WorldWideScience

Sample records for direct utilization advanced

  1. Apollo-L2, an advanced fuel tokamak reactor utilizing direct conversion

    Emmert, G.A.; Kulcinski, G.L.; Blanchard, J.P.; El-Guebaly, L.A.; Khater, H.Y.; Santarius, J.F.; Sawan, M.E.; Sviatoslavsky, I.N.; Wittenberg, L.J.; Witt, R.J.

    1989-01-01

    A scoping study of a tokamak reactor fueled by a D- 3 He plasma is presented. The Apollo D- 3 He tokamak capitalizes on recent advances in high field magnets (20 T) and utilizes rectennas to convert the synchrotron radiation directly to electricity. The low neutron wall loading (0.1 MW/m 2 ) permits a first wall lasting the life of the plant and enables the reactor to be classified as inherently safe. The cost of electricity is less than that from a similar power level DT reactor. 10 refs., 1 fig., 4 tabs

  2. Proceedings of the advanced research and technology development direct utilization, instrumentation and diagnostics contractors' review meeting

    Geiling, D.W. (USDOE Morgantown Energy Technology Center, WV (USA)); Goldberg, P.M. (eds.) (USDOE Pittsburgh Energy Technology Center, PA (USA))

    1990-01-01

    The 1990 Advanced Research and Technology Development (AR TD) Direct Utilization, and Instrumentation and Diagnostics Contractors Review Meeting was held September 16--18, 1990, at the Hyatt at Chatham Center in Pittsburgh, PA. The meeting was sponsored by the US Department of Energy (DOE), Office of Fossil Energy, and the Pittsburgh and Morgantown Energy Technology Centers. Each year the meeting provides a forum for the exchange of information among the DOE AR TD contractors and interested parties. This year's meeting was hosted by the Pittsburgh Energy Technology Center and was attended by 120 individuals from industry, academia, national laboratories, and other governmental agencies. Papers were presented on research addressing coal surface, science, devolatilization and combustion, ash behavior, emission controls for gases particulates, fluid bed combustion and utilization in diesels and turbines. Individual reports are processed separately for the data bases.

  3. Advanced directives: open issues

    Gabriella Negrini

    2013-05-01

    Full Text Available BACKGROUND In Italy Advanced directives have not been regulated by law yet. Moreover, there is a confusion of concepts: advanced directives, refusal of treatment, medical futility and euthanasia are not synonymous.DISCUSSION The following aspects are then discussed: object of directives; elapse of time between their expression and their application; knowledge of the directives and their obligatory nature. The refusal of a treatment that can save a person’s life is a critical subject. There are different ethical points of view: according to lay ethics, the patient’s self-determination prevails; the religious viewpoint, instead, says that life is a gift which we cannot dispose of. In any case, the patient will be confronted with the professional autonomy of the doctor. Should the doctor save a patient’s life in any case or should he achieve best clinical practice, in respect of his will? The doctor should interpret the patient’s will but with caution and judgment. An exemption from responsibility should be provided by law for doctors who respect patient’s living will.

  4. Psychiatric Advance Directives: Getting Started

    ... News Legal Issues Search for: About PADs A psychiatric advance directive (PAD) is a legal document that ... decisions during a mental health crisis. Getting Started Psychiatric advance directives (PADs) are relatively new legal instruments ...

  5. Eldercare at Home: Advanced Directives

    ... permanently? Helping the person fill out a living will (advance directive) A living will states a person's wishes about medical care if ... never be in a situation where another person will have to make decisions ... it is to have an advance directive. However, don't assume that your loved ...

  6. Direct utilization of geothermal energy

    Lund, J. W.

    2010-01-01

    The worldwide application of geothermal energy for direct utilization is reviewed. This paper is based on the world update for direct-use presented at the World Geothermal Congress 2010 in Bali, Indonesia (WGC2010) which also includes material presented at three world geothermal congresses in Italy, Japan and Turkey (WGC95, WGC2000 and WGC2005). This report is based on country update papers prepared for WGC2010 and data from other sources. Final update papers were received from 70 countries of which 66 reported some direct utilization of geothermal energy for WGC2010. Twelve additional countries were added to the list based on other sources of information. The 78 countries having direct utilization of geothermal energy, is a significant increase from the 72 reported in 2005, the 58 reported in 2000, and the 28 reported in 1995. An estimate of the installed thermal power for direct utilization at the end of 2009, reported from WGC2010 is 48,493 MW th , almost a 72 % increased over the 2005 data, growing at a compound rate of 11.4% annually with a capacity factor of 0.28. The thermal energy used is 423,830 TJ/year (117,740 GWh/yr), about a 55% increase over 2005, growing at a compound rate of 9.2% annually. The distribution of thermal energy used by category is approximately 47.2% for ground-source heat pumps, 25.8% for bathing and swimming (including balneology), 14.9% for space heating (of which 85% is for district heating), 5.5% for greenhouses and open ground heating, 2.8% for industrial process heating, 2.7% for aquaculture pond and raceway heating, 0.4% for agricultural drying, 0.5% for snow melting and cooling, and 0.2% for other uses. Energy savings amounted to 250 million barrels (38 million tonnes) of equivalent oil annually, preventing 33 million tonnes of carbon and 107 million tonnes of CO 2 being released to the atmosphere which includes savings in geothermal heat pump cooling (compared to using fuel oil to generate electricity). (author)

  7. Direct Utilization of Geothermal Energy

    John W. Lund

    2010-08-01

    Full Text Available The worldwide application of geothermal energy for direct utilization is reviewed. This paper is based on the world update for direct-use presented at the World Geothermal Congress 2010 in Bali, Indonesia (WGC2010 [1] which also includes material presented at three world geothermal congresses in Italy, Japan and Turkey (WGC95, WGC2000 and WGC2005. This report is based on country update papers prepared for WGC2010 and data from other sources. Final update papers were received from 70 countries of which 66 reported some direct utilization of geothermal energy for WGC2010. Twelve additional countries were added to the list based on other sources of information. The 78 countries having direct utilization of geothermal energy, is a significant increase from the 72 reported in 2005, the 58 reported in 2000, and the 28 reported in 1995. An estimate of the installed thermal power for direct utilization at the end of 2009, reported from WGC2010 is 48,493 MWt, almost a 72 % increased over the 2005 data, growing at a compound rate of 11.4% annually with a capacity factor of 0.28. The thermal energy used is 423,830 TJ/year (117,740 GWh/yr, about a 55% increase over 2005, growing at a compound rate of 9.2% annually. The distribution of thermal energy used by category is approximately 47.2% for ground-source heat pumps, 25.8% for bathing and swimming (including balneology, 14.9% for space heating (of which 85% is for district heating, 5.5% for greenhouses and open ground heating, 2.8% for industrial process heating, 2.7% for aquaculture pond and raceway heating, 0.4% for agricultural drying, 0.5% for snow melting and cooling, and 0.2% for other uses. Energy savings amounted to 250 million barrels (38 million tonnes of equivalent oil annually, preventing 33 million tonnes of carbon and 107 million tonnes of CO2 being release to the atmosphere which includes savings in geothermal heat pump cooling (compared to using fuel oil to generate electricity.

  8. Advanced energy utilization MHD power generation

    2008-01-01

    The 'Technical Committee on Advanced Energy Utilization MHD Power Generation' was started to establish advanced energy utilization technologies in Japan, and has been working for three years from June 2004 to May 2007. This committee investigated closed cycle MHD, open cycle MHD, and liquid metal MHD power generation as high-efficiency power generation systems on the earth. Then, aero-space application and deep space exploration technologies were investigated as applications of MHD technology. The spin-off from research and development on MHD power generation such as acceleration and deceleration of supersonic flows was expected to solve unstart phenomena in scramjet engine and also to solve abnormal heating of aircrafts by shock wave. In addition, this committee investigated researches on fuel cells, on secondary batteries, on connection of wind power system to power grid, and on direct energy conversion system from nuclear fusion reactor for future. The present technical report described results of investigations by the committee. (author)

  9. Law, autonomy and advance directives.

    Willmott, Lindy; White, Ben; Mathews, Ben

    2010-12-01

    The principle of autonomy underpins legal regulation of advance directives that refuse life-sustaining medical treatment. The primacy of autonomy in this domain is recognised expressly in the case law, through judicial pronouncement, and implicitly in most Australian jurisdictions, through enactment into statute of the right to make an advance directive. This article seeks to justify autonomy as an appropriate principle for regulating advance directives and relies on three arguments: the necessity of autonomy in a liberal democracy; the primacy of autonomy in medical ethics discourse; and the uncontested importance of autonomy in the law on contemporaneous refusal of medical treatment. This article also responds to key criticisms that autonomy is not an appropriate organising principle to underpin legal regulation of advance directives.

  10. Advanced clean coal utilization technologies

    Moritomi, Hiroshi [National Inst. for Resources and Environment, Tsukuba, Ibaraki (Japan)

    1993-12-31

    The most important greenhouse gas is CO{sub 2} from coal utilization. Ways of mitigating CO{sub 2} emissions include the use of alternative fuels, using renewable resources and increasing the efficiency of power generation and end use. Adding to such greenhouse gas mitigation technologies, post combustion control by removing CO{sub 2} from power station flue gases and then storing or disposing it will be available. Although the post combustion control have to be evaluated in a systematic manner relating them to whether they are presently available technology, to be available in the near future or long term prospects requiring considerable development, it is considered to be a less promising option owing to the high cost and energy penalty. By contrast, abatement technologies aimed at improving conversion efficiency or reducing energy consumption will reduce emissions while having their own commercial justification.

  11. Engineering visualization utilizing advanced animation

    Sabionski, Gunter R.; Robinson, Thomas L., Jr.

    1989-01-01

    Engineering visualization is the use of computer graphics to depict engineering analysis and simulation in visual form from project planning through documentation. Graphics displays let engineers see data represented dynamically which permits the quick evaluation of results. The current state of graphics hardware and software generally allows the creation of two types of 3D graphics. The use of animated video as an engineering visualization tool is presented. The engineering, animation, and videography aspects of animated video production are each discussed. Specific issues include the integration of staffing expertise, hardware, software, and the various production processes. A detailed explanation of the animation process reveals the capabilities of this unique engineering visualization method. Automation of animation and video production processes are covered and future directions are proposed.

  12. Directions in advanced reactor technology

    Golay, M.W.

    1990-01-01

    Successful nuclear power plant concepts must simultaneously performance in terms of both safety and economics. To be attractive to both electric utility companies and the public, such plants must produce economical electric energy consistent with a level of safety which is acceptable to both the public and the plant owner. Programs for reactor development worldwide can be classified according to whether the reactor concept pursues improved safety or improved economic performance as the primary objective. When improved safety is the primary goal, safety enters the solution of the design problem as a constraint which restricts the set of allowed solutions. Conversely, when improved economic performance is the primary goal, it is allowed to be pursued only to an extent which is compatible with stringent safety requirements. The three major reactor coolants under consideration for future advanced reactor use are water, helium and sodium. Reactor development programs focuses upon safety and upon economics using each coolant are being pursued worldwide. These programs are discussed

  13. Utility guidance to advanced LWR designers

    Yedidia, J.M.

    1990-01-01

    The purpose of this paper is to describe the process envisioned for the development of advanced reactors for future use by the utility industry. The role of the potential utility customer is gradually evolving from that of an owner-operator of such plants to that of a sponsor-participant in the actual design process. The author discusses development of a set of utility requirements, intended to describe in detail utility needs and expectations relative to the performance of future reactors. The reactor vendors, who participated actively in the preparation of the requirements documents, pledged to make every effort to meet them in their future designs. At that stage, when the requirements have been finalized and agreed to by all parties involved, including the Nuclear Regulatory Commission, the utilities were expected to move to the sidelines and wait for the reactor vendors to come up with the product

  14. Utility requirements for advanced light water reactors

    Machiels, A.; Gray, S.; Mulford, T.; Rodwell, E.

    1996-01-01

    The nuclear energy industry is actively engaged in developing advanced light water reactor (ALWR) designs for the next century. The new designs take advantage of the thousands of reactor-years of experience that have been accumulated by operating over 400 plants worldwide. The EPRI effort began in the early 1980's, when a survey of utility executives was conducted to determine their prerequisites for ordering nuclear power plants. The results were clear: new plants had to be simpler and safer, and have greater design margins, i.e., be more forgiving. The utility executives also supported making improvements to the established light water reactor technology, rather than trying to develop new reactor concepts. Finally, they wanted the option to build mid-size plants (∼600 MWe) in addition to full-size plants of more than 1200 MWe. 4 refs

  15. Advance directives: survey of primary care patients.

    O'Sullivan, Rory; Mailo, Kevin; Angeles, Ricardo; Agarwal, Gina

    2015-04-01

    To establish the prevalence of patients with advance directives in a family practice, and to describe patients' perspectives on a family doctor's role in initiating discussions about advance directives. A self-administered patient questionnaire. A busy urban family medicine teaching clinic in Hamilton, Ont. A convenience sample of adult patients attending the clinic over the course of a typical business week. The prevalence of advance directives in the patient population was determined, and the patients' expectations regarding the role of their family doctors were elucidated. The survey population consisted of 800 participants (a response rate of 72.5%) well distributed across age groups; 19.7% had written advance directives and 43.8% had previously discussed the topic of advance directives, but only 4.3% of these discussions had occurred with family doctors. In 5.7% of cases, a family physician had raised the issue; 72.3% of respondents believed patients should initiate the discussion. Patients who considered advance directives extremely important were significantly more likely to want their family doctors to start the conversation (odds ratio 3.98; P < .05). Advance directives were not routinely addressed in the family practice. Most patients preferred to initiate the discussion of advance directives. However, patients who considered the subject extremely important wanted their family doctors to initiate the discussion. Copyright© the College of Family Physicians of Canada.

  16. Research opportunities to advance solar energy utilization.

    Lewis, Nathan S

    2016-01-22

    Major developments, as well as remaining challenges and the associated research opportunities, are evaluated for three technologically distinct approaches to solar energy utilization: solar electricity, solar thermal, and solar fuels technologies. Much progress has been made, but research opportunities are still present for all approaches. Both evolutionary and revolutionary technology development, involving foundational research, applied research, learning by doing, demonstration projects, and deployment at scale will be needed to continue this technology-innovation ecosystem. Most of the approaches still offer the potential to provide much higher efficiencies, much lower costs, improved scalability, and new functionality, relative to the embodiments of solar energy-conversion systems that have been developed to date. Copyright © 2016, American Association for the Advancement of Science.

  17. [Theological moral considerations of advance directives].

    Virt, G

    1997-01-01

    The forms for advanced directives vary considerably in respect to content and wording. This article intends to develop ethical criteria for such texts, from the moraltheological point of view, also considering the social context.

  18. Preferences for Advance Directives in Korea

    So-Sun Kim

    2012-01-01

    Full Text Available Background. The goal of advance directives is to help patients retain their dignity and autonomy by making their own decisions regarding end-stage medical treatment. The purpose of this study was to examine preferences of advance directives among general population in Korea. Method. A descriptive cross-sectional survey was performed from October 2007 to June 2008 in Seoul, Korea. A total of 336 city-dwelling adults self-administered the questionnaire and returned it via mail. Data analyses were conducted using SPSS 17.0. Results. Subjects reported the need for healthcare providers' detailed explanations and recommendations regarding end-of-life care. When there is no hope of recovery and death is imminent, most subjects did not want to receive cardiopulmonary resuscitation nor an IV or tube feeding. However, most of the subjects wanted pain management care. Conclusions. The present study showed that many Korean people have an interest in advance directives. The results show that the autonomy and dignity of patient have increased in importance. To provide better end-of-life care, there is a need to educate patients on the definition and intent of an advance directive. Additional proactive communication between patients and their caregivers should be educated to healthcare providers.

  19. Utility requirements for advanced LWR passive plants

    Yedidia, J.M.; Sugnet, W.R.

    1992-01-01

    LWR Passive Plants are becoming an increasingly attractive and prominent option for future electric generating capacity for U.S. utilities. Conceptual designs for ALWR Passive Plants are currently being developed by U.S. suppliers. EPRI-sponsored work beginning in 1985 developed preliminary conceptual designs for a passive BWR and PWR. DOE-sponsored work from 1986 to the present in conjunction with further EPRI-sponsored studies has continued this development to the point of mature conceptual designs. The success to date in developing the ALWR Passive Plant concepts has substantially increased utility interest. The EPRI ALWR Program has responded by augmenting its initial scope to develop a Utility Requirements Document for ALWR Passive Plants. These requirements will be largely based on the ALWR Utility Requirements Document for Evolutionary Plants, but with significant changes in areas related to the passive safety functions and system configurations. This work was begun in late 1988, and the thirteen-chapter Passive Plant Utility Requirements Document will be completed in 1990. This paper discusses the progress to date in developing the Passive Plant requirements, reviews the top-level requirements, and discusses key issues related to adaptation of the utility requirements to passive safety functions and system configurations. (orig.)

  20. A Randomized Controlled Trial Comparing the Letter Project Advance Directive to Traditional Advance Directive.

    Periyakoil, Vyjeyanthi S; Neri, Eric; Kraemer, Helena

    2017-09-01

    Simpler alternatives to traditional advance directives that are easy to understand and available in multiple formats and can be initiated by patients and families will help facilitate advance care planning. The goal of this study was to compare the acceptability of the letter advance directive (LAD) to the traditional advance directive (TAD) of the state of California. A web-based, randomized controlled trial was conducted, in which the participants were randomized to one of two types of advance directives (ADs): the LAD (intervention) or the TAD (control). Primary outcomes were participant ratings of the ease, value, and their level of comfort in the AD document they completed. A total of 400 participants completed the study, with 216 randomized to the LAD and 184 to the TAD by a computerized algorithm. Overall, participants preferred the LAD to the TAD (success rate difference [SRD] = 0.46, 95th percentile confidence interval [CI]: 0.36-0.56, p advance directive to be a better alternative to the traditional advance directive form.

  1. [Advance directives, a tool to humanize care].

    Olmari-Ebbing, M; Zumbach, C N; Forest, M I; Rapin, C H

    2000-07-01

    The relationship between the patient and a medical care giver is complex specially as it implies to the human, juridical and practical points of view. It depends on legal and deontological considerations, but also on professional habits. Today, we are confronted to a fundamental modification of this relationship. Professional guidelines exist, but are rarely applied and rarely taught in universities. However, patients are eager to move from a paternalistic relationship to a true partnership, more harmonious and more respectful of individual values ("value based medicine"). Advance directives give us an opportunity to improve our practices and to provide care consistent with the needs and wishes of each patient.

  2. Immunotherapy for advanced melanoma: future directions.

    Valpione, Sara; Campana, Luca G

    2016-02-01

    As calculated by the meta-analysis of Korn et al., the prognosis of metastatic melanoma in the pretarget and immunological therapy era was poor, with a median survival of 6.2 and a 1-year life expectancy of 25.5%. Nowadays, significant advances in melanoma treatment have been gained, and immunotherapy is one of the promising approaches to get to durable responses and survival improvement. The aim of the present review is to highlight the recent innovations in melanoma immunotherapy and to propose a critical perspective of the future directions of this enthralling oncology subspecialty.

  3. Geysers advanced direct contact condenser research

    Henderson, J.; Bahning, T.; Bharathan, D.

    1997-12-31

    The first geothermal application of the Advanced Direct Contact Condenser (ADCC) technology developed by the National Renewable Energy Laboratory (NREL) is now operational and is being tested at The Geysers Power Plant Unit 11. This major research effort is being supported through the combined efforts of NREL, The Department of Energy (DOE), and Pacific Gas and Electric (PG&E). NREL and PG&E have entered into a Cooperative Research And Development Agreement (CRADA) for a project to improve the direct-contact condenser performance at The Geysers Power Plant. This project is the first geothermal adaptation of an advanced condenser design developed for the Ocean Thermal Energy Conversion (OTEC) systems. PG&E expects this technology to improve power plant performance and to help extend the life of the steam field by using steam more efficiently. In accordance with the CRADA, no money is transferred between the contracting parties. In this case the Department of Energy is funding NREL for their efforts in this project and PG&E is contributing funds in kind. Successful application of this technology at The Geysers will provide a basis for NREL to continue to develop this technology for other geothermal and fossil power plant systems.

  4. Older adult opinions of "advance driving directives".

    Betz, Marian E; Lowenstein, Steven R; Schwartz, Robert

    2013-01-01

    Discussions about driving cessation are difficult. "Advance driving directives" (ADDs), like advance directives for end-of-life care, would allow drivers to designate someone to help make driving decisions for them in the future. It is not known if older drivers support the concept of ADDs. Cross-sectional study of a convenience sample of English-speaking drivers (55+ years) at 2 independent living facilities and 2 community centers who completed anonymous surveys. Of 168 participants, 80% were female; the median age was 76.5 years (range = 56-93 years). Most (74%) drove daily or almost daily, and 7% reported a crash in the past year. Few had spoken with someone about driving safety (5%) or their wishes when driving skills decline (21%). Of the few who had discussed this topic, 83% had spoken with a family member; only 17% had spoken with a health care provider. However, participants were open to driving discussions, and 54% said they would be willing to complete an ADD if recommended. Of these, 79% said it was "likely" or "very likely" they would comply with the directive in the future. Most (73%) supported mandatory, age-based retesting; the median recommended testing age suggested was 80 years. More participants thought the driver (71%), a family member (61%), or a physician (59%) should determine license revocation for an unsafe driver, rather than the department of motor vehicles (32%). Many older drivers may be open to discussing their driving plans with physicians and family members. ADDs may facilitate these discussions in the present and help define driving-related wishes in the future.

  5. Direct Cardiac Reprogramming: Advances in Cardiac Regeneration

    Olivia Chen

    2015-01-01

    Full Text Available Heart disease is one of the lead causes of death worldwide. Many forms of heart disease, including myocardial infarction and pressure-loading cardiomyopathies, result in irreversible cardiomyocyte death. Activated fibroblasts respond to cardiac injury by forming scar tissue, but ultimately this response fails to restore cardiac function. Unfortunately, the human heart has little regenerative ability and long-term outcomes following acute coronary events often include chronic and end-stage heart failure. Building upon years of research aimed at restoring functional cardiomyocytes, recent advances have been made in the direct reprogramming of fibroblasts toward a cardiomyocyte cell fate both in vitro and in vivo. Several experiments show functional improvements in mouse models of myocardial infarction following in situ generation of cardiomyocyte-like cells from endogenous fibroblasts. Though many of these studies are in an early stage, this nascent technology holds promise for future applications in regenerative medicine. In this review, we discuss the history, progress, methods, challenges, and future directions of direct cardiac reprogramming.

  6. The Texas Advanced Directive Law: Unfinished Business.

    Kapottos, Michael; Youngner, Stuart

    2015-01-01

    The Texas Advance Directive Act allows physicians and hospitals to overrule patient or family requests for futile care. Purposefully not defining futility, the law leaves its determination in specific cases to an institutional process. While the law has received several criticisms, it does seem to work constructively in the cases that come to the review process. We introduce a new criticism: While the law has been justified by an appeal to professional values such as avoiding harm to patients, avoiding the provision of unseemly care, and good stewardship of medical resources, it is applied incompletely. It allows physicians and institutional committees to refuse "futile" treatments desired by patients and families while at the same time providing no way of regulating physicians who recommend or even push "futile" treatments in similar cases. In this sense, the TADA is incomplete on its own terms.

  7. Utility Leadership in Defining Requirements for Advanced Light Water Reactors

    Sugnet, William R.; Layman, William H.

    1990-01-01

    It is appropriate, based on twenty five years of operating experience, that utilities take a position of leadership in developing the technical design and performance requirements for the next generations of nuclear electric generating plants. The U. S. utilities, through the Electric Power Research Institute, began an initiative in 1985 to develop such Utility requirements. Many international Utility organizations, including Korea Electric Power Corporation, have joined as full participants in this important Utility industry initiative. In light of the closer linkage among countries of the world due to rapid travel and telecommunications, it is also appropriate that there be international dialogue and agreement on the principal standards for nuclear power plant acceptability and performance. The Utility/EPRI Advanced Light Water Reactor Program guided by the ALRR Utility Steering Committee has been very successful in developing these Utility requirements. This paper will summarize the state of development of the ALRR Utility Requirements for Evolutionary Plants, recent developments in their review by the U. S. Nuclear Regulatory Commission, resolution of open issues, and the extension of this effort to develop a companion set of ALRR Utility Requirements for plants employing passive safety features

  8. Direct utilization of geothermal energy: a technical handbook

    Anderson, D.N; Lund, J.W. (eds.)

    1979-01-01

    This technical handbook includes comprehensive discussions on nature and occurrence of the geothermal resource, its development, utilization, economics, financing, and regulation. Information on pricing parameters for the direct use of geothermal energy is included as an appendix. (MRH)

  9. Utility industry evaluation of the Sodium Advanced Fast Reactor

    Burstein, S.; DelGeorge, L.O.; Tramm, T.R.; Gibbons, J.P.; High, M.D.; Neils, G.H.; Pilmer, D.F.; Tomonto, J.R.; Wells, J.T.

    1990-02-01

    A team of utility industry representatives evaluated the Sodium Advanced Fast Reactor plant design, a current liquid metal reactor design created by an industrial team led by Rockwell International under Department of Energy sponsorship. The utility industry team concluded that the plant design offers several attractive characteristics, especially in the safety arena, as well as preserving the traditional attraction of liquid metal reactors, very high fuel utilization. Specific comments and recommendations are provided as a contribution towards improving an already attractive plant design. 18 refs

  10. Canadian advanced life support capacities and future directions

    Bamsey, M.; Graham, T.; Stasiak, M.; Berinstain, A.; Scott, A.; Vuk, T. Rondeau; Dixon, M.

    2009-07-01

    Canada began research on space-relevant biological life support systems in the early 1990s. Since that time Canadian capabilities have grown tremendously, placing Canada among the emerging leaders in biological life support systems. The rapid growth of Canadian expertise has been the result of several factors including a large and technically sophisticated greenhouse sector which successfully operates under challenging climatic conditions, well planned technology transfer strategies between the academic and industrial sectors, and a strong emphasis on international research collaborations. Recent activities such as Canada's contribution of the Higher Plant Compartment of the European Space Agency's MELiSSA Pilot Plant and the remote operation of the Arthur Clarke Mars Greenhouse in the Canadian High Arctic continue to demonstrate Canadian capabilities with direct applicability to advanced life support systems. There is also a significant latent potential within Canadian institutions and organizations with respect to directly applicable advanced life support technologies. These directly applicable research interests include such areas as horticultural management strategies (for candidate crops), growth media, food processing, water management, atmosphere management, energy management, waste management, imaging, environment sensors, thermal control, lighting systems, robotics, command and data handling, communications systems, structures, in-situ resource utilization, space analogues and mission operations. With this background and in collaboration with the Canadian aerospace industry sector, a roadmap for future life support contributions is presented here. This roadmap targets an objective of at least 50% food closure by 2050 (providing greater closure in oxygen, water recycling and carbon dioxide uptake). The Canadian advanced life support community has chosen to focus on lunar surface infrastructure and not low Earth orbit or transit systems (i.e. microgravity

  11. Direct Heat Utilization of Geothermal Resources Worldwide 2005

    Lund, John W.

    2000-01-01

    Direct utilization of geothermal energy consists of various forms for heating and cooling instead of converting the energy for electric power generation. The geothermal resources that can be utilized are in the lower temperature range that are more wide-spread than the higher temperature resources used for electricity generation. The major areas of direct utilization are: heating of swimming pools and for balneology; space heating and cooling including district heating; agriculture applications (greenhouse heating and crop drying); aquaculture applications; industrial processing; and geothermal heat pumps. Direct utilization projects are reported in 72 countries with an installed capacity of 28,268 MWt and annual energy use of 273,372 TJ (75,943 GWh) reported in 2005. The equivalent annual savings in fuel oil amounts to 170 million barrels (25.4 million tonnes) and 24 million tonnes in carbon emissions to the atmosphere. Recent trends are to combined geothermal heat and power projects in order to maximize the use of the resource and improve the economics of the project. With the recent increases in fossil fuel prices, it is estimated that direct utilizations will more than double in the next 10 years.

  12. Utility guide to advanced UT systems for PSI and ISI

    Anon.

    1987-01-01

    The number of automated UT inspection systems and techniques, currently in the marketplace or being developed, has grown in recent years to the point where a utility engineer reviewing this field is faced with a major task in trying to decide what inspection technique and system will meet his inspection requirements. Recognizing the utility engineer's problem, EPRI initiated this project to produce a utility engineer's guide to advanced, automated UT systems. Of principal concern are those that have been recently introduced, and designed for problem areas such as BWR piping. Older automated scanning systems, used primarily for pressure vessel inspection, are not being ignored, but are not covered here. Costs, benefits and inspection time are addressed for several systems in this report

  13. African Cultural Concept of Death and the Idea of Advance Care Directives.

    Ekore, Rabi Ilemona; Lanre-Abass, Bolatito

    2016-01-01

    An advance care directive is a person's oral or written instructions about his or her future medical care, if he or she becomes unable to communicate. It may be in written or oral form. Africans ordinarily do not encourage the contemplation of death or any discussion about their own or their loved ones' death. According to the African belief system, life does not end with death, but continues in another realm. Becoming an ancestor after death is a desirable goal of every individual, a feat which cannot be achieved if an individual asks for an unnatural death by attempting to utilize advance care directives. Advance care directives are considered to be too individualistic for communitarian societies such as Africa. Coupled with the communitarian nature of African societies are issues such as lack of awareness of advance directives, fear of death and grief, and the African cultural belief system, which are potential barriers to the utilization of advance care directives in the African setting. Hence, the need for culture sensitivity which makes it imperative that patient's family and loved ones are carried along as far as possible, without compromising the autonomy of the patient in question when utilizing advance care directives.

  14. Advance directives and personal identity: what is the problem?

    Furberg, Elisabeth

    2012-02-01

    The personal identity problem expresses the worry that due to disrupted psychological continuity, one person's advance directive could be used to determine the care of a different person. Even ethicists, who strongly question the possibility of the scenario depicted by the proponents of the personal identity problem, often consider it to be a very potent objection to the use of advance directives. Aiming to question this assumption, I, in this paper, discuss the personal identity problem's relevance to the moral force of advance directives. By putting the personal identity argument in relation to two different normative frameworks, I aim to show that whether or not the personal identity problem is relevant to the moral force of advance directives, and further, in what way it is relevant, depends entirely on what normative reasons we have for respecting advance directives in the first place.

  15. Advanced rotary engine components utilizing fiber reinforced Mg castings

    Goddard, D.; Whitman, W.; Pumphrey, R.; Lee, C.-M.

    1986-01-01

    Under a two-phase program sponsored by NASA, the technology for producing advanced rotary engine components utilizing graphite fiber-reinforced magnesium alloy casting is being developed. In Phase I, the successful casting of a simulated intermediate housing was demonstrated. In Phase II, the goal is to produce an operating rotor housing. The effort involves generation of a material property data base, optimization of parameters, and development of wear- and corrosion-resistant cast surfaces and surface coatings. Results to date are described.

  16. A structured review of health utility measures and elicitation in advanced/metastatic breast cancer

    Hao Y

    2016-06-01

    Full Text Available Yanni Hao,1 Verena Wolfram,2 Jennifer Cook2 1Novartis Pharmaceuticals, East Hanover, NJ, USA; 2Adelphi Values, Bollington, UK Background: Health utilities are increasingly incorporated in health economic evaluations. Different elicitation methods, direct and indirect, have been established in the past. This study examined the evidence on health utility elicitation previously reported in advanced/metastatic breast cancer and aimed to link these results to requirements of reimbursement bodies. Methods: Searches were conducted using a detailed search strategy across several electronic databases (MEDLINE, EMBASE, Cochrane Library, and EconLit databases, online sources (Cost-effectiveness Analysis Registry and the Health Economics Research Center, and web sites of health technology assessment (HTA bodies. Publications were selected based on the search strategy and the overall study objectives. Results: A total of 768 publications were identified in the searches, and 26 publications, comprising 18 journal articles and eight submissions to HTA bodies, were included in the evidence review. Most journal articles derived utilities from the European Quality of Life Five-Dimensions questionnaire (EQ-5D. Other utility measures, such as the direct methods standard gamble (SG, time trade-off (TTO, and visual analog scale (VAS, were less frequently used. Several studies described mapping algorithms to generate utilities from disease-specific health-related quality of life (HRQOL instruments such as European Organization for Research and Treatment of Cancer Quality of Life Questionnaire – Core 30 (EORTC QLQ-C30, European Organization for Research and Treatment of Cancer Quality of Life Questionnaire – Breast Cancer 23 (EORTC QLQ-BR23, Functional Assessment of Cancer Therapy – General questionnaire (FACT-G, and Utility-Based Questionnaire-Cancer (UBQ-C; most used EQ-5D as the reference. Sociodemographic factors that affect health utilities, such as age, sex

  17. Advances in direct oxidation methanol fuel cells

    Surampudi, S.; Narayanan, S. R.; Vamos, E.; Frank, H.; Halpert, G.; Laconti, Anthony B.; Kosek, J.; Prakash, G. K. Surya; Olah, G. A.

    1993-01-01

    Fuel cells that can operate directly on fuels such as methanol are attractive for low to medium power applications in view of their low weight and volume relative to other power sources. A liquid feed direct methanol fuel cell has been developed based on a proton exchange membrane electrolyte and Pt/Ru and Pt catalyzed fuel and air/O2 electrodes, respectively. The cell has been shown to deliver significant power outputs at temperatures of 60 to 90 C. The cell voltage is near 0.5 V at 300 mA/cm(exp 2) current density and an operating temperature of 90 C. A deterrent to performance appears to be methanol crossover through the membrane to the oxygen electrode. Further improvements in performance appear possible by minimizing the methanol crossover rate.

  18. Advanced DVI for ECC direct bypass mitigation

    Kwon, Tae-Soon; Song, Chul-Hwa; Baek, Won-Pil

    2009-01-01

    An ECC direct bypass fraction during a late reflood phase of a LBLOCA is strongly dependent on the characteristics of the cross flow and the geometrical configuration of a DVI in the downcomer of a pressurized light water reactor. The important design parameters of a DVI are the elevation, the azimuthal angle, and the separator to prevent a steam-water interaction. An ECC sub-channel to separate or to isolate an ECC water from a high-speed cross flow is one of the important design features to mitigate the ECC bypass phenomena. A dual core barrel cylinder as an ECC flow separator is located between a reactor vessel and a core barrel outer wall in the downcomer annulus. A new narrow gap between the core barrel and the additional dual core barrel plays the role of a downward ECC flow channel or an ECC flow separator in a high-speed cross flow field of the downcomer annulus. The flow zone around a broken cold leg in the downcomer annulus has the role of a high ECC direct bypass due to a strong suction force while the wake zone of a hot leg has the role of an ECC penetration. Thus, the relative azimuthal angle of the DVI nozzle from the broken cold leg is an important design parameter. A large azimuthal angle from a cold leg to a hot leg needs to avoid a high suction flow zone when an ECC water is being injected. The other enhancing mechanism of an ECC penetration is a grooved core barrel which has small rectangular-shaped grooves vertically arranged on the core barrel wall of the reactor vessel downcomer annulus. These grooves have the role for a generation of a vortex induced by a high-speed cross flow. Since the stagnant flow in a lateral direction and rotational vortex provides the pulling force of an ECC drop or film to flow down into the lower downcomer annulus by gravity, the ECC direct bypass fraction is reduced when compared to the current design of a smoothed wall. An open channel of grooves generates a stagnant vortex, while a closed channel of grooves

  19. Recent advances in severe accident technology - direct containment heating in advanced light water reactors

    Fontana, M.H.

    1993-01-01

    The issues affecting high-pressure melt ejection (HPME) and the consequential containment pressurization from direct containment heating (DCH), as they affect advanced light water reactors (ALWRs), specifically advanced pressurized water reactors (APWRs), were reviewed by the U.S. Department of Energy Advanced Reactor Severe Accident Program (ARSAP). Recommendations from ARSAP regarding the design of APWRs to minimize DCH are embodied within the Electric Power Research Institute ALWR Utility Requirements Document, which specifies (a) a large, strong containment; (b) an in-containment refueling water storage tank; (c) a reactor cavity configuration that minimizes energy transport to the containment atmosphere; and (d) a reactor coolant system depressurization system. Experimental and analytical efforts, which have focused on current-generation plants, and analyses for APWRs were reviewed. Although DCH is a subject of continuous research and considerable uncertainties remain, it is the judgment of the ARSAP that reactors complying with the recommended design requirements would have a low probability of early containment failure due to HPME and DCH

  20. Utility advanced turbine systems (ATS) technology readiness testing

    NONE

    2000-09-15

    The overall objective of the Advanced Turbine System (ATS) Phase 3 Cooperative Agreement between GE and the US Department of Energy (DOE) is the development of a highly efficient, environmentally superior, and cost-competitive utility ATS for base-load utility-scale power generation, the GE 7H (60 Hz) combined cycle power system, and related 9H (50 Hz) common technology. The major effort will be expended on detail design. Validation of critical components and technologies will be performed, including: hot gas path component testing, sub-scale compressor testing, steam purity test trials, and rotational heat transfer confirmation testing. Processes will be developed to support the manufacture of the first system, which was to have been sited and operated in Phase 4 but will now be sited and operated commercially by GE. This change has resulted from DOE's request to GE for deletion of Phase 4 in favor of a restructured Phase 3 (as Phase 3R) to include full speed, no load (FSNL) testing of the 7H gas turbine. Technology enhancements that are not required for the first machine design but will be critical for future ATS advances in performance, reliability, and costs will be initiated. Long-term tests of materials to confirm design life predictions will continue. A schematic of the GE H machine is shown.

  1. Clinical utility of ramucirumab in advanced gastric cancer

    Chan MMK

    2015-09-01

    Full Text Available Matthew MK Chan,1,2 Katrin M Sjoquist,1,3 John R Zalcberg4 1NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia; 2Department of Medical Oncology, Central Coast Cancer Centre, Gosford Hospital, Gosford, NSW, Australia; 3Cancer Care Centre, St George Hospital, Sydney, NSW, Australia; 4School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia Abstract: Gastric cancer is currently the third most common cause of cancer deaths worldwide. Prognosis remains poor with most patients presenting with advanced or metastatic disease. A better understanding of angiogenesis has led to the investigation of drugs that inhibit the vascular endothelial growth factor (VEGF pathway including anti-VEGF antibody therapy (eg, bevacizumab, inhibitors of angiogenic receptor tyrosine kinases (eg, sunitinib, sorafenib, apatinib, regorafenib, and inhibitors of vascular endothelial growth factor receptors (VEGFRs (eg, ramucirumab. Ramucirumab, a VEGFR-2 inhibitor, is the first anti-angiogenic agent approved by the US Food and Drug Administration for use in the treatment of advanced gastric cancers. This review will focus on the clinical utility and potential use of ramucirumab in advanced gastric cancer. Keywords: ramucirumab, IMC-1121B, gastric cancer, vascular endothelial growth factor receptor-2, angiogenesis, targeted therapy

  2. Advance Directives in Hospice Healthcare Providers: A Clinical Challenge.

    Luck, George R; Eggenberger, Terry; Newman, David; Cortizo, Jacqueline; Blankenship, Derek C; Hennekens, Charles H

    2017-11-01

    On a daily basis, healthcare providers, especially those dealing with terminally ill patients, such as hospice workers, witness how advance directives help ensure the wishes of patients. They also witness the deleterious consequences when patients fail to document the care they desire at their end of life. To the best of our knowledge there are no data concerning the prevalence of advance directives among hospice healthcare providers. We therefore explored the prevalence and factors influencing completion rates in a survey of hospice healthcare providers. Surveys that included 32 items to explore completion rates, as well as barriers, knowledge, and demographics, were e-mailed to 2097 healthcare providers, including employees and volunteers, at a nonprofit hospice. Of 890 respondents, 44% reported having completed an advance directive. Ethnicity, age, relationship status, and perceived knowledge were all significant factors influencing the completion rates, whereas years of experience or working directly with patients had no effect. Procrastination, fear of the subject, and costs were common reasons reported as barriers. Upon completion of the survey, 43% said they will now complete an advance directive, and 45% will talk to patients and families about their wishes. The majority of hospice healthcare providers have not completed an advance directive. These results are very similar to those for other healthcare providers treating patients with terminal diseases, specifically oncologists. Because, at completion, 43% said that they would now complete an advance directive, such a survey of healthcare providers may help increase completion rates. Copyright © 2017 Elsevier Inc. All rights reserved.

  3. Direct Carbon Fuel Cell System Utilizing Solid Carbonaceous Fuels

    Turgut Gur

    2010-04-30

    This 1-year project has achieved most of its objective and successfully demonstrated the viability of the fluidized bed direct carbon fuel cell (FB-DCFC) approach under development by Direct Carbon technologies, LLC, that utilizes solid carbonaceous fuels for power generation. This unique electrochemical technology offers high conversion efficiencies, produces proportionately less CO{sub 2} in capture-ready form, and does not consume or require water for gasification. FB-DCFC employs a specialized solid oxide fuel cell (SOFC) arrangement coupled to a Boudouard gasifier where the solid fuel particles are fluidized and reacted by the anode recycle gas CO{sub 2}. The resulting CO is electrochemically oxidized at the anode. Anode supported SOFC structures employed a porous Ni cermet anode layer, a dense yttria stabilized zirconia membrane, and a mixed conducting porous perovskite cathode film. Several kinds of untreated solid fuels (carbon and coal) were tested in bench scale FBDCFC prototypes for electrochemical performance and stability testing. Single cells of tubular geometry with active areas up to 24 cm{sup 2} were fabricated. The cells achieved high power densities up to 450 mW/cm{sup 2} at 850 C using a low sulfur Alaska coal char. This represents the highest power density reported in the open literature for coal based DCFC. Similarly, power densities up to 175 mW/cm{sup 2} at 850 C were demonstrated with carbon. Electrical conversion efficiencies for coal char were experimentally determined to be 48%. Long-term stability of cell performance was measured under galvanostatic conditions for 375 hours in CO with no degradation whatsoever, indicating that carbon deposition (or coking) does not pose any problems. Similar cell stability results were obtained in coal char tested for 24 hours under galvanostatic conditions with no sign of sulfur poisoning. Moreover, a 50-cell planar stack targeted for 1 kW output was fabricated and tested in 95% CO (balance CO{sub 2

  4. Toolboxes for cyanobacteria: Recent advances and future direction.

    Sun, Tao; Li, Shubin; Song, Xinyu; Diao, Jinjin; Chen, Lei; Zhang, Weiwen

    2018-05-03

    Photosynthetic cyanobacteria are important primary producers and model organisms for studying photosynthesis and elements cycling on earth. Due to the ability to absorb sunlight and utilize carbon dioxide, cyanobacteria have also been proposed as renewable chassis for carbon-neutral "microbial cell factories". Recent progresses on cyanobacterial synthetic biology have led to the successful production of more than two dozen of fuels and fine chemicals directly from CO 2 , demonstrating their potential for scale-up application in the future. However, compared with popular heterotrophic chassis like Escherichia coli and Saccharomyces cerevisiae, where abundant genetic tools are available for manipulations at levels from single gene, pathway to whole genome, limited genetic tools are accessible to cyanobacteria. Consequently, this significant technical hurdle restricts both the basic biological researches and further development and application of these renewable systems. Though still lagging the heterotrophic chassis, the vital roles of genetic tools in tuning of gene expression, carbon flux re-direction as well as genome-wide manipulations have been increasingly recognized in cyanobacteria. In recent years, significant progresses on developing and introducing new and efficient genetic tools have been made for cyanobacteria, including promoters, riboswitches, ribosome binding site engineering, clustered regularly interspaced short palindromic repeats/CRISPR-associated nuclease (CRISPR/Cas) systems, small RNA regulatory tools and genome-scale modeling strategies. In this review, we critically summarize recent advances on development and applications as well as technical limitations and future directions of the genetic tools in cyanobacteria. In addition, toolboxes feasible for using in large-scale cultivation are also briefly discussed. Copyright © 2018 Elsevier Inc. All rights reserved.

  5. Recent advances in modeling nutrient utilization in ruminants.

    Kebreab, E; Dijkstra, J; Bannink, A; France, J

    2009-04-01

    Mathematical modeling techniques have been applied to study various aspects of the ruminant, such as rumen function, postabsorptive metabolism, and product composition. This review focuses on advances made in modeling rumen fermentation and its associated rumen disorders, and energy and nutrient utilization and excretion with respect to environmental issues. Accurate prediction of fermentation stoichiometry has an impact on estimating the type of energy-yielding substrate available to the animal, and the ratio of lipogenic to glucogenic VFA is an important determinant of methanogenesis. Recent advances in modeling VFA stoichiometry offer ways for dietary manipulation to shift the fermentation in favor of glucogenic VFA. Increasing energy to the animal by supplementing with starch can lead to health problems such as subacute rumen acidosis caused by rumen pH depression. Mathematical models have been developed to describe changes in rumen pH and rumen fermentation. Models that relate rumen temperature to rumen pH have also been developed and have the potential to aid in the diagnosis of subacute rumen acidosis. The effect of pH has been studied mechanistically, and in such models, fractional passage rate has a large impact on substrate degradation and microbial efficiency in the rumen and should be an important theme in future studies. The efficiency with which energy is utilized by ruminants has been updated in recent studies. Mechanistic models of N utilization indicate that reducing dietary protein concentration, matching protein degradability to the microbial requirement, and increasing the energy status of the animal will reduce the output of N as waste. Recent mechanistic P models calculate the P requirement by taking into account P recycled through saliva and endogenous losses. Mechanistic P models suggest reducing current P amounts for lactating dairy cattle to at least 0.35% P in the diet, with a potential reduction of up to 1.3 kt/yr. A model that

  6. UTILITY ADVANCED TURBINE SYSTEMS (ATS) TECHNOLOGY READINESS TESTING

    Unknown

    1999-10-01

    The overall objective of the Advanced Turbine System (ATS) Phase 3 Cooperative Agreement between GE and the U.S. Department of Energy (DOE) is the development of a highly efficient, environmentally superior, and cost-competitive utility ATS for base-load utility-scale power generation, the GE 7H (60 Hz) combined cycle power system, and related 9H (50 Hz) common technology. The major effort will be expended on detail design. Validation of critical components and technologies will be performed, including: hot gas path component testing, sub-scale compressor testing, steam purity test trials, and rotational heat transfer confirmation testing. Processes will be developed to support the manufacture of the first system, which was to have been sited and operated in Phase 4 but will now be sited and operated commercially by GE. This change has resulted from DOE's request to GE for deletion of Phase 4 in favor of a restructured Phase 3 (as Phase 3R) to include full speed, no load (FSNL) testing of the 7H gas turbine. Technology enhancements that are not required for the first machine design but will be critical for future ATS advances in performance, reliability, and costs will be initiated. Long-term tests of materials to confirm design life predictions will continue. A schematic of the GE H machine is shown in Figure 1-1. Information specifically related to 9H production is presented for continuity in H program reporting, but lies outside the ATS program. This report summarizes work accomplished from 4Q98 through 3Q99. The most significant accomplishments are listed.

  7. Recent Advances in High-Performance Direct Methanol Fuel Cells

    Narayanan, S. R.; Chun, W.; Valdez, T. I.; Jeffries-Nakamura, B.; Frank, H.; Surumpudi, S.; Halpert, G.; Kosek, J.; Cropley, C.; La Conti, A. B.; hide

    1996-01-01

    Direct methanol fuel cells for portable power applications have been advanced significantly under DARPA- and ARO-sponsored programs over the last five years. A liquid-feed, direct methanol fuel cell developed under these programs, employs a proton exchange membrane as electrolyte and operates on aqueous solutions of methanol with air or oxygen as the oxidant.

  8. Completing advance directives for health care decisions: getting to yes.

    Shewchuk, T R

    1998-09-01

    The concept of advance directives for health care decision making has been judicially condoned, legislatively promoted, and systematically implemented by health care institutions, yet the execution rate of advance directives remains low. Physicians should discuss with their patients advance care planning generally and end-of-life issues specifically, preferably when patients are in good health and not when they face an acute medical crisis. The physician-hospital relationship poses particular challenges for the optimal implementation of advance directives that must be addressed. Hospital administrators must improve education of patients and physicians on the value of such documents as well as internal mechanisms to ensure better implementation of directives. Health insurance plans may be better able to ensure optimal gathering and implementation of directives. Patients must become more familiar and more comfortable with advance care planning and the reality of death and dying issues. Full acceptance of the value of directives ultimately rests on achieving full participation of all involved--providers, patients, families, and payors--in this most profound process.

  9. Advance directives: the clinical nurse specialist as a change agent.

    Meehan, Karen Anne

    2009-01-01

    The purpose of this article is to describe the impact the clinical nurse specialist (CNS) has on the advance directive process within the cardiac surgery patient population. As a change agent, the CNS needs to be able to increase the number of advance directives obtained and increase the provision of dignified, self-directed, quality patient care. With requirements from The Joint Commission and the Patient Self-determination Act, the change in process must take place to ensure that healthcare professionals are doing all they can do to carry out a patient's wishes. The 6-Source Influencer Model is applied to a case study to illustrate the role of the CNS as a change agent. Following this model, the CNS can facilitate lasting institutional change in the advance directive process. Based on the example, it is possible that a CNS can act as a change agent for other patient populations within the healthcare setting.

  10. Promoting advance directives among African Americans: a faith-based model.

    Bullock, Karen

    2006-02-01

    Studies show that African Americans are less likely than other ethnic groups to complete advance directives. However, what influences African Americans' decisions to complete or not complete advance directives is unclear. Using a faith-based promotion model, 102 African Americans aged 55 years or older were recruited from local churches and community-based agencies to participate in a pilot study to promote advance care planning. Focus groups were used to collect data on participants' preferences for care, desire to make personal choices, values and attitudes, beliefs about death and dying, and advance directives. A standardized interview was used in the focus groups, and the data were organized and analyzed using NUDIST 4 software (QRS Software, Victoria, Australia). Three fourths of the participants refused to complete advance directives. The following factors influenced the participants' decisions about end-of-life care and completion of an advance directive: spirituality; view of suffering, death, and dying; social support networks; barriers to utilization; and mistrust of the health care system. The dissemination of information apprises individuals of their right to self-determine about their care, but educational efforts may not produce a significant change in behavior toward completion of advance care planning. Thus, ongoing efforts are needed to improve the trust that African Americans have in medical and health care providers.

  11. Medicare and Medicaid programs; advance directives--HCFA. Final rule.

    1995-06-27

    This final rule responds to public comments on the March 6, 1992 interim final rule with comment period that amended the Medicare and Medicaid regulations governing provider agreements and contracts to establish requirements for States, hospitals, nursing facilities, skilled nursing facilities, providers of home health care or personal care services, hospice programs and managed care plans concerning advance directives. An advance directive is a written instruction, such as a living will or durable power of attorney for health care, recognized under State law, relating to the provision of health care when an individual's condition makes him or her unable to express his or her wishes. The intent of the advance directives provisions is to enhance an adult individual's control over medical treatment decisions. This rule confirms the interim final rule with several minor changes based on our review and consideration of public comments.

  12. [Are advance directives useful for doctors and what for?].

    Fournier, Véronique; Berthiau, Denis; Kempf, Emmanuelle; d'Haussy, Julie

    2013-06-01

    In France, the law has introduced the possibility to write advance directives since 2005. In this paper, we will present the results of a study designed for checking how much people over 75 years are interested by this new tool. The inquiry consisted in deep qualitative interviews (around 45') to further understand what people included in the study have to say about advance directives, but also about the conditions of ageing and dying. The study sample was composed of 8 over 75 years subgroups, chosen for being illustrative of different health status and/or disabling status. Finally, a last subgroup was also included, called "referent", because composed of people, all members of the "Association pour le droit à mourir dans la dignité" (ADMD), and as such supposed to be pro-advance directives. Interviews content was analysed through qualitative analysis referent methods ("Analyse qualitative en sciences humaines et sociales", Paillé et Muschielli, "Grounded Theory", Glaser). POPULATION OF THE STUDY: One hundred and eighty-six patients were included (106 female, 80 male, mean age 82.7 ans), 167 in the general group and 19 in the "ADMD" group. Ninety percent in the general group said that they never heard about advance directives before the inquiry. After having been informed by us about what advance directives were for, 83% remained not interested they said, some because they felt they were not personally concerned, others expressed that the tool appears to them inefficient - "things never happen the way you planned it", not useful - "doctors will act as they will decide whatever will be written", or even more potentially dangerous - "writing advance directives might lead doctors not to be as much therapeutically aggressive as for other people". Only 28 persons in the general group (17%), together with the 19 of the ADMD group, said they were interested by advance directives. They all were quite similar according to their personal character: they were quite strong

  13. Advance directives as autonomy enhancers: reality or myth?

    Navarro Michel, Mónica

    2015-01-01

    In the last few decades there has been a wealth of literature and legislation on advance directives. As you all know, it is an instrument by which a person can express their wishes as regards what treatment they should be given or, more to the point, not to be given, when he is in a situation when he can not do so himself. Regulations in the western world seem to promote advance directives as a way to enhance patient¿s autonomy in the context of human rights, and the media has presen...

  14. 1998 annual report of advanced combustion science utilizing microgravity

    NONE

    1999-03-01

    For the purpose of stabilizing energy supply, diversifying energy supply sources and reducing the worsening of global environment caused by combustion exhaust gases, advanced combustion technology was studied and the FY 1998 results were summarized. Following the previous year, the following were conducted: international research jointly with NASA, experiments using microgravity test facilities of Japan Space Utilization Promotion Center (JSUP), evaluation studies made by universities/national research institutes/private companies, etc. In the FY 1998 joint study, a total of 52 drop experiments were carried out on 4 themes using test facilities of Japan Microgravity Center (JAMIC), and 100 experiments were conducted on one theme using test facilities of NASA. In the study using microgravity test facilities, the following were carried out: study of combustion and evaporation of fuel droplets, study of ignition/combustion of fuel droplets in the suspending state, study of combustion of spherical/cylinder state liquid fuels, study of high pressure combustion of binary fuel spray, study of interaction combustion of fuel droplets in the microgravity field, etc. (NEDO)

  15. A structured review of health utility measures and elicitation in advanced/metastatic breast cancer.

    Hao, Yanni; Wolfram, Verena; Cook, Jennifer

    2016-01-01

    Health utilities are increasingly incorporated in health economic evaluations. Different elicitation methods, direct and indirect, have been established in the past. This study examined the evidence on health utility elicitation previously reported in advanced/metastatic breast cancer and aimed to link these results to requirements of reimbursement bodies. Searches were conducted using a detailed search strategy across several electronic databases (MEDLINE, EMBASE, Cochrane Library, and EconLit databases), online sources (Cost-effectiveness Analysis Registry and the Health Economics Research Center), and web sites of health technology assessment (HTA) bodies. Publications were selected based on the search strategy and the overall study objectives. A total of 768 publications were identified in the searches, and 26 publications, comprising 18 journal articles and eight submissions to HTA bodies, were included in the evidence review. Most journal articles derived utilities from the European Quality of Life Five-Dimensions questionnaire (EQ-5D). Other utility measures, such as the direct methods standard gamble (SG), time trade-off (TTO), and visual analog scale (VAS), were less frequently used. Several studies described mapping algorithms to generate utilities from disease-specific health-related quality of life (HRQOL) instruments such as European Organization for Research and Treatment of Cancer Quality of Life Questionnaire - Core 30 (EORTC QLQ-C30), European Organization for Research and Treatment of Cancer Quality of Life Questionnaire - Breast Cancer 23 (EORTC QLQ-BR23), Functional Assessment of Cancer Therapy - General questionnaire (FACT-G), and Utility-Based Questionnaire-Cancer (UBQ-C); most used EQ-5D as the reference. Sociodemographic factors that affect health utilities, such as age, sex, income, and education, as well as disease progression, choice of utility elicitation method, and country settings, were identified within the journal articles. Most

  16. Optimal utilization of a breast care advanced practice clinician.

    Russell, Katie W; Mone, Mary C; Serpico, Victoria J; Ward, Cori; Lynch, Joanna; Neumayer, Leigh A; Nelson, Edward W

    2014-12-01

    Incorporation of "lean" business philosophy within health care has the goal of adding value by reducing cost and improving quality. Applying these principles to the role of Advance Practice Clinicians (APCs) is relevant because they have become essential members of the healthcare team. An independent surgical breast care clinic directed by an APC was created with measurements of success to include the following: time to obtain an appointment, financial viability, and patient/APC/MD satisfaction. During the study period, there was a trend toward a decreased median time to obtain an appointment. Monthly APC charges increased from $388 to $30,800. The mean provider satisfaction score by Press Ganey was 96% for the APC and 95.8% for the surgeon. Both clinicians expressed significant satisfaction with clinic development. Overall, initiation of an APC breast clinic met the proposed goals of success. The use of lean philosophy demonstrates that implementation of change can result in added value in patient care. Copyright © 2014 Elsevier Inc. All rights reserved.

  17. Protecting me from my Directive: Ensuring Appropriate Safeguards for Advance Directives in Dementia.

    Auckland, Cressida

    2018-02-01

    With one in six people over 80 now suffering from dementia, advance directives provide an important means of empowerment. Upholding directives in the context of dementia, however, raises extra challenges, given the potential for the directive to conflict with an assessment of what is in the person's current best interests. Given the profound harm that tying a person with dementia to their previous wishes can do, it is essential that we have sufficient safeguards in place to ensure that we only uphold such directives where we can be sure they are truly autonomous and are intended to apply to the situation at hand-safeguards which are at present, severely lacking. This article will consider various mechanisms by which safeguards can be built into the legal regime to ensure that the original decision is autonomous, including making it mandatory for the person to undergo a consultation with a healthcare professional, which would involve a contemporaneous capacity assessment. Clinicians must also be confident that the directive applies to the situation at hand. Introducing formalities, including a standardised (though not mandatory) proforma, may help to enhance specificity about when the directive is triggered, and to what treatments it relates, to enable clinicians to better assess the directive's applicability. A national registry for advance directives might also be beneficial. It will be argued that health care professionals will have to play a much greater role in the drafting and registering of advance directives, if we are to feel comfortable in upholding them.

  18. Advanced Utility Mercury-Sorbent Field-Testing Program

    Ronald Landreth

    2007-12-31

    This report summarizes the work conducted from September 1, 2003 through December 31, 2007 on the project entitled Advanced Utility Mercury-Sorbent Field-Testing Program. The project covers the testing at the Detroit Edison St. Clair Plant and the Duke Power Cliffside and Buck Stations. The St. Clair Plant used a blend of subbituminous and bituminous coal and controlled the particulate emissions by means of a cold-side ESP. The Duke Power Stations used bituminous coals and controlled their particulate emissions by means of hot-side ESPs. The testing at the Detroit Edison St. Clair Plant demonstrated that mercury sorbents could be used to achieve high mercury removal rates with low injection rates at facilities that burn subbituminous coal. A mercury removal rate of 94% was achieved at an injection rate of 3 lb/MMacf over the thirty day long-term test. Prior to this test, it was believed that the mercury in flue gas of this type would be the most difficult to capture. This is not the case. The testing at the two Duke Power Stations proved that carbon- based mercury sorbents can be used to control the mercury emissions from boilers with hot-side ESPs. It was known that plain PACs did not have any mercury capacity at elevated temperatures but that brominated B-PAC did. The mercury removal rate varies with the operation but it appears that mercury removal rates equal to or greater than 50% are achievable in facilities equipped with hot-side ESPs. As part of the program, both sorbent injection equipment and sorbent production equipment was acquired and operated. This equipment performed very well during this program. In addition, mercury instruments were acquired for this program. These instruments worked well in the flue gas at the St. Clair Plant but not as well in the flue gas at the Duke Power Stations. It is believed that the difference in the amount of oxidized mercury, more at Duke Power, was the difference in instrument performance. Much of the equipment was

  19. Strategic directions and actions for advanced practice nursing in China

    Martha N. Hill

    2017-01-01

    Full Text Available There is a need and opportunity for China to develop education and practice innovations given that advance practice nurses (APNs improve health care and outcomes. The China Medical Board (CMB China Nursing Network (CCNN began planning for an Advanced Nursing Practice Program for education and career development that will facilitate CCNN's contributions to meeting national nursing policy priorities. This paper presents the discussion, recommendations and action plans developed at the inaugural planning meeting on June 26, 2015 at Fudan University in Shanghai. The recommendations are: Develop standards for advanced nursing practice; Develop Master's level curricula based on the standards; Commence pilot projects across a number of University affiliated hospitals; and Prepare clinical tutors and faculty. The strategic directions and actions are: Develop a clinical career ladder system; Expand the nursing role from hospital to community; and Build a specialty nurse accreditation system.

  20. Recent advances in the utilization and the irradiation technology of the refurbished BR2 reactor

    Dekeyser, J.; Benoit, P.; Decloedt, C.; Pouleur, Y.; Verwimp, A.; Weber, M.; Vankeerberghen, M.; Ponsard, B.

    1999-01-01

    Operation and utilization of the materials testing reactor BR2 at the Belgian Nuclear Research Centre (SCK·CEN) has since its start in 1963 always followed closely the needs and developments of nuclear technology. In particular, a multitude of irradiation experiments have been carried out for most types of nuclear power reactors, existing or under design. Since the early 1990s and increased focus was directed towards more specific irradiation testing needs for light water reactor fuels and materials, although other areas of utilization continued as well (e.g. fusion reactor materials, safety research, ...), including also the growing activities of radioisotope production and silicon doping. An important milestone was the decision in 1994 to implement a comprehensive refurbishment programme for the BR2 reactor and plant installations. The scope of this programme comprised very substantial studies and hardware interventions, which have been completed in early 1997 within planning and budget. Directly connected to this strategic decision for reactor refurbishment was the reinforcement of our efforts to requalify and upgrade the existing irradiation facilities and to develop advanced devices in BR2 to support emerging programs in the following fields: - LWR pressure vessel steel, - LWR irradiation assisted stress corrosion cracking (IASCC), - reliability and safety of high-burnup LWR fuel, - fusion reactor materials and blanket components, - fast neutron reactor fuels and actinide burning, - extension and diversification of radioisotope production. The paper highlights these advances in the areas of BR2 utilisation and the ongoing development activities for the required new generation of irradiations devices. (author)

  1. Law on advance health care directives: a medical perspective.

    Di Luca, A; Del Rio, A; Bosco, M; Di Luca, N M

    2018-01-01

    The paper's authors aim to elaborate on law 22 dicembre 2017, n. 219 , designed to regulate informed consent practices and advance health care directives", which has sparked a passionate debate centered on the substantial innovation achieved over the past decades in bio-medical science and at the same time, the noteworthy accomplishments made in enforcing human and personal rights. Within the paper, article three is delved into, which covers the creation of the so-called DAT ("Disposizioni anticipate di trattamento", advance health care directives), by which patients, in light of possible future incapacity to choose, can express their convictions and decisions on how to be treated and their consent or dissent to undergo treatments and procedures, including artificial nutrition and hydration. The authors peruse the new law's provisions through a medical perspective, and observe how they are heavily tilted towards patient choice, thus making doctors little more than mere tools of such decisions.

  2. Direct electroplating of plastic for advanced electrical applications

    Islam, Aminul; Hansen, Hans Nørgaard; Tang, Peter Torben

    2017-01-01

    Electrodeposition or electroplating is predominantly applied to metallic components. Electroplating of plastics is possible in some cases where an initial electroless plating layer of nickel or copper is made to provide a conductive surface on the plastic part. This paper proposes a method...... for direct electroplating of plastic eliminating the need for slow and expensive processes like electroless metal deposition, PVD coating, painting with conductive inks etc. The results obtained from the test demonstrate the potential of direct electroplating of plastic to enhance the electrical conductivity...... and the use of electroplated plastics for advanced applications like Moulded Interconnect Devices (MIDs)....

  3. Advance Directives and Powers of Attorney in Intensive Care Patients.

    de Heer, Geraldine; Saugel, Bernd; Sensen, Barbara; Rübsteck, Charlotte; Pinnschmidt, Hans O; Kluge, Stefan

    2017-06-05

    Advance directives and powers of attorney are increasingly common, yet data on their use in clinical situations remain sparse. In this single center cross-sectional study, we collected data by questionnaire from 1004 intensive care patients in a university hospital. The frequencies of advance directives and powers of attorney were determined, and the factors affecting them were studied with multivariate logistic regression analysis. Usable data were obtained from 998 patients. 51.3% stated that they had prepared a document of at least one of these two kinds. Among them, 39.6% stated that they had given the relevant document(s) to the hospital, yet such documents were present in the patient's hospital record for only 23%. 508 patients stated their reasons for preparing an advance directive or a power of attorney: the most common reason (48%) was the fear of being at other people's mercy, of the lack of self-determination, or of medical overtreatment. The most important factors associated with a patient's statement that he/she had prepared such a document were advanced age (advance directive: 1.022 [1.009; 1.036], p = 0.001; power of attorney: 1.027 [1.014; 1.040], padvance directive: 1.622 [1.138; 2.311], padvance directives and 44.1% of the powers of attorney that were present in the hospital records were poorly interpretable because of the incomplete filling-out of preprinted forms. Half of the patients who did not have such a document had already thought of preparing one, but had not yet done so. For patients hospitalized in intensive care units, there should be early discussion about the presence or absence of documents of these kinds and early evaluation of the patient's concrete wishes in critical situations. Future studies are needed to determine how best to assure that these documents will be correctly prepared and then given over to hospital staff so that they can take their place in the patient's record.

  4. Advance directives and outcomes of surrogate decision making before death.

    Silveira, Maria J; Kim, Scott Y H; Langa, Kenneth M

    2010-04-01

    Recent discussions about health care reform have raised questions regarding the value of advance directives. We used data from survey proxies in the Health and Retirement Study involving adults 60 years of age or older who had died between 2000 and 2006 to determine the prevalence of the need for decision making and lost decision-making capacity and to test the association between preferences documented in advance directives and outcomes of surrogate decision making. Of 3746 subjects, 42.5% required decision making, of whom 70.3% lacked decision-making capacity and 67.6% of those subjects, in turn, had advance directives. Subjects who had living wills were more likely to want limited care (92.7%) or comfort care (96.2%) than all care possible (1.9%); 83.2% of subjects who requested limited care and 97.1% of subjects who requested comfort care received care consistent with their preferences. Among the 10 subjects who requested all care possible, only 5 received it; however, subjects who requested all care possible were far more likely to receive aggressive care as compared with those who did not request it (adjusted odds ratio, 22.62; 95% confidence interval [CI], 4.45 to 115.00). Subjects with living wills were less likely to receive all care possible (adjusted odds ratio, 0.33; 95% CI, 0.19 to 0.56) than were subjects without living wills. Subjects who had assigned a durable power of attorney for health care were less likely to die in a hospital (adjusted odds ratio, 0.72; 95% CI, 0.55 to 0.93) or receive all care possible (adjusted odds ratio, 0.54; 95% CI, 0.34 to 0.86) than were subjects who had not assigned a durable power of attorney for health care. Between 2000 and 2006, many elderly Americans needed decision making near the end of life at a time when most lacked the capacity to make decisions. Patients who had prepared advance directives received care that was strongly associated with their preferences. These findings support the continued use of advance

  5. [Can the vascular specialist improve patient awareness about advanced directives?].

    Sanson, H; Priollet, P

    2016-05-01

    In France, the Leonetti law, adopted on April 22, 2005, stipulates the regulations concerning advanced directives. This is a patient's right that is not well known and rarely applied. In 2015, a new law project was thus presented in which the French National Authority for Health recommended that doctors, including all specialists, bring up the subject, especially during consultation. To evaluate the vascular specialist's possibility to mention the topic of advanced directives during consultations. A single and non-interventional prospective study conducted with the help of patients who consulted a private practitioner vascular specialist: recurrent patients regularly consulting a private practitioner vascular specialist were included. First-time consultants, minors and patients to whom it was not adapted to speak about the subject were not included. Between July 27 and September 23, 2015, 159 consecutive patients were examined. Fifty-five first-time consultants and four patients for whom the interview was unsuitable were excluded. In all, 100 patients were questioned. None of them refused to talk about the subject. Women made up a majority of the population (63 %) with an average age of 67 years (23-97). The principal diagnostics were common to vascular medicine consultations: deep vein thrombosis (20 %), peripheral arterial disease (15 %), varicose veins (11 %), lymphedema (11 %) and leg ulcers (9 %). Thirteen percent of the people had a history of cancer. Half of the patients had had follow-ups for over 10 years. The average time devoted to discussing the topic was 12minutes (5-40). Only 22 % of the patients declared having been familiar with advance directives. Once informed however, 78 % chose to write up an adapted form: 36 % with the help of their doctor and 42 % with a doctor and a relative. Seventy-three percent of the consultants thought that talking about the advance directives would reinforce the confidence link between the doctor and the

  6. Advanced fuel system technology for utilizing broadened property aircraft fuels

    Reck, G. M.

    1980-01-01

    Possible changes in fuel properties are identified based on current trends and projections. The effect of those changes with respect to the aircraft fuel system are examined and some technological approaches to utilizing those fuels are described.

  7. Directions for advanced use of nuclear power in century XXI

    Walter, C.E.

    1999-01-01

    Nuclear power can provide a significant contribution to electricity generation and meet other needs of the world and the US during the next century provided that certain directions are taken to achieve its public acceptance. These directions include formulation of projections of population, energy consumption, and energy resources over a responsible period of time. These projections will allow assessment of cumulative effects on the environment and on fixed resources. Use of fossil energy resources in a century of growing demand for energy must be considered in the context of long-term environmental damage and resource depletion. Although some question the validity of these consequences, they can be mitigated by use of advanced fast reactor technology. It must be demonstrated that nuclear power technology is safe, resistant to material diversion for weapon use, and economical. An unbiased examination of all the issues related to energy use, especially of electricity, is an essential direction to take

  8. Advanced materials for alternative fuel capable directly fired heat engines

    Fairbanks, J.W.; Stringer, J. (eds.)

    1979-12-01

    The first conference on advanced materials for alternative fuel capable directly fired heat engines was held at the Maine Maritime Academy, Castine, Maine. It was sponsored by the US Department of Energy, (Assistant Secretary for Fossil Energy) and the Electric Power Research Institute, (Division of Fossil Fuel and Advanced Systems). Forty-four papers from the proceedings have been entered into EDB and ERA and one also into EAPA; three had been entered previously from other sources. The papers are concerned with US DOE research programs in this area, coal gasification, coal liquefaction, gas turbines, fluidized-bed combustion and the materials used in these processes or equipments. The materials papers involve alloys, ceramics, coatings, cladding, etc., and the fabrication and materials listing of such materials and studies involving corrosion, erosion, deposition, etc. (LTN)

  9. Technological advances in site-directed spin labeling of proteins.

    Hubbell, Wayne L; López, Carlos J; Altenbach, Christian; Yang, Zhongyu

    2013-10-01

    Molecular flexibility over a wide time range is of central importance to the function of many proteins, both soluble and membrane. Revealing the modes of flexibility, their amplitudes, and time scales under physiological conditions is the challenge for spectroscopic methods, one of which is site-directed spin labeling EPR (SDSL-EPR). Here we provide an overview of some recent technological advances in SDSL-EPR related to investigation of structure, structural heterogeneity, and dynamics of proteins. These include new classes of spin labels, advances in measurement of long range distances and distance distributions, methods for identifying backbone and conformational fluctuations, and new strategies for determining the kinetics of protein motion. Copyright © 2013 Elsevier Ltd. All rights reserved.

  10. Recent advances in modeling nutrient utilization in ruminants1

    Kebreab, E.; Dijkstra, J.; Bannink, A.; France, J.

    2009-01-01

    Mathematical modeling techniques have been applied to study various aspects of the ruminant, such as rumen function, post-absorptive metabolism and product composition. This review focuses on advances made in modeling rumen fermentation and its associated rumen disorders, and energy and nutrient

  11. [Advance directives in clinical practice : Living will, healthcare power of attorney and care directive].

    Hack, J; Buecking, B; Lopez, C L; Ruchholtz, S; Kühne, C A

    2017-06-01

    In clinical practice, situations continuously occur in which medical professionals and family members are confronted with decisions on whether to extend or limit treatment for severely ill patients in end of life treatment decisions. In these situations, advance directives are helpful tools in decision making according to the wishes of the patient; however, not every patient has made an advance directive and in our experience medical staff as well as patients are often not familiar with these documents. The purpose of this article is therefore to explain the currently available documents (e.g. living will, healthcare power of attorney and care directive) and the possible (legal) applications and limitations in the routine clinical practice.

  12. Psychiatric Advance Directives in India: What will the future hold?

    Ratnam, Ashutosh; Rudra, Abhijit; Chatterjee, K; Das, R C

    2015-08-01

    Psychiatric Advance Directives (PADs) have been incorporated into India's Mental Health Care Bill, 2013. This is the first time any form of Advance Directive stands to receive legal sanction in India. PADs have numerous theoretical and empirically tenable therapeutic and financial advantages. Western experiences have shown high acceptance for the concept among psychiatric patients, and illustrated that most stable patients with severe mental illness retain the capacity to frame PADs consistent with community practice standards. However active psychopathology does impair this capacity, and therein, current subjective assessments of competence performed by Physicians without objective instruments are often inaccurate. Though PADs champion patient autonomy, when applied and studied, they have shown little significant advantage-there is currently not enough data to support evidence-based universal recommendations for PADs. PADs as incorporated into the Mental Health Care Bill model on existing Western statutes, and though many of the strengths of earlier systems have been subsumed, so have several of the shortcomings. The risks, benefits and applicability of PADs in India are complicated by the social re-calibration of patient autonomy, mental-healthcare delivery system weaknesses, and the relatively peripheral role the Psychiatrist is mandated to play in the entire advance directive process. Treating patients within the framework of their pre-stated wishes will be a much more intricate and arduous task than most of modern Psychiatric practice in India, but the difficulties, obstacles and inevitable failures encountered will provide evidence of the delivery system's weaknesses and thereby contribute to its strength. Copyright © 2015 Elsevier B.V. All rights reserved.

