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PubMed2004

Comparison of uncertainties related to standardization of urine samples with volume and creatinine concentration.

When measuring biomarkers in urine, volume (and time) or concentration of creatinine are both accepted methods of standardization for diuresis. Both types of standardization contribute uncertainty to the final result. The aim of the present paper was to compare the uncertainty introduced when using the two types of standardization on 24 h samples from healthy individuals. Estimates of uncertainties were based on results from the literature supplemented with data from our own studies. Only the difference in uncertainty related to the two standardization methods was evaluated. It was found that the uncertainty associated with creatinine standardization (19-35%) was higher than the uncertainty related to volume standardization (up to 10%, when not correcting for deviations from 24 h) for 24 h urine samples. However, volume standardization introduced an average bias of 4% due to missed volumes in population studies. When studying a single 24 h sample from one individual, there was a 15-20% risk that the sample was incomplete. In this case a bias of approximately 25% was introduced when using volume standardization, whereas the uncertainty related to creatinine standardization was independent of the completeness of the sample. The uncertainty of creatinine standardization is increased when studying single voids rather than 24 h urine samples. This is partially counteracted by the increased statistical power due to the increased number of samples for each individual. Furthermore, there is a considerable increase in convenience for the participants, when collecting small volumes rather than complete 24 h samples.

Adult↗
PubMed2006

Methodological issues when comparing hearing thresholds of a group with population standards: the case of the ferry engineers.

OBJECTIVES: To discuss appropriate and inappropriate methods for comparing distributions of hearing thresholds of a study group with distributions in population standards and to determine whether the thresholds of Washington State Ferries engineers are different from those of men in the general population, using both frequency-by-frequency comparisons and analysis of audiometric shape. DESIGN: The most recent hearing conservation program audiograms of 321 noise-exposed engineers, ages 35 to 64, were compared with the predictions of Annexes A, B, and C from ANSI S3.44. There was no screening by history or otoscopy; all audiograms were included. 95% confidence intervals (95% CIs) were calculated for the engineers' median thresholds for each ear, for the better ear (defined two ways), and for the binaural average. For Annex B, where 95% CIs are also available, it was possible to calculate z scores for the differences between Annex B and the engineers' better ears. Bulge depth, an audiometric shape statistic, measured curvature between 1 and 6 kHz. RESULTS: Engineers' better-ear median thresholds were worse than those in Annex A but (except at 1 kHz) were as good as or better than those in Annexes B and C, which are more appropriate for comparison to an unscreened noise-exposed group like the engineers. Average bulge depth for the engineers was similar to that of the Annex B standard (no added occupational noise) and was much less than that of audiograms created by using the standard with added occupational noise between 90 and 100 dBA. CONCLUSIONS: Audiograms from groups that have been selected for a particular exposure, but, without regard to severity, can appropriately be compared with population standards, if certain pitfalls are avoided. For unscreened study groups with large age-sex subgroups, a simple method to assess statistical significance, taking into consideration uncertainties in both the study group and the comparison standard, is the calculation of z scores for the proportion of better-ear thresholds above the Annex B median. A less powerful method combines small age-sex subgroups after age correction. Small threshold differences, even if statistically significant, may not be due to genuine differences in hearing sensitivity between study group and standard. Audiometric shape analysis offers an independent dimension of comparison between the study group and audiograms predicted from the ANSI S3.44 standard, with and without occupational noise exposure. Important pitfalls in comparison to population standards include nonrandom selection of study groups, inappropriate choice of population standard, use of the right and left ear thresholds instead of the better-ear threshold for comparison to Annex B, and comparing means with medians. The thresholds of the engineers in this study were similar to published standards for an unscreened population.

Adult↗
PubMed2006

Setting school-level outcome standards.

