Theories of Health Care Decision Making at the End of Life: A Meta-Ethnography.

Science.gov (United States)

Kim, Kyounghae; Heinze, Katherine; Xu, Jiayun; Kurtz, Melissa; Park, Hyunjeong; Foradori, Megan; Nolan, Marie T

2017-08-01

The aim of this meta-ethnography is to appraise the types and uses of theories relative to end-of-life decision making and to develop a conceptual framework to describe end-of-life decision making among patients with advanced cancers, heart failure, and amyotrophic lateral sclerosis (ALS) and their caregivers or providers. We used PubMed, Embase, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases to extract English-language articles published between January 2002 and April 2015. Forty-three articles were included. The most common theories included decision-making models ( n = 14) followed by family-centered ( n = 11) and behavioral change models ( n = 7). A conceptual framework was developed using themes including context of decision making, communication and negotiation of decision making, characteristics of decision makers, goals of decision making, options and alternatives, and outcomes. Future research should enhance and apply these theories to guide research to develop patient-centered decision-making programs that facilitate informed and shared decision making at the end of life among patients with advanced illness and their caregivers.

Using intuition in fuzzy front-end decision-making : a conceptual framework

NARCIS (Netherlands)

Eling, K.; Griffin, A.; Langerak, F.

2014-01-01

The goal of decision-making during the execution of the fuzzy front end (FFE) is to develop a creative new product concept. Although intuitive decision-making has been found to increase new product creativity, the theoretical knowledge base as to why and under which conditions intuition use during

Making ends meet. A synthesis of research on consumer behaviour and the environment

DEFF Research Database (Denmark)

Thøgersen, John

1999-01-01

litteratur. Især to diskussioner er mere udfoldede i denne sammenfatning end noget andet sted i disputatsen. Den ene er diskussionen om, hvordan mit teoretiske bidrag adskiller sig fra markante forgængere, især Icek Ajzens Theory of Planned Behaviour. Den anden er diskussionen af mine analysers...

Economic and Social Council ends meeting after considering poverty.

Science.gov (United States)

1993-09-01

An overview is provided of the recent meetings of the UN Economic and Social Council (UNESC) in Geneva during July 1993. The issues of the meetings focused on poverty alleviation and population issues and plans for the International Conference on Population and Development. More than 100 resolutions and decisions were approved by the UNESC Commissions. In the meeting held on June 29-30, 1993, Boutros Boutros-Ghali, Secretary General of the UN, addressed 15 ministers and 38 senior government officials and representatives of multilateral financial and trade institutions. He said that an unstable society undermines a stable economy and a stable political order. Social development must be the basis of all development. Social development has the goal of the alleviating poverty in the marginalization of populations, in discrimination in social relationship, in rootlessness of culture, and in vulnerability in ecology. The priority is in attacking poverty first. The World Summit to be held in March 1995 should enlist international cooperation in ending poverty. The UN marks its 50th anniversary also at that time, and the Summit would provide an opportunity to begin dealing with real and tangible issues such as poverty, social integration and employment. All countries are in need of formulating new directions in social policy and policies that accounting for the interrelationships globally in such a way as to put the best interests of all nations at the forefront. Development and international cooperation must "put people first." The meetings also addressed the issue of women's integration into society and the need to invest in women, as part of changing gender discrimination and contributing to their full participation in socioeconomic development. The Council requested an extension to meetings scheduled for April 1994 and the preparation of documentation by Dr. Nafis Sadik, Executive Director of the UN Population Fund that would include this Council meeting

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

Science.gov (United States)

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.

The struggle to make ends meet.

Science.gov (United States)

Bencheikh, T

1988-01-01

Morocco's severe financial problems have threatened its health-for-all goals. Restrictions have affected the recruitment and replacement of health personnel, the purchase and maintenance of equipment and buildings, hospital catering services and drug procurement. Several methods have been used to try and ease this crisis, rationalization and better deployment of resources, mobilization of national resources, and mobilization of external resources. In attaining the 1st, restrictions on the credits allocated to the Ministry of Public health have forced it to work out better ways of using its resources. These have included plans for better administrative and financial management of hospitals, improvements in drug procurement and distribution, new methods of personnel management, and efforts at improving information facilities and analytical capabilities at the central and local levels. To mobilize internal resources several steps were taken. These included revising too-low hospital charges, and charging people with social security coverage or those able to pay directly, raising funds through private charities, and the establishment of alternative, less expensive types of health centers. Morocco's continued need for funds to achieve health-for-all goals led it to also receive substantial assistance from international agencies (including the World Bank, UNICEF, UNFPA, and USAID) and friendly countries. External assistance cannot provide definitive solutions however, because of 1) the use of foreign experts and the payment of salaries abroad, 2) the purchase of products from the countries providing assistance, and 3) the unpredictability of external support and the danger programs may have to be abandoned. In times of financial crisis it is necessary to continue to budget adequately in order to reach health objectives.

Communication and Decision-Making About End-of-Life Care in the Intensive Care Unit.

Science.gov (United States)

Brooks, Laura Anne; Manias, Elizabeth; Nicholson, Patricia

2017-07-01

Clinicians in the intensive care unit commonly face decisions involving withholding or withdrawing life-sustaining therapy, which present many clinical and ethical challenges. Communication and shared decision-making are key aspects relating to the transition from active treatment to end-of-life care. To explore the experiences and perspectives of nurses and physicians when initiating end-of-life care in the intensive care unit. The study was conducted in a 24-bed intensive care unit in Melbourne, Australia. An interpretative, qualitative inquiry was used, with focus groups as the data collection method. Intensive care nurses and physicians were recruited to participate in a discipline-specific focus group. Focus group discussions were audio-recorded, transcribed, and subjected to thematic data analysis. Five focus groups were conducted; 17 nurses and 11 physicians participated. The key aspects discussed included communication and shared decision-making. Themes related to communication included the timing of end-of-life care discussions and conducting difficult conversations. Implementation and multidisciplinary acceptance of end-of-life care plans and collaborative decisions involving patients and families were themes related to shared decision-making. Effective communication and decision-making practices regarding initiating end-of-life care in the intensive care unit are important. Multidisciplinary implementation and acceptance of end-of-life care plans in the intensive care unit need improvement. Clear organizational processes that support the introduction of nurse and physician end-of-life care leaders are essential to optimize outcomes for patients, family members, and clinicians. ©2017 American Association of Critical-Care Nurses.

A multimethod analysis of shared decision-making in hospice interdisciplinary team meetings including family caregivers.

Science.gov (United States)

Washington, Karla T; Oliver, Debra Parker; Gage, L Ashley; Albright, David L; Demiris, George

2016-03-01

Much of the existing research on shared decision-making in hospice and palliative care focuses on the provider-patient dyad; little is known about shared decision-making that is inclusive of family members of patients with advanced disease. We sought to describe shared decision-making as it occurred in hospice interdisciplinary team meetings that included family caregivers as participants using video-conferencing technology. We conducted a multimethod study in which we used content and thematic analysis techniques to analyze video-recordings of hospice interdisciplinary team meetings (n = 100), individual interviews of family caregivers (n = 73) and hospice staff members (n = 78), and research field notes. Participants in the original studies from which data for this analysis were drawn were hospice family caregivers and staff members employed by one of five different community-based hospice agencies located in the Midwestern United States. Shared decision-making occurred infrequently in hospice interdisciplinary team meetings that included family caregivers. Barriers to shared decision-making included time constraints, communication skill deficits, unaddressed emotional needs, staff absences, and unclear role expectations. The hospice philosophy of care, current trends in healthcare delivery, the interdisciplinary nature of hospice teams, and the designation of a team leader/facilitator supported shared decision-making. The involvement of family caregivers in hospice interdisciplinary team meetings using video-conferencing technology creates a useful platform for shared decision-making; however, steps must be taken to transform family caregivers from meeting attendees to shared decision-makers. © The Author(s) 2015.

OA18 Population based end of life care - meeting the challenge of the ageing population.

Science.gov (United States)

Thomas, Keri

2015-04-01

The key challenge for most developed countries is meeting the needs of our ageing population, in particular, those nearing the end of their lives - population-based end-of-life care. Building on a public health approach to meet needs of an area-wide population, and a practical approach of enabling generalist frontline staff care for all people in a variety of settings using the GSF Quality Improvement Programmes, we describe progress in a few GSF Cross-Boundary Care Foundation Sites taking a population-based view to meet the challenges of the ageing population. Taking a whole-system view, we explore ways to ensure all people receive quality care towards the final stages of life in line with their needs and wishes in a way that is cost-effective, responsive and compassionate. Expanding concepts of palliative/end-of-life care to include care for people with long-term conditions, dementia, and frailty. We describe practical progress in a number of GSF XBC Sites, enabling generalist frontline staff including: Identifying and prioritising people earlier Reducing 'diagnostic apartheid' Enabling more to live well and die well in the place and manner of their choosing Encouraging integrated person-centred care, reducing inappropriate over-Hospitalisation and prevention of over - medicalising. Use of GSF in various settings to enable generalist frontline staff is described, with key outcome measures and evaluations in the UK, and internationally. As the population ages, population-based end of life care will be one of the most significant developments to meet the challenges for a fit-for-purpose health service of the future. © 2015, Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

End-of-life decision making is more than rational.

Science.gov (United States)

Eliott, Jaklin A; Olver, Ian N

2005-01-01

Most medical models of end-of-life decision making by patients assume a rational autonomous adult obtaining and deliberating over information to arrive at some conclusion. If the patient is deemed incapable of this, family members are often nominated as substitutes, with assumptions that the family are united and rational. These are problematic assumptions. We interviewed 23 outpatients with cancer about the decision not to resuscitate a patient following cardiopulmonary arrest and examined their accounts of decision making using discourse analytical techniques. Our analysis suggests that participants access two different interpretative repertoires regarding the construct of persons, invoking a 'modernist' repertoire to assert the appropriateness of someone, a patient or family, making a decision, and a 'romanticist' repertoire when identifying either a patient or family as ineligible to make the decision. In determining the appropriateness of an individual to make decisions, participants informally apply 'Sanity' and 'Stability' tests, assessing both an inherent ability to reason (modernist repertoire) and the presence of emotion (romanticist repertoire) which might impact on the decision making process. Failure to pass the tests respectively excludes or excuses individuals from decision making. The absence of the romanticist repertoire in dominant models of patient decision making has ethical implications for policy makers and medical practitioners dealing with dying patients and their families.

Ending War and Making Peace in Scandinavia, 1814–1848

DEFF Research Database (Denmark)

Ottosen, Morten Nordhagen

2016-01-01

The Napoleonic wars had a tremendous impact on the Scandinavian countries. Political and social upheaval and economic disruption ensured that ending war was no straightforward or rapid process. For traumatized veterans and those who had lost a husband or father, war never quite ended, to say...... nothing of those who remained under military occupation even after the nominal conclusion of peace. Still, the parallel process of making peace after 1815 was quite remarkable in Scandinavia, as 300 years of bitter rivalry, enmity, and perpetual conflict rapidly gave way to reconciliation to a point where...

What parents want from doctors in end-of-life decision-making for children.

Science.gov (United States)

Sullivan, J; Monagle, P; Gillam, L

2014-03-01

End-of-life decision-making is difficult for everyone involved, as many studies have shown. Within this complexity, there has been little information on how parents see the role of doctors in end-of-life decision-making for children. This study aimed to examine parents' views and experiences of end-of-life decision-making. A qualitative method with a semistructured interview design was used. Parent participants were living in the community. Twenty-five bereaved parents. Parents reported varying roles taken by doctors: being the provider of information without opinion; giving information and advice as to the decision that should be taken; and seemingly being the decision maker for the child. The majority of parents found their child's doctor enabled them to be the ultimate decision maker for their child, which was what they very clearly wanted to be, and consequently enabled them to exercise their parental autonomy. Parents found it problematic when doctors took over decision-making. A less frequently reported, yet significant role for doctors was to affirm decisions after they had been made by parents. Other important aspects of the doctor's role were to provide follow-up support and referral. Understanding the role that doctors take in end-of-life decisions, and the subsequent impact of that role from the perspective of parents can form the basis of better informed clinical practice.

Family communication and decision making at the end of life: a literature review.

Science.gov (United States)

Wallace, Cara L

2015-06-01

Patients and families coping with a terminal illness are faced with a number of decisions over the course of their disease. The role that family communication plays in the process of decision making is an important one. The objectives for this review are to examine the current state of empirical literature on the relationship between family communication and decision making about end-of-life care, to identify gaps, and to discuss implications for policy, practice, and future research. Articles were identified using systematic keyword searches within the following relevant databases: Academic Search Complete, CINAHL Plus, Communications and Mass Media Complete, ERIC, PsychINFO, MEDLINE, SocINDEX, and ProQuest. The three bodies of relevant literature that emerged during this review include: (1) the importance of family communication at the end of life (EoL); (2) family decision making at the EoL; and (3) the interrelationship of communication (both within the family and with healthcare professionals) and decision making at the EoL. While the literature highlights the role of communication between medical professionals and the patient or family members, there is very little focus on the process of how family communication among the family members themselves contributes to decision making at the end of life. Barriers to end-of-life care are important considerations for helping patients to access timely and appropriate services. Understanding the pertinent role of family communication as it relates to the decision for EoL care is the first step in working to provide another avenue for overcoming these barriers.

End-of-life decision-making for children with severe developmental disabilities: The parental perspective.

Science.gov (United States)

Zaal-Schuller, I H; de Vos, M A; Ewals, F V P M; van Goudoever, J B; Willems, D L

2016-01-01

The objectives of this integrative review were to understand how parents of children with severe developmental disorders experience their involvement in end-of-life decision-making, how they prefer to be involved and what factors influence their decisions. We searched MEDLINE, EMBASE, CINAHL and PsycINFO. The search was limited to articles in English or Dutch published between January 2004 and August 2014. We included qualitative and quantitative original studies that directly investigated the experiences of parents of children aged 0-18 years with severe developmental disorders for whom an end-of-life decision had been considered or made. We identified nine studies that met all inclusion criteria. Reportedly, parental involvement in end-of-life decision-making varied widely, ranging from having no involvement to being the sole decision-maker. Most parents preferred to actively share in the decision-making process regardless of their child's specific diagnosis or comorbidity. The main factors that influenced parents in their decision-making were: their strong urge to advocate for their child's best interests and to make the best (possible) decision. In addition, parents felt influenced by their child's visible suffering, remaining quality of life and the will they perceived in their child to survive. Most parents of children with severe developmental disorders wish to actively share in the end-of-life decision-making process. An important emerging factor in this process is the parents' feeling that they have to stand up for their child's interests in conversations with the medical team. Copyright © 2015 Elsevier Ltd. All rights reserved.

Factors That Impact End-of-Life Decision Making in African Americans With Advanced Cancer

Science.gov (United States)

Campbell, Cathy L.; Williams, Ishan C.; Orr, Tamara

2013-01-01

Significance African Americans with cancer are less likely to use hospice services and more likely to die in the hospital than white patients with the same diagnosis. However, there is much that is not understood about the factors that lead African Americans to choose options for end-of-life care. Design A qualitative, descriptive design was used in this pilot study. Methods Interviews were conducted with two groups of African Americans with advanced-stage cancer (people enrolled in hospice and those who were not under hospice care). Findings End-of-life decisions were primarily guided by clinical factors, the patient-related physical, emotional, and cognitive symptoms that are sequelae of the underlying disease or medical treatments. The physician was the healthcare provider most likely to be involved in decision making with patients, family members, and caregivers. Individual factors, such as personal beliefs, influenced end-of-life decision making. Religion and spirituality were a topic in many interviews, but they did not consistently influence decision making. Discussion Future studies should include interviews with family members, caregivers, and healthcare professionals so that factors that impact end-of-life decision making can be fully described. Strategies to facilitate recruitment will need to be added to future protocols. PMID:23645999

Regenerative Medicine Will Make Orthopaedic Implants Obsolete In Our Time Orthopaedic Research Society First Annual Meeting Debate, San Diego, March 21st , 2017.

Science.gov (United States)

Johnstone, Brian; Jacobs, Joshua J; Sandell, Linda J; Wilkinson, J Mark

2018-05-10

The mission of the Orthopaedic Research Society is to promote and advance musculoskeletal research worldwide. With this in mind, the Annual Meeting Program Committee sought to establish a debate as a key component of the meeting. Our purpose was to provoke discussion on topics that are core to our mission and to engage all constituencies within the society by examining questions of broad relevance. To this end, the topic "Regenerative medicine will make orthopaedic implants obsolete in our time" was selected as the title of the inaugural debate. The arguments for and against the motion are presented in this perspectives article. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Determinantes sociales frente a estilos de vida en la diabetes mellitus de tipo 2 en Andalucía: ¿la dificultad para llegar a fin de mes o la obesidad? Social determinants vs. lifestyle in type 2 diabetes mellitus in Andalusia (Spain: difficulty in making ends meet or obesity?

Directory of Open Access Journals (Sweden)

Antonio Escolar Pujolar

2009-10-01

Full Text Available Objetivo: Valorar las relaciones de la dificultad para llegar a fin de mes con la obesidad y la diabetes mellitus de tipo 2 en Andalucía. Métodos: Estudio transversal basado en los datos de la Encuesta de Salud de Andalucía-2003. Cálculo de prevalencias y odds ratio (OR de tener diabetes mellitus de tipo 2 según variables de estilo de vida, y de obesidad y diabetes mellitus de tipo 2 según la dificultad autopercibida para llegar a fin de mes. Resultados: La OR ajustada por edad de tener diabetes mellitus de tipo 2 en personas obesas respecto a las de peso normal fue de 2,52 (intervalo de confianza del 95% [IC95%]:1,63-3,88 y de 2,13 (IC95%:1,28-3,54 en las mujeres y los hombres, respectivamente. El sedentarismo no se asoció con un riesgo significativo de diabetes mellitus de tipo 2 en ninguno de los dos sexos. Para las mujeres con mayor dificultad económica para llegar a fin de mes, respecto a las que tienen más facilidades, la OR de ser obesa, ajustada por edad y ejercicio físico, fue de 3,03 (IC95%:1,96-4,66, y la de diabetes mellitus de tipo 2, ajustada por edad, ejercicio físico e índice de masa corporal, fue de 2,55 (IC95%:1,28-5,10. En los hombres ninguna de las OR fue estadísticamente significativa. Conclusión: En las mujeres, las dificultades para llegar a fin de mes reflejan un contexto socioeconómico favorecedor de obesidad y de diabetes mellitus de tipo 2. Las desigualdades de clase social y género identificadas pueden contribuir a ampliar el actual marco explicativo de los determinantes de la diabetes mellitus de tipo 2, excesivamente centrado en las conductas individuales. La dificultad autopercibida para llegar a fin de mes podría utilizarse como indicador de pobreza en los estudios de desigualdades en salud.Objective: To assess the relationship between difficulty in making ends meet and obesity and type 2 diabetes mellitus in Andalusia. Methods: We performed a cross-sectional survey based on the Andalusian Health

Family members' informal roles in end-of-life decision making in adult intensive care units.

Science.gov (United States)

Quinn, Jill R; Schmitt, Madeline; Baggs, Judith Gedney; Norton, Sally A; Dombeck, Mary T; Sellers, Craig R

2012-01-01

To support the process of effective family decision making, it is important to recognize and understand informal roles that various family members may play in the end-of-life decision-making process. To describe some informal roles consistently enacted by family members involved in the process of end-of-life decision making in intensive care units. Ethnographic study. Data were collected via participant observation with field notes and semistructured interviews on 4 intensive care units in an academic health center in the mid-Atlantic United States from 2001 to 2004. The units studied were a medical, a surgical, a burn and trauma, and a cardiovascular intensive care unit. Health care clinicians, patients, and family members. Informal roles for family members consistently observed were primary caregiver, primary decision maker, family spokesperson, out-of-towner, patient's wishes expert, protector, vulnerable member, and health care expert. The identified informal roles were part of families' decision-making processes, and each role was part of a potentially complicated family dynamic for end-of-life decision making within the family system and between the family and health care domains. These informal roles reflect the diverse responses to demands for family decision making in what is usually a novel and stressful situation. Identification and description of these informal roles of family members can help clinicians recognize and understand the functions of these roles in families' decision making at the end of life and guide development of strategies to support and facilitate increased effectiveness of family discussions and decision-making processes.

Influence of physicians' life stances on attitudes to end-of-life decisions and actual end-of-life decision-making in six countries

DEFF Research Database (Denmark)

Cohen, J; van Delden, J; Mortier, F

2008-01-01

AIM: To examine how physicians' life stances affect their attitudes to end-of-life decisions and their actual end-of-life decision-making. METHODS: Practising physicians from various specialties involved in the care of dying patients in Belgium, Denmark, The Netherlands, Sweden, Switzerland......) and Protestants (up to 20.4% in The Netherlands) reported ever having made such a decision. DISCUSSION: The results suggest that religious teachings influence to some extent end-of-life decision-making, but are certainly not blankly accepted by physicians, especially when dealing with real patients...... large life-stance groups in each country. RESULTS: Only small differences in life stance were found in all countries in general attitudes and intended and actual behaviour with regard to various end-of-life decisions. However, with regard to the administration of drugs explicitly intended to hasten...

Factors determining the long term back end nuclear fuel cycle strategy and future nuclear systems. Proceedings of a technical committee meeting

International Nuclear Information System (INIS)

2002-05-01

The Technical Committee Meeting (TCM) was held in Vienna on 8-10 November 1999; it was organized by the International Atomic Energy Agency and attended by 26 participants from 16 Member States. The purpose of the meeting was to exchange information among experts on the back end fuel cycle strategies adopted by Member States; to identify key factors determining the long-term back end fuel cycle strategies; and to assess the applicability of these factors to future nuclear systems. Issues associated with the back end fuel cycle supporting a country's nuclear power programme are technical, economic, institutional and political. This TCM provided an opportunity to address these issues and their impacts to the back end fuel cycles, as well as to identify and assess factors affecting the back end fuel cycle strategies. The discussion was organized ib the following topical sessions: the nuclear fuel cycle; spent fuel management; waste management and repository; plutonium management. This document contains a summary of the meeting and 22 individual papers presented by participants. Each of the papers was indexed separately

Factors determining the long term back end nuclear fuel cycle strategy and future nuclear systems. Proceedings of a technical committee meeting

Energy Technology Data Exchange (ETDEWEB)

NONE

2002-05-01

The Technical Committee Meeting (TCM) was held in Vienna on 8-10 November 1999; it was organized by the International Atomic Energy Agency and attended by 26 participants from 16 Member States. The purpose of the meeting was to exchange information among experts on the back end fuel cycle strategies adopted by Member States; to identify key factors determining the long-term back end fuel cycle strategies; and to assess the applicability of these factors to future nuclear systems. Issues associated with the back end fuel cycle supporting a country's nuclear power programme are technical, economic, institutional and political. This TCM provided an opportunity to address these issues and their impacts to the back end fuel cycles, as well as to identify and assess factors affecting the back end fuel cycle strategies. The discussion was organized ib the following topical sessions: the nuclear fuel cycle; spent fuel management; waste management and repository; plutonium management. This document contains a summary of the meeting and 22 individual papers presented by participants. Each of the papers was indexed separately.

Meeting Wise: Making the Most of Collaborative Time for Educators

Science.gov (United States)

Boudett, Kathryn Parker; City, Elizabeth A.

2014-01-01

This book, by two editors of "Data Wise: A Step-by-Step Guide to Using Assessment Results to Improve Teaching and Learning," attempts to bring about a fundamental shift in how educators think about the meetings we attend. They make the case that these gatherings are potentially the most important venue where adult and organizational…

A qualitative study of women's decision-making at the end of IVF treatment.

Science.gov (United States)

Peddie, V L; van Teijlingen, E; Bhattacharya, S

2005-07-01

The decision not to pursue further in vitro fertilization (IVF) after one or more unsuccessful attempts is an important and often difficult one for couples. Relatively little is known about the woman's perception of this decision-making process. The aim of this study was to examine patients' perspectives of decision-making, including circumstances influencing it and satisfaction with the decision-making process. Semi-structured interviews were conducted with a purposive sample of 25 women who had decided to end treatment after unsuccessful IVF treatment. Interviews were tape-recorded and transcribed by means of thematic analysis using the open coding technique. Women experienced difficulty in accepting that their infertility would remain unresolved. Many felt that they had started with unrealistic expectations of treatment success and felt vulnerable to the pressures of both the media and society. Although the decision to end treatment was difficult, it offered many women a way out of the emotional distress caused by IVF; however, the process of decision-making created a sense of 'confrontation' for the women in which they had to address issues they had previously avoided. Adoptive parents perceived less societal pressure than those who remained childless. Efforts to improve the psychological preparation of couples who decide to end IVF treatment should be directed towards examination of the existing system of consultation, which has certain limitations in terms of the quality of communication and the provision of post-treatment support. Further efforts to develop strategies, which facilitate the decision-making process, should be considered.

Putting the use of intuition for fuzzy front end decision making on the research agenda

NARCIS (Netherlands)

Eling, K.; Langerak, F.

2011-01-01

Decision making literature suggests that intuitive decision making is more appropriate than the established rational decision making approaches to handle the specific information processing needs of the fuzzy front end (FFE) of new product development. However, these earlier studies cannot be

Negotiating end-of-life decision making: a comparison of Japanese and U.S. residents' approaches.

Science.gov (United States)

Gabbay, Baback B; Matsumura, Shinji; Etzioni, Shiri; Asch, Steven M; Rosenfeld, Kenneth E; Shiojiri, Toshiaki; Balingit, Peter P; Lorenz, Karl A

2005-07-01

To compare Japanese and U.S. resident physicians' attitudes, clinical experiences, and emotional responses regarding making disclosures to patients facing incurable illnesses. From September 2003 to June 2004, the authors used a ten-item self-administered anonymous questionnaire in a cross-sectional survey of 103 internal medicine residents at two U.S. sites in Los Angeles, California, and 244 general medical practice residents at five Japanese sites in Central Honshu, Kyushu, Okinawa, Japan. The Japanese residents were more likely to favor including the family in disclosing diagnosis (95% versus 45%, pguilt about these behaviors. The residents' approaches to end-of-life decision making reflect known cultural preferences related to the role of patients and their families. Although Japanese trainees were more likely to endorse the role of the family, they expressed greater uncertainty about their approach. Difficulty and uncertainty in end-of-life decision making were common among both the Japanese and U.S. residents. Both groups would benefit from ethical training to negotiate diverse, changing norms regarding end-of-life decision making.

End-of-life decision-making in Canada: the report by the Royal Society of Canada expert panel on end-of-life decision-making.

Science.gov (United States)

Schüklenk, Udo; van Delden, Johannes J M; Downie, Jocelyn; McLean, Sheila A M; Upshur, Ross; Weinstock, Daniel

2011-11-01

This report on end-of-life decision-making in Canada was produced by an international expert panel and commissioned by the Royal Society of Canada. It consists of five chapters. Chapter 1 reviews what is known about end-of-life care and opinions about assisted dying in Canada. Chapter 2 reviews the legal status quo in Canada with regard to various forms of assisted death. Chapter 3 reviews ethical issues pertaining to assisted death. The analysis is grounded in core values central to Canada's constitutional order. Chapter 4 reviews the experiences had in a number of jurisdictions that have decriminalized or recently reviewed assisted dying in some shape or form. Chapter 5 provides recommendations with regard to the provision of palliative care in Canada, as well as recommendations for reform with respect to the various forms of assisted death covered in this document. © 2011 Blackwell Publishing Ltd.

End-Of-Life Care for Persons with Advanced Chronic Obstructive Pulmonary Disease: Report of a National Interdisciplinary Consensus Meeting

Directory of Open Access Journals (Sweden)

DM Goodridge

2009-01-01

Full Text Available While systemic shortcomings in meeting the needs of individuals with progressive chronic illnesses at the end of life have been well documented, there is growing interest in improving both care and quality of life for persons with advanced chronic obstructive pulmonary disease (COPD. For instance, the American Thoracic Society has issued an official statement on palliative care for patients with respiratory diseases, affirming that the prevention, relief, reduction and soothing of symptoms “without affecting a cure” must become an integral component of standard care. A recent Medline search located 1015 articles related to palliative or end-of-life care for people with COPD published between 2001 and 2008, compared with only 336 articles published before 2001. To address the needs of Canadian patients, an interdisciplinary consensus meeting, funded by the Canadian Institutes of Health Research and supported by the Canadian Thoracic Society, the Canadian Respiratory Health Professionals and the Canadian Lung Association was convened in Toronto, Ontario, on November 22, 2008, to begin examining the quality of end-of-life care for individuals with COPD in Canada. The present report summarizes the background to and outcomes of this consensus meeting.

End-of-life decision-making and terminal sedation among very old patients.

Science.gov (United States)

De Gendt, Cindy; Bilsen, Johan; Mortier, Freddy; Vander Stichele, Robert; Deliens, Luc

2009-01-01

About half of the persons who die in developed countries are very old (aged 80 years or older) and this proportion is still rising. In general, there is little information available concerning the circumstances and quality of the end of life of this group. This study aims (1) to describe the incidence and characteristics of medical end-of-life decisions with a possible or certain life-shortening effect (ELDs) and terminal sedation among very old patients who died nonsuddenly, (2) to describe the characteristics of the preceding decision-making process, and (3) to compare this with the deaths of younger patients. A sample of 5,005 death certificates was selected from all deaths in Flanders (Belgium) in the second half of 2001 (before euthanasia was legalized). Questionnaires were mailed to the certifying physicians. Response rate was 58.9%. An ELD was made for 53.6% very old (aged 80+) patients who died nonsuddenly (vs. 63.3% for the younger patients). Use of life-ending drugs occurred among 1.1% (six times less frequently than in younger patients), with no euthanasia cases, pain and symptom alleviation with a possible life-shortening effect among 27.3% (two times less frequently), and withholding or withdrawing life-prolonging treatments among 25.2% (slightly more frequently). Terminal sedation occurred among 6.9% of the cases, two times less frequently than for the younger patients. ELDs were not often discussed with very old patients. Among competent patients this was less than compared with younger patients. ELDs are less common for very old than for younger patients. Physicians seem to have a more reluctant attitude towards the use of lethal drugs, terminal sedation and participation in decision-making when dealing with very old patients. Advance care planning should increase the involvement of very old competent and noncompetent patients in end-of-life decision-making. (c) 2008 S. Karger AG, Basel.

Supporting End of Life Decision Making: Case Studies of Relational Closeness in Supported Decision Making for People with Severe or Profound Intellectual Disability

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Watson, Joanne; Wilson, Erin; Hagiliassis, Nick

2017-01-01

Background: The United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) promotes the use of supported decision making in lieu of substitute decision making. To date, there has been a lack of focus on supported decision making for people with severe or profound intellectual disability, including for end of life decisions.…

Ethical decision-making near the end of life.

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Finucane, T E; Harper, M

1996-05-01

For ethical decision-making near the end of life, autonomy is the moral North Star. At the same time, for some treatments, the burdens so clearly outweigh benefits that physicians may make a judgment not to offer the treatment. This is often clearer in surgery. A person with colon cancer and metastases may not insist on resection of the metastases. For some reason, some treatments have escaped these logical constraints. Attempted resuscitation of a dying patient is a good example. The circumstances in which a physician may make choices on behalf of a competent, terminally-ill patient without consent, and even without notification, are hotly debated, but data suggest that physicians do so frequently. Patients who lack capacity present even more difficult challenges. Advance directives, when available, can be extremely helpful, but even with them difficult problems can remain. If advance directives have not been established, family and close friends are an obvious source of guidance. Their legal role varies in different jurisdictions; in practice, they are crucial in bedside decision-making. Guardianship and alternatives to it remain a poor last resort. Euthanasia is a very difficult problem. We believe it is semantically misleading to lump under the term "passive euthanasia" those circumstances where potentially life-sustaining treatment is withheld or withdrawn. The tension between patient autonomy and medical common sense remains unresolved within the "futility" controversy. The authors believe it serves no purpose to discuss carefully with dying patients propositions that are nonsense. At the same time, physicians must not confuse decisions about quality of life with judgements about treatment effectiveness. We believe that what many, although not all, dying patients want are physicians with intelligent compassion who can take care of them through the dying process.

Challenges and Approach for Making the Top End Optical Assembly for the 4-meter Advanced Technology Solar Telescope

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Canzian, Blaise; Barentine, J.; Hull, T.

2012-01-01

L-3 Integrated Optical Systems (IOS) Division has been selected by the National Solar Observatory (NSO) to make the Top End Optical Assembly (TEOA) for the 4-meter Advanced Technology Solar Telescope (ATST) to operate at Haleakala, Maui. ATST will perform to a very high optical performance level in a difficult thermal environment. The TEOA, containing the 0.65-meter silicon carbide secondary mirror and support, mirror thermal management system, mirror positioning and fast tip-tilt system, field stop with thermally managed heat dump, thermally managed Lyot stop, safety interlock and control system, and support frame, operates in the "hot spot” at the prime focus of the ATST and so presents special challenges. In this paper, we will describe the L-3 IOS technical approach to meet these challenges, including subsystems for opto-mechanical positioning, rejected and stray light control, wavefront tip-tilt compensation, and thermal management. Key words: ATST, TEOA, L-3 IOS, thermal management, silicon carbide (SiC) mirrors, hexapods, solar astronomy

Planning and conducting meetings effectively, part I: planning a meeting.

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Harolds, Jay

2011-12-01

Meetings are held by leaders for many purposes, including conveying information, raising morale, asking for opinions, brain storming, making people part of the problem-solving process, building trust, getting to a consensus, and making decisions. However, many meetings waste time, some undermine the leader's power, and some decrease morale. Part I of this series of articles gives some tips on basic planning for decision-making meetings. Part II of this series of articles analyzes selected components of decision-making meetings. Part III of this series will be on how the chairperson keeps decision-making meetings on track to make them efficient and productive.

Making public ahead of print: Meetings and publications at the Royal Society, 1752?1892

OpenAIRE

Fyfe, Aileen; Moxham, Noah

2016-01-01

This essay examines the interplay between the meetings and publications of learned scientific societies during the eighteenth and nineteenth centuries, when journals were an established but not yet dominant form of scholarly communication. The practice of ‘making public’ research at meetings, long before actual ‘publication’ in society periodicals, enabled a complex of more-or-less formal sites of communication and discussion ahead of print. Using two case studies from the Royal Society of Lo...

Making decisions at the end of life when caring for a person with dementia: a literature review to explore the potential use of heuristics in difficult decision-making.

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Mathew, R; Davies, N; Manthorpe, J; Iliffe, S

2016-07-19

Decision-making, when providing care and treatment for a person with dementia at the end of life, can be complex and challenging. There is a lack of guidance available to support practitioners and family carers, and even those experienced in end of life dementia care report a lack of confidence in decision-making. It is thought that the use of heuristics (rules of thumb) may aid decision-making. The aim of this study is to identify whether heuristics are used in end of life dementia care, and if so, to identify the context in which they are being used. A narrative literature review was conducted taking a systematic approach to the search strategy, using the Centre for Reviews and Dissemination guidelines. Rapid appraisal methodology was used in order to source specific and relevant literature regarding the use of heuristics in end of life dementia care. A search using terms related to dementia, palliative care and decision-making was conducted across 4 English language electronic databases (MEDLINE, EMBASE, PsycINFO and CINAHL) in 2015. The search identified 12 papers that contained an algorithm, guideline, decision tool or set of principles that we considered compatible with heuristic decision-making. The papers addressed swallowing and feeding difficulties, the treatment of pneumonia, management of pain and agitation, rationalising medication, ending life-sustaining treatment, and ensuring a good death. The use of heuristics in palliative or end of life dementia care is not described in the research literature. However, this review identified important decision-making principles, which are largely a reflection of expert opinion. These principles may have the potential to be developed into simple heuristics that could be used in practice. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Health Care Decisions at the End of Life: Theological and Ethical Foundations for Decision Making.

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Allegretti, Joseph G.

This paper provides a framework for making sense of perplexing problems surrounding issues of death and dying by exploring the theological and ethical background to health care decision making at the end of life. The paper first examines several of the basic principles that theologians and secular ethicists employ when analyzing such questions.…

Evaluation of End-Products in Architecture Design Process: A Fuzzy Decision-Making Model

Directory of Open Access Journals (Sweden)

Serkan PALABIYIK

2012-06-01

Full Text Available This paper presents a study on the development of a fuzzy multi-criteria decision-making model for the evaluation of end products of the architectural design process. Potentials of the developed model were investigated within the scope of architectural design education, specifically an international design studio titled “Design for Disassembly and Reuse: Design & Building Multipurpose Transformable Pavilions.” The studio work followed a design process that integrated systematic and heuristic thinking. The design objectives and assessment criteria were clearly set out at the beginning of the process by the studio coordinator with the aim of narrowing the design space and increasing awareness of the consequences of design decisions. At the end of the design process, designs produced in the studio were evaluated using the developed model to support decision making. The model facilitated the identification of positive and negative aspects of the designs and selection of the design alternative that best met the studio objectives set at the beginning.

Decision-Making of Patients With Implantable Cardioverter-Defibrillators at End of Life: Family Members' Experiences.

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Lee, Mei Ching; Sulmasy, Daniel P; Gallo, Joseph; Kub, Joan; Hughes, Mark T; Russell, Stuart; Kellogg, Anela; Owens, Sharon G; Terry, Peter; Nolan, Marie T

2017-07-01

Many patients with advanced heart failure (HF) experience the life-extending benefits of implantable cardioverter-defibrillators (ICD), but at the end stage of HF, patients may experience shocks with increasing frequency and change the plan for end-of-life (EOL) care including the deactivation of the ICD. This report describes family members' experiences of patients with ICD making decisions at EOL. Understanding the decision-making of patients with ICD at EOL can promote informed decision-making and improve the quality of EOL care. This pilot study used a mixed methods approach to test the effects of a nurse-guided discussion in decision-making about ICD deactivation (turning off the defibrillation function) at the EOL. Interviews were conducted, audiotaped, and transcribed in 2012 to 2013 with 6 family members of patients with advanced HF and ICDs. Three researchers coded the data and identified themes in 2014. Three main themes described family members' experiences related to patients having HF with ICDs making health-care decision at EOL: decision-making preferences, patients' perception on ICD deactivation, and communication methods. Health-care providers need to have knowledge of patients' decision-making preferences. Preferences for decision-making include the allowing of appropriate people to involve and encourages direct conversation with family members even when advance directives is completed. Information of ICD function and the option of deactivation need to be clearly delivered to patients and family members. Education and guidelines will facilitate the communication of the preferences of EOL care.

77 FR 17001 - USDA Public Stakeholder Meeting: Match Making in the Biofuels Value Chain

Science.gov (United States)

2012-03-23

... DEPARTMENT OF AGRICULTURE USDA Public Stakeholder Meeting: Match Making in the Biofuels Value... and representatives from the participating stakeholders will respond with short formal presentations... through USDA's security clearance. ADDRESSES: Patio, United States Department of Agriculture Whitten...

End of life care and decision making: Opinions and experiences of the general public, bereaved relatives, and professionals

NARCIS (Netherlands)

N.J.H. Raijmakers (Natasja)

2013-01-01

textabstractEnd-of-life care aims to improve quality of life of patients and their relatives facing problems associated with life-threatening illness in the last days of life. End-of-life decision-making is an important aspect of end-of-life care that can have a significant impact on the process of

End-of-life decision-making for children with severe developmental disabilities: The parental perspective

NARCIS (Netherlands)

Zaal-Schuller, I. H.; de Vos, M. A.; Ewals, F. V. P. M.; van Goudoever, J. B.; Willems, D. L.

2016-01-01

The objectives of this integrative review were to understand how parents of children with severe developmental disorders experience their involvement in end-of-life decision-making, how they prefer to be involved and what factors influence their decisions. We searched MEDLINE, EMBASE, CINAHL and

Mental competence and surrogate decision-making towards the end of life.

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Strätling, M; Scharf, V E; Schmucker, P

2004-01-01

German legislation demands that decisions about the treatment of mentally incompetent patients require an 'informed consent'. If this was not given by the patient him-/herself before he/she became incompetent, it has to be sought by the physician from a guardian, who has to be formally legitimized before. Additionally this surrogate has to seek the permission of a Court of Guardianship (Vormundschaftsgericht), if he/she intends to consent to interventions, which pose significant risks to the health or the life of the person under his/her care. This includes 'end-of-life decisions'. Deviations from this procedure are only allowed in acute emergencies or cases of 'medical futility'. On the basis of epidemiological and demographical data it can be shown that the vast majority of surrogate decisions on incompetent patients in Germany is not covered by legally valid consent. Moreover, the data suggests that if consent were to be requested according to the legal regulations, both the legal and medical system could realistically never cope with the practical consequences of this. Additionally, empiric research has revealed serious deficits concerning medical 'end of life-decisions' and practical performance in palliative care. As a consequence a multidisciplinary discussion has developed in Germany about the reform of present legislation with respect to key-issues like the assessment of mental competence, the options for exercising patient self-determination via advance directives and durable powers of attorney, the improvement of palliative care facilities, the clarification of formal procedures for surrogate decision-making in health care and towards the end of life and the possibilities and their limitations of controlling these decision-making processes 'externally' (e.g., by Guardianship Courts or committees). The authors discuss those proposals, which clearly dominate the present debate: They all aim to comply with the scientific basis of German law, jurisdiction

Voices of African American, Caucasian, and Hispanic surrogates on the burdens of end-of-life decision making.

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Braun, Ursula K; Beyth, Rebecca J; Ford, Marvella E; McCullough, Laurence B

2008-03-01

End-of-life decisions are frequently made by patients' surrogates. Race and ethnicity may affect such decision making. Few studies have described how different racial/ethnic groups experience end-of-life surrogate decision making. To describe the self-reported experience the self-reported experience of African-American, Caucasian, and Hispanic surrogate decision makers of seriously ill patients and to examine the relationship of race, ethnicity, and culture to that experience. Purposive sample to include racial/ethnic minorities in a qualitative study using focus group interviews. The participants of the study were 44 experienced, mostly female, surrogate decision makers for older veterans. Transcripts were qualitatively analyzed to identify major themes, with particular attention to themes that might be unique to each of the three groups. The experience of burden of end-of-life decision making was similar in all three groups. This burden in its medical, personal, and familial dimensions is compounded by uncertainty about prognosis and the patient's preferences. Racial/ethnic variations of responses to this burden concerned the physician-family relationship, religion and faith, and past experiences with race/ethnicity concordant versus non-concordant physicians. Regardless of race/ethnicity, surrogates for seriously ill patients appeared to experience increased significant, multidimensional burdens of decision making under conditions of uncertainty about a patient's preferences. This aspect of the burden of surrogate decision making may not be fully appreciated by physicians. Physicians should identify and be especially attentive to strategies used by surrogates, which may vary by race/ethnicity, to reduce the uncertainty about a patient's preferences and thus the burden of surrogate decision making to assist them in this difficult process.

Ethics of End of Life Decisions in Pediatrics: A Narrative Review of the Roles of Caregivers, Shared Decision-Making, and Patient Centered Values

Directory of Open Access Journals (Sweden)

Jonathan D. Santoro

2018-04-01

Full Text Available Background: This manuscript reviews unique aspects of end of life decision-making in pediatrics. Methods: A narrative literature review of pediatric end of life issues was performed in the English language. Results: While a paternalistic approach is typically applied to children with life-limiting medical prognoses, the cognitive, language, and physical variability in this patient population is wide and worthy of review. In end of life discussions in pediatrics, the consideration of a child’s input is often not reviewed in depth, although a shared decision-making model is ideal for use, even for children with presumed limitations due to age. This narrative review of end of life decision-making in pediatric care explores nomenclature, the introduction of the concept of death, relevant historical studies, limitations to the shared decision-making model, the current state of end of life autonomy in pediatrics, and future directions and needs. Although progress is being made toward a more uniform and standardized approach to care, few non-institutional protocols exist. Complicating factors in the lack of guidelines include the unique facets of pediatric end of life care, including physical age, paternalism, the cognitive and language capacity of patients, subconscious influencers of parents, and normative values of death in pediatrics. Conclusions: Although there have been strides in end of life decision-making in pediatrics, further investigation and research is needed in this field.

Ethics of End of Life Decisions in Pediatrics: A Narrative Review of the Roles of Caregivers, Shared Decision-Making, and Patient Centered Values.

Science.gov (United States)

Santoro, Jonathan D; Bennett, Mariko

2018-04-26

Background: This manuscript reviews unique aspects of end of life decision-making in pediatrics. Methods: A narrative literature review of pediatric end of life issues was performed in the English language. Results: While a paternalistic approach is typically applied to children with life-limiting medical prognoses, the cognitive, language, and physical variability in this patient population is wide and worthy of review. In end of life discussions in pediatrics, the consideration of a child’s input is often not reviewed in depth, although a shared decision-making model is ideal for use, even for children with presumed limitations due to age. This narrative review of end of life decision-making in pediatric care explores nomenclature, the introduction of the concept of death, relevant historical studies, limitations to the shared decision-making model, the current state of end of life autonomy in pediatrics, and future directions and needs. Although progress is being made toward a more uniform and standardized approach to care, few non-institutional protocols exist. Complicating factors in the lack of guidelines include the unique facets of pediatric end of life care, including physical age, paternalism, the cognitive and language capacity of patients, subconscious influencers of parents, and normative values of death in pediatrics. Conclusions: Although there have been strides in end of life decision-making in pediatrics, further investigation and research is needed in this field.

End-of-Life Decision Making in Palliative Care and Recommendations of the Council of Europe: Qualitative Secondary Analysis of Interviews and Observation Field Notes.

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Martins Pereira, Sandra; Fradique, Emília; Hernández-Marrero, Pablo

2018-05-01

End-of-life decisions (ELDs) are embedded in clinical, sociocultural, political, economic, and ethical concerns. In 2014, the Council of Europe (CoE) through its Committee on Bioethics launched the "Guide on the decision-making process regarding medical treatment in end-of-life situations," aiming at improving decision-making processes and empowering professionals in making ELDs. To analyze if end-of-life decision making in palliative care (PC) is consistent with this Guide and to identify if disputed/controversial issues are part of current ELDs. Qualitative secondary analysis. Four qualitative datasets, including 44 interviews and 9 team observation field notes from previous studies with PC teams/professionals in Portugal. An analysis grid based on the abovementioned guide was created considering three dimensions: ethical and legal frameworks, decision-making process, and disputed/controversial issues. The majority of the professionals considered the ethical principle of autonomy paramount in end-of-life decision making. Justice and beneficence/nonmaleficence were also valued. Although not mentioned in the Guide, the professionals also considered other ethical principles when making ELDs, namely, responsibility, integrity, and dignity. Most of the interviewees and field notes referred to the collective interprofessional dimension of the decision-making process. Palliative sedation and the wish to hasten death were the most mentioned disputed/controversial issues. The nature, limitations, and benefits of qualitative secondary analysis are discussed. End-of-life decision-making processes made by Portuguese PC teams seem to be consistent with the guidelines of the CoE. Further research is needed about disputed/controversial issues and the actual use, effectiveness, and impact of ethical guidelines for end-of-life decision making on professionals' empowerment and for all parties involved.

Patients' Non-Medical Characteristics Contribute to Collective Medical Decision-Making at Multidisciplinary Oncological Team Meetings.

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Restivo, Léa; Apostolidis, Thémis; Bouhnik, Anne-Déborah; Garciaz, Sylvain; Aurran, Thérèse; Julian-Reynier, Claire

2016-01-01

The contribution of patients' non-medical characteristics to individual physicians' decision-making has attracted considerable attention, but little information is available on this topic in the context of collective decision-making. Medical decision-making at cancer centres is currently carried out using a collective approach, at MultiDisciplinary Team (MDT) meetings. The aim of this study was to determine how patients' non-medical characteristics are presented at MDT meetings and how this information may affect the team's final medical decisions. Observations were conducted at a French Cancer Centre during MDT meetings at which non-standard cases involving some uncertainty were discussed from March to May 2014. Physicians' verbal statements and predefined contextual parameters were collected with a non-participant observational approach. Non numerical data collected in the form of open notes were then coded for quantitative analysis. Univariate and multivariate statistical analyses were performed. In the final sample of patients' records included and discussed (N = 290), non-medical characteristics were mentioned in 32.8% (n = 95) of the cases. These characteristics corresponded to demographics in 22.8% (n = 66) of the cases, psychological data in 11.7% (n = 34), and relational data in 6.2% (n = 18). The patient's age and his/her "likeability" were the most frequently mentioned characteristics. In 17.9% of the cases discussed, the final decision was deferred: this outcome was positively associated with the patients' non-medical characteristics and with uncertainty about the outcome of the therapeutic options available. The design of the study made it difficult to draw definite cause-and-effect conclusions. The Social Representations approach suggests that patients' non-medical characteristics constitute a kind of tacit professional knowledge that may be frequently mobilised in physicians' everyday professional practice. The links observed between patients

Twitter as a place where people meet to make suicide pacts.