  13. Utilization management in radiology, part 2: perspectives and future directions.

    Duszak, Richard; Berlin, Jonathan W

    2012-10-01

    Increased utilization of medical imaging in the early part of the last decade has resulted in numerous efforts to reduce associated spending. Recent initiatives have focused on managing utilization with radiology benefits managers and real-time order entry decision support systems. Although these approaches might seem mutually exclusive and their application to radiology appears unique, the historical convergence and broad acceptance of both programs within the pharmacy sector may offer parallels for their potential future in medical imaging. In this second installment of a two-part series, anticipated trends in radiology utilization management are reviewed. Perspectives on current and future potential roles of radiologists in such initiatives are discussed, particularly in light of emerging physician payment models. Copyright © 2012 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  14. [Psychiatric advance directives and the role of autonomy].

    Ambrosini, Daniel L; Crocker, Anne G

    2009-01-01

    Although psychiatric advance directives (PADs) are grounded in the ethics of autonomy, the relationship between the two is unclear. PADs are legal documents that allow individuals with mental illness to record their treatment preferences should they become incompetent in the future. The relationship between autonomy and PADs has been discussed in ethical, legal, and philosophical terms, but has not been clearly operationalized for clinical purposes. Autonomy is a fundamental ethical value that includes having the independence from outside controlling influences and the mental capacity to direct one's personal actions. Individuals with mental illness sometimes require assistance to understand their ethical and legal rights with respect to autonomous choice, and professional stakeholders need education regarding the importance of autonomy for clinical practice. Competency to consent to treatment is the mental prerequisite that ensures individuals with mental illness are able to complete PADs with insight, whereas autonomy is the value that empowers individuals to work towards their recovery.

  15. An assessment of General Aviation utilization of advanced avionics technology

    Quinby, G. F.

    1980-01-01

    Needs of the general aviation industry for services and facilities which might be supplied by NASA were examined. In the data collection phase, twenty-one individuals from nine manufacturing companies in general aviation were interviewed against a carefully prepared meeting format. General aviation avionics manufacturers were credited with a high degree of technology transfer from the forcing industries such as television, automotive, and computers and a demonstrated ability to apply advanced technology such as large scale integration and microprocessors to avionics functions in an innovative and cost effective manner. The industry's traditional resistance to any unnecessary regimentation or standardization was confirmed. Industry's self sufficiency in applying advanced technology to avionics product development was amply demonstrated. NASA research capability could be supportive in areas of basic mechanics of turbulence in weather and alternative means for its sensing.

  16. the effect of advanced fuel designs on fuel utilization

    Sarikaya, B.; Colak, U.; Tombakoglu, M.; Yilmazbayhan, A.

    1997-01-01

    Fuel management is one of the key topic in nuclear engineering. It is possible to increase fuel burnup and reactor lifetime by using advanced fuel management strategies. In order to increase the cycle lifetime, required amount of excess reactivity must be added to system. Burnable poisons can be used to compensate this excess reactivity. Usually gadolinium (Gd) is used as burnable poison. But the use of Gd presents some difficulties that have not been encountered with the use of boron

  17. Advanced Transport Operating System (ATOPS) utility library software description

    Clinedinst, Winston C.; Slominski, Christopher J.; Dickson, Richard W.; Wolverton, David A.

    1993-01-01

    The individual software processes used in the flight computers on-board the Advanced Transport Operating System (ATOPS) aircraft have many common functional elements. A library of commonly used software modules was created for general uses among the processes. The library includes modules for mathematical computations, data formatting, system database interfacing, and condition handling. The modules available in the library and their associated calling requirements are described.

  18. Advancing the Power and Utility of Server-Side Aggregation

    Fulker, Dave; Gallagher, James

    2016-01-01

    During the upcoming Summer 2016 meeting of the ESIP Federation (July 19-22), OpenDAP will hold a Developers and Users Workshop. While a broad set of topics will be covered, a key focus is capitalizing on recent EOSDIS-sponsored advances in Hyrax, OPeNDAPs own software for server-side realization of the DAP2 and DAP4 protocols. These Hyrax advances are as important to data users as to data providers, and the workshop will include hands-on experiences of value to both. Specifically, a balanced set of presentations and hands-on tutorials will address advances in1.server installation,2.server configuration,3.Hyrax aggregation capabilities,4.support for data-access from clients that are HTTP-based, JSON-based or OGC-compliant (especially WCS and WMS),5.support for DAP4,6.use and extension of server-side computational capabilities, and7.several performance-affecting matters.Topics 2 through 7 will be relevant to data consumers, data providers andnotably, due to the open-source nature of all OPeNDAP softwareto developers wishing to extend Hyrax, to build compatible clients and servers, andor to employ Hyrax as middleware that enables interoperability across a variety of end-user and source-data contexts. A session for contributed talks will elaborate the topics listed above and embrace additional ones.

  19. Advance reactor and fuel-cycle systems--potentials and limitations for United States utilities

    Zebroski, E.L.; Williams, R.F.

    1979-01-01

    This paper reviews the potential benefits and limitations of advance reactor and fuel-cycle systems for United States utilities. The results of the review of advanced technologies show that for the near and midterm, the only advance reactor and fuel-cycle system with significant potential for United States utilities is the current LWR, and evolutionary, not revolutionary, enhancements. For the long term, the liquid-metal breeder reactor continues to be the most promising advance nuclear option. The major factors leading to this conclusion are summarized

  20. Inverter for interfacing advanced energy sources to a utility grid

    Steigerwald, Robert L.

    1984-01-01

    A transistor is operated in the PWM mode such that a hlaf sine wave of current is delivered first to one-half of a distribution transformer and then the other as determined by steering thyristors operated at the fundamental sinusoidal frequency. Power to the transistor is supplied by a dc source such as a solar array and the power is converted such that a sinusoidal current is injected into a utility at near unity power factor.

  1. A multimedia intervention on cardiopulmonary resuscitation and advance directives.

    Yamada, R; Galecki, A T; Goold, S D; Hogikyan, R V

    1999-09-01

    To assess the effects of a multimedia educational intervention about advance directives (ADs) and cardiopulmonary resuscitation (CPR) on the knowledge, attitude and activity toward ADs and life-sustaining treatments of elderly veterans. Prospective randomized controlled, single blind study of educational interventions. General medicine clinic of a university-affiliated Veterans Affairs Medical Center (VAMC). One hundred seventeen Veterans, 70 years of age or older, deemed able to make medical care decisions. The control group (n = 55) received a handout about ADs in use at the VAMC. The experimental group (n = 62) received the same handout, with an additional handout describing procedural aspects and outcomes of CPR, and they watched a videotape about ADs. Patients' attitudes and actions toward ADs, CPR and life-sustaining treatments were recorded before the intervention, after it, and 2 to 4 weeks after the intervention through self-administered questionnaires. Only 27.8% of subjects stated that they knew what an AD is in the preintervention questionnaire. This proportion improved in both the experimental and control (87.2% experimental, 52.5% control) subject groups, but stated knowledge of what an AD is was higher in the experimental group (odds ratio = 6.18, p CPR. This improved after the intervention in the experimental group (OR = 4.27, p =.004), but did not persist at follow-up. In the postintervention questionnaire, few subjects in either group stated that they discussed CPR or ADs with their physician on that day (OR = 0.97, p = NS). We developed a convenient means of educating elderly male patients regarding CPR and advance directives that improved short-term knowledge but did not stimulate advance care planning.

  2. Advanced multi-megawatt wind turbine design for utility application

    Pijawka, W. C.

    1984-08-01

    A NASA/DOE program to develop a utility class multimegawatt wind turbine, the MOD-5A, is described. The MOD-5A features a 400 foot diameter rotor which is teetered and positioned upwind of the tower; a 7.3 megawatt power rating with a variable speed electric generating system; and a redundant rotor support and torque transmission structure. The rotor blades were fabricated from an epoxy-bonded wood laminate material which was a successful outgrowth of the MOD-OA airfoil design. Preliminary data from operational tests carried out at the NASA Plumbrook test facility are presented.

  3. Advanced multi-megawatt wind turbine design for utility application

    Pijawka, W. C.

    1984-01-01

    A NASA/DOE program to develop a utility class multimegawatt wind turbine, the MOD-5A, is described. The MOD-5A features a 400 foot diameter rotor which is teetered and positioned upwind of the tower; a 7.3 megawatt power rating with a variable speed electric generating system; and a redundant rotor support and torque transmission structure. The rotor blades were fabricated from an epoxy-bonded wood laminate material which was a successful outgrowth of the MOD-OA airfoil design. Preliminary data from operational tests carried out at the NASA Plumbrook test facility are presented.

  4. Utility Advanced Turbine Systems (ATS) technology readiness testing

    NONE

    1999-05-01

    The overall objective of the Advanced Turbine System (ATS) Phase 3 Cooperative Agreement between GE and the US Department of Energy (DOE) is the development of the GE 7H and 9H combined cycle power systems. The major effort will be expended on detail design. Validation of critical components and technologies will be performed, including: hot gas path component testing, sub-scale compressor testing, steam purity test trials, and rotational heat transfer confirmation testing. Processes will be developed to support the manufacture of the first system, which was to have been sited and operated in Phase 4 but will now be sited and operated commercially by GE. This change has resulted horn DOE's request to GE for deletion of Phase 4 in favor of a restructured Phase 3 (as Phase 3R) to include fill speed, no load (FSNL) testing of the 7H gas turbine. Technology enhancements that are not required for the first machine design but will be critical for future ATS advances in performance, reliability, and costs will be initiated. Long-term tests of materials to confirm design life predictions will continue. A schematic of the GE H machine is shown.

  5. Advances in utilization of renewable substrates for biosurfactant production

    2011-01-01

    Biosurfactants are amphiphilic molecules that have both hydrophilic and hydrophobic moieties which partition preferentially at the interfaces such as liquid/liquid, gas/liquid or solid/liquid interfaces. Such characteristics enable emulsifying, foaming, detergency and dispersing properties. Their low toxicity and environmental friendly nature and the wide range of potential industrial applications in bioremediation, health care, oil and food processing industries makes them a highly sought after group of chemical compounds. Interest in them has also been encouraged because of the potential advantages they offer over their synthetic counterparts in many fields spanning environmental, food, biomedical, petrochemical and other industrial applications. Their large scale production and application however are currently restricted by the high cost of production and by the limited understanding of their interactions with cells and with the abiotic environment. In this paper, we review the current knowledge and latest advances in the search for cost effective renewable agro industrial alternative substrates for their production. PMID:21906330

  6. Clinical utility of nivolumab in the treatment of advanced melanoma

    Asmar R

    2016-02-01

    Full Text Available Ramsey Asmar,1 Jessica Yang,1 Richard D Carvajal1,2 1Department of Medicine, College of Physicians and Surgeons, 2Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY, USA Abstract: Melanomas are highly immunogenic tumors that evade the immune system by exploiting innate checkpoint pathways, rendering effector T-cells anergic. The immunotherapeutic approach of checkpoint inhibition can restore and invigorate endogenous antitumor T-cell responses and has become an important treatment option for patients with advanced melanoma. The CTLA-4 inhibitor ipilimumab and the PD-1 inhibitors nivolumab and pembrolizumab have been shown to induce durable responses and improve overall survival in metastatic, refractory melanoma. Optimization and validation of pretreatment biomarkers to predict response to these agents is a crucial area of ongoing research. Combination immunotherapy has recently demonstrated superior response rates compared to monotherapy; further investigation is needed to refine combinatorial strategies. Keywords: nivolumab, immune checkpoint inhibitors, PD-1, melanoma

  7. UTILITY ADVANCED TURBINE SYSTEMS (ATS) TECHNOLOGY READINESS TESTING

    Unknown

    1999-04-01

    The overall objective of the Advanced Turbine System (ATS) Phase 3 Cooperative Agreement between GE and the U.S. Department of Energy (DOE) is the development of the GE 7H and 9H combined cycle power systems. The major effort will be expended on detail design. Validation of critical components and technologies will be performed, including: hot gas path component testing, sub-scale compressor testing, steam purity test trials, and rotational heat transfer conflation testing. Processes will be developed to support the manufacture of the first system, which was to have been sited and operated in Phase 4 but will now be sited and operated commercially by GE. This change has resulted from DOE's request to GE for deletion of Phase 4 in favor of a restructured Phase 3 (as Phase 3R) to include full speed, no load (FSNL) testing of the 7H gas turbine. Technology enhancements that are not required for the first machine design but will be critical for future ATS advances in performance, reliability, and costs will be initiated. Long-term tests of materials to confirm design life predictions will continue. The objective of this task is to design 7H and 9H compressor rotor and stator structures with the goal of achieving high efficiency at lower cost and greater durability by applying proven GE Power Systems (GEPS) heavy-duty use design practices. The designs will be based on the GE Aircraft Engines (GEAE) CF6-80C2 compressor. Transient and steady-state thermo-mechanical stress analyses will be run to ensure compliance with GEPS life standards. Drawings will be prepared for forgings, castings, machining, and instrumentation for full speed, no load (FSNL) tests of the first unit on both 9H and 7H applications.

  8. Advanced Water Purification System for In Situ Resource Utilization

    Anthony, Stephen M.; Jolley, Scott T.; Captain, James G.

    2013-01-01

    One of NASA's goals is to enable longterm human presence in space, without the need for continuous replenishment of consumables from Earth. In situ resource utilization (ISRU) is the use of extraterrestrial resources to support activities such as human life-support, material fabrication and repair, and radiation shielding. Potential sources of ISRU resources include lunar and Martian regolith, and Martian atmosphere. Water and byproducts (including hydrochloric and hydrofluoric acids) can be produced from lunar regolith via a high-temperature hydrogen reduction reaction and passing the produced gas through a condenser. center dot Due to the high solubility of HCI and HF in water, these byproducts are expected to be present in the product stream (up to 20,000 ppm) and must be removed (less than 10 ppm) prior to water consumption or electrolysis.

  9. Psychiatric advance directives in Australian mental-health legislation.

    Ouliaris, Calina; Kealy-Bateman, Warren

    2017-12-01

    Following the recent widespread reform of mental-health legislation in Australia, psychiatric advance directives (PADs) have now been incorporated in four jurisdictions. We contextualise the potential role for PADs within the Australian legal framework and note their varying introduction across jurisdictions, with a focus on progressive legislation in the Australian Capital Territory (ACT). The formal recognition of PADs effectively shifts the trajectory of mental-health law towards a stronger recognition of consumer autonomy, albeit to varying degrees across jurisdictions. The most inspiring of these changes may be seen in the ACT Act, where an innovative framing of PAD provisions creates a safe space for clinicians and patients to engage, build therapeutic alliances and develop appropriate frameworks for further change.

  10. Geothermal Direct-Heat Utilization Assistance - Final Report; FINAL

    J. W. Lund

    1999-01-01

    The Geo-Heat Center provided (1) direct-use technical assistance, (2) research, and (3) information dissemination on geothermal energy over an 8 1/2 year period. The center published a quarterly bulletin, developed a web site and maintained a technical library. Staff members made 145 oral presentations, published 170 technical papers, completed 28 applied research projects, and gave 108 tours of local geothermal installations to 500 persons

  11. Geothermal Direct-Heat Utilization Assistance - Final Report

    J. W. Lund

    1999-07-14

    The Geo-Heat Center provided (1) direct-use technical assistance, (2) research, and (3) information dissemination on geothermal energy over an 8 1/2 year period. The center published a quarterly bulletin, developed a web site and maintained a technical library. Staff members made 145 oral presentations, published 170 technical papers, completed 28 applied research projects, and gave 108 tours of local geothermal installations to 500 persons.

  12. UTILITY ADVANCED TURBINE SYSTEMS(ATS) TECHNOLOGY READINESS TESTING

    Kenneth A. Yackly

    2001-06-01

    The following paper provides an overview of GE's H System{trademark} technology, and specifically, the design, development, and test activities associated with the DOE Advanced Turbine Systems (ATS) program. There was intensive effort expended in bringing this revolutionary advanced technology program to commercial reality. In addition to describing the magnitude of performance improvement possible through use of H System{trademark} technology, this paper discusses the technological milestones during the development of the first 9H (50Hz) and 7H (60 Hz) gas turbines. To illustrate the methodical product development strategy used by GE, this paper discusses several technologies that were essential to the introduction of the H System{trademark}. Also included are analyses of the series of comprehensive tests of materials, components and subsystems that necessarily preceded full scale field testing of the H System{trademark}. This paper validates one of the basic premises with which GE started the H System{trademark} development program: exhaustive and elaborate testing programs minimized risk at every step of this process, and increase the probability of success when the H System{trademark} is introduced into commercial service. In 1995, GE, the world leader in gas turbine technology for over half a century, in conjunction with the DOE National Energy Technology Laboratory's ATS program, introduced its new generation of gas turbines. This H System{trademark} technology is the first gas turbine ever to achieve the milestone of 60% fuel efficiency. Because fuel represents the largest individual expense of running a power plant, an efficiency increase of even a single percentage point can substantially reduce operating costs over the life of a typical gas-fired, combined-cycle plant in the 400 to 500 megawatt range. The H System{trademark} is not simply a state-of-the-art gas turbine. It is an advanced, integrated, combined-cycle system in which every

  13. FY 1994 annual report. Advanced combustion science utilizing microgravity

    NONE

    1994-10-01

    Researches on combustion in microgravity were conducted to develop combustion devices for advanced combustion techniques, and thereby to cope with the requirements for diversification of energy sources and abatement of environmental pollution by exhaust gases. This project was implemented under the research cooperation agreement with US's NASA, and the Japanese experts visited NASA's test facilities. NASA's Lewis Research Center has drop test facilities, of which the 2.2-sec drop test facilities are useful for researches by Japan. The cooperative research themes for combustion in microgravity selected include interactions between fuel droplets, high-pressure combustion of binary fuel sprays, and ignition and subsequent flame propagation in microgravity. An ignition test equipment, density field measurement equipment and flame propagation test equipment were constructed in Japan to conduct the combustion tests in microgravity for, e.g., combustion and evaporation of fuel droplets, combustion characteristics of liquid fuels mixed with solid particles, combustion of coal/oil mixture droplets, and estimating flammability limits. (NEDO)

  14. Advanced ceramics for nuclear heat utilization and energy harvesting

    Prakash, Deep; Purohit, R.D.; Sinha, P.K.

    2015-01-01

    In recent years concerns related to global warming and green house gas emissions have focused the attention towards lowering the carbon foot print of energy generation. In this scenario, nuclear energy is considered as one of the strongest options to take on the challenges. Further, the nuclear heat, originated from the fission of nuclear fuels may be utilized not only by conversion to electricity using conventional techniques, but also may be used for production of hydrogen by splitting water. In the endeavor of realizing sustainable energy generation technologies, ceramic materials find key role as critical components. This paper covers an overview of various ceramic materials which are potential candidates for energy and hydrogen generation devices. These include solid oxide fuel cells, thermoelectric oxides and sodium conducting beta-alumina for alkali metal thermoelectric converters (AMTEC). The materials, which are generally complex oxides often need to be synthesized using chemical methods for purity and compositional control. Further, ceramic materials offer advantages in terms of doping different cations to engineer defects and maneuver properties. Nonetheless, shaping of ceramics to complex components is a challenging task, due to which various techniques such as isopressing, tape-casting, extrusion, slurry coating, spray deposition etc. are employed. The paper also provides a highlight of fabrication techniques and demonstration of miniature devices which are at various stages of development. (author)

  15. Advances in the chemical utilization of alkali lignin

    Van der Klashorst, G.H.

    1985-06-01

    Large quantities of alkali lignin are produced as by-products by the South African pulping industry. The potential utilization of industrial soda/anthraquinone (soda/AQ) eucalyptus, kraft pine and soda bagasse lignin was subsequently investigated. The molecular mass distributions of the three lignins were similar when determined by high pressure gel permeation chromatography (HP-GPC). The quantitative and quanlitative occurrence of various low molecular mass lignin fragments in the different spent liquors, on the other hand, indicated that the three lignins have substantial chemical differences. Analysis of the purified degraded lignins by NMR, methoxyl content determinations, elemental analysis, carbohydrate content determinations etc., quantified various of the chemical properties of the lignin. The properties of the three lignins were ultimately used to make recommendations regarding the potential use of each lignin. One such application was investigated and it was shown that soda bagasse lignin can be used successfully in phenol formaldehyde resin applications. The reaction of formaldehyde with lignin model compounds in acidic medium was also investigated. This reaction was shown to give fast crosslinking of alkyl substituted phenolic and etherified phenolic lignin model compounds at positions meta to the aromatic hydroxy groups

  16. Advanced Water Purification System for In Situ Resource Utilization Project

    Anthony, Stephen M.

    2014-01-01

    A main goal in the field of In Situ Resource Utilization is to develop technologies that produce oxygen from regolith to provide consumables to an extratrrestrial outpost. The processes developed reduce metal oxides in the regolith to produce water, which is then electrolyzed to produce oxygen. Hydrochloric and hydrofluoric acids are byproducts of the reduction processes, which must be removed to meet electrolysis purity standards. We previously characterized Nation, a highly water selective polymeric proton-exchange membrane, as a filtrtion material to recover pure water from the contaminated solution. While the membranes successfully removed both acid contaminants, the removal efficiency of and water flow rate through the membranes were not sufficient to produce large volumes of electrolysis-grade water. In the present study, we investigated electrodialysis as a potential acid removable technique. Our studies have show a rapid and significant reduction in chloride and fluoride concentrations in the feed solution, while generating a relatively small volume of concentrated waste water. Electrodialysis has shown significant promise as the primary separation technique in ISRU water purification processes.

  17. Utilization of advanced-age donors in renal transplantation.

    Olaverri, J G; Mora Christian, J; Elorrieta, P; Esnaola, K; Rodríguez, P; Marrón, I; Uriarte, I; Landa, M J; Zarraga, S; Gainza, F J; Aranzabal, J; Zabala, J A; Pertusa, C

    2011-11-01

    The shortage of organ availability in recent years has made it necessary to use grafts from advanced-aged donors to maintain the rate of renal transplantation in our country. The objective of this study was to evaluate the graft function and patient survival using kidneys from deceased donors of over 65 year of age. From 2005 until 2010, we compared the outcomes of patients who received grafts from donors over 65 years old vs less than 65 years. We observed no significant difference in sex, time on dialysis, or cold ischemia time between the groups. As expected the recipient age was significantly different. For the analysis of survival, we used the Tablecloth-Haenzel test and the Kaplan-Meier survival estimator. Actuarial survivals at 3 years after transplantation showed 84.8% among patients transplanted with kidneys from donors over 65 years old versus 97.5% in the control group. The graft survival was 78.8% among expanded criteria versus 86.85% in the control group. When we analyzed graft survival using an "exitus-censured" analysis, we obtained graft survivals of 89.1% in the expanded criteria kidney group versus 88.6% among the controls. We concluded that the use of kidney from donors over 65 years of age allows us to increase the rate of renal transplantation to about 15 to 20 per million population, with good graft and patient survivals provided that the protocol for expanded criteria organs ensured proper macroscopic and microscopic evaluation of the organ for transplantation. Copyright © 2011. Published by Elsevier Inc.

  18. Recovery Act: Advanced Direct Methanol Fuel Cell for Mobile Computing

    Fletcher, James H. [University of North Florida; Cox, Philip [University of North Florida; Harrington, William J [University of North Florida; Campbell, Joseph L [University of North Florida

    2013-09-03

    ABSTRACT Project Title: Recovery Act: Advanced Direct Methanol Fuel Cell for Mobile Computing PROJECT OBJECTIVE The objective of the project was to advance portable fuel cell system technology towards the commercial targets of power density, energy density and lifetime. These targets were laid out in the DOE’s R&D roadmap to develop an advanced direct methanol fuel cell power supply that meets commercial entry requirements. Such a power supply will enable mobile computers to operate non-stop, unplugged from the wall power outlet, by using the high energy density of methanol fuel contained in a replaceable fuel cartridge. Specifically this project focused on balance-of-plant component integration and miniaturization, as well as extensive component, subassembly and integrated system durability and validation testing. This design has resulted in a pre-production power supply design and a prototype that meet the rigorous demands of consumer electronic applications. PROJECT TASKS The proposed work plan was designed to meet the project objectives, which corresponded directly with the objectives outlined in the Funding Opportunity Announcement: To engineer the fuel cell balance-of-plant and packaging to meet the needs of consumer electronic systems, specifically at power levels required for mobile computing. UNF used existing balance-of-plant component technologies developed under its current US Army CERDEC project, as well as a previous DOE project completed by PolyFuel, to further refine them to both miniaturize and integrate their functionality to increase the system power density and energy density. Benefits of UNF’s novel passive water recycling MEA (membrane electrode assembly) and the simplified system architecture it enabled formed the foundation of the design approach. The package design was hardened to address orientation independence, shock, vibration, and environmental requirements. Fuel cartridge and fuel subsystems were improved to ensure effective fuel

  19. 22 CFR 72.30 - Provisions in a will or advanced directive regarding disposition of remains.

    2010-04-01

    ... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Provisions in a will or advanced directive... Decreased United States Citizen Or National § 72.30 Provisions in a will or advanced directive regarding disposition of remains. United States state law regarding advance directives, deaths and estates include...

  20. Physician attitudes toward advanced directives: a literature review of variables impacting on physicians attitude toward advance directives.

    Coleman, Albert M E

    2013-11-01

    To review physician's attitudes as well as the variables that may impact on physicians' attitude toward advance directives (ADs). Literature review of 17 published articles, covering the period 1989 to 2011. Physicians overall have a positive attitude toward patients' AD. However, other factors affect this "general positive attitude." These factors influence the attitude-behavior relationship of physicians, and hence their actual practice in relation to patients' AD. The findings from this review are of importance in explaining the differences in the attitude of physicians toward AD and their compliance. This raises the issue of consideration of other ethical paradigms/theories in the clinical context other than the framework of "principlism-"based autonomy, on which AD leans on. This is important in light of the pluralism of ethical theories.

  1. A preliminary investigation of opinions and behaviors regarding advance directives for medical care.

    Elpern, E H; Yellen, S B; Burton, L A

    1993-03-01

    Advance directives are a means of promoting patient autonomy in end-of-life decisions but are used infrequently. A recent federal law requires healthcare organizations to provide information to patients about advance directives. This study explored attitudes and behaviors related to the use of advance directives in three areas: familiarity with advance directives, reasons for completing or not completing advance directives and preferences for receiving information about advance directives. A questionnaire was administered by personal interview to a nonrandomized convenience sample of 46 inpatients and 50 outpatients at a large, tertiary care, urban academic medical center in the summer of 1991. Most respondents (77%) had heard of either the living will or durable power of attorney for healthcare, but only 52% correctly understood the purpose of these documents. Twenty-nine percent of the sample had executed an advance directive. Those who had advance directives were older and considered themselves less healthy than did those without advance directives. Unfamiliarity with advance directives and procrastination were cited most often as reasons for not having an advance directive. Most subjects (65%) had spoken with someone, usually a family member or close friend, about preferences for treatment during a critical illness. Although they had rarely discussed advance directives, 83% anticipated that they would be comfortable doing so with a physician or a nurse. Advance directives are used infrequently to document treatment preferences. The success of programs to promote greater use of advance directives depends on a clearer understanding of the factors that influence both decision and action to execute an advance directive. Patients claim to be comfortable in discussing the topic and prefer that such discussions occur in the outpatient setting.

  2. Advancements in the development of a directional-position sensing fast neutron detector using acoustically tensioned metastable fluids

    Archambault, Brian C. [Sagamore Adams Laboratories, Lafayette, IN (United States); Webster, Jeffrey A.; Grimes, Thomas F.; Fischer, Kevin F.; Hagen, Alex R. [School of Nuclear Engineering, Purdue University, 400 Central Avenue, West Lafayette, IN 47907 (United States); Taleyakhan, Rusi P., E-mail: rusi@purdue.edu [Sagamore Adams Laboratories, Lafayette, IN (United States); School of Nuclear Engineering, Purdue University, 400 Central Avenue, West Lafayette, IN 47907 (United States)

    2015-06-01

    Advancements in the development of a direction and position sensing fast neutron detector which utilizes the directional acoustic tensioned metastable fluid detector (D-ATMFD) are described. The resulting D-ATMFD sensor is capable of determining the direction of neutron radiation with a single compact detector versus use of arrays of detectors in conventional directional systems. Directional neutron detection and source positioning offer enhanced detection speeds in comparison to traditional proximity searching; including enabling determination of the neutron source shape, size, and strength in near real time. This paper discusses advancements that provide the accuracy and precision of ascertaining directionality and source localization information utilizing enhanced signal processing-cum-signal analysis, refined computational algorithms, and on-demand enlargement capability of the detector sensitive volume. These advancements were accomplished utilizing experimentation and theoretical modeling. Benchmarking and qualifications studies were successfully conducted with random and fission based special nuclear material (SNM) neutron sources ({sup 239}Pu–Be and {sup 252}Cf). These results of assessments have indicated that the D-ATMFD compares well in technical performance with banks of competing directional fast neutron detector technologies under development worldwide, but it does so with a single detector unit, an unlimited field of view, and at a significant reduction in both cost and size while remaining completely blind to common background (e.g., beta-gamma) radiation. Rapid and direct SNM neutron source imaging with two D-ATMFD sensors was experimentally demonstrated, and furthermore, validated via multidimensional nuclear particle transport simulations utilizing MCNP-PoliMi. Characterization of a scaled D-ATMFD based radiation portal monitor (RPM) as a cost-effective and efficient {sup 3}He sensor replacement was performed utilizing MCNP-PoliMi simulations

  3. Possibility of utilization of direction construction in river revitalization

    Jana Synková

    2009-01-01

    Full Text Available Directing and concentrating structures are used mainly on water coursers with unstable channel and major sediment transport or in areas with major bank erosion. The main purpose of these structures is to redirect water flow from the stressed and very often eroded bank to the centre of the channel or other parts of the channel, where the water flow may be used e.g. for dispersion of unsuitable deposit before its eventual stabilization by natural succession.Another important goal is to achieve a desired change of the stream channel by using the transporting power of the water flow and targeted depositing of sediment. In the area of the deflecting structure (deflector, so-called hydraulic shadow also appears where sediment deposits. The objective is to achieve depositing of sediments at desired places of the stream.It is possible to design a whole range of suitable or less suitable types of flow deflectors. In our article, we will particularly focus on problems of revitalization of a water course; that is design of structures from biological or biotechnical elements for channel stabilization.

  4. Advanced Methods for Direct Ink Write Additive Manufacturing

    Compel, W. S. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Lewicki, J. P. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States)

    2018-01-24

    Lawrence Livermore National Laboratory is one of the world’s premier labs for research and development of additive manufacturing processes. Out of these many processes, direct ink write (DIW) is arguably one of the most relevant for the manufacture of architected polymeric materials, components and hardware. However, a bottleneck in this pipeline that has largely been ignored to date is the lack of advanced software implementation with respect to toolpath execution. There remains to be a convenient, automated method to design and produce complex parts that is user-friendly and enabling for the realization of next generation designs and structures. For a material to be suitable as a DIW ink it must possess the appropriate rheological properties for this process. Most importantly, the material must exhibit shear-thinning in order to extrude through a print head and have a rapid recovery of its static shear modulus. This makes it possible for the extrudate to be self-supporting upon exiting the print head. While this and other prerequisites narrow the scope of ‘offthe- shelf’ printable materials directly amenable to DIW, the process still tolerates a wide range of potential feedstock materials. These include metallic alloys, inorganic solvent borne dispersions, polymeric melts, filler stabilized monomer compositions, pre-elastomeric feedstocks and thermoset resins each of which requires custom print conditions tailored to the individual ink. As such, an ink perfectly suited for DIW may be prematurely determined to be undesirable for the process if printed under the wrong conditions. Defining appropriate print conditions such as extrusion rate, layer height, and maximum bridge length is a vital first step in validating an ink’s DIW capability.

  5. Is it feasible to discuss an advance directive with a Chinese patient with advanced malignancy? A prospective cohort study.

    Wong, S Y; Lo, S H; Chan, C H; Chui, H S; Sze, W K; Tung, Y

    2012-06-01

    Advance directives have been implemented for years in western countries, but the concept is new to Asian cultures. According to traditional Chinese culture, family members usually play a decisive role in a patient's treatment plan. Thus it may be hard to implement an advance directive despite its importance to the treatment of patients. The objectives of this study were to assess the feasibility of advance directive engagement and to explore significant contributing factors to achieving such a goal. Prospective cohort study. Palliative Care Unit of Clinical Oncology, Tuen Mun Hospital, Hong Kong. The subjects of the investigation were adult patients diagnosed to have advanced malignancy and newly referred to the hospice service from 24 April 2009 to 30 July 2009. Data were collected from nursing assessment forms, locally designed advance directive forms, a checklist completed by oncologists, and details available in the electronic hospital record. Of the 191 eligible patients, 120 (63%) had the advance directive, whereas 71 (37%) did not. In the Cox regression model, the patient having insight of a poor prognosis was the most significant factor facilitating advance directive engagement (P=0.001). Any family objection in the discussion of advance directives was also an important factor, though it did not reach statistical significance (P=0.082). Other factors like age, gender, education, religion, financial status, living environment, understanding the diagnosis, bereavement experience, type of cancer, nature of illness, courses of chemotherapy or radiotherapy received, main caregiver, in-house supporter, nurse-led clinic attendance, clinical psychologist consultation, and in-patient hospice nurse coordinator interview were all statistically insignificant. Our study demonstrated that it was feasible to discuss an advance directive with Chinese patients with advanced malignancy. When patients have insight about their poor prognosis and family members have no

  6. Advance Directives among Nursing Home Residents with Mild, Moderate, and Advanced Dementia.

    Tjia, Jennifer; Dharmawardene, Marisa; Givens, Jane L

    2018-01-01

    To describe prevalence and content of AD documentation among NH residents by dementia stage. The prevalence of advance directives (ADs) among nursing home (NH) residents with mild, moderate, and advanced dementia remains unclear. Population-based, cross-sectional study of all licensed NHs in five U.S. states. Subjects included all long-stay (>90 day) NH residents with dementia, aged ≥65 years, and a Cognitive Performance Scale (CPS) score ≥1 from the 2007 to 2008 Minimum Data Set 2.0 (n = 180,621). Dementia severity was classified as follows: mild (CPS 1-2), moderate (CPS 3-4), and advanced (CPS 5-6). ADs were defined as the presence of a living will, do-not-resuscitate order, do-not-hospitalize order, medication restriction, or feeding restriction). Overall, 59% of residents had any AD and 17% had a living will. Prevalence of any AD increased by dementia severity: mild (51.2%), moderate (58.2%), and advanced (61.5%) (p will was associated with higher education (≥high school graduate vs. some high school or less) and being married. While dementia severity was associated with greater likelihood of having documented any AD, almost 4 in 10 residents with dementia lacked any AD. Effective outreach may focus efforts on subgroups with lower odds of any AD or living wills, including non-white, less educated, and unmarried NH residents. A greater understanding of how such factors impact care planning will help to address barriers to patient-centered care for this population.

  7. Direct vessel inclined injection system for reduction of emergency core coolant direct bypass in advanced reactors

    Yoon, Sang H.; Lee, Jong G.; Suh, Kune Y.

    2006-01-01

    Multidimensional thermal hydraulics in the APR1400 (Advanced Power Reactor 1400 MWe) downcomer during a large-break loss-of-coolant accident (LBLOCA) plays a pivotal role in determining the capability of the safety injection system. APR1400 adopts the direct vessel injection (DVI) method for more effective core penetration of the emergency core cooling (ECC) water than the cold leg injection (CLI) method in the OPR1000 (Optimized Power Reactor 1000 MWe). The DVI method turned out to be prone to occasionally lack in efficacious delivery of ECC to the reactor core during the reflood phase of a LBLOCA, however. This study intends to demonstrate a direct vessel inclined injection (DVII) method, one of various ideas with which to maximize the ECC core penetration and to minimize the direct bypass through the break during the reflood phase of a LBLOCA. The 1/7 scaled down THETA (Transient Hydrodynamics Engineering Test Apparatus) tests show that a vertical inclined nozzle angle of the DVII system increases the downward momentum of the injected ECC water by reducing the degree of impingement on the reactor downcomer, whereby lessening the extent of the direct bypass through the break. The proposed method may be combined with other innovative measures with which to ensure an enough thermal margin in the core during the course of a LBLOCA in APR1400

  8. Advance euthanasia directives: a controversial case and its ethical implications.

    Miller, David Gibbes; Dresser, Rebecca; Kim, Scott Y H

    2018-03-03

    Authorising euthanasia and assisted suicide with advance euthanasia directives (AEDs) is permitted, yet debated, in the Netherlands. We focus on a recent controversial case in which a Dutch woman with Alzheimer's disease was euthanised based on her AED. A Dutch euthanasia review committee found that the physician performing the euthanasia failed to follow due care requirements for euthanasia and assisted suicide. This case is notable because it is the first case to trigger a criminal investigation since the 2002 Dutch euthanasia law was enacted. Thus far, only brief descriptions of the case have been reported in English language journals and media. We provide a detailed description of the case, review the main challenges of preparing and applying AEDs for persons with dementia and briefly assess the adequacy of the current oversight system governing AEDs. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  9. Automated Ecological Assessment of Physical Activity: Advancing Direct Observation.

    Carlson, Jordan A; Liu, Bo; Sallis, James F; Kerr, Jacqueline; Hipp, J Aaron; Staggs, Vincent S; Papa, Amy; Dean, Kelsey; Vasconcelos, Nuno M

    2017-12-01

    Technological advances provide opportunities for automating direct observations of physical activity, which allow for continuous monitoring and feedback. This pilot study evaluated the initial validity of computer vision algorithms for ecological assessment of physical activity. The sample comprised 6630 seconds per camera (three cameras in total) of video capturing up to nine participants engaged in sitting, standing, walking, and jogging in an open outdoor space while wearing accelerometers. Computer vision algorithms were developed to assess the number and proportion of people in sedentary, light, moderate, and vigorous activity, and group-based metabolic equivalents of tasks (MET)-minutes. Means and standard deviations (SD) of bias/difference values, and intraclass correlation coefficients (ICC) assessed the criterion validity compared to accelerometry separately for each camera. The number and proportion of participants sedentary and in moderate-to-vigorous physical activity (MVPA) had small biases (within 20% of the criterion mean) and the ICCs were excellent (0.82-0.98). Total MET-minutes were slightly underestimated by 9.3-17.1% and the ICCs were good (0.68-0.79). The standard deviations of the bias estimates were moderate-to-large relative to the means. The computer vision algorithms appeared to have acceptable sample-level validity (i.e., across a sample of time intervals) and are promising for automated ecological assessment of activity in open outdoor settings, but further development and testing is needed before such tools can be used in a diverse range of settings.

  10. Engaging Patients With Advance Directives Using an Information Visualization Approach.

    Woollen, Janet; Bakken, Suzanne

    2016-01-01

    Despite the benefits of advance directives (AD) to patients and care providers, they are often not completed due to lack of patient awareness. The purpose of the current article is to advocate for creation and use of an innovative information visualization (infovisual) as a health communication tool aimed at improving AD dissemination and engagement. The infovisual would promote AD awareness by encouraging patients to learn about their options and inspire contemplation and conversation regarding their end-of-life (EOL) journey. An infovisual may be able to communicate insights that are often communicated in words, but are much more powerfully communicated by example. Furthermore, an infovisual could facilitate vivid understanding of options and inspire the beginning of often difficult conversations among care providers, patients, and loved ones. It may also save clinicians time, as care providers may be able to spend less time explaining details of EOL care options. Use of an infovisual could assist in ensuring a well-planned EOL journey. Copyright 2016, SLACK Incorporated.

  11. Advances in directional borehole radar data analysis and visualization

    Smith, D.V.G.; Brown, P.J.

    2002-01-01

    The U.S. Geological Survey is developing a directional borehole radar (DBOR) tool for mapping fractures, lithologic changes, and underground utility and void detection. An important part of the development of the DBOR tool is data analysis and visualization, with the aim of making the software graphical user interface (GUI) intuitive and easy to use. The DBOR software system consists of a suite of signal and image processing routines written in Research Systems' Interactive Data Language (IDL). The software also serves as a front-end to many widely accepted Colorado School of Mines Center for Wave Phenomena (CWP) Seismic UNIX (SU) algorithms (Cohen and Stockwell, 2001). Although the SU collection runs natively in a UNIX environment, our system seamlessly emulates a UNIX session within a widely used PC operating system (MicroSoft Windows) using GNU tools (Noer, 1998). Examples are presented of laboratory data acquired with the prototype tool from two different experimental settings. The first experiment imaged plastic pipes in a macro-scale sand tank. The second experiment monitored the progress of an invasion front resulting from oil injection. Finally, challenges to further development and planned future work are discussed.

  12. Automated Ecological Assessment of Physical Activity: Advancing Direct Observation

    Jordan A. Carlson

    2017-12-01

    Full Text Available Technological advances provide opportunities for automating direct observations of physical activity, which allow for continuous monitoring and feedback. This pilot study evaluated the initial validity of computer vision algorithms for ecological assessment of physical activity. The sample comprised 6630 seconds per camera (three cameras in total of video capturing up to nine participants engaged in sitting, standing, walking, and jogging in an open outdoor space while wearing accelerometers. Computer vision algorithms were developed to assess the number and proportion of people in sedentary, light, moderate, and vigorous activity, and group-based metabolic equivalents of tasks (MET-minutes. Means and standard deviations (SD of bias/difference values, and intraclass correlation coefficients (ICC assessed the criterion validity compared to accelerometry separately for each camera. The number and proportion of participants sedentary and in moderate-to-vigorous physical activity (MVPA had small biases (within 20% of the criterion mean and the ICCs were excellent (0.82–0.98. Total MET-minutes were slightly underestimated by 9.3–17.1% and the ICCs were good (0.68–0.79. The standard deviations of the bias estimates were moderate-to-large relative to the means. The computer vision algorithms appeared to have acceptable sample-level validity (i.e., across a sample of time intervals and are promising for automated ecological assessment of activity in open outdoor settings, but further development and testing is needed before such tools can be used in a diverse range of settings.

  13. Usefulness of questionnaires on advance directives in haemodialysis units.

    Jornet, Angel Rodríguez; Castellanos, Loreley Ana Betancourt; Contador, Maria Isabel Bolós; Morera, Juan Carlos Oliva; López, José Antonio Ibeas

    2017-10-01

    As renal replacement therapy has become universal practice in medicine, there is a need to consider whether this treatment is suitable for elderly people. These patients have high comorbidity and may require dialysis withdrawal in certain clinical circumstances. Advance directives (ADs) drawn up by patients facilitate treatment-related decisions if they lose cognitive capacity. Questionnaires dealing with possible extreme clinical circumstances can thus help clinicians and relatives reach pertinent decisions in such cases. We studied the usefulness of questionnaires on ADs in patients who started periodic haemodialysis over a period of 10 years. Telephone interviews were conducted to assess satisfaction level among relatives/representatives of deceased patients who had been advised to limit therapeutic efforts in certain clinical situations. The questionnaire was assessed using a six-factor degree of satisfaction. Four hundred and forty-three questionnaires were distributed over a period of 10 years. A total of 41.3% of patients stated that they wished to limit therapeutic efforts in the serious clinical situations presented; 37.9% refused to complete the questionnaire; 14.7% expressed their wishes without any written confirmation; and 6.1% expressed their wish to continue on dialysis in all situations. Two hundred and twenty-four patients had died by the study end date. The cause of death in 20.2% was scheduled dialysis withdrawal. Representatives reported an extremely high degree of satisfaction with the questionnaire (94.7%). Younger people, however, were more reluctant to consider and answer questionnaires on ADs. Questionnaires on ADs are a useful tool in daily nephrology practice and should be distributed to those patients willing to consider the limitation of therapeutic efforts in extreme clinical circumstances. In general terms, these questionnaires should be given to all elderly patients. © The Author 2017. Published by Oxford University Press on

  14. Advanced orient cycle, for strategic separation, transmutation and utilization of nuclides in the nuclear fuel cycle

    Ozawa, M.; Fujita, R.; Koyama, S.; Suzuki, T.; Fujii, Y.

    2007-01-01

    which enables to directly recover pure Cm as well as pure Am with minimum number of reprocessing separation steps is reported in another paper. The recent experiments indicated that strong adsorption of 1 06Ru and 1 25Sb was observed under the diluted HCl medium, thereby completely 1 06Ru-free feed dissolver solution was obtained. The CEE separation step will follow this IX step for further purification and fabrication of RMFP material for their utilization. Based on those technologies, the Trinitarian Research and Development project (Advanced ORIENT Cycle) on partitioning, transmutation and utilization of actinides and fission products will be developed to realize ultimate reducing long-term radio toxicity in the radioactive wastes. Actinides, LLFP ( 1 35Cs, etc), MLFP ( 9 0Sr, 1 37Cs) and RMFP shall be separated to the level of isotope as well as element. The CEE process will be added for utilization of RMFP. The RMFP, one of the products of Ad. ORIENT Cycle, would be expected to be a 'FP-catalyst' to circulate between nuclear and hydrogen / fuel cell energy systems, and thereby contributing to save the natural precious metal resources

  15. Advance directives: cancer patients' preferences and family-based decision making.

    Xing, Yan-Fang; Lin, Jin-Xiang; Li, Xing; Lin, Qu; Ma, Xiao-Kun; Chen, Jie; Wu, Dong-Hao; Wei, Li; Yin, Liang-Hong; Wu, Xiang-Yuan

    2017-07-11

    Advance directives are a sensitive issue among traditional Chinese people, who usually refrain from mentioning this topic until it is imperative. Medical decisions for cancer patients are made by their families, and these decisions might violate patients' personal will. This study aimed to examine the acceptance of advance directives among Chinese cancer patients and their families and patient participation in this procedure and, finally, to analyze the moral risk involved. While 246 patients and their family members refused official discussion of an advance directive, the remaining 166 patients and their families accepted the concept of an advance directive and signed a document agreeing to give up invasive treatment when the anti-cancer treatment was terminated. Of these, only 24 patients participated in the decision making. For 101 patients, anti-cancer therapy was ended prematurely with as many as 37 patients not told about their potential loss of health interests. Participants were 412 adult cancer patients from 9 leading hospitals across China. An advance directive was introduced to the main decision makers for each patient; if they wished to sign it, the advance directive would be systematically discussed. A questionnaire was given to the oncologists in charge of each patient to evaluate the interaction between families and patients, patients' awareness of their disease, and participation in an advance directive. Advance directives were not widely accepted among Chinese cancer patients unless anti-cancer therapy was terminated. Most cancer patients were excluded from the discussion of an advance directive.

  16. Encounters With Health-Care Providers and Advance Directive Completion by Older Adults.

    Koss, Catheryn

    2018-01-01

    The Patient Self-Determination Act (PSDA) requires hospitals, home health agencies, nursing homes, and hospice providers to offer new patients information about advance directives. There is little evidence regarding whether encounters with these health-care providers prompt advance directive completion by patients. To examine whether encounters with various types of health-care providers were associated with higher odds of completing advance directives by older patients. Logistic regression using longitudinal data from the 2012 and 2014 waves of the Health and Retirement Study. Participants were 3752 US adults aged 65 and older who reported not possessing advance directives in 2012. Advance directive was defined as a living will and/or durable power of attorney for health care. Four binary variables measured whether participants had spent at least 1 night in a hospital, underwent outpatient surgery, received home health or hospice care, or spent at least one night in a nursing home between 2012 and 2014. Older adults who received hospital, nursing home, or home health/hospice care were more likely to complete advance directives. Outpatient surgery was not associated with advance directive completion. Older adults with no advance directive in 2012 who encountered health-care providers covered by the PSDA were more likely to have advance directives by 2014. The exception was outpatient surgery which is frequently provided in freestanding surgery centers not subject to PSDA mandates. It may be time to consider amending the PSDA to cover freestanding surgery centers.

  17. Characteristics of Patients With Existing Advance Directives: Evaluating Motivations Around Advance Care Planning.

    Genewick, Joanne E; Lipski, Dorothy M; Schupack, Katherine M; Buffington, Angela L H

    2018-04-01

    Although 80% of patients endorse an advance directive (AD), less than 35% of American adults have a documented AD. Much research has been done on barriers to creating ADs; however, there is a paucity of research addressing motivations for creating ADs. Previous research has identified 4 categories of influence for engaging in advance care planning (ACP). This study aimed to quantify the influence of these 4 motivating categories in creating an AD. Participants included 238 adults with documented ADs. Participants completed an 11-item questionnaire addressing 1 of the 4 hypothesized categories of influence in addressing ACP: concern for self; concern for others; expectations about the impact of ACP; and anecdotes, stories, and experiences. Principle component analysis yielded 2 factors representing dignity and personal control (intrinsic factors) and societal and familial influence (extrinsic factors). Intrinsic factors were the primary and most influential motivating factors among participants. A regression analysis of individual motivating factors showed that prior to age 50, the desire to provide guidance about personal preferences for end-of-life care significantly predicted the creation of an AD, whereas after age 50, the urging of family members significantly predicted the creation of an AD. Results indicated that intrinsic factors were the most influential motivator among participants of all ages. Extrinsic factors appeared to be less influential in the decision to create an AD. Motivating factors were also found to vary by age. These results may help physicians be more targeted in discussions surrounding ADs, thus saving time, which physicians identify as the main barrier in engaging in such discussions, while meeting patients' wishes for their physicians to bring up the topic of ADs.

  18. Public Opinion Regarding Financial Incentives to Engage in Advance Care Planning and Complete Advance Directives.

    Auriemma, Catherine L; Chen, Lucy; Olorunnisola, Michael; Delman, Aaron; Nguyen, Christina A; Cooney, Elizabeth; Gabler, Nicole B; Halpern, Scott D

    2017-09-01

    The Centers for Medicare & Medicaid Services (CMS) recently instituted physician reimbursements for advance care planning (ACP) discussions with patients. To measure public support for similar programs. Cross-sectional online and in-person surveys. English-speaking adults recruited at public parks in Philadelphia, Pennsylvania, from July to August 2013 and online through survey sampling international Web-based recruitment platform in July 2015. Participants indicated support for 6 programs designed to increase advance directive (AD) completion or ACP discussion using 5-point Likert scales. Participants also indicated how much money (US$0-US$1000) was appropriate to incentivize such behaviors, compared to smoking cessation or colonoscopy screening. We recruited 883 participants: 503 online and 380 in-person. The status quo of no systematic approach to motivate AD completion was supported by 67.0% of participants (63.9%-70.1%). The most popular programs were paying patients to complete ADs (58.0%; 54.5%-61.2%) and requiring patients to complete ADs or declination forms for health insurance (54.1%; 50.8%-57.4%). Participants more commonly supported paying patients to complete ADs than paying physicians whose patients complete ADs (22.6%; 19.8%-25.4%) or paying physicians who document ACP discussions (19.1%; 16.5%-21.7%; both P < .001). Participants supported smaller payments for AD completion and ACP than for obtaining screening colonoscopies or stopping smoking. Americans view payments for AD completion or ACP more skeptically than for other health behaviors and prefer that such payments go to patients rather than physicians. The current CMS policy of reimbursing physicians for ACP conversations with patients was the least preferred of the programs evaluated.

  19. Direct Utilization of Liquid Fuels in SOFC for Portable Applications: Challenges for the Selection of Alternative Anodes

    Massimiliano Cimenti

    2009-06-01

    Full Text Available Solid oxide fuel cells (SOFC have the advantage of being able to operate with fuels other than hydrogen. In particular, liquid fuels are especially attractive for powering portable applications such as small power generators or auxiliary power units, in which case the direct utilization of the fuel would be convenient. Although liquid fuels are easier to handle and transport than hydrogen, their direct use in SOFC can lead to anode deactivation due to carbon formation, especially on traditional nickel/yttria stabilized zirconia (Ni/YSZ anodes. Significant advances have been made in anodic materials that are resistant to carbon formation but often these materials are less electrochemically active than Ni/YSZ. In this review the challenges of using liquid fuels directly in SOFC, in terms of gas-phase and catalytic reactions within the anode chamber, will be discussed and the alternative anode materials so far investigated will be compared.

  20. Advanced health biotechnologies in Thailand: redefining policy directions.

    Velasco, Román Pérez; Chaikledkaew, Usa; Myint, Chaw Yin; Khampang, Roongnapa; Tantivess, Sripen; Teerawattananon, Yot

    2013-01-02

    Thailand faces a significant burden in terms of treating and managing degenerative and chronic diseases. Moreover, incidences of rare diseases are rising. Many of these-such as diabetes, cancer, and inherited inborn metabolic diseases-have no definite treatments or cure. Meanwhile, advanced health biotechnology has been found, in principle, to be an effective solution for these health problems. Qualitative approaches were employed to analyse the current situation and examine existing public policies related to advanced health biotechnologies in Thailand. The results of this analysis were then used to formulate policy recommendations. Our research revealed that the system in Thailand in relation to advanced health biotechnologies is fragmented, with multiple unaddressed gaps, underfunding of research and development (R&D), and a lack of incentives for the private sector. In addition, there are no clear definitions of advanced health biotechnologies, and coverage pathways are absent. Meanwhile, false advertising and misinformation are prevalent, with no responsible bodies to actively and effectively provide appropriate information and education (I&E). The establishment of a specialised institution to fill the gaps in this area is warranted. The development and implementation of a comprehensive national strategic plan related to advanced health biotechnologies, greater investment in R&D and I&E for all stakeholders, collaboration among agencies, harmonisation of reimbursement across public health schemes, and provision of targeted I&E are specifically recommended.

  1. Advanced health biotechnologies in Thailand: redefining policy directions

    Velasco Román Pérez

    2013-01-01

    Full Text Available Abstract Background Thailand faces a significant burden in terms of treating and managing degenerative and chronic diseases. Moreover, incidences of rare diseases are rising. Many of these—such as diabetes, cancer, and inherited inborn metabolic diseases—have no definite treatments or cure. Meanwhile, advanced health biotechnology has been found, in principle, to be an effective solution for these health problems. Methods Qualitative approaches were employed to analyse the current situation and examine existing public policies related to advanced health biotechnologies in Thailand. The results of this analysis were then used to formulate policy recommendations. Results Our research revealed that the system in Thailand in relation to advanced health biotechnologies is fragmented, with multiple unaddressed gaps, underfunding of research and development (R&D, and a lack of incentives for the private sector. In addition, there are no clear definitions of advanced health biotechnologies, and coverage pathways are absent. Meanwhile, false advertising and misinformation are prevalent, with no responsible bodies to actively and effectively provide appropriate information and education (I&E. The establishment of a specialised institution to fill the gaps in this area is warranted. Conclusion The development and implementation of a comprehensive national strategic plan related to advanced health biotechnologies, greater investment in R&D and I&E for all stakeholders, collaboration among agencies, harmonisation of reimbursement across public health schemes, and provision of targeted I&E are specifically recommended.

  2. Applying Precision Medicine and Immunotherapy Advances from Oncology to Host-Directed Therapies for Infectious Diseases.

    Mahon, Robert N; Hafner, Richard

    2017-01-01

    To meet the challenges of increasing antimicrobial resistance, the infectious disease community needs innovative therapeutics. Precision medicine and immunotherapies are transforming cancer therapeutics by targeting the regulatory signaling pathways that are involved not only in malignancies but also in the metabolic and immunologic function of the tumor microenvironment. Infectious diseases target many of the same regulatory pathways as they modulate host metabolic functions for their own nutritional requirements and to impede host immunity. These similarities and the advances made in precision medicine and immuno-oncology that are relevant for the current development of host-directed therapies (HDTs) to treat infectious diseases are discussed. To harness this potential, improvements in drug screening methods and development of assays that utilize the research tools including high throughput multiplexes already developed by oncology are essential. A multidisciplinary approach that brings together immunologists, infectious disease specialists, and oncologists will be necessary to fully develop the potential of HDTs.

  3. Prevalence and Contents of Advance Directives of Patients with ESRD Receiving Dialysis.

    Feely, Molly A; Hildebrandt, Daniel; Edakkanambeth Varayil, Jithinraj; Mueller, Paul S

    2016-12-07

    ESRD requiring dialysis is associated with increased morbidity and mortality rates, including increased rates of cognitive impairment, compared with the general population. About one quarter of patients receiving dialysis choose to discontinue dialysis at the end of life. Advance directives are intended to give providers and surrogates instruction on managing medical decision making, including end of life situations. The prevalence of advance directives is low among patients receiving dialysis. Little is known about the contents of advance directives among these patients with advance directives. We retrospectively reviewed the medical records of all patients receiving maintenance in-center hemodialysis at a tertiary academic medical center between January 1, 2007 and January 1, 2012. We collected demographic data, the prevalence of advance directives, and a content analysis of these advance directives. We specifically examined the advance directives for instructions on management of interventions at end of life, including dialysis. Among 808 patients (mean age of 68.6 years old; men =61.2%), 49% had advance directives, of which only 10.6% mentioned dialysis and only 3% specifically addressed dialysis management at end of life. Patients who had advance directives were more likely to be older (74.5 versus 65.4 years old; Phydration (34.3%), and pain management (43.4%) than dialysis (10.6%). Although one-half of the patients receiving dialysis in our study had advance directives, end of life management of dialysis was rarely addressed. Future research should focus on improving discernment and documentation of end of life values, goals, and preferences, such as dialysis-specific advance directives, among these patients. Copyright © 2016 by the American Society of Nephrology.

  4. Anode catalysts for direct ethanol fuel cells utilizing directly solar light illumination.

    Chu, Daobao; Wang, Shuxi; Zheng, Peng; Wang, Jian; Zha, Longwu; Hou, Yuanyuan; He, Jianguo; Xiao, Ying; Lin, Huashui; Tian, Zhaowu

    2009-01-01

    Shine a light: A PtNiRu/TiO(2) anode catalyst for direct ethanol fuel cells shows photocatalytic activity. The peak current density for ethanol oxidation under solar light illumination is 2-3 times greater than that in the absence of solar light. Ethanol is oxidized by light-generated holes, and the electrons are collected by the TiO(2) support to generate the oxidation current.Novel PtNiRu/TiO(2) anode catalysts for direct ethanol fuel cells (DEFCs) were prepared from PtNiRu nanoparticles (1:1:1 atomic ratios) and a nanoporous TiO(2) film by a sol-gel and electrodeposition method. The performances of the catalysts for ethanol oxidation were investigated by cyclic voltammetry, chronoamperometry and electrochemical impedance spectroscopy. The results indicate a remarkable enhancement of activity for ethanol oxidation under solar light illumination. Under solar light illumination, the generated oxidation peak current density is 24.6 mA cm(-2), which is about 2.5 times higher than that observed without solar light (9.9 mA cm(-2)). The high catalytic activity of the PtNiRu/TiO(2) complex catalyst for the electrooxidation of ethanol may be attributed to the modified metal/nanoporous TiO(2) film, and the enhanced electrooxidation of ethanol under solar light may be due to the photogeneration of holes in the modified nanoporous TiO(2) film.

  5. Future vision of advanced telecommunication networks for electric utilities; Denki jigyo ni okeru joho tsushin network no shorai vision

    Tonaru, S.; Ono, K.; Sakai, S.; Kawai, Y.; Tsuboi, A. [Central Research Institute of Electric Power Industry, Tokyo (Japan); Manabe, S. [Shikoku Electric Power Co., Inc., Kagawa (Japan); Miki, Y. [Kansai Electric Power Co. Inc., Osaka (Japan)

    1995-06-01

    The vision of an advanced information system is proposed to cope with the future social demand and business environmental change in electric utilities. At the large turning point such as drastic reconsideration of Electricity Utilities Industry Law, further improvement of efficiency and cost reduction are requested as well as business innovation such as proposal of a new business policy. For that purpose utilization of information and its technology is indispensable, and use of multimedia and common information in organization are the future direction for improving information basis. Consequently, free information networks without any limitation due to person and media are necessary, and the following are important: high-speed, high-frequency band, digital, easily connectable and multimedia transmission lines, and cost reduction and high reliability of networks. Based on innovation of information networks and the clear principle on advanced information system, development of new applications by multimedia technologies, diffusion of communication terminals, and promotion of standardization are essential. 60 refs., 30 figs., 5 tabs.

  6. Radiation or chemoradiation: initial utility study of selected therapy for local advanced stadium cervical cancer

    Pramitasari, D. A.; Gondhowiardjo, S.; Nuranna, L.

    2017-08-01

    This study aimed to compare radiation only or chemo radiation treatment of local advanced cervical cancers by examining the initial response of tumors and acute side effects. An initial assessment employed value based medicine (VBM) by obtaining utility values for both types of therapy. The incidences of acute lower gastrointestinal, genitourinary, and hematology side effects in patients undergoing chemoradiation did not differ significantly from those undergoing radiation alone. Utility values for patients who underwent radiation alone were higher compared to those who underwent chemoradiation. It was concluded that the complete response of patients who underwent chemoradiation did not differ significantly from those who underwent radiation alone.

  7. Advanced Gasoline Turbocharged Direction Injection (GTDI) Engine Development

    Wagner, Terrance [Ford Motor Co., Dearborn, MI (United States)

    2015-12-31

    This program was undertaken in response to US Department of Energy Solicitation DE-FOA-0000079, resulting in a cooperative agreement with Ford and MTU to demonstrate improvement of fuel efficiency in a vehicle equipped with an advanced GTDI engine. Ford Motor Company has invested significantly in GTDI engine technology as a cost effective, high volume, fuel economy solution, marketed globally as EcoBoost technology. Ford envisions additional fuel economy improvement in the medium and long term by further advancing EcoBoost technology. The approach for the project was to engineer a comprehensive suite of gasoline engine systems technologies to achieve the project objectives, and to progressively demonstrate the objectives via concept analysis / computer modeling, single-cylinder and multi-cylinder engine testing on engine dynamometer, and vehicle level testing on chassis rolls.

  8. Advanced reactor design study. Assessing nonbackfittable concepts for improving uranium utilization in light water reactors

    Fleischman, R.M.; Goldsmith, S.; Newman, D.F.; Trapp, T.J.; Spinrad, B.I.

    1981-09-01

    The objective of the Advanced Reactor Design Study (ARDS) is to identify and evaluate nonbackfittable concepts for improving uranium utilization in light water reactors (LWRs). The results of this study provide a basis for selecting and demonstrating specific nonbackfittable concepts that have good potential for implementation. Lead responsibility for managing the study was assigned to the Pacific Northwest Laboratory (PNL). Nonbackfittable concepts for improving uranium utilization in LWRs on the once-through fuel cycle were selected separately for PWRs and BWRs due to basic differences in the way specific concepts apply to those plants. Nonbackfittable concepts are those that are too costly to incorporate in existing plants, and thus, could only be economically incorporated in new reactor designs or plants in very early stages of construction. Essential results of the Advanced Reactor Design Study are summarized

  9. Advancing biomarker research: utilizing 'Big Data' approaches for the characterization and prevention of bipolar disorder.

    McIntyre, Roger S; Cha, Danielle S; Jerrell, Jeanette M; Swardfager, Walter; Kim, Rachael D; Costa, Leonardo G; Baskaran, Anusha; Soczynska, Joanna K; Woldeyohannes, Hanna O; Mansur, Rodrigo B; Brietzke, Elisa; Powell, Alissa M; Gallaugher, Ashley; Kudlow, Paul; Kaidanovich-Beilin, Oksana; Alsuwaidan, Mohammad

    2014-08-01

    and prevention of this heterogeneous disorder. Advances in bioinformatics using a 'Big Data' approach provide an opportunity for novel insights regarding the pathoetiology of BD. The coordinated integration of research centers, inclusive of mixed-age populations, is a promising strategic direction for advancing this line of neuropsychiatric research. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  10. Advanced Utility Metering; Period of Performance: April 23, 2002 - September 22, 2002

    2003-09-01

    In support of federal agencies considering the approach to utility metering appropriate for their facilities, the U.S. Department of Energy Federal Energy Management Program offers this publication as an overview of options in metering technology, system architecture, implementation, and relative costs. It provides advanced metering systems information to help potential users specify, acquire, use, and expand systems. It also addresses basic security issues and provides case studies and information resources.

  11. Utilization of MCNP code in the research and design for China advanced research reactor

    Shen Feng

    2006-01-01

    MCNP, which is the internationalized neutronics code, is used for nuclear research and design in China Advanced Research Reactor (CARR). MCNP is an important neutronics code in the research and design for CARR since many calculation tasks could be undertaken by it. Many nuclear parameters on reactor core, the design and optimization research for many reactor utilizations, much verification for other nuclear calculation code and so on are conducted with help of MCNP. (author)

  12. Development and utilization of the NRC policy statement on the regulation of advanced nuclear power plants

    Williams, P.M.; King, T.L.

    1988-06-01

    On March 26, 1985, the US Nuclear Regulatory Commission issued for public comment a ''Proposed Policy for Regulation of Advanced Nuclear Power Plants'' (50 FR 11884). This report presents and discusses the Commission's final version of that policy as titled and published on July 8, 1986 ''Regulation of Advanced Nuclear Power Plants, Statement of Policy'' (51 FR 24643). It provides an overview of comments received from the public, of the significant changes from the proposed Policy Statement to the final Policy Statement, and of the Commission's response to six questions contained in the proposed Policy Statement. The report also discusses the definition for advanced reactors, the establishment of an Advanced Reactors Group, the staff review approach and information needs, and the utilization of the Policy Statement in relation to other NRC programs, including the policies for safety goals, severe accidents and standardization. In addition, guidance for advanced reactors with respect to operating experience, technology development, foreign information and data, and prototype testing is provided. Finally, a discussion on the use of less prescriptive and nonprescriptive design criteria for advanced reactors, which the Policy Statement encourages, is presented

  13. Radiation-induced erectile dysfunction: Recent advances and future directions

    Javed Mahmood, PhD

    2016-07-01

    Full Text Available Prostate cancer is one of the most prevalent cancers and the second leading cause of cancer-related deaths in men in the United States. A large number of patients undergo radiation therapy (RT as a standard care of treatment; however, RT causes erectile dysfunction (radiation-induced erectile dysfunction; RiED because of late side effects after RT that significantly affects quality of life of prostate cancer patients. Within 5 years of RT, approximately 50% of patients could develop RiED. Based on the past and current research findings and number of publications from our group, the precise mechanism of RiED is under exploration in detail. Recent investigations have shown prostate RT induces significant morphologic arterial damage with aberrant alterations in internal pudendal arterial tone. Prostatic RT also reduces motor function in the cavernous nerve which may attribute to axonal degeneration may contributing to RiED. Furthermore, the advances in radiogenomics such as radiation induced somatic mutation identification, copy number variation and genome-wide association studies has significantly facilitated identification of biomarkers that could be used to monitoring radiation-induced late toxicity and damage to the nerves; thus, genomic- and proteomic-based biomarkers could greatly improve treatment and minimize arterial tissue and nerve damage. Further, advanced technologies such as proton beam therapy that precisely target tumor and significantly reduce off-target damage to vital organs and healthy tissues. In this review, we summarize recent advances in RiED research and novel treatment modalities for RiED. We also discuss the possible molecular mechanism involved in the development of RiED in prostate cancer patients. Further, we discuss various readily available methods as well as novel strategies such as stem cell therapies, shockwave therapy, nerve grafting with tissue engineering, and nutritional supplementations might be used to

  14. Recent Advances and Future Directions for Quality Engineering

    Vining, Geoff; Kulahci, Murat; Pedersen, Søren

    2015-01-01

    The origins of quality engineering are in manufacturing, where quality engineers apply basic statistical methodologies to improve the quality and productivity of products and processes. In the past decade, people have discovered that these methodologies are effective for improving almost any type...... of system or process, such as financial, health care, and supply chains. This paper begins with a review of key advances and trends within quality engineering over the past decade. The second part uses the first part as a foundation to outline new application areas for the field. It also discusses how...

  15. Advance directives or living wills: reflections of general practitioners ...

    Background: Living wills have long been associated with end-of-life care. This study explored the promotion of living wills by general practitioners (GPs) and frail care nursing coordinators who were directly involved in the care of the elderly in Howick, KwaZulu-Natal. The study also explored their views regarding the pro ...

  16. Multiaxial ratcheting with advanced kinematic and directional distortional hardening rules

    Feigenbaum, H. P.; Dugdale, J.; Dafalias, Y.F.; Kourousis, K. I.; Plešek, Jiří

    2012-01-01

    Roč. 49, č. 22 (2012), s. 3063-3076 ISSN 0020-7683 R&D Projects: GA MŠk(CZ) ME10024 Institutional research plan: CEZ:AV0Z20760514 Keywords : plasticity * directional distortional hardening * thermodynamics Subject RIV: JJ - Other Materials Impact factor: 1.871, year: 2012 http://www.sciencedirect.com/science/article/pii/S0020768312002612

  17. Direct medical cost and utility analysis of diabetics outpatient at Karanganyar public hospital

    Eristina; Andayani, T. M.; Oetari, R. A.

    2017-11-01

    Diabetes Mellitus is a high cost disease, especially in long-term complication treatment. Long-term complication treatment cost was a problem for the patient, it can affect patients quality of life stated with utility value. The purpose of this study was to determine the medical cost, utility value and leverage factors of diabetics outpatient. This study was cross sectional design, data collected from retrospective medical record of the financial and pharmacy department to obtain direct medical cost, utility value taken from EQ-5D-5L questionnaire. Data analyzed by Mann-Whitney and Kruskal-Wallis test. Results of this study were IDR 433,728.00 for the direct medical cost and pharmacy as the biggest cost. EQ-5D-5L questionnaire showed the biggest proportion on each dimension were 61% no problem on mobility dimension, 89% no problems on self-care dimension, 54% slight problems on usual activities dimension, 41% moderate problems on pain/discomfort dimension and 48% moderate problems on anxiety/depresion dimension. Build upon Thailand value set, utility value was 0.833. Direct medical cost was IDR 433,728.00 with leverage factors were pattern therapy, blood glucose level and complication. Utility value was 0.833 with leverage factors were patients characteristic, therapy pattern, blood glucose level and complication.

  18. Advanced direct liquefaction concepts for PETC generic units

    1992-04-01

    In the Advance Coal Liquefaction Concept Proposal (ACLCP) carbon monoxide (CO) and water have been proposed as the primary reagents in the pretreatment process. The main objective of this project is to develop a methodology for pretreating coal under mild conditions based on a combination of existing processes which have shown great promise in liquefaction, extraction and pyrolysis studies. The aim of this pretreatment process is to partially depolymerise the coal, eliminate oxygen and diminish the propensity for retograde reactions during subsequent liquefaction. The desirable outcome of the CO pretreatment step should be: (1) enhanced liquefaction activity and/or selectivity toward products of higher quality due to chemical modification of the coal structure; (2) cleaner downstream products; (3) overall improvement in operability and process economics.

  19. Geothermal energy in deep aquifers : A global assessment of the resource base for direct heat utilization

    Limberger, J.|info:eu-repo/dai/nl/371572037; Boxem, T.; Pluymaekers, Maarten; Bruhn, David; Manzella, Adelle; Calcagno, Philippe; Beekman, F.|info:eu-repo/dai/nl/123556856; Cloetingh, S.|info:eu-repo/dai/nl/069161836; van Wees, J.-D.

    In this paper we present results of a global resource assessment for geothermal energy within deep aquifers for direct heat utilization. Greenhouse heating, spatial heating, and spatial cooling are considered in this assessment. We derive subsurface temperatures from geophysical data and apply a

  20. Geothermal energy in deep aquifers: A global assessment of the resource base for direct heat utilization

    Limberger, J.; Boxem, T.; Pluymaekers, M.; Bruhn, D.; Manzella, A.; Calcagno, P.; Beekman, F.; Cloetingh, S.; Wees, J.D. van

    2018-01-01

    In this paper we present results of a global resource assessment for geothermal energy within deep aquifers for direct heat utilization. Greenhouse heating, spatial heating, and spatial cooling are considered in this assessment. We derive subsurface temperatures from geophysical data and apply a

  1. Geothermal energy in deep aquifers : A global assessment of the resource base for direct heat utilization

    Limberger, Jon; Boxem, Thijs; Pluymaekers, Maarten; Bruhn, D.F.; Manzella, Adele; Calcagno, Philippe; Beekman, Fred; Cloetingh, S.A.P.L.; van Wees, Jan Diederik

    2018-01-01

    In this paper we present results of a global resource assessment for geothermal energy within deep aquifers for direct heat utilization. Greenhouse heating, spatial heating, and spatial cooling are considered in this assessment. We derive subsurface temperatures from geophysical data and apply a

  2. Preschool life skills: Recent advancements and future directions.

    Fahmie, Tara A; Luczynski, Kevin C

    2018-01-01

    Over the past decade, researchers have replicated and extended research on the preschool life skills (PLS) program developed by Hanley, Heal, Tiger, and Ingvarsson (2007). This review summarizes recent research with respect to maximizing skill acquisition, improving generality, evaluating feasibility and acceptability, and testing predictions of the initial PLS study. For each area, we suggest directions for future research. © 2018 Society for the Experimental Analysis of Behavior.

  3. Virtual medicine: Utilization of the advanced cardiac imaging patient avatar for procedural planning and facilitation.

