On the possibility of a place code for the low pitch of high-frequency complex tonesa

PubMed Central

Santurette, Sébastien; Dau, Torsten; Oxenham, Andrew J.

2012-01-01

Harmonics are considered unresolved when they interact with neighboring harmonics and cannot be heard out separately. Several studies have suggested that the pitch derived from unresolved harmonics is coded via temporal fine-structure cues emerging from their peripheral interactions. Such conclusions rely on the assumption that the components of complex tones with harmonic ranks down to at least 9 were indeed unresolved. The present study tested this assumption via three different measures: (1) the effects of relative component phase on pitch matches, (2) the effects of dichotic presentation on pitch matches, and (3) listeners' ability to hear out the individual components. No effects of relative component phase or dichotic presentation on pitch matches were found in the tested conditions. Large individual differences were found in listeners' ability to hear out individual components. Overall, the results are consistent with the coding of individual harmonic frequencies, based on the tonotopic activity pattern or phase locking to individual harmonics, rather than with temporal coding of single-channel interactions. However, they are also consistent with more general temporal theories of pitch involving the across-channel summation of information from resolved and/or unresolved harmonics. Simulations of auditory-nerve responses to the stimuli suggest potential benefits to a spatiotemporal mechanism. PMID:23231119

[Transanal total mesorectal excision for rectal cancer - just a fashion trend?].

PubMed

Kala, Z; Skrovina, M; Procházka, V; Grolich, T; Klos, K

2014-12-01

Transanal total mesorectal excision performed using equipment for transanal minimally invasive surgery is an innovative surgical technique introduced to facilitate this procedure and to reach better oncosurgical outcomes in patients with low rectal cancer. This article presents a brief summary of guidelines for treatment of patients with low rectal carcinoma. Up-to-date information about the principles of this new method, its modifications and contemporary indications is presented. Based on their own experience and literature resources, the authors inform about the advantages, limitations and unresolved issues of minimally invasive transanal mesorectal excision.

Satellite power system concept development and evaluation program. Volume 2: System definition

NASA Technical Reports Server (NTRS)

1981-01-01

The system level results of the system definition studies performed by NASA as a part of the Department of Energy/NASA satellite power system concept development and evaluation program are summarized. System requirements and guidelines are discussed as well as the major elements that comprise the reference system and its design options. Alternative system approaches including different system sizes, solid state amplifier (microwave) concepts, and laser power transmission system cost summaries are reviewed. An overview of the system analysis and planning efforts is included. The overall study led to the conclusion that the reference satellite power system concept is a feasible baseload source of electrical power and, within the assumed guidelines, the minimum cost per kilowatt is achieved at the maximum output of 5 gigawatts to the utility grid. Major unresolved technical issues include maximum allowable microwave power density in the ionosphere and performance/mass characteristics of laser power transmission systems.

Ensemble Kalman filters for dynamical systems with unresolved turbulence

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

Grooms, Ian, E-mail: grooms@cims.nyu.edu; Lee, Yoonsang; Majda, Andrew J.

Ensemble Kalman filters are developed for turbulent dynamical systems where the forecast model does not resolve all the active scales of motion. Coarse-resolution models are intended to predict the large-scale part of the true dynamics, but observations invariably include contributions from both the resolved large scales and the unresolved small scales. The error due to the contribution of unresolved scales to the observations, called ‘representation’ or ‘representativeness’ error, is often included as part of the observation error, in addition to the raw measurement error, when estimating the large-scale part of the system. It is here shown how stochastic superparameterization (amore » multiscale method for subgridscale parameterization) can be used to provide estimates of the statistics of the unresolved scales. In addition, a new framework is developed wherein small-scale statistics can be used to estimate both the resolved and unresolved components of the solution. The one-dimensional test problem from dispersive wave turbulence used here is computationally tractable yet is particularly difficult for filtering because of the non-Gaussian extreme event statistics and substantial small scale turbulence: a shallow energy spectrum proportional to k{sup −5/6} (where k is the wavenumber) results in two-thirds of the climatological variance being carried by the unresolved small scales. Because the unresolved scales contain so much energy, filters that ignore the representation error fail utterly to provide meaningful estimates of the system state. Inclusion of a time-independent climatological estimate of the representation error in a standard framework leads to inaccurate estimates of the large-scale part of the signal; accurate estimates of the large scales are only achieved by using stochastic superparameterization to provide evolving, large-scale dependent predictions of the small-scale statistics. Again, because the unresolved scales contain so much energy, even an accurate estimate of the large-scale part of the system does not provide an accurate estimate of the true state. By providing simultaneous estimates of both the large- and small-scale parts of the solution, the new framework is able to provide accurate estimates of the true system state.« less

Detecting unresolved binary stars in Euclid VIS images

NASA Astrophysics Data System (ADS)

Kuntzer, T.; Courbin, F.

2017-10-01

Measuring a weak gravitational lensing signal to the level required by the next generation of space-based surveys demands exquisite reconstruction of the point-spread function (PSF). However, unresolved binary stars can significantly distort the PSF shape. In an effort to mitigate this bias, we aim at detecting unresolved binaries in realistic Euclid stellar populations. We tested methods in numerical experiments where (I) the PSF shape is known to Euclid requirements across the field of view; and (II) the PSF shape is unknown. We drew simulated catalogues of PSF shapes for this proof-of-concept paper. Following the Euclid survey plan, the objects were observed four times. We propose three methods to detect unresolved binary stars. The detection is based on the systematic and correlated biases between exposures of the same object. One method is a simple correlation analysis, while the two others use supervised machine-learning algorithms (random forest and artificial neural network). In both experiments, we demonstrate the ability of our methods to detect unresolved binary stars in simulated catalogues. The performance depends on the level of prior knowledge of the PSF shape and the shape measurement errors. Good detection performances are observed in both experiments. Full complexity, in terms of the images and the survey design, is not included, but key aspects of a more mature pipeline are discussed. Finding unresolved binaries in objects used for PSF reconstruction increases the quality of the PSF determination at arbitrary positions. We show, using different approaches, that we are able to detect at least binary stars that are most damaging for the PSF reconstruction process. The code corresponding to the algorithms used in this work and all scripts to reproduce the results are publicly available from a GitHub repository accessible via http://lastro.epfl.ch/software

Treating Unresolved Grief and Posttraumatic Stress Symptoms in Orphaned Children in Tanzania: Group-based Trauma-focused Cognitive Behavioral Therapy

PubMed Central

O’Donnell, Karen; Dorsey, Shannon; Gong, Wenfeng; Ostermann, Jan; Whetten, Rachel; Cohen, Judith A.; Itemba, Dafrosa; Manongi, Rachel; Whetten, Kathryn

2015-01-01

The study was designed to test the feasibility and child clinical outcomes for a group-based application of Trauma-focused Cognitive Behavior Therapy (TF-CBT) for orphaned children with unresolved grief in Moshi, Tanzania. Sixty-four orphaned children with at least mild symptoms of unresolved grief and/or traumatic stress and their guardians participated in the open trial. The evidence-based TF-CBT protocol was adapted for group delivery, resulting in 12 weekly sessions for child and guardians separately with conjoint activities and three individual visits. Using a task-sharing approach, the intervention was delivered by lay counselors with no prior mental health experience. Primary outcomes assessed were symptoms of unresolved grief and posttraumatic stress (PTS); secondary outcomes included symptoms of depression and overall behavioral adjustment. All assessments were conducted pre-treatment, post-treatment, and 3- and 12-months after the end of treatment. Results showed improved scores on all outcomes post-treatment, sustained at 3 and 12 months. Effect sizes (Cohen’s d) for baseline to post-treatment were 1.36 for child reported grief symptoms; 1.87 for child-reported PTS, and 1.15 for caregiver report of child PTS. PMID:25418514

Waiting for Brandon: How Readers Respond to Small Mysteries

PubMed Central

Gerrig, Richard J.; Love, Jessica; McKoon, Gail

2009-01-01

When readers experience narratives they often encounter small mysteries—questions that a text raises that are not immediately settled. In our experiments, participants read stories that introduced characters by proper names (e.g., “It’s just that Brandon hasn’t called in so long”). Resolved versions of the stories specified the functions those characters’ assumed in their narrative worlds with respect to the other characters (e.g., Brandon was identified as the speaker’s grandson); unresolved versions of the stories did not immediately provide that information. We predicted that characters whose functions were still unresolved would remain relatively accessible in the discourse representations. We tested that prediction in Experiments 1 and 2 by asking participants to indicate whether a name (e.g., Brandon) had appeared in the story. Participants responded most swiftly when the characters remained unresolved. In the latter experiments, we demonstrated that the presence of an unresolved character disrupted processing of information that followed that character’s introduction (Experiment 3) but not information that preceded that introduction (Experiment 4). These results support the general importance of providing a theoretical account of readers’ responses to narrative mysteries. PMID:20046984

Lipaemic donations: truth and consequences.

PubMed

Lippi, Giuseppe; Franchini, Massimo

2013-10-01

The problem of using material of unsuitable quality, including "nontransparent turbid milky plasma" or more simply "turbid plasma", for producing blood components is not trivial for several epidemiological, technical, analytical, clinical and economical reasons. With some exception, most national and international guidelines mandate that blood components should preferably not be produced from lipaemic donations. The origin of lipaemic blood is variegated, and includes physiological or paraphysiological causes and metabolic disorders, whereas a broad range of common diseases and drugs can also be associated with hypertriglyceridaemia. Overall, the frequency of lipaemic donations ranges between 0.31% and 0.35%, although sporadic reports have highlighted that the frequency might be much higher, up to 13%. Lipaemic donations pose two leading problems in transfusion medicine, that are interference during laboratory testing, and safety of producing blood components from hypertriglyceridaemic materials. While the former issue can be overcome by using chemical or mechanical methods, the clinical use of lipaemic blood for producing components remains an unresolved question. Transfusion medicine should thereby embark on a landmark effort to find a universal agreement of behaviours and harmonization of policies worldwide. Copyright © 2012 Elsevier Ltd. All rights reserved.

Social Media Channels in Health Care Research and Rising Ethical Issues.

PubMed

Azer, Samy A

2017-11-01

Social media channels such as Twitter, Facebook, and LinkedIn have been used as tools in health care research, opening new horizons for research on health-related topics (e.g., the use of mobile social networking in weight loss programs). While there have been efforts to develop ethical guidelines for internet-related research, researchers still face unresolved ethical challenges. This article investigates some of the risks inherent in social media research and discusses how researchers should handle challenges related to confidentiality, privacy, and consent when social media tools are used in health-related research. © 2017 American Medical Association. All Rights Reserved.

Unresolved issues in the management of chronic stable angina.

PubMed

Camm, A John; Manolis, Athanasios; Ambrosio, Giuseppe; Daly, Caroline; Komajda, Michel; Lopez de Sa, Esteban; Lopez-Sendon, Jose Luis; Mugelli, Alessandro; Muggli, Franco; Tamargo, Juan

2015-12-15

Chronic stable angina is a common and progressive disease which has a major impact on patient quality of life and imposes a high financial and medical burden on society. Given the range of agents now available, optimal medical therapy - which according to guidelines is the preferred option in the majority of patients with low-risk disease - offers the opportunity for effective control. However, recent studies suggest that management remains suboptimal in up to a third of patients and that physicians often underestimate the extent to which angina continues to limit patients' lives. A higher frequency of angina also relates directly to increased healthcare costs. These factors suggest the need for the development and implementation of appropriate guidelines, for tools to encourage the regular, systematic assessment of the management of chronic stable angina patients, and for improved means of communication between doctors and patients. Neither physicians nor their patients need to accept that a certain level of angina symptoms is unavoidable. Copyright © 2015. Published by Elsevier Ireland Ltd.

ISSUES IN DEVELOPING A TWO-GENERATION AVIAN TOXICITY TEST WITH JAPANESE QUAIL

EPA Science Inventory

As a subgroup of the OECD Expert Group on Assessment of Endocrine Disrupting Effects in Birds, we reviewed unresolved methodological issures important for the development of a two-generation toxicity test, discussed advantages and disadvantages of alternative approaches, and prop...

Unresolved mourning, supernatural beliefs and dissociation: a mediation analysis.

PubMed

Thomson, Paula; Jaque, S Victoria

2014-01-01

Unresolved mourning is marked by disorganized behavior and states of mind. In this study, we speculated that pathological dissociation would mediate the effects of unresolved mourning on supernatural beliefs. This hypothesis was determined based on findings that indicate an association between higher levels of dissociation, stronger beliefs in the supernatural and unresolved mourning. We examined two groups of participants, one classified as non-unresolved (non-U) (n = 56) and the other as unresolved (n = 26) (U) with respect to past loss/trauma as measured by the Adult Attachment Interview (AAI). Two self-report instruments were administered to measure supernatural beliefs and dissociation. As hypothesized, the multivariate analysis of variance indicated mean differences between the two groups. The unresolved group had greater belief in the supernatural and more pathological dissociative processes. The mediation analysis demonstrated that pathological dissociation fully mediated the effects of unresolved mourning on supernatural beliefs.

Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update).

PubMed

Bhattacharyya, Neil; Gubbels, Samuel P; Schwartz, Seth R; Edlow, Jonathan A; El-Kashlan, Hussam; Fife, Terry; Holmberg, Janene M; Mahoney, Kathryn; Hollingsworth, Deena B; Roberts, Richard; Seidman, Michael D; Steiner, Robert W Prasaad; Do, Betty Tsai; Voelker, Courtney C J; Waguespack, Richard W; Corrigan, Maureen D

2017-03-01

Objective This update of a 2008 guideline from the American Academy of Otolaryngology-Head and Neck Surgery Foundation provides evidence-based recommendations to benign paroxysmal positional vertigo (BPPV), defined as a disorder of the inner ear characterized by repeated episodes of positional vertigo. Changes from the prior guideline include a consumer advocate added to the update group; new evidence from 2 clinical practice guidelines, 20 systematic reviews, and 27 randomized controlled trials; enhanced emphasis on patient education and shared decision making; a new algorithm to clarify action statement relationships; and new and expanded recommendations for the diagnosis and management of BPPV. Purpose The primary purposes of this guideline are to improve the quality of care and outcomes for BPPV by improving the accurate and efficient diagnosis of BPPV, reducing the inappropriate use of vestibular suppressant medications, decreasing the inappropriate use of ancillary testing such as radiographic imaging, and increasing the use of appropriate therapeutic repositioning maneuvers. The guideline is intended for all clinicians who are likely to diagnose and manage patients with BPPV, and it applies to any setting in which BPPV would be identified, monitored, or managed. The target patient for the guideline is aged ≥18 years with a suspected or potential diagnosis of BPPV. The primary outcome considered in this guideline is the resolution of the symptoms associated with BPPV. Secondary outcomes considered include an increased rate of accurate diagnoses of BPPV, a more efficient return to regular activities and work, decreased use of inappropriate medications and unnecessary diagnostic tests, reduction in recurrence of BPPV, and reduction in adverse events associated with undiagnosed or untreated BPPV. Other outcomes considered include minimizing costs in the diagnosis and treatment of BPPV, minimizing potentially unnecessary return physician visits, and maximizing the health-related quality of life of individuals afflicted with BPPV. Action Statements The update group made strong recommendations that clinicians should (1) diagnose posterior semicircular canal BPPV when vertigo associated with torsional, upbeating nystagmus is provoked by the Dix-Hallpike maneuver, performed by bringing the patient from an upright to supine position with the head turned 45° to one side and neck extended 20° with the affected ear down, and (2) treat, or refer to a clinician who can treat, patients with posterior canal BPPV with a canalith repositioning procedure. The update group made a strong recommendation against postprocedural postural restrictions after canalith repositioning procedure for posterior canal BPPV. The update group made recommendations that the clinician should (1) perform, or refer to a clinician who can perform, a supine roll test to assess for lateral semicircular canal BPPV if the patient has a history compatible with BPPV and the Dix-Hallpike test exhibits horizontal or no nystagmus; (2) differentiate, or refer to a clinician who can differentiate, BPPV from other causes of imbalance, dizziness, and vertigo; (3) assess patients with BPPV for factors that modify management, including impaired mobility or balance, central nervous system disorders, a lack of home support, and/or increased risk for falling; (4) reassess patients within 1 month after an initial period of observation or treatment to document resolution or persistence of symptoms; (5) evaluate, or refer to a clinician who can evaluate, patients with persistent symptoms for unresolved BPPV and/or underlying peripheral vestibular or central nervous system disorders; and (6) educate patients regarding the impact of BPPV on their safety, the potential for disease recurrence, and the importance of follow-up. The update group made recommendations against (1) radiographic imaging for a patient who meets diagnostic criteria for BPPV in the absence of additional signs and/or symptoms inconsistent with BPPV that warrant imaging, (2) vestibular testing for a patient who meets diagnostic criteria for BPPV in the absence of additional vestibular signs and/or symptoms inconsistent with BPPV that warrant testing, and (3) routinely treating BPPV with vestibular suppressant medications such as antihistamines and/or benzodiazepines. The guideline update group provided the options that clinicians may offer (1) observation with follow-up as initial management for patients with BPPV and (2) vestibular rehabilitation, either self-administered or with a clinician, in the treatment of BPPV.

Dynamic interpretation of slug tests in highly permeable aquifers

USGS Publications Warehouse

Zurbuchen, Brian R.; Zlotnik, Vitaly A.; Butler, James J.

2002-01-01

Considerable progress has been made in developing a theoretical framework for modeling slug test responses in formations with high hydraulic conductivity K. However, several questions of practical significance remain unresolved. Given the rapid and often oscillatory nature of test responses, the traditional hydrostatic relationship between the water level and the transducer‐measured head in the water column may not be appropriate. A general dynamic interpretation is proposed that describes the relationship between water level response and transducer‐measured head. This theory is utilized to develop a procedure for transforming model‐generated water level responses to transducer readings. The magnitude of the difference between the actual water level position and the apparent position based on the transducer measurement is a function of the acceleration and velocity of the water column, test geometry, and depth of the transducer. The dynamic approach explains the entire slug test response, including the often‐noted discrepancy between the actual initial water level displacement and that measured by a transducer in the water column. Failure to use this approach can lead to a significant underestimation of K when the transducer is a considerable distance below the static water level. Previous investigators have noted a dependence of test responses on the magnitude of the initial water level displacement and have developed various approximate methods for analyzing such data. These methods are re‐examined and their limitations clarified. Practical field guidelines are proposed on the basis of findings of this work. The soundness of the dynamic approach is demonstrated through a comparison of K profiles from a series of multilevel slug tests with those from dipole‐flow tests performed in the same wells.

The Construct Validity of HPAT-Ireland for the Selection of Medical Students: Unresolved Issues and Future Research Implications

ERIC Educational Resources Information Center

Kelly, Maureen E.; O'Flynn, Siun

2017-01-01

Aptitude tests are widely used in selection. However, despite certain advantages their use remains controversial. This paper aims to critically appraise five sources of evidence for the construct validity of the Health Professions Admission Test (HPAT)-Ireland, an aptitude test used for selecting undergraduate medical students. The objectives are…

Analyzing γ rays of the Galactic Center with deep learning

NASA Astrophysics Data System (ADS)

Caron, Sascha; Gómez-Vargas, Germán A.; Hendriks, Luc; Ruiz de Austri, Roberto

2018-05-01

We present the application of convolutional neural networks to a particular problem in gamma ray astronomy. Explicitly, we use this method to investigate the origin of an excess emission of GeV γ rays in the direction of the Galactic Center, reported by several groups by analyzing Fermi-LAT data. Interpretations of this excess include γ rays created by the annihilation of dark matter particles and γ rays originating from a collection of unresolved point sources, such as millisecond pulsars. We train and test convolutional neural networks with simulated Fermi-LAT images based on point and diffuse emission models of the Galactic Center tuned to measured γ ray data. Our new method allows precise measurements of the contribution and properties of an unresolved population of γ ray point sources in the interstellar diffuse emission model. The current model predicts the fraction of unresolved point sources with an error of up to 10% and this is expected to decrease with future work.

Calcium in the prevention of postmenopausal osteoporosis: EMAS clinical guide.

PubMed

Cano, Antonio; Chedraui, Peter; Goulis, Dimitrios G; Lopes, Patrice; Mishra, Gita; Mueck, Alfred; Senturk, Levent M; Simoncini, Tommaso; Stevenson, John C; Stute, Petra; Tuomikoski, Pauliina; Rees, Margaret; Lambrinoudaki, Irene

2018-01-01

Postmenopausal osteoporosis is a highly prevalent disease. Prevention through lifestyle measures includes an adequate calcium intake. Despite the guidance provided by scientific societies and governmental bodies worldwide, many issues remain unresolved. To provide evidence regarding the impact of calcium intake on the prevention of postmenopausal osteoporosis and critically appraise current guidelines. Literature review and consensus of expert opinion. The recommended daily intake of calcium varies between 700 and 1200mg of elemental calcium, depending on the endorsing source. Although calcium can be derived either from the diet or supplements, the former source is preferred. Intake below the recommended amount may increase fragility fracture risk; however, there is no consistent evidence that calcium supplementation at, or above, recommended levels reduces risk. The addition of vitamin D may minimally reduce fractures, mainly among institutionalised people. Excessive intake of calcium, defined as higher than 2000mg/day, can be potentially harmful. Some studies demonstrated harm even at lower dosages. An increased risk for cardiovascular events, urolithiasis and even fractures has been found in association with excessive calcium intake, but this issue remains unresolved. In conclusion, an adequate intake of calcium is recommended for general bone health. Excessive calcium intake seems of no benefit, and could possibly be harmful. Copyright © 2017 Elsevier B.V. All rights reserved.

A Decade of e-Cigarettes: Limited Research & Unresolved Safety Concerns

PubMed Central

Kaisar, Mohammad Abul; Prasad, Shikha; Liles, Tylor; Cucullo, Luca

2016-01-01

It is well known that tobacco consumption is a leading cause of preventable deaths worldwide and has been linked to major diseases ranging from cancer to chronic obstructive pulmonary disease, atherosclerosis, stroke and a host of neurological/neurodegenerative disorders. In the past decade a number of alternative vaping products have hit the market, rapidly gaining consumers especially among the younger population. Electronic nicotine delivery systems or e-cigarettes have become the sought-after product due to the belief that they are much safer than traditional cigarettes. However, inadequate research and lack of regulatory guidelines for both the manufacturing process and the content of the vaping solution of the e-cigarette has become a major concern. Highly debated and unresolved questions such as whether e-cigarettes may help smokers quit and whether e-cigarettes will promote the use of nicotine among non-smokers add to the confusion of the safety of e-cigarettes. In this review article, we summarize the current understanding (and lack thereof) of the potential health impacts of e-cigarettes. We will also highlight the most recent studies (in vivo/in vitro) which seem to conflict with the broad safety claims put forward by the manufacturers. Finally, we provide potential solutions to overcome the research gap of the short and long-term health impact of e-cigarettes. PMID:27477296

Investigating the role of future thinking in social problem solving.

PubMed

Noreen, Saima; Whyte, Katherine E; Dritschel, Barbara

2015-03-01

There is well-established evidence that both rumination and depressed mood negatively impact the ability to solve social problems. A preliminary stage of the social problem solving process may be the process of catapulting oneself forward in time to think about the consequences of a problem before attempting to solve it. The aim of the present study was to examine how thinking about the consequences of a social problem being resolved or unresolved prior to solving it influences the solution of the problem as a function of levels of rumination and dysphoric mood. Eighty six participants initially completed the Beck Depression Inventory- II (BDI-II) and the Ruminative Response Scale (RRS). They were then presented with six social problems and generated consequences for half of the problems being resolved and half of the problems remaining unresolved. Participants then solved some of the problems, and following a delay, were asked to recall all of the consequences previously generated. Participants reporting higher levels of depressed mood and rumination were less effective at generating problem solutions. Specifically, those reporting higher levels of rumination produced less effective solutions for social problems that they had previously generated unresolved than resolved consequences. We also found that individuals higher in rumination, irrespective of depressed mood recalled more of the unresolved consequences in a subsequent memory test. As participants did not solve problems for scenarios where no consequences were generated, no baseline measure of problem solving was obtained. Our results suggest thinking about the consequences of a problem remaining unresolved may impair the generation of effective solutions in individuals with higher levels of rumination. Copyright © 2014 Elsevier Ltd. All rights reserved.

Critical evaluation of measured line positions of 14N16O in X2П state

NASA Astrophysics Data System (ADS)

Sulakshina, O. N.; Borkov, Yu. G.

2018-04-01

All available line positions for unresolved and resolved Λ-doublets of the 14N16O molecule in the X2 П state were collected from the literature and tested using the RITZ computer code. These data have been critically analysed and used to obtain the most complete set of 1789 experimental energy levels of unresolved Λ-doublets covering the 0-35,866 cm-1 interval. A set of 425 experimental energy levels of resolved Λ-doublets covering the 0-5957 cm-1 interval for two states 2П1/2 and 2П3/2 also have been obtained. These levels together with calculated correlation matrix can be used to generate the precise list of transitions with confidence intervals. Comparisons with the HITRAN as well as with Amiot calculations are discussed. The systematic shift between experimental energy levels of unresolved Λ-doublets and those calculated by Amiot for 2П3/2 state was found. The same systematic shift for transitions frequencies of unresolved Λ-doublets in forbidden subbands 2П1/2↔2П3/2 is also established in the HITRAN database. Comparison of the RITZ energy levels with calculated energy levels by Wong at al. was also done. It was found, that experimental RITZ energy levels for resolved Λ-doublets of 14N16O coincide with those calculated by Wong at al. within experimental uncertainties.

Learning How They Learn: A Review of the Literature on Learning Styles.

ERIC Educational Resources Information Center

Wilson, Vicki A.

The literature on learning styles is full of unresolved issues, both theoretical and practical. Early research into learning styles includes that of H. A. Witkin, who developed the Embedded Figures Test in the late 1960s. This test determines the "field dependence" or "field independence" of individuals, marking their global…

House Dust Mite Respiratory Allergy: An Overview of Current Therapeutic Strategies.

PubMed

Calderón, Moisés A; Kleine-Tebbe, Jörg; Linneberg, Allan; De Blay, Frédéric; Hernandez Fernandez de Rojas, Dolores; Virchow, Johann Christian; Demoly, Pascal

2015-01-01

Although house dust mite (HDM) allergy is a major cause of respiratory allergic disease, specific diagnosis and effective treatment both present unresolved challenges. Guidelines for the treatment of allergic rhinitis and asthma are well supported in the literature, but specific evidence on the efficacy of pharmacotherapy treatment for known HDM-allergic patients is weaker. The standard diagnostic techniques--skin prick test and specific IgE testing--can be confounded by cross-reactivity. However, component-resolved diagnosis using purified and recombinant allergens can improve the accuracy of specific IgE testing, but availability is limited. Treatment options for HDM allergy are limited and include HDM avoidance, which is widely recommended as a strategy, although evidence for its efficacy is variable. Clinical efficacy of pharmacotherapy is well documented; however, symptom relief does not extend beyond the end of treatment. Finally, allergen immunotherapy has a poor but improving evidence base (notably on sublingual tablets) and its benefits last after treatment ends. This review identifies needs for deeper physician knowledge on the extent and impact of HDM allergy in respiratory disease, as well as further development and improved access to molecular allergy diagnosis. Furthermore, there is a need for the development of better-designed clinical trials to explore the utility of allergen-specific approaches, and uptake of data into guidance for physicians on more effective diagnosis and therapy of HDM respiratory allergy in practice. Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.

Expanding Horizons and Unresolved Conundrums: Language Testing and Assessment

ERIC Educational Resources Information Center

Leung, Constant; Lewkowicz, Jo

2006-01-01

Since the last "TESOL Quarterly" commemorative issue 15 years ago, there have been too many important developments in language testing and assessment for all of them to be discussed in a single article. Therefore, this article focuses on issues that we believe are integrally linked to pedagogic and curriculum concerns of English language teaching.…

A decade of e-cigarettes: Limited research & unresolved safety concerns.

PubMed

Kaisar, Mohammad Abul; Prasad, Shikha; Liles, Tylor; Cucullo, Luca

2016-07-15

It is well known that tobacco consumption is a leading cause of preventable deaths worldwide and has been linked to major diseases ranging from cancer to chronic obstructive pulmonary disease, atherosclerosis, stroke and a host of neurological/neurodegenerative disorders. In the past decade a number of alternative vaping products have hit the market, rapidly gaining consumers especially among the younger population. Electronic nicotine delivery systems or e-cigarettes have become the sought-after product due to the belief that they are much safer than traditional cigarettes. However, inadequate research and lack of regulatory guidelines for both the manufacturing process and the content of the vaping solution of the e-cigarette has become a major concern. Highly debated and unresolved questions such as whether e-cigarettes may help smokers quit and whether e-cigarettes will promote the use of nicotine among non-smokers add to the confusion of the safety of e-cigarettes. In this review article, we summarize the current understanding (and lack thereof) of the potential health impacts of e-cigarettes. We will also highlight the most recent studies (in vivo/in vitro) which seem to conflict with the broad safety claims put forward by the manufacturers. Finally, we provide potential solutions to overcome the research gap of the short and long-term health impact of e-cigarettes. Published by Elsevier Ireland Ltd.

Infection prevention and control of Clostridium difficile: a global review of guidelines, strategies, and recommendations

PubMed Central

Balsells, Evelyn; Filipescu, Teodora; Kyaw, Moe H.; Wiuff, Camilla; Campbell, Harry; Nair, Harish

2016-01-01

Background Clostridium difficile is the leading cause of health care–associated infections. Given the high incidence of C. difficile infection (CDI) and the lack of primary prevention through immunization, health care professionals should be aware of the most current guidance, as well as strengths and limitations of the evidence base underpinning this guidance. Methods We identified publicly available national or organizational guidelines related to CDI infection and prevention control (IPC) published between 2000 and 2015 and for any health care setting through an internet search using the Google search engine. We reviewed CDI–targeted IPC recommendations and describe the assessment of evidence in available guidelines. Results We identified documents from 28 countries/territories, mainly from acute care hospitals in North America, the Western Pacific, and Europe (18 countries). We identified only a few specific recommendations for long–term care facilities (LTCFs) and from countries in South America (Uruguay and Chile), South East Asia (Thailand), and none for Africa or Eastern Mediterranean. Of 10 IPC areas, antimicrobial stewardship was universally recognized as essential and supported by high quality evidence. Five other widely reported “strong” recommendations were: effective environment cleaning (including medical equipment), case isolation, use of personal protective equipment, surveillance, and education. Several unresolved and emerging issues were documented and currently available evidence was classified mainly as of mixed quality. Conclusion Our review underlines the need for targeted CDI IPC guidelines in several countries and for LTCFs. International harmonisation on the assessment of the evidence for best practices is needed as well as more robust evidence to support targeted recommendations. PMID:28028434

Infection prevention and control of Clostridium difficile: a global review of guidelines, strategies, and recommendations.

PubMed

Balsells, Evelyn; Filipescu, Teodora; Kyaw, Moe H; Wiuff, Camilla; Campbell, Harry; Nair, Harish

2016-12-01

Clostridium difficile is the leading cause of health care-associated infections. Given the high incidence of C. difficile infection (CDI) and the lack of primary prevention through immunization, health care professionals should be aware of the most current guidance, as well as strengths and limitations of the evidence base underpinning this guidance. We identified publicly available national or organizational guidelines related to CDI infection and prevention control (IPC) published between 2000 and 2015 and for any health care setting through an internet search using the Google search engine. We reviewed CDI-targeted IPC recommendations and describe the assessment of evidence in available guidelines. We identified documents from 28 countries/territories, mainly from acute care hospitals in North America, the Western Pacific, and Europe (18 countries). We identified only a few specific recommendations for long-term care facilities (LTCFs) and from countries in South America (Uruguay and Chile), South East Asia (Thailand), and none for Africa or Eastern Mediterranean. Of 10 IPC areas, antimicrobial stewardship was universally recognized as essential and supported by high quality evidence. Five other widely reported "strong" recommendations were: effective environment cleaning (including medical equipment), case isolation, use of personal protective equipment, surveillance, and education. Several unresolved and emerging issues were documented and currently available evidence was classified mainly as of mixed quality. Our review underlines the need for targeted CDI IPC guidelines in several countries and for LTCFs. International harmonisation on the assessment of the evidence for best practices is needed as well as more robust evidence to support targeted recommendations.

Psychedelics and connectedness.

PubMed

Carhart-Harris, R L; Erritzoe, D; Haijen, E; Kaelen, M; Watts, R

2018-02-01

Psychedelic drugs are creating ripples in psychiatry as evidence accumulates of their therapeutic potential. An important question remains unresolved however: how are psychedelics effective? We propose that a sense of connectedness is key, provide some preliminary evidence to support this, and suggest a roadmap for testing it further.

Evaluation of an Optimal Epidemiological Typing Scheme for Legionella pneumophila with Whole-Genome Sequence Data Using Validation Guidelines

PubMed Central

Mentasti, Massimo; Tewolde, Rediat; Aslett, Martin; Harris, Simon R.; Afshar, Baharak; Underwood, Anthony; Harrison, Timothy G.

2016-01-01

Sequence-based typing (SBT), analogous to multilocus sequence typing (MLST), is the current “gold standard” typing method for investigation of legionellosis outbreaks caused by Legionella pneumophila. However, as common sequence types (STs) cause many infections, some investigations remain unresolved. In this study, various whole-genome sequencing (WGS)-based methods were evaluated according to published guidelines, including (i) a single nucleotide polymorphism (SNP)-based method, (ii) extended MLST using different numbers of genes, (iii) determination of gene presence or absence, and (iv) a kmer-based method. L. pneumophila serogroup 1 isolates (n = 106) from the standard “typing panel,” previously used by the European Society for Clinical Microbiology Study Group on Legionella Infections (ESGLI), were tested together with another 229 isolates. Over 98% of isolates were considered typeable using the SNP- and kmer-based methods. Percentages of isolates with complete extended MLST profiles ranged from 99.1% (50 genes) to 86.8% (1,455 genes), while only 41.5% produced a full profile with the gene presence/absence scheme. Replicates demonstrated that all methods offer 100% reproducibility. Indices of discrimination range from 0.972 (ribosomal MLST) to 0.999 (SNP based), and all values were higher than that achieved with SBT (0.940). Epidemiological concordance is generally inversely related to discriminatory power. We propose that an extended MLST scheme with ∼50 genes provides optimal epidemiological concordance while substantially improving the discrimination offered by SBT and can be used as part of a hierarchical typing scheme that should maintain backwards compatibility and increase discrimination where necessary. This analysis will be useful for the ESGLI to design a scheme that has the potential to become the new gold standard typing method for L. pneumophila. PMID:27280420

Evaluation of an Optimal Epidemiological Typing Scheme for Legionella pneumophila with Whole-Genome Sequence Data Using Validation Guidelines.

PubMed

David, Sophia; Mentasti, Massimo; Tewolde, Rediat; Aslett, Martin; Harris, Simon R; Afshar, Baharak; Underwood, Anthony; Fry, Norman K; Parkhill, Julian; Harrison, Timothy G

2016-08-01

Sequence-based typing (SBT), analogous to multilocus sequence typing (MLST), is the current "gold standard" typing method for investigation of legionellosis outbreaks caused by Legionella pneumophila However, as common sequence types (STs) cause many infections, some investigations remain unresolved. In this study, various whole-genome sequencing (WGS)-based methods were evaluated according to published guidelines, including (i) a single nucleotide polymorphism (SNP)-based method, (ii) extended MLST using different numbers of genes, (iii) determination of gene presence or absence, and (iv) a kmer-based method. L. pneumophila serogroup 1 isolates (n = 106) from the standard "typing panel," previously used by the European Society for Clinical Microbiology Study Group on Legionella Infections (ESGLI), were tested together with another 229 isolates. Over 98% of isolates were considered typeable using the SNP- and kmer-based methods. Percentages of isolates with complete extended MLST profiles ranged from 99.1% (50 genes) to 86.8% (1,455 genes), while only 41.5% produced a full profile with the gene presence/absence scheme. Replicates demonstrated that all methods offer 100% reproducibility. Indices of discrimination range from 0.972 (ribosomal MLST) to 0.999 (SNP based), and all values were higher than that achieved with SBT (0.940). Epidemiological concordance is generally inversely related to discriminatory power. We propose that an extended MLST scheme with ∼50 genes provides optimal epidemiological concordance while substantially improving the discrimination offered by SBT and can be used as part of a hierarchical typing scheme that should maintain backwards compatibility and increase discrimination where necessary. This analysis will be useful for the ESGLI to design a scheme that has the potential to become the new gold standard typing method for L. pneumophila. Copyright © 2016 David et al.

A systematic review of surface electromyography analyses of the bench press movement task.

PubMed

Stastny, Petr; Gołaś, Artur; Blazek, Dusan; Maszczyk, Adam; Wilk, Michał; Pietraszewski, Przemysław; Petr, Miroslav; Uhlir, Petr; Zając, Adam

2017-01-01

The bench press exercise (BP) plays an important role in recreational and professional training, in which muscle activity is an important multifactorial phenomenon. The objective of this paper is to systematically review electromyography (EMG) studies performed on the barbell BP exercise to answer the following research questions: Which muscles show the greatest activity during the flat BP? Which changes in muscle activity are related to specific conditions under which the BP movement is performed? PubMed, Scopus, Web of Science and Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library were searched through June 10, 2016. A combination of the following search terms was used: bench press, chest press, board press, test, measure, assessment, dynamometer, kinematics and biomechanics. Only original, full-text articles were considered. The search process resulted in 14 relevant studies that were included in the discussion. The triceps brachii (TB) and pectoralis major (PM) muscles were found to have similar activity during the BP, which was significantly higher than the activity of the anterior deltoid. During the BP movement, muscle activity changes with exercise intensity, velocity of movement, fatigue, mental focus, movement phase and stability conditions, such as bar vibration or unstable surfaces. Under these circumstances, TB is the most common object of activity change. PM and TB EMG activity is more dominant and shows greater EMG amplitude than anterior deltoid during the BP. There are six factors that can influence muscle activity during the BP; however, the most important factor is exercise intensity, which interacts with all other factors. The research on muscle activity in the BP has several unresolved areas, such as clearly and strongly defined guidelines to perform EMG measurements (e.g., how to elaborate with surface EMG limits) or guidelines for the use of exact muscle models.

Combining 3D Hydraulic Tomography with Tracer Tests for Improved Transport Characterization.

PubMed

Sanchez-León, E; Leven, C; Haslauer, C P; Cirpka, O A

2016-07-01

Hydraulic tomography (HT) is a method for resolving the spatial distribution of hydraulic parameters to some extent, but many details important for solute transport usually remain unresolved. We present a methodology to improve solute transport predictions by combining data from HT with the breakthrough curve (BTC) of a single forced-gradient tracer test. We estimated the three dimensional (3D) hydraulic-conductivity field in an alluvial aquifer by inverting tomographic pumping tests performed at the Hydrogeological Research Site Lauswiesen close to Tübingen, Germany, using a regularized pilot-point method. We compared the estimated parameter field to available profiles of hydraulic-conductivity variations from direct-push injection logging (DPIL), and validated the hydraulic-conductivity field with hydraulic-head measurements of tests not used in the inversion. After validation, spatially uniform parameters for dual-domain transport were estimated by fitting tracer data collected during a forced-gradient tracer test. The dual-domain assumption was used to parameterize effects of the unresolved heterogeneity of the aquifer and deemed necessary to fit the shape of the BTC using reasonable parameter values. The estimated hydraulic-conductivity field and transport parameters were subsequently used to successfully predict a second independent tracer test. Our work provides an efficient and practical approach to predict solute transport in heterogeneous aquifers without performing elaborate field tracer tests with a tomographic layout. © 2015, National Ground Water Association.

A method for selecting M dwarfs with an increased likelihood of unresolved ultracool companionship

NASA Astrophysics Data System (ADS)

Cook, N. J.; Pinfield, D. J.; Marocco, F.; Burningham, B.; Jones, H. R. A.; Frith, J.; Zhong, J.; Luo, A. L.; Qi, Z. X.; Lucas, P. W.; Gromadzki, M.; Day-Jones, A. C.; Kurtev, R. G.; Guo, Y. X.; Wang, Y. F.; Bai, Y.; Yi, Z. P.; Smart, R. L.

2016-04-01

Locating ultracool companions to M dwarfs is important for constraining low-mass formation models, the measurement of substellar dynamical masses and radii, and for testing ultracool evolutionary models. We present an optimized method for identifying M dwarfs which may have unresolved ultracool companions. We construct a catalogue of 440 694 M dwarf candidates, from Wide-Field Infrared Survey Explorer, Two Micron All-Sky Survey and Sloan Digital Sky Survey, based on optical- and near-infrared colours and reduced proper motion. With strict reddening, photometric and quality constraints we isolate a subsample of 36 898 M dwarfs and search for possible mid-infrared M dwarf + ultracool dwarf candidates by comparing M dwarfs which have similar optical/near-infrared colours (chosen for their sensitivity to effective temperature and metallicity). We present 1082 M dwarf + ultracool dwarf candidates for follow-up. Using simulated ultracool dwarf companions to M dwarfs, we estimate that the occurrence of unresolved ultracool companions amongst our M dwarf + ultracool dwarf candidates should be at least four times the average for our full M dwarf catalogue. We discuss possible contamination and bias and predict yields of candidates based on our simulations.

From Unresolved Anger to Sadness: Identifying Physiological Correlates

ERIC Educational Resources Information Center

Rochman, Daniel; Diamond, Gary M.

2008-01-01

This study was designed to identify physiological correlates of unresolved anger and sadness, and the shift between these emotions, in a context similar to that of emotion-focused, experiential psychotherapy. Twenty-seven university students reporting unresolved anger toward an attachment figure were induced to experience and express unresolved…

A Structural Approach to Unresolved Mourning in Single Parent Family Systems.

ERIC Educational Resources Information Center

Fulmer, Richard H.

1983-01-01

Considers the mother's depression as a special problem in therapy of single-parent families, resulting from unresolved mourning maintained by the family system. Offers reasons why the single-parent family's structure seems inherently vulnerable to unresolved mourning. Suggests techniques of Structural Family Therapy to facilitate mourning in such…

Does LEAP change the screening paradigm for food allergy in infants with eczema?

PubMed

Allen, K J; Koplin, J J

2016-01-01

The LEAP randomized controlled trial provides the first direct evidence that delayed introduction of peanut in an infant's diet significantly increases the risk of peanut allergy. However, as often is the case in ground-breaking research, the LEAP study raises almost as many questions as it resolves. Although the quality of design and excellence in study execution is unquestioned, the particular difficulty this study raises is how to generalize results from a trial of high-risk infants, which screened infants for the presence of peanut allergy prior to peanut introduction, to the general population. Although many existing infant feeding guidelines already allow for the introduction of allergenic foods from 4 to 6 months of age irrespective of co-existent risk factors for peanut allergy, these will now need to be revised to more strongly state that avoidance may be harmful. Interim guidelines have already been published which incorporate these recommendations. However, the question as to how to achieve timely introduction of peanut into an infant's diet in a safe and cost-effective way, particularly in high-risk infants, remains unresolved. © 2015 John Wiley & Sons Ltd.

Change in attachment states of mind of women with binge-eating disorder.

PubMed

Maxwell, Hilary; Tasca, Giorgio A; Grenon, Renee; Ritchie, Kerri; Bissada, Hany; Balfour, Louise

2017-11-01

Insecure and unresolved/disorganized attachment states of mind may impact affect regulation and interpersonal functioning that contribute to binge eating in women with binge-eating disorder (BED). Group psychological treatment may facilitate changes from insecure to secure and from unresolved-disorganized to non-unresolved/disorganized attachment states of mind. This study used attachment theory to understand better the psychopathology of BED and co-morbid overweight status and to understand better the treatment response of patients with BED who receive group psychotherapy. Women with BED attended group psychodynamic interpersonal psychotherapy and completed the Adult Attachment Interview pretreatment and 6 months posttreatment. Matched samples of overweight women without BED and normal-weight women without BED completed the Adult Attachment Interview at 1 time point. Women with BED had significantly higher rates of preoccupied and unresolved/disorganized attachment states of mind compared to normal-weight women without BED and had similar rates of insecure and unresolved/disorganized attachment states of mind compared to overweight women without BED. Of the women with BED who had an insecure and/or unresolved/disorganized attachment states of mind at pretreatment, about 60% demonstrated clinically relevant changes to secure and to non-unresolved/disorganized states of mind at 6 months post group psychodynamic interpersonal psychotherapy. Results indicated that some women with BED may benefit from interventions that help them regulate hyperactivated affect and create coherent narratives. Both women with BED and overweight women without BED may benefit from treatments that help them develop more adaptive affect regulation strategies related to unresolved/disorganized attachment states of mind. Copyright © 2017 John Wiley & Sons, Ltd.

77 FR 42788 - Self-Regulatory Organizations; New York Stock Exchange LLC; Notice of Filing and Immediate...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-07-20

... Unresolved Account Balances in the Exchange's Online Comparison System July 16, 2012. Pursuant to Section 19... assigning the contra party to unresolved account balances in the Exchange's Online Comparison System. The... maker (``DMM'') unit as the contra party for any unresolved omnibus account balances in the Exchange's...

Could a change in diet revitalize children who suffer from unresolved fatigue?

PubMed

Steenbruggen, Tessa Gerjanne; Hoekstra, Sietske Johanna; van der Gaag, Ellen José

2015-03-13

Many children deal with fatigue for which no proper treatment can be given. A possible explanation for their fatigue is a micro deficiency of minerals and vitamins. In this non-randomized controlled trial, we clinically evaluated symptoms of fatigue in children for whom a nutrient-rich diet was advised. A group of 98 children (2-18 years old) with unexplained symptoms of fatigue was examined. The dietary modifications consisted of green vegetables, beef, whole milk and full-fat butter. Children in the intervention group were asked to follow the diet for three months, whereas the control-group followed their normal diet. The primary outcome was symptoms of fatigue, as determined by a PedsQL Multidimensional Fatigue Scale, and secondary outcomes were compliance with the diet and BMI. Children, who followed the diet showed a significant decrease in the need to sleep (CI 0.83; 14.86, p = 0.03). They slept better through the night and took fewer naps. When analyzing components of the advised diet separately, a significant larger decrease in cognitive fatigue symptoms was seen for eating green vegetables according to the diet guidelines (CI 2.27; 30.63, p = 0.024). Furthermore, a lower need to sleep was seen when whole milk was consumed almost daily (CI 0.02; 14.62, p = 0.049). Our study showed that nutritional advice is an elegant, and effective method for decreasing some symptoms of medically unresolved fatigue in children.

Could a Change in Diet Revitalize Children Who Suffer from Unresolved Fatigue?

PubMed Central

Steenbruggen, Tessa Gerjanne; Hoekstra, Sietske Johanna; van der Gaag, Ellen José

2015-01-01

Many children deal with fatigue for which no proper treatment can be given. A possible explanation for their fatigue is a micro deficiency of minerals and vitamins. In this non-randomized controlled trial, we clinically evaluated symptoms of fatigue in children for whom a nutrient-rich diet was advised. A group of 98 children (2–18 years old) with unexplained symptoms of fatigue was examined. The dietary modifications consisted of green vegetables, beef, whole milk and full-fat butter. Children in the intervention group were asked to follow the diet for three months, whereas the control-group followed their normal diet. The primary outcome was symptoms of fatigue, as determined by a PedsQL Multidimensional Fatigue Scale, and secondary outcomes were compliance with the diet and BMI. Children, who followed the diet showed a significant decrease in the need to sleep (CI 0.83; 14.86, p = 0.03). They slept better through the night and took fewer naps. When analyzing components of the advised diet separately, a significant larger decrease in cognitive fatigue symptoms was seen for eating green vegetables according to the diet guidelines (CI 2.27; 30.63, p = 0.024). Furthermore, a lower need to sleep was seen when whole milk was consumed almost daily (CI 0.02; 14.62, p = 0.049). Our study showed that nutritional advice is an elegant, and effective method for decreasing some symptoms of medically unresolved fatigue in children. PMID:25781221

European guidelines for workplace drug and alcohol testing in hair.

PubMed

Salomone, A; Tsanaclis, L; Agius, R; Kintz, P; Baumgartner, M R

2016-10-01

Guidelines for Legally Defensible Workplace Drug Testing have been prepared and updated by the European Workplace Drug Testing Society (EWDTS). They are based on the 2010 version published by Pascal Kintz and Ronald Agius (Guidelines for European workplace drug and alcohol testing in hair. Drug Test. Anal. 2010, 2, 367) and in concordance with the Society of Hair Testing guidelines (Society of Hair Testing guidelines for drug testing in hair. Forensic Sci. Int. 2012, 218, 20-24). The European Guidelines are designed to establish best practice procedures whilst allowing individual countries to operate within the requirements of national customs and legislation. The EWDTS recommends that all European laboratories that undertake legally defensible workplace drug testing use these guidelines as a template for accreditation. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

International Guidelines on Computer-Based and Internet-Delivered Testing

ERIC Educational Resources Information Center

International Journal of Testing, 2006

2006-01-01

Developed by the International Test Commission, the International Guidelines on Computer-Based and Internet-Delivered Testing are a set of guidelines specifically developed to highlight good practice issues in relation to computer/Internet tests and testing. These guidelines have been developed from an international perspective and are directed at…

Components of the Extragalactic Gamma-Ray Background

NASA Technical Reports Server (NTRS)

Stecker, Floyd W.; Venters, Tonia M.

2011-01-01

We present new theoretical estimates of the relative contributions of unresolved blazars and star-forming galaxies to the extragalactic gamma-ray background (EGB) and discuss constraints on the contributions from alternative mechanisms such as dark matter annihilation and truly diffuse gamma-ray production. We find that the Fermi source count data do not rule out a scenario in which the EGB is dominated by emission from unresolved blazars, though unresolved star-forming galaxies may also contribute significantly to the background, within order-of-magnitude uncertainties. In addition, we find that the spectrum of the unresolved star-forming galaxy contribution cannot explain the EGB spectrum found by EGRET at energies between 50 and 200 MeV, whereas the spectrum of unresolved flat spectrum radio quasars, when accounting for the energy-dependent effects of source confusion, could be consistent with the combined spectrum of the low-energy EGRET EGB measurements and the Fermi-Large Area Telescope EGB measurements.

Effect of test concentration in the ready biodegradability test for chemical substances: Improvement of OECD test guideline 301C.

PubMed

Nabeoka, Ryosuke; Taruki, Masanori; Kayashima, Takakazu; Yoshida, Tomohiko; Kameya, Takashi

2016-01-01

In Japan, understanding the environmental persistence of chemicals is very important for risk assessment, and ready biodegradability tests are mainly conducted according to the Organisation for Economic Co-operation and Development test guideline 301C. However, the highest test concentration specified in test guideline 301C, 100 mg/L, may cause microbial toxicity and incomplete biodegradation. The authors performed test guideline 301C tests at test concentrations of 30 mg/L for 13 substances that were readily biodegradable in ready biodegradability tests but not in test guideline 301C tests. Of the 5 substances with potential to cause microbial toxicity at 100 mg/L, the percentage of biodegradation of sodium dimethyldithiocarbamate, 4-chloro-3-cresol (CC), thymol (THY), and p-tert-butyl-α-methylbenzenepropionaldehyde measured by biochemical oxygen demand (BOD) increased in the test guideline 301C test at 30 mg/L, suggesting a reduction in toxicity effects. Furthermore, CC and THY met the criteria for ready biodegradability, which are more than 60% of biodegradation by BOD and a 10-d window. Of the 8 substances with a low potential for causing microbial toxicity at 100 mg/L, the percentage of biodegradation of only 2-(diethylamino)ethanol increased in the test guideline 301C test at 30 mg/L. Employing a lower test concentration in the standard test guideline 301C test will contribute to improvement of consistency between results of a test guideline 301C test and other ready biodegradability tests. © 2015 SETAC.

40 CFR 799.11 - Availability of test guidelines.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 31 2010-07-01 2010-07-01 true Availability of test guidelines. 799.11... General Provisions § 799.11 Availability of test guidelines. (a) The TSCA and FIFRA guidelines for the...-487-4650). (b) The OECD guidelines for the various study plans are available from the following...

Cutaneous electrical stimulation treatment in unresolved facial nerve paralysis: an exploratory study.

PubMed

Hyvärinen, Antti; Tarkka, Ina M; Mervaala, Esa; Pääkkönen, Ari; Valtonen, Hannu; Nuutinen, Juhani

2008-12-01

The purpose of this study was to assess clinical and neurophysiological changes after 6 mos of transcutaneous electrical stimulation in patients with unresolved facial nerve paralysis. A pilot case series of 10 consecutive patients with chronic facial nerve paralysis either of idiopathic origin or because of herpes zoster oticus participated in this open study. All patients received below sensory threshold transcutaneous electrical stimulation for 6 mos for their facial nerve paralysis. The intervention consisted of gradually increasing the duration of electrical stimulation of three sites on the affected area for up to 6 hrs/day. Assessments of the facial nerve function were performed using the House-Brackmann clinical scale and neurophysiological measurements of compound motor action potential distal latencies on the affected and nonaffected sides. Patients were tested before and after the intervention. A significant improvement was observed in the facial nerve upper branch compound motor action potential distal latency on the affected side in all patients. An improvement of one grade in House-Brackmann scale was observed and some patients also reported subjective improvement. Transcutaneous electrical stimulation treatment may have a positive effect on unresolved facial nerve paralysis. This study illustrates a possibly effective treatment option for patients with the chronic facial paresis with no other expectations of recovery.

