WorldWideScience

Sample records for making life easier

  1. Making Healthy Choices Easier

    Guldborg Hansen, Pelle; Skov, Laurits Rohden; Lund Skov, Katrine

    2016-01-01

    . However, integration and testing of the nudge approach as part of more comprehensive public health strategies aimed at making healthy choices easier is being threatened by inadequate understandings of its scientific character, relationship with regulation and its ethical implications. This article reviews...... working with or incorporating the nudge approach into programs or policies aimed at making healthy choices easier...

  2. Making Healthy Choices Easier: Regulation versus Nudging.

    Hansen, Pelle Guldborg; Skov, Laurits Rohden; Skov, Katrine Lund

    2016-01-01

    In recent years, the nudge approach to behavior change has emerged from the behavioral sciences to challenge the traditional use of regulation in public health strategies to address modifiable individual-level behaviors related to the rise of noncommunicable diseases and their treatment. However, integration and testing of the nudge approach as part of more comprehensive public health strategies aimed at making healthy choices easier are being threatened by inadequate understandings of its scientific character, its relationship with regulation, and its ethical implications. This article reviews this character and its ethical implication with a special emphasis on the compatibility of nudging with traditional regulation, special domains of experience, and the need for a more nuanced approach to the ethical debate. The aim is to advance readers' understanding and give guidance to those who have considered working with or incorporating the nudge approach into programs or policies aimed at making healthful choices easier.

  3. Counter traction makes endoscopic submucosal dissection easier.

    Oyama, Tsuneo

    2012-11-01

    Poor counter traction and poor field of vision make endoscopic submucosal dissection (ESD) difficult. Good counter traction allows dissections to be performed more quickly and safely. Position change, which utilizes gravity, is the simplest method to create a clear field of vision. It is useful especially for esophageal and colon ESD. The second easiest method is clip with line method. Counter traction made by clip with line accomplishes the creation of a clear field of vision and suitable counter traction thereby making ESD more efficient and safe. The author published this method in 2002. The name ESD was not established in those days; the name cutting endoscopic mucosal resection (EMR) or EMR with hook knife was used. The other traction methods such as external grasping forceps, internal traction, double channel scope, and double scopes method are introduced in this paper. A good strategy for creating counter traction makes ESD easier.

  4. Counter Traction Makes Endoscopic Submucosal Dissection Easier

    Oyama, Tsuneo

    2012-01-01

    Poor counter traction and poor field of vision make endoscopic submucosal dissection (ESD) difficult. Good counter traction allows dissections to be performed more quickly and safely. Position change, which utilizes gravity, is the simplest method to create a clear field of vision. It is useful especially for esophageal and colon ESD. The second easiest method is clip with line method. Counter traction made by clip with line accomplishes the creation of a clear field of vision and suitable co...

  5. Making Health Easier: Healthy Schools in Philadelphia, PA PSA (:60)

    2013-06-07

    A middle school student is making healthy changes in his life, like eating less junk food, thanks to healthy changes at his school.  Created: 6/7/2013 by National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP).   Date Released: 6/7/2013.

  6. Making Health Easier: Active Living in Philadelphia, PA PSA (:60)

    Making communities bike-friendly can help reduce traffic congestion and increase the physical activity of residents. Learn how one Philadelphia resident worked with his community to make Philadelphia a more bike-friendly city.

  7. Making Health Easier: Active Living in Philadelphia, PA PSA (:60)

    2013-06-07

    Making communities bike-friendly can help reduce traffic congestion and increase the physical activity of residents. Learn how one Philadelphia resident worked with his community to make Philadelphia a more bike-friendly city.  Created: 6/7/2013 by National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP).   Date Released: 6/7/2013.

  8. Making Health Easier: Worksite Wellness in Pima, AZ PSA (:60)

    To ease its rising healthcare costs, one company decided to make healthy changes in the workplace, like offering healthy food in vending machines and creating a walking path. As a result of the company’s efforts, health claims dropped by 70 percent and employees lost 440 pounds as a group.

  9. Making Health Easier: Active Living in Austin, TX PSA (:60)

    2013-06-07

    A local Austin, Texas, woman started a walking group to make physical activity fun for herself and community.  Created: 6/7/2013 by National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP).   Date Released: 6/7/2013.

  10. Making Health Easier: Healthy Snacking in Philadelphia, PA PSA (:60)

    2013-06-07

    Instead of candy bars and chips, see how one employee is making healthier snack choices with the help of new vending machines.  Created: 6/7/2013 by National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP).   Date Released: 6/7/2013.

  11. Making Health Easier: Worksite Wellness in Pima, AZ PSA (:60)

    2013-06-05

    To ease its rising healthcare costs, one company decided to make healthy changes in the workplace, like offering healthy food in vending machines and creating a walking path. As a result of the company’s efforts, health claims dropped by 70 percent and employees lost 440 pounds as a group.  Created: 6/5/2013 by National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP).   Date Released: 6/5/2013.

  12. Absolute symbolic addressing, a structure making time-sharing easier

    Debraine, P.

    1968-08-01

    Time-sharing of computers asks for a certain number of conditions, particularly, an efficient dynamic loading of programs and data. This paper indicates a paging method making linkages with a minimum of table-looking operations. The principle is to use associative memory registers for calling blocks of physical memory, the block address being given by the concatenation of a file number (located in a base register) and a page number (located in the instruction proper). The position within the block is given by a displacement located in the instruction. A second associated base register contains the local part (page number + displacement) of the base address. This extended base register system allows executing programs in a very large programming complex without loss of time. The addresses are fixed at assembly time and the blocks can be loaded anywhere without modification for execution. The various problems associated with the execution of complex programs are presented in this context and shown to be easily solved by the proposed system, the realization of which would be very easy starting from the computer structures existing now. (author) [fr

  13. Ei Compendex: A new database makes life easier for engineers

    2001-01-01

    The Library is expanding its range of databases. The latest arrival, called Ei Compendex, is the world's most comprehensive engineering database, which indexes engineering literature published throughout the world. It also offers bibliographic entries for articles published in scientific journals and for conference proceedings and covers an extensive range of subjects from mechanical engineering to the environment, materials science, solid state physics and superconductivity. Moreover, it is the most relevant quality control and engineering management database. Ei Compendex contains over 4.6 million references from over 2600 journals, conference proceedings and technical reports dating from 1966 to the present. Every year, 220,000 new abstracts are added to the database which is also updated on a weekly basis. In the case of articles published in recent years, it provides an electronic link to the full texts of all major publishers. The database also contains the full texts of Elsevier periodicals (over 250...

  14. Is Making Divorce Easier Bad for Children? The Long-Run Implications of Unilateral Divorce

    Jonathan Gruber

    2004-01-01

    Most states in the U.S. allow for unilateral divorce, which increases the ease of divorce by not requiring the explicit consent of both partners. Such regulations have come under fire for their perceived negative consequences for marital stability and resulting child outcomes, but there is no evidence to date to support the contention that easier divorce regulations are actually bad for children. I assess the long run implications for children of growing up in a unilateral divorce environment...

  15. Does surface anodisation of titanium implants change osseointegration and make their extraction from bone any easier?

    Langhoff, J; Mayer, J; Faber, L; Kästner, S B; Guibert, G; Zlinszky, K; Auer, J A; von Rechenberg, B

    2008-01-01

    Objectives: Titanium implants have a tendency for high bone-implant bonding, and, in comparison to stainless steel implants are more difficult to remove. The current study was carried out to evaluate, i) the release strength of three selected anodized titanium surfaces with increased nanohardness and low roughness, and ii) bone-implant bonding in vivo. These modified surfaces were intended to give improved anchorage while facilitating easier removal of temporary implants. Material and methods...

  16. New technical design of food packaging makes the opening process easier for patients with hand disorders.

    Hensler, Stefanie; Herren, Daniel B; Marks, Miriam

    2015-09-01

    Opening packaged food is a complex daily activity carried out worldwide. Peelable packaging, as used for cheese or meat, causes real problems for many consumers, especially elderly people and those with hand disorders. Our aim was to investigate the possibility of producing meat packaging that is easier for patients with hand disorders to open. One hundred patients with hand osteoarthritis were asked to open a meat package currently available in supermarkets (Type A) and a modified, newly designed version (Type B), and rate their experiences with a consumer satisfaction index (CSI). The mean CSI of the Type B packs was 68.9%, compared with 41.9% for Type A (p food packages that afford greater consumer satisfaction. Such future packaging would benefit not only people with hand disorders but also the population as a whole. Copyright © 2015 Elsevier Ltd and The Ergonomics Society. All rights reserved.

  17. Does surface anodisation of titanium implants change osseointegration and make their extraction from bone any easier?

    Langhoff, J D; Mayer, J; Faber, L; Kaestner, S B; Guibert, G; Zlinszky, K; Auer, J A; von Rechenberg, B

    2008-01-01

    Titanium implants have a tendency for high bone-implant bonding, and, in comparison to stainless steel implants are more difficult to remove. The current study was carried out to evaluate, i) the release strength of three selected anodized titanium surfaces with increased nanohardness and low roughness, and ii) bone-implant bonding in vivo. These modified surfaces were intended to give improved anchorage while facilitating easier removal of temporary implants. The new surfaces were referenced to a stainless steel implant and a standard titanium implant surface (TiMAX). In a sheep limb model, healing period was 3 months. Bone-implant bonding was evaluated either biomechanically or histologically. The new surface anodized screws demonstrated similar or slightly higher bone-implant-contact (BIC) and torque release forces than the titanium reference. The BIC of the stainless steel implants was significant lower than two of the anodized surfaces (p = 0.04), but differences between stainless steel and all titanium implants in torque release forces were not significant (p = 0.06). The new anodized titanium surfaces showed good bone-implant bonding despite a smooth surface and increased nanohardness. However, they failed to facilitate implant removal at 3 months.

  18. 76 FR 68047 - Making It Easier for America's Small Businesses and America's Exporters to Access Government...

    2011-11-02

    ... Government should be individualized and efficient. If the private sector can allow consumers to customize... local government services as well as those of private sector partners. (3) Agencies shall make... competitiveness, innovation, and job growth. If we are to thrive in the global economy, and make America the best...

  19. Easier living?

    Høholt, Stine

    2005-01-01

    I ph.d.-projektet: "Easier Living? Streamline design og den æstetiserede livsverden" analyseres 1930'ernes Streamline-bevægelse, som tilhører den amerikanske modernisme inden for industrielt produktdesign. Bevægelsens glatte, strømlinede produkter bliver med deres enorme udbredelse det historiske...

  20. Data Access Services that Make Remote Sensing Data Easier to Use

    Lynnes, Christopher

    2010-01-01

    This slide presentation reviews some of the processes that NASA uses to make the remote sensing data easy to use over the World Wide Web. This work involves much research into data formats, geolocation structures and quality indicators, often to be followed by coding a preprocessing program. Only then are the data usable within the analysis tool of choice. The Goddard Earth Sciences Data and Information Services Center is deploying a variety of data access services that are designed to dramatically shorten the time consumed in the data preparation step. On-the-fly conversion to the standard network Common Data Form (netCDF) format with Climate-Forecast (CF) conventions imposes a standard coordinate system framework that makes data instantly readable through several tools, such as the Integrated Data Viewer, Gridded Analysis and Display System, Panoply and Ferret. A similar benefit is achieved by serving data through the Open Source Project for a Network Data Access Protocol (OPeNDAP), which also provides subsetting. The Data Quality Screening Service goes a step further in filtering out data points based on quality control flags, based on science team recommendations or user-specified criteria. Further still is the Giovanni online analysis system which goes beyond handling formatting and quality to provide visualization and basic statistics of the data. This general approach of automating the preparation steps has the important added benefit of enabling use of the data by non-human users (i.e., computer programs), which often make sub-optimal use of the available data due to the need to hard-code data preparation on the client side.

  1. Technology makes life better

    李红

    2015-01-01

    There are many theories about the relationship between technology and society.With the development of world economy,technology has made great progress.However,many changes were taken place in our daily life,especially the appearance of computer.Sending emails,chatting with others online,search for information which is what we need to learn and many other demands in people’s daily life,computers make all of it into possibility.

  2. Vivência com pais de adolescentes: uma proposta de curso que facilita o relacionamento Vivencia con padres de adolescentes: una propuesta de curso que facilita el relacionamiento An experience of life with parents of adolescents: a proposal of a course which makes the relationship easier

    Célia Maria Ferreira da Silva Teixeira

    1996-07-01

    los aspectos de la adolescencia, la repercusión de ésta en el contexto familiar, así como, propició intercambio de opiniones, compartir dudas, sentimientos de inseguridad frente a la tarea de ser padres de adolescentes, permitiendo la construcción de nuevas formas de percibir por parte de los padres, sentir expresar sus afectos.The author describes an experience of a short term course for parents of adolescents and professionals, who deal with this age group. Participants were mothers of different professions: a principal of an elementary school, a pedagogic coordinator of an elementary and a high school, pedagogues, a student of pedagogy and students of phsyco pedagogy. The reasons for the choice presented by the participants centered in difficulties in the relationship between parents and their children and in the search for more satisfactory and functional forms of the parents-children dyad. The author made use of systemic referential about the adolescence and the phsyco dramatic methodology with the objective of making easier the understanding of the thematic in question. The course not only offered information about the aspects of adolescence, its repercussion in the family context, but also propitiated exchanges of opinions, sharing of doubts, odd feelings of insecurity faced with the task of being parents of adolescents allowing the construction of new ways for the parents o perceive, feel and express their friendship.

  3. Making Cancer Health Text on the Internet Easier to Read for Deaf People Who Use American Sign Language.

    Kushalnagar, Poorna; Smith, Scott; Hopper, Melinda; Ryan, Claire; Rinkevich, Micah; Kushalnagar, Raja

    2018-02-01

    People with relatively limited English language proficiency find the Internet's cancer and health information difficult to access and understand. The presence of unfamiliar words and complex grammar make this particularly difficult for Deaf people. Unfortunately, current technology does not support low-cost, accurate translations of online materials into American Sign Language. However, current technology is relatively more advanced in allowing text simplification, while retaining content. This research team developed a two-step approach for simplifying cancer and other health text. They then tested the approach, using a crossover design with a sample of 36 deaf and 38 hearing college students. Results indicated that hearing college students did well on both the original and simplified text versions. Deaf college students' comprehension, in contrast, significantly benefitted from the simplified text. This two-step translation process offers a strategy that may improve the accessibility of Internet information for Deaf, as well as other low-literacy individuals.

  4. The reality of the women who make our lives easier: experience in a company that assemblies electric motors in Venezuela.

    Yanes Escalona, L; Sandia Venot, R; Escalona, E; Yanes, L

    2012-01-01

    intervene a workline throughout ergonomic approach to diminish incidence of Carpal Tunnel Syndrome (CTS). an ergonomic intervention study was developed in workstations with highest index of musculoskeletal disorder (MED) associated to cumulative trauma. The Deparis method, Reba and Ocra check list methods were used, also morbility reviewes. National and international ethics criteria were carried out. workers identified 3 fundamental issues using the Deparis method: repetitive activities, postures adopted and uncomfortable furniture. The analysis of the workstation with Reba and Ocra methods before the changes, evidenciated that 56% of postures adopted were high risk postures, the 44% remaining were medium and low-risk. Following the active pause program (APP), furniture changes and work rhythm decrease, was noted that the risk of suffering MED decreased. The morbility review, drop in consults of musculoskeletal system (MES) related to CTS observed. The APP was well accepted by women, but not initially men. the research show that when the work rhythm decreases, the symptom of MES related to CTS have a remarkable decrease, also that changes in the furniture, generate great ergonomic differences and changes in the work environment are not possible if workers don't empower the tools to make-it.

  5. Como tornar os termos de consentimento mais fáceis de ler? How to make consent forms easier to read?

    Diego Vinicius Pacheco de Araujo

    2010-01-01

    : Quantitative cross sectional study with 399 subjects. The sample was intentional, selected from different outpatient care units of HCFMUSP. Data collection used an instrument that contained a text with prose compatible for assessment of reading skills needed for comprehension of the consent form. Results. More than 46.6% of the interviewees were classified as functionally illiterate, of these, 12.7% were even unable to understand the proposed task in the text they read . Nevertheless , nearly 50% of the interviewees reported having at least started high school . CONCLUSION: The results and the orientations for the text writing centered on the reader allowed us to make recommendations to render the consent form easier to read . We recommend that the researcher modifies the text to a structural narrative, addressed to the reader, using terms that are familiar., In other words, with terms common to the subjects' and to the medical language. In addition to improving the relationship between the subject and researcher, it is believed that these recommendations may reduce the time taken for the proceeding of research projects, since problems in the wording of consent forms contribute significantly to project delays.

  6. Toward an easier indigocarmine chromoendoscopy.

    Barret, Maximilien; Camus, Marine; Leblanc, Sarah; Coriat, Romain; Prat, Frédéric; Chaussade, Stanislas

    2015-07-10

    Indigocarmine chromoendoscopy has been proven to improve the detection of colonic lesions during screening colonoscopy, and is associated with increased adenoma detection rates. Furthermore, it is commonly used to help in the delineation and characterization of colorectal neoplasms. However, it usually requires the use of a spraying catheter that decreases the suction capacity of the endoscope, and is time- consuming. Herein, we report on the feasibility of indigo carmine chromoendoscopy during colonoscopy without using a spraying catheter, with the dye being administered through the air/water channel of the endoscope. Since the suction channel remains free, the air can be exsufflated and the staining then applies uniformly onto the colonic walls with the excess indigocarmine dye being immediately eliminated. In our experience with various types of colonoscopes and cap-assisted colonoscopy, this procedure makes indigocarmine chromoendoscopy much easier and quicker to perform, and might save the use of a spray catheter.

  7. Making Sense Bringing Everyday Life at Work

    Egmose, Jonas; Gleerup, Janne; Nielsen, Birger Steen

    Inspired by contemporary work life studies on making sense at work this paper elaborates on using Critical Utopian Action Research as methodology for enabling shared learning spaces in which citizens and professionals can conjoin around discussions of deeper human aspirations enabled through...... synergies between civil engagement and organisational capabilities. The paper reports on experiences with enabling free spaces in the contexts of everyday life, where broader human concerns and aspirations can be addressed, as in the context of work life, where organisational responses on these orientations...

  8. Absolute symbolic addressing, a structure making time-sharing easier; Adressage symbolique absolu, structure facilitant le travail en partage de temps

    Debraine, P [Commissariat a l' Energie Atomique, 91 - Saclay (France). Centre d' Etudes Nucleaires, services scientifiques

    1968-08-01

    Time-sharing of computers asks for a certain number of conditions, particularly, an efficient dynamic loading of programs and data. This paper indicates a paging method making linkages with a minimum of table-looking operations. The principle is to use associative memory registers for calling blocks of physical memory, the block address being given by the concatenation of a file number (located in a base register) and a page number (located in the instruction proper). The position within the block is given by a displacement located in the instruction. A second associated base register contains the local part (page number + displacement) of the base address. This extended base register system allows executing programs in a very large programming complex without loss of time. The addresses are fixed at assembly time and the blocks can be loaded anywhere without modification for execution. The various problems associated with the execution of complex programs are presented in this context and shown to be easily solved by the proposed system, the realization of which would be very easy starting from the computer structures existing now. (author) [French] Le partage de temps des ordinateurs demande la realisation d'un certain nombre de conditions, en particulier, un chargement dynamique efficace des programmes et des donnees. Cet article indique une methode de pagination realisant les liaisons avec un minimum de consultations de tables. Le principe consiste a utiliser une memoire associative composee de registres pour appeler les blocs de la memoire physique, l'adresse de bloc etant donnee par concatenation d'un no de fichier (loge dans un registre de base) et d'un no de page (loge dans l'instruction proprement dite). La position a l'interieur du bloc est donnee par un deplacement loge dans l'instruction. Un second registre de base, associe au premier, contient la partie locale (no de page + deplacement) de l'adresse de base. Ce systeme d'extension de registre de base

  9. Soundoff: Mathematics Is Getting Easier.

    Usiskin, Zalman

    1984-01-01

    Teaching mathematics in hard ways, rather than using easier methods or technology, is described. Employing the most efficient means possible to solve a problem is the essence of good mathematics, rather than wasting time in practicing obsolete skills. (MNS)

  10. Creating Healthy Habits: Make Better Choices Easier

    ... O'Donnell S, Oluyomi DT, Epstein LH. Consciousness and Cognition. 2017 May;51:10-16. doi: 10.1016/ ... Editor: Tianna Hicklin, Ph.D. Illustrator: Alan Defibaugh Attention Editors: Reprint our articles and illustrations in your ...

  11. Making SPC easier with zone control charts

    Lanning, B.

    1995-01-01

    The zone control chart is a simple, easy to learn statistical process control (SPC) tool that can be applied to any process where the data are normally distributed. Several Shewhart runs rules are incorporated into a simple scoring system, with a single rule to determine when a process is out of control. Zone charts have average run lengths (ARLs) for detecting shifts in the process mean which, for most cases, are uniformly better than the standard control charts. This paper presents the simplified methodology behind the zone control chart

  12. Better science does not make decisions easier

    Ale, B.J.M.

    2013-01-01

    Forty years of development in the science and technology of estimating and quantifying risk, of understanding of human behaviour and human rationale has made decision makers more informed. We are in a much better position now, than forty years ago in estimating probabilities, consequences, and

  13. Managing Daily Life

    ... Duchenne / Managing Daily Life Print Email Managing Daily Life Environmental accessibility As the person with Duchenne starts ... such as wider doorways and ramps, can make life easier once the person with Duchenne cannot climb ...

  14. Should divorce be easier or harder?

    Gonzalez, Libertad

    2014-01-01

    Many countries have enacted legislation over the past few decades making divorce easier. Some countries have legalized divorce where it had previously been banned, and many have eased the conditions required for a divorce, such as allowing unilateral divorce (both spouses do not have to agree on the divorce). Divorce laws can regulate the grounds for divorce, division of property, child custody, and child support or maintenance payments. Reforms can have a range of social effects beyond incre...

  15. Luxuries are Easier to Postpone

    Browning, Martin; Crossley, Thomas

    2000-01-01

    We show that (Marshallian) income elasticities are proportional to (Frisch) own price elasticities if all goods are additively separable. This implies that luxuries are likely to be easier to postpone. It also implies that preferences over "consumption" are unlikely to display a constant elasticity...

  16. Go4Life

    Full Text Available ... This item has been hidden Go4Life Exercises — Building Strength Play all Try some of these Go4Life exercises to improve your strength! Stronger muscles can make it easier to do ...

  17. Economic modeling for life extension decision making

    Farber, M.A.; Harrison, D.L.; Carlson, D.D.

    1986-01-01

    This paper presents a methodology for the economic and financial analysis of nuclear plant life extension under uncertainty and demonstrates its use in a case analysis. While the economic and financial evaluation of life extension does not require new analytical tools, such studies should be based on the following three premises. First, the methodology should examine effects at the level of the company or utility system, because the most important economic implications of life extension relate to the altered generation system expansion plan. Second, it should focus on the implications of uncertainty in order to understand the factors that most affect life extension benefits and identify risk management efforts. Third, the methodology should address multiple objectives, at a minimum, both economic and financial objectives

  18. Economic modelling for life extension decision making

    Farber, M.A.; Harrison, D.L.; Carlson, D.D.

    1987-01-01

    This paper presents a methodology for the economic and financial analysis of nuclear plant life extension under uncertainty and demonstrates its use in a case analysis. While the economic and financial evaluation of life extension does not require new analytical tools, such studies should be based on the following three premises. First, the methodology should examine effects at the level of the company or utility system, because the most important economic implications of life extension relate to the altered generation system expansion plan. Second, it should focus on the implications of uncertainty in order to understand the factors that most affect life extension benefits and identify risk management efforts. Third, the methodology should address multiple objectives, at a minimum, both economic and financial objectives. An analysis of the role of life extension for Virginia Power's generating system was performed using the MIDAS model, developed by the Electric Power Research Institute. MIDAS is particularly well suited to this type of study because of its decision analysis framework. The model incorporates modules for load analysis, capacity expansion, production costing, financial analysis, and rates. The decision tree structure facilitates the multiple-scenario analysis of uncertainty. The model's output includes many economic and financial measures, including capital expenditures, fuel and purchases power costs, revenue requirements, average rates, external financing requirements, and coverage ratio. Based on findings for Virginia Power's Surry 1 plant, nuclear plant life extension has economic benefits for a utility's customers and financial benefits for the utility's investors. These benefits depend on a number of economic, technical and regulatory factors. The economic analysis presented in this paper identifies many of the key factors and issues relevant to life extension planning

  19. Decision making across the life span

    Li, S.C.; Ridderinkhof, K.R.; Samanez-Larkin, G.R.

    2014-01-01

    Learning to choose adaptively between different behavioral options in order to reach goals is a pervasive task in life for people of all ages. Individuals are often confronted with complex, uncertain situations that nonetheless require decisive actions that would facilitate the pursuit of short-term

  20. Computers make rig life extension an option

    NONE

    1996-10-01

    The worldwide semisubmersible drilling rig fleet is approaching retirement. But replacement is not an attractive option even though dayrates are reaching record highs. In 1991, Schlumberger Sedco Forex managers decided that an alternative might exist if regulators and insurers could be convinced to extend rig life expectancy through restoration. Sedco Forex chose their No. 704 semisubmersible, an 18-year North Sea veteran, to test their process. The first step was to determine what required restoration, meaning fatigue life analysis of each weld on the huge vessel. If inspected, the task would be unacceptably time-consuming and of questionable accuracy. Instead a suite of computer programs modeled the stress seen by each weld, statistically estimated the sea states seen by the rig throughout its North Sea service and calibrated a beam-element model on which to run their computer simulations. The elastic stiffness of the structure and detailed stress analysis of each weld was performed with ANSYS, a commercially available finite-element analysis program. The use of computer codes to evaluate service life extension is described.

  1. Go4Life

    Full Text Available ... strength! Stronger muscles can make it easier to do everyday things like get up from a chair, ... 797 views Trainer Sandy shows Linda how to do lower body exercises in her office with Go4Life's ...

  2. Competence and Quality in Real-Life Decision Making

    2015-01-01

    What distinguishes a competent decision maker and how should the issue of decision quality be approached in a real-life context? These questions were explored in three studies. In Study 1, using a web-based questionnaire and targeting a community sample, we investigated the relationships between objective and subjective indicators of real-life decision-making success. In Study 2 and 3, targeting two different samples of professionals, we explored if the prevalent cognitively oriented definition of decision-making competence could be beneficially expanded by adding aspects of competence in terms of social skills and time-approach. The predictive power for each of these three aspects of decision-making competence was explored for different indicators of real-life decision-making success. Overall, our results suggest that research on decision-making competence would benefit by expanding the definition of competence, by including decision-related abilities in terms of social skills and time-approach. Finally, the results also indicate that individual differences in real-life decision-making success profitably can be approached and measured by different criteria. PMID:26545239

  3. Competence and Quality in Real-Life Decision Making.

    Geisler, Martin; Allwood, Carl Martin

    2015-01-01

    What distinguishes a competent decision maker and how should the issue of decision quality be approached in a real-life context? These questions were explored in three studies. In Study 1, using a web-based questionnaire and targeting a community sample, we investigated the relationships between objective and subjective indicators of real-life decision-making success. In Study 2 and 3, targeting two different samples of professionals, we explored if the prevalent cognitively oriented definition of decision-making competence could be beneficially expanded by adding aspects of competence in terms of social skills and time-approach. The predictive power for each of these three aspects of decision-making competence was explored for different indicators of real-life decision-making success. Overall, our results suggest that research on decision-making competence would benefit by expanding the definition of competence, by including decision-related abilities in terms of social skills and time-approach. Finally, the results also indicate that individual differences in real-life decision-making success profitably can be approached and measured by different criteria.

  4. Issues surrounding end-of-life decision-making

    Tejwani V

    2013-08-01

    Full Text Available Vickram Tejwani,1,* YiFan Wu,1,* Sabrina Serrano,2 Luis Segura,2 Michael Bannon,3 Qi Qian1 1Department of Medicine, Division of Nephrology and Hypertension, 2Mayo Graduate School, 3Department of Trauma, Critical Care, and General Surgery, Mayo Clinic College of Medicine, Rochester, MN, USA *These authors contributed equally to this work Abstract: End-of-life decision-making is a complex process that can be extremely challenging. We describe a 42-year-old woman in an irreversible coma without an advance directive. The case serves to illustrate the complications that can occur in end-of-life decision-making and challenges in resolving difficult futility disputes. We review the role of advance directives in planning end-of-life care, the responsibility and historical performance of patient surrogates, the genesis of futility disputes, and approaches to resolving disputes. Keywords: end-of-life care, advance directive, surrogate, futility dispute, conflict resolution

  5. Competence and Quality in Real-Life Decision Making

    Geisler, Martin; Allwood, Carl Martin

    2015-01-01

    What distinguishes a competent decision maker and how should the issue of decision quality be approached in a real-life context? These questions were explored in three studies. In Study 1, using a web-based questionnaire and targeting a community sample, we investigated the relationships between objective and subjective indicators of real-life decision-making success. In Study 2 and 3, targeting two different samples of professionals, we explored if the prevalent cognitively oriented definiti...

  6. End-of-life decision making in the ICU.

    Siegel, Mark D

    2009-03-01

    A large proportion of deaths, particularly in the developed world, follows admission to an ICU. Therefore, end-of life decision making is an essential facet of critical care practice. For intensivists, managing death in the critically ill has become a key professional skill. They must be thoroughly familiar with the ethical framework that guides end-of-life decision making. Decisions should generally be made collaboratively by clinicians partnering with patients' families. Treatment choices should be crafted to meet specific, achievable goals. A rational, empathic approach to working with families should encourage appropriate, mutually satisfactory outcomes.

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

    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.

  8. Decision-making heuristics and biases across the life span

    Strough, JoNell; Karns, Tara E.; Schlosnagle, Leo

    2013-01-01

    We outline a contextual and motivational model of judgment and decision-making (JDM) biases across the life span. Our model focuses on abilities and skills that correspond to deliberative, experiential, and affective decision-making processes. We review research that addresses links between JDM biases and these processes as represented by individual differences in specific abilities and skills (e.g., fluid and crystallized intelligence, executive functioning, emotion regulation, personality traits). We focus on two JDM biases—the sunk-cost fallacy (SCF) and the framing effect. We trace the developmental trajectory of each bias from preschool through middle childhood, adolescence, early adulthood, and later adulthood. We conclude that life-span developmental trajectories differ depending on the bias investigated. Existing research suggests relative stability in the framing effect across the life span and decreases in the SCF with age, including in later life. We highlight directions for future research on JDM biases across the life span, emphasizing the need for process-oriented research and research that increases our understanding of JDM biases in people’s everyday lives. PMID:22023568

  9. Decision-making heuristics and biases across the life span.

    Strough, Jonell; Karns, Tara E; Schlosnagle, Leo

    2011-10-01

    We outline a contextual and motivational model of judgment and decision-making (JDM) biases across the life span. Our model focuses on abilities and skills that correspond to deliberative, experiential, and affective decision-making processes. We review research that addresses links between JDM biases and these processes as represented by individual differences in specific abilities and skills (e.g., fluid and crystallized intelligence, executive functioning, emotion regulation, personality traits). We focus on two JDM biases-the sunk-cost fallacy (SCF) and the framing effect. We trace the developmental trajectory of each bias from preschool through middle childhood, adolescence, early adulthood, and later adulthood. We conclude that life-span developmental trajectories differ depending on the bias investigated. Existing research suggests relative stability in the framing effect across the life span and decreases in the SCF with age, including in later life. We highlight directions for future research on JDM biases across the life span, emphasizing the need for process-oriented research and research that increases our understanding of JDM biases in people's everyday lives. © 2011 New York Academy of Sciences.

  10. Making the Earth to Life Connection Using Climate Change

    Haine, D. B.; Berbeco, M.

    2016-12-01

    From ocean acidification to changes in air quality to shifts in the range of disease vectors, there are many opportunities for educators to make the earth science to life science connection by incorporating the impacts of climate change on organisms and entire ecosystems and by describing how living organisms impact climate. NCSE's study in Science found that 86% of life science teachers are teaching climate, but few admit they have any formal climate science training. This session will introduce activities we developed that utilize the 2014 National Climate Assessment, data visualizations, technology tools and models to allow students to explore the evidence that climate change is impacting life. Translating the NCA into classroom activities is an approach that becomes more pertinent with the advent of the Next Generation Science Standards (NGSS). Using the NCA and the NGSS we demonstrate strategies for weaving the concept of climate change into an already packed life science curriculum by enhancing rather than displacing content and ultimately promoting integration of science and engineering practices into instruction. Since the fall of 2014 we have engaged approximately 200 K-12 educators at local, state, regional and national teacher professional development events. Here we will summarize what we have learned from science teachers about how they address life science impacts of climate change and we will summarize evaluation data to inform future efforts to engage life science educators in light of the recent USGCRP Climate and Health Assessment and the upcoming 4th National Climate Assessment.

  11. Team Leadership and Cancer End-of-Life Decision Making.

    Waldfogel, Julie M; Battle, Dena J; Rosen, Michael; Knight, Louise; Saiki, Catherine B; Nesbit, Suzanne A; Cooper, Rhonda S; Browner, Ilene S; Hoofring, Laura H; Billing, Lynn S; Dy, Sydney M

    2016-11-01

    End-of-life decision making in cancer can be a complicated process. Patients and families encounter multiple providers throughout their cancer care. When the efforts of these providers are not well coordinated in teams, opportunities for high-quality, longitudinal goals of care discussions can be missed. This article reviews the case of a 55-year-old man with lung cancer, illustrating the barriers and missed opportunities for end-of-life decision making in his care through the lens of team leadership, a key principle in the science of teams. The challenges demonstrated in this case reflect the importance of the four functions of team leadership: information search and structuring, information use in problem solving, managing personnel resources, and managing material resources. Engaging in shared leadership of these four functions can help care providers improve their interactions with patients and families concerning end-of-life care decision making. This shared leadership can also produce a cohesive care plan that benefits from the expertise of the range of available providers while reflecting patient needs and preferences. Clinicians and researchers should consider the roles of team leadership functions and shared leadership in improving patient care when developing and studying models of cancer care delivery.

  12. Ethical decision-making near the end of life.

    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.

  13. Application of structural reliability and risk assessment to life prediction and life extension decision making

    Meyer, T.A.; Balkey, K.R.; Bishop, B.A.

    1987-01-01

    There can be numerous uncertainties involved in performing component life assessments. In addition, sufficient data may be unavailable to make a useful life prediction. Structural Reliability and Risk Assessment (SRRA) is primarily an analytical methodology or tool that quantifies the impact of uncertainties on the structural life of plant components and can address the lack of data in component life prediction. As a prelude to discussing the technical aspects of SRRA, a brief review of general component life prediction methods is first made so as to better develop an understanding of the role of SRRA in such evaluations. SRRA is then presented as it is applied in component life evaluations with example applications being discussed for both nuclear and non-nuclear components

  14. Making Health Easier: Healthy Schools in Minnesota PSA (:60)

    To bring healthier meals to students at the Dover-Eyota elementary school in Minnesota, school officials and parents started a partnership with local farmers. The farm-to-school program has brought better food, like watermelon and corn on the cob, to the children while building ties within the community.

  15. On a radioimmunoassay ratio making the diagnosis of dysthyroidism easier

    Bresson, Y.; Marty, D.; Moullart, V.

    1982-01-01

    The offered ratio is a dimensionless number, independant of kits, or units and usually fluctuates around one. We obtain it by [TBGsub(m)/Tsub(4m)].[T 4 ]/[TBG] and, divided by a constant, it represents the first term of the development in series of the free thyroxin index mathematical expression from which it gives a nearly perfect value. Using this ratio the discrimination between eu- and hyperthyroidism is very apparent as well as the distinction between hypo and euthyroidism. The children from two to fifteen years of age and the women under hormonal contraception treatment show normal value. These results have been confirmed by a statistical investigation including 184 normal subjects, 76 hyperthyroid subjects without treatment, 18 euthyroid women under hormonal contraception treatment and 32 children from birth to fifteen years of age. It is conclued from this statistical investigation that the offered ratio is more accurate and more reliable as a mean of diagnosis than the free thyroxin index when calculated from the T3 uptake test [fr

  16. Making Health Easier: Active Living in Los Angeles, CA

    Childhood obesity now affects about one in six kids and disproportionately affects low-income and minority populations. This podcast highlights one preschool teacher who teaches kids about active living and is incorporating small, healthy changes that can be made in any classroom—like teaching fun dances and yoga classes.

  17. Making Health Easier: Healthy Eating in Los Angeles, CA

    Childhood obesity now affects about one in six kids and disproportionately affects low-income and minority populations. This podcast highlights one preschool teacher who teaches kids about healthy eating and is incorporating small, healthy changes that can be made in any classroom—like planting a classroom garden and eating healthy snacks.

  18. Making Health Easier: Healthy Changes Start in Preschool

    This podcast highlights the efforts of one educational organization, Los Angeles Universal Preschool (LAUP), to keep kids healthy at an early age. Childhood obesity now affects about one in six kids and disproportionately affects low-income and minority populations. LAUP teaches kids healthy habits and is incorporating small, healthy changes that can be made in any classroom—like teaching fun dances and providing nutritious snacks.

  19. Making Health Easier: Healthy Schools in Chicago, IL PSA (:60)

    2013-05-21

    To help Chicago schools increase access to healthy food, Health Educator April Lillstrom utilized community partnerships to provide school gardens, salad bars, and nutrition education to students.  Created: 5/21/2013 by National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP).   Date Released: 5/21/2013.

  20. Managing Diabetes: New Technologies Can Make It Easier

    ... Epub ahead of print]. PMID: 28855239. 12-Week 24/7 Ambulatory Artificial Pancreas With Weekly Adaptation of Insulin ... nih.gov/wellnesstoolkits . Footer Subscribe Find us on Facebook RSS Home Past Issues About Us Privacy Accessibility ...

  1. Make man-machine communication easier: fuzzy programming

    Farreny, H; Prade, H

    1982-06-01

    Procedures and data used by the human brain are not always accurately specified; fuzzy programming may help in the realisation of languages for the manipulation of such fuzzy entities. After having considered fuzzy instruction and its requirements, arguments, functions, predicates and designations, the authors present the outlines of a fuzzy filtering system. Two applications are given as examples; these are the accessing of a database and an expert system which may be used to solve problems in robotics.

  2. Direct peroral cholangioscopy using an ultrathin endoscope: making technique easier

    Javier Sola-Vera

    2014-01-01

    Full Text Available Background: Cholangioscopy is a useful tool for the study and treatment of biliary pathology. Ultrathin upper endoscopes allow direct peroral cholangioscopy (DPC but have some drawbacks. Objective: The aim of the study was to evaluate the success rate of DPC with an ultrathin endoscope using a balloon catheter to reach the biliary confluence. Material and methods: Prospective observational study. An ultrathin endoscope (Olympus XP180N, outer diameter 5.5 mm, working channel 2 mm was used. To access the biliary tree, free-hand technique was used. To reach the biliary confluence an intraductal balloon catheter (Olympus B5-2Q diameter 1.9 mm and a 0.025 inch guide wire was used. In all cases sphincterotomy and/or sphincteroplasty was performed. The success rate was defined as the percentage of cases in which the biliary confluence could be reached with the ultrathin endoscope. Results: Fifteen patients (8 men/7 women were included. Mean age was 77.7 ± 10.8 years (range 45-91. The indications for cholangioscopy were suspected bile duct stones (n = 9, electrohydraulic lithotripsy for the treatment of difficult choledocholithiasis (n = 5 and evaluation of biliary stricture (n = 1. Access to the bile duct was achieved in 14/15 cases (93.3 %. Biliary confluence was reached in 13/15 cases (86.7 %. One complication was observed in one patient (oxigen desaturation. Conclusions: DPC with an ultrathin endoscope can be done with the free-hand technique. Intraductal balloon-guided DPC allows full examination of the common bile duct in most cases.

  3. Making Health Easier: Healthy Changes Start in Preschool

    2012-09-19

    This podcast highlights the efforts of one educational organization, Los Angeles Universal Preschool (LAUP), to keep kids healthy at an early age. Childhood obesity now affects about one in six kids and disproportionately affects low-income and minority populations. LAUP teaches kids healthy habits and is incorporating small, healthy changes that can be made in any classroom—like teaching fun dances and providing nutritious snacks.  Created: 9/19/2012 by National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP).   Date Released: 10/1/2012.

  4. Making Interoperability Easier with the NASA Metadata Management Tool

    Shum, D.; Reese, M.; Pilone, D.; Mitchell, A. E.

    2016-12-01

    ISO 19115 has enabled interoperability amongst tools, yet many users find it hard to build ISO metadata for their collections because it can be large and overly flexible for their needs. The Metadata Management Tool (MMT), part of NASA's Earth Observing System Data and Information System (EOSDIS), offers users a modern, easy to use browser based tool to develop ISO compliant metadata. Through a simplified UI experience, metadata curators can create and edit collections without any understanding of the complex ISO-19115 format, while still generating compliant metadata. The MMT is also able to assess the completeness of collection level metadata by evaluating it against a variety of metadata standards. The tool provides users with clear guidance as to how to change their metadata in order to improve their quality and compliance. It is based on NASA's Unified Metadata Model for Collections (UMM-C) which is a simpler metadata model which can be cleanly mapped to ISO 19115. This allows metadata authors and curators to meet ISO compliance requirements faster and more accurately. The MMT and UMM-C have been developed in an agile fashion, with recurring end user tests and reviews to continually refine the tool, the model and the ISO mappings. This process is allowing for continual improvement and evolution to meet the community's needs.

  5. Making Health Easier: Worksite Wellness in Minnesota PSA (:60)

    When firefighters in Minnesota discovered that over 50 percent of firefighter deaths were cardiovascular-related, they decided to implement healthy changes in the workplace. The firefighters now manage a garden near the fire station and eat fresh broccoli, squash, and tomatoes between shifts.

  6. Making Health Easier: Healthy Schools in Minnesota PSA (:60)

    2013-06-05

    To bring healthier meals to students at the Dover-Eyota elementary school in Minnesota, school officials and parents started a partnership with local farmers. The farm-to-school program has brought better food, like watermelon and corn on the cob, to the children while building ties within the community.  Created: 6/5/2013 by National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP).   Date Released: 6/5/2013.

  7. Making Health Easier: Worksite Wellness in Minnesota PSA (:60)

    2013-06-04

    When firefighters in Minnesota discovered that over 50 percent of firefighter deaths were cardiovascular-related, they decided to implement healthy changes in the workplace. The firefighters now manage a garden near the fire station and eat fresh broccoli, squash, and tomatoes between shifts.  Created: 6/4/2013 by National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP).   Date Released: 6/4/2013.

  8. Making Health Easier: Active Living in Los Angeles, CA

    2013-03-05

    Childhood obesity now affects about one in six kids and disproportionately affects low-income and minority populations. This podcast highlights one preschool teacher who teaches kids about active living and is incorporating small, healthy changes that can be made in any classroom—like teaching fun dances and yoga classes.  Created: 3/5/2013 by National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP).   Date Released: 3/5/2013.

  9. Making Health Easier: Healthy Eating in Los Angeles, CA

    2013-03-05

    Childhood obesity now affects about one in six kids and disproportionately affects low-income and minority populations. This podcast highlights one preschool teacher who teaches kids about healthy eating and is incorporating small, healthy changes that can be made in any classroom—like planting a classroom garden and eating healthy snacks.  Created: 3/5/2013 by National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP).   Date Released: 3/5/2013.

  10. How to Make Evaluation Time Stress-Free!

    Peterson, Kristy

    2010-01-01

    When it's annual review time, are you frustrated or overwhelmed by the task of remembering an employee's performance throughout the year? Do you ever feel that if you took notes on each task set within the year, it would be easier for you to summarize the evaluation? There is a way to make everyone's life a little easier when giving or receiving…

  11. Life and Death Decision Making, by Baruch A. Brody.

    Veatch, Robert M

    1989-04-01

    Veatch considers the pluralistic casuistry theory advocated by Baruch Brody in his 1988 book, Life and Death Decision Making, to be an important contribution to the secular medical ethics literature. The casuistic and pluralistic elements of Brody's new model are described as intriguing but controversial because Brody both excludes several ethical appeals (i.e., classical Hippocratic ethics, virtue theory) and/or limits other questionable appeals (i.e., consequences for families and others in society, the virtue of integrity) without accounting for these decisions. Veatch also questions Brody's use of intuitional judgment to determine what ought to be done after examination of various appeals and their significance because Brody's approach raises serious problems about how various appeals are counted. Veatch does affirm the rich assessment of medical ethical problems made possible by Brody's pluralistic approach but notes the difficulties it raises.

  12. Go4Life

    Full Text Available ... all Try some of these Go4Life exercises to improve your flexibility! 2:48 Play next Play now ... all Try some of these Go4Life exercises to improve your strength! Stronger muscles can make it easier ...

  13. Go4Life

    Full Text Available ... Go4Life exercises to improve your strength! Stronger muscles can make it easier to do everyday things like ... 513 views Trainer Sandy shows Irene that you can do Go4Life exercises anywhere, even the kitchen! CC ...

  14. Breakdown Breakthrough: NREL Finds Easier Ways to Deconstruct Biomass |

    News | NREL Breakdown Breakthrough: NREL Finds Easier Ways to Deconstruct Biomass Breakdown Breakthrough: NREL Finds Easier Ways to Deconstruct Biomass May 22, 2018 Roman Brunecky (left), Yannick Bomble soften biomass. Photo by Dennis Schroeder, NREL If there's an easier, more efficient method, science will

  15. Life extension decision making of safety critical systems: An overview

    Shafiee, Mahmood; Animah, I.

    2017-01-01

    In recent years, the concept of “asset life extension” has become increasingly important to safety critical industries including nuclear power, offshore oil and gas, petrochemical, renewable energy, rail transport, aviation, shipping, electricity distribution and transmission, etc. Extending the service life of industrial assets can offer a broad range of economic, technical, social and environmental benefits as compared to other end-of-life management strategies such as decommissioning and r...

  16. JMARS - Planetary Remote Sensing Analysis Made Even Easier

    Dickenshied, S.; Christensen, P. R.; Noss, D.; Anwar, S.; Carter, S.; Smith, M. E.

    2012-12-01

    Planetary remote sensing data has been collected and made public over the years from a variety of missions, but accessing this data and performing analysis on it has often been a time consuming and problematic task. JMARS (Java Mission-planning and Analysis for Remote Sensing) is a free geospatial application developed by the Mars Space Flight Facility at Arizona State University. Originally written as a misson planning tool for the THEMIS instrument on board the MARS Odyssey Spacecraft, it was released as an analysis tool to the general public in 2003. Since then it has expanded to be used for mission planning and scientific data analysis by additional NASA missions to Mars, the Moon, and Vesta and it has come to be used by scientists, researchers and students of all ages from more than 40 countries around the world. JMARS tries to save a user from the nuances of working with planetary data by providing a quick and consistent method of accessing data from various missions which can then be analyzed and compared with each other. A user can easily access hundreds of maps and millions of individual images collected by the Viking, MOC, MOLA, TES, THEMIS, HiRISE, CTX, and CRISM instruments. Users can also import their own data and work with it in an identical fashion, then optionally share that data with other users. Recent effort has been put into making JMARS easier and more consistent to use. A new toolbar makes panning and zooming easier and more intuitive, especially for systems without three button mice. Additionally, the toolbar also exposes measuring and data investigation tools that used to only be accessible in specific layers and obscure keyboard commands. The Layer Manager, which has long allowed users to reorder layers, adjust transparency, and access layer specific options, can now be optionally docked into the main view window, making it easier to work on laptops or overhead projectors. The Layer Manager can still be torn off into it's own independent

  17. Imprinting: When Early Life Memories Make Food Smell Bad.

    Rayes, Diego; Alkema, Mark J

    2016-05-09

    A recent study has found that pathogen exposure early in the life of the nematode Caenorhabditis elegans leads to a long-lasting aversion that requires distinct sets of neurons for the formation and retrieval of the imprinted memory. Copyright © 2016 Elsevier Ltd. All rights reserved.