BACKGROUND: To establish international standards for medical schools, an appropriate panel of experts must decide on performance standards. A pilot test of such standards was set in the context of a multidimensional (multiple-choice question examination, objective structured clinical examination, faculty observation) examination at 8 leading schools in China. METHODS: A group of 16 medical education leaders from a broad array of countries met over a 3-day period. These individuals considered competency domains, examination items, and the percentage of students who could fall below a cut-off score if the school was still to be considered as meeting competencies. This 2-step process started with a discussion of the borderline school and the relative difficulty of a borderline school in achieving acceptable standards in a given competency domain. Committee members then estimated the percentage of students falling below the standard that is tolerable at a borderline school and were allowed to revise their ratings after viewing pilot data. RESULTS: Tolerable failure rates ranged from 10% to 26% across competency domains and examination types. As with other standard-setting exercises, standard deviations from initial to final estimates of the tolerable failure rates fell, but the cut-off scores did not change significantly. Final, but not initial cut-off scores were correlated with student failure rates (r = 0.59, P = 0.03). DISCUSSION: This paper describes a method to set school-level outcome standards at an international level based on prior established standard-setting methods. Further refinement of this process and validation using other examinations in other countries will be needed to achieve accurate international standards.

China↗
PubMed2006

The US radiation dosimetry standards for 60Co therapy level beams, and the transfer to the AAPM accredited dosimetry calibration laboratories.

This work reports the transfer of the primary standard for air kerma from the National Institute of Standards and Technology (NIST) to the secondary laboratories accredited by the American Association of Physics in Medicine (AAPM). This transfer, performed in August of 2003, was motivated by the recent revision of the NIST air-kerma standards for 60Co gamma-ray beams implemented on July 1, 2003. The revision involved a complete recharacterization of the two NIST therapy-level 60Co gamma-ray beam facilities, resulting in new values for the air-kerma rates disseminated by the NIST. Some of the experimental aspects of the determination of the new air-kerma rates are briefly summarized here; the theoretical aspects have been described in detail by Seltzer and Bergstrom ["Changes in the U.S. primary standards for the air-kerma from gamma-ray beams," J. Res. Natl. Inst. Stand. Technol. 108, 359-381 (2003)]. The standard was transferred to reference-class chambers submitted by each of the AAPM Accredited Dosimetry Calibration Laboratories (ADCLs). These secondary-standard instruments were then used to characterize the 60Co gamma-ray beams at the ADCLs. The values of the response (calibration coefficient) of the ADCL secondary-standard ionization chambers are reported and compared to values obtained prior to the change in the NIST air-kerma standards announced on July 1, 2003. The relative change is about 1.1% for all of these chambers, and this value agrees well with the expected change in chambers calibrated at the NIST or at any secondary-standard laboratory traceable to the new NIST standard.

Accreditation↗
PubMed1991

Comparisons of standard curve-fitting methods to quantitate Neisseria meningitidis group A polysaccharide antibody levels by enzyme-linked immunosorbent assay.

We examined several of the more commonly used models (log-log, two forms of the logit-log, and the four-parameter logistic-log transformations) for forming standard or calibration curves by using a standardized enzyme-linked immunosorbent assay (ELISA). Assay range, accuracy, and error for each function were measured and compared. Antibody levels to Neisseria meningitidis group A polysaccharide were estimated by calculating antibody concentrations of a serially diluted standard reference serum of known concentration. Each function achieved a high squared correlation coefficient (r2 greater than 0.97), indicating a high degree of accuracy in forming the standard curves. However, when predicted antibody concentrations were compared with the known values, the log-log function exhibited the least precision, with extreme percentages of error occurring at several dilutions. A partially specified logit-log transformation performed better than the log-log model over a reduced range of standard dilutions. This indicated that a high r2 alone was not a reliable measure of the accuracy of the standard curve. Of the methods surveyed, the logistic-log and fully specified logit-log functions were the most accurate models for forming standard curves and for interpolating antibody concentrations from the standard curve. The accuracy of the fully specified logit-log function is highly dependent on the precise specification of two unknown quantities, the optical densities at zero and infinite concentrations, prior to fitting the model to a typical set of calibration data. The four-parameter logistic-log function was the preferred choice for quantitating N. meningitidis group A total polysaccharide antibody by using a standardized ELISA. The function does not require prespecification of any parameters before estimating the standard curve, and the four parameters are readily interpretable in terms of identifiable physical quantities. This model also has the advantage that it is easiest to visualize since it does not incorporate complex transformations of the optical density scale.

