972 resultados para Developing Guidelines


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Red light running (RLR) is a problem in the US that has resulted in 165,000 injuries and 907 fatalities annually. In Iowa, RLR-related crashes make up 24.5 percent of all crashes and account for 31.7 percent of fatal and major injury crashes at signalized intersections. RLR crashes are a safety concern due to the increased likelihood of injury compared to other types of crashes. One tool used to combat red light running is automated enforcement in the form of RLR cameras. Automated enforcement, while effective, is often controversial. Cedar Rapids, Iowa installed RLR and speeding cameras at seven intersections across the city. The intersections were chosen based on crash rates and whether cameras could feasibly be placed at the intersection approaches. The cameras were placed starting in February 2010 with the last one becoming operational in December 2010. An analysis of the effect of the cameras on safety at these intersections was determined prudent in helping to justify the installation and effectiveness of the cameras. The objective of this research was to assess the safety effectiveness of the RLR program that has been implemented in Cedar Rapids. This was accomplished by analyzing data to determine changes in the following metrics:  Reductions in red light violation rates based on overall changes, time of day changes, and changes by lane  Effectiveness of the cameras over time  Time in which those running the red light enter the intersection  Changes in the average headway between vehicles entering the intersection

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Red light running (RLR) is a problem in the US that has resulted in 165,000 injuries and 907 fatalities annually. In Iowa, RLR-related crashes make up 24.5 percent of all crashes and account for 31.7 percent of fatal and major injury crashes at signalized intersections. RLR crashes are a safety concern due to the increased likelihood of injury compared to other types of crashes. One tool used to combat red light running is automated enforcement in the form of RLR cameras. Automated enforcement, while effective, is often controversial. Cedar Rapids, Iowa installed RLR and speeding cameras at seven intersections across the city. The intersections were chosen based on crash rates and whether cameras could feasibly be placed at the intersection approaches. The cameras were placed starting in February 2010 with the last one becoming operational in December 2010. An analysis of the effect of the cameras on safety at these intersections was determined prudent in helping to justify the installation and effectiveness of the cameras. The objective of this research was to assess the safety effectiveness of the RLR program that has been implemented in Cedar Rapids. This was accomplished by analyzing data to determine changes in the following metrics:  Reductions in red light violation rates based on overall changes, time of day changes, and changes by lane  Effectiveness of the cameras over time  Time in which those running the red light enter the intersection  Changes in the average headway between vehicles entering the intersection

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Although positive psychology (PP) was initially conceived as more a shift in perspective (towards the “positive”) than a new field per se, in pragmatic terms, it is arguably beginning to function as a distinct discipline, with people self-identifying as “positive psychologists.” Thus, we contend it is time for the field to start developing a system of professional (e.g., ethical) guidelines to inform the practice of PP. To this end, we outline one such possible system, drawing on guidelines in counselling and psychotherapy. Moreover, we argue for the creation of two tiers of professional identity within PP. Firstly, people with a master’s qualification in PP might label themselves “positive psychology practitioners.” Secondly, we raise the possibility of creating a professional doctorate in PP which would enable graduates to assume the title of “positive psychologist.” We hope that this paper will contribute towards a dialogue within the field around these issues, helping PP to develop further over the years ahead.

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OBJECTIVE: To compare published guidelines concerning screening for gestational diabetes. STUDY DESIGN: Systematic search and comparative analysis of published guidelines. Appraisal of guidelines quality. Simulation analysis. RESULTS: Ten published guidelines proposed either universal screening (5), selective screening (3) or screening when clinically indicated (2). Variations of testing schedules and blood glucose thresholds were observed. The quality of the published guidelines was low, on average 22 (8-51) percentage points on the assessment scale. These differences would have led to large variations in the number of patients to be screened. CONCLUSIONS: Large variations between guidelines have been observed which would translate in large practice variations, if the guidelines were systematically applied. These variations are partially explained by the absence of definite evidence that universal or selective screening for gestational diabetes do more good than harm on infant and maternal health. The methodology of developing guidelines should be more evidence based, systematic and explicit.

