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PubMed1997

A dedicated internal standard in fragment length analysis of hyperpolymorphic short tandem repeats.

Some of the most polymorphic short tandem repeats (STRs) have alleles differing in size by as little as one basepair. Since sizing precision with commercially available internal standards ordinarily does not allow safe discrimination at this level, typing is accomplished through comparisons with allelic ladders run on each gel. Here we introduce the use of optimally spaced sequenced alleles as a dedicated internal standard for measurement and typing of hyperpolymorphic STRs. We have constructed such a dedicated internal standard for HUMACTBP2 ([1]; Moos and Gallwitz, EMBO I., 5 (1983) 757-761) typing, including 25 sequenced, ROX labelled HUMACTBP2 alleles spanning the size range for alleles at this locus (233-333 basepairs (bp)). Comparisons of inter-gel runs of selected alleles with this dedicated standard and the commercial GS500 internal standard demonstrate that only the presently described internal standard is suited for direct typing based on fragment length measurements only. Obvious advantages of this typing procedure are that fragment measurements are precise and in accordance with sequenced lengths, and that the typing procedure via an external allelic ladder is avoided. Sequences of the alleles used in the internal standard as well as of selected alleles for allelic ladders in two other hyperpolymorphic AAAG-repeat STRs, D11S554 (Phromchotikul et al., Hum. Mol. Genet., 3 (1991) 21) and HUMAPOA11 (Kimpton et al., PCR Methods Appl., 3 (1993) 13-22) are also presented. To allow fragment length analysis of these two STRs, five D11S554 alleles, spanning from 176 to 225 basepairs, were added to the dedicated internal standard. Performing similar comparisons as for HUMACTBP2, it is demonstrated that even if sizing accuracy is not as good as with HUMACTBP2, typing based on measured fragment size only may be achieved with both other STRs as well. Selecting different colours for the three STRs, triplex electrophoretic runs were performed of a Norwegian population database of 300 unrelated individuals. The probability that two unrelated individuals have the same type in all three STRs is 5 x 10(-7), and the combined paternity exclusion power 99.77%, indicating that this STR selection may represent a good choice for forensic genetic casework.

Base Composition↗
PubMed1998

A randomized study on eversion versus standard carotid endarterectomy: study design and preliminary results: the Everest Trial.

PURPOSE: The EVEREST Trial was designed to determine whether the surgical technique influences the durability and complications of carotid endarterectomy (CEA). The current report focuses on the study design and preliminary results. METHODS: EVEREST is a randomized multicenter trial. A total of 1353 patients with carotid stenosis requiring surgical treatment were randomly assigned to received standard (n = 675) or eversion (n = 678) CEA. Primary end points included carotid occlusion, major stroke, death, and restenosis rate. RESULTS: The rate of perioperative major stroke and death (1.3 for each study group) and the incidence of early carotid occlusion (0.6% for eversion vs 0.4% for standard) were similar. No significant differences were found between eversion and standard CEA with respect to incidence of perioperative transient ischemic accident, minor stroke, cranial nerve injuries, neck hematoma, myocardial infarction, or surgical defects as detected with intraoperative quality controls. Clamping time was significantly shorter for eversion CEA compared with patch standard procedures (31.7 +/- 15.9 vs 34.5 +/- 14.4 minutes, p = 0.02). A shunt was inserted in 11% of patients undergoing eversion CEAs and in 16% of patients undergoing standard procedures. Overall 30-day events occurred in 13.3% of the eversion group and in 11.4% of the standard group (p = 0.3). At a mean follow-up of 14.9 months (range, 1 to 38 months), 16 (2.4%) restenoses occurred in the eversion group and 28 (4.1%) occurred in the standard group (odds ratio, 0.56; 95% confidence interval, 0.3 to 1.1; p = 0.08). CONCLUSION: The preliminary results of the EVEREST Trial suggest that eversion CEA is a safe and rapid procedure with low major complication rates. No significant differences in restenosis rates were observed between eversion and standard CEA at the available follow-up. Longer-term results are necessary to assess whether the eversion technique influences the durability of CEA.

