Evaluating environmental enrichment options for commercial broiler chickens

Implications Provision of environmental enrichment in line with that required by welfare-based quality assurance schemesdoes not always appear to lead to clear improvements in broiler chicken welfare. This research perhaps serves to highlightthe deficit in information regarding the ‘real world’ implications of enrichment with perches, string and straw bales.

Introduction Earlier work showed that provision of natural light and straw bales improved leg health in commercial broilerchickens (Bailie et al., 2013). This research aimed to determine if additional welfare benefits were shown in windowedhouses by increasing straw bale provision (Study 1), or by providing perches and string in addition to straw bales (Study 2).

Material and methods Commercial windowed houses in Northern Ireland containing ~23,000 broiler chickens (placed inhouses as hatched) were used in this research which took place in 2011. In Study 1 two houses on a single farm wereassigned to one of two treatments: (1) 30 straw bales per house (1 bale/44m2), or (2) 45 straw bales per house (1bale/29m2). Bales of wheat straw, each measuring 80cm x 40cm x 40cm were provided from day 10 of the rearing cycle,as in Bailie et al. (2013). Treatments were replicated over 6 production cycles (using 276,000 Ross 308 and Cobb birds),and were swapped between houses in each replicate. In Study 2, four houses on a single farm were assigned to 1 of 4treatments in a 2 x 2 factorial design. Treatments involved 2 levels of access to perches (present (24/house), or absent), and2 levels of access to string (present (24/house), or absent), and both types of enrichment were provided from the start of thecycle. Each perch consisted of a horizontal, wooden beam (300 cm x 5 cm x 5cm) with a rounded upper edge resting on 2supports (15 cm high). In the string treatment, 6 pieces of white nylon string (60 cm x 10 mm) were tied at their mid-pointto the wire above each of 4 feeder lines. Thirty straw bales were also provided per house from day 10. This study wasreplicated over 4 production cycles using 368,000 Ross 308 birds. In both studies behaviour was observed between 0900and 1800 hours in weeks 3-5 of the cycle. In Study 1, 8 focal birds were selected in each house each week, and generalactivity, exploratory and social behaviours recorded directly for 10 minutes. In Study 2, 10 minute video recordings weremade of 6 different areas (that did not contain enrichment) of each house each week. The percentage of birds engaged inlocomotion or standing was determined through scan sampling these recordings at 120 second intervals. Four perches andfour pieces of string were filmed for 25 mins in each house that contained these enrichments on one day per week. The totalnumber of times the perch or string was used was recorded, along with the duration of each bout. In both studies, gaitscores (0 (perfect) to 5 (unable to walk)) and latency to lie (measured in seconds from when a bird had been encouraged tostand) were recorded in 25 birds in each house each week. Farm and abattoir records were also used in both studies todetermine the number of birds culled for leg and other problems, mortality levels, slaughter weights, and levels of pododermatitis and hock burn. Data were analysed using SPSS (version 20.0) and treatment and age effects on behaviouralparameters were determined in normally distributed data using ANOVA (‘Straw bale density*week’, or‘string*perches*week’ as appropriate), and in non-normally distributed data using Kuskall-Wallace tests (P<0.05 forsignificance) . Treatment (but not age) effects on performance and health data were determined using the same testsdepending on normality of data.