75 FR 22400 - Draft Test Guidelines; Reopening of Comment Period

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-28

... ENVIRONMENTAL PROTECTION AGENCY [EPA-HQ-OPP-2009-0681; FRL-8822-3] Draft Test Guidelines... draft test guidelines for product performance of public health uses of antimicrobial agents. EPA...-8437-2). In that document, EPA announced the availability of four draft test guidelines for product...

77 FR 15750 - Final Test Guidelines; OCSPP 810 Series; Notice of Availability

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-16

... ENVIRONMENTAL PROTECTION AGENCY [EPA-HQ-OPP-2009-0681; FRL-9332-4] Final Test Guidelines; OCSPP.... SUMMARY: EPA is announcing the availability of the final test guidelines for Series 810--Product Performance Test Guidelines, specifically public health uses of antimicrobial agents (OCSPP 810.2000...

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

Levin, I.; Laws, W. J.; Wang, D.

A crystal-chemical framework has been proposed for the design of pseudocubic perovskites with nanoscale ferroelectric order, and its applicability has been demonstrated using a series of representative solid solutions that combined ferroelectric (K0.5Bi0.5TiO3, BaTiO3, and PbTiO3) and antiferroelectric (Nd-substituted BiFeO3) end members. The pseudocubic structures obtained in these systems exhibited distortions that were coherent on a scale ranging from sub-nanometer to tens of nanometers, but, in all cases, the macroscopic distortion remained unresolvable even if using high-resolution X-ray powder diffraction. Different coherence lengths for the local atomic displacements account for the distinctly different dielectric, ferroelectric, and electromechanical properties exhibited bymore » the samples. The guidelines identified provide a rationale for chemically tuning the coherence length to obtain the desired functional response.« less

European guidelines for workplace drug testing in oral fluid.

PubMed

Brcak, Michaela; Beck, Olof; Bosch, Tessa; Carmichael, Duncan; Fucci, Nadia; George, Claire; Piper, Mark; Salomone, Alberto; Schielen, Wim; Steinmeyer, Stefan; Taskinen, Sanna; Weinmann, Wolfgang

2018-03-01

These guidelines for Legally Defensible Workplace Drug Testing have been prepared and updated by the European Workplace Drug Testing Society (EWDTS). The European Guidelines are designed to establish best practice procedures whilst allowing individual countries to operate within the requirements of national customs and legislation. The EWDTS recommends that all European laboratories that undertake legally defensible workplace drug testing should use these guidelines as a template for accreditation. These guidelines are relevant to laboratory-based testing only. These guidelines follow current best practices and are constantly under review. Copyright © 2017 John Wiley & Sons, Ltd.

Marijuana Effects on Human Forgetting Functions

ERIC Educational Resources Information Center

Lane, Scott D.; Cherek, Don R.; Lieving, Lori M.; Tcheremissine, Oleg V.

2005-01-01

It has long been known that acute marijuana administration impairs working memory (e.g., the discrimination of stimuli separated by a delay). The determination of which of the individual components of memory are altered by marijuana is an unresolved problem. Previous human studies did not use test protocols that allowed for the determination of…

Race Preferences in Children: Insights from South Africa

ERIC Educational Resources Information Center

Shutts, Kristin; Kinzler, Katherine D.; Katz, Rachel C.; Tredoux, Colin; Spelke, Elizabeth S.

2011-01-01

Minority-race children in North America and Europe often show less own-race favoritism than children of the majority (White) race, but the reasons for this asymmetry are unresolved. The present research tested South African children in order to probe the influences of group size, familiarity, and social status on children's race-based social…

European guidelines for workplace drug testing in urine.

PubMed

Taskinen, Sanna; Beck, Olof; Bosch, Tessa; Brcak, Michaela; Carmichael, Duncan; Fucci, Nadia; George, Claire; Piper, Mark; Salomone, Alberto; Schielen, Wim; Steinmeyer, Stefan; Weinmann, Wolfgang

2017-06-01

These European Guidelines for Workplace Drug Testing in Urine have been prepared and updated by the European Workplace Drug Testing Society (EWDTS). The first version of these urine guidelines was published in 2002. Since then, the guidelines have been followed by many laboratories in different European countries and their role has been essential particularly in countries lacking legislation for workplace drug testing. In 2014, the EWDTS started a guidelines updating project and published a new version of the urine guidelines in 2015. Here we represent this updated version of the urine guidelines. The European Guidelines are designed to establish best practice procedures whilst allowing individual countries to operate within the requirements of national customs and legislation. The EWDTS recommends that all European laboratories that undertake legally defensible workplace drug testing should use these guidelines as a template for accreditation. Copyright © 2017 John Wiley & Sons, Ltd. Copyright © 2017 John Wiley & Sons, Ltd.

Draft Test Guideline: Daphnid Chronic Toxicity Test

EPA Pesticide Factsheets

The following draft test guideline is part of a series of test guidelines that have been developed by EPA for use in the testing of pesticides and toxic substances, and the development of test data for submission to the Agency for review.

Draft Test Guideline: Gammarid Acute Toxicity Test

EPA Pesticide Factsheets

The following draft test guideline is part of a series of test guidelines that have been developed by EPA for use in the testing of pesticides and toxic substances, and the development of test data for submission to the Agency for review.

Draft Test Guideline: Chironomid Sediment Toxicity Test

EPA Pesticide Factsheets

The following draft test guideline is part of a series of test guidelines that have been developed by EPA for use in the testing of pesticides and toxic substances, and the development of test data for submission to the Agency for review.

Draft Test Guideline: Mysid Acute Toxicity Test

EPA Pesticide Factsheets

The following draft test guideline is part of a series of test guidelines that have been developed by EPA for use in the testing of pesticides and toxic substances, and the development of test data for submission to the Agency for review.

Draft Test Guideline: Penaeid Acute Toxicity Test

EPA Pesticide Factsheets

The following draft test guideline is part of a series of test guidelines that have been developed by EPA for use in the testing of pesticides and toxic substances, and the development of test data for submission to the Agency for review.

Draft Test Guideline: Mysid Chronic Toxicity Test

EPA Pesticide Factsheets

The following draft test guideline is part of a series of test guidelines that have been developed by EPA for use in the testing of pesticides and toxic substances, and the development of test data for submission to the Agency for review.

[Ethical guidelines on genetic testing and gene therapy].

PubMed

Fukushima, Yoshimitsu

2005-03-01

According to the recent and rapid advances in molecular genetics research, genetic testing and gene therapy have a potential of giving unexpected influence to the human beings. To prevent and to solve various ethical, legal and social implementations (ELSI) of genetic testing and gene therapy, several guidelines have been established. In Japan, all researchers and all clinicians have to know and keep the following three guidelines on genetic testing and a guideline on gene therapy: 1) "Guidelines for Researches on Human Genome and Gene (2001)" by the three Ministries (Education, Health and Economy), 2) "Guidelines for Genetic Testing (2001)" by the Genetic--medicine--related 10 societies, 3) "Ethical Principles on Entrusted Genetic Testing (2001)" by the Japan Registered Clinical Laboratories Association, and 4) "Guidelines for Clinical Research on Gene Therapy (2002)" by the two Ministries (Health and Education).

Draft Test Guideline: Tadpole/Sediment Subchronic Toxicity Test

EPA Pesticide Factsheets

The following draft test guideline is part of a series of test guidelines that have been developed by EPA for use in the testing of pesticides and toxic substances, and the development of test data for submission to the Agency for review.

Draft Test Guideline: Bivalve Acute Toxicity Test (Embryo Larval)

EPA Pesticide Factsheets

The following draft test guideline is part of a series of test guidelines that have been developed by EPA for use in the testing of pesticides and toxic substances, and the development of test data for submission to the Agency for review.

Draft Test Guideline: Field Testing For Aquatic Organisms

EPA Pesticide Factsheets

The following draft test guideline is part of a series of test guidelines that have been developed by EPA for use in the testing of pesticides and toxic substances, and the development of test data for submission to the Agency for review.

Draft Test Guideline: Oyster Acute Toxicity Test (Shell Deposition)

EPA Pesticide Factsheets

The following draft test guideline is part of a series of test guidelines that have been developed by EPA for use in the testing of pesticides and toxic substances, and the development of test data for submission to the Agency for review.

Draft Test Guideline: Site-Specific Aquatic Microcosm Test, Laboratory

EPA Pesticide Factsheets

The following draft test guideline is part of a series of test guidelines that have been developed by EPA for use in the testing of pesticides and toxic substances, and the development of test data for submission to the Agency for review.

Draft Test Guideline: Generic Freshwater Microcosm Test, Laboratory

EPA Pesticide Factsheets

The following draft test guideline is part of a series of test guidelines that have been developed by EPA for use in the testing of pesticides and toxic substances, and the development of test data for submission to the Agency for review.

Draft Test Guideline: Fish Early-Life Stage Toxicity Test

EPA Pesticide Factsheets

The following draft test guideline is part of a series of test guidelines that have been developed by EPA for use in the testing of pesticides and toxic substances, and the development of test data for submission to the Agency for review.

Comparison of biodegradation performance of OECD test guideline 301C with that of other ready biodegradability tests.

PubMed

Kayashima, Takakazu; Taruki, Masanori; Katagiri, Kazuomi; Nabeoka, Ryosuke; Yoshida, Tomohiko; Tsuji, Toshiaki

2014-02-01

The Organisation for Economic Co-operatoin and development (OECD) Guidelines for the Testing of Chemicals list 7 types of tests for determining the ready biodegradability of chemical compounds (301A-F and 310). The present study compares the biodegradation performance of test guideline 301C, which is applied in Japan's Chemical Substances Control Law, with the performance of the other 6 ready biodegradability tests (RBTs) listed in the guidelines. Test guideline 301C specifies use of activated sludge precultured with synthetic sewage containing glucose and peptone (301C sludge) as a test inoculum; in the other RBTs, however, activated sludge from wastewater treatment plants (WWTP sludge) is frequently employed. Analysis based on percentage of biodegradation and pass levels revealed that the biodegradation intensity of test guideline 301C is relatively weak compared with the intensities of RBTs using WWTP sludge, and the following chemical compounds are probably not biodegraded under test guideline 301C conditions: phosphorus compounds; secondary, tertiary, and quaternary amines; and branched quaternary carbon compounds. The relatively weak biodegradation intensity of test guideline 301C may be related to the markedly different activities of the 301C and WWTP sludges. These findings will be valuable for evaluating RBT data in relation to Japan's Chemical Substances Control Law. © 2013 SETAC.

Unresolved trauma in mothers: intergenerational effects and the role of reorganization

PubMed Central

Iyengar, Udita; Kim, Sohye; Martinez, Sheila; Fonagy, Peter; Strathearn, Lane

2014-01-01

A mother's unresolved trauma may interfere with her ability to sensitively respond to her infant, thus affecting the development of attachment in her own child, and potentially contributing to the intergenerational transmission of trauma. One novel construct within the Dynamic Maturational Model of Attachment and Adaptation (DMM) coding of the Adult Attachment Interview (AAI) is “reorganization,” a process whereby speakers are actively changing their understanding of past and present experiences and moving toward attachment security. We conducted a study of mothers with unresolved trauma, exploring their own attachment classification, attachment outcomes of their children, and the potential effects of reorganization on child attachment. Forty-seven first-time mothers participated in the AAI during pregnancy, and returned with their child at 11 months to assess child attachment using the Strange Situation Procedure. Mothers with and without unresolved trauma were compared. We found that mothers with unresolved trauma had insecure attachment themselves and were more likely to have infants with insecure attachment. However, the one exception was that all of the mothers with unresolved trauma who were reorganizing toward secure attachment had infants with secure attachment. These preliminary findings suggest that mothers who are reorganizing may be able to more sensitively respond to their child's cues, contributing to the development of secure attachment. While our results need to be replicated in a larger cohort, this study is the first to explore the construct of reorganization and its potential relationship with child attachment. If confirmed in future studies, it may provide clinical insight into the intergenerational transmission of insecure attachment within the context of unresolved trauma. PMID:25225490

Draft Test Guideline: Aquatic Invetebrate Acute Toxicity, Test, Freshwater Daphnids

EPA Pesticide Factsheets

The following draft test guideline is part of a series of test guidelines that have been developed by EPA for use in the testing of pesticides and toxic substances, and the development of test data for submission to the Agency for review.

Draft Test Guideline: Fish Acute Toxicity Test, Freshwater And Marine

EPA Pesticide Factsheets

The following draft test guideline is part of a series of test guidelines that have been developed by EPA for use in the testing of pesticides and toxic substances, and the development of test data for submission to the Agency for review.

Draft Test Guideline: Fish Bioconcentration Factor (BCF)

EPA Pesticide Factsheets

The following draft test guideline is part of a series of test guidelines that have been developed by EPA for use in the testing of pesticides and toxic substances, and the development of test data for submission to the Agency for review.

Draft Test Guideline: Oyster Bioconcentration Factor (BCF)

EPA Pesticide Factsheets

The following draft test guideline is part of a series of test guidelines that have been developed by EPA for use in the testing of pesticides and toxic substances, and the development of test data for submission to the Agency for review.

Draft Test Guideline: Fish Life Cycle Toxicity

EPA Pesticide Factsheets

The following draft test guideline is part of a series of test guidelines that have been developed by EPA for use in the testing of pesticides and toxic substances, and the development of test data for submission to the Agency for review.

Draft Test Guideline: Aquatic Food Chain Transfer

EPA Pesticide Factsheets

The following draft test guideline is part of a series of test guidelines that have been developed by EPA for use in the testing of pesticides and toxic substances, and the development of test data for submission to the Agency for review.

The Image of the 1967 War in Israeli History Textbooks as Test Case: Studying an Active Past in a Protracted Regional Conflict

ERIC Educational Resources Information Center

Yogev, Esther

2012-01-01

This article seeks to shed light on the dilemma facing history education in regions beset by a protracted, and as yet unresolved ethno-political conflict. The article will examine this issue by means of a unique test case that observes a dramatic war event in Israeli textbooks. The event in question is the Six-Day War of 1967 and the study of its…

Revision of the OECD Genetox Test Guidelines

EPA Science Inventory

The OECD Test Guidelines (TG) on genetic toxicology were initially prepared and adopted between 1981 and 1986. In 1997 the most commonly used guidelines were updated, and the in vivo UDS test (TG 486) was added. More recently, in 2010 and 2011, two new guidelines were adopted: th...

Japanese Society of Medical Oncology Clinical Guidelines: Molecular Testing for Colorectal Cancer Treatment, Third Edition.

PubMed

Yamazaki, Kentaro; Taniguchi, Hiroya; Yoshino, Takayuki; Akagi, Kiwamu; Ishida, Hideyuki; Ebi, Hiromichi; Nakatani, Kaname; Muro, Kei; Yatabe, Yasushi; Yamaguchi, Kensei; Tsuchihara, Katsuya

2018-06-01

The Japanese Society of Medical Oncology (JSMO) previously published 2 editions of the clinical guidelines: "Japanese guidelines for testing of KRAS gene mutation in colorectal cancer" in 2008 and "Japanese Society of Medical Oncology Clinical Guidelines: RAS (KRAS/NRAS) mutation testing in colorectal cancer patients" in 2014. These guidelines have contributed to the proper use of KRAS and RAS mutation testing, respectively. Recently, clinical utility, particularly for colorectal cancer (CRC) patients with BRAF V600E mutation or DNA mismatch-repair (MMR) deficiency, has been established. Therefore, the guideline members decided these genetic alterations should also be involved. The aim of this revision is to properly carry out testing for BRAF V600E mutation and MMR deficiency in addition to RAS mutation. The revised guidelines include the basic requirements for testing for these genetic alterations based on recent scientific evidence. Furthermore, because clinical utility of comprehensive genetic testing using next-generation sequencing and somatic gene testing of analyzing circulating tumor DNA has increasingly evolved with recent advancements in testing technology, we noted the current situation and prospects for these testing technologies and their clinical implementation in the revised guidelines. © 2018 The Authors. Cancer Science published by John Wiley & Sons Australia, Ltd on behalf of Japanese Cancer Association.

Independent Confirmatory Factor Analysis of the Cognitive Assessment System (CAS): What Does CAS Measure?

ERIC Educational Resources Information Center

Kranzler, John H.; Keith, Timothy Z.

1999-01-01

Uses confirmatory factor analysis (CFA) to address unresolved issues concerning the structure of the Cognitive Assessment System, a test of intelligence based upon the planning, attention, and simultaneous-successive (PASS) processes theory of human cognition. Results reveal that the CFA of the standardization data do not support use of the CAS…

Health Professionals' Views of Communication: Implications for Assessing Performance on a Health-Specific English Language Test

ERIC Educational Resources Information Center

Elder, Cathie; Pill, John; Woodward-Kron, Robyn; McNamara, Tim; Manias, Elizabeth; Webb, Gillian; McColl, Geoff

2012-01-01

The gap between linguistic and professional criteria is a widely acknowledged but unresolved issue in the teaching and assessment of languages for specific purposes (LSP). In the teaching of professional writing, language experts and workplace professionals have been characterized as living worlds apart with respect to their views of…

Draft Test Guideline: Whole Sediment Acute Toxicity Invertebrates, Freshwater

EPA Pesticide Factsheets

The following draft test guideline is part of a series of test guidelines that have been developed by EPA for use in the testing of pesticides and toxic substances, and the development of test data for submission to the Agency for review.

Draft Test Guideline: Whole Sediment Acute Toxicity Invertebrates, Marine

EPA Pesticide Factsheets

The following draft test guideline is part of a series of test guidelines that have been developed by EPA for use in the testing of pesticides and toxic substances, and the development of test data for submission to the Agency for review.

Reduction of Non-uniform Beam Filling Effects by Vertical Decorrelation: Theory and Simulations

NASA Technical Reports Server (NTRS)

Short, David; Nakagawa, Katsuhiro; Iguchi, Toshio

2013-01-01

Algorithms for estimating precipitation rates from spaceborne radar observations of apparent radar reflectivity depend on attenuation correction procedures. The algorithm suite for the Ku-band precipitation radar aboard the Tropical Rainfall Measuring Mission satellite is one such example. The well-known problem of nonuniform beam filling is a source of error in the estimates, especially in regions where intense deep convection occurs. The error is caused by unresolved horizontal variability in precipitation characteristics such as specific attenuation, rain rate, and effective reflectivity factor. This paper proposes the use of vertical decorrelation for correcting the nonuniform beam filling error developed under the assumption of a perfect vertical correlation. Empirical tests conducted using ground-based radar observations in the current simulation study show that decorrelation effects are evident in tilted convective cells. However, the problem of obtaining reasonable estimates of a governing parameter from the satellite data remains unresolved.

Guidelines for testing and release procedures

NASA Technical Reports Server (NTRS)

Molari, R.; Conway, M.

1984-01-01

Guidelines and procedures are recommended for the testing and release of the types of computer software efforts commonly performed at NASA/Ames Research Center. All recommendations are based on the premise that testing and release activities must be specifically selected for the environment, size, and purpose of each individual software project. Guidelines are presented for building a Test Plan and using formal Test Plan and Test Care Inspections on it. Frequent references are made to NASA/Ames Guidelines for Software Inspections. Guidelines are presented for selecting an Overall Test Approach and for each of the four main phases of testing: (1) Unit Testing of Components, (2) Integration Testing of Components, (3) System Integration Testing, and (4) Acceptance Testing. Tools used for testing are listed, including those available from operating systems used at Ames, specialized tools which can be developed, unit test drivers, stub module generators, and the use of format test reporting schemes.

77 FR 22282 - Draft Guidelines on Biologics Quality Monitoring: Testing for the Detection of Mycoplasma...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-13

...] Draft Guidelines on Biologics Quality Monitoring: Testing for the Detection of Mycoplasma Contamination... Detection of Mycoplasma Contamination.'' This draft guideline identifies stages of manufacture where... contamination. Because the guidelines apply to final product and master seed/cell testing in veterinary vaccines...

Draft Test Guideline: Fish Acute Toxicity Mitigated By Humic Acid

EPA Pesticide Factsheets

The following draft test guideline is part of a series of test guidelines that have been developed by EPA for use in the testing of pesticides and toxic substances, and the development of test data for submission to the Agency for review.

Draft Test Guideline: Special Considerations for Conducting Aquatic Laboratory Studies

EPA Pesticide Factsheets

The following draft test guideline is part of a series of test guidelines that have been developed by EPA for use in the testing of pesticides and toxic substances, and the development of test data for submission to the Agency for review.

Review of achievements of the OECD Working Party on Manufactured Nanomaterials' Testing and Assessment Programme. From exploratory testing to test guidelines.

PubMed

Rasmussen, Kirsten; González, Mar; Kearns, Peter; Sintes, Juan Riego; Rossi, François; Sayre, Phil

2016-02-01

This paper charts the almost ten years of history of OECD's work on nanosafety, during which the programme of the OECD on the Testing and Assessment of Manufactured Nanomaterials covered the testing of eleven nanomaterials for about 59 end-points addressing physical-chemical properties, mammalian and environmental toxicity, environmental fate and material safety. An overview of the materials tested, the test methods applied and the discussions regarding the applicability of the OECD test guidelines, which are recognised methods for regulatory testing of chemicals, are given. The results indicate that many existing OECD test guidelines are suitable for nanomaterials and consequently, hazard data collected using such guidelines will fall under OECD's system of Mutual Acceptance of Data (MAD) which is a legally binding instrument to facilitate the international acceptance of information for the regulatory safety assessment of chemicals. At the same time, some OECD test guidelines and guidance documents need to be adapted to address nanomaterials while new test guidelines and guidance documents may be needed to address endpoints that are more relevant to nanomaterials. This paper presents examples of areas where test guidelines or guidance for nanomaterials are under development. Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.

Cueing an unresolved personal goal causes persistent ruminative self-focus: an experimental evaluation of control theories of rumination.

PubMed

Roberts, Henrietta; Watkins, Edward R; Wills, Andy J

2013-12-01

Control theory predicts that the detection of goal discrepancies initiates ruminative self-focus (Martin & Tesser, 1996). Despite the breadth of applications and interest in control theory, there is a lack of experimental evidence evaluating this prediction. The present study provided the first experimental test of this prediction. We examined uninstructed state rumination in response to the cueing of resolved and unresolved goals in a non-clinical population using a novel measure of online rumination. Consistent with control theory, cueing an unresolved goal resulted in significantly greater recurrent intrusive ruminative thoughts than cueing a resolved goal. Individual differences in trait rumination moderated the impact of the goal cueing task on the extent of state rumination: individuals who had a stronger tendency to habitually ruminate were more susceptible to the effects of cueing goal discrepancies. The findings await replication in a clinically depressed sample where there is greater variability and higher levels of trait rumination. These results indicate that control theories of goal pursuit provide a valuable framework for understanding the circumstances that trigger state rumination. Additionally, our measure of uninstructed online state rumination was found to be a valid and sensitive index of the extent and temporal course of state rumination, indicating its value for further investigating the proximal causes of state rumination. Copyright © 2013 Elsevier Ltd. All rights reserved.

How to bridge the gap between "unresolved" model and "resolved" model in CFD-DEM coupled method for sediment transport?

NASA Astrophysics Data System (ADS)

Liu, D.; Fu, X.; Liu, X.

2016-12-01

In nature, granular materials exist widely in water bodies. Understanding the fundamentals of solid-liquid two-phase flow, such as turbulent sediment-laden flow, is of importance for a wide range of applications. A coupling method combining computational fluid dynamics (CFD) and discrete element method (DEM) is now widely used for modeling such flows. In this method, when particles are significantly larger than the CFD cells, the fluid field around each particle should be fully resolved. On the other hand, the "unresolved" model is designed for the situation where particles are significantly smaller than the mesh cells. Using "unresolved" model, large amount of particles can be simulated simultaneously. However, there is a gap between these two situations when the size of DEM particles and CFD cell is in the same order of magnitude. In this work, the most commonly used void fraction models are tested with numerical sedimentation experiments. The range of applicability for each model is presented. Based on this, a new void fraction model, i.e., a modified version of "tri-linear" model, is proposed. Particular attention is paid to the smooth function of void fraction in order to avoid numerical instability. The results show good agreement with the experimental data and analytical solution for both single-particle motion and also group-particle motion, indicating great potential of the new void fraction model.

Spatially unresolved SED fitting can underestimate galaxy masses: a solution to the missing mass problem

NASA Astrophysics Data System (ADS)

Sorba, Robert; Sawicki, Marcin

2018-05-01

We perform spatially resolved, pixel-by-pixel Spectral Energy Distribution (SED) fitting on galaxies up to z ˜ 2.5 in the Hubble eXtreme Deep Field (XDF). Comparing stellar mass estimates from spatially resolved and spatially unresolved photometry we find that unresolved masses can be systematically underestimated by factors of up to 5. The ratio of the unresolved to resolved mass measurement depends on the galaxy's specific star formation rate (sSFR): at low sSFRs the bias is small, but above sSFR ˜ 10-9.5 yr-1 the discrepancy increases rapidly such that galaxies with sSFRs ˜ 10-8 yr-1 have unresolved mass estimates of only one-half to one-fifth of the resolved value. This result indicates that stellar masses estimated from spatially unresolved data sets need to be systematically corrected, in some cases by large amounts, and we provide an analytic prescription for applying this correction. We show that correcting stellar mass measurements for this bias changes the normalization and slope of the star-forming main sequence and reduces its intrinsic width; most dramatically, correcting for the mass bias increases the stellar mass density of the Universe at high redshift and can resolve the long-standing discrepancy between the directly measured cosmic SFR density at z ≳ 1 and that inferred from stellar mass densities (`the missing mass problem').

[Genetics of tremor].

PubMed

Kuhlenbäumer, G; Hopfner, F

2018-04-01

Tremor is a symptom of many diseases and can constitute a disease of its own: essential tremor. The genetics of essential tremor and differential diagnosis of monogenic diseases with the symptom tremor. Literature search and search of clinical genetics databases, e.g. OMIM, GeneReviews, MDSGene and the German Neurological Society (DGN) guidelines. The genetics of essential tremor remain unresolved in spite of large, adequately powered studies. Tremor is a symptom of differential diagnostic value in many movement disorders. A slight tremor might have been missed or not reported in many descriptions of movement disorders. Progress in the genetics of essential tremor probably requires a more detailed phenotyping allowing stratification into phenotypically defined subgroups. Tremor should always be included in the examination and description of movement disorders even if tremor is not a cardinal symptom. Tremor might be helpful in the differential diagnosis of hereditary dystonia, hereditary ataxia, spastic paraplegia and other movement disorders.

Measuring waste prevention.

PubMed

Zorpas, Antonis A; Lasaridi, Katia

2013-05-01

The Waste Framework Directive (WFD-2008/98/EC) has set clear waste prevention procedures, including reporting, reviewing, monitoring and evaluating. Based on the WFD, the European Commission and will offer support to Member States on how to develop waste prevention programmes through guidelines and information sharing on best practices. Monitoring and evaluating waste prevention activities are critical, as they constitute the main tools to enable policy makers, at the national and local level, to build their strategic plans and ensure that waste prevention initiatives are effective and deliver behaviour change. However, how one can measure something that is not there, remains an important and unresolved research question. The paper reviews and attempts to evaluate the methods that are being used for measuring waste prevention and the impact of relevant implemented activities at the household level, as the available data is still limited. Copyright © 2012 Elsevier Ltd. All rights reserved.

Characterization of Sound Radiation by Unresolved Scales of Motion in Computational Aeroacoustics

NASA Technical Reports Server (NTRS)

Rubinstein, Robert; Zhou, Ye

1999-01-01

Evaluation of the sound sources in a high Reynolds number turbulent flow requires time-accurate resolution of an extremely large number of scales of motion. Direct numerical simulations will therefore remain infeasible for the forseeable future: although current large eddy simulation methods can resolve the largest scales of motion accurately the, they must leave some scales of motion unresolved. A priori studies show that acoustic power can be underestimated significantly if the contribution of these unresolved scales is simply neglected. In this paper, the problem of evaluating the sound radiation properties of the unresolved, subgrid-scale motions is approached in the spirit of the simplest subgrid stress models: the unresolved velocity field is treated as isotropic turbulence with statistical descriptors, evaluated from the resolved field. The theory of isotropic turbulence is applied to derive formulas for the total power and the power spectral density of the sound radiated by a filtered velocity field. These quantities are compared with the corresponding quantities for the unfiltered field for a range of filter widths and Reynolds numbers.

A systematic review of surface electromyography analyses of the bench press movement task

PubMed Central

Gołaś, Artur; Blazek, Dusan; Maszczyk, Adam; Wilk, Michał; Pietraszewski, Przemysław; Petr, Miroslav; Uhlir, Petr; Zając, Adam

2017-01-01

Background The bench press exercise (BP) plays an important role in recreational and professional training, in which muscle activity is an important multifactorial phenomenon. The objective of this paper is to systematically review electromyography (EMG) studies performed on the barbell BP exercise to answer the following research questions: Which muscles show the greatest activity during the flat BP? Which changes in muscle activity are related to specific conditions under which the BP movement is performed? Strategy PubMed, Scopus, Web of Science and Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library were searched through June 10, 2016. A combination of the following search terms was used: bench press, chest press, board press, test, measure, assessment, dynamometer, kinematics and biomechanics. Only original, full-text articles were considered. Results The search process resulted in 14 relevant studies that were included in the discussion. The triceps brachii (TB) and pectoralis major (PM) muscles were found to have similar activity during the BP, which was significantly higher than the activity of the anterior deltoid. During the BP movement, muscle activity changes with exercise intensity, velocity of movement, fatigue, mental focus, movement phase and stability conditions, such as bar vibration or unstable surfaces. Under these circumstances, TB is the most common object of activity change. Conclusions PM and TB EMG activity is more dominant and shows greater EMG amplitude than anterior deltoid during the BP. There are six factors that can influence muscle activity during the BP; however, the most important factor is exercise intensity, which interacts with all other factors. The research on muscle activity in the BP has several unresolved areas, such as clearly and strongly defined guidelines to perform EMG measurements (e.g., how to elaborate with surface EMG limits) or guidelines for the use of exact muscle models. PMID:28170449

The American Indian Holocaust: healing historical unresolved grief.

PubMed

Brave Heart, M Y; DeBruyn, L M

1998-01-01

American Indians experienced massive losses of lives, land, and culture from European contact and colonization resulting in a long legacy of chronic trauma and unresolved grief across generations. This phenomenon, labeled historical unresolved grief, contributes to the current social pathology of high rates of suicide, homicide, domestic violence, child abuse, alcoholism and other social problems among American Indians. The present paper describes the concept of historical unresolved grief and historical trauma among American Indians, outlining the historical as well as present social and political forces which exacerbate it. The abundant literature on Jewish Holocaust survivors and their children is used to delineate the intergenerational transmission of trauma, grief, and the survivor's child complex. Interventions based on traditional American Indian ceremonies and modern western treatment modalities for grieving and healing of those losses are described.

Now Available – Final Test Guidelines for Ecological Effects

EPA Pesticide Factsheets

EPA's “Guidelines for Aquatic and Sediment-Dwelling Fauna, Aquatic Microcosm and Field Testing” are part of a series of test guidelines established by EPA for use in testing pesticides and other chemical substances.

76 FR 74063 - Mandatory Guidelines for Federal Workplace Drug Testing Programs

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-30

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Mandatory Guidelines for Federal Workplace Drug Testing... Federal Workplace Drug Testing Programs (Mandatory Guidelines), effective on October 1, 2010, addresses... for physicians performing a review of Federal employee drug testing results that seek approval by the...

Adherence to multiple cancer screening tests among women living in Appalachia Ohio

PubMed Central

Katz, Mira L.; Reiter, Paul L.; Young, Gregory S.; Pennell, Michael L.; Tatum, Cathy M.; Paskett, Electra D.

2015-01-01

Background There is a lack of information about the correlates of completing all three cancer screening tests among women living in Appalachia. Methods Cross-sectional telephone interviews were conducted (April-September 2013) among women (n=637) ages 51-75 from 12 Appalachia Ohio counties. Outcomes of within screening guidelines were verified by medical record. Multivariable logistic regression models identified correlates of being within guidelines for all three cancer screening tests. Results Screening rates were: mammography (32.1%), Pap test (36.1%), and a colorectal cancer test (30.1%). Only 8.6% of women were within guidelines for all tests. Having had a check-up in the past two years and having received a screening recommendation were significantly related to being within guidelines for all three tests (p<0.01). Participants with higher annual household incomes ($60,000+; OR=3.53, 95% CI: 1.49, 8.33) and conditions requiring regular medical visits (OR=3.16, 95% CI: 1.29, 7.74) were more likely to be within guidelines for all three screening tests. Conclusion Less than 10% of women had completed screening within guidelines for all three screening tests. Regular contact with the healthcare system and higher incomes were significant predictors of being within guidelines. Impact Within guidelines rates for the three recommended cancer screening tests is low among women in Appalachia Ohio. This finding illustrates the need for innovative interventions to improve rates of multiple cancer screening tests. PMID:26282630

Computer-based Written Emotional Disclosure: The Effects of Advance or Real-time Guidance and Moderation by Big 5 Personality Traits

PubMed Central

Beyer, Jonathan A.; Lumley, Mark A.; Latsch, Deborah A.; Oberleitner, Lindsay M.S.; Carty, Jennifer N.; Radcliffe, Alison M.

2014-01-01

Standard written emotional disclosure (WED) about stress, which is private and unguided, yields small health benefits. The effect of providing individualized guidance to writers may enhance WED, but has not been tested. This trial of computer-based WED compared two novel therapist-guided forms of WED—advance guidance (before sessions) or real-time guidance (during sessions, through instant messaging)—to both standard WED and control writing; it also tested Big 5 personality traits as moderators of guided WED. Young adult participants (n = 163) with unresolved stressful experiences were randomized to conditions, had three, 30-min computer-based writing sessions, and were reassessed 6 weeks later. Contrary to hypotheses, real-time guidance WED had poorer outcomes than the other conditions on several measures, and advance guidance WED also showed some poorer outcomes. Moderator analyses revealed that participants with low baseline agreeableness, low extraversion, or high conscientiousness had relatively poor responses to guidance. We conclude that providing guidance for WED, especially in real-time, may interfere with emotional processing of unresolved stress, particularly for people whose personalities have poor fit with this interactive form of WED. PMID:24266598

76 FR 57031 - Draft Harmonized Test Guidelines; Notice of Availability and Request for Comments

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-15

...EPA is announcing the availability of the draft test guidelines for Series 810--Product Performance Test Guidelines for Public Health Uses of Antimicrobial Agents, concerning specifically air, textiles, and water.

78 FR 2675 - Mandatory Guidelines for Federal Workplace Drug Testing Programs

Federal Register 2010, 2011, 2012, 2013, 2014

2013-01-14

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Mandatory Guidelines for Federal Workplace Drug Testing... Federal Workplace Drug Testing Programs (Mandatory Guidelines), effective on October 1, 2010, addresses... performing a review of Federal employee drug testing results that seek approval by the Secretary must submit...

75 FR 76478 - Mandatory Guidelines for Federal Workplace Drug Testing Programs

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-08

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Mandatory Guidelines for Federal Workplace Drug Testing... Drug Testing Programs (Mandatory Guidelines) which took effect on October 1, 2010 address the role and... Federal employee drug testing results that seek approval by the Secretary must submit their qualifications...

Decision making about healthcare-related tests and diagnostic test strategies. Paper 4: International guidelines show variability in their approaches.

PubMed

Mustafa, Reem A; Wiercioch, Wojtek; Arevalo-Rodriguez, Ingrid; Cheung, Adrienne; Prediger, Barbara; Ivanova, Liudmila; Ventresca, Matthew; Brozek, Jan; Santesso, Nancy; Bossuyt, Patrick; Garg, Amit X; Lloyd, Nancy; Lelgemann, Monika; Bühler, Diedrich; Schünemann, Holger J

2017-12-01

The objective of the study was to describe and compare current practices in developing guidelines about the use of healthcare-related tests and diagnostic strategies (HCTDS). We sampled 37 public health and clinical practice guidelines about HCTDS from various sources without language restrictions. Detailed descriptions of the systems used to assess the quality of evidence and develop recommendations were challenging to find within guidelines. We observed much variability among and within organizations with respect to how they develop recommendations about HCTDS. Twenty-four percent of the guidelines did not consider health benefits and harms but based decisions solely on test accuracy. We did not identify guidelines that described the main potential care pathways involving tests for a healthcare problem. In addition, we did not identify guidelines that systematically assessed, described, and referenced the evidence that linked test accuracy and patient-important outcomes. There is considerable variability among the processes used and factors considered in developing recommendations about the use of tests. This variability may be the cause for the disagreement we observed in recommendations about testing for the same condition. Copyright © 2017 Elsevier Inc. All rights reserved.

75 FR 4380 - Draft Test Guidelines; Notice of Availability and Request for Comments

Federal Register 2010, 2011, 2012, 2013, 2014

2010-01-27

... ENVIRONMENTAL PROTECTION AGENCY [EPA-HQ-OPP-2009-0681; FRL-8437-2] Draft Test Guidelines; Notice...: Notice. SUMMARY: EPA is announcing the availability of four draft test guidelines for Product Performance... holidays. The Docket Facility telephone number is (703) 305-5805. Electronic access to the OPPTS Test...

APA's Guidelines for Test User Qualifications: An Executive Summary.

ERIC Educational Resources Information Center

Turner, Samuel M.; DeMers, Stephen T.; Fox, Heather Roberts; Reed, Geoffrey M.

2001-01-01

Describes the American Psychological Association's (APA's) development of the Task Force on Test User Qualifications, explaining the APA's purpose in developing guidelines for the use of psychological tests. Highlights the historical background, the scope of the guidelines, generic knowledge and skills considered important for good test use, and…

75 FR 22809 - Mandatory Guidelines for Federal Workplace Drug Testing Programs

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-30

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Mandatory Guidelines for Federal Workplace Drug Testing... for Federal Workplace Drug Testing Programs (Mandatory Guidelines) from May 1, 2010, to October 1... drug testing programs as soon as possible that they will not be expected to implement the revisions to...

Attachment stability and the emergence of unresolved representations during adolescence.

PubMed

Aikins, Julie Wargo; Howes, Carollee; Hamilton, Claire

2009-09-01

This 15-year longitudinal study examined the stability of attachment representations from infancy to adolescence and investigated the emergence of unresolved representations during adolescence in a sample of 47 16-year-olds. Attachment was assessed at 12 months using the Strange Situation Procedure, at 4 years using the modified Strange Situation Procedure, and again at 16 years with the Adult Attachment Projective (AAP). The emergence of unresolved classifications in adolescence (AAP) was associated with higher rates of negative life events, low levels of early mother-child relationship security (an aggregate measure of the 12-month and 4-year measures), negative teacher-child relationship experiences in middle childhood, and low early adolescent friendship quality. The results support the growing body of evidence suggesting that changes in attachment are lawful, while adding to the growing understanding of the emergence of unresolved attachment representations.

Cross-validation and hypothesis testing in neuroimaging: An irenic comment on the exchange between Friston and Lindquist et al.

PubMed

Reiss, Philip T

2015-08-01

The "ten ironic rules for statistical reviewers" presented by Friston (2012) prompted a rebuttal by Lindquist et al. (2013), which was followed by a rejoinder by Friston (2013). A key issue left unresolved in this discussion is the use of cross-validation to test the significance of predictive analyses. This note discusses the role that cross-validation-based and related hypothesis tests have come to play in modern data analyses, in neuroimaging and other fields. It is shown that such tests need not be suboptimal and can fill otherwise-unmet inferential needs. Copyright © 2015 Elsevier Inc. All rights reserved.

An open cluster-randomized, 18-month trial to compare the effectiveness of educational outreach visits with usual guideline dissemination to improve family physician prescribing

PubMed Central

2014-01-01

Background The Portuguese National Health Directorate has issued clinical practice guidelines on prescription of anti-inflammatory drugs, acid suppressive therapy, and antiplatelets. However, their effectiveness in changing actual practice is unknown. Methods The study will compare the effectiveness of educational outreach visits regarding the improvement of compliance with clinical guidelines in primary care against usual dissemination strategies. A cost-benefit analysis will also be conducted. We will carry out a parallel, open, superiority, randomized trial directed to primary care physicians. Physicians will be recruited and allocated at a cluster-level (primary care unit) by minimization. Data will be analyzed at the physician level. Primary care units will be eligible if they use electronic prescribing and have at least four physicians willing to participate. Physicians in intervention units will be offered individual educational outreach visits (one for each guideline) at their workplace during a six-month period. Physicians in the control group will be offered a single unrelated group training session. Primary outcomes will be the proportion of cyclooxygenase-2 inhibitors prescribed in the anti-inflammatory class, and the proportion of omeprazole in the proton pump inhibitors class at 18 months post-intervention. Prescription data will be collected from the regional pharmacy claims database. We estimated a sample size of 110 physicians in each group, corresponding to 19 clusters with a mean size of 6 physicians. Outcome collection and data analysis will be blinded to allocation, but due to the nature of the intervention, physicians and detailers cannot be blinded. Discussion This trial will attempt to address unresolved issues in the literature, namely, long term persistence of effect, the importance of sequential visits in an outreach program, and cost issues. If successful, this trial may be the cornerstone for deploying large scale educational outreach programs within the Portuguese National Health Service. Trial registration ClinicalTrials.gov number NCT01984034. PMID:24423370

MYSID TWO-GENERATION TEST GUIDELINE

EPA Science Inventory

McKenney, Charles L., Jr. In press. Mysid Two-Generation Test Guideline. OECD Expert Group on Invertebrate Testing for Endocrine Disruptors, Organisation for Economic Co-operation and Development, Paris, France. 17 p. (ERL,GB 1215).

This guideline describes a two-generati...

Drug Development Pipeline

MedlinePlus

... Care Guidelines Newborn Screening Clinical Care Guidelines Sweat Test Clinical Care Guidelines Infection Prevention and Control Care Guidelines Allergic Bronchopulmonary Aspergillosis Clinical Care Guidelines ...

77 FR 38282 - Final Test Guidelines; OCSPP 850 Series; Notice of Availability

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-27

... conditions. EPA is changing the title of OPPTS 850.4450 ``Aquatic Plants Field Study, Tier III'' test....4300 ``Terrestrial Plants Field Study, Tier III'' test guideline. Public Draft OPPTS 850.4025 ``Target..., OCSPP 850.4300 ``Terrestrial Plants Field Study.'' The target area test guideline covers a special case...

75 FR 75485 - Current List of Laboratories Which Meet Minimum Standards To Engage in Urine Drug Testing for...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-03

... Current List of Laboratories Which Meet Minimum Standards To Engage in Urine Drug Testing for Federal... Guidelines for Federal Workplace Drug Testing Programs (Mandatory Guidelines). The Mandatory Guidelines were... Laboratories and Instrumented Initial Testing Facilities (IITF) must meet in order to conduct drug and specimen...

Drug Testing Guidelines and Practices for Juvenile Probation and Parole Agencies.

ERIC Educational Resources Information Center

American Probation and Parole Association, Lexington, KY.

This document, intended as a resource manual, provides guidelines on drug testing. These topics are covered: (1) National Institute on Drug Abuse guidelines applicability; (2) introduction to legal issues, drug testing in juvenile probation and parole, and juvenile law; (3) mission of a juvenile parole agency; (4) purpose of testing; (5) drug…

75 FR 62842 - Current List of Laboratories Which Meet Minimum Standards To Engage in Urine Drug Testing for...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-13

... Current List of Laboratories Which Meet Minimum Standards To Engage in Urine Drug Testing for Federal... Guidelines for Federal Workplace Drug Testing Programs (Mandatory Guidelines). The Mandatory Guidelines were... and Instrumented Initial Testing Facilities (IITF) must meet in order to conduct drug and specimen...

A dynamic subgrid-scale parameterization of the effective wall stress in atmospheric boundary layer flows over multiscale, fractal-like surfaces

NASA Astrophysics Data System (ADS)

Anderson, William; Meneveau, Charles

2010-05-01

A dynamic subgrid-scale (SGS) parameterization for hydrodynamic surface roughness is developed for large-eddy simulation (LES) of atmospheric boundary layer (ABL) flow over multiscale, fractal-like surfaces. The model consists of two parts. First, a baseline model represents surface roughness at horizontal length-scales that can be resolved in the LES. This model takes the form of a force using a prescribed drag coefficient. This approach is tested in LES of flow over cubes, wavy surfaces, and ellipsoidal roughness elements for which there are detailed experimental data available. Secondly, a dynamic roughness model is built, accounting for SGS surface details of finer resolution than the LES grid width. The SGS boundary condition is based on the logarithmic law of the wall, where the unresolved roughness of the surface is modeled as the product of local root-mean-square (RMS) of the unresolved surface height and an unknown dimensionless model coefficient. This coefficient is evaluated dynamically by comparing the plane-average hydrodynamic drag at two resolutions (grid- and test-filter scale, Germano et al., 1991). The new model is tested on surfaces generated through superposition of random-phase Fourier modes with prescribed, power-law surface-height spectra. The results show that the method yields convergent results and correct trends. Limitations and further challenges are highlighted. Supported by the US National Science Foundation (EAR-0609690).

ITC Guidelines on Quality Control in Scoring, Test Analysis, and Reporting of Test Scores

ERIC Educational Resources Information Center

Allalouf, Avi

2014-01-01

The Quality Control (QC) Guidelines are intended to increase the efficiency, precision, and accuracy of the scoring, analysis, and reporting process of testing. The QC Guidelines focus on large-scale testing operations where multiple forms of tests are created for use on set dates. However, they may also be used for a wide variety of other testing…

HIV pre-test information, discussion or counselling? A review of guidance relevant to the WHO European Region.

PubMed

Bell, Stephen A; Delpech, Valerie; Raben, Dorthe; Casabona, Jordi; Tsereteli, Nino; de Wit, John

2016-02-01

In the context of a shift from exceptionalism to normalisation, this study examines recommendations/evidence in current pan-European/global guidelines regarding pre-test HIV testing and counselling practices in health care settings. It also reviews new research not yet included in guidelines. There is consensus that verbal informed consent must be gained prior to testing, individually, in private, confidentially, in the presence of a health care provider. All guidelines recommend pre-test information/discussion delivered verbally or via other methods (information sheet). There is agreement about a minimum standard of information to be provided before a test, but guidelines differ regarding discussion about issues encouraging patients to think about implications of the result. There is heavy reliance on expert consultation in guideline development. Referenced scientific evidence is often more than ten years old and based on US/UK research. Eight new papers are reviewed. Current HIV testing and counselling guidelines have inconsistencies regarding the extent and type of information that is recommended during pre-test discussions. The lack of new research underscores a need for new evidence from a range of European settings to support the process of expert consultation in guideline development. © The Author(s) 2015.

Evidence for Unresolved Exoplanet-hosting Binaries in Gaia DR2

NASA Astrophysics Data System (ADS)

Evans, Daniel F.

2018-05-01

This note describes an effort to detect additional stellar sources in known transiting exoplanet (TEP) systems, which are unresolved or barely resolved in the Gaia Data Release 2 (DR2) catalogue. The presence of multiple unresolved stars in photometric and spectroscopic observations of a transiting planetary system biases measurements of the planet's radius, mass, and atmospheric conditions. In addition to the effect on individual planetary systems, the presence of unresolved stars across the sample of known exoplanets biases our overall understanding of planetary systems, due to the systematic underestimation of both masses and radii. This work uses the Astrometric Goodness of Fit in the Along-Scan direction (GOF_AL) and the Astrometric Excess Noise as indicators of poorly-resolved binaries. Many known close binaries in the exoplanet host star sample have highly significant GOF_AL and Astrometric Excess Noise values, such as WASP-20AB with Astrometric Excess Noise significant at $4720\\sigma$ and GOF_AL=124.

Developing Guidelines for HIV Antibody Testing among Victims of Pediatric Sexual Abuse.

ERIC Educational Resources Information Center

Gellert, George A.; And Others

1990-01-01

An interim set of human immunodeficiency virus (HIV) testing guidelines for victims of pediatric sexual abuse (PSA) is proposed. Guidelines are based on responses of 63 practitioners of PSA assessment to 7 hypothetical clinical profiles with 12 testing criteria. (Author/DB)

Comments from the Developmental Neurotoxicology Committee of the Japanese Teratology Society on the OECD Guideline for the Testing of Chemicals, Proposal for a New Guideline 426, Developmental Neurotoxicity Study, Draft Document (October 2006 version), and on the Draft Document of the Retrospective Performance Assessment of the Draft Test Guideline 426 on Developmental Neurotoxicity.

PubMed

Ema, Makoto; Fukui, Yoshihiro; Aoyama, Hiroaki; Fujiwara, Michio; Fuji, Junichiro; Inouye, Minoru; Iwase, Takayuki; Kihara, Takahide; Oi, Akihide; Otani, Hiroki; Shinomiya, Mitsuhiro; Sugioka, Kozo; Yamano, Tsunekazu; Yamashita, Keisuke H; Tanimura, Takashi

2007-06-01

In October 2006, a new revision of the draft guideline (OECD Guideline for the Testing of Chemicals, Proposal for a New Guideline 426. Developmental Neurotoxicity Study) and Draft Document of the Retrospective Performance Assessment (RPA) of the Draft Test Guideline 426 on Developmental Neurotoxicity were distributed following incorporation of the results of the Expert Consultation Meeting in Tokyo on May 24-26, 2005. The draft guideline consists of 50 paragraphs and an appendix with 102 references; and the draft RPA consists of 37 paragraphs with 109 references. National coordinators were requested to arrange for national expert reviews of these draft documents in their member countries. Members of the Developmental Neurotoxicology (DNT) Committee of the Japanese Teratology Society (JTS) reviewed, discussed, and commented on the draft Test Guideline Proposal. The DNT Committee of the JTS also commented on the draft document of the RPA. These comments were sent to the OECD Secretariat. The DNT Committee of the JTS expects the comments to be useful for the finalization of these draft documents.

Item-Writing Guidelines for Physics

ERIC Educational Resources Information Center

Regan, Tom

2015-01-01

A teacher learning how to write test questions (test items) will almost certainly encounter item-writing guidelines--lists of item-writing do's and don'ts. Item-writing guidelines usually are presented as applicable across all assessment settings. Table I shows some guidelines that I believe to be generally applicable and two will be briefly…

Challenges in Scale-Resolving Simulations of turbulent wake flows with coherent structures

NASA Astrophysics Data System (ADS)

Pereira, Filipe S.; Eça, Luís; Vaz, Guilherme; Girimaji, Sharath S.

2018-06-01

The objective of this work is to investigate the challenges encountered in Scale-Resolving Simulations (SRS) of turbulent wake flows driven by spatially-developing coherent structures. SRS of practical interest are expressly intended for efficiently computing such flows by resolving only the most important features of the coherent structures and modelling the remainder as stochastic field. The success of SRS methods depends upon three important factors: i) ability to identify key flow mechanisms responsible for the generation of coherent structures; ii) determine the optimum range of resolution required to adequately capture key elements of coherent structures; and iii) ensure that the modelled part is comprised nearly exclusively of fully-developed stochastic turbulence. This study considers the canonical case of the flow around a circular cylinder to address the aforementioned three key issues. It is first demonstrated using experimental evidence that the vortex-shedding instability and flow-structure development involves four important stages. A series of SRS computations of progressively increasing resolution (decreasing cut-off length) are performed. An a priori basis for locating the origin of the coherent structures development is proposed and examined. The criterion is based on the fact that the coherent structures are generated by the Kelvin-Helmholtz (KH) instability. The most important finding is that the key aspects of coherent structures can be resolved only if the effective computational Reynolds number (based on total viscosity) exceeds the critical value of the KH instability in laminar flows. Finally, a quantitative criterion assessing the nature of the unresolved field based on the strain-rate ratio of mean and unresolved fields is examined. The two proposed conditions and rationale offer a quantitative basis for developing "good practice" guidelines for SRS of complex turbulent wake flows with coherent structures.

21 CFR 350.60 - Guidelines for effectiveness testing of antiperspirant drug products.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 5 2011-04-01 2011-04-01 false Guidelines for effectiveness testing of antiperspirant drug products. 350.60 Section 350.60 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF... Drug Administration is providing guidelines that manufacturers may use in testing for effectiveness...

21 CFR 350.60 - Guidelines for effectiveness testing of antiperspirant drug products.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 21 Food and Drugs 5 2014-04-01 2014-04-01 false Guidelines for effectiveness testing of antiperspirant drug products. 350.60 Section 350.60 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF... Drug Administration is providing guidelines that manufacturers may use in testing for effectiveness...

21 CFR 350.60 - Guidelines for effectiveness testing of antiperspirant drug products.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 21 Food and Drugs 5 2012-04-01 2012-04-01 false Guidelines for effectiveness testing of antiperspirant drug products. 350.60 Section 350.60 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF... Drug Administration is providing guidelines that manufacturers may use in testing for effectiveness...

21 CFR 350.60 - Guidelines for effectiveness testing of antiperspirant drug products.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 21 Food and Drugs 5 2013-04-01 2013-04-01 false Guidelines for effectiveness testing of antiperspirant drug products. 350.60 Section 350.60 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF... Drug Administration is providing guidelines that manufacturers may use in testing for effectiveness...

Comments from the Behavioral Teratology Committee of the Japanese Teratology Society on OECD guideline for the testing of chemicals, proposal for a new guideline 426, developmental neurotoxicity study, draft document (September 2003).