Adult↗
PubMed1998

Aspects of implementing and harmonizing healthcare communication standards.

A variety of healthcare communication standards (HCS) have been developed during the last decade. They have improved the interoperability and the connectivity in open hospital information systems to a large extent. They have also reduced time and efforts during the implementation of standard interfaces. However, the implementation of communication standards is still far from the expected plug and play. The two reasons which are the main cause the current drawbacks are identified--the lack of a standardized terminology and the restricted flexibility of the currently used interchange formats. On the one hand the standardization of the terminology can not be solved by the standards development organizations. It is a general challenge for the medical informatics community. On the other hand the movement to a new interchange format can be initiated by standards development organizations. The application of SGML/XML as an interchange format for communication standards offers a much greater flexibility and adaptability to user needs than the currently used interchange formats. Concepts for a smooth change to a new direction are discussed.

Computer Communication Networks↗
PubMed2000

Comparison of a dietary record using reported portion size versus standard portion size for assessing nutrient intake.

OBJECTIVE: Because the percentage of missing portion sizes was large in the Aerobics Center Longitudinal Study (ACLS), careful consideration of the accuracy of standard portion sizes was necessary. The purpose of the present study was to investigate the consequences of using standard portion sizes instead of reported portion sizes on subjects' nutrient intake. METHODS: In 2307 men and 411 women, nutrient intake calculated from a 3-day dietary record using reported portion sizes was compared with nutrient intake calculated from the same record in which standard portion sizes were substituted for reported portion sizes. RESULTS: The standard portion sizes provided significantly lower estimates (>/= 20%) of energy and nutrient intakes than the reported portion sizes. Spearman correlation coefficients obtained by the two methods were high, ranging from 0.67 to 0.93. Furthermore, the agreement between both methods was fairly good. Thus, in the ACLS the use of standard portion sizes rather than reported portion sizes did not appear to be suitable to assess the absolute intake at the group level, but appeared to lead to a good ranking of individuals according to nutrient intake. These results were confirmed by the Continuing Survey of Food Intake by Individuals (CSFII), in which the assessment of the portion size was optimal. When the standard portion sizes were adjusted using the correction factor, the ability of the standard portion sizes to assess the absolute nutrient intake at the group level was considerably improved. CONCLUSIONS: This study suggests that the adjusted standard portion sizes may be able to replace missing portion sizes in the ACLS database.

Adult↗
PubMed2006

Development of a NIST standard reference material containing thirty volatile organic compounds at 5 nmol/mol in nitrogen.

Primary gravimetric gas cylinder standards containing 30 volatile organic compounds (VOCs) in nitrogen were prepared using a procedure previously developed to prepare gas mixture cylinder standards of VOCs at the 5 nmol/mol level. This set of primary standards was intercompared to existing gas cylinder standards, containing as many as 19 of the 30 volatile organics present in these new primaries, using gas chromatography with a hydrogen flame ionization detector coupled with cryogenic preconcentration. The linear regression analysis showed excellent agreement among the standards for each compound. Similar mixtures containing many of these compounds in treated aluminum gas cylinders have been evaluated over time and have shown stability for as much as 10 years. The development of these 30-component primary standards led to the preparation and certification of a reissue of Standard Reference Material (SRM) 1804 at the nominal amount-of-substance fraction of 5 nmol/mol for each analyte. A lot of 20 cylinders containing the mixture was prepared at NIST following previously demonstrated protocols for preparation of the cylinders. Each cylinder was analyzed against one cylinder from the lot, designated as the "lot standard," for each of the 30 compounds. As a result of the uncertainty analysis, the data showed that rather than declaring the lot homogeneous with a much higher uncertainty, each cylinder could be individually certified. The expanded uncertainty limits ranged from 1.5 to 10% for 28 of the 30 analytes, with two of the analytes having uncertainties as high as 19% in those SRM cylinders certified. Due to stability issues and some high uncertainties for a few analytes in 2 of the samples, 18 of the 20 candidate SRM samples were certified. These volatile organic gas mixtures represent the most complex gas SRMs developed at NIST.

