Practices with National Guideline Recommendations

    PubMed Central

    Jenkins, Timothy C.; Stella, Sarah A.; Cervantes, Lilia; Knepper, Bryan C.; Sabel, Allison L.; Price, Connie S.; Shockley, Lee; Hanley, Michael E.; Mehler, Philip S.; Burman, William J.

    2012-01-01

    Purpose Community-acquired pneumonia (CAP) is the most common infection leading to hospitalization in the U.S. The objective of this study was to evaluate management practices for inpatient CAP in relation to IDSA/ATS guidelines to identify opportunities for antibiotic and health care resource stewardship. Methods This was a retrospective cohort study of adults hospitalized for CAP at a single institution from April 15, 2008 – May 31, 2009. Results Of 209 cases, 166 (79%) were admitted to a medical ward and 43 (21%) to the intensive care unit (ICU). 61 (29%) cases were candidates for outpatient therapy per IDSA/ATS guidance with a CURB-65 score of 0 or 1 and absence of hypoxemia. 110 sputum cultures were ordered; however, an evaluable sample was obtained in 49 (45%) cases, median time from antibiotic initiation to specimen collection was 11 (IQR 6–19) hours, and a potential pathogen was identified in only 18 (16%). Blood cultures were routinely obtained for both non-ICU (81%) and ICU (95%) cases, but 15 of 36 (42%) positive cultures were false-positive results. The most common antibiotic regimen was ceftriaxone plus azithromycin (182, 87% cases). Discordant with IDSA/ATS recommendations, oral step-down therapy consisted of a new antibiotic class in 120 (66%), most commonly levofloxacin (101, 55%). Treatment durations were typically longer than suggested with a median of 10 (IQR 8 – 12) days. Conclusions In this cohort of patients hospitalized for CAP, management was frequently inconsistent with IDSA/ATS guideline recommendations revealing potential targets to reduce unnecessary antibiotic and health care resource utilization. PMID:23160837

  12. Alternative futures for Borneo show the value of integrating economic and conservation targets across borders.

    PubMed

    Runting, Rebecca K; Meijaard, Erik; Abram, Nicola K; Wells, Jessie A; Gaveau, David L A; Ancrenaz, Marc; Posssingham, Hugh P; Wich, Serge A; Ardiansyah, Fitrian; Gumal, Melvin T; Ambu, Laurentius N; Wilson, Kerrie A

    2015-04-14

    Balancing economic development with international commitments to protect biodiversity is a global challenge. Achieving this balance requires an understanding of the possible consequences of alternative future scenarios for a range of stakeholders. We employ an integrated economic and environmental planning approach to evaluate four alternative futures for the mega-diverse island of Borneo. We show what could be achieved if the three national jurisdictions of Borneo coordinate efforts to achieve their public policy targets and allow a partial reallocation of planned land uses. We reveal the potential for Borneo to simultaneously retain ∼50% of its land as forests, protect adequate habitat for the Bornean orangutan (Pongo pygmaeus) and Bornean elephant (Elephas maximus borneensis), and achieve an opportunity cost saving of over US$43 billion. Such coordination would depend on enhanced information sharing and reforms to land-use planning, which could be supported by the increasingly international nature of economies and conservation efforts.

  13. Low Cardiac Output Secondary to a Malpositioned Umbilical Venous Catheter: Value of Targeted Neonatal Echocardiography

    PubMed Central

    Weisz, Dany E.; Poon, Wei Bing; James, Andrew; McNamara, Patrick J.

    2014-01-01

    Systemic hypotension is common in very low birthweight preterm infants but the nature of the precipitating cause may be unclear. Targeted neonatal echocardiography (TnEcho) is being increasingly used to support hemodynamic decisions in the neonatal intensive care unit (NICU), including identifying impairments in the transitional circulation of preterm infants, providing timely re-evaluation after institution of therapies and evaluating the placement of indwelling catheters. We present a case of a preterm infant with systemic hypotension and low cardiac output secondary to a large transatrial shunt induced by a malpositioned umbilical venous catheter. Repositioning of the line led to resolution of the hemodynamic disturbance and clinical instability, highlighting the utility of TnEcho in the NICU. PMID:25032055

  14. Alternative futures for Borneo show the value of integrating economic and conservation targets across borders

    PubMed Central

    Runting, Rebecca K.; Meijaard, Erik; Abram, Nicola K.; Wells, Jessie A.; Gaveau, David L.A.; Ancrenaz, Marc; Posssingham, Hugh P.; Wich, Serge A.; Ardiansyah, Fitrian; Gumal, Melvin T.; Ambu, Laurentius N.; Wilson, Kerrie A.

    2015-01-01

    Balancing economic development with international commitments to protect biodiversity is a global challenge. Achieving this balance requires an understanding of the possible consequences of alternative future scenarios for a range of stakeholders. We employ an integrated economic and environmental planning approach to evaluate four alternative futures for the mega-diverse island of Borneo. We show what could be achieved if the three national jurisdictions of Borneo coordinate efforts to achieve their public policy targets and allow a partial reallocation of planned land uses. We reveal the potential for Borneo to simultaneously retain ∼50% of its land as forests, protect adequate habitat for the Bornean orangutan (Pongo pygmaeus) and Bornean elephant (Elephas maximus borneensis), and achieve an opportunity cost saving of over US$43 billion. Such coordination would depend on enhanced information sharing and reforms to land-use planning, which could be supported by the increasingly international nature of economies and conservation efforts. PMID:25871635

  15. MEthods of ASsessing blood pressUre: identifying thReshold and target valuEs (MeasureBP): a review & study protocol.

    PubMed

    Blom, Kimberly C; Farina, Sasha; Gomez, Yessica-Haydee; Campbell, Norm R C; Hemmelgarn, Brenda R; Cloutier, Lyne; McKay, Donald W; Dawes, Martin; Tobe, Sheldon W; Bolli, Peter; Gelfer, Mark; McLean, Donna; Bartlett, Gillian; Joseph, Lawrence; Featherstone, Robin; Schiffrin, Ernesto L; Daskalopoulou, Stella S

    2015-04-01

    Despite progress in automated blood pressure measurement (BPM) technology, there is limited research linking hard outcomes to automated office BPM (OBPM) treatment targets and thresholds. Equivalences for automated BPM devices have been estimated from approximations of standardized manual measurements of 140/90 mmHg. Until outcome-driven targets and thresholds become available for automated measurement methods, deriving evidence-based equivalences between automated methods and standardized manual OBPM is the next best solution. The MeasureBP study group was initiated by the Canadian Hypertension Education Program to close this critical knowledge gap. MeasureBP aims to define evidence-based equivalent values between standardized manual OBPM and automated BPM methods by synthesizing available evidence using a systematic review and individual subject-level data meta-analyses. This manuscript provides a review of the literature and MeasureBP study protocol. These results will lay the evidenced-based foundation to resolve uncertainties within blood pressure guidelines which, in turn, will improve the management of hypertension.

  16. Automatic geocoding of high-value targets using structural image analysis and GIS data

    NASA Astrophysics Data System (ADS)

    Soergel, Uwe; Thoennessen, Ulrich

    1999-12-01

    Geocoding based merely on navigation data and sensor model is often not possible or precise enough. In these cases an improvement of the preregistration through image-based approaches is a solution. Due to the large amount of data in remote sensing automatic geocoding methods are necessary. For geocoding purposes appropriate tie points, which are present in image and map, have to be detected and matched. The tie points are base of the transformation function. Assigning the tie points is combinatorial problem depending on the number of tie points. This number can be reduced using structural tie points like corners or crossings of prominent extended targets (e.g. harbors, airfields). Additionally the reliability of the tie points is improved. Our approach extracts structural tie points independently in the image and in the vector map by a model-based image analysis. The vector map is provided by a GIS using ATKIS data base. The model parameters are extracted from maps or collateral information of the scenario. The two sets of tie points are automatically matched with a Geometric Hashing algorithm. The algorithm was successfully applied to VIS, IR and SAR data.

  17. Creatine and Its Potential Therapeutic Value for Targeting Cellular Energy Impairment in Neurodegenerative Diseases

    PubMed Central

    Adhihetty, Peter J.

    2010-01-01

    Substantial evidence indicates bioenergetic dysfunction and mitochondrial impairment contribute either directly and/or indirectly to the pathogenesis of numerous neurodegenerative disorders. Treatment paradigms aimed at ameliorating this cellular energy deficit and/or improving mitochondrial function in these neurodegenerative disorders may prove to be useful as a therapeutic intervention. Creatine is a molecule that is produced both endogenously, and acquired exogenously through diet, and is an extremely important molecule that participates in buffering intracellular energy stores. Once creatine is transported into cells, creatine kinase catalyzes the reversible transphosphorylation of creatine via ATP to enhance the phosphocreatine energy pool. Creatine kinase enzymes are located at strategic intracellular sites to couple areas of high energy expenditure to the efficient regeneration of ATP. Thus, the creatinekinase/phosphocreatine system plays an integral role in energy buffering and overall cellular bioenergetics. Originally, exogenous creatine supplementation was widely used only as an ergogenic aid to increase the phosphocreatine pool within muscle to bolster athletic performance. However, the potential therapeutic value of creatine supplementation has recently been investigated with respect to various neurodegenerative disorders that have been associated with bioenergetic deficits as playing a role in disease etiology and/or progression which include; Alzheimer’s, Parkinson’s, amyotrophic lateral sclerosis (ALS), and Huntington’s disease. This review discusses the contribution of mitochondria and bioenergetics to the progression of these neurodegenerative diseases and investigates the potential neuroprotective value of creatine supplementation in each of these neurological diseases. In summary, current literature suggests that exogenous creatine supplementation is most efficacious as a treatment paradigm in Huntington’s and Parkinson’s disease but

  18. Non-Cooperative Target Recognition by Means of Singular Value Decomposition Applied to Radar High Resolution Range Profiles †

    PubMed Central

    López-Rodríguez, Patricia; Escot-Bocanegra, David; Fernández-Recio, Raúl; Bravo, Ignacio

    2015-01-01

    Radar high resolution range profiles are widely used among the target recognition community for the detection and identification of flying targets. In this paper, singular value decomposition is applied to extract the relevant information and to model each aircraft as a subspace. The identification algorithm is based on angle between subspaces and takes place in a transformed domain. In order to have a wide database of radar signatures and evaluate the performance, simulated range profiles are used as the recognition database while the test samples comprise data of actual range profiles collected in a measurement campaign. Thanks to the modeling of aircraft as subspaces only the valuable information of each target is used in the recognition process. Thus, one of the main advantages of using singular value decomposition, is that it helps to overcome the notable dissimilarities found in the shape and signal-to-noise ratio between actual and simulated profiles due to their difference in nature. Despite these differences, the recognition rates obtained with the algorithm are quite promising. PMID:25551484

  19. Non-cooperative target recognition by means of singular value decomposition applied to radar high resolution range profiles.

    PubMed

    López-Rodríguez, Patricia; Escot-Bocanegra, David; Fernández-Recio, Raúl; Bravo, Ignacio

    2014-12-29

    Radar high resolution range profiles are widely used among the target recognition community for the detection and identification of flying targets. In this paper, singular value decomposition is applied to extract the relevant information and to model each aircraft as a subspace. The identification algorithm is based on angle between subspaces and takes place in a transformed domain. In order to have a wide database of radar signatures and evaluate the performance, simulated range profiles are used as the recognition database while the test samples comprise data of actual range profiles collected in a measurement campaign. Thanks to the modeling of aircraft as subspaces only the valuable information of each target is used in the recognition process. Thus, one of the main advantages of using singular value decomposition, is that it helps to overcome the notable dissimilarities found in the shape and signal-to-noise ratio between actual and simulated profiles due to their difference in nature. Despite these differences, the recognition rates obtained with the algorithm are quite promising.

  20. Real-time targeted molecular imaging using singular value spectra properties to isolate the adherent microbubble signal.

    PubMed

    Mauldin, F William; Dhanaliwala, Ali H; Patil, Abhay V; Hossack, John A

    2012-08-21

    Ultrasound-based real-time molecular imaging in large blood vessels holds promise for early detection and diagnosis of various important and significant diseases, such as stroke, atherosclerosis, and cancer. Central to the success of this imaging technique is the isolation of ligand-receptor bound adherent microbubbles from free microbubbles and tissue structures. In this paper, we present a new approach, termed singular spectrum-based targeted molecular (SiSTM) imaging, which separates signal components using singular value spectra content over local regions of complex echo data. Simulations were performed to illustrate the effects of acoustic target motion and harmonic energy on SiSTM imaging-derived measurements of statistical dimensionality. In vitro flow phantom experiments were performed under physiologically realistic conditions (2.7 cm s⁻¹ flow velocity and 4 mm diameter) with targeted and non-targeted phantom channels. Both simulation and experimental results demonstrated that the relative motion and harmonic characteristics of adherent microbubbles (i.e. low motion and large harmonics) yields echo data with a dimensionality that is distinct from free microbubbles (i.e. large motion and large harmonics) and tissue (i.e. low motion and low harmonics). Experimental SiSTM images produced the expected trend of a greater adherent microbubble signal in targeted versus non-targeted microbubble experiments (P < 0.05, n = 4). The location of adherent microbubbles was qualitatively confirmed via optical imaging of the fluorescent DiI signal along the phantom channel walls after SiSTM imaging. In comparison with two frequency-based real-time molecular imaging strategies, SiSTM imaging provided significantly higher image contrast (P < 0.001, n = 4) and a larger area under the receiver operating characteristic curve (P < 0.05, n = 4).

  1. MODIS Collection 6 aerosol products: Comparison between Aqua's e-Deep Blue, Dark Target, and "merged" data sets, and usage recommendations

    NASA Astrophysics Data System (ADS)

    Sayer, A. M.; Munchak, L. A.; Hsu, N. C.; Levy, R. C.; Bettenhausen, C.; Jeong, M.-J.

    2014-12-01

    The Moderate Resolution Imaging Spectroradiometer (MODIS) Atmospheres data product suite includes three algorithms applied to retrieve midvisible aerosol optical depth (AOD): the Enhanced Deep Blue (DB) and Dark Target (DT) algorithms over land, and a DT over-water algorithm. All three have been refined in the recent "Collection 6" (C6) MODIS reprocessing. In particular, DB has been expanded to cover vegetated land surfaces as well as brighter desert/urban areas. Additionally, a new "merged" data set which draws from all three algorithms is included in the C6 products. This study is intended to act as a point of reference for new and experienced MODIS data users with which to understand the global and regional characteristics of the C6 DB, DT, and merged data sets, based on MODIS Aqua data. This includes validation against Aerosol Robotic Network (AERONET) observations at 111 sites, focused toward regional and categorical (surface/aerosol type) analysis. Neither algorithm consistently outperforms the other, although in many cases the retrieved AOD and the level of its agreement with AERONET are very similar. In many regions the DB, DT, and merged data sets are all suitable for quantitative applications, bearing in mind that they cannot be considered independent, while in other cases one algorithm does consistently outperform the other. Usage recommendations and caveats are thus somewhat complicated and regionally dependent.

  2. Target heart rate to determine the normal value of coronary flow reserve during dobutamine stress echocardiography

    PubMed Central

    2011-01-01

    Background The determination of coronary flow reserve (CFR) is an essential concept at the moment of decision-making in ischemic heart disease. There are several direct and indirect tests to evaluate this parameter. In this sense, dobutamine stress echocardiography is one of the pharmacological method most commonly used worldwide. It has been previously demonstrated that CFR can be determined by this technique. Despite our wide experience with dobutamine stress echocardiography, we ignored the necessary heart rate to consider sufficient the test for the analysis of CFR. For this reason, our main goal was to determine the velocity of coronary flow in each stage of dobutamine stress echocardiography and the heart rate value necessary to double the baseline values of coronary flow velocity in the territory of the left anterior descending (LAD) coronary artery. Methods A total of 33 consecutive patients were analyzed. The patients included had low risk for coronary artery disease. All the participants underwent dobutamine stress echocardiography and coronary artery flow velocity was evaluated in the distal segment of LAD coronary artery using transthoracic color-Doppler echocardiography. Results The feasibility of determining CFR in the territory of the LAD during dobutamine stress echocardiography was high: 31/33 patients (94%). Mean CFR was 2.67 at de end of dobutamine test. There was an excellent concordance between delta HR (difference between baseline HR and maximum HR) and the increase in the CFR (correlation coefficient 0.84). In this sense, we found that when HR increased by 50 beats, CFR was ≥ 2 (CI 93-99.2%). In addition, 96.4% of patients reached a CFR ≥ 2 (IC 91.1 - 99%) at 75% of their predicted maximum heart rate. Conclusions We found that the feasibility of dobutamine stress echocardiography to determine CFR in the territory of the LAD coronary artery was high. In this study, it was necessary to achieve a difference of 50 bpm from baseline HR or at

  3. Target heart rate to determine the normal value of coronary flow reserve during dobutamine stress echocardiography.

    PubMed

    Forte, Ezequiel H; Rousse, Maria G; Lowenstein, Jorge A

    2011-04-04

    The determination of coronary flow reserve (CFR) is an essential concept at the moment of decision-making in ischemic heart disease. There are several direct and indirect tests to evaluate this parameter. In this sense, dobutamine stress echocardiography is one of the pharmacological method most commonly used worldwide. It has been previously demonstrated that CFR can be determined by this technique. Despite our wide experience with dobutamine stress echocardiography, we ignored the necessary heart rate to consider sufficient the test for the analysis of CFR. For this reason, our main goal was to determine the velocity of coronary flow in each stage of dobutamine stress echocardiography and the heart rate value necessary to double the baseline values of coronary flow velocity in the territory of the left anterior descending (LAD) coronary artery. A total of 33 consecutive patients were analyzed. The patients included had low risk for coronary artery disease. All the participants underwent dobutamine stress echocardiography and coronary artery flow velocity was evaluated in the distal segment of LAD coronary artery using transthoracic color-Doppler echocardiography. The feasibility of determining CFR in the territory of the LAD during dobutamine stress echocardiography was high: 31/33 patients (94%). Mean CFR was 2.67 at de end of dobutamine test.There was an excellent concordance between delta HR (difference between baseline HR and maximum HR) and the increase in the CFR (correlation coefficient 0.84). In this sense, we found that when HR increased by 50 beats, CFR was ≥ 2 (CI 93-99.2%). In addition, 96.4% of patients reached a CFR ≥ 2 (IC 91.1 - 99%) at 75% of their predicted maximum heart rate. We found that the feasibility of dobutamine stress echocardiography to determine CFR in the territory of the LAD coronary artery was high. In this study, it was necessary to achieve a difference of 50 bpm from baseline HR or at least 75% of the maximum predicted heart

  4. A method to obtain correct standard uptake values in Pinnacle treatment planning system for target volume delineation.

    PubMed

    Salehzahi, Farshid; Tse, Jason; Lee, Jonathan; Selvaraj, Jothybasu

    2016-01-01

    Standardized uptake value (SUV) is an advanced tool for quantitative tumor identification and metabolic target volume delineation (TVD) in diagnostic and therapeutic settings. It is thus important to establish a quality assured process to maintain the traceability of data correctly by positron emission tomography (PET) systems. Patient administration of (18)fluoro-deoxy-glucose is increasingly delivered by automated infusion systems (AISs). Whenever AIS is used, its accuracy and traceability measurement need verification. In addition, it was observed that the unreproducible SUV displayed in PET and the treatment planning system (TPS) may cause grave concerns for radiation oncologists for TVD. This concern may complicate the correlation of TVD on PET and TPS and their clinical reporting. The SUV traceability was established from the PET system to AIS. Its accuracy was verified by cross-referencing to the reference dose calibrator traceable to a primary standard. The SUV values were converted in TPS using the in-house "clinical tool" to be identical as in PET, to allow radiation oncologists to use SUV confidently. The outcome of this study enables the clinical groups to rely on the correct SUV values displayed on the TPS and to improve the quality of care for patients in clinical procedures.

  5. A method to obtain correct standard uptake values in Pinnacle treatment planning system for target volume delineation

    PubMed Central

    Salehzahi, Farshid; Tse, Jason; Lee, Jonathan; Selvaraj, Jothybasu

    2016-01-01

    Standardized uptake value (SUV) is an advanced tool for quantitative tumor identification and metabolic target volume delineation (TVD) in diagnostic and therapeutic settings. It is thus important to establish a quality assured process to maintain the traceability of data correctly by positron emission tomography (PET) systems. Patient administration of 18fluoro-deoxy-glucose is increasingly delivered by automated infusion systems (AISs). Whenever AIS is used, its accuracy and traceability measurement need verification. In addition, it was observed that the unreproducible SUV displayed in PET and the treatment planning system (TPS) may cause grave concerns for radiation oncologists for TVD. This concern may complicate the correlation of TVD on PET and TPS and their clinical reporting. The SUV traceability was established from the PET system to AIS. Its accuracy was verified by cross-referencing to the reference dose calibrator traceable to a primary standard. The SUV values were converted in TPS using the in-house “clinical tool” to be identical as in PET, to allow radiation oncologists to use SUV confidently. The outcome of this study enables the clinical groups to rely on the correct SUV values displayed on the TPS and to improve the quality of care for patients in clinical procedures. PMID:28144116

  6. The recommended Threshold Limit Values for heat exposure fail to maintain body core temperature within safe limits in older working adults.

    PubMed

    Lamarche, Dallon T; Meade, Robert D; D'Souza, Andrew W; Flouris, Andreas D; Hardcastle, Stephen G; Sigal, Ronald J; Boulay, Pierre; Kenny, Glen P

    2017-09-01

    The American Conference of Governmental and Industrial Hygienists (ACGIH®) Threshold Limit Values (TLV® guidelines) for work in the heat consist of work-rest (WR) allocations designed to ensure a stable core temperature that does not exceed 38°C. However, the TLV® guidelines have not been validated in older workers. This is an important shortcoming given that adults as young as 40 years demonstrate impairments in their ability to dissipate heat. We therefore evaluated body temperature responses in older adults during work performed in accordance to the TLV® recommended guidelines. On three occasions, 9 healthy older (58 ± 5 years) males performed a 120-min work-simulated protocol in accordance with the TLV® guidelines for moderate-to-heavy intensity work (360 W fixed rate of heat production) in different wet-bulb globe temperatures (WBGT). The first was 120 min of continuous (CON) cycling at 28.0°C WBGT (CON[28°C]). The other two protocols were 15-min intermittent work bouts performed with different WR cycles and WBGT: (i) WR of 3:1 at 29.0°C (WR3:1[29°C]) and (ii) WR of 1:1 at 30.0°C (WR1:1[30°C]). Rectal temperature was measured continuously. The rate of change in mean body temperature was determined via thermometry (weighting coefficients: rectal, 0.9; mean skin temperature, 0.1) and direct calorimetry. Rectal temperature exceeded 38°C in all participants in CON[28°C] and WR3:1[29°C] whereas a statistically similar proportion of workers exceeded 38°C in WR1:1[30°C] (χ(2); P = 0.32). The average time for rectal temperature to reach 38°C was: CON[28°C], 53 ± 7; WR3:1[29°C], 79 ± 11; and WR1:1[30°C], 100 ± 29 min. Finally, while a stable mean body temperature was not achieved in any work condition as measured by thermometry (i.e., >0°C·min(-1); all P<0.01), heat balance as determined by direct calorimetry was achieved in WR3:1[29°C] and WR1:1[30°C] (both P ≥ 0.08). Our findings indicate that the TLV® guidelines do not prevent

  7. Vitamin D intake needed to maintain target serum 25-hydroxyvitamin D concentrations in participants with low sun exposure and dark skin pigmentation is substantially higher than current recommendations.

    PubMed

    Hall, Laura M; Kimlin, Michael G; Aronov, Pavel A; Hammock, Bruce D; Slusser, James R; Woodhouse, Leslie R; Stephensen, Charles B

    2010-03-01

    Cutaneous cholecalciferol synthesis has not been considered in making recommendations for vitamin D intake. Our objective was to model the effects of sun exposure, vitamin D intake, and skin reflectance (pigmentation) on serum 25-hydroxyvitamin D (25[OH]D) in young adults with a wide range of skin reflectance and sun exposure. Four cohorts of participants (n = 72 total) were studied for 7-8 wk in the fall, winter, spring, and summer in Davis, CA [38.5 degrees N, 121.7 degrees W, Elev. 49 ft (15 m)]. Skin reflectance was measured using a spectrophotometer, vitamin D intake using food records, and sun exposure using polysulfone dosimeter badges. A multiple regression model (R(2) = 0.55; P < 0.0001) was developed and used to predict the serum 25(OH)D concentration for participants with low [median for African ancestry (AA)] and high [median for European ancestry (EA)] skin reflectance and with low [20th percentile, approximately 20 min/d, approximately 18% body surface area (BSA) exposed] and high (80th percentile, approximately 90 min/d, approximately 35% BSA exposed) sun exposure, assuming an intake of 200 iu/d (5 ug/d). Predicted serum 25(OH)D concentrations for AA individuals with low and high sun exposure in the winter were 24 and 42 nmol/L and in the summer were 40 and 60 nmol/L. Corresponding values for EA individuals were 35 and 60 nmol/L in the winter and in the summer were 58 and 85 nmol/L. To achieve 25(OH)D > or =75 nmol/L, we estimate that EA individuals with high sun exposure need 1300 iu/d vitamin D intake in the winter and AA individuals with low sun exposure need 2100-3100 iu/d year-round.

  8. A comparison of food-based recommendations and nutrient values of three food guides: USDA's MyPyramid, NHLBI's Dietary Approaches to Stop Hypertension Eating Plan, and Harvard's Healthy Eating Pyramid.

    PubMed

    Reedy, Jill; Krebs-Smith, Susan M

    2008-03-01

    The purpose of this research was to compare food-based recommendations and nutrient values of three food guides: the US Department of Agriculture's MyPyramid; the National Heart, Lung, and Blood Institute's Dietary Approaches to Stop Hypertension Eating Plan, and Harvard University's Healthy Eating Pyramid. Estimates of nutrient values associated with following each of the food guides at the 2,000-calorie level were made using a composite approach. This approach calculates population-weighted nutrient composites for each food group and subgroup, assuming average choices within food groups. Nutrient estimates were compared to the Dietary Reference Intakes and other goals and limits. Recommendations were similar regarding almost all food groups for both the type and amount of foods. Primary differences were seen in the types of vegetables and protein sources recommended and the amount of dairy products and total oil recommended. Overall nutrient values were also similar for most nutrients, except vitamin A, vitamin E, and calcium. These food guides were derived from different types of nutrition research, yet they share consistent messages: eat more fruits, vegetables, legumes, and whole grains; eat less added sugar and saturated fat; and emphasize plant oils.

  9. Recommended Distribution Coefficients, Kd Values, for Special Analysis Risk Calculations Related to Waste Disposal and Tank Closure on the Savannah River Site

    SciTech Connect

    Kaplan, D

    2005-08-31

    The purpose of this document is to provide a technically defensible list of distribution coefficients, or Kd values, for use in performance assessment (PA) and special analysis (SA) calculations on the SRS. Only Kd values for radionuclides that have new information related to them or that have recently been recognized as being important are discussed in this report. Some 150 Kd values are provided in this report for various waste-disposal or tank-closure environments: soil, corrosion in grout, oxidizing grout waste, gravel, clay, and reducing concrete environments. Documentation and justification for the selection of each Kd value is provided.

  10. The prognostic and predictive value of sstr2-immunohistochemistry and sstr2-targeted imaging in neuroendocrine tumors.

    PubMed

    Brunner, Philippe; Jörg, Ann-Catherine; Glatz, Katharina; Bubendorf, Lukas; Radojewski, Piotr; Umlauft, Maria; Marincek, Nicolas; Spanjol, Petar-Marko; Krause, Thomas; Dumont, Rebecca A; Maecke, Helmut R; Müller-Brand, Jan; Briel, Matthias; Schmitt, Anja; Perren, Aurel; Walter, Martin A

    2017-03-01

    Our aim was to assess the prognostic and predictive value of somatostatin receptor 2 (sstr2) in neuroendocrine tumors (NETs). We established a tissue microarray and imaging database from NET patients that received sstr2-targeted radiopeptide therapy with yttrium-90-DOTATOC, lutetium-177-DOTATOC or alternative treatment. We used univariate and multivariate analyses to identify prognostic and predictive markers for overall survival, including sstr2-imaging and sstr2-immunohistochemistry. We included a total of 279 patients. In these patients, sstr2-immunohistochemistry was an independent prognostic marker for overall survival (HR: 0.82, 95 % CI: 0.67 - 0.99, n = 279, p = 0.037). In DOTATOC patients, sstr2-expression on immunohistochemistry correlated with tumor uptake on sstr2-imaging (n = 170, p < 0.001); however, sstr2-imaging showed a higher prognostic accuracy (positive predictive value: +27 %, 95 % CI: 3 - 56 %, p = 0.025). Sstr2-expression did not predict a benefit of DOTATOC over alternative treatment (p = 0.93). Our results suggest sstr2 as an independent prognostic marker in NETs. Sstr2-immunohistochemistry correlates with sstr2-imaging; however, sstr2-imaging is more accurate for determining the individual prognosis.

  11. Development of dietary-based toxic reference values to assess the risk of chlorophacinone to non-target raptorial birds

    USGS Publications Warehouse

    Rattner, Barnett A.; Lazarus, Rebecca; Shultz, S. L.; Horak, Katherine E.; Abbo, Benjamin G.; Volker, Steven F.; Timms, R. M.; O'Brien, J. M.

    2014-01-01

    Regulatory changes in the use of some second-generation anticoagulant rodenticides in parts of North America may result in expanded use of first-generation anticoagulant rodenticides (FGARs). Recent toxicological studies with captive raptors have demonstrated that these species are considerably more sensitive to the FGAR diphacinone than traditional avian wildlife test species (mallard, bobwhite). We have now examined the toxicity of the FGAR chlorophacinone (CPN) to American kestrels fed rat tissue mechanically-amended with CPN, or rat tissue containing biologically-incorporated CPN, for 7 days. Nominal CPN concentrations in these diets were 0.15, 0.75 and 1.5 µg/g food wet weight, and actual CPN concentration in diets were analytically verified as being close to target values. Food intake was consistent among groups, body weight fluctuated by less than 6%, exposure and adverse effects were generally dose-dependent, and there were no dramatic differences in toxicity between mechanically-amended and biologically-incorporated CPN diets. Using benchmark dose statistical methods, toxic reference values at which clotting times were prolonged in 50% of the kestrels was estimated to be about 80 µg CPN consumed/kg body weight-day for prothrombin time and 40 µg CPN/kg body weight-day for Russell's viper venom time. Based upon carcass CPN residues reported in rodents from field baiting studies, empirical measures of food consumption in kestrels, and dietary-based toxic reference values derived from the 7-day exposure scenario, some free-ranging raptors consuming CPN exposed prey might exhibit coagulopathy and hemorrhage. These sublethal responses associated with exposure to environmentally realistic concentrations of CPN could compromise survival of exposed birds.

  12. Frequency of self-monitoring blood glucose and attainment of HbA1c target values.

    PubMed

    Elgart, Jorge F; González, Lorena; Prestes, Mariana; Rucci, Enzo; Gagliardino, Juan J

    2016-02-01

    Test strips for self-monitoring of blood glucose (SMBG) represent in Argentina, around 50 % of diabetes treatment cost; the frequency of their use is closely associated with hyperglycemia treatment. However, the favorable impact of SMBG on attainment of HbA1c goal in different treatment conditions remains controversial. We therefore attempted to estimate the relationship between use of SMBG test strips and degree of attainment of metabolic control in an institution of our social security subsector (SSS) in which provision is fully covered and submitted to a regular audit system. Observational retrospective study using information of 657 patients with T2DM (period 2009-2010) from the database of the Diabetes and Other Cardiovascular Risk Factors Program (DICARO) of one institution of our SSS. DICARO provides-with an audit system-100 % coverage for all drugs and keeps records of clinical, metabolic and treatment data from every patient. The average monthly test strips/patient used for SMBG increased as a function of treatment intensification: Monotherapy with oral antidiabetic drugs (OAD) < combined OAD therapy < insulin treatment. In every condition, the number was larger in people with target HbA1c levels. Test strips represented the larger percentage of total prescription cost. In our population, the type of hyperglycemia treatment was the main driver of test strip use for SMBG; in every condition tested, targeted HbA1c values were associated with greater strip use. Patient education and prescription audit may optimize its use and treatment outcomes.

  13. Monitoring of mycophenolate mofetil metabolites in children with nephrotic syndrome and the proposed novel target values of pharmacokinetic parameters.

    PubMed

    Sobiak, Joanna; Resztak, Matylda; Ostalska-Nowicka, Danuta; Zachwieja, Jacek; Gąsiorowska, Karolina; Piechanowska, Wiktoria; Chrzanowska, Maria

    2015-09-18

    The aim of the study was to estimate target values of mycophenolate mofetil (MMF) pharmacokinetic parameters in children with proteinuric glomerulopathies by calculating the pharmacokinetic parameters of MMF metabolites (mycophenolic acid [MPA], free MPA [fMPA] and MPA glucuronide [MPAG]) and assessing their relation to proteinuria recurrence. One hundred and sixty-eight blood samples were collected from children, aged 3-18 years, diagnosed with nephrotic syndrome or lupus nephritis. MMF metabolites concentrations were examined before drug administration (Ctrough) and up to 12h afterward employing high-performance liquid chromatography. Dose-normalized MPA Ctrough and area under the concentration-time curve from 0 to 12h (AUC12) were within 0.29-6.47 μg/mL/600 mg/m(2) and 9.97-105.52 μg h/mL/600 mg/m(2), respectively. MPA Ctrough was twofold lower (p=0.024) in children with proteinuria recurrence. MPA, fMPA and MPAG concentrations correlated positively to respective AUC12. It may be suggested MMF metabolites monitoring in children with proteinuric glomerulopathies is justified by MPA Ctrough<2 μg/mL in patients at risk of the proteinuria recurrence. Such a recurrence is most probably caused by not sufficient MPA concentration during proteinuric glomerulopathies treatment. MPA Ctrough>3 μg/mL may be considered as an efficient one to avoid proteinuria recurrence. Finally, MPA target AUC12 should exceed 60 μg h/mL to ensure the safe and effective treatment in children with nephrotic syndrome, however, the upper limit is still to be established. Copyright © 2015 Elsevier B.V. All rights reserved.

  14. Prognostic Value of Coronary Flow Reserve Obtained on Dobutamine Stress Echocardiography and its Correlation with Target Heart Rate.

    PubMed

    Abreu, José Sebastião de; Rocha, Eduardo Arrais; Machado, Isadora Sucupira; Parahyba, Isabelle O; Rocha, Thais Brito; Paes, Fernando José Villar Nogueira; Diogenes, Tereza Cristina Pinheiro; Abreu, Marília Esther Benevides de; Farias, Ana Gardenia Liberato Ponte; Carneiro, Marcia Maria; Paes, José Nogueira

    2017-05-01

    Normal coronary flow velocity reserve (CFVR) (≥ 2) obtained in the left anterior descending coronary artery (LAD) from transthoracic echocardiography is associated with a good prognosis, but there is no study correlating CFVR with submaximal target heart rate (HR). To evaluate the prognostic value of CFVR obtained in the LAD of patients with preserved (>50%) left ventricular ejection fraction (LVEF) who completed a dobutamine stress echocardiography (DSE), considering target HR. Prospective study of patients with preserved LVEF and CFVR obtained in the LAD who completed DSE. In Group I (GI = 31), normal CFVR was obtained before achieving target HR, and, in Group II (GII = 28), after that. Group III (G III=24) reached target HR, but CFVR was abnormal. Death, acute coronary insufficiency, coronary intervention, coronary angiography without further intervention, and hospitalization were considered events. In 28 ± 4 months, there were 18 (21.6%) events: 6% (2/31) in GI, 18% (5/28) in GII, and 46% (11/24) in GIII. There were 4 (4.8%) deaths, 6 (7.2%) coronary interventions and 8 (9.6%) coronary angiographies without further intervention. In event-free survival by regression analysis, GIII had more events than GI (p < 0.001) and GII (p < 0.045), with no difference between GI and GII (p = 0.160). After adjustment, the only difference was between GIII and GI (p = 0.012). In patients with preserved LVEF and who completed their DSE, normal CFVR obtained before achieving target HR was associated with better prognosis. A reserva de velocidade de fluxo coronariano (RVFC) adequada (≥ 2) obtida na artéria descendente anterior (ADA) através do ecocardiograma transtorácico associa-se a bom prognóstico, mas não há estudo correlacionando-a com a frequência cardíaca (FC) alvo (submáxima). Avaliar o valor prognóstico da RVFC obtida na ADA de pacientes com fração de ejeção do ventrículo esquerdo (FEVE) preservada (>50%) e ecocardiograma sob estresse com dobutamina

  15. "Target" and "Sandwich" Signs in Thigh Muscles have High Diagnostic Values for Collagen VI-related Myopathies.

    PubMed

    Fu, Jun; Zheng, Yi-Ming; Jin, Su-Qin; Yi, Jun-Fei; Liu, Xiu-Juan; Lyn, He; Wang, Zhao-Xia; Zhang, Wei; Xiao, Jiang-Xi; Yuan, Yun

    2016-08-05

    Collagen VI-related myopathies are autosomal dominant and recessive hereditary myopathies, mainly including Ullrich congenital muscular dystrophy (UCMD) and Bethlem myopathy (BM). Muscle magnetic resonance imaging (MRI) has been widely used to diagnosis muscular disorders. The purpose of this study was to evaluate the diagnostic value of thigh muscles MRI for collagen VI-related myopathies. Eleven patients with collagen VI gene mutation-related myopathies were enrolled in this study. MRI of the thigh muscles was performed in all patients with collagen VI gene mutation-related myopathies and in 361 patients with other neuromuscular disorders (disease controls). T1-weighted images were used to assess fatty infiltration of the muscles using a modified Mercuri's scale. We assessed the sensitivity and specificity of the MRI features of collagen VI-related myopathies. The relationship between fatty infiltration of muscles and specific collagen VI gene mutations was also investigated. Eleven patients with collagen VI gene mutation-related myopathies included six UCMD patients and five BM patients. There was no significant difference between UCMD and BM patients in the fatty infiltration of each thigh muscle except sartorius (P = 0.033); therefore, we combined the UCMD and BM data. Mean fatty infiltration scores were 3.1 and 3.0 in adductor magnus and gluteus maximus, while the scores were 1.3, 1.3, and 1.5 in gracilis, adductor longus, and sartorius, respectively. A "target" sign in rectus femoris (RF) was present in seven cases, and a "sandwich" sign in vastus lateralis (VL) was present in ten cases. The "target" and "sandwich" signs had sensitivities of 63.6% and 90.9% and specificities of 97.3% and 96.9% for the diagnosis of collagen VI-related myopathies, respectively. Fatty infiltration scores were 2.0-3.0 in seven patients with mutations in the triple-helical domain, and 1.0-1.5 in three of four patients with mutations in the N- or C-domain of the collagen VI genes

  16. Re-evaluation of current A0 value recommendations for thermal disinfection of reusable human waste containers based on new experimental data.

    PubMed

    Diab-Elschahawi, M; Fürnkranz, U; Blacky, A; Bachhofner, N; Koller, W

    2010-05-01

    Issues over the correct cleaning and disinfection of reusable medical devices are of great concern for local infection control teams. We investigated the heat resistance of two important micro-organisms implicated in nosocomial infections, Enterococcus spp. and spores of Bacillus subtilis (a surrogate for Clostridium difficile). Disinfection with moist heat, based on the A(0) concept (EN ISO 15883-1), is the most common method for disinfection of human waste containers in the hospital setting. The aim of this study was to scrutinise the A(0) concept regarding the inactivation of the above-mentioned micro-organisms and to look for possible interferences. Experiments were carried out in phosphate-buffered saline, artificial soil in suspension (ASS) and dried artificial soil (AS). Artificial soil was used to simulate insufficient cleaning of bedpans. Micro-organisms were treated at different temperatures and time periods. It was shown that soil protected the micro-organisms against heat and that dried soil enhanced this effect, probably as a result of thermal insulation. The results of the current study do not support the general recommendation to use an A(0) of 60 for the disinfection of bedpans but warrant differential strategies depending on the expected microbial load. We generally recommend for disinfection processes aimed at vegetative bacteria an A(0) of >or=180. Furthermore we want to emphasise the utmost importance of not allowing freshly contaminated bedpans to dry for longer time periods, as the significance of thorough cleaning of contaminated human waste containers before being exposed to heat treatment for their disinfection was clearly demonstrated. Copyright (c) 2010 The Hospital Infection Society. Published by Elsevier Ltd. All rights reserved.

