WorldWideScience

Sample records for making significant advances

  1. Uranium chemistry: significant advances

    Mazzanti, M.

    2011-01-01

    The author reviews recent progress in uranium chemistry achieved in CEA laboratories. Like its neighbors in the Mendeleev chart uranium undergoes hydrolysis, oxidation and disproportionation reactions which make the chemistry of these species in water highly complex. The study of the chemistry of uranium in an anhydrous medium has led to correlate the structural and electronic differences observed in the interaction of uranium(III) and the lanthanides(III) with nitrogen or sulfur molecules and the effectiveness of these molecules in An(III)/Ln(III) separation via liquid-liquid extraction. Recent work on the redox reactivity of trivalent uranium U(III) in an organic medium with molecules such as water or an azide ion (N 3 - ) in stoichiometric quantities, led to extremely interesting uranium aggregates particular those involved in actinide migration in the environment or in aggregation problems in the fuel processing cycle. Another significant advance was the discovery of a compound containing the uranyl ion with a degree of oxidation (V) UO 2 + , obtained by oxidation of uranium(III). Recently chemists have succeeded in blocking the disproportionation reaction of uranyl(V) and in stabilizing polymetallic complexes of uranyl(V), opening the way to to a systematic study of the reactivity and the electronic and magnetic properties of uranyl(V) compounds. (A.C.)

  2. How do we make sense of significance?

    Lyhne, Ivar; Kørnøv, Lone

    2013-01-01

    Determination of significance is widely recognised as an important step in environmental assessment (EA) processes. The prescriptive literature and guidance on significance determination is comprehensive within the field of EA, whereas descriptive and explorative studies of how we go about making......' sense-making, including important differences in the way individuals screen and scope. These patterns concern what we notice, how fast we frame the choice, and when we are critical about the provided information. The indications provide a basis for reflections on practice and on how to organise EA...

  3. Making lasting memories: Remembering the significant

    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

  4. Making advanced analytics work for you.

    Barton, Dominic; Court, David

    2012-10-01

    Senior leaders who write off the move toward big data as a lot of big talk are making, well, a big mistake. So argue McKinsey's Barton and Court, who worked with dozens of companies to figure out how to translate advanced analytics into nuts-and-bolts practices that affect daily operations on the front lines. The authors offer a useful guide for leaders and managers who want to take a deliberative approach to big data-but who also want to get started now. First, companies must identify the right data for their business, seek to acquire the information creatively from diverse sources, and secure the necessary IT support. Second, they need to build analytics models that are tightly focused on improving performance, making the models only as complex as business goals demand. Third, and most important, companies must transform their capabilities and culture so that the analytical results can be implemented from the C-suite to the front lines. That means developing simple tools that everyone in the organization can understand and teaching people why the data really matter. Embracing big data is as much about changing mind-sets as it is about crunching numbers. Executed with the right care and flexibility, this cultural shift could have payoffs that are, well, bigger than you expect.

  5. Advanced Team Decision Making: A Developmental Model

    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

  6. Prognostic significance of obstructive uropathy in advanced prostate cancer.

    Oefelein, Michael G

    2004-06-01

    To report the incidence and prognostic implications of obstructive uropathy (OU) in patients with advanced prostate cancer receiving androgen deprivation therapy and to define the impact initial local therapy has on the development of OU in patients with prostate cancer who develop recurrence and begin androgen deprivation therapy. From a population of 260 patients with advanced prostate cancer diagnosed between 1986 and 2003, OU was identified in 51 patients. The OU treatment options included ureteral stent, percutaneous nephrostomy, transurethral resection of the prostate, Foley catheter placement, and urinary diversion. Overall survival and the factors that influenced survival were calculated using standard statistical methods. OU was diagnosed in 15 (16%) of 80 patients who received local therapy with curative intent and in whom local therapy subsequently failed and in 36 (19%) of 180 patients who had never received local therapy (P = 0.7, chi-square test). Of these 51 patients, 39 had bladder neck obstruction and 16 had ureteral obstruction. Overall survival was significantly worse for the men with OU compared with those without OU (41 versus 54 months). OU was associated with tumor stage and androgen-insensitive prostate cancer. OU results in significantly reduced survival in men with prostate cancer. In a select group of patients with prostate cancer with progression after local therapy (primarily radiotherapy), no statistically significant reduction in the development of OU was observed relative to patients matched for stage, grade, and pretreatment prostate-specific antigen level treated with androgen deprivation therapy alone. Aggressive advanced stage and hormone-insensitive disease are variables associated with OU.

  7. Advanced method for making vitreous waste forms

    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

  8. Prognostic significance of symptoms of hospitalised advanced cancer patients

    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.

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

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

    2010-04-01

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

  10. 7 CFR 1486.406 - Will CCC make advance payments to Recipients?

    2010-01-01

    ... 7 Agriculture 10 2010-01-01 2010-01-01 false Will CCC make advance payments to Recipients? 1486... PROGRAM Contributions and Reimbursements § 1486.406 Will CCC make advance payments to Recipients? (a... may make advance payments to a Recipient against an approved project budget. Up to 40 percent of the...

  11. Advancing in the Career Decision-Making Process: The Role of Coping Strategies and Career Decision-Making Profiles

    Perez, Maya; Gati, Itamar

    2017-01-01

    We tested the associations among the career decision-making difficulties, the career decision status, and either (a) the career decision-making profiles of 575 young adults, or (b) the coping strategies of 379 young adults. As hypothesized, a more advanced decision status was negatively associated with both career decision-making difficulties…

  12. 7 CFR 1484.57 - Will FAS make advance payments to a Cooperator?

    2010-01-01

    ... 7 Agriculture 10 2010-01-01 2010-01-01 false Will FAS make advance payments to a Cooperator? 1484... large cost item. FAS will provide this type of advance expense payment in lieu of direct payments by FAS... to protect FAS' financial interests. FAS will not make any special advance payment to a Cooperator...

  13. The Effects of Advanced 'Glass Cockpit' Displayed Flight Instrumentation on In-flight Pilot Decision Making

    Steigerwald, John

    The Cognitive Continuum Theory (CCT) was first proposed 25 years ago to explain the relationship between intuition and analytical decision making processes. In order for aircraft pilots to make these analytical and intuitive decisions, they obtain information from various instruments within the cockpit of the aircraft. Advanced instrumentation is used to provide a broad array of information about the aircraft condition and flight situation to aid the flight crew in making effective decisions. The problem addressed is that advanced instrumentation has not improved the pilot decision making in modern aircraft. Because making a decision is dependent upon the information available, this experimental quantitative study sought to determine how well pilots organize and interpret information obtained from various cockpit instrumentation displays when under time pressure. The population for this study was the students, flight instructors, and aviation faculty at the Middle Georgia State College School of Aviation campus in Eastman, Georgia. The sample was comprised of two groups of 90 individuals (45 in each group) in various stages of pilot licensure from student pilot to airline transport pilot (ATP). The ages ranged from 18 to 55 years old. There was a statistically significant relationship at the p safety of flight.

  14. Decision making in advanced otosclerosis: an evidence-based strategy

    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

  15. Deep Brain Stimulation Target Selection in an Advanced Parkinson's Disease Patient with Significant Tremor and Comorbid Depression

    Amar S. Patel

    2017-04-01

    Full Text Available Clinical Vignette: A 67-year-old female with advanced Parkinson's disease (PD, medically refractory tremor, and a history of significant depression presents for evaluation of deep brain stimulation (DBS candidacy.  Clinical Dilemma: Traditionally, stimulation of the subthalamic nucleus (STN has been the preferred target for patients with significant PD tremor. However, STN stimulation is avoided in patients with a significant pre-surgical history of mood disorder.  Clinical Solution: Bilateral DBS of the globus pallidus interna led to significant short term improvement in PD motor symptoms, including significant tremor reduction.  Gap in Knowledge: There is insufficient evidence to support or refute clinicians' traditional preference for STN stimulation in treating refractory PD tremor. Similarly, the available evidence for risk of worsening depression and/or suicidality after STN DBS is mixed. Both questions require further clarification to guide patient and clinician decision-making.

  16. Advances in fuzzy decision making theory and practice

    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.

  17. Agronomic Performance and Bread Making Quality of Advanced ...

    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 ...

  18. Making a measurable difference in advanced Huntington disease care.

    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.

  19. Improving Decision Making for Advanced Heart Failure Patients and Caregivers.

    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.

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

    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.)

  1. Advanced text and video analytics for proactive decision making

    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.

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

    Peicius, Eimantas; Blazeviciene, Aurelija; Kaminskas, Raimondas

    2017-06-05

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

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

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

    2013-01-01

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

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

    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.

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

    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.

  6. 12 CFR 926.2 - Bank authority to make advances to housing associates.

    2010-01-01

    ... 12 Banks and Banking 7 2010-01-01 2010-01-01 false Bank authority to make advances to housing associates. 926.2 Section 926.2 Banks and Banking FEDERAL HOUSING FINANCE BOARD FEDERAL HOME LOAN BANK MEMBERS AND HOUSING ASSOCIATES FEDERAL HOME LOAN BANK HOUSING ASSOCIATES § 926.2 Bank authority to make...

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

    Jegede, Ayodele Samuel; Adegoke, Olufunke Olufunsho

    2016-11-01

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

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

    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

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

    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

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

    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

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

    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.

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

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

    2018-01-01

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

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

    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

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

    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.

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

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

    2017-07-11

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

  16. The presence of advanced lesions and associating risk factors for advanced cervical carcinoma in patients with atypical sguamous cells of undetermined significance.

    Sun, L L; Chen, W; Fan, Y Y; Wang, M L; Wang, L N

    2015-01-01

    To characterize histopathological status, high-risk human papillomavirus (hr-HPV) infection status, and associated risk factors in patients with atypical squamous cells of undetermined significance (ASCUS). Cervical biopsies obtained from 130 ASCUS patients were subjected to histopathological examination and hr-HPV testing. Associations between advanced lesions and hr-HPV load or age were analyzed, and the confounding factors for high-grade cervical lesions were identified. Cervical biopsies from ASCUS patients had a wide range of pathological states, ranging from normal to invasive cervical carcinoma. High-risk HPV infection was significantly associated with advanced cervical lesions in ASCUS patients; hr-HPV infection and the number of gestations were risk factors for developing advanced cervical disease. A significant portion of ASCUS patients harbor advanced cervical lesions. The number of gestations and hr-HPV infection can increase the risk of developing advanced cervical lesions in ASCUS patients.

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

    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,…

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

    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 ...

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

    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

  20. The Need for Advanced Public Transport Information Services When Making Transfers

    Molin, E.; Chorus, C.; Van Sloten, R.

    2009-01-01

    This paper reports on a stated choice experiment examining the determinants of travelers' need and willingness to pay for advanced public transport information services. Specific attention is given to the role of making transfers in the decision to acquire specific types of information. Intercity

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

    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

  2. Antimicrobial Resistance Patterns in Women with Positive Urine Culture: Does Menopausal Status Make a Significant Difference?

    Pawel Miotla

    2017-01-01

    Full Text Available Aim. Urinary tract infection (UTI is considered one of the most common bacterial infections in women. The aim of this study was to investigate the types of uropathogens present, as well as the degree of antimicrobial drug resistance seen among premenopausal (n=2748 and postmenopausal (n=1705 women with uncomplicated UTI. Methods. Urinary samples (n=4453 collected from women with UTI were analyzed in terms of uropathogens present. These were considered as positive if bacterial growth was ≥105 colony forming units (CFUs/mL. Susceptibility and resistance testing for commonly used antibiotics was subsequently assessed. Results. The most common uropathogens cultured from urine samples were Escherichia coli (65.5%, followed by Enterococcus faecalis (12.2%, Klebsiella pneumoniae (4.7%, and Proteus mirabilis (4.2%. The resistance to ampicillin exceeded 40%, independently of menopausal status. Of note, resistance to ciprofloxacin exceeded 25% among postmenopausal patients. Moreover, resistance of all uropathogens to commonly used antimicrobials was significantly higher in postmenopausal women. Conclusion. Due to the high resistance rate, ampicillin, ciprofloxacin, and the trimethoprim/sulfamethoxazole combination should be avoided in treating postmenopausal women affected by UTI without being indicated by initial urine culture report. Finally, cephalexin and cefuroxime are promising alternatives as initial treatment in postmenopausal women.

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

    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.

  4. Advances in Multiple Criteria Decision Making for Sustainability: Modeling and Applications

    Kao-Yi Shen

    2018-05-01

    Full Text Available With the surging complexity of real-world problems in important domains such as sustainability, there is a need to leverage advanced modern computational methods or intelligent techniques to support decisions or policy-making. In this Special Issue, 15 selected and formally peer-reviewed papers contribute their novelty and findings, by applying various advanced decision methods or computational techniques to resolve different sustainability problems. Despite the innovations of the proposed models, most of the selected papers involve domain expert’s opinions and knowledge with in-depth discussions. These case studies enrich the practical contributions of this Special Issue.

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

    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.

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

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

    2005-10-01

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

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

    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)

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

    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.

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

    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

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

    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.

  11. Staging laparoscopy improves treatment decision-making for advanced gastric cancer.

    Hu, Yan-Feng; Deng, Zhen-Wei; Liu, Hao; Mou, Ting-Yu; Chen, Tao; Lu, Xin; Wang, Da; Yu, Jiang; Li, Guo-Xin

    2016-02-07

    To evaluate the clinical value of staging laparoscopy in treatment decision-making for advanced gastric cancer (GC). Clinical data of 582 patients with advanced GC were retrospectively analyzed. All patients underwent staging laparoscopy. The strength of agreement between computed tomography (CT) stage, endoscopic ultrasound (EUS) stage, laparoscopic stage, and final stage were determined by weighted Kappa statistic (Kw). The number of patients with treatment decision-changes was counted. A χ(2) test was used to analyze the correlation between peritoneal metastasis or positive cytology and clinical characteristics. Among the 582 patients, the distributions of pathological T classifications were T2/3 (153, 26.3%), T4a (262, 45.0%), and T4b (167, 28.7%). Treatment plans for 211 (36.3%) patients were changed after staging laparoscopy was performed. Two (10.5%) of 19 patients in M1 regained the opportunity for potential radical resection by staging laparoscopy. Unnecessary laparotomy was avoided in 71 (12.2%) patients. The strength of agreement between preoperative T stage and final T stage was in almost perfect agreement (Kw = 0.838; 95% confidence interval (CI): 0.803-0.872; P advanced GC and decrease unnecessary exploratory laparotomy.

  12. Asthma-COPD overlap syndrome: recent advances in diagnostic criteria and prognostic significance.

    Sorino, Claudio; Scichilone, Nicola; D'Amato, Maria; Patella, Vincenzo; DI Marco, Fabiano

    2017-06-01

    The term asthma-chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS) has been proposed for individuals with features of both asthma and COPD. Several attempts have been done to define ACOS on the basis of medical history, symptoms, and functional findings. The main diagnostic criteria include airflow obstruction with a strong although incomplete reversibility to bronchodilation tests, a significant exposure to cigarette or biomass smoke, and a history of atopy or asthma. Additional diagnostic elements include eosinophilic airway and systemic inflammation, a good response to corticosteroid treatment, and a high concentration of exhaled nitric oxide. ACOS should be distinguished from asthma with not fully reversible bronchial obstruction due to airway remodeling, thus the lack of smoking exposure should exclude the diagnosis of ACOS. In patients without a documented history of asthma before 40 years of age, an increase in FEV1 after bronchodilator >400 mL should be required to diagnose ACOS. ACOS has been found to be associated with impaired physical performance, functional ability, and health-related quality of life. The prevalence of ACOS increases with aging, then it is relatively stable in elderly individuals (>65 years). Long-term mortality of subjects with ACOS is similar to COPD, and worse than asthma and healthy controls. Future research is still needed to improve the understanding and management of ACOS.

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

    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...

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

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

    2013-01-01

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

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

    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

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

    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.

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

    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.

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

    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.

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

    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)

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

    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.

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

    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…

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

    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.

  3. Risk-informed decision making a keystone in advanced safety assessment

    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)

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

    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...

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

    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

  6. Make

    Frauenfelder, Mark

    2012-01-01

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

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

    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.

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

    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.

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

    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.

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

    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.

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

    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...

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

    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.

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

    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 ...

  14. In-Person Communication Between Radiologists and Acute Care Surgeons Leads to Significant Alterations in Surgical Decision Making.