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Lee, S Y; Kwon, Y

2018-06-01

To examine how Twitter is used as a place where people seek others to make suicide pacts. This is an exploratory quantitative study. We used Twitter application programming interfaces to collect all Korean tweets containing the term 'suicide pact' between October 16, 2017 and November 30, 2017. A Python program and human coders were employed to further identify tweets that aimed to seek others to make a suicide pact and analyze the content of each tweet. Poisson regression analysis was used to examine the characteristics of the tweets that attracted more replies. During the data collection period comprising 43 days, 1702 tweets posted by 551 users were aimed to find others to make suicide pacts. Many of the tweets contained detailed information such as the name of city, gender and age of the user, preferred contact method, and preferred gender of a partner. The number of replies to a tweet seeking a suicide pact varied according to the types of the information contained in the tweet. The results of this study indicate that Twitter might be an attractive place where people try to meet others to make a suicide pact. Thus, the government should try to prevent cases of suicides caused by suicide pacts made via Twitter. Copyright © 2018 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Roman concept of mental capacity to make end-of-life decisions.

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Mendelson, Danuta

2007-01-01

When assessing decisional competence of patients, psychiatrists have to balance the patients' right to personal autonomy, their condition and wishes against principles of medical ethics and professional discretion. This article explores the age-old legal and ethical dilemmas posed by refusal of vital medical treatment by patients and their mental capacity to make end-of-life decisions against the background of philosophical, legal and medical approaches to these issues in the time of the Younger Pliny (c62-c113 CE). Classical Roman discourse regarding mental competency and "voluntary death" formed an important theme of the vast corpus of Greco-Roman writings, which was moulded not only by legal permissibility of suicide but also by philosophical (in modern terms, moral or ethical) considerations. Indeed, the legal and ethical issues of evaluating the acceptability of end of life decisions discussed in the Letters are as pertinent today as they were 2000 years ago. We may gain valuable insights about our own methodologies and frames of reference in this area of the law and psychiatry by examining Classical Roman approaches to evaluating acceptability of death-choices as described in Pliny's Letters and the writings of some of his peers.

Opportunities for making ends meet and upward mobility: differences in organizational deprivation across urban and suburban poor neighborhoods.

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Murphy, Alexandra K; Wallace, Danielle

2010-01-01

Objectives. Given the recent rise of poverty in U.S. suburbs, this study asks: What poor neighborhoods are most disadvantageous, those in the city or those in the suburbs? Building on recent urban sociological work demonstrating the importance of neighborhood organizations for the poor, we are concerned with one aspect of disadvantage—the lack of availability of organizational resources oriented toward the poor. By breaking down organizations into those that promote mobility versus those that help individuals meet their daily subsistence needs, we seek to explore potential variations in the type of disadvantage that may exist.Methods. We test whether poor urban or suburban neighborhoods are more likely to be organizationally deprived by breaking down organizations into three types: hardship organizations, educational organizations, and employment organizations. We use data from the 2000 U.S. County Business Patterns and the 2000 U.S. Census and test neighborhood deprivation using logistic regression models.Results. We find that suburban poor neighborhoods are more likely to be organizationally deprived than are urban poor neighborhoods, especially with respect to organizations that promote upward mobility. Interesting racial and ethnic composition factors shape this more general finding.Conclusion. Our findings suggest that if a poor individual is to live in a poor neighborhood, with respect to access to organizational resources, he or she would be better off living in the central city. Suburban residence engenders isolation from organizations that will help meet one's daily needs and even more so from those offering opportunities for mobility.

Shared decision-making in end-stage renal disease: a protocol for a multi-center study of a communication intervention to improve end-of-life care for dialysis patients.

Science.gov (United States)

Eneanya, Nwamaka D; Goff, Sarah L; Martinez, Talaya; Gutierrez, Natalie; Klingensmith, Jamie; Griffith, John L; Garvey, Casey; Kitsen, Jenny; Germain, Michael J; Marr, Lisa; Berzoff, Joan; Unruh, Mark; Cohen, Lewis M

2015-06-12

End-stage renal disease carries a prognosis similar to cancer yet only 20 % of end-stage renal disease patients are referred to hospice. Furthermore, conversations between dialysis team members and patients about end-of-life planning are uncommon. Lack of provider training about how to communicate prognostic data may contribute to the limited number of end-of-life care discussions that take place with this chronically ill population. In this study, we will test the Shared Decision-Making Renal Supportive Care communication intervention to systematically elicit patient and caretaker preferences for end-of-life care so that care concordant with patients' goals can be provided. This multi-center study will deploy an intervention to improve end-of-life communication for hemodialysis patients who are at high risk of death in the ensuing six months. The intervention will be carried out as a prospective cohort with a retrospective cohort serving as the comparison group. Patients will be recruited from 16 dialysis units associated with two large academic centers in Springfield, Massachusetts and Albuquerque, New Mexico. Critical input from patient advisory boards, a stakeholder panel, and initial qualitative analysis of patient and caretaker experiences with advance care planning have informed the communication intervention. Rigorous communication training for hemodialysis social workers and providers will ensure that standardized study procedures are performed at each dialysis unit. Nephrologists and social workers will communicate prognosis and provide advance care planning in face-to-face encounters with patients and families using a social work-centered algorithm. Study outcomes including frequency and timing of hospice referrals, patient and caretaker satisfaction, quality of end-of-life discussions, and quality of death will be assessed over an 18 month period. The Shared Decision-Making Renal Supportive Care Communication intervention intends to improve discussions

Influence of institutional culture and policies on do-not-resuscitate decision making at the end of life.

Science.gov (United States)

Dzeng, Elizabeth; Colaianni, Alessandra; Roland, Martin; Chander, Geetanjali; Smith, Thomas J; Kelly, Michael P; Barclay, Stephen; Levine, David

2015-05-01

Controversy exists regarding whether the decision to pursue a do-not-resuscitate (DNR) order should be grounded in an ethic of patient autonomy or in the obligation to act in the patient's best interest (beneficence). To explore how physicians' approaches to DNR decision making at the end of life are shaped by institutional cultures and policies surrounding patient autonomy. We performed semistructured in-depth qualitative interviews of 58 internal medicine physicians from 4 academic medical centers (3 in the United States and 1 in the United Kingdom) by years of experience and medical subspecialty from March 7, 2013, through January 8, 2014. Hospitals were selected based on expected differences in hospital culture and variations in hospital policies regarding prioritization of autonomy vs best interest. This study identified the key influences of institutional culture and policies on physicians' attitudes toward patient autonomy in DNR decision making at the end of life. A hospital's prioritization of autonomy vs best interest as reflected in institutional culture and policy appeared to influence the way that physician trainees conceptualized patient autonomy. This finding may have influenced the degree of choice and recommendations physician trainees were willing to offer regarding DNR decision making. Trainees at hospitals where policies and culture prioritized autonomy-focused approaches appeared to have an unreflective deference to autonomy and felt compelled to offer the choice of resuscitation neutrally in all situations regardless of whether they believed resuscitation to be clinically appropriate. In contrast, trainees at hospitals where policies and culture prioritized best-interest-focused approaches appeared to be more comfortable recommending against resuscitation in situations where survival was unlikely. Experienced physicians at all sites similarly did not exclusively allow their actions to be defined by policies and institutional culture and were

Urban Biomining Meets Printable Electronics: End-To-End at Destination Biological Recycling and Reprinting

Science.gov (United States)

Rothschild, Lynn J. (Principal Investigator); Koehne, Jessica; Gandhiraman, Ram; Navarrete, Jesica; Spangle, Dylan

2017-01-01

Space missions rely utterly on metallic components, from the spacecraft to electronics. Yet, metals add mass, and electronics have the additional problem of a limited lifespan. Thus, current mission architectures must compensate for replacement. In space, spent electronics are discarded; on earth, there is some recycling but current processes are toxic and environmentally hazardous. Imagine instead an end-to-end recycling of spent electronics at low mass, low cost, room temperature, and in a non-toxic manner. Here, we propose a solution that will not only enhance mission success by decreasing upmass and providing a fresh supply of electronics, but in addition has immediate applications to a serious environmental issue on the Earth. Spent electronics will be used as feedstock to make fresh electronic components, a process we will accomplish with so-called 'urban biomining' using synthetically enhanced microbes to bind metals with elemental specificity. To create new electronics, the microbes will be used as 'bioink' to print a new IC chip, using plasma jet electronics printing. The plasma jet electronics printing technology will have the potential to use martian atmospheric gas to print and to tailor the electronic and chemical properties of the materials. Our preliminary results have suggested that this process also serves as a purification step to enhance the proportion of metals in the 'bioink'. The presence of electric field and plasma can ensure printing in microgravity environment while also providing material morphology and electronic structure tunabiity and thus optimization. Here we propose to increase the TRL level of the concept by engineering microbes to dissolve the siliceous matrix in the IC, extract copper from a mixture of metals, and use the microbes as feedstock to print interconnects using mars gas simulant. To assess the ability of this concept to influence mission architecture, we will do an analysis of the infrastructure required to execute

Advance care planning and end-of-life decision making in dialysis: a randomized controlled trial targeting patients and their surrogates.

Science.gov (United States)

Song, Mi-Kyung; Ward, Sandra E; Fine, Jason P; Hanson, Laura C; Lin, Feng-Chang; Hladik, Gerald A; Hamilton, Jill B; Bridgman, Jessica C

2015-11-01

Few trials have examined long-term outcomes of advance care planning (ACP) interventions. We examined the efficacy of an ACP intervention on preparation for end-of-life decision making for dialysis patients and surrogates and for surrogates' bereavement outcomes. A randomized trial compared an ACP intervention (Sharing Patient's Illness Representations to Increase Trust [SPIRIT]) to usual care alone, with blinded outcome assessments. 420 participants (210 dyads of prevalent dialysis patients and their surrogates) from 20 dialysis centers. Every dyad received usual care. Those randomly assigned to SPIRIT had an in-depth ACP discussion at the center and a follow-up session at home 2 weeks later. preparation for end-of-life decision making, assessed for 12 months, included dyad congruence on goals of care at end of life, patient decisional conflict, surrogate decision-making confidence, and a composite of congruence and surrogate decision-making confidence. bereavement outcomes, assessed for 6 months, included anxiety, depression, and posttraumatic distress symptoms completed by surrogates after patient death. adjusting for time and baseline values, dyad congruence (OR, 1.89; 95% CI, 1.1-3.3), surrogate decision-making confidence (β=0.13; 95% CI, 0.01-0.24), and the composite (OR, 1.82; 95% CI, 1.0-3.2) were better in SPIRIT than controls, but patient decisional conflict did not differ between groups (β=-0.01; 95% CI, -0.12 to 0.10). 45 patients died during the study. Surrogates in SPIRIT had less anxiety (β=-1.13; 95% CI, -2.23 to -0.03), depression (β=-2.54; 95% CI, -4.34 to -0.74), and posttraumatic distress (β=-5.75; 95% CI, -10.9 to -0.64) than controls. Study was conducted in a single US region. SPIRIT was associated with improvements in dyad preparation for end-of-life decision making and surrogate bereavement outcomes. Copyright © 2015 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

Healthcare decision-making in end stage renal disease-patient preferences and clinical correlates.

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Jayanti, Anuradha; Neuvonen, Markus; Wearden, Alison; Morris, Julie; Foden, Philip; Brenchley, Paul; Mitra, Sandip

2015-11-14

Medical decision-making is critical to patient survival and well-being. Patients with end stage renal disease (ESRD) are faced with incrementally complex decision-making throughout their treatment journey. The extent to which patients seek involvement in the decision-making process and factors which influence these in ESRD need to be understood. 535 ESRD patients were enrolled into the cross-sectional study arm and 30 patients who started dialysis were prospectively evaluated. Patients were enrolled into 3 groups- 'predialysis' (group A), 'in-centre' haemodialysis (HD) (group B) and self-care HD (93 % at home-group C) from across five tertiary UK renal centres. The Autonomy Preference Index (API) has been employed to study patient preferences for information-seeking (IS) and decision-making (DM). Demographic, psychosocial and neuropsychometric assessments are considered for analyses. 458 complete responses were available. API items have high internal consistency in the study population (Cronbach's alpha > 0.70). Overall and across individual study groups, the scores for information-seeking and decision-making are significantly different indicating that although patients had a strong preference to be well informed, they were more neutral in their preference to participate in DM (p gender, marital status; higher API IS scores and white ethnicity background were significant predictors of preference for decision-making. DM scores were subdivided into tertiles to identify variables associated with high (DM > 70: and low DM (≤30) scores. This shows association of higher DM scores with lower age, lower comorbidity index score, higher executive brain function, belonging in the self-caring cohort and being unemployed. In the prospectively studied cohort of predialysis patients, there was no change in decision-making preference scores after commencement of dialysis. ESRD patients prefer to receive information, but this does not always imply active involvement in

[Decision-making processes in nursing and activities at the end of life in intensive care–An international comparative study].

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Kohlen, Helen; McCarthy, Joan; Szylit Buosso, Regina; Gallagher, Ann; Andrews, Tom

2015-12-01

Intensive care units (ICUs) are traditionally settings that offer high technologically advanced treatment for those who are in critical situations due to an illness or accident. Questions regarding the withdrawal and withholding as well as the ending of life sustaining treatment are related to ethical dilemmas. Nurses’ decision-making processes and nursing activities in different countries are scarcely studied. Which end-of-life decision-making processes and activities that are performed by nurses can be identified and described? The objective is the identification of a nursing terrain regarding decision-making and activities in patient end-of-life care on the intensive care unit. Semi-structured interviews were conducted with 51 experienced nurses in university or hospital premises: 10 in Brazil, 9 in England, 10 in Germany, 10 in Ireland and 12 nurses in Palestine. The study used grounded theory to inform data collection and analysis. The finding of the study is the identification of a dynamic process in which activities with a focus on cure shift to activities with a focus on end-of-life care. The core category that emerged was ’negotiated reorienting’: The shift of activities implies negotiations between nurses and physicians, relatives as well as with oneself. Moreover the process is characterized by a constant re-orientation that is induced by changing patient data and the realisation of the whole situation. Nurses’ core practices are ’consensus seeking’ and ’emotional holding’ (sub-categories). In all countries a nursing terrain of activities in end-of-life care could be identified and described. However, it is unclear whether nursing activities connected to relatives of the patient are dominant in such a way that relations to dying patients and respect for their autonomy are put into the background. A field study could give answers to this question possible.

21 CFR 312.47 - Meetings.

Science.gov (United States)

2010-04-01

... resources permit. The general principle underlying the conduct of such meetings is that there should be free...) “End-of-Phase 2” meetings and meetings held before submission of a marketing application. At specific... meetings held near completion of Phase 3 and before submission of a marketing application (“pre-NDA...

Ethical challenges in nursing homes--staff's opinions and experiences with systematic ethics meetings with participation of residents' relatives.

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Bollig, Georg; Schmidt, Gerda; Rosland, Jan Henrik; Heller, Andreas

2015-12-01

Many ethical problems exist in nursing homes. These include, for example, decision-making in end-of-life care, use of restraints and a lack of resources. The aim of the present study was to investigate nursing home staffs' opinions and experiences with ethical challenges and to find out which types of ethical challenges and dilemmas occur and are being discussed in nursing homes. The study used a two-tiered approach, using a questionnaire on ethical challenges and systematic ethics work, given to all employees of a Norwegian nursing home including nonmedical personnel, and a registration of systematic ethics discussions from an Austrian model of good clinical practice. Ninety-one per cent of the nursing home staff described ethical problems as a burden. Ninety per cent experienced ethical problems in their daily work. The top three ethical challenges reported by the nursing home staff were as follows: lack of resources (79%), end-of-life issues (39%) and coercion (33%). To improve systematic ethics work, most employees suggested ethics education (86%) and time for ethics discussion (82%). Of 33 documented ethics meetings from Austria during a 1-year period, 29 were prospective resident ethics meetings where decisions for a resident had to be made. Agreement about a solution was reached in all 29 cases, and this consensus was put into practice in all cases. Residents did not participate in the meetings, while relatives participated in a majority of case discussions. In many cases, the main topic was end-of-life care and life-prolonging treatment. Lack of resources, end-of-life issues and coercion were ethical challenges most often reported by nursing home staff. The staff would appreciate systematic ethics work to aid decision-making. Resident ethics meetings can help to reach consensus in decision-making for nursing home patients. In the future, residents' participation should be encouraged whenever possible. © 2015 The Authors. Scandinavian Journal of Caring

A model for emergency department end-of-life communications after acute devastating events--part I: decision-making capacity, surrogates, and advance directives.

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Limehouse, Walter E; Feeser, V Ramana; Bookman, Kelly J; Derse, Arthur

2012-09-01

Making decisions for a patient affected by sudden devastating illness or injury traumatizes a patient's family and loved ones. Even in the absence of an emergency, surrogates making end-of-life treatment decisions may experience negative emotional effects. Helping surrogates with these end-of-life decisions under emergent conditions requires the emergency physician (EP) to be clear, making medical recommendations with sensitivity. This model for emergency department (ED) end-of-life communications after acute devastating events comprises the following steps: 1) determine the patient's decision-making capacity; 2) identify the legal surrogate; 3) elicit patient values as expressed in completed advance directives; 4) determine patient/surrogate understanding of the life-limiting event and expectant treatment goals; 5) convey physician understanding of the event, including prognosis, treatment options, and recommendation; 6) share decisions regarding withdrawing or withholding of resuscitative efforts, using available resources and considering options for organ donation; and 7) revise treatment goals as needed. Emergency physicians should break bad news compassionately, yet sufficiently, so that surrogate and family understand both the gravity of the situation and the lack of long-term benefit of continued life-sustaining interventions. EPs should also help the surrogate and family understand that palliative care addresses comfort needs of the patient including adequate treatment for pain, dyspnea, or anxiety. Part I of this communications model reviews determination of decision-making capacity, surrogacy laws, and advance directives, including legal definitions and application of these steps; Part II (which will appear in a future issue of AEM) covers communication moving from resuscitative to end-of-life and palliative treatment. EPs should recognize acute devastating illness or injuries, when appropriate, as opportunities to initiate end-of-life discussions and to

The impact of regional culture on intensive care end of life decision making: an Israeli perspective from the ETHICUS study.

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Ganz, F D; Benbenishty, J; Hersch, M; Fischer, A; Gurman, G; Sprung, C L

2006-04-01

Decisions of patients, families, and health care providers about medical care at the end of life depend on many factors, including the societal culture. A pan-European study was conducted to determine the frequency and types of end of life practices in European intensive care units (ICUs), including those in Israel. Several results of the Israeli subsample were different to those of the overall sample. The objective of this article was to explore these differences and provide a possible explanation based on the impact of culture on end of life decision making. All adult patients admitted consecutively to three Israeli ICUs (n = 2778) who died or underwent any limitation of life saving interventions between 1 January 1999 and 30 June 2000 were studied prospectively (n = 363). These patients were compared with a similar sample taken from the larger study (ethics in European intensive care units: ETHICUS) carried out in 37 European ICUs. Patients were followed until discharge, death, or 2 months from the decision to limit therapy. End of life decisions were prospectively organised into one of five mutually exclusive categories: cardiopulmonary resuscitation (CPR), brain death, withholding treatment, withdrawing treatment, and active shortening of the dying process (SDP). The data also included patient characteristics (gender, age, ICU admission diagnosis, chronic disorders, date of hospital admission, date and time of decision to limit therapy, date of hospital discharge, date and time of death in hospital), specific therapies limited, and the method of SDP. The majority of patients (n = 252, 69%) had treatment withheld, none underwent SDP, 62 received CPR (17%), 31 had brain death (9%), and 18 underwent withdrawal of treatment (5%). The primary reason given for limiting treatment was that the patient was unresponsive to therapy (n = 187). End of life discussions were held with 132 families (36%), the vast majority of which revolved around withholding treatment (91

A method for studying decision-making by guideline development groups.

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Gardner, Benjamin; Davidson, Rosemary; McAteer, John; Michie, Susan

2009-08-05

Multidisciplinary guideline development groups (GDGs) have considerable influence on UK healthcare policy and practice, but previous research suggests that research evidence is a variable influence on GDG recommendations. The Evidence into Recommendations (EiR) study has been set up to document social-psychological influences on GDG decision-making. In this paper we aim to evaluate the relevance of existing qualitative methodologies to the EiR study, and to develop a method best-suited to capturing influences on GDG decision-making. A research team comprised of three postdoctoral research fellows and a multidisciplinary steering group assessed the utility of extant qualitative methodologies for coding verbatim GDG meeting transcripts and semi-structured interviews with GDG members. A unique configuration of techniques was developed to permit data reduction and analysis. Our method incorporates techniques from thematic analysis, grounded theory analysis, content analysis, and framework analysis. Thematic analysis of individual interviews conducted with group members at the start and end of the GDG process defines discrete problem areas to guide data extraction from GDG meeting transcripts. Data excerpts are coded both inductively and deductively, using concepts taken from theories of decision-making, social influence and group processes. These codes inform a framework analysis to describe and explain incidents within GDG meetings. We illustrate the application of the method by discussing some preliminary findings of a study of a National Institute for Health and Clinical Excellence (NICE) acute physical health GDG. This method is currently being applied to study the meetings of three of NICE GDGs. These cover topics in acute physical health, mental health and public health, and comprise a total of 45 full-day meetings. The method offers potential for application to other health care and decision-making groups.

A method for studying decision-making by guideline development groups

Directory of Open Access Journals (Sweden)

Michie Susan

2009-08-01

Full Text Available Abstract Background Multidisciplinary guideline development groups (GDGs have considerable influence on UK healthcare policy and practice, but previous research suggests that research evidence is a variable influence on GDG recommendations. The Evidence into Recommendations (EiR study has been set up to document social-psychological influences on GDG decision-making. In this paper we aim to evaluate the relevance of existing qualitative methodologies to the EiR study, and to develop a method best-suited to capturing influences on GDG decision-making. Methods A research team comprised of three postdoctoral research fellows and a multidisciplinary steering group assessed the utility of extant qualitative methodologies for coding verbatim GDG meeting transcripts and semi-structured interviews with GDG members. A unique configuration of techniques was developed to permit data reduction and analysis. Results Our method incorporates techniques from thematic analysis, grounded theory analysis, content analysis, and framework analysis. Thematic analysis of individual interviews conducted with group members at the start and end of the GDG process defines discrete problem areas to guide data extraction from GDG meeting transcripts. Data excerpts are coded both inductively and deductively, using concepts taken from theories of decision-making, social influence and group processes. These codes inform a framework analysis to describe and explain incidents within GDG meetings. We illustrate the application of the method by discussing some preliminary findings of a study of a National Institute for Health and Clinical Excellence (NICE acute physical health GDG. Conclusion This method is currently being applied to study the meetings of three of NICE GDGs. These cover topics in acute physical health, mental health and public health, and comprise a total of 45 full-day meetings. The method offers potential for application to other health care and decision-making

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

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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.

Communication Tools for End-of-Life Decision-Making in Ambulatory Care Settings: A Systematic Review and Meta-Analysis.

Science.gov (United States)

Oczkowski, Simon J; Chung, Han-Oh; Hanvey, Louise; Mbuagbaw, Lawrence; You, John J

2016-01-01

Patients with serious illness, and their families, state that better communication and decision-making with healthcare providers is a high priority to improve the quality of end-of-life care. Numerous communication tools to assist patients, family members, and clinicians in end-of-life decision-making have been published, but their effectiveness remains unclear. To determine, amongst adults in ambulatory care settings, the effect of structured communication tools for end-of-life decision-making on completion of advance care planning. We searched for relevant randomized controlled trials (RCTs) or non-randomized intervention studies in MEDLINE, EMBASE, CINAHL, ERIC, and the Cochrane Database of Randomized Controlled Trials from database inception until July 2014. Two reviewers independently screened articles for eligibility, extracted data, and assessed risk of bias. Grading of Recommendations Assessment, Development, and Evaluation (GRADE) was used to evaluate the quality of evidence for each of the primary and secondary outcomes. Sixty-seven studies, including 46 RCTs, were found. The majority evaluated communication tools in older patients (age >50) with no specific medical condition, but many specifically evaluated populations with cancer, lung, heart, neurologic, or renal disease. Most studies compared the use of communication tools against usual care, but several compared the tools to less-intensive advance care planning tools. The use of structured communication tools increased: the frequency of advance care planning discussions/discussions about advance directives (RR 2.31, 95% CI 1.25-4.26, p = 0.007, low quality evidence) and the completion of advance directives (ADs) (RR 1.92, 95% CI 1.43-2.59, pcare desired and care received by patients (RR 1.17, 95% CI 1.05-1.30, p = 0.004, low quality evidence, 2 RCTs). The use of structured communication tools may increase the frequency of discussions about and completion of advance directives, and concordance between

Communication as care at end of life: an emerging issue from an exploratory action research study of renal end-of-life care for ethnic minorities in the UK.

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Wilkinson, Emma; Randhawa, Gurch; Brown, Edwina A; Da Silva Gane, Maria; Stoves, John; Warwick, Graham; Akhtar, Tahira; Magee, Regina; Sharman, Sue; Farrington, Ken

2014-09-01

South Asian people have a higher risk of developing kidney disease, are disproportionately represented in the patient population requiring renal replacement therapy and wait longer to receive a kidney transplant, compared with white Europeans. As a result, there is a demand for end-of-life care, which meets the needs of this group of patients. Providing end-of-life care to patients from different cultures is a challenge for renal services as there can be barriers to communication in the form of language, delegated decision-making within families and reluctance to discuss death. To explore end-of-life care for South Asians with kidney disease, 16 interviews with patients and 14 focus groups with care providers were conducted at four research sites in the UK with large South Asian populations. Using an action research design the data were analysed thematically and fed back to inform the research in a cyclical manner. If patients are not fully aware of their condition or of what end-of-life care is, it is less likely that they will be able to be involved in decision-making about their care and this is compounded where there are communication barriers. Variations in care provider awareness and experience of providing end-of-life care to South Asian patients, in turn, contributes to lack of patient awareness of end-of-life care. Communication as care at the end of life should be explored further. Researching the South Asian patient experience of end of life highlights many relevant and generalisable issues. © 2014 European Dialysis and Transplant Nurses Association/European Renal Care Association.

Seeking and Accepting: U.S. Clergy Theological and Moral Perspectives Informing Decision Making at the End of Life.

Science.gov (United States)

Sanders, Justin J; Chow, Vinca; Enzinger, Andrea C; Lam, Tai-Chung; Smith, Patrick T; Quiñones, Rebecca; Baccari, Andrew; Philbrick, Sarah; White-Hammond, Gloria; Peteet, John; Balboni, Tracy A; Balboni, Michael J

2017-10-01

People with serious illness frequently rely on religion/spirituality to cope with their diagnosis, with potentially positive and negative consequences. Clergy are uniquely positioned to help patients consider medical decisions at or near the end of life within a religious/spiritual framework. We aimed to examine clergy knowledge of end-of-life (EOL) care and beliefs about the role of faith in EOL decision making for patients with serious illness. Key informant interviews, focus groups, and survey. A purposive sample of 35 active clergy in five U.S. states as part of the National Clergy End-of-Life Project. We assessed participant knowledge of and desire for further education about EOL care. We transcribed interviews and focus groups for the purpose of qualitative analysis. Clergy had poor knowledge of EOL care; 75% desired more EOL training. Qualitative analysis revealed a theological framework for decision making in serious illness that balances seeking life and accepting death. Clergy viewed comfort-focused treatments as consistent with their faith traditions' views of a good death. They employed a moral framework to determine the appropriateness of EOL decisions, which weighs the impact of multiple factors and upholds the importance of God-given free will. They viewed EOL care choices to be the primary prerogative of patients and families. Clergy described ambivalence about and a passive approach to counseling congregants about decision making despite having defined beliefs regarding EOL care. Poor knowledge of EOL care may lead clergy to passively enable congregants with serious illness to pursue potentially nonbeneficial treatments that are associated with increased suffering.

Transparency in Transcribing: Making Visible Theoretical Bases Impacting Knowledge Construction from Open-Ended Interview Records

Directory of Open Access Journals (Sweden)

Audra Skukauskaite

2012-01-01

Full Text Available This article presents a reflexive analysis of two transcripts of an open-ended interview and argues for transparency in transcribing processes and outcomes. By analyzing ways in which a researcher's theories become consequential in producing and using transcripts of an open-ended interview, this paper makes visible the importance of examining and presenting theoretical bases of transcribing decisions. While scholars across disciplines have argued that transcribing is a theoretically laden process (GREEN, FRANQUIZ & DIXON, 1997; KVALE & BRINKMAN, 2009, few have engaged in reflexive analyses of the data history to demonstrate the consequences particular theoretical and methodological approaches pose in producing knowledge claims and inciting dialogues across traditions. The article demonstrates how theory-method-claim relationships in transcribing influence research transparency and warrantability. URN: http://nbn-resolving.de/urn:nbn:de:0114-fqs1201146

High-End Scientific Computing

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EPA uses high-end scientific computing, geospatial services and remote sensing/imagery analysis to support EPA's mission. The Center for Environmental Computing (CEC) assists the Agency's program offices and regions to meet staff needs in these areas.

Making Ends Meet: Hmong Socioeconomic Trends in the U.S.

Directory of Open Access Journals (Sweden)

Chia Youyee Vang

2012-01-01

Full Text Available This article examines Hmong socioeconomic trends from 1990 to 2010. A review of economic indicators across states and in relation to the U.S. population reveals that on an aggregate level, the Hmong American population’s socioeconomic status has improved significantly. The increases in income and earnings have, however, been shortchanged by external factors brought about partially by the financial crisis and its aftermath. Consequently, this begs us to question the extent to which such developments contribute to the overall economic well-being of Hmong Americans.

A Structured Approach to End-of-Life Decision Making Improves Quality of Care for Patients With Terminal Illness in a Teaching Hospital in Ghana.

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Edwin, Ama Kyerewaa; Johnson McGee, Summer; Opare-Lokko, Edwina Addo; Gyakobo, Mawuli Kotope

2016-03-01

To determine whether a structured approach to end-of-life decision-making directed by a compassionate interdisciplinary team would improve the quality of care for patients with terminal illness in a teaching hospital in Ghana. A retrospective analysis was done for 20 patients who consented to participate in the structured approach to end-of-life decision-making. Twenty patients whose care did not follow the structured approach were selected as controls. Outcome measures were nociceptive pain control, completing relationships, and emotional response towards dying. These measures were statistically superior in the study group compared to the control group. A structured approach to end-of-life decision-making significantly improves the quality of care for patients with terminal illness in the domains of pain control, completing relationships and emotional responses towards dying. © The Author(s) 2014.

Making the case for talking to patients about the costs of end-of-life care.

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Donley, Greer; Danis, Marion

2011-01-01

Costs at the end of life disproportionately contribute to health care costs in the United States. Addressing these costs will therefore be an important component in making the U.S. health care system more financially sustainable. In this paper, we explore the moral justifications for having discussions of end-of-life costs in the doctor-patient encounter as part of an effort to control costs. As health care costs are partly shared through pooled resources, such as insurance and taxation, and partly borne by individuals through out-of-pocket expenses, we separate our defense for, and approach to, discussing both pooled and individual aspects of cost. We argue that there needs to be a shift away from formulating the options as a dichotomous choice of paying attention to end-of-life costs versus ignoring such costs. The question should be how personal costs will be managed and how societal expenditures should be allocated. These are issues that we believe patients care about and need to have addressed in a manner with which they are comfortable. Conversations about how money will be spent at the end of life should begin before the end is near. We propose discussing costs from the onset of chronic illness and incorporating financial issues in advance care planning. Through these approaches one can avoid abruptly and insensitively introducing financial issues at the very conclusion of a person's life when one would prefer to address the painful and important issues of spiritual and existential loss that are appropriately the focus when a person is dying. © 2011 American Society of Law, Medicine & Ethics, Inc.

Shared decision-making at the end of life: A focus group study exploring the perceptions and experiences of multi-disciplinary healthcare professionals working in the home setting.

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Brogan, Paula; Hasson, Felicity; McIlfatrick, Sonja

2018-01-01

Globally recommended in healthcare policy, Shared Decision-Making is also central to international policy promoting community palliative care. Yet realities of implementation by multi-disciplinary healthcare professionals who provide end-of-life care in the home are unclear. To explore multi-disciplinary healthcare professionals' perceptions and experiences of Shared Decision-Making at end of life in the home. Qualitative design using focus groups, transcribed verbatim and analysed thematically. A total of 43 participants, from multi-disciplinary community-based services in one region of the United Kingdom, were recruited. While the rhetoric of Shared Decision-Making was recognised, its implementation was impacted by several interconnecting factors, including (1) conceptual confusion regarding Shared Decision-Making, (2) uncertainty in the process and (3) organisational factors which impeded Shared Decision-Making. Multiple interacting factors influence implementation of Shared Decision-Making by professionals working in complex community settings at the end of life. Moving from rhetoric to reality requires future work exploring the realities of Shared Decision-Making practice at individual, process and systems levels.

End of Life Issues

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Planning for the end of life can be difficult. But by deciding what end-of-life care best suits your needs when you are healthy, you can ... right choices when the time comes. End-of-life planning usually includes making choices about the following: ...

Medical end-of-life decisions in Switzerland 2001 and 2013: Who is involved and how does the decision-making capacity of the patient impact?

Science.gov (United States)

Schmid, Margareta; Zellweger, Ueli; Bosshard, Georg; Bopp, Matthias

2016-01-01

In Switzerland, the prevalence of medical end-of-life practices had been assessed on a population level only once - in 2001 - until in 2013/14 an identical study was conducted. We aimed to compare the results of the 2001 and 2013 studies with a special focus on shared decision-making and patients' decision-making capacity. Our study encompassed a 21.3% sample of deaths among residents of the German-speaking part of Switzerland aged 1 year or older. From 4998 mailed questionnaires, 3173 (63.5%) were returned. All data were weighted to adjust for age- and sex-specific differences in response rates. Cases with at least one reported end-of-life practice significantly increased from 74.5% (2001) to 82.3% (2013) of all deaths eligible for an end-of-life decision (p Switzerland, there remains potential for further improvement in shared decision-making. Efforts to motivate physicians to involve patients and relatives may be a win-win situation.

Fleeing from Frankenstein's Monster and Meeting Kafka on the Way: Algorithmic Decision-Making in Higher Education

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Prinsloo, Paul

2017-01-01

In the socio-technical imaginary of higher education, algorithmic decision-making offers huge potential, but we also cannot deny the risks and ethical concerns. In fleeing from Frankenstein's monster, there is a real possibility that we will meet Kafka on our path, and not find our way out of the maze of ethical considerations in the nexus between…

Decision Making Under Uncertainty - Bridging the Gap Between End User Needs and Science Capability

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Verdon-Kidd, D. C.; Kiem, A.; Austin, E. K.

2012-12-01

Successful adaptation outcomes depend on decision making based on the best available climate science information. However, a fundamental barrier exists, namely the 'gap' between information that climate science can currently provide and the information that is practically useful for end users and decision makers. This study identifies the major contributing factors to the 'gap' from an Australian perspective and provides recommendations as to ways in which the 'gap' may be narrowed. This was achieved via a literature review, online survey (targeted to providers of climate information and end users of that information), workshop (where both climate scientists and end users came together to discuss key issues) and focus group. The study confirmed that uncertainty in climate science is a key barrier to adaptation. The issue of uncertainty was found to be multi-faceted, with issues identified in terms of communication of uncertainty, misunderstanding of uncertainty and the lack of tools/methods to deal with uncertainty. There were also key differences in terms of expectations for the future - most end users were of the belief that uncertainty associated with future climate projections would reduce within the next five to 10 years, however producers of climate science information were well aware that this would most likely not be the case. This is a concerning finding as end users may delay taking action on adaptation and risk planning until the uncertainties are reduced - a situation which may never eventuate or may occur after the optimal time for action. Improved communication and packaging of climate information was another key theme that was highlighted in this study. Importantly, it was made clear that improved communication is not just about more glossy brochures and presentations by climate scientists, rather there is a role for a program or group to fill this role (coined a 'knowledge broker' during the workshop and focus group). The role of the 'knowledge

How to Make Poverty History: The central role of local organisations in meeting the Millennium Development Goals

Energy Technology Data Exchange (ETDEWEB)

Bigg, Tom

2006-02-15

IIED's conference 'How to make poverty history: The central role of local organisations in meeting the MDGs' brought together 58 people from 23 countries for two days of lively debate in December 2005. Nine clear messages stem from the conference, with major implications for the actions and choices pursued by governments, donor agencies and a range of non-state actors, including the private sector.

The effectiveness of sharp end and rounded end bristle toothbrush

OpenAIRE

Paulus Januar; Anastasia Susetyo; Ratih Widyastuti

2010-01-01

Background: Numerous designs of manual toothbrush are available in the market with the claims of superiority in plaque removal. It often makes the public confuse which is the best design. The sharp end bristle toothbrush is a modification that commercially available in the market. Purpose: The objective of the study was to compare the effectiveness in plaque removal of the sharp end bristle toothbrush and the rounded end bristle toothbrush. Methods: This clinical trial was a double blind cros...

Personal values underlying ethnic food choice: Means-end evidence for Japanese food

Directory of Open Access Journals (Sweden)

Yeong S. Tey

2018-03-01

Full Text Available Background: Ethnic cuisines are increasingly popular in global food markets. This study identifies the personal values underlying Malaysian consumers' decision making with respect to Japanese food. Methods: A total of 134 Malaysian consumers were interviewed and analyzed using means-end chain methodology. Results: Our findings indicate that Japanese food is chosen for the values that the attribute “tasty” can help achieve, not for that attribute per se. Conclusion: Identified values primarily related to longevity, meaningful life-style and sense of accomplishment. The identification of these connections is an important step in understanding why a particular ethnic food is favored by foreign consumers. Our findings could be helpful to restaurateurs in meeting marketing strategies with consumer values and policymakers when designing health campaigns. Keywords: Attributes, Japanese food, Means-end chain, Personal values, Product attributes, Cognition

78 FR 76660 - Arts Advisory Panel Meeting

Science.gov (United States)

2013-12-18

... otherwise noted) as follows (all meetings are Eastern time and ending times are approximate): Folk... p.m. in room 716. Music (review of nominations): This meeting will be closed. Dates: January 14... Columbus Circle, 12th Floor, New York, NY 10019. Music (application review): This meeting will be virtual...

MFTF-α+T end plug magnet design

International Nuclear Information System (INIS)

Srivastava, V.C.; O'Toole, J.A.

1983-01-01

The conceptual design of the end-plug magnets for MFTF-α+T is described. MFTF-α+ T is a near-term upgrade of MFTF-B, which features new end plugs to improve performance. The Fusion Engineering Design Center has performed the engineering design of MFTF-α+T under the overall direction of Lawrence Livermore National Laboratory. Each end plug consists of two Yin-Yang pairs, each with approx.2.5:1 mirror ratio and approx.5-T peak field on axis; two transition coils; and a recircularizing solenoid. This paper describes the end-plug magnet system functional requirements and presents a conceptual design that meets them. The peak field at the windings of the end-plug coils is approx.6-T. These coils are designed using the NbTi MFTF-B conductor and cooled by a 4.2K liquid helium bath. All the end-plug magnets are designed to operate in the cryostable mode with adequate quench protection for safety. Shielding requirements are stated and a summary of heat loads is provided. Field and force calculations are discussed. The field on axis is shown to meet the functional requirements. Force resultants are reported in terms of winding running loads and resultant coil forces are also given. The magnet structural support is described. A trade study to determine the optimum end-cell coil internal nuclear shield thickness and the resulting coil size based on minimizing the end-cell life cycle cost is summarized

Fifteenth LAMPF users group meeting

International Nuclear Information System (INIS)

Cochran, D.R.F.

1982-03-01

The Fifteenth LAMPF Users Group Meeting was held November 2-3, 1981 at the Clinton P. Anderson Meson Physical Facility. The program of papers scheduled to be presented was amended to include a Report from Washington by Clarence R. Richardson, US Department of Energy. The general meeting ended with a round-table working group discussion concerning the Planning for a Kaon Factory. Individual items from the meeting were prepared separately for the data base

75 FR 40850 - Notice of Public Meeting

Science.gov (United States)

2010-07-14

... meeting may end early if all business is completed. If the meeting date and location are changed due to... Membership 10. Old Business a. Denali Subsistence Management Plan b. Subsistence Uses of Horns, Antlers... Subsistence Resource Commission (SRC) program. SUMMARY: The Denali National Park SRC plans to meet to develop...

Signing at the beginning makes ethics salient and decreases dishonest self-reports in comparison to signing at the end

Science.gov (United States)

Shu, Lisa L.; Mazar, Nina; Gino, Francesca; Ariely, Dan; Bazerman, Max H.

2012-01-01

Many written forms required by businesses and governments rely on honest reporting. Proof of honest intent is typically provided through signature at the end of, e.g., tax returns or insurance policy forms. Still, people sometimes cheat to advance their financial self-interests—at great costs to society. We test an easy-to-implement method to discourage dishonesty: signing at the beginning rather than at the end of a self-report, thereby reversing the order of the current practice. Using laboratory and field experiments, we find that signing before—rather than after—the opportunity to cheat makes ethics salient when they are needed most and significantly reduces dishonesty. PMID:22927408

Signing at the beginning makes ethics salient and decreases dishonest self-reports in comparison to signing at the end.

Science.gov (United States)

Shu, Lisa L; Mazar, Nina; Gino, Francesca; Ariely, Dan; Bazerman, Max H

2012-09-18

Many written forms required by businesses and governments rely on honest reporting. Proof of honest intent is typically provided through signature at the end of, e.g., tax returns or insurance policy forms. Still, people sometimes cheat to advance their financial self-interests-at great costs to society. We test an easy-to-implement method to discourage dishonesty: signing at the beginning rather than at the end of a self-report, thereby reversing the order of the current practice. Using laboratory and field experiments, we find that signing before-rather than after-the opportunity to cheat makes ethics salient when they are needed most and significantly reduces dishonesty.

Attitudes, experiences, and beliefs affecting end-of-life decision-making among homeless individuals.

Science.gov (United States)

Tarzian, Anita J; Neal, Maggie T; O'Neil, J Anne

2005-02-01

Individuals who are homeless may encounter various barriers to obtaining quality end-of-life (EOL) care, including access barriers, multiple sources of discrimination, and lack of knowledge among health care providers (HCPs) of their preferences and decision-making practices. Planning for death with individuals who have spent so much energy surviving requires an understanding of their experiences and preferences. This study sought to increase HCPs' awareness and understanding of homeless or similarly marginalized individuals' EOL experiences and treatment preferences. Focus groups were conducted with homeless individuals using a semi-structured interview guide to elicit participants' EOL experiences, decision-making practices, and personal treatment preferences. Five focus groups were conducted with 20 inner-city homeless individuals (4 per group) at a free urban health care clinic for homeless individuals in the United States. Sixteen of the 20 participants were African American; 4 were Caucasian. None were actively psychotic. All had experienced multiple losses and drug addiction. Five main themes emerged: valuing an individual's wishes; acknowledging emotions; the primacy of religious beliefs and spiritual experience; seeking relationship-centered care; and reframing advance care planning. The narrative process of this qualitative study uncovered an approach to EOL decision-making in which participants' reasoning was influenced by emotions, religious beliefs, and spiritual experience. Relationship-centered care, characterized by compassion and respectful, two-way communication, was obvious by its described absence--reasons for this are discussed. Recommendations for reframing advance care planning include ways for HCPs to transform advance care planning from that of a legal document to a process of goal-setting that is grounded in human connection, respect, and understanding.

Educational Reform and Educational Research: New Challenges in Linking Research, Information and Decision Making. Final Report of the International Meeting (Tokyo, Japan, September 4-14, 1995).

Science.gov (United States)

National Inst. for Educational Research, Tokyo (Japan).

This document summarizes proceedings of a meeting held in September 1995. The purpose of the meeting was to gather educators and policymakers in order to establish criteria concerning links between educational research and decision making. Twenty participants from the following countries attended: Argentina, Australia, Bahrain, Botswana, Brazil,…

Negotiated reorienting: a grounded theory of nurses' end-of-life decision-making in the intensive care unit.

Science.gov (United States)

Gallagher, Ann; Bousso, Regina Szylit; McCarthy, Joan; Kohlen, Helen; Andrews, Tom; Paganini, Maria Cristina; Abu-El-Noor, Nasser Ibrahim; Cox, Anna; Haas, Margit; Arber, Anne; Abu-El-Noor, Mysoon Khalil; Baliza, Michelle Freire; Padilha, Katia Grillo

2015-04-01

Intensive care units (ICUs) focus on treatment for those who are critically ill and interventions to prolong life. Ethical issues arise when decisions have to be made regarding the withdrawal and withholding of life-sustaining treatment and the shift to comfort and palliative care. These issues are particularly challenging for nurses when there are varying degrees of uncertainty regarding prognosis. Little is known about nurses' end-of-life (EoL) decision-making practice across cultures. To understand nurses' EoL decision-making practices in ICUs in different cultural contexts. We collected and analysed qualitative data using Grounded Theory. Interviews were conducted with experienced ICU nurses in university or hospital premises in five countries: Brazil, England, Germany, Ireland and Palestine. Semi-structured interviews were conducted with 51 nurses (10 in Brazil, 9 in England, 10 in Germany, 10 in Ireland and 12 nurses in Palestine). They were purposefully and theoretically selected to include nurses having a variety of characteristics and experiences concerning end-of-life (EoL) decision-making. The study used grounded theory to inform data collection and analysis. Interviews were facilitated by using key questions. The comparative analysis of the data within and across data generated by the different research teams enabled researchers to develop a deeper understanding of EoL decision-making practices in the ICU. Ethical approval was granted in each of the participating countries and voluntary informed consent obtained from each participant. The core category that emerged was 'negotiated reorienting'. Whilst nurses do not make the 'ultimate' EoL decisions, they engage in two core practices: consensus seeking (involving coaxing, information cuing and voice enabling); and emotional holding (creating time-space and comfort giving). There was consensus regarding the core concept and core practices employed by nurses in the ICUs in the five countries. However

Communication skills training for dialysis decision-making and end-of-life care in nephrology.

Science.gov (United States)

Schell, Jane O; Green, Jamie A; Tulsky, James A; Arnold, Robert M

2013-04-01

Nephrology fellows often face difficult conversations about dialysis initiation or withdrawal but are frequently unprepared for these discussions. Despite evidence that communication skills are teachable, few fellowship programs include such training. A communication skills workshop for nephrology fellows (NephroTalk) focused on delivering bad news and helping patients define care goals, including end-of-life preferences. This 4-hour workshop, held in October and November 2011, included didactics and practice sessions with standardized patients. Participants were nephrology fellows at Duke University and the University of Pittsburgh (n=22). Pre- and post-workshop surveys evaluated efficacy of the curriculum and measured changes in perceived preparedness on the basis on workshop training. Overall, 14% of fellows were white and 50% were male. Less than one-third (6 of 22) reported prior palliative care training. Survey response rate varied between 86% and 100%. Only 36% (8 of 22) and 38% (8 of 21) of respondents had received structured training in discussions for dialysis initiation or withdrawal. Respondents (19 of 19) felt that communication skills were important to being a "great nephrologist." Mean level of preparedness as measured with a five-point Likert scale significantly increased for all skills (range, 0.5-1.14; Pdecision-making and end-of-life care.

End-of-life care communications and shared decision-making in Norwegian nursing homes--experiences and perspectives of patients and relatives.

Science.gov (United States)

Gjerberg, Elisabeth; Lillemoen, Lillian; Førde, Reidun; Pedersen, Reidar

2015-08-19

Involving nursing home patients and their relatives in end-of-life care conversations and treatment decisions has recently gained increased importance in several Western countries. However, there is little knowledge about how the patients themselves and their next-of-kin look upon involvement in end-of-life care decisions. The purpose of this paper is to explore nursing home patients' and next-of-kin's experiences with- and perspectives on end-of-life care conversations, information and shared decision-making. The study has a qualitative and explorative design, based on a combination of individual interviews with 35 patients living in six nursing homes and seven focus group interviews with 33 relatives. The data was analysed applying a "bricolage" approach". Participation was based on informed consent, and the study was approved by the Regional Committees for Medical and Health Research Ethics. Few patients and relatives had participated in conversations about end-of-life care. Most relatives wanted such conversations, while the patients' opinions varied. With some exceptions, patients and relatives wanted to be informed about the patient's health condition. The majority wanted to be involved in the decision-making process, but leave the final decisions to the health professionals. Among the patients, the opinion varied; some patients wanted to leave the decisions more or less completely to the nursing home staff. Conversations about end-of-life care issues are emotionally challenging, and very few patients had discussed these questions with their family. The relatives' opinions of the patient's preferences were mainly based on assumptions; they had seldom talked about this explicitly. Both patients and relatives wanted the staff to raise these questions. Nursing home staff should initiate conversations about preferences for end-of-life care, assisting patients and relatives in talking about these issues, while at the same time being sensitive to the diversity in

Decision-making on Population Return At the End of an Eruption

Science.gov (United States)

Woo, G.

