Enhancing colposcopy with polarized light.

PubMed

Ferris, Daron G; Li, Wenjing; Gustafsson, Ulf; Lieberman, Richard W; Galdos, Oscar; Santos, Carlos

2010-07-01

To determine the potential utility of polarized light used during colposcopic examinations. Matched, polarized, and unpolarized colposcopic images and diagnostic annotations from 31 subjects receiving excisional treatment of cervical neoplasia were compared. Sensitivity, specificity, and mean Euclidean distances between the centroids of the gaussian ellipsoids for the different epithelial types were calculated for unpolarized and polarized images. The sensitivities of polarized colposcopic annotations for discriminating cervical intraepithelial neoplasia (CIN) 2 or higher were greater for all 3 acetowhite categories when compared with unpolarized annotations (58% [44/76] vs 45% [34/76], 68% [50/74] vs 59% [45/76], and 68% [49/72] vs 66% [50/76], respectively). The average percent differences in Euclidean distances between the epithelial types for unpolarized and polarized cervical images were as follows: CIN 2/3 versus CIN 1 = 33% (10/30, p =.03), CIN 2/3 versus columnar epithelium = 22% (p =.004), CIN 2/3 versus immature metaplasia = 29% (14/47, p =.11), and CIN 1 versus immature metaplasia = 27% (4.4/16, p =.16). Because of its ability to interrogate at a deeper plane and eliminate obscuring glare, polarized light colposcopy may enhance the evaluation and detection of cervical neoplasias.

Normal versus Abnormal Genital Findings in Children: How Well Do Examiners Agree?

ERIC Educational Resources Information Center

Adams, Joyce A.; Wells, Robert

1993-01-01

Preselected colposcopic photographs of the anogenital area of 16 patients were shown to 170 medical examiners, who rated their level of suggestion or indication of penetrating injury. Agreement between the participants and experts was higher on the abnormal cases than on the normal cases, and higher on genital findings than on anal findings.…

Evidence supporting see-and-treat management of cervical intraepithelial neoplasia: a systematic review and meta-analysis.

PubMed

Ebisch, R M F; Rovers, M M; Bosgraaf, R P; van der Pluijm-Schouten, H W; Melchers, W J G; van den Akker, P A J; Massuger, L F A G; Bekkers, R L M

2016-01-01

Studies of see-and-treat management of cervical intraepithelial neoplasia (CIN) vary in their inclusion criteria, resulting in a broad range of overtreatment rates. To determine overtreatment rates in see-and-treat management of women referred for colposcopy because of suspected CIN, in order to define circumstances supporting see-and-treat management. MEDLINE, EMBASE, and the Cochrane Library were searched from inception up to 12 May 2014. Studies of see-and-treat management in women with a reported cervical smear result, colposcopic impression, and histology result were included. Methodological quality was assessed with the Newcastle-Ottawa scale. We used the inverse variance method for pooling incidences, and a random-effects model was used to account for heterogeneity between studies. Overtreatment was defined as treatment in patients with no CIN or CIN1. Thirteen studies (n = 4611) were included. The overall overtreatment rate in women with a high-grade cervical smear and a high-grade colposcopic impression was 11.6% (95% CI 7.8-15.3%). The overtreatment rate in women with a high-grade cervical smear and low-grade colposcopic impression was 29.3% (95% CI 16.7-41.9%), and in the case of a low-grade smear and high-grade colposcopic impression it was 46.4% (95% CI 15.7-77.1%). In women with a low-grade smear and low-grade colposcopic impression, the overtreatment rate was 72.9% (95% CI 68.1-77.7%). The pooled overtreatment rate in women with a high-grade smear and high-grade colposcopic impression is at least comparable with the two-step procedure, which supports the use of see-and-treat management in this subgroup of women. See-and-treat management is justified in the case of a high-grade smear and a high-grade colposcopic impression. © 2015 Royal College of Obstetricians and Gynaecologists.

Remote quality assurance in cervical cancer screening in low resource settings using a handheld smartphone-based colposcope

NASA Astrophysics Data System (ADS)

Millien, Christophe; Jean-Baptiste, Meredith C.; Manite, Garçon; Levitz, David

2015-03-01

Cervical cancer is a leading cause of cancer death for women all across the developing world, where much of the infrastructure required for effective cervical cancer screening is unavailable because of limited resources. One of the most common method to screen for cervical cancer is by visual inspection with acetic acid (VIA), in which the cervix is imaged with the naked eye. Given inherent challenges in analysis and documentation when characterizing cervical tissue with the naked eye, an optical solution is needed. To address this challenge, a smartphone was modified and transformed into a mobile colposcope (a device used to image the cervix from outside) by adding a custom-fit light source and optics. The mobile smartphone colposcope was designed such that it augments VIA and easily integrates within the standard of care. The mobile smartphone colposcope is controlled by an app, which, stores cervical images captured on the mobile smartphone colposcope on a portal, enabling remote doctors to evaluate images and the treatment chosen by the health worker. Images from patients undergoing cervical cancer screening by a nurse using VIA in the University Hospital of Mirebalais (HUM) GYN outpatient clinic in Haiti were captured on the mobile smartphone colposcope. These images were later analyzed by an experienced OB/GYN at HUM, who determined whether or not the patient should be treated with cryoablation; more complicated cases were also shared with a consulting doctor in the US. The opinions of the experienced OB/GYN doctors at HUM, as well as the experts from the US, were used to educate nurses and midwives performing mobile colposcopy. These results suggest that remote assessment offered by mobile colposcopy can improve training of health workers performing VIA, and ultimately affect the therapy administered to patients.

Should all women with cervical atypia be referred for colposcopy: a HARNET study. Harrisburgh Area Research Network.

PubMed

Slawson, D C; Bennett, J H; Simon, L J; Herman, J M

1994-04-01

Clinicians who manage women with Papanicolaou (Pap) smears showing atypical squamous cells of undetermined significance (ASCUS) may miss clinically significant cervical disease by repeating the cytology alone. We evaluated the ability of the human papillomavirus (HPV) screen and the naked-eye examination after a cervical acetic acid wash to enhance the follow-up Pap smear in predicting an abnormal colposcopic biopsy. Pap smears were performed on all women (N = 7458) attending six family practice offices for a health maintenance examination from August 1989 through February 1991. Consenting subjects with ASCUS underwent repeat cytological testing, an HPV screen, and a cervical acetic acid wash examination immediately before colposcopy after a 4- to 6-month waiting period. Of the 122 consenting women identified with ASCUS, 67 (55%) demonstrated abnormalities on biopsy, including 26 with condyloma, 26 with cervical intraepithelial neoplasia I (CIN I), and 15 with CIN II to III. The false-negative rate, 58%, of the follow-up Pap smear alone for detecting these cases of condyloma and CIN was significantly decreased (false-negative rate, 27%) with the use of the cervical acetic acid wash as an adjunctive test. There was no additional reduction in the false-negative rate with the use of the HPV screen. Of the 15 subjects with high-grade cervical lesions (CIN II to III), 14 had either an abnormal follow-up Pap smear or an abnormal cervical acetic acid wash examination. Among women with cervical atypia, a single follow-up Pap smear alone failed to detect one third of the cases of high-grade disease. Ninety-three percent of these cases were detected, however, with a follow-up Pap smear and an acetic acid wash. Our one subject with a high-grade lesion missed with this combination of tests had an unsatisfactory Pap smear. Use of both tests together may reliably guide clinical decisions regarding the management of cervical atypia.

[Evaluation of practices of excisional therapies for CIN: An audit of surgery rooms from Marseilles' area].

PubMed

Einaudi, L; Boubli, L; Carcopino, X

2015-11-01

To evaluate what is the proportion of surgery rooms from Marseilles' area that do perform excisional therapies for CIN without any use of colposcopic guidance. From November 2012 to January 2013, a survey was conducted among all surgery rooms from Marseilles' area practicing excisional therapies for CIN. In addition, answers from gynecologists from Marseilles' area who participated to a national survey that evaluated practices of excisional therapies in France were specifically analyzed. Among the 55 surgery rooms from Marseilles' area practicing excisional therapies, 52 (94.1%) participated to the current survey. A colposcope was available in only 19 (36.5%) surgery rooms and was systematically used for the guidance of excisional therapies in only 4 (21%) of these surgery rooms. Finally, 36 (69.2%) surgery rooms answered performing excisional therapies without any use of colposcopic guidance. Colposcopy was occasionally and systematically used in 12 (23.1%) and 4 (7.7%) surgery rooms, respectively. Among the 116 gynecologists from Marseilles' area who answered to the national survey, 88 (75.9%) answered not using colposcopy when performing excision for CIN. Only 6% answered performing excision systematically under direct colposcopic vision and 18.1% occasionally. No colposcopic guidance is used when performing excision for CIN in the majority of surgery rooms from Marseilles' area. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Scattering and absorption measurements of cervical tissues measures using low cost multi-spectral imaging

NASA Astrophysics Data System (ADS)

Bernat, Amir S.; Bar-Am, Kfir; Cataldo, Leigh; Bolton, Frank J.; Kahn, Bruce S.; Levitz, David

2018-02-01

Cervical cancer is a leading cause of death for women in low resource settings. In order to better detect cervical dysplasia, a low cost multi-spectral colposcope was developed utilizing low costs LEDs and an area scan camera. The device is capable of both traditional colposcopic imaging and multi-spectral image capture. Following initial bench testing, the device was deployed to a gynecology clinic where it was used to image patients in a colposcopy setting. Both traditional colposcopic images and spectral data from patients were uploaded to a cloud server for remote analysis. Multi-spectral imaging ( 30 second capture) took place before any clinical procedure; the standard of care was followed thereafter. If acetic acid was used in the standard of care, a post-acetowhitening colposcopic image was also captured. In analyzing the data, normal and abnormal regions were identified in the colposcopic images by an expert clinician. Spectral data were fit to a theoretical model based on diffusion theory, yielding information on scattering and absorption parameters. Data were grouped according to clinician labeling of the tissue, as well as any additional clinical test results available (Pap, HPV, biopsy). Altogether, N=20 patients were imaged in this study, with 9 of them abnormal. In comparing normal and abnormal regions of interest from patients, substantial differences were measured in blood content, while differences in oxygen saturation parameters were more subtle. These results suggest that optical measurements made using low cost spectral imaging systems can distinguish between normal and pathological tissues.

An audit of the cervical cancer screening histories of 246 women with carcinoma.

PubMed

Duggan, Máire A; Nation, Jill

2012-07-01

Women with cervical carcinoma and residing in the Calgary Health Region between 1996 and 2001 were audited to characterize factors in the opportunistic cervical cancer screening pathway contributing to screening failures. The cohort consisted of 246 women. Information on their Pap tests and colposcopic/gynecologic examinations was obtained from the files of Calgary Laboratory Services and their colposcopic/cancer center treatment charts. Screening failure factors were defined, and frequencies were calculated. Screening failure factors were as follows: (1) 41 (16.7%) were not screened, that is, no Pap test screening; (2) 29 (11.8%) were underscreened, that is, no Pap test within 12 months of diagnosis; (3) 28 (13.7%) were undersampled, that is, the Pap test result was negative; (4) 34 (13.8%) had no referral for a colposcopy/gynecology examination, and/or it was delayed for more than 3 months; (5) 18 (13.2%) had delayed referral for examination of an atypical glandular cell-high-grade squamous intraepithelial lesion and higher Pap test for more than 3 months; and (6) 73 (55.3%) were underdiagnosed, that is, the diagnosis in colposcopy examination was less than malignant. Underreported Pap tests and delayed Pap test reporting could not be fully investigated, but limited evidence suggested that underreporting contributed to some failures. Factors other than recruitment to cytological screening need targeted improvement if the region's cervical cancer prevention program is to be more effective.

Treatment of condylomata acuminata with CO2 laser under colposcopic control in pregnant women

NASA Astrophysics Data System (ADS)

Wozniak, Jakub; Opala, Tomasz; Pisarska-Krawczyk, Magdalena; Wilczak, Maciej; Pisarski, Tadeusz

1996-03-01

The results of treatment of condylomata acuminata of the anogenital region in pregnant women are presented. All patients were treated between the 28th and 35th weeks of gestation. The laser surgery was done in 23 patients. One laser procedure was done in 14 women. In 5 patients we performed two and in 4 women 3 laser therapies. Complete destruction of pathological changes was obtained and no recurrences were diagnosed. There were no clinical signs of HPV infection in all neonates. In the authors' opinion the use of carbon-dioxide laser under colposcopic control is an efficient and safe method in the treatment of condylomata acuminata in pregnant women. Colposcopic control allows us to discover and coagulate the bleeding spots using the defocused laser beam with low power density.

[New colposcopic terminology: Rio de Janeiro--2011].

PubMed

Zlatkov, V; Kostova, P

2014-01-01

The purpose of this work is to review the new colposcopic classification of the International Federation for Cervical Pathology and Colposcopy (IFCPC) from 2011 and the possibilities for its application in diagnostic and treatment processes and research. It fulfills the necessity for a modern and widely applicable nomenclature of the findings and it is based on the latest knowledge in this area. Colposcopic terminology of the vagina, as part of the pathology of the lower genital tract, is included as well, while the vulva and perineum terminology is not yet finally adopted. Furthermore, the various cervical excisional techniques are evaluated and described. According to experts, the popularity of colposcopy will not diminish and it will continue to be used as a routine technique in daily practice. In a critical sense, despite its descriptive and punctual character, the accepted terminology classification does not give a new interpretation of the severity of changes, and as such, it does not significantly modify the diagnostic and therapeutic approach. The lack of a scoring system that would allow the dynamic comparison of the severity of symptoms and the categories over time is a serious weakness. This limits the new colposcopic classification as no more than a working sheet that descriptively assesses the findings of the lower genital tract.

[Reliability of endocervical curettage after conservative treatment of intraepithelial neoplasia of the cervix].

PubMed

Lecointre, L; Akladios, C-Y; Averous, G; Lefebvre, F; Baulon, E; Thoma, V; Fender, M; Baldauf, J-J

2015-02-01

To evaluate the reliability of endocervical curettage (ECC) in patients previously treated for CIN. Retrospective analysis of data from 85 patients between January 1985 and December 2011 who received an ECC during monitoring after treatment of CIN. The reliability of the ECC was evaluated by comparison with the final histological analysis of the surgical specimen or the data for subsequent cyto-colpo-histological follow-up. Patients were referred to colposcopy either within the immediate post-treatment monitoring (n=42), meanly 9.7±5.3 months after treatment, or if cytological abnormalities were detected during long-term monitoring, meanly 78.6±52.4 months after treatment. Colposcopy was unsatisfactory in 75.3% of patients and normal colposcopic findings were found in 80% of patients. A perfect agreement between the ECC and the endocervical final diagnosis was noted in 68 patients (80%). For the diagnosis of severe cervical lesions (CIN 2+) ECC had a sensitivity of 86.2% (68.3-96.1), a specificity of 94.6% (85.1-98.9) and positive and negative predictive values of 61.4% (47.6-74.0) and 93% (83.0-98.1), respectively. The high sensitivity and negative predictive value of ECC for the diagnosis of severe post-therapeutic endocervical lesions avoid iterative treatment without increasing the risk of progression of a lesion to cancer. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

Reliability of unaided naked-eye examination as a screening test for cervical lesions in a developing country setup.

PubMed

Darwish, Atef M; Abdulla, Sayed A; Zahran, Kamal M; Abdel-Fattah, Nermat A

2013-04-01

This study aimed to test the reliability of unaided naked-eye examination (UNEE) of the cervix as a sole cervical cancer screening test in a developing country setup compared with the standard cervical cytology. A total of 3,500 nonpregnant women aged between 25 and 55 years were included. An unlubricated bivalve speculum was inserted into the vagina under good light to visualize the cervix. A thorough UNEE of the cervix was done to detect any apparent lesions. Cervical smears were obtained using the long tip of an Ayre spatula. An additional endocervical sample was obtained by cytobrush. Women with abnormal Pap smears or visible cervical lesions by UNEE were scheduled for colposcopic examination. A biopsy specimen was obtained in every abnormal colposcopic examination. Of 3,500 cases, there were 9 (2.57%) preinvasive cervical lesions (cervical intraepithelial neoplasia 1-3) diagnosed with various diagnostic tools used in the study and confirmed by histopathologic examination. Of 3,500 cases, invasive cervical lesions were diagnosed in 6 (1.71%). The sensitivity of UNEE is much better than that of Pap smear (80% vs 60%) but less than that of colposcopy (86.7%). However, the specificity of UNEE (100%) is lower than that of Pap smear (91.16%) and better than that colposcopy (83.12%). The UNEE has a poor positive predictive value (3.75%) when compared with Pap smear (100%) and colposcopy (20%). The negative predictive values of the 3 tests were nearly comparable. Whenever access to Pap smear is limited, UNEE performed by general gynecologists and well-trained nurses is an acceptable alternative for detecting cervical premalignant or malignant lesions especially in low-resource settings.

Discrepancy between colposcopy, punch biopsy and final histology of cone specimen: a prospective study.

PubMed

Petousis, Stamatios; Christidis, Panagiotis; Margioula-Siarkou, Chrysoula; Sparangis, Nikolaos; Athanasiadis, Apostolos; Kalogiannidis, Ioannis

2018-05-01

Τo estimate the discrepancy rate between colposcopy, punch biopsy histology and surgical specimen histology as well as the positive (PPV) and negative predictive value (NPV) of colposcopic diagnosis for high-grade squamous intraepithelial lesions (HGSIL). A prospective study was conducted during the period of 2012-2016. Αll cases in which surgical treatment had been applied and histopathological diagnosis of those surgical specimens was available were included. Cases in which ablation was performed and cases with incomplete data or conservative approach were excluded. Primary outcome was the agreement rate between histologic diagnosis of surgical specimen, histologic diagnosis of punch biopsy and colposcopic diagnosis according to REID Colposcopic Index. PPV and NPV of colposcopy and biopsy to diagnose HGSIL were also assessed. Τhere were 120 cases meeting our inclusion criteria, while biopsy was obtained in 104 cases. Mean age of women was 32.7 ± 9.0. Colposcopic diagnosis was CIN2 in 65 cases, CIN3 in 11 cases, CIN1 or less in 44 cases. Τhe level of agreement was fair between colposcopy-surgical specimen histology (κ value 0.443), fair between colposcopy-punch biopsy (κ value 0.34) and moderate between punch biopsy-cone specimen histology (κ value 0.443). PPV of colposcopy to detect HGSIL was 72.3%, while NPV was only 47.7%. Punch biopsy and surgical specimen histology present the highest agreement between the different diagnostic procedures. Colposcopy presented satisfying PPV for HGSIL cases, but its NPV was poor. In contrary, punch biopsy was characterized by both satisfying PPV and NPV for HGSIL cases.

Surgical Treatment of Persistent Vaginal Granulation Tissue Using CO2 Laser Vaporization Under Colposcopic and Laparoscopic Guidance

PubMed Central

Mapp, Tiffany; Mama, Saifuddin; Echols, Karolynn T.

2012-01-01

Introduction: There have been many reports in the literature on vaginal mesh erosion as a complication of pelvic floor reconstructive surgery. Several reports describe successful surgical excision of the exposed mesh as a resolution. However, in rare cases of mesh erosion, poor surgical outcomes and multiple resection failures have been reported. We describe an innovative surgical approach to persistent vaginal mesh erosion using CO2 laser vaporization under colposcopic and laparoscopic guidance. Case Description: A 58-y-old postmenopausal woman first presented with a 3-y history of vaginal discharge and spotting after undergoing a Mentor ObTape transobturator sling (Mentor Corp, Santa Barbara, CA), for the treatment of stress urinary incontinence. Despite surgical removal of the mesh and multiple attempts at cauterization of persistent granulation tissue, her symptoms persisted. Discussion: Using a CO2 laser under colposcopic and laparoscopic guidance, we were able to safely expose and remove the remaining portion of retained mesh. To our knowledge, this is the first report describing CO2 laser vaporization as a surgical approach for the successful treatment of recurrent mesh erosion. PMID:23318081

Standardized Digital Colposcopy with Dynamic Spectral Imaging for Conservative Patient Management.

PubMed

Kaufmann, Angelika; Founta, Christina; Papagiannakis, Emmanouil; Naik, Raj; Fisher, Ann

2017-01-01

Colposcopy is subjective and management of young patients with high-grade disease is challenging, as treatments may impair subsequent pregnancies and adversely affect obstetric outcomes. Conservative management of selected patients is becoming more popular amongst clinicians; however it requires accurate assessment and documentation. Novel adjunctive technologies for colposcopy could improve patient care and help individualize management decisions by introducing standardization, increasing sensitivity, and improving documentation. A nulliparous 27-year-old woman planning pregnancy underwent colposcopy following high-grade cytology. The colposcopic impression was of low-grade changes, whilst the Dynamic Spectral Imaging (DSI) map of the cervix suggested potential high-grade. A DSI-directed biopsy confirmed CIN2. At follow-up, both colposcopy and DSI were suggestive of low-grade disease only, and image comparison confirmed the absence of previously present acetowhite epithelium areas. Histology of the transformation zone following excisional treatment, as per patient's choice, showed no high-grade changes. Digital colposcopy with DSI mapping helps standardize colposcopic examinations, increase diagnostic accuracy, and monitor cervical changes over time, improving patient care. When used for longitudinal tracking of disease and when it confirms a negative colposcopy, it can help towards avoiding overtreatment and hence decrease morbidity related to cervical excision.

Quality assessment and improvement of "Unsatisfactory" liquid-based cervicovaginal papanicolaou smears.

PubMed

Mirzamani, Neda; Chau, Karen; Rafael, Oana; Shergill, Uday; Sajjan, Sujata; Sumskaya, Irina; Gimenez, Cecilia; Klein, Melissa; Das, Kasturi

2017-10-01

The quality of cervicovaginal smears determines the success of cytology in screening programs for cervical cancer. Bethesda 2014 revisited the adequacy criteria for atrophic smears and redefined the squamous cell count in the "unsatisfactory" category. In this study, we evaluated the smear quality of Thinprep liquid-based cervicovaginal Papanicolaou cytology slides (TPS) that were previously deemed unsatisfactory, to determine reasons for such categorization. In addition, we attempted to establish the impact of the new adequacy criteria on the rate and management of unsatisfactory diagnosis. About 234 unsatisfactory TPS were examined. The reasons for unsatisfactory were noted. The number of squamous cells was recounted, as per the new Bethesda criteria, in borderline adequacy cases that showed an atrophic pattern. The leading cause for unsatisfactory TPS was lubricating gel, followed by blood, as observed in older and younger age groups, respectively (Figure 1). Eleven borderline cases were reclassified as "satisfactory" using the new Bethesda cell count, with 27% above 60 years of age. About 82% of these borderline cases were negative for intraepithelial lesion or malignancy on repeat testing. There was no difference of management or change in rate of unsatisfactory when patients above 60 were reclassified into the satisfactory category using the new Bethesda count. However, a larger study is needed to evaluate whether the new recommendation for minimum cellularity can be implemented in patients above a certain age cut-off. The study highlights the need for improvement in collection practices and education of practitioners. © 2017 Wiley Periodicals, Inc.

Variation in the annual unsatisfactory rates of selected pathogens and indicators in ready-to-eat food sampled from the point of sale or service in Wales, United Kingdom.

PubMed

Meldrum, R J; Garside, J; Mannion, P; Charles, D; Ellis, P

2012-12-01

The Welsh Food Microbiological Forum "shopping basket" survey is a long running, structured surveillance program examining ready-to-eat food randomly sampled from the point of sale or service in Wales, United Kingdom. The annual unsatisfactory rates for selected indicators and pathogens for 1998 through 2008 were examined. All the annual unsatisfactory rates for the selected pathogens were <0.5%, and no pattern with the annual rate was observed. There was also no discernible trend observed for the annual rates of Listeria spp. (not moncytogenes), with all rates <0.5%. However, there was a trend observed for Esherichia coli, with a decrease in rate between 1998 and 2003, rapid in the first few years, and then a gradual increase in rate up to 2008. It was concluded that there was no discernible pattern to the annual unsatisfactory rates for Listeria spp. (not monocytogenes), L. monocytogenes, Staphylococcus aureus, and Bacillus cereus, but that a definite trend had been observed for E. coli.

Intraepithelial and invasive neoplasia of the vulva in association with human papillomavirus infection.

PubMed

Planner, R S; Hobbs, J B

1988-06-01

Colposcopic examination of 335 women with cytologically detected human papillomavirus (HPV) revealed involvement of the cervix in 316 patients (94%), vagina in 276 (82%) and vulva in 148 (44%). A symptom complex of pruritus and superficial dyspareunia was found in 98 of the 148 patients with vulvar infection (66%). Histologic examination revealed HPV-associated vulvar intraepithelial neoplasia (VIN) in 11 of 148 biopsies (7.4%). Follow-up of the patients with HPV infection with or without VIN showed a spontaneous regression rate of 56% but also demonstrated progression to VIN 3 in two patients and to invasive carcinoma of the vulva in one.

Optical design of low cost imaging systems for mobile medical applications

NASA Astrophysics Data System (ADS)

Kass, Alexander; Slyper, Ronit; Levitz, David

2015-03-01

Colposcopes, the gold standard devices for imaging the cervix at high magnfication, are expensive and sparse in low resource settings. Using a lens attachment, any smartphone camera can be turned into an imaging device for tissues such as the cervix. We create a smartphone-based colposcope using a simple lens design for high magnification. This particular design is useful because it allows parameters such as F-number, depth of field, and magnification to be controlled easily. We were therefore able to determine a set of design steps which are general to mobile medical imaging devices and allow them to maintain requisite image quality while still being rugged and affordable.

[Computerized evaluation of reparative processes of the cervix uteri].

PubMed

Pasquinucci, C; Contini, V

1990-01-01

This study was aimed to evaluate the effect of polydeoxyribonucleotide (PDRN), as reported in relevant literature, on cervical epithelia dynamics. Particularly, the interactions taking place between columnar epithelium and the squamous one have been examined. For the purposes of the study, the following computerized techniques, already widely known, have been used: The colposcope is joined to a videocamera connected with a computer (AT compatible). The computer is equipped with a graphic card capable to record and to digit the image, i.e. to make it recognizable by the computer itself. Thereafter, many operations can be performed on the colposcopic images: reductions, enlargements, retouches, record, recall, analysis, etc. Moreover, irregular epithelial areas can be easily determined to a good approximation and, using pre-established enlargement ratios, their evolution can be evaluated. By means of this technique 12 out-patients with uterine cervix ectopias, with or without normal transformation zone (NTZ), have been examined. The monthly therapy was 12 pessaries, each containing 5 mg polydeoxyribonucleotide (POLIDES 5--Farmigea), from the 7th to the 18th day of the cycle, repeated for 3 months. Since the first month of treatment a reduction of the ectopic columnar epithelium has been noted in most patients (9 on 12), with a squamous epithelium increase (peripheral reparative process). This process has kept on increasing during the following months in the 9 patients responding to the treatment, whose ectopic areas were covered by squamous epithelium (average 55% of the area; range 33%-78%). No response to the treatment has been shown in 3 cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Untitled

Cancer.gov

A collaborative study on colposcopic biopsy with aims to study cervical disease on the lesion level, optimize criteria for biopsy placement, and analyze the incremental benefit of taking multiple biopsies

EFFECT OF QUALITY OF CHEST RADIOGRAPHS ON THE CATEGORIZATION OF COALWORKERS' PNEUMOCONIOSIS

PubMed Central

Pearson, N. G.; Ashford, J. R.; Morgan, D. C.; Pasqual, R. S. H.; Rae, S.

1965-01-01

An investigation into the effect of variations in radiographic technical quality on pneumoconiosis reading standards in the Pneumoconiosis Field Research of the National Coal Board is reported. From the group of men for whom retake films had been obtained because of unsatisfactory technique of the originals, a trial series of pairs and triplets of films showing differing technique was assembled. A total of 778 films was read for pneumoconiosis and assessed for technical quality by four readers. The quality was assessed in terms of three separate factors, viz., density (at high, medium, and low levels), contrast (satisfactory and unsatisfactory), and definition (satisfactory and unsatisfactory). The intra and inter observer consistency of this assessment was estimated, and the effect of techical quality on the reading of pneumoconiosis category was determined. A tendency for lower pneumoconiosis readings to be recorded on films with unsatisfactory technique was demonstrated. A random 10% sample of the best available films (those on which routine pneumoconiosis readings have been made) for all men examined since the beginning of the research was also read for technical quality. Of the total of 4,188 films, 80% were considered satisfactory. It appeared that films taken on second surveys were, in general, of rather better quality than those taken on first surveys. The physical attributes of the men examined had some effect on the technical standards, the proportion of unsatisfactory films rising with increasing values of the weight/sitting height ratio and being greater in men with pneumoconiosis categories 1 and A and in the middle age group. The tendency for lower pneumoconiosis readings to be recorded on films with unsatisfactory technique is in contrast to the results of work previously published. Different criteria for the selection of films and the assessment of technical quality, and possibly differing reading conventions, make comparison with other work difficult. PMID:14278806

Detection of Human Papillomavirus Type 16 DNA and Papillomavirus Genus‐specific Antigens in Vulva and Cervix from Patients with Bowenoid Papulosis

PubMed Central

Sugase, Motoyasu; Moriyama, Shin‐ichi; Hata, Satoru; Matsukura, Toshihiko

1989-01-01

The warty disordered lesions of the vulva in three female patients were diagnosed as Bowenoid papulosis on the basis of clinical and histopathological findings. In all three vulvar lesions, human Papillomavirus type 16 (HPV 16) DNA was identified hy Southern blot hybridization and Papillomavirus genus‐specific (PGS) antigen was detected in one case immunohistochemically. Furthermore, colposcopic examination revealed the presence of abnormal uterine cervical lesions in two cases. They were found to be intraepithelial neoplasia which harbored HPV 16 DNA and were positive for PGS antigen. PMID:2540130

Amplification of human papillomavirus early genes for detection of nine genotypes in Venezuelan women.

PubMed

Michelli, Elvia; Téllez, Luis; Mendoza, José-Andrés; Noguera, María-Eugenia; Milano, Melisse; Vera, Reauben; Callejas, Diana

2013-12-01

Genotyping of human papillomavirus (HPV) by molecular methods may enhance assessment information for screening and following of cervical infection. In this study, cervical samples were obtained from 250 women, along with colposcopic and cytological evaluations. A Nested-PCR-Multiplex assay was used for HPV detection and genotyping for HPV E6/E7 early regions. Infection with HPV was detected in 26.0% of the samples, with 98.46% positive for at least one genotype. High-risk HPVs were identified in 98.44%. HPV18 infection was detected in 76.92% of samples and HPV16 in 36.92%, whether as individual or as multiple infections. These infections were seen more frequently in women under 35 years of age (64.7%). The Pap-smear examination showed that 16.92% (11/65) of the samples had cervical changes suggesting HPV infection, whereas the colposcopic evaluation was suggestive of HPV infection in 47.69% (31/65) of DNA-HPV positive samples. There was a high frequency of high-risk HPV genotypes, particularly HPV18, alone or in multiple-type infections. Colposcopy findings showed to have a high predictive value for the diagnosis of HPV infection. The results reflect that over 50% of HPV-positive patients had a normal colposcopy and/or cytology, highlighting the importance of including HPV testing along with genotype identification in routine gynecological evaluations.

Semi-quantitative HPV viral load in patients with ASC-US cytology: viral load correlates strongly with the presence of CIN but only weakly with its severity.

PubMed

Lee, S J; Kim, W Y; Shim, S-H; Cho, S-H; Oh, I K; Hwang, T S; Kim, S-N; Kang, S-B

2015-02-01

This study was performed to evaluate the prognostic significance of human papillomavirus (HPV) viral load, expressed in relative light units (RLUs), in patients with atypical squamous cells of undetermined significance (ASC-US) cytology. A total of 349 ASC-US cases with HPV infection, detected using Hybrid Capture 2, were diagnosed histologically. A colposcopically directed punch biopsy was performed on acetowhite areas. Endocervical curettage biopsy and random cervical punch biopsy in four quadrants were performed in unsatisfactory colposcopy cases. In negative colposcopy cases, random cervical punch biopsy in four quadrants was performed. Case with no cervical intraepithelial neoplasia (CIN), CIN1 and CIN2+ (CIN2/CIN3) accounted for 162, 135 and 52 cases, respectively. The mean age showed no difference among the three groups (P = 0.510). There was a significant correlation between RLU values and the presence of CIN (P < 0.001), but less so with its severity: the median RLU values for negative, CIN1 and CIN2+ cases were 42.68, 146.45 and 156.43, respectively, with widely overlapping confidence intervals. The cut-off values of RLU to detect CIN1+ and CIN2+ were 6.73 and 45.64, respectively. The HPV viral load in ASC-US cases showed a significant correlation with the presence of CIN and less so with its severity, and showed large overlap of viral loads between grades of CIN. In ASC-US cases, RLU was not an accurate predictor of immediate high-grade CIN. © 2014 John Wiley & Sons Ltd.

Laser vaporization in treatment of superficial endometriosis of the uterine cervix

NASA Astrophysics Data System (ADS)

Wozniak, Jakub; Wilczak, Maciej; Opala, Tomasz; Pisarska-Krawczyk, Magdalena; Cwojdzinski, Marek; Pisarski, Tadeusz

1996-03-01

The study shows the treatment of superficial endometriosis of the uterine cervix in 79 patients. After first vaporization 74 patients were cured successfully. In two cases the laser procedure should be repeated and in 3 women the operation should be performed for the third time. All patients are still under control in our department and there is no recurrence observed. Carbon- dioxide laser vaporization under colposcopic control is an efficient method of treatment of superficial endometriosis of the uterine cervix that requires no anaesthesia. The healing process after laser procedures is fast and without complications. The number of recurrences is low. Use of carbon-dioxide laser under colposcopic control because of precise destruction of lesions, fast healing and a low number of recurrences seems to be the method of choice.

Smoking as a risk factor for preinvasive and invasive cervical lesions in female sex workers in Venezuela.

PubMed

Núñez, J T; Delgado, M; Pino, G; Girón, H; Bolet, B

2002-10-01

To determine whether the number of cigarettes smoked per day and years of smoking were risk factors for preinvasive and invasive cervical lesions in Venezuelan female sex workers. The clinical history of 438 female sex workers (FSWs) was taken and each received a gynecological examination, a Pap smear, and a colposcopic examination. A colposcopically-guided cervical biopsy was taken when the epithelium appeared abnormal. The FSWs' mean age was 32.16+/-8 years. Age at first sexual intercourse was 15.9+/-2 years, parity was 4.1+/-2.3, live births were 3+/-3, and age at first delivery was 16.6+/-4.7 years. Cervical biopsies were performed in 84 FSWs. Sixty-four of them (76.2%) had preinvasive or invasive lesions and 47 (73.4%) were current smokers (Relative Risk) (RR), 1.26; 95% confidence interval (CI), 1.02-1.55; P<0.03]. FSWs who smoked more than 20 cigarettes per day had an increased RR to get a premalignant or malignant cervical lesion (RR, 1.27; 95% CI, 1.02-1.52; P<0.03). There was no statistically significant difference between FSWs who smoked 20 cigarettes or more per day and FSWs who smoked less than 20 cigarettes per day (RR, 1.36; 95% CI, 0.81-2.29; P<0.25). FSWs who had been smoking for 5 years or more were at risk to develop preinvasive or invasive cervical lesions (RR, 1.37; 95% CI, 1.01-1.86; P<0.04). The risk for FSWs to develop preinvasive or invasive cervical lesions increased with the number of cigarettes they smoked per day and their years of smoking.

Nonspecific ST-T changes associated with unsatisfactory blood pressure control among adults with hypertension in China: Evidence from the CSPTT study.

PubMed

Bao, Huihui; Cai, Huaxiu; Zhao, Yan; Huang, Xiao; Fan, Fangfang; Zhang, Chunyan; Li, Juxiang; Chen, Jing; Hong, Kui; Li, Ping; Wu, Yanqing; Wu, Qinhua; Wang, Binyan; Xu, Xiping; Li, Yigang; Huo, Yong; Cheng, Xiaoshu

2017-03-01

Nonspecific ST-segment and T-wave (ST-T) changes represent one of the most prevalent electrocardiographic abnormalities in hypertensive patients. However, a limited number of studies have investigated the association between nonspecific ST-T changes and unsatisfactory blood pressure (BP) control in adults with hypertension.The study population comprised 15,038 hypertensive patients, who were selected from 20,702 participants in the China Stroke Primary Prevention Trial. The subjects were examined with electrocardiogram test at the initial visit in order to monitor baseline heart activity. According to the results of the electrocardiogram (defined by Minnesota coding), the subjects were divided into 2 groups: ST-T abnormal and ST-T normal. Unsatisfactory BP control was defined as systolic BP ≥140 mm Hg or diastolic BP ≥90 mm Hg following antihypertensive treatment during the 4.5-year follow-up period. Multivariate analysis was used to analyze the association between nonspecific ST-T abnormalities and unsatisfactory BP control.Nonspecific ST-T changes were common in hypertensive adults (approximately 8.5% in the study), and more prevalent in women (10.3%) and diabetic patients (13.9%). The unsatisfactory BP control rate was high in the total population (47.0%), notably in the ST-T abnormal group (55.5%). The nonspecific ST-T abnormal group exhibited a significantly greater rate of unsatisfactory BP control (odds ratio [OR] 1.20, 95% confidence interval [CI] [1.06, 1.36], P = 0.005]), independent of traditional risk factors, as demonstrated by multivariate regression analysis. Notable differences were further observed in male subjects (OR 1.51, 95% CI [1.17, 1.94], P = 0.002) and in patients with comorbid diabetes (OR 1.47, 95% CI [1.04, 2.07], P = 0.029).Greater rates of unsatisfactory BP control in hypertensive patients with electrocardiographic nonspecific ST-T abnormalities were observed, notably in the subcategories of the male subjects and the diabetic patients.

Factors influencing histologic confirmation of high-grade squamous intraepithelial lesion cytology.

PubMed

Castle, Philip E; Cox, J Thomas; Schiffman, Mark; Wheeler, Cosette M; Solomon, Diane

2008-09-01

To examine the predictors of histologic confirmation of high-grade squamous intraepithelial lesion (HSIL) cytology occurring in follow-up of young women originally referred into a trial because of less severe cytology. We used enrollment HSIL cytology (N=411) as read by clinical center pathologists for women participating in the ASCUS-LSIL Triage Study (ALTS). The primary outcome was histologic cervical intraepithelial neoplasia (CIN) grade 3 and early cancer (n=195; 191 CIN 3 and four cancers) as diagnosed by the Pathology Quality Control Group during the 2-year duration of ALTS. The 2-year absolute risk of CIN 3 or worse after an HSIL cytology was 47.4% (95% confidence interval 42.5-52.4%). The 2-year absolute risk of CIN 3 or worse was lowest (14.3%) for women who were human papillomavirus (HPV)-16-negative, had colposcopic impression of less than low-grade, and whose HSIL cytology as called by the clinical center was not also called HSIL or equivocal HSIL cytology by the Pathology Quality Control Group. The 2-year absolute risk of CIN 3 or worse was highest (82.4%) for women who were HPV16-positive, had colposcopic impression of low-grade or worse, and whose HSIL cytology also was called HSIL or equivocal HSIL cytology by the Pathology Quality Control Group. Histologic confirmation of precancer among young women with HSIL cytology was more likely when other risk factors (eg, HPV16) for cervical precancer were present.

Combined Effects of Chewing Ability and Dietary Diversity on Medical Service Use and Expenditures.

PubMed

Lo, Yuan-Ting C; Wahlqvist, Mark L; Chang, Yu-Hung; Lee, Meei-Shyuan

2016-06-01

To examine whether chewing ability affects healthcare use and expenditure and whether improving dietary quality alleviates any such effects. Prospective cohort. The Elderly Nutrition and Health Survey in Taiwan (1999-2000), a nationwide community-based survey of people aged 65 and older. Individuals aged 65 and older (N = 1,793; 903 men, 890 women). Chewing ability (satisfactory or unsatisfactory) was assessed using a questionnaire, and dietary quality was assessed using a 24-hour dietary recall as a dietary diversity score. Data on annual medical use and expenditures from the interview date until December 31, 2006, were collected from National Health Insurance claims. Generalized linear models were used to assess the associations between chewing ability, dietary quality, and annual medical usage or expenditure. After 8 years of follow-up, older adults with unsatisfactory chewing ability had considerably higher emergency, hospitalization, and total medical expenditures. Older adults with unsatisfactory chewing ability and a poor diet used fewer annual preventive care and dental services than those with satisfactory chewing ability but had longer hospital stays and higher expenditures. After adjusting for covariates, unsatisfactory chewing ability resulted in significantly longer hospital stays in participants with a poor diet (β = 2.34, 95% confidence interval = 2.02-2.71, P < .001). Unsatisfactory chewing ability and a less-diverse diet together are associated with longer hospital stays and higher medical expenditures. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.

Analyzing Army Reserve Unsatisfactory Participants through Logistic Regression

DTIC Science & Technology

2012-06-08

Unsatisfactory Participants by State/Territory ...............................45 Figure 14. Observed vs . Expected Unsatisfactory Participants by Grade...47 Figure 15. Observed vs . Expected Unsatisfactory Participants by Age ............................47 x TABLES Page Table...rank, and previous military experience. “A typical 1995-96 USAR Unsatisfactory Participant was a white, unmarried male whose highest level of

An assessment of the microbiological quality and safety of raw drinking milk on retail sale in England.

PubMed

Willis, C; Jørgensen, F; Aird, H; Elviss, N; Fox, A; Jenkins, C; Fenelon, D; Sadler-Reeves, L; McLauchlin, J

2018-02-01

This study aimed to review the microbiological results for raw drinking milk (RDM) samples submitted to Public Health England laboratories between 2014 and 2016 in order to produce up-to-date data on the microbiological safety of RDM and inform future risk assessments on its sale. A total of 902 samples of RDM were collected from retail sale in England for microbiological examination. Overall, 454 of 770 samples (59·0%) taken for routine monitoring were of a satisfactory quality, whilst eight (1·0%) were 'unsatisfactory and potentially injurious to health' due to the presence of Shiga toxin-producing Escherichia coli, Campylobacter or elevated levels of Listeria monocytogenes or coagulase-positive staphylococci. In contrast, 16 of 114 (14·0%) of samples taken in follow-up to a previous unsatisfactory result and 5 of 18 (27·8%) of samples related to illness were potentially injurious. A total of 229 of 902 samples (25·4%) gave unsatisfactory results due to elevated aerobic colony counts and/or coliforms, whilst 139 of 902 samples (15·4%) were of borderline quality due to coagulase-positive staphylococci. Listeria monocytogenes was detected at levels of <100 CFU per ml in 66 of 902 samples (7·3%) and other Listeria species in 44 of 902 samples (4·9%). Pathogens and/or indicators of poor hygiene were present in almost half of samples examined. Cows' milk samples gave a significantly greater proportion of unsatisfactory results compared to milk from other species (i.e. goat, sheep, buffalo, camel). These results demonstrate the importance of maintaining strict controls on the production and sale of this product. © 2017 The Society for Applied Microbiology.

Multiple Biopsies and Detection of Cervical Cancer Precursors at Colposcopy

PubMed Central

Wentzensen, Nicolas; Walker, Joan L.; Gold, Michael A.; Smith, Katie M.; Zuna, Rosemary E.; Mathews, Cara; Dunn, S. Terence; Zhang, Roy; Moxley, Katherine; Bishop, Erin; Tenney, Meaghan; Nugent, Elizabeth; Graubard, Barry I.; Wacholder, Sholom; Schiffman, Mark

2015-01-01

Purpose Women with abnormal cervical cancer screening results are referred to colposcopy and biopsy for diagnosis of cervical cancer precursors (high-grade squamous intraepithelial lesions [HSILs]). Colposcopy with a single biopsy can miss identification of HSILs. No systematic study has quantified the improved detection of HSIL by taking multiple lesion-directed biopsies. Methods The Biopsy Study was an observational study of 690 women referred to colposcopy after abnormal cervical cancer screening results. Up to four directed biopsies were taken from distinct acetowhite lesions and ranked by colposcopic impression. A nondirected biopsy of a normal-appearing area was added if fewer than four directed biopsies were taken. HSIL identified by any biopsy was the reference standard of disease used to evaluate the incremental yield and sensitivity of multiple biopsies. Results In the overall population, sensitivities for detecting HSIL increased from 60.6% (95% CI, 54.8% to 66.6%) from a single biopsy to 85.6% (95% CI, 80.3% to 90.2%) after two biopsies and to 95.6% (95% CI, 91.3% to 99.2%) after three biopsies. A significant increase in sensitivity of multiple biopsies was observed in all subgroups. The highest increase in yield of HSIL was observed for women with a high-grade colposcopic impression, HSIL cytology, and human papillomavirus (HPV) type 16 positivity. Only 2% of all HSILs diagnosed in the participants were detected by biopsies of normal-appearing transformation zone. Conclusion Collection of additional lesion-directed biopsies during colposcopy increased detection of histologic HSIL, regardless of patient characteristics. Taking additional biopsies when multiple lesions are present should become the standard practice of colposcopic biopsy. PMID:25422481

Discordance between cytology and biopsy histology of the cervix: what to consider and what to do.

PubMed

Anschau, Fernando; Guimarães Gonçalves, Manoel Afonso

2011-01-01

Since cytology is the examination utilized for the screening of cervical cancer, it is important to determine its correlation with histologic examination, the gold standard in the diagnosis of cervical disease. A retrospective evaluation was made of 431 patients who presented with colposcopic indication for cervical biopsy between 2003 and 2007. In 90.8% (289/318) of the patients, cytology showing cervical intraepithelial neoplasia (CIN) was confirmed as CIN in the histology of the cervix, while 62.8% (71/113) of patients with normal cytology had a confirmation of a normal histology (κ = 0.558). Cytology demonstrated a sensitivity and specificity of 87.3 and 71.0%, respectively. The agreement between cervical cytology and histology, considering the presence of CIN, was moderate. Correlations between accuracy and errors of cytology are discussed with therapeutic emphasis. Copyright © 2011 S. Karger AG, Basel.

Clinical study of quantitative diagnosis of early cervical cancer based on the classification of acetowhitening kinetics

NASA Astrophysics Data System (ADS)

Wu, Tao; Cheung, Tak-Hong; Yim, So-Fan; Qu, Jianan Y.

2010-03-01

A quantitative colposcopic imaging system for the diagnosis of early cervical cancer is evaluated in a clinical study. This imaging technology based on 3-D active stereo vision and motion tracking extracts diagnostic information from the kinetics of acetowhitening process measured from the cervix of human subjects in vivo. Acetowhitening kinetics measured from 137 cervical sites of 57 subjects are analyzed and classified using multivariate statistical algorithms. Cross-validation methods are used to evaluate the performance of the diagnostic algorithms. The results show that an algorithm for screening precancer produced 95% sensitivity (SE) and 96% specificity (SP) for discriminating normal and human papillomavirus (HPV)-infected tissues from cervical intraepithelial neoplasia (CIN) lesions. For a diagnostic algorithm, 91% SE and 90% SP are achieved for discriminating normal tissue, HPV infected tissue, and low-grade CIN lesions from high-grade CIN lesions. The results demonstrate that the quantitative colposcopic imaging system could provide objective screening and diagnostic information for early detection of cervical cancer.

Using colposcopy in the rape exam: health care, forensic, and criminal justice issues.

PubMed

Sommers, Marilyn Sawyer; Fisher, Bonnie S; Karjane, Heather M

2005-01-01

In the setting of a forensic examination following rape, colposcopy allows practitioners to identify and photograph genital injury not readily visible to the unaided eye, thereby clarifying the location and extent of injury as well as providing evidence for court proceedings. Since the 1980s, the technique once reserved for victims of child abuse has been used across the lifespan and has been shown to identify genital injury in up to 87% of women who have been raped. The role of colposcopic findings as evidence in court testimony, however, remains controversial. This paper explores the history of colposcopy in the rape exam and describes the epidemiology of genital injury in consensual sex as well as rape.

Risk factors for early cytologic abnormalities after loop electrosurgical excision procedure.

PubMed

Dietrich, Charles S; Yancey, Michael K; Miyazawa, Kunio; Williams, David L; Farley, John

2002-02-01

To evaluate risk factors for early cytologic abnormalities and recurrent cervical dysplasia after loop electrosurgical excision procedure (LEEP). A retrospective analysis was performed of all pathology records for LEEPs performed at our institution from January 1996 through July 1998. Follow-up cytology from 2 through 12 months after LEEP was reviewed. Patients with abnormal cytology were referred for further colposcopic evaluation. Statistical analysis using chi2 test for trend, proportional hazards model test, Fisher exact tests, and life table analysis were performed to identify risk factors for early cytologic abnormalities after LEEP and to determine relative risk of recurrent dysplasia. A total of 298 women underwent LEEP during the study period, and 29% of these had cytologic abnormalities after LEEP. Grade of dysplasia, ectocervical marginal status, endocervical marginal status, and glandular involvement with dysplasia were not found to be independent risk factors for early cytologic abnormalities. However, when risk factors were analyzed cumulatively, the abnormal cytology rate increased from 24% with no risk factors to 67% with three risk factors present (P =.037). Of patients with abnormal cytology after LEEP, 40% developed subsequent dysplasia, and the mean time to diagnosis was approximately 6 months. The relative risk of subsequent dysplasia ranged from a 20% increase to twice the risk if post-LEEP cytology was low-grade squamous intraepithelial lesion or high-grade squamous intraepithelial lesion, respectively. Based on these results, consideration should be given for early colposcopic examination of patients who have evidence of marginal involvement or endocervical glandular involvement with dysplasia. These patients are at increased risk for abnormal cytology and recurrent dysplasia. This initial visit should occur at 6 months, as the mean time to recurrence of dysplasia was 6.5 months.

Management of atypical squamous cells of undetermined significance or low-grade squamous intraepithelial lesions of the uterine cervix with human papilloma virus infection among young women aged less than 25 years.

PubMed

Ryu, Ki-Jin; Lee, Sanghoon; Min, Kyung-Jin; Hong, Jin Hwa; Song, Jae Yun; Lee, Jae Kwan; Lee, Nak Woo

2016-12-01

Current ASCCP guidelines recommend repeat cytology 12 months after HPV-positive results in women aged 21-24 years with either atypical squamous cells of undetermined significance (ASCUS) or a low-grade squamous intraepithelial lesion (LSIL). The purpose of this study was to validate an algorithm in such women with ASCUS or LSIL. A multicenter cross-sectional study was carried out at three academic hospitals involving 40,847 Korean women who underwent cervical cancer screening with cytology and HPV testing with or without subsequent colposcopic biopsies between January 2007 and December 2013. Among a total of 3,193 women with available histopathology data, 762 women with ASCUS and 758 with LSIL were HPV-positive. Among HPV-positive women with ASCUS, 38.5% of women aged 21-24 years had ≥CIN2, compared to 20.8% of women aged 30-65 years and 21.1% of the total women. Among HPV-positive women with LSIL, 25.8% aged 21-24 years had ≥CIN2, compared to 21.2% of women aged 30-65 years and 21.9% of the total women. In HPV-positive women with ASCUS/LSIL aged less than 25 years, the prevalence of ≥CIN2 lesions was 34.5%, which was significantly higher than that (21.0%) in women aged ≥25 years. The risk of ≥CIN2 lesions in HPV-positive Korean women aged 21-24 years with ASCUS or LSIL was not lower than that in older women. Colposcopic examination should be considered for management of HPV-positive young women with ASCUS or LSIL. Diagn. Cytopathol. 2016;44:959-963. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

How to Interpret Thyroid Biopsy Results: A Three-Year Retrospective Interventional Radiology Experience

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

Oppenheimer, Jason D., E-mail: j-oppenheimer@md.northwestern.edu; Kasuganti, Deepa; Nayar, Ritu

2010-08-15

Results of thyroid biopsy determine whether thyroid nodule resection is appropriate and the extent of thyroid surgery. At our institution we use 20/22-gauge core biopsy (CBx) in conjunction with fine-needle aspiration (FNA) to decrease the number of passes and improve adequacy. Occasionally, both ultrasound (US)-guided FNA and CBx yield unsatisfactory specimens. To justify clinical recommendations for these unsatisfactory thyroid biopsies, we compare rates of malignancy at surgical resection for unsatisfactory biopsy results against definitive biopsy results. We retrospectively reviewed a database of 1979 patients who had a total of 2677 FNA and 663 CBx performed by experienced interventional radiologists undermore » US guidance from 2003 to 2006 at a tertiary-care academic center. In 451 patients who had surgery following biopsy, Fisher's exact test was used to compare surgical malignancy rates between unsatisfactory and malignant biopsy cohorts as well as between unsatisfactory and benign biopsy cohorts. We defined statistical significance at P = 0.05. We reported an overall unsatisfactory thyroid biopsy rate of 3.7% (100/2677). A statistically significant higher rate of surgically proven malignancies was found in malignant biopsy patients compared to unsatisfactory biopsy patients (P = 0.0001). The incidence of surgically proven malignancy in unsatisfactory biopsy patients was not significantly different from that in benign biopsy patients (P = 0.8625). In conclusion, an extremely low incidence of malignancy was associated with both benign and unsatisfactory thyroid biopsy results. The difference in incidence between these two groups was not statistically significant. Therefore, patients with unsatisfactory biopsy specimens can be reassured and counseled accordingly.« less

Frequent use of menfegol spermicidal vaginal foaming tablets associated with a high incidence of genital lesions.

PubMed

Goeman, J; Ndoye, I; Sakho, L M; Mboup, S; Piot, P; Karam, M; Belsey, E; Lange, J M; Laga, M; Perriëns, J H

1995-06-01

Menfegol is a spermicide with in vitro activity against human immunodeficiency virus (HIV). A randomized placebo-controlled safety study covered the use of menfegol foaming tablets for 14 days at increasing frequencies of insertion by 125 prostitutes in Dakar, Senegal. The frequencies of colposcopically diagnosed genital lesions were 5.0%, 11.8%, 27.8%, 49.7%, and 29.4% among menfegol recipients when tablets were used once every other day or 1, 2, 4, or 8 times a day, respectively (P < .05). Among placebo recipients, frequencies were 11.1% and 23.5% when tablets were used < 8 times daily and 8 times daily, respectively. There was no association between subjective genital symptoms and the incidence of colposcopically detected lesions. The high incidence of genital lesions when menfegol foaming tablets were used more than once daily suggests that their frequent use should not be recommended to prevent HIV transmission. In use at low frequency, the tablets' toxicity might be balanced by anti-HIV properties. Safety studies on vaginal microbicides should use objective methods, such as colposcopy, to assess the incidence of lesions.

ASCCP Colposcopy Standards: Risk-Based Colposcopy Practice.