    Dickerson, Elliot C; Alam, Hasan B; Brown, Richard K J; Stojanovska, Jadranka; Davenport, Matthew S

    2016-08-01

    The aim of this study was to determine if direct in-person communication between an acute care surgical team and radiologists alters surgical decision making. Informed consent was waived for this institutional review board-exempt, HIPAA-compliant, prospective quality improvement study. From January 29, 2015 to December 10, 2015, semiweekly rounds lasting approximately 60 min were held between the on-call acute care surgery team (attending surgeon, chief resident, and residents) and one of three expert abdominal radiologists. A comprehensive imaging review was performed of recent and comparison examinations for cases selected by the surgeons in which medical and/or surgical decision making was pending. All reviewed examinations had available finalized reports known to the surgical team. RADPEER interradiologist concordance scores were assigned to all reviewed examinations. The impression and plan of the attending surgeon were recorded before and after each in-person review. One hundred patients were reviewed with 11 attending surgeons. The in-person meetings led to changes in surgeons' diagnostic impressions in 43% (43 of 100) and changes in medical and/or surgical planning in 43% (43 of 100; 20 acute changes, 23 nonacute changes, 19 changes in operative management) of cases. There were major discrepancies (RADPEER score ≥3) between the impression of the reviewing radiologist and the written report in 11% of cases (11 of 100). Targeted in-person collaboration between radiologists and acute care surgeons is associated with substantial and frequent changes in patient management, even when the original written report contains all necessary data. The primary mechanism seems to be promotion of a shared mental model that facilitates the exchange of complex information. Copyright © 2016 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  15. Prognostic significance of fascin expression in advanced colorectal cancer: an immunohistochemical study of colorectal adenomas and adenocarcinomas

    Hashimoto, Yosuke; Skacel, Marek; Lavery, Ian C; Mukherjee, Abir L; Casey, Graham; Adams, Josephine C

    2006-01-01

    Fascin is an actin bundling protein with roles in the formation of cell protrusions and motility of mesenchymal and neuronal cells. Fascin is normally low or absent from epithelia, but is upregulated in several epithelial neoplasms where it may contribute to an invasive phenotype. Here, we report on the prevalence and potential clinical significance of fascin expression in relation to the progression of colorectal adenocarcinoma and to tumor cell proliferation as measured by Ki67 index. Conventional tissue sections of 107 colorectal adenomas and 35 adenocarcinomas were analyzed by immunohistochemistry for fascin and Ki67 expression. Fascin expression and Ki67 proliferation index were also investigated by use of a tissue microarray containing cores from a further 158 colorectal adenocarcinomas and 15 adenomas linked to a CCF, IRB-approved database with a mean of 38 months of clinical follow-up. Survival analysis was carried out by the Kaplan-Meier and Cox regression methods. Fascin was not expressed by the normal colonic epithelium. In conventional sections, 16% of adenomas and 26% of adenocarcinomas showed fascin expression in greater than 10% of the tumor cells. In the clinically-annotated tumors, fascin immunoreactivity was more common in tumors located in the proximal colon (p = 0.009), but was not associated with age, gender, or TNM stage. Patients with stage III/IV adenocarcinomas (n = 62) with strong fascin immunoreactivity had a worse prognosis than patients with low or absent fascin, (3-year overall survival of 11% versus 43% for fascin-negative patients; p = 0.023). In adenomas, fascin and Ki67 tended to be inversely correlated at the cellular level; this trend was less apparent in adenocarcinomas. Fascin is upregulated in a proportion of adenomas, where its expression is often focal. Strong and diffuse expression was seen in a subset of advanced colorectal adenocarcinomas that correlated with shorter survival in stage III and IV patients. Fascin may have

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

    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.

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

    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.

  18. Making a difference? Societal entrepreneurship and its significance for a practical theological ecclesiology in a local Western Cape context

    Ignatius Swart

    2011-10-01

    Full Text Available This article is concerned with the question of whether and how a local church or congregation can, as indissoluble dimension of its vocation as a Christian faith agent, make a difference by influencing the dynamics of social and economic change that are transforming the face and structures of ‘traditional’ social and religious life in its community. Based upon the authors’ own interest in the specific context of the Dutch Reformed congregation of Simondium in the Western Cape and the case study work that they have conducted in this context, an argument about the potential role of this congregation is developed through the conceptual lens of ‘societal entrepreneurship’. After exploring some recent thoughts on this concept in the literature, the authors use the results of their recently conducted case study work to show how the dynamics of a new entrepreneurial drive amongst long-established residents and newcomers in the Simondium region shape the social reality of both the region and the congregation in a forceful way. This insight leads the authors to develop a sociologically and theologically motivated argument about the way in which this changing reality offers newfound opportunities to the Simondium congregation to fulfil its Christian calling. As such, the notion of becoming an ‘entrepreneurial church’ is introduced and a more detailed perspective is offered on those factors that a contextually orientated practical theological ecclesiology should take into account in building the entrepreneurial model in the congregation.

  19. Gluten-free dough-making of specialty breads: Significance of blended starches, flours and additives on dough behaviour.

    Collar, Concha; Conte, Paola; Fadda, Costantino; Piga, Antonio

    2015-10-01

    The capability of different gluten-free (GF) basic formulations made of flour (rice, amaranth and chickpea) and starch (corn and cassava) blends, to make machinable and viscoelastic GF-doughs in absence/presence of single hydrocolloids (guar gum, locust bean and psyllium fibre), proteins (milk and egg white) and surfactants (neutral, anionic and vegetable oil) have been investigated. Macroscopic (high deformation) and macromolecular (small deformation) mechanical, viscometric (gelatinization, pasting, gelling) and thermal (gelatinization, melting, retrogradation) approaches were performed on the different matrices in order to (a) identify similarities and differences in GF-doughs in terms of a small number of rheological and thermal analytical parameters according to the formulations and (b) to assess single and interactive effects of basic ingredients and additives on GF-dough performance to achieve GF-flat breads. Larger values for the static and dynamic mechanical characteristics and higher viscometric profiles during both cooking and cooling corresponded to doughs formulated with guar gum and Psyllium fibre added to rice flour/starch and rice flour/corn starch/chickpea flour, while surfactant- and protein-formulated GF-doughs added to rice flour/starch/amaranth flour based GF-doughs exhibited intermediate and lower values for the mechanical parameters and poorer viscometric profiles. In addition, additive-free formulations exhibited higher values for the temperature of both gelatinization and retrogradation and lower enthalpies for the thermal transitions. Single addition of 10% of either chickpea flour or amaranth flour to rice flour/starch blends provided a large GF-dough hardening effect in presence of corn starch and an intermediate effect in presence of cassava starch (chickpea), and an intermediate reinforcement of GF-dough regardless the source of starch (amaranth). At macromolecular level, both chickpea and amaranth flours, singly added, determined

  20. The need for advanced public transport information services when making transfers

    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

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

    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...

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

    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.

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

    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

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

    Searight, H Russell; Gafford, Jennifer

    2005-07-01

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

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

    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.

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

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

    2012-11-01

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

  7. EU decision-making for marketing authorization of advanced therapy medicinal products: a case study.

    de Wilde, Sofieke; Coppens, Delphi G M; Hoekman, Jarno; de Bruin, Marie L; Leufkens, Hubert G M; Guchelaar, Henk-Jan; Meij, Pauline

    2018-03-21

    A comparative analysis of assessment procedures for authorization of all European Union (EU) applications for advanced therapy medicinal products (ATMPs) shows that negative opinions were associated with a lack of clinical efficacy and identified severe safety risks. Unmet medical need was often considered in positive opinions and outweighed scientific uncertainties. Numerous quality issues illustrate the difficulties in this domain for ATMP development. Altogether, it suggests that setting appropriate standards for ATMP authorization in Europe, similar to elsewhere, is a learning experience. The experimental characteristics of authorized ATMPs urge regulators, industry, and clinical practice to pay accurate attention to post-marketing risk management to limit patient risk. Methodologies for ATMP development and regulatory evaluations need to be continuously evaluated for the field to flourish. Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.

  8. The Experience of Older People in the Shared Decision-Making Process in Advanced Kidney Care

    Jenkins, Karen; McManus, Breeda; Gracey, Brian

    2016-01-01

    Introduction. This qualitative descriptive study was designed to understand the experiences of older people (>70 years) when making a decision about renal replacement therapy. This was a coproduced study, whereby patients and carers were involved in all aspects of the research process. Methods. A Patient and Carer Group undertook volunteer and research training. The group developed the interview questions and interviewed 29 people who had commenced dialysis or made a decision not to have dialysis. Interview data were transcribed and analysed, and common themes were identified. Results. 22 men and 7 women (mean age 77.4 yrs) from two hospitals were interviewed. 18 had chosen haemodialysis, 6 peritoneal dialysis, and 5 supportive care. The majority of patients were involved in the dialysis decision. Most were satisfied with the amount of information that they received, although some identified that the quality of the information could be improved, especially how daily living can be affected by dialysis. Conclusion. Our findings show that overall older patients were involved in the dialysis decision along with their families. Our approach is innovative because it is the first time that patients and carers have been involved in a coproduced study about shared decision-making. PMID:27990438

  9. Autonomic nervous system dynamics for mood and emotional-state recognition significant advances in data acquisition, signal processing and classification

    Valenza, Gaetano

    2014-01-01

    This monograph reports on advances in the measurement and study of autonomic nervous system (ANS) dynamics as a source of reliable and effective markers for mood state recognition and assessment of emotional responses. Its primary impact will be in affective computing and the application of emotion-recognition systems. Applicative studies of biosignals such as: electrocardiograms; electrodermal responses; respiration activity; gaze points; and pupil-size variation are covered in detail, and experimental results explain how to characterize the elicited affective levels and mood states pragmatically and accurately using the information thus extracted from the ANS. Nonlinear signal processing techniques play a crucial role in understanding the ANS physiology underlying superficially noticeable changes and provide important quantifiers of cardiovascular control dynamics. These have prognostic value in both healthy subjects and patients with mood disorders. Moreover, Autonomic Nervous System Dynamics for Mood and ...

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

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

    2014-01-01

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

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

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

    2012-09-01

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

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

    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.

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

    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.

  14. The Story So Far: How Embodied Cognition Advances Our Understanding of Meaning-Making

    Cedric Galetzka

    2017-07-01

    Full Text Available Meaning-making in the brain has become one of the most intensely discussed topics in cognitive science. Traditional theories on cognition that emphasize abstract symbol manipulations often face a dead end: The symbol grounding problem. The embodiment idea tries to overcome this barrier by assuming that the mind is grounded in sensorimotor experiences. A recent surge in behavioral and brain-imaging studies has therefore focused on the role of the motor cortex in language processing. Concrete, action-related words have received convincing evidence to rely on sensorimotor activation. Abstract concepts, however, still pose a distinct challenge for embodied theories on cognition. Fully embodied abstraction mechanisms were formulated but sensorimotor activation alone seems unlikely to close the explanatory gap. In this respect, the idea of integration areas, such as convergence zones or the ‘hub and spoke’ model, do not only appear like the most promising candidates to account for the discrepancies between concrete and abstract concepts but could also help to unite the field of cognitive science again. The current review identifies milestones in cognitive science research and recent achievements that highlight fundamental challenges, key questions and directions for future research.

  15. Advancing an Ethic of Embodied Relational Sexuality to Guide Decision-Making in Dementia Care.

    Grigorovich, Alisa; Kontos, Pia

    2018-03-19

    Sexuality and intimacy are universal needs that transcend age, cognitive decline, and disability; sexuality is a fundamental aspect of the human experience. However, supporting sexuality in long-term residential care presents ethical challenges as this setting is both a home environment for residents and a workplace for health practitioners. This is particularly complex in the case of residents with dementia given the need to balance protection from harm and freedom of self-determination. Despite such complexity, this challenge has received limited critical theoretical attention. The dominant approach advocated to guide ethical reasoning is the bioethical four principles approach. However, the application of this approach in the context of dementia and long-term care may set the bar for practitioners' interference excessively high, restricting assentual (i.e., voluntary) sexual expression. Furthermore, it privileges cognitive and impartial decision-making, while disregarding performative, embodied, and relational aspects of ethical reasoning. With an interest in addressing these limitations, we explicate an alternative ethic of embodied relational sexuality that is grounded in a model of citizenship that recognizes relationality and the agential status of embodied self-expression. This alternative ethic broadens ethical reasoning from the exclusive duty to protect individuals from harm associated with sexual expression, to the duty to also uphold and support their rights to experience the benefits of sexual expression (e.g., pleasure, intimacy). As such it has the potential to inform the development of policies, organizational guidelines, and professional curricula to support the sexuality of persons with dementia, and thereby ensure more humane practices in long-term residential care settings.

  16. ADVANCES IN RENEWAL DECISION-MAKING UTILISING THE PROPORTIONAL HAZARDS MODEL WITH VIBRATION COVARIATES

    Pieter-Jan Vlok

    2012-01-01

    Full Text Available

    ENGLISH ABSTRACT: Increased competitiveness in the production world necessitates improved maintenance strategies to increase availabilities and drive down cost . The maintenance engineer is thus faced with the need to make more intelligent pre ventive renewal decisions . Two of the main techniques to achieve this is through Condition Monitoring (such as vibrat ion monitoring and oil anal ysis and Statistical Failure Analysis (typically using probabilistic techniques . The present paper discusses these techniques, their uses and weaknesses and then presents th e Proportional Hazard Model as an solution to most of these weaknesses. It then goes on to compare the results of the different techniques in monetary terms, using a South African case study. This comparison shows clearly that the Proportional Hazards Model is sup erior to the present t echniques and should be the preferred model for many actual maintenance situations.

    AFRIKAANSE OPSOMMING: Verhoogde vlakke van mededinging in die produksie omgewing noodsaak verbeterde instandhouding strategies om beskikbaarheid van toerusting te verhoog en koste te minimeer. Instandhoudingsingenieurs moet gevolglik meer intellegente voorkomende hernuwings besluite neem. Twee prominente tegnieke om hierdie doelwit te bereik is Toestandsmonitering (soos vibrasie monitering of olie analise en Statistiese Falingsanalise (gewoonlik m.b.v. probabilistiese metodes. In hierdie artikel beskou ons beide hierdie tegnieke, hulle gebruike en tekortkominge en stel dan die Proporsionele Gevaarkoers Model voor as 'n oplossing vir meeste van die tekortkominge. Die artikel vergelyk ook die verskillende tegnieke in geldelike terme deur gebruik te maak van 'n Suid-Afrikaanse gevalle studie. Hierdie vergelyking wys duidelik-uit dat die Proporsionele Gevaarkoers Model groter beloft e inhou as die huidige tegni eke en dat dit die voorkeur oplossing behoort te wees in baie werklike instandhoudings situasies.

  17. Prognostic significance of tissue polypeptidespecific antigen (TPS) in patients with advanced non-small cell lung cancer

    A. van der Gaast (Ate); C.H.H. Schoenmakers (Christian); T.C. Kok (Tjebbe); B.G. Blijenberg (Bert); W.C.J. Hop (Wim); T.A.W. Splinter (Ted)

    1994-01-01

    textabstractIn this study, we evaluated the prognostic value of the tumour marker, tissue polypeptide-specific antigen (TPS), in 203 patients with non-small cell lung cancer (NSCLC), and related this to several other known prognostic factors. TPS was significantly correlated with lactate

  18. Prognostic significance of the number of postoperative intraperitoneal chemotherapy cycles for patients with advanced epithelial ovarian cancer.

    Suidan, Rudy S; Zhou, Qin; Iasonos, Alexia; O'Cearbhaill, Roisin E; Chi, Dennis S; Long Roche, Kara C; Tanner, Edward J; Denesopolis, John; Barakat, Richard R; Zivanovic, Oliver

    2015-05-01

    Phase 3 trials have demonstrated a survival advantage for patients with optimally debulked epithelial ovarian cancer who received intravenous (IV) and intraperitoneal (IP) chemotherapy compared with IV therapy alone. This was despite a significant proportion of patients in the IV/IP arms not completing all 6 planned cycles. Our objective was to evaluate the prognostic significance of the number of IV/IP cycles administered. Data were analyzed for all patients with stage III to IV epithelial ovarian cancer who underwent optimal primary cytoreduction followed by 1 or more cycles of IV/IP chemotherapy from January 2005 to July 2011 at our institution. A landmark analysis was performed to associate progression-free survival (PFS) and overall survival (OS) with the number of IV/IP cycles given. We identified 201 patients; 26 (13%) received 1 to 2 cycles of IV/IP chemotherapy, 41 (20%) received 3 to 4 cycles, and 134 (67%) received 5 to 6 cycles. The 5-year PFS for patients who received 1 to 2, 3 to 4, and 5 to 6 cycles was 18%, 29%, and 17%, respectively. The 5-year OS for patients who received 1 to 2, 3 to 4, and 5 to 6 cycles was 44%, 54%, and 57%, respectively. There was no significant difference in PFS (P = 0.31) or OS (P = 0.14) between the 3 groups. The most common reason for discontinuing IV/IP therapy was treatment-related toxicity (77%). Postoperative complications were the most common reason for not initiating IV/IP therapy (42%) in patients who subsequently transitioned to it. We did not detect a significant survival difference between patients who received 1 to 2, 3 to 4, or 5 to 6 IV/IP chemotherapy cycles. Women may still derive a survival benefit if they receive fewer than 6 IV/IP cycles.

  19. Expression and clinical significance of connective tissue growth factor in advanced head and neck squamous cell cancer.

    Kikuchi, Ryoko; Kikuchi, Yoshihiro; Tsuda, Hitoshi; Maekawa, Hitoshi; Kozaki, Ken-Ichi; Imoto, Issei; Tamai, Seiichi; Shiotani, Akihiro; Iwaya, Keiichi; Sakamoto, Masaru; Sekiya, Takao; Matsubara, Osamu

    2014-07-01

    Connective tissue growth factor (CTGF) has been reported to play critical roles in the tumorigenesis of several human malignancies. This study was performed to evaluate CTGF protein expression in head and neck squamous cell carcinoma (HNSCC). Surgical specimens from 76 primary HNSCC were obtained with written informed consents and the expression level of CTGF was immunohistochemically evaluated. The cytoplasmic immunoreactivity of CTGF in cancer cells was semiquantitatively classified into low and high expression. Among all 76 cases with or without neoadjuvant therapy, low CTGF showed significantly longer (P = 0.0282) overall survival (OS), but not disease-free survival (DFS) than high CTGF. Although low CTGF in patients with stage I, II and III did not result in any significant difference of the OS and DFS, stage IV HNSCC patients with low CTGF showed significantly longer OS (P = 0.032) and DFS (P = 0.0107) than those with high CTGF. These differences in stage IV cases were also confirmed using multivariate analyses. These results suggest that low CTGF in stage IV HNSCC is an independent prognostic factor, despite with or without neoadjuvant therapy.

