At the Intergenerational Transfer Elderly Population Based Shelter in Medan - Indonesia

Editorial Decision: Removed

Final Report of the CGIAR Working Group on Deliberation and Decision-Making Processes

Report of a working group established at the mid term meeting of the CGIAR in May 1992 by the Chairman of the Group to examine deliberation, decision making, oversight, and information sharing processes in the CGIAR, and to suggest possible changes to accommodate the recent System expansion. The working group was chaired by Robert Herdt.It recommended the CGIAR continue to hold two meetings each year, with mid term meetings in countries where centers were located; also the use of topical parallel sessions at International Centers Week meetings, and streamlining of discussion procedures. The report urged the establishment of a finance committee composed of donor representatives, and a standing committee on system-level evaluation. It suggested combination of existing public awareness activities.Agenda document, CGIAR Mid Term Meeting, May 1993. A preliminary report was discussed at the CGIAR meeting in October 1992

Paralleling of buck converters for DC microgrid operation

This paper presents the controller design of paralleled Buck converters using Droop Control to obtain common load sharing for DC Microgrid operation. Proportional Integral (PI) controllers are used to provide nested current and voltage control of the Buck converters. Droop control is applied to obtain load sharing between the paralleled converters. Then, a voltage restoration loop is applied utilizing another PI controller to restore the desired voltage in the dc microgrid, correcting any voltage deviations caused by the droop loop. The operation of the controllers is tested by simulating two paralleled Buck converters operated in the continuous current mode while sharing a common resistive load.peer-reviewe

Evaluating Quality of Decision-Making Processes in Medicines' Development, Regulatory Review, and Health Technology Assessment : A Systematic Review of the Literature.

Introduction: Although pharmaceutical companies, regulatory authorities, and health technology assessment (HTA) agencies have been increasingly using decision-making frameworks, it is not certain whether these enable better quality decision making. This could be addressed by formally evaluating the quality of decision-making process within those organizations. The aim of this literature review was to identify current techniques (tools, questionnaires, surveys, and studies) for measuring the quality of the decision-making process across the three stakeholders. Methods: Using MEDLINE, Web of Knowledge, and other Internet-based search engines, a literature review was performed to systematically identify techniques for assessing quality of decision making in medicines development, regulatory review, and HTA. A structured search was applied using key words and a secondary review was carried out. In addition, the measurement properties of each technique were assessed and compared. Ten Quality Decision-Making Practices (QDMPs) developed previously were then used as a framework for the evaluation of techniques identified in the review. Due to the variation in studies identified, meta-analysis was inappropriate. Results: This review identified 13 techniques, where 7 were developed specifically to assess decision making in medicines' development, regulatory review, or HTA; 2 examined corporate decision making, and 4 general decision making. Regarding how closely each technique conformed to the 10 QDMPs, the 13 techniques assessed a median of 6 QDMPs, with a mode of 3 QDMPs. Only 2 techniques evaluated all 10 QDMPs, namely the Organizational IQ and the Quality of Decision Making Orientation Scheme (QoDoS), of which only one technique, QoDoS could be applied to assess decision making of both individuals and organizations, and it possessed generalizability to capture issues relevant to companies as well as regulatory authorities. Conclusion: This review confirmed a general paucity of research in this area, particularly regarding the development and systematic application of techniques for evaluating quality decision making, with no consensus around a gold standard. This review has identified QoDoS as the most promising available technique for assessing decision making in the lifecycle of medicines and the next steps would be to further test its validity, sensitivity, and reliability.Peer reviewedFinal Published versio

A GIS model-based assessment of the environmental distribution of g-hexachlorocyclohexane in European soils and waters

The MAPPE GIS based multimedia model is used to produce a quantitative description of the behaviour of γ-hexachlorocyclohexane (γ-HCH) in Europe, with emphasis on continental surface waters. The model is found to reasonably reproduce γ-HCH distributions and variations along the years in atmosphere and soil; for continental surface waters, concentrations were reasonably well predicted for year 1995, when lindane was still used in agriculture, while for 2005, assuming severe restrictions in use, yields to substantial underestimation. Much better results were yielded when same mode of release as in 1995 was considered, supporting the conjecture that for γ-HCH, emission data rather that model structure and parameterization can be responsible for wrong estimation of concentrations. Future research should be directed to improve the quality of emission data. Joint interpretation of monitoring and modelling results, highlights that lindane emissions in Europe, despite the marked decreasing trend, persist beyond the provisions of existing legislation. An spatially-explicit multimedia modelling strategy was applied to describe the historical distribution of γ-HCH in European soils and surface waters

Alien Registration- Decision, Jewell (Wade, Aroostook County)

https://digitalmaine.com/alien_docs/32682/thumbnail.jp

Clinical effectiveness and cost-effectiveness of pegvisomant for the treatment of acromegaly: a systematic review and economic evaluation

Background: Acromegaly, an orphan disease usually caused by a benign pituitary tumour, is characterised by hyper-secretion of growth hormone (GH) and insulin-like growth factor I (IGF-1). It is associated with reduced life expectancy, cardiovascular problems, a variety of insidiously progressing detrimental symptoms and metabolic malfunction. Treatments include surgery, radiotherapy and pharmacotherapy. Pegvisomant (PEG) is a genetically engineered GH analogue licensed as a third or fourth line option when other treatments have failed to normalise IGF-1 levels. Methods: Evidence about effectiveness and cost-effectiveness of PEG was systematically reviewed. Data were extracted from published studies and used for a narrative synthesis of evidence. A decision analytical economic model was identified and modified to assess the cost-effectiveness of PEG. Results: One RCT and 17 non-randomised studies were reviewed for effectiveness. PEG substantially reduced and rapidly normalised IGF-1 levels in the majority of patients, approximately doubled GH levels, and improved some of the signs and symptoms of the disease. Tumour size was unaffected at least in the short term. PEG had a generally safe adverse event profile but a few patients were withdrawn from treatment because of raised liver enzymes. An economic model was identified and adapted to estimate the lower limit for the cost-effectiveness of PEG treatment versus standard care. Over a 20 year time horizon the incremental cost-effectiveness ratio was pound81,000/QALY and pound212,000/LYG. To reduce this to pound30K/QALY would require a reduction in drug cost by about one third. Conclusion: PEG is highly effective for improving patients' IGF-1 level. Signs and symptoms of disease improve but evidence is lacking about long term effects on improved signs and symptoms of disease, quality of life, patient compliance and safety. Economic evaluation indicated that if current standards (UK) for determining cost-effectiveness of therapies were to be applied to PEG it would be considered not to represent good value for money