Evaluation and Management of Right-Sided Heart Failure: A Scientific Statement From the American Heart Association.

PubMed

Konstam, Marvin A; Kiernan, Michael S; Bernstein, Daniel; Bozkurt, Biykem; Jacob, Miriam; Kapur, Navin K; Kociol, Robb D; Lewis, Eldrin F; Mehra, Mandeep R; Pagani, Francis D; Raval, Amish N; Ward, Carey

2018-05-15

The diverse causes of right-sided heart failure (RHF) include, among others, primary cardiomyopathies with right ventricular (RV) involvement, RV ischemia and infarction, volume loading caused by cardiac lesions associated with congenital heart disease and valvular pathologies, and pressure loading resulting from pulmonic stenosis or pulmonary hypertension from a variety of causes, including left-sided heart disease. Progressive RV dysfunction in these disease states is associated with increased morbidity and mortality. The purpose of this scientific statement is to provide guidance on the assessment and management of RHF. The writing group used systematic literature reviews, published translational and clinical studies, clinical practice guidelines, and expert opinion/statements to summarize existing evidence and to identify areas of inadequacy requiring future research. The panel reviewed the most relevant adult medical literature excluding routine laboratory tests using MEDLINE, EMBASE, and Web of Science through September 2017. The document is organized and classified according to the American Heart Association to provide specific suggestions, considerations, or reference to contemporary clinical practice recommendations. Chronic RHF is associated with decreased exercise tolerance, poor functional capacity, decreased cardiac output and progressive end-organ damage (caused by a combination of end-organ venous congestion and underperfusion), and cachexia resulting from poor absorption of nutrients, as well as a systemic proinflammatory state. It is the principal cause of death in patients with pulmonary arterial hypertension. Similarly, acute RHF is associated with hemodynamic instability and is the primary cause of death in patients presenting with massive pulmonary embolism, RV myocardial infarction, and postcardiotomy shock associated with cardiac surgery. Functional assessment of the right side of the heart can be hindered by its complex geometry. Multiple hemodynamic and biochemical markers are associated with worsening RHF and can serve to guide clinical assessment and therapeutic decision making. Pharmacological and mechanical interventions targeting isolated acute and chronic RHF have not been well investigated. Specific therapies promoting stabilization and recovery of RV function are lacking. RHF is a complex syndrome including diverse causes, pathways, and pathological processes. In this scientific statement, we review the causes and epidemiology of RV dysfunction and the pathophysiology of acute and chronic RHF and provide guidance for the management of the associated conditions leading to and caused by RHF. © 2018 American Heart Association, Inc.

Optimizing the management of acute coronary syndromes in sub-Saharan Africa: A statement from the AFRICARDIO 2015 Consensus Team.

PubMed

Kakou-Guikahue, Maurice; N'Guetta, Roland; Anzouan-Kacou, Jean-Baptiste; Kramoh, Euloge; N'Dori, Raymond; Ba, Serigne Abdou; Diao, Maboury; Sarr, Moustapha; Kane, Abdoul; Kane, Adama; Damorou, Findide; Balde, Dadhi; Diarra, Mamadou Bocary; Djiddou, Mohamed; Kimbally-Kaki, Gisèle; Zabsonre, Patrice; Toure, Ibrahim Ali; Houénassi, Martin; Gamra, Habib; Chajai, Bachir; Gerardin, Benoit; Pillière, Rémy; Aubry, Pierre; Iliou, Marie-Christine; Isnard, Richard; Leprince, Pascal; Cottin, Yves; Bertrand, Edmond; Juillière, Yves; Monsuez, Jean-Jacques

2016-01-01

Whereas the coronary artery disease death rate has declined in high-income countries, the incidence of acute coronary syndromes (ACS) is increasing in sub-Saharan Africa, where their management remains a challenge. To propose a consensus statement to optimize management of ACS in sub-Saharan Africa on the basis of realistic considerations. The AFRICARDIO-2 conference (Yamoussoukro, May 2015) reviewed the ongoing features of ACS in 10 sub-Saharan countries (Benin, Burkina-Faso, Congo-Brazzaville, Guinea, Ivory Coast, Mali, Mauritania, Niger, Senegal, Togo), and analysed whether improvements in strategies and policies may be expected using readily available healthcare facilities. The outcome of patients with ACS is affected by clearly identified factors, including: delay to reaching first medical contact, achieving effective hospital transportation, increased time from symptom onset to reperfusion therapy, limited primary emergency facilities (especially in rural areas) and emergency medical service (EMS) prehospital management, and hence limited numbers of patients eligible for myocardial reperfusion (thrombolytic therapy and/or percutaneous coronary intervention [PCI]). With only five catheterization laboratories in the 10 participating countries, PCI rates are very low. However, in recent years, catheterization laboratories have been built in referral cardiology departments in large African towns (Abidjan and Dakar). Improvements in patient care and outcomes should target limited but selected objectives: increasing awareness and recognition of ACS symptoms; education of rural-based healthcare professionals; and developing and managing a network between first-line healthcare facilities in rural areas or small cities, emergency rooms in larger towns, the EMS, hospital-based cardiology departments and catheterization laboratories. Faced with the increasing prevalence of ACS in sub-Saharan Africa, healthcare policies should be developed to overcome the multiple shortcomings blunting optimal management. European and/or North American management guidelines should be adapted to African specificities. Our consensus statement aims to optimize patient management on the basis of realistic considerations, given the healthcare facilities, organizations and few cardiology teams that are available. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Oral toxicity management in head and neck cancer patients treated with chemotherapy and radiation: Dental pathologies and osteoradionecrosis (Part 1) literature review and consensus statement.

PubMed

Buglione, Michela; Cavagnini, Roberta; Di Rosario, Federico; Sottocornola, Lara; Maddalo, Marta; Vassalli, Lucia; Grisanti, Salvatore; Salgarello, Stefano; Orlandi, Ester; Paganelli, Corrado; Majorana, Alessandra; Gastaldi, Giorgio; Bossi, Paolo; Berruti, Alfredo; Pavanato, Giovanni; Nicolai, Piero; Maroldi, Roberto; Barasch, Andrei; Russi, Elvio G; Raber-Durlacher, Judith; Murphy, Barbara; Magrini, Stefano M

2016-01-01

Radiotherapy alone or in combination with chemotherapy and/or surgery is the typical treatment for head and neck cancer patients. Acute side effects (such as oral mucositis, dermatitis, salivary changes, taste alterations, etc.), and late toxicities in particular (such as osteo-radionecrosis, hypo-salivation and xerostomia, trismus, radiation caries etc.), are often debilitating. These effects tend to be underestimated and insufficiently addressed in the medical community. A multidisciplinary group of head and neck cancer specialists met in Milan with the aim of reaching a consensus on clinical definitions and management of these toxicities. The Delphi Appropriateness method was used for developing the consensus, and external experts evaluated the conclusions. This paper contains 10 clusters of statements about the clinical definitions and management of head and neck cancer treatment sequels (dental pathologies and osteo-radionecroses) that reached consensus, and offers a review of the literature about these topics. The review was split into two parts: the first part dealt with dental pathologies and osteo-radionecroses (10 clusters of statements), whereas this second part deals with trismus and xerostomia. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Management of Acute Diarrheal Illness During Deployment: A Deployment Health Guideline and Expert Panel Report.

PubMed

Riddle, Mark S; Martin, Gregory J; Murray, Clinton K; Burgess, Timothy H; Connor, Patrick; Mancuso, James D; Schnaubelt, Elizabeth R; Ballard, Timothy P; Fraser, Jamie; Tribble, David R

2017-09-01

Acute diarrheal illness during deployment causes significant morbidity and loss of duty days. Effective and timely treatment is needed to reduce individual, unit, and health system performance impacts. This critical appraisal of the literature, as part of the development of expert consensus guidelines, asked several key questions related to self-care and healthcare-seeking behavior, antibiotics for self-treatment of travelers' diarrhea, what antibiotics/regimens should be considered for treatment of acute watery diarrhea and febrile diarrhea and/or dysentery, and when and what laboratory diagnostics should be used to support management of deployment-related travelers' diarrhea. Studies of acute diarrhea management in military and other travelers were assessed for relevance and quality. On the basis of this critical appraisal, guideline recommendations were developed and graded by the Expert Panel using good standards in clinical guideline development methodology. New definitions for defining the severity of diarrhea during deployment were established. A total of 13 graded recommendations on the topics of prophylaxis, therapy and diagnosis, and follow-up were developed. In addition, four non-graded consensus-based statements were adopted. Successful management of acute diarrheal illness during deployment requires action at the provider, population, and commander levels. Strong evidence supports that single-dose antimicrobial therapy is effective in most cases of moderate to severe acute diarrheal illness during deployment. Further studies are needed to address gaps in available knowledge regarding optimal therapies for treatment, prevention, and laboratory testing of acute diarrheal illness. Reprint & Copyright © 2017 Association of Military Surgeons of the U.S.

A national survey on the pediatric cardiologist's clinical approach for patients with Kawasaki disease.

PubMed

Kahwaji, I Y; Connuck, D M; Tafari, N; Dahdah, N S

2002-01-01

In 1994, the American Heart Association (AHA) published the most recent guidelines for long-term cardiovascular management of Kawasaki disease. Since then, recent publications have shed new light on different diagnostic, prognostic, and management issues. We sought the opinion of pediatric cardiologists practicing in U.S. fellowship programs on the subject by means of a multiple-choice survey. Two questions addressed therapy in the acute phase, each preceded by a statement from related literature. Ten duplicate questions addressed the long-term cardiovascular management in five sets of paired questions; each question was first given in reminiscence of a clinical situation and then preceded by a statement from particular publications representative of new information that has become available since the publication of the 1994 AHA guidelines. All questions were provided in the same mailing. Replies were received from 97 participants practicing at 29 institutions. For the acute illness, 21% of respondents do not use high-dose aspirin, and 50% support reassessment of current guidelines. Universal intravenous immune globulin (IVIG) administration is followed by 97%, among whom 20% agree that evaluation of selection criteria is needed. For long-term management, 60-75% advocate regular follow-up of risk level I patients, and 80% favor periodic follow-up, with stress imaging (34-40%), for risk level II. For risk level IV more respondents favor stress echocardiography as opposed to nuclear imaging, in consonance with recent literature. For risk levels III and IV, 36-40% perform coronary angiography on a regular basis, whereas 60% do so when coronary symptoms are present or when stress imaging suggests myocardial ischemia. Finally, 19-25% of respondents do not routinely advise healthy lifestyle to patients free of coronary artery lesions. In conclusion, the guidelines for conventional therapy in the acute phase and long-term cardiovascular management need to be revised.

The "Acute coronary syndromes: consensus recommendations for translating knowledge into action" position statement is based on a false premise.

PubMed

Forge, Brett H

2010-06-21

Recent National Heart Foundation of Australia (NHFA) guidelines for management of acute coronary syndromes (ACS) recommend increasing the rates of early invasive management of ACS and providing equal access for all Australians to percutaneous coronary intervention (PCI) facilities. For patients with ACS managed in regional hospitals without PCI facilities, review of the evidence does not show unequivocal benefit of early routine PCI over selective PCI for patients with non-ST-segment-elevation ACS or ST-elevation myocardial infarction. The current pattern of transfer based on the NHFA guidelines is expensive and disruptive of patient care, as well as undermining regional health care services. Further increase in transfer rates and increases in PCI facilities would divert resources away from supporting the regional infrastructure needed to provide evidence-based therapies, without any evidence that lives would be saved.

From words to action: visibility of management in supporting interdisciplinary team working in an acute rehabilitative geriatric hospital.

PubMed

Buttigieg, Sandra C; Cassar, Vincent; Scully, Judy W

2013-01-01

The following case study aims to explore management's, health professionals' and patients' experiences on the extent to which there is visibility of management support in achieving effective interdisciplinary team working, which is explicitly declared in the mission statement of a 60-bed acute rehabilitative geriatric hospital in Malta. A total of 21 semi-structured interviews were conducted with the above-mentioned key stakeholders. Three main distinct yet interdependent themes emerged as a result of thematic analysis: "managing a team-friendly hospital", "interdisciplinary team components", and "interdisciplinary team processes". The findings show that visibility of management support and its alignment with the process and content levels of interdisciplinary teamwork are key to integrated care for acute rehabilitative geriatric patients. The emerging phenomena may not be reproducible in a different context; although many of the emerging themes could be comfortably matched with the existing literature. The implications are geared towards raising the consciousness and conscientiousness of good practice in interdisciplinary teamwork in hospitals, as well as in emphasizing organizational and management support as crucial factors for team-based organizations. Interdisciplinary teamwork in acute rehabilitative geriatrics provides optimal quality and integrated health care delivery with the aim that the older persons are successfully discharged back to the community. The authors draw on solid theoretical frameworks--the complexity theory, team effectiveness model and the social identity theory--to support their major finding, namely the alignment of organizational and management support with intra-team factors at the process and content level.

Canadian Cardiovascular Society position statement on the management of thoracic aortic disease.

PubMed

Boodhwani, Munir; Andelfinger, Gregor; Leipsic, Jonathon; Lindsay, Thomas; McMurtry, M Sean; Therrien, Judith; Siu, Samuel C

2014-06-01

This Canadian Cardiovascular Society position statement aims to provide succinct perspectives on key issues in the management of thoracic aortic disease (TAD). This document is not a comprehensive overview of TAD and important elements of the epidemiology, presentation, diagnosis, and management of acute aortic syndromes are deliberately not discussed; readers are referred to the 2010 guidelines published by the American Heart Association, American College of Cardiology, American Association for Thoracic Surgery, and other stakeholders. Rather, this document is a practical guide for clinicians managing adult patients with TAD. Topics covered include size thresholds for surgical intervention, emerging therapies, imaging modalities, medical and lifestyle management, and genetics of TAD. The primary panel consisted of experts from a variety of disciplines that are essential for comprehensive management of TAD patients. The methodology involved a focused literature review with an emphasis on updates since 2010 and the use of Grading of Recommendations Assessment, Development, and Evaluation methodology to arrive at specific recommendations. The final document then underwent review by a secondary panel. This document aims to provide recommendations for most patients and situations. However, the ultimate judgement regarding the management of any individual patients should be made by their health care team. Copyright © 2014 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

An official American Thoracic Society/European Respiratory Society statement: key concepts and advances in pulmonary rehabilitation.

PubMed

Spruit, Martijn A; Singh, Sally J; Garvey, Chris; ZuWallack, Richard; Nici, Linda; Rochester, Carolyn; Hill, Kylie; Holland, Anne E; Lareau, Suzanne C; Man, William D-C; Pitta, Fabio; Sewell, Louise; Raskin, Jonathan; Bourbeau, Jean; Crouch, Rebecca; Franssen, Frits M E; Casaburi, Richard; Vercoulen, Jan H; Vogiatzis, Ioannis; Gosselink, Rik; Clini, Enrico M; Effing, Tanja W; Maltais, François; van der Palen, Job; Troosters, Thierry; Janssen, Daisy J A; Collins, Eileen; Garcia-Aymerich, Judith; Brooks, Dina; Fahy, Bonnie F; Puhan, Milo A; Hoogendoorn, Martine; Garrod, Rachel; Schols, Annemie M W J; Carlin, Brian; Benzo, Roberto; Meek, Paula; Morgan, Mike; Rutten-van Mölken, Maureen P M H; Ries, Andrew L; Make, Barry; Goldstein, Roger S; Dowson, Claire A; Brozek, Jan L; Donner, Claudio F; Wouters, Emiel F M

2013-10-15

Pulmonary rehabilitation is recognized as a core component of the management of individuals with chronic respiratory disease. Since the 2006 American Thoracic Society (ATS)/European Respiratory Society (ERS) Statement on Pulmonary Rehabilitation, there has been considerable growth in our knowledge of its efficacy and scope. The purpose of this Statement is to update the 2006 document, including a new definition of pulmonary rehabilitation and highlighting key concepts and major advances in the field. A multidisciplinary committee of experts representing the ATS Pulmonary Rehabilitation Assembly and the ERS Scientific Group 01.02, "Rehabilitation and Chronic Care," determined the overall scope of this update through group consensus. Focused literature reviews in key topic areas were conducted by committee members with relevant clinical and scientific expertise. The final content of this Statement was agreed on by all members. An updated definition of pulmonary rehabilitation is proposed. New data are presented on the science and application of pulmonary rehabilitation, including its effectiveness in acutely ill individuals with chronic obstructive pulmonary disease, and in individuals with other chronic respiratory diseases. The important role of pulmonary rehabilitation in chronic disease management is highlighted. In addition, the role of health behavior change in optimizing and maintaining benefits is discussed. The considerable growth in the science and application of pulmonary rehabilitation since 2006 adds further support for its efficacy in a wide range of individuals with chronic respiratory disease.

Acute Myocardial Infarction in Women: A Scientific Statement From the American Heart Association.

PubMed

Mehta, Laxmi S; Beckie, Theresa M; DeVon, Holli A; Grines, Cindy L; Krumholz, Harlan M; Johnson, Michelle N; Lindley, Kathryn J; Vaccarino, Viola; Wang, Tracy Y; Watson, Karol E; Wenger, Nanette K

2016-03-01

Cardiovascular disease is the leading cause of mortality in American women. Since 1984, the annual cardiovascular disease mortality rate has remained greater for women than men; however, over the last decade, there have been marked reductions in cardiovascular disease mortality in women. The dramatic decline in mortality rates for women is attributed partly to an increase in awareness, a greater focus on women and cardiovascular disease risk, and the increased application of evidence-based treatments for established coronary heart disease. This is the first scientific statement from the American Heart Association on acute myocardial infarction in women. Sex-specific differences exist in the presentation, pathophysiological mechanisms, and outcomes in patients with acute myocardial infarction. This statement provides a comprehensive review of the current evidence of the clinical presentation, pathophysiology, treatment, and outcomes of women with acute myocardial infarction. © 2016 American Heart Association, Inc.

Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific Association for the Study of the Liver (APASL) 2014.

PubMed

Sarin, Shiv Kumar; Kedarisetty, Chandan Kumar; Abbas, Zaigham; Amarapurkar, Deepak; Bihari, Chhagan; Chan, Albert C; Chawla, Yogesh Kumar; Dokmeci, A Kadir; Garg, Hitendra; Ghazinyan, Hasmik; Hamid, Saeed; Kim, Dong Joon; Komolmit, Piyawat; Lata, Suman; Lee, Guan Huei; Lesmana, Laurentius A; Mahtab, Mamun; Maiwall, Rakhi; Moreau, Richard; Ning, Qin; Pamecha, Viniyendra; Payawal, Diana Alcantara; Rastogi, Archana; Rahman, Salimur; Rela, Mohamed; Saraya, Anoop; Samuel, Didier; Saraswat, Vivek; Shah, Samir; Shiha, Gamal; Sharma, Brajesh Chander; Sharma, Manoj Kumar; Sharma, Kapil; Butt, Amna Subhan; Tan, Soek Siam; Vashishtha, Chitranshu; Wani, Zeeshan Ahmed; Yuen, Man-Fung; Yokosuka, Osamu

2014-10-01

The first consensus report of the working party of the Asian Pacific Association for the Study of the Liver (APASL) set up in 2004 on acute-on-chronic liver failure (ACLF) was published in 2009. Due to the rapid advancements in the knowledge and available information, a consortium of members from countries across Asia Pacific, "APASL ACLF Research Consortium (AARC)," was formed in 2012. A large cohort of retrospective and prospective data of ACLF patients was collated and followed up in this data base. The current ACLF definition was reassessed based on the new AARC data base. These initiatives were concluded on a 2-day meeting in February 2014 at New Delhi and led to the development of the final AARC consensus. Only those statements which were based on the evidence and were unanimously recommended were accepted. These statements were circulated again to all the experts and subsequently presented at the annual conference of the APASL at Brisbane, on March 14, 2014. The suggestions from the delegates were analyzed by the expert panel, and the modifications in the consensus were made. The final consensus and guidelines document was prepared. After detailed deliberations and data analysis, the original proposed definition was found to withstand the test of time and identify a homogenous group of patients presenting with liver failure. Based on the AARC data, liver failure grading, and its impact on the "Golden therapeutic Window," extra-hepatic organ failure and development of sepsis were analyzed. New management options including the algorithms for the management of coagulation disorders, renal replacement therapy, sepsis, variceal bleed, antivirals, and criteria for liver transplantation for ACLF patients were proposed. The final consensus statements along with the relevant background information are presented here.

Consensus statement on the anticipation and prevention of acute postoperative pain: multidisciplinary RADAR approach.

PubMed

Vickers, A; Bali, S; Baxter, A; Bruce, G; England, J; Heafield, R; Langford, R; Makin, R; Power, I; Trim, J

2009-10-01

There has been considerable investment in efforts to improve postoperative pain management, including the introduction of acute pain teams. There have also been a number of guidelines published on postoperative pain management and there is widespread agreement on how pain should be practically managed. Despite these advances, there is no apparent improvement in the number of patients experiencing moderately severe or extreme pain after surgery. This highlights significant scope for improvement in acute postoperative pain management. In January 2009, a multidisciplinary UK expert panel met to define and agree a practical framework to encourage implementation of the numerous guidelines and fundamentals of pain management at a local level. The panel recognised that to do this, there was a need to organise the information and guidelines into a simplified, accessible and easy-to-implement system based on their practical clinical experience. Given the volume of literature in this area, the Chair recommended that key international guidelines from professional bodies should be distributed and then reviewed during the meeting to form the basis of the framework. Consensus was reached by unanimous agreement of all ten participants. This report provides a framework for the key themes, including consensus recommendations based upon practical experience agreed during the meeting, with the aim of consolidating the key guidelines to provide a fundamental framework which is simple to teach and implement in all areas. Key priorities that emerged were: Responsibility, Anticipation, Discussion, Assessment and Response. This formed the basis of RADAR, a novel framework to help pain specialists educate the wider care team on understanding and prioritising the management of acute pain. Acute postoperative pain can be more effectively managed if it is prioritised and anticipated by a well-informed care team who are educated with regard to appropriate analgesic options and understand what the long-term benefits of pain relief are. The principles of RADAR provide structure to help with training and implementation of good practice, to achieve effective postoperative pain management.

Endovascular therapy of acute ischemic stroke: report of the Standards of Practice Committee of the Society of NeuroInterventional Surgery.

PubMed

Blackham, K A; Meyers, P M; Abruzzo, T A; Albuquerque, F C; Alberquerque, F C; Fiorella, D; Fraser, J; Frei, D; Gandhi, C D; Heck, D V; Hirsch, J A; Hsu, D P; Hussain, M Shazam; Jayaraman, M; Narayanan, S; Prestigiacomo, C; Sunshine, J L

2012-03-01

To summarize and classify the evidence for the use of endovascular techniques in the treatment of patients with acute ischemic stroke. Recommendations previously published by the American Heart Association (AHA) (Guidelines for the early management of adults with ischemic stroke (Circulation 2007) and Scientific statement indications for the performance of intracranial endovascular neurointerventional procedures (Circulation 2009)) were vetted and used as a foundation for the current process. Building on this foundation, a critical review of the literature was performed to evaluate evidence supporting the endovascular treatment of acute ischemic stroke. The assessment was based on guidelines for evidence based medicine proposed by the Stroke Council of the AHA and the University of Oxford, Centre for Evidence Based Medicine (CEBM). Procedural safety, technical efficacy and impact on patient outcomes were specifically examined.

Current state of knowledge on Takotsubo syndrome: a Position Statement from the Taskforce on Takotsubo Syndrome of the Heart Failure Association of the European Society of Cardiology.

PubMed

Lyon, Alexander R; Bossone, Eduardo; Schneider, Birke; Sechtem, Udo; Citro, Rodolfo; Underwood, S Richard; Sheppard, Mary N; Figtree, Gemma A; Parodi, Guido; Akashi, Yoshihiro J; Ruschitzka, Frank; Filippatos, Gerasimos; Mebazaa, Alexandre; Omerovic, Elmir

2016-01-01

Takotsubo syndrome is an acute reversible heart failure syndrome that is increasingly recognized in modern cardiology practice. This Position Statement from the European Society of Cardiology Heart Failure Association provides a comprehensive review of the various clinical and pathophysiological facets of Takotsubo syndrome, including nomenclature, definition, and diagnosis, primary and secondary clinical subtypes, anatomical variants, triggers, epidemiology, pathophysiology, clinical presentation, complications, prognosis, clinical investigations, and treatment approaches. Novel structured approaches to diagnosis, risk stratification, and management are presented, with new algorithms to aid decision-making by practising clinicians. These also cover more complex areas (e.g. uncertain diagnosis and delayed presentation) and the management of complex cases with ongoing symptoms after recovery, recurrent episodes, or spontaneous presentation. The unmet needs and future directions for research in this syndrome are also discussed. © 2015 The Authors European Journal of Heart Failure © 2015 European Society of Cardiology.

Evaluation of knowledge resources for public health reporting logic: Implications for knowledge authoring and management

PubMed Central

Staes, Catherine J; Altamore, Rita; Han, EunGyoung; Mottice, Susan; Rajeev, Deepthi; Bradshaw, Richard

2011-01-01

To control disease, laboratories and providers are required to report conditions to public health authorities. Reporting logic is defined in a variety of resources, but there is no single resource available for reporters to access the list of reportable events and computable reporting logic for any jurisdiction. In order to develop evidence-based requirements for authoring such knowledge, we evaluated reporting logic in the Council of State and Territorial Epidemiologist (CSTE) position statements to assess its readiness for automated systems and identify features that should be considered when designing an authoring interface; we evaluated codes in the Reportable Condition Mapping Tables (RCMT) relative to the nationally-defined reporting logic, and described the high level business processes and knowledge required to support laboratory-based public health reporting. We focused on logic for viral hepatitis. We found that CSTE tabular logic was unnecessarily complex (sufficient conditions superseded necessary and optional conditions) and was sometimes true for more than one reportable event: we uncovered major overlap in the logic between acute and chronic hepatitis B (52%), acute and Past and Present hepatitis C (90%). We found that the RCMT includes codes for all hepatitis criteria, but includes addition codes for tests not included in the criteria. The proportion of hepatitis variant-related codes included in RCMT that correspond to a criterion in the hepatitis-related position statements varied between hepatitis A (36%), acute hepatitis B (16%), chronic hepatitis B (64%), acute hepatitis C (96%), and past and present hepatitis C (96%). Public health epidemiologists have the need to communicate parameters other than just the name of a disease or organism that should be reported, such as the status and specimen sources. Existing knowledge resources should be integrated, harmonized and made computable. Our findings identified functionality that should be provided by future knowledge management systems to support epidemiologists as they communicate reporting rules for their jurisdiction. PMID:23569619

Current Perspective on the Use of Opioids in Perioperative Medicine: An Evidence-Based Literature Review, National Survey of 70,000 Physicians, and Multidisciplinary Clinical Appraisal.

PubMed

Jahr, Jonathan S; Bergese, Sergio D; Sheth, Ketan R; Bernthal, Nicholas M; Ho, Hung S; Stoicea, Nicoleta; Apfel, Christian C

2017-08-16

Opioids represent an important analgesic option for physicians managing acute pain in surgical patients. Opioid management is not without its drawbacks, however, and current trends suggest that opioids might be overused in the United States. An expert panel was convened to conduct a clinical appraisal regarding the use of opioids in the perioperative setting. The clinical appraisal consisted of the review, presentation, and assessment of current published evidence as it relates to the statement "Opioids are not overused in the United States, even though opioid adjunct therapy achieves greater pain control with less risk." The authors' evaluation of this statement was also compared with the results of a national survey of surgeons and anesthesiologists in the United States. We report the presented literature and proceedings of the panel discussion. The national survey revealed a wide range of opinions regarding opioid overuse in the United States. Current published evidence provides support for the efficacy of opioid therapy in surgical patients; however, it is not sufficient to conclude unequivocally that opioids are-or are not-overused in the management of acute surgical pain in the United States. Opioids remain a key component of multimodal perioperative analgesia, and strategic opioid use based on clinical considerations and patient-specific needs represents an opportunity to support improved postoperative outcomes and satisfaction. Future studies should focus on identifying optimal procedure-specific and patient-centered approaches to multimodal perioperative analgesia. © 2017 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association.

PubMed

Powers, William J; Rabinstein, Alejandro A; Ackerson, Teri; Adeoye, Opeolu M; Bambakidis, Nicholas C; Becker, Kyra; Biller, José; Brown, Michael; Demaerschalk, Bart M; Hoh, Brian; Jauch, Edward C; Kidwell, Chelsea S; Leslie-Mazwi, Thabele M; Ovbiagele, Bruce; Scott, Phillip A; Sheth, Kevin N; Southerland, Andrew M; Summers, Deborah V; Tirschwell, David L

2018-03-01

The purpose of these guidelines is to provide an up-to-date comprehensive set of recommendations for clinicians caring for adult patients with acute arterial ischemic stroke in a single document. The intended audiences are prehospital care providers, physicians, allied health professionals, and hospital administrators. These guidelines supersede the 2013 guidelines and subsequent updates. Members of the writing group were appointed by the American Heart Association Stroke Council's Scientific Statements Oversight Committee, representing various areas of medical expertise. Strict adherence to the American Heart Association conflict of interest policy was maintained. Members were not allowed to participate in discussions or to vote on topics relevant to their relations with industry. The members of the writing group unanimously approved all recommendations except when relations with industry precluded members voting. Prerelease review of the draft guideline was performed by 4 expert peer reviewers and by the members of the Stroke Council's Scientific Statements Oversight Committee and Stroke Council Leadership Committee. These guidelines use the American College of Cardiology/American Heart Association 2015 Class of Recommendations and Levels of Evidence and the new American Heart Association guidelines format. These guidelines detail prehospital care, urgent and emergency evaluation and treatment with intravenous and intra-arterial therapies, and in-hospital management, including secondary prevention measures that are appropriately instituted within the first 2 weeks. The guidelines support the overarching concept of stroke systems of care in both the prehospital and hospital settings. These guidelines are based on the best evidence currently available. In many instances, however, only limited data exist demonstrating the urgent need for continued research on treatment of acute ischemic stroke. © 2018 American Heart Association, Inc.

AICPA allows low-cost options for compiled financial statements.

PubMed

Reinstein, Alan; Luecke, Randall W

2002-02-01

The AICPA Accounting and Review Services Committee's (ARSC) SSARS No. 8, Amendment to Statement on Standards for Accounting and Review Services No. 1, Compilation and Review of Financial Statements, issued in October 2000, allows financial managers to provide plain-paper, compiled financial statements for the exclusive use of management. Such financial statements were disallowed in 1979 when the AICPA issued SSARS No. 1, Compilation and Review of Financial Statements. With the issuance of SSARS No. 8, financial managers can prepare plain-paper, compiled financial statements when third parties are not expected to rely on the financial statements, management acknowledges such restrictions in writing, and management acknowledges its primary responsibility for the adequacy of the financial statements.

Contemporary management of acute right ventricular failure: a statement from the Heart Failure Association and the Working Group on Pulmonary Circulation and Right Ventricular Function of the European Society of Cardiology.

PubMed

Harjola, Veli-Pekka; Mebazaa, Alexandre; Čelutkienė, Jelena; Bettex, Dominique; Bueno, Hector; Chioncel, Ovidiu; Crespo-Leiro, Maria G; Falk, Volkmar; Filippatos, Gerasimos; Gibbs, Simon; Leite-Moreira, Adelino; Lassus, Johan; Masip, Josep; Mueller, Christian; Mullens, Wilfried; Naeije, Robert; Nordegraaf, Anton Vonk; Parissis, John; Riley, Jillian P; Ristic, Arsen; Rosano, Giuseppe; Rudiger, Alain; Ruschitzka, Frank; Seferovic, Petar; Sztrymf, Benjamin; Vieillard-Baron, Antoine; Yilmaz, Mehmet Birhan; Konstantinides, Stavros

2016-03-01

Acute right ventricular (RV) failure is a complex clinical syndrome that results from many causes. Research efforts have disproportionately focused on the failing left ventricle, but recently the need has been recognized to achieve a more comprehensive understanding of RV anatomy, physiology, and pathophysiology, and of management approaches. Right ventricular mechanics and function are altered in the setting of either pressure overload or volume overload. Failure may also result from a primary reduction of myocardial contractility owing to ischaemia, cardiomyopathy, or arrhythmia. Dysfunction leads to impaired RV filling and increased right atrial pressures. As dysfunction progresses to overt RV failure, the RV chamber becomes more spherical and tricuspid regurgitation is aggravated, a cascade leading to increasing venous congestion. Ventricular interdependence results in impaired left ventricular filling, a decrease in left ventricular stroke volume, and ultimately low cardiac output and cardiogenic shock. Identification and treatment of the underlying cause of RV failure, such as acute pulmonary embolism, acute respiratory distress syndrome, acute decompensation of chronic pulmonary hypertension, RV infarction, or arrhythmia, is the primary management strategy. Judicious fluid management, use of inotropes and vasopressors, assist devices, and a strategy focusing on RV protection for mechanical ventilation if required all play a role in the clinical care of these patients. Future research should aim to address the remaining areas of uncertainty which result from the complexity of RV haemodynamics and lack of conclusive evidence regarding RV-specific treatment approaches. © 2016 The Authors European Journal of Heart Failure © 2016 European Society of Cardiology.

ANMCO-SIMEU Consensus Document: in-hospital management of patients presenting with chest pain.

PubMed

Zuin, Guerrino; Parato, Vito Maurizio; Groff, Paolo; Gulizia, Michele Massimo; Di Lenarda, Andrea; Cassin, Matteo; Cibinel, Gian Alfonso; Del Pinto, Maurizio; Di Tano, Giuseppe; Nardi, Federico; Rossini, Roberta; Ruggieri, Maria Pia; Ruggiero, Enrico; Scotto di Uccio, Fortunato; Valente, Serafina

2017-05-01

Chest pain is a common general practice presentation that requires careful diagnostic assessment because of its diverse and potentially serious causes. However, the evaluation of acute chest pain remains challenging, despite many new insights over the past two decades. The percentage of patients presenting to the emergency departments because of acute chest pain appears to be increasing. Nowadays, there are two essential chest pain-related issues: (i) the missed diagnoses of acute coronary syndromes with a poor short-term prognosis; and (ii) the increasing percentage of hospitalizations of low-risk cases. It is well known that hospitalization of a low-risk chest pain patient can lead to unnecessary tests and procedures, with an increasing trend of complications and burden of costs. Therefore, the significantly reduced financial resources of healthcare systems induce physicians and administrators to improve the efficiency of care protocols for patients with acute chest pain. Despite the efforts of the Scientific Societies in producing statements on this topic, in Italy there is still a significant difference between emergency physicians and cardiologists in managing patients with chest pain. For this reason, the aim of the present consensus document is double: first, to review the evidence-based efficacy and utility of various diagnostic tools, and, second, to delineate the critical pathways (describing key steps) that need to be implemented in order to standardize the management of chest pain patients, making a correct diagnosis and treatment as uniform as possible across the entire country.

ANMCO-SIMEU Consensus Document: in-hospital management of patients presenting with chest pain

PubMed Central

Zuin, Guerrino; Groff, Paolo; Gulizia, Michele Massimo; Di Lenarda, Andrea; Cassin, Matteo; Cibinel, Gian Alfonso; Del Pinto, Maurizio; Di Tano, Giuseppe; Nardi, Federico; Rossini, Roberta; Ruggieri, Maria Pia; Ruggiero, Enrico; Scotto di Uccio, Fortunato; Valente, Serafina

2017-01-01

Abstract Chest pain is a common general practice presentation that requires careful diagnostic assessment because of its diverse and potentially serious causes. However, the evaluation of acute chest pain remains challenging, despite many new insights over the past two decades. The percentage of patients presenting to the emergency departments because of acute chest pain appears to be increasing. Nowadays, there are two essential chest pain-related issues: (i) the missed diagnoses of acute coronary syndromes with a poor short-term prognosis; and (ii) the increasing percentage of hospitalizations of low-risk cases. It is well known that hospitalization of a low-risk chest pain patient can lead to unnecessary tests and procedures, with an increasing trend of complications and burden of costs. Therefore, the significantly reduced financial resources of healthcare systems induce physicians and administrators to improve the efficiency of care protocols for patients with acute chest pain. Despite the efforts of the Scientific Societies in producing statements on this topic, in Italy there is still a significant difference between emergency physicians and cardiologists in managing patients with chest pain. For this reason, the aim of the present consensus document is double: first, to review the evidence-based efficacy and utility of various diagnostic tools, and, second, to delineate the critical pathways (describing key steps) that need to be implemented in order to standardize the management of chest pain patients, making a correct diagnosis and treatment as uniform as possible across the entire country. PMID:28751843

[ANMCO/SIMEU Consensus document: In-hospital management of patients presenting with chest pain].

PubMed

Zuin, Guerrino; Parato, Vito Maurizio; Groff, Paolo; Gulizia, Michele Massimo; Di Lenarda, Andrea; Cassin, Matteo; Cibinel, Gian Alfonso; Del Pinto, Maurizio; Di Tano, Giuseppe; Nardi, Federico; Rossini, Roberta; Ruggieri, Maria Pia; Ruggiero, Enrico; Scotto Di Uccio, Fortunato; Valente, Serafina

2016-06-01

Chest pain is a common general practice presentation that requires careful diagnostic assessment because of its diverse and potentially serious causes. However, the evaluation of acute chest pain remains challenging, despite many new insights over the past two decades. The percentage of patients presenting to the emergency departments because of acute chest pain appears to be increasing. Nowadays, there are two essential chest pain-related issues: 1) the missed diagnoses of acute coronary syndromes with a poor short-term prognosis; 2) the increasing percentage of hospitalizations of low-risk cases.It is well known that hospitalization of a low-risk chest pain patient can lead to unnecessary tests and procedures, with an increasing trend of complications and burden of costs. Therefore, the significantly reduced financial resources of healthcare systems induce physicians and administrators to improve the efficiency of care protocols for patients with acute chest pain. Despite the efforts of the Scientific Societies in producing statements on this topic, in Italy there is still a significant difference between emergency physicians and cardiologists in managing patients with chest pain. For this reason, the aim of the present consensus document is double: first, to review the evidence-based efficacy and utility of various diagnostic tools, and, second, to delineate the critical pathways (describing key steps) that need to be implemented in order to standardize the management of chest pain patients, making a correct diagnosis and treatment as uniform as possible across the entire country.

76 FR 50494 - Water Resources Management Plan/Environmental Impact Statement, Mojave National Preserve, San...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-15

... Resources Management Plan/Environmental Impact Statement, Mojave National Preserve, San Bernardino County... Resources Management Plan/Environmental Impact Statement for Mojave National Preserve. SUMMARY: Pursuant to... preparing a Water Resources Management Plan/Environmental Impact Statement (WRMP/EIS). This plan is intended...

Global Initiative for Chronic Obstructive Lung Disease strategy for the diagnosis, management and prevention of chronic obstructive pulmonary disease: an Asia-Pacific perspective.

PubMed

2005-01-01

Chronic obstructive pulmonary disease (COPD) is a major public health problem and its prevalence and mortality are increasing throughout the world, including the Asia-Pacific region. To arrest these worldwide trends, the Global Initiative for Chronic Obstructive Lung Disease (GOLD) Expert Panel's global strategy for the diagnosis, management, and prevention of COPD was published in 2001. Based on recently published clinical trials, the GOLD statement was updated in 2003. The Asia-Pacific COPD Roundtable Group, a taskforce of expert respirologists from the Asia-Pacific region, has recently formulated a consensus statement on implementation of the GOLD strategy for COPD in the Asia-Pacific region. The key issues identified by the COPD Roundtable Group for comment are: (i) where there is no access to spirometry, diagnosis of COPD could be suspected on the basis of history, symptoms and physical signs; (ii) inhaled bronchodilators are the preferred regular treatment for COPD in the region, but oral bronchodilators may be considered if the cost of inhaled bronchodilators is a barrier to treatment; (iii) the use of a Metered Dose Inhaler with spacer in place of a nebulizer is recommended in the treatment of acute airflow obstruction in patients with COPD; (iv) influenza vaccination is recommended for all patients with COPD in communities where there is a high likelihood of Severe Acute Respiratory Syndrome; and (v) simplified pulmonary rehabilitation programmes should be established in areas where comprehensive programmes are unavailable. Physical exercise training and education on smoking cessation should be core elements of any rehabilitation program. In summary, the COPD Roundtable Group supports implementation of the GOLD strategy for the diagnosis, management and prevention of COPD in the Asia-Pacific region, subject to the additions and modifications to the guidelines suggested above.

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016.

PubMed

Rhodes, Andrew; Evans, Laura E; Alhazzani, Waleed; Levy, Mitchell M; Antonelli, Massimo; Ferrer, Ricard; Kumar, Anand; Sevransky, Jonathan E; Sprung, Charles L; Nunnally, Mark E; Rochwerg, Bram; Rubenfeld, Gordon D; Angus, Derek C; Annane, Djillali; Beale, Richard J; Bellinghan, Geoffrey J; Bernard, Gordon R; Chiche, Jean-Daniel; Coopersmith, Craig; De Backer, Daniel P; French, Craig J; Fujishima, Seitaro; Gerlach, Herwig; Hidalgo, Jorge Luis; Hollenberg, Steven M; Jones, Alan E; Karnad, Dilip R; Kleinpell, Ruth M; Koh, Younsuk; Lisboa, Thiago Costa; Machado, Flavia R; Marini, John J; Marshall, John C; Mazuski, John E; McIntyre, Lauralyn A; McLean, Anthony S; Mehta, Sangeeta; Moreno, Rui P; Myburgh, John; Navalesi, Paolo; Nishida, Osamu; Osborn, Tiffany M; Perner, Anders; Plunkett, Colleen M; Ranieri, Marco; Schorr, Christa A; Seckel, Maureen A; Seymour, Christopher W; Shieh, Lisa; Shukri, Khalid A; Simpson, Steven Q; Singer, Mervyn; Thompson, B Taylor; Townsend, Sean R; Van der Poll, Thomas; Vincent, Jean-Louis; Wiersinga, W Joost; Zimmerman, Janice L; Dellinger, R Phillip

2017-03-01

To provide an update to "Surviving Sepsis Campaign Guidelines for Management of Sepsis and Septic Shock: 2012". A consensus committee of 55 international experts representing 25 international organizations was convened. Nominal groups were assembled at key international meetings (for those committee members attending the conference). A formal conflict-of-interest (COI) policy was developed at the onset of the process and enforced throughout. A stand-alone meeting was held for all panel members in December 2015. Teleconferences and electronic-based discussion among subgroups and among the entire committee served as an integral part of the development. The panel consisted of five sections: hemodynamics, infection, adjunctive therapies, metabolic, and ventilation. Population, intervention, comparison, and outcomes (PICO) questions were reviewed and updated as needed, and evidence profiles were generated. Each subgroup generated a list of questions, searched for best available evidence, and then followed the principles of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system to assess the quality of evidence from high to very low, and to formulate recommendations as strong or weak, or best practice statement when applicable. The Surviving Sepsis Guideline panel provided 93 statements on early management and resuscitation of patients with sepsis or septic shock. Overall, 32 were strong recommendations, 39 were weak recommendations, and 18 were best-practice statements. No recommendation was provided for four questions. Substantial agreement exists among a large cohort of international experts regarding many strong recommendations for the best care of patients with sepsis. Although a significant number of aspects of care have relatively weak support, evidence-based recommendations regarding the acute management of sepsis and septic shock are the foundation of improved outcomes for these critically ill patients with high mortality.

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016.

PubMed

Rhodes, Andrew; Evans, Laura E; Alhazzani, Waleed; Levy, Mitchell M; Antonelli, Massimo; Ferrer, Ricard; Kumar, Anand; Sevransky, Jonathan E; Sprung, Charles L; Nunnally, Mark E; Rochwerg, Bram; Rubenfeld, Gordon D; Angus, Derek C; Annane, Djillali; Beale, Richard J; Bellinghan, Geoffrey J; Bernard, Gordon R; Chiche, Jean-Daniel; Coopersmith, Craig; De Backer, Daniel P; French, Craig J; Fujishima, Seitaro; Gerlach, Herwig; Hidalgo, Jorge Luis; Hollenberg, Steven M; Jones, Alan E; Karnad, Dilip R; Kleinpell, Ruth M; Koh, Younsuck; Lisboa, Thiago Costa; Machado, Flavia R; Marini, John J; Marshall, John C; Mazuski, John E; McIntyre, Lauralyn A; McLean, Anthony S; Mehta, Sangeeta; Moreno, Rui P; Myburgh, John; Navalesi, Paolo; Nishida, Osamu; Osborn, Tiffany M; Perner, Anders; Plunkett, Colleen M; Ranieri, Marco; Schorr, Christa A; Seckel, Maureen A; Seymour, Christopher W; Shieh, Lisa; Shukri, Khalid A; Simpson, Steven Q; Singer, Mervyn; Thompson, B Taylor; Townsend, Sean R; Van der Poll, Thomas; Vincent, Jean-Louis; Wiersinga, W Joost; Zimmerman, Janice L; Dellinger, R Phillip

2017-03-01

To provide an update to "Surviving Sepsis Campaign Guidelines for Management of Sepsis and Septic Shock: 2012." A consensus committee of 55 international experts representing 25 international organizations was convened. Nominal groups were assembled at key international meetings (for those committee members attending the conference). A formal conflict-of-interest (COI) policy was developed at the onset of the process and enforced throughout. A stand-alone meeting was held for all panel members in December 2015. Teleconferences and electronic-based discussion among subgroups and among the entire committee served as an integral part of the development. The panel consisted of five sections: hemodynamics, infection, adjunctive therapies, metabolic, and ventilation. Population, intervention, comparison, and outcomes (PICO) questions were reviewed and updated as needed, and evidence profiles were generated. Each subgroup generated a list of questions, searched for best available evidence, and then followed the principles of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system to assess the quality of evidence from high to very low, and to formulate recommendations as strong or weak, or best practice statement when applicable. The Surviving Sepsis Guideline panel provided 93 statements on early management and resuscitation of patients with sepsis or septic shock. Overall, 32 were strong recommendations, 39 were weak recommendations, and 18 were best-practice statements. No recommendation was provided for four questions. Substantial agreement exists among a large cohort of international experts regarding many strong recommendations for the best care of patients with sepsis. Although a significant number of aspects of care have relatively weak support, evidence-based recommendations regarding the acute management of sepsis and septic shock are the foundation of improved outcomes for these critically ill patients with high mortality.

17 CFR 239.15A - Form N-1A, registration statement of open-end management investment companies.

Code of Federal Regulations, 2010 CFR

2010-04-01

... statement of open-end management investment companies. 239.15A Section 239.15A Commodity and Securities... Registration Statements § 239.15A Form N-1A, registration statement of open-end management investment companies... management investment companies other than separate accounts of insurance companies registered under the...

5 CFR 297.307 - Statement of disagreement.

Code of Federal Regulations, 2010 CFR

2010-01-01

... Section 297.307 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS PRIVACY... concise statement of disagreement. Such a statement should be filed with the appropriate system manager... system manager should provide a copy of the statement of disagreement to any individual or agency to whom...

5 CFR 297.307 - Statement of disagreement.

Code of Federal Regulations, 2012 CFR

2012-01-01

... Section 297.307 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS PRIVACY... concise statement of disagreement. Such a statement should be filed with the appropriate system manager... system manager should provide a copy of the statement of disagreement to any individual or agency to whom...

Mechanical thrombectomy in acute ischemic stroke: Consensus statement by ESO-Karolinska Stroke Update 2014/2015, supported by ESO, ESMINT, ESNR and EAN.

PubMed

Wahlgren, Nils; Moreira, Tiago; Michel, Patrik; Steiner, Thorsten; Jansen, Olav; Cognard, Christophe; Mattle, Heinrich P; van Zwam, Wim; Holmin, Staffan; Tatlisumak, Turgut; Petersson, Jesper; Caso, Valeria; Hacke, Werner; Mazighi, Mikael; Arnold, Marcel; Fischer, Urs; Szikora, Istvan; Pierot, Laurent; Fiehler, Jens; Gralla, Jan; Fazekas, Franz; Lees, Kennedy R

2016-01-01

The original version of this consensus statement on mechanical thrombectomy was approved at the European Stroke Organisation (ESO)-Karolinska Stroke Update conference in Stockholm, 16-18 November 2014. The statement has later, during 2015, been updated with new clinical trials data in accordance with a decision made at the conference. Revisions have been made at a face-to-face meeting during the ESO Winter School in Berne in February, through email exchanges and the final version has then been approved by each society. The recommendations are identical to the original version with evidence level upgraded by 20 February 2015 and confirmed by 15 May 2015. The purpose of the ESO-Karolinska Stroke Update meetings is to provide updates on recent stroke therapy research and to discuss how the results may be implemented into clinical routine. Selected topics are discussed at consensus sessions, for which a consensus statement is prepared and discussed by the participants at the meeting. The statements are advisory to the ESO guidelines committee. This consensus statement includes recommendations on mechanical thrombectomy after acute stroke. The statement is supported by ESO, European Society of Minimally Invasive Neurological Therapy (ESMINT), European Society of Neuroradiology (ESNR), and European Academy of Neurology (EAN). © 2016 World Stroke Organization.

Cholecystectomy vs. percutaneous cholecystostomy for the management of critically ill patients with acute cholecystitis: a protocol for a systematic review.

PubMed

Ambe, Peter C; Kaptanis, Sarantos; Papadakis, Marios; Weber, Sebastian A; Zirngibl, Hubert

2015-05-30

Acute cholecystitis is a common diagnosis. However, the heterogeneity of presentation makes it difficult to standardize management. Although surgery is the mainstay of treatment, critically ill patients have been managed via percutaneous cholecystostomy. However, the role of percutaneous cholecystostomy in the management of such patients has not been clearly established. This systematic review will compare the outcomes of critically ill patients with acute cholecystitis managed with percutaneous cholecystostomy to those of similar patients managed with cholecystectomy. Systematic searches will be conducted across relevant health databases including the Cochrane Library, Cumulative Index of Nursing and Allied Health Literature (CINAHL), MEDLINE, Embase, and Scopus using the following keywords: (acute cholecystitis OR severe cholecystitis OR cholecystitis) AND (cholecystectomy OR laparoscopic cholecystectomy OR open cholecystectomy) AND (Cholecystostomy OR percutaneous cholecystectomy OR gallbladder drain OR gallbladder tube OR transhepatic gallbladder drain OR transhepatic gallbladder tube OR cholecystostomy tube). The reference lists of eligible articles will be hand searched. Articles from 2000-2014 will be identified using the key terms "acute cholecystitis, cholecystectomy, and percutaneous cholecystostomy". Studies including both interventions will be included. Relevant data will be extracted from eligible studies using a specially designed data extraction sheet. The Newcastle-Ottawa scale will be used to assess the quality of non-randomized studies. Central tendencies will be reported in terms of means and standard deviations where necessary, and risk ratios will be calculated where possible. All calculations will be performed with a 95 % confidence interval. Furthermore, the Fisher's exact test will be used for the calculation of significance, which will be set at p < 0.05. Pooled estimates will be presented after consideration of both clinical and methodological heterogeneity of included studies. Both interventions would be compared with regard to in-hospital mortality, 30-day mortality, procedure-dependent complications, re-intervention, length of intensive care unit (ICU) stay, length of hospital stay, re-admission, and cost of treatment. The review will be reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. This systematic review aims at identifying and evaluating the clinical value of percutaneous cholecystostomy in the management of critically ill patients with acute cholecystitis. PROSPERO CRD42015016205.

2015 American Heart Association/American Stroke Association Focused Update of the 2013 Guidelines for the Early Management of Patients With Acute Ischemic Stroke Regarding Endovascular Treatment: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association.