    Shinbane, Jerold S; Saxon, Leslie A

    Advances in imaging technology have led to a paradigm shift from planning of cardiovascular procedures and surgeries requiring the actual patient in a "brick and mortar" hospital to utilization of the digitalized patient in the virtual hospital. Cardiovascular computed tomographic angiography (CCTA) and cardiovascular magnetic resonance (CMR) digitalized 3-D patient representation of individual patient anatomy and physiology serves as an avatar allowing for virtual delineation of the most optimal approaches to cardiovascular procedures and surgeries prior to actual hospitalization. Pre-hospitalization reconstruction and analysis of anatomy and pathophysiology previously only accessible during the actual procedure could potentially limit the intrinsic risks related to time in the operating room, cardiac procedural laboratory and overall hospital environment. Although applications are specific to areas of cardiovascular specialty focus, there are unifying themes related to the utilization of technologies. The virtual patient avatar computer can also be used for procedural planning, computational modeling of anatomy, simulation of predicted therapeutic result, printing of 3-D models, and augmentation of real time procedural performance. Examples of the above techniques are at various stages of development for application to the spectrum of cardiovascular disease processes, including percutaneous, surgical and hybrid minimally invasive interventions. A multidisciplinary approach within medicine and engineering is necessary for creation of robust algorithms for maximal utilization of the virtual patient avatar in the digital medical center. Utilization of the virtual advanced cardiac imaging patient avatar will play an important role in the virtual health care system. Although there has been a rapid proliferation of early data, advanced imaging applications require further assessment and validation of accuracy, reproducibility, standardization, safety, efficacy, quality

  4. Chronically homeless persons' participation in an advance directive intervention: A cohort study.

    Leung, Alexander K; Nayyar, Dhruv; Sachdeva, Manisha; Song, John; Hwang, Stephen W

    2015-09-01

    Chronically homeless individuals have high rates of hospitalization and death, and they may benefit from the completion of advance directives. To determine the rate of advance directive completion using a counselor-guided intervention, identify characteristics associated with advance directive completion, and describe end-of-life care preferences in a group of chronically homeless individuals. Participants completed a survey and were offered an opportunity to complete an advance directive with a trained counselor. A total of 205 residents of a shelter in Canada for homeless men (89.1% of those approached) participated from April to June 2013. Duration of homelessness was ⩾12 months in 72.8% of participants, and 103 participants (50.2%) chose to complete an advance directive. Socio-demographic characteristics, health status, and health care use were not associated with completion of an advance directive. Participants were more likely to complete an advance directive if they reported thinking about death on a daily basis, believed that thinking about their friends and family was important, or reported knowing their wishes for end-of-life care but not having told anyone about these wishes. Among individuals who completed an advance directive, 61.2% named a substitute decision maker, and 94.1% expressed a preference to receive cardiopulmonary resuscitation in the event of a cardiorespiratory arrest if there was a chance of returning to their current state of health. A counselor-guided intervention can achieve a high rate of advance directive completion among chronically homeless persons. Most participants expressed a preference to receive cardiopulmonary resuscitation in the event of a cardiorespiratory arrest. © The Author(s) 2015.

  5. Multifunctional nanodiamonds in regenerative medicine: Recent advances and future directions.

    Whitlow, Jonathan; Pacelli, Settimio; Paul, Arghya

    2017-09-10

    With recent advances in the field of nanomedicine, many new strategies have emerged for diagnosing and treating diseases. At the forefront of this multidisciplinary research, carbon nanomaterials have demonstrated unprecedented potential for a variety of regenerative medicine applications including novel drug delivery platforms that facilitate the localized and sustained release of therapeutics. Nanodiamonds (NDs) are a unique class of carbon nanoparticles that are gaining increasing attention for their biocompatibility, highly functional surfaces, optical properties, and robust physical properties. Their remarkable features have established NDs as an invaluable regenerative medicine platform, with a broad range of clinically relevant applications ranging from targeted delivery systems for insoluble drugs, bioactive substrates for stem cells, and fluorescent probes for long-term tracking of cells and biomolecules in vitro and in vivo. This review introduces the synthesis techniques and the various routes of surface functionalization that allow for precise control over the properties of NDs. It also provides an in-depth overview of the current progress made toward the use of NDs in the fields of drug delivery, tissue engineering, and bioimaging. Their future outlook in regenerative medicine including the current clinical significance of NDs, as well as the challenges that must be overcome to successfully translate the reviewed technologies from research platforms to clinical therapies will also be discussed. Copyright © 2017 Elsevier B.V. All rights reserved.

  6. Sciences of geodesy I advances and future directions

    Xu, Guochang

    2010-01-01

    This series of reference books describes sciences of different elds in and around geodesy with independent chapters. Each chapter covers an individual eld and describes the history, theory, objective, technology, development, highlights of research and applications. In addition, problems as well as future directions are discussed. The subjects of this reference book include Absolute and Relative Gravimetry, Adaptively Robust Kalman Filters with Applications in Navigation, Airborne Gravity Field Determination, Analytic Orbit Theory, Deformation and Tectonics, Earth Rotation, Equivalence of GPS Algorithms and its Inference, Marine Geodesy, Satellite Laser Ranging, Superconducting Gravimetry and Synthetic Aperture Radar Interferometry. These are individual subjects in and around geodesy and are for the rst time combined in a unique book which may be used for teaching or for learning basic principles of many subjects related to geodesy. The material is suitable to provide a general overview of geodetic sciences f...

  7. Direct estimates of unemployment rate and capacity utilization in macroeconometric models

    Klein, L R [Univ. of Pennsylvania, Philadelphia; Su, V

    1979-10-01

    The problem of measuring resource-capacity utilization as a factor in overall economic efficiency is examined, and a tentative solution is offered. A macro-econometric model is applied to the aggregate production function by linking unemployment rate and capacity utilization rate. Partial- and full-model simulations use Wharton indices as a filter and produce direct estimates of unemployment rates. The simulation paths of durable-goods industries, which are more capital-intensive, are found to be more sensitive to business cycles than the nondurable-goods industries. 11 references.

  8. What explains racial differences in the use of advance directives and attitudes toward hospice care?

    Johnson, Kimberly S.; Kuchibhatla, Maragatha; Tulsky, James A.

    2008-01-01

    Cultural beliefs and values are thought to account for differences between African Americans and Whites in the use of advance directives and beliefs about hospice care. However, little data clarifies which beliefs and values explain these differences.

  9. Ceramic thermal wind sensor based on advanced direct chip attaching package

    Zhou Lin; Qin Ming; Chen Shengqi; Chen Bei

    2014-01-01

    An advanced direct chip attaching packaged two-dimensional ceramic thermal wind sensor is studied. The thermal wind sensor chip is fabricated by metal lift-off processes on the ceramic substrate. An advanced direct chip attaching (DCA) packaging is adopted and this new packaged method simplifies the processes of packaging further. Simulations of the advanced DCA packaged sensor based on computational fluid dynamics (CFD) model show the sensor can detect wind speed and direction effectively. The wind tunnel testing results show the advanced DCA packaged sensor can detect the wind direction from 0° to 360° and wind speed from 0 to 20 m/s with the error less than 0.5 m/s. The nonlinear fitting based least square method in Matlab is used to analyze the performance of the sensor. (semiconductor devices)

  10. Status and future directions for advanced accelerator research - conventional and non-conventional collider concepts

    Siemann, R.H.

    1997-01-01

    The relationship between advanced accelerator research and future directions for particle physics is discussed. Comments are made about accelerator research trends in hadron colliders, muon colliders, and e + 3 - linear colliders

  11. Effect of the Contents in Advance Directives on Individuals' Decision-Making.

    Park, Jae Yoon; Lim, Chi-Yeon; Puurveen, Gloria; Kim, Do Yeun; Lee, Jae Hang; Do, Han Ho; Kim, Kyung Soo; Yoo, Kyung Don; Kim, Hyo Jin; Kim, Yunmi; Shin, Sung Joon

    2018-01-01

    Completing an advance directive offers individuals the opportunity to make informed choices about end-of-life care. However, these decisions could be influenced in different ways depending on how the information is presented. We randomly presented 185 participants with four distinct types of advance directive: neutrally framed (as reference), negatively framed, religiously framed, and a combination. Participants were asked which interventions they would like to receive at the end of life. Between 60% and 70% of participants responded "accept the special interventions" on the reference form. However, the majority (70%-90%) chose "refuse the interventions" on the negative form. With respect to the religious form, 70% to 80% chose "not decided yet." Participants who refused special life-sustaining treatments were older, female, and with better prior knowledge about advance directives. Our findings imply that the specific content of advance directives could affect decision-making with regard to various interventions for end-of-life care.

  12. Advances and Research Directions in Data-Warehousing Technology

    Mukesh Mohania

    1999-11-01

    Full Text Available Information is one of the most valuable assets of an organisation and when used properly can assist in intelligent decision making that can significantly improve the functioning of an organisation. Data Warehousing is a recent technology that allows information to be easily and efficiently accessed for decision-making activities by collecting data from many operational, legacy and possibly heterogeneous data sources. On-Line Analytical Processing (OLAP tools are well-suited for complex data analysis, such as multi-dimensional data analysis, and to assist in decision support activities while data mining tools take the process one step further and actively search the data for patterns and hidden knowledge in the data held in the warehouse. Many organisations are building, or are planning to develop, a data warehouse for their operational and decision support needs. In this paper, we present an overview of data warehousing, multi-dimensional databases, OLAP and data mining technology and discuss the directions of current research in the area. We also discuss recent developments in data warehouse modelling, view selection and maintenance, indexing schemes, parallel query processing and data mining issues. A number of technical issues for exploratory research are presented and possible solutions are also discussed.

  13. Soil respiration in Mexico: Advances and future directions

    Alejandro Cueva

    2016-07-01

    Full Text Available Soil respiration (RS is a CO2 efflux from the soil to the atmosphere defined as the sum of autotrophic (respiration by roots and mycorrhizae, and heterotrophic (respiration of microorganisms that decompose fractions of organic matter and of soil fauna respiration. Globally, RS is considered to be the second largest flux of C to the atmosphere. From published literature it is clear that its main controls are soil temperature, soil moisture, photosynthesis, organic matter inputs and soil biota composition. Despite its relevance in C cycle science, there have been only twenty eight studies in Mexico in the last decade where direct measurement of gas exchange was conducted in the field. These studies were held mostly in agricultural and forest ecosystems, in Central and Southern Mexico where mild subtropical conditions prevail. However, arid, semi-arid, tropical and wetland ecosystems may have an important role in Mexico’s CO2 emissions because of their extent and extensive land use changes. From the twenty eight studies, only two provided continuous measurements of RS with high temporal resolution, highlighting the need for long-term studies to evaluate the complex biophysical controls of this flux and associated processes over different ecological succession stages. We conclude that Mexico represents an important opportunity to understand its complex dynamics, in national and global context, as ecosystems in the country cover a wide range of climatic conditions. This is particularly important because deforestation and degradation of Mexican ecosystems is rapidly increasing along with expected changes in climate.

  14. Advancing the Field Elder Abuse: Future Directions and Policy Implications

    Dong, XinQi

    2012-01-01

    Elder abuse, sometime called elder mistreatment or elder maltreatment, includes psychological, physical, and sexual abuse, neglect (caregiver neglect and self-neglect), and financial exploitation. Evidence suggests that 1 out of 10 older adult experiences some form of elder abuse, and only 1 of out 25 cases are actually reported to social services agencies. At the same time, elder abuse is associated with significant morbidity and premature mortality. Despite these findings, there is a great paucity in research, practice, and policy dealing with the pervasive issues of elder abuse. Through my experiences as a American Political Sciences Association Congressional Policy Fellow/Health and Aging Policy Fellow working with Administration on Community Living (ACL) (Previously known at Administration on Aging (AoA)) for the last two years, I will describe the major functions of the ACL; and highlight on two major pieces of federal legislation: The Older Americans Act (OAA) and the Elder Justice Act (EJA). Moreover, I will highlight major research gaps and future policy relevant research directions for the field of elder abuse. PMID:23110488

  15. Ultraclean Fuels Production and Utilization for the Twenty-First Century: Advances toward Sustainable Transportation Fuels

    Fox, Elise B.; Liu, Zhong-Wen; Liu, Zhao-Tie

    2013-11-21

    Ultraclean fuels production has become increasingly important as a method to help decrease emissions and allow the introduction of alternative feed stocks for transportation fuels. Established methods, such as Fischer-Tropsch, have seen a resurgence of interest as natural gas prices drop and existing petroleum resources require more intensive clean-up and purification to meet stringent environmental standards. This review covers some of the advances in deep desulfurization, synthesis gas conversion into fuels and feed stocks that were presented at the 245th American Chemical Society Spring Annual Meeting in New Orleans, LA in the Division of Energy and Fuels symposium on "Ultraclean Fuels Production and Utilization".

  16. The implementation of psychiatric advance directives: Experiences from a Dutch crisis card initiative.

    van der Ham, A.J.; Voskes, Y.; van Kempen, N.; Broerse, J.E.W.; Widdershoven, G.A.

    2013-01-01

    Objective: The crisis card is a specific form of psychiatric advance directive, documenting mental clients' treatment preferences in advance of a potential psychiatric crisis. In this paper, we aim to provide insight into implementation issues surrounding the crisis card. Method: A Dutch crisis-card

  17. Standardization of advanced light water reactors and progress on achieving utility requirements

    Marston, T.U.; Layman, W.H.; Bockhold, G. Jr.

    1992-01-01

    This paper reports that for a number of years, the U.S. utilities had led an industry-wide effort to establish a technical foundation for the design of the next generation of light water reactors in the United States. Since 1985, this utility initiative has been effected through a major technical program managed by the Electric Power Research Institute (EPRI); the U.S. Advanced Light Water Reactor (ALWR) Program. In addition to the U.S. utility leadership and sponsorship, the ALWR Program also has the participation and sponsorship of a number of international utility companies and close cooperation with the U.S. Department of Energy (DOE). The NPOC Strategic Plan for Building New Nuclear Plants creates a framework within which new standardized nuclear plants may be built. The Strategic Plan is an expression of the nuclear energy industry's serious intent to create the necessary conditions for new plant construction and operation. The industry has assembled a comprehensive, integrated list of actions that must be taken before new plants will be built and assigns responsibility for managing the various issues and sets time-tables and milestones against which we must measure progress

  18. Advanced Grid-Friendly Controls Demonstration Project for Utility-Scale PV Power Plants

    Gevorgian, Vahan; O' Neill, Barbara

    2016-01-21

    A typical photovoltaic (PV) power plant consists of multiple power electronic inverters and can contribute to grid stability and reliability through sophisticated 'grid-friendly' controls. The availability and dissemination of actual test data showing the viability of advanced utility-scale PV controls among all industry stakeholders can leverage PV's value from being simply an energy resource to providing additional ancillary services that range from variability smoothing and frequency regulation to power quality. Strategically partnering with a selected utility and/or PV power plant operator is a key condition for a successful demonstration project. The U.S. Department of Energy's (DOE's) Solar Energy Technologies Office selected the National Renewable Energy Laboratory (NREL) to be a principal investigator in a two-year project with goals to (1) identify a potential partner(s), (2) develop a detailed scope of work and test plan for a field project to demonstrate the gird-friendly capabilities of utility-scale PV power plants, (3) facilitate conducting actual demonstration tests, and (4) disseminate test results among industry stakeholders via a joint NREL/DOE publication and participation in relevant technical conferences. The project implementation took place in FY 2014 and FY 2015. In FY14, NREL established collaborations with AES and First Solar Electric, LLC, to conduct demonstration testing on their utility-scale PV power plants in Puerto Rico and Texas, respectively, and developed test plans for each partner. Both Puerto Rico Electric Power Authority and the Electric Reliability Council of Texas expressed interest in this project because of the importance of such advanced controls for the reliable operation of their power systems under high penetration levels of variable renewable generation. During FY15, testing was completed on both plants, and a large amount of test data was produced and analyzed that demonstrates the ability of

  19. Perspectives of Korean Patients, Families, Physicians and Nurses on Advance Directives

    Jia Lee, PhD, RN

    2010-12-01

    Conclusions: There were many differences in the perspectives of patients, families, physicians and nurses on advance directives. End-of-life care decisions should take the wishes of patients into account, and that such decisions should therefore be made before the patients lose the capacity to make them. To make well-informed decisions regarding future care, patients and families must be fully educated about advance directives and expected outcomes.

  20. Did you seek assistance for writing your advance directive? A qualitative study.

    Becker, Matthias; Jaspers, Birgit; King, Claudius; Radbruch, Lukas; Voltz, Raymond; Nauck, Friedemann

    2010-11-01

    the completion of an advanced directive is paired with a high degree of self-responsibility of the signatory. It requires anticipation of probably complex medical situations. In the literature, the family physician is often seen as the most important person for advice when writing an advance directive. But little is known about whether or not patients want to involve medical advisors and to what extent physicians are willing to give advice. The aim of this study was to analyse whether or not individuals approached advisors for the completion of their advance directive, whom they chose and which reasons were given for seeking or foregoing assistance. semi-structured interviews with healthy individuals, chronically ill individuals and patients in palliative care including questions associated with advice for completing an advance directive (8/2008-7/2009). age 55-70 years and advance directive ≥ 3 months old. The interviews were fully transcribed according to standard transcription rules and analysed applying an inductive category development. interviews were conducted with 53 probands (healthy n = 20, chronically ill n = 17, palliative care patients n = 16); 18 probands were male. Mean age was 63.2 ± 4.4 years (range 55-70 years). Professional advice was sought by 12 probands (physician = 2, nurse = 1, lawyer/notary = 8, self-employed advisor = 1), another 8 probands included family members. In 17 cases, the physician knew the proband's advance directive, 36 probands never told their doctor about its existence. Categories of reasons for seeking or foregoing advice were trust/lack of trust, autonomy, rejection and financial considerations. information about the medical implications concerning patient preferences for end-of-life care seems not to be the main focus of interest when individuals write an advance directive. Autonomy and trust into notarially certified documents seem to be more important matters. If family physicians want to have a role in their

  1. Radiation protection in dental radiology - Recent advances and future directions.

    Tsapaki, V

    2017-12-01

    Dental radiology uses X-ray technology to diagnose and design treatment of various clinical problems related to the oral cavity and surrounding tissues. As technology quickly evolves, there are numerous X-ray modalities using different tools in the attempt to best image and treat efficiently these diseases, disorders or other related clinical conditions. The reported numbers of dental X-rays, the fact that these may be under-reported in many countries and because dental X-rays are performed more on younger individuals, whose teeth and dentition are still developing, calls for increased need on radiation protection. The objectives of this paper are to report on the latest technology updates and related radiation protection issues, to present future directions and define gaps. Most of existing radiation protection national and international guidelines are more than a decade old. Update is needed to account for newer technologies such as cone beam computed tomography (CBCT) and digital imaging. Diagnostic Reference Levels (DRLs), a well established method for dose optimization, are not yet defined for CBCT and have to be set for various clinical indications. As far as shielding is concerned, recent data confirm that use of lead apron, even in pregnant patients, or gonadal shielding are not recommended, due to negligible radiation dose reduction. Thyroid lead shielding should be used in case the organ is in or close to the primary beam. Specifically for CBCT, leaded glasses, thyroid collars and collimation (smaller field of view (FOV) especially for paediatric patients) minimize the dose to organs outside the FOV. Copyright © 2017 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.

  2. Geothermal direct-heat utilization assistance. Quarterly report, October--December 1996

    NONE

    1996-12-31

    This report summarizes geothermal technical assistance, R&D and technology transfer activities of the Geo-Heat Center at Oregon Institute of Technology for the first quarter of FY-97. It describes 174 contracts with parties during this period related to technical assistance with geothermal direct heat projects. Areas dealt with include geothermal heat pumps, space heating, greenhouses, aquaculture, equipment, economics and resources. Research activities are summarized on greenhouse peaking. Outreach activities include the publication of a geothermal direct use Bulletin, dissemination of information, geothermal library, technical papers and seminars, and progress monitor reports on geothermal resources and utilization.

  3. Paramedics experiences and expectations concerning advance directives: a prospective, questionnaire-based, bi-centre study.

    Taghavi, Mahmoud; Simon, Alfred; Kappus, Stefan; Meyer, Nicole; Lassen, Christoph L; Klier, Tobias; Ruppert, David B; Graf, Bernhard M; Hanekop, Gerd G; Wiese, Christoph H R

    2012-10-01

    Advance directives and palliative crisis cards are means by which palliative care patients can exert their autonomy in end-of-life decisions. To examine paramedics' attitudes towards advance directives and end-of-life care. Questionnaire-based investigation using a self-administered survey instrument. Paramedics of two cities (Hamburg and Goettingen, Germany) were included. Participants were questioned as to (1) their attitudes about advance directives, (2) their clinical experiences in connection with end-of-life situations (e.g. resuscitation), (3) their suggestions in regard to advance directives, 'Do not attempt resuscitation' orders and palliative crisis cards. Questionnaires were returned by 728 paramedics (response rate: 81%). The majority of paramedics (71%) had dealt with advance directives and end-of-life decisions in emergency situations. Most participants (84%) found that cardiopulmonary resuscitation in end-of-life patients is not useful and 75% stated that they would withhold cardiopulmonary resuscitation in the case of legal possibility. Participants also mentioned that more extensive discussion of legal aspects concerning advance directives should be included in paramedic training curricula. They suggested that palliative crisis cards should be integrated into end-of-life care. Decision making in prehospital end-of-life care is a challenge for all paramedics. The present investigation demonstrates that a dialogue bridging emergency medical and palliative care issues is necessary. The paramedics indicated that improved guidelines on end-of-life decisions and the termination of cardiopulmonary resuscitation in palliative care patients may be essential. Participants do not feel adequately trained in end-of-life care and the content of advance directives. Other recent studies have also demonstrated that there is a need for training curricula in end-of-life care for paramedics.

  4. Can Utilities Realize the Benefits of Advanced Metering Infrastructure? : Lessons from the World Bank’s Portfolio

    Nangia, Varun; Oguah, Samuel; Gaba, Kwawu

    2016-01-01

    Advanced metering infrastructure (AMI) provides significant benefits to utilities around the world. Although it is entering the mainstream, technical concerns, policy challenges, capacity, and will in the Bank’s client countries hinder wider adoption. Starting out with smaller AMI deployments aimed at addressing revenue constraints seems to offer the best chance of success at utilities sup...

  5. Market study for direct utilization of geothermal resources by selected sectors of economy

    1980-08-01

    A comprehensive analysis is presented of industrial markets potential for direct use of geothermal energy by a total of six industry sectors: food and kindred products; tobacco manufactures; textile mill products; lumber and wood products (except furniture); chemicals and allied products; and leather and leather products. A brief statement is presented regarding sectors of the economy and major manufacturing processes which can readily utilize direct geothermal energy. Previous studies on plant location determinants are summarized and appropriate empirical data provided on plant locations. Location determinants and potential for direct use of geothermal resources are presented. The data was gathered through interviews with 30 senior executives in the six sectors of economy selected for study. Probable locations of plants in geothermal resource areas and recommendations for geothermal resource marketing are presented. Appendix A presents factors which impact on industry location decisions. Appendix B presents industry executives interviewed during the course of this study. (MHR)

  6. Advance Directives

    ... Data Conducting Clinical Trials Statistical Tools and Data Terminology Resources NCI Data Catalog Cryo-EM NCI's Role ... Withholding food and fluids Organ and tissue donation Medical Power of Attorney This is a document that ...

  7. Comparison of direct and indirect methods of estimating health state utilities for resource allocation: review and empirical analysis.

    Arnold, David; Girling, Alan; Stevens, Andrew; Lilford, Richard

    2009-07-22

    Utilities (values representing preferences) for healthcare priority setting are typically obtained indirectly by asking patients to fill in a quality of life questionnaire and then converting the results to a utility using population values. We compared such utilities with those obtained directly from patients or the public. Review of studies providing both a direct and indirect utility estimate. Papers reporting comparisons of utilities obtained directly (standard gamble or time tradeoff) or indirectly (European quality of life 5D [EQ-5D], short form 6D [SF-6D], or health utilities index [HUI]) from the same patient. PubMed and Tufts database of utilities. Sign test for paired comparisons between direct and indirect utilities; least squares regression to describe average relations between the different methods. Mean utility scores (or median if means unavailable) for each method, and differences in mean (median) scores between direct and indirect methods. We found 32 studies yielding 83 instances where direct and indirect methods could be compared for health states experienced by adults. The direct methods used were standard gamble in 57 cases and time trade off in 60(34 used both); the indirect methods were EQ-5D (67 cases), SF-6D (13), HUI-2 (5), and HUI-3 (37). Mean utility values were 0.81 (standard gamble) and 0.77 (time tradeoff) for the direct methods; for the indirect methods: 0.59(EQ-5D), 0.63 (SF-6D), 0.75 (HUI-2) and 0.68 (HUI-3). Direct methods of estimating utilities tend to result in higher health ratings than the more widely used indirect methods, and the difference can be substantial.Use of indirect methods could have important implications for decisions about resource allocation: for example, non-lifesaving treatments are relatively more favoured in comparison with lifesaving interventions than when using direct methods.

  8. Prevalence of advanced adenomas in small and diminutive colon polyps using direct measurement of size.

    Tsai, Franklin C; Strum, Williamson B

    2011-08-01

    Most studies reporting polyp size use visual estimates. Determining the prevalence of advanced histology based on direct measurement of polyp size may help guide the management of polyps found at optical colonoscopy (OC) and CT colonography (CTC). We designed a large, prospective study to assess the prevalence of advanced adenomas based on direct measurement of polyp size by a certified pathologists' assistant as reported in the pathology report. Patients between 40 and 89 years of age who presented for screening colonoscopy were included in our study. Advanced adenomas were defined as ≥10 mm or ≥25% villous features, high grade dysplasia or cancer. Polyps were divided by size into three groups: diminutive (≤5 mm), small (6-9 mm) and large (≥10 mm). If more than one adenoma was present, the most advanced was used for analysis. We evaluated 6,905 consecutive patients referred for colonoscopy between January 2005 and December 2006. Of the 4,967 who met the inclusion criteria, the mean age was 58.8 and consisted of 59% women. Overall, 930 (18.7%) had an adenoma; 248 (5%) were advanced adenomas including 8 (0.16%) cancers. Of 89 polyps≥10 mm, 76 (85%) had advanced histology; of 247 polyps 6-9 mm, 67 (27%) were advanced; of 1,025 polyps ≤5 mm, 105 (10%) were advanced. Thus, 172 of 248 (69%) patients with advanced adenomas had small or diminutive adenomas. Our data indicate the majority (69%) of advanced adenomas are advanced adenomas (10%). These findings may help guide the management of sub-centimeter colon polyps found by OC or CTC.

  9. Advanced system demonstration for utilization of biomass as an energy source. Environmental report

    McCollom, M.

    1979-01-01

    The conclusions and findings of extensive analyses undertaken to assess the environmental impacts and effects of the proposal to assist in an Advanced System Demonstration for Utilization of Biomass as an Energy Source by means of a wood-fueled power plant. Included are a description of the proposed project, a discussion of the existing environment that the project would affect, a summary of the project's impacts on the natural and human environments, a discussion of the project's relationships to other government policies and plans, and an extensive review of the alternatives which were considered in evaluating the proposed action. All findings of the research undertaken are discussed. More extensive presentations of the methods of analysis used to arrive at the various conclusions are available in ten topical technical appendices.

  10. What’s Needed from Climate Modeling to Advance Actionable Science for Water Utilities?

    Barsugli, J. J.; Anderson, C. J.; Smith, J. B.; Vogel, J. M.

    2009-12-01

    “…perfect information on climate change is neither available today nor likely to be available in the future, but … over time, as the threats climate change poses to our systems grow more real, predicting those effects with greater certainty is non-discretionary. We’re not yet at a level at which climate change projections can drive climate change adaptation.” (Testimony of WUCA Staff Chair David Behar to the House Committee on Science and Technology, May 5, 2009) To respond to this challenge, the Water Utility Climate Alliance (WUCA) has sponsored a white paper titled “Options for Improving Climate Modeling to Assist Water Utility Planning for Climate Change. ” This report concerns how investments in the science of climate change, and in particular climate modeling and downscaling, can best be directed to help make climate projections more actionable. The meaning of “model improvement” can be very different depending on whether one is talking to a climate model developer or to a water manager trying to incorporate climate projections in to planning. We first surveyed the WUCA members on present and potential uses of climate model projections and on climate inputs to their various system models. Based on those surveys and on subsequent discussions, we identified four dimensions along which improvement in modeling would make the science more “actionable”: improved model agreement on change in key parameters; narrowing the range of model projections; providing projections at spatial and temporal scales that match water utilities system models; providing projections that water utility planning horizons. With these goals in mind we developed four options for improving global-scale climate modeling and three options for improving downscaling that will be discussed. However, there does not seem to be a single investment - the proverbial “magic bullet” -- which will substantially reduce the range of model projections at the scales at which utility

  11. Challenges to implementation of advance directives of will in hospital practice.

    Cogo, Silvana Bastos; Lunardi, Valéria Lerch; Quintana, Alberto Manuel; Girardon-Perlini, Nara Marilene Oliveira; Silveira, Rosemary Silva da

    2016-01-01

    to understand the difficulties and limitations in the implementation of advance directives of will in the hospital context. qualitative, exploratory and descriptive study conducted by means of semi-structured interviews with nurses, resident physicians and family caregivers. The data were analyzed by using discursive textual analysis based on the framework of bioethics principles. the following categories emerged: Terminality as an expression of loss and cure as an option for care; concerns about legal implications; advance directives of will demand patient autonomy and proper communication. limitations and difficulties in practice of advance directives of will from the perspective of the participants show, apart from countless conflicts and dilemmas regarding end-of life matters, that impending death experiences obstruct patients' wishes.

  12. Japanese citizens' attitude toward end-of-life care and advance directives: A qualitative study for members of medical cooperatives.

    Hirayama, Yoko; Otani, Takashi; Matsushima, Masato

    2017-12-01

    Japanese citizens are interested in choosing their own end-of-life care, but few have created their own advance directive. This study examined changes among Japanese citizens' attitudes toward end-of-life care and advance directives and explored factors that affected these attitudes. We conducted five focus groups with 48 participants in 2009 and 2010. All participants were members of health cooperatives in Tokyo. We identified many barriers and reasons for creating and writing down advance directives. Experience caring for dying people and having a serious disease affected attitudes toward advance directives. Some participants changed their attitude toward end-of-life care by writing their own advance directive. When someone is writing advance directives, asking about his/her past experience of caring may be helpful. And learning about or filling out advance directives may help to break down resistance to using these documents.

  13. Utilization technique for advanced nuclear materials database system Data-Free-Way'

    Fujita, Mitsutane; Kurihara, Yutaka; Kinugawa, Junichi; Kitajima, Masahiro; Nagakawa, Josei; Yamamoto, Norikazu; Noda, Tetsuji; Yagi, Koichi; Ono, Akira

    2001-01-01

    Four organizations the National Research Institute for Metals (NRIM), the Japan Atomic Energy Research Institute (JAERI), the Japan Nuclear Fuel Cycle Development Institute (JNC) and Japan Science and Technology Incorporation (JST), conducted the 2nd period joint research for the purpose of development of utilization techniques for advanced nuclear materials database system named 'Data-Free-Way' (DFW), to make more useful system to support research and development of the nuclear materials, from FY 1995 to FY 1999. NRIM intended to fill a data system on diffusion and nuclear data by developing utilization technique on diffusion informations of steels and aluminum and nuclear data for materials for its independent system together with participating in fulfil of the DFW. And, NRIM has entered to a project on wide area band circuit application agreed at the G7 by using technologies cultivated by NRIM, to investigate network application technology with the Michigan State University over the sea under cooperation assistant business of JST, to make results on CCT diagram for welding and forecasting of welding heat history accumulated at NRIM for a long term, to perform development of a simulator assisting optimum condition decision of welding. (G.K.)

  14. Utilization technique for advanced nuclear materials database system Data-Free-Way'

    Fujita, Mitsutane; Kurihara, Yutaka; Kinugawa, Junichi; Kitajima, Masahiro; Nagakawa, Josei; Yamamoto, Norikazu; Noda, Tetsuji; Yagi, Koichi; Ono, Akira [National Research Inst. for Metals, Tsukuba, Ibaraki (Japan)

    2001-02-01

    Four organizations the National Research Institute for Metals (NRIM), the Japan Atomic Energy Research Institute (JAERI), the Japan Nuclear Fuel Cycle Development Institute (JNC) and Japan Science and Technology Incorporation (JST), conducted the 2nd period joint research for the purpose of development of utilization techniques for advanced nuclear materials database system named 'Data-Free-Way' (DFW), to make more useful system to support research and development of the nuclear materials, from FY 1995 to FY 1999. NRIM intended to fill a data system on diffusion and nuclear data by developing utilization technique on diffusion informations of steels and aluminum and nuclear data for materials for its independent system together with participating in fulfil of the DFW. And, NRIM has entered to a project on wide area band circuit application agreed at the G7 by using technologies cultivated by NRIM, to investigate network application technology with the Michigan State University over the sea under cooperation assistant business of JST, to make results on CCT diagram for welding and forecasting of welding heat history accumulated at NRIM for a long term, to perform development of a simulator assisting optimum condition decision of welding. (G.K.)

  15. Utilization of low temperature geothermal water in traditional and advanced agricultural applications

    Rossi, L.; Pacciaroni, F.

    1992-01-01

    The locations of large amounts of low temperature geothermal sources (30 to 80 degrees C) have been identified in Italy and in many European countries; one of the most interesting utilization of these sources is greenhouse heating. Surplus investment in comparison with conventional heating systems is justified only by the application of low cost technologies for well completion, heating distribution and waste heat treatment. In the last few years, many efforts have been made in the development of these technologies and selection of more profitable crops. Since 1984, ENEA (Italian Agency for Energy, New Technologies and the Environment) has carried out experimental work in two geothermal stations located in Canino (VT) and in Gorgo di Latisana (UD). In these plants, a number of greenhouses enveloped with plastic film are provided with different heating systems; the combination of soil and forced air heating is preferred. Plastic pipes, buried in the soil, are used as soil heating for horticulture and fruit production. For plot plant cultivation, soil heating is obtained by plastic pipes half-buried in a concrete floor. Asparagus cultivation is carried out with buried pipes. No additional heating with conventional fuel is provided in any greenhouse. During these years, ENEA has developed heating and water distribution technologies: current industrial components are generally utilized. Moreover, ENEA has recently completed an advanced automatic control system able to control geothermal greenhouses, manage water distribution, save energy and optimize environmental conditions

  16. Utilization of low temperature geothermal water in traditional and advanced agricultural applications

    Rossi, L.; Pacciaroni, F.

    1992-12-31

    The locations of large amounts of low temperature geothermal sources (30 to 80 degrees C) have been identified in Italy and in many European countries; one of the most interesting utilization of these sources is greenhouse heating. Surplus investment in comparison with conventional heating systems is justified only by the application of low cost technologies for well completion, heating distribution and waste heat treatment. In the last few years, many efforts have been made in the development of these technologies and selection of more profitable crops. Since 1984, ENEA (Italian Agency for Energy, New Technologies and the Environment) has carried out experimental work in two geothermal stations located in Canino (VT) and in Gorgo di Latisana (UD). In these plants, a number of greenhouses enveloped with plastic film are provided with different heating systems; the combination of soil and forced air heating is preferred. Plastic pipes, buried in the soil, are used as soil heating for horticulture and fruit production. For plot plant cultivation, soil heating is obtained by plastic pipes half-buried in a concrete floor. Asparagus cultivation is carried out with buried pipes. No additional heating with conventional fuel is provided in any greenhouse. During these years, ENEA has developed heating and water distribution technologies: current industrial components are generally utilized. Moreover, ENEA has recently completed an advanced automatic control system able to control geothermal greenhouses, manage water distribution, save energy and optimize environmental conditions.

  17. High Gain and High Directive of Antenna Arrays Utilizing Dielectric Layer on Bismuth Titanate Ceramics

    F. H. Wee

    2012-01-01

    Full Text Available A high gain and high directive microstrip patch array antenna formed from dielectric layer stacked on bismuth titanate (BiT ceramics have been investigated, fabricated, and measured. The antennas are designed and constructed with a combination of two-, four-, and six-BiT elements in an array form application on microwave substrate. For gain and directivity enhancement, a layer of dielectric was stacked on the BiT antenna array. We measured the gain and directivity of BiT array antennas with and without the dielectric layer and found that the gain of BiT array antenna with the dielectric layer was enhanced by about 1.4 dBi of directivity and 1.3 dB of gain over the one without the dielectric layer at 2.3 GHz. The impedance bandwidth of the BiT array antenna both with and without the dielectric layer is about 500 MHz and 350 MHz, respectively, which is suitable for the application of the WiMAX 2.3 GHz system. The utilization of BiT ceramics that covers about 90% of antenna led to high radiation efficiency, and small-size antennas were produced. In order to validate the proposed design, theoretical and measured results are provided and discussed.

  18. Advanced Reactor Technology Options for Utilization and Transmutation of Actinides in Spent Nuclear Fuel

    2009-09-01

    Renewed interest in the potential of nuclear energy to contribute to a sustainable worldwide energy mix is strengthening the IAEA's statutory role in fostering the peaceful uses of nuclear energy, in particular the need for effective exchanges of information and collaborative research and technology development among Member States on advanced nuclear power technologies (Articles III-A.1 and III-A.3). The major challenges facing the long term development of nuclear energy as a part of the world's energy mix are improvement of the economic competitiveness, meeting increasingly stringent safety requirements, adhering to the criteria of sustainable development, and public acceptability. The concern linked to the long life of many of the radioisotopes generated from fission has led to increased R and D efforts to develop a technology aimed at reducing the amount of long lived radioactive waste through transmutation in fission reactors or accelerator driven hybrids. In recent years, in various countries and at an international level, more and more studies have been carried out on advanced and innovative waste management strategies (i.e. actinide separation and elimination). Within the framework of the Project on Technology Advances in Fast Reactors and Accelerator Driven Systems (http://www.iaea.org/inisnkm/nkm/aws/fnss/index.html), the IAEA initiated a number of activities on utilization of plutonium and transmutation of long lived radioactive waste, accelerator driven systems, thorium fuel options, innovative nuclear reactors and fuel cycles, non-conventional nuclear energy systems, and fusion/fission hybrids. These activities are implemented under the guidance and with the support of the IAEA Nuclear Energy Department's Technical Working Group on Fast Reactors (TWG-FR). This publication compiles the analyses and findings of the Coordinated Research Project (CRP) on Studies of Advanced Reactor Technology Options for Effective Incineration of Radioactive Waste (2002

  19. Resource potential of bamboo, challenges and future directions towards sustainable management and utilization in Ethiopia

    Getachew Desalegn

    2014-08-01

    Full Text Available Aim of study: Bamboo, the fastest growing and high yielding perennial plant of the world has more than 1500 species and 1500 versatile socio-economic uses and ecological services. Ethiopia has two indigenous bamboo species namely Yushania alpina and Oxytenantheria abyssinica, covering about one million ha with a wide distribution. The objective of this paper is to highlight the potential of bamboo resources, challenges including biodeterioration damage, opportunities and future research directions towards its sustainable management and rational utilization.Area of study: Bamboo resources of EthiopiaMaterial and Methods: Reconnaissance survey was done to some parts of the bamboo growing potential areas in Ethiopia besides the literature review. Main results: The bamboo resource, despite its socio-economic and environmental benefits, currently, in most areas has been under high pressure due to land use changes, bamboo mass- flowering, poor processing with low value addition, and damage by biodeteriorating agents (termites, beetles and fungi. The preservative tests on Ethiopian bamboos revealed low natural durability and highlighted the paramount importance of appropriate protection measures such as Tanalith and vehicles used motor oil to increase durability, service life and rational utilization of bamboo-based products and structures as potential alternative construction and furniture material.Research highlights: Therefore, integrated research and development interventions involving different propagation and managements techniques, harvesting season, processing, value addition including proper seasoning and preservation technologies and marketing are recommended to fill the information and technological gaps on sustainable management and rational utilization of this fast growing and multipurpose bamboo resources in Ethiopia.Key words: Bamboo; challenges; management; socio-economic and environmental significance; utilization.

  20. Impact of an Advanced Imaging Utilization Review Program on Downstream Health Care Utilization and Costs for Low Back Pain.

    Graves, Janessa M; Fulton-Kehoe, Deborah; Jarvik, Jeffrey G; Franklin, Gary M

    2018-06-01

    Early magnetic resonance imaging (MRI) for acute low back pain (LBP) has been associated with increased costs, greater health care utilization, and longer disability duration in workers' compensation claimants. To assess the impact of a state policy implemented in June 2010 that required prospective utilization review (UR) for early MRI among workers' compensation claimants with LBP. Interrupted time series. In total, 76,119 Washington State workers' compensation claimants with LBP between 2006 and 2014. Proportion of workers receiving imaging per month (MRI, computed tomography, radiographs) and lumbosacral injections and surgery; mean total health care costs per worker; mean duration of disability per worker. Measures were aggregated monthly and attributed to injury month. After accounting for secular trends, decreases in early MRI [level change: -5.27 (95% confidence interval, -4.22 to -6.31); trend change: -0.06 (-0.01 to -0.12)], any MRI [-4.34 (-3.01 to -5.67); -0.10 (-0.04 to -0.17)], and injection [trend change: -0.12 (-0.06 to -0.18)] utilization were associated with the policy. Radiograph utilization increased in parallel [level change: 2.46 (1.24-3.67)]. In addition, the policy resulted in significant decreasing changes in mean costs per claim, mean disability duration, and proportion of workers who received disability benefits. The policy had no effect on computed tomography or surgery utilization. The UR policy had discernable effects on health care utilization, costs, and disability. Integrating evidence-based guidelines with UR can improve quality of care and patient outcomes, while reducing use of low-value health services.

  1. Advance directives for euthanasia in dementia: do law-based opportunities lead to more euthanasia?

    de Boer, M.E.; Dröes, R.M.; Jonker, C.; Eefsting, J.A.; Hertogh, C.M.P.M.

    2010-01-01

    Objective: To obtain insight into current practices regarding compliance with advance directives for euthanasia (ADEs) in cases of incompetent patients with dementia in Dutch nursing homes, in light of the legal possibility offered by the new euthanasia law to perform euthanasia in these cases.

  2. Hospital policies on life-sustaining treatments and advance directives in Canada.

    Rasooly, I; Lavery, J V; Urowitz, S; Choudhry, S; Seeman, N; Meslin, E M; Lowy, F H; Singer, P A

    1994-01-01

    OBJECTIVE: To determine the prevalence and content of hospital policies on life-sustaining treatments (cardiopulmonary resuscitation [CPR], mechanical ventilation, dialysis, artificial nutrition and hydration, and antibiotic therapy for life-threatening infections) and advance directives in Canada. DESIGN: Cross-sectional mailed survey. SETTING: Canada. PARTICIPANTS: Chief executive officers or their designates at public general hospitals. MAIN OUTCOME MEASURES: Information regarding the exis...

  3. A critical review of advance directives in Germany: attitudes, use and healthcare professionals’ compliance

    Evans, N.; Bausewein, C.; Meñaca, A.; Andrew, E.V.W.; Higginson, I.J.; Harding, R.; Pool, R.; Gysels, M.

    2012-01-01

    Objective Recent legal changes in Germany make non-compliance with advance directives (ADs) a criminal offence. This article assesses the evidence on attitudes towards, use of, and physician compliance with ADs in Germany. Methods Critical review: studies on ADs, identified from a systematic review

  4. Joint crisis plans and psychiatric advance directives in German psychiatric practice.

    Radenbach, Katrin; Falkai, Peter; Weber-Reich, Traudel; Simon, Alfred

    2014-05-01

    This study explores the attitude of German psychiatrists in leading positions towards joint crisis plans and psychiatric advance directives. This topic was examined by contacting 473 medical directors of German psychiatric hospitals and departments. They were asked to complete a questionnaire developed by us. That form contained questions about the incidence and acceptance of joint crisis plans and psychiatric advance directives and previous experiences with them. 108 medical directors of psychiatric hospitals and departments responded (response rate: 22.8%). Their answers demonstrate that in their hospitals these documents are rarely used. Among the respondents, joint crisis plans are more accepted than psychiatric advance directives. There is a certain uncertainty when dealing with these instruments. Our main conclusion is that German psychiatry needs an intensified discussion on the use of instruments for patients to constitute procedures for future critical psychiatric events. For this purpose it will be helpful to collect more empirical data. Furthermore, the proposal of joint crisis plans in psychiatric hospitals and departments should be discussed as well as the possibility of consulting an expert during the preparation of a psychiatric advance directive.

  5. Small break loss of coolant accident analysis of advanced PWR plant designs utilizing DVI line venturis

    Kemper, Robert M.; Gagnon, Andre F.; McNamee, Kevin; Cheung, Augustine C.

    1995-01-01

    The Westinghouse Advanced Passive and evolutionary Pressurizer Water Reactors (i.e. AP600 and APWR) incorporate direct vessel injection (DVI) of emergency core coolant as a means of minimizing the potential spilling of emergency core cooling water during a loss of coolant accident (LOCA). As a result, the most limiting small break LOCA (SBLOCA) event for these designs, with respect core inventory makeup capability, is a postulated double ended rupture of one of the DVI lines. This paper presents the results of a design optimization study that examines the installation of a venturi in the DVI line as a means of limiting the reactor coolant lost from the reactor vessel. The comparison results demonstrate that by incorporating a properly sized venturi in the DVI line, core uncovery concerns as a result of a DVI line break can be eliminated for both the AP600 and APWR plants. (author)

  6. Online, directed journaling in community health advanced practice nursing clinical education.

    Daroszewski, Ellen Beth; Kinser, Anita G; Lloyd, Susan L

    2004-04-01

    The sharing of experiences in advanced practice nursing clinical courses allows for application of core principals to different facets of practice, with the potential to promote discussions beyond the course objectives, create opportunities for mentoring, foster critical thinking, and facilitate change and socialization into advanced practice. A pilot test of online, directed journaling, an innovative sharing and reflection strategy, was incorporated in a two-quarter community health advanced practice nursing clinical course in an attempt to enhance clinical learning. Six female graduate nursing students completed the journaling. A 10-item evaluation measure demonstrated that the online journaling strategy was highly effective and valuable for the students. An assessment of the journaling entries found multiple examples of discussion, mentoring, critical thinking, and socialization. Innovative online strategies should become the standard for sharing in advanced practice nursing education.

  7. Effect of adaptive abilities on utilities, direct or mediated by mental health?

    Peeters, Yvette; Ranchor, Adelita V.; Vlieland, Thea P. M. Vliet; Stiggelbout, Anne M.

    2010-01-01

    Background: In cost-utility analyses gain in health can be measured using health state utilities. Health state utilities can be elicited from members of the public or from patients. Utilities given by patients tend to be higher than utilities given by members of the public. This difference is often

  8. NRC review of Electric Power Research Institute's Advanced Light Reactor Utility Requirements Document - Program summary, Project No. 669

    1992-08-01

    The staff of the US Nuclear Regulatory Commission has prepared Volume 1 of a safety evaluation report (SER), ''NRC Review of Electric Power Research Institute's Advanced Light Water Reactor Utility Requirements Document -- Program Summary,'' to document the results of its review of the Electric Power Research Institute's ''Advanced Light Water Reactor Utility Requirements Document.'' This SER provides a discussion of the overall purpose and scope of the Requirements Document, the background of the staff's review, the review approach used by the staff, and a summary of the policy and technical issues raised by the staff during its review

  9. Cost-utility model of rasagiline in the treatment of advanced Parkinson's disease in Finland.

    Hudry, Joumana; Rinne, Juha O; Keränen, Tapani; Eckert, Laurent; Cochran, John M

    2006-04-01

    The economic burden of Parkinson's disease (PD) is high, especially in patients experiencing motor fluctuations. Rasagiline has demonstrated efficacy against symptoms of PD in early and advanced stages of the disease. To assess the cost-utility of rasagiline and entacapone as adjunctive therapies to levodopa versus standard levodopa care in PD patients with motor fluctuations in Finland. A 2 year probabilistic Markov model with 3 health states: "25% or less off-time/day," "greater than 25% off-time/day," and "dead" was used. Off-time represents time awake with poor or absent motor function. Model inputs included transition probabilities from randomized clinical trials, utilities from a preference measurement study, and costs and resources from a Finnish cost-of-illness study. Effectiveness measures were quality-adjusted life years (QALYs) and number of months spent with 25% or less off-time/day. Uncertainty around parameters was taken into account by Monte Carlo simulations. Over 2 years from a societal perspective, rasagiline or entacapone as adjunctive therapies to levodopa showed greater effectiveness than levodopa alone at no additional costs. Benefits after 2 years were 0.13 (95% CI 0.08 to 0.17) additional QALYs and 5.2 (3.6 to 6.7) additional months for rasagiline and 0.12 (0.08 to 0.17) QALYs and 5.1 (3.5 to 6.6) months for entacapone, both in adjunct to levodopa compared with levodopa alone. The results of this study support the use of rasagiline and entacapone as adjunctive cost-effective alternatives to levodopa alone in PD patients with motor fluctuations in Finland. With a different mode of action, rasagiline is a valuable therapeutic alternative to entacapone at no additional charge to society.

  10. Survey of the general public's attitudes toward advance directives in Japan: How to respect patients' preferences

    Kai Ichiro

    2006-10-01

    Full Text Available Abstract Background Japanese people have become increasingly interested in the expression and enhancement of their individual autonomy in medical decisions made regarding medical treatment at and toward the end of life. However, while many Western countries have implemented legislation that deals with patient autonomy in the case of terminal illness, no such legislation exists in Japan. The rationale for this research is based on the need to investigate patient's preferences regarding treatment at the end of life in order to re-evaluate advance directives policy and practice. Methods We conducted a cross-sectional survey with 418 members of the general middle-aged and senior adults (aged between 40 and 65 in Tokyo, Japan. Respondents were asked about their attitudes toward advance directives, and preferences toward treatment options. Results Over 60% of respondents agreed that it is better to express their wishes regarding advance directives (treatment preferences in writing, appointment of proxy for care decision making, appointment of legal administrator of property, stating preferences regarding disposal of one's property and funeral arrangements but less than 10% of them had already done so. About 60% of respondents in this study preferred to indicate treatment preferences in broad rather than concrete terms. Over 80% would like to decide treatment preferences in consultation with others (22.2% with their proxy, 11.0% with the doctor, and 47.8% with both their proxy and the doctor. Conclusion This study revealed that many Japanese people indicate an interest in undertaking advance directives. This study found that there is a range of preferences regarding how advance directives are undertaken, thus it is important to recognize that any processes put into place should allow flexibility in order to best respect patients' wishes and autonomy.

  11. Experimental study of deceleration process of traveling wave direct energy converter for advanced fusion

    Takeno, Hormasa; Yamamoto, Takayoshi; Takada, Kousuke; Yasaka, Yasuyoshi

    2007-01-01

    Advanced fusion is attractive in the view point of utilization of high efficiency direct energy conversion from fusion produced ions. Deuterium-helium-3 reaction is the most possible, however, the energy of created fast proton is so enormous that conventional electro-static converters cannot be applied. Use of a traveling wave direct energy converter (TWDEC), the principle of which was inverse process of a linear accelerator, was proposed for recovering energy of the fast protons. In order to realize the TWDEC, the authors are continuing experimental study by employing a small-scale simulator. A TWDEC consists of a modulator and a decelerator. Fast proton beam extracted from a reactor is introduced in the modulator where radio frequency (RF) electrostatic field modulate the beam velocity, and hence, the protons are bunched and density-modulated in the downstream. The density-modulated protons flow into the decelerator where a number of electrodes connected to a transmission circuit are axially aligned. The flowing protons induce RF current which creates RF traveling voltage on the electrodes. The RF traveling field between aligned electrodes decelerates the protons, thus their energy is recovered into RF power. In this paper, deceleration process of TWDEC is experimentally examined. In our experimental simulator, because of the small beam current, the induced potential, i.e. the deceleration field is so weak that the beam cannot be decelerated. Thus, we examined the process by dividing into two: one was induction of the deceleration field by the modulated beam, which was called as passive decelerator. The other was energy recovery through interaction between the deceleration field and the modulated beam. In this latter experiment, the deceleration field was supplied externally, and we called this as active decelerator. As for the active decelerator mode, we performed higher beam energy experiment than previous one. As the beam energy increases, the divergence of

  12. Advance directives in english and French law: different concepts, different values, different societies.

    Horn, Ruth Judith

    2014-03-01

    In Western societies advance directives are widely recognised as important means to extend patient self-determination under circumstances of incapacity. Following other countries, England and France have adopted legislation aiming to clarify the legal status of advance directives. In this paper, I will explore similarities and differences in both sets of legislation, the arguments employed in the respective debates and the socio-political structures on which these differences are based. The comparison highlights how different legislations express different concepts emphasising different values accorded to the duty to respect autonomy and to protect life, and how these differences are informed by different socio-political contexts. Furthermore each country associates different ethical concerns with ADs which raise doubts about whether these directives are a theoretical idea which is hardly applicable in practice.

  13. Utilization of corn cob biochar in a direct carbon fuel cell

    Yu, Jinshuai; Zhao, Yicheng; Li, Yongdan

    2014-12-01

    Biochar obtained from the pyrolysis of corn cob is used as the fuel of a direct carbon fuel cell (DCFC) employing a composite electrolyte composed of a samarium doped ceria (SDC) and a eutectic carbonate phase. An anode layer made of NiO and SDC is utilized to suppress the cathode corrosion by the molten carbonate and improves the whole cell stability. The anode off-gas of the fuel cell is analyzed with a gas chromatograph. The effect of working temperature on the cell resistance and power output is examined. The maximum power output achieves 185 mW cm-2 at a current density of 340 mA cm-2 and 750 °C. An anode reaction scheme including the Boudouard reaction is proposed.

  14. EntrezAJAX: direct web browser access to the Entrez Programming Utilities

    Pallen Mark J

    2010-06-01

    Full Text Available Abstract Web applications for biology and medicine often need to integrate data from Entrez services provided by the National Center for Biotechnology Information. However, direct access to Entrez from a web browser is not possible due to 'same-origin' security restrictions. The use of "Asynchronous JavaScript and XML" (AJAX to create rich, interactive web applications is now commonplace. The ability to access Entrez via AJAX would be advantageous in the creation of integrated biomedical web resources. We describe EntrezAJAX, which provides access to Entrez eUtils and is able to circumvent same-origin browser restrictions. EntrezAJAX is easily implemented by JavaScript developers and provides identical functionality as Entrez eUtils as well as enhanced functionality to ease development. We provide easy-to-understand developer examples written in JavaScript to illustrate potential uses of this service. For the purposes of speed, reliability and scalability, EntrezAJAX has been deployed on Google App Engine, a freely available cloud service. The EntrezAJAX webpage is located at http://entrezajax.appspot.com/

  15. A hymenopterists’ guide to the Hymenoptera Anatomy Ontology: utility, clarification, and future directions

    Katja Seltmann

    2012-05-01

    Full Text Available Hymenoptera exhibit an incredible diversity of phenotypes, the result of ~240 million years of evolution and the primary subject of more than 250 years of research. Here we describe the history, development, and utility of the Hymenoptera Anatomy Ontology (HAO and its associated applications. These resources are designed to facilitate accessible and extensible research on hymenopteran phenotypes. Outreach with the hymenopterist community is of utmost importance to the HAO project, and this paper is a direct response to questions that arised from project workshops. In a concerted attempt to surmount barriers of understanding, especially regarding the format, utility, and development of the HAO, we discuss the roles of homology, “preferred terms”, and “structural equivalency”. We also outline the use of Universal Resource Identifiers (URIs and posit that they are a key element necessary for increasing the objectivity and repeatability of science that references hymenopteran anatomy. Pragmatically, we detail a mechanism (the “URI table” by which authors can use URIs to link their published text to the HAO, and we describe an associated tool (the “Analyzer” to derive these tables. These tools, and others, are available through the HAO Portal website (http://portal.hymao.org. We conclude by discussing the future of the HAO with respect to digital publication, cross-taxon ontology alignment, the advent of semantic phenotypes, and community-based curation.

  16. A Limited Submuscular Direct-to-Implant Technique Utilizing AlloMax

    Michal Brichacek, MD

    2017-07-01

    Full Text Available Background:. This study evaluates a novel limited submuscular direct-to-implant technique utilizing AlloMax where only the upper few centimeters of the implant is covered by the pectoralis, whereas the majority of the implant including the middle and lower poles are covered by acellular dermal matrix. Methods:. The pectoralis muscle is released off its inferior and inferior-medial origins and allowed to retract superiorly. Two sheets of AlloMax (6 × 16 cm are sutured together and secured to the inframammary fold, serratus fascia, and the superiorly retracted pectoralis. Thirty-seven breasts in 19 consecutive patients with follow-up at 6 months were reviewed. Results:. Nineteen consecutive patients with 37 reconstructed breasts were studied. Average age was 50 years, average BMI was 24.3. Ptosis ranged from grade 0–III, and average cup size was B (range, A–DDD. Early minor complications included 1 seroma, 3 minor postoperative hematomas managed conservatively, and 3 minor wound healing problems. Three breasts experienced mastectomy skin flap necrosis and were managed with local excision. There were no cases of postoperative infection, red breast, grade III/IV capsular contractures, or implant loss. A single patient complained of animation postoperatively. One patient desired fat grafting for rippling. Conclusions:. The limited submuscular direct-to-implant technique utilizing AlloMax appears to be safe with a low complication rate at 6 months. This technique minimizes the action of the pectoralis on the implant, reducing animation deformities but still providing muscle coverage of the upper limit of the implant. Visible rippling is reduced, and a vascularized bed remains for fat grafting of the upper pole if required.

  17. [Utility of Multiple Increased Lung Cancer Tumor Markers in Treatment of Patients with Advanced Lung Adenocarcinoma].

    Peng, Yan; Wang, Yan; Hao, Xuezhi; Li, Junling; Liu, Yutao; Wang, Hongyu

    2017-10-20

    Among frequently-used tumor markers in lung cancer, carcinoembryonic antigen (CEA) and carbohydrate antigen 125 (CA125), cytokeratin 19 (CYFRA21-1) and squamous carcinoma antigen (SCC), neuron specific enolase (NSE) and pro-gastrin-releasing peptide (ProGRP) are respectively expressed highly in lung adenocarcinoma, lung squamous carcinoma and small cell lung cancer. By comparing patients with multiple increased tumor markers (group A) and patients with increase of CEA and/or CA125 (group B), this study aims to investigate the utility of multiple increased tumor markers in therapeutic evaluation and prediction of disease relapsing in patients with advanced lung adenocarcinoma. Patients with stage IV lung adenocarcinoma who receiving the first line chemotherapy in Cancer Hospital, Chinese Academy of Medical Sciences were enrolled and retrospectively analyzed. Clinical characteristic, serum tumor markers before chemotherapy, efficacy evaluation, progression-free survival (PFS) were analyzed. Except CEA and CA125, the highest ratio of increased tumor markersin group A was CYFRA21-1 (93%), then was NSE (36%), SCC (13%) and ProGRP (12%). Patients with multiple increased tumor markers tend to have more distant metastasis (Ptumor markers have high risk of relapse, and maintenance therapy can reduce relapse risk.

  18. Multidisciplinary Service Utilization Pattern by Advanced Head and Neck Cancer Patients: A Single Institution Study

    Jacqueline C. Junn

    2012-01-01

    Full Text Available Purpose. To analyze the patterns and associations of adjunctive service visits by head and neck cancer patients receiving primary, concurrent chemoradiation therapy. Methods. Retrospective chart review of patients receiving adjunctive support during a uniform chemoradiation regimen for stages III-IV head and neck squamous cell carcinoma. Univariate and multivariate models for each outcome were obtained from simple and multivariate linear regression analyses. Results. Fifty-two consecutive patients were assessed. Female gender, single marital status, and nonprivate insurance were factors associated with an increased number of social work visits. In a multivariate analysis, female gender and marital status were related to increased social work services. Female gender and stage IV disease were significant for increased nursing visits. In a multivariate analysis for nursing visits, living greater than 20 miles between home and hospital was a negative predictive factor. Conclusion. Treatment of advanced stage head and neck cancer with concurrent chemoradiation warrants a multidisciplinary approach. Female gender, single marital status, and stage IV disease were correlated with increased utilization of social work and nursing services. Distance over 20 miles from the center was a negative factor. This information may help guide the treatment team to allocate resources for the comprehensive care of patients.

  19. Utilization of advanced calibration techniques in stochastic rock fall analysis of quarry slopes

    Preh, Alexander; Ahmadabadi, Morteza; Kolenprat, Bernd

    2016-04-01

    In order to study rock fall dynamics, a research project was conducted by the Vienna University of Technology and the Austrian Central Labour Inspectorate (Federal Ministry of Labour, Social Affairs and Consumer Protection). A part of this project included 277 full-scale drop tests at three different quarries in Austria and recording key parameters of the rock fall trajectories. The tests involved a total of 277 boulders ranging from 0.18 to 1.8 m in diameter and from 0.009 to 8.1 Mg in mass. The geology of these sites included strong rock belonging to igneous, metamorphic and volcanic types. In this paper the results of the tests are used for calibration and validation a new stochastic computer model. It is demonstrated that the error of the model (i.e. the difference between observed and simulated results) has a lognormal distribution. Selecting two parameters, advanced calibration techniques including Markov Chain Monte Carlo Technique, Maximum Likelihood and Root Mean Square Error (RMSE) are utilized to minimize the error. Validation of the model based on the cross validation technique reveals that in general, reasonable stochastic approximations of the rock fall trajectories are obtained in all dimensions, including runout, bounce heights and velocities. The approximations are compared to the measured data in terms of median, 95% and maximum values. The results of the comparisons indicate that approximate first-order predictions, using a single set of input parameters, are possible and can be used to aid practical hazard and risk assessment.

  20. International cooperative research project between NEDO and NASA on advanced combustion science utilizing microgravity

    NONE

    2001-03-01

    This paper describes an international cooperative research project between NEDO and NASA on advanced combustion science utilizing microgravity. In June, 1994, NEDO and NASA reached a basic agreement with each other about this cooperative R and D on combustion under microgravity conditions. In fiscal 2000, Japan proposed an experiment using the drop tower facilities and parabolic aircraft at NASA Glen Research Center and at JAMIC (Japan Microgravity Center). In other words, the proposals from Japan included experiments on combustion of droplets composed of diversified fuels under different burning conditions (vaporization), flame propagation in smoldering porous materials and dispersed particles under microgravity conditions, and control of interactive combustion of two droplets by acoustical and electrical perturbations. Additionally proposed were experiments on effect of low external air flow on solid material combustion under microgravity, and sooting and radiation effects on the burning of large droplets under microgravity conditions. This report gives an outline of the results of these five cooperative R and D projects. The experiments were conducted under ordinary normal gravity and microgravity conditions, with the results compared and examined mutually. (NEDO)

  1. What explains racial differences in the use of advance directives and attitudes toward hospice care?

    Johnson, Kimberly S; Kuchibhatla, Maragatha; Tulsky, James A

    2008-10-01

    Cultural beliefs and values are thought to account for differences between African Americans and whites in the use of advance directives and beliefs about hospice care, but few data clarify which beliefs and values explain these differences. Two hundred five adults aged 65 and older who received primary care in the Duke University Health System were surveyed. The survey included five scales: Hospice Beliefs and Attitudes, Preferences for Care, Spirituality, Healthcare System Distrust, and Beliefs About Dying and Advance Care Planning. African Americans were less likely than white subjects to have completed an advance directive (35.5% vs 67.4%, Pconflict with the goals of palliative care, and distrust the healthcare system. In multivariate analyses, none of these factors alone completely explained racial differences in possession of an advance directive or beliefs about hospice care, but when all of these factors were combined, race was no longer a significant predictor of either of the two outcomes. These findings suggest that ethnicity is a marker of common cultural beliefs and values that, in combination, influence decision-making at the end of life. This study has implications for the design of healthcare delivery models and programs that provide culturally sensitive end-of-life care to a growing population of ethnically diverse older adults.

  2. Direct utilization of geothermal energy in the Peoples Republic of China

    Lund, J. W.

    1980-12-01

    A brief review of the direct utilization of geothermal energy in three regions of the Peoples' Republic of China is presented, stressing a development outline for the next five to ten years. The geothermal resource of the Tianjin-Beijing area is mainly to be developed for space heating, whereas along the coastal area of Fujian and Guangdong, it will be developed for agriculture, and industrial and residential use. Electric power generation will be the main concern in the southwest at Tengchong. Most theoretical research will be done on geologic structure interpretation, corrosion of pump shafts and buried pipelines, and heat flow, with some interest in the study of geopressure and hot dry rock systems. Specific examples from the Tianjin area include a wool factory; a wool rug weaving shop; heating of a hotel; public bathing; and well drilling for apartment heating, fish breeding, and greenhouses. Direct use of geothermal energy in the Beijing area includes cotton dyeing, humidifying, medical purposes, and animal husbandry. Experimental geothermal electric power plants are summarized in table form.

  3. 15 N utilization in nitride nuclear fuels for advanced nuclear power reactors and accelerator - driven systems

    Axente, D.

    2005-01-01

    15 N utilization for nitride nuclear fuels production for nuclear power reactors and accelerator - driven systems is presented. Nitride nuclear fuel is the obvious choice for advanced nuclear reactors and ADS because of its favorable properties: a high melting point, excellent thermal conductivity, high fissile density, lower fission gas release and good radiation tolerance. The application of nitride fuels in nuclear reactors and ADS requires use of 15 N enriched nitrogen to suppress 14 C production due to (n,p) reaction on 14 N. Accelerator - driven system is a recent development merging of accelerator and fission reactor technologies to generate electricity and transmute long - lived radioactive wastes as minor actinides: Np, Am, Cm. A high-energy proton beam hitting a heavy metal target produces neutrons by spallation. The neutrons cause fission in the fuel, but unlike in conventional reactors, the fuel is sub-critical and fission ceases when the accelerator is turned off. Nitride fuel is a promising candidate for transmutation in ADS of minor actinides, which are converted into nitrides with 15 N for that purpose. Tacking into account that the world wide market is about 20 to 40 Kg 15 N annually, the supply of that isotope for nitride fuel production for nuclear power reactors and ADS would therefore demand an increase in production capacity by a factor of 1000. For an industrial plant producing 100 t/y 15 N, using present technology of isotopic exchange in NITROX system, the first separation stage of the cascade would be fed with 10M HNO 3 solution of 600 mc/h flow - rate. If conversion of HNO 3 into NO, NO 2 , at the enriching end of the columns, would be done with gaseous SO 2 , for a production plant of 100 t/y 15 N a consumption of 4 million t SO 2 /y and a production of 70 % H 2 SO 4 waste solution of 4.5 million mc/y are estimated. The reconversion of H 2 SO 4 into SO 2 in order to recycle of SO 2 is a problem to be solved to compensate the cost of SO 2

  4. Management of End-Stage Ankle Arthritis: Cost-Utility Analysis Using Direct and Indirect Costs.

    Nwachukwu, Benedict U; McLawhorn, Alexander S; Simon, Matthew S; Hamid, Kamran S; Demetracopoulos, Constantine A; Deland, Jonathan T; Ellis, Scott J

    2015-07-15

    Total ankle replacement and ankle fusion are costly but clinically effective treatments for ankle arthritis. Prior cost-effectiveness analyses for the management of ankle arthritis have been limited by a lack of consideration of indirect costs and nonoperative management. The purpose of this study was to compare the cost-effectiveness of operative and nonoperative treatments for ankle arthritis with inclusion of direct and indirect costs in the analysis. Markov model analysis was conducted from a health-systems perspective with use of direct costs and from a societal perspective with use of direct and indirect costs. Costs were derived from the 2012 Nationwide Inpatient Sample (NIS) and expressed in 2013 U.S. dollars; effectiveness was expressed in quality-adjusted life years (QALYs). Model transition probabilities were derived from the available literature. The principal outcome measure was the incremental cost-effectiveness ratio (ICER). In the direct-cost analysis for the base case, total ankle replacement was associated with an ICER of $14,500/QALY compared with nonoperative management. When indirect costs were included, total ankle replacement was both more effective and resulted in $5900 and $800 in lifetime cost savings compared with the lifetime costs following nonoperative management and ankle fusion, respectively. At a $100,000/QALY threshold, surgical management of ankle arthritis was preferred for patients younger than ninety-six years and total ankle replacement was increasingly more cost-effective in younger patients. Total ankle replacement, ankle fusion, and nonoperative management were the preferred strategy in 83%, 12%, and 5% of the analyses, respectively; however, our model was sensitive to patient age, the direct costs of total ankle replacement, the failure rate of total ankle replacement, and the probability of arthritis after ankle fusion. Compared with nonoperative treatment for the management of end-stage ankle arthritis, total ankle

  5. Advanced clay nanocomposites based on in situ photopolymerization utilizing novel polymerizable organoclays

    Kim, Soon Ki

    Polymer nanocomposite technology has had significant impact on material design. With the environmental advantages of photopolymerization, a research has recently focused on producing nanocomposites utilizing inexpensive clay particles based on in situ photopolymerization. In this research, novel polymerizable organoclays and thiol-ene photopolymerization have been utilized to develop advanced photopolymer clay nanocomposites and to overcome several limitations in conventional free radical photopolymers. To this end, factors important in nanocomposite processes such as monomer composition, clay dispersion, and photopolymerization behavior in combination with the evolution of ultimate nanocomposite properties have been investigated. For monomer-organoclay compositions, higher chemical compatibility of components induces enhanced clay exfoliation, resulting in photopolymerization rate increases due to an amplified clay template effect. Additionally, by affecting the stoichiometric ratio between thiol and acrylate double bond in the clay gallery, thiolated organoclays enhance thiol-ene copolymerization with increased final thiol conversion while acrylated organoclays encourage acrylate homopolymerization. In accordance with the reaction behavior, incorporation of thiolated organoclays makes polymer chains more flexible with decreased glass transition temperature due to higher formation of thio-ether linkages while adding acrylated organoclays significantly increases the modulus. Photopolymer nanocomposites also help overcome two major drawbacks in conventional free radical photopolymerization, namely severe polymerization shrinkage and oxygen inhibition during polymerization. With addition of a low level of thiol monomers, the oxygen inhibition in various acrylate systems can be overcome by addition of only 5wt% thiolated organoclay. The same amount of polymerizable organoclay also induces up to 90% decreases in the shrinkage stress for acrylate or thiol

  6. Advance Directive in End of Life Decision-Making among the Yoruba of South-Western Nigeria.

    Jegede, Ayodele Samuel; Adegoke, Olufunke Olufunsho

    2016-11-01

    End-of-life decision making is value-laden within the context of culture and bioethics. Also, ethics committee role is difficult to understand on this, thus need for ethnomethodological perspective in an expanding bioethical age. Anthropological approach was utilized to document Yoruba definition and perspective of death, cultural beliefs about end-of-life decision making, factors influencing it and ethics committee role. Interviews were conducted among selected Yoruba resident in Akinyele LGA, Oyo State, Nigeria. Content analytical approach was used for data analysis. Yoruba culture, death is socially constructed having spiritual, physical and social significance. Relationship between the dying and significant others influences decision making. Hierarchy of authority informs implementing traditional advance directive. Socialization, gender, patriarchy, religious belief and tradition are major considerations in end-of-life decision making. Awareness, resource allocation and advocacy are important ethics committees' roles. Further research into cultural diversity of end-of-life decision making will strengthen ethical practice in health care delivery.

  7. Direct utilization of information from nuclear data files in Monte Carlo simulation of neutron and photon transport

    Androseno, P.; Zholudov, D.; Kompaniyets, A.; Smirnova, O.

    2000-01-01

    In order to improve both the economics of Nuclear Power Plants (NPPs) as well as their safety, data and computer codes that perform benchmark calculations while simulating NPP parameters must be utilized. This work is mainly concerned with application of computer codes using the Monte Carlo method, which provides advanced accuracy of equations to be calculated. (authors)

  8. Utilizing LiDAR Datasets From Experimental Watersheds to Advance Ecohydrological Understanding in Seasonally Snow-Covered Forests

    Harpold, A. A.; Broxton, P. D.; Guo, Q.; Barlage, M. J.; Gochis, D. J.

    2014-12-01

    The Western U.S. is strongly reliant on snowmelt from forested areas for ecosystem services and downstream populations. The ability to manage water resources from snow-covered forests faces major challenges from drought, disturbance, and regional changes in climate. An exciting avenue for improving ecohydrological process understanding is Light Detection and Ranging (LiDAR) because the technology simultaneously observes topography, forest properties, and snow/ice at high-resolution (100 km2). The availability and quality of LiDAR datasets is increasing rapidly, however they remain under-utilized for process-based ecohydrology investigations. This presentation will illustrate how LiDAR datasets from the Critical Zone Observatory (CZO) network have been applied to advance ecohydrological understanding through direct empirical analysis, as well as model parameterization and verification. Direct analysis of the datasets has proved fruitful for pre- and post-disturbance snow distribution estimates and interpreting in-situ snow depth measurements across sites. In addition, we illustrate the potential value of LiDAR to parameterize and verify of physical models with two examples. First, we use LiDAR to parameterize a land surface model, Noah multi-parameterization (Noah-MP), to investigate the sensitivity of modeled water and energy fluxes to high-resolution forest information. Second, we present a Snow Physics and Laser Mapping (SnowPALM) model that is parameterized with LiDAR information at its native 1-m scale. Both modeling studies demonstrate the value of LiDAR for representing processes with greater fidelity. More importantly, the increased model fidelity led to different estimates of water and energy fluxes at larger, watershed scales. Creating a network of experimental watersheds with LiDAR datasets offers the potential to test theories and models in previously unexplored ways.

  9. Putting politics into perspective. A Study of the Implementation of EU public utilities directives

    Berglund, S.K.