Antibodies, Bacterial↗
PubMed1993

National standard for measurement of resting and ambulatory blood pressures with automated sphygmomanometers.

The Association for the Advancement of Medical Instrumentation develops voluntary standards for medical devices so that manufacturers might provide information on their product and basic safety and performance criteria that should be considered in qualifying the instrument for clinical use. American national standards are generated through a consensus process by committees consisting of experts in research, development, and design from user, industry, and government communities. Draft standards are made available for public review and may become American national standards after review by the American National Standards Institute. The first American national standard for electronic and automated sphygmomanometers was published in monograph form in 1987. The objective of the revised 1992 standard for electronic and automated sphygmomanometers is to provide updated labeling, safety, and performance requirements that help ensure that consumers and health care professionals are supplied with safe, accurate devices for the indirect measurement of blood pressure, including ambulatory blood pressure recorders. This standard permits validation of the automatic or electronic device by comparison with either direct, intra-arterial blood pressure measurements or the noninvasive cuff/stethoscope technique, based on Korotkoff sounds identified by individuals trained in auscultation. This summary report of the 1992 American national standard for automatic sphygmomanometers provides recommendations for the methods of comparison, statistical analysis of the data, presentation of the results, and criteria for acceptability. Users, researchers, and instrument designers should refer to the American national standard monograph for detailed requirements.

Autoanalysis↗
PubMed2005

Education through telemedicine networks: setting quality standards.

Quality standards for educational programming have received limited attention in telemedicine. We selected five sets of standards from the distance education literature established by: (1) the American Council on Education; (2) the American Distance Education Consortium; (3) the Council of Regional Accrediting Commissions; (4) the Distance Education and Training Council; (5) the Innovations in Distance Education Project. The standards were reviewed to determine the purposes they were intended to serve and the process by which they were established. The content of the five sets of standards were summarized around the 'four commonplaces' of education: learner, teacher, curriculum and context. Four major findings emerged. First, none of the sets of standards addresses all of the issues that are potentially relevant to telemedicine education; all emphasize certain topics while neglecting others. Second, there are some important aspects of telemedicine that are not addressed at all, such as patient confidentiality. Third, the standards generally provide a framework for defining high quality in distance education, leaving to those at the local level the task of deciding how a standard applies in their setting. Finally, the standards reviewed have many elements that could potentially apply to telemedicine education. Setting quality standards for education through telemedicine requires a systematic approach and a means for continuous improvement of those standards.

Education, Distance↗
PubMed1999

International standards for the assessment of the risk of thermal strain on clothed workers in hot environments.

The International Standards Organisation (ISO) has produced an integrated series of international standards for the assessment of human responses to thermal environments. They include standards for the assessment of thermal comfort, heat stress and cold stress and many have been adopted as European and British standards. This paper describes the series of standards and in particular those concerned with the assessment of risk in hot environments. A three tier approach is taken which involves a simple thermal index that can be used for monitoring and control of hot environments (ISO 7243), a rational approach which involves an analysis of the heat exchange between a worker and his or her environment (ISO 7933) and a standard that describes the principles of physiological measurement which can be used in the establishment of personal monitoring systems of workers exposed to hot environments (ISO 9886). The standards are self-contained and can be used independently. In any comprehensive assessment however they would be used in conjunction. The simple index provides a first stage analysis and can confirm whether or not there is likely to be unacceptable thermal strain. Where a more detailed analysis is required then ISO 7933 provides an analytical method that can provide a more extensive assessment and interpretation leading to recommendations for improvement to the working environment. Where a method needs to be confirmed, or conditions are beyond the scope of ISO 7243 and ISO 7933, then ISO 9886 provides guidance on physiological measurement and interpretation. This would be used in extreme environments where individual responses are required to ensure health and safety or, in the case where personal protective equipment (PPE) is worn, which is beyond the scope of ISO 7243 and ISO 7933. The ISO system therefore covers almost all exposures to hot environments. It would be useful however to extend the scope of the standards that provide a simple index or analytical approach. This paper describes the current standards and their scope and forms the basis and background for descriptions of proposed extensions to the scope of the standards described in other papers in this special issue.

