Distribution by Scientific Domains
Distribution within Medical Sciences

Kinds of Protocol

  • access protocol
  • acquisition protocol
  • adaptive protocol
  • administration protocol
  • alternative protocol
  • amplification protocol
  • anesthetic protocol
  • annealing protocol
  • assessment protocol
  • authentication protocol
  • care protocol
  • chemotherapy protocol
  • clinical protocol
  • clinical trial protocol
  • communication protocol
  • control protocol
  • cryopreservation protocol
  • current protocol
  • detailed protocol
  • detection protocol
  • diagnostic protocol
  • different protocol
  • differentiation protocol
  • dna extraction protocol
  • effective protocol
  • efficient protocol
  • enrichment protocol
  • evaluation protocol
  • examination protocol
  • exchange protocol
  • exercise protocol
  • existing protocol
  • experimental protocol
  • exposure protocol
  • extraction protocol
  • fatigue protocol
  • follow-up protocol
  • freezing protocol
  • gene therapy protocol
  • general protocol
  • green protocol
  • group protocol
  • hybridization protocol
  • imaging protocol
  • immunosuppression protocol
  • immunosuppressive protocol
  • improved protocol
  • induction protocol
  • infusion protocol
  • institutional protocol
  • internet protocol
  • intervention protocol
  • interview protocol
  • irradiation protocol
  • isolation protocol
  • key exchange protocol
  • kyoto protocol
  • laboratory protocol
  • loading protocol
  • local protocol
  • management protocol
  • measurement protocol
  • mild protocol
  • modified protocol
  • monitoring protocol
  • mri protocol
  • multicast protocol
  • new protocol
  • novel protocol
  • one-pot protocol
  • one-stage surgical protocol
  • optimal protocol
  • p2p protocol
  • pacing protocol
  • pcr protocol
  • practical protocol
  • practice protocol
  • preparation protocol
  • prevention protocol
  • previous protocol
  • processing protocol
  • proposed protocol
  • prospective protocol
  • purification protocol
  • rapid protocol
  • reaction protocol
  • rehabilitation protocol
  • reliable protocol
  • repeat amplification protocol
  • research protocol
  • review protocol
  • routing protocol
  • same protocol
  • sample preparation protocol
  • sampling protocol
  • scanning protocol
  • screening protocol
  • separation protocol
  • several protocol
  • similar protocol
  • simple protocol
  • specific protocol
  • staining protocol
  • standard protocol
  • standardized protocol
  • stimulation protocol
  • strict protocol
  • stroke protocol
  • study protocol
  • surgical protocol
  • surveillance protocol
  • synthesis protocol
  • synthetic protocol
  • telomeric repeat amplification protocol
  • test protocol
  • testing protocol
  • therapeutic protocol
  • therapy protocol
  • think-aloud protocol
  • tolerance induction protocol
  • training protocol
  • transduction protocol
  • transfection protocol
  • transfer protocol
  • transmission control protocol
  • transport protocol
  • treatment protocol
  • trial protocol
  • two-step protocol
  • ultrasound protocol
  • useful protocol
  • vaccination protocol
  • validation protocol
  • verbal protocol
  • weaning protocol

  • Terms modified by Protocol

  • protocol analysis
  • protocol biopsy
  • protocol compliance
  • protocol consisting
  • protocol design
  • protocol deviation
  • protocol liver biopsy
  • protocol stack
  • protocol used
  • protocol version
  • protocol violation

  • Selected Abstracts


    ABSTRACT This research investigated new paradigms that permit the simultaneous comparison of more than two samples in a discrimination study. Three successive experiments were conducted. All involved noncarbonated orange beverages. In experiment I, Torgerson's method of triads was found to be more discriminating than the multiple dual-pair method and was used in the subsequent two experiments. In experiments II and III, subjects discriminated among stimuli using the Torgerson's method as well as traditional duo,trios. In experiment II, the univariate Thurstonian model with four distributions was found to provide a suitable fit of the data, and the d, values obtained using the traditional duo,trio methodology were not found to be significantly different from those obtained with Torgerson's method. In experiment III, a multivariate, but not univariate, model provided a good fit of the data. Furthermore, d, values from the Torgerson's method were not found to be significantly different from those obtained using the traditional duo,trio methodology. PRACTICAL APPLICATIONS This research supported the use of a Thurstonian model for Torgerson's method of triads and uncovered the usefulness of the method when comparing more than two samples using a discrimination methodology, which has applications in situations involving samples with inherent intra-product variations. Flexibility in the models available also permits the estimation of the dimensionality of the differences among the stimuli involved, providing valuable information that can be obtained more efficiently than running multiple pair-wise traditional discrimination trials. [source]


    Lawrence M. Dill
    Abstract The semiwild beach-feeding bottlenose dolphins (Tursiops aduncus) of Monkey Mia, Western Australia, provide an unparalleled opportunity to examine prey preference of this species. In a series of binary-choice feeding experiments, we took advantage of the animals' willingness to be fed by hand, to explore their preferences for fish species, size, and state (freshly caught or previously frozen). At the end of each beach visit, each dolphin was provided with a pair of fish but allowed to eat only the first one chosen. The dolphins appeared indifferent among the three species of fish offered to them (yellowtail trumpeter, Amniataba caudovittatus; striped trumpeter, Pelates sexlineatus; and western butterfish, Pentapodus vitta), which were of similar body form and matched for mass. Overall, the dolphins showed a slight preference for the larger of two yellowtail trumpeter offered, suggesting the capability for rational choice when there was a basis for it (most likely energy in this case), although there was considerable individual variation. The dolphins did not distinguish between freshly caught and previously frozen yellowtail. The methodology we describe can be used to generate data of potential value for understanding food and habitat selection of wild dolphins, and for modifying management practices for semiwild dolphins at Monkey Mia and elsewhere. [source]