2015-12-01

If an eruption sequence is protracted and episodic, continuing for many months, or even a number of years, it can be very difficult for authorities to decide when an evacuated population might be allowed to return. A precautionary approach may be appropriate as a general principle, especially if the societal implications are deemed to be manageable. However, where the livelihoods of the evacuees are critically at stake, such as with farmers, and the economic costs of continuing evacuation are high, a risk-informed approach to supporting decision-making might be warranted. Such an approach has been developed, based on concepts drawn from cost-benefit analysis. On any given day during an extended volcanic crisis, a decision-maker may wish to consider whether to allow then for the return of evacuees. A delay of a decision by one day will increase the evacuation cost by one day's worth of accommodation and economic disruption. On the other hand, there is a small chance that there might be an onset to another eruption on this given day, so there would be a safety benefit in the delay. The task of quantifying this safety benefit requires a coherent synthesis of all the volcano monitoring data time series, together with an assessment of the medium and long-term historical and geological data, so that the probability of each of the alternative eruptive scenarios can be scientifically estimated. Bayesian belief networks provide a convenient framework for this synthesis. For each scenario, the potential casualty implications for returned evacuees need to be assessed. The application of this end of eruption methodology is illustrated and compared with the equivalent decision-making procedure at the start of an eruption.

The End-to-end Demonstrator for improved decision making in the water sector in Europe (EDgE)

Science.gov (United States)

Wood, Eric; Wanders, Niko; Pan, Ming; Sheffield, Justin; Samaniego, Luis; Thober, Stephan; Kumar, Rohinni; Prudhomme, Christel; Houghton-Carr, Helen

2017-04-01

High-resolution simulations of water resources from hydrological models are vital to supporting important climate services. Apart from a high level of detail, both spatially and temporally, it is important to provide simulations that consistently cover a range of timescales, from historical reanalysis to seasonal forecast and future projections. In the new EDgE project commissioned by the ECMWF (C3S) we try to fulfill these requirements. EDgE is a proof-of-concept project which combines climate data and state-of-the-art hydrological modelling to demonstrate a water-oriented information system implemented through a web application. EDgE is working with key European stakeholders representative of private and public sectors to jointly develop and tailor approaches and techniques. With these tools, stakeholders are assisted in using improved climate information in decision-making, and supported in the development of climate change adaptation and mitigation policies. Here, we present the first results of the EDgE modelling chain, which is divided into three main processes: 1) pre-processing and downscaling; 2) hydrological modelling; 3) post-processing. Consistent downscaling and bias corrections for historical simulations, seasonal forecasts and climate projections ensure that the results across scales are robust. The daily temporal resolution and 5km spatial resolution ensure locally relevant simulations. With the use of four hydrological models (PCR-GLOBWB, VIC, mHM, Noah-MP), uncertainty between models is properly addressed, while consistency is guaranteed by using identical input data for static land surface parameterizations. The forecast results are communicated to stakeholders via Sectoral Climate Impact Indicators (SCIIs) that have been created in collaboration with the end-user community of the EDgE project. The final product of this project is composed of 15 years of seasonal forecast and 10 climate change projections, all combined with four hydrological

Meeting

Indian Academy of Sciences (India)

energy is becoming less important in shaping economic growth ... making more efficient use of energy, it becomes possible to ... speech that Professor Raman gave at the Science. Congress held at ... as free from technicalities as possible, a general account of the ..... end to end as in surface films of long-chain fatty acids.

Integrated assessment and environmental policy making. In pursuit of usefulness

International Nuclear Information System (INIS)

Parson, E.A.

1995-01-01

Current integrated assessment projects primarily seek end to end integration through formal models at a national to global scale, and show three significant representational weaknesses: determinants of decadal-scale emissions trends; valuing impacts and adaptive response; and the formation and effects of policies. Meeting the needs of policy audiences may require other forms of integration; may require integration by formal modeling or by other means; and may require representing decisions of other actors through political and negotiating processes. While rational global environmental policy making requires integrated assessment, current practice admits no single vision of how to do it, so understanding will be best advanced by a diverse collection of projects pursuing distinct methods and approaches. Further practice may yield some consensus on best practice, possibly including generic assessment skills generalizable across issues. (Author)

From sea to shining sea. Making ends meet on European rivers

NARCIS (Netherlands)

Disco, Nil/Cornelis; Badenoch, Alexander; Fickers, Andreas

2010-01-01

This hopeful remark, written in 1920 by the German social critic Alfons Paquet, suggests that a ‘common spirit in Europe’ could ‘take the offensive’ in realizing waterways over both of Europe’s continental divides. As a German, Paquet conceived of these as extensions of the Rhine — via

End-of-life decisions in the intensive care unit

DEFF Research Database (Denmark)

Jensen, Hanne Irene

2012-01-01

be interdisciplinary, but the literature shows that this is not always the case. Research on end-of-life issues in Danish ICUs is limited. Aim The aims of this thesis were to • Examine Danish practices regarding end-of-life decisions in the ICU. • Examine the opinions of nurses and physicians who work in Danish ICUs...... and decision-making. Hypotheses • Nurses, intensivists, and primary physicians have different experiences of interdisciplinary collaboration regarding end-of-life decision-making in the ICU. • Specific interventions targeting end-of-life decision-making in the ICU, such as interdisciplinary audits......Background When making end-of-life decisions in intensive care units, the different staff groups have different roles in the decision-making process and may not always assess the situation identically. Practice recommendations for withholding or withdrawing therapy state that decisions should...

Is Shared Decision Making for End-of-Life Decisions Associated With Better Outcomes as Compared to Other Forms of Decision Making? A Systematic Literature Review

Directory of Open Access Journals (Sweden)

Negin Hajizadeh MD, MPH

2016-07-01

Full Text Available Background: Whether shared decision making (SDM has been evaluated for end-of-life (EOL decisions as compared to other forms of decision making has not been studied. Purpose: To summarize the evidence on SDM being associated with better outcomes for EOL decision making, as compared to other forms of decision making. Data Sources: PubMed, Web of Science, Cochrane Central Register of Controlled Trials, EMBASE, PsycINFO, and CINAHL databases were searched through April 2014. Study Selection: Studies were selected that evaluated SDM, compared to any other decision making style, for an EOL decision. Data Extraction: Components of SDM tested, comparators to SDM, EOL decision being assessed, and outcomes measured. Data Synthesis: Seven studies met the inclusion criteria (three experimental and four observational studies. Results were analyzed using narrative synthesis. All three experimental studies compared SDM interventions to usual care. The four observational studies compared SDM to doctor-controlled decision making, or reported the correlation between level of SDM and outcomes. Components of SDM specified in each study differed widely, but the component most frequently included was presenting information on the risks/benefits of treatment choices (five of seven studies. The outcome most frequently measured was communication, although with different measurement tools. Other outcomes included decisional conflict, trust, satisfaction, and “quality of dying.” Limitations: We could not analyze the strength of evidence for a given outcome due to heterogeneity in the outcomes reported and measurement tools. Conclusions: There is insufficient evidence supporting SDM being associated with improved outcomes for EOL decisions as opposed to other forms of decision making. Future studies should describe which components of SDM are being tested, outline the comparator decision making style, and use validated tools to measure outcomes.

The upgraded CDF front end electronics for calorimetry

Energy Technology Data Exchange (ETDEWEB)

Drake, G.; Frei, D.; Hahn, S.R.; Nelson, C.A.; Segler, S.L.; Stuermer, W.

1991-11-01

The front end electronics used in the calorimetry of the CDF detector has been upgraded to meet system requirements for higher expected luminosity. A fast digitizer utilizing a 2 {mu}Sec, 16 bit ADC has been designed and built. Improvements to the front end trigger circuitry have been implemented, including the production of 900 new front end modules. Operational experience with the previous system is presented, with discussion of the problems and performance goals.

The upgraded CDF front end electronics for calorimetry

International Nuclear Information System (INIS)

Drake, G.; Frei, D.; Hahn, S.R.; Nelson, C.A.; Segler, S.L.; Stuermer, W.

1991-11-01

The front end electronics used in the calorimetry of the CDF detector has been upgraded to meet system requirements for higher expected luminosity. A fast digitizer utilizing a 2 μSec, 16 bit ADC has been designed and built. Improvements to the front end trigger circuitry have been implemented, including the production of 900 new front end modules. Operational experience with the previous system is presented, with discussion of the problems and performance goals

End-to-end System Performance Simulation: A Data-Centric Approach

Science.gov (United States)

Guillaume, Arnaud; Laffitte de Petit, Jean-Luc; Auberger, Xavier

2013-08-01

In the early times of space industry, the feasibility of Earth observation missions was directly driven by what could be achieved by the satellite. It was clear to everyone that the ground segment would be able to deal with the small amount of data sent by the payload. Over the years, the amounts of data processed by the spacecrafts have been increasing drastically, leading to put more and more constraints on the ground segment performances - and in particular on timeliness. Nowadays, many space systems require high data throughputs and short response times, with information coming from multiple sources and involving complex algorithms. It has become necessary to perform thorough end-to-end analyses of the full system in order to optimise its cost and efficiency, but even sometimes to assess the feasibility of the mission. This paper presents a novel framework developed by Astrium Satellites in order to meet these needs of timeliness evaluation and optimisation. This framework, named ETOS (for “End-to-end Timeliness Optimisation of Space systems”), provides a modelling process with associated tools, models and GUIs. These are integrated thanks to a common data model and suitable adapters, with the aim of building suitable space systems simulators of the full end-to-end chain. A big challenge of such environment is to integrate heterogeneous tools (each one being well-adapted to part of the chain) into a relevant timeliness simulation.

A List of Astronomical Meetings Available via Mosaic

Science.gov (United States)

Bryson, E.; Crabtree, D.

We have been making a list of astronomical and related meetings available electronically for a number of years. Recently, several meeting organizers have made information about their meetings available via anonymous ftp or even NCSA Mosaic. We have produced a new version of our electronic meeting list available via NCSA Mosaic which provides links to the information being provided electronically. Depending upon the amount of information being provided for an individual meeting, it may be possible for a user browsing the list of meetings to click on the meeting of interest, fill out a registration form, download maps, browse abstracts, etc. We hope the availability of this service will encourage other meeting organizers to make information about their meetings available electronically and to take advantage of new technology such as NCSA Mosaic. URL: http:// cadcwww.dao.nrc.calmeetings/meetings.html

Physician-related barriers to communication and patient- and family-centred decision-making towards the end of life in intensive care: a systematic review.

Science.gov (United States)

Visser, Mieke; Deliens, Luc; Houttekier, Dirk

2014-11-18

Although many terminally ill people are admitted to an intensive care unit (ICU) at the end of life, their care is often inadequate because of poor communication by physicians and lack of patient- and family-centred care. The aim of this systematic literature review was to describe physician-related barriers to adequate communication within the team and with patients and families, as well as barriers to patient- and family-centred decision-making, towards the end of life in the ICU. We base our discussion and evaluation on the quality indicators for end-of-life care in the ICU developed by the Robert Wood Johnson Foundation Critical Care End-of-Life Peer Workgroup. Four electronic databases (MEDLINE, Embase, CINAHL and PsycINFO) were searched, using controlled vocabulary and free text words, for potentially relevant records published between 2003 and 2013 in English or Dutch. Studies were included if the authors reported on physician-related and physician-reported barriers to adequate communication and decision-making. Barriers were categorized as being related to physicians' knowledge, physicians' attitudes or physicians' practice. Study quality was assessed using design-specific tools. Evidence for barriers was graded according to the quantity and quality of studies in which the barriers were reported. Of 2,191 potentially relevant records, 36 studies were withheld for data synthesis. We determined 90 barriers, of which 46 were related to physicians' attitudes, 24 to physicians' knowledge and 20 to physicians' practice. Stronger evidence was found for physicians' lack of communication training and skills, their attitudes towards death in the ICU, their focus on clinical parameters and their lack of confidence in their own judgment of their patient's true condition. We conclude that many physician-related barriers hinder adequate communication and shared decision-making in ICUs. Better physician education and palliative care guidelines are needed to enhance

Communication tools for end-of-life decision-making in the intensive care unit: a systematic review and meta-analysis.

Science.gov (United States)

Oczkowski, Simon J W; Chung, Han-Oh; Hanvey, Louise; Mbuagbaw, Lawrence; You, John J

2016-04-09

For many patients admitted to the intensive care unit (ICU), preferences for end-of-life care are unknown, and clinicians and substitute decision-makers are required to make decisions about the goals of care on their behalf. We conducted a systematic review to determine the effect of structured communication tools for end-of-life decision-making, compared to usual care, upon the number of documented goals of care discussions, documented code status, and decisions to withdraw life-sustaining treatments, in adult patients admitted to the ICU. We searched multiple databases including MEDLINE, Embase, CINAHL, ERIC, and Cochrane from database inception until July 2014. Two reviewers independently screened articles, assessed eligibility, verified data extraction, and assessed risk of bias using the tool described by the Cochrane Collaboration and the Newcastle Ottawa Scale. Pooled estimates of effect (relative risk, standardized mean difference, or mean difference), were calculated where sufficient data existed. GRADE was used to evaluate the overall quality of evidence for each outcome. We screened 5785 abstracts and reviewed the full text of 424 articles, finding 168 eligible articles, including 19 studies in the ICU setting. The use of communication tools increased documentation of goals-of-care discussions (RR 3.47, 95% CI 1.55, 7.75, p = 0.020, very low-quality evidence), but did not have an effect on code status documentation (RR 1.03, 95% CI 0.96, 1.10, p = 0.540, low-quality evidence) or decisions to withdraw or withhold life-sustaining treatments (RR 0.98, 95% CI 0.89, 1.08, p = 0.70, low-quality evidence). The use of such tools was associated with a decrease in multiple measures of health care resource utilization, including duration of mechanical ventilation (MD -1.9 days, 95% CI -3.26, -0.54, p = 0.006, very low-quality evidence), length of ICU stay (MD -1.11 days, 95% CI -2.18, -0.03, p = 0.04, very low-quality evidence), and health care costs (SMD -0.32, 95

Decision Making Regarding the Place of End-of-Life Cancer Care: The Burden on Bereaved Families and Related Factors.

Science.gov (United States)

Yamamoto, Sena; Arao, Harue; Masutani, Eiko; Aoki, Miwa; Kishino, Megumi; Morita, Tatsuya; Shima, Yasuo; Kizawa, Yoshiyuki; Tsuneto, Satoru; Aoyama, Maho; Miyashita, Mitsunori

2017-05-01

Decision making regarding the place of end-of-life (EOL) care is an important issue for patients with terminal cancer and their families. It often requires surrogate decision making, which can be a burden on families. To explore the burden on the family of patients dying from cancer related to the decisions they made about the place of EOL care and investigate the factors affecting this burden. This was a cross-sectional mail survey using a self-administered questionnaire. Participants were 700 bereaved family members of patients with cancer from 133 palliative care units in Japan. The questionnaire covered decisional burdens, depression, grief, and the decision-making process. Participants experienced emotional pressure as the highest burden. Participants with a high decisional burden reported significantly higher scores for depression and grief (both P decision making without knowing the patient's wishes and values (P making the decision because of a due date for discharge from a former facility or hospital (P = 0.005). Decision making regarding the place of EOL care was recalled as burdensome for family decision makers. An early decision-making process that incorporates sharing patients' and family members' values that are relevant to the desired place of EOL care is important. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Signal processing and electronics for nuclear spectrometry. Proceedings of a technical meeting

International Nuclear Information System (INIS)

2009-12-01

The IAEA has responded to Member States needs by implementing programmatic activities that provide interested Member States, particularly those in developing countries, with support to increase, and in some cases establish national and regional capabilities for the proper operation, calibration, maintenance and utilization of instruments in nuclear spectrometry applications. Technological advances in instrumentation, as well as the consequent high rate of obsolescence, make it important for nuclear instrumentation laboratories in Member States to keep their knowledge and skills up to date. This publication reviews the current status, developments and trends in electronics and digital methods for nuclear spectrometry, providing useful information for interested Member States to keep pace with new and evolving technologies. All nuclear spectrometry systems contain electronic circuits and devices, commonly referred to as front-end electronics, which accept and process the electrical signals produced by radiation detectors. This front-end electronics are composed of a chain of signal processing subsystems that filter, amplify, shape, and digitise these electrical signals to finally produce digitally encoded information about the type and nature of the radiation that stimulated the radiation detector. The design objective of front-end electronics is to obtain maximum information about the radiation and with the highest possible accuracy. Historically, the front-end electronics has consisted of all analog components. The performance delivered has increased continually over time through the development and implementation of new and improved analog electronics and electronic designs. The development of digital electronics, programmable logic, and digital signal processing techniques has now enabled most of the analog front-end electronics to be replaced by digital electronics, opening up new opportunities and delivering new benefits not previously achievable. Digital

Meeting excellence: 33 tools to lead meetings that get results

National Research Council Canada - National Science Library

Parker, Glenn; Hoffman, Robert

2006-01-01

... Chapter 17 - TELECONFERENCE TIPS Chapter 18 - ACHIEVING CLEAR COMMUNICATION IN A MULTICULTURAL MEETING Chapter 19 - HOW TO MAKE A DECISION Chapter 20 - PRESENTING AT A TEAM MEETINGChapter 21 - ...

Learning to Facilitate (Online) Meetings

DEFF Research Database (Denmark)

Reimann, Peter; Bull, Susan; Vatrapu, Ravi

2013-01-01

We describe an approach to teaching collaboration skills directly by building on competences for meeting facilitation. (Online) meetings provide a rich arena to practice collaboration since they can serve multiple purposes: learning, problem solving, decision making, idea generation and advancement...

Beyond cultural stereotyping: views on end-of-life decision making among religious and secular persons in the USA, Germany, and Israel.

Science.gov (United States)

Schweda, Mark; Schicktanz, Silke; Raz, Aviad; Silvers, Anita

2017-02-17

End-of-life decision making constitutes a major challenge for bioethical deliberation and political governance in modern democracies: On the one hand, it touches upon fundamental convictions about life, death, and the human condition. On the other, it is deeply rooted in religious traditions and historical experiences and thus shows great socio-cultural diversity. The bioethical discussion of such cultural issues oscillates between liberal individualism and cultural stereotyping. Our paper confronts the bioethical expert discourse with public moral attitudes. The paper is based on a qualitative study comprising 12 focus group discussions with religious and secular persons in the USA, Germany, and Israel (n = 82). Considering the respective socio-political and legal frameworks, the thematic analysis focuses on moral attitudes towards end-of-life decision making and explores the complex interplay between individual preferences, culture, and religion. Our findings draw attention to the variety and complexity of cultural and religious aspects of end-of-life decision making. Although there is local consensus that goes beyond radical individualism, positions are not neatly matched with national cultures or religious denominations. Instead, the relevance of the specific situatedness of religious beliefs and cultural communities becomes visible: Their status and role in individual situations, for example, as consensual or conflicting on the level of personal perspectives, family relationships, or broader social contexts, e.g., as a majority or minority culture within a political system. As the group discussions indicate, there are no clear-cut positions anchored in "nationality," "culture," or "religion." Instead, attitudes are personally decided on as part of a negotiated context representing the political, social and existential situatedness of the individual. Therefore, more complex theoretical and practical approaches to cultural diversity have to be developed.

Uncharted terrain: preference construction at the end of life.

Science.gov (United States)

White, Mary T

2014-01-01

Respect for patients' self-determination has long been considered central to efforts to improve end-of-life care, yet efforts to promote advance directives or engage patients in end-of-life discussions are often unsuccessful. In this article, I contend that this is because the shared decision-making approach typically used in healthcare assumes patients' capacity to make rational choices, which is not always possible in end-of-life decisions. Drawing on decision theory, behavioral psychology, and related studies of end-of-life care, I present a growing body of evidence that suggests the novelty, complexity, and uncertainty of end-of-life circumstances make rational and stable preferences difficult to establish. I argue that an effective decision-making approach for the terminally ill must recognize and respond to the unique characteristics of end-of-life choices, including their nonrational dimensions. I conclude with a description of an initiative that appears to do so, resulting in increased patients' satisfaction. Copyright 2014 The Journal of Clinical Ethics. All rights reserved.

Conceptualizing Surrogate Decision-Making at End of Life in the Intensive Care Unit using Cognitive Task Analysis

Science.gov (United States)

Dionne-Odom, J. Nicholas; Willis, Danny G.; Bakitas, Marie; Crandall, Beth; Grace, Pamela J.

2014-01-01

Background Surrogate decision-makers (SDMs) face difficult decisions at end of life (EOL) for decisionally incapacitated intensive care unit (ICU) patients. Purpose Identify and describe the underlying psychological processes of surrogate decision-making for adults at EOL in the ICU. Method Qualitative case study design using a cognitive task analysis (CTA) interviewing approach. Participants were recruited from October 2012 to June 2013 from an academic tertiary medical center’s ICU located in the rural Northeastern United States. Nineteen SDMs for patients who had died in the ICU completed in-depth semi-structured CTA interviews. Discussion The conceptual framework formulated from data analysis reveals that three underlying, iterative, psychological dimensions: gist impressions, distressing emotions, and moral intuitions impact a SDM’s judgment about the acceptability of either the patient’s medical treatments or his or her condition. Conclusion The framework offers initial insights about the underlying psychological processes of surrogate decision-making and may facilitate enhanced decision support for SDMs. PMID:25982772

Constructions of accountability in child protection workers decision-making processes

DEFF Research Database (Denmark)

Schrøder, Ida Marie

2014-01-01

collected from three Danish local governments and consists of 24 qualitative interviews with child protection workers, leaders and economic consultants, 12 observations of team meetings and a quantitative survey of 150 cases. The study ends summer 2014 and the results of the research will be utilized...... construction of accountability as relational effects of these new forms of accounting practice. The paper draws on the preliminary results from a 2 ½ year mixed method study of how budgeting and accounting practice influences the processes of decision-making in child protection work. The data has been...... systems – such as setting standards or deciding on the delegation of decision-making authority. Using Actor-network theory as a methodological and analytical approach, it furthermore becomes clear how the types of accountability are enacted as effects, not only by the technologies offered to support...

Analytical Framework for End-to-End Delay Based on Unidirectional Highway Scenario

Directory of Open Access Journals (Sweden)

Aslinda Hassan

2015-01-01

Full Text Available In a sparse vehicular ad hoc network, a vehicle normally employs a carry and forward approach, where it holds the message it wants to transmit until the vehicle meets other vehicles or roadside units. A number of analyses in the literature have been done to investigate the time delay when packets are being carried by vehicles on both unidirectional and bidirectional highways. However, these analyses are focusing on the delay between either two disconnected vehicles or two disconnected vehicle clusters. Furthermore, majority of the analyses only concentrate on the expected value of the end-to-end delay when the carry and forward approach is used. Using regression analysis, we establish the distribution model for the time delay between two disconnected vehicle clusters as an exponential distribution. Consequently, a distribution is newly derived to represent the number of clusters on a highway using a vehicular traffic model. From there, we are able to formulate end-to-end delay model which extends the time delay model for two disconnected vehicle clusters to multiple disconnected clusters on a unidirectional highway. The analytical results obtained from the analytical model are then validated through simulation results.

REASONING IN THE FUZZY FRONT END OF INNOVATION:

DEFF Research Database (Denmark)

Haase, Louise Møller; Laursen, Linda Nhu

2018-01-01

in the fuzzy front end is the reasoning process: innovation teams are faced with open-ended, ill-defined problems, where they need to make decisions about an unknown future but have only incomplete, ambiguous and contradicting insights available. We study the reasoning of experts, how they frame to make sense...... of all the insights and create a basis for decision-making in relation to a new project. Based on case studies of five innovative products from various industries, we propose a Product DNA model for understanding the reasoning in the fuzzy front end of innovation. The Product DNA Model explains how...... experts reason and what direct their reasoning....

Proceedings of the 2007 LWR Fuel Performance Meeting / TopFuel 2007 'Zero by 2010'

International Nuclear Information System (INIS)

2007-01-01

ANS, ENS, AESJ and KNS are jointly organizing the 2007 International LWR Fuel Performance Meeting following the successful ENS TopFuel meeting held during 22-26 October, 2006 in Salamaca, Spain. Merging three premier nuclear fuel design and performance meetings: the ANS LWR Fuel Performance Meeting, the ENS TopFuel and Asian Water Reactor Fuel Performance Meeting (WRFPM) created this international meeting. The meeting will be held annually on a tri-annual rotational basis in USA, Asia, and Europe. The technical scope of the meeting includes all aspects of nuclear fuel from fuel rod to core design as well as performance experience in commercial and test reactors. The meeting excludes front end and back end fuel issues, however, it covers all front and/or back issues that impact fuel designs and performance

CFCC working group meeting: Proceedings

Energy Technology Data Exchange (ETDEWEB)

NONE

1995-12-31

The theme of the meeting was ``A Path to Commercialization`` and discussion was devoted to addressing the nearest-term products and the time frame for implementation. The objectives of the meeting were to identify the barriers to commercialization, methods to overcome these barriers, and the actions required to achieve success. The meeting was planned to bring together government agencies and industry customers and, suppliers to discuss and conclude where the CFCC Program is today, where it is going, and how they plan to get there. It was also planned to join component developers with end users who can describe systems needs and projected schedules for introducing CFCC components in industrial applications.

Traditional expectations versus US realities: first- and second-generation Asian Indian perspectives on end-of-life care.

Science.gov (United States)

Sharma, Rashmi K; Khosla, Nidhi; Tulsky, James A; Carrese, Joseph A

2012-03-01

Although end-of-life care preferences vary across racial/ethnic groups, little is known about how cultural values affect end-of-life care preferences among South Asian immigrants and their offspring in the US. To examine the perspectives of first- and second-generation South Asians living in the US regarding end-of-life care. Focus group study. Discussions explored participant preferences and experiences with family members facing the end of life. Twelve first-generation and 11 second-generation self-identified Asian Indians living in the mid-Atlantic region. Content analysis of focus group transcripts. First-generation participants ranged in age from 41 to 76 years and were evenly split by gender. Second-generation participants ranged in age from 23 to 36 years and included seven women and four men. All participants were highly educated, and two thirds were either studying or working in a health care field. All but two subjects were Hindu. Several themes emerged that highlighted cultural differences and challenges for this population in the context of end-of-life care: attitudes toward death and suffering; family duty; and preferences for information disclosure and decision making. Participants described cultural challenges due to the evolution of traditional roles, lack of explicit discussion between patients and family members about preferences and care expectations, and a tension between wanting to meet traditional expectations and the challenges in doing so given US social realities. Traditional cultural values, such as duty to family, greatly influenced end-of-life care preferences and retained importance across generations. Clinicians caring for Asian Indian patients at the end of life may be better able to assess care preferences after exploring the complex interplay between traditional expectations and specific social realities for each patient. Particular attention should be given to attitudes toward death and suffering, family duty, and preferences for

Informed Decision-Making in the Context of Prenatal Chromosomal Microarray.

Science.gov (United States)

Baker, Jessica; Shuman, Cheryl; Chitayat, David; Wasim, Syed; Okun, Nan; Keunen, Johannes; Hofstedter, Renee; Silver, Rachel

2018-03-07

The introduction of chromosomal microarray (CMA) into the prenatal setting has involved considerable deliberation due to the wide range of possible outcomes (e.g., copy number variants of uncertain clinical significance). Such issues are typically discussed in pre-test counseling for pregnant women to support informed decision-making regarding prenatal testing options. This research study aimed to assess the level of informed decision-making with respect to prenatal CMA and the factor(s) influencing decision-making to accept CMA for the selected prenatal testing procedure (i.e., chorionic villus sampling or amniocentesis). We employed a questionnaire that was adapted from a three-dimensional measure previously used to assess informed decision-making with respect to prenatal screening for Down syndrome and neural tube defects. This measure classifies an informed decision as one that is knowledgeable, value-consistent, and deliberated. Our questionnaire also included an optional open-ended question, soliciting factors that may have influenced the participants' decision to accept prenatal CMA; these responses were analyzed qualitatively. Data analysis on 106 participants indicated that 49% made an informed decision (i.e., meeting all three criteria of knowledgeable, deliberated, and value-consistent). Analysis of 59 responses to the open-ended question showed that "the more information the better" emerged as the dominant factor influencing both informed and uninformed participants' decisions to accept prenatal CMA. Despite learning about the key issues in pre-test genetic counseling, our study classified a significant portion of women as making uninformed decisions due to insufficient knowledge, lack of deliberation, value-inconsistency, or a combination of these three measures. Future efforts should focus on developing educational approaches and counseling strategies to effectively increase the rate of informed decision-making among women offered prenatal CMA.

Family factors in end-of-life decision-making: family conflict and proxy relationship.

Science.gov (United States)

Parks, Susan Mockus; Winter, Laraine; Santana, Abbie J; Parker, Barbara; Diamond, James J; Rose, Molly; Myers, Ronald E

2011-02-01

Few studies have examined proxy decision-making regarding end-of-life treatment decisions. Proxy accuracy is defined as whether proxy treatment choices are consistent with the expressed wishes of their index elder. The purpose of this study was to examine proxy accuracy in relation to two family factors that may influence proxy accuracy: perceived family conflict and type of elder-proxy relationship. Telephone interviews with 202 community-dwelling elders and their proxy decision makers were conducted including the Life-Support Preferences Questionnaire (LSPQ), and a measure of family conflict, and sociodemographic characteristics, including type of relationship. Elder-proxy accuracy was associated with the type of elder-proxy relationship. Adult children demonstrated the lowest elder-proxy accuracy and spousal proxies the highest elder-proxy accuracy. Elder-proxy accuracy was associated with family conflict. Proxies reporting higher family conflict had lower elder-proxy accuracy. No interaction between family conflict and relationship type was revealed. Spousal proxies were more accurate in their substituted judgment than adult children, and proxies who perceive higher degree of family conflict tended to be less accurate than those with lower family conflict. Health care providers should be aware of these family factors when discussing advance care planning.

Feelings of women regarding end-of-life decision making after ultrasound diagnosis of a lethal fetal malformation.

Science.gov (United States)

Benute, Gláucia R G; Nomura, Roseli M Y; Liao, Adolfo W; Brizot, Maria de Lourdes; de Lucia, Mara C S; Zugaib, M

2012-08-01

this study investigated the feelings of women regarding end-of-life decision making after ultrasound diagnosis of a lethal fetal malformation. The aim of this study was to present the decision making process of women that chose for pregnancy termination and to present selected speeches of women about their feelings. open psychological interviews conducted by a psychologist immediately after the diagnosis of fetal malformation by ultrasound. Analysis of the results was performed through a content analysis technique. the study was carried out at a public university hospital in Brazil. 249 pregnant women who had received the diagnosis of a severe lethal fetal malformation. fetal anencephaly was the most frequent anomaly detected in 135 cases (54.3%). Termination of pregnancy was decided by 172 (69.1%) patients and legally authorised by the judiciary (66%). The reason for asking for termination was to reduce suffering in all of them. In the 77 women who chose not to terminate pregnancy (30.9%), the reasons were related to feelings of guilt (74%). the results support the importance of psychological counselling for couples when lethal fetal malformation is diagnosed. The act of reviewing moral and cultural values and elements of the unconscious provides assurance in the decision-making process and mitigates the risk of emotional trauma and guilt that can continue long after the pregnancy is terminated. Copyright © 2011 Elsevier Ltd. All rights reserved.

Progress making the top end optical assembly (TEOA) for the 4-meter Advanced Technology Solar Telescope

Science.gov (United States)

Canzian, Blaise; Barentine, J.; Arendt, J.; Bader, S.; Danyo, G.; Heller, C.

2012-09-01

L-3 Integrated Optical Systems (IOS) Division has been selected by the National Solar Observatory (NSO) to design and produce the Top End Optical Assembly (TEOA) for the 4-meter Advanced Technology Solar Telescope (ATST) to operate at Haleakal', Maui. ATST will perform to a very high optical performance level in a difficult thermal environment. The TEOA, containing the 0.65-meter silicon carbide secondary mirror and support, mirror thermal management system, mirror positioning and fast tip-tilt system, field stop with thermally managed heat dump, thermally managed Lyot stop, safety interlock and control system, and support frame, operates in the "hot spot" at the prime focus of the ATST and so presents special challenges. In this paper, we describe progress in the L-3 technical approach to meeting these challenges, including silicon carbide off-axis mirror design, fabrication, and high accuracy figuring and polishing all within L-3; mirror support design; the design for stray light control; subsystems for opto-mechanical positioning and high accuracy absolute mirror orientation sensing; Lyot stop design; and thermal management of all design elements to remain close to ambient temperature despite the imposed solar irradiance load.

Building dialogue POMDPs from expert dialogues an end-to-end approach

CERN Document Server

Chinaei, Hamidreza

2016-01-01

This book discusses the Partially Observable Markov Decision Process (POMDP) framework applied in dialogue systems. It presents POMDP as a formal framework to represent uncertainty explicitly while supporting automated policy solving. The authors propose and implement an end-to-end learning approach for dialogue POMDP model components. Starting from scratch, they present the state, the transition model, the observation model and then finally the reward model from unannotated and noisy dialogues. These altogether form a significant set of contributions that can potentially inspire substantial further work. This concise manuscript is written in a simple language, full of illustrative examples, figures, and tables. Provides insights on building dialogue systems to be applied in real domain Illustrates learning dialogue POMDP model components from unannotated dialogues in a concise format Introduces an end-to-end approach that makes use of unannotated and noisy dialogue for learning each component of dialogue POM...

Storage system software solutions for high-end user needs

Science.gov (United States)

Hogan, Carole B.

1992-01-01

Today's high-end storage user is one that requires rapid access to a reliable terabyte-capacity storage system running in a distributed environment. This paper discusses conventional storage system software and concludes that this software, designed for other purposes, cannot meet high-end storage requirements. The paper also reviews the philosophy and design of evolving storage system software. It concludes that this new software, designed with high-end requirements in mind, provides the potential for solving not only the storage needs of today but those of the foreseeable future as well.

Charting the social order of meetings

DEFF Research Database (Denmark)

Ravn, Ib

, with its cumbersome rules safeguarding formal-democratic decision-making, (3) the collective–egalitarian style of community-type meetings where anyone can speak anytime about anything, and (4) the facilitative style, in which a facilitator guides the meeting conversation with a firm hand such that all...

Physician Approaches to Conflict with Families Surrounding End-of-Life Decision-making in the Intensive Care Unit. A Qualitative Study.

Science.gov (United States)

Mehter, Hashim M; McCannon, Jessica B; Clark, Jack A; Wiener, Renda Soylemez

2018-02-01

Families of critically ill patients are often asked to make difficult decisions to pursue, withhold, or withdraw aggressive care or resuscitative measures, exercising "substituted judgment" from the imagined standpoint of the patient. Conflict may arise between intensive care unit (ICU) physicians and family members regarding the optimal course of care. To characterize how ICU physicians approach and manage conflict with surrogates regarding end-of-life decision-making. Semistructured interviews were conducted with 18 critical care physicians from four academically affiliated hospitals. Interview transcripts were analyzed using methods of grounded theory. Physicians described strategies for engaging families to resolve conflict about end-of-life decision-making and tending to families' emotional health. Physicians commonly began by gauging family receptiveness to recommendations from the healthcare team. When faced with resistance to recommendations for less aggressive care, approaches ranged from deference to family wishes to various persuasive strategies designed to change families' minds, and some of those strategies may be counterproductive or harmful. The likelihood of deferring to family in the event of conflict was associated with the perceived sincerity of the family's "substituted judgment" and the ability to control patient pain and suffering. Physicians reported concern for the family's emotional needs and made efforts to alleviate the burden on families by assuming decision-making responsibility and expressing nonabandonment and commitment to the patient. Physicians were attentive to repairing damage to their relationship with the family in the aftermath of conflict. Finally, physicians described their own emotional responses to conflict, ranging from frustration and anxiety to satisfaction with successful resolution of conflict. Critical care physicians described a complex and multilayered approach to physician-family conflict. The reported strategies

75 FR 29538 - SFIREG Full Committee; Notice of Public Meeting

Science.gov (United States)

2010-05-26

... (SFIREG) Full Committee will hold a 2-day meeting, beginning on June 21, 2010 and ending June 22, 2010. This notice announces the location and times for the meeting and sets forth the tentative agenda topics. DATES: The meeting will be held on Monday, June 21, 2010 from 8:30 a.m. to 5 p.m. and 8:30 a.m to 12...

77 FR 43064 - Meeting; Technology Advisory Committee

Science.gov (United States)

2012-07-23

... customer fund segregation laws, and making false statements in financial statements filed with the... COMMODITY FUTURES TRADING COMMISSION Meeting; Technology Advisory Committee AGENCY: Commodity Futures Trading Commission (CFTC). ACTION: Notice of emergency meeting of technology advisory committee...

An alternate end design for SSC dipoles

International Nuclear Information System (INIS)

Peters, C.; Caspi, S.; Taylor, C.

1989-02-01

Experience in the SSC dipole program has shown that fabrication of cylindrical coil ends is difficult. Cable stiffness requires large forces to maintain the proper position of the conductors in the end during winding. After winding, the coil ends remain distorted nd significant motion of the need conductors is required to force the coil end into the molding cavity. Local mechanical stresses are high during this process and extra pieces of insulation are required to prevent turn-to-turn shorts from developing during the winding and molding steps. Prior to assembly the coil end is compressed in a mold cavity and injected with a filler material to correct surface irregularities and fill voids in the end. LBL has developed an alternate design which permits the conductors to be wound over the end using minimal force and technician coerosion. The conductors are placed on a conical surface where the largest diameter over the outer layer conductors is 10 cm. No coil end spaces or insulation pieces between turns are required. The conductor geometry was analytically optimized to meet SSC multipole requirements for the ends. The first 1-m dipole utilizing this end geometry has been constructed and successfully tested. Design and construction data are presented. Also model test results, including training and multipole measurements of the end are given. 1 ref., 12 figs., 3 tabs

Standardized End Point Definitions for Coronary Intervention Trials: The Academic Research Consortium-2 Consensus Document.

Science.gov (United States)

Garcia-Garcia, Hector M; McFadden, Eugène P; Farb, Andrew; Mehran, Roxana; Stone, Gregg W; Spertus, John; Onuma, Yoshinobu; Morel, Marie-Angèle; van Es, Gerrit-Anne; Zuckerman, Bram; Fearon, William F; Taggart, David; Kappetein, Arie-Pieter; Krucoff, Mitchell W; Vranckx, Pascal; Windecker, Stephan; Cutlip, Donald; Serruys, Patrick W

2018-06-14

The Academic Research Consortium (ARC)-2 initiative revisited the clinical and angiographic end point definitions in coronary device trials, proposed in 2007, to make them more suitable for use in clinical trials that include increasingly complex lesion and patient populations and incorporate novel devices such as bioresorbable vascular scaffolds. In addition, recommendations for the incorporation of patient-related outcomes in clinical trials are proposed. Academic Research Consortium-2 is a collaborative effort between academic research organizations in the United States and Europe, device manufacturers, and European, US, and Asian regulatory bodies. Several in-person meetings were held to discuss the changes that have occurred in the device landscape and in clinical trials and regulatory pathways in the last decade. The consensus-based end point definitions in this document are endorsed by the stakeholders of this document and strongly advocated for clinical trial purposes. This Academic Research Consortium-2 document provides further standardization of end point definitions for coronary device trials, incorporating advances in technology and knowledge. Their use will aid interpretation of trial outcomes and comparison among studies, thus facilitating the evaluation of the safety and effectiveness of these devices.

The Terminology of Fault Zones in the Brittle Regime: Making Field Observations More Useful to the End User

Science.gov (United States)

Shipton, Z.; Caine, J. S.; Lunn, R. J.

2013-12-01

Geologists are tiny creatures living on the 2-and-a-bit-D surface of a sphere who observe essentially 1D vanishingly small portions (boreholes, roadcuts, stream and beach sections) of complex, 4D tectonic-scale structures. Field observations of fault zones are essential to understand the processes of fault growth and to make predictions of fault zone mechanical and hydraulic properties at depth. Here, we argue that a failure of geologists to communicate their knowledge effectively to other scientists/engineers can lead to unrealistic assumptions being made about fault properties, and may result in poor economic performance and a lack of robustness in industrial safety cases. Fault zones are composed of many heterogeneously distributed deformation-related elements. Low permeability features include regions of intense grain-size reduction, pressure solution, cementation and shale smears. Other elements are likely to have enhanced permeability through fractures and breccias. Slip surfaces can have either enhanced or reduced permeability depending on whether they are open or closed, and the local stress state. The highly variable nature of 1) the architecture of faults and 2) the properties of deformation-related elements demonstrates that there are many factors controlling the evolution of fault zone internal structures (fault architecture). The aim of many field studies of faults is to provide data to constrain predictions at depth. For these data to be useful, pooling of data from multiple sites is usually necessary. This effort is frequently hampered by variability in the usage of fault terminologies. In addition, these terms are often used in ways as to make it easy for 'end-users' such as petroleum reservoir engineers, mining geologists, and seismologists to mis-interpret or over-simplify the implications of field studies. Field geologists are comfortable knowing that if you walk along strike or up dip of a fault zone you will find variations in fault rock type

Fuel cell end plate structure

Science.gov (United States)

Guthrie, Robin J.; Katz, Murray; Schroll, Craig R.

1991-04-23

The end plates (16) of a fuel cell stack (12) are formed of a thin membrane. Pressure plates (20) exert compressive load through insulation layers (22, 26) to the membrane. Electrical contact between the end plates (16) and electrodes (50, 58) is maintained without deleterious making and breaking of electrical contacts during thermal transients. The thin end plate (16) under compressive load will not distort with a temperature difference across its thickness. Pressure plate (20) experiences a low thermal transient because it is insulated from the cell. The impact on the end plate of any slight deflection created in the pressure plate by temperature difference is minimized by the resilient pressure pad, in the form of insulation, therebetween.

Family factors affect clinician attitudes in pediatric end-of-life decision making: a randomized vignette study.

Science.gov (United States)

Ruppe, Michael D; Feudtner, Chris; Hexem, Kari R; Morrison, Wynne E

2013-05-01

Conflicts between families and clinicians in pediatric end-of-life (EOL) care cause distress for providers, dissatisfaction for patients' families, and potential suffering for terminally ill children. We hypothesized that family factors might influence clinician decision making in these circumstances. We presented vignettes concerning difficult EOL decision making, randomized for religious objection to therapy withdrawal and perceived level of family involvement, to clinicians working in three Children's Hospital intensive care units. Additionally, attitudes about EOL care were assessed. Three hundred sixty-four respondents completed the questionnaire, for an overall response rate of 54%. Respondents receiving the "involved family" vignette were more likely to agree to continue medical care indefinitely (Pfamilies had nonreligious objections to withdrawal (P=0.05). Respondents who thought that a fear of being sued affected decisions were less likely to pursue unilateral withdrawal (odds ratio 0.8, 95% CI=0.6-0.9). Those who felt personal distress as a result of difficult EOL decision making, thought they often provided "futile" care, or those who felt EOL care was effectively addressed at the institution were less likely to want to defer to the parents' wishes (range of odds ratios 0.7-1). In this randomized vignette study, we have shown that family factors, particularly how involved a family seems to be in a child's life, affect what clinicians think is ethically appropriate in challenging EOL cases. Knowledge of how a family's degree of involvement may affect clinicians should be helpful to the clinical ethics consultants and offer some degree of insight to the clinicians themselves. Copyright © 2013 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

Democratic Leadership by Managing Meetings for Effective Group Decision-Making.

Science.gov (United States)

Stephens, Mary; Forest, Robert

Instrumental to successful democratic leadership is the use of committees to solve management problems. In democratic leadership, a leader encourages participation and uses a guidance approach to direct a group toward consensus. This document offers leaders guidelines in effective democratic management of meetings. The authors first discuss the…

Last Research Board Meeting for Leon Van Hove

CERN Multimedia

CERN PhotoLab

1980-01-01

Leon Van Hove chaired the meeting for the last time, the end of the year being also the end of his term as Research Director General. The place was as usual the 6th floor conference room at the Main Building. The photo shows Sergio Fubini, Claude Bovet, Erwin Gabathuler, Volker Soergel, Leslie Camilleri, Jurg May, Mike Crowley-Milling

Preferences for care towards the end of life when decision-making capacity may be impaired: A large scale cross-sectional survey of public attitudes in Great Britain and the United States.

Directory of Open Access Journals (Sweden)

Gemma Clarke

Full Text Available There is continuing public debate about treatment preferences at the end of life, and the acceptability and legal status of treatments that sustain or end life. However, most surveys use binary yes/no measures, and little is known about preferences in neurological disease when decision-making capacity is lost, as most studies focus on cancer. This study investigates changes in public preferences for care towards the end of life, with a focus on measures to sustain or end life.Large-scale international public opinion surveys using a six-stage patient vignette, respondents chose a level of intervention for each stage as health and decision-making capacity deteriorated. Cross-sectional representative samples of the general public in Great Britain and the USA (N = 2016. Primary outcome measure: changes in respondents' preferences for care, measured on a four-point scale designed before data collection. The scale ranged from: maintaining life at all costs; to intervention with agreement; to no intervention; to measures for ending life.There were no significant differences between GB and USA. Preference for measures to sustain life at all costs peaked at short-term memory loss (30.2%, n = 610. Respondents selecting 'measures to help me die peacefully' increased from 3.9% to 37.0% as the condition deteriorated, with the largest increase occurring when decision-making capacity was lost (10.3% to 23.0%. Predictors of choosing 'measures to help me die peacefully' at any stage were: previous personal experience (OR = 1.34, p<0.010, and older age (OR = 1.09 per decade, p<0.010. Negative predictors: living with children (OR = 0.72, p<0.010 and being of "black" race/ethnicity (OR = 0.45, p<0.001.Public opinion was uniform between GB and USA, but markedly heterogeneous. Despite contemporaneous capacitous consent providing an essential legal safeguard in most jurisdictions, there was a high prevalence of preference for "measures to end my life peacefully" when

77 FR 9214 - National Security Education Board Members Meeting

Science.gov (United States)

2012-02-16

... DEPARTMENT OF DEFENSE Office of the Secretary National Security Education Board Members Meeting... meeting of the National Security Education Board. The purpose of the meeting is to review and make... p.m. ADDRESSES: Defense Language and National Security Education Office, 1101 Wilson Boulevard...

78 FR 3041 - Notice of Sunshine Act Meetings

Science.gov (United States)

2013-01-15

..., 2013--Tentative Thursday, January 31, 2013 9:00 a.m. Briefing on Public Participation in NRC Regulatory Decision-Making (Public Meeting) (Contact: Lance Rakovan, 301-415-2589). This meeting will be webcast live...

Patients' preferences for participation in treatment decision-making at the end of life: qualitative interviews with advanced cancer patients.

Science.gov (United States)

Brom, Linda; Pasman, H Roeline W; Widdershoven, Guy A M; van der Vorst, Maurice J D L; Reijneveld, Jaap C; Postma, Tjeerd J; Onwuteaka-Philipsen, Bregje D

2014-01-01

Patients are often encouraged to participate in treatment decision-making. Most studies on this subject focus on choosing between different curative treatment types. In the last phase of life treatment decisions differ as they often put more emphasis on weighing quantity against quality of life, such as whether or not to start treatment aimed at life prolongation but with the possibility of side effects. This study aimed to obtain insight into cancer patients' preferences and the reasons for patients' preferred role in treatment decision-making at the end of life. 28 advanced cancer patients were included at the start of their first line treatment. In-depth interviews were held prior to upcoming treatment decisions whether or not to start a life prolonging treatment. The Control Preference Scale was used to start discussing the extent and type of influence patients wanted to have concerning upcoming treatment decision-making. Interviews were audio taped and transcribed. All patients wanted their physician to participate in the treatment decision-making process. The extent to which patients themselves preferred to participate seemed to depend on how patients saw their own role or assessed their own capabilities for participating in treatment decision-making. Patients foresaw a shift in the preferred level of participation to a more active role depending in the later phase of illness when life prolongation would become more limited and quality of life would become more important. Patients vary in how much involvement they would like to have in upcoming treatment decision-making. Individual patients' preferences may change in the course of the illness, with a shift to more active participation in the later phases. Communication about patients' expectations, wishes and preferences for participation in upcoming treatment decisions is of great importance. An approach in which these topics are openly discussed would be beneficial.