    2009-01-01

    In the area of public utilities, the member states of the European Union (EU) have agreed on ambitious policies to open up markets for competition and to regulate these markets. To have the expected effect, these policies have to be implemented effectively. In this book it is demonstrated that this is problematic; difficulties appear already in the first step of transposing the directives into national legislation. The analysis of an original quantitative data set including all public utilities directives and their transposition in five member states - the Netherlands, Germany, the United Kingdom, Spain, and Greece - shows that almost two thirds of all cases are transposed after the deadlines that are included in the directives. In order to explain problems with the implementation of EU policies, three main types of variables are used in the literature, namely political, administrative, and institutional variables. In recent literature on transposition the focus is on political explanations. However, despite a surge of attention for transposition there is no consensus regarding which type of variable is most important. In this book the focus on political variables is addressed. It is examined if such a focus is well founded, and whether and how different types of variables combine in order to produce the transposition outcome. To this end, a novel approach is taken by developing a theoretical framework that applies implementation theory to transposition. In this framework the three types of variables in the literature on transposition are combined in one coherent framework. The theoretical framework is applied mainly in a case study setting. The transposition of two packages of directives in the fields of telecommunications and energy in the Netherlands, Germany and Greece is studied in detail. The main conclusion is that political factors play an important role for the timeliness of transposition, but that a number of 'mediating' variables of institutional

  10. Palbociclib in hormone receptor positive advanced breast cancer: A cost-utility analysis.

    Raphael, J; Helou, J; Pritchard, K I; Naimark, D M

    2017-11-01

    The addition of palbociclib to letrozole improves progression-free survival in the first-line treatment of hormone receptor positive advanced breast cancer (ABC). This study assesses the cost-utility of palbociclib from the Canadian healthcare payer perspective. A probabilistic discrete event simulation (DES) model was developed and parameterised with data from the PALOMA 1 and 2 trials and other sources. The incremental cost per quality-adjusted life-month (QALM) gained for palbociclib was calculated. A time horizon of 15 years was used in the base case with costs and effectiveness discounted at 5% annually. Time-to- progression and time-to-death were derived from a Weibull and exponential distribution. Expected costs were based on Ontario fees and other sources. Probabilistic sensitivity analyses were conducted to account for parameter uncertainty. Compared to letrozole, the addition of palbociclib provided an additional 14.7 QALM at an incremental cost of $161,508. The resulting incremental cost-effectiveness ratio was $10,999/QALM gained. Assuming a willingness-to-pay (WTP) of $4167/QALM, the probability of palbociclib to be cost-effective was 0%. Cost-effectiveness acceptability curves derived from a probabilistic sensitivity analysis showed that at a WTP of $11,000/QALM gained, the probability of palbociclib to be cost-effective was 50%. The addition of palbociclib to letrozole is unlikely to be cost-effective for the treatment of ABC from a Canadian healthcare perspective with its current price. While ABC patients derive a meaningful clinical benefit from palbociclib, considerations should be given to increase the WTP threshold and reduce the drug pricing, to render this strategy more affordable. Copyright © 2017 Elsevier Ltd. All rights reserved.

  11. Assessing the utility of TAM, TPB, and UTAUT for advanced driver assistance systems.

    Rahman, Md Mahmudur; Lesch, Mary F; Horrey, William J; Strawderman, Lesley

    2017-11-01

    Advanced Driver Assistance Systems (ADAS) are intended to enhance driver performance and improve transportation safety. The potential benefits of these technologies, such as reduction in number of crashes, enhancing driver comfort or convenience, decreasing environmental impact, etc., have been acknowledged by transportation safety researchers and federal transportation agencies. Although these systems afford safety advantages, they may also challenge the traditional role of drivers in operating vehicles. Driver acceptance, therefore, is essential for the implementation of these systems into the transportation system. Recognizing the need for research into the factors affecting driver acceptance, this study assessed the utility of the Technology Acceptance Model (TAM), the Theory of Planned Behavior (TPB), and the Unified Theory of Acceptance and Use of Technology (UTAUT) for modelling driver acceptance in terms of Behavioral Intention to use an ADAS. Each of these models propose a set of factors that influence acceptance of a technology. Data collection was done using two approaches: a driving simulator approach and an online survey approach. In both approaches, participants interacted with either a fatigue monitoring system or an adaptive cruise control system combined with a lane-keeping system. Based on their experience, participants responded to several survey questions to indicate their attitude toward using the ADAS and their perception of its usefulness, usability, etc. A sample of 430 surveys were collected for this study. Results found that all the models (TAM, TPB, and UTAUT) can explain driver acceptance with their proposed sets of factors, each explaining 71% or more of the variability in Behavioral Intention. Among the models, TAM was found to perform the best in modelling driver acceptance followed by TPB. The findings of this study confirm that these models can be applied to ADAS technologies and that they provide a basis for understanding driver

  12. Direct utilization of geothermal energy: a layman's guide. Geothermal Resources Council special report No. 8

    Anderson, D.N.; Lund, J.W. (eds.)

    1979-01-01

    The following subjects are covered: nature and distribution of geothermal energy; exploration, confirmation, and evaluation of the resource; reservoir development and management; utilization; economics of direct-use development; financing direct-use projects; and legal, institutional, and environmental aspects. (MHR)

  13. From Advance Euthanasia Directive to Euthanasia: Stable Preference in Older People?

    Bolt, Eva E; Pasman, H Roeline W; Deeg, Dorly J H; Onwuteaka-Philipsen, Bregje D

    2016-08-01

    To determine whether older people with advance directive for euthanasia (ADEs) are stable in their advance desire for euthanasia in the last years of life, how frequently older people with an ADE eventually request euthanasia, and what factors determine this. Mortality follow-back study nested in a cohort study. The Netherlands. Proxies of deceased members of a cohort representative of Dutch older people (n = 168) and a cohort of people with advance directives (n = 154). Data from cohort members (possession of ADE) combined with after-death proxy information on cohort members' last 3 months of life. Multiple logistic regression analysis was performed on determinants of a euthanasia request in individuals with an ADE. Response rate was 65%. One hundred forty-two cohort members had an ADE at baseline. Three months before death, 87% remained stable in their desire for euthanasia; 47% eventually requested euthanasia (vs 6% without an ADE), and 16% died after euthanasia. People with an ADE were more likely to request euthanasia if they worried about loss of dignity. The majority of older adults who complete an ADE will have a stable preference over time, but an advance desire for euthanasia does not necessarily result in a euthanasia request. Writing an ADE may reflect a person's need for reassurance that they can request euthanasia in the future. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.

  14. A Korean perspective on developing a global policy for advance directives.

    Kim, Soyoon; Hahm, Ki-Hyun; Park, Hyoung Wook; Kang, Hyun Hee; Sohn, Myongsei

    2010-03-01

    Despite the wide and daunting array of cross-cultural obstacles that the formulation of a global policy on advance directives will clearly pose, the need is equally evident. Specifically, the expansion of medical services driven by medical tourism, just to name one important example, makes this issue urgently relevant. While ensuring consistency across national borders, a global policy will have the additional and perhaps even more important effect of increasing the use of advance directives in clinical settings and enhancing their effectiveness within each country, regardless of where that country's state of the law currently stands. One cross-cultural issue that may represent a major obstacle in formulating, let alone applying, a global policy is whether patient autonomy as the underlying principle for the use of advance directives is a universal norm or a construct of western traditions that must be reconciled with alternative value systems that may place lesser significance on individual choice. A global policy, at a minimum, must emphasize respect for patient autonomy, provision of medical information, limits to the obligations for physicians, and portability. And though the development of a global policy will be no easy task, active engagement in close collaboration with the World Health Organization can make it possible.

  15. Health literacy: a study of internet-based information on advance directives.

    Stuart, Peter

    2017-11-28

    The aim of this study was to evaluate the quality and value of web-based information on advance directives. Internet-based information on advance directives was selected because, if it is inaccurate or difficult to understand, patients risk making decisions about their care that may not be followed in practice. Two validated health information evaluation tools, the Suitability Assessment of Materials and DISCERN, and a focus group were used to assess credibility, user orientation and effectiveness. Only one of the 34 internet-based information items on advance directives reviewed fulfilled the study criteria and 30% of the sites were classed as unreadable. In terms of learning and informing, 79% of the sites were considered unsuitable. Using health literacy tools to evaluate internet-based health information highlights that often it is not at a functional literacy level and neither informs nor empowers users to make independent and valid healthcare decisions. ©2017 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.

  16. Protecting prisoners' autonomy with advance directives: ethical dilemmas and policy issues.

    Andorno, Roberto; Shaw, David M; Elger, Bernice

    2015-02-01

    Over the last decade, several European countries and the Council of Europe itself have strongly supported the use of advance directives as a means of protecting patients' autonomy, and adopted specific norms to regulate this matter. However, it remains unclear under which conditions those regulations should apply to people who are placed in correctional settings. The issue is becoming more significant due to the increasing numbers of inmates of old age or at risk of suffering from mental disorders, all of whom might benefit from using advance directives. At the same time, the closed nature of prisons and the disparate power relationships that characterise them mean that great caution must be exercised to prevent care being withdrawn or withheld from inmates who actually want to receive it. This paper explores the issue of prisoners' advance directives in the European context, starting with the position enshrined in international and European law that prisoners retain all their human rights, except the right to liberty, and are therefore entitled to self-determination regarding health care decisions.

  17. Nuclear energy development and utilization in the republic of Korea and desirable policy directions

    Yoon, Youngku; Chang, Soon Heung

    1994-01-01

    There have been important worldwide changes in recent years that will have great influence on out future. The collapse of the former Soviet Union and East Europe and the final agreements of the Uruguay Round (UR) indicate that the world's future focus lies on economics and technology rather than ideology. Each nation is trying to strengthen its international competitiveness, and thereby maximize their national interests in this age of limitless competition. The worldwide energy consumption, especially in developing countries, is expected to increase continuously in the next century. Considering the limited resources of fossil fuels, securing a stable energy supply will be a factor of paramount importance from the viewpoint of national security. Another important problem of mankind in the 21th century is to preserve the environment of the earth, while maintaining economic growth. Recognition of the importance of the earth environment is spreading very rapidly, especially in advanced countries. Concrete approaches to preserve the earth environment are expected to be formulated in the upcoming Green Round (GR) negotiations which follow the UR. Probably the GR will demand an overall reorganization of the industrial structure. With respect to nuclear energy, the threat of nuclear weapons of the former Soviet union has significantly lessened owing to the termination of the Cold War. However, international regulations for nuclear non-proliferation are being strengthened as the countermeasure for the deterioration of management and surveillance capability of the former Soviet Union for nuclear weapons and for the increase in the possibility of nuclear weapons development in Iraq, North Korea, etc. Domestically, the Declaration of Denuclearization of the Korean Peninsula, the possibility of North Korea's disregard of the NPT, and the opposition of local people to construction of nuclear facilities have caused significant difficulties in efficient development and utilization

  18. Nuclear energy development and utilization in the republic of Korea and desirable policy directions

    Yoon, Youngku; Chang, Soon Heung [Korea Advanced Institute of Science and Technology, Taejon (Korea, Republic of)

    1994-04-15

    There have been important worldwide changes in recent years that will have great influence on out future. The collapse of the former Soviet Union and East Europe and the final agreements of the Uruguay Round (UR) indicate that the world's future focus lies on economics and technology rather than ideology. Each nation is trying to strengthen its international competitiveness, and thereby maximize their national interests in this age of limitless competition. The worldwide energy consumption, especially in developing countries, is expected to increase continuously in the next century. Considering the limited resources of fossil fuels, securing a stable energy supply will be a factor of paramount importance from the viewpoint of national security. Another important problem of mankind in the 21th century is to preserve the environment of the earth, while maintaining economic growth. Recognition of the importance of the earth environment is spreading very rapidly, especially in advanced countries. Concrete approaches to preserve the earth environment are expected to be formulated in the upcoming Green Round (GR) negotiations which follow the UR. Probably the GR will demand an overall reorganization of the industrial structure. With respect to nuclear energy, the threat of nuclear weapons of the former Soviet union has significantly lessened owing to the termination of the Cold War. However, international regulations for nuclear non-proliferation are being strengthened as the countermeasure for the deterioration of management and surveillance capability of the former Soviet Union for nuclear weapons and for the increase in the possibility of nuclear weapons development in Iraq, North Korea, etc. Domestically, the Declaration of Denuclearization of the Korean Peninsula, the possibility of North Korea's disregard of the NPT, and the opposition of local people to construction of nuclear facilities have caused significant difficulties in efficient development and utilization

  19. Direct and Indirect Healthcare Resource Utilization and Costs Among Migraine Patients in the United States.

    Bonafede, Machaon; Sapra, Sandhya; Shah, Neel; Tepper, Stewart; Cappell, Katherine; Desai, Pooja

    2018-05-01

    The goal of this analysis was to provide a contemporary estimate of the burden of migraine, incorporating both direct and indirect costs, by comparing the costs of migraine patients to a matched group of patients without migraine in a large, nationally representative sample of commercially insured patients in the United States. Previous studies have shown that the economic burden of migraine in the United States is substantial for payers, patients, and employers. Despite the availability of multiple acute and preventive pharmacological treatment options and a relatively stable migraine prevalence in the United States, there has been a documented increase in migraine-related healthcare resource and pharmacy use. Given the frequently disabling nature of migraine and its high prevalence, especially during peak productive years, and the lack of recent estimates of the burden of migraine, there is a need to update the existing literature with more current data. This retrospective, observational cohort study identified migraine patients in the Truven Health Market Scan Research Databases between January 2008 and June 2013. Adult patients had 12 months of continuous enrollment before (baseline period) and after (follow-up period) the day they received migraine diagnoses and/or medications (index) and no diagnosis of HIV or malignancy during the study period. The patients with migraine were matched 1:1 to a group of patients without migraine on demographic variables and index date. Direct healthcare utilization and costs and indirect (absenteeism, short-term disability, and long-term disability) costs were assessed during the 12-month follow-up period and differences between patients with vs without migraine were assessed. Two additional multivariable logistic regression analyses were conducted. First, an analysis was conducted comparing the odds of having a short-term disability claim between patients with and without migraine after controlling for patient demographic and

  20. Highly efficient power system based on direct fission fragment energy conversion utilizing magnetic collimation

    Tsvetkov, Pavel V.; Hart, Ron R.; Parish, Theodore A.

    2003-01-01

    The present study was focused on developing a technologically feasible power system that is based on direct fission fragment energy conversion utilizing magnetic collimation. The new concept is an attempt to combine several advantageous design solutions, which have been proposed for application in both fission and fusion reactors, into one innovative system that can offer exceptional energy conversion efficiency. The analysis takes into consideration a wide range of operational aspects including fission fragment escape from the fuel, collimation, collection, criticality, long-term performance, energy conversion efficiency, heat removal, and safety characteristics. Specific characteristics of the individual system components and the entire system are evaluated. Consistent analysis and evaluation of the technological feasibility of the concept were achieved using state-of-the-art computer codes that allowed realistic and consistent modeling. The calculated energy conversion efficiencies for the presented designs without a thermodynamic cycle and with the heavy water cycle are 52% and 62%, respectively. The analysis indicates that efficiencies up to 90% are potentially achievable. (author)

  1. The relationship between physical and psychological symptoms and health care utilization in hospitalized patients with advanced cancer.

    Nipp, Ryan D; El-Jawahri, Areej; Moran, Samantha M; D'Arpino, Sara M; Johnson, P Connor; Lage, Daniel E; Wong, Risa L; Pirl, William F; Traeger, Lara; Lennes, Inga T; Cashavelly, Barbara J; Jackson, Vicki A; Greer, Joseph A; Ryan, David P; Hochberg, Ephraim P; Temel, Jennifer S

    2017-12-01

    Patients with advanced cancer often experience frequent and prolonged hospitalizations; however, the factors associated with greater health care utilization have not been described. We sought to investigate the relation between patients' physical and psychological symptom burden and health care utilization. We enrolled patients with advanced cancer and unplanned hospitalizations from September 2014-May 2016. Upon admission, we assessed physical (Edmonton Symptom Assessment System [ESAS]) and psychological symptoms (Patient Health Questionnaire 4 [PHQ-4]). We examined the relationship between symptom burden and healthcare utilization using linear regression for hospital length of stay (LOS) and Cox regression for time to first unplanned readmission within 90 days. We adjusted all models for age, sex, marital status, comorbidity, education, time since advanced cancer diagnosis, and cancer type. We enrolled 1,036 of 1,152 (89.9%) consecutive patients approached. Over one-half reported moderate/severe fatigue, poor well being, drowsiness, pain, and lack of appetite. PHQ-4 scores indicated that 28.8% and 28.0% of patients had depression and anxiety symptoms, respectively. The mean hospital LOS was 6.3 days, and the 90-day readmission rate was 43.1%. Physical symptoms (ESAS: unstandardized coefficient [B], 0.06; P cancer experience a high symptom burden, which is significantly associated with prolonged hospitalizations and readmissions. Interventions are needed to address the symptom burden of this population to improve health care delivery and utilization. Cancer 2017;123:4720-4727. © 2017 American Cancer Society. © 2017 American Cancer Society.

  2. Utility Values for Advanced Soft Tissue Sarcoma Health States from the General Public in the United Kingdom

    Julian F. Guest

    2013-01-01

    Full Text Available Soft tissue sarcomas are a rare type of cancer generally treated with palliative chemotherapy when in the advanced stage. There is a lack of published health utility data for locally advanced “inoperable”/metastatic disease (ASTS, essential for calculating the cost-effectiveness of current and future treatments. This study estimated time trade-off (TTO and standard gamble (SG preference values associated with four ASTS health states (progressive disease, stable disease, partial response, complete response among members of the general public in the UK (n=207. The four health states were associated with decreases in preference values from full health. Complete response was the most preferred health state (mean utility of 0.60 using TTO. The second most preferred health state was partial response followed by stable disease (mean utilities were 0.51 and 0.43, respectively, using TTO. The least preferred health state was progressive disease (mean utility of 0.30 using TTO. The utility value for each state was significantly different from one another (P<0.001. This study demonstrated and quantified the impact that different treatment responses may have on the health-related quality of life of patients with ASTS.

  3. Advanced chronic kidney disease in non-valvular atrial fibrillation: extending the utility of R2CHADS2 to patients with advanced renal failure.

    Bautista, Josef; Bella, Archie; Chaudhari, Ashok; Pekler, Gerald; Sapra, Katherine J; Carbajal, Roger; Baumstein, Donald

    2015-04-01

    The R2CHADS2 is a new prediction rule for stroke risk in atrial fibrillation (AF) patients wherein R stands for renal risk. However, it was created from a cohort that excluded patients with advanced renal failure (defined as glomerular filtration rate of advanced renal failure and aims to compare its predictive power against the currently used CHADS and CHA2DS2VaSc. This retrospective cohort study analyzed the 1-year risk for stroke of the 524 patients with AF at Metropolitan Hospital Center. AUC and C statistics were calculated using three groups: (i) the entire cohort including patients with advanced renal failure, (ii) a cohort excluding patients with advanced renal failure and (iii) all patients with GFR statistic was highest in R2CHADS compared with CHADS or CHADSVASC in group 1 (0.718 versus 0.605 versus 0.602) and in group 2 (0.724 versus 0.584 versus 0.579). However, there was no statistically significant difference in group 3 (0.631 versus 0.629 versus 0.623). Our study supports the utility of R2CHADS2 as a clinical prediction rule for stroke risk in patients with advanced renal failure.

  4. Consciousness in humans and non-human animals: recent advances and future directions.

    Boly, Melanie; Seth, Anil K; Wilke, Melanie; Ingmundson, Paul; Baars, Bernard; Laureys, Steven; Edelman, David B; Tsuchiya, Naotsugu

    2013-10-31

    This joint article reflects the authors' personal views regarding noteworthy advances in the neuroscience of consciousness in the last 10 years, and suggests what we feel may be promising future directions. It is based on a small conference at the Samoset Resort in Rockport, Maine, USA, in July of 2012, organized by the Mind Science Foundation of San Antonio, Texas. Here, we summarize recent advances in our understanding of subjectivity in humans and other animals, including empirical, applied, technical, and conceptual insights. These include the evidence for the importance of fronto-parietal connectivity and of "top-down" processes, both of which enable information to travel across distant cortical areas effectively, as well as numerous dissociations between consciousness and cognitive functions, such as attention, in humans. In addition, we describe the development of mental imagery paradigms, which made it possible to identify covert awareness in non-responsive subjects. Non-human animal consciousness research has also witnessed substantial advances on the specific role of cortical areas and higher order thalamus for consciousness, thanks to important technological enhancements. In addition, much progress has been made in the understanding of non-vertebrate cognition relevant to possible conscious states. Finally, major advances have been made in theories of consciousness, and also in their comparison with the available evidence. Along with reviewing these findings, each author suggests future avenues for research in their field of investigation.

  5. Cross-bridge blocker BTS permits direct measurement of SR Ca2+ pump ATP utilization in toadfish swimbladder muscle fibers.

    Young, Iain S; Harwood, Claire L; Rome, Lawrence C

    2003-10-01

    Because the major processes involved in muscle contraction require rapid utilization of ATP, measurement of ATP utilization can provide important insights into the mechanisms of contraction. It is necessary, however, to differentiate between the contribution made by cross-bridges and that of the sarcoplasmic reticulum (SR) Ca2+ pumps. Specific and potent SR Ca2+ pump blockers have been used in skinned fibers to permit direct measurement of cross-bridge ATP utilization. Up to now, there was no analogous cross-bridge blocker. Recently, N-benzyl-p-toluene sulfonamide (BTS) was found to suppress force generation at micromolar concentrations. We tested whether BTS could be used to block cross-bridge ATP utilization, thereby permitting direct measurement of SR Ca2+ pump ATP utilization in saponin-skinned fibers. At 25 microM, BTS virtually eliminates force and cross-bridge ATP utilization (both BTS. At 25 microM, BTS had no effect on SR pump ATP utilization. Hence, we used BTS to make some of the first direct measurements of ATP utilization of intact SR over a physiological range of [Ca2+]at 15 degrees C. Curve fits to SR Ca2+ pump ATP utilization vs. pCa indicate that they have much lower Hill coefficients (1.49) than that describing cross-bridge force generation vs. pCa (approximately 5). Furthermore, we found that BTS also effectively eliminates force generation in bundles of intact swimbladder muscle, suggesting that it will be an important tool for studying integrated SR function during normal motor behavior.

  6. Trial-Based Cost-Utility Analysis of Icotinib versus Gefitinib as Second-Line Therapy for Advanced Non-Small Cell Lung Cancer in China.

    Zhang, Chunxiang; Zhang, Hongmei; Shi, Jinning; Wang, Dong; Zhang, Xiuwei; Yang, Jian; Zhai, Qizhi; Ma, Aixia

    2016-01-01

    Our objective is to compare the cost-utility of icotinib and gefitinib for the second-line treatment of advanced non-small cell lung cancer (NSCLC) from the perspective of the Chinese healthcare system. Model technology was applied to assess the data of randomized clinical trials and the direct medical costs from the perspective of the Chinese healthcare system. Five-year quality-adjusted life years (QALYs) and incremental cost-utility ratios (ICURs) were calculated. One-way and probabilistic sensitivity analyses (PSA) were performed. Our model suggested that the median progression-free survival (PFS) was 4.2 months in the icotinib group and 3.5 months in the gefitinib group while they were 4.6 months and 3.4 months, respectively, in the trials. The 5-year QALYs was 0.279 in the icotinib group and 0.269 in the gefitinib group, and the according medical costs were $10662.82 and $13127.57. The ICUR/QALY of icotinib versus gefitinib presented negative in this study. The most sensitive parameter to the ICUR was utility of PFS, ranging from $-1,259,991.25 to $-182,296.61; accordingly the icotinib treatment consistently represented a dominant cost-utility strategy. The icotinib strategy, as a second-line therapy for advanced NSCLC patients in China, is the preferred strategy relative to gefitinib because of the dominant cost-utility. In addition, icotinib shows a good curative effect and safety, resulting in a strong demand for the Chinese market.

  7. Trial-Based Cost-Utility Analysis of Icotinib versus Gefitinib as Second-Line Therapy for Advanced Non-Small Cell Lung Cancer in China.

    Chunxiang Zhang

    Full Text Available Our objective is to compare the cost-utility of icotinib and gefitinib for the second-line treatment of advanced non-small cell lung cancer (NSCLC from the perspective of the Chinese healthcare system.Model technology was applied to assess the data of randomized clinical trials and the direct medical costs from the perspective of the Chinese healthcare system. Five-year quality-adjusted life years (QALYs and incremental cost-utility ratios (ICURs were calculated. One-way and probabilistic sensitivity analyses (PSA were performed.Our model suggested that the median progression-free survival (PFS was 4.2 months in the icotinib group and 3.5 months in the gefitinib group while they were 4.6 months and 3.4 months, respectively, in the trials. The 5-year QALYs was 0.279 in the icotinib group and 0.269 in the gefitinib group, and the according medical costs were $10662.82 and $13127.57. The ICUR/QALY of icotinib versus gefitinib presented negative in this study. The most sensitive parameter to the ICUR was utility of PFS, ranging from $-1,259,991.25 to $-182,296.61; accordingly the icotinib treatment consistently represented a dominant cost-utility strategy.The icotinib strategy, as a second-line therapy for advanced NSCLC patients in China, is the preferred strategy relative to gefitinib because of the dominant cost-utility. In addition, icotinib shows a good curative effect and safety, resulting in a strong demand for the Chinese market.

  8. The moral courage of nursing students who complete advance directives with homeless persons.

    Nash, Woods; Mixer, Sandra J; McArthur, Polly M; Mendola, Annette

    2016-11-01

    Homeless persons in the United States have disproportionately high rates of illness, injury, and mortality and tend to believe that the quality of their end-of-life care will be poor. No studies were found as to whether nurses or nursing students require moral courage to help homeless persons or members of any other demographic complete advance directives. We hypothesized that baccalaureate nursing students require moral courage to help homeless persons complete advance directives. Moral courage was defined as a trait of a person or an action that overcomes fears or other challenges to achieve something of great moral worth. The hypothesis was investigated through a qualitative descriptive study. Aside from the pre-selection of a single variable to study (i.e. moral courage), our investigation was a naturalistic inquiry with narrative hues insofar as it attended to specific words and phrases in the data that were associated with that variable. A total of 15 baccalaureate nursing students at a public university in the United States responded to questionnaires that sought to elicit fears and other challenges that they both expected to experience and actually experienced while helping homeless persons complete advance directives at a local, non-profit service agency. The study was approved by the Internal Review Board of the authors' university, and each participant signed an informed consent form, which stated that the study involved no reasonably foreseeable risks and that participation was voluntary. Before meeting with homeless persons, participants reported that they expected to experience two fears and a challenge: fear of behaving in ways that a homeless person would deem inappropriate, fear of discussing a homeless person's dying and death, and the challenge of adequately conveying the advance directive's meaning and accurately recording a homeless person's end-of-life wishes. In contrast, after their meetings with homeless persons, relatively few participants

  9. Wild orangutan males plan and communicate their travel direction one day in advance.

    Carel P van Schaik

    Full Text Available The ability to plan for the future beyond immediate needs would be adaptive to many animal species, but is widely thought to be uniquely human. Although studies in captivity have shown that great apes are capable of planning for future needs, it is unknown whether and how they use this ability in the wild. Flanged male Sumatran orangutans (Pongo abelii emit long calls, which females use to maintain earshot associations with them. We tested whether long calls serve to communicate a male's ever-changing predominant travel direction to facilitate maintaining these associations. We found that the direction in which a flanged male emits his long calls predicts his subsequent travel direction for many hours, and that a new call indicates a change in his main travel direction. Long calls given at or near the night nest indicate travel direction better than random until late afternoon on the next day. These results show that male orangutans make their travel plans well in advance and announce them to conspecifics. We suggest that such a planning ability is likely to be adaptive for great apes, as well as in other taxa.

  10. African Cultural Concept of Death and the Idea of Advance Care Directives

    Ekore, Rabi Ilemona; Lanre-Abass, Bolatito

    2016-01-01

    An advance care directive is a person's oral or written instructions about his or her future medical care, if he or she becomes unable to communicate. It may be in written or oral form. Africans ordinarily do not encourage the contemplation of death or any discussion about their own or their loved ones? death. According to the African belief system, life does not end with death, but continues in another realm. Becoming an ancestor after death is a desirable goal of every individual, a feat wh...

  11. Quantifying the Effect of Fast Charger Deployments on Electric Vehicle Utility and Travel Patterns via Advanced Simulation: Preprint

    Wood, E.; Neubauer, J.; Burton, E.

    2015-02-01

    The disparate characteristics between conventional (CVs) and battery electric vehicles (BEVs) in terms of driving range, refill/recharge time, and availability of refuel/recharge infrastructure inherently limit the relative utility of BEVs when benchmarked against traditional driver travel patterns. However, given a high penetration of high-power public charging combined with driver tolerance for rerouting travel to facilitate charging on long-distance trips, the difference in utility between CVs and BEVs could be marginalized. We quantify the relationships between BEV utility, the deployment of fast chargers, and driver tolerance for rerouting travel and extending travel durations by simulating BEVs operated over real-world travel patterns using the National Renewable Energy Laboratory's Battery Lifetime Analysis and Simulation Tool for Vehicles (BLAST-V). With support from the U.S. Department of Energy's Vehicle Technologies Office, BLAST-V has been developed to include algorithms for estimating the available range of BEVs prior to the start of trips, for rerouting baseline travel to utilize public charging infrastructure when necessary, and for making driver travel decisions for those trips in the presence of available public charging infrastructure, all while conducting advanced vehicle simulations that account for battery electrical, thermal, and degradation response. Results from BLAST-V simulations on vehicle utility, frequency of inserted stops, duration of charging events, and additional time and distance necessary for rerouting travel are presented to illustrate how BEV utility and travel patterns can be affected by various fast charge deployments.

  12. Patterns of resource utilization and cost for postmenopausal women with hormone-receptor–positive, human epidermal growth factor receptor-2–negative advanced breast cancer in Europe

    Jerusalem, Guy; Neven, Patrick; Marinsek, Nina; Zhang, Jie; Degun, Ravi; Benelli, Giancarlo; Saletan, Stephen; Ricci, Jean-François; Andre, Fabrice

    2015-01-01

    Healthcare resource utilization in breast cancer varies by disease characteristics and treatment choices. However, lack of clarity in guidelines can result in varied interpretation and heterogeneous treatment management and costs. In Europe, the extent of this variability is unclear. Therefore, evaluation of chemotherapy use and costs versus hormone therapy across Europe is needed. This retrospective chart review (N = 355) examined primarily direct costs for chemotherapy versus hormone therapy in postmenopausal women with hormone-receptor–positive (HR+), human epidermal growth factor receptor-2–negative (HER2–) advanced breast cancer across 5 European countries (France, Germany, The Netherlands, Belgium, and Sweden). Total direct costs across the first 3 treatment lines were approximately €10 000 to €14 000 lower for an additional line of hormone therapy-based treatment versus switching to chemotherapy-based treatment. Direct cost difference between chemotherapy-based and hormone therapy-based regimens was approximately €1900 to €2500 per month. Chemotherapy-based regimens were associated with increased resource utilization (managing side effects; concomitant targeted therapy use; and increased frequencies of hospitalizations, provider visits, and monitoring tests). The proportion of patients taking sick leave doubled after switching from hormone therapy to chemotherapy. These results suggest chemotherapy is associated with increased direct costs and potentially with increased indirect costs (lower productivity of working patients) versus hormone therapy in HR+, HER2– advanced breast cancer. The online version of this article (doi:10.1186/s12885-015-1762-3) contains supplementary material, which is available to authorized users

  13. Performance Analysis of a Utility Helicopter with Standard and Advanced Rotors

    Yeo, Hyeonsoo; Bousman, William G; Johnson, Wayne

    2002-01-01

    Flight test measurements of the performance of the UH-60 Black Hawk helicopter with both standard and advanced rotors are compared with calculations obtained using the comprehensive helicopter analysis CAMRAD II...

  14. Are advance directives helpful for good end of life decision making: a cross sectional survey of health professionals.

    Peicius, Eimantas; Blazeviciene, Aurelija; Kaminskas, Raimondas

    2017-06-05

    This paper joins the debate over changes in the role of health professionals when applying advance directives to manage the decision-making process at the end of life care. Issues in relation to advance directives occur in clinical units in Lithuania; however, it remains one of the few countries in the European Union (EU) where the discussion on advance directives is not included in the health-care policy-making agenda. To encourage the discussion of advance directives, a study was designed to examine health professionals' understanding and preferences related to advance directives. In addition, the study sought to explore the views of health care professionals of the application of Advance Directives (AD) in clinical practice in Lithuania. A cross-sectional survey was conducted by interviewing 478 health professionals based at major health care centers in Kaunas district, Lithuania. The design of the study included the use of a questionnaire developed for this study and validated by a pilot study. The collected data were analyzed using standard descriptive statistical methods. The analysis of knowledge about AD revealed some statistically significant differences when comparing the respondents' profession and gender. The analysis also indicated key emerging themes among respondents including tranquility of mind, the longest possible life expectancy and freedom of choice. Further, the study findings revealed that more than half of the study participants preferred to express their will while alive by using advance directives. The study findings revealed a low level of knowledge on advance directives among health professionals. Most health professionals agreed that AD's improved end-of-life decision making while the majority of physicians appreciated AD as the best tool for sharing responsibilities in clinical practice in Lithuania. More physicians than nurses preferred the presence of advance directives to support their decision making in end-of-life situations.

  15. From waste to value - direct utilization of limonene from orange peel in a biocatalytic cascade reaction towards chiral carvolactone

    Oberleitner, N.; Ressmann, A. K.; Bica, K.; Gaertner, P.; Fraaije, M. W.; Bornscheuer, U. T.; Rudroff, F.; Mihovilovic, M. D.

    2017-01-01

    In this proof of concept study we demonstrate direct utilization of limonene containing waste product orange peel as starting material for a biocatalytic cascade reaction. The product of this cascade is chiral carvolactone, a promising building block for thermoplastic polymers. Four different

  16. Competence to Complete Psychiatric Advance Directives: Effects of Facilitated Decision Making

    Swanson, Jeffrey W.; Appelbaum, Paul S.; Swartz, Marvin S.; Ferron, Joelle; Van Dorn, Richard A.; Wagner, H. Ryan

    2013-01-01

    Psychiatric advance directives (PADs) statutes presume competence to complete these documents, but the range and dimensions of decisional competence among people who actually complete PADs is unknown. This study examines clinical and neuropsychological correlates of performance on a measure to assess competence to complete PADs and investigates the effects of a facilitated PAD intervention on decisional capacity. N = 469 adults with psychotic disorders were interviewed at baseline and then randomly assigned to either a control group in which they received written materials about PADs or to an intervention group in which they were offered an opportunity to meet individually with a trained facilitator to create a PAD. At baseline, domains on the Decisional Competence Assessment Tool for PADs (DCAT-PAD) were most strongly associated with IQ, verbal memory, abstract thinking, and psychiatric symptoms. At one-month follow-up, participants in the intervention group showed more improvement on the DCAT-PAD than controls, particularly among participants with pre-morbid IQ estimates below the median of 100. The results suggest that PAD facilitation is an effective method to boost competence of cognitively-impaired clients to write PADs and make treatment decisions within PADs, thereby maximizing the chances their advance directives will be valid. PMID:17294136

  17. Factors affecting long-term-care residents' decision-making processes as they formulate advance directives.

    Lambert, Heather C; McColl, Mary Ann; Gilbert, Julie; Wong, Jiahui; Murray, Gale; Shortt, Samuel E D

    2005-10-01

    The purpose of this study was to describe factors contributing to the decision-making processes of elderly persons as they formulate advance directives in long-term care. This study was qualitative, based on grounded theory. Recruitment was purposive and continued until saturation was reached. Nine residents of a long-term-care facility were interviewed by use of a semistructured format. Open and axial coding of interview transcripts were carried out and the factors contributing to the decision process were defined. Elders based their decisions primarily on information gathered from personal experiences with death and illness. They obtained very little information from professionals or the media. Major factors considered by elders as they weighed information included spiritual, emotional, and social considerations. The factors considered during the decision-making process were oriented more toward the individual's experiences and less on contributions from objective sources than anticipated. Decision making for advance directives is a highly personalized process. The approach of health professionals when assisting with end-of-life decision making should be planned with these contributing factors in mind, so that the services offered to the individuals in this population best meet their needs.

  18. Study of the standard direct costs of various techniques of advanced endoscopy. Comparison with surgical alternatives.

    Loras, Carme; Mayor, Vicenç; Fernández-Bañares, Fernando; Esteve, Maria

    2018-03-12

    The complexity of endoscopy has carried out an increase in cost that has a direct effect on the healthcare systems. However, few studies have analyzed the cost of advanced endoscopic procedures (AEP). To carry out a calculation of the standard direct costs of AEP, and to make a financial comparison with their surgical alternatives. Calculation of the standard direct cost in carrying out each procedure. An endoscopist detailed the time, personnel, materials, consumables, recovery room time, stents, pathology and medication used. The cost of surgical procedures was the average cost recorded in the hospital. Thirty-eight AEP were analyzed. The technique showing lowest cost was gastroscopy + APC (€116.57), while that with greatest cost was ERCP with cholangioscopy + stent placement (€5083.65). Some 34.2% of the procedures registered average costs of €1000-2000. In 57% of cases, the endoscopic alternative was 2-5 times more cost-efficient than surgery, in 31% of cases indistinguishable or up to 1.4 times more costly. Standard direct cost of the majority of AEP is reported using a methodology that enables easy application in other centers. For the most part, endoscopic procedures are more cost-efficient than the corresponding surgical procedure. Copyright © 2018 The Author(s). Published by Elsevier Ltd.. All rights reserved.

  19. Utilizing Advanced Psychometric Methods in Research on Trait Expression across Situations

    Lang, Jonas W. B.; Tackett, Jennifer; Zettler, Ingo

    2017-01-01

    Lievens emphasized the extent to which new measurement tools and additional statistics can be used to advance research on trait expression across situations. We suggest that advanced psychometric models represent additional important and complementary building blocks for progress and new insights...... in research on trait expression across situations. Here, we offer two specific examples of this: (1) Item Response Theory modelling of within-person variability simultaneous with estimation of latent trait levels and (2) estimation of latent trait and latent situation factors from a multitrait...

  20. Utility values associated with advanced or metastatic non-small cell lung cancer: data needs for economic modeling.

    Brown, Jacqueline; Cook, Keziah; Adamski, Kelly; Lau, Jocelyn; Bargo, Danielle; Breen, Sarah; Chawla, Anita

    2017-04-01

    Cost-effectiveness analyses often inform healthcare reimbursement decisions. The preferred measure of effectiveness is the quality adjusted life year (QALY) gained, where the quality of life adjustment is measured in terms of utility. Areas covered: We assessed the availability and variation of utility values for health states associated with advanced or metastatic non-small cell lung cancer (NSCLC) to identify values appropriate for cost-effectiveness models assessing alternative treatments. Our systematic search of six electronic databases (January 2000 to August 2015) found the current literature to be sparse in terms of utility values associated with NSCLC, identifying 27 studies. Utility values were most frequently reported over time and by treatment type, and less frequently by disease response, stage of disease, adverse events or disease comorbidities. Expert commentary: In response to rising healthcare costs, payers increasingly consider the cost-effectiveness of novel treatments in reimbursement decisions, especially in oncology. As the number of therapies available to treat NSCLC increases, cost-effectiveness analyses will play a key role in reimbursement decisions in this area. Quantifying the relationship between health and quality of life for NSCLC patients via utility values is an important component of assessing the cost effectiveness of novel treatments.

  1. Characterization of nanostructures in the live cell plasma membrane utilizing advanced single molecule fluorescence techniques

    Brameshuber, M.

    2009-01-01

    Unrevealing the detailed structure of the cellular plasma membrane at a nanoscopic length scale is the key for understanding the regulation of various signaling pathways or interaction mechanism. Hypotheses postulate the existence of nanoscopic lipid platforms in the cell membrane which are termed lipid- or membrane rafts. Based on biochemical studies, rafts are believed to play a crucial role in many signaling processes. However, there is currently not much information on their size, shape, stability, surface density, composition and heterogeneity. In this thesis I present an ultra-sensitive fluorescence based method which allows for the first time the direct imaging of single mobile rafts in the live cell plasma membrane. The method senses rafts by their property to assemble a characteristic set of fluorescent marker-proteins or lipids on a time-scale of seconds. A special photobleaching protocol was developed and used to reduce the surface density of labeled mobile rafts down to the level of well-isolated diffraction-limited spots, without altering the single spot brightness. The statistical distribution of probe molecules per raft was determined by single molecule brightness analysis. For demonstration, I used the consensus markers Bodipy-GM1, a fluorescent lipid analogue, and glycosylphosphatidyl-inositol-anchored monomeric GFP. For both markers I found cholesterol-dependent association in the plasma membrane of living CHO and Jurkat T cells in the resting state, indicating the presence of mobile, stable rafts hosting these probes. I further characterized these structures by taking cell-to-cell variations under consideration. By comparing Bodipy-GM1 with mGFP-GPI homo-association upon temperature variation, two different states - a non-equilibrated and an equilibrated state - could be identified. I conclude that rafts are loaded non-randomly; the characteristic load is maintained during its lifetime in the plasma membrane of a non-activated cell. Beside these

  2. Health Resource Utilization in Patients with Advanced Non-Small Cell Lung Cancer Receiving Chemotherapy in China.

    Shi, Jing; Zhu, Jun

    2016-01-01

    Chemotherapy is the preferred treatment regimen for advanced lung cancer patients. This study investigated the health resources utilized by and medical expenses of patients with non-small cell lung cancer (NSCLC) as well as the influence of various chemotherapy regimens on the final medical costs in China. The aim of this study was to provide physicians with a reference to use as the basis for their choice of treatment. Data were collected from the Shanghai Chest Hospital's medical charts and billing database. The collected patient information included the baseline characteristics, medical history, chemotherapy regimens, and medical costs, which were used to estimate the health resources utilized by patients and the cost of treatment. This study included 328 patients, and the average total medical cost was $US14,165. This cost included drugs, which accounted for as much as 78.91% of the total cost, and chemotherapy drugs, which accounted for 51.58% of total drug expenses. The most frequently utilized chemotherapy drug was carboplatin, and the most expensive chemotherapy drug was erlotinib. In drug combinations, gemcitabine was utilized most frequently, the combination of gemcitabine and paclitaxel was the most expensive, and cisplatin was the least expensive drug. Epidermal growth factor receptor-positive patients were treated with targeted drug therapy (icotinib, erlotinib, and gefitinib). The use of recombinant human endostatin was often combined with a vinorelbine plus cisplatin regimen. Traditional Chinese medicines were the most frequently utilized non-chemotherapy drugs, and these drugs were also the most expensive. The final cost significantly depended on the specific chemotherapy regimen; thus, the rationale and cost of the chemotherapy regimen and adjuvant chemotherapy should be considered in patients with advanced NSCLC.

  3. Advanced sorting technologies for optimal wood products and woody biomass utilization

    Xiping Wang

    2012-01-01

    Forest materials represent great potential for advancing our goals in the 21st century for sustainable building, energy independence, and carbon sequestration. A critical component of an improved system for producing bioproducts and bioenergr from forest materials is the ability to sort trees, stems, and logs into end-product categories that represent their highest...

  4. Advanced Burner Reactor with Breed-and-Burn Thorium Blankets for Improved Economics and Resource Utilization

    Greenspan, Ehud [Univ. of California, Berkeley, CA (United States)

    2015-11-04

    This study assesses the feasibility of designing Seed and Blanket (S&B) Sodium-cooled Fast Reactor (SFR) to generate a significant fraction of the core power from radial thorium fueled blankets that operate on the Breed-and-Burn (B&B) mode without exceeding the radiation damage constraint of presently verified cladding materials. The S&B core is designed to maximize the fraction of neutrons that radially leak from the seed (or “driver”) into the subcritical blanket and reduce neutron loss via axial leakage. The blanket in the S&B core makes beneficial use of the leaking neutrons for improved economics and resource utilization. A specific objective of this study is to maximize the fraction of core power that can be generated by the blanket without violating the thermal hydraulic and material constraints. Since the blanket fuel requires no reprocessing along with remote fuel fabrication, a larger fraction of power from the blanket will result in a smaller fuel recycling capacity and lower fuel cycle cost per unit of electricity generated. A unique synergism is found between a low conversion ratio (CR) seed and a B&B blanket fueled by thorium. Among several benefits, this synergism enables the very low leakage S&B cores to have small positive coolant voiding reactivity coefficient and large enough negative Doppler coefficient even when using inert matrix fuel for the seed. The benefits of this synergism are maximized when using an annular seed surrounded by an inner and outer thorium blankets. Among the high-performance S&B cores designed to benefit from this unique synergism are: (1) the ultra-long cycle core that features a cycle length of ~7 years; (2) the high-transmutation rate core where the seed fuel features a TRU CR of 0.0. Its TRU transmutation rate is comparable to that of the reference Advanced Burner Reactor (ABR) with CR of 0.5 and the thorium blanket can generate close to 60% of the core power; but requires only one sixth of the reprocessing and

  5. Advanced system demonstration for utilization of biomass as an energy source

    1980-10-01

    The results of a 20 month study to explore the technical and economic feasibility of fuelwood utilization to operate a 50 megawatt energy conversion facility are described. The availability of biomass as a fuel source, the methods of harvesting and collecting the fuelstock, the costs of providing adequate fuel to the plant, and other requirements for fueling the proposed conversion facility are investigated. (MHR)

  6. Responses of advanced directives by Jehovah's Witnesses on a gynecologic oncology service

    Nagarsheth NP

    2014-12-01

    Full Text Available Nimesh P Nagarsheth,1,2 Nikhil Gupta,3 Arpeta Gupta,4 Erin Moshier,5 Herbert Gretz,1 Aryeh Shander6 1Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, Mount Sinai Medical Center, New York, NY, USA; 2Englewood Hospital and Medical Center, Englewood, NJ, USA; 3Department of Urology, North Shore – Long Island Jewish Health Service, New Hyde Park, NY, USA; 4Department of Endocrinology, Diabetes and Metabolism, St Luke's Hospital of Kansas City, Kansas City, MO, 5Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Medical Center, New York, NY, USA; 6Department of Anesthesiology, Englewood Hospital and Medical Center, Englewood, NJ, USA Objectives: To review the responses of advance directives signed by Jehovah's Witness patients prior to undergoing surgery at a gynecologic oncology service. Study design: A retrospective chart review of gynecologic oncology patients undergoing surgery at a bloodless surgery center from 1998–2007 was conducted. Demographic, pathologic, and clinical data were recorded. The proportion of patients who accepted and refused various blood-derived products was determined and was compared to previously published results from a similar study of labor and delivery unit patients. Results: No gynecologic oncology patients agreed to accept transfusions of whole blood, red cells, white cells, platelets, or plasma under any circumstance, whereas 9.8% of pregnant patients accepted transfusion (P=0.0385. However, 98% of gynecologic oncology patients agreed to accept some blood products, including fractions such as albumin, immunoglobulins, and clotting factors, while only 39% of pregnant patients agreed (P<0.0001. In addition, all gynecologic oncology patients (100% accepted intraoperative hemodilution, compared to 55% of pregnant patients (P<0.0001. Conclusion: Our results confirm the commonly held belief

  7. MOTHER MK II: An advanced direct cycle high temperature gas reactor

    Hart, R.S.; Kendall, J.M.; Marsden, B.J.

    2003-01-01

    The MOTHER (MOdular Thermal HElium Reactor) power plant concepts employ high temperature gas reactors utilizing TRISO fuel, graphite moderator, and helium coolant, in combination with a direct Brayton cycle for electricity generation. The helium coolant from the reactor vessel passes through a Power Conversion Unit (PCU), which includes a turbine-generator, recuperator, precooler, intercooler and turbine-compressors, before being returned to the reactor vessel. The PCU substitutes for the reactor coolant system pumps and steam generators and most of the Balance Of Plant (BOP), including the steam turbines and condensers, employed by conventional nuclear power plants utilizing water cooled reactors. This provides a compact, efficient, and relatively simple plant configuration. The MOTHER MK I conceptual design, completed in the 1987 - 1989 time frame, was developed to economically meet the energy demands for extracting and processing heavy oil from the tar sands of western Canada. However, considerable effort was made to maximize the market potential beyond this application. Consistent with the remote and very high labour rate environment in the tar sands region, simplification of maintenance procedures and facilitation of 'change-out' in lieu of in situ repair was a design focus. MOTHER MK I had a thermal output of 288 MW and produced 120 MW electrical when operated in the electricity only production mode. An annular Prismatic reactor core was utilized, largely to minimize day-to-day operations activities. Key features of the power conversion system included two Power Conversion Units (144 MW th each), the horizontal orientation of all rotating machinery and major heat exchangers axes, high speed rotating machinery (17,030 rpm for the turbine-compressors and 10,200 rpm for the power turbine-generator), gas (helium) bearings for all rotating machinery, and solid state frequency conversion from 170 cps (at full power) to the grid frequency. Recognizing that the on

  8. The Utilization of Historical Data and Geospatial Technology Advances at the Jornada Experimental Range to Support Western America Ranching Culture

    Kris Havstad

    2011-09-01

    that afford the opportunity to obtain high (5 cm resolution data now required for rangeland monitoring. The Jornada team is now a leader in civil UAV applications in the USA. The scientific advances at the Jornada in fields such as remote sensing can be traced to the original Western America ranching culture that established the Jornada in 1912 and which persists as an important influence in shaping research directions today.

  9. Near Real-Time Nondestructive Active Inspection Technologies Utilizing Delayed γ-Rays and Neutrons for Advanced Safeguards

    Hunt, Alan; Tobin, S. J.

    2015-01-01

    In this two year project, the research team investigated how delayed γ-rays from short-lived fission fragments detected in the short interval between irradiating pulses can be exploited for advanced safeguards technologies. This program contained experimental and modeling efforts. The experimental effort measured the emitted spectra, time histories and correlations of the delayed γ-rays from aqueous solutions and solid targets containing fissionable isotopes. The modeling effort first developed and benchmarked a hybrid Monte Carlo simulation technique based on these experiments. The benchmarked simulations were then extended to other safeguards scenarios, allowing comparisons to other advanced safeguards technologies and to investigate combined techniques. Ultimately, the experiments demonstrated the possible utility of actively induced delayed γ-ray spectroscopy for fissionable material assay.

  10. Near Real-Time Nondestructive Active Inspection Technologies Utilizing Delayed γ-Rays and Neutrons for Advanced Safeguards

    Hunt, Alan [Idaho State Univ., Pocatello, ID (United States). Idaho Accelerator Center, Dept. of Physics; Reedy, E. T.E. [Idaho State Univ., Pocatello, ID (United States). Dept. of Phyics, Idaho Accelerator Center; Mozin, V. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Tobin, S. J. [Los Alamos National Lab. (LANL), Los Alamos, NM (United States). Nuclear Nonproliferation

    2015-02-12

    In this two year project, the research team investigated how delayed γ-rays from short-lived fission fragments detected in the short interval between irradiating pulses can be exploited for advanced safeguards technologies. This program contained experimental and modeling efforts. The experimental effort measured the emitted spectra, time histories and correlations of the delayed γ-rays from aqueous solutions and solid targets containing fissionable isotopes. The modeling effort first developed and benchmarked a hybrid Monte Carlo simulation technique based on these experiments. The benchmarked simulations were then extended to other safeguards scenarios, allowing comparisons to other advanced safeguards technologies and to investigate combined techniques. Ultimately, the experiments demonstrated the possible utility of actively induced delayed γ-ray spectroscopy for fissionable material assay.

  11. Assessment of improved organ at risk sparing for advanced cervix carcinoma utilizing precision radiotherapy techniques

    Georg, D.; Georg, P.; Hillbrand, M.; Poetter, R.; Mock, U. [Dept. of Radiotherapy, Medical Univ. AKH, Vienna (Austria)

    2008-11-15

    Purpose: to evaluate the potential benefit of proton therapy and photon based intensity-modulated radiotherapy in comparison to 3-D conformal photon radiotherapy (3D-CRT) in locally advanced cervix cancer. Patients and methods: in five patients with advanced cervix cancer 3D-CRT (four-field box) was compared with intensity modulated photon (IMXT) and proton therapy (IMPT) as well as proton beam therapy (PT) based on passive scattering. Planning target volumes (PTVs) included primary tumor and pelvic and para-aortic lymph nodes. Dose-volume histograms (DVHs) were analyzed for the PTV and various organs at risk (OARs) (rectal wall, bladder, small bowel, colon, femoral heads, and kidneys). In addition dose conformity, dose inhomogeneity and overall volumes of 50% isodoses were assessed. Results: all plans were comparable concerning PTV parameters. Large differences between photon and proton techniques were seen in volumes of the 50% isodoses and conformity indices. DVH for colon and small bowel were significantly improved with PT and IMPT compared to IMXT, with D{sub mean} reductions of 50-80%. Doses to kidneys and femoral heads could also be substantially reduced with PT and IMPT. Sparing of rectum and bladder was superior with protons as well but less pronounced. Conclusion: proton beam RT has significant potential to improve treatment related side effects in the bowel compared to photon beam RT in patients with advanced cervix carcinoma. (orig.)

  12. Assessment of improved organ at risk sparing for advanced cervix carcinoma utilizing precision radiotherapy techniques

    Georg, D.; Georg, P.; Hillbrand, M.; Poetter, R.; Mock, U.

    2008-01-01

    Purpose: to evaluate the potential benefit of proton therapy and photon based intensity-modulated radiotherapy in comparison to 3-D conformal photon radiotherapy (3D-CRT) in locally advanced cervix cancer. Patients and methods: in five patients with advanced cervix cancer 3D-CRT (four-field box) was compared with intensity modulated photon (IMXT) and proton therapy (IMPT) as well as proton beam therapy (PT) based on passive scattering. Planning target volumes (PTVs) included primary tumor and pelvic and para-aortic lymph nodes. Dose-volume histograms (DVHs) were analyzed for the PTV and various organs at risk (OARs) (rectal wall, bladder, small bowel, colon, femoral heads, and kidneys). In addition dose conformity, dose inhomogeneity and overall volumes of 50% isodoses were assessed. Results: all plans were comparable concerning PTV parameters. Large differences between photon and proton techniques were seen in volumes of the 50% isodoses and conformity indices. DVH for colon and small bowel were significantly improved with PT and IMPT compared to IMXT, with D mean reductions of 50-80%. Doses to kidneys and femoral heads could also be substantially reduced with PT and IMPT. Sparing of rectum and bladder was superior with protons as well but less pronounced. Conclusion: proton beam RT has significant potential to improve treatment related side effects in the bowel compared to photon beam RT in patients with advanced cervix carcinoma. (orig.)

  13. Advancing Translational Space Research Through Biospecimen Sharing: Amplified Impact of Studies Utilizing Analogue Space Platforms

    Staten, B.; Moyer, E.; Vizir, V.; Gompf, H.; Hoban-Higgins, T.; Lewis, L.; Ronca, A.; Fuller, C. A.

    2016-01-01

    Biospecimen Sharing Programs (BSPs) have been organized by NASA Ames Research Center since the 1960s with the goal of maximizing utilization and scientific return from rare, complex and costly spaceflight experiments. BSPs involve acquiring otherwise unused biological specimens from primary space research experiments for distribution to secondary experiments. Here we describe a collaboration leveraging Ames expertise in biospecimen sharing to magnify the scientific impact of research informing astronaut health funded by the NASA Human Research Program (HRP) Human Health Countermeasures (HHC) Element. The concept expands biospecimen sharing to one-off ground-based studies utilizing analogue space platforms (e.g., Hindlimb Unloading (HLU), Artificial Gravity) for rodent experiments, thereby significantly broadening the range of research opportunities with translational relevance for protecting human health in space and on Earth.

  14. Defending to the Four Directions Evolving Uechi-ryu’s Hojoundo Exercises for Advanced Students

    Ihor Rymaruk

    2012-07-01

    Full Text Available This article introduces “Defending to the Four Directions,” techniques that add challenge to Uechi-ryu while incorporating and building upon the traditional katas which have formed the basis of the style. Making changes within a style’s training methods just to be different without any other purpose is of little value and actually destructive to the system. This article describes a meaningful and realistic addition to the practice of hojoundo, the formal exercises incorporating basic movements. “Defending to the Four Directions” is intended for advanced students who have mastered Uechi-ryu’s foundamentals. In addition, the practice is well-suited for adaptation and adoption into other martial art styles.

  15. Advanced directions of peaceful applications of nuclear energy in the Republic of Azerbaijan

    Garibov, A.A.

    2006-01-01

    Full text: Application of nuclear energy is actual during last years due to depletion of organic sources of row materials. Therefore, each country develops the programs on peaceful application of nuclear energy and using alternative as well as other energy sources on the basis of the analysis of fuel-energy balance and energy demand state. The Republic of Azerbaijan has huge hydrocarbon resources and alternative energy sources. However, taking into account the fact that hydrocarbon resources can cover increasing energy demand at maximum 50-60 years and renewable energy sources can not meet large energy demand during near future then the discovering of advanced ways on peaceful application of nuclear energy is of great importance. Since the seventies of the twentieth century, wide spectrum of scientific researches on the discovering advanced ways on peaceful application of nuclear energy are carried out in the Republic of Azerbaijan. Among them it is necessary to mark the following directions: radiation modification of the properties of polymers, absorbents, catalysts, metals and alloys, semiconductors, dielectrics, ferroelectrics and various devices; radiation oil-chemistry processes; radiation polymerization; radiation-heterogeneous processes; atomic-hydrogen energy; scientific problems of radiation safety and nuclear security; discovering possibilities for using radiation technologies in the solution of environmental problems; radiation sciences of materials and radiation physics; radiation biology and medicine; application of isotope sources in medicine; application of isotope in oil-gas industry; application of isotope sources in radiography and different fields of technique

  16. A call to improve practice concerning cultural sensitivity in advance directives: a review of the literature.

    Zager, B Sue; Yancy, Margaret

    2011-12-01

    The Patient Self Determination Act of 1990 mandates healthcare providers (HCP) to speak with patients about end-of-life preferences and advance directives (AD). HCP work with patients of varying cultures, and standard ADs do not address cultural differences. In order to understand various cultural beliefs, cultural sensitivity is important especially when discussing advance care planning (ACP). Individuals from differing ethnic backgrounds are likely to turn to their traditional norms of practice when ill or treatment choices must be made. An AD that addresses varying cultural values and beliefs was sought. A comprehensive review of the literature was conducted. Articles selected for review included qualitative and quantitative studies. The evidence was evaluated and synthesized for information related to cultural sensitivity and ADs. Three common themes emerged related to ACP discussions and culture. Healthcare provider awareness, communication, and education concerning cultural differences and ACP assisted in meeting the needs for end-of-life planning in the current era of increased globalization. Education for HCP on cultural differences and how to lead discussions promoted ACP. ADs are an essential part of health care and promote patient-centered care. (HCP) should be able to recognize differing cultural values and beliefs in order to initiate conversations about end of life. Initiating conversations about ACP can be facilitated by using open-ended questions that respect the values and beliefs of various cultures. Copyright ©2011 Sigma Theta Tau International.

  17. Regulation of advance directives in Italy: a bad law in the making.

    Gristina, Giuseppe Renato; Martin, Erica; Ranieri, Vito Marco

    2012-11-01

    The Advance Directives (ADs) have been adopted in many countries to defend patients' autonomy. In Italy, the role of ADs has recently been the subject of heated debate involving political parties and the Roman Catholic Church. In February 2009, the conservative government coalition presented a bill of law on this issue. It has been passed by the Low Chamber and is now being discussed in the Senate. The purpose of the article is to highlight any possible bill's contradiction with Italian Constitution, Italian Code of Medical Ethics (ICME), and Oviedo Convention contents, relevant for intensivists. Analysis of bill's content in the light of Italian Constitution, ICME, Oviedo Convention articles and in comparison with French legislation regarding end of life (Leonetti law). In the Authors' point of view the bill's articles -limit the moral and judicial importance of four main issues as informed consent, permanent incapacity, artificial nutrition/hydration, and withdraw/withhold treatments. In the Authors' opinion the ADs must represent informed preferences made freely by patients within the relationship with their physicians, as part of an advance care planning. When this relationship develops in accordance with the ICME rules, it contains all of the ethical/professional dimensions to legitimate right choices in each case. The law should draw inspiration from ICME principles, assigning them a juridical power, acknowledging their validity in legitimating end-of-life decisions, and defining a framework of juridical legitimacy for these decisions without infringing on patients' right to autonomy with prescriptions on the care.

  18. Facilitation of Psychiatric Advance Directives by Peers and Clinicians on Assertive Community Treatment Teams.

    Easter, Michele M; Swanson, Jeffrey W; Robertson, Allison G; Moser, Lorna L; Swartz, Marvin S

    2017-07-01

    Psychiatric advance directives (PADs) provide a legal mechanism for competent adults to document care preferences and authorize a surrogate to make treatment decisions. In a controlled research setting, an evidence-based intervention, the facilitated psychiatric advance directive (FPAD), was previously shown to overcome most barriers to PAD completion. This study examined implementation of the FPAD intervention in usual care settings as delivered by peer support specialists and nonpeer clinicians on assertive community treatment (ACT) teams. A total of 145 ACT consumers were randomly assigned, within teams, to FPAD with facilitation by either a peer (N=71) or a clinician (N=74). Completion rates and PAD quality were compared with the previous study's standard and across facilitator type. Logistic regression was used to estimate effects on the likelihood of PAD completion. The completion rate of 50% in the intent-to-treat sample (N=145) was somewhat inferior to the prior standard (61%), but the rate of 58% for the retained sample (those who completed a follow-up interview, N=116) was not significantly different from the standard. Rates for peers and clinicians did not differ significantly from each other for either sample. PAD quality was similar to that achieved in the prior study. Four consumer variables predicted completion: independent living status, problematic substance use, length of time served by the ACT team, and no perceived unmet need for hospitalization in crisis. Peers and clinicians can play a crucial role in increasing the number of consumers with PADs, an important step toward improving implementation of PADs in mental health care.

  19. Advanced direct liquefaction concepts for PETC generic units. Final report, Phase I

    NONE

    1995-03-01

    The Advanced Concepts for Direct Coal Liquefaction program was initiated by the Department of Energy in 1991 to develop technologies that could significantly reduce the cost of producing liquid fuels by the direct liquefaction of coal. The advanced 2-stage liquefaction technology that was developed at Wilsonville over the past 10 years has contributed significantly toward decreasing the cost of producing liquids from coal to about $33/bbl. It remains, however, the objective of DOE to further reduce this cost to a level more competitive with petroleum based products. This project, among others, was initiated to investigate various alternative approaches to develop technologies that might ultimately lead to a 25 % reduction in cost of product. In this project a number of novel concepts were investigated, either individually or in a coupled configuration that had the potential to contribute toward meeting the DOE goal. The concepts included mature technologies or ones closely related to them, such as coal cleaning by oil agglomeration, fluid coking and distillate hydrotreating and dewaxing. Other approaches that were either embryonic or less developed were chemical pretreatment of coal to remove oxygen, and dispersed catalyst development for application in the 2-stage liquefaction process. This report presents the results of this project. It is arranged in four sections which were prepared by participating organizations responsible for that phase of the project. A summary of the overall project and the principal results are given in this section. First, however, an overview of the process economics and the process concepts that were developed during the course of this program is presented.

  20. Advanced byproduct recovery: Direct catalytic reduction of sulfur dioxide to elemental sulfur. Quarterly report, April 1--June 30, 1997

    NONE

    1997-12-31

    The team of Arthur D. Little, Tufts University and Engelhard Corporation are conducting Phase 1 of a four and a half year, two-phase effort to develop and scale-up an advanced byproduct recovery technology that is a direct, single-stage, catalytic process for converting sulfur dioxide to elemental sulfur. This catalytic process reduces SO{sub 2} over a fluorite-type oxide (such as ceria and zirconia). The catalytic activity can be significantly promoted by active transition metals, such as copper. More than 95% elemental sulfur yield, corresponding to almost complete sulfur dioxide conversion, was obtained over a Cu-Ce-O oxide catalyst as part of an on-going DOE-sponsored, University Coal Research Program. This type of mixed metal oxide catalyst has stable activity, high selectivity for sulfur production, and is resistant to water and carbon dioxide poisoning. Tests with CO and CH{sub 4} reducing gases indicate that the catalyst has the potential for flexibility with regard to the composition of the reducing gas, making it attractive for utility use. The performance of the catalyst is consistently good over a range of SO{sub 2} inlet concentration (0.1 to 10%) indicating its flexibility in treating SO{sub 2} tail gases as well as high concentration streams. The principal objective of the Phase 1 program is to identify and evaluate the performance of a catalyst which is robust and flexible with regard to choice of reducing gas. In order to achieve this goal, the authors have planned a structured program including: Market/process/cost/evaluation; Lab-scale catalyst preparation/optimization studies; Lab-scale, bulk/supported catalyst kinetic studies; Bench-scale catalyst/process studies; and Utility review. Progress is reported from all three organizations.

  1. Can Individualized Learning Plans in an advanced clinical experience course for fourth year medical students foster Self-Directed Learning?

    Chitkara, Maribeth B; Satnick, Daniel; Lu, Wei-Hsin; Fleit, Howard; Go, Roderick A; Chandran, Latha

    2016-09-01

    Residency programs have utilized Individualized Learning Plans (ILPs) to customize resident education while undergraduate medical education has not done so in a meaningful way. We discuss the use of ILPs within a fourth year medical school course to facilitate self-directed learning (SDL). At Stony Brook University School of Medicine, an ILP component was added to the Advanced Clinical Experience (ACE) course for fourth year students. Each completed an ILP outlining personal learning goals and strategies to achieve them. An adaptation of the Motivated Strategies for Learning Questionnaire (MSLQ) (Duncan T and McKeachie W, Educ Psych 40(2):117-128, 2005 and Cook DA et al., Med Ed 45:1230-1240, 2011) was used to measure success of ILPs in improving SDL. Qualitative data analysis was conducted on the ILPs and self-reflections. Forty-eight students participated. Two of the four SDL sub-domains identified on the MSLQ showed improvement; self-efficacy (p = .001) and self-regulation (p = .002). 'Medical Knowledge' was the competency most frequently identified as an area of concentration (90 %) and professionalism was selected least frequently (4 %). A higher percentage (83 %) of students who reported complete achievement of their ILP goals also reported feeling better prepared for entering residency. ILPs improve SDL strategies among medical students and may serve as useful tools to help shape future learning goals as they transition to residency training.

  2. Geothermal direct-heat utilization assistance: Federal assistance program. Quarterly project progress report, October--December 1995

    NONE

    1996-02-01

    The report summarizes geothermal technical assistance, R&D and technology transfer activities of the Geo-Heat Center at Oregon Institute of Technology for the first quarter of FY-96. It describes 90 contacts with parties during this period related to technical assistance with geothermal direct heat projects. Areas dealt with include geothermal heat pumps, space heating, greenhouses, aquaculture, equipment and resources. Research activities are summarized on low-temperature resource assessment, geothermal district heating system cost evaluation and silica waste utilization project. Outreach activities include the publication of a geothermal direct use Bulletin, dissemination of information, geothermal library, technical papers and seminars, development of a webpage, and progress monitor reports on geothermal resources and utilization.

  3. Utility of the Seattle Heart Failure Model in patients with advanced heart failure.

    Kalogeropoulos, Andreas P; Georgiopoulou, Vasiliki V; Giamouzis, Grigorios; Smith, Andrew L; Agha, Syed A; Waheed, Sana; Laskar, Sonjoy; Puskas, John; Dunbar, Sandra; Vega, David; Levy, Wayne C; Butler, Javed

    2009-01-27

    The aim of this study was to validate the Seattle Heart Failure Model (SHFM) in patients with advanced heart failure (HF). The SHFM was developed primarily from clinical trial databases and extrapolated the benefit of interventions from published data. We evaluated the discrimination and calibration of SHFM in 445 advanced HF patients (age 52 +/- 12 years, 68.5% male, 52.4% white, ejection fraction 18 +/- 8%) referred for cardiac transplantation. The primary end point was death (n = 92), urgent transplantation (n = 14), or left ventricular assist device (LVAD) implantation (n = 3); a secondary analysis was performed on mortality alone. Patients were receiving optimal therapy (angiotensin-II modulation 92.8%, beta-blockers 91.5%, aldosterone antagonists 46.3%), and 71.0% had an implantable device (defibrillator 30.4%, biventricular pacemaker 3.4%, combined 37.3%). During a median follow-up of 21 months, 109 patients (24.5%) had an event. Although discrimination was adequate (c-statistic >0.7), the SHFM overall underestimated absolute risk (observed vs. predicted event rate: 11.0% vs. 9.2%, 21.0% vs. 16.6%, and 27.9% vs. 22.8% at 1, 2, and 3 years, respectively). Risk underprediction was more prominent in patients with an implantable device. The SHFM had different calibration properties in white versus black patients, leading to net underestimation of absolute risk in blacks. Race-specific recalibration improved the accuracy of predictions. When analysis was restricted to mortality, the SHFM exhibited better performance. In patients with advanced HF, the SHFM offers adequate discrimination, but absolute risk is underestimated, especially in blacks and in patients with devices. This is more prominent when including transplantation and LVAD implantation as an end point.

  4. Geothermal direct-heat utilization assistance. Quarterly project progress report, July 1996--September 1996. Federal Assistance Program

    Lienau, P.

    1996-11-01

    This report summarizes geothermal technical assistance, R&D and technology transfer activities of the Geo-Heat Center at Oregon Institute of Technology for the fourth quarter of FY-96. It describes 152 contacts with parties during this period related to technical assistance with geothermal direct heat projects. Areas dealt with include geothermal heat pumps, space heating, greenhouses, aquaculture, equipment, economics and resources. Research activities are summarized on greenhouse peaking. Outreach activities include the publication of a geothermal direct use Bulletin, dissemination of information, geothermal library, technical papers and seminars, and progress monitor reports on geothermal resources and utilization.

  5. Advance directives as a tool to respect patients' values and preferences: discussion on the case of Alzheimer's disease.

    Porteri, Corinna

    2018-02-20

    The proposal of the new criteria for the diagnosis of Alzheimer's disease (AD) based on biomarker data is making possible a diagnosis of AD at the mild cognitive impairment (MCI) or predementia/prodromal- stage. Given the present lack of effective treatments for AD, the opportunity for the individuals to personally take relevant decisions and plan for their future before and if cognitive deterioration occurs is one the main advantages of an early diagnosis. Advance directives are largely seen as an effective tool for planning medical care in the event the subject becomes incompetent. Nevertheless, their value has been questioned with regard to people with dementia by scholars who refer to the arguments of personal identity and of patient's changing interests before and after the onset of dementia. In this paper, I discuss the value of advance directives in Alzheimer's disease and other kind of dementia. Despite critics, I argue that advance directives are especially advisable in dementia and provide reasons in favor of their promotion at an early stage of the disease as a valuable tool to respect patients' values and preferences on medical treatment, including participation in research and end of life decisions. I mainly support advance directives that include both decisions regarding health care and the appointment of an attorney in fact. I conclude that patients with AD at a prodromal or early stage should be offered the opportunity to execute an advance directive, and that not to honor a demented individual's directive would be an unacceptable form of discrimination towards those patients.

  6. UTILITY ADVANCED TURBINE SYSTEMS (ATS) TECHNOLOGY READINESS TESTING: PHASE 3R

    None

    1999-09-01

    The overall objective of the Advanced Turbine System (ATS) Phase 3 Cooperative Agreement between GE and the US Department of Energy (DOE) is the development of the GE 7H and 9H combined cycle power systems. The major effort will be expended on detail design. Validation of critical components and technologies will be performed, including: hot gas path component testing, sub-scale compressor testing, steam purity test trials, and rotational heat transfer confirmation testing. Processes will be developed to support the manufacture of the first system, which was to have been sited and operated in Phase 4 but will now be sited and operated commercially by GE. This change has resulted from DOE's request to GE for deletion of Phase 4 in favor of a restructured Phase 3 (as Phase 3R) to include full speed, no load (FSNL) testing of the 7H gas turbine. Technology enhancements that are not required for the first machine design but will be critical for future ATS advances in performance, reliability, and costs will be initiated. Long-term tests of materials to confirm design life predictions will continue. A schematic of the GE H machine is shown. This report summarizes work accomplished in 2Q99.

  7. Advanced Acid Gas Separation Technology for the Utilization of Low Rank Coals

    Kloosterman, Jeff

    2012-12-31

    Air Products has developed a potentially ground-breaking technology – Sour Pressure Swing Adsorption (PSA) – to replace the solvent-based acid gas removal (AGR) systems currently employed to separate sulfur containing species, along with CO{sub 2} and other impurities, from gasifier syngas streams. The Sour PSA technology is based on adsorption processes that utilize pressure swing or temperature swing regeneration methods. Sour PSA technology has already been shown with higher rank coals to provide a significant reduction in the cost of CO{sub 2} capture for power generation, which should translate to a reduction in cost of electricity (COE), compared to baseline CO{sub 2} capture plant design. The objective of this project is to test the performance and capability of the adsorbents in handling tar and other impurities using a gaseous mixture generated from the gasification of lower rank, lignite coal. The results of this testing are used to generate a high-level pilot process design, and to prepare a techno-economic assessment evaluating the applicability of the technology to plants utilizing these coals.

  8. Advancing Partner Notification Through Electronic Communication Technology: A Review of Acceptability and Utilization Research.

    Pellowski, Jennifer; Mathews, Catherine; Kalichman, Moira O; Dewing, Sarah; Lurie, Mark N; Kalichman, Seth C

    2016-06-01

    A cornerstone of sexually transmitted infection (STI) prevention is the identification, tracing, and notification of sex partners of index patients. Although partner notification reduces disease burden and prevents new infections as well as reinfections, studies show that only a limited number of partners are ever notified. Electronic communication technologies, namely, the Internet, text messaging, and phone calls (i.e., e-notification), have the potential to expand partner services. We conducted a systematic review of studies that have investigated the acceptability and utility of e-notification. We identified 23 studies that met the following criteria: (a) 9 studies presented data on the acceptability of technology-based communications for contacting sex partner(s), and (b) 14 studies reported on the utilization of communication technologies for partner notification. Studies found high levels of interest in and acceptability of e-notification; however, there was little evidence for actual use of e-notification. Taken together, results suggest that electronic communications could have their greatest impact in notifying less committed partners who would otherwise be uninformed of their STI exposure. In addition, all studies to date have been conducted in resource-rich countries, although the low cost of e-notification may have its greatest impact in resource-constrained settings. Research is needed to determine the best practices for exploiting the opportunities afforded by electronic communications for expanding STI partner services.

