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

Science.gov (United States)

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

2005-10-01

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

Role of Advance Care Planning in Proxy Decision Making Among Individuals With Dementia and Their Family Caregivers.

Science.gov (United States)

Kwak, Jung; De Larwelle, Jessica A; Valuch, Katharine O'Connell; Kesler, Toni

2016-01-01

Health care proxies make important end-of-life decisions for individuals with dementia. A cross-sectional survey was conducted to examine the role of advance care planning in proxy decision making for 141 individuals with cognitive impairment, Alzheimer's disease, or other types of dementia. Proxies who did not know the preferences of individuals with dementia for life support treatments reported greater understanding of their values. Proxies of individuals with dementia who did not want life support treatments anticipated receiving less support and were more uncertain in decision making. The greater knowledge proxies had about dementia trajectory, family support, and trust of physicians, the more informed, clearer, and less uncertain they were in decision making. In addition to advance care planning, multiple factors influence proxy decision making, which should be considered in developing interventions and future research to support informed decision making for individuals with dementia and their families. Copyright 2016, SLACK Incorporated.

"Doctor, Make My Decisions": Decision Control Preferences, Advance Care Planning, and Satisfaction With Communication Among Diverse Older Adults.

Science.gov (United States)

Chiu, Catherine; Feuz, Mariko A; McMahan, Ryan D; Miao, Yinghui; Sudore, Rebecca L

2016-01-01

Culturally diverse older adults may prefer varying control over medical decisions. Decision control preferences (DCPs) may profoundly affect advance care planning (ACP) and communication. To determine the DCPs of diverse, older adults and whether DCPs are associated with participant characteristics, ACP, and communication satisfaction. A total of 146 participants were recruited from clinics and senior centers in San Francisco. We assessed DCPs using the control preferences scale: doctor makes all decisions (low), shares with doctor (medium), makes own decisions (high). We assessed associations between DCPs and demographics; prior advance directives; ability to make in-the-moment goals of care decisions; self-efficacy, readiness, and prior asked questions; and satisfaction with patient-doctor communication (on a five-point Likert scale), using Chi-square and Kruskal-Wallis analysis of variance. Mean age was 71 ± 10 years, 53% were non-white, 47% completed an advance directive, and 70% made goals of care decisions. Of the sample, 18% had low DCPs, 33% medium, and 49% high. Older age was the only characteristic associated with DCPs (low: 75 ± 11 years, medium: 69 ± 10 years, high: 70 ± 9 years, P = 0.003). DCPs were not associated with ACP, in-the-moment decisions, or communication satisfaction. Readiness was the only question-asking behavior associated (low: 3.8 ± 1.2, medium: 4.1 ± 1.2, high: 4.3 ± 1.2, P = 0.05). Nearly one-fifth of diverse, older adults want doctors to make their medical decisions. Older age and lower readiness to ask questions were the only demographic variables significantly associated with low DCPs. Yet, older adults with low DCPs still engaged in ACP, asked questions, and reported communication satisfaction. Clinicians can encourage ACP and questions for all patients, but should assess DCPs to provide the desired amount of decision support. Copyright © 2016 American Academy of Hospice and Palliative Medicine. All

Improving Decision Making for Feeding Options in Advanced Dementia: A Randomized, Controlled Trial

Science.gov (United States)

Hanson, Laura C.; Carey, Timothy S.; Caprio, Anthony J.; Lee, Tae Joon; Ersek, Mary; Garrett, Joanne; Jackman, Anne; Gilliam, Robin; Wessell, Kathryn; Mitchell, Susan L.

2011-01-01

Background Feeding problems are common in dementia, and decision-makers have limited understanding of treatment options. Objectives To test whether a decision aid improves quality of decision-making about feeding options in advanced dementia. Design Cluster randomized controlled trial. Setting 24 nursing homes in North Carolina Participants Residents with advanced dementia and feeding problems and their surrogates. Intervention Intervention surrogates received an audio or print decision aid on feeding options in advanced dementia. Controls received usual care. Measurements Primary outcome was the Decisional Conflict Scale (range 1–5) measured at 3 months; other main outcomes were surrogate knowledge, frequency of communication with providers, and feeding treatment use. Results 256 residents and surrogate decision-makers were recruited. Residents’ average age was 85; 67% were Caucasian and 79% were women. Surrogates’ average age was 59; 67% were Caucasian, and 70% were residents’ children. The intervention improved knowledge scores (16.8 vs 15.1, paid about feeding options in advanced dementia reduced decisional conflict for surrogates and increased their knowledge and communication about feeding options with providers. PMID:22091750

Advanced Surface Technology

DEFF Research Database (Denmark)

Møller, Per; Nielsen, Lars Pleht

of the components. It covers everything from biocompatible surfaces of IR absorbent or reflective surfaces to surfaces with specific properties within low friction, hardness, corrosion, colors, etc. The book includes more than 400 pages detailing virtually all analysis methods for examining at surfaces.......This new significant book on advanced modern surface technology in all its variations, is aimed at both teaching at engineering schools and practical application in industry. The work covers all the significant aspects of modern surface technology and also describes how new advanced techniques make...

Making reasonable decisions: a qualitative study of medical decision making in the care of patients with a clinically significant haemoglobin disorder.

Science.gov (United States)

Crowther, Helen J; Kerridge, Ian

2015-10-01

Therapies utilized in patients with clinically significant haemoglobin disorders appear to vary between clinicians and units. This study aimed to investigate the processes of evidence implementation and medical decision making in the care of such patients in NSW, Australia. Using semi-structured interviews, 11 haematologists discussed their medical decision-making processes with particular attention paid to the use of published evidence. Transcripts were thematically analysed by a single investigator on a line-by-line basis. Decision making surrounding the care of patients with significant haemoglobin disorders varied and was deeply contextual. Three main determinants of clinical decision making were identified - factors relating to the patient and to their illness, factors specific to the clinician and the institution in which they were practising and factors related to the notion of evidence and to utility and role of evidence-based medicine in clinical practice. Clinicians pay considerable attention to medical decision making and evidence incorporation and attempt to tailor these to particular patient contexts. However, the patient context is often inferred and when discordant with the clinician's own contexture can lead to discomfort with decision recommendations. Clinicians strive to improve comfort through the use of experience and trustworthy evidence. © 2015 John Wiley & Sons, Ltd.

Challenges in shared decision making in advanced cancer care: a qualitative longitudinal observational and interview study.

Science.gov (United States)

Brom, Linda; De Snoo-Trimp, Janine C; Onwuteaka-Philipsen, Bregje D; Widdershoven, Guy A M; Stiggelbout, Anne M; Pasman, H Roeline W

2017-02-01

Patients' preferences and expectations should be taken into account in treatment decision making in the last phase of life. Shared decision making (SDM) is regarded as a way to give the patient a central role in decision making. Little is known about how SDM is used in clinical practice in advanced cancer care. To examine whether and how the steps of SDM can be recognized in decision making about second- and third-line chemotherapy. Fourteen advanced cancer patients were followed over time using face-to-face in-depth interviews and observations of the patients' out-clinic visits. Interviews and outpatient clinic visits in which treatment options were discussed or decisions made were transcribed verbatim and analysed using open coding. Patients were satisfied with the decision-making process, but the steps of SDM were barely seen in daily practice. The creation of awareness about available treatment options by physicians was limited and not discussed in an equal way. Patients' wishes and concerns were not explicitly assessed, which led to different expectations about improved survival from subsequent lines of chemotherapy. To reach SDM in daily practice, physicians should create awareness of all treatment options, including forgoing treatment, and communicate the risk of benefit and harm. Open and honest communication is needed in which patients' expectations and concerns are discussed. Through this, the difficult process of decision making in the last phase of life can be facilitated and the focus on the best care for the specific patient is strengthened. © 2015 The Authors. Health Expectations Published by John Wiley & Sons Ltd.

US energy agency making progress

Science.gov (United States)

2017-07-01

The Advanced Research Projects Agency-Energy (ARPA-E) has the ability to make significant contributions to energy research but must be allowed time to do so, according to a report by the US National Academies of Sciences, Engineering and Medicine.

Significance of Metabolic Super scan in Patients With Locally Advanced Bladder Cancer

International Nuclear Information System (INIS)

Kotb, M.H.; El-Kholy, E.; Omar, W.; El-Refaei, S.; Taher, A.N.; El-Marakby, H.

2011-01-01

was more frequent in patients with SCC (P<0.001). Out of 401 documented bone lesions, 302 proved to be metabolic related, 97 metastatic and 2 non-metabolic benign bone lesions. The sensitivity and specificity of bone scanning in documentation of bone lesions were 100% and 91%, respectively. Serum creatinine level for metabolic group was significantly elevated (3.91 ± 1.76 compared to 1.16 ± 0.47 and 1.07 ± 0.5) for normal and metastatic groups, respectively (P<0.001). Back pressure changes were significantly higher in metabolic group (90%) compared to 20% and 17% for normal and metastatic groups, respectively (P<0.001). Regarding the mortality rate, no difference was found between the metabolic and normal groups (15.7% and 15.2%, respectively) while patients in the metabolic group showed a much higher incidence of morbidity as compared to the normal group. It could be concluded that the disturbance in bone metabolism is strongly evident in locally advanced bladder cancer patients with renal impairment. Metabolic bone changes seem to be higher in SCC patients as compared to TCC. MSS features are significantly better than bio markers in detection of metabolic changes. Integration of bone scan in the diagnostic work up of locally advanced bladder cancer is a simple reliable tool of dual benefit that may improve patient management through monitoring and differentiating between metabolic changes and skeletal metastases

Building to Make a Difference: Advanced Practice Nurses' Experience of Power.

Science.gov (United States)

Schoales, Catherine A; Bourbonnais, Frances Fothergill; Rashotte, Judy

2018-02-01

Power is necessary for nurses to affect change in patient care and to move the nursing profession forward. Despite the evolving body of nursing research on power, there have been no studies that have investigated the nature of advanced practice nurses' (APNs') power. The purpose of this study was to explore the APNs' lived experience of power. Interpretive phenomenology guided the method and analysis. Eight APNs employed in a single Canadian tertiary care teaching health-care organization engaged in in-depth interviews. The overarching theme, building to make a difference, reflected the APNs' perception of power in their practice, which involved a passion to facilitate change in practice to improve patient care. Building to make a difference involved three themes: building on, building with, and building for. The APNs experienced more power-a process they described as power creep-when they used soft power that was shared with others to affect positive change in health care. These findings contribute to our understanding of how power is perceived and manifested in the APN role, thus further enabling organizations to create working conditions to support the APNs' endeavors to empower others.

NASA Advanced Supercomputing Facility Expansion

Science.gov (United States)

Thigpen, William W.

2017-01-01

The NASA Advanced Supercomputing (NAS) Division enables advances in high-end computing technologies and in modeling and simulation methods to tackle some of the toughest science and engineering challenges facing NASA today. The name "NAS" has long been associated with leadership and innovation throughout the high-end computing (HEC) community. We play a significant role in shaping HEC standards and paradigms, and provide leadership in the areas of large-scale InfiniBand fabrics, Lustre open-source filesystems, and hyperwall technologies. We provide an integrated high-end computing environment to accelerate NASA missions and make revolutionary advances in science. Pleiades, a petaflop-scale supercomputer, is used by scientists throughout the U.S. to support NASA missions, and is ranked among the most powerful systems in the world. One of our key focus areas is in modeling and simulation to support NASA's real-world engineering applications and make fundamental advances in modeling and simulation methods.

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

Science.gov (United States)

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

2013-01-01

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

Safety significance of ATR [Advanced Test Reactor] passive safety response attributes

International Nuclear Information System (INIS)

Atkinson, S.A.

1989-01-01

The Advanced Test Reactor (ATR) at the Idaho National Engineering Laboratory was designed with some passive safety response attributes which contribute to the safety posture of the facility. The three passive safety attributes being evaluated in the paper are: (1) In-core and in-vessel natural convection cooling, (2) a passive heat sink capability of the ATR primary coolant system (PCS) for the transfer of decay power from the uninsulated piping to the confinement, and (3) gravity feed of emergency coolant makeup. The safety significance of the ATR passive safety response attributes is that the reactor can passively respond for most transients, given a reactor scram, to provide adequate decay power removal and a significant time for operator action should the normal active heat removal systems and their backup systems both fail. The ATR Interim Level 1 Probabilistic Risk Assessment (PRA) model ands results were used to evaluate the significance to ATR fuel damage frequency (or probability) of the above three passive response attributes. The results of the evaluation indicate that the first attribute is a major safety characteristic of the ATR. The second attribute has a noticeable but only minor safety significance. The third attribute has no significant influence on the ATR Level 1 PRA because of the diversity and redundancy of the ATR firewater injection system (emergency coolant system). 8 refs., 4 figs., 1 tab

Run-time coupling advanced control software with building simulation environment

NARCIS (Netherlands)

Yahiaoui, A.; Hensen, J.L.M.; Soethout, L.L.; Hensen, J.L.M.; Lain, M.

2004-01-01

The use of advanced control technologies and intelligence in buildings and infrastructure could make the current high performance system much more efficient and reliable. The integration of advanced control strategies into the building will certainly produce significant results for better building

U.S. Public Health Service Commissioned Corps pharmacists: making a difference in advancing the nation's health.

Science.gov (United States)

Flowers, Louis; Wick, Jeannette; Figg, William Douglas; McClelland, Robert H; Shiber, Michael; Britton, James E; Ngo, Diem-Kieu H; Borders-Hemphill, Vicky; Mead, Christina; Zee, Jerry; Huntzinger, Paul

2009-01-01

To describe how U.S. Public Health Service (PHS) pharmacists serving in jobs that are normal for them, but considerably different than those found in the private sector, are making a difference in advancing the nation's health. Pharmacists who serve in the Commissioned Corps of PHS fill roles that are considerably different than their counterparts in the private sector. Their work takes them out from behind the counter and into the world. Pharmacy officers advance the health and safety of the nation by their involvement in the delivery of direct patient care to medically underserved people, national security, drug vigilance, research, and policy-making endeavors. PHS pharmacists fill essential public health leadership and service roles throughout the U.S. Department of Health and Human Services (HHS) and certain non-HHS federal agencies and programs. The Health Resources and Services Administration, National Institutes of Health, Federal Bureau of Prisons, Indian Health Service, Food and Drug Administration, and U.S. Coast Guard are among the many federal agencies in which pharmacy officers are assigned. In each setting, PHS pharmacists find traditional roles augmented with assignments and challenges that broaden the scope of their practice.

[Adequacy of clinical interventions in patients with advanced and complex disease. Proposal of a decision making algorithm].

Science.gov (United States)

Ameneiros-Lago, E; Carballada-Rico, C; Garrido-Sanjuán, J A; García Martínez, A

2015-01-01

Decision making in the patient with chronic advanced disease is especially complex. Health professionals are obliged to prevent avoidable suffering and not to add any more damage to that of the disease itself. The adequacy of the clinical interventions consists of only offering those diagnostic and therapeutic procedures appropriate to the clinical situation of the patient and to perform only those allowed by the patient or representative. In this article, the use of an algorithm is proposed that should serve to help health professionals in this decision making process. Copyright © 2014 SECA. Published by Elsevier Espana. All rights reserved.

Quantitative imaging biomarkers: the application of advanced image processing and analysis to clinical and preclinical decision making.

Science.gov (United States)

Prescott, Jeffrey William

2013-02-01

The importance of medical imaging for clinical decision making has been steadily increasing over the last four decades. Recently, there has also been an emphasis on medical imaging for preclinical decision making, i.e., for use in pharamaceutical and medical device development. There is also a drive towards quantification of imaging findings by using quantitative imaging biomarkers, which can improve sensitivity, specificity, accuracy and reproducibility of imaged characteristics used for diagnostic and therapeutic decisions. An important component of the discovery, characterization, validation and application of quantitative imaging biomarkers is the extraction of information and meaning from images through image processing and subsequent analysis. However, many advanced image processing and analysis methods are not applied directly to questions of clinical interest, i.e., for diagnostic and therapeutic decision making, which is a consideration that should be closely linked to the development of such algorithms. This article is meant to address these concerns. First, quantitative imaging biomarkers are introduced by providing definitions and concepts. Then, potential applications of advanced image processing and analysis to areas of quantitative imaging biomarker research are described; specifically, research into osteoarthritis (OA), Alzheimer's disease (AD) and cancer is presented. Then, challenges in quantitative imaging biomarker research are discussed. Finally, a conceptual framework for integrating clinical and preclinical considerations into the development of quantitative imaging biomarkers and their computer-assisted methods of extraction is presented.

Cognitive function and advanced kidney disease: longitudinal trends and impact on decision-making.

Science.gov (United States)

Iyasere, Osasuyi; Okai, David; Brown, Edwina

2017-02-01

Background: Cognitive impairment commonly affects renal patients. But little is known about the influence of dialysis modality on cognitive trends or the influence of cognitive impairment on decision-making in renal patients. This study evaluated cognitive trends amongst chronic kidney disease (CKD), haemodialysis (HD) and peritoneal dialysis (PD) patients. The relationship between cognitive impairment and decision-making capacity (DMC) was also assessed. Methods: Patients were recruited from three outpatient clinics. Cognitive function was assessed 4-monthly for up to 2 years, using the Montreal Cognitive Assessment (MoCA) tool. Cognitive trends were assessed using mixed model analysis. DMC was assessed using the Macarthur Competency Assessment tool (MacCAT-T). MacCAT-T scores were compared between patients with cognitive impairment (MoCA cognitive impairment had lower MacCAT-T compared with those without [median (interquartile range) 19 (17.9-19.6) versus 17.4 (16.3-18.4); P = 0.049]. Conclusions: Cognition declines faster in dialysis patients compared with CKD patients and in HD patients compared with PD patients. Cognitive impairment affects DMC in patients with advanced kidney disease.

AdvancED Flex 4

CERN Document Server

Tiwari, Shashank; Schulze, Charlie

2010-01-01

AdvancED Flex 4 makes advanced Flex 4 concepts and techniques easy. Ajax, RIA, Web 2.0, mashups, mobile applications, the most sophisticated web tools, and the coolest interactive web applications are all covered with practical, visually oriented recipes. * Completely updated for the new tools in Flex 4* Demonstrates how to use Flex 4 to create robust and scalable enterprise-grade Rich Internet Applications.* Teaches you to build high-performance web applications with interactivity that really engages your users.* What you'll learn Practiced beginners and intermediate users of Flex, especially

Make the healthy choice the easy choice: using behavioral economics to advance a culture of health.

Science.gov (United States)

Volpp, K G; Asch, D A

2017-05-01

Despite great advances in the science and technology of health care, a large gap separates theoretically achievable advances in health from what individuals and populations actually achieve. Human behavior sits on the final common pathway to so many of our health and health care goals, including the prevention and management of illness and the fostering of wellness. Behavioral economics is a relatively new field offering approaches to supplement many of the conventional approaches to improving health behaviors that rely on education or standard economic theory. While those conventional approaches presume that an educated public will naturally make decisions that optimize personal welfare, approaches derived from behavioral economics harness existing and predictable patterns of behavior that often lead people to make choices against their best interests. By keeping these predictable patterns of behavior in mind when designing health insurance, health care programs or the health-related aspects of everyday life, behavioral economists aim to meet people half-way: no longer asking them to reshape their behavior to something more health promoting, but helping the behavioral patterns they already follow lead them to better health. © The Author 2016. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Prognostic significance of symptoms of hospitalised advanced cancer patients

NARCIS (Netherlands)

Teunissen, Saskia C.; de Graeff, Alexander; de Haes, Hanneke C.; Voest, Emile E.

2006-01-01

To assess the prognostic value of symptoms in hospitalised advanced cancer patients. A prospective analysis was performed of 181 hospitalised patients referred to a Palliative Care Team. Comprehensive symptom questionnaire, functional status, estimated life expectancy and survival were assessed.

Risk-informed decision making a keystone in advanced safety assessment

International Nuclear Information System (INIS)

Reinhart, M.

2007-01-01

Probabilistic Safety Assessment (PSA) has provided extremely valuable complementary insight, perspective, comprehension, and balance to deterministic nuclear reactor safety assessment. This integrated approach of risk-informed management and decision making has been called Risk-Informed Decision Making (RIDM). RIDM provides enhanced safety, reliability, operational flexibility, reduced radiological exposure, and improved fiscal economy. Applications of RIDM continuously increase. Current applications are in the areas of design, construction, licensing, operations, and security. Operational phase safety applications include the following: technical specifications improvement, risk-monitors and configuration control, maintenance planning, outage planning and management, in-service inspection, inservice testing, graded quality assurance, reactor oversight and inspection, inspection finding significance determination, operational events assessment, and rulemaking. Interestingly there is a significant spectrum of approaches, methods, programs, controls, data bases, and standards. The quest of many is to assimilate the full compliment of PSA and RIDM information and to achieve a balanced international harmony. The goal is to focus the best of the best, so to speak, for the benefit of all. Accordingly, this presentation will address the principles, benefits, and applications of RIDM. It will also address some of the challenges and areas to improve. Finally it will highlight efforts by the IAEA and others to capture the international thinking, experience, successes, challenges, and lessons in RIDM. (authors)

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

Science.gov (United States)

Searight, H Russell; Gafford, Jennifer

2005-07-01

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

Serum Advanced Oxidation Protein Products in Oral Squamous Cell Carcinoma: Possible Markers of Diagnostic Significance

Directory of Open Access Journals (Sweden)

Abhishek Singh Nayyar

2013-07-01

Full Text Available Background: The aim of this study was to measure the concentrations (levels ofserum total proteins and advanced oxidation protein products as markers of oxidantmediated protein damage in the sera of patients with oral cancers.Methods: The study consisted of the sera analyses of serum total protein andadvanced oxidation protein products’ levels in 30 age and sex matched controls, 60patients with reported pre-cancerous lesions and/or conditions and 60 patients withhistologically proven oral squamous cell carcinoma. One way analyses of variance wereused to test the difference between groups. To determine which of the two groups’ meanswere significantly different, the post-hoc test of Bonferroni was used. The results wereaveraged as mean ± standard deviation. In the above test, P values less than 0.05 weretaken to be statistically significant. The normality of data was checked before thestatistical analysis was performed.Results: The study revealed statistically significant variations in serum levels ofadvanced oxidation protein products (P<0.001. Serum levels of total protein showedextensive variations; therefore the results were largely inconclusive and statisticallyinsignificant.Conclusion: The results emphasize the need for more studies with larger samplesizes to be conducted before a conclusive role can be determined for sera levels of totalprotein and advanced oxidation protein products as markers both for diagnosticsignificance and the transition from the various oral pre-cancerous lesions and conditionsinto frank oral cancers.

Prognostic factors in advanced breast cancer: Race and receptor status are significant after development of metastasis.

Science.gov (United States)

Ren, Zhiyong; Li, Yufeng; Shen, Tiansheng; Hameed, Omar; Siegal, Gene P; Wei, Shi

2016-01-01

Prognostic factors are well established in early-stage breast cancer (BC), but less well-defined in advanced disease. We analyzed 323 BC patients who had distant relapse during follow-up from 1997 to 2010 to determine the significant clinicopathologic factors predicting survival outcomes. By univariate analysis, race, tumor grade, estrogen and progesterone receptors (ER/PR) and HER2 status were significantly associated with overall survival (OS) and post-metastasis survival (PMS). Applying a Cox regression model revealed that all these factors remained significant for PMS, while race, tumor grade and HER2 were independent factors for OS. Tumor grade was the only significant factor for metastasis-free survival by univariate and multivariate analyses. Our findings demonstrated that being Caucasian, hormonal receptor positive (HR+) and HER2 positive (HER2+) were all associated with a decreased hazard of death and that patients with HR+/HER2+ tumors had superior outcomes to those with HR+/HER2- disease. Further, PR status held a prognostic value over ER, thus reflecting the biologic mechanism of the importance of the functional ER pathway and the heterogeneity in the response to endocrine therapy. These observations indicate that the patients' genetic makeup and the intrinsic nature of the tumor principally govern BC progression and prognosticate the long-term outcomes in advanced disease. Copyright © 2015 Elsevier GmbH. All rights reserved.

Advanced Team Decision Making: A Developmental Model

Science.gov (United States)

1992-08-03

role - right wing, center, goalie - but as they set up plays and bring the STRONG puck down the ice, those individuals begin to function TEAM... pulled the team member’s attention away from assigned work - Unwise use of a member’s expertise in designating roles or functions In these cases, advanced

Why doesn't a family member of a person with advanced dementia use a substituted judgment when making a decision for that person?

Science.gov (United States)

Hirschman, Karen B; Kapo, Jennifer M; Karlawish, Jason H T

2006-08-01

The objective of this study was to identify what standard of decision making a family member uses when making medical decisions for their relative with advanced dementia. Thirty family members of patients with advanced dementia from an Alzheimer disease center and a suburban long-term care facility were interviewed using a semistructured interview. All interviews were audiotaped, transcribed, and analyzed using qualitative data analysis techniques. Family members were split almost evenly in the standard they used when making medical decisions for their relative: substituted judgment (43%) or best interests (57%). However, few who used the substituted judgment standard viewed it as distinct from best interests. Instead, both standards were taken into consideration when making medical decisions. In addition to not having discussions about healthcare preferences, the reasons for not using a substituted judgment included: the need for family consensus, unrealistic expectations of the patient, the need to incorporate their relative's quality of life into the decision, and the influence of healthcare professionals. Family members who did not have discussions about healthcare preferences identified various barriers to the discussion, including waiting too long, avoiding the topic, and the patient's denial of dementia. These data suggest several reasons why surrogate decision-makers for persons with advanced dementia do not use the substituted judgment standard and the potential value of interventions that would allow patients with early-stage dementia and their family members to discuss healthcare preferences.

A Review of Significant Advances in Neutron Imaging from Conception to the Present

Science.gov (United States)

Brenizer, J. S.

This review summarizes the history of neutron imaging with a focus on the significant events and technical advancements in neutron imaging methods, from the first radiograph to more recent imaging methods. A timeline is presented to illustrate the key accomplishments that advanced the neutron imaging technique. Only three years after the discovery of the neutron by English physicist James Chadwick in 1932, neutron imaging began with the work of Hartmut Kallmann and Ernst Kuhn in Berlin, Germany, from 1935-1944. Kallmann and Kuhn were awarded a joint US Patent issued in January 1940. Little progress was made until the mid-1950's when Thewlis utilized a neutron beam from the BEPO reactor at Harwell, marking the beginning of the application of neutron imaging to practical applications. As the film method was improved, imaging moved from a qualitative to a quantitative technique, with applications in industry and in nuclear fuels. Standards were developed to aid in the quantification of the neutron images and the facility's capabilities. The introduction of dynamic neutron imaging (initially called real-time neutron radiography and neutron television) in the late 1970's opened the door to new opportunities and new challenges. As the electronic imaging matured, the introduction of the CCD imaging devices and solid-state light intensifiers helped address some of these challenges. Development of improved imaging devices for the medical community has had a major impact on neutron imaging. Additionally, amorphous silicon sensors provided improvements in temporal resolution, while providing a reasonably large imaging area. The development of new neutron imaging sensors and the development of new neutron imaging techniques in the past decade has advanced the technique's ability to provide insight and understanding of problems that other non-destructive techniques could not provide. This rapid increase in capability and application would not have been possible without the

Research advances in regorafenib in treatment of hepatocellular carcinoma

Directory of Open Access Journals (Sweden)

CHEN Weibo

2017-12-01

Full Text Available Hepatocellular carcinoma (HCC is the most common malignant liver tumor, and there are limited systemic treatments for patients with advanced HCC. Regorafenib is an oral multi-kinase inhibitor, and phase III clinical trial has shown that regorafenib can significantly extend the median survival of patients with advanced HCC by 2.8 months, which makes it a second-line drug approved by FDA for the treatment of advanced HCC, just after sorafenib. This article reviews the basic and clinical research on regorafenib in the field of HCC.

Advances in fuzzy decision making theory and practice

CERN Document Server

Skalna, Iwona; Gaweł, Bartłomiej; Basiura, Beata; Duda, Jerzy; Opiła, Janusz; Pełech-Pilichowski, Tomasz

2015-01-01

This book shows how common operation management methods and algorithms can be extended to deal with vague or imprecise information in decision-making problems. It describes how to combine decision trees, clustering, multi-attribute decision-making algorithms and Monte Carlo Simulation with the mathematical description of imprecise or vague information, and how to visualize such information. Moreover, it discusses a broad spectrum of real-life management problems including forecasting the apparent consumption of steel products, planning and scheduling of production processes, project portfolio selection and economic-risk estimation. It is a concise, yet comprehensive, reference source for researchers in decision-making and decision-makers in business organizations alike.

Advanced Education and Technology Business Plan, 2007-10

Science.gov (United States)

Alberta Enterprise and Advanced Education, 2007

2007-01-01

The Government of Alberta Strategic Business Plan addresses significant opportunities and challenges facing Alberta over the next three years and positions Alberta to make the most of its economic, social and natural advantages. It is a plan to strategically manage growth and plan for a sustainable and secure future. Advanced Education and…

Intelligent decision-making models for production and retail operations

CERN Document Server

Guo, Zhaoxia

2016-01-01

This book provides an overview of intelligent decision-making techniques and discusses their application in production and retail operations. Manufacturing and retail enterprises have stringent standards for using advanced and reliable techniques to improve decision-making processes, since these processes have significant effects on the performance of relevant operations and the entire supply chain. In recent years, researchers have been increasingly focusing attention on using intelligent techniques to solve various decision-making problems. The opening chapters provide an introduction to several commonly used intelligent techniques, such as genetic algorithm, harmony search, neural network and extreme learning machine. The book then explores the use of these techniques for handling various production and retail decision-making problems, such as production planning and scheduling, assembly line balancing, and sales forecasting.

The Future of Nursing: Leading Change, Advancing Health

Science.gov (United States)

National Academies Press, 2011

2011-01-01

"The Future of Nursing" explores how nurses' roles, responsibilities, and education should change significantly to meet the increased demand for care that will be created by health care reform and to advance improvements in America's increasingly complex health system. At more than 3 million in number, nurses make up the single…

Interaction between FOXO1A-209 Genotype and Tea Drinking is Significantly Associated with Reduced Mortality at Advanced Ages

DEFF Research Database (Denmark)

Zeng, Yi; Chen, Huashuai; Ni, Ting

2016-01-01

Based on the genotypic/phenotypic data from Chinese Longitudinal Healthy Longevity Survey (CLHLS) and Cox proportional hazard model, the present study demonstrates that interactions between carrying FOXO1A-209 genotypes and tea drinking are significantly associated with lower risk of mortality...... at advanced ages. Such significant association is replicated in two independent Han Chinese CLHLS cohorts (p =0.028-0.048 in the discovery and replication cohorts, and p =0.003-0.016 in the combined dataset). We found the associations between tea drinking and reduced mortality are much stronger among carriers...... of the FOXO1A-209 genotype compared to non-carriers, and drinking tea is associated with a reversal of the negative effects of carrying FOXO1A-209 minor alleles, that is, from a substantially increased mortality risk to substantially reduced mortality risk at advanced ages. The impacts are considerably...

7 CFR 1485.18 - Advances.

Science.gov (United States)

2010-01-01

... operates MAP and EIP/MAP on a reimbursable basis. CCC will not advance funds to an EIP/MAP participant or... generic activity budget. However, CCC will not make any advance to an MAP participant where an advance is... 7 Agriculture 10 2010-01-01 2010-01-01 false Advances. 1485.18 Section 1485.18 Agriculture...

Making the Sustainable Development Goals Consistent with Sustainability

Directory of Open Access Journals (Sweden)

Mathis Wackernagel

2017-07-01

Full Text Available The UN’s Sustainable development Goals (SDGs are the most significant global effort so far to advance global sustainable development. Bertelsmann Stiftung and the sustainable development solutions network released an SDG index to assess countries’ average performance on SDGs. Ranking high on the SDG index strongly correlates with high per person demand on nature (or “Footprints”, and low ranking with low Footprints, making evident that the SDGs as expressed today vastly underperform on sustainability. Such underperformance is anti-poor because lowest-income people exposed to resource insecurity will lack the financial means to shield themselves from the consequences. Given the significance of the SDGs for guiding development, rigorous accounting is essential for making them consistent with the goals of sustainable development: thriving within the means of planet Earth.

Making the Sustainable Development Goals Consistent with Sustainability

International Nuclear Information System (INIS)

Wackernagel, Mathis; Hanscom, Laurel; Lin, David

2017-01-01

The UN’s Sustainable development Goals (SDGs) are the most significant global effort so far to advance global sustainable development. Bertelsmann Stiftung and the sustainable development solutions network released an SDG index to assess countries’ average performance on SDGs. Ranking high on the SDG index strongly correlates with high per person demand on nature (or “Footprints”), and low ranking with low Footprints, making evident that the SDGs as expressed today vastly underperform on sustainability. Such underperformance is anti-poor because lowest-income people exposed to resource insecurity will lack the financial means to shield themselves from the consequences. Given the significance of the SDGs for guiding development, rigorous accounting is essential for making them consistent with the goals of sustainable development: thriving within the means of planet Earth.

Making the Sustainable Development Goals Consistent with Sustainability

Energy Technology Data Exchange (ETDEWEB)

Wackernagel, Mathis, E-mail: mathis.wackernagel@footprintnetwork.org; Hanscom, Laurel; Lin, David [Global Footprint Network, Oakland, CA (United States)

2017-07-11

The UN’s Sustainable development Goals (SDGs) are the most significant global effort so far to advance global sustainable development. Bertelsmann Stiftung and the sustainable development solutions network released an SDG index to assess countries’ average performance on SDGs. Ranking high on the SDG index strongly correlates with high per person demand on nature (or “Footprints”), and low ranking with low Footprints, making evident that the SDGs as expressed today vastly underperform on sustainability. Such underperformance is anti-poor because lowest-income people exposed to resource insecurity will lack the financial means to shield themselves from the consequences. Given the significance of the SDGs for guiding development, rigorous accounting is essential for making them consistent with the goals of sustainable development: thriving within the means of planet Earth.

Undetected cognitive impairment and decision-making capacity in patients receiving hospice care.

Science.gov (United States)

Burton, Cynthia Z; Twamley, Elizabeth W; Lee, Lana C; Palmer, Barton W; Jeste, Dilip V; Dunn, Laura B; Irwin, Scott A

2012-04-01

: Cognitive dysfunction is common in patients with advanced, life-threatening illness and can be attributed to a variety of factors (e.g., advanced age, opiate medication). Such dysfunction likely affects decisional capacity, which is a crucial consideration as the end-of-life approaches and patients face multiple choices regarding treatment, family, and estate planning. This study examined the prevalence of cognitive impairment and its impact on decision-making abilities among hospice patients with neither a chart diagnosis of a cognitive disorder nor clinically apparent cognitive impairment (e.g., delirium, unresponsiveness). : A total of 110 participants receiving hospice services completed a 1-hour neuropsychological battery, a measure of decisional capacity, and accompanying interviews. : In general, participants were mildly impaired on measures of verbal learning, verbal memory, and verbal fluency; 54% of the sample was classified as having significant, previously undetected cognitive impairment. These individuals performed significantly worse than the other participants on all neuropsychological and decisional capacity measures, with effect sizes ranging from medium to very large (0.43-2.70). A number of verbal abilities as well as global cognitive functioning significantly predicted decision-making capacity. : Despite an absence of documented or clinically obvious impairment, more than half of the sample had significant cognitive impairments. Assessment of cognition in hospice patients is warranted, including assessment of verbal abilities that may interfere with understanding or reasoning related to treatment decisions. Identification of patients at risk for impaired cognition and decision making may lead to effective interventions to improve decision making and honor the wishes of patients and families.

Decision making in advanced otosclerosis: an evidence-based strategy

NARCIS (Netherlands)

Merkus, P.; van Loon, M.C.; Smit, C.F.G.M.; Smits, J.C.M.; de Cock, A.F.C.; Hensen, E.F.

2011-01-01

Objectives/Hypothesis: To propose an evidence-based strategy for the management of patients with advanced otosclerosis accompanied by severe to profound hearing loss. Study Design: Systematic review of the literature and development of treatment guidelines. Methods: A systematic review was conducted

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

Science.gov (United States)

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

Assessing the Decision-Making Capacity of Terminally Ill Patients with Cancer.

Science.gov (United States)

Kolva, Elissa; Rosenfeld, Barry; Saracino, Rebecca

2018-05-01

Despite the clinical, ethical, and legal magnitude of end-of-life decision-making, the capacity of terminally ill patients to make the medical decisions they often face is largely unknown. In practice, clinicians are responsible for determining when their patients are no longer competent to make treatment decisions, yet the accuracy of these assessments is unclear. The purpose of this study was to explore decision-making capacity and its assessment in terminally ill cancer patients. Fifty-five patients with advanced cancer receiving inpatient palliative care and 50 healthy adults were administered the MacArthur Competence Assessment Tool for Treatment (MacCAT-T) to evaluate decision-making capacity with regard to the four most commonly used legal standards: Choice, Understanding, Appreciation, and Reasoning. Participants made a hypothetical treatment decision about whether to accept artificial nutrition and hydration for treatment of cachexia. Participants' physicians independently rated their decision-making capacity. Terminally ill participants were significantly more impaired than healthy adults on all MacCAT-T subscales. Most terminally ill participants were able to express a treatment choice (85.7%), but impairment was common on the Understanding (44.2%), Appreciation (49.0%), and Reasoning (85.4%) subscales. Agreement between physician-rated capacity and performance on the MacCAT-T subscales was poor. The use of the MacCAT-T revealed high rates of decisional impairment in terminally ill participants. Participants' physicians infrequently detected impairment identified by the MacCAT-T. The findings from the present study reinforce the need for engagement in advance care planning for patients with advanced cancer. Copyright © 2018 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.

Randomized controlled trial of a video decision support tool for cardiopulmonary resuscitation decision making in advanced cancer.

Science.gov (United States)

Volandes, Angelo E; Paasche-Orlow, Michael K; Mitchell, Susan L; El-Jawahri, Areej; Davis, Aretha Delight; Barry, Michael J; Hartshorn, Kevan L; Jackson, Vicki Ann; Gillick, Muriel R; Walker-Corkery, Elizabeth S; Chang, Yuchiao; López, Lenny; Kemeny, Margaret; Bulone, Linda; Mann, Eileen; Misra, Sumi; Peachey, Matt; Abbo, Elmer D; Eichler, April F; Epstein, Andrew S; Noy, Ariela; Levin, Tomer T; Temel, Jennifer S

2013-01-20

Decision making regarding cardiopulmonary resuscitation (CPR) is challenging. This study examined the effect of a video decision support tool on CPR preferences among patients with advanced cancer. We performed a randomized controlled trial of 150 patients with advanced cancer from four oncology centers. Participants in the control arm (n = 80) listened to a verbal narrative describing CPR and the likelihood of successful resuscitation. Participants in the intervention arm (n = 70) listened to the identical narrative and viewed a 3-minute video depicting a patient on a ventilator and CPR being performed on a simulated patient. The primary outcome was participants' preference for or against CPR measured immediately after exposure to either modality. Secondary outcomes were participants' knowledge of CPR (score range of 0 to 4, with higher score indicating more knowledge) and comfort with video. The mean age of participants was 62 years (standard deviation, 11 years); 49% were women, 44% were African American or Latino, and 47% had lung or colon cancer. After the verbal narrative, in the control arm, 38 participants (48%) wanted CPR, 41 (51%) wanted no CPR, and one (1%) was uncertain. In contrast, in the intervention arm, 14 participants (20%) wanted CPR, 55 (79%) wanted no CPR, and 1 (1%) was uncertain (unadjusted odds ratio, 3.5; 95% CI, 1.7 to 7.2; P advanced cancer who viewed a video of CPR were less likely to opt for CPR than those who listened to a verbal narrative.

ADVANCE PAYMENTS

CERN Multimedia

Human Resources Division

2002-01-01

Administrative Circular Nº 8 makes provision for the granting of advance payments, repayable in several monthly instalments, by the Organization to the members of its personnel. Members of the personnel are reminded that these advances are only authorized in exceptional circumstances and at the discretion of the Director-General. In view of the current financial situation of the Organization, and in particular the loans it will have to incur, the Directorate has decided to restrict the granting of such advances to exceptional or unforeseen circumstances entailing heavy expenditure and more specifically those pertaining to social issues. Human Resources Division Tel. 73962

Advance payments

CERN Multimedia

Human Resources Division

2003-01-01

Administrative Circular N 8 makes provision for the granting of advance payments, repayable in several monthly instalments, by the Organization to the members of its personnel. Members of the personnel are reminded that these advances are only authorized in exceptional circumstances and at the discretion of the Director-General. In view of the current financial situation of the Organization, and in particular the loans it will have to incur, the Directorate has decided to restrict the granting of such advances to exceptional or unforeseen circumstances entailing heavy expenditure and more specifically those pertaining to social issues. Human Resources Division Tel. 73962

Prognostic significance of mediastinal {sup 18}F-FDG uptake in PET/CT in advanced ovarian cancer

Energy Technology Data Exchange (ETDEWEB)

Bats, Anne-Sophie; Lecuru, Fabrice [Universite Paris Descartes, Sorbonne Paris Cite, Faculte de Medecine, Paris (France); Hopital Europeen Georges-Pompidou, Assistance Publique-Hopitaux de Paris, Service de Chirurgie Gynecologique et Cancerologique, Paris (France); Universite Paris Descartes, Sorbonne Paris Cite, INSERM UMR-S 747, Paris (France); Hugonnet, Florent; Faraggi, Marc [Universite Paris Descartes, Sorbonne Paris Cite, Faculte de Medecine, Paris (France); Hopital Europeen Georges-Pompidou, Assistance Publique-Hopitaux de Paris, Service de Medecine Nucleaire, Paris (France); Huchon, Cyrille [Universite Paris Descartes, Sorbonne Paris Cite, Faculte de Medecine, Paris (France); Hopital Europeen Georges-Pompidou, Assistance Publique-Hopitaux de Paris, Service de Chirurgie Gynecologique et Cancerologique, Paris (France); Bensaid, Cherazade [Hopital Europeen Georges-Pompidou, Assistance Publique-Hopitaux de Paris, Service de Chirurgie Gynecologique et Cancerologique, Paris (France); Pierquet-Ghazzar, Nadia [Hopital Europeen Georges-Pompidou, Assistance Publique-Hopitaux de Paris, Service de Medecine Nucleaire, Paris (France)

2012-03-15

To evaluate the prognostic significance of increased mediastinal {sup 18}F-FDG uptake in PET/CT for the staging of advanced ovarian cancer. We retrospectively evaluated patients managed for FIGO stage III/IV ovarian cancer between 1 January 2006 and 1 June 2009. Patients were included if they had undergone {sup 18}F-FDG PET/CT and surgery for initial staging. Exclusion criteria were age younger than 18 years, inability to undergo general anaesthesia, recurrent ovarian cancer, and borderline or nonepithelial malignancy. Whole-body PET/CT was performed after intravenous {sup 18}F-FDG injection. The location of abnormal hot spots and {sup 18}F-FDG maximal standard uptake values (SUV{sub max}) were recorded. We compared the complete cytoreduction and survival rates in groups defined based on mediastinal {sup 18}F-FDG uptake and SUV{sub max} values. Kaplan-Meier curves of overall survival and disease-free survival were compared using the log-rank test. Hazard ratios with their 95% confidence intervals were computed. Adjusted hazard ratios were obtained using a multivariate Cox model. We included 53 patients, of whom 17 (32%) had increased mediastinal {sup 18}F-FDG uptake. Complete cytoreduction was achieved in 14 (87.5%) of the 16 patients managed with primary surgery and in 21 (75%) of the 28 patients managed with interval surgery. Complete cytoreduction was achieved significantly more often among patients without increased mediastinal {sup 18}F-FDG uptake (80.6% vs. 35.3%; p = 0.001). Disease-free survival was comparable between the two groups. By univariate analysis, overall mortality was significantly higher among patients with increased mediastinal {sup 18}F-FDG uptake (hazard ratio 5.70, 95% confidence interval 1.74-18.6). The only factor significantly associated with overall survival by multivariate analysis was complete cytoreduction (adjusted hazard ratio 0.24, 95% confidence interval 0.07-0.89). Increased mediastinal {sup 18}F-FDG uptake was common in patients

Advanced method for making vitreous waste forms

International Nuclear Information System (INIS)

Pope, J.M.; Harrison, D.E.

1980-01-01

A process is described for making waste glass that circumvents the problems of dissolving nuclear waste in molten glass at high temperatures. Because the reactive mixing process is independent of the inherent viscosity of the melt, any glass composition can be prepared with equal facility. Separation of the mixing and melting operations permits novel glass fabrication methods to be employed

Fluctuating capacity and advance decision-making in Bipolar Affective Disorder - Self-binding directives and self-determination.

Science.gov (United States)

Gergel, Tania; Owen, Gareth S

2015-01-01

For people with Bipolar Affective Disorder, a self-binding (advance) directive (SBD), by which they commit themselves to treatment during future episodes of mania, even if unwilling, can seem the most rational way to deal with an imperfect predicament. Knowing that mania will almost certainly cause enormous damage to themselves, their preferred solution may well be to allow trusted others to enforce treatment and constraint, traumatic though this may be. No adequate provision exists for drafting a truly effective SBD and efforts to establish such provision are hampered by very valid, but also paralysing ethical, clinical and legal concerns. Effectively, the autonomy and rights of people with bipolar are being 'protected' through being denied an opportunity to protect themselves. From a standpoint firmly rooted in the clinical context and experience of mania, this article argues that an SBD, based on a patient-centred evaluation of capacity to make treatment decisions (DMC-T) and grounded within the clinician-patient relationship, could represent a legitimate and ethically coherent form of self-determination. After setting out background information on fluctuating capacity, mania and advance directives, this article proposes a framework for constructing such an SBD, and considers common objections, possible solutions and suggestions for future research. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

Significant renoprotective effect of telbivudine during preemptive antiviral therapy in advanced liver cancer patients receiving cisplatin-based chemotherapy: a case-control study.

Science.gov (United States)

Lin, Chih-Lang; Chien, Rong-Nan; Yeh, Charisse; Hsu, Chao-Wei; Chang, Ming-Ling; Chen, Yi-Cheng; Yeh, Chau-Ting

2014-12-01

Cisplatin is a known nephrotoxic agent requiring vigorous hydration before use. However, aggressive hydration could be life-threatening. Therefore, in cirrhotic patients with advanced hepatocellular carcinoma (HCC) under cisplatin-based chemotherapy, the risk of nephrotoxicity increased. Because previous studies showed that long-term telbivudine treatment improved renal function in chronic hepatitis B virus (HBV) infected patients, we conducted a case-control study to evaluate the clinical outcome of telbivudine preemptive therapy in HBV-related advanced HCC patients treated by combination chemotherapy comprising 5-fluorouracil, mitoxantrone and cisplatin (FMP). From June 2007 to March 2012, 60 patients with HBV-related advanced HCC, all receiving the same FMP chemotherapy protocol, were enrolled. Of them, 20 did not receive any antiviral therapy, whereas the remaining 40 patients (sex and age matched) received telbivudine preemptive therapy. Progressive decrease of aminotransferase levels (p 100 ml/min (n = 34), the median overall survival was significantly longer in the telbivudine-treated group (12.1 vs. 4.9 months; p = 0.042). Preemptive use of telbivudine significantly prevented eGFR deterioration caused by cisplatin-based chemotherapy in HBV-related advanced HCC. In patients with initially sufficient eGFR level, telbivudine treatment was associated with a longer overall survival.

Endoscopic traversability in patients with locally advanced esophageal squamous cell carcinoma: Is it a significant prognostic factor?

Science.gov (United States)

Shin, Hae Jin; Moon, Hee Seok; Kang, Sun Hyung; Sung, Jae Kyu; Jeong, Hyun Yong; Kim, Seok Hyun; Lee, Byung Seok; Kim, Ju Seok; Yun, Gee Young

2017-12-01

The purpose of this study was to evaluate the prognostic impact of endoscopic traversability in patients with locally advanced esophageal squamous cell carcinoma.This retrospective study was based on medical records from a single tertiary medical center. The records of 317 patients with esophageal squamous cell carcinoma treated with surgery or definitive chemoradiotherapy (CRT) between January 2009 and March 2016 were reviewed. Finally, we retrieved the data on 168 consecutive patients. These 168 patients were divided into 2 groups based on their endoscopic traversability findings: Group A (the endoscope traversable group), and Group B (the endoscope non-traversable group). We then retrospectively compared the clinical characteristics of these 2 groups.The endoscope non-traversable group (Group B) revealed an advanced clinical stage, a poor Eastern Cooperative Oncology Group (ECOG) score, a lower serum albumin level, a higher rate of requirement for esophageal stent insertion and definitive CRT as initial treatment than the endoscope traversable group (Group A). Patients with endoscope traversable cancer showed a significantly higher 3-year overall survival and 3-year relapse-free survival than patients who were endoscope non-traversable (53.8% vs 17.3%, P squamous cell carcinoma treated with definitive CRT, the serum albumin level squamous cell carcinoma treated with definitive CRT is a significant prognostic factor. Copyright © 2017 The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved.

Forecasting and decision-making in electricity markets with focus on wind energy

DEFF Research Database (Denmark)

Jónsson, Tryggvi

This thesis deals with analysis, forecasting and decision making in liberalised electricity markets. Particular focus is on wind power, its interaction with the market and the daily decision making of wind power generators. Among recently emerged renewable energy generation technologies, wind power...... derivation of practically applicable tools for decision making highly relevant. The main characteristics of wind power differ fundamentally from those of conventional thermal power. Its effective generation capacity varies over time and is directly dependent on the weather. This dependency makes future...... has become the global leader in terms of installed capacity and advancement. This makes wind power an ideal candidate to analyse the impact of growing renewable energy generation capacity on the electricity markets. Furthermore, its present status of a significant supplier of electricity makes...

Limited role of culture conversion for decision-making in individual patient care and for advancing novel regimens to confirmatory clinical trials.

Science.gov (United States)

Phillips, Patrick P J; Mendel, Carl M; Burger, Divan A; Crook, Angela M; Crook, Angela; Nunn, Andrew J; Dawson, Rodney; Diacon, Andreas H; Gillespie, Stephen H

2016-02-04

Despite recent increased clinical trials activity, no regimen has proved able to replace the standard 6-month regimen for drug-sensitive tuberculosis. Understanding the relationship between microbiological markers measured during treatment and long-term clinical outcomes is critical to evaluate their usefulness for decision-making for both individual patient care and for advancing novel regimens into time-consuming and expensive pivotal phase III trials. Using data from the randomized controlled phase III trial REMoxTB, we evaluated sputum-based markers of speed of clearance of bacilli: time to smear negative status; time to culture negative status on LJ or in MGIT; daily rate of change of log10(TTP) to day 56; and smear or culture results at weeks 6, 8 or 12; as individual- and trial-level surrogate endpoints for long-term clinical outcome. Time to culture negative status on LJ or in MGIT, time to smear negative status and daily rate of change in log10(TTP) were each independent predictors of clinical outcome, adjusted for treatment (p limited role in decision-making for advancing regimens into phase III trials or in predicting the outcome of treatment for individual patients. REMoxTB ClinicalTrials.gov number: NCT00864383.

Louisiana: a model for advancing regional e-Research through cyberinfrastructure.