    Brant E. Fries PhD
    No abstract is available for this article. [source]


    ABSTRACT Consumers rated a set of toothpastes and a set of orange-flavored beverages on a 9-point hedonic scale, using two experimental protocols: Rank-Rating where stimuli could continually be reassessed and a more traditional approach where they could not. A 21-point hedonic scale was also used in the Rank-Rating condition. The hedonic data were analyzed in the usual way using ANOVA with multiple comparisons and also by ranking the data and using an R-index analysis. Regarding the numbers of significant differences recorded, the two analyses were comparable, with a very slight and nonsignificant advantage for the ANOVA analysis. Unlike with intensity scaling, the difference between Rank-Rating and "traditional" scaling was slight but not for all products. The same was true for scale length effects. Differences among the products suggested effects due to the number of attributes that varied. PRACTICAL APPLICATIONS The key finding in this study is the use of Rank-Rating where stimuli could continually be re-assessed for the assessment of hedonic response of consumers in the various products. Rank-Rating may possibly give a better discrimination than more traditional scaling, depending on the number of attributes which varied. The results of the study also recommend the use of R-index analyses of ranked hedonic data in the analyses rather than ANOVA with multiple comparisons. [source]


    Jeffrey Jack
    ABSTRACT: The processing of waste from confined animal feeding operations (CAFOs) presents a major environmental challenge. Treatment of waste and subsequent land application is a common best management practice (BMP) for these operations in Kentucky, USA, but there are few data assessing the effect of runoff from such operations on aquatic communities. The authors sampled a stream bordering a CAFO with a land application program to determine if runoff from the fertilized fields was adversely affecting stream communities. Water chemistry, periphyton, and macroinvertebrate samples from riffle habitats downstream of the CAFO were compared to samples collected from an upstream site and a control stream in 1999 and 2000. Riffle communities downstream of the fertilized fields had higher chlorophyll a levels than other sites, but there were no significant differences in macroinvertebrate numbers or in biometrics such as taxa richness among the sites. The BMP in place at this site may be effective in reducing this CAFO's impact on the stream; however, similar assessments at other CAFO sites should be done to assess their impacts. Functional measures such as nutrient retention and litter decomposition of streams impacted by CAFOs should also be investigated to ensure that these operations are not adversely affecting stream communities. [source]


    ABSTRACT. We combine new concepts of noncooperative coalition theory with an integrated assessment model on climate change to analyze the impact of different protocol designs on the success of coalition formation. We analyze the role of "single versus multiple coalitions,""open versus exclusive membership,""no, weak and strong consensus about membership" and "no transfers versus transfers." First, we want to find out whether and how modifications of the standard assumptions affect results that are associated with the widely applied cartel formation game in the noncooperative game theoretic analysis of international environmental agreements. Second, we discuss normative policy conclusions that emerge from the various modifications. Third, we confront our results with evidence on past international environmental treaties and derive an agenda for future research. [source]


    ARCHAEOMETRY, Issue 1 2010
    C. J. YODER
    Researchers have long debated the appropriateness of stable isotope analysis of bone apatite to reconstruct the diets of ancient animals. The debate has centred, in part, on diagenesis of bone mineral from interaction with the burial environment. A number of acetic acid treatments are used to remove diagenetic carbonates from samples; however, less is known on how different protocols alter stable isotope values. We compare two common acetic acid solution treatments (0.1 M versus 1.0 M-buffered) to examine the effects on carbon and oxygen isotope values and Fourier transform infrared spectroscopy (FTIR) spectra in human bone from different burial contexts. Results indicate that both treatments have a similar effect on isotope values and FTIR spectra in bone apatite. [source]

    To Commit or Not to Commit: Modeling Agent Conversations for Action

    Roberto A. Flores
    Conversations are sequences of messages exchanged among interacting agents. For conversations to be meaningful, agents ought to follow commonly known specifications limiting the types of messages that can be exchanged at any point in the conversation. These specifications are usually implemented using conversation policies (which are rules of inference) or conversation protocols (which are predefined conversation templates). In this article we present a semantic model for specifying conversations using conversation policies. This model is based on the principles that the negotiation and uptake of shared social commitments entail the adoption of obligations to action, which indicate the actions that agents have agreed to perform. In the same way, obligations are retracted based on the negotiation to discharge their corresponding shared social commitments. Based on these principles, conversations are specified as interaction specifications that model the ideal sequencing of agent participations negotiating the execution of actions in a joint activity. These specifications not only specify the adoption and discharge of shared commitments and obligations during an activity, but also indicate the commitments and obligations that are required (as preconditions) or that outlive a joint activity (as postconditions). We model the Contract Net Protocol as an example of the specification of conversations in a joint activity. [source]