  9. Status report on direct heat and low temperature utilization of geothermal energy in New Zealand

    Lumb, J.T.; Clelland, L.

    1990-01-01

    The Tasman Pulp and Paper Company's mill at Kawerau continues to be the dominant direct user of geothermal energy in New Zealand. Recent plant changes have increased the effectiveness of the company's use of the resource. Other uses are relatively small in scale and include air and water heating for homes, motels and other commercial and industrial premises. Commercial swimming-pool complexes and pools at hotels, motels and private homes are the other major direct users. This paper reports that overall direct use of the resource has shown a slow increase during the last five years except at Rotorua where the enforced closure of bores has led to more than 70% reduction in use

  10. Advanced light water reactor utility requirements document: Volume 1--ALWR policy and summary of top-tier requirements

    Anon.

    1990-01-01

    The U.S. utilities are leading an industry wide effort to establish the technical foundation for the design of the Advanced Light Water Reactor (ALWR). This effort, the ALWR Program, is being managed for the U.S. electric utility industry by the Electric Power Research Institute (EPRI) and includes participation and sponsorship of several international utility companies and close cooperation with the U.S. Department of Energy (DOE). The cornerstone of the ALWR Program is a set of utility design requirements which are contained in the ALWR Requirements Document. The purpose of the Requirement Document is to present a clear, complete statement of utility desires for their next generation of nuclear plants. The Requirements Document covers the entire plant up to the grid interface. It therefore is the basis for an integrated plant design, i.e., nuclear steam supply system and balance of plant, and it emphasizes those areas which are most important to the objective of achieving an ALWR which is excellent with respect to safety, performance, constructibility, and economics. The document applies to both Pressurized Water Reactors (PWRs) and Boiling Water Reactors (BWRs). The Requirements Document is organized in three volumes. Volume 1 summarizes AlWR Program policy statements and top-tier requirements. The top-tier design requirements are categorized by major functions, including safety and investment protection, performance, and design process and constructibility. There is also a set of general design requirements, such as simplification and proven technology, which apply broadly to the ALWR design, and a set of economic goals for the ALWR program. The top-tier design requirements are described further in Volume 1 and are formally invoked as requirements in Volumes 2 and 3

  11. Volterra equalization of complex modulation utilizing frequency chirp in directly modulated lasers

    Hu, Shaohua; Yi, Xingwen; Zhang, Jing; Song, Yang; Zhu, Mingyue; Qiu, Kun

    2018-02-01

    We apply Volterra-based equalization for complex modulated optical signals utilizing the frequency chirp in DMLs. We experimentally demonstrate that the higher order Volterra filter is necessary in the higher speed transmissions. For further study, we isolate the adiabatic chirp by injection locking and realize the optical PM transmission. We make a comparison among IM, FM and PM with Volterra equalization, finding that PM and FM are more power insensitive and suitable for high speed, power limited fiber transmission. The performance can be further improved by exploiting the diversity gain.

  12. Advances in directed monooxygenase evolution : from diversity generation and flow cytometry screening to tailor-made monooxygenases

    Ruff, Anna Joëlle

    2012-01-01

    Directed Evolution became a powerful tool for proteins engineers to generate tailor-made biocatalyst. Directed protein evolution consist of the following three consecutive main steps, which are performed in iterative cycles; Step 1 the gene diversity generation, Step 2 the screening for improved variants and Step 3 the isolation of gene encoding for improved proteins. In this thesis, methodological advancements in the two key steps of the directed evolution, the diversity generation (SeSaM me...

  13. Advances of the low enriched uranium utilization project in CNA-1 during 1998 and 1999

    Fink, Jose M.; Higa, Manabu; Sidelnik, Jorge I.; Perez, Ramon A.; Casario, Jose A.; Alvarez, Luis A.

    1999-01-01

    In this work, a general description of advances of the Enriched Fuel Introduction Project in CNA-1 and the main tasks performed during 1998 and 1999 are presented. The program is being satisfactorily developed and during that period the number of slightly enriched fuels (LEU) introduced had significantly increased in relation to previous years. At present, there are 181 LEU fuel elements in the core and 125 LEU fuel elements have been extracted. The number of full power burnt fuel elements per day decreased from 1.31 FE/dpp in 1994 (when all fuel was natural) to 0.92 in 1998 and 0.83 in 1999, reaching the predicted value for homogeneous LEU core of 0.7. The cost of burnt fuel in 1998 was 25% lower that if only natural fuel would have been used. (author)

  14. Operation and utilization of low power research reactor critical facility for Advanced Heavy Water Reactor (AHWR)

    De, S.K.; Karhadkar, C.G.

    2017-01-01

    An Advanced Heavy Water Reactor (AHWR) has been designed and developed for maximum power generation from thorium considering large reserves of thorium. The design envisages using 54 pin MOX cluster with different enrichment of "2"3"3U and Pu in Thoria fuel pins. Theoretical models developed to neutron transport and the geometrical details of the reactor including all reactivity devices involve approximations in modelling, resulting in uncertainties. With a view to minimize these uncertainties, a low power research reactor Critical Facility was built in which cold clean fuel can be arranged in a desired and precise geometry. Different experiments conducted in this facility greatly contribute to understand and validate the physics design parameters

  15. Medially Directed TRUS Biopsy of the Prostate: Clinical Utility and Optimal Protocol

    Park, Byung Kwan; Kim, Seung Hyup

    2012-01-01

    The objective of this study is to determine whether medially directed transrectal ultrasound (TRUS)-guided biopsy is necessary for detection of prostate cancer and for establishment of an optimal biopsy regimen that is equivalent to a systematic 12 core biopsy. A total of 302 patients underwent a TRUS-guided systematic 12 core biopsy consisting of both medial sextant biopsy obtained between the parasagittal line and midline and lateral sextant biopsy obtained between the parasagittal line and lateral border. We obtained cancer detection rates of various biopsy regimens that were produced from a systematic 12 core biopsy. Using a systematic 12 core biopsy, cancer was detected in 116 (38.4%) of 302 patients. No significant difference was observed between cancer detection rates of medial sextant biopsy and lateral sextant biopsy (33.8% versus 31.5%, p >.05). Biopsy regimens that were equivalent to the systematic 12 core regarding cancer detection rate included medially directed cores that were obtained from both medial portions of the apex. Both medially directed biopsy and laterally directed biopsy are necessary for detection of prostate cancer and for establishment of an optimal biopsy regimen.

  16. Utilization Of Second Harmonisa Fluxgate For Two Dimension Direct Magnetic Field

    Limansyah, Ivan; Djamal, Mitra

    2003-01-01

    Fluxgate magnetic field sensor is a cheap, accurate and simple solution to measure DC external weak magnetic field. With adding some modification, this sensor can be used to measure amplitude and direction of the external magnetic field. By adding another pick up coils that orthogonal with ordinary pick up coils, two dimensions fluxgate magnetic field sensor can be build

  17. Economic assessment of using nonmetallic materials in the direct utilization of geothermal energy. Final report

    Cabibbo, S.V.; Ammerlaan, T.

    1979-02-01

    The cost effectiveness of nonmetallic materials in three direct-use geothermal applications was assessed. An extensive review of the available literature was conducted in order to ascertain those processes for which sufficient design and cost data had been published to permit this economic assessment to be made. Only three such processes could be found and they are discussed.

  18. Expanding Geothermal Resource Utilization through Directed Research, Education, and Public Outreach

    Calvin, Wendy [Univ. of Nevada, Reno, NV (United States)

    2015-06-29

    The Great Basin Center for Geothermal Energy (GBCGE or the Center) was established at the University of Nevada, Reno (UNR) in May 2000 to promote research and utilization of geothermal resources. The Center received funding through this grant to promote increased geothermal development in the Great Basin, with most of the funding used for peerreviewed research. Funding to the Center and work under the contract were initiated in March 2002, with supplemental funding in subsequent years. The Center monitored the research projects that were competitively awarded in a series of proposal calls between 2002 and 2007. Peer-reviewed research promoted identification and utilization of geothermal resources in Nevada. Projects used geology, geochemistry, geophysics, remote sensing, and the synthesis of multi-disciplinary information to produce new models of geothermal systems in the Western U.S. and worldwide. Funds were also used to support graduate student research and training. Part of the grant was used to support public outreach activities, including webpages, online maps and data resources, and informational workshops for stakeholders.

  19. The Utilization of Urine Processing for the Advancement of Life Support Technologies

    Grossi-Soyster, Elysse; Hogan, John; Flynn, Michael

    2014-01-01

    The success of long-duration missions will depend on resource recovery and the self-sustainability of life support technologies. Current technologies used on the International Space Station (ISS) utilize chemical and mechanical processes, such as filtration, to recover potable water from urine produced by crewmembers. Such technologies have significantly reduced the need for water resupply through closed-loop resource recovery and recycling. Harvesting the important components of urine requires selectivity, whether through the use of membranes or other physical barriers, or by chemical or biological processes. Given the chemical composition of urine, the downstream benefits of urine processing for resource recovery will be critical for many aspects of life support, such as food production and the synthesis of biofuels. This paper discusses the beneficial components of urine and their potential applications, and the challenges associated with using urine for nutrient recycling for space application.

  20. Implant Utilization and Time to Prosthetic Rehabilitation in Conventional and Advanced Fibular Free Flap Reconstruction of the Maxilla and Mandible.

    Chuka, Richelle; Abdullah, Wael; Rieger, Jana; Nayar, Suresh; Seikaly, Hadi; Osswald, Martin; Wolfaardt, Johan

    Precisely designed jaw reconstruction rehabilitation (JRR) is important to the integrity of the jaw structure and oral functions. Advanced three-dimensional (3D) digital surgical design and simulation (SDS) techniques have the potential to reduce time to reconstructive and dental treatment completion, thereby promoting early functional oral rehabilitation. This study investigated the use of SDS in JRR procedures. A retrospective chart review was conducted on adult head and neck tumor (HNT) participants who completed JRR treatment with a fibular free flap (FFF) reconstruction. Two treatment approaches, advanced 3D SDS technique (with-SDS) and conventional, nondigitally planned technique (without-SDS), included the use of osseointegrated implants. Data were collected from adult patients treated between January 2000 and March 2014 at the Institute for Reconstructive Sciences in Medicine (iRSM). Participants were excluded if they underwent a bone-containing augmentation to the FFF reconstruction. The without-SDS group underwent a conventional, nonguided FFF reconstruction followed by nonguided implant placement. The with-SDS group underwent a guided FFF reconstruction with guided implant placement during the reconstructive surgery. The outcome measures included implant utilization (ratio of implants placed to connected) and time to prosthetic connection after FFF reconstruction. Mann-Whitney U test was used to analyze the data. The digital SDS technique (with-SDS) group completed prosthetic treatment with a significantly higher utilization of implants as well as a significantly shorter time to prosthetic delivery. SDS allows an interdisciplinary treatment team to work together to create a virtual plan that leads to greater efficiency in patient treatment time and utilization of dental implants.

  1. Expected utility without utility

    Castagnoli, E.; Licalzi, M.

    1996-01-01

    This paper advances an interpretation of Von Neumann–Morgenstern’s expected utility model for preferences over lotteries which does not require the notion of a cardinal utility over prizes and can be phrased entirely in the language of probability. According to it, the expected utility of a lottery can be read as the probability that this lottery outperforms another given independent lottery. The implications of this interpretation for some topics and models in decision theory are considered....

  2. Clinical utility of circulating cell-free DNA in advanced colorectal cancer.

    Allan A Lima Pereira

    Full Text Available Circulating cell-free DNA (cfDNA isolated from the plasma of cancer patients (pts has been shown to reflect the genomic mutation profile of the tumor. However, physician and patient assessment of clinical utility of these assays in patients with metastatic colorectal cancer (mCRC has not been previously described.Patients were prospectively consented to a prospective genomic matching protocol (Assessment of Targeted Therapies Against Colorectal Cancer [ATTACC], with collection of blood for cfDNA extraction and sequencing of a 54-gene panel in a CLIA-certified lab. Formalin-fixed, paraffin-embedded (FFPE tissue from prior resections or biopsies underwent 50-gene sequencing. Results from both assays were returned to the treating physicians for patient care and clinical trial selection. Follow-up surveys of treating physicians and chart reviews assessed clinical utility.128 mCRC pts were enrolled between 6/2014 and 1/2015. Results were returned in median of 13 and 26 days for cfDNA and FFPE sequencing, respectively. With cfDNA sequencing, 78% (100/128 of samples had a detectable somatic genomic alteration. 50% of cfDNA cases had potentially actionable alterations, and 60% of these could be genomically matched to at least one clinical trial in our institution. 50% (15/30 of these pts enrolled onto an identified matched trial. Physicians reported that the cfDNA testing improved the quality of care they could provide in 73% of the cases, and that 89% of pts reported greater satisfaction with the efforts to personalize experimental therapeutic agents.cfDNA sequencing can provide timely information on potentially actionable mutations and amplifications, thereby facilitating clinical trial enrollment and improving the perceived quality of care.

  3. Optimally setting up directed searches for continuous gravitational waves in Advanced LIGO O1 data

    Ming, Jing; Papa, Maria Alessandra; Krishnan, Badri; Prix, Reinhard; Beer, Christian; Zhu, Sylvia J.; Eggenstein, Heinz-Bernd; Bock, Oliver; Machenschalk, Bernd

    2018-02-01

    In this paper we design a search for continuous gravitational waves from three supernova remnants: Vela Jr., Cassiopeia A (Cas A) and G347.3. These systems might harbor rapidly rotating neutron stars emitting quasiperiodic gravitational radiation detectable by the advanced LIGO detectors. Our search is designed to use the volunteer computing project Einstein@Home for a few months and assumes the sensitivity and duty cycles of the advanced LIGO detectors during their first science run. For all three supernova remnants, the sky positions of their central compact objects are well known but the frequency and spin-down rates of the neutron stars are unknown which makes the searches computationally limited. In a previous paper we have proposed a general framework for deciding on what target we should spend computational resources and in what proportion, what frequency and spin-down ranges we should search for every target, and with what search setup. Here we further expand this framework and apply it to design a search directed at detecting continuous gravitational wave signals from the most promising three supernova remnants identified as such in the previous work. Our optimization procedure yields broad frequency and spin-down searches for all three objects, at an unprecedented level of sensitivity: The smallest detectable gravitational wave strain h0 for Cas A is expected to be 2 times smaller than the most sensitive upper limits published to date, and our proposed search, which was set up and ran on the volunteer computing project Einstein@Home, covers a much larger frequency range.

  4. The role of advance directives in end-of-life decisions in Austria: survey of intensive care physicians.

    Schaden, Eva; Herczeg, Petra; Hacker, Stefan; Schopper, Andrea; Krenn, Claus G

    2010-10-21

    Currently, intensive care medicine strives to define a generally accepted way of dealing with end-of-life decisions, therapy limitation and therapy discontinuation.In 2006 a new advance directive legislation was enacted in Austria. Patients may now document their personal views regarding extension of treatment. The aim of this survey was to explore Austrian intensive care physicians' experiences with and their acceptance of the new advance directive legislation two years after enactment (2008). Under the aegis of the OEGARI (Austrian Society of Anaesthesiology, Resuscitation and Intensive Care) an anonymised questionnaire was sent to the medical directors of all intensive care units in Austria. The questions focused on the physicians' experiences regarding advance directives and their level of knowledge about the underlying legislation. There were 241 questionnaires sent and 139 were turned, which was a response rate of 58%. About one third of the responders reported having had no experience with advance directives and only 9 directors of intensive care units had dealt with more than 10 advance directives in the previous two years. Life-supporting measures, resuscitation, and mechanical ventilation were the predominantly refused therapies, wishes were mainly expressed concerning pain therapy. A response rate of almost 60% proves the great interest of intensive care professionals in making patient-oriented end-of-life decisions. However, as long as patients do not make use of their right of co-determination, the enactment of the new law can be considered only a first important step forward.

  5. Approximately One In Three US Adults Completes Any Type Of Advance Directive For End-Of-Life Care.

    Yadav, Kuldeep N; Gabler, Nicole B; Cooney, Elizabeth; Kent, Saida; Kim, Jennifer; Herbst, Nicole; Mante, Adjoa; Halpern, Scott D; Courtright, Katherine R

    2017-07-01

    Efforts to promote the completion of advance directives implicitly assume that completion rates of these documents, which help ensure care consistent with people's preferences in the event of incapacity, are undesirably low. However, data regarding completion of advance directives in the United States are inconsistent and of variable quality. We systematically reviewed studies published in the period 2011-16 to determine the proportion of US adults with a completed living will, health care power of attorney, or both. Among the 795,909 people in the 150 studies we analyzed, 36.7 percent had completed an advance directive, including 29.3 percent with living wills. These proportions were similar across the years reviewed. Similar proportions of patients with chronic illnesses (38.2 percent) and healthy adults (32.7 percent) had completed advance directives. The findings provide benchmarks for gauging future policies and practices designed to motivate completion of advance directives, particularly among those people most likely to benefit from having these documents on record. Project HOPE—The People-to-People Health Foundation, Inc.

  6. Directional biases reveal utilization of arm's biomechanical properties for optimization of motor behavior.

    Goble, Jacob A; Zhang, Yanxin; Shimansky, Yury; Sharma, Siddharth; Dounskaia, Natalia V

    2007-09-01

    Strategies used by the CNS to optimize arm movements in terms of speed, accuracy, and resistance to fatigue remain largely unknown. A hypothesis is studied that the CNS exploits biomechanical properties of multijoint limbs to increase efficiency of movement control. To test this notion, a novel free-stroke drawing task was used that instructs subjects to make straight strokes in as many different directions as possible in the horizontal plane through rotations of the elbow and shoulder joints. Despite explicit instructions to distribute strokes uniformly, subjects showed biases to move in specific directions. These biases were associated with a tendency to perform movements that included active motion at one joint and largely passive motion at the other joint, revealing a tendency to minimize intervention of muscle torque for regulation of the effect of interaction torque. Other biomechanical factors, such as inertial resistance and kinematic manipulability, were unable to adequately account for these significant biases. Also, minimizations of jerk, muscle torque change, and sum of squared muscle torque were analyzed; however, these cost functions failed to explain the observed directional biases. Collectively, these results suggest that knowledge of biomechanical cost functions regarding interaction torque (IT) regulation is available to the control system. This knowledge may be used to evaluate potential movements and to select movement of "low cost." The preference to reduce active regulation of interaction torque suggests that, in addition to muscle energy, the criterion for movement cost may include neural activity required for movement control.

  7. Recent achievements of the EUR organisation (European utility requirements for advanced light water reactors) - 15365

    Jacquart, G.; Guelfi, A.; Vanhoenacker, L.; Pouget-Abadie, X.; Engstroem, J.

    2015-01-01

    For more than twenty years now, the European Utility Requirements (EUR) organisation has been actively developing and promoting harmonized technical specifications for the new designs to be proposed by the vendors in Europe. The EUR Document consists of a comprehensive set of requirements covering the whole Nuclear Power Plant (NPP). These terms of reference can be used by the utilities (guide for design assessment, technical reference for call for bids) and by the vendors (as a technical guide). The harmonization and standardization which is sought after by the EUR aims at delivering the safest and most competitive designs based on common rules shared all over Europe. Fifteen major nuclear operators across Europe are now members of the Organisation. Over the last few years, the EUR organisation has been extremely active. After the publication of the Revision D of the EUR Document (October 2012), the EUR organisation released in March 2013 its road map for the period. This paper describes the main results obtained during that period of time and the new challenges in the three following fields. First, the revision of the EUR Document in order to maintain it at a state-of-the-art level remains the highest priority for the Organisation. The paper presents the technical scope of the on-going new major revision (Revision E) which is scheduled to be issued in 2016. This project will deliver significant updates of the EUR document in many fields among which: revised Safety requirements taking into account lessons learned from the Fukushima accident and consistent with the most recent international safety standards, Instrumentation and Control, Seismic Approach, Probabilistic Safety Assessments. The assessment of new designs is the second main technical activity of the EUR organisation. The MHI EU-APWR design has been assessed against the revision D between 2012 and 2014 and new design assessments applications have been received by the EUR organisation (namely KEPCO

  8. UTILITY ADVANCED TURBINE SYSTEMS (ATS) TECHNOLOGY READINESS TESTING PHASE 3 RESTRUCTURED (3R); TOPICAL

    Unknown

    1999-01-01

    In the early 90's GE recognized the need to introduce new technology to follow on to the ''F'' technology the Company introduced in 1988. By working with industry and DOE, GE helped shape the ATS program goal of demonstrating a gas turbine, combined-cycle system using natural gas as the primary fuel that achieves the following targets: system efficiency exceeding 60% lower heating value basis; environmental superiority under full-load operating conditions without the use of post-combustion emissions controls, environmental superiority includes limiting NO(sub 2) to less than 10 parts per mission by volume (dry basis) at 15% oxygen; busbar energy costs that are 10% less than current state-of-the-art turbine systems meeting the same environmental requirements; fuel-flexible designs operating on natural gas but also capable of being adapted to operate on coal-based, distillate, or biomass fuels; reliability-availability-maintainability (RAM) that is equivalent to modern advanced power generation systems; and commercial systems that could enter the market in the year 2000

  9. Sonidegib: mechanism of action, pharmacology, and clinical utility for advanced basal cell carcinomas

    Jain S

    2017-03-01

    Full Text Available Sachin Jain,1 Ruolan Song,2 Jingwu Xie2 1Indiana University School of Medicine, 2Department of Pediatrics, Herman B Wells Center for Pediatric Research, Indianapolis, IN, USA Abstract: The Hedgehog (Hh pathway is critical for cell differentiation, tissue polarity, and stem cell maintenance during embryonic development, but is silent in adult tissues under normal conditions. However, aberrant Hh signaling activation has been implicated in the development and promotion of certain types of cancer, including basal cell carcinoma (BCC, medulloblastoma, and gastrointestinal cancers. In 2015, the US Food and Drug Administration (FDA approved sonidegib, a smoothened (SMO antagonist, for treatment of advanced BCC (aBCC after a successful Phase II clinical trial. Sonidegib, also named Odomzo, is the second Hh signaling inhibitor approved by the FDA to treat BCCs following approval of the first SMO antagonist vismodegib in 2012. What are the major features of sonidegib (mechanism of action; metabolic profiles, clinical efficacy, safety, and tolerability profiles? Will the sonidegib experience help other clinical trials using Hh signaling inhibitors in the future? In this review, we will summarize current understanding of BCCs and Hh signaling. We will focus on sonidegib and its use in the clinic, and we will discuss ways to improve its clinical application in cancer therapeutics. Keywords: Hedgehog, smoothened, inhibitor, cancer, basal cell carcinoma, sonidegib

  10. Clinical utility of vandetanib in the treatment of patients with advanced medullary thyroid cancer

    Deshpande H

    2011-12-01

    Full Text Available Hari Deshpande1,3, Vicky Marler3, Julie Ann Sosa2,31Department of Medicine, 2Department of Surgery, Yale University School of Medicine, 3Yale Cancer Center, New Haven, CT, USAAbstract: Vandetanib (ZD6474 became the first systemic agent to be approved for the treatment of metastatic or locally advanced medullary thyroid cancer. It was a proof of principle, because it is an orally bioavailable medication that targets the growth factors felt to be important in the pathogenesis of this disease, ie, the rearranged during transfection proto-oncogene and vascular endothelial growth factor receptor. It was tested initially in two Phase II studies at doses of 100 mg and 300 mg daily. Although activity was seen at both doses, the higher dose was chosen for a randomized, placebo-controlled Phase II study. This trial, which accrued more than 300 patients, showed a statistically significant benefit for the group taking vandetanib compared with those taking placebo medication. Progression-free survival for the vandetanib arm has not been reached, compared with 19 months for the placebo arm. The main toxicity appears to be diarrhea, although some patients experienced significant side effects, including torsades de pointes and sudden cardiac death. Therefore, it is now necessary for practitioners to enroll in a Risk Evaluation Mitigation Strategy before being allowed to prescribe this medication, to reduce the risk of serious side effects occurring.Keywords: ZD6474, medullary thyroid cancer, vandetanib

  11. A Study of the Utilization of Advanced Composites in Fuselage Structures of Commercial Aircraft

    Watts, D. J.; Sumida, P. T.; Bunin, B. L.; Janicki, G. S.; Walker, J. V.; Fox, B. R.

    1985-01-01

    A study was conducted to define the technology and data needed to support the introduction of advanced composites in the future production of fuselage structure in large transport aircraft. Fuselage structures of six candidate airplanes were evaluated for the baseline component. The MD-100 was selected on the basis of its representation of 1990s fuselage structure, an available data base, its impact on the schedule and cost of the development program, and its availability and suitability for flight service evaluation. Acceptance criteria were defined, technology issues were identified, and a composite fuselage technology development plan, including full-scale tests, was identified. The plan was based on composite materials to be available in the mid to late 1980s. Program resources required to develop composite fuselage technology are estimated at a rough order of magnitude to be 877 man-years exclusive of the bird strike and impact dynamic test components. A conceptual composite fuselage was designed, retaining the basic MD-100 structural arrangement for doors, windows, wing, wheel wells, cockpit enclosure, major bulkheads, etc., resulting in a 32 percent weight savings.

  12. An advanced conceptual Tokamak fusion power reactor utilizing closed cycle helium gas turbines

    Conn, R.W.

    1976-01-01

    UWMAK-III is a conceptual Tokamak reactor designed to study the potential and the problems associated with an advanced version of Tokamaks as power reactors. Design choices have been made which represent reasonable extrapolations of present technology. The major features are the noncircular plasma cross section, the use of TZM, a molybdenum based alloy, as the primary structural material, and the incorporation of a closed-cycle helium gas turbine power conversion system. A conceptual design of the turbomachinery is given together with a preliminary heat exchanger analysis that results in relatively compact designs for the generator, precooler, and intercooler. This paper contains a general description of the UWMAK-III system and a discussion of those aspects of the reactor, such as the burn cycle, the blanket design and the heat transfer analysis, which are required to form the basis for discussing the power conversion system. The authors concentrate on the power conversion system and include a parametric performance analysis, an interface and trade-off study and a description of the reference conceptual design of the closed-cycle helium gas turbine power conversion system. (Auth.)

  13. Long-term fuel cycle scenarios for advanced utilization of plutonium from LWRs

    Sato, Osamu; Tatematsu, Kenji

    2005-01-01

    The Innovative Water Reactor for Flexible fuel cycle (FLWR) realizes multiple recycling and breeding of Pu, which enables effective utilization of the uranium resource, and is based on well-developed LWR technologies. This reactor offers flexibility for the future nuclear fuel cycle situation. Three scenarios were defined for future deployment of nuclear power generation and fuel cycle systems in Japan and analyzed from the view point of Pu recycle, natural uranium consumption and stock of spent fuels. The LWR with long-term Pu recycle with or without MOX fuel reprocessing needs uranium of about 9 thousands tons per year and accumulated uranium consumption of 1.5 million tons in 2150. If the FLWR with net conversion ratio of 0.89 and 1.04 would be introduced in 2025 and 2050 or 2030, it would suppress ultimate required natural uranium and control the uranium consumption about less than 1.2 million tons in 2150, while the FLWR in 2025 and FBR with breeding ratio of 1.16 in 2050 will at 0.9 million tons after in 2100. (T. Tanaka)

  14. Recent advances in utilizing transcription factors to improve plant abiotic stress tolerance by transgenic technology

    Hongyan eWang

    2016-02-01

    Full Text Available Agricultural production and quality are adversely affected by various abiotic stresses worldwide and this will be exacerbated by the deterioration of global climate. To feed a growing world population, it is very urgent to breed stress-tolerant crops with higher yields and improved qualities against multiple environmental stresses. Since conventional breeding approaches had marginal success due to the complexity of stress tolerance traits, the transgenic approach is now being popularly used to breed stress-tolerant crops. So identifying and characterizing the the critical genes involved in plant stress responses is an essential prerequisite for engineering stress-tolerant crops. Far beyond the manipulation of single functional gene, engineering certain regulatory genes has emerged as an effective strategy now for controlling the expression of many stress-responsive genes. Transcription factors (TFs are good candidates for genetic engineering to breed stress-tolerant crop because of their role as master regulators of many stress-responsive genes. Many TFs belonging to families AP2/EREBP, MYB, WRKY, NAC, bZIP have been found to be involved in various abiotic stresses and some TF genes have also been engineered to improve stress tolerance in model and crop plants. In this review, we take five large families of TFs as examples and review the recent progress of TFs involved in plant abiotic stress responses and their potential utilization to improve multiple stress tolerance of crops in the field conditions.

  15. Advance care planning in 21st century Australia: a systematic review and appraisal of online advance care directive templates against national framework criteria.

    Luckett, Tim; Bhattarai, Priyanka; Phillips, Jane; Agar, Meera; Currow, David; Krastev, Yordanka; Davidson, Patricia M

    2015-11-01

    A drive to promote advance care planning at a population level has led to a proliferation of online advance care directive (ACD) templates but little information to guide consumer choice. The current study aimed to appraise the quality of online ACD templates promoted for use in Australia. A systematic review of online Australian ACD templates was conducted in February 2014. ACD templates were identified via Google searches, and quality was independently appraised by two reviewers against criteria from the 2011 report A National Frameworkfor Advance Care Directives. Bias either towards or against future medical treatment was assessed using criteria designed to limit subjectivity. Fourteen online ACD templates were included, all of which were available only in English. Templates developed by Southern Cross University best met the framework criteria. One ACD template was found to be biased against medical treatment--the Dying with Dignity Victoria Advance Healthcare Directive. More research is needed to understand how online resources can optimally elicit and record consumers' individual preferences for future care. Future iterations of the framework should address online availability and provide a simple rating system to inform choice and drive quality improvement.

  16. Future directions for resuscitation research. V. Ultra-advanced life support.

    Tisherman, S A; Vandevelde, K; Safar, P; Morioka, T; Obrist, W; Corne, L; Buckman, R F; Rubertsson, S; Stephenson, H E; Grenvik, A; White, R J

    1997-06-01

    Standard external cardiopulmonary resuscitation (SECPR) frequently produces very low perfusion pressures, which are inadequate to achieve restoration of spontaneous circulation (ROSC) and intact survival, particularly when the heart is diseased. Ultra-advanced life support (UALS) techniques may allow support of vital organ systems until either the heart recovers or cardiac repair or replacement is performed. Closed-chest emergency cardiopulmonary bypass (CPB) provides control of blood flow, pressure, composition and temperature, but has so far been applied relatively late. This additional low-flow time may preclude conscious survival. An easy, quick method for vessel access and a small preprimed system that could be taken into the field are needed. Open-chest CPR (OCCPR) is physiologically superior to SECPR, but has also been initiated too late in prior studies. Its application in the field has recently proven feasible. Variations of OCCPR, which deserve clinical trials inside and outside hospitals, include 'minimally invasive direct cardiac massage' (MIDCM), using a pocket-size plunger-like device inserted via a small incision and 'direct mechanical ventricular actuation' (DMVA), using a machine that pneumatically drives a cup placed around the heart. Other novel UALS approaches for further research include the use of an aortic balloon catheter to improve coronary and cerebral blood flow during SECPR, aortic flush techniques and a double-balloon aortic catheter that could allow separate perfusion (and cooling) of the heart, brain and viscera for optimal resuscitation of each. Decision-making, initiation of UALS methods and diagnostic evaluations must be rapid to maximize the potential for ROSC and facilitate decision-making regarding long-term circulatory support versus withdrawal of life support for hopeless cases. Research and development of UALS techniques needs to be coordinated with cerebral resuscitation research.

  17. Solar energy utilization in the direct photocarboxylation of 2,3-dihydrofuran using CO2.

    Aresta, Michele; Dibenedetto, Angela; Baran, Tomasz; Wojtyła, Szymon; Macyk, Wojciech

    2015-01-01

    The conversion of CO2 into high energy products (fuels) and the direct carboxylation of C-H bonds require a high energy input. Energy cannot be derived from fossil carbon, in this case. Solar energy can be used instead, with a low environmental impact and good profit. We have studied the use of white light or solar energy in the photoreduction of CO2 and in photocarboxylation reactions, using different semiconductors modified at their surface. Two examples of reduction of CO2 to methanol and CO will be shortly discussed, and two cases of carboxylation of organic substrates. The case of carboxylation of 2,3-dihydrofuran will be discussed in detail.

  18. The scrounge-atron: a phased approach to the advanced hydrotest facility utilizing proton radiography

    Alford, O.J.; Barnes, P.D. Jr.; Chargin, A.K.; Dekin, W.D.; Hartouni, E.P.; Hockman, J.; Hockman, J.N.; Ladran, A.S.; Libkind, M.A.; Moore, T.L.; Ohnuma, S.; Pastrnak, J.W.; Pico, R.E.; Ruggiero, A.G.; Souza, R.J.; Stoner, J.M.; Wilson, J.H.

    1999-01-01

    The Department of Energy has initiated its Stockpile Stewardship and Management Program (SSMP) to provide a single, integrated technical program for maintaining the continued safety and reliability of the nation's nuclear weapons stockpile in the absence of nuclear testing. Consistent with the SSMP, the Advanced Hydrotest Facility (AHF) has been conceived to provide improved radiographic imaging with multiple axes and multiple time frames. The AHF would be used to better understand the evolution of nuclear weapon primary implosion shape under normal and accident scenarios. There are three fundamental technologies currently under consideration for use on the AHF. These include linear induction acceleration, inductive-adder pulsed-power technology (both technologies using high current electron beams to produce an intense X-ray beam) and high-energy proton accelerators to produce a proton beam. The Scrounge-atron (a proton synchrotron) was conceived to be a relatively low cost demonstration of the viability of the third technology using bursts of energetic protons, magnetic lenses, and particle detectors to produce the radiographic image. In order for the Scrounge-atron to provide information useful for the AHF technology decision, the accelerator would have to be built as quickly and as economically as possible. These conditions can be met by scrounging parts from decommissioned accelerators across the country, especially the Main Ring at Fermilab. The Scrounge-atron is designed to meet the baseline parameters for single axis proton radiography: a 20 GeV proton beam of ten pulses, 10 11 protons each, spaced 250 ns apart

  19. ASSESSMENT OF THE UTILITY OF THE ADVANCED HIMAWARI IMAGER TO DETECT ACTIVE FIRE OVER AUSTRALIA

    B. Hally

    2016-06-01

    Full Text Available Wildfire detection and attribution is an issue of importance due to the socio-economic impact of fires in Australia. Early detection of fires allows emergency response agencies to make informed decisions in order to minimise loss of life and protect strategic resources in threatened areas. Until recently, the ability of land management authorities to accurately assess fire through satellite observations of Australia was limited to those made by polar orbiting satellites. The launch of the Japan Meteorological Agency (JMA Himawari-8 satellite, with the 16-band Advanced Himawari Imager (AHI-8 onboard, in October 2014 presents a significant opportunity to improve the timeliness of satellite fire detection across Australia. The near real-time availability of images, at a ten minute frequency, may also provide contextual information (background temperature leading to improvements in the assessment of fire characteristics. This paper investigates the application of the high frequency observation data supplied by this sensor for fire detection and attribution. As AHI-8 is a new sensor we have performed an analysis of the noise characteristics of the two spectral bands used for fire attribution across various land use types which occur in Australia. Using this information we have adapted existing algorithms, based upon least squares error minimisation and Kalman filtering, which utilise high frequency observations of surface temperature to detect and attribute fire. The fire detection and attribution information provided by these algorithms is then compared to existing satellite based fire products as well as in-situ information provided by land management agencies. These comparisons were made Australia-wide for an entire fire season - including many significant fire events (wildfires and prescribed burns. Preliminary detection results suggest that these methods for fire detection perform comparably to existing fire products and fire incident reporting

  20. NRC review of Electric Power Research Institute's Advanced Light Water Reactor Utility Requirements Document - Evolutionary plant designs, Chapter 1, Project No. 669

    1992-08-01

    The staff of the US Nuclear Regulatory Commission has prepared Volume 2 (Parts 1 and 2) of a safety evaluation report (SER), ''NRC Review of Electric Power Research Institute's Advanced Light Water Reactor Utility Requirements Document -- Evolutionary Plant Designs,'' to document the results of its review of the Electric Power Research Institute's ''Advanced Light Water Reactor Utility Requirements Document.'' This SER gives the results of the staff's review of Volume II of the Requirements Document for evolutionary plant designs, which consists of 13 chapters and contains utility design requirements for an evolutionary nuclear power plant (approximately 1300 megawatts-electric)

  1. NRC review of Electric Power Research Institute's Advanced Light Water Reactor Utility Requirements Document - Evolutionary plant designs, Chapters 2--13, Project No. 669

    1992-08-01

    The staff of the US Nuclear Regulatory Commission has prepared Volume 2 (Parts 1 and 2) of a safety evaluation report (SER), ''NRC Review of Electric Power Research Institute's Advanced Light Water Reactor Utility Requirements Document -- Evolutionary Plant Designs,'' to document the results of its review of the Electric Power Research Institute's ''Advanced Light Water Reactor Utility Requirements Document.'' This SER gives the results of the staff's review of Volume II of the Requirements Document for evolutionary plant designs, which consists of 13 chapters and contains utility design requirements for an evolutionary nuclear power plant (approximately 1300 megawatts-electric)

  2. Lightning Radio Source Retrieval Using Advanced Lightning Direction Finder (ALDF) Networks

    Koshak, William J.; Blakeslee, Richard J.; Bailey, J. C.

    1998-01-01

    A linear algebraic solution is provided for the problem of retrieving the location and time of occurrence of lightning ground strikes from an Advanced Lightning Direction Finder (ALDF) network. The ALDF network measures field strength, magnetic bearing and arrival time of lightning radio emissions. Solutions for the plane (i.e., no Earth curvature) are provided that implement all of tile measurements mentioned above. Tests of the retrieval method are provided using computer-simulated data sets. We also introduce a quadratic planar solution that is useful when only three arrival time measurements are available. The algebra of the quadratic root results are examined in detail to clarify what portions of the analysis region lead to fundamental ambiguities in source location. Complex root results are shown to be associated with the presence of measurement errors when the lightning source lies near an outer sensor baseline of the ALDF network. In the absence of measurement errors, quadratic root degeneracy (no source location ambiguity) is shown to exist exactly on the outer sensor baselines for arbitrary non-collinear network geometries. The accuracy of the quadratic planar method is tested with computer generated data sets. The results are generally better than those obtained from the three station linear planar method when bearing errors are about 2 deg. We also note some of the advantages and disadvantages of these methods over the nonlinear method of chi(sup 2) minimization employed by the National Lightning Detection Network (NLDN) and discussed in Cummins et al.(1993, 1995, 1998).

  3. Geothermal direct-heat utilization assistance. Quarterly project progress report, October--December 1997

    NONE

    1997-01-01

    This report summarizes geothermal technical assistance, R and D and technology transfer activities of the Geo-Heat Center at Oregon Institute of Technology for the first quarter of FY-98 (October--December 1997). It describes 216 contacts with parties during this period related to technical assistance with geothermal direct heat projects. Areas dealt with include requests for general information including maps and material for high school debates, and material on geothermal heat pumps, resource and well data, space heating and cooling, greenhouses, aquaculture, equipment, district heating, resorts and spas, industrial applications, electric power and snow melting. Research activities include work on model construction specifications of lineshaft submersible pumps and plate heat exchangers, a comprehensive aquaculture developer package and revisions to the Geothermal Direct Use Engineering and Design Guidebook. Outreach activities include the publication of the Quarterly Bulletin (Vol. 18, No. 4) which was devoted entirely to geothermal activities in South Dakota, dissemination of information mainly through mailings of publications, tours of local geothermal uses, geothermal library acquisition and use, participation in workshops, short courses and technical meetings by the staff, and progress monitor reports on geothermal activities.

  4. Future directions in psychological assessment: combining evidence-based medicine innovations with psychology's historical strengths to enhance utility.

    Youngstrom, Eric A

    2013-01-01

    Assessment has been a historical strength of psychology, with sophisticated traditions of measurement, psychometrics, and theoretical underpinnings. However, training, reimbursement, and utilization of psychological assessment have been eroded in many settings. Evidence-based medicine (EBM) offers a different perspective on evaluation that complements traditional strengths of psychological assessment. EBM ties assessment directly to clinical decision making about the individual, uses simplified Bayesian methods explicitly to integrate assessment data, and solicits patient preferences as part of the decision-making process. Combining the EBM perspective with psychological assessment creates a hybrid approach that is more client centered, and it defines a set of applied research topics that are highly clinically relevant. This article offers a sequence of a dozen facets of the revised assessment process, along with examples of corollary research studies. An eclectic integration of EBM and evidence-based assessment generates a powerful hybrid that is likely to have broad applicability within clinical psychology and enhance the utility of psychological assessments.

  5. pySCu: A new python code for analyzing remagnetizations directions by means of small circle utilities

    Calvín, Pablo; Villalaín, Juan J.; Casas-Sainz, Antonio M.; Tauxe, Lisa; Torres-López, Sara

    2017-12-01

    The Small Circle (SC) methods are founded upon two main starting hypotheses: (i) the analyzed sites were remagnetized contemporarily, acquiring the same paleomagnetic direction. (ii) The deviation of the acquired paleomagnetic signal from its original direction is only due to tilting around the bedding strike and therefore the remagnetization direction must be located on a small circle (SC) whose axis is the strike of bedding and contains the in situ paleomagnetic direction. Therefore, if we analyze several sites (with different bedding strikes) their SCs will intersect in the remagnetization direction. The SC methods have two applications: (1) the Small Circle Intersection (SCI) method is capable of providing adequate approximations to the expected paleomagnetic direction when dealing with synfolding remagnetizations. By comparing the SCI direction with that predicted from an apparent polar wander path, the (re)magnetization can be dated. (2) Once the remagnetization direction is known, the attitude of the beds (at each site) can be restored to the moment of the acquisition of the remagnetization, showing a palinspastic reconstructuion of the structure. Some caveats are necessary under more complex tectonic scenarios, in which SC-based methods can lead to erroneous interpretations. However, the graphical output of the methods tries to avoid 'black-box' effects and can minimize misleading interpretations or even help, for example, to identify local or regional vertical axis rotations. In any case, the methods must be used with caution and always considering the knowledge of the tectonic frame. In this paper, some utilities for SCs analysis are automatized by means of a new Python code and a new technique for defining the uncertainty of the solution is proposed. With pySCu the SCs methods can be easily and quickly applied, obtaining firstly a set of text files containing all calculated information and subsequently generating a graphical output on the fly.

  6. [Ethical issues in the practice of advance directives, living wills, and self-determination in end of life care].

    Fang, Hui-Feng; Jhing, Huei-Yu; Lin, Chia-Chin

    2009-02-01

    The Hospice-Palliative Care Act, enacted in Taiwan in 2000, was designed to respect the end of life medical wishes of patients with incurable illnesses, safeguard the rights of these patients, and provide clinical guidelines for healthcare workers responsible to provide end of life care. Self-determination is a core element of human dignity. Advance directive documents include a living will, and durable power of attorney for healthcare. This article reviews current issues and ethical dilemmas with regard to advance directives. Patients, family members, and clinicians may require better education on the Hospice-Palliative Care Act in order to respect more appropriately patient end of life medical care wishes.

  7. Phase III Advanced Anodes and Cathodes Utilized in Energy Efficient Aluminum Production Cells; FINAL

    Christini, R.A.; Dawless, R.K.; Ray, S.P.; Weirauch, D.A. Jr.

    2001-01-01

    During Phase I of the present program, Alcoa developed a commercial cell concept that has been estimated to save 30% of the energy required for aluminum smelting. Phase ii involved the construction of a pilot facility and operation of two pilots. Phase iii of the Advanced Anodes and Cathodes Program was aimed at bench experiments to permit the resolution of certain questions to be followed by three pilot cells. All of the milestones related to materials, in particular metal purity, were attained with distinct improvements over work in previous phases of the program. NiO additions to the ceramic phase and Ag additions to the Cu metal phase of the cermet improved corrosion resistance sufficiently that the bench scale pencil anodes met the purity milestones. Some excellent metal purity results have been obtained with anodes of the following composition: Further improvements in anode material composition appear to be dependent on a better understanding of oxide solubilities in molten cryolite. For that reason, work was commissioned with an outside consultant to model the MeO - cryolite systems. That work has led to a better understanding of which oxides can be used to substitute into the NiO-Fe2O3 ceramic phase to stabilize the ferrites and reduce their solubility in molten cryolite. An extensive number of vertical plate bench electrolysis cells were run to try to find conditions where high current efficiencies could be attained. TiB2-G plates were very inconsistent and led to poor wetting and drainage. Pure TiB2 did produce good current efficiencies at small overlaps (shadowing) between the anodes and cathodes. This bench work with vertical plate anodes and cathodes reinforced the importance of good cathode wetting to attain high current efficiencies. Because of those conclusions, new wetting work was commissioned and became a major component of the research during the third year of Phase III. While significant progress was made in several areas, much work needs to be

  8. ADVANCED MULTI-PRODUCT COAL UTILIZATION BY-PRODUCT PROCESSING PLANT

    Robert Jewell; Thomas Robl; John Groppo

    2005-03-01

    The objective of the project is to build a multi-product ash beneficiation plant at Kentucky Utilities 2,200-MW Ghent Generating Station, located in Carroll County, Kentucky. This part of the study includes the examination of the feedstocks for the beneficiation plant. The ash, as produced by the plant, and that stored in the lower pond were examined. The ash produced by the plant was found to be highly variable as the plant consumes high and low sulfur bituminous coal, in Units 1 and 2 and a mixture of subbituminous and bituminous coal in Units 3 and 4. The ash produced reflected this consisting of an iron-rich ({approx}24%, Fe{sub 2}O{sub 3}), aluminum rich ({approx}29% Al{sub 2}O{sub 3}) and high calcium (6%-7%, CaO) ash, respectively. The LOI of the ash typically was in the range of 5.5% to 6.5%, but individual samples ranged from 1% to almost 9%. The lower pond at Ghent is a substantial body, covering more than 100 acres, with a volume that exceeds 200 million cubic feet. The sedimentation, stratigraphy and resource assessment of the in place ash was investigated with vibracoring and three-dimensional, computer-modeling techniques. Thirteen cores to depths reaching nearly 40 feet, were retrieved, logged in the field and transported to the lab for a series of analyses for particle size, loss on ignition, petrography, x-ray diffraction, and x-ray fluorescence. Collected data were processed using ArcViewGIS, Rockware, and Microsoft Excel to create three-dimensional, layered iso-grade maps, as well as stratigraphic columns and profiles, and reserve estimations. The ash in the pond was projected to exceed 7 million tons and contain over 1.5 million tons of coarse carbon, and 1.8 million tons of fine (<10 {micro}m) glassy pozzolanic material. The size, quality and consistency of the ponded material suggests that it is the better feedstock for the beneficiation plant.

  9. Methods of direct (non-chromatographic) quantification of body metabolites utilizing chemical ionization mass spectrometry

    Mee, J.M.L.

    1978-01-01

    For quantitative determination of known metabolites from the biological sample by direct chemical ionization mass spectrometry (CI-MS), the method of internal standard using stable isotopically labelled analogs appears to be the method of choice. In the case where stable isotope ratio determinations could not be applied, and alternative quantification can be achieved using non-labelled external or internal standards and a calibration curve (sum of peak height per a given number of scans versus concentration). The technique of computer monitoring permits display and plotting of ion current profiles (TIC and SIC) or spectra per a given number of scans or a given range of mass per charge. Examples are given in areas of clinical application and the quantitative data show very good agreement with the conventional chromatographic measurements. (Auth.)

  10. Direct-to-Consumer Genetic Testing: User Motivations, Decision Making, and Perceived Utility of Results.

    Roberts, J Scott; Gornick, Michele C; Carere, Deanna Alexis; Uhlmann, Wendy R; Ruffin, Mack T; Green, Robert C

    2017-01-01

    To describe the interests, decision making, and responses of consumers of direct-to-consumer personal genomic testing (DTC-PGT) services. Prior to 2013 regulatory restrictions on DTC-PGT services, 1,648 consumers from 2 leading companies completed Web surveys before and after receiving test results. Prior to testing, DTC-PGT consumers were as interested in ancestry (74% very interested) and trait information (72%) as they were in disease risks (72%). Among disease risks, heart disease (68% very interested), breast cancer (67%), and Alzheimer disease (66%) were of greatest interest prior to testing. Interest in disease risks was associated with female gender and poorer self-reported health (p decisions. © 2017 S. Karger AG, Basel.

  11. A prior authorization program of a radiology benefits management company and how it has affected utilization of advanced diagnostic imaging.

    Levin, David C; Bree, Robert L; Rao, Vijay M; Johnson, Jean

    2010-01-01

    Radiology benefits management companies have evolved in recent years to meet the need to control the rapid growth in advanced diagnostic imaging. The Obama administration and other key policymakers have proposed using them as a cost-control mechanism, but little is known about how they operate or what results they have produced. The main tool they use is prior authorization. The authors describe the inner workings of the call center of one radiology benefits management company and how its prior authorization program seems to have slowed the growth in the utilization of MRI, CT, and PET in the large markets of one commercial payer. Copyright 2010 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  12. Recent advances in microbial production of mannitol: utilization of low-cost substrates, strain development and regulation strategies.

    Zhang, Min; Gu, Lei; Cheng, Chao; Ma, Jiangfeng; Xin, Fengxue; Liu, Junli; Wu, Hao; Jiang, Min

    2018-02-26

    Mannitol has been widely used in fine chemicals, pharmaceutical industries, as well as functional foods due to its excellent characteristics, such as antioxidant protecting, regulation of osmotic pressure and non-metabolizable feature. Mannitol can be naturally produced by microorganisms. Compared with chemical manufacturing, microbial production of mannitol provides high yield and convenience in products separation; however the fermentative process has not been widely adopted yet. A major obstacle to microbial production of mannitol under industrial-scale lies in the low economical efficiency, owing to the high cost of fermentation medium, leakage of fructose, low mannitol productivity. In this review, recent advances in improving the economical efficiency of microbial production of mannitol were reviewed, including utilization of low-cost substrates, strain development for high mannitol yield and process regulation strategies for high productivity.

  13. "It's like playing with your destiny": Bosnian immigrants' views of advance directives and end-of-life decision-making.

    Searight, H Russell; Gafford, Jennifer

    2005-07-01

    Patient autonomy is a primary value in US health care. It is assumed that patients want to be fully and directly informed about serious health conditions and want to engage in advance planning about medical care at the end-of-life. Written advance directives and proxy decision-makers are vehicles to promote autonomy when patients are no longer able to represent their wishes. Cross-cultural studies have raised questions about the universal acceptance of these health care values among all ethnicities. In the current investigation, Bosnian immigrants were interviewed about their views of physician-patient communication, advance directives, and locus of decision-making in serious illness. Many of the respondents indicated that they did not want to be directly informed of a serious illness. There was an expressed preference for physician- or family-based health care decisions. Advance directives and formally appointed proxies were typically seen as unnecessary and inconsistent with many respondents' personal values. The findings suggest that the value of individual autonomy and control over the health care decisions may not be applicable to cultures with a collectivist orientation.

  14. Feasibility and Clinical Utility of High-definition Transcranial Direct Current Stimulation in the Treatment of Persistent Hallucinations in Schizophrenia.

    Bose, A; Shivakumar, V; Chhabra, H; Parlikar, R; Sreeraj, V S; Dinakaran, D; Narayanaswamy, J C; Venkatasubramanian, G

    2017-12-01

    Persistent auditory verbal hallucination is a clinically significant problem in schizophrenia. Recent studies suggest a promising role for add-on transcranial direct current stimulation (tDCS) in treatment. An optimised version of tDCS, namely high-definition tDCS (HD-tDCS), uses smaller electrodes arranged in a 4x1 ring configuration and may offer more focal and predictable neuromodulation than conventional tDCS. This case report illustrates the feasibility and clinical utility of add-on HD-tDCS over the left temporoparietal junction in a 4x1 ring configuration to treat persistent auditory verbal hallucination in schizophrenia.

  15. Advanced Multi-Product Coal Utilization By-Product Processing Plant

    Thomas Robl; John Groppo

    2009-06-30

    The overall objective of this project is to design, construct, and operate an ash beneficiation facility that will generate several products from coal combustion ash stored in a utility ash pond. The site selected is LG&E's Ghent Station located in Carroll County, Kentucky. The specific site under consideration is the lower ash pond at Ghent, a closed landfill encompassing over 100 acres. Coring activities revealed that the pond contains over 7 million tons of ash, including over 1.5 million tons of coarse carbon and 1.8 million tons of fine (<10 {micro}m) glassy pozzolanic material. These potential products are primarily concentrated in the lower end of the pond adjacent to the outlet. A representative bulk sample was excavated for conducting laboratory-scale process testing while a composite 150 ton sample was also excavated for demonstration-scale testing at the Ghent site. A mobile demonstration plant with a design feed rate of 2.5 tph was constructed and hauled to the Ghent site to evaluate unit processes (i.e. primary classification, froth flotation, spiral concentration, secondary classification, etc.) on a continuous basis to determine appropriate scale-up data. Unit processes were configured into four different flowsheets and operated at a feed rate of 2.5 tph to verify continuous operating performance and generate bulk (1 to 2 tons) products for product testing. Cementitious products were evaluated for performance in mortar and concrete as well as cement manufacture process addition. All relevant data from the four flowsheets was compiled to compare product yields and quality while preliminary flowsheet designs were generated to determine throughputs, equipment size specifications and capital cost summaries. A detailed market study was completed to evaluate the potential markets for cementitious products. Results of the study revealed that the Ghent local fly ash market is currently oversupplied by more than 500,000 tpy and distant markets (i

  16. [MINIMALLY INVASIVE SURGERY FOR DIRECT REPAIR OF LUMBAR SPONDYLOLYSIS BY UTILIZING INTRAOPERATIVE NAVIGATION AND MICROENDOSCOPIC TECHNIQUES].

    Zhu, Xiaolong; Wang, Jian; Zhou, Yue; Zhang, Zhengfeng; Li, Changqing; Zheng, Wenjie

    2015-10-01

    To analyze the effectiveness of direct screw repair for lumbar spondylolysis by using intraoperative O-arm based navigation and microendoscopic techniques. Between February 2012 and May 2014, 11 consecutive patients with lumbar spondylolysis were treated with Buck's procedure by the aid of intraoperative O-arm based navigation and minimally invasive approach. The debridement and autograft of pars interarticularis defects was performed under microendoscopy. There were 7 males and 4 females, with an average age of 28.4 years (range, 19 - 47 years) and an average disease duration of 10.5 months (range, 8-23 months); no nerve symptoms or signs of lower limb was observed. The radiological examinations showed single level bilateral lumbar spondylolysis without obvious disc degeneration, lumbar instability, or spondylolisthesis. Isthmic injury located at L4 in 2 cases and at L5 in 9 cases. Of 11 patients, 7 were rated as grade 2 disc degeneration, and 4 as grade 3 disc degeneration according to the modified Pfirrmann classification system. The operation time, intraoperative blood loss, and complications were recorded. The fluoroscopic examinations were performed to assess defect repair and screw position. Visual analogue scale (VAS) score was used to evaluate the improvement of low back pain. The average operation time was 147.6 minutes (range, 126-183 minutes). The average blood loss was 54.9 mL (range, 40-85 mL). Primary healing of incision was obtained. There was no complication of nerve root injury, dural tear, or infection. Three patients had pain at donor site postoperatively, and pain disappeared within 3 weeks. The average follow-up duration was 15.7 months (range, 10-23 months). VAS score of low back pain was significantly decreased from preoperative 7.1 ± 2.3 to 1.8 ± 0.4 at last follow-up (t = 13.42, P = 0.01). Of 22 isthmic bone grafting, bilateral isthmic bony fusion was achieved in 7 patients and unilateral isthmic bony fusion in 3 patients at 6-10 months

  17. Environmental Barrier Coating Development for SiC/SiC Ceramic Matrix Composites: Recent Advances and Future Directions

    Zhu, Dongming

    2016-01-01

    This presentation briefly reviews the SiC/SiC major environmental and environment-fatigue degradations encountered in simulated turbine combustion environments, and thus NASA environmental barrier coating system evolution for protecting the SiC/SiC Ceramic Matrix Composites for meeting the engine performance requirements. The presentation will review several generations of NASA EBC materials systems, EBC-CMC component system technologies for SiC/SiC ceramic matrix composite combustors and turbine airfoils, highlighting the temperature capability and durability improvements in simulated engine high heat flux, high pressure, high velocity, and with mechanical creep and fatigue loading conditions. This paper will also focus on the performance requirements and design considerations of environmental barrier coatings for next generation turbine engine applications. The current development emphasis is placed on advanced NASA candidate environmental barrier coating systems for SiC/SiC CMCs, their performance benefits and design limitations in long-term operation and combustion environments. The efforts have been also directed to developing prime-reliant, self-healing 2700F EBC bond coat; and high stability, lower thermal conductivity, and durable EBC top coats. Major technical barriers in developing environmental barrier coating systems, the coating integrations with next generation CMCs having the improved environmental stability, erosion-impact resistance, and long-term fatigue-environment system durability performance will be described. The research and development opportunities for turbine engine environmental barrier coating systems by utilizing improved compositions, state-of-the-art processing methods, and simulated environment testing and durability modeling will be briefly discussed.

  18. Utilization of Pebax 1657 as structure directing agent in fabrication of ultra-porous ZIF-8

    Jomekian, A. [Gas Engineering Department, Ahvaz Faculty of Petroleum Engineering, Petroleum University of Technology (PUT), Post Office Box 63431, Ahvaz (Iran, Islamic Republic of); Faculty of Chemical Engineering, Iran University of Science and Technology (IUST), Narmak, Tehran (Iran, Islamic Republic of); Behbahani, R.M., E-mail: behbahani@put.ac.ir [Gas Engineering Department, Ahvaz Faculty of Petroleum Engineering, Petroleum University of Technology (PUT), Post Office Box 63431, Ahvaz (Iran, Islamic Republic of); Mohammadi, T. [Faculty of Chemical Engineering, Iran University of Science and Technology (IUST), Narmak, Tehran (Iran, Islamic Republic of); Kargari, A. [Department of Petrochemical Engineering, Amirkabir University of Technology (AUT), Mahshahr (Iran, Islamic Republic of)

    2016-03-15

    Ultra porous ZIF-8 particles synthesized using PEO/PA6 based poly(ether-block-amide) (Pebax 1657) as structure directing agent. Structural properties of ZIF-8 samples prepared under different synthesis parameters were investigated by laser particle size analysis, XRD, N{sub 2} adsorption analysis, BJH and BET tests. The overall results showed that: (1) The mean pore size of all ZIF-8 samples increased remarkably (from 0.34 nm to 1.1–2.5 nm) compared to conventionally synthesized ZIF-8 samples. (2) Exceptional BET surface area of 1869 m{sup 2}/g was obtained for a ZIF-8 sample with mean pore size of 2.5 nm. (3) Applying high concentrations of Pebax 1657 to the synthesis solution lead to higher surface area, larger pore size and smaller particle size for ZIF-8 samples. (4) Both, Increase in temperature and decrease in molar ratio of MeIM/Zn{sup 2+} had increasing effect on ZIF-8 particle size, pore size, pore volume, crystallinity and BET surface area of all investigated samples. - Highlights: • The pore size of ZIF-8 samples synthesized with Pebax 1657 increased remarkably. • The BET surface area of 1869 m{sup 2}/gr obtained for a ZIF-8 synthesized sample with Pebax. • Increase in temperature had increasing effect on textural properties of ZIF-8 samples. • Decrease in MeIM/Zn{sup 2+} had increasing effect on textural properties of ZIF-8 samples.

  19. Review on utilization of the pervaporation membrane for passive vapor feed direct methanol fuel cell

    Fauzi, N F I; Hasran, U A; Kamarudin, S K

    2013-01-01

    The Direct Methanol Fuel Cell (DMFC) is a promising portable power source for mobile electronic devices because of its advantages including easy fuel storage, high energy density, low temperature operation and compact structure. In DMFC, methanol is used as a fuel source where it can be fed in liquid or vapor phase. However, the vapor feed DMFC has an advantage over the liquid feed system as it has the potential to have a higher operating temperature to increase the reaction rates and power outputs, to enhance the mass transfers, to reduce methanol crossover, reliable for high methanol concentration and it can increase the fuel cell performance. Methanol vapor can be delivered to the anode by using a pervaporation membrane, heating the liquid methanol or another method that compatible. Therefore, this paper is a review on vapor feed DMFC as a better energy source than liquid feed DMFC, the pervaporation membrane used to vaporize methanol feed from the reservoir and its applications in vapor feed DMFC

  20. Direct utilization of geothermal energy for space and water heating at Marlin, Texas. Final report

    Conover, M.F.; Green, T.F.; Keeney, R.C.; Ellis, P.F. II; Davis, R.J.; Wallace, R.C.; Blood, F.B.

    1983-05-01

    The Torbett-Hutchings-Smith Memorial Hospital geothermal heating project, which is one of nineteen direct-use geothermal projects funded principally by DOE, is documented. The five-year project encompassed a broad range of technical, institutional, and economic activities including: resource and environmental assessments; well drilling and completion; system design, construction, and monitoring; economic analyses; public awareness programs; materials testing; and environmental monitoring. Some of the project conclusions are that: (1) the 155/sup 0/F Central Texas geothermal resource can support additional geothermal development; (2) private-sector economic incentives currently exist, especially for profit-making organizations, to develop and use this geothermal resource; (3) potential uses for this geothermal resource include water and space heating, poultry dressing, natural cheese making, fruit and vegetable dehydrating, soft-drink bottling, synthetic-rubber manufacturing, and furniture manufacturing; (4) high maintenance costs arising from the geofluid's scaling and corrosion tendencies can be avoided through proper analysis and design; (5) a production system which uses a variable-frequency drive system to control production rate is an attractive means of conserving parasitic pumping power, controlling production rate to match heating demand, conserving the geothermal resource, and minimizing environmental impacts.

  1. 41 CFR 302-10.301 - May I receive an advance of funds when payment is made directly to the carrier by my agency?

    2010-07-01

    ... PRIMARY RESIDENCE Advance of Funds § 302-10.301 May I receive an advance of funds when payment is made directly to the carrier by my agency? No, your agency will not authorize you an advance of funds when it... 41 Public Contracts and Property Management 4 2010-07-01 2010-07-01 false May I receive an advance...

  2. HIGHLY ENERGY EFFICIENT D-GLU (DIRECTED-GREEN LIQ-UOR UTILIZATION) PULPING

    Lucia, Lucian A

    2013-04-19

    Purpose: The purpose of the project was to retrofit the front end (pulp house) of a commercial kraft pulping mill to accommodate a mill green liquor (GL) impregna-tion/soak/exposure and accrue downstream physical and chemical benefits while prin-cipally reducing the energy footprint of the mill. A major player in the mill contrib-uting to excessive energy costs is the lime kiln. The project was intended to offload the energy (oil or natural gas) demands of the kiln by by-passing the causticization/slaking site in the recovery area and directly using green liquor as a pulping medium for wood. Scope: The project was run in two distinct, yet mutually compatible, phases: Phase 1 was the pre-commercial or laboratory phase in which NC State University and the Insti-tute of Paper Science and Technology (at the Georgia Institute of Technology) ran the pulping and associated experiments, while Phase 2 was the mill scale trial. The first tri-al was run at the now defunct Evergreen Pulp Mill in Samoa, CA and lead to a partial retrofit of the mill that was not completed because it went bankrupt and the work was no longer the low-hanging fruit on the tree for the new management. The second trial was run at the MeadWestvaco Pulp Mill in Evedale, TX which for all intents and pur-poses was a success. They were able to fully retrofit the mill, ran the trial, studied the pulp properties, and gave us conclusions.

  3. Utilizing ras signaling pathway to direct selective replication of herpes simplex virus-1.

    Weihong Pan

    Full Text Available Re-engineering the tropism of viruses is an attractive translational strategy for targeting cancer cells. The Ras signal transduction pathway is a central hub for a variety of pro-oncogenic events with a fundamental role in normal and neoplastic physiology. In this work we were interested in linking Ras activation to HSV-1 replication in a direct manner in order to generate a novel oncolytic herpes virus which can target cancer cells. To establish such link, we developed a mutant HSV-1 in which the expression of ICP4 (infected cell protein-4, a viral protein necessary for replication is controlled by activation of ELK, a transcription factor down-stream of the Ras pathway and mainly activated by ERK (extracellular signal-regulated kinase, an important Ras effector pathway. This mutant HSV-1 was named as Signal-Smart 1 (SS1. A series of prostate cells were infected with the SS1 virus. Cells with elevated levels of ELK activation were preferentially infected by the SS1 virus, as demonstrated by increased levels of viral progeny, herpetic glycoprotein C and overall SS1 viral protein production. Upon exposure to SS1, the proliferation, invasiveness and colony formation capabilities of prostate cancer cells with increased ELK activation were significantly decreased (p<0.05, while the rate of apoptosis/necrosis in these cells was increased. Additionally, high Ras signaling cells infected with SS1 showed a prominent arrest in the G1 phase of the cell cycle as compared to cells exposed to parental HSV-1. The results of this study reveal the potential for re-modeling the host-herpes interaction to specifically interfere with the life of cancer cells with increased Ras signaling. SS1 also serves as a "prototype" for development of a family of signal-smart viruses which can target cancer cells on the basis of their signaling portfolio.

  4. [Advance directives in prehospital emergency treatment : prospective questionnaire-based analysis].