Results Average slaughter weight, and levels of mortality, culling, hock burn and pododermatitis were not affected bytreatment in either study (P<0.05). In Study 1 straw bale (SB) density had no significant effect on the frequency orduration of behaviours including standing, walking, ground pecking, dust bathing, pecking at bales or aggression, or onaverage gait score (P>0.05). However, the average latency to lie was greater when fewer SB were provided (30SB 23.38s,45SB 18.62s, P<0.01). In Study 2 there was an interaction between perches (Pe) and age in lying behaviour, with higherpercentages of birds observed lying in the Pe treatment during weeks 4 and 5 (week 3 +Pe 77.0 -Pe 80.9, week 4 +Pe 79.5 -Pe 75.2, week 5 +Pe 78.4 -Pe 76.2, P<0.02). There was also a significant interaction between string (S) and age inlocomotory behaviour, with higher percentages of birds observed in locomotion in the string treatment during week 3 butnot weeks 4 and 5 (week 3 +S 4.9 -S 3.9, week 4 +S 3.3 -S 3.7, week 5 +S 2.6 -S 2.8, P<0.04). There was also aninteraction between S and age in average gait scores, with lower gait scores in the string treatment in weeks 3 and 5 (week3: +S 0.7, -S 0.9, week 4: +S 1.5, -S 1.4, week 5: +S 1.9, -S 2.0, P<0.05). On average per 25 min observation there were15.1 (±13.6) bouts of perching and 19.2 (±14.08) bouts of string pecking, lasting 117.4 (±92.7) and 4.2 (±2.0) s for perchesand string, respectively.

Conclusion Increasing straw bale levels from 1 bale/44m2 to 1 bale/29m2 floor space does not appear to lead to significantimprovements in the welfare of broilers in windowed houses. The frequent use of perches and string suggests that thesestimuli have the potential to improve welfare. Provision of string also appeared to positively influence walking ability.However, this effect was numerically small, was only shown in certain weeks and was not reflected in the latency to lie.Further research on optimum design and level of provision of enrichment items for broiler chickens is warranted. Thisshould include measures of overall levels of activity (both in the vicinity of, and away from, enrichment items).

QA and Enhancement Marketplace for HEIs – An Erasmus+ project

Improving European education and training system quality has been set as a key target in Europe’s strategy to become a smart, sustainable and inclusive economy by 2020 (European Commission, 2010). These objectives are more specifically defined in the so called Modernisation Agenda (European Commission, 2011). More specifically it sets a goal to improve the quality and relevance of higher education. In this process external evaluation and
Proceedings of the 11th International CDIO Conference, Chengdu University of Information Technology,
Chengdu, Sichuan, P.R. China, June 8-11, 2015.
self-assessment are seen in a key role! In the CDIO approach the 12 CDIO standards provide a framework for continuous improvement. Each institution/institutional department are encouraged to regularly do the self-evaluation using the CDIO Standards. Eight European universities identified a need for further enhancement of the self-evaluations and creation of processes with peers to reduce the inertia of heavy accreditations/evaluations in HEIs. In September 2014 these universities started an Erasmus+ project (QAEMarketPlace4HEI) aiming at
1. Developing a collaborative, comprehensive and accessible evaluation process model, methods and tools for HEIs to complement the accreditation systems.
2. Promoting, increasing and exploiting further the European collaboration in the evaluation processes and the exchange of best practices.
3. Disseminating the model, best practices and widen the cooperation to new HEIs in Europe through the partner networks.

The Impact of Colleague Peer Review on the Radiotherapy Treatment Planning Process in the Radical Treatment of Lung Cancer

AIMS: Modern radiotherapy uses techniques to reliably identify tumour and reduce target volume margins. However, this can potentially lead to an increased risk of geographic miss. One source of error is the accuracy of target volume delineation (TVD). Colleague peer review (CPR) of all curative-intent lung cancer plans has been mandatory in our institution since May 2013. At least two clinical oncologists review plans, checking treatment paradigm, TVD, prescription dose tumour and critical organ tolerances. We report the impact of CPR in our institution.

MATERIALS AND METHODS: Radiotherapy treatment plans of all patients receiving radical radiotherapy were presented at weekly CPR meetings after their target volumes were reviewed and signed off by the treating consultant. All cases and any resultant change to TVD (including organs at risk) or treatment intent were recorded in our prospective CPR database. The impact of CPR over a 13 month period from May 2013 to June 2014 is reported.

RESULTS: One hundred and twenty-two patients (63% non-small cell lung carcinoma, 17% small cell lung carcinoma and 20% 'clinical diagnosis') were analysed. On average, 3.2 cases were discussed per meeting (range 1-8). CPR resulted in a change in treatment paradigm in 3% (one patient proceeded to induction chemotherapy, two patients had high-dose palliative radiotherapy). Twenty-one (17%) had a change in TVD and one (1%) patient had a change in dose prescription. In total, 6% of patients had plan adjustment after review of dose volume histogram.