Science.gov (United States)

Katz, Daniel S; Allen, Gabrielle; Cortez, Ricardo; Cruz-Neira, Carolina; Gottumukkala, Raju; Greenwood, Zeno D; Guice, Les; Jha, Shantenu; Kolluru, Ramesh; Kosar, Tevfik; Leger, Lonnie; Liu, Honggao; McMahon, Charlie; Nabrzyski, Jarek; Rodriguez-Milla, Bety; Seidel, Ed; Speyrer, Greg; Stubblefield, Michael; Voss, Brian; Whittenburg, Scott

2009-06-28

Louisiana researchers and universities are leading a concentrated, collaborative effort to advance statewide e-Research through a new cyberinfrastructure: computing systems, data storage systems, advanced instruments and data repositories, visualization environments and people, all linked together by software programs and high-performance networks. This effort has led to a set of interlinked projects that have started making a significant difference in the state, and has created an environment that encourages increased collaboration, leading to new e-Research. This paper describes the overall effort, the new projects and environment and the results to date.

Technological advances in extracorporeal membrane oxygenation for respiratory failure.

Science.gov (United States)

Rehder, Kyle J; Turner, David A; Bonadonna, Desiree; Walczak, Richard J; Rudder, Robert J; Cheifetz, Ira M

2012-08-01

Extracorporeal membrane oxygenation (ECMO) for neonatal and pediatric cardiac and/or respiratory failure is well established, and its use for adult respiratory failure is rapidly increasing. Management strategies developed over the past 30 years coupled with significant recent technological advances have led to improved ECMO survival. These new technologies are expanding the potential applications for ECMO in exciting ways, including new patient populations and the ability to make ECMO mobile for both intra- and inter-hospital transport. In this article, we highlight some of the recent technological advances and their impact on the utilization of ECMO in increasingly diverse patient populations.

What is the significance of the circumferential margin in locally advanced rectal cancer after neoadjuvant chemoradiotherapy?

Science.gov (United States)

Trakarnsanga, Atthaphorn; Gonen, Mithat; Shia, Jinru; Goodman, Karyn A; Nash, Garrett M; Temple, Larissa K; Guillem, José G; Paty, Philip B; Garcia-Aguilar, Julio; Weiser, Martin R

2013-04-01

The circumferential resection margin (CRM) is highly prognostic for local recurrence in rectal cancer surgery without neoadjuvant treatment. However, its significance in the setting of long-course neoadjuvant chemoradiotherapy (nCRT) is not well defined. Review of a single institution's prospectively maintained database from 1998 to 2007 identified 563 patients with locally advanced rectal cancer (T3/T4 and/or N1) receiving nCRT, followed after 6 weeks by total mesorectal excision (TME). Kaplan-Meier, Cox regression, and competing risk analysis were performed. The authors noted that 75 % of all patients had stage III disease as determined by endorectal ultrasound (ERUS) and/or magnetic resonance imaging (MRI). With median follow-up of 39 months after resection, local and distant relapse were noted in 12 (2.1 %) and 98 (17.4 %) patients, respectively. On competing risk analysis, the optimal cutoff point of CRM was 1 mm for local recurrence and 2 mm for distant metastasis. Factors independently associated with local recurrence included CRM ≤1 mm, and high-grade tumor (p = 0.012 and 0.007, respectively). CRM ≤2 mm, as well as pathological, nodal, and overall tumor stage are also significant independent risk factors for distant metastasis (p = 0.025, 0.010, and dataset of locally advanced rectal cancer treated with nCRT followed by TME, CRM ≤1 mm is an independent risk factor for local recurrence and is considered a positive margin. CRM ≤2 mm was associated with distant recurrence, independent of pathological tumor and nodal stage.

The emerging role of histology in the choice of first-line treatment of advanced non-small cell lung cancer: implication in the clinical decision-making.

Science.gov (United States)

Rossi, Antonio; Maione, Paolo; Bareschino, Maria Anna; Schettino, Clorinda; Sacco, Paola Claudia; Ferrara, Marianna Luciana; Castaldo, Vincenzo; Gridelli, Cesare

2010-01-01

Lung cancer is the leading cause of cancer mortality worldwide. Non-small cell lung cancer (NSCLC), accounting for about 85% of all lung cancers, includes squamous carcinoma, adenocarcinoma and undifferentiated large cell carcinoma. The majority of patients have advanced disease at diagnosis, and medical treatment is the cornerstone of management. Several randomized trials comparing third-generation platinum-based doublets concluded that all such combinations are comparable in their clinical efficacy, failing to document a difference based on histology. However, recent evidences, arising from the availability of pemetrexed, have shown that histology represents an important variable in the decision making. The major progresses in the understanding cancer biology and mechanism of oncogenesis have allowed the development of several potential molecular targets for cancer treatment such as vascular growth factor and its receptors and epidermal growth factor receptor. Targeted drugs seem to be safer or more effective in a specific histology subtype. All of these data have led to choose the optimal first-line treatment of advanced NSCLC based on histologic diagnosis. However, this scenario raises a diagnostic issue: a specific diagnosis of NSCLC histologic subtype is mandatory. This review will discuss these new evidences in the first-line treatment of advanced NSCLC and their implication in the current clinical decision-making.

Prognostic significance of clinical and pathological stages on locally advanced rectal carcinoma after neoadjuvant chemoradiotherapy

International Nuclear Information System (INIS)

Wen, Bixiu; Zhang, Luning; Wang, Chengtao; Huang, Rong; Peng, Haihua; Zhang, Tian; Dong, Jun; Xiao, Weiwei; Zeng, Zhifan; Liu, Mengzhong; Gao, Yuanhong

2015-01-01

To investigate prognostic significance of clinical and pathological stages in patients with locally advanced rectal carcinoma treated with neoadjuvant chemoradiotherapy (neo-CRT) and total mesorectal excision. 210 patients with locally advanced rectal carcinoma (cT3-4 or cN+) treated with neo-CRT followed by total mesorectal excision. Treatment outcomes were compared according to clinical and pathological stage. Overall survival (OS), disease free survival (DFS) among patients with different clinical stage and pathological stage after neo-CRT. The median follow-up time was 47 months (range, 14–98 months). Clinical T stage was associated with 5 year OS (p = 0.042) and 5 year DFS (p = 0.014) while clinical N stage was not associated with 5 year OS (p = 0.440), 5 year DFS (p = 0.711). Pathological T stage was associate with 5 year OS (p = 0.001) and 5 year DFS (p = 0.046); and N stage was associated with 5 year OS (p = 0.001), 5 year DFS (p = 0.002). The pathological stage was further classified into three groups: ypT0–2N0 in 91 patients (43.3 %), ypT3–4N0 in 69 patients (32.9 %) and ypT0–4N+ in 50 patients (23.8 %). While pathological stage (ypT0–2 vs ypT3–4N0 vs ypT0–4N+) was associated with 5 year OS (87.9 %, 75.5 %, 56.7 %, p = 0.000), 5 year DFS (74.5 %, 77.4 %, 50.5 %, p = 0.003). Multivariate analysis showed that ypN stage was an independent prognostic factor for patients 5 year DFS. Pathological stage is strongly associated with treatment outcomes in patients with locally advanced rectal carcinoma treated with neo-CRT followed by total mesorectal excision, which may be used as guidance for further individualized treatment

The impact of awareness of terminal illness on quality of death and care decision making: a prospective nationwide survey of bereaved family members of advanced cancer patients.

Science.gov (United States)

Ahn, Eunmi; Shin, Dong Wook; Choi, Jin Young; Kang, Jina; Kim, Dae Kyun; Kim, Hyesuk; Lee, Eunil; Hwang, Kwan Ok; Oh, Bumjo; Cho, BeLong

2013-12-01

We aimed to assess whether awareness of a terminal illness can affect care decision making processes and the achievement of a good death in advanced cancer patients receiving palliative care services. Awareness of terminal illness at the time of palliative care service admission was assessed by the health care professionals during the routine initial comprehensive assessment process and was recorded in the national terminal cancer patient registry. A follow-up nationwide bereavement survey was conducted, which contained questions regarding decision making processes and the Korean version of the Good Death Inventory. Among the 345 patients included in the final analysis, the majority (68.4%) of the patients were aware of the terminal illness. Awareness of the terminal illness tended to reduce discordances in care decision making (adjusted odds ratio = 0.55; 95% CI: 0.29-1.07), and increased the patients' own decision making when there were discordances between patients and their families (adjusted odds ratio = 3.79; 95% CI: 1.31-10.94). The Good Death Inventory score was significantly higher among patients who were aware of their terminal illnesses compared with those who were not (5.04 vs. 4.80; p = 0.013) and especially in the domains of 'control over the future' (5.18 vs. 4.04; p Awareness of the terminal illness had beneficial effect on the harmonious decision making, patient autonomy, and patient's quality of death. Disclosure of terminal illness should be encouraged. Copyright © 2013 John Wiley & Sons, Ltd.

Making lasting memories: Remembering the significant

Science.gov (United States)

McGaugh, James L.

2013-01-01

Although forgetting is the common fate of most of our experiences, much evidence indicates that emotional arousal enhances the storage of memories, thus serving to create, selectively, lasting memories of our more important experiences. The neurobiological systems mediating emotional arousal and memory are very closely linked. The adrenal stress hormones epinephrine and corticosterone released by emotional arousal regulate the consolidation of long-term memory. The amygdala plays a critical role in mediating these stress hormone influences. The release of norepinephrine in the amygdala and the activation of noradrenergic receptors are essential for stress hormone-induced memory enhancement. The findings of both animal and human studies provide compelling evidence that stress-induced activation of the amygdala and its interactions with other brain regions involved in processing memory play a critical role in ensuring that emotionally significant experiences are well-remembered. Recent research has determined that some human subjects have highly superior autobiographic memory of their daily experiences and that there are structural differences in the brains of these subjects compared with the brains of subjects who do not have such memory. Understanding of neurobiological bases of such exceptional memory may provide additional insights into the processes underlying the selectivity of memory. PMID:23754441

[Clinical significance of prognostic nutritional index in patients with advanced gastric cancer].

Science.gov (United States)

Song, Shubin; Liu, Honggang; Xue, Yingwei

2018-02-25

To investigate the relationship of prognostic nutritional index (PNI) with clinicopathological factors and the clinical significance of PNI in predicting the survival in patients with advanced gastric cancer. Clinicopathological and follow-up data of 1150 patients with advanced gastric cancer who underwent radical gastrectomy from January 2007 to December 2010 at the Department of Gastrointestinal Surgery, Harbin Medical University Cancer Hospital were analyzed retrospectively. The PNI value was calculated [PNI=absolute value of lymphocyte(10 9 /L)×5 + serum albumin (g/L)] and was grouped according to the mean value of PNI. Relationships of PNI with gender, age, tumor size, depth of invasion, tumor differentiation, tumor stage, tumor location, lymph node metastasis and tumor marker detection level were analyzed. At the same time, for the survival analysis of patients, log-rank method was used for univariate analysis, and Cox method was used for multivariate analysis. Of 1150 cases, 846 were males and 304 were females with an average age of 62 (24 to 88) years. The average maximum diameter of tumor was 5.4(1.0 to 20.0) cm. Tumor of 159 cases located in the gastric fundus, 221 cases in the gastric body, 705 cases in the gastric antrum and 65 cases in the whole stomach. Well differentiated tumors were found in 198 cases and poorly differentiated tumors in 952 cases. As for depth of tumor invasion, 165 cases were T2, 343 cases were T3 and 642 cases were T4. According to TNM stage, 53 cases were stage I(, 397 cases were stage II( and 700 cases were stage III(. The average lymph node metastasis rate was 25.0%, meanwhile lymph node metastasis was N0 in 296 cases, N1 in 246 cases, N2 in 277 cases and N3 in 331 cases. Blood examination showed hemoglobin ≤130 g/L in 544 cases and >130 g/L in 606 cases; carcinoembryonic antigen ≤5 μg/L in 903 cases and >5 μg /L in 247 cases; carbohydrate antigen 19-9 ≤37 kU/L in 927 cases and >37 kU/L in 223 cases. In whole patients

Prognostic significance of normal-sized ovary in advanced serous epithelial ovarian cancer.

Science.gov (United States)

Paik, E Sun; Kim, Ji Hye; Kim, Tae Joong; Lee, Jeong Won; Kim, Byoung Gie; Bae, Duk Soo; Choi, Chel Hun

2018-01-01

We compared survival outcomes of advanced serous type epithelial ovarian cancer (EOC) patients with normal-sized ovaries and enlarged-ovarian tumors by propensity score matching analysis. The medical records of EOC patients treated at Samsung Medical Center between 2002 and 2015 were reviewed retrospectively. We investigated EOC patients with high grade serous type histology and International Federation of Gynecology and Obstetrics (FIGO) stage IIIB, IIIC, or IV who underwent primary debulking surgery (PDS) and adjuvant chemotherapy to identify patients with normal-sized ovaries. Propensity score matching was performed to compare patients with normal-sized ovaries to patients with enlarged-ovarian tumors (ratio, 1:3) according to age, FIGO stage, initial cancer antigen (CA)-125 level, and residual disease status after PDS. Of the 419 EOC patients, 48 patients had normal-sized ovary. Patients with enlarged-ovarian tumor were younger (54.0±10.3 vs. 58.4±9.2 years, p=0.005) than those with normal-sized ovary, and there was a statistically significant difference in residual disease status between the 2 groups. In total cohort with a median follow-up period of 43 months (range, 3-164 months), inferior overall survival (OS) was shown in the normal-sized ovary group (median OS, 71.2 vs. 41.4 months; p=0.003). After propensity score matching, the group with normal-sized ovary showed inferior OS compared to the group with enlarged-ovarian tumor (median OS, 72.1 vs. 41.4 months; p=0.031). In multivariate analysis for OS, normal-sized ovary remained a significant factor. Normal-sized ovary was associated with poor OS compared with the common presentation of enlarged ovaries in EOC, independent of CA-125 level or residual disease. Copyright © 2018. Asian Society of Gynecologic Oncology, Korean Society of Gynecologic Oncology

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

Science.gov (United States)

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

2014-01-01

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

Developmental change of visuo-spatial working memory in children: quantitative evaluation through an Advanced Trail Making Test.

Science.gov (United States)

Kokubo, Naomi; Inagaki, Masumi; Gunji, Atsuko; Kobayashi, Tomoka; Ohta, Hidenobu; Kajimoto, Osami; Kaga, Makiko

2012-11-01

The present study aimed to investigate the developmental change in Visuo-Spatial Working Memory (VSWM) in typically developed children using a specially designed Advanced Trail Making Test for children (ATMT-C). We developed a new method for evaluating VSWM efficiency in children using a modified version ATMT to suit their shorter sustained attention. The ATMT-C consists of two parts; a number-based ATMT and a hiragana (Japanese phonogram)-based ATMT, both employing symbols familiar to young children. A total of 94 healthy participants (6-28 years of age) were enrolled in this study. A non-linear developmental change of VSWM efficiency was observed in the results from the ATMT-C. In the number-based ATMT, children under 8 years of age showed a relatively rapid increase in VSWM efficiency while older children (9-12 years) had a more gradual increase in VSWM efficiency. Results from the hiragana-based ATMT-C showed a slightly delayed increase pattern in VSWM efficiency compared to the pattern from the number-based ATMT. There were no significant differences in VSWM efficiency for gender, handedness and test order. VSWM in children gradually matures in a non steady-state manner and there is an important stage for VSWM maturation before reaching 12 years of age. VSWM efficiency may also vary depending on developmental condition of its cognitive subsystems. Copyright © 2012 The Japanese Society of Child Neurology. Published by Elsevier B.V. All rights reserved.

Agronomic Performance and Bread Making Quality of Advanced ...

African Journals Online (AJOL)

Twenty bread wheat lines selected on the basis of their average grain protein content and yield were evaluated for six agronomic and eight baking quality traits associated with bread-making quality. All the lines were grown in randomly complete block design at two locations in Eastern Oromia, Ethiopia; namely, Haramaya ...

Eldercare at Home: Advanced Directives

Science.gov (United States)

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

An Exploratory Analysis for the Selection and Implementation of Advanced Manufacturing Technology by Fuzzy Multi-criteria Decision Making Methods: A Comparative Study

Science.gov (United States)

Nath, Surajit; Sarkar, Bijan

2017-08-01

Advanced Manufacturing Technologies (AMTs) offer opportunities for the manufacturing organizations to excel their competitiveness and in turn their effectiveness in manufacturing. Proper selection and evaluation of AMTs is the most significant task in today's modern world. But this involves a lot of uncertainty and vagueness as it requires many conflicting criteria to deal with. So the task of selection and evaluation of AMTs becomes very tedious for the evaluators as they are not able to provide crisp data for the criteria. Different Fuzzy Multi-criteria Decision Making (MCDM) methods help greatly in dealing with this problem. This paper focuses on the application of two very much potential Fuzzy MCDM methods namely COPRAS-G, EVAMIX and a comparative study between them on some rarely mentioned criteria. Each of the two methods is very powerful evaluation tool and has beauty in its own. Although, performance wise these two methods are almost at same level, but, the approach of each one of them are quite unique. This uniqueness is revealed by introducing a numerical example of selection of AMT.

Update of progress for Phase II of B&W`s advanced coal-fired low-emission boiler system

Energy Technology Data Exchange (ETDEWEB)

McDonald, D.K. [Babcock & Wilcox, Barberton, OH (United States); Madden, D.A.; Rodgers, L.W. [Babcock & Wilcox, Alliance, OH (United States)] [and others

1995-11-01

Over the past five years, advances in emission control techniques at reduced costs and auxiliary power requirements coupled with significant improvements in steam turbine and cycle design have significantly altered the governing criteria by which advanced technologies have been compared. With these advances, it is clear that pulverized coal technology will continue to be competitive in both cost and performance with other advanced technologies such as Integrated Gasification Combined Cycle (IGCC) or first generation Pressurized Fluidized Bed Combustion (PFBC) technologies for at least the next decade. In the early 1990`s it appeared that if IGCC and PFBC could achieve costs comparable to conventional pulverized coal plants, their significantly reduced NO{sub x} and SO{sub 2} emissions would make them more attractive. A comparison of current emission control capabilities shows that all three technologies can already achieve similarly low emissions levels.

"Music & Memory" and improved swallowing in advanced dementia.

Science.gov (United States)

Cohen, Dan; Post, Stephen G; Lo, Angela; Lombardo, Robin; Pfeffer, Brandon

2018-01-01

Background Dysphagia and difficulty with eating affects a significant portion of individuals with advanced dementia. Such problems with oral intake can have serious health consequences including mealtime distress, dehydration and malnutrition, aspiration, reduced quality of life, and increased mortality risk. Design We present the first data indicating that "Music & Memory" interventions improve swallowing in individuals with advanced dementia, thereby making oral feeding easier and potentially diminishing reliance on PEG. Setting Columbia Health Care Center, Wyocena, WI (with Music&Memory.org, Mineola, NY and Stony Brook University). Participants Residents with advanced dementia (N = 5). Observation by eight professional caregivers. Results (1) Enhanced swallowing mechanism with Music & Memory prior to dining; (2) decreased incidents of choking during mealtime; (3) improved nutritional status; (4) reduced weight loss; (5) reduced need for speech interventions; (6) enhanced quality of life. Conclusions The preliminary results call for additional research.

Sustaining high energy efficiency in existing processes with advanced process integration technology

International Nuclear Information System (INIS)

Zhang, Nan; Smith, Robin; Bulatov, Igor; Klemeš, Jiří Jaromír

2013-01-01

Highlights: ► Process integration with better modelling and more advanced solution methods. ► Operational changes for better environmental performance through optimisation. ► Identification of process integration technology for operational optimisation. ► Systematic implementation procedure of process integration technology. ► A case study with crude oil distillation to demonstrate the operational flexibility. -- Abstract: To reduce emissions in the process industry, much emphasis has been put on making step changes in emission reduction, by developing new process technology and making renewable energy more affordable. However, the energy saving potential of existing systems cannot be simply ignored. In recent years, there have been significant advances in process integration technology with better modelling techniques and more advanced solution methods. These methods have been applied to the new design and retrofit studies in the process industry. Here attempts are made to apply these technologies to improve the environmental performance of existing facilities with operational changes. An industrial project was carried out to demonstrate the importance and effectiveness of exploiting the operational flexibility for energy conservation. By applying advanced optimisation technique to integrate the operation of distillation and heat recovery in a crude oil distillation unit, the energy consumption was reduced by 8% without capital expenditure. It shows that with correctly identified technology and the proper execution procedure, significant energy savings and emission reduction can be achieved very quickly without major capital expenditure. This allows the industry to improve its economic and environment performance at the same time.

Advanced Industrial Materials (AIM) Program: Compilation of project summaries and significant accomplishments, FY 1995

Energy Technology Data Exchange (ETDEWEB)

NONE

1996-04-01

In many ways, the Advanced Industrial Materials (AIM) Program underwent a major transformation in Fiscal Year 1995 and these changes have continued to the present. When the Program was established in 1990 as the Advanced Industrial Concepts (AIC) Materials Program, the mission was to conduct applied research and development to bring materials and processing technologies from the knowledge derived from basic research to the maturity required for the end use sectors for commercialization. In 1995, the Office of Industrial Technologies (OIT) made radical changes in structure and procedures. All technology development was directed toward the seven ``Vision Industries`` that use about 80% of industrial energy and generated about 90% of industrial wastes. The mission of AIM has, therefore, changed to ``Support development and commercialization of new or improved materials to improve productivity, product quality, and energy efficiency in the major process industries.`` Though AIM remains essentially a National Laboratory Program, it is essential that each project have industrial partners, including suppliers to, and customers of, the seven industries. Now, well into FY 1996, the transition is nearly complete and the AIM Program remains reasonably healthy and productive, thanks to the superb investigators and Laboratory Program Managers. This report contains the technical details of some very remarkable work by the best materials scientists and engineers in the world. Subject areas covered are: advanced metals and composites; advanced ceramics and composites; polymers and biobased materials; and new materials and processes.

Adults' decision-making about the electronic waste issue: The role of the nature of science conceptualizations and moral concerns in socio-scientific decision-making

Science.gov (United States)

Yu, Yuqing

Socio-scientific issues have become increasingly important in Science-Technology-Society (STS) education as a means to make science learning more relevant to students' lives. This study used the e-waste issue as a context to investigate two aspects of socio-scientific decision-making: (1) the relationship between the nature of science (NOS) conceptualizations and decision-making; and (2) moral concerns involved in the process of decision-making. This study contributes to the field of socio-scientific issue research and STS education in the following ways. First, it is the first study that performed meta-analysis to seek the relationship between the NOS understanding and decision-making. This study concludes that valuable NOS conceptualizations that are highly related to the socio-scientific issue under investigation, rather than general NOS understanding, exert statistically significant influences on decision-making. Second, this study empirically examined the Multiple Responses Model (MRM), which enables the transfer of qualitative NOS responses into quantitative data, and hence, inferential statistics. The current study justifies the significance of unidimensionality to the application of the MRM. It addresses the limitations associated with the MRM and provides implications for future use of the MRM in other contexts. Finally, the study explores the role of moral concerns in socio-scientific decision-making. Eight participants engaged in interviews that were designed to elicit their reactions and feelings regarding the issue of exporting e-waste to poor countries. Qualitative analyses demonstrated that moral considerations were significant influences on decision-making. In addition, participants' action responses revealed that they were motivated to take action to help the environment. The study has implications for socio-scientific issue studies in other contexts and for teacher education programs that use socio-scientific issues to advance teachers' reasoning

Recent advance in polar seismology: Global impact of the International Polar Year

Science.gov (United States)

Kanao, Masaki; Zhao, Dapeng; Wiens, Douglas A.; Stutzmann, Éléonore

2015-03-01

The most exciting initiative for the recent polar studies was the International Polar Year (IPY) in 2007-2008. The IPY has witnessed a growing community of seismologists who have made considerable efforts to acquire high-quality data in polar regions. It also provided an excellent opportunity to make significant advances in seismic instrumentation of the polar regions to achieve scientific targets involving global issues. Taking these aspects into account, we organize and publish a special issue in Polar Science on the recent advance in polar seismology and cryoseismology as fruitful achievements of the IPY.

Relationship between Student Pharmacist Decision Making Preferences and Experiential Learning.

Science.gov (United States)

Williams, Charlene R; McLaughlin, Jacqueline E; Cox, Wendy C; Shepherd, Greene

2016-09-25

Objective. To determine if student pharmacists' preferences towards experiential and rational thinking are associated with performance on advanced pharmacy practice experiences (APPEs) and whether thinking style preference changes following APPEs. Methods. The Rational Experiential Inventory (REI), a validated survey of thinking style, was administered to student pharmacists before starting APPEs and re-administered after completing APPEs. APPE grades were compared to initial REI scores. Results. Rational Experiential Inventory scores remained consistent before and after APPEs. Overall, APPE grades were independent of REI scores. In a regression model, the REI experiential score was a significant negative predictor of hospital APPE grades. Conclusion. These findings suggest that overall APPE performance is independent of decision-making preference, and decision-making style does not change following immersion into APPEs. Instead of targeting teaching strategies towards a specific decision-making style, preceptors may use pedagogical approaches that promote sound clinical decision-making skills through critical thinking and reflection.

Relationship between Student Pharmacist Decision Making Preferences and Experiential Learning

Science.gov (United States)

McLaughlin, Jacqueline E.; Cox, Wendy C.; Shepherd, Greene

2016-01-01

Objective. To determine if student pharmacists’ preferences towards experiential and rational thinking are associated with performance on advanced pharmacy practice experiences (APPEs) and whether thinking style preference changes following APPEs. Methods. The Rational Experiential Inventory (REI), a validated survey of thinking style, was administered to student pharmacists before starting APPEs and re-administered after completing APPEs. APPE grades were compared to initial REI scores. Results. Rational Experiential Inventory scores remained consistent before and after APPEs. Overall, APPE grades were independent of REI scores. In a regression model, the REI experiential score was a significant negative predictor of hospital APPE grades. Conclusion. These findings suggest that overall APPE performance is independent of decision-making preference, and decision-making style does not change following immersion into APPEs. Instead of targeting teaching strategies towards a specific decision-making style, preceptors may use pedagogical approaches that promote sound clinical decision-making skills through critical thinking and reflection. PMID:27756927

Advanced Heart Failure

Science.gov (United States)

... Artery Disease Venous Thromboembolism Aortic Aneurysm More Advanced Heart Failure Updated:May 9,2017 When heart failure (HF) ... Making This content was last reviewed May 2017. Heart Failure • Home • About Heart Failure • Causes and Risks for ...

NATO Advanced Research Institute on the Application of Systems Science to Energy Policy Planning

CERN Document Server

Cherniavsky, E; Laughton, M; Ruff, L

1981-01-01

The Advanced Research Institute (ARI) on "The Application of Systems Science to Energy Policy Planning" was held under the auspices of the NATO Special Programme Panel on Systems Science in collaboration with the National Center for Analysis of Energy Sys­ tems, Brookhaven National Laboratory, USA, as a part of the NATO Science Committee's continuous effort to promote the advancement of science through international cooperation. Advanced Research Institutes are sponsored by the NATO Science Committee for the purposes of bringing together senior scientists to seek consensus on an assessment of the present state of knowl­ edge on a specific topic and to make recommendations for future research directions. Meetings are structured to encourage inten­ sive group discussion. Invitees are carefully selected so that the group as a whole will contain the experience and expertise neces­ sary to make the conclusions valid and significant. A final report is published presenting the various viewpoints and conclusions....

A Briefing on Metrics and Risks for Autonomous Decision-Making in Aerospace Applications

Science.gov (United States)

Frost, Susan; Goebel, Kai Frank; Galvan, Jose Ramon

2012-01-01

Significant technology advances will enable future aerospace systems to safely and reliably make decisions autonomously, or without human interaction. The decision-making may result in actions that enable an aircraft or spacecraft in an off-nominal state or with slightly degraded components to achieve mission performance and safety goals while reducing or avoiding damage to the aircraft or spacecraft. Some key technology enablers for autonomous decision-making include: a continuous state awareness through the maturation of the prognostics health management field, novel sensor development, and the considerable gains made in computation power and data processing bandwidth versus system size. Sophisticated algorithms and physics based models coupled with these technological advances allow reliable assessment of a system, subsystem, or components. Decisions that balance mission objectives and constraints with remaining useful life predictions can be made autonomously to maintain safety requirements, optimal performance, and ensure mission objectives. This autonomous approach to decision-making will come with new risks and benefits, some of which will be examined in this paper. To start, an account of previous work to categorize or quantify autonomy in aerospace systems will be presented. In addition, a survey of perceived risks in autonomous decision-making in the context of piloted aircraft and remotely piloted or completely autonomous unmanned autonomous systems (UAS) will be presented based on interviews that were conducted with individuals from industry, academia, and government.

Impact of postgraduate education on advanced practice nurse activity - a national survey.

Science.gov (United States)

Wilkinson, J; Carryer, J; Budge, C

2018-03-22

There is a wealth of international evidence concerning the contribution post-registration master's level education makes to advancing the discipline of nursing. There are approximately 277 nurse practitioners registered in NZ, but they account for only a small portion of nurses who have undertaken master's level education. The additional contribution these nurses make to the work environment through advanced practice activities has not, hitherto, been documented. To report the extent of advanced practice nurse activity associated with various levels of nursing education in a sample of nurses working in clinical practice in New Zealand. A replication of recent Australian research was done via a national cross-sectional survey of 3255 registered nurses and nurse practitioners in New Zealand using an online questionnaire to collect responses to the amended Advanced Practice Delineation survey tool. In addition, demographic data were collected including position titles and levels of postgraduate education. A positive association was found between postgraduate education at any level and more time spent in advanced practice activities. Independent of level of postgraduate education, the role a nurse holds also effects the extent of involvement in advanced practice activities. There is an additional contribution made to the work environment by nurses with master's level education which occurs even when they are not employed in an advanced practice role. These findings are of significance to workforce policy and planning across the globe as countries work to sustain health services by increasing nursing capacity effectively within available resources. © 2018 International Council of Nurses.

Treatment decision-making processes in the systemic treatment of ovarian cancer: review of the scientific evidence.

Science.gov (United States)

Luketina, Hrvoje; Fotopoulou, Christina; Luketina, Ruzica-Rosalia; Pilger, Adak; Sehouli, Jalid

2012-09-01

The systemic treatment of epithelial ovarian cancer (OC) is one of the cornerstones in the multimodal management of advanced OC in both primary and recurrent stages of this disease. In most situations various treatment options are available but only few data exists about the treatment decision-making process. Therefore, we conducted a review of the current literature regarding the decision-making process concerning the systemic therapy in patients with advanced ovarian cancer. The electronic database MEDLINE (PubMed) was systematically reviewed for studies that evaluate the treatment decision-making processes in patients with advanced OC. The PubMed database was searched in detail for all titles and abstracts of potentially relevant studies published between 1995 and 2011. An initial search identified 15 potentially relevant studies, but only seven met all inclusion criteria. Factors that influence treatment decisions in patients with OC include not only rational arguments and medical reasons, but also individual attitudes, fears, existential questions, various projections resulting from the physician patient relationship and the social environment. The physician's personal experience with OC treatment seems to be an important factor, followed by previous personal experience with medical issues, and the fear of side-effects and future metastases. Family and self-support organisations also seem to play a significant role in the treatment decision-making process. This review underlines the need for more research activities to explore the treatment decision-making process to enable the best individual support for patients in treatment decision-making. It is a challenge for clinicians to determine the individual information needs of women with OC and to involve them during the decision-making process to the extent they wish.

Advanced upper limb prosthetic devices: implications for upper limb prosthetic rehabilitation.

Science.gov (United States)

Resnik, Linda; Meucci, Marissa R; Lieberman-Klinger, Shana; Fantini, Christopher; Kelty, Debra L; Disla, Roxanne; Sasson, Nicole

2012-04-01

The number of catastrophic injuries caused by improvised explosive devices in the Afghanistan and Iraq Wars has increased public, legislative, and research attention to upper limb amputation. The Department of Veterans Affairs (VA) has partnered with the Defense Advanced Research Projects Agency and DEKA Integrated Solutions to optimize the function of an advanced prosthetic arm system that will enable greater independence and function. In this special communication, we examine current practices in prosthetic rehabilitation including trends in adoption and use of prosthetic devices, financial considerations, and the role of rehabilitation team members in light of our experiences with a prototype advanced upper limb prosthesis during a VA study to optimize the device. We discuss key challenges in the adoption of advanced prosthetic technology and make recommendations for service provision and use of advanced upper limb prosthetics. Rates of prosthetic rejection are high among upper limb amputees. However, these rates may be reduced with sufficient training by a highly specialized, multidisciplinary team of clinicians, and a focus on patient education and empowerment throughout the rehabilitation process. There are significant challenges emerging that are unique to implementing the use of advanced upper limb prosthetic technology, and a lack of evidence to establish clinical guidelines regarding prosthetic prescription and treatment. Finally, we make recommendations for future research to aid in the identification of best practices and development of policy decisions regarding insurance coverage of prosthetic rehabilitation. Copyright © 2012 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Prognostic Significance of p16 Expression in Advanced Cervical Cancer Treated With Definitive Radiotherapy

Energy Technology Data Exchange (ETDEWEB)

Schwarz, Julie K., E-mail: jschwarz@radonc.wustl.edu [Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO (United States); Department of Cell Biology and Physiology, Washington University School of Medicine, St. Louis, MO (United States); Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO (United States); Lewis, James S. [Division of Anatomic and Molecular Pathology, Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO (United States); Department of Otolaryngology, Washington University School of Medicine, St. Louis, MO (United States); Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO (United States); Pfeifer, John [Division of Anatomic and Molecular Pathology, Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO (United States); Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO (United States); Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO (United States); Huettner, Phyllis [Division of Anatomic and Molecular Pathology, Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO (United States); Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO (United States); Grigsby, Perry [Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO (United States); Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO (United States); Division of Nuclear Medicine, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO (United States); Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO (United States)

2012-09-01

Purpose: The purpose of this study was to evaluate the prognostic significance of p16 immunohistochemistry (IHC) in patients with advanced cervical cancer treated with radiation therapy. Materials and Methods: This was a retrospective study of 126 patients with International Federation of Gynecology and Obstetrics Stages Ib1-IVb cervical cancer treated with radiation. Concurrent cisplatin chemotherapy was given to 108 patients. A tissue microarray (TMA) was constructed from the paraffin-embedded diagnostic biopsy specimens. Immunoperoxidase staining was performed on the TMA and a p16 monoclonal antibody was utilized. IHC p16 extent was evaluated and scored in quartiles: 0 = no staining, 1 = 1-25% of cells staining, 2 = 26 to 50%, 3 = 51 to 75%, and 4 = 76 to 100%. Results: The p16 IHC score was 4 in 115 cases, 3 in 1, 2 in 3 and 0 in 7. There was no relationship between p16 score and tumor histology. Patients with p16-negative tumors were older (mean age at diagnosis 65 vs. 52 years for p16-positive tumors; p = 0.01). The 5-year cause-specific survivals were 33% for p16-negative cases (score = 0) compared with 63% for p16-positive cases (scores 1, 2, 3 or 4; p = 0.07). The 5-year recurrence-free survivals were 34% for those who were p16-negative vs. 57% for those who were p16-positive (p = 0.09). In addition, patients with p16-positive tumors (score > 0) were more likely to be complete metabolic responders as assessed by the 3-month posttherapy 18 [F]-fluorodeoxyglucose positron emission tomography (FDG-PET)/computed tomograph compared with patients with p16-negative tumors (p = 0.03). Conclusion: p16 expression is predictive of improved survival outcome after chemoradiation therapy for advanced-stage invasive cervical carcinoma. Further testing will be needed to evaluate p16-negative cervical tumors.

Raising the Bar: Significant Advances and Future Needs for Promoting Learning for Students with Severe Disabilities

Science.gov (United States)

Spooner, Fred; Browder, Diane M.

2015-01-01

This essay describes major advances in educating students with severe disabilities. The authors propose that applied behavior analysis, the focus on functional life skills, and the promotion of academic content have been the major advances in the "how" and "what" of learning for this population. An increased focus on literacy,…

Initial Efficacy Testing of an Autobiographical Memory Intervention on Advance Care Planning for Patients With Terminal Cancer.

Science.gov (United States)

Brohard, Cheryl

2017-11-01

To test the efficacy of a novel intervention to facilitate advance care planning.
. Exploratory, quasiexperimental pilot study with two independent groups.
. A large hospice located in the southwestern United States. 
. A convenience sample of 50 participants with terminal cancer enrolled in hospice.
. An autobiographical memory (ABM) intervention used the participants' experiences with cancer and end of life for the purpose of directing advance care planning.
. Two domains of advance care planning, decision making and communication, were measured in relation to 11 variables. The ABM intervention was nonthreatening, short in duration, and easily completed with participants as they recalled, without hesitation, specific personal memories of family and friends who had died and their advance care plans. The Mann-Whitney nonparametric test revealed that participants in the experimental group had a higher average rank than those in the control group for communicating the decision about antibiotics, as well as exhibited a trend toward significance for five other advance care planning variables.
. Findings showed that directive ABMs may be effective in influencing the decision making and communication of advance care planning for terminally ill patients with cancer.
. The current level of understanding about using the ABM intervention suggests that nurses can initiate an advance care planning conversation using this approach.

The need for advanced public transport information services when making transfers

NARCIS (Netherlands)

Molin, E.J.E.; Chorus, C.G.; Sloten, van R.; Silva, da A.N.R.; Souza, de L.C.L.

2007-01-01

This paper reports on a stated choice experiment examining the determinants of travelers' need and willingness to pay for advanced public transport information services. Intercity train travelers are asked to choose among information services that varied in type of information provided by the

Advanced gadolinia core and Toshiba advanced reactor management system

International Nuclear Information System (INIS)

Miyamoto, Toshiki; Yoshioka, Ritsuo; Ebisuya, Mitsuo

1988-01-01

At the Hamaoka Nuclear Power Station, Unit No. 3, advanced core design and core management technology have been adopted, significantly improving plant availability, operability and reliability. The outstanding technologies are the advanced gadolinia core (AGC) which utilizes gadolinium for the axial power distribution control, and Toshiba advanced reactor management system (TARMS) which uses a three-dimensional core physics simulator to calculate the power distribution. Presented here are the effects of these advanced technologies as observed during field testing. (author)

Advanced quantum mechanics materials and photons

CERN Document Server

Dick, Rainer

2012-01-01

Advanced Quantum Mechanics: Materials and Photons is a textbook which emphasizes the importance of advanced quantum mechanics for materials science and all experimental techniques which employ photon absorption, emission, or scattering. Important aspects of introductory quantum mechanics are covered in the first seven chapters to make the subject self-contained and accessible for a wide audience. The textbook can therefore be used for advanced undergraduate courses and introductory graduate courses which are targeted towards students with diverse academic backgrounds from the Natural Sciences or Engineering. To enhance this inclusive aspect of making the subject as accessible as possible, Appendices A and B also provide introductions to Lagrangian mechanics and the covariant formulation of electrodynamics. Other special features include an introduction to Lagrangian field theory and an integrated discussion of transition amplitudes with discrete or continuous initial or final states. Once students have acquir...

Issues surrounding end-of-life decision-making

Directory of Open Access Journals (Sweden)

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

Uncertainty Analyses of Advanced Fuel Cycles

International Nuclear Information System (INIS)

Miller, Laurence F.; Preston, J.; Sweder, G.; Anderson, T.; Janson, S.; Humberstone, M.; MConn, J.; Clark, J.

2008-01-01

The Department of Energy is developing technology, experimental protocols, computational methods, systems analysis software, and many other capabilities in order to advance the nuclear power infrastructure through the Advanced Fuel Cycle Initiative (AFDI). Our project, is intended to facilitate will-informed decision making for the selection of fuel cycle options and facilities for development

Uncertainty Analyses of Advanced Fuel Cycles

Energy Technology Data Exchange (ETDEWEB)

Laurence F. Miller; J. Preston; G. Sweder; T. Anderson; S. Janson; M. Humberstone; J. MConn; J. Clark

2008-12-12

The Department of Energy is developing technology, experimental protocols, computational methods, systems analysis software, and many other capabilities in order to advance the nuclear power infrastructure through the Advanced Fuel Cycle Initiative (AFDI). Our project, is intended to facilitate will-informed decision making for the selection of fuel cycle options and facilities for development.

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

Science.gov (United States)

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

2015-11-01

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

Recent advances in food allergy

Directory of Open Access Journals (Sweden)

Marcos Julio Caruso Alcocer

Full Text Available Summary Food allergy is a public health issue that has significantly increased worldwide in the past decade, affecting consumers’ quality of life and making increasing demands on health service resources. Despite recent advances in many areas of diagnosis and treatment, our general knowledge of the basic mechanisms of the disease remain limited i.e., not at pace with the exponential number of new cases and the explosion of new technologies. Many important key questions remain: What defines a major allergen? Why do some individuals develop food allergies and others do not? Which are the environmental factors? Could the environmental factors be monitored through epigenetics or modified by changes in the microbiome? Can tolerance to food be induced? Why are some foods more likely to trigger allergies than others? Does the route and timing of exposure have any role on sensitization? These and many other related questions remain unanswered. In this short review some of these topics are addressed in the light of recent advances in the area.

Advanced reflector materials for solar concentrators

Science.gov (United States)

Jorgensen, Gary; Williams, Tom; Wendelin, Tim

1994-10-01

This paper describes the research and development at the US National Renewable Energy Laboratory (NREL) in advanced reflector materials for solar concentrators. NREL's research thrust is to develop solar reflector materials that maintain high specular reflectance for extended lifetimes under outdoor service conditions and whose cost is significantly lower than existing products. Much of this work has been in collaboration with private-sector companies that have extensive expertise in vacuum-coating and polymer-film technologies. Significant progress and other promising developments will be discussed. These are expected to lead to additional improvements needed to commercialize solar thermal concentration systems and make them economically attractive to the solar manufacturing industry. To explicitly demonstrate the optical durability of candidate reflector materials in real-world service conditions, a network of instrumented outdoor exposure sites has been activated.

Electronic Tickets, Smart Cards, and Online Prepayments: When and How to Advance Sell

OpenAIRE

Jinhong Xie; Steven M. Shugan

2001-01-01

Advance selling occurs when sellers allow buyers to purchase at a time preceding consumption (Shugan and Xie 2000). Electronic tickets, smart cards, online prepayments, and other technological advances make advance selling possible for many, if not all, service providers. These technologies lower the cost of making complex transactions at a greater distance from the seller's site. They also give sellers more control over advance selling by decreasing arbitrage. As technology enhances the capa...

A Paradigm shift in the concept for making dental impressions.

Science.gov (United States)

Nayar, Sanjna; Mahadevan, R

2015-04-01

Digital dental impression is a revolutionary technological advancement that so surpasses the accuracy and efficiency of former techniques for obtaining replicas of prepared teeth for the purpose of fabricating restorations that its adoption by dentists is rapidly eclipsing the use of elastomeric impression materials. The ultimate goals of dentists dedicated to quality restorative dentistry are to make their treatment of patients as accurate, stressless, and efficient as possible. By elimination of the everyday problems described above, there is no question that the significant advantages of digital impressions will make intraoral digital scanning standard procedure in most dental offices within the next several years. Furthermore, digital impressions have proven to reduce remakes and returns, as well as increase overall efficiency. The patient also benefits by being provided a far more positive experience. Finally, through the use of digital impression making, it has been determined that laboratory products become more consistent and require less chair time at insertion.

A Paradigm shift in the concept for making dental impressions

Directory of Open Access Journals (Sweden)

Sanjna Nayar

2015-01-01

Full Text Available Digital dental impression is a revolutionary technological advancement that so surpasses the accuracy and efficiency of former techniques for obtaining replicas of prepared teeth for the purpose of fabricating restorations that its adoption by dentists is rapidly eclipsing the use of elastomeric impression materials. The ultimate goals of dentists dedicated to quality restorative dentistry are to make their treatment of patients as accurate, stressless, and efficient as possible. By elimination of the everyday problems described above, there is no question that the significant advantages of digital impressions will make intraoral digital scanning standard procedure in most dental offices within the next several years. Furthermore, digital impressions have proven to reduce remakes and returns, as well as increase overall efficiency. The patient also benefits by being provided a far more positive experience. Finally, through the use of digital impression making, it has been determined that laboratory products become more consistent and require less chair time at insertion.

Advanced quantum mechanics materials and photons

CERN Document Server

Dick, Rainer

2016-01-01

In this updated and expanded second edition of a well-received and invaluable textbook, Prof. Dick emphasizes the importance of advanced quantum mechanics for materials science and all experimental techniques which employ photon absorption, emission, or scattering. Important aspects of introductory quantum mechanics are covered in the first seven chapters to make the subject self-contained and accessible for a wide audience. Advanced Quantum Mechanics, Materials and Photons can therefore be used for advanced undergraduate courses and introductory graduate courses which are targeted towards students with diverse academic backgrounds from the Natural Sciences or Engineering. To enhance this inclusive aspect of making the subject as accessible as possible Appendices A and B also provide introductions to Lagrangian mechanics and the covariant formulation of electrodynamics. This second edition includes an additional 62 new problems as well as expanded sections on relativistic quantum fields and applications of�...

Values and options in cancer care (VOICE): study design and rationale for a patient-centered communication and decision-making intervention for physicians, patients with advanced cancer, and their caregivers

Science.gov (United States)

2013-01-01

Background Communication about prognosis and treatment choices is essential for informed decision making in advanced cancer. This article describes an investigation designed to facilitate communication and decision making among oncologists, patients with advanced cancer, and their caregivers. Methods/design The Values and Options in Cancer Care (VOICE) Study is a National Cancer Institute sponsored randomized controlled trial conducted in the Rochester/Buffalo, NY and Sacramento, CA regions. A total of 40 oncologists, approximately 400 patients with advanced cancer, and their family/friend caregivers (one per patient, when available) are expected to enroll in the study. Drawing upon ecological theory, the intervention uses a two-pronged approach: oncologists complete a multifaceted tailored educational intervention involving standardized patient instructors (SPIs), and patients and caregivers complete a coaching intervention to facilitate prioritizing and discussing questions and concerns. Follow-up data will be collected approximately quarterly for up to three years. Discussion The intervention is hypothesized to enhance patient-centered communication, quality of care, and patient outcomes. Analyses will examine the effects of the intervention on key elements of physician-patient-caregiver communication (primary outcomes), the physician-patient relationship, shared understanding of prognosis, patient well-being, and health service utilization (secondary outcomes). Trial registration Clinical Trials Identifier: NCT01485627 PMID:23570278

Clinical Significance of Tumor Marker Detection in Patients 
with Advanced Squamous Cell Carcimoma of the Lung

Directory of Open Access Journals (Sweden)

Ping LIANG

2016-10-01

Full Text Available Background and objective Due to it's concealment and no obvious symptoms, lung squamous carcimoma often has advanced disease when diagnosed. The aims of this study were to describe the characteristics of the disease, to evaluate the clinical importance of detection of multiple tumor markers in patients with squamous cell carcinoma of the lung. Methods The characteristics of all patients with advanced squamous cell lung cancer treated in Beijing Cancer Hospital of Chinese Academy of Medical Sciences during Jan. 2011 to Dec. 2015 were identified by cases reviewing and data extracting. The characteristics, detection levels and sensitivity of multiple tumor makers among patients were described. Results The 260 patients were treated with mean age of (59.4±9.2 years, 85.8% (n=223 of them were male, 14.2% (n=37 of them were female. 78.1% (n=203 of all were smokers and 3.1% (n=8 of patients had family history of tumor. The positive rate of cytokerantin 19 fragment (CYFRA21-1 was 71.2%, which was the highest among five tumor markers. The five tumor markers median level had no statistical significance between different tumor (T stages and node (N stages (all P>0.05, only the positive rate of SCC had statistical significance between different T stages (P=0.035. The combination measurement of CYFRA21-1+carcinogen-embryonic antigen (CEA, CYFRA21-1+CEA+cancer antigen (CA125, CA125+CYFRA21-1+CEA+neuron specific enolase (NSE, and CA125+CYFRA21-1+NSE+CEA+squamous cell carcinoma antigen (SCC were better and had higher clinical values, the positive rates were 82.7%, 84.6%, 85.0% and 86.2%, respectively. Conclusion The positive rate of CYFRA21-1 was the highest and the sensitivity of single test of five tumor markers was low, the combination of multiple tumor markers increased the sensitivity of diagnosis of SQCLC, the combination of CA125, CYFRA21-1 and CEA was the best choice.

End-of-Life Decisions and Advanced Old Age

Directory of Open Access Journals (Sweden)

Stoyles

2014-07-01

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

Advances in chemical physics

CERN Document Server

Rice, Stuart A

2014-01-01

Advances in Chemical Physics is the only series of volumes available that explores the cutting edge of research in chemical physics. This is the only series of volumes available that presents the cutting edge of research in chemical physics.Includes contributions from experts in this field of research.Contains a representative cross-section of research that questions established thinking on chemical solutions.Structured with an editorial framework that makes the book an excellent supplement to an advanced graduate class in physical chemistry or chemical physics.

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

Science.gov (United States)

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

2010-03-01

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

Physician Decision-Making in the Setting of Advanced Illness: An Examination of Patient Disposition and Physician Religiousness.

Science.gov (United States)

Frush, Benjamin W; Brauer, Simon G; Yoon, John D; Curlin, Farr A

2018-03-01

Little is known about patient and physician factors that affect decisions to pursue more or less aggressive treatment courses for patients with advanced illness. This study sought to determine how patient age, patient disposition, and physician religiousness affect physician recommendations in the context of advanced illness. A survey was mailed to a stratified random sample of U.S. physicians, which included three vignettes depicting advanced illness scenarios: 1) cancer, 2) heart failure, and 3) dementia with acute infection. One vignette included experimental variables to test how patient age and patient disposition affected physician recommendations. After each vignette, physicians indicated their likelihood to recommend disease-directed medical care vs. hospice care. Among eligible physicians (n = 1878), 62% (n = 1156) responded. Patient age and stated patient disposition toward treatment did not significantly affect physician recommendations. Compared with religious physicians, physicians who reported that religious importance was "not applicable" were less likely to recommend chemotherapy (adjusted odds ratio [OR] 0.39, 95% CI 0.23-0.66) and more likely to recommend hospice (OR 1.90, 95% CI 1.15-3.16) for a patient with cancer. Compared with physicians who ever attended religious services, physicians who never attended were less likely to recommend left ventricular assist device placement for a patient with congestive heart failure (OR 0.57, 95% CI 0.35-0.92). In addition, Asian ethnicity was independently associated with recommending chemotherapy (OR 1.72, 95% CI 1.13-2.61) and being less likely to recommend hospice (OR 0.59, 95% CI 0.40-0.91) for the patient with cancer; and it was associated with recommending antibiotics for the patient with dementia and pneumonia (OR 1.64, 95% CI 1.08-2.50). This study provides preliminary evidence that patient disposition toward more and less aggressive treatment in advanced illness does not substantially factor

Primatology: advanced ape technology.

Science.gov (United States)

McGrew, W C

2004-12-29

New findings from African rainforests show chimpanzees to have impressively advanced technology. They make tools of vegetation to harvest termites as in East and West Africa, but some apes in Central Africa show different techniques and tool sets geared for different tasks.

Law, autonomy and advance directives.

Science.gov (United States)

Willmott, Lindy; White, Ben; Mathews, Ben

2010-12-01

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

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

Science.gov (United States)

Bullock, Karen

2006-02-01

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

Making the connection: advancing traffic incident management in transportation planning : a primer.

Science.gov (United States)

2013-07-01

"The intent of this primer is to inform and guide traffic incident management (TIM) professionals and transportation planners to initiate and develop collaborative relationships and advance TIM programs through the metropolitan planning process. The ...

The Importance of Intergenerational Communication in Advance Care Planning: Generational Relationships among Perceptions and Beliefs.