PubMed

Fukui, Yoshihiro; Ema, Makoto; Fujiwara, Michio; Higuchi, Hashihiro; Inouye, Minoru; Iwase, Takayuki; Kihara, Takahide; Nishimura, Tatsuya; Oi, Akihide; Ooshima, Yojiro; Otani, Hiroki; Shinomiya, Mitsuhiro; Sugioka, Kozo; Yamano, Tsunekazu; Yamashita, Keisuke H; Tanimura, Takashi

2004-09-01

In September 2003, a new revision of the draft guideline (Organization for Economic Co-operation and Development [OECD] Guideline for the Testing of Chemicals, Proposal for a New Guideline 426, Developmental Neurotoxicity Study) was distributed. The draft guideline consists of 51 paragraphs and an appendix. The National Coordinators were requested to arrange national expert reviews of the guideline proposal in their member countries. The member of the Behavioral Teratology (BT) Committee of the Japanese Teratology Society (JTS) reviewed, discussed and commented on the draft Test Guideline proposal. The BT Committee of the JTS also commented that the International Collaborative Study to validate this protocol should be definitely performed. These comments were sent to the OECD Secretariat. The BT Committee of the JTS expects that the comments are useful for further discussion.

Impact of a clinical guideline for prescribing antibiotics to inpatients reporting penicillin or cephalosporin allergy.

PubMed

Blumenthal, Kimberly G; Shenoy, Erica S; Varughese, Christy A; Hurwitz, Shelley; Hooper, David C; Banerji, Aleena

2015-10-01

Self-reported penicillin allergy infrequently reflects an inability to tolerate penicillins. Inpatients reporting penicillin allergy receive alternative antibiotics that might be broader spectrum, more toxic, or less effective. To develop and assess a clinical guideline for the general inpatient provider that directs taking a history and prescribing antibiotics for patients with penicillin or cephalosporin allergy. A guideline was implemented to assist providers with assessing allergy history and prescribing antibiotics for patients with reported penicillin or cephalosporin allergy. The guideline used a standard 2-step graded challenge or test dose. A quasi-experimental study was performed to assess safety, feasibility, and impact on antibiotic use by comparing treatment 21 months before guideline implementation with 12 months after guideline implementation. Significantly more test doses to β-lactam antibiotics were performed monthly after vs before guideline implementation (median 14.5, interquartile range 13-16.25, vs 2, interquartile range 1-3.25, P < .001). Seven adverse drug reactions occurred during guideline-driven test doses, with no significant difference in rate (3.9% vs 6.1%, P = .44) or severity (P > .5) between periods. Guideline-driven test doses decreased alternative antimicrobial therapy after the test dose, including vancomycin (68.3% vs 37.2%, P < .001), aztreonam (11.5% vs 0.5%, P < .001), aminoglycosides (6.0% vs 1.1%, P = .004), and fluoro quinolones (15.3% vs 3.3%, P < .001). The implementation of an inpatient antibiotic prescribing guideline for patients with penicillin or cephalosporin allergy was associated with an almost 7-fold increase in the number of test doses to β-lactams without increased adverse drug reactions. Patients assessed with guideline-driven test doses were observed to have significantly decreased alternative antibiotic exposure. Copyright © 2015 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

New Approaches in International Guidelines for Genetic Toxicology Assays: Latest Updates on OECD Guidelines

EPA Science Inventory

In March 2010, the 22nd meeting of the Working Group of National Coordinators of the OECD Test Guidelines Programme (WNT) approved a project for updating the Test Guidelines on genotoxicity, with Canada, the Netherlands, France and the USA identified as lead countries for this wo...

28 CFR 42.610 - Agency enforcement of unresolved complaints.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 28 Judicial Administration 1 2014-07-01 2014-07-01 false Agency enforcement of unresolved complaints. 42.610 Section 42.610 Judicial Administration DEPARTMENT OF JUSTICE NONDISCRIMINATION; EQUAL EMPLOYMENT OPPORTUNITY; POLICIES AND PROCEDURES Procedures for Complaints of Employment Discrimination Filed...

The Nature of the Unresolved Extragalactic Cosmic Soft X-Ray Background

NASA Technical Reports Server (NTRS)

Cappelluti, N.; Ranalli, P.; Roncarelli, M.; Arevalo, P.; Zamorani, G.; Comastri, A.; Gilli, R.; Rovilos, E.; Vignali, C.; Allevato, V.;

Genetic Testing for Minors: Comparison between Italian and British Guidelines

PubMed Central

Tozzo, Pamela; Caenazzo, Luciana; Rodriguez, Daniele

2012-01-01

Genetic testing in children raises many important ethical, legal, and social issues. One of the main concerns is the ethically inappropriate genetic testing of minors. Various European countries established professional guidelines which reflect the different countries perspectives regarding the main ethical issues involved. In this paper, we analyze the Italian and the British guidelines by highlighting differences and similarities. We discuss presymptomatic, predictive, and carrier testing because we consider them to be the more ethically problematic types of genetic testing in minors. In our opinion, national guidelines should take into account the different needs in clinical practice. At the same time, in the case of genetic testing the national and supranational protection of minors could be strengthened by approving guidelines based on a common framework of principles and values. We suggest that the Oviedo Convention could represent an example of such a common framework or, at least, it could lead to articulate it. PMID:22567400

Bigeye Bomb: Unresolved Development Issues

DTIC Science & Technology

1989-08-11

the lethal agent formed inside the Bigeye bomb) at the purity or equivalent- biotoxicity level required by the Test and Eval- uation Master Plan (TEMP...during the 5 through 30-second period after mixing starts, with- out specifying either wheit the required purity or equivalent biotoxicity level should...revision of the purity or equivalent biotoxicity requirement. However, we believe that a bomb that produces lethal agent at the required purity level for 1

A new impetus for guideline development and implementation: construction and evaluation of a toolbox.

PubMed

Hilbink, Mirrian A H W; Ouwens, Marielle M T J; Burgers, Jako S; Kool, Rudolf B

2014-03-19

In the last decade, guideline organizations faced a number of problems, including a lack of standardization in guideline development methods and suboptimal guideline implementation. To contribute to the solution of these problems, we produced a toolbox for guideline development, implementation, revision, and evaluation. All relevant guideline organizations in the Netherlands were approached to prioritize the topics. We sent out a questionnaire and discussed the results at an invitational conference. Based on consensus, twelve topics were selected for the development of new tools. Subsequently, working groups were composed for the development of the tools. After development of the tools, their draft versions were pilot tested in 40 guideline projects. Based on the results of the pilot tests, the tools were refined and their final versions were presented. The vast majority of organizations involved in pilot testing of the tools reported satisfaction with using the tools. Guideline experts involved in pilot testing of the tools proposed a variety of suggestions for the implementation of the tools. The tools are available in Dutch and in English at a web-based platform on guideline development and implementation (http://www.ha-ring.nl). A collaborative approach was used for the development and evaluation of a toolbox for development, implementation, revision, and evaluation of guidelines. This approach yielded a potentially powerful toolbox for improving the quality and implementation of Dutch clinical guidelines. Collaboration between guideline organizations within this project led to stronger linkages, which is useful for enhancing coordination of guideline development and implementation and preventing duplication of efforts. Use of the toolbox could improve quality standards in the Netherlands, and might facilitate the development of high-quality guidelines in other countries as well.

Australian and New Zealand Anaesthetic Allergy Group Perioperative Anaphylaxis Investigation Guidelines.

PubMed

Scolaro, R J; Crilly, H M; Maycock, E J; McAleer, P T; Nicholls, K A; Rose, M A; The, Rih

2017-09-01

These guidelines are a consensus document developed by a working party of the Australian and New Zealand Anaesthetic Allergy Group (ANZAAG) to provide an approach to the investigation of perioperative anaphylaxis. They focus primarily on the use of skin testing as it is the investigation with the greatest clinical utility for the identification of the likely causative agent and potentially safer alternatives. The practicalities and process of skin testing, its limitations, and the place of other tests are discussed. These guidelines also address the roles of graded challenge and in vitro testing. The implications of anaphylaxis associated with neuromuscular blocking agents, beta-lactam antibiotics, local anaesthetic agents and chlorhexidine are discussed. Evidence for the recommendations is derived from literature searches using the words skin test, allergy, anaphylaxis, anaesthesia, and each of the individual agents listed in these guidelines. The individual articles were then reviewed for suitability for inclusion in these guidelines. Where evidence was not strong, as is the situation for many perioperative agents, expert consensus from the ANZAAG working party was used. These guidelines are intended for use by specialists involved in the investigation of perioperative allergy. They have been approved following peer review by members of ANZAAG and are available on the ANZAAG website: http://www.anzaag.com/anaphylaxis-management/testing-guidelines.pdf.

Extrinsic and Intrinsic Motivation at 30: Unresolved Scientific Issues

ERIC Educational Resources Information Center

Reiss, Steven

2005-01-01

The undermining effect of extrinsic reward on intrinsic motivation remains unproven. The key unresolved issues are construct invalidity (all four definitions are unproved and two are illogical); measurement unreliability (the free-choice measure requires unreliable, subjective judgments to infer intrinsic motivation); inadequate experimental…

Searching for Unresolved Binary Brown Dwarfs

NASA Astrophysics Data System (ADS)

Albretsen, Jacob; Stephens, Denise

2007-10-01

There are currently L and T brown dwarfs (BDs) with errors in their classification of +/- 1 to 2 spectra types. Metallicity and gravitational differences have accounted for some of these discrepancies, and recent studies have shown unresolved binary BDs may offer some explanation as well. However limitations in technology and resources often make it difficult to clearly resolve an object that may be binary in nature. Stephens and Noll (2006) identified statistically strong binary source candidates from Hubble Space Telescope (HST) images of Trans-Neptunian Objects (TNOs) that were apparently unresolved using model point-spread functions for single and binary sources. The HST archive contains numerous observations of BDs using the Near Infrared Camera and Multi-Object Spectrometer (NICMOS) that have never been rigorously analyzed for binary properties. Using methods developed by Stephens and Noll (2006), BD observations from the HST data archive are being analyzed for possible unresolved binaries. Preliminary results will be presented. This technique will identify potential candidates for future observations to determine orbital information.

Identification of individuals at risk for Lynch syndrome using targeted evaluations and genetic testing: National Society of Genetic Counselors and the Collaborative Group of the Americas on Inherited Colorectal Cancer joint practice guideline.

PubMed

Weissman, Scott M; Burt, Randall; Church, James; Erdman, Steve; Hampel, Heather; Holter, Spring; Jasperson, Kory; Kalady, Matt F; Haidle, Joy Larsen; Lynch, Henry T; Palaniappan, Selvi; Wise, Paul E; Senter, Leigha

2012-08-01

Identifying individuals who have Lynch syndrome (LS) involves a complex diagnostic work up that includes taking a detailed family history and a combination of various genetic and immunohistochemical tests. The National Society of Genetic Counselors (NSGC) and the Collaborative Group of the Americas on Inherited Colorectal Cancer (CGA-ICC) have come together to publish this clinical practice testing guideline for the evaluation of LS. The purpose of this practice guideline is to provide guidance and a testing algorithm for LS as well as recommendations on when to offer testing. This guideline does not replace a consultation with a genetics professional. This guideline includes explanations in support of this and a summary of background data. While this guideline is not intended to serve as a review of LS, it includes a discussion of background information on LS, and cites a number of key publications which should be reviewed for a more in-depth understanding of LS. These guidelines are intended for genetic counselors, geneticists, gastroenterologists, surgeons, medical oncologists, obstetricians and gynecologists, nurses and other healthcare providers who evaluate patients for LS.

The Instrument for Measuring the Implementation Situation of Traditional Chinese Medicine Guideline: Evaluation and Application

PubMed Central

Wang, Yangyang; Chen, Yaolong; Wang, Xiaoyun; Deng, Jingwen

2017-01-01

Clinical practice guidelines play an important role in reducing the variations in clinical practices and improving the quality of care. To assess the real effect, measuring its implementation situation is needed. The implementation situation can be reflected by testing the consistency between the actual clinical practice and the guideline. We constructed an instrument to measure the implementation situation of Traditional Chinese Medicine (TCM) guideline through consistency testing. The main objectives of our study were to validate the instrument and evaluate the implementation situation of menopause syndrome guideline of TCM, using the data from the consistency test of comparing the medical records with the guideline. A total of 621 cases were included for data analysis. Cronbach's Alpha coefficient is 0.73. The model fit of 7 items in four dimensions was good (SRMR = 0.04; GFI = 0.97; NFI = 0.97; TLI = 0.96; CFI = 0.98; AGFI = 0.90). This instrument is of good reliability and validity. It can help the guideline developers to measure the implementation situation, find the reasons affecting the implementation, and revise the guideline. The method of using consistency test to measure the implementation situation may provide a sample for evaluating the guideline implementation in other fields. PMID:29234379

Care at End of Life Influences Grief: A Nationwide Long-Term Follow-Up among Young Adults Who Lost a Brother or Sister to Childhood Cancer.

PubMed

Lövgren, Malin; Sveen, Josefin; Nyberg, Tommy; Eilegård Wallin, Alexandra; Prigerson, Holly G; Steineck, Gunnar; Kreicbergs, Ulrika

2018-02-01

A majority of cancer-bereaved siblings report long-term unresolved grief, thus it is important to identify factors that may contribute to resolving their grief. To identify modifiable or avoidable family and care-related factors associated with unresolved grief among siblings two to nine years post loss. This is a nationwide Swedish postal survey. Study-specific questions and the standardized instrument Hospital Anxiety and Depression Scale. Primary outcome was unresolved grief, and family and care-related factors were used as predictors. Cancer-bereaved sibling (N = 174) who lost a brother/sister to childhood cancer during 2000-2007 in Sweden (participation rate 73%). Seventy-three were males and 101 females. The age of the siblings at time of loss was 12-25 years and at the time of the survey between 19 and 33 years. Several predictors for unresolved grief were identified: siblings' perception that it was not a peaceful death [odds ratio (OR): 9.86, 95% confidence interval (CI): 2.39-40.65], limited information given to siblings the last month of life (OR: 5.96, 95% CI: 1.87-13.68), information about the impending death communicated the day before it occurred (OR: 2.73, 95% CI: 1.02-7.33), siblings' avoidance of the doctors (OR: 3.22, 95% CI: 0.75-13.76), and lack of communication with family (OR: 2.86, 95% CI: 1.01-8.04) and people outside the family about death (OR: 5.07, 95% CI: 1.64-15.70). Depressive symptoms (OR: 1.27, 95% CI: 1.12-1.45) and time since loss (two to four years: OR: 10.36, 95% CI: 2.87-37.48 and five to seven years: OR: 8.36, 95% CI: 2.36-29.57) also predicted unresolved grief. Together, these predictors explained 54% of the variance of unresolved grief. Siblings' perception that it was not a peaceful death and poor communication with family, friends, and healthcare increased the risk for unresolved grief among the siblings.

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

PubMed Central

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

2010-01-01

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

Technical standards and guidelines: molecular genetic testing for ultra-rare disorders.

PubMed

Maddalena, Anne; Bale, Sherri; Das, Soma; Grody, Wayne; Richards, Sue

2005-10-01

These standards and guidelines are designed primarily as an educational resource for clinical laboratory geneticists to help them provide quality clinical laboratory genetic services. Adherence to these standards and guidelines does not necessarily ensure a successful medical outcome. These standards and guidelines should not be considered inclusive of all proper procedures and tests or exclusive of other procedures and tests that are reasonably directed to obtaining the same results. In determining the propriety of any specific procedure or test, the clinical molecular geneticist should apply his or her own professional judgment to the specific clinical circumstances presented by the individual patient or specimen. It may be prudent, however, to document in the laboratory record the rationale for any significant deviation from these standards and guidelines.

Classification of spatially unresolved objects

NASA Technical Reports Server (NTRS)

Nalepka, R. F.; Horwitz, H. M.; Hyde, P. D.; Morgenstern, J. P.

1972-01-01

A proportion estimation technique for classification of multispectral scanner images is reported that uses data point averaging to extract and compute estimated proportions for a single average data point to classify spatial unresolved areas. Example extraction calculations of spectral signatures for bare soil, weeds, alfalfa, and barley prove quite accurate.

Qualitative and quantitative assessment of Unresolved Complex Mixture in PM2.5 of Bakersfield, CA.

EPA Science Inventory

The 2010 CalNex (California Nexus) field experiment offered an opportunity for detailed characterization of atmospheric particulate carbon composition and sources in Bakersfield, CA. In the current study, the authors describe and employ a new protocol for reporting unresolved com...

School-based assessment of attention deficit-hyperactivity disorder.

PubMed

Atkins, M S; Pelham, W E

1991-04-01

Schools are uniquely situated to provide information relevant to the assessment and treatment of Attention Deficit-Hyperactivity Disorder (ADHD) across a variety of tasks, settings, and observers. The importance of the school setting to the assessment and treatment of ADHD has resulted in the development of numerous measures appropriate for such assessment, but few guidelines for their use. The purpose of this article is to describe school-based assessment procedures and their relationship to ADHD. These procedures include teacher rating measures, direct observations in classrooms and on playgrounds, peer rating and sociometric measures, and permanent product measures such as academic performance. It is recommended that school-based assessment of ADHD involve the concurrent use of multiple measures to assess adequately the wide variety of symptoms associated with this disorder. It is further recommended that assessment serve the purpose of determining treatment efficacy to avoid unwarranted preoccupation with diagnostic issues that are as yet unresolved. The components of a comprehensive school-based assessment of ADHD are described, and their relationship to school-based treatment is discussed.

[Bioethics in end-of-life decisions in neonatology: Unresolved issues].

PubMed

Arnaez, Juan; Tejedor, Juan Carlos; Caserío, Sonia; Montes, María Teresa; Moral, María Teresa; González de Dios, Javier; García-Alix, Alfredo

2017-12-01

This document is the result of previous work carried out by different expert groups and submitted to multidisciplinary debate at a Conference about controversial, deficient, or new aspects in the field of neonatal palliative care, such as: 1) the deliberative decision-making process, 2) hospital and domiciliary palliative care, 3) donation after controlled cardiac death, and 4) moral stress in professionals. The most relevant conclusions were: the need to instruct professionals in bioethics and in the deliberative method to facilitate thorough and reasonable decision-making; the lack of development in the field of perinatal palliative care and domiciliary palliative care in hospitals that attend newborns; the need to provide neonatal units with resources that help train professionals in communication skills and in the management of moral distress, as well as delineate operational procedure and guidelines for neonatal organ donation. Copyright © 2017 Asociación Española de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.

Direct-to-consumer advertising of COX-2 inhibitors: effect on appropriateness of prescribing.

PubMed

Spence, Michele M; Teleki, Stephanie S; Cheetham, T Craig; Schweitzer, Stuart O; Millares, Mirta

2005-10-01

Spending on direct-to-consumer advertising (DTCA) of prescription drugs has increased dramatically in the past several years. An unresolved question is whether such advertising leads to inappropriate prescribing. In this study, the authors use survey and administrative data to determine the association of DTCA with the appropriate prescribing of cyclooxygenase-2 (COX-2) inhibitors for 1,382 patients. Treatment with either a COX-2 or a traditional nonsteroidal anti-inflammatory drug (NSAID) was defined as appropriate or not according to three different definitions of gastrointestinal risk. Patients who saw or heard a COX-2 advertisement and asked their physician about the advertised drug were significantly more likely to be prescribed a COX-2 (versus a NSAID, as recommended by evidence-based guidelines) than all other patients. Findings also suggest that some patients may benefit from DTCA. The authors discuss the need for balanced drug information for consumers, increased physician vigilance in prescribing appropriately, and further study of DTCA.

Lymphedema following treatment for breast cancer: a new approach to an old problem.

PubMed

O'Toole, Jean; Jammallo, Lauren S; Skolny, Melissa N; Miller, Cynthia L; Elliott, Krista; Specht, Michelle C; Taghian, Alphonse G

2013-11-01

Lymphedema following treatment for breast cancer can be an irreversible condition with a profound negative impact on quality of life. The lack of consensus regarding standard definitions of clinically significant lymphedema and optimal methods of measurement and quantification are unresolved problems. Inconsistencies persist regarding the appropriate timing of intervention and what forms of treatment should be the standard of care. There are reports that early detection and intervention can prevent progression, however,the Level 1 evidence to support this hypothesis has yet to be generated. To assess these controversies, we propose the implementation of a screening program to detect early lymphedema in conjunction with a randomized, prospective trial designed to generate Level 1 evidence regarding the efficacy of early intervention and appropriate treatment strategies. Collaboration among institutions that manage breast cancer patients is essential to establish a standardized approach to lymphedema and to establish guidelines for best practice. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

DEVELOPMENTAL NEUROTOXICITY TESTING GUIDELINES: A QUALIFICATIVE RETROSPECTIVE ANALYSIS OF POSITIVE CONTROL DATA.

EPA Science Inventory

The USEPA Developmental Neurotoxicity (DNT) Study Test Guideline calls for both functional and neuropathological assessments in offspring during and following maternal exposure. This guideline also requires data from positive control (PC) agents. Submission of these data permit e...

Unresolved Childhood Sexual Abuse: Are Older Adults Affected?

ERIC Educational Resources Information Center

Allers, Christopher T.; And Others

1992-01-01

Presents case studies and discussions regarding 3 observed characteristics of unresolved childhood sexual abuse in adult survivors over 65 years of age. Specifically, chronic depression, elder abuse, and misdiagnosis of residual abuse trauma as dementia or mental illness are compared to parallel issues identified by researchers working with…

The American Indian Holocaust: Healing Historical Unresolved Grief.

ERIC Educational Resources Information Center

Brave Heart, Maria Yellow Horse; DeBruyn, Lemyra M.

1998-01-01

Argues for the existence of historical unresolved grief among American Indians. Outlines the historical legacy of war, genocide, and boarding schools resulting in intergenerational trauma and a host of associated social problems. Suggests healing strategies that integrate modern and traditional approaches to healing at the individual, family, and…

29 CFR 1691.10 - Agency enforcement of unresolved complaints.

Code of Federal Regulations, 2013 CFR

2013-07-01

... Section 1691.10 Labor Regulations Relating to Labor (Continued) EQUAL EMPLOYMENT OPPORTUNITY COMMISSION... ASSISTANCE § 1691.10 Agency enforcement of unresolved complaints. (a) Upon EEOC's transmittal of a reasonable cause determination and notice of failure of conciliation under § 1691.9(b)(2) of this regulation, the...

29 CFR 1691.10 - Agency enforcement of unresolved complaints.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Section 1691.10 Labor Regulations Relating to Labor (Continued) EQUAL EMPLOYMENT OPPORTUNITY COMMISSION... ASSISTANCE § 1691.10 Agency enforcement of unresolved complaints. (a) Upon EEOC's transmittal of a reasonable cause determination and notice of failure of conciliation under § 1691.9(b)(2) of this regulation, the...

29 CFR 1691.10 - Agency enforcement of unresolved complaints.

Code of Federal Regulations, 2014 CFR

2014-07-01

... Section 1691.10 Labor Regulations Relating to Labor (Continued) EQUAL EMPLOYMENT OPPORTUNITY COMMISSION... ASSISTANCE § 1691.10 Agency enforcement of unresolved complaints. (a) Upon EEOC's transmittal of a reasonable cause determination and notice of failure of conciliation under § 1691.9(b)(2) of this regulation, the...

29 CFR 1691.10 - Agency enforcement of unresolved complaints.

Code of Federal Regulations, 2011 CFR

2011-07-01

... Section 1691.10 Labor Regulations Relating to Labor (Continued) EQUAL EMPLOYMENT OPPORTUNITY COMMISSION... ASSISTANCE § 1691.10 Agency enforcement of unresolved complaints. (a) Upon EEOC's transmittal of a reasonable cause determination and notice of failure of conciliation under § 1691.9(b)(2) of this regulation, the...

29 CFR 1691.10 - Agency enforcement of unresolved complaints.

Code of Federal Regulations, 2012 CFR

2012-07-01

... Section 1691.10 Labor Regulations Relating to Labor (Continued) EQUAL EMPLOYMENT OPPORTUNITY COMMISSION... ASSISTANCE § 1691.10 Agency enforcement of unresolved complaints. (a) Upon EEOC's transmittal of a reasonable cause determination and notice of failure of conciliation under § 1691.9(b)(2) of this regulation, the...

Staubli TX-90XL robot qualification at the LLIHE.

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

Covert, Timothy Todd

The Light Initiated High Explosive (LIHE) Facility uses a robotic arm to spray explosive material onto test items for impulse tests. In 2007, the decision was made to replace the existing PUMA 760 robot with the Staubli TX-90XL. A qualification plan was developed and implemented to verify the safe operating conditions and failure modes of the new system. The robot satisfied the safety requirements established in the qualification plan. A performance issue described in this report remains unresolved at the time of this publication. The final readiness review concluded the qualification of this robot at the LIHE facility.

ASVCP quality assurance guidelines: external quality assessment and comparative testing for reference and in-clinic laboratories.

PubMed

Camus, Melinda S; Flatland, Bente; Freeman, Kathleen P; Cruz Cardona, Janice A

2015-12-01

The purpose of this document is to educate providers of veterinary laboratory diagnostic testing in any setting about comparative testing. These guidelines will define, explain, and illustrate the importance of a multi-faceted laboratory quality management program which includes comparative testing. The guidelines will provide suggestions for implementation of such testing, including which samples should be tested, frequency of testing, and recommendations for result interpretation. Examples and a list of vendors and manufacturers supplying control materials and services to veterinary laboratories are also included. © 2015 American Society for Veterinary Clinical Pathology.

Could accreditation bodies facilitate the implementation of medical guidelines in laboratories?

PubMed

Aakre, Kristin M; Oosterhuis, Wytze P; Misra, Shivani; Langlois, Michel R; Joseph, Watine; Twomey, Patrick J; Barth, Julian H

2017-05-01

Several studies have shown that recommendations related to how laboratory testing should be performed and results interpreted are limited in medical guidelines and that the uptake and implementation of the recommendations that are available need improvement. The EFLM/UEMS Working Group on Guidelines conducted a survey amongst the national societies for clinical chemistry in Europe regarding development of laboratory-related guidelines. The results showed that most countries have guidelines that are specifically related to laboratory testing; however, not all countries have a formal procedure for accepting such guidelines and few countries have guideline committees. Based on this, the EFLM/UEMS Working Group on Guidelines conclude that there is still room for improvement regarding these processes in Europe and raise the question if the accreditation bodies could be a facilitator for an improvement.

NATO and Hybrid Conflict: Unresolved Issues from the Past or Unresolvable Threats of the Present?

DTIC Science & Technology

2012-09-01

order to strengthen the relationship between the UK and France, the Treaty of Dunkirk was signed in March 1947 expressing the Western European... Dunkirk Treaty was mainly a projection of European concerns about the reemergence of German aggression. The Rio Pact was more a representation of

Unresolved Loss, a Risk Factor for Offspring, Predicts Event-Related Potential Responses to Death-Related Imagery

ERIC Educational Resources Information Center

Bahm, Naomi I. Gribneau; Simon-Thomas, Emiliana R.; Main, Mary; Hesse, Erik

2017-01-01

This study investigates whether individual differences in attachment status can be detected by electrophysiological responses to loss-themed pictures. The Adult Attachment Interview (AAI) was used to identify discourse/reasoning lapses during the discussion of loss experiences via death that place speakers in the Unresolved/disorganized AAI…

Development of an Art Psychotherapy Model for the Prevention and Treatment of Unresolved Grief during Midlife.

ERIC Educational Resources Information Center

Turetsky, Cheryl J.; Hays, Ronald E.

2003-01-01

Presents an integrated model as an appropriate intervention to enable mourning and creativity and thus help in the prevention and treatment of unresolved grief in midlife. Two examples of this model in art-psychotherapy group treatment are provided. (Contains 53 references, 1 table, and 2 figures.) (GCP)

Unresolved Attachment, PTSD, and Dissociation in Women with Childhood Abuse Histories

ERIC Educational Resources Information Center

Stovall-McClough, K. Chase; Cloitre, Marylene

2006-01-01

The primary objective of this study was to examine unresolved trauma as assessed by the Adult Attachment Interview and current psychiatric symptoms, focusing on posttraumatic stress disorder (PTSD) and dissociation, in a group of adult female childhood abuse survivors. The authors examined psychiatric symptoms and attachment representations in a…

The Relationship between Psychological Well-Being and Perceived Wellness in Graduate-Level Counseling Students

ERIC Educational Resources Information Center

Harris, Michel; Martin, Magy; Martin, Don

2013-01-01

Research has established that individuals who provide personal therapy to others should have stable personal and professional lives, and possess a keen and accurate perception of wellness. Unfortunately, sometimes students pursuing careers in counseling and psychotherapy have unresolved psychological issues that, if unresolved, could later affect…

Observation of Unresolved Features in the Microwave Sky

NASA Astrophysics Data System (ADS)

Kowitt, M. S.; Cheng, E. S.; Cottingham, D. A.; Fixsen, D. J.; Silverberg, R. F.; Inman, C. A.; Meyer, S. S.; Puchalla, J. L.; Ruhl, J. E.; Page, L. A.

1994-12-01

We report on the detection of unresolved features in broadband observations from 5.6 to 22.5 cm(-1) with a 0\\fdg5 beam by the Medium Scale Anisotropy Measurement (Cheng et al. 1994, ApJ, 422, L37). Spectra for the features will be presented, along with a discussion of their possible origin.

47 CFR 73.810 - Third adjacent channel complaint and license modification procedure.

Code of Federal Regulations, 2012 CFR

2012-10-01

... LPFM station's remedial efforts. (d) In the event that the number of unresolved complaints plus the... interference is traceable to the LPFM station. (e) If the number of unresolved and disputed complaints exceeds...) BROADCAST RADIO SERVICES RADIO BROADCAST SERVICES Low Power FM Broadcast Stations (LPFM) § 73.810 Third...

47 CFR 73.810 - Third adjacent channel complaint and license modification procedure.

Code of Federal Regulations, 2010 CFR

2010-10-01

... LPFM station's remedial efforts. (d) In the event that the number of unresolved complaints plus the... interference is traceable to the LPFM station. (e) If the number of unresolved and disputed complaints exceeds...) BROADCAST RADIO SERVICES RADIO BROADCAST SERVICES Low Power FM Broadcast Stations (LPFM) § 73.810 Third...

47 CFR 73.810 - Third adjacent channel complaint and license modification procedure.

Code of Federal Regulations, 2011 CFR

2011-10-01

... LPFM station's remedial efforts. (d) In the event that the number of unresolved complaints plus the... interference is traceable to the LPFM station. (e) If the number of unresolved and disputed complaints exceeds...) BROADCAST RADIO SERVICES RADIO BROADCAST SERVICES Low Power FM Broadcast Stations (LPFM) § 73.810 Third...

Speckle imaging of active galactic nuclei: NGC 1068 and NGC 4151

NASA Astrophysics Data System (ADS)

Ebstein, Steven Michael

High resolution images of NGC 1068 and NGC 4151 in the 5007 A line and the nearby continuum produced from data taken with the PAPA photon counting imaging detector using the technique of speckle imaging are presented. The images show an unresolved core of 5007 A emission in the middle of an extended emission region. The extended emission tends to lie alongside the subarcsecond radio structure. In NGC 4151, the extended emission comes from a nearly linear structure extending on both sides of the unresolved core. In NGC 1068, the extended emission is concentrated in lobes lying to the unresolved core but the emission is concentrated in lobes lying to either side of the major axis. The continuum of NGC 4151 is spatially unresolved. The continuum of NGC 1068 is extended approx. 1 in to the SW of the center of the 5007 A emission. Certain aspects of the PAPA detector are discussed, including the variable threshold discriminators that track the image intensifier pulse height and the camera artifacts. The data processing is described in detail.

New Theoretical Estimates of the Contribution of Unresolved Star-Forming Galaxies to the Extragalactic Gamma-Ray Background (EGB) as Measured by EGRET and the Fermi-LAT

NASA Technical Reports Server (NTRS)

Venters, Tonia M.

2011-01-01

We present new theoretical estimates of the contribution of unresolved star-forming galaxies to the extragalactic gamma-ray background (EGB) as measured by EGRET and the Fermi-LAT. We employ several methods for determining the star-forming galaxy contribution the the EGB, including a method positing a correlation between the gamma-ray luminosity of a galaxy and its rate of star formation as calculated from the total infrared luminosity, and a method that makes use of a model of the evolution of the galaxy gas mass with cosmic time. We find that depending on the model, unresolved star-forming galaxies could contribute significantly to the EGB as measured by the Fermi-LAT at energies between approx. 300 MeV and approx. few GeV. However, the overall spectrum of unresolved star-forming galaxies can explain neither the EGRET EGB spectrum at energies between 50 and 200 MeV nor the Fermi-LAT EGB spectrum at energies above approx. few GeV.

Catch-up validation study of an in vitro skin irritation test method based on an open source reconstructed epidermis (phase II).

PubMed

Groeber, F; Schober, L; Schmid, F F; Traube, A; Kolbus-Hernandez, S; Daton, K; Hoffmann, S; Petersohn, D; Schäfer-Korting, M; Walles, H; Mewes, K R

2016-10-01

To replace the Draize skin irritation assay (OECD guideline 404) several test methods based on reconstructed human epidermis (RHE) have been developed and were adopted in the OECD test guideline 439. However, all validated test methods in the guideline are linked to RHE provided by only three companies. Thus, the availability of these test models is dependent on the commercial interest of the producer. To overcome this limitation and thus to increase the accessibility of in vitro skin irritation testing, an open source reconstructed epidermis (OS-REp) was introduced. To demonstrate the capacity of the OS-REp in regulatory risk assessment, a catch-up validation study was performed. The participating laboratories used in-house generated OS-REp to assess the set of 20 reference substances according to the performance standards amending the OECD test guideline 439. Testing was performed under blinded conditions. The within-laboratory reproducibility of 87% and the inter-laboratory reproducibility of 85% prove a high reliability of irritancy testing using the OS-REp protocol. In addition, the prediction capacity was with an accuracy of 80% comparable to previous published RHE based test protocols. Taken together the results indicate that the OS-REp test method can be used as a standalone alternative skin irritation test replacing the OECD test guideline 404. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

Guidelines of the Design of Electropyrotechnic Firing Circuit for Unmanned Flight and Ground Test Projects

NASA Technical Reports Server (NTRS)

Gonzalez, Guillermo A.; Lucy, Melvin H.; Massie, Jeffrey J.

2013-01-01

The NASA Langley Research Center, Engineering Directorate, Electronic System Branch, is responsible for providing pyrotechnic support capabilities to Langley Research Center unmanned flight and ground test projects. These capabilities include device selection, procurement, testing, problem solving, firing system design, fabrication and testing; ground support equipment design, fabrication and testing; checkout procedures and procedure?s training to pyro technicians. This technical memorandum will serve as a guideline for the design, fabrication and testing of electropyrotechnic firing systems. The guidelines will discuss the entire process beginning with requirements definition and ending with development and execution.

X-ray fluorescence microscopy artefacts in elemental maps of topologically complex samples: Analytical observations, simulation and a map correction method

NASA Astrophysics Data System (ADS)

Billè, Fulvio; Kourousias, George; Luchinat, Enrico; Kiskinova, Maya; Gianoncelli, Alessandra

2016-08-01

XRF spectroscopy is among the most widely used non-destructive techniques for elemental analysis. Despite the known angular dependence of X-ray fluorescence (XRF), topological artefacts remain an unresolved issue when using X-ray micro- or nano-probes. In this work we investigate the origin of the artefacts in XRF imaging of topologically complex samples, which are unresolved problems in studies of organic matter due to the limited travel distances of low energy XRF emission from the light elements. In particular we mapped Human Embryonic Kidney (HEK293T) cells. The exemplary results with biological samples, obtained with a soft X-ray scanning microscope installed at a synchrotron facility were used for testing a mathematical model based on detector response simulations, and for proposing an artefact correction method based on directional derivatives. Despite the peculiar and specific application, the methodology can be easily extended to hard X-rays and to set-ups with multi-array detector systems when the dimensions of surface reliefs are in the order of the probing beam size.

Patient engagement with surgical site infection prevention: an expert panel perspective.

PubMed

Tartari, E; Weterings, V; Gastmeier, P; Rodríguez Baño, J; Widmer, A; Kluytmans, J; Voss, A

2017-01-01

Despite remarkable developments in the use of surgical techniques, ergonomic advancements in the operating room, and implementation of bundles, surgical site infections (SSIs) remain a substantial burden, associated with increased morbidity, mortality and healthcare costs. National and international recommendations to prevent SSIs have been published, including recent guidelines by the World Health Organization, but implementation into clinical practice remains an unresolved issue. SSI improvement programs require an integrative approach with measures taken during the pre-, intra- and postoperative care from the numerous stakeholders involved. The current SSI prevention strategies have focused mainly on the role of healthcare workers (HCWs) and procedure related risk factors. The importance and influence of patient participation is becoming an increasingly important concept and advocated as a means to improve patient safety. Novel interventions supporting an active participative role within SSI prevention programs have not been assessed. Empowering patients with information they require to engage in the process of SSI prevention could play a major role for the implementation of recommendations. Based on available scientific evidence, a panel of experts evaluated options for patient involvement in order to provide pragmatic recommendations for pre-, intra- and postoperative activities for the prevention of SSIs. Recommendations were based on existing guidelines and expert opinion. As a result, 9 recommendations for the surgical patient are presented here, including a practice brief in the form of a patient information leaflet. HCWs can use this information to educate patients and allow patient engagement.

40 CFR 797.1050 - Algal acute toxicity test.

Code of Federal Regulations, 2010 CFR

2010-07-01

... seq.). This guideline prescribes test procedures and conditions using freshwater and marine algae to... definitions also apply to this guideline: (1) Algicidal means having the property of killing algae. (2... volumes of nutrient medium and/or test solution. Start the test by introducing algae into the test and...

40 CFR 797.1050 - Algal acute toxicity test.

Code of Federal Regulations, 2012 CFR

2012-07-01

... seq.). This guideline prescribes test procedures and conditions using freshwater and marine algae to... definitions also apply to this guideline: (1) Algicidal means having the property of killing algae. (2... volumes of nutrient medium and/or test solution. Start the test by introducing algae into the test and...

40 CFR 797.1050 - Algal acute toxicity test.

Code of Federal Regulations, 2013 CFR

2013-07-01

... seq.). This guideline prescribes test procedures and conditions using freshwater and marine algae to... definitions also apply to this guideline: (1) Algicidal means having the property of killing algae. (2... volumes of nutrient medium and/or test solution. Start the test by introducing algae into the test and...

40 CFR 797.1050 - Algal acute toxicity test.

Code of Federal Regulations, 2014 CFR

2014-07-01

... seq.). This guideline prescribes test procedures and conditions using freshwater and marine algae to... definitions also apply to this guideline: (1) Algicidal means having the property of killing algae. (2... volumes of nutrient medium and/or test solution. Start the test by introducing algae into the test and...

40 CFR 797.1050 - Algal acute toxicity test.

Code of Federal Regulations, 2011 CFR

2011-07-01

... seq.). This guideline prescribes test procedures and conditions using freshwater and marine algae to... definitions also apply to this guideline: (1) Algicidal means having the property of killing algae. (2... volumes of nutrient medium and/or test solution. Start the test by introducing algae into the test and...

Effects of Direct-to-Consumer Advertising and Clinical Guidelines on Appropriate Use of Human Papillomavirus DNA Tests

PubMed Central

2011-01-01

Background Both clinical guidelines and direct-to-consumer (DTC) advertising influence use of new health care technologies, but little is known about their relative effects. The introduction of a cervical cancer screening test in 2000 offered a unique opportunity to assess the two strategies. Objective To evaluate the effects of clinical guidelines and a targeted DTC advertising campaign on overall and appropriate use of human papillomavirus (HPV) DNA tests. Research Design Quasi-experimental study using difference-in-differences analysis. Data were MarketScan private insurance claims for 500,000 women ages 21 to 64 enrolled at least 12 consecutive months from January 2001 through December 2005. Results Both clinical guidelines and DTC advertising were associated with increases in overall HPV DNA test use. DTC advertising was associated with a statistically significant increase in HPV DNA test use in two groups of DTC cities (+5.57 percent, p<0.0001; +2.54 percent, p<0.0001). DTC advertising was associated with comparable increases in the probability of appropriate and inappropriate use of the HPV DNA test in primary screening. Clinical guideline releases from the American College of Obstetricians and Gynecologists, and by a co-sponsored panel, were associated with greater increases in HPV DNA tests for appropriate primary screening than for inappropriate primary screening (β=0.3347, p<0.05 and β=0.4175, p<0.01). Conclusions DTC advertising was associated with increased overall use of a cervical cancer screening test, while clinical guidelines were differentially associated with increased appropriate use. These findings suggest distinct influences of consumer marketing and professional guidelines on the use of health care products and services. PMID:21150798

Effects of direct-to-consumer advertising and clinical guidelines on appropriate use of human papillomavirus DNA tests.

PubMed

Price, Rebecca Anhang; Frank, Richard G; Cleary, Paul D; Goldie, Sue J

2011-02-01

Both clinical guidelines and direct-to-consumer (DTC) advertising influence the use of new health care technologies, but little is known about their relative effects. The introduction of a cervical cancer screening test in 2000 offered a unique opportunity to assess the 2 strategies. To evaluate the effects of clinical guidelines and a targeted DTC advertising campaign on overall and appropriate use of human papillomavirus (HPV) DNA tests. Quasi-experimental study using difference-in-differences analysis. Data were MarketScan private insurance claims for 500,000 women aged 21 to 64 enrolled at least 12 consecutive months from January 2001 through December 2005. Both clinical guidelines and DTC advertising were associated with increases in overall HPV DNA test use. DTC advertising was associated with a statistically significant increase in HPV DNA test use in 2 groups of DTC cities (+5.57%, P < 0.0001; +2.54%, P < 0.0001). DTC advertising was associated with comparable increases in the probability of appropriate and inappropriate use of the HPV DNA test in primary screening. Clinical guideline releases from the American College of Obstetricians and Gynecologists, and by a cosponsored panel, were associated with greater increases in HPV DNA tests for appropriate primary screening than for inappropriate primary screening (β = 0.3347, P < 0.05 and β = 0.4175, P < 0.01). DTC advertising was associated with increased overall use of a cervical cancer screening test, whereas clinical guidelines were differentially associated with increased appropriate use. These findings suggest distinct influences of consumer marketing and professional guidelines on the use of health care products and services.

The P-38 Lightning Aircraft: Lessons Learned for Future Weapon Systems Development

DTIC Science & Technology

2010-04-01

PMBOK TEL \\ u.s. WER List of ~cronyms iv Brake Horse Power Design-Build Team District of Columbia Department of Defense Department of...record. Despite unresolved issues like the flap and brake system problems and limited test hours, on 11 February 1939, Lieutenant Kelsey flew the XP-38...engine, giving the P-3 8 engines a 1425 brake horse power (BHP)22 rating. However, limitations of the integral wing leading edge intercoolers23 could

21 CFR 350.60 - Guidelines for effectiveness testing of antiperspirant drug products.

Code of Federal Regulations, 2010 CFR

2010-04-01

.... These guidelines are on file in the Dockets Management Branch (HFA-305), Food and Drug Administration... 21 Food and Drugs 5 2010-04-01 2010-04-01 false Guidelines for effectiveness testing of antiperspirant drug products. 350.60 Section 350.60 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF...

Test Guideline Methods for Bed Bug Pesticide Products Now Available

EPA Pesticide Factsheets

EPA’s final test guidelines, 810.3900 - Laboratory Product Performance Testing Methods for Bed Bug Pesticide Products, provides recommendations for the design and execution of laboratory studies to evaluate the performance of pesticide products.

Proceedings of the Guidelines for Seismometer Testing Workshop, Albuquerque, New Mexico, 9-10 May 2005 ("GST2")

USGS Publications Warehouse

Hutt, Charles R.; Nigbor, Robert L.; Evans, John R.

2009-01-01

Testing and specification of seismic and earthquake-engineering sensors and recorders has been marked by significant variations in procedures and selected parameters. These variations cause difficulty in comparing such specifications and test results. In July 1989, and again in May 2005, the U.S. Geological Survey hosted international public/private workshops with the goal of defining widely accepted guidelines for the testing of seismological inertial sensors, seismometers, and accelerometers. This document reports the Proceedings of the 2005 workshop and includes as Appendix 6 the report of the 1989 workshop. In a future document, we will attempt to collate and rationalize a single set of formal guidelines for testing and specifying seismic sensors, supplementing Advanced National Seismic System (ANSS) guidelines on instrumentation likely used by ANSS as its standard for verification, acceptance, and intermittent testing, as well as for responses to ANSS instrument requisitions.

Chemistry on the mesoscale: Modeling and measurement issues

NASA Technical Reports Server (NTRS)

Thompson, Anne; Pleim, John; Walcek, Christopher; Ching, Jason; Binkowski, Frank; Tao, Wei-Kuo; Dickerson, Russell; Pickering, Kenneth

1993-01-01

The topics covered include the following: Regional Acid Deposition Model (RADM) -- a coupled chemistry/mesoscale model; convection in RADM; unresolved issues for mesoscale modeling with chemistry -- nonprecipitating clouds; unresolved issues for mesoscale modeling with chemistry -- aerosols; tracer studies with Goddard Cumulus Ensemble Model (GCEM); field observations of trace gas transport in convection; and photochemical consequences of convection.

A Comparison of Unresolved Versus Resolved Status and Its Relationship to Behaviour in Maltreated Adolescents

ERIC Educational Resources Information Center

Webster, Linda; Hackett, Rachelle Kisst

2007-01-01

This exploratory investigation sought both to gain a better understanding of the mental representations of attachment in high-risk, maltreated adolescents and to explain how, if at all, unresolved attachment representations are related to behavioural maladjustment. Parent ratings, self-report ratings and attachment state of mind were obtained from…

NATURE OF UNRESOLVED COMPLEX MIXTURE IN SIZE-DISTRIBUTED EMISSIONS FROM RESIDENTIAL WOOD COMBUSTION AS MEASURED BY THERMAL DESORPTION-GAS CHROMATOGRAPHY-MASS SPECTROMETRY

EPA Science Inventory

In this study, the unresolved complex mixture (UCM) in size resolved fine aerosol emissions from residential wood combustion (RWC) is examined. The aerosols are sorted by size in an electrical low-pressure impactor (ELPI) and subsequently analyzed by thermal desorbtion/gas chroma...

National Technology Standards for K-12 Schools: A Case Study of Unresolved Issues in Public Relations

ERIC Educational Resources Information Center

Mullen, Carol A.; Kealy, William A.; Sullivan, Ashley

2004-01-01

This article addresses an important need--the dissemination of information relating to technology as a public relations tool--and the associated exigency for administrator and teacher technology training. Specifically, we identify the increased expectations for the performance of school leaders and teachers, as well as unresolved issues in public…

Multi-scale imaging and elastic simulation of carbonates

NASA Astrophysics Data System (ADS)

Faisal, Titly Farhana; Awedalkarim, Ahmed; Jouini, Mohamed Soufiane; Jouiad, Mustapha; Chevalier, Sylvie; Sassi, Mohamed

2016-05-01

Digital Rock Physics (DRP) is an emerging technology that can be used to generate high quality, fast and cost effective special core analysis (SCAL) properties compared to conventional experimental techniques and modeling techniques. The primary workflow of DRP conssits of three elements: 1) image the rock sample using high resolution 3D scanning techniques (e.g. micro CT, FIB/SEM), 2) process and digitize the images by segmenting the pore and matrix phases 3) simulate the desired physical properties of the rocks such as elastic moduli and velocities of wave propagation. A Finite Element Method based algorithm, that discretizes the basic Hooke's Law equation of linear elasticity and solves it numerically using a fast conjugate gradient solver, developed by Garboczi and Day [1] is used for mechanical and elastic property simulations. This elastic algorithm works directly on the digital images by treating each pixel as an element. The images are assumed to have periodic constant-strain boundary condition. The bulk and shear moduli of the different phases are required inputs. For standard 1.5" diameter cores however the Micro-CT scanning reoslution (around 40 μm) does not reveal smaller micro- and nano- pores beyond the resolution. This results in an unresolved "microporous" phase, the moduli of which is uncertain. Knackstedt et al. [2] assigned effective elastic moduli to the microporous phase based on self-consistent theory (which gives good estimation of velocities for well cemented granular media). Jouini et al. [3] segmented the core plug CT scan image into three phases and assumed that micro porous phase is represented by a sub-extracted micro plug (which too was scanned using Micro-CT). Currently the elastic numerical simulations based on CT-images alone largely overpredict the bulk, shear and Young's modulus when compared to laboratory acoustic tests of the same rocks. For greater accuracy of numerical simulation prediction, better estimates of moduli inputs for this current unresolved phase is important. In this work we take a multi-scale imaging approach by first extracting a smaller 0.5" core and scanning at approx 13 µm, then further extracting a 5mm diameter core scanned at 5 μm. From this last scale, region of interests (containing unresolved areas) are identified for scanning at higher resolutions using Focalised Ion Beam (FIB/SEM) scanning technique reaching 50 nm resolution. Numerical simulation is run on such a small unresolved section to obtain a better estimate of the effective moduli which is then used as input for simulations performed using CT-images. Results are compared with expeirmental acoustic test moduli obtained also at two scales: 1.5" and 0.5" diameter cores.

A subtraction scheme for computing QCD jet cross sections at NNLO: integrating the iterated singly-unresolved subtraction terms

NASA Astrophysics Data System (ADS)

Bolzoni, Paolo; Somogyi, Gábor; Trócsányi, Zoltán

2011-01-01

We perform the integration of all iterated singly-unresolved subtraction terms, as defined in ref. [1], over the two-particle factorized phase space. We also sum over the unresolved parton flavours. The final result can be written as a convolution (in colour space) of the Born cross section and an insertion operator. We spell out the insertion operator in terms of 24 basic integrals that are defined explicitly. We compute the coefficients of the Laurent expansion of these integrals in two different ways, with the method of Mellin-Barnes representations and sector decomposition. Finally, we present the Laurent-expansion of the full insertion operator for the specific examples of electron-positron annihilation into two and three jets.

Test Analysis Guidelines

NASA Technical Reports Server (NTRS)

Jeng, Frank F.

2007-01-01

Development of analysis guidelines for Exploration Life Support (ELS) technology tests was completed. The guidelines were developed based on analysis experiences gained from supporting Environmental Control and Life Support System (ECLSS) technology development in air revitalization systems and water recovery systems. Analyses are vital during all three phases of the ELS technology test: pre-test, during test and post test. Pre-test analyses of a test system help define hardware components, predict system and component performances, required test duration, sampling frequencies of operation parameters, etc. Analyses conducted during tests could verify the consistency of all the measurements and the performance of the test system. Post test analyses are an essential part of the test task. Results of post test analyses are an important factor in judging whether the technology development is a successful one. In addition, development of a rigorous model for a test system is an important objective of any new technology development. Test data analyses, especially post test data analyses, serve to verify the model. Test analyses have supported development of many ECLSS technologies. Some test analysis tasks in ECLSS technology development are listed in the Appendix. To have effective analysis support for ECLSS technology tests, analysis guidelines would be a useful tool. These test guidelines were developed based on experiences gained through previous analysis support of various ECLSS technology tests. A comment on analysis from an experienced NASA ECLSS manager (1) follows: "Bad analysis was one that bent the test to prove that the analysis was right to begin with. Good analysis was one that directed where the testing should go and also bridged the gap between the reality of the test facility and what was expected on orbit."

Protocol for Atomic Oxygen Testing of Materials in Ground-Based Facilities. No. 2

NASA Technical Reports Server (NTRS)

Minton, Timothy K.

1995-01-01

A second version of standard guidelines is proposed for improving materials testing in ground-based atomic oxygen environments for the purpose of predicting the durability of the tested materials in low Earth orbit (LEO). Accompanying these guidelines are background information and notes about testing. Both the guidelines and the additional information are intended to aid users who wish to evaluate the potential hazard of atomic oxygen in LEO to a candidate space component without actually flying the component in space, and to provide a framework for more consistent atomic oxygen testing in the future.

Progress Towards the Development of a Fathead Minnow Embryo Test and Comparison to the Zebrafish Embryo Test for Assessing Acute Fish Toxicity

EPA Science Inventory

The Zebrafish Embryo Test (ZFET) for acute fish toxicity is a well developed method nearing adoption as an OECD Test Guideline. Early drafts of the test guideline (TG) envisioned a suite of potential test species to be covered including zebrafish, fathead minnow, Japanese Medaka...

X-exome sequencing of 405 unresolved families identifies seven novel intellectual disability genes.