Journal Article↗
PubMed2004

Mycotoxin risk assessment for the purpose of setting international regulatory standards.

The 2003 Council for Agricultural Science and Technology Mycotoxin report states that one 21st century goal is the development of uniform regulations worldwide for foodborne mycotoxin contamination. This study informs that endeavor by a risk assessment and economic analysis of two important mycotoxins: fumonisins and aflatoxins. The goals are to identify the nations that would be most heavily impacted by tighter mycotoxin regulations, examine costs and benefits as a function of regulatory stringency, and address risk-risk tradeoffs between health benefits and economic losses from compliance with those regulations. Among industrial nations, the United States would experience the heaviest economic losses from more precautionary mycotoxin standards. Environmental conditions in the developing world, however, are more conducive to mycotoxin accumulation in crops. Contrary to concerns expressed among policymakers, the less developed countries that would likely experience the greatest loss from tighter mycotoxin standards are not sub-Saharan African nations, but China and Argentina. If a fumonisin standard of 0.5 mg/kg were adopted worldwide, total export losses from fumonisins in corn may exceed 300 million dollars annually: 3-fold higher than if the less stringent U.S. standard of 2 mg/kg were adopted. Likewise, export losses from aflatoxins in peanuts may exceed 450 million dollars under the current EU regulatory standard of 4 microg/kg: almost 5-fold higher than if the U.S. standard of 20 microg/kg were adopted. Stricter standards are unlikely to improve health significantly. In developing nations such as China where hepatitis B and C are prevalent, tighter aflatoxin standards may increase health risks until improved control methods for aflatoxins are found, as high-quality crops may be exported instead of being consumed domestically.

Aflatoxins↗
PubMed2004

Standards development of global warming gas species: methane, nitrous oxide, trichlorofluoromethane, and dichlorodifluoromethane.

Environmental scientists from federal agencies, such as the National Oceanic and Atmospheric Administration (NOAA), and academia have long suspected that increasing anthropogenic inputs of various trace gases into the atmosphere can cause changes in the earth's climate and protective ozone layer. Nitrous oxide and methane, cited in the Kyoto Protocol, as well astrichlorofluoromethane (CFC-11) and dichlorodifluoromethane (CFC-12), cited in the Montreal Protocol, are all greenhouse gases and are implicated in the destruction of the stratospheric ozone layer. The lack of national standards prompted research to determine the feasibility of preparing accurate and stable standards containing these four compounds. Development of these standards would support the measurement of these species by those in the atmospheric research community not having their own source of standards. A suite of eight primary gas standards containing methane, nitrous oxide, CFC-11, and CFC-12 in a balance of air were prepared gravimetrically to bracket the ambient atmospheric concentrations. The combined uncertainties (uc) were calculated from error propagation analysis that included the weighing data from the gravimetric preparation and other sources of error such as the purity analysis of the compounds and air matrix. The expanded uncertainties (U) for the gravimetric standards were < 0.5% as calculated from the equation U = kuc, where the coverage factor k is equal to 2 for a 95% confidence interval. Analyses of the suite of standards by gas chromatography with flame-ionization and electron capture detection resulted in average absolute residuals of < 0.25% from regression models. The NIST suite of eight gravimetric standards was used to determine the concentrations in two standardsfrom NOAA. Those analyses resulted in bias across the two laboratories of < or = 2.1%.

Air Pollutants↗
PubMed1999

Point-of-care and standard laboratory coagulation testing during cardiovascular surgery: balancing reliability and timeliness.