Process quality of decision-making in multidisciplinary cancer team meetings: a structured observational study.

Science.gov (United States)

Hahlweg, Pola; Didi, Sarah; Kriston, Levente; Härter, Martin; Nestoriuc, Yvonne; Scholl, Isabelle

2017-11-17

The quality of decision-making in multidisciplinary team meetings (MDTMs) depends on the quality of information presented and the quality of team processes. Few studies have examined these factors using a standardized approach. The aim of this study was to objectively document the processes involved in decision-making in MDTMs, document the outcomes in terms of whether a treatment recommendation was given (none vs. singular vs. multiple), and to identify factors related to type of treatment recommendation. An adaptation of the observer rating scale Multidisciplinary Tumor Board Metric for the Observation of Decision-Making (MDT-MODe) was used to assess the quality of the presented information and team processes in MDTMs. Data was analyzed using descriptive statistics and mixed logistic regression analysis. N = 249 cases were observed in N = 29 MDTMs. While cancer-specific medical information was judged to be of high quality, psychosocial information and information regarding patient views were considered to be of low quality. In 25% of the cases no, in 64% one, and in 10% more than one treatment recommendations were given (1% missing data). Giving no treatment recommendation was associated with duration of case discussion, duration of the MDTM session, quality of case history, quality of radiological information, and specialization of the MDTM. Higher levels of medical and treatment uncertainty during discussions were found to be associated with a higher probability for more than one treatment recommendation. The quality of different aspects of information was observed to differ greatly. In general, we did not find MDTMs to be in line with the principles of patient-centered care. Recommendation outcome varied substantially between different specializations of MDTMs. The quality of certain information was associated with the recommendation outcome. Uncertainty during discussions was related to more than one recommendation being considered. Time constraints

Chinese familial tradition and Western influence: a case study in Singapore on decision making at the end of life.

Science.gov (United States)

Ho, Zheng Jie Marc; Radha Krishna, Lalit Kumar; Yee, Chung Pheng Alethea

2010-12-01

Decision making for an incompetent patient at the end of life is difficult for both family members and physicians alike. Often, palliative care teams are tasked with weaving through opinions, emotions, and goals in search for an amenable solution. Occasionally, these situations get challenging. We present the case of an elderly Chinese Singaporean with metastatic cancer, whose family and physicians had conflicting goals of care. The former was adamant on treating the patient's disease with an untested drug, whereas the latter aimed to treat his symptoms with more conventional medication. Drug-drug interactions prevented treatment with both. Beginning with a discussion of the patient's best interest, we delve into the Singaporean context to show how culture affects medical decision making. Confucianism and filial piety are the values on which this family's workings were based. In an analysis of what this entails, we attempt to explain the significant and assertive family involvement in the decision-making process and their insistence on using novel medications, having exhausted conventional interventions. Within this mix were Western influences, too. Through the Internet, family members have become more informed and empowered in decision making, wresting the traditional paternalistic role of physicians in favor of "patient autonomy." An understanding of such dynamic facets will help better tailor culturally appropriate approaches to such complex situations. Copyright © 2010 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

How to make your development process user centred

CERN Multimedia

CERN. Geneva

2017-01-01

I’ve been designing and managing the development processes of websites and applications for companies since the 90s. In those years I’ve seen a lot of projects fail. The biggest issue: development teams prefer to spend the majority of their time in their cave behind their screens and clients stay in their ivory tower. This means that software is developed based on assumptions and personal taste. I’ve been to way to many meetings where arguments were leverages with ‘I don’t like this’ or ‘I think the user doesn’t want this’. During this presentation I will show the steps that should be taken to avoid all these issues and make a product that does bring the business objectives and the user’s desires together and is optimised for the real end user thus creates a usable product.

[The 10th Annual Meeting of the Japanese Society for Pharmaceutical Palliative Care and Sciences].

Science.gov (United States)

Shiokawa, Mitsuru; Kawamura, Kazumi

2018-01-01

　The 10th Annual Meeting of the Japanese Society for Pharmaceutical Palliative Care and Sciences was held at Act City Hamamatsu, Japan, with a total of 2634 participants in attendance. The theme of the meeting was realized through a number of new concepts, such as a debate symposium, information sessions, nurses' workshops, and so on. The results obtained from the participation questionnaire (n=438), which were aggregated up to 1 month following the end of this year's meeting, revealed that 89% of the participants at considered it to have been appealing. In particular, 63% of the participants favored the adoption of a debate symposium whereby it was possible to ask and respond to questions in real time. In the free comments section of the questionnaire, the participants expressed how they felt the debate symposium made it easy to give their opinions, and that this element might be further developed in the future. They also stated that they found the introduction of the Clica system effective in terms of making the annual meeting an active learning place. One issue that was highlighted concerned the observation that the hall used to host the symposium was designed as a concert venue, which meant it was highly shielded from the outside environment, in addition to access to the internet being blocked. I hope that many of the projects from this Annual Meeting will serve to guide the future style of the Society's Annual Meetings.

Eliciting regret improves decision making at the end of life.

Science.gov (United States)

Djulbegovic, Benjamin; Tsalatsanis, Athanasios; Mhaskar, Rahul; Hozo, Iztok; Miladinovic, Branko; Tuch, Howard

2016-11-01

Management choices at the end of life are high-stake decisions fraught with emotions, chief among is regret. Our objective in this paper is to test the utility of a regret-based model to facilitate referral to hospice care while helping patients clarify their preferences on how they wish to spend the remaining days of their lives. A prospective cohort study that enrolled consecutive adult patients (n = 178) aware of the terminal nature of their disease. The patients were at the point in care where they had to decide between continuing potentially 'curative/life-prolonging' treatment (Rx) versus hospice care. Preferences were elicited using a Dual Visual Analog Scale regarding the level of regret of omission versus commission (RgO/RgC) towards hospice care and Rx. Each patient's RgO/RgC was contrasted against the predictive probability of death to suggest a management plan, which was then compared with the patient's actual choice. The probability of death was estimated using validated Palliative Performance Scale predictive model. Eighty-five percent (151/178) of patients agreed with the model's recommendations (p < 0.000001). Model predicted the actual choices for 72% (128/178) of patients (p < 0.00001). Logistic regression analysis showed that people who were initially inclined to be referred to hospice and were predicted to choose hospice over disease-directed treatment by the regret model have close to 98% probability of choosing hospice care at the end of their lives. No other factors (age, gender, race, educational status and pain level) affected their choice. Using regret to elicit choices in the end-of-life setting is both descriptively and prescriptively valid. People with terminal disease who are initially inclined to choose hospice and do not regret such a choice will select hospice care with high level of certainty. Copyright © 2016 The Author(s). Published by Elsevier Ltd.. All rights reserved.

50 CFR 600.135 - Meeting procedures.

Science.gov (United States)

2010-10-01

... accessible to persons with disabilities, and that the public can make timely requests for language interpreters or other auxiliary aids at public meetings. (b) Drafts of emergency public notices must be... with disabilities, and that the public can make timely requests for language interpreters or other...

QoS Modeling for End-to-End Performance Evaluation over Networks with Wireless Access

Directory of Open Access Journals (Sweden)

Gómez Gerardo

2010-01-01

Full Text Available This paper presents an end-to-end Quality of Service (QoS model for assessing the performance of data services over networks with wireless access. The proposed model deals with performance degradation across protocol layers using a bottom-up strategy, starting with the physical layer and moving on up to the application layer. This approach makes it possible to analytically assess performance at different layers, thereby facilitating a possible end-to-end optimization process. As a representative case, a scenario where a set of mobile terminals connected to a streaming server through an IP access node has been studied. UDP, TCP, and the new TCP-Friendly Rate Control (TFRC protocols were analyzed at the transport layer. The radio interface consisted of a variable-rate multiuser and multichannel subsystem, including retransmissions and adaptive modulation and coding. The proposed analytical QoS model was validated on a real-time emulator of an end-to-end network with wireless access and proved to be very useful for the purposes of service performance estimation and optimization.

Audition of Professor Jean-Marie Chevalier (Paris 9 univ. Dauphine) at the end of the FNCCR board meeting of July 9, 2003

International Nuclear Information System (INIS)

2003-12-01

This document presents the economic analysis made by a university specialist, J.M. Chevalier, about the evolution of the energy systems in France and abroad. This analysis was made at the end of the July 9, 2003 board meeting of the National federation of granted organizations and public corporations (FNCCR). In his analysis, J.M. Chevalier presents: the un-bundling between energy generation and transportation (separation between network manager and network user, separation between transport functions (natural monopoly) and commercial functions), the advantages and drawbacks of energy markets opening, the role of a regulation authority, the public utility aspect, the security of supplies with the lack of new investments and the manipulation of prices. At the end of his presentation, J.M. Chevalier answers a series of questions about the volatility of the electricity market, the balance between monopoly and competition, the lack of a real European energy policy, the public acceptance with respect to new project of power line, the development of decentralized power generation and wind energy in the context of market deregulation, the opening of Electricite de France (EdF) and Gaz de France (GdF) capital, and the impact of deregulation on small consumers. (J.S.)

Optimization of CNC end milling process parameters using PCA ...

African Journals Online (AJOL)

Optimization of CNC end milling process parameters using PCA-based Taguchi method. ... International Journal of Engineering, Science and Technology ... To meet the basic assumption of Taguchi method; in the present work, individual response correlations have been eliminated first by means of Principal Component ...

78 FR 4476 - Sunshine Act; Meeting Notice

Science.gov (United States)

2013-01-22

...: Commissioners' Conference Room, 11555 Rockville Pike, Rockville, Maryland. STATUS: Public and Closed. Week of... live at the Web address--www.nrc.gov. 9:00 a.m. Briefing on Public Participation in NRC Regulatory Decision- Making (Public Meeting) (Contact: Lance Rakovan, 301-415-2589). This meeting will be webcast live...

Key role of social work in effective communication and conflict resolution process: Medical Orders for Life-Sustaining Treatment (MOLST) Program in New York and shared medical decision making at the end of life.

Science.gov (United States)

Bomba, Patricia A; Morrissey, Mary Beth; Leven, David C

2011-01-01

In this article, the authors review the development of the Medical Orders for Life-Sustaining Treatment (MOLST) Program and recent landmark legislation in New York State in the context of advance care planning and shared medical decision making at the end of life. Social workers are central health care professionals in working with patients, families, practitioners, health care agents, and surrogates in the health systems and in the communication and conflict resolution process that is integral to health care decision making. The critical importance of ethics and end-of-life training and education for social workers is also addressed. Data from a pilot study evaluating interdisciplinary ethics training on legal and ethical content in communication and conflict resolution skills in health care decision making are reported. Recommendations are made for research on education and training of social workers, and investigation of the role and influence of systems in shaping social work involvement in end-of-life and palliative care.

22 CFR 507.8 - Recording keeping of closed meetings.

Science.gov (United States)

2010-04-01

... of a meeting, closed to the public. (b) The Board, after review by the Chairman, shall make promptly... 22 Foreign Relations 2 2010-04-01 2010-04-01 true Recording keeping of closed meetings. 507.8 Section 507.8 Foreign Relations BROADCASTING BOARD OF GOVERNORS RULES FOR IMPLEMENTING OPEN MEETINGS UNDER...

Summary of the 1982 small tokamak users meeting

International Nuclear Information System (INIS)

Sprott, J.C.

1982-11-01

On November 1, 1982, the sixth in a series of approximately annual meetings of the users of small tokamaks was held in conjunction with the APS Division of Plasma Physics meeting at New Orleans. The meeting lasted three hours, with 34 people attending. The interest was on strengthening the ties between the small tokamaks and the large tokamaks. Accordingly, the latest meeting was dedicated to this theme, and in contrast to previous meetings, a few representatives from the large tokamaks were invited to attend and make presentations. Summaries of the various talks are included

End-of-Life Decisions and Advanced Old Age

Directory of Open Access Journals (Sweden)

Stoyles

2014-07-01

Full Text Available Despite the fact that most people die in advanced old age, little attention is given to cases involving older people in debates about the moral and legal dimensions of end-of-life decision making. The purpose of this paper is to establish some of the ways our discussions should change as we pay attention to important factors influencing end-of-life decisions for people in advanced old age. Focusing on the prevalence of comorbidities and the likelihood that people in advanced old age will experience an extended period of declining function before death, I argue that our debates should be expanded to include greater consideration of how we want to live in the final stages of life. With this, I am arguing against the tendency to think that “end-of-life” decision making concerns only making decisions about when and how it is appropriate to terminate a person’s life. I argue, further, that we should move away from the medicalization of dying.

Making Money is not an End in Itself

DEFF Research Database (Denmark)

Svensson, Christian Franklin

2014-01-01

The different experiences, motivations and negotiations associated with the social and profit-making dimensions of money are of central concern to the employees of social enterprises. These negotiations become apparent because the social dimension plays a primary role within such organizations....... Consequently, it is important for employees that a balance should be achieved between the two. The meaningfulness of what social enterprises do in expression of their social relations introduces a broader discussion of employees as actors who are embedded within and act across several dimensions and traditions....

Private sector malaria RDT initiative in Nigeria: lessons from an end-of-project stakeholder engagement meeting.

Science.gov (United States)

Odugbemi, Babatunde; Ezeudu, Chijioke; Ekanem, Anyiekere; Kolawole, Maxwell; Akanmu, Idowu; Olawole, Aderemi; Nglass, Nkabono; Nze, Chinwe; Idenu, Edward; Audu, Bala Mohammed; Ntadom, Godwin; Alemu, Wondimagegnehu; Mpazanje, Rex; Cunningham, Jane; Akubue, Augustine; Arowolo, Tolu; Babatunde, Seye

2018-02-06

The malaria rapid diagnosis testing (RDT) landscape is rapidly evolving in health care delivery in Nigeria with many stakeholders playing or having potential for critical roles. A recent UNITAID grant supported a pilot project on the deployment of quality-assured RDTs among formal and informal private service outlets in three states in Nigeria. This paper describes findings from a series of stakeholder engagement meetings held at the conclusion of the project. The agreed meeting structure was a combination of plenary presentations, structured facilitated discussions, and nominal group techniques to achieve consensus. Rapporteurs recorded the meeting proceeding and summaries of the major areas of discussion and consensus points through a retrospective thematic analysis of the submitted meeting reports. Key findings indicate that private providers were confident in the use of RDTs for malaria diagnosis and believed it has improved the quality of their services. However, concerns were raised about continued access to quality-assured RDT kits. Going forward, stakeholders recommended increasing client-driven demand, and continuous training and supervision of providers through integration with existing monitoring and supervision mechanisms.

78 FR 47409 - Meeting of the California Desert District Advisory Council

Science.gov (United States)

2013-08-05

... to the Federal Lands Recreation Enhancement Act, the Council will meet to make recommendations on the... statements with the council before or after the meeting. A public input session will be provided during the... Enhancement Act to make recommendations on BLM recreation fee proposals, which was signed into law by...

Analysis and design of a high-linearity receiver RF front-end with an improved 25%-duty-cycle LO generator for WCDMA/GSM applications

International Nuclear Information System (INIS)

Hu Song; Li Weinan; Huang Yumei; Hong Zhiliang

2012-01-01

A fully integrated receiver RF front-end that meets WCDMA/GSM system requirements is presented. It supports SAW-less operation for WCDMA. To improve the linearity in terms of both IP3 and IP2, the RF front-end is comprised of multiple-gated LNAs with capacitive desensitization, current-mode passive mixers with the proposed IP2 calibration circuit and reconfigurable Tow-Thomas-like biquad TIAs. A new power-saving multi-mode divider with low phase noise is proposed to provide the 4-phase 25%-duty-cycle LO. In addition, a constant-g m biasing with a non-chip resistor is adopted to make the conversion gain invulnerable to the process and temperature variations of the transimpedance. This RF front-end is integrated in a receiver with an on-chip frequency synthesizer in 0.13 μm CMOS. The measurement results show that owing to this high-linearity RF front-end, the receiver achieves −6 dBm IIP3 and better than +60 dBm IIP2 for all modes and bands. (semiconductor integrated circuits)

Steel making

CERN Document Server

Chakrabarti, A K

2014-01-01

"Steel Making" is designed to give students a strong grounding in the theory and state-of-the-art practice of production of steels. This book is primarily focused to meet the needs of undergraduate metallurgical students and candidates for associate membership examinations of professional bodies (AMIIM, AMIE). Besides, for all engineering professionals working in steel plants who need to understand the basic principles of steel making, the text provides a sound introduction to the subject.Beginning with a brief introduction to the historical perspective and current status of steel making together with the reasons for obsolescence of Bessemer converter and open hearth processes, the book moves on to: elaborate the physiochemical principles involved in steel making; explain the operational principles and practices of the modern processes of primary steel making (LD converter, Q-BOP process, and electric furnace process); provide a summary of the developments in secondary refining of steels; discuss principles a...

Mudaraba-Venture Capital Closed-end Mutual Funds and Mudaraba-Venture Capital Open-end Mutual Funds

OpenAIRE

Halil Ibrahim Bulut

2008-01-01

The important part of this study attempts to explain that both venture capital and interest-free financing are based on similar ground, if not the same. Two new models called Mudaraba-Venture Capital Closed-End Mutual Funds and Mudaraba-Venture Capital Open-End Mutual Funds, based on both the similarities and the needs of financial innovation in the interest-free financing system, are detailed. It is believed that the development of these two models could make some improvements not only in th...

78 FR 12070 - National Institute of Mental Health; Notice of Meeting

Science.gov (United States)

2013-02-21

... Translational Research will have a conference call on Wednesday, March 6, 2013. The Subcommittee will discuss future subcommittee activities. The meeting will be accessible by conference call. Name of Committee... meeting: Conference Call. Date: March 6, 2013. Time: 2:00 p.m.-5:00 p.m. *Eastern Time*--Approximate end...

The Mission Imperative for Sending Federal Scientists to Major Meetings: Making the Case (Invited)

Science.gov (United States)

McNutt, M. K.; Kimball, S. M.

2013-12-01

In the spring of 2012, new guidelines from the Office of Management and Budget (OMB) made travel for government scientists to meetings suddenly much more difficult in the wake of a major scandal involving excessive spending for a Las Vegas conference by a certain government agency. Deputy-Secretary-level permission was instituted for meetings involving more than 15 government staff members, with detailed documentation on the purpose of the gathering, the costs, the rationale for the choice of venue, and the role of each participant. Any ancillary events such a field trips, social gatherings, or leisure activities, were discouraged even if paid for with personal funds as they were being supported on government travel at taxpayer's expense. Furthermore, Secretarial-level waivers were required if the total meeting expense exceeded $500,000, an easy threshold to reach for large meetings that attract more than 200 participants from any one Department. An additional challenge in addressing the new OMB requirements is that many Departments and their constitutive agencies prior to the new guidelines had no centralized system for tracking conference attendance from their numerous centers and offices across the landscape. I will review how the USGS rose to the challenge in 2012 of obtaining a Secretarial waiver in order to meet its mission objectives of communicating its science results to stakeholders, maintaining the quality of its working through conferring with colleagues, providing opportunities for professional growth for junior scientists, nucleating new projects, and other important needs.

Increasing operations profitability using an end-to-end, wireless internet, gas monitoring system

Energy Technology Data Exchange (ETDEWEB)

McDougall, M. [Northrock Resources Ltd., AB (Canada); Benterud, K. [zed.i solutions, inc., Calgary, AB (Canada)

2004-10-01

Implementation by Northrock Resources Ltd., a wholly-owned subsidiary of Unocal Corporation, of a fully integrated end-to-end gas measurement and production analysis system, is discussed. The system, dubbed Smart-Alek(TM), utilizes public wireless communications and a web browser only delivery system to provide seamless well visibility to a desk-top computer. Smart-Alek(TM) is an example of a new type of end-to-end electronic gas flow measurement system, known as FINE(TM), which is an acronym for Field Intelligence Network and End-User Interface. The system delivers easy-to-use, complete, reliable and cost effective production information, far more effective than is possible to obtain with conventional SCADA technology. By installing the system, Northrock was able to increase gas volumes with more accurate electronic flow measurement in place of mechanical charts, with very low technical maintenance, and at a reduced operating cost. It is emphasized that deploying the technology alone will produce only partial benefits; to realize full benefits it is also essential to change grass roots operating practices, aiming at timely decision-making at the field level. 5 refs., 5 figs.

76 FR 30343 - SFIREG Full Working Committee; Notice of Public Meeting

Science.gov (United States)

2011-05-25

... (SFIREG) Full Committee will hold a 2-day meeting, beginning on June 20, 2011 and ending June 21, 2011. This notice announces the location and times for the meeting and sets forth the tentative agenda topics... on Tuesday, June 21, 2011. To request accommodation of a disability, please contact the person listed...

76 FR 23568 - Civil Nuclear Trade Advisory Committee Public Meeting

Science.gov (United States)

2011-04-27

... registrants requesting to make statements is greater than can be reasonably accommodated during the meeting... meeting. Man K. Cho, Acting Director, Office of Energy and Environmental Industries. [FR Doc. 2011-10149...

Review of Meeting Objectives

International Nuclear Information System (INIS)

Braams, B.J.; Chung, H.-K.

2011-01-01

This is the 21st meeting of the International Atomic and Molecular Data Centres Network. The traditional DCN meeting objectives are: to exchange information about activities in the Centres and review progress; to coordinate work in the Centres; to assess priorities in data evaluation and data production; to make plans for specific evaluations; and to evaluate and revise procedures for collection and exchange of bibliographical and numerical data. All of these are objectives for the present meeting too. In addition to the presentations from DCN and prospective DCN members we have two participants from outside the field of fusion data: Dr N. Mason will tell us about coordination of the Virtual Atomic and Molecular Data Centre and Dr S. Simakov will describe the manner in which nuclear structure and cross-section database development is coordinated by our colleagues in the Nuclear Data Section. In the discussions on Thursday and Friday there are two topics that need special attention this year: the future of our bibliographical data compilation and ways in which we can strengthen data evaluation activities, all with emphasis on collision processes and plasma-material interaction. The first 3 Data Centre Network meetings were held in 1977, 1980 and 1982 and the reports of those meetings make interesting reading and can still provide inspiration for the present meeting. I show some excerpts in the presentation. In 1977 the emphasis was on the coordination of the bibliographical database, AMBDAS, and a collision data index, CIAMDA, as the initial activities of the Network and of the newly formed IAEA A+M Data Unit. In 1980 the central topic of discussion at the meeting shifted to the numerical database and to data evaluation. The Network recommended that numerical data be reviewed by a selected group of scientists and that no unevaluated numerical A+M collision data should be distributed by the IAEA. The report of the meeting in 1982 shows that the bibliographical

Life's end: Ethnographic perspectives.

Science.gov (United States)

Goodwin-Hawkins, Bryonny; Dawson, Andrew

2018-01-01

In this introduction to the special issue, Life's End: Ethnographic Perspectives, we review the field of anthropological studies of death and dying. We make the argument that, largely because of its sub-disciplining into the larger field of the anthropology of religion, ritual and symbolism, the focus of anthropological research on death has been predominantly on post- rather than pre-death events, on death's beginnings rather than life's ends. Additionally, we argue that an anthropological aversion to the study of dying may also lie in the intimacy of the discipline's principal method, ethnography. Contrastingly, we argue that this very methodological intimacy can be a source of insight, and we offer this as a rationale for the special issue as a whole, which comprises eight ethnographic studies of dying and social relations at life's end from across Africa, Australia, Europe, and North America. Each of these studies is then summarized, and a rationale for their presentation around the themes of "structures of dying," "care for the dying," "hope in dying," and "ending life" is presented.

End-of-treatment and serial PET imaging in primary mediastinal B-cell lymphoma following dose-adjusted-EPOCH-R: A paradigm shift in clinical decision making.

Science.gov (United States)

Melani, Christopher; Advani, Ranjana; Roschewski, Mark; Walters, Kelsey M; Chen, Clara C; Baratto, Lucia; Ahlman, Mark A; Miljkovic, Milos D; Steinberg, Seth M; Lam, Jessica; Shovlin, Margaret; Dunleavy, Kieron; Pittaluga, Stefania; Jaffe, Elaine S; Wilson, Wyndham H

2018-05-10

Dose-adjusted-EPOCH-R obviates the need for radiotherapy in most patients with primary mediastinal B-cell lymphoma. End-of-treatment PET, however, does not accurately identify patients at risk of treatment failure, thereby confounding clinical decision making. To define the role of PET in primary mediastinal B-cell lymphoma following dose-adjusted-EPOCH-R, we extended enrollment and follow-up on our published phase II trial and independent series. Ninety-three patients received dose-adjusted-EPOCH-R without radiotherapy. End-of-treatment PET was performed in 80 patients, of whom 57 received 144 serial scans. One nuclear medicine physician from each institution blindly reviewed all scans from their respective institution. End-of-treatment PET was negative (Deauville 1-3) in 55 (69%) patients with one treatment failure (8-year event-free and overall survival of 96.0% and 97.7%). Among 25 (31%) patients with a positive (Deauville 4-5) end-of-treatment PET, there were 5 (20%) treatment failures (8-year event-free and overall survival of 71.1% and 84.3%). Linear regression analysis of serial scans showed a significant decrease in SUVmax in positive end-of-treatment PET non-progressors compared to an increase in treatment failures. Among 6 treatment failures, the median end-of-treatment SUVmax was 15.4 (range, 1.9-21.3) and 4 achieved long-term remission with salvage therapy. Virtually all patients with a negative end-of-treatment PET following dose-adjusted-EPOCH-R achieved durable remissions and should not receive radiotherapy. Among patients with a positive end-of-treatment PET, only 5/25 (20%) had treatment-failure. Serial PET imaging distinguished end-of-treatment PET positive patients without treatment failure, thereby reducing unnecessary radiotherapy by 80%, and should be considered in all patients with an initial positive PET following dose-adjusted-EPOCH-R (NCT00001337). Copyright © 2018, Ferrata Storti Foundation.

A model for emergency department end-of-life communications after acute devastating events--part II: moving from resuscitative to end-of-life or palliative treatment.

Science.gov (United States)

Limehouse, Walter E; Feeser, V Ramana; Bookman, Kelly J; Derse, Arthur

2012-11-01

The model for emergency department (ED) end-of-life communications after acute devastating events addresses decision-making capacity, surrogates, and advance directives, including legal definitions and application of these steps. Part II concerns communications moving from resuscitative to palliative and end-of-life treatments. After completing the steps involved in determining decision-making, emergency physicians (EPs) should consider starting palliative measures versus continuing resuscitative treatment. As communications related to these end-of-life decisions increasingly fall within the scope of emergency medicine (EM) practice, we need to become educated about and comfortable with them. © 2012 by the Society for Academic Emergency Medicine.

Both movement-end and task-end are critical for error feedback in visuomotor adaptation: a behavioral experiment.

Directory of Open Access Journals (Sweden)

Takumi Ishikawa

Full Text Available An important issue in motor learning/adaptation research is how the brain accepts the error information necessary for maintaining and improving task performance in a changing environment. The present study focuses on the effect of timing of error feedback. Previous research has demonstrated that adaptation to displacement of the visual field by prisms in a manual reaching task is significantly slowed by delayed visual feedback of the endpoint, suggesting that error feedback is most effective when given at the end of a movement. To further elucidate the brain mechanism by which error information is accepted in visuomotor adaptation, we tested whether error acceptance is linked to the end of a given task or to the end of an executed movement. We conducted a behavioral experiment using a virtual shooting task in which subjects controlled their wrist movements to meet a target with a cursor as accurately as possible. We manipulated the timing of visual feedback of the impact position so that it occurred either ahead of or behind the true time of impact. In another condition, the impact timing was explicitly indicated by an additional cue. The magnitude of the aftereffect significantly varied depending on the timing of feedback (p < 0.05, Friedman's Test. Interestingly, two distinct peaks of aftereffect were observed around movement-end and around task-end, irrespective of the existence of the timing cue. However, the peak around task-end was sharper when the timing cue was given. Our results demonstrate that the brain efficiently accepts error information at both movement-end and task-end, suggesting that two different learning mechanisms may underlie visuomotor transformation.

Adaptive RF front-ends for hand-held applications

CERN Document Server

van Bezooijen, Andre; van Roermund, Arthur

2010-01-01

The RF front-end - antenna combination is a vital part of a mobile phone because its performance is very relevant to the link quality between hand-set and cellular network base-stations. The RF front-end performance suffers from changes in operating environment, like hand-effects, that are often unpredictable. ""Adaptive RF Front-Ends for Hand-Held Applications"" presents an analysis on the impact of fluctuating environmental parameters. In order to overcome undesired behavior two different adaptive control methods are treated that make RF frond-ends more resilient: adaptive impedance control,

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

Science.gov (United States)

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.

Functions and requirements for the INEL light duty utility arm gripper end effector

International Nuclear Information System (INIS)

Pace, D.P.; Barnes, G.E.

1995-02-01

This gripper end effector system functions and requirements document defines the system functions that the end effector must perform as well as the requirements the design must meet. Safety, quality assurance, operations, environmental conditions, and regulatory requirements have been considered. The main purpose of this document is to provide a basis for the end effector engineering, design, and fabrication activities. The document shall be the living reference document to initiate the development activities and will be updated as system technologies are finalized

Functions and requirements for the INEL light duty utility arm sampler end effector

International Nuclear Information System (INIS)

Pace, D.P.; Barnes, G.E.

1995-02-01

This sampler end effector system functions and requirements document defines the system functions that the end effector must perform as well as the requirements the design must meet. Safety, quality assurance, operations, environmental conditions, and regulatory requirements have been considered. The main purpose of this document is to provide a basis for the end effector engineering, design, and fabrication activities. The document shall be the living reference document to initiate the development activities and will be updated as system technologies are finalized

77 FR 12008 - Civil Nuclear Trade Advisory Committee Public Meeting

Science.gov (United States)

2012-02-28

... make statements is greater than can be reasonably accommodated during the meeting, ITA may conduct a... within 90 days of the meeting. Man K. Cho, Team Leader for Energy, Office of Energy and Environmental...

Proceedings of the 1978 international meeting on reduced enrichment for research and test reactors

Energy Technology Data Exchange (ETDEWEB)

Travelli, A [Argonne National Laboratory, Argonne, IL (United States)

1993-08-01

November 9-10, 1978, marked the first of what has become an annual event - the International Meeting on Reduced Enrichment for Research and Test Reactors (RERTR). The RERTR Program had been started only three months earlier, and the meeting brought together for the first time many people who became major program participants in later years. This first meeting emphasized fuel development, and while it established the basis for all later meetings, it was unique in several respects. It was a time of feeling each other out, and of sharing new ideas, concerns, and hopes. In the absence of an established precedent, a number of participants came with written papers while others made only verbal presentations. Informality added spice and special importance to the discussions at the end of each presentation and, especially, to the panel discussion at the end of the meeting. An important achievement was a consensus on near-, medium-, and long-term density goals for the various fuels. This consensus resulted in a list written on the blackboard at the end of the panel discussion, and reproduced on page 216, which outlined the goals of each fabricator. Luckily, both presentations and discussions were recorded on audio tape. These recordings were transcribed and used to complete the informal presentations and to append the discussions at the end of each presentation. Considerable effort was expended in clearing the transcribed papers and key discussions with the participants. A few issues could not be resolved quickly, and in the frantic rush of those early years, these proceedings were set aside. Believing that the proceedings of this first meeting are important as a historical record of the beginning of the international RERTR effort, we have recently dusted off the manuscript and finished our editing job.

Proceedings of the 1978 international meeting on reduced enrichment for research and test reactors

International Nuclear Information System (INIS)

Travelli, A.

1993-08-01

November 9-10, 1978, marked the first of what has become an annual event - the International Meeting on Reduced Enrichment for Research and Test Reactors (RERTR). The RERTR Program had been started only three months earlier, and the meeting brought together for the first time many people who became major program participants in later years. This first meeting emphasized fuel development, and while it established the basis for all later meetings, it was unique in several respects. It was a time of feeling each other out, and of sharing new ideas, concerns, and hopes. In the absence of an established precedent, a number of participants came with written papers while others made only verbal presentations. Informality added spice and special importance to the discussions at the end of each presentation and, especially, to the panel discussion at the end of the meeting. An important achievement was a consensus on near-, medium-, and long-term density goals for the various fuels. This consensus resulted in a list written on the blackboard at the end of the panel discussion, and reproduced on page 216, which outlined the goals of each fabricator. Luckily, both presentations and discussions were recorded on audio tape. These recordings were transcribed and used to complete the informal presentations and to append the discussions at the end of each presentation. Considerable effort was expended in clearing the transcribed papers and key discussions with the participants. A few issues could not be resolved quickly, and in the frantic rush of those early years, these proceedings were set aside. Believing that the proceedings of this first meeting are important as a historical record of the beginning of the international RERTR effort, we have recently dusted off the manuscript and finished our editing job

Performance of the ATLAS hadronic end-cap calorimeter in beam tests

International Nuclear Information System (INIS)

Dowler, B.; Pinfold, J.; Soukup, J.; Vincter, M.; Cheplakov, A.; Datskov, V.; Fedorov, A.; Javadov, N.; Kalinnikov, V.; Kakurin, S.; Kazarinov, M.; Kukhtin, V.; Ladygin, E.; Lazarev, A.; Neganov, A.; Pisarev, I.; Serochkin, E.; Shilov, S.; Shalyugin, A.; Usov, Yu.; Ban, J.; Bruncko, D.; Chytracek, R.; Jusko, A.; Kladiva, E.; Strizenec, P.; Gaertner, V.; Hiebel, S.; Hohlfeld, M.; Jakobs, K.; Koepke, L.; Marschalkowski, E.; Meder, D.; Othegraven, R.; Schaefer, U.; Thomas, J.; Walkowiak, W.; Zeitnitz, C.; Leroy, C.; Mazini, R.; Mehdiyev, R.; Akimov, A.; Blagov, M.; Komar, A.; Snesarev, A.; Speransky, M.; Sulin, V.; Yakimenko, M.; Aderholz, M.; Brettel, H.; Cwienk, W.; Dulny, B.; Fent, J.; Fischer, A.; Haberer, W.; Huber, J.; Huber, R.; Karev, A.; Kiryunin, A.; Kobler, T.; Kurchaninov, L.; Laskus, H.; Lindenmayer, M.; Mooshofer, P.; Oberlack, H.; Salihagic, D.; Schacht, P.; Stenzel, H.; Striegel, D.; Tribanek, W.; Chekulaev, S.; Denisov, S.; Levitsky, M.; Minaenko, A.; Mitrofanov, G.; Moiseev, A.; Pleskatch, A.; Sytnik, V.; Benoit, P.; Hoyle, K.W.; Honma, A.; Maharaj, R.; Oram, C.J.; Pattyn, E.W.; Rosvick, M.; Sbarra, C.; Wellisch, H-P.; Wielers, M.; Birney, P.S.; Dobbs, M.; Fincke-Keeler, M.; Fortin, D.; Hodges, T.A.; Keeler, R.K.; Langstaff, R.; Lefebvre, M.; Lenckowski, M.; McPherson, R.; O'Neil, D.C.; Forbush, D.; Mockett, P.; Toevs, F.; Braun, H.M.; Thadome, J.

2002-01-01

Modules of the ATLAS liquid argon Hadronic End-cap Calorimeter (HEC) were exposed to beams of electrons, muons and pions in the energy range 6≤E≤200 GeV at the CERN SPS. A description of the HEC and of the beam test setup are given. Results on the energy response and resolution are presented and compared with simulations. The ATLAS energy resolution for jets in the end-cap region is inferred and meets the ATLAS requirements

24th Low-x Meeting

CERN Document Server

2016-01-01

This meeting follows the similar ones held at DESY, then Saclay (May 1994), Cambridge (July 1995), Durham (June 1996), Madrid (June 1997), Berlin (June 1998), Tel Aviv (June 1999) Oxford (July 2000), Cracow (June 2001), Antwerpen (September 2002), Nafplio (June 2003), Prague (September 2004), Sinaia (June 2005), Lisbon (June 2006), Helsinki (September 2007) Crete (July 2008), Ischia (September 2009), Kavala (June 2010) and Santiago de Compostela (June 2011), Cyprus (June 2012), Israel (June 2013), Japan (June 2014) and Poland (September 2015). The spirit of this series of meetings is to favour fruitful and informal discussions between experimentalists and theorists. Lots of time is used to be given to discussions on new results, hot topics and exciting open problems in QCD at Tevatron and LHC. The meeting is scheduled to start on Monday June 6 in the morning and end on Friday June 10 early agternoon. A tour in the neighborhood is planned for Wednesday June 8 in the afternoon. An optional tour is planned for S...

Quality control procedures applied to nuclear instruments. Proceedings of a technical meeting

International Nuclear Information System (INIS)

2008-11-01

Quality Control (QC), test procedures for Nuclear Instrumentation are important for assurance of proper and safe operation of the instruments, especially with regard to equipment related to radiological safety, human health and national safety. Correct measurements of radiation parameters must be ensured, i.e., accurate measurement of the number of radioactive events, counting times and in some cases accurate measurements of the radiation energy and occurring time of the nuclear events. There are several kinds of testing on nuclear instruments, for example, type-testing done by suppliers, acceptance testing made by the end users, Quality Control tests after repair and Quality Assurance/Quality Controls tests made by end-users. All of these tests are based in many cases on practical guidelines or on the experience of the own specialist, the available standards on this topic also need to be adapted to specific instruments. The IAEA has provided nuclear instruments and supported the operational maintenance efforts of the Member States. Although Nuclear Instrumentation is continuously upgraded, some older or aged instruments are still in use and in good working condition. Some of these instruments may not, however, meet modern requirements for the end-user therefore, Member States, mostly those with emerging economies, modernize/refurbish such instruments to meet the end-user demands. As a result, new instrumentation which is not commercially available, or modernized/refurbished instruments, need to be tested or verified with QC procedures to meet national or international certification requirements. A technical meeting on QC procedures applied to nuclear instruments was organized in Vienna from 23 to 24 August 2007. Existing and required QC test procedures necessary for the verification of operation and measurement of the main characteristics of nuclear instruments was the focus of discussion at this meeting. Presentations made at the technical meeting provided

The Family Meeting in Palliative Care: Role of the Oncology Nurse.

Science.gov (United States)

Glajchen, Myra; Goehring, Anna

2017-12-01

To describe the family meeting in palliative and end-of-life care, highlighting the role of the oncology nurse. Specific strategies will be provided for pre-meeting preparation, communication, and follow-up activities. A conceptual framework drawn from family and communication theory, and best practices from the clinical, research, nursing, and palliative care literature. Working with patients and families is complex, but the family meeting is a promising tool and a potential quality indicator in palliative care. The nurse is well positioned to participate fully in every aspect of the family meeting. Copyright © 2017 Elsevier Inc. All rights reserved.

77 FR 5798 - Sunshine Act Meeting

Science.gov (United States)

2012-02-06

... to the public (limited space available) and parts will be closed to the public. In order to increase the accessibility to Board meetings, persons requiring assistance should make arrangements in advance...

End-of-life decision making in respiratory failure. The therapeutic choices in chronic respiratory failure in a 7-item questionnaire

Directory of Open Access Journals (Sweden)

Dagmar Elfriede Rinnenburger

2012-01-01

Full Text Available INTRODUCTION: The transition from paternalistic medicine to a healthcare culture centred on the patient's decision making autonomy presents problems of communication and understanding. Chronic respiratory failure challenges patients, their families and caregivers with important choices, such as invasive and non-invasive mechanical ventilation and tracheostomy, which, especially in the case of neuromuscular diseases, can significantly postpone the end of life. MATERIAL AND METHODS: A 7-item questionnaire was administered to 100 patients with advanced COPD, neuromuscular diseases and pulmonary fibrosis, all of them on oxygen therapy and receiving day-hospital treatment for respiratory failure. The objective was to find out whether or not patients, if faced with a deterioration of their health condition, would want to take part in the decision making process and, if so, how and with whom. RESULTS. Results showed that: 90% of patients wanted to be interviewed, 10% preferred not to be interviewed, 82% wanted to be regularly updated on their clinical situation, 75% wanted to be intubated, if necessary, and 56% would also agree to have a tracheostomy. These choices have been confirmed one year later, with 93% of respondents accepting the questionnaire and considering it useful. CONCLUSIONS: It is possible to conclude that a simple questionnaire can be a useful tool contributing to therapeutic decision making in respiratory failure.

[Designing the Annual Meeting and Active Learning System].

Science.gov (United States)

Kawamura, Kazumi

2018-01-01

　At the 10th Annual Meeting of the Japanese Society for Pharmaceutical Palliative Care and Sciences our theme centered on active learning systems where adult learners engage on their own initiative. Many of the participants were pharmacists active in clinical practices. Regardless of their specialized skill-sets, pharmacists are constantly faced with difficult challenges in their daily work. Passive, one-way lectures are one resource for them, but unfortunately such lectures provide limited insights for resolving concrete problems. The present meeting aimed to show participants how to obtain information they need to solve specific real-world problems. This paper summarizes how we planned this year's meeting, including details about the debate symposium, social lunch, and online questionnaires. All these elements had the end goal of enabling learners proactivity to become their own best resource for learning. It is sincerely hoped that the design and execution of this meeting will prove resourceful for future annual meetings.

Completion of the Design of the Top End Optical Assembly for ATST

Science.gov (United States)

Canzian, Blaise; Barentine, J.

2013-01-01

L-3 Integrated Optical Systems (IOS) Division has been selected by the National Solar Observatory (NSO) to make the Top End Optical Assembly (TEOA) for the 4-meter Advanced Technology Solar Telescope (ATST) to operate at Haleakala, Maui. ATST will perform to a very high optical performance level in a difficult operational environment. The TEOA (including a 0.65-meter silicon carbide secondary mirror and support, mirror thermal management system, mirror positioning and fast tip-tilt system, field stop with thermally managed heat dump, Lyot stop, safety interlock and control system, and support frame) operates in the “hot spot” at the prime focus of the ATST, presenting unusual challenges. L-3 IOS has passed Critical Design Review of the TEOA. In this paper, we describe L-3 IOS success meeting technical challenges, including our solutions for optic fabrication, opto-mechanical positioning, rejected and stray light control, wavefront tip-tilt compensation, and thermal management and control.

Social Media and Scientific Meetings: Education Exhibit "Likes" at the Radiological Society of North America Annual Meeting.

Science.gov (United States)

Bunch, Paul M; Wortman, Jeremy R; Andriole, Katherine P

2016-03-01

Viewers of electronic education exhibits at the 2013 and 2014 Radiological Society of North America meetings had the opportunity to "like" exhibits, as one might "like" a Facebook or an Instagram post. The purposes of this study were (1) to evaluate for a relationship between exhibit popularity and receiving an award or RadioGraphics invitation, (2) to evaluate for a relationship between exhibit recognition and subsequent popularity, and (3) to quantify and compare the electronic education exhibit likes at the 2013 and the 2014 meetings. Exhibit likes were recorded at the midpoints and ends of both meetings. Data analyses were performed by means of one-way analysis of variance and chi-square tests. There were similar numbers of electronic education exhibits at the 2013 (1856) and 2014 (1793) meetings with no significant difference between meeting years in the number of exhibits chosen for awards (423 vs. 404, P = 0.88) or for RadioGraphics solicitation (190 vs. 169, P = 0.46). In both meeting years, there were statistically significant associations between initial and overall exhibit popularity and exhibit recognition, as well as between exhibit recognition and subsequent popularity. A 152% increase in total likes recorded was observed at the 2014 meeting as compared to the 2013 meeting (11074 vs. 4391, P < 0.0001). Popular exhibits were significantly more likely to receive awards and RadioGraphics invitations. Receiving an award or RadioGraphics invitation was associated with subsequent increased exhibit popularity. Significantly more likes were recorded at the 2014 Radiological Society of North America meeting than at the 2013 meeting. Copyright © 2015 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.

The meeting goer's lament.

Science.gov (United States)

Meyer, H

1980-10-22

Executives spend about 69% of their time in meeting with at least two other people, according to a recent study out of McGill University. In spite of this, participants do not consider this to be time used wisely and, according to the respondents, the problem seems to be growing worse. Despite the claims of some executives that government regulations or increased corporate complexity underlies the problem, society at large is viewed as the source of the change. Meyer asserts that all institutions have become less authoritarian and the trend away from command has left persuasion and consensus as the basis for corporate level decision-making. Although executives seem to agree that most time is wasted because participants fail to be succinct, the author argues that leaders could improve meetings by choosing the right participants, guiding them briskly through the agenda, and closing the meeting before it degenerates into a shouting match. The article suggests that chief executives are concluding that meeting skills can be learned. Most of the FORTUNE 500 companies have hired outside experts to teach these skills and some companies are building inhouse units for the same purpose. Since meetings have become an integral part of the business day, Meyer concluded that the goal of the executive should be to use the meeting time well.

Analytical solutions to SSC coil end design

International Nuclear Information System (INIS)

Bossert, R.C.; Brandt, J.S.; Carson, J.A.; Fulton, H.J.; Lee, G.C.; Cook, J.M.

1989-03-01

As part of the SCC magnet effort, Fermilab will build and test a series of one meter model SSC magnets. The coils in these magnets will be constructed with several different end configurations. These end designs must satisfy both mechanical and magnetic criteria. Only the mechanical problem will be addressed. Solutions will attempt to minimize stresses and provide internal support for the cable. Different end designs will be compared in an attempt to determine which is most appropriate for the SSC dipole. The mathematics required to create each end configuration will be described. The computer aided design, programming and machine technology needed to make the parts will be reviewed. 2 refs., 10 figs

Development and Validation of a Family Meeting Assessment Tool (FMAT).

Science.gov (United States)

Hagiwara, Yuya; Healy, Jennifer; Lee, Shuko; Ross, Jeanette; Fischer, Dixie; Sanchez-Reilly, Sandra

2018-01-01

A cornerstone procedure in Palliative Medicine is to perform family meetings. Learning how to lead a family meeting is an important skill for physicians and others who care for patients with serious illnesses and their families. There is limited evidence on how to assess best practice behaviors during end-of-life family meetings. Our aim was to develop and validate an observational tool to assess trainees' ability to lead a simulated end-of-life family meeting. Building on evidence from published studies and accrediting agency guidelines, an expert panel at our institution developed the Family Meeting Assessment Tool. All fourth-year medical students (MS4) and eight geriatric and palliative medicine fellows (GPFs) were invited to participate in a Family Meeting Objective Structured Clinical Examination, where each trainee assumed the physician role leading a complex family meeting. Two evaluators observed and rated randomly chosen students' performances using the Family Meeting Assessment Tool during the examination. Inter-rater reliability was measured using percent agreement. Internal consistency was measured using Cronbach α. A total of 141 trainees (MS4 = 133 and GPF = 8) and 26 interdisciplinary evaluators participated in the study. Internal reliability (Cronbach α) of the tool was 0.85. Number of trainees rated by two evaluators was 210 (MS4 = 202 and GPF = 8). Rater agreement was 84%. Composite scores, on average, were significantly higher for fellows than for medical students (P < 0.001). Expert-based content, high inter-rater reliability, good internal consistency, and ability to predict educational level provided initial evidence for construct validity for this novel assessment tool. Copyright © 2017 American Academy of Hospice and Palliative Medicine. All rights reserved.

Editorial: Nanoscience makes catalysis greener

KAUST Repository

Polshettiwar, Vivek; Basset, Jean-Marie; Astruc, Didier

2012-01-01

Green chemistry by nanocatalysis: Catalysis is a strategic field of science because it involves new ways of meeting energy and sustainability challenges. The concept of green chemistry, which makes the science of catalysis even more creative, has

IAEA International Database on Irradiated Nuclear Graphite Properties. Summary report of consultants' meeting. 12. meeting of the Technical Steering Committee

International Nuclear Information System (INIS)

Chung, H.K.; Wickham, A.J.

2010-02-01

The 12th Meeting of the Technical Steering Committee for the International Database on Irradiated Nuclear Graphite Properties was held on 12-13 November 2009 at the IAEA Headquarters, Vienna, Austria. All discussions, recommendations and actions of this Consultants' Meeting are recorded in this report. The purposes of the meeting were to review the matters and actions identified in the previous meeting, undertake a review of the current status of the database, and make recommendations for action over the next year. This report contains the status of the identified actions as well as a summary of the recommendations on enhancements to the database. (author)

Realizing directional cloning using sticky ends produced by 3ʹ-5ʹ ...

Indian Academy of Sciences (India)

The Klenow fragment (KF) has been used to make the blunt end as a tool enzyme. Its 5′-3′ polymerase activity can extend the 5′ overhanging sticky end to the blunt end, and 3′-5′ exonuclease activity can cleave the 3′ overhanging sticky end to the blunt end. The blunt end is useful for cloning. Here, we for the first ...