Science.gov (United States)

Freytag, Jennifer; Rauscher, Emily A

2017-06-01

This study explores triadic intergenerational perceptions of family members' beliefs and behaviors that often impact an individual's willingness to engage in advance care planning. Using data from 189 triads of young adults, their parents, and their grandparents, we examined generational relationships among individuals' openness about death, death anxiety, knowledge of surrogate decision-making, and advance care planning self-efficacy. Results of this study found significant relationships between grandparents and parents, as well as between parents and children for all variables except self-efficacy. Additionally, results of this study found indirect relationships between grandparents and their grandchildren for three variables. These findings underscore the need to treat advance care planning as a family communication issue. Implications for how advance care planning should be approached in conversations with healthcare providers and within the family are discussed.

Advances in chemical physics advances in liquid crystals

CERN Document Server

Prigogine, Ilya; Vij, Jagdish K

2009-01-01

Prigogine and Rice's highly acclaimed series, Advances in Chemical Physics, provides a forum for critical, authoritative reviews of current topics in every area of chemical physics. Edited by J.K. Vij, this volume focuses on recent advances in liquid crystals with significant, up-to-date chapters authored by internationally recognized researchers in the field.

The significance of tumoral ERCC1 status in patients with locally advanced cervical cancer treated with chemoradiation therapy: a multicenter clinicopathologic analysis.

Science.gov (United States)

Doll, Corinne M; Aquino-Parsons, Christina; Pintilie, Melania; Klimowicz, Alexander C; Petrillo, Stephanie K; Milosevic, Michael; Craighead, Peter S; Clarke, Blaise; Lees-Miller, Susan P; Fyles, Anthony W; Magliocco, Anthony M

2013-03-01

ERCC1 (excision repair cross-complementation group 1) expression has been shown to be a molecular marker of cisplatin resistance in many tumor sites, but has not been well studied in cervical cancer patients. The purpose of this study was to measure tumoral ERCC1 in patients with locally advanced cervical cancer treated with chemoradiation therapy (CRT) in a large multicenter cohort, and to correlate expression with clinical outcome parameters. A total of 264 patients with locally advanced cervical cancer, treated with curative-intent radical CRT from 3 major Canadian cancer centers were evaluated. Pretreatment formalin-fixed, paraffin-embedded tumor specimens were retrieved, and tissue microarrays were constructed. Tumoral ERCC1 (FL297 antibody) was measured using AQUA (R) technology. Statistical analysis was performed to determine the significance of clinical factors and ERCC1 status with progression-free survival (PFS) and overall survival (OS) at 5 years. The majority of patients had International Federation of Gynecology and Obstetrics (FIGO) stage II disease (n=119, 45%); median tumor size was 5 cm. OS was associated with tumor size (HR 1.16, P=.018), pretreatment hemoglobin status (HR 2.33, P=.00027), and FIGO stage. In addition, tumoral ERCC1 status (nuclear to cytoplasmic ratio) was associated with PFS (HR 2.33 [1.05-5.18], P=.038) and OS (HR 3.13 [1.27-7.71], P=.013). ERCC1 status was not significant on multivariate analysis when the model was adjusted for the clinical factors: for PFS (HR 1.49 [0.61-3.6], P=.38); for OS (HR 2.42 [0.94-6.24] P=.067). In this large multicenter cohort of locally advanced cervical cancer patients treated with radical CRT, stage, tumor size, and pretreatment hemoglobin status were significantly associated with PFS and OS. ERCC1 status appears to have prognostic impact on univariate analysis in these patients, but was not independently associated with outcome on multivariate analysis. Copyright © 2013. Published by Elsevier

The Significance of Tumoral ERCC1 Status in Patients With Locally Advanced Cervical Cancer Treated With Chemoradiation Therapy: A Multicenter Clinicopathologic Analysis

Energy Technology Data Exchange (ETDEWEB)

Doll, Corinne M., E-mail: Corinne.Doll@albertahealthservices.ca [Department of Oncology, University of Calgary, Calgary, AB (Canada); Aquino-Parsons, Christina [Department of Radiation Oncology, University of British Columbia, Vancouver, BC (Canada); Pintilie, Melania [Department of Biostatistics, Ontario Cancer Institute/Princess Margaret Hospital, University of Toronto, Toronto, ON (Canada); Klimowicz, Alexander C. [Department of Oncology, University of Calgary, Calgary, AB (Canada); Petrillo, Stephanie K. [Department of Pathology, University of Calgary, Calgary, AB (Canada); Milosevic, Michael [Department of Radiation Oncology, University Health Network, University of Toronto, Toronto, ON (Canada); Craighead, Peter S. [Department of Oncology, University of Calgary, Calgary, AB (Canada); Clarke, Blaise [Department of Pathology, University of Toronto, Toronto, ON (Canada); Lees-Miller, Susan P. [Departments of Biochemistry and Molecular Biology, and Oncology, University of Calgary, Calgary, AB (Canada); Fyles, Anthony W. [Department of Radiation Oncology, University Health Network, University of Toronto, Toronto, ON (Canada); Magliocco, Anthony M. [Department of Pathology, Lee Moffitt Cancer Center, Tampa, Florida (United States)

2013-03-01

Purpose: ERCC1 (excision repair cross-complementation group 1) expression has been shown to be a molecular marker of cisplatin resistance in many tumor sites, but has not been well studied in cervical cancer patients. The purpose of this study was to measure tumoral ERCC1 in patients with locally advanced cervical cancer treated with chemoradiation therapy (CRT) in a large multicenter cohort, and to correlate expression with clinical outcome parameters. Methods and Materials: A total of 264 patients with locally advanced cervical cancer, treated with curative-intent radical CRT from 3 major Canadian cancer centers were evaluated. Pretreatment formalin-fixed, paraffin-embedded tumor specimens were retrieved, and tissue microarrays were constructed. Tumoral ERCC1 (FL297 antibody) was measured using AQUA (R) technology. Statistical analysis was performed to determine the significance of clinical factors and ERCC1 status with progression-free survival (PFS) and overall survival (OS) at 5 years. Results: The majority of patients had International Federation of Gynecology and Obstetrics (FIGO) stage II disease (n=119, 45%); median tumor size was 5 cm. OS was associated with tumor size (HR 1.16, P=.018), pretreatment hemoglobin status (HR 2.33, P=.00027), and FIGO stage. In addition, tumoral ERCC1 status (nuclear to cytoplasmic ratio) was associated with PFS (HR 2.33 [1.05-5.18], P=.038) and OS (HR 3.13 [1.27-7.71], P=.013). ERCC1 status was not significant on multivariate analysis when the model was adjusted for the clinical factors: for PFS (HR 1.49 [0.61-3.6], P=.38); for OS (HR 2.42 [0.94-6.24] P=.067). Conclusions: In this large multicenter cohort of locally advanced cervical cancer patients treated with radical CRT, stage, tumor size, and pretreatment hemoglobin status were significantly associated with PFS and OS. ERCC1 status appears to have prognostic impact on univariate analysis in these patients, but was not independently associated with outcome on

The Significance of Tumoral ERCC1 Status in Patients With Locally Advanced Cervical Cancer Treated With Chemoradiation Therapy: A Multicenter Clinicopathologic Analysis

International Nuclear Information System (INIS)

Doll, Corinne M.; Aquino-Parsons, Christina; Pintilie, Melania; Klimowicz, Alexander C.; Petrillo, Stephanie K.; Milosevic, Michael; Craighead, Peter S.; Clarke, Blaise; Lees-Miller, Susan P.; Fyles, Anthony W.; Magliocco, Anthony M.

2013-01-01

Purpose: ERCC1 (excision repair cross-complementation group 1) expression has been shown to be a molecular marker of cisplatin resistance in many tumor sites, but has not been well studied in cervical cancer patients. The purpose of this study was to measure tumoral ERCC1 in patients with locally advanced cervical cancer treated with chemoradiation therapy (CRT) in a large multicenter cohort, and to correlate expression with clinical outcome parameters. Methods and Materials: A total of 264 patients with locally advanced cervical cancer, treated with curative-intent radical CRT from 3 major Canadian cancer centers were evaluated. Pretreatment formalin-fixed, paraffin-embedded tumor specimens were retrieved, and tissue microarrays were constructed. Tumoral ERCC1 (FL297 antibody) was measured using AQUA (R) technology. Statistical analysis was performed to determine the significance of clinical factors and ERCC1 status with progression-free survival (PFS) and overall survival (OS) at 5 years. Results: The majority of patients had International Federation of Gynecology and Obstetrics (FIGO) stage II disease (n=119, 45%); median tumor size was 5 cm. OS was associated with tumor size (HR 1.16, P=.018), pretreatment hemoglobin status (HR 2.33, P=.00027), and FIGO stage. In addition, tumoral ERCC1 status (nuclear to cytoplasmic ratio) was associated with PFS (HR 2.33 [1.05-5.18], P=.038) and OS (HR 3.13 [1.27-7.71], P=.013). ERCC1 status was not significant on multivariate analysis when the model was adjusted for the clinical factors: for PFS (HR 1.49 [0.61-3.6], P=.38); for OS (HR 2.42 [0.94-6.24] P=.067). Conclusions: In this large multicenter cohort of locally advanced cervical cancer patients treated with radical CRT, stage, tumor size, and pretreatment hemoglobin status were significantly associated with PFS and OS. ERCC1 status appears to have prognostic impact on univariate analysis in these patients, but was not independently associated with outcome on

25 CFR 163.23 - Advance payment for timber products.

Science.gov (United States)

2010-04-01

... contracts. However, no advance payment will be required that would make the sum of such payment and of... required, advance payments will operate the same as provided for in § 163.23(a) of this part. ... 25 Indians 1 2010-04-01 2010-04-01 false Advance payment for timber products. 163.23 Section 163...

Advanced technologies available for future solid propellant grains

Energy Technology Data Exchange (ETDEWEB)

Thepenier, J. [SNPE Propulsion, St Medard en Jalles (France); Fonblanc, G. [SNPE Propulsion, Vert le Petit (France). Centre de Recherche de Bouchet

2001-06-01

Significant advances have been made during the last decade in several fields of solid propulsion: the advances have enabled new savings in the motor development phase and in recurring costs, because they help limit the number of prototypes and tests. The purpose of the paper is to describe the improvements achieved by SNPE in solid grain technologies, making these technologies available for new developments in more efficient and reliable future SRMs: new energetic molecules, new solid propellants, new processes for grain manufacturing, quick response grain design tools associated with advanced models for grain performance predictions. Using its expertise in chemical synthesis, SNPE develops new molecules to fit new energetic material requirements. Tests based on new propellant formulations have produced good results in the propellant performance/safety behavior ratio. New processes have been developed simultaneously to reduce the manufacturing costs of the new propellants. In addition, the grain design has been optimized by using the latest generation of predictive theoretical tools supported by a large data bank of experimental parameters resulting from over 30 years' experience in solid propulsion: computer-aided method for the preliminary grain design; advanced models for SRM operating and performance predictions. All these technologies are available for industrial applications in future developments of solid propellant grains. (author)

Advances in Primary Central Nervous System Lymphoma.

Science.gov (United States)

Patrick, Lauren B; Mohile, Nimish A

2015-12-01

Primary central nervous system lymphoma (PCNSL) is a rare form of non-Hodgkin lymphoma that is limited to the CNS. Although novel imaging techniques aid in discriminating lymphoma from other brain tumors, definitive diagnosis requires brain biopsy, vitreoretinal biopsy, or cerebrospinal fluid analysis. Survival rates in clinical studies have improved over the past 20 years due to the addition of high-dose methotrexate-based chemotherapy regimens to whole-brain radiotherapy. Long-term survival, however, is complicated by clinically devastating delayed neurotoxicity. Newer regimens are attempting to reduce or eliminate radiotherapy from first-line treatment with chemotherapy dose intensification. Significant advances have also been made in the fields of pathobiology and treatment, with more targeted treatments on the horizon. The rarity of the disease makes conducting of prospective clinical trials challenging, requiring collaborative efforts between institutions. This review highlights recent advances in the biology, detection, and treatment of PCNSL in immunocompetent patients.

Advances in Ecological Speciation: an integrative approach.

Science.gov (United States)

Faria, Rui; Renaut, Sebastien; Galindo, Juan; Pinho, Catarina; Melo-Ferreira, José; Melo, Martim; Jones, Felicity; Salzburger, Walter; Schluter, Dolph; Butlin, Roger

2014-02-01

The role of natural selection in promoting reproductive isolation has received substantial renewed interest within the last two decades. As a consequence, the study of ecological speciation has become an extremely productive research area in modern evolutionary biology. Recent innovations in sequencing technologies offer an unprecedented opportunity to study the mechanisms involved in ecological speciation. Genome scans provide significant insights but have some important limitations; efforts are needed to integrate them with other approaches to make full use of the sequencing data deluge. An international conference 'Advances in Ecological Speciation' organized by the University of Porto (Portugal) aimed to review current progress in ecological speciation. Using some of the examples presented at the conference, we highlight the benefits of integrating ecological and genomic data and discuss different mechanisms of parallel evolution. Finally, future avenues of research are suggested to advance our knowledge concerning the role of natural selection in the establishment of reproductive isolation during ecological speciation. © 2013 John Wiley & Sons Ltd.

Decision Making

Directory of Open Access Journals (Sweden)

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.

SENIOR STAFF ADVANCEMENT COMMITTEE (SSAC)

CERN Document Server

2000-01-01

Composition and mandateThe Senior Staff Advancement Committee is composed of members nominated ad persona by the Director-General.The Committee examines proposals from Divisions concerning promotions to grade 13 in Career Path IX, changes of career path to Career Path IX and advancements to the exceptional grade in Career path VIII.The Director-General may consult the Committee on any matter related to senior staff careers.The Committee makes its recommendations to the Director-General.

Rule-based decision making model

International Nuclear Information System (INIS)

Sirola, Miki

1998-01-01

A rule-based decision making model is designed in G2 environment. A theoretical and methodological frame for the model is composed and motivated. The rule-based decision making model is based on object-oriented modelling, knowledge engineering and decision theory. The idea of safety objective tree is utilized. Advanced rule-based methodologies are applied. A general decision making model 'decision element' is constructed. The strategy planning of the decision element is based on e.g. value theory and utility theory. A hypothetical process model is built to give input data for the decision element. The basic principle of the object model in decision making is division in tasks. Probability models are used in characterizing component availabilities. Bayes' theorem is used to recalculate the probability figures when new information is got. The model includes simple learning features to save the solution path. A decision analytic interpretation is given to the decision making process. (author)

Effectiveness of advance care planning with family carers in dementia nursing homes: A paired cluster randomized controlled trial.

Science.gov (United States)

Brazil, Kevin; Carter, Gillian; Cardwell, Chris; Clarke, Mike; Hudson, Peter; Froggatt, Katherine; McLaughlin, Dorry; Passmore, Peter; Kernohan, W George

2018-03-01

In dementia care, a large number of treatment decisions are made by family carers on behalf of their family member who lacks decisional capacity; advance care planning can support such carers in the decision-making of care goals. However, given the relative importance of advance care planning in dementia care, the prevalence of advance care planning in dementia care is poor. To evaluate the effectiveness of advance care planning with family carers in dementia care homes. Paired cluster randomized controlled trial. The intervention comprised a trained facilitator, family education, family meetings, documentation of advance care planning decisions and intervention orientation for general practitioners and nursing home staff. A total of 24 nursing homes with a dementia nursing category located in Northern Ireland, United Kingdom. Family carers of nursing home residents classified as having dementia and judged as not having decisional capacity to participate in advance care planning discussions. The primary outcome was family carer uncertainty in decision-making about the care of the resident (Decisional Conflict Scale). There was evidence of a reduction in total Decisional Conflict Scale score in the intervention group compared with the usual care group (-10.5, 95% confidence interval: -16.4 to -4.7; p planning was effective in reducing family carer uncertainty in decision-making concerning the care of their family member and improving perceptions of quality of care in nursing homes. Given the global significance of dementia, the implications for clinicians and policy makers include them recognizing the importance of family carer education and improving communication between family carers and formal care providers.

A brief history of decision making.

Science.gov (United States)

Buchanan, Leigh; O'Connell, Andrew

2006-01-01

Sometime around the middle of the past century, telephone executive Chester Barnard imported the term decision making from public administration into the business world. There it began to replace narrower terms, like "resource allocation" and "policy making," shifting the way managers thought about their role from continuous, Hamlet-like deliberation toward a crisp series of conclusions reached and actions taken. Yet, decision making is, of course, a broad and ancient human pursuit, flowing back to a time when people sought guidance from the stars. From those earliest days, we have strived to invent better tools for the purpose, from the Hindu-Arabic systems for numbering and algebra, to Aristotle's systematic empiricism, to friar Occam's advances in logic, to Francis Bacon's inductive reasoning, to Descartes's application of the scientific method. A growing sophistication with managing risk, along with a nuanced understanding of human behavior and advances in technology that support and mimic cognitive processes, has improved decision making in many situations. Even so, the history of decision-making strategies--captured in this time line and examined in the four accompanying essays on risk, group dynamics, technology, and instinct--has not marched steadily toward perfect rationalism. Twentieth-century theorists showed that the costs of acquiring information lead executives to make do with only good-enough decisions. Worse, people decide against their own economic interests even when they know better. And in the absence of emotion, it's impossible to make any decisions at all. Erroneous framing, bounded awareness, excessive optimism: The debunking of Descartes's rational man threatens to swamp our confidence in our choices. Is it really surprising, then, that even as technology dramatically increases our access to information, Malcolm Gladwell extols the virtues of gut decisions made, literally, in the blink of an eye?

Advanced fuel technologies at General Atomics

International Nuclear Information System (INIS)

Back, Christina A.

2013-01-01

General Atomics (GA) has made significant contributions since its founding in the 1950's to develop nuclear power for peaceful means. With the conception and construction of the TRIGA reactors and research on TRISO particles, GA has long recognised the importance of 'accident-tolerant' materials. Before the accident at Fukushima Daiichi, GA had already initiated work on silicon carbide (SiC) and SiC-related technologies for application in nuclear reactors. At that time, the work was initiated in support of the GA advanced gas-cooled fast reactor concept called the Energy Multiplier Module, EM2. This work continues, however, the reasons that make SiC materials attractive for fast reactor concepts also make them attractive for advanced light water reactors. These include superior performance over zircaloy for high-temperature strength, especially above 1500 deg. C, and significantly reduced hydrogen production in accident scenarios. The current focus on 'accident-tolerant' components is to develop cladding made of silicon carbide fiber and silicon carbide matrix, SiC-SiC composites. The goal for this work is to produce a cladding that provides strength and impermeability to meet reactor performance and safety requirements. To date, GA has examined the trade-offs between processing time and infiltration uniformity to reduce fabrication time, fabricated cylindrical prototypes, and refined material properties for fracture toughness, impermeability, and thermal conductivity. Generally, the GA programme is developing innovative fuel elements that employ both high density uranium-bearing fuels that enable longer lifetime with higher burn-up, and claddings that are more resistant to neutron damage. In addition to fabrication, significant effort is devoted to measuring the critical parameters, such as thermal conductivity, mechanical strength and component performance at reactor-relevant operational conditions, using a mix of commercial equipment

Molecular neuroimaging of emotional decision-making.

Science.gov (United States)

Takahashi, Hidehiko

2013-04-01

With the dissemination of non-invasive human neuroimaging techniques such as fMRI and the advancement of cognitive science, neuroimaging studies focusing on emotions and social cognition have become established. Along with this advancement, behavioral economics taking emotional and social factors into account for economic decisions has been merged with neuroscientific studies, and this interdisciplinary approach is called neuroeconomics. Past neuroeconomics studies have demonstrated that subcortical emotion-related brain structures play an important role in "irrational" decision-making. The research field that investigates the role of central neurotransmitters in this process is worthy of further development. Here, we provide an overview of recent molecular neuroimaging studies to further the understanding of the neurochemical basis of "irrational" or emotional decision-making and the future direction, including clinical implications, of the field. Copyright © 2013 Elsevier Ireland Ltd and the Japan Neuroscience Society. All rights reserved.

On acquiring decision making skills for endovascular interventions.

Science.gov (United States)

Lanzer, Peter; Prechelt, Lutz

2008-11-01

To improve interventional training we propose a staged rational approach for decision making and skill acquisition. Education and training for endovascular interventions should start to develop the learners' decision-making skills by learning from explicit representations of master interventionist's tacit decision-making knowledge through implementation of the notions of generic interventional modules, interventional strategic and tactical designs. We hope that these suggestions will encourage action, stimulate dialogue and advance the precision of our learning, procedures, practice and patient care.

12 CFR 950.17 - Advances to housing associates.

Science.gov (United States)

2010-01-01

... that such collateral comprises mortgage loans on one-to-four family or multifamily residential property... located in the Bank's district. (b) Collateral requirements—(1) Advances to housing associates. A Bank may make an advance to any housing associate upon the security of the following collateral: (i) Mortgage...

They Make Space and Give Time

Indian Academy of Sciences (India)

... Resonance – Journal of Science Education; Volume 3; Issue 3. They Make Space and Give Time The Engineer as Poet. Gangan Prathap. Book Review Volume 3 ... Author Affiliations. Gangan Prathap1. National Aerospace Laboratories and the Jawaharlal Nehru Centre for Advanced Scientific Research in Bangalore.

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

Science.gov (United States)

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

2012-01-01

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

Safety issues on advanced fuel

International Nuclear Information System (INIS)

Gross, H.; Krebs, W.D.

1998-01-01

In the recent years a general discussion has started whether unsolved safety issues are related to advanced fuel. Advanced fuel is in this context a summary of features like high burnup, improved clad materials, low leakage loading pattern with high peaking factors etc. The design basis accidents RIA and Loca are of special interest for this discussion. From the Siemens point of view RIA is not a safety issue. There are sufficient margins between the enthalpy rise calculated by modern 3D methods and the fuel failures which occurred in RIA simulation tests when the effect of pulse width is taken into account. The evaluation of possible uncertainties for the established Loca criteria (17% equivalent corrosion, 1200 C clad temperature) for high burnup makes sense. But fuel with high burnup has significantly lower peaking factors than fuel with lower burnup. This gives sufficient margin counterbalancing possible uncertainties. In contrast to the above incomplete control rod insertion at higher burnup is potentially a real safety issue. Although Siemens fuel was not affected by the reported incidents they addressed the problem and checked that they have sufficient design margin for their fuel. (orig.) [de

Soft computing in advanced robotics

CERN Document Server

Kobayashi, Ichiro; Kim, Euntai

2014-01-01

Intelligent system and robotics are inevitably bound up; intelligent robots makes embodiment of system integration by using the intelligent systems. We can figure out that intelligent systems are to cell units, while intelligent robots are to body components. The two technologies have been synchronized in progress. Making leverage of the robotics and intelligent systems, applications cover boundlessly the range from our daily life to space station; manufacturing, healthcare, environment, energy, education, personal assistance, logistics. This book aims at presenting the research results in relevance with intelligent robotics technology. We propose to researchers and practitioners some methods to advance the intelligent systems and apply them to advanced robotics technology. This book consists of 10 contributions that feature mobile robots, robot emotion, electric power steering, multi-agent, fuzzy visual navigation, adaptive network-based fuzzy inference system, swarm EKF localization and inspection robot. Th...

Making Our Food Safe

International Nuclear Information System (INIS)

Madsen, Michael

2013-01-01

Full text: As civilization has progressed societies have strived to make food safer; from using fire to cook our food, and boiling our water to make it safe to drink, advances in technology have helped kill microorganisms that can make food unsafe. The FAO/IAEA Joint Division helps provide technical assistance to Member States that want to implement irradiation technology in making their food safer. Food and waterborne diarrhoeal diseases are estimated to kill roughly 2.2 million people annually, of which 1.9 million are children. Irradiating some of the foods we eat can save many of these lives by reducing the risk of food poisoning and killing the organisms that cause disease. Irradiation works by treating food with a small dose of ionizing radiation, this radiation disrupts the bacteria’s DNA and cell membranes structure stopping the organism from reproducing or functioning, but does not make the food radioactive. It can be applied to a variety of foods from spices and seasonings, to fruits and vegetables and is similar to pasteurization, but without the need for high temperatures that might impair food quality. (author)

Making a measurable difference in advanced Huntington disease care.

Science.gov (United States)

Moskowitz, Carol Brown; Rao, Ashwini K

2017-01-01

Neurologists' role in the care of people with advanced Huntington disease (HD) (total functional capacity speech and language pathology), behavioral and psychiatric professionals for problem-solving strategies, which must be reviewed with direct care staff before implementation; (3) encourage and support qualitative and quantitative interdisciplinary research studies, and randomized controlled studies of nonpharmacologic interventions; and (4) assist in the development of meaningful measures to further document what works to provide a good quality of life for the patient and family and a comfortable thoughtful approach to a good death. Collaborative models of care depend on: (1) clear communication; (2) ongoing education and support programs; with (3) pharmacologic and rehabilitation interventions, always in the context of respect for the person with HD, a preservation of the individuals' dignity, autonomy, and individual preferences. Copyright © 2017 Elsevier B.V. All rights reserved.

Prognostic significance of pathological response of primary tumor and metastatic axillary lymph nodes after neoadjuvant chemotherapy for locally advanced breast carcinoma.

Science.gov (United States)

Machiavelli, M R; Romero, A O; Pérez, J E; Lacava, J A; Domínguez, M E; Rodríguez, R; Barbieri, M R; Romero Acuña, L A; Romero Acuña, J M; Langhi, M J; Amato, S; Ortiz, E H; Vallejo, C T; Leone, B A

1998-01-01

The prognostic significance of pathological response of primary tumor and metastatic axillary lymph nodes after neoadjuvant chemotherapy was assessed in patients with noninflammatory locally advanced breast carcinoma. Between January 1989 and April 1995, 148 consecutive patients with locally advanced breast carcinoma participated in the study. Of these, 140 fully evaluable patients (67, stage IIIA; 73, stage IIIB) were treated with three courses of 5-fluorouracil, doxorubicin, and cyclophosphamide (FAC), followed by modified radical mastectomy when technically feasible or definitive radiation therapy. The median age was 53 years (range, 26 to 75 years); 55% of patients were postmenopausal. Objective response was recorded in 99 of 140 patients (71%; 95% confidence interval, 63% to 79%). Complete response occurred in 11 patients (8%), and partial response occurred in 88 patients (63%). No change was recorded in 37 patients (26%), and progressive disease occurred in 4 patients (3%). One hundred and thirty-six patients underwent the planned surgery. Maximal pathological response of the primary tumor (in situ carcinoma or minimal microscopic residual tumor) was observed in 24 (18%); 112 patients (82%) presented minimal pathological response of the primary tumor (gross residual tumor). The number of metastatic axillary nodes after neoadjuvant chemotherapy was as follows: N0, 39 patients (29%); N1-N3, 35 patients (26%); > N3, 62 patients (45%). Considering the initial TNM status, 75% of the patients had decreases in tumor compartment after neoadjuvant chemotherapy. Also, 31% and 23% of patients with clinical N1 and N2, respectively, showed uninvolved axillary lymph nodes. A significant correlation was noted between pathological response of primary tumor and the number of metastatic axillary lymph nodes. Median disease-free survival was 34 months, whereas median overall survival was 66 months. Pathological responses of both primary tumor and metastatic axillary lymph nodes

Making Sense of Data from Complex Assessments. CSE Technical Report.

Science.gov (United States)

Mislevy, Robert J.; Steinberg, Linda S.; Almond, Russell G.; Breyer, F. Jay; Johnson, Lynn

Advances in cognitive psychology deepen the understanding of how students gain and use knowledge and broaden the range of performances and situations researchers want to see to acquire evidence about students' developing knowledge. Advances in technology make it possible to capture more complex performances in assessment settings by including, as…

Principalship in an Indonesian School Context: Can Principal Decision-Making Styles Significantly Predict Teacher Job Satisfaction?

Science.gov (United States)

Hariri, Hasan; Monypenny, Richard; Prideaux, Murray

2012-01-01

This paper examines relationships between teacher-perceived principal decision-making styles and teacher job satisfaction in schools in Lampung Province, Indonesia. We use the General Decision-making Style instrument, the Job Satisfaction Survey and a demographic questionnaire developed for this study. Our findings show that: 12 out of the 15…

The Female Executive’s Perspective on Career Planning and Advancement in Organizations

Directory of Open Access Journals (Sweden)

Dasie J. Schulz

2014-11-01

Full Text Available Gender bias continues to play a role in the gender discrepancy at executive levels in organizations across the United States, although women hold 51% of all middle management positions. Female middle managers may be overlooked for advancement to executive positions because of a lack of synergy between individual career planning and organizational development and advancement practices. This may have significant implications for organizations as they struggle to recruit and hire qualified senior leadership to close the widening leadership gap created as baby boomers leave the workforce in record numbers over the next decade. One way to retain talented, knowledgeable, female middle managers is to incorporate career planning and advancement programs, which increase visibility for both the individual and organizational leaders into potential advancement opportunities. This descriptive phenomenological study was designed to investigate and describe the lived experiences of female executives with career planning and advancement in organizations. Data collected from 16 female executives employed in organizations in Nashville, Tennessee, revealed that although individuals must make a commitment to career planning and take responsibility for executing the plan, successful career planning and advancement are dependent on others beyond the individual seeking advancement. The findings of this study are important for women who desire advancement to executive levels and to organizational leaders who want to hire and promote the right person for the job regardless of gender.

Development of an Automated Decision-Making Tool for Supervisory Control System

Energy Technology Data Exchange (ETDEWEB)

Cetiner, Sacit M. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Muhlheim, Michael David [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Flanagan, George F. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Fugate, David L. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Kisner, Roger A. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States)

2014-09-01

This technical report was generated as a product of the Supervisory Control for Multi-Modular Small Modular Reactor (SMR) Plants project within the Instrumentation, Control and Human-Machine Interface technology area under the Advanced Small Modular Reactor (AdvSMR) Research and Development Program of the US Department of Energy. The report documents the definition of strategies, functional elements, and the structural architecture of a supervisory control system for multi-modular AdvSMR plants. This research activity advances the state of the art by incorporating real-time, probabilistic-based decision-making into the supervisory control system architectural layers through the introduction of a tiered-plant system approach. The report provides background information on the state of the art of automated decision-making, including the description of existing methodologies. It then presents a description of a generalized decision-making framework, upon which the supervisory control decision-making algorithm is based. The probabilistic portion of automated decision-making is demonstrated through a simple hydraulic loop example.

Neuroeconomic approaches to emotion-related influences on decision-making

OpenAIRE

Meyer, Friederike

2015-01-01

Decades of classic economic research have neglected the role of incidental and integral emotional factors in human decision-making. Standard economic models assume that decision-making is consequentialist in nature: Decision-making is postulated to be guided by the decision maker’s rational assessment of desirability and likelihood of alternative outcomes, i.e., by his strive to maximize utility (Rick & Loewenstein, 2008). However, advances in psychology and behavioral economics led to the gr...

Significance of tests and properties of concrete and concrete-making materials

CERN Document Server

Pielert, James H

2006-01-01

Reflects a decade of technological changes in concrete industry! The newest edition of this popular ASTM publication reflects the latest technology in concrete and concrete-making materials. Six sections cover: (1) General information on the nature of concrete, sampling, variability, and testing laboratories. A new chapter deals with modeling cement and concrete properties. (2) Properties of freshly mixed concrete. (3) Properties of hardened concrete. (4) Concrete aggregates—this section has been revised and the chapters are presented in the order that most concerns concrete users: grading, density, soundness, degradation resistance, petrographic examination, reactivity, and thermal properties. (5) Materials other than aggregates—the chapter on curing materials now reflects the current technology of materials applied to new concrete surfaces. The chapter on mineral admixtures has been separated into two chapters: supplementary cementitious materials and ground slag. (6) Specialized concretes—contains a ...

Fire science application and integration in support of decision making

Science.gov (United States)

Tom Zimmerman

2011-01-01

Wildland fire management in the United States has historically been a challenging and complex program governed by a multitude of factors including situational status, objectives, operational capability, science and technology, and changes and advances in all these factors. The improvement and advancement of risk-informed decision making has the potential to improve...

Recent BWR fuel management reactor physics advances

International Nuclear Information System (INIS)

Crowther, R.L.; Congdon, S.P.; Crawford, B.W.; Kang, C.M.; Martin, C.L.; Reese, A.P.; Savoia, P.J.; Specker, S.R.; Welchly, R.

1982-01-01

Improvements in BWR fuel management have been under development to reduce uranium and separative work (SWU) requirements and reduce fuel cycle costs, while also maintaining maximal capacity factors and high fuel reliability. Improved reactor physics methods are playing an increasingly important role in making such advances feasible. The improved design, process computer and analysis methods both increase knowledge of the thermal margins which are available to implement fuel management advance, and improve the capability to reliably and efficiently analyze and design for fuel management advances. Gamma scan measurements of the power distributions of advanced fuel assembly and advanced reactor core designs, and improved in-core instruments also are important contributors to improving 3-d predictive methods and to increasing thermal margins. This paper is an overview of the recent advances in BWR reactor physics fuel management methods, coupled with fuel management and core design advances. The reactor physics measurements which are required to confirm the predictions of performance fo fuel management advances also are summarized

Metrics for Uncertainty in Organizational Decision-Making

National Research Council Canada - National Science Library

Lawless, W. F; Chaudron, Laurent; Abubucker, C. P

2006-01-01

... intractable. To advance the mathematics of social interaction, we propose that only bi-sided or quantum computational agents will be capable of replicating social phenomena such as the dynamics of human agents, including the more difficult problem of organizational decision-making.

38 CFR 17.32 - Informed consent and advance care planning.

Science.gov (United States)

2010-07-01

...) Definitions: Advance Directive. Specific written statements made by a patient who has decision-making capacity.... Decision-making capacity. The ability to understand and appreciate the nature and consequences of health... informed consent on behalf of a patient who lacks decision-making capacity. (b) Policy. Except as otherwise...

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

Directory of Open Access Journals (Sweden)

Jia Lee, PhD, RN

2010-12-01

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

The Role of Colleges of Advanced Education in the Education of Adults. A Report to the Australian Commission on Advanced Education.

Science.gov (United States)

Nelson, A. J. A.

This report to the Australian Commission on Advanced Education is intended as a basis for discussion by those who have the responsibility for making program and policy decisions in continuing education in Australia's colleges of advanced education. Though the idea that education is continuous with life is coming to be widely accepted…

Advanced Microelectronics Technologies for Future Small Satellite Systems

Science.gov (United States)

Alkalai, Leon

1999-01-01

Future small satellite systems for both Earth observation as well as deep-space exploration are greatly enabled by the technological advances in deep sub-micron microelectronics technologies. Whereas these technological advances are being fueled by the commercial (non-space) industries, more recently there has been an exciting new synergism evolving between the two otherwise disjointed markets. In other words, both the commercial and space industries are enabled by advances in low-power, highly integrated, miniaturized (low-volume), lightweight, and reliable real-time embedded systems. Recent announcements by commercial semiconductor manufacturers to introduce Silicon On Insulator (SOI) technology into their commercial product lines is driven by the need for high-performance low-power integrated devices. Moreover, SOI has been the technology of choice for many space semiconductor manufacturers where radiation requirements are critical. This technology has inherent radiation latch-up immunity built into the process, which makes it very attractive to space applications. In this paper, we describe the advanced microelectronics and avionics technologies under development by NASA's Deep Space Systems Technology Program (also known as X2000). These technologies are of significant benefit to both the commercial satellite as well as the deep-space and Earth orbiting science missions. Such a synergistic technology roadmap may truly enable quick turn-around, low-cost, and highly capable small satellite systems for both Earth observation as well as deep-space missions.

Cash Advance Accounting: Accounting Regulations and Practices

OpenAIRE

Aristita Rotila

2012-01-01

It is known the fact that often the entities offer to staff or third parties certain amounts of money, in order to make payments for the entities, such sums being registered differently in the accounting as cash advances. In the case in which the advances are offered in a foreign currency, there is the problem of the exchange rate used when justifying the advance, for the conversion in lei of payments that were carried out. In this article we wanted to signal the effect that the exchange rate...

Artificial intelligence and foreign policy decision-making

OpenAIRE

Berkoff, Russ H.

1997-01-01

Approved for public release; distribution is unlimited With the advent of a global information society, the US will seek to tap the potential of advanced computing capability to enhance its ability to conduct foreign policy decision making. This thesis explores the potential for improving individual and organizational decision making capabilities by means of artificial intelligence (AI). The use of AI will allow us to take advantage of the plethora of information available to obtain an edg...

Accessing patient-centered care using the advanced access model.

Science.gov (United States)

Tantau, Catherine

2009-01-01

Waits and delays for healthcare are legendary. These delays are not only frustrating and potentially hazardous for patients and providers but also represent significant cost to office practices. The traditional medical model that defines urgent care versus routine care is a vain and futile attempt to sort demand. This approach is at constant odds with patients' definition of urgency. Trusting patients to determine when and how they want to access care makes sense from a customer service perspective. If approached systematically using the principles of Advanced Access, patient demand patterns can be tracked to forecast demand. These demand patterns become the template for deploying the resources necessary to meet patients' needs. Although not a simple journey, the transformation to Advanced Access provides an entree to patient-centered care where patients can say, "I get exactly the care I want and need, when I want and need it."

Advance care planning for nursing home residents with dementia: policy vs. practice.

Science.gov (United States)

Ampe, Sophie; Sevenants, Aline; Smets, Tinne; Declercq, Anja; Van Audenhove, Chantal

2016-03-01

The aims of this study were: to evaluate the advance care planning policy for people with dementia in nursing homes; to gain insight in the involvement of residents with dementia and their families in advance care planning, and in the relationship between the policy and the actual practice of advance care planning. Through advance care planning, nursing home residents with dementia are involved in care decisions, anticipating their reduced decision-making capacity. However, advance care planning is rarely realized for this group. Prevalence and outcomes have been researched, but hardly any research has focused on the involvement of residents/families in advance care planning. Observational cross-sectional study in 20 nursing homes. The ACP audit assessed the views of the nursing homes' staff on the advance care planning policy. In addition, individual conversations were analysed with 'ACP criteria' (realization of advance care planning) and the 'OPTION' instrument (involvement of residents/families). June 2013-September 2013. Nursing homes generally met three quarters of the pre-defined criteria for advance care planning policy. In almost half of the conversations, advance care planning was explained and discussed substantively. Generally, healthcare professionals only managed to involve residents/families on a baseline skill level. There were no statistically significant correlations between policy and practice. The evaluations of the policy were promising, but the actual practice needs improvement. Future assessment of both policy and practice is recommended. Further research should focus on communication interventions for implementing advance care planning in the daily practice. © 2015 John Wiley & Sons Ltd.

High satisfaction and low decisional conflict with advance care planning among chronically ill patients with advanced chronic obstructive pulmonary disease or heart failure using an online decision aid: A pilot study.

Science.gov (United States)

Van Scoy, Lauren J; Green, Michael J; Dimmock, Anne Ef; Bascom, Rebecca; Boehmer, John P; Hensel, Jessica K; Hozella, Joshua B; Lehman, Erik B; Schubart, Jane R; Farace, Elana; Stewart, Renee R; Levi, Benjamin H

2016-09-01

Many patients with chronic illnesses report a desire for increased involvement in medical decision-making. This pilot study aimed to explore how patients with exacerbation-prone disease trajectories such as advanced heart failure or chronic obstructive pulmonary disease experience advance care planning using an online decision aid and to compare whether patients with different types of exacerbation-prone illnesses had varied experiences using the tool. Pre-intervention questionnaires measured advance care planning knowledge. Post-intervention questionnaires measured: (1) advance care planning knowledge; (2) satisfaction with tool; (3) decisional conflict; and (4) accuracy of the resultant advance directive. Comparisons were made between patients with heart failure and chronic obstructive pulmonary disease. Over 90% of the patients with heart failure (n = 24) or chronic obstructive pulmonary disease (n = 25) reported being "satisfied" or "highly satisfied" with the tool across all satisfaction domains; over 90% of participants rated the resultant advance directive as "very accurate." Participants reported low decisional conflict. Advance care planning knowledge scores rose by 18% (p < 0.001) post-intervention. There were no significant differences between participants with heart failure and chronic obstructive pulmonary disease. Patients with advanced heart failure and chronic obstructive pulmonary disease were highly satisfied after using an online advance care planning decision aid and had increased knowledge of advance care planning. This tool can be a useful resource for time-constrained clinicians whose patients wish to engage in advance care planning. © The Author(s) 2016.

Probabilistic Flood Maps to support decision-making: Mapping the Value of Information

Science.gov (United States)

Alfonso, L.; Mukolwe, M. M.; Di Baldassarre, G.

2016-02-01

Floods are one of the most frequent and disruptive natural hazards that affect man. Annually, significant flood damage is documented worldwide. Flood mapping is a common preimpact flood hazard mitigation measure, for which advanced methods and tools (such as flood inundation models) are used to estimate potential flood extent maps that are used in spatial planning. However, these tools are affected, largely to an unknown degree, by both epistemic and aleatory uncertainty. Over the past few years, advances in uncertainty analysis with respect to flood inundation modeling show that it is appropriate to adopt Probabilistic Flood Maps (PFM) to account for uncertainty. However, the following question arises; how can probabilistic flood hazard information be incorporated into spatial planning? Thus, a consistent framework to incorporate PFMs into the decision-making is required. In this paper, a novel methodology based on Decision-Making under Uncertainty theories, in particular Value of Information (VOI) is proposed. Specifically, the methodology entails the use of a PFM to generate a VOI map, which highlights floodplain locations where additional information is valuable with respect to available floodplain management actions and their potential consequences. The methodology is illustrated with a simplified example and also applied to a real case study in the South of France, where a VOI map is analyzed on the basis of historical land use change decisions over a period of 26 years. Results show that uncertain flood hazard information encapsulated in PFMs can aid decision-making in floodplain planning.

Advanced Thermoelectric Materials for Efficient Waste Heat Recovery in Process Industries

Energy Technology Data Exchange (ETDEWEB)

Adam Polcyn; Moe Khaleel

2009-01-06

The overall objective of the project was to integrate advanced thermoelectric materials into a power generation device that could convert waste heat from an industrial process to electricity with an efficiency approaching 20%. Advanced thermoelectric materials were developed with figure-of-merit ZT of 1.5 at 275 degrees C. These materials were not successfully integrated into a power generation device. However, waste heat recovery was demonstrated from an industrial process (the combustion exhaust gas stream of an oxyfuel-fired flat glass melting furnace) using a commercially available (5% efficiency) thermoelectric generator coupled to a heat pipe. It was concluded that significant improvements both in thermoelectric material figure-of-merit and in cost-effective methods for capturing heat would be required to make thermoelectric waste heat recovery viable for widespread industrial application.

Expert Team Decision-Making and Problem Solving: Development and Learning

Directory of Open Access Journals (Sweden)

Simona Tancig

2009-12-01

Full Text Available Traditional research of decision-making has not significantly contributed towards better understanding of professional judgment and decisions in practice. Researchers dealing with decision-making in various professions and natural settings initiated new perspectives called naturalistic, which put the expert in the focus of research and the expertise thus entered the core of decision-making research in natural situations.Expert team is more than a group of experts. It is defined as a group of interdependent team members with a high level of task related expertise and the mastering of team processes.There have been several advances in understanding of expertise and the team. By combining theories, models, and empirical evidence we are trying to explain effectiveness and adaptation of expert teams in problem-solving and decision-making in complex and dynamic situations.A considerable research has been devoted to finding out what are the characteristics of experts and expert teams during their optimal functioning. These characteristics are discussed as input, process and output factors. As input variables the cognitive, social-affective, and motivational characteristics are presented. Process variables encompass individual and team learning, problem solving and decision-making as presented in Kolb’s cycle of learning, in deeper structures of dialogue and discussion, and in phenomena of collaboration, alignment, and distributed cognition. Outcome variables deal with task performance – activities.

Test Concept for Advanced Oxidation Techniques

DEFF Research Database (Denmark)

Bennedsen, Lars Rønn; Søgaard, Erik Gydesen; Mortensen, Lars

advanced on-site oxidation tests. The remediation techniques included are electrochemical oxidation, photochemical/photocatalytic oxidation, ozone, hydrogen peroxide, permanganate, and persulfate among others. A versatile construction of the mobile test unit makes it possible to combine different...

The design and validation of advanced operator support systems for a role in plant safety

International Nuclear Information System (INIS)

Hughes, G.

1989-06-01

Advanced operator support systems have the potential of making a significant contribution to plant safety. This note reviews the different support functions required, the specification of performance criteria and possible approaches for system validation. The importance of the different functions that can be provided is related to the stage of the accident sequence. Also, because of the restricted reliability of any single system, subdivision of the systems is suggested in order to make the maximum contribution at a number of sequential stages. In this way it should be possible to make a significant claim for reduced operator error over the full accident progression, from incipient fault to disaster. The use of performance criteria currently associated with the classification of safety-grade trip systems (e.g. detection failure probability) would seem to provide a sound basis for validation. The validation of systems is seen as a significant task which will rely on the use of design and training-simulator data together with specific plant measurements. Expert systems appear to present particular problems for validation. (author)

Fresh frozen cadaver workshops for advanced vascular surgical training.

Science.gov (United States)

Jansen, Shirley; Cowie, Margaret; Linehan, John; Hamdorf, Jeffery M

2014-11-01

Reduction in working hours, streamlined training schemes and increasing use of endovascular techniques has meant a reduction in operative experience for newer vascular surgical trainees, especially those exposures which are not routinely performed such as thoracoabdominal, thoracotomy and retroperitoneal aortic, for example. This paper describes an Advanced Anatomy of Exposure course which was designed and convened at the Clinical Training & Evaluation Centre in Western Australia and uses fresh frozen cadavers. Feedback was obtained from the participants who attended over three courses by questionnaire. Feedback was strongly positive for the course meeting both its learning outcomes and personal learning objectives, and in addition, making a significant contribution to specialty skills. Most participants thought the fresh frozen cadaveric model significantly improved the learning objectives for training. The fresh frozen cadaver is an excellent teaching model highly representative of the living open surgical scenario where advanced trainees and newly qualified consultants can improve their operative confidence and consequently patient safety in vascular surgery. An efficient fresh frozen cadaver teaching programme can benefit many health professionals simultaneously maximizing the use of donated human tissue. © 2013 Royal Australasian College of Surgeons.

Japan's advanced medicine.

Science.gov (United States)

Sho, Ri; Narimatsu, Hiroto; Murakami, Masayasu

2013-10-01

Like health care systems in other developed countries, Japan's health care system faces significant challenges due to aging of the population and economic stagnation. Advanced medicine (Senshin Iryou) is a unique system of medical care in Japan offering highly technology-driven medical care that is not covered by public health insurance. Advanced medicine has recently developed and expanded as part of health care reform. Will it work? To answer this question, we briefly trace the historical development of advanced medicine and describe the characteristics and current state of advanced medical care in Japan. We then offer our opinions on the future of advanced medicine with careful consideration of its pros and cons. We believe that developing advanced medicine is an attempt to bring health care reform in line rather than the goal of health care reform.

Amateur Telescope Making

Science.gov (United States)

Tonkin, Stephen

Many amateur astronomers make their own instruments, either because of financial considerations or because they are just interested. Amateur Telescope Making offers a variety of designs for telescopes, mounts and drives which are suitable for the home-constructor. The designs range from simple to advanced, but all are within the range of a moderately well-equipped home workshop. The book not only tells the reader what he can construct, but also what it is sensible to construct given what time is available commercially. Thus each chapter begins with reasons for undertaking the project, then looks at theoretical consideration before finishing with practical instructions and advice. An indication is given as to the skills required for the various projects. Appendices list reputable sources of (mail order) materials and components. The telescopes and mounts range from "shoestring" (very cheap) instruments to specialist devices that are unavailable commercially.

Prognostic significance of total lesion glycolysis in patients with advanced non-small cell lung cancer receiving chemotherapy

Energy Technology Data Exchange (ETDEWEB)

Zaizen, Yoshiaki [Division of Respirology, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Kurume (Japan); Azuma, Koichi, E-mail: azuma@med.kurume-u.ac.jp [Division of Respirology, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Kurume (Japan); Kurata, Seiji [Department of Radiology, Kurume University School of Medicine, Kurume (Japan); Sadashima, Eiji; Hattori, Satoshi [Biostatistics Center, Kurume University, Kurume (Japan); Sasada, Tetsuro [Department of Immunology and Immunotherapy, Kurume University School of Medicine, Kurume (Japan); Imamura, Yohei [Division of Respirology, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Kurume (Japan); Kaida, Hayato [Department of Radiology, Kurume University School of Medicine, Kurume (Japan); Kawahara, Akihiko [Department of Pathology, Kurume University School of Medicine, Kurume (Japan); Kinoshita, Takashi [Division of Respirology, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Kurume (Japan); Ishibashi, Masatoshi [Department of Radiology, Kurume University School of Medicine, Kurume (Japan); Hoshino, Tomoaki [Division of Respirology, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Kurume (Japan)

2012-12-15

Background: [{sup 18}F]fluorodeoxyglucose positron emission tomography (FDG-PET) imaging has been employed as a non-invasive diagnostic tool for malignant tumors. Total lesion glycolysis (TLG) on FDG-PET is calculated by multiplying the mean standardized uptake value (SUVmean) by the tumor volume. Unlike the maximum standardized uptake value (SUVmax), which represents the point of greatest metabolic activity within tumors, TLG has been suggested to reflect global metabolic activity in whole tumors. Methods: We retrospectively examined whether or not FDG-PET measurements, including SUVmean, SUVmax, and TLG, could predict progression-free survival (PFS) or overall survival (OS) in patients with non-small cell lung cancer (NSCLC) receiving chemotherapy. Results: This study involved 81 consecutive patients with NSCLC who received chemotherapy. All of the patients underwent FDG-PET examination before treatment. SUVmean, SUVmax, and TLG on FDG-PET were significantly associated with gender, smoking status, and tumor histology. With adjustment for several other variables, Cox regression analysis showed that TLG was significantly prognostic for both PFS [hazard ratio = 2.34; 95% confidence interval, 1.18–4.64; P = 0.015] and OS (hazard ratio = 2.80; 95% confidence interval, 1.12–6.96; P = 0.003), whereas SUVmean and SUVmax had no significant association with PFS (P = 0.693 and P = 0.322, respectively) or OS (P = 0.587 and P = 0.214, respectively). Conclusions: Our findings suggest that TLG may be more useful than SUVmean and SUVmax for predicting PFS and OS in NSCLC patients receiving chemotherapy. The TLG measurement on FDG-PET imaging could be routinely recommended to advanced NSCLC patients.

Textural features of pretreatment 18F-FDG PET/CT images: prognostic significance in patients with advanced T-stage oropharyngeal squamous cell carcinoma.