  17. Proactive management of histopathology workloads: analysis of the UK Royal College of Pathologists’ recommendations on specimens of limited or no clinical value on the workload of a teaching hospital gastrointestinal pathology service

    PubMed Central

    Cross, S S; Stone, J L

    2002-01-01

    Aims: To investigate the effect on the workload of a gastrointestinal pathology service of implementing the recommendations of the Royal College of Pathologists’ (RCPath) working party on specimens of limited or no clinical value (LONCV). Methods: All endoscopic gastrointestinal pathology reports for the first three months of 2001 at a large teaching hospital were reviewed against the RCPath recommendations. Specimens in the category of LONCV were recorded and the final histopathology diagnosis noted. Results: The biopsies in the LONCV category were 30% of oesophageal, 61% of gastric, 0.5% of duodenal, and 7% of colorectal origin. Conclusions: Implementing the RCPath recommendations would reduce the number of requests for the examination of gastrointestinal endoscopic specimens by 3500 specimens each year in this department. None of the specimens in the LONCV category showed an abnormality that could not have been detected by a more efficient and less invasive method. In the UK, where there is a severe shortage of trained histopathologists, the implementation of these recommendations would ensure that these scarce resources are not misused. PMID:12401824

  18. Distinct prognostic values and potential drug targets of ALDH1 isoenzymes in non-small-cell lung cancer

    PubMed Central

    You, Qinghua; Guo, Huanchen; Xu, Dongxiang

    2015-01-01

    Increased aldehyde dehydrogenase 1 (ALDH1) activity has been found in the stem cell populations of leukemia and some solid tumors including non-small-cell lung cancer (NSCLC). However, which ALDH1’s isoenzymes are contributing to ALDH1 activity remains elusive. In addition, the prognostic value of individual ALDH1 isoenzyme is not clear. In the current study, we investigated the prognostic value of ALDH1 isoenzymes in NSCLC patients through the Kaplan–Meier plotter database, which contains updated gene expression data and survival information from a total of 1,926 NSCLC patients. High expression of ALDH1A1 mRNA was found to be correlated to a better overall survival (OS) in all NSCLC patients followed for 20 years (hazard ratio [HR] 0.88 [0.77–0.99], P=0.039). In addition, high expression of ALDH1A1 mRNA was also found to be correlated to better OS in adenocarcinoma (Ade) patients (HR 0.71 [0.57–0.9], P=0.0044) but not in squamous cell carcinoma (SCC) patients (HR 0.92 [0.72–1.16], P=0.48). High expression of ALDH1A2 and ALDH1B1 mRNA was found to be correlated to worser OS in all NSCLC patients, as well as in Ade, but not in SCC patients. High expression of both ALDH1A3 and ALDH1L1 mRNA was not found to be correlated to OS in all NSCLC patients. These results strongly support that ALDH1A1 mRNA in NSCLC is associated with better prognosis. In addition, our current study also supports that ALDH1A2 and ALDH1B1 might be major contributors to the ALDH1 activity in NSCLC, since high expression of ALDH1A2 and ALDH1B1 mRNA was found to be significantly correlated to worser OS in all NSCLC patients. Based on our study, ALDH1A2 and ALDH1B1 might be excellent potential drug targets for NSCLC patients. PMID:26366059

  19. Assessing the clinical value of targeted massively parallel sequencing in a longitudinal, prospective population-based study of cancer patients

    PubMed Central

    Wong, S Q; Fellowes, A; Doig, K; Ellul, J; Bosma, T J; Irwin, D; Vedururu, R; Tan, A Y-C; Weiss, J; Chan, K S; Lucas, M; Thomas, D M; Dobrovic, A; Parisot, J P; Fox, S B

    2015-01-01

    Introduction: Recent discoveries in cancer research have revealed a plethora of clinically actionable mutations that provide therapeutic, prognostic and predictive benefit to patients. The feasibility of screening mutations as part of the routine clinical care of patients remains relatively unexplored as the demonstration of massively parallel sequencing (MPS) of tumours in the general population is required to assess its value towards the health-care system. Methods: Cancer 2015 study is a large-scale, prospective, multisite cohort of newly diagnosed cancer patients from Victoria, Australia with 1094 patients recruited. MPS was performed using the Illumina TruSeq Amplicon Cancer Panel. Results: Overall, 854 patients were successfully sequenced for 48 common cancer genes. Accurate determination of clinically relevant mutations was possible including in less characterised cancer types; however, technical limitations including formalin-induced sequencing artefacts were uncovered. Applying strict filtering criteria, clinically relevant mutations were identified in 63% of patients, with 26% of patients displaying a mutation with therapeutic implications. A subset of patients was validated for canonical mutations using the Agena Bioscience MassARRAY system with 100% concordance. Whereas the prevalence of mutations was consistent with other institutionally based series for some tumour streams (breast carcinoma and colorectal adenocarcinoma), others were different (lung adenocarcinoma and head and neck squamous cell carcinoma), which has significant implications for health economic modelling of particular targeted agents. Actionable mutations in tumours not usually thought to harbour such genetic changes were also identified. Conclusions: Reliable delivery of a diagnostic assay able to screen for a range of actionable mutations in this cohort was achieved, opening unexpected avenues for investigation and treatment of cancer patients. PMID:25742471

  20. Use of thermodynamic sorption models to derive radionuclide Kd values for performance assessment: Selected results and recommendations of the NEA sorption project

    USGS Publications Warehouse

    Ochs, M.; Davis, J.A.; Olin, M.; Payne, T.E.; Tweed, C.J.; Askarieh, M.M.; Altmann, S.

    2006-01-01

    For the safe final disposal and/or long-term storage of radioactive wastes, deep or near-surface underground repositories are being considered world-wide. A central safety feature is the prevention, or sufficient retardation, of radionuclide (RN) migration to the biosphere. To this end, radionuclide sorption is one of the most important processes. Decreasing the uncertainty in radionuclide sorption may contribute significantly to reducing the overall uncertainty of a performance assessment (PA). For PA, sorption is typically characterised by distribution coefficients (Kd values). The conditional nature of Kd requires different estimates of this parameter for each set of geochemical conditions of potential relevance in a RN's migration pathway. As it is not feasible to measure sorption for every set of conditions, the derivation of Kd for PA must rely on data derived from representative model systems. As a result, uncertainty in Kd is largely caused by the need to derive values for conditions not explicitly addressed in experiments. The recently concluded NEA Sorption Project [1] showed that thermodynamic sorption models (TSMs) are uniquely suited to derive K d as a function of conditions, because they allow a direct coupling of sorption with variable solution chemistry and mineralogy in a thermodynamic framework. The results of the project enable assessment of the suitability of various TSM approaches for PA-relevant applications as well as of the potential and limitations of TSMs to model RN sorption in complex systems. ?? by Oldenbourg Wissenschaftsverlag.

  1. Target virus log10 reduction values determined for two reclaimed wastewater irrigation scenarios in Japan based on tolerable annual disease burden.

    PubMed

    Ito, Toshihiro; Kitajima, Masaaki; Kato, Tsuyoshi; Ishii, Satoshi; Segawa, Takahiro; Okabe, Satoshi; Sano, Daisuke

    2017-08-26

    Multiple-barriers are widely employed for managing microbial risks in water reuse, in which different types of wastewater treatment units (biological treatment, disinfection, etc.) and health protection measures (use of personal protective gear, vegetable washing, etc.) are combined to achieve a performance target value of log10 reduction (LR) of viruses. The LR virus target value needs to be calculated based on the data obtained from monitoring the viruses of concern and the water reuse scheme in the context of the countries/regions where water reuse is implemented. In this study, we calculated the virus LR target values under two exposure scenarios for reclaimed wastewater irrigation in Japan, using the concentrations of indigenous viruses in untreated wastewater and a defined tolerable annual disease burden (10(-4) or 10(-6) disability-adjusted life years per person per year (DALYpppy)). Three genogroups of norovirus (norovirus genogroup I (NoV GI), geogroup II (NoV GII), and genogroup IV (NoV GIV)) in untreated wastewater were quantified as model viruses using reverse transcription-microfluidic quantitative PCR, and only NoV GII was present in quantifiable concentration. The probabilistic distribution of NoV GII concentration in untreated wastewater was then estimated from its concentration dataset, and used to calculate the LR target values of NoV GII for wastewater treatment. When an accidental ingestion of reclaimed wastewater by Japanese farmers was assumed, the NoV GII LR target values corresponding to the tolerable annual disease burden of 10(-6) DALYpppy were 3.2, 4.4, and 5.7 at 95, 99, and 99.9%tile, respectively. These percentile values, defined as "reliability," represent the cumulative probability of NoV GII concentration distribution in untreated wastewater below the corresponding tolerable annual disease burden after wastewater reclamation. An approximate 1-log10 difference of LR target values was observed between 10(-4) and 10(-6) DALYpppy. The

  2. Detailed recommendations

    SciTech Connect

    1996-05-01

    The recommendations which have resulted from this workshop have come from several sources, including most importantly the break-out sessions, but also from discussions with other leaders in the field, some www discussions, and least of all the organization committee of the workshop. They may be divided into three sections, the ones which need immediate attention or should happen before the bulk of activities can take place, the priority items that will form the bulk of future research activities, and the important continuing items, that are ancillary to the main objective but help to nurture the field.

  3. Sleep-time blood pressure: prognostic value and relevance as a therapeutic target for cardiovascular risk reduction.

    PubMed

    Hermida, Ramón C; Ayala, Diana E; Fernández, José R; Mojón, Artemio

    2013-03-01

    Correlation between blood pressure (BP) level and target organ damage, cardiovascular disease (CVD) risk, and long-term prognosis is greater for ambulatory BP monitoring (ABPM) than clinical BP measurements. Nevertheless, the latter continue to be the "gold standard" to diagnose hypertension, assess CVD risk, and evaluate hypertension treatment. Independent ABPM studies have found that elevated sleep-time BP is a better predictor of CVD risk than either the awake or 24-h BP mean. A major limitation of all previous ABPM-based prognostic studies is the reliance only upon a single baseline profile from each participant at the time of inclusion, without accounting for potential changes in the level and pattern of ambulatory BP thereafter during follow-up. Accordingly, impact of the alteration over time, i.e., during long-term follow-up, of specific features of the 24-h BP variation on CVD risk has never been properly investigated. We evaluated the comparative prognostic value of (i) clinic and ambulatory BP; (ii) different ABPM-derived characteristics, e.g., asleep or awake BP mean; and (iii) specific changes in ABPM characteristic during follow-up, mainly whether reduced CVD risk is more related to the progressive decrease of asleep or awake BP. We prospectively studied 3344 subjects (1718 men/1626 women), 52.6 ± 14.5 (mean ± SD) yrs of age, during a median follow-up of 5.6 yrs. Those with hypertension at baseline were randomized to ingest all their prescribed hypertension medications upon awakening or ≥1 of them at bedtime. At baseline, BP was measured at 20-min intervals from 07:00 to 23:00 h and at 30-min intervals at night for 48-h, and physical activity was simultaneously monitored every min by wrist actigraphy to accurately derive awake and asleep BP means. Identical assessment was scheduled annually and more frequently (quarterly) if treatment adjustment was required. Data collected either at baseline or the last ABPM evaluation per participant

  4. "Pulmonary embolism diagnostics of pregnant patients: What is the recommended clinical pathway considering the clinical value and associated radiation risks of available imaging tests?"

    PubMed

    Papadakis, Georgios Z; Karantanas, Apostolos H; Perisinakis, Kostas

    2017-07-28

    Pulmonary embolism (PE) during pregnancy remains the leading preventable cause of maternal morbidity and mortality in the developed countries. Diagnosis of PE in pregnant patients is a challenging clinical problem, since pregnancy-related physiologic changes can mimic signs and symptoms of PE. Patient mismanagement may result into unjustified anticoagulant treatment or unnecessary imaging tests involving contrast-related or/and radiation-related risks for both the expectant mother and embryo/fetus. On the other hand, missing or delaying diagnosis of PE could lead to life-threatening conditions for both the mother and the embryo/fetus. Thus, a timely and accurate diagnostic approach is required for the optimal management of pregnant patients with suspected PE. Aim of the current review is to discuss a pregnancy-specific clinical pathway for the early diagnosis of PE with non-ionizing radiation- and ionizing radiation-based imaging modalities taking into account previously reported data on diagnostic value of available imaging tests, and radiation related concerns. Copyright © 2017 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.

  5. Groundwater and stream threshold values for targeted and differentiated output based regulation of nutrient loadings to ecosystems

    NASA Astrophysics Data System (ADS)

    Hinsby, Klaus; Refsgaard, Jens Christian

    2015-04-01

    even field scale based on estimated acceptable nutrient loadings to transitional and coastal waters (or any other protected aquatic ecosystem in the river basin) according to the requirements of the EU Water Framework and Groundwater directives, and use these to monitor and plan sustainable water and land use management, e.g. by differentiated practices in farming and land use within sub-catchments. Specifically, we suggest that monitoring of the nitrogen outputs from catchments, sub-catchment and even delineated specific fields with new cost-effective monitoring systems in combination with coupled soil-groundwater-surface water models has a large potential for the development of efficient differentiated measures controlling nutrient loadings to aquatic ecosystems. Here we present initial considerations and suggestions for the development of new governance concepts targeted at differentiated output based regulations using threshold values for N in groundwater and streams derived from acceptable loadings to a small Danish estuary.

  6. National Beef Quality Audit-2011: Harvest-floor assessments of targeted characteristics that affect quality and value of cattle, carcasses, and byproducts

    USDA-ARS?s Scientific Manuscript database

    The National Beef Quality Audit-2011(NBQA-2011) was conducted to assess targeted characteristics on the harvest floor that affect the quality and value of cattle, carcasses, and byproducts. Survey teams evaluated approximately 18,000 cattle/carcasses between May and November 2011 in 8 beef processin...

  7. Purchases of ready-to-eat cereals vary across US household sociodemographic categories according to nutritional value and advertising targets.

    PubMed

    Castetbon, Katia; Harris, Jennifer L; Schwartz, Marlene B

    2012-08-01

    To describe ready-to-eat (RTE) cereal purchases in 2008 in the USA according to cereal nutritional quality and marketing strategy and household sociodemographic characteristics. Cross-sectional study of purchases in one year. Each type of cereal was assigned to one of four nutrition quality categories (based on Nutrient Profile Index, NPI) and one of four advertising categories based on television exposure and analysis of packaging (child-targeted, family-targeted, adult-targeted and no television advertising). Medians and distributions of purchase indicators were calculated for the cereal categories and the distributions were compared across sociodemographic groups. RTE cereals (n 249) with complete label and nutritional content. RTE cereal purchases according to household sociodemographic characteristics obtained from Nielsen Homescan, a nationally representative panel of households. Purchases of RTE cereals were highest in households with one or more child and lowest in African-American and Asian households, as well as those earning <$US 30 000 per annum. The lowest-quality products were purchased by four times as many households as the highest-quality cereals, but loyalty to these products was lower. Purchases of cereals by households with children and in African-American and Hispanic households increased as cereal nutritional quality declined. Compared with non-advertised products, advertised child-targeted cereals were purchased thirteen times more frequently; family-targeted brand purchases were ten times higher; and adult-targeted cereals were purchased four times more frequently. Our findings suggest that improving the nutritional quality of RTE cereals with advertising targeted to children could also lead to increased consumption of healthier products by young people.

  8. The relation between various conformity indices and the influence of the target coverage difference in prescription isodose surface on these values in intracranial stereotactic radiosurgery

    PubMed Central

    Ohtakara, K; Hayashi, S; Hoshi, H

    2012-01-01

    Objective The purpose of this study was to describe the relation between various frequently used conformity indices (CIs) and to examine the influence of the target coverage (TC) difference in prescription isodose surface (IDS) on these CI values in dynamic conformal arc (DCA) plans. Method 73 plans for simple-shaped brain metastases that were previously characterised for dose distribution with regard to the effect of the target volume (TV) and the depth from the skin surface were reviewed. Three different-definition CI values for each TV were calculated at the 80% IDS, and at D99, D95, D90 and D85, considering the interplanner variability in the TC values for the prescription IDS. Results The CI used as the Radiation Therapy Oncology Group criterion showed nearly perfect values at D90. The CI defined in the BrainSCAN (BrainLAB AG, Feldkirchen, Germany) treatment planning system (CIBS) denoted lower (superior) values as the TC of the reference IDS decreased. Nakamura’s CI (NCI) had lower variability but demonstrated lower (superior) values at D95. NCI showed the most stringent (higher) values at an 80% IDS, but the differences between the plans were less distinct with NCI. Conclusion The TC difference in IDS chosen for dose prescription or evaluation significantly led to CI value variability in a definition-dependent manner, even when NCI was applied. Definition of the reference IDS at a specific TC value according to clinical situation would reduce the CI value variability to a minimum and would make the CIBS sufficient for the objective metric with a perfect value of 1. PMID:21937612

  9. Recommendations for Developing Contextually Relevant HIV/AIDS Prevention Strategies Targeting African-Born Immigrants and Refugees in the United States.

    PubMed

    Kingori, Caroline; Esquivel, Camila LeMaster; Hassan, Qorsho; Elmi, Abdul; Mukasa, Bakali; Reece, Michael

    2016-10-01

    African-born immigrants and refugees have HIV infection rates six times higher than any other minority groups in the United States. Despite the increase in the population size and diversity of Somali immigrants and refugees in the United States, Somalis are one of the medically underserved population subgroups in this region. The lack of aggregate HIV infection rates among African-born immigrants, for example, Somali refugees, is a cause for alarm and calls for more research to be conducted in this subgroup. The purpose of this article was to examine contextually relevant HIV prevention strategies that will enhance HIV prevention among Somali immigrant/refugee young adults in the United States. Using the grounded theory approach, a convenience sample of 27 immigrant/refugee young adults was recruited in central Ohio. Recommendations for potential HIV prevention strategies emerged under two main categories: (1) internal community resources and (2) external platforms. Study findings support a collaborative approach involving community leaders (parents, elders, religious leaders) and educational (schools), media, and healthcare settings to tailor HIV prevention strategies that meet the needs of the priority group.

  10. Human Papillomavirus vaccination in general practice in France, three years after the implementation of a targeted vaccine recommendation based on age and sexual history

    PubMed Central

    Thierry, Pascale; Lasserre, Andrea; Rossignol, Louise; Kernéis, Solen; Blaizeau, Fanette; Stheneur, Chantal; Blanchon, Thierry; Levy-Bruhl, Daniel; Hanslik, Thomas

    2016-01-01

    In France, vaccination against human papilloma virus (HPV) was recommended in 2007 for all 14-year-old girls as well as “catch-up” vaccination for girls between 15–23 y of age either before or within one year of becoming sexually active. We evaluated the vaccine coverage according to the eligibility for vaccination in a sample of young girls aged 14 to 23 years, who were seen in general practices. A survey was proposed to 706 general practitioners (GPs) and carried out from July to September 2010. GPs, also called “family doctor,” are physicians whose practice is not restricted to a specific field of medicine but instead covers a variety of medical problems in patients of all ages. Each participating GP included, retrospectively, the last female patient aged 14–17 y and the last female patient aged 18–23 y whom he had seen. A questionnaire collected information regarding the GP and the patients' characteristics. The vaccine coverage was determined according to the eligibility for vaccination, i.e. the coverage among younger women (14–17) and among those sexually active in the second age range (18–23). Sexual activity status was assessed by GP, according to information stated in the medical record. The 363 participating physicians (response rate 51.4%) included 712 patients (357 in the 14- to 17-year-old group and 355 in the 15- to 23-year-old group) in their responses. The rate of the vaccination coverage in the 14- to 17-year-old group was 55%. Among the girls in the 18- to 23-year-old group, 126 were eligible, and their vaccination coverage rate was 82%. The evaluation of the eligibility by the GPs was incorrect in 36% of the cases. Of the 712 patients, 6% of the girls had been vaccinated without a need for the vaccination, and 26% of the girls had not been vaccinated, although they needed to be vaccinated. Regarding the vaccine uptake, vaccination at the age of 14 was not as effective as vaccinating the older population for which vaccination

  11. Human Papillomavirus vaccination in general practice in France, three years after the implementation of a targeted vaccine recommendation based on age and sexual history.

    PubMed

    Thierry, Pascale; Lasserre, Andrea; Rossignol, Louise; Kernéis, Solen; Blaizeau, Fanette; Stheneur, Chantal; Blanchon, Thierry; Levy-Bruhl, Daniel; Hanslik, Thomas

    2016-01-01

    In France, vaccination against human papilloma virus (HPV) was recommended in 2007 for all 14-year-old girls as well as "catch-up" vaccination for girls between 15-23 y of age either before or within one year of becoming sexually active. We evaluated the vaccine coverage according to the eligibility for vaccination in a sample of young girls aged 14 to 23 years, who were seen in general practices. A survey was proposed to 706 general practitioners (GPs) and carried out from July to September 2010. GPs, also called "family doctor," are physicians whose practice is not restricted to a specific field of medicine but instead covers a variety of medical problems in patients of all ages. Each participating GP included, retrospectively, the last female patient aged 14-17 y and the last female patient aged 18-23 y whom he had seen. A questionnaire collected information regarding the GP and the patients' characteristics. The vaccine coverage was determined according to the eligibility for vaccination, i.e. the coverage among younger women (14-17) and among those sexually active in the second age range (18-23). Sexual activity status was assessed by GP, according to information stated in the medical record. The 363 participating physicians (response rate 51.4%) included 712 patients (357 in the 14- to 17-year-old group and 355 in the 15- to 23-year-old group) in their responses. The rate of the vaccination coverage in the 14- to 17-year-old group was 55%. Among the girls in the 18- to 23-year-old group, 126 were eligible, and their vaccination coverage rate was 82%. The evaluation of the eligibility by the GPs was incorrect in 36% of the cases. Of the 712 patients, 6% of the girls had been vaccinated without a need for the vaccination, and 26% of the girls had not been vaccinated, although they needed to be vaccinated. Regarding the vaccine uptake, vaccination at the age of 14 was not as effective as vaccinating the older population for which vaccination was indicated as a

  12. A Roland Morris Disability Questionnaire Target Value to Distinguish between Functional and Dysfunctional States in People with Low Back Pain

    PubMed Central

    Riddle, Daniel L.

    2016-01-01

    Purpose: To estimate a threshold Roland Morris Disability Questionnaire (RMQ) value that could be used to classify patients with low back pain (LBP) as functional or dysfunctional. Methods: In this secondary analysis of data from a study that estimated clinically important RMQ change scores, participants were adults with LBP attending one of three physical therapy clinics. Diagnostic test methodology and a reference standard of goals met were applied to estimate a threshold RMQ value that best distinguished between participants with a functional status and those whose status was dysfunctional. Results: Of 143 participants, 104 (73%) met their goals. An RMQ threshold value of 4/24 best distinguished between those who met their goals and those who did not. Sensitivity and specificity for a threshold score of 4 were 94% (95% CI, 88–98) and 69% (95% CI, 52–83), respectively. Conclusions: A threshold value of 4 RMQ points provided a reasonably accurate classification of patients. Further research is necessary to cross-validate this estimate and to examine the stability of the estimated value in people with diverse functional demands. PMID:27504045

  13. Olmesartan vs ramipril in the treatment of hypertension and associated clinical conditions in the elderly: a reanalysis of two large double-blind, randomized studies at the light of the most recent blood pressure targets recommended by guidelines

    PubMed Central

    Omboni, Stefano; Malacco, Ettore; Mallion, Jean-Michel; Volpe, Massimo

    2015-01-01

    In this paper, we present the results of a reanalysis of the data of two large randomized, double-blind, parallel group studies with a similar design, comparing the efficacy of an angiotensin-receptor blocker (olmesartan medoxomil) with that of an angiotensin-converting enzyme inhibitor (ramipril), by applying two different blood pressure targets recently recommended by hypertension guidelines for all patients, irrespective of the presence of diabetes (<140/90 mmHg), and for elderly hypertensive patients (<150/90 mmHg). The efficacy of olmesartan was not negatively affected by age, sex, hypertension type, diabetes status or other concomitant clinical conditions, or cardiovascular risk factors. In most cases, olmesartan provided better blood pressure control than ramipril. Olmesartan was significantly more effective than ramipril in male patients, in younger patients (aged 65–69 years), in those with metabolic syndrome, obesity, dyslipidemia, preserved renal function, diastolic ± systolic hypertension, and, in general, in patients with a high or very high cardiovascular risk. Interestingly, patients previously untreated or treated with two or more antihypertensive drugs showed a significantly larger response with olmesartan than with ramipril. Thus, our results confirm the good efficacy of olmesartan in elderly hypertensives even when new blood pressure targets for antihypertensive treatment are considered. Such results may be relevant for the clinical practice, providing some hint on the possible different response of elderly hypertensive patients to two different drugs acting on the renin–angiotensin system, when patients are targeted according to the blood pressure levels recommended by recent hypertension guidelines. PMID:26491273

  14. Olmesartan vs ramipril in the treatment of hypertension and associated clinical conditions in the elderly: a reanalysis of two large double-blind, randomized studies at the light of the most recent blood pressure targets recommended by guidelines.

    PubMed

    Omboni, Stefano; Malacco, Ettore; Mallion, Jean-Michel; Volpe, Massimo

    2015-01-01

    In this paper, we present the results of a reanalysis of the data of two large randomized, double-blind, parallel group studies with a similar design, comparing the efficacy of an angiotensin-receptor blocker (olmesartan medoxomil) with that of an angiotensin-converting enzyme inhibitor (ramipril), by applying two different blood pressure targets recently recommended by hypertension guidelines for all patients, irrespective of the presence of diabetes (<140/90 mmHg), and for elderly hypertensive patients (<150/90 mmHg). The efficacy of olmesartan was not negatively affected by age, sex, hypertension type, diabetes status or other concomitant clinical conditions, or cardiovascular risk factors. In most cases, olmesartan provided better blood pressure control than ramipril. Olmesartan was significantly more effective than ramipril in male patients, in younger patients (aged 65-69 years), in those with metabolic syndrome, obesity, dyslipidemia, preserved renal function, diastolic ± systolic hypertension, and, in general, in patients with a high or very high cardiovascular risk. Interestingly, patients previously untreated or treated with two or more antihypertensive drugs showed a significantly larger response with olmesartan than with ramipril. Thus, our results confirm the good efficacy of olmesartan in elderly hypertensives even when new blood pressure targets for antihypertensive treatment are considered. Such results may be relevant for the clinical practice, providing some hint on the possible different response of elderly hypertensive patients to two different drugs acting on the renin-angiotensin system, when patients are targeted according to the blood pressure levels recommended by recent hypertension guidelines.

  15. Differences among Monte Carlo codes in the calculations of voxel S values for radionuclide targeted therapy and analysis of their impact on absorbed dose evaluations

    SciTech Connect

    Pacilio, M.; Lanconelli, N.; Lo Meo, S.; Betti, M.; Montani, L.; Torres Aroche, L. A.; Coca Perez, M. A.

    2009-05-15

    Several updated Monte Carlo (MC) codes are available to perform calculations of voxel S values for radionuclide targeted therapy. The aim of this work is to analyze the differences in the calculations obtained by different MC codes and their impact on absorbed dose evaluations performed by voxel dosimetry. Voxel S values for monoenergetic sources (electrons and photons) and different radionuclides ({sup 90}Y, {sup 131}I, and {sup 188}Re) were calculated. Simulations were performed in soft tissue. Three general-purpose MC codes were employed for simulating radiation transport: MCNP4C, EGSnrc, and GEANT4. The data published by the MIRD Committee in Pamphlet No. 17, obtained with the EGS4 MC code, were also included in the comparisons. The impact of the differences (in terms of voxel S values) among the MC codes was also studied by convolution calculations of the absorbed dose in a volume of interest. For uniform activity distribution of a given radionuclide, dose calculations were performed on spherical and elliptical volumes, varying the mass from 1 to 500 g. For simulations with monochromatic sources, differences for self-irradiation voxel S values were mostly confined within 10% for both photons and electrons, but with electron energy less than 500 keV, the voxel S values referred to the first neighbor voxels showed large differences (up to 130%, with respect to EGSnrc) among the updated MC codes. For radionuclide simulations, noticeable differences arose in voxel S values, especially in the bremsstrahlung tails, or when a high contribution from electrons with energy of less than 500 keV is involved. In particular, for {sup 90}Y the updated codes showed a remarkable divergence in the bremsstrahlung region (up to about 90% in terms of voxel S values) with respect to the EGS4 code. Further, variations were observed up to about 30%, for small source-target voxel distances, when low-energy electrons cover an important part of the emission spectrum of the radionuclide

  16. Recommender systems in knowledge-mining

    NASA Astrophysics Data System (ADS)

    Volna, Eva

    2017-07-01

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

  17. Continuous improvement of medical test reliability using reference methods and matrix-corrected target values in proficiency testing schemes: application to glucose assay.

    PubMed

    Delatour, Vincent; Lalere, Beatrice; Saint-Albin, Karène; Peignaux, Maryline; Hattchouel, Jean-Marc; Dumont, Gilles; De Graeve, Jacques; Vaslin-Reimann, Sophie; Gillery, Philippe

    2012-11-20

    The reliability of biological tests is a major issue for patient care in terms of public health that involves high economic stakes. Reference methods, as well as regular external quality assessment schemes (EQAS), are needed to monitor the analytical performance of field methods. However, control material commutability is a major concern to assess method accuracy. To overcome material non-commutability, we investigated the possibility of using lyophilized serum samples together with a limited number of frozen serum samples to assign matrix-corrected target values, taking the example of glucose assays. Trueness of the current glucose assays was first measured against a primary reference method by using human frozen sera. Methods using hexokinase and glucose oxidase with spectroreflectometric detection proved very accurate, with bias ranging between -2.2% and +2.3%. Bias of methods using glucose oxidase with spectrophotometric detection was +4.5%. Matrix-related bias of the lyophilized materials was then determined and ranged from +2.5% to -14.4%. Matrix-corrected target values were assigned and used to assess trueness of 22 sub-peer groups. We demonstrated that matrix-corrected target values can be a valuable tool to assess field method accuracy in large scale surveys where commutable materials are not available in sufficient amount with acceptable costs.

  18. Distribute The Highest Selected Textual Recommendation (DTHSTR)

    SciTech Connect

    2012-05-01

    The DTHSTR computer code uses a set of documents as seed documents to recommend documents of interest from a large, target set of documents. The computer code provides results that show the highest recommended documents as well as the terms in common between the recommend document and the corresponding seed document that is most similar.

  19. Targeting high value metals in lithium-ion battery recycling via shredding and size-based separation.

    PubMed

    Wang, Xue; Gaustad, Gabrielle; Babbitt, Callie W

    2016-05-01

    Development of lithium-ion battery recycling systems is a current focus of much research; however, significant research remains to optimize the process. One key area not studied is the utilization of mechanical pre-recycling steps to improve overall yield. This work proposes a pre-recycling process, including mechanical shredding and size-based sorting steps, with the goal of potential future scale-up to the industrial level. This pre-recycling process aims to achieve material segregation with a focus on the metallic portion and provide clear targets for subsequent recycling processes. The results show that contained metallic materials can be segregated into different size fractions at different levels. For example, for lithium cobalt oxide batteries, cobalt content has been improved from 35% by weight in the metallic portion before this pre-recycling process to 82% in the ultrafine (<0.5mm) fraction and to 68% in the fine (0.5-1mm) fraction, and been excluded in the larger pieces (>6mm). However, size fractions across multiple battery chemistries showed significant variability in material concentration. This finding indicates that sorting by cathode before pre-treatment could reduce the uncertainty of input materials and therefore improve the purity of output streams. Thus, battery labeling systems may be an important step towards implementation of any pre-recycling process. Copyright © 2015 Elsevier Ltd. All rights reserved.

  20. Unravelling the Complexity of Inherited Retinal Dystrophies Molecular Testing: Added Value of Targeted Next-Generation Sequencing

    PubMed Central

    Tenedini, Elena; Artuso, Lucia; Percesepe, Antonio; Artusi, Valentina; Simone, Maria Luisa; Manfredini, Rossella; Camparini, Monica; Ciardella, Antonio; Graziano, Claudio; Pietrangelo, Antonello; Marigo, Valeria

    2016-01-01

    To assess the clinical utility of targeted Next-Generation Sequencing (NGS) for the diagnosis of Inherited Retinal Dystrophies (IRDs), a total of 109 subjects were enrolled in the study, including 88 IRD affected probands and 21 healthy relatives. Clinical diagnoses included Retinitis Pigmentosa (RP), Leber Congenital Amaurosis (LCA), Stargardt Disease (STGD), Best Macular Dystrophy (BMD), Usher Syndrome (USH), and other IRDs with undefined clinical diagnosis. Participants underwent a complete ophthalmologic examination followed by genetic counseling. A custom AmpliSeq™ panel of 72 IRD-related genes was designed for the analysis and tested using Ion semiconductor Next-Generation Sequencing (NGS). Potential disease-causing mutations were identified in 59.1% of probands, comprising mutations in 16 genes. The highest diagnostic yields were achieved for BMD, LCA, USH, and STGD patients, whereas RP confirmed its high genetic heterogeneity. Causative mutations were identified in 17.6% of probands with undefined diagnosis. Revision of the initial diagnosis was performed for 9.6% of genetically diagnosed patients. This study demonstrates that NGS represents a comprehensive cost-effective approach for IRDs molecular diagnosis. The identification of the genetic alterations underlying the phenotype enabled the clinicians to achieve a more accurate diagnosis. The results emphasize the importance of molecular diagnosis coupled with clinic information to unravel the extensive phenotypic heterogeneity of these diseases. PMID:28127548

  1. Targeting patients with asthma for omalizumab therapy: choosing the right patient to get the best value for money

    PubMed Central

    Al Said, Abir; Cushen, Breda; Costello, Richard W

    2017-01-01

    The asthma syndrome has many manifestations, termed phenotypes, that arise by specific cellular and molecular mechanisms, termed endotypes. Understanding an individual’s asthma phenotype helps clinicians make rational therapeutic decisions while the understanding of endotypes has led to the development of specific precision medications. Allergic asthma is an example of an asthma phenotype and omalizumab, a monoclonal antibody that neutralizes serum immunoglobulin (Ig)E, is a specific targeted treatment which was developed as a result of an understanding of the endotype of allergic asthma. Omalizumab has been widely used in clinical practice in Europe for over a decade as an add-on therapy to treat patients who have severe refractory allergic asthma. Over this period, many centres have reported their experience with omalizumab as an add-on therapy in patients with severe asthma. These ‘real world’ clinical effectiveness studies have confirmed the benefits, cost-effectiveness and clinical utility of this medication. Combining the outcomes of both sources of research has yielded important insights that may benefit patients with severe asthma, clinicians who treat them, as well as the funding agencies that reimburse the cost of this medication. The purpose of this review is to describe how to identify and evaluate a patient with asthma for whom treatment with omalizumab may be of clinical and cost-effective benefit. The assessment and investigations used to confirm allergic asthma, the objective assessment of adherence to asthma therapy and the expected benefits of add-on omalizumab treatment are described. PMID:28348726

  2. The economic value of innovative treatments over the product life cycle: the case of targeted trastuzumab therapy for breast cancer.

    PubMed

    Garrison, Louis P; Veenstra, David L

    2009-01-01

    Pharmacoeconomic analyses typically project the expected cost-effectiveness of a new product for a specific indication. This analysis develops a dynamic life-cycle model to conduct a multi-indication evaluation using the case of trastuzumab licensed in the United States for both early-stage and metastatic (or late-stage) human epidermal growth factor receptor 2 (HER2)-positive breast cancer therapy (early breast cancer [EBC]; metastatic breast cancer [MBC]), approved in 2006 and 1998, respectively. This dynamic model combined information on expected incremental cost-utility ratios for specific indications with an epidemiologically based projection of utilization by indication over the product life cycle-from 1998 to 2016. Net economic value was estimated as the cumulative quality-adjusted life years (QALYs) gained over the life cycle multiplied by a societal valuation of health gains ($/QALY) minus cumulative net direct treatment costs. Sensitivity analyses were performed under a range of assumptions. We projected that the annual number of EBC patients receiving trastuzumab will be more than three times that of MBC by 2016, in part because adjuvant treatment reduces the future incidence of MBC. Over this life cycle, the estimated overall incremental cost-effectiveness ratio (ICER) was $35,590/QALY with a total of 432,547 discounted QALYs gained. Under sensitivity analyses, the overall ICER varied from $21,000 to $53,000/QALY, and the projected net economic value resulting from trastuzumab treatment ranged from $6.2 billion to $49.5 billion. Average ICERs for multi-indication compounds can increase or decrease over the product life cycle. In this example, the projected overall life-cycle ICER for trastuzumab was less than one half of that in the initial indication. This dynamic perspective-versus the usual static one-highlights the interdependence of drug development decisions and investment incentives, raising important reimbursement policy issues.

  3. Microvessel Landscape Assessment in Pancreatic Ductal Adenocarcinoma: Unclear Value of Targeting Endoglin (CD105) as Prognostic Factor of Clinical Outcome.

    PubMed

    Lytras, Dimitrios; Leontara, Vassileia; Kefala, Maria; Foukas, Periklis G; Giannakou, Niki; Pouliakis, Abraham; Dervenis, Christos; Panayiotides, Ioannis G; Karakitsos, Petros

    2015-01-01

    Tumor angiogenesis based on microvessel density assessment has been associated with poor prognosis in several studies of patients with pancreatic ductal adenocarcinoma (PDAC). Expression of endoglin (CD105), a tumor-induced vascularization marker, has been found to represent a negative prognostic factor in many malignant tumors. The aim of our study was to assess the value of tumoral microvascularity both with pan-endothelial markers and endoglin as well, in correlation with the clinical outcome of patients with PDAC. Fifty-eight patients with PDAC, 36 males and 22 females, with a mean (SD) age of 65.4 (10.0) years were included in the study. Deparaffinized sections from formalin-fixed areas both from the center and periphery (invasion front) of the tumors were immunostained for CD105 as well as for the endothelial markers CD31 and CD34. Tumoral angiogenesis was assessed on the basis of microvessel density (number of vessels per square millimeter) and on microvascular area (square micrometers) as well. High intratumoral microvascular area, in endoglin-stained sections, was found to be of marginal prognostic significance for recurrence (log rank, P 0.05). Survival was also marginally associated with CD31 intratumoral microvascular area (log rank, P 0.05). Further studies are needed before endoglin replaces the conventional angiogenesis markers in PDCA.

  4. Value of Targeted Prostate Biopsy Using Magnetic Resonance–Ultrasound Fusion in Men with Prior Negative Biopsy and Elevated Prostate-specific Antigen

    PubMed Central

    Sonn, Geoffrey A.; Chang, Edward; Natarajan, Shyam; Margolis, Daniel J.; Macairan, Malu; Lieu, Patricia; Huang, Jiaoti; Dorey, Frederick J.; Reiter, Robert E.; Marks, Leonard S.

    2013-01-01

    Background Conventional biopsy fails to detect the presence of some prostate cancers (PCas). Men with a prior negative biopsy but persistently elevated prostate-specific antigen (PSA) pose a diagnostic dilemma, as some harbor elusive cancer. Objective To determine whether use of magnetic resonance–ultrasound (MR-US) fusion biopsy results in improved detection of PCa compared to repeat conventional biopsy. Design, setting, and participants In a consecutive-case series, 105 subjects with prior negative biopsy and elevated PSA values underwent multiparametric magnetic resonance imaging (MRI) and fusion biopsy in an outpatient setting. Intervention Suspicious areas on multiparametric MRI were delineated and graded by a radiologist; MR–US fusion biopsy was performed by a urologist using the Artemis device; targeted and systematic biopsies were obtained regardless of MRI result. Outcome measurements and statistical analysis Detection rates of all PCa and clinically significant PCa (Gleason ≥3 + 4 or Gleason 6 with maximal cancer core length ≥4 mm) were determined. The yield of targeted biopsy was compared to systematic biopsy. The ability of an MRI grading system to predict clinically significant cancer was investigated. Stepwise multivariate logistic regression analysis was performed to determine predictors of significant cancer on biopsy. Results and limitations Fusion biopsy revealed PCa in 36 of 105 men (34%; 95% confidence interval [CI], 25–45). Seventy-two percent of men with PCa had clinically significant disease; 21 of 23 men (91%) with PCa on targeted biopsy had significant cancer compared to 15 of 28 (54%) with systematic biopsy. Degree of suspicion on MRI was the most powerful predictor of significant cancer on multivariate analysis. Twelve of 14 (86%) subjects with a highly suspicious MRI target were diagnosed with clinically significant cancer. Conclusions MR-US fusion biopsy provides improved detection of PCa in men with prior negative biopsies

  5. MRI screening-detected breast lesions in high-risk young women: the value of targeted second-look ultrasound and imaging-guided biopsy.