Acclimatization↗
PubMed1953

The international standard for aureomycin.

In 1950, the Department of Biological Standards, National Institute for Medical Research, London, was authorized by the WHO Expert Committee on Biological Standardization to proceed with the establishment of an International Standard for Aureomycin. A 100-g batch of aureomycin was obtained and was compared with the Standard Preparation of Aureomycin of the United States Food and Drug Administration (FDA) in a collaborative assay in which six laboratories in five countries participated.In all, 30 assays were carried out; 26 of these were done by biological methods, using Sarcina lutea, Bacillus pumilus, Staphylococcus aureus, or Bacillus cereus, and the remaining four by physicochemical methods. The results were subjected to standard methods of analysis, and the overall weighted mean potency (calculated from the biological assays only) was 1.0139, with limits of error of 99.5% to 100.5%.Since the International Standard is 1.39% more potent than the FDA Standard Preparation, it is probable that the latter contains a small amount of inert material; it is also possible that the International Standard itself is not 100% pure. For most practical purposes, however, both preparations may be regarded as substantially pure, and it is considered that to alter the present practice of quoting aureomycin dosage in metric units of weight would be inadvisable. Nevertheless, since the International Standard may not be a pure substance, a unit notation-for use where required in bioassays-is desirable, and the International Unit of Aureomycin has therefore been defined as the activity contained in one microgram of the International Standard.

Biological Assay↗
PubMed2004

NIST bullet signature measurement system for RM (Reference Material) 8240 standard bullets.

A bullet signature measurement system based on a stylus instrument was developed at the National Institute of Standards and Technology (NIST) for the signature measurements of NIST RM (Reference Material) 8240 standard bullets. The standard bullets are developed as a reference standard for bullet signature measurements and are aimed to support the recently established National Integrated Ballistics Information Network (NIBIN) by the Bureau of Alcohol, Tobacco and Firearms (ATF) and the Federal Bureau of Investigation (FBI). The RM bullets are designed as both a virtual and a physical bullet signature standard. The virtual standard is a set of six digitized bullet signatures originally profiled from six master bullets fired at ATF and FBI using six different guns. By using the virtual signature standard to control the tool path on a numerically controlled diamond turning machine at NIST, 40 RM bullets were produced. In this paper, a comparison parameter and an algorithm using auto-and cross-correlation functions are described for qualifying the bullet signature differences between the RM bullets and the virtual bullet signature standard. When two compared signatures are exactly the same (point by point), their cross-correlation function (CCF) value will be equal to 100%. The measurement system setup, measurement program, and initial measurement results are discussed. Initial measurement results for the 40 standard bullets, each measured at six land impressions, show that the CCF values for the 240 signature measurements are higher than 95%, with most of them even higher than 99%. These results demonstrate the high reproducibility for both the manufacturing process and the measurement system for the NIST RM 8240 standard bullets.

Algorithms↗
PubMed1995

The search for standards.