Science.gov (United States)

Cheng, Nai-Ming; Fang, Yu-Hua Dean; Chang, Joseph Tung-Chieh; Huang, Chung-Guei; Tsan, Din-Li; Ng, Shu-Hang; Wang, Hung-Ming; Lin, Chien-Yu; Liao, Chun-Ta; Yen, Tzu-Chen

2013-10-01

Previous studies have shown that total lesion glycolysis (TLG) may serve as a prognostic indicator in oropharyngeal squamous cell carcinoma (OPSCC). We sought to investigate whether the textural features of pretreatment (18)F-FDG PET/CT images can provide any additional prognostic information over TLG and clinical staging in patients with advanced T-stage OPSCC. We retrospectively analyzed the pretreatment (18)F-FDG PET/CT images of 70 patients with advanced T-stage OPSCC who had completed concurrent chemoradiotherapy, bioradiotherapy, or radiotherapy with curative intent. All of the patients had data on human papillomavirus (HPV) infection and were followed up for at least 24 mo or until death. A standardized uptake value (SUV) of 2.5 was taken as a cutoff for tumor boundary. The textural features of pretreatment (18)F-FDG PET/CT images were extracted from histogram analysis (SUV variance and SUV entropy), normalized gray-level cooccurrence matrix (uniformity, entropy, dissimilarity, contrast, homogeneity, inverse different moment, and correlation), and neighborhood gray-tone difference matrix (coarseness, contrast, busyness, complexity, and strength). Receiver-operating-characteristic curves were used to identify the optimal cutoff values for the textural features and TLG. Thirteen patients were HPV-positive. Multivariate Cox regression analysis showed that age, tumor TLG, and uniformity were independently associated with progression-free survival (PFS) and disease-specific survival (DSS). TLG, uniformity, and HPV positivity were significantly associated with overall survival (OS). A prognostic scoring system based on TLG and uniformity was derived. Patients who presented with TLG > 121.9 g and uniformity ≤ 0.138 experienced significantly worse PFS, DSS, and OS rates than those without (P 121.9 g or uniformity ≤ 0.138 were further divided according to age, and different PFS and DSS were observed. Uniformity extracted from the normalized gray

Advanced High-Level Waste Glass Research and Development Plan

Energy Technology Data Exchange (ETDEWEB)

Peeler, David K. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Vienna, John D. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Schweiger, Michael J. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Fox, Kevin M. [Savannah River Site (SRS), Aiken, SC (United States). Savannah River National Lab. (SRNL)

2015-07-01

glass formulations will reduce the cost of Hanford tank waste management by reducing the schedule for tank waste treatment and reducing the amount of HLW glass for storage, transportation, and disposal. Additional benefits will be realized if advanced glasses are developed that demonstrate more tolerance for key components in the waste (such as Al₂O₃, Cr₂O₃, SO₃ and Na₂O) above the currently defined WTP constraints. Tolerating these higher concentrations of key waste loading limiters may reduce the burden on (or even eliminate the need for) leaching to remove Cr and Al and washing to remove excess S and Na from the HLW fraction. Advanced glass formulations may also make direct vitrification of the HLW fraction without significant pretreatment more cost effective. Finally, the advanced glass formulation efforts seek not only to increase waste loading in glass, but also to increase glass production rate. When coupled with higher waste loading, ensuring that all of the advanced glass formulations are processable at or above the current contract processing rate leads to significant improvements in waste throughput (the amount of waste being processed per unit time),which could significantly reduce the overall WTP mission life. The integration of increased waste loading, reduced leaching/washing requirements, and improved melting rates provides a system-wide approach to improve the effectiveness of the WTP process.

Making ethical choices: a comprehensive decision-making model for Canadian psychologists.

Science.gov (United States)

Hadjistavropoulos, T; Malloy, D C

2000-05-01

This paper proposes a theoretical augmentation of the seven-step decision-making model outlined in the Canadian Code of Ethics for Psychologists. We propose that teleological, deontological, and existential ethical perspectives should be taken into account in the decision-making process. We also consider the influence of individual, issue-specific, significant-other, situational, and external factors on ethical decision-making. This theoretical analysis demonstrates the richness and complexity of ethical decision-making.

7 CFR 1751.103 - Loan and loan advance requirements.

Science.gov (United States)

2010-01-01

... 7 Agriculture 11 2010-01-01 2010-01-01 false Loan and loan advance requirements. 1751.103 Section... Telecommunications Modernization Plan § 1751.103 Loan and loan advance requirements. (a) For information about loan... February 13, 1996, RUS will make RUS hardship loans, RUS cost-of-money loans, and RTB loans for facilities...

What Should We Make with CO2 and How Can We Make It?

Energy Technology Data Exchange (ETDEWEB)

Bushuyev, Oleksandr S.; De Luna, Phil; Dinh, Cao Thang; Tao, Ling; Saur, Genevieve; van de Lagemaat, Jao; Kelley, Shana O.; Sargent, Edward H.

2018-03-01

In this forward-looking Perspective, we discuss the current state of technology and the economics of electrocatalytic transformation of CO2 into various chemical fuels. Our analysis finds that short-chain simple building-block molecules currently present the most economically compelling targets. Making an optimistic prediction of technology advancement in the future, we propose the gradual rise of photocatalytic, CO2 polymerization, biohybrid, and molecular machine technologies to augment and enhance already practical electrocatalytic CO2 conversion methods.

Higher-order relativistic periastron advances and binary pulsars

International Nuclear Information System (INIS)

Damour, T.; Schafer, G.

1988-01-01

The contributions to the periastron advance of a system of two condensed bodies coming from relativistic dynamical effects of order higher than the usual first post-Newtonian (1PN) equations of motion are investigated. The structure of the solution of the orbital second post-Newtonian (2PN) equations of motion is given in a simple parametrized form. The contributions to the secular pariastron advance, and the period, of orbital 2PN effects are then explicitly worked out by using the Hamilton-Jacobi method. The spin-orbit contribution to the secular precession of the orbit in space is rederived in a streamlined way by making full use of Hamiltonian methods. These results are then applied to the theoretical interpretation of the observational data of pulsars in close eccentric binary systems. It is shown that the higher-order relativistic contributions are already of theoretical and astophysical significance for interpreting the high-precision measurement of the secular periastron advance of PSR 1913+16 achived by Taylor and coworkers. The case of extremely fast spinning (millisecond) binary pulsars is also discussed, and shown to offer an easier ground for getting new tests of general relativity, and/or, a direct measurement of the moment of inertia of a neutron star

A conceptual review of decision making in social dilemmas: applying a logic of appropriateness.

Science.gov (United States)

Weber, J Mark; Kopelman, Shirli; Messick, David M

2004-01-01

Despite decades of experimental social dilemma research, "theoretical integration has proven elusive" (Smithson & Foddy, 1999, p. 14). To advance a theory of decision making in social dilemmas, this article provides a conceptual review of the literature that applies a "logic of appropriateness" (March, 1994) framework. The appropriateness framework suggests that people making decisions ask themselves (explicitly or implicitly), "What does a person like me do in a situation like this? " This question identifies 3 significant factors: recognition and classification of the kind of situation encountered, the identity of the individual making the decision, and the application of rules or heuristics in guiding behavioral choice. In contrast with dominant rational choice models, the appropriateness framework proposed accommodates the inherently social nature of social dilemmas, and the role of rule and heuristic based processing. Implications for the interpretation of past findings and the direction of future research are discussed.

GxE Interactions Between FOXO Genotypes and Tea Drinking Significantly Affect Cognitive Disability at Advanced Ages in China

DEFF Research Database (Denmark)

Zeng, Yi; Chen, Huashuai; Ni, Ting

2015-01-01

Logistic regression analysis based on data from 822 Han Chinese oldest old aged 92+ demonstrated that interactions between carrying FOXO1A-266 or FOXO3-310 or FOXO3-292 and tea drinking at around age 60 or at present time were significantly associated with lower risk of cognitive disability...... at advanced ages. Associations between tea drinking and reduced cognitive disability were much stronger among carriers of the genotypes of FOXO1A-266 or FOXO3-310 or FOXO3-292 compared with noncarriers, and it was reconfirmed by analysis of three-way interactions across FOXO genotypes, tea drinking at around...... age 60, and at present time. Based on prior findings from animal and human cell models, we postulate that intake of tea compounds may activate FOXO gene expression, which in turn may positively affect cognitive function in the oldest old population. Our empirical findings imply that the health...

Human-centric decision-making models for social sciences

CERN Document Server

Pedrycz, Witold

2014-01-01

The volume delivers a wealth of effective methods to deal with various types of uncertainty inherently existing in human-centric decision problems. It elaborates on  comprehensive decision frameworks to handle different decision scenarios, which help use effectively the explicit and tacit knowledge and intuition, model perceptions and preferences in a more human-oriented style. The book presents original approaches and delivers new results on fundamentals and applications related to human-centered decision making approaches to business, economics and social systems. Individual chapters cover multi-criteria (multiattribute) decision making, decision making with prospect theory, decision making with incomplete probabilistic information, granular models of decision making and decision making realized with the use of non-additive measures. New emerging decision theories being presented as along with a wide spectrum of ongoing research make the book valuable to all interested in the field of advanced decision-mak...

Neuroeconomics: cross-currents in research on decision-making

NARCIS (Netherlands)

Sanfey, A.G.; Loewenstein, G.; McClure, S.M.; Cohen, J.D.

2006-01-01

Despite substantial advances, the question of how we make decisions and judgments continues to pose important challenges for scientific research. Historically, different disciplines have approached this problem using different techniques and assumptions, with few unifying efforts made. However, the

Dysfunctions of decision-making and cognitive control as transdiagnostic mechanisms of mental disorders: advances, gaps, and needs in current research.

Science.gov (United States)

Goschke, Thomas

2014-01-01

Disadvantageous decision-making and impaired volitional control over actions, thoughts, and emotions are characteristics of a wide range of mental disorders such as addiction, eating disorders, depression, and anxiety disorders and may reflect transdiagnostic core mechanisms and possibly vulnerability factors. Elucidating the underlying neurocognitive mechanisms is a precondition for moving from symptom-based to mechanism-based disorder classifications and ultimately mechanism-targeted interventions. However, despite substantial advances in basic research on decision-making and cognitive control, there are still profound gaps in our current understanding of dysfunctions of these processes in mental disorders. Central unresolved questions are: (i) to which degree such dysfunctions reflect transdiagnostic mechanisms or disorder-specific patterns of impairment; (ii) how phenotypical features of mental disorders relate to dysfunctional control parameter settings and aberrant interactions between large-scale brain systems involved in habit and reward-based learning, performance monitoring, emotion regulation, and cognitive control; (iii) whether cognitive control impairments are consequences or antecedent vulnerability factors of mental disorders; (iv) whether they reflect generalized competence impairments or context-specific performance failures; (v) whether not only impaired but also chronic over-control contributes to mental disorders. In the light of these gaps, needs for future research are: (i) an increased focus on basic cognitive-affective mechanisms underlying decision and control dysfunctions across disorders; (ii) longitudinal-prospective studies systematically incorporating theory-driven behavioural tasks and neuroimaging protocols to assess decision-making and control dysfunctions and aberrant interactions between underlying large-scale brain systems; (iii) use of latent-variable models of cognitive control rather than single tasks; (iv) increased focus on

Methodology, theoretical framework and scholarly significance: An ...

African Journals Online (AJOL)

Methodology, theoretical framework and scholarly significance: An overview ... AFRICAN JOURNALS ONLINE (AJOL) · Journals · Advanced Search ... Keywords: Legal Research, Methodology, Theory, Pedagogy, Legal Training, Scholarship ...

Advanced Interval Management: A Benefit Analysis

Science.gov (United States)

Timer, Sebastian; Peters, Mark

2016-01-01

This document is the final report for the NASA Langley Research Center (LaRC)- sponsored task order 'Possible Benefits for Advanced Interval Management Operations.' Under this research project, Architecture Technology Corporation performed an analysis to determine the maximum potential benefit to be gained if specific Advanced Interval Management (AIM) operations were implemented in the National Airspace System (NAS). The motivation for this research is to guide NASA decision-making on which Interval Management (IM) applications offer the most potential benefit and warrant further research.

Cash Advance Accounting: Accounting Regulations and Practices

Directory of Open Access Journals (Sweden)

Aristita Rotila

2012-12-01

Full Text Available It is known the fact that often the entities offer to staff or third parties certain amounts of money, in order to make payments for the entities, such sums being registered differently in the accounting as cash advances. In the case in which the advances are offered in a foreign currency, there is the problem of the exchange rate used when justifying the advance, for the conversion in lei of payments that were carried out. In this article we wanted to signal the effect that the exchange rate, used in the assessment for reflecting in the accounting operations concerning cash advance reimbursements in a foreign currency, has on the information presented in the financial statement. Therewith, we signal some aspects from the content of the accounting regulations, with reference at defining the cash advances, meaning, and the presentation in the balance sheet of cash advances, which, in our opinion, impose clarifications.

Cognitive function and advanced kidney disease: longitudinal trends and impact on decision-making

OpenAIRE

Iyasere, Osasuyi; Okai, David; Brown, Edwina

2017-01-01

Background: Cognitive impairment commonly affects renal patients. But little is known about the influence of dialysis modality on cognitive trends or the influence of cognitive impairment on decision-making in renal patients. This study evaluated cognitive trends amongst chronic kidney disease (CKD), haemodialysis (HD) and peritoneal dialysis (PD) patients. The relationship between cognitive impairment and decision-making capacity (DMC) was also assessed. Methods: Patients were recruited from...

Spatial Analysis of Depots for Advanced Biomass Processing

Energy Technology Data Exchange (ETDEWEB)

Hilliard, Michael R. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Brandt, Craig C. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Webb, Erin [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Sokhansanj, Shahabaddine [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Eaton, Laurence M. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Martinez Gonzalez, Maria I. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States)

2014-09-01

The objective of this work was to perform a spatial analysis of the total feedstock cost at the conversion reactor for biomass supplied by a conventional system and an advanced system with depots to densify biomass into pellets. From these cost estimates, the conditions (feedstock cost and availability) for which advanced processing depots make it possible to achieve cost and volume targets can be identified.

Vision Based Autonomous Robotic Control for Advanced Inspection and Repair

Science.gov (United States)

Wehner, Walter S.

2014-01-01

The advanced inspection system is an autonomous control and analysis system that improves the inspection and remediation operations for ground and surface systems. It uses optical imaging technology with intelligent computer vision algorithms to analyze physical features of the real-world environment to make decisions and learn from experience. The advanced inspection system plans to control a robotic manipulator arm, an unmanned ground vehicle and cameras remotely, automatically and autonomously. There are many computer vision, image processing and machine learning techniques available as open source for using vision as a sensory feedback in decision-making and autonomous robotic movement. My responsibilities for the advanced inspection system are to create a software architecture that integrates and provides a framework for all the different subsystem components; identify open-source algorithms and techniques; and integrate robot hardware.

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

Science.gov (United States)

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

2017-08-01

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

Social acceptability: Towards a definition and shared understanding of its significance and contribution to decision-making

Energy Technology Data Exchange (ETDEWEB)

Cote, Gilles; Perusse, Martin

2010-09-15

Social acceptability is increasingly described in the discourse of social players as a sine qua non condition for projects to be carried out. It is referred to as an approach (participation in the decision-making process) and as an outcome (citizens' concurrence with the decision). The application of this new concept generated considerable expectations. In our opinion, social acceptability must pass through three complementary stages: i) discussing material (downstream) and structural (upstream) issues; ii) establishing a transparent and equitable consultation process; and iii) ensuring that a legitimate decision-making process occurs.

Hierarchy as a barrier to advancement for women in academic medicine.

Science.gov (United States)

Conrad, Peter; Carr, Phyllis; Knight, Sharon; Renfrew, Megan R; Dunn, Mary B; Pololi, Linda

2010-04-01

Research on barriers to professional advancement for women in academic medicine has not adequately considered the role of environmental factors and how the structure of organizations affects professional advancement and work experiences. This article examines the impact of the hierarchy, including both the organization's hierarchical structure and professionals' perceptions of this structure, in medical school organization on faculty members' experience and advancement in academic medicine. As part of an inductive qualitative study of faculty in five disparate U.S. medical schools, we interviewed 96 medical faculty at different career stages and in diverse specialties, using in-depth semistructured interviews, about their perceptions about and experiences in academic medicine. Data were coded and analysis was conducted in the grounded theory tradition. Our respondents saw the hierarchy of chairs, based on the indeterminate tenure of department chairs, as a central characteristic of the structure of academic medicine. Many faculty saw this hierarchy as affecting inclusion, reducing transparency in decision making, and impeding advancement. Indeterminate chair terms lessen turnover and may create a bottleneck for advancement. Both men and women faculty perceived this hierarchy, but women saw it as more consequential. The hierarchical structure of academic medicine has a significant impact on faculty work experiences, including advancement, especially for women. We suggest that medical schools consider alternative models of leadership and managerial styles, including fixed terms for chairs with a greater emphasis on inclusion. This is a structural reform that could increase opportunities for advancement especially for women in academic medicine.

Advancing Research on Undergraduate Science Learning

Science.gov (United States)

Singer, Susan Rundell

2013-01-01

This special issue of "Journal of Research in Science Teaching" reflects conclusions and recommendations in the "Discipline-Based Education Research" (DBER) report and makes a substantial contribution to advancing the field. Research on undergraduate science learning is currently a loose affiliation of related fields. The…

Robot vision for nuclear advanced robot

International Nuclear Information System (INIS)

Nakayama, Ryoichi; Okano, Hideharu; Kuno, Yoshinori; Miyazawa, Tatsuo; Shimada, Hideo; Okada, Satoshi; Kawamura, Astuo

1991-01-01

This paper describes Robot Vision and Operation System for Nuclear Advanced Robot. This Robot Vision consists of robot position detection, obstacle detection and object recognition. With these vision techniques, a mobile robot can make a path and move autonomously along the planned path. The authors implemented the above robot vision system on the 'Advanced Robot for Nuclear Power Plant' and tested in an environment mocked up as nuclear power plant facilities. Since the operation system for this robot consists of operator's console and a large stereo monitor, this system can be easily operated by one person. Experimental tests were made using the Advanced Robot (nuclear robot). Results indicate that the proposed operation system is very useful, and can be operate by only person. (author)

International Conference on Computers and Advanced Technology in Education

CERN Document Server

Advanced Information Technology in Education

2012-01-01

The volume includes a set of selected papers extended and revised from the 2011 International Conference on Computers and Advanced Technology in Education. With the development of computers and advanced technology, the human social activities are changing basically. Education, especially the education reforms in different countries, has been experiencing the great help from the computers and advanced technology. Generally speaking, education is a field which needs more information, while the computers, advanced technology and internet are a good information provider. Also, with the aid of the computer and advanced technology, persons can make the education an effective combination. Therefore, computers and advanced technology should be regarded as an important media in the modern education. Volume Advanced Information Technology in Education is to provide a forum for researchers, educators, engineers, and government officials involved in the general areas of computers and advanced technology in education to d...

Listeriosis in animals, its public health significance (food-borne zoonosis) and advances in diagnosis and control: a comprehensive review.

Science.gov (United States)

Dhama, Kuldeep; Karthik, Kumaragurubaran; Tiwari, Ruchi; Shabbir, Muhammad Zubair; Barbuddhe, Sukhadeo; Malik, Satya Veer Singh; Singh, Raj Kumar

2015-01-01

Listeriosis is an infectious and fatal disease of animals, birds, fish, crustaceans and humans. It is an important food-borne zoonosis caused by Listeria monocytogenes, an intracellular pathogen with unique potential to spread from cell to cell, thereby crossing blood-brain, intestinal and placental barriers. The organism possesses a pile of virulence factors that help to infect the host and evade from host immune machinery. Though disease occurrence is sporadic throughout the world, it can result in severe damage during an outbreak. Listeriosis is characterized by septicaemia, encephalitis, meningitis, meningoencephalitis, abortion, stillbirth, perinatal infections and gastroenteritis with the incubation period varying with the form of infection. L. monocytogenes has been isolated worldwide from humans, animals, poultry, environmental sources like soil, river, decaying plants, and food sources like milk, meat and their products, seafood and vegetables. Since appropriate vaccines are not available and infection is mainly transmitted through foods in humans and animals, hygienic practices can prevent its spread. The present review describes etiology, epidemiology, transmission, clinical signs, post-mortem lesions, pathogenesis, public health significance, and advances in diagnosis, vaccines and treatment of this disease. Special attention has been given to novel as well as prospective emerging therapies that include bacteriophage and cytokine therapy, avian egg yolk antibodies and herbal therapy. Various vaccines, including advances in recombinant and DNA vaccines and their modes of eliciting immune response, are also discussed. Due focus has also been given regarding appropriate prevention and control strategies to be adapted for better management of this zoonotic disease.

Advances in Applied Mechanics

OpenAIRE

2013-01-01

Advances in Applied Mechanics draws together recent significant advances in various topics in applied mechanics. Published since 1948, Advances in Applied Mechanics aims to provide authoritative review articles on topics in the mechanical sciences, primarily of interest to scientists and engineers working in the various branches of mechanics, but also of interest to the many who use the results of investigations in mechanics in various application areas, such as aerospace, chemical, civil, en...

Advanced fuels safety comparisons

International Nuclear Information System (INIS)

Grolmes, M.A.

1977-01-01

The safety considerations of advanced fuels are described relative to the present understanding of the safety of oxide fueled Liquid Metal Fast Breeder Reactors (LMFBR). Safety considerations important for the successful implementation of advanced fueled reactors must early on focus on the accident energetics issues of fuel coolant interactions and recriticality associated with core disruptive accidents. It is in these areas where the thermal physical property differences of the advanced fuel have the greatest significance

Make Learning Matter for the Multitasking Generation

Science.gov (United States)

Adams, Jill

2012-01-01

Technological advances have created amazing opportunities for people throughout the world to access and share information. These opportunities have helped to create a generation of young adolescents who want to make the most of each minute of the day, seizing opportunities to seek information and communicate at the same time. This generation is…

Some advances in pairing theory

International Nuclear Information System (INIS)

Rowe, D.J.

2001-01-01

Two advances are reviewed in the application of pairing-force theory in the nuclear shell model. The first exploits a discovery that a wide range of two-nucleon interactions conserve seniority as a good quantum number. As a consequence, the eigenstates of a Hamiltonian with such an interaction belong to irreducible representations of a compact unitary-symplectic group. This makes it possible to extend the simply-solvable models with J=0 pairing forces to a much richer set of models and still obtain states uniquely classified by their seniority and angular momentum quantum numbers. Moreover, many of the low-lying energy levels of such models can be obtained algebraically; in technical terms, the models are in some cases completely solvable and in other cases partially solvable by algebraic methods. The second advance exploits the discovery that, in a coherent state representation, states of good nucleon number can be projected analytically from BCS vacuum and excited quasiparticle states. This makes it possible to perform calculations in a number-projected BCS basis without losing much of the advantage of working of the quasiparticle scheme. (Author)

Ethical Decision-Making Accounting Competencies: Practitioners' Perspectives

Science.gov (United States)

Meador, Gwendolyn Parrish

2017-01-01

Recent accounting and corporate scandals call into question the ethicality of accounting practice, likewise accounting graduates. Advances in ethical accounting education are not emphasized in today's business schools leaving accounting graduates lacking necessary ethical accounting competencies to make ethical accounting decisions (Abend, 2013;…

Doing what's right: A grounded theory of ethical decision-making in occupational therapy.

Science.gov (United States)

VanderKaay, Sandra; Letts, Lori; Jung, Bonny; Moll, Sandra E

2018-04-20

Ethical decision-making is an important aspect of reasoning in occupational therapy practice. However, the process of ethical decision-making within the broader context of reasoning is yet to be clearly explicated. The purpose of this study was to advance a theoretical understanding of the process by which occupational therapists make ethical decisions in day-to-day practice. A constructivist grounded theory approach was adopted, incorporating in-depth semi-structured interviews with 18 occupational therapists from a range of practice settings and years of experience. Initially, participants nominated as key informants who were able to reflect on their decision-making processes were recruited. Theoretical sampling informed subsequent stages of data collection. Participants were asked to describe their process of ethical decision-making using scenarios from clinical practice. Interview transcripts were analyzed using a systematic process of initial then focused coding, and theoretical categorization to construct a theory regarding the process of ethical decision-making. An ethical decision-making prism was developed to capture three main processes: Considering the Fundamental Checklist, Consulting Others, and Doing What's Right. Ethical decision-making appeared to be an inductive and dialectical process with the occupational therapist at its core. Study findings advance our understanding of ethical decision-making in day-to-day clinical practice.

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

Science.gov (United States)

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.

Efficiency improvement of nuclear power plant operation: the significant role of advanced nuclear fuel technologies

International Nuclear Information System (INIS)

Velde Van de, A.; Burtak, F.

2001-01-01

Due to the increased liberalisation of the power markets, nuclear power generation is being exposed to high cost reduction pressure. In this paper we highlight the role of advanced nuclear fuel technologies to reduce the fuel cycle costs and therefore increase the efficiency of nuclear power plant operation. The key factor is a more efficient utilisation of the fuel and present developments at Siemens are consequently directed at (i) further increase of batch average burnup, (ii) improvement of fuel reliability, (iii) enlargement of fuel operation margins and (iv) improvement of methods for fuel design and core analysis. As a result, the nuclear fuel cycle costs for a typical LWR have been reduced during the past decades by about US$ 35 million per year. The estimated impact of further burnup increases on the fuel cycle costs is expected to be an additional saving of US$10 - 15 million per year. Due to the fact that the fuel will operate closer to design limits, a careful approach is required when introducing advanced fuel features in reload quantities. Trust and co-operation between the fuel vendors and the utilities is a prerequisite for the common success. (authors)

Managing, making sense of and finding meaning in advanced illness: a qualitative exploration of the coping and wellbeing experiences of patients with lung cancer.

Science.gov (United States)

Harrop, Emily; Noble, Simon; Edwards, Michelle; Sivell, Stephanie; Moore, Barbara; Nelson, Annmarie

2017-11-01

Coping plays an essential role in maintaining the wellbeing of patients with cancer. A number of different coping responses and strategies have been identified in the literature. The value and relevance of meaning based coping theory has also been emphasised, including Antonovosky's Sense of Coherence (SoC) theory. Ten patients with advanced lung cancer were interviewed up to three times. A total of twenty in depth interviews were carried out, fully transcribed and data were analysed following a methodology of Interpretative Phenomenological Analysis. Three broad domains were identified to categorise the core life concerns of participants; making sense of and managing one's illness; maintaining daily life and relationships and confronting the future. Within these domains multiple coping themes are identified, which to varying degrees help to maintain patient wellbeing and quality of life. This article considers the relevance of SoC theory for understanding the coping experiences of patients with advanced cancer, and identifies resources and factors likely to support patient coping, with implications for health and social care services. © 2017 The Authors. Sociology of Health & Illness published by John Wiley & Sons Ltd on behalf of Foundation for SHIL.

Advances in natural language processing.

Science.gov (United States)

Hirschberg, Julia; Manning, Christopher D

2015-07-17

Natural language processing employs computational techniques for the purpose of learning, understanding, and producing human language content. Early computational approaches to language research focused on automating the analysis of the linguistic structure of language and developing basic technologies such as machine translation, speech recognition, and speech synthesis. Today's researchers refine and make use of such tools in real-world applications, creating spoken dialogue systems and speech-to-speech translation engines, mining social media for information about health or finance, and identifying sentiment and emotion toward products and services. We describe successes and challenges in this rapidly advancing area. Copyright © 2015, American Association for the Advancement of Science.

Advancing Evaluation Theory and Practice in South Asia ...

International Development Research Centre (IDRC) Digital Library (Canada)

Advancing Evaluation Theory and Practice in South Asia: Community of ... evidence-based policy development, decision-making, and practice in South Asia. ... International Water Resources Association, in close collaboration with IDRC, ...

Impact of scientific and technological advances.

Science.gov (United States)

Dragan, I F; Dalessandri, D; Johnson, L A; Tucker, A; Walmsley, A D

2018-03-01

Advancements in research and technology are transforming our world. The dental profession is changing too, in the light of scientific discoveries that are advancing biological technology-from new biomaterials to unravelling the genetic make-up of the human being. As health professionals, we embrace a model of continuous quality improvement and lifelong learning. Our pedagogical approach to incorporating the plethora of scientific-technological advancements calls for us to shift our paradigm from emphasis on skill acquisition to knowledge application. The 2017 ADEE/ADEA workshop provided a forum to explore and discuss strategies to ensure faculty, students and, ultimately, patients are best positioned to exploit the opportunities that arise from integrating new technological advances and research outcomes. Participants discussed methods of incorporating the impact of new technologies and research findings into the education of our dental students. This report serves as a signpost of the way forward and how to promote incorporation of research and technology advances and lifelong learning into the dental education curriculum. © 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

An autonomous control framework for advanced reactors

Directory of Open Access Journals (Sweden)

Richard T. Wood

2017-08-01

Full Text Available Several Generation IV nuclear reactor concepts have goals for optimizing investment recovery through phased introduction of multiple units on a common site with shared facilities and/or reconfigurable energy conversion systems. Additionally, small modular reactors are suitable for remote deployment to support highly localized microgrids in isolated, underdeveloped regions. The long-term economic viability of these advanced reactor plants depends on significant reductions in plant operations and maintenance costs. To accomplish these goals, intelligent control and diagnostic capabilities are needed to provide nearly autonomous operations with anticipatory maintenance. A nearly autonomous control system should enable automatic operation of a nuclear power plant while adapting to equipment faults and other upsets. It needs to have many intelligent capabilities, such as diagnosis, simulation, analysis, planning, reconfigurability, self-validation, and decision. These capabilities have been the subject of research for many years, but an autonomous control system for nuclear power generation remains as-yet an unrealized goal. This article describes a functional framework for intelligent, autonomous control that can facilitate the integration of control, diagnostic, and decision-making capabilities to satisfy the operational and performance goals of power plants based on multimodular advanced reactors.

An autonomous control framework for advanced reactors

International Nuclear Information System (INIS)

Wood, Richard T.; Upadhyaya, Belle R.; Floyd, Dan C.

2017-01-01

Several Generation IV nuclear reactor concepts have goals for optimizing investment recovery through phased introduction of multiple units on a common site with shared facilities and/or reconfigurable energy conversion systems. Additionally, small modular reactors are suitable for remote deployment to support highly localized microgrids in isolated, underdeveloped regions. The long-term economic viability of these advanced reactor plants depends on significant reductions in plant operations and maintenance costs. To accomplish these goals, intelligent control and diagnostic capabilities are needed to provide nearly autonomous operations with anticipatory maintenance. A nearly autonomous control system should enable automatic operation of a nuclear power plant while adapting to equipment faults and other upsets. It needs to have many intelligent capabilities, such as diagnosis, simulation, analysis, planning, reconfigurability, self-validation, and decision. These capabilities have been the subject of research for many years, but an autonomous control system for nuclear power generation remains as-yet an unrealized goal. This article describes a functional framework for intelligent, autonomous control that can facilitate the integration of control, diagnostic, and decision-making capabilities to satisfy the operational and performance goals of power plants based on multimodular advanced reactors

An autonomous control framework for advanced reactors

Energy Technology Data Exchange (ETDEWEB)

Wood, Richard T.; Upadhyaya, Belle R.; Floyd, Dan C. [Dept. of Nuclear Engineering, University of Tennessee, Knoxville (United States)

2017-08-15

Several Generation IV nuclear reactor concepts have goals for optimizing investment recovery through phased introduction of multiple units on a common site with shared facilities and/or reconfigurable energy conversion systems. Additionally, small modular reactors are suitable for remote deployment to support highly localized microgrids in isolated, underdeveloped regions. The long-term economic viability of these advanced reactor plants depends on significant reductions in plant operations and maintenance costs. To accomplish these goals, intelligent control and diagnostic capabilities are needed to provide nearly autonomous operations with anticipatory maintenance. A nearly autonomous control system should enable automatic operation of a nuclear power plant while adapting to equipment faults and other upsets. It needs to have many intelligent capabilities, such as diagnosis, simulation, analysis, planning, reconfigurability, self-validation, and decision. These capabilities have been the subject of research for many years, but an autonomous control system for nuclear power generation remains as-yet an unrealized goal. This article describes a functional framework for intelligent, autonomous control that can facilitate the integration of control, diagnostic, and decision-making capabilities to satisfy the operational and performance goals of power plants based on multimodular advanced reactors.

Biotechnology and Consumer Decision-Making.

Science.gov (United States)

Sax, Joanna K

Society is facing major challenges in climate change, health care and overall quality of life. Scientific advances to address these areas continue to grow, with overwhelming evidence that the application of highly tested forms of biotechnology is safe and effective. Despite scientific consensus in these areas, consumers appear reluctant to support their use. Research that helps to understand consumer decision-making and the public’s resistance to biotechnologies such as vaccines, fluoridated water programs and genetically engineered food, will provide great social value. This article is forward-thinking in that it suggests that important research in behavioral decision-making, specifically affect and ambiguity, can be used to help consumers make informed choices about major applications of biotechnology. This article highlights some of the most controversial examples: vaccinations, genetically engineered food, rbST treated dairy cows, fluoridated water, and embryonic stem cell research. In many of these areas, consumers perceive the risks as high, but the experts calculate the risks as low. Four major thematic approaches are proposed to create a roadmap for policymakers to consider for policy design and implementation in controversial areas of biotechnology. This article articulates future directions for studies that implement decision-making research to allow consumers to appropriately assign risk to their options and make informed decisions.

Improving Decision Making for Advanced Heart Failure Patients and Caregivers.

Science.gov (United States)

McIlvennan, Colleen K

2017-04-01

In this month's Magnet® Perspectives column, Colleen K. McIlvennan, DNP, ANP, lead nurse practitioner, Advanced Heart Failure and Transplantation at the University of Colorado, discusses her groundbreaking research encompassing patients' and caregivers' emotional, rational, and fundamental beliefs when considering a left ventricular assist device (LVAD). Results have led to the development of 2 innovative decision aids that are currently in use by LVAD programs across the United States and Canada. Dr McIlvennan's efforts led to a $2 million grant from the Patient-Centered Outcomes Research Institute, as well as national recognition from the American Heart Association and the Heart Failure Society of America. Last year, she received the 2016 National Magnet Nurse of the Year® Award in the Empirical Outcomes category. In addition to sharing her findings, Dr McIlvennan examines the value of performing research in a Magnet-recognized organization.

Advances in Risk Analysis with Big Data.

Science.gov (United States)

Choi, Tsan-Ming; Lambert, James H

2017-08-01

With cloud computing, Internet-of-things, wireless sensors, social media, fast storage and retrieval, etc., organizations and enterprises have access to unprecedented amounts and varieties of data. Current risk analysis methodology and applications are experiencing related advances and breakthroughs. For example, highway operations data are readily available, and making use of them reduces risks of traffic crashes and travel delays. Massive data of financial and enterprise systems support decision making under risk by individuals, industries, regulators, etc. In this introductory article, we first discuss the meaning of big data for risk analysis. We then examine recent advances in risk analysis with big data in several topic areas. For each area, we identify and introduce the relevant articles that are featured in the special issue. We conclude with a discussion on future research opportunities. © 2017 Society for Risk Analysis.

Advances in Schoolwide Inclusive School Reform

Science.gov (United States)

Sailor, Wayne

2015-01-01

This article highlights three significant advances in schoolwide inclusive school reform and suggests three next steps to improve educational outcomes for "all" students, particularly for students for whom typical instruction is not effective. Significant advances are as follows: (a) a multi-tiered system of support (MTSS) with embedded…

Goals of patient care system change with video-based education increases rates of advance cardiopulmonary resuscitation decision-making and discussions in hospitalised rehabilitation patients.

Science.gov (United States)

Johnson, Claire E; Chong, Jeffrey C; Wilkinson, Anne; Hayes, Barbara; Tait, Sonia; Waldron, Nicholas

2017-07-01

Advance cardiopulmonary resuscitation (CPR) discussions and decision-making are not routine clinical practice in the hospital setting. Frail older patients may be at risk of non-beneficial CPR. To assess the utility and safety of two interventions to increase CPR decision-making, documentation and communication for hospitalised older patients. A pre-post study tested two interventions: (i) standard ward-based education forums with CPR content; and (ii) a combined, two-pronged strategy with 'Goals of Patient Care' (GoPC) system change and a structured video-based workshop; against usual practice (i.e. no formal training). Participants were a random sample of patients in a hospital rehabilitation unit. The outcomes were the proportion of patients documented as: (i) not for resuscitation (NFR); and (ii) eligible for rapid response team (RRT) calls, and rates of documented discussions with the patient, family and carer. When compared with usual practice, patients were more likely to be documented as NFR following the two-pronged intervention (adjusted odds ratio (aOR): 6.4, 95% confidence interval (CI): 3.0; 13.6). Documentation of discussions with patients was also more likely (aOR: 3.3, 95% CI:1.8; 6.2). Characteristics of patients documented NFR were similar between the phases, but were more likely for RRT calls following Phase 3 (P 0.03). An increase in advance CPR decisions occurred following GoPC system change with education. This appears safe as NFR patients had the same level of frailty between phases but were more likely to be eligible for RRT review. Increased documentation of discussions suggests routine use of the GoPC form may improve communication with patients about their care. © 2017 Royal Australasian College of Physicians.

[Experience assisting an AIDS-infected homosexual patient and his same-sex partner make a do-not-resuscitate decision].

Science.gov (United States)

Wang, Shu-Jang; Lai, Pei-Yu; Liou, Siao-Ying; Ko, Wen-Chien; Ko, Nai-Ying

2012-10-01

Family members play an important role in the process of writing advance directives. Homosexual men infected with HIV often wish to authorize their intimate same-sex partner or friends rather than immediate family members to make medical decisions on their behalf. Although same-sex marriage is currently illegal in Taiwan, HIV infected homosexual patients are able to write advance directives appointing their same-sex partner to be their surrogate decision maker for end-of-life medical decisions. This case report describes an experience assisting a homosexual patient with HIV to write his advance directives. The nurse assisted the patient and his partner to make a self-determined decision not to resuscitate. Family conferences held to discuss the patient's decisions regarding resuscitation helped legitimize his partner's primary role in making end-of-life healthcare decisions on his behalf. As an advocate for patient rights, nurses should understand the law as it relates to homosexuality and end-of-life decision making, inform patients on the durable power of autonomy, and help execute their advance directives.

Advance statements in the new Victorian Mental Health Act.

Science.gov (United States)

Saraf, Sudeep

2015-06-01

There is growing recognition of the utility of advance statements in the area of mental health. The definition of advance statements and procedure for making and varying advance statements under the Victorian legislation is described. The implications for psychiatrists, mental health tribunals and the process should the psychiatrist vary their decision from that made in the advance statement are discussed. Advance statements being enshrined in legislation is another step in the direction of recovery-oriented service provision for persons with mental illness. The challenge for services will be to develop systems and processes that promote increased uptake of these instruments to empower persons with mental illness to participate in their treatment. © The Royal Australian and New Zealand College of Psychiatrists 2015.

Nutrition for Advanced Chronic Kidney Disease in Adults

Science.gov (United States)

... butter. These fats are usually solid at room temperature. Trans-fatty acids are often found in commercially ... someone with advanced CKD make healthy food choices? Learning how to read and understand lab reports lets ...

Memory accessibility and medical decision-making for significant others: The role of socially-shared retrieval induced forgetting

Directory of Open Access Journals (Sweden)

Dora M Coman

2013-06-01

Full Text Available Medical decisions will often entail a broad search for relevant information. No sources alone may offer a complete picture, and many may be selective in their presentation. This selectivity may induce forgetting for previously learned material, thereby adversely affecting medical decision-making. In the study phase of two experiments, participants learned information about a fictitious disease and advantages and disadvantages of four treatment options. In the subsequent practice phase, they read a pamphlet selectively presenting either relevant (Experiment 1 or irrelevant (Experiment 2 advantages or disadvantages. A final cued recall followed and, in Experiment 2, a decision as to the best treatment for a patient. Not only did reading the pamphlet induce forgetting for related and unmentioned information, the induced forgetting adversely affected decision-making. The research provides a cautionary note about the risks of searching through selectively presented information when making a medical decision.

Conflict within the Turkish foreign policy decision making mechanism:

OpenAIRE

Oğuz, Mustafa; Oguz, Mustafa

2005-01-01

This thesis presents an analysis of Turkish foreign policy decision making in a theoretical model and argues that Turkish foreign policy is a product of negotiation and compromises among various foreign policy making actors. Theoretical foundation is built on decision units framework advanced by Margaret G. Herman. It applies this framework to two cases and four decision occasions to investigate who made foreign policy decisions and how this influenced foreign policy of Turkey. The first case...

Port Stakeholder Summit: Advancing More Sustainable Ports (April 2014)

Science.gov (United States)

EPA's National Port Stakeholders Summit, Advancing More Sustainable Ports, focused on actions to protect air quality while reducing climate risk and supporting economic growth, making ports more environmentally sustainable.

Advanced uranium enrichment technologies

International Nuclear Information System (INIS)

Merriman, R.

1983-01-01

The Advanced Gas Centrifuge and Atomic Vapor Laser Isotope Separation methods are described. The status and potential of the technologies are summarized, the programs outlined, and the economic incentives are noted. How the advanced technologies, once demonstrated, might be deployed so that SWV costs in the 1990s can be significantly reduced is described

Advanced nursing practice and Newton's three laws of motion.

Science.gov (United States)

Sturgeon, David

This article considers the reasons for the development of advanced practice roles among nurses and other healthcare professions. It explores the implications of financial constraints, consumer preferences and the development of new healthcare services on the reorganization of professional boundaries. It makes use of Sir Isaac Newton's three laws of motion to demonstrate how professional development in nursing has taken place in response to a number of external influences and demands. It also considers the significance of skill mix for the nursing profession, in particular the development and likely expansion of the physician assistant role. The application of different professionals and grades within a healthcare team or organization is central to the Government's Agenda for Change proposals and nurses have successfully adopted a number of roles traditionally performed by doctors. Nurses have demonstrated that they are capable of providing high quality care and contributing directly to positive patient outcome. Advanced nursing roles should not only reflect the changing nature of healthcare work, they should also be actively engaged in reconstructing healthcare boundaries.

Advances in Probes and Methods for Clinical EPR Oximetry

Science.gov (United States)

Hou, Huagang; Khan, Nadeem; Jarvis, Lesley A.; Chen, Eunice Y.; Williams, Benjamin B.; Kuppusamy, Periannan

2015-01-01

EPR oximetry, which enables reliable, accurate, and repeated measurements of the partial pressure of oxygen in tissues, provides a unique opportunity to investigate the role of oxygen in the pathogenesis and treatment of several diseases including cancer, stroke, and heart failure. Building on significant advances in the in vivo application of EPR oximetry for small animal models of disease, we are developing suitable probes and instrumentation required for use in human subjects. Our laboratory has established the feasibility of clinical EPR oximetry in cancer patients using India ink, the only material presently approved for clinical use. We now are developing the next generation of probes, which are both superior in terms of oxygen sensitivity and biocompatibility including an excellent safety profile for use in humans. Further advances include the development of implantable oxygen sensors linked to an external coupling loop for measurements of deep-tissue oxygenations at any depth, overcoming the current limitation of 10 mm. This paper presents an overview of recent developments in our ability to make meaningful measurements of oxygen partial pressures in human subjects under clinical settings. PMID:24729217

Distributed Sensor Coordination for Advanced Energy Systems

Energy Technology Data Exchange (ETDEWEB)

Tumer, Kagan [Oregon State Univ., Corvallis, OR (United States)

2013-07-31

The ability to collect key system level information is critical to the safe, efficient and reliable operation of advanced energy systems. With recent advances in sensor development, it is now possible to push some level of decision making directly to computationally sophisticated sensors, rather than wait for data to arrive to a massive centralized location before a decision is made. This type of approach relies on networked sensors (called “agents” from here on) to actively collect and process data, and provide key control decisions to significantly improve both the quality/relevance of the collected data and the associating decision making. The technological bottlenecks for such sensor networks stem from a lack of mathematics and algorithms to manage the systems, rather than difficulties associated with building and deploying them. Indeed, traditional sensor coordination strategies do not provide adequate solutions for this problem. Passive data collection methods (e.g., large sensor webs) can scale to large systems, but are generally not suited to highly dynamic environments, such as advanced energy systems, where crucial decisions may need to be reached quickly and locally. Approaches based on local decisions on the other hand cannot guarantee that each agent performing its task (maximize an agent objective) will lead to good network wide solution (maximize a network objective) without invoking cumbersome coordination routines. There is currently a lack of algorithms that will enable self-organization and blend the efficiency of local decision making with the system level guarantees of global decision making, particularly when the systems operate in dynamic and stochastic environments. In this work we addressed this critical gap and provided a comprehensive solution to the problem of sensor coordination to ensure the safe, reliable, and robust operation of advanced energy systems. The differentiating aspect of the proposed work is in shifting the focus

Feasibility study of advanced operation scenario in KSTAR using CRONOS

International Nuclear Information System (INIS)

Kim, H.-S.; Na, Y.-S.; Bae, Y.S.; Jeon, Y.M.; Kim, S.H.; Artaud, J.-F.

2014-01-01

We report the results of predictive modelling of advanced operation scenarios in KSTAR. Firstly, the operation windows are produced to explore the KSTAR advanced scenarios in the condition of upgrading H/CD mix. Using METIS code, the rough ranges of operation condition of I_P and B_T to utilize for the development of advanced operation scenario scenario are determined. Secondly, the advanced inductive and the advanced tokamak operation scenario of KSTAR are developing with the scaling based and the physics based transport model by using CRONOS to make a suggestion to on-going KSTAR experiment. Thirdly, the dependency of the time of L-H transition on q_0 an q_m_i_n is investigated for the advanced inductive operation scenario. These reliable results can become the useful database for exploring the advanced regime of KSTAR discharges in the future. (author)

Advanced energy materials (Preface)

Science.gov (United States)

Titus, Elby; Ventura, João; Araújo, João Pedro; Campos Gil, João

2017-12-01

Advances in material science make it possible to fabricate the building blocks of an entirely new generation of hierarchical energy materials. Recent developments were focused on functionality and areas connecting macroscopic to atomic and nanoscale properties, where surfaces, defects, interfaces and metastable state of the materials played crucial roles. The idea is to combine both, the top-down and bottom-up approach as well as shape future materials with a blend of both the paradigms.

Making Media Studies

Directory of Open Access Journals (Sweden)

David Gauntlett

2015-12-01

Full Text Available This podcast is a recording of a research seminar that took place on December 3, 2015, at the University of Westminster's Communication and Media Research Institute (CAMRI. In this contribution, David Gauntlett discusses his new book, Making Media Studies, and other new work. In Making Media Studies (Peter Lang, 2015, Gauntlett proposes a vision of media studies based around doing and making – not about the acquisition of skills, as such, but an experience of building knowledge and understanding through creative hands-on engagement with all kinds of media. Gauntlett suggests that media studies scholars have failed to recognise the significance of everyday creativity – the vital drive of people to make, exchange, and learn together, supported by online networks. He argues that we should think about media in terms of conversations, inspirations, and making things happen. Media studies can be about genuine social change, he suggests, if we recognise the significance of everyday creativity, work to transform our tools, and learn to use them wisely. David Gauntlett is a Professor in the School of Media, Arts and Design at the University of Westminster, where he is also the School's Co-Director of Research. He is the author of several books, including: Creative Explorations (2007, Media, Gender and Identity: An Introduction (2nd edition 2008, Making is Connecting (2011, and Making Media Studies (2015. He has made a number of popular online resources, videos and playthings, and has pioneered creative research and workshop methods. He is external examiner for Information Experience Design at the Royal College of Art, London.

Significance of lymphadenectomy with splenectomy in radical surgery for advanced (pT3/pT4) remnant gastric cancer.

Science.gov (United States)

Sugita, Hiroki; Oda, Eri; Hirota, Masahiko; Ishikawa, Shinji; Tomiyasu, Shinjiro; Tanaka, Hiroshi; Arita, Tetsumasa; Yagi, Yasushi; Baba, Hideo

2016-04-01

To date, the optimal surgical strategy for remnant gastric cancer has not been determined. The purpose of this study was to clarify the significance of lymphadenectomy with splenectomy in remnant gastric cancer surgery. This retrospective cohort study was conducted at the Kumamoto Regional Medical Center. The primary endpoint was overall survival after surgery. We retrospectively analyzed the clinicopathologic features, surgical treatments, and long-term prognosis of remnant gastric cancer patients treated with total gastrectomy. A total of 80 patients with gastric cancer in the remnant stomach after distal gastrectomy and who underwent total gastrectomy were enrolled in the study. Splenectomy was performed in 38 patients. Lymph node metastasis in the splenic hilum was not observed in the patients with pT1/pT2 tumors, whereas nodal metastasis at the splenic hilum was detected in 30.4% of the patients with pT3/pT4 tumors. The survival rate of the patients with pT3/pT4 tumors who underwent splenectomy was significantly higher than that of the patients who did not undergo splenectomy, although there was no difference in the patients with pT1/pT2 tumors. Among the patients classified as R0, the survival rate of the patients with pT3/pT4 tumors who underwent splenectomy was significantly higher than that of the patients who did not undergo splenectomy. Lymphadenectomy with splenectomy in radical surgery is beneficial for patients with advanced (pT3/pT4) remnant gastric cancer. Copyright © 2016 Elsevier Inc. All rights reserved.

Using imperfect advance demand information in forecasting

NARCIS (Netherlands)

Tan, T.

2008-01-01

In this paper, we consider the demand-forecasting problem of a make-to-stock system operating in a business-to-business environment where some customers provide information on their future orders, which are subject to changes in time, hence constituting imperfect advance demand information (ADI).

Advancing lean manufacturing, the role of IT

NARCIS (Netherlands)

Riezebos, J.; Klingenberg, W.

This introduction to the special issue discusses the changing role of information technology (IT) in advancing lean production. Lean principles and techniques have been applied in a wide variety of organisations, from make-to-stock to engineer-to-order industries, and even in typical service

Cost-estimate guidelines for advanced nuclear power technologies

International Nuclear Information System (INIS)

Delene, J.G.; Hudson, C.R.

1993-01-01

Various advanced power plant concepts are currently under development. These include several advanced light water reactors as well as the modular high-temperature gas-cooled reactor and the advanced liquid-metal reactor. One measure-of the attractiveness of a new concept is cost. Invariably, the cost of a new type of power plant will be compared with other alternative forms of electric generation. In order to make reasonable comparative assessments of competing technologies, consistent ground rules and assumptions must be applied when developing cost estimates. This paper describes the cost-estimate guidelines developed by Oak Ridge National Laboratory for the U.S. Department of Energy (DOE) to be used in developing cost estimates for the advanced nuclear reactors and how these guidelines relate to the DOE cost verification process

An organizational intervention to influence evidence-informed decision making in home health nursing.

Science.gov (United States)

Gifford, Wendy; Lefebre, Nancy; Davies, Barbara

2014-01-01

The aims of this study were to field test and evaluate a series of organizational strategies to promote evidence-informed decision making (EIDM) by nurse managers and clinical leaders in home healthcare. EIDM is central to delivering high-quality and effective healthcare. Barriers exist and organizational strategies are needed to support EIDM. Management and clinical leaders from 4 units participated in a 20-week organization-focused intervention. Preintervention (n = 32) and postintervention (n = 17) surveys and semistructured interviews (n = 15) were completed. Statistically significant increases were found on 4 of 31 survey items reflecting an increased organizational capacity for participants to acquire and apply research evidence in decision making. Support from designated facilitators with advanced skills in finding, appraising, and applying research was the highest rated intervention strategy. Results are useful to inform the development of organizational infrastructures to increase EIDM capacity in community-based healthcare organizations.

SOARing Into Strategic Planning: Engaging Nurses to Achieve Significant Outcomes.

Science.gov (United States)

Wadsworth, Barbara; Felton, Fiona; Linus, Rita

2016-01-01

In 2013, a new system chief nursing officer engaged the nursing leaders and staff in an Appreciative Inquiry process utilizing strengths, opportunities, aspirations, and results (SOAR), and a Journey of Excellence to assess and understand the current environment. The ultimate goal was to engage all nurses in strategic planning and goal setting to connect their patient care to the system strategic initiatives. This work led to the creation of a nursing vision, a revised professional practice model and greater council alignment, resulting in significant positive change and ongoing advancement throughout the system. The shared decision-making structure was key to the process with a direct connection of each council's goals, leading to the successful achievement of 34 of the 36 goals in 2 years. This article outlines the process, tools, and staff engagement strategies used to achieve system-wide success. This methodology has improved the outcomes across the organization in both small and system-wide work groups. This work can easily be replicated and adapted to help disparate staffs brought together through mergers or acquisitions to become aligned as a new team. This process, model, and framework, provides structure and results in significant outcomes that recognizes and celebrates the work of individual entities while aligning future strategies and goals.