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Un résumé en français est également disponible.

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Discusses the implications of the economic valuation of natural resources used for tourism and relates this valuation to the concept of total economic valuation. It demonstrates how applications of the concept of total economic valuation can be supportive of the conservation of natural resources used for tourism. Techniques for valuing tourism’s natural resources are then outlined and critically evaluated. Consideration is given to travel cost methods, contingent valuation methods, and hedonic pricing approaches before concentrating on current developments of valuation techniques, such as choice modelling. The general limitations of existing methods are considered and it is argued that more attention should be given to developing guidelines that will identify ‘optimally imperfect methods’. An overall assessment concludes this article.

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The prediction of tillering is poor or absent in existing sorghum crop models even though fertile tillers contribute significantly to grain yield. The objective of this study was to identify general quantitative relationships underpinning tiller dynamics of sorghum for a broad range of assimilate availabilities. Emergence, phenology, leaf area development and fertility of individual main calms and tillers were quantified weekly in plants grown at one of four plant densities ranging from two to 16 plants m(-2). On any given day, a tiller was considered potentially fertile (a posteriori) if its number of leaves continued to increase thereafter. The dynamics of potentially fertile tiller number per plant varied greatly with plant density, but could generally be described by three determinants, stable across plant densities: tiller emergence rate aligned with leaf ligule appearance rate; cessation of tiller emergence occurred at a stable leaf area index; and rate of decrease in potentially fertile tillers was linearly related to the ratio of realized to potential leaf area growth. Realized leaf area growth is the measured increase in leaf area, whereas potential leaf area growth is the estimated increase in leaf area if all potentially fertile tillers were to continue to develop. Procedures to predict this ratio, by estimating realized leaf area per plant from intercepted radiation and potential leaf area per plant from the number and type of developing axes, are presented. While it is suitable for modelling tiller dynamics in grain sorghum, this general framework needs to be validated by testing it in different environments and for other cultivars. (C) 2002 Annals of Botany Company.

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INTRODUCTION Evidence-based recommendations can be made with respect to many aspects of the acute management of the bleeding trauma patient, which when implemented may lead to improved patient outcomes. METHODS The multidisciplinary Task Force for Advanced Bleeding Care in Trauma was formed in 2005 with the aim of developing guidelines for the management of bleeding following severe injury. Recommendations were formulated using a nominal group process and the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) hierarchy of evidence and were based on a systematic review of published literature. RESULTS Key recommendations include the following: The time elapsed between injury and operation should be minimised for patients in need of urgent surgical bleeding control, and patients presenting with haemorrhagic shock and an identified source of bleeding should undergo immediate surgical bleeding control unless initial resuscitation measures are successful. A damage control surgical approach is essential in the severely injured patient. Pelvic ring disruptions should be closed and stabilised, followed by appropriate angiographic embolisation or surgical bleeding control, including packing. Patients presenting with haemorrhagic shock and an unidentified source of bleeding should undergo immediate further assessment as appropriate using focused sonography, computed tomography, serum lactate, and/or base deficit measurements. This guideline also reviews appropriate physiological targets and suggested use and dosing of blood products, pharmacological agents, and coagulation factor replacement in the bleeding trauma patient. CONCLUSION A multidisciplinary approach to the management of the bleeding trauma patient will help create circumstances in which optimal care can be provided. By their very nature, these guidelines reflect the current state-of-the-art and will need to be updated and revised as important new evidence becomes available.