PubMed

Powers, William J; Derdeyn, Colin P; Biller, José; Coffey, Christopher S; Hoh, Brian L; Jauch, Edward C; Johnston, Karen C; Johnston, S Claiborne; Khalessi, Alexander A; Kidwell, Chelsea S; Meschia, James F; Ovbiagele, Bruce; Yavagal, Dileep R

2015-10-01

The aim of this guideline is to provide a focused update of the current recommendations for the endovascular treatment of acute ischemic stroke. When there is overlap, the recommendations made here supersede those of previous guidelines. This focused update analyzes results from 8 randomized, clinical trials of endovascular treatment and other relevant data published since 2013. It is not intended to be a complete literature review from the date of the previous guideline publication but rather to include pivotal new evidence that justifies changes in current recommendations. Members of the writing committee were appointed by the American Heart Association/American Stroke Association Stroke Council's Scientific Statement Oversight Committee and the American Heart Association/American Stroke Association Manuscript Oversight Committee. Strict adherence to the American Heart Association conflict of interest policy was maintained throughout the consensus process. Recommendations follow the American Heart Association/American Stroke Association methods of classifying the level of certainty of the treatment effect and the class of evidence. Prerelease review of the draft guideline was performed by 6 expert peer reviewers and by the members of the Stroke Council Scientific Statement Oversight Committee and Stroke Council Leadership Committee. Evidence-based guidelines are presented for the selection of patients with acute ischemic stroke for endovascular treatment, for the endovascular procedure, and for systems of care to facilitate endovascular treatment. Certain endovascular procedures have been demonstrated to provide clinical benefit in selected patients with acute ischemic stroke. Systems of care should be organized to facilitate the delivery of this care. © 2015 American Heart Association, Inc.

Relevance of mission statements in Flemish not-for-profit healthcare organizations.

PubMed

Vandijck, Dominique; Desmidt, Sebastian; Buelens, Marc

2007-03-01

The aims of the study were to determine: (1) which components managers of Flemish not-for-profit healthcare organizations chose to incorporate in their mission statement, (2) how satisfied managers of Flemish not-for-profit healthcare organizations are with the formulation of various mission statement components and (3) if the managers of Flemish not-for-profit healthcare organizations subscribe the presumed positive relationship between mission statements and organizational performance. To address these research questions, a questionnaire was send to a convenience sample of Flemish not-for-profit healthcare managers and to a control group. The results indicate that Flemish not-for-profit healthcare managers do discriminate and differentiate between mission statement components and that they are not equally satisfied with the articulation of every component. Furthermore, Flemish not-for-profit healthcare managers do support the assumption that a well-written mission statement can produce a host of benefits. The mission statement is considered as an energy source, a guide in decision-making and to influence the managers' behaviour.

77 FR 14568 - Environmental Impact Statement for Proposed General Management Plan, Pinnacles National Monument...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-12

...] Environmental Impact Statement for Proposed General Management Plan, Pinnacles National Monument, San Benito and... Environmental Impact Statement. SUMMARY: The National Park Service is terminating the preparation of an Environmental Impact Statement (EIS) for the General Management Plan, Pinnacles National Monument, California. A...

Carotid artery stenting versus no stenting assisting thrombectomy for acute ischaemic stroke: protocol for a systematic review of randomised clinical trials with meta-analyses and trial sequential analyses.

PubMed

Steglich-Arnholm, Henrik; Holtmannspötter, Markus; Gluud, Christian; Krieger, Derk Wolfgang

2016-12-01

In patients with intracranial large vessel arterial occlusion, ipsilateral extracranial carotid artery occlusions or near-occlusions pose a significant hurdle in endovascular management of acute ischaemic stroke. Stenting of the carotid lesion may be beneficial in this situation to provide a stable access for introducing catheters through the carotid lesion into the intracranial vasculature and the target occlusion. Furthermore, carotid stenting may ensure ample blood flow for wash-out of clot material and reperfusion of the ischaemic penumbral tissue. However, antiplatelet therapy administered to prevent stent thrombosis and sudden increase in blood flow after reopening of the carotid lesion may increase the risk for intracranial haemorrhagic complications. This review aims to assess the benefits and harms of carotid stenting vs. no stenting assisting thrombectomy for acute ischaemic stroke. International and regional electronic databases will be searched to identify eligible randomised clinical trials. To identify further published, unpublished, or on-going and planned trials searches of Google Scholar, Worldwide Food and Drug Administrations, Worldwide Medicines Agencies, company homepages, reference lists, conference proceedings, and the Science Citation Index cited reference search index will be conducted. Manufacturers of relevant interventional equipment, authors, colleagues, and researchers active in the field will be contacted. No language restrictions will be applied to these searches. Randomised clinical trials will be included for assessing benefits and harms and quasi-randomised studies, and observational studies will be included for assessing harms of the intervention. Meta-analyses will be performed according to the recommendations of the Cochrane Handbook for Systematic Reviews of Interventions, and Trial Sequential Analyses will be conducted to control the risk of random errors and prevent premature statements of superiority of the experimental or control intervention or premature statement of futility. The quality of the evidence will be evaluated with the Grading of Recommendations Assessment, Development, and Evaluation. This systematic review of carotid stenting in endovascular management of acute ischaemic stroke in patients with concomitant extracranial carotid lesions and intracranial embolism will assess benefits and harms of this intervention and assesses whether carotid stenting should be encouraged or avoided in acute ischaemic stroke and identify targets for further research. PROSPERO CRD42016033346.

Nutritional Considerations in Pediatric Pancreatitis: A Position Paper from the NASPGHAN Pancreas Committee, ESPGHAN Pancreas Working Group.

PubMed

Abu-El-Haija, Maisam; Uc, Aliye; Werlin, Steven L; Freeman, A Jay; Georgieva, Miglena; Pavkov, Danijela Jojkić -; Kalnins, Daina; Kochavi, Brigitte; Koot, Bart G P; Van Biervliet, Stephanie; Walkowiak, Jaroslaw; Wilschanski, Michael; Morinville, Veronique D

2018-05-08

Wide variations exist in how physicians manage the nutritional aspects of children affected by acute pancreatitis (AP), acute recurrent pancreatitis (ARP) and chronic (CP) pancreatitis. Better consensus for optimal management is needed. This consensus statement on nutrition in pediatric pancreatic diseases was developed through a joint ESPGHAN-NASPGHAN working group that performed an evidence-based search of the literature on nutrition in AP, ARP, and CP with a focus on pediatrics. The literature was summarized, quality of evidence reviewed, and expert recommendations developed. The authorship met to discuss the evidence and statements. Voting on recommendations occurred over two rounds based on feedback. A consensus of at least 75% was required to approve a recommendation. Areas requiring further research were identified. The literature on nutrition in pediatric pancreatitis is limited. Children with mild AP benefit from starting an early nutritional regimen in the course of the attack. Early nutrition should be attempted in severe AP when possible; enteral nutrition is preferred over parenteral nutrition. Children with ARP are likely to tolerate and benefit from a regular diet. Children with CP need ongoing assessment for growth and nutritional deficiencies, exocrine and endocrine insufficiencies. This document presents the first authoritative recommendations on nutritional considerations in pediatric pancreatitis. Future research should address the gaps in knowledge particularly relating to optimal nutrition for AP in children, role of diet or dietary supplements on recurrent attacks of pancreatitis and pain episodes, monitoring practices to detect early growth and nutritional deficiencies in CP and identifying risk factors that predispose children to these deficiencies.

Consensus on surgical aspects of managing osteomyelitis in the diabetic foot

PubMed Central

Allahabadi, Sachin; Haroun, Kareem B.; Musher, Daniel M.; Lipsky, Benjamin A.; Barshes, Neal R.

2016-01-01

Background The aim of this study was to develop consensus statements that may help share or even establish ‘best practices’ in the surgical aspects of managing diabetic foot osteomyelitis (DFO) that can be applied in appropriate clinical situations pending the publication of more high-quality data. Methods We asked 14 panelists with expertise in DFO management to participate. Delphi methodology was used to develop consensus statements. First, a questionnaire elicited practices and beliefs concerning various aspects of the surgical management of DFO. Thereafter, we constructed 63 statements for analysis and, using a nine-point Likert scale, asked the panelists to indicate the extent to which they agreed or disagreed with the statements. We defined consensus as a mean score of greater than 7.0. Results The panelists reached consensus on 38 items after three rounds. Among these, seven provide guidance on initial diagnosis of DFO and selection of patients for surgical management. Another 15 statements provide guidance on specific aspects of operative management, including the timing of operations and the type of specimens to be obtained. Ten statements provide guidance on postoperative management, including wound closure and offloading, and six statements summarize the panelists’ agreement on general principles for surgical management of DFO. Conclusions Consensus statement on the perioperative management of DFO were formed with an expert panel comprised of a variety of surgical specialties. We believe these statements may serve as ‘best practice’ guidelines until properly performed studies provide more robust evidence to support or refute specific surgical management steps in DFO. PMID:27414481

National Collegiate Athletic Association Division I athletic trainers' concussion-management practice patterns.

PubMed

Kelly, Kassandra C; Jordan, Erin M; Joyner, A Barry; Burdette, G Trey; Buckley, Thomas A

2014-01-01

A cornerstone of the recent consensus statements on concussion is a multifaceted concussion-assessment program at baseline and postinjury and when tracking recovery. Earlier studies of athletic trainers' (ATs') practice patterns found limited use of multifaceted protocols; however, these authors typically grouped diverse athletic training settings together. To (1) describe the concussion-management practice patterns of National Collegiate Athletic Association (NCAA) Division I ATs, (2) compare these practice patterns to earlier studies, and (3) objectively characterize the clinical examination. Cross-sectional study. Online survey. A total of 610 ATs from NCAA Division I institutions, for a response rate of 34.4%. The survey had 3 subsections: demographic questions related to the participant's experiences, concussion-assessment practice patterns, and concussion-recovery and return-to-participation practice patterns. Specific practice-pattern questions addressed balance, cognitive and mental status, neuropsychological testing, and self-reported symptoms. Finally, specific components of the clinical examination were examined. We identified high rates of multifaceted assessments (i.e., assessments using at least 3 techniques) during testing at baseline (71.2%), acute concussion assessment (79.2%), and return to participation (66.9%). The specific techniques used are provided along with their adherence with evidence-based practice findings. Respondents endorsed a diverse array of clinical examination techniques that often overlapped objective concussion-assessment protocols or were likely used to rule out associated potential conditions. Respondents were cognizant of the Third International Consensus Statement, the National Athletic Trainers' Association position statement, and the revised NCAA Sports Medicine Handbook recommendations. Athletic trainers in NCAA Division I demonstrated widespread use of multifaceted concussion-assessment techniques and appeared compliant with recent consensus statements and the NCAA Sports Medicine Handbook.

41 CFR 105-64.407 - How do I file a Statement of Disagreement?

Code of Federal Regulations, 2012 CFR

2012-01-01

... Statement of Disagreement? You may file a Statement of Disagreement with the system manager within 30 days... inaccurate, irrelevant, untimely, or incomplete. The system manager will file the statement with your record... 41 Public Contracts and Property Management 3 2012-01-01 2012-01-01 false How do I file a...

17 CFR 274.13 - Form N-8B-3, registration statement of unincorporated management investment companies currently...

Code of Federal Regulations, 2010 CFR

2010-04-01

... statement of unincorporated management investment companies currently issuing periodic payment plan...-8B-3, registration statement of unincorporated management investment companies currently issuing..., pursuant to section 8(b) of the Investment Company Act of 1940, by unincorporated management investment...

77 FR 33237 - Saline Valley Warm Springs Management Plan/Environmental Impact Statement, Death Valley National...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-05

... Valley Warm Springs Management Plan/Environmental Impact Statement, Death Valley National Park, Inyo... an Environmental Impact Statement for the Saline Valley Warm Springs Management Plan, Death Valley... analysis process for the Saline Valley Warm Springs Management Plan for Death Valley [[Page 33238...

78 FR 13376 - Chronic Wasting Disease Management Plan/Environmental Impact Statement, Shenandoah National Park

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-27

...] Chronic Wasting Disease Management Plan/Environmental Impact Statement, Shenandoah National Park AGENCY... National Park Service (NPS) is preparing a Chronic Wasting Disease Management Plan and Environmental Impact Statement (CWD Management Plan/EIS) for Shenandoah National Park, Virginia. Action is needed at this time...

78 FR 47410 - General Management Plan, Draft Environmental Impact Statement, Gateway National Recreation Area...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-05

...] General Management Plan, Draft Environmental Impact Statement, Gateway National Recreation Area, New... (NPS) is releasing a Draft Environmental Impact Statement (DEIS) for the General Management Plan (GMP... alternatives to guide the management of the site over the next 20 years. The NPS preferred alternative...

76 FR 56220 - Draft Environmental Impact Statement for General Management Plan for Golden Gate National...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-12

... Environmental Impact Statement for General Management Plan for Golden Gate National Recreation Area and Muir... Management Plan for Golden Gate National Recreation Area and Muir Woods National Monument. SUMMARY: In accord... Environmental Impact Statement (Draft EIS) for the updating the General Management Plan (GMP) for Golden Gate...

78 FR 5490 - Draft Environmental Impact Statement for Tuolumne Wild and Scenic River Comprehensive Management...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-01-25

... Environmental Impact Statement for Tuolumne Wild and Scenic River Comprehensive Management Plan, Yosemite... Statement (DEIS) for the proposed Tuolumne Wild and Scenic River Comprehensive Management Plan (TRPCMP). The...), and will provide long-term guidance for management of the 54 miles of the Tuolumne River that flows...

76 FR 35009 - Draft Oil and Gas Management Plan/Environmental Impact Statement for Big South Fork National...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-15

... DEPARTMENT OF THE INTERIOR National Park Service [5130-0400-NZM] Draft Oil and Gas Management Plan... Management Plan/ Environmental Impact Statement for Big South Fork National River and Recreation Area and... gas management plan/environmental impact statement (OGMP/DEIS) for the proposed Big South Fork...

The Insertion and Management of External Ventricular Drains: An Evidence-Based Consensus Statement : A Statement for Healthcare Professionals from the Neurocritical Care Society.

PubMed

Fried, Herbert I; Nathan, Barnett R; Rowe, A Shaun; Zabramski, Joseph M; Andaluz, Norberto; Bhimraj, Adarsh; Guanci, Mary McKenna; Seder, David B; Singh, Jeffrey M

2016-02-01

External ventricular drains (EVDs) are commonly placed to monitor intracranial pressure and manage acute hydrocephalus in patients with a variety of intracranial pathologies. The indications for EVD insertion and their efficacy in the management of these various conditions have been previously addressed in guidelines published by the Brain Trauma Foundation, American Heart Association and combined committees of the American Association of Neurological Surgeons and the Congress of Neurological Surgeons. While it is well recognized that placement of an EVD may be a lifesaving intervention, the benefits can be offset by procedural and catheter-related complications, such as hemorrhage along the catheter tract, catheter malposition, and CSF infection. Despite their widespread use, there are a lack of high-quality data regarding the best methods for placement and management of EVDs to minimize these risks. Existing recommendations are frequently based on observational data from a single center and may be biased to the authors' view. To address the need for a comprehensive set of evidence-based guidelines for EVD management, the Neurocritical Care Society organized a committee of experts in the fields of neurosurgery, neurology, neuroinfectious disease, critical care, pharmacotherapy, and nursing. The Committee generated clinical questions relevant to EVD placement and management. They developed recommendations based on a thorough literature review using the Grading of Recommendations Assessment, Development, and Evaluation system, with emphasis placed not only on the quality of the evidence, but also on the balance of benefits versus risks, patient values and preferences, and resource considerations.

78 FR 63959 - Environmental Impact Statement; Animal Carcass Management

Federal Register 2010, 2011, 2012, 2013, 2014

2013-10-25

...] Environmental Impact Statement; Animal Carcass Management AGENCY: Animal and Plant Health Inspection Service, USDA. ACTION: Notice of intent to prepare an environmental impact statement and proposed scope of study... carcass management options used throughout the United States. This notice identifies potential...

A Consensus-Based Interpretation of the Benchmark Evidence from South American Trials: Treatment of Intracranial Pressure Trial.

PubMed

Chesnut, Randall M; Bleck, Thomas P; Citerio, Giuseppe; Classen, Jan; Cooper, D James; Coplin, William M; Diringer, Michael N; Grände, Per-Olof; Hemphill, J Claude; Hutchinson, Peter J; Le Roux, Peter; Mayer, Stephan A; Menon, David K; Myburgh, John A; Okonkwo, David O; Robertson, Claudia S; Sahuquillo, Juan; Stocchetti, Nino; Sung, Gene; Temkin, Nancy; Vespa, Paul M; Videtta, Walter; Yonas, Howard

2015-11-15

Widely-varying published and presented analyses of the Benchmark Evidence From South American Trials: Treatment of Intracranial Pressure (BEST TRIP) randomized controlled trial of intracranial pressure (ICP) monitoring have suggested denying trial generalizability, questioning the need for ICP monitoring in severe traumatic brain injury (sTBI), re-assessing current clinical approaches to monitored ICP, and initiating a general ICP-monitoring moratorium. In response to this dissonance, 23 clinically-active, international opinion leaders in acute-care sTBI management met to draft a consensus statement to interpret this study. A Delphi method-based approach employed iterative pre-meeting polling to codify the group's general opinions, followed by an in-person meeting wherein individual statements were refined. Statements required an agreement threshold of more than 70% by blinded voting for approval. Seven precisely-worded statements resulted, with agreement levels of 83% to 100%. These statements, which should be read in toto to properly reflect the group's consensus positions, conclude that the BEST TRIP trial: 1) studied protocols, not ICP-monitoring per se; 2) applies only to those protocols and specific study groups and should not be generalized to other treatment approaches or patient groups; 3) strongly calls for further research on ICP interpretation and use; 4) should be applied cautiously to regions with much different treatment milieu; 5) did not investigate the utility of treating monitored ICP in the specific patient group with established intracranial hypertension; 6) should not change the practice of those currently monitoring ICP; and 7) provided a protocol, used in non-monitored study patients, that should be considered when treating without ICP monitoring. Consideration of these statements can clarify study interpretation.

78 FR 73559 - Moose-Wilson Corridor Comprehensive Management Plan, Environmental Impact Statement, Grand Teton...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-06

...-Wilson Corridor Comprehensive Management Plan, Environmental Impact Statement, Grand Teton National Park... is preparing a Comprehensive Management Plan and Environmental Impact Statement (EIS) for the Moose...; (2) distinguish the corridor's fundamental and other important resources and values; (3) clearly...

78 FR 79658 - Environmental Impact Statement; Animal Carcass Management

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-31

...] Environmental Impact Statement; Animal Carcass Management AGENCY: Animal and Plant Health Inspection Service, USDA. ACTION: Notice of intent to prepare an environmental impact statement and proposed scope of study... management options used throughout the United States. This action will allow interested persons additional...

17 CFR 274.11b - Form N-3, registration statement of separate accounts organized as management investment companies.

Code of Federal Regulations, 2010 CFR

2010-04-01

... statement of separate accounts organized as management investment companies. 274.11b Section 274.11b... accounts organized as management investment companies. Form N-3 shall be used as the registration statement... offer variable annuity contracts to register as management investment companies. This form shall also be...

78 FR 43226 - Going-to-the-Sun Road Corridor Management Plan, Environmental Impact Statement, Glacier National...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-19

...] Going-to-the-Sun Road Corridor Management Plan, Environmental Impact Statement, Glacier National Park... Statement for the Going-to-the-Sun Road Corridor Management Plan for Glacier National Park, Montana. This effort will result in an integrated visitor and transportation management plan for the Going-to-the Sun...

77 FR 16558 - General Management Plan/Final Environmental Impact Statement, Hampton National Historic Site...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-21

... Management Plan/Final Environmental Impact Statement, Hampton National Historic Site, Maryland AGENCY...) announces the availability of the Final Environmental Impact Statement for the General Management Plan.../Baltimore County Library, 320 York Avenue, Towson, Maryland 21204. Baltimore County Tourism Office and...

44 CFR 10.10 - Preparation of environmental impact statements.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 44 Emergency Management and Assistance 1 2014-10-01 2014-10-01 false Preparation of environmental impact statements. 10.10 Section 10.10 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT... Procedures § 10.10 Preparation of environmental impact statements. (a) Scoping. After determination that an...

44 CFR 10.10 - Preparation of environmental impact statements.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 44 Emergency Management and Assistance 1 2012-10-01 2011-10-01 true Preparation of environmental impact statements. 10.10 Section 10.10 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT... Procedures § 10.10 Preparation of environmental impact statements. (a) Scoping. After determination that an...

44 CFR 10.10 - Preparation of environmental impact statements.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 44 Emergency Management and Assistance 1 2013-10-01 2013-10-01 false Preparation of environmental impact statements. 10.10 Section 10.10 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT... Procedures § 10.10 Preparation of environmental impact statements. (a) Scoping. After determination that an...

75 FR 27812 - Final Environmental Impact Statement for the General Management Plan; Monocacy National Battlefield

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-18

... DEPARTMENT OF THE INTERIOR National Park Service Final Environmental Impact Statement for the... Interior. ACTION: Notice of Availability of the Final Environmental Impact Statement for the General... Environmental Impact Statement for the General Management Plan for Monocacy National Battlefield. The plan will...

Urticaria: "You're Probably Just Allergic to Something".

PubMed

Smallwood, Jordan

2016-11-01

Urticaria is a common symptom seen in pediatric patients, and it has multiple allergic and nonallergic causes. Unfortunately, it is far too common that when children present acutely for urticaria, they are told that it is an "allergy." This statement often leads to increased anxiety while the patient waits to be evaluated by an allergist/immunologist. This article discusses the frequency that allergic reactions are involved in urticaria and provides examples of potential nonallergic causes. Additionally, the article discusses approaches to treatment that may be appropriate to initiate in the pediatrician's office or acute setting. This article is intended to provide a broader understanding of urticaria and its management in the outpatient or emergency setting so that we are able to tell our patients more than"you're probably just allergic to something." [Pediatr Ann. 2016;45(11):e399-e402.]. Copyright 2016, SLACK Incorporated.

77 FR 30320 - General Management Plan/Environmental Impact Statement, Ross Lake National Recreation Area, North...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-22

... Management Plan/Environmental Impact Statement, Ross Lake National Recreation Area, North Cascades National... Impact Statement for the new General Management Plan (GMP) for Ross Lake National Recreation Area, part... Wilderness Act of 1988. The full range of foreseeable environmental consequences from implementing the...

76 FR 75557 - Draft Environmental Impact Statement for General Management Plan/Wilderness Study, Hawaii...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-02

... Environmental Impact Statement for General Management Plan/ Wilderness Study, Hawaii Volcanoes National Park... Service is expanding the scope of the Environmental Impact Statement (EIS) that is being prepared for updating the General Management Plan (GMP) for Hawaii Volcanoes National Park. As part of this conservation...

76 FR 35467 - Deer and Vegetation Management Plan/Environmental Impact Statement, Fire Island National Seashore...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-17

... Plan/Environmental Impact Statement, Fire Island National Seashore, New York AGENCY: National Park... for a Deer and Vegetation Management Plan, Fire Island National Seashore, New York. SUMMARY: Pursuant... preparing an Environmental Impact Statement (EIS) for a Deer and Vegetation Management Plan at Fire Island...

76 FR 58543 - Draft Policy Statement on Volume Reduction and Low-Level Radioactive Waste Management

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-21

...-Level Radioactive Waste Management AGENCY: Nuclear Regulatory Commission. ACTION: Reopening of comment... for public comment a draft Policy Statement on Volume Reduction and Low-Level Radioactive Waste Management that updates the 1981 Policy Statement on Low-Level Waste Volume Reduction. The revised Policy...

17 CFR 274.11a-1 - Form N-2, registration statement of closed end management investment companies.

Code of Federal Regulations, 2010 CFR

2010-04-01

... statement of closed end management investment companies. 274.11a-1 Section 274.11a-1 Commodity and... management investment companies. This form shall be used as the registration statement to be filed pursuant to section 8(b) of the Investment Company Act of 1940 by closed end management investment companies...

International Consensus Statement on Allergy and Rhinology: Rhinosinusitis Executive Summary.

PubMed

Orlandi, Richard R; Kingdom, Todd T; Hwang, Peter H

2016-02-01

The body of knowledge regarding rhinosinusitis (RS) continues to expand, with rapid growth in number of publications yet substantial variability in the quality of those presentations. In an effort to both consolidate and critically appraise this information, rhinologic experts from around the world have produced the International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR:RS). This executive summary consolidates the findings of the ICAR:RS document. ICAR:RS presents over 140 topics in the forms of evidence-based reviews with recommendations (EBRRs) and evidence-based reviews (EBR). The structured recommendations of the EBRR sections are summarized in this executive summary. This summary compiles the EBRRs regarding medical and surgical management of acute RS (ARS) and chronic RS with and without nasal polyps (CRSwNP and CRSsNP). This ICAR:RS Executive Summary provides a compilation of the evidence-based recommendations for medical and surgical treatment of the most common forms of RS. © 2016 ARS-AAOA, LLC.

41 CFR 105-74.210 - To whom must I distribute my drug-free workplace statement?

Code of Federal Regulations, 2010 CFR

2010-07-01

... distribute my drug-free workplace statement? 105-74.210 Section 105-74.210 Public Contracts and Property Management Federal Property Management Regulations System (Continued) GENERAL SERVICES ADMINISTRATION... distribute my drug-free workplace statement? You must require that a copy of the statement described in § 105...

76 FR 57760 - Notice of Availability of Draft Resource Management Plan and Draft Environmental Impact Statement...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-16

... Availability of Draft Resource Management Plan and Draft Environmental Impact Statement for the Colorado River... prepared a Draft Resource Management Plan (RMP) and Draft Environmental Impact Statement (EIS) for the... alternative) seeks to allocate limited resources among competing human interests, land uses, and conservation...

76 FR 22917 - Dog Management Plan/Draft Environmental Impact Statement, Golden Gate National Recreation Area...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-25

... DEPARTMENT OF THE INTERIOR National Park Service [NPS-PWR-PWRO--0315-696; 8145-8B90-SZM] Dog... Impact Statement/Dog Management Plan, Golden Gate National Recreation Area. SUMMARY: The National Park Service has prepared a Draft Dog Management Plan and Environmental Impact Statement (Plan/DEIS). The Plan...

Comprehensive in-hospital monitoring in acute heart failure: applications for clinical practice and future directions for research. A statement from the Acute Heart Failure Committee of the Heart Failure Association (HFA) of the European Society of Cardiology (ESC).

PubMed

Harjola, Veli-Pekka; Parissis, John; Brunner-La Rocca, Hans-Peter; Čelutkienė, Jelena; Chioncel, Ovidiu; Collins, Sean P; De Backer, Daniel; Filippatos, Gerasimos S; Gayat, Etienne; Hill, Loreena; Lainscak, Mitja; Lassus, Johan; Masip, Josep; Mebazaa, Alexandre; Miró, Òscar; Mortara, Andrea; Mueller, Christian; Mullens, Wilfried; Nieminen, Markku S; Rudiger, Alain; Ruschitzka, Frank; Seferovic, Petar M; Sionis, Alessandro; Vieillard-Baron, Antoine; Weinstein, Jean Marc; de Boer, Rudolf A; Crespo Leiro, Maria G; Piepoli, Massimo; Riley, Jillian P

2018-04-30

This paper provides a practical clinical application of guideline recommendations relating to the inpatient monitoring of patients with acute heart failure, through the evaluation of various clinical, biomarker, imaging, invasive and non-invasive approaches. Comprehensive inpatient monitoring is crucial to the optimal management of acute heart failure patients. The European Society of Cardiology heart failure guidelines provide recommendations for the inpatient monitoring of acute heart failure, but the level of evidence underpinning most recommendations is limited. Many tools are available for the in-hospital monitoring of patients with acute heart failure, and each plays a role at various points throughout the patient's treatment course, including the emergency department, intensive care or coronary care unit, and the general ward. Clinical judgment is the preeminent factor guiding application of inpatient monitoring tools, as the various techniques have different patient population targets. When applied appropriately, these techniques enable decision making. However, there is limited evidence demonstrating that implementation of these tools improves patient outcome. Research priorities are identified to address these gaps in evidence. Future research initiatives should aim to identify the optimal in-hospital monitoring strategies that decrease morbidity and prolong survival in patients with acute heart failure. © 2018 The Authors. European Journal of Heart Failure © 2018 European Society of Cardiology.

Operational and Clinical Strategies to Address Drug Cost Containment in the Acute Care Setting.

PubMed

McConnell, Karen J; Guzman, Oscar E; Pherwani, Nisha; Spencer, Dustin D; Van Cura, Jennifer D; Shea, Katherine M

2017-01-01

To provide clinical and operational strategies to generate drug cost savings in the hospital setting. A search of the PubMed database was performed with no time limit through July 2016. All original prospective and retrospective studies, peer-reviewed guidelines, consensus statements, review articles, and accompanying references were evaluated for inclusion. Only articles published in the English language were included. Investigators reviewed 937 abstracts. The review of the literature showed that acute care hospitals are under increasing financial pressures, and the pharmacy is often responsible for opportunities to manage drug costs. The literature also indicated that cost-containment strategies in the acute care setting range from pharmacy-directed activities to initiatives requiring interdisciplinary collaboration and strategic planning. Hospital pharmacies should consider establishing an interdisciplinary team that is responsible for systematically reviewing drug cost implications and leading any initiatives that are deemed necessary. Acute care settings can use various operational and clinical strategies to lower their expenditures on high-cost drugs. Operational strategies include various activities that pharmacy staff implement related to contracting, purchasing, and inventory management. Clinical strategies utilize clinical pharmacists working with interdisciplinary teams to develop and maintain a formulary, implement established-use criteria for select drugs, use dose optimization, and implement other clinical tactics aimed at cost containment. After initiatives are implemented, assessing the outcomes of the initiatives is important to determine how successful they were at lowering costs safely and effectively. Acute care hospitals can use various operational and clinical strategies to lower overall drug costs. A systematic stepwise approach is recommended to ensure relevant drugs are regularly reviewed and addressed as needed. © 2016 Pharmacotherapy Publications, Inc.

The cardiac troponins: uses in routine clinical practice. Experiences from GUSTO and other clinical trials.

PubMed

Stubbs, P

1998-11-01

Recent advances in pharmacological and mechanical approaches to acute coronary syndromes have led to rapid changes in the management of patients admitted with acute coronary syndromes. These changes have been mirrored by the appearance of newer highly specific biochemical markers of myocardial damage particularly the cardiac troponins. When new biochemical markers become available it is the responsibility of the clinical chemist to evaluate them critically in terms of sensitivity, specificity, efficiency and analyzer precision, in the rigid setting of quality control that laboratories practise, and to compare them with other markers. When the data are shown to Clinical Cardiologists with supporting statements such as 'useful management tool' and 'can be used for early diagnosis of Myocardial Infarction', a different set of questions may need to be answered. The 'So what?' response is most frequent and is the most important hurdle that these newer biochemical markers have to overcome to convince physicians to change their current practice. This presentation will review the results of studies that have examined the potential clinical usefulness of the cardiac troponins with respect to diagnosis and risk stratification of patients admitted with suspected acute coronary syndromes. Any troponin variable that survives the 'so what' question has one further major hurdle to overcome. This is the requirement to inform physicians what different therapeutic strategies they should follow if the variable is present. Available clinical trial evidence about differing management options for patients according to their troponin status will be reviewed and outline management algorithms will be presented. Many questions remain unanswered and these will be included at the time points where they may be relevant.

75 FR 58369 - Intent To Prepare a Draft Environmental Impact Statement for the North Branch Ecorse Creek, Flood...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-09-24

... Environmental Impact Statement for the North Branch Ecorse Creek, Flood Risk Management General Reevaluation... Notice of Intent (NOI) to prepare a Draft Environmental Impact Statement (EIS) for flood risk management... flood risk management measures. The GRR/EIS is being completed in partnership with Wayne County, MI. The...

National Athletic Trainers' Association Position Statement: Acute Management of the Cervical Spine–Injured Athlete

PubMed Central

Swartz, Erik E; Boden, Barry P; Courson, Ronald W; Decoster, Laura C; Horodyski, MaryBeth; Norkus, Susan A; Rehberg, Robb S; Waninger, Kevin N

2009-01-01

Objective: To provide certified athletic trainers, team physicians, emergency responders, and other health care professionals with recommendations on how to best manage a catastrophic cervical spine injury in the athlete. Background: The relative incidence of catastrophic cervical spine injury in sports is low compared with other injuries. However, cervical spine injuries necessitate delicate and precise management, often involving the combined efforts of a variety of health care providers. The outcome of a catastrophic cervical spine injury depends on the efficiency of this management process and the timeliness of transfer to a controlled environment for diagnosis and treatment. Recommendations: Recommendations are based on current evidence pertaining to prevention strategies to reduce the incidence of cervical spine injuries in sport; emergency planning and preparation to increase management efficiency; maintaining or creating neutral alignment in the cervical spine; accessing and maintaining the airway; stabilizing and transferring the athlete with a suspected cervical spine injury; managing the athlete participating in an equipment-laden sport, such as football, hockey, or lacrosse; and considerations in the emergency department. PMID:19478836

Internal Controls and Compliance with Laws and Regulations for the Defense Business Operations Fund Consolidated Financial Statements for FY 1996

DTIC Science & Technology

1997-06-26

business areas such as Supply Management, Depot Maintenance, and Transportation. The Defense Business Operations Fund Consolidated Financial Statements for... Consolidated Financial Statements were presented fairly in accordance with Office of Management and Budget Bulletin No. 94-01, "Form and Content of...Agency Financial Statements," November 16, 1993. In addition, we determined whether controls were adequate to ensure that the consolidated financial statements were

Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association.

PubMed

Jauch, Edward C; Saver, Jeffrey L; Adams, Harold P; Bruno, Askiel; Connors, J J Buddy; Demaerschalk, Bart M; Khatri, Pooja; McMullan, Paul W; Qureshi, Adnan I; Rosenfield, Kenneth; Scott, Phillip A; Summers, Debbie R; Wang, David Z; Wintermark, Max; Yonas, Howard

2013-03-01

The authors present an overview of the current evidence and management recommendations for evaluation and treatment of adults with acute ischemic stroke. The intended audiences are prehospital care providers, physicians, allied health professionals, and hospital administrators responsible for the care of acute ischemic stroke patients within the first 48 hours from stroke onset. These guidelines supersede the prior 2007 guidelines and 2009 updates. Members of the writing committee were appointed by the American Stroke Association Stroke Council's Scientific Statement Oversight Committee, representing various areas of medical expertise. Strict adherence to the American Heart Association conflict of interest policy was maintained throughout the consensus process. Panel members were assigned topics relevant to their areas of expertise, reviewed the stroke literature with emphasis on publications since the prior guidelines, and drafted recommendations in accordance with the American Heart Association Stroke Council's Level of Evidence grading algorithm. The goal of these guidelines is to limit the morbidity and mortality associated with stroke. The guidelines support the overarching concept of stroke systems of care and detail aspects of stroke care from patient recognition; emergency medical services activation, transport, and triage; through the initial hours in the emergency department and stroke unit. The guideline discusses early stroke evaluation and general medical care, as well as ischemic stroke, specific interventions such as reperfusion strategies, and general physiological optimization for cerebral resuscitation. Because many of the recommendations are based on limited data, additional research on treatment of acute ischemic stroke remains urgently needed.

Variability in the organisation and management of hospital care for COPD exacerbations in the UK.

PubMed

Hosker, Harold; Anstey, Katharine; Lowe, Derek; Pearson, Michael; Roberts, C Michael

2007-04-01

Previous smaller UK audits have demonstrated wide variation in organisation, resources, and process of care for acute chronic obstructive pulmonary disease (COPD) admissions. Smallest units appeared to do less well. UK acute hospitals supplied information on (1) resources and organisation of care, (2) clinical data on process of care and outcomes for up to 40 consecutive COPD admissions. Comparisons were made against national recommendations. Eight thousand and thirteen admissions involved 7529 patients from 233 units (93% of UK acute Trusts). Twenty-six percent of units had at most one whole-time equivalent respiratory consultant while 12% had at least four. Thirty percent patients were admitted under a respiratory specialist and 48% discharged under their care whilst 28% had no specialist input at all. Variation in care provision was wide across all hospitals but patients in smaller hospitals had less access to specialist respiratory or admission wards, pulmonary rehabilitation programs, specialty triage or an early discharge scheme. Six percent of units did not have access to NIV and 18% to invasive ventilatory support. There remains wide variation in all aspects of acute hospital COPD care in the UK, with smaller hospitals offering fewest services. Those receiving specialist input are more likely to be offered interventions of proven effect. Management guidelines alone are insufficient to address inequalities of care and a clear statement of minimum national standards for resource provision and organisation of COPD care are required. This study provides a unique insight into the current state of care for patients admitted with COPD exacerbations in the UK.

Acute Precipitants of Physical Elder Abuse: Qualitative Analysis of Legal Records From Highly Adjudicated Cases.

PubMed

Rosen, Tony; Bloemen, Elizabeth M; LoFaso, Veronica M; Clark, Sunday; Flomenbaum, Neal E; Breckman, Risa; Markarian, Arlene; Riffin, Catherine; Lachs, Mark S; Pillemer, Karl

2016-08-01

Elder abuse is a common phenomenon with potentially devastating consequences for older adults. Although researchers have begun to identify predisposing risk factors for elder abuse victims and abusers, little is known about the acute precipitants that lead to escalation to physical violence. We analyzed legal records from highly adjudicated cases to describe these acute precipitants for physical elder abuse. In collaboration with a large, urban district attorney's office, we qualitatively evaluated legal records from 87 successfully prosecuted physical elder abuse cases from 2003 to 2015. We transcribed and analyzed narratives of the events surrounding physical abuse within victim statements, police reports, and prosecutor records. We identified major themes using content analysis. We identified 10 categories of acute precipitants that commonly triggered physical elder abuse, including victim attempting to prevent the abuser from entering or demanding that he or she leave, victim threatening or attempting to leave/escape, threat or perception that the victim would involve the authorities, conflict about a romantic relationship, presence during/intervention in ongoing family violence, issues in multi-generational child rearing, conflict about the abuser's substance abuse, confrontation about financial exploitation, dispute over theft/destruction of property, and disputes over minor household issues. Common acute precipitants of physical elder abuse may be identified. Improved understanding of these acute precipitants for escalation to physical violence and their contribution to elder abuse may assist in the development of prevention and management strategies.

Acute Precipitants of Physical Elder Abuse: Qualitative Analysis of Legal Records From Highly Adjudicated Cases

PubMed Central

Rosen, Tony; Bloemen, Elizabeth M.; LoFaso, Veronica M.; Clark, Sunday; Flomenbaum, Neal E.; Breckman, Risa; Markarian, Arlene; Riffin, Catherine; Lachs, Mark S.; Pillemer, Karl

2016-01-01

Elder abuse is a common phenomenon with potentially devastating consequences for older adults. Although researchers have begun to identify predisposing risk factors for elder abuse victims and abusers, little is known about the acute precipitants that lead to escalation to physical violence. We analyzed legal records from highly adjudicated cases to describe these acute precipitants for physical elder abuse. In collaboration with a large, urban district attorney’s office, we qualitatively evaluated legal records from 87 successfully prosecuted physical elder abuse cases from 2003 to 2015. We transcribed and analyzed narratives of the events surrounding physical abuse within victim statements, police reports, and prosecutor records. We identified major themes using content analysis. We identified 10 categories of acute precipitants that commonly triggered physical elder abuse, including victim attempting to prevent the abuser from entering or demanding that he or she leave, victim threatening or attempting to leave/escape, threat or perception that the victim would involve the authorities, conflict about a romantic relationship, presence during/intervention in ongoing family violence, issues in multi-generational child rearing, conflict about the abuser’s substance abuse, confrontation about financial exploitation, dispute over theft/destruction of property, and disputes over minor household issues. Common acute precipitants of physical elder abuse may be identified. Improved understanding of these acute precipitants for escalation to physical violence and their contribution to elder abuse may assist in the development of prevention and management strategies. PMID:27506228

Consensus Guidelines for the Treatment of Atopic Dermatitis in Korea (Part I): General Management and Topical Treatment

PubMed Central

Kim, Jung Eun; Kim, Hyun Jeong; Lew, Bark-Lynn; Lee, Kyung Ho; Hong, Seung Phil; Jang, Yong Hyun; Park, Kui Young; Seo, Seong Jun; Bae, Jung Min; Choi, Eung Ho; Suhr, Ki Beom; Lee, Seung Chul; Ko, Hyun Chang; Park, Young Lip; Son, Sang Wook; Seo, Young Jun; Lee, Yang Won; Cho, Sang Hyun; Park, Chun Wook

2015-01-01

Background Since the treatment guidelines for atopic dermatitis (AD) were released by the Korean Atopic Dermatitis Association (KADA) work group in 2006, there have been several advances in AD management. Objective We aimed to establish updated evidence- and experience-based treatment guidelines for Korean AD. Methods We collected a database of references from relevant systematic AD reviews and guidelines regarding general AD management such as bathing and skin care, avoidance of exacerbating factors, education and psychosocial support, and the use of moisturizers and topical anti-inflammatory and antipruritic drugs. Evidence for each statement was graded and the strength of the recommendation for each statement classified. Thirty-nine KADA council members participated in three rounds of voting to establish an expert consensus of recommendations. Results Basic AD treatment includes proper bathing and skin care, avoidance of exacerbating factors, proper education and psychosocial support, and use of moisturizers. The regular use of moisturizer has a steroid-sparing effect and reduces relapse episodes. The short- and long-term use of topical corticosteroids and calcineurin inhibitors improves AD symptoms and should be encouraged to use in an active and proactive treatment. Wet-wrap therapy can be used for rapid recovery of acute exacerbation. Topical antipruritic drugs cannot be recommended for the treatment of AD. Conclusion This report provides up-to-date evidence- and experience-based treatment guidelines for AD regarding general management and topical treatment. In addition, the average agreement scores obtained by a panel of experts based on the Korean healthcare system and patient adherence are presented. PMID:26512171

78 FR 19523 - General Management Plan, Draft Environmental Impact Statement, Lake Meredith National Recreation...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-01

... Management Plan, Draft Environmental Impact Statement, Lake Meredith National Recreation Area and Alibates... Management Plan, Lake Meredith National Recreation Area and Alibates Flint Quarries National Monument, Texas... management alternatives for Lake Meredith National Recreation Area and three management alternatives for...

Using the modified Delphi method to establish clinical consensus for the diagnosis and treatment of patients with rotator cuff pathology.

PubMed

Eubank, Breda H; Mohtadi, Nicholas G; Lafave, Mark R; Wiley, J Preston; Bois, Aaron J; Boorman, Richard S; Sheps, David M

2016-05-20

Patients presenting to the healthcare system with rotator cuff pathology do not always receive high quality care. High quality care occurs when a patient receives care that is accessible, appropriate, acceptable, effective, efficient, and safe. The aim of this study was twofold: 1) to develop a clinical pathway algorithm that sets forth a stepwise process for making decisions about the diagnosis and treatment of rotator cuff pathology presenting to primary, secondary, and tertiary healthcare settings; and 2) to establish clinical practice guidelines for the diagnosis and treatment of rotator cuff pathology to inform decision-making processes within the algorithm. A three-step modified Delphi method was used to establish consensus. Fourteen experts representing athletic therapy, physiotherapy, sport medicine, and orthopaedic surgery were invited to participate as the expert panel. In round 1, 123 best practice statements were distributed to the panel. Panel members were asked to mark "agree" or "disagree" beside each statement, and provide comments. The same voting method was again used for round 2. Round 3 consisted of a final face-to-face meeting. In round 1, statements were grouped and reduced to 44 statements that met consensus. In round 2, five statements reached consensus. In round 3, ten statements reached consensus. Consensus was reached for 59 statements representing five domains: screening, diagnosis, physical examination, investigations, and treatment. The final face-to-face meeting was also used to develop clinical pathway algorithms (i.e., clinical care pathways) for three types of rotator cuff pathology: acute, chronic, and acute-on-chronic. This consensus guideline will help to standardize care, provide guidance on the diagnosis and treatment of rotator cuff pathology, and assist in clinical decision-making for all healthcare professionals.

Depression as a risk factor for poor prognosis among patients with acute coronary syndrome: systematic review and recommendations: a scientific statement from the American Heart Association.

PubMed

Lichtman, Judith H; Froelicher, Erika S; Blumenthal, James A; Carney, Robert M; Doering, Lynn V; Frasure-Smith, Nancy; Freedland, Kenneth E; Jaffe, Allan S; Leifheit-Limson, Erica C; Sheps, David S; Vaccarino, Viola; Wulsin, Lawson

2014-03-25

Although prospective studies, systematic reviews, and meta-analyses have documented an association between depression and increased morbidity and mortality in a variety of cardiac populations, depression has not yet achieved formal recognition as a risk factor for poor prognosis in patients with acute coronary syndrome by the American Heart Association and other health organizations. The purpose of this scientific statement is to review available evidence and recommend whether depression should be elevated to the status of a risk factor for patients with acute coronary syndrome. Writing group members were approved by the American Heart Association's Scientific Statement and Manuscript Oversight Committees. A systematic literature review on depression and adverse medical outcomes after acute coronary syndrome was conducted that included all-cause mortality, cardiac mortality, and composite outcomes for mortality and nonfatal events. The review assessed the strength, consistency, independence, and generalizability of the published studies. A total of 53 individual studies (32 reported on associations with all-cause mortality, 12 on cardiac mortality, and 22 on composite outcomes) and 4 meta-analyses met inclusion criteria. There was heterogeneity across studies in terms of the demographic composition of study samples, definition and measurement of depression, length of follow-up, and covariates included in the multivariable models. Despite limitations in some individual studies, our review identified generally consistent associations between depression and adverse outcomes. Despite the heterogeneity of published studies included in this review, the preponderance of evidence supports the recommendation that the American Heart Association should elevate depression to the status of a risk factor for adverse medical outcomes in patients with acute coronary syndrome.

50 CFR 600.115 - Statement of organization, practices, and procedures (SOPP).

Code of Federal Regulations, 2010 CFR

2010-10-01

... Regional Fishery Management Councils § 600.115 Statement of organization, practices, and procedures (SOPP... 50 Wildlife and Fisheries 8 2010-10-01 2010-10-01 false Statement of organization, practices, and procedures (SOPP). 600.115 Section 600.115 Wildlife and Fisheries FISHERY CONSERVATION AND MANAGEMENT...

Financial Management at the Department of Defense Education Activity.

DTIC Science & Technology

1997-04-17

The Chief Financial Officers Act (Public Law 103-356) requires DoD to provide consolidated financial statements for FY 1996 to the Office of...Management and Budget. DoD consolidated financial statements will include the financial statements for DoDEA. An adequate system of funds control is a

17 CFR 270.8b-16 - Amendments to registration statement.

Code of Federal Regulations, 2010 CFR

2010-04-01

... (CONTINUED) RULES AND REGULATIONS, INVESTMENT COMPANY ACT OF 1940 § 270.8b-16 Amendments to registration statement. (a) Every registered management investment company which is required to file a semi-annual report... management investment company whose registration statement was filed on Form N-2; provided that the following...

75 FR 1359 - Notice of Availability of Final Environmental Impact Statement for the Proposed Construction of...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-01-11

... Environmental Impact Statement for the Proposed Construction of the Western Wake Regional Wastewater Management Facilities; Which Includes Regional Wastewater Pumping, Conveyance, Treatment, and Discharge Facilities To... Environmental Impact Statement for the proposed construction of the Western Wake Regional Wastewater Management...

78 FR 68469 - Draft General Management Plan/Wilderness Study/Environmental Impact Statement, Channel Islands...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-11-14

...: The park includes five remote islands spanning 2,228 square miles of land and sea. Updating the park's... General Management Plan/Wilderness Study/Environmental Impact Statement, Channel Islands National Park... (GMP)/Wilderness Study/Environmental Impact Statement (EIS) for Channel Islands National Park. The...

75 FR 13656 - Interagency Policy Statement on Funding and Liquidity Risk Management

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-22

... policy statement summarizes the principles of sound liquidity risk management that the agencies have... Supervision issued in September 2008, Principles for Sound Liquidity Risk Management and Supervision, which contains 17 principles detailing international supervisory guidance for sound liquidity risk management. \\2...

75 FR 22680 - Financial Management Service; Proposed Collection of Information: Annual Financial Statement of...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-29

... DEPARTMENT OF THE TREASURY Fiscal Service Financial Management Service; Proposed Collection of Information: Annual Financial Statement of Surety Companies--Schedule F AGENCY: Financial Management Service, Fiscal Service, Treasury. ACTION: Notice and Request for comments. SUMMARY: The Financial Management...

76 FR 22879 - Intent To Prepare an Environmental Impact Statement for Update of the Shoreline Management Plan...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-25

... environment. Affected Federal, state, or local agencies, affected Indian tribes, and other interested private... Environmental Impact Statement for Update of the Shoreline Management Plan and Supplement to the Master Plan... intent. SUMMARY: The purpose of the Environmental Impact Statement (EIS) is to address alternatives and...

76 FR 58506 - Pesticide Program Dialogue Committee; Notice of Public Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-21

... October 11, 2011: Integrated Pest Management, Comparative Safety Statements, Pollinator Protection, and...: Integrated Pest Management from 8 a.m. to noon; Comparative Safety Statements from 1 p.m. to 4 p.m... Workgroup meetings will be held in room S-4370, and the Comparative Safety Statements Workgroup meeting will...

77 FR 23245 - Pesticide Program Dialogue Committee; Notice of Public Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-18

...: Integrated Pest Management, Comparative Safety Statements, Public Health, and Pollinator Protection. The PPDC... p.m.; Comparative Safety Statements from 1 p.m. to 4 p.m.; Public Health from 1 p.m. to 4 p.m.; and... Management and Pollinator Protection Workgroup meetings. The Comparative Safety Statements [[Page 23246...

17 CFR 210.8-04 - Financial statements of businesses acquired or to be acquired.

Code of Federal Regulations, 2010 CFR

2010-04-01

... Article 8 Financial Statements of Smaller Reporting Companies § 210.8-04 Financial statements of... any periods they are under common control or management. A group of businesses is deemed to be related if: (i) They are under common control or management; (ii) The acquisition of one business is...

Framing a South Africa Policy Statement

ERIC Educational Resources Information Center

Murray, Roger F.

1978-01-01

A model position statement for the college trustee is presented that deals with the management of and decision-making for corporate equity securities. Neither selling the stock nor leaving decisions on social issues, such as the apartheid one, to corporate management is seen as a satisfactory alternative. Adoption of a position statement can guide…

77 FR 14567 - Draft General Management Plan/Environmental Impact Statement for the Ice Age Complex at Cross...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-12

... Impact Statement for the Ice Age Complex at Cross Plains, Cross Plains, Wisconsin AGENCY: National Park... General Management Plan/Environmental Impact Statement for the Ice Age Complex at Cross Plains, Wisconsin... also send comments to Superintendent, Ice Age National Scenic Trail, 700 Rayovac Drive, Suite 100...

75 FR 45133 - Statement of Organization, Functions, and Delegations of Authority

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-02

... Management Analysis and Services Office, Office of the Chief Operating Officer, Centers for Disease Control... entirety the titles and functional statements for the Management Analysis and Services Office (CAJG), insert the following: Management Analysis and Services Office (CAJG). The mission of the Management...

76 FR 57759 - Notice of Availability of Draft Resource Management Plan and Draft Environmental Impact Statement...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-16

... Availability of Draft Resource Management Plan and Draft Environmental Impact Statement for the Kremmling Field... Management Act of 1976 (FLPMA), as amended, the Bureau of Land Management (BLM) has prepared a Draft Resource... alternatives for future [[Page 57760

Assessment of a career development program for executive amd mid-level managers

NASA Technical Reports Server (NTRS)

Swanson, James R., Sr.

1994-01-01

This project sought to validate the competencies required of mid-level and executive managers at the Kennedy Space Center (KSC), in order to enable an assessment of the Resident Management Education Program (RMEP). Forty (40) statements describing management competencies were presented to a sample of 37 KSC managers, who judged each as essential, useful but not essential, or not needed at each of two management levels. A content validity ratio (CVR) was calculated for each competency statement at the two management levels. There was general agreement on the validity of 36 or the 40 competency statements. Based on the content validity ratios and comments from respondents, recommendations for improvement of the RMEP were made.

Consensus Statement National Consensus Workshop on Management of SAM Children through Medical Nutrition Therapy.