PubMed

Hu, H; Haas, S A; Chelly, J; Van Esch, H; Raynaud, M; de Brouwer, A P M; Weinert, S; Froyen, G; Frints, S G M; Laumonnier, F; Zemojtel, T; Love, M I; Richard, H; Emde, A-K; Bienek, M; Jensen, C; Hambrock, M; Fischer, U; Langnick, C; Feldkamp, M; Wissink-Lindhout, W; Lebrun, N; Castelnau, L; Rucci, J; Montjean, R; Dorseuil, O; Billuart, P; Stuhlmann, T; Shaw, M; Corbett, M A; Gardner, A; Willis-Owen, S; Tan, C; Friend, K L; Belet, S; van Roozendaal, K E P; Jimenez-Pocquet, M; Moizard, M-P; Ronce, N; Sun, R; O'Keeffe, S; Chenna, R; van Bömmel, A; Göke, J; Hackett, A; Field, M; Christie, L; Boyle, J; Haan, E; Nelson, J; Turner, G; Baynam, G; Gillessen-Kaesbach, G; Müller, U; Steinberger, D; Budny, B; Badura-Stronka, M; Latos-Bieleńska, A; Ousager, L B; Wieacker, P; Rodríguez Criado, G; Bondeson, M-L; Annerén, G; Dufke, A; Cohen, M; Van Maldergem, L; Vincent-Delorme, C; Echenne, B; Simon-Bouy, B; Kleefstra, T; Willemsen, M; Fryns, J-P; Devriendt, K; Ullmann, R; Vingron, M; Wrogemann, K; Wienker, T F; Tzschach, A; van Bokhoven, H; Gecz, J; Jentsch, T J; Chen, W; Ropers, H-H; Kalscheuer, V M

2016-01-01

X-linked intellectual disability (XLID) is a clinically and genetically heterogeneous disorder. During the past two decades in excess of 100 X-chromosome ID genes have been identified. Yet, a large number of families mapping to the X-chromosome remained unresolved suggesting that more XLID genes or loci are yet to be identified. Here, we have investigated 405 unresolved families with XLID. We employed massively parallel sequencing of all X-chromosome exons in the index males. The majority of these males were previously tested negative for copy number variations and for mutations in a subset of known XLID genes by Sanger sequencing. In total, 745 X-chromosomal genes were screened. After stringent filtering, a total of 1297 non-recurrent exonic variants remained for prioritization. Co-segregation analysis of potential clinically relevant changes revealed that 80 families (20%) carried pathogenic variants in established XLID genes. In 19 families, we detected likely causative protein truncating and missense variants in 7 novel and validated XLID genes (CLCN4, CNKSR2, FRMPD4, KLHL15, LAS1L, RLIM and USP27X) and potentially deleterious variants in 2 novel candidate XLID genes (CDK16 and TAF1). We show that the CLCN4 and CNKSR2 variants impair protein functions as indicated by electrophysiological studies and altered differentiation of cultured primary neurons from Clcn4(-/-) mice or after mRNA knock-down. The newly identified and candidate XLID proteins belong to pathways and networks with established roles in cognitive function and intellectual disability in particular. We suggest that systematic sequencing of all X-chromosomal genes in a cohort of patients with genetic evidence for X-chromosome locus involvement may resolve up to 58% of Fragile X-negative cases.

X-exome sequencing of 405 unresolved families identifies seven novel intellectual disability genes

PubMed Central

Hu, H; Haas, S A; Chelly, J; Van Esch, H; Raynaud, M; de Brouwer, A P M; Weinert, S; Froyen, G; Frints, S G M; Laumonnier, F; Zemojtel, T; Love, M I; Richard, H; Emde, A-K; Bienek, M; Jensen, C; Hambrock, M; Fischer, U; Langnick, C; Feldkamp, M; Wissink-Lindhout, W; Lebrun, N; Castelnau, L; Rucci, J; Montjean, R; Dorseuil, O; Billuart, P; Stuhlmann, T; Shaw, M; Corbett, M A; Gardner, A; Willis-Owen, S; Tan, C; Friend, K L; Belet, S; van Roozendaal, K E P; Jimenez-Pocquet, M; Moizard, M-P; Ronce, N; Sun, R; O'Keeffe, S; Chenna, R; van Bömmel, A; Göke, J; Hackett, A; Field, M; Christie, L; Boyle, J; Haan, E; Nelson, J; Turner, G; Baynam, G; Gillessen-Kaesbach, G; Müller, U; Steinberger, D; Budny, B; Badura-Stronka, M; Latos-Bieleńska, A; Ousager, L B; Wieacker, P; Rodríguez Criado, G; Bondeson, M-L; Annerén, G; Dufke, A; Cohen, M; Van Maldergem, L; Vincent-Delorme, C; Echenne, B; Simon-Bouy, B; Kleefstra, T; Willemsen, M; Fryns, J-P; Devriendt, K; Ullmann, R; Vingron, M; Wrogemann, K; Wienker, T F; Tzschach, A; van Bokhoven, H; Gecz, J; Jentsch, T J; Chen, W; Ropers, H-H; Kalscheuer, V M

2016-01-01

X-linked intellectual disability (XLID) is a clinically and genetically heterogeneous disorder. During the past two decades in excess of 100 X-chromosome ID genes have been identified. Yet, a large number of families mapping to the X-chromosome remained unresolved suggesting that more XLID genes or loci are yet to be identified. Here, we have investigated 405 unresolved families with XLID. We employed massively parallel sequencing of all X-chromosome exons in the index males. The majority of these males were previously tested negative for copy number variations and for mutations in a subset of known XLID genes by Sanger sequencing. In total, 745 X-chromosomal genes were screened. After stringent filtering, a total of 1297 non-recurrent exonic variants remained for prioritization. Co-segregation analysis of potential clinically relevant changes revealed that 80 families (20%) carried pathogenic variants in established XLID genes. In 19 families, we detected likely causative protein truncating and missense variants in 7 novel and validated XLID genes (CLCN4, CNKSR2, FRMPD4, KLHL15, LAS1L, RLIM and USP27X) and potentially deleterious variants in 2 novel candidate XLID genes (CDK16 and TAF1). We show that the CLCN4 and CNKSR2 variants impair protein functions as indicated by electrophysiological studies and altered differentiation of cultured primary neurons from Clcn4−/− mice or after mRNA knock-down. The newly identified and candidate XLID proteins belong to pathways and networks with established roles in cognitive function and intellectual disability in particular. We suggest that systematic sequencing of all X-chromosomal genes in a cohort of patients with genetic evidence for X-chromosome locus involvement may resolve up to 58% of Fragile X-negative cases. PMID:25644381

A guideline for heavy ion radiation testing for Single Event Upset (SEU)

NASA Technical Reports Server (NTRS)

Nichols, D. K.; Price, W. E.; Malone, C.

1984-01-01

A guideline for heavy ion radiation testing for single event upset was prepared to assist new experimenters in preparing and directing tests. How to estimate parts vulnerability and select an irradiation facility is described. A broad brush description of JPL equipment is given, certain necessary pre-test procedures are outlined and the roles and testing guidelines for on-site test personnel are indicated. Detailed descriptions of equipment needed to interface with JPL test crew and equipment are not provided, nor does it meet the more generalized and broader requirements of a MIL-STD document. A detailed equipment description is available upon request, and a MIL-STD document is in the early stages of preparation.

Revisiting sweat chloride test results based on recent guidelines for diagnosis of cystic fibrosis.

PubMed

Pagaduan, Jayson V; Ali, Mahesheema; Dowlin, Michael; Suo, Liye; Ward, Tabitha; Ruiz, Fadel; Devaraj, Sridevi

2018-03-01

Recent sweat chloride guidelines published by the Cystic Fibrosis Foundation changed the intermediate sweat chloride concentration range from 40-59 mmol/L to 30-59 mmol/L for age > 6 months. We wanted to know how this new guideline would impact detection of cystic fibrosis among patients who previously had sweat tests done at Texas Children's Hospital. We revisited sweat chloride test results (n = 3012) in the last 5 years at Texas Children's Hospital based on the new guidelines on diagnosis of cystic fibrosis from the Cystic Fibrosis Foundation. We identified 125 patients that would be reclassified in the intermediate sweat chloride value with the new guidelines that were classified as "unlikely to have CF" in the previous guidelines. 8 (32%) patients with CFTR gene testing were positive for CFTR gene mutation(s). 4 (50%) of these patients were identified to have 2 CFTR mutations. One had variant combination that was reported to cause CF but all were diagnosed with CFTR-related metabolic syndrome. Our findings concur with the new CF diagnosis guidelines that changing the intermediate cut-off to 30-59 mmol/L sweat chloride concentration in combination with CFTR genetic analysis enhances the probability of identifying individuals that have risk of developing CF or have CF and enables for earlier therapeutic intervention.

Pre-implementation guidelines for infectious disease point-of-care testing in medical institutions.

PubMed

van der Eijk, Annemiek A; Tintu, Andrei N; Hays, John P

2017-01-01

Infectious disease point-of-care test (ID-POCT) devices are becoming widely available, and in this respect, international quality standards and guidelines are available for consultation once ID-POCT has been implemented into medical institutions. However, specific guidelines for consultation during the initial pre-implementation decision-making process are currently lacking. Further, there exist pre-implementation issues specific to ID-POCT. Here we present pre-implementation guidelines for consultation when considering the implementation of ID-POCT in medical institutions.

A Novel Approach to Improving Utilization of Laboratory Testing.

PubMed

Zhou, Yaolin; Procop, Gary W; Riley, Jacquelyn D

2018-02-01

- The incorporation of best practice guidelines into one's institution is a challenging goal of utilization management, and the successful adoption of such guidelines depends on institutional context. Laboratorians who have access to key clinical data are well positioned to understand existing local practices and promote more appropriate laboratory testing. - To apply a novel approach to utilization management by reviewing international clinical guidelines and current institutional practices to create a reliable mechanism to improve detection and reduce unnecessary tests in our patient population. - We targeted a frequently ordered genetic test for HFE-related hereditary hemochromatosis, a disorder of low penetrance. After reviewing international practice guidelines, we evaluated 918 HFE tests and found that all patients with new diagnoses had transferrin saturation levels that were significantly higher than those of patients with nonrisk genotypes (72% versus 42%; P < .001). - Our "one-button" order that restricts HFE genetic tests to patients with transferrin saturation greater than 45% is consistent with published practice guidelines and detected 100% of new patients with HFE-related hereditary hemochromatosis. - Our proposed algorithm differs from previously published approaches in that it incorporates both clinical practice guidelines and local physician practices, yet requires no additional hands-on effort from pathologists or clinicians. This novel approach to utilization management embraces the role of pathologists as leaders in promoting high-quality patient care in local health care systems.

Quality in genetic counselling for presymptomatic testing--clinical guidelines for practice across the range of genetic conditions.

PubMed

Skirton, Heather; Goldsmith, Lesley; Jackson, Leigh; Tibben, Aad

2013-03-01

Presymptomatic testing (PST) is the performance of a genetic test on an asymptomatic individual at risk of a condition to determine whether the person has inherited the disease-causing mutation. Although relevant guidelines exist for specific diseases, there is no overarching protocol that can be adapted to any disorder or clinical setting in which such testing is offered. The objective of this European project was to develop a set of coherent guidelines for PST (for adult-onset monogenic conditions) for use by health professionals working in a range of disciplines, countries or contexts. To ensure the guidelines were appropriate and practice based, we organised a workshop attended by an expert group of practitioners with relevant health professional backgrounds from 11 countries. Models of service for offering PST were presented, the group then discussed different aspects of testing and the standard of care required to ensure that patients were prepared to make decisions and deal with results and consequences. After the workshop, several rounds of consultation were used with a wider group of professionals to refine the guidelines. The guidelines include general principles governing the offer of testing (eg, autonomous choice of the patient), objectives of genetic counselling in this context (eg, facilitation of decision making), logistical considerations (eg, use of trained staff) and topics to be included during counselling discussion with the patient (eg, consequences of both positive and negative outcomes). We recommend the adoption of these guidelines to provide an equitable structure for those seeking PST in any country.

Best practice guidelines for the molecular genetic diagnosis of Type 1 (HFE-related) hereditary haemochromatosis

PubMed Central

King, Caitriona; Barton, David E

2006-01-01

Background Hereditary haemochromatosis (HH) is a recessively-inherited disorder of iron over-absorption prevalent in Caucasian populations. Affected individuals for Type 1 HH are usually either homozygous for a cysteine to tyrosine amino acid substitution at position 282 (C282Y) of the HFE gene, or compound heterozygotes for C282Y and for a histidine to aspartic acid change at position 63 (H63D). Molecular genetic testing for these two mutations has become widespread in recent years. With diverse testing methods and reporting practices in use, there was a clear need for agreed guidelines for haemochromatosis genetic testing. The UK Clinical Molecular Genetics Society has elaborated a consensus process for the development of disease-specific best practice guidelines for genetic testing. Methods A survey of current practice in the molecular diagnosis of haemochromatosis was conducted. Based on the results of this survey, draft guidelines were prepared using the template developed by UK Clinical Molecular Genetics Society. A workshop was held to develop the draft into a consensus document. The consensus document was then posted on the Clinical Molecular Genetics Society website for broader consultation and amendment. Results Consensus or near-consensus was achieved on all points in the draft guidelines. The consensus and consultation processes worked well, and outstanding issues were documented in an appendix to the guidelines. Conclusion An agreed set of best practice guidelines were developed for diagnostic, predictive and carrier testing for hereditary haemochromatosis and for reporting the results of such testing. PMID:17134494

40 CFR 797.1330 - Daphnid chronic toxicity test.

Code of Federal Regulations, 2010 CFR

2010-07-01

... an extended period of time. In this test guideline, mortality and reproduction (and optionally... exposure over a specified period of time. In this guideline, the effect measured is immobilization. (4..., wet weight) to the volume (liters) of test solution in a test chamber at a point in time or passing...

78 FR 59946 - Current List of Laboratories and Instrumented Initial Testing Facilities Which Meet Minimum...

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2013-09-30

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76 FR 161 - Current List of Laboratories and Instrumented Initial Testing Facilities Which Meet Minimum...

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78 FR 72684 - Current List of Laboratories and Instrumented Initial Testing Facilities Which Meet Minimum...

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76 FR 31969 - Current List of Laboratories and Instrumented Initial Testing Facilities Which Meet Minimum...

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75 FR 67749 - Current List of Laboratories and Instrumented Initial Testing Facilities Which Meet Minimum...

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78 FR 66034 - Current List of Laboratories and Instrumented Initial Testing Facilities Which Meet Minimum...

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77 FR 5037 - Current List of Laboratories and Instrumented Initial Testing Facilities Which Meet Minimum...

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76 FR 75889 - Current List of Laboratories and Instrumented Initial Testing Facilities Which Meet Minimum...

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... Engage in Urine Drug Testing for Federal Agencies AGENCY: Substance Abuse and Mental Health Services... the standards of the Mandatory Guidelines for Federal Workplace Drug Testing Programs (Mandatory... ``Mandatory Guidelines for Federal Workplace Drug Testing Programs'', as amended in the revisions listed above...

77 FR 71605 - Current List of Laboratories and Instrumented Initial Testing Facilities Which Meet Minimum...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-12-03

... Engage in Urine Drug Testing for Federal Agencies AGENCY: Substance Abuse and Mental Health Services... the standards of the Mandatory Guidelines for Federal Workplace Drug Testing Programs (Mandatory... 100-71. The ``Mandatory Guidelines for Federal Workplace Drug Testing Programs'', as amended in the...

77 FR 39501 - Current List of Laboratories and Instrumented Initial Testing Facilities Which Meet Minimum...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-07-03

... Engage in Urine Drug Testing for Federal Agencies AGENCY: Substance Abuse and Mental Health Services... the standards of the Mandatory Guidelines for Federal Workplace Drug Testing Programs (Mandatory... ``Mandatory Guidelines for Federal Workplace Drug Testing Programs'', as amended in the revisions listed above...

78 FR 33429 - Current List of Laboratories and Instrumented Initial Testing Facilities Which Meet Minimum...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-04

... Engage in Urine Drug Testing for Federal Agencies AGENCY: Substance Abuse and Mental Health Services... the standards of the Mandatory Guidelines for Federal Workplace Drug Testing Programs (Mandatory... ``Mandatory Guidelines for Federal Workplace Drug Testing Programs'', as amended in the revisions listed above...

78 FR 25461 - Current List of Laboratories and Instrumented Initial Testing Facilities Which Meet Minimum...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-01

... Engage in Urine Drug Testing for Federal Agencies AGENCY: Substance Abuse and Mental Health Services... the standards of the Mandatory Guidelines for Federal Workplace Drug Testing Programs (Mandatory... ``Mandatory Guidelines for Federal Workplace Drug Testing Programs'', as amended in the revisions listed above...

77 FR 12862 - Current List of Laboratories and Instrumented Initial Testing Facilities Which Meet Minimum...

Federal Register 2010, 2011, 2012, 2013, 2014

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... Engage in Urine Drug Testing for Federal Agencies AGENCY: Substance Abuse and Mental Health Services... the standards of the Mandatory Guidelines for Federal Workplace Drug Testing Programs (Mandatory... ``Mandatory Guidelines for Federal Workplace Drug Testing Programs'', as amended in the revisions listed above...

78 FR 7795 - Current List of Laboratories and Instrumented Initial Testing Facilities Which Meet Minimum...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-04

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40 CFR 797.1330 - Daphnid chronic toxicity test.

Code of Federal Regulations, 2013 CFR

2013-07-01

... an extended period of time. In this test guideline, mortality and reproduction (and optionally... exposure over a specified period of time. In this guideline, the effect measured is immobilization. (4..., wet weight) to the volume (liters) of test solution in a test chamber at a point in time or passing...

40 CFR 797.1330 - Daphnid chronic toxicity test.

Code of Federal Regulations, 2014 CFR

2014-07-01

... an extended period of time. In this test guideline, mortality and reproduction (and optionally... exposure over a specified period of time. In this guideline, the effect measured is immobilization. (4..., wet weight) to the volume (liters) of test solution in a test chamber at a point in time or passing...

40 CFR 797.1330 - Daphnid chronic toxicity test.

Code of Federal Regulations, 2011 CFR

2011-07-01

... an extended period of time. In this test guideline, mortality and reproduction (and optionally... exposure over a specified period of time. In this guideline, the effect measured is immobilization. (4..., wet weight) to the volume (liters) of test solution in a test chamber at a point in time or passing...

40 CFR 797.1330 - Daphnid chronic toxicity test.

Code of Federal Regulations, 2012 CFR

2012-07-01

... an extended period of time. In this test guideline, mortality and reproduction (and optionally... exposure over a specified period of time. In this guideline, the effect measured is immobilization. (4..., wet weight) to the volume (liters) of test solution in a test chamber at a point in time or passing...

The Contribution of z < or Approx. 6 Sources to the Spatial Coherence in the Unresolved Cosmic Near-Infrared and X-Ray Backgrounds

NASA Technical Reports Server (NTRS)

Helgason, K.; Cappelluti, N.; Hasinger, G.; Kashlinsky, A.; Ricotti, M.

2014-01-01

A spatial clustering signal has been established in Spitzer/IRAC measurements of the unresolved cosmic near-infrared background (CIB) out to large angular scales, approx. 1deg. This CIB signal, while significantly exceeding the contribution from the remaining known galaxies, was further found to be coherent at a highly statistically significant level with the unresolved soft cosmic X-ray background (CXB). This measurement probes the unresolved CXB to very faint source levels using deep near-IR source subtraction.We study contributions from extragalactic populations at low to intermediate redshifts to the measured positive cross-power signal of the CIB fluctuations with the CXB. We model the X-ray emission from active galactic nuclei (AGNs), normal galaxies, and hot gas residing in virialized structures, calculating their CXB contribution including their spatial coherence with all infrared emitting counterparts. We use a halo model framework to calculate the auto and cross-power spectra of the unresolved fluctuations based on the latest constraints of the halo occupation distribution and the biasing of AGNs, galaxies, and diffuse emission. At small angular scales (1), the 4.5microns versus 0.5-2 keV coherence can be explained by shot noise from galaxies and AGNs. However, at large angular scales (approx.10), we find that the net contribution from the modeled populations is only able to account for approx. 3% of the measured CIB×CXB cross-power. The discrepancy suggests that the CIB×CXB signal originates from the same unknown source population producing the CIB clustering signal out to approx. 1deg.

Missed connections: Unintended consequences of updated cervical cancer screening guidelines on screening rates for sexually transmitted infections.

PubMed

Bogler, Tali; Farber, Allison; Stall, Nathan; Wijayasinghe, Sheila; Slater, Morgan; Guiang, Charlie; Glazier, Richard H

2015-10-01

To examine the effects of the updated 2012 cervical cancer screening guidelines on the rates of sexually transmitted infection (STI) screening in primary care. Retrospective chart review. Five academic family practice units at St Michael's Hospital in Toronto, Ont. Female patients, aged 19 to 25, who had at least 1 visit with a physician at 1 of the 5 academic family practice units during a 12-month period before (May 1, 2011, to April 30, 2012) or after (November 1, 2012, to October 31, 2013) the release of the updated guidelines. Number of women who received Papanicolaou tests or underwent STI screening; rates of STI screening performed during a Pap test or a periodic health examination; screening rates for HIV, syphilis, and hepatitis C; and the methods used for STI screening before and after the release of the updated guidelines. Results Before the release of the 2012 guidelines, 42 of 100 women had Pap tests and 40 of 100 women underwent STI screening. After the release of the guidelines, 17 of 100 women had Pap tests and 20 of 100 women received STI screening. Female patients were less likely to undergo STI screening under the 2012 guidelines compared with the 2005 guidelines (odds ratio 0.38, 95% CI 0.19 to 0.74; P = .003). Implementation of the 2012 cervical cancer screening guidelines was associated with lower rates of STI screening in the primary care setting. Primary care physicians should screen at-risk women for STIs at any clinically appropriate encounter and consider using noninvasive self-sampling methods.

Brain Networks for Working Memory and Factors of Intelligence Assessed in Males and Females with fMRI and DTI

ERIC Educational Resources Information Center

Tang, C. Y.; Eaves, E. L.; Ng, J. C.; Carpenter, D. M.; Mai, X.; Schroeder, D. H.; Condon, C. A.; Colom, R.; Haier, R. J.

2010-01-01

Neuro-imaging studies of intelligence implicate the importance of a parietal-frontal network. One unresolved issue is whether this network underlies a general factor of intelligence ("g") or other specific cognitive factors. A second unresolved issue is whether males and females use different parts of this network. Here we obtained intelligence…

[Attachment Representation and Emotion Regulation in Patients with Burnout Syndrome].

PubMed

Söllner, Wolfgang; Behringer, Johanna; Böhme, Stephanie; Stein, Barbara; Reiner, Iris; Spangler, Gottfried

2016-06-01

Burnout describes a syndrome of exhaustion resulting from insufficient coping with work-related distress. We investigated if patients that are being clinically treated for burnout show insecure and unresolved attachment representation more often compared with healthy controls. 50 out of 60 consecutive burnout patients participated in the study. Mental representation of attachment was measured by using the Adult Attachment Interview. Additionally, we administered the Self Report Questionnaire to Assess Emotional Experience and Emotion Regulation and several burnout specific questionnaires. A population sample was used as control group. Burnout patients were classified as insecurely attached significantly more often than controls. Unresolved attachment status concerning loss or trauma was found significantly more often within the burnout sample. Patients with insecure attachment representation reported a lower subjective significance of work. Patients with avoidant insecure attachment showed more depersonalisation. Patients with unresolved loss/trauma reported less social support. They showed more passive-negative emotion experience and emotion regulation characterized by externalization. The results of the study suggest that an insecure or unresolved attachment representation might constitute an intrapersonal risk factor for the development of burnout syndrome. © Georg Thieme Verlag KG Stuttgart · New York.

A sibling adoption study of adult attachment: The influence of shared environment on attachment states of mind

PubMed Central

Caspers, Kristin; Yucuis, Rebecca; Troutman, Beth; Arndt, Stephan; Langbehn, Douglas

2009-01-01

This study extends existing research investigating sibling concordance on attachment by examining concordance for adult attachment in a sample of 126 genetically unrelated sibling pairs. The Adult Attachment Interview (George, Kaplan, & Main, 1985; Main, Goldwyn, & Hesse, 2003) was used to assess states of mind with regard to attachment. The average age of the participants was 39 years old. The distribution of attachment classifications was independent of adoptive status. Attachment concordance rates were unassociated with gender concordance and sibling age difference. Concordance for autonomous/non-autonomous classifications was significant at 61% as was concordance for primary classifications at 53%. The concordance rate for not-unresolved/unresolved was non-significant at 67%. Our findings demonstrate similarity of working models of attachment between siblings independent of genetic relatedness between siblings and generations (i.e., parent and child). These findings extend previous research by further implicating shared environment as a major influence on sibling similarities on organized patterns of attachment in adulthood. The non-significant concordance for the unresolved classification suggests that unresolved loss or trauma may be less influenced by shared environment and more likely to be influenced by post-childhood experiences or genetic factors. PMID:18049934

A Review of the Centers for Disease Control and Prevention's Guidelines for the Clinical Laboratory Diagnosis of Lyme Disease.

PubMed

Miraglia, Caterina M

2016-12-01

The purpose of this paper is to review information regarding the current guidelines for the clinical laboratory diagnosis of Lyme disease as set forth by the Centers for Disease Control and Prevention (CDC) to chiropractic physicians and to discuss the clinical utility of this testing. The CDC's website was reviewed to determine what their current recommendations are for the clinical laboratory testing of Lyme disease. The CDC's established guidelines recommend the use of a 2-tiered serologic testing algorithm for the evaluation of patients with suspected Lyme disease. This review provides doctors of chiropractic with information to remain current with the CDC's recommended guidelines for Lyme disease testing because patients may present to their office with the associated signs and symptoms of Lyme disease.

Dispersed storage and generation case studies

NASA Technical Reports Server (NTRS)

Bahrami, K.; Stallkamp, J. A.; Walton, A.

1980-01-01

Three installations utilizing separate dispersed storage and generation (DSG) technologies were investigated. Each of the systems is described in costs and control. Selected institutional and environmental issues are discussed, including life cycle costs. No unresolved technical, environmental, or institutional problems were encountered in the installations. The wind and solar photovoltaic DSG were installed for test purposes, and appear to be presently uneconomical. However, a number of factors are decreasing the cost of DSG relative to conventional alternatives, and an increased DSG penetration level may be expected in the future.

Developmental Neurotoxicology: History and Outline of ...

EPA Pesticide Factsheets

The present work provides a brief review of basic concepts in developmental neurotoxicology, as well as current representative testing guidelines for evaluating developmental neurotoxicity (DNT) of xenobiotics. Historically, DNT was initially recognized as a “functional” teratogenicity: the main concern was that prenatal and/or early postnatal exposures to chemicals during critical periods of central nervous system (CNS) development would cause later functional abnormalities of the brain. Current internationally harmonized DNT study guidelines are thus intended to predict adverse effects of test compounds on the developing CNS by observing such postnatal parameters as motor activity, startle response, and learning and memory, as well as neropathological alterations. The reliability of current DNT study guidelines and sensitivity of testing methodologies recommended in these guidelines have been confirmed by retrospective evaluations of the many international and domestic collaborative validation studies in developed nations including Japan. Invited review with brief review of basic concepts in developmental neurotoxicology, as well as current representative testing guidelines for evaluating developmental neurotoxicity (DNT) of xenobiotics.

Revision of the ICH guideline on detection of toxicity to reproduction for medicinal products: SWOT analysis.

PubMed

Barrow, Paul

2016-09-01

SWOT analysis was used to gain insights and perspectives into the revision of the ICH S5(R2) guideline on detection of toxicity to reproduction for medicinal products. The current ICH guideline was rapidly adopted worldwide and has an excellent safety record for more than 20 years. The revised guideline should aim to further improve reproductive and developmental (DART) safety testing for new drugs. Alternative methods to animal experiments should be used whenever possible. Modern technology should be used to obtain high quality data from fewer animals. Additions to the guideline should include considerations on the following: limit dose setting, maternal toxicity, biopharmaceuticals, vaccines, testing strategies by indication, developmental immunotoxicity, and male-mediated developmental toxicity. Emerging issues, such as epigenetics and the microbiome, will most likely pose challenges to DART testing in the future. It is hoped that the new guideline will be adopted even outside the ICH regions. Copyright © 2016 Elsevier Inc. All rights reserved.

Systematic review of colorectal cancer screening guidelines for average-risk adults: Summarizing the current global recommendations.

PubMed

Bénard, Florence; Barkun, Alan N; Martel, Myriam; von Renteln, Daniel

2018-01-07

To summarize and compare worldwide colorectal cancer (CRC) screening recommendations in order to identify similarities and disparities. A systematic literature search was performed using MEDLINE, EMBASE, Scopus, CENTRAL and ISI Web of knowledge identifying all average-risk CRC screening guideline publications within the last ten years and/or position statements published in the last 2 years. In addition, a hand-search of the webpages of National Gastroenterology Society websites, the National Guideline Clearinghouse, the BMJ Clinical Evidence website, Google and Google Scholar was performed. Fifteen guidelines were identified. Six guidelines were published in North America, four in Europe, four in Asia and one from the World Gastroenterology Organization. The majority of guidelines recommend screening average-risk individuals between ages 50 and 75 using colonoscopy (every 10 years), or flexible sigmoidoscopy (FS, every 5 years) or fecal occult blood test (FOBT, mainly the Fecal Immunochemical Test, annually or biennially). Disparities throughout the different guidelines are found relating to the use of colonoscopy, rank order between test, screening intervals and optimal age ranges for screening. Average risk individuals between 50 and 75 years should undergo CRC screening. Recommendations for optimal surveillance intervals, preferred tests/test cascade as well as the optimal timing when to start and stop screening differ regionally and should be considered for clinical decision making. Furthermore, local resource availability and patient preferences are important to increase CRC screening uptake, as any screening is better than none.

Taking Ownership of the ITC's Guidelines for Computer-Based and Internet-Delivered Testing: A South African Application

ERIC Educational Resources Information Center

Foxcroft, Cheryl D.; Davies, Caroline

2006-01-01

The increased use of computer-based and Internet-delivered testing has raised a number of ethical and legal issues. The International Test Commission's (this issue) Guidelines for Computer-Based and Internet-Delivered Testing represent the most recent attempt to provide test users, publishers, and developers with guidance regarding the appropriate…

75 FR 16813 - Current List of Laboratories Which Meet Minimum Standards To Engage in Urine Drug Testing for...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-02

... Current List of Laboratories Which Meet Minimum Standards To Engage in Urine Drug Testing for Federal... Drug Testing Programs (Mandatory Guidelines). The Mandatory Guidelines were first published in the... of [[Page 16814

Investigating the physical and geometrical properties of the dusty torus in QSO

NASA Astrophysics Data System (ADS)

Martínez-Paredes, M.; González-Martín, O.; Aretxaga, I.; Alonso-Herrero, A.

2017-07-01

Usining mid-IR high angular resolution (0.3 arcsec) data from CanariCam on the 10.4m Gran Telescopio CANARIAS we study the mid-IR nuclear emission of a nearby (z<0.1) sample of QSOs. The QSOs are selected with N-band flux (fN>0.02 Jy) and hard X-ray flux (fX(2-10 keV)>1043 erg s-1). From the analysis of this data we find that the mid-IR emission is unresolved at scales of a few hundred of pc. We use unresolved emission at H-band (e.g., Veilleux et al. 2009b) and the IRS-Spitzer spectrum (e.g., Schweitzer et al. 2006) to build near- to mid-IR unresolved spectral energy distribution (SEDs).

Development and validation of an international appraisal instrument for assessing the quality of clinical practice guidelines: the AGREE project.

PubMed

2003-02-01

International interest in clinical practice guidelines has never been greater but many published guidelines do not meet the basic quality requirements. There have been renewed calls for validated criteria to assess the quality of guidelines. To develop and validate an international instrument for assessing the quality of the process and reporting of clinical practice guideline development. The instrument was developed through a multi-staged process of item generation, selection and scaling, field testing, and refinement procedures. 100 guidelines selected from 11 participating countries were evaluated independently by 194 appraisers with the instrument. Following refinement the instrument was further field tested on three guidelines per country by a new set of 70 appraisers. The final version of the instrument contained 23 items grouped into six quality domains with a 4 point Likert scale to score each item (scope and purpose, stakeholder involvement, rigour of development, clarity and presentation, applicability, editorial independence). 95% of appraisers found the instrument useful for assessing guidelines. Reliability was acceptable for most domains (Cronbach's alpha 0.64-0.88). Guidelines produced as part of an established guideline programme had significantly higher scores on editorial independence and, after the publication of a national policy, had significantly higher quality scores on rigour of development (p<0.005). Guidelines with technical documentation had higher scores on that domain (p<0.0001). This is the first time an appraisal instrument for clinical practice guidelines has been developed and tested internationally. The instrument is sensitive to differences in important aspects of guidelines and can be used consistently and easily by a wide range of professionals from different backgrounds. The adoption of common standards should improve the consistency and quality of the reporting of guideline development worldwide and provide a framework to encourage international comparison of clinical practice guidelines.

Is the time right for quantitative public health guidelines on sitting? A narrative review of sedentary behaviour research paradigms and findings.

PubMed

Stamatakis, Emmanuel; Ekelund, Ulf; Ding, Ding; Hamer, Mark; Bauman, Adrian E; Lee, I-Min

2018-06-10

Sedentary behaviour (SB) has been proposed as an 'independent' risk factor for chronic disease risk, attracting much research and media attention. Many countries have included generic, non-quantitative reductions in SB in their public health guidelines and calls for quantitative SB targets are increasing. The aim of this narrative review is to critically evaluate key evidence areas relating to the development of guidance on sitting for adults. We carried out a non-systematic narrative evidence synthesis across seven key areas: (1) definition of SB, (2) independence of sitting from physical activity, (3) use of television viewing as a proxy of sitting, (4) interpretation of SB evidence, (5) evidence on 'sedentary breaks', (6) evidence on objectively measured sedentary SB and mortality and (7) dose response of sitting and mortality/cardiovascular disease. Despite research progress, we still know little about the independent detrimental health effects of sitting, and the possibility that sitting is mostly the inverse of physical activity remains. Unresolved issues include an unclear definition, inconsistencies between mechanistic and epidemiological studies, over-reliance on surrogate outcomes, a very weak epidemiological evidence base to support the inclusion of 'sedentary breaks' in guidelines, reliance on self-reported sitting measures, and misinterpretation of data whereby methodologically inconsistent associations are claimed to be strong evidence. In conclusion, public health guidance requires a consistent evidence base but this is lacking for SB. The development of quantitative SB guidance, using an underdeveloped evidence base, is premature; any further recommendations for sedentary behaviour require development of the evidence base and refinement of the research paradigms used in the field. © 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.

40 CFR 797.1950 - Mysid shrimp chronic toxicity test.

Code of Federal Regulations, 2011 CFR

2011-07-01

... control and treatment groups. This time cannot be specified because of possible delays in sexual... control groups; PCONTROL ACT (CONTINUED) ENVIRONMENTAL EFFECTS TESTING GUIDELINES Aquatic Guidelines § 797.1950...

40 CFR 797.1950 - Mysid shrimp chronic toxicity test.

Code of Federal Regulations, 2012 CFR

2012-07-01

... control and treatment groups. This time cannot be specified because of possible delays in sexual... control groups; PCONTROL ACT (CONTINUED) ENVIRONMENTAL EFFECTS TESTING GUIDELINES Aquatic Guidelines § 797.1950...

40 CFR 797.1950 - Mysid shrimp chronic toxicity test.

Code of Federal Regulations, 2013 CFR

2013-07-01

... control and treatment groups. This time cannot be specified because of possible delays in sexual... control groups; PCONTROL ACT (CONTINUED) ENVIRONMENTAL EFFECTS TESTING GUIDELINES Aquatic Guidelines § 797.1950...

40 CFR 797.1950 - Mysid shrimp chronic toxicity test.

Code of Federal Regulations, 2014 CFR

2014-07-01

... control and treatment groups. This time cannot be specified because of possible delays in sexual... control groups; PCONTROL ACT (CONTINUED) ENVIRONMENTAL EFFECTS TESTING GUIDELINES Aquatic Guidelines § 797.1950...

Receipt of Glucose Testing and Performance of Two US Diabetes Screening Guidelines, 2007–2012

PubMed Central

Bullard, Kai McKeever; Ali, Mohammed K.; Imperatore, Giuseppina; Geiss, Linda S.; Saydah, Sharon H.; Albu, Jeanine B.; Cowie, Catherine C.; Sohler, Nancy; Albright, Ann; Gregg, Edward W.

2015-01-01

Background Screening guidelines are used to help identify prediabetes and diabetes before implementing evidence-based prevention and treatment interventions. We examined screening practices benchmarking against two US guidelines, and the capacity of each guideline to identify dysglycemia. Methods Using 2007–2012 National Health and Nutrition Examination Surveys, we analyzed nationally-representative, cross-sectional data from 5,813 fasting non-pregnant adults aged ≥20 years without self-reported diabetes. We examined proportions of adults eligible for diagnostic glucose testing and those who self-reported receiving testing in the past three years, as recommended by the American Diabetes Association (ADA) and the US Preventive Services Task Force (USPSTF-2008) guidelines. For each screening guideline, we also assessed sensitivity, specificity, and positive (PPV) and negative predictive values in identifying dysglycemia (defined as fasting plasma glucose ≥100 mg/dl or hemoglobin A1c ≥5.7%). Results In 2007–2012, 73.0% and 23.7% of US adults without diagnosed diabetes met ADA and USPSTF-2008 criteria for screening, respectively; and 91.5% had at least one major risk factor for diabetes. Of those ADA- or USPSTF-eligible adults, about 51% reported being tested within the past three years. Eligible individuals not tested were more likely to be lower educated, poorer, uninsured, or have no usual place of care compared to tested eligible adults. Among adults with ≥1 major risk factor, 45.7% reported being tested, and dysglycemia yields (i.e., PPV) ranged from 45.8% (high-risk ethnicity) to 72.6% (self-reported prediabetes). ADA criteria and having any risk factor were more sensitive than the USPSTF-2008 guideline (88.8–97.7% vs. 31.0%) but less specific (13.5–39.7% vs. 82.1%) in recommending glucose testing, resulting in lower PPVs (47.7–54.4% vs. 58.4%). Conclusion Diverging recommendations and variable performance of different guidelines may be impeding national diabetes prevention and treatment efforts. Efforts to align screening recommendations may result in earlier identification of adults at high risk for prediabetes and diabetes. PMID:25928306

77 FR 126 - Current List of Laboratories and Instrumented Initial Testing Facilities Which Meet Minimum...

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2012-01-03

... Engage in Urine Drug Testing for Federal Agencies AGENCY: Substance Abuse and Mental Health Services... certified to meet the standards of the Mandatory Guidelines for Federal Workplace Drug Testing Programs... ``Mandatory Guidelines for Federal Workplace Drug Testing Programs'', as amended in the revisions listed above...

75 FR 39023 - Current List of Laboratories Which Meet Minimum Standards To Engage in Urine Drug Testing for...

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... Current List of Laboratories Which Meet Minimum Standards To Engage in Urine Drug Testing for Federal... Drug Testing Programs (Mandatory Guidelines). The Mandatory Guidelines were first published in the... of Laboratories Engaged in Urine Drug Testing for Federal Agencies,'' sets strict standards that...

75 FR 27348 - Current List of Laboratories Which Meet Minimum Standards To Engage in Urine Drug Testing for...

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... Current List of Laboratories Which Meet Minimum Standards To Engage in Urine Drug Testing for Federal... Drug Testing Programs (Mandatory Guidelines). The Mandatory Guidelines were first published in the... of Laboratories Engaged in Urine Drug Testing for Federal Agencies,'' sets strict standards that...

75 FR 9229 - Current List of Laboratories Which Meet Minimum Standards To Engage in Urine Drug Testing for...

Federal Register 2010, 2011, 2012, 2013, 2014

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... Current List of Laboratories Which Meet Minimum Standards To Engage in Urine Drug Testing for Federal... Drug Testing Programs (Mandatory Guidelines). The Mandatory Guidelines were first published in the... of Laboratories Engaged in Urine Drug Testing for Federal Agencies,'' sets strict standards that...

75 FR 5088 - Current List of Laboratories Which Meet Minimum Standards To Engage in Urine Drug Testing for...

Federal Register 2010, 2011, 2012, 2013, 2014

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... Current List of Laboratories Which Meet Minimum Standards To Engage in Urine Drug Testing for Federal... Drug Testing Programs (Mandatory Guidelines). The Mandatory Guidelines were first published in the... of Laboratories Engaged in Urine Drug Testing for Federal Agencies,'' sets strict standards that...

75 FR 154 - Current List of Laboratories Which Meet Minimum Standards To Engage in Urine Drug Testing for...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-01-04

... Current List of Laboratories Which Meet Minimum Standards To Engage in Urine Drug Testing for Federal... Drug Testing Programs (Mandatory Guidelines). The Mandatory Guidelines were first published in the... of Laboratories Engaged in Urine Drug Testing for Federal Agencies,'' sets strict standards that...

75 FR 45128 - Current List of Laboratories Which Meet Minimum Standards To Engage in Urine Drug Testing for...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-02

... Current List of Laboratories Which Meet Minimum Standards To Engage in Urine Drug Testing for Federal... Drug Testing Programs (Mandatory Guidelines). The Mandatory Guidelines were first published in the..., ``Certification of Laboratories Engaged in Urine Drug Testing for Federal Agencies,'' sets strict standards that...

75 FR 32950 - Current List of Laboratories Which Meet Minimum Standards To Engage in Urine Drug Testing for...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-10

... Current List of Laboratories Which Meet Minimum Standards To Engage in Urine Drug Testing for Federal... Drug Testing Programs (Mandatory Guidelines). The Mandatory Guidelines were first published in the... of Laboratories Engaged in Urine Drug Testing for Federal Agencies,'' sets strict standards that...

75 FR 55795 - Current List of Laboratories Which Meet Minimum Standards To Engage in Urine Drug Testing for...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-09-14

... Current List of Laboratories Which Meet Minimum Standards To Engage in Urine Drug Testing for Federal... Drug Testing Programs (Mandatory Guidelines). The Mandatory Guidelines were first published in the... of Laboratories Engaged in Urine Drug Testing for Federal Agencies,'' sets strict standards that...

Revision of OECD Guidelines for Genotoxicity Testing: Current Status and Next Steps

EPA Science Inventory

Over the past 30 years, assays have been developed to evaluate chemical genotoxicity. OECD Genotoxicity Test Guidelines (TG) describe assay procedures for regulatory safety testing. Since the last OECD TG revision (1997), there has been tremendous scientific and technological pro...

Do the Guideline Violations Influence Test Difficulty of High-Stake Test?: An Investigation on University Entrance Examination in Turkey

ERIC Educational Resources Information Center

Atalmis, Erkan Hasan

2016-01-01

Multiple-choice (MC) items are commonly used in high-stake tests. Thus, each item of such tests should be meticulously constructed to increase the accuracy of decisions based on test results. Haladyna and his colleagues (2002) addressed the valid item-writing guidelines to construct high quality MC items in order to increase test reliability and…

Operability test report for the in SITU vapor sampling

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

Corbett, J.E., Westinghouse Hanford

1996-05-31

This report documents the successful completion of testing for the In Situ Vapor Sampling (ISVS) system. The report includes the test procedure (WHC-SD-WM-OTP-196, Rev OA), data sheets, exception resolutions, and a test report summary. This report conforms to the guidelines established in WHC-IP-1026, `Engineering Practice Guidelines,` Appendix L, `Operability Test Procedures and Reports.`

Laboratory diagnosis of creatine deficiency syndromes: a technical standard and guideline of the American College of Medical Genetics and Genomics.

PubMed

Sharer, J Daniel; Bodamer, Olaf; Longo, Nicola; Tortorelli, Silvia; Wamelink, Mirjam M C; Young, Sarah

2017-02-01

Disclaimer: These ACMG Standards and Guidelines are intended as an educational resource for clinical laboratory geneticists to help them provide quality clinical laboratory genetic services. Adherence to these standards and guidelines is voluntary and does not necessarily assure a successful medical outcome. These Standards and Guidelines should not be considered inclusive of all proper procedures and tests or exclusive of others that are reasonably directed to obtaining the same results. In determining the propriety of any specific procedure or test, clinical laboratory geneticists should apply their professional judgment to the specific circumstances presented by the patient or specimen. Clinical laboratory geneticists are encouraged to document in the patient's record the rationale for the use of a particular procedure or test, whether or not it is in conformance with these Standards and Guidelines. They also are advised to take notice of the date any particular guideline was adopted, and to consider other relevant medical and scientific information that becomes available after that date. It also would be prudent to consider whether intellectual property interests may restrict the performance of certain tests and other procedures.Cerebral creatine deficiency syndromes are neurometabolic conditions characterized by intellectual disability, seizures, speech delay, and behavioral abnormalities. Several laboratory methods are available for preliminary and confirmatory diagnosis of these conditions, including measurement of creatine and related metabolites in biofluids using liquid chromatography-tandem mass spectrometry or gas chromatography-mass spectrometry, enzyme activity assays in cultured cells, and DNA sequence analysis. These guidelines are intended to standardize these procedures to help optimize the diagnosis of creatine deficiency syndromes. While biochemical methods are emphasized, considerations for confirmatory molecular testing are also discussed, along with variables that influence test results and interpretation.Genet Med 19 2, 256-263.

Wynoochee Hydropower/Fish Hatchery: Feasibility Report and Environmental Impact Statement.

DTIC Science & Technology

1982-09-30

Unresolved Issues. There are no unresolved issues associated with the Wynoochee hydropower/fish hatchery plan. 4. Relationship to Environmental...Requirements.l/ The relationship of the Wynoochee hydropower/fish hatchery plan to environmental requirements is summarized in the following table...Implementation of the plan would I/The relationship of the satellite fish station to the environmental requirements is not included in this discussion. Compliance

The Impact of 2013 Updated ASCO/CAP HER2 Guidelines on the Diagnosis and Management of Invasive Breast Cancer: A Single-Center Study of 1739 Cases.

PubMed

Zhang, Xiaofei; Bleiweiss, Ira; Jaffer, Shabnam; Nayak, Anupma

2017-10-01

The purpose of this study was to determine the impact of revised ASCO/CAP 2013 HER2 guidelines on the clinical practice of pathologists and oncologists. Retrospective analysis of 1739 patients with invasive breast carcinoma who underwent reflex HER2 (fluorescence in situ hybridization [FISH]) testing, using both 2007 and 2013 guidelines (2007-2014). Using 2013 guidelines, 255 (15%; 95% confidence interval [CI], 13%-16%) cases were classified as HER2 + as opposed to 186 (11%; 95% CI, 9%-12%) by 2007 guidelines (odds ratio [OR] 1.4; 95% CI, 1.2-1.8; P = .0005). Sixty-nine cases equivocal by 2007 guidelines (12% of all equivocal cases) were converted to HER2 + by 2013 guidelines. Sixty-two of these 69 cases shifted from HER2 equivocal to positive due to change in FISH ratio cutoff from 2.2 to 2.0. Six cases had FISH ratio < 2.0 but immunohistochemistry (IHC) score 3+ in 10% to 30% of tumor cells. One case had FISH ratio of 2.0 and IHC score 3+ in 10% to 30% of tumor cells. FISH and IHC test results were discordant in 5% (95% CI, 4%-6%) of cases using 2013 guidelines. No increase in HER2 FISH equivocal cases was observed. Reflex FISH testing of all IHC 1+ cases at our institution additionally detected 58 patients (5%; 95% CI, 4%-6%) with HER2 amplification. The 2013 guidelines increase the detection of HER2 + cases, without introducing significant difference in discordance rate of the IHC and FISH assays. Inclusion of HER2 copy number criterion does not increase the number of FISH equivocal cases in our cohort. We recommend IHC 1+ cases should be offered reflex FISH testing because failure to test them will miss a small number (5%) of potentially treatable cases. Copyright © 2017 Elsevier Inc. All rights reserved.

Preferred Reporting Items for a Systematic Review and Meta-analysis of Diagnostic Test Accuracy Studies: The PRISMA-DTA Statement.

PubMed

McInnes, Matthew D F; Moher, David; Thombs, Brett D; McGrath, Trevor A; Bossuyt, Patrick M; Clifford, Tammy; Cohen, Jérémie F; Deeks, Jonathan J; Gatsonis, Constantine; Hooft, Lotty; Hunt, Harriet A; Hyde, Christopher J; Korevaar, Daniël A; Leeflang, Mariska M G; Macaskill, Petra; Reitsma, Johannes B; Rodin, Rachel; Rutjes, Anne W S; Salameh, Jean-Paul; Stevens, Adrienne; Takwoingi, Yemisi; Tonelli, Marcello; Weeks, Laura; Whiting, Penny; Willis, Brian H

2018-01-23

Systematic reviews of diagnostic test accuracy synthesize data from primary diagnostic studies that have evaluated the accuracy of 1 or more index tests against a reference standard, provide estimates of test performance, allow comparisons of the accuracy of different tests, and facilitate the identification of sources of variability in test accuracy. To develop the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) diagnostic test accuracy guideline as a stand-alone extension of the PRISMA statement. Modifications to the PRISMA statement reflect the specific requirements for reporting of systematic reviews and meta-analyses of diagnostic test accuracy studies and the abstracts for these reviews. Established standards from the Enhancing the Quality and Transparency of Health Research (EQUATOR) Network were followed for the development of the guideline. The original PRISMA statement was used as a framework on which to modify and add items. A group of 24 multidisciplinary experts used a systematic review of articles on existing reporting guidelines and methods, a 3-round Delphi process, a consensus meeting, pilot testing, and iterative refinement to develop the PRISMA diagnostic test accuracy guideline. The final version of the PRISMA diagnostic test accuracy guideline checklist was approved by the group. The systematic review (produced 64 items) and the Delphi process (provided feedback on 7 proposed items; 1 item was later split into 2 items) identified 71 potentially relevant items for consideration. The Delphi process reduced these to 60 items that were discussed at the consensus meeting. Following the meeting, pilot testing and iterative feedback were used to generate the 27-item PRISMA diagnostic test accuracy checklist. To reflect specific or optimal contemporary systematic review methods for diagnostic test accuracy, 8 of the 27 original PRISMA items were left unchanged, 17 were modified, 2 were added, and 2 were omitted. The 27-item PRISMA diagnostic test accuracy checklist provides specific guidance for reporting of systematic reviews. The PRISMA diagnostic test accuracy guideline can facilitate the transparent reporting of reviews, and may assist in the evaluation of validity and applicability, enhance replicability of reviews, and make the results from systematic reviews of diagnostic test accuracy studies more useful.

78 FR 25282 - Agency Information Collection Activities: Proposed Collection; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-30

... Project: Mandatory Guidelines for Federal Workplace Drug Testing Programs (OMB No. 0930-0158)--Revision SAMHSA's Mandatory Guidelines for Federal Workplace Drug Testing Programs will request OMB approval for the Federal Drug Testing Custody and Control Form for federal agency and federally regulated drug...

Improvement in safety monitoring of biologic response modifiers after the implementation of clinical care guidelines by a specialty.

PubMed

Hanson, Rebekah L; Gannon, Michael J; Khamo, Nehrin; Sodhi, Monsheel; Orr, Alexander M; Stubbings, JoAnn

2013-01-01

Tumor necrosis factor (TNF)-alpha inhibitors and other biologic response modifiers (BRMs) are frequently used to treat a variety of inflammatory diseases. Use of these agents may increase risk of serious infections, malignancies, and other complications such as worsening symptoms of heart failure or demyelinating disease. Because of these risks, a baseline assessment and routine monitoring have been recommended, but standardized guidelines for monitoring have yet to be established. To measure the compliance with the recommended safety monitoring in the Clinical Care Guidelines for BRMs at the University of Illinois Hospitals and Health Sciences System (UI Health). The Clinical Care Guidelines for BRMs was developed by a committee of pharmacists, nurses, and physicians based on an assessment of published literature and medication labeling. The guidelines included recommendations for safety monitoring prior to BRM therapy, such as the tuberculosis (TB) test, Hepatitis B surface Antigen (HBsAg) test, liver function test (LFT), complete blood count (CBC), up-to-date vaccinations, risk assessment for cancer, pregnancy testing, monitoring for contraindications with concomitant medications, concomitant disease state risk assessment, and patient education. The guidelines were introduced to UI Health in February 2012 by a systemwide email and by in-services given by the health system's Specialty Pharmacy Service. In-services were given in the clinics known to generate large numbers of BRM orders (e.g., gastroenterology and rheumatology) and at the outpatient center for infused therapies. The purpose of the in-services was to introduce providers to the guidelines and encourage their compliance. To ensure that guideline requirements were met when BRMs were ordered, a process was established to identify BRM orders, assess the orders for compliance with 4 of the safety monitoring tests from the guidelines (TB, HBsAg, LFT, and CBC), and make interventions. When necessary, Specialty Pharmacy Services coordinated with the pharmacists and other providers in the clinic to order lab tests and ensure they were completed prior to the start of therapy. Feedback was provided during the study to proactively improve compliance with the guidelines. After completion of the study, a report containing outpatient prescription orders for BRMs (abatacept, adalimumab, certolizumab, etanercept, golimumab, infliximab, and tocilizumab) from August 2011 through July 2012 was generated from the electronic medical record. Retrospective analyses of completion of safety monitoring were conducted for patients administered BRM treatment. Completion rates were compared before and after implementation of guidelines in February 2012. Completion was considered to have occurred when all 4 safety monitoring tests had been conducted -TB (unless known to be positive from a previous test), HBsAg, LFT, and CBC. Completion data from August 2011 through January 2012 were before the guidelines were implemented, and data from February 2012 through July 2012 were after the guidelines. Chi square analyses were performed on completion frequencies in the patients before and after the guidelines were implemented. Of the 320 unique patient BRM orders evaluated in this study, 195 (61%) were generated in the Rheumatology clinic, 99 (31%) in the Gastroenterology clinic, 21 (6.5%) in the Dermatology clinic, and 5 (1.5%) in the Transplant clinic. Before the guidelines were implemented, 54 ( 31%) of 173 patient orders complied with the safety monitoring by having all 4 clinical tests performed at the appropriate time points. After guideline implementation, 88 (60%) of 147 patient orders were compliant and had all 4 clinical tests conducted, which represents a statistically significant improvement in the rate of compliance (Pearson chi square = 26.43, degrees of freedom (df) = 1, P  less than  0.0001). This significant improvement in compliance rates after guideline implementation was observed in both the new patient group and the patients with continuing prescription orders/treatment changes. There was also an improvement in patients whose prescriptions were dispensed by UI Health and to a lesser degree those whose prescriptions were dispensed by an outside pharmacy. When the new patient group was analyzed separately (n = 92), 50 patients were treated before the guidelines were implemented, and 42 patients were treated after the guidelines were implemented. Compliance rates with safety monitoring in these 2 groups were 52% pre-implementation and 83% post-implementation, which represented a statistically significant improvement in compliance (Pearson chi square = 10.03, df=1, P = 0.0015). Similar results were observed in the second patient subgroup with continuing prescription orders/treatment change (n = 228). A total of 123 patients were treated before the guidelines were implemented, and 105 were treated after the guidelines were implemented. Compliance rates were 23% pre-implementation compared with 50% post-implementation, which represented a statistically significant improvement in compliance (Pearson chi square = 18.99, df = 1, P  less than  0.0001). Given the widespread and long-term use of BRMs, safety monitoring and management should be an important part of a comprehensive medication management program for their use. A coordinated effort may have a significant impact on compliance with safety monitoring guidelines.