Ohio Advanced Energy Manufacturing Center

Energy Technology Data Exchange (ETDEWEB)

Kimberly Gibson; Mark Norfolk

2012-07-30

The program goal of the Ohio Advanced Energy Manufacturing Center (OAEMC) is to support advanced energy manufacturing and to create responsive manufacturing clusters that will support the production of advanced energy and energy-efficient products to help ensure the nation's energy and environmental security. This goal cuts across a number of existing industry segments critical to the nation's future. Many of the advanced energy businesses are starting to make the transition from technology development to commercial production. Historically, this transition from laboratory prototypes through initial production for early adopters to full production for mass markets has taken several years. Developing and implementing manufacturing technology to enable production at a price point the market will accept is a key step. Since these start-up operations are configured to advance the technology readiness of the core energy technology, they have neither the expertise nor the resources to address manufacturing readiness issues they encounter as the technology advances toward market entry. Given the economic realities of today's business environment, finding ways to accelerate this transition can make the difference between success and failure for a new product or business. The advanced energy industry touches a wide range of industry segments that are not accustomed to working together in complex supply chains to serve large markets such as automotive and construction. During its first three years, the Center has catalyzed the communication between companies and industry groups that serve the wide range of advanced energy markets. The Center has also found areas of common concern, and worked to help companies address these concerns on a segment or industry basis rather than having each company work to solve common problems individually. EWI worked with three industries through public-private partnerships to sew together disparate segments helping to promote

Advanced control - technologies for suppressing harmful emission in lignitic coal-fired power generation

International Nuclear Information System (INIS)

Mir, S.; Hai, S.M.A.

2000-01-01

The production of sufficient amount of indigenous energy is a prerequisite for the prosperity of a nation. Pakistan's energy demand far exceeds its indigenous supplies. A cursory look at the energy situation in Pakistan reveals that there is an urgent need for the development of its energy resources. In this regard, coal can play a key role if its problems of high-sulfur and high ash can be rectified through the adoption adaptation of advanced technologies, like (I) clean coal technologies, and (II) control technologies. A review on clean coal technologies for utilization of lignitic coals has already been published and the present article describes the effect of harmful emissions from the combustion of high sulfur coals, like the ones found in Pakistan and their control through advanced control technologies, to make a significant contribution in the total energy economics of Pakistan. (author)

Advances in the application of decision theory to test-based decision making

NARCIS (Netherlands)

van der Linden, Willem J.

This paper reviews recent research in the Netherlands on the application of decision theory to test-based decision making about personnel selection and student placement. The review is based on an earlier model proposed for the classification of decision problems, and emphasizes an empirical

Advances in Male Contraception

Science.gov (United States)

Page, Stephanie T.; Amory, John K.; Bremner, William J.

2008-01-01

Despite significant advances in contraceptive options for women over the last 50 yr, world population continues to grow rapidly. Scientists and activists alike point to the devastating environmental impacts that population pressures have caused, including global warming from the developed world and hunger and disease in less developed areas. Moreover, almost half of all pregnancies are still unwanted or unplanned. Clearly, there is a need for expanded, reversible, contraceptive options. Multicultural surveys demonstrate the willingness of men to participate in contraception and their female partners to trust them to do so. Notwithstanding their paucity of options, male methods including vasectomy and condoms account for almost one third of contraceptive use in the United States and other countries. Recent international clinical research efforts have demonstrated high efficacy rates (90–95%) for hormonally based male contraceptives. Current barriers to expanded use include limited delivery methods and perceived regulatory obstacles, which stymie introduction to the marketplace. However, advances in oral and injectable androgen delivery are cause for optimism that these hurdles may be overcome. Nonhormonal methods, such as compounds that target sperm motility, are attractive in their theoretical promise of specificity for the reproductive tract. Gene and protein array technologies continue to identify potential targets for this approach. Such nonhormonal agents will likely reach clinical trials in the near future. Great strides have been made in understanding male reproductive physiology; the combined efforts of scientists, clinicians, industry and governmental funding agencies could make an effective, reversible, male contraceptive an option for family planning over the next decade. PMID:18436704

Novelties in design and construction of the advanced reactors

International Nuclear Information System (INIS)

Acosta Ezcurra, T.; Garcia Rodriguez, B.M.

1996-01-01

The advanced pressurized water reactors (APWR), advanced boiling water reactors (ABWR), advanced liquid metal reactors (ALMR), and modular high temperature gas-cooled reactors (MHTGR), as well as heavy water reactors (AHWR), are analyzed taking into account those characteristics which make them less complex, but safer than their current homologous ones. This fact simplifies their construction which reduces completion periods and costs, increasing safety and protection of the plants. It is demonstrated how the accumulated operational experience allows to find more standardized designs with some enhancement in the material and component technology and thus achieve also a better use of computerized systems

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

Science.gov (United States)

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

2012-11-01

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

"When does making detailed predictions make predictions worse?": Correction to Kelly and Simmons (2016).

Science.gov (United States)

2016-10-01

Reports an error in "When Does Making Detailed Predictions Make Predictions Worse" by Theresa F. Kelly and Joseph P. Simmons ( Journal of Experimental Psychology: General , Advanced Online Publication, Aug 8, 2016, np). In the article, the symbols in Figure 2 were inadvertently altered in production. All versions of this article have been corrected. (The following abstract of the original article appeared in record 2016-37952-001.) In this article, we investigate whether making detailed predictions about an event worsens other predictions of the event. Across 19 experiments, 10,896 participants, and 407,045 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 useless or redundant information more accessible and thus more likely to be incorporated into forecasts. Furthermore, we show that this differential use of information can be used to predict what kinds of events will and will not be susceptible to the negative effect of making detailed predictions. PsycINFO Database Record (c) 2016 APA, all rights reserved

Effectiveness of a theoretically-based judgment and decision making intervention for adolescents.

Science.gov (United States)

Knight, Danica K; Dansereau, Donald F; Becan, Jennifer E; Rowan, Grace A; Flynn, Patrick M

2015-05-01

Although adolescents demonstrate capacity for rational decision making, their tendency to be impulsive, place emphasis on peers, and ignore potential consequences of their actions often translates into higher risk-taking including drug use, illegal activity, and physical harm. Problems with judgment and decision making contribute to risky behavior and are core issues for youth in treatment. Based on theoretical and empirical advances in cognitive science, the Treatment Readiness and Induction Program (TRIP) represents a curriculum-based decision making intervention that can be easily inserted into a variety of content-oriented modalities as well as administered as a separate therapeutic course. The current study examined the effectiveness of TRIP for promoting better judgment among 519 adolescents (37 % female; primarily Hispanic and Caucasian) in residential substance abuse treatment. Change over time in decision making and premeditation (i.e., thinking before acting) was compared among youth receiving standard operating practice (n = 281) versus those receiving standard practice plus TRIP (n = 238). Change in TRIP-specific content knowledge was examined among clients receiving TRIP. Premeditation improved among youth in both groups; TRIP clients showed greater improvement in decision making. TRIP clients also reported significant increases over time in self-awareness, positive-focused thinking (e.g., positive self-talk, goal setting), and recognition of the negative effects of drug use. While both genders showed significant improvement, males showed greater gains in metacognitive strategies (i.e., awareness of one's own cognitive process) and recognition of the negative effects of drug use. These results suggest that efforts to teach core thinking strategies and apply/practice them through independent intervention modules may benefit adolescents when used in conjunction with content-based programs designed to change problematic behaviors.

Decision-making: Theory and practice

OpenAIRE

SM Turpin; MA Marais

2004-01-01

This paper compares a number of theoretical models of decision-making with the way in which senior managers make decisions in practice. Six prominent decision-makers were interviewed about their own decision-making style, as well as their use of decision support technology. Significant variation was found in personal decision-making styles. However, some central themes emerged, such as the importance of sensitivity to the decision-making context, attention to the presentation of information, ...

Advancing pig cloning technologies towards application in regenerative medicine.

Science.gov (United States)

Nagashima, H; Matsunari, H; Nakano, K; Watanabe, M; Umeyama, K; Nagaya, M

2012-08-01

Regenerative medicine is expected to make a significant contribution by development of novel therapeutic treatments for intractable diseases and for improving the quality of life of patients. Many advances in regenerative medicine, including basic and translational research, have been developed and tested in experimental animals; pigs have played an important role in various aspects of this work. The value of pigs as a model species is being enhanced by the generation of specially designed animals through cloning and genetic modifications, enabling more sophisticated research to be performed and thus accelerating the clinical application of regenerative medicine. This article reviews the significant aspects of the creation and application of cloned and genetically modified pigs in regenerative medicine research and considers the possible future directions of the technology. We also discuss the importance of reproductive biology as an interface between basic science and clinical medicine. © 2012 Blackwell Verlag GmbH.

Variation in decision making

NARCIS (Netherlands)

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

NATO Advanced Research Institute on the Efficiency of Manufacturing Systems

CERN Document Server

Berg, C; French, D

1983-01-01

The Advanced Research Institute (A.R. 1.) on "the efficiency of Manufacturing Systems" was held under the auspices of the NATO Special Programm~ Panel on Systems Science as a part of the NATO Science Committee's continuous effort to promote the advancement of science through international co-operation. Advanced Research Institutes are organised for the purpose of bringing together experts in a particular field of interest to identify and make known the present state of knowledge in that area and, through informed debate, to make recommendations for directions for future research that would benefit the community at large. To this end two kinds of contribution were obtained by invitation. There were those papers which were about the current state of work in the area of manufacturing systems and its organisation; in addition three theme papers were presented to provide a stimulus to the discussion in terms of ways of thinking, both about the area and about the kind of research needed.

Why is it hard to make progress in assessing children's decision-making competence?

Science.gov (United States)

Hein, Irma M; Troost, Pieter W; Broersma, Alice; de Vries, Martine C; Daams, Joost G; Lindauer, Ramón J L

2015-01-10

For decades, the discussion on children's competence to consent to medical issues has concentrated around normative concerns, with little progress in clinical practices. Decision-making competence is an important condition in the informed consent model. In pediatrics, clinicians need to strike a proper balance in order to both protect children's interests when they are not fully able to do so themselves and to respect their autonomy when they are. Children's competence to consent, however, is currently not assessed in a standardized way. Moreover, the correlation between competence to give informed consent and age in children has never been systematically investigated, nor do we know which factors exactly contribute to children's competence.This article aims at identifying these gaps in knowledge and suggests options for dealing with the obstacles in empirical research in order to advance policies and practices regarding children's medical decision-making competence. Understanding children's competency is hampered by the law. Legislative regulations concerning competency are established on a strong presumption that persons older than a certain age are competent, whereas younger persons are not. Furthermore, a number of contextual factors are believed to be of influence on a child's decision-making competence: the developmental stage of children, the influence of parents and peers, the quality of information provision, life experience, the type of medical decision, and so on. Ostensibly, these diverse and extensive barriers hinder any form of advancement in this conflicted area. Addressing these obstacles encourages the discussion on children's competency, in which the most prominent question concerns the lack of a clear operationalization of children's competence to consent. Empirical data are needed to substantiate the discussion. The empirical approach offers an opportunity to give direction to the debate. Recommendations for future research include: studying a

Making decisions with a continuous mind.

Science.gov (United States)

Scherbaum, S; Dshemuchadse, M; Kalis, A

2008-12-01

Neuroeconomics is a rapidly expanding field at the interfaces of the human sciences. The interdisciplinary nature of this field results in several challenges when attempts are made to solve puzzling questions in human decision making, such as why and how people discount future gains. We argue that an empirical approach based on dynamic systems theory (DST) could inspire and advance the neuroeconomic investigation of decision-making processes in three ways: by enriching the mental model, by extending the empirical tool set, and by facilitating interdisciplinary exchange. The present article addresses the challenges neuroeconomics faces by focusing on intertemporal choice. After a brief introduction of DST and related research, a DST-based conceptual model of decision making is developed and linked to underlying neural principles. On this basis, we outline the application of DST-informed empirical strategies to intertemporal choice. Finally, we discuss the general consequences of and possible objections to the proposed approach to research in intertemporal choice and the field of neuroeconomics.

Neuroeconomics: cross-currents in research on decision-making.

Science.gov (United States)

Sanfey, Alan G; Loewenstein, George; McClure, Samuel M; Cohen, Jonathan D

2006-03-01

Despite substantial advances, the question of how we make decisions and judgments continues to pose important challenges for scientific research. Historically, different disciplines have approached this problem using different techniques and assumptions, with few unifying efforts made. However, the field of neuroeconomics has recently emerged as an inter-disciplinary effort to bridge this gap. Research in neuroscience and psychology has begun to investigate neural bases of decision predictability and value, central parameters in the economic theory of expected utility. Economics, in turn, is being increasingly influenced by a multiple-systems approach to decision-making, a perspective strongly rooted in psychology and neuroscience. The integration of these disparate theoretical approaches and methodologies offers exciting potential for the construction of more accurate models of decision-making.

Policies toward advanced display in the Clinton administration

Science.gov (United States)

Hart, Jeffrey A.

1994-04-01

The Clinton administration is using its policy toward advanced displays as a test case for making industry-specific policies. They have established a number of criteria for advanced displays that they hope to apply to other industries in the future. For example, they want to support the development of generic technologies through ARPA and NIST, while minimizing the government's role in key business decisions. They want the industry (by which they mean the tool makers, the component assemblers, and the systems firms) to agree internally before they go ahead with their promotional policies. Given the past history of the advanced display industry, especially its disunity in regard to the enforcement of the successful antidumping petition of the Advanced Display Manufacturers Association and to efforts to create the U.S. Display Consortium, these criteria will be hard to meet. Nevertheless, there now appears to be much greater consensus among the three groups than in the past on the need to build indigenous technological capabilities in advanced displays.

Does advanced lung inflammation index (ALI) have prognostic significance in metastatic non-small cell lung cancer?

Science.gov (United States)

Ozyurek, Berna Akinci; Ozdemirel, Tugce Sahin; Ozden, Sertac Buyukyaylaci; Erdoğan, Yurdanur; Ozmen, Ozlem; Kaplan, Bekir; Kaplan, Tugba

2018-01-22

Lung cancer is the most commonly diagnosed and death-related cancer type and is more frequent in males. Non-small-cell lung cancer (NSCLC) accounts for about 85% of all case. In this study, it was aimed to research the relationship between advanced lung inflammation index (ALI) and the primary mass maximum standardized uptake value (SUVmax) and C-reactive protein (CRP) at initial diagnosis and the prognostic value of ALI in determining the survival in metastatic NSCLC. A total of 112 patients diagnosed as stage 4 non-small-lung cancer in our hospital between January 2006 and December 2013 were included in this study. ALI was calculated as body mass index (BMI) × serum albumin/neutrophil-to-lymphocyte ratio (NLR). The patients were divided into two groups as ALI ALI ≥ 18 (low inflammation). The log-rank test and Cox proportional hazard model were used to identify predictors of mortality. Evaluation was made of 94 male and 18 female patients with a mean age of 59.7 ± 9.9 years. A statistically significant negative relationship was determined between ALI and CRP values (P ALI and SUVmax values (P = .436). The median survival time in patients with ALI ALI ≥ 18, it was 16 months (P = .095). ALI is an easily calculated indicator of inflammation in lung cancer patients. Values <18 can be considered to predict a poor prognosis. © 2018 John Wiley & Sons Ltd.

Provider Tools for Advance Care Planning and Goals of Care Discussions: A Systematic Review.

Science.gov (United States)

Myers, Jeff; Cosby, Roxanne; Gzik, Danusia; Harle, Ingrid; Harrold, Deb; Incardona, Nadia; Walton, Tara

2018-01-01

Advance care planning and goals of care discussions involve the exploration of what is most important to a person, including their values and beliefs in preparation for health-care decision-making. Advance care planning conversations focus on planning for future health care, ensuring that an incapable person's wishes are known and can guide the person's substitute decision maker for future decision-making. Goals of care discussions focus on preparing for current decision-making by ensuring the person's goals guide this process. To provide evidence regarding tools and/or practices available for use by health-care providers to effectively facilitate advance care planning conversations and/or goals of care discussions. A systematic review was conducted focusing on guidelines, randomized trials, comparative studies, and noncomparative studies. Databases searched included MEDLINE, EMBASE, and the proceedings of the International Advance Care Planning Conference and the American Society of Clinical Oncology Palliative Care Symposium. Although several studies report positive findings, there is a lack of consistent patient outcome evidence to support any one clinical tool for use in advance care planning or goals of care discussions. Effective advance care planning conversations at both the population and the individual level require provider education and communication skill development, standardized and accessible documentation, quality improvement initiatives, and system-wide coordination to impact the population level. There is a need for research focused on goals of care discussions, to clarify the purpose and expected outcomes of these discussions, and to clearly differentiate goals of care from advance care planning.

Materials for advanced packaging

CERN Document Server

Wong, CP

2017-01-01

This second edition continues to be the most comprehensive review on the developments in advanced electronic packaging technologies, with a focus on materials and processing. Recognized experts in the field contribute to 22 updated and new chapters that provide comprehensive coverage on various 3D package architectures, novel bonding and joining techniques, wire bonding, wafer thinning techniques, organic substrates, and novel approaches to make electrical interconnects between integrated circuit and substrates. Various chapters also address advances in several key packaging materials, including: Lead-free solders Flip chip underfills Epoxy molding compounds Conductive adhesives Die attach adhesives/films Thermal interface materials (TIMS) Materials for fabricating embedded passives including capacitors, inductors, and resistors Materials and processing aspects on wafer-level chip scale package (CSP) and MicroElectroMechanical system (MEMS) Contributors also review new and emerging technologies such as Light ...

Quantitative study on the significance of FR cycle. Interim report of JNC/CEA joint study on advanced technology R and D for nuclear energy

International Nuclear Information System (INIS)

Fiorini, G.L.; Shinoda, Yoshihiko; Kofuji, Hirohide; Hirao, Kazunori

2001-09-01

This study on quantitative study on significance of FR cycle was carried out under the agreement between JNC and CEA in the field of advanced technology R and D for nuclear energy. JNC has been developing the quantitative evaluation method to be constructed by combining Analytic Hierarchy Process (AHP) and Multi-Attribute Utility Theory (MAUT). CEA has been caring out the qualitative evaluation from expert judgement from viewpoint of sustainability such as the response to the energetic demand, the saving of the resources and the minimization of the environmental impact. (author)

Advances in fusion reactor design

International Nuclear Information System (INIS)

Baker, C.C.

1987-01-01

The author addresses the tokamak as a power reactor. Contrary to popular opinion, there are still a few people that think a tokamak might make a good fusion power reactor. In thinking about advances in fusion reactor design, in the U.S., at least, that generally means advances relevant to the Starfire design. He reviews some of the features of Starfire. Starfire is the last major study done of the tokamak as a reactor in this country. It is now over eight years old in the sense that eight years ago was really the time in which major decisions were made as to its features. Starfire was a tokamak with a major radius of seven meters, about twice the linear dimensions of a machine like TIBER

Building leadership capacity in advanced nurse practitioners - the role of organisational management.

Science.gov (United States)

Elliott, Naomi

2017-01-01

To highlight the organisation-level management's role in building leadership capacity in advanced nurse practitioners and the need for appropriate supports to increase their becoming leaders. Little is published about the role of organisation-level management in building leadership capacity and in developing the next generation of nurse leaders. In times of economic constraint, organisations need to focus their efforts on targeted leadership initiatives. Advanced nurse practitioners are ideally positioned to act as leaders both within and beyond the health care organisation. From the available research evidence, several support structures and mechanisms are identified as enablers for advanced nurse practitioners to enact their leadership role. Health care organisations need to include building leadership capacity as a priority in their strategic plan and take action to build-up the level of advanced nurse practitioner leadership. Nurse executives have a vital role in influencing the organisation's strategic plan and making a business case for prioritising leadership capacity building within advanced nurse practitioners. A challenge for nurse executives faced with competing service and leadership development demands, involves strategic decision-making regarding whether the advanced nurse practitioner's role is limited to service delivery or its potential in leading health care reforms is realised. © 2016 John Wiley & Sons Ltd.

Make or buy strategy decision making in supply quality chain

Directory of Open Access Journals (Sweden)

Seyed Mohammad Seyedhosseini

2012-04-01

Full Text Available Minimizing the total cost is absolutely the goal of each supply chain, which is most of the time pursued. In this regards, quality related costs that have significant roles are sometimes neglected. Selecting suppliers, which supply relatively high quality raw materials in a lower cost is considered as a strategic decision. Make or Buy decision can be also noticed in supplier selection process. In this paper, the supply strategy: Make or Buy decision (SS: MOB is studied in order to find which strategy (Make or Buy should be chosen to minimize the total costs of supply chain. Therefore, two separate models are generated for each strategy and several examples are solved for the respective models. Computational experiments show the efficiency of the proposed models for making decision about selecting the best strategy.

Beyond image interpretation: Capturing the impact of radiographer advanced practice through activity diaries

International Nuclear Information System (INIS)

Snaith, B.; Milner, R.C.; Harris, M.A.

2016-01-01

Background: There is limited evidence of the impact of radiographers working in advanced roles beyond task substitution. This study reviews the contribution of advanced (and consultant) practitioner radiographers to service delivery whilst reporting radiographs and demonstrates the impact this has on patients and staff, both internal and external to the imaging department. Method: The study was a prospective exploratory study using activity diaries to allow interval sampling when individuals were rostered to report. Data was coded using a compiled list of activities and recorded in 15-min intervals over the period of one week. Thirteen radiographers who independently report radiographs participated across 6 locations in a busy multisite English National Health Service (NHS) Trust. Results: Radiographers reported the majority of the examinations during the study period (n = 4512/5671; 79.6%). The total number of coded activities recorded over the study period was 1527, equating to 380.5 relative hours. The majority of available time was spent reporting, including dictating and verifying the reports of colleagues or trainees, although 69.5% of reporting time was interrupted. Based upon the hours of reporting there was an average of 19.3 reports (patient episodes) produced per hour. Direct patient care tasks and support for staff in decision making were regularly documented. Supplementary tasks included administrative activity, amendments to rotas, preparing presentations and documenting incidents identified during reporting. Conclusion: This study has demonstrated the breadth and complexity of the activities performed by advanced practice radiographers. The findings confirm their role in supporting service delivery beyond image interpretation. - Highlights: • Radiographers can make a significant contribution to reporting workloads. • The range of activities undertaken when reporting is complex and varied. • Reporting radiographers impact on staff, patients

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

Science.gov (United States)

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

2012-06-01

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

Basic research and industrialization of CANDU advanced fuel

Energy Technology Data Exchange (ETDEWEB)

Chun, Suk Ho; Park, Joo Hwan; Jun, Ji Su [and others

2000-04-01

Wolsong Unit 1 as the first heavy water reactor in Korea has been in service for 17 years since 1983. It would be about the time to prepare a plan for the solution of problems due to aging of the reactor. The aging of CANDU reactor could lead especially to the steam generator cruding and pressure tube sagging and creep and then decreases the operation margin to make some problems on reactor operations and safety. The counterplan could be made in two ways. One is to repair or modify reactor itself. The other is to develop new advanced fuel to increase of CANDU operation margin effectively, so as to compensate the reduced operation margin. Therefore, the first objectives in the present R and D is to develop the CANFLEX-NU (CANDU Flexible fuelling-Natural Uranium) fuel as a CANDU advanced fuel. The second objectives is to develop CANDU advanced fuel bundle to utilize advanced fuel cycles such as recovered uranium, slightly enriched uranium, etc. and so to raise adaptability for change in situation of uranium market. Also, it is to develop CANDU advanced fuel technology which improve uranium utilization to cope with a world-wide imbalance between uranium supply and demand, without significant modification of nuclear reactor design and refuelling strategies. As the implementations to achieve the above R and D goal, the work contents and scope of technology development of CANDU advanced fuel using natural uranium (CANFLEX-NU) are the fuel element/bundle designs, the nuclear design and fuel management analysis, the thermalhydraulic analysis, the safety analysis, fuel fabrication technologies, the out-pile thermalhydraulic test and in-pile irradiation tests performed. At the next, the work scopes and contents of feasibility study of CANDU advanced fuel using recycled uranium (CANFLEX-RU) are the fuel element/bundle designs, the reactor physics analysis, the thermalhydraulic analysis, the basic safety analysis of a CANDU-6 reactor with CANFLEX-RU fuel, the fabrication and

Basic research and industrialization of CANDU advanced fuel

International Nuclear Information System (INIS)

Chun, Suk Ho; Park, Joo Hwan; Jun, Ji Su

2000-04-01

Wolsong Unit 1 as the first heavy water reactor in Korea has been in service for 17 years since 1983. It would be about the time to prepare a plan for the solution of problems due to aging of the reactor. The aging of CANDU reactor could lead especially to the steam generator cruding and pressure tube sagging and creep and then decreases the operation margin to make some problems on reactor operations and safety. The counterplan could be made in two ways. One is to repair or modify reactor itself. The other is to develop new advanced fuel to increase of CANDU operation margin effectively, so as to compensate the reduced operation margin. Therefore, the first objectives in the present R and D is to develop the CANFLEX-NU (CANDU Flexible fuelling-Natural Uranium) fuel as a CANDU advanced fuel. The second objectives is to develop CANDU advanced fuel bundle to utilize advanced fuel cycles such as recovered uranium, slightly enriched uranium, etc. and so to raise adaptability for change in situation of uranium market. Also, it is to develop CANDU advanced fuel technology which improve uranium utilization to cope with a world-wide imbalance between uranium supply and demand, without significant modification of nuclear reactor design and refuelling strategies. As the implementations to achieve the above R and D goal, the work contents and scope of technology development of CANDU advanced fuel using natural uranium (CANFLEX-NU) are the fuel element/bundle designs, the nuclear design and fuel management analysis, the thermalhydraulic analysis, the safety analysis, fuel fabrication technologies, the out-pile thermalhydraulic test and in-pile irradiation tests performed. At the next, the work scopes and contents of feasibility study of CANDU advanced fuel using recycled uranium (CANFLEX-RU) are the fuel element/bundle designs, the reactor physics analysis, the thermalhydraulic analysis, the basic safety analysis of a CANDU-6 reactor with CANFLEX-RU fuel, the fabrication and

ENABLING SMART MANUFACTURING TECHNOLOGIES FOR DECISION-MAKING SUPPORT

Science.gov (United States)

Helu, Moneer; Libes, Don; Lubell, Joshua; Lyons, Kevin; Morris, KC

2017-01-01

Smart manufacturing combines advanced manufacturing capabilities and digital technologies throughout the product lifecycle. These technologies can provide decision-making support to manufacturers through improved monitoring, analysis, modeling, and simulation that generate more and better intelligence about manufacturing systems. However, challenges and barriers have impeded the adoption of smart manufacturing technologies. To begin to address this need, this paper defines requirements for data-driven decision making in manufacturing based on a generalized description of decision making. Using these requirements, we then focus on identifying key barriers that prevent the development and use of data-driven decision making in industry as well as examples of technologies and standards that have the potential to overcome these barriers. The goal of this research is to promote a common understanding among the manufacturing community that can enable standardization efforts and innovation needed to continue adoption and use of smart manufacturing technologies. PMID:28649678

Is tube feeding futile in advanced dementia?

Science.gov (United States)

Lynch, Matthew C.

2016-01-01

It is controversial whether tube feeding in people with dementia improves nutritional status or prolongs survival. Guidelines published by several professional societies cite observational studies that have shown no benefit and conclude that tube feeding in patients with advanced dementia should be avoided. However, all studies on tube feeding in dementia have major methodological flaws that invalidate their findings. The present evidence is not sufficient to justify general guidelines. Patients with advanced dementia represent a very heterogeneous group, and evidence demonstrates that some patients with dementia benefit from tube feeding. However, presently available guidelines make a single recommendation against tube feeding for all patients. Clinicians, patients, and surrogates should be aware that the guidelines and prior commentary on this topic tend both to overestimate the strength of evidence for futility and to exaggerate the burdens of tube feeding. Shared decision making requires accurate information tailored to the individual patient's particular situation, not blanket guidelines based on flawed data. Lay Summary: Many doctors believe that tube feeding does not help people with advanced dementia. Scientific studies suggest that people with dementia who have feeding tubes do not live longer or gain weight compared with those who are carefully hand fed. However, these studies are not very helpful because of flaws in design, which are discussed in this article. Guidelines from professional societies make a blanket recommendation against feeding tubes for anyone with dementia, but an individual approach that takes each person's situation into account seems more appropriate. Patients and surrogates should be aware that the guidelines on this topic tend both to underestimate the benefit and exaggerate the burdens of tube feeding. PMID:27833208

Advanced Neutron Source Dynamic Model (ANSDM) code description and user guide

International Nuclear Information System (INIS)

March-Leuba, J.

1995-08-01

A mathematical model is designed that simulates the dynamic behavior of the Advanced Neutron Source (ANS) reactor. Its main objective is to model important characteristics of the ANS systems as they are being designed, updated, and employed; its primary design goal, to aid in the development of safety and control features. During the simulations the model is also found to aid in making design decisions for thermal-hydraulic systems. Model components, empirical correlations, and model parameters are discussed; sample procedures are also given. Modifications are cited, and significant development and application efforts are noted focusing on examination of instrumentation required during and after accidents to ensure adequate monitoring during transient conditions

Optoelectronic Devices Advanced Simulation and Analysis

CERN Document Server

Piprek, Joachim

2005-01-01

Optoelectronic devices transform electrical signals into optical signals and vice versa by utilizing the sophisticated interaction of electrons and light within micro- and nano-scale semiconductor structures. Advanced software tools for design and analysis of such devices have been developed in recent years. However, the large variety of materials, devices, physical mechanisms, and modeling approaches often makes it difficult to select appropriate theoretical models or software packages. This book presents a review of devices and advanced simulation approaches written by leading researchers and software developers. It is intended for scientists and device engineers in optoelectronics, who are interested in using advanced software tools. Each chapter includes the theoretical background as well as practical simulation results that help to better understand internal device physics. The software packages used in the book are available to the public, on a commercial or noncommercial basis, so that the interested r...

Advanced converters and reactors

International Nuclear Information System (INIS)

Haefele, W.; Kessler, G.

1984-01-01

As Western Europe and most countries of the Asia-Pacific region (except Australia) have only small natural uranium resources, they must import nuclear fuel from the major uranium supplier countries. The introduction of advanced converter and breeder reactor technology allows a fuel utilization of a factor of 4 to 100 higher than with present low converters (LWRs) and will make uranium-importing countries less vulnerable to price jumps and supply stops in the uranium market. In addition, breeder-reactor technology will open up a potential that can cover world energy requirements for several thousand years. The enormous development costs of advanced converter and breeder technologies can probably be raised only by highly industrialized countries. Those highly industrialized countries that have little or no uranium resources (Western Europe, Japan) will probably be the first to introduce this advanced reactor technology on a commercial scale. A number of small countries and islands will need only small power reactors with inherent safety capabilities, especially in the beginning of their nuclear energy programs. For economic reasons, the fuel cycle services should come from large reprocessing centers of countries having sufficiently large nuclear power programs or from international fuel cycle centers. (author)

Bayesian updating and decision making using correlated structural health monitoring observations

DEFF Research Database (Denmark)

Nielsen, Jannie Sønderkær

2018-01-01

A Bayesian approach is often applied when updating a deterioration model using observations from expected structural health monitoring or condition monitoring. Usually, observations are assumed to be independent conditioned on the damage size, but this assumption does not always hold, especially ...... is properly modeled. In case of correlated observations, an advanced decision model using all past observations for decision making is needed to make monitoring feasible compared to only using inspections....

Integrated assessment and environmental policy making. In pursuit of usefulness

International Nuclear Information System (INIS)

Parson, E.A.

1995-01-01

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

Cost estimate guidelines for advanced nuclear power technologies

International Nuclear Information System (INIS)

Hudson, C.R. II.

1986-07-01

To make comparative assessments of competing technologies, consistent ground rules must be applied when developing cost estimates. This document provides a uniform set of assumptions, ground rules, and requirements that can be used in developing cost estimates for advanced nuclear power technologies

Cost estimate guidelines for advanced nuclear power technologies

International Nuclear Information System (INIS)

Hudson, C.R. II.

1987-07-01

To make comparative assessments of competing technologies, consistent ground rules must be applied when developing cost estimates. This document provides a uniform set of assumptions, ground rules, and requirements that can be used in developing cost estimates for advanced nuclear power technologies

Decision making in the manufacturing environment using graph theory and fuzzy multiple attribute decision making methods

CERN Document Server

Rao, Ravipudi Venkata

2007-01-01

Manufacturing is the backbone of any industrialized nation. Recent worldwide advances in manufacturing technologies have brought about a metamorphism in the industry. Fast-changing technologies on the product front have created a need for an equally fast response from manufacturing industries. To meet these challenges, manufacturing industries have to select appropriate manufacturing strategies, product designs, manufacturing processes, work piece and tool materials, and machinery and equipment. The selection decisions are complex as decision making is more challenging today. Decision makers i

Advanced text and video analytics for proactive decision making

Science.gov (United States)

Bowman, Elizabeth K.; Turek, Matt; Tunison, Paul; Porter, Reed; Thomas, Steve; Gintautas, Vadas; Shargo, Peter; Lin, Jessica; Li, Qingzhe; Gao, Yifeng; Li, Xiaosheng; Mittu, Ranjeev; Rosé, Carolyn Penstein; Maki, Keith; Bogart, Chris; Choudhari, Samrihdi Shree

2017-05-01

Today's warfighters operate in a highly dynamic and uncertain world, and face many competing demands. Asymmetric warfare and the new focus on small, agile forces has altered the framework by which time critical information is digested and acted upon by decision makers. Finding and integrating decision-relevant information is increasingly difficult in data-dense environments. In this new information environment, agile data algorithms, machine learning software, and threat alert mechanisms must be developed to automatically create alerts and drive quick response. Yet these advanced technologies must be balanced with awareness of the underlying context to accurately interpret machine-processed indicators and warnings and recommendations. One promising approach to this challenge brings together information retrieval strategies from text, video, and imagery. In this paper, we describe a technology demonstration that represents two years of tri-service research seeking to meld text and video for enhanced content awareness. The demonstration used multisource data to find an intelligence solution to a problem using a common dataset. Three technology highlights from this effort include 1) Incorporation of external sources of context into imagery normalcy modeling and anomaly detection capabilities, 2) Automated discovery and monitoring of targeted users from social media text, regardless of language, and 3) The concurrent use of text and imagery to characterize behaviour using the concept of kinematic and text motifs to detect novel and anomalous patterns. Our demonstration provided a technology baseline for exploiting heterogeneous data sources to deliver timely and accurate synopses of data that contribute to a dynamic and comprehensive worldview.

Mixed Frames and Risky Decision-Making.

Science.gov (United States)

Peng, Jiaxi; Zhang, Jiaxi; Sun, Hao; Zeng, Zhicong; Mai, Yuexia; Miao, Danmin

2017-01-01

By applying unitive vocabulary, "die" or "save," to respective frames of the Asian disease problem, Tversky and Kahneman were able to define framing effect. In this study, we preliminarily explored the effect of mixed frames, which are characterized by the use of different vocabulary in one frame. In study 1, we found that only the sure option description had significant effect on decision-making, while the effects of risky option descriptions were not significant, nor were interactions between descriptions. In study 2, the results suggested that after controlling the effects of the hedonic tone of the sure options, risky option description did not significantly predict decision-making. In study 3, we found that neither the sure-to-risky option presentation order nor presentation order within risky options had significant effect on decision-making. We thus concluded that sure option description can serve as the decision-making foundation (reference point) for decision-makers in mixed frames.

Biotechnology and pasta-making: Lactic Acid Bacteria as a new driver of innovation

Directory of Open Access Journals (Sweden)

Vittorio eCapozzi

2012-03-01

Full Text Available Cereals-derived foods represent a key constituent in the diet of many populations. In particular, pasta is consumed in large quantities throughout the world in reason of its nutritive importance, containing significant amounts of complex carbohydrates, proteins, B-vitamins, and iron. Lactic acid bacteria (LAB are a heterogeneous group of bacteria that play a key role in the production of fermented foods and beverages with high relevance for human and animal health. A wide literature testifies the multifaceted importance of LAB biotechnological applications in cereal-based products. Several studies focused on LAB isolation and characterization in durum wheat environment, in some cases with preliminary experimental applications of LAB in pasta-making. In this paper, using sourdough as a model, we focus on the relevant state-of-art to introduce a LAB-based biotechnological step in industrial pasta-making, a potential world driver of innovation that might represent a cutting-edge advancement in pasta production.

Need for public participation in decision-making on energy

International Nuclear Information System (INIS)

Norte Gomez, M. D.

2014-01-01

This paper outlines the need to expand and improve public participation in decision-making on energy. In an advanced society like ours you can not continue using the same tools they used a century ago. Provide and transmit by the scientific community to society, information science and technology in an appropriate language that comes to them, giving them opportunities and enabling them to participate objectively in this decision making. There must be a legitimate, honest, sincere and plural debate where the participation of all the actors involved and from all strata of society. (Author)

Detecting Novelty and Significance

Science.gov (United States)

Ferrari, Vera; Bradley, Margaret M.; Codispoti, Maurizio; Lang, Peter J.

2013-01-01

Studies of cognition often use an “oddball” paradigm to study effects of stimulus novelty and significance on information processing. However, an oddball tends to be perceptually more novel than the standard, repeated stimulus as well as more relevant to the ongoing task, making it difficult to disentangle effects due to perceptual novelty and stimulus significance. In the current study, effects of perceptual novelty and significance on ERPs were assessed in a passive viewing context by presenting repeated and novel pictures (natural scenes) that either signaled significant information regarding the current context or not. A fronto-central N2 component was primarily affected by perceptual novelty, whereas a centro-parietal P3 component was modulated by both stimulus significance and novelty. The data support an interpretation that the N2 reflects perceptual fluency and is attenuated when a current stimulus matches an active memory representation and that the amplitude of the P3 reflects stimulus meaning and significance. PMID:19400680

Exploring the challenges of making data physical

DEFF Research Database (Denmark)

Alexander, Jason; Jansen, Yvonne; Hornbæk, Kasper

2015-01-01

Physical representations of data have existed for thousands of years. However, it is only now that advances in digital fabrication, actuated tangible interfaces, and shape-changing displays can support the emerging area of 'Data Physicalization': the study of computer-supported, physical....... The primary goal of this workshop is to bring together practitioners from a diverse range of communities to explore the challenges in 'making data physical' and to set a research roadmap for the next years....... representations of data and their support for cognition, communication, learning, problem solving and decision making. As physical artifacts, data physicalizations can tap more deeply into our perceptual exploration skills than classical computer setups, while their dynamic physicality alleviates some of the main...

Changing Gender Roles and Decision Making in Dangme West

African Journals Online (AJOL)

government agencies must strategically tackle the complexities of decision- making and ... Within the traditional Ghanaian family, there is unequal power relation between men ... strategies and plans of action for the advancement of women. ..... 'In these our fishing communities, men travel a lot; if you don't do that there will ...

“Don't let the world become too small” – How patients with advanced cancer and their significant others cope with transitions during the last year of life. A qualitative study

Science.gov (United States)

Chabloz-Süssenbach, Christiane; Sailer Schramm, Monique; Stoll, Hansruedi; Spirig, Rebecca

2016-07-01

Background: In the last year of life, persons with advanced cancer and their significant others are affected by several transitions. They perform psychological adjustment processes during transformation. This requires strategies for patients and their significant others. Research in German about this theme is missing. Aim: We explored the experiences with illness management during transitions in the last year of life of patients with advanced cancer and their significant others. Method: In this qualitative study, we conducted structured interviews with five dyads, consisting of persons with Karnofsky Index ≥ 60 % and life expectancy of six to twelve months as well as their significant others. To interpret the interviews, we used qualitative content analysis according to Mayring. Results: The main theme “Don't let the world become too small” expresses that limitations diminished the lifeworld and the participants struggled against this process. This is revealed in three categories: “Being shocked by diagnosis – realigning again”, “Bearing limitations and loss – finding new ways in daily life”, “Living in uncertainty – holding out together”. Conclusions: Patients and significant others live in changing lifeworlds caused by transitions. Health care professionals should be attentive and may gain deeper knowledge about transitions. Further research in German-speaking contexts will help to improve nursing care and psychooncological interventions.

Fuzzy statistical decision-making theory and applications

CERN Document Server

Kabak, Özgür

2016-01-01

This book offers a comprehensive reference guide to fuzzy statistics and fuzzy decision-making techniques. It provides readers with all the necessary tools for making statistical inference in the case of incomplete information or insufficient data, where classical statistics cannot be applied. The respective chapters, written by prominent researchers, explain a wealth of both basic and advanced concepts including: fuzzy probability distributions, fuzzy frequency distributions, fuzzy Bayesian inference, fuzzy mean, mode and median, fuzzy dispersion, fuzzy p-value, and many others. To foster a better understanding, all the chapters include relevant numerical examples or case studies. Taken together, they form an excellent reference guide for researchers, lecturers and postgraduate students pursuing research on fuzzy statistics. Moreover, by extending all the main aspects of classical statistical decision-making to its fuzzy counterpart, the book presents a dynamic snapshot of the field that is expected to stimu...

[Transparency in public health decision-making].

Science.gov (United States)

García-Altés, Anna; Argimon, Josep M

2016-11-01

Improving the quality and transparency of governmental healthcare decision-making has an impact on the health of the population through policies, organisational management and clinical practice. Moreover, the comparison between healthcare centres and the transparent feedback of results to professionals and to the wider public contribute directly to improved results. The "Results Centre" of the Catalan healthcare system measures and disseminates the results achieved by the different healthcare centres in order to facilitate a shared decision-making process, thereby enhancing the quality of healthcare provided to the population of Catalonia (Spain). This is a pioneering initiative in Spain and is aligned with the most advanced countries in terms of policies of transparency and accountability. Copyright © 2016 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.

Thermal effects and their compensation in Advanced Virgo

International Nuclear Information System (INIS)

Rocchi, A; Coccia, E; Fafone, V; Malvezzi, V; Minenkov, Y; Sperandio, L

2012-01-01

Thermal effects in the test masses of the gravitational waves interferometric detectors may result in a strong limitation to their operation and sensitivity. Already in initial LIGO and Virgo, these effects have been observed and required the installation of dedicated compensation systems. Based on CO 2 laser projectors, the thermal compensators heat the peripheral of the input test masses to reduce the lensing effect. In advanced detectors, the power circulating in the interferometer will increase, thus making thermal effects more relevant. In this paper, the concept of the compensation system for Advanced Virgo is described.

Prognostic significance of catalase expression and its regulatory effects on hepatitis B virus X protein (HBx) in HBV-related advanced hepatocellular carcinomas.

Science.gov (United States)

Cho, Mi-Young; Cheong, Jae Youn; Lim, Wonchung; Jo, Sujin; Lee, Youngsoo; Wang, Hee-Jung; Han, Kyou-Hoon; Cho, Hyeseong

2014-12-15

Hepatitis B virus X protein (HBx) plays a role in liver cancer development. We previously showed that ROS increased HBx levels and here, we investigated the role of antioxidants in the regulation of HBx expression and their clinical relevance. We found that overexpression of catalase induced a significant loss in HBx levels. The cysteine null mutant of HBx (Cys-) showed a dramatic reduction in its protein stability. In clonogenic proliferation assays, Huh7-X cells produced a significant number of colonies whereas Huh7-Cys- cells failed to generate them. The Cys at position 69 of HBx was crucial to maintain its protein stability and transactivation function in response to ROS. Among 50 HBV-related hepatocellular carcinoma (HCC) specimens, 72% of HCCs showed lower catalase levels than those of surrounding non-tumor tissues. In advanced stage IV, catalase levels in non-tumor tissues were increased whereas those in tumors were further reduced. Accordingly, patients with a high T/N ratio for catalase showed significantly longer survival than those with a low T/N ratio. Together, catalase expression in HCC patients can be clinically useful for prediction of patient survival, and restoration of catalase expression in HCCs could be an important strategy for intervention in HBV-induced liver diseases.

Prognostic significance of catalase expression and its regulatory effects on hepatitis B virus X protein (HBx) in HBV-related advanced hepatocellular carcinomas

Science.gov (United States)

Cho, Mi-Young; Cheong, Jae Youn; Lim, Wonchung; Jo, Sujin; Lee, Youngsoo; Wang, Hee-Jung; Han, Kyou-Hoon; Cho, Hyeseong

2014-01-01

Hepatitis B virus X protein (HBx) plays a role in liver cancer development. We previously showed that ROS increased HBx levels and here, we investigated the role of antioxidants in the regulation of HBx expression and their clinical relevance. We found that overexpression of catalase induced a significant loss in HBx levels. The cysteine null mutant of HBx (Cys−) showed a dramatic reduction in its protein stability. In clonogenic proliferation assays, Huh7-X cells produced a significant number of colonies whereas Huh7-Cys− cells failed to generate them. The Cys at position 69 of HBx was crucial to maintain its protein stability and transactivation function in response to ROS. Among 50 HBV-related hepatocellular carcinoma (HCC) specimens, 72% of HCCs showed lower catalase levels than those of surrounding non-tumor tissues. In advanced stage IV, catalase levels in non-tumor tissues were increased whereas those in tumors were further reduced. Accordingly, patients with a high T/N ratio for catalase showed significantly longer survival than those with a low T/N ratio. Together, catalase expression in HCC patients can be clinically useful for prediction of patient survival, and restoration of catalase expression in HCCs could be an important strategy for intervention in HBV-induced liver diseases. PMID:25361011

Fuzzy multiple attribute decision making methods and applications

CERN Document Server

Chen, Shu-Jen

1992-01-01

This monograph is intended for an advanced undergraduate or graduate course as well as for researchers, who want a compilation of developments in this rapidly growing field of operations research. This is a sequel to our previous works: "Multiple Objective Decision Making--Methods and Applications: A state-of-the-Art Survey" (No.164 of the Lecture Notes); "Multiple Attribute Decision Making--Methods and Applications: A State-of-the-Art Survey" (No.186 of the Lecture Notes); and "Group Decision Making under Multiple Criteria--Methods and Applications" (No.281 of the Lecture Notes). In this monograph, the literature on methods of fuzzy Multiple Attribute Decision Making (MADM) has been reviewed thoroughly and critically, and classified systematically. This study provides readers with a capsule look into the existing methods, their characteristics, and applicability to the analysis of fuzzy MADM problems. The basic concepts and algorithms from the classical MADM methods have been used in the development of the f...

Switzerland advances payments to CERN

CERN Multimedia

2002-01-01

In the picture, Charles Kleiber (third from left) visits the TI8 tunnel with (left to right) Jean-Luc Baldy, Head of the LHC civil engineering group, Luciano Maiani, CERN Director-General, Jean-Pierre Ruder, Swiss Delegate to CERN Council, Guy Hentsch, Personal adviser to the Director-General, Michel Buchs and Frédéric Chavan, representatives of the firm Prader Losinger. The State Secretary for Science and Research in Switzerland, Charles Kleiber, signed an agreement with CERN last week for an advancement of contributions from his country. The Confédération Helvétique will make an advanced payment of 90 million CHF. There will be no interest involved in this payment and the amount of money will be deducted from Switzerland's ordinary contributions to CERN in later years.

Advanced Solid State Lighting for Human Evaluation

Data.gov (United States)

National Aeronautics and Space Administration — Lighting intensity and color have a significant impact on human circadian rhythms.  Advanced solid state lighting was developed for the Advanced Exploration System...

Making Riverscapes Real (Invited)

Science.gov (United States)

Marcus, A.; Carbonneau, P.; Fonstad, M. A.; Walther, S. C.

2009-12-01

The structure and function of rivers have long been characterized either by: (1) qualitative models such as the River Continuum Concept or Serial Discontinuity Concept which paint broad descriptive portraits of how river habitats and communities vary, or (2) quantitative models, such as Downstream Hydraulic Geometry, which rely on a limited number of measurements spread widely throughout a river basin. In contrast, Fausch et al. (2002) proposed applying landscape ecology methods to rivers to create “riverscapes.” Application of the riverscape concept requires information on the spatial distribution of organism-scale habitats throughout entire river systems. In practical terms, this means that researchers must replicate maps of local habitat continuously throughout entire rivers to document and predict total habitat availability, structure, and function. Likewise, information on time-dependent variations in these river habitats is necessary. Given these requirements, it is not surprising that the riverscape approach has largely remained a conceptual framework with limited practical application. Recent advances in remote sensing and desktop computing, however, make the riverscape concept more achievable from a mapping perspective. Remote sensing methods now enable sub-meter measurements of depth, water surface slope, grain size, biotypes, algae, and plants, as well as estimation of derived parameters such as velocity and stream power. Although significant obstacles remain to basin-extent sub-meter mapping of physical habitat, recent advances are overcoming these obstacles and allowing the riverscape concept to be put into use by different agencies - at least from a physical habitat perspective. More problematic to the riverscape approach, however, are two major issues that cannot be solved with technical solutions. First is the difficulty in acquiring maps of fauna, whether they be macroinvertebrates, fish, or microorganisms, at scales and spatial extents

Accelerators for the advanced radiation technology project

International Nuclear Information System (INIS)

Maruyama, Michio

1990-01-01

Ion beam irradiation facilities are now under construction for the advanced radiation technology (ART) project in Takasaki Radiation Chemistry Research Establishment of (Japan Atomic Energy Research Institute) JAERI. The project is intended to make an effective use of ion beams, especially ion beams, in the research field of radiation application technology. The TIARA (Takasaki Ion Accelerators for Advanced Radiation Application) facilities include four ion accelerators to produce almost all kinds of energetic ions in the periodic table. The facilities are also provided with several advanced irradiation means and act as very powerful accelerator complex for material development. Specifically, this report presents an outline of the ART project, features of TIARA as accelerator facilities dedicated to material development, the AVF cyclotron under construction (Sumitomo Heavy Industries, Ltd., Model 930), tandem accelerator, microbeam, and experimental instruments used. (N.K.)

The Path to Advanced Practice Licensure for Clinical Nurse Specialists in Washington State.

Science.gov (United States)

Schoonover, Heather

The aim of this study was to provide a review of the history and process to obtaining advanced practice licensure for clinical nurse specialists in Washington State. Before 2016, Washington State licensed certified nurse practitioners, certified nurse midwives, and certified nurse anesthetists under the designation of an advanced registered nurse practitioner; however, the state did not recognize clinical nurse specialists as advanced practice nurses. The work to drive the rule change began in 2007. The Washington Affiliate of the National Association of Clinical Nurse Specialists used the Power Elite Theory to guide advocacy activities, building coalitions and support for the desired rule changes. On January 8, 2016, the Washington State Nursing Care Quality Assurance Commission voted to amend the state's advanced practice rules, including clinical nurse specialists in the designation of an advanced practice nurse. Since the rule revision, clinical nurse specialists in Washington State have been granted advanced registered nurse practitioner licenses. Driving changes in state regulatory rules requires diligent advocacy, partnership, and a deep understanding of the state's rule-making processes. To be successful in changing rules, clinical nurse specialists must build strong partnerships with key influencers and understand the steps in practice required to make the desired changes.

Advances in endovascular aneurysm treatment: are we making a difference?

International Nuclear Information System (INIS)

Katz, Jeffrey M.; Ougorets, Igor; Tsiouris, Apostolos J.; Biondi, Alessandra; Salvaggio, Kimberly A.; Gobin, Y. Pierre; Stieg, Philip E.; Riina, Howard A.