OBJECTIVE: The use of point-of-care technology has increased faster than efforts to validate its effectiveness compared to standard laboratory testing modalities. To address this issue with a current point-of-care coagulation system (HEMOCHRON Jr, International Technidyne Corporation (ITC), Edison, NJ), we designed a study to test the hypothesis that data obtained from point-of-care coagulation equipment correlates with data obtained from standard laboratory coagulation equipment. One of the potential advantages gained using point-of-care testing is the ability to obtain more rapid results. To address this issue, turnaround time, defined as the elapsed time (in minutes) from when the sample was acquired from the patient until the investigators knew the results, was also determined. METHODS: Following Human Investigation Committee approval and informed consent, a prospective study was conducted to compare results obtained from point-of-care coagulation equipment with those results obtained from standard laboratory coagulation equipment. The study was performed in three groups of patients undergoing cardiovascular surgery, each requiring different levels of anticoagulation. RESULTS: Of the 83 patients who met the inclusion criteria, the correlation (combining data from groups 1-3) between results obtained from point-of-care and standard laboratory prothrombin time was r = 0.867, p < 0.001. The correlation (group 3) between point-of-care and standard laboratory international normalized ratio was r = 0.943, p < 0.001. The correlation (combining data from groups 1 & 2) between point-of-care and standard laboratory activated partial thromboplastin time was r = 0.825, p < 0.001. Median turnaround time for the standard laboratory was 90 minutes, with a mean turnaround time of 74 to 78 minutes, depending upon the group. In contrast, the median turnaround time for point-of-care testing was two minutes and 14 seconds. CONCLUSIONS: The results from this study population reveal that data obtained from point-of-care prothrombin time, international normalized ratio and activated partial thromboplastin time results correlate with results obtained from standard laboratory coagulation testing. The value of obtaining reliable results in a timely fashion offers a potential advantage for point-of-care testing in dinical situations, such as in the operating room, where saving time may translate into financial savings.

Aged↗
PubMed2003

Comparison of standard and modified SPT method.

BACKGROUND: The aim of our study was to compare clinical significance and economical factors of commonly used standard skin prick tests (SPT) method with new, modified and more handy way of performing SPT. METHODS: Twenty-one subjects [with an average age of 23 years (SD +/- 2.72)] with known sensitivity to examined allergen extracts were tested with histamine, negative control solution and standard allergen extracts (Allergopharma, Reinbeck, Germany). SPT were applied to the volar surface of randomly assigned forearm with two methods: standard technique using lancet needle to prick the epidermis under small drop of extract and tested method using lancet needle which was dipped in extract before prick. In this method all extracts were placed in marked, small, plastic chambers. RESULTS: Mean wheal to histamine was 5.49 (standard method) and 5.01 (modified method). There was no statistical difference between the standard and modified method for size of wheal to histamine (P = 0.654) and to allergen extracts (n = 36, P = 0.824, Wilcoxon test). Economical analysis revealed that examined SPT technique is cheaper than standard method. CONCLUSION: Examined method may be considered to be an alternative for performing SPT as it is safe, cheaper and more convenient than standard technique. SUMMARY STATEMENT: Comparison of standard and modified SPT method revealed the new method to be more economical.

Adult↗
PubMed2002

Direct magnitude estimates of speech intelligibility in dysarthria: effects of a chosen standard.

Direct magnitude estimation (DME) has been used frequently as a perceptual scaling technique in studies of the speech intelligibility of persons with speech disorders. The technique is typically used with a standard, or reference stimulus, chosen as a good exemplar of "midrange" intelligibility. In several published studies, the standard has been chosen subjectively, usually on the basis of the expertise of the investigators. The current experiment demonstrates that a fixed set of sentence-level utterances, obtained from 4 individuals with dysarthria (2 with Parkinson disease, 2 with traumatic brain injury) as well as 3 neurologically normal speakers, is scaled differently depending on the identity of the standard. Four different standards were used in the main experiment, three of which were judged qualitatively in two independent evaluations to be good exemplars of midrange intelligibility. Acoustic analyses did not reveal obvious differences between these four standards but suggested that the standard with the worst-scaled intelligibility had much poorer voice source characteristics compared to the other three standards. Results are discussed in terms of possible standardization of midrange intelligibility exemplars for DME experiments.