CONCLUSION: The introduction of CPR in our centre has resulted in a change in a component of the treatment plan for 27% of patients receiving curative-intent lung radiotherapy. We recommend CPR as a mandatory quality assurance step in the planning process of all radical lung plans.

Guidance for laboratories performing molecular pathology for cancer patients

Molecular testing is becoming an important part of the diagnosis of any patient with cancer. The challenge to laboratories is to meet this need, using reliable methods and processes to ensure that patients receive a timely and accurate report on which their treatment will be based. The aim of this paper is to provide minimum requirements for the management of molecular pathology laboratories. This general guidance should be augmented by the specific guidance available for different tumour types and tests. Preanalytical considerations are important, and careful consideration of the way in which specimens are obtained and reach the laboratory is necessary. Sample receipt and handling follow standard operating procedures, but some alterations may be necessary if molecular testing is to be performed, for instance to control tissue fixation. DNA and RNA extraction can be standardised and should be checked for quality and quantity of output on a regular basis. The choice of analytical method(s) depends on clinical requirements, desired turnaround time, and expertise available. Internal quality control, regular internal audit of the whole testing process, laboratory accreditation, and continual participation in external quality assessment schemes are prerequisites for delivery of a reliable service. A molecular pathology report should accurately convey the information the clinician needs to treat the patient with sufficient information to allow for correct interpretation of the result. Molecular pathology is developing rapidly, and further detailed evidence-based recommendations are required for many of the topics covered here.

Factors influencing the output of rural cataract surgical facilities in China: the SHARP study

Purpose: To identify factors associated prospectively with increased cataract surgical rate (CSR) in rural Chinese hospitals.

Methods: Annual cataract surgical output was obtained at baseline and 24 months later from operating room records at 42 rural, county-level hospitals. Total local CSR (cases/million population/y), and proportion of CSR from hospital and local competitors were calculated from government records. Hospital administrators completed questionnaires providing demographic and professional information, and annual clinic and outreach screening volume. Independent cataract surgeons provided clinical information and videotapes of cases for grading by two masked experts using the Ophthalmology Surgical Competency Assessment Rubric (OSCAR). Uncorrected vision was recorded for 10 consecutive cataract cases at each facility, and 10 randomly-identified patients completed hospital satisfaction questionnaires. Total value of international nongovernmental development organization (INGDO) investment in the previous three years and demographic information on hospital catchment areas were obtained. Main outcome was 2-year percentage change in hospital CSR.

Results: Among the 42 hospitals (median catchment population 530,000, median hospital CSR 643), 78.6% (33/42) were receiving INGDO support. Median change in hospital CSR (interquartile range) was 33.3% (-6.25%, 72.3%). Predictors of greater increase in CSR included higher INGDO investment (P = 0.02, simple model), reducing patient dissatisfaction (P = 0.03, simple model), and more outreach patient screening (P = 0.002, simple and multiple model).

Conclusions: Outreach cataract screening was the strongest predictor of increased surgical output. Government and INGDO investment in screening may be most likely to enhance output of county hospitals, a major goal of China's Blindness Prevention Plan.

Developing Food Products For Consumers on a Gluten Free Diet

There is a significant increase in people that choose to follow an avoidance diet, especially excluding gluten. Unlike previously, there is now a demand for ‘no compromise’ gluten-free cereal products that have the same properties as their wheat contain counterparts. This is very challenging for the bakers and the cereal technologists due to the functional role of the gluten network in some of these products. Numerous combinations of raw materials form natural sources have been studied and critically evaluated in this review. Most of the gluten-free products are made of native and modified starches blended with different hydrocolloids due to their structure-building and water binding properties. These ingredients are added to a gluten-free flour, such as rice and corn. The legislation framework, formulations for manufacturing of highl nutritional value bread, pasta and cakes/biscuits as well as quality assurance aspects for the gluten-free manufacturers are discussed in this review.

