Interim Guidelines Research Articles

Sequelae of haemolytic uraemic syndrome.

Twenty two patients with previous episodes of haemolytic uraemic syndrome (HUS) were investigated for evidence of deficits in cognitive, behavioural, and academic function. Patients were pair matched with 22 controls for age (+/- 1 year), gender, and socioeconomic status. HUS patients had numerically lower cognitive and achievement scores and higher behavioural problem ratings than their controls on every measure. None of the group differences was significant at the 0.01 level. Significance values between 0.10 and 0.01 were obtained for the Wechsler full scale and verbal intelligence quotient scores and for several of the achievement measures and behaviour ratings. These results were conservatively interpreted as trends and are considered to provide preliminary indications of a post-HUS deficit in behaviour, verbal intelligence, and the verbally based skills of reading comprehension and vocabulary. The findings provide interim guidelines for follow up care but require confirmation and elaboration in a larger study.

Regulation of Environmental Contaminants in Drinking Water: State Methods and Problems

Risk assessment methodologies form the basis for deriving guidelines for environmental contaminants in drinking water. A state may have to set, on an emergency basis, an interim guideline for a drinking water contaminant for which only limited data are available. Additional national drinking water standards will be useful for state regulatory agencies, because maximum contaminant levels (MCLs) are legally enforceable, but the risk assessment formulations of the regulatory agencies can be challenged. A state has to issue advisories and set interim guidelines for use of water for non-drinking purposes such as washing hands, cleaning dishes, taking baths, and showers, etc. The exposure to volatile organic compounds via inhalation and through dermal absorption during showering and bathing may be equal to the exposure from ingesting 2 L/day of the same water. Further research in this area is indicated. The implementation of drinking water regulations is costly for some local water supply programs and state regulatory agencies. There is a need to find solutions to this problem. This paper was presented at the symposium on Drinking Water Issues at the 12th Annual Meeting of the American College of Toxicology held at Savannah, GA on October 21–23, 1991. The opinions presented here are solely those of the author. They do not necessarily reflect the official policy of the author's organizational affiliation (Michigan Department of Public Health or FSTRAC) or of any state or other government agency.

Interim guidelines on confidentiality and medical audit

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Interim guidelines on confidentiality and medical audit. Conference of Medical Royal Colleges and their Faculties in the United Kingdom.

Interim guidelines on confidentiality and medical audit. Conference of Medical Royal Colleges and their Faculties in the United Kingdom.

Contralateral hemiplegia following thoracic herpes zoster

To suggest interim therapeutic guidelines for stroke following truncal herpes zoster on the basis of the first reported Australian case, in a patient who showed good clinical response related temporally to antiviral therapy. A 70-year-old patient with no known underlying immune disorder presented with left-sided hemiplegia one week after right-sided truncal herpes zoster. In all probability the neurological deficit was due to large artery vasculopathy with thrombosis. Clinical improvement (not to pre-morbid levels) was noted soon after commencement of antiviral therapy with acyclovir. Stroke following herpes zoster may be a treatable condition. In view of the previously described occurrence of viral antigen within the walls of intracerebral vessels, the occasional progression of the syndrome over months, the generally low toxicity of acyclovir and the clinical response of the few patients treated with antiviral agents to date, early antiviral therapy in patients presenting with delayed contralateral hemiplegia associated with herpes zoster is recommended as prudent.

Inverse Ratio Ventilation in ARDS: Rationale and Implementation

Conventional ventilatory support of patients with the adult respiratory distress syndrome (ARDS) consists of volume-cycled ventilation with applied positive end-expiratory pressure (PEEP). Unfortunately, recent evidence suggests that this strategy, as currently implemented, may perpetuate lung damage by overinflating and injuring distensible alveolar tissues. An alternative strategy--termed inverse ratio ventilation (IRV)--extends the inspiratory time, and, in concept, maintains or improves gas exchange at lower levels of PEEP and peak distending pressures. There are two methods to administer IRV: (1) volume-cycled ventilation with an end-inspiratory pause, or with a slow or decelerating inspiratory flow rate; or (2) pressure-controlled ventilation applied with a long inspiratory time. There are several real or theoretical problems common to both forms of IRV: excessive gas-trapping; adverse hemodynamic effects; and the need for sedation in most patients. Although there are many anecdotal reports of IRV, there are no controlled studies that compare outcome in ARDS patients treated with IRV as opposed to conventional ventilation. Nonetheless, clinicians are using IRV with increasing frequency. In the absence of well-designed clinical trials, we present interim guidelines for a ventilatory strategy in patients with ARDS based on the literature and our own clinical experience.