  20. Advanced Biochemistry Course teach students how to make and criticize science

    A.B Sé

    2006-07-01

    Full Text Available In this work we are reporting a course of University of Brasilia called “Topics in Biochemistry”. It is offered to second semester medicine and nutrition students (around 12 who have just finished the Basic Biochemistry Course (BioBio, plus one or two third semester students, who are taking the course for the second time, as “coordinators”. This course is composed of two parallel activities: weekly meetings for scientific discussions and the peer-tutor activity.In  each  meeting,  one  student  presents  an  article.  The  topics  are  mostly  on  metabolic  biochemistry,  but  can  range from  animal  adaptability  to  Alzheimer  Disease.  The  requisite  is  that  the  article  was  published  in  a  recognized international journal (as Nature, American Journal of Physiology, New England Journal of Medicine and is adequate for group discussion. The emphasis of the discussion is greater on the methodology of science, instead of on specific details  about  particular  subjects.  What  did  the  authors  want  to  prove?  How  did  they  do  it?  Were  the  conclusions valid?  What  were  the  experimental  errors  and  omissions?  How  could  it  be  a  better  article?  Also,  it’s  a  good opportunity  to discuss statistics, methodology, and to exercise  the sense of criticism. Overall, the objective  of these discussions is to teach students how to make science and criticize science. The second attribution of the course is the peer-tutor activity. Each student is responsible for tutoring a BioBio group on a seminar/poster presentation (Hermes-Lima et al., Biochem.  Mol.Biol.Educ. 30: 30-34,2002  and is responsible for evaluating their group, always supervised by the coordinating professor. Moreover, they must elaborate a “true or false” exam (Sé et al. Are tutor-students capable of writing good biochemistry exams? SBBq 2004, abstract K-18

  1. Testing earthquake prediction algorithms: Statistically significant advance prediction of the largest earthquakes in the Circum-Pacific, 1992-1997

    Kossobokov, V.G.; Romashkova, L.L.; Keilis-Borok, V. I.; Healy, J.H.

    1999-01-01

    Algorithms M8 and MSc (i.e., the Mendocino Scenario) were used in a real-time intermediate-term research prediction of the strongest earthquakes in the Circum-Pacific seismic belt. Predictions are made by M8 first. Then, the areas of alarm are reduced by MSc at the cost that some earthquakes are missed in the second approximation of prediction. In 1992-1997, five earthquakes of magnitude 8 and above occurred in the test area: all of them were predicted by M8 and MSc identified correctly the locations of four of them. The space-time volume of the alarms is 36% and 18%, correspondingly, when estimated with a normalized product measure of empirical distribution of epicenters and uniform time. The statistical significance of the achieved results is beyond 99% both for M8 and MSc. For magnitude 7.5 + , 10 out of 19 earthquakes were predicted by M8 in 40% and five were predicted by M8-MSc in 13% of the total volume considered. This implies a significance level of 81% for M8 and 92% for M8-MSc. The lower significance levels might result from a global change in seismic regime in 1993-1996, when the rate of the largest events has doubled and all of them become exclusively normal or reversed faults. The predictions are fully reproducible; the algorithms M8 and MSc in complete formal definitions were published before we started our experiment [Keilis-Borok, V.I., Kossobokov, V.G., 1990. Premonitory activation of seismic flow: Algorithm M8, Phys. Earth and Planet. Inter. 61, 73-83; Kossobokov, V.G., Keilis-Borok, V.I., Smith, S.W., 1990. Localization of intermediate-term earthquake prediction, J. Geophys. Res., 95, 19763-19772; Healy, J.H., Kossobokov, V.G., Dewey, J.W., 1992. A test to evaluate the earthquake prediction algorithm, M8. U.S. Geol. Surv. OFR 92-401]. M8 is available from the IASPEI Software Library [Healy, J.H., Keilis-Borok, V.I., Lee, W.H.K. (Eds.), 1997. Algorithms for Earthquake Statistics and Prediction, Vol. 6. IASPEI Software Library]. ?? 1999 Elsevier

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

    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.

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

    Gergel, Tania; Owen, Gareth S

    2015-01-01

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

  4. 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.

    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.

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

    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

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

    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

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

    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)

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

    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

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

    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

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

    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

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

    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

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

    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.

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

    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

  14. Physician perspectives and compliance with patient advance directives: the role external factors play on physician decision making.

    Burkle, Christopher M; Mueller, Paul S; Swetz, Keith M; Hook, C Christopher; Keegan, Mark T

    2012-11-21

    Following passage of the Patient Self Determination Act in 1990, health care institutions that receive Medicare and Medicaid funding are required to inform patients of their right to make their health care preferences known through execution of a living will and/or to appoint a surrogate-decision maker. We evaluated the impact of external factors and perceived patient preferences on physicians' decisions to honor or forgo previously established advance directives (ADs). In addition, physician views regarding legal risk, patients' ability to comprehend complexities involved with their care, and impact of medical costs related to end-of-life care decisions were explored. Attendees of two Mayo Clinic continuing medical education courses were surveyed. Three scenarios based in part on previously court-litigated matters assessed impact of external factors and perceived patient preferences on physician compliance with patient-articulated wishes regarding resuscitation. General questions measured respondents' perception of legal risk, concerns over patient knowledge of idiosyncrasies involved with their care, and impact medical costs may have on compliance with patient preferences. Responses indicating strength of agreement or disagreement with statements were treated as ordinal data and analyzed using the Cochran Armitage trend test. Three hundred eighty-eight of 951 surveys were completed (41% response rate). Eighty percent reported they were likely to honor a patient's AD despite its 5 year age. Fewer than half (41%) would honor the AD of a patient in ventricular fibrillation who had expressed a desire to "pass away in peace." Few (17%) would forgo an AD following a family's request for continued resuscitative treatment. A majority (52%) considered risk of liability to be lower when maintaining someone alive against their wishes than mistakenly failing to provide resuscitative efforts. A large percentage (74%) disagreed that patients could not appreciate complexities

  15. Physician perspectives and compliance with patient advance directives: the role external factors play on physician decision making

    Burkle Christopher M

    2012-11-01

    Full Text Available Abstract Background Following passage of the Patient Self Determination Act in 1990, health care institutions that receive Medicare and Medicaid funding are required to inform patients of their right to make their health care preferences known through execution of a living will and/or to appoint a surrogate-decision maker. We evaluated the impact of external factors and perceived patient preferences on physicians’ decisions to honor or forgo previously established advance directives (ADs. In addition, physician views regarding legal risk, patients’ ability to comprehend complexities involved with their care, and impact of medical costs related to end-of-life care decisions were explored. Methods Attendees of two Mayo Clinic continuing medical education courses were surveyed. Three scenarios based in part on previously court-litigated matters assessed impact of external factors and perceived patient preferences on physician compliance with patient-articulated wishes regarding resuscitation. General questions measured respondents’ perception of legal risk, concerns over patient knowledge of idiosyncrasies involved with their care, and impact medical costs may have on compliance with patient preferences. Responses indicating strength of agreement or disagreement with statements were treated as ordinal data and analyzed using the Cochran Armitage trend test. Results Three hundred eighty-eight of 951 surveys were completed (41% response rate. Eighty percent reported they were likely to honor a patient’s AD despite its 5 year age. Fewer than half (41% would honor the AD of a patient in ventricular fibrillation who had expressed a desire to “pass away in peace.” Few (17% would forgo an AD following a family’s request for continued resuscitative treatment. A majority (52% considered risk of liability to be lower when maintaining someone alive against their wishes than mistakenly failing to provide resuscitative efforts. A large percentage

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

    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.

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

    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

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

    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.

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

    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.

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

    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.

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

    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

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

    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.

  3. Optical Measurement Technologies for High Temperature, Radiation Exposure, and Corrosive Environments—Significant Activities and Findings: In-vessel Optical Measurements for Advanced SMRs

    Anheier, Norman C.; Cannon, Bret D.; Qiao, Hong (Amy); Suter, Jonathan D.

    2012-09-01

    Development of advanced Small Modular Reactors (aSMRs) is key to providing the United States with a sustainable, economically viable, and carbon-neutral energy source. The aSMR designs have attractive economic factors that should compensate for the economies of scale that have driven development of large commercial nuclear power plants to date. For example, aSMRs can be manufactured at reduced capital costs in a factory and potentially shorter lead times and then be shipped to a site to provide power away from large grid systems. The integral, self-contained nature of aSMR designs is fundamentally different than conventional reactor designs. Future aSMR deployment will require new instrumentation and control (I&C) architectures to accommodate the integral design and withstand the extreme in-vessel environmental conditions. Operators will depend on sophisticated sensing and machine vision technologies that provide efficient human-machine interface for in-vessel telepresence, telerobotic control, and remote process operations. The future viability of aSMRs is dependent on understanding and overcoming the significant technical challenges involving in-vessel reactor sensing and monitoring under extreme temperatures, pressures, corrosive environments, and radiation fluxes

  4. Evaluating a Teaching Module on Ethically Responsible Evidence-Based Practice Decision Making in an Advanced Micro Practice Course

    Wong, Rose

    2017-01-01

    This article adds to the growing body of literature on the use of evidence-based practice (EBP) in social work. Specifically, it examines a 9-hour EBP educational model designed to prepare MSW students for appropriate decision-making strategies in working with multicultural client populations. The model places emphasis on identification and…

  5. 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.

    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.

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

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

    2012-09-01

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

  7. Mothering With Advanced Ovarian Cancer: "You've Got to Find That Little Thing That's Going to Make You Strong".

    Arida, Janet A; Bressler, Toby; Moran, Samantha; DʼArpino, Sara; Carr, Alaina; Hagan, Teresa L

    2018-02-27

    Mothers with ovarian cancer are at risk of experiencing additional demands given their substantial symptom burden and accelerated disease progression. This study describes the experience of mothers with ovarian cancer, elucidating the interaction between their roles as mothers and patients with cancer. We conducted a secondary analysis of focus groups with women with advanced ovarian cancer. Using descriptive coding, we developed a coding framework based on emerging findings and group consensus. We then identified higher-order themes capturing the breadth of experiences described by mothers with ovarian cancer. Eight of the 13 participants discussed motherhood. The mean age of participants was 48.38 (SD, 7.17) years. All women were white (9/9), most had some college education (6/9), and the majority were married (5/9). Mean time since diagnosis was 7.43 (SD, 4.69) months; more than half of women (5/9) were currently receiving treatment. Themes and exemplar quotes reflected participants' evolving self-identities from healthy mother to cancer patient to woman mothering with cancer. Subthemes related to how motherhood was impacted by symptoms, demands of treatment, and the need to gain acceptance of living with cancer. The experience of motherhood impacts how women experience cancer and how they evolve as survivors. Similarly, cancer influences mothering. Healthcare providers should understand and address the needs of mothers with ovarian cancer. This study adds to the limited literature in this area and offers insight into the unique needs faced by women mothering while facing advanced cancer.

  8. Avoiding delayed diagnosis of significant blunt bowel and mesenteric injuries: Can a scoring tool make the difference? A 7-year retrospective cohort study.

    Zingg, Tobias; Agri, Fabio; Bourgeat, Mylène; Yersin, Bertrand; Romain, Benoît; Schmidt, Sabine; Keller, Nathalie; Demartines, Nicolas

    2018-01-01

    Significant blunt bowel and mesenteric injuries (sBBMI) are frequently missed despite the widespread use of computed tomography (CT). Early treatment improves the outcome related to these injuries. The aim of this study was to assess the prevalence of sBBMI, the incidence of delayed diagnosis and to test the performance of the Bowel Injury Prediction Score (BIPS), determined by the white blood cell (WBC) count, presence or absence of abdominal tenderness and CT grade of mesenteric injury. Single-centre, registry-based retrospective cohort study, screening all consecutive trauma patients admitted to Lausanne University Hospital Trauma Centre from 2008 to 2015 after a road traffic accident. All patients with reliable information about the presence or absence of sBBMI who underwent abdominal CT and for whom calculation of the BIPS was possible were included for analysis. The incidence of delayed (>24h after admission) diagnosis in the patient group with sBBMI was determined and the diagnostic performance of the BIPS for sBBMI was assessed. For analysis, 766 patients with reliable information about the presence or absence of sBBMI were included. The prevalence of sBBMI was 3.1% (24/766). In 24% (5/21) of stable trauma patients undergoing CT, a diagnostic delay of more than 24h occurred. Abdominal tenderness (p<0.0001) and CT grade ≥4 (p<0.0001) were associated with sBBMI, whereas CT grade 4 alone (p=0.93) and WBC count ≥17G/l (p=0.30) were not. A BIPS ≥2 had a sensitivity of 89% (95% CI, 67-99), specificity of 89% (95% CI, 86-91), positive likelihood ratio of 8 (95% CI, 6.1-10), negative likelihood ratio of 0.12 (95% CI, 0.03-0.44), positive predictive value (PPV) of 19% (95% CI, 15-24) and negative predictive value (NPV) of 99.7% (95% CI, 98.7-99.9). CT alone identified 79% (15/19) and the BIPS 89% (17/19) of patients with sBBMI (p=0.66). Diagnostic delays in patients with sBBMI are common (24%), despite the routine use of abdominal CT. Application of the BIPS

  9. Advanced Genetic Testing Comes to the Pain Clinic to Make a Diagnosis of Paroxysmal Extreme Pain Disorder

    Ashley Cannon

    2016-01-01

    Full Text Available Objective. To describe the use of an advanced genetic testing technique, whole exome sequencing, to diagnose a patient and their family with a SCN9A channelopathy. Setting. Academic tertiary care center. Design. Case report. Case Report. A 61-year-old female with a history of acute facial pain, chronic pain, fibromyalgia, and constipation was found to have a gain of function SCN9A mutation by whole exome sequencing. This mutation resulted in an SCN9A channelopathy that is most consistent with a diagnosis of paroxysmal extreme pain disorder. In addition to the patient being diagnosed, four siblings have a clinical diagnosis of SCN9A channelopathy as they have consistent symptoms and a sister with a known mutation. For treatment, gabapentin was ineffective and carbamazepine was not tolerated. Nontraditional therapies improved symptoms and constipation resolved with pelvic floor retraining with biofeedback. Conclusion. Patients with a personal and family history of chronic pain may benefit from a referral to Medical Genetics. Pelvic floor retraining with biofeedback should be considered for patients with a SCN9A channelopathy and constipation.

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

    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.

  11. Deletion in HSP110 T17: correlation with wild-type HSP110 expression and prognostic significance in microsatellite-unstable advanced gastric cancers.

    Kim, Kyung-Ju; Lee, Tae Hun; Kim, Jung Ho; Cho, Nam-Yun; Kim, Woo Ho; Kang, Gyeong Hoon

    2017-09-01

    Deletion of the HSP110 T 17 mononucleotide repeat has recently been identified as a prognostic marker that is correlated with wild-type HSP110 (HSP110wt) expression in microsatellite instability-high (MSI-H) colorectal cancers. The aim of this study was to assess the correlation between deletion of the HSP110 T 17 repeat and expression of HSP110wt using DNA testing and immunohistochemistry and to determine the prognostic implications of HSP110 T 17 deletion in MSI-H advanced gastric cancers (GCs). The status of HSP110wt expression was evaluated by immunohistochemistry using an HSP110wt-specific antibody in 142 MSI-H advanced GCs. The size of the HSP110 T 17 repeat deletion was analyzed in 96 MSI-H advanced GCs; deletions were divided into small (0-2base pairs) and large deletions (3-5base pairs). Low and high expressions of HSP110wt were detected in 38 (26.8%) and 104 (73.2%) of the 142 cases, respectively. The HSP110 T 17 deletion was observed in 45 (46.9%) of the 96 MSI-H GC samples. Tumors with high expression of HSP110wt showed a tendency to have small or no deletion of HSP110 T 17 . In Kaplan-Meier survival analysis, tumors with a large HSP110 T 17 deletion were associated with favorable overall survival and disease-free survival compared with those with small/no deletion of HSP110 T 17 . However, HSP110 T 17 deletion size was not an independent prognostic factor in multivariate analysis. In summary, deletion of the HSP110 T 17 repeat was frequently observed in MSI-H GCs, and HSP110 T 17 deletion size was inversely correlated with HSP110wt expression status. Large HSP110 T 17 was not a prognostic indicator in MSI-H GCs. Copyright © 2017 Elsevier Inc. All rights reserved.

  12. Safety assessment of nanomaterials using an advanced decision-making framework, the DF4nanoGrouping

    Landsiedel, Robert; Ma-Hock, Lan; Wiench, Karin; Wohlleben, Wendel; Sauer, Ursula G.

    2017-05-01

    As presented at the 2016 TechConnect World Innovation Conference on 22-25 May 2016 in Washington DC, USA, the European Centre for Ecotoxicology and Toxicology of Chemicals (ECETOC) `Nano Task Force' proposes a Decision-making framework for the grouping and testing of nanomaterials (DF4nanoGrouping) consisting of three tiers to assign nanomaterials to four main groups with possible further subgrouping to refine specific information needs. The DF4nanoGrouping covers all relevant aspects of a nanomaterial's life cycle and biological pathways: intrinsic material properties and system-dependent properties (that depend upon the nanomaterial's respective surroundings), biopersistence, uptake and biodistribution, and cellular and apical toxic effects. Use, release, and exposure route may be applied as `qualifiers' to determine if, e.g., nanomaterials cannot be released from products, which may justify waiving of testing. The four main groups encompass (1) soluble, (2) biopersistent high aspect ratio, (3) passive, and (4) active nanomaterials. The DF4nanoGrouping foresees a stepwise evaluation of nanomaterial properties and effects with increasing biological complexity. In case studies covering carbonaceous nanomaterials, metal oxide, and metal sulfate nanomaterials, amorphous silica and organic pigments (all nanomaterials having primary particle sizes below 100 nm), the usefulness of the DF4nanoGrouping for nanomaterial hazard assessment was confirmed. The DF4nanoGrouping facilitates grouping and targeted testing of nanomaterials. It ensures that sufficient data for the risk assessment of a nanomaterial are available, and it fosters the use of non-animal methods. No studies are performed that do not provide crucial data. Thereby, the DF4nanoGrouping serves to save both animals and resources.