Curricular training report: pharmaceutical industry & spin-off company

O presente relatório expõe as atividades desenvolvidas durante o estágio curricular, frequentado na Bluepharma - Indústria Farmacêutica S.A. e na TREAT U, Lda. uma Spin-off da Universidade de Coimbra, no âmbito do Mestrado em Biomedicina Farmacêutica da Universidade de Aveiro. Esta foi uma experiência de 6 meses que teve duas componentes, uma multidisciplinar e outra monodisciplinar, as quais me permitiram desenvolver os conhecimentos e aptidões adquiridas ao longo do curso de mestrado e de as aplicar ao mundo real. Para além do desenvolvimento de competências profissionais, esta experiência possibilitou também a aquisição e desenvolvimento de várias aptidões, quer a nível pessoal como social. Nos primeiros dois meses desta minha experiência adquiri um conhecimento essencialmente teórico em várias áreas da indústria farmacêutica (financeira, desenvolvimento de negócio, assuntos regulamentares, investigação e desenvolvimento de medicamentos, garantia da qualidade, etc.) através da minha passagem pela Bluepharma. De seguida, na minha experiência de quatro meses na TREAT U, foi-me dada a oportunidade de realizar de forma mais independente, as funções inerentes ao cargo de assistente da gerência, com especial enfoque para atividades de gestão de projeto (incluindo assuntos regulamentares), tais como, apoio na preparação do plano de desenvolvimento não clínico e na preparação do pedido de aconselhamento científico. Este relatório começa assim por descrever os objectivos do estágio e uma breve descrição das instituições que me acolheram para a sua realização. De seguida, os conhecimentos adquiridos na vertente multidisciplinar do estágio e depois as atividades desenvolvidas no âmbito monodisciplinar. Por fim, apresenta uma análise das dificuldades e desafios encontrados bem como os esforços realizados para os ultrapassar.

Avaliação em contextos de blended learning no ensino superior

The increasing complexity of the Information Society and the Bologna Declaration in the European context has led Higher Education (HE) institutions to revise their curricula courses, as far as the adoption of new strategies for teaching and learning as well as evaluation are concerned. It can also be emphasized that there has been a growing use of eLearning and of blended learning (bLearning) in HE, since these modes of training seem to be a very convenient option for lifelong learning. In this context, quality is taken as an essential goal in the development of the European Space for Education and Training, where HE institutions compete among themselves, and where evaluation is determinant as a promoter of this quality. Considering the problems summarized above, the research developed, based on four published scientific papers, intended to answer a set of research questions related to evaluation of bLearning contexts in HE. The study used diverse techniques and instruments (questionnaires, document analysis, and observation mediated technologies) spanning two methodological approaches: i) study of descriptive and exploratory nature and ii) case studies of bLearning modules. In the first approach an evaluation model for bLearning courses was developed, where we collected and analyzed, at a national level, the opinions of teachers with bLearning experience about the model dimensions. The case studies presented are post graduation curricular units, where bLearning teaching, learning and evaluation strategies were explored and evaluated, namely peer assessment. The main contributions of the first approach are: the process of questioning around the evaluation of bLearning courses, namely the quality assurance criteria for bLearning, as well as the model developed, providing a framework of theoretical, methodological and empirical elements that can be adapted in similar contexts. From the case studies emerged: the developed evaluation guidelines and the data collection instruments, in order to disseminate evaluation “best practices” that may be useful for other units in similar contexts. Regarding the recommendations about the evaluation of teaching of bLearning courses we emphasize: the use of versatile evaluation objects; the evaluation throughout the process and not just at the end; and the involvement of multiple evaluators, including students (whose feedback is essential to monitor the quality of teaching and learning). From the case studies we highlight: the need for discussion of evaluation frameworks to explore, and consequent increase in the transparency of the evaluation process; the increased interaction between groups; and the peer assessment as a strategy to promote active and autonomous learning. In addition to the contributions and recommendations for practice and research in the area of evaluation in bLearning contexts in HE, listed above, it also emerged from this study useful guidelines regarding educational evaluation in bLearning contexts, in order to improve the quality of teaching, learning and evaluation in such contexts.