Aged↗
PubMedDate not supplied

A prospective study evaluating the lowering of hemoglobin standards for blood donors.

Strict regulations exist for the selection of blood donors. These include minimum hemoglobin (Hb) standards of 13.5 and 12.5 g/dL for males and females respectively. In Canada 2% of all blood donors, or approximately 25,000 individuals annually attempt to make a blood donation but are deferred because their Hb level does not meet these minimum accepted standards. In a previous study we provided a biostatistical approach to ascertain objectively the optimal minimum Hb standards for blood donors to best discriminate between iron deficient and non iron deficient individuals. The derived values were lower than the existing minimum Hb standards and because of concern that blood donors accepted using these lower Hb standards might have asymptomatic disease, the proposed new levels were not adopted. This present prospective study was undertaken to assess the impact on the blood donors of the new Hb standards. Over 26 months we evaluated 1,558 donors (695 males and 863 females). On entry into the study they were screened for a variety of medical conditions which could result in asymptomatic anemia and 6 months later they answered a health questionnaire. Blood donors were entered into 1 of 3 groups. Group I were donors accepted by the existing criteria. Group II were donors who did not meet the existing Hb criteria but satisfied the newly derived standards. Group III were donors deferred even by the new Hb standards.(ABSTRACT TRUNCATED AT 250 WORDS)

Anemia, Hypochromic↗
PubMed1998

[Standard ultrasound sections of the upper extremity--shoulder and elbow joint].

AIM: The sonographic examination of the shoulder and elbow joint is demonstrated in standardized sectional planes providing a reproducible representation of anatomical structures. METHOD: In ultrasound examination of the shoulder joint the following standardized planes are employed transverse and longitudinal planes in the dorsal, superior/lateral and ventral region. In ultrasound examination of the elbow joint the following standardized planes are employed: a transverse and two longitudinal planes in the ventral region, a transverse and a longitudinal plane in the dorsal region. These standardized sectional planes, performed in a real-time-procedure using a 7.5 MHz linear transducer, as well as the images on the screen, correspond to the guidelines provided by the German Society of Ultrasonography in the Locomotor Apparatus (DEGUM). In cases without pathological findings two standardized planes have to be documented. Otherwise the pathological finding has to be documented in two standardized planes. RESULTS: The introduced examination technique in standardized sectional planes provides an excellent overview of the shoulder and elbow joint with a sufficient evaluation of the periarticular soft tissue and the bony surface. The main advantages in comparison to other diagnostic means (i.e. CT, MRI) lies in the possible dynamic examination which allows excellent imaging especially in rotator cuff lesions. CONCLUSION: Because of the excellent evaluation of the periarticular structures, ultrasound plays a major diagnostic role in shoulder joint diseases. Furthermore this technique provides important information about intra- and periarticular disorders of the elbow joint. The standardized procedures are a useful means of assuring and improving the quality of sonographic examinations of articular and periarticular structures.

Elbow Joint↗
PubMed2000

Evaluation of early postoperative results after bicaval versus standard cardiac transplantation and review of the literature.