    PubMed

    Peter, P; Dhillon, R; Bose, S; Bourke, A

    2016-10-01

    To analyse the value of targeted second-look ultrasound and imaging-guided biopsy in high-risk young women eligible for screening magnetic resonance imaging (MRI) in a tertiary referral centre in Perth, Western Australia. A retrospective analysis of eligible high-risk young women who underwent screening breast MRI and targeted second-look ultrasound between June 2012 and June 2014 was performed with review of data. Over a 2-year period, 139 women underwent high-risk screening MRI. Of these, 30 women (with a total of 45 lesions) were recalled for targeted second-look ultrasound. Thirty-four MRI-detected lesions were identified on targeted ultrasound with 19 of them proceeding to ultrasound-guided biopsy, while the remaining 15 lesions were considered benign on ultrasound, were not biopsied, and were stable on follow-up imaging 12 months later. One lesion proceeded to an MRI-guided biopsy to confirm a benign result. Of the 11 lesions not seen on ultrasound, nine underwent MRI biopsy, one proceeded directly to hook wire localisation and excision, and one did not return for biopsy and was lost to follow-up. The overall biopsy rate was 14.4%. The cancer detection rate was 1.4%. The results of this study indicate that targeted second-look ultrasound and ultrasound-guided biopsy is a cost-effective and time-efficient approach for MRI-detected lesions in young women at high risk of developing breast cancer. MRI-guided biopsy should be considered for ultrasonographically occult suspicious lesions as there is a low, but definite, risk of cancer. Copyright © 2016 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

  6. Targeting and valuing conservation investments in support of a water fund: linking upstream land management with downstream services in the Upper Tana catchment, Kenya

    NASA Astrophysics Data System (ADS)

    Bryant, B. P.; Droogers, P.; Hunink, J.; Vogl, A.; Wolny, S.

    2014-12-01

    We apply an integrated modeling framework to both target and value watershed management interventions in the Upper Tana watershed, which provides municipal water, irrigation water, and hydropower services to Nairobi and surrounding areas. The analysis begins by applying an index model approach that incorporates existing land use and land surface characteristics to prioritize the type and location of conservation investments in different subbasins, subject to budget constraints and stakeholder concerns (Resource Investment Optimization System -- RIOS). We then run the Soil and Water Assessment Tool (SWAT) using the RIOS-identified investment scenarios to produce spatially explicit scenarios that simulate changes in water yield and suspended sediment. Finally, we link those biophysical outputs to monetary and non-monetary human well-being metrics for multiple benefit streams, including: Reduced water treatment costs, increased hydropower production, and crop yield benefits for upstream farmers in the conservation area. The viability of a payment for watershed services scheme is discussed, with attention to the various components of value assessed and to dependencies on water management approaches. While other studies have examined links between land use and the provision of hydrologic services, this study is novel in that it presents an integrated analysis that targets interventions in a decision context and then relies on calibrated, process-based, biophysical models to demonstrate the return on those investments considering multiple (and sometimes competing) hydrological services, doing so at a sub-annual time-scale.

  7. New drugs targeting the cardiac ultra-rapid delayed-rectifier current (I Kur): rationale, pharmacology and evidence for potential therapeutic value.

    PubMed

    Ford, John W; Milnes, James T

    2008-08-01

    There is a clear unmet medical need for new pharmacologic therapies for the treatment of atrial fibrillation (AF) with improved efficacy and safety. This article reviews the development of new and novel Kv1.5/ultra-rapid delayed-rectifier current (I Kur) inhibitors and presents evidence that Kv1.5 modulation provides an atrial-selective mechanism for treating AF. Academia and industry have invested heavily in Kv1.5 (>500 scientific publications and >50 patents published since 1993); however, to realize the full value of this therapeutic drug target, clinical efficacy and safety data are required for a selective Kv1.5 modulator. The reward for demonstrating clinical efficacy and safety in a pivotal Phase 3 trial, on regulatory approval, is "first in class" status.

  8. Efficacy and safety of biological and targeted-synthetic DMARDs: a systematic literature review informing the 2016 update of the ASAS/EULAR recommendations for the management of axial spondyloarthritis

    PubMed Central

    Regel, Andrea; van der Heijde, Désirée; Braun, Jürgen; Baraliakos, Xenofon; Landewé, Robert; Van den Bosch, Filip; Falzon, Louise; Ramiro, Sofia

    2017-01-01

    Objectives To update the evidence for the efficacy and safety of (b)biological and (ts)targeted-synthetic disease-modifying anti-rheumatic drugs (DMARDs) in patients with axial spondyloarthritis (axSpA) to inform the 2016 update of the Assessment of SpondyloArthritis international Society/European League Against Rheumatism (ASAS/EULAR) recommendations for the management of axSpA. Methods Systematic literature review (2009–2016) for randomised controlled trials (RCT), including long-term extensions, strategy trials and observational studies (the latter was only for safety assessment and a comparator was required). Interventions were any bDMARD or tsDMARD. All relevant efficacy and safety outcomes were included. Results 76 papers and 24 abstracts fulfilled the inclusion criteria. Large treatment effects were found both in radiographic axSpA (r-axSpA) and non-radiographic axSpA (nr-axSpA) for all tumour necrosis factor inhibitors (TNFi) (NNT to achieve ASAS40 response ranged between 2.6–5.2 for r-axSpA and 2.3–5.4 for nr-axSpA). For nr-axSpA, efficacy was superior for those who had objective signs of inflammation (positive C reactive protein or inflammation on MRI-SI). Secukinumab 150 mg has shown efficacy in two phase 3 RCTs (NNT to achieve ASAS40 response: 3.4 and 4.0). Ustekinumab and tofacitinib have shown positive results in phase 2/proof-of-concept trials; trials with apremilast, rituximab, interleukin (IL)-6 antagonists and abatacept have failed their primary end points. New (unknown) safety signals were not found in the trials but long-term observational safety data for TNFi are still scarce. Conclusions New evidence supports the efficacy and safety of TNFi both in r-axSpA and nr-axSpA. Secukinumab is the first drug targeting the IL-17 pathway in r-axSpA that has shown efficacy. PMID:28176964

  9. Management recommendations for osteoporosis in clinical guidelines.

    PubMed

    Wang, Michael; Bolland, Mark; Grey, Andrew

    2016-05-01

    Numerous guidelines advise about management of osteoporosis, but little research has been conducted on their recommendations. We analysed recommendations on management of bone health in clinical guidelines. We surveyed recommendations on assessment, treatment and monitoring of bone health in 78 clinical guidelines (22 primary focus osteoporosis, 56 primary focus not osteoporosis) lodged at the Agency for Health Research and Quality National Guidelines Clearinghouse between 1/1/2009 and 12/31/2014. Governance of guidelines; discussion of fracture risk in the target population; recommendations for assessment, treatment and monitoring of bone health. Only 14% of guidelines discussed fracture risk in the target population. When guidelines discussed assessment, 98% recommended bone mineral density (BMD) measurement but only 27% recommended estimation of fracture risk. When guidelines discussed treatment, 63-71% recommended calcium and/or vitamin D, while <12% recommended avoiding low body weight or smoking cessation. When guidelines discussed intervention, 53% did so on the basis of BMD measurement, and only 27% on the basis of estimated fracture risk. When guidelines discussed monitoring, >90% recommended BMD measurements, and only 3% recommended estimation of fracture risk. About 65% of guidelines that suggested a BMD monitoring interval recommended one of ≤3 years. Compared to guidelines with a primary focus on osteoporosis, guidelines whose primary focus was not osteoporosis were less likely to discuss fracture risk in the target population (2% vs 45%), recommend estimation of fracture risk (11% vs 55%) and recommend intervention on the basis of estimated fracture risk (10% vs 67%) (all P < 0·005). Our findings highlight a strong focus in clinical guidelines on BMD, a surrogate measure, rather than fracture risk, the clinically important outcome, particularly when bone health is not the primary focus. Addressing this issue might facilitate more rational use of

  10. HbA1c: EQA in Germany, Belgium and the Netherlands using fresh whole blood samples with target values assigned with the IFCC reference system.

    PubMed

    Kaiser, Patricia; Spannagl, Michael; van Campenhout, Christel; Lenga, Yolande; Siebelder, Carla; Weykamp, Cas

    2016-11-01

    External quality assessment/proficiency test (EQA/PT) organizers play an important role in monitoring the performance of HbA1c measurements. With increasing quality of the assays, HbA1c is increasingly used for diagnosis of diabetes and the demands on EQA/PT organizers themselves are rising constantly. EQA organizers in Germany (INSTAND), Belgium (WIV/IPV), and the Netherlands (SKML) organized a program with commutable samples and target values assigned with the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) reference system. The aim of this project was to confirm the logistic feasibility of organizing synchronically in the three countries, an accuracy-based EQA program with fresh whole blood, to investigate the performance of HbA1c assays within and across countries and manufacturers, and to review the EQA acceptance limits. Throughout 2015, ten fresh whole blood samples were supplied to the participants. Aggregated results were evaluated according to the IFCC model for quality targets at four levels: overall, per country, per manufacturer, and per country per manufacturer. Robust results in summer and winter demonstrated the feasibility of organizing an EQA with fresh whole blood samples in three countries. The overall performances, as well as the performance for each country were very similar: results fell within the IFCC criteria. Although substantial differences between results from different manufacturers were present, the performances of laboratories using tests of the same manufacturer were strikingly similar in the three countries, suggesting that the quality of HbA1c assays is for the most part manufacturer- related. The improved design of the EQA program also suggested that acceptance limits for performance can be reduced to approximately 8%.

  11. Scenario-targeted toxicity assessment through multiple endpoint bioassays in a soil posing unacceptable environmental risk according to regulatory screening values.

    PubMed

    Rodriguez-Ruiz, A; Etxebarria, J; Boatti, L; Marigómez, I

    2015-09-01

    Lanestosa is a chronically polluted site (derelict mine) where the soil (Lanestosa (LA) soil) exceeds screening values (SVs) of regulatory policies in force (Basque Country; Europe) for Zn, Pb and Cd. A scenario-targeted toxicity assessment was carried out on the basis of a multi-endpoint bioassay approach. Acute and chronic toxicity bioassays were conducted with selected test species (Vibrio fischeri, Dictyostelium discoideum, Lactuca sativa, Raphanus sativus and Eisenia fetida) in combination with chemical analysis of soils and elutriates and with bioaccumulation studies in earthworms. Besides, the toxicity profile was compared with that of the mine runoff (RO) soil and of a fresh artificially polluted soil (LAAPS) resembling LA soil pollutant profile. Extractability studies in LA soil revealed that Pb, Zn and Cd were highly available for exchange and/or release into the environment. Indeed, Pb and Zn were accumulated in earthworms and LA soil resulted to be toxic. Soil respiration, V. fischeri, vegetative and developmental cycles of D. discoideum and survival and juvenile production of E. fetida were severely affected. These results confirmed that LA soil had unacceptable environmental risk and demanded intervention. In contrast, although Pb and Zn concentrations in RO soil revealed also unacceptable risk, both metal extractability and toxicity were much lower than in LA soil. Thus, within the polluted site, the need for intervention varied between areas that posed dissimilar risk. Besides, since LAAPS, with a high exchangeable metal fraction, was the most toxic, ageing under in situ natural conditions seemingly contributed to attenuate LA soil risk. As a whole, combining multi-endpoint bioassays with scenario-targeted analysis (including leaching and ageing) provides reliable risk assessment in soils posing unacceptable environmental risk according to SVs, which is useful to optimise the required intervention measures.

  12. [Recommendations in neonatal resuscitation].

    PubMed

    2004-01-01

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

  13. Recommendations for Lipid Testing and Reporting by Australian Pathology Laboratories

    PubMed Central

    Appleton, Charles A; Caldwell, Grahame; McNeil, Alan; Meerkin, Matthew; Sikaris, Ken; Sullivan, David R; Thomas, David W; Tognarini, David P

    2007-01-01

    The importance of measuring blood lipids in determining the absolute risk of a cardiovascular event is now well established. In Australia, the National Heart Foundation of Australia and the Cardiac Society of Asutralia and New Zealand (NHFA/CSANZ) have done much to educate doctors. In recent years the recommendations of the NHFA/CSANZ have been based on values for Low-density lipoprotein (LDL-C) as well as High-density lipoprotein cholesterol (HDL-C) and Triglyceride (TG). This change has been reflected in requests to pathology laboratories. However the interpretation of these results may be difficult and the NHFA guidelines outline desirable values for patients at high risk only. There are no formal recommendations for reference intervals or interpretive comments. With the availability of expert systems, some pathology laboratories are now in a better position to provide specific comments to assist with the interpretation of test results. An ad hoc committee of private and public chemical pathologists met to draft recommendations for lipid testing and reporting by Australian pathology providers, on the basis of current guidelines and their own expertise. Provisions in the current Medicare Benefits Schedule (MBS) for lipid testing were reviewed, and the indications for lipid testing, recommended tests, the logistics of managing specimens, methods of analysis and availability of specialised tests have been documented. Recommendations are made on the provision of desirable values for lipid tests. Suggestions are provided on interpretive comments which could accompany reports of lipid test results, including categorisation of the likely associated lipoprotein abnormalities, their causes, contribution to risk for cardiovascular disease (CVD) and targets for treatment. Current and future approaches to the assessment of risk for CVD are discussed. PMID:17687413

  14. Research recommendations [Chapter 10

    Treesearch

    Daniel G. Neary; Alvin L. Medina; John N. Rinne

    2012-01-01

    This chapter contains a number of research recommendations that have developed from the 15 years of research on the UVR conducted by the Southwest Watershed Science Team, as well as from insights from key cooperators and contacts. It is meant to be our best insight as to where efforts should go now. Achieving these recommendations will depend on a number of factors,...

  15. National Beef Quality Audit-2011: Harvest-floor assessments of targeted characteristics that affect quality and value of cattle, carcasses, and byproducts.

    PubMed

    McKeith, R O; Gray, G D; Hale, D S; Kerth, C R; Griffin, D B; Savell, J W; Raines, C R; Belk, K E; Woerner, D R; Tatum, J D; Igo, J L; VanOverbeke, D L; Mafi, G G; Lawrence, T E; Delmore, R J; Christensen, L M; Shackelford, S D; King, D A; Wheeler, T L; Meadows, L R; O'Connor, M E

    2012-12-01

    The National Beef Quality Audit-2011 (NBQA-2011) was conducted to assess targeted characteristics on the harvest floor that affect the quality and value of cattle, carcasses, and byproducts. Survey teams evaluated approximately 18,000 cattle/carcasses between May and November 2011 in 8 beef processing facilities. Cattle identification methods were lot visual tags (85.7%), individual visual tags (50.6%), electronic tags (20.1%), metal-clip tags (15.7%), other (5.3%), none (2.5%), and wattles (0.5%). Hide colors or breed types were black (61.1%), red (12.8%), yellow (8.7%), Holstein (5.5%), brown (5.0%), gray (5.0%), white (1.4%), and brindle (1.0%). Brand frequencies were none (55.2%), 1 (40.4%), 2 (4.4%), and 3 or more (0.04%) brands, and brands were located on the butt (35.2%), side (9.0%), and shoulder (2.5%). Hide locations of mud or manure were no mud/manure (49.2%), legs (36.8%), belly (23.7%), side (14.9%), top-line (11.0%), and tail region (13.7%). There were 76.2% of cattle without horns, and the majority of those with horns (71.6%) were between 0 cm and 12.7 cm in length. Permanent incisor numbers were zero (87.3%), 1 (1.4%), 2 (8.0%), 3 (0.9%), 4 (1.9%), 5 (0.3%), 6 (0.2%), 7 (0.1%), and 8 (0.02%). Most carcasses (77.0%) were not bruised, 18.7% had 1 bruise, 3.4% had 2 bruises, 0.6% had 3 bruises, and 0.3% had more than 3 bruises. Bruise locations were loin (50.1%), rib (21.3%), chuck (13.8%), round (7.3%), and brisket/flank/plate (7.5%). Condemnation item and incidence were whole carcass (none recorded), liver (20.9%), lungs (17.3%), tongue (10.0%), viscera (9.3%), and head (7.2%). Compared with the NBQA-2005, the NBQA-2011 had an increased percentage of black-hided cattle (56.3 vs. 61.1%), more cattle with brands (38.7 vs. 44.8%), and more cattle with some form of identification (93.3 vs. 97.5%). In addition, there was a lesser percentage of carcasses with bruising in 2011 (23.0%) than in 2005 (35.2%), as well as a smaller percentage of carcasses with

  16. Recommended Textbooks (Booksearch).

    ERIC Educational Resources Information Center

    English Journal, 1988

    1988-01-01

    Evaluates four textbooks recommended by junior high and high school teachers for teaching writing and literature: "Enjoying Literature" (published by Macmillan, 1985); "Exposition: Critical Writing and Thinking" (Robert J. Gula); "Situational Writing" (Gene Krupa); and "Double Exposure: Composing through Writing…

  17. Updated Lightning Safety Recommendations.

    ERIC Educational Resources Information Center

    Vavrek, R. James; Holle, Ronald L.; Lopez, Raul E.

    1999-01-01

    Summarizes the recommendations of the Lightning Safety Group (LSG), which was first convened during the 1998 American Meteorological Society Conference. Findings outline appropriate actions under various circumstances when lightning threatens. (WRM)

  18. Updated Lightning Safety Recommendations.

    ERIC Educational Resources Information Center

    Vavrek, R. James; Holle, Ronald L.; Lopez, Raul E.

    1999-01-01

    Summarizes the recommendations of the Lightning Safety Group (LSG), which was first convened during the 1998 American Meteorological Society Conference. Findings outline appropriate actions under various circumstances when lightning threatens. (WRM)

  19. Social Tagging Recommender Systems

    NASA Astrophysics Data System (ADS)

    Marinho, Leandro Balby; Nanopoulos, Alexandros; Schmidt-Thieme, Lars; Jäschke, Robert; Hotho, Andreas; Stumme, Gerd; Symeonidis, Panagiotis

    The new generation of Web applications known as (STS) is successfully established and poised for continued growth. STS are open and inherently social; features that have been proven to encourage participation. But while STS bring new opportunities, they revive old problems, such as information overload. Recommender Systems are well known applications for increasing the level of relevant content over the "noise" that continuously grows as more and more content becomes available online. In STS however, we face new challenges. Users are interested in finding not only content, but also tags and even other users. Moreover, while traditional recommender systems usually operate over 2-way data arrays, STS data is represented as a third-order tensor or a hypergraph with hyperedges denoting (user, resource, tag) triples. In this chapter, we survey the most recent and state-of-the-art work about a whole new generation of recommender systems built to serve STS.We describe (a) novel facets of recommenders for STS, such as user, resource, and tag recommenders, (b) new approaches and algorithms for dealing with the ternary nature of STS data, and (c) recommender systems deployed in real world STS. Moreover, a concise comparison between existing works is presented, through which we identify and point out new research directions.

  20. Personalising exercise recommendations for brain health: considerations and future directions.

    PubMed

    Barha, Cindy K; Galea, Liisa A; Nagamatsu, Lindsay S; Erickson, Kirk I; Liu-Ambrose, Teresa

    2017-04-01

    The societal value of strategies that delay the onset and progression of dementia cannot be overstated. Physical activity-unstructured and structured-is a promising, cost-effective strategy for the promotion of brain health. However, a large degree of variation exists in its efficacy. Therefore, to increase its utility as 'medication' for healthy cognitive ageing, it is imperative to identify key moderators and mediators of the positive effects of targeted exercise training on brain health. In this commentary, we focus on the type of targeted exercise training, the determinants of individual variation, including biological sex and genotypic factors, and the mechanisms by which exercise exerts its influence on the brain. We argue that a better understanding of these factors will allow for evidence-based, personalised, tailored exercise recommendations that go beyond the one-size-fits-all approach to successfully combat dementia.

  1. "Value Added" Modern Languages Teaching in the Classroom: An Investigation into How Teachers' Use of Classroom Target Language Can Aid Pupils' Communication Skills

    ERIC Educational Resources Information Center

    Crichton, Hazel

    2009-01-01

    This paper presents some of the preliminary findings of a study into modern languages (ML) learning in five Scottish secondary schools. Five ML teachers were observed and audio-recorded over a period of several weeks while teaching their third-year classes (pupils aged 14-15 years). All the teachers used the target language extensively in their…

  2. A recommended practical approach to the management of target therapy and angiogenesis inhibitors cardiotoxicity: an opinion paper of the working group on drug cardiotoxicity and cardioprotection, Italian Society of Cardiology

    PubMed Central

    Maurea, Nicola; Spallarossa, Paolo; Cadeddu, Christian; Madonna, Rosalinda; Mele, Donato; Monte, Ines; Novo, Giuseppina; Pagliaro, Pasquale; Pepe, Alessia; Tocchetti, Carlo G.; Zito, Concetta; Mercuro, Giuseppe

    2016-01-01

    The US National Cancer Institute estimates that cardiotoxicity (CTX) from target therapy refers mostly to four groups of drugs: epidermal growth factor receptor 2 inhibitors, angiogenic inhibitors, directed Abelson murine leukemia viral oncogene homolog inhibitors, and proteasome inhibitors. The main cardiotoxic side-effects related to antiepidermal growth factor receptor 2 therapy are left ventricular systolic dysfunction and heart failure. Angiogenesis inhibitors are associated with hypertension, left ventricular dysfunction/heart failure, myocardial ischemia, QT prolongation, and thrombosis. Moreover, other agents may be related to CTX induced by treatment. In this study, we review the guidelines for a practical approach for the management of CTX in patients under anticancer target therapy. PMID:27183530

  3. 2010 Canadian Hypertension Education Program (CHEP) recommendations: The scientific summary – an update of the 2010 theme and the science behind new CHEP recommendations

    PubMed Central

    Campbell, Norman RC; Kaczorowski, Janusz; Lewanczuk, Richard Z; Feldman, Ross; Poirier, Luc; Kwong, Margaret Moy Lum; Lebel, Marcel; McAlister, Finlay A; Tobe, Sheldon W

    2010-01-01

    The present article is a summary of the theme, the key recommendations for management of hypertension and the supporting clinical evidence of the 2010 Canadian Hypertension Education Program (CHEP). In 2010, CHEP emphasizes the need for health care professionals to stay informed about hypertension through automated updates at www.htnupdate.ca. A new interactive Internet-based lecture series will be available in 2010 and a program to train community hypertension leaders will be expanded. Patients can also sign up to receive regular updates in a pilot program at www.myBPsite.ca. In 2010, the new recommendations include consideration for using automated office blood pressure monitors, new targets for dietary sodium for the prevention and treatment of hypertension that are aligned with the national adequate intake values, and recommendations for considering treatment of selected hypertensive patients at high risk with calcium channel blocker/angiotensin-converting enzyme inhibitor combinations and the use of angiotensin receptor blockers. PMID:20485687

  4. Distributed Deliberative Recommender Systems

    NASA Astrophysics Data System (ADS)

    Recio-García, Juan A.; Díaz-Agudo, Belén; González-Sanz, Sergio; Sanchez, Lara Quijano

    Case-Based Reasoning (CBR) is one of most successful applied AI technologies of recent years. Although many CBR systems reason locally on a previous experience base to solve new problems, in this paper we focus on distributed retrieval processes working on a network of collaborating CBR systems. In such systems, each node in a network of CBR agents collaborates, arguments and counterarguments its local results with other nodes to improve the performance of the system's global response. We describe D2ISCO: a framework to design and implement deliberative and collaborative CBR systems that is integrated as a part of jcolibritwo an established framework in the CBR community. We apply D2ISCO to one particular simplified type of CBR systems: recommender systems. We perform a first case study for a collaborative music recommender system and present the results of an experiment of the accuracy of the system results using a fuzzy version of the argumentation system AMAL and a network topology based on a social network. Besides individual recommendation we also discuss how D2ISCO can be used to improve recommendations to groups and we present a second case of study based on the movie recommendation domain with heterogeneous groups according to the group personality composition and a group topology based on a social network.

  5. Immunoexpression status and prognostic value of mammalian target of rapamycin and hypoxia-induced pathway members in papillary cell renal cell carcinomas.

    PubMed

    Chaux, Alcides; Schultz, Luciana; Albadine, Roula; Hicks, Jessica; Kim, Jenny J; Allaf, Mohamad E; Carducci, Michael A; Rodriguez, Ronald; Hammers, Hans-Joerg; Argani, Pedram; Reuter, Victor E; Netto, George J

    2012-12-01

    Dysregulation of the mammalian target of rapamycin and hypoxia-induced pathways has been consistently identified in clear cell renal cell carcinomas. However, experience with non-clear cell renal cell carcinoma subtypes is scant. In this study, we evaluated the immunohistochemical expression of upstream (PTEN and phosphorylated AKT) and downstream (phosphorylated S6 and 4EBP1) effectors of the mammalian target of rapamycin pathway, as well as related cell-cycle proteins (p27 and c-MYC), and a member of the hypoxia-induced pathway (HIF-1α) in 54 patients with papillary renal cell carcinoma treated by nephrectomy. PTEN was lower in tumor than in normal kidney, and loss of PTEN expression was found in 48% of the patients. In tumor tissues, phosphorylated S6, 4EBP1, and HIF-1α were higher than in normal kidney. Conversely, scores of p27 were lower in tumor than in normal kidney. Finally, scores of c-MYC and phosphorylated AKT were similar in tumor and in normal kidney. Overall mortality and cancer-specific mortality were 24% and 11%, respectively. Tumor progression was observed in 17% of the patients. None of the tested biomarkers predicted cancer-specific mortality or tumor progression. As expected, patients with high T-stage tumors had higher hazard ratios for cancer-specific mortality (hazard ratio, 6.9) and tumor progression (hazard ratio, 6.7). Patients with higher Fuhrman grades also had higher risks for cancer-specific mortality (hazard ratio, 11.4) and tumor progression (hazard ratio, 4.5). In summary, our study provides evidence of dysregulation of the mammalian target of rapamycin and hypoxia-induced pathways in papillary renal cell carcinoma. Immunohistochemistry for members of the mammalian target of rapamycin pathway and for HIF-1α lacked prognostic significance in our cohort.

  6. Aggregated Recommendation through Random Forests

    PubMed Central

    2014-01-01

    Aggregated recommendation refers to the process of suggesting one kind of items to a group of users. Compared to user-oriented or item-oriented approaches, it is more general and, therefore, more appropriate for cold-start recommendation. In this paper, we propose a random forest approach to create aggregated recommender systems. The approach is used to predict the rating of a group of users to a kind of items. In the preprocessing stage, we merge user, item, and rating information to construct an aggregated decision table, where rating information serves as the decision attribute. We also model the data conversion process corresponding to the new user, new item, and both new problems. In the training stage, a forest is built for the aggregated training set, where each leaf is assigned a distribution of discrete rating. In the testing stage, we present four predicting approaches to compute evaluation values based on the distribution of each tree. Experiments results on the well-known MovieLens dataset show that the aggregated approach maintains an acceptable level of accuracy. PMID:25180204

  7. Space Station Software Recommendations

    NASA Technical Reports Server (NTRS)

    Voigt, S. (Editor)

    1985-01-01

    Four panels of invited experts and NASA representatives focused on the following topics: software management, software development environment, languages, and software standards. Each panel deliberated in private, held two open sessions with audience participation, and developed recommendations for the NASA Space Station Program. The major thrusts of the recommendations were as follows: (1) The software management plan should establish policies, responsibilities, and decision points for software acquisition; (2) NASA should furnish a uniform modular software support environment and require its use for all space station software acquired (or developed); (3) The language Ada should be selected for space station software, and NASA should begin to address issues related to the effective use of Ada; and (4) The space station software standards should be selected (based upon existing standards where possible), and an organization should be identified to promulgate and enforce them. These and related recommendations are described in detail in the conference proceedings.

  8. Urotherapy recommendations for bedwetting.

    PubMed Central

    Robson, Lane M.; Leung, Alexander K. C.

    2002-01-01

    OBJECTIVE: To assess the efficacy of urotherapy recommendations prior to pharmacological or moisture alarm treatment in the management of bedwetting in children. METHODS: Children assessed for bedwetting at a voiding dysfunction clinic were admitted to a prospective, uncontrolled pilot study. The families were instructed to follow specific urotherapy recommendations. RESULTS: Of the 23 children who completed the study, sixteen (70%) improved with at least one less wet night per week, nine (39%) with at least a 50% reduction, and five (22%) resolved. CONCLUSION: Urotherapy recommendations prior to pharmacological or moisture alarm treatment shows promise and potential for the management of children with bedwetting. Further studies are necessary to determine if the improvement is sustained. PMID:12126283

  9. Order Theoretical Semantic Recommendation

    SciTech Connect

    Joslyn, Cliff A.; Hogan, Emilie A.; Paulson, Patrick R.; Peterson, Elena S.; Stephan, Eric G.; Thomas, Dennis G.

    2013-07-23

    Mathematical concepts of order and ordering relations play multiple roles in semantic technologies. Discrete totally ordered data characterize both input streams and top-k rank-ordered recommendations and query output, while temporal attributes establish numerical total orders, either over time points or in the more complex case of startend temporal intervals. But also of note are the fully partially ordered data, including both lattices and non-lattices, which actually dominate the semantic strcuture of ontological systems. Scalar semantic similarities over partially-ordered semantic data are traditionally used to return rank-ordered recommendations, but these require complementation with true metrics available over partially ordered sets. In this paper we report on our work in the foundations of partial order measurement in ontologies, with application to top-k semantic recommendation in workflows.

  10. Contemporary data on low-density lipoprotein cholesterol target value attainment and distance to target in a cohort of 57,885 statin-treated patients by country and region across the world.

    PubMed

    Gitt, Anselm K; Lautsch, Dominik; Ferrieres, Jean; Kastelein, John; Drexel, Heinz; Horack, Martin; Brudi, Philippe; Vanneste, Brecht; Bramlage, Peter; Chazelle, Francois; Sazonov, Vasilisa; Ambegaonkar, Baishali

    2016-12-01

    Data presented here refer to 57,885 patients on lipid-lowering statin therapy from the Dyslipidaemia International Study (DYSIS) registry. Subjects were divided into 3 discrete subsets: those at very high-risk, high-risk, and non-high-risk for cardiovascular events, with assigned low density lipoprotein cholesterol (LDL-C) targets of 70 mg/dl, 100 mg/dl and 115 mg/dl, respectively. Overall, the highest proportion of patients meeting their LDL-C target was seen in the UAE and Kuwait (49.5%), while the lowest was seen in Germany (14.3%). The smallest median distance to target was documented in Canada (18.8 mg/dl), and the largest in the Baltics (42.1 mg/dl). Interpretation and discussion of this data can be found in the manuscript entitled "Low-density lipoprotein cholesterol in a global cohort of 57,885 statin-treated patients" (Gitt et al., 2016) [1].

  11. Valuing Essays: Essaying Values

    ERIC Educational Resources Information Center

    Badley, Graham

    2010-01-01

    The essay regularly comes under attack. It is criticised for being rigidly linear rather than flexible and reflective. I first challenge this view by examining reasons why the essay should be valued as an important genre. Secondly, I propose that in using the essay form students and academics necessarily exemplify their own critical values. Essays…

  12. Value of Targeted Epidural Blood Patch and Management of Subdural Hematoma in Spontaneous Intracranial Hypotension: Case Report and Review of the Literature.

    PubMed

    Rettenmaier, Leigh A; Park, Brian J; Holland, Marshall T; Hamade, Youssef J; Garg, Shuchita; Rastogi, Rahul; Reddy, Chandan G

    2017-01-01

    Spontaneous intracranial hypotension (SIH) is a more common than previously noted condition (1-2.5 per 50,000 persons) typically caused by cerebrospinal fluid (CSF) leakage. Initial treatment involves conservative therapies, but the mainstay of treatment for patients who fail conservative management is the epidural blood patch (EBP). Subdural hematoma (SDH) is a common complication occurring with SIH, but its management remains controversial. In this report, we discuss a 62-year-old woman who presented with a 5-week history of orthostatic headaches associated with nausea, emesis, and neck pain. Despite initial imaging being negative, the patient later developed classic imaging evidence characteristic of SIH. Magnetic resonance imaging was unrevealing for the source of the CSF leak. Radionuclide cisternography showed possible CSF leak at the right-sided C7-T1 nerve root exit site. After failing a blind lumbar EBP, subsequent targeted EBP at C7-T1 improved the patient's symptoms. Two days later she developed a new headache with imaging evidence of worsening SDH with midline shift requiring burr hole drainage. This yielded sustained symptomatic relief and resolution of previously abnormal imaging findings at 2-month follow-up. A literature review revealed 174 cases of SIH complicated by SDH. This revealed conflicting opinions concerning the management of this condition. Although blind lumbar EBP is often successful, targeted EBP has a lower rate of patients requiring a second EBP or other further treatment. On the other hand, targeted EBP has a larger risk profile. Depending on the clinic situation, treatment of the SDH via surgical evacuation may be necessary. Copyright © 2016 Elsevier Inc. All rights reserved.

  13. Hand hygiene--comparison of international recommendations.

    PubMed

    Wendt, C

    2001-08-01

    The value of hand hygiene for the prevention of cross-infection was first observed in the middle of the 19th century. Since then, which procedure is the most suitable for hand hygiene has been repeatedly discussed and several different guidelines and recommendations have been published. The aim of this review is to compare different recommendations for hand hygiene regarding technique and indication. Medline, the internet and a personal library were searched to obtain as many written recommendations as possible. In addition, a small questionnaire was sent by e-mail to 20 international colleagues. As a result, written recommendations from 10 countries could be compared. Recommended methods of hand hygiene include handwashing (washing hands with plain soap), hygienic handwash (washing hands with medicated soap) and hygienic hand-rub (use of antiseptic rubs). In most countries handwashing and hygienic handwash are the methods of choice and only in central European countries is hygienic hand-rub the preferred technique. Situations in which performance of hand hygiene is recommended are comparable. However, no single indication is recommended in all guidelines. Hand hygiene is most often recommended before performing invasive procedures and after microbial contamination. Guidelines should be clear and easy to follow for them to become standard of care. Thus, guidelines are needed that do not leave to the health care worker a decision as to whether hand hygiene is indicated.

  14. Recommendations for Alternative Credit.

    ERIC Educational Resources Information Center

    Lenderman, Ed; And Others

    Following a review of the mathematics topics taught in accounting, electronics, auto, food and clothing, and metals courses at Linn-Benton Community College, Albany, Oregon, recommendations were made to grant one semester of mathematics credit for completing a two-year sequence of these courses. The other required semester of mathematics should be…

  15. CETA: Assessment and Recommendations.

    ERIC Educational Resources Information Center

    National Academy of Sciences - National Research Council, Washington, DC. Committee on Evaluation of Employment and Training Programs.

    This document presents the principal findings and recommendations of a study conducted by the Committee on Evaluation of Employment and Training Program to assess the impact of CETA (Comprehensive Employment and Training Act) on manpower programs. This report is divided into two parts. Part 1 provides an overview of CETA's history, summarizes…

  16. Personalized Course Sequence Recommendations

    NASA Astrophysics Data System (ADS)

    Xu, Jie; Xing, Tianwei; van der Schaar, Mihaela

    2016-10-01

    Given the variability in student learning it is becoming increasingly important to tailor courses as well as course sequences to student needs. This paper presents a systematic methodology for offering personalized course sequence recommendations to students. First, a forward-search backward-induction algorithm is developed that can optimally select course sequences to decrease the time required for a student to graduate. The algorithm accounts for prerequisite requirements (typically present in higher level education) and course availability. Second, using the tools of multi-armed bandits, an algorithm is developed that can optimally recommend a course sequence that both reduces the time to graduate while also increasing the overall GPA of the student. The algorithm dynamically learns how students with different contextual backgrounds perform for given course sequences and then recommends an optimal course sequence for new students. Using real-world student data from the UCLA Mechanical and Aerospace Engineering department, we illustrate how the proposed algorithms outperform other methods that do not include student contextual information when making course sequence recommendations.

  17. Significantly altered expression of miR-511-3p and its target AKT3 has negative prognostic value in human prostate cancer.

    PubMed

    Zhang, Fan; Wu, Zhongjun

    2017-09-01

    In this study, we assessed the expression and functions of microRNA-511-3p (miR-511-3p) in human prostate cancer (CaP). Gene expressions of miR-511-3p in CaP cells and human CaP tumors were assessed by qPCR. In VCaP and PC3 cells, miR-511-3p was overexpressed by lentivirus. The functions of miR-511-3p upregulation in regulating in vitro cancer proliferation, migration and in vivo cancer growth were assessed by MTT, transwell and transplantation assays, respectively. Downstream target gene of miR-511-3p, AKT3, was verified by dual-luciferase activity and qPCR assays. AKT3 was then overexpressed in miR-511-3p-upregulated CaP cells to assess its functions in miR-511-3p-mediated cancer regulation. MiR-511-3p is significantly downregulated in CaP cell lines, and human CaP tumors. MiR-511-3p was further downregulated in T3/T4-staged CaP tumors and closely correlated with shorter overall survival among CaP patients. In VCaP and PC3 cells, lentiviral-induced miR-511-3p upregulation was acting as a tumor suppressor by inhibiting in vitro cancer proliferation, migration and in vivo transplantation. Human AKT3 gene was confirmed to be the downstream target of miR-511-3p in CaP. In miR-511-3p-upregulated VCaP and PC3 cells, forced-overexpression of AKT3 reversed the tumor suppressive effects of miR-511-3p in CaP. MiR-511-3p may serve as a prognostic factor and tumor suppressor in CaP, very likely through inverse regulation of its downstream target gene of AKT3. Copyright © 2017. Published by Elsevier B.V.

  18. Motivational interviewing targeting diet and physical activity improves adherence to pediatric obesity treatment: Results from the MI Values randomized controlled trial

    PubMed Central

    Bean, Melanie K.; Powell, Priscilla; Quinoy, Alexis; Ingersoll, Karen; Wickham, Edmond P.; Mazzeo, Suzanne E.

    2014-01-01

    Background Adherence is a challenge in obesity treatment. Motivational interviewing (MI) may promote patient adherence. MI Values is a randomized controlled trial of MI implemented as an adjunct to an adolescent obesity treatment (T.E.E.N.S.). Objective Assess effects of MI Values on T.E.E.N.S. attrition and adherence. Methods Participants were randomized to MI (n=58) or control (n=41). At weeks 1 and 10, MI participants had brief MI sessions; controls viewed health education videos. All participants continued with T.E.E.N.S. (biweekly dietitian and behavioral support visits; 3x/week supervised physical activity). Assessments were repeated at baseline, 3 and 6-months. T-tests and chi-square analyses examined T.E.E.N.S. attrition and adherence by group. Results Adolescents (N=99) were primarily African American (73%) females (74%); age=13.8±1.8 years, body mass index percentile=98.0±1.2. Compared with controls, MI participants had greater 3-month adherence overall (89.2% vs. 81.0%, p=0.040), and to dietitian (91.3% vs. 84.0%; p=0.046) and behavioral support (92.9% vs. 85.2%; p=0.041) visits, and greater 6-month adherence overall (84.4% vs. 76.2%, p=0.026) and to behavioral support visits (87.5% vs. 78.8%, p=0.011). Conclusions MI enhanced adherence to this obesity intervention. MI Values is the first study to examine the impact of MI on treatment adherence among obese, primarily African American adolescents. PMID:24729537

  19. Rheumatologic rehabilitation: towards recommendations.

    PubMed

    Maddali Bongi, S; Del Rosso, A; Matucci Cerinic, M

    2014-11-06

    Rheumatic patients are highly complex and often affected by chronic diseases. Rehabilitation is generally needed for proper management of the underlying disease. This article describes the characteristics of an effective rheumatologic rehabilitation, takes into account data published in international literature, suggests recommendations based on scientific evidence to develop a correct rehabilitation plan for rheumatic patients and proposes the basis to draw up guidelines in the field of rheumatologic rehabilitation.

  20. FELASA Guidelines and Recommendations

    PubMed Central

    Guillen, Javier

    2012-01-01

    The Federation of European Laboratory Animal Science Associations (FELASA) has been releasing guidelines and recommendations on several laboratory animal science disciplines for more than 15 y. The Working Groups producing these documents comprise specialists in each of the addressed topics, are nominated by the FELASA constituent associations, and are elected by the FELASA Board of Management. The FELASA guidelines and recommendations are not regulatory but rather are proposals based on scientific knowledge and the state of the art of laboratory animal science activities. Because they are supported by laboratory animal science associations that represent the vast majority of European professionals, these guidelines and recommendations have influenced the development of various regulatory requirements in Europe, including those related to education and training, routine laboratory animal activities, and animal health monitoring. Some reports fill existing gaps in the European legal framework or complement it. The Working Groups occasionally collaborate with other European organizations, thus enhancing the professional input and effect of the documents produced. The recently established AALAS–FELASA Liaison Body may result in future international cooperation that benefits laboratory animal science and welfare in a global context. PMID:22776188

  1. What Value "Value Added"?

    ERIC Educational Resources Information Center

    Richards, Andrew

    2015-01-01

    Two quantitative measures of school performance are currently used, the average points score (APS) at Key Stage 2 and value-added (VA), which measures the rate of academic improvement between Key Stage 1 and 2. These figures are used by parents and the Office for Standards in Education to make judgements and comparisons. However, simple…

  2. What Value "Value Added"?

    ERIC Educational Resources Information Center

    Richards, Andrew

    2015-01-01

    Two quantitative measures of school performance are currently used, the average points score (APS) at Key Stage 2 and value-added (VA), which measures the rate of academic improvement between Key Stage 1 and 2. These figures are used by parents and the Office for Standards in Education to make judgements and comparisons. However, simple…

  3. The therapeutic value of natural agents to treat miRNA targeted breast cancer in African-American and Caucasian-American women.