2005-01-01

Recent advancements in endovascular aneurysm repair, including bioactive and expansile coils and intracranial stents, hold promise for improved aneurysm occlusion rates. We report the immediate and midterm clinical and angiographic outcomes of a consecutive series of patients treated since the advent of these technologies. Clinical and radiological records of 134 patients with 142 aneurysms treated between 2001 and 2004 were retrospectively evaluated by an independent neurologist. Endovascular procedures were analyzed by an independent neuroradiologist blinded to all clinical information. Seventy-two ruptured and 60 un-ruptured saccular aneurysms, nine fusiform and one post-traumatic aneurysm were treated. Matrix coils were used in 53% of saccular aneurysms and HydroCoils in 13% of all aneurysms. Neuroform stents were deployed in 19% of aneurysms. Angiographic total or subtotal occlusion was achieved in 76% of cases and in 96% at last follow-up. Aneurysm recanalization was observed in 14% over a mean follow-up of 12 months, and 18% of aneurysms were retreated. Clinically relevant complications occurred in 6.0%, resulting in procedure-related morbidity of 0.6% and 0.6% mortality at 6 months. No aneurysm bled over a cumulative 1,347 months of observation. Newer embolization technologies can be exploited successfully even in more complex aneurysms with very low morbidity and mortality. (orig.)

48 CFR 32.405 - Applying Pub. L. 85-804 to advance payments under sealed bid contracts.

Science.gov (United States)

2010-10-01

... advance payments under sealed bid contracts. 32.405 Section 32.405 Federal Acquisition Regulations System... Non-Commercial Items 32.405 Applying Pub. L. 85-804 to advance payments under sealed bid contracts. (a... provisions of law relating to contracts, as explained in 50.101-1(a), also include making advance payments...

ADVANCED MMIS TOWARD SUBSTANTIAL REDUCTION IN HUMAN ERRORS IN NPPS

Directory of Open Access Journals (Sweden)

POONG HYUN SEONG

2013-04-01

Full Text Available This paper aims to give an overview of the methods to inherently prevent human errors and to effectively mitigate the consequences of such errors by securing defense-in-depth during plant management through the advanced man-machine interface system (MMIS. It is needless to stress the significance of human error reduction during an accident in nuclear power plants (NPPs. Unexpected shutdowns caused by human errors not only threaten nuclear safety but also make public acceptance of nuclear power extremely lower. We have to recognize there must be the possibility of human errors occurring since humans are not essentially perfect particularly under stressful conditions. However, we have the opportunity to improve such a situation through advanced information and communication technologies on the basis of lessons learned from our experiences. As important lessons, authors explained key issues associated with automation, man-machine interface, operator support systems, and procedures. Upon this investigation, we outlined the concept and technical factors to develop advanced automation, operation and maintenance support systems, and computer-based procedures using wired/wireless technology. It should be noted that the ultimate responsibility of nuclear safety obviously belongs to humans not to machines. Therefore, safety culture including education and training, which is a kind of organizational factor, should be emphasized as well. In regard to safety culture for human error reduction, several issues that we are facing these days were described. We expect the ideas of the advanced MMIS proposed in this paper to lead in the future direction of related researches and finally supplement the safety of NPPs.

Advanced MMIS Toward Substantial Reduction in Human Errors in NPPs

Energy Technology Data Exchange (ETDEWEB)

Seong, Poong Hyun; Kang, Hyun Gook [Korea Advanced Institute of Science and Technology, Daejeon (Korea, Republic of); Na, Man Gyun [Chosun Univ., Gwangju (Korea, Republic of); Kim, Jong Hyun [KEPCO International Nuclear Graduate School, Ulsan (Korea, Republic of); Heo, Gyunyoung [Kyung Hee Univ., Yongin (Korea, Republic of); Jung, Yoensub [Korea Hydro and Nuclear Power Co., Ltd., Daejeon (Korea, Republic of)

2013-04-15

This paper aims to give an overview of the methods to inherently prevent human errors and to effectively mitigate the consequences of such errors by securing defense-in-depth during plant management through the advanced man-machine interface system (MMIS). It is needless to stress the significance of human error reduction during an accident in nuclear power plants (NPPs). Unexpected shutdowns caused by human errors not only threaten nuclear safety but also make public acceptance of nuclear power extremely lower. We have to recognize there must be the possibility of human errors occurring since humans are not essentially perfect particularly under stressful conditions. However, we have the opportunity to improve such a situation through advanced information and communication technologies on the basis of lessons learned from our experiences. As important lessons, authors explained key issues associated with automation, man-machine interface, operator support systems, and procedures. Upon this investigation, we outlined the concept and technical factors to develop advanced automation, operation and maintenance support systems, and computer-based procedures using wired/wireless technology. It should be noted that the ultimate responsibility of nuclear safety obviously belongs to humans not to machines. Therefore, safety culture including education and training, which is a kind of organizational factor, should be emphasized as well. In regard to safety culture for human error reduction, several issues that we are facing these days were described. We expect the ideas of the advanced MMIS proposed in this paper to lead in the future direction of related researches and finally supplement the safety of NPPs.

Advanced MMIS Toward Substantial Reduction in Human Errors in NPPs

International Nuclear Information System (INIS)

Seong, Poong Hyun; Kang, Hyun Gook; Na, Man Gyun; Kim, Jong Hyun; Heo, Gyunyoung; Jung, Yoensub

2013-01-01

This paper aims to give an overview of the methods to inherently prevent human errors and to effectively mitigate the consequences of such errors by securing defense-in-depth during plant management through the advanced man-machine interface system (MMIS). It is needless to stress the significance of human error reduction during an accident in nuclear power plants (NPPs). Unexpected shutdowns caused by human errors not only threaten nuclear safety but also make public acceptance of nuclear power extremely lower. We have to recognize there must be the possibility of human errors occurring since humans are not essentially perfect particularly under stressful conditions. However, we have the opportunity to improve such a situation through advanced information and communication technologies on the basis of lessons learned from our experiences. As important lessons, authors explained key issues associated with automation, man-machine interface, operator support systems, and procedures. Upon this investigation, we outlined the concept and technical factors to develop advanced automation, operation and maintenance support systems, and computer-based procedures using wired/wireless technology. It should be noted that the ultimate responsibility of nuclear safety obviously belongs to humans not to machines. Therefore, safety culture including education and training, which is a kind of organizational factor, should be emphasized as well. In regard to safety culture for human error reduction, several issues that we are facing these days were described. We expect the ideas of the advanced MMIS proposed in this paper to lead in the future direction of related researches and finally supplement the safety of NPPs

Decision-making and emotions in the contested information environment

Directory of Open Access Journals (Sweden)

M.W. Haas

2016-01-01

Full Text Available Future conflicts will necessitate the ability to conduct effective military operations in a contested information environment. The building and maintaining of robust situational awareness, protection of decision-making effectiveness of individuals and teams, fighting through information attacks from both in, and through, the cyberspace domain, will be essential. Increasing the knowledge of the mechanisms involved in degrading task performance and decision-making during cyber attacks will enable the development of advanced human-centered defensive techniques that aid fight-through capability. In this position paper, the development and evaluation of software that simulates real-time and persistent manipulation of the information environment is discussed. Results of the evaluation indicated that the task performance of a team of decision-makers performing collaborative tasks could be degraded through real-time manipulation of cyberspace content and operation. The paper concludes with a discussion of focus and direction for future research and development. It is suggested that the building of a deeper understanding of the perceptual and cognitive factors that are significant in the relationship between information environment manipulation and reduction in task performance is required. This understanding will aid in the defence of cyberspace attacks, will aid in fight through and mission assurance, and will aid the Information Operations community.

The development and piloting of the REnal specific Advanced Communication Training (REACT) programme to improve Advance Care Planning for renal patients.

Science.gov (United States)

Bristowe, Katherine; Shepherd, Kate; Bryan, Liz; Brown, Heather; Carey, Irene; Matthews, Beverley; O'Donoghue, Donal; Vinen, Katie; Murtagh, Fliss E M

2014-04-01

In recent years, the End-Stage Kidney Disease population has increased and is ever more frail, elderly and co-morbid. A care-focused approach needs to be incorporated alongside the disease focus, to identify those who are deteriorating and improve communication about preferences and future care. Yet many renal professionals feel unprepared for such discussions. To develop and pilot a REnal specific Advanced Communication Training (REACT) programme to address the needs of End-Stage Kidney Disease patients and renal professionals. Two-part study: (1) development of the REnal specific Advanced Communication Training programme informed by multi-professional focus group and patient survey and (2) piloting of the programme. The REnal specific Advanced Communication Training programme was piloted with 16 participants (9 renal nurses/health-care assistants and 7 renal consultants) in two UK teaching hospitals. The focus group identified the need for better information about end-of-life phase, improved awareness of patient perspectives, skills to manage challenging discussions, 'hands on' practice in a safe environment and follow-up to discuss experiences. The patient survey demonstrated a need to improve communication about concerns, treatment plans and decisions. The developed REnal specific Advanced Communication Training programme was acceptable and feasible and was associated with a non-significant increase in confidence in communicating about end-of-life issues (pre-training: 6.6/10, 95% confidence interval: 5.7-7.4; post-training: 6.9/10, 95% confidence interval: 6.1-7.7, unpaired t-test - p = 0.56), maintained at 3 months. There is a need to improve end-of-life care for End-Stage Kidney Disease patients, to enable them to make informed decisions about future care. Challenges include prioritising communication training among service providers.

Palliative surgical approach in advanced nonresponsive mucinous ovarian cancer: A rare case report

Directory of Open Access Journals (Sweden)

Manika Agarwal

2016-01-01

Full Text Available Advanced mucinous ovarian cancer is a separate entity and has different biological behaviour. There is a wide range of therapeutic challenges and dilemmas in the management of these patients. The authors present a case of advanced ovarian mucinous cystadenocarcinoma with pseudomyxoma peritonei who had poor response to standard neoadjuvant chemotherapy. This case is highlighted to emphasize the challenges in the decision making for the management of advanced mucinous ovarian cancer.

Developing model-making and model-breaking skills using direct measurement video-based activities

Science.gov (United States)

Vonk, Matthew; Bohacek, Peter; Militello, Cheryl; Iverson, Ellen

2017-12-01

This study focuses on student development of two important laboratory skills in the context of introductory college-level physics. The first skill, which we call model making, is the ability to analyze a phenomenon in a way that produces a quantitative multimodal model. The second skill, which we call model breaking, is the ability to critically evaluate if the behavior of a system is consistent with a given model. This study involved 116 introductory physics students in four different sections, each taught by a different instructor. All of the students within a given class section participated in the same instruction (including labs) with the exception of five activities performed throughout the semester. For those five activities, each class section was split into two groups; one group was scaffolded to focus on model-making skills and the other was scaffolded to focus on model-breaking skills. Both conditions involved direct measurement videos. In some cases, students could vary important experimental parameters within the video like mass, frequency, and tension. Data collected at the end of the semester indicate that students in the model-making treatment group significantly outperformed the other group on the model-making skill despite the fact that both groups shared a common physical lab experience. Likewise, the model-breaking treatment group significantly outperformed the other group on the model-breaking skill. This is important because it shows that direct measurement video-based instruction can help students acquire science-process skills, which are critical for scientists, and which are a key part of current science education approaches such as the Next Generation Science Standards and the Advanced Placement Physics 1 course.

Making and Changing Wills

Directory of Open Access Journals (Sweden)

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.

Advancing Work Practices Through Online Professional Development

DEFF Research Database (Denmark)

Noesgaard, Signe Schack

The natural expectation for professional development courses is that they will improve a participant’s work performance, but do they? This PhD research challenges several assumptions underlying the design of online professional development courses, revealing that it is after such interventions...... was not effective and subsequently terminate change that could have advanced their practices. This underlines the need to think beyond the course format to make online professional development interventions continuous, committing, and contextual. The research suggests rethinking online professional development...... as adaptive “just-in-time” technologies and proposes a design theory called “situated online professional development,” entailing six design principles for advancing work practices....

United States advanced technologies

International Nuclear Information System (INIS)

Longenecker, J.R.

1985-01-01

In the United States, the advanced technologies have been applied to uranium enrichment as a means by which it can be assured that nuclear fuel cost will remain competitive in the future. The United States is strongly committed to the development of advanced enrichment technology, and has brought both advanced gas centrifuge (AGC) and atomic vapor laser isotope separation (AVLIS) programs to a point of significant technical refinement. The ability to deploy advanced technologies is the basis for the confidence in competitive future price. Unfortunately, the development of advanced technologies is capital intensive. The year 1985 is the key year for advanced technology development in the United States, since the decision on the primary enrichment technology for the future, AGC or AVLIS, will be made shortly. The background on the technology selection process, the highlights of AGC and AVLIS programs and the way to proceed after the process selection are described. The key objective is to maximize the sales volume and minimize the operating cost. This will help the utilities in other countries supply low cost energy on a reliable, long term basis. (Kako, I.)

Moral disengagement in ethical decision making: a study of antecedents and outcomes.

Science.gov (United States)

Detert, James R; Treviño, Linda Klebe; Sweitzer, Vicki L

2008-03-01

This article advances understanding of the antecedents and outcomes of moral disengagement by testing hypotheses with 3 waves of survey data from 307 business and education undergraduate students. The authors theorize that 6 individual differences will either increase or decrease moral disengagement, defined as a set of cognitive mechanisms that deactivate moral self-regulatory processes and thereby help to explain why individuals often make unethical decisions without apparent guilt or self-censure (Bandura, 1986). Results support 4 individual difference hypotheses, specifically, that empathy and moral identity are negatively related to moral disengagement, while trait cynicism and chance locus of control orientation are positively related to moral disengagement. Two additional locus of control orientations are not significantly related to moral disengagement. The authors also hypothesize and find that moral disengagement is positively related to unethical decision making. Finally, the authors hypothesize that moral disengagement plays a mediating role between the individual differences they studied and unethical decisions. Their results offer partial support for these mediating hypotheses. The authors discuss the implications of these findings for future research and for practice. Copyright 2008 APA

Return or relocate? An inductive analysis of decision-making in a disaster.

Science.gov (United States)

Henry, Jacques

2013-04-01

This paper proposes an inductive analysis of the decision as to whether to return or to relocate by persons in the State of Louisiana, United States, who evacuated after Hurricanes Katrina and Rita in August and September 2005, respectively. Drawing on interviews with evacuees in these events and extensive fieldwork in the impacted area, the paper seeks to identify the folk dimensions of the decision-making process, assess their arrangements, and situate the process in the larger context of risk and resilience in an advanced society. It suggests that, despite the material and emotional upheaval experienced by affected persons, the decision-making process is a rational endeavour combining a definite set of tightly interconnected factors, involving material dimensions and substantive values that can act in concert or in conflict. In addition, it indicates that there are significant variations by geographic areas, homeownership, and kind of decision. Some theoretical implications, practical measures, and suggestions for future research are examined. © 2013 The Author(s). Journal compilation © Overseas Development Institute, 2013.

Challenges in process marginality for advanced technology nodes and tackling its contributors

Science.gov (United States)

Narayana Samy, Aravind; Schiwon, Roberto; Seltmann, Rolf; Kahlenberg, Frank; Katakamsetty, Ushasree

2013-10-01

Process margin is getting critical in the present node shrinkage scenario due to the physical limits reached (Rayleigh's criterion) using ArF lithography tools. K1 is used to its best for better resolution and to enhance the process margin (28nm metal patterning k1=0.31). In this paper, we would like to give an overview of various contributors in the advanced technology nodes which limit the process margins and how the challenges have been tackled in a modern foundry model. Advanced OPC algorithms are used to make the design content at the mask optimum for patterning. However, as we work at the physical limit, critical features (Hot-spots) are very susceptible to litho process variations. Furthermore, etch can have a significant impact as well. Pattern that still looks healthy at litho can fail due to etch interactions. This makes the traditional 2D contour output from ORC tools not able to predict accurately all defects and hence not able to fully correct it in the early mask tapeout phase. The above makes a huge difference in the fast ramp-up and high yield in a competitive foundry market. We will explain in this paper how the early introduction of 3D resist model based simulation of resist profiles (resist top-loss, bottom bridging, top-rounding, etc.,) helped in our prediction and correction of hot-spots in the early 28nm process development phase. The paper also discusses about the other overall process window reduction contributors due to mask 3D effects, wafer topography (focus shifts/variations) and how this has been addressed with different simulation efforts in a fast and timely manner.

Advancing Water Science through Data Visualization

Science.gov (United States)

Li, X.; Troy, T.

2014-12-01

As water scientists, we are increasingly handling larger and larger datasets with many variables, making it easy to lose ourselves in the details. Advanced data visualization will play an increasingly significant role in propelling the development of water science in research, economy, policy and education. It can enable analysis within research and further data scientists' understanding of behavior and processes and can potentially affect how the public, whom we often want to inform, understands our work. Unfortunately for water scientists, data visualization is approached in an ad hoc manner when a more formal methodology or understanding could potentially significantly improve both research within the academy and outreach to the public. Firstly to broaden and deepen scientific understanding, data visualization can allow for more analyzed targets to be processed simultaneously and can represent the variables effectively, finding patterns, trends and relationships; thus it can even explores the new research direction or branch of water science. Depending on visualization, we can detect and separate the pivotal and trivial influential factors more clearly to assume and abstract the original complex target system. Providing direct visual perception of the differences between observation data and prediction results of models, data visualization allows researchers to quickly examine the quality of models in water science. Secondly data visualization can also improve public awareness and perhaps influence behavior. Offering decision makers clearer perspectives of potential profits of water, data visualization can amplify the economic value of water science and also increase relevant employment rates. Providing policymakers compelling visuals of the role of water for social and natural systems, data visualization can advance the water management and legislation of water conservation. By building the publics' own data visualization through apps and games about water

Recent advances in control and diagnostics development and application

International Nuclear Information System (INIS)

Monson, L.R.; King, R.W.; Lindsay, R.W.; Staffon, J.D.

1989-01-01

The power industry is undergoing rapid technological advances and cultural changes. Technologies are advancing and evolving so rapidly that the industry is hard pressed to keep up and take full advantage of the many developments now in progress. Recent advantages in state-of-the-art computer technology are making in-roads in the form of advanced computer control, expert systems, on-line performance monitoring and diagnostics. Validation and verification schemes are being developed which provide increased confidence in the correctness and reliability of both computer hardware and software. Our challenge in the nuclear community is to effectively apply these new technologies to improve the operation, safety, and reliability of our plants. This presentation discusses two areas of development that are essential to advanced control strategies: application of diagnostic systems to improve fault-tolerance, and model-based graphic displays. 4 refs., 4 figs

Recent activities of the international Group on Research Reactors (IGORR) and of the Advanced Neutron Source (ANS)

International Nuclear Information System (INIS)

West, C.D.

1992-01-01

The International Group on Research Reactors (IGORR) was formed in 1990 to facilitate the sharing of knowledge and experience among those institutions and individuals who are actively working to design, build, and promote new research reactors or to make significant upgrades to existing facilities. The Advanced Neutron Source Project expects to complete conceptual design in mid-1992. In the present design concept, the neutron source is a heavy-water-cooled, moderated, and reflected reactor of about 350 MW(f) power. (author)

Clinical significance of circulating tumor cells (CTCs) with respect to optimal cut-off value and tumor markers in advanced/metastatic breast cancer.

Science.gov (United States)

Shiomi-Mouri, Yukako; Kousaka, Junko; Ando, Takahito; Tetsuka, Rie; Nakano, Shogo; Yoshida, Miwa; Fujii, Kimihito; Akizuki, Miwa; Imai, Tsuneo; Fukutomi, Takashi; Kobayashi, Katsumasa

2016-01-01

Although carcinoembryonic antigen (CEA) and cancer antigen 15-3 (CA15-3) are useful tumor markers (TMs) in metastatic breast cancer (MBC), circulating tumor cells (CTCs) are also detected in patients with advanced or metastatic breast cancer. We analyzed CTCs in MBC patients in order to establish the optimal cut-off value, to evaluate the prognostic utility of CTC count, and to clarify whether CTC count could provide information in addition to CEA and CA15-3. We studied 98 MBC patients enrolled between June 2007 and March 2013. To quantify CTCs, 7.5 ml of blood was collected and CEA and CA15-3 were measured simultaneously. CTCs were counted using the CellSearch™ System. The CTC count was dichotomized as 0 (CTC-negative) or ≥1 (CTC-positive). The clinical significance of CTCs was evaluated in terms of its relationship with levels of CEA and CA15-3. Associations between qualitative variables were evaluated using the chi-square test. In order to evaluate the predictive value of CTCs for advanced or metastatic breast cancer, multivariate Cox proportional hazards modeling was used to calculate hazard ratios. With a CTC cut-off value of 1, there were 53 (54.1 %) CTC-negative patients and 45 (45.9 %) CTC-positive patients. Patients in the CTC-positive group had worse survival than those in the CTC-negative group (p CEA and CA15-3.

Cost estimate guidelines for advanced nuclear power technologies

International Nuclear Information System (INIS)

Delene, J.G.; Hudson, C.R. II.

1990-03-01

To make comparative assessments of competing technologies, consistent ground rules must be applied when developing cost estimates. This document provides a uniform set of assumptions, ground rules, and requirements that can be used in developing cost estimates for advanced nuclear power technologies. 10 refs., 8 figs., 32 tabs

Series lecture on advanced fusion reactors

International Nuclear Information System (INIS)

Dawson, J.M.

1983-01-01

The problems concerning fusion reactors are presented and discussed in this series lecture. At first, the D-T tokamak is explained. The breeding of tritium and the radioactive property of tritium are discussed. The hybrid reactor is explained as an example of the direct use of neutrons. Some advanced fuel reactions are proposed. It is necessary to make physics consideration for burning advanced fuel in reactors. The rate of energy production and the energy loss are important things. The bremsstrahlung radiation and impurity radiation are explained. The simple estimation of the synchrotron radiation was performed. The numerical results were compared with a more detailed calculation of Taimor, and the agreement was quite good. The calculation of ion and electron temperature was made. The idea to use the energy more efficiently is that one can take X-ray or neutrons, and pass them through a first wall of a reactor into a second region where they heat the material. A method to convert high temperature into useful energy is the third problem of this lecture. The device was invented by A. Hertzberg. The lifetime of the reactor depends on the efficiency of energy recovery. The idea of using spin polarized nuclei has come up. The spin polarization gives a chance to achieve a large multiplication factor. The advanced fuel which looks easiest to make go is D plus He-3. The idea of multipole is presented to reduce the magnetic field inside plasma, and discussed. Two other topics are explained. (Kato, T.)

Constructing an Ethical Training for Advanced Nursing Practice: An Interactionist and Competency-Based Approach.

Science.gov (United States)

Pariseau-Legault, Pierre; Lallier, Melisa

2016-07-01

Advanced practice nurses are working in a highly interdisciplinary and political context. Such situations can influence the deliberative and ethical decision-making processes in which they are also involved. This can subsequently compromise their abilities to protect their moral integrity, to find innovative and nondualistic solutions to complex ethical problems, and to collaborate with other health professionals. The authors constructed a training program inspired by discourse and narrative ethics. The objective pursued was to develop advanced practice nurses' moral integrity, highlight the ethical component of their clinical judgement, and foster the development of their deliberative competencies. The pedagogical process proposed exposes how an ethical curriculum adapted to the context in which advanced practice nurses evolve can address power relationships inherent in ethical decision making. The authors suggest that this pedagogical approach has the potential to optimize the consolidation of ethical, reflective, and deliberative competencies among advanced practice nurses. [J Nurs Educ. 2016;55(7):399-402.]. Copyright 2016, SLACK Incorporated.

Usefulness of chemotherapy with gemcitabine for unresectable advanced pancreatic carcinoma

International Nuclear Information System (INIS)

Kawaguchi, Yoshiaki; Mine, Tetsuya

2007-01-01

We evaluated the usefulness of chemotherapy with gemcitabine for unresectable advanced pancreatic carcinoma. We examined 121 cases with unresectable advanced pancreatic carcinoma. They consisted of 65 locally advanced cases with no distant metastasis (Stage IVa) and 56 cases with distant metastasis (Stage IVb). Seventy-three cases were treated by chemotherapy with only gemcitabine (GEM) alone. Forty cases were not treated. Eight cases received chemoradiotherapy (CRT) combined with GEM. Their survival curves were compared. The survival curve of the GEM group was significantly longer than that of the no therapy group. In the locally advanced and distant metastasis groups, the survival curve of the GEM group was significantly longer than that of the no therapy group. And in the GEM group, the survival curve of the locally advanced group was significantly longer than that of the distant metastasis group. The survival curve of the CRT group was significantly longer than that of GEM group. Chemotherapy with gemcitabine for unresectable advanced pancreatic carcinoma was useful but the prognosis remained poor. (author)

Status of advanced bremsstrahlung converters

International Nuclear Information System (INIS)

Halbleib, J.A.

1980-01-01

This paper is an attempt to review the somewhat ill-defined area of advanced converter research in a more or less chronological fashion. Section 2 reviews the early B/sub z/ work that was motivated by the CASINO project. More recent work makes liberal use of technology from ICF research using REBs is discussed in Sec. 3. Section 4 discusses possible directions for future research, some of which are being actively pursued at Sandia National Laboratories (SNL) and elsewhere

[Interoception and decision-making].

Science.gov (United States)

Ohira, Hideki

2015-02-01

We sometimes make decisions relying not necessarily on deliberative thoughts but on intuitive and emotional processes in uncertain situations. The somatic marker hypothesis proposed by Damasio argued that interoception, which means bodily responses such as sympathetic activity, can be represented in the insula and anterior cingulate cortex and can play critical roles in decision-making. Though this hypothesis has been criticized in its theoretical and empirical aspects, recent studies are expanding the hypothesis to elucidate multiple bodily responses including autonomic, endocrine, and immune activities that affect decision-making. In addition, cumulative findings suggest that the anterior insula where the inner model of interoception is represented can act as an interface between the brain and body in decision-making. This article aims to survey recent findings on the brain-body interplays underlying decision-making, and to propose hypotheses on the significance of the body in decision-making.

Implications of advanced vehicle technologies for older drivers.

Science.gov (United States)

Molnar, Lisa J; Eby, David W

2017-09-01

Advances are being made in vehicle technologies that may help older adults compensate for some of the declines in abilities associated with aging. These advances hold promise for increasing vehicle safety, reducing injuries, and making the driving task more comfortable. However, important research gaps remain with regard to how various advanced technologies impact the safety of older drivers, as well as older drivers' perceptions about these technologies. This special issue contains seven original contributions that address these issues. Specific topics include the: congruence of design guidelines with the needs and abilities of older drivers, transfer of control between automated and manual driving, use of in-vehicle monitoring technology, motivations for technology use and assigned meanings, technology valuation, and effects on driving behavior. Copyright © 2017 Elsevier Ltd. All rights reserved.

Career Advancement and Work Support Services on the Job: Implementing the Fort Worth Work Advancement and Support Center Program

Science.gov (United States)

Schultz, Caroline; Seith, David

2011-01-01

The Work Advancement and Support Center (WASC) program in Fort Worth was part of a demonstration that is testing innovative strategies to help increase the income of low-wage workers, who make up a large segment of the U.S. workforce. The program offered services to help workers stabilize their employment, improve their skills, and increase their…

Advanced isotope separation

International Nuclear Information System (INIS)

1982-01-01

The Study Group briefly reviewed the technical status of the three Advanced Isotope Separation (AIS) processes. It also reviewed the evaluation work that has been carried out by DOE's Process Evaluation Board (PEB) and the Union Carbide Corporation-Nuclear Division (UCCND). The Study Group briefly reviewed a recent draft assessment made for DOE staff of the nonproliferation implications of the AIS technologies. The staff also very briefly summarized the status of GCEP and Advanced Centrifuge development. The Study Group concluded that: (1) there has not been sufficient progress to provide a firm scientific, technical or economic basis on which to select one of the three competing AIS processes for full-scale engineering development at this time; and (2) however, should budgetary restraints or other factors force such a selection, we believe that the evaluation process that is being carried out by the PEB provides the best basis available for making a decision. The Study Group recommended that: (1) any decisions on AIS processes should include a comparison with gas centrifuge processes, and should not be made independently from the plutonium isotope program; (2) in evaluating the various enrichment processes, all applicable costs (including R and D and sales overhead) and an appropriate discounting approach should be included in order to make comparisons on a private industry basis; (3) if the three AIS programs continue with limited resources, the work should be reoriented to focus only on the most pressing technical problems; and (4) if a decision is made to develop the Atomic Vapor Laser Isotope Separation process, the solid collector option should be pursued in parallel to alleviate the potential program impact of liquid collector thermal control problems

Introduction to special section of the Journal of Family Psychology, advances in mixed methods in family psychology: integrative and applied solutions for family science.

Science.gov (United States)

Weisner, Thomas S; Fiese, Barbara H

2011-12-01

Mixed methods in family psychology refer to the systematic integration of qualitative and quantitative techniques to represent family processes and settings. Over the past decade, significant advances have been made in study design, analytic strategies, and technological support (such as software) that allow for the integration of quantitative and qualitative methods and for making appropriate inferences from mixed methods. This special section of the Journal of Family Psychology illustrates how mixed methods may be used to advance knowledge in family science through identifying important cultural differences in family structure, beliefs, and practices, and revealing patterns of family relationships to generate new measurement paradigms and inform clinical practice. Guidance is offered to advance mixed methods research in family psychology through sound principles of peer review.

Proceedings of the third users meeting for the Advanced Photon Source

Energy Technology Data Exchange (ETDEWEB)

1990-06-01

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

Proceedings of the third users meeting for the Advanced Photon Source

International Nuclear Information System (INIS)

1990-06-01

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

Design options for advanced manned launch systems

Science.gov (United States)

Freeman, Delma C.; Talay, Theodore A.; Stanley, Douglas O.; Lepsch, Roger A.; Wilhite, Alan W.

1995-03-01

Various concepts for advanced manned launch systems are examined for delivery missions to space station and polar orbit. Included are single-and two-stage winged systems with rocket and/or air-breathing propulsion systems. For near-term technologies, two-stage reusable rocket systems are favored over single-stage rocket or two-stage air-breathing/rocket systems. Advanced technologies enable viable single-stage-to-orbit (SSTO) concepts. Although two-stage rocket systems continue to be lighter in dry weight than SSTO vehicles, advantages in simpler operations may make SSTO vehicles more cost-effective over the life cycle. Generally, rocket systems maintain a dry-weight advantage over air-breathing systems at the advanced technology levels, but to a lesser degree than when near-term technologies are used. More detailed understanding of vehicle systems and associated ground and flight operations requirements and procedures is essential in determining quantitative discrimination between these latter concepts.

Pyrotechnic countermeasures: II. Advanced aerial infrared countermeasures

Energy Technology Data Exchange (ETDEWEB)

Koch, Ernst-Christian [Diehl BGT Defence GmbH and Co. KG, Fischbachstrasse 16, D-90552 Roethenbach a. d. Pegnitz (Germany)

2006-02-15

This paper discusses the technology of advanced aerial infrared countermeasures and related work disclosed in the unclassified literature. Missile-seeker head counter-countermeasures include spectral discrimination, kinematical discrimination, rise-time discrimination, UV/VIS discrimination and area temperature matching. Advanced flare payloads designed to counter dual color seekers contain selectively emitting compositions based primarily on high carbon fuels and perchlorates. Other advanced payloads consist of low temperature emitters like pyrophoric metal foils and gasless pyrotechnic compositions like Fe/KClO{sub 4}. The optimization of black body flares, still considered essential to a successful countermeasure solution, make use of new fuels based on e.g. meta-stable alloys and nanometer-sized powders as well as high energetic oxidizers. Kinematic flares today use combined propellant and infrared grains. 116 references from the public domain are given. For part I see Propellants, Explos., Pyrotech. 2001, 26, 3. (Abstract Copyright [2006], Wiley Periodicals, Inc.)

Advanced Infantry Training: An Empirical Analysis Of (0341) Mortarman Success While Attending Advanced Mortarman Course

Science.gov (United States)

2017-12-01

system MCT Marine Combat Training MEF Marine Expeditionary Force MK Math knowledge MOS Military occupational specialty MSG Marine Security Guard...to advanced level training, specifically, the Advanced Mortarman Course (AMC). Prospective students’ success is predicated on an effective command...survival. It is evident through survival analysis that increased levels of cognitive ability have significant impacts on a Marine’s probability to

Knowledge Management Implementation and the Tools Utilized in Healthcare for Evidence-Based Decision Making: A Systematic Review.

Science.gov (United States)

Shahmoradi, Leila; Safadari, Reza; Jimma, Worku

2017-09-01

Healthcare is a knowledge driven process and thus knowledge management and the tools to manage knowledge in healthcare sector are gaining attention. The aim of this systematic review is to investigate knowledge management implementation and knowledge management tools used in healthcare for informed decision making. Three databases, two journals websites and Google Scholar were used as sources for the review. The key terms used to search relevant articles include: "Healthcare and Knowledge Management"; "Knowledge Management Tools in Healthcare" and "Community of Practices in healthcare". It was found that utilization of knowledge management in healthcare is encouraging. There exist numbers of opportunities for knowledge management implementation, though there are some barriers as well. Some of the opportunities that can transform healthcare are advances in health information and communication technology, clinical decision support systems, electronic health record systems, communities of practice and advanced care planning. Providing the right knowledge at the right time, i.e., at the point of decision making by implementing knowledge management in healthcare is paramount. To do so, it is very important to use appropriate tools for knowledge management and user-friendly system because it can significantly improve the quality and safety of care provided for patients both at hospital and home settings.

Advanced clinical practice for radiographers in Great Britain: professional roles, accountability and the educational provision

International Nuclear Information System (INIS)

Hogg, P.

2004-01-01

A change in British health care has resulted in a broadening of roles and responsibilities beyond 'traditional boundaries' for a range of health care professionals. This has occurred because of staff shortages (particularly within the medical profession) and the recognition that many 'non-doctor' health care staff can make safe, competent and effective contributions outside their 'normal' sphere of responsibilities. In the context of advanced clinical practice, this paper will explain the current arrangements for radiographers' roles and responsibilities, their accountability and the educational provision that underpins the development of competencies at these higher clinical levels. Some advanced roles that British radiographers perform, within their current normal responsibilities, will be identified and some British legislation and professional body guidance that make role advancement possible will be outlined. The article will conclude with an indication of the educational level at which the advanced competencies are learned and assessed. (author)

Ethical decision-making near the end of life.

Science.gov (United States)

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.

Advances in microscale separations towards nanoproteomics applications

Energy Technology Data Exchange (ETDEWEB)

Yi, Lian; Piehowski, Paul D.; Shi, Tujin; Smith, Richard D.; Qian, Wei-Jun

2017-11-01

Microscale separations (e.g., liquid chromatography or capillary electrophoresis) coupled with mass spectrometry (MS) has become the primary tool for advanced proteomics, an indispensable technology for gaining understanding of complex biological processes. While significant advances have been achieved in MS-based proteomics, the current platforms still face a significant challenge in overall sensitivity towards nanoproteomics (i.e., with less than 1 g total amount of proteins available) applications such as cellular heterogeneity in tissue pathologies. Herein, we review recent advances in microscale separation techniques and integrated sample processing systems that improve the overall sensitivity and coverage of the proteomics workflow, and their contributions towards nanoproteomics applications.

Decision Making in Liver Transplant Selection Committees

Science.gov (United States)

Volk, Michael L; Biggins, Scott W; Huang, Mary Ann; Argo, Curtis K; Fontana, Robert J; Anspach, Renee R

2011-01-01

Background In order to receive a liver transplant, patients must first be placed on the waiting list – a decision made in most transplant centers by a multidisciplinary committee. The function of these committees has never been studied. Objectives To describe decision making in liver transplant committees and identify opportunities for process improvement. Design Observational multi-center Setting We observed 63 meetings and interviewed 50 committee members at 4 liver transplant centers. Study Subjects Transplant committee members. Measurements Recorded transcripts and field notes were analyzed using standard qualitative sociological methods. Results While the structure of meetings varied by center, the process was uniform and involved reviewing possible reasons for patient exclusion using primarily inductive reasoning. Stated justifications for excluding patients were a) too well, b) non-hepatic comorbidities or advanced age, c) too sick in the setting of advanced liver disease, d) substance abuse, or e) other psychosocial barriers. Dominant themes identified included members’ angst over deciding who lives and dies, a high correlation between psychosocial barriers to transplant and patients’ socioeconomic status, and the influence of external forces on decision making. Consistently identified barriers to effective group decision making were: 1) unwritten center policies, and 2) confusion regarding advocacy versus stewardship roles. Limitations The use of qualitative methods provides broad understanding but limits specific inferences. These four centers may not be reflective of every transplant center nationwide. Conclusion The difficult decisions made by these committees are reasonably consistent and always well-intentioned, but might be improved by more explicit written policies and clarifying roles. This process may help inform resource allocation in other areas of medicine. Primary funding source The Greenwall Foundation. PMID:22007044

A Revolution in the Making: Advances in Materials That May Transform Future Exploration Infrastructures and Missions

Science.gov (United States)

Harris, Charles E.; Dicus, Dennis L.; Shuart, Mark J.

2001-01-01

The NASA Strategic Plan identifies the long-term goal to provide safe and affordable space access, orbital transfer, and interplanetary transportation capabilities to enable research, human exploration, and the commercial development of space; and to conduct human and robotic missions to planets and other bodies in our solar system. Numerous scientific and engineering breakthroughs will be required to develop the technology necessary to achieve this goal. Critical technologies include advanced vehicle primary and secondary structure, radiation protection, propulsion and power systems, fuel storage, electronics and devices, sensors and science instruments, and medical diagnostics and treatment. Advanced materials with revolutionary new capabilities are an essential element of each of these technologies. This paper discusses those materials best suited for aerospace vehicle structure and highlights the enormous potential of one revolutionary new material, carbon nanotubes.

Decision-making: Theory and practice

Directory of Open Access Journals (Sweden)

SM Turpin

2004-12-01

Full Text Available This paper compares a number of theoretical models of decision-making with the way in which senior managers make decisions in practice. Six prominent decision-makers were interviewed about their own decision-making style, as well as their use of decision support technology. Significant variation was found in personal decision-making styles. However, some central themes emerged, such as the importance of sensitivity to the decision-making context, attention to the presentation of information, and the use of intuition. In terms of the use of decision support technology, the use of self-help tools, such as office software, was clearly favoured.

Cognitive correlates of performance in advanced mathematics.

Science.gov (United States)

Wei, Wei; Yuan, Hongbo; Chen, Chuansheng; Zhou, Xinlin

2012-03-01

Much research has been devoted to understanding cognitive correlates of elementary mathematics performance, but little such research has been done for advanced mathematics (e.g., modern algebra, statistics, and mathematical logic). To promote mathematical knowledge among college students, it is necessary to understand what factors (including cognitive factors) are important for acquiring advanced mathematics. We recruited 80 undergraduates from four universities in Beijing. The current study investigated the associations between students' performance on a test of advanced mathematics and a battery of 17 cognitive tasks on basic numerical processing, complex numerical processing, spatial abilities, language abilities, and general cognitive processing. The results showed that spatial abilities were significantly correlated with performance in advanced mathematics after controlling for other factors. In addition, certain language abilities (i.e., comprehension of words and sentences) also made unique contributions. In contrast, basic numerical processing and computation were generally not correlated with performance in advanced mathematics. Results suggest that spatial abilities and language comprehension, but not basic numerical processing, may play an important role in advanced mathematics. These results are discussed in terms of their theoretical significance and practical implications. ©2011 The British Psychological Society.

Impact significance determination-Back to basics

International Nuclear Information System (INIS)

Lawrence, David P.

2007-01-01

Impact significance determination is widely recognized as a vital and critical EIA activity. But impact significance related concepts are poorly understood. And the quality of approaches for impact significance determination in EIA practice remains highly variable. This article seeks to help establish a sound and practical conceptual foundation for formulating and evaluating impact significance determination approaches. It addresses the nature (what is impact significance?), the core characteristics (what are the major properties of significance determination?), the rationale (why are impact significance determinations necessary?), the procedural and substantive objectives (what do impact significance determinations seek to achieve?), and the process for making impact significance judgments (how is impact significance determination conducted?). By identifying fundamental attributes and key distinctions associated with impact significance determinations, a basis is provided for designing and evaluating impact significance determination procedures at both the regulatory and applied levels

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

Science.gov (United States)

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

2008-10-01

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

Exploring the Reshoring and Insourcing Decision Making Process

DEFF Research Database (Denmark)

Bals, Lydia; Kirchoff, Jon F.; Foerstl, Kai

2016-01-01

The topics of reshoring and insourcing have recently become more widely discussed among operations management and international business scholars and managers, as some firms are revoking their offshoring and outsourcing decisions. This research focuses on and clarifies the decision making process...... organizational readiness in addition to decision drivers, improve coverage of the implementation stage and explore further contingency factors such as technological advancement as well as to focus on decision makers as the unit of analysis.......The topics of reshoring and insourcing have recently become more widely discussed among operations management and international business scholars and managers, as some firms are revoking their offshoring and outsourcing decisions. This research focuses on and clarifies the decision making processes...

The advanced control board summary and adaptation of the emergency operation support system

International Nuclear Information System (INIS)

Yamada, Yusuke; Mashio, Kenji

2009-01-01

In an attempt to further improve both reliability and operability of Pressurized Water Reactors (PWRs), the advanced main control board and the Emergency Operation Support System (EOSS), which assists operators to monitor and make judgments during an emergency situation, have been developed. In this paper, the advanced control board summary and functions of the EOSS are described. (author)

Access to augmentative and alternative communication: new technologies and clinical decision-making.

Science.gov (United States)

Fager, Susan; Bardach, Lisa; Russell, Susanne; Higginbotham, Jeff

2012-01-01

Children with severe physical impairments require a variety of access options to augmentative and alternative communication (AAC) and computer technology. Access technologies have continued to develop, allowing children with severe motor control impairments greater independence and access to communication. This article will highlight new advances in access technology, including eye and head tracking, scanning, and access to mainstream technology, as well as discuss future advances. Considerations for clinical decision-making and implementation of these technologies will be presented along with case illustrations.

Multi-level decision making models, methods and applications

CERN Document Server

Zhang, Guangquan; Gao, Ya

2015-01-01

This monograph presents new developments in multi-level decision-making theory, technique and method in both modeling and solution issues. It especially presents how a decision support system can support managers in reaching a solution to a multi-level decision problem in practice. This monograph combines decision theories, methods, algorithms and applications effectively. It discusses in detail the models and solution algorithms of each issue of bi-level and tri-level decision-making, such as multi-leaders, multi-followers, multi-objectives, rule-set-based, and fuzzy parameters. Potential readers include organizational managers and practicing professionals, who can use the methods and software provided to solve their real decision problems; PhD students and researchers in the areas of bi-level and multi-level decision-making and decision support systems; students at an advanced undergraduate, master’s level in information systems, business administration, or the application of computer science.  

Le Fort I Maxillary Advancement Using Distraction Osteogenesis

OpenAIRE

Combs, Patrick D.; Harshbarger, Raymond J.

2014-01-01

Treatment of maxillary hypoplasia has traditionally involved conventional Le Fort I osteotomies and advancement. Advancements of greater than 10 mm risk significant relapse. This risk is greater in the cleft lip and palate population, whose anatomy and soft tissue scarring from prior procedures contributes to instability of conventional maxillary advancement. Le Fort I advancement with distraction osteogenesis has emerged as viable, stable treatment modality correction of severe maxillary hyp...

Designing an advanced available-to-promise mechanism compatible with the make-to-forecast production systems through integrating inventory allocation and job shop scheduling with due dates and weighted earliness/tardiness cost

Directory of Open Access Journals (Sweden)

Masoud Rabbani

2016-06-01

Full Text Available In the competitive business world, applying a reliable and powerful mechanism to support decision makers in manufacturing companies and helping them save time by considering varieties of effective factors is an inevitable issue. Advanced Available-to-Promise is a perfect tool to design and perform such a mechanism. In this study, this mechanism which is compatible with the Make-to-Forecast production systems is presented. The ability to distinguish between batch mode and real-time mode advanced available-to-promise is one of the unique superiorities of the proposed model. We also try to strengthen this mechanism by integrating the inventory allocation and job shop scheduling by considering due dates and weighted earliness/tardiness cost that leads to more precise decisions. A mixed integer programming (MIP model and a heuristic algorithm according to its disability to solve large size problems are presented. The designed experiments and the obtained results have proved the efficiency of the proposed heuristic method.

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

Science.gov (United States)

Stuart, Peter

2017-11-28

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

Advanced technology development reducing CO2 emissions

Energy Technology Data Exchange (ETDEWEB)

Kim, Dong Sup

2010-09-15

Responding to Korean government policies on green growth and global energy/ environmental challenges, SK energy has been developing new technologies to reduce CO2 emissions by 1) CO2 capture and utilization, 2) efficiency improvement, and 3) Li-ion batteries. The paper introduces three advanced technologies developed by SK energy; GreenPol, ACO, and Li-ion battery. Contributing to company vision, a more energy and less CO2, the three technologies are characterized as follows. GreenPol utilizes CO2 as a feedstock for making polymer. Advanced Catalytic Olefin (ACO) reduces CO2 emission by 20% and increase olefin production by 17%. Li-ion Batteries for automotive industries improves CO2 emission.

Preferences for Advance Directives in Korea

Directory of Open Access Journals (Sweden)

So-Sun Kim

2012-01-01

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

Freshman Students‟ Attitudes and Behavior towards Advanced Grammar and Composition Teaching

Directory of Open Access Journals (Sweden)

Romel M. Aceron

2015-11-01

Full Text Available Teaching English advanced grammar and composition to college students is important as it provides them with high level of understanding and competence in the language. It guides them in putting words together into sentences and makes them orally produce sounds clearly and effectively. This paper aims to determine the attitudes and behavior towards advanced grammar and composition teaching among freshman college students of Batangas State University. Descriptive method of research has been used to analyze and interpret data. The following instruments such as self-made questionnaire, focus group discussion, data analysis, interview guide, have been utilized to gather data. To analyze and interpret data, mean scores have been used. Pearson’s (r Product Moment Correlation Method has been utilized to treat the null hypothesis with regard to the attitudes and behavior of the students towards advanced grammar and composition teaching. Based on the findings of the study, the students sometimes understand and feel the subject matters, i.e., morphology, phonology, grammar and usage, and mechanics and composition writing. They are also sometimes ready in particular lesson and activity which are given to them in class. The study also reveals that there is no significant relationship between the students’ attitudes and behavior towards AGCT. In this regard, college students taking advanced grammar and composition course must be well-motivated to understand, and must have the readiness to perform the activities entail in the subject areas of morphology, phonology, grammar and usage, and mechanics and composition writing through teacher’s varied approaches, strategies, researches, and integration.

Advanced maternal age: ethical and medical considerations for assisted reproductive technology.

Science.gov (United States)

Harrison, Brittany J; Hilton, Tara N; Rivière, Raphaël N; Ferraro, Zachary M; Deonandan, Raywat; Walker, Mark C

2017-01-01

This review explores the ethical and medical challenges faced by women of advanced maternal age who decide to have children. Assisted reproductive technologies (ARTs) make post-menopausal pregnancy physiologically plausible, however, one must consider the associated physical, psychological, and sociological factors involved. A quasi-systematic review was conducted in PubMed and Ovid using the key terms post-menopause, pregnancy + MeSH terms [donations, hormone replacement therapy, assisted reproductive technologies, embryo donation, donor artificial insemination, cryopreservation]. Overall, 28 papers encompassing two major themes (ethical and medical) were included in the review. There are significant ethical considerations and medical (maternal and fetal) complications related to pregnancy in peri- and post-menopausal women. When examining the ethical and sociological perspective, the literature portrays an overall positive attitude toward pregnancy in advanced maternal age. With respect to the medical complications, the general consensus in the evaluated studies suggests that there is greater risk of complication for spontaneous pregnancy when the mother is older (eg, >35 years old). This risk can be mitigated by careful medical screening of the mother and the use of ARTs in healthy women. In these instances, a woman of advanced maternal age who is otherwise healthy can carry a pregnancy with a similar risk profile to that of her younger counterparts when using donated oocytes.

Analysis of Tax-deductible Interest Payments for Re-advanceable Canadian Mortgages

Science.gov (United States)

Naseem, Almas; Reesor, Mark

2011-11-01

According to Canadian tax law the interest on loans used for investment purposes is tax deductible while interest on personal mortgage loans is not. One way of transforming from non-tax deductible to tax deductible interest expenses is to borrow against home equity to make investments. A re-advanceable mortgage is a product specifically designed to take advantage of this tax discrepancy. Using simulation we study the risk associated with the re-advanceable mortgage strategy to provide a better description of the mortgagor's position. We assume that the mortgagor invests the borrowings secured by home equity into a single risky asset (e.g., stock or mutual fund) whose evolution is described by geometric Brownian motion (GBM). With a re-advanceable mortgage we find that the average mortgage payoff time is less than the original mortgage term. However, there is considerable variation in the payoff times with a significant probability of a payoff time exceeding the original mortgage term. Higher income homeowners enjoy a payoff time distribution with both a lower average and a lower standard deviation than low-income homeowners. Thus this strategy is most beneficial to those with the highest income. We also find this strategy protects the homeowner in the event of job loss. This work is important to lenders, financial planners and homeowners to more fully understand the benefits and risk associated with this strategy.

Intermingled Bodies. Distributed Agency in an Expanded Appreciation of Making

Directory of Open Access Journals (Sweden)

Terence E. Rosenberg

2013-09-01

Full Text Available This article offers an expanded view of making and, concomitantly, an understanding that through making we constitute the way we are in the world. The article begins with the idea that making produces a 'surrogate' of the body, which extends the body into the world, reforming the body and the world and their relationship. The ideas the article offers run counter to certain currents of thought that reduce making to a narrow cast anthropocentric crafting. Instead of this reduction, where making is merely understood and fixated as a close inembodied handicraft, the article advances: first, that all that we produce is making – not just that which is crafted by the immediacy of a hand; and, second, and linked to this expanded view of making, that all making workst hrough a distributed agency that includes human and non-human actors and actants in meshworks that extend across space – synchronous - and across time –diachronous. In other words, the body is extended into the world through what is made and this made world acts ineluctably on, and in, making. The paper references the practices of three makers to make the case for the need, bothethical and poetic, to think about making as an expanded term and to consideran intentionality of making that works through distributed agency doubly constituted as material and narrative.

The prognostic significance of parapharyngeal tumour involvement in nasopharyngeal carcinoma

International Nuclear Information System (INIS)

Teo, P.Y.; Lee, W.; Yu, P.

1996-01-01

From 1984 to 1989, 903 treatment-naive non-disseminated nasopharyngeal carcinomas (NPCs) were given primary radical radiotherapy. All patients had computed tomographic and endoscopic evaluation of the primary tumour. Potentially significant parameters were analysed by both univariate and multivariate methods for independent significance. In the whole group of patients, the male sex, skull base and cranial nerve(s) involvement, advanced Ho N-level, presence of fixed or partially fixed nodes and nodes contralateral to the side of the bulk of the nasopharyngeal primary, significantly determined survival and distant metastasis rates, whereas skull base and cranial nerve involvement, advanced age and male sex significantly worsened local control. However in the Ho T2No subgroup, parapharyngeal tumour involvement was the most significant prognosticator that determined distant metastasis and survival rates in the absence of the overriding prognosticators of skull base infiltration, cranial nerve(s) palsy, and cervical nodal metastasis. The local tumour control of the Ho T2No was adversely affected by the presence of oropharyngeal tumour extension. The administration of booster radiotherapy (20 Gy) after conventional radiotherapy (60-62.5 Gy) in tumours with parapharyngeal involvement has led to an improvement in local control, short of statistical significance

Advances in nanotechnologies. How they are creating better foods

NARCIS (Netherlands)

Kampers, F.W.H.

2010-01-01

Advances in nanoscale science and technologies offer opportunities to help solve some of the food and nutrition related problems the world faces. It can help make food production more sustainable and provide new protein rich products to the ever increasing world population. It will help people stay

Advancing ecological understandings through technological transformations in noninvasive genetics.