PubMed

Sachdev, H P S; Kapil, Umesh; Vir, Sheila

2010-08-01

Severe acute malnutrition (SAM) is an important preventable and treatable cause of morbidity and mortality in children below five years of age in India. The concerned stakeholders are not in agreement about the role of product based medical nutrition therapy in the management of this condition. In November 2009, a National Consensus Workshop was organized by the Department of Human Nutrition, All India Institute of Medical Sciences, New Delhi in collaboration with the Department of Pediatrics and Clinical Epidemiology, Sitaram Bhartia Institute of Science and Research, New Delhi, and the Sub-specialty Chapter on Nutrition, Indian Academy of Pediatrics. Presentations by eminent national and international scientists, the ensuing discussions, and opinions expressed by the participants provided the basic framework for drafting the consensus statement. The draft of the consensus statement was circulated to all the participants; it underwent two revisions after consideration of their comments. (i) Critically appraise the current global evidence on the utility of Medical Nutrition Therapy (MNT) for the management of SAM in under five children; (ii) Formulate a consensus amongst stakeholders regarding the need to introduce product based MNT for the management of SAM in under five children in India; (iii) Identify research priorities for MNT for the management of SAM in under five children in India; and (iv)Ascertain potential challenges for introducing product based MNT in India, if consensus opinion identifies such a need. Guidelines related to the role of MNT in management of children suffering from SAM are presented. Global and regional data document the effectiveness of MNT using ready-to-use therapeutic foods (RUTF) and locally formulated products. Adequate caution should be exercised to ensure that MNT for SAM does not interfere with measures for the holistic prevention of childhood undernutrition. Indian manufacture of RUTF is feasible, and can be scaled up. Product-based nutrition therapy including RUTF can be introduced on a pilot basis when a delivery design and plan of action is developed and is in place as a part of the larger system to deal with childhood undernutrition. RUTF should be used only as therapeutic and not supplementary feeding, above six months of age, and for a limited time period (4-8 weeks) until the child recovers from SAM, which should be defined in explicit treatment protocols. An urgent research issue is comparison of RUTF with home-based and locally-formulated products.

75 FR 19989 - Final Environmental Impact Statement for Drought Management Planning at the Kerr Hydroelectric...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-16

... Drought Management Planning at the Kerr Hydroelectric Project, Flathead Lake, MT AGENCY: Bureau of Indian... Impact Statement (FEIS) for Drought Management Planning at the Kerr Hydroelectric Project, Flathead Lake... drought management planning at the Kerr Hydroelectric Project no sooner than 30 days following the...

75 FR 27812 - Final Environmental Impact Statement for the General Management Plan; Harpers Ferry National...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-18

... guidance to park management for administration, development, and interpretation of park resources over the... General Management Plan for Harpers Ferry National Historical Park. SUMMARY: Pursuant to the National... availability of a Final Environmental Impact Statement for the General Management Plan for Harpers Ferry [[Page...

75 FR 10308 - Fire Management Plan, Final Environmental Impact Statement, Record of Decision, Grand Canyon...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-05

... DEPARTMENT OF THE INTERIOR National Park Service Fire Management Plan, Final Environmental Impact... Statement for the Fire Management Plan, Grand Canyon National Park. SUMMARY: Pursuant to the National... the Record of Decision for the Fire Management Plan, Grand Canyon National Park, Arizona. On January...

78 FR 26067 - General Management Plan, Draft Environmental Impact Statement, Big Thicket National Preserve, Texas

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-03

.... Alternative 2, the NPS preferred alternative, would support a broad ecosystem approach for preserve management... management of cross-boundary resource issues and the importance of encouraging partnerships to address and... Management Plan, Draft Environmental Impact Statement, Big Thicket National Preserve, Texas AGENCY: National...

Forest residues management guidelines for the Pacific Northwest.

Treesearch

John M. Pierovich; Edward H. Clarke; Stewart G. Pickford; Franklin R. Ward

1975-01-01

Forest residues often require treatment to meet land management objectives. Guideline statements for managing forest residues are presented to provide direction for achieving these objectives. The latest research information and the best knowledge of experts in various land management disciplines were used to formulate these statements. A unique keying system is...

78 FR 55093 - Dog Management Plan, Supplemental Environmental Impact Statement, Golden Gate National Recreation...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-09-09

....YP0000] Dog Management Plan, Supplemental Environmental Impact Statement, Golden Gate National Recreation... the Dog Management Plan (Plan/SEIS), Golden Gate National Recreation Area (GGNRA), California. Current dog management in the park is based on a number of factors. Areas included in the GGNRA Citizens...

Management evaluation about introduction of electric medical record in the national hospital organization.

PubMed

Nakagawa, Yoshiaki; Tomita, Naoko; Irisa, Kaoru; Yoshihara, Hiroyuki; Nakagawa, Yoshinobu

2013-01-01

Introduction of Electronic Medical Record (EMR) into a hospital was started from 1999 in Japan. Then, most of all EMR company said that EMR improved efficacy of the management of the hospital. National Hospital Organization (NHO) has been promoting the project and introduced EMR since 2004. NHO has 143 hospitals, 51 hospitals offer acute-phase medical care services, the other 92 hospitals offer medical services mainly for chronic patients. We conducted three kinds of investigations, questionnaire survey, checking the homepage information of the hospitals and analyzing the financial statements of each NHO hospital. In this financial analysis, we applied new indicators which have been developed based on personnel costs. In 2011, there are 44 hospitals which have introduced EMR. In our result, the hospital with EMR performed more investment of equipment/capital than personnel expenses. So, there is no advantage of EMR on the financial efficacy.

Reaching consensus on the physiotherapeutic management of patients following upper abdominal surgery: a pragmatic approach to interpret equivocal evidence.

PubMed

Hanekom, Susan D; Brooks, Dina; Denehy, Linda; Fagevik-Olsén, Monika; Hardcastle, Timothy C; Manie, Shamila; Louw, Quinette

2012-02-06

Postoperative pulmonary complications remain the most significant cause of morbidity following open upper abdominal surgery despite advances in perioperative care. However, due to the poor quality primary research uncertainty surrounding the value of prophylactic physiotherapy intervention in the management of patients following abdominal surgery persists. The Delphi process has been proposed as a pragmatic methodology to guide clinical practice when evidence is equivocal. The objective was to develop a clinical management algorithm for the post operative management of abdominal surgery patients. Eleven draft algorithm statements extracted from the extant literature by the primary research team were verified and rated by scientist clinicians (n=5) in an electronic three round Delphi process. Algorithm statements which reached a priori defined consensus-semi-interquartile range (SIQR)<0.5-were collated into the algorithm. The five panelists allocated to the abdominal surgery Delphi panel were from Australia, Canada, Sweden, and South Africa. The 11 draft algorithm statements were edited and 5 additional statements were formulated. The panel reached consensus on the rating of all statements. Four statements were rated essential. An expert Delphi panel interpreted the equivocal evidence for the physiotherapeutic management of patients following upper abdominal surgery. Through a process of consensus a clinical management algorithm was formulated. This algorithm can now be used by clinicians to guide clinical practice in this population.

Implementation Plan. Environmental Restoration and Waste Management Programmatic Environmental Impact Statement

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

Not Available

1994-01-01

In accordance with the Department of Energy`s National Environmental Policy Act implementing procedures in Volume 10 of the Code of Federal Regulations, Section 1021,312, the Environmental Restoration and Waste Management Programmatic Environmental Impact Statement Implementation Plan has two primary purposes: to provide guidance for the preparation of the Programmatic Environmental Impact Statement and to record the issues resulting from the scoping and the extended public participation process. The Implementation Plan identifies and discusses the following: background of Environmental Restoration and Waste Management activities, the purpose of the Programmatic Environmental Impact Statement, and the relationship of the Programmatic Environmental Impact Statementmore » to other Departmental initiatives (Chapter 1); need and purposes for action (Chapter 2); scoping process and results of the public participation program in defining the scope of the Programmatic Environmental Impact Statement, including a summary of the comments received and their disposition (Chapter 3); planned scope and content of the Programmatic Environmental Impact Statement (Chapter 4); consultations with other agencies and the role of cooperating agencies (Chapter 5); planned schedule of major Programmatic Environmental Impact Statement milestones (Chapter 6); and responsibilities for preparation of the Programmatic Environmental Impact Statement (Chapter 7).« less

Clinical practice guidelines for the surgical management of colon cancer: a consensus statement of the Hellenic and Cypriot Colorectal Cancer Study Group by the HeSMO*

PubMed Central

Xynos, Evaghelos; Gouvas, Nikolaos; Triantopoulou, Charina; Tekkis, Paris; Vini, Louiza; Tzardi, Maria; Boukovinas, Ioannis; Androulakis, Nikolaos; Athanasiadis, Athanasios; Christodoulou, Christos; Chrysou, Evangelia; Dervenis, Christos; Emmanouilidis, Christos; Georgiou, Panagiotis; Katopodi, Ourania; Kountourakis, Panteleimon; Makatsoris, Thomas; Papakostas, Pavlos; Papamichael, Demetris; Pentheroudakis, Georgios; Pilpilidis, Ioannis; Sgouros, Joseph; Vassiliou, Vassilios; Xynogalos, Spyridon; Ziras, Nikolaos; Karachaliou, Niki; Zoras, Odysseas; Agalianos, Christos; Souglakos, John

2016-01-01

Despite considerable improvement in the management of colon cancer, there is a great deal of variation in the outcomes among European countries, and in particular among different hospital centers in Greece and Cyprus. Discrepancy in the approach strategies and lack of adherence to guidelines for the management of colon cancer may explain the situation. The aim was to elaborate a consensus on the multidisciplinary management of colon cancer, based on European guidelines (ESMO and EURECCA), and also taking into account local special characteristics of our healthcare system. Following discussion and online communication among members of an executive team, a consensus was developed. Statements entered the Delphi voting system on two rounds to achieve consensus by multidisciplinary international experts. Statements with an agreement rate of ≥80% achieved a large consensus, while those with an agreement rate of 60-80% a moderate consensus. Statements achieving an agreement of <60% after both rounds were rejected and not presented. Sixty statements on the management of colon cancer were subjected to the Delphi methodology. Voting experts were 109. The median rate of abstain per statement was 10% (range: 0-41%). In the end of the voting process, all statements achieved a consensus by more than 80% of the experts. A consensus on the management of colon cancer was developed by applying the Delphi methodology. Guidelines are proposed along with algorithms of diagnosis and treatment. The importance of centralization, care by a multidisciplinary team, and adherence to guidelines is emphasized. PMID:26752945

Compartment syndrome and shin splints of the lower leg.

PubMed

Gerow, G; Matthews, B; Jahn, W; Gerow, R

1993-05-01

The objective of this article is to review and categorize the current knowledge on compartment syndromes (CS) and shin splints (SS), with specific importance relegated to the diagnosis, differential diagnosis and management of these conditions. The bibliographic data sources reviewed are limited to the English language and human content and are from medical and scientific journals, as well as chiropractic and medical texts. A mini-Medline version of Index Medicus was utilized. Terms for indexing included compartment syndromes, shin splints and stress fractures. The bibliographies of the journals selected were then evaluated and, where appropriate, the specific journal or text references regarding diagnosis and management were then reviewed. This information was then included in this article, where useful, to further clarify or reference statements made. Differential diagnosis of the acute CS from chronic CS and SS requires clinical methods and imaging procedures. The pathogenesis of the acute CS of the lower leg is associated with external pressure or internal hemorrhage. If the tissue pressure were to rise above 30-40 mm Hg for 4-12 h, irreversible muscular damage would result. Emergency surgical intervention is the only appropriate form of treatment in acute CS. In chronic CS, where elevated pressures exist on a transient basis, influenced by activity, conservative management procedures are felt to be effective. However, if these methods are not helpful, surgical intervention may be necessary. The etiology of pain associated with SS is not associated with compartmental pressure elevations, but rather, results from periostitis occurring along the tibia caused by muscular and tendinous strain associated with inflammation. Conservative management is most appropriate for this disorder, with surgical intervention being an uncommon treatment approach. Although clinical findings are useful in the diagnosis of these disorders, fluid pressure findings may be necessary to fully differentiate acute CS from other disorders. Up until recently, common methods of obtaining pressure measurements of compartments included the use of a needle manometer. More recently, however, a hand-held miniature fluid pressure monitor has been developed that produces reproducible measurements of interstitial fluid, making testing potentially practical for the clinician.

Consensus on the clinical management, screening-to-treat, and surveillance of Helicobacter pylori infection to improve gastric cancer control on a nationwide scale.

PubMed

Sheu, Bor-Shyang; Wu, Ming-Shiang; Chiu, Cheng-Tang; Lo, Jing-Chuan; Wu, Deng-Chyang; Liou, Jyh-Ming; Wu, Chun-Ying; Cheng, Hsiu-Chi; Lee, Yi-Chia; Hsu, Ping-I; Chang, Chun-Chao; Chang, Wei-Lun; Lin, Jaw-Town

2017-06-01

Previous international consensus statements provided general policies for the management of Helicobacter pylori infection. However, there are geographic differences in the prevalence and antimicrobial resistance of H. pylori, and in the availability of medications and endoscopy. Thus, nationwide or regional consensus statements are needed to improve control of H. pylori infection and gastric cancer. This consensus statement for management of H. pylori in Taiwan has three major sections: (1) optimal diagnosis and indications; (2) current treatment strategies; and (3) screening-to-treat and surveillance for control of gastric cancer. The literature review emphasized recent data for development of draft statements and determination of levels of evidence. Twenty-five Taiwan experts conducted a consensus conference, by a modified Delphi process, to modify the draft statements. Consensus, defined as an agreement of least 80% of the experts, and recommendation grade were determined by anonymous voting. There were 24 consensus statements. Section 1 has seven statements on recommendations for the diagnosis and indications for treatment of H. pylori infection. Section 2 has 10 statements that provide an updated treatment algorithm for first-line, second-line, and third-line regimens. Section 3 has seven statements regarding H. pylori eradication for reducing the risk of gastric cancer, with a cost-benefit analysis. After H. pylori eradication, the consensus highlights the use of endoscopic surveillance and/or chemoprevention to further reduce the burden of gastric cancer. This consensus statement has updated recommendations for improving the clinical management of H. pylori infection in areas such as Taiwan, which have high prevalence of H. pylori infection and gastric cancer. © 2017 The Authors. Helicobacter Published by John Wiley & Sons Ltd.

Position Statements, Issue Briefs, Resolutions and Consensus Statements. Revised

ERIC Educational Resources Information Center

National Association of School Nurses (NJ1), 2012

2012-01-01

This article presents position statements, issue briefs, and resolutions and consensus statements of the National Association of School Nurses (NASN). The Position Statements include: (1) Allergy/Anaphylaxis Management in the School Setting; (2) Caseload Assignments; (3) Child Mortality in the School Setting; (4) Chronic Health Conditions, Managed…

International perspectives on air quality: risk management principles for policy development--conference statement.

PubMed

Craig, Lorraine; Krewski, Dan; Samet, Jonathan; Shortreed, John; van Bree, Leendert; Krupnick, Alan J

2008-01-01

This statement is the result of discussions held at the 2005 NERAM IV Colloquium "International Perspectives on Air Quality: Risk Management Principles for Policy Development" and represents the collective views of 35 delegates, including international air quality policy analysts, academics, nongovernmental organizations, industry representatives, and decision makers from Mexico, Canada, the United States, the United Kingdom, Brazil, Hong Kong, and The Netherlands on principles for global air quality management. The objective of the colloquium was to "establish principles for air quality management based on the identification of international best practice in air quality policy development and implementation." This statement represents the main findings of a breakout group discussion session, presentations of an international panel of speakers from Canada, the United States, Mexico, and Hong Kong and views of the delegates expressed in plenary discussions. NERAM undertook a transparent process to try to ensure that the statement would accurately reflect the conference discussions, including documenting the proceedings and inviting delegates' comments on draft versions of the statement.

Consensus statement: Using laryngeal electromyography for the diagnosis and treatment of vocal cord paralysis.

PubMed

Munin, Michael C; Heman-Ackah, Yolanda D; Rosen, Clark A; Sulica, Lucian; Maronian, Nicole; Mandel, Steven; Carey, Bridget T; Craig, Earl; Gronseth, Gary

2016-06-01

The purpose of this study was to develop an evidence-based consensus statement regarding use of laryngeal electromyography (LEMG) for diagnosis and treatment of vocal fold paralysis after recurrent laryngeal neuropathy (RLN). Two questions regarding LEMG were analyzed: (1) Does LEMG predict recovery in patients with acute unilateral or bilateral vocal fold paralysis? (2) Do LEMG findings change clinical management in these individuals? A systematic review was performed using American Academy of Neurology criteria for rating of diagnostic accuracy. Active voluntary motor unit potential recruitment and presence of polyphasic motor unit potentials within the first 6 months after lesion onset predicted recovery. Positive sharp waves and/or fibrillation potentials did not predict outcome. The presence of electrical synkinesis may decrease the likelihood of recovery, based on 1 published study. LEMG altered clinical management by changing the initial diagnosis from RLN in 48% of cases. Cricoarytenoid fixation and superior laryngeal neuropathy were the most common other diagnoses observed. If prognostic information is required in a patient with vocal fold paralysis that is more than 4 weeks and less than 6 months in duration, then LEMG should be performed. LEMG may be performed to clarify treatment decisions for vocal fold immobility that is presumed to be caused by RLN. Muscle Nerve 53: 850-855, 2016. © 2016 Wiley Periodicals, Inc.

78 FR 956 - Statement of Organization, Functions and Delegations of Authority

Federal Register 2010, 2011, 2012, 2013, 2014

2013-01-07

... Management (RB4) and Office of Information Technology (RB5). Specifically, this notice: (1) Transfers the records management function from the Office of Management (RB4) to the Office of Information Technology (RB5); (2) updates the functional statement for the Office of Management (RB4) and the Office of the...

78 FR 5834 - Notice of Intent To Prepare a Supplemental Environmental Impact Statement and Resource Management...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-01-28

... DEPARTMENT OF THE INTERIOR Bureau of Land Management [LLCON04000 L16100000.DP0000] Notice of Intent To Prepare a Supplemental Environmental Impact Statement and Resource Management Plan Amendment for the Roan Plateau, CO AGENCY: Bureau of Land Management, Interior. ACTION: Notice of Intent...

76 FR 52690 - Final Environmental Impact Statement on Nabesna Off-Road Vehicle Management Plan, Wrangell-St...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-23

...-Road Vehicle Management Plan, Wrangell-St. Elias National Park and Preserve AGENCY: National Park... a Final Environmental Impact Statement (FEIS) on Off-Road Vehicle Management in the Nabesna District... preferred alternative and four action alternatives for management of off-road vehicles in the Nabesna...

76 FR 51395 - Draft Environmental Impact Statement for the General Management Plan (DEIS/GMP), Canaveral...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-18

... Statement for the General Management Plan (DEIS/GMP), Canaveral National Seashore, FL AGENCY: National Park... General Management Plan (DEIS/GMP), Canaveral National Seashore (Seashore). SUMMARY: Pursuant to 42 U.S.C... DEIS/GMP for Canaveral National Seashore, Florida. The document provides a framework for management...

76 FR 3652 - Dog Management Plan/Environmental Impact Statement, Golden Gate National Recreation Area, California

Federal Register 2010, 2011, 2012, 2013, 2014

2011-01-20

... DEPARTMENT OF THE INTERIOR National Park Service [8145-8B90-SZM] Dog Management Plan/Environmental...: Notice of Availability of a Draft Environmental Impact Statement for the Dog Management Plan, Golden Gate... the Dog Management Plan (Draft Plan/EIS), Golden Gate National Recreation Area (GGNRA), California...

Applications for detection of acute kidney injury using electronic medical records and clinical information systems: workgroup statements from the 15(th) ADQI Consensus Conference.

PubMed

James, Matthew T; Hobson, Charles E; Darmon, Michael; Mohan, Sumit; Hudson, Darren; Goldstein, Stuart L; Ronco, Claudio; Kellum, John A; Bagshaw, Sean M

2016-01-01

Electronic medical records and clinical information systems are increasingly used in hospitals and can be leveraged to improve recognition and care for acute kidney injury. This Acute Dialysis Quality Initiative (ADQI) workgroup was convened to develop consensus around principles for the design of automated AKI detection systems to produce real-time AKI alerts using electronic systems. AKI alerts were recognized by the workgroup as an opportunity to prompt earlier clinical evaluation, further testing and ultimately intervention, rather than as a diagnostic label. Workgroup members agreed with designing AKI alert systems to align with the existing KDIGO classification system, but recommended future work to further refine the appropriateness of AKI alerts and to link these alerts to actionable recommendations for AKI care. The consensus statements developed in this review can be used as a roadmap for development of future electronic applications for automated detection and reporting of AKI.

Defining Futile and Potentially Inappropriate Interventions: A Policy Statement From the Society of Critical Care Medicine Ethics Committee.

PubMed

Kon, Alexander A; Shepard, Eric K; Sederstrom, Nneka O; Swoboda, Sandra M; Marshall, Mary Faith; Birriel, Barbara; Rincon, Fred

2016-09-01

The Society of Critical Care Medicine and four other major critical care organizations have endorsed a seven-step process to resolve disagreements about potentially inappropriate treatments. The multiorganization statement (entitled: An official ATS/AACN/ACCP/ESICM/SCCM Policy Statement: Responding to Requests for Potentially Inappropriate Treatments in Intensive Care Units) provides examples of potentially inappropriate treatments; however, no clear definition is provided. This statement was developed to provide a clear definition of inappropriate interventions in the ICU environment. A subcommittee of the Society of Critical Care Medicine Ethics Committee performed a systematic review of empirical research published in peer-reviewed journals as well as professional organization position statements to generate recommendations. Recommendations approved by consensus of the full Society of Critical Care Medicine Ethics Committees and the Society of Critical Care Medicine Council were included in the statement. ICU interventions should generally be considered inappropriate when there is no reasonable expectation that the patient will improve sufficiently to survive outside the acute care setting, or when there is no reasonable expectation that the patient's neurologic function will improve sufficiently to allow the patient to perceive the benefits of treatment. This definition should not be considered exhaustive; there will be cases in which life-prolonging interventions may reasonably be considered inappropriate even when the patient would survive outside the acute care setting with sufficient cognitive ability to perceive the benefits of treatment. When patients or surrogate decision makers demand interventions that the clinician believes are potentially inappropriate, the seven-step process presented in the multiorganization statement should be followed. Clinicians should recognize the limits of prognostication when evaluating potential neurologic outcome and terminal cases. At times, it may be appropriate to provide time-limited ICU interventions to patients if doing so furthers the patient's reasonable goals of care. If the patient is experiencing pain or suffering, treatment to relieve pain and suffering is always appropriate. The Society of Critical Care Medicine supports the seven-step process presented in the multiorganization statement. This statement provides added guidance to clinicians in the ICU environment.

41 CFR 105-53.112 - General statement of functions.

Code of Federal Regulations, 2010 CFR

2010-07-01

... contracting; real and personal property management; transportation, public transportation, public utilities... 41 Public Contracts and Property Management 3 2010-07-01 2010-07-01 false General statement of functions. 105-53.112 Section 105-53.112 Public Contracts and Property Management Federal Property...

44 CFR 5.81 - Statement of policy.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Statement of policy. 5.81 Section 5.81 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND SECURITY GENERAL PRODUCTION OR DISCLOSURE OF INFORMATION Subpoenas or Other Legal Demands for...

How to avoid the inappropriate use of antibiotics in upper respiratory tract infections? A position statement from an expert panel.

PubMed

Piltcher, Otávio Bejzman; Kosugi, Eduardo Macoto; Sakano, Eulalia; Mion, Olavo; Testa, José Ricardo Gurgel; Romano, Fabrizio Ricci; Santos, Marco Cesar Jorge; Di Francesco, Renata Cantisani; Mitre, Edson Ibrahim; Bezerra, Thiago Freire Pinto; Roithmann, Renato; Padua, Francini Greco; Valera, Fabiana Cardoso Pereira; Lubianca Neto, José Faibes; Sá, Leonardo Conrado Barbosa; Pignatari, Shirley Shizue Nagata; Avelino, Melissa Ameloti Gomes; Caixeta, Juliana Alves de Souza; Anselmo-Lima, Wilma Terezinha; Tamashiro, Edwin

Bacterial resistance burden has increased in the past years, mainly due to inappropriate antibiotic use. Recently it has become an urgent public health concern due to its impact on the prolongation of hospitalization, an increase of total cost of treatment and mortality associated with infectious disease. Almost half of the antimicrobial prescriptions in outpatient care visits are prescribed for acute upper respiratory infections, especially rhinosinusitis, otitis media, and pharyngotonsillitis. In this context, otorhinolaryngologists play an important role in orienting patients and non-specialists in the utilization of antibiotics rationally and properly in these infections. To review the most recent recommendations and guidelines for the use of antibiotics in acute otitis media, acute rhinosinusitis, and pharyngotonsillitis, adapted to our national reality. A literature review on PubMed database including the medical management in acute otitis media, acute rhinosinusitis, and pharyngotonsillitis, followed by a discussion with a panel of specialists. Antibiotics must be judiciously prescribed in uncomplicated acute upper respiratory tract infections. The severity of clinical presentation and the potential risks for evolution to suppurative and non-suppurative complications must be taken into 'consideration'. Periodic revisions on guidelines and recommendations for treatment of the main acute infections are necessary to orient rationale and appropriate use of antibiotics. Continuous medical education and changes in physicians' and patients' behavior are required to modify the paradigm that all upper respiratory infection needs antibiotic therapy, minimizing the consequences of its inadequate and inappropriate use. Copyright © 2018 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.

Acute exacerbations of chronic bronchitis: a pharmacoeconomic review of antibacterial use.

PubMed

Morris, Stephen; Anderson, Pippa; Irwin, Debra E

2002-01-01

Chronic bronchitis is a common problem affecting a large proportion of the adult population. People with chronic bronchitis are subject to recurrent attacks of bronchial inflammation called acute exacerbations of chronic bronchitis (AECBs). In patients with AECBs, symptoms may worsen due to a bacterial infection; the exacerbation is then known as an acute bacterial exacerbation of chronic bronchitis (ABECB). ABECBs are thought to be controllable through the use of antibacterial agents. In this paper we review current evidence on the cost of chronic bronchitis and AECBs, the cost effectiveness of antibacterials in the management of ABECB, and the factors that may affect the cost-effectiveness of antibacterials in the management of ABECB. We find that the number of economic evaluations conducted in this area is small. Of the few economic evaluations that have been conducted there has been only one prospective economic evaluation based on a clinical trial. The remainder are simple decision analysis-based modelling studies or retrospective database studies. Our principle findings are as follows: a key factor affecting the cost-effective use of antibacterials in the management of ABECB is the definitive diagnosis of the condition. Unfortunately, diagnosing a bacterial cause of an AECB is difficult, which presents problems in ensuring that antibacterials are not prescribed unnecessarily;current evidence suggests but does not prove that use of more effective but more costly first-line antibacterials may be relatively cost effective and may minimise overall expenditure by reducing the high costs associated with treatment failure;chronic bronchitis and AECB have a significant and negative physical and psychological effect on health-related quality of life. In conclusion, the small number of economic evaluations conducted in this area, coupled with the nature of the design of these studies, precludes a definitive statement recommending which specific antibacterial should be preferred on cost-effectiveness grounds for the management of ABECB. On the basis of our findings we suggest some topics for further research.

17 CFR 274.11A - Form N-1A, registration statement of open-end management investment companies.

Code of Federal Regulations, 2010 CFR

2010-04-01

... statement of open-end management investment companies. 274.11A Section 274.11A Commodity and Securities...(b) of the Investment Company Act of 1940 by open-end management investment companies other than... registration under the Securities Act of 1933 of the securities of all open-end management investment companies...

17 CFR 239.17a - Form N-3, registration statement for separate accounts organized as management investment companies.

Code of Federal Regulations, 2010 CFR

2010-04-01

... statement for separate accounts organized as management investment companies. 239.17a Section 239.17a... accounts organized as management investment companies. Form N-3 shall be used for registration under the... register under the Investment Company Act of 1940 as management investment companies, and certain other...

75 FR 44981 - Notice of Availability of the Final Environmental Impact Statement for Vegetation Treatments...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-30

... Treatments Using Herbicides on Bureau of Land Management Lands in Oregon AGENCY: Bureau of Land Management... Impact Statement (EIS) for Vegetation Treatments Using Herbicides on Bureau of Land Management lands in... herbicides currently in use on BLM- managed lands in Oregon and increase the number of objectives for which...

12 CFR 18.1 - Purpose and OMB control number.

Code of Federal Regulations, 2010 CFR

2010-01-01

... annual financial disclosure statement, and to make this statement available to security holders... statement with narrative information management deems important. The availability of this information is...

Clinical practice guidelines for the management of metastatic colorectal cancer: a consensus statement of the Hellenic Society of Medical Oncologists (HeSMO)

PubMed Central

Dervenis, Christos; Xynos, Evaghelos; Sotiropoulos, George; Gouvas, Nikolaos; Boukovinas, Ioannis; Agalianos, Christos; Androulakis, Nikolaos; Athanasiadis, Athanasios; Christodoulou, Christos; Chrysou, Evangelia; Emmanouilidis, Christos; Georgiou, Panagiotis; Karachaliou, Niki; Katopodi, Ourania; Kountourakis, Panteleimon; Kyriazanos, Ioannis; Makatsoris, Thomas; Papakostas, Pavlos; Papamichael, Demetris; Pechlivanides, George; Pentheroudakis, Georgios; Pilpilidis, Ioannis; Sgouros, Joseph; Tekkis, Paris; Triantopoulou, Charina; Tzardi, Maria; Vassiliou, Vassilis; Vini, Louiza; Xynogalos, Spyridon; Ziras, Nikolaos; Souglakos, John

2016-01-01

There is discrepancy and failure to adhere to current international guidelines for the management of metastatic colorectal cancer (CRC) in hospitals in Greece and Cyprus. The aim of the present document is to provide a consensus on the multidisciplinary management of metastastic CRC, considering both special characteristics of our Healthcare System and international guidelines. Following discussion and online communication among the members of an executive team chosen by the Hellenic Society of Medical Oncology (HeSMO), a consensus for metastastic CRC disease was developed. Statements were subjected to the Delphi methodology on two voting rounds by invited multidisciplinary international experts on CRC. Statements reaching level of agreement by ≥80% were considered as having achieved large consensus, whereas statements reaching 60-80% moderate consensus. One hundred and nine statements were developed. Ninety experts voted for those statements. The median rate of abstain per statement was 18.5% (range: 0-54%). In the end of the process, all statements achieved a large consensus. The importance of centralization, care by a multidisciplinary team, adherence to guidelines, and personalization is emphasized. R0 resection is the only intervention that may offer substantial improvement in the oncological outcomes. PMID:27708505

The Chinese Stroke Association scientific statement: intravenous thrombolysis in acute ischaemic stroke

PubMed Central

Dong, Qiang; Dong, Yi; Liu, Liping; Xu, Anding; Zhang, Yusheng; Zheng, Huaguang; Wang, Yongjun

2017-01-01

The most effective medical treatment for acute ischaemic stroke (AIS) is to offer intravenous thrombolysis during the ultra-early period of time after the onset. Even based on the Consensus of Chinese Experts on Intravenous Thrombolysis for AIS in 2012 and 2014 Chinese Guidelines on the Diagnosis and Treatment of AIS, the rate of thrombolysis for AIS in China remained around 2.4%, and the rate of intravenous tissue plasminogen activator usage was only about 1.6% in real world. The indication of thrombolysis for AIS has been expanded, and contraindications have been reduced with recently published studies. In order to facilitate the standardisation of treating AIS, improve the rate of thrombolysis and benefit patients who had a stroke, Chinese Stroke Association has organised and developed this scientific statement. PMID:28989804

Medication appropriateness tool for co-morbid health conditions in dementia: consensus recommendations from a multidisciplinary expert panel.

PubMed

Page, A T; Potter, K; Clifford, R; McLachlan, A J; Etherton-Beer, C

2016-10-01

Medication management for people living with dementia is a complex task as it is unclear what constitutes optimal medication management in this population due to the shifting focus of health priorities and the balance between the benefits and harms of medications. This study sought expert opinion to create a consensus list to define appropriate medication management of co-morbidities for people with dementia. This study used the Delphi technique. We invited multidisciplinary experts in geriatric therapeutics including pharmacists, doctors, nurse practitioners, a patient advocate and a psychologist to participate. Participants were asked to engage into three or more rounds of questioning. Round 1 was a questionnaire comprised of one question defining dementia and seven open-ended questions about appropriate management of co-morbidities in people with dementia. Two investigators qualitatively analysed the responses to questions from Round 1 using thematic analysis. The results of this analysis were provided to participants as statements in the Round 2 survey. The participants were asked to rate their agreement with each statement on a 5-point Likert scale. The median and interquartile range (IQR) were calculated for the responses to each statement. Consensus was pre-specified as an IQR less than or equal to 1. Statements where consensus was not achieved were presented to participants in Round 3. The Round 2 median and IQR values were provided and participants were again asked to rate their agreement with each statement on a 5-point Likert scale. The statements where participants agreed or strongly agreed were included in the Medication Appropriateness Tool for Co-morbid Health conditions in Dementia criteria. Fifty-seven experts agreed to participate in the study, of whom 58% were pharmacists and 36% were medical practitioners. Fifty-five participants completed the Round 1 (95% response rate). A total of 128 statements was included in the Round 2 survey. Consensus was reached on 93 statements in Round 2 (n = 48 responders, 84% response rate) and on 18 statements in Round 3 (n = 43 responders, 75% response rate). The participants reached consensus on 111 of 128 statements. Of these statements, 67 statements were included in the Medication Appropriateness Tool for Co-morbid Health conditions in Dementia criteria. The statements were in the broad themes of preventative medication, symptom management, disease progression, psychoactive medication, treatment goals, principles of medication use, side-effects and medication reviews. This research provides consensus-based guidance for clinicians who manage co-morbid health conditions in people with dementia. © 2016 The Authors. Internal Medicine Journal by Wiley Publishing Asia Pty Ltd on behalf of Royal Australasian College of Physicians.

Financial statement analysis, internal controls, and audit readiness: Bestpractices for Pakistan army financial management officers

DTIC Science & Technology

2017-06-01

2012). Noland and Metrejean (2013) emphasize the importance of the internal control environment and cite the June 2010 case of a non -existent...NAVAL POSTGRADUATE SCHOOL MONTEREY, CALIFORNIA MBA PROFESSIONAL REPORT FINANCIAL STATEMENT ANALYSIS, INTERNAL CONTROLS , AND...FINANCIAL STATEMENT ANALYSIS, INTERNAL CONTROLS , AND AUDIT READINESS: BEST PRACTICES FOR PAKISTAN ARMY FINANCIAL MANAGEMENT OFFICERS 5. FUNDING NUMBERS 6

17 CFR 274.11 - Form N-1, registration statement of open-end management investment companies.

Code of Federal Regulations, 2010 CFR

2010-04-01

... statement of open-end management investment companies. 274.11 Section 274.11 Commodity and Securities Exchanges SECURITIES AND EXCHANGE COMMISSION (CONTINUED) FORMS PRESCRIBED UNDER THE INVESTMENT COMPANY ACT...(b) of the Investment Company Act of 1940 by open-end management investment companies that are...

17 CFR 230.486 - Effective date of post-effective amendments and registration statements filed by certain closed...

Code of Federal Regulations, 2010 CFR

2010-04-01

...-effective amendments and registration statements filed by certain closed-end management investment companies...-end management investment companies. (a) Automatic effectiveness. Except as otherwise provided in this... management investment company or business development company which makes periodic repurchase offers under...

Financial Management at the American Forces Information Service.

DTIC Science & Technology

1997-05-07

The Federal Financial Management Act of 1994, Public Law 103-356, requires DoD to provide FY 1996 consolidated financial statements to the Office of...Management and Budget. Financial data from the American Forces Information Service will be included in the DoD FY 1996 consolidated financial statements . In

43 CFR 3453.2-2 - Forms and statements.

Code of Federal Regulations, 2013 CFR

2013-10-01

... MANAGEMENT, DEPARTMENT OF THE INTERIOR MINERALS MANAGEMENT (3000) MANAGEMENT OF EXISTING LEASES Transfers by Assignment, Sublease or Otherwise § 3453.2-2 Forms and statements. (a) Transfers of any record title interest...) No specific form need be used for requests for approval of transfers. The request for approval shall...

43 CFR 3453.2-2 - Forms and statements.

Code of Federal Regulations, 2012 CFR

2012-10-01

... MANAGEMENT, DEPARTMENT OF THE INTERIOR MINERALS MANAGEMENT (3000) MANAGEMENT OF EXISTING LEASES Transfers by Assignment, Sublease or Otherwise § 3453.2-2 Forms and statements. (a) Transfers of any record title interest...) No specific form need be used for requests for approval of transfers. The request for approval shall...

[A statement the Polish Cardiac Society Working Group on Pulmonary Circulation on screening for CTEPH patients after acute pulmonary embolism].

PubMed

Ciurzyński, Michał; Kurzyna, Marcin; Kopeć, Grzegorz; Błaszczak, Piotr; Chrzanowski, Łukasz; Kamiński, Karol; Mizia-Stec, Katarzyna; Mularek-Kubzdela, Tatiana; Mroczek, Ewa; Biederman, Andrzej; Pruszczyk, Piotr; Torbicki, Adam

2017-01-01

Both pharmacological and invasive treatment of chronic thromboembolic pulmonary hypertension (CTEPH) is now available in Poland and the awareness of the disease among physicians is growing. Thus, the Polish Cardiac Society's Working Group on Pulmonary Circulation in cooperation with independent experts in this field, have launched the statement on algorithm to guide a CTEPH diagnosis in patients with previous acute pulmonary embolism (APE). In Poland, every year this disease affects about 250 patients. CTEPH should be suspected in individuals after APE with dyspnea, despite at least 3 months period of effective anticoagulation, particularly when specified risk factors are present. Echocardiography is a main screening tool. The authors suggest that a diagnostic process of patients with significant clinical suspicion of CTEPH and right ventricle overload in echocardiography should be performed in reference centres. The document contains a list of Polish centres diagnosing patients with suspected CTEPH. Pulmonary scintigraphy is a safe and highly sensitive screening test for CTEPH. Multi-detector computed tomography with precise detection of thromboembolic residues in pulmonary circulation is important for planning of pulmonary endarterectomy. Right heart catheterisation definitely confirms the presence of pulmonary hypertension and direct pulmonary angiography allows for identification of lesions suitable for thromboendarterectomy or pulmonary balloon angioplasty. In this document a diagnostic algorithm in patients with suspected CTEPH is also proposed. With individualised sequential diagnostic strategy each patient can be finally qualified for a particular mode of therapy by dedicated CTEPH Heart Team. Moreover the document contains short information for the primary care physician about the management of patients after APE.

Consensus on current management of endometriosis.

PubMed

Johnson, Neil P; Hummelshoj, Lone

2013-06-01

Is there a global consensus on the management of endometriosis that considers the views of women with endometriosis? It was possible to produce an international consensus statement on the current management of endometriosis through engagement of representatives of national and international, medical and non-medical societies with an interest in endometriosis. Management of endometriosis anywhere in the world has been based partially on evidence-based practices and partially on unsubstantiated therapies and approaches. Several guidelines have been developed by a number of national and international bodies, yet areas of controversy and uncertainty remain, not least due to a paucity of firm evidence. A consensus meeting, in conjunction with a pre- and post-meeting process, was undertaken. A consensus meeting was held on 8 September 2011, in conjunction with the 11th World Congress on Endometriosis in Montpellier, France. A rigorous pre- and post-meeting process, involving 56 representatives of 34 national and international, medical and non-medical organizations from a range of disciplines, led to this consensus statement. A total of 69 consensus statements were developed. Seven statements had unanimous consensus; however, none of the statements were made without expression of a caveat about the strength of the statement or the statement itself. Only two statements failed to achieve majority consensus. The statements covered global considerations, the role of endometriosis organizations, support groups, centres or networks of expertise, the impact of endometriosis throughout a woman's life course, and a full range of treatment options for pain, infertility and other symptoms related to endometriosis. This consensus process differed from that of formal guideline development. A different group of international experts from those participating in this process would likely have yielded subtly different consensus statements. This is the first time that a large, global, consortium, representing 34 major stake-holding organizations from five continents, has convened to systematically evaluate the best available current evidence on the management of endometriosis, and to reach consensus. In addition to 18 international medical organizations, representatives from 16 national endometriosis organizations were involved, including lay support groups, thus generating input from women who suffer from endometriosis.

Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association.

PubMed

McCrindle, Brian W; Rowley, Anne H; Newburger, Jane W; Burns, Jane C; Bolger, Anne F; Gewitz, Michael; Baker, Annette L; Jackson, Mary Anne; Takahashi, Masato; Shah, Pinak B; Kobayashi, Tohru; Wu, Mei-Hwan; Saji, Tsutomu T; Pahl, Elfriede

2017-04-25

Kawasaki disease is an acute vasculitis of childhood that leads to coronary artery aneurysms in ≈25% of untreated cases. It has been reported worldwide and is the leading cause of acquired heart disease in children in developed countries. To revise the previous American Heart Association guidelines, a multidisciplinary writing group of experts was convened to review and appraise available evidence and practice-based opinion, as well as to provide updated recommendations for diagnosis, treatment of the acute illness, and long-term management. Although the cause remains unknown, discussion sections highlight new insights into the epidemiology, genetics, pathogenesis, pathology, natural history, and long-term outcomes. Prompt diagnosis is essential, and an updated algorithm defines supplemental information to be used to assist the diagnosis when classic clinical criteria are incomplete. Although intravenous immune globulin is the mainstay of initial treatment, the role for additional primary therapy in selected patients is discussed. Approximately 10% to 20% of patients do not respond to initial intravenous immune globulin, and recommendations for additional therapies are provided. Careful initial management of evolving coronary artery abnormalities is essential, necessitating an increased frequency of assessments and escalation of thromboprophylaxis. Risk stratification for long-term management is based primarily on maximal coronary artery luminal dimensions, normalized as Z scores, and is calibrated to both past and current involvement. Patients with aneurysms require life-long and uninterrupted cardiology follow-up. These recommendations provide updated and best evidence-based guidance to healthcare providers who diagnose and manage Kawasaki disease, but clinical decision making should be individualized to specific patient circumstances. © 2017 American Heart Association, Inc.

Concussion-Management Practice Patterns of National Collegiate Athletic Association Division II and III Athletic Trainers: How the Other Half Lives.

PubMed

Buckley, Thomas A; Burdette, Glenn; Kelly, Kassandra

2015-08-01

The National Collegiate Athletic Association (NCAA) has published concussion-management practice guidelines consistent with recent position and consensus statements. Whereas NCAA Division I athletic trainers appear highly compliant, little is known about the concussion-management practice patterns of athletic trainers at smaller institutions where staffing and resources may be limited. To descriptively define the concussion-management practice patterns of NCAA Division II and III athletic trainers. Cross-sectional study. Web-based questionnaire. A total of 755 respondents (response rate = 40.2%) from NCAA Division II and Division III institutions. The primary outcome measures were the rate of multifaceted concussion-assessment techniques, defined as 3 or more assessments; the specific practice patterns of each assessment battery; and tests used during a clinical examination. Most respondents indicated using a multifaceted assessment during acute assessment (Division II = 76.9%, n = 473; Division III = 76.0%, n = 467) and determination of recovery (Division II = 65.0%, n = 194; Division III = 63.1%, n = 288) but not at baseline (Division II = 43.1%, n = 122; Division III = 41.0%, n = 176). Typically, when a postconcussion assessment was initiated, testing occurred daily until baseline values were achieved, and most respondents (80.6% [244/278]) reported using a graded exercise protocol before return to participation. We found limited use of the multifaceted assessment battery at baseline but higher rates at both acute assessment and return-to-participation time points. A primary reason cited for not using test-battery components was a lack of staffing or funding for the assessments. We observed limited use of neuropsychologists to interpret neuropsychological testing. Otherwise, most respondents reported concussion-management protocols consistent with recommendations, including a high level of use of objective measures and incorporation of a progressive return-to-participation protocol.

Applicability of the National Comprehensive Cancer Network/Multinational Association of Supportive Care in Cancer Guidelines for Prevention and Management of Chemotherapy-Induced Nausea and Vomiting in Southeast Asia: A Consensus Statement.

PubMed

Chan, Alexandre; Abdullah, Matin M; Ishak, Wan Zamaniah B Wan; Ong-Cornel, Annielyn B; Villalon, Antonio H; Kanesvaran, Ravindran

2017-12-01

A meeting of regional experts was convened in Manila, Philippines, to develop a resource-stratified chemotherapy-induced nausea and vomiting (CINV) management guideline. In patients treated with highly emetogenic chemotherapy in general clinical settings, triple therapy with a serotonin (5-hydroxytryptamine-3 [5-HT 3 ]) antagonist (preferably palonosetron), dexamethasone, and aprepitant is recommended for acute CINV prevention. In resource-restricted settings, triple therapy is still recommended, although a 5-HT 3 antagonist other than palonosetron may be used. In both general and resource-restricted settings, dual therapy with dexamethasone (days 2 to 4) and aprepitant (days 2 to 3) is recommended to prevent delayed CINV. In patients treated with moderately emetogenic chemotherapy, dual therapy with a 5-HT 3 antagonist, preferably palonosetron, and dexamethasone is recommended for acute CINV prevention in general settings; any 5-HT 3 antagonist can be combined with dexamethasone in resource-restricted environments. In general settings, for the prevention of delayed CINV associated with moderately emetogenic chemotherapy, corticosteroid monotherapy on days 2 and 3 is recommended. If aprepitant is used on day 1, it should be continued on days 2 and 3. Prevention of delayed CINV with corticosteroids is preferred in resource-restricted settings. The expert panel also developed CINV management guidelines for anthracycline plus cyclophosphamide combination schedules, multiday cisplatin, and chemotherapy with low or minimal emetogenic potential, and its recommendations are detailed in this review. Overall, these regional guidelines provide definitive guidance for CINV management in general and resource-restricted settings. These consensus recommendations are anticipated to contribute to collaborative efforts to improve CINV management in Southeast Asia.

Applicability of the National Comprehensive Cancer Network/Multinational Association of Supportive Care in Cancer Guidelines for Prevention and Management of Chemotherapy-Induced Nausea and Vomiting in Southeast Asia: A Consensus Statement

PubMed Central

Abdullah, Matin M.; Ishak, Wan Zamaniah B. Wan; Ong-Cornel, Annielyn B.; Villalon, Antonio H.; Kanesvaran, Ravindran

2017-01-01

A meeting of regional experts was convened in Manila, Philippines, to develop a resource-stratified chemotherapy-induced nausea and vomiting (CINV) management guideline. In patients treated with highly emetogenic chemotherapy in general clinical settings, triple therapy with a serotonin (5-hydroxytryptamine-3 [5-HT3]) antagonist (preferably palonosetron), dexamethasone, and aprepitant is recommended for acute CINV prevention. In resource-restricted settings, triple therapy is still recommended, although a 5-HT3 antagonist other than palonosetron may be used. In both general and resource-restricted settings, dual therapy with dexamethasone (days 2 to 4) and aprepitant (days 2 to 3) is recommended to prevent delayed CINV. In patients treated with moderately emetogenic chemotherapy, dual therapy with a 5-HT3 antagonist, preferably palonosetron, and dexamethasone is recommended for acute CINV prevention in general settings; any 5-HT3 antagonist can be combined with dexamethasone in resource-restricted environments. In general settings, for the prevention of delayed CINV associated with moderately emetogenic chemotherapy, corticosteroid monotherapy on days 2 and 3 is recommended. If aprepitant is used on day 1, it should be continued on days 2 and 3. Prevention of delayed CINV with corticosteroids is preferred in resource-restricted settings. The expert panel also developed CINV management guidelines for anthracycline plus cyclophosphamide combination schedules, multiday cisplatin, and chemotherapy with low or minimal emetogenic potential, and its recommendations are detailed in this review. Overall, these regional guidelines provide definitive guidance for CINV management in general and resource-restricted settings. These consensus recommendations are anticipated to contribute to collaborative efforts to improve CINV management in Southeast Asia. PMID:29244998

American Society for Pain Management nursing position statement: pain management in patients with substance use disorders.

PubMed

Oliver, June; Coggins, Candace; Compton, Peggy; Hagan, Susan; Matteliano, Deborah; Stanton, Marsha; St Marie, Barbara; Strobbe, Stephen; Turner, Helen N

2012-10-01

The American Society for Pain Management Nursing (ASPMN) has updated its position statement on managing pain in patients with substance use disorders. This position statement is endorsed by the International Nurses Society on Addictions (IntNSA) and includes clinical practice recommendations based on current evidence. It is the position of ASPMN and IntNSA that every patient with pain, including those with substance use disorders, has the right to be treated with dignity, respect, and high-quality pain assessment and management. Failure to identify and treat the concurrent conditions of pain and substance use disorders will compromise the ability to treat either condition effectively. Barriers to caring for these patients include stigmatization, misconceptions, and limited access to providers skilled in these two categories of disorders. Topics addressed in this position statement include the scope of substance use and related disorders, conceptual models of addiction, ethical considerations, addiction risk stratification, and clinical recommendations.

77 FR 12877 - Record of Decision for the General Management Plan/Abbreviated Final Environmental Impact...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-02

... Decision for the General Management Plan/Abbreviated Final Environmental Impact Statement for New River... Abbreviated Final Environmental Impact Statement for the General Management Plan for New River Gorge National... Record of Decision can be downloaded from the NPS Planning, Environment and Public Comment (PEPC) Web...

75 FR 60721 - Notice of Intent to Prepare a Programmatic Environmental Impact Statement on Implementing...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-01

... Impact Statement (PEIS) to analyze the environmental impacts of implementing specific management actions... responsible for management of Hawaiian monk seals, under the Endangered Species Act (ESA; 16 U.S.C. 1531 et... to levels at which ESA protection is no longer needed. Research, enhancement, and management...

77 FR 7178 - Notice of Correction to Notice of Intent To Prepare Environmental Impact Statements and...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-02-10

... Impact Statements To Incorporate Greater Sage-grouse Conservation Measures Into Land Use Plans and Land Management Plans AGENCY: Bureau of Land Management, Interior. ACTION: Notice of Correction. SUMMARY: The BLM... Supplemental EISs, extends the scoping period, and adds 11 Forest Service Land Management Plans (LMPs) to this...

75 FR 15427 - Notice of Intent To Prepare an Environmental Impact Statement/Staff Assessment for the Proposed...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-29

... Management Notice of Intent To Prepare an Environmental Impact Statement/ Staff Assessment for the Proposed... Land Use Plan Amendments AGENCY: Western Area Power Administration, DOE; Bureau of Land Management, DOI... Land Policy and Management Act of 1976 (FLPMA), as amended, and the California Environmental Quality...

75 FR 4413 - Notice of Intent to Prepare an Environmental Impact Statement for a General Management Plan...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-01-27

... to this initial phase of developing the general management plan/wilderness study/environmental impact... DEPARTMENT OF THE INTERIOR National Park Service Notice of Intent to Prepare an Environmental Impact Statement for a General Management Plan Amendment/Wilderness Study, for Gates of the Arctic...

77 FR 42758 - Notice of Availability of the Prehistoric Trackways National Monument Draft Resource Management...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-07-20

... Environmental Impact Statement, New Mexico AGENCY: Bureau of Land Management, Interior. ACTION: Notice of availability. SUMMARY: In accordance with the National Environmental Policy Act of 1969, as amended, and the... prepared a Draft Resource Management Plan (RMP) and Draft Environmental Impact Statement (EIS) for the...

77 FR 65401 - Notice of Availability of the Final Environmental Impact Statement for the Restoration Design...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-26

... DEPARTMENT OF THE INTERIOR Bureau of Land Management [LLAZ910000.L13400000.DT0000.LXSS058A0000] Notice of Availability of the Final Environmental Impact Statement for the Restoration Design Energy Project and Proposed Resource Management Plan Amendments, AZ AGENCY: Bureau of Land Management, Interior...