    PubMed

    Rahman, K M Wahidur; Sakr, Wael A

    2012-12-01

    Breast cancer is the most common cancer in women in the United States, with African-American (AA) women showing significantly higher rates than Caucasian-American (CA) women do. The reason for this racial disparity remains unknown, and factors that might be responsible for the differences in incidence and mortality have not been identified. One possible factor could be microRNAs (miRs), which are small noncoding regulatory RNAs involved intimately in cancer, and the expression of certain miRs may be decreased or increased in the breast tumors of AA and CA women. Therefore, modulation of miRs using natural agents could lead to the development of a novel therapeutic strategy to treat aggressive forms of breast cancer in women of different racial backgrounds. The function of natural agents in the regulation of miRs has not been investigated extensively. In this review, we will discuss the potential role of naturally occurring agents as potent antitumor agents thought to function by targeting miRs as contributing factors to the disparity in breast cancer between AA and CA women.

  4. [The Prognostic Significance of ICF Data with Regard to Realization of Recommendations Given in the Medical Discharge Report after In-Patient Psychosomatic Rehabilitation].

    PubMed

    Oster, Jörg; von Wietersheim, Jörn; Müller, Gottfried; Braunger, Carina

    2017-05-01

    Target In this trial, the prognostic significance of ICF-related diagnostics compared to social and medical, disease-related and personal factors with regard to realization of recommendations given in the medical discharge report after the in-patient psychosomatic rehabilitation should be examined. Methodology ICF-related, social and medical, disease-related and personal prognostic factors were surveyed by questionnaires and interviews, on admission, discharge and 6 months after discharge from rehabilitation (time of catamnesis). As target criteria, realizations of recommendations from the fields of sports and exercise, psychotherapy and social medicine were chosen, they could be evaluated by telephone from N=344 participants at the time of catamnesis. For determination of relevant predictors, bivariate and multi-variate analyses were performed. Results 70% of patients realized the recommended sports and exercise, 45% the recommended psychotherapy and 44% a social and medical recommendation. With regard to the target criterion for the realization of recommended sports and exercise, the elevated prognostic factors had only a low prognostic value. For the prognosis of the target criterion of realizing a recommended psychotherapy, interpersonal problems and a low ability to interact in groups (Mini-ICF-APP) turned out to be relevant ICF-related predictors. Different problems (e. g., job-related conditions) appeared as relevant, ICF-related predictors concerning the realization of social and medical recommendations. Disturbances of reliability, self-evaluated by means of ICF AT-50 Psych, showed in the bivariate analyses significant correlations with the target criteria. Conclusion Besides other variables, also ICF-supported attributes turned out to be suitable for the prognosis of target criteria. They should be evaluated and considered in the rehabilitation process. © Georg Thieme Verlag KG Stuttgart · New York.

  5. Consistent set of nuclear parameters values for absolute INAA

    SciTech Connect

    Heft, R.E.

    1980-01-01

    Gamma spectral analysis of irradiated material can be used to determine absolute disintegration rates for specific radionuclides. These data, together with measured values for the thermal and epithermal neutron fluxes, and irradiation, cooling and counting time values, are all the experimental information required to do absolute Instrumental Neutron Activation Analysis. The calculations required to go from product photon emission rate to target nuclide amount depend upon values used for the thermal neutron capture cross-section, the resonance absorption integral, the half-life and photon branching ratios. Values for these parameters were determined by irradiating and analyzing a series of elemental standards. The results of these measurements were combined with values reported by other workers to arrive at a set of recommended values for the constants. Values for 114 nuclides are listed.

  6. Limited value of pro-inflammatory oxylipins and cytokines as circulating biomarkers in endometriosis – a targeted ‘omics study

    PubMed Central

    Lee, Yie Hou; Cui, Liang; Fang, Jinling; Chern, Bernard Su Min; Tan, Heng Hao; Chan, Jerry K. Y.

    2016-01-01

    Endometriosis is a common, complex gynecologic disorder characterized by the presence of endometrial-like tissues at extrauterine sites. Elevation in protein and lipid mediators of inflammation including oxylipins and cytokines within the peritoneum characterize the inflamed pelvic region and may contribute to the survival and growth of displaced endometrial tissues. The presence of a clinically silent but molecularly detectable systemic inflammation in endometriosis has been proposed. Thus, we examined serum oxylipin and immunomodulatory protein levels in 103 women undergoing laparoscopy to evaluate systematically any involvement in systemic pathophysiological inflammation in endometriosis. Oxylipin levels were similar between women with and without endometriosis. Stratification by menstrual phase or severity did not offer any difference. Women with ovarian endometriosis had significantly lower 12-HETE relative to peritoneal endometriosis (−50.7%). Serum oxylipin levels were not associated with pre-operative pain symptoms. Changes to immunomodulatory proteins were minimal, with IL-12(p70), IL-13 and VEGF significantly lower in mild endometriotic women compared to non-endometriotic women (−39%, −54% and −76% respectively). Verification using C-reactive protein as a non-specific marker of inflammation further showed similar levels between groups. The implications of our work suggest pro-inflammatory mediators in the classes studied may have potentially limited value as circulating biomarkers for endometriosis, suggesting of potentially tenuous systemic inflammation in endometriosis. PMID:27193963

  7. Personalized professional content recommendation

    DOEpatents

    Xu, Songhua

    2015-10-27

    A personalized content recommendation system includes a client interface configured to automatically monitor a user's information data stream transmitted on the Internet. A hybrid contextual behavioral and collaborative personal interest inference engine resident to a non-transient media generates automatic predictions about the interests of individual users of the system. A database server retains the user's personal interest profile based on a plurality of monitored information. The system also includes a server programmed to filter items in an incoming information stream with the personal interest profile and is further programmed to identify only those items of the incoming information stream that substantially match the personal interest profile.

  8. Panel summary of recommendations

    NASA Technical Reports Server (NTRS)

    Dunbar, Bonnie J.; Coleman, Martin E.; Mitchell, Kenneth L.

    1990-01-01

    The following Space Station internal contamination topics were addressed: past flight experience (Skylab and Spacelab missions); present flight activities (Spacelabs and Soviet Space Station Mir); future activities (materials science and life science experiments); Space Station capabilities (PPMS, FMS, ECLSS, and U.S. Laboratory overview); manned systems/crew safety; internal contamination detection; contamination control - stowage and handling; and contamination control - waste gas processing. Space Station design assumptions are discussed. Issues and concerns are discussed as they relate to (1) policy and management, (2) subsystem design, (3) experiment design, and (4) internal contamination detection and control. The recommendations generated are summarized.

  9. Clinical Recommendation: Vulvovaginitis.

    PubMed

    Zuckerman, Andrea; Romano, Mary

    2016-12-01

    Vulvovaginitis is a commonly encountered condition among prepubertal and adolescent females. The objective of this report is to provide the latest evidence regarding the diagnosis and management of vulvovaginitis in prepubertal and adolescent females. In this systematic review we used the Grading of Recommendations Assessment, Development and Evaluation evidence system. Vulvovaginal complaints are common in the pediatric and adolescent age group. The patient's age in conjunction with history and associated complaints will guide evaluation, diagnosis, and treatment. Treatment should include counseling on hygiene and voiding techniques as well as therapy for any specific pathogens identified.

  10. National Beef Quality Audit-2011: In-plant survey of targeted carcass characteristics related to quality, quantity, value, and marketing of fed steers and heifers.

    PubMed

    Moore, M C; Gray, G D; Hale, D S; Kerth, C R; Griffin, D B; Savell, J W; Raines, C R; Belk, K E; Woerner, D R; Tatum, J D; Igo, J L; VanOverbeke, D L; Mafi, G G; Lawrence, T E; Delmore, R J; Christensen, L M; Shackelford, S D; King, D A; Wheeler, T L; Meadows, L R; O'Connor, M E

    2012-12-01

    The 2011 National Beef Quality Audit (NBQA-2011) assessed the current status of quality and consistency of fed steers and heifers. Beef carcasses (n = 9,802), representing approximately 10% of each production lot in 28 beef processing facilities, were selected randomly for the survey. Carcass evaluation for the cooler assessment of this study revealed the following traits and frequencies: sex classes of steer (63.5%), heifer (36.4%), cow (0.1%), and bullock (0.03%); dark cutters (3.2%); blood splash (0.3%); yellow fat (0.1%); calloused rib eye (0.05%); overall maturities of A (92.8%), B (6.0%), and C or greater (1.2%); estimated breed types of native (88.3%), dairy type (9.9%), and Bos indicus (1.8%); and country of origin of United States (97.7%), Mexico (1.8%), and Canada (0.5%). Certified or marketing program frequencies were age and source verified (10.7%), ≤A(40) (10.0%), Certified Angus Beef (9.3%), Top Choice (4.1%), natural (0.6%), and Non-Hormone-Treated Cattle (0.5%); no organic programs were observed. Mean USDA yield grade (YG) traits were USDA YG (2.9), HCW (374.0 kg), adjusted fat thickness (1.3 cm), LM area (88.8 cm2), and KPH (2.3%). Frequencies of USDA YG distributions were YG 1, 12.4%; YG 2, 41.0%; YG 3, 36.3%; YG 4, 8.6%; and YG 5, 1.6%. Mean USDA quality grade (QG) traits were USDA quality grade (Select(93)), marbling score (Small(40)), overall maturity (A(59)), lean maturity (A(54)), and skeletal maturity (A(62)). Frequencies of USDA QG distributions were Prime, 2.1%; Choice, 58.9%; Select, 32.6%; and Standard or less, 6.3%. Marbling score distribution was Slightly Abundant or greater, 2.3%; Moderate, 5.0%; Modest, 17.3%; Small, 39.7%; Slight, 34.6%; and Traces or less, 1.1%. Carcasses with QG of Select or greater and YG 3 or less represented 85.1% of the sample. This is the fifth benchmark study measuring targeted carcass characteristics, and information from this survey will continue to help drive progress in the beef industry. Results will

  11. [Syndrome of recommended patient].

    PubMed

    Sanz Rubiales, A; del Valle Rivero, M L; Flores Pérez, L A; Hernansanz de la Calle, S; García Recio, C; López-Lara Martín, F

    2002-08-01

    "Syndrome of recommended patient" is manifested as the presence of numerous unexpected and unusual complications in patients that the treating physician is trying to give a better assistance. Even assuming that a few complications may appear by chance, there are several factors from daily clinical practice that facilitate the presence of such a syndrome, and some of them can be corrected in order to reduce its incidence. All of them come from the change on daily clinical practice on these patients, as if they do not fit for the attention provided for other people. These factors favouring the presence of this syndrome come from: patients' attitude, inefficient use of health resources, absence of an adequate register of clinical data and change in usual clinical practice on interpretation of diagnostic tests as well as in the indication of treatment of these patients. The best way to prevent this "syndrome of recommended patient" is to maintain, even within these patients, an attitude based on solid clinical knowledge and to follow up the same clinical rules accepted for other patients.

  12. French recommendations on electroencephalography.

    PubMed

    André-Obadia, N; Lamblin, M D; Sauleau, P

    2015-03-01

    Electroencephalography allows the functional analysis of electrical brain cortical activity and is the gold standard for analyzing electrophysiological processes involved in epilepsy but also in several other dysfunctions of the central nervous system. Morphological imaging yields complementary data, yet it cannot replace the essential functional analysis tool that is EEG. Furthermore, EEG has the great advantage of being non-invasive, easy to perform and allows repeat testing when follow-up is necessary, even at the patient's bedside. Faced with advances in knowledge, techniques and indications, the Société de neurophysiologie clinique de langue française (SNCLF) and the Ligue française contre l'épilepsie (LFCE) found it necessary to provide an update on EEG recommendations. This article will review the methodology applied to this work, refine the various topics detailed in the following chapters. It will go over the summary of recommendations for each of these chapters and highlight proposals for writing an EEG report. Some questions could not be answered by review of the literature; in such cases, in addition to the guidelines the working and reading groups provided their expert opinion.

  13. Deployment of Recommender Systems: Operational and Strategic Issues

    ERIC Educational Resources Information Center

    Ghoshal, Abhijeet

    2011-01-01

    E-commerce firms are increasingly adopting recommendation systems to effectively target customers with products and services. The first essay examines the impact that improving a recommender system has on firms that deploy such systems. A market with customers heterogeneous in their search costs is considered. We find that in a monopoly, a firm…

  14. Deployment of Recommender Systems: Operational and Strategic Issues

    ERIC Educational Resources Information Center

    Ghoshal, Abhijeet

    2011-01-01

    E-commerce firms are increasingly adopting recommendation systems to effectively target customers with products and services. The first essay examines the impact that improving a recommender system has on firms that deploy such systems. A market with customers heterogeneous in their search costs is considered. We find that in a monopoly, a firm…

  15. Wind Farm Recommendation Report

    SciTech Connect

    John Reisenauer

    2011-05-01

    On April 21, 2011, an Idaho National Laboratory (INL) Land Use Committee meeting was convened to develop a wind farm recommendation for the Executive Council and a list of proposed actions for proceeding with the recommendation. In terms of land use, the INL Land Use Committee unanimously agrees that Site 6 is the preferred location of the alternatives presented for an INL wind farm. However, further studies and resolution to questions raised (stated in this report) by the INL Land Use Committee are needed for the preferred location. Studies include, but are not limited to, wind viability (6 months), bats (2 years), and the visual impact of the wind farm. In addition, cultural resource surveys and consultation (1 month) and the National Environmental Policy Act process (9 to 12 months) need to be completed. Furthermore, there is no documented evidence of developers expressing interest in constructing a small wind farm on INL, nor a specific list of expectations or concessions for which a developer might expect INL to cover the cost. To date, INL assumes the National Environmental Policy Act activities will be paid for by the Department of Energy and INL (the environmental assessment has only received partial funding). However, other concessions also may be expected by developers such as roads, fencing, power line installation, tie-ins to substations, annual maintenance, snow removal, access control, down-time, and remediation. These types of concessions have not been documented, as a request, from a developer and INL has not identified the short and long-term cost liabilities for such concessions should a developer expect INL to cover these costs. INL has not identified a go-no-go funding level or the priority this Wind Farm Project might have with respect to other nuclear-related projects, should the wind farm remain an unfunded mandate. The Land Use Committee recommends Legal be consulted to determine what, if any, liabilities exist with the Wind Farm Project and

  16. Screening for breast cancer: U.S. Preventive Services Task Force recommendation statement.

    PubMed

    2009-11-17

    Update of the 2002 U.S. Preventive Services Task Force (USPSTF) recommendation statement on screening for breast cancer in the general population. The USPSTF examined the evidence on the efficacy of 5 screening modalities in reducing mortality from breast cancer: film mammography, clinical breast examination, breast self-examination, digital mammography, and magnetic resonance imaging in order to update the 2002 recommendation. To accomplish this update, the USPSTF commissioned 2 studies: 1) a targeted systematic evidence review of 6 selected questions relating to benefits and harms of screening, and 2) a decision analysis that used population modeling techniques to compare the expected health outcomes and resource requirements of starting and ending mammography screening at different ages and using annual versus biennial screening intervals. The USPSTF recommends against routine screening mammography in women aged 40 to 49 years. The decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take into account patient context, including the patient's values regarding specific benefits and harms. (Grade C recommendation) The USPSTF recommends biennial screening mammography for women between the ages of 50 and 74 years. (Grade B recommendation) The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of screening mammography in women 75 years or older. (I statement) The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of clinical breast examination beyond screening mammography in women 40 years or older. (I statement) The USPSTF recommends against clinicians teaching women how to perform breast self-examination. (Grade D recommendation) The USPSTF concludes that the current evidence is insufficient to assess additional benefits and harms of either digital mammography or magnetic resonance imaging instead of

  17. Recommendation in evolving online networks

    NASA Astrophysics Data System (ADS)

    Hu, Xiao; Zeng, An; Shang, Ming-Sheng

    2016-02-01

    Recommender system is an effective tool to find the most relevant information for online users. By analyzing the historical selection records of users, recommender system predicts the most likely future links in the user-item network and accordingly constructs a personalized recommendation list for each user. So far, the recommendation process is mostly investigated in static user-item networks. In this paper, we propose a model which allows us to examine the performance of the state-of-the-art recommendation algorithms in evolving networks. We find that the recommendation accuracy in general decreases with time if the evolution of the online network fully depends on the recommendation. Interestingly, some randomness in users' choice can significantly improve the long-term accuracy of the recommendation algorithm. When a hybrid recommendation algorithm is applied, we find that the optimal parameter gradually shifts towards the diversity-favoring recommendation algorithm, indicating that recommendation diversity is essential to keep a high long-term recommendation accuracy. Finally, we confirm our conclusions by studying the recommendation on networks with the real evolution data.

  18. IRIS Product Recommendations

    NASA Technical Reports Server (NTRS)

    Short, David A.

    2000-01-01

    This report presents the Applied Meteorology Unit's (AMU) evaluation of SIGMET Inc.'s Integrated Radar Information System (IRIS) Product Generator and recommendations for products emphasizing lightning and microburst tools. The IRIS Product Generator processes radar reflectivity data from the Weather Surveillance Radar, model 74C (WSR-74C), located on Patrick Air Force Base. The IRIS System was upgraded from version 6.12 to version 7.05 in late December 1999. A statistical analysis of atmospheric temperature variability over the Cape Canaveral Air Force Station (CCAFS) Weather Station provided guidance for the configuration of radar products that provide information on the mixed-phase (liquid and ice) region of clouds, between 0 C and -20 C. Mixed-phase processes at these temperatures are physically linked to electrification and the genesis of severe weather within convectively generated clouds. Day-to-day variations in the atmospheric temperature profile are of sufficient magnitude to warrant periodic reconfiguration of radar products intended for the interpretation of lightning and microburst potential of convectively generated clouds. The AMU also examined the radar volume-scan strategy to determine the scales of vertical gaps within the altitude range of the 0 C to -20 C isotherms over the Kennedy Space Center (KSC)/CCAFS area. This report present's two objective strategies for designing volume scans and proposes a modified scan strategy that reduces the average vertical gap by 37% as a means for improving radar observations of cloud characteristics in the critical 0 C to -20 C layer. The AMU recommends a total of 18 products, including 11 products that require use of the IRIS programming language and the IRIS User Product Insert feature. Included is a cell trends product and display, modeled after the WSR-88D cell trends display in use by the National Weather Service.

  19. Measuring Nursing Care Value.

    PubMed

    Welton, John M; Harper, Ellen M

    2016-01-01

    The value of nursing care as well as the contribution of individual nurses to clinical outcomes has been difficult to measure and evaluate. Existing health care financial models hide the contribution of nurses; therefore, the link between the cost and quality o nursing care is unknown. New data and methods are needed to articulate the added value of nurses to patient care. The final results and recommendations of an expert workgroup tasked with defining and measuring nursing care value, including a data model to allow extraction of key information from electronic health records to measure nursing care value, are described. A set of new analytic metrics are proposed.

  20. Uncertainties and recommendations.

    PubMed

    Callaghan, Terry V; Björn, Lars Olof; Chernov, Yuri; Chapin, Terry; Christensen, Torben R; Huntley, Brian; Ims, Rolf A; Johansson, Margareta; Jolly, Dyanna; Jonasson, Sven; Matveyeva, Nadya; Panikov, Nicolai; Oechel, Walter; Shaver, Gus

    2004-11-01

    An assessment of the impacts of changes in climate and UV-B radiation on Arctic terrestrial ecosystems, made within the Arctic Climate Impacts Assessment (ACIA), highlighted the profound implications of projected warming in particular for future ecosystem services, biodiversity and feedbacks to climate. However, although our current understanding of ecological processes and changes driven by climate and UV-B is strong in some geographical areas and in some disciplines, it is weak in others. Even though recently the strength of our predictions has increased dramatically with increased research effort in the Arctic and the introduction of new technologies, our current understanding is still constrained by various uncertainties. The assessment is based on a range of approaches that each have uncertainties, and on data sets that are often far from complete. Uncertainties arise from methodologies and conceptual frameworks, from unpredictable surprises, from lack of validation of models, and from the use of particular scenarios, rather than predictions, of future greenhouse gas emissions and climates. Recommendations to reduce the uncertainties are wide-ranging and relate to all disciplines within the assessment. However, a repeated theme is the critical importance of achieving an adequate spatial and long-term coverage of experiments, observations and monitoring of environmental changes and their impacts throughout the sparsely populated and remote region that is the Arctic.

  1. Site Recommendation Subsurface Layout

    SciTech Connect

    C.L. Linden

    2000-06-28

    The purpose of this analysis is to develop a Subsurface Facility layout that is capable of accommodating the statutory capacity of 70,000 metric tons of uranium (MTU), as well as an option to expand the inventory capacity, if authorized, to 97,000 MTU. The layout configuration also requires a degree of flexibility to accommodate potential changes in site conditions or program requirements. The objective of this analysis is to provide a conceptual design of the Subsurface Facility sufficient to support the development of the Subsurface Facility System Description Document (CRWMS M&O 2000e) and the ''Emplacement Drift System Description Document'' (CRWMS M&O 2000i). As well, this analysis provides input to the Site Recommendation Consideration Report. The scope of this analysis includes: (1) Evaluation of the existing facilities and their integration into the Subsurface Facility design. (2) Identification and incorporation of factors influencing Subsurface Facility design, such as geological constraints, thermal loading, constructibility, subsurface ventilation, drainage control, radiological considerations, and the Test and Evaluation Facilities. (3) Development of a layout showing an available area in the primary area sufficient to support both the waste inventories and individual layouts showing the emplacement area required for 70,000 MTU and, if authorized, 97,000 MTU.

  2. [Recommendations for neonatal transport].

    PubMed

    Moreno Hernando, J; Thió Lluch, M; Salguero García, E; Rite Gracia, S; Fernández Lorenzo, J R; Echaniz Urcelay, I; Botet Mussons, F; Herranz Carrillo, G; Sánchez Luna, M

    2013-08-01

    During pregnancy, it is not always possible to identify maternal or foetal risk factors. Infants requiring specialised medical care are not always born in centres providing intensive care and will need to be transferred to a referral centre where intensive care can be provided. Therefore Neonatal Transport needs to be considered as part of the organisation of perinatal health care. The aim of Neonatal Transport is to transfer a newborn infant requiring intensive care to a centre where specialised resources and experience can be provided for the appropriate assessment and continuing treatment of a sick newborn infant. Intrauterine transfer is the ideal mode of transport when the birth of an infant with risk factors is diagnosed. Unfortunately, not all problems can be detected in advance with enough time to safely transfer a pregnant woman. Around 30- 50% of risk factors will be diagnosed during labour or soon after birth. Therefore, it is important to have the knowledge and resources to resuscitate and stabilise a newborn infant, as well as a specialised neonatal transport system. With this specialised transport it is possible to transfer newly born infants with the same level of care that they would receive if they had been born in a referral hospital, without increasing their risks or affecting the wellbeing of the newborn. The Standards Committee of the Spanish Society of Neonatology reviewed and updated recommendations for intrauterine transport and indications for neonatal transfer. They also reviewed organisational and logistic factors involved with performing neonatal transport. The Committee review included the type of personnel who should be involved; communication between referral and receiving hospitals; documentation; mode of transport; equipment to stabilise newly born infants; management during transfer, and admission at the referral hospital.

  3. The new carbohydrate intake recommendations.

    PubMed

    Jeukendrup, Asker

    2013-01-01

    Carbohydrate intake during prolonged exercise has been shown to increase endurance capacity and improve performance. Until recently, the advice was to ingest 30-60 g of carbohydrate per hour. The upper limit was based on studies that demonstrated that intakes greater than 60-70 g/h would not result in greater exogenous carbohydrate oxidation rates. The lower limit was an estimated guess of the minimum amount of carbohydrate required for ergogenic effects. In addition, the advice was independent of the type, the duration or the intensity of the activity as well as the level of athlete. Since 2004, significant advances in the understanding of the effects of carbohydrate intake during exercise have made it possible to be much more prescriptive and individual with the advice. Studies revealed that oxidation rates can reach much higher values (up to 105 g/h) when multiple transportable carbohydrates are ingested (i.e. glucose:fructose). It has also been observed that carbohydrate ingested during shorter higher intensity exercise (1 h, 80%VO2max) can improve performance, although mechanisms are distinctly different. These findings resulted in new recommendations that are dependent on the duration and intensity of exercise and not only specify the quantity of carbohydrate to be ingested but also the type. Copyright © 2013 Nestec Ltd., Vevey/S. Karger AG, Basel.

  4. Models and strategies for value clarification in population education.

    PubMed

    Villanueva, C L

    1976-01-01

    Teachers, principals, supervisiors, superintendents, policymakers, and researchers all agree that value clarification is the most effective method for teaching value-laden population issues. It has been recognized that cultural attitudes and beliefs that are negative to family planning block acceptance of the population program. Education can become an effective vehicle in raising the level of awareness and acceptance of population practices. Teachers and students must 1st critically examine a set of alternative population values, for then they can weigh the pros and cons in order to arrive at value decisions regarding fertility behavior. Discussion and recommendations for practice and policy are presented for 9 problem areas: defining value clarification, affective versus cognitive process, teacher participation, open-ended versus closed-ended approach, use of resources and devices, target group, teacher personality, selecting appropriate issues, and dealing with controversial subjects.

  5. Solving the stability-accuracy-diversity dilemma of recommender systems

    NASA Astrophysics Data System (ADS)

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

    2017-02-01

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

  6. Human target acquisition performance

    NASA Astrophysics Data System (ADS)

    Teaney, Brian P.; Du Bosq, Todd W.; Reynolds, Joseph P.; Thompson, Roger; Aghera, Sameer; Moyer, Steven K.; Flug, Eric; Espinola, Richard; Hixson, Jonathan

    2012-06-01

    The battlefield has shifted from armored vehicles to armed insurgents. Target acquisition (identification, recognition, and detection) range performance involving humans as targets is vital for modern warfare. The acquisition and neutralization of armed insurgents while at the same time minimizing fratricide and civilian casualties is a mounting concern. U.S. Army RDECOM CERDEC NVESD has conducted many experiments involving human targets for infrared and reflective band sensors. The target sets include human activities, hand-held objects, uniforms & armament, and other tactically relevant targets. This paper will define a set of standard task difficulty values for identification and recognition associated with human target acquisition performance.

  7. Value, Value, Where Is the Value?

    ERIC Educational Resources Information Center

    Kaufman, Roger

    2003-01-01

    Discusses measurement in performance improvement, including the Kirkpatrick four-level model of evaluation for training, and adding value. Highlights include adding value at all levels of organizational performance, for the clients and society; other models of performance improvement; the major focus of HPT (human performance technology); and…

  8. Step count recommendations for children based on body fat.

    PubMed

    Duncan, J Scott; Schofield, Grant; Duncan, Elizabeth K

    2007-01-01

    Current recommendations for pedometer-determined physical activity in children (boys, 15,000 steps/day; girls, 12,000 steps/day) were based on the association between weekday step counts and body mass index. The objective of this study was to develop new targets using both weekday and weekend step counts with percentage body fat (%BF) as the criterion reference. The %BF of 969 New Zealand European, Polynesian, and Asian children (515 male, 454 female) aged 5-12 years was measured in 2004 using hand-to-foot bioelectrical impedance analysis. Weekday and weekend step counts, assessed using sealed multi-day-memory pedometers over 5 days, were combined into a scaled mean step count. The contrasting groups method for determining criterion-referenced cut-off points was used to establish the optimal step count values for predicting overweight (%BF>85th percentile) and non-overweight (%BF<85th percentile). Overweight children had significantly lower mean step counts (14,238+/-3343, boys; 12,555+/-3169, girls) than non-overweight children (16,106+/-3208, boys; 14,176+/-2728, girls). Optimal step count cut-off points were 16,000 steps/day for boys and 13,000 steps/day for girls. Step count targets for reducing the risk of excess body fat in children are 1000 steps/day higher than existing BMI-referenced guidelines.

  9. Hit Identification and Optimization in Virtual Screening: Practical Recommendations Based Upon a Critical Literature Analysis

    PubMed Central

    Zhu, Tian; Cao, Shuyi; Su, Pin-Chih; Patel, Ram; Shah, Darshan; Chokshi, Heta B.; Szukala, Richard; Johnson, Michael E.; Hevener, Kirk E.

    2013-01-01

    A critical analysis of virtual screening results published between 2007 and 2011 was performed. The activity of reported hit compounds from over 400 studies was compared to their hit identification criteria. Hit rates and ligand efficiencies were calculated to assist in these analyses and the results were compared with factors such as the size of the virtual library and the number of compounds tested. A series of promiscuity, drug-like, and ADMET filters were applied to the reported hits to assess the quality of compounds reported and a careful analysis of a subset of the studies which presented hit optimization was performed. This data allowed us to make several practical recommendations with respect to selection of compounds for experimental testing, defining hit identification criteria, and general virtual screening hit criteria to allow for realistic hit optimization. A key recommendation is the use of size-targeted ligand efficiency values as hit identification criteria. PMID:23688234

  10. Hit identification and optimization in virtual screening: practical recommendations based on a critical literature analysis.

    PubMed

    Zhu, Tian; Cao, Shuyi; Su, Pin-Chih; Patel, Ram; Shah, Darshan; Chokshi, Heta B; Szukala, Richard; Johnson, Michael E; Hevener, Kirk E

    2013-09-12

    A critical analysis of virtual screening results published between 2007 and 2011 was performed. The activity of reported hit compounds from over 400 studies was compared to their hit identification criteria. Hit rates and ligand efficiencies were calculated to assist in these analyses, and the results were compared with factors such as the size of the virtual library and the number of compounds tested. A series of promiscuity, druglike, and ADMET filters were applied to the reported hits to assess the quality of compounds reported, and a careful analysis of a subset of the studies that presented hit optimization was performed. These data allowed us to make several practical recommendations with respect to selection of compounds for experimental testing, definition of hit identification criteria, and general virtual screening hit criteria to allow for realistic hit optimization. A key recommendation is the use of size-targeted ligand efficiency values as hit identification criteria.

  11. Nutritional recommendations for divers.

    PubMed

    Benardot, Dan; Zimmermann, Wes; Cox, Gregory R; Marks, Saul

    2014-08-01

    Competitive diving involves grace, power, balance, and flexibility, which all require satisfying daily energy and nutrient needs. Divers are short, well-muscled, and lean, giving them a distinct biomechanical advantage. Although little diving-specific nutrition research on performance and health outcomes exists, there is concern that divers are excessively focused on body weight and composition, which may result in reduced dietary intake to achieve desired physique goals. This will result in low energy availability, which may have a negative impact on their power-to-weight ratio and health risks. Evidence is increasing that restrictive dietary practices leading to low energy availability also result in micronutrient deficiencies, premature fatigue, frequent injuries, and poor athletic performance. On the basis of daily training demands, estimated energy requirements for male and female divers are 3,500 kcal and 2,650 kcal, respectively. Divers should consume a diet that provides 3-8 g/kg/day of carbohydrate, with the higher values accommodating growth and development. Total daily protein intake (1.2-1.7 g/kg) should be spread evenly throughout the day in 20 to 30 g amounts and timed appropriately after training sessions. Divers should consume nutrient-dense foods and fluids and, with medical supervision, certain dietary supplements (i.e., calcium and iron) may be advisable. Although sweat loss during indoor training is relatively low, divers should follow appropriate fluid-intake strategies to accommodate anticipated sweat losses in hot and humid outdoor settings. A multidisciplinary sports medicine team should be integral to the daily training environment, and suitable foods and fluids should be made available during prolonged practices and competitions.

  12. National Recommended Water Quality Criteria

    EPA Pesticide Factsheets

    The National Recommended Water Quality Criteria is a compilation of national recommended water quality criteria for the protection of aquatic life and human health in surface water for approximately 150 pollutants. These criteria provide guidance for states and tribes to use in adopting water quality standards.

  13. Teacher Leadership: Federal Policy Recommendations

    ERIC Educational Resources Information Center

    Gran, Jackie; Young, Margaret; Broin, Alexandra

    2015-01-01

    This policy brief was developed specifically for federal policymakers, and builds upon the policy recommendations included in "Leading from Every Seat: Empowering Principals to Cultivate Teacher Leadership for School Improvement." The recommendations in this report include the following: (1) Uncover New Leadership Ideas and Seed…

  14. Recommendations for Constructing Roadside Vegetation ...

    EPA Pesticide Factsheets

    Recommendations for external partners planting roadside vegetation. Intended for broad use, but immediate use will be to provide to project partners on the RESES roadside vegetation project and as an attachment to the RESES project QAPP Provide recommendations on the physical characteristics of roadside vegetation that can provide a local air quality benefit

  15. Context-Aware Recommender Systems

    NASA Astrophysics Data System (ADS)

    Adomavicius, Gediminas; Tuzhilin, Alexander

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

  16. Patients' refusal of recommended treatment.

    PubMed

    Dickens, Bernard M; Cook, Rebecca J

    2015-10-01

    When patients require information to decide whether to accept recommended treatments, a question in both law and ethics is whether the same information is adequate whether they consent or refuse, or whether refusal requires more or repeated information. Refusals of recommended treatment can carry increased risks for patients' well-being and so require more emphatic disclosure without imposing pressure. A related question is whether guardians of dependents who would decline recommended treatment for themselves--for instance on religious grounds--can similarly decline it for their dependents. When pregnant women, children, and adolescents are able to give consent for recommended treatment, the question arises whether they are equally competent to refuse it and prevent their decisions being overridden by guardians or courts. Consenting to and refusing medical treatments recommended in one's own or dependents' best interests might not be the same sorts of decisions and could require different levels of disclosure and capacity. Copyright © 2015. Published by Elsevier Ireland Ltd.

  17. Recommended procedures for measuring aircraft noise and associated parameters

    NASA Technical Reports Server (NTRS)

    Marsh, A. H.

    1977-01-01

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

  18. Avoiding congestion in recommender systems

    NASA Astrophysics Data System (ADS)

    Ren, Xiaolong; Lü, Linyuan; Liu, Runran; Zhang, Jianlin

    2014-06-01

    Recommender systems use the historical activities and personal profiles of users to uncover their preferences and recommend objects. Most of the previous methods are based on objects’ (and/or users’) similarity rather than on their difference. Such approaches are subject to a high risk of increasingly exposing users to a narrowing band of popular objects. As a result, a few objects may be recommended to an enormous number of users, resulting in the problem of recommendation congestion, which is to be avoided, especially when the recommended objects are limited resources. In order to quantitatively measure a recommendation algorithm's ability to avoid congestion, we proposed a new metric inspired by the Gini index, which is used to measure the inequality of the individual wealth distribution in an economy. Besides this, a new recommendation method called directed weighted conduction (DWC) was developed by considering the heat conduction process on a user-object bipartite network with different thermal conductivities. Experimental results obtained for three benchmark data sets showed that the DWC algorithm can effectively avoid system congestion, and greatly improve the novelty and diversity, while retaining relatively high accuracy, in comparison with the state-of-the-art methods.

  19. Recommended for release on recognizance: factors affecting pretrial release recommendations.

    PubMed

    Petee, T A

    1994-06-01

    Researchers have acknowledged the influence of pretrial release agencies in judicial decision making regarding bail; however, few researchers have focused on the process used by the pretrial release agencies to make bail-bond recommendations. In this study I sought to establish which factors were most salient in making the decision to recommend a defendant for release on recognizance. I found that both officially sanctioned release criteria and "extralegal" variables were predictive of this decision.

  20. 76 FR 52664 - Request for Information: Announcement of Carcinogen and Recommended Exposure Limit (REL) Policy...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-08-23

    ... Carcinogen and Recommended Exposure Limit (REL) Policy Assessment AGENCY: National Institute for Occupational... review its approach to classifying carcinogens and establishing recommended exposure limits (RELs) for... recommended exposure limit (REL) for carcinogens or should lower targets be considered? (4) In establishing...

  1. 76 FR 81 - Adoption of Recommendation

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-01-03

    ...; ] ADMINISTRATIVE CONFERENCE OF THE UNITED STATES Adoption of Recommendation AGENCY: Administrative Conference of... the attached recommendation at its Fifty-third Plenary Session. The recommendation addresses issues... makes recommendations for improvements to the agencies, collectively or individually, and to...

  2. Values Research

    DTIC Science & Technology

    2009-10-01

    horizontal vs. vertical. • According to the theory of Planned Behavior ( Ajzen , 1988, 2002) attitude, subjective norms and perceived control...determines intention which may end in behavior . 7 Defining Human Values Cross-cultural theories on values emerged in the 80s developed by three main...attitudes with social structure. 4 Defining Human Values • According to Parsons (Parsons & Shils, 1951), values instigate behavior . • In line

  3. GRADE guidelines: 15. Going from evidence to recommendation-determinants of a recommendation's direction and strength.

    PubMed

    Andrews, Jeffrey C; Schünemann, Holger J; Oxman, Andrew D; Pottie, Kevin; Meerpohl, Joerg J; Coello, Pablo Alonso; Rind, David; Montori, Victor M; Brito, Juan Pablo; Norris, Susan; Elbarbary, Mahmoud; Post, Piet; Nasser, Mona; Shukla, Vijay; Jaeschke, Roman; Brozek, Jan; Djulbegovic, Ben; Guyatt, Gordon

    2013-07-01

    In the GRADE approach, the strength of a recommendation reflects the extent to which we can be confident that the composite desirable effects of a management strategy outweigh the composite undesirable effects. This article addresses GRADE's approach to determining the direction and strength of a recommendation. The GRADE describes the balance of desirable and undesirable outcomes of interest among alternative management strategies depending on four domains, namely estimates of effect for desirable and undesirable outcomes of interest, confidence in the estimates of effect, estimates of values and preferences, and resource use. Ultimately, guideline panels must use judgment in integrating these factors to make a strong or weak recommendation for or against an intervention. Copyright © 2013 Elsevier Inc. All rights reserved.

  4. [GRADE guidelines 15: going from evidence to recommendation - determinants of a recommendation's direction and strength].

    PubMed

    Nußbaumer, Barbara; Gartlehner, Gerald; Kien, Christina; Kaminski-Hartenthaler, Angela; Langer, Gero; Meerpohl, Joerg J; Schünemann, Holger J

    2014-01-01

    In the GRADE approach, the strength of a recommendation reflects the extent to which we can be confident that the composite desirable effects of a management strategy outweigh the composite undesirable effects. This article addresses GRADE's approach to determining the direction and strength of a recommendation. The GRADE describes the balance of desirable and undesirable outcomes of interest among alternative management strategies depending on four domains, namely estimates of effect for desirable and undesirable outcomes of interest, confidence in the estimates of effect, estimates of values and preferences, and resource use. Ultimately, guideline panels must use judgment in integrating these factors to make a strong or weak recommendation for or against an intervention. Copyright © 2014. Published by Elsevier GmbH.

  5. Temperature targets revisited under climate sensitivity uncertainty

    NASA Astrophysics Data System (ADS)

    Neubersch, Delf; Roth, Robert; Held, Hermann

    2015-04-01

    While the 2° target has become an official goal of the COP (Conference of the Parties) process recent work has shown that it requires re-interpretation if climate sensitivity uncertainty in combination with anticipated future learning is considered (Schmidt et al., 2011). A strict probabilistic limit as suggested by the Copenhagen diagnosis may lead to conceptual flaws in view of future learning such a negative expected value of information or even ill-posed policy recommendations. Instead Schmidt et al. suggest trading off the probabilistic transgression of a temperature target against mitigation-induced welfare losses and call this procedure cost risk analysis (CRA). Here we spell out CRA for the integrated assessment model MIND and derive necessary conditions for the exact nature of that trade-off. With CRA at hand it is for the first time that the expected value of climate information, for a given temperature target, can meaningfully be assessed. When focusing on a linear risk function as the most conservative of all possible risk functions, we find that 2° target-induced mitigation costs could be reduced by up to 1/3 if the climate response to carbon dioxide emissions were known with certainty, amounting to hundreds of billions of Euros per year (Neubersch et al., 2014). Further benefits of CRA over strictly formulated temperature targets are discussed. References: D. Neubersch, H. Held, A. Otto, Operationalizing climate targets under learning: An application of cost-risk analysis, Climatic Change, 126 (3), 305-318, DOI 10.1007/s10584-014-1223-z (2014). M. G. W. Schmidt, A. Lorenz, H. Held, E. Kriegler, Climate Targets under Uncertainty: Challenges and Remedies, Climatic Change Letters, 104 (3-4), 783-791, DOI 10.1007/s10584-010-9985-4 (2011).