Interim guidelines regarding psychiatrists who are HIV infected.

Back to table of contents Previous article ArticleNo AccessInterim Guidelines Regarding Psychiatrists Who Are HIV InfectedPublished Online:1 Apr 2006https://doi.org/10.1176/ajp.148.6.822AboutSectionsView articleAbstractPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail View articleAbstractThis revision of the statement originally adopted in September 1988 was proposed by the Commission on AIDS.1 It was approved by the Assembly of District Branches in November 1990 and by the Board of Trustees in December 1990. Access content To read the fulltext, please use one of the options below to sign in or purchase access. Personal login Institutional Login Sign in via OpenAthens Purchase Save for later Item saved, go to cart PPV Articles - American Journal of Psychiatry $35.00 Add to cart PPV Articles - American Journal of Psychiatry Checkout Please login/register if you wish to pair your device and check access availability. Not a subscriber? Subscribe Now / Learn More PsychiatryOnline subscription options offer access to the DSM-5 library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development. Need more help? PsychiatryOnline Customer Service may be reached by emailing [email protected] or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.). FiguresReferencesCited byDetailsCited ByTreatment of the Mentally Ill Physician1 August 1997 | The Canadian Journal of Psychiatry, Vol. 42, No. 6Le traitement du médecin souffrant de maladie mentale1 August 1997 | The Canadian Journal of Psychiatry, Vol. 42, No. 6 Volume 148Issue 6 June 1991Pages 822-822 Metrics PDF download History Published online 1 April 2006 Published in print 1 June 1991

Interim guidelines for occupational HIV exposure protocols and protections.

Interim guidelines for occupational HIV exposure protocols and protections.

A citizen-activist looks at EMF

Because of our commitment to seeing safer user practices now, along with greater and more definitive research, the author recommends that a multi-disciplinary Think Tank group be formed immediately to develop interim guidelines for safer distribution and use of electric power. This group should be composed of people from many disciplines; electrical and electronic engineers, cellular biologists, epidemiologists, architects and representatives of the utility industry, business, and citizen advocates. The group's work product should be on a fast track: its recommendations should be published within one year of its formation. The author says we need - but cannot wait for - the results of more definitive scientific studies, which may not be available for 8-10 years. We must protect our children now. Here, as elsewhere, it is better to be safe than sorry.

Current status and rationale for composite inlays and onlays

Composite inlay systems, now available to the dental profession, are classified and evaluated. Principle motives for their deployment are the aviodance or reduction of in situ polymerisation shrinkage and the optimisation of restoration contour and adaptation. The criteria for placement of direct or indirect composite inlay restorations are critically reviewed in relation to alternative materials and operative procedures. Dimensions of typical molar and premolar inlay cavities are presented and interim guidelines for inlay cavity design are discussed.

Developing guidelines for HIV antibody testing among victims of pediatric sexual abuse

The incidence of human immunodeficiency virus (HIV) infection acquired by children through sexual abuse is presently unknown. A telephone survey of 63 practitioners of pediatric sexual abuse (PSA) assessment in the five U.S. regions with highest prevalence of HIV infection was conducted to determine the present status of guidelines for HIV antibody testing of PSA victims. No formal protocol was used by any of those surveyed, and a literature review found no existing guidelines for HIV antibody testing of PSA victims. A standard set of clinical situations was presented to practitioners to assess whether a consensus exists of indications for HIV antibody testing of abused children. Seven clinical profiles with 12 criteria were presented including HIV antibody status, AIDS/ARC clinical profile, and behavioral profile of the assailant; clinical profile of the victim; pre-assault victim behavioral profile compatible with high risk of HIV infection (exclusively adolescents); parent/guardian anxiety/psychosocial profile; and profile of the assaultive act with respect to potential transmissibility of HIV. We found an 85% or greater consensus for 6 testing criteria, and based upon these propose an interim set of HIV antibody testing guidelines for PSA victims. There was no consensus about five testing criteria, but their frequent citation merits further consideration. Clinical application of interim guidelines and design of prospective studies to quantitatively evaluate them are reviewed.

