What does grade s mean in court

Many factors go into determining which hardwood floor to choose for a new project, including the species, board size, and type of finish. But another factor should be the wood grade. There are several options out there, and you should choose the wood grade based on the specifics of each project — not based on whatever option is the cheapest or most convenient.

So, for example, well designed case series may provide high quality evidence for complication rates from surgery or procedures, such as intraoperative deaths or perforations after colonoscopy, which is more directly relevant than evidence from randomised trials.

Similarly, cohort studies can provide high quality evidence for rates of recall or procedures precipitated by false positive screening results, such as biopsy rates after mammography. Study quality refers to the detailed study methods and execution. Reviewers should use appropriate criteria to assess study quality for each important outcome. Reviewers should make explicit their reasons for downgrading a quality rating.

For example, they may state that failure to blind patients and physicians reduced the quality of evidence for an intervention's impact on pain severity and that they considered this a serious limitation.

Consistency refers to the similarity of estimates of effect across studies. If there is important unexplained inconsistency in the results, our confidence in the estimate of effect for that outcome decreases.

Differences in the direction of effect, the size of the differences in effect, and the significance of the differences guide the inevitably somewhat arbitrary decision about whether important inconsistency exists. Separate estimates of magnitude of effect for different subgroups should follow when investigators identify a compelling explanation for inconsistency.

For instance, differences in the effect of carotid endarterectomy on high and lower grade stenoses should lead to separate estimates for these two subgroups.

Directness refers to the extent to which the people, interventions, and outcome measures are similar to those of interest. For example, there may be uncertainty about the directness of the evidence if the people of interest are older, sicker, or have more comorbidity than those in the studies.

Because many interventions have more or less the same relative effects across most patient groups, we should not apply overly stringent criteria in deciding whether evidence is direct. For some therapies—for example, behavioural interventions in which cultural differences are likely to be important—more stringent criteria may be appropriate.

Similarly, reviewers may identify uncertainty about the directness of evidence for drugs that differ from those in the studies but are within the same class.

Similar issues arise for other types of interventions. For instance, can you generalise results to a less intense counselling intervention than that used in a study, or to an alternative surgical technique? These judgments can be difficult, 40 and it is important for investigators to explain the rationale for the conclusions that they draw.

On the other hand, studies using surrogate outcomes generally provide less direct evidence than those using outcomes that are important to people. It is therefore prudent to use much more stringent criteria when considering the directness of evidence for surrogate outcomes. Examples of indirect evidence based on surrogate outcomes that subsequent trials showed to be misleading include suppression of cardiac arrhythmia in patients who have had a myocardial infarction as a surrogate for mortality, 41 changes in lipoproteins as a surrogate for coronary heart disease, 37 and bone density in postmenopausal women as a surrogate for fracture reduction.

The accuracy of a diagnostic test is also a surrogate for important outcomes that might be affected by accurate diagnosis, including improved health outcomes from appropriate treatment and reduced harms from false positive results. Different criteria must be used when considering study design for studies of diagnostic accuracy.

However, consideration of the directness of evidence is based on how confident we are of the relation between being classified correctly as a true positive or negative or incorrectly as a false positive or negative and important consequences of this. For example, there is consistent evidence from well designed studies that there are fewer false negative results with non-contrast helical computed tomography than with intravenous pyelography in the diagnosis of suspected acute urolithiasis.

Another type of indirect evidence arises when there are no direct comparisons of interventions and investigators must make comparisons across studies. For example, this would be the case if there were randomised trials that compared selective serotonin reuptake inhibitors with placebo and tricyclics with placebo, but no trials that compared selective serotonin reuptake inhibitors with tricyclics.

Indirect comparisons always leave greater uncertainty than direct comparisons because of all the other differences between studies that can affect the results. The quality of evidence for each main outcome can be determined after considering each of the above elements: study design, study quality, consistency, and directness. Our approach initially categorises evidence based on study design into randomised trials and observational studies cohort studies, case-control studies, interrupted time series analyses, and controlled before and after studies.

We then suggest considering whether the studies have serious limitations, important inconsistencies in the results, or whether uncertainty about the directness of the evidence is warranted box 2. We suggest the following definitions in grading the quality of the evidence:.

Limitations in study quality, important inconsistency of results, or uncertainty about the directness of the evidence can lower the grade of evidence. For instance, if all available studies have serious limitations, the grade will drop by one level, and if all studies have very serious limitations the grade will drop by two levels. Fatally flawed studies may be excluded.

Additional considerations that can lower the quality of evidence include imprecise or sparse data box 3 and high risk of reporting bias.

Additional considerations that can raise the quality of evidence include:. A very strong association for example, a fold risk of poisoning fatalities with tricyclic antidepressants compared with selective serotonin reuptake inhibitors, see table 2 or strong association for example, a threefold increased risk of head injuries among cyclists who do not use helmets compared with those that do Quality assessment of trials comparing selective serotonin reuptake inhibitors SSRIs with tricyclic antidepressants for treatment of moderate depression in primary care 2.

Presence of all plausible residual confounding would have reduced the observed effect. For example, plausible explanatory factors that were not adjusted for in studies comparing mortality rates of for-profit and not-for-profit hospitals would have reduced the observed effect. These considerations act cumulatively. For example, if randomised trials have both serious limitations and there is uncertainty about the directness of the evidence, the grade of evidence would drop from high to low.