PubMed

Wentzensen, Nicolas; Schiffman, Mark; Silver, Michelle I; Khan, Michelle J; Perkins, Rebecca B; Smith, Katie M; Gage, Julia C; Gold, Michael A; Conageski, Christine; Einstein, Mark H; Mayeaux, Edward J; Waxman, Alan G; Huh, Warner K; Massad, L Stewart

2017-10-01

The American Society for Colposcopy and Cervical Pathology (ASCCP) Colposcopy Standards recommendations address the role of and approach to colposcopy for cervical cancer prevention in the United States. The recommendations were developed by an expert working group appointed by ASCCP's Board of Directors. This article describes the rationale, evidence, and recommendations related to risk-based colposcopy practice. Women referred to colposcopy have a wide range of underlying precancer risk, which can be estimated by referral screening tests including cytology and human papillomavirus testing, in conjunction with the colposcopic impression. Multiple targeted biopsies, at least 2 and up to 4, are recommended to improve detection of prevalent precancers. At the lowest end of the risk spectrum, untargeted biopsies are not recommended, and women with a completely normal colposcopic impression can be observed. At the highest end of the risk spectrum, immediate treatment is an alternative to biopsy confirmation. Assessing the risk of cervical precancer at the colposcopy visit allows for modification of colposcopy procedures consistent with a woman's risk. Implementation of these recommendations is expected to lead to improved detection of cervical precancers at colposcopy, while providing more reassurance of negative colposcopy results.

Prognostic relevance of human papillomavirus L1 capsid protein detection within mild and moderate dysplastic lesions of the cervix uteri in combination with p16 biomarker.

PubMed

Hilfrich, Ralf; Hariri, Jalil

2008-04-01

To proof the prognostic relevance of HPV L1 capsid protein detection on colposcopically-guided punch biopsies in combination with p16. Sections of colposcopically-guided punch biopsies from 191 consecutive cases with at least 5 years of follow-up were stained with HPV L1 capsid protein antibodies (Cytoactiv screening antibody) and a monoclonal anti-p16 antibody. Fifty sections were derived from a benign group, 91 from low-grade (cervical intraepithelial neoplasia [CIN 1]) lesions and 50 from high-grade (CIN 2 and 3) lesions. Overall only 16.1% of the 87 L1-negative, p16-positive CIN lesions showed remission of the lesion compared to 72.4% of the double positive cases. None of the L1/p16 double negative CIN lesions progressed. HPV L1 capsid protein detection with Cytoactiv screening antibody seems to be a promising new tool to predict the behavior of HPV-associated (p16-positive) early dysplastic lesions.

Microbiological examination of cold ready-to-eat sliced meats from catering establishments in the United Kingdom.

PubMed

Gillespie, I; Little, C; Mitchell, R

2000-03-01

A microbiological study of cold, ready-to-eat sliced meats from 2579 catering establishments (public houses, hotels, cafés, restaurants, residential homes and other catering premises) found that 2587 of 3494 samples (74%) were of acceptable quality, 892 (26%) were of unsatisfactory quality and 15 (<1%) were of unacceptable quality. Unacceptable results were due to high levels of Escherichia coli, Staphylococcus aureus, Listeria species and/or Clostridium perfringens. Unsatisfactory results were mostly due to high Aerobic Plate Counts. The microbiological quality of cold, ready-to-eat meats was associated with meat type, premises type, management training, hygienic practices, meat supplier and length of storage. The relationship between food hygiene training and microbiological quality is discussed.

Assertiveness and aggressiveness as potential moderators of verbal behaviors following unsatisfactory service.

PubMed

Swanson, Scott R

2007-04-01

This research is an extension of earlier studies that examined Assertiveness and Aggressiveness as potential moderators of verbal intentions. A sample of 127 women and 137 men participated in the survey which used random residential telephone numbers. Respondents ranged in age from 18 to 71 years (M=33.2, SD= 12.4), with men making up 51.9% of the total sample. Those respondents classified as having an Aggressive interaction style were least likely to have discussed their unsatisfactory service encounters. The nature of the verbal communications was negative for all four interaction styles investigated. Similar to previous findings, men and women were equally Assertive, but men were more likely to be Aggressive when engaging in marketplace interactions.

Identifying Gaps in the Performance of Pediatric Trainees Who Receive Marginal/Unsatisfactory Ratings.

PubMed

Li, Su-Ting T; Tancredi, Daniel J; Schwartz, Alan; Guillot, Ann; Burke, Ann; Trimm, R Franklin; Guralnick, Susan; Mahan, John D; Gifford, Kimberly A

2018-01-01

To perform a derivation study to determine in which subcompetencies marginal/unsatisfactory pediatric residents had the greatest deficits compared with their satisfactorily performing peers and which subcompetencies best discriminated between marginal/unsatisfactory and satisfactorily performing residents. Multi-institutional cohort study of all 21 milestones (rated on four or five levels) reported to the Accreditation Council for Graduate Medical Education, and global marginal/unsatisfactory versus satisfactory performance reported to the American Board of Pediatrics. Data were gathered in 2013-2014. For each level of training (postgraduate year [PGY] 1, 2, and 3), mean differences between milestone levels of residents with marginal/unsatisfactory and satisfactory performance adjusted for clustering by program and C-statistics (area under receiver operating characteristic curve) were calculated. A Bonferroni-corrected significance threshold of .0007963 was used to account for multiple comparisons. Milestone and overall performance evaluations for 1,704 pediatric residents in 41 programs were obtained. For PGY1s, two subcompetencies had almost a one-point difference in milestone levels between marginal/unsatisfactory and satisfactory trainees and outstanding discrimination (≥ 0.90): organize/prioritize (0.93; C-statistic: 0.91) and transfer of care (0.97; C-statistic: 0.90). The largest difference between marginal/unsatisfactory and satisfactory PGY2s was trustworthiness (0.78). The largest differences between marginal/unsatisfactory and satisfactory PGY3s were ethical behavior (1.17), incorporating feedback (1.03), and professionalization (0.96). For PGY2s and PGY3s, no subcompetencies had outstanding discrimination. Marginal/unsatisfactory pediatric residents had different subcompetency gaps at different training levels. While PGY1s may have global deficits, senior residents may have different performance deficiencies requiring individualized counseling and targeted performance improvement plans.

Low back pain at school: unique risk deriving from unsatisfactory grade in maths and school-type recommendation.

PubMed

Erne, Cordula; Elfering, Achim

2011-12-01

Psychosocial stress and pain may relate to educational selection. At the end of primary school (International Standard Classification of Education: ISCED level 1) children are recommended for one of three performance-based lower secondary level types of school (ISCED level 2). The study examines the association of educational selection and other risk factors with pain in the upper back (UBP), lower back pain (LBP), peripheral (limb) pain (PP), and abdominal pain (AP). Teacher reports of unsatisfactory grades in mathematics, and official school-type recommendation are included as objective psychosocial risk factors. One hundred and ninety-two schoolchildren, aged between 10 and 13 from 11 classes of 7 schools in Switzerland participated in the cross-sectional study. In logistic regression analysis, predictor variables included age, sex, BMI, participation in sport, physical mobility, weight of satchel, hours of daily TV, video, and computer use, pupils' back pain reported by the mother and father, psychosocial strain, unsatisfactory grade in mathematics, and school-type recommendation. Analysis of pain drawings was highly reliable and revealed high prevalence rates of musculoskeletal pain in the last 4 weeks (UBP 15.3%, LBP 13:8%, PP 33.9%, AP 20.1%). Psychosocial risk factors were uniquely significant predictors of UBP (psychosocial strain), LBP (psychosocial strain, unsatisfactory grade in mathematics, school-type recommendation), and AP (school-type recommendation). In conclusion, selection in terms of educational school system was uniquely associated with LBP in schoolchildren. Stress caused by educational selection should be addressed in primary prevention of musculoskeletal pain in schoolchildren.

[Colonic perforation during colonoscopy. 100 cases].

PubMed

Hureau, J; Avtan, L; Germain, M; Blanc, D; Chaussade, G

1992-01-01

The analysis of 100 cases of colon perforation during colposcopic examinations highly demonstrates such a statement. The perforation risk during colposcopies is generally of the order of 0.2% for a diagnosis coloscopy. According to the statistic data used, it can reach 0.5 to 3% in therapy coloscopy. This is a risk inherent to the technique used. It is thus required to analyse the causes and take the appropriate measures to reduce it to a minimum. Mortality due to such a complication remains high (14%), i.e about 0.015 to 0.1% (#2/10000) of all colposcopies. In 11% of the patients, serious sequelae are to be observed. This demonstrates the significance of the medico-legal problem set by these perforations during colposcopies. The whole personnel responsibility can be involved: colposcopist, surgeon, anesthetist and hospital unit.

In Response to Rowland on "Realism and Debateability in Policy Advocacy."

ERIC Educational Resources Information Center

Herbeck, Dale A.; Katsulas, John P.

1986-01-01

Argues that Robert Rowland has overstated the case against the permutation process for assessing counterplan competitiveness. Claims that the permutation standard is a viable method for ascertaining counterplan competitiveness. Examines Rowland's alternative and argues that it is an unsatisfactory method for determining counterplan…

A Critical Review of Leadership Concepts and Research: The Implications for Educational Administration.

ERIC Educational Resources Information Center

Watkins, Peter

This monograph critiques the literature on organizational and educational leadership, asserting that traditional approaches are unsatisfactory in their own right and within the existing positivist-functionalist paradigm. After outlining problems in defining leadership, the paper critically examines the "trait" approach, particularly…

Initial clinical testing of a multi-spectral imaging system built on a smartphone platform

NASA Astrophysics Data System (ADS)

Mink, Jonah W.; Wexler, Shraga; Bolton, Frank J.; Hummel, Charles; Kahn, Bruce S.; Levitz, David

2016-03-01

Multi-spectral imaging systems are often expensive and bulky. An innovative multi-spectral imaging system was fitted onto a mobile colposcope, an imaging system built around a smartphone in order to image the uterine cervix from outside the body. The multi-spectral mobile colposcope (MSMC) acquires images at different wavelengths. This paper presents the clinical testing of MSMC imaging (technical validation of the MSMC system is described elsewhere 1 ). Patients who were referred to colposcopy following abnormal screening test (Pap or HPV DNA test) according to the standard of care were enrolled. Multi-spectral image sets of the cervix were acquired, consisting of images from the various wavelengths. Image acquisition took 1-2 sec. Areas suspected for dysplasia under white light imaging were biopsied, according to the standard of care. Biopsied sites were recorded on a clockface map of the cervix. Following the procedure, MSMC data was processed from the sites of biopsied sites. To date, the initial histopathological results are still outstanding. Qualitatively, structures in the cervical images were sharper at lower wavelengths than higher wavelengths. Patients tolerated imaging well. The result suggests MSMC holds promise for cervical imaging.

Cervical collagen imaging for determining preterm labor risks using a colposcope with full Mueller matrix capability

NASA Astrophysics Data System (ADS)

Stoff, Susan; Chue-Sang, Joseph; Holness, Nola A.; Gandjbakhche, Amir; Chernomordik, Viktor; Ramella-Roman, Jessica

2016-02-01

Preterm birth is a worldwide health issue, as the number one cause of infant mortality and neurological disorders. Although affecting nearly 10% of all births, an accurate, reliable diagnostic method for preterm birth has, yet, to be developed. The primary constituent of the cervix, collagen, provides the structural support and mechanical strength to maintain cervical closure, through specific organization, during fetal gestation. As pregnancy progresses, the disorganization of the cervical collagen occurs to allow eventual cervical pliability so the baby can be birthed through the cervical opening. This disorganization of collagen affects the mechanical properties of the cervix and, if the changes occur prematurely, may be a significant factor leading to preterm birth. The organization of collagen can be analyzed through the use of Mueller Matrix Polarimetric imaging of the characteristic birefringence of collagen. In this research, we have built a full Mueller Matrix Polarimetry attachment to a standard colposcope to enable imaging of human cervixes during standard prenatal exams at various stages of fetal gestation. Analysis of the polarimetric images provides information of quantity and organization of cervical collagen at specific gestational stages of pregnancy. This quantitative information may provide an indication of risk of preterm birth.

9 CFR 113.452 - Erysipelothrix Rhusiopathiae Antibody.

Code of Federal Regulations, 2010 CFR

2010-01-01

... die from erysipelas within 7 days post-challenge, the test is invalid. All dead mice shall be examined... found unsatisfactory by a prescribed test shall not be released. (a) Each serial shall meet the applicable general requirements provided in § 113.450. (b) Potency test. Bulk or final container samples of...

Strike Four! Do-Over Policies Institutionalize GPA Distortion

ERIC Educational Resources Information Center

Marx, Jonathan; Meeler, David

2013-01-01

Purpose: The aim of this paper is to illustrate how universities play an institutional role in inflating student grade point averages (GPA) by modifying academic polices such as course withdraw, repeats, and satisfactory/unsatisfactory grade options. Design/methodology/approach: Three research strategies are employed: an examination of eight…

The Relationship between Music and Visual Arts Formal Study and Academic Achievement on the Eighth-Grade Louisiana Educational Assessment Program (LEAP) Test

ERIC Educational Resources Information Center

Baker, Richard Allen, Jr.

2011-01-01

The purpose of this study was to examine the policy implications allowing administrators to exempt a student from required arts instruction if the student obtained unsatisfactory scores on the high-stake state mandated tests in English and mathematics. This study examined English language arts and math test scores for 37,222 eighth grade students…

Microbiological examination of ready-to-eat burgers sampled anonymously at the point of sale in the United Kingdom.

PubMed

Little, C L; Gillespie, I A; Mitchell, R T

2001-12-01

During May and June 1999 a microbiological study of ready-to-eat burgers purchased anonymously from burger outlets (combined take-away and burger restaurants, take-away-only fixed premises, mobile vendors, temporary stalls and other burger outlets) was undertaken. The intention was to determine the microbiological quality of ready-to-eat burgers as purchased by customers of take-away premises and to ascertain, where information was available, whether the Chief Medical Officer's advice on cooking burgers was being followed. Examination of 3,128 ready-to-eat burgers found that 2,868 (92%) were of acceptable quality and 260 (8%) were of unsatisfactory quality. Unsatisfactory results were mostly due to high aerobic colony counts (ACCs). Salmonella spp., Campylobacter spp. and Escherichia coli O157 were not detected in any of the samples examined. Acceptable microbiological quality of ready-to-eat burgers was associated with outlets, such as combined take-away and burger restaurants and in particular national franchise outlets, which had management food hygiene training and hazard analysis in place. Poor microbiological quality was associated with undercooking and local outlets as indicated by Local Authority Inspectors' Consumers at Risk scores.

Microarray detection of human papilloma virus genotypes among Turkish women with abnormal cytology at a colposcopy unit

PubMed Central

Uzun Çilingir, Işıl; Bengisu, Ergin; Ağaçfidan, Ali; Koksal, Muammer Osman; Topuz, Samet; Berkman, Sinan; İyibozkurt, Ahmet Cem

2013-01-01

Objective: There is a well-known association between human papilloma virus (HPV) and cervical neoplasia. The aim of this study was to investigate the types of HPV DNA and to compare the results with colposcopic findings among women with abnormal cytology. Material and Methods: A series of 76 consecutive women attending the clinic with the usual referral indications (ASC-US or higher in Pap) were examined by the conventional diagnostic tools (PAP smear, colposcopy,punch biopsy) and subjected to HPV testing. For HPV genotyping, we used a commercially avaliable HPV DNA chip (Genomica-CLART) which is a PCR based microarray system.The HPV test detected 35types of HPV (HPV-6/-11/-16/-18/-26/-31/-33/-35/-39/-40/-42/-43/-44/-45/-51/-52/-53/-54/-56/-58/-59/-61/-62/-66/-70/-71/-72/-73/-81/-83/84/-85/-89). Results: Overall, 44.7% of all patients were HPV positive. HPV was positive in 35%, 51.9%, 77.7% of the ASCUS, LSIL and HSIL groups respectively and HPV 16 was the most prevalent type in all groups. 6 %of patients had mutiple infections. 57.8% of biopsy proven SIL’s were HPV positive. The most prevalent HPV type was HPV 16 (54.5%).Colposcopic assessment revealed pathologic findings in 94.7% of biopsy proven SIL cases. Conclusion: Although it has been reported that the prevalence of HPV in the general population is lower than Western countries, and the prevalence and distribution of genotypes are smilar in patients with abnormal cytology. Further population based studies are needed to determine the prevalance and type distribution of HPV with normal and abnormal cytology in Turkish women. Despite the new technological progress in HPV virion, colposcopy is still very important diagnostic tool in the management of abnormal smears. PMID:24592066

CO2 laser surgery for vulvar intraepithelial neoplasia. Excisional, destructive and combined techniques.

PubMed

Penna, Carlo; Fallani, M Grazia; Fambrini, Massimiliano; Zipoli, Elisa; Marchionni, Mauro

2002-11-01

To evaluate CO2 laser excision, vaporization and combined techniques for treatment of vulvar intraepithelial neoplasia (VIN). Thirty-nine cases of VIN 3, 15 cases of VIN 2 and 9 of VIN 1, for a total of 63 patients with histologically proven VIN, underwent laser excision or vaporization under colposcopic guidance, using local anesthesia, in an outpatient setting or after day-surgery admission. Clinical aspects, cervical intraepithelial neoplasia (CIN) and vaginal intraepithelial neoplasia (VaIN) association, types of CO2 laser treatment, follow-up, recurrences and second treatments were evaluated. Twenty-seven (41.3%) patients underwent laser vaporization, and 37 (58.7%) with VIN 3, underwent laser excision or the combined technique. Colposcopic and biopsy examinations of patients with VIN revealed three cases of CIN 3 and nine cases of VaIN 3; two patients had concomitant VIN 3, CIN 3 and VaIN 3. Local anesthesia, using 2% carbocaine, and outpatient or day-surgery treatments were possible in all cases. A small incidence of intraoperative complications (4.8%) and absence of postoperative complications were observed. A single session was curative in 76.9% of patients treated with laser vaporization and in 78.4% of those treated with laser excision. Eleven cases of recurrent VIN and two cases of invasive vulvar carcinoma were observed during follow-up. A second laser procedure was carred out in all cases of relapsed VIN, with an overall cure rate of 96.8% after two treatments. Radical vulvectomy associated with inguinal-femoral lymphadenectomy was performed in the two cases of invasive carcinoma. CO2 laser surgery permits treatment of VIN in an outpatient or day-surgery setting under local anesthesia with excellent cosmetic and functional results. The treatment can also be adjusted to the patient's specific needs, with the possibility of calibrating the depth of the vaporized and removed tissues. Excisional treatment is the preferred method because it permits histologic evaluation of the excised tissue and detection of possible occult early invasion.

Improvements in estimating proportions of objects from multispectral data

NASA Technical Reports Server (NTRS)

Horwitz, H. M.; Hyde, P. D.; Richardson, W.

1974-01-01

Methods for estimating proportions of objects and materials imaged within the instantaneous field of view of a multispectral sensor were developed further. Improvements in the basic proportion estimation algorithm were devised as well as improved alien object detection procedures. Also, a simplified signature set analysis scheme was introduced for determining the adequacy of signature set geometry for satisfactory proportion estimation. Averaging procedures used in conjunction with the mixtures algorithm were examined theoretically and applied to artificially generated multispectral data. A computationally simpler estimator was considered and found unsatisfactory. Experiments conducted to find a suitable procedure for setting the alien object threshold yielded little definitive result. Mixtures procedures were used on a limited amount of ERTS data to estimate wheat proportion in selected areas. Results were unsatisfactory, partly because of the ill-conditioned nature of the pure signature set.

Triage of the abnormal Papanicolaou smear in pregnancy.

PubMed

Apgar, B S; Zoschnick, L B

1998-06-01

Triage of the abnormal Papanicolaou smear in pregnancy requires colposcopic evaluation and directed biopsy. If histologic cervical intraepithelial neoplasia is confirmed, the patient can be managed with observations and can be re-evaluated in the postpartum period. If evidence of microinvasion is present, conization must be performed. For patients with invasive disease, a delay in therapy until fetal maturity is achieved does not compromise survival.

Locus of Control, Self-Reported Depression, and Perceived Causes of Depression

ERIC Educational Resources Information Center

Calhoun, Lawrence G.; And Others

1974-01-01

Examines the relation of depression to locus of control and to the perceived causes of depression in a nonpsychiatric population. Findings suggest that adolescent females tend to hold themselves more responsible than males for unsatisfactory personal situations, and this extends to the attribution of causes for unhappy moods. (Author/PC)

Rural Schools in Developing Countries: A Case of Donon Manga in Eastern Tandjile in Chad

ERIC Educational Resources Information Center

Ndoutorlengar, Médard; Djangrang, Man-na; Mamgue, Bassinang; Yongsi, H. B. Nguendo; Groza, Octavian

2014-01-01

The schools in rural areas in developing countries are often confronted with difficulties which are, in general, related to poverty, the quantitative and qualitative insufficiency of the professionals and the organization. Consequently, every year, the examinations results are unsatisfactory playing on the curriculum and excellence in the…

Participant recruitment and motivation for participation in optical technology for cervical cancer screening research trials.

PubMed

Shuhatovich, Olga M; Sharman, Mathilde P; Mirabal, Yvette N; Earle, Nan R; Follen, Michele; Basen-Engquist, Karen

2005-12-01

In order to improve recruitment for cervical cancer screening trials, it is necessary to analyze the effectiveness of recruitment strategies used in current trials. A trial to test optical spectroscopy for the diagnosis of cervical neoplasia recruited 1000 women from the community; the trial evaluated the emerging technology against Pap smears and colposcopically directed biopsies for cervical dysplasia. We have examined women's reasons for participating as well as the effectiveness and efficiency for each recruitment strategy. Reasons for participation were identified and compared between trials. The recruitment method that resulted in the most contacts was newspaper reportorial coverage and advertising, followed by family and friends, then television news coverage. The most cost-effective method for finding eligible women who attend the research appointment is word of mouth from a family member or friend. Recommendations are given for maximizing the efficiency of recruitment for cervical cancer screening trials.

Optoelectronic method for detection of cervical intraepithelial neoplasia and cervical cancer

NASA Astrophysics Data System (ADS)

Pruski, D.; Przybylski, M.; Kędzia, W.; Kędzia, H.; Jagielska-Pruska, J.; Spaczyński, M.

2011-12-01

The optoelectronic method is one of the most promising concepts of biophysical program of the diagnostics of CIN and cervical cancer. Objectives of the work are evaluation of sensitivity and specificity of the optoelectronic method in the detection of CIN and cervical cancer. The paper shows correlation between the pNOR number and sensitivity/specificity of the optoelectronic method. The study included 293 patients with abnormal cervical cytology result and the following examinations: examination with the use of the optoelectronic method — Truscreen, colposcopic examination, and histopathologic biopsy. Specificity of the optoelectronic method for LGSIL was estimated at 65.70%, for HGSIL and squamous cell carcinoma of cervix amounted to 90.38%. Specificity of the optoelectronic method used to confirm lack of cervical pathology was estimated at 78.89%. The field under the ROC curve for the optoelectronic method was estimated at 0.88 (95% CI, 0.84-0.92) which shows high diagnostic value of the test in the detection of HGSIL and squamous cell carcinoma. The optoelectronic method is characterised by high usefulness in the detection of CIN, present in the squamous epithelium and squamous cell carcinoma of cervix.

Microbiological quality of take-away cooked rice and chicken sandwiches: effectiveness of food hygiene training of the management.

PubMed

Little, C L; Barnes, J; Mitchell, R T

2002-12-01

During August 2001 a microbiological study of ready-to-eat cooked rice from take-aways and of chicken sandwiches made on the premises from sandwich bars was undertaken. The intention was to identify risk factors in the production, storage and handling of cooked rice and sandwiches, and to establish their effect on microbiological quality. Examination of cooked rice revealed that the majority of samples (87%; 442 of 508) were of satisfactory/acceptable microbiological quality; 50 (10%) were unsatisfactory, and 16 (3%) were of unacceptable quality due to Bacillus cereus and/or other Bacillus spp in excess of 10(5) cfu/g. The microbiological quality of cooked rice was associated with cuisine type (p < 0.00001), rice type (p < 0.01), cooking (p < 0.01), serving methods (p < 0.00001), and management food hygiene training (p < 0.01). Examination of chicken sandwiches found that most (75%; 335 of 449) were of satisfactory/acceptable microbiological quality and 114 (25%) were unsatisfactory. Acceptable microbiological quality of sandwiches was associated with sandwich bars that had hazard analysis in place (p < 0.05). Smaller businesses, as indicated by Local Authority Inspectors' Consumer at Risk scores, were more likely to have samples classified as unsatisfactory or unacceptable compared to larger businesses (p < 0.001). The majority (90%) of premises had hand-washing facilities accessible and available for use, although only over half (55%) were correctly used as judged by the sampling officer. Where the manager of the premises had received some form of food hygiene training, food safety procedures such as the hazard analysis system were more likely to be in place (p < 0.0001).

Management of ASCUS findings in Papanicolaou smears. A retrospective study.

PubMed

Iavazzo, C; Boutas, I; Grigoriadis, C; Vrachnis, N; Salakos, N

2012-01-01

Atypical squamous cells of undetermined significance (ASCUS) are a cervical cytologic finding category suggestive but not definitive of squamous intraepithelial lesions. ASCUS remains an incompletely described entity and accounts for even 5%-10% of reported Papanicolaou (Pap) smears. The management of women with such cytologic findings remains controversial. The aim of this study was to evaluate the cytology laboratory findings with regards to ASCUS diagnosis, using cervical Pap smears, and colposcopic biopsies, as well as their management. This is a retrospective study of patients with ASCUS Pap smears taken during the period January 2010 - December 2010 in the Second Department of Obstetrics and Gynecology, Aretaieion Hospital. During the study period, 657 Pap smears were examined at the Aretaieion Hospital; moreover, seven patients, whose Pap smears were cytologically diagnosed with ASCUS, were referred from other clinics, providing a total of 42 cases with a descriptive diagnosis of ASCUS for review. Of the 42 cases, eight were not studied because they were either lost in follow-up or they did not have available data. The remaining 34/42 patients were evaluated by colposcopic examination and directed biopsies where necessary. The ratio of ASCUS to low-grade squamous intraepithelial lesion (LGSIL), high-grade squamous cell intraepithelial lesion (HGSIL) or squamous cell carcinoma (SCC) was 5/34, 1/34, and 0/34, respectively. In the 34 ASCUS cases evaluated by colposcopy, the age distribution varied from 22 to 54 years. Eight of 34 cases did not have a child, 7/34 were primigravida, 18/34 were secondi-gravida, and 1/34 had four children. Four out of 34 cases were postmenopausal, 3/34 referred no history of abnormal bleeding, 21/34 were smokers, 6/34 used oral contraceptives, 2/34 used intrauterine devices, 1/34 took replacement of hormones, 4/34 had prior abnormal Pap smears human papillomavirus (HPV), or 1/34 had previous cancer (breast cancer). Colposcopy was inconclusive in 4/34 patients, while 8/34 cases were negative for Schiller and acetic acid tests and also had normal colposcopy. Infectious organisms were found in 8/34 patients with ASCUS, including actinomyces (1/8), trichomonas (5/8), and candida albicans (2/8). Histologic tests revealed 16/34 koilocytosis cases, 5/34 LGSIL, 1/34 HGSIL, and 0/34 SCC. The dilemma in the management of patients with an ASCUS diagnosis still exists as a significant problem for clinicians.

Application of laser technology in treatment of diseases of the external genitals

NASA Astrophysics Data System (ADS)

Wilczak, Maciej; Wozniak, Jakub; Sajdak, Stefan; Opala, Tomasz; Rabiega, Dorota

2000-11-01

Lasersurgery is the very profitable method of treatment of diseases of external sexual organs, with regard to high efficiency and little relapses. Lasersurgery is recommended especially for pregnant women considering possibility of physiological childbirth. We prefer laser CO2 in connexion with colposcope in treatment of diseases of external sexual organs. The application of this method is limited by the high cost of equipment.

In vivo Diagnosis of Cervical Intraepithelial Neoplasia Using 337-nm- Excited Laser-Induced Fluorescence

NASA Astrophysics Data System (ADS)

Ramanujam, N.; Mitchell, M. F.; Mahadevan, A.; Warren, S.; Thomsen, S.; Silva, E.; Richards-Kortum, R.

1994-10-01

Laser-induced fluorescence at 337-nm excitation was used in vivo to differentiate neoplastic [cervical intraepithelial neoplasia (CIN)], nonneoplastic abnormal (inflammation and human papilloma viral infection), and normal cervical tissues. A colposcope (low-magnification microscope used to view the cervix with reflected light) was used to identify 66 normal and 49 abnormal (5 inflammation, 21 human papilloma virus infection, and 23 CIN) sites on the cervix in 28 patients. These sites were then interrogated spectroscopically. A two-stage algorithm was developed to diagnose CIN. The first stage differentiated histologically abnormal tissues from colposcopically normal tissues with a sensitivity, specificity, and positive predictive value of 92%, 90%, and 88%, respectively. The second stage differentiated preneoplastic and neoplastic tissues from nonneoplastic abnormal tissues with a sensitivity, specificity, and positive predictive value of 87%, 73%, and 74%, respectively. Spectroscopic differences were consistent with a decrease in the absolute contribution of collagen fluorescence, an increase in the absolute contribution of oxyhemoglobin attenuation, and an increase in the relative contribution of reduced nicotinamide dinucleotide phosphate [NAD(P)H] fluorescence as tissue progresses from normal to abnormal in the same patient. These results suggest that in vivo fluorescence spectroscopy of the cervix can be used to diagnose CIN at colposcopy.

Real-Time Monitoring and Evaluation of a Visual-Based Cervical Cancer Screening Program Using a Decision Support Job Aid.

PubMed

Peterson, Curtis W; Rose, Donny; Mink, Jonah; Levitz, David

2016-05-16

In many developing nations, cervical cancer screening is done by visual inspection with acetic acid (VIA). Monitoring and evaluation (M&E) of such screening programs is challenging. An enhanced visual assessment (EVA) system was developed to augment VIA procedures in low-resource settings. The EVA System consists of a mobile colposcope built around a smartphone, and an online image portal for storing and annotating images. A smartphone app is used to control the mobile colposcope, and upload pictures to the image portal. In this paper, a new app feature that documents clinical decisions using an integrated job aid was deployed in a cervical cancer screening camp in Kenya. Six organizations conducting VIA used the EVA System to screen 824 patients over the course of a week, and providers recorded their diagnoses and treatments in the application. Real-time aggregated statistics were broadcast on a public website. Screening organizations were able to assess the number of patients screened, alongside treatment rates, and the patients who tested positive and required treatment in real time, which allowed them to make adjustments as needed. The real-time M&E enabled by "smart" diagnostic medical devices holds promise for broader use in screening programs in low-resource settings.

Image processing and machine learning techniques to automate diagnosis of Lugol's iodine cervigrams for a low-cost point-of-care digital colposcope

NASA Astrophysics Data System (ADS)

Asiedu, Mercy Nyamewaa; Simhal, Anish; Lam, Christopher T.; Mueller, Jenna; Chaudhary, Usamah; Schmitt, John W.; Sapiro, Guillermo; Ramanujam, Nimmi

2018-02-01

The world health organization recommends visual inspection with acetic acid (VIA) and/or Lugol's Iodine (VILI) for cervical cancer screening in low-resource settings. Human interpretation of diagnostic indicators for visual inspection is qualitative, subjective, and has high inter-observer discordance, which could lead both to adverse outcomes for the patient and unnecessary follow-ups. In this work, we a simple method for automatic feature extraction and classification for Lugol's Iodine cervigrams acquired with a low-cost, miniature, digital colposcope. Algorithms to preprocess expert physician-labelled cervigrams and to extract simple but powerful color-based features are introduced. The features are used to train a support vector machine model to classify cervigrams based on expert physician labels. The selected framework achieved a sensitivity, specificity, and accuracy of 89.2%, 66.7% and 80.6% with majority diagnosis of the expert physicians in discriminating cervical intraepithelial neoplasia (CIN +) relative to normal tissues. The proposed classifier also achieved an area under the curve of 84 when trained with majority diagnosis of the expert physicians. The results suggest that utilizing simple color-based features may enable unbiased automation of VILI cervigrams, opening the door to a full system of low-cost data acquisition complemented with automatic interpretation.

A noval approach to monitoring pathogen progression during uterine and placental infection in the mare using biophotonic imaging technology and lux modified bacteria

USDA-ARS?s Scientific Manuscript database

Uterine and placental infections are the leading cause of abortion, stillbirth, and preterm delivery in the mare. Whereas uterine and placental infections in women have been studied extensively, a comprehensive examination of the pathogenic processes leading to this unsatisfactory pregnancy outcome ...

Does Documenting the Regulation Process on a Blog Enhance Pre-Service Teachers' Self- and Co-Regulation in a Collaborative Project?

ERIC Educational Resources Information Center

Cho, Moon-Heum; Lim, Seongmi; Lee, Kyeonghwa

2017-01-01

Students often complain about unsatisfactory experiences resulting from disproportionate contributions to collaborative projects. To improve the experience, we applied regulation theory to design a process to document regulation on a blog and examined whether such documentation enhanced students' self-regulation and co-regulation skills while…

Principals' Human Capital Development Practices for Enhancing Staff Personnel Administration in Secondary Schools in Oyo State, Nigeria

ERIC Educational Resources Information Center

Chidi, Nnebedum; Victor, Akinfolarin Akinwale

2017-01-01

Unsatisfactory performance of secondary school students in external examinations in Oyo State seems to suggest lapses in principals' application of human capital development practices especially in the areas of training and mentoring of teachers to enhance instructional delivery. This unpleasant state of affair necessitated the researchers to…

Emergences and Affordances as Opportunities to Develop Teachers' Mathematical Content Knowledge

ERIC Educational Resources Information Center

Julie, Cyril

2014-01-01

Teachers' mathematical content knowledge has been under scrutiny for some time. This development is in the wake of learners' unsatisfactory performance in national examinations and international achievement tests. A widely held belief is that one, if not the most important, of the efforts to improve and enhance the performance and…

38 CFR 21.364 - Unsatisfactory conduct and cooperation.

Code of Federal Regulations, 2010 CFR

2010-07-01

... AFFAIRS (CONTINUED) VOCATIONAL REHABILITATION AND EDUCATION Vocational Rehabilitation and Employment Under... or revised) is suitable to such veteran's abilities, aptitudes, and interests. (b) Unsatisfactory...

Unsatisfactory Glucose Management and Adverse Pregnancy Outcomes of Gestational Diabetes Mellitus in the Real World of Clinical Practice: A Retrospective Study.

PubMed

Feng, Ru; Liu, Lu; Zhang, Yuan-Yuan; Yuan, Zhong-Shang; Gao, Ling; Zuo, Chang-Ting

2018-05-05

Facing the increasing prevalence of gestational diabetes mellitus (GDM), this study aimed to evaluate the management of GDM and its association with adverse pregnancy outcomes. The data of 996 inpatients with GDM who terminated pregnancies in our hospital from January 2011 to December 2015 were collected. Treatments during pregnancy and the last hospital admission before delivery were analyzed. Pregnancy outcomes of the GDM patients were compared with 996 nondiabetic subjects matched by delivery year and gestational age. The association between fasting plasma glucose (FPG) and adverse pregnancy outcomes was examined by logistic regression analyses. The average prevalence of GDM over the 5 years was 4.4% (1330/30,191). Within the GDM patients, 42.8% (426/996) received dietary intervention, whereas 19.1% (190/996) received insulin treatment. Adverse outcomes were more likely to occur in patients with unsatisfactory control of blood glucose such as respiratory distress syndrome (RDS, χ 2 = 13.373, P < 0.01). Elevated FPG was identified as an independent risk factor for premature birth (odds ratio [OR] = 1.460, P < 0.001), neonatal care unit admission (OR = 1.284, P < 0.001), RDS (OR = 1.322, P = 0.001), and stillbirth (OR = 1.427, P < 0.001). Management of GDM in the real world of clinical practice was unsatisfactory, which might have contributed to adverse pregnancy outcomes.

Evaluation of Glycemic Control, Lifestyle and Clinical Characteristics in Patients with Type 2 Diabetes Treated at King Abdullah University Hospital in Jordan.

PubMed

Al-Eitan, Laith N; Nassar, Ahmad M; Saadeh, Nesreen A; Almomani, Basima A

2016-12-01

The study aimed to assess glycemic control in a Jordanian population with type 2 diabetes and to explore the sociodemographic, clinical and medication-related factors as well as the anthropometric indexes and laboratory values associated with and possibly contributing to unsatisfactory glycemic control. We included 237 patients previously diagnosed as having type 2 diabetes. Data were collected through direct interviews. Sociodemographic and clinical details were collected using a questionnaire designed for the purpose of the study, anthropometric measurements were obtained at the time of the interviews, and laboratory data were extracted from the medical records of King Abdullah University Hospital. Of the participants, 60.8% were found to have unsatisfactory glycemic control (glycated hemoglobin levels ≥7%). Unsatisfactory glycemic control was associated with younger ages at diabetes diagnosis, higher mean weights and higher prevalences of diabetic neuropathy. No relationships were found among glycemic control and body mass index, waist circumference or central obesity. Patients with adequate control were more likely to have health insurance and to have hypothyroidism as a comorbidity. Insulin use and medication plans containing insulin were associated with unsatisfactory control. Patients with unsatisfactory control had higher mean levels of low-density lipoproteins and triglycerides and lower mean levels of high-density lipoproteins. Moreover, elevated triglycerides (≥150 mg/dL) and dyslipidemia were associated with unsatisfactory glycemic control. More than half of the participants had unsatisfactory glycemic control, highlighting the need for a change in the approach and strategies used for patients with diabetes in Jordan. Factors associated with glycemic control that were found in this study should be further studied and used in the prevention and management of diabetes. Copyright © 2016 Canadian Diabetes Association. Published by Elsevier Inc. All rights reserved.

Endoscopic carpal tunnel release: a prospective analysis of factors associated with unsatisfactory results.

PubMed

Straub, T A

1999-04-01

The first 100 consecutive cases of endoscopic carpal tunnel release (ECTR) performed by the author were studied prospectively during 6 to 24 months follow-up. Various preoperative and postoperative factors were subjected to statistical analysis to determine possible associations with unsatisfactory results. Overall, 92% of hands had a satisfactory result from ECTR, although not all were rendered symptom-free. There were no significant complications. Preoperative factors associated with an increased likelihood of unsatisfactory results included hands with preoperative weakness, widened two-point discrimination, myofascial pain syndrome or fibromyalgia, involvement in litigation, multiple compressive neuropathies, or the presence of abnormal psychological factors. A trend to less satisfactory results was present in Workers' Compensation cases and patients with normal motor latencies on nerve conduction studies. Multiple postoperative factors correlated with unsatisfactory results.

The microbiological examination of ready-to-eat organic vegetables from retail establishments in the United Kingdom.

PubMed

Sagoo, S K; Little, C L; Mitchell, R T

2001-12-01

A microbiological study of uncooked ready-to-eat organic vegetables was undertaken to determine the microbiological quality of these vegetables on retail sale in the UK. Organic vegetables were collected and examined according to a standardized protocol. The majority (3185 of 3200; 99.5%) of samples were found to be of satisfactory/acceptable quality whilst only 15 (0.5%) were of unsatisfactory quality. Unsatisfactory results were due to Escherichia coli and Listeria spp. (not L. monocytogenes) levels in excess of 102 cfu g-1. The absence of pathogens (L. monocytogenes, Salmonella, Campylobacter and E. coli O157) and the low incidence (1.5%) of E. coli and Listeria spp. associated with these organic vegetables indicates that overall agricultural, hygiene, harvesting and production practices were good. There has been a significant expansion of the UK organic market since 1998/99. Of the various commodity sectors making up the organic market, fruit and vegetables is the largest sector and this has been reflected in an increased interest in their microbiological safety. This is the first study to provide information on the microbiological quality of organic vegetables.

Unsatisfactory Performance: How California's K-12 Education System Protects Mediocrity and How Teacher Quality Can Be Improved.

ERIC Educational Resources Information Center

Dawson, Thomas C.; Billingsley, K. Lloyd

This study examines the quality of California's K-12 education, discussing how the system protects mediocrity and how to improve educational quality in the state. It explains that what most ails the teaching force is that excellent teachers are not rewarded for superior work, and failing teachers are rarely held accountable for poor performance.…

The Industry Commission inquiry into charitable organisations.

PubMed

Suter, K

1996-01-01

The Industry Commission has carried out Australia's largest inquiry into charities. It was, from the point of view of charities, an unsatisfactory operation, all the more so since it was not clear why the task had been given to the commission. This article examines the commission's work in three ways: the overall relationship between government and charities; the commission's proposed major reforms; and the minor reforms.

Rationale and development of an on-line quality assurance programme for colposcopy in a population-based cervical screening setting in Italy.

PubMed

Bucchi, Lauro; Cristiani, Paolo; Costa, Silvano; Schincaglia, Patrizia; Garutti, Paola; Sassoli de Bianchi, Priscilla; Naldoni, Carlo; Olea, Oswaldo; Sideri, Mario

2013-06-28

Colposcopy, the key step in the management of women with abnormal Pap smear results, is a visual technique prone to observer variation, which implies the need for prolonged apprenticeship, continuous training, and quality assurance (QA) measures. Colposcopy QA programmes vary in level of responsibility of organizing subjects, geographic coverage, scope, model, and type of actions. The programmes addressing the clinical standards of colposcopy (quality of examination and appropriateness of clinical decisions) are more limited in space and less sustainable over time than those focused on the provision of the service (resources, accessibility, etc.). This article reports on the protocol of a QA programme targeting the clinical quality of colposcopy in a population-based cervical screening service in an administrative region of northern Italy. After a situation analysis of local colposcopy audit practices and previous QA initiatives, a permanent web-based QA programme was developed. The design places more emphasis on providing education and feedback to participants than on testing them. The technical core is a log-in web application accessible on the website of the regional Administration. The primary objectives are to provide (1) a practical opportunity for retraining of screening colposcopists, and (2) a platform for them to interact with colposcopists from other settings and regions through exchange and discussion of digital colposcopic images. The retraining function is based on repeated QA sessions in which the registered colposcopists log-in, classify a posted set of colpophotographs, and receive on line a set of personal feedback data. Each session ends with a plenary seminar featuring the presentation of overall results and an interactive review of the test set of colpophotographs. This is meant to be a forum for an open exchange of views that may lead to more knowledge and more diagnostic homogeneity. The protocol includes the criteria for selection of colpophotographs and the rationale for colposcopic gold standards. This programme is an ongoing initiative open to further developments, in particular in the area of basic training. It uses the infrastructure of the internet to give a novel solution to technical problems affecting colposcopy QA in population-based screening services.

Evaluation of hygiene practices in catering premises at large-scale events in the UK: identifying risks for the Olympics 2012.

PubMed

Willis, C; Elviss, N; Aird, H; Fenelon, D; McLauchlin, J

2012-08-01

To investigate hygiene practices of caterers at large events in order to: support the production of guidance on catering at such events; to compare hygiene standards at weekends with other times in the week; and to learn lessons in preparation for the London Olympics in 2012. UK-wide study of caterers at large events, including questionnaires on hygiene procedures and microbiological examination of food, water and environmental samples. In total, 1364 samples of food, water, surface swabs and cloths were collected at 139 events, by local authority sampling officers, and transported to laboratories for microbiological analysis. Eight percent of food samples were of an unsatisfactory quality, and a further 2% contained potentially hazardous levels of Bacillus spp. A significantly higher proportion of unsatisfactory food samples were taken from vendors without adequate food safety procedures in place. Fifty-two percent of water samples, 38% of swabs and 71% of cloths were also unsatisfactory. The majority of samples (57%) were collected on Saturdays, Sundays or bank holidays. Environmental swab results were significantly poorer at weekends compared with other days of the week. This study reinforces the fact that food hygiene is a continuing cause for concern in mobile vendors, and indicates a need for an ongoing programme of training and monitoring of caterers in preparation for the London Olympics. Copyright © 2012 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

[Local treatment of cervical intraepithelial neoplasia with a 5 percent fluorouracil ointment].

PubMed

Barten, G

1987-01-01

The results of treatment of histologically proven cervical intraepithelial neoplasia (CIN) in 10 women are described. Two of them had CIN I and 8 CIN III. All patients had a application of 5 g 5 per cent 5-fluorouracil cream in a cervical cup daily over a period of 12 hours for one week. All 10 patients have been examined colposcopically, cytological and by biopsy following therapy. In 8 women cone biopsie were done 6-12 months afterwards for having a final diagnosis 2 patients having CIN I pretherapeutically were follow up for 16 months with cytology, colposcopy and punch biopsy. In 6 cases we found better findings (Twice complete healing, twice only CIN I and twice CIN II as residues). In 4 cases severe dysplasia and carcinoma in situ could be found in endocervix. Based on these results were recommended more (not only one) treatment cycles for local efficient chemotherapy using 5 per cent 5-fluorouracil cream.

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

Not Available

This report summarizes lessons learned to date by the transit industry regarding four major types of strategic initiatives aimed to improving productivity or cost-effectiveness of public-transit services. Successful policies to reduce absenteeism are recorded; most combine incentives for improved attendance and disciplinary measures for unsatisfactory performance. Part-time labor is examined as a means to reduce labor costs. Competitive selection of bus service providers--examines the productivity and cost-effectiveness implications of increased service competition. The fourth strategy concerns the better targeting of supply to demand. The final chapter in the report addresses how the suggested actions might be implemented.

FAA's alleged unsatisfactory coordination and improper fund control of occupational safety and health programs

DOT National Transportation Integrated Search

1997-01-27

This report responds to a complaint received by the Office of Inspector : General (OIG), Department of Transportation, concerning unsatisfactory program coordination and budget control activities between the Federal Aviation Administration (FAA), Off...

Cytological surveillance compared with immediate referral for colposcopy in management of women with low grade cervical abnormalities: multicentre randomised controlled trial.

PubMed

2009-07-28

To examine the effectiveness of cytological surveillance in primary care compared with immediate referral for colposcopic examination in women with low grade abnormal results on cervical cytology tests. Multicentre individually randomised controlled trial. NHS cervical screening programmes in Grampian, Tayside, and Nottingham. 4439 women, aged 20-59, with a cytology result showing borderline nuclear abnormalities or mild dyskaryosis, October 1999-October 2002. Cytological screening every six months in primary care (n=2223) or referral for colposcopy and related interventions (n=2216). All women were followed for three years, concluding with an exit appointment at which colposcopic examination was undertaken. Colposcopists assessing outcome at this appointment were blinded to randomisation. Primary end point: cumulative incidence of cervical intraepithelial neoplasia grade II or more severe disease. Other end points: cervical intraepithelial neoplasia grade III or worse, clinically significant anxiety and depression, other self reported after effects, and rates of non-attendance. Analysis was by intention to treat; all those randomised were included. The cumulative incidence of cervical intraepithelial neoplasia grade II or worse was 79 per 1000 person years in the colposcopy arm and 58 per 1000 person years in the cytological surveillance arm (relative risk 1.37, 95% confidence interval 1.19 to 1.57). This difference was less marked for cervical intraepithelial neoplasia grade III or more severe disease, but the incidence was still higher in the colposcopy arm (relative risk 1.26, 1.04 to 1.53). Among women randomised to immediate colposcopy, 79% (74.9% to 82.5%) of cases of cervical intraepithelial neoplasia grade II or worse were diagnosed at the time of the immediate colposcopy, while among women randomised to cytological surveillance, 77% (72.1% to 81.2%) of cases were detected by surveillance cytology and related interventions. Similar proportions of women were anxious or depressed in the two arms. A higher proportion of women in the colposcopy arm reported after effects, and these were of longer duration and more severe. Non-attendance was low in both arms. The more marked difference between the arms in the occurrence of cervical intraepithelial neoplasia grade II or worse than in the occurrence of grade III or worse can probably be accounted for by the spontaneous regression of some cases of grade II neoplasia. Compared with cytological surveillance, a policy of immediate colposcopy detects more cervical intraepithelial neoplasia grade II or worse, and some more grade III or worse, but might lead to overtreatment. Such a policy is associated with a higher rate of reported after effects, which are more severe and of longer duration than those associated with cytological surveillance. ISRCTN 34841617.

Toward a Definition of Learning Disability.

ERIC Educational Resources Information Center

Campbell, Paul B.

The paper summarizes several approaches to the identification of learning disability and then discusses the nature of learning disability in the context of competing hypotheses as possible explanations of insufficient or unsatisfactory achievement. Because learning disability may only be inferred as a cause of unsatisfactory learning, the…

42 CFR 493.845 - Standard; Toxicology.

Code of Federal Regulations, 2012 CFR

2012-10-01

... acceptable responses for each analyte in each testing event is unsatisfactory analyte performance for the... testing event. (e)(1) For any unsatisfactory analyte or test performance or testing event for reasons... any unacceptable analyte or testing event score, remedial action must be taken and documented, and the...

42 CFR 493.851 - Standard; Hematology.

Code of Federal Regulations, 2014 CFR

2014-10-01

... acceptable responses for each analyte in each testing event is unsatisfactory analyte performance for the... testing event. (e)(1) For any unsatisfactory analyte or test performance or testing event for reasons... any unacceptable analyte or testing event score, remedial action must be taken and documented, and the...

42 CFR 493.843 - Standard; Endocrinology.

Code of Federal Regulations, 2013 CFR

2013-10-01

... acceptable responses for each analyte in each testing event is unsatisfactory analyte performance for the... testing event. (e)(1) For any unsatisfactory analyte or test performance or testing event for reasons... any unacceptable analyte or testing event score, remedial action must be taken and documented, and the...

42 CFR 493.845 - Standard; Toxicology.

Code of Federal Regulations, 2014 CFR

2014-10-01

... acceptable responses for each analyte in each testing event is unsatisfactory analyte performance for the... testing event. (e)(1) For any unsatisfactory analyte or test performance or testing event for reasons... any unacceptable analyte or testing event score, remedial action must be taken and documented, and the...

42 CFR 493.845 - Standard; Toxicology.

Code of Federal Regulations, 2013 CFR

2013-10-01

... acceptable responses for each analyte in each testing event is unsatisfactory analyte performance for the... testing event. (e)(1) For any unsatisfactory analyte or test performance or testing event for reasons... any unacceptable analyte or testing event score, remedial action must be taken and documented, and the...

42 CFR 493.851 - Standard; Hematology.

Code of Federal Regulations, 2013 CFR

2013-10-01

... acceptable responses for each analyte in each testing event is unsatisfactory analyte performance for the... testing event. (e)(1) For any unsatisfactory analyte or test performance or testing event for reasons... any unacceptable analyte or testing event score, remedial action must be taken and documented, and the...

42 CFR 493.843 - Standard; Endocrinology.

Code of Federal Regulations, 2012 CFR

2012-10-01

... acceptable responses for each analyte in each testing event is unsatisfactory analyte performance for the... testing event. (e)(1) For any unsatisfactory analyte or test performance or testing event for reasons... any unacceptable analyte or testing event score, remedial action must be taken and documented, and the...

42 CFR 493.843 - Standard; Endocrinology.

Code of Federal Regulations, 2014 CFR

2014-10-01

... acceptable responses for each analyte in each testing event is unsatisfactory analyte performance for the... testing event. (e)(1) For any unsatisfactory analyte or test performance or testing event for reasons... any unacceptable analyte or testing event score, remedial action must be taken and documented, and the...

42 CFR 493.851 - Standard; Hematology.

Code of Federal Regulations, 2012 CFR

2012-10-01

... acceptable responses for each analyte in each testing event is unsatisfactory analyte performance for the... testing event. (e)(1) For any unsatisfactory analyte or test performance or testing event for reasons... any unacceptable analyte or testing event score, remedial action must be taken and documented, and the...

[Pallidal and subthalamic stimulation in Parkinson's disease: lessons from the unsatisfactory results].

PubMed

2001-01-01

Deep brain stimulation is being widely used in advanced Parkinson's disease (PD). Outcome determinants are not known. Some relevant data about outcome may be obtained from the study of patients with unsatisfactory results. We have retrospectively analyzed the number and causes of unsatisfactory results (insufficient improvement 6 months after the intervention) in 211 patients. Forty patients (18.9%) experienced an unsatisfactory result. Inadequate clinical selection by advanced age, abnormal MRI and levodopa unresponsive symptoms was the main cause in 28 cases. In 11 patients a misplacement of the electrode was reported. In 2 cases no cause was identified. Thirty-four out of the 40 patients corresponded to the early experience of the teams involved in the study. We conclude that the main factors responsible for a negative outcome are related to the inadequate clinical selection of the patients and the incorrect placement of the electrode. The experience of the team may also be a key factor.

The acetic acid test in evaluation of subclinical genital papillomavirus infection: a comparative study on penoscopy, histopathology, virology and scanning electron microscopy findings.

PubMed Central

Wikström, A; Hedblad, M A; Johansson, B; Kalantari, M; Syrjänen, S; Lindberg, M; von Krogh, G

1992-01-01

OBJECTIVES--To evaluate colposcopic criteria in acetowhite lesions of the penis ("penoscopy") for the diagnosis of subclinical genitoanal papillomavirus infection (GPVI) compared with histopathological criteria of HPV involvement and to various hybridisation assays for HPV DNA detection, and to depict typical lesions by scanning electron microscopy. DESIGN--The study included 101 randomly selected male partners of females with known GPVI, or with penile symptoms such as itching, burning and dyspareunia who did not exhibit overt genital warts but appeared to be afflicted with acetowhite penile lesions after topical application of 5% acqueous acetic acid. Lesions were judged by penoscopy as either typical, conspicuous or nontypical for underlying HPV infection. Biopsy specimens from 91 men were examined by light microscopy and by either Southern blot (SB), polymerase chain reaction (PCR) and/or in situ hybridisation (ISH) assays for the presence of HPV DNA of the HPV types 6, 11, 16, 18, 31, 33 and 42 (Group A). From another ten men lesions clinically typical for GPVI were also examined topographically by scanning electronic microscopy (Group B). SETTING--The STD out-patient clinic of the Department of Dermatovenereology of Karolinska Hospital, Stockholm, Sweden. RESULTS--Group A Seventy eight (86%) of the biopsied lesions met the penoscopy criteria of being either typical of or conspicuous for GVPI. The agreement between penoscopy and histopathology was fairly good, as HPV diagnosis was made by both methods in 56 (62%) of the cases. The reliability of applying strict colposcopic hallmarks was further substantiated by the finding that 55 (60%) of the biopsy specimens taken from penoscopically typical/conspicuous lesions contained HPV DNA. However, there are diagnostic pitfalls for the acetic acid test. Coexistence of an eczematoid reaction with changes indicative of HPV influence was detected in six (7%) of the cases, while an inflammatory response only occurred in 17 (19%) of the specimens. Additional histopathological diagnoses (normal epithelium, lichen sclerosus et atrophicus, balanitis circinata parakeratotica, verruca plana) were established in another eight (9%) of the cases. Among the HPV DNA positive cases, all of the HPV types tested for were detected with the exception of HPV 18. A severe penile intraepithelial neoplasia (PIN III) was revealed in five (5%) of biopsies; HPV 16 was present in two and HPV 42 in one of these biopsy specimens. GROUP B--Scanning electron microscopy depiction harmonised with the penoscopy findings showing that subclinical GPVI characteristically exhibits a well demarcated, slightly elevated border and that the central area of lesions often displays a "groove" in which the epithelium appears to be thin with protrusions from beneath that probably represent capillaries. CONCLUSION--Use of the acetic acid test for evaluation of GPVI should be combined with a colposcopic evaluation based on strict topographic hallmarks, followed by a directed biopsy for light microscopic evaluation. We found that the positive predictive value of colposcopy was as high when correlated with histopathological findings (72%) as when virological methods were used, whether HPV DNA hybridisation testing was performed with the well established SB and ISH assays (45%), or by applying the newly introduced and highly sensitive PCR assay as well (71%). False positivity from the acetic acid test occurs and is mainly due to inflammatory conditions but also to the presence of other conditions. Epithelial fissures are evidently associated with some subclinical GPVI lesions and may potentially represent loci minores for infectious stimuli and perhaps facilitate the transmission of some blood-borne STDs. We prose that the term "papillomavirus balanoposthitis" should be used for penile HPV infection associated with inflammatory responses. Our study indicates that PIN III frequently occurs in a subclinical form and may be associated with not only previously identified "high-risk" HPV types such as type 16, but also with the HPV type 42 that has not previously been considered as oncogenic. Images PMID:1316310

Age-related changes in the diagnostic assessment of women with severe cervical lesions.