  13. Making a More Significant Impact on Society.

    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)

  14. Decision Making

    Pier Luigi Baldi

    2006-06-01

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

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

    Kim, Eun Young; Kim, Nambeom; Kim, Young Saing; Seo, Ja-Young; Park, Inkeun; Ahn, Hee Kyung; Jeong, Yu Mi; Kim, Jeong Ho

    2016-01-01

    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 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 ALI using BMI. ALI is a simple and useful prognostic indicator in SCLC.

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

    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.

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

    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.

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

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

    2015-11-01

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

  19. U.S. Geological Survey assessment of global potash production and resources—A significant advancement for global development and a sustainable future.

    Cocker, Mark D.; Orris, Greta J.; Wynn, Jeff

    2016-01-01

    During the past 15 yr, the global requirement for fertilizers has grown considerably, mainly due to demand by a larger and wealthier world population for more and higher-quality food. The demand and price for potash as a primary fertilizer ingredient have increased in tandem, because of the necessity to increase the quantity and quality of food production on the decreasing amount of available arable land. The primary sources of potash are evaporates, which occur mainly in marine salt basins and a few brine-bearing continental basins. World potash resources are large, but distribution is inequitable and not presently developed in countries where population and food requirements are large and increasing. There is no known substitute for potash in fertilizer, so knowledge of the world’s potash resources is critical for a sustainable future. The U.S. Geological Survey recently completed a global assessment of evaporite-hosted potash resources, which included a geographic information system–based inventory of known potash resources. This assessment included permissive areas or tracts for undiscovered resources at a scale of 1:1,000,000. Assessments of undiscovered potash resources were conducted for a number of the world’s evaporite-hosted potash basins. The data collected provide a major advance in our knowledge of global potash resources that did not exist prior to this study. The two databases include: (1) potash deposits and occurrences, and (2) potash tracts (basins that contain these deposits and occurrences and potentially undiscovered potash deposits). Data available include geology, mineralogy, grade, tonnage, depth, thickness, areal extent, and structure, as well as numerous pertinent references.

  20. 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

    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.

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

    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

  2. Prognostic significance of pretherapeutic and therapeutic factors in patients with advanced cancer of the uterine cervix treated with radical radiotherapy alone

    Karolewski, K.; Korzeniowski, S.; Urbanski, K.; Kojs, Z. [Centre of Oncology, Maia Sklodowska-Curie Memorial Inst., Krakow (Poland); Sokolowski, A. [Dept. of Statistics, Cracow Univ. of Economics (Poland)

    1999-11-01

    The prognostic importance of various pretherapeutic and therapeutic factors was analysed in a group of 413 cervical cancer patients with stage IIB (183 pts) and IIIB (230 pts) treated with radical radiotherapy, which consisted of external irradiation and intracavitary brachytherapy. Univariate analysis of pretherapeutic factors revealed the prognostic significance of patient age, history of abortion, stage, haemoglobin and hematocrit levels. Five-year overall survival rate in stage IIB patients was 51% in stage IIIB 40% and the respective rates for local control at each stage were 61%, and 46%. Univariate analysis of therapeutic factors showed that survival and local control rates increased with the dose, but a significant difference was found only in the case of a paracentral (point A) dose. In a multivariate analysis only patient age, abortions, and clinical stage appeared to have a significant and independent impact on survival. Linear regression analysis results indicated that prolongation of treatment time between 33 and 108 days caused a loss of local control of 0.36% per day. (orig.)

  3. DEVELOPMENT OF A NOVEL RADIATIVELY/CONDUCTIVELY STABILIZED BURNER FOR SIGNIFICANT REDUCTION OF NOx EMISSIONS AND FOR ADVANCING THE MODELING AND UNDERSTANDING OF PULVERIZED COAL COMBUSTION AND EMISSIONS

    Noam Lior; Stuart W. Churchill

    2003-10-01

    The primary objective of the proposed study was the study and analysis of, and design recommendations for, a novel radiatively-conductively stabilized combustion (RCSC) process for pulverized coal, which, based on our prior studies with both fluid fuels and pulverized coal, holds a high promise to reduce NO{sub x} production significantly. We have primarily engaged in continuing and improving our process modeling and analysis, obtained a large amount of quantitative information about the effects of the major parameters on NO{sub x} production, conducted an extensive exergy analysis of the process, evaluated the practicalities of employing the Radiatively-Conductively Stabilized Combustor (RCSC) to large power and heat plants, and improved the experimental facility. Prior experimental work has proven the feasibility of the combustor, but slagging during coal combustion was observed and should be dealt with. The primary outcomes and conclusions from the study are: (1) we developed a model and computer program that represents the pulverized coal combustion in the RCSC, (2) the model predicts that NO{sub x} emissions can be reduced by a number of methods, detailed in the report. (3) the exergy analysis points out at least a couple of possible ways to improve the exergetic efficiency in this combustor: increasing the effectiveness of thermal feedback, and adjusting the combustor mixture exit location, (4) because of the low coal flow rates necessitated in this study to obtain complete combustion in the burner, the size of a burner operating under the considered conditions would have to be up to an order of magnitude, larger than comparable commercial burners, but different flow configurations of the RCSC can yield higher feed rates and smaller dimensions, and should be investigated. Related to this contract, eleven papers were published in journals and conference proceedings, and ten invited presentations were given at university and research institutions, as well as at

  4. End-to-end models for marine ecosystems: Are we on the precipice of a significant advance or just putting lipstick on a pig?

    Kenneth A. Rose

    2012-02-01

    Full Text Available There has been a rapid rise in the development of end-to-end models for marine ecosystems over the past decade. Some reasons for this rise include need for predicting effects of climate change on biota and dissatisfaction with existing models. While the benefits of a well-implemented end-to-end model are straightforward, there are many challenges. In the short term, my view is that the major role of end-to-end models is to push the modelling community forward, and to identify critical data so that these data can be collected now and thus be available for the next generation of end-to-end models. I think we should emulate physicists and build theoretically-oriented models first, and then collect the data. In the long-term, end-to-end models will increase their skill, data collection will catch up, and end-to-end models will move towards site-specific applications with forecasting and management capabilities. One pathway into the future is individual efforts, over-promise, and repackaging of poorly performing component submodels (“lipstick on a pig”. The other pathway is a community-based collaborative effort, with appropriate caution and thoughtfulness, so that the needed improvements are achieved (“significant advance”. The promise of end-to-end modelling is great. We should act now to avoid missing a great opportunity.

  5. US energy agency making progress

    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.

  6. 'Informed and uninformed decision making'--women's reasoning, experiences and perceptions with regard to advanced maternal age and delayed childbearing: a meta-synthesis.

    Cooke, Alison; Mills, Tracey A; Lavender, Tina

    2010-10-01

    To identify what factors affect women's decisions to delay childbearing, and to explore women's experiences and their perceptions of associated risks. Systematic procedures were used for search strategy, study selection, data extraction and analysis. Findings were synthesised using an approach developed from meta-ethnography. We included qualitative papers, not confined to geographical area (1980-2009). Databases included CINAHL, MEDLINE, EMBASE, PsycInfo, ASSIA, MIDIRS, British Nursing Index and the National Research Register. We selected qualitative empirical studies exploring the views and experiences of women of advanced maternal age who were childless or primigravidae with a singleton pregnancy or primiparous. Twelve papers fulfilled the selection criteria and were included for synthesis. Women appear to face an issue of 'informed and uninformed decision making'; those who believe they are informed but may not be, those who are not informed and find out they are at risk once pregnant, and those who are well informed but choose to delay pregnancy anyway. Maternity services could provide information to enable informed choice regarding timing of childbearing. Health professionals need to be mindful of the fact that women delay childbearing for various reasons. A strategy of pre-conception education may be beneficial in informing childbearing decisions. Obstetricians and midwives should be sensitive to the fact that women may not be aware of all the risks associated with delayed childbearing. Copyright (c) 2010 Elsevier Ltd. All rights reserved.

  7. Advanced Surface Technology

    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...

  8. “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

    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.

  9. 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

    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.

  10. 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.

    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.

  11. ADVANCE PAYMENTS

    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

  12. Advance payments

    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

  13. NASA Advanced Supercomputing Facility Expansion

    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.

  14. AdvancED Flex 4

    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

  15. Research Advances. Image Pinpoints All 5 Million Atoms in Viral Coat; Bilirubin, "Animals-Only" Pigment, Found in Plants; New Evidence Shows Humans Make Salicylic Acid

    King, Angela G.

    2009-08-01

    Recent "firsts" in chemical research: image of a viral capsid pinpointing 5 million atoms; isolation and identification of an "animal" pigment, bilirubin, from a plant source; evidence that humans make salicylic acid.

  16. Detecting Novelty and Significance

    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

  17. Making the most of limited data in the evaluation of advanced traveler information services (ATIS) through experimental resampling : Cincinnati case study

    2004-02-01

    Researchers and practitioners are commonly faced with the problem of limited data in the evaluation of ITS systems. Due to high data collection costs and limited resources, they are often forced to make decisions about the efficacy of a system or tec...

  18. Advanced research workshop "South Caucasus : making the best use of external assistance for stability building and for co-operation with NATO"

    2003-01-01

    Leedu Kaitseministeeriumi poolt 22.-23. septembrini 2003 Vilniuses korraldatud seminaril "South Caucasus: making the best use of external assistance for stability building and for co-operation with NATO" arutati, kas ja kuidas on Lõuna-Kaukaasia regioonis võimalik rakendada Balti riikide julgeolekualase koostöö kogemusi

  19. 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

    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

  20. Treatment decision-making for advanced non-small cell lung cancer and differences among European countries: 1st AIOT-ETOP meeting.

    Gridelli, Cesare; Stahel, Rolf; Besse, Benjamin; Ciardiello, Fortunato; Felip, Enriqueta; Gasparini, Stefano; Graziano, Paolo; Rossi, Antonio; de Marinis, Filippo

    2011-12-01

    The Italian Association of Thoracic Oncology (AIOT) and the European Thoracic Oncology Platform (ETOP) realized the first conjunct educational meeting, open to European oncologists involved in the treatment of thoracic malignancies, entitled "Advanced non-small cell lung cancer: new perspectives in first-line setting". The educational meeting included 8 interactive talks, held by European key opinion leaders, and 5 related clinical cases in which the attendees, divided in working tables based on their country origin, were involved for interactive discussion. The aim of this course was to elucidate the differences or similarities among the European countries in the first-line treatment of patients affected by advanced non-small cell lung cancer (NSCLC). Twenty-two attendees of the following countries participated: Austria, France, Italy, Spain, Swiss, and UK. As expected, some discrepancies between the groups were identified concerning the approach to the diagnostic phase, the choice of first-line regimen, the duration of treatment and the use of maintenance therapy. These discrepancies were mainly due to familiarity with specific therapies and lack of access to certain therapies due to local regulatory issues. The European Medicine Agency grants marketing of drugs in all Europe, regulatory agency of each country can register the drug, but can also deny public reimbursement thus restricting the options of the oncologist. The European Oncology Associations should join to their effort to achieve a uniform access to the cancer therapy for all patients in Europe. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  1. Advancing the Direction of Health Information Management in Greek Public Hospitals: Theoretical Directions and Methodological Implications for Sharing Information in order to Obtain Decision-Making

    Evagelia Lappa

    2016-08-01

    Full Text Available Although consultants have long placed the use of research information at the centre of their activity, the extent that physicians use this information tends to vary widely. Despite this study and its recommendations, there is still a gap between the functions of a manager and the use of the associated information, while the decision-making procedures vary according to the organization in which they work. The cost of IT remains the largest barrier, while some current IT solutions are not user friendly and out-of-date, particularly for public hospitals in Greece. The knowledge management is concerned not only with the facts and figures of production, but also with the know-how of staff. The information needs protocol should not be referred only to those who comply with formal computer-based information systems, but also to those who take into account other informal information and its flow within the organization. In a field such as medicine, where out-of-date information may be positively dangerous, doctors make heavy use of journals and several texts from the web. The decision-making process is a complex approach, particularly in human diagnostic and therapeutic applications. Therefore, it is very important to set priorities in the sector of health information management and promote education and training on information and communication technology (ICT.

  2. Emerging methods and tools for environmental risk assessment, decision-making, and policy for nanomaterials: summary of NATO Advanced Research Workshop

    Linkov, Igor; Steevens, Jeffery; Adlakha-Hutcheon, Gitanjali; Bennett, Erin; Chappell, Mark; Colvin, Vicki; Davis, J. Michael; Davis, Thomas; Elder, Alison; Foss Hansen, Steffen; Hakkinen, Pertti Bert; Hussain, Saber M.; Karkan, Delara; Korenstein, Rafi; Lynch, Iseult; Metcalfe, Chris

    2009-01-01

    Nanomaterials and their associated technologies hold promising opportunities for the development of new materials and applications in a wide variety of disciplines, including medicine, environmental remediation, waste treatment, and energy conservation. However, current information regarding the environmental effects and health risks associated with nanomaterials is limited and sometimes contradictory. This article summarizes the conclusions of a 2008 NATO workshop designed to evaluate the wide-scale implications (e.g., benefits, risks, and costs) of the use of nanomaterials on human health and the environment. A unique feature of this workshop was its interdisciplinary nature and focus on the practical needs of policy decision makers. Workshop presentations and discussion panels were structured along four main themes: technology and benefits, human health risk, environmental risk, and policy implications. Four corresponding working groups (WGs) were formed to develop detailed summaries of the state-of-the-science in their respective areas and to discuss emerging gaps and research needs. The WGs identified gaps between the rapid advances in the types and applications of nanomaterials and the slower pace of human health and environmental risk science, along with strategies to reduce the uncertainties associated with calculating these risks.

  3. [Using the synergies between strategic environmental evaluation and HIA to advance the integration of environmental and health issues in public decision-making processes].

    Simos, Jean; Arrizabalaga, Philippe

    2006-01-01

    The Geneva rule was the first one in Switzerland to introduce the concept of Strategic Environmental Assessment (SEA). This assessment constitutes a decision making aid which describes the process set up to allow evaluation of potential environmental impact and comparison of possible variants, recommends the choice for the best option and suggests the precautions to take. It presents much resemblances to HIA. In this case therefore the application of SEA in the urban planning project MICA has been presented. It is in this framework that a first experience of integration HIA to the SEA process was realized. In an additional way to SEA, HIA is focused on the following fields of potential impact: transport and movements, housing, public facilities, water management.

  4. A comprehensive assessment of memory, delay aversion, timing, inhibition, decision making and variability in attention deficit hyperactivity disorder: advancing beyond the three-pathway models.

    Coghill, D R; Seth, S; Matthews, K

    2014-07-01

    Although attention deficit hyperactivity disorder (ADHD) has been associated with a broad range of deficits across various neuropsychological domains, most studies have assessed only a narrow range of neuropsychological functions. Direct cross-domain comparisons are rare, with almost all studies restricted to less than four domains. Therefore, the relationships between these various domains remain undefined. In addition, almost all studies included previously medicated participants, limiting the conclusions that can be drawn. We present the first study to compare a large cohort of medication-naive boys with ADHD with healthy controls on a broad battery of neuropsychological tasks, assessing six key domains of neuropsychological functioning. The neuropsychological functioning of 83 medication-naive boys with well-characterized ADHD (mean age 8.9 years) was compared with that of 66 typically developing (TYP) boys (mean age 9.0 years) on a broad battery of validated neuropsychological tasks. Data reduction using complementary factor analysis (CFA) confirmed six distinct neuropsychological domains: working memory, inhibition, delay aversion, decision making, timing and response variability. Boys with ADHD performed less well across all six domains although, for each domain, only a minority of boys with ADHD had a deficit [effect size (% with deficit) ADHD versus TYP: working memory 0.95 (30.1), inhibition 0.61 (22.9), delay aversion 0.82 (36.1), decision making 0.55 (20.5), timing 0.71 (31.3), response variability 0.37 (18.1)]. The clinical syndrome of ADHD is neuropsychologically heterogeneous. These data highlight the complexity of the relationships between the different neuropsychological profiles associated with ADHD and the clinical symptoms and functional impairment.

  5. Quality of life is significantly associated with survival in women with advanced epithelial ovarian cancer: An ancillary data analysis of the NRG Oncology/Gynecologic Oncology Group (GOG-0218) study.

    Phippen, N T; Secord, A A; Wolf, S; Samsa, G; Davidson, B; Abernethy, A P; Cella, D; Havrilesky, L J; Burger, R A; Monk, B J; Leath, C A

    2017-10-01

    Evaluate association between baseline quality of life (QOL) and changes in QOL measured by FACT-O TOI with progression-free disease (PFS) and overall survival (OS) in advanced epithelial ovarian cancer (EOC). Patients enrolled in GOG-0218 with completed FACT-O TOI assessments at baseline and at least one follow-up assessment were eligible. Baseline FACT-O TOI scores were sorted by quartiles (Q1-4) and outcomes compared between Q1 and Q2-4 with log-rank statistic and multivariate Cox regression adjusting for age, stage, post-surgical residual disease size, and performance status (PS). Trends in FACT-O TOI scores from baseline to the latest follow-up assessment were evaluated for impact on intragroup (Q1 or Q2-4) outcome by log-rank analysis. Of 1152 eligible patients, 283 formed Q1 and 869 formed Q2-4. Mean baseline FACT-O TOI scores were 47.5 for Q1 vs. 74.7 for Q2-4 (P<0.001). Q1 compared to Q2-4 had worse median OS (37.5 vs. 45.6months, P=0.001) and worse median PFS (12.5 vs. 13.1months, P=0.096). Q2-4 patients had decreased risks of disease progression (HR 0.974, 95% CI 0.953-0.995, P=0.018), and death (HR 0.963, 95% CI 0.939-0.987, P=0.003) for each five-point increase in baseline FACT-O TOI. Improving versus worsening trends in FACT-O TOI scores were associated with longer median PFS (Q1: 12.7 vs. 8.6months, P=0.001; Q2-4: 16.7 vs. 11.1months, P<0.001) and median OS (Q1: 40.8 vs. 16months, P<0.001; Q2-4: 54.4 vs. 33.6months, P<0.001). Baseline FACT-O TOI scores were independently prognostic of PFS and OS while improving compared to worsening QOL was associated with significantly better PFS and OS in women with EOC. Copyright © 2017 Elsevier Inc. All rights reserved.