  18. Examining Community Life "in the Making": Emile Durkheim's "Moral Education"

    Prus, Robert

    2011-01-01

    Although often overlooked in sociological circles, Emile Durkheim's ("1902-1903") "Moral Education" provides an important cornerstone in the quest to understand community life. Not only does "Moral Education" give a vibrant realism to the sociological venture in ways that Durkheim's earlier works ("1893", "1895", "1897') fail to achieve, but in…

  19. What is a “good” treatment decision?: Decisional control, knowledge, treatment decision-making, and quality of life in men with clinically localized prostate cancer

    Orom, Heather; Biddle, Caitlin; Underwood, Willie; Nelson, Christian J.; Homish, D. Lynn

    2016-01-01

    Objective We explored whether active patient involvement in decision making and greater patient knowledge are associated with better treatment decision making experiences and better quality of life (QOL) among men with clinically localized prostate cancer. Localized prostate cancer treatment decision-making is an advantageous model for studying patient treatment decision-making dynamics as there are multiple treatment options and a lack of empirical evidence to recommend one over the other; consequently, it is recommended that patients be fully involved in making the decision. Methods Men with newly diagnosed clinically localized prostate cancer (N=1529) completed measures of decisional control, prostate cancer knowledge, and their decision-making experience (decisional conflict, and decision-making satisfaction and difficulty) shortly after they made their treatment decision. Prostate cancer-specific QOL was assessed 6-months after treatment. Results More active involvement in decision making and greater knowledge were associated with lower decisional conflict and higher decision-making satisfaction, but greater decision-making difficulty. An interaction between decisional control and knowledge revealed that greater knowledge was only associated with greater difficulty for men actively involved in making the decision (67% of sample). Greater knowledge, but not decisional control predicted better QOL 6-months post-treatment. Conclusion Although men who are actively involved in decision making and more knowledgeable may make more informed decisions, they could benefit from decisional support (e.g., decision-making aids, emotional support from providers, strategies for reducing emotional distress) to make the process easier. Men who were more knowledgeable about prostate cancer and treatment side effects at the time they made their treatment decision may have appraised their QOL as higher because they had realistic expectations about side effects. PMID:26957566

  20. Dwelling in Possibilities: Our Students' Spectacular Hunger for Life Makes Them Radically Vulnerable

    Edmundson, Mark

    2009-01-01

    In this article, the author discusses how today's student generation has a spectacular hunger for life and more life. They want to study, travel, make friends, make more friends, read everything (superfast), take in all the movies, listen to every hot band, keep up with everyone they've ever known. They live to multiply possibilities. The author…

  1. Making perfect life : bio-engineering (in) the 21st century : interim study

    Est, van R.; Keulen, van I.; Geesink, I.; Schuiff, M.

    2010-01-01

    Reportnumber: PE 438.829; This document is the result of the preparatory phase of the STOA-project "Making perfect life", that defined the project focus. This resulted in the study document Making Perfect Life: Bio-engineering (in) the 21st century. A project plan for the next two phases was

  2. Nurse involvement in end-of-life decision making: the ETHICUS Study

    Benbenishty, Julie; Ganz, Freda DeKeyser; Lippert, Anne

    2006-01-01

    The purpose was to investigate physicians' perceptions of the role of European intensive care nurses in end-of-life decision making.......The purpose was to investigate physicians' perceptions of the role of European intensive care nurses in end-of-life decision making....

  3. Eliciting regret improves decision making at the end of life.

    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.

  4. The Effect of Providing Life Support on Nurses' Decision Making Regarding Life Support for Themselves and Family Members in Japan.

    Shaku, Fumio; Tsutsumi, Madoka

    2016-12-01

    Decision making in terminal illness has recently received increased attention. In Japan, patients and their families typically make decisions without understanding either the severity of illness or the efficacy of life-supporting treatments at the end of life. Japanese culture traditionally directs the family to make decisions for the patient. This descriptive study examined the influence of the experiences of 391 Japanese nurses caring for dying patients and family members and how that experience changed their decision making for themselves and their family members. The results were mixed but generally supported the idea that the more experience nurses have in caring for the dying, the less likely they would choose to institute lifesupport measures for themselves and family members. The results have implications for discussions on end-of-life care. © The Author(s) 2016.

  5. Remodelling the Life Course: Making the Most of Life with Multiple Sclerosis

    Milka Satinovic

    2017-06-01

    Full Text Available The aim of the study was to develop a substantive grounded theory on how to live a life as good as possible with multiple sclerosis (MS. The question of how to improve the quality of life is of key importance when speaking of a chronic illness like MS. We still have little knowledge of this important question from the patients’ perspective. Classic grounded theory was used to explore patients’ experiences of living with MS. The aim was to identify their main concern and how they process this concern at different phases in their life course. Twenty-one interviews were conducted with 17 participants diagnosed with multiple sclerosis. Participant observation at five courses for people with a multiple sclerosis diagnosis generated field notes. The participants’ main concern was how to live a life as good as possible in spite of their deteriorating health. The participants met this challenge through a process of remodelling the life course, in four phases: postponing (keeping up a normal life, adjusting (moving on to a changed life, restructuring (doing the best of it in a changed life, and transforming (preventing illness from controlling life. The remodelling process is influenced by the individual context, like the current health situation, biography, relations, and structural conditions. The process of remodelling helps us understand what facilitates and what hinders patients with MS from living a good life.

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

    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...

  7. Are networks with more edges easier to synchronize, or not?

    Zhi-Sheng, Duan; Chao, Liu; Guan-Rong, Chen; Wen-Xu, Wang

    2009-01-01

    In this paper, the relationship between network synchronizability and the edge-addition of its associated graph is investigated. First, it is shown that adding one edge to a cycle definitely decreases the network synchronizability. Then, since sometimes the synchronizability can be enhanced by changing the network structure, the question of whether the networks with more edges are easier to synchronize is addressed. Based on a subgraph and complementary graph method, it is shown by examples that the answer is negative even if the network structure is arbitrarily optimized. This reveals that generally there are redundant edges in a network, which not only make no contributions to synchronization but actually may reduce the synchronizability. Moreover, a simple example shows that the node betweenness centrality is not always a good indicator for the network synchronizability. Finally, some more examples are presented to illustrate how the network synchronizability varies following the addition of edges, where all the examples show that the network synchronizability globally increases but locally fluctuates as the number of added edges increases. (general)

  8. The quality of life of single mothers making the transition from welfare to work.

    Cook, Kay; Davis, Elise; Smyth, Paul; McKenzie, Hayley

    2009-09-01

    This study examined the quality of life of single mothers making the mandatory transition from welfare to work. The Australian government purported that the benefits of making this transition would include higher incomes, better social participation, and improved wellbeing. It is currently unknown, however, how single mothers currently engaged in welfare to work programs evaluate their quality of life. Quality of life scores for 334 single mothers engaged in welfare to work in Australia were compared with normative data. Participants reported significantly lower quality of life scores than the general population for all quality of life domains, highlighting the need to carefully examine welfare to work policies to ensure they promote participants' quality of life.

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

    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.…

  10. "Asthma can take over your life but having the right support makes that easier to deal with." Informing research priorities by exploring the barriers and facilitators to asthma control: a qualitative analysis of survey data.

    Normansell, Rebecca; Welsh, Emma

    2015-01-01

    Involving patients and the public in research prioritisation is important. Cochrane Airways works with authors to produce systematic reviews of evidence related to chronic airways disease. Cochrane Airways has undertaken activities to identify research priorities, including workshops with stakeholders and consultation with experts. We present the findings of an online survey, designed to align our work with the priorities of people affected by asthma. We promoted a survey comprising open-ended questions via social media to people affected by asthma. We compiled the free-text responses and conducted an exploratory thematic analysis to identify important barriers and facilitators to asthma control. We triangulated findings with other research prioritisation activities to produce new review questions. We received 57 survey responses. Eight main themes emerged, most encompassing both facilitators and barriers: attitudes and knowledge; financial costs; environmental factors and triggers; healthcare systems; lifestyle factors; medication; self-care; and support. Barriers were more frequently mentioned than facilitators and many related to healthcare systems. These findings offer valuable insights into the challenges faced by individuals affected by asthma in the UK, and possibly further afield. We developed a list of priority reviews based on what was said by people in this survey and at a workshop. This demonstrates the real impact that people affected by asthma have on the research agenda of Cochrane Airways. Over the next 2-3 years we will produce reviews that address some of these questions hopefully leading to health benefits.

  11. How do trees and the small life forms under the ground talk to each other and other outside things: Can they make our world hot (or cool) again?

    Sihi, D.

    2017-12-01

    Trees use water and a bad stuff in air as food with the help of sun light and store the bad stuff in it's body parts (both the parts above the ground and under the ground). However, trees (both above and under ground parts) also return part of the same bad stuff stored in their food to air as it grows. After death, these trees become part of the dead things under the ground and a large part of the bad stuff can be locked under the ground for quite a long time. But, small life forms living under the ground, eat these dead things and return part of the bad stuff locked in these dead things under the ground to the air. The small life forms living under the ground can also make two other stuff (which are even more bad) while eating these dead things under the ground and return them to the air. All of these bad stuffs returned to the air make the air hot. Different things (like sun light, rain, water in the air and under the ground) could make it easier or harder in either storing or returning each of these bad stuffs by the trees or life forms living under the ground in different ways. We study how trees and the small life forms living under the ground talk to each other and to other things mentioned above, and decide how much of those bad stuffs to store and return. But, we do not know well how each of these things can change one another and how trees and small life forms living under the ground will respond to these changes. So, we are yet to understand how much the air will be hotter (if more bad stuff are returned to the air than stored in trees and under the ground) or cooler (if less bad stuffs are returned to the air than stored in trees and under the ground) in tomorrow's world.

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

    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

  13. RELATION BETWEEN QUALITY OF LIFE, CHOICE MAKING, AND FUTURE EXPECTATIONS IN ADULTS WITH INTELLECTUAL DISABILITY

    Vesna KOSTIKJ-IVANOVIKJ

    2016-09-01

    Full Text Available Introduction: Quality of life of individuals depends significantly on the ability to have control over everyday life, realized through the freedom to make choices from available options and self-determination. Objective: To determine the correlation between possibilities for making choices and expectations for the future with the quality of life in adults with intellectual disabilities according self-assessment and assessment by others. Methods: Descriptive, method of correlation and comparative analysis ware applied. From techniques, analysis of documents, surveys with the Quality of life questionnaire by Schalock and Keith and Questionnaire for expectations for the future by Speck, and scaling with the Scale for assessment of the opportunities for making choices by Kishi et al. Sample consisted of 130 intellectually disabled adults and 130 proxies. For establishing connection between the examined phenomena Pearson correlation coefficient (r was used, at p<0,01. Results: There is a strong correlation between the results obtained from the questionnaires about quality of life and opportunities for making choices, self-assessment r(130=0,497, p<0,01, assessment by others r(130=0,482, p<0,01. There is a correlation between the results obtained from the questionnaires about quality of life and expectations for the future, but not very strong, self-assessment r(130=0,233, p=0,008<0,01, assessment by others r(130=0,305, p<0,01. Conclusion: There is a correlation between opportunities for making choices and expectations for the future with the quality of life in adults with intellectual disabilities. To improve the quality of life in these individuals, it is necessary to design programs that will develop self-concept, abilities for self-determination and making personal choices.

  14. The enactment stage of end-of-life decision-making for children.

    Sullivan, Jane Elizabeth; Gillam, Lynn Heather; Monagle, Paul Terence

    2018-01-11

    Typically pediatric end-of-life decision-making studies have examined the decision-making process, factors, and doctors' and parents' roles. Less attention has focussed on what happens after an end-of-life decision is made; that is, decision enactment and its outcome. This study explored the views and experiences of bereaved parents in end-of-life decision-making for their child. Findings reported relate to parents' experiences of acting on their decision. It is argued that this is one significant stage of the decision-making process. A qualitative methodology was used. Semi-structured interviews were conducted with bereaved parents, who had discussed end-of-life decisions for their child who had a life-limiting condition and who had died. Data were thematically analysed. Twenty-five bereaved parents participated. Findings indicate that, despite differences in context, including the child's condition and age, end-of-life decision-making did not end when an end-of-life decision was made. Enacting the decision was the next stage in a process. Time intervals between stages and enactment pathways varied, but the enactment was always distinguishable as a separate stage. Decision enactment involved making further decisions - parents needed to discern the appropriate time to implement their decision to withdraw or withhold life-sustaining medical treatment. Unexpected events, including other people's actions, impacted on parents enacting their decision in the way they had planned. Several parents had to re-implement decisions when their child recovered from serious health issues without medical intervention. Significance of results A novel, critical finding was that parents experienced end-of-life decision-making as a sequence of interconnected stages, the final stage being enactment. The enactment stage involved further decision-making. End-of-life decision-making is better understood as a process rather than a discrete once-off event. The enactment stage has particular

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

    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.

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

    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.

  17. Preferences for autonomy in end-of-life decision making in modern Korean society.

    Kim, Su Hyun

    2015-03-01

    The demand for autonomy in medical decision making is increasing among Korean people, but it is not well known why some people prefer autonomy in decision making but others do not. The aim of this study was to determine the extent to which Korean adults wished to exercise autonomy in the process of decision making regarding end-of-life treatment and to determine whether economic issues and family functioning, in particular, were associated with preferences for participation in decision making in Korean people. This study was a cross-sectional correlational study using a survey. Data were collected using structured questionnaires from 354 patients or their families who visited ambulatory departments at two general hospitals in South Korea, recruited by the proportionate quota sampling method. Data analysis was performed using multinomial logistic regression analyses. The study was approved by the hospitals' directors and the ethics committee of Kyungpook National University Hospital. Written informed consent was given by all participants. A majority of Korean people wanted to make autonomous decisions regarding treatment at the end of life. Preferences for autonomous decision making regarding end-of-life treatment, rather than relying on family, showed a significant increase in association with poor family functioning and low income. Results of this study suggested the necessity for development of alternatives to a dominant traditional "family-centered" approach in Korean people, in order to enhance end-of-life decision making for people who wish to take an active role in the decision-making process. Healthcare providers need to examine not only patients' preferred decision-making style but also any reasons for their choice, in particular, family conflict and financial burden. © The Author(s) 2014.

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

    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.

  19. [The influence of meaning making following stressful life experiences on change of self-concept].

    Horita, Ryo; Sugie, Masashi

    2013-10-01

    As interest in meaning making following stressful life experiences continues to grow, it is important to clarify the features and functions of the meaning- making process. We examined the influence of meaning making following stressful life experiences on change of self-concept. In two studies, university students selected their most stressful life experience and completed the Assimilation and Accommodation of Meaning Making Scale. In Study 1, 235 university students also completed questionnaires regarding post-traumatic growth and positive change of the sense of identity following their stressful life experience. The results of covariance structure analysis indicated that accommodation promoted a positive change of self-concept. In Study 2, 199 university students completed questionnaires regarding change of self-concept and emotion as a positive or negative change following stressful life experiences. The results of covariance structure analysis indicated that accommodation promoted a positive change, similar to the results of Study 1. In addition, accommodation also promoted negative change. However, assimilation did not promote positive change but did restrain negative change.

  20. The rational choice model in family decision making at the end of life.

    Karasz, Alison; Sacajiu, Galit; Kogan, Misha; Watkins, Liza

    2010-01-01

    Most end-of-life decisions are made by family members. Current ethical guidelines for family decision making are based on a hierarchical model that emphasizes the patient's wishes over his or her best interests. Evidence suggests that the model poorly reflects the strategies and priorities of many families. Researchers observed and recorded 26 decision-making meetings between hospital staff and family members. Semi-structured follow-up interviews were conducted. Transcriptions were analyzed using qualitative techniques. For both staff and families, consideration of a patient's best interests generally took priority over the patient's wishes. Staff generally introduced discussion of the patient's wishes for rhetorical purposes, such as persuasion. Competing moral frameworks, which de-emphasized the salience of patients' autonomy and "right to choose," played a role in family decision making. The priority given to the patients' wishes in the hierarchical model does not reflect the priorities of staff and families in making decisions about end-of-life care.

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

    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.

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

    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.

  3. Perceived risks around choice and decision making at end-of-life: a literature review.

    Wilson, F; Gott, M; Ingleton, C

    2013-01-01

    the World Health Organization identifies meeting patient choice for care as central to effective palliative care delivery. Little is known about how choice, which implies an objective balancing of options and risks, is understood and enacted through decision making at end-of-life. to explore how perceptions of 'risk' may inform decision-making processes at end-of-life. an integrative literature review was conducted between January and February 2010. Papers were reviewed using Hawker et al.'s criteria and evaluated according to clarity of methods, analysis and evidence of ethical consideration. All literature was retained as background data, but given the significant international heterogeneity the final analysis specifically focused on the UK context. the databases Medline, PsycINFO, Assia, British Nursing Index, High Wire Press and CINAHL were explored using the search terms decision*, risk, anxiety, hospice and palliative care, end-of-life care and publication date of 1998-2010. thematic analysis of 25 papers suggests that decision making at end-of-life is multifactorial, involving a balancing of risks related to caregiver support; service provider resources; health inequalities and access; challenges to information giving; and perceptions of self-identity. Overall there is a dissonance in understandings of choice and decision making between service providers and service users. the concept of risk acknowledges the factors that shape and constrain end-of-life choices. Recognition of perceived risks as a central factor in decision making would be of value in acknowledging and supporting meaningful decision making processes for patients with palliative care needs and their families.

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

    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.

  5. Managing Small Spacecraft Projects: Less is Not Easier

    Barley, Bryan; Newhouse, Marilyn

    2012-01-01

    Managing small, low cost missions (class C or D) is not necessarily easier than managing a full flagship mission. Yet, small missions are typically considered easier to manage and used as a training ground for developing the next generation of project managers. While limited resources can be a problem for small missions, in reality most of the issues inherent in managing small projects are not the direct result of limited resources. Instead, problems encountered by managers of small spacecraft missions often derive from 1) the perception that managing small projects is easier if something is easier it needs less rigor and formality in execution, 2) the perception that limited resources necessitate or validate omitting standard management practices, 3) less stringent or unclear guidelines or policies for small projects, and 4) stakeholder expectations that are not consistent with the size and nature of the project. For example, the size of a project is sometimes used to justify not building a full, detailed integrated master schedule. However, while a small schedule slip may not be a problem for a large mission, it can indicate a serious problem for a small mission with a short development phase, highlighting the importance of the schedule for early identification of potential issues. Likewise, stakeholders may accept a higher risk posture early in the definition of a low-cost mission, but as launch approaches this acceptance may change. This presentation discusses these common misconceptions about managing small, low cost missions, the problems that can result, and possible solutions.

  6. Medical futility in children's nursing: making end-of-life decisions.

    Brien, Irene O; Duffy, Anita; Shea, Ellen O

    Caring for infants at end of life is challenging and distressing for parents and healthcare professionals, especially in relation to making decisions regarding withholding or withdrawal of treatment. The concept of medical futility must be considered under these circumstances. Parents and healthcare professionals should be involved together in making these difficult decisions. However, for some parents, emotions and guilt often are unbearable and, understandably, parents can be reluctant to make a decision. Despite the recognition of parental autonomy, if parents disagree with a decision made by medical staff, the case will be referred to and solved by the courts. The courts' decisions are often based on the best interest of the child. In this article, the authors discuss the concepts of 'parental autonomy' and 'the child's best interests' when determining medical futility for infants or neonates. The role of the nurse when caring for the dying child and their family is multifaceted. While nurses do not have a legitimate role in decision making at the end of life, it is often nurses who, through their advocacy role, inform doctors about parents' wishes and it is often nurses who support parents during this difficult time. Furthermore, nurses caring for dying children should be familiar to the family, experienced in end-of-life care and comfortable talking to parents about death and dying and treatment choices. Children's nurses therefore require advanced communication skills and an essential understanding of the ethical and legal knowledge relating to medical futility in end-of-life children's nursing.

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

    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.

  8. The Forms and Functions of Real-Life Moral Decision-Making.

    Krebs, Dennis L.; Denton, Kathy; Wark, Gillian

    1997-01-01

    Observes that the Kohlbergian model of morality does not give a good account of the ways in which people make moral decisions in their everyday lives. Argues that a functional model of moral judgment and moral behavior derived from evolutionary theory may supply a better account of real-life morality. (DSK)

  9. Potential of life cycle assessment to support environmental decision making at commercial dairy farms

    Meul, M.; Middelaar, van C.E.; Boer, de I.J.M.; Passel, van S.; Fremaut, D.; Haesaert, G.

    2014-01-01

    In this paper, we evaluate the potential of life cycle assessment (LCA) to support environmental decision making at commercial dairy farms. To achieve this, we follow a four-step method that allows converting environmental assessment results using LCA into case-specific advice for farmers. This is

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

    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

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

    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

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

    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.…

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

    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.

  14. Parental explicit heuristics in decision-making for children with life-threatening illnesses.

    Renjilian, Chris B; Womer, James W; Carroll, Karen W; Kang, Tammy I; Feudtner, Chris

    2013-02-01

    To identify and illustrate common explicit heuristics (decision-making aids or shortcuts expressed verbally as terse rules of thumb, aphorisms, maxims, or mantras and intended to convey a compelling truth or guiding principle) used by parents of children with life-threatening illnesses when confronting and making medical decisions. Prospective cross-sectional observational study of 69 parents of 46 children who participated in the Decision-making in Pediatric Palliative Care Study between 2006 and 2008 at the Children's Hospital of Philadelphia. Parents were guided individually through a semistructured in-depth interview about their experiences and thoughts regarding making medical decisions on behalf of their ill children, and the transcribed interviews were qualitatively analyzed. All parents in our study employed explicit heuristics in interviews about decision-making for their children, with the number of identified explicit heuristics used by an individual parent ranging from tens to hundreds. The heuristics served 5 general functions: (1) to depict or facilitate understanding of a complex situation; (2) to clarify, organize, and focus pertinent information and values; (3) to serve as a decision-making compass; (4) to communicate with others about a complex topic; and (5) to justify a choice. Explicit heuristics played an important role in decision-making and communication about decision-making in our population of parents. Recognizing explicit heuristics in parent interactions and understanding their content and functions can aid clinicians in their efforts to partner with parents in the decision-making process.

  15. AAS Publishing News: Preparing Your Manuscript Just Got Easier

    Kohler, Susanna

    2016-03-01

    Watermarking using the command watermark{DRAFT, v2}.Are you an astronomer considering submitting a paper to an AAS journal (i.e., AJ, ApJ, ApJ Letters, or ApJ Supplements)? If so, this post is for you! Read on to find out about the exciting new things you can do with the AASs newest LaTeX class file, available for download now.Why the Update?AAS publishing has maintained a consistent class file for LaTeX manuscript preparation for the past decade. But academic publishing is changing rapidly in todays era of electronic journals! Since its journals went fully electronic, the AAS has been continuously adding new publishing capabilities based on the recommendations of the Journals Task Force and the needs and requests of AAS authors. The AASs manuscript preparation tools are now being updated accordingly.Whats New in AASTex 6.0?There are many exciting new features and capabilities in AASTex 6.0. Here are just a few:Tracking options for author revisions include added{text}, deleted{text}, replaced{old}{new}, and explain{text}.Based on emulateapjDo you use the popular class file emulateapj to prepare your manuscripts? AASTex 6.0 is based on emulateapj, rather than on the older AASTex 5.2 (though 5.2 is still supported). This means that it is easy to produce a double-columned, single-spaced, and astro-ph-ready manuscript. Since two thirds of the AAS journals authors use emulateapj, this transition was designed to make manuscript preparation and sharing an easier and more seamless process.Tools for collaborationsDo you work in a large collaboration? AASTex now includes new tools to make preparing a manuscript within a collaboration easier. Drafts can now be watermarked to differentiate between versions. New markup for large author lists streamlines the display so that readers can access article information immediately, yet they can still access the full author list and affiliations at the end of the paper. And author revision markup allows members of a collaboration to

  16. "What makes life good?" Developing a culturally grounded quality of life measure for Alaska Native college students.

    Sharma, Dinghy Kristine B; Lopez, Ellen D S; Mekiana, Deborah; Ctibor, Alaina; Church, Charlene

    2013-01-01

    Alaska Native (AN) college students experience higher attrition rates than their non-Native peers. Understanding the factors that contribute to quality of life ("what makes life good") for AN students will help inform supportive programs that are congruent with their culture and college life experiences. Co-develop a conceptual model and a measure of quality of life (QOL) that reflects the experiences of AN college students. Six focus groups were conducted with 26 AN college students. Within a community-academic partnership, interactive data collection activities, co-analysis workgroup sessions and an interactive findings forum ensured a participant-driven research process. Students identified and operationally defined eight QOL domains (values, culture and traditions, spirituality, relationships, basic needs, health, learning and leisure). The metaphor of a tree visually illustrates how the domains values, culture and traditions and spirituality form the roots to the other domains that appear to branch out as students navigate the dual worldviews of Native and Western ways of living. The eight QOL domains and their items identified during focus groups were integrated into a visual model and an objective QOL measure. The hope is to provide a useful tool for developing and evaluating university-based programs and services aimed toward promoting a positive QOL and academic success for AN students.

  17. Like cognitive function, decision making across the life span shows profound age-related changes.

    Tymula, Agnieszka; Rosenberg Belmaker, Lior A; Ruderman, Lital; Glimcher, Paul W; Levy, Ifat

    2013-10-15

    It has long been known that human cognitive function improves through young adulthood and then declines across the later life span. Here we examined how decision-making function changes across the life span by measuring risk and ambiguity attitudes in the gain and loss domains, as well as choice consistency, in an urban cohort ranging in age from 12 to 90 y. We identified several important age-related patterns in decision making under uncertainty: First, we found that healthy elders between the ages of 65 and 90 were strikingly inconsistent in their choices compared with younger subjects. Just as elders show profound declines in cognitive function, they also show profound declines in choice rationality compared with their younger peers. Second, we found that the widely documented phenomenon of ambiguity aversion is specific to the gain domain and does not occur in the loss domain, except for a slight effect in older adults. Finally, extending an earlier report by our group, we found that risk attitudes across the life span show an inverted U-shaped function; both elders and adolescents are more risk-averse than their midlife counterparts. Taken together, these characterizations of decision-making function across the life span in this urban cohort strengthen the conclusions of previous reports suggesting a profound impact of aging on cognitive function in this domain.

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

    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.

  19. Environmental performance of straw-based pulp making: A life cycle perspective.

    Sun, Mingxing; Wang, Yutao; Shi, Lei

    2018-03-01

    Agricultural straw-based pulp making plays a vital role in pulp and paper industry, especially in forest deficient countries such as China. However, the environmental performance of straw-based pulp has scarcely been studied. A life cycle assessment on wheat straw-based pulp making in China was conducted to fill of the gaps in comprehensive environmental assessments of agricultural straw-based pulp making. On average, the global warming potential (GWP), GWP excluding biogenic carbon, acidification potential and eutrophication potential of wheat straw based pulp making are 2299kg CO 2 -eq, 4550kg CO 2 -eq, 16.43kg SO 2 -eq and 2.56kg Phosphate-eq respectively. The dominant factors contributing to environmental impacts are coal consumption, electricity consumption, and chemical (NaOH, ClO 2 ) input. Chemical input decrease and energy recovery increase reduce the total environmental impacts dramatically. Compared with wood-based and recycled pulp making, wheat straw-based pulp making has higher environmental impacts, which are mainly due to higher energy and chemical requirements. However, the environmental impacts of wheat straw-based pulp making are lower than hemp and flax based pulp making from previous studies. It is also noteworthy that biogenic carbon emission is significant in bio industries. If carbon sequestration is taken into account in pulp making industry, wheat straw-based pulp making is a net emitter rather than a net absorber of carbon dioxide. Since wheat straw-based pulp making provides an alternative for agricultural residue management, its evaluation framework should be expanded to further reveal its environmental benefits. Copyright © 2017 Elsevier B.V. All rights reserved.

  20. Much Lower Launch Costs Make Resupply Cheaper than Recycling for Space Life Support

    Jones, Harry W.

    2017-01-01

    The development of commercial launch vehicles by SpaceX has greatly reduced the cost of launching mass to Low Earth Orbit (LEO). Reusable launch vehicles may further reduce the launch cost per kilogram. The new low launch cost makes open loop life support much cheaper than before. Open loop systems resupply water and oxygen in tanks for crew use and provide disposable lithium hydroxide (LiOH) in canisters to remove carbon dioxide. Short human space missions such as Apollo and shuttle have used open loop life support, but the long duration International Space Station (ISS) recycles water and oxygen and removes carbon dioxide with a regenerative molecular sieve. These ISS regenerative and recycling life support systems have significantly reduced the total launch mass needed for life support. But, since the development cost of recycling systems is much higher than the cost of tanks and canisters, the relative cost savings have been much less than the launch mass savings. The Life Cycle Cost (LCC) includes development, launch, and operations. If another space station was built in LEO, resupply life support would be much cheaper than the current recycling systems. The mission most favorable to recycling would be a long term lunar base, since the resupply mass would be large, the proximity to Earth would reduce the need for recycling reliability and spares, and the launch cost would be much higher than for LEO due to the need for lunar transit and descent propulsion systems. For a ten-year lunar base, the new low launch costs make resupply cheaper than recycling systems similar to ISS life support.

  1. Real-life decision making in college students. II: Do individual differences show reliable effects?

    Galotti, Kathleen M; Tandler, Jane M; Wiener, Hillary J D

    2014-01-01

    First-year undergraduates participated in a short-term longitudinal study of real-life decision making over their first 14 months of college. They were surveyed about 7 different decisions: choosing courses for upcoming terms (on 3 different occasions), choosing an academic major (twice), planning for the upcoming summer, and planning for sophomore-year housing. They also completed a survey of self-reported decision-making styles and the Need for Cognition survey (Cacioppo & Petty, 1982) to assess their focus on rationality and enjoyment of analytic thinking. Results showed few statistically significant correlations between stylistic measures and behavioral measures of decision making, in either the amount of information considered or the way in which the information integration tracked predictions of linear models of decision making applied to each participant's data. However, there were consistent correlations, across the 7 decisions, between stylistic measures and affective reactions to, or retrospective descriptions of, episodes of decision making. We suggest that decision-making styles instruments may better reflect the construction of narratives of self as a decision maker more than they do actual behavior during decision making.

  2. STRATEGIC DECISION MAKING, ENTREPRENEURIAL ORIENTATION AND PERFORMANCE: AN ORGANIZATIONAL LIFE CYCLE APPROACH

    Héctor Montiel Campos

    2015-06-01

    Full Text Available EntrepreneurialOrientation (EO and Strategic Decision Making (SDM have been studied in awide variety of settings. However, there is not enough research available thatcombines both topics and studies the ways in which entrepreneurs make strategicdecisions in early stages of organizational life cycle. The purpose of thisresearch was therefore to examine the effects of the factors associated withthe decision maker influencing EO and performance for two categories of firms.The results were achieved by using empirical data from two independent samplesof firms in different stages of organizational life cycle: start-up stage (n=133 and growth stage (n=173. The results show that SDM andcontrol variables have different effects in the two samples; however, for bothsamples there is significant relation between EO and performance. The paperconcludes with a discussion about the results and suggestions for futureresearch.

  3. Medical futility in children's nursing: making end-of-life decisions.

    Brien, Irene O

    2012-02-01

    Caring for infants at end of life is challenging and distressing for parents and healthcare professionals, especially in relation to making decisions regarding withholding or withdrawal of treatment. The concept of medical futility must be considered under these circumstances. Parents and healthcare professionals should be involved together in making these difficult decisions. However, for some parents, emotions and guilt often are unbearable and, understandably, parents can be reluctant to make a decision. Despite the recognition of parental autonomy, if parents disagree with a decision made by medical staff, the case will be referred to and solved by the courts. The courts\\' decisions are often based on the best interest of the child. In this article, the authors discuss the concepts of \\'parental autonomy\\' and \\'the child\\'s best interests\\' when determining medical futility for infants or neonates. The role of the nurse when caring for the dying child and their family is multifaceted. While nurses do not have a legitimate role in decision making at the end of life, it is often nurses who, through their advocacy role, inform doctors about parents\\' wishes and it is often nurses who support parents during this difficult time. Furthermore, nurses caring for dying children should be familiar to the family, experienced in end-of-life care and comfortable talking to parents about death and dying and treatment choices. Children\\'s nurses therefore require advanced communication skills and an essential understanding of the ethical and legal knowledge relating to medical futility in end-of-life children\\'s nursing.

  4. An expandable software model for collaborative decision making during the whole building life cycle

    Papamichael, K.; Pal, V.; Bourassa, N.; Loffeld, J.; Capeluto, G.

    2000-01-01

    Decisions throughout the life cycle of a building, from design through construction and commissioning to operation and demolition, require the involvement of multiple interested parties (e.g., architects, engineers, owners, occupants and facility managers). The performance of alternative designs and courses of action must be assessed with respect to multiple performance criteria, such as comfort, aesthetics, energy, cost and environmental impact. Several stand-alone computer tools are currently available that address specific performance issues during various stages of a building's life cycle. Some of these tools support collaboration by providing means for synchronous and asynchronous communications, performance simulations, and monitoring of a variety of performance parameters involved in decisions about a building during building operation. However, these tools are not linked in any way, so significant work is required to maintain and distribute information to all parties. In this paper we describe a software model that provides the data management and process control required for collaborative decision making throughout a building's life cycle. The requirements for the model are delineated addressing data and process needs for decision making at different stages of a building's life cycle. The software model meets these requirements and allows addition of any number of processes and support databases over time. What makes the model infinitely expandable is that it is a very generic conceptualization (or abstraction) of processes as relations among data. The software model supports multiple concurrent users, and facilitates discussion and debate leading to decision making. The software allows users to define rules and functions for automating tasks and alerting all participants to issues that need attention. It supports management of simulated as well as real data and continuously generates information useful for improving performance prediction and

  5. How Accumulated Real Life Stress Experience and Cognitive Speed Interact on Decision-Making Processes.

    Friedel, Eva; Sebold, Miriam; Kuitunen-Paul, Sören; Nebe, Stephan; Veer, Ilya M; Zimmermann, Ulrich S; Schlagenhauf, Florian; Smolka, Michael N; Rapp, Michael; Walter, Henrik; Heinz, Andreas

    2017-01-01

    Rationale: Advances in neurocomputational modeling suggest that valuation systems for goal-directed (deliberative) on one side, and habitual (automatic) decision-making on the other side may rely on distinct computational strategies for reinforcement learning, namely model-free vs. model-based learning. As a key theoretical difference, the model-based system strongly demands cognitive functions to plan actions prospectively based on an internal cognitive model of the environment, whereas valuation in the model-free system relies on rather simple learning rules from operant conditioning to retrospectively associate actions with their outcomes and is thus cognitively less demanding. Acute stress reactivity is known to impair model-based but not model-free choice behavior, with higher working memory capacity protecting the model-based system from acute stress. However, it is not clear which impact accumulated real life stress has on model-free and model-based decision systems and how this influence interacts with cognitive abilities. Methods: We used a sequential decision-making task distinguishing relative contributions of both learning strategies to choice behavior, the Social Readjustment Rating Scale questionnaire to assess accumulated real life stress, and the Digit Symbol Substitution Test to test cognitive speed in 95 healthy subjects. Results: Individuals reporting high stress exposure who had low cognitive speed showed reduced model-based but increased model-free behavioral control. In contrast, subjects exposed to accumulated real life stress with high cognitive speed displayed increased model-based performance but reduced model-free control. Conclusion: These findings suggest that accumulated real life stress exposure can enhance reliance on cognitive speed for model-based computations, which may ultimately protect the model-based system from the detrimental influences of accumulated real life stress. The combination of accumulated real life stress exposure

  6. Towards a life cycle sustainability assessment: making informed choices on products

    Ciroth, Andreas [GreenDeltaTC, Berlin (Germany); Finkbeiner, Matthias; Traverso, Marzia [TU Berlin (Germany); Hildenbrand, Jutta [Chalmers University (United States); Kloepffer, Walter [Editor-in-Chief of the International Journal of Life Cycle Assessment (Germany); Mazijn, Bernard [Ghent University (Belgium); Prakash, Siddharth [Oeko-Institut (Germany); Sonnemann, Guido; Valdivia, Sonia [UNEP (France); Ugaya, Cassia Maria Lie [Technological Federal University of Parana, ACV (Brazil); Vickery-Niederman, Gina [University of Arkansas (United States)

    2011-07-01

    In this introduction to the concept of life cycle sustainability assessment (LCSA), we acknowledge the foundations laid by previous works and initiatives. One such initiative has been the ISO 14040 series (Environmental management -- Life cycle assessment -- Principles and framework), which in addition to the ISO 26000: Social Responsibility Guidance Standard, and the contribution of a number of international initiatives (Appendix A) have been essential for the development of this publication. The life cycle of a product involves flows of material, energy and money. Nonetheless, the picture is not complete unless we look also at the production and consumption impacts on all actors along the 'value chain' -- workers, local communities, consumers and society itself. Different life cycle assessment techniques allow individuals and enterprises to assess the impact of their purchasing decisions and production methods along different aspects of this value chain. An (Environmental) life cycle assessment (LCA) looks at potential impacts to the environment as a result of the extraction of resources, transportation, production, use, recycling and discarding of products; life cycle costing (LCC) is used to assess the cost implications of this life cycle; and social life cycle assessment (S-LCA) examines the social consequences. However, in order to get the 'whole picture', it is vital to extend current life cycle thinking to encompass all three pillars of sustainability: (i) environmental, (ii) economic and (iii) social. This means carrying out an assessment based on environmental, economic and social issues -- by conducting an overarching life cycle sustainability assessment (LCSA). This publication shows how all three techniques -- which all share similar methodological frameworks and aims -- can be combined to make the move towards an overarching LCSA possible. Because it is holistic, systemic and rigorous, (environmental) LCA is the preferred technique

  7. Towards a life cycle sustainability assessment: making informed choices on products

    Ciroth, Andreas [GreenDeltaTC, Berlin (Germany); Finkbeiner, Matthias; Traverso, Marzia [TU Berlin (Germany); Hildenbrand, Jutta [Chalmers University (United States); Kloepffer, Walter [Editor-in-Chief of the International Journal of Life Cycle Assessment (Germany); Mazijn, Bernard [Ghent University (Belgium); Prakash, Siddharth [Oeko-Institut (Germany); Sonnemann, Guido; Valdivia, Sonia [UNEP (France); Ugaya, Cassia Maria Lie [Technological Federal University of Parana, ACV (Brazil); Vickery-Niederman, Gina [University of Arkansas (United States)

    2011-07-01

    In this introduction to the concept of life cycle sustainability assessment (LCSA), we acknowledge the foundations laid by previous works and initiatives. One such initiative has been the ISO 14040 series (Environmental management -- Life cycle assessment -- Principles and framework), which in addition to the ISO 26000: Social Responsibility Guidance Standard, and the contribution of a number of international initiatives (Appendix A) have been essential for the development of this publication. The life cycle of a product involves flows of material, energy and money. Nonetheless, the picture is not complete unless we look also at the production and consumption impacts on all actors along the 'value chain' -- workers, local communities, consumers and society itself. Different life cycle assessment techniques allow individuals and enterprises to assess the impact of their purchasing decisions and production methods along different aspects of this value chain. An (Environmental) life cycle assessment (LCA) looks at potential impacts to the environment as a result of the extraction of resources, transportation, production, use, recycling and discarding of products; life cycle costing (LCC) is used to assess the cost implications of this life cycle; and social life cycle assessment (S-LCA) examines the social consequences. However, in order to get the 'whole picture', it is vital to extend current life cycle thinking to encompass all three pillars of sustainability: (i) environmental, (ii) economic and (iii) social. This means carrying out an assessment based on environmental, economic and social issues -- by conducting an overarching life cycle sustainability assessment (LCSA). This publication shows how all three techniques -- which all share similar methodological frameworks and aims -- can be combined to make the move towards an overarching LCSA possible. Because it is holistic, systemic and rigorous, (environmental) LCA is the preferred technique when it comes to

  8. Work-life Balance Decision-making of Norwegian Students: Implications for Human Resources Management

    Remigiusz Gawlik

    2016-12-01

    Full Text Available Objective: The paper aims at identifying and assessing the significance of work-life balance determinants between the Youth of highly developed societies and its implications for human resources management on the example of Norway. Research Design & Methods: The research target group consists of 236 respondents recruited among Norwegian tertiary education students. It employed literature analysis, two-stage exploratory research: direct individual in-depth interviews, survey based on a self-administered, web-based questionnaire with single-answer, limited choice qualitative & quantitative, as well as explanatory research (informal moderated group discussions. Findings: The research on perceptions of determinants of quality of life and attractiveness of life strategies shows that in a country with relatively high socio-economic development level, such as Norway, differences in rankings do exist. They can be observed in relevance to both material and non-material QoL determinants. Implications & Recommendations: The study revealed a need for deeper research on individually driven early decision-making of future employees and entrepreneurs. This will result in closer modelling of socio-economic phenomena, including more accurate adaptation to trends on the labour market and creation of new business models. Contribution & Value Added: Research value added comes from the comparison of perceptions of quality of life determinants between countries at various stages of socio-economic development and its implications for human resource management.

  9. Life support decision making in critical care: Identifying and appraising the qualitative research evidence.

    Giacomini, Mita; Cook, Deborah; DeJean, Deirdre

    2009-04-01

    The objective of this study is to identify and appraise qualitative research evidence on the experience of making life-support decisions in critical care. In six databases and supplementary sources, we sought original research published from January 1990 through June 2008 reporting qualitative empirical studies of the experience of life-support decision making in critical care settings. Fifty-three journal articles and monographs were included. Of these, 25 reported prospective studies and 28 reported retrospective studies. We abstracted methodologic characteristics relevant to the basic critical appraisal of qualitative research (prospective data collection, ethics approval, purposive sampling, iterative data collection and analysis, and any method to corroborate findings). Qualitative research traditions represented include grounded theory (n = 15, 28%), ethnography or naturalistic methods (n = 15, 28%), phenomenology (n = 9, 17%), and other or unspecified approaches (n = 14, 26%). All 53 documents describe the research setting; 97% indicate purposive sampling of participants. Studies vary in their capture of multidisciplinary clinician and family perspectives. Thirty-one (58%) report research ethics board review. Only 49% report iterative data collection and analysis, and eight documents (15%) describe an analytically driven stopping point for data collection. Thirty-two documents (60%) indicated a method for corroborating findings. Qualitative evidence often appears outside of clinical journals, with most research from the United States. Prospective, observation-based studies follow life-support decision making directly. These involve a variety of participants and yield important insights into interactions, communication, and dynamics. Retrospective, interview-based studies lack this direct engagement, but focus on the recollections of fewer types of participants (particularly patients and physicians), and typically address specific issues (communication and

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

    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

  11. Real-life decision making in college students. I: Consistency across specific decisions.

    Galotti, Kathleen M; Wiener, Hillary J D; Tandler, Jane M

    2014-01-01

    First-year undergraduates participated in a short-term longitudinal study of real-life decision making over their first 14 months of college. They were surveyed about 7 different decisions: choosing courses for an upcoming term (3 different terms), choosing an academic major (twice), planning for the upcoming summer, and planning for sophomore-year housing. Participants showed moderate levels of consistency in the options they considered and in the criteria they used to decide between options, with about half of the options or criteria being used at 2 different points on the decision repeatedly studied. Participants varied somewhat in structural consistency, the tendency to consider the same number of options or criteria across decisions. They also varied in the way they integrated information across decision-making tasks. We suggest that people attempt to keep the information demands of the task within workable limits, sometimes sacrificing consistency as a result.

  12. Spiritual Growth or Decline and Meaning-Making as Mediators of Anxiety and Satisfaction with Life During Religious Struggle.

    Zarzycka, Beata; Zietek, Pawel

    2018-03-14

    A number of studies have demonstrated links between spiritual struggles and health problems. As yet, however, only a few studies have investigated what makes religious struggle a source of mental problems or a source of well-being. We determined whether spiritual growth, spiritual decline, and meaning-making mediated the relationship between religious struggle and anxiety and satisfaction with life. Of the 180 respondents, 92 were women, and mean (SD) age was 24 (8.2) years. Each respondent completed the Religious and Spiritual Struggles Scale, the Meaning-Making Scale, the Spiritual Transformation Scale, the State-Trait Anxiety Inventory, and the Satisfaction with Life Scale. Religious struggle correlated positively with anxiety and negatively with satisfaction with life. Spiritual growth mediated the relationship between moral and demonic struggle with satisfaction with life, and spiritual decline mediated the relationship between demonic, moral, and interpersonal struggle with anxiety. Finally, meaning-making mediated the relationship between religious doubt and satisfaction with life.

  13. How Accumulated Real Life Stress Experience and Cognitive Speed Interact on Decision-Making Processes

    Eva Friedel

    2017-06-01

    Full Text Available Rationale: Advances in neurocomputational modeling suggest that valuation systems for goal-directed (deliberative on one side, and habitual (automatic decision-making on the other side may rely on distinct computational strategies for reinforcement learning, namely model-free vs. model-based learning. As a key theoretical difference, the model-based system strongly demands cognitive functions to plan actions prospectively based on an internal cognitive model of the environment, whereas valuation in the model-free system relies on rather simple learning rules from operant conditioning to retrospectively associate actions with their outcomes and is thus cognitively less demanding. Acute stress reactivity is known to impair model-based but not model-free choice behavior, with higher working memory capacity protecting the model-based system from acute stress. However, it is not clear which impact accumulated real life stress has on model-free and model-based decision systems and how this influence interacts with cognitive abilities.Methods: We used a sequential decision-making task distinguishing relative contributions of both learning strategies to choice behavior, the Social Readjustment Rating Scale questionnaire to assess accumulated real life stress, and the Digit Symbol Substitution Test to test cognitive speed in 95 healthy subjects.Results: Individuals reporting high stress exposure who had low cognitive speed showed reduced model-based but increased model-free behavioral control. In contrast, subjects exposed to accumulated real life stress with high cognitive speed displayed increased model-based performance but reduced model-free control.Conclusion: These findings suggest that accumulated real life stress exposure can enhance reliance on cognitive speed for model-based computations, which may ultimately protect the model-based system from the detrimental influences of accumulated real life stress. The combination of accumulated real life

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

    Jegede, Ayodele Samuel; Adegoke, Olufunke Olufunsho

    2016-11-01

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

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

    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.