Following are the abstracts from the Fourth Annual Meeting of the Society for Molecular Imaging

Directory of Open Access Journals (Sweden)

2005-07-01

Full Text Available Declaration of Financial Interests or Relationships To insure balance, independence, objectivity and scientific rigor in all CME programs it is the policy of the meeting's joint sponsors that any speaker or poster presenter who makes a presentation at a program designated for AMA Physician's Recognition Award (PRA Category 1 or 2 credit must disclose any real or apparent financial interest or other relationship (i.e., grants, research support, consultant, honoraria that the presenter may have with the manufacturers, distributors or providers of any commercial products or services that may be discussed in the presentation. ISMRM and SMI do not imply that such financial interests or relationships are inherently improper or that such interests or relationships would prevent the presenter from making an objective presentation. However, it is imperative that such financial interests or relationships be identified by the presenter so that participants at the CME activity may have these facts fully disclosed prior to the presentation, and may form their own judgments about the presentation. Towards this end, the information provided by each presenter can be found at the bottom of each abstract. Every speaker, abstract presenter, organizer or anyone else who has control over any content in this meeting has been required to submit a Declaration of Financial Interests or Relationships, even if there is no conflict or relationship to declare.

Notification of upcoming AGU Council meeting

Science.gov (United States)

Williams, Billy

2012-10-01

The AGU Council will meet on Sunday, 2 December 2012, at the InterContinental Hotel in San Francisco, Calif. The meeting, which is open to all AGU members, will include discussions of AGU's new Grand Challenge Project (a project that will be introduced to members at the 2012 Fall Meeting), the proposed AGU scientific ethics policy, publishing strategies, future plans for honors and recognition, and leadership transition as new members join the Council. This year the Council experimented with a new approach to conducting business. By holding virtual meetings throughout the year, Council members have been able to act in a more timely manner and provide input on important membership and science issues on the Board of Directors' agenda. The Council Leadership Team—an elected subset of the Council—also experimented with a new approach, meeting every month to keep moving projects forward. This approach has increased communication and improved effectiveness in Council decision making.

Decision Making Among Older Adults at the End of Life: A Theoretical Perspective.

Science.gov (United States)

Romo, Rafael D; Dawson-Rose, Carol S; Mayo, Ann M; Wallhagen, Margaret I

Understanding changes in decision making among older adults across time is important for health care providers. We examined how older adults with a limited prognosis used their perception of prognosis and health in their decision-making processes and related these findings to prospect theory. The theme of decision making in the context of ambiguity emerged, reflecting how participants used both prognosis and health to value choices, a behavior not fully captured by prospect theory. We propose an extension of the theory that can be used to better visualize decision making at this unique time of life among older adults.

Head-end process technology for the new reprocessing plants in France and Japan

International Nuclear Information System (INIS)

Saudray, D.; Hugelmann, D.; Cho, A.

1991-01-01

Major technological innovations brought to the new UP3 and UP2-800 reprocessing plants of COGEMA LA HAGUE and also to the JNFS ROKKASHO plant concern the head-end process. The continuous process designed allows for high throughputs whilst meeting stringent safety requirements. The head-end of each plant includes two lines for each operation in order to guarantee availability. This paper presents the T1 head-end facility of the UP3 plant as well as the few adaptations implemented in the ROKKASHO Reprocessing Plant to fulfill the particular design requirements in Japan

Decision-making in abnormal radiological situations

International Nuclear Information System (INIS)

Pretre, S.

1998-01-01

General problems associated with social impacts of radiology and decision making is discussed, as the main topics of the meeting. The problem of population is discussed living in areas contaminates with radioactive substances resulting from a major accident or from pest practices. This situation needs decision making process for initiating actions like relocation, resettlement or large-scale decontamination. The roles of various participants in this decision making process and in the communication with the public are considered. (R.P.)

Report of nuclear powered ship meeting

International Nuclear Information System (INIS)

Anon.

1983-01-01

The research and development of nuclear powered ships in Japan have been advanced centering around the Japan Nuclear Ship Development Agency established in 1963. It is regretful that the development of ''Mutsu'' is largely behind the schedule due to the radiation leak in 1974, and the expected objective has not yet been attained even today. The government decided to advance the research on the improvement of marine nuclear reactors in 1980, and this new research function was given to the Agency by changing its organization. However, recently various arguments have arisen concerning the way of the research and development of nuclear ships in Japan centering around ''Mutsu'', such as the necessity of developing nuclear ships, the enormous expenditure for the development, the aging of ''Mutsu'' more than 10 years after the construction, the introduction of nuclear ship technology from foreign countries and so on. By the end of fiscal 1984, the Agency is expected to merge with other organization related to atomic energy, therefore, it is necessary to decide the way of research and development. This meeting organized by the Atomic Energy Commission makes this report to show the way of thinking about the above arguments. (Kako, I.)

77 FR 42484 - Civil Nuclear Trade Advisory Committee (CINTAC) Public Meeting

Science.gov (United States)

2012-07-19

.... If the number of registrants requesting to make statements is greater than can be reasonably.... Copies of CINTAC meeting minutes will be available within 90 days of the meeting. Man K. Cho, Team Leader...

A qualitative exploration of patient and family views and experiences of treatment decision-making in bipolar II disorder.

Science.gov (United States)

Fisher, Alana; Manicavasagar, Vijaya; Sharpe, Louise; Laidsaar-Powell, Rebekah; Juraskova, Ilona

2018-02-01

Treatment decision-making in bipolar II disorder (BPII) is challenging, yet the decision support needs of patients and family remain unknown. To explore patient and family perspectives of treatment decision-making in BPII. Semistructured, qualitative interviews were conducted with 28 patients with BPII-diagnosis and 13 family members with experience in treatment decision-making in the outpatient setting. Interviews were audiotaped, transcribed verbatim and analysed thematically using framework methods. Participant demographics, clinical characteristics and preferences for patient decision-making involvement were assessed. Four inter-related themes emerged: (1) Attitudes and response to diagnosis and treatment; (2) Influences on decision-making; (3) The nature and flow of decision-making; (4) Decision support and challenges. Views differed according to patient involvement preferences, time since diagnosis and patients' current mood symptoms. This is the first known study to provide in-depth patient and family insights into the key factors influencing BPII treatment decision-making, and potential improvements and challenges to this process. Findings will inform the development of BPII treatment decision-making resources that better meet the informational and decision-support priorities of end users. This research was partly funded by a Postgraduate Research Grant awarded to the first author by the University of Sydney. No conflicts of interest declared.

Proceedings of the first meeting of IEA, Bioenergy, Task 17

Energy Technology Data Exchange (ETDEWEB)

Christersson, L.; Ledin, S. [eds.

1999-07-01

The present proceedings are the result of the first meeting of Task 17 within the frame of IEA, Bioenergy. During the meeting the objectives of Task 17 were discussed and determined to be: * to stimulate the full-scale implementation of energy crops in participating countries; * to strengthen the contacts and co-operation between participating countries, scientists, biomass producers, machine developers, entrepreneurs, and end users; * to select the most urgent research and development areas, and to suggest projects of co-operation; * to deliver Proceedings from the meetings, and * to inform Ex-Co-members. Separate abstracts have been prepared for all the 7 papers presented.

Advanced nuclear plants: Meeting the economic challenge

International Nuclear Information System (INIS)

Redding, J.R.; MacGregor, P.R.

1993-01-01

This article examines the economic challenges to nuclear power meeting the forecasted power demand of the end of the century. The topics of the article include the economic challenge, safety, competition from other energy sources, a US case study, environmental costs, capital costs, reducing operation and maintenance costs, and non-technical features

76 FR 13182 - Science Advisory Board Staff Office; Notification of a Public Meeting of the Science Advisory...

Science.gov (United States)

2011-03-10

... a Public Meeting of the Science Advisory Board Committee on Science Integration for Decision Making... Agency (EPA or Agency) Science Advisory Board (SAB) Staff Office announces a public meeting of the SAB Committee on Science Integration for Decision Making. DATES: The meeting dates are March 29, 2011 from 9 a.m...

Fight against fracking in rural Netherlands: from community meetings to decision-making

NARCIS (Netherlands)

Benneworth, Paul Stephen; Velderman, Willem-Jan

2016-01-01

In late 2014, in our home region of Twente, the Netherlands, the local newspaper reported that the Dutch National Oil Company (NAM) was meeting with local citizens to give them information about the injection of waste water from oil drilling operations (an extraction technique similar to fracking)

76 FR 8350 - Notice of Federal Advisory Committee Meeting

Science.gov (United States)

2011-02-14

... federal advisory committee meeting of the DoD Board of Actuaries will take place: DATES: July 14-15, 2011... Office of the Actuary, 4040 N. Fairfax Drive, Suite 308, Arlington, VA 22203. SUPPLEMENTARY INFORMATION... Board of Actuaries meeting or make an oral presentation or submit a written statement for consideration...

Report of fission study meeting

International Nuclear Information System (INIS)

1986-03-01

This book is the report of fission Study Meeting held from September 19 to 21, 1985 in the Research Center for Nuclear Physics, Osaka University. The objective of this study meeting was to stimulate the research on nuclear physics in Japan, which began to show new development accompanying the advance of the research on heavy ion nuclear reaction, and to make this a new starting point. More than 50 participants from physical, chemical and engineering fields, who have interest in the theory and experiment related to nuclear fission, gathered, and the meeting was a success beyond expectation. The contents covered a wide range including nuclear smashing reaction as well as nuclear fission in a narrow sense. In this book, the gists of 28 papers are collected. (Kako, I.)

What Happens to Teacher Salaries during a Recession? Schools in Crisis: Making Ends Meet

Science.gov (United States)

Simpkins, Jim; Roza, Marguerite; Simburg, Suzanne

2012-01-01

In many districts where budgets are tight and forcing cuts in services, are teacher incomes also falling behind? Is teaching becoming a less remunerative occupation relative to other local opportunities such that over time it may become less attractive? Or, do the automatic salary triggers shift wages up despite revenue constraints? This study…

Cardiopulmonary resuscitation knowledge and opinions on end of life decision making of older adults admitted to an acute medical service.

Science.gov (United States)

Sharma, Rupali; Jayathissa, Sisira; Weatherall, Mark

2016-01-08

To determine the knowledge in cardiopulmonary resuscitation (CPR) process, preference for CPR, and desire to participate in end-of-life decision making amongst older hospitalised patients. We prospectively interviewed 100 participants above 65 years of age awaiting discharge from acute medical ward and collected demographics, knowledge of CPR and opinion on CPR in various clinical scenarios. Amongst the participants, 58% had good understanding of all components of CPR and 91% overestimated its success. Fifty-eight percent wished to have CPR in current health status, but this declined if they were presented a hypothetical scenario of critical illness (46%), functional impairment (17%), terminal illness (13%) and dementia (13%). Tertiary education, male gender and not living alone were associated with accepting CPR. Ninety-three percent were comfortable discussing CPR and 84% felt comfortable documenting their wishes in the medical notes. Seventy percent wished such discussion to include themselves and their family. Older inpatients have a reasonable understanding of the components of CPR and wish to be involved in CPR decision-making. Clinical scenarios with poor prognosis may lead to patients declining CPR. Discussion and documentation of resuscitation wishes is useful in routine assessment process among elderly hospitalised patients.

Materials reliability in the back end of the nuclear fuel cycle

International Nuclear Information System (INIS)

1987-05-01

Operating experience of nuclear fuel cycle facilities has proved that the performance and availability of key equipment largely depend on the reliability of its construction materials. In general, the materials of construction have performed well in accordance with the design criteria of equipment. In some cases, however, materials failure problems have been encountered, the causes of which are related to their corrosion and mechanical degradation. In response to the growing interest in these topics, the IAEA convened the Technical Committee Meeting on ''Materials Reliability in the Back-End of the Nuclear Fuel Cycle'' at its Headquarters from September 2 to 5, 1986. This Technical Document contains the 15 papers presented during the Meeting. Material aspects of the following fields of the back-end of the nuclear fuel cycle are covered: interim and long-term storage of spent fuel; final disposal of spent fuel; storage and vitrification of High Level Liquid Wastes (HLLW); long-term storage of High Level Wastes (HLW); and spent fuel treatment

Summary report of consultants meeting on IAEA International Database on Irradiated Nuclear Graphite Properties. 11. meeting of the Technical Steering Committee

International Nuclear Information System (INIS)

Humbert, D.; Wickham, A.J.

2009-05-01

The 11th Meeting of the Technical Steering Committee for the International Database on Irradiated Nuclear Graphite Properties was held on 25-26 March 2009 at the IAEA Headquarters, Vienna, Austria. All discussions, recommendations and actions of this Consultants' Meeting are recorded in this report. The purposes of the meeting were to review the matters and actions identified in the previous meeting, undertake a review of the current status of the database, and make recommendations for action over the next year. This report contains the status of the identified actions as well as a summary of the recommendations on enhancements to the database. (author)

Summary report of consultants' meeting - IAEA International Database on Irradiated Nuclear Graphite Properties. 8th meeting of the Technical Steering Committee

International Nuclear Information System (INIS)

Humbert, D.; Wickham, A.J.

2006-05-01

The '8th Meeting of the Technical Steering Committee for the International Database on Irradiated Nuclear Graphite Properties' was held on 15-16 March 2006 at the IAEA Headquarters, Vienna, Austria. All discussions, recommendations and actions of this Consultants' Meeting are recorded in this report. The purposes of the meeting were to review the matters and actions identified in the previous meeting, undertake a review of the current status of the database and make recommendations for actions for the next year. This report contains the current status of the identified actions as well as a summary of the recommendations on enhancements to the database. (author)

Analog front end circuit design of CSNS beam loss monitor system

International Nuclear Information System (INIS)

Xiao Shuai; Guo Xian; Tian Jianmin; Zeng Lei; Xu Taoguang; Fu Shinian

2013-01-01

The China Spallation Neutron Source (CSNS) beam loss monitor system uses gas ionization chamber to detect beam losses. The output signals from ionization chamber need to be processed in the analog front end circuit, which has been designed and developed independently. The way of transimpedance amplifier was used to achieve current-voltage (I-V) conversion measurement of signal with low repetition rate, low duty cycle and low amplitude. The analog front end circuit also realized rapid response to the larger beam loss in order to protect the safe operation of the accelerator equipment. The testing results show that the analog front end circuit meets the requirements of beam loss monitor system. (authors)

End-of-life decisions: Christian perspectives.

Science.gov (United States)

Stempsey, William E

1997-12-01

While legal rights to make medical treatment decisions at the end of one's life have been recognized by the courts, particular religious traditions put axiological and metaphysical meat on the bare bones of legal rights. Mere legal rights do not capture the full reality, meaning and importance of death. End-of-life decisions reflect not only the meaning we find in dying, but also the meaning we have found in living. The Christian religions bring particular understandings of the vision of life as a gift from God, human responsibility for stewardship of that life, the wholeness of the person, and the importance of the dying process in preparing spiritually for life beyond earthly life, to bear on end-of-life decisions.

12 CFR 516.170 - When will OTS conduct a meeting on an application?

Science.gov (United States)

2010-01-01

... application, or otherwise determines that a meeting will benefit the decision-making process. OTS may limit... inform the applicant and all commenters requesting a meeting of its decision to grant or deny a meeting request, or of its decision to conduct a meeting on its own initiative. (c) If OTS decides to conduct a...

George Williams in Thailand: An Ethical Decision-Making Exercise

Science.gov (United States)

James, Constance R.; Smith, J. Goosby

2007-01-01

This article presents a classroom ethical decision-making exercise designed to help students make reasoned ethical decisions while gaining insight into their own and others' ethical decision-making strategies. During the exercise, students individually analyze an original mini-case, then meet in small groups to reach consensus on the advice and…

PENGEMBANGAN 24 DESTINASI WISATA BAHARI KABUPATEN ENDE

Directory of Open Access Journals (Sweden)

Josef Alfonsius Gadi Djou

2013-04-01

Full Text Available There are 24 marine tourism destinations in Ende District that have not been managed well enough. To improve tourism development, some management strategies should be taken by stakeholders. First, the government should make some policies that give opportunities and easy access to stakeholders. Scond, the government should make a development planning for the potential destinations. Third, they should make plans that would give information about the most potential destination. Fourth, the government and marine communities should prepare human resource in management. At last, the government should promote those marine tourism destinations continuosly.

78 FR 59337 - Black Hills National Forest Advisory Board; Meeting

Science.gov (United States)

2013-09-26

... Advisory Board (Board) will meet in Rapid City, South Dakota. The Board is established consistent with the... include time for people to make oral statements of three minutes or less. Individuals wishing to make an...

Hospice decision making: diagnosis makes a difference.

Science.gov (United States)

Waldrop, Deborah P; Meeker, Mary Ann

2012-10-01

This study explored the process of decision making about hospice enrollment and identified factors that influence the timing of that decision. This study employed an exploratory, descriptive, cross-sectional design and was conducted using qualitative methods. In-depth in-person semistructured interviews were conducted with 36 hospice patients and 55 caregivers after 2 weeks of hospice care. The study was guided by Janis and Mann's conflict theory model (CTM) of decision making. Qualitative data analysis involved a directed content analysis using concepts from the CTM. A model of hospice enrollment decision making is presented. Concepts from the CTM (appraisal, surveying and weighing the alternatives, deliberations, adherence) were used as an organizing framework to illustrate the dynamics. Distinct differences were found by diagnosis (cancer vs. other chronic illness, e.g., heart and lung diseases) during the pre-encounter phase or before the hospice referral but no differences emerged during the post-encounter phase. Differences in decision making by diagnosis suggest the need for research about effective means for tailored communication in end-of-life decision making by type of illness. Recognition that decision making about hospice admission varies is important for clinicians who aim to provide person-centered and family-focused care.

78 FR 25436 - SFIREG Environmental Quality Issues Committee; Notice of Public Meeting

Science.gov (United States)

2013-05-01

... on May 20, 2013 and ending May 21, 2013. This notice announces the location and times for the meeting and sets forth the tentative agenda topics. DATES: The meeting will be held on Monday, May 20, 2013 from 8:30 a.m. to 5 p.m. and 8:30 a.m. to 12 noon on Tuesday May 21, 2013. To request accommodations of...

76 FR 8352 - Meeting of a Federal Advisory Committee

Science.gov (United States)

2011-02-14

... committee meeting of the DoD Medicare-Eligible Retiree Health Care Board of Actuaries will take place: DATES... 22203. FOR FURTHER INFORMATION CONTACT: Margot Kaplan at the DoD Office of the Actuary, 4040 N. Fairfax... desiring to attend the DoD Medicare-Eligible Retiree Health Care Board of Actuaries meeting or make an oral...

Poly(ethyl glyoxylate)-Poly(ethylene oxide) Nanoparticles: Stimuli-Responsive Drug Release via End-to-End Polyglyoxylate Depolymerization.

Science.gov (United States)

Fan, Bo; Gillies, Elizabeth R

2017-08-07

The ability to disrupt polymer assemblies in response to specific stimuli provides the potential to release drugs selectively at certain sites or conditions in vivo. However, most stimuli-responsive delivery systems require many stimuli-initiated events to release drugs. "Self-immolative polymers" offer the potential to provide amplified responses to stimuli as they undergo complete end-to-end depolymerization following the cleavage of a single end-cap. Herein, linker end-caps were developed to conjugate self-immolative poly(ethyl glyoxylate) (PEtG) with poly(ethylene oxide) (PEO) to form amphiphilic block copolymers. These copolymers were self-assembled to form nanoparticles in aqueous solution. Cleavage of the linker end-caps were triggered by a thiol reducing agent, UV light, H 2 O 2 , and combinations of these stimuli, resulting in nanoparticle disintegration. Low stimuli concentrations were effective in rapidly disrupting the nanoparticles. Nile red, doxorubin, and curcumin were encapsulated into the nanoparticles and were selectively released upon application of the appropriate stimulus. The ability to tune the stimuli-responsiveness simply by changing the linker end-cap makes this new platform highly attractive for applications in drug delivery.

Meeting the Educational Challenges of Income Inequality

Science.gov (United States)

Duncan, Greg J.; Murnane, Richard J.

2014-01-01

Can the nation's schools meet today's challenge of providing all students with the skills they will need to thrive in the rapidly changing economy and society of the 21st century? The authors point out in this article that a large percentage of children, overwhelmingly from low-income families, end their formal schooling without the…

Strategies for the back end of the nuclear fuel cycle. Proceedings of a technical committee meeting held in Vienna, 1-4 June 1993

Energy Technology Data Exchange (ETDEWEB)

NONE

1995-11-01

The selection of an option for the back end of the nuclear fuel cycle is an important decision for all countries with nuclear power programmes. Likewise, the process for making that option selection is also important. Some countries have begun utilizing nuclear energy for electricity generation without formally determining what would be done with the spent nuclear fuel and radioactive wastes. In a number of those countries the inventories of spent fuel are approaching their storage capacity - and an option selection must soon be made. This report provides an analysis of both the policies chosen by a number of Member States and the process that led to those selections. The intent of this analysis and this publication is to assist other countries in their deliberations on this subject. This publication presents conclusions concerning the factors that were considered important by different countries and the processes which they followed in making their determination of the policy for disposal of nuclear waste. Refs, figs, tabs.

Strategies for the back end of the nuclear fuel cycle. Proceedings of a technical committee meeting held in Vienna, 1-4 June 1993

International Nuclear Information System (INIS)

1995-11-01

The selection of an option for the back end of the nuclear fuel cycle is an important decision for all countries with nuclear power programmes. Likewise, the process for making that option selection is also important. Some countries have begun utilizing nuclear energy for electricity generation without formally determining what would be done with the spent nuclear fuel and radioactive wastes. In a number of those countries the inventories of spent fuel are approaching their storage capacity - and an option selection must soon be made. This report provides an analysis of both the policies chosen by a number of Member States and the process that led to those selections. The intent of this analysis and this publication is to assist other countries in their deliberations on this subject. This publication presents conclusions concerning the factors that were considered important by different countries and the processes which they followed in making their determination of the policy for disposal of nuclear waste. Refs, figs, tabs

Machine vision method for online surface inspection of easy open can ends

Science.gov (United States)

Mariño, Perfecto; Pastoriza, Vicente; Santamaría, Miguel

2006-10-01

Easy open can end manufacturing process in the food canning sector currently makes use of a manual, non-destructive testing procedure to guarantee can end repair coating quality. This surface inspection is based on a visual inspection made by human inspectors. Due to the high production rate (100 to 500 ends per minute) only a small part of each lot is verified (statistical sampling), then an automatic, online, inspection system, based on machine vision, has been developed to improve this quality control. The inspection system uses a fuzzy model to make the acceptance/rejection decision for each can end from the information obtained by the vision sensor. In this work, the inspection method is presented. This surface inspection system checks the total production, classifies the ends in agreement with an expert human inspector, supplies interpretability to the operators in order to find out the failure causes and reduce mean time to repair during failures, and allows to modify the minimum can end repair coating quality.

Decision making about medical interventions in the end-of-life care of people with intellectual disabilities: a national survey of the considerations and beliefs of GPs, ID physicians and care staff.

NARCIS (Netherlands)

Bekkema, N.; Veer, A.J.E. de; Wagemans, A.M.A.; Hertogh, C.M.P.M.; Francke, A.L.

2014-01-01

Objective: This paper explores the personal beliefs and specific considerations of professionals regarding decisions about potentially burdensome medical interventions in the end-of-life care for people with intellectual disabilities (ID). Methods: A survey questionnaire covering decision making

Decision making about medical interventions in the end-of-life care of people with intellectual disabilities: A national survey of the considerations and beliefs of GPs, ID physicians and care staff

NARCIS (Netherlands)

Bekkema, N.; de Veer, A.J.E.; Wagemans, A.M.A.; Hertogh, C.M.P.M.; Francke, A.L.

2014-01-01

Objective: This paper explores the personal beliefs and specific considerations of professionals regarding decisions about potentially burdensome medical interventions in the end-of-life care for people with intellectual disabilities (ID). Methods: A survey questionnaire covering decision making

Combined fishing and climate forcing in the southern Benguela upwelling ecosystem: an end-to-end modelling approach reveals dampened effects.

Directory of Open Access Journals (Sweden)

Morgane Travers-Trolet

Full Text Available The effects of climate and fishing on marine ecosystems have usually been studied separately, but their interactions make ecosystem dynamics difficult to understand and predict. Of particular interest to management, the potential synergism or antagonism between fishing pressure and climate forcing is analysed in this paper, using an end-to-end ecosystem model of the southern Benguela ecosystem, built from coupling hydrodynamic, biogeochemical and multispecies fish models (ROMS-N2P2Z2D2-OSMOSE. Scenarios of different intensities of upwelling-favourable wind stress combined with scenarios of fishing top-predator fish were tested. Analyses of isolated drivers show that the bottom-up effect of the climate forcing propagates up the food chain whereas the top-down effect of fishing cascades down to zooplankton in unfavourable environmental conditions but dampens before it reaches phytoplankton. When considering both climate and fishing drivers together, it appears that top-down control dominates the link between top-predator fish and forage fish, whereas interactions between the lower trophic levels are dominated by bottom-up control. The forage fish functional group appears to be a central component of this ecosystem, being the meeting point of two opposite trophic controls. The set of combined scenarios shows that fishing pressure and upwelling-favourable wind stress have mostly dampened effects on fish populations, compared to predictions from the separate effects of the stressors. Dampened effects result in biomass accumulation at the top predator fish level but a depletion of biomass at the forage fish level. This should draw our attention to the evolution of this functional group, which appears as both structurally important in the trophic functioning of the ecosystem, and very sensitive to climate and fishing pressures. In particular, diagnoses considering fishing pressure only might be more optimistic than those that consider combined effects

The unscalable frequency of meetings

CERN Multimedia

CERN. Geneva

2015-01-01

The November 2014 document "Summary of IT Programme of Work and Outlook for 2015" mentions: '...the input generated by the IT staff survey (...) suggested to make increased use of more modern communication methods (e.g. social.cern.ch)...'. Experience has shown the futility of investing all hopes for making an effective change into a single method, even the most contemporary or versatile. This talk will suggest small, achievable steps for staying connected and informed, yet limiting all kinds of meetings-for-their-own-sake.

Management of radioactive wastes. Closing meeting

International Nuclear Information System (INIS)

2006-01-01

The law from December 30, 1991, precisely defines 3 axes of researches for the management of high level and long-lived radioactive wastes: separation/transmutation, surface storage and underground disposal. A global evaluation report about these researches is to be supplied in 2006 by the French government to the Parliament. A first synthesis of the knowledge gained after 14 years of research has led the national commission of the public debate (CNDP) to organize a national debate about the general options of management of high-level and long-lived radioactive wastes before the 2006 date line. The debate comprised 4 public hearings (September 2005: Bar-le-Duc, Saint-Dizier, Pont-du-Gard, Cherbourg), 12 round-tables (October and November 2005: Paris, Joinville, Caen, Nancy, Marseille), a synthesis meeting (December 2005, Dunkerque) and a closing meeting (January 2006, Lyon). This document is the proceedings of this closing meeting. The aim of this meeting is to make a status of the different public hearings and round-tables and to stress on some particular points of the nuclear waste management debate. Some points concern the social and democratic dimension of this debate which can be summarized in few words like: public information, decision making, secrecy, confidence, transparency, acceptability, ethics. Some other points concern the scientific and technical dimensions of nuclear waste management and refer to the advantages and drawbacks of the different options of the 1991 law (transmutation, deep geologic disposal, and subsurface storage). (J.S.)

Meeting review: 2002 O'Reilly Bioinformatics Technology Conference.

Science.gov (United States)

Counsell, Damian

2002-01-01

At the end of January I travelled to the States to speak at and attend the first O'Reilly Bioinformatics Technology Conference. It was a large, well-organized and diverse meeting with an interesting history. Although the meeting was not a typical academic conference, its style will, I am sure, become more typical of meetings in both biological and computational sciences.Speakers at the event included prominent bioinformatics researchers such as Ewan Birney, Terry Gaasterland and Lincoln Stein; authors and leaders in the open source programming community like Damian Conway and Nat Torkington; and representatives from several publishing companies including the Nature Publishing Group, Current Science Group and the President of O'Reilly himself, Tim O'Reilly. There were presentations, tutorials, debates, quizzes and even a 'jam session' for musical bioinformaticists.

End-of-life decisions for people with intellectual disabilities, an interview study with patient representatives

NARCIS (Netherlands)

Wagemans, A.M.; Schrojenstein Lantman-de Valk, H.M. van; Proot, I.M.; Metsemakers, J.; Tuffrey-Wijne, I.; Curfs, L.M.G.

2013-01-01

Background: Not much is known about the process of end-of-life decision-making for people with intellectual disabilities. Aim: To clarify the process of end-of-life decision-making for people with intellectual disabilities from the perspective of patient representatives. Design: A qualitative study

Meeting to discuss laser cavity design for photon linear collider ...

Indian Academy of Sciences (India)

linear collider – Daresbury, UK, 10 January 2006. ALEXANDER JOHN FINCH ... On 10 January 2006, a meeting to discuss laser cavity design for the photon linear collider was held at the Daresbury .... important to continue making contact with people in fields outside the accelerator community. Few experts at this meeting ...

[End of life and vulnerability, a public health issue].

Science.gov (United States)

Boucomont, Aude

2016-02-01

End of life and precarity, two words which were linked by the French national observatory for end of life care in its work carried out in 2014. The study provided an overview of current support practices in different areas, highlighting certain lessons to be learned and making recommendations to the different partners involved. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

An Economic Case for End System Multicast

Science.gov (United States)

Analoui, Morteza; Rezvani, Mohammad Hossein

This paper presents a non-strategic model for the end-system multicast networks based on the concept of replica exchange economy. We believe that microeconomics is a good candidate to investigate the problem of selfishness of the end-users (peers) in order to maximize the aggregate throughput. In this solution concept, the decisions that a peer might make, does not affect the actions of the other peers at all. The proposed mechanism tunes the price of the service in such a way that general equilibrium holds.

Patient participation in decision making on biomedical research: changing the network

NARCIS (Netherlands)

Caron - Flinterman, J.F.; Broerse, J.E.W.; Bunders - Aelen, J.G.F.

2007-01-01

Participation of end users in decision-making on science is increasingly practiced, as witnessed by the growing body of scientific literature on case evaluations. In the biomedical field, however, end-user participation in decision-making is rare. Some scholars argue that because patients are

Challenges in Special Steel Making

Science.gov (United States)

Balachandran, G.

2018-02-01

Special bar quality [SBQ] is a long steel product where an assured quality is delivered by the steel mill to its customer. The bars have enhanced tolerance to higher stress application and it is demanded for specialised component making. The SBQ bars are sought for component making processing units such as closed die hot forging, hot extrusion, cold forging, machining, heat treatment, welding operations. The final component quality of the secondary processing units depends on the quality maintained at the steel maker end along with quality maintained at the fabricator end. Thus, quality control is ensured at every unit process stages. The various market segments catered to by SBQ steel segment is ever growing and is reviewed. Steel mills need adequate infrastructure and technological capability to make these higher quality steels. Some of the critical stages of processing SBQ and the critical quality maintenance parameters at the steel mill in the manufacture has been brought out.

Nuclear power's effects on electric rate making

International Nuclear Information System (INIS)

Smith, D.S.; Lancaster, A.A.

1978-01-01

Government and the electric utility industry are re-evaluating nuclear power's contribution to the total U.S. energy supplies. This article addresses how the recently increased nuclear plant construction and operation costs are translated into the prices that consumers pay for electricity. The electric rates that consumers pay must reflect the costs of producing electricity, as well as the costs of transmission, distribution, metering, and billing. The use of nuclear power for electric production is anticipated to grow rapidly so as to meet a larger portion of our country's electricity needs through the end of the century; so nuclear power costs are expected to be an even larger portion of the total electricity price. There are certain rate-making issues that are actively being discussed in public forums and before state and Federal regulatory bodies. These issues are not unique to nuclear power, but take on added significance when nuclear power is used by utilities to produce electricity because of the technology required and because of the type, timing, and magnitude of the costs involved. These are: (1) inclusion of construction work in progress in the rate base; (2) fuel adjustment clauses and treatment of nuclear fuel cycle costs; (3) treatment of certain taxes under the rate-making method called normalization or deferral accounting (sometimes referred to as ''phantom taxes''); and (4) rate treatment for particular nuclear expense items reflecting costs of delays, plant cancellations, and operational slowdowns

Next Steps on the Road to Zero Energy Buildings: Report on October 23-24, 2000 Meeting Held at the National Renewable Energy Laboratory, Golden, Colorado

Energy Technology Data Exchange (ETDEWEB)

Comer, Jerry [National Renewable Energy Lab. (NREL), Golden, CO (United States)

2000-11-01

This report summarizes a 2-day meeting held October 23-24, 2000 at the National Renewable Energy Laboratory in Golden, Colorado. Approximately 60 individuals attended the meeting from the following segments: building industry; solar thermal manufacturers (solar hot water, SHW); photovoltaic manufacturers (PV); generalists (consultants and interested parties involved in renewable energy); National Renewable Energy Laboratory (NREL) and Sandia National Laboratory (SNL); and US Department of Energy. The objectives of the meeting included: acquaint attendees with the Zero Energy Buildings (ZEB) goal; determine the most cost effective methods of incorporating solar technologies in production-built homes; identify 'make or break' areas to focus on; outline 6 month, 1 year, 5 year strategies and tactics; and create action plan with designated responsibilities. The format of the meeting was designed to maximize interaction between all attendees and to create a 'working' environment where a roadmap and action plans to support ZEB efforts would be created. Presentations the morning of the first day set the context for the discussions and breakout sessions that followed. The agenda was modified at the end of the first day of meetings to reflect the input of attendees. The revised agenda is included in the Appendix.

Trends in End-of-Life Decision Making in Patients With and Without Cancer

NARCIS (Netherlands)

Pardon, K.; Chambaere, K.; Pasman, H.R.W.; Deschepper, R.; Rietjens, J.; Deliens, L.

2013-01-01

Purpose: Because of cancer's high symptom burden and specific disease course, patients with cancer are more likely than other patients to face end-of-life decisions that have possible or certain life-shortening effects (ELDs). This study examines the incidence of ELDs in patients with cancer

ENS RRFM 2005: 9th international topical meeting on research reactor fuel management. Transactions

International Nuclear Information System (INIS)

2005-01-01

The ENS topical meeting on research reactor fuel management is an annual conference launched successfully in 1997. It has since then grown into well established international forum for the exchange and expertise on all significant aspects of the nuclear fuel cycle of research reactors. Oral presentations at this meeting were divided in the following four sessions: International Topics; Fuel Development, Qualification, Fabrication and Licensing; Reactor Operation, Fuel Safety and Core Conversion; Spent Fuel Management, Back-end Options, Transportation. The three poster sessions were devoted to fuel development, qualification, fabrication and licensing; reactor operation, fuel safety, core conversion, spent fuel; spent fuel management, fuel cycle back-end options, transportation

In vivo blunt-end cloning through CRISPR/Cas9-facilitated non-homologous end-joining

Science.gov (United States)

Geisinger, Jonathan M.; Turan, Sören; Hernandez, Sophia; Spector, Laura P.; Calos, Michele P.

2016-01-01

The CRISPR/Cas9 system facilitates precise DNA modifications by generating RNA-guided blunt-ended double-strand breaks. We demonstrate that guide RNA pairs generate deletions that are repaired with a high level of precision by non-homologous end-joining in mammalian cells. We present a method called knock-in blunt ligation for exploiting these breaks to insert exogenous PCR-generated sequences in a homology-independent manner without loss of additional nucleotides. This method is useful for making precise additions to the genome such as insertions of marker gene cassettes or functional elements, without the need for homology arms. We successfully utilized this method in human and mouse cells to insert fluorescent protein cassettes into various loci, with efficiencies up to 36% in HEK293 cells without selection. We also created versions of Cas9 fused to the FKBP12-L106P destabilization domain in an effort to improve Cas9 performance. Our in vivo blunt-end cloning method and destabilization-domain-fused Cas9 variant increase the repertoire of precision genome engineering approaches. PMID:26762978

6th CTF3 Collaboration Meeting

CERN Document Server

2000-01-01

The sixth CTF3 collaboration meeting was held at CERN from the 1st to the 2nd November 2000. This meeting was devoted to the CTF3 combiner ring, delay loop and transfer lines, with the participation of members of the CLIC study group at CERN and of collaborators from INFN-Frascati. The CTF3 status has been summarized by the project leader, and several members of the INFN-Frascati group have presented an overview of the design activity of the different components. Working group sessions have been held on beam optics, on diagnostics and equipment and on RF deflectors. The main conclusions from the working groups have been reported at the end of the meeting. Issues that have been addressed include prototype design and construction (RF deflectors, path-length tuning wigglers, extraction kicker and vacuum chamber sections) and deadlines for component specifications. The impedance budget for the ring, delay loop and transfer lines, its impact on the choice of beam-position monitors and the problem of beam stability...

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

Science.gov (United States)

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.

THE MAKING OF DECISION MAKING

Directory of Open Access Journals (Sweden)

Leonardo Yuji Tamura

2016-04-01

Full Text Available Quantum Electronics was a Brazilian startup in the 1990's that was acquired by an American equity fund in 2012. They are currently the largest manufacturer of vehicle tracking and infotainment systems. The company was founded by three college friends, who are currently executives at the company: Camilo Santos, Pedro Barbosa and Luana Correa. Edward Hutter was sent by the equity fund to take over the company’s finances, but is having trouble making organizational decisions with his colleagues. As a consultant, I was called to help them improve their decision making process and project prioritization. I adapted and deployed our firm's methodology, but, in the end, its adequacy is shown to be very much in question. The author of this case study intends to explore how actual organizational decisions rely on different decision models and their assumptions, .as well as demonstrate that a decision model is neither absolutely good nor bad as its quality is context dependent.

The Impact of Faith Beliefs on Perceptions of End-of-Life Care and Decision Making among African American Church Members.

Science.gov (United States)

Johnson, Jerry; Hayden, Tara; True, Jennifer; Simkin, Daren; Colbert, Louis; Thompson, Beverly; Stewart, Denise; Martin, Latoya

2016-02-01

African Americans underuse palliative care and hospice services because of a combination of factors including faith beliefs. As the spiritual family for many African Americans, the church presents an opportunity to improve communication about palliative care and hospice and end-of-life (EOL) decision making. We conducted a focus group study to understand the cultural and spiritual perspectives that influence decisions about palliative care and hospice among African American church members who visit and support persons with life-limiting illnesses. Our specific aims were to elicit their perceptions, beliefs, and attitudes about: (1) the relation between faith beliefs and EOL care; (2) emotional and family influences on EOL decision making; (3) palliative care and hospice resources; and (4) opportunities to improve communication among lay persons and health professionals and within families. Seven focus groups using purposeful sampling. We partnered with two African American churches. Of 51 persons, 27 were deacons or deaconesses, 17 were members of health or bereavement ministries, and 7 were other members of the congregations. We found that faith beliefs of African Americans can support discussions about palliative care and hospice. Participants perceived that many of their congregants harbor beliefs, perceptions, and feelings about death and dying that were often not communicated to family members or to health providers. Among African Americans, faith beliefs, emotional issues, family dynamics, and insufficient knowledge of palliative care and hospice are intertwined and influence decision making about palliative care and hospice. Our findings confirm the influence of faith beliefs of African Americans on decisions about palliative care and hospice and demonstrate the opportunity to improve communication about palliative care and hospice and EOL through collaborations with the African American church.

Meetings on Particle Physics - Abstracts and Slides

International Nuclear Information System (INIS)

Hirsch, M.; Machado, P.; Bertuzzo, E.; Villanova del Moral, A.; Wingerter, A.; Lellouch, L.; Garron, N.; Portelli, A.; Vulvert, G.; Zerwas, D.; Djouadi, A.; Drieu la Rochelle, G.; Fairbairn, M.; Le Boulc'h, Q.; Dumont, B.; Da Silva, J.; Brax, P.; Weiland, C.; Gelis, F.; Mehtar-Tani, Y.; Epelbaum, T.; Meunier, E.; Dudas, E.; Jezo, T.; Urbano, A.; Smith, C.; Machet, B.; Nezri, E.; Salam, G.; Kosnik, N.; Greynat, D.; Petrov, K.

2014-01-01

RPP (Meetings on Particle Physics) annual meetings are aimed at gathering the theoretical particle physicists' community, providing the participants with the opportunity not only to present their research topics, but also to make contact with the latest developments in adjacent fields. RPP-2012 will have a few review talks on topics such as flavors, Higgs bosons, astro-particle physics and cosmology, heavy ions, physics beyond the standard model, and quantum chromodynamics. This document gathers the slides of the presentations, a few presentations are accompanied by an abstract.

78 FR 3479 - Notice of Public Meeting of Fort Scott Council

Science.gov (United States)

2013-01-16

... submitted on cards that will be provided at the meeting, via mail to Laurie Fox, Presidio Trust, 103... stated prominently at the beginning of the comments. The Trust will make available for public inspection... PRESIDIO TRUST Notice of Public Meeting of Fort Scott Council AGENCY: The Presidio Trust. ACTION...

76 FR 9615 - National Council on Federal Labor-Management Relations Meetings

Science.gov (United States)

2011-02-18

... makes recommendations to the President on innovative ways to improve delivery of services and products... Management and Budget. At its meetings, the Council will continue its work in promoting cooperative and... established to promote telework. The meetings are open to the public. Please contact the Office of Personnel...

76 FR 10888 - Science Advisory Board (SAB); Notice of Open Meeting

Science.gov (United States)

2011-02-28

... general, each individual or group making a verbal presentation will be limited to a total time of five (5... meeting. SUMMARY: The Science Advisory Board (SAB) was established by a Decision Memorandum dated... quality and provide optimal support to resource management. TIME AND DATE: The meeting will be held...

End-Users, Front Ends and Librarians.

Science.gov (United States)

Bourne, Donna E.

1989-01-01

The increase in end-user searching, the advantages and limitations of front ends, and the role of the librarian in end-user searching are discussed. It is argued that librarians need to recognize that front ends can be of benefit to themselves and patrons, and to assume the role of advisors and educators for end-users. (37 references) (CLB)

Static end-expiratory and dynamic forced expiratory tracheal collapse in COPD

International Nuclear Information System (INIS)

O'Donnell, C.R.; Bankier, A.A.; O'Donnell, D.H.; Loring, S.H.; Boiselle, P.M.

2014-01-01

Aim: To determine the range of tracheal collapse at end-expiration among chronic obstructive pulmonary disease (COPD) patients and to compare the extent of tracheal collapse between static end-expiratory and dynamic forced-expiratory multidetector-row computed tomography (MDCT). Materials and methods: After institutional review board approval and obtaining informed consent, 67 patients meeting the National Heart, Lung, and Blood Institute (NHLBI)/World Health Organization (WHO) Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria for COPD were sequentially imaged using a 64-detector-row CT machine at end-inspiration, during forced expiration, and at end-expiration. Standardized respiratory coaching and spirometric monitoring were employed. Mean percentage tracheal collapse at end-expiration and forced expiration were compared using correlation analysis, and the power of end-expiratory cross-sectional area to predict excessive forced-expiratory tracheal collapse was computed following construction of receiver operating characteristic (ROC) curves. Results: Mean percentage expiratory collapse among COPD patients was 17 ± 18% at end-expiration compared to 62 ± 16% during forced expiration. Over the observed range of end-expiratory tracheal collapse (approximately 10–50%), the positive predictive value of end-expiratory collapse to predict excessive (≥80%) forced expiratory tracheal collapse was <0.3. Conclusion: COPD patients demonstrate a wide range of end-expiratory tracheal collapse. The magnitude of static end-expiratory tracheal collapse does not predict excessive dynamic expiratory tracheal collapse

Health Care Professionals' Understandings of Cross-Cultural Interaction in End-of-Life Care: A Focus Group Study.

Science.gov (United States)

Milberg, Anna; Torres, Sandra; Ågård, Pernilla

2016-01-01

The academic debate on cross-cultural interaction within the context of end-of-life care takes for granted that this interaction is challenging. However, few empirical studies have actually focused on what health care professionals think about this interaction. This study aimed to explore health care professionals' understandings of cross-cultural interaction during end-of-life care. Sixty end-of-life care professionals were recruited from eleven care units in Sweden to take part in focus group interviews. These interviews were analyzed using qualitative content analysis. The health care professionals interviewed talked about cross-cultural interaction in end-of-life care as interaction that brings about uncertainty, stress and frustration even though they had limited experience of this type of interaction. The focus group discussions brought attention to four specific challenges that they expected to meet when they care for patients with migrant backgrounds since they took for granted that they would have an ethno-cultural background that is different to their own. These challenges had to do with communication barriers, 'unusual' emotional and pain expressions, the expectation that these patients' families would be 'different' and the anticipation that these patients and their families lack knowledge. At the core of the challenges in question is the idea that cross-cultural interaction means meeting "the unknown". In addition, the end-of-life care professionals interviewed talked about patients whose backgrounds they did not share in homogenizing terms. It is against this backdrop that they worried about their ability to provide end-of-life care that is individualized enough to meet the needs of these patients. The study suggests that end-of-life care professionals who regard cross-cultural interaction in this manner could face actual challenges when caring for patients whose backgrounds they regard as "the unknown" since they anticipate a variety of challenges

Health Care Professionals’ Understandings of Cross-Cultural Interaction in End-of-Life Care: A Focus Group Study

Science.gov (United States)

Torres, Sandra; Ågård, Pernilla

2016-01-01

Objective The academic debate on cross-cultural interaction within the context of end-of-life care takes for granted that this interaction is challenging. However, few empirical studies have actually focused on what health care professionals think about this interaction. This study aimed to explore health care professionals’ understandings of cross-cultural interaction during end-of-life care. Methods Sixty end-of-life care professionals were recruited from eleven care units in Sweden to take part in focus group interviews. These interviews were analyzed using qualitative content analysis. Results The health care professionals interviewed talked about cross-cultural interaction in end-of-life care as interaction that brings about uncertainty, stress and frustration even though they had limited experience of this type of interaction. The focus group discussions brought attention to four specific challenges that they expected to meet when they care for patients with migrant backgrounds since they took for granted that they would have an ethno-cultural background that is different to their own. These challenges had to do with communication barriers, ‘unusual’ emotional and pain expressions, the expectation that these patients’ families would be ‘different’ and the anticipation that these patients and their families lack knowledge. At the core of the challenges in question is the idea that cross-cultural interaction means meeting “the unknown”. In addition, the end-of-life care professionals interviewed talked about patients whose backgrounds they did not share in homogenizing terms. It is against this backdrop that they worried about their ability to provide end-of-life care that is individualized enough to meet the needs of these patients. Conclusions The study suggests that end-of-life care professionals who regard cross-cultural interaction in this manner could face actual challenges when caring for patients whose backgrounds they regard as �

Health Care Professionals' Understandings of Cross-Cultural Interaction in End-of-Life Care: A Focus Group Study.

Directory of Open Access Journals (Sweden)

Anna Milberg

Full Text Available The academic debate on cross-cultural interaction within the context of end-of-life care takes for granted that this interaction is challenging. However, few empirical studies have actually focused on what health care professionals think about this interaction. This study aimed to explore health care professionals' understandings of cross-cultural interaction during end-of-life care.Sixty end-of-life care professionals were recruited from eleven care units in Sweden to take part in focus group interviews. These interviews were analyzed using qualitative content analysis.The health care professionals interviewed talked about cross-cultural interaction in end-of-life care as interaction that brings about uncertainty, stress and frustration even though they had limited experience of this type of interaction. The focus group discussions brought attention to four specific challenges that they expected to meet when they care for patients with migrant backgrounds since they took for granted that they would have an ethno-cultural background that is different to their own. These challenges had to do with communication barriers, 'unusual' emotional and pain expressions, the expectation that these patients' families would be 'different' and the anticipation that these patients and their families lack knowledge. At the core of the challenges in question is the idea that cross-cultural interaction means meeting "the unknown". In addition, the end-of-life care professionals interviewed talked about patients whose backgrounds they did not share in homogenizing terms. It is against this backdrop that they worried about their ability to provide end-of-life care that is individualized enough to meet the needs of these patients.The study suggests that end-of-life care professionals who regard cross-cultural interaction in this manner could face actual challenges when caring for patients whose backgrounds they regard as "the unknown" since they anticipate a variety

77 FR 6127 - Submission of Extended Digital Electrocardiogram Waveform Data; Notice of Public Meeting

Science.gov (United States)

2012-02-07

...] Submission of Extended Digital Electrocardiogram Waveform Data; Notice of Public Meeting AGENCY: Food and... Drug Administration (FDA) is announcing a public meeting to consider changes in how digital... encouraged. There is no fee to attend the meeting, and attendees who do not wish to make an oral presentation...