  6. Recommended Immunizations for Adults 50+

    MedlinePlus

    ... page please turn Javascript on. Health Screenings and Immunizations Recommended Immunizations For Adults 50+ The content in this section ... out more, visit How Vaccines Prevent Disease . Vaccines, Vaccinations, and Immunizations Understanding the difference between vaccines, vaccinations, ...

  7. [Comparison of international recommendations for the recognition of asymptomatic high risk patients for a heart attack in Germany].

    PubMed

    von Eckardstein, A; Schulte, H; Assmann, G

    2005-01-01

    The recommendations of the International Task Force for the Prevention of Coronary Heart Disease/International Atherosclerosis Society (ITF/IAS), the US-American Adult Treatment Panel III of the National Cholesterol Education Programs (ATP III) and the 3rd Joint European Guidelines (3JE) for the prevention coronary heart disease (CHD) show good agreement in tertiary prevention. All three guidelines recommend that patients with manifest CHD should have a blood pressure below 140/90 mm Hg and LDL-cholesterol below 2.6 mmol/l (100 mg/dl). By contrast, the three recommendations differ with respect to the prevention of cardiovascular events in asymptomatic high risk patients (secondary prevention), notably in the strategy to be used for risk assessment. Both the ITF/IAS guidelines and the 3JE guidelines can be adapted and realized in the various European countries. We therefore compared the prognostic values of the three recommendations by applying them to the data of male participants of the Prospective Cardiovascular Munster (PROCAM) Study. The ITF/IAS recommendations show the highest specificity (94.5%), positive predictive value (32.0%) and diagnostic efficacy (90.5%); the 3JE guidelines have the highest sensitivity (64.6%) but lowest specificity (77.9%), positive predictive value (17.5%) and diagnostic efficacy (77.0%). The application of the 3JE recommendations would target 25% of German men aged 35-65 years as cardiovascular high risk patients, by contrast to 7.5% through application of the ITF/IAS guidelines. In view of the limited resources in the public health systemthe application of the ITF/IAS guidelines in Germany appears more appropriate.

  8. NUCLEAR DATA EVALUATIONS AND RECOMMENDATIONS

    SciTech Connect

    HOLDEN, N.E.

    2005-05-08

    The published scientific literature is scanned and periodically evaluated for neutron and non-neutron nuclear data and the resulting recommendations are published [1,2]. After the literature has been scanned and appropriate data collected, there are often problems with regard to the treatment of the various types of data during this evaluation process and with regard to the method by which the recommendations are drawn from the assessment of the collection of individual measurements. Some-problems with uncertainties are presented.

  9. Constructing an interdisciplinary flow regime recommendation

    USGS Publications Warehouse

    Bartholow, J.M.

    2010-01-01

    It is generally agreed that river rehabilitation most often relies on restoring a more natural flow regime, but credibly defining the desired regime can be problematic. I combined four distinct methods to develop and refine month-by-month and event-based flow recommendations to protect and partially restore the ecological integrity of the Cache la Poudre River through Fort Collins, Colorado. A statistical hydrologic approach was used to summarize the river's natural flow regime and set provisional monthly flow targets at levels that were historically exceeded 75% of the time. These preliminary monthly targets were supplemented using results from three Poudre-specific disciplinary studies. A substrate maintenance flow model was used to better define the high flows needed to flush accumulated sediment from the river's channel and help sustain the riparian zone in this snowmelt-dominated river. A hydraulic/habitat model and a water temperature model were both used to better define the minimum flows necessary to maintain a thriving cool water fishery. The result is a range of recommended monthly flows and daily flow guidance illustrating the advantage of combining a wide range of available disciplinary information, supplemented by judgment based on ecological principles and a general understanding of river ecosystems, in a highly altered, working river. ?? 2010 American Water Resources Association.

  10. Introduction on health recommender systems.

    PubMed

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

    2015-01-01

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

  11. Infrared target array development

    NASA Astrophysics Data System (ADS)

    Scott, E. A.

    1980-04-01

    The US Army Yuma Proving Ground (USAYPG) was requested to develop and acquire a series of infrared targets with controllable thermal signatures to support the test and evaluation of the Target Acquisition Designation System/Pilot Night Vision System (TADS/PNVS) subsystems of the Advanced Attack Helicopter (AAH) Fire Control System. Prior to this development effort, no capability beyond the use of real-scene targets existed at USAYPG to provide thermally active targets with characteristic signatures in the infrared band. Three targets were acquired: (1) a detection target; (2) a recognition target; and (3) a laser scoring board. It is concluded that design goals were met and the system was delivered in time to perform its function. The system provides sufficient thermal realism and has advanced the state-of-the-art of infrared imaging system test and evaluation. It is recommended that the Field Equivalent Bar Target (FEBT) system be validated as a potential test standard and that environmentally 'hardened' targets be acquired for continued thermal sight testing.

  12. Knowledge of cholesterol levels and targets in patients with coronary artery disease.

    PubMed

    Cheng, Susan; Lichtman, Judith H; Amatruda, Joan M; Smith, Grace L; Mattera, Jennifer A; Roumanis, Sarah A; Krumholz, Harlan M

    2005-01-01

    Little is known about the extent to which patients are aware of nationally-recommended cholesterol and lipid subfraction targets. The authors interviewed 738 patients hospitalized with coronary artery disease to assess their knowledge of their low-density lipoprotein, high-density lipoprotein, and total cholesterol levels as well as corresponding national targets. Only 8%, 8%, and 43% of patients could recall their low-density lipoprotein, high-density lipoprotein, and total cholesterol values, respectively. Only 5%, 2%, and 50% could correctly name targets for these values. Knowledge of cholesterol targets was particularly poor among women, nonwhites, and patients without any college education. Patients with multiple cardiac risk factors and patients with a previous history of cardiovascular disease were no more knowledgeable about their cholesterol targets than those without these conditions. These findings suggest that current cholesterol education efforts appear inadequate, particularly for women, nonwhites, and patients without any college education.

  13. Economics and lighting level recommendations

    SciTech Connect

    Clear, R.; Berman, S.

    1992-04-01

    The Illuminating Engineering Society of North America develops light level recommendations for tasks where visual performance is important. The 1959 and 1972 recommendations for illumination levels were based on the principle of delivering a fixed level of performance as predicted by the visual performance models of the time. This same principle is being considered for future revisions to the recommendations. There is currently no explicit method for determining whether a given fixed performance level is in any sense optimal or best. Visual performance increases with lighting levels, but so do economic and environmental costs. These costs lessen the economic benefits of the improved visual performance. A formal method for including these factors in light level recommendations is to restate the problem in terms of net benefits (benefits minus costs). The resulting equations have well defined optima versus light level, and thus give an explicit estimate of what the best lighting levels are in terms of current visual performance models, and current economic conditions. A simple net-benefit procedure is described, and sample calculations are shown for two current visual performance models. Fixed performance levels do not provide economically optimal recommendations with either model. There are also differences between models, but they are less significant than the large differences between the principles of fixed performance levels and economic optimization.

  14. Value Added?

    ERIC Educational Resources Information Center

    UCLA IDEA, 2012

    2012-01-01

    Value added measures (VAM) uses changes in student test scores to determine how much "value" an individual teacher has "added" to student growth during the school year. Some policymakers, school districts, and educational advocates have applauded VAM as a straightforward measure of teacher effectiveness: the better a teacher,…

  15. Forestland values.

    Treesearch

    John H. Beuter; Ralph J. Alig

    2004-01-01

    This issue of the journal of Forestry is devoted to articles about forestland values. Viewed broadly, natural resources and humans are our two basic resources. An expression of the importance of land as a foundation for forest ecosystems is forestland value. Our attitudes about land and the forest ecosystems that they support have changed considerably in recent years....

  16. Recommender Systems on the Web: A Model-Driven Approach

    NASA Astrophysics Data System (ADS)

    Rojas, Gonzalo; Domínguez, Francisco; Salvatori, Stefano

    Recommendation techniques have been increasingly incorporated in e-commerce applications, supporting clients in identifying those items that best fit their needs. Unfortunately, little effort has been made to integrate these techniques into methodological proposals of Web development, discouraging the adoption of engineering approaches to face the complexity of recommender systems. This paper introduces a proposal to develop Web-based recommender systems from a model-driven perspective, specifying the elements of recommendation algorithms from a high abstraction level. Adopting the item-to-item approach, this proposal adopts the conceptual models of an existing Web development process to represent the preferences of users for different items, the similarity between obtained from different algorithms, and the selection and ordering of the recommended items according to a predicted rating value. Along with systematizing the development of these systems, this approach permits to evaluate different algorithms with minor changes at conceptual level, simplifying their mapping to final implementations.

  17. The CCDS Data Compression Recommendations: Development and Status

    NASA Technical Reports Server (NTRS)

    Yeh, Pen-Shu; Moury, Gilles; Armbruster, Philippe; Day, John H. (Technical Monitor)

    2002-01-01

    The Consultative Committee for Space Data Systems (CCSDS) has been engaging in recommending data compression standards for space applications. The first effort focused on a lossless scheme that was adopted in 1997. Since then, space missions benefiting from this recommendation range from deep space probes to near Earth observatories. The cost savings result not only from reduced onboard storage and reduced bandwidth, but also in ground archive of mission data. In many instances, this recommendation also enables more science data to be collected for added scientific value. Since 1998, the compression sub-panel of CCSDS has been investigating lossy image compression schemes and is currently working towards a common solution for a single recommendation. The recommendation will fulfill the requirements for remote sensing conducted on space platforms.

  18. [Recommendations for antibiotic monitoring in ICU patients].

    PubMed

    Alvarez, Francisco; Olaechea, Pedro; Grau, Santiago; Marín, Mónica; Domínguez, Alfonso; Martínez-Lanao, José; Soy, Dolors; Alos, Manuel; Victoria, María; Sádaba, Belén; Mediavilla, Africa; Fatela, Daniel

    2008-01-01

    Monitoring plasma concentrations of antimicrobial agents used to treat infection in critically ill patients is one of the recommended strategies for improving clinical outcome. Drug monitoring has a double aim: to limit adverse events and to increase the effectiveness of the drugs. In clinical practice, however, this approach is mainly limited to monitoring plasma concentrations of vancomycin and aminoglycosides, although future extension to other antimicrobial agents would be desirable. Application of this technique varies considerably between hospitals, and this makes interpretation and comparison of the results obtained difficult. For this reason, representatives of various scientific societies related to the pharmacokinetic area have developed a series of recommendations for monitoring plasma concentrations of antimicrobials using vancomycin and several aminoglycosides as the reference. The recommendations are based on 14 questions encompassing all steps of the process: indication for the test, blood sampling (timing of blood collection, blood volume, tubes), transport to the laboratory, techniques applied, normal values, dose adjustment, and reporting the results. The purpose of these guidelines is to develop a process of monitoring plasma antimicrobial concentrations that is as homogeneous as possible to facilitate the design of multicenter studies, as well as the interpretation and comparison of results.

  19. Plan for early action: Recommendations

    SciTech Connect

    1998-12-31

    This report contains recommendations on the implementation of an action plan to reduce or recapture greenhouse gas (GHG) emissions in British Columbia. The report includes the consensus recommendations of the BC Greenhouse Gas Forum, as well as those items on which Forum participants have agreed to disagree, plus the reasons for those differences. The recommendations include: Umbrella actions which may affect several or all sectors of the economy, or support the success of other actions; actions to reduce vehicle kilometers travelled; actions to increase vehicle efficiency or increase the use of alternative fuels or technologies; actions to decrease GHG emissions from energy production; actions to increase end-use energy efficiency; and actions to reduce non-energy-related emissions. Appendices include work sheets on each action, with a description of the action and information on the action`s rationale, experience elsewhere, related policy initiatives, and key issues regarding feasibility and implementation.

  20. Recommended Practices in Thrust Measurements

    NASA Technical Reports Server (NTRS)

    Polk, James E.; Pancotti, Anthony; Haag, Thomas; King, Scott; Walker, Mitchell; Blakely, Joseph; Ziemer, John

    2013-01-01

    Accurate, direct measurement of thrust or impulse is one of the most critical elements of electric thruster characterization, and one of the most difficult measurements to make. The American Institute of Aeronautics and Astronautics has started an initiative to develop standards for many important measurement processes in electric propulsion, including thrust measurements. This paper summarizes recommended practices for the design, calibration, and operation of pendulum thrust stands, which are widely recognized as the best approach for measuring micro N- to mN-level thrust and micro Ns-level impulse bits. The fundamentals of pendulum thrust stand operation are reviewed, along with its implementation in hanging pendulum, inverted pendulum, and torsional balance configurations. Methods of calibration and recommendations for calibration processes are presented. Sources of error are identified and methods for data processing and uncertainty analysis are discussed. This review is intended to be the first step toward a recommended practices document to help the community produce high quality thrust measurements.

  1. Publication recommendations for electrodermal measurements.

    PubMed

    Boucsein, Wolfram; Fowles, Don C; Grimnes, Sverre; Ben-Shakhar, Gershon; roth, Walton T; Dawson, Michael E; Filion, Diane L

    2012-08-01

    This committee was appointed by the SPR Board to provide recommendations for publishing data on electrodermal activity (EDA). They are intended to be a stand-alone source for newcomers and experienced users. A short outline of principles for electrodermal measurement is given, and recommendations from an earlier report (Fowles et al., ) are incorporated. Three fundamental techniques of EDA recording are described: (1) endosomatic recording without the application of an external current, (2) exosomatic recording with direct current (the most widely applied methodology), and (3) exosomatic recording with alternating current-to date infrequently used but a promising future methodology. In addition to EDA recording in laboratories, ambulatory recording has become an emerging technique. Specific problems that come with this recording of EDA in the field are discussed, as are those emerging from recording EDA within a magnetic field (e.g., fMRI). Recommendations for the details that should be mentioned in publications of EDA methods and results are provided.

  2. Empowering Recommendation Technologies Through Argumentation

    NASA Astrophysics Data System (ADS)

    Chesñevar, Carlosiván; Maguitman, Ana Gabriela; González, María Paula

    User support systems have evolved in the last years as specialized tools to assist users in a plethora of computer-mediated tasks by providing guidelines or hints 19. Recommender systems are a special class of user support tools that act in cooperation with users, complementing their abilities and augmenting their performance by offering proactive or on-demand, context-sensitive support. Recommender systems are mostly based on machine learning and information retrieval algorithms, providing typically suggestions based on quantitative evidence (i.e. measures of similarity between objects or users). The inference process which led to such suggestions is mostly unknown (i.e. ‘black-box’ metaphor). Although the effectiveness of existing recommenders is remarkable, they still have some serious limitations.

  3. Recommended Practices in Thrust Measurements

    NASA Technical Reports Server (NTRS)

    Polk, James E.; Pancotti, Anthony; Haag, Thomas; King, Scott; Walker, Mitchell; Blakely, Joseph; Ziemer, John

    2013-01-01

    Accurate, direct measurement of thrust or impulse is one of the most critical elements of electric thruster characterization, and one of the most difficult measurements to make. The American Institute of Aeronautics and Astronautics has started an initiative to develop standards for many important measurement processes in electric propulsion, including thrust measurements. This paper summarizes recommended practices for the design, calibration, and operation of pendulum thrust stands, which are widely recognized as the best approach for measuring micro N- to mN-level thrust and micro Ns-level impulse bits. The fundamentals of pendulum thrust stand operation are reviewed, along with its implementation in hanging pendulum, inverted pendulum, and torsional balance configurations. Methods of calibration and recommendations for calibration processes are presented. Sources of error are identified and methods for data processing and uncertainty analysis are discussed. This review is intended to be the first step toward a recommended practices document to help the community produce high quality thrust measurements.

  4. The value of value congruence.

    PubMed

    Edwards, Jeffrey R; Cable, Daniel M

    2009-05-01

    Research on value congruence has attempted to explain why value congruence leads to positive outcomes, but few of these explanations have been tested empirically. In this article, the authors develop and test a theoretical model that integrates 4 key explanations of value congruence effects, which are framed in terms of communication, predictability, interpersonal attraction, and trust. These constructs are used to explain the process by which value congruence relates to job satisfaction, organizational identification, and intent to stay in the organization, after taking psychological need fulfillment into account. Data from a heterogeneous sample of employees from 4 organizations indicate that the relationships that link individual and organizational values to outcomes are explained primarily by the trust that employees place in the organization and its members, followed by communication, and, to a lesser extent, interpersonal attraction. Polynomial regression analyses reveal that the relationships emanating from individual and organizational values often deviated from the idealized value congruence relationship that underlies previous theory and research. The authors' results also show that individual and organizational values exhibited small but significant relationships with job satisfaction and organizational identification that bypassed the mediators in their model, indicating that additional explanations of value congruence effects should be pursued in future research. (c) 2009 APA, all rights reserved.

  5. Capacity Value of Wind Plants and Overview of U.S. Experience (Presentation)

    SciTech Connect

    Milligan, M.

    2011-08-01

    This presentation provides an overview and summary of the capacity value of wind power plants, based primarily on the U.S. experience. Resource adequacy assessment should explicitly consider risk. Effective load carrying capability (ELCC) captures each generators contribution to resource adequacy. On their own, reserve margin targets as a percent of peak can't capture risks effectively. Recommend benchmarking reliability-based approaches with others.

  6. Action Recommendation for Cyber Resilience

    SciTech Connect

    Choudhury, Sutanay; Rodriguez, Luke R.; Curtis, Darren S.; Oler, Kiri J.; Nordquist, Peter L.; Chen, Pin-Yu; Ray, Indrajit

    2015-09-01

    This paper presents an unifying graph-based model for representing the infrastructure, behavior and missions of an enterprise. We describe how the model can be used to achieve resiliency against a wide class of failures and attacks. We introduce an algorithm for recommending resilience establishing actions based on dynamic updates to the models. Without loss of generality, we show the effectiveness of the algorithm for preserving latency based quality of service (QoS). Our models and the recommendation algorithms are implemented in a software framework that we seek to release as an open source framework for simulating resilient cyber systems.

  7. Procyon LLC: From Music Recommendations to Preference Mapping

    ERIC Educational Resources Information Center

    Chinn, Susan J.

    2011-01-01

    Procyon LLC had re-launched and renamed their music discovery site, Electra, to Capella, in 2008. Its core strength had originated from Electra's proprietary technology, which used music libraries from real people, its members, to generating "automated word-of-mouth" recommendations, targeted advertising and editorial content. With the re-launch,…

  8. Procyon LLC: From Music Recommendations to Preference Mapping

    ERIC Educational Resources Information Center

    Chinn, Susan J.

    2011-01-01

    Procyon LLC had re-launched and renamed their music discovery site, Electra, to Capella, in 2008. Its core strength had originated from Electra's proprietary technology, which used music libraries from real people, its members, to generating "automated word-of-mouth" recommendations, targeted advertising and editorial content. With the re-launch,…

  9. An intervention targeting fundamental values among caregivers at residential facilities: effects of a cluster-randomized controlled trial on residents' self-reported empowerment, person-centered climate and life satisfaction.

    PubMed

    Roos, Charlotte; Silén, Marit; Skytt, Bernice; Engström, Maria

    2016-07-07

    In Sweden the national fundamental values for care of older people state that care should ensure that they can live in dignity and with a sense of well-being. Our hypothesis was that a caregiver intervention targeting the national fundamental values would improve perceived empowerment, person-centered climate and life satisfaction among older people living in residential facilities. The study was a cluster-randomized controlled trial with a pre- and one post-test design, conducted in 27 units (17 study units) at 12 residential facilities for older people in five municipalities in central Sweden. The units in each municipality were randomly assigned to intervention or control group. The caregiver intervention was carried out using an interpretative approach with eight guided face-to-face seminars, where self-reflection and dialogue were used. Data were collected using questionnaires. The number of residents was 43 (78 %) in the intervention group and 37 (71 %) in the control group. The Chi-square test and Mann-Whitney U-tests were performed to detect differences between groups and Wilcoxon signed rank tests to explore differences in change over time within groups. Furthermore, generalized estimating equation (GEE) models were used to study effects of the intervention controlling for clustering effects. Primary outcome measures were empowerment, person-centered climate and life satisfaction. In the intervention group, improvements at follow-up were found in residents' self-reported empowerment (n = 42; p = 0.001, Median difference 4.0, 95 % CI 1.5;6.0), person-centered climate (n = 42; p ≤0.001, Median difference 8.0, 95 % CI 4.5;11.4) and life satisfaction regarding the factor quality of everyday activities (n = 40; p = 0.033, Median difference 9.7, 95 % CI 1.0;21.9) while disempowerment decreased (n = 43; p = 0.018, Median difference -1.3, 95 % CI -2.0;0.0). In the control group person-centered climate decreased (n = 37; p

  10. A generalised model for individualising a treatment recommendation based on group-level evidence from randomised clinical trials

    PubMed Central

    Marcucci, Maura; Sinclair, John C

    2013-01-01

    Objectives Randomised controlled trials report group-level treatment effects. However, an individual patient confronting a treatment decision needs to know whether that person's expected treatment benefit will exceed the expected treatment harm. We describe a flexible model for individualising a treatment decision. It individualises group-level results from randomised trials using clinical prediction guides. Methods We constructed models that estimate the size of individualised absolute risk reduction (ARR) for the target outcome that is required to offset individualised absolute risk increase (ARI) for the treatment harm. Inputs to the model include estimates for the individualised predicted absolute treatment benefit and harm, and the relative value assigned by the patient to harm/benefit. A decision rule recommends treatment when the predicted benefit exceeds the predicted harm, value-adjusted. We also derived expressions for the maximum treatment harm, or the maximum relative value for harm/benefit, above which treatment would not be recommended. Results For the simpler model, including one kind of benefit and one kind of harm, the individualised ARR required to justify treatment was expressed as required ARRtarget(i)=ARIharm(i) × RVharm/target(i). A complex model was also developed, applicable to treatments causing multiple kinds of benefits and/or harms. We demonstrated the applicability of the models to treatments tested in superiority trials (either placebo or active control, either fixed harm or variable harm) and non-inferiority trials. Conclusions Individualised treatment recommendations can be derived using a model that applies clinical prediction guides to the results of randomised trials in order to identify which individual patients are likely to derive a clinically important benefit from the treatment. The resulting individualised prediction-based recommendations require validation by comparison with strategies of treat all or treat none. PMID

  11. A generalised model for individualising a treatment recommendation based on group-level evidence from randomised clinical trials.

    PubMed

    Marcucci, Maura; Sinclair, John C

    2013-08-13

    Randomised controlled trials report group-level treatment effects. However, an individual patient confronting a treatment decision needs to know whether that person's expected treatment benefit will exceed the expected treatment harm. We describe a flexible model for individualising a treatment decision. It individualises group-level results from randomised trials using clinical prediction guides. We constructed models that estimate the size of individualised absolute risk reduction (ARR) for the target outcome that is required to offset individualised absolute risk increase (ARI) for the treatment harm. Inputs to the model include estimates for the individualised predicted absolute treatment benefit and harm, and the relative value assigned by the patient to harm/benefit. A decision rule recommends treatment when the predicted benefit exceeds the predicted harm, value-adjusted. We also derived expressions for the maximum treatment harm, or the maximum relative value for harm/benefit, above which treatment would not be recommended. For the simpler model, including one kind of benefit and one kind of harm, the individualised ARR required to justify treatment was expressed as required ARRtarget(i)=ARIharm(i) × RVharm/target(i). A complex model was also developed, applicable to treatments causing multiple kinds of benefits and/or harms. We demonstrated the applicability of the models to treatments tested in superiority trials (either placebo or active control, either fixed harm or variable harm) and non-inferiority trials. Individualised treatment recommendations can be derived using a model that applies clinical prediction guides to the results of randomised trials in order to identify which individual patients are likely to derive a clinically important benefit from the treatment. The resulting individualised prediction-based recommendations require validation by comparison with strategies of treat all or treat none.

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

    ERIC Educational Resources Information Center

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

    2017-01-01

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

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

    ERIC Educational Resources Information Center

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

    2017-01-01

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

  14. Office lighting: A review of 80 years of standards and recommendations

    SciTech Connect

    Osterhaus, W.K.E.

    1993-05-01

    This paper traces the development of quantitative office lighting standards from its beginnings to the present. It discusses the sources of recommended lighting practice, the nature of the quantitative recommendations, and trends in recommended values on a comparative basis. A critical assessment of contemporary standards is provided within this historical context.

  15. Recommendations for Institutional Prematriculation Immunizations

    ERIC Educational Resources Information Center

    Journal of American College Health, 2006

    2006-01-01

    The "Recommendations for Institutional Prematriculation Immunizations" described in this article are provided to colleges and universities to facilitate the implementation of a comprehensive institutional prematriculation immunization policy. In response to changing epidemiology and the introduction of new vaccines, the American College Health…

  16. Ubiquitous Multicriteria Clinic Recommendation System.

    PubMed

    Chen, Toly

    2016-05-01

    Advancements in information, communication, and sensor technologies have led to new opportunities in medical care and education. Patients in general prefer visiting the nearest clinic, attempt to avoid waiting for treatment, and have unequal preferences for different clinics and doctors. Therefore, to enable patients to compare multiple clinics, this study proposes a ubiquitous multicriteria clinic recommendation system. In this system, patients can send requests through their cell phones to the system server to obtain a clinic recommendation. Once the patient sends this information to the system, the system server first estimates the patient's speed according to the detection results of a global positioning system. It then applies a fuzzy integer nonlinear programming-ordered weighted average approach to assess four criteria and finally recommends a clinic with maximal utility to the patient. The proposed methodology was tested in a field experiment, and the experimental results showed that it is advantageous over two existing methods in elevating the utilities of recommendations. In addition, such an advantage was shown to be statistically significant.

  17. Recommended Guidelines for PKU Programs.

    ERIC Educational Resources Information Center

    Children's Bureau (DHEW), Washington, DC.

    A discussion of screening tests for phenylketonuria recommends and provides some data on two tests, lists five disadvantages of urine tests, and discusses three new tests. Also considered are the role of the central laboratory facility and seven suggestions for screening different types of infants at different times. Treatment or followup programs…

  18. Annual Manpower Report with Recommendations.

    ERIC Educational Resources Information Center

    Hawaii State Commission on Manpower and Full Employment, Honolulu.

    A coordinated approach to attain full employment in Hawaii remains a priority need in governmental policy. Manpower problems which began to mount after 1970 were compounded by fuel and material shortages in 1974. The report urges that adequate policies now be formulated to meet the problems. It recommends the adoption of a State policy which…

  19. Annual Manpower Report with Recommendations.

    ERIC Educational Resources Information Center

    Hawaii State Commission on Manpower and Full Employment, Honolulu.

    A coordinated approach to attain full employment in Hawaii remains a priority need in governmental policy. Manpower problems which began to mount after 1970 were compounded by fuel and material shortages in 1974. The report urges that adequate policies now be formulated to meet the problems. It recommends the adoption of a State policy which…

  20. 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…

  1. Recommendations for Institutional Prematriculation Immunizations

    ERIC Educational Resources Information Center

    Journal of American College Health, 2006

    2006-01-01

    The "Recommendations for Institutional Prematriculation Immunizations" described in this article are provided to colleges and universities to facilitate the implementation of a comprehensive institutional prematriculation immunization policy. In response to changing epidemiology and the introduction of new vaccines, the American College Health…

  2. 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…

  3. Recommended Vaccines for Healthcare Workers

    MedlinePlus

    ... and your family members. Make sure you are up-to-date with recommended vaccines. Healthcare workers include physicians, nurses, ... series, or if you don't have an up-to-date blood test that shows you are immune to ...

  4. The ageing practitioner: ANZCA's recommendations.

    PubMed

    Baker, A B

    2016-04-01

    The aim is to present recommendations of the Australian and New Zealand College of Anaesthetists (ANZCA) with respect to practice implications for ageing specialists, together with brief discussion of effects of ageing on professional medical capabilities and recommendations on preparing to retire from medical practice. Practitioners should recognise that planning for retirement is part of good management of a medical career, and that the ageing process will inevitably compromise their ability to treat patients safely unless they retire at the appropriate time. Planning should include adequate financial preparation, and cultivation of interests and friends outside medicine. Practitioners should also realise that insight is likely to be compromised, so that they should seek colleagues who are trusted to advise them if/when they begin to lose competency. Lastly all practitioners should ensure that they consult a General Practitioner frequently, and that they have arranged all the proper legal instructions such as a Will, a Power of Attorney and an Advanced Health Directive.The ANZCA recommendations concerning ageing specialists have wide application to all medical specialties, not just for anaesthetists, and therefore all Medical Colleges should generate their own specific recommendations for ageing practitioners and the general effects of fatigue particularly for aged practitioners. © The Royal Australian and New Zealand College of Psychiatrists 2015.

  5. Alleviating bias leads to accurate and personalized recommendation

    NASA Astrophysics Data System (ADS)

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

    2013-11-01

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

  6. A Flexible Electronic Commerce Recommendation System

    NASA Astrophysics Data System (ADS)

    Gong, Songjie

    Recommendation systems have become very popular in E-commerce websites. Many of the largest commerce websites are already using recommender technologies to help their customers find products to purchase. An electronic commerce recommendation system learns from a customer and recommends products that the customer will find most valuable from among the available products. But most recommendation methods are hard-wired into the system and they support only fixed recommendations. This paper presented a framework of flexible electronic commerce recommendation system. The framework is composed by user model interface, recommendation engine, recommendation strategy model, recommendation technology group, user interest model and database interface. In the recommender strategy model, the method can be collaborative filtering, content-based filtering, mining associate rules method, knowledge-based filtering method or the mixed method. The system mapped the implementation and demand through strategy model, and the whole system would be design as standard parts to adapt to the change of the recommendation strategy.

  7. New Recommendations for Mefloquine Use in Pregnancy

    MedlinePlus

    ... CDC Malaria Branch clinician. malaria@cdc.gov Update: New Recommendations for Mefloquine Use in Pregnancy Recommend on Facebook Tweet Share Compartir Update: New Recommendations for Mefloquine Use in Pregnancy The Centers ...

  8. How Is Physician Work Valued?

    PubMed

    Jacobs, Jeffrey P; Lahey, Stephen J; Nichols, Francis C; Levett, James M; Johnston, George Gilbert; Freeman, Richard K; St Louis, James D; Painter, Julie; Yohe, Courtney; Wright, Cameron D; Kanter, Kirk R; Mayer, John E; Naunheim, Keith S; Rich, Jeffrey B; Bavaria, Joseph E

    2017-02-01

    Strategies to value physician work continue to evolve. The Society of Thoracic Surgeons and The Society of Thoracic Surgeons National Database have an increasingly important role in this evolution. An understanding of the Current Procedural Terminology (CPT) system (American Medical Association [AMA], Chicago, IL) and the Relative Value Scale Update Committee (RUC) is necessary to comprehend how physician work is valued. In 1965, with the dawn of increasingly complex medical care, immense innovation, and the rollout of Medicare, the need for a common language describing medical services and procedures was recognized as being of critical importance. In 1966, the AMA, in cooperation with multiple major medical specialty societies, developed the CPT system, which is a coding system for the description of medical procedures and medical services. The RUC was created by the AMA in response to the passage of the Omnibus Budget Reconciliation Act of 1989, legislation of the United States of America Federal government that mandated that the Centers for Medicare & Medicaid Services adopt a relative value methodology for Medicare physician payment. The role of the RUC is to develop relative value recommendations for the Centers for Medicare & Medicaid Services. These recommendations include relative value recommendations for new procedures or services and also updates to relative value recommendations for previously valued procedures or services. These recommendations pertain to all physician work delivered to Medicare beneficiaries and propose relative values for all physician services, including updates to those based on the original resource-based relative value scale developed by Hsaio and colleagues. In so doing, widely differing work and services provided can be reviewed and comparisons of their relative value (to each other) can be established. The resource-based relative value scale assigns value to physician services using relative value units (RVUs), which consist

  9. TATR (Tactical Air Target Recommender): A Prototype Expert System for Tactical Air Targeting

    DTIC Science & Technology

    1984-08-01

    program. The weaponeering subroutine that calculates weapons effects is pro- grammed in the C programming language ( Kernighan and Ritchie, 1978... Kernighan , B., and D. Ritchie, The C Programming Language, Prentice-Hall, Inc., Englewood Cliffs, New Jersey, 1978. 8. Waterman, D., An Investigation

  10. Treatment of Neuromyelitis Optica: Review and Recommendations

    PubMed Central

    Kimbrough, Dorlan J; Fujihara, Kazuo; Jacob, Anu; Lana-Peixoto, Marco A; Leite, Maria Isabel; Levy, Michael; Marignier, Romain; Nakashima, Ichiro; Palace, Jacqueline; de Seze, Jérôme; Stuve, Olaf; Tenembaum, Silvia N; Traboulsee, Anthony; Waubant, Emmanuelle; Weinshenker, Brian G; Wingerchuk, Dean M

    2014-01-01

    Neuromyelitis optica (NMO) is an autoimmune demyelinating disease preferentially targeting the optic nerves and spinal cord. Once regarded as a variant of multiple sclerosis (MS), NMO is now recognized to be a different disease with unique pathology and immunopathogenesis that does not respond to traditional MS immunomodulators such as interferons. Preventive therapy in NMO has focused on a range of immunosuppressive medications, none of which have been validated in a rigorous randomized trial. However, multiple retrospective and a few recent prospective studies have provided evidence for the use of six medications for the prevention of NMO exacerbations: azathioprine, rituximab, mycophenolate mofetil, prednisone, methotrexate and mitoxantrone. This review provides a comprehensive analysis of each of these medications in NMO and concludes with a set of recommended consensus practices. PMID:24555176

  11. Obesity prevention: recommended strategies and challenges.

    PubMed

    Wolf, Anne M; Woodworth, Kristina A

    2009-04-01

    Lifelong healthy weight maintenance is an important goal for all Americans to avoid the health problems associated with excessive body weight. In those who are overweight, even modest weight loss can reduce the risk of developing diseases associated with obesity. Federal health agencies, including the Centers for Disease Control and Prevention and the US Department of Agriculture, have recognized the critical nature of the obesity epidemic and the importance of lifelong weight management. As a result, these agencies have published evidence-based dietary and exercise recommendations, as well as analyses of population-based efforts to achieve weight loss that specifically address strategies to maintain a healthy weight. Despite the availability of recommendations and increased public education efforts, however, obesity rates continue to climb. The rising prevalence of obesity in the United States suggests that current efforts to control weight have been inadequate. Large-scale prevention programs that involve interventions targeting individuals as well as the larger community, including initiatives spearheaded through workplaces and schools, are needed to control weight and reduce the risk of long-term health consequences.

  12. Finding Your Literature Match - A Recommender System

    NASA Astrophysics Data System (ADS)

    Henneken, Edwin A.; Kurtz, Michael J.; Accomazzi, Alberto; Grant, Carolyn; Thompson, Donna; Bohlen, Elizabeth; Di Milia, Giovanni; Luker, Jay; Murray, Stephen S.

    The universe of potentially interesting, searchable literature is expanding continuously. Besides the normal expansion, there is an additional influx of literature because of interdisciplinary boundaries becoming more and more diffuse. Hence, the need for accurate, efficient and intelligent search tools is bigger than ever. Even with a sophisticated search engine, looking for information can still result in overwhelming results. An overload of information has the intrinsic danger of scaring visitors away, and any organization, for-profit or not-for-profit, in the business of providing scholarly information wants to capture and keep the attention of its target audience. Publishers and search engine engineers alike will benefit from a service that is able to provide visitors with recommendations that closely meet their interests. Providing visitors with special deals, new options and highlights may be interesting to a certain degree, but what makes more sense (especially from a commercial point of view) than to let visitors do most of the work by the mere action of making choices? Hiring psychics is not an option, so a technological solution is needed to recommend items that a visitor is likely to be looking for. In this presentation we will introduce such a solution and argue that it is practically feasible to incorporate this approach into a useful addition to any information retrieval system with enough usage.

  13. User-Centered Design for Developing Interventions to Improve Clinician Recommendation of Human Papillomavirus Vaccination

    PubMed Central

    Henninger, Michelle L; McMullen, Carmit K; Firemark, Alison J; Naleway, Allison L; Henrikson, Nora B; Turcotte, Joseph A

    2017-01-01

    Introduction Human papillomavirus (HPV) is the most common sexually transmitted infection in the US and is associated with multiple types of cancer. Although effective HPV vaccines have been available since 2006, coverage rates in the US remain much lower than with other adolescent vaccinations. Prior research has shown that a strong recommendation from a clinician is a critical determinant in HPV vaccine uptake and coverage. However, few published studies to date have specifically addressed the issue of helping clinicians communicate more effectively with their patients about the HPV vaccine. Objective To develop one or more novel interventions for helping clinicians make strong and effective recommendations for HPV vaccination. Methods Using principles of user-centered design, we conducted qualitative interviews, interviews with persons from analogous industries, and a data synthesis workshop with multiple stakeholders. Results Five potential intervention strategies targeted at health care clinicians, youth, and their parents were developed. The two most popular choices to pursue were a values-based communication strategy and a puberty education workbook. Conclusion User-centered design is a useful strategy for developing potential interventions to improve the rate and success of clinicians recommending the HPV vaccine. Further research is needed to test the effectiveness and acceptability of these interventions in clinical settings. PMID:28898195

  14. Sputter target

    DOEpatents

    Gates, Willard G.; Hale, Gerald J.

    1980-01-01

    The disclosure relates to an improved sputter target for use in the deposition of hard coatings. An exemplary target is given wherein titanium diboride is brazed to a tantalum backing plate using a gold-palladium-nickel braze alloy.

  15. Value Added

    ERIC Educational Resources Information Center

    Welch, Matt

    2004-01-01

    This article profiles retiring values teacher Gene Doxey and describes his foundational contributions to the students of California's Ramona Unified School District. Every one of the Ramona Unified School District's 7,200 students is eventually funneled through Doxey's Contemporary Issues class, a required rite of passage between elementary school…

  16. Value Added

    ERIC Educational Resources Information Center

    Welch, Matt

    2004-01-01

    This article profiles retiring values teacher Gene Doxey and describes his foundational contributions to the students of California's Ramona Unified School District. Every one of the Ramona Unified School District's 7,200 students is eventually funneled through Doxey's Contemporary Issues class, a required rite of passage between elementary school…

  17. Value Added

    ERIC Educational Resources Information Center

    Wilson, M. Roy

    2015-01-01

    With more than a thousand honors programs or colleges in the United States and that number growing every year, defining the value of honors is a significant undertaking. Honors seems to have become an obligatory upgrade that no college or university president can afford to be without, but there is more than institutional trending to be considered,…

  18. Adding Value.

    ERIC Educational Resources Information Center

    Orsini, Larry L.; Hudack, Lawrence R.; Zekan, Donald L.

    1999-01-01

    The value-added statement (VAS), relatively unknown in the United States, is used in financial reports by many European companies. Saint Bonaventure University (New York) has adapted a VAS to make it appropriate for not-for-profit universities by identifying stakeholder groups (students, faculty, administrators/support personnel, creditors, the…

  19. Valuing Difference?

    ERIC Educational Resources Information Center

    Watters, Kate

    2005-01-01

    How well are adult and community learning providers doing when it comes to ensuring equality of opportunity (EO) and valuing diversity? Many are in transition from a defensive position of emphasising legal compliance towards making respect for diversity intrinsic to their strategic aims, plans and actions, according to the February edition of…

  20. Redeeming Value.

    ERIC Educational Resources Information Center

    Whitwell, Stuart C. A.