  16. METHOD OF STRATEGIC PLANNING AND MANAGEMENT DECISION-MAKING CONSIDERING THE LIFE CYCLE THEORY

    Tetiana Kniazieva

    2017-12-01

    are made. Results of the survey are to substantiate the methodology of strategic planning under conditions of external environment uncertainty with the consideration of the life cycle theory. Practical implications: the possibilities of using life-cycle models allow: 1. reasonably predicting sales and plan production program; 2. determining the basic strategies at different stages of development; 3. determining the sequence of stages of enterprise development; 4. ensuring harmonious interaction of organizational characteristics with the external environment factors that influence the process of organizational development. Increasing the sustainability of the organization’s development can be achieved by re-establishment of dynamic changes in the plan in terms of using effective methods for forecasting with the consideration of the life cycle theory. It is necessary to take into account the interconnection between all levels of life cycles: industry, technology, enterprises, product; ensuring the competitive advantage of the organization. Using the theory of optimal solutions making in uncertain conditions under the analysis of long-term projects allows transferring qualitative factors into quantitative indicators that can be used in the future to bring investment projects to the same kind and choose the best. In conditions of increased uncertainty of the external environment, it is necessary to develop the theory of enterprise management, taking into account its life cycle, as well as the life cycle of its separate elements and processes at all levels. Combination of strategic management with the life cycles theory will increase the objectivity and effectiveness of taken management decisions. The accounting of the organization life cycles in strategic planning allows choosing an effective strategy.

  17. Contributions of the life course perspective to research on food decision making.

    Wethington, Elaine; Johnson-Askew, Wendy L

    2009-12-01

    The life course perspective (LCP) has emerged as a powerful organizing framework for the study of health, illness, and mortality. LCP represents a "whole life" analysis perspective which originated in the field of sociology. Its concepts are increasingly applied to understanding the development of chronic disease over long periods of time in the human life span. A missing link, however, in the adaptation of the LCP to health research, is the insight the LCP may offer into understanding the societal, social network, and family contexts that frame stability and change in dietary behavior. This paper reviews key concepts that comprise the LCP but primarily focuses on applications that have relevance to food decision making in social context. A case study of chronic work-family stress and perceived time scarcity as barriers to dietary improvement is included. Illustrative findings are presented on dietary behavior in a diverse sample of lower-income working parents. This paper also offers ideas on increasing the contributions of the LCP to nutritional research.

  18. The legal guardians' dilemma: Decision making associated with invasive non-life-saving procedures

    2012-01-01

    Background ICU patients frequently undergo non-life-saving invasive procedures. When patient informed consent cannot be obtained, legal guardianship (LG), often from a close relative, may be required by law. The objective of this cohort study was to investigate the attitudes of LGs of ICU patients regarding the process of decision making for invasive non-life-saving procedures. Methods The study was conducted from May 2009 until June 2010 in general medical/surgical ICUs in two large Israeli medical centers. All 64 LGs who met the study criteria agreed to participate in the study. Three questionnaires were administered: a demographic data questionnaire, the Family Satisfaction with ICU 34 Questionnaire, and the Attitudes towards the LG Decision Making Process questionnaire, developed by the authors. Results The sample consisted of 64 LGs. Most participants were married (n = 56, 87.5%), male (n = 33, 51.6%), who had either a high school (n = 24, 37.5%) or college (n = 19, 29.7%) education, and were at a mean age of 49.2 (±11.22). Almost all of the procedures performed were tracheotomies (n = 63, 98.4%). About two-thirds of the LGs preferred decisions to be made by the medical staff after discussing options with them (n = 42, 65.6%) and about three-fifths stated that decisions could be made without the need for the appointment of an LG (n = 37, 57.8%). Attitudes towards ease of obtaining information and honesty of information were more positive compared to those of consistency and understanding of information. Conclusions The legal guardianship process requires better communication and more understandable information in order to assist LGs in making decisions for others in at times vague and stressful situations. PMID:23006738

  19. Make

    Frauenfelder, Mark

    2012-01-01

    The first magazine devoted entirely to do-it-yourself technology projects presents its 29th quarterly edition for people who like to tweak, disassemble, recreate, and invent cool new uses for technology. MAKE Volume 29 takes bio-hacking to a new level. Get introduced to DIY tracking devices before they hit the consumer electronics marketplace. Learn how to build an EKG machine to study your heartbeat, and put together a DIY bio lab to study athletic motion using consumer grade hardware.

  20. Relationship of external influence to parental distress in decision making regarding children with a life-threatening illness.

    Miller, Victoria A; Luce, Mary Frances; Nelson, Robert M

    2011-01-01

    To examine the relationship of external influence to parental distress when making a decision about research or treatment for a child with a life-threatening illness and to test potential moderators of this relationship. Parents (n = 219) who made a decision about research or treatment for a child completed measures of external influence, distress, decision-making preference, and coping. More external influence was associated with more hostility, uncertainty, and confusion. Decision-making preference and coping style moderated the relationship between external influence and distress: More external influence was associated with more distress when decision-making preference was low and task-focused coping was high. External influence appears to be related to distress in parents making research and treatment decisions for children with life-threatening illnesses. However, it is important to consider parent characteristics, such as decision-making preference and coping style, when examining the effects of contextual factors on distress during decision making.

  1. Asset life cycle plans: twelve steps to assist strategic decision-making in asset life cycle management

    Ruitenburg, Richard Jacob; Braaksma, Anne Johannes Jan; van Dongen, Leonardus Adriana Maria; Carnero, Maria Carmen; Gonzalez-Prida, Vicente

    2017-01-01

    Effective management of physical assets should deliver maximum business value. Therefore, Asset Management standards such as PAS 55 and ISO 55000 ask for a life cycle approach. However, most existing methods focus only on the short term of the asset's life or the estimation of its remaining life.

  2. Approaches to end-of-life decision-making in the NICU: insights from Dostoevsky's The Grand Inquisitor.

    Paris, J J; Graham, N; Schreiber, M D; Goodwin, M

    2006-07-01

    For many parents stopping life-sustaining medical treatment on their dying infant is psychologically impossible. Dostoevsky's insights into human behavior, particularly the fact that individuals do not want the anxiety and guilt associated with responsibility for making difficult decisions, might change the way physicians approach parents for permission to withdraw life-prolonging medical interventions on dying infants.

  3. Exploiting Software Tool Towards Easier Use And Higher Efficiency

    Lin, G. H.; Su, J. T.; Deng, Y. Y.

    2006-08-01

    In developing countries, using data based on instrument made by themselves in maximum extent is very important. It is not only related to maximizing science returns upon prophase investment -- deep accumulations in every aspects but also science output. Based on the idea, we are exploiting a software (called THDP: Tool of Huairou Data Processing). It is used for processing a series of issues, which is met necessary in processing data. This paper discusses its designed purpose, functions, method and specialities. The primary vehicle for general data interpretation is through various techniques of data visualization, techniques of interactive. In the software, we employed Object Oriented approach. It is appropriate to the vehicle. it is imperative that the approach provide not only function, but do so in as convenient a fashion as possible. As result of the software exploiting, it is not only easier to learn data processing for beginner and more convenienter to need further improvement for senior but also increase greatly efficiency in every phrases include analyse, parameter adjusting, result display. Under frame of virtual observatory, for developing countries, we should study more and newer related technologies, which can advance ability and efficiency in science research, like the software we are developing

  4. Situational and Age-Dependent Decision Making during Life Threatening Distress in Myotis macrodactylus.

    Xiaobin Huang

    Full Text Available Echolocation and audiovocal communication have been studied extensively in bats. The manner in which these abilities are incorporated within escape behaviors during life-threatening distress is largely unknown. Here we tested the hypothesis that behavioral response profiles expressed during distress are relatively stereotypic given their evolutionary adaptations to avoid predators. We subjected juvenile and adult big-footed myotis (Myotis macrodactylus to a sequence of three types of life threatening distress: 1 trapping them in a mist-net (environmental threat, 2 approaching them when trapped (predator threat, and 3 partially restraining their freedom to move (arrest, and recorded their escape behavior in each of the three conditions. Response profiles differed across individuals and with the context in which they were expressed. During environmental and predator threat, bats displayed significantly more biting and wing-flapping behaviors and emitted more echolocation pulses than during arrest. Response profiles also varied with age. During arrest, juveniles were more likely than adults to emit distress calls and vice-versa for biting and wing flapping during environmental and predator threat. Overall, individualized response profiles were classified into ten clusters that were aligned along two divergent response trajectories when viewed within two-dimensional, multifactorial decision space. Juvenile behaviors tended to follow a predominantly "social-dependence" trajectory, whereas adult behaviors were mostly aligned along a "self-reliance" trajectory. We conclude that bats modify their vocal behavior and make age-appropriate and contextually adaptive decisions when distressed. This decision-making ability is consistent with observations in other social species, including humans.

  5. Life-oriented approach for urban policy decision-making: Surveys and applications

    Junyi Zhang; Yubing Xiong; Minh Tu Tran

    2014-01-01

    In this study, we propose an additional approach, called life-oriented approach, for supporting urban policy decisions. The life-oriented approach argues that people's decisions on various life choices are not independent of each other and that an understanding of life choices should not be constrained by the boundary of any single discipline. People's life choices are closely linked with the quality of life (QOL), which can be roughly captured from the perspective of life domains such as res...

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

    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.

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

    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.

  8. Multiple criteria decision making with life cycle assessment for material selection of composites

    A. S. Milani

    2011-12-01

    Full Text Available With the advancement of interdisciplinary approaches in today’s modern engineering, current efforts in optimal design of composites include seeking material selection protocols that can (1 simultaneously consider a series of mechanical/electrical/chemical cost criteria over a set of alternative material options, and (2 closely take into account environmental aspects of final products including recycling and end-of-life disposal options. In this paper, in addition to a review of some recent experimental and methodological advances in the above areas, a new application of multiple criteria decision making (MCDM is presented to deal with decision conflicts often seen among design criteria in composite material selection with the help of life cycle assessment (LCA. To show the application, an illustrative case study on a plastic gear material selection is conducted where the cost, mechanical and thermal properties along with environmental impact criteria are to be satisfied simultaneously. A pure plastic gear is compared to a Polyethylene terephthalate (PET/aluminum-powder composite alternative. Results suggest that simple MCDM models, including a signal-to-noise measure adapted to MCDM in the same case study, can be used to explore both trade-offs and design break-even points in large decision spaces as the decision maker’s perspective over environmental, material performance and cost attributes change during the design process. More advanced topics including the account of material data uncertainties are addressed.

  9. Contributions of the Life Course Perspective to Research on Food Decision Making

    Johnson-Askew, Wendy L.

    2012-01-01

    Background The life course perspective (LCP) has emerged as a powerful organizing framework for the study of health, illness, and mortality. LCP represents a “whole life” analysis perspective which originated in the field of sociology. Methods Its concepts are increasingly applied to understanding the development of chronic disease over long periods of time in the human life span. A missing link, however, in the adaptation of the LCP to health research, is the insight the LCP may offer into understanding the societal, social network, and family contexts that frame stability and change in dietary behavior. Results This paper reviews key concepts that comprise the LCP but primarily focuses on applications that have relevance to food decision making in social context. A case study of chronic work–family stress and perceived time scarcity as barriers to dietary improvement is included. Conclusion Illustrative findings are presented on dietary behavior in a diverse sample of lower-income working parents. This paper also offers ideas on increasing the contributions of the LCP to nutritional research. PMID:19890684

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

    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.

  11. Meaning Making and Psychological Adjustment following Cancer: The Mediating Roles of Growth, Life Meaning, and Restored Just-World Beliefs

    Park, Crystal L.; Edmondson, Donald; Fenster, Juliane R.; Blank, Thomas O.

    2008-01-01

    Cancer survivors' efforts at meaning making may influence the extent to which they successfully make meaning from their experience (i.e., experience posttraumatic growth, find life meaningful, and restore beliefs in a just world), which may, in turn, influence their psychological adjustment. Previous research regarding both meaning making…

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

    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.

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

    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.

  14. Pushing the limits of signal resolution to make coupling measurement easier.

    Herbert Pucheta, José Enrique; Pitoux, Daisy; Grison, Claire M; Robin, Sylvie; Merlet, Denis; Aitken, David J; Giraud, Nicolas; Farjon, Jonathan

    2015-05-07

    Probing scalar couplings are essential for structural elucidation in molecular (bio)chemistry. While the measurement of JHH couplings is facilitated by SERF experiments, overcrowded signals represent a significant limitation. Here, a new band selective pure shift SERF allows access to δ(1)H and JHH with an ultrahigh spectral resolution.

  15. Making Health Easier: Tobacco Free Living in Santa Clara, CA PSA (:60)

    2013-05-21

    Instead of walking through clouds of smoke, students in a California community college can now breathe clean air. A college health nurse made it happen with the help of students, faculty, and partners.  Created: 5/21/2013 by National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP).   Date Released: 5/21/2013.

  16. High reward makes items easier to remember, but harder to bind to a new temporal context

    Christopher R Madan

    2012-08-01

    Full Text Available Learning through reward is central to adaptive behaviour. Indeed, items are remembered better if they are experienced while participants expect a reward, and people can deliberately prioritize memory for high- over low-valued items. Do memory advantages for high-valued items only emerge after deliberate prioritization in encoding? Or, do reward-based memory enhancements also apply to unrewarded memory tests and to implicit memory? First, we tested for a high-value memory advantage in unrewarded implicit and explicit tests (Exp 1. Participants first learned high or low reward values of 36 words, followed by unrewarded lexical decision and free recall tests. High-value words were judged faster in lexical decision, and more often recalled in free recall. These two memory advantages for high-value words were negatively correlated suggesting at least two mechanisms by which reward value can influence later item-memorability. The ease at which the values were originally acquired explained the negative correlation: People who learned values earlier showed reward effects in implicit memory while people who learned values later showed reward effects in explicit memory. We then asked whether a high-value advantage would persist if trained items were linked to a new context (Exps 2a,b. Following the same value training as in Exp 1, participants learned lists composed of previously trained words mixed with new words, each followed by free recall. Thus, participants had to retrieve words only from the most recent list, irrespective of their values. High- and low-value words were recalled equally, but low-value words were recalled earlier than high-value words and high-value words were more often intruded (proactive interference. Thus, the high-value advantage holds for implicit and explicit memory, but comes with a side effect: High-value items are more difficult to relearn in a new context. Similar to emotional arousal, reward value can both enhance and impair memory.

  17. Can evolutionary design of social networks make it easier to be 'green'?

    Dickinson, Janis L; Crain, Rhiannon L; Reeve, H Kern; Schuldt, Jonathon P

    2013-09-01

    The social Web is swiftly becoming a living laboratory for understanding human cooperation on massive scales. It has changed how we organize, socialize, and tackle problems that benefit from the efforts of a large crowd. A new, applied, behavioral ecology has begun to build on theoretical and empirical studies of cooperation, integrating research in the fields of evolutionary biology, social psychology, social networking, and citizen science. Here, we review the ways in which these disciplines inform the design of Internet environments to support collective pro-environmental behavior, tapping into proximate prosocial mechanisms and models of social evolution, as well as generating opportunities for 'field studies' to discover how we can support massive collective action and shift environmental social norms. Copyright © 2013 Elsevier Ltd. All rights reserved.

  18. Making Health Easier: Tobacco Free Living in Santa Clara, CA PSA (:60)

    Instead of walking through clouds of smoke, students in a California community college can now breathe clean air. A college health nurse made it happen with the help of students, faculty, and partners.

  19. Making it easier for clean technologies to get returns from GHG credits

    Baumann, T.

    2009-01-01

    This paper discusses how clean technologies can get returns from greenhouse gases credits. Businesses recognize that climate change opportunity is bigger than information technology. Clean technologies and climate change will transform the economy. Clean technologies will bring business opportunities, revitalize industry and the economy, bring jobs and increase exports.

  20. A life cycle analysis approach to D and D decision-making

    Yuracko, K.L.; Gresalfi, M.; Yerace, P.; Krstich, M.; Gerrick, D.

    1998-05-01

    This paper describes a life cycle analysis (LCA) approach that makes decontamination and decommissioning (D and D) of US Department of Energy facilities more efficient and more responsive to the concerns of the society. With the considerable complexity of D and D projects and their attendant environmental and health consequences, projects can no longer be designed based on engineering and economic criteria alone. Using the LCA D and D approach, the evaluation of material disposition alternatives explicitly includes environmental impacts, health and safety impacts, socioeconomic impacts, and stakeholder attitudes -- in addition to engineering and economic criteria. Multi-attribute decision analysis is used to take into consideration the uncertainties and value judgments that are an important part of all material disposition decisions. Use of the LCA D and D approach should lead to more appropriate selections of material disposition pathways and a decision-making process that is both understandable and defensible. The methodology and procedures of the LCA D and D approach are outlined and illustrated by an application of the approach at the Department of Energy's West Valley Demonstration Project. Specifically, LCA was used to aid decisions on disposition of soil and concrete from the Tank Pad D and D Project. A decision tree and the Pollution Prevention/Waste Minimization Users Guide for Environmental Restoration Projects were used to identify possible alternatives for disposition of the soil and concrete. Eight alternatives encompassing source reduction, segregation, treatment, and disposal were defined for disposition of the soil; two alternatives were identified for disposition of the concrete. Preliminary results suggest that segregation and treatment are advantageous in the disposition of both the soil and the concrete. This and other recent applications illustrate the strength and ease of application of the LCA D and D approach

  1. Is patient autonomy a critical determinant of quality of life in Korea? End-of-life decision making from the perspective of the patient.

    Mo, Ha Na; Shin, Dong Wook; Woo, Jae Ha; Choi, Jin Young; Kang, Jina; Baik, Young Ji; Huh, Yu Rae; Won, Joo Hee; Park, Myung Hee; Cho, Sang Hee

    2012-04-01

    We aimed to investigate the current practice of the involvement in decision making from the perspectives of terminal cancer patients, and to explore its possible associations with quality of life and quality of death in Korea. A multi-center, cross-sectional survey was performed on 93 terminal cancer patients. The questionnaire solicited their opinions regarding participation in treatment decision making, as well as quality of life (European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaire for Palliative Care) and quality of death (Good Death Inventory-Patient Version). A total of 78.5% of the patients had awareness of their terminal status, while 21.5% did not; 42.4% stated that they knew their condition and shared the decision-making responsibility with the medical staff and their family, while 21.7% made decisions on their own, and 35.9% left the decision-making responsibility to others. Patients who were aware of their illness and who actively participated in the decision making did not score higher than others on outcome measures of quality of life and quality of death. Moreover, the former even showed lower scores in some domains, including the 'physical and psychological comfort' (4.99 versus 5.61, p = 0.03), 'environmental comfort' (5.51 versus 6.04, p = 0.08), and 'emotional functioning' (55.70 versus 71.01, p = 0.06). in Korea, patient autonomy is not a universally accepted value from the perspectives of terminal cancer patients, nor is patient involvement in decision making always conducive to high quality of life or quality of death. The level of information and the pace at which it is provided should be tailored to each individual's ability, preference, need, and culture.

  2. Development of a support system to make economic and technical assessments for the issues relating to plant life extension

    Takao, T.; Soneda, N.; Sakai, T.

    1994-01-01

    To realize the life extension of nuclear power plants, overall evaluation for the plant is required, which covers technology, economy such as cost of repair or/and replacement of components, and regal regulations for licensing. A prototype of integrated assessment support system for life extension ''INPLEX'' have developed in order to evaluate the technical and economic issues relating to the plant life extension and to make a life extension scenario. Analysis procedure of INPLEX is as follows. A comparison of the cost between the life extension and the reconstruction is made to see whether the life extension is cost effective or not. Next, components required detailed assessments are selected, and the residual life assessment of these components are made. After those procedures life extension measures are selected and the implementation time schedule is set on the basis of the formulas for predicting the degradation of the components and the component reliability data. Finally the implementation time schedule is optimized from the viewpoint of economy, and the life extension scenario is proposed. INPLEX also has the data base ''PRINS'', in which information and data related to life extension are registered, such as component degradation experiences, degradation management methodologies, degradation mitigation measures, and so on. PRINS can be referred at any time during the operation of INPLEX

  3. Ethical Decision Making With End-of-Life Care: Palliative Sedation and Withholding or Withdrawing Life-Sustaining Treatments

    Olsen, Molly L.; Swetz, Keith M.; Mueller, Paul S.

    2010-01-01

    Palliative sedation (PS) is the use of medications to induce decreased or absent awareness in order to relieve otherwise intractable suffering at the end of life. Although uncommon, some patients undergoing aggressive symptom control measures still have severe suffering from underlying disease or therapy-related adverse effects. In these circumstances, use of PS is considered. Although the goal is to provide relief in an ethically acceptable way to the patient, family, and health care team, health care professionals often voice concerns whether such treatment is necessary or whether such treatment equates to physician-assisted suicide or euthanasia. In this review, we frame clinical scenarios in which PS may be considered, summarize the ethical underpinnings of the practice, and further differentiate PS from other forms of end-of-life care, including withholding and/or withdrawing life-sustaining therapy and physician-assisted suicide and euthanasia. PMID:20805544

  4. Making the link between work-life balance practices and organizational performance

    T. Alexandra Beauregard; Lesley C. Henry

    2009-01-01

    The business case for work-life balance practices, as espoused by many organizations, rests on attracting better applicants and reducing work-life conflict among existing employees in order to enhance organizational performance. This review of the literature provides some evidence for the claim regarding recruitment, but there is insufficient evidence to support the notion that work-life practices enhance performance by means of reduced work-life conflict. We suggest that the business case ma...

  5. Encompassing the Work-Life Balance into Early Career Decision-Making of Future Employees Through the Analytic Hierarchy Process

    Gawlik, Remigiusz

    2016-01-01

    The paper presents the results of ranking of the significance of quality of life determinants by University students that are starting professional activities. Research methodology: literature review; elaboration of an AHP decision-making model; two-stage expert selection; significance rankings by experts and a graphical and descriptive presentation of obtained results. Research sample: 14 experts out of almost 200 University students. Research outcome: a decision-making model that aims at ma...

  6. Integrating adolescent girls' voices on sexual decision making in the Life Orientation Sexuality Education Programme / Ronél Koch

    Koch, Ronél

    2012-01-01

    The aim of this research study was to find out how adolescent girls engage in the process of sexual decision making in order to make recommendations for the development and presentation of the current Life Orientation Sexuality Education Programme in South African schools. As the results of this study are aimed at providing guidelines for the development and presentation of this specific programme, a qualitative interpretive descriptive research design was used, because this type of research ...

  7. Phylotastic! Making tree-of-life knowledge accessible, reusable and convenient.

    Stoltzfus, Arlin; Lapp, Hilmar; Matasci, Naim; Deus, Helena; Sidlauskas, Brian; Zmasek, Christian M; Vaidya, Gaurav; Pontelli, Enrico; Cranston, Karen; Vos, Rutger; Webb, Campbell O; Harmon, Luke J; Pirrung, Megan; O'Meara, Brian; Pennell, Matthew W; Mirarab, Siavash; Rosenberg, Michael S; Balhoff, James P; Bik, Holly M; Heath, Tracy A; Midford, Peter E; Brown, Joseph W; McTavish, Emily Jane; Sukumaran, Jeet; Westneat, Mark; Alfaro, Michael E; Steele, Aaron; Jordan, Greg

    2013-05-13

    Scientists rarely reuse expert knowledge of phylogeny, in spite of years of effort to assemble a great "Tree of Life" (ToL). A notable exception involves the use of Phylomatic, which provides tools to generate custom phylogenies from a large, pre-computed, expert phylogeny of plant taxa. This suggests great potential for a more generalized system that, starting with a query consisting of a list of any known species, would rectify non-standard names, identify expert phylogenies containing the implicated taxa, prune away unneeded parts, and supply branch lengths and annotations, resulting in a custom phylogeny suited to the user's needs. Such a system could become a sustainable community resource if implemented as a distributed system of loosely coupled parts that interact through clearly defined interfaces. With the aim of building such a "phylotastic" system, the NESCent Hackathons, Interoperability, Phylogenies (HIP) working group recruited 2 dozen scientist-programmers to a weeklong programming hackathon in June 2012. During the hackathon (and a three-month follow-up period), 5 teams produced designs, implementations, documentation, presentations, and tests including: (1) a generalized scheme for integrating components; (2) proof-of-concept pruners and controllers; (3) a meta-API for taxonomic name resolution services; (4) a system for storing, finding, and retrieving phylogenies using semantic web technologies for data exchange, storage, and querying; (5) an innovative new service, DateLife.org, which synthesizes pre-computed, time-calibrated phylogenies to assign ages to nodes; and (6) demonstration projects. These outcomes are accessible via a public code repository (GitHub.com), a website (http://www.phylotastic.org), and a server image. Approximately 9 person-months of effort (centered on a software development hackathon) resulted in the design and implementation of proof-of-concept software for 4 core phylotastic components, 3 controllers, and 3 end

  8. Meaning making and psychological adjustment following cancer: the mediating roles of growth, life meaning, and restored just-world beliefs.

    Park, Crystal L; Edmondson, Donald; Fenster, Juliane R; Blank, Thomas O

    2008-10-01

    Cancer survivors' efforts at meaning making may influence the extent to which they successfully make meaning from their experience (i.e., experience posttraumatic growth, find life meaningful, and restore beliefs in a just world), which may, in turn, influence their psychological adjustment. Previous research regarding both meaning making processes and meanings made as determinants of adjustment has shown inconsistent effects, partly because of the lack of clearly articulated theoretical frameworks and problematic research strategies. In a 1-year longitudinal study, the authors distinguished the meaning making process from the outcomes of that process (meanings made), employing specific measures of both. The authors tested pathways through which meaning making efforts led to 3 different meanings made (growth, life meaning, and restored just-world belief) in a sample of 172 young to middle-age adult cancer survivors, and they explored whether those meanings made mediated the effect of meaning making efforts on psychological adjustment. Cross-sectional and longitudinal path models of the meaning making process indicate that meaning making efforts are related to better adjustment through the successful creation of adaptive meanings made from the cancer experience. The authors conclude with clinical implications and suggestions for future research. (c) 2008 APA, all rights reserved.

  9. Quality of life in active surveillance and the associations with decision-making-a literature review.

    Menichetti, Julia; Valdagni, Riccardo; Bellardita, Lara

    2018-02-01

    Several studies have been conducted on the quality of life (QoL) in men with low risk prostate cancer (PCa) who choose active surveillance (AS). While recent reviews have shown a lack of consistency among the available QoL-studies, a few key points have been identified, including decision-making (DM)-related issues and their potential effect on QoL. The importance of this theme has also been recently highlighted by the international task force of the European School of Oncology. However, to our knowledge, there are no studies that have specifically marshalled scientific knowledge on the association between DM and QoL among men with low-risk PCa undergoing AS. We performed a literature review to fill this gap, taking a systematic approach to retrieving and selecting articles that included both DM and QoL measures. Among the 272 articles retrieved, we selected nine observational, quantitative articles with both DM and QoL measures. The most considered DM aspects within these studies were decisional conflict and preference for the patient's role in the DM process, as well as health-related QoL aspects. The studies included 42 assessments of the relationship between an empirical measure of DM and an empirical measure of QoL. Among these assessments, 23 (55%) were both positive and significant. They mostly concerned the relationship between patient-related (decisional self-efficacy, decisional control and knowledge) and external (presence of social support, collaborative role within the DM process, and influence of different physicians) DM aspects, as well as the QoL after choice. The findings of these studies revealed key challenges to research and clinical practice related to DM and QoL in AS. These include adopting a person-centred perspective where clinicians, caregivers and their interactions are also included in evaluations and where the psychosocial existential experience of individuals within the DM and AS journey is considered. Much more attention needs to be

  10. Putting health metrics into practice: using the disability-adjusted life year for strategic decision making.

    Longfield, Kim; Smith, Brian; Gray, Rob; Ngamkitpaiboon, Lek; Vielot, Nadja

    2013-01-01

    Implementing organizations are pressured to be accountable for performance. Many health impact metrics present limitations for priority setting; they do not permit comparisons across different interventions or health areas. In response, Population Services International (PSI) adopted the disability-adjusted life year (DALY) averted as its bottom-line performance metric. While international standards exist for calculating DALYs to determine burden of disease (BOD), PSI's use of DALYs averted is novel. It uses DALYs averted to assess and compare the health impact of its country programs, and to understand the effectiveness of a portfolio of interventions. This paper describes how the adoption of DALYs averted influenced organizational strategy and presents the advantages and constraints of using the metric. Health impact data from 2001-2011 were analyzed by program area and geographic region to measure PSI's performance against its goal of doubling health impact between 2007-2011. Analyzing 10 years of data permitted comparison with previous years' performance. A case study of PSI's Asia and Eastern European (A/EE) region, and PSI/Laos, is presented to illustrate how the adoption of DALYs averted affected strategic decision making. Between 2007-2011, PSI's programs doubled the total number of DALYs averted from 2002-2006. Most DALYs averted were within malaria, followed by HIV/AIDS and family planning (FP). The performance of PSI's A/EE region relative to other regions declined with the switch to DALYs averted. As a result, the region made a strategic shift to align its work with countries' BOD. In PSI/Laos, this redirection led to better-targeted programs and an approximate 50% gain in DALYs averted from 2009-2011. PSI's adoption of DALYs averted shifted the organization's strategic direction away from product sales and toward BOD. Now, many strategic decisions are based on "BOD-relevance," the share of the BOD that interventions can potentially address. This switch

  11. 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

    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.

  12. BioBlocks: Programming protocols in biology made easier

    Pau, Ivan; Gupta, Vishal; Irimia, Jesus; Rodriguez-Paton, Alfonso

    2016-01-01

    The methods to execute biological experiments are evolving. Affordable fluid handling robots and on-demand biology enterprises are making automating entire experiments a reality. Automation offers the benefit of high-throughput experimentation, rapid prototyping and improved reproducibility of results. However, learning to automate and codify experiments is a difficult task as it requires programming expertise. Here, we present a web-based visual development environment called BioBlocks for d...

  13. Quality of Life Issues for Families Who Make the Decision to Use a Feeding Tube for Their Child with Disabilities.

    Brotherson, Mary Jane; And Others

    1995-01-01

    Eight families deciding to use a feeding tube to meet the nutrition needs of their children with disabilities were interviewed over a two-year period. Family decision making in the context of quality of life was examined using a theoretical family systems model. Implications for future interventions are addressed. (Author/SW)

  14. Informed decision making does not affect health-related quality of life in lung cancer screening (NELSON trial)

    van den Bergh, Karien A. M.; Essink-Bot, Marie-Louise; van Klaveren, Rob J.; de Koning, Harry J.

    2010-01-01

    Background: It is believed that making an informed decision about (screening) participation is associated with better health-related quality of life (HRQoL) outcomes. This is the first study in cancer screening to explore this association in subjects participating in a lung cancer computed

  15. Relationship of External Influence to Parental Distress in Decision Making Regarding Children with a Life-Threatening Illness

    Luce, Mary Frances; Nelson, Robert M.

    2011-01-01

    Objective To examine the relationship of external influence to parental distress when making a decision about research or treatment for a child with a life-threatening illness and to test potential moderators of this relationship. Methods Parents (n = 219) who made a decision about research or treatment for a child completed measures of external influence, distress, decision-making preference, and coping. Results More external influence was associated with more hostility, uncertainty, and confusion. Decision-making preference and coping style moderated the relationship between external influence and distress: More external influence was associated with more distress when decision-making preference was low and task-focused coping was high. Conclusions External influence appears to be related to distress in parents making research and treatment decisions for children with life-threatening illnesses. However, it is important to consider parent characteristics, such as decision-making preference and coping style, when examining the effects of contextual factors on distress during decision making. PMID:21693541

  16. The need for operating guidelines and a decision making framework applicable to the discovery of non-intelligent extraterrestrial life

    Race, Margaret S.; Randolph, Richard O.

    While formal principles have been adopted for the eventuality of detecting intelligent life in our galaxy (SETI Principles), no such guidelines exist for the discovery of non-intelligent extraterrestrial life within the solar system. Current scientifically based planetary protection policies for solar system exploration address how to undertake exploration, but do not provide clear guidance on what to do if and when life is detected. Considering that martian life could be detected under several different robotic and human exploration scenarios in the coming decades, it is appropriate to anticipate how detection of non-intelligent, microbial life could impact future exploration missions and activities, especially on Mars. This paper discusses a proposed set of interim guidelines based loosely on the SETI Principles and addresses issues extending from the time of discovery through future handling and treatment of extraterrestrial life on Mars or elsewhere. Based on an analysis of both scientific and ethical considerations, there is a clear need for developing operating protocols applicable at the time of discovery and a decision making framework that anticipates future missions and activities, both robotic and human. There is growing scientific confidence that the discovery of extraterrestrial life in some form is nearly inevitable. If and when life is discovered beyond Earth, non-scientific dimensions may strongly influence decisions about the nature and scope of future missions and activities. It is appropriate to encourage international discussion and consideration of the issues prior to an event of such historical significance.

  17. Application of preference selection index method for decision making over the design stage of production system life cycle

    Rajesh Attri

    2015-07-01

    Full Text Available The life cycle of production system shows the progress of production system from the inception to the termination of the system. During each stage, mainly in the design stage, certain strategic decisions have to be taken. These decisions are more complex as the decision makers have to assess a wide range of alternatives based on a set of conflicting criteria. As the decision making process is found to be unstructured, characterized by domain dependent knowledge, there is a need to apply an efficient multi-criteria decision making (MCDM tool to help the decision makers in making correct decisions. This paper explores the application of a novel MCDM method i.e. Preference selection index (PSI method to solve various decision-making problems that are generally encountered in the design stage of production system life cycle. To prove the potentiality, applicability and accuracy of PSI method in solving decision making problem during the design stage of production system life cycle, five examples are cited from the literature and are compared with the results obtained by the past researchers.

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

    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

  19. Counting is easier while experiencing a congruent motion.

    Luisa Lugli

    Full Text Available Several studies suggest that numerical and spatial representations are intrinsically linked. Recent findings demonstrate that also motor actions interact with number magnitude processing, showing a motor-to-semantic effect. The current study assesses whether calculation processes can be modulated by motions performed with the whole body. Participants were required to make additions or subtractions while performing (on-line condition or after having experienced (off-line condition an ascending or descending motion through a passive (i.e., taking the elevator or an active (i.e., taking the stairs mode. Results show a congruency effect between the type of calculation and the direction of the motion depending on: a the off-line or on-line condition, b the passive or active mode and c the real or imagined task. Implications of the results for an embodied and grounded perspective view will be discussed.

  20. BioBlocks: Programming Protocols in Biology Made Easier.

    Gupta, Vishal; Irimia, Jesús; Pau, Iván; Rodríguez-Patón, Alfonso

    2017-07-21

    The methods to execute biological experiments are evolving. Affordable fluid handling robots and on-demand biology enterprises are making automating entire experiments a reality. Automation offers the benefit of high-throughput experimentation, rapid prototyping, and improved reproducibility of results. However, learning to automate and codify experiments is a difficult task as it requires programming expertise. Here, we present a web-based visual development environment called BioBlocks for describing experimental protocols in biology. It is based on Google's Blockly and Scratch, and requires little or no experience in computer programming to automate the execution of experiments. The experiments can be specified, saved, modified, and shared between multiple users in an easy manner. BioBlocks is open-source and can be customized to execute protocols on local robotic platforms or remotely, that is, in the cloud. It aims to serve as a de facto open standard for programming protocols in Biology.

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

    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

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

    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.

  3. Are Models Easier to Understand than Code? An Empirical Study on Comprehension of Entity-Relationship (ER) Models vs. Structured Query Language (SQL) Code

    Sanchez, Pablo; Zorrilla, Marta; Duque, Rafael; Nieto-Reyes, Alicia

    2011-01-01

    Models in Software Engineering are considered as abstract representations of software systems. Models highlight relevant details for a certain purpose, whereas irrelevant ones are hidden. Models are supposed to make system comprehension easier by reducing complexity. Therefore, models should play a key role in education, since they would ease the…

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

    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.

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

    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.

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

    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.

  7. HIV inhibition by lactobacilli: easier in a test tube than in real life.

    Witkin, Steven S; Linhares, Iara M

    2015-10-06

    A lactobacillus-dominant vaginal microbiota has been shown to decrease heterosexual HIV transmission. Nunn et al. now report that a vaginal microbiota dominated by Lactobacillus crispatus is associated with a relative inability of HIV pseudoviral particles to transverse cervicovaginal mucus (CVM) in vitro [mBio 6(5):e01084-15, 2015, doi:10.1128/mBio.01084-15]. The purported inhibitory mechanism is the interaction between carboxyl groups present on HIV and in CVM that occurred only under acidic conditions when carboxyl groups were protonated. L. crispatus produces high levels of lactic acid and results in the lowest vaginal pH when it is the dominant vaginal bacterium. In addition, high levels of lactic acid inhibit the proliferation of other bacteria that might negatively affect CVM structure. The utility of enhancing L. crispatus dominance to inhibit HIV transmission awaits assessment of the influence of ejaculated semen on this property and investigations on the role of Lactobacillus products such as d-lactic acid in this property. Copyright © 2015 Witkin and Linhares.

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

    Peicius, Eimantas; Blazeviciene, Aurelija; Kaminskas, Raimondas

    2017-06-05

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

  9. There’s a dad for that! : Naming men in work-life balance and entrepreneurial decision-making

    Rice, Joseph; Collinson, David; Gatrell, Caroline

    2017-01-01

    This thesis explores work-family balance in relation to entrepreneurial decision-making using men and masculinities literature as the lens of critical analysis. This research critically examines men’s subjective work-life balance experiences by evaluating their attempts to navigate between their fatherhood and entrepreneurial goals. There has been a flood of research since the introduction of Greenhaus and Beutell’s (1985) sources of conflict between work and family where the central focus is...

  10. Effects of Healthy Aging and Mild Cognitive Impairment on a Real-Life Decision-Making Task.

    Pertl, Marie-Theres; Benke, Thomas; Zamarian, Laura; Delazer, Margarete

    2017-01-01

    In this study, we investigated the effects of age and of mild cognitive impairment (MCI) on decision making under risk by adopting a task representing real-life health-related situations and involving complex numerical information. Moreover, we assessed the relationship of real-life decision making to other cognitive functions such as number processing, executive functions, language, memory, and attention. For this reason, we compared the performance of 19 healthy, relatively younger adults with that of 18 healthy older adults and the performance of the 18 healthy older adults with that of 17 patients with MCI. Results indicated difficulties in real-life decision making for the healthy older adults compared with the healthy, relatively younger adults. Difficulties of patients with MCI relative to the healthy older adults arose in particular in difficult items requiring processing of frequencies and fractions. Significant effects of age and of MCI in processing frequencies were also evident in a ratio number comparison task. Decision-making performance of healthy participants and of the patient group correlated significantly with number processing. There was a further significant correlation with executive functions for the healthy participants and with reading comprehension for the patients. Our results suggest that healthy older individuals and patients with MCI make less advantageous decisions when the information is complex and high demands are put on executive functions and numerical abilities. Moreover, we show that executive functions and numerical abilities are not only essential in laboratory gambling tasks but also in more realistic and ecological decision situations within the health context.

  11. East meets West: cross-cultural perspective in end-of-life decision making from Indian and German viewpoints.

    Chattopadhyay, Subrata; Simon, Alfred

    2008-06-01

    Culture creates the context within which individuals experience life and comprehend moral meaning of illness, suffering and death. The ways the patient, family and the physician communicate and make decisions in the end-of-life care are profoundly influenced by culture. What is considered as right or wrong in the healthcare setting may depend on the socio-cultural context. The present article is intended to delve into the cross-cultural perspectives in ethical decision making in the end-of-life scenario. We attempt to address the dynamics of the roles of patient, family and physician therein across two countries from East and West, namely, India and Germany. In India, where illness is more a shared family affair than an individual incident, a physician is likely to respect the family's wishes and may withhold the [Symbol: see text]naked truth' about the diagnosis of a fatal disease to the patient. In Germany, a physician is legally required to inform the patient about the disease. In India, advance directive being virtually non-existent, the family acts as the locus of the decision-making process, taking into account the economic cost of available medical care. In Germany, advance directive is regarded as mandatory and healthcare is covered by insurance. Family and the physician appear to play larger roles in ethical decision making for patients in India than for those in Germany, who place greater emphasis on autonomy of the individual patient. Our study explicates how culture matters in ethical decision-making and why the bioethical discourse is necessary in the concrete realities of the socio-cultural context. To explore the possibility of finding a common ground of morality across different cultures while acknowledging and respecting cultural diversity, thus remains a formidable challenge for the bioethicists.

  12. Planning cultural heritage protection is easier than managing an actual disaster

    Zdena Rosická

    2011-01-01

    Full Text Available Efficient preparedness is easier to carry out comparing to dealing with consequences of disasters, anthropogenic incidents and other emergencies. Most disasters are water related, i.e. the result of flooding due to high water, water used to extinguish the fire, etc. Cultural heritage as a whole is exposed to attack from natural weathering processes, pollutants as well as water-origin disasters, fires, arson, theft, landslides or extreme weather events. In case of a disaster or any other emergency, unfortunately, no one can afford to wait for all the data and information to be entirely completed in order to make conclusions and survive a disastrous attack. When a disaster occurs and a historical object is affected, decisions must me made fast about rescue priorities, which items to save and which to sacrifice; there must be available priority lists, working guides for salvage teams as well as a disaster plan, updated lists of human resources, suppliers and service providers, lists of types and number of vehicles including passable roads available in case the movable cultural heritage evacuation becomes urgent. Emergency-response officials must be trained in measures to ensure relevant handling, conservation and care.

  13. [Quality of life or life expectancy? Criteria and sources of information in the decision-making of patients undergoing aortic valve surgery].

    Schmied, Wolfram; Barnick, Saskia; Heimann, Dierk; Schäfers, Hans-Joachim; Köllner, Volker

    2015-01-01

    Physicians are expected to involve patients adequately in the decision-making process prior to surgery. To this end, it is essential to have knowledge about the potential reasons for such a decision. In this study we investigated which information sources and decision criteria are important to patients prior to aortic valve surgery. A consecutive sample of 468 patients (70.1%m, aged 66.9±14.2 years) was examined 2 years after aortic valve replacement or reconstruction with a self-developed questionnaire. Preoperative discussion with a cardiologist or a cardiac surgeon was the information source patients used most frequently and felt to be the most helpful. The most important decision criterion was quality of life, followed by life expectancy and likelihood of reoperation. Two years postoperatively, 97.3% of the patients were satisfied with their decision. Preoperative counseling by a physician plays an essential role in the decision-making process prior to cardiac surgery. Patients want to be involved in decision-making, though they do not want to bear the full responsibility.

  14. What makes couples happy? Marital and life satisfaction among ethnic groups in the Netherlands

    Celenk, O.; van de Vijver, F.J.R.

    2013-01-01

    This study examines predictors of life satisfaction that are more distal (spousal normative beliefs and attitudes) and more proximal (marital satisfaction) in 404 mainstreamers, 375 Western, and 195 non-Western immigrants living in the Netherlands. In the immigrant groups, we used ethnic and

  15. Life Contexts Make a Difference : Emotional Stability in Younger and Older Adults

    Brose, Annette; Scheibe, Susanne; Schmiedek, Florian

    Emotional stability, as indicated by low affect variability and low affective reactivity to daily events, for example, tends to increase across the adult life span. This study investigated a contextual explanation for such age differences, relating affect variability and affective reactivity to

  16. Life Support Baseline Values and Assumptions Document

    Anderson, Molly S.; Ewert, Michael K.; Keener, John F.

    2018-01-01

    The Baseline Values and Assumptions Document (BVAD) provides analysts, modelers, and other life support researchers with a common set of values and assumptions which can be used as a baseline in their studies. This baseline, in turn, provides a common point of origin from which many studies in the community may depart, making research results easier to compare and providing researchers with reasonable values to assume for areas outside their experience. This document identifies many specific physical quantities that define life support systems, serving as a general reference for spacecraft life support system technology developers.

  17. A grey-based group decision-making methodology for the selection of hydrogen technologiess in Life Cycle Sustainability perspective

    Manzardo, Alessandro; Ren, Jingzheng; Mazzi, Anna

    2012-01-01

    The objective of this research is to develop a grey-based group decision-making methodology for the selection of the best renewable energy technology (including hydrogen) using a life cycle sustainability perspective. The traditional grey relational analysis has been modified to better address...... the issue of uncertainty. The proposed methodology allows multi-person to participate in the decision-making process and to give linguistic evaluation on the weights of the criteria and the performance of the alternative technologies. In this paper, twelve hydrogen production technologies have been assessed...... using the proposed methodology, electrolysis of water technology by hydropower has been considered to be the best technology for hydrogen production according to the decision-making group....

  18. Individual variations in maternal care early in life correlate with later life decision-making and c-fos expression in prefrontal subregions of rats.

    Felisa N van Hasselt

    Full Text Available Early life adversity affects hypothalamus-pituitary-adrenal axis activity, alters cognitive functioning and in humans is thought to increase the vulnerability to psychopathology--e.g. depression, anxiety and schizophrenia--later in life. Here we investigated whether subtle natural variations among individual rat pups in the amount of maternal care received, i.e. differences in the amount of licking and grooming (LG, correlate with anxiety and prefrontal cortex-dependent behavior in young adulthood. Therefore, we examined the correlation between LG received during the first postnatal week and later behavior in the elevated plus maze and in decision-making processes using a rodent version of the Iowa Gambling Task (rIGT. In our cohort of male and female animals a high degree of LG correlated with less anxiety in the elevated plus maze and more advantageous choices during the last 10 trials of the rIGT. In tissue collected 2 hrs after completion of the task, the correlation between LG and c-fos expression (a marker of neuronal activity was established in structures important for IGT performance. Negative correlations existed between rIGT performance and c-fos expression in the lateral orbitofrontal cortex, prelimbic cortex, infralimbic cortex and insular cortex. The insular cortex correlations between c-fos expression and decision-making performance depended on LG background; this was also true for the lateral orbitofrontal cortex in female rats. Dendritic complexity of insular or infralimbic pyramidal neurons did not or weakly correlate with LG background. We conclude that natural variations in maternal care received by pups may significantly contribute to later-life decision-making and activity of underlying brain structures.

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

    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.

  20. Effect of professional expertise and exposure to everyday life decision-making on moral choices.

    Boccia, Maddalena; Verde, Paola; Angelino, Gregorio; Carrozzo, Paolo; Vecchi, Diego; Piccardi, Laura; Colangeli, Stefano; Cordellieri, Pierluigi; Ferlazzo, Fabio; Giannini, Anna Maria

    2017-07-27

    Moral sense is defined as a feeling of fairness or unfairness of an action that knowingly causes harm to people other than the subject. It is crucial in determining human behavior and becomes pivotal in operational environments. Here we assessed whether professional daily life experience in an operational environment affects moral judgment by asking 41 military pilots of the Italian Air Force (P) and 69 controls (C) to solve 40 moral dilemmas. We found that P gave more morally acceptable utilitarian responses to moral dilemmas. Interestingly, men and women in P equally accepted utilitarian resolutions of moral dilemmas, whereas in C women were less prone than men to accept utilitarian responses. We conclude that professional daily life experience of P, in an operational environment, affects moral judgment and mitigates gender predisposition towards moral dilemmas. Copyright © 2017 Elsevier B.V. All rights reserved.