    To Explant or Not to Explant: An Invasive and Noninvasive Monitoring Protocol to Determine the Need of Continued Ventricular Assist Device Support

    Satoru Osaki MD
    Predictors of myocardial recovery after ventricular assist device (VAD) implantation are not well defined. The authors report their current VAD weaning protocol. Between 2003 and 2006, 38 patients received VAD implants. The authors performed 5 tests in 4 patients in whom echocardiography findings suggested myocardial recovery after implant. The protocol consists of assessing symptoms, electrocardiographic findings, hemodynamics, and cardiac function at baseline and as VAD support is weaned. As a result, 3 patients passed the weaning protocol and were explanted. There has been no recurrence of heart failure 667, 752, and 1007 days after explant, respectively. One patient failed the protocol after 151 days of support because of low cardiac index during the protocol. This patient was transplanted. This current experience of VAD weaning protocol is a novel tool to identify candidates for successful VAD explantation. [source]

    Economic Growth and Biodiversity Loss in an Age of Tradable Permits

    comercio de emisiones; límite y comercio; proceso ciencia-política; Protocolo de Kyoto Abstract:,Tradable permits are increasingly becoming part of environmental policy and conservation programs. The efficacy of tradable permit schemes in addressing the root cause of environmental decline,economic growth,will not be achieved unless the schemes cap economic activity based on ecological thresholds. Lessons can be learned from the largest tradable permit scheme to date, emissions trading now being implemented with the Kyoto Protocol. The Kyoto Protocol caps neither greenhouse gas emissions at a level that will achieve climate stability nor economic growth. If patterned after the Kyoto Protocol, cap-and-trade schemes for conservation will not ameliorate biodiversity loss either because they will not address economic growth. In response to these failures to cap economic growth, professional organizations concerned about biodiversity conservation should release position statements on economic growth and ecological thresholds. The statements can then be used by policy makers to infuse these positions into the local, national, and international environmental science-policy process when these schemes are being developed. Infusing language into the science-policy process that calls for capping economic activity based on ecological thresholds represents sound conservation science. Most importantly, position statements have a greater potential to ameliorate biodiversity loss if they are created and released than if this information remains within professional organizations because there is the potential for these ideas to be enacted into law and policy. Resumen:,Cada vez más, los permisos comerciables son parte de la política ambiental y de los programas de conservación. La eficacia de los esquemas de permisos comerciables para atender la causa principal de la declinación ambiental,crecimiento económico,será baja a menos que los esquemas limiten la actividad económica con base en umbrales ecológicos. Se pueden aprender lecciones del mayor esquema de permisos comerciables a la fecha, la comercialización de emisiones implementada con el Protocolo de Kyoto. El Protocolo de Kyoto no limita a las emisiones de gases a un nivel que logre la estabilidad climática ni al crecimiento económico. Si se sigue el modelo del Protocolo de Kyoto, los esquemas de límite y comercio tampoco reducirán las pérdidas de biodiversidad porque no considerarán al crecimiento económico. En respuesta a estas fallas para limitar el crecimiento económico, las organizaciones profesionales preocupadas por la conservación de la biodiversidad deberían emitir declaraciones sobre su posición respecto a umbrales ecológicos y de crecimiento económico. Las declaraciones luego pueden ser usadas por políticos para infundir estas posiciones en el proceso ciencia ambiental-política a nivel local, nacional e internacional cuando estos esquemas estén siendo desarrollados. La infusión de lenguaje que demanda la limitación de actividades de crecimiento económico con base en umbrales ecológicos es ciencia de la conservación sólida. Más notablemente, las declaraciones de posición tienen un mayor potencial para reducir las pérdidas de biodiversidad si son creadas y publicadas que si esta información permanece dentro de las organizaciones profesionales porque existe el potencial para que estas ideas se constituyan en leyes y políticas. [source]

    Effect of angiotensin II and endothelin-1 receptor blockade on the haemodynamic and hormonal changes after acute blood loss and after retransfusion in conscious dogs

    ACTA PHYSIOLOGICA, Issue 4 2004
    R. C. E. Francis
    Abstract Aim:, This study investigates angiotensin II and endothelin-1 mediated mechanisms involved in the haemodynamic, hormonal, and renal response towards acute hypotensive haemorrhage. Methods:, Conscious dogs were pre-treated with angiotensin II type 1 (AT1) and/or endothelin-A (ETA) receptor blockers or not. Protocol 1: After a 60-min baseline period, 25% of the dog's blood was rapidly withdrawn. The blood was retransfused 60 min later and data recorded for another hour. Protocol 2: Likewise, but preceded by AT1 blockade with i.v. Losartan. Protocol 3: Likewise, but preceded by ETA blockade with i.v. ABT-627. Protocol 4: Likewise, but with combined AT1plus ETAblockade. Results:, In controls, haemorrhage decreased mean arterial pressure (MAP) by approximately 25%, cardiac output by approximately 40%, and urine volume by approximately 60%, increased angiotensin II (3.1-fold), endothelin-1 (1.13-fold), vasopressin (116-fold), and adrenaline concentrations (3.2-fold). Glomerular filtration rate and noradrenaline concentrations remained unchanged. During AT1 blockade, the MAP decrease was exaggerated (,40%) and glomerular filtration rate fell. During ETA blockade, noradrenaline increased after haemorrhage instead of adrenaline, and the MAP recovery after retransfusion was blunted. The decrease in cardiac output was similar in all protocols. Conclusions:, Angiotensin II is more important than endothelin-1 for the short-term regulation of MAP and glomerular filtration rate after haemorrhage, whereas endothelin-1 seems necessary for complete MAP recovery after retransfusion. After haemorrhage, endothelin-1 seems to facilitate adrenaline release and to blunt noradrenaline release. Haemorrhage-induced compensatory mechanisms maintain blood flow more effectively than blood pressure, as the decrease in cardiac output , but not MAP , was similar in all protocols. [source]