    1995-01-01

    Presents an essay on organizational transformation and the way successful marketing transformations redeem a sense of value. Focuses on challenges faced by not-for-profit institutions, current changes in the library profession, and implications of the American Library Association's Goal 2000. A sidebar summarizes an interview with the director of…

  1. Adherence to the obesity-related lifestyle intervention targets in the IDEFICS study.

    PubMed

    Kovács, E; Siani, A; Konstabel, K; Hadjigeorgiou, C; de Bourdeaudhuij, I; Eiben, G; Lissner, L; Gwozdz, W; Reisch, L; Pala, V; Moreno, L A; Pigeot, I; Pohlabeln, H; Ahrens, W; Molnár, D

    2014-09-01

    To address behaviours associated with childhood obesity, certain target values are recommended that should be met to improve children's health. In the IDEFICS (Identification and prevention of Dietary- and lifestyle-induced health Effects in Children and infantS) study such lifestyle recommendations were conveyed as six key messages. Here, we investigate the adherence of European children to these messages. The IDEFICS intervention was based on the intervention mapping approach with the following six targets: increase water consumption (to replace sugar-containing beverages), increase fruit/vegetable consumption, reduce daily screen time, increase daily physical activity, improve the quality of family life and ensure adequate sleep duration. Internationally recommended target values were applied to determine the prevalence of children meeting these targets. In a cohort of 18,745 children participating in the IDEFICS baseline survey or newly recruited during follow-up, data on the above lifestyle behaviours were collected for a varying number of 8302 to 17,212 children. Information on all six behaviours was available for 5140 children. Although 52.5% of the cohort was classified in the highest category of water consumption, only 8.8% met the target of an intake of fruits/vegetables five times a day. The prevalence of children adhering to the recommendation regarding total screen time-below 1 h for pre-school children and 2 h for school children-was 51.1%. The recommended amount of at least 60 min of moderate-to-vigorous physical activity per day was fulfilled by 15.2%. Family life of the child measured by various indicators was considered as satisfactory in 22.8%. Nocturnal sleep duration of 11 (10) hours or more in pre-school (school) children was achieved by 37.9%. In general, children in northern countries and younger children showed better adherence to the recommendations. Only 1.1% of the children adhered to at least five of these recommendations. Current

  2. Adherence to the obesity-related lifestyle intervention targets in the IDEFICS study

    PubMed Central

    Kovács, E; Siani, A; Konstabel, K; Hadjigeorgiou, C; de Bourdeaudhuij, I; Eiben, G; Lissner, L; Gwozdz, W; Reisch, L; Pala, V; Moreno, L A; Pigeot, I; Pohlabeln, H; Ahrens, W; Molnár, D

    2014-01-01

    Background/objectives: To address behaviours associated with childhood obesity, certain target values are recommended that should be met to improve children's health. In the IDEFICS (Identification and prevention of Dietary- and lifestyle-induced health Effects in Children and infantS) study such lifestyle recommendations were conveyed as six key messages. Here, we investigate the adherence of European children to these messages. Methods: The IDEFICS intervention was based on the intervention mapping approach with the following six targets: increase water consumption (to replace sugar-containing beverages), increase fruit/vegetable consumption, reduce daily screen time, increase daily physical activity, improve the quality of family life and ensure adequate sleep duration. Internationally recommended target values were applied to determine the prevalence of children meeting these targets. Results: In a cohort of 18 745 children participating in the IDEFICS baseline survey or newly recruited during follow-up, data on the above lifestyle behaviours were collected for a varying number of 8302 to 17 212 children. Information on all six behaviours was available for 5140 children. Although 52.5% of the cohort was classified in the highest category of water consumption, only 8.8% met the target of an intake of fruits/vegetables five times a day. The prevalence of children adhering to the recommendation regarding total screen time—below 1 h for pre-school children and 2 h for school children—was 51.1%. The recommended amount of at least 60 min of moderate-to-vigorous physical activity per day was fulfilled by 15.2%. Family life of the child measured by various indicators was considered as satisfactory in 22.8%. Nocturnal sleep duration of 11 (10) hours or more in pre-school (school) children was achieved by 37.9%. In general, children in northern countries and younger children showed better adherence to the recommendations. Only 1.1% of the children adhered

  3. Scientific and educational recommender systems

    NASA Astrophysics Data System (ADS)

    Guseva, A. I.; Kireev, V. S.; Bochkarev, P. V.; Kuznetsov, I. A.; Philippov, S. A.

    2017-01-01

    This article discusses the questions associated with the use of reference systems in the preparation of graduates in physical function. The objective of this research is creation of model of recommender system user from the sphere of science and education. The detailed review of current scientific and social network for scientists and the problem of constructing recommender systems in this area. The result of this study is to research user information model systems. The model is presented in two versions: the full one - in the form of a semantic network, and short - in a relational form. The relational model is the projection in the form of semantic network, taking into account the restrictions on the amount of bonds that characterize the number of information items (research results), which interact with the system user.

  4. [Choosing wisely recommendations in gastroenterology].

    PubMed

    Koop, H; Lynen Jansen, P; Zeuzem, S

    2017-06-01

    The Choosing wisely initiative of the German Society of Internal Medicine addresses procedures which are inadequately implemented (deficits in patient care) as well as those which are performed too often but without proven benefits for patients (misuse or overuse of health services). Based on their guidelines, The German Society of Gastroenterology, Digestive and Metabolic Diseases has identified such aspects and incorporated them into the respective recommendations.

  5. [Sugar and diabetes: international recommendations].

    PubMed

    Sanz París, Alejandro; Boj Carceller, Diana; Melchor Lacleta, Isabel; Albero Gamboa, Ramón

    2013-07-01

    Nutrition in the diabetic patient is not just a mere nutrient but his treatment is based. In fact, international scientific societies have called "medical nutrition therapy" to give it the emphasis it deserves. Nutritional recommendations of scientific societies have been changing in recent years with evidence-based medicine. Regarding the consumption of sugar, most believe it does not affect metabolic control if it is replaced by other carbohydrates, but does not indicate a specific amount.

  6. Automatic Home Nursing Activity Recommendation

    PubMed Central

    Luo, Gang; Tang, Chunqiang

    2009-01-01

    The rapid deployment of Web-based, consumer-centric electronic medical records (CEMRs) is an important trend in healthcare. In this paper, we incorporate nursing knowledge into CEMR so that it can automatically recommend home nursing activities (HNAs). Those more complex HNAs are made clickable for users to find detailed implementation procedures. We demonstrate the effectiveness of our techniques using USMLE medical exam cases. PMID:20351888

  7. APLAR rheumatoid arthritis treatment recommendations.

    PubMed

    Lau, Chak Sing; Chia, Faith; Harrison, Andrew; Hsieh, Tsu-Yi; Jain, Rahul; Jung, Seung Min; Kishimoto, Mitsumasa; Kumar, Ashok; Leong, Khai Pang; Li, Zhanguo; Lichauco, Juan Javier; Louthrenoo, Worawit; Luo, Shue-Fen; Nash, Peter; Ng, Chin Teck; Park, Sung-Hwan; Suryana, Bagus Putu Putra; Suwannalai, Parawee; Wijaya, Linda Kurniaty; Yamamoto, Kazuhiko; Yang, Yue; Yeap, Swan Sim

    2015-09-01

    Rheumatoid arthritis is a chronic inflammatory condition that affects approximately 1% of the world's population. There are a wide number of guidelines and recommendations available to support the treatment of rheumatoid arthritis; however, the evidence used for these guidelines is predominantly based on studies in Caucasian subjects and may not be relevant for rheumatoid arthritis patients in the Asia-Pacific region. Therefore, the Asia Pacific League of Associations for Rheumatology established a Steering Committee in 2013 to address this issue. The AGREE II instrument and the ADAPTE Collaboration framework were applied to systematically identify, appraise, synthesize, and adapt international rheumatoid arthritis guidelines for use in the Asia-Pacific region. Forty rheumatoid arthritis treatment recommendations, based on evidence and expert opinion, were drafted and are presented in this report. The Asia Pacific of Associations for Rheumatology rheumatoid arthritis treatment recommendations are intended to serve as a reference for best practice management of rheumatoid arthritis in Asia-Pacific, focusing on local issues to ensure the delivery of basic care for these patients, and to improve their outcomes. In addition, the document will serve as a reference for national rheumatology associations in Asia-Pacific for developing guidelines in their respective countries. © 2015 Asia Pacific League of Associations for Rheumatology and Wiley Publishing Asia Pty Ltd.

  8. A Systematic Review of Preventive Health Educational Videos Targeting Infectious Diseases in Schoolchildren

    PubMed Central

    Bieri, Franziska A.; Gray, Darren J.; Raso, Giovanna; Li, Yue-Sheng; McManus, Donald P.

    2012-01-01

    We conducted a systematic review of preventive health educational videos targeting infectious diseases in schoolchildren to formulate recommendations for establishing an evidence base for future studies. We included studies that evaluated interventions involving video-based health education in schools to improve knowledge and attitudes and to change behavior regarding different infections. The majority of the 11 studies we reviewed concluded that videos were well received by schools, teachers, and children, and are promising and effective health education tools, having a positive impact on knowledge and attitudes. However, there is a pressing need for more standardized, high-quality studies to draw evidence-based conclusions on the value of educational videos targeting infectious diseases. Therefore, we provide a descriptive summary of the results and make recommendations for studies using preventive educational videos targeting infectious diseases in schoolchildren on the basis of our experiences gained in a video-based cluster randomized trial. PMID:23222138

  9. Towards Information Enrichment through Recommendation Sharing

    NASA Astrophysics Data System (ADS)

    Weng, Li-Tung; Xu, Yue; Li, Yuefeng; Nayak, Richi

    Nowadays most existing recommender systems operate in a single organisational basis, i.e. a recommender system recommends items to customers of one organisation based on the organisation's datasets only. Very often the datasets of a single organisation do not have sufficient resources to be used to generate quality recommendations. Therefore, it would be beneficial if recommender systems of different organisations with similar nature can cooperate together to share their resources and recommendations. In this chapter, we present an Ecommerce-oriented Distributed Recommender System (EDRS) that consists of multiple recommender systems from different organisations. By sharing resources and recommendations with each other, these recommenders in the distributed recommendation system can provide better recommendation service to their users. As for most of the distributed systems, peer selection is often an important aspect. This chapter also presents a recommender selection technique for the proposed EDRS, and it selects and profiles recommenders based on their stability, average performance and selection frequency. Based on our experiments, it is shown that recommenders' recommendation quality can be effectively improved by adopting the proposed EDRS and the associated peer selection technique.

  10. 28 CFR 0.36 - Recommendations.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 28 Judicial Administration 1 2010-07-01 2010-07-01 false Recommendations. 0.36 Section 0.36... Pardon Attorney § 0.36 Recommendations. The Pardon Attorney shall submit all recommendations in clemency... recommendations to the President....

  11. 28 CFR 0.36 - Recommendations.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 28 Judicial Administration 1 2013-07-01 2013-07-01 false Recommendations. 0.36 Section 0.36... Pardon Attorney § 0.36 Recommendations. The Pardon Attorney shall submit all recommendations in clemency... recommendations to the President....

  12. 28 CFR 0.36 - Recommendations.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 28 Judicial Administration 1 2011-07-01 2011-07-01 false Recommendations. 0.36 Section 0.36... Pardon Attorney § 0.36 Recommendations. The Pardon Attorney shall submit all recommendations in clemency... recommendations to the President....

  13. 28 CFR 0.36 - Recommendations.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 28 Judicial Administration 1 2012-07-01 2012-07-01 false Recommendations. 0.36 Section 0.36... Pardon Attorney § 0.36 Recommendations. The Pardon Attorney shall submit all recommendations in clemency... recommendations to the President....

  14. 28 CFR 0.36 - Recommendations.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 28 Judicial Administration 1 2014-07-01 2014-07-01 false Recommendations. 0.36 Section 0.36... Pardon Attorney § 0.36 Recommendations. The Pardon Attorney shall submit all recommendations in clemency... recommendations to the President....

  15. Moving from principles to practice: recommended policy changes to promote family-centered care.

    PubMed

    Kilmer, Ryan P; Cook, James R; Palamaro Munsell, Eylin

    2010-12-01

    This paper emphasizes the value of family-centered care. Discussion highlights family-centered philosophies (e.g., Systems of Care [SOCs]) and practice models (i.e., wraparound) and identifies discrepancies between conceptualizations and actual practice. Data from multiple sources detail issues in fidelity to family-centered values and needs and risks experienced by siblings of children with severe emotional disturbance and their caregivers. This discussion provides a springboard for policy recommendations to strengthen family support programming and enhance family-centered care, from modifying funding streams such that systems extend their reach beyond children with full-blown, diagnosable problems (those meeting standards of "medical necessity), to supporting prevention and early intervention initiatives that address families as targets for intervention. Recommendations include ensuring that communities with SOC funding address the needs of families; broadening Medicaid rules and definitions; expanding the range of reimbursable activities and services; and increasing funding for evaluating family-centered care models and family support programming.

  16. Recommendations for provoked challenge urine testing.

    PubMed

    Ruha, Anne-Michelle

    2013-12-01

    "Urine mobilization test," "challenge test," and "provoked urine test" are all terms used to describe the administration of a chelating agent to a person prior to collection of their urine to test for metals. There is no standard, validated challenge test. Despite recommendations by professional and government organizations against the use of provoked urine testing, the tests are still commonly used and recommended by some practitioners. Challenge testing utilizes a variety of chelating agents, including dimercaptosuccinic acid (DMSA), dimercaptopropanesulfonate (DMPS), and ethylenediaminetetraacetic acid (EDTA). The agents are given by a variety of routes of administration, doses used are inconsistent, and urine collection procedures vary. Additional problems with challenge tests include comparison of results to inappropriate reference ranges and creatinine correction of urine obtained within hours of chelator administration. Human volunteer studies demonstrate that mercury is detected in the urine of most people even in the absence of known exposure or chelator administration, and that urinary mercury excretion rises after administration of a chelator, regardless of exposure history and in an unpredictable fashion. Studies also demonstrate that challenge testing fails to reveal a "body burden" of mercury due to remote exposure. Chelating agents have been associated with adverse reactions. Current evidence does not support the use of DMPS, DMSA, or other chelation challenge tests for the diagnosis of metal toxicity. Since there are no established reference ranges for provoked urine samples in healthy subjects, no reliable evidence to support a diagnostic value for the tests, and potential harm, these tests should not be utilized.

  17. European recommendations for antimicrobial resistance surveillance.

    PubMed

    Cornaglia, G; Hryniewicz, W; Jarlier, V; Kahlmeter, G; Mittermayer, H; Stratchounski, L; Baquero, F

    2004-04-01

    The problem of antimicrobial resistance surveillance in Europe has been debated extensively in many excellent documents issued by national committees that often assume the value of national guidelines. However, a comprehensive document addressing the whole matter from a European perspective, as well as reviewing its present status and drafting future perspectives, has been lacking. The present recommendations have been produced by the ESCMID Study Group for Antimicrobial Resistance Surveillance (ESGARS) through a consensus process involving all members of the Study Group. The recommendations focus on the detection of bacterial resistance and its reporting to clinicians, public health officers and a wider-and ever-increasing-audience. The leading concept is that the basis for resistance monitoring is microbiological diagnostics. The prerequisites for resistance monitoring are findings of adequate quality and quantity, which have been recorded properly and evaluated correctly. Different types of surveillance studies should fulfil different requirements with regard to data collection and reporting, the expected use of data, and the prerequisites for networking such activities. To generate relevant indicators, bacterial resistance data should be reported using adequate denominators and stratification. Reporting of antimicrobial resistance data is necessary for selection of empirical therapy at the local level, for assessing the scale of the resistance problem at the local, national or international levels, for monitoring changes in resistance rates, and for detecting the emergence and spread of new resistances types. Any type of surveillance study should conclude, where appropriate, with a proposal for intervention based on the data obtained.

  18. Recommended vaccines for international travelers to India.

    PubMed

    Verma, Ramesh; Khanna, Pardeep; Chawla, Suraj

    2015-01-01

    India's tourism industry generated 6.6% of the nation's Gross Domestic Product (GDP) during 2012. International travel to India is predicted to grow at an average annual rate of ∼ 8% over the next decade. The number of foreign tourists has increased by 9% to 5.8 million. Approximately 8% of travelers to developing countries require medical care during or after travel; the main diagnoses are vaccine-preventable diseases. Travelers to India can be exposed to various infectious diseases; water-borne, water-related, and zoonotic diseases may be imported to India where the disease is not endemic. The World Health Organization (WHO) emphasizes that all international travelers should be up to date with routine vaccinations. The recommended vaccinations for travelers to India vary according to the traveler's age, immunization history, existing medical conditions, duration, legal requirements for entry into countries being visited, travelers preferences, and values. Travelers should consult with a doctor so that there is sufficient time for completion of optimal vaccination schedules. No matter where traveling, one should be aware of potential exposure to certain organisms that can cause severely illnesses, even death. There is no doubt that vaccines have reduced or virtually eliminated many diseases that killed or severely disabled children and adults just a few generations ago. Thus, travelers must take recommended vaccines per schedule before traveling to India.

  19. Recommended vaccines for international travelers to India.

    PubMed

    Verma, Ramesh; Khanna, Pardeep; Chawla, Suraj

    2014-06-18

    India's tourism industry generated 6.6% of the nation's Gross Domestic Product (GDP) during 2012. International travel to India is predicted to grow at an average annual rate of ~8% over the next decade. The number of foreign tourists has increased by 9% to 5.8 million. Approximately 8% of travelers to developing countries require medical care during or after travel; the main diagnoses are vaccine-preventable diseases. Travelers to India can be exposed to various infectious diseases; water-borne, water-related, and zoonotic diseases may be imported to India where the disease is not endemic. The World Health Organization (WHO) emphasizes that all international travelers should be up to date with routine vaccinations. The recommended vaccinations for travelers to India vary according to the traveler's age, immunization history, existing medical conditions, duration, legal requirements for entry into countries being visited, travelers preferences, and values. Travelers should consult with a doctor so that there is sufficient time for completion of optimal vaccination schedules. No matter where traveling, one should be aware of potential exposure to certain organisms that can cause severely illnesses, even death. There is no doubt that vaccines have reduced or virtually eliminated many diseases that killed or severely disabled children and adults just a few generations ago. Thus, travelers must take recommended vaccines per schedule before traveling to India.

  20. Research of intelligent recommendation for mobile reading

    NASA Astrophysics Data System (ADS)

    Li, Qu

    2013-07-01

    Mobile reading is the trend of current publishing industry. Intelligent Recommendation system is useful and profitable for mobile reading platforms. Currently, intelligent recommendation systems mainly focus on news recommendation or production recommendation in e-commerce. In this paper, we designed and implemented an intelligent recommendation system based on slope one algorithm. Results show that our algorithm can help the users to find their interested books and thus greatly improve the income of mobile reading platform.

  1. Professional values and nursing.

    PubMed

    Sellman, Derek

    2011-05-01

    The values of nursing arise from a concern with human flourishing. If the desire to become a nurse is a reflection of an aspiration to care for others in need then we should anticipate that those who choose to nurse have a tendency towards the values we would normally associate with a caring profession (care, compassion, perhaps altruism, and so on). However, these values require a secure base if they are not to succumb to the corrupting pressures of the increasingly instrumental nature of the values of the institutions in which healthcare in general and nursing in particular takes place. One way of securing a base for withstanding the corrupting influences of the institution is to understand nursing as a practice in the sense in which Alasdair MacIntyre uses that term. In this brief paper I will outline ways in which the managerial imperative of meeting targets is both distorting practice and undermining nursing's values. I conclude that understanding nursing as a MacIntyrean practice provides a refuge from what might otherwise be overwhelming pressures for nurses to adopt instrumental values to the detriment of professional caring values.

  2. Senate committee recommends replacing FEMA

    NASA Astrophysics Data System (ADS)

    Zielinski, Sarah

    2006-05-01

    Flaws in the U.S. Federal Emergency Management Agency (FEMA) that were exposed after Hurricane Katrina struck the U.S. Gulf Coast in August 2005 are too substantial to be fixed, and the agency should be replaced with a more capable structure, recommends a 27 April report released by the Senate Committee on Homeland Security and Government Affairs. ``FEMA is discredited, demoralized, and dysfunctional. It is beyond repair. Just tweaking the organizational chart will not solve the problem,'' said Committee Chair Sen. Susan Collins (R-Maine).

  3. Clinical recommendation: pediatric lichen sclerosus.

    PubMed

    Bercaw-Pratt, Jennifer L; Boardman, Lori A; Simms-Cendan, Judith S

    2014-04-01

    Lichen sclerosus is a chronic inflammatory condition affecting the anogenital region that may present in the prepubertal or adolescent patient. Clinical presentations include significant pruritus, labial adhesions, and loss of pigmentation. Treatment includes topical anti-inflammatory agents and long-term follow-up as there is a high risk of recurrence and an increased risk of vulvar cancer in adult women with history of lichen sclerosus. These recommendations are intended for pediatricians, gynecologists, nurse practitioners and others who care for pediatric/adolescent girls in order to facilitate diagnosis and treatment.

  4. Targeted Workshops Improve Marketing Knowledge and Skills.

    ERIC Educational Resources Information Center

    Flaskerud, George

    1995-01-01

    Most of the 201 agricultural producers who attended 2-day targeted workshops learned marketing concepts and changed their attitudes about marketing. Refresher workshops were recommended to help them use the marketing techniques learned. (SK)

  5. Planning Value vs Earned Value

    DTIC Science & Technology

    2011-05-01

    20 196 10 98 7 Postmortem 4 200 2 100 Les Dupaix - 17Earned Value Duration Charts Gantt (Bar) Chart Si lmp e Can show dependencies Tracking planned vs...7 7 4 2 Identify Requirements 78 86 39 43 4 6 96 103 43 3 Match Requirements 20 106 10 53 5 7 24 127 53 to Phases 4 Identify Risk Areas 20 126 10 63

  6. Analysis and recommendations for DPA calculations in SiC

    SciTech Connect

    Heinisch, H.L.

    1998-09-01

    Recent modeling results, coupled with the implications of available experimental results, provide sufficient information to achieve consensus on the values of threshold displacement energies to use in displacements per atom (DPA) calculations. The values recommended here, 20 eV for C and 35 eV for Si, will be presented for adoption by the international fusion materials community at the next IEA SiC/SiC workshop.

  7. Beyond Values Clarification: Addressing Client Values in Clinical Behavior Analysis

    PubMed Central

    Bonow, Jordan T; Follette, William C

    2009-01-01

    Ethical principles of psychology, as exemplified in the American Psychological Association (APA) Code of Ethics (2002), provide impractical advice for addressing client values during psychotherapy. These principles seem to argue that each client's values should be respected and protected at all times, except in cases in which this would result in harm to the client or the general public. Although the code is appropriately designed as a defense against potential and actual abuses of professional power, this general proscription against directly targeting client values for change is based on an understanding of values that grants them special ontological status and has resulted in limited clinical interventions focusing solely on “values clarification.” With its strong foundation in a unified philosophical system, clinical behavior analysis offers a sophisticated alternative approach to values that both defines what they are and identifies when they can be ethically targeted to improve the lives of clients. PMID:22478514

  8. Practical Recommendations on Students' Tolerant Behavior Formation in Universities

    ERIC Educational Resources Information Center

    Kutuev, Ruslan A.; Katicheva, Marina G.; Rassolov, Ilya M.; Derdizova, Farida V.; Yevgrafova, Olga G.; Kozhanov, Igor V.

    2016-01-01

    The relevance of the study is conditioned by the development of civil society and legal state, which are characterized by the observance of and respect for the rights and freedoms of man and citizen, a recognition of individual freedom and the values of each person. The purpose of this article is to develop practical recommendations on formation…

  9. Weathering effects on fuel moisture sticks: corrections and recommendations.

    Treesearch

    Donald A. Haines; John S. Frost

    1978-01-01

    Describes response to weathering of 100-gram (1/2-inch) fuel moisture sticks over 6-month fire season in the Northeast. Presents a chart for correcting weathered-stick values and gives replacement recommendations for those sticks used in the National Fire Danger Rating System.

  10. 40 CFR 240.203-2 - Recommended procedures: Design.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... WASTES GUIDELINES FOR THE THERMAL PROCESSING OF SOLID WASTES Requirements and Recommended Procedures... characteristics of all solid wastes expected to be processed should be determined by survey and analysis. The gross calorific value of the solid wastes to be processed should be determined to serve as a basis...

  11. The optimal target hemoglobin.

    PubMed

    Ritz, E; Schwenger, V

    2000-07-01

    There is still controversy concerning the optimal target hemoglobin during treatment with recombinant human erythropoietin (rHuEPO). Some evidence suggests that hemoglobin concentrations higher than currently recommended lead to improvements in cognitive function, physical performance, and rehabilitation. At least in patients with advanced cardiac disease, however, one controlled trial failed to show a benefit from normalizing predialysis hemoglobin concentrations. In contrast, preliminary observations in three additional studies (albeit with limited statistical power) failed to show adverse cardiovascular effects from normalization of hemoglobin, but definite benefit with respect to quality of life, physical performance, and cardiac geometry. These observations are consistent with the notion that hemoglobin concentrations higher than those recommended by the National Kidney Foundation Dialysis Outcomes Quality Initiative Anemia Work Group are beneficial, at least in patients without advanced cardiac disease.

  12. Development of an underwater target classifier using target specific features

    NASA Astrophysics Data System (ADS)

    Supriya, M. H.; Pillai, P. R. Saseendran

    2003-04-01

    In Sonar, the detection and estimation functions are performed by signal processors, which involve the computation of various statistics, for enhancing the overall performance of the system. This also takes into account all the undesirable propagation effects caused by the underwater channel. Underwater targets can be classified by using certain target specific features such as target strength, target dynamics, and the signatures of the noise generated by the targets. Rough identification of the targets is carried out with target strength values at known aspects while for precise identification, classification clues from target dynamics and target signatures are generated. Databases for the engine noise spectra of various underwater targets, propeller noises, machinery noises and cavitation noises, speed-noise characteristics, etc., have been developed. The signal energy estimated within a finite-time interval is compared with the earlier detection/estimation decisions, which are stored in the target data record and the relevant target data are updated. The algorithm for identification of target from the most matching signature patterns in the database will generate the classification clues, which will help in target identification. Salient highlights of an underwater target classifier using the above-discussed target specific features are presented in this paper.

  13. Valuing hope.

    PubMed

    McMillan, John; Walker, Simon; Hope, Tony

    2014-01-01

    This article argues that hope is of value in clinical ethics and that it can be important for clinicians to be sensitive to both the risks of false hope and the importance of retaining hope. However, this sensitivity requires an understanding of the complexity of hope and how it bears on different aspects of a well-functioning doctor-patient relationship. We discuss hopefulness and distinguish it, from three different kinds of hope, or 'hopes for', and then relate these distinctions back to differing accounts of autonomy. This analysis matters because it shows how an overly narrow view of the ethical obligations of a clinician to their patient, and autonomy, might lead to scenarios where patients regret the choices they make.

  14. Competence Description for Personal Recommendations: The Importance of Identifying the Complexity of Learning and Performance Situations

    ERIC Educational Resources Information Center

    Prins, Frans J.; Nadolski, Rob J.; Berlanga, Adriana J.; Drachsler, Hendrik; Hummel, Hans G. K.; Koper, Rob

    2008-01-01

    For competences development of learners and professionals, target competences and corresponding competence development opportunities have to be identified. Personal Recommender Systems (PRS) provide personal recommendations for learners aimed at finding and selecting learning activities that best match their needs. This article argues that a…

  15. Competence Description for Personal Recommendations: The Importance of Identifying the Complexity of Learning and Performance Situations

    ERIC Educational Resources Information Center

    Prins, Frans J.; Nadolski, Rob J.; Berlanga, Adriana J.; Drachsler, Hendrik; Hummel, Hans G. K.; Koper, Rob

    2008-01-01

    For competences development of learners and professionals, target competences and corresponding competence development opportunities have to be identified. Personal Recommender Systems (PRS) provide personal recommendations for learners aimed at finding and selecting learning activities that best match their needs. This article argues that a…

  16. Valuing Stillbirths

    PubMed Central

    Phillips, John; Millum, Joseph

    2016-01-01

    Estimates of the burden of disease assess the mortality and morbidity that affect a population by producing summary measures of health such as quality-adjusted life years (QALYs) and disability-adjusted life years (DALYs). These measures typically do not include stillbirths (fetal deaths occurring during the later stages of pregnancy or during labor) among the negative health outcomes they count. Priority setting decisions that rely on these measures are therefore likely to place little value on preventing the more than three million stillbirths that occur annually worldwide. In contrast, neonatal deaths, which occur in comparable numbers, have a substantial impact on burden of disease estimates and are commonly seen as a pressing health concern. In this paper we argue in favor of incorporating unintended fetal deaths that occur late in pregnancy into estimates of the burden of disease. Our argument is based on the similarity between late-term fetuses and newborn infants and the assumption that protecting newborns is important. We respond to four objections to counting stillbirths: (1) that fetuses are not yet part of the population and so their deaths should not be included in measures of population health; (2) that valuing the prevention of stillbirths will undermine women’s reproductive rights; (3) that including stillbirths implies that miscarriages (fetal deaths early in pregnancy) should also be included; and (4) that birth itself is in fact ethically significant. We conclude that our proposal is ethically preferable to current practice and, if adopted, is likely to lead to improved decisions about health spending. PMID:25395144

  17. A heterogeneous graph-based recommendation simulator

    SciTech Connect

    Yeonchan, Ahn; Sungchan, Park; Lee, Matt Sangkeun; Sang-goo, Lee

    2013-01-01

    Heterogeneous graph-based recommendation frameworks have flexibility in that they can incorporate various recommendation algorithms and various kinds of information to produce better results. In this demonstration, we present a heterogeneous graph-based recommendation simulator which enables participants to experience the flexibility of a heterogeneous graph-based recommendation method. With our system, participants can simulate various recommendation semantics by expressing the semantics via meaningful paths like User Movie User Movie. The simulator then returns the recommendation results on the fly based on the user-customized semantics using a fast Monte Carlo algorithm.

  18. A Group Recommender System for Tourist Activities

    NASA Astrophysics Data System (ADS)

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

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

  19. LIQUID TARGET

    DOEpatents

    Martin, M.D.; Salsig, W.W. Jr.

    1959-01-13

    A liquid handling apparatus is presented for a liquid material which is to be irradiated. The apparatus consists essentially of a reservoir for the liquid, a target element, a drain tank and a drain lock chamber. The target is in the form of a looped tube, the upper end of which is adapted to be disposed in a beam of atomic particles. The lower end of the target tube is in communication with the liquid in the reservoir and a means is provided to continuously circulate the liquid material to be irradiated through the target tube. Means to heat the reservoir tank is provided in the event that a metal is to be used as the target material. The apparatus is provided with suitable valves and shielding to provide maximum safety in operation.

  20. Conclusions and Recommendations. Chapter 37

    NASA Technical Reports Server (NTRS)

    Lamar, John E.; Hummel, Dietrich

    2009-01-01

    This chapter provides a brief wrap-up of the task group report and focuses on the overall conclusions and recommendations for future work for the CAWAPI and VFE-2 facets beyond the task group. The overall conclusion is that the Technology Readiness Level (TRL) of CFD solvers has been improved in predicting the flow-physics of vortex-dominated flows during the work of the task group, by having flight and wind-tunnel data available for comparison. Moreover, like all good scientific studies, this task group has identified flight conditions on the F-16XL airplane or wind-tunnel test conditions for a specific leading-edge radius on the 65 delta-wing model where the TRL still needs to be increased.

  1. Conclusions and Recommendations. Chapter 37

    NASA Technical Reports Server (NTRS)

    Lamar, John E.; Hummel, Dietrich

    2009-01-01

    This chapter provides a brief wrap-up of the task group report and focuses on the overall conclusions and recommendations for future work for the CAWAPI and VFE-2 facets beyond the task group. The overall conclusion is that the Technology Readiness Level (TRL) of CFD solvers has been improved in predicting the flow-physics of vortex-dominated flows during the work of the task group, by having flight and wind-tunnel data available for comparison. Moreover, like all good scientific studies, this task group has identified flight conditions on the F-16XL airplane or wind-tunnel test conditions for a specific leading-edge radius on the 65 delta-wing model where the TRL still needs to be increased.

  2. Recommendations for managing hospital closure.

    PubMed

    van der Wal, R; Bouthillette, F; Havlovic, S J

    1998-01-01

    An acute care hospital was closed by the British Columbia Ministry of Health in 1993. A research study was conducted to investigate the ways closure of the hospital affected hospital employees and to identify ways to facilitate the closure/reorganization process. Unstructured interviews were conducted with 25 employees around the time of closure and six months after the closure. In the category Living with Closure, six themes arose from the qualitative analysis. They related to (1) provision of information; (2) effect of closure on the working environment and colleagues; (3) perceived stress; (4) recognition of one's worth; (5) provision of support services; and (6) the process of having a new job. The authors offer recommendations stemming from the analysis, which are intended to assist others planning for future hospital reorganizations or closures.

  3. Valuing vaccination

    PubMed Central

    Bärnighausen, Till; Bloom, David E.; Cafiero-Fonseca, Elizabeth T.; O’Brien, Jennifer Carroll

    2014-01-01

    Vaccination has led to remarkable health gains over the last century. However, large coverage gaps remain, which will require significant financial resources and political will to address. In recent years, a compelling line of inquiry has established the economic benefits of health, at both the individual and aggregate levels. Most existing economic evaluations of particular health interventions fail to account for this new research, leading to potentially sizable undervaluation of those interventions. In line with this new research, we set forth a framework for conceptualizing the full benefits of vaccination, including avoided medical care costs, outcome-related productivity gains, behavior-related productivity gains, community health externalities, community economic externalities, and the value of risk reduction and pure health gains. We also review literature highlighting the magnitude of these sources of benefit for different vaccinations. Finally, we outline the steps that need to be taken to implement a broad-approach economic evaluation and discuss the implications of this work for research, policy, and resource allocation for vaccine development and delivery. PMID:25136129

  4. Polarimetric laser radar target classification.

    PubMed

    Chun, Cornell S L; Sadjadi, Firooz A

    2005-07-15

    Imaging laser radar (ladar) systems have been developed for automatic target identification in surveillance systems. Ladar uses the range value at the target pixels to estimate the target's 3-D shape and identify the target. For targets in clutter and partially hidden targets, there are ambiguities in determining which pixels are on target that lead to uncertainties in determining the target's 3-D shape. An improvement is to use the polarization components of the reflected light. We describe the operation and preliminary evaluation of a polarization diverse imaging ladar system. Using a combination of intensity, range, and degree of polarization, we are better able to identify and distinguish the target from other objects of the same class.

  5. Can soda fountains be recommended in hospitals?

    PubMed

    Chaberny, Iris F; Kaiser, Peter; Sonntag, Hans-Günther

    2006-09-01

    Mineral water (soda water) is very popular in Germany. Therefore, soda fountains were developed as alternatives to the traditional deposit bottle system. Nowadays, different systems of these devices are commercially available. For several years, soda fountains produced by different companies have been examined at the University Hospital of Heidelberg. In 1998, it was possible for the first time to observe and evaluate one of these systems over a period of 320 days in a series of microbiological examinations. The evaluation was implemented on the basis of the German drinking water regulation (Anonymous, 1990. Gesetz über Trinkwasser und Wasser für Lebensmittelbetriebe (Trinkwasserverordnung - TrinkwV) vom 12. Dezember 1990. Bundesgesetzblatt 66, 2613ff). Initially, the bacteria counts exceeded the reference values imposed by the German drinking water regulation in almost 50% of the analyses. Pseudomonas aeruginosa was also detected in almost 38% of the samples. After a re-arrangement of the disinfection procedure and the removal of the charcoal filter, Pseudomonas aeruginosa was not detectable any more. However, the bacteria counts still frequently exceeded the reference values of the German drinking water regulation. Following our long-term analysis, we would not recommend soda fountains in high-risk areas of hospitals. If these devices are to be used in hospitals, the disinfection procedures should be executed in weekly or fortnightly intervals and the water quality should be examined periodically.

  6. Preventive Care Recommendations for Adults with MS

    MedlinePlus

    Preventive Care Recommendations THE BASIC FACTS MULTIPLE SCLEROSIS The Three Most Common Eye Disorders Carlos Healey, diagnosed in 2001 in Multiple Sclerosis Medical checklist: Recommendations: Dates of last & next test ...

  7. Recommendations for the management of tyrosinaemia type 1

    PubMed Central

    2013-01-01

    The management of tyrosinaemia type 1 (HT1, fumarylacetoacetase deficiency) has been revolutionised by the introduction of nitisinone but dietary treatment remains essential and the management is not easy. In this review detailed recommendations for the management are made based on expert opinion, published case reports and investigational studies as the evidence base is limited and there are no prospective controlled studies. The added value of this paper is that it summarises in detail current clinical knowledge about HT1 and makes recommendations for the management. PMID:23311542

  8. [Vaccination schedule of the Spanish association of paediatrics: recommendations 2010].

    PubMed

    Marès Bermúdez, J; van Esso Arbolave, D; Arístegui Fernández, J; Ruiz Contreras, J; González Hachero, J; Merino Moína, M; Barrio Corrales, F; Alvarez García, F J; Cilleruelo Ortega, M J; Ortigosa Del Castillo, L; Moreno Pérez, D

    2010-06-01

    The Vaccine Advisory Committee of the Spanish Association of Paediatrics updates annually, the immunization schedule, taking into account epidemiological data, as well as evidence of the effectiveness and efficiency of vaccines. This vaccination schedule includes grades of recommendation. The committee has graded as universal vaccines those that all children should receive, as recommended those with a profile of universal vaccination in childhood and which are desirable that all children receive, but that can be prioritized based on resources for its public funding and for risk groups those targeting groups of people in situations of epidemiological risk. The Committee considers as a priority to achieve a common immunization schedule. The Committee reaffirms the recommendation to include pneumococcal vaccination in the routine vaccination schedule. Vaccination against varicella in the second year of life is an effective strategy and therefore a desirable goal. Vaccination against rotavirus is recommended for all infants given the morbidity and high burden on the health care system. The Committee adheres to the recommendations of the Interterritorial Council of the National Health Care System in reference to routine vaccination against HPV for all girls aged 11 to 14 years and stresses the need to vaccinate against influenza and hepatitis A all patients with risk factors for these diseases. Finally, it stresses the need to update incomplete immunization schedules using accelerated immunization schedules. Copyright 2010 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.

  9. Decision-Guided Recommenders with Composite Alternatives

    ERIC Educational Resources Information Center

    Alodhaibi, Khalid

    2011-01-01

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

  10. 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... HEARINGS § 108.6 Recommendations. At the conclusion of any hearing under this part, the Administrative Law Judge shall, based on the record, issue tentative findings of fact and recommendations concerning...

  11. 22 CFR 908.3 - Board recommendations.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

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

  12. 5 CFR 2638.506 - Director's recommendation.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

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

  13. 45 CFR 1616.4 - Recommendations.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

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

  14. 16 CFR 1.43 - Recommendations.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

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

  15. 22 CFR 909.3 - Board recommendation.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

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

  16. 5 CFR 2638.506 - Director's recommendation.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 5 Administrative Personnel 3 2014-01-01 2014-01-01 false Director's recommendation. 2638.506... Cases Involving Individual Executive Agency Employees § 2638.506 Director's recommendation. (a) Where... employee is the head of an agency, the Director shall make any such recommendation to the President and...

  17. 45 CFR 1616.4 - Recommendations.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 45 Public Welfare 4 2014-10-01 2014-10-01 false Recommendations. 1616.4 Section 1616.4 Public... § 1616.4 Recommendations. (a) Before filling an attorney position, a recipient shall notify the organized... seek recommendations for attorneys who meet the qualifications established for the position. (b)...

  18. 22 CFR 908.3 - Board recommendations.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 22 Foreign Relations 2 2014-04-01 2014-04-01 false Board recommendations. 908.3 Section 908.3 Foreign Relations FOREIGN SERVICE GRIEVANCE BOARD REMEDIES § 908.3 Board recommendations. (a) If the Board... disciplinary action against any employee of an Agency, it shall make an appropriate recommendation to the...

  19. 16 CFR 1.43 - Recommendations.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

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

  20. 5 CFR 2638.506 - Director's recommendation.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

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

  1. 16 CFR 1.43 - Recommendations.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 16 Commercial Practices 1 2012-01-01 2012-01-01 false Recommendations. 1.43 Section 1.43... PROCEDURES Export Trade Associations § 1.43 Recommendations. Whenever the Commission has reason to believe... association recommendations for the readjustment of its business. If the association fails to comply with...

  2. 45 CFR 1616.4 - Recommendations.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 45 Public Welfare 4 2013-10-01 2013-10-01 false Recommendations. 1616.4 Section 1616.4 Public... § 1616.4 Recommendations. (a) Before filling an attorney position, a recipient shall notify the organized... seek recommendations for attorneys who meet the qualifications established for the position. (b)...

  3. 45 CFR 1616.4 - Recommendations.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 45 Public Welfare 4 2012-10-01 2012-10-01 false Recommendations. 1616.4 Section 1616.4 Public... § 1616.4 Recommendations. (a) Before filling an attorney position, a recipient shall notify the organized... seek recommendations for attorneys who meet the qualifications established for the position. (b)...

  4. 40 CFR 108.6 - Recommendations.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 40 Protection of Environment 22 2014-07-01 2013-07-01 true Recommendations. 108.6 Section 108.6... HEARINGS § 108.6 Recommendations. At the conclusion of any hearing under this part, the Administrative Law Judge shall, based on the record, issue tentative findings of fact and recommendations concerning...

  5. 16 CFR 1.43 - Recommendations.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 16 Commercial Practices 1 2013-01-01 2013-01-01 false Recommendations. 1.43 Section 1.43... PROCEDURES Export Trade Associations § 1.43 Recommendations. Whenever the Commission has reason to believe... association recommendations for the readjustment of its business. If the association fails to comply with...

  6. 5 CFR 9001.108 - Prohibited recommendations.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 5 Administrative Personnel 3 2014-01-01 2014-01-01 false Prohibited recommendations. 9001.108... CONDUCT FOR EMPLOYEES OF THE FEDERAL HOUSING FINANCE AGENCY § 9001.108 Prohibited recommendations. Employees shall not make any recommendation or suggestion, directly or indirectly, concerning...