PubMed

Giannella, L; Fodero, C; Boselli, F; Mfuta, K; Rubino, T; Prandi, S

2015-01-01

To evaluate the effect of age on the diagnostic assessment of women with severe cervical intraepithelial neoplasia (CIN). This retrospective observational study included 338 consecutive women with a diagnosis of CIN3 on cone specimen. Patients were divided into three groups according to age: < 35 years (Group A), 35-49 years (Group B), and ≥ 50 years (Group C). Clinical and colposcopic variables were compared, and human papillomavirus (HPV) genotype distribution was measured. The most common HPV genotype was HPV-16 (63.65%), followed by HPV-33 (7%), HPV-18 (6.2%), and HPV-31 (5.4%). The rate of the following high-grade lesion predictors was lower in Group C than in Groups A and B: HPV-16 infections (55.9% vs. 75% vs. 70.9%, respectively, p = 0.022); high-grade colposcopic impression (29.4% vs. 51.8% vs. 51.7%, respectively, p < 0.0001); and high-grade cytological changes (30.9% vs. 56.2% vs. 45.4%, respectively, p = 0.025). An endocervical lesion location was more frequent in Group C than in Groups A and B (55.6% vs. 6.8% vs. 11.8%, respectively, p < 0.0001). Women aged 50 years and older with CIN3 showed a significant reduction of high-grade lesion predictors along with physiological confounding cervical changes (transformation zone type 3 and endocervical lesion location). The diagnostic work-up of cervical lesions in older women should provide their potential consideration as a special population.

The Colposcopic Atlas of Schistosomiasis in the Lower Female Genital Tract Based on Studies in Malawi, Zimbabwe, Madagascar and South Africa

PubMed Central

Norseth, Hanne M.; Ndhlovu, Patricia D.; Kleppa, Elisabeth; Randrianasolo, Bodo S.; Jourdan, Peter M.; Roald, Borghild; Holmen, Sigve D.; Gundersen, Svein G.; Bagratee, Jayanthilall; Onsrud, Mathias; Kjetland, Eyrun F.

2014-01-01

Background Schistosoma (S.) haematobium is a neglected tropical disease which may affect any part of the genital tract in women. Female genital schistosomiasis (FGS) may cause abnormal vaginal discharge, contact bleeding, genital tumours, ectopic pregnancies and increased susceptibility to HIV. Symptoms may mimic those typical of sexually transmitted infections (STIs) and women with genital schistosomiasis may be incorrectly diagnosed. An expert consensus meeting suggested that the following findings by visual inspection should serve as proxy indicators for the diagnosis of schistosomiasis of the lower genital tract in women from S. haematobium endemic areas: sandy patches appearing as (1) single or clustered grains or (2) sandy patches appearing as homogenous, yellow areas, or (3) rubbery papules. In this atlas we aim to provide an overview of the genital mucosal manifestations of schistosomiasis in women. Methodology/Principal findings Photocolposcopic images were captured from women, between 1994 and 2012 in four different study sites endemic for S. haematobium in Malawi, Zimbabwe, South Africa and Madagascar. Images and specimens were sampled from sexually active women between 15 and 49 years of age. Colposcopic images of other diseases are included for differential diagnostic purposes. Significance This is the first atlas to present the clinical manifestations of schistosomiasis in the lower female genital tract. It will be freely available for online use, downloadable as a presentation and for print. It could be used for training purposes, further research, and in clinical practice. PMID:25412334

The colposcopic atlas of schistosomiasis in the lower female genital tract based on studies in Malawi, Zimbabwe, Madagascar and South Africa.

PubMed

Norseth, Hanne M; Ndhlovu, Patricia D; Kleppa, Elisabeth; Randrianasolo, Bodo S; Jourdan, Peter M; Roald, Borghild; Holmen, Sigve D; Gundersen, Svein G; Bagratee, Jayanthilall; Onsrud, Mathias; Kjetland, Eyrun F

2014-01-01

Schistosoma (S.) haematobium is a neglected tropical disease which may affect any part of the genital tract in women. Female genital schistosomiasis (FGS) may cause abnormal vaginal discharge, contact bleeding, genital tumours, ectopic pregnancies and increased susceptibility to HIV. Symptoms may mimic those typical of sexually transmitted infections (STIs) and women with genital schistosomiasis may be incorrectly diagnosed. An expert consensus meeting suggested that the following findings by visual inspection should serve as proxy indicators for the diagnosis of schistosomiasis of the lower genital tract in women from S. haematobium endemic areas: sandy patches appearing as (1) single or clustered grains or (2) sandy patches appearing as homogenous, yellow areas, or (3) rubbery papules. In this atlas we aim to provide an overview of the genital mucosal manifestations of schistosomiasis in women. Photocolposcopic images were captured from women, between 1994 and 2012 in four different study sites endemic for S. haematobium in Malawi, Zimbabwe, South Africa and Madagascar. Images and specimens were sampled from sexually active women between 15 and 49 years of age. Colposcopic images of other diseases are included for differential diagnostic purposes. This is the first atlas to present the clinical manifestations of schistosomiasis in the lower female genital tract. It will be freely available for online use, downloadable as a presentation and for print. It could be used for training purposes, further research, and in clinical practice.

Analysis of the causes of surgery-related medical disputes in Taiwan: Need for acute care surgeons to improve quality of care.

PubMed

Hu, Yi-Hsuan; Wang, Chien-Ying; Huang, Mu-Shun; Lee, Chen-Hsen; Wen, Yi-Szu

2016-11-01

This study investigated surgery-related medical disputes and analyzed disease etiologies and the main causes of disputes in order to identify key points for the purpose of improving the quality of surgical patient care in Taiwan. Reports on all surgery-related cases appraised by the Taiwan Witness Examiner Committee of the Department of Health between 2004 and 2008 were reviewed retrospectively by three senior physicians from the emergency department who specialize in both trauma and emergency general surgery. The causes of the various medical disputes were categorized under the following descriptions: operation- or procedure-related complication, anesthesia complication, inappropriate management or decision, delayed diagnosis or misdiagnosis, and unsatisfactory result. A total of 154 cases were reviewed, of which 39 were trauma-related and 115 were disease-related. The two leading causes of disputes in this review were found to be operation- or procedure-related complications (35.7%) and unsatisfactory results (31.8%), followed by delayed diagnoses or misdiagnoses, inappropriate management, and anesthesia complications. Among these, 74 cases (48.1%) required the care of an acute care surgeon and 40 cases (26.0%) required emergency general surgery intervention. Surgery- or procedure-related complications and unsatisfactory treatment results constituted the major causes of medical disputes in Taiwan. The majority of these cases involved acute care surgery; thus, the establishment of an acute care surgery system should be considered to improve patient care. The management of hemorrhagic shock and incarcerated hernia should be reinforced in future medical training. Copyright © 2016. Published by Elsevier Taiwan LLC.

Surrogacy: ill-conceived rights.

PubMed

Willmott, Lindy

2002-11-01

Despite the fact that altruistic surrogacy arrangements occur in Australia, the law does not adequately regulate many important aspects of such arrangements. Failure to regulate surrogacy leaves infertile couples contemplating such treatment, as well as clinics dealing with them, in an unsatisfactory position. This article examines the law that operates in Australian States and Territories (and the problems associated with them) as well as in New Zealand, the United Kingdom and some United States jurisdictions, considers whether the argument against surrogacy arrangements can be legitimately sustained in modern times, and examines some regulatory regimes that seem to be working satisfactorily elsewhere in the world.

19 CFR 148.37 - Replacement of unsatisfactory articles acquired abroad.

Code of Federal Regulations, 2010 CFR

2010-04-01

... customs matters and was without willful intent to avoid CBP supervision. (b) Procedure for replacement... 19 Customs Duties 2 2010-04-01 2010-04-01 false Replacement of unsatisfactory articles acquired abroad. 148.37 Section 148.37 Customs Duties U.S. CUSTOMS AND BORDER PROTECTION, DEPARTMENT OF HOMELAND...

19 CFR 148.37 - Replacement of unsatisfactory articles acquired abroad.

Code of Federal Regulations, 2013 CFR

2013-04-01

... customs matters and was without willful intent to avoid CBP supervision. (b) Procedure for replacement... 19 Customs Duties 2 2013-04-01 2013-04-01 false Replacement of unsatisfactory articles acquired abroad. 148.37 Section 148.37 Customs Duties U.S. CUSTOMS AND BORDER PROTECTION, DEPARTMENT OF HOMELAND...

19 CFR 148.37 - Replacement of unsatisfactory articles acquired abroad.

Code of Federal Regulations, 2014 CFR

2014-04-01

... customs matters and was without willful intent to avoid CBP supervision. (b) Procedure for replacement... 19 Customs Duties 2 2014-04-01 2014-04-01 false Replacement of unsatisfactory articles acquired abroad. 148.37 Section 148.37 Customs Duties U.S. CUSTOMS AND BORDER PROTECTION, DEPARTMENT OF HOMELAND...

19 CFR 148.37 - Replacement of unsatisfactory articles acquired abroad.

Code of Federal Regulations, 2011 CFR

2011-04-01

... customs matters and was without willful intent to avoid CBP supervision. (b) Procedure for replacement... 19 Customs Duties 2 2011-04-01 2011-04-01 false Replacement of unsatisfactory articles acquired abroad. 148.37 Section 148.37 Customs Duties U.S. CUSTOMS AND BORDER PROTECTION, DEPARTMENT OF HOMELAND...

19 CFR 148.37 - Replacement of unsatisfactory articles acquired abroad.

Code of Federal Regulations, 2012 CFR

2012-04-01

... customs matters and was without willful intent to avoid CBP supervision. (b) Procedure for replacement... 19 Customs Duties 2 2012-04-01 2012-04-01 false Replacement of unsatisfactory articles acquired abroad. 148.37 Section 148.37 Customs Duties U.S. CUSTOMS AND BORDER PROTECTION, DEPARTMENT OF HOMELAND...

9 CFR 114.15 - Disposal of unsatisfactory products and byproducts.

Code of Federal Regulations, 2010 CFR

2010-01-01

... production purposes, all carcasses (part or whole) of production or test animals, and any undesirable... 9 Animals and Animal Products 1 2010-01-01 2010-01-01 false Disposal of unsatisfactory products and byproducts. 114.15 Section 114.15 Animals and Animal Products ANIMAL AND PLANT HEALTH INSPECTION...

Persistent infection with high-risk human papilloma viruses: cohort study, Mérida, Venezuela

PubMed Central

Téllez, Luis; Michelli, Elvia; Mendoza, José Andrés; Vielma, Silvana; Noguera, María-Eugenia; Callejas, Diana; Cavazza, María; Correnti, María

2015-01-01

Cervical lesions have been associated with infection by high-risk human papilloma virus (high-risk HPV). In 409 women aged >15 years high-risk HPV lesions were identified. In a cohort of this population persistent infection was compared with cytological, colposcopic, and histological lesions. Cervical scrapes were taken and DNA was isolated. HPV was detected by PCR in the E6/E7 region. Genotyping was performed by PCR nested multiple E6/E7. HPV was detected in a 37.40% (153/409), high-risk HPV in 86% (153/178), HPV18 46.64% (83/178), HPV16 34.28% (61/178). Among these 53.93% (96/178) were multiple infections, and HPV18/16 (30/96) was the most frequent 31.25%. The cytology showed changes in 15% of positive patients. A 49.67% in women positive for HPV infection showed abnormalities in the colposcopic study, a relationship that turned out to be statistically significant ( p < 0.0019 test χ2). Among all 85% of the women were younger than 45 years of age. Fifty-seven patients were evaluated 15 months after the base study, with initial prevalence of morbidity 49.12% (28/57) and at the end 10.53% (6/57), showing in 89.29% (25/28) negative for HR-HPV infection, 10.34% (3/28) showed persistence of infection, 17.54% (10/57) presented cytological alterations, with 80% of positivity for HPV, and a regression of 100% (10/10) of the previously identified lesions. With colposcopy, 50% (14/28) presented alterations related to HPV, of these 85.71% (12/14) showed regression of such an alteration. The cumulative incidence for HPV was 10.34% (3/29). The incidence rate was 4.23% (3/71), which is equal to 4.23 new cases of HPV infection per 100 people, per year of follow-up. In conclusion, the present work shows a high frequency of infection by high-risk HPV, with predominance of HPV18 and 16 and in general for multiple infections. Colposcopy was better predictor than the Pap smear for infection. The follow-up study revealed a low percentage of persistent infection, and a high frequency of negativity for viral infection, high regression of cytological and colposcopic lesions, a low cumulative and incidence rate similar to that reported by other Latin American countries and higher than the European countries. PMID:26557877

Reflex Human Papillomavirus Test Results as an Option for the Management of Korean Women With Atypical Squamous Cells Cannot Exclude High-Grade Squamous Intraepithelial Lesion

PubMed Central

Ryu, Ki-Jin; Lee, Sanghoon; Min, Kyung-Jin; Kim, Jae Won; Hong, Jin Hwa; Song, Jae Yun; Lee, Jae Kwan

2015-01-01

Background. Current guidelines recommend initial colposcopy with biopsy regardless of human papillomavirus (HPV) test results in women with atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion (ASC-H). The purpose of this study was to evaluate the value of HPV testing in women with ASC-H based on colposcopic pathology results. Materials and Methods. A multicenter cross-sectional study was carried out at three academic hospitals and involved 40,847 Korean women who underwent cervical cancer screening with cytology and HPV tests with or without subsequent colposcopic biopsies between January 2007 and December 2013. Results. ASC-H was diagnosed in 276 women (0.7%). Only 6 of 68 (8.8%) women with ASC-H who were HPV negative had cervical intraepithelial neoplasia grade ≥2 (CIN ≥2) lesions, whereas 47.4% of the women with ASC-H who were HPV positive had CIN ≥2 lesions. No cases of invasive cervical cancer were diagnosed among women with ASC-H who were HPV negative. Logistic regression analysis was performed using the group with normal Papanicolaou test results and HPV-negative status as the reference group. Women with ASC-H who were HPV positive had a significantly increased risk of CIN ≥2 lesions, whereas no significant increase was observed in patients with ASC-H and HPV-negative status. Conclusion. If the result of the HPV test was negative, the risk of CIN ≥2 lesions in Korean women with ASC-H cytology was low. Reflex HPV testing should be an option for the management of women with cytology showing ASC-H to decrease unnecessary colposcopic biopsies, which are expensive and invasive. Implications for Practice: Current American Society for Colposcopy and Cervical Pathology guidelines recommend universal colposcopy for the management of women with atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion (ASC-H) on cytology, regardless of human papillomavirus (HPV) test results. The present study suggested that HPV cotesting in patients with ASC-H cytology can provide more detailed and useful information regarding the risk of high-grade cervical intraepithelial neoplasia (CIN) lesions and the need for further treatment. When the result of the HPV test was negative, the risk of CIN lesions of grade ≥2 in women with ASC-H cytology was low. Consequently, reflex HPV testing, rather than immediately performance of invasive and expensive colposcopy with biopsy, should be an option for the management of women with ASC-H. PMID:25964305

Design and preliminary analysis of a vaginal inserter for speculum-free cervical cancer screening

PubMed Central

Agudogo, Júlia; Krieger, Marlee S.; Miros, Robert; Proeschold-Bell, Rae Jean; Schmitt, John W.; Ramanujam, Nimmi

2017-01-01

Objective Cervical cancer screening usually requires use of a speculum to provide a clear view of the cervix. The speculum is one potential barrier to screening due to fear of pain, discomfort and embarrassment. The aim of this paper is to present and demonstrate the feasibility of a tampon-sized inserter and the POCkeT Colposcope, a miniature pen sized-colposcope, for comfortable, speculum-free and potentially self-colposcopy. Study design We explored different designs using 3D computer-aided design (CAD) software and performed mechanical testing simulations on each. Designs were rapid prototyped and tested using a custom vaginal phantom across a range of vaginal pressures and uterine tilts to select an optimal design. Two final designs were tested with fifteen volunteers to assess cervix visualization, comfort and usability compared to the speculum and the optimal design, the curved-tip inserter, was selected for testing in volunteers. Results We present a vaginal inserter as an alternative to the standard speculum for use with the POCkeT Colposcope. The device has a slim tubular body with a funnel-like curved tip measuring approximately 2.5 cm in diameter. The inserter has a channel through which a 2 megapixel (MP) mini camera with LED illumination fits to enable image capture. Mechanical finite element testing simulations with an applied pressure of 15 cm H2O indicated a high factor of safety (90.9) for the inserter. Testing of the device with a custom vaginal phantom, across a range of supine vaginal pressures and uterine tilts (retroverted, anteverted and sideverted), demonstrated image capture with a visual area comparable to the speculum for a normal/axial positioned uteri and significantly better than the speculum for anteverted and sideverted uteri (p<0.00001). Volunteer studies with self-insertion and physician-assisted cervix image capture showed adequate cervix visualization for 83% of patients. In addition, questionnaire responses from volunteers indicated a 92.3% overall preference for the inserter over the speculum and all indicated that the inserter was more comfortable than the speculum. The inserter provides a platform for self-cervical cancer screening and also enables acetic acid/Lugol’s iodine application and insertion of swabs for Pap smear sample collection. Conclusion This study demonstrates the feasibility of an inserter and miniature-imaging device for comfortable cervical image capture of women with potential for synergistic HPV and Pap smear sample collection. PMID:28562669

77 FR 64759 - Rescission of 10-Day Agency Discretionary Period in Assigning Unsatisfactory Safety Ratings

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-23

... hazardous materials carriers must cease operation after receiving a proposed unsatisfactory safety rating... Carrier Safety Act of 1990 (1990 Act) (section 15 of the Sanitary Food Transportation Act of 1990, Pub. L. 101-500, 104 Stat. 1218) amended the Hazardous Materials Transportation Act to prohibit motor carriers...

42 CFR 493.859 - Standard; ABO group and D (Rho) typing.

Code of Federal Regulations, 2013 CFR

2013-10-01

... attain a score of at least 100 percent of acceptable responses for each analyte or test in each testing event is unsatisfactory analyte performance for the testing event. (b) Failure to attain an overall.... (2) For any unacceptable analyte or unsatisfactory testing event score, remedial action must be taken...

42 CFR 493.859 - Standard; ABO group and D (Rho) typing.

Code of Federal Regulations, 2012 CFR

2012-10-01

... attain a score of at least 100 percent of acceptable responses for each analyte or test in each testing event is unsatisfactory analyte performance for the testing event. (b) Failure to attain an overall.... (2) For any unacceptable analyte or unsatisfactory testing event score, remedial action must be taken...

42 CFR 493.859 - Standard; ABO group and D (Rho) typing.

Code of Federal Regulations, 2014 CFR

2014-10-01

... attain a score of at least 100 percent of acceptable responses for each analyte or test in each testing event is unsatisfactory analyte performance for the testing event. (b) Failure to attain an overall.... (2) For any unacceptable analyte or unsatisfactory testing event score, remedial action must be taken...

Frequency of unsatisfactory cervical cytology smears in cancer screening of Japanese women: A systematic review and meta-analysis.

PubMed

Hosono, Satoyo; Terasawa, Teruhiko; Katayama, Takafumi; Sasaki, Seiju; Hoshi, Keika; Hamashima, Chisato

2018-04-01

The Bethesda system (TBS) has been used for cervical cytological diagnosis in Japan since 2008. Evaluation of specimen adequacy is the most important aspect of quality assurance and for precise diagnosis in TBS. A systematic review and meta-analysis were carried out to assess the unsatisfactory specimen rate in the primary cervical cancer screening setting in Japan. Ovid Medline and Ichushi-Web databases were searched from inception through to May 2017. Prospective and retrospective studies that reported the proportion of unsatisfactory specimens in healthy asymptomatic Japanese women in a cervical cancer screening program were eligible for inclusion; 17 studies were included in the meta-analysis. The random-effects model meta-analysis calculated summary estimates of the unsatisfactory rate of 0.60% (95% confidence interval [CI], 0.18-1.96%; I 2 = 99%) for conventional cytology and 0.04% (95% CI, 0.00-0.35%; I 2 = 99%) for liquid-based cytology (LBC). However, comparative results between conventional and liquid-based cytology, based on four direct and nine comparative studies, showed no significant difference (summary odds ratio = 3.5 × 10 -2 favoring LBC [95% CI, 6.9 × 10 -4 -1.7]; I 2 = 98%). In the subgroup analyses and meta-regressions, use of non-cotton devices for conventional cytology and use of a particular platform for LBC were associated with lower unsatisfactory rates. Meta-regression also suggested chronological improvement in unsatisfactory rates for both tests. In Japanese cervical cancer screening programs, conventional cytology remains prevalent. Future research needs to focus on evaluating the impact of screening programs using LBC by comparing the accuracy, performance, and cost-effectiveness with conventional cytology in the Japanese population. © 2018 The Authors. Cancer Science published by John Wiley & Sons Australia, Ltd on behalf of Japanese Cancer Association.

Estimating climate sensitivity from paleo-data.

NASA Astrophysics Data System (ADS)

Crowley, T. J.; Hegerl, G. C.

2003-12-01

For twenty years estimates of climate sensitivity from the instrumental record have neen between about 1.5-4.5° C for a doubling of CO2. Various efforts, most notably by J. Hansen, and M. Hoffert and C. Covey. have been made to test this range against paleo-data for the ice age and Cretaceous, yielding approximately the same range with a "best guess" sensitivity of about 2.0-3.0° C. Here we re-examine this issue with new paleo-data and also include information for the time period 1000-present. For this latter interval formal pdfs can for the first time be calculated for paleo data. Regardless of the time interval examined we generally find that paleo-sensitivities still fall within the range of about 1.5-4.5° C. The primary impediments to more precise determinations involve not only uncertainties in forcings but also the paleo reconstructions. Barring a dramatic breakthrough in reconciliation of some long-standing differences in the magnitude of paleotemperature estimates for different proxies, the range of paleo-sensitivities will continue to have this uncertainty. This range can be considered either unsatisfactory or satisfactory. It is unsatisfactory because some may consider it insufficiently precise. It is satisfactory in the sense that the range is both robust and entirely consistent with the range independently estimated from the instrumental record.

Is colposcopy necessary at twelve months after large loop excision of the transformation zone? A clinical audit.

PubMed

Thompson, Valerie; Marin, Raymond

2013-12-01

The purpose of this study was to review outcomes from LLETZ (large loop excision of the transformation zone) procedures carried out for high-grade cervical intraepithelial neoplasia (CIN), in particular findings at colposcopy, cytology and HR-HPV(high-risk human papilloma virus) result to assess whether colposcopy provides any additional information in the management of women at 12 months. We retrospectively analysed 252 patients who had a LLETZ procedure for a HSIL (high-grade squamous intraepithelial lesion) between January 2005 and December 2010. Eighty per cent of women who had a LLETZ procedure for HSIL were reviewed in our colposcopy clinic at 12 months after the procedure. Colposcopy at 12 months after LLETZ was documented as unsatisfactory for 30% of these women. The sensitivity of colposcopy at 12 months after LLETZ was 0.47, and the specificity was 0.95. Colposcopy examination is an insensitive tool for detection of persisting HPV-related change after excision of high-grade CIN. Its usefulness to investigate persistent or recurrent HSIL is further reduced by the high rate of unsatisfactory colposcopy examinations after a LLETZ procedure. Papanicolaou smear and HRHPV tests may be adequate follow-up at 12 months after LLETZ for women at low risk of recurrence of HSIL. © 2013 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

Comparison of Keyes Punch Biopsy Instrument with Cervical Punch Biopsy Forceps for Diagnosing Cervical Lesions.

PubMed

Tyagi, Natasha; Suneja, Amita; Mishra, Kiran; Jain, Sandhya; Vaid, Neelam Bala; Guleria, Kiran

2017-01-01

To assess the feasibility and efficacy of Keyes punch biopsy instrument (KP) in diagnosing cervical lesions and compare it with cervical punch biopsy forceps (CP). 75 women having satisfactory colposcopy with abnormal transformation zone were included and paired colposcopic directed biopsies were taken using KP followed by CP from the same target area. It was feasible in all cases to take cervical biopsy with KP after increasing its effective length. The volume of gross specimen obtained by KP was less than CP (0.076 ± 0.097 vs. 0.101 ± 0.156 cm3, p = 0.061), however on microscopic examination, mean length and mean depth of tissue in KP was greater than CP by 0.06 mm (p = 0.810) and 0.14 mm (p = 0.634) respectively. Exact agreement was found with the final surgical specimen in 42% of cases in both the biopsy forceps. KP is almost at par with CP for diagnosing preinvasive cervical lesions and is a useful adjunct to the existing armamentarium of biopsy forceps. © 2016 S. Karger AG, Basel.

[Squamous intraepithlelial lesions in women's lupus].

PubMed

Mercado, Ulises

2009-09-01

previous studies have suggested an association between systemic lupus erythematosus (SLE), abnormal cervical smears and squamous intraepithelial lesions (SIL), but the underlying cause of this association is not well defined. To review Pap smear and biopsy results in SLE women compared with healthy controls and to identify traditional risk factors associated with abnormal smears. Retrospective cohort study. Sixty-two SLE patients and 1719 controls were included. Women with abnormal Pap smear results were referred to colposcopic biopsy histology. Information on traditional risk factors was obtained. Among SLE patients, activity score (Mex-SLEDAI) and immunosuppressive drugs exposure also were determined. Fourteen (22%) out of 62 patients had abnormal Pap smear results, compared with 120 (7%) out of 1719 controls. Thirteen (92%) out of 14 patients showed SIL by histological examination, compared with 27 (22%) out of 120 controls. Two SLE women had condylomata. There were no significant differences in the use of immunosuppressive agents among SLE patients with and without SIL. Abnormal Pap smears, SIL by biopsy and changes in the sexual behavioral were more common among SLE patients than in controls. The immunosuppressive drug exposure was not associated with abnormal Pap smears.

Can an inadequate cervical cytology sample in ThinPrep be converted to a satisfactory sample by processing it with a SurePath preparation?

PubMed

Sørbye, Sveinung Wergeland; Pedersen, Mette Kristin; Ekeberg, Bente; Williams, Merete E Johansen; Sauer, Torill; Chen, Ying

2017-01-01

The Norwegian Cervical Cancer Screening Program recommends screening every 3 years for women between 25 and 69 years of age. There is a large difference in the percentage of unsatisfactory samples between laboratories that use different brands of liquid-based cytology. We wished to examine if inadequate ThinPrep samples could be satisfactory by processing them with the SurePath protocol. A total of 187 inadequate ThinPrep specimens from the Department of Clinical Pathology at University Hospital of North Norway were sent to Akershus University Hospital for conversion to SurePath medium. Ninety-one (48.7%) were processed through the automated "gynecologic" application for cervix cytology samples, and 96 (51.3%) were processed with the "nongynecological" automatic program. Out of 187 samples that had been unsatisfactory by ThinPrep, 93 (49.7%) were satisfactory after being converted to SurePath. The rate of satisfactory cytology was 36.6% and 62.5% for samples run through the "gynecology" program and "nongynecology" program, respectively. Of the 93 samples that became satisfactory after conversion from ThinPrep to SurePath, 80 (86.0%) were screened as normal while 13 samples (14.0%) were given an abnormal diagnosis, which included 5 atypical squamous cells of undetermined significance, 5 low-grade squamous intraepithelial lesion, 2 atypical glandular cells not otherwise specified, and 1 atypical squamous cells cannot exclude high-grade squamous intraepithelial lesion. A total of 2.1% (4/187) of the women got a diagnosis of cervical intraepithelial neoplasia 2 or higher at a later follow-up. Converting cytology samples from ThinPrep to SurePath processing can reduce the number of unsatisfactory samples. The samples should be run through the "nongynecology" program to ensure an adequate number of cells.

Microbiological safety of retail vacuum-packed and modified-atmosphere-packed cooked meats at end of shelf life.

PubMed

Sagoo, S K; Little, C L; Allen, G; Williamson, K; Grant, K A

2007-04-01

A study of retail modified-atmosphere-packed and vacuum-packed cooked ready-to-eat meats was undertaken from September through mid-November 2003 to determine the microbiological quality at the end of shelf life and to establish any risk factors in the production, storage, and display of this product. Examination of 2,981 samples using Microbiological Guidelines criteria revealed that 66% were of satisfactory or acceptable microbiology quality, 33% were of unsatisfactory quality mainly due to high aerobic colony counts and Enterobacteriaceae concentrations, and 1% were of unacceptable quality due to the presence of Listeria monocytogenes at 100 CFU/g or higher (27 samples; range of 10(2) to 106 CFU/g) and Campylobacter jejuni (1 sample), indicating a risk to health. All samples at the end of the shelf life had satisfactory (<20 CFU/g) and/or acceptable (<102 CFU/g) levels of Staphylococcus aureus and Clostridium perfringens, four samples (<1%) had unsatisfactory levels of Escherichia coli (range of 102 to 106 CFU/g) and 5.5% of the samples contained L. monocytogenes at <20 CFU/g (4.8%) or between 20 and 100 CFU/g (0.7%). More samples of chicken (45%; 224 of 495 samples), beef (43%; 160 of 371 samples), and turkey (41%; 219 of 523 samples) were of unsatisfactory or unacceptable quality compared with ham (23%; 317 of 1,351 samples) or pork (32%; 67 of 206 samples). Twelve different L. monocytogenes typing characters (serotype-amplified fragment length polymorphism type-phage type) were evaluated for isolates recovered from samples of unacceptable quality, and the 1/2-IX-NT type was recovered from almost half (48%) of these samples. Salmonella was not detected in any samples examined. Risk factors identified for cooked meats that were microbiologically contaminated more frequently included vacuum packaging, packaging on retail premises, slicing, temperature not monitored in display units, and no hazard analysis system in place. Results from this study also suggest that the shelf life assigned to some modified-atmosphere-packed and vacuum-packed meats may not be appropriate.

Rationale and development of an on-line quality assurance programme for colposcopy in a population-based cervical screening setting in Italy

PubMed Central

2013-01-01

Background Colposcopy, the key step in the management of women with abnormal Pap smear results, is a visual technique prone to observer variation, which implies the need for prolonged apprenticeship, continuous training, and quality assurance (QA) measures. Colposcopy QA programmes vary in level of responsibility of organizing subjects, geographic coverage, scope, model, and type of actions. The programmes addressing the clinical standards of colposcopy (quality of examination and appropriateness of clinical decisions) are more limited in space and less sustainable over time than those focused on the provision of the service (resources, accessibility, etc.). This article reports on the protocol of a QA programme targeting the clinical quality of colposcopy in a population-based cervical screening service in an administrative region of northern Italy. Methods/design After a situation analysis of local colposcopy audit practices and previous QA initiatives, a permanent web-based QA programme was developed. The design places more emphasis on providing education and feedback to participants than on testing them. The technical core is a log-in web application accessible on the website of the regional Administration. The primary objectives are to provide (1) a practical opportunity for retraining of screening colposcopists, and (2) a platform for them to interact with colposcopists from other settings and regions through exchange and discussion of digital colposcopic images. The retraining function is based on repeated QA sessions in which the registered colposcopists log-in, classify a posted set of colpophotographs, and receive on line a set of personal feedback data. Each session ends with a plenary seminar featuring the presentation of overall results and an interactive review of the test set of colpophotographs. This is meant to be a forum for an open exchange of views that may lead to more knowledge and more diagnostic homogeneity. The protocol includes the criteria for selection of colpophotographs and the rationale for colposcopic gold standards. Discussion This programme is an ongoing initiative open to further developments, in particular in the area of basic training. It uses the infrastructure of the internet to give a novel solution to technical problems affecting colposcopy QA in population-based screening services. PMID:23809615

New technologies and advances in colposcopic assessment.

PubMed

Tan, Jeffrey H J; Wrede, C David H

2011-10-01

To have a good grasp of clinical colposcopy, it is necessary to understand the histopathologic structure of the normal and dysplastic cervical epithelium. Previous meta-analyses had indicated high overall sensitivity of colposcopy in detecting dysplastic lesions, but recent studies have suggested that the technique has much lower sensitivity in detecting high-grade intraepithelial neoplasia. The best practice in colposcopy relies on accurately taking a biopsy from the correct (i.e. most morphological abnormal) site, and by taking more than one biopsy, the sensitivity for detection of high-grade cervical intraepithelial neoplasia can be increased. Cytological screening programmes of proven and maintained high quality will enhance the predictive colposcopic accuracy for high-grade cervical intraepithelial neoplasia after referral. With the advent of computerised colposcopy and the Internet, digital imaging can be transmitted in real-time for instant viewing, facilitating distant consultation and education. This form of 'telemedicine' will allow family practice and remote areas to have access to colposcopy expertise. Of all the currently available technological adjuncts to colposcopy, spectroscopy devices have demonstrated relatively high sensitivities, and seem to have the best potential to become the technique of choice in future routine clinical practice in developed countries following the human papillomavirus vaccination. Other alternatives may need to be used in parts of the globe with high disease incidence and without organised screening or vaccination programmes. Opportunities remain for global collaboration in research, education and training to promote more effective and affordable cervical screening, and to enhance the skills of colposcopists worldwide. Copyright © 2011 Elsevier Ltd. All rights reserved.

CO2 laser in treatment of condylomata acuminata of male reproductive organs

NASA Astrophysics Data System (ADS)

Wozniak, Jakub; Opala, Tomasz; Pisarska-Krawczyk, Magdalena; Wilczak, Maciej; Pisarski, Tadeusz

1996-03-01

The results of laser therapy in the treatment of condylomata acuminata of male reproductive organs are reported. Between November 1991 and February 1995 in the Department of Reproduction, Institute of Gynecology and Obstetrics, Karol Marcinkowski University School of Medical Sciences, Poznan in 28 patients with condylomatous changes of reproductive organs carbon-dioxide laser therapy under colposcopic control was done. In 24 of them the healing was achieved. In four patients second laser therapy was done. All patients are still under control in the Department of Reproduction and there was no recurrence diagnosed.

Determining the Relationship Between Moral Waivers and Marine Corps Unsuitability Attrition

DTIC Science & Technology

2008-03-01

observed characteristics. However, econometric research indicates that the magnitude of interaction effects estimated via probit or logit models may...1997 to 2005. Multivariate probit models were used to analyze the effects of moral waivers on unsatisfactory service separations. 15. NUMBER OF...files from fiscal years 1997 to 2005. Multivariate probit models were used to analyze the effects of moral waivers on unsatisfactory service

Haematological validation of a computer-based bone marrow reporting system.

PubMed Central

Nguyen, D T; Diamond, L W; Cavenagh, J D; Parameswaran, R; Amess, J A

1997-01-01

AIMS: To prove the safety and effectiveness of "Professor Belmonte", a knowledge-based system for bone marrow reporting, a formal evaluation of the reports generated by the system was performed. METHODS: Three haematologists (a consultant, a senior registrar, and a junior registrar), none of whom were involved in the development of the software, compared the unedited reports generated by Professor Belmonte with the original bone marrow reports in 785 unselected cases. Each haematologist independently graded the quality of Belmonte's reports using one of four categories: (a) better than the original report (more informative, containing useful information missing in the original report); (b) equivalent to the original report; (c) satisfactory, but missing information that should have been included; and (d) unsatisfactory. RESULTS: The consultant graded 64 reports as more informative than the original, 687 as equivalent to the original, 32 as satisfactory, and two as unsatisfactory. The senior registrar considered 29 reports to be better than the original, 739 to be equivalent to the original, 15 to be satisfactory, and two to be unsatisfactory. The junior registrar found that 88 reports were better than the original, 681 were equivalent to the original, 14 were satisfactory, and two were unsatisfactory. Each judge found two different reports to be unsatisfactory according to their criteria. All 785 reports generated by the computer system received at least two scores of satisfactory or better. CONCLUSIONS: In this representative study, Professor Belmonte generated bone marrow reports that proved to be as accurate as the original reports in a large university hospital. The haematology knowledge contained within the system, the reasoning process, and the function of the software are safe and effective for assisting haematologists in generating high quality bone marrow reports. PMID:9215118

Unsatisfactory exfoliative anal cytology samples, 15-year experience with histologic, cytologic, and molecular follow-up.

PubMed

Khattab, Ruba; McMeekin, Emily; Taege, Alan J; Hekman, James M; Brainard, Jennifer A; Underwood, Dawn; Procop, Gary W; Sturgis, Charles D

2018-02-01

The incidence of anal carcinoma has risen in recent decades. Exfoliative cytology screening of selected high risk patients is performed in many centers. Unsatisfactory cytology results are frustrating to patients, clinicians, and laboratorians. The aim of this study is to ascertain outcomes of patients with non-diagnostic anal cytology. A retrospective review of anal cytology testing performed at the Cleveland Clinic between 01/01/2001 and 12/31/2015 was performed. All cases were received as liquid-based samples and processed as ThinPreps (Hologic, Marlborough, MA). Co-testing for HR-HPV DNA was performed using Hybrid Capture 2® (Qiagen, Germantown, MD) in the majority of patients. Of 1,276 ThinPrep anal cytology samples, 130 (10%) were deemed unsatisfactory. 77% of patients were HIV positive. 85% were males. Of the unsatisfactory cases, 116 (89%) were co-tested for HR-HPV DNA. Of those, 40 patients (34%) had a simultaneous positive HR-HPV DNA. Adequate follow up cytology within a one year and a two year period revealed that 18/130 (14%) and 26/130 (20%) of patients had ASC or SIL respectively. Histologic follow-up within one and two years showed 3 patients (2%) and 8 patients (6%) with HSIL or worse. High risk patients with unsatisfactory anal cytology are not "negative". At least one-third proved to be concomitantly HR-HPV DNA positive with one-fifth showing subsequent cytologic squamous abnormalities and with more than 5% being diagnosed with a high grade intraepithelial lesion within two years. Prompt repeat cytology and/or HR-HPV DNA is recommended for high risk patients with non-diagnostic cytology. © 2017 Wiley Periodicals, Inc.

Standardized inspections of food premises during the 2004 Athens Olympic Games: descriptive analysis and risk factors for unsatisfactory results.

PubMed

Hadjichristodoulou, Christos; Mouchtouri, Varvara; Varzakas, Theodoros; Arvanitoyannis, Ioannis; Kremastinou, Jenny

2008-08-01

Standardized inspections of food premises are part of environmental health systems implemented worldwide. The food safety strategy for the 2004 Olympic Games included standardized inspections to ensure uniformity and consistency of procedures and effective electronic management of data. Inspections were carried out by 196 inspectors in the five Olympic cities: Athens, Thessalonica, Volos, Iraklio, and Patra. From January 2003 to September 2004, a total of 1,249 food premises were inspected. An unsatisfactory inspection result (C grade) was received by 347 (27.8%) food premises, a relatively satisfactory result (B grade) was received by 332 (26.6%), and a satisfactory result (A grade) was received by 570 (45.6%). About 16% of inspected premises did not hold a valid permit. Unsatisfactory inspection results were more frequent for premises located in the two largest Greek cities in comparison with the other smaller cities (relative risk = 1.95, 95% confidence interval [CI] = 1.36 to 2.80). Based on logistic regression analysis, unsatisfactory inspection results were positively associated with food premises that were not located on a ground floor (odds ratio [OR] = 2.56, 95% CI = 1.39 to 4.73) and negatively associated with application of hazard analysis critical control point (HACCP) principles (OR = 0.27, 95% CI = 0.10 to 0.71). Food hygiene education through formal training programs should be encouraged to improve compliance of food premises. Food premises located on hotel floors and serving buffet meals are at higher risk for unsatisfactory conditions. Businesses that implemented a HACCP system within their operations to ensure food safety operated under more hygienic conditions. Future inspections by Public Health Authorities should involve elements of audit after the legislation for the application of HACCP principles.

Student evaluations of teaching: teaching quantitative courses can be hazardous to one’s career

PubMed Central

Smibert, Dylan

2017-01-01

Anonymous student evaluations of teaching (SETs) are used by colleges and universities to measure teaching effectiveness and to make decisions about faculty hiring, firing, re-appointment, promotion, tenure, and merit pay. Although numerous studies have found that SETs correlate with various teaching effectiveness irrelevant factors (TEIFs) such as subject, class size, and grading standards, it has been argued that such correlations are small and do not undermine the validity of SETs as measures of professors’ teaching effectiveness. However, previous research has generally used inappropriate parametric statistics and effect sizes to examine and to evaluate the significance of TEIFs on personnel decisions. Accordingly, we examined the influence of quantitative vs. non-quantitative courses on SET ratings and SET based personnel decisions using 14,872 publicly posted class evaluations where each evaluation represents a summary of SET ratings provided by individual students responding in each class. In total, 325,538 individual student evaluations from a US mid-size university contributed to theses class evaluations. The results demonstrate that class subject (math vs. English) is strongly associated with SET ratings, has a substantial impact on professors being labeled satisfactory vs. unsatisfactory and excellent vs. non-excellent, and the impact varies substantially depending on the criteria used to classify professors as satisfactory vs. unsatisfactory. Professors teaching quantitative courses are far more likely not to receive tenure, promotion, and/or merit pay when their performance is evaluated against common standards. PMID:28503380

Use of clinical and computed tomography findings to assess long-term unsatisfactory outcome after femoral head and neck ostectomy in four large breed dogs.

PubMed

Ober, Ciprian; Pestean, Cosmin; Bel, Lucia; Taulescu, Marian; Milgram, Joshua; Todor, Adrian; Ungur, Rodica; Leșu, Mirela; Oana, Liviu

2018-05-10

Femoral head and neck ostectomy (FHNO) is a salvage surgical procedure intended to eliminate hip joint laxity associated pain in the immature dog, or pain due to secondary osteoarthritis in the mature dog. The outcome of the procedure is associated with the size of the dog but the cause of a generally poorer outcome in larger breeds has not been determined. The objective of this study was to assess the long-term results of FHNO associated with unsatisfactory functional outcome by means of clinical examination and computed tomography (CT) scanning. Four large mixed breed dogs underwent FHNO in different veterinary clinics. Clinical and CT scanning evaluations were carried out long time after the procedures had been done. Hip pain, muscle atrophy, decreased range of motion and chronic lameness were observed at clinical examination. Extensive remodelling, unacceptable bone-on-bone contact with bony proliferation involving the femoral neck and acetabulum, but also excessive removal with bone lysis were observed by CT scanning. Revision osteotomy was performed in one dog. Deep gluteal muscle interposition was used, but no improvements were observed postoperatively. This is the first report on the evaluation of three-dimensional CT reconstructions of the late bone remodelling associated with poor clinical outcome in large dogs. The study shows that FHNO could lead to severe functional deficits in large breed dogs. An extensive follow-study is necessary to more accurately determine the frequency of such complications.

Student evaluations of teaching: teaching quantitative courses can be hazardous to one's career.

PubMed

Uttl, Bob; Smibert, Dylan

2017-01-01

Anonymous student evaluations of teaching (SETs) are used by colleges and universities to measure teaching effectiveness and to make decisions about faculty hiring, firing, re-appointment, promotion, tenure, and merit pay. Although numerous studies have found that SETs correlate with various teaching effectiveness irrelevant factors (TEIFs) such as subject, class size, and grading standards, it has been argued that such correlations are small and do not undermine the validity of SETs as measures of professors' teaching effectiveness. However, previous research has generally used inappropriate parametric statistics and effect sizes to examine and to evaluate the significance of TEIFs on personnel decisions. Accordingly, we examined the influence of quantitative vs. non-quantitative courses on SET ratings and SET based personnel decisions using 14,872 publicly posted class evaluations where each evaluation represents a summary of SET ratings provided by individual students responding in each class. In total, 325,538 individual student evaluations from a US mid-size university contributed to theses class evaluations. The results demonstrate that class subject (math vs. English) is strongly associated with SET ratings, has a substantial impact on professors being labeled satisfactory vs. unsatisfactory and excellent vs. non-excellent, and the impact varies substantially depending on the criteria used to classify professors as satisfactory vs. unsatisfactory. Professors teaching quantitative courses are far more likely not to receive tenure, promotion, and/or merit pay when their performance is evaluated against common standards.

Preadmission Predictors of On-time Graduation in a Doctor of Pharmacy Program.

PubMed

Allen, Rondall E; Diaz, Carroll; Gant, Kisha; Taylor, Ashley; Onor, Ifeanyi

2016-04-25

Objective. To determine which preadmission variables or combination of variables are able to predict on-time graduation in a doctor of pharmacy program. Methods. Transcripts and student files were reviewed for 460 students who entered the college between 2007 and 2009. Results. The preadmission variables with significant correlations to on-time graduation included having a prior degree, student type, the number of unsatisfactory grades (nonscience and math-science courses, and the combination), prepharmacy cumulative grade point average (GPA), and math-science GPA. Of these variables, the significant predictors of on-time graduation were prior degree, the presence of no unsatisfactory grades in nonscience courses, and prepharmacy cumulative GPA. Conclusion. Having a prior degree, lack of unsatisfactory grades in nonscience courses, and prepharmacy GPA were identified as significant predictors of on-time graduation.

Preadmission Predictors of On-time Graduation in a Doctor of Pharmacy Program

PubMed Central

Diaz, Carroll; Gant, Kisha; Taylor, Ashley; Onor, Ifeanyi

2016-01-01

Objective. To determine which preadmission variables or combination of variables are able to predict on-time graduation in a doctor of pharmacy program. Methods. Transcripts and student files were reviewed for 460 students who entered the college between 2007 and 2009. Results. The preadmission variables with significant correlations to on-time graduation included having a prior degree, student type, the number of unsatisfactory grades (nonscience and math-science courses, and the combination), prepharmacy cumulative grade point average (GPA), and math-science GPA. Of these variables, the significant predictors of on-time graduation were prior degree, the presence of no unsatisfactory grades in nonscience courses, and prepharmacy cumulative GPA. Conclusion. Having a prior degree, lack of unsatisfactory grades in nonscience courses, and prepharmacy GPA were identified as significant predictors of on-time graduation. PMID:27170814

Identification and analysis of unsatisfactory psychosocial work situations: a participatory approach employing video-computer interaction.

PubMed

Hanse, J J; Forsman, M

2001-02-01

A method for psychosocial evaluation of potentially stressful or unsatisfactory situations in manual work was developed. It focuses on subjective responses regarding specific situations and is based on interactive worker assessment when viewing video recordings of oneself. The worker is first video-recorded during work. The video is then displayed on the computer terminal, and the filmed worker clicks on virtual controls on the screen whenever an unsatisfactory psychosocial situation appears; a window of questions regarding psychological demands, mental strain and job control is then opened. A library with pictorial information and comments on the selected situations is formed in the computer. The evaluation system, called PSIDAR, was applied in two case studies, one of manual materials handling in an automotive workshop and one of a group of workers producing and testing instrument panels. The findings indicate that PSIDAR can provide data that are useful in a participatory ergonomic process of change.

OCT in Gynecology

NASA Astrophysics Data System (ADS)

Kuznetsova, Irina A.; Gladkova, Natalia D.; Gelikonov, Valentin M.; Belinson, Jerome L.; Shakhova, Natalia M.; Feldchtein, Felix I.

Timely and efficient diagnosis of diseases of the female reproductivesystem is very important from the social viewpoint [1, 2]. Diagnosticefficacy of the existing techniques still needs improvement sincemalignant neoplasms of the female reproductive system organs are stableleaders among causes of death (over 35.9 %) [3]. Each year, 851.9 thousand genital cancer cases are recorded worldwide [1, 2]. However, the diagnostic efficacy of the visual examination with biopsy is limited. Correct interpretation of colposcopic features requires high skills and long-term clinical experience, which makes colposcopy very subjective and limits interobserver agreement [8-10]. OCT is known to visualize in vivo and noninvasively tissue microstructure with spatial resolution approaching the histologic level and therefore can be expected to guide biopsies and to provide real-time tissue structure information when biopsies are contraindicated or impractical. Although thorough clinical studies are required to determine if OCT can be suitable for this purpose in gynecology in general and for cervical cancer in particular, the early results look encouraging. In this chapter, we present a wide spectrum of the OCT studies of different partsof the female reproductive system and demonstrate the potential of the clinical use of this new visualization method in gynecological practice.

Laser surgery in the treatment of vaginal cysts

NASA Astrophysics Data System (ADS)

Wozniak, Jakub; Dydowicz, Piotr; Opala, Tomasz; Pisarska-Krawczyk, Magdalena; Wilczak, Maciej; Pisarski, Tadeusz

1997-10-01

The authors described the results of treatment of vaginal cysts with CO2 laser under colposcopic control in 12 women. In five of them the recurrent Bartholin's, in another five the Gartner's and in tow the endometrial cysts were diagnosed. All laser surgeries were done in the Department of Reproduction, Institute of Gynecology, Karol Marcinkowski School of Medical Sciences, Poznan, Poland between September 1995 and September 1996. In the authors' opinion the use of CO2 laser is the efficient method of treatment of vaginal cysts. The most of laser procedures are doing as the one-day surgery. There are no serious postoperative complications after laser surgery.

Assessment of the microbiological safety of salad vegetables and sauces from kebab take-away restaurants in the United Kingdom.

PubMed

Meldrum, R J; Little, C L; Sagoo, S; Mithani, V; McLauchlin, J; de Pinna, E

2009-09-01

The purpose of this study was to establish the microbiological safety of salad vegetables and sauces served in kebab take-away restaurants. Comparison with published microbiological guidelines revealed that 4.7% of 1213 salad vegetable samples were of unsatisfactory microbiological quality due to Escherichia coli and/or Staphylococcus aureus levels at > or =10(2) cfu g(-1). Another 0.3% of salad samples were of unacceptable quality due to S. aureus at > or =10(4) cfu g(-1) (2 samples) or the presence of Salmonella Kentucky (1 sample). Cucumber was the most contaminated salad vegetable with regards to unsatisfactory levels of E. coli (6.0%) or S. aureus (4.5%). Five percent of 1208 sauce samples were of unsatisfactory microbiological quality due to E. coli, S. aureus at > or =10(2) cfu g(-1) and/or Bacillus cereus and other Bacillus spp. at > or =10(4) cfu g(-1). A further 0.6% of sauce samples were of unacceptable quality due to Bacillus spp. (Bacillus subtilis, Bacillus pumilus, Bacillus licheniformis) at > or =10(5) cfu g(-1) or the presence of Salmonella Agbeni (1 sample). More samples of chili sauce (8.7%) were of unsatisfactory or unacceptable microbiological quality than any other sauce types. The results emphasize the need for good hygiene practices in kebab take-away restaurants handling these types of ready-to-eat products.

Interferon-α salvage treatment is effective for patients with acute leukemia/myelodysplastic syndrome with unsatisfactory response to minimal residual disease-directed donor lymphocyte infusion after allogeneic hematopoietic stem cell transplantation.

PubMed

Mo, Xiaodong; Zhang, Xiaohui; Xu, Lanping; Wang, Yu; Yan, Chenhua; Chen, Huan; Chen, Yuhong; Han, Wei; Wang, Fengrong; Wang, Jingzhi; Liu, Kaiyan; Huang, Xiaojun

2018-04-14

The efficacy of salvage interferon-α (IFN-α) treatment was investigated in patients with unsatisfactory response to minimal residual disease (MRD)-directed donor lymphocyte infusion (DLI) (n = 24). Patients who did not become MRD-negative at 1 month after DLI were those with unsatisfactory response and were eligible to receive salvage IFN-α treatment within 3 months of DLI. Recombinant human IFN-α-2b injections were subcutaneously administered 2-3 times a week for 6 months. Nine (37.5%), 6 (25.0%), and 3 (12.5%) patients became MRD-negative at 1, 2, and > 2 months after the salvage IFN-α treatment, respectively. Two-year cumulative incidences of relapse and non-relapse mortality were 35.9% and 8.3%, respectively. Two-year probabilities of event-free survival, disease-free survival, and overall survival were 51.6%, 54.3%, and 68.0%, respectively. Outcomes of patients subjected to salvage IFN-α treatment after DLI were significantly better than those with persistent MRD without IFN-α treatment. Moreover, clinical outcomes were comparable between the salvage DLI and IFN-α treatment groups. Thus, salvage IFN-α treatment may help improve the outcome of patients with unsatisfactory responses to MRD-directed DLI and could be a potential salvage treatment for these patients after allogeneic hematopoietic stem cell transplantation.

Evaluation of Biomechanical Changes in Myopia Patients with Unsatisfactory Corneas After Femto Second-Laser In Situ Keratomileusis (FS-LASIK) Concurrent with Accelerated Corneal Collagen Cross-Linking Using Corvis-ST: Two-Year Follow-Up Results.