    Trials update in wales

    CYTOPATHOLOGY, Issue 2007
    A. Fiander
    Three ongoing studies will be presented and discussed. Prevalence of Human Papillomavirus Infection in a South Wales Screening population Methods: A total of 10 000 consecutive, anonymous liquid based cytology screening samples were collected over a five month period in 2004. Age, cytology result and social deprivation score was provided for each specimen. The methodology was chosen to ensure inclusion of all women attending routine cervical screening, avoiding potential constraints associated with obtaining individual informed consent. The liquid based cytology samples were processed and reported by the receiving cytology laboratory and the residual specimens sent to the HPV Research Laboratory, Wales College of Medicine, where they were processed and stored at -80°C until analysis. High risk and low risk HPV Typing was undertaken using PCR , EIA (Jacobs et al 1997). Full high risk typing was performed on HPV positive specimens. Results: The study population had a mean age of 38 years with 92% negative, 5% borderline and 3% dyskaryotic cytology. The average social deprivation score was 17.4 (based upon the Welsh Index of multiple deprivation). The following results will be presented: HPV prevalence by age. HPV prevalence by cytology result. Type specific HPV prevalence in single and multiple infection. Conclusion: This study represents the largest type specific HPV Prevalence Study in the UK to date. As such it will form a useful base line against which to access performance of marketed HPV tests and evaluating the impact following implementation of HPV vaccination. [Funded by Welsh Office for Research and Development] CRISP , 1 Study (Cervical Randomized Intervention Study Protocol -1) Background: Indole-3-carbinol (I3C) and Diindolylmethane (DIM) are found in cruciferous vegetables and have been identified as compounds that could potentially prevent or halt carcinogenesis. I3C spontaneously forms DIM in vivo during acid digestion. I3C has been shown to prevent the development of cervical cancer in HPV 16 transgenic mice and both I3C and DIM have been shown to promote cell death in cervical cancer cell models. DIM is the major active bi-product of I3C and preliminary data indicate that DIM is active in cervical dysplasia and may be better tolerated than I3C. Aim: To investigate chemoprevention of high grade cervical neoplasia using Diindolylmethane (DIM) supplementation in women with low grade cytological abnormalities on cervical cytology. Objectives: To observe any reduction in the prevalence of histological proven high-grade cervical intraepithelial neoplasia (CIN) after 6 months of supplementation. ,,To observe any reduction in the prevalence of cytological abnormalities. ,,To observe any changes in the clinical appearance of the cervix. To assess acceptability and monitor any side effects of DIM supplementation. ,,To assess whether any benefit is seen in relation to Human Papillomavirus (HPV) status including HPV Type, Viral load and integration. Methods: This is a double blind randomized placebo-controlled trial involving 600,700 women with low grade cytological abnormalities on a cervical smear. Randomization is in the ratio of 2 : 1 in favour of active medication. Women with first mildly dyskaryotic smear or second borderline smear are eligible. They are asked to take two capsules daily for 6 months. At the end of 6 months they undergo repeat cervical cytology, HPV testing and colposcopy. Results: A progress report will be given for this ongoing study. [Funded: - Cancer Research UK] Type Specific HPV Infection in Welsh Cervical Cancers Background: Whilst there have been numerous studies of HPV infection associated with cervical cancer and on prevalence of Human Papillomavirus in diverse populations there have been no studies of these variables in the same population. Against a background of prophylactic HPV vaccination it is important to assess potential protection against cervical cancer within a given population. The most comprehensive analysis of HPV type specific cervical cancer is a meta-analysis published by the IARC in 2003. This however included only three UK based studies, totalling 118 cases, 75 of which were only investigated by HPV type PCR for four high risk types. None of this data was presented with associated population based prevalence data. Therefore, the research objectives for this study in combination with the first study above, are as follows: To determine the frequency of specific HPV types in cervical cancers in Wales. To compare the distribution of specific HPV types amongst cervical cancers with their prevalence in the general population. This will allow accurate delineation of the relationship between prevalence of specific HPV types in the general population and their association with clinically relevant disease. This information is a pre-requisite to assess the potential impact of prophylactic vaccination against HPV infection in Wales. Methods: Welsh Cervical Cancer specimens from 2000,2005 will be identified from pathology departments within Wales. The pathology of each tumour will be reviewed by a single Gynaecological Pathologist. The age of the patient and pathological features of the tumour will be noted. DNA will be extracted from the paraffin sections and HPV typed by PCR-EIA. Results: A progress report will be given for this ongoing study. [Funded by Welsh Office for Research and Development] [source]

    Optimal Design of the Online Auction Channel: Analytical, Empirical, and Computational Insights,