An evaluation of four box models for instantaneous dense-gas releases

Four box models for instantaneous hazardous gas releases have been evaluated with data from the Burro field scale tests and also laboratory scale experiments performed at the University of Arkansas. The models are the OME model, the DENS1 model, the SLAB model and the BOX model. The BOX model, developed during this study, incorporates the proposed equation for translational speed by Wheatley and Prince (ref. 1), of a dense gas cloud. The models are evaluated using statistical measures similar to the interim guidelines on air quality model evaluation given by the United States Environmental Protection Agency. The non parametric bootstrap resampling procedure, which is relatively new method, was used to obtain confidence limits on the various statistical measures. In predicting ground level concentrations, the SLAB model performed well in all atmospheric conditions and calm conditions; and the BOX model showed a similar performance in unstable cases, neutral cases and calm conditions. The DENS1 model predictions of the cloud speed under all the conditions are in good agreement with observations.

Products of incomplete combustion (O x, CO x, HO x, NO x, SO x RO x, MO x and PO x)

Perceived needs to identify easily measured surrogates for products of incomplete combustion (PICs) from hazardous wastes incinerators have spawned a spirited scientific debate. Can any simple surrogates be correlated with PICs? What surrogates can be measured and at what levels? How should surrogates be normalized, averaged, and reported? Carbon monoxide (CO) and total hydrocarbons (THC) are two possible candidates. Interim guidelines of 100 ppm for CO and 20 ppm for THC have been suggested by the U.S. EPA for use by permit writers. Formal proposal, public comment, and promulgation as regulatory standards are being considered. Although CO, and possibly THC, have some utility as parameters of operation, both have recognized limitations as parameters of performance. There are also shortcomings in their measurement, normalization and statistical averaging. Correlations of CO or THC with PICs, or with each other, are not quantitative. Continuous emission monitoring (CEM) is difficult. Interpretation of results is equivocal. Alternatives to technology-forcing “guidelines” are needed. Flexible control strategies, further development of CEM monitoring technology, valid statistical analysis of emissions, and consideration of composite parameters are encouraged.

BMA Interim Guidelines on the Use of Fetal Tissue in Transplantation Therapy

BMA Interim Guidelines on the Use of Fetal Tissue in Transplantation Therapy

Book Review

Book reviewed in this article: Directory of International Periodicals and Newsletters on the Built Environment, Frances C. Gretes Interior Graphic and Design Standards, S. C. Reznikoff A Practical Guide to Behavior Research— Tools and Techniques (Second Edition), Robert Sommer and Barbara B. Sommer French Interiors and Furniture: The Period of Henry TV, Frances J. Geek. Boulder The Designer's Guide to Window Coverings, Lamar Griggs and Bobbie Tawater. Fort Worth Revised Interim Guidelines For Automated Offices, Arthur I. Rubin, Ph.D. Washington: A report sponsored by the General Services Administration done in the Center For Building Technology, National Bureau of Standards Environmental Design Research: How to Do It and How to Apply It, Robert Wehrli Overall, Robert Wehrli's book on Envinwuntal Design Research will probably enjoy a rather limited following in the interior design community. Some educators and practitioners may find its discussion of research proposal writing and lb directory of potential funding sources to be of personal interest. And, it does provide a better than average overview of behavioral science methods for designers which may justify its use as supple mentary text. In general, however, the book lacks the organizational clarify and technical and theoretical substance necessary to anchor an introductory interior design research or programming course. Its content is a sometimes disjointed array of superficial introductions in some areas interwoven with inexplicably rich and detailed renews of other seemingly less significant content. Ultimately, the book will probably do little to diminish the next of expectation with which the next work on the subject is awaited.

Interim Guidelines on Consent to Medical and Surgical Treatment, Contraception, Sterilisation and Abortion in the Mentally Handicapped: Section for the Psychiatry of Mental Handicap

Interim Guidelines on Consent to Medical and Surgical Treatment, Contraception, Sterilisation and Abortion in the Mentally Handicapped: Section for the Psychiatry of Mental Handicap

Interim Guidelines on Consent to Medical and Surgical Treatment, Contraception, Sterilisation and Abortion in the Mentally Handicapped

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The importance of trophic transfer in the bioaccumulation of chemical contaminants in aquatic ecosystems.