OBJECTIVE: Previous studies have been inconsistent in defining a clinical benefit to the bicaval cardiac transplantation technique relative to the standard technique, and many major centers have not adopted this newer approach. The purpose of this study was to determine whether clinically significant benefits support utilization of the bicaval technique. METHODS: Sixty-eight consecutive adult patients undergoing a standard cardiac transplant were compared with 75 consecutive patients who underwent the bicaval technique during the period from 1991 to 1999. Etiology, recipient sex, recipient age, donor age, and pulmonary vascular resistance were similar between the two groups. RESULTS: Cardiac index at 24 hours after operation was increased for the bicaval group relative to the standard group (3.15 +/- 0.7 vs 2.7 +/- 0.5 L/min/m(2), P <. 05). Inotropic requirements were significantly less, and there was significantly less tricuspid regurgitation in the bicaval group relative to the standard group. In addition, the bicaval group more frequently had a nonpaced normal sinus rhythm at 24 hours after operation (73.9% vs 50.7% [standard group], P =.025) and had fewer postoperative arrhythmias (29.3% vs 47.7% [standard group], P <.01). Finally, although mortality was similar for the two groups, length of postoperative hospitalization was longer for the standard group relative to the bicaval group (12.1 +/- 11 vs 20.4 +/- 12 days, P <. 001). Review of the literature identified reduced tricuspid regurgitation and improved rhythm as consistent benefits of the bicaval technique. CONCLUSION: This review demonstrates a clinical benefit during the early postoperative period with bicaval cardiac transplantation (relative to standard) and encourages further utilization of this technique.

Adult↗
PubMed2001

The risks of spontaneous preterm delivery and perinatal mortality in relation to size at birth according to fetal versus neonatal growth standards.

OBJECTIVE: The aim of this study was to test the null hypothesis that size at birth relative to fetal or neonatal growth standards is not a significant variable related to the risk of spontaneous preterm delivery. STUDY DESIGN: This was a hospital-based cohort study of consecutive births at a tertiary care perinatal center from January 1, 1985, to December 31, 1996. A total of 37,377 pregnancies met the following inclusion criteria: (1) singleton gestation, (2) 25 to 40 weeks' gestation, and (3) no anomalies. Neonates were divided into 5 birth weight categories according to either fetal (uncorrected for sex) or neonatal (corrected for sex) growth standards, as follows: (1) intrauterine growth restriction, birth weight <3rd percentile; (2) borderline intrauterine growth restriction, birth weight > or = 3rd percentile and <10th percentile; (3) appropriate for gestational age, birth weight from 10th percentile through 90th percentile; (4) borderline large for gestational age, birth weight >90th percentile but < or = 97th percentile, and (5) large for gestational age, birth weight >97th percentile. Logistic regression analysis was used to estimate the independent effect of birth weight category on the risk of preterm delivery after spontaneous onset of labor, with the appropriate-for-gestational-age group serving as a reference. RESULTS: When fetal growth standards were applied, there was a significant increase in the risk of spontaneous preterm delivery when birth weight was outside the appropriate-for-gestational-age range (odds ratios of 2.5, 1.4, 1.2, and 1.9 for intrauterine growth restriction, borderline intrauterine growth restriction, borderline large-for-gestational age, and large-for-gestational-age groups, respectively). In contrast, when neonatal growth standards were applied, the risks of spontaneous preterm delivery in intrauterine growth restriction, borderline intrauterine growth restriction, and large-for-gestational-age groups were significantly lower (odds ratios of 0.5, 0.7, and 0.7 for intrauterine growth restriction, borderline intrauterine growth restriction, and large-for-gestational-age groups, respectively) because of an underestimation in the number of fetuses with abnormal size at birth delivered prematurely. With both fetal and neonatal growth standards there was a 5-to 6-fold greater risk of perinatal death for both preterm and term fetuses with intrauterine growth restriction. CONCLUSION: Fetal growth standards are more appropriate in predicting the impact of birth weight category on the risk of spontaneous preterm delivery than are neonatal growth standards. When fetal standards are applied, the risks of preterm birth in both extreme abnormal birth weight categories (intrauterine growth restriction and large for gestational age) are 2- to 3-fold greater than the risk among appropriate-for-gestational-age infants.

Adult↗
PubMed2001

Volume standards for high-risk surgical procedures: potential benefits of the Leapfrog initiative.