41 CFR 105-74.205 - What must I include in my drug-free workplace statement?

Code of Federal Regulations, 2010 CFR

2010-07-01

... 41 Public Contracts and Property Management 3 2010-07-01 2010-07-01 false What must I include in my drug-free workplace statement? 105-74.205 Section 105-74.205 Public Contracts and Property Management Federal Property Management Regulations System (Continued) GENERAL SERVICES ADMINISTRATION...

75 FR 74742 - Notice of Extension of Public Comment Period to Notice of Availability of the Draft Jarbidge...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-01

... Resource Management Plan and Environmental Impact Statement, Idaho AGENCY: Bureau of Land Management... Availability of the Draft Jarbidge Field Office Resource Management Plan (RMP) and Environmental Impact Statement (EIS) in the Federal Register on September 3, 2010 [75 FR 54177] and [[Page 74743

77 FR 36573 - DRAFT General Management Plan and Draft Environmental Impact Statement, Fort Matanzas National...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-19

... Statement (EIS) for the General Management Plan (GMP) for Fort Matanzas National Monument (Monument... EIS/GMP describes the NPS preferred alternative--Alternative B--to guide the management of the... prescriptions to ensure protection, access and enjoyment of the Monument's resources. An up-to-date GMP is...

78 FR 2685 - Notice of Intent To Prepare a Programmatic Environmental Impact Statement (EIS) for the Navajo...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-01-14

... Environmental Impact Statement (EIS) for the Navajo Nation Integrated Weed Management Plan Within Coconino...-year integrated weed management plan for the Navajo Indian Reservation. The Navajo Indian Reservation... integrated weed management plan include, but will not be limited to, mechanical, cultural, biological and...

76 FR 45515 - Second Notice of Intent To Prepare an Environmental Impact Statement Related to Two Joint State...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-29

... Resource Management Plans for Puget Sound Hatchery Programs and Reopening of Comment Period AGENCY... prepare an Environmental Impact Statement (EIS) for two hatchery Resource Management Plans and appended Hatchery and Genetic Management Plans (HGMPs) jointly proposed by the Washington Department of Fish and...

American Society for Pain Management nursing position statement: pain management in patients with substance use disorders.

PubMed

Oliver, June; Coggins, Candace; Compton, Peggy; Hagan, Susan; Matteliano, Deborah; Stanton, Marsha; St Marie, Barbara; Strobbe, Stephen; Turner, Helen N

2012-09-01

The American Society for Pain Management Nursing (ASPMN) has updated its position statement on managing pain in patients with substance use disorders. This position statement is endorsed by the International Nurses Society on Addictions (IntNSA) and includes clinical practice recommendations based on current evidence. It is the position of ASPMN and IntNSA that every patient with pain, including those with substance use disorders, has the right to be treated with dignity, respect, and high-quality pain assessment and management. Failure to identify and treat the concurrent conditions of pain and substance use disorders will compromise the ability to treat either condition effectively. Barriers to caring for these patients include stigmatization, misconceptions, and limited access to providers skilled in these two categories of disorders. Topics addressed in this position statement include the scope of substance use and related disorders, conceptual models of addiction, ethical considerations, addiction risk stratification, and clinical recommendations. Copyright © 2012 International Nursing Society on Addiction (IntNSA) and the American Society for Pain Management Nursing (ASPMN). Published by Elsevier Inc. All rights reserved.

Measuring financial performance: an overview of financial statements.

PubMed

Dalsted, N L

1995-07-01

Financial management has emerged as a critical component in the long-term viability of today's ranches and farms. Proper and timely financial reporting and analysis of financial statements are valuable tools that agricultural producers can use to monitor, coordinate, and plan their operational production and marketing schemes and strategies. A side note to preparation of financial statements. With the concerns over lender liability issues associated with statements either assisted with or prepared by a lending officer, agricultural producers will be responsible for preparing their own statements. The lending institutions may prepare their own statements in their assessment of the financial condition of a business and or individual, but, ultimately, the responsibility of financial statements is the borrower's. Some of the material presented in this article provides important input for use in such analytical programs as the National Cattlemen's Association, Integrated Resource Committees, and Standard Performance Analysis (SPA). SPA techniques and associated software have been or currently are under development for cow-calf, stocker, seedstock, and sheep enterprises. Critical to the analysis is having complete and correct financial statements. These analytical programs build on the financial statements. These analytical programs build on the financial statements as recommended by the FFSTF. Proper financial reporting is critical not only to a SPA assessment but also to the overall financial management of today's farms and ranches. Recognizing the importance of financial management in production agriculture is not enough, taking a proactive stance in one's financial plan is paramount to success. Failure to do so will only enhance the exit rates of producers from production agriculture.

Nurses' Educational Needs Assessment for Financial Management Education Using the Nominal Group Technique.

PubMed

Noh, Wonjung; Lim, Ji Young

2015-06-01

The purpose of this study was to identify the financial management educational needs of nurses in order to development an educational program to strengthen their financial management competencies. Data were collected from two focus groups using the nominal group technique. The study consisted of three steps: a literature review, focus group discussion using the nominal group technique, and data synthesis. After analyzing the results, nine key components were selected: corporate management and accounting, introduction to financial management in hospitals, basic structure of accounting, basics of hospital accounting, basics of financial statements, understanding the accounts of financial statements, advanced analysis of financial statements, application of financial management, and capital financing of hospitals. The present findings can be used to develop a financial management education program to strengthen the financial management competencies of nurses. Copyright © 2015. Published by Elsevier B.V.

49 CFR Appendix II to Part 805 - Employees Required To Submit Statements

Code of Federal Regulations, 2010 CFR

2010-10-01

...—Employees Required To Submit Statements Statements of employment and financial interests are required of the... 49 Transportation 7 2010-10-01 2010-10-01 false Employees Required To Submit Statements II...) Office of the managing director: (1) Legislative affairs officer. (2) Program analysis officer. (d...

Highlights: Selected Statements from the Literature on Collaboration and Coordination.

ERIC Educational Resources Information Center

Roberts, Jane

Thirty documents selected from the literature on educational change, social systems, and management and organization were searched for statements considered relevant to collaboration and coordination between organizational units. These statements, either quoted or paraphrased, are listed in this report along with their sources. The statements are…

2 CFR 182.205 - What must I include in my drug-free workplace statement?

Code of Federal Regulations, 2010 CFR

2010-01-01

... workplace statement? 182.205 Section 182.205 Grants and Agreements OFFICE OF MANAGEMENT AND BUDGET GOVERNMENTWIDE GUIDANCE FOR GRANTS AND AGREEMENTS Reserved GOVERNMENTWIDE REQUIREMENTS FOR DRUG-FREE WORKPLACE... drug-free workplace statement? You must publish a statement that— (a) Tells your employees that the...

Evidence-based Modeling of Critical Illness: An Initial Consensus from the Society for Complexity in Acute Illness

PubMed Central

Vodovotz, Yoram; Clermont, Gilles; Hunt, C. Anthony; Lefering, Rolf; Bartels, John; Seydel, Ruediger; Hotchkiss, John; Ta'asan, Shlomo; Neugebauer, Edmund; An, Gary

2007-01-01

Introduction: Given the complexity of biological systems, understanding their dynamic behaviors, such as the Acute Inflammatory Response (AIR), requires a formal synthetic process. Dynamic Mathematical Modeling (DMM) represents a suite of methods intended for inclusion within the required synthetic framework. DMM, however, is a relatively novel approach in the practice of biomedical research. The Society for Complexity in Acute Illness (SCAI) was formed in 2004 from the leading research groups utilizing DMM in the study of acute inflammation. This Society believes that it is important to offer guidelines for the design, development and utilization of DMM in the setting of AIR research to avoid the “garbage-in garbage-out” problem. Accordingly, SCAI identified a need for and carried out a critical appraisal of DMM as currently used in the setting of acute illness. Methods: The SCAI annual meeting in 2005, the 4th International Conference on Complexity in Acute Illness (ICCAI; Cologne, Germany), was structured with the intent of developing a consensus statement on the methods and execution of DMM in AIR research. The conference was organized to include a series of interactive breakout sessions that included thought leaders from both the DMM and acute illness fields, the results of which were then presented in summary form to the entire group for discussion and consensus. The information in this manuscript represents the concatenation of those presentations. Results: The output from the 4th ICCAI involved consensus statements for the following topics: 1) the need for DMM, 2) a suggested approach for the process of establishing a modeling project, 3) the type of “wet” lab experiments and data needed to establish a modeling project, 4) general quality measures for data to be input to a modeling project, and 5) a descriptive list of several types of DMM to provide guidance in selection of a method for a project. Conclusion: We believe that the complexity of biological systems requires that DMM needs to be among the methods used to improve understanding and make progress with attempts to characterize and manipulate the AIR. We believe that this consensus statement will help guide the integration, rational implementation, and standardization of DMM into general biomedical research. PMID:17371750

Exercise and type 2 diabetes: American College of Sports Medicine and the American Diabetes Association: joint position statement. Exercise and type 2 diabetes.

PubMed

Colberg, Sheri R; Albright, Ann L; Blissmer, Bryan J; Braun, Barry; Chasan-Taber, Lisa; Fernhall, Bo; Regensteiner, Judith G; Rubin, Richard R; Sigal, Ronald J

2010-12-01

Although physical activity (PA) is a key element in the prevention and management of type 2 diabetes mellitus (T2DM), many with this chronic disease do not become or remain regularly active. High-quality studies establishing the importance of exercise and fitness in diabetes were lacking until recently, but it is now well established that participation in regular PA improves blood glucose control and can prevent or delay T2DM, along with positively affecting lipids, blood pressure, cardiovascular events, mortality, and quality of life. Structured interventions combining PA and modest weight loss have been shown to lower T2DM risk by up to 58% in high-risk populations. Most benefits of PA on diabetes management are realized through acute and chronic improvements in insulin action, accomplished with both aerobic and resistance training. The benefits of physical training are discussed, along with recommendations for varying activities, PA-associated blood glucose management, diabetes prevention, gestational diabetes, and safe and effective practices for PA with diabetes-related complications.

Exercise and type 2 diabetes: the American College of Sports Medicine and the American Diabetes Association: joint position statement.

PubMed

Colberg, Sheri R; Sigal, Ronald J; Fernhall, Bo; Regensteiner, Judith G; Blissmer, Bryan J; Rubin, Richard R; Chasan-Taber, Lisa; Albright, Ann L; Braun, Barry

2010-12-01

Although physical activity (PA) is a key element in the prevention and management of type 2 diabetes, many with this chronic disease do not become or remain regularly active. High-quality studies establishing the importance of exercise and fitness in diabetes were lacking until recently, but it is now well established that participation in regular PA improves blood glucose control and can prevent or delay type 2 diabetes, along with positively affecting lipids, blood pressure, cardiovascular events, mortality, and quality of life. Structured interventions combining PA and modest weight loss have been shown to lower type 2 diabetes risk by up to 58% in high-risk populations. Most benefits of PA on diabetes management are realized through acute and chronic improvements in insulin action, accomplished with both aerobic and resistance training. The benefits of physical training are discussed, along with recommendations for varying activities, PA-associated blood glucose management, diabetes prevention, gestational diabetes mellitus, and safe and effective practices for PA with diabetes-related complications.

20 CFR 266.3 - Information considered in determining whether to make representative payments.

Code of Federal Regulations, 2013 CFR

2013-04-01

... managing or directing the management of benefit payments. For example, a statement by a physician or other medical professional based upon his or her recent examination of the annuitant and his or her knowledge of... direct the management of benefit payments. (c) Other evidence. The Board may also consider statements of...

78 FR 57878 - Notice of Availability of the Proposed Bureau of Land Management Tres Rios Field Office and San...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-09-20

... and Resource Management Plan/Final Environmental Impact Statement AGENCY: Bureau of Land Management... Environmental Impact Statement (LRMP/Final EIS) for the San Juan Public Lands Planning Area in Colorado, and by... and woodlands; and other components of the biological, physical and cultural environment. Copies of...

75 FR 35079 - Notice of Intent To Prepare an Environmental Impact Statement for the Proposed Arturo Mine...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-21

... DEPARTMENT OF THE INTERIOR Bureau of Land Management [LLNVE00000 L51100000.GN0000 LVEMF1000580... Statement for the Proposed Arturo Mine Project, Elko County, NV AGENCY: Bureau of Land Management, Interior... amended, (NEPA) and the Federal Land Policy and Management Act of 1976, as amended, the Bureau of Land...

77 FR 42505 - Notice of Intent To Prepare an Environmental Impact Statement for the Proposed Long Canyon Mine...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-07-19

... DEPARTMENT OF THE INTERIOR Bureau of Land Management [LLNVE03000 L51100000.GN0000. LVEMF1201550... Statement for the Proposed Long Canyon Mine Project, Elko County, NV AGENCY: Bureau of Land Management... 1969 (NEPA), as amended, and the Federal Land Policy and Management Act (FLPMA) of 1976, as amended...

20 CFR 266.3 - Information considered in determining whether to make representative payments.

Code of Federal Regulations, 2010 CFR

2010-04-01

... managing or directing the management of benefit payments. For example, a statement by a physician or other medical professional based upon his or her recent examination of the annuitant and his or her knowledge of... direct the management of benefit payments. (c) Other evidence. The Board may also consider statements of...

77 FR 68814 - Notice of Availability of the Draft Environmental Impact Statement for the Gas Hills In Situ...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-11-16

... DEPARTMENT OF THE INTERIOR Bureau of Land Management [LLWYR05000.L51100000.GN0000.LVEMK10CW370-WYW... Recovery Uranium Project, Fremont and Natrona Counties, WY AGENCY: Bureau of Land Management, Interior... (NEPA), the Bureau of Land Management (BLM) has prepared a Draft Environmental Impact Statement (EIS...

75 FR 62112 - Intent To Prepare an Environmental Impact Statement (EIS) for the San Juan Creek and Tributaries...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-07

... Environmental Impact Statement (EIS) for the San Juan Creek and Tributaries Flood Risk Management Study, Orange... evaluate flood risk management alternative measures along the lower portions of San Juan, Trabuco, and Oso... Trabuco Creek have been channelized for flood risk management and erosion control within the City of San...

76 FR 45848 - Draft Environmental Impact Statement on a Denali Park Road Vehicle Management Plan for Denali...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-01

... DEPARTMENT OF THE INTERIOR National Park Service Draft Environmental Impact Statement on a Denali..., Interior. ACTION: Notice of availability of the Draft Environmental Impact Statement on a Denali Park Road... announces the availability of a Draft Environmental Impact Statement (DEIS) on a Denali Park Road Vehicle...

The level and determinants of mission statement use: a questionnaire survey.

PubMed

Desmidt, Sebastian; Prinzie, Anita; Heene, Aimé

2008-10-01

Although mission statements are one of the most popular management instruments, little is known about the nature and direction of the presumed relationship between mission statements and organizational performance. In particular, empirical insights into the degree of mission statement use by individual organizational members are insufficient. We address the observed knowledge gap by (a) measuring the level of mission statement use (e.g., explaining the mission statement, making linkages to extant programs or practices, communicating enthusiasm, and adapting the mission statement to the personal work situation) by individual organizational members, and (b) identifying the antecedents that influence mission statement use. Questionnaires were used to collect data from a sample of 510 nurses from three Flemish hospitals. Mission statement use was measured by means of Fairhurst's Management of Meaning Scale. Antecedents of mission statement use were derived from the Theory of Planned Behavior and the mission statement literature. The findings indicate that mission statement use is low on average. Attitude, subjective norm, perceived behavioral control, and formal involvement in mission statement communication proved to be significant determinants of mission statement use and accounted for 43% of the variance. The results of the conducted regression analyses indicate that nurses (a) who have a positive attitude towards the mission statement, (b) who perceive pressure from superiors and colleagues to use the mission statement, (c) who feel they are in control of performing such behavior, and (d) who are formally involved in the mission statement communication processes are more likely to use the mission statement. Furthermore, the results indicated that demographic characteristics are not associated with mission statement use. To effectively increase mission statement use, investments should focus on redesigning a work environment that stresses the importance of the organizational mission statement and provides detailed information on the ways that individual organizational members can contribute in realizing the mission statement.

Revisit, revamp, and revitalize your business plan: part 3.

PubMed

Waldron, David

2011-01-01

Managing with financial statements is discussed, including fundamental definitions and conventions related to this process such as an income statement and a balance sheet. Balanced scorecards and dashboards can be used to measure progress and to communicate achievements. Steps taken to defining data using KPIs, sourcing data, and structuring the scorecard are outlined. A core part of managing with financial statements is understanding how to drive the business and engage the staff using balanced scorecards.

Data principles for the U.S. Global Change Research Program

NASA Technical Reports Server (NTRS)

Ludwig, George H.; Shaffer, Lisa R.

1991-01-01

The U.S. Interagency Working Group on Data Management for Global Change has developed a set of data management and access principles. The overall purpose of these statements of principle is to stimulate responsible stewardship for data and related information and to facilitate full and open access to them. These statements have been accepted by the U.S. Agencies responsible for the Global Change Research Program. The statements of principle are presented and discussed.

Asian Organization for Crohn's and Colitis and Asia Pacific Association of Gastroenterology consensus on tuberculosis infection in patients with inflammatory bowel disease receiving anti-tumor necrosis factor treatment. Part 2: management.

PubMed

Park, Dong Il; Hisamatsu, Tadakazu; Chen, Minhu; Ng, Siew Chien; Ooi, Choon Jin; Wei, Shu Chen; Banerjee, Rupa; Hilmi, Ida Normiha; Jeen, Yoon Tae; Han, Dong Soo; Kim, Hyo Jong; Ran, Zhihua; Wu, Kaichun; Qian, Jiaming; Hu, Pin-Jin; Matsuoka, Katsuyoshi; Andoh, Akira; Suzuki, Yasuo; Sugano, Kentaro; Watanabe, Mamoru; Hibi, Toshifumi; Puri, Amarender S; Yang, Suk-Kyun

2018-01-01

Because anti-tumor necrosis factor (anti-TNF) therapy has become increasingly popular in many Asian countries, the risk of developing active tuberculosis (TB) among anti-TNF users may raise serious health problems in this region. Thus, the Asian Organization for Crohn's and Colitis and the Asia Pacific Association of Gastroenterology have developed a set of consensus statements about risk assessment, detection and prevention of latent TB infection, and management of active TB infection in patients with inflammatory bowel disease (IBD) receiving anti-TNF treatment. Twenty-three consensus statements were initially drafted and then discussed by the committee members. The quality of evidence and the strength of recommendations were assessed by using the Grading of Recommendations Assessment, Development, and Evaluation methodology. Web-based consensus voting was performed by 211 IBD specialists from 9 Asian countries concerning each statement. A consensus statement was accepted if at least 75% of the participants agreed. Part 2 of the statements comprised 3 parts: management of latent TB in preparation for anti-TNF therapy, monitoring during anti-TNF therapy, and management of an active TB infection after anti-TNF therapy. These consensus statements will help clinicians optimize patient outcomes by reducing the morbidity and mortality related to TB infections in patients with IBD receiving anti-TNF treatment.

Major obstetric haemorrhage of 2000 ml or greater: a clinical audit.

PubMed

O'Sullivan, J; Mansfield, R; Talbot, R; Cairns, A E

2018-05-04

Haemorrhage remains a leading cause of maternal death. We conducted an audit to identify strategies to improve the management at our local NHS Trust. A data collection form was based on our local guideline. A coded database search was conducted for all deliveries where the estimated blood loss was ≥2000 ml (from June 1 2015 to December 31 2015), returning 68 search results (13.7/1000 births). Fifty-six records were included. Poor compliance (<75%) was seen in some key areas including the major obstetric haemorrhage (MOH) call activation (52%), the presence of an anaesthetic consultant (63%) and tranexamic acid administration (46%). Thirty out of 56 cases (54%) were acutely transfused. Women, who were not transfused acutely, appeared to be more likely to need a secondary transfusion if no MOH call had been activated (9/27 (33%) versus 3/29 (10%), p = .052). A key area for improvement was the activation of MOH calls. Following this audit, we adjusted our guideline to make it more clinically useful and staff training sessions were held, including simulation training. Impact statement What is already known on this subject? A postpartum haemorrhage (PPH) is an obstetric emergency. A structured approach is important to optimise the care of the mothers during this dangerous time, and has been shown to reduce the transfusion requirements. However, clinical practice may not adhere to the guideline recommendations. What the results of this study add? With the objective evidence of increased rates of PPH ≥2000 ml at our institution, our work identifying the flaws in management was a critical component of the work to improve the outcomes. This study gives impetus to find innovative ways to improve adherence to guidelines, and inspired an update of our local guideline to improve the applicability and utility. This project suggests a new marker for the adequacy of an acute management (a requirement for secondary blood transfusion without having received an acute transfusion), and raises questions about what constitutes optimum PPH management. What the implications are of these findings for clinical practice and/or further research? The primary and secondary transfusion data raised new questions to investigate in the future: does the involvement of consultants and the escalation of care via the instigation of major haemorrhage protocols improve decision-making and patient outcomes? Does the necessity for a secondary transfusion indicate a suboptimal acute care?

SCAI expert consensus statement: Evaluation, management, and special considerations of cardio-oncology patients in the cardiac catheterization laboratory (Endorsed by the Cardiological Society of India, and Sociedad Latino Americana de Cardiologıa Intervencionista).

PubMed

Iliescu, Cezar; Grines, Cindy L; Herrmann, Joerg; Yang, Eric H; Cilingiroglu, Mehmet; Charitakis, Konstantinos; Hakeem, Abdul; Toutouzas, Konstantinos; Leesar, Massoud A; Marmagkiolis, Konstantinos

2016-04-01

In the United States alone, there are currently approximately 14.5 million cancer survivors, and this number is expected to increase to 20 million by 2020. Cancer therapies can cause significant injury to the vasculature, resulting in angina, acute coronary syndromes (ACS), stroke, critical limb ischemia, arrhythmias, and heart failure, independently from the direct myocardial or pericardial damage from the malignancy itself. Consequently, the need for invasive evaluation and management in the cardiac catheterization laboratory (CCL) for such patients has been increasing. In recognition of the need for a document on special considerations for cancer patients in the CCL, the Society for Cardiovascular Angiography and Interventions (SCAI) commissioned a consensus group to provide recommendations based on the published medical literature and on the expertise of operators with accumulated experience in the cardiac catheterization of cancer patients. © 2015 Wiley Periodicals, Inc.

SCAI Expert consensus statement: Evaluation, management, and special considerations of cardio-oncology patients in the cardiac catheterization laboratory (endorsed by the cardiological society of india, and sociedad Latino Americana de Cardiologıa intervencionista).

PubMed

Iliescu, Cezar A; Grines, Cindy L; Herrmann, Joerg; Yang, Eric H; Cilingiroglu, Mehmet; Charitakis, Konstantinos; Hakeem, Abdul; Toutouzas, Konstantinos P; Leesar, Massoud A; Marmagkiolis, Konstantinos

2016-04-01

In the United States alone, there are currently approximately 14.5 million cancer survivors, and this number is expected to increase to 20 million by 2020. Cancer therapies can cause significant injury to the vasculature, resulting in angina, acute coronary syndromes (ACS), stroke, critical limb ischemia, arrhythmias, and heart failure, independently from the direct myocardial or pericardial damage from the malignancy itself. Consequently, the need for invasive evaluation and management in the cardiac catheterization laboratory (CCL) for such patients has been increasing. In recognition of the need for a document on special considerations for cancer patients in the CCL, the Society for Cardiovascular Angiography and Interventions (SCAI) commissioned a consensus group to provide recommendations based on the published medical literature and on the expertise of operators with accumulated experience in the cardiac catheterization of cancer patients. © 2016 Wiley Periodicals, Inc.

How much is too much? (Part 2) International Olympic Committee consensus statement on load in sport and risk of illness

PubMed Central

Schwellnus, Martin; Alonso, Juan-Manuel; Bahr, Roald; Clarsen, Ben; Dijkstra, H Paul; Gabbett, Tim J; Gleeson, Michael; Hutchinson, Mark R; Janse Van Rensburg, Christa; Meeusen, Romain; Orchard, John W; Pluim, Babette M; Raftery, Martin; Budgett, Richard; Engebretsen, Lars

2016-01-01

The modern-day athlete participating in elite sports is exposed to high training loads and increasingly saturated competition calendar. Emerging evidence indicates that inappropriate load management is a significant risk factor for acute illness and the overtraining syndrome. The IOC convened an expert group to review the scientific evidence for the relationship of load—including rapid changes in training and competition load, competition calendar congestion, psychological load and travel—and health outcomes in sport. This paper summarises the results linking load to risk of illness and overtraining in athletes, and provides athletes, coaches and support staff with practical guidelines for appropriate load management to reduce the risk of illness and overtraining in sport. These include guidelines for prescription of training and competition load, as well as for monitoring of training, competition and psychological load, athlete well-being and illness. In the process, urgent research priorities were identified. PMID:27535991

Financial Management: Corps of Engineers Equipment Reporting on Financial Statements for FY 2002

DTIC Science & Technology

2003-08-20

U.S. Army Corps of Engineers civil service and uniformed officers responsible for financial reporting of equipment should read this report. It...discusses the management controls that are necessary to support the financial reporting of equipment on financial statements.

8 CFR 286.5 - Remittance and statement procedures.

Code of Federal Regulations, 2011 CFR

2011-01-01

... Financial Management, INS. (e) Annually, each U.S. based remitter, which retains an independent accountant... Commissioner, Financial Management a report from the independent accountant in accordance with the Statement on... Procedures established by the American Institute of Certified Public Accountants and the Service, to the...

Best Practices for Audit and Financial Advisory Committees Within the Department of Defense

DTIC Science & Technology

2007-12-06

oversight of an organization’s annual financial statement audit, risk management plan, internal control framework, and compliance with external...is generally responsible for providing independent oversight of an organization’s annual financial statement audit, risk management plan, internal...achieving financial management objectives and identify areas of risk or concern. 40 11.2. Systems of Internal Controls

77 FR 39253 - Final Environmental Impact Statement on the Denali Park Road Vehicle Management Plan, Denali...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-07-02

... alternative would continue current management of vehicle use on the park road. In addition to a seasonal limit... Impact Statement for the Denali Park Road Vehicle Management Plan. SUMMARY: Pursuant to Sec. 102(2)(C... end of the Savage River Bridge (mile 14.8) and continues to the former Mt. McKinley National Park...

41 CFR 105-74.220 - By when must I publish my drug-free workplace statement and establish my drug-free awareness...

Code of Federal Regulations, 2010 CFR

2010-07-01

... 41 Public Contracts and Property Management 3 2010-07-01 2010-07-01 false By when must I publish my drug-free workplace statement and establish my drug-free awareness program? 105-74.220 Section 105-74.220 Public Contracts and Property Management Federal Property Management Regulations System...

Corporate environmental policy statements in mainland China: to what extent do they conform to ISO 14000 documentation?

PubMed

Chung, Shan Shan; Fryxell, Gerald E; Lo, Carlos W H

2005-04-01

For decades, industry has been the main source of pollution in China. Determined to make changes, the mainland Chinese authorities have decided to promote mechanisms that incorporate environmental concerns into the internal management of enterprises. This is manifested in the rapid adoption of the ISO14000 standards, including a significant increase in ISO14001 registrations in China. Thus, this study examined the environmental policy statements of 106 certified facilities in mainland China against a strict interpretation of the mandatory requirements of the ISO 14001:1996 standard and the nonmandatory ISO14004 requirements in order to shed some light on the implementation of environmental management systems in an emerging economic giant. It was decided to analyze the environmental policy statement because such a statement is a core element in the ISO system of environmental management of each facility and there are relatively clear and specific requirements on what an environmental policy statement shall include. An analysis of the contents of the environmental policy statements shows that conformance to the relevant requirements of both the mandatory ISO14001 standard and the nonmandatory ISO14004 standard is far from impressive and that the facilities in our sample seldom went beyond the minimum requirements. By using ISO14001 and ISO14004 conformance scores as the dependent variables, we found that conformity to ISO14001 and overall conformance to ISO14000 series can be explained to some extent by the degree of top management commitment, the experience with informal environmental management systems, and the form of ownership of the facilities.

Guidelines clarify managed care accounting procedures.

PubMed

Cheramy, S J; Garner, M

1989-08-01

Two new documents offer guidance for accounting issues involved in managed care programs. The American Institute of Certified Public Accountants' Statement of Position 89-5 and HFMA's Principles and Practices Board Statement No. 11 address risk contracting from the perspective of the managed care program and the healthcare provider, respectively. One key issue addressed in the documents is the timing of expense recognition of the costs of providing health services to members of managed care plans.

Report on Fiscal Year 1991 financial statement audit of the Low-Level Radioactive Waste Surcharge Escrow Account (CR-FC-92-1)

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

Not Available

1992-06-26

The attached audit report on the subject account presents the opinion of the independent certified public accounts on financial statements as of September 30, 1991. In their opinion, the Surcharge Account statements are fairly presented in all material respects in accordance with generally accepted accounting principles. Also attached are reports on the internal control structure and compliance with laws and regulations, ass well as management`s letter on addressing needed improvements.

US Department of Energy Naval Petroleum and Oil Shale Reserves combined financial statements and management overview and supplemental financial and management information, September 30, 1995 and 1994

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

NONE

1996-02-15

This report presents the results of the independent certified public accountant`s audit of the Department of Energy`s (Department) Naval Petroleum and Oil Shale Reserves (NPOSR) financial statements as of September 30, 1995. The auditors have expressed an unqualified opinion on the 1995 statements. Their reports on the NPOSR internal control structure and compliance with laws and regulations are also provided.

77 FR 36019 - Submission for OMB Review; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-15

... 2006. The Statement describes the types of internal controls and risk management procedures that the... PRA that does not display a valid Office of Management and Budget (OMB) control number. Background..., Washington, DC 20549-0213. Extension: Interagency Statement on Sound Practices; OMB Control No. 3235- 0622...

75 FR 61157 - Statement of Organization, Functions and Delegations of Authority

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-04

... coordinates personnel activities for BPHC; (3) provides organization and management analysis, coordinating the... Organization, Functions and Delegations of Authority This notice amends Part R of the Statement of Organization... Primary Health Care (RC). Specifically, this notice (1) Creates the Office of Administrative Management...

43 CFR 1601.0-6 - Environmental impact statement policy.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 43 Public Lands: Interior 2 2014-10-01 2014-10-01 false Environmental impact statement policy. 1601.0-6 Section 1601.0-6 Public Lands: Interior Regulations Relating to Public Lands (Continued) BUREAU OF LAND MANAGEMENT, DEPARTMENT OF THE INTERIOR GENERAL MANAGEMENT (1000) PLANNING, PROGRAMMING...

43 CFR 1601.0-6 - Environmental impact statement policy.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 43 Public Lands: Interior 2 2012-10-01 2012-10-01 false Environmental impact statement policy. 1601.0-6 Section 1601.0-6 Public Lands: Interior Regulations Relating to Public Lands (Continued) BUREAU OF LAND MANAGEMENT, DEPARTMENT OF THE INTERIOR GENERAL MANAGEMENT (1000) PLANNING, PROGRAMMING...

43 CFR 1601.0-6 - Environmental impact statement policy.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 43 Public Lands: Interior 2 2013-10-01 2013-10-01 false Environmental impact statement policy. 1601.0-6 Section 1601.0-6 Public Lands: Interior Regulations Relating to Public Lands (Continued) BUREAU OF LAND MANAGEMENT, DEPARTMENT OF THE INTERIOR GENERAL MANAGEMENT (1000) PLANNING, PROGRAMMING...

Intellectual Capital and New Public Management: Reintroducing Enterprise

ERIC Educational Resources Information Center

Mouritsen, Jan; Thorbjornsen, Stefan; Bukh, Per N.; Johansen, Mette R.

2004-01-01

The paper reports on public sector organisations'/institutions' work to develop knowledge management and intellectual capital statements. Building on experiences collected during 2001-2002 where 26 public sector institutions in Denmark sought to develop intellectual capital statements, this paper discusses their experiences and in particular, it…

41 CFR 60-3.1 - Statement of purpose.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 41 Public Contracts and Property Management 1 2010-07-01 2010-07-01 true Statement of purpose. 60-3.1 Section 60-3.1 Public Contracts and Property Management Other Provisions Relating to Public Contracts OFFICE OF FEDERAL CONTRACT COMPLIANCE PROGRAMS, EQUAL EMPLOYMENT OPPORTUNITY, DEPARTMENT OF LABOR...

43 CFR 1601.0-6 - Environmental impact statement policy.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 43 Public Lands: Interior 2 2011-10-01 2011-10-01 false Environmental impact statement policy. 1601.0-6 Section 1601.0-6 Public Lands: Interior Regulations Relating to Public Lands (Continued) BUREAU OF LAND MANAGEMENT, DEPARTMENT OF THE INTERIOR GENERAL MANAGEMENT (1000) PLANNING, PROGRAMMING...

Image-Based Medical Expert Teleconsultation in Acute Care of Injuries. A Systematic Review of Effects on Information Accuracy, Diagnostic Validity, Clinical Outcome, and User Satisfaction

PubMed Central

Hasselberg, Marie; Beer, Netta; Blom, Lisa; Wallis, Lee A.; Laflamme, Lucie

2014-01-01

Objective To systematically review the literature on image-based telemedicine for medical expert consultation in acute care of injuries, considering system, user, and clinical aspects. Design Systematic review of peer-reviewed journal articles. Data sources Searches of five databases and in eligible articles, relevant reviews, and specialized peer-reviewed journals. Eligibility criteria Studies were included that covered teleconsultation systems based on image capture and transfer with the objective of seeking medical expertise for the diagnostic and treatment of acute injury care and that presented the evaluation of one or several aspects of the system based on empirical data. Studies of systems not under routine practice or including real-time interactive video conferencing were excluded. Method The procedures used in this review followed the PRISMA Statement. Predefined criteria were used for the assessment of the risk of bias. The DeLone and McLean Information System Success Model was used as a framework to synthesise the results according to system quality, user satisfaction, information quality and net benefits. All data extractions were done by at least two reviewers independently. Results Out of 331 articles, 24 were found eligible. Diagnostic validity and management outcomes were often studied; fewer studies focused on system quality and user satisfaction. Most systems were evaluated at a feasibility stage or during small-scale pilot testing. Although the results of the evaluations were generally positive, biases in the methodology of evaluation were concerning selection, performance and exclusion. Gold standards and statistical tests were not always used when assessing diagnostic validity and patient management. Conclusions Image-based telemedicine systems for injury emergency care tend to support valid diagnosis and influence patient management. The evidence relates to a few clinical fields, and has substantial methodological shortcomings. As in the case of telemedicine in general, user and system quality aspects are poorly documented, both of which affect scale up of such programs. PMID:24887257

Essential features of designating out-of-hospital cardiac arrest as a reportable event: a scientific statement from the American Heart Association Emergency Cardiovascular Care Committee; Council on Cardiopulmonary, Perioperative, and Critical Care; Council on Cardiovascular Nursing; Council on Clinical Cardiology; and Quality of Care and Outcomes Research Interdisciplinary Working Group.

PubMed

Nichol, Graham; Rumsfeld, John; Eigel, Brian; Abella, Benjamin S; Labarthe, Darwin; Hong, Yuling; O'Connor, Robert E; Mosesso, Vincent N; Berg, Robert A; Leeper, Barbara Bobbi; Weisfeldt, Myron L

2008-04-29

The 2010 impact goal of the American Heart Association is to reduce death rates from heart disease and stroke by 25% and to lower the prevalence of the leading risk factors by the same proportion. Much of the burden of acute heart disease is initially experienced out of hospital and can be reduced by timely delivery of effective prehospital emergency care. Many patients with an acute myocardial infarction die from cardiac arrest before they reach the hospital. A small proportion of those with cardiac arrest who reach the hospital survive to discharge. Current health surveillance systems cannot determine the burden of acute cardiovascular illness in the prehospital setting nor make progress toward reducing that burden without improved surveillance mechanisms. Accordingly, the goals of this article provide a brief overview of strategies for managing out-of-hospital cardiac arrest. We review existing surveillance systems for monitoring progress in reducing the burden of out-of-hospital cardiac arrest in the United States and make recommendations for filling significant gaps in these systems, including the following: 1. Out-of-hospital cardiac arrests and their outcomes through hospital discharge should be classified as reportable events as part of a heart disease and stroke surveillance system. 2. Data collected on patients' encounters with emergency medical services systems should include descriptions of the performance of cardiopulmonary resuscitation by bystanders and defibrillation by lay responders. 3. National annual reports on key indicators of progress in managing acute cardiovascular events in the out-of-hospital setting should be developed and made publicly available. Potential barriers to action on cardiac arrest include concerns about privacy, methodological challenges, and costs associated with designating cardiac arrest as a reportable event.

78 FR 39736 - Agency Information Collection Activities; Announcement of Office of Management and Budget...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-02

... Labeling; Notification Procedures for Statements on Dietary Supplements AGENCY: Food and Drug... information entitled ``Food Labeling; Notification Procedures for Statements on Dietary Supplements'' to OMB... collection of information entitled ``Food Labeling; Notification Procedures for Statements on Dietary...

Physician Satisfaction at Keller Army Community Hospital.

DTIC Science & Technology

1998-04-01

STATEMENT A Approved for Public Release Distribution Unlimited Henry T. Lippert, Ed.D Graduate Management Project April 1, 1998 20000113 052 OTIC...lngton?VA 22202^302; and to the Office of Management and Budget. Paperwork Reduction Project (0704-0188), Washington. DC 20503. 1. AGENCY USE ONLY...List of Figures 6 Introduction 7 Conditions Which Prompted the Study 8 Statement of the Management Question 10 Literature Review 11

41 CFR 105-64.407 - How do I file a Statement of Disagreement?

Code of Federal Regulations, 2013 CFR

2013-07-01

... Statement of Disagreement? You may file a Statement of Disagreement with the system manager within 30 days of the denial to amend a record. The statement should explain why you believe the record to be..., provide a copy to anyone who had previously received the record, and include a copy of it in any future...

41 CFR 105-64.407 - How do I file a Statement of Disagreement?

Code of Federal Regulations, 2011 CFR

2011-01-01

... Statement of Disagreement? You may file a Statement of Disagreement with the system manager within 30 days of the denial to amend a record. The statement should explain why you believe the record to be..., provide a copy to anyone who had previously received the record, and include a copy of it in any future...

41 CFR 105-64.407 - How do I file a Statement of Disagreement?

Code of Federal Regulations, 2010 CFR

2010-07-01

... Statement of Disagreement? You may file a Statement of Disagreement with the system manager within 30 days of the denial to amend a record. The statement should explain why you believe the record to be..., provide a copy to anyone who had previously received the record, and include a copy of it in any future...

41 CFR 105-64.407 - How do I file a Statement of Disagreement?

Code of Federal Regulations, 2014 CFR

2014-01-01

... Statement of Disagreement? You may file a Statement of Disagreement with the system manager within 30 days of the denial to amend a record. The statement should explain why you believe the record to be..., provide a copy to anyone who had previously received the record, and include a copy of it in any future...

Pharmacologic management of chronic neuropathic pain: Review of the Canadian Pain Society consensus statement.

PubMed

Mu, Alex; Weinberg, Erica; Moulin, Dwight E; Clarke, Hance

2017-11-01

To provide family physicians with a practical clinical summary of the Canadian Pain Society (CPS) revised consensus statement on the pharmacologic management of neuropathic pain. A multidisciplinary interest group within the CPS conducted a systematic review of the literature on the current treatments of neuropathic pain in drafting the revised consensus statement. Gabapentinoids, tricyclic antidepressants, and serotonin-norepinephrine reuptake inhibitors are the first-line agents for treating neuropathic pain. Tramadol and other opioids are recommended as second-line agents, while cannabinoids are newly recommended as third-line agents. Other anticonvulsants, methadone, tapentadol, topical lidocaine, and botulinum toxin are recommended as fourth-line agents. Many pharmacologic analgesics exist for the treatment of neuropathic pain. Through evidence-based recommendations, the CPS revised consensus statement helps guide family physicians in the management of patients with neuropathic pain. Copyright© the College of Family Physicians of Canada.

75 FR 69700 - Final Environmental Impact Statement and Cape Hatteras National Seashore Off-Road Vehicle...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-15

... Hatteras National Seashore Off-Road Vehicle Management Plan AGENCY: National Park Service, Interior. ACTION... Off-Road Vehicle Management Plan. SUMMARY: Pursuant to the National Environmental Policy Act of 1969... environmental impact statement (FEIS) for the proposed Cape Hatteras National Seashore (Seashore) Off-Road...

76 FR 60525 - Final Wilderness and Backcountry Management Plan and Environmental Impact Statement for Isle...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-29

... and Environmental Impact Statement for Isle Royale National Park, MI AGENCY: National Park Service... the availability of a Final Wilderness and Backcountry Management Plan and Environmental Impact... the Internet through the NPS Planning, Environment, and Public Comment Web site ( http://parkplanning...

76 FR 23623 - Backcountry Management Plan, Environmental Impact Statement, Grand Canyon National Park, Arizona

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-27

... DEPARTMENT OF THE INTERIOR National Park Service Backcountry Management Plan, Environmental Impact Statement, Grand Canyon National Park, Arizona AGENCY: National Park Service, Department of the Interior..., Grand Canyon National Park. SUMMARY: Pursuant to the National Environmental Policy Act of 1969 (42 U.S.C...

77 FR 37438 - Draft Trail Management Plan and Environmental Impact Statement for Cuyahoga Valley National Park...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-21

... DEPARTMENT OF THE INTERIOR National Park Service [NPS-MWR-CUVA-10100; 6065-4000-409] Draft Trail Management Plan and Environmental Impact Statement for Cuyahoga Valley National Park, Ohio AGENCY: National Park Service, Interior. ACTION: Notice of Availability. SUMMARY: The National Park Service (NPS...

75 FR 61511 - Intent To Prepare a Supplemental Environmental Impact Statement: Outer Continental Shelf, Alaska...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-05

... DEPARTMENT OF THE INTERIOR Bureau of Ocean Energy Management, Regulation and Enforcement Intent To Prepare a Supplemental Environmental Impact Statement: Outer Continental Shelf, Alaska OCS Region, Chukchi Sea Planning Area, Oil and Gas Lease Sale 193 AGENCY: Bureau of Ocean Energy Management, Regulation...

24 CFR 242.58 - Books, accounts, and financial statements.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 24 Housing and Urban Development 2 2011-04-01 2011-04-01 false Books, accounts, and financial... Requirements § 242.58 Books, accounts, and financial statements. (a) Books and accounts. The mortgagor's books... Agreement. (f) Books of management agents. The books and records of management agents, lessees, operators...

24 CFR 242.58 - Books, accounts, and financial statements.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 24 Housing and Urban Development 2 2013-04-01 2013-04-01 false Books, accounts, and financial... Requirements § 242.58 Books, accounts, and financial statements. (a) Books and accounts. The mortgagor's books... Agreement. (f) Books of management agents. The books and records of management agents, lessees, operators...

24 CFR 242.58 - Books, accounts, and financial statements.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 24 Housing and Urban Development 2 2012-04-01 2012-04-01 false Books, accounts, and financial... Requirements § 242.58 Books, accounts, and financial statements. (a) Books and accounts. The mortgagor's books... Agreement. (f) Books of management agents. The books and records of management agents, lessees, operators...

24 CFR 242.58 - Books, accounts, and financial statements.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 24 Housing and Urban Development 2 2014-04-01 2014-04-01 false Books, accounts, and financial... Requirements § 242.58 Books, accounts, and financial statements. (a) Books and accounts. The mortgagor's books... Agreement. (f) Books of management agents. The books and records of management agents, lessees, operators...

12 CFR 350.4 - Contents of annual disclosure statement.

Code of Federal Regulations, 2010 CFR

2010-01-01

... for each such year. The annual disclosure statement may, at the option of bank management, consist of... Reserve System: (i) Schedule RC (Balance Sheet); (ii) Schedule RC-N (Past Due and Nonaccrual, Loans... option, provide additional information that bank management considers important to an evaluation of the...

12 CFR 18.4 - Contents of annual disclosure statement.

Code of Federal Regulations, 2010 CFR

2010-01-01

... the preceding year. The annual disclosure statement may, at the option of bank management, consist of... schedules. (1) For national banks: (i) Schedule RC (Balance Sheet); (ii) Schedule RC-N (Past Due and... narrative. Bank management may, at its option, provide a narrative discussion to supplement the annual...

Healthcare Financial Management Association, Principles and Practices Board. Statement No. 16. Classifying, valuing, and analyzing accounts receivable related to patient services.

PubMed

1993-05-01

This Principles and Practices Board project was undertaken in response to the frequent requests from HFMA members for a standard calculation of "days of revenue in receivables." The board's work on this project indicated that every element of the calculation required standards, which is what this statement provides. Since there have been few standards for accounts receivable related to patient services, the industry follows a variety of practices, which often differ from each other. This statement is intended to provide a framework for enhanced external comparison of accounts receivable related to patient services, and thereby improve management information related to this very important asset. Thus, the standards described in this statement represent long-term goals for gradual transition of recordkeeping practices and not a sudden or revolutionary change. The standards described in this statement will provide the necessary framework for the most meaningful external comparisons. Furthermore, management's understanding of deviations from these standards will immediately assist in analysis of differences in data between providers.

Canadian Association of Emergency Physicians position statement on acute ischemic stroke.

PubMed

Harris, Devin; Hall, Christopher; Lobay, Kevin; McRae, Andrew; Monroe, Tanya; Perry, Jeffrey J; Shearing, Anthony; Wollam, Gabe; Goddard, Tom; Lang, Eddy

2015-03-01

The CAEP Stroke Practice Committee was convened in the spring of 2013 to revisit the 2001 policy statement on the use of thrombolytic therapy in acute ischemic stroke. The terms of reference of the panel were developed to include national representation from urban academic centres as well as community and rural centres from all regions of the country. Membership was determined by attracting recognized stroke leaders from across the country who agreed to volunteer their time towards the development of revised guidance on the topic. The guideline panel elected to adopt the GRADE language to communicate guidance after review of existing systematic reviews and international clinical practice guidelines. Stroke neurologists from across Canada were engaged to work alongside panel members to develop guidance as a dyad-based consensus when possible. There was no unique systematic review performed to support this guidance, rather existing efficacy data was relied upon. After a series of teleconferences and face to face meetings, a draft guideline was developed and presented to the CAEP board in June of 2014. The panel noted the development of significant new evidence to inform a number of clinical questions related to acute stroke management. In general terms the recommendations issued by the CAEP Stroke Practice Committee are supportive of the use of thrombolytic therapy when treatment can be administered within 3 hours of symptom onset. The committee is also supportive of system-level changes including pre-hospital interventions, the transport of patients to dedicated stroke centers when possible and tele-health measures to support thrombolytic therapy in a timely window. Of note, after careful deliberation, the panel elected to issue a conditional recommendation against the use of thrombolytic therapy in the 3–4.5 hour window. The view of the committee was that as a result of a narrow risk benefit balance, one that is considerably narrower than the same considerations under 3 hours, a significant number of informed patients and families would opt against the risk of early intracranial hemorrhage and the possibility of increased 90-day mortality that is not seen for more timely treatment. Furthermore, the frequently impaired nature of patients suffering an acute stroke and the difficulties in asking families to make life and death decisions in a highly time-sensitive context led the panel to restrict a strong endorsement of thrombolytic to the 3 hour outermost limit. The committee noted as well that Health Canada has not approved a thrombolytic agent beyond a three hour window in acute ischemic stroke.

Asian Organization for Crohn's and Colitis and Asia Pacific Association of Gastroenterology consensus on tuberculosis infection in patients with inflammatory bowel disease receiving anti-tumor necrosis factor treatment. Part 2: Management.

PubMed

Park, Dong Il; Hisamatsu, Tadakazu; Chen, Minhu; Ng, Siew Chien; Ooi, Choon Jin; Wei, Shu Chen; Banerjee, Rupa; Hilmi, Ida Normiha; Jeen, Yoon Tae; Han, Dong Soo; Kim, Hyo Jong; Ran, Zhihua; Wu, Kaichun; Qian, Jiaming; Hu, Pin-Jin; Matsuoka, Katsuyoshi; Andoh, Akira; Suzuki, Yasuo; Sugano, Kentaro; Watanabe, Mamoru; Hibi, Toshifumi; Puri, Amarender S; Yang, Suk-Kyun

2018-01-01

Because anti-tumor necrosis factor (anti-TNF) therapy has become increasingly popular in many Asian countries, the risk of developing active tuberculosis (TB) among anti-TNF users may raise serious health problems in this region. Thus, the Asian Organization for Crohn's and Colitis and the Asia Pacific Association of Gastroenterology have developed a set of consensus statements about risk assessment, detection and prevention of latent TB infection, and management of active TB infection in patients with inflammatory bowel disease (IBD) receiving anti-TNF treatment. Twenty-three consensus statements were initially drafted and then discussed by the committee members. The quality of evidence and the strength of recommendations were assessed by using the Grading of Recommendations Assessment, Development, and Evaluation methodology. Web-based consensus voting was performed by 211 IBD specialists from nine Asian countries concerning each statement. A consensus statement was accepted if at least 75% of the participants agreed. Part 2 of the statements comprised three parts: (3) management of latent TB in preparation for anti-TNF therapy, (4) monitoring during anti-TNF therapy, and (5) management of an active TB infection after anti-TNF therapy. These consensus statements will help clinicians optimize patient outcomes by reducing the morbidity and mortality related to TB infections in patients with IBD receiving anti-TNF treatment. © 2017 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.

75 FR 18208 - Notice of Issuance of Statement of Federal Financial Accounting Standard 37, Social Insurance...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-09

... FEDERAL ACCOUNTING STANDARDS ADVISORY BOARD Notice of Issuance of Statement of Federal Financial Accounting Standard 37, Social Insurance: Additional Requirements for Management's Discussion and Analysis and Basic Financial Statements AGENCY: Federal Accounting Standards Advisory Board. ACTION: Notice...

Consensus Statements for Management of Barrett’s Dysplasia and Early-Stage Esophageal Adenocarcinoma, Based on a Delphi Process

PubMed Central

BENNETT, CATHY; VAKIL, NIMISH; BERGMAN, JACQUES; HARRISON, REBECCA; ODZE, ROBERT; VIETH, MICHAEL; SANDERS, SCOTT; GAY, LAURA; PECH, OLIVER; LONGCROFT–WHEATON, GAIUS; ROMERO, YVONNE; INADOMI, JOHN; TACK, JAN; CORLEY, DOUGLAS A.; MANNER, HENDRIK; GREEN, SUSI; DULAIMI, DAVID AL; ALI, HAYTHEM; ALLUM, BILL; ANDERSON, MARK; CURTIS, HOWARD; FALK, GARY; FENNERTY, M. BRIAN; FULLARTON, GRANT; KRISHNADATH, KAUSILIA; MELTZER, STEPHEN J.; ARMSTRONG, DAVID; GANZ, ROBERT; CENGIA, GIANPAOLO; GOING, JAMES J.; GOLDBLUM, JOHN; GORDON, CHARLES; GRABSCH, HEIKE; HAIGH, CHRIS; HONGO, MICHIO; JOHNSTON, DAVID; FORBES–YOUNG, RICKY; KAY, ELAINE; KAYE, PHILIP; LERUT, TONI; LOVAT, LAURENCE B.; LUNDELL, LARS; MAIRS, PHILIP; SHIMODA, TADAKUZA; SPECHLER, STUART; SONTAG, STEPHEN; MALFERTHEINER, PETER; MURRAY, IAIN; NANJI, MANOJ; POLLER, DAVID; RAGUNATH, KRISH; REGULA, JAROSLAW; CESTARI, RENZO; SHEPHERD, NEIL; SINGH, RAJVINDER; STEIN, HUBERT J.; TALLEY, NICHOLAS J.; GALMICHE, JEAN–PAUL; THAM, TONY C. K.; WATSON, PETER; YERIAN, LISA; RUGGE, MASSIMO; RICE, THOMAS W.; HART, JOHN; GITTENS, STUART; HEWIN, DAVID; HOCHBERGER, JUERGEN; KAHRILAS, PETER; PRESTON, SEAN; SAMPLINER, RICHARD; SHARMA, PRATEEK; STUART, ROBERT; WANG, KENNETH; WAXMAN, IRVING; ABLEY, CHRIS; LOFT, DUNCAN; PENMAN, IAN; SHAHEEN, NICHOLAS J.; CHAK, AMITABH; DAVIES, GARETH; DUNN, LORNA; FALCK–YTTER, YNGVE; DECAESTECKER, JOHN; BHANDARI, PRADEEP; ELL, CHRISTIAN; GRIFFIN, S. MICHAEL; ATTWOOD, STEPHEN; BARR, HUGH; ALLEN, JOHN; FERGUSON, MARK K.; MOAYYEDI, PAUL; JANKOWSKI, JANUSZ A. Z.