The U.S. Environmental Protection Agency (EPA) is responsible for establishing Water Quality Criteria which are protective of fresh water and marine life as well as human health. In 1980 the EPA announced the availability of criteria for 65 priority toxic pollutants listed under section 307 (a)(1) of the 1977 amendments of the Clean Water Act. Stara et al. (1980) have reviewed the processes and problems involved in establishing such criteria. They list four levels of toxic effects: (1) acute, subchronic and chronic, (2) mutagenic, (3) teratogenic, and (4) carcinogenic. The latter three are all potentially genotoxic in action. Chemicals causing genetic aberrations theoretically have no threshold (Albert et al. 1977) and therefore a zero-incidence is desirable. Chemicals causing toxic action other than genotoxicity are subject to the establishment of a “No Observable Affect Exposure Level” (NOAEL) (Stara et al. 1980) and therefore have a definable threshold. Often the establishment of zero incidence levels is not feasible for genotoxic materials so risk models must be developed. The “one-hit” model recommended in the EPA’s Interim Cancer Procedures and Guidelines for Health Risk… (1976) has been used for non-threshold risk assessment in the establishment of Water Quality Criteria (EPA 1980), and a modified version was used for chemicals with determinable thresholds. In both models the accuracy of the eventual predicted measure is highly dependent on the reliability of the bioconcentration data which are available in the literature.

Diet, nutrition, and cancer: Interim dietary guidelines

The Committee on Diet, Nutrition, and Cancer of the National Academy of Sciences recently evaluated the role of diet in carcinogenesis. Both epidemiological and laboratory evidence suggests that a high intake of total fat increases susceptibility to cancer of different sites, particularly the breast and colon. In epidemiological studies frequent consumption of certain fruits and vegetables and in laboratory experiments some components of fruits and vegetables, especially cruciferous vegetables, appear to decrease the incidence of cancers at various sites. In contrast, frequent consumption of salt-cured, salt-pickled, or smoked foods, possibly because they may contain nitrosamines or polycyclic aromatic hydrocarbons, appears to increase the risk of esophageal or stomach cancer. Excessive alcohol consumption among smokers appears to be associated with an elevated risk of cancers of the oral cavity, esophagus, larynx, and respiratory tract. Interim dietary guidelines to reduce the risk of cancer were proposed in accordance with these conclusions. No definitive conclusions were reached for other dietary factors, including total calories, cholesterol, fiber, and selenium, nor could the quantitative contribution of diet to overall cancer risk be estimated.

Design Concepts for Offshore Produced-Water Treating and Disposal Systems

Summary The general theories governing, produced-water treating equipment design are presented and qualitative conclusions drawn from the resultant equations. The design and use of various common components used in offshore produced-water treating systems are discussed. Introduction The engineer charged with designing an offshore produced-water treating and disposal system is faced with an almost insurmountable problem. While the endpoint is fixed for the design, usually little is known about the quality of the water that must be treated. The basic data set forming the basis of the current U.S. discharge guidelines is contained in a 1974 study conducted for the Offshore Operators Committee (OOC). Each type of final treating device was analyzed separately with specific conclusions drawn for pits, tanks, flotation systems, plate coalescers, fibrous media coalescers, and loose media coalescers. The report concluded: "Flotation units and loose media coalescers were found to produce the lowest mean effluent oil concentrations of the processes studied. Flotation is a widely used process and is applicable almost universally. Loose media coalescers were not selected to represent exemplary performance because of operating problems at many locations." The validity of this conclusion concerning loose media coalescers subsequently was verified by an in-depth study conducted by the OOC. The U.S. EPA analyzed these data, plus additional data furnished from industry and from EPA-conducted field verification studies, and arrived at their interim guidelines of 48 mg/L. The derivation of discharge quality based on exemplary performance of flotation systems does not imply that the installation of a flotation system will necessarily meet this criterion. In determining "exemplary" flotation systems the EPA eliminated many data. For example, in the original OOC study, about 25 % of the flotation systems analyzed had mean effluent-oil concentrations in excess of 48 mg/L. Thus, any water treating system that includes a flotation unit must be designed carefully for the conditions expected at that particular facility. Similarly, it is not necessary to install a flotation unit in each water treating system. The EPA-specified effluent limitations can be achieved with less sophisticated equipment under certain circumstances. W.L. Berry states: " Not all treatment processes are applicable at all locations. Performance of water treatment systems is not only a function of retention time, design parameters, use of chemical coagulants…but is also influenced by a number of factors most of which the operator has little or no control over including: water characteristics, crude type and solubility, degree of entrained oil emulsification, sizes of the entrained oil droplets, and suspended solids concentrations and characteristics. [Because of these factors,] if identical treatment systems are installed at two different locations, the average produced-water effluent oil content may be quite different." JPT P. 276^