Science.gov (United States)

Beja-Pereira, Albano; Oliveira, Rita; Alves, Paulo C; Schwartz, Michael K; Luikart, Gordon

2009-09-01

Noninvasive genetic approaches continue to improve studies in molecular ecology, conservation genetics and related disciplines such as forensics and epidemiology. Noninvasive sampling allows genetic studies without disturbing or even seeing the target individuals. Although noninvasive genetic sampling has been used for wildlife studies since the 1990s, technological advances continue to make noninvasive approaches among the most used and rapidly advancing areas in genetics. Here, we review recent advances in noninvasive genetics and how they allow us to address important research and management questions thanks to improved techniques for DNA extraction, preservation, amplification and data analysis. We show that many advances come from the fields of forensics, human health and domestic animal health science, and suggest that molecular ecologists explore literature from these fields. Finally, we discuss how the combination of advances in each step of a noninvasive genetics study, along with fruitful areas for future research, will continually increase the power and role of noninvasive genetics in molecular ecology and conservation genetics. © 2009 Blackwell Publishing Ltd.

SPIRIT trial: A phase III pragmatic trial of an advance care planning intervention in ESRD.

Science.gov (United States)

Song, Mi-Kyung; Unruh, Mark L; Manatunga, Amita; Plantinga, Laura C; Lea, Janice; Jhamb, Manisha; Kshirsagar, Abhijit V; Ward, Sandra E

2018-01-01

Advance care planning (ACP) is a central tenet of dialysis care, but the vast majority of dialysis patients report never engaging in ACP discussions with their care providers. Over the last decade, we have developed and iteratively tested SPIRIT (Sharing Patient's Illness Representation to Increase Trust), a theory-based, patient- and family-centered advance care planning intervention. SPIRIT is a six-step, two-session, face-to-face intervention to promote cognitive and emotional preparation for end-of-life decision making for patients with ESRD and their surrogates. In these explanatory trials, SPIRIT was delivered by trained research nurses. Findings consistently revealed that patients and surrogates in SPIRIT showed significant improvement in preparedness for end-of-life decision making, and surrogates in SPIRIT reported significantly improved post-bereavement psychological outcomes after the patient's death compared to a no treatment comparison condition. As a critical next step, we are conducting an effectiveness-implementation study. This study is a multicenter, clinic-level cluster randomized pragmatic trial to evaluate the effectiveness of SPIRIT delivered by dialysis care providers as part of routine care in free-standing outpatient dialysis clinics, compared to usual care plus delayed SPIRIT implementation. Simultaneously, we will evaluate the implementation of SPIRIT, including sustainability. We will recruit 400 dyads of patients at high risk of death in the next year and their surrogates from 30 dialysis clinics in four states. This trial of SPIRIT will generate novel, meaningful insights about improving ACP in dialysis care. ClinicalTrials.govNCT03138564, registered 05/01/2017. Copyright © 2017 Elsevier Inc. All rights reserved.

Research on self-esteem in decision-making and decision-making styles in orienteering athletes

Directory of Open Access Journals (Sweden)

Eroğlu Başak

2016-01-01

Full Text Available The aim of this study is to examine the self-esteem in decision making and decision-making styles of orienteering athletes in terms of different variables. 157 male and 43 female orienteering athletes, making a total of 200 athletes that joined the 3rd Level of Turkey Championship in 2015 have participated in this study which is in a survey model. The data collection tools were the Melbourne Decision-making. Quastionnaire I-II and the Personal Information Form which were adapted into Turkish by Deniz (2004. In the data analysis, descriptive statics, anova, t test and Tukey test have been utilized. There is a significant difference between athletes’ marital status, age groups, experiences in orienteering sports and self-esteem in decision making, decision making styles (p<0.05. According to the research results, it has been determined that married orienteering athletes prefer both self-esteem in decision making and vigilance decision-making style more often than the single athletes that mostly prefer procrastination decision-making style. Also, it has been found out that as the athletes’ age and experiences in sports increase, selfesteem and decision-making styles are affected more positively as well.

Projected role of advanced computational aerodynamic methods at the Lockheed-Georgia company

Science.gov (United States)

Lores, M. E.

1978-01-01

Experience with advanced computational methods being used at the Lockheed-Georgia Company to aid in the evaluation and design of new and modified aircraft indicates that large and specialized computers will be needed to make advanced three-dimensional viscous aerodynamic computations practical. The Numerical Aerodynamic Simulation Facility should be used to provide a tool for designing better aerospace vehicles while at the same time reducing development costs by performing computations using Navier-Stokes equations solution algorithms and permitting less sophisticated but nevertheless complex calculations to be made efficiently. Configuration definition procedures and data output formats can probably best be defined in cooperation with industry, therefore, the computer should handle many remote terminals efficiently. The capability of transferring data to and from other computers needs to be provided. Because of the significant amount of input and output associated with 3-D viscous flow calculations and because of the exceedingly fast computation speed envisioned for the computer, special attention should be paid to providing rapid, diversified, and efficient input and output.

Advanced Geothermal Turbodrill

Energy Technology Data Exchange (ETDEWEB)

W. C. Maurer

2000-05-01

Approximately 50% of the cost of a new geothermal power plant is in the wells that must be drilled. Compared to the majority of oil and gas wells, geothermal wells are more difficult and costly to drill for several reasons. First, most U.S. geothermal resources consist of hot, hard crystalline rock formations which drill much slower than the relatively soft sedimentary formations associated with most oil and gas production. Second, high downhole temperatures can greatly shorten equipment life or preclude the use of some technologies altogether. Third, producing viable levels of electricity from geothermal fields requires the use of large diameter bores and a high degree of fluid communication, both of which increase drilling and completion costs. Optimizing fluid communication often requires creation of a directional well to intersect the best and largest number of fracture capable of producing hot geothermal fluids. Moineau motor stators made with elastomers cannot operate at geothermal temperatures, so they are limited to the upper portion of the hole. To overcome these limitations, Maurer Engineering Inc. (MEI) has developed a turbodrill that does not use elastomers and therefore can operate at geothermal temperatures. This new turbodrill uses a special gear assembly to reduce the output speed, thus allowing a larger range of bit types, especially tri-cone roller bits, which are the bits of choice for drilling hard crystalline formations. The Advanced Geothermal Turbodrill (AGT) represents a significant improvement for drilling geothermal wells and has the potential to significantly reduce drilling costs while increasing production, thereby making geothermal energy less expensive and better able to compete with fossil fuels. The final field test of the AGT will prepare the tool for successful commercialization.

Strategic analytics: towards fully embedding evidence in healthcare decision-making.

Science.gov (United States)

Garay, Jason; Cartagena, Rosario; Esensoy, Ali Vahit; Handa, Kiren; Kane, Eli; Kaw, Neal; Sadat, Somayeh

2015-01-01

Cancer Care Ontario (CCO) has implemented multiple information technology solutions and collected health-system data to support its programs. There is now an opportunity to leverage these data and perform advanced end-to-end analytics that inform decisions around improving health-system performance. In 2014, CCO engaged in an extensive assessment of its current data capacity and capability, with the intent to drive increased use of data for evidence-based decision-making. The breadth and volume of data at CCO uniquely places the organization to contribute to not only system-wide operational reporting, but more advanced modelling of current and future state system management and planning. In 2012, CCO established a strategic analytics practice to assist the agency's programs contextualize and inform key business decisions and to provide support through innovative predictive analytics solutions. This paper describes the organizational structure, services and supporting operations that have enabled progress to date, and discusses the next steps towards the vision of embedding evidence fully into healthcare decision-making. Copyright © 2014 Longwoods Publishing.

Advances in Numerical Methods

CERN Document Server

Mastorakis, Nikos E

2009-01-01

Features contributions that are focused on significant aspects of current numerical methods and computational mathematics. This book carries chapters that advanced methods and various variations on known techniques that can solve difficult scientific problems efficiently.

Use of Advanced Solar Cells for Commercial Communication Satellites

Science.gov (United States)

Bailey, Sheila G.; Landis, Geoffrey A.

1995-01-01

The current generation of communications satellites are located primarily in geosynchronous Earth orbit (GEO). Over the next decade, however, a new generation of communications satellites will be built and launched, designed to provide a world-wide interconnection of portable telephones. For this mission, the satellites must be positioned in lower polar and near-polar orbits. To provide complete coverage, large numbers of satellites will be required. Because the required number of satellites decreases as the orbital altitude is increased, fewer satellites would be required if the orbit chosen were raised from low to intermediate orbit. However, in intermediate orbits, satellites encounter significant radiation due to trapped electrons and protons. Radiation tolerant solar cells may be necessary to make such satellites feasible. We analyze the amount of radiation encountered in low and intermediate polar orbits at altitudes of interest to next-generation communication satellites, calculate the expected degradation for silicon, GaAs, and InP solar cells, and show that the lifetimes can be significantly increased by use of advanced solar cells.

Recent advances in insertion devices

International Nuclear Information System (INIS)

Gluskin, E.; Moog, E.R.

1995-01-01

Demand for more and better insertion devices (IDs) at new third-generation synchrotron radiation facilities has led to significant advances in ID technology at different laboratories around the world. In this overview of this progress, focus is on those results that apply to IDs in general rather than one specific ID or laboratory. The advances fall into two general categories: those that reduce the net effect that the ID has on the particle beam, and those that enhance the quality of the emitted light spectrum. The need for these advances, factors that are most important inaachieving them, and the current state of the art are discussed

Career Decision-Making Processes of Young Adults With First-Episode Psychosis.

Science.gov (United States)

Boychuk, Christa; Lysaght, Rosemary; Stuart, Heather

2018-05-01

The first episode of psychosis often emerges during young adulthood, when individuals are pursuing important educational and career goals that can become derailed because of the development of major impairments. Past research has neglected the developmental nature of employment and education decisions that young adults with first-episode psychosis make within the context of their lives. The purpose of this grounded theory study was to advance a model of the career decision-making processes of young adults with first-episode psychosis, and the influences that affect their career decision-making. The career decision-making of young adults with first-episode psychosis emerged as a multistaged, iterative process that unfolded over three phases of illness, and was affected by several internal and environmental influences. These findings suggest the phase of illness and career decision-making stage should be considered in future vocational programming for young adults with first-episode psychosis.

Molecular basis of structural make-up of feeds in relation to nutrient absorption in ruminants, revealed with advanced molecular spectroscopy: A review on techniques and models

Energy Technology Data Exchange (ETDEWEB)

Rahman, Md. Mostafizar [Department of Animal and Poultry Science, University of Saskatchewan, Saskatoon, Saskatchewan, Canada; Yu, Peiqiang [Department of Animal and Poultry Science, University of Saskatchewan, Saskatoon, Saskatchewan, Canada

2017-01-31

Progress in ruminant feed research is no more feasible only based on wet chemical analysis, which is merely able to provide information on chemical composition of feeds regardless of their digestive features and nutritive value in ruminants. Studying internal structural make-up of functional groups/feed nutrients is often vital for understanding the digestive behaviors and nutritive values of feeds in ruminant because the intrinsic structure of feed nutrients is more related to its overall absorption. In this article, the detail information on the recent developments in molecular spectroscopic techniques to reveal microstructural information of feed nutrients and the use of nutrition models in regards to ruminant feed research was reviewed. The emphasis of this review was on (1) the technological progress in the use of molecular spectroscopic techniques in ruminant feed research; (2) revealing spectral analysis of functional groups of biomolecules/feed nutrients; (3) the use of advanced nutrition models for better prediction of nutrient availability in ruminant systems; and (4) the application of these molecular techniques and combination of nutrient models in cereals, co-products and pulse crop research. The information described in this article will promote better insight in the progress of research on molecular structural make-up of feed nutrients in ruminants.

Advances in cervical screening technology.

Science.gov (United States)

Stoler, M H

2000-03-01

The Pap smear unquestionably is a successful screening test for cervical cancer. However, recent advances in technology have raised questions regarding whether the conventional Pap smear is still the standard of care. This article relates issues of screening and cost-effectiveness to the state of the art in thin layer preparations, cytology automation, human papillomavirus screening, human papillomavirus vaccines, and other cervical screening adjuncts. Perhaps nowhere in medicine is clinical decision making being more strongly influenced by market and other external forces than in cervical cytopathology.

PET/CT: underlying physics, instrumentation, and advances.

Science.gov (United States)

Torres Espallardo, I

Since it was first introduced, the main goal of PET/CT has been to provide both PET and CT images with high clinical quality and to present them to radiologists and specialists in nuclear medicine as a fused, perfectly aligned image. The use of fused PET and CT images quickly became routine in clinical practice, showing the great potential of these hybrid scanners. Thanks to this success, manufacturers have gone beyond considering CT as a mere attenuation corrector for PET, concentrating instead on design high performance PET and CT scanners with more interesting features. Since the first commercial PET/CT scanner became available in 2001, both the PET component and the CT component have improved immensely. In the case of PET, faster scintillation crystals with high stopping power such as LYSO crystals have enabled more sensitive devices to be built, making it possible to reduce the number of undesired coincidence events and to use time of flight (TOF) techniques. All these advances have improved lesion detection, especially in situations with very noisy backgrounds. Iterative reconstruction methods, together with the corrections carried out during the reconstruction and the use of the point-spread function, have improved image quality. In parallel, CT instrumentation has also improved significantly, and 64- and 128-row detectors have been incorporated into the most modern PET/CT scanners. This makes it possible to obtain high quality diagnostic anatomic images in a few seconds that both enable the correction of PET attenuation and provide information for diagnosis. Furthermore, nowadays nearly all PET/CT scanners have a system that modulates the dose of radiation that the patient is exposed to in the CT study in function of the region scanned. This article reviews the underlying physics of PET and CT imaging separately, describes the changes in the instrumentation and standard protocols in a combined PET/CT system, and finally points out the most important

Insertion devices at the advanced photon source

International Nuclear Information System (INIS)

Moog, E.R.

1996-01-01

The insertion devices being installed at the Advanced Photon Source cause the stored particle beam to wiggle, emitting x-rays with each wiggle. These x-rays combine to make an intense beam of radiation. Both wiggler and undulator types of insertion devices are being installed; the characteristics of the radiation produced by these two types of insertion devices are discussed, along with the reasons for those characteristics

When Organizational Identification Elicits Moral Decision-Making: A Matter of the Right Climate

NARCIS (Netherlands)

S. van Gils (Suzanne); M.A. Hogg (Michael A.); N. van Quaquebeke (Niels); D.L. van Knippenberg (Daan)

2017-01-01

textabstractTo advance current knowledge on ethical decision-making in organizations, we integrate two perspectives that have thus far developed independently: the organizational identification perspective and the ethical climate perspective. We illustrate the interaction between these perspectives

Prognostic Significance of Modified Advanced Lung Cancer Inflammation Index (ALI in Patients with Small Cell Lung Cancer_ Comparison with Original ALI.

Directory of Open Access Journals (Sweden)

Eun Young Kim

Full Text Available Advanced lung cancer inflammation index (ALI, body mass index [BMI] x serum albumin/neutrophil-lymphocyte ratio [NLR] has been shown to predict overall survival (OS in small cell lung cancer (SCLC. CT enables skeletal muscle to be quantified, whereas BMI cannot accurately reflect body composition. The purpose was to evaluate prognostic value of modified ALI (mALI using CT-determined L3 muscle index (L3MI, muscle area at L3/height2 beyond original ALI.L3MIs were calculated using the CT images of 186 consecutive patients with SCLC taken at diagnosis, and mALI was defined as L3MI x serum albumin/NLR. Using chi-squared test determined maximum cut-offs for low ALI and low mALI, the prognostic values of low ALI and low mALI were tested using Kaplan-Meier method and Cox proportional hazards analysis. Finally, deviance statistics was used to test whether the goodness of fit of the prognostic model is improved by adding mALI as an extra variable.Patients with low ALI (cut-off, 31.1, n = 94 had shorter OS than patients with high ALI (median, 6.8 months vs. 15.8 months; p < 0.001, and patients with low mALI (cut-off 67.7, n = 94 had shorter OS than patients with high mALI (median, 6.8 months vs. 16.5 months; p < 0.001. There was no significant difference in estimates of median survival time between low ALI and low mALI (z = 0.000, p = 1.000 and between high ALI and high mALI (z = 0.330, p = 0.740. Multivariable analysis showed that low ALI was an independent prognostic factor for shorter OS (HR, 1.67, p = 0.004, along with advanced age (HR, 1.49, p = 0.045, extensive disease (HR, 2.27, p < 0.001, supportive care only (HR, 7.86, p < 0.001, and elevated LDH (HR, 1.45, p = 0.037. Furthermore, goodness of fit of this prognostic model was not significantly increased by adding mALI as an extra variable (LR difference = 2.220, p = 0.136.The present study confirms mALI using CT-determined L3MI has no additional prognostic value beyond original ALI using BMI. ALI

Career Advancement and Work Support Services on the Job: Implementing the Fort Worth Work Advancement and Support Center Program. Executive Summary

Science.gov (United States)

Schultz, Caroline; Seith, David

2011-01-01

The Work Advancement and Support Center (WASC) program in Fort Worth was part of a demonstration that is testing innovative strategies to help increase the income of low-wage workers, who make up a large segment of the U.S. workforce. The program offered services to help workers stabilize their employment, improve their skills, and increase their…

Making It Real: Using a Collaborative Simulation to Teach Crisis Communications

Science.gov (United States)

Olson, K. S.

2012-01-01

Even seasoned public relations (PR) practitioners can find it difficult to handle communications during a crisis situation when the consequences of making poor decisions may seem overwhelming. This article shares results from using a collaborative simulation to teach college students about crisis communications in an advanced-level PR course.…

Women workers and the politics of claims-making in a globalizing economy

OpenAIRE

Kabeer, Naila

2015-01-01

The paper analyses the evolving politics of claims-making by women workers in the Global South in the context of a globalized economy. It addresses the following questions. What kinds of claims are prioritized in relation to women workers? Who is making these claims? To whom are they addressed? What strategies are pursued to advance these claims? Which claims are heard and acted on - and which go unheard? The paper considers three categories of women workers: those working in global value cha...

Linear induction accelerator approach for advanced radiography

International Nuclear Information System (INIS)

Caporaso, G.J.

1997-05-01

Recent advances in induction accelerator technology make it possible to envision a single accelerator that can serve as an intense, precision multiple pulse x-ray source for advanced radiography. Through the use of solid-state modulator technology repetition rates on the order of 1 MHz can be achieved with beam pulse lengths ranging from 200 ns to 2 microsecs. By using fast kickers, these pulses may be sectioned into pieces which are directed to different beam lines so as to interrogate the object under study from multiple lines of sight. The ultimate aim is to do a time dependent tomographic reconstruction of a dynamic object. The technology to accomplish these objectives along with a brief discussion of the experimental plans to verify it will be presented

The impact of data integrity on decision making in early lead discovery

Science.gov (United States)

Beck, Bernd; Seeliger, Daniel; Kriegl, Jan M.

2015-09-01

Data driven decision making is a key element of today's pharmaceutical research, including early drug discovery. It comprises questions like which target to pursue, which chemical series to pursue, which compound to make next, or which compound to select for advanced profiling and promotion to pre-clinical development. In the following paper we will exemplify how data integrity, i.e. the context data is generated in and auxiliary information that is provided for individual result records, can influence decision making in early lead discovery programs. In addition we will describe some approaches which we pursue at Boehringer Ingelheim to reduce the risk for getting misguided.

A study on improving international political and diplomatic acceptability of advanced nuclear fuel cycle for Korea

International Nuclear Information System (INIS)

Lee, Joeng Hoon

2011-03-01

In order to establish an advanced nuclear fuel cycle program for Korea, U.S. support and trust are imperative. In the midst of the negotiations for the renewal of the U.S.-South Korea agreement on peaceful nuclear cooperation, the two obvious components of an advanced nuclear fuel cycle - enrichment and reprocessing - have surfaced as major issues. Despite the United States' firm commitment to nonproliferation, South Korea is in dire need to advance its nuclear fuel cycle proportionate to its now significant nuclear energy program. This research project's objective is to put the U.S.-South Korea Nuclear Agreement into proper alliance perspective. The military alliance between the two countries have weathered decades of trials and tribulations. It is one of the most staunch alliances in existence in global politics. As such, the negotiations for the nuclear agreement must be dealt with in the context of the broader alliance relations, not to be lost in the technicalities of the nonproliferation arguments. But even so, South Korea's track record is far better than some of the states the United States has recently granted a most lenient nuclear agreement - India being a case in point. Fairness issue also surfaces when it comes to the agreement the United States has concluded with Japan. As an equally if not more important ally in Asia, South Korea must be permitted to make significant advancements in either enrichment or reprocessing procedures. This project argues that this is the appropriate direction given the history of the two nations' alliance relations. In the final analysis, this research puts forward the argument that the matter that should count the most is not the question of whether South Korea will proliferate or not, but rather whether the United States trusts its battle-tested ally, enough to help develop a peaceful and efficient advanced nuclear fuel cycle program in South Korea

Making the clean available: Escaping India’s Chulha Trap

International Nuclear Information System (INIS)

Smith, Kirk R.; Sagar, Ambuj

2014-01-01

Solid cookfuel pollution is the largest energy-related health risk globally and most important cause of ill-health for Indian women and girls. At 700 million cooking with open biomass chulhas, the Indian population exposed has not changed in several decades, in spite of hundreds of programs to make the “available clean”, i.e. to burn biomass cleanly in advanced stoves. While such efforts continue, there is need to open up another front to attack this health hazard. Gas and electric cooking, which are clean at the household, are already the choice for one-third of Indians. Needed is a new agenda to make the “clean available”, i.e., to vigorously extend these clean fuels into populations that are caught in the Chulha Trap. This will require engaging new actors including the power and petroleum ministries as well as the ministry of health, which have not to date been directly engaged in addressing this problem. It will have implications for LPG imports, distribution networks, and electric and gas user technologies, as well as setting new priorities for electrification and biofuels, but at heart needs to be addressed as a health problem, not one of energy access, if it is to be solved effectively. - Highlights: • Pollution from cooking with solid fuels is largest health hazard for Indian women and girls. • 700 million Indians are caught in a trap using solid fuels with little change in number exposed for decades. • Efforts to make the biomass fuel clean through advanced stoves have made only modest progress in decades. • A major new effort is needed to make the clean available, in the form of gas and electricity. • This will require forging new partnerships and rethinking how these fuels are currently promoted

Specification of advanced safety modeling requirements (Rev. 0).

Energy Technology Data Exchange (ETDEWEB)

Fanning, T. H.; Tautges, T. J.

2008-06-30

The U.S. Department of Energy's Global Nuclear Energy Partnership has lead to renewed interest in liquid-metal-cooled fast reactors for the purpose of closing the nuclear fuel cycle and making more efficient use of future repository capacity. However, the U.S. has not designed or constructed a fast reactor in nearly 30 years. Accurate, high-fidelity, whole-plant dynamics safety simulations will play a crucial role by providing confidence that component and system designs will satisfy established design limits and safety margins under a wide variety of operational, design basis, and beyond design basis transient conditions. Current modeling capabilities for fast reactor safety analyses have resulted from several hundred person-years of code development effort supported by experimental validation. The broad spectrum of mechanistic and phenomenological models that have been developed represent an enormous amount of institutional knowledge that needs to be maintained. Complicating this, the existing code architectures for safety modeling evolved from programming practices of the 1970s. This has lead to monolithic applications with interdependent data models which require significant knowledge of the complexities of the entire code in order for each component to be maintained. In order to develop an advanced fast reactor safety modeling capability, the limitations of the existing code architecture must be overcome while preserving the capabilities that already exist. To accomplish this, a set of advanced safety modeling requirements is defined, based on modern programming practices, that focuses on modular development within a flexible coupling framework. An approach for integrating the existing capabilities of the SAS4A/SASSYS-1 fast reactor safety analysis code into the SHARP framework is provided in order to preserve existing capabilities while providing a smooth transition to advanced modeling capabilities. In doing this, the advanced fast reactor safety models

Specification of advanced safety modeling requirements (Rev. 0)

International Nuclear Information System (INIS)

Fanning, T. H.; Tautges, T. J.

2008-01-01

The U.S. Department of Energy's Global Nuclear Energy Partnership has lead to renewed interest in liquid-metal-cooled fast reactors for the purpose of closing the nuclear fuel cycle and making more efficient use of future repository capacity. However, the U.S. has not designed or constructed a fast reactor in nearly 30 years. Accurate, high-fidelity, whole-plant dynamics safety simulations will play a crucial role by providing confidence that component and system designs will satisfy established design limits and safety margins under a wide variety of operational, design basis, and beyond design basis transient conditions. Current modeling capabilities for fast reactor safety analyses have resulted from several hundred person-years of code development effort supported by experimental validation. The broad spectrum of mechanistic and phenomenological models that have been developed represent an enormous amount of institutional knowledge that needs to be maintained. Complicating this, the existing code architectures for safety modeling evolved from programming practices of the 1970s. This has lead to monolithic applications with interdependent data models which require significant knowledge of the complexities of the entire code in order for each component to be maintained. In order to develop an advanced fast reactor safety modeling capability, the limitations of the existing code architecture must be overcome while preserving the capabilities that already exist. To accomplish this, a set of advanced safety modeling requirements is defined, based on modern programming practices, that focuses on modular development within a flexible coupling framework. An approach for integrating the existing capabilities of the SAS4A/SASSYS-1 fast reactor safety analysis code into the SHARP framework is provided in order to preserve existing capabilities while providing a smooth transition to advanced modeling capabilities. In doing this, the advanced fast reactor safety models will

Advanced Engineering Environments: Implications for Aerospace Manufacturing

Science.gov (United States)

Thomas, D.

2001-01-01

There are significant challenges facing today's aerospace industry. Global competition, more complex products, geographically-distributed design teams, demands for lower cost, higher reliability and safer vehicles, and the need to incorporate the latest technologies quicker all face the developer of aerospace systems. New information technologies offer promising opportunities to develop advanced engineering environments (AEEs) to meet these challenges. Significant advances in the state-of-the-art of aerospace engineering practice are envisioned in the areas of engineering design and analytical tools, cost and risk tools, collaborative engineering, and high-fidelity simulations early in the development cycle. These advances will enable modeling and simulation of manufacturing methods, which will in turn allow manufacturing considerations to be included much earlier in the system development cycle. Significant cost savings, increased quality, and decreased manufacturing cycle time are expected to result. This paper will give an overview of the NASA's Intelligent Synthesis Environment, the agency initiative to develop an AEE, with a focus on the anticipated benefits in aerospace manufacturing.

Improving efficiency of decision making units through BSC-DEA technique

Directory of Open Access Journals (Sweden)

Amir Reza Khaki

2012-01-01

Full Text Available Performance evaluation is one of the most important techniques to prioritize different decision making units. Data envelopment analysis (DEA, as a non-parametric method, plays an important role for measuring relative efficiency. Balanced score card, on the other hand, is another method to evaluate a business plan based on non-financial perspectives. The integrated BSC-DEA takes advantage of the advantages of both methods' features. In this paper, we propose a BSC-DEA method to rank different decision making units. We consider different financial criteria such as profit-margin, return on assets along with non-financial criteria such as customer satisfaction, advanced services, employee skills to compare the performance of different banks. The results are analyzed and discussed, which could be used for making better decisions.

Resent advance in electron linear accelerators

International Nuclear Information System (INIS)

Takeda, Seishi; Tsumori, Kunihiko; Takamuku, Setsuo; Okada, Toichi; Hayashi, Koichiro; Kawanishi, Masaharu

1986-01-01

In recently constructed electron linear accelerators, there has been remarkable advance both in acceleration of a high-current single bunch electron beam for radiation research and in generation of high accelerating gradient for high energy accelerators. The ISIR single bunch electron linear accelerator has been modified an injector to increase a high-current single bunch charge up to 67 nC, which is ten times greater than the single bunch charge expected in early stage of construction. The linear collider projects require a high accelerating gradient of the order of 100 MeV/m in the linear accelerators. High-current and high-gradient linear accelerators make it possible to obtain high-energy electron beam with small-scale linear accelerators. The advance in linear accelerators stimulates the applications of linear accelerators not only to fundamental research of science but also to industrial uses. (author)

Recent Advancements in Semiconductor-based Optical Signal Processing

DEFF Research Database (Denmark)

Nielsen, M L; Mørk, Jesper

2006-01-01

Significant advancements in technology and basic understanding of device physics are bringing optical signal processing closer to a commercial breakthrough. In this paper we describe the main challenges in high-speed SOA-based switching.......Significant advancements in technology and basic understanding of device physics are bringing optical signal processing closer to a commercial breakthrough. In this paper we describe the main challenges in high-speed SOA-based switching....

Use of a Shared Mental Model by a Team Composed of Oncology, Palliative Care, and Supportive Care Clinicians to Facilitate Shared Decision Making in a Patient With Advanced Cancer.

Science.gov (United States)

D'Ambruoso, Sarah F; Coscarelli, Anne; Hurvitz, Sara; Wenger, Neil; Coniglio, David; Donaldson, Dusty; Pietras, Christopher; Walling, Anne M

2016-11-01

Our case describes the efforts of team members drawn from oncology, palliative care, supportive care, and primary care to assist a woman with advanced cancer in accepting care for her psychosocial distress, integrating prognostic information so that she could share in decisions about treatment planning, involving family in her care, and ultimately transitioning to hospice. Team members in our setting included a medical oncologist, oncology nurse practitioner, palliative care nurse practitioner, oncology social worker, and primary care physician. The core members were the patient and her sister. Our team grew organically as a result of patient need and, in doing so, operationalized an explicitly shared understanding of care priorities. We refer to this shared understanding as a shared mental model for care delivery, which enabled our team to jointly set priorities for care through a series of warm handoffs enabled by the team's close proximity within the same clinic. When care providers outside our integrated team became involved in the case, significant communication gaps exposed the difficulty in extending our shared mental model outside the integrated team framework, leading to inefficiencies in care. Integration of this shared understanding for care and close proximity of team members proved to be key components in facilitating treatment of our patient's burdensome cancer-related distress so that she could more effectively participate in treatment decision making that reflected her goals of care.

How to make a cost-efficient and reliable diagnosis in equine dermatology?

NARCIS (Netherlands)

Sloet van Oldruitenborgh-Oosterbaan, M.M.

2012-01-01

To make a diagnosis in skin disease it is important to establish the signalment of the patient and to obtain an comprehensive anamnesis (history). Many skin conditions are presented initially at an advanced stage and many have had some (or more) attempts at treatment. A thorough

Advanced computers and simulation

International Nuclear Information System (INIS)

Ryne, R.D.

1993-01-01

Accelerator physicists today have access to computers that are far more powerful than those available just 10 years ago. In the early 1980's, desktop workstations performed less one million floating point operations per second (Mflops), and the realized performance of vector supercomputers was at best a few hundred Mflops. Today vector processing is available on the desktop, providing researchers with performance approaching 100 Mflops at a price that is measured in thousands of dollars. Furthermore, advances in Massively Parallel Processors (MPP) have made performance of over 10 gigaflops a reality, and around mid-decade MPPs are expected to be capable of teraflops performance. Along with advances in MPP hardware, researchers have also made significant progress in developing algorithms and software for MPPS. These changes have had, and will continue to have, a significant impact on the work of computational accelerator physicists. Now, instead of running particle simulations with just a few thousand particles, we can perform desktop simulations with tens of thousands of simulation particles, and calculations with well over 1 million particles are being performed on MPPs. In the area of computational electromagnetics, simulations that used to be performed only on vector supercomputers now run in several hours on desktop workstations, and researchers are hoping to perform simulations with over one billion mesh points on future MPPs. In this paper we will discuss the latest advances, and what can be expected in the near future, in hardware, software and applications codes for advanced simulation of particle accelerators

Using the Situated Clinical Decision-Making framework to guide analysis of nurses' clinical decision-making.

Science.gov (United States)

Gillespie, Mary

2010-11-01

Nurses' clinical decision-making is a complex process that holds potential to influence the quality of care provided and patient outcomes. The evolution of nurses' decision-making that occurs with experience has been well documented. In addition, literature includes numerous strategies and approaches purported to support development of nurses' clinical decision-making. There has been, however, significantly less attention given to the process of assessing nurses' clinical decision-making and novice clinical educators are often challenged with knowing how to best support nurses and nursing students in developing their clinical decision-making capacity. The Situated Clinical Decision-Making framework is presented for use by clinical educators: it provides a structured approach to analyzing nursing students' and novice nurses' decision-making in clinical nursing practice, assists educators in identifying specific issues within nurses' clinical decision-making, and guides selection of relevant strategies to support development of clinical decision-making. A series of questions is offered as a guide for clinical educators when assessing nurses' clinical decision-making. The discussion presents key considerations related to analysis of various decision-making components, including common sources of challenge and errors that may occur within nurses' clinical decision-making. An exemplar illustrates use of the framework and guiding questions. Implications of this approach for selection of strategies that support development of clinical decision-making are highlighted. Copyright © 2010 Elsevier Ltd. All rights reserved.

Advanced Technology Training Program for the Apparel Industry. Final Report.

Science.gov (United States)

El Paso Community Coll., TX.

A project developed rapid response, advanced technology courses that met the apparel market labor needs of the El Paso (Texas) community. Courses were designed for four options: computerized marker making and pattern grading, computerized front office systems, high technology machinery operation, and high technology machinery mechanics. The…

Barriers to Advance Care Planning in End-Stage Renal Disease: Who is to Blame, and What Can be Done?

Science.gov (United States)

Kelley, Alan Taylor; Turner, Jeffrey; Doolittle, Benjamin

2018-07-01

Patients with end-stage renal disease experience significant mortality and morbidity, including cognitive decline. Advance care planning has been emphasized as a responsibility and priority of physicians caring for patients with chronic kidney disease in order to align with patient values before decision-making capacity is lost and to avoid suffering. This emphasis has proven ineffective, as illustrated in the case of a patient treated in our hospital. Is this ineffectiveness a consequence of failure in the courtroom or the clinic? Through our own experience we affirm what has been written before: that legal precedent favors intensive treatment in virtually all cases without 'clear and convincing evidence' of a patient's previously declared wishes to the contrary. Equally clear is that more than 20 years of support in the clinical literature suggesting advance care planning early in the course of disease can address challenges in the legal system for those lacking capacity. However, many physicians fail to recognize the need for advance care planning in a timely manner and lack the necessary training to provide it. The need for more training and new tools to recognize opportunities for advance care planning in daily practice remains unmet.

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

Science.gov (United States)

Shewchuk, T R

1998-09-01

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

Prevalence and clinical significance of cancer cachexia based on time from treatment in advanced-stage head and neck squamous cell carcinoma.

Science.gov (United States)

Kwon, Minsu; Kim, Rock Bum; Roh, Jong-Lyel; Lee, Sang-Wook; Kim, Sung-Bae; Choi, Seung-Ho; Nam, Soon Yuhl; Kim, Sang Yoon

2017-04-01

The purpose of this study was to identify the prevalence of cancer cachexia and its prognostic impact in patients with advanced head and neck squamous cell carcinoma (HNSCC). The prevalence of cancer cachexia was analyzed according to the follow-up periods during the first year after curative initial treatment. Recurrences, noncancer health events (NCHEs), and cause-specific survival outcomes were also analyzed according to the incidence of cancer cachexia during follow-up. Cancer cachexia was identified in 22 (6.1%), 148 (41%), 66 (18.4%), and 65 (18.7%) of 361 enrolled patients at pretreatment, immediately after treatment, 6-months after treatment, and 12-months after treatment, respectively. Sustained or newly developed cachexia at 6 and 12 months showed a significant association with recurrence and NCHE occurrence (p cachexia had a higher probability of cancer-specific death, noncancerous death, and overall death (p Cachexia prevalence at 6 and 12 months after treatment for HNSCC indicates a higher chance of recurrence, NCHE, and death. © 2016 Wiley Periodicals, Inc. Head Neck 39: 716-723, 2017. © 2016 Wiley Periodicals, Inc.

Metrology aspects of SIMS depth profiling for advanced ULSI processes

International Nuclear Information System (INIS)

Budrevich, Andre; Hunter, Jerry

1998-01-01

As the semiconductor industry roadmap passes through the 0.1 μm technology node, the junction depth of the transistor source/drain extension will be required to be less than 20 nm and the well doping will be near 1.0 μm in depth. The development of advanced ULSI processing techniques requires the evolution of new metrology tools to ensure process capability. High sensitivity (ppb) coupled with excellent depth resolution (1 nm) makes SIMS the technique of choice for measuring the in-depth chemical distribution of these dopants with high precision and accuracy. This paper will discuss the issues, which impact the accuracy and precision of SIMS measurements of ion implants (both shallow and deep). First this paper will discuss common uses of the SIMS technique in the technology development and manufacturing of advanced ULSI processes. In the second part of this paper the ability of SIMS to make high precision measurements of ion implant depth profiles will be studied

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

Science.gov (United States)

1995-06-27

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

Adult Neurogenesis in the Mammalian Brain: Significant Answers and Significant Questions

Science.gov (United States)

Ming, Guo-li; Song, Hongjun

2011-01-01

Summary Adult neurogenesis, a process of generating functional neurons from adult neural precursors, occurs throughout life in restricted brain regions in mammals. The past decade has witnessed tremendous progress in addressing questions related to almost every aspect of adult neurogenesis in the mammalian brain. Here we review major advances in our understanding of adult mammalian neurogenesis in the dentate gyrus of the hippocampus and from the subventricular zone of the lateral ventricle, the rostral migratory stream to the olfactory bulb. We highlight emerging principles that have significant implications for stem cell biology, developmental neurobiology, neural plasticity, and disease mechanisms. We also discuss remaining questions related to adult neural stem cells and their niches, underlying regulatory mechanisms and potential functions of newborn neurons in the adult brain. Building upon the recent progress and aided by new technologies, the adult neurogenesis field is poised to leap forward in the next decade. PMID:21609825

Role of the medial prefrontal cortex in impaired decision making in juvenile attention-deficit/hyperactivity disorder.

Science.gov (United States)

Hauser, Tobias U; Iannaccone, Reto; Ball, Juliane; Mathys, Christoph; Brandeis, Daniel; Walitza, Susanne; Brem, Silvia

2014-10-01

Attention-deficit/hyperactivity disorder (ADHD) has been associated with deficient decision making and learning. Models of ADHD have suggested that these deficits could be caused by impaired reward prediction errors (RPEs). Reward prediction errors are signals that indicate violations of expectations and are known to be encoded by the dopaminergic system. However, the precise learning and decision-making deficits and their neurobiological correlates in ADHD are not well known. To determine the impaired decision-making and learning mechanisms in juvenile ADHD using advanced computational models, as well as the related neural RPE processes using multimodal neuroimaging. Twenty adolescents with ADHD and 20 healthy adolescents serving as controls (aged 12-16 years) were examined using a probabilistic reversal learning task while simultaneous functional magnetic resonance imaging and electroencephalogram were recorded. Learning and decision making were investigated by contrasting a hierarchical Bayesian model with an advanced reinforcement learning model and by comparing the model parameters. The neural correlates of RPEs were studied in functional magnetic resonance imaging and electroencephalogram. Adolescents with ADHD showed more simplistic learning as reflected by the reinforcement learning model (exceedance probability, Px = .92) and had increased exploratory behavior compared with healthy controls (mean [SD] decision steepness parameter β: ADHD, 4.83 [2.97]; controls, 6.04 [2.53]; P = .02). The functional magnetic resonance imaging analysis revealed impaired RPE processing in the medial prefrontal cortex during cue as well as during outcome presentation (P decision making and learning mechanisms in adolescents with ADHD are driven by impaired RPE processing in the medial prefrontal cortex. This novel, combined approach furthers the understanding of the pathomechanisms in ADHD and may advance treatment strategies.

Advanced Controller for the Free-Piston Stirling Convertor

Science.gov (United States)

Gerber, Scott S.; Jamison, Mike; Roth, Mary Ellen; Regan, Timothy F.

2004-01-01

The free-piston Stirling power convertor is being considered as an advanced power conversion technology to be used for future NASA deep space missions requiring long life radioisotope power systems. This technology has a conversion efficiency of over 25%, which is significantly higher than the efficiency of the Radioisotope Thermal-electric Generators (RTG) now in use. The NASA Glenn Research Center has long been recognized as a leader in Stirling technology and is responsible for the development of advanced technologies that are intended to significantly improve key characteristics of the Stirling convertor. The advanced technologies identified for development also consider the requirements of potential future missions and the new capabilities that have become available in the associated technical areas. One of the key areas identified for technology development is the engine controller. To support this activity, an advanced controller is being developed for the Stirling power convertor. This controller utilizes active power factor correction electronics and microcontroller-based controls. The object of this paper is to present an overview of the advanced controller concept with modeling, simulation and hardware test data.

Advancing Alternative Analysis: Integration of Decision Science.

Science.gov (United States)

Malloy, Timothy F; Zaunbrecher, Virginia M; Batteate, Christina M; Blake, Ann; Carroll, William F; Corbett, Charles J; Hansen, Steffen Foss; Lempert, Robert J; Linkov, Igor; McFadden, Roger; Moran, Kelly D; Olivetti, Elsa; Ostrom, Nancy K; Romero, Michelle; Schoenung, Julie M; Seager, Thomas P; Sinsheimer, Peter; Thayer, Kristina A

2017-06-13

Decision analysis-a systematic approach to solving complex problems-offers tools and frameworks to support decision making that are increasingly being applied to environmental challenges. Alternatives analysis is a method used in regulation and product design to identify, compare, and evaluate the safety and viability of potential substitutes for hazardous chemicals. We assessed whether decision science may assist the alternatives analysis decision maker in comparing alternatives across a range of metrics. A workshop was convened that included representatives from government, academia, business, and civil society and included experts in toxicology, decision science, alternatives assessment, engineering, and law and policy. Participants were divided into two groups and were prompted with targeted questions. Throughout the workshop, the groups periodically came together in plenary sessions to reflect on other groups' findings. We concluded that the further incorporation of decision science into alternatives analysis would advance the ability of companies and regulators to select alternatives to harmful ingredients and would also advance the science of decision analysis. We advance four recommendations: a ) engaging the systematic development and evaluation of decision approaches and tools; b ) using case studies to advance the integration of decision analysis into alternatives analysis; c ) supporting transdisciplinary research; and d ) supporting education and outreach efforts. https://doi.org/10.1289/EHP483.

Let's Make Data Count

Science.gov (United States)

Budden, A. E.; Abrams, S.; Chodacki, J.; Cruse, P.; Fenner, M.; Jones, M. B.; Lowenberg, D.; Rueda, L.; Vieglais, D.

2017-12-01

The impact of research has traditionally been measured by citations to journal publications and used extensively for evaluation and assessment in academia, but this process misses the impact and reach of data and software as first-class scientific products. For traditional publications, Article-Level Metrics (ALM) capture the multitude of ways in which research is disseminated and used, such as references and citations within social media and other journal articles. Here we present on the extension of usage and citation metrics collection to include other artifacts of research, namely datasets. The Make Data Count (MDC) project will enable measuring the impact of research data in a manner similar to what is currently done with publications. Data-level metrics (DLM) are a multidimensional suite of indicators measuring the broad reach and use of data as legitimate research outputs. By making data metrics openly available for reuse in a number of different ways, the MDC project represents an important first step on the path towards the full integration of data metrics into the research data management ecosystem. By assuring researchers that their contributions to scholarly progress represented by data corpora are acknowledged, data level metrics provide a foundation for streamlining the advancement of knowledge by actively promoting desirable best practices regarding research data management, publication, and sharing.

Smoking cessation programmes in radon affected areas: can they make a significant contribution to reducing radon-induced lung cancers?

International Nuclear Information System (INIS)

Denman, A.R.; Groves-Kirkby, C.J.; Timson, K.; Shield, G.; Rogers, S.; Phillips, P.S.

2008-01-01

Domestic radon levels in parts of the UK are sufficiently high to increase the risk of lung cancer in the occupants. Public health campaigns in Northamptonshire, a designated radon affected area with 6.3% of homes having average radon levels over the UK action level of 200 Bq m -3 , have encouraged householders to test for radon and then to carry out remediation in their homes, but have been only partially successful. Only 40% of Northamptonshire houses have been tested, and only 15% of householders finding raised levels proceed to remediate. Of those who did remediate, only 9% smoked, compared to a countywide average of 28.8%. This is unfortunate, since radon and smoking combine to place the individual at higher risk by a factor of around 4, and suggests that current strategies to reduce domestic radon exposure are not reaching those most at risk. During 2004-5, the NHS Stop Smoking Services in Northamptonshire assisted 2,808 smokers to quit to the 4-week stage, with some 30% of 4-week quitters remaining quitters at 1 year. We consider whether smoking cessation campaigns make significant contributions to radon risk reduction on their own, by assessing individual occupants' risk of developing lung cancer from knowledge of their age, gender, and smoking habits, together with he radon level in their house. The results demonstrate that smoking cessation programmes have significant added value in radon affected areas, and contribute a greater health benefit than reducing radon levels in the smokers' homes, whilst they remain smokers. Additionally, results are presented from a questionnaire-based survey of quitters, addressing their reasons for seeking help in quitting smoking, and whether knowledge of radon risks influenced this decision. The impact of these findings on future public health campaigns to reduce the impact of radon and smoking are discussed. (author)

Advanced monitoring with complex stream processing

CERN Multimedia

CERN. Geneva

2015-01-01

Making sense of metrics and logs for service monitoring can be a complicated task. Valuable information is normally scattered across several streams of monitoring data, requiring aggregation, correlation and time-based analysis to promptly detect problems and failures. This presentations shows a solution which is used to support the advanced monitoring of the messaging services provided by the IT Department. It uses Esper, an open-source software product for Complex Event Processing (CEP), that analyses series of events for deriving conclusions from them.

Neuroanatomical basis for recognition primed decision making.

Science.gov (United States)

Hudson, Darren

2013-01-01

Effective decision making under time constraints is often overlooked in medical decision making. The recognition primed decision making (RPDM) model was developed by Gary Klein based on previous recognized situations to develop a satisfactory solution to the current problem. Bayes Theorem is the most popular decision making model in medicine but is limited by the need for adequate time to consider all probabilities. Unlike other decision making models, there is a potential neurobiological basis for RPDM. This model has significant implication for health informatics and medical education.

Making a More Significant Impact on Society.

Science.gov (United States)

Cunningham, Phyllis M.

1989-01-01

The current quest for technical professionalism in adult education is narrowing the field's focus. Ignored in the process is its social action history in such movements as popular education, socialist education, the education of African Americans, and workers' education. (SK)

Distinguishing between statistical significance and practical/clinical meaningfulness using statistical inference.

Science.gov (United States)

Wilkinson, Michael

2014-03-01

Decisions about support for predictions of theories in light of data are made using statistical inference. The dominant approach in sport and exercise science is the Neyman-Pearson (N-P) significance-testing approach. When applied correctly it provides a reliable procedure for making dichotomous decisions for accepting or rejecting zero-effect null hypotheses with known and controlled long-run error rates. Type I and type II error rates must be specified in advance and the latter controlled by conducting an a priori sample size calculation. The N-P approach does not provide the probability of hypotheses or indicate the strength of support for hypotheses in light of data, yet many scientists believe it does. Outcomes of analyses allow conclusions only about the existence of non-zero effects, and provide no information about the likely size of true effects or their practical/clinical value. Bayesian inference can show how much support data provide for different hypotheses, and how personal convictions should be altered in light of data, but the approach is complicated by formulating probability distributions about prior subjective estimates of population effects. A pragmatic solution is magnitude-based inference, which allows scientists to estimate the true magnitude of population effects and how likely they are to exceed an effect magnitude of practical/clinical importance, thereby integrating elements of subjective Bayesian-style thinking. While this approach is gaining acceptance, progress might be hastened if scientists appreciate the shortcomings of traditional N-P null hypothesis significance testing.

77 FR 65395 - Air Cargo Advance Screening (ACAS) Pilot Program

Science.gov (United States)

2012-10-26

... DEPARTMENT OF HOMELAND SECURITY U.S. Customs and Border Protection Air Cargo Advance Screening (ACAS) Pilot Program Correction In notice document 2012-26031 appearing on pages 65006-65009 in the issue of October 24, 2012 make the following correction: On page 65007, in the first column, under the...

Making Healthy Choices Easier: Regulation versus Nudging.

Science.gov (United States)

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.

Advance Care Planning Does Not Adversely Affect Hope or Anxiety Among Patients With Advanced Cancer.

Science.gov (United States)

Green, Michael J; Schubart, Jane R; Whitehead, Megan M; Farace, Elana; Lehman, Erik; Levi, Benjamin H

2015-06-01

Many physicians avoid advance care planning (ACP) discussions because they worry such conversations will lead to psychological distress. To investigate whether engaging in ACP using online planning tools adversely affects hope, hopelessness, or anxiety among patients with advanced cancer. Patients with advanced cancer and an estimated survival of two years or less (Intervention group) and a Control group were recruited at a tertiary care academic medical center (2007-2012) to engage in ACP using an online decision aid ("Making Your Wishes Known"). Pre/post and between-group comparisons were made, including hope (Herth Hope Index), hopelessness (Beck Hopelessness Scale), and anxiety (State Trait Anxiety Inventory). Secondary outcomes included ACP knowledge, self-determination, and satisfaction. A total of 200 individuals completed the study. After engaging in ACP, there was no decline in hope or increase in hopelessness in either the Control or Intervention group. Anxiety was likewise unchanged in the Control group but decreased slightly in the Intervention group. Knowledge of ACP (% correct answers) increased in both the groups, but more so in the Intervention group (13% increase vs. 4%; P<0.01). Self-determination increased slightly in both groups, and satisfaction with the ACP process was greater (P<0.01) in the Intervention than Control group. Engaging in ACP with online planning tools increases knowledge without diminishing hope, increasing hopelessness, or inducing anxiety in patients with advanced cancer. Physicians need not avoid ACP out of concern for adversely affecting patients' psychological well-being. Copyright © 2015 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Internal and External Oxidation of Manganese in Advanced High Strength Steels

NARCIS (Netherlands)

Aghaei Lashgari, V.

2014-01-01

Advanced high strength steels (AHSS) have been used extensively in the automotive industries. The main characteristic of these steels is combination of high strength and enhanced formability that makes them very attractive for automotive application. However, the major drawback of these steels is

Advances in surgical techniques in non-small cell lung cancer.

Science.gov (United States)

Kim, Anthony W; Detterbeck, Frank C

2013-12-01

Thoracic surgery is a dynamic field, and many scientific, technological, technical, and organizational changes are occurring. A prominent example is the use of less invasive approaches to major resection of non-small cell lung cancer (NSCLC), both thoracoscopic and robotic. Sophisticated technology corroborated by clinical data has led to these approaches becoming accepted additions to the armamentarium. Additionally, improvements in perioperative pain management have also contributed to dramatically changing the experience of patients who undergo modern thoracic surgery. Lung cancer is being detected more often at an early stage. At the same time, advances in techniques, patient care, clinical science, and multidisciplinary treatment support an increased role for aggressive resection in the face of larger locally advanced tumors or for those with limited metastatic disease. These advances, conducted in the setting of multidisciplinary decision making, have resulted in real and palpable advancements for patients with lung cancer. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

The impact of simulation sequencing on perceived clinical decision making.

Science.gov (United States)

Woda, Aimee; Hansen, Jamie; Paquette, Mary; Topp, Robert

2017-09-01

An emerging nursing education trend is to utilize simulated learning experiences as a means to optimize competency and decision making skills. The purpose of this study was to examine differences in students' perception of clinical decision making and clinical decision making-related self-confidence and anxiety based on the sequence (order) in which they participated in a block of simulated versus hospital-based learning experiences. A quasi-experimental crossover design was used. Between and within group differences were found relative to self-confidence with the decision making process. When comparing groups, at baseline the simulation followed by hospital group had significantly higher self-confidence scores, however, at 14-weeks both groups were not significantly different. Significant within group differences were found in the simulation followed by hospital group only, demonstrating a significant decrease in clinical decision making related anxiety across the semester. Finally, there were no significant difference in; perceived clinical decision making within or between the groups at the two measurement points. Preliminary findings suggest that simulated learning experiences can be offered with alternating sequences without impacting the process, anxiety or confidence with clinical decision making. This study provides beginning evidence to guide curriculum development and allow flexibility based on student needs and available resources. Copyright © 2017. Published by Elsevier Ltd.