Combination of binaural and harmonic masking release effects in the detection of a single component in complex tones.

PubMed

Klein-Hennig, Martin; Dietz, Mathias; Hohmann, Volker

2018-03-01

Both harmonic and binaural signal properties are relevant for auditory processing. To investigate how these cues combine in the auditory system, detection thresholds for an 800-Hz tone masked by a diotic (i.e., identical between the ears) harmonic complex tone were measured in six normal-hearing subjects. The target tone was presented either diotically or with an interaural phase difference (IPD) of 180° and in either harmonic or "mistuned" relationship to the diotic masker. Three different maskers were used, a resolved and an unresolved complex tone (fundamental frequency: 160 and 40 Hz) with four components below and above the target frequency and a broadband unresolved complex tone with 12 additional components. The target IPD provided release from masking in most masker conditions, whereas mistuning led to a significant release from masking only in the diotic conditions with the resolved and the narrowband unresolved maskers. A significant effect of mistuning was neither found in the diotic condition with the wideband unresolved masker nor in any of the dichotic conditions. An auditory model with a single analysis frequency band and different binaural processing schemes was employed to predict the data of the unresolved masker conditions. Sensitivity to modulation cues was achieved by including an auditory-motivated modulation filter in the processing pathway. The predictions of the diotic data were in line with the experimental results and literature data in the narrowband condition, but not in the broadband condition, suggesting that across-frequency processing is involved in processing modulation information. The experimental and model results in the dichotic conditions show that the binaural processor cannot exploit modulation information in binaurally unmasked conditions. Copyright © 2017 Elsevier B.V. All rights reserved.

Reflecting on Earlier Experiences with Unsolicited Findings: Points to Consider for Next-Generation Sequencing and Informed Consent in Diagnostics

PubMed Central

Rigter, Tessel; Henneman, Lidewij; Kristoffersson, Ulf; Hall, Alison; Yntema, Helger G; Borry, Pascal; Tönnies, Holger; Waisfisz, Quinten; Elting, Mariet W; Dondorp, Wybo J; Cornel, Martina C

2013-01-01

High-throughput nucleotide sequencing (often referred to as next-generation sequencing; NGS) is increasingly being chosen as a diagnostic tool for cases of expected but unresolved genetic origin. When exploring a higher number of genetic variants, there is a higher chance of detecting unsolicited findings. The consequential increased need for decisions on disclosure of these unsolicited findings poses a challenge for the informed consent procedure. This article discusses the ethical and practical dilemmas encountered when contemplating informed consent for NGS in diagnostics from a multidisciplinary point of view. By exploring recent similar experiences with unsolicited findings in other settings, an attempt is made to describe what can be learned so far for implementing NGS in standard genetic diagnostics. The article concludes with a set of points to consider in order to guide decision-making on the extent of return of results in relation to the mode of informed consent. We hereby aim to provide a sound basis for developing guidelines for optimizing the informed consent procedure. PMID:23784691

Improving Efficiency and Quality of the Children's ASD Diagnostic Pathway: Lessons Learned from Practice.

PubMed

Rutherford, Marion; Burns, Morag; Gray, Duncan; Bremner, Lynne; Clegg, Sarah; Russell, Lucy; Smith, Charlie; O'Hare, Anne

2018-05-01

The 'autism diagnosis crisis' and long waiting times for assessment are as yet unresolved, leading to undue stress and limiting access to effective support. There is therefore a significant need for evidence to support practitioners in the development of efficient services, delivering acceptable waiting times and effectively meeting guideline standards. This study reports statistically significant reductions in waiting times for autism diagnostic assessment following a children's health service improvement programme. The average wait between referral and first appointment reduced from 14.2 to 10.4 weeks (t(21) = 4.3, p < 0.05) and between referral and diagnosis shared, reduced from 270 to 122.5 days, (t(20) = 5.5, p < 0.05). The proportion of girls identified increased from 5.6 to 2.7:1. Methods reported include: local improvement action planning; evidence based pathways; systematic clinical data gathering and a training plan. This is a highly significant finding for many health services wrestling with the challenges of demand and capacity for autism diagnosis and assessment.

Critical appraisal of the unmet needs in the treatment of chronic spontaneous urticaria with omalizumab: an Italian perspective.

PubMed

Asero, Riccardo; Canonica, Giorgio W; Cristaudo, Antonio; Fierro, Maria T; Girolomoni, Giampiero; Marzano, Angelo V; Nettis, Eustachio; Pepe, Patrizia; Pigatto, Paolo; Rossi, Oliviero

2017-12-01

The humanized anti-IgE antibody omalizumab has been available for patients with chronic spontaneous urticaria (CSU) in Italy since 2015. This review summarizes the unresolved issues and unmet therapeutic needs associated with omalizumab and discusses practical recommendations for its use in the management of CSU. Although modern second-generation H1-antihistamines are the standard of care for patients with CSU, adjunctive treatments (including omalizumab) may be required for effective control of symptoms in many patients. Evidence from clinical trials and experience from daily clinical practice suggest that the use of omalizumab in patients with CSU who have inadequate response to H1-antihistamines remains challenging. Based on current international guidelines, omalizumab labelling information and our experience in clinical practice, we provide treatment recommendations regarding the use of omalizumab in patients with CSU. These include: optimal treatment duration, the use of concomitant antihistamine therapy, the definition and management of disease relapse after treatment, and the management of patients with late or no response to treatment.

Diagnosis of Acute Gout: A Clinical Practice Guideline From the American College of Physicians.

PubMed

Qaseem, Amir; McLean, Robert M; Starkey, Melissa; Forciea, Mary Ann

2017-01-03

The American College of Physicians (ACP) developed this guideline to present the evidence and provide clinical recommendations on the diagnosis of gout. This guideline is based on a systematic review of published studies on gout diagnosis, identified using several databases, from database inception to February 2016. Evaluated outcomes included the accuracy of the test results; intermediate outcomes (results of laboratory and radiographic tests, such as serum urate and synovial fluid crystal analysis and radiographic or ultrasonography changes); clinical decision making (additional testing and pharmacologic or dietary management); short-term clinical (patient-centered) outcomes, such as pain and joint swelling and tenderness; and adverse effects of the tests. This guideline grades the evidence and recommendations by using the ACP grading system, which is based on the GRADE (Grading of Recommendations Assessment, Development and Evaluation) method. The target audience for this guideline includes all clinicians, and the target patient population includes adults with joint inflammation suspected to be gout. ACP recommends that clinicians use synovial fluid analysis when clinical judgment indicates that diagnostic testing is necessary in patients with possible acute gout. (Grade: weak recommendation, low-quality evidence).

Guidelines for Standardized Testing of Broadband Seismometers and Accelerometers

USGS Publications Warehouse

Hutt, Charles R.; Evans, John R.; Followill, Fred; Nigbor, Robert L.; Wielandt, Erhard

2010-01-01

Testing and specification of seismic and earthquake-engineering sensors and recorders has been marked by significant variations in procedures and selected parameters. These variations cause difficulty in comparing such specifications and test results. In July 1989, and again in May 2005, the U.S. Geological Survey hosted international pub-lic/private workshops with the goal of defining widely accepted guidelines for the testing of seismological inertial sensors, seismometers, and accelerometers. The Proceedings of the 2005 workshop have been published and include as appendix 6 the report of the 1989 workshop. This document represents a collation and rationalization of a single set of formal guidelines for testing and specifying broadband seismometers and accelerometers.

In honor of the Teratology Society's 50th anniversary: The role of Teratology Society members in the development and evolution of in vivo developmental toxicity test guidelines.

PubMed

Tyl, Rochelle W

2010-06-01

Members of the Teratology Society (established in 1960) were involved in the first governmental developmental and reproductive toxicity testing guidelines (1966) by FDA following the thalidomide epidemic, followed by other national and international governmental testing guidelines. The Segment II (developmental toxicity) study design, described in rodents and rabbits, has evolved with additional enhanced endpoints and better descriptions, mechanistic insights, range-finding studies, and toxico/pharmacokinetic ADME information (especially for pharmaceuticals). Society members were also involved in the development of the current screening assays and tests for endocrine disruptors (beginning in 1996) and are now involved with developing new testing guidelines (e.g., the extended one-generation protocol), and evaluating the current test guidelines and new initiatives under ILSI/HESI sponsorship. New initiatives include ToxCast from the U.S. EPA to screen, prioritize, and predict toxic chemicals by high throughput and high-content in vitro assays, bioinformation, and modeling to reduce (or eliminate) in vivo whole animal studies. Our Society and its journal have played vital roles in the scientific and regulatory accomplishments in birth defects research over the past 50 years and will continue to do so in the future. Happy 50th anniversary! (c) 2010 Wiley-Liss, Inc.

Progress Towards an LES Wall Model Including Unresolved Roughness

NASA Astrophysics Data System (ADS)

Craft, Kyle; Redman, Andrew; Aikens, Kurt

2015-11-01

Wall models used in large eddy simulations (LES) are often based on theories for hydraulically smooth walls. While this is reasonable for many applications, there are also many where the impact of surface roughness is important. A previously developed wall model has been used primarily for jet engine aeroacoustics. However, jet simulations have not accurately captured thick initial shear layers found in some experimental data. This may partly be due to nozzle wall roughness used in the experiments to promote turbulent boundary layers. As a result, the wall model is extended to include the effects of unresolved wall roughness through appropriate alterations to the log-law. The methodology is tested for incompressible flat plate boundary layers with different surface roughness. Correct trends are noted for the impact of surface roughness on the velocity profile. However, velocity deficit profiles and the Reynolds stresses do not collapse as well as expected. Possible reasons for the discrepancies as well as future work will be presented. This work used the Extreme Science and Engineering Discovery Environment (XSEDE), which is supported by National Science Foundation grant number ACI-1053575. Computational resources on TACC Stampede were provided under XSEDE allocation ENG150001.

Optimisation of chromatographic resolution using objective functions including both time and spectral information.

PubMed

Torres-Lapasió, J R; Pous-Torres, S; Ortiz-Bolsico, C; García-Alvarez-Coque, M C

2015-01-16

The optimisation of the resolution in high-performance liquid chromatography is traditionally performed attending only to the time information. However, even in the optimal conditions, some peak pairs may remain unresolved. Such incomplete resolution can be still accomplished by deconvolution, which can be carried out with more guarantees of success by including spectral information. In this work, two-way chromatographic objective functions (COFs) that incorporate both time and spectral information were tested, based on the peak purity (analyte peak fraction free of overlapping) and the multivariate selectivity (figure of merit derived from the net analyte signal) concepts. These COFs are sensitive to situations where the components that coelute in a mixture show some spectral differences. Therefore, they are useful to find out experimental conditions where the spectrochromatograms can be recovered by deconvolution. Two-way multivariate selectivity yielded the best performance and was applied to the separation using diode-array detection of a mixture of 25 phenolic compounds, which remained unresolved in the chromatographic order using linear and multi-linear gradients of acetonitrile-water. Peak deconvolution was carried out using the combination of orthogonal projection approach and alternating least squares. Copyright © 2014 Elsevier B.V. All rights reserved.

Vitamin D supplementation for osteoporosis in older adults: can we make it help better?

PubMed

Dong, C-H; Gao, Q-M; Wang, Z-M; Wang, A-M; Zhen, P

2016-11-01

With the increase of the average age of our population, the incidence of diseases specific for older adults has been increasing. One of such diseases is osteoporosis. The true incidence of osteoporosis is unknown. But the estimates indicate that this disease affects wide proportions of the population, ranging in millions or even ten millions in large countries like the United States. As this poses a significant burden on the health care system, interventions that could prevent or treat this condition are in the focus of clinical research. Vitamin D, the determinant of bone health, has been tested in clinical studies as the agent to treat osteoporosis. Despite the progress, there is still some controversy about the targeted blood levels of vitamin D, most efficient way to supplement this vitamin, and clinical efficacy of this supplementation in the elderly.In the present review, we will highlight the metabolism of vitamin D and the aforementioned unresolved issues, as well as review the recent interventional studies on vitamin D supplementation. In the present review, we will highlight the metabolism of vitamin D and the aforementioned unresolved issues, as well as review the recent interventional studies on vitamin D supplementation.

A framework for testing and comparing binaural models.

PubMed

Dietz, Mathias; Lestang, Jean-Hugues; Majdak, Piotr; Stern, Richard M; Marquardt, Torsten; Ewert, Stephan D; Hartmann, William M; Goodman, Dan F M

2018-03-01

Auditory research has a rich history of combining experimental evidence with computational simulations of auditory processing in order to deepen our theoretical understanding of how sound is processed in the ears and in the brain. Despite significant progress in the amount of detail and breadth covered by auditory models, for many components of the auditory pathway there are still different model approaches that are often not equivalent but rather in conflict with each other. Similarly, some experimental studies yield conflicting results which has led to controversies. This can be best resolved by a systematic comparison of multiple experimental data sets and model approaches. Binaural processing is a prominent example of how the development of quantitative theories can advance our understanding of the phenomena, but there remain several unresolved questions for which competing model approaches exist. This article discusses a number of current unresolved or disputed issues in binaural modelling, as well as some of the significant challenges in comparing binaural models with each other and with the experimental data. We introduce an auditory model framework, which we believe can become a useful infrastructure for resolving some of the current controversies. It operates models over the same paradigms that are used experimentally. The core of the proposed framework is an interface that connects three components irrespective of their underlying programming language: The experiment software, an auditory pathway model, and task-dependent decision stages called artificial observers that provide the same output format as the test subject. Copyright © 2017 Elsevier B.V. All rights reserved.

Guidelines for the Design, Fabrication, Testing, Installation and Operation of Srf Cavities

NASA Astrophysics Data System (ADS)

Theilacker, J.; Carter, H.; Foley, M.; Hurh, P.; Klebaner, A.; Krempetz, K.; Nicol, T.; Olis, D.; Page, T.; Peterson, T.; Pfund, P.; Pushka, D.; Schmitt, R.; Wands, R.

2010-04-01

Superconducting Radio-Frequency (SRF) cavities containing cryogens under pressure pose a potential rupture hazard to equipment and personnel. Generally, pressure vessels fall within the scope of the ASME Boiler and Pressure Vessel Code however, the use of niobium as a material for the SRF cavities is beyond the applicability of the Code. Fermilab developed a guideline to ensure sound engineering practices governing the design, fabrication, testing, installation and operation of SRF cavities. The objective of the guideline is to reduce hazards and to achieve an equivalent level of safety afforded by the ASME Code. The guideline addresses concerns specific to SRF cavities in the areas of materials, design and analysis, welding and brazing, pressure relieving requirements, pressure testing and quality control.

Partially-Averaged Navier Stokes Model for Turbulence: Implementation and Validation

NASA Technical Reports Server (NTRS)

Girimaji, Sharath S.; Abdol-Hamid, Khaled S.

2005-01-01

Partially-averaged Navier Stokes (PANS) is a suite of turbulence closure models of various modeled-to-resolved scale ratios ranging from Reynolds-averaged Navier Stokes (RANS) to Navier-Stokes (direct numerical simulations). The objective of PANS, like hybrid models, is to resolve large scale structures at reasonable computational expense. The modeled-to-resolved scale ratio or the level of physical resolution in PANS is quantified by two parameters: the unresolved-to-total ratios of kinetic energy (f(sub k)) and dissipation (f(sub epsilon)). The unresolved-scale stress is modeled with the Boussinesq approximation and modeled transport equations are solved for the unresolved kinetic energy and dissipation. In this paper, we first present a brief discussion of the PANS philosophy followed by a description of the implementation procedure and finally perform preliminary evaluation in benchmark problems.

40 CFR 799.9325 - TSCA 90-day dermal toxicity.

Code of Federal Regulations, 2013 CFR

2013-07-01

... Health Effects Test Guidelines § 799.9325 TSCA 90-day dermal toxicity. (a) Scope. This section is...-observed-effects level (NOEL) and toxic effects associated with continuous or repeated exposure to a test... human exposure. (b) Source. The source material used in developing this TSCA test guideline is the...

40 CFR 799.9325 - TSCA 90-day dermal toxicity.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Health Effects Test Guidelines § 799.9325 TSCA 90-day dermal toxicity. (a) Scope. This section is...-observed-effects level (NOEL) and toxic effects associated with continuous or repeated exposure to a test... human exposure. (b) Source. The source material used in developing this TSCA test guideline is the...

40 CFR 799.9325 - TSCA 90-day dermal toxicity.

Code of Federal Regulations, 2012 CFR

2012-07-01

... Health Effects Test Guidelines § 799.9325 TSCA 90-day dermal toxicity. (a) Scope. This section is...-observed-effects level (NOEL) and toxic effects associated with continuous or repeated exposure to a test... human exposure. (b) Source. The source material used in developing this TSCA test guideline is the...

40 CFR 799.9325 - TSCA 90-day dermal toxicity.

Code of Federal Regulations, 2014 CFR

2014-07-01

... Health Effects Test Guidelines § 799.9325 TSCA 90-day dermal toxicity. (a) Scope. This section is...-observed-effects level (NOEL) and toxic effects associated with continuous or repeated exposure to a test... human exposure. (b) Source. The source material used in developing this TSCA test guideline is the...

40 CFR 799.9325 - TSCA 90-day dermal toxicity.

Code of Federal Regulations, 2011 CFR

2011-07-01

... Health Effects Test Guidelines § 799.9325 TSCA 90-day dermal toxicity. (a) Scope. This section is...-observed-effects level (NOEL) and toxic effects associated with continuous or repeated exposure to a test... human exposure. (b) Source. The source material used in developing this TSCA test guideline is the...

40 CFR 797.1930 - Mysid shrimp acute toxicity test.

Code of Federal Regulations, 2013 CFR

2013-07-01

... in a control group. (ii) Acclimation. (A) Any change in the temperature and chemistry of the dilution... SUBSTANCES CONTROL ACT (CONTINUED) ENVIRONMENTAL EFFECTS TESTING GUIDELINES Aquatic Guidelines § 797.1930... test regulations under the Toxic Substances Control Act (TSCA) (Pub. L. 94-469, 90 Stat. 2003, 15 U.S.C...

40 CFR 797.1930 - Mysid shrimp acute toxicity test.

Code of Federal Regulations, 2014 CFR

2014-07-01

... in a control group. (ii) Acclimation. (A) Any change in the temperature and chemistry of the dilution... SUBSTANCES CONTROL ACT (CONTINUED) ENVIRONMENTAL EFFECTS TESTING GUIDELINES Aquatic Guidelines § 797.1930... test regulations under the Toxic Substances Control Act (TSCA) (Pub. L. 94-469, 90 Stat. 2003, 15 U.S.C...

40 CFR 797.1930 - Mysid shrimp acute toxicity test.

Code of Federal Regulations, 2012 CFR

2012-07-01

... in a control group. (ii) Acclimation. (A) Any change in the temperature and chemistry of the dilution... SUBSTANCES CONTROL ACT (CONTINUED) ENVIRONMENTAL EFFECTS TESTING GUIDELINES Aquatic Guidelines § 797.1930... test regulations under the Toxic Substances Control Act (TSCA) (Pub. L. 94-469, 90 Stat. 2003, 15 U.S.C...

40 CFR 797.1930 - Mysid shrimp acute toxicity test.

Code of Federal Regulations, 2011 CFR

2011-07-01

... in a control group. (ii) Acclimation. (A) Any change in the temperature and chemistry of the dilution... SUBSTANCES CONTROL ACT (CONTINUED) ENVIRONMENTAL EFFECTS TESTING GUIDELINES Aquatic Guidelines § 797.1930... test regulations under the Toxic Substances Control Act (TSCA) (Pub. L. 94-469, 90 Stat. 2003, 15 U.S.C...

40 CFR 795.228 - Oral/dermal pharmacokinetics.

Code of Federal Regulations, 2010 CFR

2010-07-01

... CONTROL ACT (CONTINUED) PROVISIONAL TEST GUIDELINES Provisional Health Effects Guidelines § 795.228 Oral... laboratory. The animals shall be selected at random for the test groups and any animal showing signs of ill health shall not be used. In all studies, unless otherwise specified, each test group shall contain at...

40 CFR 795.228 - Oral/dermal pharmacokinetics.

Code of Federal Regulations, 2012 CFR

2012-07-01

... CONTROL ACT (CONTINUED) PROVISIONAL TEST GUIDELINES Provisional Health Effects Guidelines § 795.228 Oral... laboratory. The animals shall be selected at random for the test groups and any animal showing signs of ill health shall not be used. In all studies, unless otherwise specified, each test group shall contain at...

40 CFR 795.228 - Oral/dermal pharmacokinetics.

Code of Federal Regulations, 2011 CFR

2011-07-01

... CONTROL ACT (CONTINUED) PROVISIONAL TEST GUIDELINES Provisional Health Effects Guidelines § 795.228 Oral... laboratory. The animals shall be selected at random for the test groups and any animal showing signs of ill health shall not be used. In all studies, unless otherwise specified, each test group shall contain at...

40 CFR 795.228 - Oral/dermal pharmacokinetics.

Code of Federal Regulations, 2013 CFR

2013-07-01

... CONTROL ACT (CONTINUED) PROVISIONAL TEST GUIDELINES Provisional Health Effects Guidelines § 795.228 Oral... laboratory. The animals shall be selected at random for the test groups and any animal showing signs of ill health shall not be used. In all studies, unless otherwise specified, each test group shall contain at...

40 CFR 795.228 - Oral/dermal pharmacokinetics.

Code of Federal Regulations, 2014 CFR

2014-07-01

... CONTROL ACT (CONTINUED) PROVISIONAL TEST GUIDELINES Provisional Health Effects Guidelines § 795.228 Oral... laboratory. The animals shall be selected at random for the test groups and any animal showing signs of ill health shall not be used. In all studies, unless otherwise specified, each test group shall contain at...

75 FR 41488 - Agency Information Collection Activities: Submission for OMB Review; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-16

.... Project: Mandatory Guidelines for Federal Workplace Drug Testing Programs (OMB No. 0930-0158)--Revision SAMHSA's Mandatory Guidelines for Federal Workplace Drug Testing Programs will request OMB approval for the Federal Drug Testing Custody and Control Form for Federal agency and federally regulated drug...

77 FR 52610 - Pesticides; Microbial Pesticide Definitions and Applicability; Clarification and Availability of...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-30

... Pesticides; Microbial Pesticide Definitions and Applicability; Clarification and Availability of Test... pesticide test guideline that further explains the existing data requirement to deposit a sample in a... as the final microbial pesticide test guideline, are expected to enhance the ability of industry to...

NASA Electronic Parts and Packaging Field Programmable Gate Array Single Event Effects Test Guideline Update

NASA Technical Reports Server (NTRS)

Berg, Melanie D.; LaBel, Kenneth A.

2018-01-01

The following are updated or new subjects added to the FPGA SEE Test Guidelines manual: academic versus mission specific device evaluation, single event latch-up (SEL) test and analysis, SEE response visibility enhancement during radiation testing, mitigation evaluation (embedded and user-implemented), unreliable design and its affects to SEE Data, testing flushable architectures versus non-flushable architectures, intellectual property core (IP Core) test and evaluation (addresses embedded and user-inserted), heavy-ion energy and linear energy transfer (LET) selection, proton versus heavy-ion testing, fault injection, mean fluence to failure analysis, and mission specific system-level single event upset (SEU) response prediction. Most sections within the guidelines manual provide information regarding best practices for test structure and test system development. The scope of this manual addresses academic versus mission specific device evaluation and visibility enhancement in IP Core testing.

NASA Electronic Parts and Packaging (NEPP) Field Programmable Gate Array (FPGA) Single Event Effects (SEE) Test Guideline Update

NASA Technical Reports Server (NTRS)

Berg, Melanie D.; LaBel, Kenneth A.

2018-01-01

The following are updated or new subjects added to the FPGA SEE Test Guidelines manual: academic versus mission specific device evaluation, single event latch-up (SEL) test and analysis, SEE response visibility enhancement during radiation testing, mitigation evaluation (embedded and user-implemented), unreliable design and its affects to SEE Data, testing flushable architectures versus non-flushable architectures, intellectual property core (IP Core) test and evaluation (addresses embedded and user-inserted), heavy-ion energy and linear energy transfer (LET) selection, proton versus heavy-ion testing, fault injection, mean fluence to failure analysis, and mission specific system-level single event upset (SEU) response prediction. Most sections within the guidelines manual provide information regarding best practices for test structure and test system development. The scope of this manual addresses academic versus mission specific device evaluation and visibility enhancement in IP Core testing.

Comparison between diagnosis and treatment of community-acquired pneumonia in children in various medical centres across Europe with the United States, United Kingdom and the World Health Organization guidelines.

PubMed

Usonis, Vytautas; Ivaskevicius, Rimvydas; Diez-Domingo, Javier; Esposito, Susanna; Falup-Pecurariu, Oana G; Finn, Adam; Rodrigues, Fernanda; Spoulou, Vana; Syrogiannopoulos, George A; Greenberg, David

2016-01-01

The aim of this study was to review the current status and usage of guidelines in the diagnosis and treatment of community-acquired pneumonia (CAP) in European countries and to compare to established guidelines in the United States (US), United Kingdom (UK), and the World Health Organization (WHO). A questionnaire was developed and distributed by the Community-Acquired Pneumonia Paediatric Research Initiative (CAP-PRI) working group and distributed to medical centres across Europe. Out of 19 European centres, 6 (31.6 %) used WHO guidelines (3 in combination with other guidelines), 5 (26.3 %) used national guidelines, and 5 (26.3 %) used local guidelines. Chest radiograph and complete blood count were the most common diagnostic examinations, while evaluation of clinical symptoms and laboratory tests varied significantly. Tachypnoea and chest recession were considered criteria for diagnosis in all three guidelines. In US and UK guidelines blood cultures, atypical bacterial and viral detection tests were recommended. In European centres in outpatient settings, amoxicillin was used in 16 (84 %) centers, clarithromycin in 9 (37 %) centers and azithromycin in 7 (47 %) centers, whereas in hospital settings antibiotic treatment varied widely. Amoxicillin is recommended as the first drug of choice for outpatient treatment in all guidelines. Although local variations in clinical criteria, laboratory tests, and antibiotic resistance rates may necessitate some differences in standard empirical antibiotic regimens, there is considerable scope for standardisation across European centres for the diagnosis and treatment of CAP.

Sustainable design guidelines to support the Washington State ferries terminal design manual : design guideline application and refinement.

DOT National Transportation Integrated Search

2013-08-01

The Sustainable Design Guidelines were developed in Phase I of this research program (WA-RD : 816.1). Here we are reporting on the Phase II effort that beta-tested the Phase I Guidelines on : example ferry terminal designs and refinements made ...

Cervical Cancer Screening Guideline Adherence Before and After Guideline Changes in Pennsylvania Medicaid.

PubMed

Parekh, Natasha; Donohue, Julie M; Men, Aiju; Corbelli, Jennifer; Jarlenski, Marian

2017-01-01

To assess changes in cervical cancer screening after the 2009 American College of Obstetricians and Gynecologists' guideline change and to determine predictors associated with underscreening and overscreening among Medicaid-enrolled women. We performed an observational cohort study of Pennsylvania Medicaid claims from 2007 to 2013. We evaluated guideline adherence of 18- to 64-year-old continuously enrolled women before and after the 2009 guideline change. To define adherence, we categorized intervals between Pap tests as longer than (underscreening), within (appropriate screening), or shorter than (overscreening) guideline-recommended intervals (±6-month). We stratified results by age and assessed predictors of underscreening and overscreening through logistic regression. Among 29,650 women, appropriate cervical cancer screening significantly decreased after the guideline change (from 45% [95% confidence interval (CI) 44-46%] to 11% [95% CI 11-12%] among 17,360 younger than 30 year olds and from 27% [95% CI 26-28%] to 6% [95% CI 6-7%] among 12,290 women 30 years old or older). Overscreening significantly increased (from 6% [95% CI 5-6%] to 67% [95% CI 66-68%] in those younger than 30 years old and from 54% [95% CI 52-55%] to 65% [95% CI 64-67%] in those 30 years old or older), whereas underscreening significantly increased only in those 30 years old or older (from 20% [95% CI 19-21%] to 29% [95% CI 27-30%]). Pap tests after guideline change, pregnancy, Managed Care enrollment (in those younger than 30 years old), and black race (in those younger than 30 years old) were associated with underscreening. Pap tests after guideline change, more visits, more sexually transmitted infection testing, and white race (in those 30 years old or older) were associated with overscreening. We observed high rates of cervical cancer overscreening and underscreening and low rates of appropriate screening after the guideline change. Interventions should target both underscreening and overscreening to address these separate yet significant issues.

American Society of Clinical Oncology Clinical Practice Guideline: Update on Adjuvant Endocrine Therapy for Women With Hormone Receptor–Positive Breast Cancer

PubMed Central

Burstein, Harold J.; Prestrud, Ann Alexis; Seidenfeld, Jerome; Anderson, Holly; Buchholz, Thomas A.; Davidson, Nancy E.; Gelmon, Karen E.; Giordano, Sharon H.; Hudis, Clifford A.; Malin, Jennifer; Mamounas, Eleftherios P.; Rowden, Diana; Solky, Alexander J.; Sowers, MaryFran R.; Stearns, Vered; Winer, Eric P.; Somerfield, Mark R.; Griggs, Jennifer J.

2010-01-01

Purpose To develop evidence-based guidelines, based on a systematic review, for endocrine therapy for postmenopausal women with hormone receptor–positive breast cancer. Methods A literature search identified relevant randomized trials. Databases searched included MEDLINE, PREMEDLINE, the Cochrane Collaboration Library, and those for the Annual Meetings of the American Society of Clinical Oncology (ASCO) and the San Antonio Breast Cancer Symposium (SABCS). The primary outcomes of interest were disease-free survival, overall survival, and time to contralateral breast cancer. Secondary outcomes included adverse events and quality of life. An expert panel reviewed the literature, especially 12 major trials, and developed updated recommendations. Results An adjuvant treatment strategy incorporating an aromatase inhibitor (AI) as primary (initial endocrine therapy), sequential (using both tamoxifen and an AI in either order), or extended (AI after 5 years of tamoxifen) therapy reduces the risk of breast cancer recurrence compared with 5 years of tamoxifen alone. Data suggest that including an AI as primary monotherapy or as sequential treatment after 2 to 3 years of tamoxifen yields similar outcomes. Tamoxifen and AIs differ in their adverse effect profiles, and these differences may inform treatment preferences. Conclusion The Update Committee recommends that postmenopausal women with hormone receptor–positive breast cancer consider incorporating AI therapy at some point during adjuvant treatment, either as up-front therapy or as sequential treatment after tamoxifen. The optimal timing and duration of endocrine treatment remain unresolved. The Update Committee supports careful consideration of adverse effect profiles and patient preferences in deciding whether and when to incorporate AI therapy. PMID:20625130

Assessment of Intervention Fidelity and Recommendations for Researchers Conducting Studies on the Diagnosis and Treatment of Chronic Cough in the Adult

PubMed Central

Diekemper, Rebecca L.; Irwin, Richard S.; Adams, Todd M.; Altman, Kenneth W.; Barker, Alan F.; Birring, Surinder S.; Blackhall, Fiona; Bolser, Donald C.; Boulet, Louis-Philippe; Braman, Sidney S.; Brightling, Christopher; Callahan-Lyon, Priscilla; Canning, Brendan J.; Chang, Anne B.; Coeytaux, Remy; Cowley, Terrie; Davenport, Paul; Diekemper, Rebecca L.; Ebihara, Satoru; El Solh, Ali A.; Escalante, Patricio; Feinstein, Anthony; Field, Stephen K.; Fisher, Dina; French, Cynthia T.; Gibson, Peter; Gold, Philip; Gould, Michael K.; Grant, Cameron; Harding, Susan M.; Harnden, Anthony; Hill, Adam T.; Irwin, Richard S.; Kahrilas, Peter J.; Keogh, Karina A.; Lane, Andrew P.; Lim, Kaiser; Malesker, Mark A.; Mazzone, Peter; Mazzone, Stuart; McCrory, Douglas C.; McGarvey, Lorcan; Molasiotis, Alex; Murad, M. Hassan; Newcombe, Peter; Nguyen, Huong Q.; Oppenheimer, John; Prezant, David; Pringsheim, Tamara; Restrepo, Marcos I.; Rosen, Mark; Rubin, Bruce; Ryu, Jay H.; Smith, Jaclyn; Tarlo, Susan M.; Vertigan, Anne E.; Wang, Gang; Weinberger, Miles; Weir, Kelly

2015-01-01

BACKGROUND: Successful management of chronic cough has varied in the primary research studies in the reported literature. One of the potential reasons relates to a lack of intervention fidelity to the core elements of the diagnostic and/or therapeutic interventions that were meant to be used by the investigators. METHODS: We conducted a systematic review to summarize the evidence supporting intervention fidelity as an important methodologic consideration in assessing the effectiveness of clinical practice guidelines used for the diagnosis and management of chronic cough. We developed and used a tool to assess for five areas of intervention fidelity. Medline (PubMed), Scopus, and the Cochrane Database of Systematic Reviews were searched from January 1998 to May 2014. Guideline recommendations and suggestions for those conducting research using guidelines or protocols to diagnose and manage chronic cough in the adult were developed and voted upon using CHEST Organization methodology. RESULTS: A total of 23 studies (17 uncontrolled prospective observational, two randomized controlled, and four retrospective observational) met our inclusion criteria. These articles included 3,636 patients. Data could not be pooled for meta-analysis because of heterogeneity. Findings related to the five areas of intervention fidelity included three areas primarily related to the provider and two primarily related to the patients. In the area of study design, 11 of 23 studies appeared to be underpinned by a single guideline/protocol; for training of providers, two of 23 studies reported training, and zero of 23 reported the use of an intervention manual; and for the area of delivery of treatment, when assessing the treatment of gastroesophageal reflux disease, three of 23 studies appeared consistent with the most recent guideline/protocol referenced by the authors. For receipt of treatment, zero of 23 studies mentioned measuring concordance of patient-interventionist understanding of the treatment recommended, and zero of 23 mentioned measuring enactment of treatment, with three of 23 measuring side effects and two of 23 measuring adherence. The overall average intervention fidelity score for all 23 studies was poor (20.74 out of 48). CONCLUSIONS: Only low-quality evidence supports that intervention fidelity strategies were used when conducting primary research in diagnosing and managing chronic cough in adults. This supports the contention that some of the variability in the reporting of patients with unexplained or unresolved chronic cough may be due to lack of intervention fidelity. By following the recommendations and suggestions in this article, researchers will likely be better able to incorporate strategies to address intervention fidelity, thereby strengthening the validity and generalizability of their results that provide the basis for the development of trustworthy guidelines. PMID:25764280

End of FY2014 Report - Filter Measurement System for Nuclear Material Storage Canisters (Including Altitude Correction for Filter Pressure Drop)

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

Moore, Murray E.; Reeves, Kirk Patrick

2015-02-24

Two LANL FTS (Filter Test System ) devices for nuclear material storage canisters are fully operational. One is located in PF-4 ( i.e. the TA-55 FTS) while the other is located at the Radiation Protection Division’s Aerosol Engineering Facility ( i.e. the TA-3 FTS). The systems are functionally equivalent , with the TA-3 FTS being the test-bed for new additions and for resolving any issues found in the TA-55 FTS. There is currently one unresolved issue regarding the TA-55 FTS device. The canister lid clamp does not give a leak tight seal when testing the 1 QT (quart) or 2more » QT SAVY lids. An adapter plate is being developed that will ensure a correct test configuration when the 1 or 2 QT SAVY lid s are being tested .« less

Health Information in Bengali (Bangla / বাংলা)

MedlinePlus

... Society Guidelines for the Early Detection of Cancer - English PDF American Cancer Society Guidelines for the Early ... Screening It's a Simple Test - Cervical Cancer Screening - English PDF It's a Simple Test - Cervical Cancer Screening - ...

Cervical cancer screening among women who attend sexually transmitted diseases (STD) clinics: background paper for 2010 STD Treatment Guidelines.

PubMed

Datta, S Deblina; Saraiya, Mona

2011-12-01

In April 2008, experts reviewed updates on sexually transmitted disease (STD) prevention and treatment in preparation for the revision of the Centers for Disease Control and Prevention (CDC) STD Treatment Guidelines. This included a review of cervical cancer screening in the STD clinical setting. Key questions were identified with assistance from an expert panel. Reviews of the literature were conducted using the PubMed computerized database and shared with the panel. Updated information was incorporated in the 2010 CDC STD Treatment Guidelines. We recommend that STD clinics offering cervical screening services screen and treat women according to guidelines by the American College of Obstetrics and Gynecology, the American Cancer Society, the US Preventive Services Task Force, and the American Society for Colposcopists and Cervical Pathologists. New to the 2010 guidelines are higher age for initiating cervical screening (age ≥ 21 years) and less frequent intervals of screening (at least every 3 years). New recommendations include new technologies, such as liquid-based cytology and high-risk human papillomavirus (HPV) DNA tests. Liquid-based technologies are not recommended over conventional testing. HPV DNA tests are recommended as adjunct tests and with new indications for use in cervical screening and management. Stronger recommendations were issued for STD clinics offering cervical screening services to have protocols in place for follow-up of test results and referral (eg, colposcopy). Important additions to the 2010 STD Treatment Guidelines include information on updated algorithms for screening and management of women and recommendations for use of liquid-based cytology and high-risk HPV testing.

Measuring the charged pion polarizability in the gamma gamma -> pi+pi- reaction

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

Lawrence, David W.; Miskimen, Rory A.; Mushkarenkov, Alexander Nikolaevich

2013-08-01

Development has begun of a new experiment to measure the charged pion polarizabilitymore » $$\\alpha_{\\pi}-\\beta_{\\pi}$$. The charged pion polarizability ranks among the most important tests of low-energy QCD presently unresolved by experiment. Analogous to precision measurements of $$\\pi^{\\circ}\\rightarrow\\gamma\\gamma$$ that test the intrinsic odd-parity (anomalous) sector of QCD, the pion polarizability tests the intrinsic even-parity sector of QCD. The measurement will be performed using the $$\\gamma\\gamma\\rightarrow\\pi^{+{}}\\pi^{-{}}$$ cross section accessed via the Primakoff mechanism on nuclear targets using the GlueX detector in Hall D at Jefferson Lab. The linearly polarized photon source in Hall-D will be utilized to separate the Primakoff cross-section from coherent $$\\rho^{\\circ}$$ production.« less

HIV testing in dermatology - a national audit.

PubMed

Esson, Gavin A; Holme, S A

2018-05-01

Forty percent of individuals have late-stage HIV at the time of diagnosis, resulting in increased morbidity. Identifying key diseases which may indicate HIV infection can prompt clinicians to trigger testing, which may result in more timely diagnosis. The British HIV Association has published guidelines on such indicator diseases in dermatology. We audited the practice of HIV testing in UK dermatologists and General Practitioners (GPs) and compared results with the national guidelines. This audit showed that HIV testing in key indicator diseases remains below the standard set out by the national guidelines, and that GPs with special interest in dermatology have a lower likelihood for testing, and lower confidence when compared to consultants, registrars and associate specialists. Large proportions of respondents believed further training in HIV testing would be beneficial.

77 FR 1708 - Center for Substance Abuse Prevention; Notice of Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2012-01-11

... Abuse Prevention (CSAP) Drug Testing Advisory Board (DTAB) will meet on January 31 and February 1, 2012... opioids as potential analytes in the Mandatory Guidelines for Federal Workplace Drug Testing Programs. The... Guidelines for Federal Workplace Drug Testing Programs. This portion of the meeting is closed to the public...

Considerations for a Proton Single Event Effects (SEE) Guideline

NASA Technical Reports Server (NTRS)

LaBel, Kenneth A.

2010-01-01

The intent of this document is to provide guidance on when and what type of -SEE tests should be performed on a device under test (OUT) based on orbit, technology, existing data, and application. It is NOT intended to provide a detailed guideline for how to perform proton SEE radiation tests on electronics.

Applying EALTA Guidelines as Baseline for the Foreign Language Proficiency Test in Turkey: The Case of YDS

ERIC Educational Resources Information Center

Kavakli, Nurdan; Arslan, Sezen

2017-01-01

Within the scope of educational testing and assessment, setting standards and creating guidelines as a code of practice provide more prolific and sustainable outcomes. In this sense, internationally accepted and regionally accredited principles are suggested for standardization in language testing and assessment practices. Herein, ILTA guidelines…

Considerations for a Proton Single Event Effects (SEE) Guideline

NASA Technical Reports Server (NTRS)

LaBel, Kenneth A.

2010-01-01

The intent of this document is to provide guidance on when and what type of SEE tests should be performed on a device under test (DUT) based on orbit, technology, existing data, and application. It is NOT intended to provide a detailed guideline for how to perform proton SEE radiation tests on electronics.

Evaluation of Internet-Based Clinical Decision Support Systems

PubMed Central

Thomas, Karl W; Dayton, Charles S

1999-01-01

Background Scientifically based clinical guidelines have become increasingly used to educate physicians and improve quality of care. While individual guidelines are potentially useful, repeated studies have shown that guidelines are ineffective in changing physician behavior. The Internet has evolved as a potentially useful tool for guideline education, dissemination, and implementation because of its open standards and its ability to provide concise, relevant clinical information at the location and time of need. Objective Our objective was to develop and test decision support systems (DSS) based on clinical guidelines which could be delivered over the Internet for two disease models: asthma and tuberculosis (TB) preventive therapy. Methods Using open standards of HTML and CGI, we developed an acute asthma severity assessment DSS and a preventative tuberculosis treatment DSS based on content from national guidelines that are recognized as standards of care. Both DSS's are published on the Internet and operate through a decision algorithm developed from the parent guidelines with clinical information provided by the user at the point of clinical care. We tested the effectiveness of each DSS in influencing physician decisions using clinical scenario testing. Results We first validated the asthma algorithm by comparing asthma experts' decisions with the decisions reached by nonpulmonary nurses using the computerized DSS. Using the DSS, nurses scored the same as experts (89% vs. 88%; p = NS). Using the same scenario test instrument, we next compared internal medicine residents using the DSS with residents using a printed version of the National Asthma Education Program-2 guidelines. Residents using the computerized DSS scored significantly better than residents using the paper-based guidelines (92% vs. 84%; p <0.002). We similarly compared residents using the computerized TB DSS to residents using a printed reference card; the residents using the computerized DSS scored significantly better (95.8% vs. 56.6% correct; p<0.001). Conclusions Previous work has shown that guidelines disseminated through traditional educational interventions have minimal impact on physician behavior. Although computerized DSS have been effective in altering physician behavior, many of these systems are not widely available. We have developed two clinical DSS's based on national guidelines and published them on the Internet. Both systems improved physician compliance with national guidelines when tested in clinical scenarios. By providing information that is coupled to relevant activity, we expect that these widely available DSS's will serve as effective educational tools to positively impact physician behavior. PMID:11720915

Managing work-related psychological complaints by general practitioners, in coordination with occupational physicians: a pilot study.

PubMed

Buijs, Peter C; van Dijk, Frank J H; Evers, Marÿe; vd Klink, Jacques J L; Anema, Han

2007-01-01

Increasingly, workers have psychological work-related complaints, endangering their work ability and causing considerable economic losses. Many employees consult their general practitioner (GP). He, however, often pays insufficient attention to work-relatedness or to coordination with occupational physicians (OPs). Appropriate guidelines are missing. Consequently, we developed a GP guideline to handle these problems in coordination with OPs, and tested it in a pilot, using an explorative, evaluative study design. 23 GPs were trained to include employed patients and to test the guideline. Patients received questionnaires after 0, 4, 10 and 30 wk, GPs after 4 and 30 wk. The result was a new guideline, regarding problem orientation, diagnosis and advice, meant to avoid contradictory GP-OP advice and to activate patient responsibility. It included a GP-OP-patient communication form concerning information exchange and harmonization of insight/advice. Implementing GPs concluded that the guideline promotes recovery and work resumption and OP-GP contact benefits patients, prevents conflicting advice and promotes agreement on task division. They judged guideline efficiency and OP commitment less positively. Patients were positive, especially about GP-OP contact. Accordingly, an improved guideline, when tested for its effectiveness in a Randomized Controlled Trial, can help GPs to cope with a growing, complex problem, in collaboration with their occupational colleagues.

Familial Hypercholesterolemia: A Systematic Review of Guidelines on Genetic Testing and Patient Management.

PubMed

Migliara, Giuseppe; Baccolini, Valentina; Rosso, Annalisa; D'Andrea, Elvira; Massimi, Azzurra; Villari, Paolo; De Vito, Corrado

2017-01-01

Familial hypercholesterolemia (FH) is an autosomal-dominant hereditary disorder of lipid metabolism that causes lifelong exposure to increased LDL levels resulting in premature coronary heart disease and, if untreated, death. Recent studies have shown its prevalence to be higher than previously considered, which has important implications for the mortality and morbidity of associated cardiovascular disease (CVD). Several clinical tools are used worldwide to help physicians diagnose FH, but nevertheless most patients remain undetected. This systematic review of guidelines aims to assess the role of genetic testing in the screening, diagnosis, and management of patients affected by heterozygous or homozygous FH and to identify related health-care pathways. We performed a systematic review of the literature; inclusion criteria were English or Italian guidelines focusing on genetic testing. The guidelines were included and evaluated for their content and development process using the Appraisal of Guidelines for Research and Evaluation II instrument. Ten guidelines were considered eligible, and all were judged to be of good quality, with slight differences among them. The most common indications for performing genetic tests were high levels of cholesterol, or physical findings consistent with lipid disorder, in the subject or in the family history. Subsequent screening of family members was indicated when a mutation had been identified in the index patient. Regarding patient management, the various guidelines agreed that intensive treatment with lipid-lowering medications should begin as quickly as possible and that lifestyle modifications should be an integral part of the therapy. Since the early detection of affected patients is beneficial for effective prevention of CVD, genetic testing is particularly useful for identifying family members via cascade screening and for distinguishing between heterozygous and homozygous individuals, the latter of which require more extreme therapeutic intervention.

Guidelines for European workplace drug testing in oral fluid.

PubMed

Cooper, Gail; Moore, Christine; George, Claire; Pichini, Simona

2011-05-01

Over the past decade, oral fluid has established itself as a robust testing matrix for monitoring drug use or misuse. Commercially available collection devices provide opportunities to collect and test oral fluid by the roadside and near-patient testing with both clinical and criminal justice applications. One of the main advantages of oral fluid relates to the collection of the matrix which is non-invasive, simple, and can be carried out under direct observation making it ideal for workplace drug testing. Laboratories offering legally defensible oral fluid workplace drug testing must adhere to national and international quality standards (ISO/IEC 17025); however, these standards do not address issues specific to oral fluid testing. The European Workplace Drug Testing Society (EWDTS) recognizes the importance of providing best practice guidelines to organizations offering testing and those choosing to use oral fluid drug testing to test their employees. The aim of this paper is to present the EWDTS guidelines for oral fluid workplace drug testing. Copyright © 2011 John Wiley & Sons, Ltd.

Binary Systems and the Initial Mass Function

NASA Astrophysics Data System (ADS)

Malkov, O. Yu.

2017-07-01

In the present paper we discuss advantages and disadvantages of binary stars, which are important for star formation history determination. We show that to make definite conclusions of the initial mass function shape, it is necessary to study binary population well enough to correct the luminosity function for unresolved binaries; to construct the mass-luminosity relation based on wide binaries data, and to separate observational mass functions of primaries, of secondaries, and of unresolved binaries.

Distinguishing dark matter from unresolved point sources in the Inner Galaxy with photon statistics

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

Lee, Samuel K.; Lisanti, Mariangela; Safdi, Benjamin R., E-mail: samuelkl@princeton.edu, E-mail: mlisanti@princeton.edu, E-mail: bsafdi@princeton.edu

2015-05-01

Data from the Fermi Large Area Telescope suggests that there is an extended excess of GeV gamma-ray photons in the Inner Galaxy. Identifying potential astrophysical sources that contribute to this excess is an important step in verifying whether the signal originates from annihilating dark matter. In this paper, we focus on the potential contribution of unresolved point sources, such as millisecond pulsars (MSPs). We propose that the statistics of the photons—in particular, the flux probability density function (PDF) of the photon counts below the point-source detection threshold—can potentially distinguish between the dark-matter and point-source interpretations. We calculate the flux PDFmore » via the method of generating functions for these two models of the excess. Working in the framework of Bayesian model comparison, we then demonstrate that the flux PDF can potentially provide evidence for an unresolved MSP-like point-source population.« less

Radio supernovae and super star clusters in the circumnuclear region of NGC 1365

NASA Astrophysics Data System (ADS)

Lindblad, P. O.; Kristen, H.

Groundbased optical and VLA observations have shown that the nucleus of the barred Seyfert 1 galaxy NGC 1365 is surrounded by a number of star forming regions, or "hot spots", as well as a number of resolved and unresolved continuum radio sources. HST/FOC observations reveal that the nucleus is surrounded by a ring of very compact unresolved sources of the kind that have been discovered in a number of other galaxies, and that have been assumed to be very compact young globular star clusters. The hot spots are resolved into groups of such compact sources. VLA observations at lambda = 2 cm, where the resolution approaches that of HST, reveals that the brightest unresolved radio source at 2 cm, which has been assumed to be a radio supernova, coincides with one of the compact HST sources. The implications of this will be discussed.

Current status of accreditation for drug testing in hair.

PubMed

Cooper, Gail; Moeller, Manfred; Kronstrand, Robert

2008-03-21

At the annual meeting of the Society of Hair Testing in Vadstena, Sweden in 2006, a committee was appointed to address the issue of guidelines for hair testing and to assess the current status of accreditation amongst laboratories offering drug testing in hair. A short questionnaire was circulated amongst the membership and interested parties. Fifty-two responses were received from hair testing laboratories providing details on the amount and type of hair tests they offered and the status of accreditation within their facilities. Although the vast majority of laboratories follow current guidelines (83%), only nine laboratories were accredited to ISO/IEC 17025 for hair testing. A significant number of laboratories reporting that they were in the process of developing quality systems with a view to accrediting their methods within 2-3 years. This study provides an insight into the status of accreditation in hair testing laboratories and supports the need for guidelines to encourage best practice.

Revised Bethesda Guidelines for Hereditary Nonpolyposis Colorectal Cancer (Lynch Syndrome) and Microsatellite Instability

PubMed Central

Umar, Asad; Boland, C. Richard; Terdiman, Jonathan P.; Syngal, Sapna; de la Chapelle, Albert; Rüschoff, Josef; Fishel, Richard; Lindor, Noralane M.; Burgart, Lawrence J.; Hamelin, Richard; Hamilton, Stanley R.; Hiatt, Robert A.; Jass, Jeremy; Lindblom, Annika; Lynch, Henry T.; Peltomaki, Païvi; Ramsey, Scott D.; Rodriguez-Bigas, Miguel A.; Vasen, Hans F. A.; Hawk, Ernest T.; Barrett, J. Carl; Freedman, Andrew N.; Srivastava, Sudhir

2010-01-01

Hereditary nonpolyposis colorectal cancer (HNPCC), also known as Lynch syndrome, is a common autosomal dominant syndrome characterized by early age at onset, neoplastic lesions, and microsatellite instability (MSI). Because cancers with MSI account for approximately 15% of all colorectal cancers and because of the need for a better understanding of the clinical and histologic manifestations of HNPCC, the National Cancer Institute hosted an international workshop on HNPCC in 1996, which led to the development of the Bethesda Guidelines for the identification of individuals with HNPCC who should be tested for MSI. To consider revision and improvement of the Bethesda Guidelines, another HNPCC workshop was held at the National Cancer Institute in Bethesda, MD, in 2002. In this commentary, we summarize the Workshop presentations on HNPCC and MSI testing; present the issues relating to the performance, sensitivity, and specificity of the Bethesda Guidelines; outline the revised Bethesda Guidelines for identifying individuals at risk for HNPCC; and recommend criteria for MSI testing. PMID:14970275

The ethics of human gene transfer.

PubMed

Kimmelman, Jonathan

2008-03-01

Almost 20 years since the first gene-transfer trial was carried out in humans, the field has made significant advances towards clinical application. Nevertheless, it continues to face numerous unresolved ethical challenges--among them are the question of when to initiate human testing, the acceptability of germline modification and whether the technique should be applied to the enhancement of traits. Although such issues have precedents in other medical contexts, they take on a different character in gene transfer, in part because of the scientific uncertainty and the social context of innovation.

Digital image profilers for detecting faint sources which have bright companions

NASA Technical Reports Server (NTRS)

Morris, Elena; Flint, Graham; Slavey, Robert

1992-01-01

For this program, an image profiling system was developed which offers the potential for detecting extremely faint optical sources that are located in close proximity to bright companions. The approach employed is novel in three respects. First, it does not require an optical system wherein extraordinary measures must be taken to minimize diffraction and scatter. Second, it does not require detectors possessing either extreme uniformity in sensitivity or extreme temporal stability. Finally, the system can readily be calibrated, or nulled, in space by testing against an unresolved singular stellar source.

Determinants of Practice Patterns and Quality Gaps in Lung Cancer Staging and Diagnosis

PubMed Central

Niu, Jiangong; Elting, Linda S.; Buchholz, Thomas A.; Giordano, Sharon H.