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The early-age thermal development of structural mass concrete elements has a significant impact on the future durability and longevity of the elements. If the heat of hydration is not controlled, the elements may be susceptible to thermal cracking and damage from delayed ettringite formation. In the Phase I study, the research team reviewed published literature and current specifications on mass concrete. In addition, the team observed construction and reviewed thermal data from the westbound (WB) I-80 Missouri River Bridge. Finally, the researchers conducted an initial investigation of the thermal analysis software programs ConcreteWorks and 4C-Temp&Stress. The Phase II study is aimed at developing guidelines for the design and construction of mass concrete placements associated with large bridge foundations. This phase included an additional review of published literature and a more in-depth investigation of current mass concrete specifications. In addition, the mass concrete construction of two bridges, the WB I-80 Missouri River Bridge and the US 34 Missouri River Bridge, was documented. An investigation was conducted of the theory and application of 4C-Temp&Stress. ConcreteWorks and 4C-Temp&Stress were calibrated with thermal data recorded for the WB I-80 Missouri River Bridge and the US 34 Missouri River Bridge. ConcreteWorks and 4C-Temp&Stress were further verified by means of a sensitivity study. Finally, conclusions and recommendations were developed, as included in this report.

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Il existe une nouvelle catégorie de technologie, les vaccins dérivés de plantes («VDPs»), qui englobe des produits qui ont un grand potentiel pour l’amélioration de la santé à l’échelle globale. Bien qu’ils ne soient pas encore disponibles pour le public, le développement des VDPs a progressé de façon telle qu’ils devraient être prêts à être mis en marché et distribués sous peu. Ainsi, c’est le moment idéal pour lancer un débat sur la meilleure façon de protéger cette nouvelle catégorie de technologie. Vu leur nature, les VDPs ne se qualifient pas parfaitement pour aucune forme de protection de propriété intellectuelle. En effet, un VDP est à la fois une variété de plante, une biotechnologie, un médicament et un produit qui vise spécifiquement les besoins de pays en voie de développement. Chacune de ces caractéristiques soulève ses propres problématiques en ce qui a trait à la propriété intellectuelle. C’est pourquoi il appert difficile d’identifier la forme de protection la plus adéquate et appropriée pour les VDPs. Cet article traite de la nature d’un VDP, des différentes catégories dans lesquelles il pourrait être classé, des différents types de systèmes de protection de propriété intellectuelle auxquels il pourrait être éligible ainsi que des problèmes qui pourraient être soulevés par tous ces éléments. Ces discussions visent à mettre l’accent sur le fait que nous avons affaire à une toute nouvelle catégorie d’innovation technologique. L’auteure est donc d’avis qu’une approche proactive est nécessaire pour discuter d’un système de protection de propriété intellectuelle en relation avec les VDPs. En ce moment, c’est l’inventeur qui choisi comment il protègera son invention. Les moyens employés par ce dernier pourraient être subséquemment modifiés ou annulés par une décision judiciaire mais comme plusieurs autres inventeurs d’une même catégorie de technologie auront probablement déjà adopté une stratégie de protection similaire, ce type de mesures judiciaire, très tard dans le processus, pourra avoir des résultats néfastes sur les détenteurs de droits. Le développement de lignes directrices d’entrée de jeu, avec l’aide d’un panel d’experts de préférence, peut contribuer à éviter les situations de confusion qui ont déjà été vécues avec l’application d’autres nouvelles technologies et qui devraient servir de leçon pour l’encadrement des VDPs.

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El neurofeedback es una técnica no invasiva en la que se pretende corregir, mediante condicionamiento operante, ondas cerebrales que se encuentren alteradas en el electroencefalograma. Desde 1967, se han conducido numerosas investigaciones relacionadas con los efectos de la técnica en el tratamiento de alteraciones psicológicas. Sin embargo, a la fecha no existen revisiones sistemáticas que reúnan los temas que serán aquí tratados. El aporte de este trabajo es la revisión de 56 artículos, publicados entre los años 1995 y 2013 y la evaluación metodológica de 29 estudios incluidos en la revisión. La búsqueda fue acotada a la efectividad del neurofeedback en el tratamiento de depresión, ansiedad, trastorno obsesivo compulsivo (TOC), ira y fibromialgia. Los hallazgos demuestran que el neurofeedback ha tenido resultados positivos en el tratamiento de estos trastornos, sin embargo, es una técnica que aún está en desarrollo, con unas bases teóricas no muy bien establecidas y cuyos resultados necesitan de diseños metodológicamente más sólidos que ratifiquen su validez.