78 FR 23960 - Annual Public Meeting

Science.gov (United States)

2013-04-23

... annual open public meeting. The Foundation will provide an overview of its history, project updates, as... p.m. Time allotted for each registrant will be 3 minutes. The contact person will notify interested... individuals interested in making formal comments should notify the contact person and submit a brief statement...

Composite material and method of making

Science.gov (United States)

Fryxell, Glen E.; Samuels, William D.; Simmons, Kevin L.

2004-04-20

The composite material and methods of making the present invention rely upon a fully dense monolayer of molecules attached to an oxygenated surface at one end, and an organic terminal group at the other end, which is in turn bonded to a polymer. Thus, the composite material is a second material chemically bonded to a polymer with fully dense monolayer there between.

End-of-life decisions for people with intellectual disabilities, an interview study with patient representatives.

Science.gov (United States)

Wagemans, Annemieke M A; Van Schrojenstein Lantman-de Valk, Henny M J; Proot, Ireen M; Metsemakers, Job; Tuffrey-Wijne, Irene; Curfs, Leopold M G

2013-09-01

Not much is known about the process of end-of-life decision-making for people with intellectual disabilities. To clarify the process of end-of-life decision-making for people with intellectual disabilities from the perspective of patient representatives. A qualitative study based on semi-structured interviews, recorded digitally and transcribed verbatim. Data were analysed using Grounded Theory procedures. We interviewed 16 patient representatives after the deaths of 10 people with intellectual disabilities in the Netherlands. The core category 'Deciding for someone else' describes the context in which patient representatives took end-of-life decisions. The patient representatives felt highly responsible for the outcomes. They had not involved the patients in the end-of-life decision-making process, nor any professionals other than the doctor. The categories of 'Motives' and 'Support' were connected to the core category of 'Deciding for someone else'. 'Motives' refers to the patient representatives' ideas about quality of life, prevention from suffering, patients who cannot understand the burden of interventions and emotional reasons reported by patient representatives. 'Support' refers to the support that patient representatives wanted the doctors to give to them in the decision-making process. From the perspective of the patient representatives, the process of end-of-life decision-making can be improved by ensuring clear roles and an explicit description of the tasks and responsibilities of all participants. Regular discussion between everyone involved including people with intellectual disabilities themselves can improve knowledge about each other's motives for end-of-decisions and can clarify expectations towards each other.

MEETING REPORT: OMG Technical Committee Meeting in Orlando, FL, sees significant enhancement to CORBA

Science.gov (United States)

1998-06-01

The Object Management Group (OMG) Platform Technology Committee (PTC) ratified its support for a new asynchronous messaging service for CORBA at OMG's recent Technical Committee Meeting in Orlando, FL. The meeting, held from 8 - 12 June, saw the PTC send the Messaging Service out for a final vote among the OMG membership. The Messaging Service, which will integrate Message Oriented Middleware (MOM) with CORBA, will give CORBA a true asynchronous messaging capability - something of great interest to users and developers. Formal adoption of the specification will most likely occur by the end of the year. The Messaging Service The Messaging Service, when adopted, will be the world's first standard for Message Oriented Middleware and will give CORBA a true asynchronous messaging capability. Asynchronous messaging allows developers to build simpler, richer client environments. With asynchronous messaging there is less need for multi-threaded clients because the Asynchronous Method Invocation is non-blocking, meaning the client thread can continue work while the application waits for a reply. David Curtis, Director of Platform Technology for OMG, said: `This messaging service is one of the more valuable additions to CORBA. It enhances CORBA's existing asynchronous messaging capabilities which is a feature of many popular message oriented middleware products. This service will allow better integration between ORBs and MOM products. This enhanced messaging capability will only make CORBA more valuable for builders of distributed object systems.' The Messaging Service is one of sixteen technologies currently being worked on by the PTC. Additionally, seventeen Revision Task Forces (RTFs) are working on keeping OMG specifications up to date. The purpose of these Revision Task Forces is to take input from the implementors of OMG specifications and clarify or make necessary changes based on the implementor's input. The RTFs also ensure that the specifications remain up to date

How senior entomologists can be involved in the annual meeting: organization and the coming together of a large event

Science.gov (United States)

The Annual Meeting for the Entomological Society of America is a large event where planning is started at the end of the previous years’ meeting. The President of the Society named the Program Committee Co-Chairs for Entomology 2017 at the 2015 Annual Meeting, so that they could handle the duties o...

Making working in retailing interesting

DEFF Research Database (Denmark)

Esbjerg, Lars; Buck, Nuka; Grunert, Klaus G.

2010-01-01

This paper is about how five retail chains in the Danish grocery industry attempt to make low-wage, low-status store-level retail jobs as checkout operators and sales assistants interesting from the perspective of both retailers and employees. Following analysis of the social and institutional...... and make store-level retail jobs interesting to them. Although retailers mainly focus their attention on career seekers, we find that working in retailing is interesting for all employee types because the retailers are currently able to meet their respective motivations and aspirations. Nevertheless, we...

78 FR 64961 - Center for Scientific Review; Amended Notice of Meeting

Science.gov (United States)

2013-10-30

... Charles Street, Baltimore, MD 21201 which was published in the Federal Register on September 9, 2013, 78 FR 174 pgs. 55086-55087. The meeting will start on November 20, 2013 at 8:00 a.m. and will end on...

Decision-making in end of life care. Are we really playing together in the same team?

Science.gov (United States)

Lomero-Martínez, M M; Jiménez-Herrera, M F; Bodí-Saera, M A; Llauradó-Serra, M; Masnou-Burrallo, N; Oliver-Juan, E; Sandiumenge-Camps, A

2018-05-18

Limitation of life-sustaining treatment is increasingly common in critical care units, and controlled donation after circulatory death is starting to be included as an option within patient care plans. Lack of knowledge and misunderstandings can place a barrier between healthcare professionals. To determine the perceptions, knowledge and attitudes of physicians and nurses working in intensive care units regarding Limitation of life-sustaining treatment and controlled donation after circulatory death. Cross-sectional study carried out in 13 Spanish hospitals by means of an ad hoc questionnaire. Contingency tables, Pearson's chi-squared test, Student's t-test and the Mann-Whitney u-test were used to carry out descriptive, bivariate and multivariate statistical analyses of responses. Although Limitation of life-sustaining treatment is a widespread practice, the survey revealed that nurses feel excluded from the development of protocols and the decision-making process, whilst the perception of physicians is that they have greater knowledge of the topic, and decisions are reached in consensus. Multi-disciplinary training programmes can help critical healthcare providers to work together with greater coordination, thus benefitting patients and their next of kin by providing excellent end-of-life care. Copyright © 2018 Sociedad Española de Enfermería Intensiva y Unidades Coronarias (SEEIUC). Publicado por Elsevier España, S.L.U. All rights reserved.

Digital health for the End TB Strategy: developing priority products and making them work.

Science.gov (United States)

Falzon, Dennis; Timimi, Hazim; Kurosinski, Pascal; Migliori, Giovanni Battista; Van Gemert, Wayne; Denkinger, Claudia; Isaacs, Chris; Story, Alistair; Garfein, Richard S; do Valle Bastos, Luis Gustavo; Yassin, Mohammed A; Rusovich, Valiantsin; Skrahina, Alena; Van Hoi, Le; Broger, Tobias; Abubakar, Ibrahim; Hayward, Andrew; Thomas, Bruce V; Temesgen, Zelalem; Quraishi, Subhi; von Delft, Dalene; Jaramillo, Ernesto; Weyer, Karin; Raviglione, Mario C

2016-07-01

In 2014, the World Health Organization (WHO) developed the End TB Strategy in response to a World Health Assembly Resolution requesting Member States to end the worldwide epidemic of tuberculosis (TB) by 2035. For the strategy's objectives to be realised, the next 20 years will need novel solutions to address the challenges posed by TB to health professionals, and to affected people and communities. Information and communication technology presents opportunities for innovative approaches to support TB efforts in patient care, surveillance, programme management and electronic learning. The effective application of digital health products at a large scale and their continued development need the engagement of TB patients and their caregivers, innovators, funders, policy-makers, advocacy groups, and affected communities.In April 2015, WHO established its Global Task Force on Digital Health for TB to advocate and support the development of digital health innovations in global efforts to improve TB care and prevention. We outline the group's approach to stewarding this process in alignment with the three pillars of the End TB Strategy. The supplementary material of this article includes target product profiles, as developed by early 2016, defining nine priority digital health concepts and products that are strategically positioned to enhance TB action at the country level. The content of this work is ©the authors or their employers. Design and branding are ©ERS 2016.

Back end of the fuel cycle

International Nuclear Information System (INIS)

Wolfe, B.; Lambert, R.W.

1975-01-01

At present, that portion of the nuclear fuel cycle involving reprocessing, waste management, and mixed-oxide fuel fabrication is in an unsettled state. Government regulatory requirements with respect to all aspects of the back end of the fuel cycle are still being formulated, and there is little positive experience on the operation of commercial reprocessing or mixed-oxide fabrication plants. In view of this unsettled situation, it will be difficult to meet the reprocessing and mixed-oxide fabrication needs of the next decade in the pattern previously anticipated. The costs in the back end of the fuel cycle are much higher than had been anticipated several years ago, a situation similar to that of almost all large endeavors in this country. On the other hand, the added costs are small relative to total power costs and do not affect the economic advantage of nuclear power as compared to other power sources. A rough economic analysis indicates that the question for the back end of the fuel cycle has changed from one of optimizing profitability to one of determining the most economic disposition of spent fuel. Long-term spent fuel storage is a practical and economically acceptable way to provide time for determining a sound course of action for the back end of the fuel cycle. Indeed, if one could count on a breeder economy before the end of the century, one possible course of action is to store light-water fuel until the plutonium can be used in breeders. However, for philosophical as well as practical reasons, it is important that the uncertainties in the course of action should be resolved as quickly as possible. Long-term storage should not be an excuse to delay resolution of the basic questions. (U.S.)

A Methodology for Making Early Comparative Architecture Performance Evaluations

Science.gov (United States)

Doyle, Gerald S.

2010-01-01

Complex and expensive systems' development suffers from a lack of method for making good system-architecture-selection decisions early in the development process. Failure to make a good system-architecture-selection decision increases the risk that a development effort will not meet cost, performance and schedule goals. This research provides a…

78 FR 66372 - Center for Scientific Review; Amended Notice of Meeting

Science.gov (United States)

2013-11-05

... September 05, 2013, 78 FR 54664-54665. The meeting will be held at the Hotel Monaco Baltimore, 2 North Charles Street, Baltimore, MD 21201 on November 22, 2013, starting at 08:00 a.m. and ending at 07:00 p.m...

End to End Travel

Data.gov (United States)

US Agency for International Development — E2 Solutions is a web based end-to-end travel management tool that includes paperless travel authorization and voucher document submissions, document approval...

Decision-Making for Supply Chain Integration Supply Chain Integration

CERN Document Server

Lettice, Fiona; Durowoju, Olatunde

2012-01-01

Effective supply chain integration, and the tight co-ordination it creates, is an essential pre-requisite for successful supply chain management.  Decision-Making for Supply Chain Integration is a practical reference on recent research in the area of supply chain integration focusing on distributed decision-making problems. Recent applications of various decision-making tools for integrating supply chains are covered including chapters focusing on: •Supplier selection, pricing strategy and inventory decisions in multi-level supply chains, •RFID-enabled distributed decision-making, •Operational risk issues and time-critical decision-making for sensitive logistics nodes, Modelling end to end processes to improve supply chain integration, and •Integrated systems to improve service delivery and optimize resource use. Decision-Making for Supply Chain Integration provides an insight into the tools and methodologies of this field with support from real-life case studies demonstrating successful application ...

Quality of antiretroviral therapy in public health facilities in Nigeria and perceptions of end users.

Science.gov (United States)

Chiegil, Robert J; Zungu, Lindiwe I; Jooste, Karien

2014-04-01

This paper describes perceptions of the end users on quality of antiretroviral therapy (ART) in public health facilities in Nigeria. Health care services in Nigeria face challenges of meeting end users' requirements and expectations for quality ART service provision. A qualitative design was followed. Unstructured focus group discussions were conducted with end users (n = 64) in six locations across the six geopolitical zones of Nigeria. The findings indicate that end users were satisfied with uninterrupted antiretroviral drug supplies, courtesy treatment, volunteerism of support group members and quality counselling services. End users expect effective collaboration between healthcare providers and support group members, to enhance the quality of life of people living with HIV. A best practice guideline for the provision of end user focused ART service provision was developed for nurse managers. © 2013 John Wiley & Sons Ltd.

Transforming communicative spaces: the rhythm of gender in meetings in rural Solomon Islands

Directory of Open Access Journals (Sweden)

Michelle Dyer

2018-03-01

Full Text Available Women's lack of participation in important decision making is noted as an obstacle to sustainable development in many parts of the world. An initial issue for gender equity in environmental decision making in many developing country contexts is not only women's inclusion but also their substantive participation in decision-making forums. In this article I examine the power structures embedded in the public communicative spaces in a village in the Western Province of Solomon Islands using empirical data in conjunction with ethnographic understanding of gendered meeting styles. The data reveal some reasons why women may be silenced as public political actors. It also raises the potential for development actors to create conceptual space for specific women's ways of meeting and validating women's meeting styles. These findings have implications for encouraging transformative communicative spaces and formats that allow transcendence of socially embedded power structures.

Making Connections: Where STEM Learning and Earth Science Data Services Meet

Science.gov (United States)

Bugbee, Kaylin; Ramachandran, Rahul; Maskey, Manil; Gatlin, Patrick; Weigel, Amanda

2016-01-01

STEM (Science, Technology, Engineering, Mathematics) learning is most effective when students are encouraged to see the connections between science, technology and real world problems. Helping to make these connections has become an increasingly important aspect of Earth Science data research. The Global Hydrology Resource Center (GHRC), one of NASA's 12 EOSDIS (Earth Observing System Data Information System) data centers, has developed a new type of documentation called the micro article to facilitate making connections between data and Earth science research problems.

Weighted-DESYNC and Its Application to End-to-End Throughput Fairness in Wireless Multihop Network

Directory of Open Access Journals (Sweden)

Ui-Seong Yu

2017-01-01

Full Text Available The end-to-end throughput of a routing path in wireless multihop network is restricted by a bottleneck node that has the smallest bandwidth among the nodes on the routing path. In this study, we propose a method for resolving the bottleneck-node problem in multihop networks, which is based on multihop DESYNC (MH-DESYNC algorithm that is a bioinspired resource allocation method developed for use in multihop environments and enables fair resource allocation among nearby (up to two hops neighbors. Based on MH-DESYNC, we newly propose weighted-DESYNC (W-DESYNC as a tool artificially to control the amount of resource allocated to the specific user and thus to achieve throughput fairness over a routing path. Proposed W-DESYNC employs the weight factor of a link to determine the amount of bandwidth allocated to a node. By letting the weight factor be the link quality of a routing path and making it the same across a routing path via Cucker-Smale flocking model, we can obtain throughput fairness over a routing path. The simulation results show that the proposed algorithm achieves throughput fairness over a routing path and can increase total end-to-end throughput in wireless multihop networks.

End-User Applications of Real-Time Earthquake Information in Europe

Science.gov (United States)

Cua, G. B.; Gasparini, P.; Giardini, D.; Zschau, J.; Filangieri, A. R.; Reakt Wp7 Team

2011-12-01

The primary objective of European FP7 project REAKT (Strategies and Tools for Real-Time Earthquake Risk Reduction) is to improve the efficiency of real-time earthquake risk mitigation methods and their capability of protecting structures, infrastructures, and populations. REAKT aims to address the issues of real-time earthquake hazard and response from end-to-end, with efforts directed along the full spectrum of methodology development in earthquake forecasting, earthquake early warning, and real-time vulnerability systems, through optimal decision-making, and engagement and cooperation of scientists and end users for the establishment of best practices for use of real-time information. Twelve strategic test cases/end users throughout Europe have been selected. This diverse group of applications/end users includes civil protection authorities, railway systems, hospitals, schools, industrial complexes, nuclear plants, lifeline systems, national seismic networks, and critical structures. The scale of target applications covers a wide range, from two school complexes in Naples, to individual critical structures, such as the Rion Antirion bridge in Patras, and the Fatih Sultan Mehmet bridge in Istanbul, to large complexes, such as the SINES industrial complex in Portugal and the Thessaloniki port area, to distributed lifeline and transportation networks and nuclear plants. Some end-users are interested in in-depth feasibility studies for use of real-time information and development of rapid response plans, while others intend to install real-time instrumentation and develop customized automated control systems. From the onset, REAKT scientists and end-users will work together on concept development and initial implementation efforts using the data products and decision-making methodologies developed with the goal of improving end-user risk mitigation. The aim of this scientific/end-user partnership is to ensure that scientific efforts are applicable to operational

Decision Making and Communications Process Assessment of NASA Using Three Change Requests from the Space Launch System Program

Science.gov (United States)

Hicks, Karen Campbell

2015-01-01

This thesis investigated the communication and decision making process as part of the Systems Engineering practices at the NASA/Marshall Center to determine its level of effectiveness. Data was collected across three change requests to assess how decisions were made, how the decisions were communicated, and whether a process mattered in the formulation and dissemination of those decisions. Data results revealed the comprehensive decision making process for the technical change requests to be effective. Evidence revealed that the process was sufficiently tailored to accommodate the need of each individual technical change which promoted effective communication amongst the stakeholders in the formulation of the strategic decision recommendations elevated to upper management. However, data results also revealed the dissemination of the final decision and approval of the change requests from the higher organizational level down to all stakeholders was less effective. An establishment of a culmination meeting at the end of the change request decision process in which to close the communication loop with all entities would be beneficial.

Physicians' experiences with end-of-life decision-making: Survey in 6 European countries and Australia

Directory of Open Access Journals (Sweden)

Mortier Freddy

2008-02-01

Full Text Available Abstract Background In this study we investigated (a to what extent physicians have experience with performing a range of end-of-life decisions (ELDs, (b if they have no experience with performing an ELD, would they be willing to do so under certain conditions and (c which background characteristics are associated with having experience with/or being willing to make such ELDs. Methods An anonymous questionnaire was sent to 16,486 physicians from specialities in which death is common: Australia, Belgium, Denmark, Italy, the Netherlands, Sweden and Switzerland. Results The response rate differed between countries (39–68%. The experience of foregoing life-sustaining treatment ranged between 37% and 86%: intensifying the alleviation of pain or other symptoms while taking into account possible hastening of death between 57% and 95%, and experience with deep sedation until death between 12% and 46%. Receiving a request for hastening death differed between 34% and 71%, and intentionally hastening death on the explicit request of a patient between 1% and 56%. Conclusion There are differences between countries in experiences with ELDs, in willingness to perform ELDs and in receiving requests for euthanasia or physician-assisted suicide. Foregoing treatment and intensifying alleviation of pain and symptoms are practiced and accepted by most physicians in all countries. Physicians with training in palliative care are more inclined to perform ELDs, as are those who attend to higher numbers of terminal patients. Thus, this seems not to be only a matter of opportunity, but also a matter of attitude.

Remote handling and automation in back end of fuel cycle

International Nuclear Information System (INIS)

Nair, K.N.S.

2010-01-01

Full text: Indian nuclear programme is readying for a quantum leap and it is essential that technology is available for building advanced fuel recycle plants in the back end and for sustained operation of such plants. Remote technology and automation plays a big role to achieve this goal. With the introduction of advanced fuel cycles in indigenous programme and scenario of international cooperation it is essential to be ready with indigenous technology for meeting all challenges. Work has been progressing to develop locally support technology for remote handling and automation with good success. Essential RH tools such as master slave manipulators, power manipulators and hot cell viewing systems have been developed and commercial production has been established. Customised RH requirements for back end plants have been met and the designs have proven to be worthy for hot operations over the years. In the last few years stress has been on development of equipment and technology to meet the increasing demands of higher throughput plants. Substantial progress has been achieved in the head end and reconversion laboratory systems of reprocessing plants. Similarly successful efforts have also been made for establishing Thoria processing cells and also the RH in the reconversion operations. Custom designed equipment has been developed for decommissioning of ceramic melter, used glove boxes etc. Efforts are on hand to develop automated RH equipment for material handling in underground repositories. This paper aims at bringing out the theme based on some of our own experiences and some reports from plants in operation abroad. (author)

Executive committee report: geotechnical instrumentation working group meeting

International Nuclear Information System (INIS)

Wilder, D.G.; Rogue, F.; Beloff, W.R.; Binnall, E.; Gregory, E.C.

1982-01-01

Responding to the widespread need for the geotechnical community to discuss instrumentation for nuclear waste repositories, a meeting was held December 2 and 3, 1981, in Denver, Colorado. This report gives the group's consensus recommendations to aid in making decisions for development of instrumentation for future repository work. The main conclusions of the working group meeting were as follows: (1) monitoring of geotechnical parameters in nuclear waste repositories will be necessary to meet licensing requirements; (2) currently available instruments are underdeveloped for this monitoring; (3) research and development to provide adequate instrumentation will need to be performed under federal sponsorship by national laboratories, universities, contractors, and consultants; and (4) a NASA-type reliability program is needed to meet the quality assurance, durability, calibration, and time schedule demands of geotechnical instrumentation development. This will require significant financial commitments from the federal sector

Uncovering the end uses of the rare earth elements

Energy Technology Data Exchange (ETDEWEB)

Du, Xiaoyue, E-mail: xiaoyue.du@empa.ch [Swiss Federal Laboratories for Materials Science and Technology (EMPA), Lerchenfeldstrasse 5, 9014 St. Gallen (Switzerland); Yale University, 195 Prospect Street, New Haven CT 06511 (United States); Graedel, T.E. [Yale University, 195 Prospect Street, New Haven CT 06511 (United States)

2013-09-01

The rare earth elements (REE) are a group of fifteen elements with unique properties that make them indispensable for a wide variety of emerging and conventional established technologies. However, quantitative knowledge of REE remains sparse, despite the current heightened interest in future availability of the resources. Mining is heavily concentrated in China, whose monopoly position and potential restriction of exports render primary supply vulnerable to short term disruption. We have drawn upon the published literature and unpublished materials in different languages to derive the first quantitative annual domestic production by end use of individual rare earth elements from 1995 to 2007. The information is illustrated in Sankey diagrams for the years 1995 and 2007. Other years are available in the supporting information. Comparing 1995 and 2007, the production of the rare earth elements in China, Japan, and the US changed dramatically in quantities and structure. The information can provide a solid foundation for industries, academic institutions and governments to make decisions and develop strategies. - Highlights: • We have derived the first quantitative end use information of the rare earths (REE). • The results are for individual REE from 1995 to 2007. • The end uses of REE in China, Japan, and the US changed dramatically in quantities and structure. • This information can provide solid foundation for decision and strategy making.

End-to-side and end-to-end anastomoses give similar results in cervical oesophagogastrostomy.

Science.gov (United States)

Pierie, J P; De Graaf, P W; Poen, H; Van Der Tweel, I; Obertop, H

1995-12-01

To find out if there were any differences in healing between end-to-end and end-to-side anastomoses for oesophagogastrostomy. Open study with historical controls. University hospital, The Netherlands. 28 patients with end-to-end and 90 patients with end-to-side anastomoses after transhiatal oesophagectomy and partial gastrectomy for cancer of the oesophagus or oesophagogastric junction, with gastric tube reconstruction and cervical anastomosis. Leak and stricture rates, and the number of dilatations needed to relieve dysphagia. There were no significant differences in leak rates (end-to-end 4/28, 14%, and end-to-side 13/90, 14%) or anastomotic strictures (end-to-end 9/28, 32%, and end-to-side 26/90, 29%). The median number of dilatations needed to relieve dysphagia was 7 (1-33) after end-to-end and 9 (1-113) after end-to-side oesophagogastrostomy. There were no differences between the two methods of suture of cervical oesophagogastrostomy when leakage, stricture, and number of dilatations were used as criteria of good healing.

Family-centered end-of-life care in the ICU.

Science.gov (United States)

Wiegand, Debra L; Grant, Marian S; Cheon, Jooyoung; Gergis, Mary A

2013-08-01

Families of older adults are intricately involved in the end-of-life decision-making process for a family member with a serious illness in the intensive care unit (ICU) setting. However, families are not always as involved and as informed as they would like to be. Creating a culture that assesses family needs and supports families is an important component of family-centered care. There are several strategies that nurses and other members of the interdisciplinary team can use to promote family-centered end-of-life care in the ICU. Nurses can get to know the family by spending time talking with them, assessing them, seeking to understand their perspectives on their family member's condition, and discussing previously verbalized patient wishes for care. This article offers strategies nurses can use to help guide the family through the end-of-life decision-making process, support families as difficult and complex decisions are made in collaboration with the health care team, and prepare families for the dying process. Copyright 2013, SLACK Incorporated.

Shear strength of end slabs of prestressed concrete reactor vessels

International Nuclear Information System (INIS)

Cheung, K.C.; Gotschall, H.L.; Liu, T.C.

1975-01-01

Prestressed concrete reactor vessels (PCRV's) have been adopted for primary containments in most large high-temperature gas-cooled reactor installations. The most common configuration for PCRVs is a right-vertical cylinder with thick end slabs. In order to assess the integrity of a PCRV it is necessary to predict the ultimate strength of the end slabs. The complexity of the basic mechanism of shear failure in the PCRV end slabs has thus far prohibited the development of a completely analytical solution. However, many experimental investigations of PCRV end slabs have been conducted over the past decade. This information makes it possible to establish empirical formulae for the ultimate strength of PCRV end slabs. The basis and development of an empirical shear-flexure interaction expression is presented. (Auth.)

Sixth coordination meeting of the Division of Nuclear Physics Program to meet high-priority nuclear data needs of the Office of Fusion Energy

International Nuclear Information System (INIS)

1990-06-01

The Sixth Coordination Meeting of the Program to Meet Nuclear Data Needs for Fusion Energy was held in Athens, September 19--21, 1989. The principal change from the previous meeting at Argonne was the larger international participation. One scientist from Japan represented the only non-US participation at Argonne. The present meeting included about 20% non-US participants. This change is a welcome one since the data needs are international and the limited availability of manpower and facilities will likely make international cooperation increasingly important in the future. The organization of the meeting involved collecting and distributing to all participants progress reports from the Department of Energy laboratories in advance of the meeting. Twenty-five oral presentations were made at the meeting, including many from non-DOE labs. The meeting then divided into experimental and theoretical task force groups, which carried out assigned agenda items. The reports of these groups, abstracts of the talks presented at the meeting, and the progress reports are included in this report. The topics discussed will be very familiar to participants in past meetings, but continued progress in most areas was reported. One discussion topic which reflects continuing and perhaps worsening problems was the aging of facilities and personnel, coupled with a lack of programs to renew

Let's Get Parents Ready for Their Initial IEP Meeting

Science.gov (United States)

Hammond, Helen; Ingalls, Lawrence

2017-01-01

Parental participation in the initial Individual Education Program (IEP) meeting is a critical component of the process. Even though parents have rights to be equally involved in making decisions at the IEP meetings, frequently parents aren't prepared to be equal members on the team with school personnel. This study focused on a preparation…

Public meetings in the departments

CERN Multimedia

Staff Association

2012-01-01

During our recent information meetings, we discussed four topics: the new Saved Leave Scheme (LTSLS); the new developments concerning pensions; the MARS Advancement and Promotion scheme and its 2012 budget; the recently updated Administrative and Operation Circulars. These meetings were attended by a large number of staff members and were a great opportunity for the Staff Association to engage in direct dialogue with the staff in the various departments. The vast majority of questions or comments were on the LTSLS and on the possibility to save leave, which is to be taken at the end of a career.  A few comments were also made on MARS, a system many considered to be not very motivating and that takes up a lot of resources for minimal positive results. Thanks and encouragement After the presentation on Pensions, on behalf of the Staff Association we thanked Dorothée Duret, who for personal reasons had to resign from the Pension Fund Governing Board (PFGB) and from the Staff Council...

Design and evaluation of an end-user friendly tool for robot programming

NARCIS (Netherlands)

Buchina, N.; Barakova, E.I.; Kamel, S.M.W.

2016-01-01

End-user programming for robots is becoming an increasingly important topic since robots are being introduced into a wide variety of domains. We propose a design of a web based programming interface that makes it possible for end-users with different backgrounds to program robots using natural

3rd Singularity Theory Meeting of Northeast region & the Brazil-Mexico 2nd Meeting on Singularities

CERN Document Server

Neto, Aurélio; Mond, David; Saia, Marcelo; Snoussi, Jawad; BMMS 2/NBMS 3; ENSINO; Singularities and foliations geometry, topology and applications

2018-01-01

This proceedings book brings selected works from two conferences, the 2nd Brazil-Mexico Meeting on Singularity and the 3rd Northeastern Brazilian Meeting on Singularities, that were hold in Salvador, in July 2015. All contributions were carefully peer-reviewed and revised, and cover topics like Equisingularity, Topology and Geometry of Singularities, Topological Classification of Singularities of Mappings, and more. They were written by mathematicians from several countries, including Brazil, Spain, Mexico, Japan and the USA, on relevant topics on Theory of Singularity, such as studies on deformations, Milnor fibration, foliations, Catastrophe theory, and myriad applications. Open problems are also introduced, making this volume a must-read both for graduate students and active researchers in this field.

Abstracts and papers of the 1996 International RERTR Meeting

International Nuclear Information System (INIS)

1996-10-01

The 1996 International Meeting on Reduced Enrichment for Research and Test Reactors (RERTR) was sponsored by the Korea Atomic Energy Research Institute and the International Atomic Energy Agency and was held in Seoul, Korea, on 6-10 October 1996. The abstracts and available papers that were presented at this meeting are provided. The most important subject dealt with was progress of the Reduced Enrichment Research and Test Reactor (RERTR) Program. The major events, findings, and activities of 1996 are reviewed with the results which the RERTR Program has achieved by the end of 1995 in collaboration of the ANL and its many international partners

Abstracts and papers of the 1996 International RERTR Meeting

Energy Technology Data Exchange (ETDEWEB)

NONE

1996-10-01

The 1996 International Meeting on Reduced Enrichment for Research and Test Reactors (RERTR) was sponsored by the Korea Atomic Energy Research Institute and the International Atomic Energy Agency and was held in Seoul, Korea, on 6-10 October 1996. The abstracts and available papers that were presented at this meeting are provided. The most important subject dealt with was progress of the Reduced Enrichment Research and Test Reactor (RERTR) Program. The major events, findings, and activities of 1996 are reviewed with the results which the RERTR Program has achieved by the end of 1995 in collaboration of the ANL and its many international partners.

Meeting Ecologists Requirements with Adaptive Data Acquisition

DEFF Research Database (Denmark)

Chang, Marcus; Bonnet, Philippe

their potential if they meet the scientists requirements. In an ideal world, an ecologist expresses requirements in terms of a target dataset, which the sensor network then actually collects and stores. In fact, failures occur and interesting events happen making uniform, systematic ecosys- tem sampling neither...

CSNI specialist meeting on simulators and plant analyzers

International Nuclear Information System (INIS)

Miettinen, J.; Holmstroem, H.

1994-01-01

The Specialist Meeting on Simulators and Plant Analyzers, held in June 9-12, 1992, in Lappeenranta, Finland, was sponsored by the Committee on the Safety on Nuclear Installations (CSNI) of the OECD Nuclear Energy Agency (NEA). It was organized in collaboration with the Technical Research Centre of Finland (VTT) and the Lappeenranta Technical University of Technology (LTKK). All the presented papers were invited and devided into four sessions. In the first session the objectives, requirements and consepts of simulators were discussed against present standards and guidelines. The second session focused on the capabilities of current analytical models. The third session focused on the experiences gained so far from the applications. The final fourth session concentrated on simulators, which are currently under development, and future plans with regard to both development and utilization. At the end of the meeting topics of the meeting were discussed at the panel discussion. Summaries of the sessions and shortened version of the panel discussion are included into the proceeding. (orig.)

Dewey Meets the "Mozart of Psychology" in Moscow: The Untold Story.

Science.gov (United States)

Prawat, Richard S.

2000-01-01

Discusses the possibility that L. Vygotsky, described as the "Mozart of Psychology," met and exchanged views with John Dewey in 1928 and describes the meeting of the minds evidenced in Dewey's writings after 1925 and Vygotsky's writings toward the end of his life. (SLD)

Our October 2013 public meetings (first part)

CERN Multimedia

Staff Association

2013-01-01

Several hundred of you took part in our public meetings held from the 1st to the 8th of October 2013 and for that we thank you. The main presentation was preceded by a tribute to Philippe Defert, Vice-President of the Staff Association, who passed away in September. Philippe had been an active member of the Staff Association and a delegate to the Staff Council since 1992. At the end of those meetings thanks were given to Marcel Aymon, Member of the Staff Council for 25 years and member of the Executive Committee for almost as many years. Marcel has held, almost uninterruptedly, the position of Secretary within the Executive Committee except for the four years during which he held the position of Vice President. Thank you Marcel for your exemplary dedication! After each meeting around a cup of coffee or tea more personalized discussions between staff members and their delegates took place. Files with the presentations are available at the URL https://indico.cern.ch/conferenceDisplay.py?confId=275010. He...

Mobility, Context and Cloud – Exploring Integration Issues in a Meeting Room Scenario

Directory of Open Access Journals (Sweden)

Tor-Morten Grønli

2012-04-01

Full Text Available In this paper we pursue the context-aware paradigm in a distributed mobile environment. Context-awareness plays a significant role in the domain of implicit human computer interaction and we present an intelligent context-aware meeting room application. The distributed mobile application consists of multiple mobile operating system clients, a Google Android based presenter that, through proximity technology, communicates with a server in the meeting room, and a Google Cloud backend server. Over 40 users have evaluated the application. Results show that the context aware meeting room was well received by users who displayed a strong positive bias towards cloud integration and, in particular, automatic meeting-note push. We conclude that our context-aware meeting assistant can provide valuable assistance to end users and that there is promise for such use of heterogeneous mobile context-aware platforms.

Museum professionals meet at CERN

CERN Multimedia

2005-01-01

As part of the World Year of Physics, CERN organised a day of meetings attended by professionals from French and Swiss science museums. The poster for the Einstein exhibition that will open in Bern on 16 June 2005. Around thirty professionals from science museums, as well as representatives of France's Office de Coopération et d'Information Muséographiques (OCIM) and the Suisse Romande Réseau Science et Cité, congregated at CERN on 10th February with the purpose, among other things, of exchanging ideas and information on proposed exhibitions for the World Year of Physics. "We thought that it would be a good idea to start the World Year of Physics with a meeting at CERN that could provide inspiration for future exhibitions", explains Emma Sanders, Head of the Visits Service and Microcosm. Many scientific museums are trying to improve the way they cover contemporary science, and CERN is an ideal place to observe science in the making. Other goals of the meeting were to strengthen links between French and...

Wind blade spar cap and method of making

Science.gov (United States)

Mohamed, Mansour H [Raleigh, NC

2008-05-27

A wind blade spar cap for strengthening a wind blade including an integral, unitary three-dimensional woven material having a first end and a second end, corresponding to a root end of the blade and a tip end of the blade, wherein the material tapers in width from the first to the second end while maintaining a constant thickness and decreasing weight therebetween, the cap being capable of being affixed to the blade for providing increased strength with controlled variation in weight from the root end to the tip end based upon the tapered width of the material thereof. The present inventions also include the method of making the wind blade spar cap and a wind blade including the wind blade spar cap.

Standardizing an End-to-end Accounting Service

Science.gov (United States)

Greenberg, Edward; Kazz, Greg

2006-01-01

Currently there are no space system standards available for space agencies to accomplish end-to-end accounting. Such a standard does not exist for spacecraft operations nor for tracing the relationship between the mission planning activities, the command sequences designed to perform those activities, the commands formulated to initiate those activities and the mission data and specifically the mission data products created by those activities. In order for space agencies to cross-support one another for data accountability/data tracing and for inter agency spacecraft to interoperate with each other, an international CCSDS standard for end-to-end data accountability/tracing needs to be developed. We will first describe the end-to-end accounting service model and functionality that supports the service. This model will describe how science plans that are ultimately transformed into commands can be associated with the telemetry products generated as a result of their execution. Moreover, the interaction between end-to-end accounting and service management will be explored. Finally, we will show how the standard end-to-end accounting service can be applied to a real life flight project i.e., the Mars Reconnaissance Orbiter project.

Toward a psychology of surrogate decision-making

OpenAIRE

Tunney, Richard J.; Ziegler, Fenja

2016-01-01

Many of the decisions that we make in everyday life are made for the benefit of other people. However, research suggests that people often make decisions on behalf of other people that are different from those that the other person would choose for himself or herself. This raises practical problems in the case of legally designated surrogate decision-makers who may not meet the legal normative benchmark — the substituted judgment standard. We review evidence from our own ...

Nurses' autonomy in end-of-life situations in intensive care units.

Science.gov (United States)

Paganini, Maria Cristina; Bousso, Regina Szylit

2015-11-01

The intensive care unit environment focuses on interventions and support therapies that prolong life. The exercise by nurses of their autonomy impacts on perception of the role they assume in the multidisciplinary team and on their function in the intensive care unit context. There is much international research relating to nurses' involvement in end-of-life situations; however, there is a paucity of research in this area in Brazil. In the Brazilian medical scenario, life support limitation generated a certain reluctance of a legal nature, which has now become unjustifiable with the publication of a resolution by the Federal Medical Council. In Brazil, the lack of medical commitments to end-of-life care is evident. To understand the process by which nurses exercise autonomy in making end-of-life decisions in intensive care units. Symbolic Interactionism and Corbin and Strauss theory methodology were used for this study. Data were collected through single audio-recorded qualitative interviews with 14 critical care nurses. The comparative analysis of the data has permitted the understanding of the meaning of nurse's experience in exercising autonomy relating to end-of-life decision-making. Institutional ethics approval was obtained for data collection. Participants gave informed consent. All data were anonymized. The results revealed that nurses experience the need to exercise autonomy in intensive care units on a daily basis. Their experience expressed by the process of increase opportunities to exercise autonomy is conditioned by the pressure of the intensive care unit environment, in which nurses can grow, feel empowered, and exercise their autonomy or else can continuously depend on the decisions made by other professionals. Nurses exercise their autonomy through care. They work to create new spaces at the same time that they acquire new knowledge and make decisions. Because of the complexity of the end-of-life situation, nurses must adopt a proactive attitude

Identifying and Managing Undue Influence From Family Members in End-of-Life Decisions for Patients With Advanced Cancer.

Science.gov (United States)

Baker, Francis X; Gallagher, Colleen M

2017-10-01

Undue influence from family members of patients with advanced cancer remains a serious ethical problem in end-of-life decision making. Despite the wealth of articles discussing the problem of undue influence, little has been written by way of practical guidance to help clinicians identify and effectively manage situations of undue influence. This article briefly lays out how to identify and manage situations of undue influence sensitively and effectively. We explain how undue influence may present itself in the clinic and distinguish it from ethically permissible expressions of relational autonomy. In addition, we lay out a process by which any clinician suspecting undue influence may gather additional information and, if necessary, conduct a family meeting to address the undue influence. It is our hope that by providing clinicians at all levels of patient care with such guidance, they will feel empowered to respond to cases of undue influence when they arise.

The 1991 DOE/Sandia Crystalline Photovoltaic Technology Project Review Meeting

Science.gov (United States)

Whipple, M. L.

1991-07-01

This document serves as the proceedings for the manual project review meeting held by Sandia's Photovoltaic Technology Research Division. It contains information supplied by each organization making a presentation at the meeting, which was held July 30 through 31, 1991 at the Sheraton Hotel in Albuquerque, New Mexico. Sessions were held to discuss national photovoltaic programs, one-sun crystalline silicon cell research, concentrator silicon cell research, and concentrating collector development.

Clinical Decision Making of Nurses Working in Hospital Settings

OpenAIRE

Ida Torunn Bjørk; Glenys A. Hamilton

2011-01-01

This study analyzed nurses' perceptions of clinical decision making (CDM) in their clinical practice and compared differences in decision making related to nurse demographic and contextual variables. A cross-sectional survey was carried out with 2095 nurses in four hospitals in Norway. A 24-item Nursing Decision Making Instrument based on cognitive continuum theory was used to explore how nurses perceived their CDM when meeting an elective patient for the first time. Data were analyzed with d...

Older Adults Making End of Life Decisions: An Application of Roy's Adaptation Model

Directory of Open Access Journals (Sweden)

Weihua Zhang

2013-01-01

Full Text Available Purpose. The purpose of this study was to identify variables that influenced completion of advanced directives in the context of adaptation from national data in older adults. Knowledge gained from this study would help us identify factors that might influence end of life discussions and shed light on strategies on effective communication on advance care planning. Design and Method. A model-testing design and path analysis were used to examine secondary data from 938 participants. Items were extracted from the data set to correspond to variables for this study. Scales were constructed and reliabilities were tested. Results. The final path model showed that physical impairment, self-rated health, continuing to work, and family structure had direct and indirect effects on completion of advanced directives. Five percent of the variance was accounted for by the path analysis. Conclusion. The variance accounted for by the model was small. This could have been due to the use of secondary data and limitations imposed for measurement. However, health care providers and families should explore patient’s perception of self-health as well as their family and work situation in order to strategize a motivational discussion on advance directive or end of life care planning.

A Legal and Ethical Analysis of the Effects of Triggering Conditions on Surrogate Decision-Making in End-of-Life Care in the US.

Science.gov (United States)

Clint Parker, J; Goldberg, Daniel S

2016-03-01

The central claim of this paper is that American states' use of so-called "triggering conditions" to regulate surrogate decision-making authority in end-of-life care leaves unresolved a number of important ethical and legal considerations regarding the scope of that authority. The paper frames the issue with a case set in a jurisdiction in which surrogate authority to withdraw life-sustaining treatment is triggered by two specific clinical conditions. The case presents a quandary insofar as the clinical facts do not satisfy the triggering conditions, and yet both the appropriate surrogates and the care team agree that withdrawal of life-sustaining treatment is in the best interest of the patient. The paper surveys applicable law across the 50 states and weighs the arguments for and against the inclusion of such triggering conditions in relevant legal regimes. The paper concludes by assessing the various legal and policy options states have for regulating surrogate decision-making authority in light of the moral considerations (including epistemic difficulties), and notes the possibility for conflict within ethics teams arising from the potential tension between prudence, risk-aversion, and moral obligation.

Book Review: The End of Poverty: Economic Possibilities for Our Time

OpenAIRE

Rector, Shiela G

2010-01-01

The End of Poverty: Economic Possibilities for Our Time by Jeffrey D. Sachs details the work of Sachs, a global economist in helping impoverished countries to improve their economy. His passion and sense of possibility for ending poverty is backed by real-life experience in a number of third world countries. He makes a call for the American government and citizens to take the challenge to end extreme world poverty by the year 2025. He also points out the vital role education plays in helping ...

Working on an LHC dipole end-cap

CERN Multimedia

Laurent Guiraud

1999-01-01

A metal worker constructs an end-cap for an LHC dipole magnet. These magnets will be used to bend the proton beams around the LHC, which is due to start up in 2008. The handmade prototype seen here will be used to make a mold from which the final set of components will be made for the accelerator.

End-of-Discharge and End-of-Life Prediction in Lithium-Ion Batteries with Electrochemistry-Based Aging Models

Science.gov (United States)

Daigle, Matthew; Kulkarni, Chetan S.

2016-01-01

As batteries become increasingly prevalent in complex systems such as aircraft and electric cars, monitoring and predicting battery state of charge and state of health becomes critical. In order to accurately predict the remaining battery power to support system operations for informed operational decision-making, age-dependent changes in dynamics must be accounted for. Using an electrochemistry-based model, we investigate how key parameters of the battery change as aging occurs, and develop models to describe aging through these key parameters. Using these models, we demonstrate how we can (i) accurately predict end-of-discharge for aged batteries, and (ii) predict the end-of-life of a battery as a function of anticipated usage. The approach is validated through an experimental set of randomized discharge profiles.

Toward a Psychology of Surrogate Decision Making.

Science.gov (United States)

Tunney, Richard J; Ziegler, Fenja V

2015-11-01

In everyday life, many of the decisions that we make are made on behalf of other people. A growing body of research suggests that we often, but not always, make different decisions on behalf of other people than the other person would choose. This is problematic in the practical case of legally designated surrogate decision makers, who may not meet the substituted judgment standard. Here, we review evidence from studies of surrogate decision making and examine the extent to which surrogate decision making accurately predicts the recipient's wishes, or if it is an incomplete or distorted application of the surrogate's own decision-making processes. We find no existing domain-general model of surrogate decision making. We propose a framework by which surrogate decision making can be assessed and a novel domain-general theory as a unifying explanatory concept for surrogate decisions. © The Author(s) 2015.

SYNCHRONOUS MEETINGS: A Way to Put Personality in an Online Class

Directory of Open Access Journals (Sweden)

Barba Aldis, PATTON

2008-10-01

Full Text Available Synchronous meetings provide both professor and student the advantages of face to face (traditional class meetings while in reality they can be many miles apart. With today’s lifestyle it is not always possible for students to attend classes on a physical campus in a specific city at a specific time. The use of synchronous meetings allow the online classes to be supplemented with online office sessions, study sessions, special instruction, brain storming get togethers, collaborations, etc. The meetings can be held almost any time 24/7 that is agreeable with the participants. In 2008, it seems that everyone is concerned about confidentially. Synchronous meetings allow both professor and student to meet and all personal information such as cell phone number, home phone and personal address are not known unless someone wants to divulge such information. A few simple rules, which are included in the article, can and will help to make all meetings more success for all.

Balancing dual roles in end-of-life research.

Science.gov (United States)

Martin, Wanda; Grey, Meredith; Webber, Terry; Robinson, Linnea; Hartt, Nancy; Cairns, Moira; Stajduhar, Kelli

2007-01-01

Ethical and practical issues are sure to arise from the majority of research studies done with palliative populations. Whether it is feeling opportunistic, being emotionally available, or struggling with witnessing a gap in service and needs of the participants receiving care, nurses involved in research find a way to balance both roles to meet the needs of the participants as well as the study (McIlfatrick, Sullivan, & McKenna, 2006). This paper highlights some of the practical and ethical issues that arise when frontline nurses also take on the role of research assistant for studies with palliative populations. Specifically, the authors highlight their personal experiences based on their research assistant work on a study examining family caregiver coping in end-of-life cancer care. The authors discuss the "balancing act" of taking on these dual roles and offer recommendations on how to be with and approach people when doing research at the end of life using a framework based on Swanson's Theory of Caring (1991).

Consultants’ Meeting (Preparatory Meeting) on the IAEA Coordinated Research Project (CRP) “PHENIX End-of-Life Tests”. Working Material

International Nuclear Information System (INIS)

2008-01-01

The overall objective of the CRP is to improve/validate the Member States' analytical capabilities in the field of fast reactor simulation and design. A necessary condition towards achieving this objective is a wide international verification and validation effort of the analysis methodology and codes currently employed in the fields of fast reactor neutronics, thermal hydraulics and plant dynamics to achieve enhanced safety. Therefore, in providing the required wide international basis of interested Member States, each applying different methodologies, the CRP will contribute towards achieving the stated objective with the help of benchmark exercises focusing on the experimental results obtained during the planned PHENIX End-of-Life (EOL) Tests

1990 DOE/SANDIA crystalline photovoltaic technology project review meeting

Energy Technology Data Exchange (ETDEWEB)

Ruby, D.S. (ed.)

1990-07-01

This document serves as the proceedings for the annual project review meeting held by Sandia's Photovoltaic Cell Research Division and Photovoltaic Technology Division. It contains information supplied by each organization making a presentation at the meeting, which was held August 7 through 9, 1990 at the Sheraton Hotel in Albuquerque, New Mexico. Sessions were held to discuss national photovoltaic programs, one-sun crystalline silicon cell research, concentrator silicon cell research, concentrator 3-5 cell research, and concentrating collector development.

Cementitious building material incorporating end-capped polyethylene glycol as a phase change material

Science.gov (United States)

Salyer, Ival O.; Griffen, Charles W.

1986-01-01

A cementitious composition comprising a cementitious material and polyethylene glycol or end-capped polyethylene glycol as a phase change material, said polyethylene glycol and said end-capped polyethylene glycol having a molecular weight greater than about 400 and a heat of fusion greater than about 30 cal/g; the compositions are useful in making pre-formed building materials such as concrete blocks, brick, dry wall and the like or in making poured structures such as walls or floor pads; the glycols can be encapsulated to reduce their tendency to retard set.