2014-01-01

Background: Guidelines recommend mediastinal lymph node sampling as the first invasive diagnostic procedure in patients with suspected lung cancer with mediastinal lymphadenopathy without distant metastases. Methods: Patients were a retrospective cohort of 15,316 patients with lung cancer with regional spread without metastatic disease in the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) or Texas Cancer Registry Medicare-linked databases. Patients were categorized based on the sequencing of invasive diagnostic tests performed: (1) evaluation consistent with guidelines, mediastinal sampling done first; (2) evaluation inconsistent with guidelines, non-small cell lung cancer (NSCLC) present, mediastinal sampling performed but not as part of the first invasive test; (3) evaluation inconsistent with guidelines, NSCLC present, mediastinal sampling never done; and (4) evaluation inconsistent with guidelines, small cell lung cancer. The primary outcome was whether guideline-consistent care was delivered. Secondary outcomes included whether patients with NSCLC ever had mediastinal sampling and use of transbronchial needle aspiration (TBNA) among pulmonologists. Results: Only 21% of patients had a diagnostic evaluation consistent with guidelines. Only 56% of patients with NSCLC had mediastinal sampling prior to treatment. There was significant regional variability in guideline-consistent care (range, 12%-29%). Guideline-consistent care was associated with lower patient age, metropolitan areas, and if the physician ordering or performing the test was male, trained in the United States, had seen more patients with lung cancer, and was a pulmonologist or thoracic surgeon who had graduated more recently. More recent pulmonary graduates were also more likely to perform TBNA (P < .001). Conclusions: Guideline-consistent care varied regionally and was associated with physician-level factors, suggesting that a lack of effective physician training may be contributing to the quality gaps observed. PMID:24202651

Guidelines for cone penetration test : performance and design

DOT National Transportation Integrated Search

1978-07-01

This manual presents procedures and guidelines applicable to the use of the cone penetration test. Dr. Schmertmann prepared this manual in February 1977 and made minor additions in May 1978. It represents his interpretation of the state-of-the-art in...

Diagnostic hearing testing of infants aged 0-36 months in 3 South African provinces - Comparison of audiology records to HPCSA guidelines.

PubMed

Moodley, Selvarani; Störbeck, Claudine

2016-12-01

Within the Early Hearing Detection and Intervention (EHDI) pathway, which includes the processes of screening, diagnosis and intervention for paediatric hearing loss, paediatric diagnostic audiology involves a battery of specific tests and procedures. International studies have highlighted a golden standard for diagnosis of paediatric hearing loss as based on the Joint Committee of Infant Hearing (2007) diagnostic guidelines, closely resembling the HPCSA diagnostic guidelines. There are limited South African studies on the processes and protocols followed in diagnostic paediatric audiology. This study aims to provide a comparison for how the tests used for diagnosis of paediatric hearing loss in South Africa (within both the public and private healthcare sectors) compare to the HPCSA recommended diagnostic guidelines. A retrospective record review of paediatric clients with hearing loss (recruited through nonprobability convenience sampling) was conducted. This study is part of a longitudinal study of 711 deaf or hard of hearing children referred to the HI HOPES early intervention programme from September 2006 to December 2011. Diagnostic data from audiology reports of 117 children between 0 and 36 months were coded and analysed. Large variation was found in the tests included in the diagnostic audiology reports. For 22 children (19%) a comprehensive test battery was used. Health Professions Council of South Africa (HPCSA) recommended guidelines for diagnostic testing were not followed in any of the records analysed. Components of the HPCSA recommended test battery most frequently omitted was bone conduction testing. For both electrophysiology and behavioural testing, there was limited frequency specificity information. This exclusion of information is evidence of deficiencies in data recording and management, as well as having an effect on accuracy of classification of degree and type of hearing loss. There are gaps in age-appropriate assessment protocols, which will have an effect on accurate differential diagnosis of paediatric hearing loss. Reasons for not including all testing components of the HPCSA recommended guidelines, as well as the possibility of developing guidelines more relevant to a developing world context, should be explored. There might be a need for. The impact of South African specific factors that have an effect on provision of accurate paediatric diagnostic audiology services should be determined. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Single Health System Adherence to 2012 Cervical Cancer Screening Guidelines at Extremes of Age and Posthysterectomy.

PubMed

Teoh, Deanna; Isaksson Vogel, Rachel; Hultman, Gretchen; Monu, Minnu; Downs, Levi; Geller, Melissa A; Le, Chap; Melton-Meaux, Genevieve; Kulasingam, Shalini

2017-03-01

To estimate the proportion of guideline nonadherent Pap tests in women aged younger than 21 years and older than 65 years and posthysterectomy in a single large health system. Secondary objectives were to describe temporal trends and patient and health care provider characteristics associated with screening in these groups. A retrospective cross-sectional chart review was performed at Fairview Health Services and University of Minnesota Physicians. Reasons for testing and patient and health care provider information were collected. Tests were designated as indicated or nonindicated per the 2012 cervical cancer screening guidelines. Point estimates and descriptive statistics were calculated. Patient and health care provider characteristics were compared between indicated and nonindicated groups using χ and Wilcoxon rank-sum tests. A total of 3,920 Pap tests were performed between September 9, 2012, and August 31, 2014. A total of 257 (51%; 95% confidence interval [CI] 46.1-54.9%) of tests in the younger than 21 years group, 536 (40%; 95% CI 37.7-43.1%) in the older than 65 years group, and 605 (29%; 95% CI 27.1-31.0%) in the posthysterectomy group were not indicated. White race in the older than 65 years group was the only patient characteristic associated with receipt of a nonindicated Pap test (P=.007). Health care provider characteristics associated with nonindicated Pap tests varied by screening group. Temporal trends showed a decrease in the proportion of nonindicated tests in the younger than 21 years group but an increase in the posthysterectomy group. For women aged younger than 21 years and older than 65 years and posthysterectomy, 35% of Pap tests performed in our health system were not guideline-adherent. There were no patient or health care provider characteristics associated with guideline nonadherent screening across all groups.

Implementation guidelines for drug and alcohol regulations in mass transit

DOT National Transportation Integrated Search

2002-08-01

These guidelines will assist transit agencies in developing drug and alcohol testing programs that comply with regulations of the Federal Transit Administration (FTA). The guidelines provide a comprehensive, up-to-date summary of the regulatory requi...

40 CFR 799.9310 - TSCA 90-day oral toxicity in rodents.

Code of Federal Regulations, 2011 CFR

2011-07-01

... REQUIREMENTS Health Effects Test Guidelines § 799.9310 TSCA 90-day oral toxicity in rodents. (a) Scope. This... a test substance for a period of 90 days. This study is not capable of determining those effects... exposure. (b) Source. The source material used in developing this TSCA test guideline is the Office of...

40 CFR 799.9310 - TSCA 90-day oral toxicity in rodents.

Code of Federal Regulations, 2014 CFR

2014-07-01

... REQUIREMENTS Health Effects Test Guidelines § 799.9310 TSCA 90-day oral toxicity in rodents. (a) Scope. This... a test substance for a period of 90 days. This study is not capable of determining those effects... exposure. (b) Source. The source material used in developing this TSCA test guideline is the Office of...

40 CFR 799.9310 - TSCA 90-day oral toxicity in rodents.

Code of Federal Regulations, 2010 CFR

2010-07-01

... REQUIREMENTS Health Effects Test Guidelines § 799.9310 TSCA 90-day oral toxicity in rodents. (a) Scope. This... a test substance for a period of 90 days. This study is not capable of determining those effects... exposure. (b) Source. The source material used in developing this TSCA test guideline is the Office of...

40 CFR 799.9310 - TSCA 90-day oral toxicity in rodents.

Code of Federal Regulations, 2013 CFR

2013-07-01

... REQUIREMENTS Health Effects Test Guidelines § 799.9310 TSCA 90-day oral toxicity in rodents. (a) Scope. This... a test substance for a period of 90 days. This study is not capable of determining those effects... exposure. (b) Source. The source material used in developing this TSCA test guideline is the Office of...

40 CFR 799.9310 - TSCA 90-day oral toxicity in rodents.

Code of Federal Regulations, 2012 CFR

2012-07-01

... REQUIREMENTS Health Effects Test Guidelines § 799.9310 TSCA 90-day oral toxicity in rodents. (a) Scope. This... a test substance for a period of 90 days. This study is not capable of determining those effects... exposure. (b) Source. The source material used in developing this TSCA test guideline is the Office of...

An Agency with a Mind of Its Own: The EEOC's Guidelines on Employment Testing.

ERIC Educational Resources Information Center

Lyons, Phil

1985-01-01

Analyzes the legislative and judicial background of the Equal Employment Opportunities Commission (EEOC)'s 1978 Uniform Guidelines on Employment Selection Procedures. Argues that the guidelines' apparent objectives are at odds with those of the legislators who created the EEOC in the 1960s: the guidelines force employers to discriminate by race.…

American Gastroenterological Association guidelines are inaccurate in detecting pancreatic cysts with advanced neoplasia: a clinicopathologic study of 225 patients with supporting molecular data.

PubMed

Singhi, Aatur D; Zeh, Herbert J; Brand, Randall E; Nikiforova, Marina N; Chennat, Jennifer S; Fasanella, Kenneth E; Khalid, Asif; Papachristou, Georgios I; Slivka, Adam; Hogg, Melissa; Lee, Kenneth K; Tsung, Allan; Zureikat, Amer H; McGrath, Kevin

2016-06-01

The American Gastroenterological Association (AGA) recently reported evidence-based guidelines for the management of asymptomatic neoplastic pancreatic cysts. These guidelines advocate a higher threshold for surgical resection than prior guidelines and imaging surveillance for a considerable number of patients with pancreatic cysts. The aims of this study were to assess the accuracy of the AGA guidelines in detecting advanced neoplasia and present an alternative approach to pancreatic cysts. The study population consisted of 225 patients who underwent EUS-guided FNA for pancreatic cysts between January 2014 and May 2015. For each patient, clinical findings, EUS features, cytopathology results, carcinoembryonic antigen analysis, and molecular testing of pancreatic cyst fluid were reviewed. Molecular testing included the assessment of hotspot mutations and deletions for KRAS, GNAS, VHL, TP53, PIK3CA, and PTEN. Diagnostic pathology results were available for 41 patients (18%), with 13 (6%) harboring advanced neoplasia. Among these cases, the AGA guidelines identified advanced neoplasia with 62% sensitivity, 79% specificity, 57% positive predictive value, and 82% negative predictive value. Moreover, the AGA guidelines missed 45% of intraductal papillary mucinous neoplasms with adenocarcinoma or high-grade dysplasia. For cases without confirmatory pathology, 27 of 184 patients (15%) with serous cystadenomas (SCAs) based on EUS findings and/or VHL alterations would continue magnetic resonance imaging (MRI) surveillance. In comparison, a novel algorithmic pathway using molecular testing of pancreatic cyst fluid detected advanced neoplasias with 100% sensitivity, 90% specificity, 79% positive predictive value, and 100% negative predictive value. The AGA guidelines were inaccurate in detecting pancreatic cysts with advanced neoplasia. Furthermore, because the AGA guidelines manage all neoplastic cysts similarly, patients with SCAs will continue to undergo unnecessary MRI surveillance. The results of an alternative approach with integrative molecular testing are encouraging but require further validation. Copyright © 2016 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

Aquatic Animal Models – Not Just for Ecotox Anymore

EPA Science Inventory

A wide range of internationally harmonized toxicity test guidelines employing aquatic animal models have been established for regulatory use. For fish alone, there are over a dozen internationally harmonized toxicity test guidelines that have been, or are being, validated. To dat...

DEVELOPMENTAL NEUROTOXICITY TESTING GUIDELINES: VARIABILITY IN MORPHOMETRIC ASSESSMENTS OF NEUROPATHOLOGY.

EPA Science Inventory

The USEPA Developmental Neurotoxicity (DNT) Study Test Guideline (OPPTS 870.6300) calls for neuropathological and morphometric assessments of rat pups on postnatal day (PND) 11 and at study termination (after PND 60). In recent discussions about conducting these studies on pesti...

Quality Multiple-Choice Test Questions: Item-Writing Guidelines and an Analysis of Auditing Testbanks.

ERIC Educational Resources Information Center

Hansen, James D.; Dexter, Lee

1997-01-01

Analysis of test item banks in 10 auditing textbooks found that 75% of questions violated one or more guidelines for multiple-choice items. In comparison, 70% of a certified public accounting exam bank had no violations. (SK)

75 FR 22256 - Difenoconazole Pesticide Tolerances

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-28

... http://www.gpoaccess.gov/ecfr . To access the OPPTS Harmonized Test Guidelines referenced in this document electronically, please go to http://www.epa.gov/oppts and select ``Test Methods & Guidelines'' on... food as follows: i. Acute exposure. Quantitative acute dietary exposure and risk assessments are...

USING SEDIMENT QUALITY GUIDELINES IN DREDGED MATERIAL ASSESSMENTS

EPA Science Inventory

Sediment quality guidelines (SQGs) are not formally included in the frameworks described in the Inland Testing manual and the Green Book because these frameworks are biologically based. The SQGs are often used informally, however, to help put the results of biological testing in ...

Comparison of application of 2013 ACC/AHA guideline and 2011 European Society of Cardiology guideline for the management of dyslipidemias for primary prevention in a Turkish cohort.

PubMed

Yılmaz, Mustafa; Atar, İlyas; Hasırcı, Senem; Akyol, Kadirhan; Tekin, Abdullah; Karaçağlar, Emir; Çiftçi, Orçun; Müderrisoğlu, Haldun

2017-02-01

Atherosclerotic cardiovascular disease is a major global cause of death. The common approach in primary prevention of cardiovascular disease is to identify patients at high risk for cardiovascular disease. This article analyzes and compares the application of 2013 American College of Cardiology/American Heart Association (ACC/AHA) guideline and the 2011 European Society of Cardiology (ESC) guideline for the management of dyslipidemias for primary prevention in Turkish population. The study included 833 patients (482 women and 351 men). Risk scores were calculated according to both guidelines and indications for statin treatment were determined according to sex and age group. Variables are presented as mean±SD or median with interquartile range for continuous data and as proportions for categorical data. Variables were analyzed by unpaired t-test, Mann-Whitney U test, chi-square or Fischer's exact test as appropriate. The ACC/AHA would suggest statin treatment in 415 patients out of 833 (49.5%), while ESC would recommend statin for 193 patients out of 833 (23.1%)(p<0.001). Statins would be recommended for 40.4% of women and 62.6% of men for primary prevention by the ACC/AHA, while this figure was 12% for women and 38.4% for men according to the ESC guideline (p<0.001 for both). When compared to the ESC guideline, the ACC/AHA guideline suggests augmented statin treatment for primary prevention in Turkish population.

Guidelines on the management of abnormal liver blood tests

PubMed Central

Cramb, Rob; Davison, Suzanne M; Dillon, John F; Foulerton, Mark; Godfrey, Edmund M; Hall, Richard; Harrower, Ulrike; Hudson, Mark; Langford, Andrew; Mackie, Anne; Mitchell-Thain, Robert; Sennett, Karen; Sheron, Nicholas C; Verne, Julia; Walmsley, Martine; Yeoman, Andrew

2018-01-01

These updated guidelines on the management of abnormal liver blood tests have been commissioned by the Clinical Services and Standards Committee (CSSC) of the British Society of Gastroenterology (BSG) under the auspices of the liver section of the BSG. The original guidelines, which this document supersedes, were written in 2000 and have undergone extensive revision by members of the Guidelines Development Group (GDG). The GDG comprises representatives from patient/carer groups (British Liver Trust, Liver4life, PBC Foundation and PSC Support), elected members of the BSG liver section (including representatives from Scotland and Wales), British Association for the Study of the Liver (BASL), Specialist Advisory Committee in Clinical Biochemistry/Royal College of Pathology and Association for Clinical Biochemistry, British Society of Paediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN), Public Health England (implementation and screening), Royal College of General Practice, British Society of Gastrointestinal and Abdominal Radiologists (BSGAR) and Society of Acute Medicine. The quality of evidence and grading of recommendations was appraised using the AGREE II tool. These guidelines deal specifically with the management of abnormal liver blood tests in children and adults in both primary and secondary care under the following subheadings: (1) What constitutes an abnormal liver blood test? (2) What constitutes a standard liver blood test panel? (3) When should liver blood tests be checked? (4) Does the extent and duration of abnormal liver blood tests determine subsequent investigation? (5) Response to abnormal liver blood tests. They are not designed to deal with the management of the underlying liver disease. PMID:29122851

A tailored e-learning program to improve handover in the chain of emergency care: a pre-test post-test study.

PubMed

Ebben, Remco H A; van Grunsven, Pierre M; Moors, Marie Louise; Aldenhoven, Peter; de Vaan, Jordan; van Hout, Roger; van Achterberg, Theo; Vloet, Lilian C M

2015-04-16

To standardize patient handover in the chain of emergency care a handover guideline was developed. The main guideline recommendation is to use the DeMIST model (Demographics, Mechanism of Injury/illness, Injury/Illness, Signs, Treatment given) to structure pre-hospital notification and handover. To benefit from the new guideline, guideline adherence is necessary. As adherence to guidelines in emergency care settings is variable, there is a need to systematically implement the new guideline. For implementation of the guideline we developed a e-learning program tailored to influencing factors. The aim of the study was to evaluate the effectiveness of this e-learning program to improve emergency care professionals' adherence to the handover guideline during pre-hospital notification and handover in the chain of emergency medical service (EMS), emergency medical dispatch (EMD), and emergency department (ED). A prospective pre-test post-test study was conducted. The intervention was a tailored e-learning program that was offered to ambulance crew and emergency medical dispatchers (n=88). Data on adherence included pre-hospital notifications and handovers and were collected through observations and audiotapes before and after the e-learning program. Data were analyzed using X(2)-tests and t-tests. In total, 78/88 (88.6%) professionals followed the e-learning program. During pre- and post-test, 146 and 169 handovers were observed respectively. After the e-learning program, no significant difference in the number of handovers with the DeMIST model (77.9% vs. 73.1%, p=.319) and the number of handovers with the correct sequence of the DeMIST model (69.9% vs. 70.5%, p=.159) existed. During the handover, the number of questions by ED staff and interruptions significantly increased from 49.0% to 68.9% and from 15.2% to 52.7% respectively (both p=.000). Most handovers were performed after patient transfer, this did not change after the intervention (p=.167). The number of handovers where information was documented during handover slightly increased from 26.9% to 29.3% (p=.632). The tailored e-learning program did not improve adherence to a handover guideline in the chain of emergency care. Results show a relatively high baseline adherence rate to usage and correct sequence of the DeMIST model. Improvements in the handover process can be made on the documentation of information during handover, the number of interruptions and questions, and the handover moment.

Estimated saving of antibiotics in pharyngitis and lower respiratory tract infections if general practitioners used rapid tests and followed guidelines.

PubMed

Llor, Carles; Moragas, Ana; Cots, Josep M; López-Valcárcel, Beatriz González

General practitioners (GP) in Spain do not have access to rapid tests and adherence to guidelines is usually suboptimal. The aim of the study is to evaluate the estimated number of antibiotics that could have been saved if GPs had appropriately used these tests and had followed the guidelines. Observational study. Primary care centres from eight Autonomous Communities in Spain. GPs who had not participated in previous studies on rational use of antibiotics. GPs registered all the cases of pharyngitis and lower respiratory tract infections (LRTI) during 15 working days in 2015, by means of a 47-item audit. Actual GPs' antibiotic prescription and estimated number of antibiotics that could have been saved according to recent guidelines. A total of 126 GPs registered 1012 episodes of pharyngitis and 1928 LRTIs. Antibiotics were given or patients were referred in 497 patients with pharyngitis (49.1%) and 963 patients with LRTI (49.9%). If GPs had appropriately used rapid antigen detection tests and C-reactive protein tests and had strictly followed current guidelines, antibiotics would have been given to 7.6% and 15.1%, respectively, with an estimated saving of 420 antibiotics in patients with sore throat (estimated saving of 84.5%; 95% CI: 81.1-87.4%) and 672 antibiotics in LRTIs (estimated saving of 69.8%,95% CI: 67.1-72.5%). GP adherence to guidelines and a correct introduction of rapid tests in clinical practice in Spain could result in a considerable saving of unnecessary prescription of antibiotics in pharyngitis and LRTIs. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

Guidelines for model calibration and application to flow simulation in the Death Valley regional groundwater system

USGS Publications Warehouse

Hill, M.C.; D'Agnese, F. A.; Faunt, C.C.

2000-01-01

Fourteen guidelines are described which are intended to produce calibrated groundwater models likely to represent the associated real systems more accurately than typically used methods. The 14 guidelines are discussed in the context of the calibration of a regional groundwater flow model of the Death Valley region in the southwestern United States. This groundwater flow system contains two sites of national significance from which the subsurface transport of contaminants could be or is of concern: Yucca Mountain, which is the potential site of the United States high-level nuclear-waste disposal; and the Nevada Test Site, which contains a number of underground nuclear-testing locations. This application of the guidelines demonstrates how they may be used for model calibration and evaluation, and also to direct further model development and data collection.Fourteen guidelines are described which are intended to produce calibrated groundwater models likely to represent the associated real systems more accurately than typically used methods. The 14 guidelines are discussed in the context of the calibration of a regional groundwater flow model of the Death Valley region in the southwestern United States. This groundwater flow system contains two sites of national significance from which the subsurface transport of contaminants could be or is of concern: Yucca Mountain, which is the potential site of the United States high-level nuclear-waste disposal; and the Nevada Test Site, which contains a number of underground nuclear-testing locations. This application of the guidelines demonstrates how they may be used for model calibration and evaluation, and also to direct further model development and data collection.

Broadband ion mobility deconvolution for rapid analysis of complex mixtures.

PubMed

Pettit, Michael E; Brantley, Matthew R; Donnarumma, Fabrizio; Murray, Kermit K; Solouki, Touradj

2018-05-04

High resolving power ion mobility (IM) allows for accurate characterization of complex mixtures in high-throughput IM mass spectrometry (IM-MS) experiments. We previously demonstrated that pure component IM-MS data can be extracted from IM unresolved post-IM/collision-induced dissociation (CID) MS data using automated ion mobility deconvolution (AIMD) software [Matthew Brantley, Behrooz Zekavat, Brett Harper, Rachel Mason, and Touradj Solouki, J. Am. Soc. Mass Spectrom., 2014, 25, 1810-1819]. In our previous reports, we utilized a quadrupole ion filter for m/z-isolation of IM unresolved monoisotopic species prior to post-IM/CID MS. Here, we utilize a broadband IM-MS deconvolution strategy to remove the m/z-isolation requirement for successful deconvolution of IM unresolved peaks. Broadband data collection has throughput and multiplexing advantages; hence, elimination of the ion isolation step reduces experimental run times and thus expands the applicability of AIMD to high-throughput bottom-up proteomics. We demonstrate broadband IM-MS deconvolution of two separate and unrelated pairs of IM unresolved isomers (viz., a pair of isomeric hexapeptides and a pair of isomeric trisaccharides) in a simulated complex mixture. Moreover, we show that broadband IM-MS deconvolution improves high-throughput bottom-up characterization of a proteolytic digest of rat brain tissue. To our knowledge, this manuscript is the first to report successful deconvolution of pure component IM and MS data from an IM-assisted data-independent analysis (DIA) or HDMSE dataset.

Evaluating compliance with institutional preoperative testing guidelines for minimal-risk patients undergoing elective surgery.

PubMed

Siriussawakul, Arunotai; Nimmannit, Akarin; Rattana-arpa, Sirirat; Chatrattanakulchai, Siritda; Saengtawan, Puttachard; Wangdee, Aungsumat

2013-01-01

Few investigations preoperatively are important for low-risk patients. This study was designed to determine the level of compliance with preoperative investigation guidelines for ASA I patients undergoing elective surgery. Secondary objectives included the following: to identify common inappropriate investigations, to evaluate the impact of abnormal testing on patient management, to determine factors affecting noncompliant tests, and to estimate unnecessary expenditure. This retrospective study was conducted on adult patients over a one-year period. The institute's guidelines recommend tests according to the patients' age groups: a complete blood count (CBC) for those patients aged 18-45; CBC, chest radiograph (CXR) and electrocardiography (ECG) for those aged 46-60; and CBC, CXR, ECG, electrolytes, blood glucose, blood urea nitrogen (BUN), and creatinine (Cr) for patients aged 61-65. The medical records of 1,496 patients were reviewed. Compliant testing was found in only 12.1% (95% CI, 10.5-13.9). BUN and Cr testings were the most frequently overprescribed tests. Overinvestigations tended to be performed on major surgery and younger patients. Overall, overinvestigation incurred an estimated cost of US 200,000 dollars during the study period. The need to utilize the institution's preoperative guidelines should be emphasized in order to decrease unnecessary testing and the consequential financial burden.

Efficient clinical evaluation of guideline quality: development and testing of a new tool

PubMed Central

2014-01-01

Background Evaluating the methodological quality of clinical practice guidelines is essential before deciding which ones which could best inform policy or practice. One current method of evaluating clinical guideline quality is the research-focused AGREE II instrument. This uses 23 questions scored 1–7, arranged in six domains, which requires at least two independent testers, and uses a formulaic weighted domain scoring system. Following feedback from time-poor clinicians, policy-makers and managers that this instrument did not suit clinical need, we developed and tested a simpler, shorter, binary scored instrument (the iCAHE Guideline Quality Checklist) designed for single users. Methods Content and construct validity, inter-tester reliability and clinical utility were tested by comparing the new iCAHE Guideline Quality Checklist with the AGREE II instrument. Firstly the questions and domains in both instruments were compared. Six randomly-selected guidelines on a similar theme were then assessed by three independent testers with different experience in guideline quality assessment, using both instruments. Per guideline, weighted domain and total AGREE II scores were calculated, using the scoring rubric for three testers. Total iCAHE scores were calculated per guideline, per tester. The linear relationship between iCAHE and AGREE II scores was assessed using Pearson r correlation coefficients. Score differences between testers were assessed for the iCAHE Guideline Quality Checklist. Results There were congruent questions in each instrument in four domains (Scope & Purpose, Stakeholder involvement, Underlying evidence/Rigour, Clarity). The iCAHE and AGREE II scores were moderate to strongly correlated for the six guidelines. There was generally good agreement between testers for iCAHE scores, irrespective of their experience. The iCAHE instrument was preferred by all testers, and took significantly less time to administer than the AGREE II instrument. However, the use of only three testers and six guidelines compromised study power, rendering this research as pilot investigations of the psychometric properties of the iCAHE instrument. Conclusion The iCAHE Guideline Quality Checklist has promising psychometric properties and clinical utility. PMID:24885893

Guidance for Classifying Studies Conducted Using the OECD Test Guideline 223 (TG223) (Acute Avian Oral Sequential Dose Study)

EPA Pesticide Factsheets

Guidance based on comparison of results from the TG223 validation studies to results from avian acute oral studies previously submitted to EPA for two test chemicals following EPA's 850.2100 (public draft) guidelines.

75 FR 29908 - Prothioconazole; Pesticide Tolerances

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-28

....gpoaccess.gov/ecfr . To access the harmonized test guidelines referenced in this document electronically, please go http://www.epa.gov/ocspp and select ``Test Methods and Guidelines.'' C. Can I File an Objection... dietary exposures and all other exposures for which there is reliable information.'' This includes...

Molecular Biomarkers for the Evaluation of Colorectal Cancer: Guideline From the American Society for Clinical Pathology, College of American Pathologists, Association for Molecular Pathology, and American Society of Clinical Oncology.

PubMed

Sepulveda, Antonia R; Hamilton, Stanley R; Allegra, Carmen J; Grody, Wayne; Cushman-Vokoun, Allison M; Funkhouser, William K; Kopetz, Scott E; Lieu, Christopher; Lindor, Noralane M; Minsky, Bruce D; Monzon, Federico A; Sargent, Daniel J; Singh, Veena M; Willis, Joseph; Clark, Jennifer; Colasacco, Carol; Bryan Rumble, R; Temple-Smolkin, Robyn; B Ventura, Christina; Nowak, Jan A

2017-05-01

- To develop evidence-based guideline recommendations through a systematic review of the literature to establish standard molecular biomarker testing of colorectal cancer (CRC) tissues to guide epidermal growth factor receptor (EGFR) therapies and conventional chemotherapy regimens. - The American Society for Clinical Pathology, College of American Pathologists, Association for Molecular Pathology, and American Society of Clinical Oncology convened an expert panel to develop an evidence-based guideline to establish standard molecular biomarker testing and guide therapies for patients with CRC. A comprehensive literature search that included more than 4,000 articles was conducted. - Twenty-one guideline statements were established. - Evidence supports mutational testing for EGFR signaling pathway genes, since they provide clinically actionable information as negative predictors of benefit to anti-EGFR monoclonal antibody therapies for targeted therapy of CRC. Mutations in several of the biomarkers have clear prognostic value. Laboratory approaches to operationalize CRC molecular testing are presented.

Exercise Blood Pressure Guidelines: Time to Re-evaluate What is Normal and Exaggerated?

PubMed

Currie, Katharine D; Floras, John S; La Gerche, Andre; Goodman, Jack M

2018-03-24

Blood pressure responses to graded exercise testing can provide important diagnostic and prognostic information. While published guidelines outline what constitutes a "normal" and "abnormal" (i.e., exaggerated) blood pressure response to exercise testing, the widespread use of exaggerated blood pressure responses as a clinical tool is limited due to sparse and inconsistent data. A review of the original sources from these guidelines reveals an overall lack of empirical evidence to support both the normal blood pressure responses and their upper limits. In this current opinion, we critically evaluate the current exercise blood pressure guidelines including (1) the normal blood pressure responses to graded exercise testing; (2) the upper limits of this normal response; (3) the blood pressure criteria for test termination; and (4) the thresholds for exaggerated blood pressure responses. We provide evidence that exercise blood pressure responses vary according to subject characteristics, and subsequently a re-evaluation of what constitutes normal and abnormal responses is necessary to strengthen the clinical utility of this assessment.

Validation of the OECD reproduction test guideline with the New Zealand mudsnail Potamopyrgus antipodarum using trenbolone and prochloraz.

PubMed

Geiß, Cornelia; Ruppert, Katharina; Askem, Clare; Barroso, Carlos; Faber, Daniel; Ducrot, Virginie; Holbech, Henrik; Hutchinson, Thomas H; Kajankari, Paula; Kinnberg, Karin Lund; Lagadic, Laurent; Matthiessen, Peter; Morris, Steve; Neiman, Maurine; Penttinen, Olli-Pekka; Sanchez-Marin, Paula; Teigeler, Matthias; Weltje, Lennart; Oehlmann, Jörg

2017-04-01

The Organisation for Economic Cooperation and Development (OECD) provides several standard test methods for the environmental hazard assessment of chemicals, mainly based on primary producers, arthropods, and fish. In April 2016, two new test guidelines with two mollusc species representing different reproductive strategies were approved by OECD member countries. One test guideline describes a 28-day reproduction test with the parthenogenetic New Zealand mudsnail Potamopyrgus antipodarum. The main endpoint of the test is reproduction, reflected by the embryo number in the brood pouch per female. The development of a new OECD test guideline involves several phases including inter-laboratory validation studies to demonstrate the robustness of the proposed test design and the reproducibility of the test results. Therefore, a ring test of the reproduction test with P. antipodarum was conducted including eight laboratories with the test substances trenbolone and prochloraz and results are presented here. Most laboratories could meet test validity criteria, thus demonstrating the robustness of the proposed test protocol. Trenbolone did not have an effect on the reproduction of the snails at the tested concentration range (nominal: 10-1000 ng/L). For prochloraz, laboratories produced similar EC 10 and NOEC values, showing the inter-laboratory reproducibility of results. The average EC 10 and NOEC values for reproduction (with coefficient of variation) were 26.2 µg/L (61.7%) and 29.7 µg/L (32.9%), respectively. This ring test shows that the mudsnail reproduction test is a well-suited tool for use in the chronic aquatic hazard and risk assessment of chemicals.

Carotid and coronary disease management prior to open and endovascular aortic surgery. What are the current guidelines?

PubMed

Thompson, J P

2014-04-01

Several bodies produce broadly concurring and updated guidelines for the evaluation and treatment of cardiovascular disease in both surgical and non-surgical patients. Recent developments include revised recommendations on preoperative stress testing, referral for possible coronary revascularization and medical management. It is recognized that non-invasive cardiac tests are relatively poor at predicting perioperative risk, and "prophylactic" coronary revascularization has a limited role. The planned aortic intervention (open or endovascular repair) also influences preoperative management. Patients presenting for elective abdominal aortic aneurysm (AAA) repair should only be referred for cardiological testing if they have active symptoms of coronary artery disease (CAD), known CAD and poor functional exercise capacity, or multiple risk factors for CAD. Coronary revascularization before AAA surgery should be limited to patients with established indications, so cardiac stress testing should only be performed if it would change management i.e. the patient is a candidate for and would benefit from coronary revascularization. When endovascular aortic repair is planned, it is reasonable to proceed to surgery without further cardiac stress testing or evaluation unless otherwise indicated. All non-emergency patients require medical optimization, but perioperative beta blockade benefits only certain patients. Some of the data informing recent guidelines have been questioned and some guidelines are being revised. Current guidelines do not specifically address the management of patients with known or suspected carotid artery disease who may require aortic surgery. For these patients, an individualized approach is required. This review considers recent guidelines. Algorithms for investigation and management based on their recommendations are included.

ASVCP quality assurance guidelines: control of preanalytical and analytical factors for hematology for mammalian and nonmammalian species, hemostasis, and crossmatching in veterinary laboratories.

PubMed

Vap, Linda M; Harr, Kendal E; Arnold, Jill E; Freeman, Kathleen P; Getzy, Karen; Lester, Sally; Friedrichs, Kristen R

2012-03-01

In December 2009, the American Society for Veterinary Clinical Pathology (ASVCP) Quality Assurance and Laboratory Standards committee published the updated and peer-reviewed ASVCP Quality Assurance Guidelines on the Society's website. These guidelines are intended for use by veterinary diagnostic laboratories and veterinary research laboratories that are not covered by the US Food and Drug Administration Good Laboratory Practice standards (Code of Federal Regulations Title 21, Chapter 58). The guidelines have been divided into 3 reports: (1) general analytical factors for veterinary laboratory performance and comparisons; (2) hematology, hemostasis, and crossmatching; and (3) clinical chemistry, cytology, and urinalysis. This particular report is one of 3 reports and provides recommendations for control of preanalytical and analytical factors related to hematology for mammalian and nonmammalian species, hemostasis testing, and crossmatching and is adapted from sections 1.1 and 2.3 (mammalian hematology), 1.2 and 2.4 (nonmammalian hematology), 1.5 and 2.7 (hemostasis testing), and 1.6 and 2.8 (crossmatching) of the complete guidelines. These guidelines are not intended to be all-inclusive; rather, they provide minimal guidelines for quality assurance and quality control for veterinary laboratory testing and a basis for laboratories to assess their current practices, determine areas for improvement, and guide continuing professional development and education efforts. © 2012 American Society for Veterinary Clinical Pathology.

Examining the Alignment of Chinese National Physics Curriculum Guidelines and 12th-Grade Exit Examinations: A Case Study

ERIC Educational Resources Information Center

Liang, Ling L.; Yuan, Haiquan

2008-01-01

This study reports findings from an analysis of the 2002 Chinese National Physics Curriculum Guidelines and the alignment between the curriculum guidelines and two most recent provincial-level 12th-grade exit examinations in China. Both curriculum guidelines and test content were represented using two-dimensional matrices (i.e., topic by level of…

Assessing 1D Atmospheric Solar Radiative Transfer Models: Interpretation and Handling of Unresolved Clouds.

NASA Astrophysics Data System (ADS)

Barker, H. W.; Stephens, G. L.; Partain, P. T.; Bergman, J. W.; Bonnel, B.; Campana, K.; Clothiaux, E. E.; Clough, S.; Cusack, S.; Delamere, J.; Edwards, J.; Evans, K. F.; Fouquart, Y.; Freidenreich, S.; Galin, V.; Hou, Y.; Kato, S.; Li, J.;  Mlawer, E.;  Morcrette, J.-J.;  O'Hirok, W.;  Räisänen, P.;  Ramaswamy, V.;  Ritter, B.;  Rozanov, E.;  Schlesinger, M.;  Shibata, K.;  Sporyshev, P.;  Sun, Z.;  Wendisch, M.;  Wood, N.;  Yang, F.

2003-08-01

The primary purpose of this study is to assess the performance of 1D solar radiative transfer codes that are used currently both for research and in weather and climate models. Emphasis is on interpretation and handling of unresolved clouds. Answers are sought to the following questions: (i) How well do 1D solar codes interpret and handle columns of information pertaining to partly cloudy atmospheres? (ii) Regardless of the adequacy of their assumptions about unresolved clouds, do 1D solar codes perform as intended?One clear-sky and two plane-parallel, homogeneous (PPH) overcast cloud cases serve to elucidate 1D model differences due to varying treatments of gaseous transmittances, cloud optical properties, and basic radiative transfer. The remaining four cases involve 3D distributions of cloud water and water vapor as simulated by cloud-resolving models. Results for 25 1D codes, which included two line-by-line (LBL) models (clear and overcast only) and four 3D Monte Carlo (MC) photon transport algorithms, were submitted by 22 groups. Benchmark, domain-averaged irradiance profiles were computed by the MC codes. For the clear and overcast cases, all MC estimates of top-of-atmosphere albedo, atmospheric absorptance, and surface absorptance agree with one of the LBL codes to within ±2%. Most 1D codes underestimate atmospheric absorptance by typically 15-25 W m-2 at overhead sun for the standard tropical atmosphere regardless of clouds.Depending on assumptions about unresolved clouds, the 1D codes were partitioned into four genres: (i) horizontal variability, (ii) exact overlap of PPH clouds, (iii) maximum/random overlap of PPH clouds, and (iv) random overlap of PPH clouds. A single MC code was used to establish conditional benchmarks applicable to each genre, and all MC codes were used to establish the full 3D benchmarks. There is a tendency for 1D codes to cluster near their respective conditional benchmarks, though intragenre variances typically exceed those for the clear and overcast cases. The majority of 1D codes fall into the extreme category of maximum/random overlap of PPH clouds and thus generally disagree with full 3D benchmark values. Given the fairly limited scope of these tests and the inability of any one code to perform extremely well for all cases begs the question that a paradigm shift is due for modeling 1D solar fluxes for cloudy atmospheres.

Development and evaluation of online evidence based guideline bank system.

PubMed

Park, Myonghwa

2006-01-01

The purpose of this study was to develop and evaluate the online evidence-based nursing practice guideline bank system to support the best evidence-based decision in the clinical and community practice settings. The main homepage consisted of seven modules for introduction of site, EBN, guideline bank, guideline development, guideline review, related sites, and community. The major contents in the guidelines were purpose, developer, intended audience, method of development, target population, testing, knowledge components, and evaluation. Electronic versions of the guidelines were displayed by XML, PDF, and PDA versions. The system usability were evaluated by general users, guideline developers, and guideline reviewers on the web and the results showed high scores of satisfaction. This online evidence-based guideline bank system could support nurses' best and cost-effective clinical decision using the sharable standardized guidelines with education module of evidence based nursing.

Mutation Detection in Patients With Advanced Cancer by Universal Sequencing of Cancer-Related Genes in Tumor and Normal DNA vs Guideline-Based Germline Testing.

PubMed

Mandelker, Diana; Zhang, Liying; Kemel, Yelena; Stadler, Zsofia K; Joseph, Vijai; Zehir, Ahmet; Pradhan, Nisha; Arnold, Angela; Walsh, Michael F; Li, Yirong; Balakrishnan, Anoop R; Syed, Aijazuddin; Prasad, Meera; Nafa, Khedoudja; Carlo, Maria I; Cadoo, Karen A; Sheehan, Meg; Fleischut, Megan H; Salo-Mullen, Erin; Trottier, Magan; Lipkin, Steven M; Lincoln, Anne; Mukherjee, Semanti; Ravichandran, Vignesh; Cambria, Roy; Galle, Jesse; Abida, Wassim; Arcila, Marcia E; Benayed, Ryma; Shah, Ronak; Yu, Kenneth; Bajorin, Dean F; Coleman, Jonathan A; Leach, Steven D; Lowery, Maeve A; Garcia-Aguilar, Julio; Kantoff, Philip W; Sawyers, Charles L; Dickler, Maura N; Saltz, Leonard; Motzer, Robert J; O'Reilly, Eileen M; Scher, Howard I; Baselga, Jose; Klimstra, David S; Solit, David B; Hyman, David M; Berger, Michael F; Ladanyi, Marc; Robson, Mark E; Offit, Kenneth

2017-09-05

Guidelines for cancer genetic testing based on family history may miss clinically actionable genetic changes with established implications for cancer screening or prevention. To determine the proportion and potential clinical implications of inherited variants detected using simultaneous sequencing of the tumor and normal tissue ("tumor-normal sequencing") compared with genetic test results based on current guidelines. From January 2014 until May 2016 at Memorial Sloan Kettering Cancer Center, 10 336 patients consented to tumor DNA sequencing. Since May 2015, 1040 of these patients with advanced cancer were referred by their oncologists for germline analysis of 76 cancer predisposition genes. Patients with clinically actionable inherited mutations whose genetic test results would not have been predicted by published decision rules were identified. Follow-up for potential clinical implications of mutation detection was through May 2017. Tumor and germline sequencing compared with the predicted yield of targeted germline sequencing based on clinical guidelines. Proportion of clinically actionable germline mutations detected by universal tumor-normal sequencing that would not have been detected by guideline-directed testing. Of 1040 patients, the median age was 58 years (interquartile range, 50.5-66 years), 65.3% were male, and 81.3% had stage IV disease at the time of genomic analysis, with prostate, renal, pancreatic, breast, and colon cancer as the most common diagnoses. Of the 1040 patients, 182 (17.5%; 95% CI, 15.3%-19.9%) had clinically actionable mutations conferring cancer susceptibility, including 149 with moderate- to high-penetrance mutations; 101 patients tested (9.7%; 95% CI, 8.1%-11.7%) would not have had these mutations detected using clinical guidelines, including 65 with moderate- to high-penetrance mutations. Frequency of inherited mutations was related to case mix, stage, and founder mutations. Germline findings led to discussion or initiation of change to targeted therapy in 38 patients tested (3.7%) and predictive testing in the families of 13 individuals (1.3%), including 6 for whom genetic evaluation would not have been initiated by guideline-based testing. In this referral population with selected advanced cancers, universal sequencing of a broad panel of cancer-related genes in paired germline and tumor DNA samples was associated with increased detection of individuals with potentially clinically significant heritable mutations over the predicted yield of targeted germline testing based on current clinical guidelines. Knowledge of these additional mutations can help guide therapeutic and preventive interventions, but whether all of these interventions would improve outcomes for patients with cancer or their family members requires further study. clinicaltrials.gov Identifier: NCT01775072.

Critical attitudes and beliefs towards guidelines amongst palliative care professionals - results from a national survey.

PubMed

Kalies, Helen; Schöttmer, Rieke; Simon, Steffen T; Voltz, Raymond; Crispin, Alexander; Bausewein, Claudia

2017-03-21

Little is known about palliative care professionals' attitudes towards guidelines. In 2015, the German Association for Palliative Medicine (DGP) published an evidence based guideline for palliative care in adults with incurable cancer. Before publication we conducted a national survey among members of the DGP to detect possible barriers and facilitators for its implementation. The aim of the present publication was to evaluate critical attitudes and beliefs which could hinder the effective implementation of the new guideline and to evaluate differences within professional groups and medical specialisations. This web-based online survey was addressed to all members of the DGP in summer 2014. Twenty-one questions concerning attitudes and beliefs towards guidelines were a priori developed to represent the following topics: scepticism regarding the quality of guidelines, doubts about the implementation of guidelines, restrictions in treatment options through guidelines, discrepancy between palliative care values and guidelines. Differences within professions and specialisations were tested using Kruskal-Wallis tests. All 4.786 members with known email address were invited, 1.181 followed the link, 1.138 began to answer the questionnaire and 1.031 completed the questionnaire. More than half of participating members were physicians and one third nurses. Scepticism regarding the quality of existing guidelines was high (range 12.8-73.2%). Doubts regarding practical aspects of guidelines were less prevalent but still high (range 21.8-57.6%). About one third (range 5.4-31.4%) think that guidelines restrict their treatment options. In addition, 38.8% believed that guidelines are a kind of cookbook and restrict the flexibility of individual patient care. The majority saw no or little discrepancy between palliative care values and guidelines (range 68.4-82.6%). There were relatively small but significant differences between professions and specialisations. The person-centred and individual approach of palliative care does not seem to contradict the acceptance of guidelines. Main barriers were related to scepticism regarding the quality of guidelines and the implementation of guidelines in general.

A Litmus Test for Performance Assessment.

ERIC Educational Resources Information Center

Finson, Kevin D.; Beaver, John B.

1992-01-01

Presents 10 guidelines for developing performance-based assessment items. Presents a sample activity developed from the guidelines. The activity tests students ability to observe, classify, and infer, using red and blue litmus paper, a pH-range finder, vinegar, ammonia, an unknown solution, distilled water, and paper towels. (PR)

77 FR 56782 - Bifenthrin; Pesticide Tolerances

Federal Register 2010, 2011, 2012, 2013, 2014

2012-09-14

..., hay. Interregional Research Project Number 4 (IR-4) requested these tolerances under the Federal Food... OCSPP test guidelines referenced in this document electronically, please go to http://www.epa.gov/ocspp and select ``Test Methods and Guidelines.'' C. How can I file an objection or hearing request? Under...

78 FR 55635 - Prometryn; Pesticide Tolerances

Federal Register 2010, 2011, 2012, 2013, 2014

2013-09-11

.... Interregional Research Project Number 4 (IR-4) requested these tolerances under the Federal Food, Drug, and... test guidelines referenced in this document electronically, please go to http://www.epa.gov/ocspp and select ``Test Methods and Guidelines. C. How can I file an objection or hearing request? Under FFDCA...

Academia's role in Test Ban Treaty monitoring remains unresolved

NASA Astrophysics Data System (ADS)

Wakefield, J.

However, some progress has been made in negotiating how this university consortium will be coordinated with the federal government's efforts to develop comprehensive nuclear test ban monitoring systems. Before Congress closed shop, changes were made in the conference wording of a Defense authorization bill for fiscal year 1995 that covers seismic research. Instead of requiring the secretaries of Defense and State to sign off on all seismic projects for monitoring nuclear explosions before the funds may be obligated, as the Senate version of the bill originally proposed, the seismic projects must now be approved by an existing annual review group, which was established by a classified presidential directive. In addition, some of the controversial language in a complementing Senate report will be changed.

Status of thermalhydraulic modelling and assessment: Open issues

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

Bestion, D.; Barre, F.

1997-07-01

This paper presents the status of the physical modelling in present codes used for Nuclear Reactor Thermalhydraulics (TRAC, RELAP 5, CATHARE, ATHLET,...) and attempts to list the unresolved or partially resolved issues. First, the capabilities and limitations of present codes are presented. They are mainly known from a synthesis of the assessment calculations performed for both separate effect tests and integral effect tests. It is also interesting to list all the assumptions and simplifications which were made in the establishment of the system of equations and of the constitutive relations. Many of the present limitations are associated to physical situationsmore » where these assumptions are not valid. Then, recommendations are proposed to extend the capabilities of these codes.« less

International Collegium of Rehabilitative Audiology (ICRA) recommendations for the construction of multilingual speech tests. ICRA Working Group on Multilingual Speech Tests.

PubMed

Akeroyd, Michael A; Arlinger, Stig; Bentler, Ruth A; Boothroyd, Arthur; Dillier, Norbert; Dreschler, Wouter A; Gagné, Jean-Pierre; Lutman, Mark; Wouters, Jan; Wong, Lena; Kollmeier, Birger

2015-01-01

To provide guidelines for the development of two types of closed-set speech-perception tests that can be applied and interpreted in the same way across languages. The guidelines cover the digit triplet and the matrix sentence tests that are most commonly used to test speech recognition in noise. They were developed by a working group on Multilingual Speech Tests of the International Collegium of Rehabilitative Audiology (ICRA). The recommendations are based on reviews of existing evaluations of the digit triplet and matrix tests as well as on the research experience of members of the ICRA Working Group. They represent the results of a consensus process. The resulting recommendations deal with: Test design and word selection; Talker characteristics; Audio recording and stimulus preparation; Masking noise; Test administration; and Test validation. By following these guidelines for the development of any new test of this kind, clinicians and researchers working in any language will be able to perform tests whose results can be compared and combined in cross-language studies.

Drug Testing. Federal Agency Plans for Testing Employees. Report to the Chairman, Subcommittee on Treasury, Postal Service, and General Government, Committee on Appropriations, U.S. Senate.

ERIC Educational Resources Information Center

General Accounting Office, Washington, DC. General Government Div.

The drug-testing plans covering 11 of the 12 civilian federal cabinet-level agencies met the requirements of U.S. Department of Health and Human Services guidelines, and the guidelines themselves were found to contain the elements required by Public Law 100-71. However, the drug-testing plans differ, so employees may find different circumstances…

Integration of collinear-type doubly unresolved counterterms in NNLO jet cross sections

NASA Astrophysics Data System (ADS)

Del Duca, Vittorio; Somogyi, Gábor; Trócsányi, Zoltán

2013-06-01

In the context of a subtraction method for jet cross sections at NNLO accuracy in the strong coupling, we perform the integration over the two-particle factorised phase space of the collinear-type contributions to the doubly unresolved counterterms. We present the final result as a convolution in colour space of the Born cross section and of an insertion operator, which is written in terms of master integrals that we expand in the dimensional regularisation parameter.

A subtraction scheme for computing QCD jet cross sections at NNLO: integrating the subtraction terms I

NASA Astrophysics Data System (ADS)

Somogyi, Gábor; Trócsányi, Zoltán

2008-08-01

In previous articles we outlined a subtraction scheme for regularizing doubly-real emission and real-virtual emission in next-to-next-to-leading order (NNLO) calculations of jet cross sections in electron-positron annihilation. In order to find the NNLO correction these subtraction terms have to be integrated over the factorized unresolved phase space and combined with the two-loop corrections. In this paper we perform the integration of all one-parton unresolved subtraction terms.

A subtraction scheme for computing QCD jet cross sections at NNLO: integrating the doubly unresolved subtraction terms

NASA Astrophysics Data System (ADS)

Somogyi, Gábor

2013-04-01

We finish the definition of a subtraction scheme for computing NNLO corrections to QCD jet cross sections. In particular, we perform the integration of the soft-type contributions to the doubly unresolved counterterms via the method of Mellin-Barnes representations. With these final ingredients in place, the definition of the scheme is complete and the computation of fully differential rates for electron-positron annihilation into two and three jets at NNLO accuracy becomes feasible.

[Latest international guidelines for screening, prevention and treatment of familial breast cancer - implications for the relevant practice in Hungary].

PubMed

Romics, László; Kocsis, Judit; Ormándi, Katalin; Molnár, Béla Ákos

2016-07-01

Screening, prevention and treatment of familial breast cancer require a multidisciplinary approach. New guidelines were published in the United Kingdom for the management of familial breast cancer. The authors summarise these new guidelines and analyse the relevant practice in Hungary. Relevant guidelines of the National Institute for Health and Care Excellence and Familial Breast Cancer Report (NHS Scotland) are described. New guidelines will increase the number of genetic tests as well as genetic counselling. An increase in the number of breast magnetic resonance imaging is expected, too. Chemoprevention can be offered for individuals with medium risk and above. Promising trials are underway with platinum based chemotherapy and polyADP-ribose polimerase inhibitors for the systemic treatment of familial breast cancer. The increase in the number of genetic tests, counselling, and breast magnetic resonance imaging may have a significant impact on health care budget. These guidelines will change some aspects of the current management of familial breast cancer. Orv. Hetil., 2016, 157(28), 1117-1125.

South African HIV self-testing policy and guidance considerations.

PubMed

Venter, Francois; Majam, Mohammed; Jankelowitz, Lauren; Adams, Siraaj; Moorhouse, Michelle; Carmona, Sergio; Stevens, Wendy; Msimanga, Busisiwe R; Allen, David; Balani, Pooja; Nevhutalu, Zwoitwaho; Rhagnath, Naleni; Shroufi, Amir; Devillé, Walter; Kazangarare, Victoria; van der Wiel, Renee; Templeman, Hugo; Puren, Adrian; Tucker, Tim; van Cutsem, Gilles; Conradie, Francesca; Dong, Krista; Chidarikire, Thato; Gray, Andy

2017-01-01

The gap in HIV testing remains significant and new modalities such as HIV self-testing (HIVST) have been recommended to reach key and under-tested populations. In December 2016, the World Health Organization (WHO) released the Guidelines on HIV Self-Testing and Partner Notification: A Supplement to the Consolidated Guidelines on HIV Testing Services (HTS) and urged member countries to develop HIVST policy and regulatory frameworks. In South Africa, HIVST was included as a supplementary strategy in the National HIV Testing Services Policy in 2016, and recently, guidelines for HIVST were included in the South African National Strategic Plan for HIV, sexually transmitted infections and tuberculosis 2017-2022. This document serves as an additional guidance for the National HIV Testing Services Policy 2016, with specific focus on HIVST. It is intended for policy advocates, clinical and non-clinical HTS providers, health facility managers and healthcare providers in private and public health facilities, non-governmental, community-based and faith-based organisations involved in HTS and outreach, device manufacturers, workplace programmes and institutes of higher education.