The International Organization for Standardization (ISO) assigned the responsibility for developing valve standards to its technical committee on surgical implants. A sub-committee on cardiovascular implants and the working group for heart valves were formed more than 20 years ago. The working group has learned a great deal, not only from its experience with ISO, but most of all from the collaboration of its international experts representing science, engineering and manufacturing. The first valve standard was published in 1984, revised in 1989, and the next revision will probably be published in 1995. After the formation of this ISO working group in 1972, the U.S. Food and Drug Administration (FDA) developed regulations for the premarket approval of heart valves in the United States. The European Committee for Standardization (CEN) was subsequently formed and appointed a working group to develop heart valve standards for Europe. It rapidly became apparent that the lack of co-ordination and communication of three separate organizations writing documents with different requirements and tests would lead to inconsistent and conflicting requirements. The ultimate outcome could have been a threat to public welfare by limiting the availability of medical devices. The commitment to the harmonization of standards by CEN and ISO, and the recent FDA policy to participate actively in standards development, have greatly improved this situation. Past errors, omissions and inappropriate attitudes have often slowed the standards process or have resulted in incomplete standards. This learning experience, while painful, should point the way to more timely and complete standards development in the future.

Biomedical Engineering↗
PubMedDate not supplied

[Evaluation of the degree of compliance of Spanish scientific biomedical journals with international standards of presentation of periodicals].

BACKGROUND: Because standardization is important to ensure the successful transfer of scientific information, compliance with international standards for the presentation of periodicals in 205 Spanish biomedical journals, with the aim of improving their quality as instruments of information transfer, is evaluated. METHODS: Journals were identified by consulting five printed bibliographies and four electronic databases. A total of 136 parameters of evaluation for the presentation of periodicals derived from ISO (International Standardization Organization) standards (86%) and recommendations published by UNESCO, the International Committee of Medical Journal Editors, The Council of Biology Editors, and EJ Huth (14%) were evaluated. Three features (inclusion, presentation and location) were recorded for most data item, and the total number of items studied was 342. RESULTS: The rate of compliance with standards in Spanish biomedical journals was 33.5% +/- 8.5 (DE). Compliance was highest for items related with the identification of the journal in the text pages and the issue contents list. The lowest rates of compliance were found for items related the volume and the abstract sheet. The worst standardized journals were those published by private firms and public administration organizations. As a group, journals published annually were the best standardized. CONCLUSIONS: The low rate of compliance with standards did not reflect inadequate compliance with all items, but was rather the result of complete noncompliance with particular standards, especially those relating to the abstract sheet, volume front cover, volume contents list and volume index. To improve compliance a change in the policies governing the availability of standards, the preparation of guides and manuals for scientific periodical publishing, and the development of training programs aimed at authors, editors, publishers, librarians and information scientists, is suggested.

Bibliographies as Topic↗
PubMed1993

Standards of practice for the nutrition support dietitian: importance and value to practitioners.

OBJECTIVE: To determine whether the American Society for Parenteral and Enteral Nutrition (ASPEN) standards of practice for nutrition support dietitians reflect current practice. DESIGN: A mailed survey questionnaire was used to determine how important nine functions of the nutrition support dietitian are to the practice of nutrition support dietetics, how important the ASPEN standards are to practitioners, the frequency of application of each standard to patients, and demographic data of the respondents. SAMPLE: The survey was sent to 1,048 randomly selected dietitian members of The American Dietetic Association's Dietitians in Nutrition Support dietetic practice group and ASPEN. The final sample included 460 dietitians, a return rate of 44%. For purposes of comparison, dietitian respondents were categorized into three groups: nutrition support dietitians (n = 286); non-nutrition support dietitians (n = 136); and supervisors of nutrition support dietitians (n = 38). STATISTICAL ANALYSES PERFORMED: Descriptive data are reported as frequency or mean +/- standard deviation. Differences in importance ratings of the standards by nutrition support dietitians, non-nutrition support dietitians, and supervisors of nutrition support dietitians were compared with one-way analysis of variance ANOVA and Scheffe post hoc tests. chi 2 Analysis was used to compare group differences in the frequency of application of each standard to patients. Probability was set at the .05 level. RESULTS: Nutrition support functions rated as very important included performing nutrition assessments, identifying high-risk patients, implementing and monitoring parenteral and enteral nutrition, supervising transitional feeding, and documentation. The standards of practice were all rated as very important by nutrition support dietitians, non-nutrition support dietitians, and supervisors, and there was no difference in perceived importance. More than half of the respondents applied each standard with 75% to 100% of their patients; however, there was a higher frequency of application by nutrition support dietitians. APPLICATIONS/CONCLUSIONS: The findings give validity to the standards of practice. Practitioners evaluate them as being important in practice and in theory. The standards of practice for nutrition support dietitians were approved for use by the House of Delegates of The American Dietetic Association in October 1992.