Minutes of the IFMIF technical meetings, May 17-20, 2005, Tokyo, Japan

International Nuclear Information System (INIS)

Ida, Mizuho; Nakamura, Hiroo; Yutani, Toshiaki; Maebara, Sunao; Umetsu, Tomotake; Sugimoto, Masayoshi

2005-08-01

The International Fusion Materials Irradiation Facility (IFMIF) Technical Meetings were held on May 17-20, 2005 at Japan Atomic Energy Research Institute (JAERI) Tokyo. The main objectives were 1) to review technical status of the subsystems; accelerator, target and test facilities, 2) to technically discuss interface issues between target and test facilities, 3) to review results of peer-reviews performed in the EU and Japan, 4) to harmonize design/experimental activities among the subsystems, 5) to review and discuss the Engineering Validation and Engineering Design Activity (EVEDA) tasks, and 6) to make a report of 1) - 5) to the IFMIF Executive Subcommittee. This report presents a brief summary of the Target Technical, Meeting, Test Facilities Technical Meeting, Target/Test Facilities Interface Meeting, Accelerator Technical Meeting and the Technical Integration Meeting. (author)

ORIGINAL ARTICLES Medical futility and end-of-life care

African Journals Online (AJOL)

2008-04-01

Apr 1, 2008 ... It is based on the probability of a treatment not having the desired effect ... as empathetic participants in end-of-life decision-making is underscored. .... growing awareness of the limits of medical science's propensity to cure ...

Research priorities on ending child marriage and supporting married girls.

Science.gov (United States)

Svanemyr, Joar; Chandra-Mouli, Venkatraman; Raj, Anita; Travers, Ellen; Sundaram, Lakshmi

2015-09-03

Over the past few years the issue of child marriage has received growing political and programmatic attention. In spite of some progress in a number of countries, global rates have not declined over the past decade. Knowledge gaps remain in understanding trends, drivers and approaches to ending child marriage, especially to understand what is needed to achieve results on a large scale. This commentary summarizes the outcomes of an Expert Group Meeting organized by World Health Organization to discuss research priorities on Ending Child Marriage and Supporting Married Girls. It presents research gaps and recommends priorities for research in five key areas; (i) prevalence and trends of child marriage; (ii) causes of child marriage (iii) consequences of child marriage; (iv) efforts to prevent child marriage; (v) efforts to support married girls.

Meeting of the ITPA Topic Group on SOL and Divertor Physics

International Nuclear Information System (INIS)

Lipschultz, B.; Asakura, N.

2003-01-01

The most recent meeting of the Scrape-Off Layer (SOL) and Divertor Physics Group of the International Tokamak Physics Activity (ITPA) was held in Lausanne, Switzerland, on October 21-23, 2002 at the CRPP/EFL laboratory. The meeting was hosted by Dr. R. Pitts of that laboratory, with the help of other laboratory staff. There were 23 participants. The meeting format was slightly changed from that of the previous meeting (February 25-27, 2002) in so far that more time was allowed for discussions, thus making the meeting more productive. There were 28 detailed presentations over two and a half days falling into three primary areas: the physics of ELMs and their effects; radial transport and wall recycling; materials issues (T codeposition, use of W for tiles, etc.)

Single-Family Houses That Meet The Future Energy Demands

DEFF Research Database (Denmark)

Rose, Jørgen; Svendsen, Svend

2002-01-01

). Before any further tightening of the regulations are introduced, however, it is necessary to illustrate the consequences of such actions with regard to finance, building technology, indoor climate and comfort. Therefore a series of investigations and experimental projects are being launched, in order...... to examine these consequences thoroughly. The department is presently contributing to this end by participating in quite a few investigative projects, where single-family houses are designed to meet the proposed future energy demands. This paper describes the results obtained from one such project where...... the department, in co-operation with a major building entrepreneur, has developed a single-family house that shows that there are no evident problems in meeting the future energy demands....

On the end-user QoS-awareness of a distributed service environment

NARCIS (Netherlands)

Widya, I.; Stap, R.E.; Teunissen, L.J.; Hopman, B.F.

2001-01-01

A lot of attention has been given to network quality of service and efforts to make layers on top of the network also QoS-aware increase noticeably. This paper explores QoS-aware service provisioning at a level close to end-user's perception. It shows how end-user oriented QoS requirements have been

76 FR 64992 - Debt Management Advisory Committee; Meeting

Science.gov (United States)

2011-10-19

... from representatives of the financial community prior to making its final decisions on major financing... announcement of financing plans may not reflect the recommendations provided in reports of the Committee... the Committee meeting, following the release of a statement of economic conditions and financing...

Making Sustainable Decisions Using the KONVERGENCE Framework

Energy Technology Data Exchange (ETDEWEB)

Piet, Steven James; Gibson, Patrick Lavern; Joe, Jeffrey Clark; Kerr, Thomas A; Nitschke, Robert Leon; Dakins, Maxine Ellen

2003-02-01

Hundreds of contaminated facilities and sites must be cleaned up. “Cleanup” includes decommissioning, environmental restoration, and waste management. Cleanup can be complex, expensive, risky, and time-consuming. Decisions are often controversial, can stall or be blocked, and are sometimes re-done - some before implementation, some decades later. Making and keeping decisions with long time horizons involves special difficulties and requires new approaches, including: • New ways (mental model) to analyze and visualize the problem, • Awareness of the option to shift strategy or reframe from a single decision to an adaptable network of decisions, and • Improved tactical processes that account for several challenges. These include the following: • Stakeholder values are a more fundamental basis for decision making and keeping than “meeting regulations.” • Late-entry players and future generations will question decisions. • People may resist making “irreversible” decisions. • People need “compelling reasons” to take action in the face of uncertainties. Our project goal is to make cleanup decisions easier to make, implement, keep, and sustain. By sustainability, we mean decisions that work better over the entire time-period—from when a decision is made, through implementation, to its end point. That is, alternatives that can be kept “as is” or adapted as circumstances change. Increased attention to sustainability and adaptability may decrease resistance to making and implementing decisions. Our KONVERGENCE framework addresses these challenges. The framework is based on a mental model that states: where Knowledge, Values, and Resources converge (the K, V, R in KONVERGENCE), you will find a sustainable decision. We define these areas or universes as follows: • Knowledge: what is known about the problem and possible solutions? • Values: what is important to those affected by the decision? • Resources: what is available to implement

77 FR 26758 - Sunshine Act Meeting; Farm Credit Administration Board

Science.gov (United States)

2012-05-07

... to the public (limited space available) and parts will be closed to the public. In order to increase the accessibility to Board meetings, persons requiring assistance should make arrangements in [[Page...

77 FR 47068 - Farm Credit Administration Board; Sunshine Act Meeting

Science.gov (United States)

2012-08-07

... to the public (limited space available) and parts will be closed to the public. In order to increase the accessibility to Board meetings, persons requiring assistance should make arrangements in advance...

UO3 deactivation end point criteria

International Nuclear Information System (INIS)

Stefanski, L.D.

1994-01-01

The UO 3 Deactivation End Point Criteria are necessary to facilitate the transfer of the UO 3 Facility from the Office of Facility Transition and Management (EM-60) to the office of Environmental Restoration (EM-40). The criteria were derived from a logical process for determining end points for the systems and spaces at the UO 3 , Facility based on the objectives, tasks, and expected future uses pertinent to that system or space. Furthermore, the established criteria meets the intent and supports the draft guidance for acceptance criteria prepared by EM-40, open-quotes U.S. Department of Energy office of Environmental Restoration (EM-40) Decontamination and Decommissioning Guidance Document (Draft).close quotes For the UO 3 Facility, the overall objective of deactivation is to achieve a safe, stable and environmentally sound condition, suitable for an extended period, as quickly and economically as possible. Once deactivated, the facility is kept in its stable condition by means of a methodical surveillance and maintenance (S ampersand M) program, pending ultimate decontamination and decommissioning (D ampersand D). Deactivation work involves a range of tasks, such as removal of hazardous material, elimination or shielding of radiation fields, partial decontamination to permit access for inspection, installation of monitors and alarms, etc. it is important that the end point of each of these tasks be established clearly and in advance, for the following reasons: (1) End points must be such that the central element of the deactivation objective - to achieve stability - is unquestionably achieved. (2) Much of the deactivation work involves worker exposure to radiation or dangerous materials. This can be minimized by avoiding unnecessary work. (3) Each task is, in effect, competing for resources with other deactivation tasks and other facilities. By assuring that each task is appropriately bounded, DOE's overall resources can be used most fully and effectively

The Evolution of End-of-Life Care: Ethical Implications for Case Management.

Science.gov (United States)

Fink-Samnick, Ellen

2016-01-01

This article: : Applicable to all health care sectors where case management is practiced. Few topics are more intimate and multifaceted for case managers than engaging with today's culturally diverse patient populations around end-of-life processes. The already prominent focus of this issue has been further elevated by a series of events to receive public attention. These include the Institute of Medicine's 2014 report-Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life, rising numbers of patients around the globe requesting to end life on their own terms, and corresponding death with dignity initiatives and legislation.Another vital factor in the end-of-life equation involves how the latest generation of shared decision making influences the management of treatment dialogues among practitioners, patients, as well as insurance companies. Case managers are at the intersection of these complex interactions, working to achieve ethical, as well as legal accountability to the patient, employer, and profession while balancing personal perspectives. Professionals strive to effectively intervene with patients and their support systems facing end-of-life care decisions. It is essential case managers actively consider the intricacies of ethical practice and current contexts including death with dignity legislation, shared decision making, and shifts in regulations and reimbursement for end-of-life care.Case management's ethical envelope will continue to be pushed. To that end amid shifting societal constructs, professionals must have mastery of applicable codes, standards, principles, and rules essential for adherence to ethical practice.

14 Ways To Make More Time for Leadership.

Science.gov (United States)

Furman, Robert

1999-01-01

Principals can effectively manage their workday by prioritizing paperwork, creating tickler and flyer files, postponing missed phone calls, stashing supplies, structuring agendas, scheduling meetings, recording phone numbers on calendars, avoiding procrastination, delegating responsibility, deputizing delegates, making a faculty suggestion board,…

End-of-Life Preferences: A Theory-Driven Inventory

Science.gov (United States)

Bonin-Scaon, Sylvie; Munoz Sastre, Maria Teresa; Chasseigne, Gerard; Sorum, Paul C.; Mullet, Etienne

2009-01-01

The study aimed at making a theory-driven inventory of end-of-life preferences. Participants were asked about a variety of preferences representing all eight motivational states described in Apter's Metamotivational Theory (AMT; Apter, 2001). Data from a convenience sample of 965 community participants and a convenience sample of 81 persons…

OISI dynamic end-to-end modeling tool

Science.gov (United States)

Kersten, Michael; Weidler, Alexander; Wilhelm, Rainer; Johann, Ulrich A.; Szerdahelyi, Laszlo

2000-07-01

The OISI Dynamic end-to-end modeling tool is tailored to end-to-end modeling and dynamic simulation of Earth- and space-based actively controlled optical instruments such as e.g. optical stellar interferometers. `End-to-end modeling' is meant to denote the feature that the overall model comprises besides optical sub-models also structural, sensor, actuator, controller and disturbance sub-models influencing the optical transmission, so that the system- level instrument performance due to disturbances and active optics can be simulated. This tool has been developed to support performance analysis and prediction as well as control loop design and fine-tuning for OISI, Germany's preparatory program for optical/infrared spaceborne interferometry initiated in 1994 by Dornier Satellitensysteme GmbH in Friedrichshafen.

End-of-life decisions in Malaysia: Adequacies of ethical codes and developing legal standards.

Science.gov (United States)

Kassim, Puteri Nemie Jahn; Alias, Fadhlina

2015-06-01

End-of-life decision-making is an area of medical practice in which ethical dilemmas and legal interventions have become increasingly prevalent. Decisions are no longer confined to clinical assessments; rather, they involve wider considerations such as a patient's religious and cultural beliefs, financial constraints, and the wishes and needs of family members. These decisions affect everyone concerned, including members of the community as a whole. Therefore it is imperative that clear ethical codes and legal standards are developed to help guide the medical profession on the best possible course of action for patients. This article considers the relevant ethical, codes and legal provisions in Malaysia governing certain aspects of end-of-life decision-making. It highlights the lack of judicial decisions in this area as well as the limitations with the Malaysian regulatory system. The article recommends the development of comprehensive ethical codes and legal standards to guide end-of-life decision-making in Malaysia.

OLS Dialog: An open-source front end to the Ontology Lookup Service

Directory of Open Access Journals (Sweden)

Eidhammer Ingvar

2010-01-01

Full Text Available Abstract Background With the growing amount of biomedical data available in public databases it has become increasingly important to annotate data in a consistent way in order to allow easy access to this rich source of information. Annotating the data using controlled vocabulary terms and ontologies makes it much easier to compare and analyze data from different sources. However, finding the correct controlled vocabulary terms can sometimes be a difficult task for the end user annotating these data. Results In order to facilitate the location of the correct term in the correct controlled vocabulary or ontology, the Ontology Lookup Service was created. However, using the Ontology Lookup Service as a web service is not always feasible, especially for researchers without bioinformatics support. We have therefore created a Java front end to the Ontology Lookup Service, called the OLS Dialog, which can be plugged into any application requiring the annotation of data using controlled vocabulary terms, making it possible to find and use controlled vocabulary terms without requiring any additional knowledge about web services or ontology formats. Conclusions As a user-friendly open source front end to the Ontology Lookup Service, the OLS Dialog makes it straightforward to include controlled vocabulary support in third-party tools, which ultimately makes the data even more valuable to the biomedical community.

39 CFR 6.1 - Regular meetings, annual meeting.

Science.gov (United States)

2010-07-01

... 39 Postal Service 1 2010-07-01 2010-07-01 false Regular meetings, annual meeting. 6.1 Section 6.1 Postal Service UNITED STATES POSTAL SERVICE THE BOARD OF GOVERNORS OF THE U.S. POSTAL SERVICE MEETINGS (ARTICLE VI) § 6.1 Regular meetings, annual meeting. The Board shall meet regularly on a schedule...

End-preparation assessments and tests for compounded sterile preparations.

Science.gov (United States)

McElhiney, Linda F

2013-01-01

Outsourcing has become a necessity to obtain sterile products that are currently on backorder. Because of the expense of outsourcing sterile compounding, pharmacy leadership in health systems are now considering the option of insourcing and batch preparing compounded sterile preparations, which can be a viable option for a health system. It can significantly decrease drug-spending costs, and the pharmacy has a complete record of the compounding process. The key to preparing high-quality, safe, sterile preparations and meeting United States Pharmacopeia standards is end-preparation assessments and tests.

Fuel cycle options for light water reactors and heavy water reactors. Proceedings of a technical committee meeting

International Nuclear Information System (INIS)

1999-11-01

In the second half of the 20th century nuclear power has evolved from the research and development environment to an industry that supplies 16% of the world's electricity. By the end of 1997, over 8500 reactor-years of operating experience had been accumulated. Global environmental change, and the continuing increase in global energy supply required to provide increasing populations with an improving standard of living, make the contribution from nuclear energy even more important for the next century. For nuclear power to achieve its full potential and make its needed contribution, it must be safe, economical, reliable and sustainable. All of these factors can be enhanced by judicious choice and development of advanced fuel cycle options. The Technical Committee Meeting (TCM) on Fuel Cycle Options for Light Water Reactors and Heavy Water Reactors was hosted by Atomic Energy of Canada Limited (AECL) on behalf of the Canadian Government and was jointly conducted within the frame of activities of the IAEA International Working Group on Advanced Technologies for Light Water Reactors (IWG-LWR) and the IAEA International Working Group on Advanced Technologies for Heavy Water Reactors (IWG-HWR). The TCM provided the opportunity to have in-depth discussions on important technical topics which were highlighted in the International Symposium on Nuclear Fuel Cycle and Reactor Strategies: Adjusting to New Realities, held in Vienna, 3-6 June 1997. The main results and conclusions of the TCM were presented as input for discussion at the first meeting of the IAEA newly formed International Working Group on Fuel Cycle Options

78 FR 60851 - Science Advisory Board Meeting

Science.gov (United States)

2013-10-02

... written statements. In general, each individual or group making a verbal presentation will be limited to a... Advisory Board (SAB) was established by a Decision Memorandum dated September 25, 1997, and is the only... resource management. Time and Date: The meeting will be held Tuesday, November 19, 2013 from 10:00 a.m. to...

Democracy in NGOs: Making the Cooperative Option Work.

Science.gov (United States)

Wardle, Chris

1988-01-01

Discusses several problems encountered by nongovernmental organizations (NGOs) that structure themselves as cooperatives, with all members being equal. Presents four problem areas--(1) decision making, (2) meetings, (3) job rotation, and (4) growth--as well as strategies to solve potential problems. (CH)

75 FR 21280 - National Advisory Committee on Institutional Quality and Integrity (NACIQI) Meeting

Science.gov (United States)

2010-04-23

... Academic Accreditation in Audiology and Speech-Language Pathology. 4. Commission on Massage Therapy... another meeting notice and invite individuals and groups to submit requests to make oral presentations... distributed to the NACIQI for its consideration. Individuals making oral presentations may not distribute...

Stakeholder Meeting: Integrated Knowledge Translation Approach to Address the Caregiver Support Gap.

Science.gov (United States)

Holroyd-Leduc, Jayna M; McMillan, Jacqueline; Jette, Nathalie; Brémault-Phillips, Suzette C; Duggleby, Wendy; Hanson, Heather M; Parmar, Jasneet

2017-03-01

Family caregivers are an integral and increasingly overburdened part of the health care system. There is a gap between what research evidence shows is beneficial to caregivers and what is actually provided. Using an integrated knowledge translation approach, a stakeholder meeting was held among researchers, family caregivers, caregiver associations, clinicians, health care administrators, and policy makers. The objectives of the meeting were to review current research evidence and conduct multi-stakeholder dialogue on the potential gaps, facilitators, and barriers to the provision of caregiver supports. A two-day meeting was attended by 123 individuals. Three target populations of family caregivers were identified for discussion: caregivers of seniors with dementia, caregivers in end-of-life care, and caregivers of frail seniors with complex health needs. The results of this meeting can and are being used to inform the development of implementation research endeavours and policies targeted at providing evidence-informed caregiver supports.

A Serializer ASIC at 5 Gbps for Detector Front-end Electronics Readout

CERN Document Server

Gong, D; The ATLAS collaboration; Liu, T; Xiang, A; Ye, J

2010-01-01

High speed and ultra low power serial data transmission over fiber optics plays an essential roll in detector front-end electronics readout for experiments at the LHC. The ATLAS Liquid Argon Calorimeter front-end readout upgrade for the sLHC calls for an optical link system with a data bandwidth of 100 Gbps per each front-end board (FEB), a factor of 62 increase compared with the present optical link system. The transmitter of this optical link will have to withstand the radiation environment where the front-end crates are situated, and stay within the current power dissipation budget limited by the present FEB cooling capacity. To meet these challenges, we developed a 16:1 serializer based on a commercial 0.25 μm silicon-on-sapphire (SOS) CMOS technology. This serializer, designed to work at 5 Gbps, is a key component in an optical link system. Test results of this ASIC will be reported. A system design for the 100 Gbps optical link system will also be presented, with discussions about key components identi...

What Makes Women Experience Desire?

NARCIS (Netherlands)

Laan, Ellen; Both, Stephanie

2008-01-01

What makes women experience sexual desire? According to Kaplan, normal sexual response starts with desire, progresses through excitement or arousal, and ends with orgasm (Kaplan, 1974). This model implies that sexual desire is something you either have or don't have, and, if you don't have it, there

Linking pre-meeting communication to meeting effectiveness

NARCIS (Netherlands)

Allen, J.A.; Lehmann-Willenbrock, N.K.; Landowski, N.

2014-01-01

Purpose – The purpose of this paper is to investigate the importance of communication that occurs just before workplace meetings (i.e. pre-meeting talk). The paper explores how four specific types of pre-meeting talk (small talk, work talk, meeting preparatory talk, and shop talk) impact

Hydration and nutrition at the end of life: a systematic review of emotional impact, perceptions, and decision-making among patients, family, and health care staff.

Science.gov (United States)

Del Río, M I; Shand, B; Bonati, P; Palma, A; Maldonado, A; Taboada, P; Nervi, F

2012-09-01

Decrease in oral intake, weight loss, and muscular weakness in the last phases of a terminal illness, particularly in the context of the cachexia-anorexia syndrome, can be an important source of anxiety for the triad of patient, family, and health staff. The present literature review examines the emotional impact of reduced oral intake as well as perceptions and attitudes toward assisted nutrition and hydration for terminally ill patients(1) at the end of life, among patients, family, and health care staff. We have identified the ways in which emotional and cultural factors influence decision-making about assisted nutrition and hydration. Lack of information and misperceptions of medically assisted nutrition and hydration can play a predominant role in the decision to begin or suspend nutritional or hydration support. Our literature review reveals that these social, emotional, and clinical misperception elements should be considered in the decision-making processes to help the triad develop functional forms of care at this final stage of life. Copyright © 2011 John Wiley & Sons, Ltd. Copyright © 2011 John Wiley & Sons, Ltd.

Meetings and meeting modeling in smart surroundings

NARCIS (Netherlands)

op den Akker, Hendrikus J.A.; Heylen, Dirk K.J.; Nijholt, Antinus; Nishida, T.

2004-01-01

In this paper we survey our research on smart meeting rooms and its relevance for augmented reality meeting support and virtual reality generation of meetings in real-time or off-line. Intelligent real-time and off-line generation requires understanding of what is going on during a meeting. The

The art of grocery shopping on a food stamp budget: factors influencing the food choices of low-income women as they try to make ends meet.

Science.gov (United States)

Wiig, Kristen; Smith, Chery

2009-10-01

Amidst a hunger-obesity paradox, the purpose of the present study was to examine the grocery shopping behaviour and food stamp usage of low-income women with children to identify factors influencing their food choices on a limited budget. Focus groups, which included questions based on Social Cognitive Theory constructs, examined food choice in the context of personal, behavioural and environmental factors. A quantitative grocery shopping activity required participants to prioritize food purchases from a 177-item list on a budget of $US 50 for a one-week period, an amount chosen based on the average household food stamp allotment in 2005. Ninety-two low-income women, with at least one child aged 9-13 years in their household, residing in the Twin Cities, Minnesota, USA. Participants' mean age was 37 years, and 76% were overweight or obese (BMI> or =25.0 kg/m2). Key findings suggest that their food choices and grocery shopping behaviour were shaped by not only individual and family preferences, but also their economic and environmental situation. Transportation and store accessibility were major determinants of shopping frequency, and they used various strategies to make their food dollars stretch (e.g. shopping based on prices, in-store specials). Generally, meat was the most important food group for purchase and consumption, according to both the qualitative and quantitative data. Efforts to improve food budgeting skills, increase nutrition knowledge, and develop meal preparation strategies involving less meat and more fruits and vegetables, could be valuable in helping low-income families nutritionally make the best use of their food dollars.

76 FR 35410 - Science Advisory Board; Meeting

Science.gov (United States)

2011-06-17

... statements. In general, each individual or group making a verbal presentation will be limited to a total time... Advisory Board (SAB) was established by a Decision Memorandum dated September 25, 1997, and is the only... management. Time and Date: The meeting will be held Wednesday, July 20, 2011, from 9:30 a.m. to 5:30 p.m. and...

77 FR 38273 - Science Advisory Board; Meeting

Science.gov (United States)

2012-06-27

... will be limited to a total time of five (5) minutes. Individuals or groups planning to make a verbal... Advisory Board (SAB) was established by a Decision Memorandum dated September 25, 1997, and is the only... management. Time and Date: The meeting will be held Monday, July 16, 2012 from 9 a.m. to 5:30 p.m. and...

Meetings and Meeting Modeling in Smart Environments

NARCIS (Netherlands)

Nijholt, Antinus; op den Akker, Hendrikus J.A.; Heylen, Dirk K.J.

In this paper we survey our research on smart meeting rooms and its relevance for augmented reality meeting support and virtual reality generation of meetings in real time or off-line. The research reported here forms part of the European 5th and 6th framework programme projects multi-modal meeting

Comet Kohoutek, The Arab Oil Embargo, and the Jan 1974 AAS Meeting

Science.gov (United States)

Duncan, D. K.

1999-05-01

An unlikely combination of factors, including Comet Kohoutek and the Arab Oil embargo, combined to make my first AAS Meeting my most memorable. Three young graduate students confronted lack of gas, lack of money, and lack of planning to attend the Jan 1974 meeting in Tucson, AZ. One, Steve Hawley, displayed skills which would later be valuable when he became the astronaut who launched HST. Although we became stranded in the desert, two of the three of us made it to the meeting, and only one didn't....

Strategies of bringing drug product marketing applications to meet current regulatory standards.

Science.gov (United States)

Wu, Yan; Freed, Anita; Lavrich, David; Raghavachari, Ramesh; Huynh-Ba, Kim; Shah, Ketan; Alasandro, Mark

2015-08-01

In the past decade, many guidance documents have been issued through collaboration of global organizations and regulatory authorities. Most of these are applicable to new products, but there is a risk that currently marketed products will not meet the new compliance standards during audits and inspections while companies continue to make changes through the product life cycle for continuous improvement or market demands. This discussion presents different strategies to bringing drug product marketing applications to meet current and emerging standards. It also discusses stability and method designs to meet process validation and global development efforts.

A Participatory Evacuation Map Making Towards Sustainable Urban Heritage Kotagede, Yogyakarta

Directory of Open Access Journals (Sweden)

Dyah R Hizbaron

2015-08-01

Full Text Available This research aims at development of Participatory Evacuation Map Making (PEMM for Kotagede, Yogyakarta – Indonesia. The research area is one of an important cultural heritage sites in Indonesia which is subjected towards earthquake hazard. The preliminary observation revealed that the area is a densely populated area, which characterized by dense wooden building structure, narrow street and minimum information of evacuation route which increase their vulnerability potentials. This leads to the idea of developing the PEMM to improve their awareness and preparedness during disaster events and creates sustainable condition for local livelihood security. The method develops within this research is actually a lesson learn from Ritsumeikan University, that has developed CSR for integration disaster management into heritage sites at Kyoto Prefecture. Their CSR covers several activities such as developing disaster information via vending machine and tourism map. Since Yogyakarta and Kyoto are engaged in “Sister City Development Program”, hereafter Universitas Gadjah Mada tries to do similar thing. Map making is an alternative prior to community experience in map making is rather frequent compare to vending machine habit. The preliminary finding of this research indicates that the Kotagede community has been involved in several map making activity, such as “Green Map” and “Rehabilitation Sites Map”.  However, they have not yet any experience to create any map which includes information such as evacuation route, fire extinguisher, shelter information center and important meeting points. An improved critics from this research is to include meeting points level. As we all aware off, each meeting point have significant carrying capacity, thereby in the future a research on similar topics should add level and or category of meeting points. This is an important steppingstone for the research to conduct further research.

Individual decision making, group decision making and deliberation

Directory of Open Access Journals (Sweden)

Radovanović Bojana

2012-01-01

Full Text Available Each of us makes a number of decisions, from the less important to those with far-reaching consequences. As members of different groups, we are also actors of group decision making. In order to make a rational decision, a choice-making procedure must satisfy a number of assumptions (conditions of rationality. In addition, when it comes to group decisions, those procedures should also be “fair.” However, it is not possible to define a procedure of choice-making that would transform individual orders of alternatives based on preferences of perfectly rational individuals into a single social order and still meet conditions of rationality and ethics. The theory of deliberative democracy appeared in response to the impossibility of Social Choice theory. The basic assumption of deliberative democracy is that individuals adjust their preferences taking into account interests of the community. They are open for discussion with other group members and are willing to change their attitudes in order to achieve common interests. Ideally, group members come to an agreement during public discussion (deliberation. Still, this concept cannot completely over­come all the difficulties posed by the theory of social choice. Specifically, there is no solution for strategic and manipulative behavior of individuals. Also, the concept of deliberative democracy faces certain problems particular to this approach, such as, to name but a few, problems with the establishment of equality of participants in the debate and their motivation, as well as problems with the organization of public hearings. [Projekat Ministarstva nauke Republike Srbije, br. 47009: Evropske integracije i društveno-ekonomske promene privrede Srbije na putu ka EU i br. 179015: Izazovi i perspektive strukturnih promena u Srbiji: Strateški pravci ekonomskog razvoja i usklađivanje sa zahtevima EU

IOM and DHHS meeting on making clinical practice guidelines appropriate for patients with multiple chronic conditions.

Science.gov (United States)

Goodman, Richard A; Boyd, Cynthia; Tinetti, Mary E; Von Kohorn, Isabelle; Parekh, Anand K; McGinnis, J Michael

2014-01-01

The increasing prevalence of Americans with multiple (2 or more) chronic conditions raises concerns about the appropriateness and applicability of clinical practice guidelines for patient management. Most guidelines clinicians currently rely on have been designed with a single chronic condition in mind, and many such guidelines are inattentive to issues related to comorbidities. In response to the need for guideline developers to address comorbidities in guidelines, the Department of Health and Human Services convened a meeting in May 2012 in partnership with the Institute of Medicine to identify principles and action options. Eleven principles to improve guidelines' attentiveness to the population with multiple chronic conditions were identified during the meeting. They are grouped into 3 interrelated categories: (1) principles intended to improve the stakeholder technical process for developing guidelines; (2) principles intended to strengthen content of guidelines in terms of multiple chronic conditions; and (3) principles intended to increase focus on patient-centered care. This meeting built upon previously recommended actions by identifying additional principles and options for government, guideline developers, and others to use in strengthening the applicability of clinical practice guidelines to the growing population of people with multiple chronic conditions. The suggested principles are helping professional societies to improve guidelines' attentiveness to persons with multiple chronic conditions.

Proceedings of the 16. 2015 energy meetings

International Nuclear Information System (INIS)

2015-01-01

The energy meetings is the biggest annual event for French local communities in the energy domain. These meetings brought together more than 2000 participants during 3 days. The public is mainly composed of officials, representatives from local communities, institutions, private organisations and associations. The scope has been broaden to encompass all strategic domains dealing with energy and climate issues. This 16. edition put the question of the territorial governance by positioning the actors and their practices in the centre of the game and in a situation where they can overcome the limits imposed by the traditional public intervening forces. It demonstrates the catalytic role that local communities can play to make the energy transition a societal transition. The meetings were organised in 64 workshops and forums. These proceedings brings together the available material: 47 presentations (slides) given at 24 workshops described separately in fact sheets, plus 63 fact sheets for the description of forums content

MANAGEMENT BOARD MEETING OF 6 DECEMBER 2001

CERN Multimedia

2001-01-01

Outcome of the Special Meeting of the Scientific Policy Committee on 16th November 2001 and of the Special Meeting of the Committee of Council on 21st November 2001 The Director-General reported that the special meeting of the Scientific Policy Committee on 16 November had been devoted to an examination of the LHC Cost Review and of the Management's proposed funding scenarios and organizational measures for LHC completion on the basis of the relevant documents already submitted to the Finance Committee on 6 and 7 November. The SPC had welcomed the creation of the five internal task forces set up to examine the possibilities for and implications of savings, increased efficiency and restructuring throughout the Organization, expressing appreciation for the inclusion of an external representative in each task force and noting that the conclusions reached in that framework would enable it to advise the Management and Council on how to make the maximum savings with minimum damage to the European particle physics p...

In Absentia: An Exploratory Study of How Patients Are Considered in Multidisciplinary Cancer Team Meetings

NARCIS (Netherlands)

Hahlweg, P.; Hoffmann, J.; Harter, M.; Frosch, D.L.; Elwyn, G.; Scholl, I.

2015-01-01

BACKGROUND: Multidisciplinary team meetings and shared decision-making are potential means of delivering patient-centred care. Not much is known about how those two paradigms fit together in cancer care. This study aimed to investigate how decisions are made in multidisciplinary team meetings and

Proceedings of the OECD/CSNI specialists meeting on fuel-coolant interactions

Energy Technology Data Exchange (ETDEWEB)

Akiyama, Mamoru; Yamano, Norihiro; Sugimoto, Jun [eds.

1998-01-01

The OECD/CSNI Specialists Meeting on Fuel Coolant Interactions (FCI) was held at Tokai-mura in Japan on May 19 through 21, 1997, and attended by 80 participants from 14 countries and one international organizations. In the meeting 36 papers were presented followed by active discussions in six sessions on various aspects of FCI issues, such as reactor application, premixing, propagation/trigger, experiments and code/models. At the end of the Meeting, the participants have reached to the consensus on the summary and recommendations, which consists of the following items; (1) We find no new evidence that would change or violate the conclusion of SERG-2 (1996) that alpha-mode failure is not risk significant. (2) Significant progress has been made since the Santa Barbara meeting (1993). (3) Several areas have been identified, which need further investigations to understand the basic FCI phenomena, and to improve the modeling. (4) We recommend maximizing open communication between various research groups in order to accelerate the resolution of the remaining issues. (5) We recommend that the next specialist meeting be held within 3 to 5 years in order to synthesize the activities described above. (J.P.N.)

Proceedings of the third users meeting for the Advanced Photon Source

Energy Technology Data Exchange (ETDEWEB)

1990-06-01

The Third Users Meetings for the Advanced Photon Source, held on October 12--13, 1989, at Argonne National Laboratory, brought together scientists and engineers from industry, universities, and national laboratories to review the status of the facility and make plans for its use. The presentations documented in these proceedings include overviews of the project status and the user access policy; updates on several fundamental research efforts that make use of synchrotron radiation; reports on insertion-device R D and beam line design activities; cost and manpower estimates for beam line construction; and a panel discussion on strategies for developing and managing Collaborative Access Teams. The actions taken at the 1989 Business Meeting of the Advanced Photon Source Users Organization are also documented.

Proceedings of the third users meeting for the Advanced Photon Source

International Nuclear Information System (INIS)

1990-06-01

The Third Users Meetings for the Advanced Photon Source, held on October 12--13, 1989, at Argonne National Laboratory, brought together scientists and engineers from industry, universities, and national laboratories to review the status of the facility and make plans for its use. The presentations documented in these proceedings include overviews of the project status and the user access policy; updates on several fundamental research efforts that make use of synchrotron radiation; reports on insertion-device R ampersand D and beam line design activities; cost and manpower estimates for beam line construction; and a panel discussion on strategies for developing and managing Collaborative Access Teams. The actions taken at the 1989 Business Meeting of the Advanced Photon Source Users Organization are also documented

Making ends meet - when school leaders use data and feedback in the development of leadership practice

DEFF Research Database (Denmark)

Hansen, Pernille; Nørgaard, Camilla; Hornskov, Søren

In the wake of a major school reform in Denmark, school leaders face a policy driven demand for developing leadership practices, which contributes to increasing learning outcomes for all students. The use of data, assessment and feedback are promoted as part and parcel of such leadership practices...... or with a reference to the formative use of data for development (Hornskov et al 2015). However, in our case study of how school leadership teams use and interpret data and feedback on their own leadership practices, the boundaries between accountability and development does not seem clear cut....

75 FR 65298 - Gulf of Mexico Fishery Management Council; Public Meeting

Science.gov (United States)

2010-10-22

..., November 10, 2010. ADDRESSES: The meeting will be held at the Crowne Plaza Hotel, 5303 West Kennedy Blvd... separation and allocation such as the legal framework for making allocation decisions; constituent...

76 FR 48161 - Farm Credit Administration Board; Sunshine Act; Regular Meeting

Science.gov (United States)

2011-08-08

... to the public (limited space available), and parts will be closed to the public. In order to increase the accessibility to Board meetings, persons requiring assistance should make arrangements in advance...

75 FR 23761 - Farm Credit Administration Board; Sunshine Act Regular Meeting

Science.gov (United States)

2010-05-04

... to the public (limited space available), and parts will be closed to the public. In order to increase the accessibility to Board meetings, persons requiring assistance should make arrangements in advance...

76 FR 32360 - Farm Credit Administration Board; Sunshine Act; Regular Meeting

Science.gov (United States)

2011-06-06

... to the public (limited space available), and parts will be closed to the public. In order to increase the accessibility to Board meetings, persons requiring assistance should make arrangements in advance...

76 FR 55387 - Farm Credit Administration Board; Sunshine Act; Regular Meeting

Science.gov (United States)

2011-09-07

... to the public (limited space available), and parts will be closed to the public. In order to increase the accessibility to Board meetings, persons requiring assistance should make arrangements in advance...

77 FR 66838 - Farm Credit Administration Board; Sunshine Act; Regular Meeting

Science.gov (United States)

2012-11-07

... public (limited space available) and parts will be closed to the public. In order to increase the accessibility to Board meetings, persons requiring assistance should make arrangements in advance. The matters...

75 FR 75674 - Farm Credit Administration Board; Sunshine Act; Regular Meeting

Science.gov (United States)

2010-12-06

... to the public (limited space available), and parts will be closed to the public. In order to increase the accessibility to Board meetings, persons requiring assistance should make arrangements in advance...

78 FR 55074 - Farm Credit System Insurance Corporation Board; Regular Meeting

Science.gov (United States)

2013-09-09

... public (limited space available) and parts will be closed to the public. In order to increase the accessibility to Board meetings, persons requiring assistance should make arrangements in advance. The matters...

76 FR 69269 - Farm Credit Administration Board; Sunshine Act; Regular Meeting

Science.gov (United States)

2011-11-08

... to the public (limited space available), and parts will be closed to the public. In order to increase the accessibility to Board meetings, persons requiring assistance should make arrangements in advance...

75 FR 17140 - Sunshine Act; Farm Credit Administration Board; Regular Meeting

Science.gov (United States)

2010-04-05

... to the public (limited space available), and parts will be closed to the public. In order to increase the accessibility to Board meetings, persons requiring assistance should make arrangements in advance...

77 FR 74183 - Farm Credit System Insurance Corporation Board; Regular Meeting

Science.gov (United States)

2012-12-13

... public (limited space available) and parts will be closed to the public. In order to increase the accessibility to Board meetings, persons requiring assistance should make arrangements in advance. The matters...

78 FR 19708 - Farm Credit Administration Board; Sunshine Act; Regular Meeting

Science.gov (United States)

2013-04-02

... public (limited space available) and parts will be closed to the public. In order to increase the accessibility to Board meetings, persons requiring assistance should make arrangements in advance. The matters...

77 FR 1066 - Farm Credit Administration Board; Sunshine Act; Regular Meeting

Science.gov (United States)

2012-01-09

... to the public (limited space available) and parts will be closed to the public. In order to increase the accessibility to Board meetings, persons requiring assistance should make arrangements in advance...

76 FR 75878 - Farm Credit Administration Board; Sunshine Act; Regular Meeting

Science.gov (United States)

2011-12-05

... to the public (limited space available), and parts will be closed to the public. In order to increase the accessibility to Board meetings, persons requiring assistance should make arrangements in advance...

76 FR 1156 - Farm Credit Administration Board; Sunshine Act; Regular Meeting

Science.gov (United States)

2011-01-07

... to the public (limited space available), and parts will be closed to the public. In order to increase the accessibility to Board meetings, persons requiring assistance should make arrangements in advance...

Accessibility Guidelines for Astronomy and Astrophysics Meetings

Science.gov (United States)

Monkiewicz, Jacqueline; Murphy, Nicholas; Diaz-Merced, Wanda Liz; Aarnio, Alicia; Knierman, Karen; AAS Working Group for Accessibility and Disability

2018-01-01

Attendance at meetings and conferences is a critical component of an astronomer's professional life, providing opportunities for presenting one's work, staying current in the field, career networking, and scientific collaboration. Exclusion from these gatherings due to lack of accessibility and accommodation failure is a reality for disabled astronomers, and contributes substantially to low levels of representation in the senior-most levels of the field. We present a preview of the AAS Working Group for Accessibility and Disability's best practice recommendations for meetings accessibility. Applying the principles of universal access and barrier-free design, we model a paradigm of anticipating and removing accessibility barriers in advance, rather than putting the burden of requesting accommodation solely on disabled astronomers and students. We cite several professional and nonprofessional societies identified as meetings accessibility exemplars, and model our guidelines on their best practices. We establish standards for accessibility budgeting, venue choice, publication of policies online, designating point persons, and identifying barriers. We make recommendations for oral and poster presentations, event registration, receptions and banquets, excursions, and other typical conference activities. For meetings which are constrained by fixed budgets and venue choice, we identify a number of low cost/high reward accessibility steps which might still have a large beneficial impact. We likewise provide adapted recommendations for low budget meetings. THIS IS A POSTER LOCATED IN THE AAS BOOTH

Contemplation: If It Makes for Peace, Why Not for Christian Witness Too?

Directory of Open Access Journals (Sweden)

Pawel Tarasiewicz

2017-03-01

Full Text Available The author attempts to answer the following question: Why does Christian witness need contemplation? He claims that Christian witness needs contemplation, because contemplation reveals the truth about the nature of reality; it is this truth which is one of the factors that constitute the foundation of Christian faith. In a sense, contemplation is analogical to mysticism: as mystical visions make Christian belief grounded on the immediate experience of (meeting with the Truth, so the contemplation of the creatures makes Christian belief based on the indirect experience of the Truth (i.e., the meeting with the traces left by the Creator in the world.

An application of differential geometry to SSC magnet end winding

International Nuclear Information System (INIS)

Cook, J.M.

1990-04-01

It is expected that a large fraction of the total cost of the proposed Superconducting Supercollider will be spent on magnets, and, as Leon Lederman has remarked, ''most of the cost of making a magnet is in the ends.'' Among the mechanical problems to be solved there is the construction of an end-configuration for the superconducting cables which will minimize their strain energy. The purpose of this paper is to promote the use of differential geometry in this minimization. The use will be illustrated by a specific application to the winding of dipole ends. The cables are assumed to be clamped so firmly that their strain is not altered by Lorentz stresses. 15 refs

Predictive Surface Roughness Model for End Milling of Machinable Glass Ceramic

Energy Technology Data Exchange (ETDEWEB)

Reddy, M Mohan; Gorin, Alexander [School of Engineering and Science, Curtin University of Technology, Sarawak (Malaysia); Abou-El-Hossein, K A, E-mail: mohan.m@curtin.edu.my [Mechanical and Aeronautical Department, Nelson Mandela Metropolitan University, Port Elegebeth, 6031 (South Africa)

2011-02-15

Advanced ceramics of Machinable glass ceramic is attractive material to produce high accuracy miniaturized components for many applications in various industries such as aerospace, electronics, biomedical, automotive and environmental communications due to their wear resistance, high hardness, high compressive strength, good corrosion resistance and excellent high temperature properties. Many research works have been conducted in the last few years to investigate the performance of different machining operations when processing various advanced ceramics. Micro end-milling is one of the machining methods to meet the demand of micro parts. Selecting proper machining parameters are important to obtain good surface finish during machining of Machinable glass ceramic. Therefore, this paper describes the development of predictive model for the surface roughness of Machinable glass ceramic in terms of speed, feed rate by using micro end-milling operation.

Predictive Surface Roughness Model for End Milling of Machinable Glass Ceramic

International Nuclear Information System (INIS)

Reddy, M Mohan; Gorin, Alexander; Abou-El-Hossein, K A

2011-01-01

Advanced ceramics of Machinable glass ceramic is attractive material to produce high accuracy miniaturized components for many applications in various industries such as aerospace, electronics, biomedical, automotive and environmental communications due to their wear resistance, high hardness, high compressive strength, good corrosion resistance and excellent high temperature properties. Many research works have been conducted in the last few years to investigate the performance of different machining operations when processing various advanced ceramics. Micro end-milling is one of the machining methods to meet the demand of micro parts. Selecting proper machining parameters are important to obtain good surface finish during machining of Machinable glass ceramic. Therefore, this paper describes the development of predictive model for the surface roughness of Machinable glass ceramic in terms of speed, feed rate by using micro end-milling operation.

2010 ANNUAL MEETING ON NUCLEAR TECHNOLOGY. Pt. 4. Section reports

International Nuclear Information System (INIS)

Berlepsch, Thilo v.; Hering, Wolfgang

2011-01-01

Summary report on 2 Sessions of Section: - New Build and Innovations (Section 12) of the ANNUAL MEETING On NUCLEAR TECHNOLOGY held in Berlin on May 4 to 6, 2010. The other Sections 'Reactor Physics and Methods of Calculation (Section 1)', 'Thermodynamics and Fluid Dynamics (Section 2)', 'Safety of Nuclear Installations - Methods, Analysis, Results (Section 3)', 'Front End and Back End of the Fuel Cycle, Radioactive Waste, Storage (Section 4)', 'Front End of the Fuel Cycle, Fuel Elements and Core Components (Section 5)', 'Operation of Nuclear Installations (Section 6)', 'Decommissioning of Nuclear Installations (Section 7)', 'Fusion Technology (Section 8)', 'Energy Industry and Economics (Section 10)', 'Radiation Protection (Section 11)', 'New Build and Innovations (Session New Build and Innovations, Section 12)', and 'Education, Expert Knowledge, Know-how-Transfer (Section 13)' have been covered in atw issues 10, 11 and 12 (2010). (orig.)

78 FR 77132 - Notification of a Public Meeting of the Government Accountability and Transparency Board

Science.gov (United States)

2013-12-20

...] Notification of a Public Meeting of the Government Accountability and Transparency Board AGENCY: Office of... Government Accountability and Transparency (GAT) Board will host a meeting for the public to make... Accountability and Transparency Board's mandate appears in Executive Order 13576 (June 13, 2011), which in short...

Phase Radiation Characteristics of an Open-Ended Circular Waveguide

DEFF Research Database (Denmark)

Shishkova, A.V.; Pivnenko, Sergiy; Kim, O.S.

2002-01-01

Analytic expressions for phase radiation characteristics of a semi-infinite open-ended circular waveguide regardless of its aperture size and operating frequency have been obtained making use of the rigorous Weinstein's theory. The analysis of phase radiation patterns has been carried out...... for the dominant mode (TE11) as well as for the high order modes TM01 and TE01, both for a single and multimode propagation. The measurement of radiation characteristics of an open-ended circular waveguide has been carried out at the DTU-ESA Spherical Near-Field Antenna Test Facility. It is shown...

On emotion specificity in decision making

OpenAIRE

Marcel Zeelenberg; Rob M. A. Nelissen; Seger M. Breugelmans; Rik Pieters

2008-01-01

We present a motivational account of the impact of emotion on decision making, termed the feeling-is-for-doing approach. We first describe the psychology of emotion and argue for a need to be specific when studying emotion's impact on decision making. Next we describe what our approach entails and how it relates emotion, via motivation to behavior. Then we offer two illustrations of our own research that provide support for two important elements in our reasoning. We end with specifying four ...

French speaking meeting on fuzzy logics and its applications

International Nuclear Information System (INIS)

1999-01-01

The LFA meeting is a opportunity for university searchers and industrialists to meet each others and to present their most recent results on the theory of fuzzy sets and/or on its applications. The domain of applications ranges from the fuzzy control of processes to classifying, pattern recognition, data analysis, decision making, reasoning, image processing and interpretation, data fusion, artificial intelligence or data management systems. This issue of the LFA meeting inaugurates some new theories of uncertainty such as the Dempster-Shafer theory of belief functions or the qualitative approaches. From the 40 communications published in this book, two fall into the Inis scope (radioactive waste management and 3-D NMR imaging of brain tissues) and one into the Etde scope (fuzzy control of an electric-powered vehicle). (J.S.)

Making connections: Where STEM learning and Earth science data services meet

Science.gov (United States)

Bugbee, K.; Ramachandran, R.; Maskey, M.; Gatlin, P. N.; Weigel, A. M.

2016-12-01

STEM learning is most effective when students are encouraged to see the connections between science, technology and real world problems. Helping to make these connections has become an increasingly important aspect of Earth science data research. The Global Hydrology Resource Center (GHRC), one of NASA's 12 EOSDIS data centers, has developed a new type of documentation called the micro article to facilitate making connections between data and Earth science research problems. Micro articles are short academic texts that enable a reader to quickly understand a scientific phenomena, a case study, or an instrument used to collect data. While originally designed to increase data discovery and usability, micro articles also serve as a reliable starting point for project-based learning, an educational approach in STEM education, for high school and higher education environments. This presentation will highlight micro articles at the Global Hydrology Resource Center data center and will demonstrate the potential applications of micro articles in project-based learning.

Equality for followers of South Asian religions in end-of-life care.

Science.gov (United States)

Samanta, Jo

2013-06-01

Significant minority populations confer richness and diversity to British society. Responsive end-of-life care is a universal need that has ascended the public agenda following myriad reports of inadequate provision. Nevertheless, the potential exists for unwitting discrimination when caring for terminally ill patients on the basis of their religion or faith. Recent implementation of the Equality Act 2010, together with the government and professional initiatives, promises to positively impact upon this area of contemporary relevance and concern, although the extent to which facilitative policies can truly enhance patient care will depend upon how these are translated into care at the bedside. The contributions of health professionals will be central in meeting the challenges and seizing the opportunities for meeting the religion and faith interests of patients of South Asian descent.