    DECISION SCIENCES, Issue 4 2002
    Ravi Bapna
    ABSTRACT The focus of this study is on business-to-consumer (B2C) online auctions made possible by the advent of electronic commerce over an open-source, ubiquitous Internet Protocol (IP) computer network. This work presents an analytical model that characterizes the revenue generation process for a popular B2C online auction, namely, Yankee auctions. Such auctions sell multiple identical units of a good to multiple buyers using an ascending and open auction mechanism. The methodologies used to validate the analytical model range from empirical analysis to simulation. A key contribution of this study is the design of a partitioning scheme of the discrete valuation space of the bidders such that equilibrium points with higher revenue structures become identifiable and feasible. Our analysis indicates that the auctioneers are, most of the time, far away from the optimal choice of key control factors such as the bid increment, resulting in substantial losses in a market with already tight margins. With this in mind, we put forward a portfolio of tools, varying in their level of abstraction and information intensity requirements, which help auctioneers maximize their revenues. [source]

    Injection Necrosis of the Glabella: Protocol for Prevention and Treatment After Use of Dermal Fillers

    BACKGROUND Injection of filler materials into the dermis is well tolerated with few mild and transient side effects. Injection necrosis is a rare but clinically important potential complication caused by interruption of the vascular supply to the area by compression, injury, and/or obstruction of the vessel(s). The glabella is a particular danger zone for injection necrosis regardless of the type of filler used. OBJECTIVE We recommend a protocol that may be used to help prevent and treat injection necrosis of the glabella after injection with dermal fillers. CONCLUSION Injection necrosis in the glabellar region may be prevented by a knowledge of the local anatomy and an understanding of its pathophysiology and treated by a suggested protocol. [source]

    The Cartagena Protocol: Implications for Regional Trade and Technology Development in Africa

    E. Jane Morris
    The majority of African countries have ratified or acceded to the Cartagena Protocol on Biosafety, and many have received support through the Global Environment Facility and the UN Environment Programme for development of their National Biosafety Frameworks. This article examines the extent to which these frameworks are aligned with the goals of the Regional Economic and Regional Research Communities of which they are members. Many national approaches lack alignment with regional trade, economic, science and technology policies. The strict application of the precautionary principle and the imposition of costly administrative hurdles are likely to hinder intra-regional trade and technology development. [source]

    The Diabetes UK Mozambique Twinning Programme.

    DIABETIC MEDICINE, Issue 8 2010
    Results of improvements in diabetes care in Mozambique: a reassessment 6 years later using the Rapid Assessment Protocol for Insulin Access
    Diabet. Med. 27, 855,861 (2010) Abstract Objective, To assess improvements in diabetes care in Mozambique between 2003 and 2009 following the implementation of the Diabetes UK Twinning Programme. Methods, As in 2003, a Rapid Assessment Protocol was implemented from August to September 2009 in order to assess the improvements in diabetes care and impact of the Diabetes UK Twinning Programme. One hundred and eighty-four interviews were carried out at different levels of the health system in different areas of Mozambique. Results, The Diabetes UK Twinning Programme in Mozambique allowed the development of the first comprehensive non-communicable disease plan in sub-Saharan Africa. The other main improvements include a strengthening of the diabetes association with an 8-fold increase in membership, 265 health workers trained in diabetes care in all provinces, the development of patient education materials inspired by some Diabetes UK tools and the expansion of public awareness, particularly from events associated with World Diabetes Day. Conclusions, Much progress has been made in Mozambique with regard to diabetes and non-communicable diseases. Besides the direct impact of specific activities supported by Diabetes UK, this project allowed for ,collateral' benefits in the overall provision of diabetes care. As diabetes and non-communicable diseases have a low profile on the global health agenda, twinning partnerships based on rigorous needs assessment have the capacity to make significant improvements in diabetes care at a relatively low level of investment. Moreover, this study suggests that the tool used might be of value in assessing progress in health system strengthening as well as in conducting the initial needs assessment. [source]

    Diabetes Care Protocol: effects on patient-important outcomes.

    DIABETIC MEDICINE, Issue 4 2010
    A cluster randomized, non-inferiority trial in primary care
    Diabet. Med. 27, 442,450 (2010) Abstract Aims, The Diabetes Care Protocol (DCP) combines task delegation, intensification of diabetes treatment and feedback. It reduces cardiovascular risk in Type 2 diabetes (T2DM) patients. This study determines the effects of DCP on patient-important outcomes. Methods, A cluster randomized, non-inferiority trial, by self-administered questionnaires in 55 Dutch primary care practices: 26 practices DCP (1699 patients), 26 usual care (1692 patients). T2DM patients treated by their general practitioner were included. Main outcome was the 1-year between-group difference in Diabetes Health Profile (DHP-18) total score. Secondary outcomes: DHP-18 subscales, general perceived health [Medical Outcomes Study 36-Items Short Form Health Survey (SF-36), Euroqol 5 Dimensions (EQ-5D) and Euroqol visual analogue scale (EQ-VAS)], treatment satisfaction (Diabetes Treatment Satisfaction Questionnaire; DTSQ status) and psychosocial self-efficacy (Diabetes Empowerment Scale Short Form; DES-SF). Per protocol (PP) and intention-to-treat (ITT) analyses were performed: non-inferiority margin , = ,2%. At baseline 2333 questionnaires were returned and 1437 1 year thereafter. Results, Comparing DCP with usual care, DHP-18 total score was non-inferior: PP ,0.88 (95% CI ,1.94 to 0.12), ITT ,0.439 (95% CI ,1.01 to 0.08), SF-36 ,health change' improved: PP 3.51 (95% CI 1.23 to 5.82), ITT 1.91 (95% CI 0.62 to 3.23), SF-36 ,social functioning' was inconclusive: PP ,1.57 (95% CI ,4.3 to 0.72), ITT ,1.031 (95% CI ,2.52 to ,0.25). Other DHP and SF-36 scores were inconsistent or non-inferior. DHP-18 ,disinhibited eating' was significantly worse in PP analyses. For EQ-5D/EQ-VAS, DTSQ and DES-SF, no significant between-group differences were found. Conclusion, DCP does not seem to influence health status negatively, therefore diabetes care providers should not shrink from intensified treatment. However, they should take possible detrimental effects on ,social functioning' and ,disinhibited eating' into account. [source]