BACKGROUND: As part of a broader effort aimed at improving hospital safety, a large coalition of employers, the Leapfrog Group, will soon require hospitals caring for their employees to meet volume standards for 5 high-risk surgical procedures. We estimated the potential benefits of full nationwide implementation of these volume standards. METHODS. Using data from Nationwide Inpatient Sample and other sources, we first estimated the total number of each of the 5 procedures-coronary-artery bypass graft, abdominal aortic aneurysm repair, coronary angioplasty, esophagectomy, and carotid endarterectomy-performed each year in hospitals in US metropolitan areas. (Leapfrog exempts hospitals in rural areas to avoid access issues.) We then projected the effectiveness of volume standards (in terms of relative risks of mortality) for each procedure using data from a published structured literature review. RESULTS: With full implementation nationwide, the Leapfrog volume standards would save 2581 lives. Of the procedures, volume standards would save the most lives with coronary-artery bypass graft (1486), followed by abdominal aortic-aneurysm repair (464), coronary angioplasty (345), esophagectomy (168), and carotid endarterectomy (118). In our estimates of the number of lives saved, we considered assumptions about how many patients would be affected and the effectiveness of volume standards (ie, strength of underlying volume-outcome relationships with each procedure). CONCLUSIONS: If the Leapfrog volume standards are successfully implemented, employers and health-care purchasers could prevent many surgical deaths by requiring hospital volume standards for high-risk procedures.

Humans↗
PubMed2006

Analysis of exchanges between novice and cooperating teachers during internships using the NCATE/NASPE Standards for Teacher Preparation in Physical Education as guidelines.

To be recognized as an accredited program, Physical Education Teacher Education (PETE) programs in the country must abide by guidelines put forward by the National Association for Sport and Physical Education (NASPE), in collaboration with the National Council for the Accreditation of Teacher Education (NCATE). The guidelines are divided into nine standards and identify a number of outcomes (NASPE, 1998). The purpose of this study was to determine the nature of the exchanges between novice teachers (NTs) and cooperating teachers (CTs), when using the NASPE Standards (1998) as a reference point, and determine if the focus of the exchanges differed over time and according to data source. Six pairs of CTs and their NT participated in the study. Data were collected through recorded conversations between NTs and their CT as well as NTs' logs. Data showed that the majority of conversations focused on planning and instruction (Standard 6) and management and motivation (Standard 4), while few related to diverse learners (Standard 3), growth and development (Standard 2), and communication (Standard 5). The small amount of information shared by CTs in some standards indicates a need for PETE programs to share the guidelines with CTs to make them aware of the importance of offering a variety of topics to interns, because CTs are the primary source of information during this crucial experience.

Adult↗
PubMed1994

Quality standard for assurance of measles immunity among health care workers. The Infectious Diseases Society of America.

OBJECTIVE: The objective of this quality standard is to prevent nosocomial transmission of measles by assuring universal measles-mumps-rubella (MMR) vaccination of all health care workers who lack immunity to measles. Although the primary emphasis is on health care workers in hospitals, those at other sites, such as clinics, nursing homes, and schools, are also included. It will be the responsibility of designated individuals at these institutions to implement the standard. OPTIONS: We considered advocating the use of measles vaccine rather than MMR but chose the latter because it also protects against mumps and rubella and because it is more readily available. OUTCOMES: The desired outcome is a reduction in the nosocomial transmission of measles. EVIDENCE: Although direct comparative studies are lacking, nosocomial outbreaks of measles have been reported (as recently as 1992) in institutions where measles immunization of nonimmune health care workers is not universal, whereas such outbreaks have not been reported in institutions with universal immunization. VALUES AND VALIDATION: We consulted more than 50 infectious-disease experts in epidemiology, government, medicine, nursing, obstetrics and gynecology, pediatrics, and surgery. In light of disagreement regarding the implementation of the standard, we used group discussions to reach a consensus. BENEFITS, HARMS, AND COSTS: The consequences of the transmission of measles (and of mumps and rubella) in a health care institution include not only the morbidity and mortality attributable to the disease, but also the significant cost of evaluating and containing an outbreak and the serious disruption of regular hospital routines when control measures are instituted. The potential harm to health care workers after the implementation of the standard consists of untoward effects of MMR vaccine, although the reactions of vaccines should be minimal with adherence to recommended vaccination procedures. Implementation of the standard should entail no expense to health care workers; the precise cost to institutions is unknown, but the expense would be mitigated by prevention of measles outbreaks. RECOMMENDATIONS: We recommend MMR vaccination of all health care workers who lack immunity to measles. SPONSORS: The Quality Standards Subcommittee of the Clinical Affairs Committee of the Infectious Diseases Society of America (IDSA) developed the standard. The subcommittee was composed of representatives of the IDSA (Drs. Gross and McGowan), the Society for Hospital Epidemiology of America (Dr. Wenzel), the Surgical Infection Society (Dr. Dellinger), the Pediatric Infectious Diseases Society (Dr. Krause), the Centers for Disease Control and Prevention (Dr. Martone), the Obstetrics and Gynecology Infectious Diseases Society (Dr. Sweet), and the Association of Practitioners of Infection Control (Ms. Barrett). Funding was provided by the IDSA and the other cooperating organizations. The standard is endorsed by the IDSA.