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Background and aims: GP-TCM is the 1st EU-funded Coordination Action consortium dedicated to traditional Chinese medicine (TCM) research. This paper aims to summarise the objectives, structure and activities of the consortium and introduces the position of the consortium regarding good practice, priorities, challenges and opportunities in TCM research. Serving as the introductory paper for the GPTCM Journal of Ethnopharmacology special issue, this paper describes the roadmap of this special issue and reports how the main outputs of the ten GP-TCM work packages are integrated, and have led to consortium-wide conclusions. Materials and methods: Literature studies, opinion polls and discussions among consortium members and stakeholders. Results: By January 2012, through 3 years of team building, the GP-TCM consortium had grown into a large collaborative network involving ∼200 scientists from 24 countries and 107 institutions. Consortium members had worked closely to address good practice issues related to various aspects of Chinese herbal medicine (CHM) and acupuncture research, the focus of this Journal of Ethnopharmacology special issue, leading to state-of-the-art reports, guidelines and consensus on the application of omics technologies in TCM research. In addition, through an online survey open to GP-TCM members and non-members, we polled opinions on grand priorities, challenges and opportunities in TCM research. Based on the poll, although consortium members and non-members had diverse opinions on the major challenges in the field, both groups agreed that high-quality efficacy/effectiveness and mechanistic studies are grand priorities and that the TCM legacy in general and its management of chronic diseases in particular represent grand opportunities. Consortium members cast their votes of confidence in omics and systems biology approaches to TCM research and believed that quality and pharmacovigilance of TCM products are not only grand priorities, but also grand challenges. Non-members, however, gave priority to integrative medicine, concerned on the impact of regulation of TCM practitioners and emphasised intersectoral collaborations in funding TCM research, especially clinical trials. Conclusions: The GP-TCM consortium made great efforts to address some fundamental issues in TCM research, including developing guidelines, as well as identifying priorities, challenges and opportunities. These consortium guidelines and consensus will need dissemination, validation and further development through continued interregional, interdisciplinary and intersectoral collaborations. To promote this, a new consortium, known as the GP-TCM Research Association, is being established to succeed the 3-year fixed term FP7 GP-TCM consortium and will be officially launched at the Final GP-TCM Congress in Leiden, the Netherlands, in April 2012.

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Colorectal cancer (CRC) is one of the commonest malignancies of Western countries, with approximately half the incidence occurring in patients >70 years of age. Elderly CRC patients, however, are understaged, undertreated and underrepresented in clinical trials. The International Society of Geriatric Oncology created a task force with a view to assessing the potential for developing guidelines for the treatment of elderly (geriatric) CRC patients. A review of the evidence presented by the task force members confirmed the paucity of clinical trial data in elderly people and the lack of evidence-based guidelines. However, recommendations have been proposed on the basis of the available data and on the emerging evidence that treatment outcomes for fit, elderly CRC patients can be similar to those of younger patients. It is hoped that these will pave the way for formal treatment guidelines based upon solid scientific evidence in the future.