    Protocol for Optimal Detection and Exclusion of a Patent Foramen Ovale Using Transthoracic Echocardiography with Agitated Saline Microbubbles

    ECHOCARDIOGRAPHY, Issue 7 2006
    Robert R. Attaran M.B.Ch.B.
    Agitated saline bubble studies in conjunction with echocardiography, in particular transesophageal echocardiography, are currently the principal means in the diagnosis of patent foramen ovale (PFO). We describe techniques and guidelines for the detection and exclusion of a PFO. The potential for misinterpretation of these bubble studies exists and therefore, several false positive and false negative scenarios are illustrated and discussed. [source]

    Examination Protocol for Three-Dimensional Echocardiography

    ECHOCARDIOGRAPHY, Issue 8 2004
    Navin C. Nanda M.D.
    First page of article [source]

    Therapeutic Yield and Outcomes of a Community Teaching Hospital Code Stroke Protocol

    Andrew W. Asimos MD
    Objectives: To describe the experience of a community teaching hospital emergency department (ED) Code Stroke Protocol (CSP) for identifying acute ischemic stroke (AIS) patients and treating them with tissue plasminogen activator (tPA) and to compare outcome measures with those achieved in the National Institute of Neurological Disorders and Stroke (NINDS) trial. Methods: This study was a retrospective review from a hospital CSP registry. Results: Over a 56-month period, CSP activation occurred 255 times, with 24% (n= 60) of patients treated with intravenous (IV) tPA. The most common reasons for thrombolytic therapy exclusion were mild or rapidly improving symptoms in 37% (n= 64), intracerebral hemorrhage (ICH) in 23% (n= 39), and unconfirmed symptom onset time for 14% (n= 24) of patients. Within 36 hours of IV tPA treatment, 10% (NINDS = 6%) of patients (n= 6) sustained a symptomatic ICH (SICH). Three months after IV tPA treatment, 60% of patients had achieved an excellent neurologic outcome, based on a Barthel Index of ,95 (NINDS = 52%), while mortality measured 12% (NINDS = 17%). Among IV tPA-treated patients, those developing SICH were significantly older and had a significantly higher mean initial glucose value. Treatment protocol violations occurred in 32% of IV tPA-treated patients but were not significantly associated with SICH (Fisher's exact test). Conclusions: Over the study period, the CSP yielded approximately one IV tPA-treated patient for every four screened and, despite prevalent protocol violations, attained three-month functional outcomes equal to those achieved in the NINDS trial. For community teaching hospitals, ED-directed CSPs are a feasible and effective means to screen AIS patients for treatment with thrombolysis. [source]

    The evolution of Chinese policies and governance structures on environment, energy and climate

    Stephen Tsang
    Abstract Although a successor to the 1997 Kyoto Protocol has not yet materialized, the 2009 Copenhagen meeting underlined the importance of China in international debates on climate and energy. This is based not only on China's current climate emissions, but also on its expected energy use and economic growth. Within China, climate issues have, like environmental pollution more generally, received increasing government and societal attention, but so has energy , topics that relate to one other but also have different priorities and actor interests behind them. However, while climate change has become more prominent, as shown in the targets included in the current five-year plan, its institutional embeddedness in relation to particularly energy issues has received limited attention. This paper aims to help shed some light on how Chinese policies and governance structures on energy, climate and environment have evolved, particularly considering the roles of national and provincial authorities. Administrative structures and policy-making processes turn out to be very complex, with a range of units and bodies at different levels with distinct responsibilities as well as inter-linkages. Moreover, tensions and conflicts can be found regarding climate change and environmental policies on the one hand, and prevailing objectives to further economic development on the other. Energy policies serve the same economic goals, with climate change being most often operationalized in terms of energy conservation. Copyright © 2010 John Wiley & Sons, Ltd and ERP Environment. [source]

    Path-dependent climate policy: the history and future of emissions trading in Europe