PubMed

Xu, Weiwei; Tao, Ye; Wang, Liqiang; Huang, Yifei

2017-07-27

BACKGROUND Some myopia patients with unsatisfactory corneas consider corneal refractive surgery for different reasons. Accelerated corneal collagen crosslinking (ACXL) is an effective method to enhance the resistance of the cornea. The present investigation was designed to evaluate the changes of biomechanical properties in patients with myopia and thin corneas after femtosecond-laser in situ keratomileusis (FS-LASIK) concurrent with ACXL. MATERIAL AND METHODS A prospective study was designed. A total of 22 eyes of 11 myopia astigmatism patients with unsatisfactory corneas were enrolled. The patients were assigned to femtosecond-laser in situ keratomileusis concurrent with accelerated corneal collagen crosslinking (FS-LASIK-ACXL). The follow-up duration was 24 months. Manifest refraction, uncorrected (UDVA), and corrected distance visual acuity (CDVA), ultra-high-speed camera (Corvis-ST), corneal topography, anterior segment OCT (AS-OCT), Pentacam, and endothelial cell density (ECD) were examined before and after the operation. The corneal biomechanical and refractive data was analyzed using SAS9.3. Data were analyzed through normal distribution test and variance of analysis. The difference was considered as statistically significant when p<0.05. RESULTS The steep K (Ks) values, flat K (Kf) values, average keratometry values (Avek) values, and central corneal thickness (CCT) declined significantly after FS-LASIK-ACXL operation. The values of first applanation length (A1L), the second applanation length (A2L), the first applanation velocity (A1V), the second applanation velocity (A2V), deformation amplitude (DA), highest concavity peak distance (PD), and radius of curvature at the time of highest concavity (HCR) did not show significant difference after the operation. CONCLUSIONS FS-LASIK-ACXL is an effective and safe surgery for improving visual acuity for myopic patients with thin corneas, and it does not increase the risk of iatrogenic keratectasia.

Can an inadequate cervical cytology sample in ThinPrep be converted to a satisfactory sample by processing it with a SurePath preparation?

PubMed Central

Sørbye, Sveinung Wergeland; Pedersen, Mette Kristin; Ekeberg, Bente; Williams, Merete E. Johansen; Sauer, Torill; Chen, Ying

2017-01-01

Background: The Norwegian Cervical Cancer Screening Program recommends screening every 3 years for women between 25 and 69 years of age. There is a large difference in the percentage of unsatisfactory samples between laboratories that use different brands of liquid-based cytology. We wished to examine if inadequate ThinPrep samples could be satisfactory by processing them with the SurePath protocol. Materials and Methods: A total of 187 inadequate ThinPrep specimens from the Department of Clinical Pathology at University Hospital of North Norway were sent to Akershus University Hospital for conversion to SurePath medium. Ninety-one (48.7%) were processed through the automated “gynecologic” application for cervix cytology samples, and 96 (51.3%) were processed with the “nongynecological” automatic program. Results: Out of 187 samples that had been unsatisfactory by ThinPrep, 93 (49.7%) were satisfactory after being converted to SurePath. The rate of satisfactory cytology was 36.6% and 62.5% for samples run through the “gynecology” program and “nongynecology” program, respectively. Of the 93 samples that became satisfactory after conversion from ThinPrep to SurePath, 80 (86.0%) were screened as normal while 13 samples (14.0%) were given an abnormal diagnosis, which included 5 atypical squamous cells of undetermined significance, 5 low-grade squamous intraepithelial lesion, 2 atypical glandular cells not otherwise specified, and 1 atypical squamous cells cannot exclude high-grade squamous intraepithelial lesion. A total of 2.1% (4/187) of the women got a diagnosis of cervical intraepithelial neoplasia 2 or higher at a later follow-up. Conclusions: Converting cytology samples from ThinPrep to SurePath processing can reduce the number of unsatisfactory samples. The samples should be run through the “nongynecology” program to ensure an adequate number of cells. PMID:28900466

Female genital schistosomiasis due to Schistosoma haematobium. Clinical and parasitological findings in women in rural Malawi.

PubMed

Kjetland, E F; Poggensee, G; Helling-Giese, G; Richter, J; Sjaastad, A; Chitsulo, L; Kumwenda, N; Gundersen, S G; Krantz, I; Feldmeier, H

1996-12-30

A total of 51 women with urinary schistosomiasis haematobium were examined in order to identify diagnostic indicators for female genital schistosomiasis (FGS). Patients were selected at random from the outpatient department of the Mangochi District Hospital, Malawi. The medical histories were recorded according to a pre-designed questionnaire and the women were subjected to a thorough gynaecological examination including colposcopy and photographic documentation of lesions. Microscopy of genital biopsies revealed that 33 of the 51 women had S. haematobium ova in cervix, vagina and/or vulva in addition to the presence of ova in urine. The most sensitive diagnostic procedure was beside microscopic examination of a wet cervix biopsy crushed between two glass slides, which revealed 25 of the 33 genital infections. There was a significant correlation between the size of genital lesions and the number of ova counted per mm2 of crushed tissue. Women with FGS had significantly more tumours in the vulva than women with schistosomiasis limited to the urinary tract. Most of the observed genital pathology could easily be identified by the naked eye, but colposcopic examination yielded valuable additional information like the demonstration of neovascularisation around cervical sandy patches. Few of the symptoms previously regarded as indicators for FGS could be linked to the presence of schistosome ova in genital tissue. Husbands of infertile women with FGS had children with other women significantly more often than husbands of women who only had urinary schistosomiasis. This, together with the finding that the majority of the divorced women had FGS, indicates that the manifestation of this disease may have implications for the marital and sexual life of the affected women.

A case control study of nutritional factors and cervical dysplasia.

PubMed

Liu, T; Soong, S J; Wilson, N P; Craig, C B; Cole, P; Macaluso, M; Butterworth, C E

1993-01-01

The association of nutritional factors with cervical dysplasia was examined through a case-control study. Analysis was conducted in 257 cases and 133 controls confirmed both by cytological examination and colposcopic findings. A 24-h dietary recall questionnaire was used to assess nutritional intake. Various risk factors (including age at first intercourse, number of sexual partners, parity, cigarette smoking, oral contraceptive use, human papillomavirus type 16 infection, and age and race) were adjusted for their potential confounding effects. While analyses were also performed to adjust for total calories, results were not changed significantly. Among the nutrients examined, vitamin A intake showed a significantly increased risk at the lowest quartile compared to the highest quartile, with an odds ratio of 2.2 (95% confidence interval, 1.2-4.2). A significant trend of increasing risk was also observed with lower intake of vitamin A (P = 0.05). Riboflavin showed increased risk at the two lower quartiles of intake with a trend test P value of 0.04. Increased risk was also found for lower intakes of vitamin C compared to the highest intake level. For folate, increased risk was found in the second highest quartile compared with the highest quartile with an odds ratio of 2.0 (95% confidence interval, 1.0-3.8). The calcium:phosphorus ratio showed an increased risk at the lowest level (odds ratio, 2.0; 95% confidence interval, 1.0-4.3). Insufficient intake of vitamin A, riboflavin, ascorbate, and folate is associated with an increased risk of cervical dysplasia.

Impact of bowel preparation on surveillance colonoscopy interval.

PubMed

Singhal, Shashideep; Virk, Muhammad Asif; Momeni, Mojdeh; Krishnaiah, Mahesh; Anand, Sury

2014-07-01

Atpresent there are no guidelines for colonoscopy surveillance interval in subjects with unsatisfactory bowel preparation. Study was designed to compare outcomes of repeat colonoscopy at different surveillance intervals in patients with unsatisfactory preparation on index exam. Ten thousand nine hundred and eight colonoscopies were done during the study period. Patients with index colonoscopy exam complete up to cecum but suboptimal bowel prep were included. Two hundred and ninety-seven patients met the inclusion criteria. The interval for repeat colonoscopy was <1 year in 38.5%, 1-2 years in 33.3%, 2-3 years in 16.7%, and 3-5 years in 11.5% subjects. Adenoma detection rate (ADR) was 24%, high-risk adenoma detection rate (HR-ADR) was 8.4%, and colorectal cancer detection rate was 1.7%. The HR-ADR based on surveillance intervals <1 year, 1-2 years, 2-3 years, and 3-5 years was 8%, 7.9%, 2%, and 19.4%, respectively. The HR-ADR was significantly higher at surveillance interval 3-5 years (p < 0.05). Colonoscopies repeated at interval >3 years showed a significant HR-ADR. The study indicates that a surveillance interval of 3 years can be reasonable for subjects having an index colonoscopy with suboptimal/fair/poor bowel prep and complete colon examination. Colonoscopy should be repeated earlier if symptoms develop.

Performance of p16INK4a ELISA as a primary cervical cancer screening test among a large cohort of HIV-infected women in western Kenya: a 2-year cross-sectional study.

PubMed

Wu, Tara J; Smith-McCune, Karen; Reuschenbach, Miriam; von Knebel Doeberitz, Magnus; Maloba, May; Huchko, Megan J

2016-09-13

A biomarker with increased specificity for cervical dysplasia compared with human papillomavirus (HPV) testing would be an attractive option for cervical cancer screening among HIV-infected women in resource-limited settings. p16(INK4a) has been explored as a biomarker for screening in general populations. A 2-year cross-sectional study. 2 large HIV primary care clinics in western Kenya. 1054 HIV-infected women in western Kenya undergoing cervical cancer screening as part of routine HIV care from October 2010 to November 2012. Participants underwent p16(INK4a) specimen collection and colposcopy. Lesions with unsatisfactory colposcopy or suspicious for cervical intraepithelial neoplasia 2+ (CIN2+; including CIN2/3 or invasive cervical cancer) were biopsied. Following biopsy, disease status was determined by histopathological diagnosis. We measured the sensitivity, specificity and predictive values of p16(INK4a) ELISA for CIN2+ detection among HIV-infected women and compared them to the test characteristics of current screening methods used in general as well as HIV-infected populations. Average p16(INK4a) concentration in cervical samples was 37.4 U/mL. After colposcopically directed biopsy, 127 (12%) women were determined to have CIN2+. Receiver operating characteristic analysis showed an area under the curve of 0.664 for p16(INK4a) to detect biopsy-proven CIN2+. At a p16(INK4a) cut-off level of 9 U/mL, sensitivity, specificity, positive and negative predictive values were 89.0%, 22.9%, 13.6% and 93.8%, respectively. The overall p16(INK4a) positivity at a cut-off level of 9 U/mL was 828 (78.6%) women. There were 325 (30.8%) cases of correct p16(INK4a) prediction to detect or rule out CIN2+, and 729 (69.2%) cases of incorrect p16(INK4a) prediction. p16(INK4a) ELISA did not perform well as a screening test for CIN2+ detection among HIV-infected women due to low specificity. Our study contributes to the ongoing search for a more specific alternative to HPV testing for CIN2+ detection. 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/

Performance of p16INK4a ELISA as a primary cervical cancer screening test among a large cohort of HIV-infected women in western Kenya: a 2-year cross-sectional study

PubMed Central

Wu, Tara J; Smith-McCune, Karen; Reuschenbach, Miriam; von Knebel Doeberitz, Magnus; Maloba, May; Huchko, Megan J

2016-01-01

Objective A biomarker with increased specificity for cervical dysplasia compared with human papillomavirus (HPV) testing would be an attractive option for cervical cancer screening among HIV-infected women in resource-limited settings. p16INK4a has been explored as a biomarker for screening in general populations. Design A 2-year cross-sectional study. Setting 2 large HIV primary care clinics in western Kenya. Participants 1054 HIV-infected women in western Kenya undergoing cervical cancer screening as part of routine HIV care from October 2010 to November 2012. Interventions Participants underwent p16INK4a specimen collection and colposcopy. Lesions with unsatisfactory colposcopy or suspicious for cervical intraepithelial neoplasia 2+ (CIN2+; including CIN2/3 or invasive cervical cancer) were biopsied. Following biopsy, disease status was determined by histopathological diagnosis. Primary and secondary outcome measures We measured the sensitivity, specificity and predictive values of p16INK4a ELISA for CIN2+ detection among HIV-infected women and compared them to the test characteristics of current screening methods used in general as well as HIV-infected populations. Results Average p16INK4a concentration in cervical samples was 37.4 U/mL. After colposcopically directed biopsy, 127 (12%) women were determined to have CIN2+. Receiver operating characteristic analysis showed an area under the curve of 0.664 for p16INK4a to detect biopsy-proven CIN2+. At a p16INK4a cut-off level of 9 U/mL, sensitivity, specificity, positive and negative predictive values were 89.0%, 22.9%, 13.6% and 93.8%, respectively. The overall p16INK4a positivity at a cut-off level of 9 U/mL was 828 (78.6%) women. There were 325 (30.8%) cases of correct p16INK4a prediction to detect or rule out CIN2+, and 729 (69.2%) cases of incorrect p16INK4a prediction. Conclusions p16INK4a ELISA did not perform well as a screening test for CIN2+ detection among HIV-infected women due to low specificity. Our study contributes to the ongoing search for a more specific alternative to HPV testing for CIN2+ detection. PMID:27625065

Measuring and Improving the Quality of Preprocedural Assessments.

PubMed

Manji, Farah; McCarty, Kelsey; Kurzweil, Vanessa; Mark, Eden; Rathmell, James P; Agarwala, Aalok V

2017-06-01

Preprocedural assessments are used by anesthesia providers to optimize perioperative care for patients undergoing invasive procedures. When these assessments are performed in advance by providers who are not caring for the patient during the procedure, there is an additional layer of complexity in ensuring that the workup meets the needs of the primary anesthesia care team. In this study, anesthesia providers were asked to rate the quality of preprocedural assessments prepared by other providers to evaluate anesthesia care team satisfaction. Quality ratings for preprocedural assessments were collected from anesthesia providers on the day of surgery using an electronic quality assurance tool from January 9, 2014 to October 21, 2014. Users could rate assessments as "exemplary," "satisfactory," or "unsatisfactory." Free text comments could be entered for any of the quality ratings chosen. A reviewer trained in clinical anesthesia categorized all comments as "positive," "constructive," or "neutral" and conducted in-depth chart reviews triggered by 67 "constructive" comments submitted during the first 3 months of data collection to further subcategorize perceived deficiencies in the preprocedural assessments. In May 2014, providers were asked to participate in a midpoint survey and provide general feedback about the preprocedural process and evaluations. 37,611 procedures requiring anesthesia were analyzed. Of the 17,522 (46.6%) cases with a rated preprocedural assessment, anesthesia providers rated 3828 (21.8%) as "exemplary," 13,454 (76.8%) as "satisfactory," and 240 (1.4%) as "unsatisfactory." The monthly proportion of "unsatisfactory" ratings ranged from 3.1% to 0% over the study period, whereas the midpoint survey showed that anesthesia providers estimated that the number of unsatisfactory evaluations was 11.5%. Preprocedural evaluations performed on inpatients received significantly better ratings than evaluations performed on outpatients by the preadmission testing clinic or phone program (P < .0001). The most common reason given for "unsatisfactory" ratings was a perception of "missing information" (49.2%). Chart reviews revealed that inadequate documentation was in reality the most common deficiency in preprocedural evaluations (35 of 67 reviews, 52.2%). The overwhelming majority of preprocedural assessments performed at our institution were considered satisfactory or exemplary by day-of-surgery anesthesia providers. This was demonstrated by both the case-by-case ratings and midpoint survey. However, the perceived frequency of "unsatisfactory" evaluations was worse when providers were asked to reflect on the quality of preprocedural evaluations generally versus rate them individually. Analysis of comments left by providers allowed us to identify specific and actionable areas for improvement. This method can be used by other institutions to identify systemic deficiencies in the preprocedural evaluation process.

The microbiological quality of ready-to-eat foods with added spices.

PubMed

Little, C L; Omotoye, R; Mitchell, R T

2003-03-01

A microbiological study of ready-to-eat foods with added spices or spice ingredients was undertaken to identify any risk factors in the production, storage and display of this product and to establish their effect on microbiological quality. Examination of 1946 ready-to-eat foods from sandwich bars, cafés, public houses, restaurants, specialist sandwich producers, bakers, delicatessens, market stalls and mobile vendors found that 1291 (66%) were of satisfactory/acceptable microbiological quality, 609 (32%) were of unsatisfactory quality, and 46 (2%) were of unacceptable quality. Unacceptable results were due to high levels of B. cereus and/or other Bacillus spp. (>/=10(5) cfu g(-1)). Unsatisfactory results were mostly due to high Aerobic Colony Counts (up to >/=10(7) cfu g(-1)), Enterobacteriaceae (>/=10(4) cfu g(-1)), Escherichia coli (>/=10(2) cfu g(-1)), and Bacillus spp (>/=10(4) cfu g(-1)). Examination of 750 spices and spice ingredients revealed that B. cereus were present in 142 (19%) samples, other Bacillus spp. in 399 (53%) samples, and Salmonella spp. (S. enteritidis PT 11) in one (<1%) sample. Approximately a third (222) of spice and spice ingredients examined contained high counts (>/=10(4) cfu g(-1)) of B. cereus and/or other Bacillus spp., and appeared to be associated with the corresponding ready-to-eat foods containing similar high counts of these organisms (P<0.0001). Acceptable microbiological quality of ready-to-eat foods to which spices or spice ingredients have been added was associated with premises that had management food hygiene training and hazard analysis in place. Poor microbiological quality was associated with preparation on the premises, premises type, little or no confidence in the food business management of food hygiene, and small premises as indicated by local authority inspectors' confidence in management and consumer at risk scores.

Management of environmental health issues for the 2004 Athens Olympic Games: is enhanced integrated environmental health surveillance needed in every day routine operation?

PubMed Central

Hadjichristodoulou, Christos; Mouchtouri, Varvara; Vaitsi, Vasiliki; Kapoula, Christina; Vousoureli, Anastasia; Kalivitis, Isidiros; Chervoni, Julia; Papastergiou, Panagiotis; Vasilogiannakopoulos, Antonios; Daniilidis, Vasilis D; Kremastinou, Jenny

2006-01-01

Background Management of environmental health issues is an integral part of public health systems. An active integrated environmental health surveillance and response system was developed for the Athens Olympics to monitor and prevent exposure to environmental hazards. The potential for permanent implementation of the program was examined. Methods The environmental health surveillance and response system included standardization, computerization and electronic transmission of data concerning environmental inspections of 17 site categories (restaurants, swimming pools etc) of public health interest, drinking and recreational water examinations and suggested corrective actions. The Olympic Planning Unit integrated and centrally managed data from 13 public health agencies, recommended, supervised and coordinated prompt corrective actions. Methods used to test the effectiveness of the program were the assessment of water quality test and inspection results trends over time using linear regression and epidemiological surveillance findings. Results Between January 2003 and September the 30th, 2004, 196 inspectors conducted 8562 inspections, collected 5024 water samples and recommended 17 027 corrective actions. In 10 cruise ships used as floating hotels inspectors conducted 10 full inspections, 2 re-inspections, and 27 follow-up inspections. Unsatisfactory inspection results (r = 0.44, p < 0.0001) and positive water quality tests (r = 0.39, p < 0.001) presented an overall decrease trend over time. In August, 2003, an outbreak of salmonellosis was linked to a hotel restaurant which accommodated athletes during a test event. Conclusion Lessons learned for future events include timely implementation and installation of communication processes, and rapid and coordinated response to unsatisfactory inspection results. Routine national programs need to adopt enhanced environmental health surveillance aimed at public health decision-making, but with a different perspective. PMID:17176469

Management of environmental health issues for the 2004 Athens Olympic Games: is enhanced integrated environmental health surveillance needed in every day routine operation?

PubMed

Hadjichristodoulou, Christos; Mouchtouri, Varvara; Vaitsi, Vasiliki; Kapoula, Christina; Vousoureli, Anastasia; Kalivitis, Isidiros; Chervoni, Julia; Papastergiou, Panagiotis; Vasilogiannakopoulos, Antonios; Daniilidis, Vasilis D; Kremastinou, Jenny

2006-12-18

Management of environmental health issues is an integral part of public health systems. An active integrated environmental health surveillance and response system was developed for the Athens Olympics to monitor and prevent exposure to environmental hazards. The potential for permanent implementation of the program was examined. The environmental health surveillance and response system included standardization, computerization and electronic transmission of data concerning environmental inspections of 17 site categories (restaurants, swimming pools etc) of public health interest, drinking and recreational water examinations and suggested corrective actions. The Olympic Planning Unit integrated and centrally managed data from 13 public health agencies, recommended, supervised and coordinated prompt corrective actions. Methods used to test the effectiveness of the program were the assessment of water quality test and inspection results trends over time using linear regression and epidemiological surveillance findings. Between January 2003 and September the 30th, 2004, 196 inspectors conducted 8562 inspections, collected 5024 water samples and recommended 17 027 corrective actions. In 10 cruise ships used as floating hotels inspectors conducted 10 full inspections, 2 re-inspections, and 27 follow-up inspections. Unsatisfactory inspection results (r = 0.44, p < 0.0001) and positive water quality tests (r = 0.39, p < 0.001) presented an overall decrease trend over time. In August, 2003, an outbreak of salmonellosis was linked to a hotel restaurant which accommodated athletes during a test event. Lessons learned for future events include timely implementation and installation of communication processes, and rapid and coordinated response to unsatisfactory inspection results. Routine national programs need to adopt enhanced environmental health surveillance aimed at public health decision-making, but with a different perspective.

Mitotic rate in primary melanoma: interobserver and intraobserver reliability, analyzed using H&E sections and immunohistochemistry.

PubMed

Garbe, Claus; Eigentler, Thomas K; Bauer, Jürgen; Blödorn-Schlicht, Norbert; Cerroni, Lorenzo; Fend, Falko; Hantschke, Markus; Kurschat, Peter; Kutzner, Heinz; Metze, Dieter; Mielke, Volker; Preßler, Harald; Reusch, Michael; Reusch, Ursula; Stadler, Rudolf; Tronnier, Michael; Yazdi, Amir; Metzler, Gisela

2016-09-01

In 2009, the AJCC issued a revised melanoma staging system. In addition to tumor thickness and ulceration, the mitotic rate was introduced as the third major prognostic parameter for the classification of primary cutaneous melanoma. Given that, according to the 2009 AJCC classification, the detection of one or more dermal tumor mitoses leads to an upstaging - from stage Ia to Ib - of melanomas with a tumor thickness of ≤ 1.0 mm, we set out to investigate the reproducibility of this new parameter. In order to assess interobserver reliability, 17 dermatopathologists und pathologists - all well versed in the diagnosis of cutaneous melanoma - analyzed the mitotic rate in 15 thin primary cutaneous melanomas (mean tumor thickness 0.91 mm) using identical slides. Mitotic rates were determined on H&E and phosphohistone H3 (Ser10)-stained samples. Without knowledge of their previous assessment, five of the aforementioned examiners reevaluated the samples after more than one year in order to ascertain intraobserver reliability. Interobserver reliability of the mitotic rate in thin primary melanomas is disappointing and independent of whether H&E or immunohistochemically stained samples are used (kappa value: 0.088 [H&E], 0.154 [IH], respectively). Kappa values improved to 0.345 (H&E) and 0.403 (IH) when using a cutoff of 0/1 vs. 2+ mitoses. Similarly unsatisfactory, kappa values for intraobserver reliability ranged from 0.18 and 0.348, depending on the individual examiner. Given the unsatisfactory reproducibility and large variations in assessing the mitotic rate, it remains a matter of debate whether this diagnostic parameter should play a role in therapeutic decisions. © 2016 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

Hysterosalpingography After Radiofrequency Endometrial Ablation and Hysteroscopic Sterilization as a Concomitant Procedure.

PubMed

Hopkins, Matthew R; Laughlin-Tommaso, Shannon K; Wall, Darci J; Breitkopf, Daniel M; Creedon, Douglas J; El-Nashar, Sherif A; Famuyide, Abimbola O

2015-09-01

To evaluate the accuracy of hysterosalpingography (HSG) in patients who underwent concomitant radiofrequency endometrial ablation and hysteroscopic sterilization. This historical cohort study was conducted at a midwestern academic medical center. A total of 186 women (94 with combined procedure and 92 with sterilization alone) were identified as having undergone intervention between January 1, 2003, and June 30, 2011. Two reviewers blinded to the surgical procedure interpreted the standard clinically indicated HSGs in each group. The primary outcome assessed was the inability to rely on the microinserts for contraception based on HSG interpretation using manufacturers' guidelines (unsatisfactory HSG). Position of the devices and occlusion of tubes were assessed on all 3-month and, when available, all 6-month repeat HSGs. At the 3-month HSG, 5 of 76 (6.6%, 95% confidence interval [CI] 2.2-14.7%) in the sterilization-only group had unsatisfactory HSG compared with 13 of 71 (18.3%, 95% CI 10.1-29.3%) in the combined group (P=.03). After accounting for the seven patients who underwent repeat HSG at 6 months, 3 of 76 (3.95%, 95% CI 0.8-11.1%) in the sterilization-only group had unsatisfactory HSG compared with 13 of 71 (18.31%, 95% CI 10.1-29.3%) in the combined group (P=.005). After completing all clinically indicated HSGs, patients who undergo concomitant radiofrequency endometrial ablation and hysteroscopic sterilization have an approximate fivefold increase (odds ratio 5.45, 95% CI 1.48-20.0) in the rate of unsatisfactory HSG for purposes of documenting tubal occlusion. II.

Assessment of Primary Health Care in the Treatment of Tuberculosis in a Brazilian Locality of the International Triple Frontier.

PubMed

Silva-Sobrinho, Reinaldo Antonio; Wysocki, Anneliese Domingues; Scatena, Lúcia Marina; Pinto, Erika Simone Galvão; Beraldo, Aline Ale; Andrade, Rubia Laine Paula; Zilly, Adriana; Munhak da Silva, Rosane Meire; Gomes, Michela Prestes; Mayer, Paulo César Morales; Ruffino-Netto, Antonio; Villa, Tereza Cristina Scatena

2017-01-01

To evaluate the performance of Primary Health Care (PHC) in treatment of TB patients in a triple international border municipality. The present study was an evaluative survey of cross-sectional and quantitative approach conducted with 225 PHC healthcare professionals. Data was collected through a structured and validated instrument, which provided five indicators of "structure" and four indicators of "process" classified as unsatisfactory, regular or satisfactory. The "structure" component was unsatisfactory for the indicator of professionals involved in TB care and training, and regular for the indicator of connection between the units and other levels of care. The "process" component was regular for the indicators of TB information, directly observed treatment and reference and counter reference on TB, and unsatisfactory for external actions on TB control. The "structure" and "process" components points out some weaknesses in terms of management and organization of human resources. Low frequency of training and the turnover influenced the involvement of professionals. Elements of "structure" and "process" show the need for investing in the PHC team and improving the clinical management of cases.

Costs and Cost Effectiveness of Three Approaches for Cervical Cancer Screening among HIV-Positive Women in Johannesburg, South Africa

PubMed Central

Lince-Deroche, Naomi; Phiri, Jane; Michelow, Pam; Smith, Jennifer S.; Firnhaber, Cindy

2015-01-01

Background South Africa has high rates of HIV and HPV and high incidence and mortality from cervical cancer. However, cervical cancer is largely preventable when early screening and treatment are available. We estimate the costs and cost-effectiveness of conventional cytology (Pap), visual inspection with acetic acid (VIA) and HPV DNA testing for detecting cases of CIN2+ among HIV-infected women currently taking antiretroviral treatment at a public HIV clinic in Johannesburg, South Africa. Methods Method effectiveness was derived from a validation study completed at the clinic. Costs were estimated from the provider perspective using micro-costing between June 2013-April 2014. Capital costs were annualized using a discount rate of 3%. Two different service volume scenarios were considered. Threshold analysis was used to explore the potential for reducing the cost of HPV DNA testing. Results VIA was least costly in both scenarios. In the higher volume scenario, the average cost per procedure was US$ 3.67 for VIA, US$ 8.17 for Pap and US$ 54.34 for HPV DNA. Colposcopic biopsies cost on average US$ 67.71 per procedure. VIA was least sensitive but most cost-effective at US$ 17.05 per true CIN2+ case detected. The cost per case detected for Pap testing was US$ 130.63 using a conventional definition for positive results and US$ 187.52 using a more conservative definition. HPV DNA testing was US$ 320.09 per case detected. Colposcopic biopsy costs largely drove the total and per case costs. A 71% reduction in HPV DNA screening costs would make it competitive with the conservative Pap definition. Conclusions Women need access to services which meet their needs and address the burden of cervical dysplasia and cancer in this region. Although most cost-effective, VIA may require more frequent screening due to low sensitivity, an important consideration for an HIV-positive population with increased risk for disease progression. PMID:26569487

Costs and Cost Effectiveness of Three Approaches for Cervical Cancer Screening among HIV-Positive Women in Johannesburg, South Africa.

PubMed

Lince-Deroche, Naomi; Phiri, Jane; Michelow, Pam; Smith, Jennifer S; Firnhaber, Cindy

2015-01-01

South Africa has high rates of HIV and HPV and high incidence and mortality from cervical cancer. However, cervical cancer is largely preventable when early screening and treatment are available. We estimate the costs and cost-effectiveness of conventional cytology (Pap), visual inspection with acetic acid (VIA) and HPV DNA testing for detecting cases of CIN2+ among HIV-infected women currently taking antiretroviral treatment at a public HIV clinic in Johannesburg, South Africa. Method effectiveness was derived from a validation study completed at the clinic. Costs were estimated from the provider perspective using micro-costing between June 2013-April 2014. Capital costs were annualized using a discount rate of 3%. Two different service volume scenarios were considered. Threshold analysis was used to explore the potential for reducing the cost of HPV DNA testing. VIA was least costly in both scenarios. In the higher volume scenario, the average cost per procedure was US$ 3.67 for VIA, US$ 8.17 for Pap and US$ 54.34 for HPV DNA. Colposcopic biopsies cost on average US$ 67.71 per procedure. VIA was least sensitive but most cost-effective at US$ 17.05 per true CIN2+ case detected. The cost per case detected for Pap testing was US$ 130.63 using a conventional definition for positive results and US$ 187.52 using a more conservative definition. HPV DNA testing was US$ 320.09 per case detected. Colposcopic biopsy costs largely drove the total and per case costs. A 71% reduction in HPV DNA screening costs would make it competitive with the conservative Pap definition. Women need access to services which meet their needs and address the burden of cervical dysplasia and cancer in this region. Although most cost-effective, VIA may require more frequent screening due to low sensitivity, an important consideration for an HIV-positive population with increased risk for disease progression.

The video fluorescent device for diagnostics of cancer of human reproductive system

NASA Astrophysics Data System (ADS)

Brysin, Nickolay N.; Linkov, Kirill G.; Stratonnikov, Alexander A.; Savelieva, Tatiana A.; Loschenov, Victor B.

2008-06-01

Photodynamic therapy (PDT) is one of the advanced methods of treatment of skin cancer and surfaces of internal organs. The basic advantages of PDT are high efficiency and low cost of treatment. PDT technique is needed for providing fluorescent diagnostics. Laser-based systems are widely applied to the fluorescence excitations for diagnostic because of a narrow spectrum of fluorescence excitation and high density of radiation. Application of laser systems for carrying out fluorescent diagnostics gives the image of a tumor distorted by speckles that does not give an opportunity to obtain full information about the form of a tumor quickly. Besides, these laser excitation systems have complicated structure and high cost. As a base for the development and creation of a video fluorescent device one of commercially produced colposcopes was chosen. It allows to decrease cost of the device, and also has enabled to make modernization for already used colposcopes. A LED-based light source was offered to be used for fluorescence excitation in this work. The maximum in a spectrum of radiation of LEDs corresponds to the general spectral maximum of protoporphyrin IX (PPIX) absorption. Irradiance in the center of a light spot is 31 mW/cm2. The receiving optical system of the fluorescent channel is adjusted at 635 nm where a general spectral maximum of fluorescence PPIX is located. Also the device contains a RGB video channel, a white light source and a USB spectrometer LESA-01-BIOSPEC, for measurement of spectra of fluorescence and diffusion reflections in treatment area. The software is developed for maintenance of the device. Some studies on laboratory animals were made. As a result, areas with the increased concentration of a PPIX were correctly detected. At present, the device is used for diagnostics of cancer of female reproductive system in Research Centre for Obstetrics, Gynecology and Perinatology of the Russian Academy of Medical Sciences (Moscow, Russia).

Factors associated with psychological distress following colposcopy among women with low-grade abnormal cervical cytology: a prospective study within the Trial Of Management of Borderline and Other Low-grade Abnormal smears (TOMBOLA).

PubMed

Sharp, Linda; Cotton, Seonaidh; Carsin, Anne-Elie; Gray, Nicola; Thornton, Alison; Cruickshank, Margaret; Little, Julian

2013-02-01

Little is known about psychological after-effects of colposcopy and associated investigations and treatment in women with low-grade abnormal cervical cytology. We investigated psychological distress following colposcopy and related procedures. Nine hundred and eighty-nine women aged 20-59 years with routine cytology showing low-grade abnormalities were recruited to the Trial of Management of Borderline and other Low-grade Abnormal smears and attended colposcopy. If the cervical transformation zone (TZ) was colposcopically abnormal, women had immediate loop excision or diagnostic punch biopsies, with treatment if these showed cervical intraepithelial neoplasia grade 2/3 (CIN2/3). Women completed socio-demographic and psychosocial questionnaires at recruitment and before colposcopy. Six weeks after their last procedure, women completed the Impact of Event Scale (IES). Logistic regression was used to determine factors associated with significant psychological distress (IES ≥ 9). Analyses were stratified by colposcopic impression. The response rate was 74%. Six weeks after the last procedure, 86 (21%) of 391 women with a normal TZ had significant distress compared with 144 (42%) of 337 with an abnormal TZ. In both groups, significant distress was associated with anxiety pre-colposcopy and pain or discharge afterwards. Additional variables predicting distress in women with a normal TZ were worries about having sex and dissatisfaction with support from others. In women with an abnormal TZ, additional predictors of distress were younger age, CIN2/3, bleeding following colposcopy and worries about having cancer. Substantial proportions of women experience psychological distress after colposcopy and related procedures, even when the colposcopy is normal. This is an important cost of cervical screening. Interventions to alleviate these adverse psychological effects are required. Copyright © 2011 John Wiley & Sons, Ltd.

Malaria knowledge and treatment adherence in a Brazilian Amazon community.

PubMed

Souza, Taisa Guimarães de; Reiners, Annelita Almeida Oliveira; Azevedo, Rosemeiry Capriata de Souza; Fontes, Cor Jesus Fernandes; Ferreira, Rita Graziela; Do Carmo, Priscilla Uiara

2016-11-24

Malaria remains an important public health problem despite recent scientific breakthroughs regarding knowledge about malaria and treatment strategies. The objective of this study was to analyze malaria patients' knowledge about the disease, its treatment and prevention, linking it to drug treatment adherence. A descriptive, cross-sectional, epidemiological survey study was conducted in the district of Três Fronteiras-MT. The study included 618 individuals who were interviewed and examined for Plasmodium infection. Of the 52 patients diagnosed with malaria, 27 were visited at home for an interview about malaria knowledge and treatment adherence. Treatment adherence was evaluated by self-reports and drug conference. A total of 18 patients had satisfactory knowledge (66.6%) and 9 were evaluated as having unsatisfactory knowledge (33.4%) about malaria. Of the 27 malaria patients, 21 (77.8%) reported having taken all the medication as prescribed, in the correct period of time and dosage, and had no medication tablets remaining. The majority (72.2%) of patients who had satisfactory knowledge, as well as the majority (88.8%) of those who had unsatisfactory knowledge, adhered to the malaria treatment. This study revealed a high proportion of patients with satisfactory prior knowledge about malaria and revealed that this knowledge was not related to disease treatment adherence. These results have implications for planning strategies for malaria control in the region and could contribute to the reduction in the cases of non-adherence to malaria treatment.

Associations between sperm abnormalities, breed, age, and scrotal circumference in beef bulls

PubMed Central

Menon, Ajitkumar G.; Barkema, Herman W.; Wilde, Randy; Kastelic, John P.; Thundathil, Jacob C.

2011-01-01

The objectives of this study were to determine the associations of breed, age, and scrotal circumference (SC), and their interaction, on the prevalence of sperm abnormalities in beef bulls in Alberta, Canada, and the percentage of satisfactory potential breeders identified during breeding soundness examination solely due to normal sperm morphology. Eosin-nigrosin stained semen smears and evaluation reports of 1642 bull breeding soundness evaluations were procured from 6 veterinary clinics in Alberta. Sperm morphology was determined for at least 100 sperm per bull. The most common defects were detached head [4.86% ± 5.71%; mean ± standard deviation (s)], distal midpiece reflex (6.19% ± 9.13%), and bent tail (1.01% ± 1.54%). Although breed, age, and SC did not significantly affect the prevalence of head or midpiece defects, morphologically normal or abnormal sperm, tail defects were more prevalent in Angus and Hereford bulls compared with other breeds. Overall, solely on the basis of sperm morphology, 1363 (83.0%) bulls were classified as satisfactory potential breeders and the remainder 279 (17.0%) as unsatisfactory (> 30% abnormal sperm, > 20% defective heads, or both). Although not significantly different, the breed with the highest percentage of satisfactory potential breeders was Limousin (90.6%) and the lowest was Hereford (78.8%). That 17% of bulls subjected to breeding soundness evaluation were designated as unsatisfactory solely on the basis of sperm morphology highlights its importance. PMID:22468020

A reexamination of the effects of adsorbates on the Raman spectrum of gibbsite.

USGS Publications Warehouse

Cunningham, K.W.; Goldberg, M.C.

1983-01-01

Previous workers have attributed substantial changes in the Raman intensities of the OH stretching bands in solid, powdered gibbsite of surface area 10 m2/g to surface interactions with the adsorbates 093Ca2+,HxPO43x- and SiO2.xH2O. These changes apparently resulted from an unsatisfactory Raman measurement procedure as a re-examination using an internal intensity standard (Na2C2O4 crystals) with gibbsite of surface area 39 m2/g showed no significant changes in the low-frequency band-height ratios of gibbsite and adsorbates.-D.J.M.

Continuing education for general practice. 2. Systematic learning from experience.

PubMed Central

al-Shehri, A; Stanley, I; Thomas, P

1993-01-01

Prompted by evidence that the recently-adopted arrangements for ongoing education among established general practitioners are unsatisfactory, the first of a pair of papers examined the theoretical basis of continuing education for general practice and proposed a model of self-directed learning in which the experience of established practitioners is connected, through the media of reading, reflection and audit, with competence for the role. In this paper a practical, systematic approach to self-directed learning by general practitioners is described based on the model. The contribution which appropriate participation in continuing medical education can make to enhancing learning from experience is outlined. PMID:8373649

The impact of customer focus on program participation rates in the Virginia WIC Program (Special Supplemental Nutrition Program for Women, Infants, and Children).

PubMed

Chance, K G; Green, C G

2001-01-01

It has been shown in the for-profit sector (business, service, and manufacturing) that the success of an organization depends on its ability to satisfy customer requirements while eliminating waste and reducing costs. The purpose of this article was to examine the impact of current practices in customer focus on program participation rates in the Virginia WIC Program. The results of this study showed that the use of customer-focused strategies was correlated to program participation rates in the WIC Program. The mean data showed that teamwork and accessibility were at unsatisfactory levels in Virginia.

10-year experience of CO2-laser application in ambulance gynecology

NASA Astrophysics Data System (ADS)

Stachanov, Michael L.; Masychev, Victor I.; Velsher, Leonid Z.; Kirkin, Vladimir V.; Zhashkov, Roman V.; Kocharian, Emilia A.

2000-10-01

CO2-laser surgical systems have come to stay in everyday practice of modern physicians and are successfully used in colposcopic and laparoscopic surgery. Results, obtained in ambulance gynecology are especially impressing. CO2- laser provides high medical- and cost-effective treatment. Presented work describes many-years experience of CO2- laser application. 439 patients with various vulvaric and cervix diseases were operated within this period. Laser beam parameters were selected according to requirements ((tau) =4 J/cm2) treatment without carbonization. Analyses of the results showed that the laser successfully destructs uterine cervix erosion, endocervicosis, dysplasia, leukoplakia, eritoplakia of uterine cervix, various benignant pathologies and focus degenerative process in ambulate conditions.

Colposcopy audit for improving quality of service in areas with a high incidence of cervical cancer.

PubMed

Manopunya, Manatsawee; Suprasert, Prapaporn; Srisomboon, Jatupol; Kietpeerakool, Chumnan

2010-01-01

To audit routine colposcopy performance using 8 standard requirements of the National Health Service Cervical Screening Programme (NHSCSP). Records of women who underwent colposcopy for abnormal cervical cytology between January and December 2008 at Chiang Mai University Hospital, Thailand, were reviewed. The standard requirements were not achieved in 2 practices: (1) the proportion of women who had recordings of visibility of the transformation zone (96.6%) did not achieve the NHSCSP requirement of 100%; and (2) the rate of excisional biopsy (87.8%) was lower than the 95% minimum required. Colposcopic performance at Chiang Mai University Hospital was generally favorable. However, re-audit is necessary to ensure that unmet standards of performance are improved and achieved standards are maintained.

The Fate of DDH Hips Showing Cartilaginous or Fibrous Tissue-filled Joint Spaces Following Primary Reduction.

PubMed

Kim, Hui Taek; Lee, Tae Hoon; Ahn, Tae Young; Jang, Jae Hoon

Because the use of magnetic resonance imaging is still not universal for the patients with developmental dysplasia of the hip patients, orthopaedists do not generally distinguish widened joint spaces which are "empty" after primary treatment (and therefore still reducible), from those which are filled and much more difficult to treat. To date no studies have focused on the latter hips. We treated and observed the outcomes for 19 hips which showed filled joint spaces after primary treatment. We retrospectively reviewed 19 cases of developmental dysplasia of the hip: (1) who showed a widened joint space on radiographs after primary treatment; and (2) whose magnetic resonance imaging showed that the widened joint space was accompanied by acetabular cartilage hypertrophy and/or was filled with fibrous tissues. All patients were over 1 year old at the time of primary reduction (reduction was closed in 4 patients, open in 6, and open with pelvic osteotomy in 9). Thirteen patients received at least 1 secondary treatment. Final results were classified using a modified Severin classification. Final outcomes were satisfactory in 10 (52.6%) and unsatisfactory in 9 (47.4%). The widened joint spaces gradually filled with bone, resulting in a shallow acetabulum in the patients with unsatisfactory results. Of 9 patients who underwent combined pelvic osteotomy at the time of primary reduction, results were satisfactory in 6 (66.7%), whereas all patients who had only closed or open primary reduction had unsatisfactory results. Combined pelvic osteotomy at the time of primary reduction is advisable in hips with widened joint spaces. However, hips with filled joint spaces after primary treatment often have unsatisfactory results even after additional pelvic and/or femoral osteotomy. Level IV-prognostic study.

Impact of specimen adequacy on the assessment of renal allograft biopsy specimens.

PubMed

Cimen, S; Geldenhuys, L; Guler, S; Imamoglu, A; Molinari, M

2016-01-01

The Banff classification was introduced to achieve uniformity in the assessment of renal allograft biopsies. The primary aim of this study was to evaluate the impact of specimen adequacy on the Banff classification. All renal allograft biopsies obtained between July 2010 and June 2012 for suspicion of acute rejection were included. Pre-biopsy clinical data on suspected diagnosis and time from renal transplantation were provided to a nephropathologist who was blinded to the original pathological report. Second pathological readings were compared with the original to assess agreement stratified by specimen adequacy. Cohen's kappa test and Fisher's exact test were used for statistical analyses. Forty-nine specimens were reviewed. Among these specimens, 81.6% were classified as adequate, 6.12% as minimal, and 12.24% as unsatisfactory. The agreement analysis among the first and second readings revealed a kappa value of 0.97. Full agreement between readings was found in 75% of the adequate specimens, 66.7 and 50% for minimal and unsatisfactory specimens, respectively. There was no agreement between readings in 5% of the adequate specimens and 16.7% of the unsatisfactory specimens. For the entire sample full agreement was found in 71.4%, partial agreement in 20.4% and no agreement in 8.2% of the specimens. Statistical analysis using Fisher's exact test yielded a P value above 0.25 showing that - probably due to small sample size - the results were not statistically significant. Specimen adequacy may be a determinant of a diagnostic agreement in renal allograft specimen assessment. While additional studies including larger case numbers are required to further delineate the impact of specimen adequacy on the reliability of histopathological assessments, specimen quality must be considered during clinical decision making while dealing with biopsy reports based on minimal or unsatisfactory specimens.

Assessment of Primary Health Care in the Treatment of Tuberculosis in a Brazilian Locality of the International Triple Frontier

PubMed Central

Silva-Sobrinho, Reinaldo Antonio; Wysocki, Anneliese Domingues; Scatena, Lúcia Marina; Pinto, Erika Simone Galvão; Beraldo, Aline Ale; Andrade, Rubia Laine Paula; Zilly, Adriana; Munhak da Silva, Rosane Meire; Gomes, Michela Prestes; Mayer, Paulo César Morales; Ruffino-Netto, Antonio; Villa, Tereza Cristina Scatena

2017-01-01

Objective: To evaluate the performance of Primary Health Care (PHC) in treatment of TB patients in a triple international border municipality. Methods: The present study was an evaluative survey of cross-sectional and quantitative approach conducted with 225 PHC healthcare professionals. Data was collected through a structured and validated instrument, which provided five indicators of "structure" and four indicators of "process" classified as unsatisfactory, regular or satisfactory. Results: The "structure" component was unsatisfactory for the indicator of professionals involved in TB care and training, and regular for the indicator of connection between the units and other levels of care. The "process" component was regular for the indicators of TB information, directly observed treatment and reference and counter reference on TB, and unsatisfactory for external actions on TB control. Conclusion: The "structure" and "process" components points out some weaknesses in terms of management and organization of human resources. Low frequency of training and the turnover influenced the involvement of professionals. Elements of "structure" and "process" show the need for investing in the PHC team and improving the clinical management of cases. PMID:29204229

Recruiting Faculty Leaders at U.S. Medical Schools: A Process Without Improvement?

PubMed

Marsh, James D; Chod, Ronald

2017-11-01

Recruiting faculty leaders to work in colleges of medicine is a ubiquitous, time-consuming, costly activity. Little quantitative information is available about contemporary leadership recruiting processes and outcomes. In this article, the authors examine current recruiting methods and outcomes in colleges of medicine and compare academic search approaches with the approaches often employed in intellectual-capital-rich industries.In 2015, the authors surveyed chairs of internal medicine at U.S. medical schools regarding their recruiting practices and outcomes-specifically their selection methods, the duration of searches, the recruitment of women and minorities underrepresented in medicine (URM), and their satisfaction with search outcomes.The authors found that department chairs were extensively engaged in numerous searches for leaders. The recruitment process most commonly required 7 to 12 months from initiation to signed contract. Interestingly, longer searches (19+ months) were much more frequently associated with a recruitment outcome that chairs viewed as unsatisfactory or very unsatisfactory. Most leadership searches produced very few women and URM finalists. The biggest perceived hurdles to successful recruitment were the need to relocate the candidate and family and the shortage of good candidates.The process of recruiting leaders in academic medicine has changed little in more than 25 years. Process improvement is important and should entail carefully structured search processes, including both an overhaul of search committees and further emphasis on leadership development within the college of medicine. The authors propose specific steps to enhance recruitment of members of URM groups and women to leadership positions in academic medicine.

A follow-up study of hygiene in catering premises at large-scale events in the United Kingdom.

PubMed

Willis, C; Elviss, N; McLauchlin, J

2015-01-01

To investigate food hygiene practices at large events by assessing the microbiological quality of ready-to-eat food, drinking water, food preparation surfaces, cleaning cloths and wristbands worn by food handlers for event security purposes. Over a 7-month period, 1662 samples were collected at 153 events and examined for microbiological contamination. Eight per cent of food samples were of an unsatisfactory quality. A further one per cent contained potentially hazardous levels of human pathogenic bacteria. 27% of water samples, 32% of swabs and 56% of cloths were also unsatisfactory. These results represented an improvement in hygiene compared to a previous study carried out 12 months previously. A fifth of food handler wristbands were contaminated with Enterobacteriaceae, Escherichia coli and/or coagulase-positive staphylococci, with those bands made from fabric being more frequently contaminated than those made from plastic or other materials. This study provides evidence that the food hygiene at large-scale events may have improved. However, there is still a need for continued efforts to maintain an ongoing improvement in cleaning regimes and food hygiene management. This study was part of an ongoing focus on large events in the lead-up to the London 2012 Olympics. Lessons learnt here will be important in the planning of future large events. © 2014 Crown copyright. © 2014 Society for Applied Microbiology This article is Published with the permission of the Controller of HMSO and Queen's Printer for Scotland.

Factors related to attrition in surgery residency based on application data.

PubMed

Naylor, Rebekah A; Reisch, Joan S; Valentine, R James

2008-07-01

To determine whether variables in the surgery resident selection process will predict attrition or performance during residency training. Retrospective study. A university residency program. A total of 111 categorical surgery residents matched during a 10-year period (1991-2000). Satisfactory outcome included successful completion of training and the American Board of Surgery examinations on the first attempt. Participants with a satisfactory outcome were stratified into good or marginal performance based on adverse actions during residency. Of 111 residents studied, 28 (25.2%) had an unsatisfactory outcome; attrition occurred in 25 (22.5%). Univariate analysis identified the following variables as predictors of unsatisfactory outcome: age at entry older than 29 years (P = .005), female sex (P = .02), courses repeated (P = .01), "C" grades on transcript (P = .01), no participation in team sports (P = .02), and lack of superlative comments in the dean's letter (P = .03). The following variables were retained in the multivariate model: age older than 29 years (odds ratio [OR], 0.11; 95% confidence interval [CI], 0.02-0.47; P = .003), summary comments in the dean's letter (OR, 4.57; 95% CI, 2.00-10.43; P < .001), participation in team sports (OR, 4.96; 95% CI, 1.36-18.05; P = .02), and merit scholarship in medical school (OR, 0.25; 95% CI, 0.08-0.78; P = .02). Attrition can be predicted from factors identified on residency applications, with nonacademic factors being more important. Among residents who completed the program, no predictors of performance were identified.

Type of employment relationship and mortality: prospective study among Finnish employees in 1984-2000.

PubMed

Nätti, Jouko; Kinnunen, Ulla; Mäkikangas, Anne; Mauno, Saija

2009-04-01

The study investigated the relationship between the type of employment (permanent/temporary) contract and mortality. Factors through which temporary employment was expected to be associated with increased mortality were the degree of satisfaction with the uncertainty related to temporary work situation (Study 1) and the voluntary/involuntary basis for temporary work (Study 2). In Study 1 the data consisted of representative survey on Finnish employees in 1984 (n = 4502), which was merged with register-based follow-up data in Statistics Finland covering years 1985-2000. In Study 2 the data consisted of representative survey on Finnish employees in 1990 (n = 3502) with register-based follow-up data covering years 1991-2000. The relative risk of death was examined by conducting Cox proportional hazards analyses for the permanent and the two temporary employment groups, respectively. In Study 1 temporary employees feeling the insecure situation unsatisfactory had a 1.95-fold higher risk of mortality than permanent employees (95% CI 1.13-3.35) after adjusted for background, health- and work-related factors. In Study 2 employees in the position of having a temporary job on the involuntarily basis had a 2.59-fold higher risk of mortality than permanent employees (95% CI 1.16-5.80). The present study confirmed that temporary employees are not a homogeneous group, which holds true even for mortality. Those temporary employees, who either felt the insecure situation unsatisfactory or who worked in temporary work involuntarily, had higher risk of mortality than permanent employees.

[Clinical studies on flomoxef in acute tonsillitis].

PubMed

Tomiyama, M

1994-09-01

To objectively evaluate the clinical efficacy and safety in acute tonsillitis, flomoxef (FMOX) was examined for the distribution of sensitivity of clinical strains to it and for its clinical usefulness. 1. The 80% minimum inhibitory concentration of 11 clinical strains of Gram-positive bacteria, 6 of Gram-negative bacteria and 5 of anaerobic bacteria was 0.39 microgram/ml. FMOX showed the strongest, most comprehensive antibacterial action among the drugs tested. 2. Thirty patients received FMOX. Clinical effectiveness was evaluated in 28 patients, and clinical usefulness and safety in 30. 3. The clinical efficacy rate ('excellent' and 'good') was 75% (21/28). 4. As for bacteriological response, bacterial elimination rates were 67% for Gram-positive bacteria, 100% for Gram-negative bacteria, 100% for anaerobic bacteria and 100% for mixed infections. 5. Side effects occurred in 2 (6%) patients: drug eruption and diarrhea in 1 patient each. These symptoms improved rapidly after discontinuation of the drug. 6. Although abnormal clinical test results were found in 7 (23%) patients, i.e., increases in GOT and GPT in 2, in GPT in 4 and in BUN in 1, they were transient. 7. The usefulness of FMOX was assessed in light of its efficacy and safety. It was highly satisfactory in 14 patients, satisfactory in 11, relatively satisfactory in 1, unsatisfactory in 2 and highly unsatisfactory in 2, and rate of usefulness was 83%. FMOX is considered to be highly useful for the treatment of severe acute tonsillitis.

Pity and Fear: Myths and Images of the Disabled in Literature Old and New = Lastima y Miedo: Mito e Imagenes del Invalido en la Literatura Antigua y Moderna = La Pitie et la Peur: Mythes et Images des Infirmes dans la Literature Ancienne et Moderne. Proceedings of a Literary Symposium Sponsored by ICD-International Center for the Disabled in Collaboration with the United Nations (October 27, 1981).

ERIC Educational Resources Information Center

Fiedler, Leslie A.; And Others

The booklet (also in Spanish and French) presents an edited transcript of a conference dealing with images of the disabled in literature and the arts. L. Fielder's keynote paper traces the evolving role of disabled people by examining, in films and novels, the role of myth in society, the debilitating use of euphemisms, the unsatisfactory attempts…

Pityriasis rubra pilaris: evolution of challenges in promising treatment options.

PubMed

Sehgal, Virendra N; Srivastava, Govind; Verma, Prashant

2012-01-01

Pityriasis rubra pilaris is an uncommon inflammatory dermatosis that is well recognized across the globe. Erythroderma is a common presentation. A precise diagnosis of pityriasis rubra pilaris is based on morphologic features and is classified into 6 types: classic adult onset (type I), atypical adult (type II), classic juvenile (type III), circumscribed juvenile (type IV), atypical juvenile (type V), and human immunodeficiency virus-associated (type VI). Several conventional systemic and/or topical treatments are currently in use. Largely, their results are unsatisfactory and limited by long-term toxicity. The authors investigate the efficacy of a wide spectrum of drugs by examining historical (archive) and promising (modern) treatment modalities for the treatment of pityriasis rubra pilaris.

Gender differences in health care utilization and outcome of respiratory tuberculosis in Alexandria.

PubMed

Kamel, M I; Rashed, S; Foda, N; Mohie, A; Loutfy, M

2003-07-01

A study of gender differences in health care utilization and outcome of respiratory tuberculosis was carried out in Alexandria, Egypt. A cohort of 334 patients was followed-up for 8 months; 69.2% of cases were males. The pattern of tuberculosis symptoms was similar for both sexes. Women started treatment earlier than men. Women had significantly lower scores in knowledge, beliefs and attitudes about tuberculosis than men. Compliance was unsatisfactory for both sexes. Men tended to be more adherent to drugs and to sputum and X-ray examinations but there were no sex differences in compliance with health education and medical examinations. No significant sex differences in treatment outcome were found: the overall cure rate was 60.5% and treatment failure was 4.8%. Multiple regression analysis showed satisfaction with medical care was the only significant predictor of treatment failure.