  6. Predicting significant torso trauma.

    Nirula, Ram; Talmor, Daniel; Brasel, Karen

    2005-07-01

    Identification of motor vehicle crash (MVC) characteristics associated with thoracoabdominal injury would advance the development of automatic crash notification systems (ACNS) by improving triage and response times. Our objective was to determine the relationships between MVC characteristics and thoracoabdominal trauma to develop a torso injury probability model. Drivers involved in crashes from 1993 to 2001 within the National Automotive Sampling System were reviewed. Relationships between torso injury and MVC characteristics were assessed using multivariate logistic regression. Receiver operating characteristic curves were used to compare the model to current ACNS models. There were a total of 56,466 drivers. Age, ejection, braking, avoidance, velocity, restraints, passenger-side impact, rollover, and vehicle weight and type were associated with injury (p < 0.05). The area under the receiver operating characteristic curve (83.9) was significantly greater than current ACNS models. We have developed a thoracoabdominal injury probability model that may improve patient triage when used with ACNS.

  7. Advancing the application of systems thinking in health: realist evaluation of the Leadership Development Programme for district manager decision-making in Ghana.

    Kwamie, Aku; van Dijk, Han; Agyepong, Irene Akua

    2014-06-16

    Although there is widespread agreement that strong district manager decision-making improves health systems, understanding about how the design and implementation of capacity-strengthening interventions work is limited. The Ghana Health Service has adopted the Leadership Development Programme (LDP) as one intervention to support the development of management and leadership within district teams. This paper seeks to address how and why the LDP 'works' when it is introduced into a district health system in Ghana, and whether or not it supports systems thinking in district teams. We undertook a realist evaluation to investigate the outcomes, contexts, and mechanisms of the intervention. Building on two working hypotheses developed from our earlier work, we developed an explanatory case study of one rural district in the Greater Accra Region of Ghana. Data collection included participant observation, document review, and semi-structured interviews with district managers prior to, during, and after the intervention. Working backwards from an in-depth analysis of the context and observed short- and medium-term outcomes, we drew a causal loop diagram to explain interactions between contexts, outcomes, and mechanisms. The LDP was a valuable experience for district managers and teams were able to attain short-term outcomes because the novel approach supported teamwork, initiative-building, and improved prioritisation. However, the LDP was not institutionalised in district teams and did not lead to increased systems thinking. This was related to the context of high uncertainty within the district, and hierarchical authority of the system, which triggered the LDP's underlying goal of organisational control. Consideration of organisational context is important when trying to sustain complex interventions, as it seems to influence the gap between short- and medium-term outcomes. More explicit focus on systems thinking principles that enable district managers to better cope with

  8. 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

    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.

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

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

  10. Clinical significance of VEGFR-2 and {sup 18}F-FDG PET/CT SUVmax pretreatment score in predicting the long-term outcome of patients with locally advanced rectal cancer treated with neoadjuvant therapy

    Sole, Claudio V. [Hospital General Universitario Gregorio Maranon, Department of Oncology, Madrid (Spain); School of Medicine Complutense University, Madrid (Spain); Hospital General Universitario Gregorio Maranon, Institute for Sanitary Research, Madrid (Spain); Hospital General Universitario Gregorio Maranon, Madrid (Spain); Calvo, Felipe A. [Hospital General Universitario Gregorio Maranon, Department of Oncology, Madrid (Spain); School of Medicine Complutense University, Madrid (Spain); Hospital General Universitario Gregorio Maranon, Institute for Sanitary Research, Madrid (Spain); Alvarez, Emilio; Peligros, Isabel [School of Medicine Complutense University, Madrid (Spain); Hospital General Universitario Gregorio Maranon, Department of Pathology, Madrid (Spain); Hospital General Universitario Gregorio Maranon, Institute for Sanitary Research, Madrid (Spain); Garcia-Alfonso, Pilar [Hospital General Universitario Gregorio Maranon, Service of Medical Oncology, Madrid (Spain); Hospital General Universitario Gregorio Maranon, Institute for Sanitary Research, Madrid (Spain); Ferrer, Carlos; Ochoa, Enrique [Hospital Provincial de Castellon, Institute of Oncology, Castellon de la Plana (Spain); Herranz, Rafael [Hospital General Universitario Gregorio Maranon, Service of Radiation Oncology, Madrid (Spain); Hospital General Universitario Gregorio Maranon, Institute for Sanitary Research, Madrid (Spain); Carreras, Jose L. [School of Medicine Complutense University, Madrid (Spain); Hospital General Universitario Gregorio Maranon, Department of Radiology and Medical Physics, Madrid (Spain)

    2013-10-15

    Vascular endothelial growth factor receptor-2 (VEGFR-2), epidermal growth factor receptor-1 (EGFR), and cyclooxygenase-2 (COX-2) stimulate key processes involved in tumor progression and are important targets for cancer drugs. {sup 18}F-FDG maximum standardized uptake value (SUVmax) is a marker of tumor metabolic activity. The purpose of this study was to measure SUVmax combined with VEGFR-2, EGFR and COX-2 proteins in pretreatment tumor biopsies from patients with locally advanced rectal cancer receiving intensive neoadjuvant treatment and to correlate the findings with clinical outcome. VEGFR-2, EGFR and COX-2 were measured using the immunoreactive score (IRS). SUVmax (median 8.4) was quantified in tumors with molecular overexpression (IRS {>=}3 + SUVmax {>=} 8.4 indicating active tumors; SUVmax <8.4 indicating inactive tumors). The Cox proportional hazards model was used to explore associations between tumor markers, disease-free survival (DFS) and overall survival (OS). The study group comprised 38 patients with a median follow-up of 69.3 months (range 4.5 - 92 months). Multivariate analysis showed that active tumors (overexpressing VEGFR-2, high SUVmax) were associated with worse DFS (HR 4.73, 95 % CI 1.18 - 22.17; p = 0.04) and OS (HR 4.28, 95 % CI 1.04 - 20.12; p = 0.05). Active tumors overexpressing VEGFR-2 are associated with a worse overall outcome in patients with rectal cancer treated with induction chemotherapy followed by pelvic chemoradiation and surgery. The optimal diagnostic cut-off level for this novel biomarker association should be investigated. Evaluation in a clinical trial is required to determine whether selected patients could benefit from a VEGFR-targeting drug. (orig.)

  11. Prognostic Significance of Carbohydrate Antigen 19-9 in Unresectable Locally Advanced Pancreatic Cancer Treated With Dose-Escalated Intensity Modulated Radiation Therapy and Concurrent Full-Dose Gemcitabine: Analysis of a Prospective Phase 1/2 Dose Escalation Study

    Vainshtein, Jeffrey M.; Schipper, Matthew; Zalupski, Mark M.; Lawrence, Theodore S.; Abrams, Ross; Francis, Isaac R.; Khan, Gazala; Leslie, William; Ben-Josef, Edgar

    2013-01-01

    Purpose: Although established in the postresection setting, the prognostic value of carbohydrate antigen 19-9 (CA19-9) in unresectable locally advanced pancreatic cancer (LAPC) is less clear. We examined the prognostic utility of CA19-9 in patients with unresectable LAPC treated on a prospective trial of intensity modulated radiation therapy (IMRT) dose escalation with concurrent gemcitabine. Methods and Materials: Forty-six patients with unresectable LAPC were treated at the University of Michigan on a phase 1/2 trial of IMRT dose escalation with concurrent gemcitabine. CA19-9 was obtained at baseline and during routine follow-up. Cox models were used to assess the effect of baseline factors on freedom from local progression (FFLP), distant progression (FFDP), progression-free survival (PFS), and overall survival (OS). Stepwise forward regression was used to build multivariate predictive models for each endpoint. Results: Thirty-eight patients were eligible for the present analysis. On univariate analysis, baseline CA19-9 and age predicted OS, CA19-9 at baseline and 3 months predicted PFS, gross tumor volume (GTV) and black race predicted FFLP, and CA19-9 at 3 months predicted FFDP. On stepwise multivariate regression modeling, baseline CA19-9, age, and female sex predicted OS; baseline CA19-9 and female sex predicted both PFS and FFDP; and GTV predicted FFLP. Patients with baseline CA19-9 ≤90 U/mL had improved OS (median 23.0 vs 11.1 months, HR 2.88, P<.01) and PFS (14.4 vs 7.0 months, HR 3.61, P=.001). CA19-9 progression over 90 U/mL was prognostic for both OS (HR 3.65, P=.001) and PFS (HR 3.04, P=.001), and it was a stronger predictor of death than either local progression (HR 1.46, P=.42) or distant progression (HR 3.31, P=.004). Conclusions: In patients with unresectable LAPC undergoing definitive chemoradiation therapy, baseline CA19-9 was independently prognostic even after established prognostic factors were controlled for, whereas CA19-9 progression

  12. Prognostic Significance of Carbohydrate Antigen 19-9 in Unresectable Locally Advanced Pancreatic Cancer Treated With Dose-Escalated Intensity Modulated Radiation Therapy and Concurrent Full-Dose Gemcitabine: Analysis of a Prospective Phase 1/2 Dose Escalation Study

    Vainshtein, Jeffrey M., E-mail: jvainsh@med.umich.edu [Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan (United States); Schipper, Matthew [Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan (United States); Zalupski, Mark M. [Division of Hematology Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan (United States); Lawrence, Theodore S. [Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan (United States); Abrams, Ross [Department of Radiation Oncology, Rush Medical Center, Chicago, Illinois (United States); Francis, Isaac R. [Department of Radiology, University of Michigan, Ann Arbor, Michigan (United States); Khan, Gazala [Division of Hematology Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan (United States); Leslie, William [Division of Hematology Oncology, Department of Internal Medicine, Rush Medical Center, Chicago, Illinois (United States); Ben-Josef, Edgar [Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania (United States)

    2013-05-01

    Purpose: Although established in the postresection setting, the prognostic value of carbohydrate antigen 19-9 (CA19-9) in unresectable locally advanced pancreatic cancer (LAPC) is less clear. We examined the prognostic utility of CA19-9 in patients with unresectable LAPC treated on a prospective trial of intensity modulated radiation therapy (IMRT) dose escalation with concurrent gemcitabine. Methods and Materials: Forty-six patients with unresectable LAPC were treated at the University of Michigan on a phase 1/2 trial of IMRT dose escalation with concurrent gemcitabine. CA19-9 was obtained at baseline and during routine follow-up. Cox models were used to assess the effect of baseline factors on freedom from local progression (FFLP), distant progression (FFDP), progression-free survival (PFS), and overall survival (OS). Stepwise forward regression was used to build multivariate predictive models for each endpoint. Results: Thirty-eight patients were eligible for the present analysis. On univariate analysis, baseline CA19-9 and age predicted OS, CA19-9 at baseline and 3 months predicted PFS, gross tumor volume (GTV) and black race predicted FFLP, and CA19-9 at 3 months predicted FFDP. On stepwise multivariate regression modeling, baseline CA19-9, age, and female sex predicted OS; baseline CA19-9 and female sex predicted both PFS and FFDP; and GTV predicted FFLP. Patients with baseline CA19-9 ≤90 U/mL had improved OS (median 23.0 vs 11.1 months, HR 2.88, P<.01) and PFS (14.4 vs 7.0 months, HR 3.61, P=.001). CA19-9 progression over 90 U/mL was prognostic for both OS (HR 3.65, P=.001) and PFS (HR 3.04, P=.001), and it was a stronger predictor of death than either local progression (HR 1.46, P=.42) or distant progression (HR 3.31, P=.004). Conclusions: In patients with unresectable LAPC undergoing definitive chemoradiation therapy, baseline CA19-9 was independently prognostic even after established prognostic factors were controlled for, whereas CA19-9 progression

  13. Model : making

    Bottle, Neil

    2013-01-01

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

  14. Making Riverscapes Real (Invited)

    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

  15. Steel making

    Chakrabarti, A K

    2014-01-01

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

  16. Significant accomplishments, 2009

    2009-01-01

    BTS data is vital to improve transportation decision making, as well as evaluations of performance and what works in the nations transportation systems. As BTS continues its course of producing relevant, accurate, and timely transportation d...

  17. Make Sense?

    Gyrd-Jones, Richard; Törmälä, Minna

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

  18. Making and Changing Wills

    Cheryl Tilse

    2016-02-01

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

  19. Variation in decision making

    Dall, Sasha R. X.; Gosling, Samuel; Gordon D.A., Brown,; Dingemanse, Niels; Ido, Erev,; Martin, Kocher,; Laura, Schulz,; Todd, Peter M; Weissing, Franz; Wolf, Max; Hammerstein, Peter; Stevens, Jeffrey R.

    2012-01-01

    Variation in how organisms allocate their behavior over their lifetimes is key to determining Darwinian fitness., and thus the evolution of human and nonhuman decision making. This chapter explores how decision making varies across biologically and societally significant scales and what role such

  20. Run-time coupling advanced control software with building simulation environment

    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

  1. Decision making.

    Chambers, David W

    2011-01-01

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

  2. Synthetic definition of biological significance

    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

  3. Making Connections

    Pien, Cheng Lu; Dongsheng, Zhao

    2011-01-01

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

  4. Significant NRC Enforcement Actions

    Nuclear Regulatory Commission — This dataset provides a list of Nuclear Regulartory Commission (NRC) issued significant enforcement actions. These actions, referred to as "escalated", are issued by...

  5. Advances in Applied Mechanics

    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...

  6. Advanced fuels safety comparisons

    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

  7. Advanced Education and Technology Business Plan, 2007-10

    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…

  8. The Future of Nursing: Leading Change, Advancing Health

    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…

  9. Research advances in regorafenib in treatment of hepatocellular carcinoma

    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.

  10. Making Our Food Safe

    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)

  11. Making Yugoslavs

    Nielsen, Christian Axboe

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

  12. THE MAKING OF DECISION MAKING

    Leonardo Yuji Tamura

    2016-04-01

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

  13. Advanced Ceramics

    1989-01-01

    The First Florida-Brazil Seminar on Materials and the Second State Meeting about new materials in Rio de Janeiro State show the specific technical contribution in advanced ceramic sector. The others main topics discussed for the development of the country are the advanced ceramic programs the market, the national technic-scientific capacitation, the advanced ceramic patents, etc. (C.G.C.) [pt

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

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

    2017-08-23

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

  15. Advanced uranium enrichment technologies

    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

  16. 7 CFR 1485.18 - Advances.

    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...

  17. Primatology: advanced ape technology.

    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.

  18. Advanced Heart Failure

    ... 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 ...

  19. Japan's advanced medicine.

    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.

  20. Amateur Telescope Making

    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.

  1. Advances in Numerical Methods

    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.

  2. Significant Tsunami Events

    Dunbar, P. K.; Furtney, M.; McLean, S. J.; Sweeney, A. D.

    2014-12-01

    Tsunamis have inflicted death and destruction on the coastlines of the world throughout history. The occurrence of tsunamis and the resulting effects have been collected and studied as far back as the second millennium B.C. The knowledge gained from cataloging and examining these events has led to significant changes in our understanding of tsunamis, tsunami sources, and methods to mitigate the effects of tsunamis. The most significant, not surprisingly, are often the most devastating, such as the 2011 Tohoku, Japan earthquake and tsunami. The goal of this poster is to give a brief overview of the occurrence of tsunamis and then focus specifically on several significant tsunamis. There are various criteria to determine the most significant tsunamis: the number of deaths, amount of damage, maximum runup height, had a major impact on tsunami science or policy, etc. As a result, descriptions will include some of the most costly (2011 Tohoku, Japan), the most deadly (2004 Sumatra, 1883 Krakatau), and the highest runup ever observed (1958 Lituya Bay, Alaska). The discovery of the Cascadia subduction zone as the source of the 1700 Japanese "Orphan" tsunami and a future tsunami threat to the U.S. northwest coast, contributed to the decision to form the U.S. National Tsunami Hazard Mitigation Program. The great Lisbon earthquake of 1755 marked the beginning of the modern era of seismology. Knowledge gained from the 1964 Alaska earthquake and tsunami helped confirm the theory of plate tectonics. The 1946 Alaska, 1952 Kuril Islands, 1960 Chile, 1964 Alaska, and the 2004 Banda Aceh, tsunamis all resulted in warning centers or systems being established.The data descriptions on this poster were extracted from NOAA's National Geophysical Data Center (NGDC) global historical tsunami database. Additional information about these tsunamis, as well as water level data can be found by accessing the NGDC website www.ngdc.noaa.gov/hazard/

  3. FAmily CEntered (FACE) advance care planning: Study design and methods for a patient-centered communication and decision-making intervention for patients with HIV/AIDS and their surrogate decision-makers.