    Edwin Woerdman
    At the end of the 1990s, the EU was still sceptical towards emissions trading, but in 2003 it adopted a directive that enables such trading in the EU from 2005 onwards. Instead of presenting ad hoc explanations, we develop and apply the path dependence approach to clarify this remarkable attitude change. Sunk costs, switching costs and learning explain why politicians were initially tempted to add credit trading to existing, sub-optimal policy. Permit trading, however, is more efficient and effective. An institutional lock-in was bound to occur, but attitudes changed as a result of internal pressures, such as the pioneering role of the European Commission, and external ,shocks', such as the withdrawal of the US from the Kyoto Protocol. A full-scale institutional break-out towards efficiency is not guaranteed, though, because elements of credit trading can still enter the permit trading directive. The risk is that these elements become locked in, from which it may be difficult to escape. Copyright © 2004 John Wiley & Sons, Ltd and ERP Environment. [source]

    Bioethanol from agricultural waste residues

    Pascale Champagne
    Abstract Under the Kyoto Protocol, the Government of Canada has committed to reducing its greenhouse gas emissions by 6% from 1990 levels between 2008 and 2012. Ethanol-blended gasolines have the potential to contribute significantly to these emission reductions. Ethanol is derived from biologically renewable resources and can be employed to replace octane enhancers and aromatic hydrocarbons or oxygenates. To date, the ethanol production industry in Canada is comprised mainly of small-scale plants producing ethanol primarily from agricultural crops as feedstock. Research interests in the area of bioethanol production from organic waste materials emerged in the late 1980. Significant advances in lignocellulosic material extraction and enzymatic hydrolysis have been reported in the last decade, however, continued research efforts are essential for the development of technically feasible and economically viable large-scale enzyme-based biomass-to-ethanol conversion processes. This research aims to develop and test an enzyme-based biomass-to-ethanol conversion process, which employs organic waste materials, such as livestock manures, as alternative sources of cellulosic material feedstock. The source of the livestock manure, manure management practices and cellulose extraction procedures have a significant impact on the quantity and quality of the cellulosic materials derived. As such, raw feedstock materials must be carefully characterized to assess the impact of these factors on the yield of bioethanol and residual end products. The success of cellulose-to-ethanol conversion processes for cellulose extracted from these waste materials as feedstock is generally a function of cellulose fiber pretreatment, enzyme selection and operating conditions. These will differ depending on the source of the waste material feedstock. The long-term benefits of this research will be to introduce a sustainable solid waste management strategy for a number of livestock manure and other lignocellulosic waste materials; contribute to the mitigation in greenhouse gases through sustained carbon and nutrient recycling; reduce the potential for water, air, and soil contamination associated with land disposal of organic waste materials; and to broaden the feedstock source of raw materials for the ethanol production industry. © 2007 American Institute of Chemical Engineers Environ Prog, 2008 [source]

    AIChE offers technological insights to the public policy debate on global climate change

    David E. Gushee
    Global climate change has been a major issue on the national political agenda since 1988. Several Committees on Capitol Hill conducted hearings concerning the heat waves then searing the nation. Testimony by several well-regarded scientists at those hearings that "we ain't seen nothing yet" led to impressive headlines in the national media. Since then, unusually high temperatures, a succession of forecasts of serious negative impacts from the projected continued warming, and well-publicized Congressional hearings led to the creation of the United Nation's Framework Convention on Climate Change (FCCC) and its Kyoto Protocol. As a result, climate change is on just about every technology organization's agenda. In 1996, the American Institute of Chemical Engineers joined the list of organizations formally responding to the issue. The Government Relations Committee (GRC) formed a Task Force on Climate Change, made up of Institute members active in a number of aspects of the issue area. The charge to the Task Force: Look for opportunities for the Institute to contribute to the public policy debate on the issue and frame position papers accordingly. The first major conclusion of the Task Force was that AIChE is not in a position to state whether or not global climate change is a real public policy problem. However, to the extent that the public policy process treats climate change as an issue, the Institute is well positioned to comment on the technical merits of proposed policy responses. The Task Force recommended this posture to the GRC, which agreed. [source]

    Long-range transport of organic chemicals in the environment

    Martin Scheringer
    Abstract The long-range transport (LRT) of organic chemicals in the environment is reviewed, with particular focus on the role of environmental fate and transport models and the relationship between model results and field data. Results from generic multimedia box models, spatially resolved multimedia box models, and atmospheric transport models are highlighted, including conceptual investigations of cold-trap effect and global fractionation as well as results for particular chemicals, such as hexachlorocyclohexanes, DDT, polychlorinated biphenyls, perfluoroocctanoic acid, and polybrominated diphenyl ethers. Comparison of model results to field data shows that in many cases environmental fate models provide a good description of the distribution dynamics observed in the field, with deviations between measured and modeled concentrations around a factor of five. Sorption to atmospheric aerosols as a key process influencing the LRT of semivolatile organic chemicals (SOCs) is discussed, and the need for more measurements of the aerosol,air partitioning of SOCs and of the reactivity of particle-bound chemicals is pointed out. Key findings from field campaigns measuring legacy persistent organic pollutants (POPs) as well as new POPs are summarized. Finally, the relationship between science and politics in the field of POPs is addressed. Research into the LRT of organic chemicals has always occurred in interaction with political activities aiming to reduce the emissions of POPs. Since the late 1990s, the Stockholm Convention and the Aarhus Protocol on POPs have formed an important political context for research concerning POPs; the implementation of these international treaties creates a demand for ongoing research into the LRT of organic chemicals. [source]