2017-01-01

BACKGROUND & AIMS Esophageal adenocarcinoma (EA) is increasingly common among patients with Barrett’s esophagus (BE). We aimed to provide consensus recommendations based on the medical literature that clinicians could use to manage patients with BE and low-grade dysplasia, high-grade dysplasia (HGD), or early-stage EA. METHODS We performed an international, multidisciplinary, systematic, evidence-based review of different management strategies for patients with BE and dysplasia or early-stage EA. We used a Delphi process to develop consensus statements. The results of literature searches were screened using a unique, interactive, Web-based data-sifting platform; we used 11,904 papers to inform the choice of statements selected. An a priori threshold of 80% agreement was used to establish consensus for each statement. RESULTS Eighty-one of the 91 statements achieved consensus despite generally low quality of evidence, including 8 clinical statements: (1) specimens from endoscopic resection are better than biopsies for staging lesions, (2) it is important to carefully map the size of the dysplastic areas, (3) patients that receive ablative or surgical therapy require endoscopic follow-up, (4) high-resolution endoscopy is necessary for accurate diagnosis, (5) endoscopic therapy for HGD is preferred to surveillance, (6) endoscopic therapy for HGD is preferred to surgery, (7) the combination of endoscopic resection and radiofrequency ablation is the most effective therapy, and (8) after endoscopic removal of lesions from patients with HGD, all areas of BE should be ablated. CONCLUSIONS We developed a data-sifting platform and used the Delphi process to create evidence-based consensus statements for the management of patients with BE and early-stage EA. This approach identified important clinical features of the diseases and areas for future studies. PMID:22537613

Formal consensus to identify clinically important changes in management resulting from the use of cardiovascular magnetic resonance (CMR) in patients who activate the primary percutaneous coronary intervention (PPCI) pathway.

PubMed

Pufulete, Maria; Brierley, Rachel C; Bucciarelli-Ducci, Chiara; Greenwood, John P; Dorman, Stephen; Anderson, Richard A; Harris, Jessica; McAlindon, Elisa; Rogers, Chris A; Reeves, Barnaby C

2017-06-22

To define important changes in management arising from the use of cardiovascular magnetic resonance (CMR) in patients who activate the primary percutaneous coronary intervention (PPCI) pathway. Formal consensus study using literature review and cardiologist expert opinion to formulate consensus statements and setting up a consensus panel to review the statements (by completing a web-based survey, attending a face-to-face meeting to discuss survey results and modify the survey to reflect group discussion and completing the modified survey to determine which statements were in consensus). Formulation of consensus statements: four cardiologists (two CMR and two interventional) and six non-clinical researchers. Formal consensus: seven cardiologists (two CMR and three interventional, one echocardiography and one heart failure). Forty-nine additional cardiologists completed the modified survey. Thirty-seven draft statements describing changes in management following CMR were generated; these were condensed into 12 statements and reviewed through the formal consensus process. Three of 12 statements were classified in consensus in the first survey; these related to the role of CMR in identifying the cause of out-of-hospital cardiac arrest, providing a definitive diagnosis in patients found to have unobstructed arteries on angiography and identifying patients with left ventricular thrombus. Two additional statements were in consensus in the modified survey, relating to the ability of CMR to identify patients who have a poor prognosis after PPCI and assess ischaemia and viability in patients with multivessel disease. There was consensus that CMR leads to clinically important changes in management in five subgroups of patients who activate the PPCI pathway. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

A modified Delphi study to determine the level of consensus across the European Union on the structures, processes and desired outcomes of the management of polypharmacy in older people

PubMed Central

Gibson-Smith, Kathrine; MacLure, Katie; Mair, Alpana; Alonso, Albert; Codina, Carles; Cittadini, Antonio; Fernandez-Llimos, Fernando; Fleming, Glenda; Gennimata, Dimitra; Gillespie, Ulrika; Harrison, Cathy; Junius-Walker, Ulrike; Kardas, Przemysław; Kempen, Thomas; Kinnear, Moira; Lewek, Pawel; Malva, Joao; McIntosh, Jennifer; Scullin, Claire; Wiese, Birgitt

2017-01-01

Background Inappropriate use of multiple medicines (inappropriate polypharmacy) is a major challenge in older people with consequences of increased prevalence and severity of adverse drug reactions and interactions, and reduced medicines adherence. The aim of this study was to determine the levels of consensus amongst key stakeholders in the European Union (EU) in relation to aspects of the management of polypharmacy in older people. Methods Forty-six statements were developed on aspects of healthcare structures, processes and desired outcomes, with consensus defined at ≥ 80% agreement. Panel members were strategists (e.g. directors, leading clinicians and commissioners) from each of the 28 EU member states, with a target recruitment of five per member state. Three Delphi rounds were conducted via email, with panel members being provided with summative results and collated, anonymised comments at the commencement of Rounds 2 and 3. Results Ninety panel members were recruited (64.3% of target), with high participation levels throughout the three Delphi rounds (91.1%, 83.3%, 72.2%). During Round 1, consensus was obtained for 27/46 statements (58.7%), with an additional two statements in Round 2 and none in Round 3. Consensus was obtained for statements relating to: potential gain arising from polypharmacy management (3/4 statements); strategic development (7/7); change management (5/7) indicator measures (4/6); legislation (0/3); awareness raising (5/5); polypharmacy reviews (5/7); and EU vision (0/7). Analysis of free text comments indicated that the vision statements were too ambitious and not achievable by the specified timeframe of 2025. Conclusion Consensus was obtained amongst key EU strategists around many aspects of polypharmacy management in older people. Notably, no consensus was achieved in relation to statements relating to the need to alter legislation in areas of healthcare delivery, remuneration and practitioner scope of practice. While the vision for the EU by 2025 was considered rather ambitious, there is great potential and clear opportunity to advance polypharmacy management throughout the EU and beyond. PMID:29155870

A modified Delphi study to determine the level of consensus across the European Union on the structures, processes and desired outcomes of the management of polypharmacy in older people.

PubMed

Stewart, Derek; Gibson-Smith, Kathrine; MacLure, Katie; Mair, Alpana; Alonso, Albert; Codina, Carles; Cittadini, Antonio; Fernandez-Llimos, Fernando; Fleming, Glenda; Gennimata, Dimitra; Gillespie, Ulrika; Harrison, Cathy; Junius-Walker, Ulrike; Kardas, Przemysław; Kempen, Thomas; Kinnear, Moira; Lewek, Pawel; Malva, Joao; McIntosh, Jennifer; Scullin, Claire; Wiese, Birgitt

2017-01-01

Inappropriate use of multiple medicines (inappropriate polypharmacy) is a major challenge in older people with consequences of increased prevalence and severity of adverse drug reactions and interactions, and reduced medicines adherence. The aim of this study was to determine the levels of consensus amongst key stakeholders in the European Union (EU) in relation to aspects of the management of polypharmacy in older people. Forty-six statements were developed on aspects of healthcare structures, processes and desired outcomes, with consensus defined at ≥ 80% agreement. Panel members were strategists (e.g. directors, leading clinicians and commissioners) from each of the 28 EU member states, with a target recruitment of five per member state. Three Delphi rounds were conducted via email, with panel members being provided with summative results and collated, anonymised comments at the commencement of Rounds 2 and 3. Ninety panel members were recruited (64.3% of target), with high participation levels throughout the three Delphi rounds (91.1%, 83.3%, 72.2%). During Round 1, consensus was obtained for 27/46 statements (58.7%), with an additional two statements in Round 2 and none in Round 3. Consensus was obtained for statements relating to: potential gain arising from polypharmacy management (3/4 statements); strategic development (7/7); change management (5/7) indicator measures (4/6); legislation (0/3); awareness raising (5/5); polypharmacy reviews (5/7); and EU vision (0/7). Analysis of free text comments indicated that the vision statements were too ambitious and not achievable by the specified timeframe of 2025. Consensus was obtained amongst key EU strategists around many aspects of polypharmacy management in older people. Notably, no consensus was achieved in relation to statements relating to the need to alter legislation in areas of healthcare delivery, remuneration and practitioner scope of practice. While the vision for the EU by 2025 was considered rather ambitious, there is great potential and clear opportunity to advance polypharmacy management throughout the EU and beyond.

Sustainability Insights from the Mission Statements of Leading Brazilian Universities

ERIC Educational Resources Information Center

Deus, Rafael Mattos; Battistelle, Rosane Aparecida Gomes; Ribeiro da Silva, Gustavo Henrique

2016-01-01

Purpose: The purpose of this paper is to investigate the mission statements from 30 leading Brazilian universities, evaluating the statements based on a sustainable model that involves an environmental management system, public participation and social responsibility, and sustainable education and research. Design/methodology/approach: Content…

75 FR 20810 - Proposed Information Collection; Comment Request; Statement of Financial Interests, Regional...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-21

... Collection; Comment Request; Statement of Financial Interests, Regional Fishery Management Councils AGENCY... must provide an update of their statements at any time any such financial interest is acquired, or... financial interest in any Council fishery. These interests include harvesting, processing, lobbying...

77 FR 1973 - Environmental Impact Statement: In the Vicinity of the City and Borough of Juneau, AK

Federal Register 2010, 2011, 2012, 2013, 2014

2012-01-12

... DEPARTMENT OF TRANSPORTATION Federal Highway Administration Environmental Impact Statement: In the..., in cooperation with DOT&PF, will prepare a supplemental environmental impact statement (SEIS) for... Lynn Canal corridor. FOR FURTHER INFORMATION CONTACT: Mr. Tim Haugh, Environmental Program Manager...

Hydrologic Engineering Center River Analysis System (HEC-RAS) Water Temperature Models Developed for the Missouri River Recovery Management Plan and Environmental Impact Statement

DTIC Science & Technology

2017-09-18

Temperature Models Developed for the Missouri River Recovery Management Plan and Environmental Impact Statement En vi ro nm en ta l L ab or at or y...Engineering Center-River Analysis System (HEC-RAS) Water Temperature Models Developed for the Missouri River Recovery Management Plan and Environmental...Prepared for U.S. Army Corps of Engineers Washington, DC 20314-1000 Under Project 396939, “Missouri River Recovery Management Plan and Environmental

Development of practice and consensus-based strategies including a treat-to-target approach for the management of moderate and severe juvenile dermatomyositis in Germany and Austria.

PubMed

Hinze, Claas H; Oommen, Prasad T; Dressler, Frank; Urban, Andreas; Weller-Heinemann, Frank; Speth, Fabian; Lainka, Elke; Brunner, Jürgen; Fesq, Heike; Foell, Dirk; Müller-Felber, Wolfgang; Neudorf, Ulrich; Rietschel, Christoph; Schwarz, Tobias; Schara, Ulrike; Haas, Johannes-Peter

2018-06-25

Juvenile dermatomyositis (JDM) is the most common inflammatory myopathy in childhood and a major cause of morbidity among children with pediatric rheumatic diseases. The management of JDM is very heterogeneous. The JDM working group of the Society for Pediatric Rheumatology (GKJR) aims to define consensus- and practice-based strategies in order to harmonize diagnosis, treatment and monitoring of JDM. The JDM working group was established in 2015 consisting of 23 pediatric rheumatologists, pediatric neurologists and dermatologists with expertise in the management of JDM. Current practice patterns of management in JDM had previously been identified via an online survey among pediatric rheumatologists and neurologists. Using a consensus process consisting of online surveys and a face-to-face consensus conference statements were defined regarding the diagnosis, treatment and monitoring of JDM. During the conference consensus was achieved via nominal group technique. Voting took place using an electronic audience response system, and at least 80% consensus was required for individual statements. Overall 10 individual statements were developed, finally reaching a consensus of 92 to 100% regarding (1) establishing a diagnosis, (2) case definitions for the application of the strategies (moderate and severe JDM), (3) initial diagnostic testing, (4) monitoring and documentation, (5) treatment targets within the context of a treat-to-target strategy, (6) supportive therapies, (7) explicit definition of a treat-to-target strategy, (8) various glucocorticoid regimens, including intermittent intravenous methylprednisolone pulse and high-dose oral glucocorticoid therapies with tapering, (9) initial glucocorticoid-sparing therapy and (10) management of refractory disease. Using a consensus process among JDM experts, statements regarding the management of JDM were defined. These statements and the strategies aid in the management of patients with moderate and severe JDM.

Academic Pancreas Centers of Excellence: Guidance from a multidisciplinary chronic pancreatitis working group at PancreasFest

PubMed Central

Sheth, Sunil G.; Conwell, Darwin L.; Whitcomb, David C.; Alsante, Matthew; Anderson, Michelle A.; Barkin, Jamie; Brand, Randall; Cote, Gregory A.; Freedman, Steven D.; Gelrud, Andres; Gorelick, Fred; Lee, Linda S.; Morgan, Katherine; Pandol, Stephen; Singh, Vikesh K.; Yadav, Dhiraj; Mel Wilcox, C.; Hart, Phil A.

2017-01-01

Chronic pancreatitis (CP) is a progressive inflammatory disease, which leads to loss of pancreatic function and other disease-related morbidities. A group of academic physicians and scientists developed comprehensive guidance statements regarding the management of CP that include its epidemiology, diagnosis, medical treatment, surgical treatment, and screening. The statements were developed through literature review, deliberation, and consensus opinion. These statements were ultimately used to develop a conceptual framework for the multidisciplinary management of chronic pancreatitis referred to as an academic pancreas center of excellence (APCOE). PMID:28268158

76 FR 59158 - Notice of Availability of Draft General Management Plan/Environmental Impact Statement for Effigy...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-23

... Management Plan/ Environmental Impact Statement for Effigy Mounds National Monument, Iowa AGENCY: National... Protection Agency. Public meetings will be held during the 60-day review period on the GMP/EIS in the Harpers... experience, to the socioeconomic environment, and to monument operations and facilities. The preferred...

75 FR 1807 - Notice of Intent To Prepare an Environmental Impact Statement for the Restoration Design Energy...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-01-13

... DEPARTMENT OF THE INTERIOR Bureau of Land Management Notice of Intent To Prepare an Environmental Impact Statement for the Restoration Design Energy Project and Possible Land Use Plan Amendment AGENCY: Bureau of Land Management, Interior. ACTION: Notice of Intent. SUMMARY: In compliance with the National...

77 FR 67661 - Notice of Availability of the Final Environmental Impact Statement for the Restoration Design...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-11-13

... DEPARTMENT OF THE INTERIOR Bureau of Land Management [LLAZ910000.L13400000.DT0000.LXSS058A0000] Notice of Availability of the Final Environmental Impact Statement for the Restoration Design Energy... Management, Interior. ACTION: Correction. SUMMARY: This notice corrects acreages and information referenced...

The Conflicted Realities of Community College Mission Statements

ERIC Educational Resources Information Center

Lake, Rebecca S.; Mrozinski, Mark D.

2011-01-01

Over the last 40 years, the mission statement has been consistently viewed as an indispensable management tool for organizations in both the public and private sectors. In addition, there is a plethora of popular management literature that puts mission identification as the first and most important task of an organization's leadership. Strategic…

41 CFR 302-2.20 - What is a duplicate reimbursement disclosure statement?

Code of Federal Regulations, 2012 CFR

2012-07-01

... 41 Public Contracts and Property Management 4 2012-07-01 2012-07-01 false What is a duplicate reimbursement disclosure statement? 302-2.20 Section 302-2.20 Public Contracts and Property Management Federal... knowledge, no third party has accepted duplicate reimbursement for your relocation expenses. The duplicate...

41 CFR 302-2.20 - What is a duplicate reimbursement disclosure statement?

Code of Federal Regulations, 2014 CFR

2014-07-01

... 41 Public Contracts and Property Management 4 2014-07-01 2014-07-01 false What is a duplicate reimbursement disclosure statement? 302-2.20 Section 302-2.20 Public Contracts and Property Management Federal... knowledge, no third party has accepted duplicate reimbursement for your relocation expenses. The duplicate...

41 CFR 302-2.20 - What is a duplicate reimbursement disclosure statement?

Code of Federal Regulations, 2013 CFR

2013-07-01

... 41 Public Contracts and Property Management 4 2013-07-01 2012-07-01 true What is a duplicate reimbursement disclosure statement? 302-2.20 Section 302-2.20 Public Contracts and Property Management Federal... knowledge, no third party has accepted duplicate reimbursement for your relocation expenses. The duplicate...

78 FR 5494 - Off-Road Vehicle Management Plan, Draft Environmental Impact Statement, Lake Meredith National...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-01-25

... DEPARTMENT OF THE INTERIOR National Park Service [NPS-IMR-LAMR-10224; 2310-0091-422] Off-Road... Service (NPS) is releasing a Draft Environmental Impact Statement (DEIS) for the Off- Road Vehicle... impacts of four alternatives that address off-road vehicle (ORV) management in the national recreation...

77 FR 9694 - Notice of Availability of the Draft Environmental Impact Statement for the Restoration Design...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-02-17

... DEPARTMENT OF THE INTERIOR Bureau of Land Management [LLAZ910000.L14300000.DB0000.LXSS058A0000] Notice of Availability of the Draft Environmental Impact Statement for the Restoration Design Energy Project and Land Use Plan Amendments AGENCY: Bureau of Land Management, Interior. ACTION: Notice of...

77 FR 62528 - Termination of Environmental Impact Statement for the General Management Plan, Mount Rushmore...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-15

... environmental impact statement (EIS) for the Mount Rushmore National Memorial General Management Plan (GMP) and will be preparing an Environmental Assessment (EA) instead. DATES: The draft GMP EA is expected to be... the appropriate level of environmental documentation for the GMP. Preliminary analysis of alternatives...

77 FR 30319 - Draft Environmental Impact Statement for General Management Plan, Fort Pulaski National Monument, GA

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-22

... Environmental Impact Statement (DEIS) for the General Management Plan (GMP) and Wilderness Study for Fort... of the monument, the DEIS/GMP/Wilderness Study describes three alternatives including the NPS... and enjoyment of the monument's resources. An up-to-date GMP is needed to address how visitors access...

76 FR 70483 - Environmental Impact Statement and General Management Plan, Paterson Great Falls National...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-14

...) announces its intent to prepare a General Management Plan and Environmental Impact Statement (GMP/EIS) for... implementation of the GMP. The Paterson Great Falls NHP Advisory Commission will be involved early in the... planners in the NPS Northeast Region, with assistance from advisors and consultants, the GMP/EIS will...

75 FR 44977 - General Management Plan/Abbreviated Final Environmental Impact Statement, Roosevelt-Vanderbilt...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-30

... Impact Statement for the General Management Plan (GMP/EIS) for Roosevelt-Vanderbilt National Historic Sites, Hyde Park, New York. The Abbreviated Final GMP/EIS includes an analysis of agency and public comments received on the Draft GMP/EIS with NPS responses, errata sheets detailing editorial corrections to...

78 FR 15039 - Extending Scoping Period To Prepare a Programmatic Environmental Impact Statement (EIS) for the...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-08

... DEPARTMENT OF THE INTERIOR Bureau of Indian Affairs Extending Scoping Period To Prepare a Programmatic Environmental Impact Statement (EIS) for the Navajo Nation Integrated Weed Management Plan Within... Integrated Weed Management Plan on the Navajo Indian Reservation. DATES: Scoping comments are due on March 20...

Clinical assessment of acute lateral ankle sprain injuries (ROAST): 2019 consensus statement and recommendations of the International Ankle Consortium.

PubMed

Delahunt, Eamonn; Bleakley, Chris M; Bossard, Daniela S; Caulfield, Brian M; Docherty, Carrie L; Doherty, Cailbhe; Fourchet, François; Fong, Daniel T; Hertel, Jay; Hiller, Claire E; Kaminski, Thomas W; McKeon, Patrick O; Refshauge, Kathryn M; Remus, Alexandria; Verhagen, Evert; Vicenzino, Bill T; Wikstrom, Erik A; Gribble, Phillip A

2018-06-09

Lateral ankle sprain injury is the most common musculoskeletal injury incurred by individuals who participate in sports and recreational physical activities. Following initial injury, a high proportion of individuals develop long-term injury-associated symptoms and chronic ankle instability. The development of chronic ankle instability is consequent on the interaction of mechanical and sensorimotor insufficiencies/impairments that manifest following acute lateral ankle sprain injury. To reduce the propensity for developing chronic ankle instability, clinical assessments should evaluate whether patients in the acute phase following lateral ankle sprain injury exhibit any mechanical and/or sensorimotor impairments. This modified Delphi study was undertaken under the auspices of the executive committee of the International Ankle Consortium. The primary aim was to develop recommendations, based on expert (n=14) consensus, for structured clinical assessment of acute lateral ankle sprain injuries. After two modified Delphi rounds, consensus was achieved on the clinical assessment of acute lateral ankle sprain injuries. Consensus was reached on a minimum standard clinical diagnostic assessment. Key components of this clinical diagnostic assessment include: establishing the mechanism of injury, as well as the assessment of ankle joint bones and ligaments. Through consensus, the expert panel also developed the International Ankle Consortium Rehabilitation-Oriented ASsessmenT (ROAST). The International Ankle Consortium ROAST will help clinicians identify mechanical and/or sensorimotor impairments that are associated with chronic ankle instability. This consensus statement from the International Ankle Consortium aims to be a key resource for clinicians who regularly assess individuals with acute lateral ankle sprain injuries. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

American Society for Pain Management Nursing position statement: pain management at the end of life.

PubMed

Reynolds, Janice; Drew, Debra; Dunwoody, Colleen

2013-09-01

Pain at the end of life continues to be of great concern as it may be unrecognized or untreated. While nurses have an ethical obligation to reduce suffering at the end of life, barriers remain regarding appropriate and adequate pain management at the end of life. This position statement from the American Society for Pain Management Nursing contains recommendations for nurses, prescribers, and institutions that would improve pain management for this vulnerable population. Copyright © 2013 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

Caries preventive measures in orthodontic practice: the development of a clinical practice guideline.

PubMed

Oosterkamp, B C M; van der Sanden, W J M; Frencken, J E F M; Kuijpers-Jagtman, A M

2016-02-01

White spot lesions (WSLs) are a side effect of orthodontic treatment, causing esthetic problems and a risk of deeper enamel and dentine lesions. Many strategies have been developed for preventing WSLs, but great variability exists in preventive measures between orthodontists. This study developed statements on which a clinical practice guideline (CPG) can be developed in order to help orthodontists select preventive measures based on the best available evidence. A nominal group technique (RAND-e modified Delphi procedure) was used. A multidisciplinary expert panel rated 264 practice- and evidence-based statements related to the management of WSLs. To provide panel members with the same knowledge, a total of six articles obtained from a systematic review of the literature were read by the panel in preparation of three consensus rounds. According to the technique, a threshold of 75% of all ratings within any 3-point section of the 9-point scale regarding a specific statement was accepted as consensus. After the first and second consensus rounds, consensus was reached on 37.5 and 31.1% of statements, respectively. For the remaining 31.4% of statements, consensus was reached during a 4-h consensus meeting. Statements on the management of WSLs derived from a systematic literature review combined with expert opinion were formally integrated toward consensus through a nominal group technique. These statements formed the basis for developing a CPG on the management of WSLs before and during orthodontic treatment. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

30 CFR 281.5 - False statements.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 30 Mineral Resources 2 2010-07-01 2010-07-01 false False statements. 281.5 Section 281.5 Mineral Resources MINERALS MANAGEMENT SERVICE, DEPARTMENT OF THE INTERIOR OFFSHORE LEASING OF MINERALS OTHER THAN OIL, GAS, AND SULPHUR IN THE OUTER CONTINENTAL SHELF General § 281.5 False statements. Under the...

76 FR 7577 - Agency Information Collection Activities: Submission for OMB Review; Comment Request, OMB No...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-02-10

...; Debt Collection Financial Statement AGENCY: Federal Emergency Management Agency, DHS. ACTION: Notice... No. 1660-0011; FEMA Form 127-0-1 (currently FEMA Form 22-13), Debt Collection Financial Statement... . SUPPLEMENTARY INFORMATION: Collection of Information Title: Debt Collection Financial Statement. Type of...

Uranium Leasing Program PEIS Information Center

Science.gov Websites

Search Go search Uranium Leasing Program Programmatic Environmental Impact Statement Information Center Environmental Impact Statement (PEIS) for the Uranium Leasing Program. The United States Department of Energy (DOE) Office of Legacy Management (LM) has prepared a Programmatic Environmental Impact Statement (PEIS

78 FR 53186 - Revised Notice of Intent To Prepare an Environmental Impact Statement: Milwaukee County, Wisconsin

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-28

... Environmental Impact Statement: Milwaukee County, Wisconsin AGENCY: Federal Highway Administration (FHWA), DOT... the public that the project limits for the I-94 East-West Corridor Environmental Impact Statement (EIS... CONTACT: Bethaney Bacher-Gresock, Environmental Program Manager, FHWA Wisconsin Division Office, City...

77 FR 11547 - Agency Information Collection Activities; Submission for Office of Management and Budget Review...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-02-27

... Request; Experimental Study on Consumer Responses to Whole Grain Labeling Statements on Food Packages... and title ``Experimental Study on Consumer Responses to Whole Grain Labeling Statements on Food... review and clearance. Experimental Study on Consumer Responses to Whole Grain Labeling Statements on Food...

The Role of Athletic Trainers in Preventing and Managing Posttraumatic Osteoarthritis in Physically Active Populations: a Consensus Statement of the Athletic Trainers' Osteoarthritis Consortiuma

PubMed Central

Cameron, Kenneth L.; DiStefano, Lindsey J.; Driban, Jeffrey B.; Pietrosimone, Brian; Thomas, Abbey C.; Tourville, Timothy W.; Consortium, Athletic Trainers' Osteoarthritis

2017-01-01

Objective:  To provide athletic trainers with a fundamental understanding of the pathogenesis and risk factors associated with the development of posttraumatic osteoarthritis (PTOA) as well as the best current recommendations for preventing and managing this condition. Background:  Posttraumatic osteoarthritis, or osteoarthritis that develops secondary to joint injury, accounts for approximately 5.5 million US cases annually. A young athlete with a joint injury is at high risk for PTOA before the age of 40, which could lead to the patient living more than half of his or her life with a painful and disabling disorder. Given our frequent contact with physically active people who often sustain traumatic joint injuries, athletic trainers are in a unique position to help prevent and manage PTOA. We can, therefore, regularly monitor joint health in at-risk patients and implement early therapies as necessary. Recommendations:  The recommendations for preventing and managing PTOA are based on the best available evidence. Primary injury prevention, self-management strategies, maintenance of a healthy body weight, and an appropriate level of physical activity should be encouraged among those at risk for PTOA after acute traumatic joint injury. Education of athletic trainers and patients regarding PTOA is also critical for effective prevention and management of this disease. PMID:28653866

Department of Energy Programmatic Environmental Impact Statement (PEIS) scoping session

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

Not Available

1992-12-31

The purpose of this programmatic environmental impact statement (PEIS) scoping meeting was: to present the ground water program so as to build some familiarity and understanding about the issue involved; and to get the Durango community`s input. This report contains the presentations made by the project manager for the uranium mill tailings program, site manager for the Durango UMTRA site, manager of ground water hydrology, and includes comments made by local residents.

The mystery of the Hawaii liver disease cluster in summer 2013: A pragmatic and clinical approach to solve the problem.

PubMed

Teschke, Rolf; Schwarzenboeck, Alexander; Frenzel, Christian; Schulze, Johannes; Eickhoff, Axel; Wolff, Albrecht

2016-01-01

In the fall of 2013, the US Centers for Disease Control and Prevention (CDC) published a preliminary report on a cluster of liver disease cases that emerged in Hawaii in the summer 2013. This report claimed a temporal association as sufficient evidence that OxyELITE Pro (OEP), a dietary supplement (DS) mainly for weight loss, was the cause of this mysterious cluster. However, the presented data were inconsistent and required a thorough reanalysis. To further investigate the cause(s) of this cluster, we critically evaluated redacted raw clinical data of the cluster patients, as the CDC report received tremendous publicity in local and nationwide newspapers and television. This attention put regulators and physicians from the medical center in Honolulu that reported the cluster, under enormous pressure to succeed, risking biased evaluations and hasty conclusions. We noted pervasive bias in the documentation, conclusions, and public statements, also poor quality of case management. Among the cases we reviewed, many causes unrelated to any DS were evident, including decompensated liver cirrhosis, acute liver failure by acetaminophen overdose, acute cholecystitis with gallstones, resolving acute hepatitis B, acute HSV and VZV hepatitis, hepatitis E suspected after consumption of wild hog meat, and hepatotoxicity by acetaminophen or ibuprofen. Causality assessments based on the updated CIOMS scale confirmed the lack of evidence for any DS including OEP as culprit for the cluster. Thus, the Hawaii liver disease cluster is now best explained by various liver diseases rather than any DS, including OEP.

Obesity and Metabolic Syndrome Among Adult Survivors of Childhood Leukemia.

PubMed

Gibson, Todd M; Ehrhardt, Matthew J; Ness, Kirsten K

2016-04-01

Treatment-related obesity and the metabolic syndrome in adult survivors of childhood acute lymphoblastic leukemia (ALL) are risk factors for cardiovascular disease. Both conditions often begin during therapy. Preventive measures, including dietary counseling and tailored exercise, should be initiated early in the course of survivorship, with referral to specialists to optimize success. However, among adults who develop obesity or the metabolic syndrome and who do not respond to lifestyle therapy, medical intervention may be indicated to manage underlying pathology, such as growth hormone deficiency, or to mitigate risk factors of cardiovascular disease. Because no specific clinical trials have been done in this population to treat metabolic syndrome or its components, clinicians who follow adult survivors of childhood ALL should use the existing American Heart Association/National Heart Lung and Blood Institute Scientific Statement to guide their approach.

Factors associated with lease financing in the hospital industry.

PubMed

McCue, Michael J

2007-01-01

In contrast to capital leases, which are reported on the balance sheet as debt, operating leases are a form of off-balance sheet financing only reported in the notes to the financial statement and have limited disclosure requirements. Following the perpetuity method of corporate finance, this study developed a capitalized operating lease value for hospitals. Evaluating the substitutability between lease and debt financing, the findings show a marginal displacement of debt by lease financing. Assessing the relationship of market, mission, operating, and financial factors on lease financing for all short-term, acute-care hospitals across the United States, the results indicate that investor-owned hospital management companies and hospitals located in CON markets are less likely to lease and that smaller hospitals with fewer unoccupied beds, higher proportion of government payers, low liquidity, and lower capital expenditures are more likely to lease.

Death of a child in the emergency department.

PubMed

O'Malley, Patricia J; Barata, Isabel A; Snow, Sally K

2014-07-01

The death of a child in the emergency department (ED) is one of the most challenging problems facing ED clinicians. This revised technical report and accompanying policy statement reaffirm principles of patient- and family-centered care. Recent literature is examined regarding family presence, termination of resuscitation, bereavement responsibilities of ED clinicians, support of child fatality review efforts, and other issues inherent in caring for the patient, family, and staff when a child dies in the ED. Appendices are provided that offer an approach to bereavement activities in the ED, carrying out forensic responsibilities while providing compassionate care, communicating the news of the death of a child in the acute setting, providing a closing ritual at the time of terminating resuscitation efforts, and managing the child with a terminal condition who presents near death in the ED.

Acute pancreatitis: current perspectives on diagnosis and management

PubMed Central

Shah, Adarsh P; Mourad, Moustafa M; Bramhall, Simon R

2018-01-01

The last two decades have seen the emergence of significant evidence that has altered certain aspects of the management of acute pancreatitis. While most cases of acute pancreatitis are mild, the challenge remains in managing the severe cases and the complications associated with acute pancreatitis. Gallstones are still the most common cause with epidemiological trends indicating a rising incidence. The surgical management of acute gallstone pancreatitis has evolved. In this article, we revisit and review the methods in diagnosing acute pancreatitis. We present the evidence for the supportive management of the condition, and then discuss the management of acute gallstone pancreatitis. Based on the evidence, our local institutional pathways, and clinical experience, we have produced an outline to guide clinicians in the management of acute gallstone pancreatitis. PMID:29563826

41 CFR 102-192.155 - What should our agency-wide mail management policy statement cover?

Code of Federal Regulations, 2010 CFR

2010-07-01

... correct street addresses, and minimizing use of hand-written addresses; (j) Ensuring that a USPS mail... should our agency-wide mail management policy statement cover? You should have a written, agency-wide...), or to return it to the sender if the addressee cannot be identified. On the other hand, agencies may...

76 FR 379 - Notice of Intent To Prepare an Environmental Impact Statement for the TransWest Express 600 kV...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-01-04

... Management, Wyoming State Office, TransWest Express Transmission Project, P.O. Box 20678, 5353 Yellowstone... DEPARTMENT OF THE INTERIOR Bureau of Land Management DEPARTMENT OF ENERGY Western Area Power... Intent To Prepare an Environmental Impact Statement for the TransWest Express 600 kV Direct Current...

75 FR 13268 - Extension of the Public Comment Period for the Draft Tank Closure and Waste Management...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-19

... Management Environmental Impact Statement for the Hanford Site, Richland, WA AGENCY: Department of Energy... Statement for the Hanford Site, Richland, Washington (Draft EIS, DOE/EIS-00391), made available for public... Draft EIS is also available through the Hanford Web site at: http://www.hanford.gov/orp . Issued in...

5 CFR 2606.304 - Response to a request for review of an initial refusal to amend; disagreement statements.

Code of Federal Regulations, 2011 CFR

2011-01-01

... OFFICE OF GOVERNMENT ETHICS ORGANIZATION AND PROCEDURES PRIVACY ACT RULES Amendment of Records § 2606.304... steps to advise the data subject, and to direct the appropriate system manager: (1) To amend the record... disagreement statement must be concise. The appropriate system manager has the authority to determine the...

77 FR 74508 - Notice of Availability of the Draft Resource Management Plan Amendment, Draft Environmental...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-12-14

... Statement for the Ring of Fire Resource Management Plan--Haines Planning Area, Alaska AGENCY: Bureau of Land.../Draft Environmental Impact Statement (EIS) for the Ring of Fire RMP for the Haines Planning Area and by... Fire RMP-- Haines Planning Area Amendment by any of the following methods: Email: [email protected

76 FR 62089 - General Management Plan/Abbreviated Final Environmental Impact Statement, New River Gorge...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-10-06

... Impact Statement for the General Management Plan (GMP/EIS) for New River Gorge National River, West..., and interpretation of park resources over the next 20 years. The Abbreviated Final GMP/EIS includes an analysis of agency and public comments received on the Draft GMP/EIS with NPS responses, errata sheets...

77 FR 24980 - Final General Management Plan and Environmental Impact Statement for the South Unit of Badlands...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-26

... the availability of the Final General Management Plan and Environmental Impact Statement (GMP/EIS) for the South Unit of Badlands National Park, South Dakota. DATES: The Final GMP/EIS will remain available... Register by the Environmental Protection Agency. ADDRESSES: Copies of the GMP/EIS are available by request...

77 FR 132 - General Management Plan and Environmental Impact Statement for Lincoln Home National Historic Site

Federal Register 2010, 2011, 2012, 2013, 2014

2012-01-03

...: The Abbreviated Final General Management Plan and Environmental Impact Statement (GMP/EIS) will remain... Site. SUPPLEMENTARY INFORMATION: We, the National Park Service, prepared a draft GMP/EIS for the park... summaries of the draft GMP/EIS. In addition to the distribution, the draft GMP/EIS was also made available...

Evaluation of Increasing Antecedent Specificity in Goal Statements on Adherence to Positive Behavior-Management Strategies

ERIC Educational Resources Information Center

Cohrs, Corey M.; Shriver, Mark D.; Burke, Raymond V.; Allen, Keith D.

2016-01-01

We evaluated the impact of antecedent specificity in goal statements on adherence to positive behavior-management strategies. Teaching staff were recruited from 2 different school settings where there were routine expectations to use behavior-specific praise in the classroom, but adherence was poor. In a concurrent multiple baseline design, the…

77 FR 15795 - Notice of Availability of a Final Environmental Impact Statement for the Gasco Energy Inc. Uinta...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-16

... DEPARTMENT OF THE INTERIOR Bureau of Land Management [LLUTG01100-12-L13110000-EJ0000] Notice of Availability of a Final Environmental Impact Statement for the Gasco Energy Inc. Uinta Basin Natural Gas Development Project, Uintah County, UT AGENCY: Bureau of Land Management, Interior. ACTION: Notice of...

75 FR 60805 - Notice of Availability of a Draft Environmental Impact Statement for the Gasco Uinta Basin...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-01

... DEPARTMENT OF THE INTERIOR Bureau of Land Management [LLUTG01100-09-L13100000-EJ0000] Notice of Availability of a Draft Environmental Impact Statement for the Gasco Uinta Basin Natural Gas Development Project, Duchesne and Uintah Counties, UT AGENCY: Bureau of Land Management, Interior. ACTION: Notice of...

Recommendations for the management of biofilm: a consensus document.

PubMed

Bianchi, T; Wolcott, R D; Peghetti, A; Leaper, D; Cutting, K; Polignano, R; Rosa Rita, Z; Moscatelli, A; Greco, A; Romanelli, M; Pancani, S; Bellingeri, A; Ruggeri, V; Postacchini, L; Tedesco, S; Manfredi, L; Camerlingo, Maria; Rowan, S; Gabrielli, A; Pomponio, G

2016-06-01

The potential impact of biofilm on healing in acute and chronic wounds is one of the most controversial current issues in wound care. A significant amount of laboratory-based research has been carried out on this topic, however, in 2013 the European Wound Management Association (EWMA) pointed out the lack of guidance for managing biofilms in clinical practice and solicited the need for guidelines and further clinical research. In response to this challenge, the Italian Nursing Wound Healing Society (AISLeC) initiated a project which aimed to achieve consensus among a multidisciplinary and multiprofessional international panel of experts to identify what could be considered part of 'good clinical practice' with respect to the recognition and management of biofilms in acute and chronic wounds. The group followed a systematic approach, developed by the GRADE working group, to define relevant questions and clinical recommendations raised in clinical practice. An independent librarian retrieved and screened approximately 2000 pertinent published papers to produce tables of levels of evidence. After a smaller focus group had a multistep structured discussion, and a formal voting process had been completed, ten therapeutic interventions were identified as being strongly recommendable for clinical practice, while another four recommendations were graded as being 'weak'. The panel subsequently formulated a preliminary statement (although with a weak grade of agreement): 'provided that other causes that prevent optimal wound healing have been ruled out, chronic wounds are chronically infected'. All members of the panel agreed that there is a paucity of reliable, well-conducted clinical trials which have produced clear evidence related to the effects of biofilm presence. In the meantime it was agreed that expert-based guidelines were needed to be developed for the recognition and management of biofilms in wounds and for the best design of future clinical trials. This is a fundamental and urgent task for both laboratory-based scientists and clinicians.

Highlighting clinical needs in Clostridium difficile infection: the views of European healthcare professionals at the front line.

PubMed

Aguado, J M; Anttila, V J; Galperine, T; Goldenberg, S D; Gwynn, S; Jenkins, D; Norén, T; Petrosillo, N; Seifert, H; Stallmach, A; Warren, T; Wenisch, C

2015-06-01

Clostridium difficile infection (CDI) is the leading cause of infectious nosocomial diarrhoea in Europe. Despite increased focus, its incidence and severity are increasing in many European countries. We developed a series of consensus statements to identify unmet clinical needs in the recognition and management of CDI. A consortium of European experts prepared a series of 29 statements representing their collective views on the diagnosis and management of CDI in Europe. The statements were grouped into the following six broad themes: diagnosis; definitions of severity; treatment failure, recurrence and its consequences; infection prevention and control interventions; education and antimicrobial stewardship; and National CDI clinical guidance and policy. These statements were reviewed using questionnaires by 1047 clinicians involved in managing CDI, who indicated their level of agreement with each statement. Levels of agreement exceeded the 66% threshold for consensus for 27 out of 29 statements (93.1%), indicating strong support. Variance between countries and specialties was analysed and showed strong alignment with the overall consensus scores. Based on the consensus scores of the respondent group, recommendations are suggested for the further development of CDI services in order to reduce transmission and recurrence and to ensure that appropriate diagnosis and treatment strategies are applied across all healthcare settings. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

75 FR 19991 - Notice of Availability of the Final Environmental Impact Statement for the UNEV Refined Liquid...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-16

...-82385] Notice of Availability of the Final Environmental Impact Statement for the UNEV Refined Liquid...) has prepared a Proposed Resource Management Plan Amendment (RMPA)/Final Environmental Impact Statement..., Tooele, Juab, Millard, Beaver, Iron, and Washington Counties in Utah; and Lincoln and Clark Counties in...

78 FR 37269 - 30-Day Notice of Proposed Information Collection: Statement of Exigent/Special Family...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-20

...: Statement of Exigent/Special Family Circumstances for Issuance of a U.S. Passport to a Minor Under Age 16... Information Collection: Statement of Exigent/ Special Family Circumstances for Issuance of a U.S. Passport to...: Bureau of Consular Affairs, Passport Services, Office of Program Management and Operational Support...

Fiscal Year 2011 U.S. Government Financial Statements: The Federal Government Faces Continuing Financial Management and Long-Term Fiscal Challenges

DTIC Science & Technology

2012-03-01

GAO annually audits the consolidated financial statements of the U.S. government. The Congress and the President need reliable, useful, and timely...based consolidated financial statements . Unless these weaknesses are adequately addressed, they will, among other things, continue to (1) hamper the

GASB 35 Implementation Guide: Questions and Answers for Public Colleges and Universities Using Business Type Activity (BTA) Reporting. A Supplement to GASB's Implementation Guide for Statement 34

ERIC Educational Resources Information Center

National Association of College and University Business Officers (NJ1), 2001

2001-01-01

This guide was prepared for public institution business officers as a supplement to the "Guide to Implementation of GASB Statement 54 on Basic Financial Statements--and Management's Discussion and Analysis--for State and Local Governments, published in April 2000 by the Governmental Accounting Standards Board (GASB) on GASB Statements 34 and 35.…

U.S. GOVERNMENT FINANCIAL STATEMENTS: FY 2001 Results Highlight the Continuing Need to Accelerate Federal Financial Management Reform

DTIC Science & Technology

2002-04-09

consolidated financial statements for fiscal years 2001 and 2000. Both the consolidated financial statements and this report are included in the fiscal year 2001 Financial Report of the United States Government, which was issued by the Department of the Treasury (Treasury) on March 29, 2002, and is available through GAO’s Internet site, at www.gao.gov. Work by the subcommittee has been a catalyst to facilitate government management reform over the past 5 years and will be critical to ultimately restoring the confidence of

Revision of the Jones Criteria for the diagnosis of acute rheumatic fever in the era of Doppler echocardiography: a scientific statement from the American Heart Association.

PubMed

Gewitz, Michael H; Baltimore, Robert S; Tani, Lloyd Y; Sable, Craig A; Shulman, Stanford T; Carapetis, Jonathan; Remenyi, Bo; Taubert, Kathryn A; Bolger, Ann F; Beerman, Lee; Mayosi, Bongani M; Beaton, Andrea; Pandian, Natesa G; Kaplan, Edward L

2015-05-19

Acute rheumatic fever remains a serious healthcare concern for the majority of the world's population despite its decline in incidence in Europe and North America. The goal of this statement was to review the historic Jones criteria used to diagnose acute rheumatic fever in the context of the current epidemiology of the disease and to update those criteria to also take into account recent evidence supporting the use of Doppler echocardiography in the diagnosis of carditis as a major manifestation of acute rheumatic fever. To achieve this goal, the American Heart Association's Council on Cardiovascular Disease in the Young and its Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee organized a writing group to comprehensively review and evaluate the impact of population-specific differences in acute rheumatic fever presentation and changes in presentation that can result from the now worldwide availability of nonsteroidal anti-inflammatory drugs. In addition, a methodological assessment of the numerous published studies that support the use of Doppler echocardiography as a means to diagnose cardiac involvement in acute rheumatic fever, even when overt clinical findings are not apparent, was undertaken to determine the evidence basis for defining subclinical carditis and including it as a major criterion of the Jones criteria. This effort has resulted in the first substantial revision to the Jones criteria by the American Heart Association since 1992 and the first application of the Classification of Recommendations and Levels of Evidence categories developed by the American College of Cardiology/American Heart Association to the Jones criteria. This revision of the Jones criteria now brings them into closer alignment with other international guidelines for the diagnosis of acute rheumatic fever by defining high-risk populations, recognizing variability in clinical presentation in these high-risk populations, and including Doppler echocardiography as a tool to diagnose cardiac involvement. © 2015 American Heart Association, Inc.

Ethics in practice: managed care and the changing health care environment: medicine as a profession managed care ethics working group statement.

PubMed

Povar, Gail J; Blumen, Helen; Daniel, John; Daub, Suzanne; Evans, Lois; Holm, Richard P; Levkovich, Natalie; McCarter, Alice O; Sabin, James; Snyder, Lois; Sulmasy, Daniel; Vaughan, Peter; Wellikson, Laurence D; Campbell, Amy

2004-07-20

Cost pressures and changes in the health care environment pose ethical challenges and hard choices for patients, physicians, policymakers, and society. In 2000 and 2001, the American College of Physicians, with the Harvard Pilgrim Health Care Ethics Program, convened a working group of stakeholders--patients, physicians, and managed care representatives, along with medical ethicists--to develop a statement of ethics for managed care. The group explored the impact of a changing health care environment on patient-physician relationships and how to best apply the principles of professionalism in this environment. The statement that emerged offers guidance on preserving the patient-clinician relationship, patient rights and responsibilities, confidentiality and privacy, resource allocation and stewardship, the obligation of health plans to foster an ethical environment for the delivery of care, and the clinician's responsibility to individual patients, the community, and the public health, among other issues.

75 FR 81249 - Intent To Prepare a Supplemental Draft Environmental Impact Statement for a Proposed Flood Risk...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-27

... Draft Environmental Impact Statement for a Proposed Flood Risk Management Project on the Red River of... Study (EIS/FS) for a Proposed Fargo- Moorhead Flood Risk Management Project on the Red River of the North in Fargo, ND, and Moorhead, MN (Proposed Fargo-Moorhead Project). On May 5, 2009, the St. Paul...

76 FR 82320 - Extension of Public Scoping Period for the Draft Environmental Impact Statement for Adoption of a...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-30

... Management Plan for the Operation of Glen Canyon Dam AGENCY: Bureau of Reclamation and National Park Service... Impact Statement (EIS) for Adoption of a Long-term Experimental and Management Plan (LTEMP) for the Operation of Glen Canyon Dam to January 31, 2012. The Notice to Solicit Comments and Hold Public Scoping...

[Mission statements of Dutch mental health institutions; the quality of communication with stakeholders].

PubMed

Krol, D G H; de Kruif, J

2013-01-01

As a result of recent reforms in Dutch health care, healthcare providers are having to operate more and more like commercial organisations and adopt some of the rules prevailing in the profit sector. Because missions statements can be an efficient means of useful communication with internal and external stakeholders they can make a useful contribution to the way healthcare institutions are managed and to their status and reputation. Research shows that in view of this the quality of the messages conveyed via mission statements is important. To ascertain which stakeholders are mentioned in the mission statements of Dutch mental healthcare providers and to quantify the quality of the messages conveyed to them via mission statements. We examined the mission statements of 34 mental health providers to find out which stakeholders were included. The message conveyed to the stakeholders was quantified by means of a validated measuring instrument devised specifically for this purpose. Patients were referred to in all mission statements and the quality of the messages conveyed was of higher quality than the messages conveyed to other stakeholders. Other important stakeholders on whom the institutions depended were referred to much less frequently and the quality of sections of text referring to them was definitely inferior. Mission statements frequently serve as management tool for Dutch mental healthcare providers. The potential benefits that these statements could bestow on the providers are not being fully exploited because the standard of communication with several internal and external stakeholders is of poor quality.

77 FR 68771 - Pesticide Program Dialogue Committee; Notice of Public Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2012-11-16

... follows: PPDC Work Group on Integrated Pest Management; PPDC Work Group on Comparative Safety Statements.... to 4 p.m.; Comparative Safety Statements from 1 p.m. to 4 p.m.; and Pollinator Protection from 1 p.m..., 2012, in room S- 4850-70 Potomac Yards South. The PPDC Work Group on Comparative Safety Statements will...

76 FR 16039 - Agency Information Collection (Statement in Support of Claim for Service Connection for PTSD...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-03-22

... to the Office of Management and Budget (OMB) for review and comment. The PRA submission describes the...: Titles: a. Statement in Support of Claim for Service Connection for Post- Traumatic Stress Disorder (PTSD), VA Form 21-0781. b. Statement in Support of Claim for Service Connection for Post- Traumatic Stress...

78 FR 48713 - Notice of Availability of the Draft Environmental Impact Statement for the Ochoa Mine Project in...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-09

...] Notice of Availability of the Draft Environmental Impact Statement for the Ochoa Mine Project in Lea County, New Mexico AGENCY: Bureau of Land Management, Interior. ACTION: Notice of availability. SUMMARY... Draft Environmental Impact Statement (EIS) for the Ochoa Mine Project (Project) and by this notice is...

76 FR 30962 - Notice of Availability of Draft Environmental Impact Statement for the Sigurd to Red Butte No. 2...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-27

...; UTU-83067] Notice of Availability of Draft Environmental Impact Statement for the Sigurd to Red Butte..., as amended, the Bureau of Land Management (BLM) has prepared a Draft Environmental Impact Statement... Service; State of Utah; Millard, Sevier, Beaver, Iron, and Washington counties, Utah; and the cities of St...

77 FR 67860 - 60-Day Notice of Proposed Information Collection: Statement Regarding a Lost or Stolen U.S...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-11-14

...: Statement Regarding a Lost or Stolen U.S. Passport Book and/or Card ACTION: Notice of request for public... Information Collection: Statement Regarding a Lost or Stolen U.S. Passport Book and/or Card. OMB Control...: Bureau of Consular Affairs, Passport Services, Office of Program Management and Operational Support...

76 FR 13443 - 30-Day Notice of Proposed Information Collection: Form DS-0064, Statement Regarding a Lost or...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-03-11

... DS-0064, Statement Regarding a Lost or Stolen Passport, 1405-0014 ACTION: Notice of request for... Collection: Statement Regarding a Lost or Stolen Passport. OMB Control Number: 1405-0014. Type of Request... supporting documents from Passport Forms Management Officer, U.S. Department of State, Office of Program...

North Dakota University System Annual Financial Report, Fiscal Year Ended June 30, 2007

ERIC Educational Resources Information Center

North Dakota University System, 2007

2007-01-01

This report provides financial data for the North Dakota University System (the "System") for the fiscal year ended June 30, 2007. The Management Discussion and Analysis; the Statement of Net Assets; the Statement of Revenues, Expenses, and Changes in Net Assets; and the Statement of Cash Flows provide information on the System as a…

76 FR 75554 - Notice of Availability of the Draft Environmental Impact Statement for the Mount Hope Project...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-02

... Environmental Impact Statement for the Mount Hope Project, Eureka County, NV AGENCY: Bureau of Land Management... Impact Statement (EIS) for the Mount Hope Project and by this notice is announcing the opening of the... Mount Hope Project Draft EIS within 90 days following the date the Environmental Protection Agency...

75 FR 44278 - Notice of Availability of the Final Environmental Impact Statement for the Imperial Valley Solar...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-28

... mirrors concentrate solar energy onto the solar receiver of the PCU. The project also includes an..., LVRAB109AA01] Notice of Availability of the Final Environmental Impact Statement for the Imperial Valley Solar... Management Plan (RMP) Amendment/Final Environmental Impact Statement (EIS) for the Imperial Valley Solar, LLC...