  7. 22 CFR 908.3 - Board recommendations.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

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

  8. 22 CFR 908.3 - Board recommendations.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 22 Foreign Relations 2 2012-04-01 2009-04-01 true Board recommendations. 908.3 Section 908.3 Foreign Relations FOREIGN SERVICE GRIEVANCE BOARD REMEDIES § 908.3 Board recommendations. (a) If the Board... disciplinary action against any employee of an Agency, it shall make an appropriate recommendation to the...

  9. 22 CFR 909.3 - Board recommendation.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 22 Foreign Relations 2 2014-04-01 2014-04-01 false Board recommendation. 909.3 Section 909.3 Foreign Relations FOREIGN SERVICE GRIEVANCE BOARD DECISIONMAKING § 909.3 Board recommendation. Where the Board's decision is a recommendation, it shall be directed to the head of the Agency. A copy of...

  10. 5 CFR 9001.108 - Prohibited recommendations.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 5 Administrative Personnel 3 2012-01-01 2012-01-01 false Prohibited recommendations. 9001.108... CONDUCT FOR EMPLOYEES OF THE FEDERAL HOUSING FINANCE AGENCY § 9001.108 Prohibited recommendations. Employees shall not make any recommendation or suggestion, directly or indirectly, concerning...

  11. 22 CFR 909.3 - Board recommendation.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 22 Foreign Relations 2 2012-04-01 2009-04-01 true Board recommendation. 909.3 Section 909.3 Foreign Relations FOREIGN SERVICE GRIEVANCE BOARD DECISIONMAKING § 909.3 Board recommendation. Where the Board's decision is a recommendation, it shall be directed to the head of the Agency. A copy of...

  12. 5 CFR 9001.108 - Prohibited recommendations.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 5 Administrative Personnel 3 2013-01-01 2013-01-01 false Prohibited recommendations. 9001.108... CONDUCT FOR EMPLOYEES OF THE FEDERAL HOUSING FINANCE AGENCY § 9001.108 Prohibited recommendations. Employees shall not make any recommendation or suggestion, directly or indirectly, concerning...

  13. 16 CFR 1.43 - Recommendations.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 16 Commercial Practices 1 2014-01-01 2014-01-01 false Recommendations. 1.43 Section 1.43... PROCEDURES Export Trade Associations § 1.43 Recommendations. Whenever the Commission has reason to believe... association recommendations for the readjustment of its business. If the association fails to comply with...

  14. 5 CFR 9401.110 - Prohibited recommendations.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 5 Administrative Personnel 3 2014-01-01 2014-01-01 false Prohibited recommendations. 9401.110 Section 9401.110 Administrative Personnel BUREAU OF CONSUMER FINANCIAL PROTECTION SUPPLEMENTAL STANDARDS... recommendations. An employee shall not make recommendations or suggestions, directly or indirectly, concerning...

  15. 22 CFR 909.3 - Board recommendation.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

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

  16. 22 CFR 908.3 - Board recommendations.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 22 Foreign Relations 2 2013-04-01 2009-04-01 true Board recommendations. 908.3 Section 908.3 Foreign Relations FOREIGN SERVICE GRIEVANCE BOARD REMEDIES § 908.3 Board recommendations. (a) If the Board... disciplinary action against any employee of an Agency, it shall make an appropriate recommendation to the...

  17. 5 CFR 9401.110 - Prohibited recommendations.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 5 Administrative Personnel 3 2013-01-01 2013-01-01 false Prohibited recommendations. 9401.110 Section 9401.110 Administrative Personnel BUREAU OF CONSUMER FINANCIAL PROTECTION SUPPLEMENTAL STANDARDS... recommendations. An employee shall not make recommendations or suggestions, directly or indirectly, concerning...

  18. 22 CFR 909.3 - Board recommendation.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 22 Foreign Relations 2 2013-04-01 2009-04-01 true Board recommendation. 909.3 Section 909.3 Foreign Relations FOREIGN SERVICE GRIEVANCE BOARD DECISIONMAKING § 909.3 Board recommendation. Where the Board's decision is a recommendation, it shall be directed to the head of the Agency. A copy of...

  19. 5 CFR 2638.506 - Director's recommendation.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 5 Administrative Personnel 3 2012-01-01 2012-01-01 false Director's recommendation. 2638.506... Cases Involving Individual Executive Agency Employees § 2638.506 Director's recommendation. (a) Where... employee is the head of an agency, the Director shall make any such recommendation to the President and...

  20. 45 CFR 1616.4 - Recommendations.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

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

  1. 5 CFR 9001.108 - Prohibited recommendations.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

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

  2. 40 CFR 108.6 - Recommendations.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

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

  3. Decision-Guided Recommenders with Composite Alternatives

    ERIC Educational Resources Information Center

    Alodhaibi, Khalid

    2011-01-01

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

  4. Recommendations of everolimus use in liver transplant.

    PubMed

    Rubín Suárez, Angel; Bilbao Aguirre, Itxarone; Fernández-Castroagudin, Javier; Pons Miñano, José Antonio; Salcedo Plaza, Magdalena; Varo Pérez, Evaristo; Prieto Castillo, Martín

    2017-07-22

    Mammalian target of rapamycin (mTOR) inhibitors, everolimus (EVL) and sirolimus are immunosuppressive agents with a minor nephrotoxic effect, limited to the development of proteinuria in some cases. The combination of EVL and low-dose tacrolimus has proven to be as safe and effective as standard therapy with tacrolimus for the prevention of acute cellular rejection. Early initiation of EVL-based immunosuppressive regimens with reduced exposure to calcineurin inhibitors has been shown to significantly improve renal function of LT recipients during induction and maintenance phases, with comparable efficacy and safety profiles. In patients with established kidney failure, initiating EVL may enable clinicians to reduce calcineurin inhibitors exposure, thereby contributing to the improved renal function of these patients. Although there is not sufficient evidence to recommend their use to prevent the recurrence of hepatocellular carcinoma and the progression of de novo tumours, they are used in this context in routine clinical practice. Copyright © 2017 Elsevier España, S.L.U., AEEH y AEG. All rights reserved.

  5. Measures of visual hallucinations: Review and recommendations.

    PubMed

    Aynsworth, Charlotte; Collerton, Daniel; Dudley, Robert

    2017-05-11

    Studies designed to investigate visual hallucinations (VH) require reliable and valid measures that can appropriately capture peoples' experiences. This review aimed to assess the psychometric rigour and usefulness of VH measures. A systematic literature search was carried out against inclusion criteria (e.g. more than one specific question on VH, measures for adults in clinical and non-clinical populations). Eighteen measures were identified and rated against an adapted evaluation grid, which included essential criteria such as clear purpose and definition, psychometric properties including reliability and validity, and appropriate exploration of visual hallucinations. Measures could be categorised into 3 groups; those for general psychotic symptoms, those for all hallucinations, or those specifically for visual hallucinations. With one exception (the North East Visual Hallucinations Inventory), the measures were considered to be limited as they often targeted one population and hence lacked generalisability, or were limited in the characteristics of the visions that were described, or that psychometric properties were not adequately evaluated. Measures of VH require further development. The need to establish a clearer definition of VH is essential to provide clarity and consistency within research and practice. Measures need to demonstrate good psychometric properties to indicate robustness whilst being sensitive to change to help in the evaluation of treatments. Other recommendations include developing cross-cultural measures and involving service users in item development. Copyright © 2017 Elsevier Ltd. All rights reserved.

  6. Implementation strategies: recommendations for specifying and reporting

    PubMed Central

    2013-01-01

    Implementation strategies have unparalleled importance in implementation science, as they constitute the ‘how to’ component of changing healthcare practice. Yet, implementation researchers and other stakeholders are not able to fully utilize the findings of studies focusing on implementation strategies because they are often inconsistently labelled and poorly described, are rarely justified theoretically, lack operational definitions or manuals to guide their use, and are part of ‘packaged’ approaches whose specific elements are poorly understood. We address the challenges of specifying and reporting implementation strategies encountered by researchers who design, conduct, and report research on implementation strategies. Specifically, we propose guidelines for naming, defining, and operationalizing implementation strategies in terms of seven dimensions: actor, the action, action targets, temporality, dose, implementation outcomes addressed, and theoretical justification. Ultimately, implementation strategies cannot be used in practice or tested in research without a full description of their components and how they should be used. As with all intervention research, their descriptions must be precise enough to enable measurement and ‘reproducibility.’ We propose these recommendations to improve the reporting of implementation strategies in research studies and to stimulate further identification of elements pertinent to implementation strategies that should be included in reporting guidelines for implementation strategies. PMID:24289295

  7. Implementation strategies: recommendations for specifying and reporting.

    PubMed

    Proctor, Enola K; Powell, Byron J; McMillen, J Curtis

    2013-12-01

    Implementation strategies have unparalleled importance in implementation science, as they constitute the 'how to' component of changing healthcare practice. Yet, implementation researchers and other stakeholders are not able to fully utilize the findings of studies focusing on implementation strategies because they are often inconsistently labelled and poorly described, are rarely justified theoretically, lack operational definitions or manuals to guide their use, and are part of 'packaged' approaches whose specific elements are poorly understood. We address the challenges of specifying and reporting implementation strategies encountered by researchers who design, conduct, and report research on implementation strategies. Specifically, we propose guidelines for naming, defining, and operationalizing implementation strategies in terms of seven dimensions: actor, the action, action targets, temporality, dose, implementation outcomes addressed, and theoretical justification. Ultimately, implementation strategies cannot be used in practice or tested in research without a full description of their components and how they should be used. As with all intervention research, their descriptions must be precise enough to enable measurement and 'reproducibility.' We propose these recommendations to improve the reporting of implementation strategies in research studies and to stimulate further identification of elements pertinent to implementation strategies that should be included in reporting guidelines for implementation strategies.

  8. Undergraduate materials education 2010: Status and recommendations

    NASA Astrophysics Data System (ADS)

    Schwartz, Lyle H.

    2010-03-01

    In discussing undergraduate materials education in engineering schools, I begin by reviewing the historical development of today’s array of materials departments and the progress toward a true materials science and engineering (MSE) discipline. I then go on to explore the range of implications for the undergraduate curriculum that are incumbent upon these departments being situated in engineering schools, schools that are themselves undergoing great change as we enter the 21st century. Turning to the specifics of undergraduate curriculum I am able to draw on recent data compilations of others to give a reasonable picture of the developing commonality in “core” curricula in the MSE degrees that now constitute the majority of undergraduate materials degrees offered. I explore briefly the issues of continuing education demanded by an undergraduate curriculum that is increasingly broad, not deep, and then look (with some envy) at the extensive efforts to address these issues by our colleagues in the UK. The paper closes with recommendations targeted at the individual departments, their collective leadership in the University Materials Council, the professional societies, and finally the newly formed Undergraduate Education Coordinating Committee, a joint committee of several of the leading materials societies.

  9. Recommended Screening Practices for Launch Collision Aviodance

    NASA Technical Reports Server (NTRS)

    Beaver, Brian A.; Hametz, Mark E.; Ollivierre, Jarmaine C.; Newman, Lauri K.; Hejduk, Matthew D.

    2015-01-01

    The objective of this document is to assess the value of launch collision avoidance (COLA) practices and provide recommendations regarding its implementation for NASA robotic missions. The scope of this effort is limited to launch COLA screens against catalog objects that are either spacecraft or debris. No modifications to manned safety COLA practices are considered in this effort. An assessment of the value of launch COLA can be broken down into two fundamental questions: 1) Does collision during launch represent a significant risk to either the payload being launched or the space environment? 2) Can launch collision mitigation be performed in a manner that provides meaningful risk reduction at an acceptable level of operational impact? While it has been possible to piece together partial answers to these questions for some time, the first attempt to comprehensively address them is documented in reference (a), Launch COLA Operations: an Examination of Data Products, Procedures, and Thresholds, Revision A. This report is the product of an extensive study that addressed fundamental technical questions surrounding launch collision avoidance analysis and practice. The results provided in reference (a) will be cited throughout this document as these two questions are addressed. The premise of this assessment is that in order to conclude that launch COLA is a value-added activity, the answer to both of these questions must be affirmative. A "no" answer to either of these questions points toward the conclusion that launch COLA provides little or no risk mitigation benefit. The remainder of this assessment will focus on addressing these two questions.

  10. Recommendations for pathology peer review.

    PubMed

    Morton, Daniel; Sellers, Rani S; Barale-Thomas, Erio; Bolon, Brad; George, Catherine; Hardisty, Jerry F; Irizarry, Armando; McKay, Jennifer S; Odin, Marielle; Teranishi, Munehiro

    2010-12-01

    Pathology peer review verifies and improves the accuracy and quality of pathology diagnoses and interpretations. Pathology peer review is recommended when important risk assessment or business decisions are based on nonclinical studies. For pathology peer review conducted before study completion, the peer-review pathologist reviews sufficient slides and pathology data to assist the study pathologist in refining pathology diagnoses and interpretations. Materials to be reviewed are selected by the peer-review pathologist. Consultations with additional experts or a formal (documented) pathology working group may be used to resolve discrepancies. The study pathologist is solely responsible for the content of the final pathology data and report, makes changes resulting from peer-review discussions, initiates the audit trail for microscopic observations after all changes resulting from peer-review have been made, and signs the final pathologist's report. The peer-review pathologist creates a signed peer-review memo describing the peer-review process and confirming that the study pathologist's report accurately and appropriately reflects the pathology data. The study pathologist also may sign a statement of consensus. It is not necessary to archive working notes created during the peer-review process.

  11. Nutritional recommendations for synchronized swimming.

    PubMed

    Robertson, Sherry; Benardot, Dan; Mountjoy, Margo

    2014-08-01

    The sport of synchronized swimming is unique, because it combines speed, power, and endurance with precise synchronized movements and high-risk acrobatic maneuvers. Athletes must train and compete while spending a great amount of time underwater, upside down, and without the luxury of easily available oxygen. This review assesses the scientific evidence with respect to the physiological demands, energy expenditure, and body composition in these athletes. The role of appropriate energy requirements and guidelines for carbohydrate, protein, fat, and micronutrients for elite synchronized swimmers are reviewed. Because of the aesthetic nature of the sport, which prioritizes leanness, the risks of energy and macronutrient deficiencies are of significant concern. Relative Energy Deficiency in Sport and disordered eating/eating disorders are also of concern for these female athletes. An approach to the healthy management of body composition in synchronized swimming is outlined. Synchronized swimmers should be encouraged to consume a well-balanced diet with sufficient energy to meet demands and to time the intake of carbohydrate, protein, and fat to optimize performance and body composition. Micronutrients of concern for this female athlete population include iron, calcium, and vitamin D. This article reviews the physiological demands of synchronized swimming and makes nutritional recommendations for recovery, training, and competition to help optimize athletic performance and to reduce risks for weight-related medical issues that are of particular concern for elite synchronized swimmers.

  12. Vietnam recommended dietary allowances 2007.

    PubMed

    Khan, Nguyen Cong; Hoan, Pham Van

    2008-01-01

    It has been well acknowledged that Vietnam is undergoing a nutrition transition. With a rapid change in the country's reform and economic growth, food supply at the macronutrient level has improved. Changes of the Vietnamese diet include significantly more foods of animal origin, and an increase of fat/oils, and ripe fruits. Consequently, nutritional problems in Vietnam now include not only malnutrition but also overweight/obesity, metabolic syndrome and other chronic diseases related to nutrition and lifestyles. The recognition of these shifts, which is also associated with morbidity and mortality, was a major factor in the need to review and update the Recommended Dietary Allowances (RDA) for the Vietnamese population. This revised RDA established an important science-based tool for evaluation of nutrition adequacy, for teaching, and for scientific communications within Vietnam. It is expected that the 2007 Vietnam RDA and its conversion to food-based dietary guidelines will facilitate education to the public, as well as the policy implementation of programs for prevention of non-communicable chronic diseases and addressing the double burden of both under and over nutrition.

  13. Four simple recommendations to encourage best practices in research software

    PubMed Central

    Jiménez, Rafael C.; Kuzak, Mateusz; Alhamdoosh, Monther; Barker, Michelle; Batut, Bérénice; Borg, Mikael; Capella-Gutierrez, Salvador; Chue Hong, Neil; Cook, Martin; Corpas, Manuel; Flannery, Madison; Garcia, Leyla; Gelpí, Josep Ll.; Gladman, Simon; Goble, Carole; González Ferreiro, Montserrat; Gonzalez-Beltran, Alejandra; Griffin, Philippa C.; Grüning, Björn; Hagberg, Jonas; Holub, Petr; Hooft, Rob; Ison, Jon; Katz, Daniel S.; Leskošek, Brane; López Gómez, Federico; Oliveira, Luis J.; Mellor, David; Mosbergen, Rowland; Mulder, Nicola; Perez-Riverol, Yasset; Pergl, Robert; Pichler, Horst; Pope, Bernard; Sanz, Ferran; Schneider, Maria V.; Stodden, Victoria; Suchecki, Radosław; Svobodová Vařeková, Radka; Talvik, Harry-Anton; Todorov, Ilian; Treloar, Andrew; Tyagi, Sonika; van Gompel, Maarten; Vaughan, Daniel; Via, Allegra; Wang, Xiaochuan; Watson-Haigh, Nathan S.; Crouch, Steve

    2017-01-01

    Scientific research relies on computer software, yet software is not always developed following practices that ensure its quality and sustainability. This manuscript does not aim to propose new software development best practices, but rather to provide simple recommendations that encourage the adoption of existing best practices. Software development best practices promote better quality software, and better quality software improves the reproducibility and reusability of research. These recommendations are designed around Open Source values, and provide practical suggestions that contribute to making research software and its source code more discoverable, reusable and transparent. This manuscript is aimed at developers, but also at organisations, projects, journals and funders that can increase the quality and sustainability of research software by encouraging the adoption of these recommendations. PMID:28751965

  14. Four simple recommendations to encourage best practices in research software.

    PubMed

    Jiménez, Rafael C; Kuzak, Mateusz; Alhamdoosh, Monther; Barker, Michelle; Batut, Bérénice; Borg, Mikael; Capella-Gutierrez, Salvador; Chue Hong, Neil; Cook, Martin; Corpas, Manuel; Flannery, Madison; Garcia, Leyla; Gelpí, Josep Ll; Gladman, Simon; Goble, Carole; González Ferreiro, Montserrat; Gonzalez-Beltran, Alejandra; Griffin, Philippa C; Grüning, Björn; Hagberg, Jonas; Holub, Petr; Hooft, Rob; Ison, Jon; Katz, Daniel S; Leskošek, Brane; López Gómez, Federico; Oliveira, Luis J; Mellor, David; Mosbergen, Rowland; Mulder, Nicola; Perez-Riverol, Yasset; Pergl, Robert; Pichler, Horst; Pope, Bernard; Sanz, Ferran; Schneider, Maria V; Stodden, Victoria; Suchecki, Radosław; Svobodová Vařeková, Radka; Talvik, Harry-Anton; Todorov, Ilian; Treloar, Andrew; Tyagi, Sonika; van Gompel, Maarten; Vaughan, Daniel; Via, Allegra; Wang, Xiaochuan; Watson-Haigh, Nathan S; Crouch, Steve

    2017-01-01

    Scientific research relies on computer software, yet software is not always developed following practices that ensure its quality and sustainability. This manuscript does not aim to propose new software development best practices, but rather to provide simple recommendations that encourage the adoption of existing best practices. Software development best practices promote better quality software, and better quality software improves the reproducibility and reusability of research. These recommendations are designed around Open Source values, and provide practical suggestions that contribute to making research software and its source code more discoverable, reusable and transparent. This manuscript is aimed at developers, but also at organisations, projects, journals and funders that can increase the quality and sustainability of research software by encouraging the adoption of these recommendations.

  15. Diffusion-like recommendation with enhanced similarity of objects

    NASA Astrophysics Data System (ADS)

    An, Ya-Hui; Dong, Qiang; Sun, Chong-Jing; Nie, Da-Cheng; Fu, Yan

    2016-11-01

    In the last decade, diversity and accuracy have been regarded as two important measures in evaluating a recommendation model. However, a clear concern is that a model focusing excessively on one measure will put the other one at risk, thus it is not easy to greatly improve diversity and accuracy simultaneously. In this paper, we propose to enhance the Resource-Allocation (RA) similarity in resource transfer equations of diffusion-like models, by giving a tunable exponent to the RA similarity, and traversing the value of this exponent to achieve the optimal recommendation results. In this way, we can increase the recommendation scores (allocated resource) of many unpopular objects. Experiments on three benchmark data sets, MovieLens, Netflix and RateYourMusic show that the modified models can yield remarkable performance improvement compared with the original ones.

  16. AMCP Partnership Forum: Driving Value and Outcomes in Oncology.

    PubMed

    2017-05-01

    Innovation in cancer treatment has provided a wealth of recently available therapeutic agents and a healthy drug pipeline that promises to change the way we approach this disease and the lives of those affected in the years to come. However, the majority of these new agents, many of which are targeted to specific genomic features of various tumors, may challenge the health care system's ability to afford cancer care. This innovation drives the need to focus on the value of the treatments provided to patients with cancer and on methods to optimize the efficiency of the dollars we spend, in addition to the clinical value itself. The Academy of Managed Care Pharmacy (AMCP) convened a Partnership Forum to address how to improve value and outcomes in cancer care. In this multistakeholder forum, several areas were addressed: current methods for assessing the value of oncology products, the need for balancing population management with precision medicine, and the outlook for value-based contracting for oncology medications in managed care settings. Participants recommended ways in which stakeholders can work toward solutions in these areas. The forum brought together stakeholders from health plans, integrated delivery systems, pharmacy benefit managers, clinical practice, biopharmaceutical industry, and laboratory companies. Also participating were representatives from trade and professional associations. During this 1.5-day forum, participants identified current challenges, readiness, and ways to address value and improve outcomes in cancer therapy. Some of the challenges identified include choosing a viable (and practical) outcome target for value-based contracting in oncology, the development and use of value frameworks and clinical pathways, managing cancer diagnostics, utilization of alternative payment systems, moving from a large evidence base to a small clinical trial base in considering targeted treatments, and lack of best practices in value-based payment

  17. Hybrid recommendation methods in complex networks.

    PubMed

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

    2015-07-01

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

  18. Physical activity recommendations for older Australians.

    PubMed

    Sims, Jane; Hill, Keith; Hunt, Susan; Haralambous, Betty

    2010-06-01

    The aim of this research was to produce evidence-based recommendations on physical activity designed to improve and maintain the health of older Australians. The authors reviewed existing guidelines and consensus statements, systematic reviews, meta-analyses and research articles. Draft recommendations were circulated to stakeholder agencies and to an expert advisory group. Final recommendations were then forwarded to the Commonwealth Department of Health and Ageing for Ministerial approval. The physical activity recommendations for older Australians complement the current National Physical Activity Guidelines for adults and the American College of Sports Medicine and American Heart Association recommendations for older adults. The recommendations provide advice developed specifically for older Australians. Although the recommendations may be manifested in different ways, according to specific populations or settings, they apply to older people across all levels of health and have application to community dwelling people and those in residential care accommodation.

  19. Human Genetic Engineering: A Survey of Student Value Stances

    ERIC Educational Resources Information Center

    Wilson, Sara McCormack; And Others

    1975-01-01

    Assesses the values of high school and college students relative to human genetic engineering and recommends that biology educators explore instructional strategies merging human genetic information with value clarification techniques. (LS)

  20. Human Genetic Engineering: A Survey of Student Value Stances

    ERIC Educational Resources Information Center

    Wilson, Sara McCormack; And Others

    1975-01-01

    Assesses the values of high school and college students relative to human genetic engineering and recommends that biology educators explore instructional strategies merging human genetic information with value clarification techniques. (LS)

  1. Does Values Education Belong in the Curriculum?

    ERIC Educational Resources Information Center

    Hornbeck, David W.

    This report recommends ways to integrate values education into schools' curricula. Societal problems indicate that values play as important a role in students' development as math and science, as suggested by statistics on increasing teenage suicide, pregnancies, and dropping out. While it is important to ensure that at-risk students become…

  2. Values Education and Some Suggestions to Teachers

    ERIC Educational Resources Information Center

    Demirhan Iscan, Canay

    2011-01-01

    This paper focuses on the process, approaches and teacher roles in values education and offers recommendations for teachers. It uses print materials and Internet sources on values education. These sources were analyzed and synthesized to reveal certain cases and/or opinions. In addition to contemporary sources, older reference materials were also…

  3. Does Values Education Belong in the Curriculum?

    ERIC Educational Resources Information Center

    Hornbeck, David W.

    This report recommends ways to integrate values education into schools' curricula. Societal problems indicate that values play as important a role in students' development as math and science, as suggested by statistics on increasing teenage suicide, pregnancies, and dropping out. While it is important to ensure that at-risk students become…

  4. Comparison of recommendations for screening mammography using CISNET models.

    PubMed

    Arleo, Elizabeth Kagan; Hendrick, R Edward; Helvie, Mark A; Sickles, Edward A

    2017-08-21

    Currently, there are several different recommendations for screening mammography from major national health care organizations, including: 1) annual screening at ages 40 to 84 years; 2) screening annually at ages 45 to 54 years, then biennially at ages 55 to 79 years; and 3) biennial screening at ages 50 to 74 years. Mean values of six Cancer Intervention and Surveillance Modeling Network (CISNET) models were used to compare these three screening mammography recommendations in terms of benefits and risks. Mean mortality reduction was greatest with the recommendation of annual screening at ages 40 to 84 years (39.6%), compared with the hybrid recommendation of screening annually at ages 45 to 54 years, then biennially at ages 55 to 79 years (30.8%), and the recommendation of biennial screening at ages 50 to 74 years (23.2%). For a single-year cohort of US women aged 40 years, assuming 100% compliance, more breast cancers deaths would be averted over their lifetime with annual screening starting at age 40 (29,369) than with the hybrid recommendation (22,829) or biennial screening ages 50-74 (17,153 based on 2009 CISNET estimates, 15,599 based on 2016 CISNET estimates). To achieve the greatest mortality benefit, this single-year cohort of women would have the greatest total number of screening mammograms, benign recalls, and benign biopsies performed over the course of screening by following annual screening starting at age 40 years (90.2 million, 6.8 million, and 481,269, respectively) than by following the hybrid recommendation (49.0 million, 4.1 million, and 286,288, respectively) or biennial screening at ages 50 to 74 years (27.3 million, 2.3 million, and 162,885, respectively). CISNET models demonstrate that the greatest mortality reduction is achieved with annual screening of women starting at age 40 years. Cancer 2017. © 2017 American Cancer Society. © 2017 American Cancer Society.

  5. Rapid Target Locator

    NASA Astrophysics Data System (ADS)

    Bisbee, John

    1985-12-01

    Like beauty, "real time" is in the eye of the beholder. Airborne electro-optical (EO) reconnaissance systems can transmit an image in real time to a display in an imagery interpreter's (II) console, but it then takes around 15 min for the II to issue his report. Thus, while the II sees real-time imagery, the officer in the field who requested the coverage sees a report that is not real time and that may be rapidly losing its value. The greatest delay in issuing the report comes from having to determine where the target is. This is currently done on the Analytical Photogrammetric Positioning System (APPS) that uses stereophotomaps to determine the x, y, z coordinates of a point on the ground; it takes many minutes to measure the position of each target. Our goal is to reduce that portion of the recce cycle that uses Itek technology--from time over target to issuance of a report--to less than 2 min. A still shorter time would be desirable in the face of rapidly moving targets,, but there is little point in making the time negligible compared to that required for Oil to evaluate the report and issue orders, plus the time required to respond to the orders. It is clear that we can achieve this 2-min goal only if we can greatly reduce the time it now takes to determine the location of a target. The accuracy with which a target is located should not suffer while the time is reduced. There is a tradeoff to be made between timeliness and accuracy when the target is moving: neither short time with poor accuracy nor high accuracy with long time is desirable. We have arbitrarily adopted goals in which a target can be located to about 100 ft in less than half a minute. The experiments reported here investigated one concept, called Rapid Target Locator (RATL), for achieving this performance.

  6. Smaller Fixation Target Size Is Associated with More Stable Fixation and Less Variance in Threshold Sensitivity

    PubMed Central

    Okano, Kana; Koshiji, Risako; Funaki, Wakana; Shoji, Nobuyuki

    2016-01-01

    The aims of this randomized observational case control study were to quantify fixation behavior during standard automated perimetry (SAP) with different fixation targets and to evaluate the relationship between fixation behavior and threshold variability at each test point in healthy young participants experienced with perimetry. SAP was performed on the right eyes of 29 participants using the Octopus 900 perimeter, program 32, dynamic strategy. The fixation targets of Point, Cross, and Ring were used for SAP. Fixation behavior was recorded using a wearable eye-tracking glass. All participants underwent SAP twice with each fixation target in a random fashion. Fixation behavior was quantified by calculating the bivariate contour ellipse area (BCEA) and the frequency of deviation from the fixation target. The BCEAs (deg2) of Point, Cross, and Ring targets were 1.11, 1.46, and 2.02, respectively. In all cases, BCEA increased significantly with increasing fixation target size (p < 0.05). The logarithmic value of BCEA demonstrated the same tendency (p < 0.05). A positive correlation was identified between fixation behavior and threshold variability for the Point and Cross targets (ρ = 0.413–0.534, p < 0.05). Fixation behavior increased with increasing fixation target size. Moreover, a larger fixation behavior tended to be associated with a higher threshold variability. A small fixation target is recommended during the visual field test. PMID:27829030

  7. Limitations of the evidence base used to set recommended nutrient intakes for infants and lactating women.

    USDA-ARS?s Scientific Manuscript database

    Reported values for the concentrations of micronutrients in human milk form the basis of the majority of micronutrient intake recommendations for infants and the additional maternal requirements for lactation. The infant recommendations may also be extrapolated to provide estimates for young childre...

  8. On Target.

    ERIC Educational Resources Information Center

    Barbalich, Andrea

    1991-01-01

    Campus public relations professionals offer advice for improving the effectiveness of public relations efforts by (1) setting behavioral goals; (2) targeting audiences carefully; (3) focusing appeals by making messages explicit; (4) connecting the public relations message with larger societal issues; and (5) reaching internal as well as external…

  9. Students Target

    NASA Image and Video Library

    2005-12-19

    Using the JMars targeting software, eighth grade students from Charleston Middle School in Charleston, IL, selected the location of -8.37N and 276.66E for capture by the THEMIS visible camera during Mars Odyssey sixth orbit of Mars on Nov. 22, 2005

  10. Tackling Targets.

    ERIC Educational Resources Information Center

    Further Education Unit, London (England).

    This document is designed to help British training and enterprise councils (TECs) and further education (FE) colleges develop and implement strategies for achieving the National Targets for Education and Training (NTET), which were developed by the Confederation of British Industry in 1992 and endorsed by the British government. The findings from…

  11. Targeting hardwoods

    Treesearch

    Douglass F. Jacobs

    2011-01-01

    Increasing demand for hardwood seedlings has prompted research to identify target seedling characteristics that promote hardwood plantation establishment. Operational establishment of hardwood plantations has typically emphasized seed collection from non-improved genetic sources, bareroot nursery seedling production, and spring planting using machine planters. The...

  12. Target: Lifestyle.

    ERIC Educational Resources Information Center

    Poehlman, Eric T.

    1985-01-01

    "Target: Lifestyle" is a physical education curriculum adopted by Detroit Country Day School which incorporates instruction in nutrition, physical fitness, first aid, and lifetime sports. This curriculum aims to influence student attitudes and lifestyles in health and physical fitness. Four levels of instruction are described. (DF)

  13. A regional consensus recommendation on brain atrophy as an outcome measure in multiple sclerosis.

    PubMed

    Alroughani, Raed; Deleu, Dirk; El Salem, Khalid; Al-Hashel, Jasem; Alexander, K John; Abdelrazek, Mohamed Assem; Aljishi, Adel; Alkhaboori, Jaber; Al Azri, Faisal; Al Zadjali, Nahida; Hbahbih, Majed; Sokrab, Tag Eldin; Said, Mohamed; Rovira, Àlex

    2016-11-24

    Multiple sclerosis (MS) is a chronic autoimmune disease characterized by inflammatory and neurodegenerative processes leading to irreversible neurological impairment. Brain atrophy occurs early in the course of the disease at a rate greater than the general population. Brain volume loss (BVL) is associated with disability progression and cognitive impairment in patients with MS; hence its value as a potential target in monitoring and treating MS is discussed. A group of MS neurologists and neuro-radiologists reviewed the current literature on brain atrophy and discussed the challenges in assessing and implementing brain atrophy measurements in clinical practice. The panel used a voting system to reach a consensus and the votes were counted for the proposed set of questions for cognitive and brain atrophy assessments. The panel of experts was able to identify recent studies, which demonstrated the correlation between BVL and future worsening of disability and cognition. The current evidence revealed that reduction of BVL could be achieved with different disease-modifying therapies (DMTs). BVL provided a better treatment and monitoring strategy when it is combined to the composite measures of "no evidence of disease activity" (NEDA). The panel recommended a set of cognitive assessment tools and MRI methods and software applications that may help in capturing and measuring the underlying MS pathology with high degree of specificity. BVL was considered to be a useful measurement to longitudinally assess disease progression and cognitive function in patients with MS. Brain atrophy measurement was recommended to be incorporated into the concept of NEDA. Consequently, a consensus recommendation was reached in anticipation for implementation of the use of cognitive assessment and brain atrophy measurements on a regional level.

  14. Utilization of cardiac troponin assays in adult and pediatric populations: Guideline recommendations vs. reality.

    PubMed

    Saenger, Amy K; Haymond, Shannon

    2015-12-01

    We hypothesized significant gaps remained for cardiac troponin (cTn) utilization in the United States, despite an emerging evidence base and guideline recommendations. We tested this hypothesis and investigated differences and trends between the use of cTn in adult versus pediatric hospitals. Individuals were identified by a targeted distribution through personal contact and professional society email lists. Participants completed an online survey (Qualtrics) from 07/15/13 to 07/26/13. The 31-item questionnaire used skipped logic and collected data about the respondent and their institutional cTn clinical practices. Data tabulation and analysis were conducted using Qualtrics and Microsoft Excel. A total of 159 unique laboratories responded to the survey, representing primarily adult (81%) versus pediatric (19%) institutions. 59% of laboratories utilize the guideline recommended 99th percentile as the upper reference limit (URL) for cTn, with large variability in reporting practices among users of the same assay. 73% of laboratories reported simultaneous ordering of other cardiac biomarkers with cTn, a majority which included CK-MB. Interpretive comments were used with cTn in 71 laboratories with a significant amount of heterogeneity. Pediatric hospitals reported a lower frequency of cTn orders and were less likely to consider elevated cTn a critical value. Gaps in current utilization and reporting of cTn exist, along with practices inconsistent with clinical guideline recommendations. Implementation of the 99th percentile and serial sampling protocols will be critical to adoption of high-sensitivity cTn assays. Differences in chest pain etiology are the most likely reason for the notable differences between cTn use in adults versus pediatric hospitals. Copyright © 2015 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.

  15. [French as 2005-recommendations on the management of arterial hypertension].

    PubMed

    Chamontin, B; Halimi, J M

    2007-01-01

    Self blood pressure measurements (home BP) and/or ambulatory BP measurements are recommended in mild to moderate hypertension (140/90 - 179/109 mmHg) in order to confirm sustained hypertension and identify white coat and masked hypertension. The evaluation of target organ damages (TOD) has to be integrated in cardiovascular risk estimate and taken into account in the management of hypertensive patients. Beside echocardiography, there is a place for the screening of microalbuminuria in non diabetic hypertensive patients, but these investigations should not be performed systematically. Arterial stiffness evaluation and carotid intima-media thickness quantification are not yet recommended. Cardiovascular risk (CV risk) estimate plays a pivotal role in the therapeutic decision and strategy. The cardiovascular risk grade is based on [1] the list of cardiovascular risk factors (same list AFSSAPS recommendations on dyslipidemia), [2] the presence or absence of TOD and [3] cardiovascular complications: "low", "medium", and "high" CV risk. Lifestyle modifications are recommended in all hypertensive patients. Five antihypertensive drugs are recommended for first line therapy: beta-blockers, thiazide diuretics, ACEIs, ARA II and CCBs (and fixed low dose combinations with AFSSAPS agreement for first line). In order to initiate the treatment, Evidence-based therapy (according to clinical trials conducted in different clinical situations), certain comorbid conditions (compelling indications), efficacy and side-effects in a previous experience, and the cost are the determinants of the first choice. Most hypertensive patients require more than one agent to achieve target blood pressure and for second line therapy the recommended combinations are: betablockers-diuretics, ACEIs-diuretics, ARAII-diuretics, betablockers-CCBs (DHP), ACEIs-CCBs, ARA II-CCBs and CCBs-diuretics. The delay to establish a combination therapy depend on CV risk. The BP goals are those recommended by ESH

  16. New recommendations for measuring collagen solubility.

    PubMed

    Latorre, María E; Lifschitz, Adrian L; Purslow, Peter P

    2016-08-01

    The heat-solubility of intramuscular collagen is usually conducted in 1/4 Ringer's solution at pH7.4, despite this ionic strength and pH being inappropriate for post-rigor meat. The current work studied the percentage of soluble collagen and hydrothermal isometric tension characteristics of perimysial strips on bovine semitendinosus muscles in either 1/4 Ringer's solution, distilled water, PBS, or a solution of the same salt concentration as 1/4 Ringer's but at pH5.6. Values of % soluble collagen were lower at pH7.4 than 5.6. Increasing ionic strength reduced % soluble collagen. The maximum perimysial isometric tension was independent of the bathing medium, but the percent relaxation was higher at pH7.4 than at pH5.6, and increased with ionic strength of the media. It is recommended that future measurements of collagen solubility and tests on connective tissue components of post-rigor meat should be carried out in a solution of concentrations NaCl and KCl equivalent to those in 1/4 Ringer's, but at pH5.6, a pH relevant to post-rigor meat.

  17. Improving treatment of neurodevelopmental disorders: recommendations based on preclinical studies.

    PubMed

    Homberg, Judith R; Kyzar, Evan J; Stewart, Adam Michael; Nguyen, Michael; Poudel, Manoj K; Echevarria, David J; Collier, Adam D; Gaikwad, Siddharth; Klimenko, Viktor M; Norton, William; Pittman, Julian; Nakamura, Shun; Koshiba, Mamiko; Yamanouchi, Hideo; Apryatin, Sergey A; Scattoni, Maria Luisa; Diamond, David M; Ullmann, Jeremy F P; Parker, Matthew O; Brown, Richard E; Song, Cai; Kalueff, Allan V

    2016-01-01

    Neurodevelopmental disorders (NDDs) are common and severely debilitating. Their chronic nature and reliance on both genetic and environmental factors makes studying NDDs and their treatment a challenging task. Herein, the authors discuss the neurobiological mechanisms of NDDs, and present recommendations on their translational research and therapy, outlined by the International Stress and Behavior Society. Various drugs currently prescribed to treat NDDs also represent a highly diverse group. Acting on various neurotransmitter and physiological systems, these drugs often lack specificity of action, and are commonly used to treat multiple other psychiatric conditions. There has also been relatively little progress in the development of novel medications to treat NDDs. Based on clinical, preclinical and translational models of NDDs, our recommendations cover a wide range of methodological approaches and conceptual strategies. To improve pharmacotherapy and drug discovery for NDDs, we need a stronger emphasis on targeting multiple endophenotypes, a better dissection of genetic/epigenetic factors or "hidden heritability," and a careful consideration of potential developmental/trophic roles of brain neurotransmitters. The validity of animal NDD models can be improved through discovery of novel (behavioral, physiological and neuroimaging) biomarkers, applying proper environmental enrichment, widening the spectrum of model organisms, targeting developmental trajectories of NDD-related behaviors and comorbid conditions beyond traditional NDDs. While these recommendations cannot be addressed all in once, our increased understanding of NDD pathobiology may trigger innovative cross-disciplinary research expanding beyond traditional methods and concepts.

  18. [CCAFU Recommendations 2013: Prostate cancer].