  1. Visualization in medicine and life sciences III towards making an impact

    Hamann, Bernd; Hege, Hans-Christian

    2016-01-01

    The book discusses novel visualization techniques driven by the needs in medicine and life sciences as well as new application areas and challenges for visualization within these fields. It presents ideas and concepts for visual analysis of data from scientific studies of living organs or to the delivery of healthcare. Target scientific domains include the entire field of biology at all scales - from genes and proteins to organs and populations - as well as interdisciplinary research based on technological advances such as bioinformatics, biomedicine, biochemistry, or biophysics. Moreover, they comprise the field of medicine and the application of science and technology to healthcare problems. This book does not only present basic research pushing the state of the art in the field of visualization, but it also documents the impact in the fields of medicine and life sciences.

  2. "Future Life How?": The Making of Deaf Sociality and Aspiration in Urban India

    Friedner, Michele Ilana

    2011-01-01

    With the decline of the public sector in India, corporate rationalities have come to play an increasingly important role in everyday life in urban India. In analyzing this trend, this dissertation tracks what possibilities and constraints these new rationalities offer deaf young adults in the spaces that they circulate through. This dissertation argues that vocational training for deaf people is now focused on creating (immobile) workers for the Information Technology sector and that corporat...

  3. Work-life Balance Decision-making of Norwegian Students: Implications for Human Resources Management

    Gawlik, Remigiusz; Jacobsen, Gorm

    2016-01-01

    Objective: The paper aims at identifying and assessing the significance of work-life balance determinants between the Youth of highly developed societies and its implications for human resources management on the example of Norway. Research Design & Methods: The research target group consists of 236 respondents recruited among Norwegian tertiary education students. It employed literature analysis , two-stage exploratory research: direct individual in-depth interviews, survey based on a se...

  4. Using Life Cycle Assessment to Inform Decision-Making for Sustainable Buildings

    Mieke Vandenbroucke

    2015-05-01

    Full Text Available Because the student residences of the Vrije Universiteit Brussel built in 1973 are not adapted to current comfort standards, the university decided to construct new accommodation facilities at the border of the campus. However, besides demolition, there was no strategy on how to deal with the existing ones. In the search for a more sustainable strategy, the university’s administration assigned the TRANSFORM research team to define various design strategies and to assess the long-term environmental consequences in order to select the best strategy by the use of Life Cycle Environmental Assessment. Current Life Cycle Environmental Assessments generally include maintenance, repair, replacement and operational energy consumption during use, but do not include future refurbishments. However, it is likely that their impact cannot be neglected either. Therefore, this article offers a framework which takes future refurbishments into account, in addition to the standard use impacts: initial and end-of-life impact. We report on the construction assemblies, the results of the assessments conducted and the advice provided. The results confirm that the impact of future refurbishments cannot be neglected. In addition, we observed that there were significant environmental savings when transforming the residences compared to new construction, and long-term benefits of a design enabling the reuse of building elements.

  5. Adapting the SLIM diabetes prevention intervention to a Dutch real-life setting: joint decision making by science and practice.

    Jansen, Sophia C; Haveman-Nies, Annemien; Duijzer, Geerke; Ter Beek, Josien; Hiddink, Gerrit J; Feskens, Edith J M

    2013-05-08

    Although many evidence-based diabetes prevention interventions exist, they are not easily applicable in real-life settings. Moreover, there is a lack of examples which describe the adaptation process of these interventions to practice. In this paper we present an example of such an adaptation. We adapted the SLIM (Study on Lifestyle intervention and Impaired glucose tolerance Maastricht) diabetes prevention intervention to a Dutch real-life setting, in a joint decision making process of intervention developers and local health care professionals. We used 3 adaptation steps in accordance with current adaptation frameworks. In the first step, the elements of the SLIM intervention were identified. In the second step, these elements were judged for their applicability in a real-life setting. In the third step, adaptations were proposed and discussed for those elements which were deemed not applicable. Participants invited for this process included intervention developers and local health care professionals (n=19). In the first adaptation step, a total of 22 intervention elements were identified. In the second step, 12 of these 22 intervention elements were judged as inapplicable. In the third step, a consensus was achieved for the adaptations of all 12 elements. The adapted elements were in the following categories: target population, techniques, intensity, delivery mode, materials, organisational structure, and political and financial conditions. The adaptations either lay in changing the SLIM protocol (6 elements) or the real-life working procedures (1 element), or a combination of both (4 elements). The positive result of this study is that a consensus was achieved within a relatively short time period (nine months) between the developers of the SLIM intervention and local health care professionals on the adaptations needed to make SLIM applicable in a Dutch real-life setting. Our example shows that it is possible to combine the perspectives of scientists and

  6. Informed decision making about predictive DNA tests: arguments for more public visibility of personal deliberations about the good life.

    Boenink, Marianne; van der Burg, Simone

    2010-05-01

    Since its advent, predictive DNA testing has been perceived as a technology that may have considerable impact on the quality of people's life. The decision whether or not to use this technology is up to the individual client. However, to enable well considered decision making both the negative as well as the positive freedom of the individual should be supported. In this paper, we argue that current professional and public discourse on predictive DNA-testing is lacking when it comes to supporting positive freedom, because it is usually framed in terms of risk and risk management. We show how this 'risk discourse' steers thinking on the good life in a particular way. We go on to argue that empirical research into the actual deliberation and decision making processes of individuals and families may be used to enrich the environment of personal deliberation in three ways: (1) it points at a richer set of values that deliberators can take into account, (2) it acknowledges the shared nature of genes, and (3) it shows how one might frame decisions in a non-binary way. We argue that the public sharing and discussing of stories about personal deliberations offers valuable input for others who face similar choices: it fosters their positive freedom to shape their view of the good life in relation to DNA-diagnostics. We conclude by offering some suggestions as to how to realize such public sharing of personal stories.

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

    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

  8. Patient involvement in the decision-making process improves satisfaction and quality of life in postmastectomy breast reconstruction.

    Ashraf, Azra A; Colakoglu, Salih; Nguyen, John T; Anastasopulos, Alexandra J; Ibrahim, Ahmed M S; Yueh, Janet H; Lin, Samuel J; Tobias, Adam M; Lee, Bernard T

    2013-09-01

    The patient-physician relationship has evolved from the paternalistic, physician-dominant model to the shared-decision-making and informed-consumerist model. The level of patient involvement in this decision-making process can potentially influence patient satisfaction and quality of life. In this study, patient-physician decision models are evaluated in patients undergoing postmastectomy breast reconstruction. All women who underwent breast reconstruction at an academic hospital from 1999-2007 were identified. Patients meeting inclusion criteria were mailed questionnaires at a minimum of 1 y postoperatively with questions about decision making, satisfaction, and quality of life. There were 707 women eligible for our study and 465 completed surveys (68% response rate). Patients were divided into one of three groups: paternalistic (n = 18), informed-consumerist (n = 307), shared (n = 140). There were differences in overall general satisfaction (P = 0.034), specifically comparing the informed group to the paternalistic group (66.7% versus 38.9%, P = 0.020) and the shared to the paternalistic group (69.3% versus 38.9%, P = 0.016). There were no differences in aesthetic satisfaction. There were differences found in the SF-12 physical component summary score across all groups (P = 0.033), and a difference was found between the informed and paternalistic groups (P mental component score (P = 0.42). Women undergoing breast reconstruction predominantly used the informed model of decision making. Patients who adopted a more active role, whether using an informed or shared approach, had higher general patient satisfaction and physical component summary scores compared with patients whose decision making was paternalistic. Copyright © 2013 Elsevier Inc. All rights reserved.

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

    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

  10. A life-cycle based decision-making framework for electricity generation system planning

    Norrie, S.J.; Fang, L. [Ryerson Polytechnic Univ., Toronto, ON (Canada). Environmental Applied Science and Management Graduate Program

    2006-07-01

    This paper proposed a framework for the consideration of multiple objectives in the long-term planning of electricity generation systems. The framework was comprised of 3 components: (1) information based on life-cycle inventories of electricity generation technologies; (2) a set of alternative scenarios to be evaluated and ranked using the framework; and (3) stakeholder values for decision objectives. Scenarios were developed to represent a set of future conditions, and values were derived through the use of questionnaires. Planning for electricity generation in Ontario was selected as a test case for the DM framework. Three scenarios were presented: (1) a business as usual scenario characterized by large, central power plants; (2) a mix of central power plants, distributed generation, and advanced conventional fuel technologies; and (3) small-scale distributed and renewable energy sources and aggressive demand-side management. The life-cycle based information from the scenario evaluation was used to estimate the performance of each scenario on the established decision criteria. Results showed that scenario 3 was the closest to achieving the fundamental objectives according to the decision criteria. It was concluded that the DM framework showed that the use of holistic environmental information and preferential information for multiple objectives can be integrated into a framework that openly and consistently evaluates a set of alternative scenarios. 31 refs., 7 tabs., 4 figs.

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

    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.

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

    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.

  13. 'To do or not to do'? The neurobiology of decision-making in daily life: I. Getting the basics

    André Palmini

    Full Text Available Abstract The constant conflict between decisions leading to immediate pleasurable consequences versus behaviors aiming at long-term social advantages is reviewed here in the framework of the evolutionary systems regulating behavior. The inescapable temporal perspective in decision-making in everyday life is highlighted and integrated with the role of the executive functions in the modulation of subcortical systems. In particular, the representations of the 'non-existent' future in the prefrontal cortical regions and how these representations can bridge theory and practice in everyday life are addressed. Relevant discussions regarding the battle between emotions and reasons in the determination of more complex decisions in the realm of neuroeconomics and in moral issues have been reserved for a second essay.

  14. Including Life Cycle Assessment for decision-making in controlling wastewater nutrient removal systems

    Corominas, Lluís; Larsen, Henrik Fred; Flores-Alsina, Xavier

    2013-01-01

    This paper focuses on the use of Life Cycle Assessment (LCA) to evaluate the performance of seventeen control strategies in wastewater treatment plants (WWTPs). It tackles the importance of using site-specific factors for nutrient enrichment when decision-makers have to select best operating....../or energy savings present an environmental benefit for N&P and P-deficient systems. This is not the case when addressing N-deficient systems for which the use of chemicals (even for improving N removal efficiencies) is not always beneficial for the environment. A sensitivity analysis on using weighting...... of the impact categories is conducted to assess how value choices (policy decisions) may affect the management of WWTPs. For the scenarios with only N-limitation, the LCA-based ranking of the control strategies is sensitive to the choice of weighting factors, whereas this is not the case for N&P or P...

  15. Is holography ready for yet another life? or make holography great again

    Trolinger, James D.

    2016-08-01

    Holographic metrology, unlike most other applications of holography, has always thrived and continues to thrive by continuously incorporating new supporting technologies that make it more powerful and useful. Successes, failures, lives, and deaths are examined and recognized as evolutionary steps that position the field where opportunities are as great and as many as ever. This is a story of that evolution. Comparisons and analogies with other applications of holography such as data storage, archiving, the arts, entertainment, advertising, and security and their evolution are interesting. Critical events, successes, mistakes, and coincidences represent milestones of abandonment or failure to deliver in many holography communities that followed a different evolutionary path. Events and new technical developments continue to emerge in supporting fields that can revive and expand all holography applications. New opportunities are described with encouragement to act on them and take some risks. Don't wait until all of the required technology and hardware are available, because good scientists always act before then. The paper is about "making holography great again" and your opportunity to be a part of the upcoming revolution. Although the discussion focuses on holographic metrology, the same principles should apply to other holography communities.

  16. Risking your life without a second thought: intuitive decision-making and extreme altruism.

    David G Rand

    Full Text Available When faced with the chance to help someone in mortal danger, what is our first response? Do we leap into action, only later considering the risks to ourselves? Or must instinctive self-preservation be overcome by will-power in order to act? We investigate this question by examining the testimony of Carnegie Hero Medal Recipients (CHMRs, extreme altruists who risked their lives to save others. We collected published interviews with CHMRs where they described their decisions to help. We then had participants rate the intuitiveness versus deliberativeness of the decision-making process described in each CHMR statement. The statements were judged to be overwhelmingly dominated by intuition; to be significantly more intuitive than a set of control statements describing deliberative decision-making; and to not differ significantly from a set of intuitive control statements. This remained true when restricting to scenarios in which the CHMRs had sufficient time to reflect before acting if they had so chosen. Text-analysis software found similar results. These findings suggest that high-stakes extreme altruism may be largely motivated by automatic, intuitive processes.

  17. Associations between social networks and life satisfaction among older Japanese: Does birth cohort make a difference?

    Kobayashi, Erika; Liang, Jersey; Sugawara, Ikuko; Fukaya, Taro; Shinkai, Shoji; Akiyama, Hiroko

    2015-12-01

    Japanese older people experienced drastic changes in family structure and values after World War II at different life stages by birth cohorts. We examined how linkages between different types of social ties and life satisfaction (LS) vary across cohorts, in conjunction with age and survey year differences. Data from face-to-face interviews conducted in 1987, 1999, and 2012 with a nationally representative sample of older Japanese (N = 4,917) were analyzed. The participants were members of 4 birth cohorts (C1: 1901-1912, C2: 1913-1924, C3: 1925-1936, C4: 1937-1949), categorized into 6 groups based on cohort and age at time of measurement (young-old [YO]: 63-74; old-old [OO]: 75-86): C1OO, C2YO, C2OO, C3YO, C3OO, and C4YO. Effects of social networks on LS among the 6 groups were compared simultaneously and separately by gender using the Amos software. There were significant cohort variations in the linkages between family network and LS. The positive association between being married and LS was stronger for later cohorts (C3, C4) among men, whereas that of co-residence with a child and LS was stronger for the earlier cohorts (C1, C2) among women. Moreover, the positive association between meeting with nonfamily members and LS increased from 1987 to 2012 among women, indicating a period effect over a cohort effect. The effects of being married and participation in community groups on LS also changed with age. Our results suggest that linkages between social relations and LS should be interpreted within the context of individual and social changes over time. (c) 2015 APA, all rights reserved).

  18. Prioritization of Bioethanol Production Pathways in China based on Life Cycle Sustainability Assessment and Multi-Criteria Decision-Making

    Ren, Jingzheng; Manzardo, Alessandro; Mazzi, Anna

    2015-01-01

    Purpose The study objectives are two-fold: (i) combining the life cycle sustainability assessment (LCSA) framework and the multi-criteria decision-making (MCDM) methodology for sustainability assessment; (ii) determining the most sustainable scenario for bioethanol production in China according......’s proposed method investigates an illustrative case about three alternative bioethanol production scenarios (wheat-based, corn-based and cassava-based): the prior sequence (based on the sustainability performances) in descending order is cassava-based, corn-based and wheat-based. The proposed methodology...... is to test the combination of a MCDM methodology and LCSA for sustainability decision-making by studying three alternative pathways for bioethanol production in China. The proposed method feasibly enables the decision-makers/stakeholders to find the most sustainable scenario to achieve their objectives among...

  19. Online public reactions to fMRI communication with patients with disorders of consciousness: Quality of life, end-of-life decision making, and concerns with misdiagnosis.

    Chandler, Jennifer A; Sun, Jeffrey A; Racine, Eric

    2017-01-01

    Recently, the news media have reported on the discovery of covert awareness and the establishment of limited communication using a functional magnetic resonance imaging (fMRI) neuroimaging technique with several brain-injured patients thought to have been in a vegetative state. This discovery has raised many ethical, legal, and social questions related to quality of life, end-of-life decision making, diagnostic and prognostic accuracy in disorders of consciousness, resource allocation, and other issues. This project inquires into the public responses to these discoveries. We conducted a thematic analysis of online comments (n = 779) posted in response to 15 news articles and blog posts regarding the case of a Canadian patient diagnosed for 12 years as in a vegetative state, but who was reported in 2012 as having been able to communicate via fMRI. The online comments were coded using an iteratively refined codebook structured around 14 main themes. Among the most frequent public reactions revealed in the online comments were discussions of the quality of life of patients with disorders of consciousness, whether life-sustaining treatment should be withdrawn (and whether the fMRI communication technique should be used to ask patients about this), and misgivings about the accuracy of diagnosis in disorders of consciousness and brain death. These public perspectives are relevant to the obligations of clinicians, lawyers, and public policymakers to patients, families, and the public. Future work should consider how best to alleviate families' concerns as this type of research shakes their faith in diagnostic accuracy, to clarify the legal rules relating to advance directives in this context, and to address the manner in which public messaging might help to alleviate any indirect impact on confidence in the organ donation system.

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

    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.

  1. Risk taking and adult attention deficit/hyperactivity disorder: A gap between real life behavior and experimental decision making.

    Pollak, Yehuda; Shalit, Reut; Aran, Adi

    2018-01-01

    Adults with attention deficit/hyperactivity disorder (ADHD) are prone to suboptimal decision making and risk taking. The aim of this study was to test performance on a theoretically-based probabilistic decision making task in well-characterized adults with and without ADHD, and examine the relation between experimental risk taking and history of real-life risk-taking behavior, defined as cigarette, alcohol, and street drug use. University students with and without ADHD completed a modified version of the Cambridge Gambling Test, in which they had to choose between alternatives varied by level of risk, and reported their history of substance use. Both groups showed similar patterns of risk taking on the experimental decision making task, suggesting that ADHD is not linked to low sensitivity to risk. Past and present substance use was more prevalent in adults with ADHD. These finding question the validity of experimental probabilistic decision making task as a valid model for ADHD-related risk-taking behavior. Copyright © 2017 Elsevier B.V. All rights reserved.

  2. A simple artificial life model explains irrational behavior in human decision-making.

    Carolina Feher da Silva

    Full Text Available Although praised for their rationality, humans often make poor decisions, even in simple situations. In the repeated binary choice experiment, an individual has to choose repeatedly between the same two alternatives, where a reward is assigned to one of them with fixed probability. The optimal strategy is to perseverate with choosing the alternative with the best expected return. Whereas many species perseverate, humans tend to match the frequencies of their choices to the frequencies of the alternatives, a sub-optimal strategy known as probability matching. Our goal was to find the primary cognitive constraints under which a set of simple evolutionary rules can lead to such contrasting behaviors. We simulated the evolution of artificial populations, wherein the fitness of each animat (artificial animal depended on its ability to predict the next element of a sequence made up of a repeating binary string of varying size. When the string was short relative to the animats' neural capacity, they could learn it and correctly predict the next element of the sequence. When it was long, they could not learn it, turning to the next best option: to perseverate. Animats from the last generation then performed the task of predicting the next element of a non-periodical binary sequence. We found that, whereas animats with smaller neural capacity kept perseverating with the best alternative as before, animats with larger neural capacity, which had previously been able to learn the pattern of repeating strings, adopted probability matching, being outperformed by the perseverating animats. Our results demonstrate how the ability to make predictions in an environment endowed with regular patterns may lead to probability matching under less structured conditions. They point to probability matching as a likely by-product of adaptive cognitive strategies that were crucial in human evolution, but may lead to sub-optimal performances in other environments.

  3. A simple artificial life model explains irrational behavior in human decision-making.

    Feher da Silva, Carolina; Baldo, Marcus Vinícius Chrysóstomo

    2012-01-01

    Although praised for their rationality, humans often make poor decisions, even in simple situations. In the repeated binary choice experiment, an individual has to choose repeatedly between the same two alternatives, where a reward is assigned to one of them with fixed probability. The optimal strategy is to perseverate with choosing the alternative with the best expected return. Whereas many species perseverate, humans tend to match the frequencies of their choices to the frequencies of the alternatives, a sub-optimal strategy known as probability matching. Our goal was to find the primary cognitive constraints under which a set of simple evolutionary rules can lead to such contrasting behaviors. We simulated the evolution of artificial populations, wherein the fitness of each animat (artificial animal) depended on its ability to predict the next element of a sequence made up of a repeating binary string of varying size. When the string was short relative to the animats' neural capacity, they could learn it and correctly predict the next element of the sequence. When it was long, they could not learn it, turning to the next best option: to perseverate. Animats from the last generation then performed the task of predicting the next element of a non-periodical binary sequence. We found that, whereas animats with smaller neural capacity kept perseverating with the best alternative as before, animats with larger neural capacity, which had previously been able to learn the pattern of repeating strings, adopted probability matching, being outperformed by the perseverating animats. Our results demonstrate how the ability to make predictions in an environment endowed with regular patterns may lead to probability matching under less structured conditions. They point to probability matching as a likely by-product of adaptive cognitive strategies that were crucial in human evolution, but may lead to sub-optimal performances in other environments.

  4. Life Cycle Analysis for D and D Decision Making: Disposition of Hanford Railcars

    Yuracko, K.L.

    2001-01-11

    This report summarizes a joint venture between the U.S. Department of Energy (DOE) Deactivation and Decommissioning Focus Area and the Oak Ridge Operations Assets Utilization (AU) Facilities and Materials Reuse Division (FMRD) in its role as the DOE National Center of Excellence for Metals Recycle (NMR), to better address problems in the DOE complex. This task was initially developed to meet a request from the Richland Operations Office (RL) to AU FMRD for assistance in analyzing equipment reuse and metals recycling opportunities at RL, utilizing expertise and experience related to life cycle analysis (LCA), technology, and planning. Oak Ridge National Laboratory (ORNL) has developed an LCA system to assist DOE in identifying and analyzing opportunities for equipment and materials reuse and recycle. This report presents the use of the LCA system to identify and analyze methods for disposition of surplus railcars at the Hanford site. Alternative possible disposition pathways were evaluated for their financial, health and safety, environmental, programmatic, and institutional impacts; and a preferred disposition pathway was identified.

  5. Coping with Inflammatory Bowel Disease: Engaging with Information to Inform Health-Related Decision Making in Daily Life.

    Restall, Gayle J; Simms, Alexandria M; Walker, John R; Haviva, Clove; Graff, Lesley A; Sexton, Kathryn A; Miller, Norine; Targownik, Laura E; Bernstein, Charles N

    2017-08-01

    People with inflammatory bowel disease (IBD) require disease and lifestyle information to make health-related decisions in their daily lives. Derived from a larger qualitative study of the lived experiences of people with IBD, we report on findings that explored how people with IBD engage with health-related information in their daily lives. Participants were recruited primarily from the Manitoba IBD Cohort Study. We used purposive sampling to select people with a breadth of characteristics and experiences. Individual interviews were audio-recorded and transcribed verbatim. Data were analyzed using inductive qualitative methods consistent with a phenomenological approach. Forty-five people with IBD participated; 51% were women. Findings highlighted the temporal and contextual influences on engagement with health-related information. Temporal influences were described as the changing need for health-related information over time. Participants identified 6 contextual factors influencing engagement with information to make health decisions: (1) emotional and attitudinal responses, (2) perceived benefits and risks, (3) trust in the source of the information, (4) knowledge and skills to access and use information, (5) availability of evidence to support decisions, and (6) social and economic environments. Findings illustrate the changing needs for health-related information over the course of IBD, and with evolving health and life circumstances. Practitioners can be responsive to information needs of people with IBD by having high-quality information available at the right time in a variety of formats and by supporting the incorporation of information in daily life.

  6. Sensory shelf life estimation of minimally processed lettuce considering two stages of consumers' decision-making process.

    Ares, Gastón; Giménez, Ana; Gámbaro, Adriana

    2008-01-01

    The aim of the present work was to study the influence of context, particularly the stage of the decision-making process (purchase vs consumption stage), on sensory shelf life of minimally processed lettuce. Leaves of butterhead lettuce were placed in common polypropylene bags and stored at 5, 10 and 15 degrees C. Periodically, a panel of six assessors evaluated the appearance of the samples, and a panel of 40 consumers evaluated their appearance and answered "yes" or "no" to the questions: "Imagine you are in a supermarket, you want to buy a minimally processed lettuce, and you find a package of lettuce with leaves like this, would you normally buy it?" and "Imagine you have this leaf of lettuce stored in your refrigerator, would you normally consume it?". Survival analysis was used to calculate the shelf lives of minimally processed lettuce, considering both decision-making stages. Shelf lives estimated considering rejection to purchase were significantly lower than those estimated considering rejection to consume. Therefore, in order to be conservative and assure the products' quality, shelf life should be estimated considering consumers' rejection to purchase instead of rejection to consume, as traditionally has been done. On the other hand, results from logistic regressions of consumers' rejection percentage as a function of the evaluated appearance attributes suggested that consumers considered them differently while deciding whether to purchase or to consume minimally processed lettuce.

  7. Making James Joyce’s life into a graphic novel. An interview with Alfonso Zapico

    Carlos Menéndez Otero

    2014-03-01

    Full Text Available Alfonso Zapico was born in Blimea, Asturias, Spain, in 1981.He started working as a professional illustrator and cartoonist in 2006 and has since published four graphic novels: La guerre du professeur Bertenev (2006, set in the Crimean War; Café Budapest (2008, about the Israeli-Palestinian conflict; Dublinés (2011, a biography of James Joyce, and  La ruta Joyce (2011, a kind of ‘making of’ of Dublinés. His works have received several prestigious awards and been published in Spain, France, Belgium, Switzerland, Poland, Germany and Ireland, where The O’Brien Press released the English version of Dublinés, James Joyce. Portrait of a Dubliner, in May 2013. Just a few days before, the Niemeyer Center in Avilés, Asturias, opened Pasos encontrados. Un viaje dibujado de Alfonso Zapico, an exhibition focused on his career and, more particularly, on Dublinés and La ruta Joyce. He will soon be publishing his fifth graphic novel, El otro mar, about Vasco Núñez de Balboa and the expedition that led to the European discovery of the Pacific Ocean in 1513.We interviewed Zapico at the Niemeyer Center on June 29th, 2013.

  8. Gambling with your life: the process of breast cancer treatment decision making in Chinese women.

    Lam, Wendy Wt; Fielding, Richard; Chan, Miranda; Chow, Louis; Or, Amy

    2005-01-01

    Treatment decision making (TDM) studies have primarily focused on assessing TDM quality and predominantly presume rational analytic processes as the gold standard. In a grounded theory study of 22 Hong Kong Chinese women following breast surgery who completed an in-depth interview exploring the process of TDM in breast cancer (BC), narrative data showed that discovery of a breast abnormality and emotional responses to BC diagnosis influence the TDM process. Lack of guidance from surgeons impaired TDM. Decisions were, for the most part, made using intuitive, pragmatic and emotionally driven criteria in the absence of complete information. The experience of TDM, which was likened to gambling, did not end once the decision was made but unfolded while waiting for surgery and the post-operative report. In this waiting period, women were emotionally overwhelmed by fear of death and the uncertainty of the surgical outcome, and equivocated over whether they had made the 'right' choice. This suggests that Chinese women feel they are gambling with their lives during TDM. These women are particularly emotionally vulnerable whilst waiting for their surgery and the post-surgical clinical pathology results. Providing emotional support is particularly important at this time when these women are overwhelmed by uncertainty. 2004 John Wiley & Sons, Ltd.

  9. A decision-making framework for effective maintenance management using life cycle costing (LCC in a rolling stock environment

    Fourie, Cornelius Jacobus

    2016-12-01

    Full Text Available In this paper, a life cycle costing (LCC framework for effective maintenance management is investigated and developed for use in a railway rolling stock environment. The framework consists of combining typical mission-critical components together with their failure and maintenance history. All costs related to the operation and maintenance of these components throughout their life cycle are also determined. The next step involves considering different scenarios under which the components can be used in relation to operations, maintenance, and replacements. The decision about which scenario to take is based on the one with the most favourable net present value after life cycle costing is performed over a specified period of time. A typical railway rolling-stock maintenance organisation in South Africa was used to highlight the practical implications of such a framework and how the company could make informed and appropriate decisions. The conclusion of this study is that such a framework is useful, and that it can be used as a basis for estimating LCC across a spectrum of critical assets found in the rolling stock environment.

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

    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.

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

    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.

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

    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.

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

    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.

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

    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.

  15. Subject Relative Clauses Are Not Universally Easier to Process: Evidence from Basque

    Carreiras, Manuel; Dunabeitia, Jon Andoni; Vergara, Marta; de la Cruz-Pavia, Irene; Laka, Itziar

    2010-01-01

    Studies from many languages consistently report that subject relative clauses (SR) are easier to process than object relatives (OR). However, Hsiao and Gibson (2003) report an OR preference for Chinese, a finding that has been contested. Here we report faster OR versus SR processing in Basque, an ergative, head-final language with pre-nominal…

  16. Review of life-cycle approaches coupled with data envelopment analysis: launching the CFP + DEA method for energy policy making.

    Vázquez-Rowe, Ian; Iribarren, Diego

    2015-01-01

    Life-cycle (LC) approaches play a significant role in energy policy making to determine the environmental impacts associated with the choice of energy source. Data envelopment analysis (DEA) can be combined with LC approaches to provide quantitative benchmarks that orientate the performance of energy systems towards environmental sustainability, with different implications depending on the selected LC + DEA method. The present paper examines currently available LC + DEA methods and develops a novel method combining carbon footprinting (CFP) and DEA. Thus, the CFP + DEA method is proposed, a five-step structure including data collection for multiple homogenous entities, calculation of target operating points, evaluation of current and target carbon footprints, and result interpretation. As the current context for energy policy implies an anthropocentric perspective with focus on the global warming impact of energy systems, the CFP + DEA method is foreseen to be the most consistent LC + DEA approach to provide benchmarks for energy policy making. The fact that this method relies on the definition of operating points with optimised resource intensity helps to moderate the concerns about the omission of other environmental impacts. Moreover, the CFP + DEA method benefits from CFP specifications in terms of flexibility, understanding, and reporting.

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

    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

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

    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.

  19. 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.

    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/

  20. 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.

    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.

  1. Pressure during decision making of continuous sedation in end-of-life situations in Dutch general practice

    Blanker Marco H

    2012-07-01

    Full Text Available Abstract Background Little is known about pressure from patients or relatives on physician’s decision making of continuous palliative sedation. We aim to describe experienced pressure by general practitioners (GPs in cases of continuous sedation after the introduction of the Dutch practice guideline, using a questionnaire survey. Methods A sample of 918 Dutch GPs were invited to fill out a questionnaire about their last patient under continuous sedation. Cases in which GPs experienced pressure from the patient, relatives or other persons were compared to those without pressure. Results 399 of 918 invite GPs (43% returned the questionnaire and 250 provided detailed information about their most recent case of continuous sedation. Forty-one GPs (16% indicated to have experienced pressure from the patient, relatives or colleagues. In GPs younger than 50, guideline knowledge was not related to experienced pressure, whereas in older GPs, 15% with and 36% without guideline knowledge reported pressure. GPs experienced pressure more often when patients had psychological symptoms (compared to physical symptoms only and when patients had a longer estimated life expectancy. A euthanasia request of the patient coincided with a higher prevalence of pressure for GPs without, but not for GPs with previous experience with euthanasia. GPs who experienced pressure had consulted a palliative consultation team more often than GPs who did not experience pressure. Conclusion One in six GPs felt pressure from patients or relatives to start sedation. This pressure was related to guideline knowledge, especially in older GPs, longer life expectancy and the presence of a euthanasia request, especially for GPs without previous experience of euthanasia.

  2. Pressure during decision making of continuous sedation in end-of-life situations in Dutch general practice

    2012-01-01

    Background Little is known about pressure from patients or relatives on physician’s decision making of continuous palliative sedation. We aim to describe experienced pressure by general practitioners (GPs) in cases of continuous sedation after the introduction of the Dutch practice guideline, using a questionnaire survey. Methods A sample of 918 Dutch GPs were invited to fill out a questionnaire about their last patient under continuous sedation. Cases in which GPs experienced pressure from the patient, relatives or other persons were compared to those without pressure. Results 399 of 918 invite GPs (43%) returned the questionnaire and 250 provided detailed information about their most recent case of continuous sedation. Forty-one GPs (16%) indicated to have experienced pressure from the patient, relatives or colleagues. In GPs younger than 50, guideline knowledge was not related to experienced pressure, whereas in older GPs, 15% with and 36% without guideline knowledge reported pressure. GPs experienced pressure more often when patients had psychological symptoms (compared to physical symptoms only) and when patients had a longer estimated life expectancy. A euthanasia request of the patient coincided with a higher prevalence of pressure for GPs without, but not for GPs with previous experience with euthanasia. GPs who experienced pressure had consulted a palliative consultation team more often than GPs who did not experience pressure. Conclusion One in six GPs felt pressure from patients or relatives to start sedation. This pressure was related to guideline knowledge, especially in older GPs, longer life expectancy and the presence of a euthanasia request, especially for GPs without previous experience of euthanasia. PMID:22759834

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

    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.

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

    Searight, H Russell; Gafford, Jennifer

    2005-07-01

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

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

    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.

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

    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

  7. The Relationship Between Job Satisfaction And Life Satisfaction: Empirical Evidence From Logistics Practitioners In A South African Steel-Making Company

    Chengedzai Mafini

    2014-01-01

    There has been an explosion of research interests centered upon the job satisfaction-life satisfaction nexus within organizations. Be that as it may, there is a relative paucity of research on the job satisfaction of logistics practitioners in general and limited evidence of studies that specifically address the issue of job satisfaction in the steel-making industry in developing countries. The aim of this study was to investigate the structural relationships between job satisfaction and life...

  8. Escogiendo Salud: Comiendo Saludable en Philadelphia, PA PSA (:60) (Making Health Easier: Healthy Eating in Philadelphia, PA)

    Clara Santos, la dueña de Olivares Food Market, está haciendo cambios en las opciones de comida que ofrece a su comunidad. Aprenda cómo incorporó alimentos frescos y saludables en su pequeña tienda y como usted también puede hacerlo.

  9. Words that make pills easier to swallow: a communication typology to address practical and perceptual barriers to medication intake behavior

    Linn, A.J.; van Weert, J.C.M.; Schouten, B.C.; Smit, E.G.; van Bodegraven, A.A.; van Dijk, L.

    2012-01-01

    Purpose: The barriers to patients’ successful medication intake behavior could be reduced through tailored communication about these barriers. The aim of this study is therefore (1) to develop a new communication typology to address these barriers to successful medication intake behavior, and (2) to

  10. Words that make pills easier to swallow: a communication typology to address practical and perceptual barriers to medication intake behavior.

    Linn, A.J.; Weert, J.C.M. van; Schouten, B.C.; Smit, E.G.; Bodegraven, A.A. van; Dijk, L. van

    2012-01-01

    Purpose: The barriers to patients’ successful medication intake behavior could be reduced through tailored communication about these barriers. The aim of this study is therefore (1) to develop a new communication typology to address these barriers to successful medication intake behavior, and (2) to

  11. Words that make pills easier to swallow: a communication typology to address practical and perceptual barriers to medication intake behavior

    Linn AJ

    2012-12-01

    Full Text Available Annemiek J Linn,1 Julia CM van Weert,1 Barbara C Schouten,1 Edith G Smit,1 Ad A van Bodegraven,2 Liset van Dijk31Amsterdam School of Communication Research (ASCoR, University of Amsterdam, Amsterdam, The Netherlands; 2VU University Medical Center, Amsterdam, The Netherlands; 3Netherlands Institute for Health Services Research, Utrecht, The NetherlandsPurpose: The barriers to patients’ successful medication intake behavior could be reduced through tailored communication about these barriers. The aim of this study is therefore (1 to develop a new communication typology to address these barriers to successful medication intake behavior, and (2 to examine the relationship between the use of the typology and the reduction of the barriers to successful medication intake behavior.Patients and methods: Based on a literature review, the practical and perceptual barriers to successful medication intake behavior typology (PPB-typology was developed. The PPB-typology addresses four potential types of barriers that can be either practical (memory and daily routine barriers or perceptual (concern and necessity barriers. The typology describes tailored communication strategies that are organized according to barriers and communication strategies that are organized according to provider and patient roles. Eighty consultations concerning first-time medication use between nurses and inflammatory bowel disease patients were videotaped. The verbal content of the consultations was analyzed using a coding system based on the PPB-typology. The Medication Understanding and Use Self-efficacy Scale and the Beliefs about Medicine Questionnaire Scale were used as indicators of patients’ barriers and correlated with PPB-related scores.Results: The results showed that nurses generally did not communicate with patients according to the typology. However, when they did, fewer barriers to successful medication intake behavior were identified. A significant association was found between nurses who encouraged question-asking behavior and memory barriers (r = −0.228, P = 0.042 and between nurses who summarized information (r = −0.254, P = 0.023 or used cartoons or pictures (r = −0.249, P = 0.026 and concern barriers. Moreover, a significant relationship between patients’ emotional cues about side effects and perceived concern barriers (r = 0.244, P = 0.029 was found as well.Conclusion: The PPB-typology provides communication recommendations that are designed to meet patients’ needs and assist providers in the promotion of successful medication intake behavior, and it can be a useful tool for developing effective communication skills training programs.Keywords: interpersonal communication, tailoring, adherence, coding provider-patient interaction, beliefs, self-efficacy

  12. Words that make pills easier to swallow: a communication typology to address practical and perceptual barriers to medication intake behavior.

    Linn, A.J.; Weert, J.C.M. van; Schouten, B.C.; Smit, E.G.; Bodegraven, A.A. van; Dijk, L. van

    2012-01-01

    Annemiek J Linn,1 Julia CM van Weert,1 Barbara C Schouten,1 Edith G Smit,1 Ad A van Bodegraven,2 Liset van Dijk31Amsterdam School of Communication Research (ASCoR), University of Amsterdam, Amsterdam, The Netherlands; 2VU University Medical Center, Amsterdam, The Netherlands; 3Netherlands Institute for Health Services Research, Utrecht, The NetherlandsPurpose: The barriers to patients’ successful medication intake behavior could be reduced through tailored communication about these ...

  13. Words that make pills easier to swallow: a communication typology to address practical and perceptual barriers to medication intake behavior.

    Linn, Annemiek J; van Weert, Julia Cm; Schouten, Barbara C; Smit, Edith G; van Bodegraven, Ad A; van Dijk, Liset

    2012-01-01

    The barriers to patients' successful medication intake behavior could be reduced through tailored communication about these barriers. The aim of this study is therefore (1) to develop a new communication typology to address these barriers to successful medication intake behavior, and (2) to examine the relationship between the use of the typology and the reduction of the barriers to successful medication intake behavior. Based on a literature review, the practical and perceptual barriers to successful medication intake behavior typology (PPB-typology) was developed. The PPB-typology addresses four potential types of barriers that can be either practical (memory and daily routine barriers) or perceptual (concern and necessity barriers). The typology describes tailored communication strategies that are organized according to barriers and communication strategies that are organized according to provider and patient roles. Eighty consultations concerning first-time medication use between nurses and inflammatory bowel disease patients were videotaped. The verbal content of the consultations was analyzed using a coding system based on the PPB-typology. The Medication Understanding and Use Self-efficacy Scale and the Beliefs about Medicine Questionnaire Scale were used as indicators of patients' barriers and correlated with PPB-related scores. The results showed that nurses generally did not communicate with patients according to the typology. However, when they did, fewer barriers to successful medication intake behavior were identified. A significant association was found between nurses who encouraged question-asking behavior and memory barriers (r = -0.228, P = 0.042) and between nurses who summarized information (r = -0.254, P = 0.023) or used cartoons or pictures (r = -0.249, P = 0.026) and concern barriers. Moreover, a significant relationship between patients' emotional cues about side effects and perceived concern barriers (r = 0.244, P = 0.029) was found as well. The PPB-typology provides communication recommendations that are designed to meet patients' needs and assist providers in the promotion of successful medication intake behavior, and it can be a useful tool for developing effective communication skills training programs.

  14. Escogiendo Salud: Comiendo Saludable en Philadelphia, PA PSA (:60) (Making Health Easier: Healthy Eating in Philadelphia, PA)

    2013-05-22

    Clara Santos, la dueña de Olivares Food Market, está haciendo cambios en las opciones de comida que ofrece a su comunidad. Aprenda cómo incorporó alimentos frescos y saludables en su pequeña tienda y como usted también puede hacerlo.  Created: 5/22/2013 by National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP).   Date Released: 5/22/2013.

  15. Detectability matters: conspicuous nestling mouth colours make prey transfer easier for parents in a cavity nesting bird.

    Dugas, Matthew B

    2015-11-01

    An often underappreciated function of signals is to notify receivers of the presence and position of senders. The colours that ornament the mouthparts of nestling birds, for example, have been hypothesized to evolve via selective pressure generated by parents' inability to efficiently detect and feed nestlings without such visually conspicuous targets. This proposed mechanism has primarily been evaluated with comparative studies and experimental tests for parental allocation bias, leaving untested the central assumption of this detectability hypothesis, that provisioning offspring is a visually challenging task for avian parents and conspicuous mouths help. To test this assumption, I manipulated the mouths of nestling house sparrows to appear minimally and maximally conspicuous, and quantified prey transfer difficulty as the total duration of a feeding event and the number of transfer attempts required. Prey transfer to inconspicuous nestlings was, as predicted, more difficult. While this suggests that detectability constraints could shape nestling mouth colour evolution, even minimally conspicuous nestlings were not prohibitively difficult for parents to feed, indicating that a more nuanced explanation for interspecific diversity in this trait is needed. © 2015 The Author(s).

  16. Does Pressing a Button Make It Easier to Pass an Exam? Evaluating the Effectiveness of Interactive Technologies in Higher Education

    Castillo-Manzano, Jose I.; Castro-Nuño, Mercedes; Sanz Díaz, María Teresa; Yñiguez, Rocio

    2016-01-01

    The aim of this paper was to evaluate how audience response system (ARS) technology may increase improvements in academic performance in higher education, using the first year of the Administration and Business Management degree course at the University of Seville (Spain) as a case study. The experiment assesses whether the use of ARSs increases…

  17. Individual variations in maternal care early in life correlate with later life decision-making and c-fos expression in prefrontal subregions of rats.

    van Hasselt, F.N.; Visser, L.; Tieskens, J.M.; Cornelisse, S.; Baars, A.M.; Lavrijsen, M.; Krugers, H.J.; van den Bos, R.; Joëls, M.

    2012-01-01

    Early life adversity affects hypothalamus-pituitary-adrenal axis activity, alters cognitive functioning and in humans is thought to increase the vulnerability to psychopathology-e.g. depression, anxiety and schizophrenia- later in life. Here we investigated whether subtle natural variations among

  18. Individual variations in maternal care early in life correlate with later life decision-making and c-fos expression in prefrontal subregions of rats

    van Hasselt, F.N.; de Visser, L.; Tieskens, J.M.; Cornelisse, S.; Baars, A.M.; Lavrijsen, M.; Krugers, H.J.; van den Bos, R.; Joëls, M.

    2012-01-01

    Early life adversity affects hypothalamus-pituitary-adrenal axis activity, alters cognitive functioning and in humans is thought to increase the vulnerability to psychopathology--e.g. depression, anxiety and schizophrenia--later in life. Here we investigated whether subtle natural variations among

  19. Participation and Life Satisfaction in Aged People with Spinal Cord Injury: Does Age at Onset Make a Difference?

    Post, Marcel W M; Reinhardt, Jan D

    2015-01-01

    Few studies have reported on outcomes in samples of elderly people with SCI and the impact of the age at onset of SCI is unclear. To study levels of participation and life satisfaction in individuals with SCI aged 65 years or older and to analyze differences in participation and life satisfaction scores between individuals injured before or after 50 years of age. This cross-sectional survey included 128 individuals with SCI who were at least 65 years old. Age at onset was dichotomized as scale of the Utrecht Scale for Evaluation-Participation, and life satisfaction was measured with 5 items of the World Health Organization Quality of Life abbreviated form. Participants who were injured before 50 years of age showed similar levels of functional status and numbers of secondary health conditions but higher participation and life satisfaction scores compared to participants injured at older age. In the multiple regression analysis of participation, lower current age, higher education, and having paraplegia were significant independent determinants of increased participation (explained variance, 25.7%). In the regression analysis of life satisfaction, lower age at onset and higher education were significant independent determinants of higher life satisfaction (explained variance, 15.3%). Lower age at onset was associated with better participation and life satisfaction. This study did not reveal indications for worsening participation or life satisfaction due to an accelerated aging effect in this sample of persons with SCI.

  20. A survey of views and practice patterns of dialysis medical directors toward end-of-life decision making for patients with end-stage renal disease.

    Fung, Enrica; Slesnick, Nate; Kurella Tamura, Manjula; Schiller, Brigitte

    2016-07-01

    Patients with end-stage renal disease report infrequent end-of-life discussions, and nephrology trainees report feeling unprepared for end-of-life decision making, but the views of dialysis medical directors have not been studied. Our objective is to understand dialysis medical directors' views and practice patterns on end-of-life decision making for patients with ESRD. We administered questionnaires to dialysis medical directors during medical director meetings of three different dialysis organizations in 2013. Survey questions corresponded to recommendations from the Renal Physicians Association clinical practice guidelines on initiation and withdrawal of dialysis. There were 121 medical director respondents from 28 states. The majority of respondents felt "very prepared" (66%) or "somewhat prepared" (29%) to participate in end-of-life decisions and most (80%) endorsed a model of shared decision making. If asked to do so, 70% of the respondents provided prognostic information "often" or "nearly always." For patients with a poor prognosis, 36% of respondents would offer a time-limited trial of dialysis "often" or "nearly always", while 56% of respondents would suggest withdrawal from dialysis "often" or "nearly always" for those with a poor prognosis currently receiving dialysis therapy. Patient resistance and fear of taking away hope were the most commonly cited barriers to end-of-life discussions. Views and reported practice patterns of medical directors are consistent with clinical practice guidelines for end-of-life decision making for patients with end-stage renal disease but inconsistent with patient perceptions. © The Author(s) 2016.

  1. Factors Affecting Quality of Life at Different Intervals After Treatment of Localized Prostate Cancer: Unique Influence of Treatment Decision Making Satisfaction, Personality and Sexual Functioning.

    Victorson, David E; Schuette, Stephanie; Schalet, Benjamin D; Kundu, Shilajit D; Helfand, Brian T; Novakovic, Kristian; Sufrin, Nathaniel; McGuire, Michael; Brendler, Charles

    2016-11-01

    Using patient reported outcomes measures we identified the most informative set of factors associated with quality of life in a large sample of men treated for localized prostate cancer. We examined relationships with quality of life using FACIT (Functional Assessment of Chronic Illness Therapy). We also hypothesized variables in a sample of men diagnosed with localized prostate cancer who represented different time points since treatment, including less than 12 months in 70, 1 to 3 years in 344, greater than 3 to 5 years in 291 and greater than 5 years in 97. Correlative measures included subscales of MAX-PC (Memorial Anxiety Scale for Prostate Cancer), short forms of PROMIS® and SOMS (Surgical Outcomes Measurement System), TDM-SATS (Treatment Decision-Making Satisfaction Scale) and subscales of the BFI (Big Five Inventory) of personality. Quality of life was significantly associated with hypothesized variables across different time cohorts. In regression models several factors accounted for most of the variability in quality of life scores depending on time since treatment, including 47%, 22%, 29% and 27% at less than 12 months, 1 to 3 years, greater than 3 to 5 years and greater than 5 years, respectively. Upon examining the unique contribution of these variables, treatment decision making satisfaction was the only variable to have a significant and unique contribution to quality of life across all 4 time cohorts (standardized coefficients 0.33, 0.27, 0.31 and 0.49, respectively, p personality style also had unique associations with quality of life (standardized coefficients 0.25 and -0.20, respectively). When considering the short-term and the longer term quality of life of a man after treatment for localized prostate cancer, our findings highlight the importance of treatment decision making satisfaction, erectile function and personality. Copyright © 2016 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights

  2. Current health and preferences for life-prolonging treatments: an application of prospect theory to end-of-life decision making.