    Brokmann, J C; Grützmann, T; Pidun, A K; Groß, D; Rossaint, R; Beckers, S K; May, A T

    2014-01-01

    The handling of advance directives (AD) in prehospital emergency treatment in Germany is characterized by instability. In the project "Advance directives in preclinical emergency medical aid" ("Patientenverfügungen in der präklinischen Notfallmedizin") the frequency and quality of ADs in emergency situations was investigated. The aim of this study was to fill the gaps in research and to collate data on how consideration of the self-determination of patients in emergency situations can be optimized. Over a period of 12 months from December 2007 to December 2008 a questionnaire was included in the emergency documentation of the medical emergency service in Aachen. Emergency patients were asked by emergency physicians to provide an AD and the quantitative as well as qualitative features of these ADs were examined. Furthermore, the study recorded what kinds of problems occurred with ADs in emergency situations and what measures were needed to correct this deficiency. The reactions of patients were documented on a numeral rating scale with a score of 1 reflecting a negative and 10 reflecting a positive reaction. In the 12-month period emergency doctors recorded 1,321 missions and after application of the exclusion criteria (e.g. missing signature, incomplete documentation and late delivery) 1,047 documented questionnaires were available for the analysis. A total of 127 out of 1,047 emergency patients provided an AD, 44 had a durable power of attorney and 27 had appointed a legal representative for healthcare. Of the emergency patients 20 had a legal attendant and 43 out of the 127 ADs could be presented to the emergency team during the emergency mission. The emergency team often encountered difficulties regarding the handling of the ADs due to the time factor and unclear wording. The latter included the following problems: misleading formulation (19.1 %), difficulty with the complexity (14.9 %) and contradicting information (4 %). Only 29 (61.7 %) of the

  5. Directional Limits on Persistent Gravitational Waves from Advanced LIGO's First Observing Run.

    Abbott, B P; Abbott, R; Abbott, T D; Abernathy, M R; Acernese, F; Ackley, K; Adams, C; Adams, T; Addesso, P; Adhikari, R X; Adya, V B; Affeldt, C; Agathos, M; Agatsuma, K; Aggarwal, N; Aguiar, O D; Aiello, L; Ain, A; Ajith, P; Allen, B; Allocca, A; Altin, P A; Ananyeva, A; Anderson, S B; Anderson, W G; Appert, S; Arai, K; Araya, M C; Areeda, J S; Arnaud, N; Arun, K G; Ascenzi, S; Ashton, G; Ast, M; Aston, S M; Astone, P; Aufmuth, P; Aulbert, C; Avila-Alvarez, A; Babak, S; Bacon, P; Bader, M K M; Baker, P T; Baldaccini, F; Ballardin, G; Ballmer, S W; Barayoga, J C; Barclay, S E; Barish, B C; Barker, D; Barone, F; Barr, B; Barsotti, L; Barsuglia, M; Barta, D; Bartlett, J; Bartos, I; Bassiri, R; Basti, A; Batch, J C; Baune, C; Bavigadda, V; Bazzan, M; Beer, C; Bejger, M; Belahcene, I; Belgin, M; Bell, A S; Berger, B K; Bergmann, G; Berry, C P L; Bersanetti, D; Bertolini, A; Betzwieser, J; Bhagwat, S; Bhandare, R; Bilenko, I A; Billingsley, G; Billman, C R; Birch, J; Birney, R; Birnholtz, O; Biscans, S; Biscoveanu, A S; Bisht, A; Bitossi, M; Biwer, C; Bizouard, M A; Blackburn, J K; Blackman, J; Blair, C D; Blair, D G; Blair, R M; Bloemen, S; Bock, O; Boer, M; Bogaert, G; Bohe, A; Bondu, F; Bonnand, R; Boom, B A; Bork, R; Boschi, V; Bose, S; Bouffanais, Y; Bozzi, A; Bradaschia, C; Brady, P R; Braginsky, V B; Branchesi, M; Brau, J E; Briant, T; Brillet, A; Brinkmann, M; Brisson, V; Brockill, P; Broida, J E; Brooks, A F; Brown, D A; Brown, D D; Brown, N M; Brunett, S; Buchanan, C C; Buikema, A; Bulik, T; Bulten, H J; Buonanno, A; Buskulic, D; Buy, C; Byer, R L; Cabero, M; Cadonati, L; Cagnoli, G; Cahillane, C; Calderón Bustillo, J; Callister, T A; Calloni, E; Camp, J B; Campbell, W; Canepa, M; Cannon, K C; Cao, H; Cao, J; Capano, C D; Capocasa, E; Carbognani, F; Caride, S; Casanueva Diaz, J; Casentini, C; Caudill, S; Cavaglià, M; Cavalier, F; Cavalieri, R; Cella, G; Cepeda, C B; Cerboni Baiardi, L; Cerretani, G; Cesarini, E; Chamberlin, S J; Chan, M; Chao, S; Charlton, P; Chassande-Mottin, E; Cheeseboro, B D; Chen, H Y; Chen, Y; Cheng, H-P; Chincarini, A; Chiummo, A; Chmiel, T; Cho, H S; Cho, M; Chow, J H; Christensen, N; Chu, Q; Chua, A J K; Chua, S; Chung, S; Ciani, G; Clara, F; Clark, J A; Cleva, F; Cocchieri, C; Coccia, E; Cohadon, P-F; Colla, A; Collette, C G; Cominsky, L; Constancio, M; Conti, L; Cooper, S J; Corbitt, T R; Cornish, N; Corsi, A; Cortese, S; Costa, C A; Coughlin, E; Coughlin, M W; Coughlin, S B; Coulon, J-P; Countryman, S T; Couvares, P; Covas, P B; Cowan, E E; Coward, D M; Cowart, M J; Coyne, D C; Coyne, R; Creighton, J D E; Creighton, T D; Cripe, J; Crowder, S G; Cullen, T J; Cumming, A; Cunningham, L; Cuoco, E; Dal Canton, T; Danilishin, S L; D'Antonio, S; Danzmann, K; Dasgupta, A; Da Silva Costa, C F; Dattilo, V; Dave, I; Davier, M; Davies, G S; Davis, D; Daw, E J; Day, B; Day, R; De, S; DeBra, D; Debreczeni, G; Degallaix, J; De Laurentis, M; Deléglise, S; Del Pozzo, W; Denker, T; Dent, T; Dergachev, V; De Rosa, R; DeRosa, R T; DeSalvo, R; Devenson, J; Devine, R C; Dhurandhar, S; Díaz, M C; Di Fiore, L; Di Giovanni, M; Di Girolamo, T; Di Lieto, A; Di Pace, S; Di Palma, I; Di Virgilio, A; Doctor, Z; Dolique, V; Donovan, F; Dooley, K L; Doravari, S; Dorrington, I; Douglas, R; Dovale Álvarez, M; Downes, T P; Drago, M; Drever, R W P; Driggers, J C; Du, Z; Ducrot, M; Dwyer, S E; Edo, T B; Edwards, M C; Effler, A; Eggenstein, H-B; Ehrens, P; Eichholz, J; Eikenberry, S S; Essick, R C; Etienne, Z; Etzel, T; Evans, M; Evans, T M; Everett, R; Factourovich, M; Fafone, V; Fair, H; Fairhurst, S; Fan, X; Farinon, S; Farr, B; Farr, W M; Fauchon-Jones, E J; Favata, M; Fays, M; Fehrmann, H; Fejer, M M; Fernández Galiana, A; Ferrante, I; Ferreira, E C; Ferrini, F; Fidecaro, F; Fiori, I; Fiorucci, D; Fisher, R P; Flaminio, R; Fletcher, M; Fong, H; Forsyth, S S; Fournier, J-D; Frasca, S; Frasconi, F; Frei, Z; Freise, A; Frey, R; Frey, V; Fries, E M; Fritschel, P; Frolov, V V; Fulda, P; Fyffe, M; Gabbard, H; Gadre, B U; Gaebel, S M; Gair, J R; Gammaitoni, L; Gaonkar, S G; Garufi, F; Gaur, G; Gayathri, V; Gehrels, N; Gemme, G; Genin, E; Gennai, A; George, J; Gergely, L; Germain, V; Ghonge, S; Ghosh, Abhirup; Ghosh, Archisman; Ghosh, S; Giaime, J A; Giardina, K D; Giazotto, A; Gill, K; Glaefke, A; Goetz, E; Goetz, R; Gondan, L; González, G; Gonzalez Castro, J M; Gopakumar, A; Gorodetsky, M L; Gossan, S E; Gosselin, M; Gouaty, R; Grado, A; Graef, C; Granata, M; Grant, A; Gras, S; Gray, C; Greco, G; Green, A C; Groot, P; Grote, H; Grunewald, S; Guidi, G M; Guo, X; Gupta, A; Gupta, M K; Gushwa, K E; Gustafson, E K; Gustafson, R; Hacker, J J; Hall, B R; Hall, E D; Hammond, G; Haney, M; Hanke, M M; Hanks, J; Hanna, C; Hannam, M D; Hanson, J; Hardwick, T; Harms, J; Harry, G M; Harry, I W; Hart, M J; Hartman, M T; Haster, C-J; Haughian, K; Healy, J; Heidmann, A; Heintze, M C; Heitmann, H; Hello, P; Hemming, G; Hendry, M; Heng, I S; Hennig, J; Henry, J; Heptonstall, A W; Heurs, M; Hild, S; Hoak, D; Hofman, D; Holt, K; Holz, D E; Hopkins, P; Hough, J; Houston, E A; Howell, E J; Hu, Y M; Huerta, E A; Huet, D; Hughey, B; Husa, S; Huttner, S H; Huynh-Dinh, T; Indik, N; Ingram, D R; Inta, R; Isa, H N; Isac, J-M; Isi, M; Isogai, T; Iyer, B R; Izumi, K; Jacqmin, T; Jani, K; Jaranowski, P; Jawahar, S; Jiménez-Forteza, F; Johnson, W W; Jones, D I; Jones, R; Jonker, R J G; Ju, L; Junker, J; Kalaghatgi, C V; Kalogera, V; Kandhasamy, S; Kang, G; Kanner, J B; Karki, S; Karvinen, K S; Kasprzack, M; Katsavounidis, E; Katzman, W; Kaufer, S; Kaur, T; Kawabe, K; Kéfélian, F; Keitel, D; Kelley, D B; Kennedy, R; Key, J S; Khalili, F Y; Khan, I; Khan, S; Khan, Z; Khazanov, E A; Kijbunchoo, N; Kim, Chunglee; Kim, J C; Kim, Whansun; Kim, W; Kim, Y-M; Kimbrell, S J; King, E J; King, P J; Kirchhoff, R; Kissel, J S; Klein, B; Kleybolte, L; Klimenko, S; Koch, P; Koehlenbeck, S M; Koley, S; Kondrashov, V; Kontos, A; Korobko, M; Korth, W Z; Kowalska, I; Kozak, D B; Krämer, C; Kringel, V; Królak, A; Kuehn, G; Kumar, P; Kumar, R; Kuo, L; Kutynia, A; Lackey, B D; Landry, M; Lang, R N; Lange, J; Lantz, B; Lanza, R K; Lartaux-Vollard, A; Lasky, P D; Laxen, M; Lazzarini, A; Lazzaro, C; Leaci, P; Leavey, S; Lebigot, E O; Lee, C H; Lee, H K; Lee, H M; Lee, K; Lehmann, J; Lenon, A; Leonardi, M; Leong, J R; Leroy, N; Letendre, N; Levin, Y; Li, T G F; Libson, A; Littenberg, T B; Liu, J; Lockerbie, N A; Lombardi, A L; London, L T; Lord, J E; Lorenzini, M; Loriette, V; Lormand, M; Losurdo, G; Lough, J D; Lousto, C O; Lovelace, G; Lück, H; Lundgren, A P; Lynch, R; Ma, Y; Macfoy, S; Machenschalk, B; MacInnis, M; Macleod, D M; Magaña-Sandoval, F; Majorana, E; Maksimovic, I; Malvezzi, V; Man, N; Mandic, V; Mangano, V; Mansell, G L; Manske, M; Mantovani, M; Marchesoni, F; Marion, F; Márka, S; Márka, Z; Markosyan, A S; Maros, E; Martelli, F; Martellini, L; Martin, I W; Martynov, D V; Mason, K; Masserot, A; Massinger, T J; Masso-Reid, M; Mastrogiovanni, S; Matas, A; Matichard, F; Matone, L; Mavalvala, N; Mazumder, N; McCarthy, R; McClelland, D E; McCormick, S; McGrath, C; McGuire, S C; McIntyre, G; McIver, J; McManus, D J; McRae, T; McWilliams, S T; Meacher, D; Meadors, G D; Meidam, J; Melatos, A; Mendell, G; Mendoza-Gandara, D; Mercer, R A; Merilh, E L; Merzougui, M; Meshkov, S; Messenger, C; Messick, C; Metzdorff, R; Meyers, P M; Mezzani, F; Miao, H; Michel, C; Middleton, H; Mikhailov, E E; Milano, L; Miller, A L; Miller, A; Miller, B B; Miller, J; Millhouse, M; Minenkov, Y; Ming, J; Mirshekari, S; Mishra, C; Mitra, S; Mitrofanov, V P; Mitselmakher, G; Mittleman, R; Moggi, A; Mohan, M; Mohapatra, S R P; Montani, M; Moore, B C; Moore, C J; Moraru, D; Moreno, G; Morriss, S R; Mours, B; Mow-Lowry, C M; Mueller, G; Muir, A W; Mukherjee, Arunava; Mukherjee, D; Mukherjee, S; Mukund, N; Mullavey, A; Munch, J; Muniz, E A M; Murray, P G; Mytidis, A; Napier, K; Nardecchia, I; Naticchioni, L; Nelemans, G; Nelson, T J N; Neri, M; Nery, M; Neunzert, A; Newport, J M; Newton, G; Nguyen, T T; Nielsen, A B; Nissanke, S; Nitz, A; Noack, A; Nocera, F; Nolting, D; Normandin, M E N; Nuttall, L K; Oberling, J; Ochsner, E; Oelker, E; Ogin, G H; Oh, J J; Oh, S H; Ohme, F; Oliver, M; Oppermann, P; Oram, Richard J; O'Reilly, B; O'Shaughnessy, R; Ottaway, D J; Overmier, H; Owen, B J; Pace, A E; Page, J; Pai, A; Pai, S A; Palamos, J R; Palashov, O; Palomba, C; Pal-Singh, A; Pan, H; Pankow, C; Pannarale, F; Pant, B C; Paoletti, F; Paoli, A; Papa, M A; Paris, H R; Parker, W; Pascucci, D; Pasqualetti, A; Passaquieti, R; Passuello, D; Patricelli, B; Pearlstone, B L; Pedraza, M; Pedurand, R; Pekowsky, L; Pele, A; Penn, S; Perez, C J; Perreca, A; Perri, L M; Pfeiffer, H P; Phelps, M; Piccinni, O J; Pichot, M; Piergiovanni, F; Pierro, V; Pillant, G; Pinard, L; Pinto, I M; Pitkin, M; Poe, M; Poggiani, R; Popolizio, P; Post, A; Powell, J; Prasad, J; Pratt, J W W; Predoi, V; Prestegard, T; Prijatelj, M; Principe, M; Privitera, S; Prodi, G A; Prokhorov, L G; Puncken, O; Punturo, M; Puppo, P; Pürrer, M; Qi, H; Qin, J; Qiu, S; Quetschke, V; Quintero, E A; Quitzow-James, R; Raab, F J; Rabeling, D S; Radkins, H; Raffai, P; Raja, S; Rajan, C; Rakhmanov, M; Rapagnani, P; Raymond, V; Razzano, M; Re, V; Read, J; Regimbau, T; Rei, L; Reid, S; Reitze, D H; Rew, H; Reyes, S D; Rhoades, E; Ricci, F; Riles, K; Rizzo, M; Robertson, N A; Robie, R; Robinet, F; Rocchi, A; Rolland, L; Rollins, J G; Roma, V J; Romano, J D; Romano, R; Romie, J H; Rosińska, D; Rowan, S; Rüdiger, A; Ruggi, P; Ryan, K; Sachdev, S; Sadecki, T; Sadeghian, L; Sakellariadou, M; Salconi, L; Saleem, M; Salemi, F; Samajdar, A; Sammut, L; Sampson, L M; Sanchez, E J; Sandberg, V; Sanders, J R; Sassolas, B; Sathyaprakash, B S; Saulson, P R; Sauter, O; Savage, R L; Sawadsky, A; Schale, P; Scheuer, J; Schlassa, S; Schmidt, E; Schmidt, J; Schmidt, P; Schnabel, R; Schofield, R M S; Schönbeck, A; Schreiber, E; Schuette, D; Schutz, B F; Schwalbe, S G; Scott, J; Scott, S M; Sellers, D; Sengupta, A S; Sentenac, D; Sequino, V; Sergeev, A; Setyawati, Y; Shaddock, D A; Shaffer, T J; Shahriar, M S; Shapiro, B; Shawhan, P; Sheperd, A; Shoemaker, D H; Shoemaker, D M; Siellez, K; Siemens, X; Sieniawska, M; Sigg, D; Silva, A D; Singer, A; Singer, L P; Singh, A; Singh, R; Singhal, A; Sintes, A M; Slagmolen, B J J; Smith, B; Smith, J R; Smith, R J E; Son, E J; Sorazu, B; Sorrentino, F; Souradeep, T; Spencer, A P; Srivastava, A K; Staley, A; Steinke, M; Steinlechner, J; Steinlechner, S; Steinmeyer, D; Stephens, B C; Stevenson, S P; Stone, R; Strain, K A; Straniero, N; Stratta, G; Strigin, S E; Sturani, R; Stuver, A L; Summerscales, T Z; Sun, L; Sunil, S; Sutton, P J; Swinkels, B L; Szczepańczyk, M J; Tacca, M; Talukder, D; Tanner, D B; Tao, D; Tápai, M; Taracchini, A; Taylor, R; Theeg, T; Thomas, E G; Thomas, M; Thomas, P; Thorne, K A; Thrane, E; Tippens, T; Tiwari, S; Tiwari, V; Tokmakov, K V; Toland, K; Tomlinson, C; Tonelli, M; Tornasi, Z; Torrie, C I; Töyrä, D; Travasso, F; Traylor, G; Trifirò, D; Trinastic, J; Tringali, M C; Trozzo, L; Tse, M; Tso, R; Turconi, M; Tuyenbayev, D; Ugolini, D; Unnikrishnan, C S; Urban, A L; Usman, S A; Vahlbruch, H; Vajente, G; Valdes, G; van Bakel, N; van Beuzekom, M; van den Brand, J F J; Van Den Broeck, C; Vander-Hyde, D C; van der Schaaf, L; van Heijningen, J V; van Veggel, A A; Vardaro, M; Varma, V; Vass, S; Vasúth, M; Vecchio, A; Vedovato, G; Veitch, J; Veitch, P J; Venkateswara, K; Venugopalan, G; Verkindt, D; Vetrano, F; Viceré, A; Viets, A D; Vinciguerra, S; Vine, D J; Vinet, J-Y; Vitale, S; Vo, T; Vocca, H; Vorvick, C; Voss, D V; Vousden, W D; Vyatchanin, S P; Wade, A R; Wade, L E; Wade, M; Walker, M; Wallace, L; Walsh, S; Wang, G; Wang, H; Wang, M; Wang, Y; Ward, R L; Warner, J; Was, M; Watchi, J; Weaver, B; Wei, L-W; Weinert, M; Weinstein, A J; Weiss, R; Wen, L; Weßels, P; Westphal, T; Wette, K; Whelan, J T; Whiting, B F; Whittle, C; Williams, D; Williams, R D; Williamson, A R; Willis, J L; Willke, B; Wimmer, M H; Winkler, W; Wipf, C C; Wittel, H; Woan, G; Woehler, J; Worden, J; Wright, J L; Wu, D S; Wu, G; Yam, W; Yamamoto, H; Yancey, C C; Yap, M J; Yu, Hang; Yu, Haocun; Yvert, M; Zadrożny, A; Zangrando, L; Zanolin, M; Zendri, J-P; Zevin, M; Zhang, L; Zhang, M; Zhang, T; Zhang, Y; Zhao, C; Zhou, M; Zhou, Z; Zhu, S J; Zhu, X J; Zucker, M E; Zweizig, J

    2017-03-24

    We employ gravitational-wave radiometry to map the stochastic gravitational wave background expected from a variety of contributing mechanisms and test the assumption of isotropy using data from the Advanced Laser Interferometer Gravitational Wave Observatory's (aLIGO) first observing run. We also search for persistent gravitational waves from point sources with only minimal assumptions over the 20-1726 Hz frequency band. Finding no evidence of gravitational waves from either point sources or a stochastic background, we set limits at 90% confidence. For broadband point sources, we report upper limits on the gravitational wave energy flux per unit frequency in the range F_{α,Θ}(f)<(0.1-56)×10^{-8}    erg cm^{-2} s^{-1} Hz^{-1}(f/25  Hz)^{α-1} depending on the sky location Θ and the spectral power index α. For extended sources, we report upper limits on the fractional gravitational wave energy density required to close the Universe of Ω(f,Θ)<(0.39-7.6)×10^{-8}  sr^{-1}(f/25  Hz)^{α} depending on Θ and α. Directed searches for narrowband gravitational waves from astrophysically interesting objects (Scorpius X-1, Supernova 1987 A, and the Galactic Center) yield median frequency-dependent limits on strain amplitude of h_{0}<(6.7,5.5,  and  7.0)×10^{-25}, respectively, at the most sensitive detector frequencies between 130-175 Hz. This represents a mean improvement of a factor of 2 across the band compared to previous searches of this kind for these sky locations, considering the different quantities of strain constrained in each case.

  6. [Advance Directives in Family Practices: Results of a Survey of GP Patients on their Care Situation].

    Schnakenberg, Rieke; Just, Johannes; Thiessen, Vitali; Puth, Marie-Therese; Bleckwenn, Markus; Weckbecker, Klaus

    2017-07-26

    Background Advance directives (AD) are an important tool for documentation of patients' wishes and are therefore recommended to the elderly as well as patients with chronic diseases. However, there is no standardized procedure in Germany and no guideline for counseling patients who wish to write an AD with or without health care proxy. The aim of this study was to evaluate the care situation concerning the ADs and the role of the primary care physician in drafting the document Method We conducted semi-structured interviews with patients in primary care in North Rhine-Westphalia using a cross-sectional study design. Result Most of the 154 patients who were interviewed (average age: 58 years; 52% female) suffered from chronic diseases (79%), and about one-third (32%) already had an AD. Fear of "loss of autonomy" was the main reason for preparing an AD. Patients without AD were generally not opposed to the concept and named procrastination (43%) as the main reason for not having prepared one. The chance for preparing an AD increased by the factor 1.08 per life-year (Odds ratio (OR): 1.08; CI: 1.04-1.11). Patients with AD mostly got advice via the internet (22%), their primary care physicians (12%) and relatives (12%). Most patients were satisfied with their AD. Conclusion The majority of primary care patients do not make use of ADs. The primary care physicians play an important role in counseling and should motivate patients to complete ADs. Here, the establishment of quality standards would be desirable in the future. © Georg Thieme Verlag KG Stuttgart · New York.

  7. Default options in advance directives: study protocol for a randomised clinical trial

    Gabler, Nicole B; Cooney, Elizabeth; Small, Dylan S; Troxel, Andrea B; Arnold, Robert M; White, Douglas B; Angus, Derek C; Loewenstein, George; Volpp, Kevin G; Bryce, Cindy L; Halpern, Scott D

    2016-01-01

    Introduction Although most seriously ill Americans wish to avoid burdensome and aggressive care at the end of life, such care is often provided unless patients or family members specifically request otherwise. Advance directives (ADs) were created to provide opportunities to set limits on aggressive care near life's end. This study tests the hypothesis that redesigning ADs such that comfort-oriented care is provided as the default, rather than requiring patients to actively choose it, will promote better patient-centred outcomes. Methods and analysis This multicentre trial randomises seriously ill adults to receive 1 of 3 different ADs: (1) a traditional AD that requires patients to actively choose their goals of care or preferences for specific interventions (eg, feeding tube insertion) or otherwise have their care guided by their surrogates and the prevailing societal default toward aggressive care; (2) an AD that defaults to life-extending care and receipt of life-sustaining interventions, enabling patients to opt out from such care; or (3) an AD that defaults to comfort care, enabling patients to opt into life-extending care. We seek to enrol 270 patients who return complete, legally valid ADs so as to generate sufficient power to detect differences in the primary outcome of hospital-free days (days alive and not in an acute care facility). Secondary outcomes include hospital and intensive care unit admissions, costs of care, hospice usage, decision conflict and satisfaction, quality of life, concordance of preferences with care received and bereavement outcomes for surrogates of patients who die. Ethics and dissemination This study has been approved by the Institutional Review Boards at all trial centres, and is guided by a data safety and monitoring board and an ethics advisory board. Study results will be disseminated using methods that describe the results in ways that key stakeholders can best understand and implement. Trial registration number NCT02017548

  8. [Advance directives in Italy: a goal not yet reached but already passed?].

    Riccioni, Luigi; Gristina, Giuseppe

    2015-10-01

    The advance directives (ADs) have been adopted in many countries to defend patients' autonomy. In Italy, in the past, this topic gave rise to a heated debate involving philosophers, theologians, and politicians. In 2009, the government presented a bill of law on ADs firmly criticized from a scientific, moral and juridical point of view because the bill's content is against the principles of Italian Constitution, Italian Code of Medical Ethics, Oviedo Convention, and official statements of many scientific societies. Although the bill has passed the Low Chamber it lies, even since, in the Senate, lacking in regard any agreement among the political parties. The purpose of this article is to highlight that, in our country, patients, relatives and doctors deserve a law not only related to the specific topic of ADs, but - as in other European countries (Germany, Spain, France, UK) - aimed to deal with the complex issue of end of life care as a whole. This law should take into account the sound evidence existing in regard to the four fundamental principles supporting the best scientific and ethical approaches to the end of life issues: shared decision making process between doctors and patients/relatives; rejection of dying process marked by the suffering; withholding/withdrawing futile treatments together with palliative sedation as two crucial contributions to suppress the patient suffering and pain; clear-cut difference between these clinical/ethical options and euthanasia. At the same time, this law should be able to provide physicians with a legal coverage to make all the clinical and ethical decisions more and more complex because of the continuous evolution of medical science on one hand, and the impressive development of biotechnology on the other hand.

  9. Development and Testing of the Advanced CHP System Utilizing the Off-Gas from the Innovative Green Coke Calcining Process in Fluidized Bed

    Chudnovsky, Yaroslav [Gas Technology Inst., Des Plaines, IL (United States); Kozlov, Aleksandr [Gas Technology Inst., Des Plaines, IL (United States)

    2013-08-15

    Green petroleum coke (GPC) is an oil refining byproduct that can be used directly as a solid fuel or as a feedstock for the production of calcined petroleum coke. GPC contains a high amount of volatiles and sulfur. During the calcination process, the GPC is heated to remove the volatiles and sulfur to produce purified calcined coke, which is used in the production of graphite, electrodes, metal carburizers, and other carbon products. Currently, more than 80% of calcined coke is produced in rotary kilns or rotary hearth furnaces. These technologies provide partial heat utilization of the calcined coke to increase efficiency of the calcination process, but they also share some operating disadvantages. However, coke calcination in an electrothermal fluidized bed (EFB) opens up a number of potential benefits for the production enhancement, while reducing the capital and operating costs. The increased usage of heavy crude oil in recent years has resulted in higher sulfur content in green coke produced by oil refinery process, which requires a significant increase in the calcinations temperature and in residence time. The calorific value of the process off-gas is quite substantial and can be effectively utilized as an “opportunity fuel” for combined heat and power (CHP) production to complement the energy demand. Heat recovered from the product cooling can also contribute to the overall economics of the calcination process. Preliminary estimates indicated the decrease in energy consumption by 35-50% as well as a proportional decrease in greenhouse gas emissions. As such, the efficiency improvement of the coke calcinations systems is attracting close attention of the researchers and engineers throughout the world. The developed technology is intended to accomplish the following objectives: - Reduce the energy and carbon intensity of the calcined coke production process. - Increase utilization of opportunity fuels such as industrial waste off-gas from the novel

  10. The role of advance directives in end-of-life decisions in Austria: survey of intensive care physicians

    Schopper Andrea

    2010-10-01

    Full Text Available Abstract Background Currently, intensive care medicine strives to define a generally accepted way of dealing with end-of-life decisions, therapy limitation and therapy discontinuation. In 2006 a new advance directive legislation was enacted in Austria. Patients may now document their personal views regarding extension of treatment. The aim of this survey was to explore Austrian intensive care physicians' experiences with and their acceptance of the new advance directive legislation two years after enactment (2008. Methods Under the aegis of the OEGARI (Austrian Society of Anaesthesiology, Resuscitation and Intensive Care an anonymised questionnaire was sent to the medical directors of all intensive care units in Austria. The questions focused on the physicians' experiences regarding advance directives and their level of knowledge about the underlying legislation. Results There were 241 questionnaires sent and 139 were turned, which was a response rate of 58%. About one third of the responders reported having had no experience with advance directives and only 9 directors of intensive care units had dealt with more than 10 advance directives in the previous two years. Life-supporting measures, resuscitation, and mechanical ventilation were the predominantly refused therapies, wishes were mainly expressed concerning pain therapy. Conclusion A response rate of almost 60% proves the great interest of intensive care professionals in making patient-oriented end-of-life decisions. However, as long as patients do not make use of their right of co-determination, the enactment of the new law can be considered only a first important step forward.

  11. Sigma Team for Advanced Actinide Recycle FY2015 Accomplishments and Directions

    Moyer, Bruce A. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States)

    2015-09-30

    noncomplexing aqueous solution and submission of this scientific breakthrough as a paper in Science; The first-ever co-crystallization of Am(VI) with UO2(NO3)2 ∙ 6H2O, opening the door to a new approach for separating hexavalent actinides as a group; Results showing that three potentially problematic metals will not present risk in ALSEP; Improvement in ALSEP contactor stripping kinetics to acceptable performance; A comparison of centrifugal contactors vs mixer-settlers showing the former performs better in ALSEP stripping; Synthesis of new mixed N,O-donor extractants with enhanced solubility and strength for selective trivalent actinide extraction; Development of computational methods showing promise in prediction of the selectivity of new extractants for trivalent actinides vs lanthanides; An order-of-magnitude improvement in aqueous Am/Eu complexation selectivity of an alternative macrocyclic stripping agent for ALSEP, potentially enabling an option for an Am product stream free from both Ln and Cm. An alternative aqueous combination of dipicolinate complexant and malonate buffer that may present options for ALSEP and TALSPEAK (Trivalent Actinide-Lanthanide Separations by Phosphorus-reagent Extraction from Aqueous Komplexes) type separations. The ALSEP concept is advancing toward a benchtop flowsheet demonstration planned for FY 2016, and a bench-scale test bed at Idaho National Laboratory (INL) will be employed to demonstrate at least one tandem Am oxidation and separation concept. This report outlines the goals of the STAAR, significance of achieving these goals, STAAR organization around the above aims and questions, recent highlights, and future directions. The report also includes a listing of publications, reports, patents, and dissertations.

  12. Reconciling ocean mass content change based on direct and inverse approaches by utilizing data from GRACE, altimetry and Swarm

    Rietbroek, R.; Uebbing, B.; Lück, C.; Kusche, J.

    2017-12-01

    Ocean mass content (OMC) change due to the melting of the ice-sheets in Greenland and Antarctica, melting of glaciers and changes in terrestrial hydrology is a major contributor to present-day sea level rise. Since 2002, the GRACE satellite mission serves as a valuable tool for directly measuring the variations in OMC. As GRACE has almost reached the end of its lifetime, efforts are being made to utilize the Swarm mission for the recovery of low degree time-variable gravity fields to bridge a possible gap until the GRACE-FO mission and to fill up periods where GRACE data was not existent. To this end we compute Swarm monthly normal equations and spherical harmonics that are found competitive to other solutions. In addition to directly measuring the OMC, combination of GRACE gravity data with altimetry data in a global inversion approach allows to separate the total sea level change into individual mass-driven and steric contributions. However, published estimates of OMC from the direct and inverse methods differ not only depending on the time window, but also are influenced by numerous post-processing choices. Here, we will look into sources of such differences between direct and inverse approaches and evaluate the capabilities of Swarm to derive OMC. Deriving time series of OMC requires several processing steps; choosing a GRACE (and altimetry) product, data coverage, masks and filters to be applied in either spatial or spectral domain, corrections related to spatial leakage, GIA and geocenter motion. In this study, we compare and quantify the effects of the different processing choices of the direct and inverse methods. Our preliminary results point to the GIA correction as the major source of difference between the two approaches.

  13. When lithography meets self-assembly: a review of recent advances in the directed assembly of complex metal nanostructures on planar and textured surfaces

    Hughes, Robert A.; Menumerov, Eredzhep; Neretina, Svetlana

    2017-07-01

    One of the foremost challenges in nanofabrication is the establishment of a processing science that integrates wafer-based materials, techniques, and devices with the extraordinary physicochemical properties accessible when materials are reduced to nanoscale dimensions. Such a merger would allow for exacting controls on nanostructure positioning, promote cooperative phenomenon between adjacent nanostructures and/or substrate materials, and allow for electrical contact to individual or groups of nanostructures. With neither self-assembly nor top-down lithographic processes being able to adequately meet this challenge, advancements have often relied on a hybrid strategy that utilizes lithographically-defined features to direct the assembly of nanostructures into organized patterns. While these so-called directed assembly techniques have proven viable, much of this effort has focused on the assembly of periodic arrays of spherical or near-spherical nanostructures comprised of a single element. Work directed toward the fabrication of more complex nanostructures, while still at a nascent stage, has nevertheless demonstrated the possibility of forming arrays of nanocubes, nanorods, nanoprisms, nanoshells, nanocages, nanoframes, core-shell structures, Janus structures, and various alloys on the substrate surface. In this topical review, we describe the progress made in the directed assembly of periodic arrays of these complex metal nanostructures on planar and textured substrates. The review is divided into three broad strategies reliant on: (i) the deterministic positioning of colloidal structures, (ii) the reorganization of deposited metal films at elevated temperatures, and (iii) liquid-phase chemistry practiced directly on the substrate surface. These strategies collectively utilize a broad range of techniques including capillary assembly, microcontact printing, chemical surface modulation, templated dewetting, nanoimprint lithography, and dip-pen nanolithography and

  14. ADVANCED BYPRODUCT RECOVERY: DIRECT CATALYTIC REDUCTION OF SO2 TO ELEMENTAL SULFUR; FINAL

    Robert S. Weber

    1999-01-01

    Arthur D. Little, Inc., together with its commercialization partner, Engelhard Corporation, and its university partner Tufts, investigated a single-step process for direct, catalytic reduction of sulfur dioxide from regenerable flue gas desulfurization processes to the more valuable elemental sulfur by-product. This development built on recently demonstrated SO(sub 2)-reduction catalyst performance at Tufts University on a DOE-sponsored program and is, in principle, applicable to processing of regenerator off-gases from all regenerable SO(sub 2)-control processes. In this program, laboratory-scale catalyst optimization work at Tufts was combined with supported catalyst formulation work at Engelhard, bench-scale supported catalyst testing at Arthur D. Little and market assessments, also by Arthur D. Little. Objectives included identification and performance evaluation of a catalyst which is robust and flexible with regard to choice of reducing gas. The catalyst formulation was improved significantly over the course of this work owing to the identification of a number of underlying phenomena that tended to reduce catalyst selectivity. The most promising catalysts discovered in the bench-scale tests at Tufts were transformed into monolith-supported catalysts at Engelhard. These catalyst samples were tested at larger scale at Arthur D. Little, where the laboratory-scale results were confirmed, namely that the catalysts do effectively reduce sulfur dioxide to elemental sulfur when operated under appropriate levels of conversion and in conditions that do not contain too much water or hydrogen. Ways to overcome those limitations were suggested by the laboratory results. Nonetheless, at the end of Phase I, the catalysts did not exhibit the very stringent levels of activity or selectivity that would have permitted ready scale-up to pilot or commercial operation. Therefore, we chose not to pursue Phase II of this work which would have included further bench-scale testing

  15. ADVANCED BYPRODUCT RECOVERY: DIRECT CATALYTIC REDUCTION OF SO2 TO ELEMENTAL SULFUR

    Robert S. Weber

    1999-05-01

    Arthur D. Little, Inc., together with its commercialization partner, Engelhard Corporation, and its university partner Tufts, investigated a single-step process for direct, catalytic reduction of sulfur dioxide from regenerable flue gas desulfurization processes to the more valuable elemental sulfur by-product. This development built on recently demonstrated SO{sub 2}-reduction catalyst performance at Tufts University on a DOE-sponsored program and is, in principle, applicable to processing of regenerator off-gases from all regenerable SO{sub 2}-control processes. In this program, laboratory-scale catalyst optimization work at Tufts was combined with supported catalyst formulation work at Engelhard, bench-scale supported catalyst testing at Arthur D. Little and market assessments, also by Arthur D. Little. Objectives included identification and performance evaluation of a catalyst which is robust and flexible with regard to choice of reducing gas. The catalyst formulation was improved significantly over the course of this work owing to the identification of a number of underlying phenomena that tended to reduce catalyst selectivity. The most promising catalysts discovered in the bench-scale tests at Tufts were transformed into monolith-supported catalysts at Engelhard. These catalyst samples were tested at larger scale at Arthur D. Little, where the laboratory-scale results were confirmed, namely that the catalysts do effectively reduce sulfur dioxide to elemental sulfur when operated under appropriate levels of conversion and in conditions that do not contain too much water or hydrogen. Ways to overcome those limitations were suggested by the laboratory results. Nonetheless, at the end of Phase I, the catalysts did not exhibit the very stringent levels of activity or selectivity that would have permitted ready scale-up to pilot or commercial operation. Therefore, we chose not to pursue Phase II of this work which would have included further bench-scale testing

  16. Direct utilization of information from nuclear data files in Monte Carlo simulation of neutron and photon transport

    Androsenko, P.; Joloudov, D.; Kompaniyets, A.

    2001-01-01

    Questions, related to Monte-Carlo method for solution of neutron and photon transport equation, are discussed in the work concerned. Problems dealing with direct utilization of information from evaluated nuclear data files in run-time calculations are considered. ENDF-6 format libraries have been used for calculations. Approaches provided by the rules of ENDF-6 files 2, 3-6, 12-15, 23, 27 and algorithms for reconstruction of resolved and unresolved resonance region cross sections under preset energy are described. The comparison results of calculations made by NJOY and GRUCON programs and computed cross sections data are represented. Test computation data of neutron leakage spectra for spherical benchmark-experiments are also represented. (authors)

  17. Teach It, Don’t Preach It: The Differential Effects of Directly-communicated and Self-generated Utility Value Information

    Canning, Elizabeth A.; Harackiewicz, Judith M.

    2015-01-01

    Social-psychological interventions in education have used a variety of “self-persuasion” or “saying-is-believing” techniques to encourage students to articulate key intervention messages. These techniques are used in combination with more overt strategies, such as the direct communication of messages in order to promote attitude change. However, these different strategies have rarely been systematically compared, particularly in controlled laboratory settings. We focus on one intervention based in expectancy-value theory designed to promote perceptions of utility value in the classroom and test different intervention techniques to promote interest and performance. Across three laboratory studies, we used a mental math learning paradigm in which we varied whether students wrote about utility value for themselves or received different forms of directly-communicated information about the utility value of a novel mental math technique. In Study 1, we examined the difference between directly-communicated and self-generated utility-value information and found that directly-communicated utility-value information undermined performance and interest for individuals who lacked confidence, but that self-generated utility had positive effects. However, Study 2 suggests that these negative effects of directly-communicated utility value can be ameliorated when participants are also given the chance to generate their own examples of utility value, revealing a synergistic effect of directly-communicated and self-generated utility value. In Study 3, we found that individuals who lacked confidence benefited more when everyday examples of utility value were communicated, rather than career and school examples. PMID:26495326

  18. Teach It, Don't Preach It: The Differential Effects of Directly-communicated and Self-generated Utility Value Information.

    Canning, Elizabeth A; Harackiewicz, Judith M

    2015-03-01

    Social-psychological interventions in education have used a variety of "self-persuasion" or "saying-is-believing" techniques to encourage students to articulate key intervention messages. These techniques are used in combination with more overt strategies, such as the direct communication of messages in order to promote attitude change. However, these different strategies have rarely been systematically compared, particularly in controlled laboratory settings. We focus on one intervention based in expectancy-value theory designed to promote perceptions of utility value in the classroom and test different intervention techniques to promote interest and performance. Across three laboratory studies, we used a mental math learning paradigm in which we varied whether students wrote about utility value for themselves or received different forms of directly-communicated information about the utility value of a novel mental math technique. In Study 1, we examined the difference between directly-communicated and self-generated utility-value information and found that directly-communicated utility-value information undermined performance and interest for individuals who lacked confidence, but that self-generated utility had positive effects. However, Study 2 suggests that these negative effects of directly-communicated utility value can be ameliorated when participants are also given the chance to generate their own examples of utility value, revealing a synergistic effect of directly-communicated and self-generated utility value. In Study 3, we found that individuals who lacked confidence benefited more when everyday examples of utility value were communicated, rather than career and school examples.

  19. Elastic Model Transitions: a Hybrid Approach Utilizing Quadratic Inequality Constrained Least Squares (LSQI) and Direct Shape Mapping (DSM)

    Jurenko, Robert J.; Bush, T. Jason; Ottander, John A.

    2014-01-01

    A method for transitioning linear time invariant (LTI) models in time varying simulation is proposed that utilizes both quadratically constrained least squares (LSQI) and Direct Shape Mapping (DSM) algorithms to determine physical displacements. This approach is applicable to the simulation of the elastic behavior of launch vehicles and other structures that utilize multiple LTI finite element model (FEM) derived mode sets that are propagated throughout time. The time invariant nature of the elastic data for discrete segments of the launch vehicle trajectory presents a problem of how to properly transition between models while preserving motion across the transition. In addition, energy may vary between flex models when using a truncated mode set. The LSQI-DSM algorithm can accommodate significant changes in energy between FEM models and carries elastic motion across FEM model transitions. Compared with previous approaches, the LSQI-DSM algorithm shows improvements ranging from a significant reduction to a complete removal of transients across FEM model transitions as well as maintaining elastic motion from the prior state.

  20. Use of direct oral anticoagulants in the first year after market entry of edoxaban: A Danish nationwide drug utilization study.

    Pottegård, Anton; Grove, Erik L; Hellfritzsch, Maja

    2018-02-01

    To describe the early uptake of edoxaban; the fourth direct oral anticoagulant (DOAC) to enter the market. Using the Danish nationwide health registries, we identified new users of edoxaban (n = 609) from June 6 (day of marketing) through June 2017. For comparison, we also identified new users of dabigatran (n = 2211), rivaroxaban (n = 19 227), and apixaban (n = 14 736). Users were described regarding indication of use, previous anticoagulant experience, comorbidity, and co-medication. The rate of edoxaban initiation increased to 2.0 per 100 000 person months in June 2017, compared with 6.3, 37.5, and 27.0 for dabigatran, rivaroxaban, and apixaban. Atrial fibrillation was the most common registered indication for edoxaban (67%) as well as the other DOACs (41-55%). Overall, users of edoxaban were comparable to users of other DOACs (median age 75 vs 72-76 years and 57% vs 53-59% males), except for a generally lower concomitant use of other drugs. Noticeably, 95% of edoxaban users had previously received anticoagulant treatment compared with 31% to 43% for new users of other DOACs, with 77% switching directly from another anticoagulant treatment to edoxaban (45% directly from VKA and 32% directly from DOACs). While the use of edoxaban is still limited compared with other DOACs, it is increasing. The majority of edoxaban users switch to edoxaban from other anticoagulant treatments. Continued monitoring of the utilization of DOACs, including effectiveness and safety, is considered essential to the safe and rational use of these drugs. Copyright © 2017 John Wiley & Sons, Ltd.

  1. Correction: An unsymmetrical non-fullerene acceptor: synthesis via direct heteroarylation, self-assembly, and utility as a low energy absorber in organic photovoltaic cells.

    Payne, Abby-Jo; Li, Shi; Dayneko, Sergey V; Risko, Chad; Welch, Gregory C

    2017-09-21

    Correction for 'An unsymmetrical non-fullerene acceptor: synthesis via direct heteroarylation, self-assembly, and utility as a low energy absorber in organic photovoltaic cells' by Abby-Jo Payne et al., Chem. Commun., 2017, 53, 10168-10171.

  2. Thermodynamic Considerations of Direct Oxygen Removal from Titanium by Utilizing the Deoxidation Capability of Rare Earth Metals

    Okabe, Toru H.; Zheng, Chenyi; Taninouchi, Yu-ki

    2018-06-01

    Oxygen removal from metallic Ti is extremely difficult and, currently, there is no commercial process for effectively deoxidizing Ti or its alloys. The oxygen concentration in Ti scraps is normally higher than that in virgin metals such as in Ti sponges produced by the Kroll process. When scraps are remelted with virgin metals for producing primary ingots of Ti or its alloys, the amount of scrap that can be used is limited owing to the accumulation of oxygen impurities. Future demands of an increase in Ti production and of mitigating environmental impacts require that the amount of scrap recycled as a feed material of Ti ingots should also increase. Therefore, it is important to develop methods for removing oxygen directly from Ti scraps. In this study, we evaluated the deoxidation limit for β-Ti using Y or light rare earth metals (La, Ce, Pr, or Nd) as a deoxidant. Thermodynamic considerations suggest that extra-low-oxygen Ti, with an oxygen concentration of 100 mass ppm or less can be obtained using a molten salt equilibrating with rare earth metals. The results presented herein also indicate that methods based on molten salt electrolysis for producing rare earth metals can be utilized for effectively and directly deoxidizing Ti scraps.

  3. Preparing Children to Look at Pictures: Advance Descriptions Direct Attention and Facilitate Active Processing

    Carr, Thomas H.; And Others

    1977-01-01

    The effect of three different kinds of advance descriptions on recognition memory for component information from pictures was measured for 72 first-grade children. All descriptions resulted in higher retention of all components than viewing without description. (Author/JMB)

  4. Engaging Men and Boys in Advancing Women's Agency : Where We Stand and New Directions

    Fleming, Paul J.; Barker, Gary; McCleary-Sills, Jennifer; Morton, Matthew

    2013-01-01

    Despite advances in gender equality, women and girls still face disadvantages and limits on their agency. Men and boys can be key stakeholders and allies to increase women's agency. This paper focuses on examining men's attitudes and behaviors related to gender equality and violence perpetration to better understand how to engage men and boys as. It uses data collected from men and women f...

  5. Faculty Development for Advancing Community Engagement in Higher Education: Current Trends and Future Directions

    Welch, Marshall; Plaxton-Moore, Star

    2017-01-01

    This research involved the conduct of a conceptual review of 28 refereed journal articles and a survey of campus centers for community engagement staff to identify salient features and trends of existing faculty development programming designed to advance service-learning and community engagement in higher education. Results of this investigation…

  6. The Clinical Utility and Diagnostic Performance of MRI for Identification of Early and Advanced Knee Osteoarthritis: A Systematic Review

    Quatman, Carmen E.; Hettrich, Carolyn M.; Schmitt, Laura C.; Spindler, Kurt P.

    2013-01-01

    Background Current diagnostic strategies for detection of structural articular cartilage abnormalities, the earliest structural signs of osteoarthritis, often do not capture the condition until it is too far advanced for the most potential benefit of non-invasive interventions. Purpose Systematically review the literature relative to the following questions: (1) Is MRI a valid, sensitive, specific, accurate and reliable instrument to identify knee articular cartilage abnormalities compared to arthroscopy? (2) Is MRI a sensitive tool that can be utilized to identify early cartilage degeneration? Study Design Systematic Review Methods A systematic search was performed in November 2010 using PubMed MEDLINE (from 1966), CINAHL (from 1982), SPORTDiscus (from 1985), and SCOPUS (from 1996) databases. Results Fourteen level I and 13 level II studies were identified that met inclusion criteria and provided information related to diagnostic performance of MRI compared to arthroscopic evaluation. The diagnostic performance of MRI demonstrated a large range of sensitivities, specificities, and accuracies. The sensitivity for identifying articular cartilage abnormalities in the knee joint was reported between 26–96%. Specificity and accuracy was reported between 50–100% and 49–94%, respectively. The sensitivity, specificity, and accuracy for identifying early osteoarthritis were reported between 0–86%, 48–95%, and 5–94%, respectively. As a result of inconsistencies between imaging techniques and methodological shortcomings of many of the studies, a meta-analysis was not performed and it was difficult to fully synthesize the information to state firm conclusions about the diagnostic performance of MRI. Conclusions There is evidence in some MRI protocols that MRI is a relatively valid, sensitive, specific, accurate, and reliable clinical tool for identifying articular cartilage degeneration. Due to heterogeneity of MRI sequences it is not possible to make definitive

  7. Relationship of social support and decisional conflict to advance directives attitude in Korean older adults: A community-based cross-sectional study.

    Lee, JuHee; Jung, Dukyoo; Choi, MoonKi

    2016-01-01

    The aim of this study was to clarify the relationship between social support, decisional conflict, and attitude towards advance directives, and determine whether decisional conflict mediates the relation between social support and advance directives attitude among older adults in South Korea. In total, 209 community-based older adults (mean age, 74.82 years) participated in this cross-sectional study. Demographic characteristics, self-perceived health status, social support, decisional conflict, and advance directives attitude were investigated via a structured questionnaire. Data analysis was carried out using Pearson's correlation and path analyses. The mean score of advance directives attitude was 48.01 (range, 35-61). Decisional conflict and social support were both significantly related to advance directives attitude (P conflict was a mediator between social support and advance directives attitudes. The results confirmed the importance of social support for reducing decisional conflict and encouraging positive attitudes toward advance directives. Future studies are needed to support the development of culturally sensitive educational approaches regarding advance directives for older adults in Korea. © 2015 The Authors. Japan Journal of Nursing Science © 2015 Japan Academy of Nursing Science.

  8. Advance Directives for End-of-Life Care and the Role of Health Education Specialists: Applying the Theory of Reasoned Action

    Tremethick, Mary Jane; Johnson, Maureen K.; Carter, Mary R.

    2011-01-01

    Quality end-of-life care is subjective and based on individual values and beliefs. An advance directive provides a legal means of communicating these values and beliefs, as well as preferences in regards to end-of-life care when an individual is no longer able to make his or her desires known. In many nations, advance directives are underused…

  9. Key Advances in the Systemic Therapy for Soft tissue Sarcomas: Current Status and Future Directions

    Neelesh Soman

    2013-10-01

    Full Text Available Soft tissue sarcomas (STS represent a heterogeneous group of diverse neoplasms of mesenchymal origin. Once relapsed from standard therapy, STS patients have limited treatment options especially those that present with advanced or metastatic disease. In this review article, we highlight recent clinical data that led to the US Food and Drug Administration (FDA approval of pazopanib (Votrient® for STS and regorafenib (Stivarga®, BAY 73-4506 in gastrointestinal stromal tumours. We also review ongoing safety/efficacy data for trabectedin (Yondelis®, ET-743, and data from clinical studies of ridaforolimus (AP23573; MK-8669 and palifosfamide (ZIO-201. We provide a list of some promising ongoing trials in soft tissue sarcomas including first line studies of TH-302 and trabectedin. Finally, our article delves into recent advances in our understanding of the molecular pathogenesis of STS and novel therapies that might be explored as treatment options for specific STS histologies.

  10. An update on current management of advanced renal cell cancer, biomarkers, and future directions

    Zhi, Wanqing Iris; Kim, Jenny J.

    2014-01-01

    In the past decade, metastatic renal cell carcinoma (mRCC) treatment underwent significant advancement that resulted in an unprecedented improvement in the prognosis of this disease. This review will provide an updated review of currently approved treatment options, namely antiangiogenic and immunotherapy, as well as treatment guideline recommended by the National Comprehensive Cancer Network (NCCN). We will summarize studies ongoing in determining prognostic and predictive biomarkers in maxi...

  11. Direct methods for limit and shakedown analysis of structures advanced computational algorithms and material modelling

    Pisano, Aurora; Weichert, Dieter

    2015-01-01

    Articles in this book examine various materials and how to determine directly the limit state of a structure, in the sense of limit analysis and shakedown analysis. Apart from classical applications in mechanical and civil engineering contexts, the book reports on the emerging field of material design beyond the elastic limit, which has further industrial design and technological applications. Readers will discover that “Direct Methods” and the techniques presented here can in fact be used to numerically estimate the strength of structured materials such as composites or nano-materials, which represent fruitful fields of future applications.   Leading researchers outline the latest computational tools and optimization techniques and explore the possibility of obtaining information on the limit state of a structure whose post-elastic loading path and constitutive behavior are not well defined or well known. Readers will discover how Direct Methods allow rapid and direct access to requested information in...

  12. Novel Emergency Medicine Curriculum Utilizing Self-Directed Learning and the Flipped Classroom Method: Genitourinary Emergencies Small Group Module

    Andrew King

    2017-07-01

    Full Text Available Audience: This curriculum, created and implemented at The Ohio State University Wexner Medical Center, was designed to educate our emergency medicine (EM residents, PGY-1 to PGY-3, as well as medical students. Introduction: In 2013, there were over 6 million Emergency Department visits in the United States which resulted in a primary diagnosis of the genitourinary system. This represents 5.2% of all Emergency Department visits.1 Residents must be proficient in the differential diagnosis and management of the wide variety of genitourinary emergencies. This flipped classroom curricular model emphasizes self-directed learning activities completed by learners, followed by small group discussions pertaining to the topic reviewed. The active learning fostered by this curriculum increases faculty and learner engagement and interaction time typically absent in traditional lecture-based formats.2-4 Studies have revealed that the application of knowledge through case studies, personal interaction with content experts, and integrated questions are effective learning strategies for emergency medicine residents.4-6 The Ohio State University Wexner Medical Center EM Residency didactic curriculum recently transitioned to a “flipped classroom” approach.7-10 We created this innovative curriculum aimed to improve our residency education program and to share educational resources with other EM residency programs. Our curriculum utilizes an 18-month curricular cycle to cover the defined emergency medicine content. The flipped classroom curriculum maximizes didactic time and resident engagement, fosters intellectual curiosity and active learning, and meets the needs of today’s learners. 3,6,11 Objectives: We aim to teach the presentation and management of genitourinary emergencies through the creation of a flipped classroom design. This unique, innovative curriculum utilizes resources chosen by education faculty and resident learners, study questions, real

  13. Novel Emergency Medicine Curriculum Utilizing Self-Directed Learning and the Flipped Classroom Method: Gastrointestinal Emergencies Small Group Module

    Andrew King

    2017-01-01

    Full Text Available Audience and type of curriculum: This curriculum created and implemented at The Ohio State University Wexner Medical Center was designed to educate our emergency medicine (EM residents, PGY-1 to PGY-3, as well as medical students and attending physicians. Introduction/Background: Gastrointestinal (GI emergencies comprise approximately 12% of emergency department (ED visits.1 Residents must be proficient in the differential diagnosis and management of the wide variety of GI emergencies. The flipped classroom curricular model emphasizes self-directed learning activities completed by learners, followed by small group discussions pertaining to the topic reviewed. The active learning fostered by this curriculum increases faculty and learner engagement and interaction time typically absent in traditional lecture-based formats.2-4 Studies have revealed that the application of knowledge through case studies, personal interaction with content experts, and integrated questions are effective learning strategies for emergency medicine residents.4-6 The Ohio State University EM Residency didactic curriculum recently transitioned to a “flipped classroom” approach.7-10 We created this innovative curriculum aimed to improve our residency education program and to share educational resources with other EM residency programs. This proposed curriculum utilizes an 18-month curricular cycle. The flipped classroom curriculum maximizes didactic time and resident engagement, fosters intellectual curiosity and active learning, and meets the needs of today’s learners. 3,6,11 Objectives: We aim to teach the presentation and management of GI emergencies through the creation of a flipped classroom design. This unique, innovative curriculum utilizes resources chosen by education faculty and resident learners, study questions, real-life experiences, and small group discussions in place of traditional lectures. In doing so, a goal of the curriculum is to encourage self-directed

  14. Novel Emergency Medicine Curriculum Utilizing Self-Directed Learning and the Flipped Classroom Method: Psychiatric Emergencies Small Group Module

    Andrew King

    2017-07-01

    Full Text Available Audience: This curriculum created and implemented at The Ohio State University Wexner Medical Center was designed to educate our emergency medicine (EM residents, PGY-1 to PGY-3, as well as medical students and attending physicians. Introduction: In 2007, there were 12 million adult Emergency Department visits for mental health and substance abuse complaints. This represents 12.5% of all adult emergency department visits.1 Residents must be proficient in the differential diagnosis and management of the wide variety of psychiatric emergencies. The flipped classroom curricular model emphasizes self-directed learning activities completed by learners, followed by small group discussions pertaining to the topic reviewed. The active learning fostered by this curriculum increases faculty and learner engagement and interaction time typically absent in traditional lecture-based formats.2-4 Studies have revealed that the application of knowledge through case studies, personal interaction with content experts, and integrated questions are effective learning strategies for emergency medicine residents.4-6 The Ohio State University EM Residency didactic curriculum recently transitioned to a “flipped classroom” approach.7-10 We created this innovative curriculum aimed to improve our residency education program and to share educational resources with other EM residency programs. Our curriculum utilizes an 18-month curricular cycle to cover the defined emergency medicine content. The flipped classroom curriculum maximizes didactic time and resident engagement, fosters intellectual curiosity and active learning, and meets the needs of today’s learners. 3,6,11 Objectives: We aim to teach the presentation and management of psychiatric emergencies through the creation of a flipped classroom design. This unique, innovative curriculum utilizes resources chosen by education faculty and resident learners, study questions, real-life experiences, and small group

  15. Advanced Direct-Drive Generator for Improved Availability of Oscillating Wave Surge Converter Power Generation Systems Final Technical Report

    Englebretson, Steven [ABB Inc., Cary, NC (United States); Ouyang, Wen [ABB Inc., Cary, NC (United States); Tschida, Colin [ABB Inc., Cary, NC (United States); Carr, Joseph [ABB Inc., Cary, NC (United States); Ramanan, V.R. [ABB Inc., Cary, NC (United States); Johnson, Matthew [Texas A& M Univ., College Station, TX (United States); Gardner, Matthew [Texas A& M Univ., College Station, TX (United States); Toliyat, Hamid [Texas A& M Univ., College Station, TX (United States); Staby, Bill [Resolute Marine Energy, Inc., Boston, MA (United States); Chertok, Allan [Resolute Marine Energy, Inc., Boston, MA (United States); Hazra, Samir [ABB Inc., Cary, NC (United States); Bhattacharya, Subhashish [ABB Inc., Cary, NC (United States)

    2017-05-13

    This report summarizes the activities conducted under the DOE-EERE funded project DE-EE0006400, where ABB Inc. (ABB), in collaboration with Texas A&M’s Advanced Electric Machines & Power Electronics (EMPE) Lab and Resolute Marine Energy (RME) designed, derisked, developed, and demonstrated a novel magnetically geared electrical generator for direct-drive, low-speed, high torque MHK applications The project objective was to investigate a novel and compact direct-drive electric generator and its system aspects that would enable elimination of hydraulic components in the Power Take-Off (PTO) of a Marine and Hydrokinetic (MHK) system with an oscillating wave surge converter (OWSC), thereby improving the availability of the MHK system. The scope of this project was limited to the development and dry lab demonstration of a low speed generator to enable future direct drive MHK systems.

  16. Seismic PSA implementation standards by AESJ and the utilization of the advanced safety examination guideline for seismic design for nuclear power plant

    Ebisawa, Katsumi; Hibino, Kenta

    2008-01-01

    The Advanced Safety Examination Guideline for Seismic Design for Nuclear Power Plant (the advanced safety examination guideline) was worked out on September 19, 2006. In this paper, a summary of the method of probability theory in the advanced safety examination guideline and the Seismic PSA Implementation Standards is stated. On utilization of the probability theory for the advanced safety examination guideline, the uncertainty resulting from the process of the decision of the basic design earthquake ground motion (Ss) is stated to be considered using the proper method. The references of the extra probability for evaluation of earthquake hazard and combination of the working load and the earthquake load are stated. Definition, evaluation method and effort to lower the 'residual risks', and relation between the residual risks and the extra probability of Ss are described. A summary of the earthquake-resistant design for nuclear power facilities is explained by the old guideline. (S.Y.)

  17. Direct bio-utilization of untreated rapeseed meal for effective iturin A production by Bacillus subtilis in submerged fermentation.

    Hu Jin

    Full Text Available The feasibility of using untreated rapeseed meal as a nitrogen source for iturin A production by Bacillus subtilis 3-10 in submerged fermentation was first evaluated by comparison with two different commercial nitrogen sources of peptone and ammonium nitrate. A significant promoting effect of rapeseed meal on iturin A production was observed and the maximum iturin A concentration of 0.60 g/L was reached at 70 h, which was 20% and 8.0 fold higher than that produced from peptone and ammonium nitrate media, respectively. It was shown that rapeseed meal had a positive induction effect on protease secretion, contributing to the release of soluble protein from low water solubility solid rapeseed meal for an effective supply of available nitrogen during fermentation. Moreover, compared to raw rapeseed meal, the remaining residue following fermentation could be used as a more suitable supplementary protein source for animal feed because of the great decrease of major anti-nutritional components including sinapine, glucosinolate and its degradation products of isothiocyanate and oxazolidine thione. The results obtained from this study demonstrate the potential of direct utilization of low cost rapeseed meal as a nitrogen source for commercial production of iturin A and other secondary metabolites by Bacillus subtilis.

  18. A directly cooled grating substrate for ALS [Advanced Light Source] undulator beam lines

    DiGennaro, R.; Swain, T.

    1989-08-01

    Design analyses using finite element methods are presented for thermal distortion of water-cooled diffraction grating substrates for a potential application at the LBL Advanced Light Source, demonstrating that refinements in cooling channel configuration and heat flux distribution can significantly reduce optical surface distortion with high heat loads. Using an existing grating substrate design, sensitivity of tangential slope errors due to thermal distortion is evaluated for a variety of thermal boundary conditions, including coolant flow rate and heat transfer film coefficients, surface illumination area and heat distribution profile, and location of the convection cooling surfaces adjacent to the heated region. 1 ref., 5 figs., 2 tabs

  19. Advances in direct radiographic magnification technique: First studies with a 1μ focal spot tube

    Huettenbrink, K.B.; Schadel, A.

    1986-01-01

    A direct radiographic enlargement technique mainly depends on the size of the focal spot. Up to now, its reduction was limited for physical reasons; therefore only minor degrees of magnification were applicable. With the new 1 μ focal spot tube, structures of microscopic dimensions can be visualized for the first time in a direct radiographic magnification of up to 100 diameters. First studies in isolated middle ear ossicles and a phantom soft-tissue-skull are demonstrated. Clinical usefullness seems to be limited, whereas its application for experimental research looks promising. (orig.) [de

  20. Implementation of an advanced hybrid MPC-PID control system using PAT tools into a direct compaction continuous pharmaceutical tablet manufacturing pilot plant.

    Singh, Ravendra; Sahay, Abhishek; Karry, Krizia M; Muzzio, Fernando; Ierapetritou, Marianthi; Ramachandran, Rohit

    2014-10-01

    It is desirable for a pharmaceutical final dosage form to be manufactured through a quality by design (QbD)-based approach rather than a quality by testing (QbT) approach. An automatic feedback control system coupled with PAT tools that is part of the QbD paradigm shift, has the potential to ensure that the pre-defined end product quality attributes are met in a time and cost efficient manner. In this work, an advanced hybrid MPC-PID control architecture coupled with real time inline/online monitoring tools and principal components analysis (PCA) based additional supervisory control layer has been proposed for a continuous direct compaction tablet manufacturing process. The advantages of both MPC and PID have been utilized in a hybrid scheme. The control hardware and software integration and implementation of the control system has been demonstrated using feeders and blending unit operation of a continuous tablet manufacturing pilot plant and an NIR based PAT tool. The advanced hybrid MPC-PID control scheme leads to enhanced control loop performance of the critical quality attributes in comparison to a regulatory (e.g. PID) control scheme indicating its potential to improve pharmaceutical product quality. Copyright © 2014 Elsevier B.V. All rights reserved.

  1. Advanced control of direct-driven PMSG generator in wind turbine system

    Gajewski Piotr

    2016-12-01

    Full Text Available The paper presents the advanced control system of the wind energy conversion with a variable speed wind turbine. The considered system consists of a wind turbine with the permanent magnet synchronous generator (PMSG, machine side converter (MSC, grid side converter (GSC and control circuits. The mathematical models of a wind turbine system, the PMSG generator and converters have been described. The control algorithms of the converter systems based on the methods of vector control have been applied. In the advanced control system of the machine side converter the optimal MPPT control method has been used. Additionally the pitch control scheme is included in order to achieve the limitation of maximum power and to prevent mechanical damage of the wind turbine. In the control system of the grid side converter the control of active and reactive power has been applied with the application of Voltage Oriented Control (VOC. The performance of the considered wind energy system has been studied by digital simulation. The results of simulation studies confirmed the good effectiveness of the considered wind turbine system and very good performance of the proposed methods of vector control and control systems.

  2. Metabolic engineering of Bacillus subtilis fueled by systems biology: Recent advances and future directions.

    Liu, Yanfeng; Li, Jianghua; Du, Guocheng; Chen, Jian; Liu, Long

    By combining advanced omics technology and computational modeling, systems biologists have identified and inferred thousands of regulatory events and system-wide interactions of the bacterium Bacillus subtilis, which is commonly used both in the laboratory and in industry. This dissection of the multiple layers of regulatory networks and their interactions has provided invaluable information for unraveling regulatory mechanisms and guiding metabolic engineering. In this review, we discuss recent advances in the systems biology and metabolic engineering of B. subtilis and highlight current gaps in our understanding of global metabolism and global pathway engineering in this organism. We also propose future perspectives in the systems biology of B. subtilis and suggest ways that this approach can be used to guide metabolic engineering. Specifically, although hundreds of regulatory events have been identified or inferred via systems biology approaches, systematic investigation of the functionality of these events in vivo has lagged, thereby preventing the elucidation of regulatory mechanisms and further rational pathway engineering. In metabolic engineering, ignoring the engineering of multilayer regulation hinders metabolic flux redistribution. Post-translational engineering, allosteric engineering, and dynamic pathway analyses and control will also contribute to the modulation and control of the metabolism of engineered B. subtilis, ultimately producing the desired cellular traits. We hope this review will aid metabolic engineers in making full use of available systems biology datasets and approaches for the design and perfection of microbial cell factories through global metabolism optimization. Copyright © 2016 Elsevier Inc. All rights reserved.

  3. Recent advances on Zeolite modification for direct alcohol fuel cells (DAFCs)

    Makertihartha, I. G. B. N.; Zunita, M.; Rizki, Z.; Dharmawijaya, P. T.

    2017-03-01

    The increase of energy demand and global warming issues has driven studies of alternative energy sources. The polymer electrolyte membrane fuel cell (PEMFC) can be an alternative energy source by (partially) replacing the use of fossil fuel which is in line with the green technology concept. However, the usage of hydrogen as a fuel has several disadvantages mainly transportation and storage related to its safety aspects. Recently, alcohol has gained attention as an energy source for fuel cell application, namely direct alcohol fuel cell (DAFC). Among alcohols, high-mass energy density methanol and ethanol are widely used as direct methanol fuel cell (DMFC) and direct ethanol fuel cell (DEFC), respectively. Currently, the performance of DMFC is still rudimentary. Furthermore, the use of ethanol gives some additional privileges such as non-toxic property, renewable, ease of production in great quantity by the fermentation of sugar-containing raw materials. Direct alcohol fuel cell (DAFC) still has weakness in the low proton conductivity and high alcohol crossover. Therefore, to increase the performance of DAFC, modification using zeolite has been performed to improve proton conductivity and decrease alcohol crossover. Zeolite also has high thermal resistance properties, thereby increasing DAFC performance. This paper will discuss briefly about modification of catalyst and membrane for DAFC using zeolite. Zeolite modification effect on fuel cell performance especially proton conductivity and alcohol crossover will be presented in detail.

  4. Investigation of Ruthenium Dissolution in Advanced Membrane Electrode Assemblies for Direct Methanol Based Fuel Cells Stacks

    Valdez, T. I.; Firdosy, S.; Koel, B. E.; Narayanan, S. R.

    2005-01-01

    This viewgraph presentation gives a detailed review of the Direct Methanol Based Fuel Cell (DMFC) stack and investigates the Ruthenium that was found at the exit of the stack. The topics include: 1) Motivation; 2) Pathways for Cell Degradation; 3) Cell Duration Testing; 4) Duration Testing, MEA Analysis; and 5) Stack Degradation Analysis.

  5. Impact of a stay in the intensive care unit on the preparation of Advance Directives: Descriptive, exploratory, qualitative study.

    Andreu, Pascal; Dargent, Auguste; Large, Audrey; Meunier-Beillard, Nicolas; Vinault, Sandrine; Leiva-Rojas, Uriel; Ecarnot, Fiona; Prin, Sébastien; Charles, Pierre-Emmanuel; Fournel, Isabelle; Rigaud, Jean-Philippe; Quenot, Jean-Pierre

    2018-04-01

    Our objective was to assess, through a qualitative, exploratory study, the thought processes of patients regarding the formulation of advance directives (AD) after a stay in the ICU. The study was conducted from May to July 2016 using telephone interviews performed by four senior ICU physicians. Inclusion criteria were: patients discharged from ICU to home>3 months earlier. Semi-directive interviews with patients focused on 5 main points surrounding AD. In total, among 159 eligible patients, data from 94 (59%) were available for analysis. Among all those interviewed, 83.5% had never heard of "advance directives". Only 2% had executed AD before ICU admission, and 7% expressed a desire to prepare AD further to their ICU stay. Among the barriers to preparation of AD, lack of information was the main reason cited for not executing AD. Patients noted the following in their AD: withdrawal of life-support in case of vegetative/minimally conscious state or when there is no longer any hope, in case of uncontrollable pain, and if impossible to wean from mechanical ventilation. The ideal time to engage patients in these discussions is most likely well before an acute health event occurs, although this warrants further investigation both before and after ICU admissions. Copyright © 2017 Société française d’anesthésie et de réanimation (Sfar). Published by Elsevier Masson SAS. All rights reserved.

  6. The efficacy of self-directed modules for clinical learning: advanced competencies in entry-level physical therapy education.

    Peck, Kirk; Paschal, Karen; Black, Lisa; Nelson, Kelly

    2014-01-01

    Prior to graduation, students often express an interest to advance clinical and professional skills in teaching, research, administration, and various niche practice areas. The acquisition of advanced education in selected areas of practice is believed to improve employment opportunities, accelerate career advancement including eligibility for professional certifications, and contribute to personal satisfaction in the profession. The purpose of this paper is to (1) describe an innovative model of education, the Directed Practice Experience (DPE) elective, that incorporates a student-initiated learning process designed to achieve student-identified professional goals, and (2) report the outcomes for graduates who have completed the DPE in an entry-level program in physical therapy education. Students who met select criteria were eligible to complete a DPE. Applicants designed a 4- to 6-week clinical education experience consisting of stated rationale for personal and professional growth, examples of leadership and service, and self-directed objectives that are beyond entry-level expectations as measured by the revised Physical Therapist Clinical Performance Instrument, version 2006. Twenty-six students have completed DPEs since 2005. Fifty percent resulted in new academic partnerships. At least 25% of graduates now serve as clinical instructors for the entry-level program. Those who participated in DPEs have also completed post-graduate residencies, attained ABPTS Board certifications, authored peer-reviewed publications, and taught in both PT and residency programs. The DPE model allows qualified students to acquire advanced personal skills and knowledge prior to graduation in areas of professional practice that exceed entry-level expectations. The model is applicable to all CAPTE accredited physical therapy education programs and is especially beneficial for academic programs desiring to form new community partnerships for student clinical education.

  7. Effect of -based Direct-fed Microbial on Performance, Nutrient Utilization, Intestinal Morphology and Cecal Microflora in Broiler Chickens

    Xinjian Lei

    2015-02-01

    Full Text Available The present study was conducted to evaluate the effect of the dietary supplementation of Bacillus amyloliquefaciens-based direct-fed microbial (DFM on growth performance, nutrient utilization, intestinal morphology and cecal microflora in broiler chickens. A total of two hundred and eighty eight 1-d-old Arbor Acres male broilers were randomly allocated to one of four experimental treatments in a completely randomized design. Each treatment was fed to eight replicate cages, with nine birds per cage. Dietary treatments were composed of an antibiotic-free basal diet (control, and the basal diet supplemented with either 15 mg/kg of virginiamycin as antibiotic growth promoter (AGP, 30 mg/kg of Bacillus amyloliquefaciens-based DFM (DFM 30 or 60 mg/kg of Bacillus amyloliquefaciens-based DFM (DFM 60. Experimental diets were fed in two phases: starter (d 1 to 21 and finisher (d 22 to 42. Growth performance, nutrient utilization, morphological parameters of the small intestine and cecal microbial populations were measured at the end of the starter (d 21 and finisher (d 42 phases. During the starter phase, DFM and virginiamycin supplementation improved the feed conversion ratio (FCR; p<0.01 compared with the control group. For the finisher phase and the overall experiment (d 1 to 42 broilers fed diets with the DFM had better body weight gain (BWG and FCR than that of control (p<0.05. Supplementation of virginiamycin and DFM significantly increased the total tract apparent digestibility of crude protein (CP, dry matter (DM and gross energy during both starter and finisher phases (p<0.05 compared with the control group. On d 21, villus height, crypt depth and villus height to crypt depth ratio of duodenum, jejunum, and ileum were significantly increased for the birds fed with the DFM diets as compared with the control group (p<0.05. The DFM 30, DFM 60, and AGP groups decreased the Escherichia coli population in cecum at d 21 and d 42 compared with control

  8. Advanced direct liquefaction concepts for PETC generic units. Quarterly technical progress report, January--March 1992

    1992-04-01

    In the Advance Coal Liquefaction Concept Proposal (ACLCP) carbon monoxide (CO) and water have been proposed as the primary reagents in the pretreatment process. The main objective of this project is to develop a methodology for pretreating coal under mild conditions based on a combination of existing processes which have shown great promise in liquefaction, extraction and pyrolysis studies. The aim of this pretreatment process is to partially depolymerise the coal, eliminate oxygen and diminish the propensity for retograde reactions during subsequent liquefaction. The desirable outcome of the CO pretreatment step should be: (1) enhanced liquefaction activity and/or selectivity toward products of higher quality due to chemical modification of the coal structure; (2) cleaner downstream products; (3) overall improvement in operability and process economics.

  9. The Crosstalk between Tissue Engineering and Pharmaceutical Biotechnology: Recent Advances and Future Directions.

    Pacheco, Daniela P; Reis, Rui L; Correlo, Vítor M; Marques, Alexandra P

    2015-01-01

    Tissue-engineered constructs made of biotechnology-derived materials have been preferred due to their chemical and physical composition, which offers both high versatility and a support to enclose/ incorporate relevant signaling molecules and/or genes known to therapeutically induce tissue repair. Herein, a critical overview of the impact of different biotechnology-derived materials, scaffolds, and recombinant signaling molecules over the behavior of cells, another element of tissue engineered constructs, as well its regulatory role in tissue regeneration and disease progression is given. Additionally, these tissue-engineered constructs evolved to three-dimensional (3D) tissue-like models that, as an advancement of two-dimensional standard culture methods, are expected to be a valuable tool in the field of drug discovery and pharmaceutical research. Despite the improved design and conception of current proposed 3D tissue-like models, advanced control systems to enable and accelerate streamlining and automation of the numerous labor-intensive steps intrinsic to the development of tissue-engineered constructs are still to be achieved. In this sense, this review intends to present the biotechnology- derived materials that are being explored in the field of tissue engineering to generate 3D tissue-analogues and briefly highlight their foremost breakthroughs in tissue regeneration and drug discovery. It also aims to reinforce that the crosstalk between tissue engineering and pharmaceutical biotechnology has been fostering the outcomes of tissue engineering approaches through the use of biotechnology-derived signaling molecules. Gene delivery/therapy is also discussed as a forefront area that represents another cross point between tissue engineering and pharmaceutical biotechnology, in which nucleic acids can be considered a "super pharmaceutical" to drive biological responses, including tissue regeneration.

  10. Proceedings of the national symposium on advances in utility systems for industrial and nuclear installations (held at Bombay during January 9-11, 1992)

    1992-01-01

    The symposium was held when various utility systems, integral and peripheral to industries and organizations undergone a significant advancement in the recent years to cope with the stringent requirements of operating conditions, energy conservation and reliability. The concept of multidisciplinary approach for operating and designing these utility systems have been proved successful to meet demand of ever growing and complex processes. Keeping this in view, the subjects of the symposium were diversified in few major areas like mechanical and electrical systems, control and instrumentation, energy conservation and safety. 73 papers were included in the proceedings

  11. Advancing Direct Corporate Accountability in International Human Rights Law: The Role of State-Owned Enterprises

    Ma, Xili

    2017-01-01

    Resorting to the immensely State-centric international legal system to regulate corporate human rights abuses is often viewed as inadequate. Among many proposals aiming at filling the international regulatory gaps, imposing international human rights obligations directly on corporations is a bold one, which, due to profound doctrinal and practical challenges, has yet to be agreed upon or established. However, State-Owned Enterprises (SOEs), given its prima facie “State-Business nexus” that bl...

  12. Advance Directives of Will (Living Will: Ethical and Legal Implications Based on the Principle of Dignity of Human Person

    Maria Aparecida Alkimim

    2016-12-01

    Full Text Available This paper, with methodology of philosophical, bibliographical and documentary research intends to apply the principle of dignity of human person to the vicissitudes around the advance directives of will, to the ethical aspects disciplined by the Code of Medical Ethics, as well as to what regards the legal aspects, involving the Federal Constitution, the Civil Code, the Code of Medical Ethics and the Resolution 1995/2012 (CFM. The principle of dignity of human person along with the consequent application in the principles of bioethics is considered in a personalistic perspective. This kind of approach is indicative of the interdisciplinarity of bioethics.

  13. Factors affecting the potential of direct load control for non-generating utilities. Final report. [Distribution and wholesale power supply interaction

    None

    1979-04-01

    Several alternatives are available for achieving load management, including direct or voluntary control of customer loads, customer or utility energy storage systems for diurnal load shifting, and expanded interconnection and operation of electric power systems. All of these alternatives are available to the fully integrated (generating, transmitting and distributing) electric utility and the analysis of their effects encompasses the power supply and delivery system. However, the costs and benefits of the alternatives to the fully integrated electric utility are perhaps not so obvious. Therefore, by considering a non-generating utility, this analysis focuses upon the distribution system and wholesale power supply interaction as a step toward an analysis including the power supply and delivery system. This report develops an analysis procedure and discusses some of the relevant factors to be consdered in the application of direct load control for a non-generating utility system. The analysis concentrates on the distribution system only to determine the effect of rates and payback as a result of direct load control. Thus, the study is responsive to the specific needs of the non-generating utility. This analysis of direct load control encompasses the determination of those loads amenable to control, the selection of a suitable one-way communications system to rend control and the estimation of expected benefits and costs. The complementary functions to the application of direct load control such as automatic meter reading via the addition of a bi-directional communications system and voltage control are not included in the analysis but are detailed for future consideration.

  14. Design and Implementation of a CO2 Flood Utilizing Advanced Reservoir Characterization and Horizontal Injection Wells In a Shallow Shelf Carbonate Approaching Waterflood Depletion, Class II

    Wier, Don R. Chimanhusky, John S.; Czirr, Kirk L.; Hallenbeck, Larry; Gerard, Matthew G.; Dollens, Kim B.; Owen, Rex; Gaddis, Maurice; Moshell, M.K.

    2002-11-18

    The purpose of this project was to economically design an optimum carbon dioxide (CO2) flood for a mature waterflood nearing its economic abandonment. The original project utilized advanced reservoir characterization and CO2 horizontal injection wells as the primary methods to redevelop the South Cowden Unit (SCU). The development plans; project implementation and reservoir management techniques were to be transferred to the public domain to assist in preventing premature abandonment of similar fields.

  15. New directions in hypnosis research: strategies for advancing the cognitive and clinical neuroscience of hypnosis

    Jensen, Mark P.; Jamieson, Graham A.; Lutz, Antoine; Mazzoni, Giuliana; McGeown, William J.; Santarcangelo, Enrica L.; Demertzi, Athena; De Pascalis, Vilfredo; Bányai, Éva I.; Rominger, Christian; Vuilleumier, Patrik; Faymonville, Marie-Elisabeth; Terhune, Devin B.