75 FR 7570 - Notice of Public Hearings for the Draft Environmental Impact Statement for the Silver Strand...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-02-22

... Impact Statement for the Silver Strand Training Complex, San Diego, CA; Correction AGENCY: Department of... Impact Statement for the Silver Strand Training Complex, San Diego, CA. The document contained incorrect.... Kent Randall, SSTC EIS Project Manager, 1220 Pacific Highway, Building 1, 5th Floor, San Diego, CA...

77 FR 49825 - Notice of Availability of the Final Environmental Impact Statement for the Lost Creek Uranium In...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-17

...-166318] Notice of Availability of the Final Environmental Impact Statement for the Lost Creek Uranium In Situ Recovery Project in Sweetwater County, WY AGENCY: Bureau of Land Management, Interior. ACTION... (BLM) has prepared a Final Environmental Impact Statement (EIS) for the Lost Creek Uranium In Situ...

Evaluation of increasing antecedent specificity in goal statements on adherence to positive behavior-management strategies.

PubMed

Cohrs, Corey M; Shriver, Mark D; Burke, Raymond V; Allen, Keith D

2016-12-01

We evaluated the impact of antecedent specificity in goal statements on adherence to positive behavior-management strategies. Teaching staff were recruited from 2 different school settings where there were routine expectations to use behavior-specific praise in the classroom, but adherence was poor. In a concurrent multiple baseline design, the use of behavior-specific praise by 4 participants was found to be unaffected by goal statements that increasingly specified the behavior to be used and the conditions under which the behavior should occur. However, adherence by 3 of the 4 participants did change when goal statements included teacher-specified frequencies with which the behavior should occur. Results were systematically replicated in a second study in which, in a concurrent multiple baseline design, 3 participants showed marked increases in adherence when goal statements specified the target behavior, the conditions under which it should occur, and the frequency with which it should occur. © 2016 Society for the Experimental Analysis of Behavior.

How much is too much? (Part 2) International Olympic Committee consensus statement on load in sport and risk of illness.

PubMed

Schwellnus, Martin; Soligard, Torbjørn; Alonso, Juan-Manuel; Bahr, Roald; Clarsen, Ben; Dijkstra, H Paul; Gabbett, Tim J; Gleeson, Michael; Hägglund, Martin; Hutchinson, Mark R; Janse Van Rensburg, Christa; Meeusen, Romain; Orchard, John W; Pluim, Babette M; Raftery, Martin; Budgett, Richard; Engebretsen, Lars

2016-09-01

The modern-day athlete participating in elite sports is exposed to high training loads and increasingly saturated competition calendar. Emerging evidence indicates that inappropriate load management is a significant risk factor for acute illness and the overtraining syndrome. The IOC convened an expert group to review the scientific evidence for the relationship of load-including rapid changes in training and competition load, competition calendar congestion, psychological load and travel-and health outcomes in sport. This paper summarises the results linking load to risk of illness and overtraining in athletes, and provides athletes, coaches and support staff with practical guidelines for appropriate load management to reduce the risk of illness and overtraining in sport. These include guidelines for prescription of training and competition load, as well as for monitoring of training, competition and psychological load, athlete well-being and illness. In the process, urgent research priorities were identified. 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/

British Society for Sexual Medicine Guidelines on Adult Testosterone Deficiency, With Statements for UK Practice.

PubMed

Hackett, Geoff; Kirby, Michael; Edwards, David; Jones, Thomas Hugh; Wylie, Kevan; Ossei-Gerning, Nick; David, Janine; Muneer, Asif

2017-12-01

Testosterone deficiency (TD) is an increasingly common problem with significant health implications, but its diagnosis and management can be challenging. To review the available literature on TD and provide evidence-based statements for UK clinical practice. Evidence was derived from Medline, EMBASE, and Cochrane searches on hypogonadism, testosterone (T) therapy, and cardiovascular safety from May 2005 to May 2015. Further searches continued until May 2017. To provide a guideline on diagnosing and managing TD, with levels of evidence and grades of recommendation, based on a critical review of the literature and consensus of the British Society of Sexual Medicine panel. 25 statements are provided, relating to 5 key areas: screening, diagnosis, initiating T therapy, benefits and risks of T therapy, and follow-up. 7 statements are supported by level 1, 8 by level 2, 5 by level 3, and 5 by level 4 evidence. To help guide UK practitioners on effectively diagnosing and managing primary and age-related TD. A large amount of literature was carefully sourced and reviewed, presenting the best evidence available at the time. However, some statements provided are based on poor-quality evidence. This is a rapidly evolving area of research and recommendations are subject to change. Guidelines can never replace clinical expertise when making treatment decisions for individual patients, but rather help to focus decisions and take personal values and preferences and individual circumstances into account. Many issues remain controversial, but in the meantime, clinicians need to manage patient needs and clinical expectations armed with the best clinical evidence and the multidisciplinary expert opinion available. Improving the diagnosis and management of TD in adult men should provide somatic, sexual, and psychological benefits and subsequent improvements in quality of life. Hackett G, Kirby M, Edwards D, et al. British Society for Sexual Medicine Guidelines on Adult Testosterone Deficiency, With Statements for UK Practice. J Sex Med 2017;14:1504-1523. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

Compilation of FY 1997 Air Force General Funds Consolidated Financial Statements at the Defense Finance and Accounting Service Denver Center.

DTIC Science & Technology

1998-10-05

Consolidated Financial Statements to the Air Force Audit Agency. The Defense Finance and Accounting Service Denver Center maintained accounting records and prepared the FY 1997 financial statements for the Air Force. More than $343 billion in total assets was reported at year’s end in these statements, and total revenues for the year exceeded $64 billion. The Air Force Audit Agency disclaimed an opinion on these statements. Additionally, although the Office of Management and Budget does not require budgetary resource reporting until FY 1998, the Air Force

Asian Consensus Report on Functional Dyspepsia

PubMed Central

Miwa, Hiroto; Ghoshal, Uday C; Gonlachanvit, Sutep; Gwee, Kok-Ann; Ang, Tiing-Leong; Chang, Full-Young; Fock, Kwong Ming; Hongo, Michio; Hou, Xiaohua; Kachintorn, Udom; Ke, Meiyun; Lai, Kwok-Hung; Lee, Kwang Jae; Lu, Ching-Liang; Mahadeva, Sanjiv; Miura, Soichiro; Park, Hyojin; Rhee, Poong-Lyul; Sugano, Kentaro; Vilaichone, Ratha-korn; Wong, Benjamin CY

2012-01-01

Background/Aims Environmental factors such as food, lifestyle and prevalence of Helicobacter pylori infection are widely different in Asian countries compared to the West, and physiological functions and genetic factors of Asians may also be different from those of Westerners. Establishing an Asian consensus for functional dyspepsia is crucial in order to attract attention to such data from Asian countries, to articulate the experience and views of Asian experts, and to provide a relevant guide on management of functional dyspepsia for primary care physicians working in Asia. Methods Consensus team members were selected from Asian experts and consensus development was carried out using a modified Delphi method. Consensus teams collected published papers on functional dyspepsia especially from Asia and developed candidate consensus statements based on the generated clinical questions. At the first face-to-face meeting, each statement was reviewed and e-mail voting was done twice. At the second face-to-face meeting, final voting on each statement was done using keypad voting system. A grade of evidence and a strength of recommendation were applied to each statement according to the method of the GRADE Working Group. Results Twenty-nine consensus statements were finalized, including 7 for definition and diagnosis, 5 for epidemiology, 9 for pathophysiology and 8 for management. Algorithms for diagnosis and management of functional dyspepsia were added. Conclusions This consensus developed by Asian experts shows distinctive features of functional dyspepsia in Asia and will provide a guide to the diagnosis and management of functional dyspepsia for Asian primary care physicians. PMID:22523724

StressModEx--Physiotherapist-led Stress Inoculation Training integrated with exercise for acute whiplash injury: study protocol for a randomised controlled trial.

PubMed

Ritchie, Carrie; Kenardy, Justin; Smeets, Rob; Sterling, Michele

2015-07-01

Whiplash associated disorders are the most common non-hospitalised injuries following a road traffic crash. Up to 50% of individuals who experience a whiplash injury will not fully recover and report ongoing pain and disability. Most recovery, if it occurs, takes place in the first 2-3 months post injury, indicating that treatment provided in the early stages is critical to long-term outcome. However, early management approaches for people with acute whiplash associated disorders are modestly effective. One reason may be that the treatments have been non-specific and have not targeted the processes shown to be associated with poor recovery, such as post-traumatic stress symptoms. Targeting and modulating these early stress responses in the early management of acute whiplash associated disorders may improve health outcomes. Early aggressive psychological interventions in the form of psychological debriefing may be detrimental to recovery and are now not recommended for management of early post-traumatic stress symptoms. In contrast, Stress Inoculation Training (SIT) is a cognitive behavioural approach that teaches various general problem-solving and coping strategies to manage stress-related anxiety (ie, relaxation training, cognitive restructuring and positive self-statements) and provides important information to injured individuals about the impact of stress on their physical and psychological wellbeing. While referral to a psychologist may be necessary in some cases where acute stress disorder or other more significant psychological reactions to stress are evident, in the case of acute whiplash injuries, it is neither feasible nor necessary for a psychologist to deliver the early stress modulation intervention to all injured individuals. The feasibility of using other specially trained health professionals to deliver psychological interventions has been explored in conditions such as chronic low back pain, chronic whiplash and cancer, but few trials have studied this approach in acute musculoskeletal conditions with the aim of preventing the development of chronic pain. As physiotherapy is the most common intervention received by individuals with a whiplash injury, physiotherapists are ideally placed to provide SIT in conjunction with standard physical rehabilitation. This study (StressModEx) will target individuals in the acute stage of injury and address the stress responses associated with the accident or injury (event-related distress) with the aim of improving both physical and mental health outcomes. Is SIT integrated with standard physiotherapy exercise and delivered by physiotherapists more effective than physiotherapy exercise alone in reducing neck pain and disability in individuals with acute whiplash associated disorders? Parallel randomised controlled trial with blinded outcome assessment. 100 individuals with grade II or III (no fracture/dislocation or neurological loss) acute whiplash associated disorder<4 weeks duration and at least moderate neck pain-related disability and hyper-arousal symptoms will be recruited for the study. Participants will be assessed via online surveys or in-person at a university research laboratory. Interventions will be provided at community physiotherapy practices in Brisbane, Gold Coast, Toowoomba and Mackay, Queensland, Australia. Clinical-guideline-recommended supervised physiotherapy exercise sessions (10 sessions) integrated with six (once per week) SIT sessions. Clinical-guideline-recommended supervised physiotherapy exercise sessions (10) only. Primary (Neck Disability Index) and secondary (Acute Stress Disorder Scale; Post-traumatic Stress Diagnostic Scale; Depression, Anxiety and Stress Scale; Pain Catastrophisingo Scale; Pain Self-Efficacy Questionnaire; Coping Strategies Questionnaire; Global impression of recovery; pain intensity; SF36) outcomes will be measured at baseline, 6 weeks, 6 months and 12 months after randomisation. Data analysis will be blinded and by intention to treat. Outcomes will be analysed using linear mixed and logistic regression models that will include baseline scores as covariates, participants as random effects and treatment conditions as fixed factors. This study will be the first to address early stress responses following acute whiplash injury through a novel intervention that integrates SIT and physiotherapy exercise. Crown Copyright © 2015. Published by Elsevier B.V. All rights reserved.

78 FR 19711 - Statement of Organization, Functions, and Delegations of Authority

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-02

... Knowledge Management Office (CQA5), Office of the Director (CQA). Revise the functional statement for the... following: (9) establish collaboration and coordination between clinical medicine and public health to...

EMAS statement: benign accountability or wishful thinking? Insights from the Greek EMAS registry.

PubMed

Skouloudis, Antonis; Jones, Keith; Sfakianaki, Eleni; Lazoudi, Eugenia; Evangelinos, Konstantinos

2013-10-15

Do organizations certified under the Eco-Management and Audit Scheme (EMAS) effectively discharge their environmental accountability through their statements? Is the EMAS statement a step forward for the transparency of environmental management and the empowerment of organizational stakeholders' decision-making? Drawing from the Greek EMAS registry we apply an evaluation method for the completeness and materiality of environmental statements. While the latest version of the EMAS Regulation has introduced a set of forward-looking - yet challenging - improvements, the application of the standard should be closely examined. With this in mind, the key objective of this research note is to provide - from a descriptive standpoint - insights on the content of EMAS-based environmental accountability and a basis for future research as well as fruitful policy debate. Copyright © 2013 Elsevier Ltd. All rights reserved.

Product Lifecycle Management Architecture: A Model Based Systems Engineering Analysis.

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

Noonan, Nicholas James

2015-07-01

This report is an analysis of the Product Lifecycle Management (PLM) program. The analysis is centered on a need statement generated by a Nuclear Weapons (NW) customer. The need statement captured in this report creates an opportunity for the PLM to provide a robust service as a solution. Lifecycles for both the NW and PLM are analyzed using Model Based System Engineering (MBSE).

Approaches to the management of agents used for the treatment of multiple sclerosis: consensus statements from a panel of U.S. managed care pharmacists and physicians.

PubMed

Miller, Ross M; Happe, Laura E; Meyer, Kellie L; Spear, Rachel J

2012-01-01

Multiple sclerosis (MS) is a chronic, disabling, and costly disease with several treatment options available; however, there is variability in evidence-based clinical guidelines. Therefore, payers are at a disadvantage when making management decisions without the benefit of definitive guidance from treatment guidelines. To outline approaches for the management of agents used to treat MS, as determined from a group of U.S. managed care pharmacists and physicians. A modified Delphi process was used to develop consensus statements regarding MS management approaches. The panel was composed of experts in managed care and included 8 pharmacy directors and 6 medical directors presently or previously involved in formulary decision making from 12 health plans, 1 specialty pharmacy, and 1 consulting company. These decision makers, who have experience designing health care benefits that include MS treatments, provided anonymous feedback through 2 rounds of web-based surveys and participated in 1 live panel meeting held in December 2010. Consensus was defined as a mean response of at least 3.3 or 100% of responses either "agree" or "strongly agree" (i.e., no panelist answered "disagree" or "strongly disagree") on a 4-item Likert scale (1=strongly disagree, 2=disagree, 3=agree, 4=strongly agree). After 3 phases, these managed care representatives reached consensus on 25 statements for management of patients with MS. Consistent with managed care principles, this group of managed care experts found that health plans should consider efficacy, effectiveness, and safety, as well as patient preference, when evaluating MS therapies for formulary placement. Cost and contracting should be considered if efficacy and safety are judged to be comparable between agents. The consensus statements developed by a panel of managed care representatives provide some insight into decision making in formulary and utilization management of MS therapies.

Consensus on Exercise Reporting Template (CERT): Explanation and Elaboration Statement.

PubMed

Slade, Susan C; Dionne, Clermont E; Underwood, Martin; Buchbinder, Rachelle

2016-10-05

Exercise is effective for prevention and management of acute and chronic health conditions. However, trial descriptions of exercise interventions are often suboptimal, leaving readers unclear about the content of effective programmes. To address this, the 16-item internationally endorsed Consensus on Exercise Reporting Template (CERT) was developed. The aim is to present the final template and provide an Explanation and Elaboration Statement to operationalise the CERT. Development of the CERT was based on the EQUATOR Network methodological framework for developing reporting guidelines. We used a modified Delphi technique to gain consensus of international exercise experts and conducted 3 sequential rounds of anonymous online questionnaires and a Delphi workshop. The 16-item CERT is the minimum data set considered necessary to report exercise interventions. The contents may be included in online supplementary material, published as a protocol or located on websites and other electronic repositories. The Explanation and Elaboration Statement is intended to enhance the use, understanding and dissemination of the CERT and presents the meaning and rationale for each item, together with examples of good reporting. The CERT is designed specifically for the reporting of exercise programmes across all evaluative study designs for exercise research. The CERT can be used by authors to structure intervention reports, by reviewers and editors to assess completeness of exercise descriptions and by readers to facilitate the use of the published information. The CERT has the potential to increase clinical uptake of effective exercise programmes, enable research replication, reduce research waste and improve patient outcomes. 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/.

U.S. Government Financial Statements: FY 2000 Reporting Underscores the Need to Accelerate Federal Financial Management Reform

DTIC Science & Technology

2001-03-30

I am pleased to be here today to discuss our report on the U.S. government’s consolidated financial statements for fiscal year 2000. Both the... consolidated financial statements and our report are included in the Fiscal Year 2000 Financial Report of the United States Government (Financial Report...CFO Act agencies), beginning with fiscal year 1996, and consolidated financial statements for the U.S. government, beginning with fiscal year 1997.

Predictive acute toxicity tests with pesticides.

PubMed

Brown, V K

1983-01-01

By definition pesticides are biocidal products and this implies a probability that pesticides may be acutely toxic to species other than the designated target species. The ways in which pesticides are manufactured, formulated, packaged, distributed and used necessitates a potential for the exposure of non-target species although the technology exists to minimize adventitious exposure. The occurrence of deliberate exposure of non-target species due to the misuse of pesticides is known to happen. The array of predictive acute toxicity tests carried out on pesticides and involving the use of laboratory animals can be justified as providing data on which hazard assessment can be based. This paper addresses the justification and rationale of this statement.

78 FR 36815 - 30-Day Notice of Proposed Information Collection: Statement of Consent: Issuance of a U.S...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-19

...: Statement of Consent: Issuance of a U.S. Passport to a Minor Under Age 16 ACTION: Notice of request for... Information Collection: Statement of Consent: Issuance of a U.S. Passport to a Minor under Age 16. OMB Control...: Bureau of Consular Affairs, Passport Services, Office of Program Management and Operational Support...

77 FR 74044 - 60-Day Notice of Proposed Information Collection: Statement of Consent: Issuance of a U.S...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-12-12

...: Statement of Consent: Issuance of a U.S. Passport to a Minor Under Age 16 ACTION: Notice of request for... Information Collection: Statement of Consent: Issuance of a U.S. Passport to a Minor under Age 16. OMB Control...: Bureau of Consular Affairs, Passport Services, Office of Program Management and Operational Support...

78 FR 15799 - 30-Day Notice of Proposed Information Collection: Statement Regarding a Lost or Stolen U.S...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-12

...: Statement Regarding a Lost or Stolen U.S. Passport Book and/or Card ACTION: Notice of request for public... Collection: Statement Regarding a Lost or Stolen U.S. Passport Book and/or Card OMB Control Number: 1405-0014... Affairs, Passport Services, Office of Program Management and Operational Support, Program Coordination...

Naval Petroleum and Oil Shale Reserves Combined Financial Statements September 30, 1994 and 1993 and Management Overview and Supplemental Financial and Management Information

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

NONE

1994-12-31

This report presents the results of the independent certified public accountant`s audit of the Department of Energy`s (Department) Naval Petroleum and Oil Shale Reserves (NPOSR) financial statements as of September 30, 1994. The auditors have expressed an unqualified opinion on the 1994 statements. Their reports on the NPOSR internal control structure and on compliance with laws and regulations, and management letter on addressing needed improvements are also provided. NPOSR consists of petroleum reserves in California and Wyoming, and oil shale reserves in Colorado and Utah. The Government`s interests in NPOSR are managed by the Department through its headquarters office inmore » Washington, D.C. In addition, the Department has site offices in both California and Wyoming that are responsible for contractor oversight functions. Daily operations are conducted under contract by two management and operating contractors. By law, NPOSR was authorized to produce crude oil at the maximum efficient rate for six years. The law allowed production to be extended for three year periods, provided that the President of the United States certified that continued maximum production was in the best interest of the nation. The current three year period ends on April 5, 1997. Additional information about NPOSR is provided in the overview and notes to the financial statements.« less

Death of a child in the emergency department.

PubMed

O'Malley, Patricia; Barata, Isabel; Snow, Sally

2014-07-01

The death of a child in the emergency department (ED) is one of the most challenging problems facing ED clinicians. This revised technical report and accompanying policy statement reaffirm principles of patient- and family-centered care. Recent literature is examined regarding family presence, termination of resuscitation, bereavement responsibilities of ED clinicians, support of child fatality review efforts, and other issues inherent in caring for the patient, family, and staff when a child dies in the ED. Appendices are provided that offer an approach to bereavement activities in the ED, carrying out forensic responsibilities while providing compassionate care, communicating the news of the death of a child in the acute setting, providing a closing ritual at the time of terminating resuscitation efforts, and managing the child with a terminal condition who presents near death in the ED. Copyright © 2014 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved. Published by Mosby, Inc. All rights reserved.

Death of a child in the emergency department.

PubMed

O'Malley, Patricia; Barata, Isabel; Snow, Sally

2014-07-01

The death of a child in the emergency department (ED) is one of the most challenging problems facing ED clinicians. This revised technical report and accompanying policy statement reaffirm principles of patient- and family-centered care. Recent literature is examined regarding family presence, termination of resuscitation, bereavement responsibilities of ED clinicians, support of child fatality review efforts, and other issues inherent in caring for the patient, family, and staff when a child dies in the ED. Appendices are provided that offer an approach to bereavement activities in the ED, carrying out forensic responsibilities while providing compassionate care, communicating the news of the death of a child in the acute setting, providing a closing ritual at the time of terminating resuscitation efforts, and managing the child with a terminal condition who presents near death in the ED. Copyright © 2014 by the American Academy of Pediatrics.

Canada's public health system: is the pace of progress sufficient?

PubMed

Lozon, Jeffrey C; Alikhan, L Miin

2007-01-01

Tilson and Berkowitz review the Institute of Medicine reports that catalyzed the serious re-examination of the United States public health enterprise. For Canada, a similar catalyst stemmed from the lessons learned during the 2003 severe acute respiratory syndrome outbreak. While strong policy statements of commitment to strengthen the public health system are a necessary first step to stewarding change, they are insufficient without defined accountabilities, operationalized relationships and supporting legislation. Investments in critical enablers of sustainable reform, such as inter-sectoral partnerships, human capacity building and an electronic backbone, are also required. To support the value added by public health functions and services, both from a health benefit and economic perspective, a performance management system is necessary. While the 2004 establishment of the Public Health Agency of Canada was a progressive step, persistent political will and leadership are required to ensure this agency's effectiveness and preparedness before the next crisis hits.

Expert consensus on acute exacerbation of chronic obstructive pulmonary disease in the People’s Republic of China

PubMed Central

Cai, Bai-qiang; Cai, Shao-xi; Chen, Rong-chang; Cui, Li-ying; Feng, Yu-lin; Gu, Yu-tong; Huang, Shao-guang; Liu, Rong-yu; Liu, Guang-nan; Shi, Huan-zhong; Shi, Yi; Song, Yuan-lin; Sun, Tie-ying; Wang, Chang-zheng; Wang, Jing-lan; Wen, Fu-qiang; Xiao, Wei; Xu, Yong-jian; Yan, Xi-xin; Yao, Wan-zhen; Yu, Qin; Zhang, Jing; Zheng, Jin-ping; Liu, Jie; Bai, Chun-xue

2014-01-01

Chronic obstructive pulmonary disease (COPD) is a common disease that severely threatens human health. Acute exacerbation of COPD (AECOPD) is a major cause of disease progression and death, and causes huge medical expenditures. This consensus statement represents a description of clinical features of AECOPD in the People’s Republic of China and a set of recommendations. It is intended to provide clinical guidelines for community physicians, pulmonologists and other health care providers for the prevention, diagnosis, and treatment of AECOPD. PMID:24812503

Pharmacologic management of chronic neuropathic pain

PubMed Central

Mu, Alex; Weinberg, Erica; Moulin, Dwight E.; Clarke, Hance

2017-01-01

Abstract Objective To provide family physicians with a practical clinical summary of the Canadian Pain Society (CPS) revised consensus statement on the pharmacologic management of neuropathic pain. Quality of evidence A multidisciplinary interest group within the CPS conducted a systematic review of the literature on the current treatments of neuropathic pain in drafting the revised consensus statement. Main message Gabapentinoids, tricyclic antidepressants, and serotonin-norepinephrine reuptake inhibitors are the first-line agents for treating neuropathic pain. Tramadol and other opioids are recommended as second-line agents, while cannabinoids are newly recommended as third-line agents. Other anticonvulsants, methadone, tapentadol, topical lidocaine, and botulinum toxin are recommended as fourth-line agents. Conclusion Many pharmacologic analgesics exist for the treatment of neuropathic pain. Through evidence-based recommendations, the CPS revised consensus statement helps guide family physicians in the management of patients with neuropathic pain. PMID:29138154

76 FR 20006 - Notice of Intent To Prepare an Environmental Impact Statement for the Proposed Sun Valley to...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-11

...In compliance with the National Environmental Policy Act of 1969 (NEPA), as amended, and the Federal Land Policy and Management Act of 1976, as amended, the Bureau of Land Management (BLM) Hassayampa Field Office, Phoenix, Arizona, intends to prepare an Environmental Impact Statement (EIS) which may include discussion of an amendment to the Bradshaw-Harquahala Resource Management Plan (RMP), and by this notice is announcing the beginning of the scoping process to solicit public comments and identify issues.

78 FR 43224 - Notice of Availability of the Final Environmental Impact Statement for the Proposed Sun Valley to...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-19

...In accordance with the National Environmental Policy Act of 1969, as amended (NEPA), and the Federal Land Policy and Management Act of 1976, as amended (FLPMA), the Bureau of Land Management (BLM) has prepared a Final Environmental Impact Statement (EIS) for the proposed Sun Valley to Morgan 500/230-kilovolt (kV) Transmission Line Project (Project) and Proposed Bradshaw-Harquahala Resource Management Plan (RMP) Amendment for the BLM Hassayampa Field Office, and by this notice is announcing its availability.

Asia-Pacific consensus statements on Crohn's disease. Part 2: Management.

PubMed

Ooi, Choon Jin; Makharia, Govind K; Hilmi, Ida; Gibson, Peter R; Fock, Kwong Ming; Ahuja, Vineet; Ling, Khoon Lin; Lim, Wee Chian; Thia, Kelvin T; Wei, Shu-chen; Leung, Wai Keung; Koh, Poh Koon; Gearry, Richard B; Goh, Khean Lee; Ouyang, Qin; Sollano, Jose; Manatsathit, Sathaporn; de Silva, H Janaka; Rerknimitr, Rungsun; Pisespongsa, Pises; Abu Hassan, Muhamad Radzi; Sung, Joseph; Hibi, Toshifumi; Boey, Christopher C M; Moran, Neil; Leong, Rupert W L

2016-01-01

The Asia Pacific Working Group on Inflammatory Bowel Disease was established in Cebu, Philippines, at the Asia Pacific Digestive Week conference in 2006 under the auspices of the Asian Pacific Association of Gastroenterology (APAGE) with the goal of developing best management practices, coordinating research and raising awareness of IBD in the region. The consensus group previously published recommendations for the diagnosis and management of ulcerative colitis (UC) with specific relevance to the Asia-Pacific region. The present consensus statements were developed following a similar process to address the epidemiology, diagnosis and management of Crohn's disease (CD). The goals of these statements are to pool the pertinent literature specifically highlighting relevant data and conditions in the Asia-Pacific region relating to the economy, health systems, background infectious diseases, differential diagnoses and treatment availability. It does not intend to be all-comprehensive and future revisions are likely to be required in this ever-changing field. © 2015 Journal of Gastroenterology and Hepatology Foundation and Wiley Publishing Asia Pty Ltd.

Indian Society of Gastroenterology consensus statements on Crohn's disease in India.

PubMed

Ramakrishna, Balakrishnan S; Makharia, Govind K; Ahuja, Vineet; Ghoshal, Uday C; Jayanthi, Venkataraman; Perakath, Benjamin; Abraham, Philip; Bhasin, Deepak K; Bhatia, Shobna J; Choudhuri, Gourdas; Dadhich, Sunil; Desai, Devendra; Goswami, Bhaba Dev; Issar, Sanjeev K; Jain, Ajay K; Kochhar, Rakesh; Loganathan, Goundappa; Misra, Sri Prakash; Ganesh Pai, C; Pal, Sujoy; Philip, Mathew; Pulimood, Anna; Puri, Amarender S; Ray, Gautam; Singh, Shivaram P; Sood, Ajit; Subramanian, Venkatraman

2015-01-01

In 2012, the Indian Society of Gastroenterology's Task Force on Inflammatory Bowel Diseases undertook an exercise to produce consensus statements on Crohn's disease (CD). This consensus, produced through a modified Delphi process, reflects our current recommendations for the diagnosis and management of CD in India. The consensus statements are intended to serve as a reference point for teaching, clinical practice, and research in India.

Financial Statement: Major Deficiencies in Financial Reporting for Other Defense Organizations-General Funds

DTIC Science & Technology

2002-05-31

Financial Statement May 31, 2002 Office of the Inspector General of the Department of Defense Major Deficiencies in Financial Reporting for Other...Subtitle Financial Statement: Major Deficiencies in Financial Reporting for Other Defense Organizations-General Funds Contract Number Grant Number...use the financial reports of the Other Defense Organizations-General Funds to make management decisions. It explains major financial reporting deficiencies

17 CFR 210.3-18 - Special provisions as to registered management investment companies and companies required to be...

Code of Federal Regulations, 2014 CFR

2014-04-01

... fiscal year conforming to the requirements of § 210.6-07. (3) An audited statement of cash flows for the... 245 days of the date of filing. In addition, the statements of operations and cash flows (if required... addition, the statements of operations, cash flows, and changes in net assets shall be provided for the...

17 CFR 210.3-18 - Special provisions as to registered management investment companies and companies required to be...

Code of Federal Regulations, 2013 CFR

2013-04-01

... fiscal year conforming to the requirements of § 210.6-07. (3) An audited statement of cash flows for the... 245 days of the date of filing. In addition, the statements of operations and cash flows (if required... addition, the statements of operations, cash flows, and changes in net assets shall be provided for the...

17 CFR 210.3-18 - Special provisions as to registered management investment companies and companies required to be...

Code of Federal Regulations, 2012 CFR

2012-04-01

... fiscal year conforming to the requirements of § 210.6-07. (3) An audited statement of cash flows for the... 245 days of the date of filing. In addition, the statements of operations and cash flows (if required... addition, the statements of operations, cash flows, and changes in net assets shall be provided for the...

DOD Financial Management: Improved Documentation Needed to Support the Air Force’s Military Payroll and Meet Audit Readiness Goals

DTIC Science & Technology

2015-12-01

balances to match Treasury balances. 19The financial reporting system collects and consolidates information for financial statement presentation...2The financial reporting system collects and consolidates information for financial statement presentation. 3Subsistence...efforts to achieve auditability of its financial statements , the Air Force in July 2014 asserted audit readiness for its Schedule of Budgetary

Federal Energy Regulatory Commission financial statements, September 30, 1995 and 1994

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

NONE

1996-02-12

The attached report presents the results of the independent certified public accountant`s audit of the Federal Energy Regulatory Commission`s (FERC) financial statements as of September 30, 1995 and 1994. The auditors have expressed an unqualified opinion on the 1995 statements. Their reports on FERC`s internal control structure and on compliance with laws and regulations, and management letter are also provided.

ERS statement on protracted bacterial bronchitis in children.

PubMed

Kantar, Ahmad; Chang, Anne B; Shields, Mike D; Marchant, Julie M; Grimwood, Keith; Grigg, Jonathan; Priftis, Kostas N; Cutrera, Renato; Midulla, Fabio; Brand, Paul L P; Everard, Mark L

2017-08-01

This European Respiratory Society statement provides a comprehensive overview on protracted bacterial bronchitis (PBB) in children. A task force of experts, consisting of clinicians from Europe and Australia who manage children with PBB determined the overall scope of this statement through consensus. Systematic reviews addressing key questions were undertaken, diagrams in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement constructed and findings of relevant studies summarised. The final content of this statement was agreed upon by all members.The current knowledge regarding PBB is presented, including the definition, microbiology data, known pathobiology, bronchoalveolar lavage findings and treatment strategies to manage these children. Evidence for the definition of PBB was sought specifically and presented. In addition, the task force identified several major clinical areas in PBB requiring further research, including collecting more prospective data to better identify the disease burden within the community, determining its natural history, a better understanding of the underlying disease mechanisms and how to optimise its treatment, with a particular requirement for randomised controlled trials to be conducted in primary care. Copyright ©ERS 2017.

Recommendations for managing patients with diabetes mellitus in cardiopulmonary rehabilitation: an American Association of Cardiovascular and Pulmonary Rehabilitation statement.

PubMed

Lopez-Jimenez, Francisco; Kramer, Valerie Carroll; Masters, Barbara; Stuart, Patricia Mickey W; Mullooly, Cathy; Hinshaw, Ling; Haas, Linda; Warwick, Kathy

2012-01-01

Diabetes mellitus is a highly prevalent condition in patients participating in cardiopulmonary rehabilitation. However, research and subsequent guidelines specifically applicable to patients with diabetes, participating in cardiopulmonary rehabilitation, are limited. Recognizing this limitation, the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) initiated this statement, with the goal of developing a template that incorporated recommendations provided in the AACVPR Core Components and the American Association of Diabetes Educators 7 Self-Care Behaviors. This statement describes key processes regarding evaluation, interventions, and expected outcomes in each of the core components for the management of patients with diabetes in a cardiopulmonary rehabilitation program.

The European Federation of Organisations for Medical Physics Policy Statement No 14: the role of the Medical Physicist in the management of safety within the magnetic resonance imaging environment: EFOMP recommendations.

PubMed

Hand, J; Bosmans, H; Caruana, C; Keevil, S; Norris, D G; Padovani, R; Speck, O

2013-03-01

This European Federation of Organisations for Medical Physics (EFOMP) Policy Statement outlines the way in which a Safety Management System can be developed for MRI units. The Policy Statement can help eliminate or at least minimize accidents or incidents in the magnetic resonance environment and is recommended as a step towards harmonisation of safety of workers, patients, and the general public regarding the use of magnetic resonance imaging systems in diagnostic and interventional procedures. Copyright © 2012 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.

Microscopic enteritis: Bucharest consensus

PubMed Central

Rostami, Kamran; Aldulaimi, David; Holmes, Geoffrey; Johnson, Matt W; Robert, Marie; Srivastava, Amitabh; Fléjou, Jean-François; Sanders, David S; Volta, Umberto; Derakhshan, Mohammad H; Going, James J; Becheanu, Gabriel; Catassi, Carlo; Danciu, Mihai; Materacki, Luke; Ghafarzadegan, Kamran; Ishaq, Sauid; Rostami-Nejad, Mohammad; Peña, A Salvador; Bassotti, Gabrio; Marsh, Michael N; Villanacci, Vincenzo

2015-01-01

Microscopic enteritis (ME) is an inflammatory condition of the small bowel that leads to gastrointestinal symptoms, nutrient and micronutrient deficiency. It is characterised by microscopic or sub-microscopic abnormalities such as microvillus changes and enterocytic alterations in the absence of definite macroscopic changes using standard modern endoscopy. This work recognises a need to characterize disorders with microscopic and submicroscopic features, currently regarded as functional or non-specific entities, to obtain further understanding of their clinical relevance. The consensus working party reviewed statements about the aetiology, diagnosis and symptoms associated with ME and proposes an algorithm for its investigation and treatment. Following the 5th International Course in Digestive Pathology in Bucharest in November 2012, an international group of 21 interested pathologists and gastroenterologists formed a working party with a view to formulating a consensus statement on ME. A five-step agreement scale (from strong agreement to strong disagreement) was used to score 21 statements, independently. There was strong agreement on all statements about ME histology (95%-100%). Statements concerning diagnosis achieved 85% to 100% agreement. A statement on the management of ME elicited agreement from the lowest rate (60%) up to 100%. The remaining two categories showed general agreement between experts on clinical presentation (75%-95%) and pathogenesis (80%-90%) of ME. There was strong agreement on the histological definition of ME. Weaker agreement on management indicates a need for further investigations, better definitions and clinical trials to produce quality guidelines for management. This ME consensus is a step toward greater recognition of a significant entity affecting symptomatic patients previously labelled as non-specific or functional enteropathy. PMID:25759526

Microscopic enteritis: Bucharest consensus.

PubMed

Rostami, Kamran; Aldulaimi, David; Holmes, Geoffrey; Johnson, Matt W; Robert, Marie; Srivastava, Amitabh; Fléjou, Jean-François; Sanders, David S; Volta, Umberto; Derakhshan, Mohammad H; Going, James J; Becheanu, Gabriel; Catassi, Carlo; Danciu, Mihai; Materacki, Luke; Ghafarzadegan, Kamran; Ishaq, Sauid; Rostami-Nejad, Mohammad; Peña, A Salvador; Bassotti, Gabrio; Marsh, Michael N; Villanacci, Vincenzo

2015-03-07

Microscopic enteritis (ME) is an inflammatory condition of the small bowel that leads to gastrointestinal symptoms, nutrient and micronutrient deficiency. It is characterised by microscopic or sub-microscopic abnormalities such as microvillus changes and enterocytic alterations in the absence of definite macroscopic changes using standard modern endoscopy. This work recognises a need to characterize disorders with microscopic and submicroscopic features, currently regarded as functional or non-specific entities, to obtain further understanding of their clinical relevance. The consensus working party reviewed statements about the aetiology, diagnosis and symptoms associated with ME and proposes an algorithm for its investigation and treatment. Following the 5(th) International Course in Digestive Pathology in Bucharest in November 2012, an international group of 21 interested pathologists and gastroenterologists formed a working party with a view to formulating a consensus statement on ME. A five-step agreement scale (from strong agreement to strong disagreement) was used to score 21 statements, independently. There was strong agreement on all statements about ME histology (95%-100%). Statements concerning diagnosis achieved 85% to 100% agreement. A statement on the management of ME elicited agreement from the lowest rate (60%) up to 100%. The remaining two categories showed general agreement between experts on clinical presentation (75%-95%) and pathogenesis (80%-90%) of ME. There was strong agreement on the histological definition of ME. Weaker agreement on management indicates a need for further investigations, better definitions and clinical trials to produce quality guidelines for management. This ME consensus is a step toward greater recognition of a significant entity affecting symptomatic patients previously labelled as non-specific or functional enteropathy.

[Experts consensus on the management of the right heart function in critically ill patients].

PubMed

Wang, X T; Liu, D W; Zhang, H M; Long, Y; Guan, X D; Qiu, H B; Yu, K J; Yan, J; Zhao, H; Tang, Y Q; Ding, X; Ma, X C; Du, W; Kang, Y; Tang, B; Ai, Y H; He, H W; Chen, D C; Chen, H; Chai, W Z; Zhou, X; Cui, N; Wang, H; Rui, X; Hu, Z J; Li, J G; Xu, Y; Yang, Y; Ouyan, B; Lin, H Y; Li, Y M; Wan, X Y; Yang, R L; Qin, Y Z; Chao, Y G; Xie, Z Y; Sun, R H; He, Z Y; Wang, D F; Huang, Q Q; Jiang, D P; Cao, X Y; Yu, R G; Wang, X; Chen, X K; Wu, J F; Zhang, L N; Yin, M G; Liu, L X; Li, S W; Chen, Z J; Luo, Z

2017-12-01

To establish the experts consensus on the right heart function management in critically ill patients. The panel of consensus was composed of 30 experts in critical care medicine who are all members of Critical Hemodynamic Therapy Collaboration Group (CHTC Group). Each statement was assessed based on the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) principle. Then the Delphi method was adopted by 52 experts to reassess all the statements. (1) Right heart function is prone to be affected in critically illness, which will result in a auto-exaggerated vicious cycle. (2) Right heart function management is a key step of the hemodynamic therapy in critically ill patients. (3) Fluid resuscitation means the process of fluid therapy through rapid adjustment of intravascular volume aiming to improve tissue perfusion. Reversed fluid resuscitation means reducing volume. (4) The right ventricle afterload should be taken into consideration when using stroke volume variation (SVV) or pulse pressure variation (PPV) to assess fluid responsiveness.(5)Volume overload alone could lead to septal displacement and damage the diastolic function of the left ventricle. (6) The Starling curve of the right ventricle is not the same as the one applied to the left ventricle,the judgement of the different states for the right ventricle is the key of volume management. (7) The alteration of right heart function has its own characteristics, volume assessment and adjustment is an important part of the treatment of right ventricular dysfunction (8) Right ventricular enlargement is the prerequisite for increased cardiac output during reversed fluid resuscitation; Nonetheless, right heart enlargement does not mandate reversed fluid resuscitation.(9)Increased pulmonary vascular resistance induced by a variety of factors could affect right heart function by obstructing the blood flow. (10) When pulmonary hypertension was detected in clinical scenario, the differentiation of critical care-related pulmonary hypertension should be a priority. (11) Attention should be paid to the change of right heart function before and after implementation of mechanical ventilation and adjustment of ventilator parameter. (12) The pulmonary arterial pressure should be monitored timingly when dealing with critical care-related pulmonary hypertension accompanied with circulatory failure.(13) The elevation of pulmonary aterial pressure should be taken into account in critical patients with acute right heart dysfunction. (14) Prone position ventilation is an important measure to reduce pulmonary vascular resistance when treating acute respiratory distress syndrome patients accompanied with acute cor pulmonale. (15) Attention should be paid to right ventricle-pulmonary artery coupling during the management of right heart function. (16) Right ventricular diastolic function is more prone to be affected in critically ill patients, the application of critical ultrasound is more conducive to quantitative assessment of right ventricular diastolic function. (17) As one of the parameters to assess the filling pressure of right heart, central venous pressure can be used to assess right heart diastolic function. (18). The early and prominent manifestation of non-focal cardiac tamponade is right ventricular diastolic involvement, the elevated right atrial pressure should be noticed. (19) The effect of increased intrathoracic pressure on right heart diastolic function should be valued. (20) Ttricuspid annular plane systolic excursion (TAPSE) is an important parameter that reflects right ventricular systolic function, and it is recommended as a general indicator of critically ill patient. (21) Circulation management with right heart protection as the core strategy is the key point of the treatment of acute respiratory distress syndrome. (22) Right heart function involvement after cardiac surgery is very common and should be highly valued. (23) Right ventricular dysfunction should not be considered as a routine excuse for maintaining higher central venous pressure. (24) When left ventricular dilation, attention should be paid to the effect of left ventricle on right ventricular diastolic function. (25) The impact of left ventricular function should be excluded when the contractility of the right ventricle is decreased. (26) When the right heart load increases acutely, the shunt between the left and right heart should be monitored. (27) Attention should be paid to the increase of central venous pressure caused by right ventricular dysfunction and its influence on microcirculation blood flow. (28) When the vasoactive drugs was used to reduce the pressure of pulmonary circulation, different effects on pulmonary and systemic circulation should be evaluated. (29) Right atrial pressure is an important factor affecting venous return. Attention should be paid to the influence of the pressure composition of the right atrium on the venous return. (30) Attention should be paid to the role of the right ventricle in the acute pulmonary edema. (31) Monitoring the difference between the mean systemic filling pressure and the right atrial pressure is helpful to determine whether the infusion increases the venous return. (32) Venous return resistance is often considered to be a insignificant factor that affects venous return, but attention should be paid to the effect of the specific pathophysiological status, such as intrathoracic hypertension, intra-abdominal hypertension and so on. Consensus can promote right heart function management in critically ill patients, optimize hemodynamic therapy, and even affect prognosis.

In-flight cardiac arrest and in-flight cardiopulmonary resuscitation during commercial air travel: consensus statement and supplementary treatment guideline from the German Society of Aerospace Medicine (DGLRM).

PubMed

Hinkelbein, Jochen; Böhm, Lennert; Braunecker, Stefan; Genzwürker, Harald V; Kalina, Steffen; Cirillo, Fabrizio; Komorowski, Matthieu; Hohn, Andreas; Siedenburg, Jörg; Bernhard, Michael; Janicke, Ilse; Adler, Christoph; Jansen, Stefanie; Glaser, Eckard; Krawczyk, Pawel; Miesen, Mirko; Andres, Janusz; De Robertis, Edoardo; Neuhaus, Christopher

2018-05-05

By the end of the year 2016, approximately 3 billion people worldwide travelled by commercial air transport. Between 1 out of 14,000 and 1 out of 50,000 passengers will experience acute medical problems/emergencies during a flight (i.e., in-flight medical emergency). Cardiac arrest accounts for 0.3% of all in-flight medical emergencies. So far, no specific guideline exists for the management and treatment of in-flight cardiac arrest (IFCA). A task force with clinical and investigational expertise in aviation, aviation medicine, and emergency medicine was created to develop a consensus based on scientific evidence and compiled a guideline for the management and treatment of in-flight cardiac arrests. Using the GRADE, RAND, and DELPHI methods, a systematic literature search was performed in PubMed. Specific recommendations have been developed for the treatment of IFCA. A total of 29 specific recommendations for the treatment and management of in-flight cardiac arrests were generated. The main recommendations included emergency equipments as well as communication of the emergency. Training of the crew is of utmost importance, and should ideally have a focus on CPR in aircraft. The decision for a diversion should be considered very carefully.

The recognition, assessment and management of dementing disorders: conclusions from the Canadian Consensus Conference on Dementia.

PubMed

Patterson, C J; Gauthier, S; Bergman, H; Cohen, C A; Feightner, J W; Feldman, H; Hogan, D B

1999-06-15

To develop evidence based consensus statements on which to build clinical practice guidelines for primary care physicians toward the recognition, assessment and management of dementing disorders and to disseminate and evaluate the impact of these statements and guidelines built on these statements. Structured approach to assessment, including recommended laboratory tests, choices for neuroimaging and referral, management of complications (especially behavioural problems and depression) and use of cognitive enhancing agents. POTENTIAL OUTCOMES: Consistent and improved clinical care of persons with dementia; cost containment by more selective use of laboratory investigations; neuroimaging and referrals; and appropriate use of cognitive enhancing agents. Authors of each background paper were entrusted to perform a literature search, discover additional relevant material, including references cited in retrieved articles, consult with other experts in the field and then synthesize information. Standard rules of evidence were applied. Based on this evidence, consensus statements were developed by a group of experts, guided by a steering committee of 8 individuals, from the areas of Neurology, Geriatric Medicine, Psychiatry, Family Medicine, Preventive Health Care and Health Care Systems. Recommendations have been developed with particular attention to the context of primary care, and are intended to support family physicians in their ongoing assessment and care of patients with dementia. BENEFITS HARM AND COSTS: Potential for improved clinical care of people with dementia. A dissemination and evaluation strategy will attempt to measure the impact of the recommendations. Forty-eight recommendations are offered that address the following aspects of dementia care: early recognition; importance of careful history and examination in making a positive diagnosis; essential laboratory tests; rules for neuroimaging and referral; disclosure of diagnosis; importance of monitoring and providing support to caregivers; cultural aspects; detection and treatment of depression; observation and management of behavioural disturbances; detection and reporting of unsafe motor vehicle driving; genetic factors and opportunities for preventing dementia; pharmacological treatment with particular emphasis on cognitive enhancing agents. Four other sets of consensus statement or guidelines have been published recently. These recommendations are generally congruent with our own consensus statements. The consensus statements have been endorsed by relevant bodies in Canada.

Draft Programmatic Environmental Impact Statement for Revision of the Coronado National Forest Land and Resource Management Plan: Cochise, Graham, Pima, Pinal, and Santa Cruz Counties, Arizona; Hidalgo County, New Mexico

Treesearch

Albert Peralta; Andrea Wargo Campbell; Ann Lynch; Cheri Bowen; Christopher Stetson; Craig Wilcox; Daniela Zormeier; Debby Kriegel; Delilah Jaworski; Dustin Walters; Eli Curiel; Erin Boyle; George McKay; Janet Moser; Jennifer Morrissey; Jennifer M. Ruyle; Jeremy Sautter; Judy York; Kenna Schoenle; Larry Jones; Laura White; Linda Peery; Mary Farrell; Mindi Lehew; Mindy Sue Vogel; Nicholas Laluk; Rachael Biggs; Robert Lefevre; Richard Gerhart; Salek Shafiqullah; Sara Dechter; Sarah Davis; Sharon Biedenbender; Tami Emmett; Terry Austin; William Gillespie; Yolynda Begay

2013-01-01

The U.S. Department of Agriculture, Forest Service, Coronado National Forest prepared this programmatic environmental impact statement to disclose the potential effects of a proposed action to revise the "Coronado National Forest Land and Resource Management Plan" (1986, as amended). The Coronado comprises 1,783,639 acres, most of which are located in...

An evidence-based approach to case management model selection for an acute care facility: is there really a preferred model?

PubMed

Terra, Sandra M

2007-01-01

This research seeks to determine whether there is adequate evidence-based justification for selection of one acute care case management model over another. Acute Inpatient Hospital. This article presents a systematic review of published case management literature, resulting in classification specific to terms of level of evidence. This review examines the best available evidence in an effort to select an acute care case management model. Although no single case management model can be identified as preferred, it is clear that adequate evidence-based literature exists to acknowledge key factors driving the acute care model and to form a foundation for the efficacy of hospital case management practice. Although no single case management model can be identified as preferred, this systematic review demonstrates that adequate evidence-based literature exists to acknowledge key factors driving the acute care model and forming a foundation for the efficacy of hospital case management practice. Distinctive aspects of case management frameworks can be used to guide the development of an acute care case management model. The study illustrates: * The effectiveness of case management when there is direct patient contact by the case manager regardless of disease condition: not only does the quality of care increase but also length of stay (LOS) decreases, care is defragmented, and both patient and physician satisfaction can increase. * The preferred case management models result in measurable outcomes that can directly relate to, and demonstrate alignment with, organizational strategy. * Acute care management programs reduce cost and LOS, and improve outcomes. * An integrated case management program that includes social workers, as well as nursing, is the most effective acute care management model. * The successful case management model will recognize physicians, as well as patients, as valued customers with whom partnership can positively affect financial outcomes in terms of reduction in LOS, improvement in quality, and delivery of care.

Intrasectoral variation in mission and values: the case of the Catholic health systems.

PubMed

White, Kenneth R; Dandi, Roberto

2009-01-01

Catholic health systems represent a unique sector of nonprofit health care delivery organizations because they must be accountable to institutional pressures of the Roman Catholic Church, in addition to responsiveness to market pressures. Mission statements and values are purported to be the driving force of Catholic institutional identity. Central to the understanding of the Catholic health care delivery sector is the exploration of variation in mission and values statements across the homogeneous field of organizations. The purposes of this study were to identify expressed organizational identity variation-in terms of keywords in mission statements and values-of Catholic health systems in the United States by applying a methodology that integrates text and social network analytical techniques. Data were obtained from the Web site of The Catholic Health Association of the United States and the Web sites of 50 Catholic health systems in 2007. Catholic health system mission statements and values were assessed using a cross-sectional study design. Text analysis and social network techniques were employed to identify the most central words in the texts and linkages among mission statement components and values. This study identifies the components of a common mission statement and the most shared and unique values for a Catholic health system. Even with tremendous similarity, there is also evidence of intrasectoral variation between Catholic health system keywords in mission statements and values. Management implications include the consideration of word relationships developing and constructing mission and values statements to form the framework for strategic vision and management decision making, to assess potential partnership arrangements based on expressed mission statements and values, and to use in executing due diligence in mergers and partnerships.

[Statements before the Subcommittee on Elementary, Secondary, and Vocational Education, Committee on Education and Labor, U.S. House of Representatives.].

ERIC Educational Resources Information Center

Molina, John C.; Ridge, Elton W.

This document consists of two statements, one made by John Molina, Director of the Office of Bilingual Education, and the other by Elton W. Ridge, Project Manager of the Lau-Bilingual programs. The statement by Molina discusses the scope and the goals of ESEA Title VII programs and what has been accomplished. Statistics are presented on the number…

DOD Military Retirement Health Benefits Liability for FY 1997.

DTIC Science & Technology

1998-10-13

Management Act of 1994 (Public Law 103-356). Public Law 103-356 requires DoD and other Government agencies to prepare consolidated financial statements for...eligible beneficiaries through private sector health care providers and DoD military treatment facilities. The DoD-wide consolidated financial statements for...series of reports addressing selected accounts of the DoD-wide consolidated financial statements for FY 1997 and beyond. Audit Objectives. The objective

Report: Audit of EPA’s Fiscal 2002 and 2001 Financial Statements

EPA Pesticide Factsheets

Report #2003-1-00045, January 29, 2003. We did not identify any inconsistencies between the info presented in EPA’s financial statements and the info presented in EPA’s RSSI, Required Supplemental Information, and Management Discussion and Analysis.