    Impact of Emergency Medicine Faculty and an Airway Protocol on Airway Management

    James H. Jones MD
    Objective: To determine the impact of emergency medicine (EM) faculty presence and an airway management protocol on success rates of tracheal intubation in the emergency department (ED). Methods: A retrospective observational study of prospectively collected data on rates of successful intubations between June 1997 and December 2001 in the ED of a large urban teaching hospital. The authors compared success rates of the first attempt at intubation and times to intubation prior to and after EM faculty presence and the institution of an airway management protocol. Results: Prior to EM faculty presence and the airway management protocol, tracheal intubation was achieved on the first attempt 46% of the time; more than six attempts were required 2.9% of the time. The mean time to intubation was 9.2 minutes (±13.2 SD). Following EM faculty presence and the airway protocol, the success rate on the first attempt was 62%, more than six attempts were required 1.1% of the time, and the mean time to intubation was 4.6 minutes (±6.2 SD). Conclusions: First-attempt intubation success rates and decreased mean time to successful intubation improved following EM faculty presence and the introduction of an airway management protocol. [source]

    Borax-Catalyzed and pH-Controlled Selective Oxidation of Organic Sulfides by H2O2: An Environmentally Clean Protocol

    Sahid Hussain
    Abstract The selective oxidation of sulfides to sulfoxides and sulfones was achieved in high yields at room temperature with borax as a recyclable catalyst and H2O2 as the terminal oxidant by varying the pH of the reaction medium. The borax/H2O2 system can chemoselectively oxidize alkyl and aryl sulfides in the presence of oxidation-prone functional groups such as C=C, ,CN, and ,OH.(© Wiley-VCH Verlag GmbH & Co. KGaA, 69451 Weinheim, Germany, 2009) [source]

    A Straightforward Protocol for the Solution-Phase Parallel Synthesis of Ceramide Analogues

    Santiago Grijalvo
    Abstract A simple solution-phase protocol for the synthesis of ceramide analogues from easily accessible enantiopure scaffolds is disclosed. The method relies on the use of nucleophilic thiolates or phenoxides and appropriate supported reagents or scavengers to give the target compounds in good overall yields. The method is easily adaptable to combinatorial protocols and also amenable to automated processes for the generation of small-to-medium-sized libraries for further screening.(© Wiley-VCH Verlag GmbH & Co. KGaA, 69451 Weinheim, Germany, 2008) [source]

    Variation in Institutional Review Board Responses to a Standard Protocol for a Multicenter Clinical Trial

    Thomas O. Stair MD
    Abstract. Multicenter clinical trials require approval by multiple local institutional review boards (IRBs). The Multicenter Airway Research Collaboration mailed a clinical trial protocol to its U.S. investigators and 44 IRBs ultimately reviewed it. Objective: To describe IRB responses to one standard protocol and thereby gain insight into the advantages and disadvantages of local IRB review. Methods: Two surveys were mailed to participants, with telephone follow-up of nonrespondents. Survey 1 was mailed to 82 investigators across North America. Survey 2 was mailed to investigators from 44 medical centers in 17 U.S. states. Survey 1 asked about each investigator's local IRB (e.g., frequency of meetings, membership), whereas survey 2 asked about IRB queries and concerns related to the submitted clinical trial. Results: Both surveys had 100% response rate. Investigators submitted applications a median of 58 days (interquartile range [IQR], 40-83) after receipt of the protocol, and IRB approval took an additional 38 days (IQR, 26-62). Although eight applications were approved with little or no changes, IRBs requested an average of 3.5 changes per site. Changes involved study logistics and supervision for 45%, the research process for 43%, and the consent form for 91%. Despite these numerous requests, all eventually approved the basic protocol, including inclusion criteria, intervention, and data collection. Conclusions: The IRBs showed extreme variability in their initial responses to a standard protocol, but ultimately all gave approval. Almost all IRBs changed the consent form. A national, multicenter IRB process might streamline ethical review and warrants further consideration. [source]

    Variable carbon recovery of Walkley-Black analysis and implications for national soil organic carbon accounting

    S. Lettens
    Summary There is considerable interest in the computation of national and regional soil carbon stocks, largely as the result of the provisions of the Kyoto Protocol. Such stocks are often calculated and compared without proper reference to the uncertainties induced by different analytical methodologies. We illustrate the nature and magnitude of these uncertainties with the present soil organic carbon (SOC) study in Belgium. The SOC recovery of the Walkley-Black method was investigated based on a database of 475 samples of silt loam and sandy soils, which cover different soil depths and vegetation types in northern Belgium. The organic carbon content of the soil samples was measured by the original Walkley-Black method and by a total organic carbon analyser. The recovery was computed as the ratio of these two results per soil sample. Land use, texture and soil sampling depth had a significant influence on the recovery as well as their three-way interaction term (land use × texture × sampling depth). The impact of a land use, texture and sampling depth dependent Walkley-Black correction on the year 2000 SOC inventory of Belgium was determined by regression analysis. Based on new correction factors, the national SOC stocks increased by 22% for the whole country, ranging from 18% for cropland to 31% for mixed forest relative to the standard corrected SOC inventory. The new recovery values influenced therefore not only C stocks in the year 2000, but also the expected SOC change following land use change. Adequate correction of Walkley-Black measurements is therefore crucial for the absolute and comparative SOC assessments that are required for Kyoto reporting and must be computed to take into account the regional status of soil and land use. ,Universal' corrections are probably an unrealistic expectation. [source]