    Winter, Laraine; Parker, Barbara

    2007-10-01

    As a substantial body of research attests, the acceptability of life-prolonging treatment (e.g., tube feeding) tends to be greater among people in worse health than among healthier ones. Because a decision for or against a life-prolonging treatment represents a choice between two prospects-life (usually in poor health) and death-we propose a decision model, Prospect Theory, as a theoretical account of this phenomenon. Prospect Theory postulates that pairs of distant prospects are less distinguishable than pairs of closer ones. Thus, to healthy individuals, the prospects of death and life in poor health would both be remote, and therefore, the distinction between them, small. To less healthy individuals, however, the difference between the same pairs of prospects would appear greater, and therefore, life-prolonging treatment may be more acceptable. In a cross-sectional study of 304 community-dwelling people, aged 60 years and over in the Philadelphia area, USA, preferences for 4 life-prolonging treatments in 9 health scenarios were examined in relation to participants' current health, operationalized as number of deficits in physical functioning. As predicted, less healthy people expressed stronger preferences for all life-prolonging treatments compared with healthier ones, with differences greatest in the worse-health scenarios. Preferences also varied by health scenario, with any treatment preferred in the better health scenarios. Treatment preferences did not differ by type of treatment, depressed mood or any demographic characteristic except race, with African-Americans expressing stronger treatment preferences. Implications for advance care planning are discussed.

  3. Burnout and Life Satisfaction: Does Gratitude Intervention Make a Difference among Chinese School Teachers in Hong Kong?

    Chan, David W.

    2011-01-01

    This study investigated the effectiveness of a gratitude intervention programme in promoting life satisfaction and reducing burnout symptoms. Sixty-three Hong Kong Chinese school teachers aged 22-54 participated in an eight-week count-your-blessings study that used a pre-test/post-test design. Increases in life satisfaction and the sense of…

  4. Absorption of solar energy heats up our planet's surface and the atmosphere and makes life for us po

    2002-01-01

    Credit: Image courtesy Barbara Summey, NASA Goddard Visualization Analysis Lab, based upon data processed by Takmeng Wong, CERES Science Team, NASA Langley Research Center Satellite: Terra Sensor: CERES Image Date: 09-30-2001 VE Record ID: 11546 Description: Absorption of solar energy heats up our planet's surface and the atmosphere and makes life for us possible. But the energy cannot stay bound up in the Earth's environment forever. If it did then the Earth would be as hot as the Sun. Instead, as the surface and the atmosphere warm, they emit thermal longwave radiation, some of which escapes into space and allows the Earth to cool. This false-color image of the Earth was produced on September 30, 2001, by the Clouds and the Earth's Radiant Energy System (CERES) instrument flying aboard NASA's Terra spacecraft. The image shows where more or less heat, in the form of longwave radiation, is emanating from the top of Earth's atmosphere. As one can see in the image, the thermal radiation leaving the oceans is fairly uniform. The blue swaths across the central Pacific represent thick clouds, the tops of which are so high they are among the coldest places on Earth. In the American Southwest, which can be seen in the upper righthand corner of the globe, there is often little cloud cover to block outgoing radiation and relatively little water to absorb solar energy. Consequently, the amount of outgoing radiation in the American Southwest exceeds that of the oceans. Also, that region was experiencing an extreme heatwave when these data were acquired. Recently, NASA researchers discovered that incoming solar radiation and outgoing thermal radiation increased in the tropics from the 1980s to the 1990s. (Click to read the press release .) They believe that the reason for the unexpected increase has to do with an apparent change in circulation patterns around the globe, which effectively reduced the amount of water vapor and cloud cover in the upper reaches of the atmosphere

  5. Process Fragment Libraries for Easier and Faster Development of Process-based Applications

    David Schumm

    2011-01-01

    Full Text Available The term “process fragment” is recently gaining momentum in business process management research. We understand a process fragment as a connected and reusable process structure, which has relaxed completeness and consistency criteria compared to executable processes. We claim that process fragments allow for an easier and faster development of process-based applications. As evidence to this claim we present a process fragment concept and show a sample collection of concrete, real-world process fragments. We present advanced application scenarios for using such fragments in development of process-based applications. Process fragments are typically managed in a repository, forming a process fragment library. On top of a process fragment library from previous work, we discuss the potential impact of using process fragment libraries in cross-enterprise collaboration and application integration.

  6. Steam explosions of molten iron oxide drops: easier initiation at small pressurizations

    Nelson, L.S.; Duda, P.M.

    1982-01-01

    Steam explosions caused by hot molten materials contacting liquid water following a possible light water nuclear reactor core overheat have been investigated by releasing single drops of a core melt simulant, molten iron oxide, into liquid water. Small steam explosions were triggered shortly afterwards by applying a pressure pulse to the water. The threshold peak pulse level above which an explosion always occurs was studied at ambient pressures between 0.083 and 1.12 MPa. It was found that the threshold decreased to a minimum in the range 0.2 - 0.8 MPa and then increased again. The effect of easier initiation as ambient pressure increases may have an important role in the triggering and propagation of a large scale steam explosion through a coarsely premixed dispersion of melt in water. (U.K.)

  7. Portrayal of medical decision making around medical interventions life-saving encounters on three medical television shows.

    Schwei, Rebecca J; Jacobs, Elizabeth A; Wingert, Katherine; Montague, Enid

    2015-07-01

    Previous literature has shown that patients obtain information about the medical system from television shows. Additionally, shared decision making is regularly cited as the ideal way to make decisions during a medical encounter. Little information exists surrounding the characteristics of medical decision-making, such as who makes the decision, on medical television shows. We evaluate the characteristics of medical decisions in lifesaving encounters on medical television shows and evaluate if these characteristics were different on staged and reality television shows. We coded type of medical intervention, patient's ability to participate in decision, presence of patient advocate during decision, final decision maker, decision to use intervention, and controversy surrounding decision on three television shows. Frequencies by show were calculated and differences across the three television shows and between staged (ER) and reality ( BostonMed and Hopkins ) television shows were assessed with chi-square tests. The final data set included 37 episodes, 137 patients and 593 interventions. On ER, providers were significantly more likely to make the decision about the medical intervention without informing the patient when a patient was capable of making a decision compared to BostonMed or Hopkins (ptelevision shows we analyzed. It is possible that what patients see on television influences their expectations surrounding the decision making process and the use of medical interventions in everyday healthcare encounters.

  8. Interactions of age and cognitive functions in predicting decision making under risky conditions over the life span.

    Brand, Matthias; Schiebener, Johannes

    2013-01-01

    Little is known about how normal healthy aging affects decision-making competence. In this study 538 participants (age 18-80 years) performed the Game of Dice Task (GDT). Subsamples also performed the Iowa Gambling Task as well as tasks measuring logical thinking and executive functions. In a moderated regression analysis, the significant interaction between age and executive components indicates that older participants with good executive functioning perform well on the GDT, while older participants with reduced executive functions make more risky choices. The same pattern emerges for the interaction of age and logical thinking. Results demonstrate that age and cognitive functions act in concert in predicting the decision-making performance.

  9. Supporting young people living with cancer to tell their stories in ways that make them stronger: The Beads of Life approach.

    Portnoy, Sara; Girling, Isabella; Fredman, Glenda

    2016-04-01

    This article describes the 'Beads of Life' approach--a five-part methodology informed by narrative therapy to enable children and young people to make sense of their cancer journey in ways that make them stronger. Young people are invited to use beads as prompts to tell preferred stories of their identity to create a safe place to stand from which to story their cancer journey. The approach positions young people as experts in their lives. It aims to change their relationship with cancer to reduce its negative impact on life by lessening isolation. By enabling medical staff to get to know the young person apart from the cancer, this approach aims to create hope for the future and improve quality of care. © The Author(s) 2015.

  10. Development and Enhancement of a Model of Performance and Decision Making Under Stress in a Real Life Setting

    1993-02-12

    admission tnat occurred during airway manipulation, distracted the attending anesthesiologist managing patient one from detecting why the mechanical... articular interest in settings where skilled individuals function as a tear are the relationships between team performance and individual decision-making

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

    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.

  12. Method of making a long life high current density cathode from tungsten and iridium powders using a quaternary compound as the impregnant

    Branovich, L.E.; Smith, B.; Freemen, G.L.; Eckart, D.W.

    1990-01-01

    This patent describes a method of making a long life high current density cathode. It is suitable for operation in microwave devices. It is made from tungsten and iridium powders using a quaternary compound including barium, oxygen, a metal selected from the group consisting of osmium, iridium, rhodium, and rhenium, and a metal selected from the group consisting of strontium, calcium, scandium, and titanium as the impregnant

  13. What doesn't kill you makes you poorer: Adult wages and early-life mortality in India.

    Lawson, Nicholas; Spears, Dean

    2016-05-01

    A growing literature indicates that effects of early-life health on adult economic outcomes could be substantial in developing countries, but the magnitude of this effect is debated. We document a robust gradient between the early-life mortality environment to which men in India were locally exposed in their district and year of birth and the wages that they earn as adults. A 1 percentage point reduction in infant mortality (or 10 point reduction in IMR) in an infant's district and year of birth is associated with an approximately 2 percent increase in his subsequent adult wages. Consistent with theories and evidence in the literature, we find that the level of schooling chosen for a child does not mediate this association. Because of its consequences for subsequent wages, early-life health could also have considerable fiscal externalities; if so, public health investments could come at very low net present cost. Copyright © 2015 Elsevier B.V. All rights reserved.

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

    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.

  15. Physician medical decision-making at the end of life in newborns : Insight into implementation at 2 Dutch centers

    Verhagen, A. A. Eduard; van der Hoeven, Mark A. H.; van Meerveld, R. Corine; Sauer, Pieter J. J.

    OBJECTIVE. Decisions regarding end-of-life care in critically ill newborns in the Netherlands have received considerable criticism from the media and from the public. This might be because of a lack of proper information and knowledge. Our purpose was to provide detailed information about how and

  16. The Process of End-of-Life Decision-Making in Pediatrics: A National Survey in the 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,

  17. The Process of End-of-Life Decision-Making in Pediatrics : A National Survey in the 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,

  18. Participation and Life Satisfaction in Aged People with Spinal Cord Injury : Does Age at Onset Make a Difference?

    Post, Marcel W M; Reinhardt, Jan D

    2015-01-01

    BACKGROUND: Few studies have reported on outcomes in samples of elderly people with SCI and the impact of the age at onset of SCI is unclear. OBJECTIVE: To study levels of participation and life satisfaction in individuals with SCI aged 65 years or older and to analyze differences in participation

  19. "All of a sudden, a lot less still makes it worthwhile to be alive:" Palliative care patients' views on life.

    Romotzky, Vanessa; Strupp, Julia; Hayn, Alexander; Rüffer, Jens Ulrich; Grümmer, Judith; Voltz, Raymond

    2018-03-08

    We aimed to elucidate the views on life as narrated by patients in palliative care (PC) to find out what patients deem to be essential in their life, whether something has changed concerning their view of life in light of the disease, and whether interviewees would like to give others something to take with them. Data were collected from narrative audio and video interviews with 18 inpatients in a specialized PC unit. Interviews were recorded and transcribed verbatim and analyzed using qualitative content analysis applying MAXQDA software. CDs and DVDs with recorded interviews were provided to patients. Result Eighteen interviews were analyzed: 11 audio and 7 video recordings. The age range was 41-80 years. Patients reported on changes in their views on life. Despite it being a complex and painful process, patients still gave examples of benefits experienced during their illness trajectory. Patients identified resources and coping strategies such as meaningful contacts with close others and mindfulness. Shifts have occurred in terms of taking more time for themselves, enjoying the moment, being more calm, and spending more time with family and friends. What patients wanted to pass on to others was to pay attention to the needs of both the self and the others, shape your life individually, confront yourself early with issues of death and dying, and care for your fellow human beings. Patients and relatives valued the opportunity to keep their interview as a CD/DVD. Significance of results Results support the idea that many people facing terminal illness continue to focus on living and remain within their biographies and the contexts of their lives, even if their functional status declines. Patients and relatives appreciated that interviews were provided as kind of a legacy. Yet, more robust research is needed to decide whether such interviews yield any therapeutic effect.

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

    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.

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

    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.

  2. Early life disease programming during the preconception and prenatal period: making the link between stressful life events and type-1 diabetes.

    Jasveer Virk

    Full Text Available BACKGROUND: To assess the risk of developing Type-1 diabetes among children who were exposed to maternal bereavement during the prenatal or 1-year preconception period. METHODS: We identified N = 1,548,746 singleton births born in Denmark between January 1(st 1979 through December 31(st 2004, and their next of kin. Altogether, 39,857 children were exposed to bereavement during their prenatal life. The main outcome of interest was hospitalization for type-1 diabetes (ICD 8: 249; ICD 10: E10. RESULTS: We found the strongest association for type-1 diabetes among children exposed to traumatic father or sibling deaths (aIRR: 2.03, 1.22-3.38; the association was mainly seen for girls (aIRR: 2.91, 1.61-5.26. CONCLUSIONS: We found evidence to suggest that female fetuses exposed to severe prenatal stress are at increased risk for developing type-1 diabetes.

  3. Early stress, parental motivation, and reproductive decision-making: applications of life history theory to parental behavior.

    Cabeza de Baca, Tomás; Ellis, Bruce J

    2017-06-01

    This review focuses on the impact of parental behavior on child development, as interpreted from an evolutionary-developmental perspective. We employ psychosocial acceleration theory to reinterpret the effects of variation in parental investment and involvement on child development, arguing that these effects have been structured by natural selection to match the developing child to current and expected future environments. Over time, an individual's development, physiology, and behavior are organized in a coordinated manner (as instantiated in 'life history strategies') that facilitates survival and reproductive success under different conditions. We review evidence to suggest that parental behavior (1) is strategic and contingent on environmental opportunities and constraints and (2) influences child life history strategies across behavioral, cognitive, and physiological domains. Copyright © 2017 Elsevier Ltd. All rights reserved.

  4. ‘Democracy always comes first’ : Adolescents’ views on decision-making in everyday life and political democracy

    Nieuwelink, H.; Dekker, P.; Geijsel, F.; ten Dam, G.

    2016-01-01

    Research shows adolescents to be positively oriented towards democracy, but little is known about what it actually means to them and what their views are on decision-making in both everyday situations and political democracy. To gain insight into these aspects of adolescents’ democratic views, we

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

    Löfmark, Rurik; Nilstun, Tore; Cartwright, Colleen

    2008-01-01

    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...

  6. Pressure during decision making of continuous sedation in end-of-life situations in Dutch general practice

    Blanker, M.H.; Koerhuis-Roessink, M.; Swart, S.J.; Zuurmond, W.W.A.; van der Heide, A.; Perez, R.S.G.M.; Rietjens, J.A.C.

    2012-01-01

    Background: Little is known about pressure from patients or relatives on physician's decision making of continuous palliative sedation. We aim to describe experienced pressure by general practitioners (GPs) in cases of continuous sedation after the introduction of the Dutch practice guideline, using

  7. Work life balance up in the air: Does gender make a difference between female and male international business travelers?

    Kollinger-Santer, Iris; Fischlmayr, Iris C.

    2013-01-01

    Managing work-life balance (WLB) has become an issue for both employees and HR departments since WLB tensions may reduce performance, overall job satisfaction and finally, increase the fluctuation rate. Having a balance between job and non-work is a particular challenge for international business travelers, but research on this topic is still in its very infancy. The aim of this article and its underlying qualitative study was to discover factors that influence WLB of those employees, and to ...

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

    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

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

    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.

  10. A Life Below the Threshold?: Examining Conflict Between Ethical Principles and Parental Values in Neonatal Treatment Decision Making.

    Cunningham, Thomas V

    2016-01-01

    Three common ethical principles for establishing the limits of parental authority in pediatric treatment decision-making are the harm principle, the principle of best interest, and the threshold view. This paper considers how these principles apply to a case of a premature neonate with multiple significant co-morbidities whose mother wanted all possible treatments, and whose health care providers wondered whether it would be ethically permissible to allow him to die comfortably despite her wishes. Whether and how these principles help in understanding what was morally right for the child is questioned. The paper concludes that the principles were of some value in understanding the moral geography of the case; however, this case reveals that common bioethical principles for medical decision-making are problematically value-laden because they are inconsistent with the widespread moral value of medical vitalism.

  11. Negotiation and Decision Making with Collaborative Software: How MarineMap 'Changed the Game' in California's Marine Life Protected Act Initiative.

    Cravens, Amanda E

    2016-02-01

    Environmental managers and planners have become increasingly enthusiastic about the potential of decision support tools (DSTs) to improve environmental decision-making processes as information technology transforms many aspects of daily life. Discussions about DSTs, however, rarely recognize the range of ways software can influence users' negotiation, problem-solving, or decision-making strategies and incentives, in part because there are few empirical studies of completed processes that used technology. This mixed-methods study-which draws on data from approximately 60 semi-structured interviews and an online survey--examines how one geospatial DST influenced participants' experiences during a multi-year marine planning process in California. Results suggest that DSTs can facilitate communication by creating a common language, help users understand the geography and scientific criteria in play during the process, aid stakeholders in identifying shared or diverging interests, and facilitate joint problem solving. The same design features that enabled the tool to aid in decision making, however, also presented surprising challenges in certain circumstances by, for example, making it difficult for participants to discuss information that was not spatially represented on the map-based interface. The study also highlights the importance of the social context in which software is developed and implemented, suggesting that the relationship between the software development team and other participants may be as important as technical software design in shaping how DSTs add value. The paper concludes with considerations to inform the future use of DSTs in environmental decision-making processes.

  12. Negotiation and Decision Making with Collaborative Software: How MarineMap `Changed the Game' in California's Marine Life Protected Act Initiative

    Cravens, Amanda E.

    2016-02-01

    Environmental managers and planners have become increasingly enthusiastic about the potential of decision support tools (DSTs) to improve environmental decision-making processes as information technology transforms many aspects of daily life. Discussions about DSTs, however, rarely recognize the range of ways software can influence users' negotiation, problem-solving, or decision-making strategies and incentives, in part because there are few empirical studies of completed processes that used technology. This mixed-methods study—which draws on data from approximately 60 semi-structured interviews and an online survey—examines how one geospatial DST influenced participants' experiences during a multi-year marine planning process in California. Results suggest that DSTs can facilitate communication by creating a common language, help users understand the geography and scientific criteria in play during the process, aid stakeholders in identifying shared or diverging interests, and facilitate joint problem solving. The same design features that enabled the tool to aid in decision making, however, also presented surprising challenges in certain circumstances by, for example, making it difficult for participants to discuss information that was not spatially represented on the map-based interface. The study also highlights the importance of the social context in which software is developed and implemented, suggesting that the relationship between the software development team and other participants may be as important as technical software design in shaping how DSTs add value. The paper concludes with considerations to inform the future use of DSTs in environmental decision-making processes.

  13. Use of Integrative Oncology, Involvement in Decision-Making, and Breast Cancer Survivor Health-Related Quality of Life in the First 5 Years Postdiagnosis.

    Andersen, M Robyn; Sweet, Erin; Hager, Shelly; Gaul, Marcia; Dowd, Fred; Standish, Leanna J

    2018-03-01

    This study sought to describe changes in the health-related quality of life (HRQOL) of women who do and do not seek naturopathic oncology (NO) complementary and alternative medicine (CAM) care during and immediately after breast cancer treatment, and to explore the predictive role of NO CAM care, demographic characteristics, and involvement in decision-making on HRQOL in breast cancer survivors. Matched cohorts of breast cancer survivors who did and did not choose to supplement their breast cancer treatment with NO care within 2 years of diagnosis participated. NO users were identified through naturopathic doctors' clinics and usual care (UC) controls with similar prognosis were identified through a cancer registry. The registry provided information about all participants' age, race, ethnicity, marital status, stage of cancer at time of diagnosis, date of diagnosis, and use of conventional medical treatments (surgery, chemotherapy, radiation, and endocrine therapy). Data of participants' self-reported involvement in decision-making and HRQOL were collected at study enrollment and at 6-month follow-up. At 6-month follow-up, the NO patients reported significantly more involvement in decision-making about care and better general health than did UC patients ( P decision-making about cancer treatment was associated with better role-physical, role-emotional, and social-functional well-being ( P decision-making about cancer treatment may be associated with better HRQOL in breast cancer survivors.

  14. Same-sex sexual relationships in the national social life, health and aging project: making a case for data collection.

    Brown, Maria T; Grossman, Brian R

    2014-01-01

    This study describes the previously unexplored subsample of respondents who reported at least 1 same-sex sexual relationship (SSSR) in the National Social Life, Health, and Aging Project (NSHAP). The NSHAP collected data from 3,005 adults (aged 57-85). Approximately 4% (n = 102) of respondents reported at least one SSSR. These sexual minority elders were younger, more educated, were more likely to be working, had fewer social supports, and better physical health. Results may indicate crisis competence in sexual minority elders. Collecting sexual orientation and gender identity data in larger, US-based probability samples would inform the development of appropriate community-based services and supports.

  15. Uncovering the exposure mechanisms of sunken heavy oil that makes it chronically toxic to early life stages of fish

    Martin, J.; Young, G.; Lemire, B.; Hodson, P.

    2010-01-01

    A train derailment in 2005 caused the release of 150,000 litres of No. 6 heavy fuel oil into a lake in Alberta. The oil is a residue of the crude oil refinement process and contains 3-4 ringed alkylated forms of polycyclic aromatic hydrocarbons (PAH) that are known to cause sub-lethal toxic responses during the early life stages of rainbow trout. Because the oil does not disperse well, oil patches still persist in near-shore sediments of the lake where fish spawn. This study assessed how the behaviour of heavy oil in water interacts with exposure and toxicity to the early life stages of fish. Daily renewal tests with heavy fuel oil coated on glass plate demonstrated higher levels of toxicity to trout embryos than oil that was mechanically or chemically dispersed. A flow-through oil gravel column was used to assess whether the toxic constituents of the heavy oil are transferred quickly enough to cause toxicity. The aim of the study was to develop exposure and toxicity test methods that accurately reflect the behaviour of heavy oil after a spill.

  16. Cybersex addiction: Experienced sexual arousal when watching pornography and not real-life sexual contacts makes the difference.

    Laier, Christian; Pawlikowski, Mirko; Pekal, Jaro; Schulte, Frank P; Brand, Matthias

    2013-06-01

    Background and aims Cybersex addiction is discussed controversially, while empirical evidence is widely missing. With respect to its mechanisms of development and maintenance Brand et al. (2011) assume that reinforcement due to cybersex should lead to the development of cue-reactivity and craving explaining recurrent cybersex use in the face of growing but neglected negative consequences. To support this hypothesis, two experimental studies were conducted. Methods In a cue-reactivity paradigm 100 pornographic cues were presented to participants and indicators of sexual arousal and craving were assessed. The first study aimed at identifying predictors of cybersex addiction in a freely recruited sample of 171 heterosexual males. The aim of the second study was to verify the findings of the first study by comparing healthy (n = 25) and problematic (n = 25) cybersex users. Results The results show that indicators of sexual arousal and craving to Internet pornographic cues predicted tendencies towards cybersex addiction in the first study. Moreover, it was shown that problematic cybersex users report greater sexual arousal and craving reactions resulting from pornographic cue presentation. In both studies, the number and subjective quality of real-life sexual contacts were not associated to cybersex addiction. Discussion The results support the gratification hypothesis, which assumes reinforcement, learning mechanisms, and craving to be relevant processes in the development and maintenance of cybersex addiction. Poor or unsatisfying sexual real-life contacts cannot sufficiently explain cybersex addiction. Conclusions Positive reinforcement in terms of gratification plays a major role in cybersex addiction.

  17. Caed Interactions During A Product Life Cycle Oriented Towards the Decision-Making in the Design of Polymeric Elements

    Suffo, M.

    2017-08-01

    In this work, we present the real case of an industrial product was placed prematurely on the market without having checked the different stages of its life cycle. This type of products must be validated by numerical methods and by mechanical tests to verify their rheological behavior. In particular, the product consists of two small pieces in contact, one made of HDPE and the other one corresponding to a stainless steel. The polymeric piece supports the metal pressure under a constant static load over time. As a result of normal operation, the polymer experienced a “crazing” breakdown, which caused the failure to occur. In the study, design methods and computer assisted analysis software (CAED) have been used. These methods were complemented by scanning electron microscopy that confirmed the initial failure hypothesis. Using the finite element method (FEM), a series of load scenarios were carried out, where the different load hypothesis the product must go through prior to its placing on the market were simulated. It is shown that the failure was initiated by stress concentration on one of the edges of the polymeric piece. The proposed solution of the problem based on the analysis focuses on a simple redesign of the piece, which should have been round, or to the reduction of the thickness of the metal piece. As a result of the alteration of its natural life cycle, the company assumed both monetary costs and the definitive loss of customer confidence.

  18. Evaluate the use of tanning agent in leather industry using material flow analysis, life cycle assessment and fuzzy multi-attribute decision making (FMADM)

    Alfarisi, Salman; Sutono, Sugoro Bhakti; Sutopo, Wahyudi

    2017-11-01

    Tanning industry is one of the companies that produce many pollutants and cause the negative impact on the environment. In the production process of tanning leather, the use of input material need to be evaluated. The problem of waste, not only have a negative impact on the environment, but also human health. In this study, the impact of mimosa as vegetable tanning agent evaluated. This study will provide alternative solutions for improvements to the use of vegetable tanning agent. The alternative solution is change mimosa with indusol, gambier, and dulcotan. This study evaluate the vegetable tanning of some aspects using material flow analysis and life cycle assessment approach. Life cycle assessment (LCA) is used to evaluate the environmental impact of vegetable tanning agent. Alternative solution selection using fuzzy multi-attribute decision making (FMADM) approach. Results obtained by considering the environment, human toxicity, climate change, and marine aquatic ecotoxicity, is to use dulcotan.

  19. The effects of the Make a Wish intervention on psychiatric symptoms and health-related quality of life of children with cancer: a randomised controlled trial.

    Shoshani, Anat; Mifano, Keren; Czamanski-Cohen, Johanna

    2016-05-01

    Children with life-threatening medical conditions frequently undergo invasive medical procedures that may elicit anxiety and distress. However, there are few empirically validated interventions that reduce mental health symptoms and increase the resilience of children during the acute stages of illness. This study aimed to evaluate the efficacy of the Make a Wish intervention for children with life-threatening cancer. The design was a wait-list-controlled trial with two parallel groups. Sixty-six children aged 5-12 with an initial diagnosis of life-threatening cancer were identified and randomly assigned to the Make a Wish intervention (n = 32) or a wait-list control group (n = 34). Children completed measures of psychiatric and health-related symptoms, positive and negative affect, hope, and optimism pre-intervention and post-intervention. After baseline data collection, children were interviewed and made an authentic wish that they wanted to come true. These wishes were made possible 5-6 months after baseline data collection, to fuel anticipation and excitement over the wish-fulfillment event. The post-intervention assessment point was 5 weeks after wish fulfillment (approximately 7 months after baseline data collection). Children in the intervention group exhibited a significant reduction in general distress (d = 0.54), depression (d = 0.70), and anxiety symptoms (d = 0.41), improved health-related quality of life (d = 0.59), hope (d = 0.71), and positive affect (d = 0.80) compared to decrease in positive affect and no significant changes in the other measures in the control group. These findings emphasize the role of hope and positive emotions in fostering the well-being of children who suffer from serious illnesses.

  20. A matter of life and death: controversy at the interface between clinical and legal decision-making in prolonged disorders of consciousness.

    Turner-Stokes, Lynne

    2017-07-01

    Best interests decision-making and end-of-life care for patients in permanent vegetative or minimally conscious states (VS/MCS) is a complex area of clinical and legal practice, which is poorly understood by most clinicians, lawyers and members of the public. In recent weeks, the Oxford Shrieval lecture by Mr Justice Baker ('A Matter of Life and Death', 11 October 2016) and its subsequent reporting in the public press has sparked debate on the respective roles of clinicians, the Court of Protection and the Mental Capacity Act 2005 in decisions to withhold or withdraw life-sustaining treatments from patients with disorders of consciousness. The debate became polarised and confused by misquotation and inaccurate terminology, and highlighted a lack of knowledge about how patients in VS/MCS die in the absence of court approval. This article sets out the background and discussion and attempts to give a more accurate representation of the facts. In the spirit of transparency, I present a mortality review of all the patients in VS/MCS who have died under the care of my own unit in the last decade-with or without referral to the court, but always in accordance with the law. These data demonstrate that clinicians regularly undertake best interests decision-making in conjunction with families that may include life and death decisions (sometimes even the withdrawal or withholding of clinically assisted nutrition and hydration); and that these can be made within the current legal framework without necessarily involving the court in all cases. This is the first published case series of its kind. 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/.

  1. ON THE MAKING OF A SYSTEM THEORY OF LIFE: PAUL A WEISS AND LUDWIG VON BERTALANFFY’S CONCEPTUAL CONNECTION

    Drack, Manfred; Apfalter, Wilfried; Pouvreau, David

    2010-01-01

    In this article, we review how two eminent Viennese system thinkers, Paul A Weiss and Ludwig von Bertalanffy, began to develop their own perspectives toward a system theory of life in the 1920s. Their work is especially rooted in experimental biology as performed at the Biologische Versuchsanstalt, as well as in philosophy, and they converge in basic concepts. We underline the conceptual connections of their thinking, among them the organism as an organized system, hierarchical organization, and primary activity. With their system thinking, both biologists shared a strong desire to overcome what they viewed as a “mechanistic” approach in biology. Their interpretations are relevant to the renaissance of system thinking in biology—“systems biology.” Unless otherwise noted, all translations are our own. PMID:18217527

  2. On the making of a system theory of life: Paul A Weiss and Ludwig von Bertalanffy's conceptual connection.

    Drack, Manfred; Apfalter, Wilfried; Pouvreau, David

    2007-12-01

    In this article, we review how two eminent Viennese system thinkers, Paul A Weiss and Ludwig von Bertalanffy, began to develop their own perspectives toward a system theory of life in the 1920s. Their work is especially rooted in experimental biology as performed at the Biologische Versuchsanstalt, as well as in philosophy, and they converge in basic concepts. We underline the conceptual connections of their thinking, among them the organism as an organized system, hierarchical organization, and primary activity. With their system thinking, both biologists shared a strong desire to overcome what they viewed as a "mechanistic" approach in biology. Their interpretations are relevant to the renaissance of system thinking in biology--"systems biology." Unless otherwise noted, all translations are our own.

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

    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

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

    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

  5. An Economic Model of Mortality Salience in Personal Financial Decision Making: Applications to Annuities, Life Insurance, Charitable Gifts, Estate Planning, Conspicuous Consumption, and Healthcare

    Russell N James III

    2016-12-01

    Full Text Available The study of personal mortality salience and the denial of death have a long history in psychology leading to the modern field of Terror Management Theory. However, a simple consumer utility function predicts many of the outcomes identified in experimental research in this field. Further, this economic approach explains a range of otherwise unexpected financial decision-making behaviors in areas as diverse as annuities, life insurance, charitable gifts and bequests, intra-family gifts and bequests, conspicuous consumption, and healthcare. With its relevance to such a wide range of personal financial decisions, understanding the impact of mortality salience can be particularly useful to advisors in related fields.

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

    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

  7. Everyday and medical life choices: decision-making among 8- to 15-year-old school students.

    Alderson, P

    1992-01-01

    How much do young patients expect to be involved in medical decisions affecting them? We are investigating this question during interviews with 8- to 15-year-olds having orthopaedic surgery. Many youngsters taking part in our research project on consent to surgery are more than usually dependent on their parents. We wondered how their views would compare with those of their peers at school. This paper reports a schools survey carried out as a background to the research with young people in hospital. Students in seven schools answered questionnaires on choices about late-night television viewing, new friends, timing homework, seeing their family doctor and consenting to surgery. They were asked about agreement with their parents, how they negotiate disagreement, and when they think they were/will be old enough to make everyday and medical decisions without their parents' help.

  8. From lab to life: Making storable orange-fleshed sweetpotato purée a commercial reality

    Bocher Temesgen

    2017-02-01

    Full Text Available Research in Rwanda demonstrated that orange-fleshed sweetpotato (OFSP purée (steamed, mashed roots was an economically viable, vitamin A enhancing ingredient in baked products when the purée was produced and used in the same bakery. Having a storable, packaged OFSP purée produced by a firm to supply bakers is an alternative model. Vacuum-packed OFSP purée with preservatives with a four-month shelf-life at 23°C was developed by the International Potato Center under laboratory conditions in 2015. Turning it into a commercial reality required developing a public-private partnership to establish an OFSP purée-bread value chain. The phases in developing the chain are described. Cost-benefit assessment focuses on two points along the chain: the farmers producing roots for the purée factory and purée production. The first OFSP bread began to be marketed in six Tuskys’ stores in June 2015 at a premium price (5 Ksh above its regular bread, reaching 20 stores by August 2016. OFSP bread was well-received by consumers. Purée production became profitable (18% profit margin when we shifted from using peeled to unpeeled roots--the new product being a “high fiber” purée. Commercial OFSP purée production has been improved and is poised for profitable, larger-scale output.

  9. Stressful life events and depressive symptoms in a post-war context: which informal support makes a difference?

    Jawad, May H; Sibai, Abla M; Chaaya, Monique

    2009-03-01

    Gerontological literature utilizes the life stress paradigm to understand the impact of stress on psychological well-being, as well as the protective role that social resources play in buffering those effects; however these relationships are not well understood within various historical and social contexts. Utilizing a sample of 490 community-residing older adults in post-civil war Lebanon, this study investigates the moderating role of various social support factors in the stress-depression relationship. Contrary to expectations, results suggest that older Lebanese are more susceptible to the effects of health-decline and serious accident events than other types of stressors such as losses in the family and financial problems. Furthermore, findings provide evidence for a differential protective role for the respondent's spouse and children for only certain stressful events. The discussion highlights the role of family as a stress buffer in a shifting physical, social and political environmental context. Results from this study add to the discourse by emphasizing the importance of understanding the saliency of the stressor as well as source of support provided.

  10. Life course approach in social epidemiology: an overview, application and future implications.

    Cable, Noriko

    2014-01-01

    The application of the life course approach to social epidemiology has helped epidemiologists theoretically examine social gradients in population health. Longitudinal data with rich contextual information collected repeatedly and advanced statistical approaches have made this challenging task easier. This review paper provides an overview of the life course approach in epidemiology, its research application, and future challenges. In summary, a systematic approach to methods, including theoretically guided measurement of socioeconomic position, would assist researchers in gathering evidence for reducing social gradients in health, and collaboration across individual disciplines will make this task achievable.

  11. 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.

    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.

  12. Parental refusal of life-saving treatments for adolescents: Chinese familism in medical decision-making re-visited.

    Hui, Edwin

    2008-06-01

    This paper reports two cases in Hong Kong involving two native Chinese adolescent cancer patients (APs) who were denied their rights to consent to necessary treatments refused by their parents, resulting in serious harm. We argue that the dynamics of the 'AP-physician-family-relationship' and the dominant role Chinese families play in medical decision-making (MDM) are best understood in terms of the tendency to hierarchy and parental authoritarianism in traditional Confucianism. This ethic has been confirmed and endorsed by various Chinese writers from Mainland China and Hong Kong. Rather than giving an unqualified endorsement to this ethic, based more on cultural sentimentalism than rational moral reasoning, we warn that a strong familism in MDM, which deprives 'weak' family members of rights, represents the less desirable elements of this tradition, against which healthcare professionals working in this cultural milieu need to safeguard. Specifically for APs, we suggest that parental authority and family integrity should be re-interpreted in terms of parental responsibility and the enhancement of children's interests respectively, as done in the West. This implies that when parents refuse to consent to necessary treatment and deny their adolescent children's right to consent, doctors, as the only remaining advocates of the APs' interest, have the duty to inform the state, which can override parental refusal to enable the doctors to fulfill their professional and moral obligations. In so doing the state exercises its 'parens patriae' power to defend the defenseless in society and the integrity of the medical profession.

  13. Making Marine Noise Pollution Impacts Heard: The Case of Cetaceans in the North Sea within Life Cycle Impact Assessment

    Heleen Middel

    2017-06-01

    Full Text Available Oceans represent more than 95% of the world’s biosphere and are among the richest sources of biodiversity on Earth. However, human activities such as shipping and construction of marine infrastructure pose a threat to the quality of marine ecosystems. Due to the dependence of most marine animals on sound for their communication, foraging, protection, and ultimately their survival, the effects of noise pollution from human activities are of growing concern. Life cycle assessment (LCA can play a role in the understanding of how potential environmental impacts are related to industrial processes. However, noise pollution impacts on marine ecosystems have not yet been taken into account. This paper presents a first approach for the integration of noise impacts on marine ecosystems into the LCA framework by developing characterization factors (CF for the North Sea. Noise pollution triggers a large variety of impact pathways, but as a starting point and proof-of-concept we assessed impacts on the avoidance behaviour of cetaceans due to pile-driving during the construction of offshore windfarms in the North Sea. Our approach regards the impact of avoidance behaviour as a temporary loss of habitat, and assumes a temporary loss of all individuals within that habitat from the total regional population. This was verified with an existing model that assessed the population-level effect of noise pollution on harbour porpoises (Phocoena phocoena in the North Sea. We expanded our CF to also include other cetacean species and tested it in a case study of the construction of an offshore windfarm (Prinses Amalia wind park. The total impact of noise pollution was in the same order of magnitude as impacts on other ecosystems from freshwater eutrophication, freshwater ecotoxicity, terrestrial acidification, and terrestrial ecotoxicity. Although there are still many improvements to be made to this approach, it provides a basis for the implementation of noise

  14. ANALYSING THE IMPACT OF THE PRODUCT LIFE CYCLE ON THE IMPORTANCE OF OUTSOURCING DECISION-MAKING CRITERIA: A MANUFACTURING CASE STUDY

    M. Cheshmberah

    2012-01-01

    Full Text Available

    ENGLISH ABSTRACT: This study has been carried out to discover the impact of the product life cycle (PLC on the importance of outsourcing decision-making criteria in a manufacturing firm. The four dimensions of outsourcing decision-making were identified, based on a literature review and on the conditions of the firm: (1 core competencies, (2 information leakage risk, (3 technological capability, and (4 cost. A case study and survey research were used, along with two non-parametric tests (Friedman’s test and Kendall’s W. The results show in particular that the importance of ‘technological capability’ and ‘strategic information leakage risk’ does not differ across the various PLC stages. The importance of ‘leakage risk of product volume information’ and ‘total cost’ change over different stages of the product life cycle are also addressed. For the latter two criteria, the probabilities of each rating related to each criterion importance have been estimated by ordinal logistic regression, and the weights of these criteria have been calculated at each stage of the product life cycle.

    AFRIKAANSE OPSOMMING: Die navorsing ondersoek die invloed van produklewensiklus op die gebruik van buite leweransiers deur ’n vervaardigingsonderneming. ’n Besluitvormingsmetode word ontwerp en getoets deur skepping van ’n boeket van wiskundige gereedskap soos, onder andere, ordinale logistiese regressie en die logistieke funksie. Die metode word ten slotte afgerond met ’n keurige gebruik van die Wasigheidsleer.

  15. Making fate and exposure models for freshwater ecotoxicity in life cycle assessment suitable for organic acids and bases.

    van Zelm, Rosalie; Stam, Gea; Huijbregts, Mark A J; van de Meent, Dik

    2013-01-01

    Freshwater fate and exposure factors were determined for organic acids and bases, making use of the knowledge on electrical interaction of ionizing chemicals and their sorption to particles. The fate factor represents the residence time in the environment whereas exposure factors equal the dissolved fraction of a chemical. Multimedia fate, exposure, and effect model USES-LCA was updated to take into account the influence of ionization, based upon the acid dissociation constant (pK(a)) of a chemical, and the environmental pH. Freshwater fate (FF) and exposure (XF) factors were determined for 415 acids and 496 bases emitted to freshwater, air, and soil. The relevance of taking account of the degree of ionization of chemicals was tested by determining the ratio (R) of the new vs. fate and exposure factors determined with USES-LCA suitable for neutral chemicals only. Our results show that the majority of freshwater fate and exposure factors of chemicals that are largely ionized in the environment are larger with the ionics model compared to the factors determined with the neutrals model version. R(FF) ranged from 2.4×10(-1) to 1.6×10(1) for freshwater emissions, from 1.2×10(-2) to 2.0×10(4) for soil emissions and from 5.8×10(-2) to 6.0×10(3) for air emissions, and R(XF) from 5.3×10(-1) to 2.2×10(1). Prediction of changed solid-water partitioning, implying a change in runoff and in removal via sedimentation, and prediction of negligible air-water partition coefficient, leading to negligible volatilization were the main contributors to the changes in freshwater fate factors. Copyright © 2012 Elsevier Ltd. All rights reserved.

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

    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.

  17. The Rights of theWronged: Norms of Nuclearism, the Polygon and the Making of Waste-life

    Aliya Sartbayeva Peleo

    2017-04-01

    Full Text Available On 16th December 1991 Kazakhstan inherited “1216 nuclear warheads for intercontinental ballistic missiles and heavy bombers” (Werner and Purvis-Roberts, 2006. Moreover, Kazakhstan was also presumed to have significant amounts of enriched weapon-grade uranium enough for at least “two dozen warheads” (ibid.. However on 23rd May 1992 Kazakhstan signed the Lisbon Protocol to the Strategic Arms Reduction Treaty (START, gave up its “nuclear ambitions” and agreed “to become a non-nuclear weapon state” (Ayazbekov, 2014. Why did Kazakhstan give up nuclear weapons? This can be adequately answered only by linking the issue with the high material, human and environmental costs of hosting WMDs within the state territory. This paper examines the case of ‘waste-lives’ (Bauman, 2004 related to the Semipalatinsk Polygon in Kazakhstan. The Polygon experienced 467 nuclear tests during the period of 1949-1989 “without regard for the health and safety of those living and working near the test site” (Loretz, 2015. The issues of “human” exclusion of the periphery of the Cold War IR and its effects after the end of the Cold War are at the core of this case study. The structure of the international system (Waltz, 1979 and “nuclear deterrence” (Brodie, 1958 that explain “Long Peace” during the Cold War came at the cost of well-being of the population that supposed to benefit out of the absence of warfare. Geopolitical perspective of the Cold War views historical events as anonymous or mechanical, except those that involved prominent leaders and disregards the “human” aspects of military industrial complex, particularly its biopolitical impact on the life-system of population. The fall of the USSR and “triumph of liberalism” helped to politicise and recognise the long-term effects of radiation contamination. However, this revelation did not resolve the issues as persistent problems being framed as a legacy of the

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

    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.

  19. 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.

    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

  20. 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

    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

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

    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

  2. Speech-language pathology students' self-reports on voice training: easier to understand or to do?

    Lindhe, Christina; Hartelius, Lena

    2009-01-01

    The aim of the study was to describe the subjective ratings of the course 'Training of the student's own voice and speech', from a student-centred perspective. A questionnaire was completed after each of the six individual sessions. Six speech and language pathology (SLP) students rated how they perceived the practical exercises in terms of doing and understanding. The results showed that five of the six participants rated the exercises as significantly easier to understand than to do. The exercises were also rated as easier to do over time. Results are interpreted within in a theoretical framework of approaches to learning. The findings support the importance of both the physical and reflective aspects of the voice training process.

  3. Making Life Easier for the Visually Impaired Web Searcher: It Is Now Clearer How This Should and Can Be Done, but Implementation Lags. A Review of: Sahib, N. G., Tombros, A., & Stockman, T. (2012. A comparative analysis of the information-seeking behavior of visually impaired and sighted searchers. Journal of the American Society for Information Science and Technology, 63(2, 377–391. doi: 10.1002/asi.21696

    R. Laval Hunsucker

    2013-03-01

    Full Text Available Objective – To determine how the behaviour of visually impaired persons significantly differs from that of sighted persons in the carrying out of complex search tasks on the internet.Design – A comparative observational user study, plus semi-structured interviews.Setting – Not specified.Subjects – 15 sighted and 15 visually impaired persons, all of them experienced and frequent Internet search engine users, of both sexes and varying in age from early twenties to mid-fifties.Methods – The subjects carried out self selected complex search tasks on their own equipment and in their own familiar environments. The investigators observed this activity to some extent directly, but for the most part via video camera, through use of a screen-sharing facility, or with screen-capture software. They distinguished four stages of search task activity: query formulation, search results exploration, query reformulation, and search results management. The visually impaired participants, of whom 13 were totally blind and two had only marginal vision, were all working with text-to-speech screen readers and depended exclusively for all their observed activity on those applications’ auditory output. For data analysis, the investigators devised a grounded-theory based coding scheme. They employed a search log format for deriving further quantitative data which they later controlled for statistical significance (two-tailed unpaired t-test; p Main Results – The investigators found significant differences between the sighted participants’ search behaviour and that of the visually impaired searchers. The latter displayed a clearly less “orienteering” (O'Day & Jeffries, 1993 disposition and style, more often starting out with already relatively long and comprehensive combinations of relatively precise search terms; “their queries were more expressive” (p. 386. They submitted fewer follow-up queries, and were considerably less inclined to attempt query reformulation. They were aiming to achieve a satisfactory search outcome in a single step. Nevertheless, they rarely employed advanced operators, and made far less use (in only 4 instances of their search engine’s query-support features than did the sighted searchers (37 instances. Fewer of them (13% ventured beyond the first page of the results returned for their query by the search engine than was the case among the sighted searchers (43%. They viewed fewer (a mean of 4.27, as opposed to 13.40 retrieved pages, and they visited fewer external links (6 visits by 4 visually impaired searchers, compared with 34 visits by 11 sighted searchers. The visually impaired participants more frequently engaged in note taking than did the sighted participants.The visually impaired searchers were in some cases, the investigators discovered, unaware of search engine facilities or searching tactics which might have improved their search outcomes. Yet even when they were aware of these, they very often chose not to employ them because doing so via their screen readers would have cost them more time and effort than they were willing to expend. In general, they were more diffident and less resourceful than the sighted searchers, and had more trust in the innate capacity and reliability of their search engine to return in an efficient manner the best available results.Conclusion – Despite certain inherent limitations of the present study (the relatively small sample sizes and the non-randomness of the purposive sighted-searcher sample, the possible presence of extraneous variables, the impossibility of entirely ruling out familiarity bias, its findings strongly support the conclusion that working with today’s search engine user interfaces through the intermediation of currently available assistive technologies necessarily imposes severe limits on the degree to which visually impaired persons can efficiently search the web for information relevant to their needs. The findings furthermore suggest that there are various measures that it would be possible to take toward allev

  4. Development and validation of a shared decision-making instrument for health-related quality of life one year after total hip replacement based on quality registries data.