Report: AUDIT OF EPA’S FISCAL 2000 FINANCIAL STATEMENTS

EPA Pesticide Factsheets

Report #2001-1-00107, Feb 28, 2001. We did not identify any material inconsistencies between the info presented in EPA’s financial statements and the info presented in EPA’s RSSI, Required Supplemental Information, and Management Discussion and Analysis.

15 CFR 923.60 - Review/approval procedures.

Code of Federal Regulations, 2014 CFR

2014-01-01

...) NATIONAL OCEANIC AND ATMOSPHERIC ADMINISTRATION, DEPARTMENT OF COMMERCE OCEAN AND COASTAL RESOURCE... management program are not required, OCRM will prepare draft and final environmental impact statements, in... preparation and dissemination of draft and final environmental impact statements and lengthy Federal agency...

76 FR 50204 - Environmental Management Site-Specific Advisory Board, Nevada

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-12

... DEPARTMENT OF ENERGY Environmental Management Site-Specific Advisory Board, Nevada AGENCY...-Wide Environmental Impact Statement (EIS) Committee of the Environmental Management Site- Specific... management in the areas of environmental restoration, waste management, and related activities. Purpose of...

Testing a computer-based ostomy care training resource for staff nurses.

PubMed

Bales, Isabel

2010-05-01

Fragmented teaching and ostomy care provided by nonspecialized clinicians unfamiliar with state-of-the-art care and products have been identified as problems in teaching ostomy care to the new ostomate. After conducting a literature review of theories and concepts related to the impact of nurse behaviors and confidence on ostomy care, the author developed a computer-based learning resource and assessed its effect on staff nurse confidence. Of 189 staff nurses with a minimum of 1 year acute-care experience employed in the acute care, emergency, and rehabilitation departments of an acute care facility in the Midwestern US, 103 agreed to participate and returned completed pre- and post-tests, each comprising the same eight statements about providing ostomy care. F and P values were computed for differences between pre- and post test scores. Based on a scale where 1 = totally disagree and 5 = totally agree with the statement, baseline confidence and perceived mean knowledge scores averaged 3.8 and after viewing the resource program post-test mean scores averaged 4.51, a statistically significant improvement (P = 0.000). The largest difference between pre- and post test scores involved feeling confident in having the resources to learn ostomy skills independently. The availability of an electronic ostomy care resource was rated highly in both pre- and post testing. Studies to assess the effects of increased confidence and knowledge on the quality and provision of care are warranted.

Causal Evaluation of Acute Recurrent and Chronic Pancreatitis in Children: Consensus From the INSPPIRE Group.

PubMed

Gariepy, Cheryl E; Heyman, Melvin B; Lowe, Mark E; Pohl, John F; Werlin, Steven L; Wilschanski, Michael; Barth, Bradley; Fishman, Douglas S; Freedman, Steven D; Giefer, Matthew J; Gonska, Tanja; Himes, Ryan; Husain, Sohail Z; Morinville, Veronique D; Ooi, Chee Y; Schwarzenberg, Sarah J; Troendle, David M; Yen, Elizabeth; Uc, Aliye

2017-01-01

Acute recurrent pancreatitis (ARP) and chronic pancreatitis (CP) have been diagnosed in children at increasing rates during the past decade. As pediatric ARP and CP are still relatively rare conditions, little quality evidence is available on which to base the diagnosis and determination of etiology. The aim of the study was to review the current state of the literature regarding the etiology of these disorders and to developed a consensus among a panel of clinically active specialists caring for children with these disorders to help guide the diagnostic evaluation and identify areas most in need of future research. A systematic review of the literature was performed and scored for quality, followed by consensus statements developed and scored by each individual in the group for level of agreement and strength of the supporting data using a modified Delphi method. Scores were analyzed for the level of consensus achieved by the group. The panel reached consensus on 27 statements covering the definitions of pediatric ARP and CP, evaluation for potential etiologies of these disorders, and long-term monitoring. Statements for which the group reached consensus to make no recommendation or could not reach consensus are discussed. This consensus helps define the minimal diagnostic evaluation and monitoring of children with ARP and CP. Even in areas in which we reached consensus, the quality of the evidence is weak, highlighting the need for further research. Improved understanding of the underlying cause will facilitate treatment development and targeting.

The Causal Evaluation of Acute Recurrent and Chronic Pancreatitis in Children: Consensus From the INSPPIRE Group

PubMed Central

Gariepy, Cheryl E.; Heyman, Melvin B.; Lowe, Mark E.; Pohl, John F.; Werlin, Steven L.; Wilschanski, Michael; Barth, Bradley; Fishman, Douglas S.; Freedman, Steven D.; Giefer, Matthew J.; Gonska, Tanja; Himes, Ryan; Husain, Sohail Z.; Morinville, Veronique D.; Ooi, Chee Y.; Schwarzenberg, Sarah Jane; Troendle, David M.; Yen, Elizabeth; Uc, Aliye

2016-01-01

Acute recurrent pancreatitis (ARP) and chronic pancreatitis (CP) have been diagnosed in children at increasing rates over the past decade. However, as pediatric ARP and CP are still relatively rare conditions, little quality evidence is available on which to base the diagnosis and determination of etiology. Objectives: To review the current state of the literature regarding the etiology of these disorders and to developed a consensus among a panel of clinically active specialists caring for children with these disorders to help guide the diagnostic evaluation and identify areas most in need of future research. Methods: A systematic review of the literature was performed and scored for quality, then consensus statements developed and scored by each individual in the group for level of agreement and strength of the supporting data using a modified Delphi method. Scores were analyzed for the level of consensus achieved by the group. Results: The panel reached consensus on 27 statements covering the definitions of pediatric ARP and CP, evaluation for potential etiologies of these disorders, and long-term monitoring. Statements for which the group reached consensus to make no recommendation or could not reach consensus are discussed. Conclusion: This consensus helps define the minimal diagnostic evaluation and monitoring of children with ARP and CP. Even in areas in which we reached consensus, the quality of the evidence is weak, highlighting the need for further research. Improved understanding of the underlying cause will facilitate treatment development and targeting. PMID:27782962

British Thoracic Society Quality Standards for acute non-invasive ventilation in adults

PubMed Central

Davies, Michael; Allen, Martin; Bentley, Andrew; Bourke, Stephen C; Creagh-Brown, Ben; D’Oliveiro, Rachel; Glossop, Alastair; Gray, Alasdair; Jacobs, Phillip; Mahadeva, Ravi; Moses, Rachael; Setchfield, Ian

2018-01-01

Introduction The purpose of the quality standards document is to provide healthcare professionals, commissioners, service providers and patients with a guide to standards of care that should be met for the provision of acute non-invasive ventilation in adults together with measurable markers of good practice. Methods Development of British Thoracic Society (BTS) Quality Standards follows the BTS process of quality standard production based on the National Institute for Health and Care Excellence process manual for the development of quality standards. Results 6 quality statements have been developed, each describing a standard of care for the provision of acute non-invasive ventilation in the UK, together with measurable markers of good practice. Conclusion BTS Quality Standards for acute non-invasive ventilation in adults form a key part of the range of supporting materials that the Society produces to assist in the dissemination and implementation of guideline’s recommendations. PMID:29636979

Risk Measuremant and Fair Valuation Assessment in the Life Insurance Field

NASA Astrophysics Data System (ADS)

Coppola, Mariarosaria; D'Amato, Valeria; Lorenzo, Emilia di; Sibillo, Marilena

New solvency requirements are coming into the insurance business management, in particular through Pillar 2 of Solvency 2. The guidelines lead towards an increasing importance ascribed to the particular risk profile of the single company. Regarding the mathematical provision, this statement reveals to be fundamental, being in the aim of the correct management to keep not more than the sufficient capital amount as solvency capital, and this statement strongly depends on the company risk profile.

77 FR 27478 - Notice of Availability of the Draft Environmental Impact Statement and Draft Proposed California...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-10

...In accordance with the National Environmental Policy Act of 1969, as amended, and the Federal Land Policy and Management Act of 1976, as amended, the Bureau of Land Management (BLM) has prepared a Draft Proposed California Desert Conservation Area (CDCA) Plan Amendment and a Draft Environmental Impact Statement (EIS) for the Haiwee Geothermal Leasing Area (HGLA), Inyo County, California, and by this notice is announcing the opening of the comment period.

75 FR 4417 - Wind Cave National Park, Custer County, SD

Federal Register 2010, 2011, 2012, 2013, 2014

2010-01-27

... DEPARTMENT OF THE INTERIOR Wind Cave National Park, Custer County, SD AGENCY: National Park... Final Environmental Impact Statement, Wind Cave National Park, Custer County, South Dakota. SUMMARY... Management Plan and Final Environmental Impact Statement (Plan), Wind Cave National Park, Custer County...

76 FR 56492 - Environmental Impact Statement: St. Louis County, Missouri

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-13

... DEPARTMENT OF TRANSPORTATION Federal Highway Administration Environmental Impact Statement: St.../Shackelford Road in northwestern St. Louis County, Missouri. These roads lie within the floodplain of the... Manager, St. Louis County Department of Highways and Traffic, 121 S. Meramec Avenue, Clayton, Missouri...

Global Container Management Process Improvements

DTIC Science & Technology

2015-06-19

Salesman Problem . Retrieved December 31, 2014, from TSP: http://www.math.uwaterloo.ca/tsp/ Department of Defense. (2002, January 1). MIL-HDBK-138B...6 Problem Statement... Problem Statement SDDC has a fragmented GCM policy caused by horizontal levels of authority, conflicting mission and metrics, incomplete

The use of fund accounting and the need for single fund reporting by institutional healthcare providers. Principles and Practices Board Statement No. 8. Healthcare Financial Management Association.

PubMed

1986-06-01

For many years, hospitals and other institutional healthcare providers used fund accounting as a basis for presenting their financial statements. Recently, authoritative literature has placed less emphasis on separate fund reporting. This is evidenced by the reduction of fund classifications specified in the literature. This trend seems to follow the recognition that institutional healthcare activities should be reported in a manner comparable to other businesses. The Principles and Practices Board (P&P Board) of the Healthcare Financial management Association believes that general purpose financial statements of institutional healthcare providers should be comparable to reporting by other businesses. That is, all assets, liabilities, and equity are presented in a single aggregated balance sheet without differentiation by fund. This form of presentation, referred to in this statement as single fund reporting, should be used by all institutional healthcare providers including those that are part of HMOs, universities, municipalities, and other larger entities when separate reports of the provider are issued. The P&P Board is studying other significant issues concerning the reporting of revenues and components of equity and changes therein. The conclusion in this statement can be implemented even though conclusions on these related subjects are not yet complete. The P&P Board recognizes that certain circumstances may require detailed records and reports for special purposes. This statement deals only with those general purpose financial statements on which an independent accountant's opinion is expressed.

77 FR 67653 - Statement of Organization, Functions, and Delegations of Authority; Office of the Deputy...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-11-13

..., including position management, performance management, employee recognition, staffing, recruitment, employee... management activities, including recruitment, selection, position management, performance management, designated performance and incentive awards and employee assistance programs and other services to ACF...

Updated consensus statement on the use of rituximab in patients with rheumatoid arthritis

PubMed Central

Buch, Maya H; Smolen, Josef S; Betteridge, Neil; Breedveld, Ferdinand C; Burmester, Gerd; Dörner, Thomas; Ferraccioli, Gianfranco; Gottenberg, Jacques-Eric; Isaacs, John; Kvien, Tore K; Mariette, Xavier; Martin-Mola, Emilio; Pavelka, Karel; Tak, Paul P; van der Heijde, Desiree; van Vollenhoven, Ronald F; Emery, Paul

2011-01-01

Background Since initial approval for the treatment of rheumatoid arthritis (RA), rituximab has been evaluated in clinical trials involving various populations with RA. Information has also been gathered from registries. This report therefore updates the 2007 consensus document on the use of rituximab in the treatment of RA. Methods Preparation of this new document involved many international experts experienced in the treatment of RA. Following a meeting to agree upon the core agenda, a systematic literature review was undertaken to identify all relevant data. Data were then interrogated by a drafting committee, with subsequent review and discussion by a wider expert committee leading to the formulation of an updated consensus statement. These committees also included patients with RA. Results The new statement covers wide-ranging issues including the use of rituximab in earlier RA and impact on structural progression, and aspects particularly pertinent to rituximab such as co-medication, optimal dosage regimens, repeat treatment cycles and how to manage non-response. Biological therapy following rituximab usage is also addressed, and safety concerns including appropriate screening for hepatitis, immunoglobulin levels and infection risk. This consensus statement will support clinicians and inform patients when using B-cell depletion in the management of RA, providing up-to-date information and highlighting areas for further research. Conclusion New therapeutic strategies and treatment options for RA, a chronic destructive and disabling disease, have expanded over recent years. These have been summarised in general strategic suggestions and specific management recommendations, emphasising the importance of expedient disease-modifying antirheumatic drug implementation and tight disease control. This consensus statement is in line with these fundamental principles of management. PMID:21378402

Concussion is Treatable: Statements of Agreement from the Targeted Evaluation and Active Management (TEAM) Approaches to Treating Concussion Meeting held in Pittsburgh, October 15–16, 2015

PubMed Central

Collins, Michael W.; Kontos, Anthony P.; Okonkwo, David O.; Almquist, Jon; Bailes, Julian; Barisa, Mark; Bazarian, Jeffrey; Bloom, O. Josh; Brody, David; Cantu, Robert; Cardenas, Javier; Clugston, Jay; Cohen, Randall; Echemendia, Ruben; Elbin, R.J.; Ellenbogen, Richard; Fonseca, Janna; Gioia, Gerard; Guskiewicz, Kevin; Heyer, Robert; Hotz, Gillian; Iverson, Grant L.; Jordan, Barry; Manley, Geoffrey; Maroon, Joseph; McAllister, Thomas; McCrea, Michael; Mucha, Anne; Pieroth, Elizabeth; Podell, Kenneth; Pombo, Matthew; Shetty, Teena; Sills, Allen; Solomon, Gary; Thomas, Danny G.; Valovich McLeod, Tamara C.; Yates, Tony; Zafonte, Ross

2016-01-01

Background Conventional management for concussion involves prescribed rest and progressive return to activity. Recent evidence challenges this notion and suggests that active approaches may be effective for some patients. Previous concussion consensus statements provide limited guidance regarding active treatment. Objective To describe the current landscape of treatment for concussion and provide summary agreements related to treatment in order to assist clinicians in the treatment of concussion. Methods On October 14–16, 2015, the Targeted Evaluation & Active Management (TEAM) Approaches To Treating Concussion meeting was convened in Pittsburgh, Pennsylvania, USA. 37 concussion experts from neuropsychology, neurology, neurosurgery, sports medicine, physical medicine and rehabilitation, physical therapy, athletic training, and research, and 12 individuals representing sport, military, and public health organizations attended the meeting. The 37 experts indicated their agreement on a series of statements using an audience response system clicker device. Results A total of 16 statements of agreement were supported covering: 1) Summary of the Current Approach to Treating Concussion, 2) Heterogeneity and Evolving Clinical Profiles of Concussion, 3) Targeted Evaluation and Active Management Approach to Concussion Treatment: Specific Strategies, and 4) Future Directions: A Call to Research. Support (ie, response of agree or somewhat agree) for the statements ranged from to 97–100%. Conclusion Concussions are characterized by diverse symptoms and impairments and evolving clinical profiles; recovery varies based on modifying factors, injury severity, and treatments. Active and targeted treatments may enhance recovery following concussion. Research is needed on concussion clinical profiles, biomarkers, and the effectiveness and timing of treatments. PMID:27741219

Weight management strategies for those with chronic kidney disease - a consensus report from the Asia Pacific Society of Nephrology and Australia and New Zealand Society of Nephrology 2016 renal dietitians meeting.

PubMed

Lambert, Kelly; Beer, Jo; Dumont, Ruth; Hewitt, Katie; Manley, Karen; Meade, Anthony; Salamon, Karen; Campbell, Katrina

2017-07-25

Develop a consensus report to guide dietetic management of overweight or obese individuals with Chronic Kidney Disease (CKD). Six statements relating weight management in CKD guided a comprehensive review of the literature. A summary of the evidence was then presented at the renal nutrition meeting of the 2016 Asia Pacific Society of Nephrology and Australia and New Zealand Society of Nephrology. Majority agreement was defined as group agreement on a statement of between 50-74%, and consensus was considered ≥ 75% agreement. The recommendations were developed via a mini Delphi process. Two statements achieved group consensus: the current guidelines used by dietitians to estimate energy requirements for overweight and obese people with CKD are not relevant and weight loss medications may be unsafe or ineffective in isolation for those with CKD. One statement achieved group agreement: Meal replacement formulas are safe and efficacious in those with CKD. No agreement was achieved on the statements of whether there is strong evidence of benefit for weight loss prior to kidney transplantation; whether traditional weight loss strategies can be used in those with CKD and if bariatric surgery in those with end stage kidney disease is feasible and effective. There is a limited evidence base to guide the dietetic management of overweight and obese individuals with CKD. Medical or surgical strategies to facilitate weight loss are not recommended in isolation and require a multidisciplinary approach with the involvement of a skilled renal dietitian. This article is protected by copyright. All rights reserved.

The Audit Opinion of the DISA FY 2011 Working Capital Fund Financial Statements Was Not Adequately Supported

DTIC Science & Technology

2013-04-26

President’s Council on Integrity and Efficiency MD&A Management Discussion and Analysis MFR Memorandum for Record NoF Notification of...memorandums for record ( MFRs ) would have a material impact on the financial statements and ultimately Acuity’s opinion, • perform adequate completeness...the deficiencies identified by DISA in its FBWT MFRs would impact the reliability of the financial statements and ultimately Acuity’s opinion

Acute pain in children and adults with sickle cell disease: management in the absence of evidence-based guidelines.

PubMed

Field, Joshua J; Knight-Perry, Jessica E; Debaun, Michael R

2009-05-01

Acute, vaso-occlusive pain is the most characteristic complication of sickle cell disease (SCD). Although there has been rigorous work examining the pathogenesis of vaso-occlusion, fewer studies have focused on approaches to the clinical management of acute pain. In this review, we will examine the epidemiology and management strategies of acute pain events and we will identify limitations in the best available studies. Most acute pain events in adults with SCD are managed at home without physician contact. Prior descriptions of the natural history of pain episodes from the Cooperative Study of Sickle Cell Disease relied on physician contact, limiting the generalizability of these findings to current practice. Patient-controlled analgesia has replaced on-demand therapy to become the standard for management of severe pain events in children and adults with SCD requiring hospital admission. Unfortunately, most clinical practice guidelines for the management of acute pain are not based on randomized clinical trials. As a result, our practice of pain management is primarily limited to expert opinion and inferences from observational studies. Additional clinical trials in management of acute pain in children and adults with SCD are critical for the development of evidence-based guidelines.

Skill sets required for the management of military head, face and neck trauma: a multidisciplinary consensus statement.

PubMed

Breeze, John; Blanch, R; Baden, J; Monaghan, A M; Evriviades, D; Harrisson, S E; Roberts, S; Gibson, A; MacKenzie, N; Baxter, D; Gibbons, A J; Heppell, S; Combes, J G; Rickard, R F

2018-05-01

The evolution of medical practice is resulting in increasing subspecialisation, with head, face and neck (HFN) trauma in a civilian environment usually managed by a combination of surgical specialties working as a team. However, the full combination of HFN specialties commonly available in the NHS may not be available in future UK military-led operations, necessitating the identification of a group of skill sets that could be delivered by one or more deployed surgeons. A systematic review was undertaken to identify those surgical procedures performed to treat acute military head, face, neck and eye trauma. A multidisciplinary consensus group was convened following this with military HFN trauma expertise to define those procedures commonly required to conduct deployed, in-theatre HFN surgical combat trauma management. Head, face, neck and eye damage control surgical procedures were identified as comprising surgical cricothyroidotomy, cervico-facial haemorrhage control and decompression of orbital haemorrhage through lateral canthotomy. Acute in-theatre surgical skills required within 24 hours consist of wound debridement, surgical tracheostomy, decompressive craniectomy, intracranial pressure monitor placement, temporary facial fracture stabilisation for airway management or haemorrhage control and primary globe repair. Delayed in-theatre procedures required within 5 days prior to predicted evacuation encompass facial fracture fixation, delayed lateral canthotomy, evisceration, enucleation and eyelid repair. The identification of those skill sets required for deployment is in keeping with the General Medical Council's current drive towards credentialing consultants, by which a consultant surgeon's capabilities in particular practice areas would be defined. Limited opportunities currently exist for trainees and consultants to gain experience in the management of traumatic head, face, neck and eye injuries seen in a kinetic combat environment. Predeployment training requires that the surgical techniques described in this paper are covered and should form the curriculum of future military-specific surgical fellowships. Relevant continued professional development will be necessary to maintain required clinical competency. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Collaborative Aviation Weather Statement - An Impact-based Decision Support Tool

NASA Astrophysics Data System (ADS)

Blondin, Debra

2016-04-01

Historically, convection causes the highest number of air traffic constraints on the United States National Air Space (NAS). Increased NAS predictability allows traffic flow managers to more effectively initiate, amend or terminate planned or active traffic management initiatives, resulting in more efficient use of available airspace. A Collaborative Aviation Weather Statement (CAWS) is an impact-based decision support tool used for the timely delivery of high-confidence, high-relevance aviation convective weather forecasts to air traffic managers. The CAWS is a graphical and textual forecast produced by a collaborative team of meteorologists from the Aviation Weather Center (AWC), Center Weather Service Units, and airlines to bring attention to high impact areas of thunderstorms. The CAWS addresses thunderstorm initiation or movement into the airports having the highest volume of traffic or into traffic sensitive jet routes. These statements are assessed by planners at the Federal Aviation Administration's (FAA) Air Route Traffic Control Centers and are used for planning traffic management initiatives to balance air traffic flow across the United States. The FAA and the airline industry use the CAWS to plan, manage, and execute operations in the NAS, thereby improving the system efficiency and safety and also saving dollars for industry and the traveling public.

Management of primary hypothyroidism: statement by the British Thyroid Association Executive Committee.

PubMed

Okosieme, Onyebuchi; Gilbert, Jackie; Abraham, Prakash; Boelaert, Kristien; Dayan, Colin; Gurnell, Mark; Leese, Graham; McCabe, Christopher; Perros, Petros; Smith, Vicki; Williams, Graham; Vanderpump, Mark

2016-06-01

The management of primary hypothyroidism with levothyroxine (L-T4) is simple, effective and safe, and most patients report improved well-being on initiation of treatment. However, a proportion of individuals continue to suffer with symptoms despite achieving adequate biochemical correction. The management of such individuals has been the subject of controversy and of considerable public interest. The American Thyroid Association (ATA) and the European Thyroid Association (ETA) have recently published guidelines on the diagnosis and management of hypothyroidism. These guidelines have been based on extensive reviews of the medical literature and include sections on the role of combination therapy with L-T4 and liothyronine (L-T3) in individuals who are persistently dissatisfied with L-T4 therapy. This position statement by the British Thyroid Association (BTA) summarises the key points in these guidelines and makes recommendations on the management of primary hypothyroidism based on the current literature, review of the published positions of the ETA and ATA, and in line with best principles of good medical practice. The statement is endorsed by the Association of Clinical Biochemistry, (ACB), British Thyroid Foundation, (BTF), Royal College of Physicians (RCP) and Society for Endocrinology (SFE). © 2015 John Wiley & Sons Ltd.

Tonsillectomy and Adenoidectomy in Children with Sleep-Related Breathing Disorders: Consensus Statement of a UK Multidisciplinary Working Party

PubMed Central

Robb, PJ; Bew, S; Kubba, H; Murphy, N; Primhak, R; Rollin, A-M; Tremlett, M

2009-01-01

During 2008, ENT-UK received a number of professional enquiries from colleagues about the management of children with upper airway obstruction and uncomplicated obstructive sleep apnoea (OSA). These children with sleep-related breathing disorders (SRBDs) are usually referred to paediatricians and ENT surgeons. In some district general hospitals, (DGHs) where paediatric intensive care (PICU) facilities to ventilate children were not available, paediatrician and anaesthetist colleagues were expressing concern about children with a clinical diagnosis of OSA having routine tonsillectomy, with or without adenoidectomy. As BAPO President, I was asked by the ENT-UK President, Professor Richard Ramsden, to investigate the issues and rapidly develop a working consensus statement to support safe but local treatment of these children. The Royal Colleges of Anaesthetists and Paediatrics and Child Health and the Association of Paediatric Anaesthetists nominated expert members from both secondary and tertiary care to contribute and develop a consensus statement based on the limited evidence base available. Our terms of reference were to produce a statement that was brief, with a limited number of references, to inform decision-making at the present time. With patient safety as the first priority, the working party wished to support practice that facilitated referral to a tertiary centre of those children who could be expected, on clinical assessment alone, potentially to require PICU facilities. In contrast, the majority of children who could be safely managed in a secondary care setting should be managed closer to home in a DGH. BAPO, ENT-UK, APA, RCS-CSF and RCoA have endorsed the consensus statement; the RCPCH has no mechanism for endorsing consensus statements, but the RCPCH Clinical Effectiveness Committee reviewed the statement, concluding it was a ‘concise, accurate and helpful document’. The consensus statement is an interim working tool, based on level-five evidence. It is intended as the starting point to catalyze further development towards a fully structured, evidence-based guideline; to this end, feedback and comment are welcomed. This and the constructive feedback from APA and RCPCH will be incorporated into a future guideline proposal. PMID:19622257

Tonsillectomy and adenoidectomy in children with sleep-related breathing disorders: consensus statement of a UK multidisciplinary working party.

PubMed

Robb, P J; Bew, S; Kubba, H; Murphy, N; Primhak, R; Rollin, A-M; Tremlett, M

2009-07-01

During 2008, ENT-UK received a number of professional enquiries from colleagues about the management of children with upper airway obstruction and uncomplicated obstructive sleep apnoea (OSA). These children with sleep-related breathing disorders (SRBDs) are usually referred to paediatricians and ENT surgeons. In some district general hospitals, (DGHs) where paediatric intensive care (PICU) facilities to ventilate children were not available, paediatrician and anaesthetist colleagues were expressing concern about children with a clinical diagnosis of OSA having routine tonsillectomy, with or without adenoidectomy. As BAPO President, I was asked by the ENT-UK President, Professor Richard Ramsden, to investigate the issues and rapidly develop a working consensus statement to support safe but local treatment of these children. The Royal Colleges of Anaesthetists and Paediatrics and Child Health and the Association of Paediatric Anaesthetists nominated expert members from both secondary and tertiary care to contribute and develop a consensus statement based on the limited evidence base available. Our terms of reference were to produce a statement that was brief, with a limited number of references, to inform decision-making at the present time. With patient safety as the first priority, the working party wished to support practice that facilitated referral to a tertiary centre of those children who could be expected, on clinical assessment alone, potentially to require PICU facilities. In contrast, the majority of children who could be safely managed in a secondary care setting should be managed closer to home in a DGH. BAPO, ENT-UK, APA, RCS-CSF and RCoA have endorsed the consensus statement; the RCPCH has no mechanism for endorsing consensus statements, but the RCPCH Clinical Effectiveness Committee reviewed the statement, concluding it was a 'concise, accurate and helpful document'. The consensus statement is an interim working tool, based on level-five evidence. It is intended as the starting point to catalyze further development towards a fully structured, evidence-based guideline; to this end, feedback and comment are welcomed. This and the constructive feedback from APA and RCPCH will be incorporated into a future guideline proposal.

Neurodevelopmental outcomes in children with congenital heart disease: evaluation and management: a scientific statement from the American Heart Association.

PubMed

Marino, Bradley S; Lipkin, Paul H; Newburger, Jane W; Peacock, Georgina; Gerdes, Marsha; Gaynor, J William; Mussatto, Kathleen A; Uzark, Karen; Goldberg, Caren S; Johnson, Walter H; Li, Jennifer; Smith, Sabrina E; Bellinger, David C; Mahle, William T

2012-08-28

The goal of this statement was to review the available literature on surveillance, screening, evaluation, and management strategies and put forward a scientific statement that would comprehensively review the literature and create recommendations to optimize neurodevelopmental outcome in the pediatric congenital heart disease (CHD) population. A writing group appointed by the American Heart Association and American Academy of Pediatrics reviewed the available literature addressing developmental disorder and disability and developmental delay in the CHD population, with specific attention given to surveillance, screening, evaluation, and management strategies. MEDLINE and Google Scholar database searches from 1966 to 2011 were performed for English-language articles cross-referencing CHD with pertinent search terms. The reference lists of identified articles were also searched. The American College of Cardiology/American Heart Association classification of recommendations and levels of evidence for practice guidelines were used. A management algorithm was devised that stratified children with CHD on the basis of established risk factors. For those deemed to be at high risk for developmental disorder or disabilities or for developmental delay, formal, periodic developmental and medical evaluations are recommended. A CHD algorithm for surveillance, screening, evaluation, reevaluation, and management of developmental disorder or disability has been constructed to serve as a supplement to the 2006 American Academy of Pediatrics statement on developmental surveillance and screening. The proposed algorithm is designed to be carried out within the context of the medical home. This scientific statement is meant for medical providers within the medical home who care for patients with CHD. Children with CHD are at increased risk of developmental disorder or disabilities or developmental delay. Periodic developmental surveillance, screening, evaluation, and reevaluation throughout childhood may enhance identification of significant deficits, allowing for appropriate therapies and education to enhance later academic, behavioral, psychosocial, and adaptive functioning.

5 CFR 300.705 - Agency action following statement.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Agency action following statement. 300.705 Section 300.705 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS EMPLOYMENT (GENERAL) Statutory Bar to Appointment of Persons Who Fail To Register Under Selective Service Law...

77 FR 21722 - Gore Creek Restoration Project; Intent To Prepare an Environmental Impact Statement

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-11

... complete previously analyzed vegetation management projects, an analysis of additional temporary roads... DEPARTMENT OF AGRICULTURE Forest Service Gore Creek Restoration Project; Intent To Prepare an Environmental Impact Statement AGENCY: Medicine Bow-Routt National Forests, Forest Service, USDA. Project: Gore...

5 CFR 2606.304 - Response to a request for review of an initial refusal to amend; disagreement statements.

Code of Federal Regulations, 2014 CFR

2014-01-01

... “conciseness” of the statement, taking into account the scope of the disagreement and the complexity of the... disagreement, the appropriate system manager will clearly note any disputed portion(s) of the record(s) and...

5 CFR 2606.304 - Response to a request for review of an initial refusal to amend; disagreement statements.

Code of Federal Regulations, 2012 CFR

2012-01-01

... “conciseness” of the statement, taking into account the scope of the disagreement and the complexity of the... disagreement, the appropriate system manager will clearly note any disputed portion(s) of the record(s) and...

75 FR 44951 - Environmental Impact Statements; Notice of Availability

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-30

... Six Tracts of Federal Coal Reserves Adjacent to the Black Thunder, Jacob Ranch, and North Antelope..., Southwest Idaho Ecogroup Land and Resource Management Plan, Updated Information to Reanalyze the Effects of... ENVIRONMENTAL PROTECTION AGENCY [ER-FRL-8991-8] Environmental Impact Statements; Notice of...

78 FR 77194 - Data Collection Available for Public Comments

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-20

... these institutions, SBA requires them to submit audited financial statements annually as well as interim, quarterly financial statements and other reports to facilitate the Agency's oversight of these lenders... comments to Andrea Giles, Supervisory Financial Analyst, Office of Credit Risk Management, Small Business...

5 CFR 300.705 - Agency action following statement.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 5 Administrative Personnel 1 2011-01-01 2011-01-01 false Agency action following statement. 300.705 Section 300.705 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS EMPLOYMENT (GENERAL) Statutory Bar to Appointment of Persons Who Fail To Register Under Selective Service Law...

5 CFR 300.705 - Agency action following statement.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 5 Administrative Personnel 1 2014-01-01 2014-01-01 false Agency action following statement. 300.705 Section 300.705 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS EMPLOYMENT (GENERAL) Statutory Bar to Appointment of Persons Who Fail To Register Under Selective Service Law...

A Different Kind of Web-Based Knowledge Management: The DTRA Acquisition ToolBook

DTIC Science & Technology

2008-12-01

Reimbursement Order MIPR: Military Interdepartmental Purchase Request PWS: Performance Work Statement SOO: Statement of Objectives SOW: Scope of Work Figure 1...Competitive BAA: Broad Agency Announcement IACRO: Inter-Agency Cost Reimbur ement Order MIPR: Military Interdepartmental Purchas Request PWS

75 FR 28811 - Statement of Organization, Functions, and Delegations of Authority

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-24

... comprehensive strategic human resource leadership and career training and development program for all... statement for the Office of Health and Safety (CAJP), insert the following: Human Capital Management Office... training programs; (3) develops, designs, and implements a comprehensive strategic human resource...

Analysis of the Nursing Documentation in Use in Portugal - Building a Clinical Data Model of Nursing Centered on the Management of Treatment Regimen.

PubMed

Cruz, Inês; Bastos, Fernanda; Pereira, Filipe; Silva, Abel; Sousa, Paulino

2016-01-01

The use of technology to support information produced by nurses, especially information and communication technologies, is a current reality, but the proliferation of different statements of nursing diagnosis has made it more difficult for the production of indicators, hindering semantic interoperability of data. This study analyzed all statements of diagnosis focused on the management of medication regimen, customized to the Nursing Practice Support System (SAPE®) that was being used in Portugal in 2013. A total of 598 statements of nursing diagnoses about the phenomenon under study were analyzed, through an a priori analysis model - the ISO 18104 standard: 2003. The purpose was to identify terms used by nurses to describe the range of diagnoses, thus avoiding conceptual redundancy. After a content analysis process conducted by researchers and a broader group of experts, and when excluded all conceptual redundancy, 30 statements of nursing diagnosis were identified.

Updated recommendations for managing the care of patients receiving oral bisphosphonate therapy: an advisory statement from the American Dental Association Council on Scientific Affairs.

PubMed

Edwards, Beatrice J; Hellstein, John W; Jacobsen, Peter L; Kaltman, Steven; Mariotti, Angelo; Migliorati, Cesar A

2008-12-01

and Overview. In 2005, the American Dental Association (ADA) Council on Scientific Affairs convened an expert panel to develop clinical recommendations for dentists treating patients who are receiving oral bisphosphonate therapy. The Journal of the American Dental Association published the resulting report in 2006. This 2008 advisory statement is the first of projected periodic updates of the 2006 clinical recommendations. This 2008 advisory statement concludes, on the basis of a review of the current literature, that for patients receiving bisphosphonate therapy, the risk of developing bisphosphonate-associated osteonecrosis (BON) of the jaw apparently remains low. It also newly concludes that current screening and diagnostic tests are unreliable for predicting a patient's risk of developing the condition. This statement updates the 2006 recommendations regarding general dentistry, management of periodontal diseases, implant placement and maintenance, oral and maxillofacial surgery, endodontics, restorative dentistry and prosthodontics, and orthodontics.

Therapeutic patient education in adrenal insufficiency.

PubMed

Guignat, Laurence

2018-06-01

It is essential to encourage patient autonomy in the management of their illness, and notably their participation in treatment education programs; specific programs target avoidance or early preventive treatment of acute adrenal insufficiency, which is a life-threatening complication. Therapeutic patient education is recommended by the two international consensus statements on the management of primary adrenal insufficiency and the French consensus on adrenal insufficiency. Although there is no common international reference framework to date, the objective of the French consensus was to provide a frame of reference to facilitate the development of therapeutic education for patients with adrenal insufficiency. The principal educational objectives were: for the patient to always carry the necessary emergency equipment; be able to identify situations of increased risk and the early signs of adrenal crisis; know how to adjust oral glucocorticoid treatment; be capable of administering hydrocortisone by subcutaneous injection; be able to adjust treatment to different situations (heat, physical exercise, travel); and be able to appropriately use the resources of the healthcare services. Other programs could also be developed to respond to patients' needs and expectations, notably concerning hydrocortisone dose adjustment to avoid overdose in the context of chronic fatigue syndrome. Copyright © 2018 Elsevier Masson SAS. All rights reserved.

40 CFR 1.33 - Office of Administration and Resources Management.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Management Interns, OHRM establishes policies; assesses and projects Agency executive needs and workforce... out human resources management projects of special interest to Agency management. The Office... Management. 1.33 Section 1.33 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY GENERAL STATEMENT OF...

76 FR 55370 - Environmental Management Site-Specific Advisory Board, Nevada

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-07

... DEPARTMENT OF ENERGY Environmental Management Site-Specific Advisory Board, Nevada AGENCY...-Wide Environmental Impact Statement (EIS) Committee of the Environmental Management Site- Specific... the areas of environmental restoration, waste management, and related activities. Purpose of the...

76 FR 80342 - Coastal Zone Management Program: Illinois

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-23

... DEPARTMENT OF COMMERCE National Oceanic and Atmospheric Administration Coastal Zone Management Program: Illinois AGENCY: Office of Ocean and Coastal Resource Management (OCRM), National Oceanic and... Environmental Impact Statement. SUMMARY: NOAA's Office of Ocean and Coastal Resource Management (OCRM) announces...

Simulation of Behavioral Variations in the Submission of Student Financial Statements: Effects on BEOG Costs. Stage I Draft Final Report for the Study of Program Management Procedures in the Campus-Based and Basic Grant Programs. (Volume IV).

ERIC Educational Resources Information Center

Ellis, Richard

Volume IV of a study of program management procedures in the campus-based and Basic Educational Opportunity Grant (BEOG) programs deals with a set of simulated modifications in the statements made by BEOG applicants about their financial circumstances. Various kinds of misrepresentation of income, assets, and other factors are postulated, and the…

76 FR 11193 - Sequoia National Forest; California; Piute Mountains Travel Management Plan; Correction

Federal Register 2010, 2011, 2012, 2013, 2014

2011-03-01

... National Forest; California; Piute Mountains Travel Management Plan; Correction AGENCY: Forest Service... intent to prepare an environmental impact statement for the Piute Mountains Travel Management Plan. FOR...

Musculoskeletal Injuries: Description of an Under-Recognized Injury Problem Among Military Personnel

DTIC Science & Technology

2010-01-01

et al. Consensus statement on injury defınitions and data collection procedures for studies of injuries in Rugby Union . Clin J SportMed 2007;17(3):177...sports, includ- ng soccer and rugby .28–32 Although acute trauma may be a factor in some cases, any of the injury-related musculoskeletal conditions esult

Topical, geospatial, and temporal diffusion of the 2015 North American Menopause Society position statement on nonhormonal management of vasomotor symptoms.

PubMed

Carpenter, Janet S; Laine, Tei; Harrison, Blake; LePage, Meghan; Pierce, Taran; Hoteling, Nathan; Börner, Katy

2017-10-01

We sought to depict the topical, geospatial, and temporal diffusion of the 2015 North American Menopause Society position statement on the nonhormonal management of menopause-associated vasomotor symptoms released on September 21, 2015, and its associated press release from September 23, 2015. Three data sources were used: online news articles, National Public Radio, and Twitter. For topical diffusion, we compared keywords and their frequencies among the position statement, press release, and online news articles. We also created a network figure depicting relationships across key content categories or nodes. For geospatial diffusion within the United States, we compared locations of the 109 National Public Radio (NPR) stations covering the statement to 775 NPR stations not covering the statement. For temporal diffusion, we normalized and segmented Twitter data into periods before and after the press release (September 12, 2015 to September 22, 2015 vs September 23, 2015 to October 3, 2015) and conducted a burst analysis to identify changes in tweets from before to after. Topical information diffused across sources was similar with the exception of the more scientific terms "vasomotor symptoms" or "vms" versus the more colloquial term "hot flashes." Online news articles indicated media coverage of the statement was mainly concentrated in the United States. NPR station data showed similar proportions of stations airing the story across the four census regions (Northeast, Midwest, south, west; P = 0.649). Release of the statement coincided with bursts in the menopause conversation on Twitter. The findings of this study may be useful for directing the development and dissemination of future North American Menopause Society position statements and/or press releases.

Financial Management: Extending the Financial Statements Audit Requirement of the CFO Act to Additional Federal Agencies

DTIC Science & Technology

2002-05-14

Defense Nuclear Facilities Safety Board has balance-sheet-only audits every 3 to 5 years, most recently for fiscal year 1997. It did not prepare fiscal...associated with the agency’s operations were the most important factors to Have had financial statements audits Defense Nuclear Facilities Safety...audits, the International Trade Commission and the Defense Nuclear Facilities Safety Board, did not have financial statements audits for fiscal year

76 FR 34075 - Statement of Organization, Functions, and Delegations of Authority

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-10

...) determines, recommends, and implements procedural changes needed to maintain effective management of CDC... Organization, Functions, and Delegations of Authority Part C (Centers for Disease Control and Prevention) of the Statement of Organization, Functions, and Delegations of Authority of the Department of Health and...

75 FR 4079 - Agency Information Collection Activities; Submission for Office of Management and Budget Review...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-01-26

... Request; Food Labeling; Notification Procedures for Statements on Dietary Supplements AGENCY: Food and... and clearance. Food Labeling; Notification Procedures for Statements on Dietary Supplements--21 CFR...)) requires that the agency be notified by manufacturers, packers, and distributors of dietary supplements...

50 CFR 600.115 - Statement of organization, practices, and procedures (SOPP).

Code of Federal Regulations, 2013 CFR

2013-10-01

... 50 Wildlife and Fisheries 12 2013-10-01 2013-10-01 false Statement of organization, practices, and procedures (SOPP). 600.115 Section 600.115 Wildlife and Fisheries FISHERY CONSERVATION AND MANAGEMENT, NATIONAL OCEANIC AND ATMOSPHERIC ADMINISTRATION, DEPARTMENT OF COMMERCE MAGNUSON-STEVENS ACT PROVISIONS...

50 CFR 600.115 - Statement of organization, practices, and procedures (SOPP).

Code of Federal Regulations, 2012 CFR

2012-10-01

... 50 Wildlife and Fisheries 12 2012-10-01 2012-10-01 false Statement of organization, practices, and procedures (SOPP). 600.115 Section 600.115 Wildlife and Fisheries FISHERY CONSERVATION AND MANAGEMENT, NATIONAL OCEANIC AND ATMOSPHERIC ADMINISTRATION, DEPARTMENT OF COMMERCE MAGNUSON-STEVENS ACT PROVISIONS...

Goals & Objectives Statements. SPEC Kit 15.

ERIC Educational Resources Information Center

Association of Research Libraries, Washington, DC. Office of Management Studies.

This collection of statements of goals and objectives from member libraries of the Association of Research Libraries (ARL) contains: (1) sections from management review and analysis program reports from the University of Washington Libraries and the University of Rochester Library; (2) a detailed organization description from the Columbia…

A Process Manual: Staff Development in American-Sponsored Overseas Schools.

ERIC Educational Resources Information Center

Anderson, Carrel M.; Schaffer, Raymond, Jr.

This manual is written for those responsible for staff development in American-sponsored overseas schools (ASOS). Program management for staff development planning is divided into seven categories: (1) mission statement preparation; (2) needs assessment survey; (3) goal statements preparation; (4) staff objectives preparation; (5) activities…

77 FR 76067 - Notice of Availability of a Proposed Land Use Plan Amendment and Final Environmental Impact...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-12-26

... Statement for the Proposed McCoy Solar Energy Project, CA AGENCY: Bureau of Land Management, Interior... amendment and final environmental impact statement (EIS) for the McCoy Solar Energy Project (project)--a photovoltaic solar electricity generation [[Page 76068

Optimising experimental research in respiratory diseases: an ERS statement.

PubMed

Bonniaud, Philippe; Fabre, Aurélie; Frossard, Nelly; Guignabert, Christophe; Inman, Mark; Kuebler, Wolfgang M; Maes, Tania; Shi, Wei; Stampfli, Martin; Uhlig, Stefan; White, Eric; Witzenrath, Martin; Bellaye, Pierre-Simon; Crestani, Bruno; Eickelberg, Oliver; Fehrenbach, Heinz; Guenther, Andreas; Jenkins, Gisli; Joos, Guy; Magnan, Antoine; Maitre, Bernard; Maus, Ulrich A; Reinhold, Petra; Vernooy, Juanita H J; Richeldi, Luca; Kolb, Martin

2018-05-01

Experimental models are critical for the understanding of lung health and disease and are indispensable for drug development. However, the pathogenetic and clinical relevance of the models is often unclear. Further, the use of animals in biomedical research is controversial from an ethical perspective.The objective of this task force was to issue a statement with research recommendations about lung disease models by facilitating in-depth discussions between respiratory scientists, and to provide an overview of the literature on the available models. Focus was put on their specific benefits and limitations. This will result in more efficient use of resources and greater reduction in the numbers of animals employed, thereby enhancing the ethical standards and translational capacity of experimental research.The task force statement addresses general issues of experimental research (ethics, species, sex, age, ex vivo and in vitro models, gene editing). The statement also includes research recommendations on modelling asthma, chronic obstructive pulmonary disease, pulmonary fibrosis, lung infections, acute lung injury and pulmonary hypertension.The task force stressed the importance of using multiple models to strengthen validity of results, the need to increase the availability of human tissues and the importance of standard operating procedures and data quality. Copyright ©ERS 2018.

Management of the acute painful crisis in sickle cell disease- a re-evaluation of the use of opioids in adult patients.

PubMed

Telfer, Paul; Bahal, Nawal; Lo, Alice; Challands, Joanne

2014-07-01

Management of the acute painful crisis (APC) of sickle cell disease (SCD) remains unsatisfactory despite advances in the understanding and management of acute pain in other clinical settings. One reason for this is an unsophisticated approach to the use of opioid analgesics for pain management. This applies to haematologists who are responsible for developing acute sickle pain management protocols for their patients, and to health care staff in the acute care setting. The objective of this article is to evaluate the evidence for use of opioids in APC management. We have highlighted the possibilities for improving management by using alternatives to morphine, and intranasal (IN) or transmucosal routes of administration for rapid onset of analgesia in the emergency department (ED). We suggest how experience gained in managing acute sickle pain in children could be extrapolated to adolescents and young adults. We have also questioned whether patients given strong opioids in the acute setting are being safely monitored and what resources are required to ensure efficacy, safety and patient satisfaction. We also identify aspects of care where there are significant differences of opinion, which require further study by randomized controlled trial. © 2014 John Wiley & Sons Ltd.

District of Columbia Public Schools: Availability of Funds and the Cost of FY 1997 Roof Projects. Testimony before the Subcommittee on Oversight of Government Management, Restructuring and the District of Columbia Committee on Governmental Affairs, U.S. Senate. Statement of Gloria L. Jaimon, Director, Health, Education, and Human Services Accounting and Financial Management Issues, Accounting and Information Management Division.

ERIC Educational Resources Information Center

General Accounting Office, Washington, DC. Accounting and Information Management Div.

This document presents the results of a review of the District of Columbia Public Schools' (DCPS) efforts to repair school roofs during the summer of 1997. The statement details when funds were made available to pay for roof repairs, the costs of the roof repairs, and additional roofs to be fixed in fiscal year 1998 and beyond. Sufficient funding…

Management of acute pancreatitis in children.

PubMed

Abu-El-Haija, Maisam; Lin, Tom K; Nathan, Jaimie D

2017-10-01

Pediatric acute pancreatitis has been on the rise in the last decades, with an incidence close to adult pancreatitis. In the majority of cases acute pancreatitis resolves spontaneously, but in a subset of children the disease progresses to severe acute pancreatitis with attendant morbidity and mortality. Pediatric acute pancreatitis in this era is recognized as a separate entity from adult acute pancreatitis given that the causes and disease outcomes are different. There are slow but important advances made in understanding the best management for acute pancreatitis in children from medical, interventional, and surgical aspects. Supportive care with fluids, pain medications, and nutrition remain the mainstay for acute pancreatitis management. For complicated or severe pancreatitis, specialized interventions may be required with endoscopic or drainage procedures. Surgery has an important but limited role in pediatric acute pancreatitis.

75 FR 63851 - Draft General Management Plan and Environmental Impact Statement, Hampton National Historic Site...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-18

... DEPARTMENT OF THE INTERIOR National Park Service Draft General Management Plan and Environmental... the Interior. ACTION: Notice of Availability of the Draft General Management Plan and Environmental... 63852

The diagnosis and management of food allergies. Position paper of the Food Allergy Section the Polish Society of Allergology

PubMed Central

Kaczmarski, Maciej; Czerwionka-Szaflarska, Mieczysława; Małaczyńska, Teresa; Krogulska, Aneta

2017-01-01

The paper concerns the current position of the Polish Society of Allergology Food Allergy Section on the diagnosis and management of food allergies. The aim of this position is to provide evidence-based recommendations on the diagnosis and management of patients with allergic hypersensitivity to foods. This position statement includes a systematic review of studies in three areas, namely, the epidemiology, diagnosis and management of food allergies. While taking into account the specific Polish setting, in this publication we also used the current European Academy of Allergy and Clinical Immunology (EAACI) position paper and other current position statements, including those of the United States National Institute of Allergy and Infectious Diseases (NIAID). PMID:29507553

The diagnosis and management of food allergies. Position paper of the Food Allergy Section the Polish Society of Allergology.

PubMed

Bartuzi, Zbigniew; Kaczmarski, Maciej; Czerwionka-Szaflarska, Mieczysława; Małaczyńska, Teresa; Krogulska, Aneta

2017-10-01

The paper concerns the current position of the Polish Society of Allergology Food Allergy Section on the diagnosis and management of food allergies. The aim of this position is to provide evidence-based recommendations on the diagnosis and management of patients with allergic hypersensitivity to foods. This position statement includes a systematic review of studies in three areas, namely, the epidemiology, diagnosis and management of food allergies. While taking into account the specific Polish setting, in this publication we also used the current European Academy of Allergy and Clinical Immunology (EAACI) position paper and other current position statements, including those of the United States National Institute of Allergy and Infectious Diseases (NIAID).

Rapid resolution of acute subdural hematoma and effects on the size of existent subdural hygroma: a case report.

PubMed

Coşar, Murat; Eser, Olcay; Aslan, Adem; Ela, Yüksel

2007-07-01

The diagnosis and management of acute subdural hematoma is important in neurosurgery practice. Rapid spontaneous resolution of acute subdural hematoma within a few hours is seen rarely on the CT scan. We present a case that enlarged the existent subdural hygroma showing rapid resolution of acute subdural hematoma with resolution in 9 hours after the trauma. Additionally, the follow-up CT scans in the 1st month showed the decrease of enlargement of subdural hygroma. The resolution of acute subdural hematoma and effect of acute subdural hematoma on subdural hygroma must be considered during management. The relation of acute subdural hematoma and subdural hygroma is important for the resolution and management of acute subdural hematoma.

The Society for Obstetric Anesthesia and Perinatology consensus statement on the management of cardiac arrest in pregnancy.

PubMed

Lipman, Steven; Cohen, Sheila; Einav, Sharon; Jeejeebhoy, Farida; Mhyre, Jill M; Morrison, Laurie J; Katz, Vern; Tsen, Lawrence C; Daniels, Kay; Halamek, Louis P; Suresh, Maya S; Arafeh, Julie; Gauthier, Dodi; Carvalho, Jose C A; Druzin, Maurice; Carvalho, Brendan

2014-05-01

This consensus statement was commissioned in 2012 by the Board of Directors of the Society for Obstetric Anesthesia and Perinatology to improve maternal resuscitation by providing health care providers critical information (including point-of-care checklists) and operational strategies relevant to maternal cardiac arrest. The recommendations in this statement were designed to address the challenges of an actual event by emphasizing health care provider education, behavioral/communication strategies, latent systems errors, and periodic testing of performance. This statement also expands on, interprets, and discusses controversial aspects of material covered in the American Heart Association 2010 guidelines.

Diagnosis and Management of Acute Concussion.