Optimization of the Pultrusion process

Manufacturing processes need permanently to innovate and optimize because any can be susceptible to continuous improvement. Innovation and commitment to the development of these new solutions resulting from existing expertise and the continuing need to increase productivity, flexibility and ensuring the necessary quality of the manufactured products. To increase flexibility, it is necessary to significantly reduce set-up times and lead time in order to ensure the delivery of products ever faster. This objective can be achieved through a normalization of the pultrusion line elements. Implicitly, there is an increase of productivity by this way. This work is intended to optimize the pultrusion process of structural profiles. We consider all elements of the system from the storehouse of the fibers (rack) to the pultrusion die. Particular attention was devoted to (a) the guidance system of the fibers and webs, (b) the resin container where the fibers are impregnated, (c) standard plates positioning of the fibers towards the entrance to the spinneret and also (d) reviewed the whole process of assembling and fixing the die as well as its the heating system. With the implementation of these new systems was achieved a significant saving of time set-up and were clearly reduced the unit costs of production. Quality assurance was also increased.

Optimização do processo de fabrico de componentes para a indústria automóvel

A qualidade é um factor-chave na indústria automóvel. Todos os fornecedores de componentes para a indústria automóvel estão sujeitos a qualificações e auditorias sistemáticas, com vista a melhorar os processos e verificar a sua rastreabilidade. Quando os processos assentam essencialmente em mão-de-obra intensiva, torna-se muito mais difícil atingir a ambicionada meta dos zero-defeitos, e a garantia da qualidade pode ficar comprometida, sendo necessário instalar procedimentos de controlo mais apurados. No entanto, se o processo ou processos forem convenientemente definidos, e se optar por capital intensivo em detrimento da mão-de-obra intensiva, a garantia da qualidade pode ser uma realidade, podendo ser fortemente minimizadas as operações de controlo da qualidade. Este trabalho teve por base a necessidade de reduzir fortemente, ou eliminar mesmo, o aparecimento de defeitos de montagem num sistema designado por remachado. Após cuidada análise do processo instalado, já parcialmente automatizado, mas ainda fortemente dependente de mão-de-obra, procedeu-se ao projecto de um equipamento capaz de reproduzir o mesmo efeito, mas que acomodasse alguns possíveis defeitos oriundos dos fornecedores dos componentes que são inseridos neste conjunto, colocados a montante na cadeia de fornecimento do produto. O equipamento resultante deste trabalho permitiu baixar o tempo de ciclo, acomodar a variabilidade dimensional detectada nos componentes que constituem o conjunto e reduzir drasticamente o número de não-conformidades.

Otimização do processo de injeção de ZAMAK

A indústria automóvel necessita aumentar a produtividade de forma sistemática, com vista à redução de custos e incremento da competitividade. A otimização dos produtos e processos é uma constante. O presente trabalho foi solicitado pela empresa FicoCables, do Grupo FICOSA, tendo em vista a otimização do processo de injeção de pequenas peças injetadas em ZAMAK, que constituem o bloqueio na extremidade de cada cabo metálico inserido nos automóveis para abertura da mala, portas, travão de mão, reservatório de combustível, capô, etc. A empresa possui cerca de 52 equipamentos de injeção de ZAMAK, cuja temperatura dos bicos era mantida com base numa chama de gás. Os sucessivos problemas de controlo do sistema ditaram uma mudança estratégica no aquecimento desses bicos, passando a ser usadas resistências elétricas anelares. No entanto, esta mudança veio a apresentar problemas inesperados, os quais se vieram inclusivamente a tornar em problemas de segurança, devido ao desgaste interior prematuro dos bicos, os quais apresentaram esmo problema de rotura. Paralelamente, todos os parâmetros relacionados com este processo de fabrico estavam também estudados de forma algo incipiente, pelo que se tornou necessário compreender e dissecar todas as variáveis relacionadas com o processo e implementar sistemas que impedissem o ajuste não controlado dos parâmetros por parte dos operadores. Também os moldes foram alvo de ações de melhoria, com vista a evitar problemas na zona de contacto do bico com o molde. O processo foi analisado em pormenor, permitindo um controlo muito mais apurado do mesmo. Os resultados fizeram sentir-se de forma imediata, graças ao trabalho desenvolvido neste estudo e à abertura demonstrada pela empresa para implementar todas as soluções propostas. O resultado final traduz-se num incremento significativo da segurança para os operadores, num controlo muito mais apurado de todos os parâmetros envolvidos no processo, numa maior garantia da qualidade nos produtos injetados em ZAMAK e em ganhos financeiros significativos para a empresa.