    Nemes, Szilard; Rolfson, Ola; Garellick, Göran

    2018-02-01

    Clinicians considering improvements in health-related quality of life (HRQoL) after total hip replacement (THR) must account for multiple pieces of information. Evidence-based decisions are important to best assess the effect of THR on HRQoL. This work aims at constructing a shared decision-making tool that helps clinicians assessing the future benefits of THR by offering predictions of 1-year postoperative HRQoL of THR patients. We used data from the Swedish Hip Arthroplasty Register. Data from 2008 were used as training set and data from 2009 to 2012 as validation set. We adopted two approaches. First, we assumed a continuous distribution for the EQ-5D index and modelled the postoperative EQ-5D index with regression models. Second, we modelled the five dimensions of the EQ-5D and weighted together the predictions using the UK Time Trade-Off value set. As predictors, we used preoperative EQ-5D dimensions and the EQ-5D index, EQ visual analogue scale, visual analogue scale pain, Charnley classification, age, gender, body mass index, American Society of Anesthesiologists, surgical approach and prosthesis type. Additionally, the tested algorithms were combined in a single predictive tool by stacking. Best predictive power was obtained by the multivariate adaptive regression splines (R 2  = 0.158). However, this was not significantly better than the predictive power of linear regressions (R 2  = 0.157). The stacked model had a predictive power of 17%. Successful implementation of a shared decision-making tool that can aid clinicians and patients in understanding expected improvement in HRQoL following THR would require higher predictive power than we achieved. For a shared decision-making tool to succeed, further variables, such as socioeconomics, need to be considered. © 2016 John Wiley & Sons, Ltd.

  5. Student life - Making politics matter.

    McCullough, Siobhan

    2014-12-02

    'What has politics got to do with nursing?' This is a question I hear often as a lecturer in nursing with a specialist interest in politics, as is the comment: 'I did not come into nursing to learn about politics.'

  6. Retrospective Occupational Exposure Assessment in Community-Based Studies Made Easier

    Fritschi, L.; Girschik, J.; Friesen, M.C.; Glass, D.; Monash, G.B.; Sadkowsky, T.

    2010-01-01

    Occ DEAS Assessing occupational exposure in retrospective community-based case-control studies is difficult as measured exposure data are very seldom available. The expert assessment method is considered the most accurate way to attribute exposure but it is a time consuming and expensive process and may be seen as subjective, non reproducible, and non transparent. In this paper, we describe these problems and outline our solutions as ope rationalized in a web-based software application (Occ DEAS). The novel aspects of Occ DEAS are combining all steps in the assessment into one software package; enmeshing the process of assessment into the development of questionnaires; selecting the exposure(s) of interest; specifying rules for exposure assignment; allowing manual or automatic assessments; ensuring that circumstances in which exposure is possible for an individual are highlighted for review; providing reports to ensure consistency of assessment. Development of this application has the potential to make high-quality occupational assessment more efficient and accessible for epidemiological studies

  7. Easier Seen Than Done: Merely Watching Others Perform Can Foster an Illusion of Skill Acquisition.

    Kardas, Michael; O'Brien, Ed

    2018-04-01

    Modern technologies such as YouTube afford unprecedented access to the skilled performances of other people. Six experiments ( N = 2,225) reveal that repeatedly watching others can foster an illusion of skill acquisition. The more people merely watch others perform (without actually practicing themselves), the more they nonetheless believe they could perform the skill, too (Experiment 1). However, people's actual abilities-from throwing darts and doing the moonwalk to playing an online game-do not improve after merely watching others, despite predictions to the contrary (Experiments 2-4). What do viewers see that makes them think they are learning? We found that extensive viewing allows people to track what steps to take (Experiment 5) but not how those steps feel when taking them. Accordingly, experiencing a "taste" of performing attenuates the illusion: Watching others juggle but then holding the pins oneself tempers perceived change in one's own ability (Experiment 6). These findings highlight unforeseen problems for self-assessment when watching other people.

  8. The Trial of Ascertaining Individual Preferences for Loved Ones' Role in End-of-Life Decisions (TAILORED) Study: A Randomized Controlled Trial to Improve Surrogate Decision Making.

    Sulmasy, Daniel P; Hughes, Mark T; Yenokyan, Gayane; Kub, Joan; Terry, Peter B; Astrow, Alan B; Johnson, Julie A; Ho, Grace; Nolan, Marie T

    2017-10-01

    Patients with terminal illnesses often require surrogate decision makers. Prior research has demonstrated high surrogate stress, and that despite standards promoting substituted judgment, most patients do not want their surrogates to make pure substituted judgments for them. It is not known how best to help loved ones fulfill the surrogate role. To test the effectiveness of an intervention to help surrogate decision makers. One hundred sixty-six patients (41% with amyotrophic lateral sclerosis and 59% with gastrointestinal cancers) and their surrogates at two university medical centers were randomized to an intensive nurse-directed discussion of the end-of-life decision control preferences of the patient (TAILORED) or a discussion of nutrition (CONTROL); 163 completed baseline interviews and underwent the intervention. Twelve patients died during follow-up and 137 dyads completed the study. Post-intervention, using all available data, TAILORED patients and surrogates became more likely to endorse mutual surrogate decision making, that is, a balance of their own wishes and what the surrogate thinks best (adjusted odds compared with baseline for patients = 1.78, P = 0.04; adjusted odds for surrogates = 2.05, P = 0.03). CONTROL patients became 40% less likely to endorse mutual surrogate decision making (P = 0.08), and CONTROL surrogates did not change significantly from baseline (adjusted odds = 1.44, P = 0.28). Stress levels decreased for TAILORED surrogates (impact of events scale = 23.1 ± 14.6 baseline, 20.8 ± 15.3 f/u, P = 0.046), but not for CONTROL (P = 0.85), and post-intervention stress was lower for TAILORED than CONTROL (P = 0.04). Surrogates' confidence was uniformly high at baseline and did not change. Caregiver burden (Zarit) increased from 12.5 ± 6.5 to 14.7 ± 8.1 for TAILORED (P decision making was higher at follow-up for TAILORED than for CONTROL (71% vs. 52%, P = 0.03). TAILORED patients and surrogates who

  9. Acute acromioclavicular dislocation: a cheaper, easier and all-arthroscopic system. Is it effective in nowadays economical crisis?

    Sastre, Sergi; Dada, Michelle; Santos, Simon; Lozano, Lluis; Alemany, Xavier; Peidro, Lluis

    2015-03-01

    The objective of this manuscript is to show an effective, easier and cheaper way to reduce acute acromioclavicular (AC) dislocation type III and V (Rockwood classification). Numerous procedures have been described for surgical management of acromioclavicular joint disruption. Newest devices involve an arthroscopic technique that allows nonrigid anatomic fixation of the acromioclavicular joint. Arthroscopically assisted treatment of acute AC joint dislocation is advantageous because it provides good clinical results and few complications. It also allows reviewing glenohumeral associated lesions. This surgical technique requires no specific implants to achieve a correct AC reduction. Actually, economical advantages are very important factors to decide the use of determinate surgical techniques.

  10. Designing the Social Context for Easier Verification, Validation, and Uncertainty Quantification of Earth Science Data

    Barkstrom, B. R.; Loeb, N. G.; Wielicki, B. A.

    2017-12-01

    Verification, Validation, and Uncertainty Quantification (VVUQ) are key actions that support conclusions based on Earth science data. Communities of data producers and users must undertake VVUQ when they create and use their data. The strategies [S] and tools [T] suggested below come from successful use on two large NASA projects. The first was the Earth Radiation Budget Experiment (ERBE). The second is the investigation of Clouds and the Earth's Radiant Energy System (CERES). [S] 1. Partition the production system into subsystems that deal with data transformations confined to limited space and time scales. Simplify the subsystems to minimize the number of data transformations in each subsystem. [S] 2. Derive algorithms from the fundamental physics and chemistry governing the parameters in each subsystem including those for instrument calibration. [S] 3. Use preliminary uncertainty estimates to detect unexpected discrepancies. Removing these requires diagnostic work as well as development and testing of fixes. [S] 4. Make sure there are adequate resources to support multiple end-to-end reprocessing of all data products. [T] 1. Create file identifiers that accommodate temporal and spatial sequences of data files and subsystem version changes. [T] 2. Create libraries of parameters used in common by different subsystems to reduce errors due to inconsistent values. [T] 3. Maintain a list of action items to record progress on resolving discrepancies. [T] 4. Plan on VVUQ activities that use independent data sources and peer review before distributing and archiving data. The goal of VVUQ is to provide a transparent link between the data and the physics and chemistry governing the measured quantities. The VVUQ effort also involves specialized domain experience and nomenclature. It often requires as much effort as the original system development. ERBE and CERES demonstrated that these strategies and tools can reduce the cost of VVUQ for Earth science data products.

  11. The Breathe Easier through Weight Loss Lifestyle (BE WELL Intervention: A randomized controlled trial

    Buist A

    2010-03-01

    Full Text Available Abstract Background Obesity and asthma have reached epidemic proportions in the US. Their concurrent rise over the last 30 years suggests that they may be connected. Numerous observational studies support a temporally-correct, dose-response relationship between body mass index (BMI and incident asthma. Weight loss, either induced by surgery or caloric restriction, has been reported to improve asthma symptoms and lung function. Due to methodological shortcomings of previous studies, however, well-controlled trials are needed to investigate the efficacy of weight loss strategies to improve asthma control in obese individuals. Methods/Design BE WELL is a 2-arm parallel randomized clinical trial (RCT of the efficacy of an evidence-based, comprehensive, behavioral weight loss intervention, focusing on diet, physical activity, and behavioral therapy, as adjunct therapy to usual care in the management of asthma in obese adults. Trial participants (n = 324 are patients aged 18 to 70 years who have suboptimally controlled, persistent asthma, BMI between 30.0 and 44.9 kg/m2, and who do not have serious comorbidities (e.g., diabetes, heart disease, stroke. The 12-month weight loss intervention to be studied is based on the principles of the highly successful Diabetes Prevention Program lifestyle intervention. Intervention participants will attend 13 weekly group sessions over a four-month period, followed by two monthly individual sessions, and will then receive individualized counseling primarily by phone, at least bi-monthly, for the remainder of the intervention. Follow-up assessment will occur at six and 12 months. The primary outcome variable is the overall score on the Juniper Asthma Control Questionnaire measured at 12 months. Secondary outcomes include lung function, asthma-specific and general quality of life, asthma medication use, asthma-related and total health care utilization. Potential mediators (e.g., weight loss and change in physical

  12. Developmental changes in real life decision making: performance on a gambling task previously shown to depend on the ventromedial prefrontal cortex.

    Crone, Eveline A; van der Molen, Maurits W

    2004-01-01

    Patients with bilateral lesions of the ventromedial prefrontal cortex, when performing gambling tasks modeling real-life decision-making, opt for choices that yield high immediate gains in spite of higher future losses. Under the hypothesis that the prefrontal cortex is the last brain region to mature, it was examined whether young children would show a similar preference for immediate prospects. In Experiment 1, 4 age groups (6-9, 10-12, 13-15 and 18-25 years olds) performed 2 versions of a computerized variant of the original Iowa gambling task under 3 different feedback conditions (no feedback, global feedback, and option-specific feedback) and completed the Raven Standard Progressive Matrices as an index of inductive reasoning ability. In Experiment 2, 3 age groups (7-8, 11-12, and 15-16 year olds) performed both task versions in addition to a working memory task ("Digit Span Backwards"). Results showed a developmental increase in the sensitivity to future consequences, positive or negative, that could not be explained by developmental changes in working memory capacity or inductive reasoning. It was concluded that young children share with ventromedial prefrontal patients the failure to anticipate on future outcomes.

  13. 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.

    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.

  14. Easier surveillance of climate-related health vulnerabilities through a Web-based spatial OLAP application

    Gosselin Pierre

    2009-04-01

    Full Text Available Abstract Background Climate change has a significant impact on population health. Population vulnerabilities depend on several determinants of different types, including biological, psychological, environmental, social and economic ones. Surveillance of climate-related health vulnerabilities must take into account these different factors, their interdependence, as well as their inherent spatial and temporal aspects on several scales, for informed analyses. Currently used technology includes commercial off-the-shelf Geographic Information Systems (GIS and Database Management Systems with spatial extensions. It has been widely recognized that such OLTP (On-Line Transaction Processing systems were not designed to support complex, multi-temporal and multi-scale analysis as required above. On-Line Analytical Processing (OLAP is central to the field known as BI (Business Intelligence, a key field for such decision-support systems. In the last few years, we have seen a few projects that combine OLAP and GIS to improve spatio-temporal analysis and geographic knowledge discovery. This has given rise to SOLAP (Spatial OLAP and a new research area. This paper presents how SOLAP and climate-related health vulnerability data were investigated and combined to facilitate surveillance. Results Based on recent spatial decision-support technologies, this paper presents a spatio-temporal web-based application that goes beyond GIS applications with regard to speed, ease of use, and interactive analysis capabilities. It supports the multi-scale exploration and analysis of integrated socio-economic, health and environmental geospatial data over several periods. This project was meant to validate the potential of recent technologies to contribute to a better understanding of the interactions between public health and climate change, and to facilitate future decision-making by public health agencies and municipalities in Canada and elsewhere. The project also aimed at

  15. Easier surveillance of climate-related health vulnerabilities through a Web-based spatial OLAP application.

    Bernier, Eveline; Gosselin, Pierre; Badard, Thierry; Bédard, Yvan

    2009-04-03

    Climate change has a significant impact on population health. Population vulnerabilities depend on several determinants of different types, including biological, psychological, environmental, social and economic ones. Surveillance of climate-related health vulnerabilities must take into account these different factors, their interdependence, as well as their inherent spatial and temporal aspects on several scales, for informed analyses. Currently used technology includes commercial off-the-shelf Geographic Information Systems (GIS) and Database Management Systems with spatial extensions. It has been widely recognized that such OLTP (On-Line Transaction Processing) systems were not designed to support complex, multi-temporal and multi-scale analysis as required above. On-Line Analytical Processing (OLAP) is central to the field known as BI (Business Intelligence), a key field for such decision-support systems. In the last few years, we have seen a few projects that combine OLAP and GIS to improve spatio-temporal analysis and geographic knowledge discovery. This has given rise to SOLAP (Spatial OLAP) and a new research area. This paper presents how SOLAP and climate-related health vulnerability data were investigated and combined to facilitate surveillance. Based on recent spatial decision-support technologies, this paper presents a spatio-temporal web-based application that goes beyond GIS applications with regard to speed, ease of use, and interactive analysis capabilities. It supports the multi-scale exploration and analysis of integrated socio-economic, health and environmental geospatial data over several periods. This project was meant to validate the potential of recent technologies to contribute to a better understanding of the interactions between public health and climate change, and to facilitate future decision-making by public health agencies and municipalities in Canada and elsewhere. The project also aimed at integrating an initial collection of geo

  16. Make the most of your doctor visit

    ... the notes in your phone or in an email to your provider. Writing things down makes it easier to remember details ... Duplication for commercial use must be authorized in writing by ADAM Health Solutions. About MedlinePlus Site ... to RSS Follow us Disclaimers Copyright ...

  17. Excel 2016 for biological and life sciences statistics a guide to solving practical problems

    Quirk, Thomas J; Horton, Howard F

    2016-01-01

    This book is a step-by-step exercise-driven guide for students and practitioners who need to master Excel to solve practical biological and life science problems. If understanding statistics isn’t your strongest suit, you are not especially mathematically-inclined, or if you are wary of computers, this is the right book for you. Excel is an effective learning tool for quantitative analyses in biological and life sciences courses. Its powerful computational ability and graphical functions make learning statistics much easier than in years past. However, Excel 2016 for Biological and Life Sciences Statistics: A Guide to Solving Practical Problems is the first book to capitalize on these improvements by teaching students and managers how to apply Excel 2016 to statistical techniques necessary in their courses and work. Each chapter explains statistical formulas and directs the reader to use Excel commands to solve specific, easy-to-understand biological and life science problems. Practice problems are provided...

  18. Making "ethical safe space" in the translation of contested knowledge: the role of community debate in defining end-of-life decision ethics.

    Kaufert, Joseph; Schwartz, Karen; Wiebe, Rhonda; Derksen, Jim; Lutfiyya, Zana M; Richert, Dean

    2013-04-01

    The objectives of this article are, first, to document a unique process of research knowledge translation (KT), which the authors describe as the creation of "ethical safe space," and, second, to document the narratives of forum participants and describe their interaction in a dialogue about vulnerability, the authority of physicians, and the perspective of people with disabilities on the policy. Narrative data from qualitative interviews with individual key informants and focus groups were used to identify speakers with specific expertise on policy, disability perspectives, and bioethical issues, who were invited to participate in the Forum on Ethical Safe Space. The planning workgroup adopted a model for enabling representative participation in the public forum designed to reduce the impact of physical, sensory, financial, language, and professional status barriers. Using the transcripts and keynote speakers' printed texts, primary themes and patterns of interaction were identified reflecting the alternative perspectives. Through the development of a workshop on ethical, legal, and disability-related implications of professional policy guidelines developed by the College of Physicians and Surgeons of Manitoba, we provided a qualitative analysis of the discourse involving experts and disability community members supporting alternative positions on the impact of the policy statement, and discuss ethical, legal, and disability rights issues identified in the public debate. Contested policy and ethical frameworks for making decisions about withdrawing and withholding life supporting treatment may influence both the perspectives of palliative care providers and patients referred to palliative care facilities. An innovative model for KT using a public forum that enabled stakeholders with conflicting perspectives to engage with ethical and professional policy issues asserting the physician's authority in contested decisions involving withdrawing or withholding life

  19. Process integrated modelling for steelmaking Life Cycle Inventory analysis

    Iosif, Ana-Maria; Hanrot, Francois; Ablitzer, Denis

    2008-01-01

    During recent years, strict environmental regulations have been implemented by governments for the steelmaking industry in order to reduce their environmental impact. In the frame of the ULCOS project, we have developed a new methodological framework which combines the process integrated modelling approach with Life Cycle Assessment (LCA) method in order to carry out the Life Cycle Inventory of steelmaking. In the current paper, this new concept has been applied to the sinter plant which is the most polluting steelmaking process. It has been shown that this approach is a powerful tool to make the collection of data easier, to save time and to provide reliable information concerning the environmental diagnostic of the steelmaking processes

  20. 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.

    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

  1. Uncertainty calculations made easier

    Hogenbirk, A.

    1994-07-01

    The results are presented of a neutron cross section sensitivity/uncertainty analysis performed in a complicated 2D model of the NET shielding blanket design inside the ITER torus design, surrounded by the cryostat/biological shield as planned for ITER. The calculations were performed with a code system developed at ECN Petten, with which sensitivity/uncertainty calculations become relatively simple. In order to check the deterministic neutron transport calculations (performed with DORT), calculations were also performed with the Monte Carlo code MCNP. Care was taken to model the 2.0 cm wide gaps between two blanket segments, as the neutron flux behind the vacuum vessel is largely determined by neutrons streaming through these gaps. The resulting neutron flux spectra are in excellent agreement up to the end of the cryostat. It is noted, that at this position the attenuation of the neutron flux is about 1 l orders of magnitude. The uncertainty in the energy integrated flux at the beginning of the vacuum vessel and at the beginning of the cryostat was determined in the calculations. The uncertainty appears to be strongly dependent on the exact geometry: if the gaps are filled with stainless steel, the neutron spectrum changes strongly, which results in an uncertainty of 70% in the energy integrated flux at the beginning of the cryostat in the no-gap-geometry, compared to an uncertainty of only 5% in the gap-geometry. Therefore, it is essential to take into account the exact geometry in sensitivity/uncertainty calculations. Furthermore, this study shows that an improvement of the covariance data is urgently needed in order to obtain reliable estimates of the uncertainties in response parameters in neutron transport calculations. (orig./GL)

  2. Satisfaction with life and character strengths of non-religious and religious people: it’s practicing one’s religion that makes the difference

    Berthold, Anne; Ruch, Willibald

    2014-01-01

    According to systematic reviews, religious beliefs and practices are related to higher life satisfaction, happiness, and positive affect (Koenig and Larson, 2001). The present research extends previous findings by comparing satisfaction with life and character strengths of non-religious people, religious people, who practice their religion and people that have a religious affiliation but do not practice their religion. We assessed life satisfaction (SWLS), character strengths (VIA-IS) and the...

  3. Broad themes of difference between French and Americans in attitudes to food and other life domains: Personal versus communal values, quantity versus quality, and comforts versus joys

    Paul eRozin

    2011-07-01

    Full Text Available Analysis of previous literature on the role of food in life in France and the United States suggests some fundamental differences in attitudes which may generalize outside of the food domain. Questionnaire results from French and American adults suggest that, compared to the French, Americans emphasize quantity rather than quality in making choices, Americans have a higher preference for variety, and Americans usually prefer comforts (things that make life easier over joys (unique things that make life interesting. The American preference for quantity over quality is discussed in terms of the American focus on abundance as opposed to the French preference for moderation. The American preference for variety is reflective of Americans’ more personal as opposed to communal food and other values.

  4. Broad Themes of Difference between French and Americans in Attitudes to Food and Other Life Domains: Personal Versus Communal Values, Quantity Versus Quality, and Comforts Versus Joys.

    Rozin, Paul; Remick, Abigail K; Fischler, Claude

    2011-01-01

    Analysis of previous literature on the role of food in life in France and the United States suggests some fundamental differences in attitudes which may generalize outside of the food domain. Questionnaire results from French and American adults suggest that, compared to the French, Americans emphasize quantity rather than quality in making choices, Americans have a higher preference for variety, and Americans usually prefer comforts (things that make life easier) over joys (unique things that make life interesting). The American preference for quantity over quality is discussed in terms of the American focus on abundance as opposed to the French preference for moderation. The American preference for variety is reflective of Americans' more personal as opposed to communal food and other values.

  5. Does Naming Therapy Make Ordering in a Restaurant Easier? Dynamics of Co-Occurring Change in Cognitive-Linguistic and Functional Communication Skills in Aphasia

    Johnson, Jeffrey P.; Villard, Sarah; Kiran, Swathi

    2017-01-01

    Purpose This study was conducted to investigate the static and dynamic relationships between impairment-level cognitive-linguistic abilities and activity-level functional communication skills in persons with aphasia (PWA). Method In Experiment 1, a battery of standardized assessments was administered to a group of PWA (N = 72) to examine associations between cognitive-linguistic ability and functional communication at a single time point. In Experiment 2, impairment-based treatment was administered to a subset of PWA from Experiment 1 (n = 39) in order to examine associations between change in cognitive-linguistic ability and change in function and associations at a single time point. Results In both experiments, numerous significant associations were found between scores on tests of cognitive-linguistic ability and a test of functional communication at a single time point. In Experiment 2, significant treatment-induced gains were seen on both types of measures in participants with more severe aphasia, yet cognitive-linguistic change scores were not significantly correlated with functional communication change scores. Conclusions At a single time point, cognitive-linguistic and functional communication abilities are associated in PWA. However, although changes on standardized assessments reflecting improvements in both types of skills can occur following an impairment-based therapy, these changes may not be significantly associated with each other. PMID:28196373

  6. Facilitando la salud: haciendo cambios saludables en guarderías infantiles (Making Health Easier: Healthy Changes Start in Preschool)

    2012-10-04

    Vea cómo enseñar a los niños hábitos saludables incorporando pequeños cambios que pueden realizarse en cualquier aula.  Created: 10/4/2012 by National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP).   Date Released: 10/4/2012.

  7. Can Food Stamps Do More to Improve Food Choices? An Economic Perspective--Making Healthy Food Choices Easier: Ideas From Behavioral Economics

    Mancino, Lisa; Andrews, Margaret S.

    2007-01-01

    With obesity the most prevalent nutrition problem facing Americans at all economic levels, promoting diets that provide adequate nutrition without too many calories has become an important objective for the Food Stamp Program. Findings from behavioral economics suggest innovative, low-cost ways to improve the diet quality of food stamp participants without restricting their freedom of choice. Unlike more traditional economic interventions, such as changing prices or banning specific foods, th...

  8. Nudging – A Way to Encourage Public Tenants to More Sustainable Behaviour? : A study on how public landlords can make the sustainable choice easier

    Haglund, Albin

    2017-01-01

    The public sector owns and manages approximately 90 million square meters of premises. One of the toughest challenges today is managing both climate-friendly and energy efficient buildings. For the landlords who facilitate these properties to reach national targets by 2020, they will need well thought out strategies. New technology and installations are not enough. Tenants also have to change their behaviour. A relatively new way to influence behaviour without changing values of people is nud...

  9. Making healthy choices easy choices: the role of empowerment

    Koelen, M.A.; Lindström, B.

    2005-01-01

    An important goal of health promotion is to make it easier for people to make healthy choices. However, this may be difficult if people do not feel control over their environment and their personal circumstances. An important concept in relation to this is empowerment. Health professionals are

  10. Satisfaction with life and character strengths of non-religious and religious people: it's practicing one's religion that makes the difference.

    Berthold, Anne; Ruch, Willibald

    2014-01-01

    According to systematic reviews, religious beliefs and practices are related to higher life satisfaction, happiness, and positive affect (Koenig and Larson, 2001). The present research extends previous findings by comparing satisfaction with life and character strengths of non-religious people, religious people, who practice their religion and people that have a religious affiliation but do not practice their religion. We assessed life satisfaction (SWLS), character strengths (VIA-IS) and the orientations to happiness (OTH) in a sample of N = 20538 participants. People with a religious affiliation that also practice their religion were found to be more satisfied with their life and scored higher on life of meaning than those who do not practice their religion and than non-religious people. Also religious people who practice their religion differed significantly from those who do not practice their religion and non-religious people regarding several character strengths; they scored higher on kindness, love, gratitude, hope, forgiveness, and on spirituality. There were no substantial differences between people who had no religious affiliation and those with a religious affiliation that do not practice their religion (all [Formula: see text]s religious affiliation if they also actively practice their religion.

  11. Satisfaction with life and character strengths of nonreligious and religious people: it’s practicing one’s religion that makes the difference

    Anne eBerthold

    2014-08-01

    Full Text Available According to systematic reviews, religious beliefs and practices are related to higher life satisfaction, happiness, and positive affect (Koenig & Larson, 2001. The present research extends previous findings by comparing satisfaction with life and character strengths of nonreligious people, religious people, who practice their religion and people that have a religious affiliation but do not practice their religion. We assessed life satisfaction (SWLS, character strengths (VIA-IS and the orientations to happiness (OTH in a sample of N=20538 participants. People with a religious affiliation that also practice their religion were found to be more satisfied with their life and scored higher on life of meaning than those who do not practice their religion and than nonreligious people. Also religious people who practice their religion differed significantly from those who do not practice their religion and nonreligious people regarding several character strengths; they scored higher on kindness, love, gratitude, hope, forgiveness, and on spirituality. There were no substantial differences between people who had no religious affiliation and those with a religious affiliation that do not practice their religion (all ηp2s < .009. Altogether, the present findings suggest that people profit from a religious affiliation if they also actively practice their religion.

  12. The reluctance to burden others as a value in end-of-life decision making: a source of inaccuracy in substituted judgment.

    Winter, Laraine; Parks, Susan M

    2012-03-01

    Most patients are decisionally incapacitated at the end of life, leaving final treatment decisions to proxies, whose substituted judgment is often inaccurate. We investigated the reluctance to burden others (RBO), a commonly cited patient value, as a possible source of proxy inaccuracy. In a sample of 202 elders and their proxies, elders responded to three burden-related questions and the Life-prolonging Treatment Preferences Questionnaire. Proxies used substituted judgment to respond to the same questions. Although RBO predicted treatment preferences for both elders and proxies, elders rated RBO significantly more important than did proxies. In addition, larger elder-proxy differences in RBO were associated with more inaccurate substituted judgment.

  13. Making Women the Subjects of the Abortion Debate: A Class Exercise that Moves beyond "Pro-Choice" and "Pro-Life"

    Crawley, Sara L.; Willman, Rebecca K.; Clark, Leisa; Walsh, Clare

    2009-01-01

    In this article, the authors describe a classroom exercise designed to put women (and children and men) back at the center of the abortion debate, avoiding the standard rhetoric and engaging reflection on how everyone might find common political goals among the so-called pro-life and pro-choice sides. The exercise the authors offer in this article…

  14. Ethical issues in communication of diagnosis and end-of-life decision-making process in some of the Romanian Roma communities.

    Roman, Gabriel; Enache, Angela; Pârvu, Andrada; Gramma, Rodica; Moisa, Ştefana Maria; Dumitraş, Silvia; Ioan, Beatrice

    2013-08-01

    Medical communication in Western-oriented countries is dominated by concepts of shared decision-making and patient autonomy. In interactions with Roma patients, these behavioral patterns rarely seem to be achieved because the culture and ethnicity have often been shown as barriers in establishing an effective and satisfying doctor-patient relationship. The study aims to explore the Roma's beliefs and experiences related to autonomy and decision-making process in the case of a disease with poor prognosis. Forty-eight Roma people from two Romanian counties participated in semi-structured interviews, conducted by a research team from the University of Medicine and Pharmacy of Iasi. Participants were recruited among the chronically ill patients and caregivers. The Roma community opposes informing the terminal patients about their condition, the "silence conspiracy" being widely practiced. The family fully undertakes the right of decision making, thus minimizing the patient's autonomy. We identified ethical dilemmas concerning autonomy, lack of patients' real decision-making power, and paternalistic attitudes exerted firstly by the family and, on demand, by the physician. Instead, the Roma patient benefits from a very active support network, being accompanied at the hospital by numerous relatives. The patient's right to make autonomous decisions promoted in the Western countries and stipulated by the Romanian law has diminished value in the Roma community. For the Roma, the understanding of dignity is not simply individual and personal, but it is closely related to their cultural particularities. Ignoring their cultural values could create conflicts between healthcare providers and community.

  15. Making Smart Food Choices

    ... turn JavaScript on. Feature: Healthy Aging Making Smart Food Choices Past Issues / Winter 2015 Table of Contents Everyday ... NIH www.nia.nih.gov/Go4Life Making Smart Food Choices To maintain a healthy weight, balance the calories ...

  16. How Adults in Developmental Reading Courses Describe Their Educational Life Experiences: A Phenomenological Case Study Examining Whether Experiences Influence Reading Attitudes and Decision-Making Processes

    Reece Armour, Ashley

    2017-01-01

    The purpose of this phenomenological case study is to explore the reading attitudes and decision-making skills of college freshmen enrolled in remedial language arts courses. The theoretical framework guiding this study is qualitative phenomenology explained by Baxter and Jack (2008). This specific type of research "provides tools for…

  17. "It gave me something big in my life to wonder and think about which took over the space … and not MS": managing well-being in multiple sclerosis through art-making.

    Hunt, Laura; Nikopoulou-Smyrni, Panagiota; Reynolds, Frances

    2014-01-01

    Individuals living with Multiple Sclerosis (MS) often face progressive loss of function, uncertainty and disruption to self-image and valued roles. Previous studies show that creative self-expression is valued by some people living with long-term illness, yet its meaning for people living with MS is unclear. This research study explored the meanings of leisure-based visual art-making for people living with MS. This qualitative study followed guidelines for Interpretative Phenomenological Analysis (IPA). Single semi-structured interviews were conducted with five adults (2 males; 3 females; 40-65 years), recruited from MS Ireland. Participants valued art-making for contributing to a more satisfying way of life; for filling occupational voids and using time well. Deep immersion offered respite from worry about illness. Creative classes offered social camaraderie and opportunities for learning and development. Art-making processes and products were highly affirmative, increasing emotional well-being and promoting self-worth. Most felt that they expressed valued aspects of self through their art. Art-making appeared to assist with identity maintenance, accommodating functional losses associated with MS whilst opening "new doors". Art-making offered a multi-faceted means of supporting identity and increasing fulfilment in lives that were restricted in many ways by MS.

  18. Comments on John D. Keen and James E. Keen, What is the point: will screening mammography save my life? BMC Medical Informatics and Decision Making, 2009.

    Retsky, Michael

    2009-04-02

    This paper by John D. Keen and James E. Keen addresses a thorny subject. The numerical findings and commentaries in their paper will be disturbing to some readers and seem to defy logic and well established viewpoints. It may well generate angry letters to the editor. However such numerical analysis and reporting including civil discussion should be welcomed and are the basis for informed decision making - something that is highly needed in this field.

  19. 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.

    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

  20. To Which Degree Does Sector Specific Standardization Make Life Cycle Assessments Comparable?—The Case of Global Warming Potential of Smartphones

    Anders S. G. Andrae

    2014-11-01

    Full Text Available Here attributional life cycle assessments (LCAs for the same smartphone model are presented by two different organizations (Orange, OGE and Huawei, HuW and the effect of different modeling approach is analyzed. A difference of around 32% (29.6 kg and 39.2 kg for CO2e baseline scores is found using same study object and sector specific LCA standard, however, different metrics, emission intensities, and LCA software programs. The CO2e difference is reduced to 12% (29.9 kg and 33.5 kg when OGE use HuW metrics for use phase power consumption and total mass, and when HuW use OGE metrics for gold mass and silicon die area. Further, a probability test confirms that present baseline climate change results, for one specific study object modeled with two largely different and independent LCA modeling approaches, are comparable if both use the European Telecommunications Standard Institute (ETSI LCA standard. The general conclusion is that the ETSI LCA standard strongly facilitates comparable CC results for technically comparable smartphone models. Moreover, thanks to the reporting requirements of ETSI LCA standard, a clear understanding of the differences between LCA modeling approaches is obtained. The research also discusses the magnitude of the CO2e reduction potential in the life cycle of smartphones.

  1. Making and Changing Wills

    Cheryl Tilse

    2016-02-01

    Full Text Available Wills are important social, economic, and legal documents. Yet little is known about current will making practices and intentions. A comprehensive national database on the prevalence of will making in Australia was developed to identify who is or is not most likely to draw up a will and triggers for making and changing wills. A national survey of 2,405 adults aged above 18 years was administered by telephone in August and September 2012. Fifty-nine percent of the Australian adult population has a valid will, and the likelihood of will making increases with age and estate value. Efforts to get organized, especially in combination with life stage and asset changes trigger will making; procrastination, rather than a strong resistance, appears to explain not making a will. Understanding will making is timely in the context of predicted significant intergenerational transfers of wealth, changing demographics, and a renewed emphasis on retirement planning.

  2. Development of an Nearly Zero Emission Building (nZEB Life Cycle Cost Assessment Tool for Fast Decision Making in the Early Design Phase

    Hae Jin Kang

    2017-01-01

    Full Text Available An economic feasibility optimization method for the life cycle cost (LCC has been developed to apply energy saving techniques in the early design stages of a building. The method was developed using default data (e.g., operation schedules, energy consumption prediction equations and cost prediction equations utilizing design variables considered in the early design phase. With certain equations developed, an LCC model was constructed using the computational program MATLAB, to create an automated optimization process. To verify the results from the newly developed assessment tool, a case study on an office building was performed to outline the results of the designer’s proposed model and the cost optimal model.

  3. A life-cycle approach to technology, infrastructure, and climate policy decision making: Transitioning to plug-in hybrid electric vehicles and low-carbon electricity

    Samaras, Constantine

    In order to mitigate the most severe effects of climate change, large global reductions in the current levels of anthropogenic greenhouse gas (GHG) emissions are required in this century to stabilize atmospheric carbon dioxide (CO2) concentrations at less than double pre-industrial levels. The Intergovernmental Panel on Climate Change (IPCC) fourth assessment report states that GHG emissions should be reduced to 50-80% of 2000 levels by 2050 to increase the likelihood of stabilizing atmospheric CO2 concentrations. In order to achieve the large GHG reductions by 2050 recommended by the IPCC, a fundamental shift and evolution will be required in the energy system. Because the electric power and transportation sectors represent the largest GHG emissions sources in the United States, a unique opportunity for coupling these systems via electrified transportation could achieve synergistic environmental (GHG emissions reductions) and energy security (petroleum displacement) benefits. Plug-in hybrid electric vehicles (PHEVs), which use electricity from the grid to power a portion of travel, could play a major role in reducing greenhouse gas emissions from the transport sector. However, this thesis finds that life cycle GHG emissions from PHEVs depend on the electricity source that is used to charge the battery, so meaningful GHG emissions reductions with PHEVs are conditional on low-carbon electricity sources. Power plants and their associated GHGs are long-lived, and this work argues that decisions made regarding new electricity supplies within the next ten years will affect the potential of PHEVs to play a role in a low-carbon future in the coming decades. This thesis investigates the life cycle engineering, economic, and policy decisions involved in transitioning to PHEVs and low-carbon electricity. The government has a vast array of policy options to promote low-carbon technologies, some of which have proven to be more successful than others. This thesis uses life

  4. Hardships of end-of-life care with court-appointed guardians.

    Hastings, Kylie B

    2014-02-01

    In the United States, the court-appointed guardians do not have the ability to make decisions regarding end-of-life (EOL) care for their clients. Additionally, the process of initiating EOL care measures can be slow and cumbersome, despite an existing process of getting approval for such care. This process has the potential to prolong suffering and delay imperative decisions. This article reviews the hardships that patients, court-appointed guardians, and health care staff endure while moving through the oppressive process of obtaining EOL care orders through the court. This article also proposes ways of tuning up the laws, regulations, and communications to make it easier and faster to obtain orders regarding EOL care to preserve the dignity of our patients and loved ones. "A guardianship is a legal relationship created when a person or institution named in a will or assigned by the court to take care of minor children or incompetent adults."

  5. The evil of good is better: Making the case for basic life support transport for penetrating trauma victims in an urban environment.

    Rappold, Joseph F; Hollenbach, Kathryn A; Santora, Thomas A; Beadle, Dania; Dauer, Elizabeth D; Sjoholm, Lars O; Pathak, Abhijit; Goldberg, Amy J

    2015-09-01

    Controversy remains over the ideal way to transport penetrating trauma victims in an urban environment. Both advance life support (ALS) and basic life support (BLS) transports are used in most urban centers. A retrospective cohort study was conducted at an urban Level I trauma center. Victims of penetrating trauma transported by ALS, BLS, or police from January 1, 2008, to November 31, 2013, were identified. Patient survival by mode of transport and by level of care received was analyzed using logistic regression. During the study period, 1,490 penetrating trauma patients were transported by ALS (44.8%), BLS (15.6%), or police (39.6%) personnel. The majority of injuries were gunshot wounds (72.9% for ALS, 66.8% for BLS, 90% for police). Median transport minutes were significantly longer for ALS (16 minutes) than for BLS (14.5 minutes) transports (p = 0.012). After adjusting for transport time and Injury Severity Score (ISS), among victims with an ISS of 0 to 30, there was a 2.4-fold increased odds of death (95% confidence interval [CI], 1.3-4.4) if transported by ALS as compared with BLS. With an ISS of greater than 30, this relationship did not exist (odds ratio, 0.9; 95% CI, 0.3-2.7). When examined by type of care provided, patients with an ISS of 0 to 30 given ALS support were 3.7 times more likely to die than those who received BLS support (95% CI, 2.0-6.8). Among those with an ISS of greater than 30, no relationship was evident (odds ratio, 0.9; 95% CI, 0.3-2.7). Among penetrating trauma victims with an ISS of 30 or lower, an increased odds of death was identified for those treated and/or transported by ALS personnel. For those with an ISS of greater than 30, no survival advantage was identified with ALS transport or care. Results suggest that rapid transport may be more important than increased interventions. Therapeutic study, level IV.

  6. Life cycle and human health risk assessments as tools for decision making in the design and implementation of nanofiltration in drinking water treatment plants.

    Ribera, G; Clarens, F; Martínez-Lladó, X; Jubany, I; V Martí; Rovira, M

    2014-01-01

    A combined methodology using life cycle assessment (LCA) and human health risk assessment (HHR) is proposed in order to select the percentage of water in drinking water treatment plants (DWTP) that should be nanofiltered (NF). The methodological approach presented here takes into account environmental and social benefit criteria evaluating the implementation of new processes into conventional ones. The inclusion of NF process improves drinking water quality, reduces HHR but, in turn, increases environmental impacts as a result of energy and material demand. Results from this study lead to balance the increase of the impact in various environmental categories with the reduction in human health risk as a consequence of the respective drinking water production and consumption. From an environmental point of view, the inclusion of NF and recommended pretreatments to produce 43% of the final drinking water means that the environmental impact is nearly doubled in comparison with conventional plant in impact categories severely related with electricity production, like climate change. On the other hand, the carcinogenic risk (HHR) associated to trihalomethane formation potential (THMFP) decreases with the increase in NF percentage use. Results show a reduction of one order of magnitude for the carcinogenic risk index when 100% of drinking water is produced by NF. © 2013. Published by Elsevier B.V. All rights reserved.

  7. Health-related quality of life in women with breast cancer in Korea: do sociodemographic characteristics and time since diagnosis make a difference?

    Chae, Young Ran; Seo, Kumin

    2010-07-01

    To describe whether levels of health-related quality of life (HRQOL) differ by sociodemographic characteristics and time since breast cancer diagnosis in women in Korea. A descriptive, cross-sectional study of women with breast cancer. An outpatient clinic of one large hospital in Seoul, Republic of Korea. A convenience sample of 244 women with breast cancer after mastectomy. Study participants completed sociodemographic characteristics and HRQOL questionnaires. Medical charts were reviewed to determine time since breast cancer diagnosis. Sociodemographic characteristics (age, marital status, employment status, education, monthly household income, and religion), time since diagnosis, and HRQOL. The psychological well-being domain scored the lowest among domains of HRQOL. Women who are younger, married, unemployed, highly educated, or religious, with higher monthly household income or with greater than one year elapsed time since diagnosis, had higher HRQOL. Study findings will be useful to establish priorities in planning nursing interventions to enhance HRQOL in care of women with breast cancer. Nursing interventions can be provided to Korean women with breast cancer who are not religious, who are older, single or widowed, or employed, with lower education level, with lower monthly household income, or with one year or less elapsed time since breast cancer diagnosis.

  8. Decision Making

    Pier Luigi Baldi

    2006-06-01

    Full Text Available This article points out some conditions which significantly exert an influence upon decision and compares decision making and problem solving as interconnected processes. Some strategies of decision making are also examined.

  9. Making Real Life Connections and Engaging High School Students as They Become Climate Detectives using data obtained through JOIDES Resolution Expedition 341

    Chegwidden, D.; Mote, A. S.; Manley, J.; Ledley, T. S.; Haddad, N.; Ellins, K.; Lynds, S. E.

    2016-02-01

    Texas is a state that values and supports an Earth Science curriculum, and as an experienced educator in Texas, I find it crucial to educate my students about the various Ocean Science careers that exist and also be able to use the valuable data that is obtained in a core sample from the ocean floor. "Climate Detective" is an EarthLabs module that is supported by TERC and International Ocean Discovery Program (IODP) Expedition 341. This module contains hands-on activities, many opportunities to interpret actual data from a core sample, and collaborative team skills to solve a problem. Through the module, students are able to make real connections with scientists when they understand various roles aboard the JOIDES Resolution. Students can also visually experience real-time research via live video streaming within the research vessel. In my classroom, the use of the "Climate Detective" not only establishes a beneficial relationship between teacher and marine scientists, but such access to the data also helps enhance the climate-related concepts and explanatory procedures involved in obtaining reports. Data is applied to a challenge question for all student groups to answer at the end of the module. This Project-based learning module emphasizes different forms of evidence and requires that learners apply different inquiry approaches to build the knowledge each one needs to acquire, as they become climate-literate citizens. My involvement with the EarthLabs project has strengthened my overall knowledge and confidence to teach about Earth's systems and climate change. In addition, this experience has led me to become an advocate who promotes vigorous classroom discussion among my students; additionally, I am encouraged to collaborate with other educators through the delivery of professional development across the state of Texas. Regularly, I connect with scientists in my classroom and such connection truly enriches not only my personal knowledge, but also provides a

  10. "Christ offered salvation, and not an easy life": How do port chaplains make sense of providing welfare for seafarers? An idiographic, phenomenological approach analysis.

    Palmer, Tiffany; Murray, Esther

    2016-01-01

    The shipping industry has historically leaned towards a biomedical model of health when assessing, treating and caring for seafarers. In recent years there has been more concern for the mental health of seafarers in both the academic literature and the commercial world, however, the psychological and emotional well-being of seafarers still largely falls on the shoulders of the port chaplains. The aim of the study was to explore how port chaplains make sense of providing welfare for seafarers by taking an idiographic, phenomenological approach (IPA). Six male participants working as chaplains in United Kingdom ports took part in recorded face-to-face, semi-structured interviews covering three areas of questioning: role, identity and coping. Interviews were transcribed verbatim, and data analysed using interpretative phenomenological analysis. Three super-ordinate themes were identified from participants accounts; "We walk a very strange and middle path", "Exploited" and "Patching up". Rich data emerged in relation to the personal impact chaplains felt they made, which was facilitated by the historical role of the Church; this led to the second super-ordinate theme of how chaplains felt towards seafarers. Lastly, the analysis demonstrates how chaplains adapt to the limitations forced upon them to provide welfare, and a degree of acceptance at the injustice. Results were discussed in reference to theoretical models, including self-efficacy, empathic responding and the transactional model of stress and coping. Chaplains in ports perform their role autonomously with no input from healthcare professionals. Recommendations are made for a biopsychosocial model of health involving primary care, benefiting the health and well-being of seafarers and providing support and guidance for port chaplains at the frontline of welfare for seafarers.

  11. Model : making

    Bottle, Neil

    2013-01-01

    The Model : making exhibition was curated by Brian Kennedy in collaboration with Allies & Morrison in September 2013. For the London Design Festival, the Model : making exhibition looked at the increased use of new technologies by both craft-makers and architectural model makers. In both practices traditional ways of making by hand are increasingly being combined with the latest technologies of digital imaging, laser cutting, CNC machining and 3D printing. This exhibition focussed on ...

  12. Hospice decision making: diagnosis makes a difference.

    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.

  13. LCA-ship. Design tool for energy efficient ships. A Life Cycle Analysis Program for Ships. Final report

    Jiven, Karl; Sjoebris, Anders [MariTerm AB, Goeteborg (Sweden); Nilsson, Maria [Lund Univ. (Sweden). Stiftelsen TEM; Ellis, Joanne; Traegaardh, Peter; Nordstroem, Malin [SSPA Sweden AB, Goeteborg (Sweden)

    2004-05-01

    In order to make it easier to include aspects during ship design that will improve environmental performance, general methods for life cycle calculations and a prototype tool for LCA calculations of ships and marine transportation have been developed. The base of the life cycle analyses is a comprehensive set of life cycle data that was collected for the materials and consumables used in ship construction and vessel operations. The computer tool developed makes it possible to quickly and simply specify (and calculate) the use of consumables over the vessel's life time cycle. Special effort has been made to allow the tool to be used for different types of vessels and sea transport. The main result from the project is the computer tool LCA ship, which incorporates collected and developed life cycle data for some of the most important materials and consumables used in ships and their operation. The computer application also contains a module for propulsion power calculations and a module for defining and optimising the energy system onboard the vessel. The tool itself is described in more detail in the Computer application manual. The input to the application should, as much as possible, be the kind of information that is normally found in a shipping company concerning vessel data and vessel movements. It all starts with defining the ship to be analysed and continues with defining how the ship is used over the lifetime. The tool contains compiled and processed background information about specific materials and processes (LCA data) connected to shipping operations. The LCA data is included in the tool in a processed form. LCA data for steel will for example include the environmental load from the steel production, the process to build the steel structure of the ship, the scrapping and the recycling phase. To be able to calculate the environmental load from the use of steel the total amount of steel used over the life cycle of the ship is also needed. The

  14. Maintaining families’ well-being in everyday life

    Kristina Ziegert

    2011-05-01

    Full Text Available The aim of this paper is to discuss how everyday life changes for the family in the event of chronic illness or disability. It changes physically due to loss of body function and socially due to time and other constraints related to treatment or lack of mobility. Equally important, there is a psychological impact due to the uncertainty of the future. The article will explore how family participation can help to maintain well-being in everyday life. The family should therefore focus on their own needs as much as on the needs of the family members who are ill. In order to maintain well-being in everyday life, it is crucial for the family to create routines and spend time doing things that they enjoy. By doing this, the family will create a rhythm of well-being regardless of the critical family situation. Family members and professional caregivers also need to come together at the beginning and during the illness or disability event to discuss changes that could be made day-to-day for all those involved, thereby making for an easier transition into care giving.