    2017-01-01

    This article summarizes key advances in hypnosis research during the past two decades, including (i) clinical research supporting the efficacy of hypnosis for managing a number of clinical symptoms and conditions, (ii) research supporting the role of various divisions in the anterior cingulate and prefrontal cortices in hypnotic responding, and (iii) an emerging finding that high hypnotic suggestibility is associated with atypical brain connectivity profiles. Key recommendations for a research agenda for the next decade include the recommendations that (i) laboratory hypnosis researchers should strongly consider how they assess hypnotic suggestibility in their studies, (ii) inclusion of study participants who score in the middle range of hypnotic suggestibility, and (iii) use of expanding research designs that more clearly delineate the roles of inductions and specific suggestions. Finally, we make two specific suggestions for helping to move the field forward including (i) the use of data sharing and (ii) redirecting resources away from contrasting state and nonstate positions toward studying (a) the efficacy of hypnotic treatments for clinical conditions influenced by central nervous system processes and (b) the neurophysiological underpinnings of hypnotic phenomena. As we learn more about the neurophysiological mechanisms underlying hypnosis and suggestion, we will strengthen our knowledge of both basic brain functions and a host of different psychological functions. PMID:29034102

  16. Fairly direct hit. Advances in imaging of shotgun projectiles in MRI

    Eggert, Sebastian [Kantonsspital Baden AG, Department of Radiology, Baden (Switzerland); University of Zurich, Institute of Forensic Medicine, Zurich (Switzerland); Kubik-Huch, Rahel A.; Peters, Alexander [Kantonsspital Baden AG, Department of Radiology, Baden (Switzerland); Klarhoefer, Markus [Siemens Healthcare, Zurich (Switzerland); Bolliger, Stephan A.; Thali, Michael J. [University of Zurich, Institute of Forensic Medicine, Zurich (Switzerland); Anderson, Suzanne [Kantonsspital Baden AG, Department of Radiology, Baden (Switzerland); University of Notre Dame Australia, Radiology, Sydney School of Medicine, Sydney, NSW (Australia); Froehlich, Johannes M. [Federal Institute of Technology, Pharmaceutical Sciences, Zurich (Switzerland)

    2015-09-15

    To investigate the magnetic properties of different types of projectiles and qualify the metal artefact reduction technique for diagnostic and/or forensic MRI. Ten different projectiles embedded in ordnance gelatine blocks underwent an in vitro 1.5-T MR study with seven sequences including a recently developed metal artefact reduction sequence (Advanced WARP) combining VAT (view-angle-tilting) and SEMAC (slice-encoding metal-artefact-correction). Resulting image quality (five-point scale: 1=best; 5=worst) was scored. Quantifiable magnetic characteristics were correlated with qualitative rating of the MR sequences and torque dislodgment. Metal artefact reduction sequence (median: 2.5) significantly (p < 0.001) improves depiction of projectiles in comparison to all other MR pulse sequences (median: 4.75). Images from diamagnetic composed bullets (median: 2) are much less disturbed compared to magnetic attracted ones (median: 5). Correlation (0.623) between deflection angle measurement (ferromagnetic mean 84.2 ; paramagnetic 62 ; diamagnetic mean 0 ) and median qualitative image quality was highly significant (p = 0.027). Torque dislodgement was distinct for elongated magnetic attracted projectiles. Significant improvement of MR imaging of projectiles using metal artefact reduction techniques has important implications for diagnostic/forensic work-up. The correlations between magnetic attraction force, deflection-angle results and image properties demonstrate that the MR safety of projectiles can be estimated with one of these methods. (orig.)

  17. Fairly direct hit. Advances in imaging of shotgun projectiles in MRI

    Eggert, Sebastian; Kubik-Huch, Rahel A.; Peters, Alexander; Klarhoefer, Markus; Bolliger, Stephan A.; Thali, Michael J.; Anderson, Suzanne; Froehlich, Johannes M.

    2015-01-01

    To investigate the magnetic properties of different types of projectiles and qualify the metal artefact reduction technique for diagnostic and/or forensic MRI. Ten different projectiles embedded in ordnance gelatine blocks underwent an in vitro 1.5-T MR study with seven sequences including a recently developed metal artefact reduction sequence (Advanced WARP) combining VAT (view-angle-tilting) and SEMAC (slice-encoding metal-artefact-correction). Resulting image quality (five-point scale: 1=best; 5=worst) was scored. Quantifiable magnetic characteristics were correlated with qualitative rating of the MR sequences and torque dislodgment. Metal artefact reduction sequence (median: 2.5) significantly (p < 0.001) improves depiction of projectiles in comparison to all other MR pulse sequences (median: 4.75). Images from diamagnetic composed bullets (median: 2) are much less disturbed compared to magnetic attracted ones (median: 5). Correlation (0.623) between deflection angle measurement (ferromagnetic mean 84.2 ; paramagnetic 62 ; diamagnetic mean 0 ) and median qualitative image quality was highly significant (p = 0.027). Torque dislodgement was distinct for elongated magnetic attracted projectiles. Significant improvement of MR imaging of projectiles using metal artefact reduction techniques has important implications for diagnostic/forensic work-up. The correlations between magnetic attraction force, deflection-angle results and image properties demonstrate that the MR safety of projectiles can be estimated with one of these methods. (orig.)

  18. Proton exchange membrane materials for the advancement of direct methanol fuel-cell technology

    Cornelius, Christopher J [Albuquerque, NM

    2006-04-04

    A new class of hybrid organic-inorganic materials, and methods of synthesis, that can be used as a proton exchange membrane in a direct methanol fuel cell. In contrast with Nafion.RTM. PEM materials, which have random sulfonation, the new class of materials have ordered sulfonation achieved through self-assembly of alternating polyimide segments of different molecular weights comprising, for example, highly sulfonated hydrophilic PDA-DASA polyimide segment alternating with an unsulfonated hydrophobic 6FDA-DAS polyimide segment. An inorganic phase, e.g., 0.5 5 wt % TEOS, can be incorporated in the sulfonated polyimide copolymer to further improve its properties. The new materials exhibit reduced swelling when exposed to water, increased thermal stability, and decreased O.sub.2 and H.sub.2 gas permeability, while retaining proton conductivities similar to Nafion.RTM.. These improved properties may allow direct methanol fuel cells to operate at higher temperatures and with higher efficiencies due to reduced methanol crossover.

  19. Advanced Byproduct Recovery: Direct Catalytic Reduction of Sulfur Dioxide to Elemental Sulfur.

    NONE

    1997-06-01

    More than 170 wet scrubber systems applied, to 72,000 MW of U.S., coal-fired, utility boilers are in operation or under construction. In these systems, the sulfur dioxide removed from the boiler flue gas is permanently bound to a sorbent material, such as lime or limestone. The sulfated sorbent must be disposed of as a waste product or, in some cases, sold as a byproduct (e.g. gypsum). Due to the abundance and low cost of naturally occurring gypsum, and the costs associated with producing an industrial quality product, less than 7% of these scrubbers are configured to produce usable gypsum (and only 1% of all units actually sell the byproduct). The disposal of solid waste from each of these scrubbers requires a landfill area of approximately 200 to 400 acres. In the U.S., a total of 19 million tons of disposable FGD byproduct are produced, transported and disposed of in landfills annually. The use of regenerable sorbent technologies has the potential to reduce or eliminate solid waste production, transportation and disposal. In a regenerable sorbent system, the sulfur dioxide in the boiler flue gas is removed by the sorbent in an adsorber. The S0{sub 2}s subsequently released, in higher concentration, in a regenerator. All regenerable systems produce an off-gas stream from the regenerator that must be processed further in order to obtain a salable byproduct, such as elemental sulfur, sulfuric acid or liquid S0{sub 2}.

  20. Fluctuating capacity and advance decision-making in Bipolar Affective Disorder - Self-binding directives and self-determination.

    Gergel, Tania; Owen, Gareth S

    2015-01-01

    For people with Bipolar Affective Disorder, a self-binding (advance) directive (SBD), by which they commit themselves to treatment during future episodes of mania, even if unwilling, can seem the most rational way to deal with an imperfect predicament. Knowing that mania will almost certainly cause enormous damage to themselves, their preferred solution may well be to allow trusted others to enforce treatment and constraint, traumatic though this may be. No adequate provision exists for drafting a truly effective SBD and efforts to establish such provision are hampered by very valid, but also paralysing ethical, clinical and legal concerns. Effectively, the autonomy and rights of people with bipolar are being 'protected' through being denied an opportunity to protect themselves. From a standpoint firmly rooted in the clinical context and experience of mania, this article argues that an SBD, based on a patient-centred evaluation of capacity to make treatment decisions (DMC-T) and grounded within the clinician-patient relationship, could represent a legitimate and ethically coherent form of self-determination. After setting out background information on fluctuating capacity, mania and advance directives, this article proposes a framework for constructing such an SBD, and considers common objections, possible solutions and suggestions for future research. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

  1. The Knowing-Doing Gap in Advance Directives in Asian Americans: The Role of Education and Acculturation.

    Jang, Yuri; Park, Nan Sook; Chiriboga, David A; Radhakrishnan, Kavita; Kim, Miyong T

    2017-11-01

    The purposes of the present study were (1) to explore the completion rate of advance directives (ADs) in a sample of Asian Americans and (2) to examine the direct and moderating effects of knowledge of AD, education, and acculturation in predicting AD completion. Education and acculturation were conceptualized as moderators in the link between knowledge and completion of ADs. Using data from 2609 participants in the 2015 Asian American Quality of Life survey (aged 18-98), logistic regression analyses on AD completion were conducted, testing both direct and moderating effects. The overall AD completion rate in sample was about 12%. The AD knowledge and acculturation independently predicted AD completion. No direct effect of education was found; however, it interacted with AD knowledge. The AD knowledge was more likely to be translated into completion in the group with higher education. The AD completion rate observed in the present sample of Asian Americans was much lower than that of the US general population (26%-36%). The interactive role of education helps to explain the gap between AD knowledge and completion and suggests intervention strategies.

  2. Development of advanced direct perception displays for nuclear power plants to enhance monitoring, control and fault management

    Jones, B.; Shaheen, S.; Moray, N.; Sanderson, P.; Reising, D.V.

    1993-01-01

    With recent theoretical and empirical research in basic and applied psychology, human factors, and engineering, it is now sufficient to define an integrated approach to the deign of advanced displays for present and future nuclear power plants. Traditionally, the conventional displays have shown operators the individual variables on gauges, meters, strip charts, etc. This design approach requires the operators to mentally integrate the separately displayed variables and determine the implications for the plant state. This traditional approach has been known as the single-sensor-single-indicator display design and it places an intolerable amount of mental workload on operators during transients and abnormal conditions. This report discusses a new alternative approach which is the use of direct perception interfaces. Direct perception a interfaces display the underlying physical and system constraints of the situation in a directly perceptual way, such that the viewer need not reason about what is seen to identify system states, but can identify the state of the system perceptually. It is expected that displays which show the dynamics of fundamental physical laws should better support operator decisions and diagnoses of plant states. The purpose of this research project is to develop a suite of direct perception displays for PWR nuclear power plant operations

  3. Advanced direct liquefaction concepts for PETC generic units. Quarterly technical progress report, April 1992--June 1992

    1992-08-01

    CAER/UK: Detail coal and starting solvents from Wilsonville were analyzed to develop the data necessary to conduct process studies in the CO Pretreatment and Catalyst Evaluation segment of this program. A comparison of the solvent separation analysis with the distillation/separation used at Wilsonville showed that the residual solvent components contained a large amount of residual pentane soluble products. The ashy resid contained 3% iron and 400 ppM molybdenum. Although the iron content in the distillate and deashed resid was much less, namely about 200 ppM., the molybdenum concentrations in these fractions were not significantly reduced over the concentration in the ashy resid, i.e., 200 ppM in each. The pretreatment of coal with CO/H{sub 2}O in the presence of NaOH and Na{sub 2}CO{sub 3} has been shown to give a product which is lower in oxygen content and higher in hydrogen content compared to the raw coal. The atomic H/C ratios of the H{sub 2}O-insolubles, THF insolubles and the PA+A fractions of the products-together with the hydrogen consumption data suggested that the raw coal has been substantially depolymerized and hydrogenated via the WGS reaction during the pretreatment process. The extensive amount of molecular reconstruction that has occurred in the solid product was evident from the ease of solubilization of the product into pyridine. The result of the pretreatment process is a product which is highly reactive under hydroliquefaction conditions at 400{degrees}C. Reaction rates seem to be much faster than the raw coal, especially at shorter reaction times, providing the opportunity for major reductions in plant vessel sizes, and preliminary data has led us to believe that better efficiency in hydrogen utilization is achieved.

  4. Impact of Integrated Care Model (ICM) on Direct Medical Costs in Management of Advanced Chronic Obstructive Pulmonary Disease (COPD).

    Bandurska, Ewa; Damps-Konstańska, Iwona; Popowski, Piotr; Jędrzejczyk, Tadeusz; Janowiak, Piotr; Świętnicka, Katarzyna; Zarzeczna-Baran, Marzena; Jassem, Ewa

    2017-06-12

    BACKGROUND Chronic obstructive pulmonary disease (COPD) is a commonly diagnosed condition in people older than 50 years of age. In advanced stage of this disease, integrated care (IC) is recommended as an optimal approach. IC allows for holistic and patient-focused care carried out at the patient's home. The aim of this study was to analyze the impact of IC on costs of care and on demand for medical services among patients included in IC. MATERIAL AND METHODS The study included 154 patients diagnosed with advanced COPD. Costs of care (general, COPD, and exacerbations-related) were evaluated for 1 year, including 6-months before and after implementing IC. The analysis included assessment of the number of medical procedures of various types before and after entering IC and changes in medical services providers. RESULTS Direct medical costs of standard care in advanced COPD were 886.78 EUR per 6 months. Costs of care of all types decreased after introducing IC. Changes in COPD and exacerbation-related costs were statistically significant (p=0.012492 and p=0.017023, respectively). Patients less frequently used medical services for respiratory system and cardiovascular diseases. Similarly, the number of hospitalizations and visits to emergency medicine departments decreased (by 40.24% and 8.5%, respectively). The number of GP visits increased after introducing IC (by 7.14%). CONCLUSIONS The high costs of care in advanced COPD indicate the need for new forms of effective care. IC caused a decrease in costs and in the number of hospitalization, with a simultaneous increase in the number of GP visits.

  5. Racial and Ethnic Differences in Advance Directive Possession: Role of Demographic Factors, Religious Affiliation, and Personal Health Values in a National Survey of Older Adults.

    Huang, Ivy A; Neuhaus, John M; Chiong, Winston

    2016-02-01

    Black and Hispanic older Americans are less likely than white older Americans to possess advance directives. Understanding the reasons for this racial and ethnic difference is necessary to identify targets for future interventions to improve advance care planning in these populations. The aim of the study was to evaluate whether racial and ethnic differences in advance directive possession are explained by other demographic factors, religious characteristics, and personal health values. A general population survey was conducted in a nationally representative sample using a web-enabled survey panel of American adults aged 50 and older (n = 2154). In a sample of older Americans, white participants are significantly more likely to possess advance directives (44.0%) than black older Americans (24.0%, p personal health values. These findings support targeted efforts to mitigate racial disparities in access to advance care planning.

  6. Effect of the PREPARE Website vs an Easy-to-Read Advance Directive on Advance Care Planning Documentation and Engagement Among Veterans: A Randomized Clinical Trial.

    Sudore, Rebecca L; Boscardin, John; Feuz, Mariko A; McMahan, Ryan D; Katen, Mary T; Barnes, Deborah E

    2017-08-01

    Documentation rates of patients' medical wishes are often low. It is unknown whether easy-to-use, patient-facing advance care planning (ACP) interventions can overcome barriers to planning in busy primary care settings. To compare the efficacy of an interactive, patient-centered ACP website (PREPARE) with an easy-to-read advance directive (AD) to increase planning documentation. This was a comparative effectiveness randomized clinical trial from April 2013 to July 2016 conducted at multiple primary care clinics at the San Francisco VA Medical Center. Inclusion criteria were age of a least 60 years; at least 2 chronic and/or serious conditions; and 2 or more primary care visits; and 2 or more additional clinic, hospital, or emergency room visits in the last year. Participants were randomized to review PREPARE plus an easy-to-read AD or the AD alone. There were no clinician and/or system-level interventions or education. Research staff were blinded for all follow-up measurements. The primary outcome was new ACP documentation (ie, legal forms and/or discussions) at 9 months. Secondary outcomes included patient-reported ACP engagement at 1 week, 3 months, and 6 months using validated surveys of behavior change process measures (ie, 5-point knowledge, self-efficacy, readiness scales) and action measures (eg, surrogate designation, using a 0-25 scale). We used intention-to-treat, mixed-effects logistic and linear regression, controlling for time, health literacy, race/ethnicity, baseline ACP, and clustering by physician. The mean (SD) age of 414 participants was 71 (8) years, 38 (9%) were women, 83 (20%) had limited literacy, and 179 (43%) were nonwhite. No participant characteristic differed significantly among study arms at baseline. Retention at 6 months was 90%. Advance care planning documentation 6 months after enrollment was higher in the PREPARE arm vs the AD-alone arm (adjusted 35% vs 25%; odds ratio, 1.61 [95% CI, 1.03-2.51]; P = .04). PREPARE also resulted

  7. Transcranial Direct Current Stimulation in Stroke Rehabilitation: A Review of Recent Advancements

    Gomez Palacio Schjetnan, Andrea; Faraji, Jamshid; Metz, Gerlinde A.; Tatsuno, Masami; Luczak, Artur

    2013-01-01

    Transcranial direct current stimulation (tDCS) is a promising technique to treat a wide range of neurological conditions including stroke. The pathological processes following stroke may provide an exemplary system to investigate how tDCS promotes neuronal plasticity and functional recovery. Changes in synaptic function after stroke, such as reduced excitability, formation of aberrant connections, and deregulated plastic modifications, have been postulated to impede recovery from stroke. However, if tDCS could counteract these negative changes by influencing the system's neurophysiology, it would contribute to the formation of functionally meaningful connections and the maintenance of existing pathways. This paper is aimed at providing a review of underlying mechanisms of tDCS and its application to stroke. In addition, to maximize the effectiveness of tDCS in stroke rehabilitation, future research needs to determine the optimal stimulation protocols and parameters. We discuss how stimulation parameters could be optimized based on electrophysiological activity. In particular, we propose that cortical synchrony may represent a biomarker of tDCS efficacy to indicate communication between affected areas. Understanding the mechanisms by which tDCS affects the neural substrate after stroke and finding ways to optimize tDCS for each patient are key to effective rehabilitation approaches. PMID:23533955

  8. Advancing the field of elder abuse: future directions and policy implications.

    Dong, XinQi

    2012-11-01

    Elder abuse, sometimes called elder mistreatment or elder maltreatment, includes psychological, physical, and sexual abuse; neglect (caregiver neglect and self-neglect); and financial exploitation. Evidence suggests that one in 10 older adults experiences some form of elder abuse, but only one in 25 cases is reported to social services agencies. At the same time, elder abuse is associated with significant morbidity and premature mortality. Despite these findings, there is a great paucity in research, practice, and policy addressing the pervasive issues of elder abuse. Through my experiences as a American Political Sciences Association Congressional Policy Fellow and Health and Aging Policy Fellow working with the Administration on Community Living (ACL) (previously known as the Administration on Aging) for the last 2 years, I will describe the major functions of the ACL and highlight two major pieces of federal legislation: The Older Americans Act and the Elder Justice Act. I will also highlight major research gaps and future policy relevant research directions for the field of elder abuse. © 2012, Copyright the Authors Journal compilation © 2012, The American Geriatrics Society.

  9. Advanced feeder-free generation of induced pluripotent stem cells directly from blood cells.

    Trokovic, Ras; Weltner, Jere; Nishimura, Ken; Ohtaka, Manami; Nakanishi, Mahito; Salomaa, Veikko; Jalanko, Anu; Otonkoski, Timo; Kyttälä, Aija

    2014-12-01

    Generation of validated human induced pluripotent stem cells (iPSCs) for biobanking is essential for exploring the full potential of iPSCs in disease modeling and drug discovery. Peripheral blood mononuclear cells (PBMCs) are attractive targets for reprogramming, because blood is collected by a routine clinical procedure and is a commonly stored material in biobanks. Generation of iPSCs from blood cells has previously been reported using integrative retroviruses, episomal Sendai viruses, and DNA plasmids. However, most of the published protocols require expansion and/or activation of a specific cell population from PBMCs. We have recently collected a PBMC cohort from the Finnish population containing more than 2,000 subjects. Here we report efficient generation of iPSCs directly from PBMCs in feeder-free conditions in approximately 2 weeks. The produced iPSC clones are pluripotent and transgene-free. Together, these properties make this novel method a powerful tool for large-scale reprogramming of PBMCs and for iPSC biobanking. ©AlphaMed Press.

  10. Advancing predictive models for particulate formation in turbulent flames via massively parallel direct numerical simulations

    Bisetti, Fabrizio

    2014-07-14

    Combustion of fossil fuels is likely to continue for the near future due to the growing trends in energy consumption worldwide. The increase in efficiency and the reduction of pollutant emissions from combustion devices are pivotal to achieving meaningful levels of carbon abatement as part of the ongoing climate change efforts. Computational fluid dynamics featuring adequate combustion models will play an increasingly important role in the design of more efficient and cleaner industrial burners, internal combustion engines, and combustors for stationary power generation and aircraft propulsion. Today, turbulent combustion modelling is hindered severely by the lack of data that are accurate and sufficiently complete to assess and remedy model deficiencies effectively. In particular, the formation of pollutants is a complex, nonlinear and multi-scale process characterized by the interaction of molecular and turbulent mixing with a multitude of chemical reactions with disparate time scales. The use of direct numerical simulation (DNS) featuring a state of the art description of the underlying chemistry and physical processes has contributed greatly to combustion model development in recent years. In this paper, the analysis of the intricate evolution of soot formation in turbulent flames demonstrates how DNS databases are used to illuminate relevant physico-chemical mechanisms and to identify modelling needs. © 2014 The Author(s) Published by the Royal Society.

  11. Advances in Virus-Directed Therapeutics against Epstein-Barr Virus-Associated Malignancies

    Sajal K. Ghosh

    2012-01-01

    Full Text Available Epstein-Barr virus (EBV is the causal agent in the etiology of Burkitt’s lymphoma and nasopharyngeal carcinoma and is also associated with multiple human malignancies, including Hodgkin’s and non-Hodgkin’s lymphoma, and posttransplantation lymphoproliferative disease, as well as sporadic cancers of other tissues. A causal relationship of EBV to these latter malignancies remains controversial, although the episomic EBV genome in most of these cancers is clonal, suggesting infection very early in the development of the tumor and a possible role for EBV in the genesis of these diseases. Furthermore, the prognosis of these tumors is invariably poor when EBV is present, compared to their EBV-negative counterparts. The physical presence of EBV in these tumors represents a potential “tumor-specific” target for therapeutic approaches. While treatment options for other types of herpesvirus infections have evolved and improved over the last two decades, however, therapies directed at EBV have lagged. A major constraint to pharmacological intervention is the shift from lytic infection to a latent pattern of gene expression, which persists in those tumors associated with the virus. In this paper we provide a brief account of new virus-targeted therapeutic approaches against EBV-associated malignancies.

  12. Advancing vector biology research: a community survey for future directions, research applications and infrastructure requirements

    Kohl, Alain; Pondeville, Emilie; Schnettler, Esther; Crisanti, Andrea; Supparo, Clelia; Christophides, George K.; Kersey, Paul J.; Maslen, Gareth L.; Takken, Willem; Koenraadt, Constantianus J. M.; Oliva, Clelia F.; Busquets, Núria; Abad, F. Xavier; Failloux, Anna-Bella; Levashina, Elena A.; Wilson, Anthony J.; Veronesi, Eva; Pichard, Maëlle; Arnaud Marsh, Sarah; Simard, Frédéric; Vernick, Kenneth D.

    2016-01-01

    Vector-borne pathogens impact public health, animal production, and animal welfare. Research on arthropod vectors such as mosquitoes, ticks, sandflies, and midges which transmit pathogens to humans and economically important animals is crucial for development of new control measures that target transmission by the vector. While insecticides are an important part of this arsenal, appearance of resistance mechanisms is increasingly common. Novel tools for genetic manipulation of vectors, use of Wolbachia endosymbiotic bacteria, and other biological control mechanisms to prevent pathogen transmission have led to promising new intervention strategies, adding to strong interest in vector biology and genetics as well as vector–pathogen interactions. Vector research is therefore at a crucial juncture, and strategic decisions on future research directions and research infrastructure investment should be informed by the research community. A survey initiated by the European Horizon 2020 INFRAVEC-2 consortium set out to canvass priorities in the vector biology research community and to determine key activities that are needed for researchers to efficiently study vectors, vector-pathogen interactions, as well as access the structures and services that allow such activities to be carried out. We summarize the most important findings of the survey which in particular reflect the priorities of researchers in European countries, and which will be of use to stakeholders that include researchers, government, and research organizations. PMID:27677378

  13. Effect of an End-of-Life Planning Intervention on the completion of advance directives in homeless persons: a randomized trial.

    Song, John; Ratner, Edward R; Wall, Melanie M; Bartels, Dianne M; Ulvestad, Nancy; Petroskas, Dawn; West, Melissa; Weber-Main, Anne Marie; Grengs, Leah; Gelberg, Lillian

    2010-07-20

    Few interventions have focused on improving end-of-life care for underserved populations, such as homeless persons. To determine whether homeless persons will complete a counseling session on advance care planning and fill out a legal advance directive designed to assess care preferences and preserve the dignity of marginalized persons. Prospective, single-blind, randomized trial comparing self-guided completion of an advance directive with professionally assisted advance care planning. (ClinicalTrials.gov registration number: NCT00546884) 8 sites serving homeless persons in Minneapolis, Minnesota. 262 homeless persons recruited between November 2007 and August 2008. Minimal, self-guided intervention consisting of advance directive forms and written educational information versus a one-on-one advance planning intervention consisting of counseling and completing an advance directive with a social worker. Rate of advance directive completion, assessed by inspection of completed documents. The overall completion rate for advance directives was 26.7% (95% CI, 21.5% to 32.5%), with a higher rate in the counselor-guided group (37.9%) than in the self-guided group (12.8%) (CI of adjusted difference, 15.3 to 34.3 percentage points). This difference persisted across all sites and most subgroups. The advance directive's 4 clinical scenarios found a preference for surrogate decision making in 29% to 34% of written responses. Sampling was limited to a more stable subset of the homeless population in Minneapolis and may have been subject to selection bias. Modest compensation to complete the preintervention survey could have influenced participants to complete advance directives. Both a simple and complex intervention successfully engaged a diverse sample of homeless persons in advance care planning. One-on-one assistance significantly increased the completion rate. Homeless persons can respond to an intervention to plan for end-of-life care and can express specific preferences

  14. Advancements in high-power high-brightness laser bars and single emitters for pumping and direct diode application

    An, Haiyan; Jiang, Ching-Long J.; Xiong, Yihan; Zhang, Qiang; Inyang, Aloysius; Felder, Jason; Lewin, Alexander; Roff, Robert; Heinemann, Stefan; Schmidt, Berthold; Treusch, Georg

    2015-03-01

    We have continuously optimized high fill factor bar and packaging design to increase power and efficiency for thin disc laser system pump application. On the other hand, low fill factor bars packaged on the same direct copper bonded (DCB) cooling platform are used to build multi-kilowatt direct diode laser systems. We have also optimized the single emitter designs for fiber laser pump applications. In this paper, we will give an overview of our recent advances in high power high brightness laser bars and single emitters for pumping and direct diode application. We will present 300W bar development results for our next generation thin disk laser pump source. We will also show recent improvements on slow axis beam quality of low fill factor bar and its application on performance improvement of 4-5 kW TruDiode laser system with BPP of 30 mm*mrad from a 600 μm fiber. Performance and reliability results of single emitter for multiemitter fiber laser pump source will be presented as well.

  15. Cost-utility analysis of an advanced pressure ulcer management protocol followed by trained wound, ostomy, and continence nurses.

    Kaitani, Toshiko; Nakagami, Gojiro; Iizaka, Shinji; Fukuda, Takashi; Oe, Makoto; Igarashi, Ataru; Mori, Taketoshi; Takemura, Yukie; Mizokami, Yuko; Sugama, Junko; Sanada, Hiromi

    2015-01-01

    The high prevalence of severe pressure ulcers (PUs) is an important issue that requires to be highlighted in Japan. In a previous study, we devised an advanced PU management protocol to enable early detection of and intervention for deep tissue injury and critical colonization. This protocol was effective for preventing more severe PUs. The present study aimed to compare the cost-effectiveness of the care provided using an advanced PU management protocol, from a medical provider's perspective, implemented by trained wound, ostomy, and continence nurses (WOCNs), with that of conventional care provided by a control group of WOCNs. A Markov model was constructed for a 1-year time horizon to determine the incremental cost-effectiveness ratio of advanced PU management compared with conventional care. The number of quality-adjusted life-years gained, and the cost in Japanese yen (¥) ($US1 = ¥120; 2015) was used as the outcome. Model inputs for clinical probabilities and related costs were based on our previous clinical trial results. Univariate sensitivity analyses were performed. Furthermore, a Bayesian multivariate probability sensitivity analysis was performed using Monte Carlo simulations with advanced PU management. Two different models were created for initial cohort distribution. For both models, the expected effectiveness for the intervention group using advanced PU management techniques was high, with a low expected cost value. The sensitivity analyses suggested that the results were robust. Intervention by WOCNs using advanced PU management techniques was more effective and cost-effective than conventional care. © 2015 by the Wound Healing Society.

  16. ADVANCED FLUE GAS CONDITIONING AS A RETROFIT UPGRADE TO ENHANCE PM COLLECTION FROM COAL-FIRED ELECTRIC UTILITY BOILERS

    C. Jean Bustard

    2003-12-01

    ADA Environmental Solutions (ADA-ES) has successfully completed a research and development program granted by the Department of Energy National Energy Technology Laboratory (NETL) to develop a family of non-toxic flue gas conditioning agents to provide utilities and industries with a cost-effective means of complying with environmental regulations on particulate emissions and opacity. An extensive laboratory screening of potential additives was completed followed by full-scale trials at four utility power plants. The developed cohesivity additives have been demonstrated on a 175 MW utility boiler that exhibited poor collection of unburned carbon in the electrostatic precipitator. With cohesivity conditioning, opacity spiking caused by rapping reentrainment was reduced and total particulate emissions were reduced by more than 30%. Ammonia conditioning was also successful in reducing reentrainment on the same unit. Conditioned fly ash from the process is expected to be suitable for dry or wet disposal and for concrete admixture.

  17. NRC review of Electric Power Research Institute's advanced light water reactor utility requirements document. Passive plant designs, chapter 1, project number 669

    1994-08-01

    The Electric Power Research Institute (EPRI) is preparing a compendium of technical requirements, referred to as the open-quotes Advanced Light Water Reactor [ALWR] Utility Requirements Documentclose quotes, that is acceptable to the design of an ALWR power plant. When completed, this document is intended to be a comprehensive statement of utility requirements for the design, construction, and performance of an ALWR power plant for the 1990s and beyond. The Requirements Document consists of three volumes. Volume 1, open-quotes ALWR Policy and Summary of Top-Tier Requirementsclose quotes, is a management-level synopsis of the Requirements Document, including the design objectives and philosophy, the overall physical configuration and features of a future nuclear plant design, and the steps necessary to take the proposed ALWR design criteria beyond the conceptual design state to a completed, functioning power plant. Volume II consists of 13 chapters and contains utility design requirements for an evolutionary nuclear power plant [approximately 1350 megawatts-electric (MWe)]. Volume III contains utility design requirements for nuclear plants for which passive features will be used in their designs (approximately 600 MWe). In April 1992, the staff of the Office of Nuclear Reactor Regulation, U.S. Nuclear Regulatory Commission, issued Volume 1 and Volume 2 (Parts 1 and 2) of its safety evaluation report (SER) to document the results of its review of Volumes 1 and 2 of the Requirements Document. Volume 1, open-quotes NRC Review of Electric Power Research Institute's Advanced Light Water Reactor Utility Requirements Document - Program Summaryclose quotes, provided a discussion of the overall purpose and scope of the Requirements Document, the background of the staff's review, the review approach used by the staff, and a summary of the policy and technical issues raised by the staff during its review

  18. NRC review of Electric Power Research Institute's advanced light water reactor utility requirements document. Passive plant designs, chapters 2-13, project number 669

    1994-08-01

    The Electric Power Research Institute (EPRI) is preparing a compendium of technical requirements, referred to as the open-quotes Advanced Light Water Reactor [ALWR] Utility Requirements Documentclose quotes, that is acceptable to the design of an ALWR power plant. When completed, this document is intended to be a comprehensive statement of utility requirements for the design, construction, and performance of an ALWR power plant for the 1990s and beyond. The Requirements Document consists of three volumes. Volume I, open-quotes ALWR Policy and Summary of Top-Tier Requirementsclose quotes, is a management-level synopsis of the Requirements Document, including the design objectives and philosophy, the overall physical configuration and features of a future nuclear plant design, and the steps necessary to take the proposed ALWR design criteria beyond the conceptual design state to a completed, functioning power plant. Volume II consists of 13 chapters and contains utility design requirements for an evolutionary nuclear power plant [approximately 1350 megawatts-electric (MWe)]. Volume III contains utility design requirements for nuclear plants for which passive features will be used in their designs (approximately 600 MWe). In April 1992, the staff of the Office of Nuclear Reactor Regulation, U.S. Nuclear Regulatory Commission, issued Volume 1 and Volume 2 (Parts 1 and 2) of its safety evaluation report (SER) to document the results of its review of Volumes 1 and 2 of the Requirements Document. Volume 1, open-quotes NRC Review of Electric Power Research Institute's Advanced Light Water Reactor Utility Requirements Document - Program Summaryclose quotes, provided a discussion of the overall purpose and scope of the Requirements Document, the background of the staff's review, the review approach used by the staff, and a summary of the policy and technical issues raised by the staff during its review

  19. Views of the electric utility industry on the direction and progress of the Department of Energy's Nuclear Waste Program

    Mills, L.E.

    1986-01-01

    The NWPA does provide guidance for a reasonable waste management program and one must work to implement it in an efficient and effective manner. It is well recognized that the lack of stability and predictability has been the bane of many nuclear reactor projects. The electric utilities are not satisfied with the progress of the nuclear waste program even though much has been achieved. DOE must continue in its struggle to seek a better balance between the technical, political and institutional aspects of the program to provide reasonable assurance that it will fulfill its contractual obligation with utilities

  20. Utility advanced turbine systems (ATS) technology readiness testing -- Phase 3. Annual report, October 1, 1996--September 30, 1997

    NONE

    1997-12-31

    The overall objective of the Advanced Turbine System (ATS) Phase 3 Cooperative Agreement between GE and the US Department of Energy (DOE) is the development of the GE 7H and 9H combined cycle power systems. The major effort will be expended on detail design. Validation of critical components and technologies will be performed including: hot gas path component testing, sub-scale compressor testing, steam purity test trials, and rotational heat transfer confirmation testing. Processes will be developed to support the manufacture of the first system. Technology enhancements that are not required for the first machine design but will be critical for future ATS advances in performance, reliability, and costs will be initiated. Long-term tests of materials to confirm design life predictions will continue. A schematic of the GE H machine is shown.

  1. Utility of FMISO PET in advanced head and neck cancer treated with chemoradiation incorporating a hypoxia-targeting chemotherapy agent

    Hicks, Rodney J. [Peter MacCallum Cancer Centre, Centre for Molecular Imaging, Melbourne (Australia); University of Melbourne, Department of Medicine, St Vincent' s Medical School, Melbourne (Australia); Rischin, Danny [University of Melbourne, Department of Medicine, St Vincent' s Medical School, Melbourne (Australia); Peter MacCallum Cancer Centre, Division of Haematology and Medical Oncology, Melbourne (Australia); Fisher, Richard [Peter MacCallum Cancer Centre, Centre for Biostatistics and Clinical Trials, Melbourne (Australia); Binns, David [Peter MacCallum Cancer Centre, Centre for Molecular Imaging, Melbourne (Australia); Scott, Andrew M. [Austin Hospital, Centre for PET, and Ludwig Institute for Cancer Research, Melbourne (Australia); Peters, Lester J. [Peter MacCallum Cancer Centre, Division of Radiation Oncology, Melbourne (Australia)

    2005-12-01

    The purpose of the study was to evaluate [{sup 18}F]fluoromisonidazole (FMISO) PET in advanced head and neck cancer during hypoxia-targeting therapy. Fifteen of 16 patients in a phase I trial of chemoradiation plus tirapazamine (specific cytotoxin for hypoxic cells) in advanced (T3/4 and/or N2/3) head and neck cancer underwent serial [{sup 18}F]fluorodeoxyglucose (FDG) and FMISO PET. We have previously reported excellent early clinical outcome of these patients and now review FMISO PET results in the context of longer follow-up of this patient cohort. Based on blinded qualitative scoring by two readers, FMISO PET was positive in 13/15 patients at baseline: 12/15 of primary sites and 8/13 neck nodes were scored as positive. All sites of corresponding FDG and FMISO abnormality at baseline showed marked qualitative reduction of uptake within 4 weeks of commencing therapy, consistent with effective hypoxia-targeted therapy. With a median follow-up of 6.9 years, there have been only four locoregional failures, while three other patients have died of metachronous lung cancer. The 5-year overall survival was 50% (95% CI 27-73%), the 5-year failure-free survival was 44% (95% CI 22-68%) and the 5-year freedom from locoregional failure was 68% (95% CI 38-88%). The high prevalence of hypoxia demonstrated on FMISO PET imaging is consistent with the advanced disease stage of these patients and would be expected to predict an adverse prognosis. Evidence of the early resolution of FMISO abnormality during treatment, associated with excellent locoregional control in this patient cohort, supports further investigation of hypoxia-targeting agents in advanced head and neck cancer. (orig.)

  2. Utility of FMISO PET in advanced head and neck cancer treated with chemoradiation incorporating a hypoxia-targeting chemotherapy agent

    Hicks, Rodney J.; Rischin, Danny; Fisher, Richard; Binns, David; Scott, Andrew M.; Peters, Lester J.

    2005-01-01

    The purpose of the study was to evaluate [ 18 F]fluoromisonidazole (FMISO) PET in advanced head and neck cancer during hypoxia-targeting therapy. Fifteen of 16 patients in a phase I trial of chemoradiation plus tirapazamine (specific cytotoxin for hypoxic cells) in advanced (T3/4 and/or N2/3) head and neck cancer underwent serial [ 18 F]fluorodeoxyglucose (FDG) and FMISO PET. We have previously reported excellent early clinical outcome of these patients and now review FMISO PET results in the context of longer follow-up of this patient cohort. Based on blinded qualitative scoring by two readers, FMISO PET was positive in 13/15 patients at baseline: 12/15 of primary sites and 8/13 neck nodes were scored as positive. All sites of corresponding FDG and FMISO abnormality at baseline showed marked qualitative reduction of uptake within 4 weeks of commencing therapy, consistent with effective hypoxia-targeted therapy. With a median follow-up of 6.9 years, there have been only four locoregional failures, while three other patients have died of metachronous lung cancer. The 5-year overall survival was 50% (95% CI 27-73%), the 5-year failure-free survival was 44% (95% CI 22-68%) and the 5-year freedom from locoregional failure was 68% (95% CI 38-88%). The high prevalence of hypoxia demonstrated on FMISO PET imaging is consistent with the advanced disease stage of these patients and would be expected to predict an adverse prognosis. Evidence of the early resolution of FMISO abnormality during treatment, associated with excellent locoregional control in this patient cohort, supports further investigation of hypoxia-targeting agents in advanced head and neck cancer. (orig.)

  3. A Mode Propagation Database Suitable for Code Validation Utilizing the NASA Glenn Advanced Noise Control Fan and Artificial Sources

    Sutliff, Daniel L.

    2014-01-01

    The NASA Glenn Research Center's Advanced Noise Control Fan (ANCF) was developed in the early 1990s to provide a convenient test bed to measure and understand fan-generated acoustics, duct propagation, and radiation to the farfield. A series of tests were performed primarily for the use of code validation and tool validation. Rotating Rake mode measurements were acquired for parametric sets of: (i) mode blockage, (ii) liner insertion loss, (iii) short ducts, and (iv) mode reflection.

  4. Advanced Parkinson’s disease effect on goal-directed and habitual processes involved in visuomotor associative learning

    Fadila eHadj-Bouziane

    2013-01-01

    Full Text Available The present behavioral study readdresses the question of habit learning in Parkinson's disease. Patients were early onset, non-demented, dopa-responsive, candidates for surgical treatment, similar to those we found earlier as suffering greater dopamine depletion in the putamen than in the caudate nucleus. The task was the same conditional associative learning task as that used previously in monkeys and healthy humans to unveil the striatum involvement in habit learning. Sixteen patients and 20 age- and education-matched healthy control subjects learned sets of 3 visuo-motor associations between complex patterns and joystick displacements during two testing sessions separated by a few hours. We distinguished errors preceding versus following the first correct response to compare patients' performance during the earliest phase of learning dominated by goal-directed actions with that observed later on, when responses start to become habitual. The disease significantly retarded both learning phases, especially in patients under sixty years of age. However, only the late phase deficit was disease severity-dependent and persisted on the second testing session. These findings provide the first corroboration in Parkinson patients of two ideas well-established in the animal literature. The first is the idea that associating visual stimuli to motor acts is a form of habit learning that engages the striatum. It is confirmed here by the global impairment in visuo-motor learning induced by Parkinson's disease. The second idea is that goal-directed behaviors are predominantly caudate-dependent whereas habitual responses are primarily putamen-dependent. At the advanced Parkinson's disease stages tested here, dopamine depletion is greater in the putamen than in the caudate nucleus. Accordingly, the late phase of learning corresponding to the emergence of habitual responses was more vulnerable to the disease than the early phase dominated by goal-directed

  5. Degradation mechanism of alachlor during direct ozonation and O(3)/H(2)O(2) advanced oxidation process.

    Qiang, Zhimin; Liu, Chao; Dong, Bingzhi; Zhang, Yalei

    2010-01-01

    The degradation of alachlor by direct ozonation and advanced oxidation process O(3)/H(2)O(2) was investigated in this study with focus on identification of degradation byproducts. The second-order reaction rate constant between ozone and alachlor was determined to be 2.5+/-0.1M(-1)s(-1) at pH 7.0 and 20 degrees C. Twelve and eight high-molecular-weight byproducts (with the benzene ring intact) from alachlor degradation were identified during direct ozonation and O(3)/H(2)O(2), respectively. The common degradation byproducts included N-(2,6-diethylphenyl)-methyleneamine, 8-ethyl-3,4-dihydro-quinoline, 8-ethyl-quinoline, 1-chloroacetyl-2-hydro-3-ketone-7-acetyl-indole, 2-chloro-2',6'-diacetyl-N-(methoxymethyl)acetanilide, 2-chloro-2'-acetyl-6'-ethyl-N-(methoxymethyl)-acetanilide, and two hydroxylated alachlor isomers. In direct ozonation, four more byproducts were also identified including 1-chloroacetyl-2,3-dihydro-7-ethyl-indole, 2-chloro-2',6'-ethyl-acetanilide, 2-chloro-2',6'-acetyl-acetanilide and 2-chloro-2'-ethyl-6'-acetyl-N-(methoxymethyl)-acetanilide. Degradation of alachlor by O(3) and O(3)/H(2)O(2) also led to the formation of low-molecular-weight byproducts including formic, acetic, propionic, monochloroacetic and oxalic acids as well as chloride ion (only detected in O(3)/H(2)O(2)). Nitrite and nitrate formation was negligible. Alachlor degradation occurred via oxidation of the arylethyl group, N-dealkylation, cyclization and cleavage of benzene ring. After O(3) or O(3)/H(2)O(2) treatment, the toxicity of alachlor solution examined by the Daphnia magna bioassay was slightly reduced. 2009 Elsevier Ltd. All rights reserved.

  6. Direct endoscopic necrosectomy versus step-up approach for walled-off pancreatic necrosis: comparison of clinical outcome and health care utilization.

    Kumar, Nitin; Conwell, Darwin L; Thompson, Christopher C

    2014-11-01

    Infected walled-off pancreatic necrosis (WOPN) is a complication of acute pancreatitis requiring intervention. Surgery is associated with considerable morbidity. Percutaneous catheter drainage (PCD), initial therapy in the step-up approach, minimizes complications. Direct endoscopic necrosectomy (DEN) has demonstrated safety and efficacy. We compared outcome and health care utilization of DEN versus step-up approach. This was a matched cohort study using a prospective registry. Twelve consecutive DEN patients were matched with 12 step-up approach patients. Outcomes were clinical resolution after primary therapeutic modality, new organ failure, mortality, endocrine or exocrine insufficiency, length of stay, and health care utilization. Clinical resolution in 11 of 12 patients after DEN versus 3 of 12 step-up approach patients after PCD (P endocrine insufficiency, and shorter length of stay (P < 0.05). Health care utilization was lower after DEN by 5.2:1 (P < 0.01). Direct endoscopic necrosectomy may be superior to step-up approach for WOPN with suspected or established infection. Primary PCD generally delayed definitive therapy. Given the higher efficacy, shorter length of stay, and lower health care utilization, DEN could be the first-line therapy for WOPN, with primary PCD for inaccessible or immature collections.

  7. An unsymmetrical non-fullerene acceptor: synthesis via direct heteroarylation, self-assembly, and utility as a low energy absorber in organic photovoltaic cells.

    Payne, Abby-Jo; Li, Shi; Dayneko, Sergey V; Risko, Chad; Welch, Gregory C

    2017-09-12

    This study reports on the design and synthesis of an unsymmetrical π-conjugated organic molecule composed of perylene diimide, thienyl diketopyrrolopyrrole, and indoloquinoxaline pieced together using direct heteroarylation. This material demonstrates unprecedented response in the thin-film upon post-deposition solvent vapor annealing, resulting in dramatic red-shifts in optical absorption. Such changes were utilized to enhance photocurrent generation in P3HT based organic solar cells.

  8. Hyaluronic Acid Injections for Treatment of Advanced Osteoarthritis of the Knee: Utilization and Cost in a National Population Sample.

    Weick, Jack W; Bawa, Harpreet S; Dirschl, Douglas R

    2016-09-07

    The prevalence of knee osteoarthritis is increasing in the aging U.S. The efficacy and cost-effectiveness of the use of hyaluronic acid (HA) injections for the treatment of knee osteoarthritis are debated. In this study, we assessed the utilization and costs of HA injections in the 12 months preceding total knee arthroplasty (TKA) and evaluated the usage of HA injections in end-stage knee osteoarthritis management in relation to other treatments. MarketScan Commercial Claims and Encounters and Medicare Supplemental and Coordination of Benefits databases (Truven Health Analytics) were reviewed to identify patients who underwent TKA from 2005 to 2012. The utilization of patient-specific osteoarthritis-related health care (including medications, corticosteroid injections, HA injections, imaging, and office visits) and payment information were analyzed for the 12 months preceding TKA. A total of 244,059 patients met the inclusion criteria. Of those, 35,935 (14.7%) had ≥1 HA injection in the 12 months preceding TKA. HA injections were responsible for 16.4% of all knee osteoarthritis-related payments, trailing only imaging studies (18.2%), and HA injections accounted for 25.2% of treatment-specific payments, a rate that was higher than that of any other treatment. Patients receiving HA injections were significantly more likely to receive additional knee osteoarthritis-related treatments compared with patients who did not receive HA injections. Despite numerous studies questioning the efficacy and cost-effectiveness of HA injections for osteoarthritis of the knee, HA injections are still utilized for a substantial percentage of patients. Given the paucity of data supporting the effectiveness of HA injections and the current cost-conscious health-care climate, decreasing their use among patients with end-stage knee osteoarthritis may represent a substantial cost reduction that likely does not adversely impact the quality of care. Copyright © 2016 by The Journal of Bone

  9. Practical and Ethical Aspects of Advance Research Directives for Research on Healthy Aging: German and Israeli Professionals' Perspectives.

    Werner, Perla; Schicktanz, Silke

    2018-01-01

    Healthy aging is the development and maintenance of optimal cognitive, social and physical well-being, and function in older adults. Preventing or minimizing disease is one of the main ways of achieving healthy aging. Dementia is one of the most prevalent and life-changing diseases of old age. Thus, dementia prevention research is defined as one of the main priorities worldwide. However, conducting research with persons who lack the capacity to give consent is a major ethical issue. Our study attempts to explore if and how advance research directives (ARDs) may be used as a future tool to deal with the ethical and practical issues in dementia research. We conducted focus groups and in-depth interviews with German and Israeli professional stakeholders from the fields of gerontology, ethics, medical law, psychiatry, neurology and policy advice ( n  = 16), and analyzed the main topics discussed regarding cross-national similarities and controversies within the groups, as well as across the two national contexts. While both countries are in the midst of a developmental process and have recognized the importance and need for ARD as a tool for expanding healthy aging, Germany is in a more advanced stage than Israel because of the EU regulation process, which indicates the influence of international harmonization on these research-related ethical issues. Consensual themes within the qualitative material were identified: the need for a broader debate on ARD, the ethical importance of autonomy and risk-benefit assessment for ARD implementation, the role of the proxy and the need for the differentiation of types of dementia research. Controversies and dilemmas aroused around themes such as the current role of IRBs in each country, the need for limits, and how to guaranty safeguarding and control. Implementing a new tool is a step-by-step procedure requiring a thorough understanding of the current state of knowledge as well as of the challenges and hurdles ahead. As long

  10. Practical and Ethical Aspects of Advance Research Directives for Research on Healthy Aging: German and Israeli Professionals’ Perspectives

    Perla Werner

    2018-04-01

    Full Text Available BackgroundHealthy aging is the development and maintenance of optimal cognitive, social and physical well-being, and function in older adults. Preventing or minimizing disease is one of the main ways of achieving healthy aging. Dementia is one of the most prevalent and life-changing diseases of old age. Thus, dementia prevention research is defined as one of the main priorities worldwide. However, conducting research with persons who lack the capacity to give consent is a major ethical issue.ObjectiveOur study attempts to explore if and how advance research directives (ARDs may be used as a future tool to deal with the ethical and practical issues in dementia research.MethodWe conducted focus groups and in-depth interviews with German and Israeli professional stakeholders from the fields of gerontology, ethics, medical law, psychiatry, neurology and policy advice (n = 16, and analyzed the main topics discussed regarding cross-national similarities and controversies within the groups, as well as across the two national contexts.ResultsWhile both countries are in the midst of a developmental process and have recognized the importance and need for ARD as a tool for expanding healthy aging, Germany is in a more advanced stage than Israel because of the EU regulation process, which indicates the influence of international harmonization on these research-related ethical issues. Consensual themes within the qualitative material were identified: the need for a broader debate on ARD, the ethical importance of autonomy and risk–benefit assessment for ARD implementation, the role of the proxy and the need for the differentiation of types of dementia research. Controversies and dilemmas aroused around themes such as the current role of IRBs in each country, the need for limits, and how to guaranty safeguarding and control.DiscussionImplementing a new tool is a step-by-step procedure requiring a thorough understanding of the current state of knowledge

  11. Direct utilization of geothermal resources field experiments at Monroe, Utah. Final report, July 14, 1978-July 13, 1981

    Blair, C.K.; Owen, L.B. (eds.)

    1982-12-01

    The City of Monroe, Utah undertook a project to demonstrate the economic and technical viability of utilizing a low temperature geothermal resource to provide space and hot water heating to commercial, municipal, and domestic users within the community. During the course of the project, resource development and assessment, including drilling of a production well, was successfully completed. Upon completion of the field development and assessment phase of the program and of a preliminary design of the district heating system, it was determined that the project as proposed was not economically viable. This was due to: (1) a significant increase in estimated capital equipment costs resulting from the general inflation in construction costs, the large area/low population density in Monroe, and a more remote fluid disposal well site than planned, could not balance increased construction costs, (2) a lower temperature resource than predicted, and (3) due to predicted higher pumping and operating costs. After a thorough investigation of alternatives for utilizing the resource, further project activities were cancelled because the project was no longer economical and an alternative application for the resource could not be found within the constraints of the project. The City of Monroe, Utah is still seeking a beneficial use for the 600 gpm, 164/sup 0/F geothermal well. A summary of project activities included.

  12. High utilization platinum deposition on single-walled carbon nanotubes as catalysts for direct methanol fuel cell

    Wang, J.J.; Yin, G.P.; Zhang, J.; Wang, Z.B.; Gao, Y.Z.

    2007-01-01

    This research aims to enhance the activity of Pt catalysts, thus to lower the loading of Pt metal in fuel cell. Highly dispersed platinum supported on single-walled carbon nanotubes (SWNTs) as catalyst was prepared by ion exchange method. The homemade Pt/SWNTs underwent a repetition of ion exchange and reduction process in order to achieve an increase of the metal loading. For comparison, the similar loading of Pt catalyst supported on carbon nanotubes was prepared by borohydride reduction method. The catalysts were characterized by using energy dispersive analysis of X-ray (EDAX), transmission electron micrograph (TEM), X-ray diffraction (XRD), and X-ray photoelectron spectrum (XPS). Compared with the Pt/SWNTs catalyst prepared by borohydride method, higher Pt utilization was achieved on the SWNTs by ion exchange method. Furthermore, in comparison to the E-TEK 20 wt.% Pt/C catalyst with the support of carbon black, the results from electrochemical measurement indicated that the Pt/SWNTs prepared by ion exchange method displayed a higher catalytic activity for methanol oxidation and higher Pt utilization, while no significant increasing in the catalytic activity of the Pt/SWNTs catalyst obtained by borohydride method

  13. Cost-Utility Analysis of Heberprot-P as an Add-on Therapy to Good Wound Care for Patients in Slovakia with Advanced Diabetic Foot Ulcer

    Tomas Tesar

    2017-12-01

    Full Text Available Objectives: To explore whether Heberprot-P (an epidermal growth factor is a cost-effective option for the treatment of advanced diabetic foot ulcer as an add-on therapy to good wound care (GWC in Slovakia from the perspective of health care payers.Methods: A Markov model was constructed to compare the costs and effects of Heberprot-P plus GWC to those of GWC alone from the perspective of health care payers. The 52-week clinical trial period was extended to 5- and 10-year time horizons. Transition probabilities were calculated based on a previous clinical trial of Heberprot, utility values were derived from the scientific literature, and cost vectors were collected from the General Health Insurance Fund database in Slovakia. A one-way deterministic sensitivity analysis was employed to explore the influence of uncertainty for each input parameter on the incremental cost-effectiveness ratio (ICER.Results: Based on the ICER threshold of €30,030 per quality-adjusted life year (QALY recommended by the Slovak Ministry of Health, Heberprot-P therapy plus GWC is not a cost-effective alternative to GWC alone over a 10-year time horizon. The ICER increases if a longer time horizon is applied, as the incremental costs are similar, but the aggregated utility gain from avoided amputation is lower. Based on the sensitivity analysis, the utility multiplier for the health state “no ulcer after small amputation” had the most impact on the ICER; however, the model was robust to changes in all input parameters.Conclusions: Heberprot-P, as an add-on therapy to GWC in the treatment of advanced diabetic foot ulcer, is not a cost-effective alternative to GWC alone. However, if the unit cost of Heberprot-P were to be reduced to <€273, its ICER would be <€30,030.

  14. La perspectiva de las personas mayores sobre el testamento vital Elders´perspective about Advance Directives

    Inés Mª Barrio Cantalejo

    2006-06-01

    Full Text Available Antecedentes. La popularización del testamento vital (TV exige conocer la perspectiva que sobre él tienen sus potenciales usuarios. Cualquier intento de generalizar el TV sin evaluar cómo será recibido por las personas mayores está condenado al fracaso. Objetivo: Explorar la perspectiva de los mayores sobre el testamento vital. Diseño: Estudio cualitativo. 40 personas mayores, usuarios de 3 Centros de Salud y 1 Residencia Asistida de Madrid, se reunieron en 5 grupos de discusión en abril de 2004. Participantes: 14 mediadores captaron a 2-3 participantes cada uno. Se consideró que edad y residencia en medio familiar o institucional son las variables que más diferencian la elaboración de los discursos sobre el TV. Se utilizaron, pues, como criterios de segmentación, buscando heterogeneidad entre grupos y homogeneidad y heterogeneidad intragrupal. La saturación se consideró cuando las ideas expresadas resultaron recurrentes. Resultados: 4 ideas se extraen de los datos: 1 los mayores prefieren la planificación anticipada de decisiones al TV. 2 Su opinión sobre el TV se asocia a la vivencia singular de otros eventos en el final de la vida. 3 Conceden un papel relevante a la familia. 4 Desean conducir su propia vida, pero "sin papeles escritos". Conclusiones. La implementación del TV a través de una estrategia educativa e institucional se beneficiará si consideramos la perspectiva de la población mayor española sobre el TV.Background: The introduction of advance directives (AD require to examine the perspective their potential users have about. Any public policy about the implementation of ADs adressed to elders will fall if their perspective is unknown. Objective: To examine the elders' perspective about advance directives. Methods: Qualitative study. 40 elders, users of 3 Primary Health Care Center, and of 1 Nursing Home from Madrid. 5 focus groups were organized in 2004 April. Participants: 14 providers recruited 2

  15. The cultural context of patient's autonomy and doctor's duty: passive euthanasia and advance directives in Germany and Israel.

    Schicktanz, Silke; Raz, Aviad; Shalev, Carmel

    2010-11-01

    The moral discourse surrounding end-of-life (EoL) decisions is highly complex, and a comparison of Germany and Israel can highlight the impact of cultural factors. The comparison shows interesting differences in how patient's autonomy and doctor's duties are morally and legally related to each other with respect to the withholding and withdrawing of medical treatment in EoL situations. Taking the statements of two national expert ethics committees on EoL in Israel and Germany (and their legal outcome) as an example of this discourse, we describe the similarity of their recommendations and then focus on the differences, including the balancing of ethical principles, what is identified as a problem, what social role professionals play, and the influence of history and religion. The comparison seems to show that Israel is more restrictive in relation to Germany, in contrast with previous bioethical studies in the context of the moral and legal discourse regarding the beginning of life, in which Germany was characterized as far more restrictive. We reflect on the ambivalence of the cultural reasons for this difference and its expression in various dissenting views on passive euthanasia and advance directives, and conclude with a comment on the difficulty in classifying either stance as more or less restrictive.

  16. Fast wave direct electron heating in advanced inductive and ITER baseline scenario discharges in DIII-D

    Pinsker, R. I.; Jackson, G. L.; Luce, T. C.; Politzer, P. A. [General Atomics, PO Box 85608, San Diego, California 92186-5608 (United States); Austin, M. E. [University of Texas at Austin, Austin, Texas 78712 (United States); Diem, S. J.; Kaufman, M. C.; Ryan, P. M. [Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831 (United States); Doyle, E. J.; Zeng, L. [University of California Los Angeles, Los Angeles, California 90095 (United States); Grierson, B. A.; Hosea, J. C.; Nagy, A.; Perkins, R.; Solomon, W. M.; Taylor, G. [Princeton Plasma Physics Laboratory, Princeton, New Jersey 08543 (United States); Maggiora, R.; Milanesio, D. [Politecnico di Torino, Dipartimento di Elettronica, Torino (Italy); Porkolab, M. [Massachusetts Institute of Technology, Cambridge, Massachusetts 02139 (United States); Turco, F. [Columbia University, New York, New York 10027 (United States)

    2014-02-12

    Fast Wave (FW) heating and electron cyclotron heating (ECH) are used in the DIII-D tokamak to study plasmas with low applied torque and dominant electron heating characteristic of burning plasmas. FW heating via direct electron damping has reached the 2.5 MW level in high performance ELMy H-mode plasmas. In Advanced Inductive (AI) plasmas, core FW heating was found to be comparable to that of ECH, consistent with the excellent first-pass absorption of FWs predicted by ray-tracing models at high electron beta. FW heating at the ∼2 MW level to ELMy H-mode discharges in the ITER Baseline Scenario (IBS) showed unexpectedly strong absorption of FW power by injected neutral beam (NB) ions, indicated by significant enhancement of the D-D neutron rate, while the intended absorption on core electrons appeared rather weak. The AI and IBS discharges are compared in an effort to identify the causes of the different response to FWs.

  17. The factors impacted to local contractor from Foreign Direct Investment in advancing economic hub development in Iskandar Malaysia

    Syafiq Salim, Muhamad; Zakaria, Rozana; Aminuddin, Eeydzah; Hamid, Abdul Rahim Abdul; Abdullah, Redzuan; Shahzaib Khan, Jam

    2018-04-01

    Iskandar Malaysia is an advanced economic hub which is rapidly growing in the State of Johor. It has been an attractive place for Foreign Direct Investment (FDI) to invest. Many sectors are affected by the presence of FDI including the construction sector. This paper highlights the investigation on the effects of FDI to the local contractor in the Iskandar Malaysia Development. In this study, a questionnaire survey was carried out to gain the information on problems from internal factors and external factors that caused the limitation on involvement in FDI project by local contractors. 73 numbers of local contractor registered under CIDB in class G5, G6 and G7 are the respondents. Frequency analysis and Average Index Analysis are used for the results. This study provides the factors that impacted local construction players in Iskandar Malaysia Development. This study has portrayed that FDI plays a vital and significant role in spearheading the active involvement of local contractors in an urban sustainable development.

  18. Advance directives from haematology departments: the patient's freedom of choice and communication with families. A qualitative analysis of 35 written documents.

    Trarieux-Signol, S; Bordessoule, D; Ceccaldi, J; Malak, S; Polomeni, A; Fargeas, J B; Signol, N; Pauliat, H; Moreau, S

    2018-01-02

    In France, advance directives are favourably perceived by most of the population, although the drafting rate is low. This ambivalence is challenging because advance directives are meant to promote the autonomy and freedom of choice of patients. The purpose of this study was to analyse the content of advance directives written by patients suffering from malignant haemopathies to better understand how patients put them into practice. These could be relevant as early as the initial diagnosis of haematological malignancies because of the uncertain course of the disease. This was a multicentre, qualitative, descriptive study. The advance directives written by patients with malignant haemopathies treated in one of the six French hospital departments were included in the study from 01/06/2008 to 15/04/2016. A thematic analysis of the advance directives was performed by two researchers: a senior haematologist and a research assistant. The median age of the patients was 69. Most were women (sex ratio: 0.59), living as a couple (57%), with lymphoid pathologies (66%), who were still alive two years after the instructions were written (63%) and had nominated a health care proxy (88.6%). Free texts (62.9%) were richer in content than pre-defined forms. The advance directives were used in three ways: for a purely legal purpose, to focus on medical treatments or actions, or to communicate a message to the family. Three main themes emerged: (1) refusal of medical treatment (100%), in which patients express refusal of life-sustaining care (97.1%). The actual treatments or the moment when they should be limited or stopped were not always mentioned in detail. (2) A desire for effective pain relief to avoid suffering (57.1%) and (3) messages for their family (34.3%), such as funeral arrangements (17.1%) and messages of love or trust (14.3%). Patients who write advance directives are not necessarily at the end of their lives. Their content mainly conveys treatment wishes, although

  19. Advanced ceramic coating development for industrial/utility gas turbines. Final report, 11 Mar 1979-1 Sep 1981

    Vogan, J.W.; Stetson, A.R.

    1982-01-01

    A program was conducted with the objective of developing advanced thermal barrier coating (TBC) systems. Coating application was by plasma spray. Duplex, triplex and graded coatings were tested. Coating systems incorporated both NiCrAly and CoCrAly bond coats. Four ceramic overlays were tested: ZrO 2 .82O 3 , CaO.TiO 2 , 2CaO.SiO 2 , and MgO.Al 2 O 3 . The best overall results were obtained with a CaO.TiO 2 coating applied to a NiCrAly bond coat. This coating was less sensitive than the ZrO 2 .8Y 2 O 3 coating to process variables and part geometry. Testing with fuels contaminated with compounds containing sulfur, phosphorus and alkali metals showed the zirconia coatings were destabilized. The calcium titanate coatings were not affected by these contaminants. However, when fuels were used containing 50 ppm of vanadium and 150 ppm of magnesium, heavy deposits were formed on the test specimens and combustor components that required frequent cleaning of the test rig. During the program Mars engine first-stage turbine blades were coated and installed for an engine cyclic endurance run with the zirconia, calcium titanate, and calcium silicate coatings. Heavy spalling developed with the calcium silicate system. The zirconia and calcium titanate systems survived the full test duration. It was concluded that these two TBC's showed potential for application in gas turbines

  20. [INVITED] Recent advances in surface plasmon resonance based fiber optic chemical and biosensors utilizing bulk and nanostructures

    Gupta, Banshi D.; Kant, Ravi

    2018-05-01

    Surface plasmon resonance has established itself as an immensely acclaimed and influential optical sensing tool with quintessential applications in life sciences, environmental monitoring, clinical diagnostics, pharmaceutical developments and ensuring food safety. The implementation of sensing principle of surface plasmon resonance employing an optical fiber as a substrate has concomitantly resulted in the evolution of fiber optic surface plasmon resonance as an exceptionally lucrative scaffold for chemical and biosensing applications. This perspective article outlines the contemporary studies on fiber optic sensors founded on the sensing architecture of propagating as well as localized surface plasmon resonance. An in-depth review of the prevalent analytical and surface chemical tactics involved in configuring the sensing layer over an optical fiber for the detection of various chemical and biological entities is presented. The involvement of nanomaterials as a strategic approach to enhance the sensor sensitivity is furnished concurrently providing an insight into the diverse geometrical blueprints for designing fiber optic sensing probes. Representative examples from the literature are discussed to appreciate the latest advancements in this potentially valuable research avenue. The article concludes by identifying some of the key challenges and exploring the opportunities for expanding the scope and impact of surface plasmon resonance based fiber optic sensors.

  1. ADVANCED FLUE GAS CONDITIONING AS A RETROFIT UPGRADE TO ENHANCE PM COLLECTION FROM COAL-FIRED ELECTRIC UTILITY BOILERS

    Kenneth E. Baldrey

    2002-01-01

    The U.S. Department of Energy and ADA Environmental Solutions are engaged in a project to develop commercial flue gas conditioning additives. The objective is to develop conditioning agents that can help improve particulate control performance of smaller or under-sized electrostatic precipitators on utility coal-fired boilers. The new chemicals will be used to control both the electrical resistivity and the adhesion or cohesivity of the fly ash. There is a need to provide cost-effective and safer alternatives to traditional flue gas conditioning with SO(sub 3) and ammonia. During this reporting quarter, performance testing of flue gas conditioning was underway at the PacifiCorp Jim Bridger Power Plant. The product tested, ADA-43, was a combination resistivity modifier with cohesivity polymers. This represents the first long-term full-scale testing of this class of products. Modifications to the flue gas conditioning system at Jim Bridger, including development of alternate injection lances, was also undertaken to improve chemical spray distribution and to avoid spray deposition to duct interior surfaces. Also in this quarter, a firm commitment was received for another long-term test of the cohesivity additives. This plant fires a bituminous coal and has opacity and particulate emissions performance issues related to fly ash re-entrainment. Ammonia conditioning is employed here on one unit, but there is interest in liquid cohesivity additives as a safer alternative

  2. Optimal conditions in direct dimethyl ether synthesis from syngas utilizing a dual-type fluidized bed reactor

    Yousefi, Ahmad; Eslamloueyan, Reza; Kazerooni, Nooshin Moradi

    2017-01-01

    Concerns over environmental pollution and ever-increasing energy demand have urged the global community to tap clean-burning fuels among which dimethyl ether is a promising candidate for contribution in the transportation sector. Direct dimethyl ether synthesis from syngas, in which methanol production and dehydration take place simultaneously, is arguably the preferred route for large scale production. In this study, direct dimethyl ether synthesis is proposed in an industrial dual-type fluidized bed reactor. This configuration involves two fluidized bed reactors operating in different conditions. In the first catalytic reactor (water-cooled reactor), the synthesis gas is partly converted to methanol after being preheated by the reaction heat in the second reactor (gas-cooled reactor). A two-phase generalized comprehensive reactor model, comprised of the flow in three different regimes is applied and a smooth transition between flow regimes is provided based on the probabilistic averaging approach. The optimal operating conditions are sought by employing differential evolution algorithm as a robust optimization strategy. The dimethyl ether mole fraction is considered as the objective function during the optimization. The results show considerable dimethyl ether enhancement by 16% and 14% compared to the conventional direct dimethyl ether synthesis reactor and dual-type fixed bed dimethyl ether reactor arrangements, respectively. - Highlights: • Dual-type catalytic fluidized bed reactors for dimethyl ether synthesis is studied. • A two-phase comprehensive model comprised of flow in three regimes is used. • Probabilistic averaging approach is applied for smooth transitions between regimes. • Differential evolution method is employed to determine optimal operating conditions. • Production capacity is remarkably enhanced compared to conventional reactor.

  3. Microbial surface displayed enzymes based biofuel cell utilizing degradation products of lignocellulosic biomass for direct electrical energy.

    Fan, Shuqin; Hou, Chuantao; Liang, Bo; Feng, Ruirui; Liu, Aihua

    2015-09-01

    In this work, a bacterial surface displaying enzyme based two-compartment biofuel cell for the direct electrical energy conversion from degradation products of lignocellulosic biomass is reported. Considering that the main degradation products of the lignocellulose are glucose and xylose, xylose dehydrogenase (XDH) displayed bacteria (XDH-bacteria) and glucose dehydrogenase (GDH) displayed bacteria (GDH-bacteria) were used as anode catalysts in anode chamber with methylene blue as electron transfer mediator. While the cathode chamber was constructed with laccase/multi-walled-carbon nanotube/glassy-carbon-electrode. XDH-bacteria exhibited 1.75 times higher catalytic efficiency than GDH-bacteria. This assembled enzymatic fuel cell exhibited a high open-circuit potential of 0.80 V, acceptable stability and energy conversion efficiency. Moreover, the maximum power density of the cell could reach 53 μW cm(-2) when fueled with degradation products of corn stalk. Thus, this finding holds great potential to directly convert degradation products of biomass into electrical energy. Copyright © 2015 Elsevier Ltd. All rights reserved.

  4. Three-dimensional matrix fiber alignment modulates cell migration and MT1-MMP utility by spatially and temporally directing protrusions

    Fraley, Stephanie I.; Wu, Pei-Hsun; He, Lijuan; Feng, Yunfeng; Krisnamurthy, Ranjini; Longmore, Gregory D.; Wirtz, Denis

    2015-10-01

    Multiple attributes of the three-dimensional (3D) extracellular matrix (ECM) have been independently implicated as regulators of cell motility, including pore size, crosslink density, structural organization, and stiffness. However, these parameters cannot be independently varied within a complex 3D ECM protein network. We present an integrated, quantitative study of these parameters across a broad range of complex matrix configurations using self-assembling 3D collagen and show how each parameter relates to the others and to cell motility. Increasing collagen density resulted in a decrease and then an increase in both pore size and fiber alignment, which both correlated significantly with cell motility but not bulk matrix stiffness within the range tested. However, using the crosslinking enzyme Transglutaminase II to alter microstructure independently of density revealed that motility is most significantly predicted by fiber alignment. Cellular protrusion rate, protrusion orientation, speed of migration, and invasion distance showed coupled biphasic responses to increasing collagen density not predicted by 2D models or by stiffness, but instead by fiber alignment. The requirement of matrix metalloproteinase (MMP) activity was also observed to depend on microstructure, and a threshold of MMP utility was identified. Our results suggest that fiber topography guides protrusions and thereby MMP activity and motility.

  5. Advance directives for future dementia can be modified by a brief video presentation on dementia care: An experimental study.

    Theresia Volhard

    practice of formulating, revising, and supporting advance directives.

  6. COMETS2: An advanced MATLAB toolbox for the numerical analysis of electric fields generated by transcranial direct current stimulation.

    Lee, Chany; Jung, Young-Jin; Lee, Sang Jun; Im, Chang-Hwan

    2017-02-01

    Since there is no way to measure electric current generated by transcranial direct current stimulation (tDCS) inside the human head through in vivo experiments, numerical analysis based on the finite element method has been widely used to estimate the electric field inside the head. In 2013, we released a MATLAB toolbox named COMETS, which has been used by a number of groups and has helped researchers to gain insight into the electric field distribution during stimulation. The aim of this study was to develop an advanced MATLAB toolbox, named COMETS2, for the numerical analysis of the electric field generated by tDCS. COMETS2 can generate any sizes of rectangular pad electrodes on any positions on the scalp surface. To reduce the large computational burden when repeatedly testing multiple electrode locations and sizes, a new technique to decompose the global stiffness matrix was proposed. As examples of potential applications, we observed the effects of sizes and displacements of electrodes on the results of electric field analysis. The proposed mesh decomposition method significantly enhanced the overall computational efficiency. We implemented an automatic electrode modeler for the first time, and proposed a new technique to enhance the computational efficiency. In this paper, an efficient toolbox for tDCS analysis is introduced (freely available at http://www.cometstool.com). It is expected that COMETS2 will be a useful toolbox for researchers who want to benefit from the numerical analysis of electric fields generated by tDCS. Copyright © 2016. Published by Elsevier B.V.

  7. Dose-volume based ranking of incident beam direction and its utility in facilitating IMRT beam placement

    Schreibmann, Eduard; Xing Lei

    2005-01-01

    Purpose: Beam orientation optimization in intensity-modulated radiation therapy (IMRT) is computationally intensive, and various single beam ranking techniques have been proposed to reduce the search space. Up to this point, none of the existing ranking techniques considers the clinically important dose-volume effects of the involved structures, which may lead to clinically irrelevant angular ranking. The purpose of this work is to develop a clinically sensible angular ranking model with incorporation of dose-volume effects and to show its utility for IMRT beam placement. Methods and Materials: The general consideration in constructing this angular ranking function is that a beamlet/beam is preferable if it can deliver a higher dose to the target without exceeding the tolerance of the sensitive structures located on the path of the beamlet/beam. In the previously proposed dose-based approach, the beamlets are treated independently and, to compute the maximally deliverable dose to the target volume, the intensity of each beamlet is pushed to its maximum intensity without considering the values of other beamlets. When volumetric structures are involved, the complication arises from the fact that there are numerous dose distributions corresponding to the same dose-volume tolerance. In this situation, the beamlets are not independent and an optimization algorithm is required to find the intensity profile that delivers the maximum target dose while satisfying the volumetric constraints. In this study, the behavior of a volumetric organ was modeled by using the equivalent uniform dose (EUD). A constrained sequential quadratic programming algorithm (CFSQP) was used to find the beam profile that delivers the maximum dose to the target volume without violating the EUD constraint or constraints. To assess the utility of the proposed technique, we planned a head-and-neck and abdominal case with and without the guidance of the angular ranking information. The qualities of the

  8. Utilizing topobathy LIDAR datasets to identify shoreline variations and to direct charting updates in the northern Gulf of Mexico

    Gremillion, S. L.; Wright, S. L.