Use of Mueller matrix colposcopy in the characterization of cervical collagen anisotropy

NASA Astrophysics Data System (ADS)

Montejo, Karla A.; Chue-Sang, Joseph; Bai, Yuqiang; Stoff, Susan; Holness, Nola; Gonzalez, Mariacarla; Gomes, Jefferson; Gandjbakhche, Amir; Chernomordik, Viktor V.; Ramella-Roman, Jessica C.

2017-02-01

Preterm birth (PTB) presents a serious medical heath concern in both economically developed and developing nations, with incidence rate from 15%-11% respectively. Changes in cervical collagen bundle orientation and distribution may prove to be a predictor of PTB. Polarization imaging is an effective means to measure optical anisotropy in birefringent biological tissue such as those rich in collagen. Non-invasive, full-field Mueller Matrix polarimetry (MMP) imaging methodologies, optical coherence tomography (OCT), and second harmonic generation (SHG) microscopy were used to assess cervical collagen content and structure in non-pregnant cervices. In vivo studies using a Mueller Matrix colposcope are underway. Further studies of cervical collagen orientation throughout pregnancy are needed to understand if Mueller matrix polarimetry can effectively identify at-risk conditions for PTB.

Atypical Squamous Cells of Undetermined Significance: Bethesda Classification and Association with Human Papillomavirus

PubMed Central

Barcelos, Ana Cristina Macêdo; Michelin, Márcia Antoniazi; Adad, Sheila Jorge; Murta, Eddie Fernando Candido

2011-01-01

Introduction. To analyze patients with atypical squamous cells of undetermined significance (ASCUS) through a cytology review and the presence of microbiological agents, with consideration of colposcopy and semiannual tracking. Methods. 103 women with ASCUS were reviewed and reclassified: normal/inflammatory, ASCUS, low-grade squamous intraepithelial lesion (LSIL), or high-grade squamous intraepithelial lesion (HSIL). If ASCUS confirmed, it was subclassified in reactive or neoplastic ASCUS, ASC-US, or ASC-H; and Regione Emilia Romagna Screening Protocol. Patients underwent a colposcopic examination, and test for Candida sp., bacterial vaginosis, Trichomonas vaginalis, and human papillomavirus (HPV) were performed. Results. Upon review, ASCUS was diagnosis in 70/103 (67.9%), being 38 (54.2%) reactive ASCUS and 32 (45.71%) neoplastic ASCUS; 62 (88.5%) ASC-US and 8 (11.41%) ASC-H. ASCUS (Regione Protocol), respectively 1-5: 15 (21.4%), 19 (27.1%), 3 (27.1%), 16 (22.8%), and 1 (1.4%). A higher number of cases of cervical intraepithelial neoplasia (CIN) II/III in the biopsies of patients with ASC-H compared to ASC-US (P = .0021). High-risk HPV test and presence of CIN II/III are more frequent in ASC-H than ASC-US (P = .031). Conclusions. ASC-H is associated with clinically significant disease. High-risk HPV-positive status in the triage for colposcopy of patients with ASC-US is associated with increased of CIN. PMID:21760701

High-resolution anoscopy: Unchartered territory for gastroenterologists?

PubMed

Albuquerque, Andreia

2015-09-25

High-resolution anoscopy (HRA) is a procedure where patients with an increased risk of anal cancer, like men who have sex with men, human immunodeficiency virus infected individuals, transplant patients and women with a history of lower genital tract neoplasia, with abnormal anal cytology results, are submitted to anal and perianal visualization under magnification. This will allow for a better detection of anal high-grade lesions that can be treated, in an effort to prevent anal cancer. Anal cancer screening follows the same principles that cervical cancer screening. During this procedure, an anoscope is inserted and a colposcope is used to examine systematically the squamocolumnar junction, the transformation zone and the perianal skin. Initially the observation is done with no staining and then with the application of acetic acid and Lugol's iodine solution, allowing for better lesion identification and characterization. Any suspicious lesion seen should be carefully evaluated and biopsied. Without HRA only a small percentage of suspicious lesions are identified. High-grade lesions that are detected can be ablated under HRA. This is a challenging exam to perform, with a long learning curve and the number of clinicians performing it is limited, although the growing number of patients that need to been screened. Specific equipment is required, with these patients ideally been followed by a multidisciplinary team, in a reference centre. HRA remains unfamiliar for many gastroenterologists.

Visual inspection of cervix with acetic acid: a good alternative to pap smear for cervical cancer screening in resource-limited setting.

PubMed

Khan, Momna; Sultana, Syeda Seema; Jabeen, Nigar; Arain, Uzma; Khans, Salma

2015-02-01

To determine the diagnostic accuracy of visual inspection of cervix using 3% acetic acid as a screening test for early detection of cervical cancer taking histopathology as the gold standard. The cross-sectional study was conducted at Civil Hospital Karachi from July 1 to December 31, 2012 and comprised all sexually active women aged 19-60 years. During speculum examination 3% acetic acid was applied over the cervix with the help of cotton swab. The observations were noted as positive or negative on visual inspection of the cervix after acetic acid application according to acetowhite changes. Colposcopy-guided cervical biopsy was done in patients with positive or abnormal looking cervix. Colposcopic-directed biopsy was taken as the gold standard to assess visual inspection readings. SPSS 17 was used for statistical analysis. There were 500 subjects with a mean age of 35.74 ± 9.64 years. Sensitivity, specifically, positive predicted value, negative predicted value of visual inspection of the cervix after acetic acid application was 93.5%, 95.8%, 76.3%, 99%, and the diagnostic accuracy was 95.6%. Visual inspection of the cervix after acetic acid application is an effective method of detecting pre-invasive phase of cervical cancer and a good alternative to cytological screening for cervical cancer in resource-poor setting like Pakistan and can reduce maternal morbidity and mortality.

In vivo diagnosis of cervical precancer using Raman spectroscopy and genetic algorithm techniques.

PubMed

Duraipandian, Shiyamala; Zheng, Wei; Ng, Joseph; Low, Jeffrey J H; Ilancheran, A; Huang, Zhiwei

2011-10-21

This study aimed to evaluate the clinical utility of applying near-infrared (NIR) Raman spectroscopy and genetic algorithm-partial least squares-discriminant analysis (GA-PLS-DA) to identify biomolecular changes of cervical tissues associated with dysplastic transformation during colposcopic examination. A total of 105 in vivo Raman spectra were measured from 57 cervical sites (35 normal and 22 precancer sites) of 29 patients recruited, in which 65 spectra were from normal sites, while 40 spectra were from cervical precancerous lesions (i.e., 7 low-grade CIN and 33 high-grade CIN). The GA feature selection technique incorporated with PLS was utilized to study the significant biochemical Raman bands for differentiation between normal and precancer cervical tissues. The GA-PLS-DA algorithm with double cross-validation (dCV) identified seven diagnostically significant Raman bands in the ranges of 925-935, 979-999, 1080-1090, 1240-1260, 1320-1340, 1400-1420, and 1625-1645 cm(-1) related to proteins, nucleic acids and lipids in tissue, and yielded a diagnostic accuracy of 82.9% (sensitivity of 72.5% (29/40) and specificity of 89.2% (58/65)) for precancer detection. The results of this exploratory study suggest that Raman spectroscopy in conjunction with GA-PLS-DA and dCV methods has the potential to provide clinically significant discrimination between normal and precancer cervical tissues at the molecular level.

Safety and pharmacokinetics of dapivirine delivery from matrix and reservoir intravaginal rings to HIV-negative women.

PubMed

Nel, Annalene; Smythe, Shanique; Young, Katherine; Malcolm, Karl; McCoy, Clare; Rosenberg, Zeda; Romano, Joseph

2009-08-01

Vaginal microbicides for the prevention of HIV transmission may be an important option for protecting women from infection. Incorporation of dapivirine, a lead candidate nonnucleoside reverse transcriptase inhibitor, into intravaginal rings (IVRs) for sustained mucosal delivery may increase microbicide product adherence and efficacy compared with conventional vaginal formulations. Twenty-four healthy HIV-negative women 18-35 years of age were randomly assigned (1:1:1) to dapivirine matrix IVR, dapivirine reservoir IVR, or placebo IVR. Dapivirine concentrations were measured in plasma and vaginal fluid samples collected at sequential time points over the 33-day study period (28 days of IVR use, 5 days of follow-up). Safety was assessed by pelvic/colposcopic examinations, clinical laboratory tests, and adverse events. Both IVR types were safe and well tolerated with similar adverse events observed in the placebo and dapivirine groups. Dapivirine from both IVR types was successfully distributed throughout the lower genital tract at concentrations over 4 logs greater than the EC50 against wild-type HIV-1 (LAI) in MT4 cells. Maximum concentration (Cmax) and area under the concentration-time curve (AUC) values were significantly higher with the matrix than reservoir IVR. Mean plasma concentrations of dapivirine were <2 ng/mL. These findings suggest that IVR delivery of microbicides is a viable option meriting further study.

The effect of "breathable" panty liners on the female lower genital tract.

PubMed

Giraldo, Paulo C; Amaral, Rose L G; Juliato, Cássia; Eleutério, José; Brolazo, Eliane; Gonçalves, Ana K S

2011-10-01

To evaluate whether the use of "breathable" panty liners (BPLs) alters the normal vaginal flora, increases the incidence of bacterial vaginosis and/or vaginal candidiasis, or causes vulvar irritation. A randomized controlled trial assessed the vaginal ecosystem of women without complaints of vaginal discharge. The study group (n=53) wore BPLs for 10-12 hours each day for 75 consecutive days, whereas the control group (n=54) wore only their usual underwear. At each of 6 visits during 3 menstrual cycles, participants underwent gynecologic examination with colposcopic evaluation and pH measurement, in addition to assessment of vaginal microbial flora, intensity of inflammatory processes, and presence of vaginal candidiasis/bacterial vaginosis in Gram-stained smears. After 75 consecutive days of BPL use, 40/44 (90.9%) and 42/44 (95.5%) women reported no complaints of vaginal discharge or vulvar itching/burning, respectively. There was no significant difference between the study group and the control group with regard to positive vaginal fungus cultures (5/44 [11.4%] vs 8/50 [16.0%]; P=0.7848) or bacterial vaginosis (3/44 [6.8%] vs 2/50 [4.0%]; P=0.7974) at the end of the study period. After 75 days of BPL use, there was no significant increase in vulvovaginal candidiasis, bacterial vaginosis, vulvovaginal irritation, or vulvovaginal inflammation. Copyright © 2011 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

An audit of the laboratory service provided to the Health Service Executive Orthodontic Department, St James Hospital, Dublin.

PubMed

Al-Awadhi, E A; Wolstencroft, S J; Blake, M

2006-01-01

To evaluate the service purchased from contracted orthodontic laboratories used by HSE (SWA) regional orthodontic unit, St. James's Hospital, Dublin and identify deficiencies in the current service. A data collection questionnaire was designed and distributed to the departmental orthodontists for a period of three months (October-December 2004). Gold standards, drawn up based on the authors' ideal requirements and published guidelines, were supplied to grade the work returned. During the study period 363 items of laboratory work were requested. 20% of the laboratory work arrived late and most of the delayed work was delayed for more than 24 hours. Most laboratory delays occurred with functional appliances, retainers and study models. Prior to fit, 20% of the appliances required adjustments for more than 30 seconds. 65% of laboratory work returned to the department met all of the gold standards. 10% of appliances were considered unsatisfactory. Functional appliances were most often ill fitting accounting for almost half of the unsatisfactory laboratory work. The majority of the laboratory work returned to the department met our gold standards and arrived on time. Forty six percent of the appliances required adjustments. Functional appliances required the most adjustments; one in five of all functional appliances ordered were considered unsatisfactory.

Effect of novel patient interaction on students’ performance of pregnancy options counseling

PubMed Central

Shaddeau, Angela; Nimz, Abigail; Sheeder, Jeanelle; Tocce, Kristina

2015-01-01

Background Although options counseling is a fundamental skill for medical providers, previous research has identified gaps in medical school reproductive health education. Purpose To determine if a 1-h novel patient interaction (NPI) improves student performance when caring for a standardized patient with an unintended pregnancy. Methods From September 2012 to June 2013 we randomized third-year medical students at the University of Colorado School of Medicine to the standard curriculum plus an NPI, or the standard curriculum only. The NPI consisted of a 1-h small-group session with a patient who discussed her experiences with options counseling and her decision to terminate her pregnancy. Students completed an Objective Structured Clinical Examination (OSCE) at the rotation's end, which included options counseling. The primary outcome was the proportion of participants achieving ‘excellence’ on the OSCE checklist. ‘Excellence’ was defined as a score ≥90%. Examinations were flagged as ‘unsatisfactory encounters’ if core competencies were not addressed. OSCE standardized patients and evaluators were blinded to group assignment. Results In total, 135 students were eligible and randomized: 75 to NPI; 60 to control. During the OSCE, few students achieved ‘excellence’ (24% NPI vs. 28% control, p=0.57). There were no differences between scores for components of options counseling. More students in the control group ‘appeared somewhat uncomfortable’ delivering the pregnancy test results (5% NPI vs. 18% control, p=0.006). More than half (54%) of the intervention group and 67% of controls had ‘unsatisfactory encounters’ (p=0.16), almost exclusively due to omission of adoption. Most students addressed abortion (96% NPI vs. 92% control, p=0.29). Conclusions A 1-h NPI does not improve medical students’ performance of pregnancy options counseling and the option of adoption is routinely omitted. Adoption is clearly an area that needs greater attention when designing comprehensive reproductive health curriculum for medical students. PMID:26654215

Effect of novel patient interaction on students' performance of pregnancy options counseling.

PubMed

Shaddeau, Angela; Nimz, Abigail; Sheeder, Jeanelle; Tocce, Kristina

2015-01-01

Although options counseling is a fundamental skill for medical providers, previous research has identified gaps in medical school reproductive health education. To determine if a 1-h novel patient interaction (NPI) improves student performance when caring for a standardized patient with an unintended pregnancy. From September 2012 to June 2013 we randomized third-year medical students at the University of Colorado School of Medicine to the standard curriculum plus an NPI, or the standard curriculum only. The NPI consisted of a 1-h small-group session with a patient who discussed her experiences with options counseling and her decision to terminate her pregnancy. Students completed an Objective Structured Clinical Examination (OSCE) at the rotation's end, which included options counseling. The primary outcome was the proportion of participants achieving 'excellence' on the OSCE checklist. 'Excellence' was defined as a score ≥90%. Examinations were flagged as 'unsatisfactory encounters' if core competencies were not addressed. OSCE standardized patients and evaluators were blinded to group assignment. In total, 135 students were eligible and randomized: 75 to NPI; 60 to control. During the OSCE, few students achieved 'excellence' (24% NPI vs. 28% control, p=0.57).There were no differences between scores for components of options counseling. More students in the control group 'appeared somewhat uncomfortable' delivering the pregnancy test results (5% NPI vs. 18% control, p=0.006). More than half (54%) of the intervention group and 67% of controls had 'unsatisfactory encounters' (p=0.16), almost exclusively due to omission of adoption. Most students addressed abortion (96% NPI vs. 92% control, p=0.29). A 1-h NPI does not improve medical students' performance of pregnancy options counseling and the option of adoption is routinely omitted. Adoption is clearly an area that needs greater attention when designing comprehensive reproductive health curriculum for medical students.

Microbiological study of ready-to-eat salad vegetables from retail establishments uncovers a national outbreak of salmonellosis.

PubMed

Sagoo, S K; Little, C L; Ward, L; Gillespie, I A; Mitchell, R T

2003-03-01

The increasing availability of bagged prepared salad vegetables reflects consumer demand for fresh, healthy, convenient, and additive-free foods that are safe and nutritious. During May and June 2001 a study of retail bagged prepared ready-to-eat salad vegetables was undertaken to determine the microbiological quality of these vegetables. Examination of the salad vegetables revealed that the vast majority (3,826 of 3,852 samples; 99.3%) were of satisfactory or acceptable microbiological quality according to Public Health Laboratory Service microbiological guidelines, while 20 (0.5%) samples were of unsatisfactory microbiological quality. Unsatisfactory quality was due to Escherichia coli and Listeria spp. (not Listeria monocytogenes) levels in excess of 10(2) CFU/g. However, six (0.2%) samples were of unacceptable microbiological quality because of the presence of Salmonella (Salmonella Newport PT33 [one sample], Salmonella Umbilo [three samples], and Salmonella Durban [one sample]) or because of a L. monocytogenes level of 660 CFU/g, which indicates a health risk. In each case, the retailer involved and the UK Food Standards Agency were immediately informed, and full investigations were undertaken. Nineteen cases of Salmonella Newport PT33 infection were subsequently identified throughout England and Wales. The outbreak strain of Salmonella Newport PT33 isolated from the salad and from humans had a unique plasmid profile. Campylobacter spp. and E. coli O157 were not detected in any of the samples examined. The presence of Salmonella, as well as high levels of L. monocytogenes, is unacceptable. However, minimally processed cut and packaged salad is exposed to a range of conditions during growth, harvest, preparation, and distribution, and it is possible that these conditions may increase the potential for microbial contamination, highlighting the necessity for the implementation of good hygiene practices from farm to fork to prevent contamination and/or bacterial growth in these salad products.

Accuracy of reading liquid based cytology slides using the ThinPrep Imager compared with conventional cytology: prospective study

PubMed Central

d'Assuncao, Jefferson; Irwig, Les; Macaskill, Petra; Chan, Siew F; Richards, Adele; Farnsworth, Annabelle

2007-01-01

Objective To compare the accuracy of liquid based cytology using the computerised ThinPrep Imager with that of manually read conventional cytology. Design Prospective study. Setting Pathology laboratory in Sydney, Australia. Participants 55 164 split sample pairs (liquid based sample collected after conventional sample from one collection) from consecutive samples of women choosing both types of cytology and whose specimens were examined between August 2004 and June 2005. Main outcome measures Primary outcome was accuracy of slides for detecting squamous lesions. Secondary outcomes were rate of unsatisfactory slides, distribution of squamous cytological classifications, and accuracy of detecting glandular lesions. Results Fewer unsatisfactory slides were found for imager read cytology than for conventional cytology (1.8% v 3.1%; P<0.001). More slides were classified as abnormal by imager read cytology (7.4% v 6.0% overall and 2.8% v 2.2% for cervical intraepithelial neoplasia of grade 1 or higher). Among 550 patients in whom imager read cytology was cervical intraepithelial neoplasia grade 1 or higher and conventional cytology was less severe than grade 1, 133 of 380 biopsy samples taken were high grade histology. Among 294 patients in whom imager read cytology was less severe than cervical intraepithelial neoplasia grade 1 and conventional cytology was grade 1 or higher, 62 of 210 biopsy samples taken were high grade histology. Imager read cytology therefore detected 71 more cases of high grade histology than did conventional cytology, resulting from 170 more biopsies. Similar results were found when one pathologist reread the slides, masked to cytology results. Conclusion The ThinPrep Imager detects 1.29 more cases of histological high grade squamous disease per 1000 women screened than conventional cytology, with cervical intraepithelial neoplasia grade 1 as the threshold for referral to colposcopy. More imager read slides than conventional slides were satisfactory for examination and more contained low grade cytological abnormalities. PMID:17604301

Integrative approach to diagnosis of genital human papillomaviruses (HPV) infection of female.

PubMed

Dunjic, Momir; Stanisic, Slavisa; Krstic, Dejan; Stanisic, Miodrag; Ignjatic, Z Jovanovic; Dunjic, Marija

2014-01-01

Human papillomavirus (HPV) is a virus from the papillomavirus family that is capable of infecting humans. Some types of HPVs cause warts, while others can lead to cancers of the cervix, vulva, vagina, penis, oropharynx and anus. High-risk human papillomavirus (hr HPV) has been detected in almost all cervical squamous cell carcinomas and adenocarcinomas. All patients examined by colposcopy. Cervical swab is routinely done and patients are screened with both HPV DNA by Real Time Polimerase Chain Reaction (RT PCR) testing and Pap testing. Pictures obtained by colposcopy were examined by indirect Bi-Digital O-Ring Test (BDORT) by using reference control substance (RCS): HPV 16, HPV 18, and Integrin α5 β1. BDORT was developed by Prof. Omura Y. of New York and received U.S. patent in 1993. For detection of HPV DNA we used RT PCR and standard Qiagen method which detect 18 types (16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68, 6, 11, 42, 43, 44) of HPV from smear. From 63 patients where is BDORT indicated presence of HPV, in 49 patients (77.8%) RT PCR confirmed presence of HPV. From 63 patients in 54 patients (85.7%), we detected, by colposcopic exam, some kind of lesions associated with HPV infection. Results obtained by RT PCR: one type (1/18) of DNA HPV in 25 patients (51.02%), 2 types (2/18) in 15 patients (30.61%) and 3 types (3/18) in 9 patients (18.37%). Although BDORT results usually have higher sensitivity and detection rate is much higher, it can be used together with RT PCR in detection of HPV and cervical lesions associated with HPV infection.

Preliminary study on pressure brazing and diffusion welding of Nb-1Zr to Inconel 718

NASA Technical Reports Server (NTRS)

Moore, T. J.

1990-01-01

Future space power systems may include Nb-1Zr/Inconel 718 dissimilar metal joints for operation at 1000 K for 60,000 h. The serviceability of pressure-brazed and diffusion-welded joints was investigated. Ni-based metallic glass foil filler metals were used for brazing. Ni and Fe foils were used as diffusion welding inter-layers. Joint soundness was determined by metallographic examination in the as-brazed and as-welded condition, after aging at 1000 K, and after thermal cycling. Brazed joints thermally cycled in the as-brazed condition and diffusion-welded joints were unsatisfactory because of cracking problems. Brazed joints may meet the service requirements if the joints are aged at 1000 K prior to thermal cycling.

Capitation and risk adjustment in health care financing: an international progress report.

PubMed

Rice, N; Smith, P C

2001-01-01

In every system of health care, capitation payments have become the accepted tool used by health care purchasers in much of the developed world to determine prospective budgets. The policy prescription of capitation is perceived to address both equity objectives (of great importance in publicly funded systems of health care) and efficiency objectives (the dominant concern in competitive insurance markets). An examination of the current state of the art in 20 countries outside the United States in which health care capitation has been implemented confirms that capitation has assumed central importance within diverse systems of health care. In practice, however, the setting of capitation payments has been heavily constrained to date by poor data availability and unsatisfactory analytic methodology.

Intermediate-grade squamous intraepithelial lesion may be a valid diagnostic/interpretive category.

PubMed

Ravinsky, Esther; Baker, Patricia

2009-02-01

We undertook this study to assess the characteristics of smears with features intermediate between high-grade squamous intraepithelial lesion (HSIL) and low-grade squamous intraepithelial lesion (ISIL). We also wanted to determine how these smears correlate with high risk biopsy diagnosis and to compare this with the biopsy correlation of LSIL and HSIL. Seventy-four squamous intraepithelial lesion (SIL) smears were identified as intermediate-grade SIL smears taken at colposcopy in a 1 year period. They were correlated with concurrent colposcopically guided biopsies. Thirty-five percent of cases with intermediate-grade SIL smears had a biopsy diagnosis of moderate dysplasia or higher as compared with 12% for LSIL 74% for HSIL. This confirmed our hypothesis that intermediate-grade SIL smears have a rate of biopsy diagnosis of moderate dysplasia or higher intermediate to that of LSIL and HSIL.

Examinations regarding the prevalence of intestinal parasitic diseases in Polish soldiers contingents assigned to missions abroad.

PubMed

Korzeniewski, Krzysztof

2011-01-01

The aim of this paper is to present the program of diagnostic examinations regarding the detection and following treatment of intestinal parasitic diseases in the population of Polish soldiers serving in different climatic and sanitary conditions. Intestinal parasitoses remain one of the health problems of soldiers participating in contemporary military operations. This fact mainly results from unsatisfactory sanitary and hygienic standards in the regions where troops are deployed, contamination of water and soil, inappropriate processes of purifying drinking water, and the terrible condition of sewage systems, water purification plants, or sewage treatment facilities. The occurrence of such diseases is further facilitated by disregard of some basic principles of food and feeding hygiene. Mass examinations of Polish troops to find the prevalence of intestinal parasitoses will cause a decrease in the morbidity rate of parasitic diseases among Polish soldiers deployed in military operations. They can also lead to a decrease in expenditure on medical treatment of disease-related complications and on damages awarded to soldiers who have developed a serious disease while being engaged in a mission abroad.

Air Charter - The Business Airline of the Future...But, Does the Business Traveler Know?

NASA Technical Reports Server (NTRS)

Kaps, Robert W.; Gardner, Robin C.; Hartung, Jeffrey W.

2001-01-01

Historically, FAR Part 121 commercial carriers have provided efficient, economical and safe air transportation for corporate and business users. Recently, however, corporate and business travelers find their travel plans disrupted by delays, bankruptcies, poor service, lost baggage, fare increases, labor strikes and other systemic difficulties that degrade their travel experience to unsatisfactory levels. This article examines these Part 121 service delivery problems and, utilizing a tripartite investigative methodology, examines an alternative air transport mode: FAR Part 135 on-demand charter travel products. This long extant segment of our national air transportation system is set prime to support increased demand for charter services. Corporate and business travelers are set prime to utilize viable, cost effective alternatives to commercial travel products. Two research questions emerge. First is whether corporate and business travelers are aware of Part 135 travel alternatives. Second is whether Part 135 charter service providers are aware of this latent demand and are effectively targeting this demand segment in their marketing efforts. The three-part surveys employed to investigate these questions examined demand side

An assessment of the microbiological quality of liver-based pâté in England 2012-13: comparison of samples collected at retail and from catering businesses.

PubMed

McLAUCHLIN, J; Jørgensen, F; Aird, H; Charlett, A; Elviss, N; Fenelon, D; Fox, A; Willis, C; Amar, C F L

2017-06-01

The purpose of this study was to investigate the microbiological quality of liver pâté. During 2012-13, a total of 870 samples, unrelated to the investigation of food-poisoning outbreaks, were collected either at retail (46%), catering (53%) or the point of manufacture (1%) and were tested using standard methods to detect Salmonella spp. or Campylobacter spp., and to enumerate for Listeria spp., including Listeria monocytogenes, Clostridium perfringens, coagulase-positive staphylococci including Staphylococcus aureus, Bacillus spp., including Bacillus cereus, Escherichia coli, Enterobacteriaceae, and aerobic colony counts (ACCs). Seventy-three percent of samples were of satisfactory microbiological quality, 18% were borderline and 9% unsatisfactory. Salmonella spp. or Campylobacter spp. was not recovered from any sample. The most common causes of unsatisfactory results were elevated ACCs (6% of the samples) and high Enterobacteriaceae counts (4% of samples). The remaining unsatisfactory results were due to elevated counts of: E. coli (three samples); B. cereus (one sample at 2·6 × 105 cfu/g); or L. monocytogenes (one sample at 2·9 × 103 cfu/g). Pâté from retail was less likely to be contaminated with L. monocytogenes than samples collected from catering and samples from supermarkets were of significantly better microbiological quality than those from catering establishments.

The psychopharmacology algorithm project at the Harvard South Shore Program: an update on schizophrenia.

PubMed

Osser, David N; Roudsari, Mohsen Jalali; Manschreck, Theo

2013-01-01

This article is an update of the algorithm for schizophrenia from the Psychopharmacology Algorithm Project at the Harvard South Shore Program. A literature review was conducted focusing on new data since the last published version (1999-2001). The first-line treatment recommendation for new-onset schizophrenia is with amisulpride, aripiprazole, risperidone, or ziprasidone for four to six weeks. In some settings the trial could be shorter, considering that evidence of clear improvement with antipsychotics usually occurs within the first two weeks. If the trial of the first antipsychotic cannot be completed due to intolerance, try another until one of the four is tolerated and given an adequate trial. There should be evidence of bioavailability. If the response to this adequate trial is unsatisfactory, try a second monotherapy. If the response to this second adequate trial is also unsatisfactory, and if at least one of the first two trials was with risperidone, olanzapine, or a first-generation (typical) antipsychotic, then clozapine is recommended for the third trial. If neither trial was with any these three options, a third trial prior to clozapine should occur, using one of those three. If the response to monotherapy with clozapine (with dose adjusted by using plasma levels) is unsatisfactory, consider adding risperidone, lamotrigine, or ECT. Beyond that point, there is little solid evidence to support further psychopharmacological treatment choices, though we do review possible options.

East Coast fever as a continued constraint to livestock improvement in Tanzania: a case study.

PubMed

Kambarage, D M

1995-08-01

An investigation was carried out into the cause of deaths in a recently established dairy farm with 211 animals. Clinical examination revealed that 14 out of 15 sick animals were depressed, pyrexic, anorexic and had variable degrees of respiratory distress and enlarged lymph nodes. These clinical signs were suggestive of East Coast fever (ECF). This was confirmed on positive demonstration of piroplasms and macroschizonts in blood and lymph node smears respectively, and on post-mortem examination. Parasites were also demonstrated in smears taken from 5 other animals which were pyrexic and had enlarged lymph nodes. Epidemiological investigation revealed that the occurrence of the disease was associated with contact with tick-infested pastures and unsatisfactory tick control due to improper dipping of the herd. The use of pasture by pastoral cattle which are rarely dipped also increased tick infestation. It is concluded that, unless effective disease control is applied ECF will continue to be a major killer disease of cattle in Tanzania.

Teaching for Scientific Literacy? An Examination of Instructional Practices in Secondary Schools in Barbados

NASA Astrophysics Data System (ADS)

Archer-Bradshaw, Ramona E.

2017-02-01

This study examined the extent to which the instructional practices of science teachers in Barbados are congruent with best practices for teaching for scientific literacy. Additionally, through observation of practice, it sought to determine the teachers' demonstrated role in the classroom, their demonstration of learning through discourse, learning goals and the nature of classroom activities. Five hundred nineteen students from 12 of the 23 secondary schools on the island and 15 teachers across 8 schools participated in the study. Data were collected by means of a questionnaire, an observational schedule and field notes. It was found that while problem-solving and questioning were mainly used in the classroom, the use of experiments was among the least popular teaching strategies. Additionally, results showed that teachers' display of the knowledge of the characteristics of scientific literacy was unsatisfactory. Generally, the findings indicate a gap between teaching for scientific literacy as expressed in the literature and current instructional practices in secondary science classrooms in Barbados.

Plato's Pharmacy and Derrida's Drugstore.

ERIC Educational Resources Information Center

Mortensen, Chris

2000-01-01

In a long essay titled "Plato's Pharmacy, Jacques Derrida attacked Western metaphysics. This article undertakes to defend Western philosophy from Derrida's arguments. It is shown that Derrida's arguments are very unsatisfactory. (Author/VWL)

Free-Spinning and Recovery Characteristics of a 1/19-Scale Model of the North American T-28C Airplane, TED No. NACA AD 3127

NASA Technical Reports Server (NTRS)

Bowman, James S., Jr.

1956-01-01

An investigation has been conducted in the Langley 20-foot free-spinning tunnel on a l/19-scale model of the North American T-28C airplane to determine the spin and recovery characteristics. The T-28C airplane is similar to the T-28B airplane except for slight modifications for the arresting hook. The lower rear section of the fuselage was cut out and, consequently, the lower part of the rudder was removed to make a smooth fairing with the fuselage. The T-28B airplane had good recovery characteristics; but these modifications, along with the addition of gun packages on the wings, led to poor and unsatisfactory spin-recovery characteristics during demonstration spins of the T-28C airplane. Model test results indicated that without the gun packages installed, satisfactory recoveries could be obtained if the elevators were held full back while the rudder was fully reversed and the ailerons were held neutral. However, with the addition of gun packages to the wings and the corresponding change in loading, recoveries were considered unsatisfactory. Recoveries attempted by using a larger chord or larger span rudder were improved very slightly, but were still considered marginal or unsatisfactory. Strakes placed on the nose of the model were effective in slowing the spin rotation slightly and, in most instances, decreased the turns for recovery slightly. Recovery characteristics were slightly marginal for the full fuel loading when strakes and the extended-chord rudder were installed; but with the wing fuel partly used, recovery characteristics were again considered unsatisfactory or, at least, definitely on the marginal side. The optimum control technique for recovery is movement of the rudder to full against the spin with the stick held full back (elevators full up) and the ailerons held neutral, followed by forward movement of the stick only after the spin rotation ceases. Inverted-spin test results indicate that the airplane will spin steep and fast and that recovery by full rudder reversal will be satisfactory if the ailerons are held neutral.

Micronuclei as biomarkers for evaluating the risk of malignant transformation in the uterine cervix.

PubMed

Aires, G M A; Meireles, J R C; Oliveira, P C; Oliveira, J L; Araújo, E L; Pires, B C; Cruz, E S A; Jesus, N F; Pereira, C A B; Cerqueira, E M M

2011-01-01

We evaluated micronucleus and apoptosis occurrence among women with normal smears and women with different kinds of cervical abnormalities, i.e., inflammatory processes and low- and high-grade squamous intraepithelial lesions (N = 12, N = 10 and N = 27, respectively). The sample included 59 women who were seen at a public medical service for cervical cancer prevention in Feira de Santana, Bahia, Brazil. The diagnosis was established by means of cytological, colposcopic, and histopathological examination. Cytogenetic analysis was performed on 2000 cells from each woman and included assessment of micronuclei and nuclear degenerative abnormalities indicative of apoptosis (karyorrhexis, pyknosis and condensed chromatin). Micronucleus frequency was significantly higher in the women with high-grade squamous intraepithelial lesions than in the women without cervical abnormalities or inflammatory processes (P< 0.001) or in the women with low-grade squamous intraepithelial lesions (P < 0.005). The frequency of apoptosis was similar in women without cervical abnormalities and women showing high-grade squamous intraepithelial lesions (P > 0.50), and significantly lower in women without cervical abnormalities and in women showing high-grade squamous intraepithelial lesions than in women showing inflammatory processes or low-grade squamous intraepithelial lesions (P < 0.0001). These results indicate that, in addition to Papanicolaou cervical cytological analysis, it would be useful to use micronucleus analysis to screen women who are at risk of developing cervical cancer. The assessment of nuclear degenerative abnormalities indicative of apoptosis increased the sensitivity of this test.

ThinPrep Pap-smear and cervical intraepithelial neoplasia in reproductive-aged Thai women.

PubMed

Rugpao, S; Koonlertkit, S; Ruengkrist, T; Lamlertkittikul, S; Pinjaroen, S; Limtrakul, A; Werawatakul, Y; Sinchai, W

2009-06-01

To estimate the incidence of abnormal cervical cytology by ThinPrep Pap-tests and cervical intraepithelial neoplasia (CIN) in young adult reproductive-aged Thai women. A total of 1254 women distributed in all regions of Thailand were monitored from 2002 through 2004. Women were screened for abnormal cervical cytology using the ThinPrep method every 6 months. Interpretation of cervical cytology was based on the Bethesda system, version 2001. Women who had the ThinPrep Pap results as atypical squamous cells of undetermined significance or worse underwent colposcopic examination. The ThinPrep and all cervical tissue samples obtained from diagnostic or therapeutic procedures were analyzed and reviewed by Covance Central Laboratory Service, Inc., Indianapolis, USA. The cumulative incidence of abnormal ThinPrep Pap-tests was as follows: 15.3 per 100 woman years (WY) (95% confidence interval [CI] 12.3, 18.9) at 6 months; 12.3 per 100 WY (95% CI 10.3, 14.6) at 12 months; and 11.6 per 100 WY (95% CI 10.0, 13.5) at 18 months. Of 1448.6 woman years of follow up, the incidence of CIN1 was 4.1 per 100 WY (95% CI 3.2, 5.3); CIN2 0.8 per 100 WY (95% CI 0.4, 1.4); and CIN3 0.6 per 100 WY (95% CI 0.3, 1.2). The incidence of abnormal ThinPrep Pap-test and CIN in young adult Thai women had been reported. No comparable data is available.

An experimental investigation of a hollow cathode discharge

NASA Technical Reports Server (NTRS)

Wilbur, P. J.

1971-01-01

An experimental study of the effects of various modifications to the hollow cathode discharge region of a 20 cm electron bombardment ion thruster is presented. The introduction of electrical insulation between the main and cathode discharge regions is shown to have no significant effect on thruster performance. Adjustment of both the diameter and length of the cathode discharge region from the design condition are examined and the reduced sizes are shown to effect large improvements in propellant utilization when the thruster is operating at about 30% of the design thrust level. Performance improvements are shown to be less significant at higher thrust levels. The feasibility of using a high voltage tickler electrode to initiate the cathode-keeper discharge is considered and results obtained suggest this mode of startup is unsatisfactory.

Evaluation of the ADHD rating scale in youth with autism

PubMed Central

Yerys, Benjamin E.; Nissley-Tsiopinis, Jenelle; de Marchena, Ashley; Watkins, Marley W.; Antezana, Ligia; Power, Thomas J.; Schultz, Robert T.

2016-01-01

Scientists and clinicians regularly use clinical screening tools for attention deficit/hyperactivity disorder (ADHD) to assess comorbidity without empirical evidence that these measures are valid in youth with autism spectrum disorder (ASD). We examined the prevalence of youth meeting ADHD criteria on the ADHD rating scale fourth edition (ADHD-RS-IV), the relationship of ADHD-RS-IV ratings with participant characteristics and behaviors, and its underlying factor structure in 386 7-17 year olds with ASD without intellectual disability. Expected parent prevalence rates, relationships with age and externalizing behaviors were observed, but confirmatory factor analyses revealed unsatisfactory fits for one-, two-, three-factor models. Exploratory analyses revealed several items cross-loading on multiple factors. Implications of screening ADHD in youth with ASD using current diagnostic criteria are discussed. PMID:27738853

The DSM diagnostic criteria for pedophilia.

PubMed

Blanchard, Ray

2010-04-01

This paper contains the author's report on pedophilia, submitted on June 2, 2008, to the work group charged with revising the diagnoses concerning sexual and gender identity disorders for the fifth edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM). The author reviews the previously published criticisms and empirical research concerning the diagnostic criteria for pedophilia and presents criticism and relevant research of his own. The review shows that the DSM diagnostic criteria for pedophilia have repeatedly been criticized as unsatisfactory on logical or conceptual grounds, and that published empirical studies on the reliability and validity of these criteria have produced ambiguous results. It therefore seems that the current (i.e., DSM-IV-TR) diagnostic criteria need to be examined with an openness to major changes in the DSM-V.

Comparisons of monthly mean cosmic ray counting rates observes from worldwide network of neutron monitors

NASA Technical Reports Server (NTRS)

Ryu, J. Y.; Wada, M.

1985-01-01

In order to examine the stability of neutron monitor observation, each of the monthly average counting rates of a neutron monitors is correlated to those of Kiel neutron monitor. The regression coefficients thus obtained are compared with the coupling coefficients of isotropic intensity radiation. The results of the comparisons for five year periods during 1963 to 1982, and for whole period are given. The variation spectrum with a single power law with an exponent of -0.75 up to 50 GV is not so unsatisfactory one. More than one half of the stations show correlations with the coefficient greater than 0.9. Some stations have shifted the level of mean counting rates by changing the instrumental characteristics which can be adjusted.

LASER BIOLOGY AND MEDICINE: Combined application of optical methods to increase the information content of optical coherent tomography in diagnostics of neoplastic processes

NASA Astrophysics Data System (ADS)

Kuranov, R. V.; Sapozhnikova, V. V.; Shakhova, N. M.; Gelikonov, V. M.; Zagainova, E. V.; Petrova, S. A.

2002-11-01

A combined application of optical methods [optical coherent tomography (OCT), cross-polarisation optical coherent tomography, and fluorescence spectroscopy] is proposed for obtaining information on morphological and biochemical changes occurring in tissues in norm and pathology. It is shown that neoplastic and scar changes in esophagus can be distinguished using a combination of polarisation and standard OCT due to the difference between the depolarising properties of the tissues caused by the structural properties of collagenic fibres in stroma. It is shown that OCT combined with fluorescence spectroscopy with the use of 5-aminolevulinic acid is promising for determining the boundaries of carcinoma of the uterine cervix and vulva. It is found that the tumour boundary detected by optical methods coincides with the morphological boundary and extends beyond colposcopically determined boundary by about 2 mm.

Combined application of optical methods to increase the information content of optical coherent tomography in diagnostics of neoplastic processes

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

Kuranov, R V; Sapozhnikova, V V; Shakhova, N M

2002-11-30

A combined application of optical methods [optical coherent tomography (OCT), cross-polarisation optical coherent tomography, and fluorescence spectroscopy] is proposed for obtaining information on morphological and biochemical changes occurring in tissues in norm and pathology. It is shown that neoplastic and scar changes in esophagus can be distinguished using a combination of polarisation and standard OCT due to the difference between the depolarising properties of the tissues caused by the structural properties of collagenic fibres in stroma. It is shown that OCT combined with fluorescence spectroscopy with the use of 5-aminolevulinic acid is promising for determining the boundaries of carcinoma ofmore » the uterine cervix and vulva. It is found that the tumour boundary detected by optical methods coincides with the morphological boundary and extends beyond colposcopically determined boundary by about 2 mm. (laser biology and medicine)« less

[Changes in the vitamin A status in dysplastic epithelium of the cervix].

PubMed

Volz, J; van Rissenbeck, A; Blanke, M; Melchert, F; Schneider, A; Biesalski, H K

1995-01-01

In 34 patients with HVP-infection of the cervix and in 40 patients with CIN III standardised biopsies were taken from the involved area and normal cervical epithelium for determination of the local concentration of retinylester. In all cases diagnosis was confirmed colposcopically, cytologically and by histology. HPV infection was confirmed by in situ hybridisation. Determination of retinylester was performed by HPLC. No significant difference of local retinyl-plamitate concentration was detectable in HPV infected versus normal tissue. Retinyl-palmitate concentration was extremely lower in CIN III compared with normal cervical epithelium and HPV-infected tissue. The determination of plasma level of retinol showed no significant difference between the two groups. So it can be presumed that the reduction of retinyl-palmitat in CIN III is a local process and a local supplementation of Vitamin A might contribute to the prevention of cervical neoplasia.

42 CFR 433.120 - Procedures for reduction of FFP after reapproval review.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Claims Processing and Information Retrieval Systems § 433.120 Procedures for reduction of FFP after... significance of the unsatisfactory conditions in overall mechanized claims processing and information retrieval...

Geographic Education for Spaceship Earth

ERIC Educational Resources Information Center

Blachford, Kevin

1974-01-01

Six unsatisfactory ways of approaching geographic concepts in the classroom are presented. An alternative that would promote global-mindedness and the development of accurate mental maps in students is discussed in terms of teaching techniques. (JH)

9 CFR 113.406 - Tuberculin, Intradermic.

Code of Federal Regulations, 2014 CFR

2014-01-01

... stain) or other microorganisms (Gram stain). A serial which contains microorganisms is unsatisfactory... from one source which weigh 500-700 grams at the beginning of the test and which have not been used in...

9 CFR 113.406 - Tuberculin, Intradermic.

Code of Federal Regulations, 2011 CFR

2011-01-01

... stain) or other microorganisms (Gram stain). A serial which contains microorganisms is unsatisfactory... from one source which weigh 500-700 grams at the beginning of the test and which have not been used in...

9 CFR 113.406 - Tuberculin, Intradermic.

Code of Federal Regulations, 2012 CFR

2012-01-01

... stain) or other microorganisms (Gram stain). A serial which contains microorganisms is unsatisfactory... from one source which weigh 500-700 grams at the beginning of the test and which have not been used in...

9 CFR 113.406 - Tuberculin, Intradermic.

Code of Federal Regulations, 2013 CFR

2013-01-01

... stain) or other microorganisms (Gram stain). A serial which contains microorganisms is unsatisfactory... from one source which weigh 500-700 grams at the beginning of the test and which have not been used in...

9 CFR 113.406 - Tuberculin, Intradermic.

Code of Federal Regulations, 2010 CFR

2010-01-01

... stain) or other microorganisms (Gram stain). A serial which contains microorganisms is unsatisfactory... from one source which weigh 500-700 grams at the beginning of the test and which have not been used in...

48 CFR 49.504 - Termination of fixed-price contracts for default.

Code of Federal Regulations, 2010 CFR

2010-10-01

... simplified acquisition threshold, if appropriate (e.g., if the acquisition involves items with a history of unsatisfactory quality). (2) Transportation. If the contract is for transportation or transportation-related...

Regeneration after clear-cutting second-growth northern hardwoods

Treesearch

Robert W. Wilson; Victor S. Jensen

1954-01-01

Regeneration after clear-cutting second-growth northern hardwoods is often unsatisfactory, in both quantity and species composition. A small area on the Bartlett Experimental Forest near Bartlett, N.H., provides a good example.

Solution to the indexing problem of frequency domain simulation experiments

NASA Technical Reports Server (NTRS)

Mitra, Mousumi; Park, Stephen K.

1991-01-01

A frequency domain simulation experiment is one in which selected system parameters are oscillated sinusoidally to induce oscillations in one or more system statistics of interest. A spectral (Fourier) analysis of these induced oscillations is then performed. To perform this spectral analysis, all oscillation frequencies must be referenced to a common, independent variable - an oscillation index. In a discrete-event simulation, the global simulation clock is the most natural choice for the oscillation index. However, past efforts to reference all frequencies to the simulation clock generally yielded unsatisfactory results. The reason for these unsatisfactory results is explained in this paper and a new methodology which uses the simulation clock as the oscillation index is presented. Techniques for implementing this new methodology are demonstrated by performing a frequency domain simulation experiment for a network of queues.

Identification of platelet refractoriness in oncohematologic patients

PubMed Central

Ferreira, Aline Aparecida; Zulli, Roberto; Soares, Sheila; de Castro, Vagner; Moraes-Souza, Helio

2011-01-01

OBJECTIVES: To identify the occurrence and the causes of platelet refractoriness in oncohematologic patients. INTRODUCTION: Platelet refractoriness (unsatisfactory post-transfusion platelet increment) is a severe problem that impairs the treatment of oncohematologic patients and is not routinely investigated in most Brazilian services. METHODS: Forty-four episodes of platelet concentrate transfusion were evaluated in 16 patients according to the following parameters: corrected count increment, clinical conditions and detection of anti-platelet antibodies by the platelet immunofluorescence test (PIFT) and panel reactive antibodies against human leukocyte antigen class I (PRA-HLA). RESULTS: Of the 16 patients evaluated (median age: 53 years), nine (56%) were women, seven of them with a history of pregnancy. An unsatisfactory increment was observed in 43% of the transfusion events, being more frequent in transfusions of random platelet concentrates (54%). Platelet refractoriness was confirmed in three patients (19%), who presented immunologic and non-immunologic causes. Alloantibodies were identified in eight patients (50%) by the PIFT and in three (19%) by the PRA-HLA. Among alloimmunized patients, nine (64%) had a history of transfusion, and three as a result of pregnancy (43%). Of the former, two were refractory (29%). No significant differences were observed, probably as a result of the small sample size. CONCLUSION: The high rate of unsatisfactory platelet increment, refractoriness and alloimmunization observed support the need to set up protocols for the investigation of this complication in all chronically transfused patients, a fundamental requirement for the guarantee of adequate management. PMID:21437433

Management effectiveness evaluation in protected areas of southern Ecuador.

PubMed

López-Rodríguez, Fausto; Rosado, Daniel

2017-04-01

Protected areas are home to biodiversity, habitats and ecosystem as well as a critical component of human well-being and a generator of leisure-related revenues. However, management is sometimes unsatisfactory and requires new ways of evaluation. Management effectiveness of 36 protected areas in southern Ecuador have been assessed. The protected areas belong to three categories: Heritage of Natural Areas of the Ecuadorian State (PANE), created and funded by the State, Areas of Forest and Protective Vegetation (ABVP), created but no funded by the State, and private reserves, declared and funded by private entities. Management effectiveness was evaluated by answers of managers of the protected areas to questionnaires adapted to the socio-economic and environmental characteristics of the region. Questions were classified into six elements of evaluation: context, planning, inputs, processes, outputs and outcomes as recommended by IUCN. Results were classified into four levels: unsatisfactory, slightly satisfactory, satisfactory and very satisfactory. The PANE areas and private reserves showed higher management effectiveness levels (satisfactory and very satisfactory) than ABVP areas, where slightly satisfactory and unsatisfactory levels prevailed. Resources availability was found as the main reason behind this difference. The extension, age and province of location were found irrelevant. Outputs, inputs and processes require main efforts to improve management effectiveness. Improving planning and input in the PANE areas and inputs and outcomes on ABVP areas is necessary to obtain a similar result in all areas. Copyright © 2016 Elsevier Ltd. All rights reserved.

Determinants of Quality of Interview and Impact on Risk Estimates in a Case-Control Study of Bladder Cancer

PubMed Central

Silverman, Debra T.; Malats, Núria; Tardon, Adonina; Garcia-Closas, Reina; Serra, Consol; Carrato, Alfredo; Fortuny, Joan; Rothman, Nathaniel; Dosemeci, Mustafa; Kogevinas, Manolis

2009-01-01

The authors evaluated potential determinants of the quality of the interview in a case-control study of bladder cancer and assessed the effect of the interview quality on the risk estimates. The analysis included 1,219 incident bladder cancer cases and 1,271 controls recruited in Spain in 1998–2001. Information on etiologic factors for bladder cancer was collected through personal interviews, which were scored as unsatisfactory, questionable, reliable, or high quality by the interviewers. Eight percent of the interviews were unsatisfactory or questionable. Increasing age, lower socioeconomic status, and poorer self-perceived health led to higher proportions of questionable or unreliable interviews. The odds ratio for cigarette smoking, the main risk factor for bladder cancer, was 6.18 (95% confidence interval: 4.56, 8.39) overall, 3.20 (95% confidence interval: 1.13, 9.04) among unsatisfactory or questionable interviews, 6.86 (95% confidence interval: 4.80, 9.82) among reliable interviews, and 7.70 (95% confidence interval: 3.64, 16.30) among high-quality interviews. Similar trends were observed for employment in high-risk occupations, drinking water containing elevated levels of trihalomethanes, and use of analgesics. Higher quality interviews led to stronger associations compared with risk estimation that did not take the quality of interview into account. The collection of quality of interview scores and the exclusion of unreliable interviews probably reduce misclassification of exposure in observational studies. PMID:19478234

Factors that affect substance users' suicidal behavior: a view from the Addiction Severity Index in Korea.

PubMed

Kwon, Min; Yang, Soo; Park, Kyongran; Kim, Dai-Jin

2013-11-12

In South Korea, it has not been easy to negotiate studies that target drug users who are being punished by law, and accordingly, no study on suicidal ideation among substance users has been accomplished yet. In this study, the factors that affect substance users' suicidal ideation were confirmed. It was based on the data collected from 'The 2009 Study on Substance-Dependent Individuals in Korea' , which was conducted by The Catholic University of Korea in 2010 as a project sponsored by the Ministry of Health and Welfare of Korea. This study targeted 523 former hospital inpatients, prison inmates, and persons under protective supervision who had used substances such as psychotropic drugs, marijuana, and narcotic agents, and were in the recovery stage at various treatment/rehabilitation centers. Student's t and chi-square tests were used, and multivariate analysis was performed to examine the strength of the relationships between suicide ideation and various factors. According to this study, 41% of these substance users planned suicide with suicidal ideation. Suicidal ideation was confirmed as associated with an unsatisfactory domestic environment, insufficient and unsatisfactory spare time experiences with others, emotional abuse, severe depression, and trouble with controlling violent behavior. Of the substance users who had planned to commit suicide, 56% attempted suicide. Their suicide attempts were shown to have been associated with insufficient protective supervision and the experiences of physical abuse, trouble with controlling violent behavior, and doctors' prescriptions due to psychological or emotional problems. Based on this analysis of the factors that affect suicidal behavior, preventive measures and strategies for substance user were suggested in this study.

From habits of attrition to modes of inclusion: enhancing the role of private practitioners in routine disease surveillance.

PubMed

Phalkey, Revati K; Butsch, Carsten; Belesova, Kristine; Kroll, Marieke; Kraas, Frauke

2017-08-25

Private practitioners are the preferred first point of care in a majority of low and middle-income countries and in this position, best placed for the surveillance of diseases. However their contribution to routine surveillance data is marginal. This systematic review aims to explore evidence with regards to the role, contribution, and involvement of private practitioners in routine disease data notification. We examined the factors that determine the inclusion of, and the participation thereof of private practitioners in disease surveillance activities. Literature search was conducted using the PubMed, Web of Knowledge, WHOLIS, and WHO-IRIS databases to identify peer-reviewed and gray full-text documents in English with no limits for year of publication or study design. Forty manuscripts were reviewed. The current participation of private practitioners in disease surveillance efforts is appalling. The main barriers to their participation are inadequate knowledge leading to unsatisfactory attitudes and misperceptions that influence their practices. Complicated reporting mechanisms with unclear guidelines, along with unsatisfactory attitudes on behalf of the government and surveillance program managers also contribute to the underreporting of cases. Infrastructural barriers especially the availability of computers and skilled human resources are critical to improving private sector participation in routine disease surveillance. The issues identified are similar to those for underreporting within the Integrated infectious Disease Surveillance and Response systems (IDSR) which collects data mainly from public healthcare facilities. We recommend that surveillance program officers should provide periodic training, supportive supervision and offer regular feedback to the practitioners from both public as well as private sectors in order to improve case notification. Governments need to take leadership and foster collaborative partnerships between the public and private sectors and most importantly exercise regulatory authority where needed.

External Quality Monitoring of the Cervical Cytopathological Exams in the Rio de Janeiro City.

PubMed

Rocha, Vânia Stiepanowez de Oliveira; Malfacini, Solange da Silva; Gomes, Alex Moreira; Rocha, Cláudia Ramos Marques da

2018-06-20

 To discuss the implementation and contributions of the External Quality Monitoring in the city of Rio de Janeiro and to analyze the performance of the main providers of cervical cytopathology in this city from September 2013 to March 2017, here referred to as "Alpha laboratory" and "Beta laboratory."  Observational, cross-sectional, retrospective study using information from the Cervical Cancer Control Information System (SISCOLO, in the Portuguese acronym), municipal coordination module, External Quality Monitoring report. The proportions of false positives, false negatives, unsatisfactory samples and rejected samples were estimated. The agreement among the observers was analyzed through the Kappa index and the reduction of disagreements in the period for each laboratory studied, comparing the results of each cycle.  A total of 19,158 examinations were selected, of which 19,130 (99.85%) were monitored, 16.649 (87, 03%) were reviewed by the External Quality Monitoring Unit, 2,481 (12,97%) were rejected and 441 (2,65%) were considered unsatisfactory. The "Beta laboratory" presented excellent concordance in all cycles; the "Alpha laboratory" had good concordance in the first two cycles (K = 0.76 and 0.79), becoming excellent in the following four cycles. The average Kappa index was 0.85, with median of 0.86. The percentage of diagnostic disagreement was 6.63% of the reviewed exams, of which 5.38% required a change of conduct CONCLUSION:  External Quality Monitoring is an exercise in diagnostic improvement, and its implementation was fundamental to ensure the reliability of the cytopathological exams in the city of Rio de Janeiro. Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil.