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Esse trabalho busca analisar o sistema educacional na tribo Ticuna, localizada na região do Alto Solimões, estado do Amazonas, onde estou há 21 anos em contato permanente com os índios Ticuna. Com o passar dos anos tenho observado que a cada dia, e de forma mais intensa, a manutenção de sua cultura vem sofrendo com o processo de influência da cultura não índia. Nesse trabalho realiza-se um levantamento histórico referente à possível existência de duas correntes educacionais entre os professores Ticuna. Uma considera importante um ensino bilíngue, o estudo dos mitos e costumes para preservação da cultura; a outra acredita que é inócuo estudar os mitos e outros aspectos culturais, que podem ser apreendidos no dia a dia, defendem que os índios precisam de uma educação igual a dos não indígenas, para competir no mercado em condições de igualdade. Inicialmente propõe-se uma busca histórica sobre o processo educacional relacionado à cultura Ticuna fora da escola, procurando verificar as relações entre o que é transmitido pela escola e o que se evidencia no cotidiano Ticuna. Em seguida, realiza-se uma análise de como se processa a educação implantada no meio Ticuna sob o título Educação Indígena . Destacam-se os fatores que influenciaram a fundação da escola, sua localização e aspectos relacionados ao meio físico, econômico, social e cultural, bem como, o ambiente humano e de aprendizagem, dados esses que subsidiam o objetivo proposto para este trabalho. Procura-se verificar se a educação desenvolvida na escola indígena cumpre o papel de estar constantemente buscando alternativas para uma educação que seja apropriada à sobrevivência da cultura Ticuna, uma educação adequada à realidade cultural. A pesquisa baseia-se em levantamento de dados através de documentos, como também em entrevistas com lideranças, professores e idosos da Tribo Ticuna; também na observação direta, com anotações feitas em caderno de campo. O processo de assimilação e influência da cultura não índia predomina na região do Alto Solimões e tem esmagado a cultura Ticuna, fazendo com que muitos já não queiram mais pescar, caçar ou viver como produtores ou coletores. É necessário buscar alternativas educacionais para a escola indígena Ticuna, em uma educação que seja apropriada para a sobrevivência de sua cultura e ao mesmo tempo minimize o preconceito enfrentado por esse povo. As lideranças e professores Ticuna esperam que a escola ajude na preservação e valorização de sua cultura. O prejuízo causado à educação cultural dos índios Ticuna é grande, a maioria dos jovens e crianças não são conhecedores dos significados dos rituais religiosos, mitos, lendas e crenças. Muitas vezes sabem até realizar o ritual, mas parece mais uma imitação de gestos, que se desvincula do seu real sentido. Espera-se que ao final dessa pesquisa sejamos capazes de utilizar o material desenvolvido para reflexão e que ela talvez possa servir como ponto de partida para os professores Ticuna na elaboração de diretrizes e desenvolvimento de um novo paradigma educacional que valorize mais a cultura.

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Objectives: To analyze mortality rates of children with severe sepsis and septic shock in relation to time-sensitive fluid resuscitation and treatments received and to define barriers to the implementation of the American College of Critical Care Medicine/Pediatric Advanced Life Support guidelines in a pediatric intensive care unit in a developing country. Methods: Retrospective chart review and prospective analysis of septic shock treatment in a pediatric intensive care unit of a tertiary care teaching hospital. Ninety patients with severe sepsis or septic shock admitted between July 2002 and June 2003 were included in this study. Results: Of the 90 patients, 83% had septic shock and 17% had severe sepsis; 80 patients had preexisting severe chronic diseases. Patients with septic shock who received less than a 20-mL/kg dose of resuscitation fluid in the first hour of treatment had a mortality rate of 73%, whereas patients who received more than a 40-mL/kg dose in the first hour of treatment had a mortality rate of 33% (P < 0.05.) Patients treated less than 30 minutes after diagnosis of severe sepsis and septic shock had a significantly lower mortality rate (40%) than patients treated more than 60 Minutes after diagnosis (P < 0.05). Controlling for the risk of mortality, early fluid resuscitation was associated with a 3-fold reduction in the odds of death (odds ratio, 0.33; 95% confidence interval, 0.13-0.85). The most important barriers to achieve adequate severe sepsis and septic shock treatment were lack of adequate vascular access, lack of recognition of early shock, shortage of health care providers, and nonuse of goals and treatment protocols. Conclusions: The mortality rate was higher for children older than years, for those who received less than 40 mL/kg in the first hour, and for those whose treatment was not initiated in the first 30 Minutes after the diagnosis of septic shock. The acknowledgment of existing barriers to a timely fluid administration and the establishment of objectives to overcome these barriers may lead to a more successful implementation of the American College of Critical Care Medicine guidelines and reduced mortality rates for children with septic shock in the developing world.