Evaluation of outpatient child-adolescent mental health services (CAMHS) in Attica-Greece

ABSTRACT: Background: Childhood is a critical time for social and emotional development, educational progress and mental health prevention. Mental health for children and adolescents is defined by the achievement of expected developmental, cognitive, social and emotional skills. The development of child-adolescent mental health services (CAMHS) is a necessity for each country, not only as a prevention measure for the wellbeing of people, but also as an investment to the future of countries. Qualitative evaluation of services is the only way to ensure whether services function under quality standards and increase the possibility of better outcomes for their patients. This study examines the greek outpatient CAMHS against the British Standards of National Institute of Excellence for community CAMHS. The Standards assessed refer to the areas of Assessment, Care and Intervention. Objectives: The main objectives of the study are 1) to evaluate Greek outpatient CAMHS in the Attica region 2) to promote the evaluation process for mental health services in Greece. Methods: Due to the fact that Greek services are based on the British model, the tool used was the British self-review questionnaire of Quality Network for Community CAMHS(QNCC).The tool was translated, adapted and posted to services. Twelve out of twenty outpatient CAMHS of Attica (including Athens) responded. Data was collected and performed by the Statistical Package for Social Sciences SPSS. Results: The study resulted that the CAMHS examined, meet moderately the British Standards of 1) Referral and Access, 2) Assessment & Care planning, 3) Care & Intervention. Two out of twelve services examined, meet the standards of "Assessment and Care" in a higher percentage between 75% and 100%. Conclusions: The paper describes a satisfactory function of CAMHS in Attica prefecture taking into consideration the extremely difficult political situation of Greece at the time of the research. Strong and weak domains are identified. Also the translation and adaptation of British tools promote the evaluation process and quality assurance of Greek CAMHS.

Nouvelles directives assécurologiques pour la prise en charge de la chirurgie bariatrique: conséquences pratiques [New guidelines for bariatric surgery care: practical implications].

From the 1st of January 2011, new conditions have been validated in which surgery for weight loss is borne by the basic insurance. These are very significant changes compared to the old criteria. Indeed, on one hand, patients with BMI > or = 35 kg/m2 may, without age limit and in the absence of comorbidities benefit from surgery without prior request to the medical council health insurance company concerned. On the other hand, the notion of a minimum casuistry is for the first time introduced in centers performing this type of intervention. In addition, certified centers are required to follow standard procedures for the patients' teaching and follow up.

Establishing an association between a peri-operative perfusion score system (PerfSCORE) and post-operative patient morbidity/mortality during CPB cardiac surgery.