  15. Steel making

    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...

  16. Making Daily Mobility

    Jensen, Ole B.; Wind, Simon

    elucidate aspects of urban everyday mobility that can be utilized in policy and planning perspectives. This knowledge can aid construction of generalized qualitative scenarios that together with quantitative transport models can serve as wider knowledge foundation in decision making process.......In 2012 the average daily transportation distance for every Dane were 40 km (TU Data). Realising how much of life is spend thinking about, planning and performing mobility practices it becomes evident that it is much more than an instrumental physical phenomenon – it has great repercussions on life......, social networks, understanding of places and ultimately ourselves and others. To successfully accomplish everyday life, households have to cope with large number of different activities and mobility in relation to their children, work, social life, obligations, expectations, needs and wishes. Drawing...

  17. Can law make life too simple?

    Sommer, Tine

    At the heart of this doctoral thesis are the challenges to modern patent law, particularly from the rapid developments in biotechnology. This book focuses on human gene patents, patents in the animal world, and the pressures put on the patent system by the climate change debate. However, the title...

  18. Make Sense?

    Gyrd-Jones, Richard; Törmälä, Minna

    Purpose: An important part of how we sense a brand is how we make sense of a brand. Sense-making is naturally strongly connected to how we cognize about the brand. But sense-making is concerned with multiple forms of knowledge that arise from our interpretation of the brand-related stimuli......: Declarative, episodic, procedural and sensory. Knowledge is given meaning through mental association (Keller, 1993) and / or symbolic interaction (Blumer, 1969). These meanings are centrally related to individuals’ sense of identity or “identity needs” (Wallpach & Woodside, 2009). The way individuals make...... sense of brands is related to who people think they are in their context and this shapes what they enact and how they interpret the brand (Currie & Brown, 2003; Weick, Sutcliffe, & Obstfeld, 2005; Weick, 1993). Our subject of interest in this paper is how stakeholders interpret and ascribe meaning...

  19. Making Healthy Decisions About Sex

    ... For Teens: How to Make Healthy Decisions About Sex Page Content Article Body Before you decide to ... alcohol or use drugs. Are You Ready for Sex? Sex can change your life and relationships. Having ...

  20. End of Life Issues

    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: ...

  1. Young Idea People Mix with Old Idea People to Make the World Better

    Hall, M.

    2017-12-01

    Groups of young idea people come to eat, drink, and talk about new ideas that old idea people are working on to change the world for the better. The ideas may fix our body and mind, make our lives easier or harder, and more. The young idea people lead, learn, listen and act, so they can become old idea people. The young idea people scare the old idea people because their ideas are different. And, sometimes, the young idea people have new ideas that the old idea people have not thought about. When this happens it makes the old idea people happy and better at their work. The old idea people get to go places and share their ideas around the world. They make good money and have fun lives. They write about their work and can be well known, or not. The young idea people learn from the old idea people how they can be like them. Together the young and old idea people build things and talk about crazy ideas that may come to be. Sometimes the old idea people talk too much and don't listen. They use big words that can be hard to understand. But, the young idea people help them learn to use known words so everyone learns. We know the young idea people learn and grow from this act and they grow happier about their life. We also know that the old idea people get happy that the young idea people are so bright.

  2. Information Technology for Agriculture: Using it tools to aid decision-making process in small properties

    Caroline de Oliveira Ferraz

    2017-07-01

    Full Text Available With the current scenario of agricultural competitiveness, the use of Information and Communication Technology (ICT tools has become increasingly common in the rural community, making life easier for farmers. The information obtained through Agroinformatics (Information Technology applied to agribusiness, serves as a basis for both decision-making, planning, and application of the best techniques and production processes. In Brazil, companies such as EMPRAPA (The Brazilian Agricultural Research Corporation work in the research and development of new technological tools, which seek to boost the agricultural production of small rural producers, reducing their costs and improving their results. But for this, it is necessary that the producers understand the concept of the importance in carrying out information collection in a correct way, because the information will be processed according to what is inserted in the systems. In this sense, this article aims to demonstrate through an explanatory research of qualitative nature and bibliographical character the importance of the use of ICT to support decision-making in the Brazilian rural sector. Also highlighting the benefits originated by the use of ICT in all stages of agricultural production and its accounting management, through examples of tools.

  3. Decision making.

    Chambers, David W

    2011-01-01

    A decision is a commitment of resources under conditions of risk in expectation of the best future outcome. The smart decision is always the strategy with the best overall expected value-the best combination of facts and values. Some of the special circumstances involved in decision making are discussed, including decisions where there are multiple goals, those where more than one person is involved in making the decision, using trigger points, framing decisions correctly, commitments to lost causes, and expert decision makers. A complex example of deciding about removal of asymptomatic third molars, with and without an EBD search, is discussed.

  4. Clinical decision-making and health-related quality of life during first-line and maintenance therapy in patients with advanced non-small cell lung cancer (NSCLC): findings from a real-world setting.

    Sztankay, Monika; Giesinger, Johannes Maria; Zabernigg, August; Krempler, Elisabeth; Pall, Georg; Hilbe, Wolfgang; Burghuber, Otto; Hochmair, Maximilian; Rumpold, Gerhard; Doering, Stephan; Holzner, Bernhard

    2017-08-23

    Maintenance therapy (MT) with pemetrexed has been shown to improve overall and progression-free survival of patients with non-squamous non-small cell lung cancer (NSCLC), without impairing patients' health-related quality of life (HRQOL) substantially. Comprehensive data on HRQOL under real-life conditions are necessary to enable informed decision-making. This study aims to (1) assess HRQOL during first-line chemotherapy and subsequent MT and (2) record patients' and physicians' reasons leading to clinical decisions on MT. Patients treated for NSCLC at three Austrian medical centres were included. HRQOL was assessed at every chemotherapy cycle using the EORTC QLQ-C30/+LC13 questionnaire. Semi-structured interviews were conducted before MT initiation and at the time of discontinuation to evaluate patients' and physicians' reasons for treatment decisions. Longitudinal QOL analysis was based on linear mixed models. Sixty-one (73%) out of 84 patients were considered for MT. Thirty-six patients (43%) received MT and 29 (35%) discontinued therapy. Decisions on MT initiation (in 20 cases by the physician vs 4 by the patient) and discontinuation (19 vs 10) were mainly voiced by the physician. Treatment toxicity of first-line chemotherapy was the main reason for rejection of MT in patients with stable disease and was more often indicated by patients than clinicians. HRQOL data were collected from 83 patients at 422 assessment time points and indicated significantly lower symptom severity during MT compared with first-line therapy for nausea and vomiting (p = 0.006), sleep disturbances (p loss (p = 0.043), constipation (p = 0.017) and chest pain (p = 0.022), and a deterioration in emotional functioning (p = 0.023) and cognitive functioning (p = 0.044) during MT. Our results indicate that HRQOL and symptom burden improve between first-line treatment to MT in some respects, although some late toxicity persists. Discrepancies between patients' and physicians

  5. Making Connections

    Pien, Cheng Lu; Dongsheng, Zhao

    2011-01-01

    Effective teaching includes enabling learners to make connections within mathematics. It is easy to accord with this statement, but how often is it a reality in the mathematics classroom? This article describes an approach in "connecting equivalent" fractions and whole number operations. The authors illustrate how a teacher can combine a common…

  6. A new system for the X-ray examination of casualties: easier, faster examnination without changing the patient's position by means of the Vertix 3 D

    Eisenscher, A.; Jaquemord, P.; Jeandeau, M.; Schweg-Toffler, E.; Murrmann, J.

    1982-01-01

    Due to the adjustment problems with the traditional overhead support, repeatedly the conventional radiation systems applied until today in emergency departments resulted to be disadvantageous. Another disadvantage is that the patient's position has often to be changed in order to photograph the individual sections to be examined. With a stirrup system attached to the overhead support and a patient table board with a thin plate vertically adjustable, these disadvantages can be eliminated. Since the system works with a fixed raster cassette with a high camera shaft ratio, a lighter constructional design and an easier operation without an impairment of image quality are rendered possible. This study describes the applicability of a new unit especially designed for emergency diagnostics, which is supplemented with a previously programmed generator, a table board with vertical adjustment and an exchangeable mobile sliding mattress. (orig.) [de

  7. EASIER ACCESS TO STANDARDS DOCUMENTATION

    2001-01-01

    Many organizations issuing standards offer reduced prices for publications to their members. Paying a membership fee, even a site membership fee, can therefore be worthwhile - even if relatively few standards are needed. The Library is now exploring the possibility, in collaboration with the rest of the CERN community, of joining standards-issuing organizations. So why not share your costs with the rest of the organization wherever this can be done without violating copyright or access regulations? The Library now provides documentation and other member services from IPC, the Association Connecting Electronics Industries (http://www.ipc.org/html/fsabout.htm) at favourable prices for the entire CERN population. For more information, or if you are a member of any other organization which provides services which could be shared CERN-wide, please contact library.desk@cern.ch . We remind all users of international standards, that CERN has special agreements with ISO and IEC (see Bulletin 50/2000). You can order st...

  8. Easier Analysis With Rocket Science

    2003-01-01

    Analyzing rocket engines is one of Marshall Space Flight Center's specialties. When Marshall engineers lacked a software program flexible enough to meet their needs for analyzing rocket engine fluid flow, they overcame the challenge by inventing the Generalized Fluid System Simulation Program (GFSSP), which was named the co-winner of the NASA Software of the Year award in 2001. This paper describes the GFSSP in a wide variety of applications

  9. SAADA: Astronomical Databases Made Easier

    Michel, L.; Nguyen, H. N.; Motch, C.

    2005-12-01

    Many astronomers wish to share datasets with their community but have not enough manpower to develop databases having the functionalities required for high-level scientific applications. The SAADA project aims at automatizing the creation and deployment process of such databases. A generic but scientifically relevant data model has been designed which allows one to build databases by providing only a limited number of product mapping rules. Databases created by SAADA rely on a relational database supporting JDBC and covered by a Java layer including a lot of generated code. Such databases can simultaneously host spectra, images, source lists and plots. Data are grouped in user defined collections whose content can be seen as one unique set per data type even if their formats differ. Datasets can be correlated one with each other using qualified links. These links help, for example, to handle the nature of a cross-identification (e.g., a distance or a likelihood) or to describe their scientific content (e.g., by associating a spectrum to a catalog entry). The SAADA query engine is based on a language well suited to the data model which can handle constraints on linked data, in addition to classical astronomical queries. These constraints can be applied on the linked objects (number, class and attributes) and/or on the link qualifier values. Databases created by SAADA are accessed through a rich WEB interface or a Java API. We are currently developing an inter-operability module implanting VO protocols.

  10. It is easier with teledentistry

    Milosavljević Gordana Đ.

    2012-01-01

    Full Text Available Introduction. The imperative of global society is a change. The most effective way that modern man is 'in step' with daily changes is the application of information and communication technologies. Expansion and development of information and telecommunication technologies rapidly found their application in the health care system by improving medical practice itself. Medical informatics with its specific subbranch - dental informatics is engaged in the development, implementation and evaluation of information technologies in medicine and dentistry, ie. solving problems related to information and communication in health care. The Internet is the largest global network today and is increasingly used in medicine and dentistry. Using the Internet and other telecommunication methods allows us to easily keep pace with the continuous expansion of knowledge base. The entire information technology has been recognized as an integral part of the health care and an important element of good clinical practice, resulting in the emergence of telemedicine, teledentistry and telepharmacology. Telemedicine with the use of modern communication systems enables the transfer of medical data, which can provide medical services regardless of physical location of doctors and patients. Conclusion. Teledentistry is the combination of telecommunication and dentistry, it involves the exchange of clinical information and images over long distances for specialist dental consultation, diagnosis and treatment planning. Pillars of modern teledentistry are the application of the Internet and the rapid flow of data.

  11. Struggling to find meaning in life among spouses of people with ALS.

    Ozanne, Anneli O; Graneheim, Ulla H; Strang, Susann

    2015-08-01

    The aim of this study was to illuminate experiences of finding meaning in life among spouses of people with amyotrophic lateral sclerosis. Thirteen interviews were analyzed with qualitative content analysis. The spouses were struggling for meaning at the end of a dark tunnel. They felt limited and isolated in their proximity to death. They lived imprisoned lives, felt lonely, considered life to be unfair and incomplete, and mourned the loss of their future. However, they found meaning despite the proximity of death through cherishing their own lives, fellowship, accepting the present, and believing in meaning after the partner's death. Meaning in life strengthened spouses' well-being and ability to find pleasure in a difficult situation. It also strengthened their will to live after the partner's death. Limitations and isolations were strong predictors of what could impair their well-being and the possibility of finding meaning after the partner's death. Spouses need individual support throughout the disease process and after the partner's death, to give them the strength to find meaning in life and prioritize what is important for them. Paying attention to what might prevent them from finding meaning could make it easier to help them in their situation. Providing joint support to the patient and spouse might also help them to see each other's situation, come together, and help each other.

  12. Making Yugoslavs

    Nielsen, Christian Axboe

    . By the time Aleksandar was killed by an assassin’s bullet five years later, he not only had failed to create a unified Yugoslav nation but his dictatorship had also contributed to an increase in interethnic tensions.   In Making Yugoslavs, Christian Axboe Nielsen uses extensive archival research to explain...... the failure of the dictatorship’s program of forced nationalization. Focusing on how ordinary Yugoslavs responded to Aleksandar’s nationalization project, the book illuminates an often-ignored era of Yugoslav history whose lessons remain relevant not just for the study of Balkan history but for many...

  13. THE MAKING OF DECISION MAKING

    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.

  14. Dos procesos de fin de vida: Cuando la intervención de los profesionales marca la diferencia Two end-of-life processes: When professional intervention makes all the difference

    J. Schmidt

    2008-12-01

    Full Text Available Introducción. Desde el punto de vista de la medicina curativa actual la muerte es una consecuencia indeseable, que no debe contemplarse como una posibilidad. El desarrollo de la medicina paliativa está cambiando estas mentalidades, aunque persisten aún muchos problemas organizativos. Metodología. En este artículo presentamos dos procesos de fin de vida: en una unidad de cuidados paliativos y en unidades hospitalarias convencionales. Los datos se recogieron a través de familiares trascurrido un mes desde su fallecimiento. Los datos se analizaron cualitativamente mediante análisis narrativo. Resultados. El conocimiento u omisión del diagnóstico y del pronóstico marca la diferencia entre los dos procesos y el posterior duelo de la familia. Discusión. El conocimiento de la cercanía de la propia muerte permite al paciente y a la familia elaborar estrategias de duelo anticipado y contribuye a afianzar la sensación de “auto-control”. El desconocimiento de dicho diagnóstico se traduce en un esfuerzo infructuoso por la alternativa curativa. Los cuidados paliativos han demostrado que cuando las necesidades físicas y emocionales de los procesos de fin de vida son tenidas en cuenta disminuye la frustración en el paciente y la familia.Introduction. From the point of view of modern curative medicine, death is an undesirable consequence which should not be considered as a possibility. Although the development of palliative medicine is changing those attitudes, many organisational problems still persist. Methodology. In this article we present two end-of-life processes: one in a palliative care unit and one in conventional hospital units. Data were collected from family members a month after the patients' deaths. Data were qualitatively analysed using narrative analysis. Results. The knowledge or omission of diagnostic and prognostic makes all the difference in both processes and in the subsequent families' grief. Discussion. Being aware of

  15. Actions speak louder: a look at congressional votes on human life issues.

    Shannon, D; Mazpule, D

    1991-01-01

    The decision to bring a new life into the world is the most important decision a caring person can make. Many fundamental factors must be considered like: housing, income, food, clothing, etc. The terms pro-choice and pro-life are used to describe both sides of the abortion debate, a debate that is of critical importance when making that decision about new life. While most members of Congress who are pro-choice also support social programs that make raising children easier; most members who are pro-life do not support such social justice programs. It seems paradoxical that someone claiming to be pro-life would then be anti-social justice. To be truly pro-life, a person must not only support a woman's right to choose, but must also support programs and policies that help parents to raise healthy, happy, and productive children. Yet it is the very people who claim to be pro-life that fight equally as hard against choice and against social justice. They fight legal abortion, but they also fight legislation that would make abortion less necessary. This article includes charts of the voting records of all members of the 101st Congress on legislation supported by 7 pro-choice or pro-child organizations. Planned Parenthood Federation of America (PPFA), the Children's Defense Fund (CDF), the Leadership Conference on Civil Rights (LCCR), the National Women's Political Caucus (NWPC), the American Public Health Association (APHA) and the League of Conservation Voters (LCV). The CDF, LCCR, and LCV do not have positions on abortion rights. The voting record of the JustLife Educational Fund are also given. In comparing the voting records, those that supported PPFA at least 75% of the time were labeled pro-choice, those that supported PPFA less than 25% of the time were called anti-choice, and those that supported it 26-74% of the time were called mixed. Once this determination is made, a comparison of their voting records for the other organizations clearly confirm that those

  16. Qualidade de vida e medidas de utilidade: parâmetros clínicos para as tomadas de decisão em saúde Quality of life and utility measures: clinical parameters for decision-making in health

    Alessandro Gonçalves Campolina

    2006-02-01

    Full Text Available In recent decades, the international scientific community has become increasingly interested in the concept of quality of life. One of the most important implications of the focus on quality of life is a shift from "cure" to "a guarantee of a better life" as a health care goal, as well as the inclusion of individuals' preferences for certain health states in the decision-making process associated with treatments, diagnostic strategies, and health spending. This is especially important as the prevalence of chronic diseases increases as a result of the aging of the population. This piece describes the main concepts and applications related to this new health paradigm, including quality of life itself, utility measures, quality-adjusted life years (QALYs, and health decision analysis.

  17. An analysis from the Quality Outcomes Database, Part 1. Disability, quality of life, and pain outcomes following lumbar spine surgery: predicting likely individual patient outcomes for shared decision-making.

    McGirt, Matthew J; Bydon, Mohamad; Archer, Kristin R; Devin, Clinton J; Chotai, Silky; Parker, Scott L; Nian, Hui; Harrell, Frank E; Speroff, Theodore; Dittus, Robert S; Philips, Sharon E; Shaffrey, Christopher I; Foley, Kevin T; Asher, Anthony L

    2017-10-01

    OBJECTIVE Quality and outcomes registry platforms lie at the center of many emerging evidence-driven reform models. Specifically, clinical registry data are progressively informing health care decision-making. In this analysis, the authors used data from a national prospective outcomes registry (the Quality Outcomes Database) to develop a predictive model for 12-month postoperative pain, disability, and quality of life (QOL) in patients undergoing elective lumbar spine surgery. METHODS Included in this analysis were 7618 patients who had completed 12 months of follow-up. The authors prospectively assessed baseline and 12-month patient-reported outcomes (PROs) via telephone interviews. The PROs assessed were those ascertained using the Oswestry Disability Index (ODI), EQ-5D, and numeric rating scale (NRS) for back pain (BP) and leg pain (LP). Variables analyzed for the predictive model included age, gender, body mass index, race, education level, history of prior surgery, smoking status, comorbid conditions, American Society of Anesthesiologists (ASA) score, symptom duration, indication for surgery, number of levels surgically treated, history of fusion surgery, surgical approach, receipt of workers' compensation, liability insurance, insurance status, and ambulatory ability. To create a predictive model, each 12-month PRO was treated as an ordinal dependent variable and a separate proportional-odds ordinal logistic regression model was fitted for each PRO. RESULTS There was a significant improvement in all PROs (p disability, QOL, and pain outcomes following lumbar spine surgery were employment status, baseline NRS-BP scores, psychological distress, baseline ODI scores, level of education, workers' compensation status, symptom duration, race, baseline NRS-LP scores, ASA score, age, predominant symptom, smoking status, and insurance status. The prediction discrimination of the 4 separate novel predictive models was good, with a c-index of 0.69 for ODI, 0.69 for EQ-5

  18. Making Microbiology Even Smaller!

    Young, Linda Mull; Motz, Vicki Abrams

    2013-01-01

    We outline protocols for producing slant-minis (SLINIs) and mini-deeps (MEEPs) and examples of their use in simple microbiology experiments suitable for high school students. The principal benefits of these protocols are decreased cost associated with significantly reduced media use; easier, less expensive disposal of waste; and increased safety…

  19. Making weapons, talking peace

    York, H.F.

    1987-01-01

    The memoirs of the author traces his life from his first-year graduate studies in physics at the University of Rochester in 1942 to his present position as Director of the University of California's Institute on Global Conflict and Cooperation. The part of his life involved in making weapons extends from 1942 to 1961. During this period, he worked with E.O. Lawrence on the Manhattan Project and served as director of Livermore after it became the Atomic Energy Commission's second nuclear weapons laboratory. He also served on many government advisory boards and commissions dealing with nuclear and other weapons. In 1961, the combination of a heart attack and changes in administration in Washington led York too return to the University of California for the talking peace portion of his life. He has since become a public exponent of arms control and disarmament and the futility of seeking increased security through more and better nuclear weapons. York's explanation of his move from making weapons to talking peace leaves the reader with a puzzle

  20. Quality of life technologies

    Wac, Katarzyna; Fiordelli, M.; Gustarini, M.

    2015-01-01

    Inevitably, as basic human needs are assured in any developed society, differentiating factors for quality of life (QoL) relate to a greater capacity to make informed decisions across daily life activities, especially those related to health. The availability of powerful, personalized, and wearable...

  1. The Effect of Decision-Making Skill Training Programs on Self-Esteem and Decision-Making Styles

    Colakkadioglu, Oguzhan; Celik, D. Billur

    2016-01-01

    Problem Statement: Decision making is a critical cognitive process in every area of human life. In this process, the individuals play an active role and obtain outputs with their functional use of decision-making skills. Therefore, the decision-making process can affect the course of life, life satisfaction, and the social relations of an…

  2. Making marketing difficult

    Meyer, Gitte

    2005-01-01

    embraced by the market-place, while maintaining the old scientific alienation from political life. The case is made that modern science was born ambiguous towards the market-place, and that such ambivalence - relating to different interpretations of the idea of knowledge as a common good - is still...... to be encountered among scientists. Drawing on series of interviews with scientists from bioscience and biotechnology it is argued that, on the one hand, scientists are into marketing and PR exercises; but, on the other hand, they also voice a demand that journalists should make such marketing difficult...

  3. Decision making in extreme situations involving children : withholding or withdrawal of life supporting treatment in paediatric care. Statement of the ethics working group of the Confederation of the European Specialists of Paediatrics (CESP)

    Kurz, R

    Paediatricians increasingly find themselves in situations in which decisions must be made regarding withholding or withdrawing life-supporting treatment in the care of a paediatric patient. There comes a point when the artificial prolongation of life only contributes to extending the act of dying

  4. LIFE SKILLS OF YOUNG PEOPLE WITH DISABILITIES AND YOUTH WITHOUT DISABILITIES

    Izeta Husić-Đuzić

    2017-09-01

    Full Text Available The aim of this paper is to determine the differences in life skills of young people with and without disability in chronological age from 18-35 year-old in Tuzla Canton. The respondents sample consists of two sub-samples. First sub-sample contains 50 young people with disability, chronological age from 18-35 of both genders. Second sub-sample contained 50 young people without disability, chronological age from 18- 35 of both genders. Research data were analysed using method of parametric and non-parametric statistics. Frequencies, percentages and measures of central tendency have been calculated (arithmetic mean and standard deviation. P-values have been used for examining the difference between variables and variance analysis has been used for examining the importance of differences. The results show that there is a significant statistical difference between young people with and without disabilities in the of life skills assessed: job retention skills, skills to cope in danger. Based on the results obtained, it is recommended to start the program and training in early age which will make life easier to disabled persons and their families.

  5. Architecture is Life... ...Life is Architecture

    Snider, David E

    2001-01-01

    When thinking about architecture, I cannot help but think about my life and the things that have affected my life. How does the environment around us effect the daily decisions we make? How do the experiences throughout our life impact who we are and who we become? The people and surroundings we choose will ultimately decide the type of people we become. When we select our surroundings we are in turn selecting our ideal community. Everyone is trying to achieve community in some sense, from in...

  6. Decision making in neonatologia.

    Paterlini, G; Tagliabue, P

    2010-06-01

    The field of neonatology presents a fascinating context in which hugely important decisions have to be made on the basis of physicians' assessments of the long term consequences of various possible choices. In many cases such assessments cannot be derived from a consensual professional opinion; the situation is characterized by a high level of uncertainty. A sample of neonatologists in different countries received a questionnaire including vignette cases for which no clear consensus exists regarding the (probabilistic) prognosis. They were asked to (I) assess the probability of various outcomes (death, severe impairment) and (II) choose a treatment to be offered to the parents. Information on the physicians' professional and socio-demographic characteristics and their ethical "values" was also collected. The goal of this international survey is to understand the prognosis and to analyze decision making by professionals in the context of life and death in medicine. The availability of an identical technology in different social and institutional contexts should help identifying the convergences and differences under consideration. Seventy percent of those invited responded to the questionnaire (International 60-80%). Italian neonatologists seem to be quite pessimistic about the prognosis of infants at high risk of death or long term disabilities, they show a pro-life attitude, but in a certain proportion are willing to change their minds if requested by parents. Furthermore personal opinions predominate in the decision-making process and the contribution of team meeting and/or ethic consultation seem not significantly modify the decisions.

  7. Coordinated powertrain control for automatic transmission systems - a contribution to making driving easier and reducing environmental pollution; Koordinierte Antriebsstrangsteuerung fuer automatische Getriebe - ein Beitrag zur Entlastung von Fahrer und Umwelt

    Huelser, H.; Loeffler, J. [Robert Bosch GmbH, Stuttgart (Germany); Mies, M. [Adam Opel AG, Ruesselsheim (Germany)

    1999-07-01

    The contribution presents a coordinated powertrain control system for vehicles with automatic transmission. The control system is universally applicable with different types of engines and transmission systems. It works by selecting gears and engine torque according to the position of the driving pedal and thus optimizes fuel consumption, vehicle dynamics and emissions. The powertrain control system is integrated in the CARTRONIC system architecture which ensures simple, coordinated handling of all control systems of the vehicle. Together with a board network management system, it can be integrated into an overall system for optimisation of mechanical and electrical energy use in the vehicle. [German] Der Beitrag stellt eine Koordinierte Antriebsstrangsteuerung fuer Fahrzeuge mit automatischen Getrieben vor, die einen Verbrennungsmotor mit elektronischer Motorleistungssteuerung, eine automatisierte mechanische Kupplung bzw. eine Wandlerueberbrueckungskupplung, sowie das Getriebe steuert. Diese Steuerung ist fuer unterschiedliche Typen von Motoren und Getrieben universell einsetzbar. Die Antriebsstrangsteuerung interpretiert die Fahrpedalstellung als Fahrerwunsch nach einer Vortriebsleistung und setzt diese durch geeignete Auswahl von Gang und Motordrehmoment um. Durch eine Adaption der Gangauswahl an den Fahrertyp, die Fahrsituation und Umgebungsbedingungen wird ein optimaler Fahrzeugbetrieb hinsichtlich Kraftstoffverbrauch, dynamischem Fahrverhalten und Emissionen erreicht. Die Koordinierte Antriebsstrangsteuerung ist integriert in die CARTRONIC-Systemarchitektur, die den fahrzeugweiten Verbund der Steuerungs- und Regelungssysteme einfach handhabbar macht. So kann sie gemeinsam mit einem Bordnetz-Management in ein fahrzeugweites System zur Gesamt-Optimierung von mechanischer und elektrischer Energie integriert werden. (orig.)

  8. Towards the bibliography of life

    David King

    2011-11-01

    Full Text Available This paper discusses how we intend to take forward the vision of a Bibliography of Life in the ViBRANT project. The underlying principle of the Bibliography is to provide taxonomists and others with a freely accessible bibliography covering the whole of life. Such a bibliography has been achieved for specific study areas within taxonomy, but not for “life” as a whole.The creation of such a comprehensive tool has been hindered by various social and technical issues. The social concerns focus on the willingness of users to contribute to the Bibliography. The technical concerns relate to the architecture required to deliver the Bibliography. These issues are discussed in the paper and approaches to addressing them within the ViBRANT project are described, to demonstrate how we can now seriously consider building a Bibliography of Life. We are particularly interested in the potential of the resulting tool to improve the quality of bibliographic references. Through analysing the large number of references in the Bibliography we will be able to add metadata by resolving known issues such as geographical name variations. This should result in a tool that will assist taxonomists in two ways. Firstly, it will be easier for them to discover relevant literature, especially pre-digital literature; and secondly, it will be easier for them to identify the canonical form for a citation.The paper also covers related issues relevant to building the tool in ViBRANT, including implementation and copyright, with suggestions as to how we could address them.

  9. SIMPLE LIFE AND RELIGION

    Ahmet YILDIRIM

    2014-07-01

    Full Text Available Individuals in terms of the economy in which we live is one of the most important phenomenon of the century. This phenomenon present itself as the only determinant of people's lives by entering almost makes itself felt. The mo st obvious objective needs of the economy by triggering motive is to induce people to consume . Consumer culture pervades all aspects of the situation are people . Therefore, these people have the blessing of culture , beauty and value all in the name of w hatever is consumed. This is way out of the siege of moral and religious values we have is to go back again . Referred by local cultural and religious values, based on today increasingly come to the fore and the Muslim way of life appears to be close to th e plain / lean preferred by many people life has been a way of life. Even the simple life , a way of life in the Western world , a conception of life , a philosophy, a movement as it has become widely accepted. Here in determining the Muslim way of life Pr ophet. Prophet (sa lived the kind of life a very important model, sample, and determining which direction is known. Religious values, which is the carrier of the prophets, sent to the society they have always been examples and models. Because every aspect of human life, his life style and the surrounding area has a feature. We also value his life that he has unknowingly and without learning and skills and to understand it is not possible to live our religion . We also our presentation, we mainly of Islam o utlook on life and predicted life - style, including the Prophet of Islam 's (sa simple life to scrutinize and lifestyle issues related to reveal , in short Islam's how life has embraced and the Prophet. Prophet's will try to find answers to questions reg arding how to live.

  10. Making Everyday Mobility

    Wind, Simon

    2013; Urry 2007) and family theory (Holdsworth 2013; Morgan 2011), it is argued that family mobility is far from only an instrumental phenomenon, displacing family members back and forth between activities and doings, but also a type of family practice (Morgan, 2011) carrying social and emotional...... coping process in the family, it is argued that making and performing mobility practices is to be understood as creating elasticity. Following this, it is elasticity that enables family members to stretch to accommodate the family’s practical, social and emotional conditions as well as adapt......Based upon a qualitative PhD study of 11 families everyday mobility, this paper inquiries into the everyday mobility of families with children in the Greater Copenhagen Area and the role mobility plays in contributing to coping in the families’ everyday life. Drawing on Mobilities theory (Jensen...

  11. Making it work

    Winther, Jonas

    Within the field of health research, the randomised controlled trial (RCT) is often highlighted as the best method for producing statistically valid evidence about the effects of health interventions. To produce evidence that is also socially relevant, health researchers increasingly perform trials...... outside the laboratory in people’s everyday lives. This creates a situation, in which scientific ideals of methodological rigour must be made to work with trial participants and their ongoing everyday lives. Jonas Winther’s dissertation, Making it Work, explores how this ambition is pursued in practice....... The dissertation builds on Winther’s engagement as an ethnologist in an interdisciplinary research project in Denmark, which was structured around an intervention trial that tested the health effects of exercise in everyday life. Through ethnographic fieldwork among the participants and the researchers...

  12. Making Sense for Society

    van der Heide, J. J.; Grus, M. M.; Nouwens, J. C. A. J.

    2017-09-01

    The Netherlands is a densely populated country. Cities in the metropolitan area (Randstad) will be growing at a fast pace in the coming decades1. Cities like Amsterdam and Rotterdam are being overrun by tourists. Climate change effects are noticed in cities (heavy rains for instance). Call for circular economy rises. Traffic increases. People are more self-reliant. Public space is shared by many functions. These challenges call for smart answers, more specific and directly than ever before. Sensor data is a cornerstone of these answers. In this paper we'll discuss the approaches of Dutch initiatives using sensor data as the new language to live a happy life in our cities. Those initiatives have been bundled in a knowledge platform called "Making sense for society" 1 https://www.cbs.nl/nl-nl/nieuws/2016/37/pbl-cbs-prognose-groei-steden-zet-door (in dutch)

  13. Making sustainability work

    Binswanger, Hans Christoph

    1998-01-01

    Today's economic theory usually neglects the role of nature and environment. To make sustainability work it is, however, essential to (re-)integrate nature into the standard concepts of economics, especially by incorporating natural factors into the production function. It must be acknowledged that economic growth is not (only) the result of technical change but is mainly caused by rising energy-inputs into the economy, and that this is necessarily followed by resource exhaustion and pollution. Therefore, nature must not only be taken into account as a central factor of production but also in the form of environmental quality which is the basis for human quality of life. A numeric example shows that a small, but steady decrease of yearly resource consumption is already apt to redirect the economy on a path of sustainable development

  14. How informed is declared altruism in clinical trials? A qualitative interview study of patient decision-making about the QUEST trials (Quality of Life after Mastectomy and Breast Reconstruction)

    Bidad, Natalie; MacDonald, Lindsay; Winters, Zoë E; Edwards, Sarah J L; Emson, Marie; Griffin, Clare L.; Bliss, Judith; Horne, Rob

    2016-01-01

    Background: Randomised controlled trials (RCTs) often fail to recruit sufficient participants, despite altruism being cited as their motivation. Previous investigations of factors influencing participation decisions have been methodologically limited. This study evaluated how women weigh up different motivations after initially expressing altruism, and explored their understanding of a trial and its alternatives. The trial was the 'Quality of Life after Mastectomy and Breast Reconstruction' (...

  15. Toward an Expanded Definition of Adaptive Decision Making.

    Phillips, Susan D.

    1997-01-01

    Uses the lifespan, life-space model to examine the definition of adaptive decision making. Reviews the existing definition of adaptive decision making as "rational" decision making and offers alternate perspectives on decision making with an emphasis on the implications of using the model. Makes suggestions for future theory, research,…

  16. Effects of Aqua Exercises Towards Improving The Quality of Life (QoL) of Obese Women in Malaysia

    Karim, Noor Liyana Binti; Jalil, Asma Diyana binti Abd; Hasri, Noor Haninah Binti; Rahman, Hezlin Aryani Binti Abd; Shari, Maisarah Binti; Idris, Nur Izzati Binti

    2018-05-01

    Aqua exercise is a form of water exercise, done in the water which is beneficial for weight loss as well as improving the quality of life. It is suitable for all age group and fitness levels whereby due to the water buoyancy makes it easier to perform exercises especially for obese and knee-injured people. However, there was not much study done to measure the effectiveness of the aqua exercises in improving the quality life. Thus, this study aims to investigate and compare the effectiveness of aqua exercises towards obese women within eight domains of the Quality of Life (QoL). This study uses the 36-Items Short Form Health Survey (SF-36) questionnaire and a purposive sample of 61 participants to measure the effectiveness of the aqua exercise before and after 36 days of aqua workout. As the nature of the data collected was not normally distributed, hence the Wilcoxon signed rank test was used as the statistical method of analysis. The findings of this study showed that there was a significant difference between the overall QoL pre and post since the p-value physical functioning, general health, social functioning, mental health, and health transition were the domains showing significant difference between the pre and post-test (p-value < 0.05), and where majority of the participants showed a significant improvement after the aqua workouts. Thus, it can be concluded that aqua exercises is effective in improving the general QoL of obese women.

  17. Conducting everyday life

    Juhl, Pernille

    , they are involved in preventive interventions. I conducted participatory observations with the children in their everyday life. Overall, the study stresses that even small children must be perceived as active participants who act upon and struggle with different conditions and meaning making processes across......In the paper I discuss how small children (0-4 year) develop through ‘conducting everyday life’ across contexts (Holzkamp 2013). I discuss how this process of conducting everyday life is essential when discussing the ‘good life for children’ from a child perspective. These issues are addressed...... contexts (home, day care, part-time foster family) and in relation to other co-participants....

  18. BWR internals life assurance

    Herrera, M.L.; Stancavage, P.P.

    1988-01-01

    Boiling water reactor (BWR) internal components play an important role in power plant life extension. Many important internals were not designed for easy removal and changes in material properties and local environmental effects due to high radiation makes stress corrosion cracking more likely and more difficult to correct. Over the past several years, operating experience has shown that inspection, monitoring and refurbishment can be accomplished for internal structures with existing technology. In addition, mitigation techniques which address the causes of degradation are available to assure that life extension targets can be met. This paper describes the many considerations and aspects when evaluating life extension for reactor vessel internals

  19. Make or Buy: An Analysis of the Impacts of 3D Printing Operations, 3D Laser Scanning Technology, and Collaborative Product Life-Cycle Management on Ship Maintenance and Modernization Cost Savings

    2015-04-30

    ååì~ä=^Åèìáëáíáçå= oÉëÉ~êÅÜ=póãéçëáìã= tÉÇåÉëÇ~ó=pÉëëáçåë= sçäìãÉ=f= = Make or Buy: An Analysis of the Impacts of 3D Printing Operations, 3D Laser...COVERED 00-00-2015 to 00-00-2015 4. TITLE AND SUBTITLE Make or Buy: An Analysis of the Impacts of 3D Printing Operations, 3D Laser Scanning...Åèìáëáíáçå=oÉëÉ~êÅÜ=mêçÖê~ãW= `êÉ~íáåÖ=póåÉêÖó=Ñçê=fåÑçêãÉÇ=`Ü~åÖÉ= - 182 - Make or Buy: An Analysis of the Impacts of 3D Printing Operations, 3D Laser

  20. Culture as meaning-making

    Lenkauskienė, Rūta; Liubinienė, Vilmantė

    2002-01-01

    The present paper analyses the role of social and cultural background knowledge in the cognition of meaning. Language and culture integrated studies have long been in the focus of attention. In order to study the language of a target culture, one should understand how human beings construct meanings, understand processes of meaning-making, account for different meanings, and examine their effects in social life. The language cannot be interpreted in the right way without taking the target cul...

  1. Promoting Shared Decision Making through Descriptive Inquiry

    Seher, Rachel; Traugh, Cecelia; Cheng, Alan

    2018-01-01

    This article shows how City-As-School, a progressive public school in New York City, used descriptive inquiry to deepen shared decision making, which is a central value of the school and part of a democratic way of life. Descriptive inquiry is a democratic knowledge-making process that was developed at the Prospect School in North Bennington,…

  2. Life histories in occupational therapy clinical practice.

    Frank, G

    1996-04-01

    This article defines and compares several narrative methods used to describe and interpret patients' lives. The biographical methods presented are case histories, life-charts, life histories, life stories, assisted autobiography, hermeneutic case reconstruction, therapeutic employment, volitional narratives, and occupational storytelling and story making. Emphasis is placed the clinician as a collaborator and interpreter of the patient's life through ongoing interactions and dialogue.

  3. Learning for Life

    Robotham, Dan

    2011-01-01

    People working in the field of education know well the positive effects adult and community learning can have on mental health and wellbeing. Participating in adult and community learning can help to widen social networks and improve life and employment chances; it makes for better general health; and can strengthen the learner's self-confidence,…

  4. STRATEGIC MARKETING PLANNING IN SPORTS – A PERSPECTIVE OF QUALITY OF LIFE IMPROVEMENT

    Caescu Stefan Claudiu

    2012-12-01

    Full Text Available Strategic marketing planning requires that the marketing objectives strategies for a specific product-market configuration be in full correlation with the directions and the resources allocated at the corporate level or at the strategic business unit one. Such a correlation is more than necessary under the current market conditions, when the economic crisis affects both consumer behavior and corporate decisions. This article focuses on the particularities of strategic marketing planning in sport, given the fact that the vast majority of sports organizations in Romania, although very active on the reference market, do not have a marketing activity correlated with the medium and long term market needs. One of these needs refers to quality of life improvement, knowing that sport activities have positive influence on many dimensions of quality of life, such as health, education, social inclusion, relaxation and leisure. The improvement within the population participation in sport (both as an active participant and as a spectator, the increased duration of leisure and the development of private financing have led to the creation of a large market, where marketing plays a central role. Therefore the marketing management process must also be implemented within the sports organization, in order to make it easier in building and maintaining a relationship with the customer, especially if the organization wants a customer orientation strategy. Such an orientation includes identifying the current needs as well as the future ones in terms of target audience, to offer a series of sports products and services that bring their significant contribution to improving the quality of life. In this paper are highlighted the influences that consumer requirements concerning quality of life have on all components of marketing management process, starting with sports organization mission statement, up to establish strategies for the marketing mix (product, price

  5. Building the Encyclopedia of Life

    Mangiafico, P. A.; Patterson, D. J.

    2010-04-01

    The Encyclopedia of Life (EOL) is a collaborative project that indexes information about species, and makes it freely accessible to anyone. In order to accomplish this, EOL is building collaborative tools and infrastructure to unify the information.

  6. The right to life

    Dr.Sc. Stavri Sinjari

    2013-06-01

    Full Text Available The right to life constitutes one of the main human rights and freedoms, foreseen by article 21 of the Albanian Constitution and article 2 of European Human Rights Convention. No democratic or totalitarian society can function without guarantees and protection of the human right to life We intend to address these issues on our article: What is life. What we legally understand with life. When the life starts and finish. How this right has evolved. Which is the state interest on protecting the life. Should we consider that the life is the same for all. Should the state interfere at any cost to protect the life. Is there any criminal charge for responsible persons to the violation of this right. Is this issue treated by European Human Rights Court. What are the Albanian legal provisions on protection of this right. This research is performed mainly according to a comparative and analytical methodology. Comperative analysis will be present almost throughout the paper. Treatment of issues of this research will be achieved through a system comparable with international standards in particular and the most advanced legislation in this area. At the same time, this research is conducted by analytical and statistical data processing. We believe that our research will make a modest contribution, not only to the legal literature, but also to criminal policy makers, law makers, lawyers and attorneys.

  7. Plant life management in Hungary

    Gillemot, F.

    1998-01-01

    The life management in Hungary is in an early stage. The preparation of a suitable database, development of maintenance systems and education of the plant and consultant staff is essential. The Act of Nuclear Safety, the introduction of the 10 years periodic safety review system (periodic licence extension) is a good basis for life management. At the same time the economic changes in the country make the life management difficult. Presently most important task is to prepare the technical environment and the methodology for NPP Life management, and within a few years, when the economy would be consolidated, a real life management will be performed

  8. How informed is declared altruism in clinical trials? A qualitative interview study of patient decision-making about the QUEST trials (Quality of Life after Mastectomy and Breast Reconstruction).

    Bidad, Natalie; MacDonald, Lindsay; Winters, Zoë E; Edwards, Sarah J L; Emson, Marie; Griffin, Clare L; Bliss, Judith; Horne, Rob

    2016-09-02

    Randomised controlled trials (RCTs) often fail to recruit sufficient participants, despite altruism being cited as their motivation. Previous investigations of factors influencing participation decisions have been methodologically limited. This study evaluated how women weigh up different motivations after initially expressing altruism, and explored their understanding of a trial and its alternatives. The trial was the 'Quality of Life after Mastectomy and Breast Reconstruction' (QUEST) trial. Thirty-nine women participated in qualitative interviews 1 month post-surgery. Twenty-seven women (10 trial decliners and 17 acceptors) who spontaneously mentioned 'altruism' were selected for thematic analysis. Verbatim transcripts were coded independently by two researchers. Participants' motivations to accept or decline randomisation were cross-referenced with their understanding of the QUEST trials and the process of randomisation. The seven emerging themes were: (1) altruism expressed by acceptors and decliners; (2) overriding personal needs in decliners; (3) pure altruism in acceptors; (4) 'hypothetical altruism' amongst acceptors; (5) weak altruism amongst acceptors; (6) conditional altruism amongst acceptors; and (7) sense of duty to participate. Poor understanding of the trial rationale and its implications was also evident. Altruism was a motivating factor for participation in the QUEST randomised controlled trials where the main outcomes comprised quality of life and allocated treatments comprised established surgical procedures. Women's decisions were influenced by their understanding of the trial. Both acceptors and decliners of the trial expressed 'altruism', but most acceptors lacked an obvious treatment preference, hoped for personal benefits regarding a treatment allocation, or did not articulate complete understanding of the trial. QUEST A, ISRCTN38846532 ; Date assigned 6 January 2010. QUEST B, ISRCTN92581226 ; Date assigned 6 January 2010.

  9. Shared decision making

    ... page: //medlineplus.gov/ency/patientinstructions/000877.htm Shared decision making To use the sharing features on this page, ... treatment you both support. When to use Shared Decision Making Shared decision making is often used when you ...

  10. The concept of wrongful life in the law.

    Kasper, A S

    1983-01-01

    In the history of the law the concept of wrongful life is not new, but it has become of interest recently due to changing social attitudes and advances in contraceptive and genetic technologies. This discussion tries to assess the effects of wrongful life as a legal concept on the rights of childbearing women and their offspring. An unborn child had no rights under common law, which held that a fetus in utero had no existence separate from its mother. Consequently, a child had no right of action for personal harm brought upon it by another person. On occasion early courts disagreed with this view, but the majority of courts maintained that a child had no existence as a human being during gestation. The effect that this concept of common law would have on current abortion laws would be to make it considerably easier to argue for a woman's right to choose an abortion. The notion of wrongful life initially appeared in cases of illegitimate births. In Zepeda v. Zepeda, 1963, and Williams v. State of New York, 1966, the plaintiffs maintained that the children's births and existence were wrongful because they were unintended and illegitimate. In Williams the court ruled that birth under 1 set of circumstances and not another is not a recoverable injury. These cases failed to meet the requirements of tort law, and the court rejected the notion of children finding legal recourse for being born to a poor family or being born to a less desired race or class. A series of cases followed in which recovery for physical injury or birth deformities were claimed by parents for themselves and their children. In June 1980 a California appeals court reversed the decision of a lower court, addressing the fundamental principles of wrongful life as a legal concept. In Curlender v. Bio-Science Laboratories an infant brought suit alleging that the laboratories failed to correctly inform her parents of their status as carriers of Tay-Sachs disease during the mother's pregnancy. The infant

  11. Decision making and imperfection

    Karny, Miroslav; Wolpert, David

    2013-01-01

    Decision making (DM) is ubiquitous in both natural and artificial systems. The decisions made often differ from those recommended by the axiomatically well-grounded normative Bayesian decision theory, in a large part due to limited cognitive and computational resources of decision makers (either artificial units or humans). This state of a airs is often described by saying that decision makers are imperfect and exhibit bounded rationality. The neglected influence of emotional state and personality traits is an additional reason why normative theory fails to model human DM process.   The book is a joint effort of the top researchers from different disciplines to identify sources of imperfection and ways how to decrease discrepancies between the prescriptive theory and real-life DM. The contributions consider:   ·          how a crowd of imperfect decision makers outperforms experts' decisions;   ·          how to decrease decision makers' imperfection by reducing knowledge available;   ...