Ergonomics perspective for identifying and reducing internal operative flow disruption for laparoscopic urological surgery.

PubMed

Al-Hakim, Latif; Xiao, Jiaquan; Sengupta, Shomik

2017-12-01

The aim of this study is to examine operative flow disruption that occurs inside the surgical field, (internal operative flow disruption (OFD)), during urological laparoscopies, and to relate those events to external ergonomics environment in terms of monitor location, level of instruments' handles, and location of surgical team members. According to the our best knowledge, this is the first study of its kind. A combination of real and video-aided observational study was conducted in the operating rooms at hospitals in Australia and China. Brain storming sessions were first conducted to identify the main internal OFD events, and the observable reasons, potential external, and latent ergonomic factors were listed. A prospective observational study was then conducted. The observer's records and the related video records of internal surgical fields were analysed. Procedures were categorised into groups based on similarity in ergonomics environment. The mapping process revealed 39 types of internal OFD events resulted from six reasons. A total of 24 procedures were selected and arranged into two groups, each with twelve procedures. Group A was carried out under satisfactory ergonomics environment, while Group B was conducted under unsatisfactory ergonomics environment. A total of 1178 OFD events were detected delaying the total observed operative times (2966 min) by 220 min (7.43%). Average OFD/h in group A was less than 15, while in group B about 29 OFD/h. There are two main latent ergonomics factors affecting the surgeon's performance; non-physiological posture and long-period static posture. The delays and number of internal OFD were nearly doubled where procedures were conducted under unsatisfactory external ergonomics environment. Some events such as stopping operation and irrelevant conversations during long procedures may have a positive influence on the surgeon's performance.

External rhinoplasty for the Arabian nose: a columellar scar analysis.

PubMed

Foda, Hossam M T

2004-01-01

This study aimed to evaluate columellar scar problems after external rhinoplasty in the Arabian population, and to analyze the technical factors that help prevent such problems and maximize the scar cosmesis. The investigation was conducted in university and private practice settings of the author in Alexandria, Egypt. A total of 600 Arab patients who underwent external rhinoplasty were included in the study. All the patients underwent surgery using the external rhinoplasty approach, in which bilateral alar marginal incisions were connected by an inverted V-shaped transcolumellar incision. At completion of the procedure, a two-layer closure of the columellar incision was performed. At a minimum of 1 year postoperatively, the columellar scar was evaluated subjectively by means of a patient questionnaire, and objectively by clinical examination and comparison of the close-up pre- and postoperative basal view photographs. Objectively, anything less than a barely visible, leveled, thin, linear scar was considered unsatisfactory. Subjectively, 95.5% of the patients rated the scar as unnoticeable, 3% as noticeable but acceptable, and 1.5% as unacceptable. Objectively, the scar was unsatisfactory in 7% of the cases. This was because of scar widening with or without depression (5%), hyperpigmentation (1.5%), and columellar rim notching (0.5%). The use of a deep 6/0 polydioxanon (PDS) suture significantly decreased the incidence of scar widening (p < 0.005).The columellar incision can be used safely in the Arab population regardless of their thick, dark, and oily skin. Technical factors that contributed to the favorable outcome of the columellar scar included proper planning of location and design of the incision used, precise execution, meticulous multilayered closure, and good postoperative care.

Does 100% Rapid Review Improve Cervical Cancer Screening?

PubMed

Queiroz Filho, José; Eleutério, José; Ney Cobucci, Ricardo; de Oliveira Crispim, Janaina Cristiana; Giraldo, Paulo César; Gonçalves, Ana Katherine

2018-01-01

The aim of this work was to evaluate 100% rapid review (100% RR) as a useful tool to detect false negative (FN) results. A sample of 8,677 swabs was investigated; the unsatisfactory and negative results were referred to 100% RR, concordant results were taken as the final diagnosis, while the discordant results were debated in a consensus meeting to reach a conclusion. The positive results were examined by 2 cytologists. The data were entered into SAS statistical software, and the agreement of the 100% RR results with the final diagnosis was tested with the weighted kappa statistic. There was a significant increase in unsatisfactory results from 348 to 1,927, and of positive results from 174 to 349. On the other hand, there was a substantial decrease in negative results from 8,155 to 6,401. Assessing the relative risk of FN results in smears that were not referred to quality control (100% RR) revealed the following results: atypical squamous cells of undetermined significance (ASC-US), 2.93; low-grade squamous intraepithelial lesion (LSIL), 2.72; high-grade squamous intraepithelial lesion/atypical squamous cells - cannot exclude HSIL (HSIL/ASC-H), 2.25. Evaluating by age group, a higher risk for LSIL (4.90) and ASC-US (3.85) was observed in patients aged under 25 years, whereas patients between 25 and 64 years and those over 64 years presented a higher risk for HSIL and ASC-H: 2.46 and 2.75, respectively. 100% RR is an effective screening tool for FN results in countries where molecular tests for DNA-HPV and prophylactic vaccines are not available in cervical cancer screening programs. © 2018 S. Karger AG, Basel.

Ultrasound-guided fine-needle aspiration biopsy of the thyroid.

PubMed

Tambouret, R; Szyfelbein, W M; Pitman, M B

1999-10-25

We reviewed the Massachusetts General Hospital experience with ultrasound-guided fine-needle aspiration biopsies (FNABs) of the thyroid to determine the indications, rate of unsatisfactory smears, correlation with excisional biopsy results, and verification of efficient use of personnel time. All radiologically guided FNABs of the thyroid from January 1993 through June 1997 were reviewed. As a measure of efficient use of technologist time, a sample of times spent by the technologist during the procedure for 20 cases in 1993 and 1997 was compared with that of an equal number of random nonthyroid image guided FNABs. Two hundred-ninety FNABs were identified in 251 patients, representing 12% of all thyroid FNABs and 11% of all radiologically guided FNABs. Indications in the 251 patients included multiple nodules (78), solitary nodules (61), complex nodules (39), prior failed FNAB (39), thyroid bed abnormalities post-thyroidectomy (21), difficult access (7), and investigation of recurrent tumor in residual thyroid lobe (6). Available records indicated 118 lesions were palpable and 45 were nonpalpable; the physical examination characteristics of the remainder (88) were not stated. Diagnoses included 44 unsatisfactory cases (15%), 103 macrofollicular lesions, 20 microfollicular lesions, 26 mixed macro/microfollicular lesions, 5 oxyphilic lesions, 1 trabecular pattern, 15 nonspecific follicular cell pattern, 9 follicular cell atypia, 30 cysts, 11 thyroiditis, 23 malignant tumors, and 3 other (1 parathyroid, 2 lymph node). Eighty-nine FNABs from 76 patients had subsequent surgical biopsy. Excisional biopsies in 14 unsatisfactory FNABs were benign. In the remaining 75 FNABs from 67 patients, 18 malignancies on FNAB were correctly diagnosed, but 3 other papillary carcinomas were only qualified as atypical follicular cells on cytology. No false-positive cases occurred. Of 15 macrofollicular lesions on cytology, 10 were adenomas on excision, only 2 of which were microfollicular adenomas, and 4 were adenomatous nodules. An aspirate of a parathyroid adenoma was misinterpreted as a macrofollicular lesion of the thyroid. Three microfollicular lesions on FNAB proved to be nodular hyperplasia on excision, and the other 11 were adenomas, 5 of them microfollicular. Average technologist time was significantly longer for thyroid FNABs than nonthyroid FNABs in 1993, but in the 1997 sample no significant difference was identified. Radiologically guided FNAB of the thyroid is a clinically useful procedure with a high correlation between benign lesions not needing excision (macrofollicular), and lesions that need excision (microfollicular/oxyphilic cell or malignant). Technologist time needed for immediate evaluation tends to decrease with increasing operator experience. Cancer (Cancer Cytopathol) Copyright 1999 American Cancer Society.

Mouth examination performance by children's parents and by adolescents in Fanconi anemia.

PubMed

Pivovar, Allana; Furquim, Camila Pinheiro; Bonfim, Carmem; Torres-Pereira, Cassius Carvalho

2017-11-01

Fanconi anemia (FA) is a rare genetic syndrome characterized by increased risk of developing malignant neoplasms, particularly oral squamous cell carcinoma. This study aims to ascertain the extent to which adolescents and guardians/parents of children with FA are aware of their oral cancer risks and assess their ability to perform mouth examination (ME). A cross-sectional study was conducted among patients with FA (between 6 and 16 years) and their parents. A total of 45 patients, 19 children and 26 adolescents, participated in the study. Among children less than 12 years of age, caregivers performed ME and adolescents between 12 and 16 years of age performed mouth self-examination (MSE). All parents were given a self-reporting questionnaire to collect sociodemographic data, information about health-related behaviors, and oral cancer awareness. Performance was evaluated using criteria for mucosal visualization and retracting ability. Subsequently, a dentist clinically examined all patient participants. Performance evaluation indicated that the examination quality was unsatisfactory in both groups. Statistical significance was found between ability to perform ME by marital status (P < 0.036), where divorced parents had more difficulty performing ME than nondivorced parents. Oral mucosa surveillance performed by parents and adolescents seems to be inaccurate. However, as an oral examination is a relatively inexpensive form of secondary prevention, it merits attention to teaching the technique to patients with FA and their caregivers. © 2017 Wiley Periodicals, Inc.

Evaluations of Guardrail Breakaway Cable Terminals

DOT National Transportation Integrated Search

1982-05-01

Currently recommended guardrail and median barrier breakaway cable terminals (BCT) were to be evaluated for performance with 1800-lb (800-kg) class minicars. Early findings indicated unsatisfactory performance of the guardrail BCT for end-on impacts ...

78 FR 6405 - Agency Information Collection (Supplemental Information for Change of Program or Reenrollment...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-01-30

... aptitudes, interests, and abilities, or that the cause of any unsatisfactory progress or conduct has been... already available in the claimant's VA education records or the results of academic or vocational...

45 CFR 1174.12 - Special grant or subgrant conditions for “high-risk” grantees.

Code of Federal Regulations, 2011 CFR

2011-10-01

...) NATIONAL FOUNDATION ON THE ARTS AND THE HUMANITIES NATIONAL ENDOWMENT FOR THE HUMANITIES UNIFORM...) Has a history of unsatisfactory performance, or (2) Is not financially stable, or (3) Has a management...

45 CFR 1174.12 - Special grant or subgrant conditions for “high-risk” grantees.

Code of Federal Regulations, 2013 CFR

2013-10-01

...) NATIONAL FOUNDATION ON THE ARTS AND THE HUMANITIES NATIONAL ENDOWMENT FOR THE HUMANITIES UNIFORM...) Has a history of unsatisfactory performance, or (2) Is not financially stable, or (3) Has a management...

45 CFR 1174.12 - Special grant or subgrant conditions for “high-risk” grantees.

Code of Federal Regulations, 2014 CFR

2014-10-01

...) NATIONAL FOUNDATION ON THE ARTS AND THE HUMANITIES NATIONAL ENDOWMENT FOR THE HUMANITIES UNIFORM...) Has a history of unsatisfactory performance, or (2) Is not financially stable, or (3) Has a management...

45 CFR 1174.12 - Special grant or subgrant conditions for “high-risk” grantees.

Code of Federal Regulations, 2012 CFR

2012-10-01

...) NATIONAL FOUNDATION ON THE ARTS AND THE HUMANITIES NATIONAL ENDOWMENT FOR THE HUMANITIES UNIFORM...) Has a history of unsatisfactory performance, or (2) Is not financially stable, or (3) Has a management...

[Heavy silicone oil (Densiron® 68) in proliferative vitreoretinopathy: 4 years of experience].

PubMed

Macías-Murelaga, B; Ruiz, M; Bascarán, L; Gibelalde, A; Aldazabal, M; Irigoyen, C

2013-11-01

Prospective observational study including 10 patients (age range: 27-74 years) with recurrent retinal detachment (RD) and proliferative vitreoretinopathy (PVR) and 2.8 mean unsatisfactory previous surgeries. Densiron® was injected in all patients, with surgical retinectomy being required in 70% of them. Minimum follow-up time was 12 months. The mean length of time before Densiron® withdrawal was 4 months. Three patients (30%) presented with a new RD. The main complication detected was cataract development. No relationship was found between re-detachments and tamponade time, baseline disease or RD evolution time. Densiron® may be a good option in cases of recurrent RD in which previous treatment with scleral buckle, gas and/or 1,000/5,000 silicone oils has proven to be unsatisfactory. Copyright © 2012 Sociedad Española de Oftalmología. Published by Elsevier Espana. All rights reserved.

[Magnetic resonance imaging in facial injuries and digital fusion CT/MRI].

PubMed

Kozakiewicz, Marcin; Olszycki, Marek; Arkuszewski, Piotr; Stefańczyk, Ludomir

2006-01-01

Magnetic resonance images [MRI] and their digital fusion with computed tomography [CT] data, observed in patients affected with facial injuries, are presented in this study. The MR imaging of 12 posttraumatic patients was performed in the same plains as their previous CT scans. Evaluation focused on quality of the facial soft tissues depicting, which was unsatisfactory in CT. Using the own "Dental Studio" programme the digital fusion of the both modalities was performed. Pathologic dislocations and injures of facial soft tissues are visualized better in MRI than in CT examination. Especially MRI properly reveals disturbances in intraorbital soft structures. MRI-based assessment is valuable in patients affected with facial soft tissues injuries, especially in case of orbita/sinuses hernia. Fusion CT/MRI scans allows to evaluate simultaneously bone structure and soft tissues of the same region.

Mixed periapical lesion: an atypical radicular cyst with extensive calcifications.

PubMed

Ramos-Perez, Flávia Maria de Moraes; Pontual, Andréa dos Anjos; França, Talita Ribeiro Tenório de; Pontual, Maria Luiza dos Anjos; Beltrão, Ricardo Villar; Perez, Danyel Elias da Cruz

2014-01-01

The radicular cyst is an inflammatory odontogenic cyst of endodontic origin. Radiographically, the lesion appears as a periapical radiolucent image. This report describes a very rare case of a mixed periapical radiographic image diagnosed as a radicular cyst. A 37-year-old female patient presented a mixed, well-circumscribed image located in the periapical region of the left maxillary central incisor, which presented unsatisfactory endodontic treatment. Microscopic examination revealed a cavity lined by non-keratinized squamous epithelium and extensive calcifications in the cystic lumen and lining epithelium. Diagnosis of radicular cyst with extensive calcifications was established. Endodontic retreatment was performed and no radiographic signs of recurrence were observed 18 months after treatment. Although very rare, a radicular cyst should be considered in the differential diagnosis of a mixed periapical image associated to teeth with pulp necrosis.

Reform Japanese style: Voyage into an unknown and chaotic future

NASA Astrophysics Data System (ADS)

Ogawa, Masakata

2001-09-01

This article critically examines the ongoing revisions of school education in Japan in general, and of science education and science teacher education in particular. One of the major issues is that the revision policy does not necessarily reflect another emergent national policy, namely: science and technology as Japan's survival strategy. The reasons why such a discrepancy between two national policies has happened are investigated from sociocultural viewpoints. The policymakers realize that the school education system in Japan is now in a crisis, as almost all social institutions of traditional Japan society - family, rural communities, and schools - are collapsing, and their educational roles and functions are being lost. Thus, the top priority in the revision of school education is how to recover such educational roles and functions within school settings. So far, the revisions in science education have been unsatisfactory.

Review: The variability of the eating quality of beef can be reduced by predicting consumer satisfaction.

PubMed

Bonny, S P F; Hocquette, J-F; Pethick, D W; Legrand, I; Wierzbicki, J; Allen, P; Farmer, L J; Polkinghorne, R J; Gardner, G E

2018-04-02

The Meat Standards Australia (MSA) grading scheme has the ability to predict beef eating quality for each 'cut×cooking method combination' from animal and carcass traits such as sex, age, breed, marbling, hot carcass weight and fatness, ageing time, etc. Following MSA testing protocols, a total of 22 different muscles, cooked by four different cooking methods and to three different degrees of doneness, were tasted by over 19 000 consumers from Northern Ireland, Poland, Ireland, France and Australia. Consumers scored the sensory characteristics (tenderness, flavor liking, juiciness and overall liking) and then allocated samples to one of four quality grades: unsatisfactory, good-every-day, better-than-every-day and premium. We observed that 26% of the beef was unsatisfactory. As previously reported, 68% of samples were allocated to the correct quality grades using the MSA grading scheme. Furthermore, only 7% of the beef unsatisfactory to consumers was misclassified as acceptable. Overall, we concluded that an MSA-like grading scheme could be used to predict beef eating quality and hence underpin commercial brands or labels in a number of European countries, and possibly the whole of Europe. In addition, such an eating quality guarantee system may allow the implementation of an MSA genetic index to improve eating quality through genetics as well as through management. Finally, such an eating quality guarantee system is likely to generate economic benefits to be shared along the beef supply chain from farmers to retailors, as consumers are willing to pay more for a better quality product.

Knowledge, care-seeking behavior, and factors associated with patient delay among newly-diagnosed pulmonary tuberculosis patients, Federal Capital Territory, Nigeria, 2010.

PubMed

Biya, Oladayo; Gidado, Saheed; Abraham, Ajibola; Waziri, Ndadilnasiya; Nguku, Patrick; Nsubuga, Peter; Suleman, Idris; Oyemakinde, Akin; Nasidi, Abdulsalami; Sabitu, Kabir

2014-01-01

Early treatment of Tuberculosis (TB) cases is important for reducing transmission, morbidity and mortality associated with TB. In 2007, Federal Capital Territory (FCT), Nigeria recorded low TB case detection rate (CDR) of 9% which implied that many TB cases were undetected. We assessed the knowledge, care-seeking behavior, and factors associated with patient delay among pulmonary TB patients in FCT. We enrolled 160 newly-diagnosed pulmonary TB patients in six directly observed treatment short course (DOTS) hospitals in FCT in a cross-sectional study. We used a structured questionnaire to collect data on socio-demographic variables, knowledge of TB, and care-seeking behavior. Patient delay was defined as > 4 weeks between onset of cough and first hospital contact. Mean age was 32.8 years (± 9 years). Sixty two percent were males. Forty seven percent first sought care in a government hospital, 26% with a patent medicine vendor and 22% in a private hospital. Forty one percent had unsatisfactory knowledge of TB. Forty two percent had patient delay. Having unsatisfactory knowledge of TB (p = 0.046) and multiple care-seeking (p = 0.02) were significantly associated with patient delay. After controlling for travel time and age, multiple care-seeking was independently associated with patient delay (Adjusted Odds Ratio = 2.18, 95% CI = 1.09-4.35). Failure to immediately seek care in DOTS centers and having unsatisfactory knowledge of TB are factors contributing to patient delay. Strategies that promote early care-seeking in DOTS centers and sustained awareness on TB should be implemented in FCT.

76 FR 13365 - Credit Enhancement for Charter School Facilities Program; Office of Innovation and Improvement...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-03-11

... inch). Use one of the following fonts: Times New Roman, Courier, Courier New, or Arial. Furthermore... is not financially stable; has a history of unsatisfactory performance; has a financial or other...

78 FR 76131 - Applications for New Awards; National Institute on Disability and Rehabilitation Research...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-16

... than 10 pitch (characters per inch). Use one of the following fonts: Times New Roman, Courier, Courier... history of unsatisfactory performance; has a financial or other management system that does not meet the...

Identification of Youngsters with Emotional Disabilities.

ERIC Educational Resources Information Center

Smith, Carl R.

A clarification of the identification process for emotionally disturbed children is presented. Traditional definitions of emotional disturbance (ED) are explored and four behavioral clusters within traditional definitions are presented. The four are withdrawal from social interaction (autism), unsatisfactory interpersonal relationships,…

A Strategy for Teaching Students Interpersonal Skills

ERIC Educational Resources Information Center

Sanchez-Craig, Martha

1977-01-01

Using the Lazarus model, the author presents a reappraisal strategy to help students cope with inadequate, stressful social interactions. Identification of the unsatisfactory situation, generation of alternative interpretations and behaviors, cognitive rehearsal, and new response implementation are described. (Author/HLM)

Lamarck vs. Darwin: Dueling Theories.

ERIC Educational Resources Information Center

Firenze, Richard

1997-01-01

Argues that, for a misconception to be abandoned, the learner must come to see it as unsatisfactory. The new conception must be intelligible, plausible, and fruitful. Suggests that students should have an active cognitive involvement in the process. Contains 16 references. (DDR)

45 CFR 1183.12 - Special grant or subgrant conditions for “high-risk” grantees.

Code of Federal Regulations, 2011 CFR

2011-10-01

...) NATIONAL FOUNDATION ON THE ARTS AND THE HUMANITIES INSTITUTE OF MUSEUM AND LIBRARY SERVICES UNIFORM...) Has a history of unsatisfactory performance, or (2) Is not financially stable, or (3) Has a management...

45 CFR 1183.12 - Special grant or subgrant conditions for “high-risk” grantees.

Code of Federal Regulations, 2013 CFR

2013-10-01

...) NATIONAL FOUNDATION ON THE ARTS AND THE HUMANITIES INSTITUTE OF MUSEUM AND LIBRARY SERVICES UNIFORM...) Has a history of unsatisfactory performance, or (2) Is not financially stable, or (3) Has a management...

45 CFR 1183.12 - Special grant or subgrant conditions for “high-risk” grantees.

Code of Federal Regulations, 2014 CFR

2014-10-01

...) NATIONAL FOUNDATION ON THE ARTS AND THE HUMANITIES INSTITUTE OF MUSEUM AND LIBRARY SERVICES UNIFORM...) Has a history of unsatisfactory performance, or (2) Is not financially stable, or (3) Has a management...

45 CFR 1183.12 - Special grant or subgrant conditions for “high-risk” grantees.

Code of Federal Regulations, 2012 CFR

2012-10-01

...) NATIONAL FOUNDATION ON THE ARTS AND THE HUMANITIES INSTITUTE OF MUSEUM AND LIBRARY SERVICES UNIFORM...) Has a history of unsatisfactory performance, or (2) Is not financially stable, or (3) Has a management...

Use of food labels by adolescents to make healthier choices on snacks: a cross-sectional study from Sri Lanka.

PubMed

Talagala, Ishanka A; Arambepola, Carukshi

2016-08-08

Unhealthy snacking is commonly seen among adolescents. Therefore, use of food labels is promoted for making healthier choices on packaged snacks. This study was conducted to assess the use of food labels in making choices on packaged snack and its associated factors among adolescents. A cross-sectional study was conducted in 2012 among 542 Grade 12 students in Sri Lanka. Eight classes were selected as 'clusters' for the study (two classes each from two schools that were selected randomly from each list of 'Girls only' and 'Boys only' schools in Colombo district). A self-administered questionnaire assessed their socio-demography, snacking behaviour, attitudes and nutrition knowledge related to food labels. Adolescents' use of labels was assessed by three practices (label reading frequency, attention paid to label contents and correct interpretation of six hypothetical labels of snacks). Based on total scores obtained for the three practices, 'satisfactory' (score ≥75(th) percentile mark) and 'unsatisfactory' (score <75(th) percentile mark) label users were identified. Using SPSS, associations were assessed at 0.05 significance level using Chi-square-test. Of the participants, 51 % were males; 61 % spent their pocket money at least once/week on packaged snacks; predominantly on biscuits (85 %) and cola-drinks (77 %) and 88 % selected snacks on their own. The majority (74.5 %) was frequent ('always' or 'most often') label readers with female predominance (p < 0.05). Over 74 % paid attention frequently to the brand name (75 %), price (85 %) and nutrition panel (81 %). Over 64 % were able to select the better food label when given a choice between two snacks, although some did it for reasons such as attractive label (63 %). The majority (84 %) had good knowledge (obtaining more than the 75(th) percentile mark) on interpreting labels. Although not statistically significant, 'unsatisfactory' label use was higher among males (73 %), purchasing power (70.4 %) and unhealthy snacking behaviour (73 %). In contrast, among the marketing strategies, identifying known brands (73.2 %) and imported products (75.8 %) as 'good' products were significantly associated with 'unsatisfactory' label use (p < 0.05). Despite having good knowledge and positive attitudes, food label use is unsatisfactory among adolescents. Skills in reading labels should be addressed in the 'School canteen policy' in Sri Lanka.

Innovations in Science Education in Europe

NASA Astrophysics Data System (ADS)

Schuepbach, E.

2001-12-01

At many European Universities, the retention of skilled science graduates is hindered mainly by organisational structures. In particular, women students are often under-represented in sciences, and career progression is in general difficult. The linear system of knowhow transfer is inefficient from the pedagogical point of view and unsatisfactory for many students. Owing to fast changes in society and the working environment, a re-building of curricula in tertiary education (including University Education) has begun. Conceptual visions aim at influencing the investment in the largely untapped human capital and preparing the students for quick adaptation and enhanced flexiblity. Traditional methods of classroom teaching and knowhow transfer are increasingly complemented by New Learning Technologies and Mentoring. The EU Project INDECS (Potentials of Interdisciplinary Degree Courses in Engineering, Information Technology, Natural and Socio-Economic Sciences in a Changing Society) examines such pedagogical aspects in European degree courses combining engineering, IT, physical sciences and socio-economic sciences. Inclusion of specific IT and social science topics in modular form is examined. How innovation in University Teaching will meet the attractiveness to both students and employers in Europe is major focus of the study.

[Etiological analysis and individualized treatment of pharyngeal paraesthesia].

PubMed

Lou, Zhengcai; Gong, Xuhong; Lou, Fangyi; He, Lanjuan; Zhu, Qiaoying

2009-07-01

To analyze the nosazontology of pharyngeal paraesthesia and investigate the treatment. Two hundred and twelve misdiagnosed pharyngeal paraesthesia patients were investigated by history inquiry, routine examination, 24-hour esophageal pH monitoring, barium X-ray of the oesophagus, anxieties-athymic private measuring scale, coefficient of variation of the R-R (CVR-R), bioavailable testosterone detection (Bio-T), erection experiment and questionnaire about man climacteric syndrome. The concomitant symptoms and positions of pharyngeal paresthesia were also studied. We adopted individuallized sequential multi-therapy for every patient according to the cause of disease. The cause of disease within 212 cases of pharyngeal paraesthesia included 62 psychic trauma, 32 endocrine system disease, 106 upper gastrointestinal disease, circulatory disease, 9 circulatory disease, 3 idiopathic. With individualized treatment, 110 cases had fully recovered, 63 cases excellence and 31 cases utility, and the efficiency rate was 96.23%. Pharyngeal paraesthesia can be caused by several factors. Thorough examination and comprehensive analysis should be applied to those incurable patient who has been treated for a long time. Short course of treatment and irrational drug use are the main causes of short-term recurrence and unsatisfactory curative effect.

48 CFR 1509.170-4 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... each performance category. Ratings are defined as follows: 0 = unsatisfactory, 1 = poor, 2 = fair, 3... PLANNING CONTRACTOR QUALIFICATIONS Contractor Performance Evaluations 1509.170-4 Definitions. (a) Contractor Performance Report is an evaluation of a contractor's performance for a specified period of time...

5 CFR 430.303 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-01-01

...: Appointing authority means the department or agency head, or other official with authority to make... senior executive's performance will be appraised and rated. Balanced measures means an approach to... contributes to organizational goals and results and is so important that unsatisfactory performance of the...

5 CFR 430.303 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-01-01

...: Appointing authority means the department or agency head, or other official with authority to make... senior executive's performance will be appraised and rated. Balanced measures means an approach to... contributes to organizational goals and results and is so important that unsatisfactory performance of the...

Overview of adolescent problems.

PubMed

Nair, M K C

2003-11-01

Adolescent care has ever been unsatisfactory. The author has discussed the need for adolescent care policy for India, the adolescent problems in India and the adolescent care policy instruments, in depth, looking at the possibility of empowering the adolescents--the future parents of India.

48 CFR 52.232-32 - Performance-Based Payments.

Code of Federal Regulations, 2010 CFR

2010-10-01

... is endangered by the Contractor's (i) failure to make progress, or (ii) unsatisfactory financial... title; (iii) Nondurable (i.e., noncapital) tools, jigs, dies, fixtures, molds, patterns, taps, gauges... Government access. The Contractor shall promptly furnish reports, certificates, financial statements, and...

38 CFR 21.7153 - Progress and conduct.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Bill-Active Duty) Pursuit of Courses § 21.7153 Progress and conduct. (a) Satisfactory pursuit of... must maintain satisfactory progress. VA will discontinue educational assistance if the individual does not maintain satisfactory progress. Progress is unsatisfactory if the individual does not...

Connecting Volunteers and Agents: A Social Constructionist Perspective

ERIC Educational Resources Information Center

Dillivan, K. D.

2013-01-01

Extension volunteers benefit from participation in training activities. Furthermore, Extension personnel are best positioned to provide volunteers with relevant training. However, trainers neglecting relationship building and failing to attend to the communicative process may achieve unsatisfactory results. Social constructionism, a theoretical…

Identification of potential missed opportunities for human papillomavirus (HPV) vaccination in women referred to an academic colposcopy clinic for evaluation of abnormal cervical cytology.

PubMed

Dorton, Benjamin J; Vitonis, Allison F; Feldman, Sarah

2016-06-02

To identify possible predictors of missed opportunities for human papillomavirus (HPV) counseling and vaccination prior to presentation at an academic colposcopy clinic. We examined the characteristics of 638 vaccinated and 1,024 unvaccinated age-eligible patients using data from a patient registry of women presenting for colposcopic evaluation between 2/26/2007 and 3/10/2014 who were aged 26 or less at presentation. Demographics, smoking history, pregnancy history, sexually transmitted infections (STIs), sexual history, contraception use, immunosuppression, and medical problems were compared between HPV vaccinated and unvaccinated women. Multivariable logistic regression models included age, race, language, marital status, insurance type, lifetime number of sexual partners, other medical illnesses, number of pregnancies, contraception use, history of STIs, and smoking history to determine predictors of HPV vaccination. In multivariable analysis, race, marital status, and language were not significantly associated with HPV vaccination. Women with fewer pregnancies were more likely to be vaccinated (p-trend <0 .0001). Vaccinated women were more likely to have other medical illnesses (OR=1.44, 95% CI=1.13-1.83) and be aware of their HPV status (OR=1.75, 95% CI= 1.40-2.18). In this study, greater number of pregnancies was associated with lower vaccination rates as compared to women who had never been pregnant. Reproductive health visits, such as postpartum and family planning visits, represent an ideal opportunity to educate women about HPV and the importance of vaccination, and should be an area of focus to improve current HPV vaccination rates.

Comparison of human papillomavirus DNA tests, liquid-based cytology and conventional cytology for the early detection of cervix uteri cancer.

PubMed

Girianelli, Vania R; Thuler, Luiz Claudio S; Szklo, Moyses; Donato, Alexandre; Zardo, Lucilia M G; Lozana, José A; Almeida Neto, Olimpio F; Carvalho, Aurenice C L; Matos, Jorge H; Figueiredo, Valeska

2006-12-01

To compare the performance of human papillomavirus DNA tests (samples collected by a healthcare professional and self-collected) and liquid-based cytology with conventional cytology in the detection of cervix uteri cancer and its precursor lesions. A cross-sectional study was carried out in 1777 women living in poor communities in Rio de Janeiro State, Brazil. Eligibility criteria included ages 25-59 years and not having had a Papanicolau test within at least 3 years prior to the study. Cytology (conventional or liquid-based) and human papillomavirus DNA (collected by a healthcare professional or self-collected) tests were performed using samples collected in a single visit. Women with abnormalities in at least one test and a systematic sample of 70 women with negative test results were referred to a colposcopic examination. Test readings were double-masked, and the outcome of interest was high-grade squamous intraepithelial lesion or worse. The pathology report was used as the gold standard. The prevalence of high-grade squamous intraepithelial lesion or worse was 2.0%. Human papillomavirus DNA test collected by a health professional alone or combined with conventional cytology had the highest sensitivity (91.4 and 97.1%, respectively). The highest specificity was found for conventional cytology (91.6%) and for a human papillomavirus DNA test collected by a healthcare professional (90.2%). On the basis of only test performance, the use of human papillomavirus DNA tests, alone or combined with cytology, would seem to be recommended. Its population-wide implementation, however, is conditional on a cost-effectiveness analysis.

Analyses of atypical glandular cells re-defined by the 2006 Bethesda System: histologic outcomes and clinical implication of follow-up management.

PubMed

Ulker, V; Numanoglu, C; Akyol, A; Kuru, O; Akbayir, O; Erim, A; Ongut, C

2013-01-01

To evaluate the histopathology and the long-term follow-up outcome of women who had atypical glandular cells on Pap smears. All women with atypical glandular cells (AGC) who underwent colposcopic and histopathologic evaluation between January 2005 and October 2010 were reviewed. Patient data were examined up to October 2012, allowing for at least two years of follow-up for all patients. Forty-four women with AGC Pap test underwent histologic follow-up during the study period. Overall, upon reclassification of smears, 35 (79.5%) cases were diagnosed with AGC "not otherwise specified" (NOS) and nine (20.5%) with AGC "favour neoplasia". Seven out of nine patients (77.7%) with AGC "favour neoplasia" had significant pathology. On the other hand, only 11 out of 35 cases (31.4%) with AGC "NOS" had significant pathology. Significant correlation was found between AGC "favour neoplasia" smears and a significant pathology (p: 0.01). Of the 44 patients, 18 (40.9%) had significant pathology. Eight patients (18.2%) had low grade cervical intraepithelial neoplasia (CIN 1), four (9%) had high-grade cervical intraepithelial neoplasia (CIN 2/3), one (2.2%) had microinvasive squamous cell carcinoma of uterine cervix, one (2.2%) had cervical adenocarcinoma in situ, one (2.2%) had cervical adenocarcinoma, one (2.2%) had endometrial adenocarcinoma, and two (4.5%) had endometrial hyperplasia. Reporting AGC in the population is clinically significant due to the high prevalence of underlying preinvasive and invasive diseases (40.9%). The subtypes of the AGC category are significant predictor of such lesions.

Conservative approach to preneoplastic cervical lesions in postmenopause.

PubMed

Vetrano, Giuseppe; Aleandri, Vincenzo; Ciolli, Paola; Scardamaglia, Paola; Pacchiarotti, Arianna; Verrico, Monica; Carboni, Simona; Corosu, Roberto

2008-01-01

To evaluate the recurrence rate of high-grade squamous intraepithelial lesions in postmenopausal women previously submitted to laser CO2 conization and the role of persistent oncogenic HPV types. Fifty-five patients with a cytological diagnosis of high-grade squamous intraepithelial lesions were triaged with a standard colposcopy. Hormonal replacement therapy was considered as significative in influencing cervical trophism. Vaginal smears for microbiological examination were obtained. H-R HPV test was performed by PCR. The follow-up checks including cytology, colposcopy and HVP test were performed for a minimum of 5 years. Histological analysis revealed 19 CIN2 (cervical intraepithelial lesions) and 36 CIN3 lesions. The cumulative failure rate at first treatment was 14%. HPV test was positive for HPV 16 type in all patients. Forty-two patients during the follow up checks resulted negative to cytology, colposcopy and HR HPV test. At the one-year follow-up check, 7 patients revealed normal cytological and abnormal colposcopical findings and persistent positive HR HPV test. At the five-year follow-up check, 14 patients with a normal cytological smear had a recurrence of CIN2/3 and positive HR HPV test. In postmenopause, the correct management of H-R squamous intraepithelial lesions is still debated. However, a satisfactory follow-up is the main requirement for the conservative management. HPV typing in the follow-up is important to detect persistent types to identify women at risk of developing cervical abnormalities. The incidence of cervical neoplasia does not decrease with increasing age. Since HPV positivity predicted subsequent infection, testing postmenopausal patients for the virus may be a cost-effective method of disease prevention.

History of colposcopy: a brief biography of Hinselmann

PubMed Central

Fusco, Eugenio; Padula, Francesco; Mancini, Emanuela; Cavaliere, Alessandro; Grubisic, Goran

2008-01-01

Objectives: To consider all the historical reasons for the slow growth of colposcopy through a brief biography of Hinselmann. The history of colposcopy is beginning in March 1924. In the first experiments, colposcopic examination was almost impossible to perform because of the distance from the focus, that was no more than 80 mm. Hinselmann tried to solve this problem by pulling out the uterine cervix. The examined part is anemised by this procedure, which can prejudice the final result and a small amount of blood might leak as well. Beside that, a patient can feel pain if the portio is held by a thin forceps. The colposcopy, established in Germany, had spread throughout slowly its motherland, probably thanks to the many mistakes caused by Hinselmann himself: a technique proposed and almost exclusively intended for early discovery of cervical carcinoma;very authoritative imposition of terms, especially histological, which caused resistance by hystopathologists possibly induced by the fear of loosing their prestige who considered them too complex;his stubbornness in considering leukoplakia as precancerous lesion imposed him a lot of opponents;until the 1950's there had not yet been any adequate didactic material at the disposal of numerous gynaecologists;Hinselmann’s temper, described by Wespi as a mixture of innocence and missionary eagerness, had not prepared him for dialogue and compromise. Conclusion: It might seem surprising that colposcopy, accurate in detecting all benign lesions and initial atypical transformations, and perfectly capable of pointing safe biopsy in cases of suspicious lesions, did not develop as it should have a method whose function is of great importance in the prevention and treatment of CIN. Despite the role and the importance of cytology in the realization of the population programme of cervical cancer detection, the colposcopy allows the precise diagnosis among women with abnormal pap smears. PMID:22439022

Developing a Model of Occupational Choice.

ERIC Educational Resources Information Center

Egner, Joan Roos; And Others

Review of the literature in counseling, sociology, psychology, and organizational behavior failed to yield a model satisfactory for a comprehensive research framework investigating why people choose different occupations. Rational and irrational occupational decision making models were unsatisfactory in capturing the many dimensions of the…

Self rating of health is associated with stressful life events, social support and residency in East and West Berlin shortly after the fall of the wall.

PubMed

Hillen, T; Schaub, R; Hiestermann, A; Kirschner, W; Robra, B P

2000-08-01

To compare the health status and factors influencing the health of populations that had previously lived under different political systems. Cross sectional health and social survey using postal interviews. The relation between self reported health and psychosocial factors (stressful life events, social support, education, health promoting life style and health endangering behaviour) was investigated. To determine East-West differences a logistic regression model including interaction terms was fitted. East and West Berlin shortly after reunification 1991. Representative sample of 4430 Berlin residents aged 18 years and over (response rate 63%). Of all respondents, 15.4% rated their health as unsatisfactory. Residents of East Berlin rated their health more frequently as unsatisfactory than residents of West Berlin (Or(age adjusted)= 1.29, 95%CI 1.08, 1.52), these differences occurred predominantly in the over 60 years age group. Logistic regression showed significant independent effects of stressful life events, social support, education, and health promoting life style on self rated health. The effects of education and health promoting life style were observed to be more pronounced in the western part of Berlin. Old age and female sex showed a stronger association with unsatisfactory health status in the eastern part of Berlin. For subjects aged over 60 years there was evidence that living in the former East Berlin had an adverse effect on health compared with West Berlin. The impact of education and a health promoting lifestyle on self rated health seemed to be weaker in a former socialist society compared with that of a Western democracy. This study supports an "additive model" rather than a "buffering model" in explaining the effects of psychosocial factors on health.

Pero Vaz de Caminha: an-interchange program for quality control between Brazil and Portugal.

PubMed

Utagawa, Maria Lúcia; di Loreto, Celso; de Freitas, Cristina; Milanezi, Fernanda; Longatto Filho, Adhemar; Pereira, Sónia Maria Miranda; Maeda, Marina Yoshiê Sakamoto; Schmitt, Fernando C

2006-01-01

To start an interexchange program for quality control in cervical cytology and discuss conceptual criteria for diagnosis. Slides were selected in the archives of the 2 institutes and included cases with unsatisfactory, negative and positive results. Sets of slides were changed between the partners every 3 months. At the end of each year a senior cytopathologist was invited to discuss the major discrepancies found in the study. A total of 1,041 cases were analyzed. Full concordance was obtained in 74.4% (774) of cases and discrepancies in 25.6% (267 cases). Full agreement was achieved in 276 (39%) of 707 cases categorized as negative. In 421 negative cases from laboratory A, this concordance represents 65.5% and 96.5% for laboratory B, which submitted 286 negative cases. The main discordance was the high number of atypical squamous cells of undetermined significance cases: 3.1% for A and 128 (33.2%) for B. Samples with discrepancies related to the quality of the material was another controversial issue: of 16 cases from laboratory A, 6 (37.5%) unsatisfactory cases were the same and 10 (62.5%) different. Laboratory B presented 20 unsatisfactory cases, and 14 (70.0%) had other diagnoses. Low grade squamous intraepithelial lesion and high grade squamous intraepithelial lesion concordance ranged from 75% to 80%, and invasive carcinoma has 4 discordances (28.5%), 3 previously screened as high grade squamous intraepithelial lesion and 1 as atypical squamous cells of undetermined significance. The kappa value obtained was 0.65, indicating substantial agreement. Our results indicated that atypical squamous cells of undetermined significance diagnoses are the crucial point of controversies and concern the quality of routine diagnosis in cytopathology.

On Substrate for Atomic Chain Electronics

NASA Technical Reports Server (NTRS)

Yamada, Toshishige; Bauschlicher, Charles W., Jr.; Partridge, Harry; Saini, Subhash (Technical Monitor)

1998-01-01

A substrate for future atomic chain electronics, where adatoms are placed at designated positions and form atomically precise device components, is studied theoretically. The substrate has to serve as a two-dimensional template for adatom mounting with a reasonable confinement barrier and also provide electronic isolation, preventing unwanted coupling between independent adatom structures. However, the two requirements conflict. For excellent electronic isolation, we may seek adatom confinement via van der Waals interaction without chemical bonding to the substrate atoms, but the confinement turns out to be very weak and hence unsatisfactory. An alternative chemical bonding scheme with excellent structural strength is examined, but even fundamental adatom chain properties such as whether chains are semiconducting or metallic are strongly influenced by the nature of the chemical bonding, and electronic isolation is not always achieved. Conditions for obtaining semiconducting chains with well-localized surface-modes, leading to good isolation, are clarified and discussed.

Preparation of samples for leaf architecture studies, a method for mounting cleared leaves.

PubMed

Vasco, Alejandra; Thadeo, Marcela; Conover, Margaret; Daly, Douglas C

2014-09-01

Several recent waves of interest in leaf architecture have shown an expanding range of approaches and applications across a number of disciplines. Despite this increased interest, examination of existing archives of cleared and mounted leaves shows that current methods for mounting, in particular, yield unsatisfactory results and deterioration of samples over relatively short periods. Although techniques for clearing and staining leaves are numerous, published techniques for mounting leaves are scarce. • Here we present a complete protocol and recommendations for clearing, staining, and imaging leaves, and, most importantly, a method to permanently mount cleared leaves. • The mounting protocol is faster than other methods, inexpensive, and straightforward; moreover, it yields clear and permanent samples that can easily be imaged, scanned, and stored. Specimens mounted with this method preserve well, with leaves that were mounted more than 35 years ago showing no signs of bubbling or discoloration.

A survey of camera error sources in machine vision systems

NASA Astrophysics Data System (ADS)

Jatko, W. B.

In machine vision applications, such as an automated inspection line, television cameras are commonly used to record scene intensity in a computer memory or frame buffer. Scene data from the image sensor can then be analyzed with a wide variety of feature-detection techniques. Many algorithms found in textbooks on image processing make the implicit simplifying assumption of an ideal input image with clearly defined edges and uniform illumination. The ideal image model is helpful to aid the student in understanding the principles of operation, but when these algorithms are blindly applied to real-world images the results can be unsatisfactory. This paper examines some common measurement errors found in camera sensors and their underlying causes, and possible methods of error compensation. The role of the camera in a typical image-processing system is discussed, with emphasis on the origination of signal distortions. The effects of such things as lighting, optics, and sensor characteristics are considered.

Outsourced central archiving: an information bridge in a multi-IMAC environment

NASA Astrophysics Data System (ADS)

Gustavsson, Staffan; Tylen, Ulf; Carlsson, Goeran; Angelhed, Jan-Erik; Wintell, Mikael; Helmersson, Roger; Norrby, Clas

2001-08-01

In 1998 three hospitals merged to form the Sahlgrenska University Hospital. The total radiology production became 325 000 examinations per year. Two different PACS and RIS with different and incompatible archiving solutions were used since 1996. One PACS had commercial origin and the other was developed inhouse. Together they managed 1/3 of the total production. Due to differences in standard compliance and system architecture the communication was unsatisfactory. In order to improve efficiency, communication and the service level to our customers the situation was evaluated. It was decided to build a transparent virtual radiology department based on a modular approach. A common RIS and a central DICOM image archive as the central nodes in a star configured system were chosen. Web technique was chosen as the solution for distribution of images and reports. The reasons for the decisions as well as the present status of the installation are described and discussed is this paper.

CEACAM1: Expression and Role in Melanocyte Transformation

PubMed Central

Turcu, Gabriela; Ion, Daniela Adriana; Brînzea, Alice; Cioplea, Mirela Daniela; Jilaveanu, Lucia Beatrice

2016-01-01

Metastases represent the main cause of death in melanoma patients. Despite the current optimized targeted therapy or immune checkpoint inhibitors the treatment of metastatic melanoma is unsatisfactory. Because of the poor prognosis of advanced melanoma there is an urgent need to identify new biomarkers to differentiate melanoma cells from normal melanocytes, to stratify patients according to their risk, and to identify subgroups of patients that require close follow-up or more aggressive therapy. Furthermore, melanoma progression has been associated with the dysregulation of cell adhesion molecules. We have reviewed the literature and have discussed the important role of the expression of the carcinoembryonic antigen cell adhesion molecule 1 (CEACAM1) in the development of melanoma. Thus, novel insights into CEACAM1 may lead to promising strategies in melanoma treatment, in monitoring melanoma patients, in assessing the response to immunotherapy, and in completing the standard immunohistochemical panel used in melanoma examination. PMID:27642217

Influence of Additives on Masonry and Protective Paints’ Quality

NASA Astrophysics Data System (ADS)

Kostiunina, I. L.; Vyboishchik, A. V.

2017-11-01

The environment is one of main factors influencing the living conditions of urban population in Russia nowadays. One of the main drawbacks restraining the aesthetic improvement process of modern Russian cities is unsatisfactory protection of buildings from atmospheric phenomena. Moreover, industrial waste in modern industrial cities of Russia prevents a long-lasting decoration of urban buildings. The article presents an overview of the composition and physical properties of masonry paints applied in the Chelyabinsk region. The traditional technology of coatings obtaining is studied, the drawbacks of this technology are examined, the new materials and applications are offered. The influence of additives on the basic properties of masonry paints, viz. weather resistance, viscosity, hardness, cost, is considered. The application of new technologies utilizing industrial waste can solve the abovestated problem, which also, along with improving basic physical and chemical properties, will result in the cost reduction and the increase of the masonry paints hardness.

Vaginal health in contraceptive vaginal ring users - A review.

PubMed

Lete, Iñaki; Cuesta, María C; Marín, Juan M; Guerra, Sandra

2013-08-01

To provide an overview of the available data from clinical studies of vaginal conditions in women who use a vaginal ring as a contraceptive. A systematic review of the literature. Millions of women have already used the ethylene vinyl acetate vaginal ring that releases ethinylestradiol and etonogestrel for contraception. Because of its small size, more than four out of five women using the ring report that they do not feel it, even during sexual intercourse. No colposcopic or cytological changes have been observed in users, although approximately 10% have increased vaginal discharge. While in vitro studies have shown adhesion of Candida yeasts to the vaginal ring surface, clinical studies have not demonstrated a greater incidence of Candida infections compared to users of equivalent oral contraceptives. Some clinical studies suggest a lower incidence of bacterial vaginosis. No interaction exists between concomitant use of the vaginal ring and other drugs or products for vaginal use. The use of a contraceptive vaginal ring does not alter the vaginal ecosystem and therefore does not substantially affect vaginal health.

Colposcopic and histologic findings in women with a cytologic diagnosis of atypical squamous cells of undetermined significance.

PubMed

Yarandi, Fariba; Izadi Mood, Narges; Mirashrafi, Fatemeh; Eftekhar, Zahra

2004-12-01

The optimal method for managing a patient diagnosed with atypical squamous cells of undetermined significance (ASCUS) has not yet been established. The interim guidelines published by the National Cancer Institute suggest that a patient should be referred for colposcopy after the second ASCUS diagnosis within 2 years. To assess the significance of ASCUS in predicting the presence of underlying squamous intraepithelial lesion (SIL) of the uterine cervix. Women undergoing colposcopy for ASCUS cytology at a teaching hospital in Tehran University, in the years 1998-2001, considered eligible to enter this retrospective study. Of the 266 patients who underwent colposcopy, 28 (11%) had low-grade squamous intraepithelial lesion (LSIL), 16 (6.3%) had high-grade squamous intraepithelial lesion (HSIL) two (0.8%) had squamous cell carcinoma (SCC), and 48 (18.8%) had flat condyloma. Atypical squamous cells of undetermined significance (ASCUS) on a cervical smear is a good marker for detecting underlying SIL and condyloma. Thus, immediate colposcopy and directed biopsy are appropriate follow-up procedures.

22 CFR 513.305 - Causes for debarment.

Code of Federal Regulations, 2010 CFR

2010-04-01

... public agreements or transactions; (2) A history of failure to perform or of unsatisfactory performance... 22 Foreign Relations 2 2010-04-01 2010-04-01 true Causes for debarment. 513.305 Section 513.305 Foreign Relations BROADCASTING BOARD OF GOVERNORS GOVERNMENT DEBARMENT AND SUSPENSION (NONPROCUREMENT) AND...

Teacher Attitudes about Classroom Conditions

ERIC Educational Resources Information Center

Earthman, Glen I.; Lemasters, Linda K.

2009-01-01

Purpose: This research was designed to investigate the possible relationship between the attitudes, teachers have about the condition of their classrooms when the classrooms were independently assessed. Previous research reported teachers in unsatisfactory classrooms felt frustrated and neglected to such an extent that they sometimes reported they…

42 CFR 493.1445 - Standard; Laboratory director responsibilities.

Code of Federal Regulations, 2010 CFR

2010-10-01

... quality laboratory services for all aspects of test performance, which includes the preanalytic, analytic... result is found to be unacceptable or unsatisfactory; (5) Ensure that the quality control and quality assessment programs are established and maintained to assure the quality of laboratory services provided and...

Break a Leg

ERIC Educational Resources Information Center

Gisolfi, Peter A.

2005-01-01

The basic dilemma in creating performance spaces in secondary schools is that such spaces often must serve multiple functions. Ideally, there should be three different spaces: one to present dramas; another for musical performances; and a third for assemblies--lectures, movies, political and community events. Often, the unsatisfactory solution to…

Intelligent Processing of Ferroelectric Thin Films

DTIC Science & Technology

1994-05-31

unsatisfactory. To detect the electroopic effects of thin films deposited on opaque substrates a waveguide refractometry of category 3 was reported. An advantage...of the waveguide refractometry is its capability of resolving the change in ordinary index from the change in the extraordinary index. Some successes

7 CFR 3402.23 - Documentation of progress on funded projects.

Code of Federal Regulations, 2010 CFR

2010-01-01

...: Graduates; is officially terminated from the Fellowship or the academic program due to unsatisfactory academic progress; or voluntarily withdraws from the Fellowship or the academic program. If a Fellow has... Research Information System (CRIS). The CRIS database contains narrative project information, progress...

38 CFR 21.4277 - Discontinuance: unsatisfactory progress, conduct and attendance.

Code of Federal Regulations, 2010 CFR

2010-07-01

... progress, conduct and attendance. (a) Satisfactory pursuit of program. Entitlement to benefits for a... the pursuit of such program, continues to maintain satisfactory progress. If the veteran or eligible person does not maintain satisfactory progress, educational benefits will be discontinued by the...

CONTRASTIVE CULTURAL FEATURES IN FL TEACHING.

ERIC Educational Resources Information Center

FISCHER, MILLA

CONTRASTIVE CULTURAL FEATURES SHOULD BE INCLUDED WITHIN THE FRAMEWORK OF THE GRAMMATICAL LESSON AS A MEANS OF COUNTERBALANCING THE GENERALLY UNSATISFACTORY MATERIAL USED FOR RUSSIAN TEXTS. LESSONS FOR AMERICAN STUDENTS LEARNING RUSSIAN SHOULD INCLUDE PHONOLOGICAL DRILLS ON VOWEL LENGTHS, DISTRIBUTION OF VOICED OBSTRUENTS, AND OBSTRUENT CLUSTERS,…

High-Stakes Cheating

ERIC Educational Resources Information Center

Dessoff, Alan

2011-01-01

Administrators and teachers in several large districts nationwide have cheated on standardized tests to make achievement levels look better than they actually were. The offenses range from giving students advance answers to questions on standardized tests, to erasing and changing unsatisfactory answers. As a result of district and state…

Prevalence of pathogenic bacteria in street vended ready-to-eat meats in Windhoek, Namibia.

PubMed

Shiningeni, Daphney; Chimwamurombe, Percy; Shilangale, Renatus; Misihairabgwi, Jane

2018-05-31

To determine the prevalence of pathogenic bacteria in street vended ready-to-eat meats in Windhoek, Namibia, a total of 96 street vended ready to eat meat samples were evaluated. Prevalences of 42%, 52%, 15%, 6% and 83% were observed for Escherichia coli, Staphylococcus aureus, Listeria monocytogenes, Shigella and Enterobacteriaceae respectively, while the highest aerobic plate counts were 7.74 Log 10 cfu/g, 5.67 Log 10 cfu/g, 5.12 Log 10 cfu/g , 4.56 Log 10 cfu/g, 3.3 Log 10 cfu/g, 5.75 Log 10 cfu/g respectively. Unsatisfactory microbial levels were 32% for aerobic plate count, 26% for Enterobacteriaceae, 35% for Escherichia coli, 11% for Listeria monocytogenes, 7% for Staphylococcus aureus and 6% for Shigella. Salmonella was detected in 11% and 40% of samples from two suburbs. The unsatisfactory microbiological quality of some ready-to-eat meats necessitates the provision of training on food safety and hygiene to street vendors for consumer protection. Copyright © 2018 Elsevier Ltd. All rights reserved.