    Kimmel, Allison L; Wang, Jichuan; Scott, Rachel K; Briggs, Linda; Lyon, Maureen E

    2015-07-01

    Although the human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) has become a chronic illness, disease-specific advance care planning has not yet been evaluated for the palliative care needs of adults with HIV/AIDS. This prospective, longitudinal, randomized, two-arm controlled clinical trial aims to test the efficacy of FAmily CEntered advance care planning among adults living with AIDS and/or HIV with co-morbidities on congruence in treatment preferences, healthcare utilization, and quality of life. The FAmily CEntered intervention arm is two face-to-face sessions with a trained, certified facilitator: Session 1) Disease-Specific Advance Care Planning Respecting Choices Interview; Session 2) Completion of advance directive. The Healthy Living Control arm is: Session 1) Developmental/Relationship History; Session 2) Nutrition. Follow-up data will be collected at 3, 6, 12, and 18 months post-intervention. A total of 288 patient/surrogate dyads will be enrolled from five hospital-based, out-patient clinics in Washington, District of Columbia. Participants will be HIV positive and ≥ 21 years of age; surrogates will be ≥ 18 years of age. Exclusion criteria are homicidality, suicidality, psychosis, and impaired cognitive functioning. We hypothesize that this intervention will enhance patient-centered communication with a surrogate decision-maker about end of life treatment preferences over time, enhance patient quality of life and decrease health care utilization. We further hypothesize that this intervention will decrease health disparities for Blacks in completion of advance directives. If proposed aims are achieved, the benefits of palliative care, particularly increased treatment preferences about end-of-life care and enhanced quality of life, will be extended to people living with AIDS. Copyright © 2015 Elsevier Inc. All rights reserved.

  4. Advances in Male Contraception

    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

  5. Eldercare at Home: Advanced Directives

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

  6. Testing Significance Testing

    Joachim I. Krueger

    2018-04-01

    Full Text Available The practice of Significance Testing (ST remains widespread in psychological science despite continual criticism of its flaws and abuses. Using simulation experiments, we address four concerns about ST and for two of these we compare ST’s performance with prominent alternatives. We find the following: First, the 'p' values delivered by ST predict the posterior probability of the tested hypothesis well under many research conditions. Second, low 'p' values support inductive inferences because they are most likely to occur when the tested hypothesis is false. Third, 'p' values track likelihood ratios without raising the uncertainties of relative inference. Fourth, 'p' values predict the replicability of research findings better than confidence intervals do. Given these results, we conclude that 'p' values may be used judiciously as a heuristic tool for inductive inference. Yet, 'p' values cannot bear the full burden of inference. We encourage researchers to be flexible in their selection and use of statistical methods.

  7. Safety significance evaluation system

    Lew, B.S.; Yee, D.; Brewer, W.K.; Quattro, P.J.; Kirby, K.D.

    1991-01-01

    This paper reports that the Pacific Gas and Electric Company (PG and E), in cooperation with ABZ, Incorporated and Science Applications International Corporation (SAIC), investigated the use of artificial intelligence-based programming techniques to assist utility personnel in regulatory compliance problems. The result of this investigation is that artificial intelligence-based programming techniques can successfully be applied to this problem. To demonstrate this, a general methodology was developed and several prototype systems based on this methodology were developed. The prototypes address U.S. Nuclear Regulatory Commission (NRC) event reportability requirements, technical specification compliance based on plant equipment status, and quality assurance assistance. This collection of prototype modules is named the safety significance evaluation system

  8. Gas revenue increasingly significant

    Megill, R.E.

    1991-01-01

    This paper briefly describes the wellhead prices of natural gas compared to crude oil over the past 70 years. Although natural gas prices have never reached price parity with crude oil, the relative value of a gas BTU has been increasing. It is one of the reasons that the total amount of money coming from natural gas wells is becoming more significant. From 1920 to 1955 the revenue at the wellhead for natural gas was only about 10% of the money received by producers. Most of the money needed for exploration, development, and production came from crude oil. At present, however, over 40% of the money from the upstream portion of the petroleum industry is from natural gas. As a result, in a few short years natural gas may become 50% of the money revenues generated from wellhead production facilities

  9. Tumor significant dose

    Supe, S.J.; Nagalaxmi, K.V.; Meenakshi, L.

    1983-01-01

    In the practice of radiotherapy, various concepts like NSD, CRE, TDF, and BIR are being used to evaluate the biological effectiveness of the treatment schedules on the normal tissues. This has been accepted as the tolerance of the normal tissue is the limiting factor in the treatment of cancers. At present when various schedules are tried, attention is therefore paid to the biological damage of the normal tissues only and it is expected that the damage to the cancerous tissues would be extensive enough to control the cancer. Attempt is made in the present work to evaluate the concent of tumor significant dose (TSD) which will represent the damage to the cancerous tissue. Strandquist in the analysis of a large number of cases of squamous cell carcinoma found that for the 5 fraction/week treatment, the total dose required to bring about the same damage for the cancerous tissue is proportional to T/sup -0.22/, where T is the overall time over which the dose is delivered. Using this finding the TSD was defined as DxN/sup -p/xT/sup -q/, where D is the total dose, N the number of fractions, T the overall time p and q are the exponents to be suitably chosen. The values of p and q are adjusted such that p+q< or =0.24, and p varies from 0.0 to 0.24 and q varies from 0.0 to 0.22. Cases of cancer of cervix uteri treated between 1978 and 1980 in the V. N. Cancer Centre, Kuppuswamy Naidu Memorial Hospital, Coimbatore, India were analyzed on the basis of these formulations. These data, coupled with the clinical experience, were used for choice of a formula for the TSD. Further, the dose schedules used in the British Institute of Radiology fraction- ation studies were also used to propose that the tumor significant dose is represented by DxN/sup -0.18/xT/sup -0.06/

  10. Meaning and significance of

    Ph D Student Roman Mihaela

    2011-05-01

    Full Text Available The concept of "public accountability" is a challenge for political science as a new concept in this area in full debate and developement ,both in theory and practice. This paper is a theoretical approach of displaying some definitions, relevant meanings and significance odf the concept in political science. The importance of this concept is that although originally it was used as a tool to improve effectiveness and eficiency of public governance, it has gradually become a purpose it itself. "Accountability" has become an image of good governance first in the United States of America then in the European Union.Nevertheless,the concept is vaguely defined and provides ambiguous images of good governance.This paper begins with the presentation of some general meanings of the concept as they emerge from specialized dictionaries and ancyclopaedies and continues with the meanings developed in political science. The concept of "public accontability" is rooted in economics and management literature,becoming increasingly relevant in today's political science both in theory and discourse as well as in practice in formulating and evaluating public policies. A first conclusin that emerges from, the analysis of the evolution of this term is that it requires a conceptual clarification in political science. A clear definition will then enable an appropriate model of proving the system of public accountability in formulating and assessing public policies, in order to implement a system of assessment and monitoring thereof.

  11. Significant Radionuclides Determination

    Jo A. Ziegler

    2001-07-31

    The purpose of this calculation is to identify radionuclides that are significant to offsite doses from potential preclosure events for spent nuclear fuel (SNF) and high-level radioactive waste expected to be received at the potential Monitored Geologic Repository (MGR). In this calculation, high-level radioactive waste is included in references to DOE SNF. A previous document, ''DOE SNF DBE Offsite Dose Calculations'' (CRWMS M&O 1999b), calculated the source terms and offsite doses for Department of Energy (DOE) and Naval SNF for use in design basis event analyses. This calculation reproduces only DOE SNF work (i.e., no naval SNF work is included in this calculation) created in ''DOE SNF DBE Offsite Dose Calculations'' and expands the calculation to include DOE SNF expected to produce a high dose consequence (even though the quantity of the SNF is expected to be small) and SNF owned by commercial nuclear power producers. The calculation does not address any specific off-normal/DBE event scenarios for receiving, handling, or packaging of SNF. The results of this calculation are developed for comparative analysis to establish the important radionuclides and do not represent the final source terms to be used for license application. This calculation will be used as input to preclosure safety analyses and is performed in accordance with procedure AP-3.12Q, ''Calculations'', and is subject to the requirements of DOE/RW-0333P, ''Quality Assurance Requirements and Description'' (DOE 2000) as determined by the activity evaluation contained in ''Technical Work Plan for: Preclosure Safety Analysis, TWP-MGR-SE-000010'' (CRWMS M&O 2000b) in accordance with procedure AP-2.21Q, ''Quality Determinations and Planning for Scientific, Engineering, and Regulatory Compliance Activities''.

  12. Advanced gadolinia core and Toshiba advanced reactor management system

    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)

  13. Advances in chemical physics

    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.

  14. The significance of small streams

    Wohl, Ellen

    2017-09-01

    Headwaters, defined here as first- and secondorder streams, make up 70%‒80% of the total channel length of river networks. These small streams exert a critical influence on downstream portions of the river network by: retaining or transmitting sediment and nutrients; providing habitat and refuge for diverse aquatic and riparian organisms; creating migration corridors; and governing connectivity at the watershed-scale. The upstream-most extent of the channel network and the longitudinal continuity and lateral extent of headwaters can be difficult to delineate, however, and people are less likely to recognize the importance of headwaters relative to other portions of a river network. Consequently, headwaters commonly lack the legal protections accorded to other portions of a river network and are more likely to be significantly altered or completely obliterated by land use.

  15. Relationship between Student Pharmacist Decision Making Preferences and Experiential Learning.

    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.

  16. Intelligent decision-making models for production and retail operations

    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.

  17. Relationship between Student Pharmacist Decision Making Preferences and Experiential Learning

    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

  18. Making Media Studies

    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.

  19. Impact significance determination-Back to basics

    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

  20. Advanced Electronics

    2017-07-21

    AFRL-RV-PS- AFRL-RV-PS- TR-2017-0114 TR-2017-0114 ADVANCED ELECTRONICS Ashwani Sharma 21 Jul 2017 Interim Report APPROVED FOR PUBLIC RELEASE...NUMBER Advanced Electronics 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 62601F 6. AUTHOR(S) 5d. PROJECT NUMBER 4846 Ashwani Sharma 5e. TASK NUMBER...Approved for public release; distribution is unlimited. (RDMX-17-14919 dtd 20 Mar 2018) 13. SUPPLEMENTARY NOTES 14. ABSTRACT The Space Electronics

  1. Advanced energy materials (Preface)

    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.

  2. Advanced Geothermal Turbodrill

    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.

  3. Let's Make Data Count

    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.

  4. Advanced calculus

    Nickerson, HK; Steenrod, NE

    2011-01-01

    ""This book is a radical departure from all previous concepts of advanced calculus,"" declared the Bulletin of the American Mathematics Society, ""and the nature of this departure merits serious study of the book by everyone interested in undergraduate education in mathematics."" Classroom-tested in a Princeton University honors course, it offers students a unified introduction to advanced calculus. Starting with an abstract treatment of vector spaces and linear transforms, the authors introduce a single basic derivative in an invariant form. All other derivatives - gradient, divergent, curl,

  5. Technological advances in extracorporeal membrane oxygenation for respiratory failure.

    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.

  6. Advances in Primary Central Nervous System Lymphoma.

    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.

  7. Advances in Ecological Speciation: an integrative approach.

    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.

  8. Recent advances in food allergy

    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.

  9. Safety issues on advanced fuel

    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

  10. SENIOR STAFF ADVANCEMENT COMMITTEE (SSAC)

    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.

  11. A Paradigm shift in the concept for making dental impressions.

    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.

  12. A Paradigm shift in the concept for making dental impressions

    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.

  13. United States advanced technologies

    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.)

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

    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...

  15. Significance of Literature in Foreign Language Teaching

    Babaee, Ruzbeh; Yahya, Wan Roselezam Bt Wan

    2014-01-01

    This research aims to consider literature as a significant tool for teaching fundamental language skills including speaking, listening, reading and writing. Reasons for the use of literature in language classrooms and major factors for choosing appropriate kinds of literary texts in such classes should be highlighted in order to make readers aware…

  16. Discovering the Significance of Scientific Design Practice

    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...

  17. Decision making under uncertainty

    Cyert, R.M.

    1989-01-01

    This paper reports on ways of improving the reliability of products and systems in this country if we are to survive as a first-rate industrial power. The use of statistical techniques have, since the 1920s, been viewed as one of the methods for testing quality and estimating the level of quality in a universe of output. Statistical quality control is not relevant, generally, to improving systems in an industry like yours, but certainly the use of probability concepts is of significance. In addition, when it is recognized that part of the problem involves making decisions under uncertainty, it becomes clear that techniques such as sequential decision making and Bayesian analysis become major methodological approaches that must be utilized

  18. Advanced Virgo

    Virgo, a first-generation interferometric gravitational wave (GW) detector, located in the European Gravitational Observatory, EGO, Cascina (Pisa-Italy) and constructed by the collaboration of French and Italian institutes (CNRS and INFN) has successfully completed its long-duration data taking runs. It is now undergoing a fundamental upgrade that exploits available cutting edges technology to open an exciting new window on the universe, with the first detection of a gravitational wave signal. Advanced Virgo (AdV) is the project to upgrade the Virgo detector to a second-generation instrument. AdV will be able to scan a volume of the Universe 1000 times larger than initial Virgo. AdV will be hosted in the same infrastructures as Virgo. The Advanced VIRGO project is funded and at present carried on by a larger collaboration of institutes belonging to CNRS- France , RMKI - Hungary, INFN- Italy, Nikhef - The Netherlands Polish Academy of Science - Poland.

  19. Advanced Combustion

    Holcomb, Gordon R. [NETL

    2013-03-11

    The activity reported in this presentation is to provide the mechanical and physical property information needed to allow rational design, development and/or choice of alloys, manufacturing approaches, and environmental exposure and component life models to enable oxy-fuel combustion boilers to operate at Ultra-Supercritical (up to 650{degrees}C & between 22-30 MPa) and/or Advanced Ultra-Supercritical conditions (760{degrees}C & 35 MPa).

  20. [Interoception and decision-making].

    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.

  1. Materials for advanced packaging

    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 ...

  2. Advances in chemical physics advances in liquid crystals

    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.

  3. Making the Sustainable Development Goals Consistent with Sustainability

    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.

  4. Making the Sustainable Development Goals Consistent with Sustainability

    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.

  5. Making the Sustainable Development Goals Consistent with Sustainability

    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.

  6. Oil industry decision making

    Collier, T.S.

    1992-01-01

    This paper reports that the oil and gas business is undergoing a significant restructuring. In order to maintain control of our own destiny and succeed in an increasingly competitive business environment, the industry must set goals which are consistent with its continued success and focus on those goals in every aspect of its strategic management. By applying an approach to decision making which focuses on the achievement of the key goals required for success at every decision point and systematic follow-up, a firm can greatly increase its ability to succeed in the business environment of the future

  7. Making ecological models adequate

    Getz, Wayne M.; Marshall, Charles R.; Carlson, Colin J.; Giuggioli, Luca; Ryan, Sadie J.; Romañach, Stephanie; Boettiger, Carl; Chamberlain, Samuel D.; Larsen, Laurel; D'Odorico, Paolo; O'Sullivan, David

    2018-01-01

    Critical evaluation of the adequacy of ecological models is urgently needed to enhance their utility in developing theory and enabling environmental managers and policymakers to make informed decisions. Poorly supported management can have detrimental, costly or irreversible impacts on the environment and society. Here, we examine common issues in ecological modelling and suggest criteria for improving modelling frameworks. An appropriate level of process description is crucial to constructing the best possible model, given the available data and understanding of ecological structures. Model details unsupported by data typically lead to over parameterisation and poor model performance. Conversely, a lack of mechanistic details may limit a model's ability to predict ecological systems’ responses to management. Ecological studies that employ models should follow a set of model adequacy assessment protocols that include: asking a series of critical questions regarding state and control variable selection, the determinacy of data, and the sensitivity and validity of analyses. We also need to improve model elaboration, refinement and coarse graining procedures to better understand the relevancy and adequacy of our models and the role they play in advancing theory, improving hind and forecasting, and enabling problem solving and management.

  8. Advanced calculus

    Friedman, Avner

    2007-01-01

    This rigorous two-part treatment advances from functions of one variable to those of several variables. Intended for students who have already completed a one-year course in elementary calculus, it defers the introduction of functions of several variables for as long as possible, and adds clarity and simplicity by avoiding a mixture of heuristic and rigorous arguments.The first part explores functions of one variable, including numbers and sequences, continuous functions, differentiable functions, integration, and sequences and series of functions. The second part examines functions of several

  9. Advanced calculus

    Fitzpatrick, Patrick M

    2009-01-01

    Advanced Calculus is intended as a text for courses that furnish the backbone of the student's undergraduate education in mathematical analysis. The goal is to rigorously present the fundamental concepts within the context of illuminating examples and stimulating exercises. This book is self-contained and starts with the creation of basic tools using the completeness axiom. The continuity, differentiability, integrability, and power series representation properties of functions of a single variable are established. The next few chapters describe the topological and metric properties of Euclide

  10. Advanced trigonometry

    Durell, C V; Robson, A

    1950-01-01

    This volume will provide a welcome resource for teachers seeking an undergraduate text on advanced trigonometry, when few are readily available. Ideal for self-study, this text offers a clear, logical presentation of topics and an extensive selection of problems with answers. Contents include the properties of the triangle and the quadrilateral; equations, sub-multiple angles, and inverse functions; hyperbolic, logarithmic, and exponential functions; and expansions in power-series. Further topics encompass the special hyperbolic functions; projection and finite series; complex numbers; de Moiv

  11. Advanced Hydrogen Turbine Development

    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

  12. Shared decision making

    ... page: //medlineplus.gov/ency/patientinstructions/000877.htm Shared decision making To use the sharing features on this page, ... treatment you both support. When to use Shared Decision Making Shared decision making is often used when you ...

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

    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.

  14. Advanced Solid State Lighting for Human Evaluation

    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...

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

    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.

  16. Advanced computers and simulation

    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

  17. Decision-making: Theory and practice

    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, ...

  18. Advanced Pacemaker

    1990-01-01

    Synchrony, developed by St. Jude Medical's Cardiac Rhythm Management Division (formerly known as Pacesetter Systems, Inc.) is an advanced state-of-the-art implantable pacemaker that closely matches the natural rhythm of the heart. The companion element of the Synchrony Pacemaker System is the Programmer Analyzer APS-II which allows a doctor to reprogram and fine tune the pacemaker to each user's special requirements without surgery. The two-way communications capability that allows the physician to instruct and query the pacemaker is accomplished by bidirectional telemetry. APS-II features 28 pacing functions and thousands of programming combinations to accommodate diverse lifestyles. Microprocessor unit also records and stores pertinent patient data up to a year.