Nuclear regulatory decision making

International Nuclear Information System (INIS)

2005-01-01

The fundamental objective of all nuclear safety regulatory bodies is to ensure that nuclear utilities operate their plants at all times in an acceptably safe manner. In meeting this objective, the regulatory body should strive to ensure that its regulatory decisions are technically sound, consistent from case to case, and timely. In addition, the regulator must be aware that its decisions and the circumstances surrounding those decisions can affect how its stakeholders, such as government policy makers, the industry it regulates, and the public, view it as an effective and credible regulator. In order to maintain the confidence of those stakeholders, the regulator should make sure that its decisions are transparent, have a clear basis in law and regulations, and are seen by impartial observers to be fair to all parties. Based on the work of a Nuclear Energy Agency (NEA) expert group, this report discusses some of the basic principles and criteria that a regulatory body should consider in making decisions and describes the elements of an integrated framework for regulatory decision making. (author)

77 FR 12577 - Department of Defense (DoD) Board of Actuaries; Federal Advisory Committee Meeting

Science.gov (United States)

2012-03-01

... DEPARTMENT OF DEFENSE Office of the Secretary Department of Defense (DoD) Board of Actuaries... that the following Federal advisory committee meeting of the DoD Board of Actuaries will take place... Actuaries meeting or make an oral presentation or submit a written statement for consideration at the...

22 CFR 1500.9 - Transcripts, recording of closed meetings.

Science.gov (United States)

2010-04-01

..., closed to the public. (b) The Foundation, after review by the General Counsel, shall make promptly... 22 Foreign Relations 2 2010-04-01 2010-04-01 true Transcripts, recording of closed meetings. 1500.9 Section 1500.9 Foreign Relations AFRICAN DEVELOPMENT FOUNDATION SUNSHINE REGULATIONS § 1500.9...

Achieving Speaker Gender Equity at the American Society for Microbiology General Meeting.

Science.gov (United States)

Casadevall, Arturo

2015-08-04

In 2015, the American Society for Microbiology (ASM) General Meeting essentially achieved gender equity, with 48.5% of the oral presentations being given by women. The mechanisms associated with increased female participation were (i) making the Program Committee aware of gender statistics, (ii) increasing female representation among session convener teams, and (iii) direct instruction to try to avoid all-male sessions. The experience with the ASM General Meeting shows that it is possible to increase the participation of female speakers in a relatively short time and suggests concrete steps that may be taken to achieve this at other meetings. Public speaking is very important for academic advancement in science. Historically women have been underrepresented as speakers in many scientific meetings. This article describes concrete steps that were associated with achieving gender equity at a major meeting. Copyright © 2015 Casadevall.

Is jurisdiction ousting policy-making

International Nuclear Information System (INIS)

Fuerst, W.

1981-01-01

This report was given by the President of the Federal Administrative Court at a meeting of the Rechts- und Staatswissenschaftliche Vereinigung (Jurisprudence and Political Science Association) held at Duesseldorf in April 1979. It points out problems arising with the administration of justice in the field of administrative law as well as the limits set to it. If parliaments avoid to take political responsibility, the solving of political conflicts will be shifted to the other two powers. In case of controversy, jurisdiction in the field of administrative law would then have to make the final decision. It is for the legislator to preserve the function of judicial power, i.e., to exact from judges to make political, especially socio-political decisions. (HSCH) [de

Emotional Impact of End-of-Life Decisions on Professional Relationships in the ICU: An Obstacle to Collegiality?

Science.gov (United States)

Laurent, Alexandra; Bonnet, Magalie; Capellier, Gilles; Aslanian, Pierre; Hebert, Paul

2017-12-01

End-of-life decisions are not only common in the ICU but also frequently elicit strong feelings among health professionals. Even though we seek to develop more collegial interprofessional approaches to care and health decision-making, there are many barriers to successfully managing complex decisions. The aim of this study is to better understand how emotions influence the end-of-life decision-making process among professionals working in ICU. Qualitative study with clinical interviews. All interviews were transcribed verbatim and analyzed thematically using interpretative phenomenological analysis. Two independent ICUs at the "Centre Hospitalier de l'Université de Montréal." Ten physicians and 10 nurses. None. During the end-of-life decision-making process, families and patients restructure the decision-making frame by introducing a strong emotional dimension. This results in the emergence of new challenges quite different from the immediacy often associated with intensive care. In response to changes in decision frames, physicians rely on their relationship with the patient's family to assist with advanced care decisions. Nurses, however, draw on their relationship and proximity to the patient to denounce therapeutic obstinacy. Our study suggests that during the end-of-life decision-making process, nurses' feelings toward their patients and physicians' feelings toward their patients' families influence the decisions they make. Although these emotional dimensions allow nurses and physicians to act in a manner that is consistent with their professional ethics, the professionals themselves seem to have a poor understanding of these dimensions and often overlook them, thus hindering collegial decisions.

End-to-end simulations and planning of a small space telescopes: Galaxy Evolution Spectroscopic Explorer: a case study

Science.gov (United States)

Heap, Sara; Folta, David; Gong, Qian; Howard, Joseph; Hull, Tony; Purves, Lloyd

2016-08-01

Large astronomical missions are usually general-purpose telescopes with a suite of instruments optimized for different wavelength regions, spectral resolutions, etc. Their end-to-end (E2E) simulations are typically photons-in to flux-out calculations made to verify that each instrument meets its performance specifications. In contrast, smaller space missions are usually single-purpose telescopes, and their E2E simulations start with the scientific question to be answered and end with an assessment of the effectiveness of the mission in answering the scientific question. Thus, E2E simulations for small missions consist a longer string of calculations than for large missions, as they include not only the telescope and instrumentation, but also the spacecraft, orbit, and external factors such as coordination with other telescopes. Here, we illustrate the strategy and organization of small-mission E2E simulations using the Galaxy Evolution Spectroscopic Explorer (GESE) as a case study. GESE is an Explorer/Probe-class space mission concept with the primary aim of understanding galaxy evolution. Operation of a small survey telescope in space like GESE is usually simpler than operations of large telescopes driven by the varied scientific programs of the observers or by transient events. Nevertheless, both types of telescopes share two common challenges: maximizing the integration time on target, while minimizing operation costs including communication costs and staffing on the ground. We show in the case of GESE how these challenges can be met through a custom orbit and a system design emphasizing simplification and leveraging information from ground-based telescopes.

76 FR 44017 - Risk Communication Advisory Committee; Notice of Meeting

Science.gov (United States)

2011-07-22

...] Risk Communication Advisory Committee; Notice of Meeting AGENCY: Food and Drug Administration, HHS... Communication Advisory Committee. General Function of the Committee: To provide advice and recommendations to... and former members of the Risk Communication Advisory Committee. FDA intends to make background...

Editorial: Nanoscience makes catalysis greener

KAUST Repository

Polshettiwar, Vivek

2012-01-09

Green chemistry by nanocatalysis: Catalysis is a strategic field of science because it involves new ways of meeting energy and sustainability challenges. The concept of green chemistry, which makes the science of catalysis even more creative, has become an integral part of sustainability. This special issue is at the interface of green chemistry and nanocatalysis, and features excellent background articles as well as the latest research results. Copyright © 2012 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Meeting of the ITER CTA Project Board

International Nuclear Information System (INIS)

2001-01-01

Full text: A preparatory meeting of the Co-ordinated Technical Activities (CTA) Project Board took place in Vienna on 16 July 2001. The Board Members of Canada, EU, Japan, RF and of the CTA International Team participated in the Meeting, which was chaired by Acad. E. Velikhov. The major item on the Meeting Agenda was the discussion of the scope of the CTA. In this discussion the following comments were expressed: One of the prime objectives during the CTA is to develop technical specifications for procurement of critical items (magnets, vacuum vessel, and buildings). It was noted that the discussions with potential suppliers should confirm manufacturing processes in details in order to explore possible schedule reduction strategies. Safety analysis and licensing preparation should proceed on all proposed sites up to the preferred site designation, to ensure the overall implementation schedule is minimized and to resolve major technical issues needed for licensing. Several R and D issues remain to be further developed during the CTA. Special attention should be given by the Participants to two areas: Diagnostics; Heating and Current Drive Systems. Arrangements for continuation of the ITER Physics Expert Groups activities should be provided. To this end a new framework, called International Tokamak Physics Activity, is being planned. The Board encouraged the Participants' Representatives in the Co-ordinating committee of this activity to support the preparation for urgent Topical Group Meetings. The Board agreed that the Design Authority will be invested in the International Team and that proposals for site specific design changes should be agreed upon by the International Team Leader before being studied in detail. The Meeting agreed on some arrangements which will remain from the EDA, namely the ITER EDA Council Office in Moscow as Office of the PB Chair, and the ITER Office located at the IAEA in Vienna as agreed by the IAEA. The Board recommended that effective

Standing Concertation Committee - Ordinary Meeting on 26 May 2004

CERN Document Server

2004-01-01

Original: English This meeting was devoted to the main topics summarised below. Preparation for the 5-Yearly Review 2005 The SCC took note of the final version of the Management's document 'Preparation for the 5-Yearly Review and Work Planning of TREF', which took account of earlier discussions at the meetings of TREF and the SCC in May. Once approved by the Council in June, this document will be the basis for the forthcoming 5-Yearly Review of employment conditions, which will be launched this autumn. The SCC then held a first discussion on the internal work planning for the 5-Yearly Review and, in particular, the setting up of study teams in order to start preparatory work on the various issues. It was agreed to resume discussion of this topic at the next meeting on the basis of HR study teams, in the framework of a comprehensive work planning of the SCC's activities foreseen until the end of 2005. CERN Health Insurance Scheme (CHIS) - Confidential declaration of family situation The Committee took note...

Course Evaluation Systems for Open-ended Quality Enhancement

DEFF Research Database (Denmark)

Piihl, Jesper; Rasmussen, Jens Smed

2013-01-01

Quality in higher education is widely controlled through surveys asking students to evaluate teaching. However, control of quality does not necessarily lead to enhancement of quality. Drawing on accounting research and a case study, a measurement-based and open-ended quality control system...... emphasising quality enhancement is suggested. The case shows how interactive use of performance measurement can lead to more engaged and enabling dialogue amongst involved actors concerning quality enhancement, however institutionalised beliefs regarding course evaluation systems makes a change challenging....... The chapter suggests that open-ended measurement systems enabling stakeholders to take responsibility for quality enhancement is not so much a matter of technical design as a matter of an enabling style of use....

Developing the science of end-of-life and palliative care research: National Institute of Nursing Research summit.

Science.gov (United States)

Csikai, Ellen L

2011-01-01

A rare opportunity to examine accomplishments and identify ways to advance research in end-of-life and palliative care was offered by the National Institute of Nursing Research (NINR) through a summit meeting held in August 2011. The Science of Compassion: Future Directions in End-of-Life and Palliative Care brought together nationally recognized leaders in end-of-life and palliative care research, including grantees of NINR, as well as more than 700 attendees from all disciplines. It was an exciting affirmation of the importance of moving forward in the field. Presented in this article is a summary of the summit and a call to action for end-of-life and palliative care social workers to engage in seeking funding to conduct needed research and to ensure our unique perspective is represented.

Profitable tail-end production

Energy Technology Data Exchange (ETDEWEB)

Pinchbeck, R.H.

1997-12-31

This presentation discusses the origins of the present challenge faced in making mature oil fields profitable in the North Sea. It briefly examines the origins of these challenges, which are rooted in the industrial psychology of the North Sea. It develops a methodological formula for the successful re-engineering of inefficiently-run assets, focusing in particular on the personnel management aspects. It identifies some key areas to seek sustainable cost reductions and recognises the importance of renewing the context for investment in tail-end fields. Finally, it speculates about the way in which the learnings developed in the experiences of the last few years will influence the future of the North Sea. 2 refs.

78 FR 2961 - Sunshine Act Meeting-Closed Meeting

Science.gov (United States)

2013-01-15

... COMMODITY FUTURES TRADING COMMISSION Sunshine Act Meeting--Closed Meeting The following notice of a closed meeting is published pursuant to the provisions of the Government in the Sunshine Act, Public Law 94- 409, 5 U.S.C. 552b. AGENCY HOLDING THE MEETING: Commodity Futures Trading Commission. TIME...

78 FR 6306 - Sunshine Act Meeting-Closed Meeting

Science.gov (United States)

2013-01-30

... COMMODITY FUTURES TRADING COMMISSION Sunshine Act Meeting--Closed Meeting The following notice of a closed meeting is published pursuant to the provisions of the Government in the Sunshine Act, Public Law 94- 409, 5 U.S.C. 552b. AGENCY HOLDING THE MEETING: Commodity Futures Trading Commission. TIME...

How Do Enzymes 'Meet' Nanoparticles and Nanomaterials?

Science.gov (United States)

Chen, Ming; Zeng, Guangming; Xu, Piao; Lai, Cui; Tang, Lin

2017-11-01

Enzymes are fundamental biological catalysts responsible for biological regulation and metabolism. The opportunity for enzymes to 'meet' nanoparticles and nanomaterials is rapidly increasing due to growing demands for applications in nanomaterial design, environmental monitoring, biochemical engineering, and biomedicine. Therefore, understanding the nature of nanomaterial-enzyme interactions is becoming important. Since 2014, enzymes have been used to modify, degrade, or make nanoparticles/nanomaterials, while numerous nanoparticles/nanomaterials have been used as materials for enzymatic immobilization and biosensors and as enzyme mimicry. Among the various nanoparticles and nanomaterials, metal nanoparticles and carbon nanomaterials have received extensive attention due to their fascinating properties. This review provides an overview about how enzymes meet nanoparticles and nanomaterials. Copyright © 2017 Elsevier Ltd. All rights reserved.

40 CFR 35.4045 - What requirements must my group meet as a TAG recipient?

Science.gov (United States)

2010-07-01

... for the purpose of participating in decision making at the Superfund site for which we provide a TAG... 40 Protection of Environment 1 2010-07-01 2010-07-01 false What requirements must my group meet as... Responsibilities As A Tag Recipient § 35.4045 What requirements must my group meet as a TAG recipient? Your group...

77 FR 54568 - Meeting of the Defense Advisory Committee on Women in the Services (DACOWITS)

Science.gov (United States)

2012-09-05

... briefings from the Services on their current retention programs, a briefing from the Army on their gender neutral standards, and a briefing on Australian Defence Force gender restrictions and development and... make an oral presentation of their issue during an open portion of this meeting or at a future meeting...

77 FR 21592 - Proposal Review Panel for Materials Research; Notice of Meeting: Correction

Science.gov (United States)

2012-04-10

.... This notice is to correct the ending time of the meeting on April 24, 2012 being held at the Pennsylvania State University, College Station, PA. Correction On page 19362, column 2, under Dates & Times.... Open-Poster Session''. Dated: April 5, 2012. Susanne Bolton, Committee Management Officer. [FR Doc...

Making Fieldwork Valuable: Designing fieldwork programmes to meet the needs of young geologists

Science.gov (United States)

Thorne, Michael

2016-04-01

consolidator to abstract ideas in class and the importance of its role in team building exercises were also broadly held views. The strength of opinion demonstrated by students reinforces the importance of decisions made regarding fieldwork. Following the initial auditing stage potential field sites were then investigated by staff and assessed for their potential to meet the desired characteristics, where promise was shown these localities were then developed into individual courses where discrete skills could be developed. By assembling together the range of learning outcomes from each individual field trip a narrative 'learning journey' was developed with a clear end goal. Having been through this process and seeing the positive effects on student progress this work presents a toolkit to educators to provide assistance and framework in the development of further programmes of field study through equally considered design.

Promotion of technical harmonisation on risk-based decision making

International Nuclear Information System (INIS)

Kirchsteiger, Christian; Cojazzi, Giacomo

2000-01-01

The EC-JRC International Workshop on Promotion of Technical Harmonisation on Risk-Based Decision Making, held at Stresa and Ispra, Italy, 22-25 May 2000, was an experts meeting to discuss the possible need of developing an internationally accepted generic 'standard' for risk-based decision making.This paper briefly describes the workshop background, its organisation and summarises its main results and conclusions; it reflects the personal opinions of the authors and in no way commits the European Commission. (author)

Online Knowledge Communities: Meeting places for continuing professional development.

NARCIS (Netherlands)

de Vries, Sjoerd A.; van Weert, Tom J.; Munro, Robert K.

2003-01-01

This paper describes the concept of Online Knowledge Communities (okc) as meeting places for continuing professional development (cpd). An okc is defined as a social network of members, who are online and are organized by making use of an online knowledge center. The okc has a particular group

78 FR 64201 - Commerce Spectrum Management Advisory Committee Meeting

Science.gov (United States)

2013-10-28

... innovation as possible; and make wireless services available to all Americans. See Charter at http://www.ntia... new subcommittees established to help the NTIA develop new or revised strategies for responding more....doc.gov , at least five (5) business days before the meeting. Status: Interested parties are invited...

Validation procedures of software applied in nuclear instruments. Proceedings of a technical meeting

International Nuclear Information System (INIS)

2007-09-01

The IAEA has supported the availability of well functioning nuclear instruments in Member States over more than three decades. Some older or aged instruments are still being used and are still in good working condition. However, those instruments may not meet modern software requirements for the end-user in all cases. Therefore, Member States, mostly those with emerging economies, modernize/refurbish such instruments to meet the end-user demands. New advanced software is not only applied in case of new instrumentation, but often also for new and improved applications of modernized and/or refurbished instruments in many Member States for which in few cases the IAEA also provided support. Modern software applied in nuclear instrumentation plays a key role for their safe operation and execution of commands in a user friendly manner. Correct data handling and transfer has to be ensured. Additional features such as data visualization, interfacing to PC for control and data storage are often included. To finalize the task, where new instrumentation which is not commercially available is used, or aged instruments are modernized/refurbished, the applied software has to be verified and validated. A Technical Meeting on 'Validation Procedures of Software Applied in Nuclear Instruments' was organized in Vienna, 20-23 November 2006, to discuss the verification and validation process of software applied to operation and use of nuclear instruments. The presentations at the technical meeting included valuable information, which has been compiled and summarized in this publication, which should be useful for technical staff in Member States when modernizing/refurbishing nuclear instruments. 22 experts in the field of modernization/refurbishment of nuclear instruments as well as users of applied software presented their latest results. Discussion sessions followed the presentations. This publication is the outcome of deliberations during the meeting

Writing abstracts and developing posters for national meetings.

Science.gov (United States)

Wood, Gordon J; Morrison, R Sean

2011-03-01

Presenting posters at national meetings can help fellows and junior faculty members develop a national reputation. They often lead to interesting and fruitful networking and collaboration opportunities. They also help with promotion in academic medicine and can reveal new job opportunities. Practically, presenting posters can help justify funding to attend a meeting. Finally, this process can be invaluable in assisting with manuscript preparation. This article provides suggestions and words of wisdom for palliative care fellows and junior faculty members wanting to present a poster at a national meeting describing a case study or original research. It outlines how to pick a topic, decide on collaborators, and choose a meeting for the submission. It also describes how to write the abstract using examples that present a general format as well as writing tips for each section. It then describes how to prepare the poster and do the presentation. Sample poster formats are provided as are talking points to help the reader productively interact with those that visit the poster. Finally, tips are given regarding what to do after the meeting. The article seeks to not only describe the basic steps of this entire process, but also to highlight the hidden curriculum behind the successful abstracts and posters. These tricks of the trade can help the submission stand out and will make sure the reader gets the most out of the hard work that goes into a poster presentation at a national meeting.

78 FR 55749 - Office of the Director, National Institutes of Health; Notice of Meeting

Science.gov (United States)

2013-09-11

... Councils. The meeting will be open to the public as indicated below, with attendance limited to space... discussions could disclose confidential trade secrets or commercial property such as patentable material, and... NIH Update; Overview of Shared and High-End, Instrumentation Program; Scientific Presentation. Place...

76 FR 627 - Medicare Program; End-Stage Renal Disease Quality Incentive Program

Science.gov (United States)

2011-01-05

... important components of the Medicare ESRD payment system. In the proposed rule, we described the evolution...) of the Social Security Act (the Act), as the next step in the evolution of the ESRD quality program...-mix (for example, nursing home patients, patients with complex conditions) that may make meeting the...

Identifying, meeting, and assessing customer expectations

International Nuclear Information System (INIS)

Danner, T.A.

1995-01-01

Maintaining proficiency in carrying out mission goals is fundamental to the success of any organization. The definitive mission of the Waste Management and Remedial Action Division (WMRAD) of Oak Ridge National Laboratory (ORNL) is open-quotes to conduct waste management activities in a compliant, publicly acceptable, technically sound, and cost-efficient mannerclose quotes. In order to effectively fulfill this mission, must meet or exceed several standards in respect to our customers. These include: (1) identifying current and future customer expectations; (2) managing our relationships with our customers; (3) ensuring our commitment to our customers; and (4) measuring our success m customer satisfaction. Our customers have a great variety of requirements and expectations. Many of these are in the form of local, state, and federal regulations and environmental standards. Others are brought to our attention through inquires made to the Department of Energy (DOE).Consumer surveys have proven to be effective tools which have been used to make improvements, enhance certain program elements, and identify beneficial areas in already existing programs. In addition, national working groups, technology transfer meetings, and manager/contractor's meeting offer excellent opportunities to assess our activities

The nuclear fuel cycle desperately in need of front end alignment

International Nuclear Information System (INIS)

White, G.; Reaves, J.

1983-01-01

The front end of the nuclear fuel cycle which includes uranium supply, conversion of U308 to UF6 and enrichment of UF6, is characterized by excess capacity, excess production, growing inventories and price weakness. Excess capacity resulted from uncritical acceptance by suppliers of overly optimistic utility plans for nuclear growth. Cancellation and deferrals of nuclear plans led to reductions in forecast demand just as the new production capacity was coming on line to meet the high levels of demand forecast earlier. The unique and conservative nature of the utilities as business entities and the unique, sole-end-use character of uranium and its related fuel cycle services suggest that the markets for these materials and services will differ from those of other fuels. An international market is foreseen, marked by continuing boom-bust cycles

Decision-Making as a Struggle and a Play: On Alternative Rationalities in Schools as Organizations

Science.gov (United States)

Salo, Petri

2008-01-01

In this article an alternative interpretation of the functions of decision-making and the inherent activities at teachers' meetings at schools are presented. The metaphor of "play" is introduced in order to make the teachers' actions during decision-making comprehensible, not only for outsiders, but more importantly for "involved insiders", such…

Meeting the health needs of older people with learning disabilities.

Science.gov (United States)

Jenkins, Robert

The increasing population of older people with learning disabilities may lead to higher demand for contact with registered nurses. To date, little research has been undertaken regarding the role of registered nurses in meeting the health and care needs of this client group. In this article, the author reports on the second stage of a three-stage research study that used six case studies to explore this issue. Implications for nursing were identified in areas such as health needs, record keeping, medication, advocacy, social aspects, ageing in place, percutaneous endoscopic gastrostomy (PEG) feeding, spirituality and end-of-life care. The author concludes that registered nurses will need to continue to remain up to date to meet the complex needs of older individuals with learning disabilities.

75 FR 67958 - Blue Ribbon Commission on America's Nuclear Future

Science.gov (United States)

2010-11-04

... meeting in a timely fashion. In addition, the dates for this meeting and the location, Washington, DC... end of the nuclear fuel cycle. The Commission will provide advice and make recommendations on issues... purpose of this meeting is to better understand the fuel cycle policies that have been established by...

Meeting Disorders.

Science.gov (United States)

Yager, Joel; Katzman, Jeffrey W

2017-12-01

Although meetings are central to organizational work, considerable time devoted to meetings in Academic Health Centers appears to be unproductively spent. The primary purposes of this article are to delineate and describe Meeting Disorders, pathological processes resulting in these inefficient and ineffective scenarios, and Meeting Fatigue Disorder (MFD), a clinical syndrome. The paper also offers preliminary approaches to remedies. The authors integrate observations made during tens of thousands of hours in administrative meetings in academic medical settings with information in the literature regarding the nature, causes and potential interventions for dysfunctional groups and meetings. Meeting Disorders, resulting from distinct pathologies of leadership and organization, constitute prevalent subgroups of the bureaucrapathologies, pathological conditions caused by dysfunctional bureaucratic processes that generate excesses of wasted time, effort, and other resources. These disorders also generate frustration and demoralization among participants, contributing to professional burnout. Meeting Fatigue Disorder (MFD) is a subjective condition that develops in individuals who overdose on these experiences and may reflect one manifestation of burnout. Meeting disorders and Meeting Fatigue Disorder occur commonly in bureaucratic life. Resources and potential remedies are available to help ameliorate their more deleterious effects.

29 CFR 2701.2 - Open meetings policy; closure of meetings.

Science.gov (United States)

2010-07-01

... 29 Labor 9 2010-07-01 2010-07-01 false Open meetings policy; closure of meetings. 2701.2 Section... GOVERNMENT IN THE SUNSHINE ACT REGULATIONS § 2701.2 Open meetings policy; closure of meetings. (a) Policy. Commission meetings will generally be open to public observation, including meetings concerning the...

76 FR 76409 - Meeting of the Farm Credit System Insurance Corporation Board

Science.gov (United States)

2011-12-07

... open to the public (limited space available) and parts will be closed to the public. In order to increase the accessibility to Board meetings, persons requiring assistance should make arrangements in...

75 FR 61228 - Board Meeting: Technical Lessons Gained From High-Level Nuclear Waste Disposal Efforts

Science.gov (United States)

2010-10-04

... Nuclear Waste Disposal Efforts Pursuant to its authority under section 5051 of Public Law 100-203, Nuclear... the hotel for meeting attendees. To ensure receiving the meeting rate, reservations must be made by October 6, 2010. For directions to the hotel or to make reservations, go to http://www.marriott.com/hotels...

Specialists' meeting on fuel element performance computer modelling, Preston, United Kingdom, 15-19 March 1982

International Nuclear Information System (INIS)

1983-03-01

The 46 papers of the meeting concerned with computer models of Water Reactor fuel elements cover practically all aspects of behavior of fuel elements in normal operation and in accident condition. Each session of the meeting produced a critical evaluation of one of the 5 topics into which the subject area had been divided. The sessions' report summarize the papers and make recommendations for further work. Separate abstracts were prepared for all the papers presented at this meeting

Meeting Venus

Science.gov (United States)

Sterken, Christiaan; Aspaas, Per Pippin

2013-06-01

On 2-3 June 2012, the University of Tromsoe hosted a conference about the cultural and scientific history of the transits of Venus. The conference took place in Tromsoe for two very specific reasons. First and foremost, the last transit of Venus of this century lent itself to be observed on the disc of the Midnight Sun in this part of Europe during the night of 5 to 6 June 2012. Second, several Venus transit expeditions in this region were central in the global enterprise of measuring the scale of the solar system in the eighteenth century. The site of the conference was the Nordnorsk Vitensenter (Science Centre of Northern Norway), which is located at the campus of the University of Tromsoe. After the conference, participants were invited to either stay in Tromsoe until the midnight of 5-6 June, or take part in a Venus transit voyage in Finnmark, during which the historical sites Vardoe, Hammerfest, and the North Cape were to be visited. The post-conference program culminated with the participants observing the transit of Venus in or near Tromsoe, Vardoe and even from a plane near Alta. These Proceedings contain a selection of the lectures delivered on 2-3 June 2012, and also a narrative description of the transit viewing from Tromsoe, Vardoe and Alta. The title of the book, Meeting Venus, refers the title of a play by the Hungarian film director, screenwriter and opera director Istvan Szabo (1938-). The autobiographical movie Meeting Venus (1991) directed by him is based on his experience directing Tannhauser at the Paris Opera in 1984. The movie brings the story of an imaginary international opera company that encounters a never ending series of difficulties and pitfalls that symbolise the challenges of any multicultural and international endeavour. As is evident from the many papers presented in this book, Meeting Venus not only contains the epic tales of the transits of the seventeenth, eighteenth and nineteenth centuries, it also covers the conference

Making a difference through veterinary public health.

Science.gov (United States)

2016-06-11

More than 100 people gathered in Birmingham on April 23 for the third joint conference of the Veterinary Public Health Association and the Association of Government Vets. With the theme of 'VPH hands on - making a difference together', the meeting considered the role vets play in society through their work on public health and sustainability. Kathryn Clark reports. British Veterinary Association.

Governance and Youth Participation in local policy making

DEFF Research Database (Denmark)

Eklund Karlsson, Leena; Haaber Pettersen, Charlotte Louise; Aro, Arja R.

2016-01-01

research strategy was applied to examine these two case studies. Data was collected under the REPOPA Project (Research into Policy to enhance Physical Activity) though semi-structures interviews (N=11), analysed through content analysis and supported by analysis of 123 background documents. Results: Youth...... was involved in policy making only through adult representation. These adult stakeholders became part of participatory governance in developing the healthy public policies in both Odense and Esbjerg municipalities. Conclusion: Youth participation in local HEPA policy making in Esbjerg and Odense did not meet...... the Danish principle of participatory policy process and good health system governance. Main messages: Mechanisms to facilitate youth participation in policy making in the study communities were lacking. The Danish goal of improved participatory policy making at the local level was not met....

On Kant's idea of humanity as an end in itself

NARCIS (Netherlands)

Nyholm, S.R.

2016-01-01

Writers like Christine Korsgaard and Allen Wood understand Kant's idea of rational nature as an end in itself as a commitment to a substantive value. This makes it hard for them to explain the supposed equivalence between the universal law and humanity formulations of the categorical imperative,

Summary report of consultants' meeting on IAEA international database on irradiated nuclear graphite properties

International Nuclear Information System (INIS)

Humbert, D.; Wickham, A.J.

2007-06-01

The '9th Meeting of the Technical Steering Committee for the International Database on Irradiated Nuclear Graphite Properties' was held on 26-27 March 2007 at the IAEA Headquarters, Vienna, Austria. All discussions, recommendations and actions of this Consultants' Meeting are recorded in this report. The purposes of the meeting were to review the matters and actions identified in the previous meeting, undertake a review of the current status of the database and make recommendations for actions for the next year. This report contains the current status of the identified actions as well as a summary of the recommendations on enhancements to the database. (author)

Towards ending conflict and insecurity in the Niger Delta region: A ...

African Journals Online (AJOL)

Towards ending conflict and insecurity in the Niger Delta region: A collective ... State as conflicts in different parts of the country have continued to make life insecure. ... Findings from the work show that the Federal Government's approach to ...

Proceedings of the specialists' meeting on reactor group constants

Energy Technology Data Exchange (ETDEWEB)

Katakura, Jun-ichi (ed.) [Japan Atomic Energy Research Inst., Tokai, Ibaraki (Japan). Tokai Research Establishment

2001-08-01

This report is the Proceedings of the Specialists' Meeting on Reactor Group Constants. The meeting was held on February 22-23, 2001 at Tokai Research Establishment of Japan Atomic Energy Research Institute with the participation of 59 specialists. The evaluation work for JENDL-3.3 is going on for the publication in a short time. The processing JENDL-3.3 file to make reactor group constants is needed when it is used in application fields. In the meeting, the present status of the reactor group constants was reviewed and the issues relating to them were discussed in such fields as thermal reactor, criticality safety, fast reactor, high energy region, burn-up calculation and radiation shielding. At the final session in the meeting, standardization of reactor group constants was discussed and the need of the reference group constants was confirmed by the participants. The 11 of the presented papers are indexed individually. (J.P.N.)

Perceptions of Civility for Mobile Phone Use in Formal and Informal Meetings

Science.gov (United States)

Washington, Melvin C.; Okoro, Ephraim A.; Cardon, Peter W.

2014-01-01

We report our survey research about what American business professionals consider appropriate or civil mobile phone behavior during formal and informal meetings. The findings come from two of our recent research studies: an open-ended survey of 204 employees at a beverage distributor on the East Coast and a nationwide, random-sample survey of 350…

The Process of End-of-Life Decision-Making in Pediatrics: A National Survey in the Netherlands

NARCIS (Netherlands)

de Vos, Mirjam A.; van der Heide, Agnes; Maurice-Stam, Heleen; Brouwer, Oebele F.; Plötz, Frans B.; Schouten-van Meeteren, Antoinette Y. N.; Willems, Dick L.; Heymans, Hugo S. A.; Bos, Albert P.

2011-01-01

OBJECTIVE: The goal of this study was to investigate how Dutch pediatric specialists reach end-of-life decisions, how they involve parents, and how they address conflicts. METHODS: We conducted a national cross-sectional survey among pediatric intensivists, oncologists, neurologists, neurosurgeons,

The Process of End-of-Life Decision-Making in Pediatrics : A National Survey in the Netherlands

NARCIS (Netherlands)

de Vos, Mirjam A.; van der Heide, Agnes; Maurice-Stam, Heleen; Brouwer, Oebele F.; Plotz, Frans B.; Schouten-van Meeteren, Antoinette Y. N.; Willems, Dick L.; Heymans, Hugo S. A.; Bos, Albert P.

OBJECTIVE: The goal of this study was to investigate how Dutch pediatric specialists reach end-of-life decisions, how they involve parents, and how they address conflicts. METHODS: We conducted a national cross-sectional survey among pediatric intensivists, oncologists, neurologists, neurosurgeons,

75 FR 17929 - Secretary's Advisory Committee on Heritable Disorders in Newborns and Children; Notice of Meeting

Science.gov (United States)

2010-04-08

...: Renaissance Washington, DC Dupont Circle Hotel, 1143 New Hampshire Avenue, NW., Washington, DC 20037. Status...: The meeting will include: (1) A presentation of the External Review Workgroup's final report on the... of the meeting. Those individuals who want to make a comment are requested to register online by...

Remanufacturing Aided Added-Value Creation, Innovations Meeting to Deliver Sustainable Manufacturing

Science.gov (United States)

Tariq Abullah, Ziyad; Guo, Shun Sheng; Yun, Sheng Bu

2015-05-01

End-of-life scrap steel such as vehicles bulks and bodies, steel wheel and shells are easily land filled at the end-of-life when treated in a developing country with non-industrial infrastructure. Research idea is about composite shape steel remanufacturing to be sheet steel for construction application through nested recovered pieces of scrap steel within new sheet steel base to meet innovation value creation of remanufactured steel and innovation eco-design of steel products to close supply chain through linkage developed and developing countries of non-industrial infrastructure economy. That can be satisfied through comprehensive business- education-training model conduction firstly at the developing countries to reduce costs and change the intensive labour remanufacturing paradigm collaboratively. Sustainable remanufacturing business model can be applied based on infrastructure of educational institutions such as institutes of technology to adopt environmental, economic, and social developments as triple bottom line sustainability. Such innovation value creation is driven by eco-design and eco-innovation enabling where the meet to deliver human development, employment, and education conscious environment and bench mark recommendations of development directions for upgrading to apply business that allows eco-societies to emerge, through cooperative steel scrap processing.

75 FR 73083 - Sunshine Act Meeting; Open Commission Meeting

Science.gov (United States)

2010-11-29

... FEDERAL COMMUNICATIONS COMMISSION Sunshine Act Meeting; Open Commission Meeting November 30, 2010. The Federal Communications Commission will hold an Open Meeting on the subjects listed below on... demonstrate accessibility technologies. The meeting site is fully accessible to people using wheelchairs or...

Availability and End-to-end Reliability in Low Duty Cycle Multihop Wireless Sensor Networks.

Science.gov (United States)

Suhonen, Jukka; Hämäläinen, Timo D; Hännikäinen, Marko

2009-01-01

A wireless sensor network (WSN) is an ad-hoc technology that may even consist of thousands of nodes, which necessitates autonomic, self-organizing and multihop operations. A typical WSN node is battery powered, which makes the network lifetime the primary concern. The highest energy efficiency is achieved with low duty cycle operation, however, this alone is not enough. WSNs are deployed for different uses, each requiring acceptable Quality of Service (QoS). Due to the unique characteristics of WSNs, such as dynamic wireless multihop routing and resource constraints, the legacy QoS metrics are not feasible as such. We give a new definition to measure and implement QoS in low duty cycle WSNs, namely availability and reliability. Then, we analyze the effect of duty cycling for reaching the availability and reliability. The results are obtained by simulations with ZigBee and proprietary TUTWSN protocols. Based on the results, we also propose a data forwarding algorithm suitable for resource constrained WSNs that guarantees end-to-end reliability while adding a small overhead that is relative to the packet error rate (PER). The forwarding algorithm guarantees reliability up to 30% PER.

Availability and End-to-end Reliability in Low Duty Cycle MultihopWireless Sensor Networks

Directory of Open Access Journals (Sweden)

Timo D. Hämäläinen

2009-03-01

Full Text Available A wireless sensor network (WSN is an ad-hoc technology that may even consist of thousands of nodes, which necessitates autonomic, self-organizing and multihop operations. A typical WSN node is battery powered, which makes the network lifetime the primary concern. The highest energy efficiency is achieved with low duty cycle operation, however, this alone is not enough. WSNs are deployed for different uses, each requiring acceptable Quality of Service (QoS. Due to the unique characteristics of WSNs, such as dynamic wireless multihop routing and resource constraints, the legacy QoS metrics are not feasible as such. We give a new definition to measure and implement QoS in low duty cycle WSNs, namely availability and reliability. Then, we analyze the effect of duty cycling for reaching the availability and reliability. The results are obtained by simulations with ZigBee and proprietary TUTWSN protocols. Based on the results, we also propose a data forwarding algorithm suitable for resource constrained WSNs that guarantees end-to-end reliability while adding a small overhead that is relative to the packet error rate (PER. The forwarding algorithm guarantees reliability up to 30% PER.

Open-ended guidewire for percutaneous therapy of varicocele

International Nuclear Information System (INIS)

Benea, G.; Galeotti, R.; Tartari, S.; Mannella, P.

1989-01-01

Percutaneous transvenous treatment has become the elective therapy for varicocele because it is a simple, safe, economic and reliable procedure. The presence of proximal anastomoses connecting a competent valved spermatic trunk with the renal vein can be responsible for a varicocele and make its treatment difficult. In such cases, the valve of the spermatic venous trunk can be bypassed using an open-ended guidewire with a removable mandril core, and then injecting the sclerosing agent through the guide. Moreover, the guidewire can facilitate the insertion of catheter through the competent valve, thus allowing the placement of Gianturco coils. During the past 12 months the authors have successfully treated 4 patients affected by varicocele with competent valved venous trunk using the open-ended guidewire

IAEA International Database on Irradiated Nuclear Graphite Properties. 7th meeting of the Technical Steering Committee

International Nuclear Information System (INIS)

Humbert, D.; Wickham, A.J.

2005-06-01

This report summarizes the Consultant Meeting '7th Meeting of the Technical Steering Committee for the International Database on Irradiated Nuclear Graphite Properties' held on 16-17 March 2005 at the IAEA Headquarters, Vienna, Austria. The purposes of the meeting were to review the matters and actions identified in the previous meeting, undertake a review of the current status of the database and to make recommendations for actions for the next year. The purposes of the meeting were fully met. This report contains the current status of the identified actions as well as a summary of the recommendations on enhancements to the database. (author)

IAEA International Database on Irradiated Nuclear Graphite Properties. 6th meeting of the Technical Steering Committee

International Nuclear Information System (INIS)

Humbert, D.; Wickham, A.J.

2004-12-01

This report summarizes the Consultant Meeting 6th Meeting of the Technical Steering Committee for the International Database on Irradiated Nuclear Graphite Properties' held on 16-17 September 2004 at Plas Tan-Y-Bwlch, Maentwrog, Gwynedd, UK. The purposes of the meeting were to review the matters and actions identified in the previous meeting, undertake a review of the current status of the database and to make recommendations for actions for the next year. The purposes of the meeting were fully met. This report contains the current status of the identified actions as well as a summary of the recommendations on enhancements to the database. (author)

Improving Family Meetings in Intensive Care Units: A Quality Improvement Curriculum.

Science.gov (United States)

Gruenewald, David A; Gabriel, Michelle; Rizzo, Dorothy; Luhrs, Carol A

2017-07-01

Family meetings in the intensive care unit are associated with beneficial outcomes for patients, their families, and health care systems, yet these meetings often do not occur in a timely, effective, reliable way. The Department of Veterans Affairs Comprehensive End-of-Life Care Implementation Center sponsored a national initiative to improve family meetings in Veterans Affairs intensive care units across the United States. Process measures of success for the initiative were identified, including development of a curriculum to support facility-based quality improvement projects to implement high-quality family meetings. Identified curriculum requirements included suitability for distance learning and applicability to many clinical intensive care units. Curriculum modules were cross-mapped to the "Plan-Do-Study-Act" model to aid in planning quality improvement projects. A questionnaire was e-mailed to users to evaluate the curriculum's effectiveness. Users rated the curriculum's effectiveness in supporting and achieving aims of the initiative as 3.6 on a scale of 0 (not effective) to 4 (very effective). Users adapted the curriculum to meet local needs. The number of users increased from 6 to 17 quality improvement teams in 2 years. All but 3 teams progressed to implementation of an action plan. Users were satisfied with the effectiveness and adaptability of a family-meeting quality improvement curriculum to support implementation of a quality improvement project in Veterans Affairs intensive care units. This tool may be useful in facilitating projects to improve the quality of family meetings in other intensive care units. ©2017 American Association of Critical-Care Nurses.

Managing Controversies in the Fuzzy Front End

DEFF Research Database (Denmark)

Christiansen, John K.; Gasparin, Marta

2016-01-01

. The analysis investigates the microprocesses around the controversies that emerge during the fuzzy front end of four products. Five different types of controversies are identified: profit, production, design, brand and customers/market. Each controversy represents a threat, but also an opportunity to search...... for new solutions in the unpredictable non-linear processes. The study uses an ethnographic approach using qualitative data from interviews, company documents, external communication and marketing material, minutes of meetings, informal conversations and observations. The analysis of four FFE processes...... demonstrates how the fuzzy front requires managers to deal with controversies that emerge from many different places and involve both human and non-human actors. Closing the controversies requires managers to take account of the situation, identify the problem that needs to be addressed, and initiate a search...

Draft Executive Summary Hawaii Geothermal Project - EIS Scoping Meetings

Energy Technology Data Exchange (ETDEWEB)

None

1992-03-01

After introductions by the facilitator and the program director from DOE, process questions were entertained. It was also sometimes necessary to make clarifications as to process throughout the meetings. Topics covered federal involvement in the HGP-EIS; NEPA compliance; public awareness, review, and access to information; Native Hawaiian concerns; the record of decision, responsibility with respect to international issues; the impacts of prior and on-going geothermal development activities; project definition; alternatives to the proposed action; necessary studies; Section 7 consultations; socioeconomic impacts; and risk analysis. Presentations followed, in ten meetings, 163 people presented issues and concerns, 1 additional person raised process questions only.

Influence Of Tools Input/Output Requirements On Managers Core Front End Activities In New Product Development

DEFF Research Database (Denmark)

Appio, Francesco P.; Achiche, Sofiane; Minin, Alberto Di

2011-01-01

opportunities; make this early phase of the innovation process uncertain and extremely risky. Literature suggests that the understanding, selection and use of appropriate tools/techniques to support decision making are instrumental for a less fuzzy front end of innovation. This paper considers the adoption......The object of analysis of this explorative research is the Fuzzy Front End of Innovation in Product Development, described by those activities going from the opportunity identification to the concept definition. Business scholars have shown that confusion in terms of goals and different ideas about...

A novel end-to-end classifier using domain transferred deep convolutional neural networks for biomedical images.

Science.gov (United States)

Pang, Shuchao; Yu, Zhezhou; Orgun, Mehmet A

2017-03-01

Highly accurate classification of biomedical images is an essential task in the clinical diagnosis of numerous medical diseases identified from those images. Traditional image classification methods combined with hand-crafted image feature descriptors and various classifiers are not able to effectively improve the accuracy rate and meet the high requirements of classification of biomedical images. The same also holds true for artificial neural network models directly trained with limited biomedical images used as training data or directly used as a black box to extract the deep features based on another distant dataset. In this study, we propose a highly reliable and accurate end-to-end classifier for all kinds of biomedical images via deep learning and transfer learning. We first apply domain transferred deep convolutional neural network for building a deep model; and then develop an overall deep learning architecture based on the raw pixels of original biomedical images using supervised training. In our model, we do not need the manual design of the feature space, seek an effective feature vector classifier or segment specific detection object and image patches, which are the main technological difficulties in the adoption of traditional image classification methods. Moreover, we do not need to be concerned with whether there are large training sets of annotated biomedical images, affordable parallel computing resources featuring GPUs or long times to wait for training a perfect deep model, which are the main problems to train deep neural networks for biomedical image classification as observed in recent works. With the utilization of a simple data augmentation method and fast convergence speed, our algorithm can achieve the best accuracy rate and outstanding classification ability for biomedical images. We have evaluated our classifier on several well-known public biomedical datasets and compared it with several state-of-the-art approaches. We propose a robust

Correcting coils in end magnets of accelerators

Directory of Open Access Journals (Sweden)

L. R. P. Kassab

1998-05-01

Full Text Available We present an empirical investigation of the correcting coils behavior used to homogenize the field distribution of the race-track microtron accelerator end magnets. These end magnets belong to the second stage of the 30.0 MeV cw electron accelerator under construction at IFUSP, the race-track microtron booster, in which the beam energy is raised from 1.97 to 5.1 MeV. The correcting coils are attached to the pole faces and are based on the inhomogeneities of the magnetic field measured. The performance of these coils, when operating the end magnets with currents that differ by ±10% from the one used in the mappings that originated the coils copper leads, is presented. For one of the magnets, adjusting conveniently the current of the correcting coils makes it possible to homogenize field distributions of different intensities, once their shapes are practically identical to those that originated the coils. For the other one, the shapes are changed and the coils are less efficient. This is related to intrinsic factors that determine the inhomogeneities. However, we obtained uniformity of 0.001% in both cases.

76 FR 70709 - Sunshine Act Meeting; Emergency Meeting Notice

Science.gov (United States)

2011-11-15

... COMMODITY FUTURES TRADING COMMISSION Sunshine Act Meeting; Emergency Meeting Notice This notice that an emergency meeting was held is published pursuant to the provisions of the Government in the Sunshine Act, Public Law 94-409, 5 U.S.C. 552b. AGENCY HOLDING THE MEETING: Commodity Futures Trading...

Practice development using video-reflexive ethnography: promoting safe space(s towards the end of life in hospital

Directory of Open Access Journals (Sweden)

Aileen Collier

2016-05-01

Full Text Available Background: There is international consensus of the need for improved palliative and end-of-life care in hospital settings. What is less clear is how such improvements might be realised in practice. Research and practice improvement methodologies need to acknowledge the relational, spiritual, moral and ethical as well as physical dimensions of death and dying if improvements in care are to be achieved. Aims and objectives: The aim of this article is to explore the potential of video-reflexive ethnography as a practice development methodology to improve care of people with a life-limiting illness in the hospital setting. Methods: The study used video-reflexive ethnography and was underpinned by an indigenous research ethical framework. Findings: Study findings highlight the potential of video-reflexive ethnography as a practice development methodology. The reach of video extended internally and externally beyond immediate practice research sites to make hospital dying tangible. The research acted as a disruptive innovation, foregrounding peoples’ (patients and families expertise as well as that of healthcare workers. For some patient and family participants, the research offered a visual legacy. Conclusions: The theories underpinning video-reflexive ethnography and practice development are closely aligned; the former has potential as a practice development methodology to promote person-centred palliative and end-of-life care. The underpinning philosophical, ethical and values framework through which it is applied, along with the skills and aptitude of facilitation, are critical if its potential is to be realised. Implications for practice development: The delivery of person-centred end-of-life care may be facilitated by: Healthcare workers seeing themselves and those they care for differently Healthcare organisations seeing their employees as well as patients and families differently Researchers also being prepared to see themselves differently

Dead-time free pixel readout architecture for ATLAS front-end IC

CERN Document Server

Einsweiler, Kevin F; Kleinfelder, S A; Luo, L; Marchesini, R; Milgrome, O; Pengg, F X

1999-01-01

A low power sparse scan readout architecture has been developed for the ATLAS pixel front-end IC. The architecture supports a dual discriminator and extracts the time over threshold (TOT) information along with a 2-D spatial address $9 of the hits associating them with a unique 7-bit beam crossing number. The IC implements level-1 trigger filtering along with event building (grouping together all hits in a beam crossing) in the end of column (EOC) buffer. The $9 events are transmitted over a 40 MHz serial data link with the protocol supporting buffer overflow handling by appending error flags to events. This mixed-mode full custom IC is implemented in 0.8 mu HP process to meet the $9 requirements for the pixel readout in the ATLAS inner detector. The circuits have been tested and the IC provides dead-time-less ambiguity free readout at 40 MHz data rate.