2012 European guideline on the diagnosis and treatment of gonorrhoea in adults.

PubMed

Bignell, C; Unemo, M

2013-02-01

Gonorrhoea is a major public health concern globally. Of particularly grave concern is that resistance to the extended-spectrum cephalosporins has emerged during the most recent years. This guideline provides recommendations regarding the diagnosis and treatment of gonorrhoea in Europe. Compared to the outdated 2009 European gonorrhoea guideline, this 2012 European gonorrhoea guideline provides up-to-date guidance on, broader indications for testing and treatment of gonorrhoea;the introduction of dual antimicrobial therapy (ceftriaxone 500 mg and azithromycin 2 g) for uncomplicated gonorrhoea when the antimicrobial sensitivity is unknown; recommendation of test of cure in all gonorrhoea cases to ensure eradication of infection and identify emerging resistance; and recommendations to identify, verify and report failures with recommended treatment regimens. Optimisations of the testing, diagnostics, antimicrobial treatment and follow-up of gonorrhoea patients are crucial in controlling the emergent spread of cephalosporin-resistant and multidrug-resistant gonorrhoea.

Mechanism of freeze-thaw injury and recovery: A cool retrospective and warming up to new ideas.

PubMed

Arora, Rajeev

2018-05-01

Understanding cellular mechanism(s) of freeze-thaw injury (FTI) is key to the efforts for improving plant freeze-tolerance by cultural methods or molecular/genetic approaches. However, not much work has been done in the last 25+ years to advance our understanding of the nature and cellular loci of FTI. Currently, two FTI lesions are predominantly implicated: 1) structural and functional perturbations in plasma membrane; 2) ROS-induced oxidative damage. While both have stood the test of time, many questions remain unresolved and other potentially significant lesions need to be investigated. Additionally, molecular mechanism of post-thaw recovery (PTR), a critical component of frost-survival, has not been well investigated. Mechanistic understanding of repair after reversible injury could expand the options for strategies to improve frost-hardiness. In this review, without claiming to be exhaustive, I have attempted to synthesize major discoveries from last several decades on the mechanisms of FTI and the relatively little research conducted thus far on PTR mechanisms. It is followed by proposing of hypotheses for mechanism(s) for irreversible FTI or PTR involving cytosolic calcium and ROS signaling. Perspective is presented on some unresolved questions and research on new ideas to fill the knowledge gaps and advance the field. Copyright © 2018 Elsevier B.V. All rights reserved.

Examining Changes in Prevention Guidelines in Maternal and Child Health: Development of a Teaching Activity.

PubMed

Thompson, Erika L; Vamos, Cheryl A; Windsor-Hardy, Amber; Griner, Stacey B; Daley, Ellen M

2018-06-26

Purpose Recent changes in preventive guidelines (e.g., pap testing, mammography) have resulted in confusion for both providers and patients. These changes have occurred either because new research has been introduced or because evidence for the practice is not established. Public health has the responsibility to promote the dissemination and implementation of changing guidelines into practice to improve the public's health. Health literacy may facilitate this process. The purpose of this study is to describe a teaching tool applying principles of health literacy to changes in prevention guidelines. The objectives of the teaching activity were to: (1) understand the development of evidence-informed prevention guidelines; and (2) use health literacy to evaluate the target population's perspectives on the guideline change using a health literacy approach. Description An interactive lecture and a practice-based assignment were created; the assignment was pilot-tested in graduate Women's Health classes. Multiple final products were developed in order to facilitate the lecture and assignment: (1) lesson plan; (2) slide presentation; (3) health literacy interview guide worksheet; and (4) grading rubric. After the presentation, students interviewed women from the guideline target population using health literacy constructs and synthesized their findings to create an overall assessment report. Assessment Feedback from the pilot test informed the revision of the teaching activity. Conclusions This teaching tool can be applied in a wide variety of settings in higher education, such as courses in public health, nursing, or medicine. As health literacy continues to be an important determinant of health status, integrating this determinant into the dissemination and communication of preventive guideline changes is needed.

Comparison of application of 2013 ACC/AHA guideline and 2011 European Society of Cardiology guideline for the management of dyslipidemias for primary prevention in a Turkish cohort

PubMed Central

Yılmaz, Mustafa; Atar, İlyas; Hasırcı, Senem; Akyol, Kadirhan; Tekin, Abdullah; Karaçağlar, Emir; Çiftçi, Orçun; Müderrisoğlu, Haldun

2017-01-01

Objective: Atherosclerotic cardiovascular disease is a major global cause of death. The common approach in primary prevention of cardiovascular disease is to identify patients at high risk for cardiovascular disease. This article analyzes and compares the application of 2013 American College of Cardiology/American Heart Association (ACC/AHA) guideline and the 2011 European Society of Cardiology (ESC) guideline for the management of dyslipidemias for primary prevention in Turkish population. Methods: The study included 833 patients (482 women and 351 men). Risk scores were calculated according to both guidelines and indications for statin treatment were determined according to sex and age group. Variables are presented as mean±SD or median with interquartile range for continuous data and as proportions for categorical data. Variables were analyzed by unpaired t-test, Mann-Whitney U test, chi-square or Fischer’s exact test as appropriate. Results: The ACC/AHA would suggest statin treatment in 415 patients out of 833 (49.5%), while ESC would recommend statin for 193 patients out of 833 (23.1%) (p<0.001). Statins would be recommended for 40.4% of women and 62.6% of men for primary prevention by the ACC/AHA, while this figure was 12% for women and 38.4% for men according to the ESC guideline (p<0.001 for both). Conclusion: When compared to the ESC guideline, the ACC/AHA guideline suggests augmented statin treatment for primary prevention in Turkish population. PMID:27684519

EMQN best practice guidelines for the molecular genetic testing and reporting of chromosome 11p15 imprinting disorders: Silver–Russell and Beckwith–Wiedemann syndrome

PubMed Central

Eggermann, Katja; Bliek, Jet; Brioude, Frédéric; Algar, Elizabeth; Buiting, Karin; Russo, Silvia; Tümer, Zeynep; Monk, David; Moore, Gudrun; Antoniadi, Thalia; Macdonald, Fiona; Netchine, Irène; Lombardi, Paolo; Soellner, Lukas; Begemann, Matthias; Prawitt, Dirk; Maher, Eamonn R; Mannens, Marcel; Riccio, Andrea; Weksberg, Rosanna; Lapunzina, Pablo; Grønskov, Karen; Mackay, Deborah JG; Eggermann, Thomas

2016-01-01

Molecular genetic testing for the 11p15-associated imprinting disorders Silver–Russell and Beckwith–Wiedemann syndrome (SRS, BWS) is challenging because of the molecular heterogeneity and complexity of the affected imprinted regions. With the growing knowledge on the molecular basis of these disorders and the demand for molecular testing, it turned out that there is an urgent need for a standardized molecular diagnostic testing and reporting strategy. Based on the results from the first external pilot quality assessment schemes organized by the European Molecular Quality Network (EMQN) in 2014 and in context with activities of the European Network of Imprinting Disorders (EUCID.net) towards a consensus in diagnostics and management of SRS and BWS, best practice guidelines have now been developed. Members of institutions working in the field of SRS and BWS diagnostics were invited to comment, and in the light of their feedback amendments were made. The final document was ratified in the course of an EMQN best practice guideline meeting and is in accordance with the general SRS and BWS consensus guidelines, which are in preparation. These guidelines are based on the knowledge acquired from peer-reviewed and published data, as well as observations of the authors in their practice. However, these guidelines can only provide a snapshot of current knowledge at the time of manuscript submission and readers are advised to keep up with the literature. PMID:27165005

75 FR 4284 - Triticonazole; Pesticide Tolerances

Federal Register 2010, 2011, 2012, 2013, 2014

2010-01-27

... harmonized test guidelines referenced in this document electronically, please go to http://www.epa.gov/oppts and select ``Test Methods & Guidelines'' on the left-side navigation menu. C. Can I File an Objection..., P.O. Box 13528, Research Triangle Park, NC 27709-3528. The petition requested that 40 CFR 180.583 be...

IN CASE YOU MISSED IT: EPA Releases New Chemical Safety Guidelines Aimed at Curbing Animal Testing, Tracking Mercury Imports, and Facilitating the Sharing of Confidential Business Information

EPA Pesticide Factsheets

EPA News Release: IN CASE YOU MISSED IT: EPA Releases New Chemical Safety Guidelines Aimed at Curbing Animal Testing, Tracking Mercury Imports, and Facilitating the Sharing of Confidential Business Information

SUPPRESSION OF IMMUNE FUNCTION AND SUSCEPTIBILITY TO INFECTIONS IN HUMANS: ASSOCIATION OF IMMUNE FUNCTION WITH CLINICAL DISEASE

EPA Science Inventory

ABSTRACT
A number of regulatory agencies in western Europe, Japan and the US now include guidelines for evaluating the potential immunotoxicity of chemicals, including drugs, as part of routine toxicity testing. Most testing guidelines recommend observational or functional as...

40 CFR 795.120 - Gammarid acute toxicity test.

Code of Federal Regulations, 2014 CFR

2014-07-01

... culture container. The control group shall be exposed to the same dilution water, conditions and... CONTROL ACT (CONTINUED) PROVISIONAL TEST GUIDELINES Provisional Environmental Effects Guidelines § 795.120... under the Toxic Substances Control Act (TSCA) (Pub. L. 94-469, 90 Stat. 2003 (15 U.S.C. 2601 et seq...

40 CFR 795.120 - Gammarid acute toxicity test.

Code of Federal Regulations, 2011 CFR

2011-07-01

... culture container. The control group shall be exposed to the same dilution water, conditions and... CONTROL ACT (CONTINUED) PROVISIONAL TEST GUIDELINES Provisional Environmental Effects Guidelines § 795.120... under the Toxic Substances Control Act (TSCA) (Pub. L. 94-469, 90 Stat. 2003 (15 U.S.C. 2601 et seq...

40 CFR 795.120 - Gammarid acute toxicity test.

Code of Federal Regulations, 2010 CFR

2010-07-01

... culture container. The control group shall be exposed to the same dilution water, conditions and... CONTROL ACT (CONTINUED) PROVISIONAL TEST GUIDELINES Provisional Environmental Effects Guidelines § 795.120... under the Toxic Substances Control Act (TSCA) (Pub. L. 94-469, 90 Stat. 2003 (15 U.S.C. 2601 et seq...

40 CFR 795.120 - Gammarid acute toxicity test.

Code of Federal Regulations, 2012 CFR

2012-07-01

... culture container. The control group shall be exposed to the same dilution water, conditions and... CONTROL ACT (CONTINUED) PROVISIONAL TEST GUIDELINES Provisional Environmental Effects Guidelines § 795.120... under the Toxic Substances Control Act (TSCA) (Pub. L. 94-469, 90 Stat. 2003 (15 U.S.C. 2601 et seq...

40 CFR 795.120 - Gammarid acute toxicity test.

Code of Federal Regulations, 2013 CFR

2013-07-01

... culture container. The control group shall be exposed to the same dilution water, conditions and... CONTROL ACT (CONTINUED) PROVISIONAL TEST GUIDELINES Provisional Environmental Effects Guidelines § 795.120... under the Toxic Substances Control Act (TSCA) (Pub. L. 94-469, 90 Stat. 2003 (15 U.S.C. 2601 et seq...

40 CFR 795.231 - Pharmacokinetics of isopropanal.

Code of Federal Regulations, 2013 CFR

2013-07-01

... SUBSTANCES CONTROL ACT (CONTINUED) PROVISIONAL TEST GUIDELINES Provisional Health Effects Guidelines § 795... groups and any animal showing signs of ill health shall not be used. In all studies, unless otherwise specified, each test group shall contain at least four animals of each sex for a total of at least eight...

40 CFR 795.231 - Pharmacokinetics of isopropanal.

Code of Federal Regulations, 2010 CFR

2010-07-01

... SUBSTANCES CONTROL ACT (CONTINUED) PROVISIONAL TEST GUIDELINES Provisional Health Effects Guidelines § 795... groups and any animal showing signs of ill health shall not be used. In all studies, unless otherwise specified, each test group shall contain at least four animals of each sex for a total of at least eight...

40 CFR 795.231 - Pharmacokinetics of isopropanal.

Code of Federal Regulations, 2011 CFR

2011-07-01

... SUBSTANCES CONTROL ACT (CONTINUED) PROVISIONAL TEST GUIDELINES Provisional Health Effects Guidelines § 795... groups and any animal showing signs of ill health shall not be used. In all studies, unless otherwise specified, each test group shall contain at least four animals of each sex for a total of at least eight...

40 CFR 795.231 - Pharmacokinetics of isopropanal.

Code of Federal Regulations, 2014 CFR

2014-07-01

... SUBSTANCES CONTROL ACT (CONTINUED) PROVISIONAL TEST GUIDELINES Provisional Health Effects Guidelines § 795... groups and any animal showing signs of ill health shall not be used. In all studies, unless otherwise specified, each test group shall contain at least four animals of each sex for a total of at least eight...

40 CFR 795.231 - Pharmacokinetics of isopropanal.

Code of Federal Regulations, 2012 CFR

2012-07-01

... SUBSTANCES CONTROL ACT (CONTINUED) PROVISIONAL TEST GUIDELINES Provisional Health Effects Guidelines § 795... groups and any animal showing signs of ill health shall not be used. In all studies, unless otherwise specified, each test group shall contain at least four animals of each sex for a total of at least eight...

78 FR 78740 - Isopyrazam; Pesticide Tolerances

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-27

... access the OCSPP test guidelines referenced in this document electronically, please go to http://www.epa.gov/ocspp and select ``Test Methods and Guidelines.'' C. How can I file an objection or hearing... validity, completeness, and reliability as well as the relationship of the results of the studies to human...

A Rationale for Criterion-Referenced Proficiency Testing

ERIC Educational Resources Information Center

Clifford, Ray

2016-01-01

This article summarizes some of the technical issues that add to the complexity of language testing. It focuses in particular on the criterion-referenced nature of the ACTFL Proficiency Guidelines-Speaking; and it proposes a criterion-referenced interpretation of the ACTFL guidelines for reading and listening. It then demonstrates how using…

Current use of pharmacogenetic testing: a national survey of thiopurine methyltransferase testing prior to azathioprine prescription.

PubMed

Fargher, E A; Tricker, K; Newman, W; Elliott, R; Roberts, S A; Shaffer, J L; Bruce, I; Payne, K

2007-04-01

Azathioprine is an immunosuppressant prescribed for the treatment of inflammatory conditions and after organ transplantation. Risk of neutropaenia has limited the effective use of azathioprine (AZA) and driven requirements for careful monitoring and blood tests. Thiopurine methyltransferase (TPMT) is a genetically moderated key enzyme involved in the metabolism of AZA that can be used to stratify individuals into different levels of risk of developing neutropaenia. Two techniques can be used to measure TPMT status: enzyme-level testing (phenotype testing) and DNA based testing (genotype testing). To identify the current uptake of TPMT enzyme-level testing, TPMT genotype testing, and, the role of guidelines; to inform the prescribing and monitoring of AZA. A survey was mailed to a consultant dermatologist, gastroenterologist, and rheumatologist at every NHS Hospital Trust in England. The survey comprised mainly closed questions exploring: use of AZA and monitoring; use of TPMT enzyme-level testing and genotype testing; and, the role of guidelines to guide prescribing practice. A 70% (n=287) response rate was obtained. The majority of respondents reported prescribing AZA (99%, n=283). Prescribing and monitoring patterns differed between individual respondents and between the three disciplines. TPMT enzyme-level testing was reportedly used by 67% (n=189) of respondents, but this differed by discipline (dermatologists 94%, gastroenterologists 60%, rheumatologists 47%). In 91% of cases enzyme-level testing was carried out prior to prescribing AZA. Genotype testing is not typically available to NHS clinicians but 15 clinicians (six dermatologists, six gastroenterologists, three rheumatologists) reported using it. Most consultants (82%) reported using guidelines to inform their AZA prescribing and monitoring (dermatologists 81%, gastroenterologists 75%, rheumatologists 94%). Two-thirds of the consultants surveyed in England are using TPMT enzyme-level testing, prior to AZA treatment. Uptake differs between specialities. High uptake of TPMT enzyme-level testing by dermatologists, compared with gastroenterologists and rheumatologists, may reflect national guidelines advocating its use prior to AZA. Uptake of enzyme-level testing may alter in other specialties as other guidelines are developed.

Knowledge of thromboprophylaxis guidelines pre- and post-didactic lectures during a venous thromboembolism awareness day at a tertiary-care hospital.

PubMed

Al-Dorzi, Hasan M; Cherfan, Antoine; Al-Harbi, Shmylan; Al-Askar, Ahmad; Al-Azzam, Saleh; Hroub, Ahmad; Olivier, Joan; Al-Hameed, Fahad; Al-Moamary, Mohamed; Abdelaal, Mohamed; Poff, Gregory A; Arabi, Yaseen M

2013-07-01

Didactic lectures are frequently used to improve compliance with practice guidelines. This study assessed the knowledge of health-care providers (HCPs) at a tertiary-care hospital of its evidence-based thromboprophylaxis guidelines and the impact of didactic lectures on their knowledge. The hospital launched a multifaceted approach to improve thromboprophylaxis practices, which included posters, a pocket-size guidelines summary and didactic lectures during the annual thromboprophylaxis awareness days. A self-administered questionnaire was distributed to HCPs before and after lectures on thromboprophylaxis guidelines (June 2010). The questionnaire, formulated and validated by two physicians, two nurses and a clinical pharmacist, covered various subjects such as risk stratification, anticoagulant dosing and the choice of anticoagulants in specific clinical situations. Seventy-two and 63 HCPs submitted the pre- and post-test, respectively (62% physicians, 28% nurses, from different clinical disciplines). The mean scores were 7.8 ± 2.1 (median = 8.0, range = 2-12, maximum possible score = 15) for the pre-test and 8.4 ± 1.8 for the post-test, P = 0.053. There was no significant difference in the pre-test scores of nurses and physicians (7.9 ± 1.7 and 8.2 ± 2.4, respectively, P = 0.67). For the 35 HCPs who completed the pre- and post-tests, their scores were 7.7 ± 1.7 and 8.8 ± 1.6, respectively, P = 0.003. Knowledge of appropriate anticoagulant administration in specific clinical situations was frequently inadequate, with approximately two-thirds of participants failing to adjust low-molecular-weight heparin doses in patients with renal failure. Education via didactic lectures resulted in a modest improvement of HCPs' knowledge of thromboprophylaxis guidelines. This supports the need for a multifaceted approach to improve the awareness and implementation of thromboprophylaxis guidelines.

Knowledge of thromboprophylaxis guidelines pre- and post-didactic lectures during a venous thromboembolism awareness day at a tertiary-care hospital

PubMed Central

Al-Dorzi, Hasan M.; Cherfan, Antoine; Al-Harbi, Shmylan; Al-Askar, Ahmad; Al-Azzam, Saleh; Hroub, Ahmad; Olivier, Joan; Al-Hameed, Fahad; Al-Moamary, Mohamed; Abdelaal, Mohamed; Poff, Gregory A.; Arabi, Yaseen M.

2013-01-01

BACKGROUND: Didactic lectures are frequently used to improve compliance with practice guidelines. This study assessed the knowledge of health-care providers (HCPs) at a tertiary-care hospital of its evidence-based thromboprophylaxis guidelines and the impact of didactic lectures on their knowledge. METHODS: The hospital launched a multifaceted approach to improve thromboprophylaxis practices, which included posters, a pocket-size guidelines summary and didactic lectures during the annual thromboprophylaxis awareness days. A self-administered questionnaire was distributed to HCPs before and after lectures on thromboprophylaxis guidelines (June 2010). The questionnaire, formulated and validated by two physicians, two nurses and a clinical pharmacist, covered various subjects such as risk stratification, anticoagulant dosing and the choice of anticoagulants in specific clinical situations. RESULTS: Seventy-two and 63 HCPs submitted the pre- and post-test, respectively (62% physicians, 28% nurses, from different clinical disciplines). The mean scores were 7.8 ± 2.1 (median = 8.0, range = 2-12, maximum possible score = 15) for the pre-test and 8.4 ± 1.8 for the post-test, P = 0.053. There was no significant difference in the pre-test scores of nurses and physicians (7.9 ± 1.7 and 8.2 ± 2.4, respectively, P = 0.67). For the 35 HCPs who completed the pre- and post-tests, their scores were 7.7 ± 1.7 and 8.8 ± 1.6, respectively, P = 0.003. Knowledge of appropriate anticoagulant administration in specific clinical situations was frequently inadequate, with approximately two-thirds of participants failing to adjust low-molecular-weight heparin doses in patients with renal failure. CONCLUSIONS: Education via didactic lectures resulted in a modest improvement of HCPs′ knowledge of thromboprophylaxis guidelines. This supports the need for a multifaceted approach to improve the awareness and implementation of thromboprophylaxis guidelines. PMID:23922612

Defining protein expression in the urothelium: a problem of more than transitional interest

PubMed Central

Yu, Weiqun

2011-01-01

The transitional epithelium of the bladder, the urothelium, is a challenging tissue to study due to its fragility, complex cellular makeup, stratified composition, and intimate connections to both neural and connective tissue elements. With the increasing focus on the urothelium as a mechanosensory tissue with complex autocrine and paracrine signaling activities, there have arisen a number of unresolved controversies in the urothelial literature regarding whether certain important sensory and signaling proteins are expressed by the urothelium. Prominent examples of this include the transient receptor potential (TRP) family member TRPV1 and the purinergic receptor P2X3. The problem is more than one of scientific bookkeeping since studies utilizing genetic models (primarily knockout mice) claim additional credibility for urothelial functions when phenotypes are discovered. Furthermore, both of the above-mentioned receptors are important therapeutic targets for various bladder disorders including inflammatory and neuropathic pain. The reasons for the confusion about urothelial expression are manifold, but they likely include low expression levels in some cases, poor specificity of antibodies (sometimes lacking adequate controls), the presence of nonurothelial cells resident within the urothelium, and the fact that the urothelium is particularly prone to aspecific adsorption of antibodies. In this review, we attempt to summarize some of the pitfalls with currently accepted practices in this regard, as well as to describe a set of guidelines which will improve the reliability of conclusions related to urothelial expression. It is hoped that this will be of value to investigators studying the urothelium, to those attempting to interpret conflicts in the literature, and hopefully also those charged with reviewing unpublished work. These recommendations will outline a set of “baseline” and “best practice” guidelines by which both researchers and reviewers will be able to evaluate the evidence presented. PMID:21880838

Defining protein expression in the urothelium: a problem of more than transitional interest.

PubMed

Yu, Weiqun; Hill, Warren G

2011-11-01

The transitional epithelium of the bladder, the urothelium, is a challenging tissue to study due to its fragility, complex cellular makeup, stratified composition, and intimate connections to both neural and connective tissue elements. With the increasing focus on the urothelium as a mechanosensory tissue with complex autocrine and paracrine signaling activities, there have arisen a number of unresolved controversies in the urothelial literature regarding whether certain important sensory and signaling proteins are expressed by the urothelium. Prominent examples of this include the transient receptor potential (TRP) family member TRPV1 and the purinergic receptor P2X(3). The problem is more than one of scientific bookkeeping since studies utilizing genetic models (primarily knockout mice) claim additional credibility for urothelial functions when phenotypes are discovered. Furthermore, both of the above-mentioned receptors are important therapeutic targets for various bladder disorders including inflammatory and neuropathic pain. The reasons for the confusion about urothelial expression are manifold, but they likely include low expression levels in some cases, poor specificity of antibodies (sometimes lacking adequate controls), the presence of nonurothelial cells resident within the urothelium, and the fact that the urothelium is particularly prone to aspecific adsorption of antibodies. In this review, we attempt to summarize some of the pitfalls with currently accepted practices in this regard, as well as to describe a set of guidelines which will improve the reliability of conclusions related to urothelial expression. It is hoped that this will be of value to investigators studying the urothelium, to those attempting to interpret conflicts in the literature, and hopefully also those charged with reviewing unpublished work. These recommendations will outline a set of "baseline" and "best practice" guidelines by which both researchers and reviewers will be able to evaluate the evidence presented.

IUE and Einstein observations of the LINER galaxy NGC 4579

NASA Technical Reports Server (NTRS)

Reichert, G. A.; Puchnarewicz, E. M.; Mason, K. O.

1990-01-01

Results of International Ultraviolet Explorer (IUE) and Einstein observations of the LINER galaxy NGC 4579 are reported. Spatial profiles of the long wavelength IUE emission show a two component structure, with an unresolved core superimposed on broader underlying emission. The core spectrum shows strong C II lambda 2326 and broad Mg II lambda 2800 emission, and perhaps emission due to blends of Fe II multiplets (2300 to 23600 angstrom). The short wavelength emission is spatially unresolved, and shows C II lambda 1335, C III lambda 1909 broad C IV lambda 1550 emission, and a broad feature at approximately 1360 angstrom which may be due to 0.1 lambda 1356. Contrary to previous reports no evidence for He II lambda 1640 is found in the spectrum. An unresolved x ray source is detected at the location of the nucleus; its spectrum is well fitted by a power law of energy slope alpha approximately -0.5. These results further support the idea that NGC 4579 may contain a dwarf Seyfert nucleus.

Unfinished Business in Bereavement

PubMed Central

Klingspon, Kara L.; Holland, Jason M.; Neimeyer, Robert A.; Lichtenthal, Wendy G.

2016-01-01

Unfinished business (incomplete, unexpressed or unresolved relationship issues with the deceased) is frequently discussed as a risk factor for chronic and severe grief reactions. However, few empirical studies have examined this construct. The present study aimed to address this gap in the literature by examining the presence and severity of unfinished business as well as common themes of unfinished business reported in open-ended qualitative narratives among a sample of 224 bereaved individuals. In bivariate analyses, self-reported presence of unfinished business and the severity of distress due to unfinished business were both found to be associated with poorer bereavement outcomes. However, after controlling for potential confounds, distress related to unresolved issues with the deceased emerged as a more robust correlate of these outcomes. Qualitative responses were categorized, and the type of reported unfinished business was not significantly related to the degree of unfinished business distress or other bereavement outcomes. These findings provide preliminary justification for bereavement interventions that aim to ameliorate distress related to unresolved relational issues with the deceased. PMID:26057117

Unfinished Business in Bereavement.

PubMed

Klingspon, Kara L; Holland, Jason M; Neimeyer, Robert A; Lichtenthal, Wendy G

2015-01-01

Unfinished business (incomplete, unexpressed or unresolved relationship issues with the deceased) is frequently discussed as a risk factor for chronic and severe grief reactions. However, few empirical studies have examined this construct. The present study aimed to address this gap in the literature by examining the presence and severity of unfinished business as well as common themes of unfinished business reported in open-ended qualitative narratives among a sample of 224 bereaved individuals. In bivariate analyses, self-reported presence of unfinished business and the severity of distress due to unfinished business were both found to be associated with poorer bereavement outcomes. However, after controlling for potential confounds, distress related to unresolved issues with the deceased emerged as a more robust correlate of these outcomes. Qualitative responses were categorized, and the type of reported unfinished business was not significantly related to the degree of unfinished business distress or other bereavement outcomes. These findings provide preliminary justification for bereavement interventions that aim to ameliorate distress related to unresolved relational issues with the deceased.

Parameterizing unresolved obstacles with source terms in wave modeling: A real-world application

NASA Astrophysics Data System (ADS)

Mentaschi, Lorenzo; Kakoulaki, Georgia; Vousdoukas, Michalis; Voukouvalas, Evangelos; Feyen, Luc; Besio, Giovanni

2018-06-01

Parameterizing the dissipative effects of small, unresolved coastal features, is fundamental to improve the skills of wave models. The established technique to deal with this problem consists in reducing the amount of energy advected within the propagation scheme, and is currently available only for regular grids. To find a more general approach, Mentaschi et al., 2015b formulated a technique based on source terms, and validated it on synthetic case studies. This technique separates the parameterization of the unresolved features from the energy advection, and can therefore be applied to any numerical scheme and to any type of mesh. Here we developed an open-source library for the estimation of the transparency coefficients needed by this approach, from bathymetric data and for any type of mesh. The spectral wave model WAVEWATCH III was used to show that in a real-world domain, such as the Caribbean Sea, the proposed approach has skills comparable and sometimes better than the established propagation-based technique.

Auxiliary-cavity-assisted ground-state cooling of an optically levitated nanosphere in the unresolved-sideband regime

NASA Astrophysics Data System (ADS)

Feng, Jin-Shan; Tan, Lei; Gu, Huai-Qiang; Liu, Wu-Ming

2017-12-01

We theoretically analyze the ground-state cooling of an optically levitated nanosphere in the unresolved-sideband regime by introducing a coupled high-quality-factor cavity. On account of the quantum interference stemming from the presence of the coupled cavity, the spectral density of the optical force exerting on the nanosphere gets changed and then the symmetry between the heating and the cooling processes is broken. Through adjusting the detuning of a strong-dissipative cavity mode, one obtains an enhanced net cooling rate for the nanosphere. It is illustrated that the ground-state cooling can be realized in the unresolved sideband regime even if the effective optomechanical coupling is weaker than the frequency of the nanosphere, which can be understood by the picture that the effective interplay of the nanosphere and the auxiliary cavity mode brings the system back to an effective resolved regime. Besides, the coupled cavity refines the dynamical stability of the system.

Unresolved subclinical hypothyroidism is independently associated with progression of chronic kidney disease.

PubMed

Kim, Eun Oh; Lee, Ihn Suk; Choi, Yoo A; Lee, Sang Ju; Chang, Yoon Kyung; Yoon, Hye Eun; Jang, Yi Sun; Lee, Jong Min; Kim, Hye Soo; Yang, Chul Woo; Kim, Suk Young; Hwang, Hyeon Seok

2014-01-01

Patients with chronic kidney disease (CKD) often have subclinical hypothyroidism. However, few reports have investigated changes in the status of subclinical hypothyroidism in CKD patients and its clinical significance in CKD progression. We included 168 patients with nondialysis-dependent CKD stages 2-4. The normalization of subclinical hypothyroidism during follow-up was assessed, and the association between transitions in subclinical hypothyroid status and the rate of decline of the estimated glomerular filtration rate (eGFR) was investigated. At baseline, 127 patients were euthyroid and 41 (24.4%) patients were diagnosed with subclinical hypothyroidism. Of these 41 patients, 21 (51.2%) spontaneously resolved to euthyroid during follow-up. The rate of eGFR decline of patients with resolved subclinical hypothyroidism was similar to that of euthyroid patients. The patients with unresolved subclinical hypothyroidism showed a steeper renal function decline than patients with euthyroidism or resolved subclinical hypothyroidism (all p < 0.05). The progression to end-stage renal disease was more frequent in those with unresolved subclinical hypothyroidism than in those who were euthyroid (p = 0.006). In multivariate linear regression for rate of eGFR decrease, unresolved subclinical hypothyroidism (β = -5.77, p = 0.001), baseline renal function (β = -0.12, p < 0.001) and level of proteinuria (β = -2.36, p = 0.015) were independently associated with the rate of renal function decline. Half of the CKD patients with subclinical hypothyroidism did not resolve to euthyroidism, and this lack of resolution was independently associated with rapid renal function decline.

2017 European guideline for the screening, prevention and initial management of hepatitis B and C infections in sexual health settings.

PubMed

Brook, Gary; Brockmeyer, Norbert; van de Laar, Thijs; Schellberg, Sven; Winter, Andrew J

2018-01-01

This guideline updates the 2010 European guideline for the management of hepatitis B and C virus infections. It is primarily intended to provide advice on testing, prevention and initial management of viral hepatitis B and C for clinicians working in sexual health clinical settings in European countries. The guideline is in a new question and answer format based on clinical situations, from which population/intervention/comparison/outcome questions were formulated. Updates cover areas such as epidemiology, point-of-care tests for hepatitis B, hepatitis C risk and 'chemsex', and HIV pre-exposure prophylaxis and hepatitis B. We have also included a short paragraph on hepatitis E noting there is no evidence for sexual transmission. The guideline has been prepared in accordance with the Europe protocol for production available at http://www.iusti.org/regions/europe/pdf/2017/ProtocolForProduction2017.pdf.

Publishing web-based guidelines using interactive decision models.

PubMed

Sanders, G D; Nease, R F; Owens, D K

2001-05-01

Commonly used methods for guideline development and dissemination do not enable developers to tailor guidelines systematically to specific patient populations and update guidelines easily. We developed a web-based system, ALCHEMIST, that uses decision models and automatically creates evidence-based guidelines that can be disseminated, tailored and updated over the web. Our objective was to demonstrate the use of this system with clinical scenarios that provide challenges for guideline development. We used the ALCHEMIST system to develop guidelines for three clinical scenarios: (1) Chlamydia screening for adolescent women, (2) antiarrhythmic therapy for the prevention of sudden cardiac death; and (3) genetic testing for the BRCA breast-cancer mutation. ALCHEMIST uses information extracted directly from the decision model, combined with the additional information from the author of the decision model, to generate global guidelines. ALCHEMIST generated electronic web-based guidelines for each of the three scenarios. Using ALCHEMIST, we demonstrate that tailoring a guideline for a population at high-risk for Chlamydia changes the recommended policy for control of Chlamydia from contact tracing of reported cases to a population-based screening programme. We used ALCHEMIST to incorporate new evidence about the effectiveness of implantable cardioverter defibrillators (ICD) and demonstrate that the cost-effectiveness of use of ICDs improves from $74 400 per quality-adjusted life year (QALY) gained to $34 500 per QALY gained. Finally, we demonstrate how a clinician could use ALCHEMIST to incorporate a woman's utilities for relevant health states and thereby develop patient-specific recommendations for BRCA testing; the patient-specific recommendation improved quality-adjusted life expectancy by 37 days. The ALCHEMIST system enables guideline developers to publish both a guideline and an interactive decision model on the web. This web-based tool enables guideline developers to tailor guidelines systematically, to update guidelines easily, and to make the underlying evidence and analysis transparent for users.

41 CFR 60-3.1 - Statement of purpose.

Code of Federal Regulations, 2012 CFR

2012-07-01

.... Purpose of guidelines. These guidelines incorporate a single set of principles which are designed to... race, color, religion, sex, and national origin. They are designed to provide a framework for determining the proper use of tests and other selection procedures. These guidelines do not require a user to...

41 CFR 60-3.1 - Statement of purpose.

Code of Federal Regulations, 2011 CFR

2011-07-01

.... Purpose of guidelines. These guidelines incorporate a single set of principles which are designed to... race, color, religion, sex, and national origin. They are designed to provide a framework for determining the proper use of tests and other selection procedures. These guidelines do not require a user to...

41 CFR 60-3.1 - Statement of purpose.

Code of Federal Regulations, 2014 CFR

2014-07-01

.... Purpose of guidelines. These guidelines incorporate a single set of principles which are designed to... race, color, religion, sex, and national origin. They are designed to provide a framework for determining the proper use of tests and other selection procedures. These guidelines do not require a user to...

41 CFR 60-3.1 - Statement of purpose.

Code of Federal Regulations, 2013 CFR

2013-07-01

.... Purpose of guidelines. These guidelines incorporate a single set of principles which are designed to... race, color, religion, sex, and national origin. They are designed to provide a framework for determining the proper use of tests and other selection procedures. These guidelines do not require a user to...

The SPORT-NMR Software: A Tool for Determining Relaxation Times in Unresolved NMR Spectra

NASA Astrophysics Data System (ADS)

Geppi, Marco; Forte, Claudia

1999-03-01

A software package which allows the correct determination of individual relaxation times for all the nonequivalent nuclei in poorly resolved NMR spectra is described. The procedure used, based on the fitting of each spectrum in the series recorded in the relaxation experiment, should improve the analysis of relaxation data in terms of quantitative dynamic information, especially in anisotropic phases. Tests on simulated data and experimental examples concerning1H and13CT1ρmeasurement in a solid copolymer and2HT1ZandT1Qmeasurement in a liquid crystal are shown and discussed.

Renormalization-group theory for the eddy viscosity in subgrid modeling

NASA Technical Reports Server (NTRS)

Zhou, YE; Vahala, George; Hossain, Murshed

1988-01-01

Renormalization-group theory is applied to incompressible three-dimensional Navier-Stokes turbulence so as to eliminate unresolvable small scales. The renormalized Navier-Stokes equation now includes a triple nonlinearity with the eddy viscosity exhibiting a mild cusp behavior, in qualitative agreement with the test-field model results of Kraichnan. For the cusp behavior to arise, not only is the triple nonlinearity necessary but the effects of pressure must be incorporated in the triple term. The renormalized eddy viscosity will not exhibit a cusp behavior if it is assumed that a spectral gap exists between the large and small scales.

Spread Spectrum Receiver Electromagnetic Interference (EMI) Test Guide

NASA Technical Reports Server (NTRS)

Wheeler, Mark L.

1998-01-01

This program consisted of: (1) a study to define appropriate EMI test guidelines and test methods for direct sequence (DS) spread spectrum receivers; and (2) preparation of a written test guide to document the recommended test methods. The scope of this test guide includes: (1) a discussion of generic DS receiver performance characteristics; (2) a summary of S-band TDRSS receiver operation; (3) a discussion of DS receiver EMI susceptibility mechanisms and characteristics; (4) a summary of military standard test guidelines; (5) recommended test approach and methods; and (6) general conclusions and recommendations for future studies in the area of spread spectrum receiver testing.

Post hoc evaluation of a common-sense intervention for asthma management in community pharmacy.

PubMed

Watkins, Kim; Seubert, Liza; Schneider, Carl R; Clifford, Rhonda

2016-11-18

The aim was to evaluate a common-sense, behavioural change intervention to implement clinical guidelines for asthma management in the community pharmacy setting. The components of the common-sense intervention were described in terms of categories and dimensions using the Intervention Taxonomy (ITAX) and Behaviour Change Techniques (BCTs) using the Behaviour Change Wheel (BCW), Capability, Opportunity and Motivation-Behaviour (COM-B) System and Behaviour Change Techniques Taxonomy (BCTTv1). The retrospective application of these existing tools facilitated evaluation of the mechanism, fidelity, logistics and rationale of the common-sense intervention. The initial intervention study was conducted in 336 community pharmacies in the metropolitan area of Perth, Western Australia. Small-group workshops were conducted in 25 pharmacies; 162 received academic detailing and 149 acted as controls. The intervention was designed to improve pharmacy compliance with guidelines for a non-prescription supply of asthma reliever medications. Retrospective application of ITAX identified mechanisms for the short-acting β agonists intervention including improving knowledge, behavioural skills, problem-solving skills, motivation and self-efficacy. All the logistical elements were considered in the intervention design but the duration and intensity of the intervention was minimal. The intervention was delivered as intended (as a workshop) to 13.4% of participants indicating compromised fidelity and significant adaptation. Retrospective application of the BCW, COM-B system and BCTTv1 identified 9 different behaviour change techniques as the rationale for promoting guideline-based practice change. There was a sound rationale and clear mechanism for all the components of the intervention but issues related to logistics, adaptability and fidelity might have affected outcomes. Small group workshops could be a useful implementation strategy in community pharmacy, if logistical issues can be overcome and less adaptation occurs. Duration, intensity and reinforcement need consideration for successful wider implementation. Further qualitative evaluations, triangulation of research and evaluations across interventions should be used to provide a greater understanding of unresolved issues. 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/.

Gaining insight into the Clinical Practice Guideline development processes: qualitative study in a workshop to implement the GRADE proposal in Spain

PubMed Central

Calderón, Carlos; Rotaeche, Rafael; Etxebarria, Arritxu; Marzo, Mercé; Rico, Rosa; Barandiaran, Marta

2006-01-01

Background The GRADE method represents a new approach to grading the quality of evidence and strength of recommendations in the preparation of Clinical Practice Guidelines (CPG). In the context of a pilot study to assess the implementability of the system in Spain, we considered it relevant to gain an insight into the significance of the perceptions and attitudes expressed by the actual experts participating in the system try-out. Methods Qualitative research with an ethnographic approach, through non-participant observation and focus groups within the context of a consensus workshop in which 19 CPG experts participated to evaluate the GRADE proposal using 12 evidence tables taken from hypertension, asthma and arthritis CPGs. The interventions were recorded, under a guarantee of confidentiality. The transcriptions and field notes were analyzed, based on a sociological discourse analysis model, and the provisional findings were re-sent to participants in order to improve their validity. Results 1) Certain problems over procedure and terminology hindered the acceptance of this new method as a common reference system for the preparation of CPGs. 2). A greater closeness to clinical practice was accompanied by concerns over value judgments and subjectivity, with a demand for greater explicitness in the consensus process. 3). The type of "evidence" on which the guidelines are based, how and by whom the evidence is prepared, and what the role of the different actors should be, all constitute unresolved concerns in the CPG preparation and implementation processes. 4). The grading process is not neutral: professional background, prior experience and the degree of leadership all condition the participants' input and interactions. Conclusion The findings obtained allow the quantitative evaluation to be better interpreted and, in turn, go beyond the particularities of the GRADE method. Adaptation to the complexities of clinical practice, the need for carefully designed multi-disciplinary work and the reflexivity present in the CPG preparation process, all represent lines of debate that are necessary to improve the CPG quality in the Spanish health care sector. PMID:17059600

Evaluation of the theory-based Quality Improvement in Physical Therapy (QUIP) programme: a one-group, pre-test post-test pilot study.

PubMed

Rutten, Geert M; Harting, Janneke; Bartholomew, L Kay; Schlief, Angelique; Oostendorp, Rob A B; de Vries, Nanne K

2013-05-25

Guideline adherence in physical therapy is far from optimal, which has consequences for the effectiveness and efficiency of physical therapy care. Programmes to enhance guideline adherence have, so far, been relatively ineffective. We systematically developed a theory-based Quality Improvement in Physical Therapy (QUIP) programme aimed at the individual performance level (practicing physiotherapists; PTs) and the practice organization level (practice quality manager; PQM). The aim of the study was to pilot test the multilevel QUIP programme's effectiveness and the fidelity, acceptability and feasibility of its implementation. A one-group, pre-test, post-test pilot study (N = 8 practices; N = 32 PTs, 8 of whom were also PQMs) done between September and December 2009. Guideline adherence was measured using clinical vignettes that addressed 12 quality indicators reflecting the guidelines' main recommendations. Determinants of adherence were measured using quantitative methods (questionnaires). Delivery of the programme and management changes were assessed using qualitative methods (observations, group interviews, and document analyses). Changes in adherence and determinants were tested in the paired samples T-tests and expressed in effect sizes (Cohen's d). Overall adherence did not change (3.1%; p = .138). Adherence to three quality indicators improved (8%, 24%, 43%; .000 ≤ p ≤ .023). Adherence to one quality indicator decreased (-15.7%; p = .004). Scores on various determinants of individual performance improved and favourable changes at practice organizational level were observed. Improvements were associated with the programme's multilevel approach, collective goal setting, and the application of self-regulation; unfavourable findings with programme deficits. The one-group pre-test post-test design limits the internal validity of the study, the self-selected sample its external validity. The QUIP programme has the potential to change physical therapy practice but needs considerable revision to induce the ongoing quality improvement process that is required to optimize overall guideline adherence. To assess its value, the programme needs to be tested in a randomized controlled trial.

A UK national survey of investigations for beta-lactam hypersensitivity - heterogeneity in practice and a need for national guidelines - on behalf of British Society for Allergy and Clinical Immunology (BSACI).

PubMed

Richter, A G; Nasser, S M; Krishna, M T

2013-08-01

Beta lactams (BL) are the most widely prescribed antibiotics in the UK and the commonest cause of hypersensitivity reactions. There are no UK guidelines for BL testing and the most relevant guidelines were devised by the European Network for Drug Allergy (ENDA) on behalf of the European Academy of Allergy and Clinical Immunology. Delivery of allergy services differs across Europe, so this survey was designed to investigate how closely UK practice adhered to these guidelines. An online survey, using surveymonkey.com software, was sent to all consultants offering an allergy service in the UK and who were members of either BSACI or 'Travellers' (Immunology consultant group). The response rate was 48% (n=81/165) and BL allergy testing was undertaken by 78% of respondents. All responders requested SsIgE, although four responders stated they rarely requested. Skin testing was undertaken by 87% of respondents who perform beta lactam testing with 17% undertaking skin prick testing (SPT) only, 77% SPT followed by intra-dermal testing (IDT) if the former were negative or indeterminate and 6% SPT and IDT in all cases. The drugs, doses and protocols for skin testing varied considerably. Drug provocation testing was undertaken by 87% of respondents who undertake beta lactam testing with significant heterogeneity in protocols. Respondents that investigated ≤ 20 patients per year demonstrated lower adherence to ENDA recommendations compared to those who saw > 20. Following positive testing, 79% advised avoidance of all penicillins only and the remainder advised additional drug avoidance. This survey revealed variation in the investigation and management of BL hypersensitivity in the UK with some centres reporting procedures that could potentially put patients at risk of anaphylaxis if allergy was falsely excluded. This survey highlights an urgent need for evidence based national guidelines and standardisation of practice. © 2013 John Wiley & Sons Ltd.

Cardiac cachexia: hic et nunc: "hic et nunc" - here and now.

PubMed

Loncar, Goran; Springer, Jochen; Anker, Markus; Doehner, Wolfram; Lainscak, Mitja

2015-12-15

Cardiac cachexia (CC) is the clinical entity at the end of chronic natural course of heart failure (HF). Despite the efforts, even the most recent definition of cardiac cachexia has been challenged, more precisely the addition of new criteria on top of obligatory weight loss. The pathophysiology of CC is complex and multifactorial. Better understanding of pathophysiological pathways in body wasting will contribute to establish potentially novel treatment strategies. The complex biochemical network related with CC and HF pathophysiology underlines that a single biomarker cannot reflect all of the features of the disease. Biomarkers that could pick-up the changes in body composition before they convey into clinical manifestations of CC would be of great importance. The development of preventive and therapeutic strategies against cachexia, sarcopenia and wasting disorders is perceived as an urgent need by healthcare professionals. The treatment of body wasting remains an unresolved challenge to this day. As CC is a multifactorial disorder, it is unlikely that any single agent will be completely effective in treating this condition. Among all investigated therapeutic strategies, aerobic exercise training in HF patients is the most proved to counteract skeletal muscle wasting and is recommended by treatment guidelines for HF.

Intensive care unit patients with lower respiratory tract nosocomial infections: the ENIRRIs project.

PubMed

De Pascale, Gennaro; Ranzani, Otavio T; Nseir, Saad; Chastre, Jean; Welte, Tobias; Antonelli, Massimo; Navalesi, Paolo; Garofalo, Eugenio; Bruni, Andrea; Coelho, Luis Miguel; Skoczynski, Szymon; Longhini, Federico; Taccone, Fabio Silvio; Grimaldi, David; Salzer, Helmut J F; Lange, Christoph; Froes, Filipe; Artigas, Antoni; Díaz, Emili; Vallés, Jordi; Rodríguez, Alejandro; Panigada, Mauro; Comellini, Vittoria; Fasano, Luca; Soave, Paolo M; Spinazzola, Giorgia; Luyt, Charles-Edouard; Alvarez-Lerma, Francisco; Marin, Judith; Masclans, Joan Ramon; Chiumello, Davide; Pezzi, Angelo; Schultz, Marcus; Mohamed, Hafiz; Van Der Eerden, Menno; Hoek, Roger A S; Gommers, D A M P J; Pasquale, Marta Di; Civljak, Rok; Kutleša, Marko; Bassetti, Matteo; Dimopoulos, George; Nava, Stefano; Rios, Fernando; Zampieri, Fernando G; Povoa, Pedro; Bos, Lieuwe D; Aliberti, Stefano; Torres, Antoni; Martín-Loeches, Ignacio

2017-10-01

The clinical course of intensive care unit (ICU) patients may be complicated by a large spectrum of lower respiratory tract infections (LRTI), defined by specific epidemiological, clinical and microbiological aspects. A European network for ICU-related respiratory infections (ENIRRIs), supported by the European Respiratory Society, has been recently established, with the aim at studying all respiratory tract infective episodes except community-acquired ones. A multicentre, observational study is in progress, enrolling more than 1000 patients fulfilling the clinical, biochemical and radiological findings consistent with a LRTI. This article describes the methodology of this study. A specific interest is the clinical impact of non-ICU-acquired nosocomial pneumonia requiring ICU admission, non-ventilator-associated LRTIs occurring in the ICU, and ventilator-associated tracheobronchitis. The clinical meaning of microbiologically negative infectious episodes and specific details on antibiotic administration modalities, dosages and duration are also highlighted. Recently released guidelines address many unresolved questions which might be answered by such large-scale observational investigations. In light of the paucity of data regarding such topics, new interesting information is expected to be obtained from our network research activities, contributing to optimisation of care for critically ill patients in the ICU.

Trophic Ecology of Benthic Marine Invertebrates with Bi-Phasic Life Cycles: What Are We Still Missing?

PubMed

Calado, Ricardo; Leal, Miguel Costa

2015-01-01

The study of trophic ecology of benthic marine invertebrates with bi-phasic life cycles is critical to understand the mechanisms shaping population dynamics. Moreover, global climate change is impacting the marine environment at an unprecedented level, which promotes trophic mismatches that affect the phenology of these species and, ultimately, act as drivers of ecological and evolutionary change. Assessing the trophic ecology of marine invertebrates is critical to understanding maternal investment, larval survival to metamorphosis, post-metamorphic performance, resource partitioning and trophic cascades. Tools already available to assess the trophic ecology of marine invertebrates, including visual observation, gut content analysis, food concentration, trophic markers, stable isotopes and molecular genetics, are reviewed and their main advantages and disadvantages for qualitative and quantitative approaches are discussed. The challenges to perform the partitioning of ingestion, digestion and assimilation are discussed together with different approaches to address each of these processes for short- and long-term fingerprinting. Future directions for research on the trophic ecology of benthic marine invertebrates with bi-phasic life cycles are discussed with emphasis on five guidelines that will allow for systematic study and comparative meta-analysis to address important unresolved questions. © 2015 Elsevier Ltd. All rights reserved.

Obesity drug therapy.

PubMed

Baretić, M

2013-09-01

Obesity is a chronic disease, and it requires chronic therapy. Hypertension, dyslipidemia, diabetes and cardiovascular diseases are leading causes of mortality in the modern world. All of them are strongly linked to obesity. While treating obesity, those conditions are also managed. Obese patients should always be treated through lifestyle interventions, though the results of such interventions are modest. Pharmacotherapy is a second step in the treatment of obesity, approved only when weight loss targets were not reached through lifestyle intervention. During the history of antiobesity drugs, many of them were withdrawn because of their side effects. Various guidelines recommend prescribing drug therapy for obesity through consideration of the potential benefits and limitations. Orlistat deactivates intestinal lipase and inhibits intestinal fat lipolysis. It is actually the only drug on the European market approved for the treatment of obesity. Orlistat therapy reduces weight to a modest extent, but it reduces the incidence of diabetes beyond the result achieved with lifestyle changes. Recently, some effective antiobesity drugs like sibutramine and rimonabant have been removed from the market due to their side effects. The new combination of topimarate and fentermine is approved in the US but not in Europe. The cost effectiveness of long-term pharmacotherapy of obesity is still an unresolved question.

Cardiac cachexia: hic et nunc

PubMed Central

Loncar, Goran; Springer, Jochen; Anker, Markus; Doehner, Wolfram

2016-01-01

Abstract Cardiac cachexia (CC) is the clinical entity at the end of the chronic natural course of heart failure (HF). Despite the efforts, even the most recent definition of cardiac cachexia has been challenged, more precisely, the addition of new criteria on top of obligatory weight loss. The pathophysiology of CC is complex and multifactorial. A better understanding of pathophysiological pathways in body wasting will contribute to establish potentially novel treatment strategies. The complex biochemical network related with CC and HF pathophysiology underlines that a single biomarker cannot reflect all of the features of the disease. Biomarkers that could pick up the changes in body composition before they convey into clinical manifestations of CC would be of great importance. The development of preventive and therapeutic strategies against cachexia, sarcopenia, and wasting disorders is perceived as an urgent need by healthcare professionals. The treatment of body wasting remains an unresolved challenge to this day. As CC is a multifactorial disorder, it is unlikely that any single agent will be completely effective in treating this condition. Among all investigated therapeutic strategies, aerobic exercise training in HF patients is the most proved to counteract skeletal muscle wasting and is recommended by treatment guidelines for HF. PMID:27386168

Pharmacogenomic Testing for Neuropsychiatric Drugs: Current Status of Drug Labeling, Guidelines for Using Genetic Information, and Test Options

PubMed Central

Drozda, Katarzyna; Müller, Daniel J.; Bishop, Jeffrey R.

2014-01-01

Advancements in pharmacogenomics have introduced an increasing number of opportunities to bring personalized medicine into clinical practice. Understanding how and when to use this technology to help guide pharmacotherapy used to treat neuropsychiatric conditions remains a challenge for many clinicians. Currently, guidelines exist to assist clinicians in the use of genetic information for drug selection and/or dosing for the tricyclic antidepressants, carbamazepine, and phenytoin. Additional language in the product labeling suggests that genetic information may also be useful for assessing the starting and target doses, as well as drug interaction potential, for a number of other medications used to treat psychiatric and neurological conditions. In this review, we outline the current status of pharmacogenomic testing for neuropsychiatric drugs as it pertains to information contained in drug labeling, consensus guidelines, and test panels, as well as considerations related to obtaining tests for patients. PMID:24523097

A Guideline to Local Anesthetic Allergy Testing

PubMed Central

Canfield, David W.; Gage, Tommy W.