Analysis of Variance↗
PubMed1996

Clinical trial of retrograde warm blood reperfusion versus standard cold topical irrigation of transplanted hearts.

BACKGROUND: A prospective, randomized clinical study involving 34 patients undergoing heart transplantation compared myocardial preservation of donor hearts maintained with continuous reperfusion with retrograde warm blood cardioplegia during surgical implantation versus the standard cold topical irrigation. METHODS: Hearts in both groups were arrested with a standard crystalloid solution and maintained in a cold saline solution during transportation. In the retrograde group, cardioplegia was administered through a catheter in the coronary sinus during surgical implantation. An average of 471 +/- 30 mL of hyperkalemic crystalloid solution diluted 1:4 in warm blood from the oxygenator was infused. In the standard group, the heart was kept cold by topical irrigation of cold saline solution and was reperfused only when the ascending aorta was unclamped. RESULTS: Preoperative characteristics of donors and recipients were similar in the two cohorts. Ischemic time average 139 +/- 12 minutes in the retrograde group compared with 130 +/- 11 minutes in the standard group (p = 0.57). Cardiopulmonary bypass time averaged 89 +/- 4 minutes in the retrograde group and 110 +/- 12 minutes in the standard group (p = 0.12). Defibrillation at reperfusion was performed in 4 patients (4/17, 24%) in the retrograde group and 12 patients (12/18, 67%) in the standard group (p = 0.01). There were no deaths in the retrograde group (0/17), whereas in the standard group, 3 patients (3/17) died of early graft failure (p = 0.11). Four early graft failures occurred in the standard group (p = 0.06). Two patients (2/17, 12%) were weaned from bypass with ventricular assist devices in the standard group. The number of subendocardial necrotic cells in the first two weekly endomyocardial biopsy specimens averaged 2.7 +/- 0.8 cells/mm2 in the retrograde group and 5.9 +/- 2.4 cells/mm2 in the standard group (p = 0.12). CONCLUSIONS: Retrograde warm blood reperfusion appears to improve the initial recovery of transplanted hearts. The technique is easy to use and may be a useful approach to graft protection during surgical implantation.

Adult↗
PubMed1985

Quantitation of antibody isotypes in solid-phase assays. Comparison of myeloma protein and monoisotypic antibody standards.

Two methods have been proposed for the standardization of isotype specific antibody assays. In one, myeloma proteins directly attached to plastic surfaces are used as standards, whereas the other method employs antigen coated surfaces followed by monoisotypic antibodies as standards. These standardization methodologies have been investigated by submitting 4 monoisotypic human antibodies to a solid-phase assay standardized by the myeloma method. Specific antibody concentrations of each were determined so that each could serve as a monoisotypic standard. Three purified monoclonal mouse antibodies were also tested which allowed use of the same preparation as a monoisotypic antibody standard or as a 'myeloma protein' standard. Ten times more myeloma protein than specific antibody is needed for the same level of binding of the anti-isotype antibody. Therefore, assays standardized with myeloma proteins give erroneously high concentrations for sample antibodies. The same concentration of antibodies of different specificities (used with different antigen coats) gave very comparable levels of binding of the labeled antibody. This supports the claim that for quantitation of antibodies an antibody standard can be used that is of different specificity to the sample antibody to be measured.