Overview of advanced technologies for stabilization of 238Pu-contaminated waste

International Nuclear Information System (INIS)

Ramsey, K.B.; Foltyn, E.M.; Heslop, J.M.

1998-02-01

This paper presents an overview of potential technologies for stabilization of 238 Pu-contaminated waste. Los Alamos National Laboratory (LANL) has processed 238 PuO 2 fuel into heat sources for space and terrestrial uses for the past several decades. The 88-year half-life of 238 Pu and thermal power of approximately 0.6 watts/gram make this isotope ideal for missions requiring many years of dependable service in inaccessible locations. However, the same characteristic which makes 238 Pu attractive for heat source applications, the high Curie content (17 Ci/gram versus 0.06 Ci/gram for 239 Pu ), makes disposal of 238 Pu-contaminated waste difficult. Specifically, the thermal load limit on drums destined for transport to the Waste Isolation Pilot Plant (WIPP), 0.23 gram per drum for combustible waste, is impossible to meet for nearly all 238 Pu-contaminated glovebox waste. Use of advanced waste treatment technologies including Molten Salt Oxidation (MSO) and aqueous chemical separation will eliminate the combustible matrix from 238 Pu-contaminated waste and recover kilogram quantities of 238 PuO 2 from the waste stream. A conceptual design of these advanced waste treatment technologies will be presented

Software for the ACP [Advanced Computer Program] multiprocessor system

International Nuclear Information System (INIS)

Biel, J.; Areti, H.; Atac, R.

1987-01-01

Software has been developed for use with the Fermilab Advanced Computer Program (ACP) multiprocessor system. The software was designed to make a system of a hundred independent node processors as easy to use as a single, powerful CPU. Subroutines have been developed by which a user's host program can send data to and get results from the program running in each of his ACP node processors. Utility programs make it easy to compile and link host and node programs, to debug a node program on an ACP development system, and to submit a debugged program to an ACP production system

The influence on the performance of operators along with the introduction of the advanced main control board

International Nuclear Information System (INIS)

Ohsuga, Yasuhiko

2010-01-01

This paper describes an influence on the performance of operators along with the introduction of the advanced main control board (MCB). The influence on the performance of operators is considered based on the operating procedure, the requirements for operators and the operator training. The operating procedure is the document which puts forward the way that the designer has thought in advance for the operators and describes the performance of operators. The introduction of the advanced MCB seems to be bringing a change of the operating procedure. The requirements for operators are the knowledge, skills and attitude, and crew resource management (CRM) skill. CRM skill makes use of the knowledge, skills and attitude and improves the team performance. The advanced MCB seems to induce a change of CRM skill i.e. the communication, decision making or problem solving, team building, situation awareness, and workload management of different shift teams. The operator training is the best way to verify the change of the operating procedure and CRM skill. (author)

Improving advance care planning for English-speaking and Spanish-speaking older adults: study protocol for the PREPARE randomised controlled trial

OpenAIRE

Sudore, RL; Barnes, DE; Le, GM; Ramos, R; Osua, SJ; Richardson, SA; Boscardin, J; Schillinger, D

2016-01-01

Introduction Advance care planning (ACP) is a process that allows patients to identify their goals for medical care. Traditionally, ACP has focused on completing advance directives; however, we have expanded the ACP paradigm to also prepare patients to communicate their wishes and make informed decisions. To this end, we created an ACP website called PREPARE (http://www.prepareforyourcare.org) to prepare diverse English-speaking and Spanish-speaking older adults for medical decision-making. H...

Advance care planning - a multi-centre cluster randomised clinical trial

DEFF Research Database (Denmark)

Rietjens, Judith A C; Korfage, Ida J; Dunleavy, Lesley

2016-01-01

patients, relatives and professional caregivers about patients' values and care preferences. It raises awareness of the need to anticipate possible future deterioration of health. ACP has the potential to improve current and future healthcare decision-making, provide patients with a sense of control......BACKGROUND: Awareness of preferences regarding medical care should be a central component of the care of patients with advanced cancer. Open communication can facilitate this but can occur in an ad hoc or variable manner. Advance care planning (ACP) is a formalized process of communication between...... Choices program from the perspectives of patients, their Personal Representatives, healthcare providers and facilitators. DISCUSSION: Transferring the concept of ACP from care of the elderly to patients with advanced cancer, who on average are younger and retain their mental capacity for a larger part...

Seasonal weather-related decision making for cattle production in the Northern Great Plains

Science.gov (United States)

High inter-annual variability of seasonal weather patterns can greatly affect forage and therefore livestock production in the Northern Great Plains. This variability can make it difficult for ranchers to set yearly stocking rates, particularly in advance of the grazing season. To better understand ...

The practical equity implications of advanced metering infrastructure

Energy Technology Data Exchange (ETDEWEB)

Felder, Frank A.

2010-07-15

Reductions in advanced metering costs and the efficiency benefits of dynamic pricing make a compelling case to adopt both, particularly for industrial and commercial facilities. Regulators should seriously consider such policies for residential households as well. Regulators can take meaningful steps to mitigate, if not entirely offset, the possibility that some low-income ratepayers may have higher electricity bills with AM and DP. (author)

Quantifying quality of life and disability of patients with advanced schistosomiasis japonica.

Directory of Open Access Journals (Sweden)

Tie-Wu Jia

Full Text Available BACKGROUND: The Chinese government lists advanced schistosomiasis as a leading healthcare priority due to its serious health and economic impacts, yet it has not been included in the estimates of schistosomiasis burden in the Global Burden of Disease (GBD study. Therefore, the quality of life and disability weight (DW for the advanced cases of schistosomiasis japonica have to be taken into account in the re-estimation of burden of disease due to schistosomiasis. METHODOLOGY/PRINCIPAL FINDINGS: A patient-based quality-of-life evaluation was performed for advanced schistosomiasis japonica. Suspected or officially registered advanced cases in a Schistosoma japonicum-hyperendemic county of the People's Republic of China (P.R. China were screened using a short questionnaire and physical examination. Disability and morbidity were assessed in confirmed cases, using the European quality of life questionnaire with an additional cognitive dimension (known as the "EQ-5D plus", ultrasonography, and laboratory testing. The age-specific DW of advanced schistosomiasis japonica was estimated based on patients' self-rated health scores on the visual analogue scale of the questionnaire. The relationships between health status, morbidity and DW were explored using multivariate regression models. Of 506 candidates, 215 cases were confirmed as advanced schistosomiasis japonica and evaluated. Most of the patients reported impairments in at least one health dimension, such as pain or discomfort (90.7%, usual activities (87.9%, and anxiety or depression (80.9%. The overall DW was 0.447, and age-specific DWs ranged from 0.378 among individuals aged 30-44 years to 0.510 among the elderly aged ≥ 60 years. DWs are positively associated with loss of work capacity, psychological abnormality, ascites, and active hepatitis B virus, while splenectomy and high albumin were protective factors for quality of life. CONCLUSIONS/SIGNIFICANCE: These patient-preference disability

Memory accessibility and medical decision-making for significant others: The role of socially-shared retrieval induced forgetting

OpenAIRE

Dora M Coman; Alin eComan; William eHirst

2013-01-01

Medical decisions will often entail a broad search for relevant information. No sources alone may offer a complete picture, and many may be selective in their presentation. This selectivity may induce forgetting for previously learned material, thereby adversely affecting medical decision-making. In the study phase of two experiments, participants learned information about a fictitious disease and advantages and disadvantages of four treatment options. In the subsequent practice phase, the...

Advanced Markov chain Monte Carlo methods learning from past samples

CERN Document Server

Liang, Faming; Carrol, Raymond J

2010-01-01

This book provides comprehensive coverage of simulation of complex systems using Monte Carlo methods. Developing algorithms that are immune to the local trap problem has long been considered as the most important topic in MCMC research. Various advanced MCMC algorithms which address this problem have been developed include, the modified Gibbs sampler, the methods based on auxiliary variables and the methods making use of past samples. The focus of this book is on the algorithms that make use of past samples. This book includes the multicanonical algorithm, dynamic weighting, dynamically weight

Observation on optimal transition from conventional energy with resource constraints to advanced energy with virtually unlimited resource

International Nuclear Information System (INIS)

Suzuki, Atsuyuki

1980-01-01

The paper is aimed at making a theoretical analysis on optimal shift from finite energy resources like presently used oil toward advanced energy sources like nuclear and solar. First, the value of conventional energy as a finite resource is derived based on the variational principle. Second, a simplified model on macroeconomy is used to obtain and optimal relationship between energy production and consumption and thereby the optimality on energy price is provided. Third, the meaning of research and development of advanced energy is shown by taking into account resource constraints and technological progress. Finally, an optimal timing of the shift from conventional to advanced energies is determined by making use of the maximum principle. The methematical model employed there is much simplified but can be used to conclude that in order to make an optimal shift some policy-oriented decision must be made prior to when an economically competitive condition comes and that, even with that decision made, some recession of energy demand is inevitable during the transitional phase. (author)

Assessing clinical significance of treatment outcomes using the DASS-21.

Science.gov (United States)

Ronk, Fiona R; Korman, James R; Hooke, Geoffrey R; Page, Andrew C

2013-12-01

Standard clinical significance classifications are based on movement between the "dysfunctional" and "functional" distributions; however, this dichotomy ignores heterogeneity within the "dysfunctional" population. Based on the methodology described by Tingey, Lambert, Burlingame, and Hansen (1996), the present study sought to present a 3-distribution clinical significance model for the 21-item version of the Depression Anxiety Stress Scales (DASS-21; P. F. Lovibond & Lovibond, 1995) using data from a normative sample (n = 2,914), an outpatient sample (n = 1,000), and an inpatient sample (n = 3,964). DASS-21 scores were collected at pre- and post-treatment for both clinical samples, and patients were classified into 1 of 5 categories based on whether they had made a reliable change and whether they had moved into a different functional range. Evidence supported the validity of the 3-distribution model for the DASS-21, since inpatients who were classified as making a clinically significant change showed lower symptom severity, higher perceived quality of life, and higher clinician-rated functioning than those who did not make a clinically significant change. Importantly, results suggest that the new category of recovering is an intermediate point between recovered and making no clinically significant change. Inpatients and outpatients have different treatment goals and therefore use of the concept of clinical significance needs to acknowledge differences in what constitutes a meaningful change. (c) 2013 APA, all rights reserved.

Assessing patients' needs and preferences in the management of advanced colorectal cancer.

OpenAIRE

Redmond, K.

1998-01-01

Clinical decision-making in advanced cancer is a highly complex process. Many factors are thought to influence this process arguably the most important of these is the patient's own preference. Studies show that most patients want to be fully informed as to their diagnosis and involved in clinical decision-making. However, the attitudes of healthcare workers often preclude patient involvement. Studies have also shown that acceptability of chemotherapy for minimal therapeutic gain differs mark...

Evaluation of advanced wastewater treatment systems for water reuse in the era of advanced wastewater treatment

Science.gov (United States)

Kon, Hisao; Watanabe, Masahiro

This study focuses on effluent COD concentration from wastewater treatment in regards to the reduction of pathogenic bacteria and trace substances in public waters. The main types of secondary wastewater treatment were conventional activated sludge processes. Recently, however, advance wastewater treatment processes have been developed aimed at the removal of nitrogen and phosphorus, and the effluent quality of these processes was analyzed in this study. Treatment processes for water reclamation that make effluent to meet the target water quality for reuse purposes were selected and also optimum design parameters for these processes were proposed. It was found that the treatment cost to water reclamation was greatly affected by the effluent COD of the secondary treatment. It is important to maintain low COD concentration in the secondary treated effluent. Therefore, it is considered that adequate cost benefits would be obtained by achieving target COD quality through shifting from a conventional activated sludge process to an advanced treatment process.

Le Fort I Maxillary Advancement Using Distraction Osteogenesis

Science.gov (United States)

Combs, Patrick D.; Harshbarger, Raymond J.

2014-01-01

Treatment of maxillary hypoplasia has traditionally involved conventional Le Fort I osteotomies and advancement. Advancements of greater than 10 mm risk significant relapse. This risk is greater in the cleft lip and palate population, whose anatomy and soft tissue scarring from prior procedures contributes to instability of conventional maxillary advancement. Le Fort I advancement with distraction osteogenesis has emerged as viable, stable treatment modality correction of severe maxillary hypoplasia in cleft, syndromic, and noncleft patients. In this article, the authors provide a review of current data and recommendations concerning Le Fort I advancement with distraction osteogenesis. In addition, they outline their technique for treating severe maxillary hypoplasia with distraction osteogenesis using internal devices. PMID:25383054

Advances in semantic authoring and publishing

CERN Document Server

Groza, T

2012-01-01

Dissemination can be seen as a communication process between scientists. Over the course of several publications, they expose and support their findings, while discussing stated claims. Such discourse structures are trapped within the content of the publications, thus making the semantics discoverable only by humans. In addition, the lack of advances in scientific publishing, where electronic publications are still used as simple projections of paper documents, combined with the current growth in the amount of scientific research being published, transforms the process of finding relevant lite

Fish passage assessment of an advanced hydropower turbine and conventional turbine using blade-strike modeling

Energy Technology Data Exchange (ETDEWEB)

Deng, Z.; Carlson, T. J.; Dauble, D. D.; Ploskey, G. R. [Pacific Northwest National Laboratory, Richland, WA 99352 (United States)

2011-07-01

Hydropower is the largest renewable energy source in the world. However, in the Columbia and Snake River basins, several species of Pacific salmon and steelhead have been listed for protection under the Endangered Species Act due to significant declines of fish population. Dam operators and design engineers are thus faced with the task of making hydroelectric facilities more fish friendly through changes in hydro-turbine design and operation. Public Utility District No. 2 of Grant County, Washington, applied for relicensing from the U.S. Federal Energy Regulatory Commission to replace the 10 turbines at Wanapum Dam with advanced hydropower turbines that were designed to increase power generation and improve fish passage conditions. We applied both deterministic and stochastic blade-strike models to compare fish passage performance of the newly installed advanced turbine to an existing turbine. Modeled probabilities were compared to the results of a large-scale live-fish survival study and a Sensor Fish study under the same operational parameters. Overall, injury rates predicted by the deterministic model were higher than experimental rates of injury, while those predicted by the stochastic model were in close agreement with experimental results. Fish orientation at the time of entry into the plane of the leading edges of the turbine runner blades was an important factor contributing to uncertainty in modeled results. The advanced design turbine had slightly higher modeled injury rates than the existing turbine design; however, no statistical evidence suggested significant differences in blade-strike injuries between the two turbines, thus the hypothesis that direct fish survival rate through the advanced hydropower turbine is equal to or higher than that for fish passing through the conventional turbine could not be rejected. (authors)

Fish Passage Assessment of an Advanced Hydropower Turbine and Conventional Turbine Using Blade-Strike Modeling

Directory of Open Access Journals (Sweden)

Zhiqun Deng

2011-01-01

Full Text Available Hydropower is the largest renewable energy source in the world. However, in the Columbia and Snake River basins, several species of Pacific salmon and steelhead have been listed for protection under the Endangered Species Act due to significant declines of fish population. Dam operators and design engineers are thus faced with the task of making hydroelectric facilities more fish friendly through changes in hydro-turbine design and operation. Public Utility District No. 2 of Grant County, Washington, applied for relicensing from the U.S. Federal Energy Regulatory Commission to replace the 10 turbines at Wanapum Dam with advanced hydropower turbines that were designed to increase power generation and improve fish passage conditions. We applied both deterministic and stochastic blade-strike models to compare fish passage performance of the newly installed advanced turbine to an existing turbine. Modeled probabilities were compared to the results of a large-scale live-fish survival study and a Sensor Fish study under the same operational parameters. Overall, injury rates predicted by the deterministic model were higher than experimental rates of injury, while those predicted by the stochastic model were in close agreement with experimental results. Fish orientation at the time of entry into the plane of the leading edges of the turbine runner blades was an important factor contributing to uncertainty in modeled results. The advanced design turbine had slightly higher modeled injury rates than the existing turbine design; however, no statistical evidence suggested significant differences in blade-strike injuries between the two turbines, thus the hypothesis that direct fish survival rate through the advanced hydropower turbine is equal to or higher than that for fish passing through the conventional turbine could not be rejected.

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

Science.gov (United States)

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

2016-01-01

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

Development of advanced, non-toxic, synthetic radiation shielding aggregate

Energy Technology Data Exchange (ETDEWEB)

Mudgal, Manish; Chouhan, Ramesh Kumar; Verma, Sarika; Amritphale, Sudhir Sitaram; Das, Satyabrata [CSIR-Advanced Materials and Processes Research Institute, Bhopal (India); Shrivastva, Arvind [Nuclear Power Corporation of India Ltd. (NPCIL), Mumbai (India)

2018-04-01

For the first time in the world, the capability of red mud waste has been explored for the development of advanced synthetic radiation shielding aggregate. Red mud, an aluminium industry waste consists of multi component, multi elemental characteristics. In this study, red mud from two different sources have been utilized. Chemical formulation and mineralogical designing of the red mud has been done by ceramic processing using appropriate reducing agent and additives. The chemical analysis, SEM microphotographs and XRD analysis confirms the presence of multi-component, multi shielding and multi-layered phases in both the different developed advance synthetic radiation shielding aggregate. The mechanical properties, namely aggregate impact value, aggregate crushing value and aggregate abrasion value have also been evaluated and was compared with hematite ore aggregate and found to be an excellent material useful for making advanced radiation shielding concrete for the construction of nuclear power plants and other radiation installations.

Advanced SOA tools and applications

CERN Document Server

Brzezinski, Jerzy; Cellary, Wojciech; Grzech, Adam; Zielinski, Krzysztof

2014-01-01

This book presents advanced software development tools for construction, deployment and governance of Service Oriented Architecture (SOA) applications. Novel technical concepts and paradigms, formulated during the research stage and during development of such tools are presented and illustrated by practical usage examples. Hence this book will be of interest not only to theoreticians but also to engineers who cope with real-life problems. Additionally, each chapter contains an overview of related work, enabling comparison of the proposed concepts with exiting solutions in various areas of the SOA development process. This makes the book interesting also for students and scientists who investigate similar issues.

Identification of distinct phenotypes of locally advanced pancreatic adenocarcinoma.

LENUS (Irish Health Repository)

Teo, Minyuen

2013-03-01

A significant number of pancreatic ductal adenocarcinoma present as locally advanced disease. Optimal treatment remains controversial. We sought to analyze the clinical course of locally advanced pancreatic adenocarcinoma (LAPC) in order to identify potential distinct clinical phenotypes.

Advanced split-illumination electron holography without Fresnel fringes

International Nuclear Information System (INIS)

Tanigaki, Toshiaki; Aizawa, Shinji; Park, Hyun Soon; Matsuda, Tsuyoshi; Harada, Ken; Shindo, Daisuke

2014-01-01

Advanced split-illumination electron holography was developed by employing two biprisms in the illuminating system to split an electron wave into two coherent waves and two biprisms in the imaging system to overlap them. A focused image of an upper condenser-biprism filament was formed on the sample plane, and all other filaments were placed in its shadow. This developed system makes it possible to obtain precise reconstructed object waves without modulations due to Fresnel fringes, in addition to holograms of distant objects from reference waves. - Highlights: • Advanced split-illumination electron holography without Fresnel fringes is developed. • Two biprisms are installed in illuminating system of microscope. • High-precision holographic observations of an area locating far from the sample edge become possible

Advanced split-illumination electron holography without Fresnel fringes

Energy Technology Data Exchange (ETDEWEB)

Tanigaki, Toshiaki, E-mail: tanigaki-toshiaki@riken.jp [Center for Emergent Matter Science (CEMS), RIKEN, Hirosawa 2-1, Wako, Saitama 351-0198 (Japan); Aizawa, Shinji; Park, Hyun Soon [Center for Emergent Matter Science (CEMS), RIKEN, Hirosawa 2-1, Wako, Saitama 351-0198 (Japan); Matsuda, Tsuyoshi [Japan Science and Technology Agency, Kawaguchi, Saitama 332-0012 (Japan); Harada, Ken [Central Research Laboratory, Hitachi, Ltd., Hatoyama, Saitama 350-0395 (Japan); Shindo, Daisuke [Center for Emergent Matter Science (CEMS), RIKEN, Hirosawa 2-1, Wako, Saitama 351-0198 (Japan); Institute of Multidisciplinary Research for Advanced Materials, Tohoku University, Katahira 2-1-1, Sendai 980-8577 (Japan)

2014-02-01

Advanced split-illumination electron holography was developed by employing two biprisms in the illuminating system to split an electron wave into two coherent waves and two biprisms in the imaging system to overlap them. A focused image of an upper condenser-biprism filament was formed on the sample plane, and all other filaments were placed in its shadow. This developed system makes it possible to obtain precise reconstructed object waves without modulations due to Fresnel fringes, in addition to holograms of distant objects from reference waves. - Highlights: • Advanced split-illumination electron holography without Fresnel fringes is developed. • Two biprisms are installed in illuminating system of microscope. • High-precision holographic observations of an area locating far from the sample edge become possible.

Discovering the Significance of Scientific Design Practice

DEFF Research Database (Denmark)

Pries-Heje, Jan; Baskerville, Richard

This paper aims at discussing and defining what it is that makes design science research significant. First it reviews the values and processes of old science and how this attacks complexity through analysis. It then shows how new science attacks complexity through synthesis. Then the paper argue...

Advancing neurosurgery through translational research.

Science.gov (United States)

Lacey, Claire; Sutherland, Garnette

2013-01-01

Every year, the number of published research articles increases significantly. However, many potentially useful ideas are lost in this flood of data. Translational research provides a framework through which investigators or laboratories can maximize the likelihood that the product of their research will be adopted in medical practice. There are 2 recognizable models of translation appropriate for the majority of research: investigator driven and industry enabled. Investigator-driven research has more range because it does not have to consider the profit margin of research, but it is a slow process. The industry-enabled model accelerates the translational research process through the power of industry funding but is interested primarily in products with potential for profit. Two cases are examined to illustrate different methods of partnering with industry. IMRIS is a company founded by investigators to distribute intraoperative magnetic resonance imaging technology based on a movable high-field magnet. It took 7 years for IMRIS to make its first sale, but it is now a successful company. With neuroArm, a surgical robot, investigators decided to sell the intellectual property to an established company to ensure successful global commercialization. Translational research advances medicine by creating and distributing effective solutions to contemporary problems.

Effect of collagen turnover on the accumulation of advanced glycation end products

NARCIS (Netherlands)

Verzijl, N.; Degroot, J.; Thorpe, S. R.; Bank, R. A.; Shaw, J. N.; Lyons, T. J.; Bijlsma, J. W.; Lafeber, F. P.; Baynes, J. W.; TeKoppele, J. M.

2000-01-01

Collagen molecules in articular cartilage have an exceptionally long lifetime, which makes them susceptible to the accumulation of advanced glycation end products (AGEs). In fact, in comparison to other collagen-rich tissues, articular cartilage contains relatively high amounts of the AGE

Advanced Hydrogen Turbine Development

Energy Technology Data Exchange (ETDEWEB)

Marra, John [Siemens Energy, Inc., Orlando, FL (United States)

2015-09-30

Under the sponsorship of the U.S. Department of Energy (DOE) National Energy Technology Laboratories, Siemens has completed the Advanced Hydrogen Turbine Development Program to develop an advanced gas turbine for incorporation into future coal-based Integrated Gasification Combined Cycle (IGCC) plants. All the scheduled DOE Milestones were completed and significant technical progress was made in the development of new technologies and concepts. Advanced computer simulations and modeling, as well as subscale, full scale laboratory, rig and engine testing were utilized to evaluate and select concepts for further development. Program Requirements of: A 3 to 5 percentage point improvement in overall plant combined cycle efficiency when compared to the reference baseline plant; 20 to 30 percent reduction in overall plant capital cost when compared to the reference baseline plant; and NOx emissions of 2 PPM out of the stack. were all met. The program was completed on schedule and within the allotted budget

[Decision making and executive function in severe traumatic brain injured patients: validation of a decision-making task and correlated features].

Science.gov (United States)

Wiederkehr, S; Barat, M; Dehail, P; de Sèze, M; Lozes-Boudillon, S; Giroire, J-M

2005-02-01

At the chronic stage, severe traumatic brain injured (TBI) patients experience difficulty in making decisions. Several studies have demonstrated the involvement of the prefrontal cortex, in particular the orbitofrontal region, in decision-making. The aim of the present study was to validate a decision-making task in this population and to ascertain whether the components of their dysexecutive syndrome may affect their decision-making and lead to difficulties for social rehabilitation. Fifteen TBI patients and 15 controlled subjects matched for age, sex and years of education were assessed by a battery of executive tests (GREFEX) and by the gambling task (GT). The TBI subjects performed significantly worse than the controlled group in five out of six GREFEX tests. The TBI choices are significantly more disadvantageous than the choices of the control group when considering the three last blocks of 20 cards of the GT. The GT total score correlated significantly with execution time of the Stroop interference condition and the Trail Making Task B, as well as with the two measures (correct sequence span and number of crossed boxes) of the double condition of Baddeley's task. We postulate that executive functioning (supervisory attentional system) influence performance in the gambling task through mechanisms of inhibitory control, divided attention and working memory. Thus, this task seems to be determined by multiple factors; the process of decision-making may depend on frontal integrity.

Full Service ISDN Satellite (FSIS) network model for advanced ISDN satellite design and experiments

Science.gov (United States)

Pepin, Gerard R.

1992-01-01

The Full Service Integrated Services Digital Network (FSIS) network model for advanced satellite designs describes a model suitable for discrete event simulations. A top down model design uses the Advanced Communications Technology Satellite (ACTS) as its basis. The ACTS and the Interim Service ISDN Satellite (ISIS) perform ISDN protocol analyses and switching decisions in the terrestrial domain, whereas FSIS makes all its analyses and decisions on-board the ISDN satellite.

Advanced control rooms and crew performance issues: Implications for human reliability

International Nuclear Information System (INIS)

O'Hara, J.M.; Hall, R.E.

1991-01-01

Recent trends in advanced control room (ACR) design are considered with respect to their impact on human performance. It is concluded that potentially negative influences exist, however, a variety of factors make it difficult to model, analyze, and quantify these effects for human reliability analyses (HRAs)

[Nurses' Attitudes toward the “Advanced Nursing Process” before and after an educational intervention – a quasi-experimental study].

Science.gov (United States)

Leoni-Scheiber, Claudia; Gothe, Raffaella Matteucci; Müller-Staub, Maria

2016-02-01

The attitude of nurses influences their application of the Advanced Nursing Process. Studies reveal deficits in the application of the Advanced Nursing Process that is based on valid assessments and nursing classifications. These deficits affect decision-making and – as a result – nursing care quality. In German speaking countries nurses' attitudes towards nursing diagnoses as part of the Advanced Nursing Process were not yet measured. The aim of this study was to evaluate the effects of an educational intervention on nurses' attitude. A quasi-experimental intervention study was carried out in Austria and Germany. Before and after a standardised educational intervention 51 nurses estimated their attitude with the instrument Positions on Nursing Diagnosis (PND). Analyses were performed by Wilcoxon- and U-tests. Before the educational intervention the average attitude score of the Austrian nurses was more positive than in the German group. After the study intervention both groups regarded nursing diagnostics statistically significant more convincing and better understandable. However, both groups still described the application of the Advanced Nursing Process as difficult and demanding to perform. In the future, more attention should be given to the reflexion and development of nurses' attitude towards the Advanced Nursing Process because attitudes lead nurses' actions. In further studies influencing organizational and structural factors in diverse settings will be analysed.

Racial Differences in Mathematics Test Scores for Advanced Mathematics Students

Science.gov (United States)

Minor, Elizabeth Covay

2016-01-01

Research on achievement gaps has found that achievement gaps are larger for students who take advanced mathematics courses compared to students who do not. Focusing on the advanced mathematics student achievement gap, this study found that African American advanced mathematics students have significantly lower test scores and are less likely to be…

When Oil and Wind Turbine Companies Make Green Sense Together

DEFF Research Database (Denmark)

Backer, Lise

2009-01-01

strengthen their relationships with companies such as Vestas – that are born green. This is so since companies that are born green have strong green ecocentric business beliefs that can function as important engines in shared green sense‐making with companies that are not born green and have more hesitant......In this article I contribute to descriptive green business research on how processes of eco‐effective greening business unfold in practical reality. I look into the case of the increasing interaction between the multinational oil company Shell and the world's largest wind turbine company Vestas. I...... draw on descriptive organizational sense‐making theory and analyse to this end the shared green sense‐making of Shell and Vestas on off‐shore wind energy business. The article concludes that greening companies such as Shell – that are not born green – might be considerably advanced if these companies...

Improving shared decision-making in chronic lymphocytic leukemia through multidisciplinary education.

Science.gov (United States)

Rocque, Gabrielle B; Williams, Courtney P; Halilova, Karina I; Borate, Uma; Jackson, Bradford E; Van Laar, Emily S; Pisu, Maria; Butler, Thomas W; Davis, Randall S; Mehta, Amitkumar; Knight, Sara J; Safford, Monika M

2018-03-01

New treatments for chronic lymphocytic leukemia (CLL) with excellent response rates and varying toxicity profiles have emerged in recent years, creating an opportunity for a patient's personal preferences to contribute to treatment decisions. We conducted a prospective, quasi-experimental pre- and post-evaluation of a multilevel educational program and its impact on knowledge of CLL and shared decision-making (SDM). We educated patients, lay navigators, nurses/advanced practice providers (APPs), and physicians. Patients were evaluated for change in patient activation, distress, desired role in decision-making, perception of decision-making, satisfaction with oncologist explanation of treatment choice, and knowledge of CLL. Lay navigators, nurses/APPs, and physicians were evaluated for change in CLL knowledge and perception of decision-making. Forty-four patients, 33 lay navigators, 27 nurses/APPs, and 27 physicians participated in the educational program. We observed trends toward improved patient activation, with 68% before education versus 76% after education reporting a Patient Activation Measure (PAM) score of 3 or 4. The percentage of patients desiring and perceiving SDM trended upward from 47% to 67% and from 35% to 49%, respectively. The percentage of patients understanding that CLL is incurable increased from 80% to 90%, as did reporting awareness of signs of progression (64% to 76%). Patients' satisfaction with their oncologists' explanations of therapy increased significantly from 83% to 95% (p = .03). CLL knowledge increased after education for lay navigators (36% vs 63%) and nurses/APPs (35% vs 69%), and remained high for physicians (85% vs 87%). Nurses/APPs and physicians perceived at least some patient involvement in decision-making at baseline, whereas 12% of patients and 23% of lay navigators perceived that physicians made decisions independently. This project demonstrated trends toward improvements in patient engagement, prognostic awareness

Advances in river ice hydrology 1999-2003

Science.gov (United States)

Morse, Brian; Hicks, Faye

2005-01-01

In the period 1999 to 2003, river ice has continued to have important socio-economic impacts in Canada and other Nordic countries. Concurrently, there have been many important advances in all areas of Canadian research into river ice engineering and hydrology. For example: (1) River ice processes were highlighted in two special journal issues (Canadian Journal of Civil Engineering in 2003 and Hydrological Processes in 2002) and at five conferences (Canadian Committee on River Ice Processes and the Environment in 1999, 2001 and 2003, and International Association of Hydraulic Research in 2000 and 2002). (2) A number of workers have clearly advanced our understanding of river ice processes by bringing together disparate information in comprehensive review articles. (3) There have been significant advances in river ice modelling. For example, both one-dimensional (e.g. RIVICE, RIVJAM, ICEJAM, HEC-RAS, etc.) and two-dimensional (2-D; www.river2d.ca) public-domain ice-jam models are now available. Work is ongoing to improve RIVER2D, and a commercial 2-D ice-process model is being developed. (4) The 1999-2003 period is notable for the number of distinctly hydrological and ecological studies. On the quantitative side, many are making efforts to determine streamflow during the winter period. On the ecological side, some new publications have addressed the link to water quality (temperature, dissolved oxygen, nutrients and pollutants), and others have dealt with sediment transport and geomorphology (particularly as it relates to break-up), stream ecology (plants, food cycle, etc.) and fish habitat.There is the growing recognition, that these types of study require collaborative efforts. In our view, the main areas requiring further work are: (1) to interface geomorphological and habitat models with quantitative river ice hydrodynamic models; (2) to develop a manager's toolbox (database management, remote sensing, forecasting, intervention methodologies, etc.) to enable

Nitrogen-Doped Carbon Nanotube/Graphite Felts as Advanced Electrode Materials for Vanadium Redox Flow Batteries.

Science.gov (United States)

Wang, Shuangyin; Zhao, Xinsheng; Cochell, Thomas; Manthiram, Arumugam

2012-08-16

Nitrogen-doped carbon nanotubes have been grown, for the first time, on graphite felt (N-CNT/GF) by a chemical vapor deposition approach and examined as an advanced electrode for vanadium redox flow batteries (VRFBs). The unique porous structure and nitrogen doping of N-CNT/GF with increased surface area enhances the battery performance significantly. The enriched porous structure of N-CNTs on graphite felt could potentially facilitate the diffusion of electrolyte, while the N-doping could significantly contribute to the enhanced electrode performance. Specifically, the N-doping (i) modifies the electronic properties of CNT and thereby alters the chemisorption characteristics of the vanadium ions, (ii) generates defect sites that are electrochemically more active, (iii) increases the oxygen species on CNT surface, which is a key factor influencing the VRFB performance, and (iv) makes the N-CNT electrochemically more accessible than the CNT.

[The relationship between career decision-making self efficacy and anxiety].

Science.gov (United States)

Yao, Chen; Cai, Yun; Liu, Jia; Shan, Dan; Zhou, Xia

2012-03-01

The purpose of the paper is to examine the relationship among Career Decision-Making Self Efficacy, existential anxiety and anxiety in the sample of college students during the professional choice. Data on The Revised Career Decision-Making Self-Efficacy-Shot Form, Existential Anxiety Scale (EAS), SCL-90 and self-identity status were collected and analyzed on a sample of 500 college students. 201 rural students' career decision making self-efficacy scores were as follows: self-appraisal (12.58 ± 3.48), occupational information (12.07 ± 3.05), goal selection (12.48 ± 3.51), planning (12.17 ± 3.10), problem solving (9.75 ± 2.38), all scores were lower than urban students, the difference was statistically significant (P guilt anxiety (13.72 ± 2.38), alienation and loneliness anxiety (16.82 ± 2.51), all scores are higher than urban students, the difference was statistically significant (P decision making self-efficacy. There is a significant positive correlation between anxiety and existential anxiety. There exists a significant negative correlation among factors of student and career decision making self-efficacy and anxiety. Meaningless and emptiness anxiety on career decision making self-efficacy are significant predictors. There is negative correlation among existential anxiety, occupational information and anxiety during the professional choice.

A Paradigm shift in the concept for making dental impressions

OpenAIRE

Nayar, Sanjna; Mahadevan, R.

2015-01-01

Digital dental impression is a revolutionary technological advancement that so surpasses the accuracy and efficiency of former techniques for obtaining replicas of prepared teeth for the purpose of fabricating restorations that its adoption by dentists is rapidly eclipsing the use of elastomeric impression materials. The ultimate goals of dentists dedicated to quality restorative dentistry are to make their treatment of patients as accurate, stressless, and efficient as possible. By eliminati...

NATO Advanced Study Institute on Recent Advances in the Modeling of Hydrologic Systems

CERN Document Server

O’Connell, P

1991-01-01

Modeling of the rainfall-runoff process is of both scientific and practical significance. Many of the currently used mathematical models of hydrologic systems were developed a genera­ tion ago. Much of the effort since then has focused on refining these models rather than on developing new models based on improved scientific understanding. In the past few years, however, a renewed effort has been made to improve both our fundamental understanding of hydrologic processes and to exploit technological advances in computing and remote sensing. It is against this background that the NATO Advanced Study Institute on Recent Advances in the Modeling of Hydrologic Systems was organized. The idea for holding a NATO ASI on this topic grew out of an informal discussion between one of the co-directors and Professor Francisco Nunes-Correia at a previous NATO ASI held at Tucson, Arizona in 1985. The Special Program Panel on Global Transport Mechanisms in the Geo-Sciences of the NATO Scientific Affairs Division agreed to sp...

Anatomic and functional leg-length inequality: A review and recommendation for clinical decision-making. Part I, anatomic leg-length inequality: prevalence, magnitude, effects and clinical significance

Directory of Open Access Journals (Sweden)

Knutson Gary A

2005-07-01

Full Text Available Abstract Background Leg-length inequality is most often divided into two groups: anatomic and functional. Part I of this review analyses data collected on anatomic leg-length inequality relative to prevalence, magnitude, effects and clinical significance. Part II examines the functional "short leg" including anatomic-functional relationships, and provides an outline for clinical decision-making. Methods Online database – Medline, CINAHL and MANTIS – and library searches for the time frame of 1970–2005 were done using the term "leg-length inequality". Results and Discussion Using data on leg-length inequality obtained by accurate and reliable x-ray methods, the prevalence of anatomic inequality was found to be 90%, the mean magnitude of anatomic inequality was 5.2 mm (SD 4.1. The evidence suggests that, for most people, anatomic leg-length inequality does not appear to be clinically significant until the magnitude reaches ~ 20 mm (~3/4". Conclusion Anatomic leg-length inequality is near universal, but the average magnitude is small and not likely to be clinically significant.

Factors and outcomes of decision making for cancer clinical trial participation.

Science.gov (United States)

Biedrzycki, Barbara A

2011-09-01

To describe factors and outcomes related to the decision-making process regarding participation in a cancer clinical trial. Cross-sectional, descriptive. Urban, academic, National Cancer Institute-designated comprehensive cancer center in the mid-Atlantic United States. 197 patients with advanced gastrointestinal cancer. Mailed survey using one investigator-developed instrument, eight instruments used in published research, and a medical record review. disease context, sociodemographics, hope, quality of life, trust in healthcare system, trust in health professional, preference for research decision control, understanding risks, and information. decision to accept or decline research participation and satisfaction with this decision. All of the factors within the Research Decision Making Model together predicted cancer clinical trial participation and satisfaction with this decision. The most frequently preferred decision-making style for research participation was shared (collaborative) (83%). Multiple factors affect decision making for cancer clinical trial participation and satisfaction with this decision. Shared decision making previously was an unrecognized factor and requires further investigation. Enhancing the process of research decision making may facilitate an increase in cancer clinical trial enrollment rates. Oncology nurses have unique opportunities as educators and researchers to support shared decision making by those who prefer this method for deciding whether to accept or decline cancer clinical trial participation.

The Economics of Academic Advancement Within Surgery.

Science.gov (United States)

Baimas-George, Maria; Fleischer, Brian; Korndorffer, James R; Slakey, Douglas; DuCoin, Christopher

The success of an academic surgeon's career is often viewed as directly related to academic appointment; therefore, the sequence of promotion is a demanding, rigorous process. This paper seeks to define the financial implication of academic advancement across different surgical subspecialties. Data was collected from the Association of American Medical College's 2015 report of average annual salaries. Assumptions included 30 years of practice, 5 years as assistant professor, and 10 years as associate professor before advancement. The base formula used was: (average annual salary) × (years of practice [30 years - fellowship/research years]) + ($50,000 × years of fellowship/research) = total adjusted lifetime salary income. There was a significant increase in lifetime salary income with advancement from assistant to associate professor in all subspecialties when compared to an increase from associate to full professor. The greatest increase in income from assistant to associate professor was seen in transplant and cardiothoracic surgery (35% and 27%, respectively). Trauma surgery and surgical oncology had the smallest increases of 8% and 9%, respectively. With advancement to full professor, the increase in lifetime salary income was significantly less across all subspecialties, ranging from 1% in plastic surgery to 8% in pediatric surgery. When analyzing the economics of career advancement in academic surgery, there is a substantial financial benefit in lifetime income to becoming an associate professor in all fields; whereas, advancement to full professor is associated with a drastically reduced economic benefit. Copyright © 2017 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

New Advances Push Engineered Tissues Toward 3-D: Multidisciplinary Collaboration is Key to the Success of Regenerative Medicine.

Science.gov (United States)

Mertz, Leslie

2017-01-01

Although doctors still cannot simply order new, functioning organs for patients who need replacements, researchers in labs around the world are making the important advances in tissue engineering that set the stage for regenerative medicine as well as make other biomedical technologies possible.

Advanced teaching labs in physics - celebrating progress; challenges ahead

Science.gov (United States)

Peterson, Richard

A few examples of optical physics experiments may help us first reflect on significant progress on how advanced lab initiatives may now be more effectively developed, discussed, and disseminated - as opposed to only 10 or 15 years back. Many cooperative developments of the last decade are having profound impacts on advanced lab workers and students. Central to these changes are the programs of the Advanced Laboratory Physics Association (ALPhA) (Immersions, BFY conferences), AAPT (advlab-l server, ComPADRE, apparatus competitions, summer workshops/sessions), APS (Reichert Award, FEd activities and sessions), and the Jonathan F. Reichert Foundation (ALPhA support and institution matched equipment grants for Immersion participants). Broad NSF support has helped undergird several of these initiatives. Two of the most significant challenges before this new advanced lab community are (a) to somehow enhance funding opportunities for teaching equipment and apparatus in an era of minimal NSF equipment support, and (b) to help develop a more complementary relationship between research-based advanced lab pedagogies and the development of fresh physics experiments that help enable the mentoring and experimental challenge of our students.

Advanced game design with HTML5 and JavaScript

CERN Document Server

van der Spuy, Rex

2015-01-01

How do you make a video game? Advanced Game Design with HTML5 and JavaScript is a down to earth education in how to make video games from scratch, using the powerful HTML5 and JavaScript technologies. This book is a point-by-point round up of all the essential techniques that every game designer needs to know. You'll discover how to create and render game graphics, add interactivity, sound, and animation. You'll learn how to build your own custom game engine with reusable components so that you can quickly develop games with maximum impact and minimum code. You'll also learn the secrets o

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

Science.gov (United States)

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

2005-02-01

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

Synthetic definition of biological significance

International Nuclear Information System (INIS)

Buffington, J.D.

1975-01-01

The central theme of the workshop is recounted and the views of the authors are summarized. Areas of broad agreement or disagreement, unifying principles, and research needs are identified. Authors' views are consolidated into concepts that have practical utility for the scientist making impact assessments. The need for decision-makers and managers to be cognizant of the recommendations made herein is discussed. Finally, bringing together the diverse views of the workshop participants, a conceptual definition of biological significance is synthesized

Evaluation of the applicability of existing nuclear power plant regulatory requirements in the U.S. to advanced small modular reactors.

Energy Technology Data Exchange (ETDEWEB)

LaChance, Jeffrey L.; Wheeler, Timothy A.; Farnum, Cathy Ottinger; Middleton, Bobby D.; Jordan, Sabina Erteza; Duran, Felicia Angelica; Baum, Gregory A.

2013-05-01

The current wave of small modular reactor (SMR) designs all have the goal of reducing the cost of management and operations. By optimizing the system, the goal is to make these power plants safer, cheaper to operate and maintain, and more secure. In particular, the reduction in plant staffing can result in significant cost savings. The introduction of advanced reactor designs and increased use of advanced automation technologies in existing nuclear power plants will likely change the roles, responsibilities, composition, and size of the crews required to control plant operations. Similarly, certain security staffing requirements for traditional operational nuclear power plants may not be appropriate or necessary for SMRs due to the simpler, safer and more automated design characteristics of SMRs. As a first step in a process to identify where regulatory requirements may be met with reduced staffing and therefore lower cost, this report identifies the regulatory requirements and associated guidance utilized in the licensing of existing reactors. The potential applicability of these regulations to advanced SMR designs is identified taking into account the unique features of these types of reactors.

Editorial perspective--advances in B-cell non-Hodgkin's lymphoma

NARCIS (Netherlands)

Hagenbeek, A.; Bischof Delaloye, A.

2003-01-01

Radioimmunotherapy (RIT) represents an exciting new therapeutic option for the treatment of B-cell non-Hodgkin's lymphoma (NHL), emerging at a time when significant advances have been made in NHL classification, molecular genetics and treatment. Despite recent treatment advances, including the use

Design and installation of advanced computer safety related instrumentation

International Nuclear Information System (INIS)

Koch, S.; Andolina, K.; Ruether, J.

1993-01-01

The rapidly developing area of computer systems creates new opportunities for commercial utilities operating nuclear reactors to improve plant operation and efficiency. Two of the main obstacles to utilizing the new technology in safety-related applications is the current policy of the licensing agencies and the fear of decision making managers to introduce new technologies. Once these obstacles are overcome, advanced diagnostic systems, CRT-based displays, and advanced communication channels can improve plant operation considerably. The article discusses outstanding issues in the area of designing, qualifying, and licensing of computer-based instrumentation and control systems. The authors describe the experience gained in designing three safety-related systems, that include a Programmable Logic Controller (PLC) based Safeguard Load Sequencer for NSP Prairie Island, a digital Containment Isolation monitoring system for TVA Browns Ferry, and a study that was conducted for EPRI/NSP regarding a PLC-based Reactor Protection system. This article presents the benefits to be gained in replacing existing, outdated equipment with new advanced instrumentation

MIMO Technologies in 3GPP LTE and LTE-Advanced

Directory of Open Access Journals (Sweden)

Zhang Jianzhong(Charlie

2009-01-01

Full Text Available Abstract 3rd Generation Partnership Project (3GPP has recently completed the specification of the Long Term Evolution (LTE standard. Majority of the world's operators and vendors are already committed to LTE deployments and developments, making LTE the market leader in the upcoming evolution to 4G wireless communication systems. Multiple input multiple output (MIMO technologies introduced in LTE such as spatial multiplexing, transmit diversity, and beamforming are key components for providing higher peak rate at a better system efficiency, which are essential for supporting future broadband data service over wireless links. Further extension of LTE MIMO technologies is being studied under the 3GPP study item "LTE-Advanced" to meet the requirement of IMT-Advanced set by International Telecommunication Union Radiocommunication Sector (ITU-R. In this paper, we introduce various MIMO technologies employed in LTE and provide a brief overview on the MIMO technologies currently discussed in the LTE-Advanced forum.

How genes make up your mind

DEFF Research Database (Denmark)

Ramsøy, Thomas; Skov, Martin

2010-01-01

Neuroeconomics is the multidisciplinary study of value-based decision-making. One of the core topics is how emotions affect decision-making. Developments in economic models of decision-making have been influenced by technological innovations and empirical findings in cognitive neuroscience. Now......, a recent approach in cognitive neuroscience, often referred to as "imaging genetics", promises to make significant contributions to our understanding of both behavioral and neural aspects of value-based decision-making. Recent work has demonstrated the role of neurotransmitter alterations in clinical...... states such as Parkinson's disease, depression and anxiety, and how this may affect decision behavior. However, these insights are limited through their focus on extreme neuropathology, which sheds little light on similar functions in healthy individuals. Here, we present and discuss studies of the role...

Adding structure to the transition process to advanced mathematical activity

Science.gov (United States)

Engelbrecht, Johann

2010-03-01

The transition process to advanced mathematical thinking is experienced as traumatic by many students. Experiences that students had of school mathematics differ greatly to what is expected from them at university. Success in school mathematics meant application of different methods to get an answer. Students are not familiar with logical deductive reasoning, required in advanced mathematics. It is necessary to assist students in this transition process, in moving from general to mathematical thinking. In this article some structure is suggested for this transition period. This essay is an argumentative exposition supported by personal experience and international literature. This makes this study theoretical rather than empirical.

Sequential hemi-body radiotherapy in advanced multiple myeloma

International Nuclear Information System (INIS)

Jaffe, J.P.; Bosch, A.; Raich, P.C.

1979-01-01

Eleven patients with advanced multiple myeloma refractory to standard chemotherapy were treated with a regimen of sequential hemi-body radiotherapy consisting of 800 rad midplane in a single dose to each half. 9/10 patients experienced significant relief of skeletal pain and there were 5/11 objective tumor responses with one complete remission. Treatment-related morbidity was significant and consisted primarily of nausea and emesis, bone marrow suppression, and pneumonitis. This therapy is helpful in the management of advanced myeloma, and should be studied earlier in the course of the disease

Improvement potential of a real geothermal power plant using advanced exergy analysis

International Nuclear Information System (INIS)

Gökgedik, Harun; Yürüsoy, Muhammet; Keçebaş, Ali

2016-01-01

The main purpose of this paper is to quantitatively evaluate thermodynamic performance of a geothermal power plant (GPP) from potential for improvement point of view. Thus, sources of inefficiency and irreversibilities can be determined through exergy analysis. The advanced exergy analysis is more appropriate to determine real potential for thermodynamic improvements of the system by splitting exergy destruction into unavoidable and avoidable portions. The performance critical components and the potential for exergy efficiency improvement of a GPP were determined by means of the advanced exergy analysis. This plant is the Bereket GPP in Denizli/Turkey as a current operating system. The results show that the avoidable portion of exergy destruction in all components except for the turbines is higher than the unavoidable value. Therefore, much can be made to lessen the irreversibilities for components of the Bereket GPP. The total exergy efficiency of the system is found to be 9.60%. Its efficiency can be increased up to 15.40% by making improvements in the overall components. Although the heat exchangers had lower exergy and modified exergy efficiencies, their exergy improvement potentials were high. Finally, in the plant, the old technology is believed to be one of the main reasons for low efficiencies. - Highlights: • Evaluation of potential for improvement of a GPP using advanced exergy analysis. • Efficiency can be increased up to 15.40% by making improvements in the components. • Heat exchangers are the highest avoidable values, making them the least efficient components in plant. • The main reasons for low efficiencies are believed to be the old technology.

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

Science.gov (United States)

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

2012-01-01

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

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

Science.gov (United States)

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

2012-09-18

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

Complex decision making in patients with dementia in an internal medicine department.

Science.gov (United States)

Kabelka, Ladislav

2017-10-01

With the increase of polymorbidity, extending life expectancy and improving treatment options for chronic diseases, the care for dementia is moving into other areas of medicine. The length and quality of life with advanced dementia is directly dependent on the quality of medical and nursing care, early detection and treatment of complications, nutritional support and palliative care plan. Significant is also the support for family carers. The key coordinators of care for patients with dementia are general practitioners (GPs), geriatricians, psychiatrists, and an increasingly important role play internists. Case reports of patients admitted to an internal medicine department. Description of clinical experiences with caring on patients with dementia. In the internal departments of regional hospitals, there is a room for adjustment of the care plan, for comprehensive assessment of the patient and for making crucial decisions regarding nutrition, treatment of chronic diseases, consideration of previously expressed wishes in the context of the patient condition, and potential prognostic indicators. This assessment must result in a comprehensive documentation and communication with patients, and in the case of advanced dementia with their family members. The general internal medicine is very often the first place where the patient has a chance to hear about indication for palliative care. Without the availability of a multidisciplinary assessment, good communication and documentation, it is unrealistic to expect that the hospital would provide comprehensive care for patients with dementia.

SEG Advances in Rotational Seismic Measurements

Energy Technology Data Exchange (ETDEWEB)

Pierson, Robert; Laughlin, Darren; Brune, Bob

2016-10-17

Significant advancements in the development of sensors to enable rotational seismic measurements have been achieved. Prototypes are available now to support experiments that help validate the utility of rotational seismic measurements.

Ash chemistry and behavior in advanced co-combustion