The same rules should be applied to judgments about the quality of evidence for harms and benefits. Important plausible harms can and should be included in evidence summaries by considering the indirect evidence that makes them plausible. For example, if there is concern about anxiety in relation to screening for melanoma and no direct evidence is found, it may be appropriate to consider evidence from studies of other types of screening.

Judgments about the quality of evidence for important outcomes across studies can and should be made in the context of systematic reviews, such as Cochrane reviews. Judgments about the overall quality of evidence, trade-offs, and recommendations typically require information beyond the results of a review.

Other systems have commonly based judgments of the overall quality of evidence on the quality of evidence for the benefits of interventions. When the risk of an adverse effect is critical for a judgment, and evidence regarding that risk is weaker than evidence of benefit, ignoring uncertainty about the risk of harm is problematic. We suggest that the lowest quality of evidence for any of the outcomes that are critical to making a decision should provide the basis for rating overall quality of evidence.

Outcomes that are important, but not critical, should be included in evidence profiles and should be considered when making judgments about the balance between health benefits and harms but should not be taken into consideration when grading the overall quality of evidence. Deciding whether an outcome is critical, important but not critical, or not important is a value judgment. So far as possible these judgments should take account of the values of those who will be affected by adherence to subsequent recommendations.

There is not an empirical basis for defining imprecise or sparse data. Two possible definitions are:. Data are sparse if the results include just a few events or observations and they are uninformative.

Data are imprecise if the confidence intervals are sufficiently wide that an estimate is consistent with either important harms or important benefits. These different definitions can result in different judgments. Although it may not be possible to reconcile these differences, we offer the following guidance when considering whether to downgrade the quality of evidence due to imprecise or sparse data:. The threshold for considering data imprecise or sparse should be lower when there is only one study.

A single study with a small sample size or few events yielding wide confidence intervals spanning both the potential for harm and benefit should be considered as imprecise or sparse data. Confidence intervals that are sufficiently wide that, irrespective of other outcomes, the estimate is consistent with conflicting recommendations should be considered as imprecise or sparse data. The decision regarding what is critical can be difficult. The plausibility of adverse outcomes may influence the decision regarding whether they are critical.

Weak evidence about implausible putative harms should not lower the overall grade of evidence. Decisions about whether a putative harm is plausible may come from indirect evidence.

For example, if there is important concern about serious adverse effects of a drug because of animal studies, the overall quality of evidence may receive a lower grade based on whatever human evidence is available for that particular adverse effect.

Sometimes lack of evidence for plausible putative harms may make it impossible to assess the net benefit of an intervention. In these circumstances a guideline panel may elect to recommend additional research. If the evidence for all of the critical outcomes favours the same alternative, and there is high quality evidence for some, but not all, of those outcomes, the overall quality of evidence might still be considered high. For example, there is high quality evidence that antiplatelet therapy reduces the risk of non-fatal stroke and non-fatal myocardial infarction in patients who have had a myocardial infarction.

Although the evidence for all-cause mortality is of moderate quality, the overall quality of evidence might still be considered high, even if all cause mortality was considered a critical outcome. Recommendations involve a trade-off between benefits and harms. Making that trade-off inevitably involves placing, implicitly or explicitly, a relative value on each outcome.

It is often difficult to judge how much weight to give to different outcomes, and different people will often have different values. People making judgments on behalf of others are on stronger ground if they have evidence of the values of those affected. For instance, people making recommendations about chemotherapy for women with early breast cancer will be in a stronger position if they have evidence about the relative importance those women place on reducing the risk of a recurrence of breast cancer relative to avoiding the side effects of chemotherapy.

We suggest making explicit judgments about the balance between the main health benefits and harms before considering costs. Does the intervention do more good than harm? Recommendations must apply to specific settings and particular groups of patients whenever the benefits and harms differ across settings or patient groups. For instance, consider whether we should recommend that patients with atrial fibrillation receive warfarin to reduce their risk of stroke, despite the increase in bleeding risk that will result.

Recommendations, or their strength, are likely to differ in settings where regular monitoring of the intensity of anticoagulation is available and settings where it is not. Furthermore, recommendations or their strength are likely to differ in patients at very low risk of stroke those under 65 without any comorbidity and patients at higher risk such as older patients with heart failure because of differences in the absolute reduction in risk.

Recommendations must therefore be specific to a patient group, and a practice setting. It is particularly important to consider the circumstances of disadvantaged populations when making recommendations and, when appropriate, modify recommendations to take into consideration differences between advantaged and disadvantaged populations.

Sometimes, the big announcement comes at a pep rally, school assembly, or public ceremony one or more days before the game.

Other schools crown their royalty at the Homecoming football game, a dance or other school event. Often, the previous year's Queen and King are invited back to crown their successors.

If they are absent for whatever reason, someone else - usually, another previous Queen or King, a popular teacher, or other designated person - will perform those duties. Usually, the Queen is crowned first, followed by the King. The crowning method also varies by school. Homecoming court members who are not crowned king or queen are often called escorts or royalty.

They are often expected to participate in the week's activities as well. Anyone can go to homecoming as long as they have a ticket for that school's homecoming :. Pump up the student body.

Let them know they should attend the homecoming game and dance. It will be fun. Thank the, again. Be you? I mean that's how you got on the court right?? Homecoming may be translated as "Hemkomst". Homecoming is rated R. Hardcore Homecoming was created in Hardcore Homecoming ended in Mariandl's Homecoming was created in Casanova's Homecoming was created in Ender's Homecoming was created in The summary offense part means that you can get sentenced to up to 90 days in jail.

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