    PubMed

    Salomon, L; Bastide, C; Beuzeboc, P; Cormier, L; Fromont, G; Hennequin, C; Mongiat-Artus, P; Peyromaure, M; Ploussard, G; Renard-Penna, R; Rozet, F; Azria, D; Coloby, P; Molinié, V; Ravery, V; Rebillard, X; Richaud, P; Villers, A; Soulié, M

    2013-11-01

    The sub Comittee prostate of the CCAFU established guidelines for diagnostic, treatment, evaluation and standart of care of prostate cancer. Guidelines 2010 were updated based on systematic literature search performed by the sub-Comittee in Medline and PubMed databases to evaluate references, levels of evidence and grade of recommandation. Pathological examination of the tissue specimens was defined specifically for Gleason score according to ISP 2005 recommandations. Prostate and pelvis RMN became the reference in terms of radiological exam. Individual and early diagnosis of prostate cancer was defined and role of PSA was precised. Active surveillance became one of the standart of care of low-risk tumors, radical prostatectomy remained one of the options for all risk group tumors, length of hormonotherapy in association with radiotherapy was precised according to the risk group. Side effects of hormonotherapy treament needed specific supervision ; hormonotherapy had no indication in case of non metastatic tumors and intermittent hormonotherapy in metastatic tumors. New hormonal drugs in pre and post chemotherapy and bone target drugs opened new therapeutics pathways. From 2010 to 2013, standarts of care of prostate cancer were modified because of results of prospective studies and new therapeutics. They allowed precise treatments for each specific clinical situation. In the future, multidisciplinary treatments for high risk tumors, time of adjuvant treatment and sequencies of new hormonal treatment had to be defined. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

  19. The Healthy Worker Survivor Effect: Target Parameters and Target Populations.

    PubMed

    Brown, Daniel M; Picciotto, Sally; Costello, Sadie; Neophytou, Andreas M; Izano, Monika A; Ferguson, Jacqueline M; Eisen, Ellen A

    2017-07-15

    We offer an in-depth discussion of the time-varying confounding and selection bias mechanisms that give rise to the healthy worker survivor effect (HWSE). In this update of an earlier review, we distinguish between the mechanisms collectively known as the HWSE and the statistical bias that can result. This discussion highlights the importance of identifying both the target parameter and the target population for any research question in occupational epidemiology. Target parameters can correspond to hypothetical workplace interventions; we explore whether these target parameters' true values reflect the etiologic effect of an exposure on an outcome or the potential impact of enforcing an exposure limit in a more realistic setting. If a cohort includes workers hired before the start of follow-up, HWSE mechanisms can limit the transportability of the estimates to other target populations. We summarize recent publications that applied g-methods to control for the HWSE, focusing on their target parameters, target populations, and hypothetical interventions.

  20. Network-based recommendation algorithms: A review

    NASA Astrophysics Data System (ADS)

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

    2016-06-01

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

  1. Arterial Stiffness: Recommendations and Standardization

    PubMed Central

    Townsend, Raymond R.

    2017-01-01

    The use of arterial stiffness measurements in longitudinal cohorts of normal populations, hypertensive patients, diabetic patients, healthy elderly, and patients on hemodialysis have confirmed the value of this important measure of arterial health, and established its complementary role to measures of blood pressure. Its contribution to understanding cardiovascular and mortality risk beyond blood pressure measurements has moved measures of arterial stiffness into the ranks of factors such as elevated cholesterol, diabetes, and left ventricular hypertrophy in considering cardiovascular risk. The recent international collaboration's publication of reference ranges for normal people and those with hypertension, along with the American Heart Association's recent scientific statement on standardizing arterial stiffness measurements are important aspects to consider in future studies employing these valuable methods, particularly as interventions that not only lower blood pressure but improve arterial function are tested in the clinical arena. PMID:28275588

  2. Recommendation advertising method based on behavior retargeting

    NASA Astrophysics Data System (ADS)

    Zhao, Yao; YIN, Xin-Chun; CHEN, Zhi-Min

    2011-10-01

    Online advertising has become an important business in e-commerce. Ad recommended algorithms are the most critical part in recommendation systems. We propose a recommendation advertising method based on behavior retargeting which can avoid leakage click of advertising due to objective reasons and can observe the changes of the user's interest in time. Experiments show that our new method can have a significant effect and can be further to apply to online system.

  3. Uncovering the information core in recommender systems

    NASA Astrophysics Data System (ADS)

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

    2014-08-01

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

  4. Uncovering the information core in recommender systems

    PubMed Central

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

    2014-01-01

    With the rapid growth of the Internet and overwhelming amount of information that people are confronted with, recommender systems have been developed to effectively support users' decision-making process in online systems. So far, much attention has been paid to designing new recommendation algorithms and improving existent ones. However, few works considered the different contributions from different users to the performance of a recommender system. Such studies can help us improve the recommendation efficiency by excluding irrelevant users. In this paper, we argue that in each online system there exists a group of core users who carry most of the information for recommendation. With them, the recommender systems can already generate satisfactory recommendation. Our core user extraction method enables the recommender systems to achieve 90% of the accuracy of the top-L recommendation by taking only 20% of the users into account. A detailed investigation reveals that these core users are not necessarily the large-degree users. Moreover, they tend to select high quality objects and their selections are well diversified. PMID:25142186

  5. Barriers of and Facilitators to Physician Recommendation of Colorectal Cancer Screening

    PubMed Central

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

    2007-01-01

    BACKGROUND Colorectal cancer screening (CRCS) has been demonstrated to be effective and is consistently recommended by clinical practice guidelines. However, only slightly over half of all Americans have ever been screened. Patients cite physician recommendation as the most important motivator of screening. This study explored the barriers of and facilitators to physician recommendation of CRCS. METHODS A 3-component qualitative study to explore the barriers of and facilitators to physician recommendation of CRCS: in-depth, semistructured interviews with 29 purposively sampled, community- and academic-based primary care physicians; chart-stimulated recall, a technique that utilizes patient charts to probe physician recall and provide context about the barriers of and facilitators to physician recommendation of CRCS during actual clinic encounters; and focus groups with 18 academic primary care physicians. Grounded theory techniques of analysis were used. RESULTS All the participating physicians were aware of and recommended CRCS. The overwhelmingly preferred test was colonoscopy. Barriers of physician recommendation of CRCS included patient comorbidities, prior patient refusal of screening, physician forgetfulness, acute care visits, lack of time, and lack of reminder systems and test tracking systems. Facilitators to physician recommendation of CRCS included patient request, patient age 50–59, physician positive attitudes about CRCS, physician prioritization of screening, visits devoted to preventive health, reminders, and incentives. CONCLUSION There are multiple physician, patient, and system barriers to recommending CRCS. Thus, interventions may need to target barriers at multiple levels to successfully increase physician recommendation of CRCS. PMID:17939007

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

    NASA Astrophysics Data System (ADS)

    Felder, R.

    2005-08-01

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

  7. Activation of microRNA-494-targeting Bmi1 and ADAM10 by silibinin ablates cancer stemness and predicts favourable prognostic value in head and neck squamous cell carcinomas

    PubMed Central

    Chang, Yu-Chao; Lai, Yu-Chi; Hu, Fang-Wei; Yu, Cheng-Chia

    2015-01-01

    Tumor initiating cells (TICs) possessing cancer stemness were shown to be enriched after therapy, resulting in the relapse and metastasis of head and neck squamous cell carcinomas (HNC). An effective therapeutic approach suppressing the HNC-TICs would be a potential method to improve the treatments for HNC. We observed that the treatment of silibinin (SB) dose dependently down-regulated the ALDH1 activity, CD133 positivity, stemness signatures expression, self-renewal property, and chemoresistance in ALDH1+CD44+ HNC-TICs. Using miRNA-microarray and mechanistic studies, SB increased the expression of microRNA-494 (miR-494) and both Bmi1 and ADAM10 were identified as the novel targets of miR-494. Moreover, overexpression of miR-494 results in a reduction in cancer stemness. However, knockdown of miR-494 in CD44−ALDH1−non-HNC-TICs enhanced cancer stemness and oncogenicity, while co-knockdown of Bmi1 and ADAM10 effectively reversed these phenomena. Mice model showed that SB treatment by oral gavage to xenograft tumors reduced tumor growth and prolonged the survival time of tumor-bearing mice by activation of miR-494-inhibiting Bmi1/ADAM10 expression. Survival analysis indicated that a miR494highBmi1lowADAM10low phenotype predicted a favourable clinical outcome. We conclude that the inhibition of tumor aggressiveness in HNC-TICs by SB was mediated by up-regulation miR-494, suggesting that SB would be a valuable anti-cancer drug for treatment of HNC. PMID:26090866

  8. Nutrition for Tennis: Practical Recommendations

    PubMed Central

    Ranchordas, Mayur K.; Rogersion, David; Ruddock, Alan; Killer, Sophie C.; Winter, Edward M.

    2013-01-01

    Tennis is a pan-global sport that is played year-round in both hemispheres. This places notable demands on the physical and psychological preparation of players and included in these demands are nutritional and fluid requirements both of training and match- play. Thus, the purpose of this article is to review nutritional recommendations for tennis. Notably, tennis players do not excel in any particular physiological or anthropometric characteristic but are well adapted in all areas which is probably a result of the varied nature of the training demands of tennis match play. Energy expenditures of 30.9 ± 5.5 and 45.3 ± 7.3 kJ·min-1 have been reported in women and men players respectively regardless of court surface. Tennis players should follow a habitually high carbohydrate diet of between 6-10 g·kg-1·d-1 to ensure adequate glycogen stores, with women generally requiring slightly less than men. Protein intake guidelines for tennis players training at a high intensity and duration on a daily basis should be ~1.6 g·kg-1·d-1 and dietary fat intake should not exceed 2 g·kg-1·d-1. Caffeine in doses of 3 mg·kg-1 provides ergogenic benefit when taken before and/or during tennis match play. Depending on environmental conditions, sweat rates of 0.5 to and over 5 L·hr-1 and sodium losses of 0.5 - 1.8 g have been recorded in men and women players. 200 mL of fluid containing electrolytes should be consumed every change-over in mild to moderate temperatures of < 27°C but in temperatures greater than 27°C players should aim for ≤ 400 mL. 30-60 g·hr-1 of carbohydrate should be ingested when match play exceeds 2 hours. Key Points Tennis players should follow a habitually high carbohydrate diet of between 6-10 g·kg-1 to ensure adequate glycogen stores, with women generally requiring slightly less than men. Protein intake guidelines for tennis players training at a high intensity and duration on a daily basis should be ~1.6 g·kg-1·d-1. Dietary fat intake should

  9. Physical activity recommendations: an alternative approach using energy expenditure.

    PubMed

    Mudd, Lanay M; Rafferty, Ann P; Reeves, Mathew J; Pivarnik, James M

    2008-10-01

    Most adults do not meet the American College of Sports Medicine and Centers for Disease Control and Prevention (ACSM/CDC) physical activity recommendations. Even fewer meet the more extreme Institute of Medicine (IOM) physical activity recommendations. Compliance with either recommendation has been conventionally assessed by combining frequencies and durations of self-reported activities. Leisure-time energy expenditure is a cumulative measure of activity that offers an alternative method of defining compliance. To calculate the leisure-time energy expenditure of adults complying with the ACSM/CDC or the IOM physical activity recommendations determined by conventional measures and to reexamine compliance with the IOM recommendation using energy expenditure criteria. National, cross-sectional data from the 2000 Behavioral Risk Factor Surveillance System determined the mode, frequency, and duration of up to two leisure-time activities performed by adults. Four mutually exclusive activity groups (Non-, Low-, ACSM/CDC-, and IOM-Active) were defined on the basis of frequencies and durations of reported activities. Leisure-time energy expenditure (kcal x kg(-1) x wk(-1)) was calculated per respondent. The energy expenditure threshold for meeting the IOM recommendation was calculated as 21 kcal x kg(-1) x wk(-1). Of the 162,669 respondents included in the analyses, 29.9% were Nonactive, whereas 42.3%, 23.3%, and 4.5% were Low-, ACSM/CDC-, and IOM-Active, respectively. Median leisure-time energy expenditure values were 9.0, 27.4, and 63.0 kcal x kg(-1) x wk(-1) for Low-, ACSM/CDC-, and IOM-Active groups, respectively. When using energy expenditure criteria, compliance with the IOM recommendation rose to 27.7% of respondents. Compliance with the IOM physical activity recommendation dramatically increased when assessed by energy expenditure compared with conventional criteria, thereby highlighting the potential bias of conventional methods. A significant proportion of adults

  10. Target assembly

    DOEpatents

    Lewis, Richard A.

    1980-01-01

    A target for a proton beam which is capable of generating neutrons for absorption in a breeding blanket includes a plurality of solid pins formed of a neutron emissive target material disposed parallel to the path of the beam and which are arranged axially in a plurality of layers so that pins in each layer are offset with respect to pins in all other layers, enough layers being used so that each proton in the beam will strike at least one pin with means being provided to cool the pins. For a 300 mA, 1 GeV beam (300 MW), stainless steel pins, 12 inches long and 0.23 inches in diameter are arranged in triangular array in six layers with one sixth of the pins in each layer, the number of pins being such that the entire cross sectional area of the beam is covered by the pins with minimum overlap of pins.

  11. Voyager: Exploratory Analysis via Faceted Browsing of Visualization Recommendations.

    PubMed

    Wongsuphasawat, Kanit; Moritz, Dominik; Anand, Anushka; Mackinlay, Jock; Howe, Bill; Heer, Jeffrey

    2016-01-01

    General visualization tools typically require manual specification of views: analysts must select data variables and then choose which transformations and visual encodings to apply. These decisions often involve both domain and visualization design expertise, and may impose a tedious specification process that impedes exploration. In this paper, we seek to complement manual chart construction with interactive navigation of a gallery of automatically-generated visualizations. We contribute Voyager, a mixed-initiative system that supports faceted browsing of recommended charts chosen according to statistical and perceptual measures. We describe Voyager's architecture, motivating design principles, and methods for generating and interacting with visualization recommendations. In a study comparing Voyager to a manual visualization specification tool, we find that Voyager facilitates exploration of previously unseen data and leads to increased data variable coverage. We then distill design implications for visualization tools, in particular the need to balance rapid exploration and targeted question-answering.

  12. Recommendations for NEAMS Engagement with the NRC: Preliminary Report

    SciTech Connect

    Bernholdt, David E

    2012-06-01

    The vision of the Nuclear Energy Advanced Modeling and Simulation (NEAMS) program is to bring a new generation of analytic tools to the nuclear engineering community in order to facilitate students, faculty, industry and laboratory researchers in investigating advanced reactor and fuel cycle designs. Although primarily targeting at advance nuclear technologies, it is anticipated that these new capabilities will also become interesting and useful to the nuclear regulator Consequently, the NEAMS program needs to engage with the Nuclear Regulatory Commission as the software is being developed to ensure that they are familiar with and ready to respond to this novel approach when the need arises. Through discussions between key NEAMS and NRC staff members, we tentatively recommend annual briefings to the Division of Systems Analysis in the NRC's Office of Nuclear Regulatory Research. However the NEAC subcommittee review of the NEAMS program may yield recommendations that would need to be considered before finalizing this plan.

  13. Factors influencing intentions to use social recommender systems: a social exchange perspective.

    PubMed

    Chang, Tsung-Sheng; Hsiao, Wei-Hung

    2013-05-01

    This study employs the perspective of social exchange theory and seeks to understand users' intentions to use social recommender systems (SRS) through three psychological factors: trust, shared values, and reputation. We use structural equation modeling to analyze 221 valid questionnaires. The results show that trust has a direct positive influence on the intention to use SRS, followed by shared values, whereas reputation has an indirect influence on SRS use. We further discuss specific recommendations concerning these factors for developing SRS.

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

    PubMed

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

    2015-05-01

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

  15. Values in Education and Education in Values.

    ERIC Educational Resources Information Center

    Halstead, J. Mark, Ed.; Taylor, Monica J., Ed.

    The major purpose of this book is to set out some of the key issues and debates relating to the importance of values in education and of education in values. After an introductory chapter about the concept of values and values education, part 1 provides a variety of perspectives on the values that underpin contemporary education. The introduction…

  16. 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...

  17. 77 FR 2257 - Adoption of Recommendations

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-01-17

    ... innovations in e-rulemaking. FOR FURTHER INFORMATION CONTACT: For Recommendations 2011-5 and 2011-8, Emily.... Recommendation 2011-8, ``Agency Innovations in E-Rulemaking,'' addresses how Federal agency rulemaking can be... Standards, Nat'l Sci. & Tech. Council, Exec. Office of the President, Federal Engagement in...

  18. Developing a Standardized Letter of Recommendation

    ERIC Educational Resources Information Center

    Walters, Alyssa M.; Kyllonen, Patrick C.; Plante, Janice W.

    2006-01-01

    The Standardized Letter of Recommendation (SLR) is a Web-based admission tool designed to replace traditional, narrative letters of recommendation with a more systematic and equitable source of information about applicants to institutions of higher education. The SLR includes a rating scale and open-ended response space that prompt evaluators to…

  19. 40 CFR 108.6 - Recommendations.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 40 Protection of Environment 23 2013-07-01 2013-07-01 false Recommendations. 108.6 Section 108.6 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) WATER PROGRAMS EMPLOYEE PROTECTION... Judge shall, based on the record, issue tentative findings of fact and recommendations concerning...

  20. 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...

  1. 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...

  2. Higher Education Funding Recommendations, 1997-98.

    ERIC Educational Resources Information Center

    New Mexico Commission on Higher Education.

    This report summarizes recommendations by New Mexico's Commission on Higher Education for funding the state's two- and four-year colleges in fiscal year 1997-98. Following a preface reviewing the 3-year policy framework and priorities used by the Commission in making its funding recommendations, the first section provides a summary of the…

  3. 12 CFR 263.110 - Recommended decision.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 12 Banks and Banking 4 2013-01-01 2013-01-01 false Recommended decision. 263.110 Section 263.110 Banks and Banking FEDERAL RESERVE SYSTEM (CONTINUED) BOARD OF GOVERNORS OF THE FEDERAL RESERVE SYSTEM... shall file the record of the proceeding on the fee application upon the filing of the recommended...

  4. 33 CFR 62.63 - Recommendations.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ....63 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY AIDS TO NAVIGATION UNITED STATES AIDS TO NAVIGATION SYSTEM Public Participation in the Aids to Navigation System § 62.63 Recommendations. (a) The public may recommend changes to existing aids to navigation, request new aids or...

  5. 33 CFR 62.63 - Recommendations.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ....63 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY AIDS TO NAVIGATION UNITED STATES AIDS TO NAVIGATION SYSTEM Public Participation in the Aids to Navigation System § 62.63 Recommendations. (a) The public may recommend changes to existing aids to navigation, request new aids or...

  6. 33 CFR 62.63 - Recommendations.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ....63 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY AIDS TO NAVIGATION UNITED STATES AIDS TO NAVIGATION SYSTEM Public Participation in the Aids to Navigation System § 62.63 Recommendations. (a) The public may recommend changes to existing aids to navigation, request new aids or...

  7. 33 CFR 62.63 - Recommendations.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ....63 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY AIDS TO NAVIGATION UNITED STATES AIDS TO NAVIGATION SYSTEM Public Participation in the Aids to Navigation System § 62.63 Recommendations. (a) The public may recommend changes to existing aids to navigation, request new aids or...

  8. 33 CFR 62.63 - Recommendations.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ....63 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY AIDS TO NAVIGATION UNITED STATES AIDS TO NAVIGATION SYSTEM Public Participation in the Aids to Navigation System § 62.63 Recommendations. (a) The public may recommend changes to existing aids to navigation, request new aids or...

  9. Vitamin D recommendations for older adults

    USDA-ARS?s Scientific Manuscript database

    This position paper of the International Osteoporosis Foundation makes recommendations for vitamin D nutrition in elderly men and women from an evidence-based perspective. The key recommendations are that the optimal level of 25-hydroxyvitamin D for musculoskeletal health is 75 nmol/L. An intake of ...

  10. Personalized Recommender System for Digital Libraries

    ERIC Educational Resources Information Center

    Omisore, M. O.; Samuel, O. W.

    2014-01-01

    The huge amount of information available online has given rise to personalization and filtering systems. Recommender systems (RS) constitute a specific type of information filtering technique that present items according to user's interests. In this research, a web-based personalized recommender system capable of providing learners with books that…

  11. Culinary Occupations. Instructional Materials Committee Recommendations Report.

    ERIC Educational Resources Information Center

    Louisiana State Technical Resource Center, Natchitoches.

    This resource listing contains those culinary occupations instructional materials given a rating of "highly recommended" or "recommended" by a committee of instructors. Titles are arranged alphabetically by title within each of the following Classification of Instructional Programs (CIP) categories: institutional management;…

  12. Aggregation Trade Offs in Family Based Recommendations

    NASA Astrophysics Data System (ADS)

    Berkovsky, Shlomo; Freyne, Jill; Coombe, Mac

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

  13. Culinary Occupations. Instructional Materials Committee Recommendations Report.

    ERIC Educational Resources Information Center

    Louisiana State Technical Resource Center, Natchitoches.

    This resource listing contains those culinary occupations instructional materials given a rating of "highly recommended" or "recommended" by a committee of instructors. Titles are arranged alphabetically by title within each of the following Classification of Instructional Programs (CIP) categories: institutional management;…

  14. 5 CFR 2638.506 - Director's recommendation.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 5 Administrative Personnel 3 2013-01-01 2013-01-01 false Director's recommendation. 2638.506... Cases Involving Individual Executive Agency Employees § 2638.506 Director's recommendation. (a) Where... of the respondent employee's agency that appropriate disciplinary action be taken. If the respondent...

  15. Global recommendations on physical activity for health

    MedlinePlus

    ... English Français Русский Español Global Strategy on Diet, Physical Activity and Health Menu Diet, Physical Activity & Health Global ... obesity Documents & publications Related links Global recommendations on physical activity for health WHO developed the "Global Recommendations on ...

  16. Statewide Telecommunications Task Force. Report and Recommendations.

    ERIC Educational Resources Information Center

    Florida State Postsecondary Education Planning Commission, Tallahassee.

    This report provides recommendations for a comprehensive telecommunications policy for Florida that focuses the state's technological resources on the accomplishment of specific educational goals. The recommendations are based on a review of the relevant literature, a survey of approximately 950 community college and university faculty, and a…

  17. 12 CFR 308.181 - Recommended decision.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... days after the conclusion of the hearing, whichever is later. The recommended decision shall include written proposed findings and conclusions on the applicant's eligibility and its status as a prevailing... party a copy of the recommended decision, findings, conclusions, and proposed order. ...

  18. 7 CFR 1.420 - Consent recommendation.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 7 Agriculture 1 2013-01-01 2013-01-01 false Consent recommendation. 1.420 Section 1.420 Agriculture Office of the Secretary of Agriculture ADMINISTRATIVE REGULATIONS Rules of Practice Governing... consent recommendation shall be filed with the Hearing Clerk, signed by the parties with appropriate space...

  19. Personalized Recommender System for Digital Libraries

    ERIC Educational Resources Information Center

    Omisore, M. O.; Samuel, O. W.

    2014-01-01

    The huge amount of information available online has given rise to personalization and filtering systems. Recommender systems (RS) constitute a specific type of information filtering technique that present items according to user's interests. In this research, a web-based personalized recommender system capable of providing learners with books that…

  20. Electron capture Q value of {sup 179}Ta

    SciTech Connect

    Hindi, M.M.; Faircloth, B.O.; Kozub, R.L.

    1995-10-01

    There is a discrepancy in the measured electron capture Q value of {sup 179}Ta; from the EC(L)/EC(K) capture ratio of Bisi et al.one obtains Q = 103{plus_minus}6 keV, while the ratio measured by Jopson et al. gives Q = 121 {plus_minus} 7 keV. To resolve this discrepancy we have remeasured the L to K capture ratio. A {sup 179}Ta source was produced by bombarding a natural Hf target with 20-MeV protons from LBL`s 88-inch cyclotron, and, after a suitable delay, extracted radiochemically from the Hf. The L x rays were counted in a planar Ge detector (FWHM = 280 eV at 8 keV) and the K x rays in a well-type NaI detector. From the ratio of L x rays in anti-coincidence with K x rays to those in coincidence with them we deduce a Q value of 111.2 {plus_minus} 1.9 keV. This value is in agreement with the recommended value of 110 {plus_minus} 5 keV found in the latest Evaluated Nuclear Structure Data File.

  1. Unified Synthesis Product (USP) Recommendations

    NASA Astrophysics Data System (ADS)

    Peterson, T. C.

    2009-05-01

    points are reached. 5. Enhance understanding of how society can adapt to climate change in the context of multiple stresses. There is currently limited knowledge about the ability of communities, regions, and sectors to adapt to future climate change. It is essential to improve understanding of how the capacity to adapt to a changing climate might be exercised, and the vulnerabilities to climate change and other environmental stresses that might remain. Results from these efforts would inform future assessments that continue building our understanding of humanity's impacts on climate, and climate's impacts on us. Such assessments will continue to play a role in helping the U.S. respond to changing conditions. A vision for future climate change assessments includes both sustained extensive practitioner and stakeholder involvement, and periodic, targeted, scientifically rigorous reports similar to the CCSP Synthesis and Assessment Products.

  2. 25 CFR 700.119 - Establishment of fair market value.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 25 Indians 2 2012-04-01 2012-04-01 false Establishment of fair market value. 700.119 Section 700... value. (a) General. The Commission shall establish the amount of fair market value to be offered to the... recommendations as to the fair market value of the habitations and/or improvements; or (2) The fair market...

  3. Recommendations for field measurements of aircraft noise

    NASA Technical Reports Server (NTRS)

    Marsh, A. H.

    1982-01-01

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

  4. [The latest in paediatric resuscitation recommendations].

    PubMed

    López-Herce, Jesús; Rodríguez, Antonio; Carrillo, Angel; de Lucas, Nieves; Calvo, Custodio; Civantos, Eva; Suárez, Eva; Pons, Sara; Manrique, Ignacio

    2017-04-01

    Cardiac arrest has a high mortality in children. To improve the performance of cardiopulmonary resuscitation, it is essential to disseminate the international recommendations and the training of health professionals and the general population in resuscitation. This article summarises the 2015 European Paediatric Cardiopulmonary Resuscitation recommendations, which are based on a review of the advances in cardiopulmonary resuscitation and consensus in the science and treatment by the International Council on Resuscitation. The Spanish Paediatric Cardiopulmonary Resuscitation recommendations, developed by the Spanish Group of Paediatric and Neonatal Resuscitation, are an adaptation of the European recommendations, and will be used for training health professionals and the general population in resuscitation. This article highlights the main changes from the previous 2010 recommendations on prevention of cardiac arrest, the diagnosis of cardiac arrest, basic life support, advanced life support and post-resuscitation care, as well as reviewing the algorithms of treatment of basic life support, obstruction of the airway and advanced life support.

  5. Congressional panel makes recommendations on belt safety

    SciTech Connect

    Fiscor, S.

    2007-12-15

    The Mine Improvement and New Emergency Response Act of 2006 (MINER Act) called for a Technical Study Panel to present a review and make recommendations on the use of belt air and the composition and fire retardant properties of belt materials in underground coal mining. In October 2007 the Panel released 20 recommendations publicly. These are presented in the article. Many recommendations encouraged the MSHA to enforce existing laws of maintenance and fire protection or example more vigorously. Maybe the biggest change recommended was that the industry should adopt the Belt Evaluation Laboratory Test (BELT) standard proposed in 1992. Another important recommendation was one that would help eliminate hazards associated with point feeding. 1 photo.

  6. Targetting Teenagers.

    ERIC Educational Resources Information Center

    Bernard van Leer Foundation Newsletter, 1995

    1995-01-01

    This theme issue of the Bernard van Leer Foundation newsletter focuses on the problem of teenage pregnancy and teenage parenthood in developing and developed nations, and examines the problems that teenage mothers face in different societies. It explores societal norms and values related to teenage parenting; the effects of teenage parents on…

  7. Target engagement in lead generation.

    PubMed

    Durham, Timothy B; Blanco, Maria-Jesus

    2015-03-01

    The pharmaceutical industry is currently facing multiple challenges, in particular the low number of new drug approvals in spite of the high level of R&D investment. In order to improve target selection and assess properly the clinical hypothesis, it is important to start building an integrated drug discovery approach during Lead Generation. This should include special emphasis on evaluating target engagement in the target tissue and linking preclinical to clinical readouts. In this review, we would like to illustrate several strategies and technologies for assessing target engagement and the value of its application to medicinal chemistry efforts.

  8. [Vaccination schedule of the Spanish Association of Paediatrics: recommendations 2011].

    PubMed

    Marès Bermúdez, J; van Esso Arbolave, D; Moreno-Pérez, D; Merino Moína, M; Alvarez García, F J; Cilleruelo Ortega, M J; Arístegui Fernández, J; Ortigosa del Castillo, L; Ruiz-Contreras, J; Barrio Corrales, F; González-Hachero, J

    2011-02-01

    The Advisory Committee on Vaccines of the Spanish Paediatric Association updates annually the immunization schedule, taking into account epidemiological data as well as evidence of the effectiveness and efficiency of vaccines. This vaccination schedule includes grades of recommendation. The committee has graded as universal vaccines those that all children should receive, as recommended, those with a profile of universal vaccines of childhood and as are desirable those that all children may receive, but that can be prioritized based on public funding resources and for risk groups, targeting those groups of people in epidemiological situations of risk. The Committee considers as a priority to achieve a common immunization schedule for Spain. The Committee reaffirms the recommendation to include pneumococcal vaccination in the routine vaccination schedule. Vaccination against varicella in the second year of life is an effective strategy and therefore a desirable goal. Given the morbidity and high burden on the health care system, vaccination against rotavirus is recommended for all infants. Due to the current problems of availability of both vaccines, associated with the recent finding of circovirus, the committee urges that rotavirus vaccination is restarted as soon as possible as it is considered a desirable health benefit for all children in our country. The Committee adheres to the recommendations of the National Health Coordination Council in reference to routine vaccination against HPV for all girls aged 11 to 14 years and stresses the need to vaccinate all patients with risk factors for these diseases against influenza and hepatitis A. Finally, it stresses the need to update incomplete immunizations using accelerated immunization schedules.

  9. Vision screening for children 36 to <72 months: recommended practices.

    PubMed

    Cotter, Susan A; Cyert, Lynn A; Miller, Joseph M; Quinn, Graham E

    2015-01-01

    This article provides recommendations for screening children aged 36 to younger than 72 months for eye and visual system disorders. The recommendations were developed by the National Expert Panel to the National Center for Children's Vision and Eye Health, sponsored by Prevent Blindness, and funded by the Maternal and Child Health Bureau of the Health Resources and Services Administration, United States Department of Health and Human Services. The recommendations describe both best and acceptable practice standards. Targeted vision disorders for screening are primarily amblyopia, strabismus, significant refractive error, and associated risk factors. The recommended screening tests are intended for use by lay screeners, nurses, and other personnel who screen children in educational, community, public health, or primary health care settings. Characteristics of children who should be examined by an optometrist or ophthalmologist rather than undergo vision screening are also described. There are two current best practice vision screening methods for children aged 36 to younger than 72 months: (1) monocular visual acuity testing using single HOTV letters or LEA Symbols surrounded by crowding bars at a 5-ft (1.5 m) test distance, with the child responding by either matching or naming, or (2) instrument-based testing using the Retinomax autorefractor or the SureSight Vision Screener with the Vision in Preschoolers Study data software installed (version 2.24 or 2.25 set to minus cylinder form). Using the Plusoptix Photoscreener is acceptable practice, as is adding stereoacuity testing using the PASS (Preschool Assessment of Stereopsis with a Smile) stereotest as a supplemental procedure to visual acuity testing or autorefraction. The National Expert Panel recommends that children aged 36 to younger than 72 months be screened annually (best practice) or at least once (accepted minimum standard) using one of the best practice approaches. Technological updates will be

  10. Vision Screening for Children 36 to <72 Months: Recommended Practices

    PubMed Central

    Cotter, Susan A.; Cyert, Lynn A.; Miller, Joseph M.; Quinn, Graham E.

    2015-01-01

    ABSTRACT Purpose This article provides recommendations for screening children aged 36 to younger than 72 months for eye and visual system disorders. The recommendations were developed by the National Expert Panel to the National Center for Children’s Vision and Eye Health, sponsored by Prevent Blindness, and funded by the Maternal and Child Health Bureau of the Health Resources and Services Administration, United States Department of Health and Human Services. The recommendations describe both best and acceptable practice standards. Targeted vision disorders for screening are primarily amblyopia, strabismus, significant refractive error, and associated risk factors. The recommended screening tests are intended for use by lay screeners, nurses, and other personnel who screen children in educational, community, public health, or primary health care settings. Characteristics of children who should be examined by an optometrist or ophthalmologist rather than undergo vision screening are also described. Results There are two current best practice vision screening methods for children aged 36 to younger than 72 months: (1) monocular visual acuity testing using single HOTV letters or LEA Symbols surrounded by crowding bars at a 5-ft (1.5 m) test distance, with the child responding by either matching or naming, or (2) instrument-based testing using the Retinomax autorefractor or the SureSight Vision Screener with the Vision in Preschoolers Study data software installed (version 2.24 or 2.25 set to minus cylinder form). Using the Plusoptix Photoscreener is acceptable practice, as is adding stereoacuity testing using the PASS (Preschool Assessment of Stereopsis with a Smile) stereotest as a supplemental procedure to visual acuity testing or autorefraction. Conclusions The National Expert Panel recommends that children aged 36 to younger than 72 months be screened annually (best practice) or at least once (accepted minimum standard) using one of the best practice approaches

  11. Accelerator target

    SciTech Connect

    Schlyer, David J.; Ferrieri, Richard A.; Koehler, Conrad

    1999-01-01

    A target includes a body having a depression in a front side for holding a sample for irradiation by a particle beam to produce a radioisotope. Cooling fins are disposed on a backside of the body opposite the depression. A foil is joined to the body front side to cover the depression and sample therein. A perforate grid is joined to the body atop the foil for supporting the foil and for transmitting the particle beam therethrough. A coolant is circulated over the fins to cool the body during the particle beam irradiation of the sample in the depression.

  12. Accelerator target

    DOEpatents

    Schlyer, D.J.; Ferrieri, R.A.; Koehler, C.

    1999-06-29

    A target includes a body having a depression in a front side for holding a sample for irradiation by a particle beam to produce a radioisotope. Cooling fins are disposed on a backside of the body opposite the depression. A foil is joined to the body front side to cover the depression and sample therein. A perforate grid is joined to the body atop the foil for supporting the foil and for transmitting the particle beam therethrough. A coolant is circulated over the fins to cool the body during the particle beam irradiation of the sample in the depression. 5 figs.

  13. Accelerator target

    SciTech Connect

    Schlyer, D.J.; Ferrieri, R.A.; Koehler, C.

    1999-06-29

    A target includes a body having a depression in a front side for holding a sample for irradiation by a particle beam to produce a radioisotope. Cooling fins are disposed on a backside of the body opposite the depression. A foil is joined to the body front side to cover the depression and sample therein. A perforate grid is joined to the body atop the foil for supporting the foil and for transmitting the particle beam therethrough. A coolant is circulated over the fins to cool the body during the particle beam irradiation of the sample in the depression. 5 figs.

  14. Complex-Valued Autoencoders

    PubMed Central

    Baldi, Pierre; Lu, Zhiqin

    2012-01-01

    Autoencoders are unsupervised machine learning circuits, with typically one hidden layer, whose learning goal is to minimize an average distortion measure between inputs and outputs. Linear autoencoders correspond to the special case where only linear transformations between visible and hidden variables are used. While linear autoencoders can be defined over any field, only real-valued linear autoencoders have been studied so far. Here we study complex-valued linear autoencoders where the components of the training vectors and adjustable matrices are defined over the complex field with the L2 norm. We provide simpler and more general proofs that unify the real-valued and complex-valued cases, showing that in both cases the landscape of the error function is invariant under certain groups of transformations. The landscape has no local minima, a family of global minima associated with Principal Component Analysis, and many families of saddle points associated with orthogonal projections onto sub-space spanned by sub-optimal subsets of eigenvectors of the covariance matrix. The theory yields several iterative, convergent, learning algorithms, a clear understanding of the generalization properties of the trained autoencoders, and can equally be applied to the hetero-associative case when external targets are provided. Partial results on deep architecture as well as the differential geometry of autoencoders are also presented. The general framework described here is useful to classify autoencoders and identify general properties that ought to be investigated for each class, illuminating some of the connections between autoencoders, unsupervised learning, clustering, Hebbian learning, and information theory. PMID:22622264

  15. Factors associated with knowledge of personal gestational weight gain recommendations.

    PubMed

    Ledoux, Tracey; Van Den Berg, Patricia; Leung, Patrick; Berens, Pamela D

    2015-08-13

    Excess adiposity (obesity and excess gestational weight gain, GWG) during pregnancy (EADP) increases risk for gestational diabetes, preeclampsia, and child and maternal obesity. Personal GWG goals predict total GWG. Some estimates suggest only 30% of pregnant women have personal GWG goals that are congruent with Institute of Medicine GWG recommendations. The primary purpose of this study was to determine the extent to which perceived pre-pregnancy weight status, healthcare provider advice, knowledge of EADP risks, and value for healthy GWG predicted knowledge of GWG recommendations. The secondary purpose was to determine sources of GWG information among pregnant women. Pregnant women with a confirmed singleton pregnancy completed a one-time survey in obstetric clinic waiting rooms. Logistic regression analysis was used. 246 predominantly African American, low income, overweight/obese women completed surveys. Average age was 25 (SD 5.3) and gestation age ranged from 7 to 40 weeks. Knowledge of pre-pregnancy weight status was the only unique predictor of GWG recommendation knowledge (B = .642, p = .03). The top three sources of GWG information were physicians, internet, and books. The least frequently reported sources of GWG information were other healthcare providers, community programs, and television. In low income diverse overweight/obese pregnant women, accurate pre-pregnancy weight status perception was the only significant unique predictor of knowledge of GWG recommendations. Physicians were the preferred source of GWG information. Clinicians should have frequent, ongoing conversations about weight status with women before, during, and after pregnancy.

  16. Targeting circuits

    PubMed Central

    Rajasethupathy, Priyamvada; Ferenczi, Emily; Deisseroth, Karl

    2017-01-01

    Current optogenetic methodology enables precise inhibition or excitation of neural circuits, spanning timescales as needed from the acute (milliseconds) to the chronic (many days or more), for experimental modulation of network activity and animal behavior. Such broad temporal versatility, unique to optogenetic control, is particularly powerful when combined with brain activity measurements that span both acute and chronic timescales as well. This enables, for instance, the study of adaptive circuit dynamics across the intact brain, and tuning interventions to match activity patterns naturally observed during behavior in the same individual. Although the impact of this approach has been greater on basic research than on clinical translation, it is natural to ask if specific neural circuit activity patterns discovered to be involved in controlling adaptive or maladaptive behaviors could become targets for treatment of neuropsychiatric diseases. Here we consider the landscape of such ideas related to therapeutic targeting of circuit dynamics, taking note of developments not only in optical but also in ultrasonic, magnetic, and thermal methods. We note the recent emergence of first-in-kind optogenetically-guided clinical outcomes, as well as opportunities related to the integration of interventions and readouts spanning diverse circuit-physiology, molecular, and behavioral modalities. PMID:27104976

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

    PubMed Central

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

    2012-01-01

    Background: Informed decision-making approaches to cancer screening emphasise the importance of decisions being determined by individuals' own values and preferences. However, advice from a trusted source may also contribute to autonomous decision-making. This study examined preferences regarding a recommendation from the NHS and information provision in the context of colorectal cancer (CRC) screening. Methods: In face-to-face interviews, a population-based sample of adults across Britain (n=1964; age 50–80 years) indicated their preference between: (1) a strong recommendation to participate in CRC screening, (2) a recommendation alongside advice to make an individual decision, and (3) no recommendation but advice to make an individual decision. Other measures included trust in the NHS and preferences for information on benefits and risks. Results: Most respondents (84%) preferred a recommendation (47% strong recommendation, 37% recommendation plus individual decision-making advice), but the majority also wanted full information on risks (77%) and benefits (78%). Men were more in favour of a recommendation than women (86% vs 81%). Trust in the NHS was high overall, but the minority who expressed low trust were less likely to want a recommendation. Conclusion: Most British adults want full information on risks and benefits of screening but they also want a recommendation from an authoritative source. An ‘expert' view may be an important part of autonomous health decision-making. PMID:23175148

  18. Ocular toxicity of targeted therapies.

    PubMed

    Renouf, Daniel J; Velazquez-Martin, Juan P; Simpson, Rand; Siu, Lillian L; Bedard, Philippe L

    2012-09-10

    Molecularly targeted agents are commonly used in oncology practice, and many new targeted agents are currently being tested in clinical trials. Although these agents are thought to be more specific and less toxic then traditional cytotoxic chemotherapy, they are associated with a variety of toxicities, including ocular toxicity. Many of the molecules targeted by anticancer agents are also expressed in ocular tissues. We reviewed the literature for described ocular toxicities associated with both approved and investigational molecularly targeted agents. Ocular toxicity has been described with numerous approved targeted agents and also seems to be associated with several classes of agents currently being tested in early-phase clinical trials. We discuss the proposed pathogenesis, monitoring guidelines, and management recommendations. It is important for oncologists to be aware of the potential for ocular toxicity, with prompt recognition of symptoms that require referral to an ophthalmologist. Ongoing collaboration between oncologists and ocular disease specialists is critical as the use of molecularly targeted agents continues to expand and novel targeted drug combinations are developed.

  19. 48 CFR 19.505 - Rejecting Small Business Administration recommendations.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

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

  20. 48 CFR 19.505 - Rejecting Small Business Administration recommendations.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

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