  19. Test Concept for Advanced Oxidation Techniques

    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...

  20. Advanced converters and reactors

    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)

  1. Making the Most of MASINT and Advanced Geospatial Intelligence

    2012-04-10

    SIGINT), human intelligence (HUMINT), open source intelligence , ( OSINT ), and measurement and signatures intelligence (MASINT). All sources progress...the underlying principles of MASINT technologies and the operators and analysts who have intelligence questions that MASINT sources may be able to...integrity, analysts should instead use these sources of MASINT in support of less time-sensitive intelligence problems. Through creative or

  2. Making friends on the fly advances in ad hoc teamwork

    Barrett, Samuel

    2015-01-01

    This book is devoted to the encounter and interaction of agents such as robots with other agents and describes how they cooperate with their previously unknown teammates, forming an Ad Hoc team. It presents a new algorithm, PLASTIC, that allows agents to quickly adapt to new teammates by reusing knowledge learned from previous teammates.  PLASTIC is instantiated in both a model-based approach, PLASTIC-Model, and a policy-based approach, PLASTIC-Policy.  In addition to reusing knowledge learned from previous teammates, PLASTIC also allows users to provide expert-knowledge and can use transfer learning (such as the new TwoStageTransfer algorithm) to quickly create models of new teammates when it has some information about its new teammates. The effectiveness of the algorithm is demonstrated on three domains, ranging from multi-armed bandits to simulated robot soccer games.

  3. Law, autonomy and advance directives.

    Willmott, Lindy; White, Ben; Mathews, Ben

    2010-12-01

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

  4. Advanced reflector materials for solar concentrators

    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.

  5. Medical decision making

    Stiggelbout, A.M.; Vries, M. de; Scherer, L.; Keren, G.; Wu, G.

    2016-01-01

    This chapter presents an overview of the field of medical decision making. It distinguishes the levels of decision making seen in health-care practice and shows how research in judgment and decision making support or improve decision making. Most of the research has been done at the micro level,

  6. Advances in optical imaging

    Bremer, C.; Ntziachristos, V.; Mahmood, U.; Tung, C.H.; Weissleder, R.

    2001-01-01

    Different optical imaging technologies have significantly progressed over the last years. Besides advances in imaging techniques and image reconstruction, new 'smart' optical contrast agents have been developed which can be used to detect molecular targets (such as endogenous enzymes) in vivo. The combination of novel imaging technologies coupled with smart agents bears great diagnostic potential both clinically and experimentally. This overview outlines the basic principles of optical imaging and summarizes the current state of the art. (orig.) [de

  7. Delirium in advanced disease

    Harris, Dylan

    2007-01-01

    Delirium in advanced disease, while common, is often not recognised or poorly treated. The aim of management of delirium is to assess and treat reversible causes in combination with environmental, psychological and pharmacological intervention to control symptoms. Delirium presents significant distress and impedes communication between patients and their families at the end of life. A structured approach to recognise, assess and manage delirium is essential for all clinicians caring for patie...

  8. Decision Making and Cancer

    Reyna, Valerie F.; Nelson, Wendy L.; Han, Paul K.; Pignone, Michael P.

    2015-01-01

    We review decision-making along the cancer continuum in the contemporary context of informed and shared decision making, in which patients are encouraged to take a more active role in their health care. We discuss challenges to achieving informed and shared decision making, including cognitive limitations and emotional factors, but argue that understanding the mechanisms of decision making offers hope for improving decision support. Theoretical approaches to decision making that explain cogni...

  9. Uncertainty Analyses of Advanced Fuel Cycles

    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

  10. Uncertainty Analyses of Advanced Fuel Cycles

    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.

  11. Decision making in neonatologia.

    Paterlini, G; Tagliabue, P

    2010-06-01

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

  12. 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.

    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.

  13. Making Type Inference Practical

    Schwartzbach, Michael Ignatieff; Oxhøj, Nicholas; Palsberg, Jens

    1992-01-01

    We present the implementation of a type inference algorithm for untyped object-oriented programs with inheritance, assignments, and late binding. The algorithm significantly improves our previous one, presented at OOPSLA'91, since it can handle collection classes, such as List, in a useful way. Abo......, the complexity has been dramatically improved, from exponential time to low polynomial time. The implementation uses the techniques of incremental graph construction and constraint template instantiation to avoid representing intermediate results, doing superfluous work, and recomputing type information....... Experiments indicate that the implementation type checks as much as 100 lines pr. second. This results in a mature product, on which a number of tools can be based, for example a safety tool, an image compression tool, a code optimization tool, and an annotation tool. This may make type inference for object...

  14. Significant variables associated with epilepsy

    Cheema, F.A.; Qayyum, K.; Ahmad, N.; Makhdoomi, A.; Safdar, A.; Asif, A.; Chaudhry, H.R.

    2003-01-01

    Objective: To study the characteristics of the epileptics and the risk factors contributing to the development of epilepsy. Results: Majority of the subjects were single (77.84%), 1st born among their siblings (25.95%), belonged to low social class (50.63%), and unemployed(25.31%). The major risk factors were family history of illness (23.52%) and positive medical problem around birth (12.66%). The presence of family history of illness, positive medical problem around birth and advanced maternal age at birth were associated with early onset of epilepsy. Vulnerability for the epilepsy also increases among hospital deliveries. Conclusion: Although the present study has identified various risk factors, yet the results need to be further confirmed through case-control studies. (author)

  15. Hospice decision making: diagnosis makes a difference.

    Waldrop, Deborah P; Meeker, Mary Ann

    2012-10-01

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

  16. Make or buy strategy decision making in supply quality chain

    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.

  17. Significance of irradiation of blood

    Sekine, Hiroshi; Gotoh, Eisuke; Mochizuki, Sachio

    1992-01-01

    Many reports of fatal GVHD occurring in non-immunocompromised patients after blood transfusion have been published in Japan. One explantation is that transfused lymphocytes were simulated and attack the recipient organs recognized as HLA incompatible. That is so called 'one-way matching'. To reduce the risk of post-transfusion GVHD, one of the most convenient methods is to irradiate the donated blood at an appropriate dose for inactivation of lymphocytes. Because no one knows about the late effect of irradiated blood, it is necessary to make the prospective safety control. (author)

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

    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.

  19. Advances in diaper technology

    Sahana M Srinivas

    2016-01-01

    Full Text Available Diapering practices vary among different countries from the use of cloth diapers to the modern disposable diaper. In the last few decades, diaper technology has advanced significantly thus decreasing the prevalence of diaper dermatitis. Recent innovative techniques used in the manufacturing of diapers include incorporation of superabsorbent polymer gel that can absorb 30 times its weight in liquid. Recently, smart diapers have been developed which not only prevents diaper dermatitis but significantly has reduced the burden on parents. This article reviews how changes in disposable diaper technology have improved diapering practices.

  20. Advancing neurosurgery through translational research.

    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.

  1. Advances in natural language processing.

    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.

  2. Making Science Work.

    Thomas, Lewis

    1981-01-01

    Presents a viewpoint concerning the impact of recent scientific advances on society. Discusses biological discoveries, space exploration, computer technology, development of new astronomical theories, the behavioral sciences, and basic research. Challenges to keeping science current with technological advancement are also discussed. (DS)

  3. They Make Space and Give Time

    ... 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.

  4. Make Learning Matter for the Multitasking Generation

    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…

  5. Make Better Food Choices

    10 tips Nutrition Education Series make better food choices 10 tips for women’s health Fruits Grains Dairy Vegetables Protein Make yourself a priority and take time to care for yourself. ChooseMyPlate. gov ...

  6. Categorization = Decision Making + Generalization

    Seger, Carol A; Peterson, Erik J.

    2013-01-01

    We rarely, if ever, repeatedly encounter exactly the same situation. This makes generalization crucial for real world decision making. We argue that categorization, the study of generalizable representations, is a type of decision making, and that categorization learning research would benefit from approaches developed to study the neuroscience of decision making. Similarly, methods developed to examine generalization and learning within the field of categorization may enhance decision making research. We first discuss perceptual information processing and integration, with an emphasis on accumulator models. We then examine learning the value of different decision making choices via experience, emphasizing reinforcement learning modeling approaches. Next we discuss how value is combined with other factors in decision making, emphasizing the effects of uncertainty. Finally, we describe how a final decision is selected via thresholding processes implemented by the basal ganglia and related regions. We also consider how memory related functions in the hippocampus may be integrated with decision making mechanisms and contribute to categorization. PMID:23548891

  7. Labour analgesia: Recent advances

    Pandya, Sunil T

    2010-01-01

    Advances in the field of labour analgesia have tread a long journey from the days of ether and chloroform in 1847 to the present day practice of comprehensive programme of labour pain management using evidence-based medicine. Newer advances include introduction of newer techniques like combined spinal epidurals, low-dose epidurals facilitating ambulation, pharmacological advances like introduction of remifentanil for patient-controlled intravenous analgesia, introduction of newer local anaesthetics and adjuvants like ropivacaine, levobupivacaine, sufentanil, clonidine and neostigmine, use of inhalational agents like sevoflourane for patient-controlled inhalational analgesia using special vaporizers, all have revolutionized the practice of pain management in labouring parturients. Technological advances like use of ultrasound to localize epidural space in difficult cases minimizes failed epidurals and introduction of novel drug delivery modalities like patient-controlled epidural analgesia (PCEA) pumps and computer-integrated drug delivery pumps have improved the overall maternal satisfaction rate and have enabled us to customize a suitable analgesic regimen for each parturient. Recent randomized controlled trials and Cochrane studies have concluded that the association of epidurals with increased caesarean section and long-term backache remains only a myth. Studies have also shown that the newer, low-dose regimes do not have a statistically significant impact on the duration of labour and breast feeding and also that these reduce the instrumental delivery rates thus improving maternal and foetal safety. Advances in medical technology like use of ultrasound for localizing epidural space have helped the clinicians to minimize the failure rates, and many novel drug delivery modalities like PCEA and computer-integrated PCEA have contributed to the overall maternal satisfaction and safety. PMID:21189877

  8. Historical Significant Volcanic Eruption Locations

    Department of Homeland Security — A significant eruption is classified as one that meets at least one of the following criteriacaused fatalities, caused moderate damage (approximately $1 million or...

  9. Explosive advances

    Crosby, W. [Mining Resource Engineering Ltd. (Canada)

    2002-08-01

    The paper explores the way in which various control blast designs can offer large mines improved final wall angles, resulting in significant overall cost reductions. The recent introduction of the Bucyrus 39R drill which can drill at reverse angles can produce steeper pit walls if geotechnical conditions allow, by employing large low cost rotary drills for final wall development. 9 refs., 9 figs., 2 tabs.

  10. Significance of the Lausanne Covenant

    J.S. Rhee

    1975-03-01

    Full Text Available In his long address called “Why Lausanne?” Dr Billy Graham clearly stated the reason and purpose to have the International Congress on World Evangelization by saying that “we are met to pray, talk, plan and to advance the work of evangelism ,” and he adds: “This is a conference of evangelicals. The participants were asked to come because you are evangelical-concerned with evangelism and missions; and we here tonight stand firmly in the evangelical tradition of Biblical faith.” Here we can find two specific reasons for the congress: to discuss for furtherance of world evangelism and to bring evangelicals together for a united front of the world evangelization. For this purpose the invitations were sent to all over the world. According to statistics published officially by the congress six continents sent their representatives to the congress responding to the invitation though it was sent on individual basis: 458 from Africa, 729 from Asia, 1 115 from North and Central America, 777 from Europe, 180 from South America and 150 from Oceania. Literally it was a world-wide congress. There was never such a large gathering before on a single purpose.

  11. Teachers' Grading Decision Making

    Isnawati, Ida; Saukah, Ali

    2017-01-01

    This study investigated teachers' grading decision making, focusing on their beliefs underlying their grading decision making, their grading practices and assessment types, and factors they considered in grading decision making. Two teachers from two junior high schools applying different curriculum policies in grade reporting in Indonesian…

  12. I: Making Art

    Rosenfeld, Malke; Johnson, Marquetta; Plemons, Anna; Makol, Suzanne; Zanskas, Meghan; Dzula, Mark; Mahoney, Meg Robson

    2014-01-01

    Writing about the teaching artist practice should mean writing about art making. As both teacher and artist, the authors are required to be cognizant of their own art-making processes, both how it works and why it is important to them, in order to make this process visible to their students. They also need the same skills to write about how and…

  13. Elements of Making

    Rodriguez, Shelly; Harron, Jason; Fletcher, Steven; Spock, Hannah

    2018-01-01

    While there is no official definition, making is generally thought of as turning ideas into products through design, invention, and building. Support is growing for integrating making into science, technology, engineering, and mathematics (STEM) education. Making can help high school students explore science concepts and phenomena, yet, lacking…

  14. CANDU advanced fuel cycles

    Slater, J.B.

    1986-03-01

    This report is based on informal lectures and presentations made on CANDU Advanced Fuel Cycles over the past year or so, and discusses the future role of CANDU in the changing environment for the Canadian and international nuclear power industry. The changing perspectives of the past decade lead to the conclusion that a significant future market for a CANDU advanced thermal reactor will exist for many decades. Such a reactor could operate in a stand-alone strategy or integrate with a mixed CANDU-LWR or CANDU-FBR strategy. The consistent design focus of CANDU on enhanced efficiency of resource utilization combined with a simple technology to achieve economic targets, will provide sufficient flexibility to maintain CANDU as a viable power producer for both the medium- and long-term future

  15. Advances in soil dynamics

    Advances in Soil Dynamics, Volume 3, represents the culmination of the work undertaken by the Advances in Soil Dynamics Monograph Committee, PM-45-01, about 15 years ago to summarize important developments in this field over the last 35 years. When this project was initiated, the main goal...... was to abridge major strides made in the general area of soil dynamics during the sixties, seventies, and eighties. However, by about the mid-nineties soil dynamics research in the US and much of the developed world had come to a virtual standstill. Although significant progress was made prior to the mid......-nineties, we still do not have a sound fundamental knowledge of soil-machine and soil-plant interactions. It is the hope of the editors that these three volumes will provide a ready reference for much needed future research in this area....

  16. Recent advances in insertion devices

    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

  17. Significance evaluation in factor graphs

    Madsen, Tobias; Hobolth, Asger; Jensen, Jens Ledet

    2017-01-01

    in genomics and the multiple-testing issues accompanying them, accurate significance evaluation is of great importance. We here address the problem of evaluating statistical significance of observations from factor graph models. Results Two novel numerical approximations for evaluation of statistical...... significance are presented. First a method using importance sampling. Second a saddlepoint approximation based method. We develop algorithms to efficiently compute the approximations and compare them to naive sampling and the normal approximation. The individual merits of the methods are analysed both from....... Conclusions The applicability of saddlepoint approximation and importance sampling is demonstrated on known models in the factor graph framework. Using the two methods we can substantially improve computational cost without compromising accuracy. This contribution allows analyses of large datasets...

  18. Significant Lactic Acidosis from Albuterol

    Deborah Diercks

    2018-03-01

    Full Text Available Lactic acidosis is a clinical entity that demands rapid assessment and treatment to prevent significant morbidity and mortality. With increased lactate use across many clinical scenarios, lactate values themselves cannot be interpreted apart from their appropriate clinical picture. The significance of Type B lactic acidosis is likely understated in the emergency department (ED. Given the mortality that sepsis confers, a serum lactate is an important screening study. That said, it is with extreme caution that we should interpret and react to the resultant elevated value. We report a patient with a significant lactic acidosis. Though he had a high lactate value, he did not require aggressive resuscitation. A different classification scheme for lactic acidosis that focuses on the bifurcation of the “dangerous” and “not dangerous” causes of lactic acidosis may be of benefit. In addition, this case is demonstrative of the potential overuse of lactates in the ED.

  19. Advanced alarm management system

    Easter, J.R.

    1995-01-01

    The Westinghouse Advanced Alarm Management System (AWARE) is one of the Man-Machine Design Interfaces (MMI) which has great flexibility with regard to hardware type and configuration, alarm system concept, plant scope, engineering scope and installation. The AWARE System provides the capability to better manage the quantity prioritization and presentation of real-time process alarm messages in the control room. The messages are specific, precise and dynamic. The AWARE System can provide a large reduction in the number of messages that the control room staff must address at any one time, thus making the alarm message system a useful tool for the operators during situations that normally produce a high volume of messages as well as improving the clarity of the presentation of process abnormalities during small disturbances. The operating staff is now provided with the basis for a better understanding of the current plant state and for taking the appropriate control actions. (2 refs., 3 figs.)

  20. Advancing family psychology.

    Fiese, Barbara H

    2016-02-01

    To realize the broad and complex nature of the field of family psychology, I have slightly revised the mission statement of the Journal of Family Psychology (JFP) to capture contemporary scholarship in family psychology and to advance systems perspectives in this top-tier scientific journal. Over the next 6 years, I hope that authors will consider JFP as an outlet for their best work in the following areas: (1) JFP addresses societal challenges faced by families today; (2) JFP publishes important studies on what makes couple and family relationships work; (3) JFP is a leader in publishing reports that use cutting-edge sophisticated approaches to research design and data analysis; and (4) JFP imparts knowledge about effective therapy and prevention programs relevant to couples and families. The journal is also expanding its publication rate to eight issues per year. (c) 2016 APA, all rights reserved).

  1. Focused Science Delivery makes science make sense.

    Rachel W. Scheuering; Jamie. Barbour

    2004-01-01

    Science does not exist in a vacuum, but reading scientific publications might make you think it does. Although the policy and management implications of their findings could often touch a much wider audience, many scientists write only for the few people in the world who share their area of expertise. In addition, most scientific publications provide information that...

  2. Making detailed predictions makes (some) predictions worse

    Kelly, Theresa F.