Animals↗
PubMed1991

The current status of hygiene standard setting for chemical substances in workplaces in China.

The hygiene standard setting for occupational hazards was started in the mid 1950s in China. Three documents on exposure limits for chemical substances in the work environment and some other documents related to exposure limits for physical agents have been published since then. The latest documentation on "Hygiene Standards for the Design of Industrial Premises" (Standard TJ 36-79) was promulgated in 1979. It contains a MAC list of 134 toxin agents and dusts which are most frequently used and encountered in China. However, a more sophisticated system of scientific research on hygiene standard setting has been created since the establishment of the National Scientific Commission of Hygiene Standard Setting in 1980. This system emphasizes health as a basic criterion, it strengthens epidemiological study of the human population, it integrates domestic and international information sources and it periodically reappraises the recommended standards. Based on these principles, more than forty new standards have been set for both chemicals and dusts since the founding of the committee. These new MACs are now in the process of being promulgated and are expected to take effect as the additional part of the MAC list published in 1979. In addition, further considerations of hygiene standard setting related to the conceptual renewal, selection of safety factor, legislation and enforcement of the hygiene standard, recommendations of exposure limits for occupational carcinogens, and speeding up the pace of hygiene standard setting are proposed in this paper.

Carcinogens↗
PubMed1994

Confirmation of Leinfelder clinical wear standards.

OBJECTIVES: Accuracy of composite wear studies based on Leinfelder standards has been disputed. There are differences with other well-calibrated systems such as the M-L and Vivadent wear standards. The objective of this study was to reevaluate the margin height at key regions along the restoration margins for each of the 6 Leinfelder standards using laser profiling techniques. METHODS: The Leinfelder standards were profiled in parallel paths 100 microns apart and measured in x-y-z position every 20 microns along those paths using a laser profilometer. RESULTS: Rounding of cavosurface enamel margins from intraoral wear greatly increased the uncertainty of the true enamel margin location and step height measurements, precluding unequivocal measurements for standards #2 and #3. Values for other standards for the original report, newly measured means and standard errors, and measured ranges were: #4 (322 microns, 333 +/- 34 microns, 171-507 microns), #5 (382 microns, 459 +/- 44 microns, 202-649 microns), and #6 (493 microns, 584 +/- 91 microns, 315-1022 microns). There were no statistically significant differences (p < or = 0.10) between these and original values. Large standard errors may have obscured small differences that may exist. The Leinfelder cast conversion scale seems to be the correct relative magnitude. SIGNIFICANCE: Differences between Leinfelder casts and other standards may be due to differences in shadow production. Clinical wear may be systematically underestimated by other cast evaluation methods that have well-defined margins. This emphasizes the need for standard casts with margin morphology similar to the clinical casts being evaluated for wear.

Bicuspid↗
PubMed1991

Regulating behavioral procedures for individuals with handicaps: review of state department standards.

We reviewed standards (i.e., mandatory policies or recommended guidelines) from 39 state departments of special education and 41 state departments of developmental disabilities/mental retardation (DD/MR) to determine how they addressed the use of behavioral procedures. Results indicated that many standards described procedures to change behaviors of individuals with handicaps and identified ways to regulate usage. Major findings were that (a) standards from state departments of DD/MR addressed behavioral procedures more frequently than standards from special education departments; (b) many standards addressed procedures to decrease, but not increase, behavior; (c) several standards identified safeguards to clients' rights, such as prior approval requirements and periodic review of behavioral procedures' effects; (d) some standards prohibited and/or restricted the use of specific procedures, such as those judged to be aversive; (e) about one-fifth of special education standards and two-thirds of DD/MR standards described staff training requirements for using some procedures; and (f) relatively few standards used decision models to select behavioral procedures. Implications of these findings for policy makers, service providers, and future research efforts are discussed.

Aversive Therapy↗