Perceived unsatisfactory care as a barrier to diabetes self-management for Coeur d'Alene tribal members with type 2 diabetes.

PubMed

Tiedt, Jane A; Sloan, Rebecca S

2015-05-01

The prevalence of diabetes and related complications are disproportionally higher in Native Americans. Diabetes self-management (DSM) is instrumental in preventing complications. The results presented here are a part of a larger hermeneutic phenomenology study to explore living with diabetes for one Pacific Northwest tribe. This study identified barriers to DSM within the worldview of the tribal people. Using purposive sampling, 10 Coeur d'Alene tribal members, ages 26 to 86 years, participated in in-depth interviews. Data interpretation used a three-step method leading to integrated themes across the transcripts. Perceived unsatisfactory care emerged as the major barrier to self-management, including communication barriers (distrust, misunderstanding, and educational methods) and organizational barriers (quality of care and access issues). Findings highlight the need to improve cross-cultural communication and calls for different approaches to diabetes education. Our profession is challenged to create new DSM and diabetes educational approaches for acceptable and compassionate cross-cultural nursing care. © The Author(s) 2014.

Preparation of a novel antiserum to aromatase with high affinity and specificity: Its clinicopathological significance on breast cancer tissue.

PubMed

Kanomata, Naoki; Matsuura, Shiro; Nomura, Tsunehisa; Kurebayashi, Junichi; Mori, Taisuke; Kitawaki, Jo; Moriya, Takuya

2017-01-01

Aromatase inhibitors have been widely used for the endocrine treatment of estrogen-dependent breast cancer in postmenopausal patients. However, clinicopathological studies of aromatase have been limited due to unsatisfactory specificity and/or restricted availability of anti-aromatase antibodies. Here, we have generated a polyclonal antiserum with high affinity and specificity for human aromatase using a monoclonal antibody tagged immunoaffinity chromatography on an industrial production scale. Our preliminary immunohistochemical analysis of 221 invasive breast cancer cases indicated that 87.3% (193/221) had at least 5% aromatase positive cells. The histoscore for aromatase was inversely correlated with pT (p = 0.019), pN (p = 0.001), stage (p < 0.001), histologic grade (p = 0.003), lymphatic infiltration (p < 0.001), venous infiltration (p < 0.001), and Ki-67 index (p < 0.001). However, cancer aromatase expression was independent of estrogen receptor (ER), progesterone receptor (PgR), and human epidermal growth factor receptor 2 statuses. This antiserum will be applicable to clinicopathological examination of aromatase in addition to ER and PgR for an appropriate use of aromatase inhibitor on the treatment of breast cancer. Further studies on the relationship between Aromatase inhibitors have been widely used for the endocrine treatment of estrogen-dependent breast cancer in postmenopausal patients. However, clinicopathological studies of aromatase have been limited due to unsatisfactory specificity and/or restricted availability of anti-aromatase antibodies. Here, we have generated a polyclonal antiserum with high affinity and specificity for human aromatase using a monoclonal antibody tagged immunoaffinity chromatography on an industrial production scale. Our preliminary immunohistochemical analysis of 221 invasive breast cancer cases indicated that 87.3% (193/221) had at least 5% aromatase positive cells. The histoscore for aromatase was inversely correlated with pT (p = 0.019), pN (p = 0.001), stage (p < 0.001), histologic grade (p = 0.003), lymphatic infiltration (p < 0.001), venous infiltration (p < 0.001), and Ki-67 index (p < 0.001). However, cancer aromatase expression was independent of estrogen receptor (ER), progesterone receptor (PgR), and human epidermal growth factor receptor 2 statuses. This antiserum will be applicable to clinicopathological examination of aromatase in addition to ER and PgR for an appropriate use of aromatase inhibitor on the treatment of breast cancer. Further studies on the relationship between aromatase expression and aromatase inhibitors are warranted.

Assessment of Different Strategies to Determine MAP-specific Cellular Immune Responses in Cattle

USDA-ARS?s Scientific Manuscript database

Assessment of cellular immunity in cattle against Mycobacterium avium ssp. paratuberculosis (MAP) by established methods remains unsatisfactory for diagnostic purposes. Recent studies conclude that analysis of T-cell subset responsiveness may improve diagnostic outcome. Aim of this study was to iden...

Criteria of Police Officer Performance.

ERIC Educational Resources Information Center

Baehr, Melany E.

The indifferent success in achieving the goal of reliable and valid police officer work performance measures has been attributed to the complexity of the job. This study explored reasons for unsatisfactory police performance evaluation, reviewing and integrating previous studies and new recently collected but not yet published data. Performance…

The Cognitive-Behavioral Management of Pain: Neurophysiological Relevancies.

ERIC Educational Resources Information Center

Stone, Christopher I.

Traditional medical interventions for the management of pain have consisted largely of either pharmacological treatments or surgery to interrupt the involved neural pathways. The results of these procedures have been largely unsatisfactory because of debilitating side effects and recurrence of pain. Investigations of a host of psychological…

Improved wetland classification using eight-band high-resolution satellite imagery and a hybrid approach

EPA Science Inventory

Although remote sensing technology has long been used in wetland inventory and monitoring, the accuracy and detail level of derived wetland maps were limited or often unsatisfactory largely due to the relatively coarse spatial resolution of conventional satellite imagery. This re...

14 CFR 91.1095 - Initial and transition training and checking: Flight instructors (aircraft), flight instructors...

Code of Federal Regulations, 2013 CFR

2013-01-01

... methods, procedures, and techniques for conducting flight instruction. (4) Proper evaluation of student... unsatisfactory training progress. (6) The approved methods, procedures, and limitations for performing the... instructor certificate— (i) The fundamental principles of the teaching-learning process; (ii) Teaching...

14 CFR 91.1095 - Initial and transition training and checking: Flight instructors (aircraft), flight instructors...

Code of Federal Regulations, 2014 CFR

2014-01-01

... methods, procedures, and techniques for conducting flight instruction. (4) Proper evaluation of student... unsatisfactory training progress. (6) The approved methods, procedures, and limitations for performing the... instructor certificate— (i) The fundamental principles of the teaching-learning process; (ii) Teaching...

14 CFR 121.414 - Initial and transition training and checking requirements: flight instructors (airplane), flight...

Code of Federal Regulations, 2012 CFR

2012-01-01

... teaching-learning process; (ii) Teaching methods and procedures; and (iii) The instructor-student... policies and procedures. (3) The appropriate methods, procedures, and techniques for conducting flight...) The corrective action in the case of unsatisfactory training progress. (6) The approved methods...

14 CFR 121.414 - Initial and transition training and checking requirements: flight instructors (airplane), flight...

Code of Federal Regulations, 2011 CFR

2011-01-01

... teaching-learning process; (ii) Teaching methods and procedures; and (iii) The instructor-student... policies and procedures. (3) The appropriate methods, procedures, and techniques for conducting flight...) The corrective action in the case of unsatisfactory training progress. (6) The approved methods...

14 CFR 121.414 - Initial and transition training and checking requirements: flight instructors (airplane), flight...

Code of Federal Regulations, 2013 CFR

2013-01-01

... teaching-learning process; (ii) Teaching methods and procedures; and (iii) The instructor-student... policies and procedures. (3) The appropriate methods, procedures, and techniques for conducting flight...) The corrective action in the case of unsatisfactory training progress. (6) The approved methods...

14 CFR 91.1095 - Initial and transition training and checking: Flight instructors (aircraft), flight instructors...

Code of Federal Regulations, 2011 CFR

2011-01-01

... methods, procedures, and techniques for conducting flight instruction. (4) Proper evaluation of student... unsatisfactory training progress. (6) The approved methods, procedures, and limitations for performing the... instructor certificate— (i) The fundamental principles of the teaching-learning process; (ii) Teaching...

14 CFR 91.1095 - Initial and transition training and checking: Flight instructors (aircraft), flight instructors...

Code of Federal Regulations, 2012 CFR

2012-01-01

... methods, procedures, and techniques for conducting flight instruction. (4) Proper evaluation of student... unsatisfactory training progress. (6) The approved methods, procedures, and limitations for performing the... instructor certificate— (i) The fundamental principles of the teaching-learning process; (ii) Teaching...

14 CFR 121.414 - Initial and transition training and checking requirements: flight instructors (airplane), flight...

Code of Federal Regulations, 2010 CFR

2010-01-01

... teaching-learning process; (ii) Teaching methods and procedures; and (iii) The instructor-student... policies and procedures. (3) The appropriate methods, procedures, and techniques for conducting flight...) The corrective action in the case of unsatisfactory training progress. (6) The approved methods...

7 CFR 3402.23 - Documentation of progress on funded projects.

Code of Federal Regulations, 2011 CFR

2011-01-01

... the academic program due to unsatisfactory academic progress; or voluntarily withdraws from the Fellowship or the academic program. If a Fellow has not completed all degree requirements at the end of the... database contains narrative project information, progress/impact statements, and final technical reports...

7 CFR 3402.23 - Documentation of progress on funded projects.

Code of Federal Regulations, 2014 CFR

2014-01-01

... the academic program due to unsatisfactory academic progress; or voluntarily withdraws from the Fellowship or the academic program. If a Fellow has not completed all degree requirements at the end of the... database contains narrative project information, progress/impact statements, and final technical reports...

7 CFR 3402.23 - Documentation of progress on funded projects.

Code of Federal Regulations, 2012 CFR

2012-01-01

... the academic program due to unsatisfactory academic progress; or voluntarily withdraws from the Fellowship or the academic program. If a Fellow has not completed all degree requirements at the end of the... database contains narrative project information, progress/impact statements, and final technical reports...

7 CFR 3402.23 - Documentation of progress on funded projects.

Code of Federal Regulations, 2013 CFR

2013-01-01

... the academic program due to unsatisfactory academic progress; or voluntarily withdraws from the Fellowship or the academic program. If a Fellow has not completed all degree requirements at the end of the... database contains narrative project information, progress/impact statements, and final technical reports...

Field tests of a down-hole TDR profiling water content measurement system

USDA-ARS?s Scientific Manuscript database

Accurate soil profile water content monitoring at multiple depths has previously been possible only using the neutron probe (NP), but with great effort and at unsatisfactory intervals. Despite the existence of several capacitance systems for profile water content measurements, accuracy and spatial r...

38 CFR 21.7653 - Progress, conduct, and attendance.

Code of Federal Regulations, 2010 CFR

2010-07-01

... on which the school official who is responsible for determining whether a student is making progress...) Satisfactory pursuit of program. In order to receive educational assistance for pursuit of a program of education, a reservist must maintain satisfactory progress. Progress is unsatisfactory if the reservist does...

Termination of School Employees: Legal Issues and Techniques.

ERIC Educational Resources Information Center

National School Boards Association, Alexandria, VA. Council of School Attorneys.

The termination of unsatisfactory school employees is an ubiquitous and often expensive legal problem for school districts. This monograph was designed to help school attorneys and administrators in handling the termination process as fairly and efficiently as possible. The monograph begins with articles on documentation, evaluation, and…

The Nature of Adventure Education.

ERIC Educational Resources Information Center

Cousineau, Claude

Man answers a natural call for adventure in many ways including escape into fantasy, vertigo seeking, kinetic euphoria, and by exercising the pioneer spirit. Adventure education can help equip people to satisfy their need for adventure in meaningful, enriching ways. A reaction to unsatisfactory educational milieus, adventure education has emerged…

[Results of urethral reconstruction in adults after multiple hypospadias repairs].

PubMed

Gamidov, S I; Shneiderman, M G; Pushkar, D Yu; Vasil'ev, A O; Govorov, A V; Ovchinnikov, R I; Popova, A Yu; Dusmukhamedov, R D

2017-06-01

To improve treatment results in patients after multiple hypospadias repairs by optimizing the postoperative management. Eighty-two patients (mean age 48.1+/-15.3 years) with urethral strictures secondary to failed hypospadias repairs underwent staged graft urethroplasty using oral mucosa (cheek, lip, tongue) as a grafting material. In 62 patients, at the end of surgery the bladder was drained with a standard Foley catheter. In twenty patients the bladder was drained with a modified silicone urethral catheter, which had an additional channel for delivering drugs and removing the urethral wound effluent, and a second additional channel for inflating a balloon fixed to the catheter tube at different parts of the catheter. The mean length of the stricture was 5.4+/-1.2 cm (from 1 to 16 cm). Twenty-eight patients had postoperative complications. Using the modified catheter resulted in statistically significantly (p<0.05) smaller percentage of complications (10% vs 41.9%) compared to standard Foley catheter. Urinalysis and sperm test on the follow up examination at 12 months showed that only 9 (10.9%) patients had signs of the inflammatory process. Seventy-five patients (91.5%) rated the appearance of the penis as "good"; only 5 (6.1%) and 2 (2.4%) patients considered the result as "satisfactory" and "unsatisfactory", respectively. Eighty patient (97.6%) regarded the treatment result as "good" for the quality of urination and only two (2.4%) considered it "satisfactory". When assessing the strength of urinary stream, 64 (78.1%), 13 (15.8%) and 5 (6.1%) patients rated it as "good", "satisfactory", and "unsatisfactory", respectively. The study findings shows that staged urethroplasty using the oral mucosa restores the urethral patency, reduces the severity of the inflammatory process, thus improving the quality of life of patients after failed hypospadias repair. The proposed modification of the catheter ensures the timely delivery of drugs to the surgical site, evacuation the wound effluent from the urethra and helps prevent strictures by periodically inflating the adjustable balloon-dilator.

Profiling strugglers in a graduate-entry medicine course at Nottingham: a retrospective case study

PubMed Central

2012-01-01

Background 10-15% of students struggle at some point in their medicine course. Risk factors include weaker academic qualifications, male gender, mental illness, UK ethnic minority status, and poor study skills. Recent research on an undergraduate medicine course provided a toolkit to aid early identification of students likely to struggle, who can be targeted by established support and study interventions. The present study sought to extend this work by investigating the number and characteristics of strugglers on a graduate-entry medicine (GEM) programme. Methods A retrospective study of four GEM entry cohorts (2003–6) was carried out. All students who had demonstrated unsatisfactory progress or left prematurely were included. Any information about academic, administrative, personal, or social difficulties, were extracted from their course progress files into a customised database and examined. Results 362 students were admitted to the course, and 53 (14.6%) were identified for the study, of whom 15 (4.1%) did not complete the course. Students in the study group differed from the others in having a higher proportion of 2ii first degrees, and scoring less well on GAMSAT, an aptitude test used for admission. Within the study group, it proved possible to categorise students into the same groups previously reported (struggler throughout, pre-clinical struggler, clinical struggler, health-related struggler, borderline struggler) and to identify the majority using a number of flags for early difficulties. These flags included: missed attendance, unsatisfactory attitude or behaviour, health problems, social/family problems, failure to complete immunity status checks, and attendance at academic progress committee. Conclusions Problems encountered in a graduate-entry medicine course were comparable to those reported in a corresponding undergraduate programme. A toolkit of academic and non-academic flags of difficulty can be used for early identification of many who will struggle, and could be used to target appropriate support and interventions. PMID:23249471

Alpha-galactosidase versus active charcoal for improving sonographic visualization of abdominal organs in patients with excessive intestinal gas

PubMed Central

Maconi, G.; Bolzacchini, E.; Radice, E.; Marzocchi, M.; Badini, M.

2012-01-01

Background and aims Intestinal gas is a frequent cause of poor visualization during gastrointestinal ultrasound (US). The enzyme alpha-galactosidase may reduce intestinal gas production, thereby improving abdominal US visualization. We compared the efficacies of alpha-galactosidase and active charcoal in improving US visualization in patients with previous unsatisfactory abdominal US scans caused by excessive intestinal gas. Materials and methods: 45 patients with poor visualization of at least one target organ: pancreas, hepatic lobes (score 0–2) or common bile duct (CBD) (score 0–1) were enrolled in a prospective randomized, crossover, observer-blinded study. The patients received alpha-galactosidase (Sinaire Forte, Promefarm, Milan, Italy) 600 GalU t.i.d. for 2 days before abdominal US plus 900 GalU the morning of exam or active charcoal 448 mg t.i.d., for 2 days before the exam plus 672 mg the morning of the exam. Visualization was graded as follows: 0 = none (complete gas interference); 1 = severe interference, 2 = moderate interference, 3 = mild interference; 4 = complete (no gas interference). Results: 42 patients completed the study. Both alpha-galactosidase and active charcoal improved the visualization of target organs. Visualization of the right hepatic lobe, CBD and pancreatic tail was significantly improved (vs. baseline) only by alpha-galactosidase (p < 0.01). Scores ≥3 for all parts of the pancreas and both hepatic lobes were achieved in only 12.5% of the patients after both treatments. Both products were well tolerated. Conclusion: Alpha-galactosidase and active charcoal can improve US visualization of abdominal organs in patients whose scans are frequently unsatisfactory due to excessive intestinal gas. Visualization of the pancreatic tail and right hepatic lobe was significantly improved only by alpha-galactosidase. However, both treatments allowed adequate visualization of all target organs during the same examination only in a few patients. PMID:23730387

Arizona's Three-Year Medical Curriculum: A Postmortem.

ERIC Educational Resources Information Center

Kettel, Louis J.; And Others

1979-01-01

Students and faculty at the University of Arizona College of Medicine found the three-year medical program to be an unsatisfactory educational experience due to excessive intensity of classroom work, insufficient vacation time, and inadequate time to teach basic science. Measures of student performance showed no differences between three- and…

"Connectivism"--A New Paradigm for the Mathematics Anxiety Challenge?

ERIC Educational Resources Information Center

Klinger, Christopher M.

2011-01-01

A major challenge for practitioners in adult mathematics education is to achieve effective learning outcomes in the face of prevailing negative attitudes in their students, often present as a consequence of unsatisfactory early mathematics learning experience and flowing from the wellestablished connection between adult innumeracy and mathematics…

9 CFR 113.311 - Bovine Virus Diarrhea Vaccine.

Code of Federal Regulations, 2010 CFR

2010-01-01

... virus diarrhea post-challenge; or both, the Master Seed Virus is unsatisfactory. (6) A sequential test... virus diarrhea susceptible calves shall be used as test animals (20 vaccinates and five controls). Blood... serum dilution in a varying serum-constant virus neutralization test with less than 500 TCID50 of bovine...

9 CFR 113.110 - Clostridium Botulinum Type C Bacterin-Toxoid.

Code of Federal Regulations, 2012 CFR

2012-01-01

..., safety, and potency as prescribed in this section. A serial found unsatisfactory by any prescribed test shall not be released. (a) Purity test. Final container samples of completed product from each serial... test. Bulk or final container samples of completed product from each serial shall be tested for safety...

9 CFR 113.110 - Clostridium Botulinum Type C Bacterin-Toxoid.

Code of Federal Regulations, 2010 CFR

2010-01-01

..., safety, and potency as prescribed in this section. A serial found unsatisfactory by any prescribed test shall not be released. (a) Purity test. Final container samples of completed product from each serial... test. Bulk or final container samples of completed product from each serial shall be tested for safety...

9 CFR 113.205 - Newcastle Disease Vaccine, Killed Virus.

Code of Federal Regulations, 2010 CFR

2010-01-01

.... A serial found unsatisfactory by a prescribed test shall not be released. (a) Safety test. The prechallenge part of the potency test in paragraph (b) of this section shall constitute a safety test. If.... If unfavorable reactions which are not attributable to the product occur, the test shall be declared...

22 CFR 1006.800 - What are the causes for debarment?

Code of Federal Regulations, 2010 CFR

2010-04-01

... business integrity or business honesty that seriously and directly affects your present responsibility; (b... public agreements or transactions; (2) A history of failure to perform or of unsatisfactory performance..., 1995; (2) Knowingly doing business with an ineligible person, except as permitted under § 1006.120; (3...

22 CFR 1508.800 - What are the causes for debarment?

Code of Federal Regulations, 2010 CFR

2010-04-01

... business integrity or business honesty that seriously and directly affects your present responsibility; (b... public agreements or transactions; (2) A history of failure to perform or of unsatisfactory performance..., 1995; (2) Knowingly doing business with an ineligible person, except as permitted under § 1508.120; (3...

Transformational Events

ERIC Educational Resources Information Center

Denning, Peter J.; Hiles, John E.

2006-01-01

Transformational Events is a new pedagogic pattern that explains how innovations (and other transformations) happened. The pattern is three temporal stages: an interval of increasingly unsatisfactory ad hoc solutions to a persistent problem (the "mess"), an offer of an invention or of a new way of thinking, and a period of widespread adoption and…

7 CFR 1730.25 - Corrective action.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 11 2010-01-01 2010-01-01 false Corrective action. 1730.25 Section 1730.25... AGRICULTURE ELECTRIC SYSTEM OPERATIONS AND MAINTENANCE Operations and Maintenance Requirements § 1730.25 Corrective action. (a) For any items on the RUS Form 300 rated unsatisfactory (i.e., 0 or 1) by the borrower...

Range management visual impacts

Treesearch

Bruce R. Brown; David Kissel

1979-01-01

Historical overgrazing of western public rangelands has resulted in the passage of the Public Rangeland Improvement Act of 1978. The main purpose of this Act is to improve unsatisfactory range conditions. A contributing factor to unfavorable range conditions is adverse visual impacts. These visual impacts can be identified in three categories of range management: range...

Development of a Measure of Experiential Avoidance: The Multidimensional Experiential Avoidance Questionnaire

ERIC Educational Resources Information Center

Gamez, Wakiza; Chmielewski, Michael; Kotov, Roman; Ruggero, Camilo; Watson, David

2011-01-01

Experiential avoidance (EA) has been conceptualized as the tendency to avoid negative internal experiences and is an important concept in numerous conceptualizations of psychopathology as well as theories of psychotherapy. Existing measures of EA have either been narrowly defined or demonstrated unsatisfactory internal consistency and/or evidence…

Interobserver Agreement and Disagreement in Continuous Recording Exemplified by Measurement of Behavior State.

ERIC Educational Resources Information Center

Mudford, Oliver C.; Hogg, James; Roberts, Jessica

1997-01-01

Continuous observational recording over 57 hours evaluated behavior states of three adults with profound and multiple disabilities. Two independent observers also recorded for 22 hours. Although overall percentage agreement was satisfactory (above 80%), agreement on occurrence was unsatisfactory (mean of 65%). Agreement data were superimposed on…

The Labour Party's Blunkett Review: A Comprehensive Disappointment

ERIC Educational Resources Information Center

Lichman, Keith

2014-01-01

David Blunkett's "Review of Education Structures" for the Labour Party recognises that there is a chaotic and unsatisfactory situation in the English education system but its response is ambiguous and self-contradictory. Its proposals seek to normalise and regulate rather than remedy a system in which lack of democratic accountability,…

48 CFR 9.406-2 - Causes for debarment.

Code of Federal Regulations, 2014 CFR

2014-10-01

... laws, or receiving stolen property; (4) Intentionally affixing a label bearing a “Made in America... terms of one or more contracts; or (B) A history of failure to perform, or of unsatisfactory performance... drug-free workplace (see 23.504). (iii) Intentionally affixing a label bearing a “Made in America...

Creating Simulations for An "Introduction to Research Methods" Course

ERIC Educational Resources Information Center

Adamson, Bob

2010-01-01

This paper describes the production of a software program for Master of Education students studying the "Introduction to Research Methods" course at a tertiary institution in Hong Kong. The course was originally delivered in a lecture mode, which proved unsatisfactory in providing sufficient learning support for the students. The paper…

Concepts. The Journal of Defense Systems Acquisition Management. Summer 1981. Volume 4, Number 3.

DTIC Science & Technology

1981-01-01

Performance FREQUENCY POWER OUTPUT GIZMO MODEL 25 0-50 MHZ SATISFACTORY 50-125 MHZ UNSATISFACTORY ASTROMATICS MODEL C 0-50 MHZ SATISFACTORY 50-125 MHZ...MHZ) GIZMO ----- ASTROMATICS- NOTES: 1. Diagrams excellent for portraying precise technical relationships. 2. Diagrams are economical means of

42 CFR 493.1407 - Standard; Laboratory director responsibilities.

Code of Federal Regulations, 2010 CFR

2010-10-01

... developed and used for each of the tests performed in the laboratory provide quality laboratory services for... results are found to be unacceptable or unsatisfactory; (5) Ensure that the quality control and quality assessment programs are established and maintained to assure the quality of laboratory services provided and...

Machine-Aided Translation: From Terminology Banks to Interactive Translation Systems.

ERIC Educational Resources Information Center

Greenfield, Concetta C.; Serain, Daniel

The rapid growth of the need for technical translations in recent years has led specialists to utilize computer technology to improve the efficiency and quality of translation. The two approaches considered were automatic translation and terminology banks. Since the results of fully automatic translation were considered unsatisfactory by various…

9 CFR 113.209 - Rabies Vaccine, Killed Virus.

Code of Federal Regulations, 2010 CFR

2010-01-01

... immunogenicity of vaccine prepared with virus at the highest passage from the Master Seed shall be established in... the availability of this material at NARA, call 202-741-6030, or go to: http://www.archives.gov... observation period, the serial is unsatisfactory. (3) Potency test. Bulk or final container samples of...

Analysis of Aptitude, Training, and Job Performance Measures

DTIC Science & Technology

1982-02-01

provisions have been made for students with unsatisfactory performance to be " recycled ", that is, to retake a module or part of a course (e.g., 2841, Marine...clear, simple language o questions avoided trivia , and were related to task performance o response choices were parallel and realistic. The assessment

41 CFR 105-68.800 - What are the causes for debarment?

Code of Federal Regulations, 2010 CFR

2010-07-01

... obstruction of justice; or (4) Commission of any other offense indicating a lack of business integrity or business honesty that seriously and directly affects your present responsibility; (b) Violation of the... or transactions; (2) A history of failure to perform or of unsatisfactory performance of one or more...

29 CFR 98.800 - What are the causes for debarment?

Code of Federal Regulations, 2010 CFR

2010-07-01

... business integrity or business honesty that seriously and directly affects your present responsibility; (b... public agreements or transactions; (2) A history of failure to perform or of unsatisfactory performance..., 1995; (2) Knowingly doing business with an ineligible person, except as permitted under § 98.120; (3...

9 CFR 113.34 - Detection of hemagglutinating viruses.

Code of Federal Regulations, 2014 CFR

2014-01-01

... suspension of fresh chicken red blood cells. (d) If the results are inconclusive, one or two blind passages... hemagglutinating viruses provided in this section shall be conducted when such a test is prescribed in an... product is observed, the serial is unsatisfactory. [38 FR 29889, Oct. 30, 1973] ...

9 CFR 113.34 - Detection of hemagglutinating viruses.

Code of Federal Regulations, 2013 CFR

2013-01-01

... suspension of fresh chicken red blood cells. (d) If the results are inconclusive, one or two blind passages... hemagglutinating viruses provided in this section shall be conducted when such a test is prescribed in an... product is observed, the serial is unsatisfactory. [38 FR 29889, Oct. 30, 1973] ...

Alternate Theory Formation by Students.

ERIC Educational Resources Information Center

Hanson, R. Keith

Video tapes of student teachers micro-teaching in a high school biology class were analyzed. Attention was focussed on students' interpretations of data and the teacher's responses to these interpretations. Examples are given of student explanations which teachers find unsatisfactory but which are valid alternatives based on the data available to…

Methods of Cost Reduction for United States Coast Guard Telephone Systems.

DTIC Science & Technology

1981-03-01

System (’FTS) for a single low utilization command is questionable. Small FAX machines such as EXXON’s QWIP /FAX can be purchased at approxi- mately...unsatisfactory operating condi- tion. Electrical faults, such as leakage or poor insulation, noise induction, crosstalk, or poor transmission

Critical Incidents of Student Satisfaction at German Universities

ERIC Educational Resources Information Center

Vianden, Jörg; Yakaboski, Tamara

2017-01-01

Purpose: The purpose of this paper is to advance a classification of satisfactory and unsatisfactory critical incidents of student-university relationships at German universities. Design/methodology/approach: Using the Critical Incident Technique (CIT), this paper reports the results of an exploratory study of 15 tertiary education students at…

48 CFR 52.208-9 - Contractor Use of Mandatory Sources of Supply or Services.

Code of Federal Regulations, 2010 CFR

2010-10-01

... by the Committee for Purchase From People Who Are Blind or Severely Disabled (the Committee) under... mandatory source is unsatisfactory. The Contractor shall not purchase the supplies or services from other... central nonprofit agency has authorized purchase from other sources. (c) Price and delivery information...

14 CFR 121.414 - Initial and transition training and checking requirements: flight instructors (airplane), flight...

Code of Federal Regulations, 2014 CFR

2014-01-01

...-learning process; (ii) Teaching methods and procedures; and (iii) The instructor-student relationship. (d... procedures. (3) The appropriate methods, procedures, and techniques for conducting flight instruction. (4... corrective action in the case of unsatisfactory training progress. (6) The approved methods, procedures, and...

Helping Principals Make Better Use of Existing Facilities.

ERIC Educational Resources Information Center

Fredrickson, John H.

The findings of two studies establish some deleterious effects of unsatisfactory physical environment on school children. However, modern technology enables the exercise of total environmental control in new and existing facilities. Between the realities of today and the exceptations of tomorrow we have a transitional model--the open plan concept.…

Teaching Consumer Redress through Complaint Letter Writing.

ERIC Educational Resources Information Center

Prawitz, Aimee D; Lawrence, Frances C.

1993-01-01

College students (n=40) in a consumer economics course wrote letters of complaint regarding unsatisfactory products or services. Eighty percent received responses, most within three weeks; 43% of companies complied with requests; 64% of students were satisfied with responses. Those who received no response were less likely to consider doing…

Understanding School Counseling Internships from a Communities of Practice Framework

ERIC Educational Resources Information Center

Woodside, Marianne; Ziegler, Mary; Paulus, Trena M.

2009-01-01

School counseling interns are on the boundary of communities of practice. This study explored how school counselors develop competence during internship experiences by analyzing an online dialogue taking place among a small group of interns. Feelings of being on the boundary intensified with unsatisfactory supervisor-intern relationships (lack of…

Overstory removal: stand factors related to success and failure

Treesearch

Robert J. Laacke; Gary O. Fiddler

1986-01-01

Overstory removal can offer economic and esthetic advantages over clearcutting and regeneration, but projecting success is difficult. Twenty-nine units on nine operational overstory removal cuts in northern California were studied to determine what factors are related to satisfactory or unsatisfactory stocking after harvest. Stocking determinations were based on number...

Prohexadione-calcium improves stand density and yield of alfalfa interseeded into silage corn

USDA-ARS?s Scientific Manuscript database

Interseeded alfalfa (Medicago sativa L.) could serve as a dual-purpose crop to provide groundcover for silage corn (Zea mays L.) and forage during subsequent years of production, but interspecific competition often leads to poor stands of alfalfa and unsatisfactory yields of corn. Four experiments e...

Institutionalized Racism and the Education of Blacks

ERIC Educational Resources Information Center

Spears, Arthur K.

1978-01-01

Research into the causes of the unsatisfactory educational performance of many black students has focused on linguistic and cultural differences of blacks. Institutionalized racism, however, should be recognized as the major factor affecting black academic achievement. Black students should not be evaluated by the same criteria as white students.…

38 CFR 21.9635 - Discontinuance dates.

Code of Federal Regulations, 2010 CFR

2010-07-01

... error or error in judgment by VA, the Department of Defense, or the Department of Homeland Security with....9635 Section 21.9635 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS (CONTINUED... disapproval. (Authority: 38 U.S.C. 3034(a), 3323(a), 3671(b), 3672(a), 3690) (j) Unsatisfactory progress. If...

38 CFR 21.9635 - Discontinuance dates.

Code of Federal Regulations, 2014 CFR

2014-07-01

... error or error in judgment by VA, the Department of Defense, or the Department of Homeland Security with....9635 Section 21.9635 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS (CONTINUED... disapproval. (Authority: 38 U.S.C. 3034(a), 3323(a), 3671(b), 3672(a), 3690) (j) Unsatisfactory progress. If...

38 CFR 21.9635 - Discontinuance dates.

Code of Federal Regulations, 2012 CFR

2012-07-01

... error or error in judgment by VA, the Department of Defense, or the Department of Homeland Security with....9635 Section 21.9635 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS (CONTINUED... disapproval. (Authority: 38 U.S.C. 3034(a), 3323(a), 3671(b), 3672(a), 3690) (j) Unsatisfactory progress. If...

38 CFR 21.9635 - Discontinuance dates.

Code of Federal Regulations, 2011 CFR

2011-07-01

... error or error in judgment by VA, the Department of Defense, or the Department of Homeland Security with....9635 Section 21.9635 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS (CONTINUED... disapproval. (Authority: 38 U.S.C. 3034(a), 3323(a), 3671(b), 3672(a), 3690) (j) Unsatisfactory progress. If...

New inducible genetic method reveals critical roles of GABA in the control of feeding and metabolism

USDA-ARS?s Scientific Manuscript database

Currently available inducibleCre/loxPsystems, despite their considerable utility in gene manipulation, have pitfalls in certain scenarios, such as unsatisfactory recombination rates and deleterious effects on physiology and behavior. To overcome these limitations, we designed a new, inducible gene-t...

The Contextual over the Referential in Military Translation

ERIC Educational Resources Information Center

Al-Ma'ani, Musallam

2015-01-01

Dictionaries of all types, monolingual or bilingual, specialized or general, form the basic tools for both undergraduate translation students (UTSs) and professional translators (PTs). However, it is generally accepted that the difference between UTSs and PTs is that UTSs normally over-rely on dictionaries, which produces unsatisfactory results.…

9 CFR 113.105 - Leptospira Hardjo Bacterin.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 9 Animals and Animal Products 1 2010-01-01 2010-01-01 false Leptospira Hardjo Bacterin. 113.105 Section 113.105 Animals and Animal Products ANIMAL AND PLANT HEALTH INSPECTION SERVICE, DEPARTMENT OF... unsatisfactory by any prescribed test shall not be released. (a) Purity test. Final container samples of...

Rodin, Patton, Edison, Wilson, Einstein: Were They Really Learning Disabled?

ERIC Educational Resources Information Center

Adelman, Kimberly A.; Adelman, Howard S.

1987-01-01

The practice of posthumously diagnosing historical figures is discussed. Emphasis is on the unsatisfactory nature of evidence found for those diagnosed as learning-disabled or dyslexic and the possibility of other explanations for identified problems. Posthumous diagnoses of Auguste Rodin, George Patton, Thomas Edison, Woodrow Wilson, and Albert…

An evaluation of overnight fixation to facilitate neuropathological examination in Coroner's autopsies: our experience of over 200 cases.

PubMed

Scott, Ian Stuart; MacDonald, Alastair Wray

2013-01-01

Following recent changes in Coroner's Rules, there has been a desire to examine brains at the time of autopsy, rather than after a prolonged period of immersion fixation. Examination of the fresh brain at postmortem can yield unsatisfactory results where detailed histological examination is required. We aim to provide a compromise, where detailed examination of the brain is possible, without the requirement for prolonged fixation, interference with funeral arrangements and delay in the Coronial process. A retrospective audit of over 200 neuropathology cases requested by HM Coroner for the East Riding of Yorkshire between 2007 and 2010 was performed. The cases consisted of full neuropathology autopsies (n=212) and brains referred by general pathology colleagues (n=26). Of the 238 brains examined, approximately half (n=109) of the brains were sectioned fresh in the mortuary. The remaining brains (n=129) were immersion fixed overnight in 20% formalin prior to cutting and sampling for histology (n=127). The median time for reporting was 31 days (range 1-167; n=101) for brains requiring histology. This equates to a median turnaround time of 1 month for a neuropathological autopsy requiring detailed histology. In all cases, the report was prepared and available to HM Coroner in advance of the Inquest. This method provides reliable histological diagnoses in neuropathological autopsies and does not interfere with funeral arrangements for bereaved families following deaths falling under Coronial jurisdiction. In all cases, the body could be released to relatives, at Coroner's discretion, within two working days of the autopsy.

Professional dental and oral surgery liability in Italy: a comparative analysis of the insurance products offered to health workers.

PubMed

Di Lorenzo, Pierpaolo; Paternoster, Mariano; Nugnes, Mariarosaria; Pantaleo, Giuseppe; Graziano, Vincenzo; Niola, Massimo

2016-01-01

In Italy there has been an increase in claims for damages for alleged medical malpractice. A study was therefore conducted that aimed at assessing the content of the coverage of insurance policy contracts offered to oral health professionals by the insurance market. The sample analysed composed of 11 insurance policy contracts for professional dental liability offered from 2010 to 2015 by leading insurance companies operating in the Italian market. The insurance products analysed are structured on the "claims made" clause. No policy contract examined covers the damage due to the failure to acquire consent for dental treatment and, in most cases, damage due to unsatisfactory outcomes of treatment of an aesthetic nature and the failure to respect regulatory obligations on privacy. On entering into a professional liability insurance policy contract, the dentist should pay particular attention to the period covered by the guarantee, the risks both covered and excluded, as well as the extent of the limit of liability and any possible fixed/percentage excess. When choosing a professional liability contract, a dentist should examine the risks in relation to the professional activity carried out before signing.

Critiquing bachelor candidates' theses: are the criteria useful?

PubMed

Kapborg, I; Berterö, C

2002-06-01

Nursing education programmes should be at an academic level and connected to research. In Sweden, empirical studies are generally required in order to obtain a Bachelor's degree; hence, in some cases, these studies are replaced by a literature review. A study was conducted using 11 criteria. Thirteen theses produced in a department of nursing science were examined, elaborated and reproduced by reviewing international and national literature. Thereafter, the criteria themselves were scrutinized. Principal findings when critiquing the theses were that in eight theses the purpose was dearly identified and well defined in relation to the study accomplished; in three theses the purpose was indistinct and vague; and in two the definitions and research questions were lacking. The topic was relevant for the area of nursing in all theses. General problems identified were poor spelling and grammar, and unsatisfactory thesis structure. This article discusses whether criteria are useful when examining the Bachelor candidates' theses. The authors report that the criteria seemed to be useful, giving some guidance for scrutinizing theses and facilitating correspondence. Criteria could be appropriate guidelines for using to increase the quality of the theses as well as the quality of nursing.

Diagnosing Cervical Neoplasia in Rural Brazil Using a Mobile Van Equipped with In Vivo Microscopy: A Cluster-Randomized Community Trial.

PubMed

Hunt, Brady; Fregnani, José Humberto Tavares Guerreiro; Schwarz, Richard A; Pantano, Naitielle; Tesoni, Suelen; Possati-Resende, Júlio César; Antoniazzi, Marcio; de Oliveira Fonseca, Bruno; de Macêdo Matsushita, Graziela; Scapulatempo-Neto, Cristovam; Kerr, Ligia; Castle, Philip E; Schmeler, Kathleen; Richards-Kortum, Rebecca

2018-06-01

Cervical cancer is a leading cause of death in underserved areas of Brazil. This prospective randomized trial involved 200 women in southern/central Brazil with abnormal Papanicolaou tests. Participants were randomized by geographic cluster and referred for diagnostic evaluation either at a mobile van upon its scheduled visit to their local community, or at a central hospital. Participants in both arms underwent colposcopy, in vivo microscopy, and cervical biopsies. We compared rates of diagnostic follow-up completion between study arms, and also evaluated the diagnostic performance of in vivo microscopy compared with colposcopy. There was a 23% absolute and 37% relative increase in diagnostic follow-up completion rates for patients referred to the mobile van (102/117, 87%) compared with the central hospital (53/83, 64%; P = 0.0001; risk ratio = 1.37, 95% CI, 1.14-1.63). In 229 cervical sites in 144 patients, colposcopic examination identified sites diagnosed as cervical intraepithelial neoplasia grade 2 or more severe (CIN2+; 85 sites) with a sensitivity of 94% (95% CI, 87%-98%) and specificity of 50% (95% CI, 42%-58%). In vivo microscopy with real-time automated image analysis identified CIN2+ with a sensitivity of 92% (95% CI, 84%-97%) and specificity of 48% (95% CI, 40%-56%). Women referred to the mobile van were more likely to complete their diagnostic follow-up compared with those referred to a central hospital, without compromise in clinical care. In vivo microscopy in a mobile van provides automated diagnostic imaging with sensitivity and specificity similar to colposcopy. Cancer Prev Res; 11(6); 359-70. ©2018 AACR . ©2018 American Association for Cancer Research.

HPV genotypes and cervical intraepithelial neoplasia in a multiethnic cohort in the southeastern USA.

PubMed

Vidal, Adriana C; Smith, Jennifer S; Valea, Fidel; Bentley, Rex; Gradison, Maggie; Yarnall, Kimberly S H; Ford, Anne; Overcash, Francine; Grant, Kathy; Murphy, Susan K; Hoyo, Cathrine

2014-08-01

For poorly understood reasons, invasive cervical cancer (ICC) incidence and mortality rates are higher in women of African descent. Oncogenic human papillomavirus (HPV) genotypes distribution may vary between European American (EA) and African-American (AA) women and may contribute to differences in ICC incidence. The current study aimed at disentangling differences in HPV distribution among AA and EA women. Five-hundred and seventy-two women were enrolled at the time of colposcopic evaluation following an abnormal liquid-based cytology screen. HPV infections were detected using HPV linear array, and chi-squared tests and linear regression models were used to compare HPV genotypes across racial/ethnic groups by CIN status. Of the 572 participants, 494 (86 %) had detectable HPV; 245 (43 %) had no CIN lesion, 239 (42 %) had CIN1, and 88 (15 %) had CIN2/3. Seventy-three percent of all women were infected with multiple HPV genotypes. After adjusting for race, age, parity, income, oral contraception use, and current smoking, AAs were two times less likely to harbor HPV 16/18 (OR 0.48, 95 % CI 0.21-0.94, p = 0.03) when all women were considered. This association remained unchanged when only women with CIN2/3 lesions were examined (OR 0.22, 95 % CI 0.05-0.95, p = 0.04). The most frequent high-risk HPV genotypes detected among EAs were 16, 18, 56, 39, and 66, while HPV genotypes 33, 35, 45, 58, and 68 were the most frequent ones detected in AAs. Our data suggest that while HPV 16/18 are the most common genotypes among EA women with CIN, AAs may harbor different genotypes.

Early invasive (FIGO stage IA) carcinoma of the cervix: a clinico-pathologic study of 476 cases.

PubMed

Elliott, P.; Coppleson, M.; Russell, P.; Liouros, P.; Carter, J.; MacLeod, C.; Jones, M.

2000-01-01

The clinical and histologic features of 476 tumors fitting the 1995 FIGO definition of stage IA cervical cancer, treated at a Sydney tertiary referral hospital between 1953 and 1992, are reviewed. Five-year follow-up was complete with a median of 10 years. The diagnosis was increasingly made by histologic examination of colposcopically directed cone biopsy. The majority (88%) of tumors were squamous. The proportion of both younger women (3 mm. Treatment was surgical in 99% and was increasingly more conservative as the study progressed with no apparent increase in treatment failure. From 1973 treatment by cone biopsy rose from 6.5 to 35%, by radical hysterectomy fell from 51 to 21% and by lymphadenectomy from 53 to 26%. Only one of 115 patients treated by cone biopsy died. Positive lymph nodes were detected in 1.7% of 180 patients undergoing lymphadenectomy. There were 16 recurrences (3.4%); six vaginal with no cancer deaths, nine pelvic and one distant, with nine deaths and three new cancers (two deaths). Univariate analysis suggests that older age, glandular tumors and those invading 3 mm were associated with more treatment failures and multivariate analysis showed that both conservative hysterectomy and the omission of lymphadenectomy are associated with higher recurrence rates with >3 mm invasion. The study failed to resolve the dilemma of predicting those tumors with a poor prognosis.

Development of a Scale to Assess Knowledge about Suicide Postvention Using Item Response Theory

ERIC Educational Resources Information Center

Nader, Ingo W.; Niederkrotenthaler, Thomas; Schild, Anne H. E.; Koller, Ingrid; Tran, Ulrich S.; Kapusta, Nestor D.; Sonneck, Gernot; Voracek, Martin

2013-01-01

Knowledge about suicide postvention (KSPV) is an important distal outcome in the evaluation of suicide prevention programs that focus on the bereaved. However, most scales are specifically tailored to the evaluation study in question and psychometric properties are often unsatisfactory. Therefore, we developed the KSPV scale. Scale properties were…

Teaching Reaction Engineering Using the Attainable Region

ERIC Educational Resources Information Center

Metzger, Matthew J.; Glasser, Benjamin J.; Glasser, David; Hausberger, Brendon; Hildebrandt, Diane

2007-01-01

Ask a graduating chemical engineering student the following question: What makes one reactor different from the next? The answers received will often be unsatisfactory and will vary widely in scope. Some may cite the difference between the basic design equations, others may point out a PFR is "longer," and still others may state that it…

9 CFR 113.208 - Avian Encephalomyelitis Vaccine, Killed Virus.

Code of Federal Regulations, 2011 CFR

2011-01-01

... vaccine. For a valid test, at least 80 percent of the embryos shall survive for 48 hours post-inoculation... requirements prescribed in this section. Any serial found unsatisfactory by a prescribed test shall not be released. (a) Safety tests. (1) The prechallenge part of the potency test prescribed in paragraph (b) of...

9 CFR 113.208 - Avian Encephalomyelitis Vaccine, Killed Virus.

Code of Federal Regulations, 2010 CFR

2010-01-01

... vaccine. For a valid test, at least 80 percent of the embryos shall survive for 48 hours post-inoculation... requirements prescribed in this section. Any serial found unsatisfactory by a prescribed test shall not be released. (a) Safety tests. (1) The prechallenge part of the potency test prescribed in paragraph (b) of...

9 CFR 113.208 - Avian Encephalomyelitis Vaccine, Killed Virus.

Code of Federal Regulations, 2012 CFR

2012-01-01

... vaccine. For a valid test, at least 80 percent of the embryos shall survive for 48 hours post-inoculation... requirements prescribed in this section. Any serial found unsatisfactory by a prescribed test shall not be released. (a) Safety tests. (1) The prechallenge part of the potency test prescribed in paragraph (b) of...

49 CFR 385.13 - Unsatisfactory rated motor carriers; prohibition on transportation; ineligibility for Federal...

Code of Federal Regulations, 2013 CFR

2013-10-01

..., a motor carrier rated “unsatisfactory” is prohibited from operating a CMV. Information on motor... materials in quantities requiring placarding, and motor carriers transporting passengers in a CMV, are prohibited from operating a CMV in motor carrier operations in commerce beginning on the 46th day after the...

49 CFR 385.13 - Unsatisfactory rated motor carriers; prohibition on transportation; ineligibility for Federal...

Code of Federal Regulations, 2011 CFR

2011-10-01

..., a motor carrier rated “unsatisfactory” is prohibited from operating a CMV. Information on motor... materials in quantities requiring placarding, and motor carriers transporting passengers in a CMV, are prohibited from operating a CMV in motor carrier operations in commerce beginning on the 46th day after the...

49 CFR 385.13 - Unsatisfactory rated motor carriers; prohibition on transportation; ineligibility for Federal...

Code of Federal Regulations, 2014 CFR

2014-10-01

..., a motor carrier rated “unsatisfactory” is prohibited from operating a CMV. Information on motor... materials in quantities requiring placarding, and motor carriers transporting passengers in a CMV, are prohibited from operating a CMV in motor carrier operations in commerce beginning on the 46th day after the...

49 CFR 385.13 - Unsatisfactory rated motor carriers; prohibition on transportation; ineligibility for Federal...

Code of Federal Regulations, 2010 CFR

2010-10-01

..., a motor carrier rated “unsatisfactory” is prohibited from operating a CMV. Information on motor... materials in quantities requiring placarding, and motor carriers transporting passengers in a CMV, are prohibited from operating a CMV in motor carrier operations in commerce beginning on the 46th day after the...

49 CFR 385.13 - Unsatisfactory rated motor carriers; prohibition on transportation; ineligibility for Federal...

Code of Federal Regulations, 2012 CFR

2012-10-01

..., a motor carrier rated “unsatisfactory” is prohibited from operating a CMV. Information on motor... materials in quantities requiring placarding, and motor carriers transporting passengers in a CMV, are prohibited from operating a CMV in motor carrier operations in commerce beginning on the 46th day after the...

2 CFR 2424.1110 - When may a HUD official issue a limited denial of participation?

Code of Federal Regulations, 2011 CFR

2011-01-01

... would constitute an unsatisfactory risk; (2) There are irregularities in a person's past performance in... the performance of obligations incurred pursuant to a grant of financial assistance or pursuant to a... or further hearing. (d) An affiliate or organizational element may be included in a limited denial of...

2 CFR 2424.1110 - When may a HUD official issue a limited denial of participation?

Code of Federal Regulations, 2010 CFR

2010-01-01

... would constitute an unsatisfactory risk; (2) There are irregularities in a person's past performance in... the performance of obligations incurred pursuant to a grant of financial assistance or pursuant to a... or further hearing. (d) An affiliate or organizational element may be included in a limited denial of...

Teamwork in First Year Law Units: Can It Work?

ERIC Educational Resources Information Center

Carver, Tracey L.; Stickley, Amanda

2012-01-01

There is an abundance of literature on the importance of teamwork in undergraduate degrees; how to teach it, how to assess it and how to manage it. However, there is also much recorded about students' dislike of teamwork, especially where an early experience is unsatisfactory and builds resistance against such assessment. Accordingly, despite the…

24 CFR 200.204 - What actions may HUD take against unsatisfactory appraisers on the Appraiser Roster?

Code of Federal Regulations, 2010 CFR

2010-04-01

... appraiser; (vi) Being issued a final debarment, suspension, or limited denial of participation; (vii... you have been issued a final debarment, suspension, or limited denial of participation, in which case...) Automatic removal for issuance of final debarment, suspension, or limited denial of participation. If you...

41 CFR 105-71.112 - Special grant or subgrant conditions for “high-risk” grantees.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 41 Public Contracts and Property Management 3 2011-01-01 2011-01-01 false Special grant or... Management Federal Property Management Regulations System (Continued) GENERAL SERVICES ADMINISTRATION... unsatisfactory performance, or (2) Is not financially stable, or (3) Has a management system which does not meet...

49 CFR Appendix E to Part 238 - General Principles of Reliability-Based Maintenance Programs

Code of Federal Regulations, 2010 CFR

2010-10-01

... 49 Transportation 4 2010-10-01 2010-10-01 false General Principles of Reliability-Based... STANDARDS Pt. 238, App. E Appendix E to Part 238—General Principles of Reliability-Based Maintenance... maintenance programs are based on the following general principles. A failure is an unsatisfactory condition...

48 CFR 9.406-2 - Causes for debarment.

Code of Federal Regulations, 2013 CFR

2013-10-01

... laws, or receiving stolen property; (4) Intentionally affixing a label bearing a “Made in America... terms of one or more contracts; or (B) A history of failure to perform, or of unsatisfactory performance... America” inscription (or any inscription having the same meaning) to a product sold in or shipped to the...

48 CFR 9.406-2 - Causes for debarment.

Code of Federal Regulations, 2011 CFR

2011-10-01

... laws, or receiving stolen property; (4) Intentionally affixing a label bearing a “Made in America... terms of one or more contracts; or (B) A history of failure to perform, or of unsatisfactory performance... America” inscription (or any inscription having the same meaning) to a product sold in or shipped to the...

48 CFR 9.406-2 - Causes for debarment.

Code of Federal Regulations, 2012 CFR

2012-10-01

... laws, or receiving stolen property; (4) Intentionally affixing a label bearing a “Made in America... terms of one or more contracts; or (B) A history of failure to perform, or of unsatisfactory performance... America” inscription (or any inscription having the same meaning) to a product sold in or shipped to the...

Skills for Work in the Future: A Youth Perspective

ERIC Educational Resources Information Center

Lyngdoh, Bremley W. B.

2005-01-01

According to a 2004 International Labour Organization (ILO) report, young people represent 130 million of the world's 550 million working poor who are unable to lift themselves and their families above the equivalent of the $1 per day poverty line. These young people struggle to survive, often performing work under unsatisfactory conditions in the…

The Role of Subject Expertise in Searching the Chemical Literature. . . and Pitfalls That Await the Inexperienced Searcher.

ERIC Educational Resources Information Center

Roth, Dana Lincoln

1985-01-01

This article expresses concerns about online searches being run by inexperienced searchers or nonchemists for other nonchemists or students. Studies concerning problems in the use of Chemical Condensates Database, Chemical Abstracts, Medline, and patent information are highlighted. Examples of searches yielding unsatisfactory results are noted.…

Teaching Problem Solving without Modeling through "Thinking Aloud Pair Problem Solving."

ERIC Educational Resources Information Center

Pestel, Beverly C.

1993-01-01

Reviews research relevant to the problem of unsatisfactory student problem-solving abilities and suggests a teaching strategy that addresses the issue. Author explains how she uses teaching aloud problem solving (TAPS) in college chemistry and presents evaluation data. Among the findings are that the TAPS class got fewer problems completely right,…

Parents Who Abduct: A Qualitative Study with Implications for Practice.

ERIC Educational Resources Information Center

Greif, Geoffrey L.; Hegar, Rebecca L.

1994-01-01

Conducted in-depth interviews with 17 parents (9 fathers and 8 mothers) who had abducted their own children. Reported reasons for abduction included unsatisfactory contact with court-related professionals, revenge, and fear for the child's safety. Some abductors, after the abduction had been resolved, had increased contact with their children.…

Broadened Agency Discretion under the Civil Service Reform Act of 1978.

DTIC Science & Technology

1986-06-16

Lqa reFusal to scrutinize the reasons for a security clearance denial is consistent with ’revious Board deci3ioas not to look behind a conviction to...receiving a written notice of unsatisfactory perfor- mance. In addition, the appellant was referred to education - al resource material which could aid

On Designing and Evaluating Teaching Sequences Taking Geometrical Optics as an Example

ERIC Educational Resources Information Center

Andersson, Bjorn; Bach, Frank

2005-01-01

National assessments and other investigations have drawn attention to the fact that there is considerable room for improvement in science teaching and learning. This article describes, exemplifies, and discusses a research program set up to address this unsatisfactory state of affairs. Briefly, the idea of the program is that researchers in…

Autoclaving practice in microbiology laboratories: report of a survey. The Public Health Laboratory Service Subcommittee on laboratory autoclaves.

PubMed Central

1978-01-01

The performance of autoclaves in 27 laboratories, operated in accordance with the normal routine of local practice, has been monitored using thermometric equipment. Sterilising performance was unsatisfactory on 10 of 62 occasions, and cooling was inadequate on 52 of 60 occasions. PMID:649767

The formula Scribner log rule.