BACKGROUND: To date, there is no quality assurance program that correlates patient outcome to perfusion service provided during cardiopulmonary bypass (CPB). A score was devised, incorporating objective parameters that would reflect the likelihood to influence patient outcome. The purpose was to create a new method for evaluating the quality of care the perfusionist provides during CPB procedures and to deduce whether it predicts patient morbidity and mortality. METHODS: We analysed 295 consecutive elective patients. We chose 10 parameters: fluid balance, blood transfused, Hct, ACT, PaO2, PaCO2, pH, BE, potassium and CPB time. Distribution analysis was performed using the Shapiro-Wilcoxon test. This made up the PerfSCORE and we tried to find a correlation to mortality rate, patient stay in the ICU and length of mechanical ventilation. Univariate analysis (UA) using linear regression was established for each parameter. Statistical significance was established when p < 0.05. Multivariate analysis (MA) was performed with the same parameters. RESULTS: The mean age was 63.8 +/- 12.6 years with 70% males. There were 180 CABG, 88 valves, and 27 combined CABG/valve procedures. The PerfSCORE of 6.6 +/- 2.4 (0-20), mortality of 2.7% (8/295), CPB time 100 +/- 41 min (19-313), ICU stay 52 +/- 62 hrs (7-564) and mechanical ventilation of 10.5 +/- 14.8 hrs (0-564) was calculated. CPB time, fluid balance, PaO2, PerfSCORE and blood transfused were significantly correlated to mortality (UA, p < 0.05). Also, CPB time, blood transfused and PaO2 were parameters predicting mortality (MA, p < 0.01). Only pH was significantly correlated for predicting ICU stay (UA). Ultrafiltration (UF) and CPB time were significantly correlated (UA, p < 0.01) while UF (p < 0.05) was the only parameter predicting mechanical ventilation duration (MA). CONCLUSIONS: CPB time, blood transfused and PaO2 are independent risk factors of mortality. Fluid balance, blood transfusion, PaO2, PerfSCORE and CPB time are independent parameters for predicting morbidity. PerfSCORE is a quality of perfusion measure that objectively quantifies perfusion performance.

Device-specific weighted T-score for two quantitative ultrasounds: operational propositions for the management of osteoporosis for 65 years and older women in Switzerland.

The World Health Organization (WHO) criteria for the diagnosis of osteoporosis are mainly applicable for dual X-ray absorptiometry (DXA) measurements at the spine and hip levels. There is a growing demand for cheaper devices, free of ionizing radiation such as promising quantitative ultrasound (QUS). In common with many other countries, QUS measurements are increasingly used in Switzerland without adequate clinical guidelines. The T-score approach developed for DXA cannot be applied to QUS, although well-conducted prospective studies have shown that ultrasound could be a valuable predictor of fracture risk. As a consequence, an expert committee named the Swiss Quality Assurance Project (SQAP, for which the main mission is the establishment of quality assurance procedures for DXA and QUS in Switzerland) was mandated by the Swiss Association Against Osteoporosis (ASCO) in 2000 to propose operational clinical recommendations for the use of QUS in the management of osteoporosis for two QUS devices sold in Switzerland. Device-specific weighted "T-score" based on the risk of osteoporotic hip fractures as well as on the prediction of DXA osteoporosis at the hip, according to the WHO definition of osteoporosis, were calculated for the Achilles (Lunar, General Electric, Madison, Wis.) and Sahara (Hologic, Waltham, Mass.) ultrasound devices. Several studies (totaling a few thousand subjects) were used to calculate age-adjusted odd ratios (OR) and area under the receiver operating curve (AUC) for the prediction of osteoporotic fracture (taking into account a weighting score depending on the design of the study involved in the calculation). The ORs were 2.4 (1.9-3.2) and AUC 0.72 (0.66-0.77), respectively, for the Achilles, and 2.3 (1.7-3.1) and 0.75 (0.68-0.82), respectively, for the Sahara device. To translate risk estimates into thresholds for clinical application, 90% sensitivity was used to define low fracture and low osteoporosis risk, and a specificity of 80% was used to define subjects as being at high risk of fracture or having osteoporosis at the hip. From the combination of the fracture model with the hip DXA osteoporotic model, we found a T-score threshold of -1.2 and -2.5 for the stiffness (Achilles) determining, respectively, the low- and high-risk subjects. Similarly, we found a T-score at -1.0 and -2.2 for the QUI index (Sahara). Then a screening strategy combining QUS, DXA, and clinical factors for the identification of women needing treatment was proposed. The application of this approach will help to minimize the inappropriate use of QUS from which the whole field currently suffers.