1987-01-01

Patients with a history of adverse reactions to a local anesthetic may often be incorrectly labeled as “allergic.” Determining if a patient is allergic to a local anesthetic is essential in the selection of appropriate pain control techniques. Local anesthetic allergy testing may be performed safely and with reasonable accuracy by a knowledgeable practitioner. This paper presents guidelines for an allergy testing method. ImagesFigure 1 PMID:3318567

Software OT&E Guidelines. Volume 1. Software Test Manager’s Handbook

DTIC Science & Technology

1981-02-01

on reverse side If neceeary and identify by block number) The Software OT&E Guidelines is a set of handbooks prepared by the Computer / Support Systems...is one of a set of handbooks prepared by the Computer /Support Systems Division of the Test and Evaluation Directorate, Air Force Test and Evaluation...15 E. Software Maintainability .. .. ........ ... 16 F. Standard Questionnaires. .. .. ....... .... 16 1. Operator- Computer Interface Evaluation

European Respiratory Society guidelines for the diagnosis of primary ciliary dyskinesia.

PubMed

Lucas, Jane S; Barbato, Angelo; Collins, Samuel A; Goutaki, Myrofora; Behan, Laura; Caudri, Daan; Dell, Sharon; Eber, Ernst; Escudier, Estelle; Hirst, Robert A; Hogg, Claire; Jorissen, Mark; Latzin, Philipp; Legendre, Marie; Leigh, Margaret W; Midulla, Fabio; Nielsen, Kim G; Omran, Heymut; Papon, Jean-Francois; Pohunek, Petr; Redfern, Beatrice; Rigau, David; Rindlisbacher, Bernhard; Santamaria, Francesca; Shoemark, Amelia; Snijders, Deborah; Tonia, Thomy; Titieni, Andrea; Walker, Woolf T; Werner, Claudius; Bush, Andrew; Kuehni, Claudia E

2017-01-01

The diagnosis of primary ciliary dyskinesia is often confirmed with standard, albeit complex and expensive, tests. In many cases, however, the diagnosis remains difficult despite the array of sophisticated diagnostic tests. There is no "gold standard" reference test. Hence, a Task Force supported by the European Respiratory Society has developed this guideline to provide evidence-based recommendations on diagnostic testing, especially in light of new developments in such tests, and the need for robust diagnoses of patients who might enter randomised controlled trials of treatments. The guideline is based on pre-defined questions relevant for clinical care, a systematic review of the literature, and assessment of the evidence using the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach. It focuses on clinical presentation, nasal nitric oxide, analysis of ciliary beat frequency and pattern by high-speed video-microscopy analysis, transmission electron microscopy, genotyping and immunofluorescence. It then used a modified Delphi survey to develop an algorithm for the use of diagnostic tests to definitively confirm and exclude the diagnosis of primary ciliary dyskinesia; and to provide advice when the diagnosis was not conclusive. Finally, this guideline proposes a set of quality criteria for future research on the validity of diagnostic methods for primary ciliary dyskinesia. Copyright ©ERS 2017.

76 FR 77742 - Guidelines Establishing Test Procedures for the Analysis of Pollutants Under the Clean Water Act...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-14

... ENVIRONMENTAL PROTECTION AGENCY 40 CFR Part 136 [EPA-HQ-OW-2010-0192; FRL-9504-2] Guidelines Establishing Test Procedures for the Analysis of Pollutants Under the Clean Water Act; Analysis and Sampling... waste constituent. Similarly, if EPA has established sampling requirements, measurements taken under an...

75 FR 33190 - Trifloxystrobin; Pesticide Tolerances

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-11

....gpoaccess.gov/ecfr . To access the harmonized test guidelines referenced in this document electronically, please go http://www.epa.gov/ocspp and select ``Test Methods and Guidelines.'' C. How Can I File an... (PP 8F7487) by Bayer CropScience, 2 T.W. Alexander Drive, P.O. Box 12014, Research Triangle Park, NC...

RELATIONSHIPS AMONG EXCEEDENCES OF CHEMICAL CRITERIA OR GUIDELINES, THE RESULTS OF AMBIENT TOXICITY TESTS AND COMMUNITY METRICS IN AQUATIC ECOSYSTEMS (FINAL)

EPA Science Inventory

The EPA document, Relationships Among Exceedances of Chemical Criteria or Guidelines, the Results of Ambient Toxicity Tests, and Community Metrics in Aquatic Ecosystems, presents two studies where the three general approaches for the ecological assessment of contaminant ex...

75 FR 27434 - [alpha]-(p-Nonylphenol)-[omega]-hydroxypoly(oxyethylene) Sulfate and Phosphate Esters; Time...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-17

.... study with the reproduction/ developmental toxicity screening test in rats (NPEPSD) LOAEL = 300 mg/kg... toxicity screening test. In the Harmonized Guideline 870.3650 study with the nonylphenol ethoxylate... Guideline 870.3650 study in rats following pre- and post-natal exposure to NPEPSDs. E. Aggregate Risks and...

Fair Employment and Performance Appraisal: Legal Requirements and Practical Guidelines.

ERIC Educational Resources Information Center

Edwards, Keith J.

The use of tests in personnel decisions has become an increasing legal liability for employers. The major questions raised by the courts concerning this use of tests are described. Current federal guidelines for performance appraisal systems, as established by the Equal Employment Opportunity Commission, are explained and traced to Title VII of…

The guideline implementability research and application network (GIRAnet): an international collaborative to support knowledge exchange: study protocol.

PubMed

Gagliardi, Anna R; Brouwers, Melissa C; Bhattacharyya, Onil K

2012-04-02

Modifying the format and content of guidelines may facilitate their use and lead to improved quality of care. We reviewed the medical literature to identify features desired by different users and associated with guideline use to develop a framework of implementability and found that most guidelines do not contain these elements. Further research is needed to develop and evaluate implementability tools. We are launching the Guideline Implementability Research and Application Network (GIRAnet) to enable the development and testing of implementability tools in three domains: Resource Implications, Implementation, and Evaluation. Partners include the Guidelines International Network (G-I-N) and its member guideline developers, implementers, and researchers. In phase one, international guidelines will be examined to identify and describe exemplar tools. Indication-specific and generic tools will populate a searchable repository. In phase two, qualitative analysis of cognitive interviews will be used to understand how developers can best integrate implementability tools in guidelines and how health professionals use them for interpreting and applying guidelines. In phase three, a small-scale pilot test will assess the impact of implementability tools based on quantitative analysis of chart-based behavioural outcomes and qualitative analysis of interviews with participants. The findings will be used to plan a more comprehensive future evaluation of implementability tools. Infrastructure funding to establish GIRAnet will be leveraged with the in-kind contributions of collaborating national and international guideline developers to advance our knowledge of implementation practice and science. Needs assessment and evaluation of GIRAnet will provide a greater understanding of how to develop and sustain such knowledge-exchange networks. Ultimately, by facilitating use of guidelines, this research may lead to improved delivery and outcomes of patient care.

Quality of Acute Care for Patients With Urinary Stones in the United States.

PubMed

Scales, Charles D; Bergman, Jonathan; Carter, Stacey; Jack, Gregory; Saigal, Christopher S; Litwin, Mark S

2015-11-01

To describe guideline adherence for patients with suspected upper tract stones. We performed a cross-sectional analysis of visits recorded by the National Hospital Ambulatory Medical Care Survey (emergency department [ED] component) in 2007-2010 (most recent data). We assessed adherence to clinical guidelines for diagnostic laboratory testing, imaging, and pharmacologic therapy. Multivariable regression models controlled for important covariates. An estimated 4,956,444 ED visits for patients with suspected kidney stones occurred during the study period. Guideline adherence was highest for diagnostic imaging, with 3,122,229 (63%) visits providing optimal imaging. Complete guideline-based laboratory testing occurred in only 2 of every 5 visits. Pharmacologic therapy to facilitate stone passage was prescribed during only 17% of eligible visits. In multivariable analysis of guideline adherence, we found little variation by patient, provider, or facility characteristics. Guideline-recommended care was absent from a substantial proportion of acute care visits for patients with suspected kidney stones. These failures of care delivery likely increase costs and temporary disability. Targeted interventions to improve guideline adherence should be designed and evaluated to improve care for patients with symptomatic kidney stones. Published by Elsevier Inc.

Quality of Acute Care for Patients with Urinary Stones in the United States

PubMed Central

Scales, Charles D.; Bergman, Jonathan; Carter, Stacey; Jack, Gregory; Saigal, Christopher S.; Litwin, Mark S.

2015-01-01

Objective To describe guideline adherence for patients with suspected upper tract stones. Methods We performed a cross-sectional analysis of visits recorded by the National Hospital Ambulatory Medical Care Survey (ED component) in 2007–2010 (most recent data). We assessed adherence to clinical guidelines for diagnostic laboratory testing, imaging, and pharmacologic therapy. Multivariable regression models controlled for important covariates. Results An estimated 4,956,444 ED visits for patients with suspected kidney stones occurred during the study period. Guideline adherence was highest for diagnostic imaging, with 3,122,229 (63%) visits providing optimal imaging. Complete guideline-based laboratory testing occurred in only 2 of every 5 visits. Pharmacologic therapy to facilitate stone passage was prescribed during only 17% of eligible visits. In multivariable analysis of guideline adherence, we found little variation by patient, provider or facility characteristics. Conclusions Guideline-recommended care was absent from a substantial proportion of acute care visits for patients with suspected kidney stones. These failures of care delivery likely increase costs and temporary disability. Targeted interventions to improve guideline adherence should be designed and evaluated to improve care for patients with symptomatic kidney stones. PMID:26335495

Development of a novel, multilayered presentation format for clinical practice guidelines.

PubMed

Kristiansen, Annette; Brandt, Linn; Alonso-Coello, Pablo; Agoritsas, Thomas; Akl, Elie A; Conboy, Tara; Elbarbary, Mahmoud; Ferwana, Mazen; Medani, Wedad; Murad, Mohammad Hassan; Rigau, David; Rosenbaum, Sarah; Spencer, Frederick A; Treweek, Shaun; Guyatt, Gordon; Vandvik, Per Olav

2015-03-01

Bridging the gap between clinical research and everyday health-care practice requires effective communication strategies. To address current shortcomings in conveying practice recommendations and supporting evidence, we are creating and testing presentation formats for clinical practice guidelines (CPGs). We carried out multiple cycles of brainstorming and sketching, developing a prototype. Physicians participating in the user testing viewed CPG formats linked to clinical scenarios and engaged in semistructured interviews applying a think-aloud method for exploring important aspects of user experience. We developed a multilayered presentation format that allows clinicians to successively view more in-depth information. Starting with the recommendations, clinicians can, on demand, access a rationale and a key information section containing statements on quality of the evidence, balance between desirable and undesirable consequences, values and preferences, and resource considerations. We collected feedback from 27 stakeholders and performed user testing with 47 practicing physicians from six countries. Advisory group feedback and user testing of the first version revealed problems with conceptual understanding of underlying CPG methodology, as well as difficulties with the complexity of the layout and content. Extensive revisions made before the second round of user testing resulted in most participants expressing overall satisfaction with the final presentation format. We have developed an electronic, multilayered, CPG format that enhances the usability of CPGs for frontline clinicians. We have implemented the format in electronic guideline tools that guideline organizations can now use when authoring and publishing their guidelines.

9 CFR 101.2 - Administrative terminology.

Code of Federal Regulations, 2010 CFR

2010-01-01

.... Division. A marketing unit established by the licensee which may be named on labels, advertisements and... license. Guidelines. Guidelines establish principles or practices related to test procedures...

Nutrition practices of nurseries in England. Comparison with national guidelines☆

PubMed Central

Neelon, Sara E. Benjamin; Burgoine, Thomas; Hesketh, Kathryn R.; Monsivais, Pablo

2015-01-01

Recent national guidelines call for improved nutrition within early years settings. The aim of this cross-sectional study was to describe foods and beverages served in nurseries, assess provider behaviors related to feeding, and compare these practices to national guidelines. We administered a mailed survey to a random sample of nurseries across England, stratifying by tertile of deprivation. A total of 851 nurseries returned the survey (54.3% response rate). We fitted separate multivariate logistic regression models to estimate the association of deprivation with each of the 13 food and beverage guidelines and the seven provider behavior guidelines. We also conducted a joint F-test for any deprivation effect, to evaluate the effect of the guidelines combined. After adjusting for confounders, we observed differences in the frequency of nurseries that reported serving healthier foods across the tertiles of deprivation (p = 0.02 for joint F test). These adjusted results were driven mainly by nurseries in more deprived areas serving more whole grains (OR 1.57 (95% CI 1.00, 2.46)) and legumes, pulses, and lentils (1.40 (1.01, 2.14)). We also observed differences in the frequency of nurseries reporting more provider behaviors consistent with national guidelines across the tertiles of deprivation (p = 0.01 for joint F test). Nurseries in more deprived areas were more likely to dilute juice with water (2.35 (1.48, 3.73)), allow children to select their own portions (1.09 (1.06, 1.58)), and sit with children during meals (1.84 (1.07, 3.15)). While nurseries in the most deprived areas reported serving more healthy foods, a large percentage were still not meeting national guidelines. Policy and intervention efforts may increase compliance with national guidelines in nurseries in more deprived areas, and across England. PMID:25450898

Proportion of adults fasting for lipid testing relative to guideline changes in Alberta.

PubMed

Ma, Irene; Viczko, Jeannine; Naugler, Christopher

2017-04-01

Guidelines have historically recommended measuring lipid profile tests in a fasting state. However, in April 2011 and 2014, the Canadian city of Calgary and its province of Alberta, respectively, have changed their lipid guidelines to allow testing for individuals in any fasting state; several years prior to the release of the 2016 Canadian Cardiovascular Society and Hypertension Canada guidelines. The purpose of this study was to document the proportion of individuals in Calgary who fasted for a lipid encounter in relation to the change in various guidelines and policies. Counts were collected each month per gender from January 1, 2010 to June 30, 2016 for community-based adults ≥18years old who fasted (≥8h) or did not fast (<8h) for a lipid encounter. During the study period, 793,719 community-based lipid profiles were performed, 590,174 in a fasting state. The proportion of adults who fasted declined from 98.59%±0.379% (mean±SD) in 2010 to 41.65%±1.295% (mean±SD) in 2016. However, a marked decline in the proportion of adults fasting for a lipid encounter was not observed until February 2015, which coincided with the release of Alberta's Toward Optimized Practice Clinical Practice Guidelines. This documentation of individuals fasting for a lipid encounter may assist other jurisdictions in Canada with the new nonfasting lipid guideline changes. We recommend releasing provincial clinical practice guidelines, in addition to laboratory bulletins and continuing medical education presentations, regarding the new nonfasting lipid recommendations in other jurisdictions to ensure community patients are aware of this change. Copyright © 2016 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.

A computerized handheld decision-support system to improve pulmonary embolism diagnosis: a randomized trial.

PubMed

Roy, Pierre-Marie; Durieux, Pierre; Gillaizeau, Florence; Legall, Catherine; Armand-Perroux, Aurore; Martino, Ludovic; Hachelaf, Mohamed; Dubart, Alain-Eric; Schmidt, Jeannot; Cristiano, Mirko; Chretien, Jean-Marie; Perrier, Arnaud; Meyer, Guy

2009-11-17

Testing for pulmonary embolism often differs from that recommended by evidence-based guidelines. To assess the effectiveness of a handheld clinical decision-support system to improve the diagnostic work-up of suspected pulmonary embolism among patients in the emergency department. Cluster randomized trial. Assignment was by random-number table, providers were not blinded, and outcome assessment was automated. (ClinicalTrials.gov registration number: NCT00188032). 20 emergency departments in France. 1103 and 1768 consecutive outpatients with suspected pulmonary embolism. After a preintervention period involving 20 centers and 1103 patients, in which providers grew accustomed to inputting clinical data into handheld devices and investigators assessed baseline testing, emergency departments were randomly assigned to activation of a decision-support system on the devices (10 centers, 753 patients) or posters and pocket cards that showed validated diagnostic strategies (10 centers, 1015 patients). Appropriateness of diagnostic work-up, defined as any sequence of tests that yielded a posttest probability less than 5% or greater than 85% (primary outcome) or as strict adherence to guideline recommendations (secondary outcome); number of tests per patient (secondary outcome). The proportion of patients who received appropriate diagnostic work-ups was greater during the trial than in the preintervention period in both groups, but the increase was greater in the computer-based guidelines group (adjusted mean difference in increase, 19.3 percentage points favoring computer-based guidelines [95% CI, 2.9 to 35.6 percentage points]; P = 0.023). Among patients with appropriate work-ups, those in the computer-based guidelines group received slightly fewer tests than did patients in the paper guidelines group (mean tests per patient, 1.76 [SD, 0.98] vs. 2.25 [SD, 1.04]; P < 0.001). The study was not designed to show a difference in the clinical outcomes of patients during follow-up. A handheld decision-support system improved diagnostic decision making for patients with suspected pulmonary embolism in the emergency department.

Genetic testing for BRCA1: effects of a randomised study of knowledge provision on interest in testing and long term test uptake; implications for the NICE guidelines.

PubMed

Hall, Julia; Gray, Susan; A'Hern, Roger; Shanley, Susan; Watson, Maggie; Kash, Kathryn; Croyle, Robert; Eeles, Rosalind

2009-01-01

Interest in searching for mutations in BRCA1 and BRCA2 is high. Knowledge regarding these genes and the advantages and limitations of genetic testing is limited. It is unknown whether increasing knowledge about breast cancer genetic testing alters interest in testing. Three hundred and seventy nine women (260 with a family history of breast cancer; 119 with breast cancer) from The Royal Marsden NHS Foundation Trust were randomised to receive or not receive written educational information on cancer genetics. A questionnaire was completed assessing interest in BRCA1 testing and knowledge on breast cancer genetics and screening. Actual uptake of BRCA1 testing is reported with a six year follow-up. Eighty nine percent of women at risk of breast cancer and 76% of women with breast cancer were interested in BRCA1 testing (P < 0.0001). Provision of educational information did not affect level of interest. Knowledge about breast cancer susceptibility genes was poor. According to the NICE guidelines regarding eligibility for BRCA1 and BRCA2 testing, the families of 66% of the at risk group and 13% of the women with breast cancer would be eligible for testing (probability of BRCA1 mutation >or=20%). Within six years of randomisation, genetic testing was actually undertaken on 12 women, only 10 of whom would now be eligible, on the NICE guidelines. There is strong interest in BRCA1 testing. Despite considerable ignorance of factors affecting the inheritance of breast cancer, education neither reduced nor increased interest to undergo testing. The NICE guidelines successfully triage those with a high breast cancer risk to be managed in cancer genetics clinics.

Regulatory ecotoxicity testing of nanomaterials - proposed modifications of OECD test guidelines based on laboratory experience with silver and titanium dioxide nanoparticles.

PubMed

Hund-Rinke, Kerstin; Baun, Anders; Cupi, Denisa; Fernandes, Teresa F; Handy, Richard; Kinross, John H; Navas, José M; Peijnenburg, Willie; Schlich, Karsten; Shaw, Benjamin J; Scott-Fordsmand, Janeck J

2016-12-01

Regulatory ecotoxicity testing of chemicals is of societal importance and a large effort is undertaken at the OECD to ensure that OECD test guidelines (TGs) for nanomaterials (NMs) are available. Significant progress to support the adaptation of selected TGs to NMs was achieved in the context of the project MARINA ( http://www.marina-fp7.eu/ ) funded within the 7th European Framework Program. Eight OECD TGs were adapted based on the testing of at least one ion-releasing NM (Ag) and two inert NMs (TiO 2 ). With the materials applied, two main variants of NMs (ion releasing vs. inert NMs) were addressed. As the modifications of the test guidelines refer to general test topics (e.g. test duration or measuring principle), we assume that the described approaches and modifications will be suitable for the testing of further NMs with other chemical compositions. Firm proposals for modification of protocols with scientific justification(s) are presented for the following tests: growth inhibition using the green algae Raphidocelis subcapitata (formerly: Pseudokirchneriella subcapitata; TG 201), acute toxicity with the crustacean Daphnia magna (TG 202), development toxicity with the fish Danio rerio (TG 210), reproduction of the sediment-living worm Lumbriculus variegatus (TG 225), activity of soil microflora (TGs 216, 217), and reproduction of the invertebrates (Enchytraeus crypticus, Eisenia fetida, TGs 220, 222). Additionally, test descriptions for two further test systems (root elongation of plants in hydroponic culture; test on fish cells) are presented. Ecotoxicological data obtained with the modified test guidelines for TiO 2 NMs and Ag NM and detailed method descriptions are available.

Heterogeneity in testing practices for infections during pregnancy: national survey across Switzerland.

PubMed

Aebi-Popp, Karoline; Kahlert, Christian; Rauch, Andri; Mosimann, Beatrice; Baud, David; Low, Nicola; Surbek, Daniel

2016-01-01

Detection and treatment of infections during pregnancy are important for both maternal and child health. The objective of this study was to describe testing practices and adherence to current national guidelines in Switzerland. We invited all registered practicing obstetricians and gynaecologists in Switzerland to complete an anonymous web-based questionnaire about strategies for testing for 14 infections during pregnancy. We conducted a descriptive analysis according to demographic characteristics. Of 1138 invited clinicians, 537 (47.2%) responded and 520 (45.6%) were eligible as they are currently caring for pregnant women. Nearly all eligible respondents tested all pregnant women for group B streptococcus (98.0%), hepatitis B virus (HBV) (96.5%) and human immunodeficiency virus (HIV) (94.7%), in accordance with national guidelines. Although testing for toxoplasmosis is not recommended, 24.1% of respondents tested all women and 32.9% tested at the request of the patient. Hospital doctors were more likely not to test for toxoplasmosis than doctors working in private practice (odds ratio [OR] 2.52, 95% confidence interval [CI] 1.04-6.13, p = 0.04). Only 80.4% of respondents tested all women for syphilis. There were regional differences in testing for some infections. The proportion of clinicians testing all women for HIV, HBV and syphilis was lower in Eastern Switzerland and the Zurich region (69.4% and 61.2%, respectively) than in other regions (range 77.1-88.1%, p <0.001). Most respondents (74.5%) said they would appreciate national guidelines about testing for infections during pregnancy. Testing practices for infections in pregnant women vary widely in Switzerland. More extensive national guidelines could improve consistency of testing practices.

A qualitative study of the determinants of HIV guidelines implementation in two south-eastern districts of Tanzania

PubMed Central

Geubbels, Eveline; Wringe, Alison; Todd, Jim; Klatser, Paul; Dieleman, Marjolein

2017-01-01

Abstract Current HIV policies in Tanzania have adopted the three long-term impact results of zero new infections, zero HIV deaths and zero stigma and discrimination. Strategies to reach these results include scaling-up HIV Testing and Counselling (HTC); Preventing Mother-To-Child Transmission (PMTCT); and strengthening Care and Treatment Clinic (CTC) services. Previous studies showed that HIV policy and guideline recommendations were not always implemented in rural South Tanzania. This study aims to identify the determinants of HIV guideline implementation. A qualitative study of 23 semi-structured interviews with facility in-charges; healthcare workers; district, regional and national HIV coordinators was conducted. Five health facilities were purposively selected by level, ownership and proximity to district headquarters. Interviews were analysed according to Fleuren’s five determinants of innovation uptake related to: strategies used in guideline development and dissemination; guideline characteristics; the guideline implementing organization; guideline users; and the socio-cultural and regulatory context. None of the facilities had the HTC national guideline document. Non-involvement of providers in revisions and weak planning for guideline dissemination impeded their implementation. Lengthy guidelines and those written in English were under-used, and activities perceived to be complicated, like WHO-staging, were avoided. Availability of staff and lack of supplies like test kits and medication impeded implementation. Collaboration between facilities enhanced implementation, as did peer-support among providers. Provider characteristics including education level, knowledge of, and commitment to the guideline influenced implementation. According to providers, determinants of clients’ service use included gender norms, stigma, trust and perceived benefits. The regulatory context prohibited private hospitals from buying HIV supplies. Being tools for bringing policies to practice, national guidelines are crucial in the efforts towards the three zeros. Strategies to improve providers’ adherence to guidelines should include development of clearer guideline dissemination plans, strengthening of the health system, and possibly addressing of provider-perceived patient-level barriers to utilizing HIV services. PMID:28369374

Binary Star Orbits. 3. Revisiting the Remarkable Case of Tweedledum and Tweedledee

DTIC Science & Technology

2010-06-11

Observation Date 0.00 0.05 0.10 0.15 0.20 S ep ar at io n D iff er en ce FIN 332 Aa,Ab Unresolved Aa,Ab bB,aBdevlosernU bB,aB 233 NIF 1960 1970 1980 1990...2000 2010 Observation Date 0 50 100 150 200 P os iti on A ng le D iff er en ce FIN 332 Aa,Ab Unresolved Aa,Ab bB,aBdevlosernU bB,aB 233 NIF Figure

Use of thyroid-stimulating hormone tests for identifying primary hypothyroidism in family medicine patients.

PubMed

Birk-Urovitz, Elizabeth; Elisabeth Del Giudice, M; Meaney, Christopher; Grewal, Karan

2017-09-01

To assess the use of thyroid-stimulating hormone (TSH) tests for identifying primary hypothyroidism in 2 academic family medicine settings. Descriptive study involving a retrospective electronic chart review of family medicine patients who underwent TSH testing. Two academic family practice sites: one site is within a tertiary hospital in Toronto, Ont, and the other is within a community hospital in Newmarket, Ont. A random sample of 205 adult family medicine patients who had 1 or more TSH tests for identifying potential primary hypothyroidism between July 1, 2009, and September 15, 2013. Exclusion criteria included a previous diagnosis of any thyroid condition or abnormality, as well as pregnancy or recent pregnancy within the year preceding the study period. The proportion of normal TSH test results and the proportion of TSH tests that did not conform to test-ordering guidelines. Of the 205 TSH test results, 200 (97.6%, 95% CI 94.4% to 99.2%) showed TSH levels within the normal range. All 5 patients with abnormal TSH test results had TSH levels above the upper reference limits. Nearly one-quarter (22.4%, 95% CI 16.9% to 28.8%) of tests did not conform to test-ordering guidelines. All TSH tests classified as not conforming to test-ordering guidelines showed TSH levels within normal limits. There was a significant difference ( P < .001) between the proportions of nonconforming TSH tests at the tertiary site (14.3%, 95% CI 8.2% to 22.5%) and the community site (31.0%, 95% CI 22.1% to 41.0%). Preliminary analyses examining which variables might be associated with abnormal TSH levels showed that only muscle cramps or myalgia ( P = .0286) and a history of an autoimmune disorder ( P = .0623) met or approached statistical significance. In this study, the proportion of normal TSH test results in the context of primary hypothyroidism case finding and screening was high, and the overall proportion of TSH tests that did not conform to test-ordering guidelines was relatively high as well. These results highlight a need for more consistent TSH test-ordering guidelines for primary hypothyroidism and perhaps some educational interventions to help curtail the overuse of TSH tests in the family medicine setting. Copyright© the College of Family Physicians of Canada.

Community-acquired pneumonia requiring hospitalization: rational decision making and interpretation of guidelines.

PubMed

Postma, Douwe F; van Werkhoven, Cornelis H; Oosterheert, Jan Jelrik

2017-05-01

This review focuses on the evidence base for guideline recommendations on the diagnosis, the optimal choice, timing and duration of empirical antibiotic therapy, and the use of microbiological tests for patients hospitalized with community-acquired pneumonia (CAP): issues for which guidelines are frequently used as a quick reference. Furthermore, we will discuss possibilities for future research in these topics. Many national and international guideline recommendations, even on critical elements of CAP management, are based on low-to-moderate quality evidence. The diagnosis and management of CAP has hardly changed for decades. The recommendation to cover atypical pathogens in all hospitalized CAP patients is based on observational studies only and is challenged by two recent trials. The following years, improved diagnostic testing, radiologically by low-dose Computed Tomography or ultrasound and/or microbiologically by point-of-care multiplex PCR, has the potential to largely influence the choice and start of antibiotic therapy in hospitalized CAP patients. Rapid microbiological testing will hopefully improve antibiotic de-escalation or early pathogen-directed therapy, both potent ways of reducing broad-spectrum antibiotic use. Current guideline recommendations on the timing and duration of antibiotic therapy are based on limited evidence, but will be hard to improve.

Guidelines for Proof Test Analysis

NASA Technical Reports Server (NTRS)

Chell, G. G.; McClung, R. C.; Kuhlman, C. J.; Russell, D. A.; Garr, K.; Donnelly, B.

1999-01-01

These guidelines integrate state-of-the-art elastic-plastic fracture mechanics (EPFM) and proof test implementation issues into a comprehensive proof test analysis procedure in the form of a road map which identifies the types of data, fracture mechanics based parameters, and calculations needed to perform flaw screening and minimum proof load analyses of fracture critical components. Worked examples are presented to illustrate the application of the road map to proof test analysis. The state-of-the art fracture technology employed in these guidelines is based on the EPFM parameter, J, and a pictorial representation of a J fracture analysis, called the failure assessment diagram (FAD) approach. The recommended fracture technology is validated using finite element J results, and laboratory and hardware fracture test results on the nickel-based superalloy Inconel 718, the aluminum alloy 2024-T3511, and ferritic pressure vessel steels. In all cases the laboratory specimens and hardware failed by ductile mechanisms. Advanced proof test analyses involving probability analysis and multiple-cycle proof testing (MCPT) are addressed. Finally, recommendations are provided on how to account for the effects of the proof test overload on subsequent service fatigue and fracture behaviors.

South African HIV self-testing policy and guidance considerations

PubMed Central

Jankelowitz, Lauren; Adams, Siraaj; Msimanga, Busisiwe R.; Nevhutalu, Zwoitwaho; Rhagnath, Naleni; Shroufi, Amir; Devillé, Walter; Kazangarare, Victoria; van der Wiel, Renee; Templeman, Hugo; Conradie, Francesca; Chidarikire, Thato; Gray, Andy

2017-01-01

The gap in HIV testing remains significant and new modalities such as HIV self-testing (HIVST) have been recommended to reach key and under-tested populations. In December 2016, the World Health Organization (WHO) released the Guidelines on HIV Self-Testing and Partner Notification: A Supplement to the Consolidated Guidelines on HIV Testing Services (HTS) and urged member countries to develop HIVST policy and regulatory frameworks. In South Africa, HIVST was included as a supplementary strategy in the National HIV Testing Services Policy in 2016, and recently, guidelines for HIVST were included in the South African National Strategic Plan for HIV, sexually transmitted infections and tuberculosis 2017–2022. This document serves as an additional guidance for the National HIV Testing Services Policy 2016, with specific focus on HIVST. It is intended for policy advocates, clinical and non-clinical HTS providers, health facility managers and healthcare providers in private and public health facilities, non-governmental, community-based and faith-based organisations involved in HTS and outreach, device manufacturers, workplace programmes and institutes of higher education. PMID:29568643

Neurocysticercosis: Diagnostic problems & current therapeutic strategies

PubMed Central

Rajshekhar, Vedantam

2016-01-01

Neurocysticercosis (NCC) is the most common single cause of seizures/epilepsy in India and several other endemic countries throughout the world. It is also the most common parasitic disease of the brain caused by the cestode Taenia solium or pork tapeworm. The diagnosis of NCC and the tapeworm carrier (taeniasis) can be relatively inaccessible and expensive for most of the patients. In spite of the introduction of several new immunological tests, neuroimaging remains the main diagnostic test for NCC. The treatment of NCC is also mired in controversy although, there is emerging evidence that albendazole (a cysticidal drug) may be beneficial for patients by reducing the number of seizures and hastening the resolution of live cysts. Currently, there are several diagnostic and management issues which remain unresolved. This review will highlight some of these issues. PMID:28139530

Electro-optic tracking R&D for defense surveillance

NASA Astrophysics Data System (ADS)

Sutherland, Stuart; Woodruff, Chris J.

1995-09-01

Two aspects of work on automatic target detection and tracking for electro-optic (EO) surveillance are described. Firstly, a detection and tracking algorithm test-bed developed by DSTO and running on a PC under Windows NT is being used to assess candidate algorithms for unresolved and minimally resolved target detection. The structure of this test-bed is described and examples are given of its user interfaces and outputs. Secondly, a development by Australian industry under a Defence-funded contract, of a reconfigurable generic track processor (GTP) is outlined. The GTP will include reconfigurable image processing stages and target tracking algorithms. It will be used to demonstrate to the Australian Defence Force automatic detection and tracking capabilities, and to serve as a hardware base for real time algorithm refinement.

Expert system verification and validation guidelines/workshop task. Deliverable no. 1: ES V/V guidelines

NASA Technical Reports Server (NTRS)

French, Scott W.

1991-01-01

The goals are to show that verifying and validating a software system is a required part of software development and has a direct impact on the software's design and structure. Workshop tasks are given in the areas of statistics, integration/system test, unit and architectural testing, and a traffic controller problem.

Novel residual-based large eddy simulation turbulence models for incompressible magnetohydrodynamics

NASA Astrophysics Data System (ADS)

Sondak, David

The goal of this work was to develop, introduce, and test a promising computational paradigm for the development of turbulence models for incompressible magnetohydrodynamics (MHD). MHD governs the behavior of an electrically conducting fluid in the presence of an external electromagnetic (EM) field. The incompressible MHD model is used in many engineering and scientific disciplines from the development of nuclear fusion as a sustainable energy source to the study of space weather and solar physics. Many interesting MHD systems exhibit the phenomenon of turbulence which remains an elusive problem from all scientific perspectives. This work focuses on the computational perspective and proposes techniques that enable the study of systems involving MHD turbulence. Direct numerical simulation (DNS) is not a feasible approach for studying MHD turbulence. In this work, turbulence models for incompressible MHD were developed from the variational multiscale (VMS) formulation wherein the solution fields were decomposed into resolved and unresolved components. The unresolved components were modeled with a term that is proportional to the residual of the resolved scales. Two additional MHD models were developed based off of the VMS formulation: a residual-based eddy viscosity (RBEV) model and a mixed model that partners the VMS formulation with the RBEV model. These models are endowed with several special numerical and physics features. Included in the numerical features is the internal numerical consistency of each of the models. Physically, the new models are able to capture desirable MHD physics such as the inverse cascade of magnetic energy and the subgrid dynamo effect. The models were tested with a Fourier-spectral numerical method and the finite element method (FEM). The primary test problem was the Taylor-Green vortex. Results comparing the performance of the new models to DNS were obtained. The performance of the new models was compared to classic and cutting-edge dynamic Smagorinsky eddy viscosity (DSEV) models. The new models typically outperform the classical models.

Improving the sensitivity of gamma-ray telescopes to dark matter annihilation in dwarf spheroidal galaxies

DOE PAGES

Carlson, Eric; Hooper, Dan; Linden, Tim

2015-03-01

The Fermi-LAT Collaboration has studied the gamma-ray emission from a stacked population of dwarf spheroidal galaxies and used this information to set constraints on the dark matter annihilation cross section. Interestingly, their analysis uncovered an excess with a test statistic (TS) of 8.7. If interpreted naively, this constitutes a 2.95σ local excess (p-value=0.003), relative to the expectations of their background model. In order to further test this interpretation, the Fermi-LAT team studied a large number of blank sky locations and found TS>8.7 excesses to be more common than predicted by their background model, decreasing the significance of their dwarf excessmore » to 2.2σ(p-value=0.027). We argue that these TS>8.7 blank sky locations are largely the result of unresolved blazars, radio galaxies, and star-forming galaxies, and show that multiwavelength information can be used to reduce the degree to which such sources contaminate the otherwise blank sky. In particular, we show that masking regions of the sky that lie within 1° of sources contained in the BZCAT or CRATES catalogs reduce the fraction of blank sky locations with TS>8.7 by more than a factor of 2. Taking such multiwavelength information into account can enable experiments such as Fermi to better characterize their backgrounds and increase their sensitivity to dark matter in dwarf galaxies, the most important of which remain largely uncontaminated by unresolved point sources. We also note that for the range of dark matter masses and annihilation cross sections currently being tested by studies of dwarf spheroidal galaxies, simulations predict that Fermi should be able to detect a significant number of dark matter subhalos. These subhalos constitute a population of subthreshold gamma-ray point sources and represent an irreducible background for searches for dark matter annihilation in dwarf galaxies.« less

Nutrition practices of nurseries in England. Comparison with national guidelines.

PubMed

Neelon, Sara E Benjamin; Burgoine, Thomas; Hesketh, Kathryn R; Monsivais, Pablo

2015-02-01

Recent national guidelines call for improved nutrition within early years settings. The aim of this cross-sectional study was to describe foods and beverages served in nurseries, assess provider behaviors related to feeding, and compare these practices to national guidelines. We administered a mailed survey to a random sample of nurseries across England, stratifying by tertile of deprivation. A total of 851 nurseries returned the survey (54.3% response rate). We fitted separate multivariate logistic regression models to estimate the association of deprivation with each of the 13 food and beverage guidelines and the seven provider behavior guidelines. We also conducted a joint F-test for any deprivation effect, to evaluate the effect of the guidelines combined. After adjusting for confounders, we observed differences in the frequency of nurseries that reported serving healthier foods across the tertiles of deprivation (p = 0.02 for joint F test). These adjusted results were driven mainly by nurseries in more deprived areas serving more whole grains (OR 1.57 (95% CI 1.00, 2.46)) and legumes, pulses, and lentils (1.40 (1.01, 2.14)). We also observed differences in the frequency of nurseries reporting more provider behaviors consistent with national guidelines across the tertiles of deprivation (p = 0.01 for joint F test). Nurseries in more deprived areas were more likely to dilute juice with water (2.35 (1.48, 3.73)), allow children to select their own portions (1.09 (1.06, 1.58)), and sit with children during meals (1.84 (1.07, 3.15)). While nurseries in the most deprived areas reported serving more healthy foods, a large percentage were still not meeting national guidelines. Policy and intervention efforts may increase compliance with national guidelines in nurseries in more deprived areas, and across England. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

The influence of standards and clinical guidelines on prosthetic and orthotic service quality: a scoping review.

PubMed

Sadeghi-Demneh, Ebrahim; Forghany, Saeed; Onmanee, Pornsuree; Trinler, Ursula; Dillon, Michael P; Baker, Richard

2017-06-20

Standards and guidelines are an integral part of prosthetic and orthotic service delivery in the developed world underpinned by an assumption that they lead to improved services. Implementing them has a cost, however, and that cost needs to be justified, particularly in resource-limited environments. This scoping review thus asks the question, "What is the evidence of the impact of standards and guidelines on service delivery outcomes in prosthetics and orthotics?" A structured search of three electronic databases (Medline, Scopus and Web of Science) followed by manual searching of title, abstract and full text, yielded 29 articles. Four categories of papers were identified: Descriptions and Commentaries (17 papers), Guideline Development (7), Guideline Testing (2) and Standards implementation (3). No articles were explicitly designed to assess the impact of standards and guidelines on service delivery outcomes in prosthetics and orthotics. Studies tended to be commentaries on or descriptions of guideline development, testing or implementation of standards. The literature is not sufficiently well developed to warrant the cost and effort of a systematic review. Future primary research should seek to demonstrate whether and how guidelines and standards improve the outcomes for people that require prostheses, orthoses and other assistive devices. Implications for Rehabilitation International Standards and Clinical Guidelines are now an integral part of clinical service provision in prosthetics and orthotics in the developed world. Complying with standards and guidelines has a cost and, particularly in resource-limited environments, it should be possible to justify this in terms of the resulting benefits. This scoping review concludes that there have been no previous studies designed to directly quantify the effects of implementing standards and guidelines on service delivery.

Improved access to life insurance after genetic diagnosis of familial hypercholesterolaemia: cross-sectional postal questionnaire study

PubMed Central

Huijgen, Roeland; Homsma, Sietske JM; Hutten, Barbara A; Kindt, Iris; Vissers, Maud N; Kastelein, John JP; van Rijckevorsel, Jan LA

2012-01-01

A decade ago, in the initial stage of genetic testing for familial hypercholesterolaemia (FH) in The Netherlands, it was reported that such screening decreased access to affordable life insurance for mutation carriers. In 2003, in order to improve access to insurance for FH mutation carriers, insurers agreed to underwrite according to a set of guidelines. In this cross-sectional study, we assessed whether access to insurance has improved since the advent of these guidelines. We approached 2825 subjects that had participated in the genetic testing for FH between 1998 and 2003. We compared unconditional acceptance rates before and after FH diagnosis and before and after the guidelines were issued by means of logistic regression analysis. Our study outcome pertains to 414 FH patients who applied for life insurance. Unconditional acceptance of a policy before DNA diagnosis and before the issue of guidelines occurred in 182 out of 255 (71%) cases, versus 27 out of 35 (77%) cases after DNA diagnosis, but before the issue of guidelines. De facto, 107 out of 124 (86%) patients received unconditional acceptance after DNA diagnosis and after the issue of guidelines (P for trend=0.002). Access to life insurance improved for FH patients after molecular diagnosis and it improved even further after the guidelines were issued. Therefore, we argue that limited access to life insurance on the basis of ‘DNA discrimination' is no longer a valid argument against genetic cascade testing for FH, at least not in our country. PMID:22293687

A computerized clinical decision support system as a means of implementing depression guidelines.

PubMed

Trivedi, Madhukar H; Kern, Janet K; Grannemann, Bruce D; Altshuler, Kenneth Z; Sunderajan, Prabha

2004-08-01

The authors describe the history and current use of computerized systems for implementing treatment guidelines in general medicine as well as the development, testing, and early use of a computerized decision support system for depression treatment among "real-world" clinical settings in Texas. In 1999 health care experts from Europe and the United States met to confront the well-documented challenges of implementing treatment guidelines and to identify strategies for improvement. They suggested the integration of guidelines into computer systems that is incorporated into clinical workflow. Several studies have demonstrated improvements in physicians' adherence to guidelines when such guidelines are provided in a computerized format. Although computerized decision support systems are being used in many areas of medicine and have demonstrated improved patient outcomes, their use in psychiatric illness is limited. The authors designed and developed a computerized decision support system for the treatment of major depressive disorder by using evidence-based guidelines, transferring the knowledge gained from the Texas Medication Algorithm Project (TMAP). This computerized decision support system (CompTMAP) provides support in diagnosis, treatment, follow-up, and preventive care and can be incorporated into the clinical setting. CompTMAP has gone through extensive testing to ensure accuracy and reliability. Physician surveys have indicated a positive response to CompTMAP, although the sample was insufficient for statistical testing. CompTMAP is part of a new era of comprehensive computerized decision support systems that take advantage of advances in automation and provide more complete clinical support to physicians in clinical practice.

Hygiene guideline for the planning, installation, and operation of ventilation and air-conditioning systems in health-care settings - Guideline of the German Society for Hospital Hygiene (DGKH).

PubMed

Külpmann, Rüdiger; Christiansen, Bärbel; Kramer, Axel; Lüderitz, Peter; Pitten, Frank-Albert; Wille, Frank; Zastrow, Klaus-Dieter; Lemm, Friederike; Sommer, Regina; Halabi, Milo

2016-01-01

Since the publication of the first "Hospital Hygiene Guideline for the implementation and operation of air conditioning systems (HVAC systems) in hospitals" (http://www.krankenhaushygiene.de/informationen/fachinformationen/leitlinien/12) in 2002, it was necessary due to the increase in knowledge, new regulations, improved air-conditioning systems and advanced test methods to revise the guideline. Based on the description of the basic features of ventilation concepts, its hygienic test and the usage-based requirements for ventilation, the DGKH section "Ventilation and air conditioning technology" attempts to provide answers for the major air quality issues in the planning, design and the hygienically safe operation of HVAC systems in rooms of health care.

Representing nursing guideline with unified modeling language to facilitate development of a computer system: a case study.

PubMed

Choi, Jeeyae; Choi, Jeungok E

2014-01-01

To provide best recommendations at the point of care, guidelines have been implemented in computer systems. As a prerequisite, guidelines are translated into a computer-interpretable guideline format. Since there are no specific tools to translate nursing guidelines, only a few nursing guidelines are translated and implemented in computer systems. Unified modeling language (UML) is a software writing language and is known to well and accurately represent end-users' perspective, due to the expressive characteristics of the UML. In order to facilitate the development of computer systems for nurses' use, the UML was used to translate a paper-based nursing guideline, and its ease of use and the usefulness were tested through a case study of a genetic counseling guideline. The UML was found to be a useful tool to nurse informaticians and a sufficient tool to model a guideline in a computer program.

Quality assurance program guidelines for application to and use by manufacturers of rail/guideway vehicles, buses, automatic train control systems, and their major subsystems

NASA Technical Reports Server (NTRS)

Witkin, S. A.

1976-01-01

Guidelines are presented for a quality assurance system to be implemented by the manufacturer in support of designing, developing, fabricating, assembling, inspecting, testing, handling, and delivery of equipment being procured for use in public urban mass transit systems. The guidelines apply to this equipment when being procured for: (1) use in revenue service; (2) demonstration of systems that will be revenue producing or used by the public; (3) use as a prototype for follow-on operational/revenue producing equipment procurements; and (4) qualification tests.

Whiplash and the compensation hypothesis.

PubMed

Spearing, Natalie M; Connelly, Luke B

2011-12-01

Review article. To explain why the evidence that compensation-related factors lead to worse health outcomes is not compelling, either in general, or in the specific case of whiplash. There is a common view that compensation-related factors lead to worse health outcomes ("the compensation hypothesis"), despite the presence of important, and unresolved sources of bias. The empirical evidence on this question has ramifications for the design of compensation schemes. Using studies on whiplash, this article outlines the methodological problems that impede attempts to confirm or refute the compensation hypothesis. Compensation studies are prone to measurement bias, reverse causation bias, and selection bias. Errors in measurement are largely due to the latent nature of whiplash injuries and health itself, a lack of clarity over the unit of measurement (specific factors, or "compensation"), and a lack of appreciation for the heterogeneous qualities of compensation-related factors and schemes. There has been a failure to acknowledge and empirically address reverse causation bias, or the likelihood that poor health influences the decision to pursue compensation: it is unclear if compensation is a cause or a consequence of poor health, or both. Finally, unresolved selection bias (and hence, confounding) is evident in longitudinal studies and natural experiments. In both cases, between-group differences have not been addressed convincingly. The nature of the relationship between compensation-related factors and health is unclear. Current approaches to testing the compensation hypothesis are prone to several important sources of bias, which compromise the validity of their results. Methods that explicitly test the hypothesis and establish whether or not a causal relationship exists between compensation factors and prolonged whiplash symptoms are needed in future studies.

Enhancing implementation of tobacco use prevention and cessation counselling guideline among dental providers: a cluster randomised controlled trial.

PubMed

Amemori, Masamitsu; Korhonen, Tellervo; Kinnunen, Taru; Michie, Susan; Murtomaa, Heikki

2011-02-14

Tobacco use adversely affects oral health. Tobacco use prevention and cessation (TUPAC) counselling guidelines recommend that healthcare providers ask about each patient's tobacco use, assess the patient's readiness and willingness to stop, document tobacco use habits, advise the patient to stop, assist and help in quitting, and arrange monitoring of progress at follow-up appointments. Adherence to such guidelines, especially among dental providers, is poor. To improve guideline implementation, it is essential to understand factors influencing it and find effective ways to influence those factors. The aim of the present study protocol is to introduce a theory-based approach to diagnose implementation difficulties of TUPAC counselling guidelines among dental providers. Theories of behaviour change have been used to identify key theoretical domains relevant to the behaviours of healthcare providers involved in implementing clinical guidelines. These theoretical domains will inform the development of a questionnaire aimed at assessing the implementation of the TUPAC counselling guidelines among Finnish municipal dental providers. Specific items will be drawn from the guidelines and the literature on TUPAC studies. After identifying potential implementation difficulties, we will design two interventions using theories of behaviour change to link them with relevant behaviour change techniques aiming to improve guideline adherence. For assessing the implementation of TUPAC guidelines, the electronic dental record audit and self-reported questionnaires will be used. To improve guideline adherence, the theoretical-domains approach could provide a comprehensive basis for assessing implementation difficulties, as well as designing and evaluating interventions. After having identified implementation difficulties, we will design and test two interventions to enhance TUPAC guideline adherence. Using the cluster randomised controlled design, we aim to provide further evidence on intervention effects, as well as on the validity and feasibility of the theoretical-domain approach. The empirical data collected within this trial will be useful in testing whether this theoretical-domain approach can improve our understanding of the implementation of TUPAC guidelines among dental providers. Current Controlled Trials ISRCTN15427433.

Unresolved Subclinical Hypothyroidism is Independently Associated with Progression of Chronic Kidney Disease

PubMed Central

Kim, Eun Oh; Lee, Ihn Suk; Choi, Yoo A; Lee, Sang Ju; Chang, Yoon Kyung; Yoon, Hye Eun; Jang, Yi Sun; Lee, Jong Min; Kim, Hye Soo; Yang, Chul Woo; Kim, Suk Young; Hwang, Hyeon Seok

2014-01-01

Background and Aim: Patients with chronic kidney disease (CKD) often have subclinical hypothyroidism. However, few reports have investigated changes in the status of subclinical hypothyroidism in CKD patients and its clinical significance in CKD progression. Methods: We included 168 patients with nondialysis-dependent CKD stages 2-4. The normalization of subclinical hypothyroidism during follow-up was assessed, and the association between transitions in subclinical hypothyroid status and the rate of decline of the estimated glomerular filtration rate (eGFR) was investigated. Results: At baseline, 127 patients were euthyroid and 41 (24.4%) patients were diagnosed with subclinical hypothyroidism. Of these 41 patients, 21 (51.2%) spontaneously resolved to euthyroid during follow-up. The rate of eGFR decline of patients with resolved subclinical hypothyroidism was similar to that of euthyroid patients. The patients with unresolved subclinical hypothyroidism showed a steeper renal function decline than patients with euthyroidism or resolved subclinical hypothyroidism (all p < 0.05). The progression to end-stage renal disease was more frequent in those with unresolved subclinical hypothyroidism than in those who were euthyroid (p = 0.006). In multivariate linear regression for rate of eGFR decrease, unresolved subclinical hypothyroidism (β = -5.77, p = 0.001), baseline renal function (β = -0.12, p < 0.001) and level of proteinuria (β = -2.36, p = 0.015) were independently associated with the rate of renal function decline. Conclusions: Half of the CKD patients with subclinical hypothyroidism did not resolve to euthyroidism, and this lack of resolution was independently associated with rapid renal function decline. PMID:24396286

CXB surface brightness fluctuations: A new frontier of ICM structure and outskirts studies of (un)resolved galaxy clusters?

NASA Astrophysics Data System (ADS)

Kolodzig, A.; Gilfanov, M.; Hutsi, G.; Sunyaev, R.

2017-10-01

Surface brightness fluctuations of the cosmic X-ray background (CXB) carry unique information about the intracluster-medium (ICM) structure of galaxy clusters and groups up to the virial radius, which is inaccessible by conventional observations of selected nearby resolved clusters. We present results of our CXB fluctuation analysis of the ˜5ks-deep, ˜9deg^2-large Chandra survey XBOOTES. We find that our fluctuation signal of resolved clusters is dominated by nearby, high-luminosity sources. The shape of its power spectrum suggests that for the brightest cluster we are sensitive to the ICM structure up to ˜2× R_{500};(˜2 Mpc/h). The energy spectrum of the fluctuation signal from resolved and unresolved clusters follows a typical ICM spectrum, where redshifts and temperatures are consistent with expectations. It also demonstrates that fluctuations of our unresolved CXB are dominated by unresolved clusters with an average z˜0.4 and T˜1.3keV, suggesting an average L_{0.5-2keV}˜3×10^{42} erg/s and M_{500}˜4×10^{13} M_{Sun}/h. Comparison with modeling suggests, that our fluctuation signal can be described with the one-halo-term of clusters and that it might be sensitive to the presence of substructures. Discrepancies between model and measurement could be utilized to improve our understanding of the ICM structure in a statistical manner. We briefly discuss the potential of larger surveys (e.g. Stripe82, XXL, SRG/eRosita).

Results of arthroscopic treatment in unresolved Osgood-Schlatter disease in athletes.

PubMed

Circi, Esra; Beyzadeoglu, Tahsin

2017-02-01

In this study we aimed to determine outcomes following arthroscopic ossicle excision in athletes with unresolved Osgood-Schlatter disease (OSD). Arthroscopy was performed on 11 patients (11 knees) with OSD between September 2008 and November 2014. Surgical treatment inclusion criteria were determined as: failure of conservative treatment; isolated pain over the tibial tubercle and distal patellar tendon; pain limiting sporting performance at a competitive level. All patients had a documented history of OSD; the mean duration of persistent pain over the tibial tubercle was 15.5 months. The mean age was 23 years. The mean follow-up period was 66.1 months. The mean latency in returning to sports related training activities after the surgery was 6.7 weeks. The mean Kujala patello-femoral score improved from 82.9 points pre-operatively, to 98.5 points at the final follow-up (p < 0.01). The mean Lysholm knee scale score was 87.5 points in the pre-operative period, increasing to a score of 96.9 points at final follow-up (p < 0.01). The mean Tegner activity level score was 7.5 in the pre-operative period, increasing to 8.5 post-operatively (p < 0.01). We investigated the functional outcomes after arthroscopic treatment of unresolved OSD in athletes. All athletes with OSD showed satisfactory functional recovery following arthroscopic treatment. All patients were able to return to the same level of athletic activity. Arthroscopic surgery for unresolved OSD has the major advantage of faster recovery and avoiding damage to the patellar tendon.

CF and School

MedlinePlus

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About Cystic Fibrosis

MedlinePlus

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Allergic Bronchopulmonary Aspergillosis

MedlinePlus

... Testing for Cystic Fibrosis CFTR-Related Metabolic Syndrome (CRMS) How Babies Are Screened in IRT-Only vs. ... Guidelines Infant Care Clinical Care Guidelines Management of CRMS in First 2 Years and Beyond Clinical Care ...