Treesearch

George R. Staebler

1952-01-01

The Scribner Decimal C is the accepted log rule in the Pacific Northwest. Usually volume, growth and yield tables are expressed by this rule to give them practical meaning. Yet in the research required for such studies, the rule is unsatisfactory because of rounded values and irregular jumps in volume from diameter to diameter and length to length.

77 FR 17039 - Application for New Awards; Training for Realtime Writers Program

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-23

... of the following fonts: Times New Roman, Courier, Courier New, or Arial. An application submitted in any other font (including Times Roman or Arial Narrow) will not be accepted. The page limit does not... grantee is not financially stable; has a history of unsatisfactory performance; has a financial or other...

76 FR 18198 - European Union-United States Atlantis Program

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-01

... fonts: Times New Roman, Courier, Courier New, or Arial. An application submitted in any other font (including Times Roman or Arial Narrow) will not be accepted. The 6000-word limit does not apply to the cover... applicant or grantee is not financially stable; has a history of unsatisfactory performance; has a financial...

Does the Medium Matter in Collaboration? Using Visually Supported Collaboration Technology in an Interior Design Studio

ERIC Educational Resources Information Center

Cho, Ji Young; Cho, Moon-Heum; Kozinets, Nadya

2016-01-01

With the recognition of the importance of collaboration in a design studio and the advancement of technology, increasing numbers of design students collaborate with others in a technology-mediated learning environment (TMLE); however, not all students have positive experiences in TMLEs. One possible reason for unsatisfactory collaboration…

Weighted Student Formula: Putting Funds Where They Count in Education Reform

ERIC Educational Resources Information Center

Cooper, Bruce S.; DeRoche, Timothy R.; Ouchi, William G.; Segal, Lydia G.; Brown, Carolyn

2006-01-01

Ever since the publication of "A Nation At Risk" in 1983, Americans have been preoccupied with two problems regarding public education: (1) student performance is unsatisfactory to most Americans despite large increases in real spending per student; and despite several attempts at reforming curricula, teacher training, testing, and other…

A Needs Assessment: The Parenting Needs of Parents of Typical Children, Ages 6-10

ERIC Educational Resources Information Center

Cho, Charles Joon

2012-01-01

Programs and resources are available to parents to inform and improve their parenting skills. Despite these resources, the need for parent education continues to increase as parents find existing networks unsatisfactory or inaccessible. Parenting programs have produced inconsistent results in meeting the needs of parents. This study identifies the…

32 CFR Enclosure - Suggested Format, Affidavit of Service by Mail

Code of Federal Regulations, 2011 CFR

2011-07-01

... 32 National Defense 1 2011-07-01 2011-07-01 false Suggested Format, Affidavit of Service by Mail Enclosure National Defense Department of Defense OFFICE OF THE SECRETARY OF DEFENSE PERSONNEL, MILITARY AND CIVILIAN UNSATISFACTORY PERFORMANCE OF READY RESERVE OBLIGATION Definitions. Pt. 100, Encl. Enclosure—Suggested Format, Affidavit of Service b...

32 CFR Enclosure - Suggested Format, Affidavit of Service by Mail

Code of Federal Regulations, 2012 CFR

2012-07-01

... 32 National Defense 1 2012-07-01 2012-07-01 false Suggested Format, Affidavit of Service by Mail Enclosure National Defense Department of Defense OFFICE OF THE SECRETARY OF DEFENSE PERSONNEL, MILITARY AND CIVILIAN UNSATISFACTORY PERFORMANCE OF READY RESERVE OBLIGATION Definitions. Pt. 100, Encl. Enclosure—Suggested Format, Affidavit of Service b...

32 CFR Enclosure - Suggested Format, Affidavit of Service by Mail

Code of Federal Regulations, 2010 CFR

2010-07-01

... 32 National Defense 1 2010-07-01 2010-07-01 false Suggested Format, Affidavit of Service by Mail Enclosure National Defense Department of Defense OFFICE OF THE SECRETARY OF DEFENSE PERSONNEL, MILITARY AND CIVILIAN UNSATISFACTORY PERFORMANCE OF READY RESERVE OBLIGATION Definitions. Pt. 100, Encl. Enclosure—Suggested Format, Affidavit of Service b...

Guess Again: Will Changing the Grades Save Middle-Level Education?

ERIC Educational Resources Information Center

Beane, James; Lipka, Richard

2006-01-01

Blaming unsatisfactory student achievement on the middle school concept is a case of mistaken identity. Too many middle schools have failed to fully implement the middle school concept. Based on statements from the Carnegie Council and the National Middle School Association, the middle school concept calls for improved academic achievement for all…

9 CFR 113.454 - Clostridium Perfringens Type C Antitoxin.

Code of Federal Regulations, 2014 CFR

2014-01-01

... unsatisfactory by a prescribed test shall not be released. (a) Each serial shall meet the applicable general requirements provided in § 113.450. (b) Potency test. Bulk or final container samples of completed product from each serial shall be tested using the toxin-neutralization test for Beta Antitoxin provided in this...

9 CFR 113.454 - Clostridium Perfringens Type C Antitoxin.

Code of Federal Regulations, 2012 CFR

2012-01-01

... unsatisfactory by a prescribed test shall not be released. (a) Each serial shall meet the applicable general requirements provided in § 113.450. (b) Potency test. Bulk or final container samples of completed product from each serial shall be tested using the toxin-neutralization test for Beta Antitoxin provided in this...

9 CFR 113.455 - Clostridium Perfringens Type D Antitoxin.

Code of Federal Regulations, 2014 CFR

2014-01-01

... unsatisfactory by a prescribed test shall not be released. (a) Each serial shall meet the applicable general requirements provided in § 113.450. (b) Potency test. Bulk or final container samples of completed product from each serial shall be tested using the toxin-neutralization test for Epsilon Antitoxin provided in this...

9 CFR 113.455 - Clostridium Perfringens Type D Antitoxin.

Code of Federal Regulations, 2013 CFR

2013-01-01

... unsatisfactory by a prescribed test shall not be released. (a) Each serial shall meet the applicable general requirements provided in § 113.450. (b) Potency test. Bulk or final container samples of completed product from each serial shall be tested using the toxin-neutralization test for Epsilon Antitoxin provided in this...

9 CFR 113.454 - Clostridium Perfringens Type C Antitoxin.

Code of Federal Regulations, 2013 CFR

2013-01-01

... unsatisfactory by a prescribed test shall not be released. (a) Each serial shall meet the applicable general requirements provided in § 113.450. (b) Potency test. Bulk or final container samples of completed product from each serial shall be tested using the toxin-neutralization test for Beta Antitoxin provided in this...

9 CFR 113.455 - Clostridium Perfringens Type D Antitoxin.

Code of Federal Regulations, 2012 CFR

2012-01-01

... unsatisfactory by a prescribed test shall not be released. (a) Each serial shall meet the applicable general requirements provided in § 113.450. (b) Potency test. Bulk or final container samples of completed product from each serial shall be tested using the toxin-neutralization test for Epsilon Antitoxin provided in this...

9 CFR 113.499 - Products for treatment of failure of passive transfer.

Code of Federal Regulations, 2010 CFR

2010-01-01

... for potency as provided in this section. Any serial found unsatisfactory by a prescribed test shall... directions may indicate a single dosage regardless of weight, in which case the animals in the study shall be... taken from each animal. (5) Pretreatment and post treatment serum IgG concentrations shall be...

9 CFR 113.499 - Products for treatment of failure of passive transfer.

Code of Federal Regulations, 2011 CFR

2011-01-01

... for potency as provided in this section. Any serial found unsatisfactory by a prescribed test shall... directions may indicate a single dosage regardless of weight, in which case the animals in the study shall be... taken from each animal. (5) Pretreatment and post treatment serum IgG concentrations shall be...

9 CFR 113.499 - Products for treatment of failure of passive transfer.

Code of Federal Regulations, 2013 CFR

2013-01-01

... for potency as provided in this section. Any serial found unsatisfactory by a prescribed test shall... directions may indicate a single dosage regardless of weight, in which case the animals in the study shall be... taken from each animal. (5) Pretreatment and post treatment serum IgG concentrations shall be...

9 CFR 113.499 - Products for treatment of failure of passive transfer.

Code of Federal Regulations, 2014 CFR

2014-01-01

... for potency as provided in this section. Any serial found unsatisfactory by a prescribed test shall... directions may indicate a single dosage regardless of weight, in which case the animals in the study shall be... taken from each animal. (5) Pretreatment and post treatment serum IgG concentrations shall be...

9 CFR 113.499 - Products for treatment of failure of passive transfer.

Code of Federal Regulations, 2012 CFR

2012-01-01

... for potency as provided in this section. Any serial found unsatisfactory by a prescribed test shall... directions may indicate a single dosage regardless of weight, in which case the animals in the study shall be... taken from each animal. (5) Pretreatment and post treatment serum IgG concentrations shall be...

Activity Analysis and Cost Analysis in Medical Schools.

ERIC Educational Resources Information Center

Koehler, John E.; Slighton, Robert L.

There is no unique answer to the question of what an ongoing program costs in medical schools. The estimates of program costs generated by classical methods of cost accounting are unsatisfactory because such accounting cannot deal with the joint production or joint cost problem. Activity analysis models aim at calculating the impact of alternative…

A Framework for Bilingual School Consultation to Facilitate Multitier Systems of Support for English Language Learners

ERIC Educational Resources Information Center

Harris, Bryn; Sullivan, Amanda L.

2017-01-01

Bilingual students comprise a substantial and growing proportion of U.S. school enrollment and often experience unsatisfactory school outcomes attributed to limited opportunities to learn. Bilingual consultants have the unique opportunity to shape school psychological services and general education supports for all bilingual students by working…

9 CFR 113.108 - Clostridium Novyi Bacterin-Toxoid.

Code of Federal Regulations, 2010 CFR

2010-01-01

... serial found unsatisfactory by any prescribed test shall not be released. (a) Purity test. Final... words and terms shall mean: (i) International antitoxin unit. (I.U.) That quantity of Alpha Antitoxin... chloride in each 100 ml of distilled water; adjusting the pH to 7.2; autoclaving at 121 °C for 25 minutes...

Management of Cultural Differences under Various Forms of China-UK Higher Education Strategic Alliances

ERIC Educational Resources Information Center

Li, Xiaoqing; Roberts, Joanne; Yan, Yanni; Tan, Hui

2016-01-01

International strategic alliances are notorious for their high failure rate. Increased inter-partner conflict resulting from ineffective cross-cultural management is perceived to be one of the key reasons for unsatisfactory alliance performance. Driven by globalization, universities are extending into foreign markets through the establishment of…

THE NEUROLEPTIC MALIGNANT SYNDROME : REPORT OF THREE CASES

PubMed Central

Sharma, R.C.; Thakur, S.; Sharma, Vijay

1996-01-01

Three patients, one male and two females who developed neuroleptic malignant syndrome following exposure to depot and oral neuroleptic are presented. The patients satisfied Levenson′s criteria for diagnosis. Bromocriptine and Electro Convulsive Therapy were found effective whereas trihexyphenidyl proved unsatisfactory in the treatment. All the patients recovered completely without complications. PMID:21584154

Improving the Utilisation of Management Information Systems in Secondary Schools

ERIC Educational Resources Information Center

Bosker, R. J.; Branderhorst, E. M.; Visscher, A. J.

2007-01-01

Although most secondary schools do use management information systems (MISs), these systems tend not to be used to support higher order managerial activities but are currently primarily used for clerical purposes. This situation is unsatisfactory as MISs fully utilised could offer invaluable support to schools, which are increasingly being granted…

14 CFR 382.157 - What are carriers' obligations for recordkeeping and reporting on disability-related complaints?

Code of Federal Regulations, 2014 CFR

2014-01-01

..., storage and delay of assistive device, service animal problem, unsatisfactory information, and other. (d... carrier's or foreign carrier's services. (b) If you are a carrier covered by this part, conducting... disability. Data concerning the alleged discrimination or service problem related to the disability must be...

14 CFR 382.157 - What are carriers' obligations for recordkeeping and reporting on disability-related complaints?

Code of Federal Regulations, 2013 CFR

2013-01-01

..., storage and delay of assistive device, service animal problem, unsatisfactory information, and other. (d... carrier's or foreign carrier's services. (b) If you are a carrier covered by this part, conducting... disability. Data concerning the alleged discrimination or service problem related to the disability must be...

Newton's Cradle in Physics Education

ERIC Educational Resources Information Center

Gauld, Colin F.

2006-01-01

Newton's Cradle is a series of bifilar pendulums used in physics classrooms to demonstrate the role of the principles of conservation of momentum and kinetic energy in elastic collisions. The paper reviews the way in which textbooks use Newton's Cradle and points out the unsatisfactory nature of these treatments in almost all cases. The literature…

A Lingua Franca for Africa. Esperanto Documents No. 36A.

ERIC Educational Resources Information Center

Farukuoye, Helga

The actual possibilities for communication among Africans are unsatisfactory. While the north has adopted Arabic as its lingua franca, most African states south of the Sahara still use the language(s) of their former colonial masters as official languages, thereby neglecting their native languages. This situation excludes many people from higher…

Role Perceptions of Science Academics Who Teach to First-Year Students: The Influence of Gender

ERIC Educational Resources Information Center

Jacobs, Melanie; Jacobs, Gerrie J.

2014-01-01

A marked increase in student enrolments in South African public universities over the last two decades have admitted substantially more 'non-traditional' students to the sector. These students typically have unsatisfactory levels of school performance, lack communication skills (especially in English) and mostly have first-generation status. The…

Managing outdoor recreation conflict on the Squamish, British Columbia Trail Network

Treesearch

Ana Elia Ramón Hidalgo; Howard Harshaw

2012-01-01

Recreationists with high expectations of satisfaction from outdoor recreation activities are increasingly using trails networks near urban areas. But differences in expectations, behaviors and values of trail users may create conflicts resulting in unsatisfactory experiences. The objective of this study was to test the efficacy of management practices that may reduce...

Dismissal of Tenured Faculty--the College Administrator's Ugly Responsibility.

ERIC Educational Resources Information Center

Fusch, Gene E.

The purpose of this study was to investigate the proper procedures that must be followed in the dismissal of tenured faculty at a technical community college. While many resources on motivating and managing employees exist, little information is available pertaining to strategies for coping with unsatisfactory instructors who are unresponsive to…

VENDING PERMITS FOOD SERVICE TO GROW WITH COLLEGE.

ERIC Educational Resources Information Center

RUSHING, JOE B.

WHEN FUNDS WERE NOT AVAILABLE FOR BUILDING A CAFETERIA AT THE JUNIOR COLLEGE OF BROWARD COUNTY, FLORIDA, USE OF VENDING MACHINES PROVED TO BE AN EFFECTIVE MEANS OF PROVIDING FOOD SERVICE TO THE STUDENTS OF THE GROWING COLLEGE. SANDWICH SERVICE HAD ALREADY BEEN FOUND UNSATISFACTORY, AND LACK OF KITCHEN FACILITIES PRECLUDED PREPARATION OF FOOD ON…

9 CFR 113.118 - Pasteurella Multocida Bacterin, Avian Isolate, Type 3.

Code of Federal Regulations, 2011 CFR

2011-01-01

... viable bacteria and fungi as provided in § 113.26. (b) Safety test. Observation of the vaccinated turkeys... turkey, test results shall be determined by observing the remaining 20 turkeys. The test is inconclusive... more turkeys, but the serial is unsatisfactory if the test is not repeated. (c) Potency test. Bulk or...

9 CFR 113.116 - Pasteurella Multocida Bacterin, Avian Isolate, Type 4.

Code of Federal Regulations, 2014 CFR

2014-01-01

... turkeys during the prechallenge period of the potency test provided in paragraph (c) of this section shall... turkey, test results shall be determined by observing the remaining 20 turkeys. The test is inconclusive... more turkeys, but the serial is unsatisfactory if the test is not repeated. (c) Potency test. Bulk or...

9 CFR 113.116 - Pasteurella Multocida Bacterin, Avian Isolate, Type 4.

Code of Federal Regulations, 2012 CFR

2012-01-01

... turkeys during the prechallenge period of the potency test provided in paragraph (c) of this section shall... turkey, test results shall be determined by observing the remaining 20 turkeys. The test is inconclusive... more turkeys, but the serial is unsatisfactory if the test is not repeated. (c) Potency test. Bulk or...

9 CFR 113.116 - Pasteurella Multocida Bacterin, Avian Isolate, Type 4.

Code of Federal Regulations, 2011 CFR

2011-01-01

... turkeys during the prechallenge period of the potency test provided in paragraph (c) of this section shall... turkey, test results shall be determined by observing the remaining 20 turkeys. The test is inconclusive... more turkeys, but the serial is unsatisfactory if the test is not repeated. (c) Potency test. Bulk or...

9 CFR 113.118 - Pasteurella Multocida Bacterin, Avian Isolate, Type 3.

Code of Federal Regulations, 2012 CFR

2012-01-01

... viable bacteria and fungi as provided in § 113.26. (b) Safety test. Observation of the vaccinated turkeys... turkey, test results shall be determined by observing the remaining 20 turkeys. The test is inconclusive... more turkeys, but the serial is unsatisfactory if the test is not repeated. (c) Potency test. Bulk or...

9 CFR 113.118 - Pasteurella Multocida Bacterin, Avian Isolate, Type 3.

Code of Federal Regulations, 2013 CFR

2013-01-01

... viable bacteria and fungi as provided in § 113.26. (b) Safety test. Observation of the vaccinated turkeys... turkey, test results shall be determined by observing the remaining 20 turkeys. The test is inconclusive... more turkeys, but the serial is unsatisfactory if the test is not repeated. (c) Potency test. Bulk or...

9 CFR 113.116 - Pasteurella Multocida Bacterin, Avian Isolate, Type 4.

Code of Federal Regulations, 2013 CFR

2013-01-01

... turkeys during the prechallenge period of the potency test provided in paragraph (c) of this section shall... turkey, test results shall be determined by observing the remaining 20 turkeys. The test is inconclusive... more turkeys, but the serial is unsatisfactory if the test is not repeated. (c) Potency test. Bulk or...

9 CFR 113.118 - Pasteurella Multocida Bacterin, Avian Isolate, Type 3.

Code of Federal Regulations, 2010 CFR

2010-01-01

... viable bacteria and fungi as provided in § 113.26. (b) Safety test. Observation of the vaccinated turkeys... turkey, test results shall be determined by observing the remaining 20 turkeys. The test is inconclusive... more turkeys, but the serial is unsatisfactory if the test is not repeated. (c) Potency test. Bulk or...

9 CFR 113.118 - Pasteurella Multocida Bacterin, Avian Isolate, Type 3.

Code of Federal Regulations, 2014 CFR

2014-01-01

... viable bacteria and fungi as provided in § 113.26. (b) Safety test. Observation of the vaccinated turkeys... turkey, test results shall be determined by observing the remaining 20 turkeys. The test is inconclusive... more turkeys, but the serial is unsatisfactory if the test is not repeated. (c) Potency test. Bulk or...

9 CFR 113.116 - Pasteurella Multocida Bacterin, Avian Isolate, Type 4.

Code of Federal Regulations, 2010 CFR

2010-01-01

... turkeys during the prechallenge period of the potency test provided in paragraph (c) of this section shall... turkey, test results shall be determined by observing the remaining 20 turkeys. The test is inconclusive... more turkeys, but the serial is unsatisfactory if the test is not repeated. (c) Potency test. Bulk or...

Human Food Consumption: A Primer on Nonequilibrium Thermodynamics for College Physics

ERIC Educational Resources Information Center

Zurcher, Ulrich

2008-01-01

Students often have great difficulties with applications of the energy principle, especially those from biology, although most introductory physics texts include a brief discussion of metabolism. We point out that many of these discussions are unsatisfactory, since they often fail to mention how biological systems are "thermal systems in…

Sufism in the Novel: "Cat's Eyes"

ERIC Educational Resources Information Center

Miniawi, Nayera

2013-01-01

"Cat's Eyes" is a novel about suffering and endurance, early marriage, spirituality and the sanctuary it provides, and Sufism in particular. It uses certain motifs to depict the psychological suffering of a young girl, caused by her conservative father and unsatisfactory marriage, which persists until she finally reaches a moment of…

Poetic Rhyme Reflects Cross-Linguistic Differences in Information Structure

ERIC Educational Resources Information Center

Wagner, Michael; McCurdy, Katherine

2010-01-01

Identical rhymes (right/write, attire/retire) are considered satisfactory and even artistic in French poetry but are considered unsatisfactory in English. This has been a consistent generalization over the course of centuries, a surprising fact given that other aspects of poetic form in French were happily applied in English. This paper puts…

Restoration of Complicated Epicanthus: Modified Reverse Skin Redraping With Mini-epicanthoplasty for Rescue in Unsatisfied Epicanthoplasty Patients.

PubMed

Chung, Yoon Jae; Han, Kyung Eun; Park, Bo Young

2017-06-01

We had reported the surgical outcome of reverse skin redraping technique for restoration of previously performed epicanthoplasty. In this study, we introduce a modified reverse skin redraping technique that added mini-epicanthoplasty in patients with unsatisfactory results after epicanthoplasty. Three hundred twenty-four patients (288 female and 36 male patients) who had unsatisfied results with previous epicanthoplasty and that were treated with our modified restoration surgery were included in this study. The mean preoperative interepicanthal distance was 33.6 mm, and the mean postoperative interepicanthal distance was 36.9 mm; the mean difference in the interepicanthal distance before and after restoration surgery was 3.3 mm. Satisfactory aesthetic results were obtained with improvements in areas of asymmetry, overexposure of the caruncle, and the appearance of the previous scar. Only minor complications developed in 15 patients (4.6%) that were resolved with minor revisions. No severe complications requiring reoperations were noted. Our modified method involving reverse skin redraping and mini-epicanthoplasty is simple and reproducible and is useful for resolution of unsatisfactory results to obtain a naturally shaped epicanthus.

The Psychological Effects of Unemployment and Unsatisfactory Employment on Young Adults: Findings from a 10-Year Longitudinal Study.

PubMed

Winefield, Anthony H; Delfabbro, Paul H; Winefield, Helen R; Duong, David; Malvaso, Catia

2017-01-01

The purpose of the present study was to extend the external validity of an earlier longitudinal study of school leavers by including participants from a representative sample of secondary schools. Questionnaires were administered annually to a sample of South Australian school leavers over a 10-year period. At Time 1 participants were in the last compulsory year of high school aged around 15 years and at Time 10 they were aged around 25 years. Results confirmed those from an earlier longitudinal study showing that the transition from school to satisfactory employment was associated with significant improvements in psychological well-being, whereas transition from school to unemployment or unsatisfactory employment showed no change in psychological well-being. The current findings extended the external validity of the earlier study because whereas participants in the earlier study were sampled from co-educational metropolitan public high schools, the current study included participants from every kind of high school: single sex as well as co-educational, rural as well as metropolitan, and private as well as public.

Evaluation of light intensity output of QTH and LED curing devices in various governmental health institutions.

PubMed

Al Shaafi, Mm; Maawadh, Am; Al Qahtani, Mq

2011-01-01

The purpose of this study was to evaluate the light intensity output of quartz-tungsten-halogen (QTH) and light emitting diode (LED) curing devices located at governmental health institutions in Riyadh, Saudi Arabia.Eight governmental institutions were involved in the study. The total number of evaluated curing devices was 210 (120 were QTH and 90 were LED). The reading of the light intensity output for each curing unit was achieved using a digital spectrometer; (Model USB4000 Spectrometer, Ocean Optics Inc, Dunedin, FL, USA). The reading procedure was performed by a single investigator; any recording of light intensity below 300 mW/cm2 was considered unsatisfactory.The result found that the recorded mean values of light intensity output for QTH and LED devices were 260 mW/cm2 and 598 mW/cm2, respectively. The percentage of QTH devices and LED devices considered unsatisfactory was 67.5% and 15.6%, respectively. Overall, the regular assessment of light curing devices using light meters is recommended to assure adequate output for clinical use.

Effects of ultrasound implementation on physical examination learning and teaching during the first year of medical education.

PubMed

Dinh, Vi Am; Frederick, Jon; Bartos, Rebekah; Shankel, Tamara M; Werner, Leonard

2015-01-01

Increasing emphasis has been placed on point-of-care ultrasound in medical school. The overall effects of ultrasound curriculum implementation on the traditional physical examination skills of medical students are still unknown. We studied the effects on the Objective Standardized Clinical Examination (OSCE) scores of year 1 medical students before and after ultrasound curriculum implementation. An ultrasound curriculum was incorporated into the physical diagnosis course for year 1 medical students in the 2012-2013 academic year. We performed a prospective observational study comparing traditional OSCE scores of year 1 medical students exposed to the ultrasound curriculum (post-ultrasound) versus historic year 1 medical student controls (pre-ultrasound) with no ultrasound exposure. Questionnaire data were also obtained from year 1 medical students and physical diagnosis faculty to assess attitudes toward ultrasound implementation. The final overall OSCE scores were graded with a 5-point Likert-type scale from unsatisfactory to outstanding. There was a significant increase in outstanding scores in the post-ultrasound compared to the pre-ultrasound group (27.0% versus 10.9%; P< .001). The post-ultrasound group had significantly (P< .05) increased first-time pass rates on blood pressure measurements, the abdominal examination, and professionalism. Student and physical diagnosis faculty questionnaire data showed an overall positive response, with most agreeing or strongly agreeing that ultrasound should be included in the future year 1 medical student curriculum. Ultrasound implementation into a physical diagnosis curriculum for year 1 medical students is feasible and may improve their overall traditional physical examination skills. © 2015 by the American Institute of Ultrasound in Medicine.

Self rating of health is associated with stressful life events, social support and residency in East and West Berlin shortly after the fall of the wall

PubMed Central

Hillen, T.; Schaub, R.; Hiestermann, A.; Kirschner, W.; Robra, B.

2000-01-01

STUDY OBJECTIVE—To compare the health status and factors influencing the health of populations that had previously lived under different political systems.
DESIGN—Cross sectional health and social survey using postal interviews. The relation between self reported health and psychosocial factors (stressful life events, social support, education, health promoting life style and health endangering behaviour) was investigated. To determine East-West differences a logistic regression model including interaction terms was fitted.
SETTING—East and West Berlin shortly after reunification 1991.
PARTICIPANTS—Representative sample of 4430 Berlin residents aged 18 years and over (response rate 63%).
RESULTS—Of all respondents, 15.4% rated their health as unsatisfactory. Residents of East Berlin rated their health more frequently as unsatisfactory than residents of West Berlin (Orage adjusted= 1.29, 95%CI 1.08, 1.52), these differences occurred predominantly in the over 60 years age group. Logistic regression showed significant independent effects of stressful life events, social support, education, and health promoting life style on self rated health. The effects of education and health promoting life style were observed to be more pronounced in the western part of Berlin. Old age and female sex showed a stronger association with unsatisfactory health status in the eastern part of Berlin.
CONCLUSIONS—For subjects aged over 60 years there was evidence that living in the former East Berlin had an adverse effect on health compared with West Berlin. The impact of education and a health promoting lifestyle on self rated health seemed to be weaker in a former socialist society compared with that of a Western democracy. This study supports an "additive model" rather than a "buffering model" in explaining the effects of psychosocial factors on health.


Keywords: self rated health; health inequalities; stress; social support PMID:10890868

Characteristic findings of cervical Papanicolaou tests from transgender patients on androgen therapy: Challenges in detecting dysplasia.

PubMed

Adkins, B D; Barlow, A B; Jack, A; Schultenover, S J; Desouki, M M; Coogan, A C; Weiss, V L

2018-02-28

The characteristic features of Papanicolaou (Pap) tests collected from female-to-male (FTM) transgender patients on androgen therapy have not been well defined in the literature. FTM transgender patients require cervical cancer screening with the same recommended frequency as cis-gender females. Dysplasia remains challenging to differentiate from atrophy. Without pertinent history, the atrophic findings in younger transgender patients can be misinterpreted as high-grade dysplasia. A review of all cervical Pap tests of transgender patients receiving androgen therapy (2010-2017) was performed. Bethesda diagnosis, cytomorphological features, HPV testing and cervical biopsy results were reviewed. Eleven transgender patients receiving androgen therapy were identified with 23 cervical Pap tests, 11 HPV tests and five cervical biopsies performed. A review of the Pap tests demonstrated: 57% negative for intraepithelial lesion; 13% unsatisfactory; 13% atypical squamous cells of undetermined significance; 13% atypical squamous cells - cannot exclude high-grade squamous intraepithelial lesion; and 4% high-grade squamous intraepithelial lesion. The rates of abnormal tests were higher than our age-matched cis-gender atrophic cohort rates of unsatisfactory (0.5%), atypical squamous cells of undetermined significance (7%), atypical squamous cells-cannot exclude high-grade squamous intraepithelial lesion (0%) and high-grade squamous intraepithelial lesion (0.5%). The cytological findings from liquid-based preparations included dispersed and clustered parabasal-type cells, scattered degenerated cells, smooth evenly dispersed chromatin, and occasional mild nuclear enlargement and irregularity. Dysplastic cells had larger nuclei, hyperchromatic clumped chromatin, and more irregular nuclear contours. The evaluation of dysplasia can be challenging on Pap tests from transgender patients on androgen therapy. The cohort evaluated had higher rates of unsatisfactory and abnormal Pap tests. Pathologists should be familiar with the distinctive cytomorphological changes in the Pap tests from patients on androgen therapy to evaluate them appropriately. © 2018 John Wiley & Sons Ltd.

Risk Factors for Immediate and Delayed-Onset Fever After Percutaneous Transhepatic Biliary Drainage

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

Lucatelli, Pierleone, E-mail: pierleone.lucatelli@gmail.com; Corradini, Stefano Ginanni, E-mail: stefano.corradini@uniroma1.it; Corona, Mario, E-mail: mario.corona@uniroma1.it

ObjectivesTo prospectively investigate the pre and intra-procedural risk factors for immediate (IF) and delayed-onset (DOF) fever development after percutaneous transhepatic biliary drainage (PTBD).MethodsInstitutional review board approval and informed patient consent were obtained. Between February 2013 and February 2014, 97 afebrile patients (77 at the Sapienza University of Rome, Italy and 20 at the Sun Yat-sen University of Guangzhou, China) with benign (n = 31) and malignant (n = 66) indications for a first PTBD were prospectively enrolled. Thirty pre- and intra-procedural clinical/radiological characteristics, including the amount of contrast media injected prior to PTBD placement, were collected in relation to the development of IF (withinmore » 24 h) or DOF (after 24 h). Fever was defined as ≥37.5 °C. Binary logistic regression analysis was used to assess independent associations with IF and DOF.ResultsFourteen (14.4 %) patients developed IF and 17 (17.5 %) developed DOF. At multivariable analysis, IF was associated with pre-procedural absence of intrahepatic bile duct dilatation (OR 63.359; 95 % CI 2.658–1510.055; P = 0.010) and low INR (OR 4.7 × 10{sup −4}; 95 % CI 0.000–0.376; P = 0.025), while DOF was associated with unsatisfactory biliary drainage at the end of PTBD (OR 4.571; 95 % CI 1.161–17.992; P = 0.030).ConclusionsThe amount of contrast injected is not associated with post-PTBD fever development. Unsatisfactory biliary drainage at the end of PTBD is associated with DOF, suggesting that complete biliary tree decompression should be pursued within the first PTBD. Patients with unsatisfactory drainage and those with the absence of pre-procedural intrahepatic bile duct dilatation, which is associated with IF, require tailored post-PTBD management.« less

Psychometric evaluation and wording effects on the Chinese version of the parent-proxy Kid-KINDL.

PubMed

Lee, Chih-Ting; Lin, Chung-Ying; Tsai, Meng-Che; Strong, Carol; Lin, Yi-Ching

2016-09-05

The pediatric quality of life (QoL) questionnaire, the child-rated Kid-KINDL, has wording effects. However, no studies have examined for its parallel questionnaire, the parent-proxy Kid-KINDL. This study aimed to examine the psychometric properties and wording effects of the parent-proxy Kid-KINDL. Parents with 8- to 12-year-old children (n = 247) completed the parent-proxy Kid-KINDL, 83 of them completed it again 7-14 days later, and 241 of their children completed the child-rated Kid-KINDL. Internal consistency was examined using Cronbach's α; test-retest reliability and concurrent validity, using Pearson correlation coefficients (r); construct validity and wording effects, using confirmatory factor analyses (CFAs). The internal consistency of the parent-proxy Kid-KINDL total score was acceptable (α = .86). Test-retest reliability (r = .33-.60) and concurrent validity (r = .27-.42) were acceptable or nearly acceptable for all subscales and the total score. The CFA models simultaneously accounting for QoL traits and wording effects had satisfactory fit indices, and outperformed the model accounting only for QoL traits. However, four subscales had unsatisfactory internal consistency, which might be attributable to wording effects. When children are unable to complete a QoL questionnaire, the parent-proxy Kid-KINDL can substitute with all due cautions to wording effects and inconsistent reliability among different raters.

Phase II Trial of β-All-trans-Retinoic Acid for Cervical Intraepithelial Neoplasia Delivered via a Collagen Sponge and Cervical Cap

PubMed Central

Graham, Vivian; Surwit, Earl S.; Weiner, Sheldon; Meyskens, Frank L.

1986-01-01

Retinoids are effective suppressors of the phenotypic development of cancer in many animal systems, whether the process is initiated by chemical, physical or viral carcinogens. Cases of cervical intraepithelial neoplasia are excellent for studying the effectiveness of retinoids as chemopreventive agents because the process can be closely followed by serial colposcopic and pathologic (cytology or biopsy) means and changes in the condition safely monitored. We have previously conducted a phase I study of trans-retinoic acid (Tretinoin) given topically by a collagen sponge and cervical cap. A dose of 0.372% was selected for phase II trial. We have treated 20 patients with topical retinoic acid, and a complete response with total regression of disease was obtained in 50%. Systemic and cervical side effects were mild and vaginal side effects moderate but tolerable. These results provide a clinical basis for a randomized, double-blind phase III study to definitely answer the question of whether retinoic acid is an effective chemopreventive agent for cervical cancer. ImagesFigure. 1. PMID:3765597

Computerized image analysis for acetic acid induced intraepithelial lesions

NASA Astrophysics Data System (ADS)

Li, Wenjing; Ferris, Daron G.; Lieberman, Rich W.

2008-03-01

Cervical Intraepithelial Neoplasia (CIN) exhibits certain morphologic features that can be identified during a visual inspection exam. Immature and dysphasic cervical squamous epithelium turns white after application of acetic acid during the exam. The whitening process occurs visually over several minutes and subjectively discriminates between dysphasic and normal tissue. Digital imaging technologies allow us to assist the physician analyzing the acetic acid induced lesions (acetowhite region) in a fully automatic way. This paper reports a study designed to measure multiple parameters of the acetowhitening process from two images captured with a digital colposcope. One image is captured before the acetic acid application, and the other is captured after the acetic acid application. The spatial change of the acetowhitening is extracted using color and texture information in the post acetic acid image; the temporal change is extracted from the intensity and color changes between the post acetic acid and pre acetic acid images with an automatic alignment. The imaging and data analysis system has been evaluated with a total of 99 human subjects and demonstrate its potential to screening underserved women where access to skilled colposcopists is limited.

Improved data retrieval from TreeBASE via taxonomic and linguistic data enrichment

PubMed Central

Anwar, Nadia; Hunt, Ela

2009-01-01

Background TreeBASE, the only data repository for phylogenetic studies, is not being used effectively since it does not meet the taxonomic data retrieval requirements of the systematics community. We show, through an examination of the queries performed on TreeBASE, that data retrieval using taxon names is unsatisfactory. Results We report on a new wrapper supporting taxon queries on TreeBASE by utilising a Taxonomy and Classification Database (TCl-Db) we created. TCl-Db holds merged and consolidated taxonomic names from multiple data sources and can be used to translate hierarchical, vernacular and synonym queries into specific query terms in TreeBASE. The query expansion supported by TCl-Db shows very significant information retrieval quality improvement. The wrapper can be accessed at the URL The methodology we developed is scalable and can be applied to new data, as those become available in the future. Conclusion Significantly improved data retrieval quality is shown for all queries, and additional flexibility is achieved via user-driven taxonomy selection. PMID:19426482

Complementary approaches to the assessment of personality disorder. The Personality Assessment Schedule and Adult Personality Functioning Assessment compared.

PubMed

Hill, J; Fudge, H; Harrington, R; Pickles, A; Rutter, M

2000-05-01

Current concepts and measures of personality disorder are in many respects unsatisfactory. To establish agreement between two contrasting measures of personality disorder, and to compare subject-informant agreement on each. To examine the extent to which trait abnormality can be separated from interpersonal and social role dysfunction. Fifty-six subjects and their closest informants were interviewed and rated independently. Personality functioning was assessed using a modified Personality Assessment Schedule (M-PAS), and the Adult Personality Functioning Assessment (APFA). Subject-informant agreement on the M-PAS was moderately good, and agreement between the M-PAS and the APFA, across and within subjects and informants, was comparable to that for the M-PAS. This was equally the case when M-PAS trait plus impairment scores and trait abnormality scores were used. The M-PAS and the APFA are probably assessing similar constructs. Trait abnormalities occur predominantly in an interpersonal context and could be assessed within that context.

The Association Between Dissatisfaction with Debriefing and Post-Traumatic Stress Disorder (PTSD) in Rescue and Recovery Workers for the Oklahoma City Bombing.

PubMed

Tran, Duy Vu; North, Carol S

2018-03-15

The purpose of this study was to investigate potential association between psychopathology and subjective evaluation of the experience of debriefing in disaster-exposed rescue and recovery workers. Structured diagnostic interviews for DSM-III-R psychiatric disorders were conducted with 166 firefighters who served as rescue and recovery workers for the 1995 Oklahoma City bombing, who categorized their satisfaction with the debriefing on 4 levels. "Very dissatisfied" responses were examined for their association with post-traumatic stress disorder (PTSD) and with PTSD symptom groups. Being "very dissatisfied" with the debriefing was significantly associated with the DSM-III-R avoidance and numbing group and with PTSD. These findings suggest that debriefing may be an unsatisfactory intervention for people with prominent avoidance and numbing symptoms, such as those with PTSD. These individuals might be better served by referral directly to psychiatric treatment (Disaster Med Public Health Preparedness. 2018;page 1 of 5).

High serum creatinine nonlinearity: a renal vital sign?

PubMed

Palant, Carlos E; Chawla, Lakhmir S; Faselis, Charles; Li, Ping; Pallone, Thomas L; Kimmel, Paul L; Amdur, Richard L

2016-08-01

Patients with chronic kidney disease (CKD) may have nonlinear serum creatinine concentration (SC) trajectories, especially as CKD progresses. Variability in SC is associated with renal failure and death. However, present methods for measuring SC variability are unsatisfactory because they blend information about SC slope and variance. We propose an improved method for defining and calculating a patient's SC slope and variance so that they are mathematically distinct, and we test these methods in a large sample of US veterans, examining the correlation of SC slope and SC nonlinearity (SCNL) and the association of SCNL with time to stage 4 CKD (CKD4) and death. We found a strong correlation between SCNL and rate of CKD progression, time to CKD4, and time to death, even in patients with normal renal function. We therefore argue that SCNL may be a measure of renal autoregulatory dysfunction that provides an early warning sign for CKD progression. Copyright © 2016 the American Physiological Society.

[A short version of the Narcissistic Personality Inventory (NPI-15): dimensionality and psychometric properties in a representative sample of the German population].

PubMed

Spangenberg, Lena; Romppel, Matthias; Bormann, Bianca; Hofmeister, Dirk; Brähler, Elmar; Strauß, Bernhard

2013-08-01

The Narcissistic Personality Inventory (NPI) is a commonly used measure of narcissism. This study administered a 15 item short version of the NPI (NPI-15). Central aims of the present study were to examine its dimensionality, and to provide data on its psychometric properties. NPI-15 and Hospital Anxiety and Depression Scale (HADS-D) were assessed in a representative sample of the German population (N=2,512). According to Scree-plot and model fit, a solution with 2 or 3 factors seemed feasible. Because of factor loadings and item-level associations to depression/anxiety we decided to favour a 2-factor-solution. 2 subscales reflecting different facets of narcissism were compiled (leadership ability/personality [LA/LP], grandiosity [G]). The psychometric properties of these scales were good (LA/LP) respectively unsatisfactory (G). The validity of the NPI-15 needs to be further studied. © Georg Thieme Verlag KG Stuttgart · New York.

High-speed autoverifying technology for printed wiring boards

NASA Astrophysics Data System (ADS)

Ando, Moritoshi; Oka, Hiroshi; Okada, Hideo; Sakashita, Yorihiro; Shibutani, Nobumi

1996-10-01

We have developed an automated pattern verification technique. The output of an automated optical inspection system contains many false alarms. Verification is needed to distinguish between minor irregularities and serious defects. In the past, this verification was usually done manually, which led to unsatisfactory product quality. The goal of our new automated verification system is to detect pattern features on surface mount technology boards. In our system, we employ a new illumination method, which uses multiple colors and multiple direction illumination. Images are captured with a CCD camera. We have developed a new algorithm that uses CAD data for both pattern matching and pattern structure determination. This helps to search for patterns around a defect and to examine defect definition rules. These are processed with a high speed workstation and a hard-wired circuits. The system can verify a defect within 1.5 seconds. The verification system was tested in a factory. It verified 1,500 defective samples and detected all significant defects with only a 0.1 percent of error rate (false alarm).

Bacteria and Nutrients in the Obhur Recreational Sharm, Jeddah, Saudi Arabia

NASA Astrophysics Data System (ADS)

Turki, Adnan; Mudarris, Mohammed

2013-04-01

Environmental pollution that render waters along the recreational shore unsatisfactory for use by the general public has become a global health problem. This study was carried out to examine the marine waters in sampling stations located at Sharm Obhur (North of Jeddah). These parameters included: total coliform (TC), l fecal coliform (FC) and nutrients (NO2-N, NO3-N, NH4-N and PO4-P). A comparison of the mean values of nutrients in Sharm Obhur with those of other locations in the Red Sea suggests that the mean levels of nutrients were similar to those of unpolluted areas. TC and FC counts were higher at the north sampling stations than the south ones, and with little variations between their numbers. FC was not recovered at stations to the south. The study shows that TC and FC counts at all sampling stations similar to the levels reported for normal unpolluted sea water. Keywords: Pollution, Nutrients, Coliforms, Sharm Obhur, Red Sea.

Preparation of samples for leaf architecture studies, a method for mounting cleared leaves1

PubMed Central

Vasco, Alejandra; Thadeo, Marcela; Conover, Margaret; Daly, Douglas C.

2014-01-01

• Premise of the study: Several recent waves of interest in leaf architecture have shown an expanding range of approaches and applications across a number of disciplines. Despite this increased interest, examination of existing archives of cleared and mounted leaves shows that current methods for mounting, in particular, yield unsatisfactory results and deterioration of samples over relatively short periods. Although techniques for clearing and staining leaves are numerous, published techniques for mounting leaves are scarce. • Methods and Results: Here we present a complete protocol and recommendations for clearing, staining, and imaging leaves, and, most importantly, a method to permanently mount cleared leaves. • Conclusions: The mounting protocol is faster than other methods, inexpensive, and straightforward; moreover, it yields clear and permanent samples that can easily be imaged, scanned, and stored. Specimens mounted with this method preserve well, with leaves that were mounted more than 35 years ago showing no signs of bubbling or discoloration. PMID:25225627

A guide to diagnosis and treatment of Leigh syndrome.

PubMed

Baertling, Fabian; Rodenburg, Richard J; Schaper, Jörg; Smeitink, Jan A; Koopman, Werner J H; Mayatepek, Ertan; Morava, Eva; Distelmaier, Felix

2014-03-01

Leigh syndrome is a devastating neurodegenerative disease, typically manifesting in infancy or early childhood. However, also late-onset cases have been reported. Since its first description by Denis Archibald Leigh in 1951, it has evolved from a postmortem diagnosis, strictly defined by histopathological observations, to a clinical entity with indicative laboratory and radiological findings. Hallmarks of the disease are symmetrical lesions in the basal ganglia or brain stem on MRI, and a clinical course with rapid deterioration of cognitive and motor functions. Examinations of fresh muscle tissue or cultured fibroblasts are important tools to establish a biochemical and genetic diagnosis. Numerous causative mutations in mitochondrial and nuclear genes, encoding components of the oxidative phosphorylation system have been described in the past years. Moreover, dysfunctions in pyruvate dehydrogenase complex or coenzyme Q10 metabolism may be associated with Leigh syndrome. To date, there is no cure for affected patients, and treatment options are mostly unsatisfactory. Here, we review the most important clinical aspects of Leigh syndrome, and discuss diagnostic steps as well as treatment options.

[Computer graphic display of retinal examination results. Software improving the quality of documenting fundus changes].

PubMed

Jürgens, Clemens; Grossjohann, Rico; Czepita, Damian; Tost, Frank

2009-01-01

Graphic documentation of retinal examination results in clinical ophthalmological practice is often depicted using pictures or in handwritten form. Popular software products used to describe changes in the fundus do not vary much from simple graphic programs that enable to insert, scale and edit basic graphic elements such as: a circle, rectangle, arrow or text. Displaying the results of retinal examinations in a unified way is difficult to achieve. Therefore, we devised and implemented modern software tools for this purpose. A computer program enabling to quickly and intuitively form graphs of the fundus, that can be digitally archived or printed was created. Especially for the needs of ophthalmological clinics, a set of standard digital symbols used to document the results of retinal examinations was developed and installed in a library of graphic symbols. These symbols are divided into the following categories: preoperative, postoperative, neovascularization, retinopathy of prematurity. The appropriate symbol can be selected with a click of the mouse and dragged-and-dropped on the canvas of the fundus. Current forms of documenting results of retinal examinations are unsatisfactory, due to the fact that they are time consuming and imprecise. Unequivocal interpretation is difficult or in some cases impossible. Using the developed computer program a sketch of the fundus can be created much more quickly than by hand drawing. Additionally the quality of the medica documentation using a system of well described and standardized symbols will be enhanced. (1) Graphic symbols used to document the results of retinal examinations are a part of everyday clinical practice. (2) The designed computer program will allow quick and intuitive graphical creation of fundus sketches that can be either digitally archived or printed.

To amend title 5, United States Code, to provide that civilian employees of the Department of Defense performing unsatisfactory work shall not be eligible for annual nationwide adjustments to pay schedules.

THOMAS, 112th Congress

Rep. West, Allen B. [R-FL-22

2011-03-29

House - 04/01/2011 Referred to the Subcommittee on Federal Workforce, U.S. Postal Service, and Labor Policy. (All Actions) Tracker: This bill has the status IntroducedHere are the steps for Status of Legislation:

Teacher Qualification and Students' Academic Performance in Science Mathematics and Technology Subjects in Kenya

ERIC Educational Resources Information Center

Musau, Lydia M.; Abere, Migosi Joash

2015-01-01

Performance in Science, Mathematics and Technology (SMT) subjects among students in Kitui County, Kenya has perpetually been unsatisfactory. The aim of this study was to look into the extent to which teacher qualification influenced students' academic performance in SMT subjects. The study applied ex-post-facto survey research design. Random…

The Findings of an Assessment Audit: An NTFS Project Report

ERIC Educational Resources Information Center

Hughes, Ian

2006-01-01

An Assessment Audit is described consisting of 47 questions, each being scored 0 to 4, by the module team depending on the extent to which the audit point was satisfied. Scores of 2 or less indicated unsatisfactory provision. Audits were carried out on 14 bioscience- or medicine-based modules in 13 universities. There was great variability between…

Strengths and Weaknesses of Elementary and Secondary Education in Uganda: Evaluation Based on a Teachers' Survey

ERIC Educational Resources Information Center

Walugembe, Frederick

2009-01-01

This study intends to identify the aspects of the Ugandan teachers' jobs and work environment perceived by selective participants as satisfactory, as well as those perceived as less satisfactory or unsatisfactory. The study is based on the assumption that teachers, being directly involved in the current activities of educational institutions, have…

Calibration of the Wedge Prism

Treesearch

Charles B. Briscoe

1957-01-01

Since the introduction of plotless cruising in this country by Grosenbaugh and the later suggestion of using a wedge prism as an angle gauge by Bruce this method of determining basal area has been widely adopted in the South. One of the factors contributing to the occasionally unsatisfactory results obtained is failure to calibrate the prism used. As noted by Bruce the...

Extraterrestrial Hemorrhage Control: Terrestrial Developments in Technique, Technology, and Philosophy with Applicability to Traumatic Hemorrhage Control in Long-Duration Spaceflight

DTIC Science & Technology

2005-01-01

instability, or allow oxygen- ation of a patient suffering from a severe respiratory insult such as a massive toxic inhalation , but would be unsatisfactory... trehalose survive freeze-drying. Cryobiology 2001; 42:79–87. 151. Fischer TH, Merricks EP, Bode AP, et al. Thrombus formation with rehydrated

What Specific Science Abilities and Skills Are Romanian Students Developing during Primary Education? A Comparison with the Abilities Tested by the TIMSS 2011 Inquiry

ERIC Educational Resources Information Center

Ciascai, Liliana; Dulama, Maria-Eliza

2013-01-01

The results of Romanian students at international comparative TIMSS and PISA tests have constantly proven to be unsatisfactory. The present paper aims at analyzing the school syllabi "Mathematics and Environment exploration", "Environmental Education" and "Natural Sciences" studied during primary education in Romania…

76 FR 15956 - Applications for New Awards; Fund for the Improvement of Postsecondary Education-Comprehensive...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-03-22

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2013-06-14

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Federal Register 2010, 2011, 2012, 2013, 2014

2011-02-08

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Federal Register 2010, 2011, 2012, 2013, 2014

2011-01-13

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77 FR 12041 - Applications for New Awards; Migrant Education Program (MEP) Consortium Incentive Grants Program

Federal Register 2010, 2011, 2012, 2013, 2014

2012-02-28

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9 CFR 113.55 - Detection of extraneous agents in Master Seed Virus.

Code of Federal Regulations, 2010 CFR

2010-01-01

... MSV that is found unsatisfactory by any prescribed test. (a) At least a 1.0 ml aliquot per cell... monkey kidney) cell line; (2) Embryonic cells, neonatal cells, or a cell line of the species for which...) and (a)(2) of this section. Cell lines used shall have been found satisfactory when tested as...

Balance models for equatorial planetary-scale dynamics

NASA Astrophysics Data System (ADS)

Chan, Ian Hiu-Fung

This thesis aims at advancing our understanding of large-scale dynamics in the tropics, specifically the characterization of slow planetary-scale motions through a balance theory; current balance theories in the tropics are unsatisfactory as they filter out Kelvin waves, which are an important component of variability, along with fast inertia-gravity (IG) waves. (Abstract shortened by UMI.).

Management of sexuality problem in quadriplegia: a brief summary.

PubMed

Wiwanitkit, Viroj

2010-09-01

Quadriplegia is a serious group of spinal disability. Cases with quadriplegia usually present unsatisfactory sexual life. In male, the main problem is the ability to reach orgasm deficient. In female, pregnancy problem should be noted. Management of sexuality problem in quadriplegia is of interest. In this article, the author will briefly review on this topic.

13 CFR 143.12 - Special grant or subgrant conditions for “high-risk” grantees.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 13 Business Credit and Assistance 1 2010-01-01 2010-01-01 false Special grant or subgrant conditions for âhigh-riskâ grantees. 143.12 Section 143.12 Business Credit and Assistance SMALL BUSINESS... or subgrantee: (1) Has a history of unsatisfactory performance, or (2) Is not financially stable, or...

Competency-Based Training: An Assessment of Its Strengths and Weaknesses by New South Wales Vocational Teachers.

ERIC Educational Resources Information Center

Cornford, Ian R.

1997-01-01

A survey of 72 New South Wales vocational teachers revealed that competency-based training has created perceived pressures to pass students, is difficult to implement with limited resources, encourages modularization, and is hampered by unsatisfactory assessment and standards. Over 61% of the teachers felt that it has hindered or severely hindered…

49 CFR 1155.23 - Additional requirements when filing after an unsatisfactory result from a State, local, or...

Code of Federal Regulations, 2010 CFR

2010-10-01

... Procedures Governing Applications for a Land-Use-Exemption Permit § 1155.23 Additional requirements when... the facility. (a) When an applicant has previously sought permission from the applicable state, local... siting of the facility, the applicant may petition the Board to accept an application for a land-use...

77 FR 28451 - Unsatisfactory Safety Rating; Revocation of Operating Authority Registration; Technical Amendments

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-14

... carrier for failure to comply with safety fitness requirements; if the Agency determines that a motor carrier is ``Unfit'' based on its Safety Fitness Determination procedures, the Agency must revoke the... failure to comply with safety fitness requirements. See 49 U.S.C. 13905(f)(1)(B) and (3). The implementing...

Perspectives and Practices of Academics and Students of English Language Teaching Post-Graduate Programs within the Mediation Theory

ERIC Educational Resources Information Center

Asmali, Mehmet

2018-01-01

Due to unsatisfactory number of researches investigating ELT post-graduate programs, and perceptions of academics and students in these programs regarding mediation theory of Feuerstein, this study attempted to investigate the aspects of this theory in doctorate and master programs in ELT department of a state university. Methodologically, this…

14 CFR Appendix D to Part 43 - Scope and Detail of Items (as Applicable to the Particular Aircraft) To Be Included in Annual and...

Code of Federal Regulations, 2010 CFR

2010-01-01

... group: (1) Radio and electronic equipment—for improper installation and insecure mounting. (2) Wiring...) Systems and components—for improper installation, apparent defects, and unsatisfactory operation. (3...) improper operation. (5) Flight and engine controls—for improper installation and improper operation. (6...

Parental Involvement: What Counts, Who Counts It, and Does It Help?

ERIC Educational Resources Information Center

Flessa, Joseph

2008-01-01

When asked to explain why so many urban schools show unsatisfactory results on academic or social measures, principals routinely and quickly turn to descriptions of parents. In other words, when seeking to explain why work within a school is so difficult or why reform initiatives have been unsuccessful, many principals point outside the school.…

Picture-Tube Imperialism? The Impact of U. S. Television on Latin America.

ERIC Educational Resources Information Center

Wells, Alan

Current theories of national economic development are reviewed and found unsatisfactory, and an alternative scheme is presented, based on the concepts of consumerism and producerism, as well as the realization that development is not a unitary phenomenon, but proceeds at different rates in different sectors of the economy and different parts of a…

9 CFR 113.109 - Clostridium Sordellii Bacterin-Toxoid.

Code of Federal Regulations, 2010 CFR

2010-01-01

... prescribed in this section. A serial found unsatisfactory by any prescribed test shall not be released. (a... following words and terms shall mean: (i) International antitoxin unit. (I.U.) That quantity of antitoxin... distilled water; adjusting the pH to 7.2; autoclaving at 121 °C for 25 minutes; and storing at 4 °C until...