    2017-12-01

    Topographic and bathymetric light detection and ranging (LIDAR), remote sensing tools used to measure vertical elevations, are commonly employed to monitor shoreline fluctuations. Many of these publicly available datasets provide wide-swath, nearshore topobathy which can be used to extract shoreline positions and analyze coastlines experiencing the greatest temporal and spatial variability. This study focused on the shorelines of Mississippi's Jackson County to determine the minimum time for significant positional changes to occur, relative to currently published NOAA navigational charts. Many of these dynamic shorelines are vulnerable to relative sea level rise, storm surge, and coastal erosion. Utilizing LIDAR datasets from 1998-2015, shoreline positions were derived and analyzed against NOAA's Continually Updated Shoreline Product (CUSP) to recommend the frequency at which future surveys should be conducted. Advisement of charting updates were based upon the resolution of published charts, and the magnitude of observed variances. Jackson County shorelines were divided into four areas for analysis; the mainland, Horn Island, Petit Bois Island (PBI), and a dredge spoil area west of PBI. The mainland shoreline experienced an average change rate of +0.57 m/yr during the study period. This stability was due to engineering structures implemented in the early 1920's to protect against tropical storms. Horn Island, the most stable barrier island, changed an average of -1.34 m/yr, while PBI had an average change of -2.70 m/yr throughout. Lastly, the dredge spoil area changed by +9.06 m/yr. Based on these results, it is recommended that LIDAR surveys for Jackson County's mainland be conducted at least every two years, while surveys of the offshore barrier islands be conducted annually. Furthermore, insufficient LIDAR data for Round Island and the Round Island Marsh Restoration Project highlight these two areas as priority targets for future surveys.

  9. Advance Health Care Directives and “Public Guardian”: The Italian Supreme Court Requests the Status of Current and Not Future Inability

    Francesco Paolo Busardò

    2014-01-01

    Full Text Available Advance health care decisions animate an intense debate in several European countries, which started more than 20 years ago in the USA and led to the adoption of different rules, based on the diverse legal, sociocultural and philosophical traditions of each society. In Italy, the controversial issue of advance directives and end of life’s rights, in the absence of a clear and comprehensive legislation, has been over time a subject of interest of the Supreme Court. Since 2004 a law introduced the “Public Guardian,” aiming to provide an instrument of assistance to the person lacking in autonomy because of an illness or incapacity. Recently, this critical issue has once again been brought to the interest of the Supreme Court, which passed a judgment trying to clarify the legislative application of the appointment of the Guardian in the field of advance directives.

  10. Advancing Patient-Centered Care in Tuberculosis Management: A Mixed-Methods Appraisal of Video Directly Observed Therapy.

    Holzman, Samuel B; Zenilman, Avi; Shah, Maunank

    2018-04-01

    Directly observed therapy (DOT) remains an integral component of treatment support and adherence monitoring in tuberculosis care. In-person DOT is resource intensive and often burdensome for patients. Video DOT (vDOT) has been proposed as an alternative to increase treatment flexibility and better meet patient-specific needs. We conducted a pragmatic, prospective pilot implementation of vDOT at 3 TB clinics in Maryland. A mixed-methods approach was implemented to assess (1) effectiveness, (2) acceptability, and (3) cost. Medication adherence on vDOT was compared with that of in-person DOT. Interviews and surveys were conducted with patients and providers before and after implementation, with framework analysis utilized to extract salient themes. Last, a cost analysis assessed the economic impacts of vDOT implementation across heterogeneous clinic structures. Medication adherence on vDOT was comparable to that of in-person DOT (94% vs 98%, P = .17), with a higher percentage of total treatment doses (inclusive of weekend/holiday self-administration) ultimately observed during the vDOT period (72% vs 66%, P = .03). Video DOT was well received by staff and patients alike, who cited increased treatment flexibility, convenience, and patient privacy. Our cost analysis estimated a savings with vDOT of $1391 per patient for a standard 6-month treatment course. Video DOT is an acceptable and important option for measurement of TB treatment adherence and may allow a higher proportion of prescribed treatment doses to be observed, compared with in-person DOT. Video DOT may be cost-saving and should be considered as a component of individualized, patient-centered case management plans.

  11. Motivations, aims and communication around advance directives A mixed-methods study into the perspective of their owners and the influence of a current illness

    van Wijmen, M.P.S.; Pasman, H.R.W.; Widdershoven, G.A.M.; Onwuteaka-Philipsen, B.D.

    2014-01-01

    Objective: What are motivations of owners of an advance directive (AD) to draft an AD, what do they aim for with their AD and do they communicate about their AD? Methods: Written questionnaires were sent to a cohort of people owning different types of ADs (n= 5768). A purposive sample of people

  12. A phase I, dose-escalation study of TB-403, a monoclonal antibody directed against PlGF, in patients with advanced solid tumours

    Lassen, U; Nielsen, D L; Sørensen, M

    2012-01-01

    BACKGROUND: TB-403 (RO 5323441), a humanised monoclonal antibody, is a novel antiangiogenesis agent directed against placental growth factor. The safety, pharmacokinetics (PK), and antitumour activity of TB-403 were assessed in a phase I, dose-escalation study in patients with advanced solid...

  13. Nurses' knowledge of advance directives and perceived confidence in end-of-life care: a cross-sectional study in five countries.

    Coffey, Alice

    2016-01-28

    Nurses\\' knowledge regarding advance directives may affect their administration and completion in end-of-life care. Confidence among nurses is a barrier to the provision of quality end-of-life care. This study investigated nurses\\' knowledge of advance directives and perceived confidence in end-of-life care, in Hong Kong, Ireland, Israel, Italy and the USA using a cross-sectional descriptive design (n = 1089). In all countries, older nurses and those who had more professional experience felt more confident managing patients\\' symptoms at end-of-life and more comfortable stopping preventive medications at end-of-life. Nurses in the USA reported that they have more knowledge and experience of advance directives compared with other countries. In addition, they reported the highest levels of confidence and comfort in dealing with end-of-life care. Although legislation for advance directives does not yet exist in Ireland, nurses reported high levels of confidence in end-of-life care.

  14. Dříve vyslovená přání (advance directives). Právní a etické úvahy

    Doležal, Adam

    2017-01-01

    Roč. 7, č. 2 (2017), s. 1-15 ISSN 1804-8137 Institutional support: RVO:68378122 Keywords : advance directives * living will * euthanasia Subject RIV: AG - Legal Sciences OBOR OECD: Law http://www.ilaw.cas.cz/medlawjournal/index.php/medlawjournal/article/view/141

  15. Some new features of Direct Analysis in Real Time mass spectrometry utilizing the desorption at an angle option.

    Chernetsova, Elena S; Revelsky, Alexander I; Morlock, Gertrud E

    2011-08-30

    The present study is a first step towards the unexplored capabilities of Direct Analysis in Real Time (DART) mass spectrometry (MS) arising from the possibility of the desorption at an angle: scanning analysis of surfaces, including the coupling of thin-layer chromatography (TLC) with DART-MS, and a more sensitive analysis due to the preliminary concentration of analytes dissolved in large volumes of liquids on glass surfaces. In order to select the most favorable conditions for DART-MS analysis, proper positioning of samples is important. Therefore, a simple and cheap technique for the visualization of the impact region of the DART gas stream onto a substrate was developed. A filter paper or TLC plate, previously loaded with the analyte, was immersed in a derivatization solution. On this substrate, owing to the impact of the hot DART gas, reaction of the analyte to a colored product occurred. An improved capability of detection of DART-MS for the analysis of liquids was demonstrated by applying large volumes of model solutions of coumaphos into small glass vessels and drying these solutions prior to DART-MS analysis under ambient conditions. This allowed the introduction of, by up to more than two orders of magnitude, increased quantities of analyte compared with the conventional DART-MS analysis of liquids. Through this improved detectability, the capabilities of DART-MS in trace analysis could be strengthened. Copyright © 2011 John Wiley & Sons, Ltd.

  16. Geothermal direct-heat utilization assistance. Federal Assistance Program quarterly project progress report, April 1--June 30, 1998

    NONE

    1998-07-01

    This report summarizes geothermal technical assistance, R and D and technology transfer activities of the Geo-Heat Center at Oregon Institute of Technology for the third quarter of FY98 (April--June, 1998). It describes 231 contacts with parties during this period related to technical assistance with geothermal direct heat projects. Areas dealt with included requests for general information including material for high school and university students, and material on geothermal heat pumps, resource and well data, spacing heating and cooling, greenhouses, aquaculture, equipment, district heating, resorts and spas, industrial applications, snow melting and electric power. Research activities include work on model construction specifications for line shaft submersible pumps and plate heat exchangers, and a comprehensive aquaculture developers package. A brochure on Geothermal Energy in Klamath County was developed for state and local tourism use. Outreach activities include the publication of the Quarterly Bulletin (Vol. 19, No. 2) with articles on research at the Geo-Heat Center, sustainability of geothermal resources, injection well drilling in Boise, ID and a greenhouse project in the Azores. Other outreach activities include dissemination of information mainly through mailings of publications, tours of local geothermal uses, geothermal library acquisitions and use, participation in workshops, short courses and technical meetings by the staff, and progress monitor reports on geothermal activities.

  17. Diagnostic utility of a direct immunofluorescence test to detect feline coronavirus antigen in macrophages in effusive feline infectious peritonitis.

    Litster, A L; Pogranichniy, R; Lin, T-L

    2013-11-01

    The antemortem diagnosis of feline infectious peritonitis (FIP) remains challenging in clinical practice, since current testing methods have suboptimal diagnostic accuracy. Immunohistochemical testing of biopsy specimens and postmortem examination are the standard diagnostic methods, although direct immunofluorescence (DIF) testing to detect feline coronavirus in macrophages in effusion specimens has been reported to have 100% specificity and has been recommended as an antemortem confirmatory test. The aim of this study was to compare the results of DIF testing in antemortem feline effusions with postmortem results using field samples. Effusion specimens were collected antemortem from 17 cats and tested by DIF, followed by postmortem examination. Histopathological examination of specimens collected at postmortem confirmed FIP in 10/17 cases and ruled out FIP out in 7/17 cases. Antemortem DIF testing was positive in all 10 cases confirmed as FIP at postmortem examination. In the seven cats where FIP was ruled out at postmortem examination, DIF was negative in five cases and positive in the remaining two cases. The calculated sensitivity of DIF testing was 100% and the specificity was 71.4%. Duplicate effusion specimens from eight cats that were initially DIF positive were stored refrigerated (4 °C) or at room temperature (22-25 °C) and subjected to serial DIF testing to determine the duration of positive results. DIF-positive specimens stored at both temperatures retained their positive status for at least 2 days. Copyright © 2013 Elsevier Ltd. All rights reserved.

  18. Utility of Interobserver Agreement Statistics in Establishing Radiology Resident Learning Curves During Self-directed Radiologic Anatomy Training.

    Tureli, Derya; Altas, Hilal; Cengic, Ismet; Ekinci, Gazanfer; Baltacioglu, Feyyaz

    2015-10-01

    The aim of the study was to ascertain the learning curves for the radiology residents when first introduced to an anatomic structure in magnetic resonance images (MRI) to which they have not been previously exposed to. The iliolumbar ligament is a good marker for testing learning curves of radiology residents because the ligament is not part of a routine lumbar MRI reporting and has high variability in detection. Four radiologists, three residents without previous training and one mentor, studied standard axial T1- and T2-weighted images of routine lumbar MRI examinations. Radiologists had to define iliolumbar ligament while blinded to each other's findings. Interobserver agreement analyses, namely Cohen and Fleiss κ statistics, were performed for groups of 20 cases to evaluate the self-learning curve of radiology residents. Mean κ values of resident-mentor pairs were 0.431, 0.608, 0.604, 0.826, and 0.963 in the analysis of successive groups (P 0.8). Therefore, a junior radiology resident can obtain enough experience in identifying a rather ambiguous anatomic structure in routine MRI after a brief instruction of a few minutes by a mentor and studying approximately 80 cases by oneself. Implementing this methodology will help radiology educators obtain more concrete ideas on the optimal time and effort required for supported self-directed visual learning processes in resident education. Copyright © 2015 AUR. Published by Elsevier Inc. All rights reserved.

  19. Utilization of solar energy for direct contact membrane distillation process: An experimental study for desalination of real seawater

    Palanisami, Nallasamy; He, Ke; Moon, Il Shik

    2014-01-01

    Membrane distillation (MD), a non-isothermal membrane separation process, is based on the phenomenon that pure water in its vapor state can be extracted from aqueous solutions by passing vapor through a hydrophobic microporous membrane when a temperature difference is established across it. We used three commercially available hydrophobic microporous membranes (C02, C07 and C12; based on the pore size 0.2, 0.7 and 1.2 µm respectively) for desalination via direct contact MD (DCMD). The effects of operating parameters on permeation flux were studied. In addition, the desalination of seawater by solar assisted DCMD process was experimentally investigated. First, using solar power only short-term (one day), successful desalination of real seawater was achieved without temperature control under the following conditions: feed inlet temperature 65.0 .deg. C, permeate inlet temperature 25.0 .deg. C, and a flow rate of 2.5 L/min. The developed system also worked well in the long-term (150 days) for seawater desalination using both solar and electric power. Long-term test flux was reduced from 28.48 to only 26.50 L/m 2 hr, indicating system feasibility

  20. Utilization of solar energy for direct contact membrane distillation process: An experimental study for desalination of real seawater

    Palanisami, Nallasamy; He, Ke; Moon, Il Shik [Sunchon National University, Suncheon (Korea, Republic of)

    2014-01-15

    Membrane distillation (MD), a non-isothermal membrane separation process, is based on the phenomenon that pure water in its vapor state can be extracted from aqueous solutions by passing vapor through a hydrophobic microporous membrane when a temperature difference is established across it. We used three commercially available hydrophobic microporous membranes (C02, C07 and C12; based on the pore size 0.2, 0.7 and 1.2 µm respectively) for desalination via direct contact MD (DCMD). The effects of operating parameters on permeation flux were studied. In addition, the desalination of seawater by solar assisted DCMD process was experimentally investigated. First, using solar power only short-term (one day), successful desalination of real seawater was achieved without temperature control under the following conditions: feed inlet temperature 65.0 .deg. C, permeate inlet temperature 25.0 .deg. C, and a flow rate of 2.5 L/min. The developed system also worked well in the long-term (150 days) for seawater desalination using both solar and electric power. Long-term test flux was reduced from 28.48 to only 26.50 L/m{sup 2}hr, indicating system feasibility.

  1. The utility of high-resolution intraoperative MRI in endoscopic transsphenoidal surgery for pituitary macroadenomas: early experience in the Advanced Multimodality Image Guided Operating suite

    Zaidi, Hasan A.; De Los Reyes, Kenneth; Barkhoudarian, Garni; Litvack, Zachary N.; Bi, Wenya Linda; Rincon-Torroella, Jordina; Mukundan, Srinivasan; Dunn, Ian F.; Laws, Edward R.

    2016-01-01

    Objective Endoscopic skull base surgery has become increasingly popular among the skull base surgery community, with improved illumination and angled visualization potentially improving tumor resection rates. Intraoperative MRI (iMRI) is used to detect residual disease during the course of the resection. This study is an investigation of the utility of 3-T iMRI in combination with transnasal endoscopy with regard to gross-total resection (GTR) of pituitary macroadenomas. Methods The authors retrospectively reviewed all endoscopic transsphenoidal operations performed in the Advanced Multimodality Image Guided Operating (AMIGO) suite from November 2011 to December 2014. Inclusion criteria were patients harboring presumed pituitary macroadenomas with optic nerve or chiasmal compression and visual loss, operated on by a single surgeon. Results Of the 27 patients who underwent transsphenoidal resection in the AMIGO suite, 20 patients met the inclusion criteria. The endoscope alone, without the use of iMRI, would have correctly predicted 13 (65%) of 20 cases. Gross-total resection was achieved in 12 patients (60%) prior to MRI. Intraoperative MRI helped convert 1 STR and 4 NTRs to GTRs, increasing the number of GTRs from 12 (60%) to 16 (80%). Conclusions Despite advances in visualization provided by the endoscope, the incidence of residual disease can potentially place the patient at risk for additional surgery. The authors found that iMRI can be useful in detecting unexpected residual tumor. The cost-effectiveness of this tool is yet to be determined. PMID:26926058

  2. Health Resource Utilization Associated with Skeletal-Related Events in Patients with Advanced Prostate Cancer: A European Subgroup Analysis from an Observational, Multinational Study

    Amit Bahl

    2014-07-01

    Full Text Available This study aimed to increase the understanding of health resource utilization (HRU associated with skeletal-related events (SREs occurring in patients with bone metastases secondary to advanced prostate cancer. A total of 120 patients from Germany, Italy, Spain and the United Kingdom were enrolled in this observational study. They had bone metastases secondary to prostate cancer and had experienced at least one SRE in the 97 days before giving informed consent. HRU data were collected retrospectively for 97 days before enrolment and prospectively for up to 18–21 months. HRU, including the number and duration of inpatient hospitalizations, number of outpatient and emergency department visits and procedures, was independently attributed by investigators to an SRE. Of the 222 SREs included in this analysis, 26% were associated with inpatient stays and the mean duration per SRE was 21.4 days (standard deviation (SD 17.8 days. Overall, 174 SREs (78% required an outpatient visit and the mean number of visits per SRE was 4.6 (SD 4.6. All SREs are associated with substantial HRU. Preventing SREs in patients with advanced prostate cancer and bone metastases may help to reduce the burden to both patients and European healthcare systems.

  3. Online corrections - Evidence based practice utilizing electronic portal imaging to improve the accuracy of field placement for locally advanced prostate cancer

    Middleton, M.; Medwell, S.; Rolfo, A.; Joon, M.L.

    2003-01-01

    The requirement of accurate field placement in the treatment of locally advanced prostate cancer is of great significance given the onset of dose escalation and increased Planning Target Volume (PTV) conformity. With these factors in mind, it becomes essential to ensure accurate field placement for the duration of a course of Radiotherapy. This study examines the role of Online Corrections to increase accuracy of field placement, utilizing Varian Vision EPI equipment. The study also examines the hypothetical scenario of effect on three-dimensional computer dosimetry if Online Corrections were not performed, incorporating TCP and NTCP data. Field placement data was collected on patients receiving radical radiotherapy to the prostate utilizing the Varian Vision (TM)EPI software. Both intra and inter field data was collected with Online Corrections being carried out within the confines of the BAROC PROSTATE EPI POLICY. Analysis was performed on the data to illustrate the value of Online Corrections in the pursuit of accurate field placement. This evidence was further supported by computer dosimetry presenting the worst case possible impact upon a patients total course of treatment if Online Corrections were not performed. The use of Online Corrections can prove to be of enormous benefit to both patient and practitioner. For centres with the available technology, it places the responsibility of field placement upon the Radiation Therapist. This responsibility in turn impacts on the education, training and empowerment of the Radiation Therapy group. These are issues of the utmost importance to centres considering the use of Online Corrections

  4. Advanced-fueled fusion reactors suitable for direct energy conversion. Project note: temperature-gradient enhancement of electrical fields in insulators

    Blum, A.S.; Mancebo, L.

    1976-01-01

    Direct energy converters for use on controlled fusion reactors utilize electrodes operated at elevated voltages and temperatures. The insulating elements that position these electrodes must support large voltages and under some circumstances large thermal gradients. It is shown that even modest thermal gradients can cause major alterations of the electric-field distribution within the insulating element

  5. Direct synthesis of Pt-free catalyst on gas diffusion layer of fuel cell and usage of high boiling point fuels for efficient utilization of waste heat

    Nandan, Ravi; Goswami, Gopal Krishna; Nanda, Karuna Kar

    2017-01-01

    Graphical abstract: Direct-grown boron-doped carbon nanotubes on gas-diffusion layer as efficient Pt-free cathode catalyst for alcohol fuel cells, high boiling point fuels used to obtain hot fuels for the enhancement of cell performance that paves the way for the utilization of waste heat. Display Omitted -- Highlights: •One-step direct synthesis of boron-doped carbon nanotubes (BCNTs) on gas diffusion layer (GDL). •Home built fuel-cell testing using BCNTs on GDL as Pt-free cathode catalyst. •BCNTs exhibit concentration dependent oxygen reduction reaction and the cell performance. •Effective utilization of waste heat to raise the fuel temperature. •Fuel selectivity to raise the fuel temperature and the overall performance of the fuel cells. -- Abstract: Gas diffusion layers (GDL) and electrocatalysts are integral parts of fuel cells. It is, however, a challenging task to grow Pt-free robust electrocatalyst directly on GDL for oxygen reduction reaction (ORR) – a key reaction in fuel cells. Here, we demonstrate that boron-doped carbon nanotubes (BCNTs) grown directly on gas-diffusion layer (which avoid the need of ionomer solution used for catalyst loading) can be used as efficient Pt-free catalyst in alcohol fuel cells. Increase in boron concentration improves the electrochemical ORR activity in terms of onset and ORR peak positions, half-wave potentials and diffusion-limited current density that ensure the optimization of the device performance. The preferential 4e − pathway, excellent cell performance, superior tolerance to fuel crossover and long-term stability makes directly grown BCNTs as an efficient Pt-free cathode catalyst for cost-effective fuel cells. The maximum power density of the fuel cell is found to increase monotonically with boron concentration. In addition to the application of BCNTs in fuel cell, we have introduced the concept of hot fuels so that waste heat can effectively be used and external power sources can be avoided. The fuel

  6. Health Care Resource Utilization for Outpatient Cardiovascular Disease and Diabetes Care Delivery Among Advanced Practice Providers and Physician Providers in Primary Care.

    Virani, Salim S; Akeroyd, Julia M; Ramsey, David J; Deswal, Anita; Nasir, Khurram; Rajan, Suja S; Ballantyne, Christie M; Petersen, Laura A

    2017-10-10

    Although effectiveness of diabetes or cardiovascular disease (CVD) care delivery between physicians and advanced practice providers (APPs) has been shown to be comparable, health care resource utilization between these 2 provider types in primary care is unknown. This study compared health care resource utilization between patients with diabetes or CVD receiving care from APPs or physicians. Diabetes (n = 1,022,588) or CVD (n = 1,187,035) patients with a primary care visit between October 2013 and September 2014 in 130 Veterans Affairs facilities were identified. Using hierarchical regression adjusting for covariates including patient illness burden, the authors compared number of primary or specialty care visits and number of lipid panels and hemoglobinA1c (HbA1c) tests among diabetes patients, and number of primary or specialty care visits and number of lipid panels and cardiac stress tests among CVD patients receiving care from physicians and APPs. Physicians had significantly larger patient panels compared with APPs. In adjusted analyses, diabetes patients receiving care from APPs received fewer primary and specialty care visits and a greater number of lipid panels and HbA1c tests compared with patients receiving care from physicians. CVD patients receiving care from APPs received more frequent lipid testing and fewer primary and specialty care visits compared with those receiving care from physicians, with no differences in the number of stress tests. Most of these differences, although statistically significant, were numerically small. Health care resource utilization among diabetes or CVD patients receiving care from APPs or physicians appears comparable, although physicians work with larger patient panels.

  7. Productivity loss and resource utilization, and associated indirect and direct costs in individuals providing care for adults with schizophrenia in the EU5

    Gupta S

    2015-11-01

    Full Text Available Shaloo Gupta,1 Gina Isherwood,2 Kevin Jones,3 Kristel Van Impe4 1Kantar Health, Princeton, NJ, USA; 2Kantar Health, Epsom, Surrey, UK; 3European Federation of Associations of Families of People with Mental Illness, Diestsevest, Leuven, Belgium; 4Janssen-Cilag GmbH, Neuss, Germany Objective: This study aimed to understand the impact of providing care for adults with schizophrenia on productivity, resource utilization, and costs in the EU5 (France, Germany, Italy, Spain, and UK. Methods: Data from the 2010, 2011, and 2013 EU5 National Health and Wellness Survey, an online questionnaire of a nationwide sample of adults, were analyzed. Schizophrenia caregivers (n=398 were matched to noncaregivers (n=158,989 and other caregivers (n=14,341 via propensity scores. Outcome measures included health care utilization, Work Productivity and Activity Impairment questionnaire-based scores, and associated direct and indirect costs (estimated from the literature. Significant differences between schizophrenia caregivers vs noncaregivers and other caregivers (eg, cancer and Alzheimer's disease were examined. Results: After matching, schizophrenia caregivers reported greater activity impairment (38.4% vs 26.1%, provider visits (8.0 vs 5.7, emergency room visits (0.9 vs 0.2, hospitalizations (0.8 vs 0.1, and direct costs (€2,258 vs €617 than noncaregivers, all P<0.001. Employed schizophrenia caregivers reported greater absenteeism, presenteeism, overall work impairment (35.0% vs 20.7%, and indirect costs (€6,667 vs €3,795 than noncaregivers, all P<0.001. Schizophrenia caregivers (vs other caregivers reported greater activity impairment (38.4% vs 32.3% and provider visits (8.0 vs 6.6, P<0.05. A greater proportion of schizophrenia caregivers (vs other caregivers reported at least one emergency room visit (26.1% vs 20.2% and hospitalization (20.4% vs 14.3%, P<0.05. Employed schizophrenia caregivers incurred greater indirect costs than other caregivers (€6

  8. Physician perspectives and compliance with patient advance directives: the role external factors play on physician decision making.

    Burkle, Christopher M; Mueller, Paul S; Swetz, Keith M; Hook, C Christopher; Keegan, Mark T

    2012-11-21

    Following passage of the Patient Self Determination Act in 1990, health care institutions that receive Medicare and Medicaid funding are required to inform patients of their right to make their health care preferences known through execution of a living will and/or to appoint a surrogate-decision maker. We evaluated the impact of external factors and perceived patient preferences on physicians' decisions to honor or forgo previously established advance directives (ADs). In addition, physician views regarding legal risk, patients' ability to comprehend complexities involved with their care, and impact of medical costs related to end-of-life care decisions were explored. Attendees of two Mayo Clinic continuing medical education courses were surveyed. Three scenarios based in part on previously court-litigated matters assessed impact of external factors and perceived patient preferences on physician compliance with patient-articulated wishes regarding resuscitation. General questions measured respondents' perception of legal risk, concerns over patient knowledge of idiosyncrasies involved with their care, and impact medical costs may have on compliance with patient preferences. Responses indicating strength of agreement or disagreement with statements were treated as ordinal data and analyzed using the Cochran Armitage trend test. Three hundred eighty-eight of 951 surveys were completed (41% response rate). Eighty percent reported they were likely to honor a patient's AD despite its 5 year age. Fewer than half (41%) would honor the AD of a patient in ventricular fibrillation who had expressed a desire to "pass away in peace." Few (17%) would forgo an AD following a family's request for continued resuscitative treatment. A majority (52%) considered risk of liability to be lower when maintaining someone alive against their wishes than mistakenly failing to provide resuscitative efforts. A large percentage (74%) disagreed that patients could not appreciate complexities

  9. Physician perspectives and compliance with patient advance directives: the role external factors play on physician decision making

    Burkle Christopher M

    2012-11-01

    Full Text Available Abstract Background Following passage of the Patient Self Determination Act in 1990, health care institutions that receive Medicare and Medicaid funding are required to inform patients of their right to make their health care preferences known through execution of a living will and/or to appoint a surrogate-decision maker. We evaluated the impact of external factors and perceived patient preferences on physicians’ decisions to honor or forgo previously established advance directives (ADs. In addition, physician views regarding legal risk, patients’ ability to comprehend complexities involved with their care, and impact of medical costs related to end-of-life care decisions were explored. Methods Attendees of two Mayo Clinic continuing medical education courses were surveyed. Three scenarios based in part on previously court-litigated matters assessed impact of external factors and perceived patient preferences on physician compliance with patient-articulated wishes regarding resuscitation. General questions measured respondents’ perception of legal risk, concerns over patient knowledge of idiosyncrasies involved with their care, and impact medical costs may have on compliance with patient preferences. Responses indicating strength of agreement or disagreement with statements were treated as ordinal data and analyzed using the Cochran Armitage trend test. Results Three hundred eighty-eight of 951 surveys were completed (41% response rate. Eighty percent reported they were likely to honor a patient’s AD despite its 5 year age. Fewer than half (41% would honor the AD of a patient in ventricular fibrillation who had expressed a desire to “pass away in peace.” Few (17% would forgo an AD following a family’s request for continued resuscitative treatment. A majority (52% considered risk of liability to be lower when maintaining someone alive against their wishes than mistakenly failing to provide resuscitative efforts. A large percentage

  10. A New Option for the Reconstruction of Primary or Recurrent Ischial Pressure Sores: Hamstring-Adductor Magnus Muscle Advancement Flap and Direct Closure.

    Burm, Jin Sik; Hwang, Jungil; Lee, Yung Ki

    2018-04-01

    Owing to the high recurrence rates of ischial pressure sores, surgeons should consider the possibility of future secondary flap surgery during flap selection. The purpose of this article is to present a new surgical option for the reconstruction of primary or recurrent ischial pressure sores using a simple hamstring-adductor magnus advancement flap and direct closure. After horizontal fusiform skin excision, complete bursa excision and ischiectomy were performed. The tenomuscular origin of the adductor magnus and the conjoined tenomuscular origin of the biceps femoris long head and semitendinosus were isolated and completely detached from the inferior border of the ischial tuberosity. They were then advanced in a cephalad direction without detachment of the distal tendon or muscle and securely affixed to the sacrotuberous ligament. The wound was directly closed without further incision or dissection. Twelve ischial pressure sores (6 primary and 6 recurrent; 12 patients) were surgically corrected. The follow-up period was 12 to 65 months. All patients healed successfully without early postoperative complications, such as hematoma, seroma, infection, wound dehiscence, or partial necrosis. Late complications included wound disruption 5 weeks after surgery that spontaneously healed in 1 case and recurrence 3 years later in another case. The new surgical option presented herein, which involves hamstring-adductor magnus advancement flap and direct closure, is a simple and reliable method for providing sufficient muscle bulk to fill the dead space and proper padding to the bone stump while preserving the main vascular perforators and pedicles as well as future surgical options.

  11. The cost-effectiveness and cost-utility of high-dose palliative radiotherapy for advanced non-small-cell lung cancer

    Coy, Peter; Schaafsma, Joseph; Schofield, John A.

    2000-01-01

    Purpose: To compute cost-effectiveness/cost-utility (CE/CU) ratios, from the treatment clinic and societal perspectives, for high-dose palliative radiotherapy treatment (RT) for advanced non-small-cell lung cancer (NSCLC) against best supportive care (BSC) as comparator, and thereby demonstrate a method for computing CE/CU ratios when randomized clinical trial (RCT) data cannot be generated. Methods and Materials: Unit cost estimates based on an earlier reported 1989-90 analysis of treatment costs at the Vancouver Island Cancer Centre, Victoria, British Columbia, Canada, are updated to 1997-1998 and then used to compute the incremental cost of an average dose of high-dose palliative RT. The incremental number of life days and quality-adjusted life days (QALDs) attributable to treatment are from earlier reported regression analyses of the survival and quality-of-life data from patients who enrolled prospectively in a lung cancer management cost-effectiveness study at the clinic over a 2-year period from 1990 to 1992. Results: The baseline CE and CU ratios are $9245 Cdn per life year (LY) and $12,836 per quality-adjusted life year (QALY), respectively, from the clinic perspective; and $12,253/LY and $17,012/QALY, respectively, from the societal perspective. Multivariate sensitivity analysis for the CE ratio produces a range of $5513-28,270/LY from the clinic perspective, and $7307-37,465/LY from the societal perspective. Similar calculations for the CU ratio produce a range of $7205-37,134/QALY from the clinic perspective, and $9550-49,213/QALY from the societal perspective. Conclusion: The cost effectiveness and cost utility of high-dose palliative RT for advanced NSCLC compares favorably with the cost effectiveness of other forms of treatment for NSCLC, of treatments of other forms of cancer, and of many other commonly used medical interventions; and lies within the US $50,000/QALY benchmark often cited for cost-effective care

  12. Conferring of contracts by utilities in the Single European Market. Transposition of the sectoral directive where it concerns construction and delivery orders into German law

    Pick, H.; Wetzel, U.

    1994-01-01

    After the enactment of the Second Law Amending the Law on Budgetary Principles, the Ordinance on the Confering of Contracts, and the Ordinance on Verification; and the amendment of the ordinances on the placing of construction and delivery orders (VOB and VOL) the European Directives on so-called ''public'' tendering can be said to be transposed into German law as far as they concern construction and delivery orders. This means that as of 1 March 1994 besides the ''classical'' public contractors utilities, too, must invite bids Europe-wide. According to European law this also applies to service orders as of 1 July 1994, but this provision still awaits transposition into German law. (orig.) [de

  13. A hybrid pulse combining topology utilizing the combination of modularized avalanche transistor Marx circuits, direct pulse adding, and transmission line transformer.

    Li, Jiangtao; Zhao, Zheng; Sun, Yi; Liu, Yuhao; Ren, Ziyuan; He, Jiaxin; Cao, Hui; Zheng, Minjun

    2017-03-01

    Numerous applications driven by pulsed voltage require pulses to be with high amplitude, high repetitive frequency, and narrow width, which could be satisfied by utilizing avalanche transistors. The output improvement is severely limited by power capacities of transistors. Pulse combining is an effective approach to increase the output amplitude while still adopting conventional pulse generating modules. However, there are drawbacks in traditional topologies including the saturation tendency of combining efficiency and waveform oscillation. In this paper, a hybrid pulse combining topology was adopted utilizing the combination of modularized avalanche transistor Marx circuits, direct pulse adding, and transmission line transformer. The factors affecting the combining efficiency were determined including the output time synchronization of Marx circuits, and the quantity and position of magnetic cores. The numbers of the parallel modules and the stages were determined by the output characteristics of each combining method. Experimental results illustrated the ability of generating pulses with 2-14 kV amplitude, 7-11 ns width, and a maximum 10 kHz repetitive rate on a matched 50-300 Ω resistive load. The hybrid topology would be a convinced pulse combining method for similar nanosecond pulse generators based on the solid-state switches.

  14. Application of effect-directed analysis to identify mutagenic nitrogenous disinfection by-products of advanced oxidation drinking water treatment

    Vughs, D.; Baken, K.A.; Kolkman, A.; Martijn, A.J.; de Voogt, P.

    Advanced oxidation processes are important barriers for organic micropollutants in (drinking) water treatment. It is however known that medium pressure UV/H2O2 treatment may lead to mutagenicity in the Ames test, which is no longer present after granulated activated carbon (GAC) filtration. Many

  15. Utility of the Hebb–Williams Maze Paradigm for Translational Research in Fragile X Syndrome: A Direct Comparison of Mice and Humans

    Boutet, Isabelle; Collin, Charles A.; MacLeod, Lindsey S.; Messier, Claude; Holahan, Matthew R.; Berry-Kravis, Elizabeth; Gandhi, Reno M.; Kogan, Cary S.

    2018-01-01

    To generate meaningful information, translational research must employ paradigms that allow extrapolation from animal models to humans. However, few studies have evaluated translational paradigms on the basis of defined validation criteria. We outline three criteria for validating translational paradigms. We then evaluate the Hebb–Williams maze paradigm (Hebb and Williams, 1946; Rabinovitch and Rosvold, 1951) on the basis of these criteria using Fragile X syndrome (FXS) as model disease. We focused on this paradigm because it allows direct comparison of humans and animals on tasks that are behaviorally equivalent (criterion #1) and because it measures spatial information processing, a cognitive domain for which FXS individuals and mice show impairments as compared to controls (criterion #2). We directly compared the performance of affected humans and mice across different experimental conditions and measures of behavior to identify which conditions produce comparable patterns of results in both species. Species differences were negligible for Mazes 2, 4, and 5 irrespective of the presence of visual cues, suggesting that these mazes could be used to measure spatial learning in both species. With regards to performance on the first trial, which reflects visuo-spatial problem solving, Mazes 5 and 9 without visual cues produced the most consistent results. We conclude that the Hebb–Williams mazes paradigm has the potential to be utilized in translational research to measure comparable cognitive functions in FXS humans and animals (criterion #3). PMID:29643767

  16. A possible utilization of the mice forced swim test for modeling manic-like increase in vigor and goal-directed behavior.

    Flaisher-Grinberg, Shlomit; Einat, Haim

    2009-01-01

    The lack of appropriate animal models for bipolar disorder (BPD) is a major factor hindering the research of its pathophysiology and the development of new drug treatments. In line with the notion that BPD might represent a heterogeneous group of disorders, it was suggested that models for specific domains of BPD should be developed. The present study tested the possible utilization of the forced swim test (FST) as a model for the heightened vigor and goal-directed behavior domain of mania, using mice with low baseline immobility. Black Swiss mice were previously identified to have low immobility in the FST but similar spontaneous activity levels compared with several other mice strains. Thus, spontaneous activity and behavior in the FST were evaluated following treatment with the mood stabilizer valproate and the antidepressant imipramine. The results indicated that valproate increased immobility in the FST without affecting spontaneous activity whereas imipramine had no effect in the FST but increased spontaneous activity. These findings suggest that in mice with low baseline immobility scores, the FST might be a useful model for the elevated vigor and goal-directed behavior domain of mania. As such, this test might be well integrated into a battery of models for different domains of BPD.

  17. Utility of the Hebb-Williams Maze Paradigm for Translational Research in Fragile X Syndrome: A Direct Comparison of Mice and Humans.

    Boutet, Isabelle; Collin, Charles A; MacLeod, Lindsey S; Messier, Claude; Holahan, Matthew R; Berry-Kravis, Elizabeth; Gandhi, Reno M; Kogan, Cary S

    2018-01-01

    To generate meaningful information, translational research must employ paradigms that allow extrapolation from animal models to humans. However, few studies have evaluated translational paradigms on the basis of defined validation criteria. We outline three criteria for validating translational paradigms. We then evaluate the Hebb-Williams maze paradigm (Hebb and Williams, 1946; Rabinovitch and Rosvold, 1951) on the basis of these criteria using Fragile X syndrome (FXS) as model disease. We focused on this paradigm because it allows direct comparison of humans and animals on tasks that are behaviorally equivalent (criterion #1) and because it measures spatial information processing, a cognitive domain for which FXS individuals and mice show impairments as compared to controls (criterion #2). We directly compared the performance of affected humans and mice across different experimental conditions and measures of behavior to identify which conditions produce comparable patterns of results in both species. Species differences were negligible for Mazes 2, 4, and 5 irrespective of the presence of visual cues, suggesting that these mazes could be used to measure spatial learning in both species. With regards to performance on the first trial, which reflects visuo-spatial problem solving, Mazes 5 and 9 without visual cues produced the most consistent results. We conclude that the Hebb-Williams mazes paradigm has the potential to be utilized in translational research to measure comparable cognitive functions in FXS humans and animals (criterion #3).

  18. Direct coupling of electromembrane extraction to mass spectrometry – Advancing the probe functionality toward measurements of zwitterionic drug metabolites

    Kige Rye, Torstein; Fuchs, David; Pedersen-Bjergaard, Stig

    2017-01-01

    A triple-flow electromembrane extraction (EME) probe was developed and coupled directly to electrospray-ionization mass spectrometry (ESI-MS). Metabolic reaction mixtures (pH 7.4) containing drug substances and related metabolites were continuously drawn (20 μL/min) into the EME probe in one flow......-nitrophenyl octyl ether (and for some experiments containing 30% triphenyl phosphate (TPP)), and into 20 μL min-1 of formic acid as acceptor phase, which was introduced through a third flow channel. The acceptor phase was pumped directly to the MS system, and the ion intensity of extracted analytes......, the system can potentially be used for direct analysis of various kinds of chemical reactions that have to be run at pH conditions unfavorable for direct analyte extractions....

  19. Factors Affecting the Self-directed Learning of Students at Clinical Practice Course for Advanced Practice Nurse

    Miyoung Kim, RN, PhD, MBA, GNP

    2011-03-01

    Conclusions: This study demonstrated the hierarchical relationship among belongingness, self-esteem, and self-directed learning based on the conceptual framework developed by Levett-Jones and Lathlean, thus proving the usefulness of this framework for application in the field. Therefore, this study found that there are needs of high self-esteem and belongingness in order to improve self-directed learning for APN students in clinical practice.

  20. Are written advance directives helpful to guide end-of-life therapy in the intensive care unit? A retrospective matched-cohort study.

    Hartog, Christiane S; Peschel, Ilka; Schwarzkopf, Daniel; Curtis, J Randall; Westermann, Isabella; Kabisch, Bjoern; Pfeifer, Ruediger; Guenther, Albrecht; Michalsen, Andrej; Reinhart, Konrad

    2014-02-01

    The purpose of the study was to determine whether treatment preferences in patients' advance directives (ADs) are associated with life-supporting treatments received during end-of-life care in the intensive care unit (ICU). This is a retrospective cohort study, including patients who died in 4 ICUs of a university hospital in Germany. Patients with ADs were matched with 2 patients each without ADs using propensity scores. Sixty-four (13%) of 477 patients had ADs, written a median of 109 weeks before admission. Five categories of applicability conditions were identified, most of them difficult to interpret in the ICU (eg, "advanced brain impairment" or "imminent death"). Advance directives contained a number of treatment refusals. Specifically, 63 of 64 refused "life-sustaining measures." Compared to patients without ADs, patients with ADs were less likely to receive cardiopulmonary resuscitation (9% vs 23%, P = .029) and more likely to have do-not-resuscitate orders (77% vs 56%, P = .007). Therapy-limiting decisions and ICU length of stay did not differ between those with or without ADs. Patients with ADs are less likely to receive cardiopulmonary resuscitation but otherwise receive similar life-sustaining treatments compared to matched patients without ADs. More research is needed to explore reasons for potential noncompliance with patient preferences. © 2013.

  1. DISTINCT: Diversity in Solar Talent Through INnovative Curriculum and Training: An Integrated Research and Education Approach towards Creating Diversity and Advancing Utility-Scale Solar Technology

    Krishnaswami, Hariharan [Univ. of Texas, San Antonio, TX (United States)

    2018-02-05

    The DISTINCT project research objective is to develop an innovative N-port power converter for a utility-scale PV system that is modular, compact and cost-effective and that will enable the integration of a high-frequency, high-voltage solid-state transformer. The novelty of the proposed research is the electrical power conversion architecture using an N-port converter system that replaces the output 60Hz transformer with an integrated high-frequency low-weight solid-state transformer reducing power electronics and BOS costs to meet SunShot goals through modularity and direct high-voltage interconnection. A challenge in direct integration with a 13.8kV line is the high voltage handling capacity of the converters combined with high efficiency operation. The front-end converter for each port is a Neutral-Point Clamped (NPC) Multi-Level dc-dc Dual-Active Bridge (ML-DAB) which allows Maximum Power Point Tracking (MPPT). The integrated high frequency transformer provides the galvanic isolation between the PV and grid side and also steps up the low dc voltage from PV source. Following the ML-DAB stage, in each port, is an inverter with H-bridge configuration or NPC configuration. N number of NPC inverters’ outputs are cascaded to attain the per-phase line-to-neutral voltage to connect directly to the distribution grid (i.e. 13.8 kV). The cascaded inverters have the inherent advantage of using lower rated devices, smaller filters and low Total Harmonic Distortion (THD) required for PV grid interconnection. Our analysis and simulation results show improved performance on cost, efficiency, service life with zero downtime and THD. A comprehensive control scheme is presented to ensure the maximum power from each port and each phase are sent to the grid. A functional prototype of a 2-port converter with ML-DAB and cascaded H-bridges has been designed, built, and tested in a laboratory setup to verify the target technical metrics. The N-port converter system due to its

  2. Utility of Direct Fluorescent Antibody Test for detection of Chlamydia trachomatis and its detection in male patients with non gonococcal urethritis in New Delhi

    Agrawal S

    2003-03-01

    Full Text Available The purpose of this study was assessment of prevalence of Chlamydia trachomatis and utility of Direct Fluorescent Antibody (DFA test for its detection in male patients with non gonococcal urethritis in New Delhi , India Thirty male patients with symptoms of dysuria showing polymorphs in their gram stained urethral smears with no evidence of Neisseria gonorrhoeae, and negative for Trichomonas vaginalis and Candida albicans by wet mount were subjected to DFA test for detection of C. trachomatis in urethral samples. Microscopic examination of gram stained urethral smears revealed 5-7 polymorphs / HPF in 90% of the patients. Evidence of C. trachomatis with DFA (MicroTrak was detected in 11 cases (36.67% when a cut off of 10 elementary bodies was considered essential. It is concluded that C. trachomatis is an important cause of non gonococcal urethritis in male patients in New Delhi and DFA test is a useful diagnostic tool in its detection. Where facilities are not available for its detection antichlamydial therapy should be recommended emperically.

  3. ‘Overall Regional Planning, Whole Advancement, and Terminal Offer’is the Fundamental Outset for Prohibition of Burning Straw in Field and Total Utilization of Straws in China

    CHANG Zhi-zhou

    2015-08-01

    Full Text Available Straw burning is a serious problem, which draws high attention from the whole society. In this study, the issues of management, policy and techniques regarding to the straw burning and its integrated utilization were analyzed. Based on the analysis results, a novel strategy, i.e., overall regional planning, village basis, combination of collection and returning, policy guidance and market operation, was raised to inhibit straw burning and enhance the efficiency of straw utilization. In technology, the methods of regional control, balance of harvest and return, effective collection, improving application, creative mechanism were emphasized. In addition, the effect of total utilization replying on the method of overall regional planning and whole advancement was presented on the village-scale. The application results in Chemen Township, Sihong County, Jiangsu Province showed that the goal of total utilization of straws and prohibition of burning in the regional scale could be achieved according to the novel strategy.

  4. Direct coupling of electromembrane extraction to mass spectrometry - Advancing the probe functionality toward measurements of zwitterionic drug metabolites.

    Rye, Torstein Kige; Fuchs, David; Pedersen-Bjergaard, Stig; Petersen, Nickolaj Jacob

    2017-08-29

    A triple-flow electromembrane extraction (EME) probe was developed and coupled directly to electrospray-ionization mass spectrometry (ESI-MS). Metabolic reaction mixtures (pH 7.4) containing drug substances and related metabolites were continuously drawn (20 μL/min) into the EME probe in one flow channel, and mixed inside the probe with 7.5 μL min -1 of 1 M formic acid as make-up flow from a second flow channel. Following this acidification, the drug substances and their related metabolites were continuously extracted by EME at 400 V, across a supported liquid membrane (SLM) comprising 2-nitrophenyl octyl ether (and for some experiments containing 30% triphenyl phosphate (TPP)), and into 20 μL min -1 of formic acid as acceptor phase, which was introduced through a third flow channel. The acceptor phase was pumped directly to the MS system, and the ion intensity of extracted analytes was followed continuously as function of time. The triple-flow EME probe was used for co-extraction of positively charged parent drugs and their zwitterionic drug metabolites (hydroxyzine and its carboxylic acid metabolite cetirizine; and vortioxetine and its carboxylic acid metabolite Lu AA34443). While the zwitterionic metabolites could not be extracted at pH 7.4, it was shown that by acidifying the sample solution the zwitterionic metabolites could be extracted effectively. Various extraction parameters like make-up flow, extraction voltage and SLM composition were optimized for simultaneous extraction of parent drugs and metabolites. It was found that TPP added to the SLM improved extraction efficiencies of certain drug metabolites. Finally the optimized and characterized triple-flow EME probe was used for online studying the in-vitro metabolism of hydroxyzine and vortioxetine by rat liver microsomes. Due to the automated pre-extraction acidification of the rat liver microsomal solutions, it was possible to continuously monitor formation of the zwitterionic drug

  5. Development of advanced pump impeller fabrication technology using direct nano- ceramic dispersion casting for long time erosion durability

    Rhee, Chang Kyu; Lee, Min Ku; Park, Jin Ju

    2008-09-01

    Many components of pump impeller of nuclear power plants is generally made of stainless steel and Al-bronze with superior corrosion resistance to sea water. However, they should be replaced by one- to five-year period because of material damage by a very big cavitation impact load, even though their designed durability is twenty years. Especially, in case of Young-Gwang nuclear power plant located at the west sea, damage of components of pump impeller is so critical due to the additional damage by solid particle erosion and hence their replacement period is very short as several months compared to other nuclear power plants. In addition, it is very difficult to maintain and repair the components of pump impeller since there is no database on the exact durability and damage mechanism. Therefore, in this study, fabrication technology of new advanced materials modified by dispersion of nano-carbide and -oxide ceramics into the matrix is developed first. Secondly, technology to estimate the dynamic damage by solid particle erosion is established and hence applied to the prediction of the service life of the components of pump impeller

  6. Preoperative Direct Puncture Embolization of Advanced Juvenile Nasopharyngeal Angiofibroma in Combination with Transarterial Embolization: An Analysis of 22 Consecutive Patients

    Lv Mingming; Fan, Xin-dong; Su Lixin; Chen Dong

    2013-01-01

    ObjectiveThis study was designed to evaluate the clinical application of preoperative auxiliary embolization for juvenile nasopharyngeal angiofibroma (JNA) by direct puncture embolization (DPE) of the tumor in combination with transarterial embolization (TAE). The study included 22 patients. An 18-gauge needle was used to puncture directly into the tumor, and 20–25 % N-butyl cyanoacrylate was injected under the guidance of fluoroscopy after confirming the placement of the needle into the JNA and no leaking into the surrounding tissue. Tumors were obstructed later via TAE. The supplying arteries of JNA were from branches of the internal carotid and external carotid arteries. Control angiography showed the obliteration of contrast stain in the entire tumor mass and the distal supplying arteries disappeared after DPE in combination with TAE. Surgical resection was performed within 4 days after embolization and none of the patients required blood transfusion. The use of DPE in combination with TAE was a safe, feasible, and efficacious method. It can devascularize effectively the JNAs and reduce intraoperative bleeding when JNAs are extirpated.

  7. Preoperative Direct Puncture Embolization of Advanced Juvenile Nasopharyngeal Angiofibroma in Combination with Transarterial Embolization: An Analysis of 22 Consecutive Patients

    Lv Mingming, E-mail: lvmingming001@163.com; Fan, Xin-dong, E-mail: fanxindong@yahoo.com.cn [Shanghai Jiao Tong University School of Medicine, Department of Radiology, Ninth People' s Hospital (China); Su Lixin, E-mail: sulixin1975@126.com [Shanghai Jiao Tong University School of Medicine, Department of Oral and Maxillofacial Surgery, Ninth People' s Hospital (China); Chen Dong, E-mail: chenjsun@public8.sta.net.cn [Shanghai Jiao Tong University School of Medicine, Department of Otolaryngology, Ninth People' s Hospital (China)

    2013-02-15

    ObjectiveThis study was designed to evaluate the clinical application of preoperative auxiliary embolization for juvenile nasopharyngeal angiofibroma (JNA) by direct puncture embolization (DPE) of the tumor in combination with transarterial embolization (TAE). The study included 22 patients. An 18-gauge needle was used to puncture directly into the tumor, and 20-25 % N-butyl cyanoacrylate was injected under the guidance of fluoroscopy after confirming the placement of the needle into the JNA and no leaking into the surrounding tissue. Tumors were obstructed later via TAE. The supplying arteries of JNA were from branches of the internal carotid and external carotid arteries. Control angiography showed the obliteration of contrast stain in the entire tumor mass and the distal supplying arteries disappeared after DPE in combination with TAE. Surgical resection was performed within 4 days after embolization and none of the patients required blood transfusion. The use of DPE in combination with TAE was a safe, feasible, and efficacious method. It can devascularize effectively the JNAs and reduce intraoperative bleeding when JNAs are extirpated.

  8. Advances in Methane Isotope Measurements via Direct Absorption Spectroscopy with Applications to Oil and Gas Source Characterization

    Yacovitch, T. I.; Herndon, S. C.; Roscioli, J. R.; Petron, G.; Shorter, J. H.; Jervis, D.; McManus, J. B.; Nelson, D. D.; Zahniser, M. S.; Kolb, C. E., Jr.

    2015-12-01

    Instrumental developments in the measurement of multiple isotopes of methane (12CH4, 13CH4 and 12CH3D) are presented. A first generation 8-micron instrument quantifies 12CH4 and 13CH4 at a 1-second rate via tunable infrared direct absorption spectroscopy (TILDAS). A second generation instrument uses two 3-micron intraband cascade lasers in an Aerodyne dual laser chassis for simultaneous measurement of 12CH4, 13CH4 and 12CH3D. Sensitivity and noise performance improvements are examined. The isotopic signature of methane provides valuable information for emission source identification of this greenhouse gas. A first generation spectrometer has been deployed in the field on a mobile laboratory along with a sophisticated 4-tank calibration system. Calibrations are done on an agressive schedule, allowing for the correction of measured isotope ratios to an absolute isotope scale. Distinct isotopic signatures are found for a number of emission sources in the Denver-Julesburg Basin: oil and gas gathering stations, compressor stations and processing plants; a municipal landfill, and dairy/cattle operations. The isotopic signatures are compared with measured ethane/methane ratios. These direct absorption measurements have larger uncertainties than samples measured via gas chromatography-mass spectrometry, but have several advantages over canister sampling methods: individual sources of short duration are easier to isolate; calibrated isotope ratio results are available immediately; replicate measurements on a single source are easily performed; and the number of sources sampled is not limited by canister availability and processing time.

  9. Land usage attributed to corn ethanol production in the United States: sensitivity to technological advances in corn grain yield, ethanol conversion, and co-product utilization.

    Mumm, Rita H; Goldsmith, Peter D; Rausch, Kent D; Stein, Hans H

    2014-01-01

    Although the system for producing yellow corn grain is well established in the US, its role among other biofeedstock alternatives to petroleum-based energy sources has to be balanced with its predominant purpose for food and feed as well as economics, land use, and environmental stewardship. We model land usage attributed to corn ethanol production in the US to evaluate the effects of anticipated technological change in corn grain production, ethanol processing, and livestock feeding through a multi-disciplinary approach. Seven scenarios are evaluated: four considering the impact of technological advances on corn grain production, two focused on improved efficiencies in ethanol processing, and one reflecting greater use of ethanol co-products (that is, distillers dried grains with solubles) in diets for dairy cattle, pigs, and poultry. For each scenario, land area attributed to corn ethanol production is estimated for three time horizons: 2011 (current), the time period at which the 15 billion gallon cap for corn ethanol as per the Renewable Fuel Standard is achieved, and 2026 (15 years out). Although 40.5% of corn grain was channeled to ethanol processing in 2011, only 25% of US corn acreage was attributable to ethanol when accounting for feed co-product utilization. By 2026, land area attributed to corn ethanol production is reduced to 11% to 19% depending on the corn grain yield level associated with the four corn production scenarios, considering oil replacement associated with the soybean meal substituted in livestock diets with distillers dried grains with solubles. Efficiencies in ethanol processing, although producing more ethanol per bushel of processed corn, result in less co-products and therefore less offset of corn acreage. Shifting the use of distillers dried grains with solubles in feed to dairy cattle, pigs, and poultry substantially reduces land area attributed to corn ethanol production. However, because distillers dried grains with solubles

  10. The Airborne Process{sup TM} : advancement in multi-pollutant emissions control technology by product utilization and the commercialization process

    Mortson, M. [Airborne Clean Energy LLC, Terrace Park, OH (United States)

    2006-07-01

    This paper described research and development programs conducted to develop a pollution abatement technology called the Airborne process. The Airborne process is comprised of 3 stages: (1) sodium flue gas purification; (2) sodium bicarbonate regeneration; and (3) a patented granulation process in which ammonia byproducts are transformed into fertilizer. A research program conducted by CANMET developed a new technique to remove heavy metals from sodium sulfate scrubbing solutions, and tested the scrubbing of mixed flue gas in a bench-scale reaction chamber. Pilot tests were conducted to scrub the flue gas in a 0.3 MW coal-fired combustor. The removal of heavy metals and particulates prior to fertilizer production resulted in fertilizer purity that exceeds all global standards. A total of 11 combustion trials were conducted with 11 different types of coal. Results of vertical combustor tests showed that both sulphur oxides (SO{sub x}) and nitrogen oxides (NO{sub x}) decreased rapidly after injection started. The scrubber was effective in removing oxidized states of NO as well as 75 per cent of mercury (Hg) capture. The technology was adopted by the Kentucky Utilities Generating Station 6 MW regeneration plant, which developed an automated operation of a scaled down version of the CANMET system. Sulphur dioxide (SO{sub 2}) and sulfite (SO{sub 3}) reduction at the plant was almost 100 per cent. NO{sub x} reduction to date was approximately 92 per cent, while Hg reduction was 70 per cent. An advanced mercury and NO{sub x} program was developed to examine the chemical effects of oxidants as well as to examine methods of total mercury and NO{sub x} removal. A simplified process schematic of the system was provided. The 3 proven technologies were then integrated to form the Airborne system. It was concluded that full-scale systems are now in operation in power plants across North America. A case study of the Airborne process used at the Mustang generating station in New

  11. Development of advanced direct perception displays for nuclear power plants to enhance monitoring, control and fault management

    Jones, B.G.; Shaheen, S.; Moray, N.

    1997-01-01

    Traditional Single-Sensor-Single Indicator (SSSI) displays are poorly matched to the cognitive abilities of operators, especially for large and complex systems. It is difficult for operators to monitor very large arrays of displays and controls, and to integrate the information displayed therein. In addition, standard operating procedures (SOPs) are bulky (running to many hundreds of pages) and difficult to use, and operators may become lost. For these reasons, and also because it is becoming increasingly difficult to find replacements for aging hardware components, there is a trend towards computerized graphical interfaces for nuclear power plants (NPPs). There is, however, little rational theory for display design in this domain. This report describes some recent theoretical developments and shows how to develop displays which will greatly reduce the cognitive load on the operator and allow the use of perceptual rather than cognitive mechanisms while using SON and to support state diagnosis and fault management. The report outlines the conceptual framework within which such a new approach could be developed, and provides an example of how the operating procedures for the start-up sequence of a NPP could be realized. A detailed description of a set of displays for a graphical interface for the SON of the feedwater system is provided as an example of how the proposed approach could be realized, and a general account of how it would fit into the overall start-up sequence is given. Examples of open-quotes direct perceptionclose quotes or open-quotes ecologicalclose quotes configural state space displays to support the use of the proposed direct manipulation SOP interface are provided, and also a critical discussion which identifies some difficulties which may be anticipated should the general approach herein advocated be adopted

  12. Advanced direct liquefaction concepts for PETC generic units. [Mainly, the effect of preteatment of coal with carbon monoxide and steam

    1992-08-01

    CAER/UK: Detail coal and starting solvents from Wilsonville were analyzed to develop the data necessary to conduct process studies in the CO Pretreatment and Catalyst Evaluation segment of this program. A comparison of the solvent separation analysis with the distillation/separation used at Wilsonville showed that the residual solvent components contained a large amount of residual pentane soluble products. The ashy resid contained 3% iron and 400 ppM molybdenum. Although the iron content in the distillate and deashed resid was much less, namely about 200 ppM., the molybdenum concentrations in these fractions were not significantly reduced over the concentration in the ashy resid, i.e., 200 ppM in each. The pretreatment of coal with CO/H{sub 2}O in the presence of NaOH and Na{sub 2}CO{sub 3} has been shown to give a product which is lower in oxygen content and higher in hydrogen content compared to the raw coal. The atomic H/C ratios of the H{sub 2}O-insolubles, THF insolubles and the PA+A fractions of the products-together with the hydrogen consumption data suggested that the raw coal has been substantially depolymerized and hydrogenated via the WGS reaction during the pretreatment process. The extensive amount of molecular reconstruction that has occurred in the solid product was evident from the ease of solubilization of the product into pyridine. The result of the pretreatment process is a product which is highly reactive under hydroliquefaction conditions at 400{degrees}C. Reaction rates seem to be much faster than the raw coal, especially at shorter reaction times, providing the opportunity for major reductions in plant vessel sizes, and preliminary data has led us to believe that better efficiency in hydrogen utilization is achieved.

  13. Novel Emergency Medicine Curriculum Utilizing Self-Directed Learning and the Flipped Classroom Method: Head, Eyes, Ears, Nose and Throat Emergencies Small Group Module

    Andrew King

    2017-09-01

    Full Text Available Audience: This curriculum created and implemented at The Ohio State University Wexner Medical Center was designed to educate our emergency medicine (EM residents, PGY-1 to PGY-3, as well as medical students and attending physicians. Introduction: Head, Eyes, Ears, Nose and Throat (HEENT complaints are very commonly seen in the Emergency Department. Numbers vary as to exact prevalence, but sources show that there are about 2 million annual emergency department (ED visits in the United States for non-traumatic dental problems, representing 1.5% of all ED visits.1 Other sources show that symptoms referable to the throat encompass 2,496,000 visits or 1.9% of total visits.2 Notably, about 8% of the written exam in emergency medicine covers the topic of head and neck complaints, making it the second most tested topic behind cardiovascular.3 Residents must be proficient in the differential diagnosis and management of the wide variety of HEENT emergencies. The flipped classroom curricular model emphasizes self-directed learning activities completed by learners, followed by small group discussions pertaining to the topic reviewed. The active learning fostered by this curriculum increases faculty and learner engagement and interaction time typically absent in traditional lecture-based formats.4-6 Studies have revealed that the application of knowledge through case studies, personal interaction with content experts, and integrated questions are effective learning strategies for emergency medicine residents.6-8 The Ohio State University EM Residency didactic curriculum recently transitioned to a “flipped classroom” approach.9-13 We created this innovative curriculum aimed to improve our residency education program and to share educational resources with other EM residency programs. Our curriculum utilizes an 18-month curricular cycle to cover the defined emergency medicine content. The flipped classroom curriculum maximizes didactic time and resident

  14. ON THE UTILITY OF ENFORCING DIRECTIVE 2013/34/EU IN THE FIELD OF THE SOCIAL RESPONSBILITY OF THE PUBLIC ORGANISATIONS

    Potincu Cristian Romeo

    2015-07-01

    Full Text Available This work analyses the utility and possibility of extending the legislation adopted at the European Union level – in the field of reporting the socially responsible results of the joint-stock companies, limited liability companies, partnerships limited by shares, general partnerships, and limited partnerships – also in the case of the public organisations. The scientific work starts from the concept of the corporate social responsibility, a concept including five types of responsibilities: ecologic responsibility, economic responsibility, juridical responsibility, ethical responsibility, and philanthropic responsibility. Further to the analyses of the results of a quantitative marketing research performed in 2014 in Brașov municipality, Romania, and Directive 2013/34/EU of the European Parliament and Council regarding the annual financial statements, consolidated financial statements and related reports of certain types of enterprises, as well as of the special situation, in most of the cases, of the performed activity and profit achieved by the public organizations, the de lege ferenda proposals have been exposed regarding the possibility of extending the juridical regulations concerning the philanthropic component of the social responsibility also on the public organisations. The marketing research on ”Attitudes and opinions of the Brașov citizens regarding social responsibility” has had the final sample made up 386 persons, with a random error of ± 4.99%, which can be considered a minimum limit of representativeness. Thus, the results of this research are representative for Brașov town, and can also be extended in the case of other large towns from Romania. The analysed results have revealed the view of the questioned Brașov citizens regarding the reporting activity and the manner of reporting from the business operators of the socially responsible activity. The juridical analysis of the provisions of Directive 2013/34/EU of the

  15. Novel Emergency Medicine Curriculum Utilizing Self-Directed Learning and the Flipped Classroom Method: Obstetric and Gynecologic Emergencies Small Group Module

    Jillian McGrath

    2017-09-01

    Full Text Available Audience: This curriculum, created and implemented at The Ohio State University Wexner Medical Center, was primarily designed to educate our emergency medicine (EM residents (PGY1-3 and emergency medicine/internal medicine (EM/IM residents (PGY1-5 on core obstetrics and gynecology topics in EM. Additional audience members include medical students and faculty physicians. Introduction: In 2013, there were over 1 million emergency department visits in the United States which resulted in primary obstetric or gynecologic diagnoses.1 EM Residents must be proficient in the differential diagnosis and management of the wide variety of obstetric and gynecologic emergencies. To do this, we developed a flipped classroom curricular model, which consists of self-directed learning activities completed by learners, followed by small group discussions pertaining to the topic reviewed. The active learning fostered by this type of curriculum increases faculty and learner engagement and interaction time typically absent in traditional lecture-based formats.2-4 Studies have revealed that the application of knowledge through case studies, personal interaction with content experts, and integrated questions are effective learning strategies for EM residents.4-6 The Ohio State University Wexner Medical Center EM residency didactic curriculum recently transitioned to a “flipped classroom” approach.7-10 Our didactic curriculum is delivered over the course of 18 months; however, it could easily be adapted to other academic calendar cycles. The flipped classroom curriculum maximizes didactic time and resident engagement, fosters intellectual curiosity and active learning, and meets the needs of today’s learners. 3,6,11 Objectives: We aim to teach the presentation and management of obstetric and gynecologic emergencies through the creation of a flipped classroom design. This unique, innovative curriculum utilizes resources chosen by education faculty and resident

  16. MoS2 nanosheets direct supported on reduced graphene oxide: An advanced electrocatalyst for hydrogen evolution reaction.

    Jiamu Cao

    Full Text Available Molybdenum disulfide nanosheets/reduced graphene oxide (MoS2 NSs/rGO nanohybrid as a highly effective catalyst for hydrogen evolution reaction (HER have been successfully synthesized by a facile microwave-assisted method. The results clearly reveal that direct grown of MoS2 NSs on rGO have been achieved. Electrochemical tests show that the as-prepared hybrid material exhibited excellent HER activity, with a small Tafel slope of 57 mV dec-1, an overpotential of 130 mV and remarkable cycling stability. After analysis, the observed outstanding catalytic performance can be attributed to the uniform distribution of the MoS2 NSs, which are characterized by the presence of multiple active sites as well as the effective electron transport route provided by the conductive rGO substrate. Moreover, according to the classic theory, the mechanism governing of the catalytic HER on the MoS2 NSs/rGO nanohybrid has been clarified.

  17. Advancing Solar Irradiance Measurement for Climate-Related Studies: Accurate Constraint on Direct Aerosol Radiative Effect (DARE)

    Tsay, Si-Chee; Ji, Q. Jack

    2011-01-01

    Earth's climate is driven primarily by solar radiation. As summarized in various IPCC reports, the global average of radiative forcing for different agents and mechanisms, such as aerosols or CO2 doubling, is in the range of a few W/sq m. However, when solar irradiance is measured by broadband radiometers, such as the fleet of Eppley Precision Solar Pyranometers (PSP) and equivalent instrumentation employed worldwide, the measurement uncertainty is larger than 2% (e.g., WMO specification of pyranometer, 2008). Thus, out of the approx. 184 W/sq m (approx.263 W/sq m if cloud-free) surface solar insolation (Trenberth et al. 2009), the measurement uncertainty is greater than +/-3.6 W/sq m, overwhelming the climate change signals. To discern these signals, less than a 1 % measurement uncertainty is required and is currently achievable only by means of a newly developed methodology employing a modified PSP-like pyranometer and an updated calibration equation to account for its thermal effects (li and Tsay, 2010). In this talk, we will show that some auxiliary measurements, such as those from a collocated pyrgeometer or air temperature sensors, can help correct historical datasets. Additionally, we will also demonstrate that a pyrheliometer is not free of the thermal effect; therefore, comparing to a high cost yet still not thermal-effect-free "direct + diffuse" approach in measuring surface solar irradiance, our new method is more economical, and more likely to be suitable for correcting a wide variety of historical datasets. Modeling simulations will be presented that a corrected solar irradiance measurement has a significant impact on aerosol forcing, and thus plays an important role in climate studies.

  18. Advances in the simulation and automated measurement of well-sorted granular material: 2. Direct measures of particle properties

    Buscombe, D.; Rubin, D. M.

    2012-06-01

    In this, the second of a pair of papers on the structure of well-sorted natural granular material (sediment), new methods are described for automated measurements from images of sediment, of: 1) particle-size standard deviation (arithmetic sorting) with and without apparent void fraction; and 2) mean particle size in material with void fraction. A variety of simulations of granular material are used for testing purposes, in addition to images of natural sediment. Simulations are also used to establish that the effects on automated particle sizing of grains visible through the interstices of the grains at the very surface of a granular material continue to a depth of approximately 4 grain diameters and that this is independent of mean particle size. Ensemble root-mean squared error between observed and estimated arithmetic sorting coefficients for 262 images of natural silts, sands and gravels (drawn from 8 populations) is 31%, which reduces to 27% if adjusted for bias (slope correction between observed and estimated values). These methods allow non-intrusive and fully automated measurements of surfaces of unconsolidated granular material. With no tunable parameters or empirically derived coefficients, they should be broadly universal in appropriate applications. However, empirical corrections may need to be applied for the most accurate results. Finally, analytical formulas are derived for the one-step pore-particle transition probability matrix, estimated from the image's autocorrelogram, from which void fraction of a section of granular material can be estimated directly. This model gives excellent predictions of bulk void fraction yet imperfect predictions of pore-particle transitions.

  19. Utility of preoperative ferumoxtran-10 MRI to evaluate retroperitoneal lymph node metastasis in advanced cervical cancer: Results of ACRIN 6671/GOG 0233

    Mostafa Atri

    2015-01-01

    Conclusion: Addition of f-10 increased MRI sensitivity to detect LN metastasis in advanced cervical cancer. Increased sensitivity did not reach statistical significance and was at the expense of lower specificity.

  20. Motivations, aims and communication around advance directives: a mixed-methods study into the perspective of their owners and the influence of a current illness.

    van Wijmen, Matthijs P S; Pasman, H Roeline W; Widdershoven, Guy A M; Onwuteaka-Philipsen, Bregje D

    2014-06-01

    What are motivations of owners of an advance directive (AD) to draft an AD, what do they aim for with their AD and do they communicate about their AD? Written questionnaires were sent to a cohort of people owning different types of ADs (n=5768). A purposive sample of people suffering from an illness was selected from the cohort for an in-depth interview (n=29). About half of our population had no direct motivation to draft their AD. Most mentioned motivation for the other half was an illness of a family member or friend. Many different and specific aims for drafting an AD were mentioned. An often mentioned more general aim in people with different ADs was to prevent unnecessary lengthening of life or treatment (14-16%). Most respondents communicated about having an AD with close-ones (63-88%) and with their GP (65-79%). In the interviews people gave vivid examples of experiences of what they hoped to prevent at the end of life. Some mentioned difficulties foreseeing the future and gave examples of response shift. ADs can give directions to caregivers about what people want at the end of life. ADs have to be discussed in detail by their owners and caregivers, since owners often have specific aims with their AD. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  1. Japanese utilities' plutonium utilization program

    Matsuo, Yuichiro.

    1996-01-01

    Japan's 10 utility companies are working and will continue to work towards establishing a fully closed nuclear fuel cycle. The key goals of which are: (1) reprocessing spent fuel; (2) recycling recovered uranium and plutonium; and (3) commercializing fast breeder technology by around the year 2030. This course of action by the Japanese electric power industry is in full accordance with Japan's national policy outlined in the government's report ''The Long-Term Program for Research, Development, and Nuclear Energy,'' which was published in June 1994. The Japanese civilian nuclear program is a long-term program that looks into the 21st century and beyond. It is quite true that sustaining the recycling option for energy security and the global environment demands a large investment. For it to be accepted by the public, safety must be the highest priority and will be pursued at a great cost if necessary. In its history, Japan has learned that as technology advances, costs will come down. The Japanese utility industry will continue investment in technology without compromising safety until the recycling option becomes more competitive with other options. This effort will be equally applied to the development of the commercial FBRs. The Japanese utility industry is confident that Japan's stable policy and strong objective to develop competitive and peaceful technology will contribute to the global economy and the environment without increasing the threat of plutonium proliferation

  2. DESIGN AND IMPLEMENTATION OF A CO2 FLOOD UTILIZING ADVANCED RESERVOIR CHARACTERIZATION AND HORIZONTAL INJECTION WELLS IN A SHALLOW SHELF CARBONATE APPROACHING WATERFLOOD DEPLETION

    K.J. Harpole; Ed G. Durrett; Susan Snow; J.S. Bles; Carlon Robertson; C.D. Caldwell; D.J. Harms; R.L. King; B.A. Baldwin; D. Wegener; M. Navarrette

    2002-09-01

    The purpose of this project was to economically design an optimum carbon dioxide (CO{sub 2}) flood for a mature waterflood nearing its economic abandonment. The original project utilized advanced reservoir characterization and CO{sub 2} horizontal injection wells as the primary methods to redevelop the South Cowden Unit (SCU). The development plans; project implementation and reservoir management techniques were to be transferred to the public domain to assist in preventing premature abandonment of similar fields. The Unit was a mature waterflood with water cut exceeding 95%. Oil must be mobilized through the use of a miscible or near-miscible fluid to recover significant additional reserves. Also, because the unit was relatively small, it did not have the benefit of economies of scale inherent in normal larger scale projects. Thus, new and innovative methods were required to reduce investment and operating costs. Two primary methods used to accomplish improved economics were use of reservoir characterization to restrict the flood to the higher quality rock in the unit and use of horizontal injection wells to cut investment and operating costs. The project consisted of two budget phases. Budget Phase I started in June 1994 and ended late June 1996. In this phase Reservoir Analysis, Characterization Tasks and Advanced Technology Definition Tasks were completed. Completion enabled the project to be designed, evaluated, and an Authority for Expenditure (AFE) for project implementation submitted to working interest owners for approval. Budget Phase II consisted of the implementation and execution of the project in the field. Phase II was completed in July 2001. Performance monitoring, during Phase II, by mid 1998 identified the majority of producing wells which under performed their anticipated withdrawal rates. Newly drilled and re-activated wells had lower offtake rates than originally forecasted. As a result of poor offtake, higher reservoir pressure was a concern

  3. Current status and future potential for advanced volume reduction technologies

    Rutland, L.; Naughton, M.D.; Papaiya, N.C.

    1984-01-01

    With escalating costs for disposal of low-level radioactive waste (LLW) from nuclear power plants, and the possibility of unavailability of disposal space, some nuclear power utilities responded by commiting to implementing advanced volume reduction (VR) systems. This paper presents recent experience to implement advanced volume reduction technologies; their performance and typical operating and capital costs. This experience in the light of current economic conditions may enable us to predict the directio