Cross Infection↗
PubMed2002

Comparative anxiolytic activity profile of various preparations of Passiflora incarnata linneaus: a comment on medicinal plants' standardization.

OBJECTIVES: Mother tincture preparation of Passiflora incarnata from five reputable manufacturers of homeopathic medicines were compared to the bioactive fraction of methanol extract of P. incarnata (standard) for their anxiolytic activity in mice using the elevated plus-maze model of anxiety. MATERIALS AND METHODS: The extracts of P. incarnata were further subdivided in four doses, i.e., 100, 200, 300, and 400 mg/kg, suspended in a vehicle, and administered orally to groups of mice. Methanol extract of P. incarnata (125 mg/kg, orally) was taken as a standard. Anxiolytic activity was measured using the elevated plus-maze model. All treatments were given orally. Forty-five (45) minutes after the treatments, mice were placed on the center of the elevated plus-maze and the number of entries in open arms were measured for 5 minutes. SUBJECTS: Studies were performed with Swiss albino mice. RESULTS: The dried mother tincture preparations exhibited maximum anxiolytic activity at 300 mg/kg (SBL); 400 mg/kg (DWSI and DWSG); 200 mg/kg (DRCG), and nil (BHL) respectively, with reference to anxiolytic activity exhibited by the methanol extract of aerial parts of P. incarnata (125 mg/kg). CONCLUSIONS: To ensure uniformity and consistency of the biologic effects exhibited by plant-derived phytopharmaceuticals, uniform standards are required globally. The monographs on P. incarnata mention standardization of the plant using any known flavonoid as the chemical marker and the marker compound was not the one responsible for the plants multifarious biologic effects. The recent report of a trisubstituted benzoflavone compound (BZF) as the main bioactive phytoconstituent of P. incarnata made it feasible to resort to biologic standardization of this plant using BZF as the biomarker compound. The biologic standardization would ensure bioequivalence of the medicinal preparations of P. incarnata. These studies also recommend the incorporation of leaf constants, ash values, extractive values, thin layer chromatography profile (vital "fingerprints" specific for a plant), and the quantitative assay by determining the bioactive BZF moiety in pharmacopoeias in order to ensure uniform biologic results and standards of P. incarnata because the plant currently has tremendous usefulness. The herbal pharmacopoeias, which are still in their "infancy," can be strengthened by incorporating the appropriate bioactive constituents that need to be identified by using modern technological procedures. Once the appropriate bioactive constituent(s) are established and authenticated, their qualitative and quantitative assay procedures can be developed. Reporting the vital fingerprint parameters of the plant and incorporation of assay procedures of the bioactive phytomoiety in the official monographs of medicinal plants, will certainly strengthen the herbal pharmacopoeias. This is perhaps the most important scientific approach that would ensure uniform standards and bioequivalence of plant-medicines - a need to revive faith in the healing potentials of plant-derived medicines.

Administration, Oral↗