PubMed

McCrea, Michael A; Nelson, Lindsay D; Guskiewicz, Kevin

2017-05-01

Over the past 2 decades, there have been major advances in the basic and clinical science of concussion and mild traumatic brain injury. These advances now provide a more evidence-informed approach to the definition, diagnosis, assessment, and management of acute concussion. Standardized clinical tools have been developed and validated for assessment of acute concussion across injury settings (eg, civilian, sport, military). Consensus guidelines now provide guidance regarding injury management and approaches to ensure safe return to activity after acute concussion. This article provides a brief, high-level overview of approaches to best practice in diagnosis, assessment, and management of acute concussion. Copyright © 2017 Elsevier Inc. All rights reserved.

FY 2004 Performance and Accountability Report

ERIC Educational Resources Information Center

US Department of Education, 2004

2004-01-01

The Department?s financial statements, which appear on pp. 115?119, received an unqualified audit opinion issued by the independent accounting firm of Ernst & Young LLP for the third consecutive year. Preparing these statements is part of the Department?s continuing efforts to achieve financial management excellence and to provide accurate and…

76 FR 60815 - Final Legislative Environmental Impact Statement (LEIS) for the Limestone Hills Training Area...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-30

... DEPARTMENT OF DEFENSE Department of the Army Final Legislative Environmental Impact Statement... Bureau of Land Management (BLM) of the Department of Interior (DOI) (cooperating agency). The LEIS... Environmental Policy Act to be included in a recommendation or report on a legislative proposal to Congress...

30 CFR 281.5 - False statements.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 30 Mineral Resources 2 2011-07-01 2011-07-01 false False statements. 281.5 Section 281.5 Mineral Resources BUREAU OF OCEAN ENERGY MANAGEMENT, REGULATION, AND ENFORCEMENT, DEPARTMENT OF THE INTERIOR OFFSHORE LEASING OF MINERALS OTHER THAN OIL, GAS, AND SULPHUR IN THE OUTER CONTINENTAL SHELF General § 281...

76 FR 53901 - The President's Management Advisory Board (PMAB); Notification of Upcoming Public Advisory Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-30

....m. eastern time, ending no later than 12 p.m. FOR FURTHER INFORMATION CONTACT: Mr. Stephen..., General Services Administration, 1776 G Street NW., Washington, DC 20006, at stephen[email protected] following methods: Electronic Statements: Submit written statements to Stephen Brockelman, Designated...

77 FR 68813 - Notice of Availability of the Draft Environmental Impact Statement and Environmental Impact...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-11-16

... geothermal unit, which is currently providing energy sufficient to power three operating geothermal plants... the Casa Diablo IV Geothermal Development Project, CA AGENCY: Bureau of Land Management, Interior... Statement (EIS)/Environmental Impact Report (EIR) for the proposed Casa Diablo IV Geothermal Development...

7 CFR 226.6 - State agency administrative responsibilities.

Code of Federal Regulations, 2011 CFR

2011-01-01

... statement. Institutions must submit their nondiscrimination policy statement and a media release, unless the State agency has issued a Statewide media release on behalf of all institutions; (iv) Management plan..., except that: (A) The State agency and an institution that is a school food authority must enter into a...

78 FR 49735 - Intent To Prepare a Draft Environmental Impact Statement for Dam Safety Study, Lake Lewisville...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-15

... determine appropriate permanent methods for correcting potential problems, interim risk reduction measures... Environmental Impact Statement for Dam Safety Study, Lake Lewisville Dam, Elm Fork Trinity River, Denton County... primary purposes of the project are flood risk management, [[Page 49736

Financial Accounting at the On-Site Inspection Agency

DTIC Science & Technology

1997-04-15

Public Law 103-356 requires DoD to provide consolidated financial statements for FY 1996 to the Office of Management and Budget. Financial data from...the On-Site Inspection Agency (OSIA) will be included in the category "Other Defense Organizations" in the consolidated financial statements for DoD

Appropriated Capital Used in the FY 1995 Defense Business Operations Fund Financial Statements.

DTIC Science & Technology

1997-01-27

financial statements were presented fairly in accordance with the "other comprehensive basis of accounting" described in Office of Management and...The overall revenue accounts audit objective was to determine whether revenues reported on the FY. 1996 Defense Business Operations Fund consolidated

Effectiveness in the Environmental Impact Statement: A Study in Public Rhetoric.

ERIC Educational Resources Information Center

Killingsworth, M. Jimmie; Steffens, Dean

1989-01-01

Presents a case study of several environmental impact statements (EISs) produced by the Bureau of Land Management. Reveals that to determine a document's effectiveness, its social and cultural context must be considered, along with characteristics of the text's organization and style. Recommends a genre theory approach. (MM)

Farm Business Records and Financial Statements. Teacher Edition. Farm Business Management Series.

ERIC Educational Resources Information Center

Oklahoma State Dept. of Vocational and Technical Education, Stillwater. Curriculum and Instructional Materials Center.

Contained in this teacher's guide are the materials necessary to teach seven instructional units related to keeping farm business records and preparing financial statements. The following instructional units are presented: (1) orientation; (2) inventories; (3) journal entry; (4) enterprise accounting and supplemental records; (5) cash flow…

12 CFR 620.11 - Content of quarterly report to shareholders.

Code of Federal Regulations, 2011 CFR

2011-01-01

... results to be expected for the year. (c) Management's discussion and analysis of financial condition and.... For purposes of this section, major captions to be provided in the financial statements are the same as those provided in the financial statements contained in the institution's annual report to...

75 FR 6399 - Statement of Organization, Functions and Delegation of Authority

Federal Register 2010, 2011, 2012, 2013, 2014

2010-02-09

... DUCS Case Managers which, in effect, involved the exercise of these authorities prior to the effective... DEPARTMENT OF HEALTH AND HUMAN SERVICES Administration for Children and Families Statement of... the January 12, 2010 earthquake in Haiti. (c) Effective Date This delegation of authority is effective...

76 FR 50223 - Statement of Organization, Functions, and Delegations of Authority

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-12

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention Statement of... Human Services (45 FR 67772-76, dated October 14, 1980, and corrected at 45 FR 69296, October 20, 1980...). (1) Provides leadership, management, and oversight for all division activities; (2) provides...

77 FR 45663 - James William Eisenberg, M.D.; Decision and Order

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-01

... failed to consider any non-opioid management other than cannabis, and failed to review the Controlled... noticed and alleged in its prehearing statement and documentary evidence that Respondent issued controlled..., (Gov't Ex. 11).\\1\\ \\1\\ I find in this case that the Government's prehearing statements and documentary...

78 FR 77108 - Intent To Prepare a Draft Supplemental Environmental Impact Statement for the Middle Mississippi...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-20

... DEPARTMENT OF DEFENSE Department of the Army, Corps of Engineers Intent To Prepare a Draft Supplemental Environmental Impact Statement for the Middle Mississippi River Regulating Works Project, Missouri... stabilization and sediment management to ensure adequate navigation depth and width. Project improvements are...

Report on Fiscal Year 1991 financial statement audit of the Low-Level Radioactive Waste Surcharge Escrow Account (CR-FC-92-1)

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

Not Available

1992-06-26

The attached audit report on the subject account presents the opinion of the independent certified public accounts on financial statements as of September 30, 1991. In their opinion, the Surcharge Account statements are fairly presented in all material respects in accordance with generally accepted accounting principles. Also attached are reports on the internal control structure and compliance with laws and regulations, ass well as management's letter on addressing needed improvements.

ISASS Policy Statement – Lumbar Artificial Disc

PubMed Central

Garcia, Rolando

2015-01-01

Purpose The primary goal of this Policy Statement is to educate patients, physicians, medical providers, reviewers, adjustors, case managers, insurers, and all others involved or affected by insurance coverage decisions regarding lumbar disc replacement surgery. Procedures This Policy Statement was developed by a panel of physicians selected by the Board of Directors of ISASS for their expertise and experience with lumbar TDR. The panel's recommendation was entirely based on the best evidence-based scientific research available regarding the safety and effectiveness of lumbar TDR. PMID:25785243

Anesthetic variation and potential impact of anesthetics used during endovascular management of acute ischemic stroke.

PubMed

Sivasankar, Chitra; Stiefel, Michael; Miano, Todd A; Kositratna, Guy; Yandrawatthana, Sukanya; Hurst, Robert; Kofke, W Andrew

2016-11-01

Many authors have reported that general anesthesia (GA), as a generic and uncharacterized therapy, is contraindicated for patients undergoing endovascular management of acute ischemic stroke (EMAIS). The recent American Heart Association update cautiously suggests that it might be reasonable to favor conscious sedation over GA during EMAIS. We are concerned that such recommendations will result in patients undergoing endovascular treatment without consideration of the effects of specific anesthetic agents and anesthetic dose, and without appropriate critical consideration of the individual patient's issues. We hypothesized that significant variation in anesthetic practice comprises GA, and that outcome differences among types of GA would arise. With IRB approval, we examined the records of patients who underwent anterior circulation EMAIS at the University of Pennsylvania from 2010 to 2015. Patients were managed by different anesthesiologists with no specific protocol. We analyzed American Society of Anesthesiologists status, NIH Stroke Scale, type of stroke, procedure, different types of anesthetic, blood pressure control, and outcome metrics. Modified Rankin Scale (mRS) scores were determined from medical records. GA was used in 91% of patients. Several types of GA were employed: intravenous, volatile, and intravenous/volatile combined. mRS scores ≤2 at discharge were observed in 42.8% of patients receiving volatile anesthesia and were better in patients receiving only volatile agents after induction of anesthesia (p<0.05). Our data support the notion that anesthetic techniques and associated physiology used in EMAIS are not homogeneous, making any statements about the effects of generic GA in stroke ambiguous. Moreover, our data suggest that the type of GA may affect the outcome after EMAIS. 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/.

Reading and understanding financial statements.

PubMed

White, Joseph P

2005-01-01

Feeling comfortable reading and understanding financial statements is critical to the success of healthcare executives and physicians involved in management. Businesses use three primary financial statements: a balance sheet represents the equation, Assets = Liabilities + Equity; an income statement represents the equation, Revenues - Expenses = Net Income; a statement of cash flows reports all sources and uses of cash during the represented period. The balance sheet expresses financial indicators at one particular moment in time, whereas the income statement and the statement of cash flows show activity that occurred over a stretch of time. Additional information is disclosed in attached footnotes and other supplementary materials. There are two ways to prepare financial statements. Cash-basis accounting recognizes revenue when it is received and expenses when they are paid. Accrual-basis accounting recognizes revenue when it is earned and expenses when they are incurred. Although cash-basis is acceptable, periodically using the accrual method reveals important information about receivables and liabilities that could otherwise remain hidden. Become more engaged with your financial statements by spending time reading them, tracking key performance indicators, and asking accountants and financial advisors questions. This will help you better understand your business and build a successful future.

FASB Statement No. 132 simplifies benefits disclosures.

PubMed

Luecke, R W; Andrzejewski, C

1999-06-01

In February 1998, the FASB issued Statement of Financial Accounting Standards No. 132, Employers' Disclosures about Pensions and Other Postretirement Benefits. The new standard is designed to streamline pension and other postretirement benefits disclosures in public and nonpublic entities' financial statements. For nonpublic entities, the statement eliminates separate disclosures of the components of net periodic benefit cost, eliminates the disclosure of the components of benefit obligations and of alternative obligation measures, eliminates the disclosure of plan provisions, adds the disclosure of comprehensive income, eliminates the disclosure of sensitivity to changes in healthcare trend rates, and standardizes the disclosures for pension and other postretirement benefits. Financial managers and their organizations' actuaries and auditors should work together to determine which disclosures their organizations should make to be in compliance with FASB Statement No. 132.

Southwestern Power Administration Combined Financial Statements, 2006-2009

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

None

2009-09-01

We have audited the accompanying combined balance sheets of the Southwestern Federal Power System (SWFPS), as of September 30, 2009, 2008, 2007, and 2006, and the related combined statements of revenues and expenses, changes in capitalization, and cash flows for the years then ended. As described in note 1(a), the combined financial statement presentation includes the hydroelectric generation functions of another Federal agency (hereinafter referred to as the generating agency), for which Southwestern Power Administration (Southwestern) markets and transmits power. These combined financial statements are the responsibility of the management of Southwestern and the generating agency. Our responsibility is tomore » express an opinion on these combined financial statements based on our audits. We conducted our audits in accordance with auditing standards generally accepted in the United States of America. Those standards require that we plan and perform the audits to obtain reasonable assurance about whether the combined financial statements are free of material misstatement. An audit includes consideration of internal control over financial reporting as a basis for designing audit procedures that are appropriate in the circumstances, but not for the purpose of expressing an opinion on the effectiveness of Southwestern and the generating agency’s internal control over financial reporting. Accordingly, we express no such opinion. An audit also includes examining, on a test basis, evidence supporting the amounts and disclosures in the combined financial statements, assessing the accounting principles used and significant estimates made by management, as well as evaluating the overall combined financial statement presentation. We believe that our audits provide a reasonable basis for our opinion. In our opinion, the combined financial statements referred to above present fairly, in all material respects, the respective financial position of the Southwestern Federal Power System, as of September 30, 2009, 2008, 2007, and 2006, and the results of its operations and its cash flow for the years then ended, in conformity with U.S. generally accepted accounting principles. Our audits were conducted for the purpose of forming an opinion on the 2009, 2008, 2007, and 2006 SWFPS’s combined financial statements taken as a whole. The supplementary information in the combining financial statements is presented for purposes of additional analysis and is not a required part of the basic combined financial statements. The supplementary information has been subjected to the auditing procedures applied in the audit of the basic combined financial statements and, in our opinion, is fairly stated in all material respects in relation to the basic combined financial statements taken as a whole.« less

Testing of low-risk patients presenting to the emergency department with chest pain: a scientific statement from the American Heart Association.

PubMed

Amsterdam, Ezra A; Kirk, J Douglas; Bluemke, David A; Diercks, Deborah; Farkouh, Michael E; Garvey, J Lee; Kontos, Michael C; McCord, James; Miller, Todd D; Morise, Anthony; Newby, L Kristin; Ruberg, Frederick L; Scordo, Kristine Anne; Thompson, Paul D

2010-10-26

The management of low-risk patients presenting to emergency departments is a common and challenging clinical problem entailing 8 million emergency department visits annually. Although a majority of these patients do not have a life-threatening condition, the clinician must distinguish between those who require urgent treatment of a serious problem and those with more benign entities who do not require admission. Inadvertent discharge of patients with acute coronary syndrome from the emergency department is associated with increased mortality and liability, whereas inappropriate admission of patients without serious disease is neither indicated nor cost-effective. Clinical judgment and basic clinical tools (history, physical examination, and electrocardiogram) remain primary in meeting this challenge and affording early identification of low-risk patients with chest pain. Additionally, established and newer diagnostic methods have extended clinicians' diagnostic capacity in this setting. Low-risk patients presenting with chest pain are increasingly managed in chest pain units in which accelerated diagnostic protocols are performed, comprising serial electrocardiograms and cardiac injury markers to exclude acute coronary syndrome. Patients with negative findings usually complete the accelerated diagnostic protocol with a confirmatory test to exclude ischemia. This is typically an exercise treadmill test or a cardiac imaging study if the exercise treadmill test is not applicable. Rest myocardial perfusion imaging has assumed an important role in this setting. Computed tomography coronary angiography has also shown promise in this setting. A negative accelerated diagnostic protocol evaluation allows discharge, whereas patients with positive findings are admitted. This approach has been found to be safe, accurate, and cost-effective in low-risk patients presenting with chest pain.

Intravenous Recombinant Tissue Plasminogen Activator and Ischemic Stroke: Focused Update of 2010 Clinical Practice Advisory From the American Academy of Emergency Medicine.

PubMed

Meurer, William J; Barth, Bradley; Abraham, Michael; Hoffman, Jerome R; Vilke, Gary M; DeMers, Gerard

2018-05-01

Stroke treatment is a continuum that begins with the rapid identification of symptoms and treatment with transition to successful rehabilitation. Therapies for acute ischemic stroke (AIS) may vary based on anatomic location, interval from symptom onset, and coexisting health conditions. Successful therapy requires a seamless systematic approach with coordination from prehospital environment through acute management at medical facilities to disposition and long-term care of the patient. The emergency physician must balance the benefits and risks of alteplase recombinant tissue plasminogen activator (rtPA) for AIS management. We review the recent medical literature on the topic of AIS and assess intravenous rtPA for the following questions: 1) is there any applicable, new, high-quality evidence that the benefits of intravenous rtPA are justified in light of the harms associated with it, and 2) if so, does the evidence clarify which patients, if any, are most likely to benefit from the treatment. A MEDLINE literature search from January 2010 to October 2016 and limited to human studies written in English for articles with keywords of cerebrovascular accident and (thromboly* OR alteplase). Guideline statements and nonsystematic reviews were excluded. Studies targeting differences between specific populations (males vs. females) were excluded. Studies identified then underwent a structured review from which results could be evaluated. Three hundred twenty-two papers on thrombolytic use were screened and nine appropriate articles were rigorously reviewed and recommendations given. No new studies published between 2010 and 2016 meaningfully reduced uncertainty regarding our understanding of the benefits and harms of intravenous rtPA for AIS. Discussions regarding benefit and harm should occur for patients, and risk prediction scores may facilitate the conversation. Published by Elsevier Inc.

Moral distress: levels, coping and preferred interventions in critical care and transitional care nurses.

PubMed

Wilson, Melissa A; Goettemoeller, Diana M; Bevan, Nancy A; McCord, Jennifer M

2013-05-01

To examine the level and frequency of moral distress in staff nurses working in two types of units in an acute care hospital and to gather information for future interventions addressing moral distress. In 2008, the American Association of Critical Care Nurses published a Position Statement on Moral Distress. Nurses working in units where critically ill patients are admitted may encounter distressing situations. Moral distress is the painful feelings and/or psychological disequilibrium that may occur when taking care of patients. An exploratory, descriptive design study was used to identify the type and frequency of moral distress experienced by nurses. The setting was an acute care hospital in which the subjects were sampled from two groups of nurses based on their unit assignment. A descriptive, questionnaire study was used. Nurses completed the 38-item moral distress scale, a coping questionnaire, and indicated their preferred methods for institutional support in managing distressing situations. A convenience sample of staff nurses was approached to complete the moral distress questionnaire. Overall, the nurses reported low levels of moral distress. Situations creating the highest levels of moral distress were those related to futile care. A significance between group differences was found in the physician practice dimension. Specific resources were identified to help guide future interventions to recognise and manage moral distress. Nurses reported lower levels and frequency of moral distress in these units but their open-ended responses appeared to indicate moral distress. Nurses identified specific resources that they would find helpful to alleviate moral distress. There are numerous studies that identify the situations and the impact of moral distress, but not many studies explore treatments and interventions for moral distress. This study attempted to identify nurse preferences for lessening the impact of moral distress. © 2013 Blackwell Publishing Ltd.

75 FR 1806 - Draft General Management Plan and Environmental Impact Statement, New River Gorge National River, WV

Federal Register 2010, 2011, 2012, 2013, 2014

2010-01-13

... DEPARTMENT OF THE INTERIOR National Park Service Draft General Management Plan and Environmental... Interior. ACTION: Notice of availability of the Draft General Management Plan and Environmental Impact...

Maintenance Management Update.

ERIC Educational Resources Information Center

Sternloff, Robert E.

1987-01-01

Current trends in park maintenance are overviewed, including maintenance impact statements, avoidance of cost through efficient use and national resource conservation, horticultural accomplishments that influence maintenance management, and vandalism prevention. (CB)

Emergency Medicine Management of Sickle Cell Disease Complications: An Evidence-Based Update.

PubMed

Simon, Erica; Long, Brit; Koyfman, Alex

2016-10-01

Sickle cell disease (SCD) affects approximately 100,000 individuals in the United States. Due to alterations in the structural conformation of hemoglobin molecules under deoxygenated conditions, patients with SCD are predisposed to numerous sequelae, many of which require acute intervention. Our aim was to provide emergency physicians with an evidence-based update regarding the diagnosis and management of SCD complications. SCD patients experience significant morbidity and mortality secondary to cerebrovascular accident, acute chest syndrome, acute vaso-occlusive pain crises, SCD-related multi-organ failure, cholecystitis, acute intrahepatic cholestasis, acute sickle hepatic crisis, acute hepatic sequestration, priapism, and renal disease. Emergency physicians must recognize acute manifestations of SCD in order to deliver timely management and determine patient disposition. A comprehensive review of the emergency department management of acute SCD complications is provided. Comprehensive understanding of these aspects of SCD can assist physicians in expediting patient evaluation and treatment, thus decreasing the morbidity and mortality associated with this hemoglobinopathy. Copyright © 2016 Elsevier Inc. All rights reserved.

75 FR 369 - Office of the Assistant Secretary for Administration; Statement of Organization, Functions, and...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-01-05

... Management and Equal Employment Opportunity (AJI). Office of Business Management and Transformation (AJJ... of Business Management and Transformation (AJJ). The Office of Business Management and Transformation... existing offices within OS. FOR FURTHER INFORMATION CONTACT: Lila Lee, Office of Business Management and...

Spontaneous Coronary Artery Dissection: Current State of the Science: A Scientific Statement From the American Heart Association.

PubMed

Hayes, Sharonne N; Kim, Esther S H; Saw, Jacqueline; Adlam, David; Arslanian-Engoren, Cynthia; Economy, Katherine E; Ganesh, Santhi K; Gulati, Rajiv; Lindsay, Mark E; Mieres, Jennifer H; Naderi, Sahar; Shah, Svati; Thaler, David E; Tweet, Marysia S; Wood, Malissa J

2018-05-08

Spontaneous coronary artery dissection (SCAD) has emerged as an important cause of acute coronary syndrome, myocardial infarction, and sudden death, particularly among young women and individuals with few conventional atherosclerotic risk factors. Patient-initiated research has spurred increased awareness of SCAD, and improved diagnostic capabilities and findings from large case series have led to changes in approaches to initial and long-term management and increasing evidence that SCAD not only is more common than previously believed but also must be evaluated and treated differently from atherosclerotic myocardial infarction. High rates of recurrent SCAD; its association with female sex, pregnancy, and physical and emotional stress triggers; and concurrent systemic arteriopathies, particularly fibromuscular dysplasia, highlight the differences in clinical characteristics of SCAD compared with atherosclerotic disease. Recent insights into the causes of, clinical course of, treatment options for, outcomes of, and associated conditions of SCAD and the many persistent knowledge gaps are presented. © 2018 American Heart Association, Inc.

Consensus on the management of intracranial germ-cell tumours.

PubMed

Murray, Matthew J; Bartels, Ute; Nishikawa, Ryo; Fangusaro, Jason; Matsutani, Masao; Nicholson, James C

2015-09-01

The management of intracranial germ-cell tumours is complex because of varied clinical presentations, tumour sites, treatments and outcomes, and the need for multidisciplinary input. Participants of the 2013 Third International CNS Germ Cell Tumour Symposium (Cambridge, UK) agreed to undertake a multidisciplinary Delphi process to identify consensus in the clinical management of intracranial germ-cell tumours. 77 delegates from the symposium were selected as suitable experts in the field and were invited to participate in the Delphi survey, of which 64 (83%) responded to the invitation. Invited participants represented multiple disciplines from Asia, Australasia, Europe, and the Americas. 38 consensus statements encompassing aspects of intracranial germ-cell tumour work-up, staging, treatment, and follow-up were prepared. To achieve consensus, statements required at least 70% agreement from at least 60% of respondents. Overall, 34 (89%) of 38 statements met consensus criteria. This international Delphi approach has defined key areas of consensus that will help guide and streamline clinical management of patients with intracranial germ-cell tumours. Additionally, the Delphi approach identified areas of different understanding and clinical practice internationally in the management of these tumours, areas which should be the focus of future collaborative studies. Such efforts should translate into improved patient outcomes. Copyright © 2015 Elsevier Ltd. All rights reserved.

78 FR 15882 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-13

... effect in accordance with section 553(b) of the Administrative Procedure Act (APA) (5 U.S.C. 553(b... incorporates a statement of the finding and the reasons therefore in the notice. Section 553(b) of the APA..., this correcting document does not constitute a rulemaking that would be subject to the APA notice and...

Urinary tract infections in infants and children: Diagnosis and management

PubMed Central

Robinson, Joan L; Finlay, Jane C; Lang, Mia Eileen; Bortolussi, Robert

2014-01-01

Recent studies have resulted in major changes in the management of urinary tract infections (UTIs) in children. The present statement focuses on the diagnosis and management of infants and children >2 months of age with an acute UTI and no known underlying urinary tract pathology or risk factors for a neurogenic bladder. UTI should be ruled out in preverbal children with unexplained fever and in older children with symptoms suggestive of UTI (dysuria, urinary frequency, hematuria, abdominal pain, back pain or new daytime incontinence). A midstream urine sample should be collected for urinalysis and culture in toilet-trained children; others should have urine collected by catheter or by suprapubic aspirate. UTI is unlikely if the urinalysis is completely normal. A bagged urine sample may be used for urinalysis but should not be used for urine culture. Antibiotic treatment for seven to 10 days is recommended for febrile UTI. Oral antibiotics may be offered as initial treatment when the child is not seriously ill and is likely to receive and tolerate every dose. Children <2 years of age should be investigated after their first febrile UTI with a renal/bladder ultrasound to identify any significant renal abnormalities. A voiding cystourethrogram is not required for children with a first UTI unless the renal/bladder ultrasound reveals findings suggestive of vesicoureteral reflux, selected renal anomalies or obstructive uropathy. PMID:25332662

Urinary tract infections in infants and children: Diagnosis and management.

PubMed

Robinson, Joan L; Finlay, Jane C; Lang, Mia Eileen; Bortolussi, Robert

2014-06-01

Recent studies have resulted in major changes in the management of urinary tract infections (UTIs) in children. The present statement focuses on the diagnosis and management of infants and children >2 months of age with an acute UTI and no known underlying urinary tract pathology or risk factors for a neurogenic bladder. UTI should be ruled out in preverbal children with unexplained fever and in older children with symptoms suggestive of UTI (dysuria, urinary frequency, hematuria, abdominal pain, back pain or new daytime incontinence). A midstream urine sample should be collected for urinalysis and culture in toilet-trained children; others should have urine collected by catheter or by suprapubic aspirate. UTI is unlikely if the urinalysis is completely normal. A bagged urine sample may be used for urinalysis but should not be used for urine culture. Antibiotic treatment for seven to 10 days is recommended for febrile UTI. Oral antibiotics may be offered as initial treatment when the child is not seriously ill and is likely to receive and tolerate every dose. Children <2 years of age should be investigated after their first febrile UTI with a renal/bladder ultrasound to identify any significant renal abnormalities. A voiding cystourethrogram is not required for children with a first UTI unless the renal/bladder ultrasound reveals findings suggestive of vesicoureteral reflux, selected renal anomalies or obstructive uropathy.

78 FR 60880 - Statement of Organization, Functions, and Delegations of Authority

Federal Register 2010, 2011, 2012, 2013, 2014

2013-10-02

... Commissioner (KFB) Division of Business and Resource Management (KFB2) Division of Customer Communications... Systems, Division of Business and Resource Management, Division of Customer Communications, Division of...: The Division of Management Services to the Division of Business and Resource Management; the Division...

76 FR 38685 - Draft General Management Plan Amendment/Environmental Impact Statement, Tumacacori National...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-01

... experience at Tumacacori by developing access to these associated mission resources. A general management... DEPARTMENT OF THE INTERIOR National Park Service Draft General Management Plan Amendment... Management Plan, Tumacacori National Historical Park, in favor of an Environmental Assessment. SUMMARY: The...

Using Simulation as an Investigational Methodology to Explore the Impact of Technology on Team Communication and Patient Management: A Pilot Evaluation of the Effect of an Automated Compression Device.

PubMed

Gittinger, Matthew; Brolliar, Sarah M; Grand, James A; Nichol, Graham; Fernandez, Rosemarie

2017-06-01

This pilot study used a simulation-based platform to evaluate the effect of an automated mechanical chest compression device on team communication and patient management. Four-member emergency department interprofessional teams were randomly assigned to perform manual chest compressions (control, n = 6) or automated chest compressions (intervention, n = 6) during a simulated cardiac arrest with 2 phases: phase 1 baseline (ventricular tachycardia), followed by phase 2 (ventricular fibrillation). Patient management was coded using an Advanced Cardiovascular Life Support-based checklist. Team communication was categorized in the following 4 areas: (1) teamwork focus; (2) huddle events, defined as statements focused on re-establishing situation awareness, reinforcing existing plans, and assessing the need to adjust the plan; (3) clinical focus; and (4) profession of team member. Statements were aggregated for each team. At baseline, groups were similar with respect to total communication statements and patient management. During cardiac arrest, the total number of communication statements was greater in teams performing manual compressions (median, 152.3; interquartile range [IQR], 127.6-181.0) as compared with teams using an automated compression device (median, 105; IQR, 99.5-123.9). Huddle events were more frequent in teams performing automated chest compressions (median, 4.0; IQR, 3.1-4.3 vs. 2.0; IQR, 1.4-2.6). Teams randomized to the automated compression intervention had a delay to initial defibrillation (median, 208.3 seconds; IQR, 153.3-222.1 seconds) as compared with control teams (median, 63.2 seconds; IQR, 30.1-397.2 seconds). Use of an automated compression device may impact both team communication and patient management. Simulation-based assessments offer important insights into the effect of technology on healthcare teams.

Parental Preference Assessment for Vesicoureteral Reflux Management in Children.

PubMed

Tran, Geraldine N; Bodapati, Anand V; Routh, Jonathan C; Saigal, Christopher S; Copp, Hillary L

2017-03-01

Parents of children with vesicoureteral reflux are presented with a variety of management options, which in many cases offer a similar risk-benefit ratio. To facilitate shared decision making, parental preferences regarding vesicoureteral reflux treatment options need to be acknowledged. We aimed to characterize the clinical experience of parents and elicit core themes affecting decision making in regard to managing vesicoureteral reflux in their child. A semistructured, qualitative interview script was developed and vetted by 25 pediatric urologists to discuss treatment options for vesicoureteral reflux. Additional patient interviews were conducted until new themes failed to arise. Content analysis was performed to extract all statements that described treatment options. Similar statements were combined until a final list of unique themes emerged. A total of 26 interviews were performed, yielding 689 statements about overall parent experiences with managing vesicoureteral reflux in the child and 450 statements (65%) pertaining to treatment options. Of the 13 themes that emerged, those most commonly considered were the prevention of future urinary tract infections by 85% of parents, the efficacy rate of treatment options by 85%, the burden of daily maintenance or compliance by 77%, antibiotic resistance by 69%, chronic kidney damage by 62% and invasiveness by 58%. Our study emphasizes that when choosing a treatment option for vesicoureteral reflux in their child, parent preferences regarding risks and benefits are variable. However, their chief concerns include whether a method decreases the risk of urinary tract infections, has an acceptable efficacy rate and aligns itself with the capabilities of the family. These themes help frame discussions between families and clinicians regarding vesicoureteral reflux management, and they can facilitate shared decision making. Copyright © 2017 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Department of Education: Multiple, Nonintegrated Systems Hamper Management of Student Financial Aid Programs. Testimony before the Committee on Labor and Human Resources, U. S. Senate. Statement of Cornelia M. Blanchette, Associate Director Education and Employment Issues, Health, Education, and Human Services Division.

ERIC Educational Resources Information Center

Blanchette, Cornelia M.

This statement of Cornelia M. Blanchette to the U.S. Senate Committee on Labor and Human Reources discusses Department of Education information management systems that support the financial aid programs authorized by Title IV of the Higher Education Act of 1965, as amended. These programs help the Federal Family Education Loan Program (FFELP), the…

Anxiety management training for anxiety states: positive compared with negative self-statements.

PubMed

Ramm, E; Marks, I M; Yuksel, S; Stern, R S

1982-04-01

Twelve patients complaining of chronic free-floating anxiety, usually also with panic attacks, were assigned at random to treatment by six hour-long sessions of anxiety-management training, either with positive or with negative self-statements, given over six weeks. Patients in both treatment conditions improved, with a small trend favouring positive over negative self-instruction, especially at follow-up. It is unclear how much self-instruction, rather than therapeutic attention or mere passage of time, accounted for the bulk of the modest improvement obtained.

Poststroke Fatigue: Emerging Evidence and Approaches to Management: A Scientific Statement for Healthcare Professionals From the American Heart Association.

PubMed

Hinkle, Janice L; Becker, Kyra J; Kim, Jong S; Choi-Kwon, Smi; Saban, Karen L; McNair, Norma; Mead, Gillian E

2017-07-01

At least half of all stroke survivors experience fatigue; thus, it is a common cause of concern for patients, caregivers, and clinicians after stroke. This scientific statement provides an international perspective on the emerging evidence surrounding the incidence, prevalence, quality of life, and complex pathogenesis of poststroke fatigue. Evidence for pharmacological and nonpharmacological interventions for management are reviewed, as well as the effects of poststroke fatigue on both stroke survivors and caregivers. © 2017 American Heart Association, Inc.

A new compact for owners and directors. The Working Group on Corporate Governance.

PubMed

1991-01-01

The virtual demise of hostile takeovers and leveraged buyouts has not cooled the tensions over corporate governance. In congressional hearings, at annual meetings, and in proxy contests splashed across the business pages, senior executives and powerful shareholders continue to confront each other. The basic issues remain remarkably consistent. When do investors' legitimate needs for returns translate into destructive pressures on long-term corporate prosperity? What kinds of accountability do top managers owe shareholders in terms of strategic consultation and disclosure? What is the precise role of the board of directors as a management monitor and shareholder representative? More than a year ago, a working group of distinguished lawyers representing large public companies and leading institutional investors began a series of meetings to cut through the rancor. Their goal was to reach common ground on a set of principles that reconciles the tensions between owners and managers. Recently, the group agreed on a statement that all eight members endorsed. The statement, "A New Charter for Owners and Managers," deserves wide readership, scrutiny, and commentary. HBR is pleased the working group chose it as the exclusive forum to release its statement.

2018 International Olympic Committee consensus statement on prevention, diagnosis and management of paediatric anterior cruciate ligament (ACL) injuries

PubMed Central

Ekås, Guri Ranum; Grindem, Hege; Moksnes, Håvard; Anderson, Allen F; Chotel, Franck; Cohen, Moises; Forssblad, Magnus; Ganley, Theodore J; Feller, Julian A; Karlsson, Jón; Kocher, Minider S; LaPrade, Robert F; McNamee, Michael; Mandelbaum, Bert; Micheli, Lyle; Mohtadi, Nicholas; Reider, Bruce; Roe, Justin; Seil, Romain; Siebold, Rainer; Witvrouw, Erik; Engebretsen, Lars

2018-01-01

In October 2017, the International Olympic Committee hosted an international expert group of physiotherapists and orthopaedic surgeons who specialise in treating and researching paediatric ACL injuries. Representatives from the American Orthopaedic Society for Sports Medicine, European Paediatric Orthopaedic Society, European Society for Sports Traumatology, Knee Surgery & Arthroscopy, International Society of Arthroscopy Knee Surgery and Orthopaedic Sports Medicine, Pediatric Orthopaedic Society of North America and Sociedad Latinoamericana de Artroscopia, Rodilla y Deporte attended. Physiotherapists and orthopaedic surgeons with clinical and research experience in the field, and an ethics expert with substantial experience in the area of sports injuries also participated. Injury management is challenging in the current landscape of clinical uncertainty and limited scientific knowledge. Injury management decisions also occur against the backdrop of the complexity of shared decision-making with children and the potential long-term ramifications of the injury. This consensus statement addresses six fundamental clinical questions regarding the prevention, diagnosis and management of paediatric ACL injuries. The aim of this consensus statement is to provide a comprehensive, evidence-informed summary to support the clinician, and help children with ACL injury and their parents/guardians make the best possible decisions. PMID:29478021

Challenges for the implementation of World Health Organization guidelines for acute stress, PTSD, and bereavement: a qualitative study in Uganda.

PubMed

Kane, Jeremy C; Adaku, Alex; Nakku, Juliet; Odokonyero, Raymond; Okello, James; Musisi, Seggane; Augustinavicius, Jura; Greene, M Claire; Alderman, Steve; Tol, Wietse A

2016-03-15

In 2013, the World Health Organization (WHO) published new guidelines for the management of conditions specifically related to stress, including symptoms of acute stress, bereavement, and post-traumatic stress disorder (PTSD). It is important to evaluate potential challenges for the implementation of these guidelines in low-resource settings, however, there is a dearth of research in this area. The current qualitative study aimed to assess perspectives on the feasibility and acceptability of the new guidelines in four clinics that provide mental health services in post-conflict northern Uganda. In-depth interviews were conducted with 19 mental health-care providers and program developers in northern Uganda to address three major research objectives: (1) describe the current standard practices and guidelines used for treating conditions related to stress in Uganda; (2) identify barriers and challenges associated with implementing the new WHO guidelines; and (3) identify and describe potential strategies for overcoming these barriers and challenges. An emergent thematic analysis was used to develop a coding scheme for the transcribed interviews. Practices for managing conditions related to stress included group psychological interventions, psychoeducation, and medication for clients with severe signs and symptoms. Several themes were identified from the interviews on barriers to guideline implementation. These included (1) a lack of trained and qualified mental health professionals to deliver WHO-recommended psychological interventions; (2) a perception that psychological interventions developed in high-income countries would not be culturally adaptable in Uganda; and (3) reluctance about blanket statements regarding medication for the management of acute stress symptoms and PTSD. Identified strategies for overcoming these barriers included (1) training and capacity building for current mental health staff; (2) a stepped care approach to mental health services; and (3) cultural modification of psychological interventions to improve treatment acceptability by clients. Guidelines were viewed positively by mental health professionals in Uganda, but barriers to implementation were expressed. Recommendations for implementation include (1) strengthening knowledge on effectiveness of existing cultural practices for improving mental health; (2) improving supervision capacity of current mental health staff to address shortage in human resources; and (3) increasing awareness of help-seeking clients on the potential effectiveness of psychological vs. pharmacological interventions.

Reflective practice: a framework for case manager development.

PubMed

Brubakken, Karen; Grant, Sara; Johnson, Mary K; Kollauf, Cynthia

2011-01-01

The role of a nurse case manager (NCM) incorporates practice that is built upon knowledge gained in other roles as well as components unique to case management. The concept of reflective practice was used in creating a framework to recognize the developmental stages that occur within community based case management practice. The formation of this framework and its uses are described in this article. The practice setting is a community based case management department in a large midwestern metropolitan health care system with Magnet recognition. Advanced practice nurses provide care for clients with chronic health conditions. Twenty-four narratives were used to identify behaviors of community based case managers and to distinguish stages of practice. The behaviors of advanced practice found within the narratives were labeled and analyzed for similarities. Related behaviors were grouped and descriptor statements were written. These statements grouped into 3 domains of practice: relationship/partnership, coordination/collaboration, and clinical knowledge/decision making. The statements in each domain showed practice variations from competent to expert, and 3 stages were determined. Reliability and validity of the framework involved analysis of additional narratives. The reflective practice process, used for monthly case review presentations, provides opportunity for professional development and group learning focused on improving case manager practice. The framework is also being used in orientation as new case managers acclimate to the role. Reflective writing has unveiled the richness and depth of nurse case manager practice. The depth of knowledge and skills involved in community-based case management is captured within this reflective practice framework. This framework provides a format for describing community based case manager practice development over the course of time and has been used as a tool for orientation and peer review.

A practice-based approach to the 2012 position statement of the American Diabetes Association and the European Association for the Study of Diabetes.

PubMed

Schwartz, Stanley S

2013-07-01

The position statement on the management of hyperglycemia in patients with type 2 diabetes mellitus issued in 2012 by the American Diabetes Association and the European Association for the Study of Diabetes contains significant improvements over the 2009 version, including an emphasis on patient-centered care, enhanced strategies for lifestyle modification, a focus on comprehensive cardiovascular risk reduction, and increased pharmacotherapy choices. As diabetes management evolves over time, further improvements may be made in future consensus statements, including a focus on prevention and early treatment and improved glycemic control in all patients, including those with comorbidities. These goals will be achievable by waning use of therapies known to cause hypoglycemia and weight gain and the increased use of therapies that do not carry these risks.

The management of ectodermal dysplasia and severe hypodontia. International conference statements.

PubMed

Hobkirk, J A; Nohl, F; Bergendal, B; Storhaug, K; Richter, M K

2006-09-01

An international conference on ectodermal dysplasias and hypodontia, held in London in 2004, featured a session devoted to the management of the ectodermal dysplasias and severe hypodontia. This paper presents a set of statements prepared by an international specialist panel, including representatives of patient support groups, who presented and subsequently debated a series of papers on this subject. The following topics were explored: potential roles of patient support groups; core care standards, including the roles and composition of medical and dental multidisciplinary teams for treating these conditions; the format of a baseline data set for patients with an ED; and priorities for research in ectodermal dysplasias, with particular regard to laboratory and clinical studies, and research methodology. The statements are intended to form an international framework for developing patient care pathways, and collaborative research in this field.

Risk Management in Cocurricular Activities.

ERIC Educational Resources Information Center

Webb, Edward M.

1988-01-01

Discusses risk management for colleges' cocurricular activities. Discusses tort liability, contributory negligence, and assumption of risk. Provides six concrete steps for managing risks responsibly and professionally: adopting an educational mission statement, assigning risk to others, establishing safety standards, training club advisors,…

75 FR 47059 - Notice To Rescind Notice of Intent To Prepare an Environmental Impact Statement: Warren County, IA

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-04

... Prepare an Environmental Impact Statement: Warren County, IA AGENCY: Federal Highway Administration (FHWA... Realty Manager, FHWA Iowa Division Office, 105 Sixth Street, Ames, IA 50010, Phone 515-233-7302; or James... Lincoln Way, Ames, IA 50010, Phone 515-239-1798. SUPPLEMENTARY INFORMATION: Electronic Access An...

75 FR 51478 - Notice of Availability of the Draft Supplemental Environmental Impact Statement for the Cortez...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-20

... amended, the Bureau of Land Management (BLM), Battle Mountain District, Mount Lewis Field Office, Battle Mountain, Nevada, has prepared a Draft Supplemental Environmental Impact Statement (EIS) for the Cortez... meetings in Crescent Valley and Battle Mountain, Nevada. The BLM will announce future meetings or hearings...

75 FR 41516 - Notice of Intent To Prepare a Supplemental Environmental Impact Statement for the Cortez Hills...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-16

..., the Bureau of Land Management (BLM), Battle Mountain District, Mount Lewis Field Office, Battle Mountain, Nevada, intends to prepare a Supplemental Environmental Impact Statement (EIS) for the Cortez... Cortez Hills Expansion Project are available at the BLM Battle Mountain District Office, 50 Bastian Road...

76 FR 2705 - Notice of Availability of the Final Supplemental Environmental Impact Statement for the Cortez...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-01-14

... amended, the Bureau of Land Management (BLM), Battle Mountain District, Mount Lewis Field Office, Battle Mountain, Nevada, has prepared a Final Supplemental Environmental Impact Statement (EIS) for the Cortez... Final Supplemental EIS are available for public inspection at the Battle Mountain District Office, 50...

78 FR 76864 - Wells Fargo Funds Trust, et al.; Notice of Application

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-19

... David P. Bartels, Branch Chief, at (202) 551-6821 (Division of Investment Management, Chief Counsel's... fees. 4. Regulation S-X sets forth the requirements for financial statements required to be included as... include in its financial statement information about the investment advisory fees. 5. Section 6(c) of the...

75 FR 5803 - Intent To Prepare an Environmental Impact Statement for the New Merced Wild and Scenic River...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-02-04

... DEPARTMENT OF THE INTERIOR National Park Service Intent To Prepare an Environmental Impact Statement for the New Merced Wild and Scenic River Comprehensive Management Plan Yosemite National Park, Mariposa and Madera Counties, CA ACTION: Notice of second extension of public scoping period. SUMMARY...

75 FR 18875 - Notice of Intent To Prepare an Environmental Impact Statement for the Proposed Dairy Syncline...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-13

...] DEPARTMENT OF AGRICULTURE Forest Service Notice of Intent To Prepare an Environmental Impact Statement for... Management, Interior; U.S. Forest Service, Agriculture. ACTION: Notice of Intent. SUMMARY: Notice is hereby... the U.S. Department of Agriculture, Forest Service (FS), Caribou-Targhee National Forest, will jointly...

77 FR 12004 - Stanislaus National Forest, CA; Notice of Intent To Prepare an Environmental Impact Statement for...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-02-28

... Prepare an Environmental Impact Statement for Candy Rock Quarry Management AGENCY: Forest Service, USDA... Forest proposes to set permanent limitations on recreational target shooting at Candy Rock Quarry near... an appropriate activity at Candy Rock Quarry in the context of safety, public health, and applicable...

77 FR 47358 - Withdrawal of Notice of Intent To Prepare an Environmental Impact Statement for Proposed...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-08

... of Notice of Intent To Prepare an Environmental Impact Statement for Proposed Amendment of Rogue... of land and resource management plans (LRMP) of the Rogue River, Umpqua and Winema National Forests... and operate a natural gas pipeline that crosses the Rogue River, Umpqua and Winema National Forests...

76 FR 50500 - Request for Comments on the Draft Policy Statement on Volume Reduction and Low-Level Radioactive...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-15

... NUCLEAR REGULATORY COMMISSION [NRC-2011-0183] Request for Comments on the Draft Policy Statement on Volume Reduction and Low-Level Radioactive Waste Management AGENCY: Nuclear Regulatory Commission. ACTION: Request for public comment. SUMMARY: The U.S. Nuclear Regulatory Commission (NRC) is revising its...

78 FR 65962 - Revision of the Land Management Plan for the Flathead National Forest

Federal Register 2010, 2011, 2012, 2013, 2014

2013-11-04

... over time. Under the 2012 Planning Rule, the assessment of ecological, social, and economic trends and... environmental impact statement and revised Forest Plan for public review and comment, and the preparation of the final environmental impact statement and revised Forest Plan. The third stage of the process is...

DOD Financial Management: Weaknesses in Controls over the Use of Public Funds and Related Improper Payments

DTIC Science & Technology

2011-09-22

achieved: (1) effectiveness and efficiency of operations; (2) reliability of financial reporting ; and (3) compliance with laws and regulations. Within... financial reporting .7 Auditors of DOD s financial statements are to assess the effectiveness of these controls as part of the financial statement audit

78 FR 19444 - Pawnee National Grassland, Colorado; Oil and Gas Leasing Analysis Environmental Impact Statement

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-01

... horizontal drilling and hydraulic fracturing technologies to improve the ability to access and recover oil... National Grassland, Colorado; Oil and Gas Leasing Analysis Environmental Impact Statement AGENCY: Forest... (ROD) for the Revision of the Land and Resource Management Plan (LRMP), which included the Oil and Gas...

75 FR 8105 - Notice of Availability of the Draft Environmental Impact Statement/Staff Assessment for the...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-02-23

... DEPARTMENT OF THE INTERIOR Bureau of Land Management [CACA 47740, LLCAD07000, L51030000.FX0000, LVRAB109AA01] Notice of Availability of the Draft Environmental Impact Statement/Staff Assessment for the Stirling Energy Systems Solar Two Project and Possible California Desert Conservation Area Plan Amendment...

[Position statement: surgery and diabetes mellitus].

PubMed

Fasching, Peter; Huber, Joakim; Clodi, Martin; Abrahamian, Heidemarie; Ludvik, Bernhard

2016-04-01

This position statement reflects the opinion of the Austrian Diabetes Association concerning the perioperative management of patients with diabetes mellitus based on the available scientific evidence. The paper covers necessary preoperative examinations from an internal/diabetological point of view as well as the perioperative metabolic control by means of oral antidiabetics and/or insulin therapy.

[Position statement: Surgery and diabetes mellitus].

PubMed

Fasching, Peter; Huber, Joakim; Clodi, Martin; Abrahamian, Heidemarie; Ludvik, Bernhard

2012-12-01

This position statement reflects the opinion of the Austrian Diabetes Association concerning the perioperative management of patients with diabetes mellitus based on the available scientific evidence. The paper covers necessary preoperative examinations from an internal/diabetological point of view as well as the perioperative metabolic control by means of oral antidiabetics and/or insulin therapy.

2012 National Guard Bureau Posture Statement

DTIC Science & Technology

2012-01-01

Illinois / Poland Indiana / Slovakia Kansas / Armenia Maine/ Montenegro Maryland / Estonia Maryland / Bosnia Michigan / Latvia Minnesota / Croatia New Jersey...alternative methods of planting to help increase crop production in the area. 2012 Posture Statement 19 Global Engagement State Partnership...horticulture ( plant cultivation), pest control, veterinary/animal husbandry techniques, civil engineering, and energy management. As a result of the

The Statement that Some Ochratoxins are “..classified as human carcinogens” is Not Accurate

USDA-ARS?s Scientific Manuscript database

To the Editor, We are writing in response to a statement made in the recent “Editor’s Highlights” of the paper on ochratoxin and the microbiome (Toxicological Sciences, 141(1), 2014, 1). Ochratoxins, like the other agriculturally-important mycotoxins, are natural contaminants and must be managed o...

29 CFR 451.1 - Introductory statement.

Code of Federal Regulations, 2010 CFR

2010-07-01

... provisions of the Act with “a practical guide * * * as to how the office representing the public interest in....1 Introductory statement. (a) This part discusses the meaning and scope of sections 3(i) and 3(j) of..., nor to section 505 of title V, which amends section 302 (a), (b), and (c) of the Labor Management...

14 CFR 1216.308 - Preparation of draft statements.

Code of Federal Regulations, 2012 CFR

2012-01-01

... submit the draft statement and any attachments to the Associate Administrator for Management for NASA review prior to any formal review outside NASA. This submission shall be accompanied by a list of Federal... parties (40 CFR 1506.6 of the CEQ Regulations) from whom comments should be requested. (b) After the NASA...

78 FR 36164 - Tongass National Forest; Ketchikan-Misty Fiords Ranger District; Alaska; Saddle Lakes Timber Sale...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-17

... District; Alaska; Saddle Lakes Timber Sale Environmental Impact Statement AGENCY: Forest Service, USDA... Notice of Intent (NOI) to prepare an Environmental Impact Statement for the Saddle Lakes Timber Sale... management plans documented with a Record of Decision or Decision Notice (reference 36 CFR part 218). This...

Making Mission Statements Operational: Perceptions of Principals from Tri-Association Schools

ERIC Educational Resources Information Center

Fayad, Juan David; Yoshida, Roland K.

2014-01-01

Researchers and theorists in the management and educational leadership fields have debated the importance of mission statements. This study investigated this issue within the context of American schools that are members of the Tri-Association (Mexico, Central America, Colombia, and the Caribbean). The results showed that about the same percentage…

Risk factors.

PubMed

Robbins, Catherine J; Connors, K C; Sheehan, Timothy J; Vaughan, James S

2005-06-01

Minimize surprises on your financial statement by adopting a model for integrated risk management that: Examines interrelationships among operations, investments, and financing. Incorporates concepts of the capital asset pricing model to manage unexpected volatility

40 CFR 273.32 - Notification.

Code of Federal Regulations, 2012 CFR

2012-07-01

... universal waste management activities; (4) A list of all the types of universal waste managed by the handler (e.g., batteries, pesticides, mercury-containing equipment, and lamps); and (5) A statement...

40 CFR 273.32 - Notification.

Code of Federal Regulations, 2014 CFR

2014-07-01

... universal waste management activities; (4) A list of all the types of universal waste managed by the handler (e.g., batteries, pesticides, mercury-containing equipment, and lamps); and (5) A statement...

40 CFR 273.32 - Notification.

Code of Federal Regulations, 2013 CFR

2013-07-01

... universal waste management activities; (4) A list of all the types of universal waste managed by the handler (e.g., batteries, pesticides, mercury-containing equipment, and lamps); and (5) A statement...

40 CFR 273.32 - Notification.

Code of Federal Regulations, 2010 CFR

2010-07-01

... universal waste management activities; (4) A list of all the types of universal waste managed by the handler (e.g., batteries, pesticides, mercury-containing equipment, and lamps); and (5) A statement...