  12. Making better scientific figures

    Hawkins, Ed; McNeall, Doug

    2016-04-01

    In the words of the UK government chief scientific adviser "Science is not finished until it's communicated" (Walport 2013). The tools to produce good visual communication have never been so easily accessible to scientists as at the present. Correspondingly, it has never been easier to produce and disseminate poor graphics. In this presentation, we highlight some good practice and offer some practical advice in preparing scientific figures for presentation to peers or to the public. We identify common mistakes in visualisation, including some made by the authors, and offer some good reasons not to trust defaults in graphics software. In particular, we discuss the use of colour scales and share our experiences in running a social media campaign (http://tiny.cc/endrainbow) to replace the "rainbow" (also "jet", or "spectral") colour scale as the default in (climate) scientific visualisation.

  13. [Limiting life sustaining therapies].

    Azoulay, E

    2006-09-01

    Intensivists are increasingly implementing end-of-life decisions in patients who remain dependent on life sustaining therapies without hope for recovery. Descriptive studies have provided epidemiological data on ICU end-of-life care, identifying areas for improvement. Qualitative studies have highlighted the complexity of the decision making process. In addition to considering the legal and ethical issues involved, this review describes cultural, religious and individual variations observed in ICU end-of-life care. It is important for intensivists to respect patients' preferences and values, but also, in some family members, to avoid increasing the burden and the guilt of sharing the decision. Intensivists should improve their ability to meet the needs of dying patients and their family members. Each situation, patient, family and caregiver is unique, and therefore needs a specific approach. Introducing palliative care and multidisciplinary teams into the ICU might provide an additional opportunity for patients and families to be informed and listened to.

  14. Life Style Assessment: So What!

    Aubry, William E.

    The construct life style was used by Alfred Adler to describe the characteristic way in which individuals act and think. Followers of his theories are now collecting evidence to support or validate his contentions. The assessment of client life styles serves: (1) to make the client aware of his misconceptions, (2) as a reference point for therapy,…

  15. Emergence of Life

    Marie-Paule Bassez

    2011-09-01

    Full Text Available Indeed, even if we know that many individual components are necessary for life to exist, we do not yet know what makes life emerge. One goal of this journal Life is to juxtapose articles with multidisciplinary approaches and perhaps to answer in the near future this question of the emergence of life. Different subjects and themes will be developed, starting of course with the multiple definitions of life and continuing with others such as: life diversity and universality; characteristics of living systems; thermodynamics with energy and entropy; kinetics and catalysis; water in its different physical states; circulation of sap and blood and its origin; the first blood pump and first heart; the first exchange of nutrients between cells, sap and blood; essential molecules of living systems; chirality; molecular asymmetry and its origin; formation of enantiomer excess and amplification; microscopic observations on a micrometer and sub-micrometer scales, at molecular and atomic levels; the first molecules at the origin of genetic information, viroids, circular RNA; regions of space or the area inside membranes and cells capable of initiating and maintaining life; phenomena at the origin of the emergence of life; molecules studied in the traditional field of chemistry and in the recent field of nanoscience governed by new laws; interaction between the individual molecules and components of living systems; interaction between living systems and the environment; transfer of information through generations; continuation of life from one generation to the next; prebiotic chemistry and prebiotic signatures on Earth, on Mars, on other planets; biosignatures of the first forms of life; fossils and pseudofossils dating 3.5 Ga ago and more recent ones; experimental fossilization; pluricellular eukaryotes dating 2.1 Ga ago; sudden increase in oxygen in the atmosphere around 2.0 to 2.5 Ga ago and its relation to geology; shell symmetry; aging with

  16. Human life support for advanced space exploration

    Schwartzkopf, S. H.

    1997-01-01

    -term technologies are adequate to implement a Lunar Base CELSS. There are no apparent "show-stoppers" which require the development of new technologies. However, there are several areas in which new materials and technologies could be used for a more efficient implementation of the system, e.g., by decreasing mass or power requirement and increasing recycling efficiency. These areas must be further addressed through research and development. Finally, although this study focused on the development of a Lunar Base CELSS, the same technologies and a nearly identical design would be appropriate for a Mars base. Actually, except for the distance of transportation, the implementation of a CELSS on Mars would even be easier than it would be on the Moon. The presence of atmospheric CO2 on Mars, although in low concentration, coupled with the fact that the day/night cycle on Mars is very similar to that on Earth, makes the use of light-weight, greenhouse-like structures for growing food plants even more feasible than on the Moon. There are some environmental problems, which would have to be dealt with, like dust storms and the large amount of the ultraviolet radiation incident on the planet's surface. However, the materials and methods are largely available today to develop such a life support system for a Mars base.

  17. Life on Mars

    McKay, Christopher P.; Cuzzi, Jeffrey (Technical Monitor)

    1996-01-01

    Although the Viking results may indicate that Mars has no life today, the possibility exists that Mars may hold the best record of the events that led to the origin of life. There is direct geomorphological evidence that in the past Mars had large amounts of liquid water on its surface. Atmospheric models would suggest that this early period of hydrological activity was due to the presence of a thick atmosphere and the resulting warmer temperatures. From a biological perspective the existence of liquid water, by itself motivates the question of the origin of life on Mars. From studies of the Earth's earliest biosphere we know that by 3.5 Gyr. ago, life had originated on Earth and reached a fair degree of biological sophistication. Surface activity and erosion on Earth make it difficult to trace the history of life before the 3.5 Gyr timeframe. If Mars did maintain a clement environment for longer than it took for life to originate on Earth, then the question of the origin of life on Mars follows naturally.

  18. Where Should We Look for Life?

    Kohler, Susanna

    2018-04-01

    The first challenge in the hunt for life elsewhere in our universe is to decide where to look. In a new study, two scientists examine whether Sun-like stars or low-mass M dwarfs are the best bet for hosting exoplanets with detectable life.Ambiguity of HabitabilityThe habitable zones of cool M-dwarf stars lie much closer in than for Sun-like stars, placing habitable-zone planets around M dwarfs at greater risk of being affected by space weather.Most exoplanet scientists will freely admit frustration with the term habitability its a word that has many different meanings and is easily misinterpreted when it appears in news articles. Just because a planet lies in a stars habitable zone, for instance, doesnt mean its necessarily capable of supporting life.This ambiguity, argue authors Manasvi Lingam and Abraham Loeb (Harvard University and Harvard-Smithsonian Center for Astrophysics), requires us to take a strategic approach when pursuing the search for primitive life outside of our solar system. In particular, we risk losing the enthusiasm and support of the public (and funding sources!) when wefocus on the general search for planets in stellar habitable zones, rather than specifically searching for the planets most likely to have detectable signatures of life.Illustration of the difference between a Sun-like star and a lower-mass, cooler M-dwarf star. [NASAs Goddard Space Flight Center/S. Wiessinger]Weighing Two TargetsSo how do we determine where best to look for planets with detectable biosignatures? To figure out which stars make the optimal targets, Lingam and Loeb suggest an approach based on standard cost-benefit analyses common in economics. Here, whats being balanced is the cost of an exoplanet survey mission against the benefit of different types of stellar targets.In particular, Lingam and Loeb weigh the benefit of targeting solar-type stars against that of targeting stars of any other mass (such as low-mass M-dwarfs, popular targets of many current

  19. Medical decision making

    Stiggelbout, A.M.; Vries, M. de; Scherer, L.; Keren, G.; Wu, G.

    2016-01-01

    This chapter presents an overview of the field of medical decision making. It distinguishes the levels of decision making seen in health-care practice and shows how research in judgment and decision making support or improve decision making. Most of the research has been done at the micro level,

  20. Picturing Life

    Molly Bathje MS, OTR/L

    2013-08-01

    Full Text Available The cover art of the summer 2013 issue of The Open Journal of Occupational Therapy provided by Jonathan Darnall reflects his unique life perspective, current roles, and values. An exploration of Jon’s life experience reveals how creative arts, including photography, have positively influenced his life and inform OT practitioners about the benefits of photography as an intervention and an occupation.

  1. Toward a Psychology of Surrogate Decision Making.

    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.

  2. Making Sustainable Decisions Using The KONVERGENCE Framework

    Piet, S. J.; Gibson, P. L.; Joe, J. C.; Kerr, T. A.; Nitschke, R. L.; Dakins, M. E.

    2003-02-25

    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. 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: (1) Knowledge: what is known about the problem and possible solutions? (2) Values: what is important to those affected by the decision? (3) Resources: what is available to implement possible solutions or improve knowledge? This mental model helps analyze and visualize what is happening as decisions are made and kept. Why is there disagreement? Is there movement toward konvergence? Is a past decision drifting out of konvergence? The framework includes strategic improvements, i.e., expand the spectrum of alternatives to include adaptable alternatives and decision networks. It includes tactical process improvements derived from experience, values, and relevant literature. This paper includes diagnosis and medication (suggested path forward) for intractable cases.

  3. Making Sustainable Decisions Using The KONVERGENCE Framework

    Piet, S. J.; Gibson, P. L.; Joe, J. C.; Kerr, T. A.; Nitschke, R. L.; Dakins, M. E.

    2003-01-01

    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. 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: (1) Knowledge: what is known about the problem and possible solutions? (2) Values: what is important to those affected by the decision? (3) Resources: what is available to implement possible solutions or improve knowledge? This mental model helps analyze and visualize what is happening as decisions are made and kept. Why is there disagreement? Is there movement toward konvergence? Is a past decision drifting out of konvergence? The framework includes strategic improvements, i.e., expand the spectrum of alternatives to include adaptable alternatives and decision networks. It includes tactical process improvements derived from experience, values, and relevant literature. This paper includes diagnosis and medication (suggested path forward) for intractable cases

  4. Decision Making and Cancer

    Reyna, Valerie F.; Nelson, Wendy L.; Han, Paul K.; Pignone, Michael P.

    2015-01-01

    We review decision-making along the cancer continuum in the contemporary context of informed and shared decision making, in which patients are encouraged to take a more active role in their health care. We discuss challenges to achieving informed and shared decision making, including cognitive limitations and emotional factors, but argue that understanding the mechanisms of decision making offers hope for improving decision support. Theoretical approaches to decision making that explain cogni...

  5. Meaning in Work Life

    Ravn, Ib

    meaningful is still lacking (Harpaz & Fu, 2002), as are definitions of key terms. Here, I define meaning as the experience that something fits into a wider context or coheres within a larger whole.     I conceptualize meaning in work life as deriving from four factors, each of which helps us contribute...... to something larger than ourselves (Seligman, 2002) through our work. Thus, a person experiences meaning in work life when she... A. is able to use her signature strengths at work (Peterson and Seligman, 2004), B. makes an important contribution to the workplace (Drucker, 1999), C. participates in a productive...

  6. Life Cycle Environmental Management

    Pedersen, Claus Stig; Jørgensen, Jørgen; Pedersen, Morten Als

    1996-01-01

    A precondition for environmentally conscious management is the awareness of the environmental impact potentials created by an industrial company. There is an obvious need for management tools to support the implementation of relevant environmental criteria into the industrial decision making...... processes. The discipline of life cycle environmental management (LCEM) focuses on the incorporation of environmental criteria from the life cycles of products and other company activities into the company management processes. This paper introduces the concept of LCEM as an important element...... of the complete set of environmental objects in an industrial manufacturing company....

  7. Making nuclear 'normal'

    Haehlen, Peter; Elmiger, Bruno

    2000-01-01

    The mechanics of the Swiss NPPs' 'come and see' programme 1995-1999 were illustrated in our contributions to all PIME workshops since 1996. Now, after four annual 'waves', all the country has been covered by the NPPs' invitation to dialogue. This makes PIME 2000 the right time to shed some light on one particular objective of this initiative: making nuclear 'normal'. The principal aim of the 'come and see' programme, namely to give the Swiss NPPs 'a voice of their own' by the end of the nuclear moratorium 1990-2000, has clearly been attained and was commented on during earlier PIMEs. It is, however, equally important that Swiss nuclear energy not only made progress in terms of public 'presence', but also in terms of being perceived as a normal part of industry, as a normal branch of the economy. The message that Swiss nuclear energy is nothing but a normal business involving normal people, was stressed by several components of the multi-prong campaign: - The speakers in the TV ads were real - 'normal' - visitors' guides and not actors; - The testimonials in the print ads were all real NPP visitors - 'normal' people - and not models; - The mailings inviting a very large number of associations to 'come and see' activated a typical channel of 'normal' Swiss social life; - Spending money on ads (a new activity for Swiss NPPs) appears to have resulted in being perceived by the media as a normal branch of the economy. Today we feel that the 'normality' message has well been received by the media. In the controversy dealing with antinuclear arguments brought forward by environmental organisations journalists nowadays as a rule give nuclear energy a voice - a normal right to be heard. As in a 'normal' controversy, the media again actively ask themselves questions about specific antinuclear claims, much more than before 1990 when the moratorium started. The result is that in many cases such arguments are discarded by journalists, because they are, e.g., found to be

  8. Heuristics: foundations for a novel approach to medical decision making.

    Bodemer, Nicolai; Hanoch, Yaniv; Katsikopoulos, Konstantinos V

    2015-03-01

    Medical decision-making is a complex process that often takes place during uncertainty, that is, when knowledge, time, and resources are limited. How can we ensure good decisions? We present research on heuristics-simple rules of thumb-and discuss how medical decision-making can benefit from these tools. We challenge the common view that heuristics are only second-best solutions by showing that they can be more accurate, faster, and easier to apply in comparison to more complex strategies. Using the example of fast-and-frugal decision trees, we illustrate how heuristics can be studied and implemented in the medical context. Finally, we suggest how a heuristic-friendly culture supports the study and application of heuristics as complementary strategies to existing decision rules.

  9. Automatically exposing OpenLifeData via SADI semantic Web Services.

    González, Alejandro Rodríguez; Callahan, Alison; Cruz-Toledo, José; Garcia, Adrian; Egaña Aranguren, Mikel; Dumontier, Michel; Wilkinson, Mark D

    2014-01-01

    Two distinct trends are emerging with respect to how data is shared, collected, and analyzed within the bioinformatics community. First, Linked Data, exposed as SPARQL endpoints, promises to make data easier to collect and integrate by moving towards the harmonization of data syntax, descriptive vocabularies, and identifiers, as well as providing a standardized mechanism for data access. Second, Web Services, often linked together into workflows, normalize data access and create transparent, reproducible scientific methodologies that can, in principle, be re-used and customized to suit new scientific questions. Constructing queries that traverse semantically-rich Linked Data requires substantial expertise, yet traditional RESTful or SOAP Web Services cannot adequately describe the content of a SPARQL endpoint. We propose that content-driven Semantic Web Services can enable facile discovery of Linked Data, independent of their location. We use a well-curated Linked Dataset - OpenLifeData - and utilize its descriptive metadata to automatically configure a series of more than 22,000 Semantic Web Services that expose all of its content via the SADI set of design principles. The OpenLifeData SADI services are discoverable via queries to the SHARE registry and easy to integrate into new or existing bioinformatics workflows and analytical pipelines. We demonstrate the utility of this system through comparison of Web Service-mediated data access with traditional SPARQL, and note that this approach not only simplifies data retrieval, but simultaneously provides protection against resource-intensive queries. We show, through a variety of different clients and examples of varying complexity, that data from the myriad OpenLifeData can be recovered without any need for prior-knowledge of the content or structure of the SPARQL endpoints. We also demonstrate that, via clients such as SHARE, the complexity of federated SPARQL queries is dramatically reduced.

  10. Life sciences

    Day, L. (ed.)

    1991-04-01

    This document is the 1989--1990 Annual Report for the Life Sciences Divisions of the University of California/Lawrence Berkeley Laboratory. Specific progress reports are included for the Cell and Molecular Biology Division, the Research Medicine and Radiation Biophysics Division (including the Advanced Light Source Life Sciences Center), and the Chemical Biodynamics Division. 450 refs., 46 figs. (MHB)

  11. Life sciences

    Day, L.

    1991-04-01

    This document is the 1989--1990 Annual Report for the Life Sciences Divisions of the University of California/Lawrence Berkeley Laboratory. Specific progress reports are included for the Cell and Molecular Biology Division, the Research Medicine and Radiation Biophysics Division (including the Advanced Light Source Life Sciences Center), and the Chemical Biodynamics Division. 450 refs., 46 figs

  12. Keep the best of your life

    Stultiens, Andrea

    Keep the Best of Your Life (for the Rest of Your Life) is part Making Oneself ‘a twofold exhibition of both historical investigations and contemporary showcases of photo studio practises in South and Southeast Asia and Uganda.’ ‘Making Oneself’ was one exhibitions of the Noorderlicht Photo festival

  13. Reading Makes Cents Resource Review

    Lacie Ashby

    2011-12-01

    Full Text Available In today’s economy, it is more crucial than ever to focus our educational efforts on increasing financial literacy. Many young people are unskilled in managing their personal finances, yet this critical life skill will greatly affect their future economic well-being. Reading Makes Cents, developed by Penn State University, is an excellent resource to address this need. A reviewed and recommended curriculum by National 4-H, this complete, easy to use curriculum targets youth in grades 3-5 with a combination of financial literacy and reading. The curriculum explores basic money concepts such as spending, saving, and sharing money. Lessons incorporate hands-on activities and children’s literature to reinforce lesson objectives. With evaluation questions and family activities included, Reading Makes Cents is a perfect guide for educators to easily pick up and teach.

  14. Sex and life expectancy.

    Seifarth, Joshua E; McGowan, Cheri L; Milne, Kevin J

    2012-12-01

    A sexual dimorphism in human life expectancy has existed in almost every country for as long as records have been kept. Although human life expectancy has increased each year, females still live longer, on average, than males. Undoubtedly, the reasons for the sex gap in life expectancy are multifaceted, and it has been discussed from both sociological and biological perspectives. However, even if biological factors make up only a small percentage of the determinants of the sex difference in this phenomenon, parity in average life expectancy should not be anticipated. The aim of this review is to highlight biological mechanisms that may underlie the sexual dimorphism in life expectancy. Using PubMed, ISI Web of Knowledge, and Google Scholar, as well as cited and citing reference histories of articles through August 2012, English-language articles were identified, read, and synthesized into categories that could account for biological sex differences in human life expectancy. The examination of biological mechanisms accounting for the female-based advantage in human life expectancy has been an active area of inquiry; however, it is still difficult to prove the relative importance of any 1 factor. Nonetheless, biological differences between the sexes do exist and include differences in genetic and physiological factors such as progressive skewing of X chromosome inactivation, telomere attrition, mitochondrial inheritance, hormonal and cellular responses to stress, immune function, and metabolic substrate handling among others. These factors may account for at least a part of the female advantage in human life expectancy. Despite noted gaps in sex equality, higher body fat percentages and lower physical activity levels globally at all ages, a sex-based gap in life expectancy exists in nearly every country for which data exist. There are several biological mechanisms that may contribute to explaining why females live longer than men on average, but the complexity of the

  15. Make Better Food Choices

    10 tips Nutrition Education Series make better food choices 10 tips for women’s health Fruits Grains Dairy Vegetables Protein Make yourself a priority and take time to care for yourself. ChooseMyPlate. gov ...

  16. Categorization = Decision Making + Generalization

    Seger, Carol A; Peterson, Erik J.

    2013-01-01

    We rarely, if ever, repeatedly encounter exactly the same situation. This makes generalization crucial for real world decision making. We argue that categorization, the study of generalizable representations, is a type of decision making, and that categorization learning research would benefit from approaches developed to study the neuroscience of decision making. Similarly, methods developed to examine generalization and learning within the field of categorization may enhance decision making research. We first discuss perceptual information processing and integration, with an emphasis on accumulator models. We then examine learning the value of different decision making choices via experience, emphasizing reinforcement learning modeling approaches. Next we discuss how value is combined with other factors in decision making, emphasizing the effects of uncertainty. Finally, we describe how a final decision is selected via thresholding processes implemented by the basal ganglia and related regions. We also consider how memory related functions in the hippocampus may be integrated with decision making mechanisms and contribute to categorization. PMID:23548891

  17. Optimizing medical device buying. Value analysis models can help you improve decision-making process.

    Feldstein, Josh; Brooks, Elizabeth

    2010-05-01

    Value Analysis Models (VAMs) are a burgeoning analytical tool that can help materials managers, operating room managers, CFOs and others to make comparative value assessments before reaching a critical purchasing decision. Although relatively new to the hospital field, more and more manufacturers are supporting these initiatives to bring critical information to their customers and the health care industry. VAMs aren't designed to conclude that one product is better than another but to be a tool that can help make the product acquisition process much easier.

  18. Negotiating Life Chances

    Korzenevica, Marina

    to and negotiate both educational and labour mobility - both of which are associated with the chance of a better life. This thesis is about young people (aged 16-31): How they negotiate their life chances and how they contribute to transformations of the socio-political space of their communities in two villages...... becoming. Aspirations prevail over political interests: young people navigate and negotiate their engagement in party and community politics by making calculations concerning their own mobility, life strategies and obligations to kin. In this way, young men engage in, but also balance and shift......, conversely, can only aspire to educational mobility due to gender norms. Furthermore, many of their hopes of ‘becoming somebody’ collapse upon marriage. Women find that they cannot continue their education, nor use the skills they have acquired in local politics, as they need to follow traditional...

  19. Teachers' Grading Decision Making

    Isnawati, Ida; Saukah, Ali

    2017-01-01

    This study investigated teachers' grading decision making, focusing on their beliefs underlying their grading decision making, their grading practices and assessment types, and factors they considered in grading decision making. Two teachers from two junior high schools applying different curriculum policies in grade reporting in Indonesian…

  20. I: Making Art

    Rosenfeld, Malke; Johnson, Marquetta; Plemons, Anna; Makol, Suzanne; Zanskas, Meghan; Dzula, Mark; Mahoney, Meg Robson

    2014-01-01

    Writing about the teaching artist practice should mean writing about art making. As both teacher and artist, the authors are required to be cognizant of their own art-making processes, both how it works and why it is important to them, in order to make this process visible to their students. They also need the same skills to write about how and…

  1. Elements of Making

    Rodriguez, Shelly; Harron, Jason; Fletcher, Steven; Spock, Hannah

    2018-01-01

    While there is no official definition, making is generally thought of as turning ideas into products through design, invention, and building. Support is growing for integrating making into science, technology, engineering, and mathematics (STEM) education. Making can help high school students explore science concepts and phenomena, yet, lacking…

  2. COMPETENCYTHE FORMATION FOR LIFE

    Milagros Mederos-Piñeiro

    2016-07-01

    Full Text Available The formation of life competences is the result of a quality education that prepares students to meet the challenges of a fast moving world where equality and equal opportunities should constitute premises of education; training them is a challenge teachers to assume new generations contribute actively to a better world. In Cuba are important research on the formation of communication competences and self-regulated learning in primary school. The paper shows the result of an investigation that provides a methodology for the formation of life competences in primary school education, used as an essential pathway research activity. The methodological approach of research has a quantitative approach and an explanatory scope to establish and make sense of understanding the causal relationship between the direction of research activity and training of life competences. Theoretical, empirical and mathematical-statistical, for characterizing the initial state, processing of results and analysis: research methods are used. The application of the methodology for the formation of life competences makes teachers lead the teaching-learning process with a research and transforming teaching concept, where the school is the protagonist of their learning and causes changes in their performances, which are evident in the formed competences related to effective and affective communication; the solution of problems related to life; the use of means in obtaining the knowledge and the expression of a behavior consistent with school and social demands. The effectiveness of the methodology confirms that there is a causal relationship between the direction of research activity by teachers and the formation of life competences in school.

  3. Women in public life.

    1992-01-01

    The UN Division for the Advancement of Women publication has devoted an issue to the role of women in public lie based on an analysis of women's status in industrialized countries presented in Vienna, Austria, in May 1991. Women already contribute to political life and make a difference in politics, but societal institutions and government processes have not yet adapted to this fact. Women's nongovernmental organizations promote women's interests at the governmental level, but often do not have the economic or political power as do other interests groups such as trade unions. Women often participation public life via their membership in women's organizations, community action groups, voluntary organizations, and other close to home groups. They prefer to participate in activities which are problem solving rather than institution building. These activities and groups operate outside established political institutions and are not considered as part of public and political life. Society's exclusion of women from leadership positions in public life keeps it from benefiting from the special contributions that women bring to decision making. Women show a tendency to have different leadership styles than men (e.g., ability to relate to people affected by their decisions), which are most needed for the modern world. They often do not campaign just for women's issues, but, once in office, they do tend to become more involved in women's issues. Women have affected positive changes in career and child care, often on a non-Socialist agenda, in various countries (e.g. Norway). This effect is referred to as the politics of motherhood. More access to politics and public life calls for removal of structural and situational barriers including the glass ceiling, discrimination, insufficient funds, and bearing most of the responsibility for child care. The UN women's groups has drafted a platform for interregional consultation on women's role in public life and scheduled the 4th

  4. Extraterrestrial Life

    Klein, M. J.

    1993-01-01

    Extraterrestrial Intelligence is intelligent life that developed somewhere other than the earth. Such life has not yet been discovered. However, scientific research, including astronomy, biology, planetary science and studies of fossils here on earth have led many scientists to conclude that such life may exist on planets orbiting at least some of the hundreds of billions of stars in our Milky Way Galaxy. Today, some researchers are trying to find evidence for extraterrestrial intelligence. This effort is often called SETI, which stands for Search for Extraterrestrial Intelligence. SETI researchers decided that looking for evidence of their technology might be the best way to discover other intelligent life in the Galaxy. They decided to use large radio telescopes to search the sky over a wide range of radio frequencies...

  5. Focused Science Delivery makes science make sense.

    Rachel W. Scheuering; Jamie. Barbour

    2004-01-01

    Science does not exist in a vacuum, but reading scientific publications might make you think it does. Although the policy and management implications of their findings could often touch a much wider audience, many scientists write only for the few people in the world who share their area of expertise. In addition, most scientific publications provide information that...

  6. Making detailed predictions makes (some) predictions worse

    Kelly, Theresa F.

    In this paper, we investigate whether making detailed predictions about an event makes other predictions worse. Across 19 experiments, 10,895 participants, and 415,960 predictions about 724 professional sports games, we find that people who made detailed predictions about sporting events (e.g., how many hits each baseball team would get) made worse predictions about more general outcomes (e.g., which team would win). We rule out that this effect is caused by inattention or fatigue, thinking too hard, or a differential reliance on holistic information about the teams. Instead, we find that thinking about game-relevant details before predicting winning teams causes people to give less weight to predictive information, presumably because predicting details makes information that is relatively useless for predicting the winning team more readily accessible in memory and therefore incorporated into forecasts. Furthermore, we show that this differential use of information can be used to predict what kinds of games will and will not be susceptible to the negative effect of making detailed predictions.

  7. Making of Magnet Barium Ferit Anisotropic

    Idayati, Novrita; Dedi

    2003-01-01

    Barium Hexa ferrite (BaFe 12 O 19 ) is ceramic and materials which usually used for making of permanent magnet. In this research Barium Hexa ferrite were made Anisotropic, and applied for loudspeaker, electro motors, dynamo, KWh metre, etc. this Magnet is commonly used due to its high Induction of Remanen (Br) and coercivity (high Hc). Besides it applies a more simple and easier process technology, cheaper raw material, and easy to find it, hence the magnetic component is much cheaper. Powder Metallurgy was used for the process technology, by reacting all materials in the powder (oxide), with a certain size distribution and a tight preparation step. The next step was mixing ferrite and Barium Carbonate (in the form of oxide), calcination, compaction, cantering and characterisation. The Anisotropic particle effects a high Induce Remanen (Br) and of koersifitas (high Hc). All the process steps will is determine physical and chemical characteristics of the magnet. The best Magnet characteristic of the magnet produced in this research is Induction of Remanen (Br) = 4,27 kg, Coercivity (Hc) = 1,745 kOe, Energy Product max (BHmaks) = 2,31 MGOe

  8. Making Sustainable Decisions Using the KONVERGENCE Framework

    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

  9. Media life of the young

    Westlund, Oscar; Bjur, Jakob

    2014-01-01

    This is a thorough investigation into contemporary young people and their media life. The article conceptualizes a typology of media life, drawing on a theoretical body involving the sociology of generations, life course research, media life and individualization. This empirically derived typology...... makes a strong instrument for an understanding of the media life of the young, furnishing insights into how they have constructed their use of media. The investigation is based on a robust national survey with Swedes born 1994–2001, conducted in 2010, and focusing on four media: television, gaming......, the Internet and mobile devices. Two of the findings are particularly surprising. Firstly, the results reveal that the young generally lead heterogeneous media lives, varying with age and sex. Secondly, although some young people literarily live their life in media, there are also de facto young who live...

  10. Goal Setting and Decision Making by At-Risk Youth

    Galotti, Kathleen M.; Kozberg, Steven F.; Gustafon, Mary

    2009-01-01

    Typically, adolescence is a time when individuals begin to make consequential, life-framing decisions. However, much of the decision-making literature focuses on high-risk decisions, such as the use of drugs and alcohol, while much less is known about how adolescents make positive decisions, for example, regarding their educational or career…

  11. Make pupils young researchers!

    Gouhier, Armelle

    2015-04-01

    With the 2011 educational reform in France, a new course has been created in secondary schools : Methods & Practices in Science (MPS). The main goal was to improve the pupils working methods in science, including laboratory and field works. In addition, the pedagogy develops pupils autonomy and creativity, a key factor in a research process. Three teachers are working together (Mathematics, Physics and Geology-Biology), showing how different disciplines complement one another. Eventually, this is aimed at attracting more students in scientific sections. This course is optional, in the "seconde" class in French secondary schools (i.e., for 15 years old students). For the next class, they will have to choose between scientific, economic and literature sections : it is a useful option for them to decide which section has their preference. In my high-school in Clermont-Ferrand, we have chosen a research subject on hydrogeology & water quality improvement in region "Auvergne". The pupils will have to develop and set up appropriate tools to check and improve the water quality, related to different disciplines : - Geology & Biology: hydrogeology, effects of different pollutants on aquatic life, solutions to improve water quality (example of the natural water treatment zone in the lake of "Aydat, Auvergne, France"). - Physics & Chemistry: water potability criteria, pollution tests in water, water treatment plants working. - Mathematics: algorithm development, modeling on excel of the dispersion of pollutants The pedagogy of this course is new in French high-schools : pupils work in groups of three, so as to develop cooperation and autonomy. The teachers give the guidelines at the beginning of each working session, and answer the students questions when necessary. The evaluation is competence-based : instead of a mark, which is the main evaluation method in France, the pupils have to evaluate their own skills. Then, the teachers make an evaluation, and the global process is

  12. Easier Said than Done: Leading Technology Integration

    Bleakley, David A.; Mangin, Melinda M.

    2013-01-01

    In this case, Mr. Phuture, a district administrator, attempts to lead a diverse team of educators and community members in an effort to develop a district-wide action plan for the integration of instructional technology in K-12 classrooms. Along the way, Mr. Phuture confronts ambiguities in the superintendent's directives, passionate contradicting…

  13. Syringe-delivered tumescent anesthesia made easier

    Lapid, Oren

    2011-01-01

    A simple method for the infiltration of tumescent anesthesia is presented. An assembly is made using an infusion set, a three-way tap, and two unidirectional valves. The assembly and use of this system are straightforward and easy. The addition of unidirectional valves prevents the risk of reverse

  14. Managing Asthma: Learning to Breathe Easier

    ... lungs. When symptoms flare up, it’s called an asthma attack. The airways of people with asthma are prone ... every day to help control symptoms and prevent asthma attacks. “Inhaled corticosteroids are recommended as the preferred long- ...

  15. Intraocular Surgery in Kyphosis: An Easier Approach

    Karanjit S. Kooner

    2013-06-01

    Full Text Available We describe a 49-year-old man with advanced kyphosis and dense cataract, who could only recline to about 40° from the vertical axis despite a maximal reverse Trendelenburg position and pillows under the head, neck, shoulders and knees. With a single corneal retraction suture at 6 o'clock, the eye could be rotated horizontally, which enabled the surgeon to perform a complex cataract surgery despite prior glaucoma shunt, posterior synechiae, a small pupil and the need to stain the capsule. As the eye can be brought into any desired position with a retraction suture, patients with kyphosis or other conditions that prevent them from assuming a supine position can still have safe intraocular procedures. This maneuver reduces the need to tilt patients to an uncomfortable position that may cause pain, increased breathing difficulty and elevated posterior vitreous pressure.

  16. Breathing easier: Indonesia works towards cleaner air

    Madsen, Michael Amdi

    2015-01-01

    Indonesians can look forward to breathing cleaner air following upcoming changes in regulations introduced as a result of a study conducted using nuclear analytical techniques. Lead pollution and other fine particulate matter in the air is now, for the first time, being accurately monitored and is giving Indonesian officials a good understanding of their air pollution problem and how to manage it.

  17. Easier Said than Done: Writing an Autoethnography

    Sarah Wall BScN, MHSA

    2008-03-01

    Full Text Available Autoethnography is an intriguing and promising qualitative method that offers a way of giving voice to personal experience for the purpose of extending sociological understanding. The author's experience of writing an autoethnography about international adoption has shown her, however, that autoethnography can be a very difficult undertaking. In writing her autoethnography, she confronted anxiety-producing questions pertaining to representation, balance, and ethics. As well, she dealt with the acceptability of her autoethnography by informal and formal reviewers. In this article she discusses the challenges she faced in her autoethnographic project to inform future autoethnographers and to inspire them to share their experiences and reflections. For the author questions linger, but she hopes that sharing issues that arise in autoethnographic work will strengthen our understandings of this challenging yet highly promising form of inquiry.

  18. Breathing Easier: HVAC Specifications for Schools.

    Trent, C. Curtis; Trent, Warren C.

    1996-01-01

    A major source of indoor air contamination in schools originates within the heating, ventilating, and air-conditioning systems (HVAC), with draw-through systems being the worst offenders. Lists provisions for designing an HVAC system and a set of criteria to adhere to when planning new construction or renovations. (nine references) (MLF)

  19. [Safer operating theatre: easier said than done].

    Kalkman, C J

    2008-10-18

    The Netherlands Health Care Inspectorate recently changed its approach to quality of care and patient safety from a reactive to a firmly proactive style. In two reports, the current perioperative processes in Dutch hospitals were scrutinised. Despite a highly-motivated workforce, the inspectorate detected a lack of standardisation, incomplete or inaccessible patient data, poor adherence to hygiene standards and gaps during transfer of care in both the preoperative and intraoperative stages ofsurgery. The inspectorate mandates rapid implementation of various new patient safety approaches, including the use of checklists, 'time-outs' before the start of surgery, double checking of intravenous drugs and improved compliance with hygiene standards, as well as a strict definition of roles and responsibilities of team members. Implementation will require major changes within the processes and culture of operating theatres in Dutch hospitals. Such a change is unlikely to be completed within the short timeframe allowed by the inspectorate.

  20. Business making decisions

    Enrique Benjamín Franklin Fincowsky

    2011-06-01

    Full Text Available People and organizations make better or get wrong as consequence of making decisions. Sometimes making decisions is just a trial and error process. Some others, decisions are good and the results profitable with a few of mistakes, most of the time because it’s considered the experience and the control of a specific field or the good intention of who makes them. Actually, all kinds of decisions bring learning. What is important is the intention, the attitude and the values considered in this process. People from different scenes face many facts and circumstances—almost always out of control—that affect the making decisions process. There is not a unique way to make decisions for all companies in many settings. The person who makes a decision should identify the problem, to solve it later using alternatives and solutions. Even though, follow all the steps it’s not easy as it seems. Looking back the conditions related to the decisions, we can mention the followings: uncertainty, risk and certainty. When people identify circumstances and facts, as well as its effects in a possible situation, they will make decisions with certainty. As long as the information decreases and it becomes ambiguous the risk becomes an important factor in the making decisions process because they are connected to probable objectives (clear or subjective (opinion judgment or intuition. To finish, uncertainty, involves people that make a decision with no or little information about circumstances or criteria with basis

  1. Most common usability mistakes coders make

    CERN. Geneva

    2017-01-01

    This presentation contains an overview of bad practises in interface design. Though real-life screenshots elements like ‘setting up your page’, ‘forms’, ‘navigation and interactions’ and ‘colours’ will be covered. It’s easy to point out the negative aspects so a solution on how to make the examples will be given in addition.

  2. Decision Making Under Uncertainty

    2010-11-01

    A sound approach to rational decision making requires a decision maker to establish decision objectives, identify alternatives, and evaluate those...often violate the axioms of rationality when making decisions under uncertainty. The systematic description of such observations may lead to the...which leads to “anchoring” on the initial value. The fact that individuals have been shown to deviate from rationality when making decisions

  3. Life Science Teachers' Decision Making on Sex Education

    Gill, Puneet Singh

    2013-01-01

    The desires of young people and especially young bodies are constructed at the intersections of policies that set the parameters of sex education policies, the embodied experiences of students in classrooms, and the way bodies are discussed in the complex language of science. Moreover, more research points to the lack of scientifically and…

  4. Making Sense of Academic Life: Academics, Universities and Change.

    Taylor, Peter G.

    Universities and academics today are facing challenges that require more active and self-interested management. The book argues that higher education in the future will not become any more ordered, but will actually become more complex, more fractured and less bounded, and that academics will have to respond with new ways of thinking. The book…

  5. Factors in decision-making concerning life support therapy

    G Burger

    1999-11-01

    Moderne tegnologie het dit moontlik gemaak om lewe vir 'n onbepaalde tydperk te verleng, maar ongelukkig bied dit nie antwoorde op vrae wat in suike situasies ontstaan nie. *Please note: This is a reduced version of the abstract. Please refer to PDF for full text.

  6. Recognising life

    Nissen, Morten

    2013-01-01

    ’ – that the contemporary discursive pragmatics of more or less pharmaceutical life practices still include forms of transcendence – and by the wish to fertilize the field of bio-politics with the indexical inter-subjectivity of the concept of ideology, as derived from an antiessentialist reading of Hegelian......–Marxist traditions. The analysis unfolds as an ideology critique that reconstructs, and seeks ways to overcome, particular forms of recognition that are identifiable in the data and in the field of drug practices, and how these form part of the constitution of singular collectives and participants – in these life...

  7. Life cycle of transformer oil

    Đurđević Ksenija R.; Vojinović-Miloradov Mirjana; Sokolović Slobodan M.

    2008-01-01

    The consumption of electric power is constantly increasing due to industrialization and population growth. This results in much more severe operating conditions of transformers, the most important electrical devices that make integral parts of power transmission and distribution systems. The designed operating life of the majority of worldwide transformers has already expired, which puts the increase of transformer reliability and operating life extension in the spotlight. Transformer oil pla...

  8. Make up nov 04

    Chantel

    ABSTRACT. According to anecdotal reports,AIDS stigma and discrimination continue to influence people living with and .... received stigma affects the quality of work life for ..... Intersecting health risks: adolescent unwanted pregnancy, unsafe.

  9. Making Team Differences Work

    Strathman, Beth

    2015-01-01

    Most district and school leaders understand that recruiting group members who have differing backgrounds, perspectives, talents, and personalities makes for good decision-making. Unfortunately, simply assembling a variety of top-notch individuals does not necessarily mean their talents and perspectives will be fully considered. Beth Strathman…

  10. It Makes You Think

    Harden, Helen

    2009-01-01

    This article provides an overview of the "It Makes You Think" resource. The lessons provided by this resource show how students can learn about the global dimension through science. The "It Makes You Think" resource contains ten topics: (1) Metals in jewellery worldwide; (2) Global food market; (3) The worldwide travels of…

  11. Variation in decision making

    Dall, Sasha R. X.; Gosling, Samuel; Gordon D.A., Brown,; Dingemanse, Niels; Ido, Erev,; Martin, Kocher,; Laura, Schulz,; Todd, Peter M; Weissing, Franz; Wolf, Max; Hammerstein, Peter; Stevens, Jeffrey R.

    2012-01-01

    Variation in how organisms allocate their behavior over their lifetimes is key to determining Darwinian fitness., and thus the evolution of human and nonhuman decision making. This chapter explores how decision making varies across biologically and societally significant scales and what role such

  12. [Decision making in cariology

    Verdonschot, E.H.A.M.; Liem, S.L.; Palenstein Helderman, W.H. van

    2003-01-01

    By conducting an oral examination, during radiographic examination and in treatment planning procedures dentists make numerous decisions. A dentist will be required to make his decisions explicit. Decision trees and decision analyses may play an important role. In a decision analysis, the

  13. Culinary Decision Making.

    Curtis, Rob

    1987-01-01

    Advises directors of ways to include day care workers in the decision-making process. Enumerates benefits of using staff to help focus and direct changes in the day care center and discusses possible pitfalls in implementation of a collective decision-making approach to management. (NH)

  14. Extraterrestrial Life: Life on Mars - Then and Now

    Arrhenius, Gustaf; Mojzsis, Stephen

    1996-01-01

    The recent claim to have identified possible signs of ancient life on Mars has been widely publicized and discussed. The authors conceded that none of the half-dozen pieces of evidence adduced in their paper individually provided strong support for extraterrestrial life, though they argued that the pieces added up to a case worth considering. Most - perhaps all - of the observed phenomena have counterparts in the inorganic world, so even the combination does not make a compelling case that there was ever life on Mars. Nevertheless, the importance of the problem has justified bringing the results to general attention. The paper has focussed interest on the origin and possible ubiquity of life, and on how we can design techniques capable of giving a more definitive answer to the question of whether there is, or has ever been, life elsewhere in the Universe.

  15. Decision making and cancer.

    Reyna, Valerie F; Nelson, Wendy L; Han, Paul K; Pignone, Michael P

    2015-01-01

    We review decision making along the cancer continuum in the contemporary context of informed and shared decision making in which patients are encouraged to take a more active role in their health care. We discuss challenges to achieving informed and shared decision making, including cognitive limitations and emotional factors, but argue that understanding the mechanisms of decision making offers hope for improving decision support. Theoretical approaches to decision making that explain cognition, emotion, and their interaction are described, including classical psychophysical approaches, dual-process approaches that focus on conflicts between emotion versus cognition (or reason), and modern integrative approaches such as fuzzy-trace theory. In contrast to the earlier emphasis on rote use of numerical detail, modern approaches emphasize understanding the bottom-line gist of options (which encompasses emotion and other influences on meaning) and retrieving relevant social and moral values to apply to those gist representations. Finally, research on interventions to support better decision making in clinical settings is reviewed, drawing out implications for future research on decision making and cancer. PsycINFO Database Record (c) 2015 APA, all rights reserved.

  16. Water and Life on Mars

    McKay, Christopher P.; DeVincenzi, Donald (Technical Monitor)

    2000-01-01

    Mars appears to be cold dry and dead world. However there is good evidence that early in its history it had liquid water, more active volcanism, and a thicker atmosphere. Mars had this earth-like environment over three and a half billion years ago, during the same time that life appeared on Earth. The main question in the exploration of Mars then is the search for a independent origin of life on that planet. Ecosystems in cold, dry locations on Earth - such as the Antarctic - provide examples of how life on Mars might have survived and where to look for fossils. Although the Viking results may indicate that Mars has no life today, there is direct geomorphological evidence that, in the past, Mars had large amounts of liquid water on its surface - possibly due to a thicker atmosphere. From a biological perspective the existence of liquid water, by itself motivates the question of the origin of life on Mars. One of the martian meteorites dates back to this early period and may contain evidence consistent with life. From studies of the Earth's earliest biosphere we know that by 3.5 Gyr. ago, life had originated on Earth and reached a fair degree of biological sophistication. Surface activity and erosion on Earth make it difficult to trace the history of life before the 3.5 Gyr timeframe. Ecosystems in cold, dry locations on Earth - such as the Antarctic - provide examples of how life on Mars might have survived and where to look for fossils.

  17. Life Cycle Collection Management

    Helen Shenton

    2003-09-01

    Full Text Available Life cycle collection management is a way of taking a long-term approach to the responsible stewardship of the British Library's collections and is one of the Library's strategic strands. It defines the different stages in a collection item's existence over time. These stages range from selection and acquisitions processing, cataloguing and press marking, through to preventive conservation, storage and retrieval. Life cycle collection management seeks to identify the costs of each stage in order to show the economic interdependencies between the phases over time. It thereby aims to demonstrate the long-term consequences of what the library takes into its collections, by making explicit the financial and other implications of decisions made at the beginning of the life cycle for the next 100 plus years. This paper describes the work over the past year at the British Library on this complex and complicated subject. It presents the emerging findings and suggests how it can be used for practical reasons (by individual curators and selectors and for economic, governance and political purposes. The paper describes the next steps in the project, for example, on a predictive data model. The British Library is seeking to benchmark itself against comparable organisations in this area. It intends to work with others on specific comparison for example, of life cycle costing of electronic and paper journals, as a prelude to eliding digital and 'traditional' formats.

  18. Life's end: Ethnographic perspectives.

    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.

  19. Guidance Tools for Use in Nuclear Material Management Decisions Making

    Johnson, G. V.; Baker, D. J.; Sorenson, K. B.; Boeke, S. G.

    2002-02-26

    This paper describes the results of Recommendation 14 of the Integrated Nuclear Materials Management Plan (INMMP) which was the product of a management initiative at the highest levels of the Department of Energy responding to a congressional directive to accelerate the work of achieving integration and cutting long-term costs associated with the management of nuclear materials, with the principal focus on excess materials. The INMMP provided direction to ''Develop policy-level decision support tools to support long-term planning and decision making.'' To accomplish this goal a team from the Savannah River Site, Sandia National Laboratories, Idaho National Engineering and Environmental Laboratory (INEEL), and the U.S. Department of Energy experienced in the decision-making process developed a Guidebook to Decision-Making Methods. The goal of the team organized to implement Recommendation 14 was to instill transparency, consistency, rigor, and discipline in the DOE decision process. The guidebook introduces a process and a selection of proven methods for disciplined decision-making so that the results are clearer, more transparent, and easier for reviewers to understand and accept. It was written to set a standard for a consistent decision process.

  20. One life

    Demkova E.E.

    2016-06-01

    Full Text Available It is not easy to care for a special needs child. Especially, it is easy to understand parents’ worries about their grown up children. Living in one’s own family or supported living in the community are much more preferable than the options the state can offer. The author — a mother of a young woman with autism — contemplates about possibilities for independent living for a person with special needs after their parents are gone. She is confident that teaching a child skills for independent living is not less important than giving them school education. The author illustrates her thoughts with real examples of support for adults with disabilities in their independent life or life in a foster family in a city, as well in rural areas.