    In this paper, we investigate whether making detailed predictions about an event makes other predictions worse. Across 19 experiments, 10,895 participants, and 415,960 predictions about 724 professional sports games, we find that people who made detailed predictions about sporting events (e.g., how many hits each baseball team would get) made worse predictions about more general outcomes (e.g., which team would win). We rule out that this effect is caused by inattention or fatigue, thinking too hard, or a differential reliance on holistic information about the teams. Instead, we find that thinking about game-relevant details before predicting winning teams causes people to give less weight to predictive information, presumably because predicting details makes information that is relatively useless for predicting the winning team more readily accessible in memory and therefore incorporated into forecasts. Furthermore, we show that this differential use of information can be used to predict what kinds of games will and will not be susceptible to the negative effect of making detailed predictions.

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

    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....

  4. Ohio Advanced Energy Manufacturing Center

    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

  5. Advanced isotope separation

    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

  6. The historical significance of oak

    J. V. Thirgood

    1971-01-01

    A brief history of the importance of oak in Europe, contrasting the methods used in France and Britain to propagate the species and manage the forests for continued productivity. The significance of oak as a strategic resource during the sailing-ship era is stressed, and mention is made of the early development of oak management in North America. The international...

  7. Rule-based decision making model

    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)

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

    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.

  9. Soft computing in advanced robotics

    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...

  10. Business making decisions

    Enrique Benjamín Franklin Fincowsky

    2011-06-01

    Full Text Available People and organizations make better or get wrong as consequence of making decisions. Sometimes making decisions is just a trial and error process. Some others, decisions are good and the results profitable with a few of mistakes, most of the time because it’s considered the experience and the control of a specific field or the good intention of who makes them. Actually, all kinds of decisions bring learning. What is important is the intention, the attitude and the values considered in this process. People from different scenes face many facts and circumstances—almost always out of control—that affect the making decisions process. There is not a unique way to make decisions for all companies in many settings. The person who makes a decision should identify the problem, to solve it later using alternatives and solutions. Even though, follow all the steps it’s not easy as it seems. Looking back the conditions related to the decisions, we can mention the followings: uncertainty, risk and certainty. When people identify circumstances and facts, as well as its effects in a possible situation, they will make decisions with certainty. As long as the information decreases and it becomes ambiguous the risk becomes an important factor in the making decisions process because they are connected to probable objectives (clear or subjective (opinion judgment or intuition. To finish, uncertainty, involves people that make a decision with no or little information about circumstances or criteria with basis

  11. Status of advanced bremsstrahlung converters

    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

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

    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.

  13. Enforcement actions: Significant actions resolved

    1994-03-01

    This compilation summarizes significant enforcement actions that have been resolved during one quarterly period (October - December 1993) and includes copies of letters, Notices, and Orders sent by the Nuclear Regulatory Commission to licensees with respect to these enforcement actions. It is anticipated that the information in this publication will be widely disseminated to managers and employees engaged in activities licensed by the NRC, so that actions can be taken to improve safety by avoiding future violations similar to those described in this publication

  14. Enforcement actions: Significant actions resolved

    1992-11-01

    This compilation summarizes significant enforcement actions that have been resolved during one quarterly period (July - September 1992) and includes copies of letters, Notices, and Orders sent by the Nuclear Regulatory Commission to licensees with respect to these enforcement actions. It is anticipated that the information in this publication will be widely disseminated to managers and employees engaged in activities licensed by the NRC, so that actions can be taken to improve safety by avoiding future violations similar to those described in this publication

  15. Dual purpose or not? The significant factors

    Bak, W.; Roland, V.

    1999-01-01

    The development of spent fuel storage systems requires consideration of many factors in making design decisions. A significant issue affecting the design is the need to incorporate transportability of the canister or cask system design, which results in major changes to the storage system design. This paper presents a review of the significant factors affecting storage system design to incorporate transportation requirements and looks at the trends in both the United States and Europe where Transnucleaire and its US affiliated companies Transnuclear Inc., Transnuclear West and PacTec are active. A discussion is also presented relative to the pros and cons of whether the spent fuel storage system vendor should anticipate these transportation needs in the design of their systems. (author)

  16. Advanced SLARette delivery machine

    Bodner, R.R.

    1995-01-01

    SLARette 1 equipment, comprising of a SLARette Delivery Machine, SLAR Tools, SLAR power supplies and SLAR Inspection Systems was designed, developed and manufactured to service fuel channels of CANDU 6 stations during the regular yearly station outages. The Mark 2 SLARette Delivery Machine uses a Push Tube system to provide the axial and rotary movements of the SLAR Tool. The Push Tubes are operated remotely but must be attached and removed manually. Since this operation is performed at the Reactor face, there is radiation dose involved for the workers. An Advanced SLARette Delivery Machine which incorporates a computer controlled telescoping Ram in the place of the Push Tubes has been recently designed and manufactured. Utilization of the Advanced SLARette Delivery Machine significantly reduces the amount of radiation dose picked up by the workers because the need to have workers at the face of the Reactor during the SLARette operation is greatly reduced. This paper describes the design, development and manufacturing process utilized to produce the Advanced SLARette Delivery Machine and the experience gained during the Gentilly-2 NGS Spring outage. (author)

  17. Advances in titanium alloys

    Seagle, S.R.; Wood, J.R.

    1993-01-01

    As described above, new developments in the aerospace market are focusing on higher temperature alloys for jet engine components and higher strength/toughness alloys for airframe applications. Conventional alloys for engines have reached their maximum useful temperature of about 1000 F (540 C) because of oxidation resistance requirements. IMI 834 and Ti-1100 advanced alloys show some improvement, however, the major improvement appears to be in gamma titanium aluminides which could extend the maximum usage temperature to about 1500 F (815 C). This puts titanium alloys in a competitive position to replace nickel-base superalloys. Advanced airframe alloys such as Ti-6-22-22S, Beta C TM , Ti-15-333 and Ti-10-2-3 with higher strength than conventional Ti-6-4 are being utilized in significantly greater quantities, both in military and commercial applications. These alloys offer improved strength with little or no sacrifice in toughness and improved formability, in some cases. Advanced industrial alloys are being developed for improved corrosion resistance in more reducing and higher temperature environments such as those encountered in sour gas wells. Efforts are focused on small precious metal additions to optimize corrosion performance for specific applications at a modest increase in cost. As these applications develop, the usage of titanium alloys for industrial markets should steadily increase to approach that for aerospace applications. (orig.)

  18. Statistical significance versus clinical relevance.

    van Rijn, Marieke H C; Bech, Anneke; Bouyer, Jean; van den Brand, Jan A J G

    2017-04-01

    In March this year, the American Statistical Association (ASA) posted a statement on the correct use of P-values, in response to a growing concern that the P-value is commonly misused and misinterpreted. We aim to translate these warnings given by the ASA into a language more easily understood by clinicians and researchers without a deep background in statistics. Moreover, we intend to illustrate the limitations of P-values, even when used and interpreted correctly, and bring more attention to the clinical relevance of study findings using two recently reported studies as examples. We argue that P-values are often misinterpreted. A common mistake is saying that P < 0.05 means that the null hypothesis is false, and P ≥0.05 means that the null hypothesis is true. The correct interpretation of a P-value of 0.05 is that if the null hypothesis were indeed true, a similar or more extreme result would occur 5% of the times upon repeating the study in a similar sample. In other words, the P-value informs about the likelihood of the data given the null hypothesis and not the other way around. A possible alternative related to the P-value is the confidence interval (CI). It provides more information on the magnitude of an effect and the imprecision with which that effect was estimated. However, there is no magic bullet to replace P-values and stop erroneous interpretation of scientific results. Scientists and readers alike should make themselves familiar with the correct, nuanced interpretation of statistical tests, P-values and CIs. © The Author 2017. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.

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

    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

  20. 25 CFR 163.23 - Advance payment for timber products.

    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...

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

    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.

  2. Advances in fingerprint analysis.

    Hazarika, Pompi; Russell, David A

    2012-04-10

    Fingerprints have been used in forensic investigations for the identification of individuals since the late 19th century. However, it is now clear that fingerprints can provide significantly more information about an individual. Here, we highlight the considerable advances in fingerprinting technology that can simultaneously provide chemical information regarding the drugs ingested and the explosives and drugs handled by a person as well as the identity of that individual. Copyright © 2012 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  3. Decision Making Under Uncertainty

    2010-11-01

    A sound approach to rational decision making requires a decision maker to establish decision objectives, identify alternatives, and evaluate those...often violate the axioms of rationality when making decisions under uncertainty. The systematic description of such observations may lead to the...which leads to “anchoring” on the initial value. The fact that individuals have been shown to deviate from rationality when making decisions

  4. Making ''unconventional'' energy resources conventional

    Beattie, D A; Bresee, J C; Cooper, M J; Herwig, L O; Kintner, E E

    1977-01-01

    Three ''unconventional'' energy technologies - geothermal, solar and fusion - looked upon in the United States as possessing significant potential for the large scale production of energy. Both fusion and solar energy promise virtually inexhaustible supplies in the long term while geothermal resources offer a relatively near term prospect for more modest, but still significant, energy contributions. Realizing energy production from any of these technologies will require: (1) a great deal of scientific information and/or engineering development; (2) a significant effort to achieve and insure attractive economics; and (3) the development of adequate industrial capacity and technological infrastructure. Here the status of the United States Energy Research and Development Administration's technology development programs in geothermal, solar and fusion energy systems is reviewed. Recent advances in overcoming significant technological barriers are discussed and future directions are described. Special needs and unique opportunities for contributions to each technology are also set forth.

  5. Enforcement actions: Significant actions resolved

    1993-09-01

    This compilation summarizes significant enforcement actions that have been resolved during one quarterly period (April--June 1993) and includes copies of letters, Notices, and Orders sent by the Nuclear Regulatory Commission to licensees with respect to these enforcement actions. It is anticipated that the information in this publication will be widely disseminated to managers and employees engaged in activities licensed by the NRC, so that actions can be taken to improve safety by avoiding future violations similar to those described in this publication

  6. Enforcement actions: Significant actions resolved

    1990-05-01

    This compilation summarizes significant enforcement actions that have been resolved during one quarterly period (January--March 1990) and includes copies of letters, Notices, and Orders sent by the Nuclear Regulatory Commission to licensees with respect to these enforcement actions. Also included are a number of enforcement actions that had been previously resolved but not published in this NUREG. It is anticipated that the information in this publication will be widely disseminated to managers and employees engaged in activities licensed by the NRC, so that actions can be taken to improve safety by avoiding future violations similar to those described in this publication

  7. Enforcement actions: Significant actions resolved

    1991-05-01

    This compilation summarizes significant enforcement actions that have been resolved during one quarterly period (January--March 1991) and includes copies of letters, Notices, and Orders sent by the Nuclear Regulatory Commission to licensees with respect to these enforcement actions. It is anticipated that the information in this publication will be widely disseminated to managers and employees engaged in activities licensed by the NRC, so that actions can be taken to improve safety by avoiding future violations similar to those described in this publication

  8. Enforcement actions: Significant actions resolved

    1991-02-01

    This compilation summarizes significant enforcement actions that have been resolved during one quarterly period (October--December 1990) and includes copies of letters, Notices, and Orders sent by the Nuclear Regulatory Commission to licensees with respect to these enforcement actions. It is anticipated that the information in this publication will be widely disseminated to managers and employees engaged in activities licensed by the NRC, so that actions can be taken to improve safety by avoiding future violations similar to those described in this publication

  9. Enforcement actions: Significant actions resolved

    1990-03-01

    This compilation summarizes significant enforcement actions that have been resolved during one quarterly period (October--December 1989) and includes copies of letters, Notices, and Orders sent by the Nuclear Regulatory Commission to licensees with respect to these enforcement actions. It is anticipated that the information in this publication will be widely disseminated to managers and employees engaged in activities licensed by the NRC, so that actions can be taken to improve safety by avoiding future violations similar to those described in this publication

  10. Enforcement actions: Significant actions resolved

    1990-11-01

    This compilation summarizes significant enforcement actions that have been resolved during one quarterly period (July--September 1990) and includes copies of letters, notices, and orders sent by the Nuclear Regulatory Commission to licensees with respect to these enforcement actions. It is anticipated that the information in this publication will be widely disseminated to managers and employees engaged in activities licensed by the NRC, so that actions can be taken to improve safety by avoiding future violations similar to those described in this publication

  11. Enforcement actions: Significant actions resolved

    1992-08-01

    This compilation summarizes significant enforcement actions that have been resolved during one quarterly period (April--June 1992) and includes copies of letters, Notices, and Orders sent by the Nuclear Regulatory Commission to licensees with respect to these enforcement actions. It is anticipated that the information in this publication will be widely disseminated to managers and employees engaged in activities licensed by the NRC, so that actions can be taken to improve safety by avoiding future violations similar to those described in this publication

  12. Enforcement actions: Significant actions resolved

    1990-09-01

    This compilation summarizes significant enforcement actions that have been resolved during one quarterly period (April--June 1990) and includes copies of letters, notices, and orders sent by the Nuclear Regulatory Commission to licensees with respect to these enforcement actions. It is anticipated that the information in this publication will be widely disseminated to managers and employees engaged in activities licensed by the NRC, so that actions can be taken to improve safety by avoiding future violations similar to those described in this publication

  13. Clinical significance of neonatal menstruation.

    Brosens, Ivo; Benagiano, Giuseppe

    2016-01-01

    Past studies have clearly shown the existence of a spectrum of endometrial progesterone responses in neonatal endometrium, varying from proliferation to full decidualization with menstrual-like shedding. The bleedings represent, similar to what occurs in adult menstruation, a progesterone withdrawal bleeding. Today, the bleeding is completely neglected and considered an uneventful episode of no clinical significance. Yet clinical studies have linked the risk of bleeding to a series of events indicating fetal distress. The potential link between the progesterone response and major adolescent disorders requires to be investigated by prospective studies. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  14. Enforcement actions: Significant actions resolved

    1993-06-01

    This compilation summarizes significant enforcement actions that have been resolved during one quarterly period (January--March 1993) and includes copies of letters, Notices, and Orders sent by the Nuclear Regulatory Commission to licensees with respect to these enforcement actions. It is anticipated that the information in this publication will be widely disseminated to managers and employees engaged in activities licensed by the NRC, so that actions can be taken to improve safety by avoiding future violations similar to those described in this publication

  15. Enforcement actions: Significant actions resolved

    1992-05-01

    This compilation summarizes significant enforcement actions that have been resolved during one quarterly period (January--March 1992) and includes copies of letters, Notices, and Orders sent by the Nuclear Regulatory Commission to licensees with respect to these enforcement actions. It is anticipated that the information in this publication will be widely disseminated to managers and employees engaged in activities licensed by the NRC, so that actions can be taken to improve safety by avoiding future violations similar to those described in this publication

  16. Enforcement actions: Significant actions resolved

    1993-12-01

    This compilation summarizes significant enforcement actions that have been resolved during one quarterly period (July--September 1993) and includes copies of letters, Notices, and Orders sent by the Nuclear Regulatory Commission to licensees with respect to these enforcement actions. It is anticipated that the information in this publication will be widely disseminated to managers and employees engaged in activities licensed by the NRC, so that actions can be taken to improve safety by avoiding future violations similar to those described in this publication

  17. Enforcement actions: Significant actions resolved

    1993-03-01

    This compilation summarizes significant enforcement actions that have been resolved during one quarterly period (October--December 1992) and includes copies of letters, Notices, and Orders sent by the Nuclear Regulatory Commission to licensees with respect to these enforcement actions. It is anticipated that the information in this publication will be widely disseminated to managers and employees engaged in activities licensed by the NRC, so that actions can be taken to improve safety by avoiding future violations similar to those described in this publication

  18. Enforcement actions: Significant actions resolved

    1991-07-01

    This compilation summarizes significant enforcement actions that have been resolved during one quarterly period (April-June 1991) and includes copies of letters, Notices, and Orders sent by the Nuclear Regulatory Commission to licensees with respect to these enforcement actions. It is anticipated that the information in this publication will be widely disseminated to managers and employees engaged in activities licensed by the NRC, so that actions can be taken to improve safety by avoiding future violations similar to those described in this publication

  19. Enforcement actions: Significant actions resolved

    1991-11-01

    This compilation summarizes significant enforcement actions that have been resolved during one quarterly period (July--September 1991) and includes copies of letters, Notices, and Orders sent by the Nuclear Regulatory Commission to licensees with respect to these enforcement actions. It is anticipated that the information in this publication will be widely disseminated to managers and employees engaged in activities licensed by the NRC, so that actions can be taken to improve safety by avoiding future violations similar to those described in this publication

  20. Enforcement actions: Significant actions resolved

    1992-03-01

    This compilation summarizes significant enforcement actions that have been resolved during one quarterly period (October--December 1991) and includes copies of letters, Notices, and Orders sent by the Nuclear Regulatory Commission to licensees with respect to these enforcement actions. It is anticipated that the information in this publication will be widely disseminated to managers and employees engaged in activities licensed by the NRC, so that actions can be taken to improve safety by avoiding future violations similar to those described in this publication

  1. Enforcement actions: Significant actions resolved

    1989-06-01

    This compilation summarizes significant enforcement actions that have been resolved during one quarterly period (January--March 1989) and includes copies of letters, Notices, and Orders sent by the Nuclear Regulatory Commission to licensees with respect to these enforcement actions. Also included are a number of enforcement actions that had been previously resolved but not published in this NUREG. It is anticipated that the information in this publication will be widely disseminated to managers and employees engaged in activities licensed by the NRC, so that actions can be taken to improve safety by avoiding future violations similar to those described in this publication

  2. Enforcement actions: Significant actions resolved

    1989-12-01

    This compilation summarizes significant enforcement actions that have been resolved during one quarterly period (July--September 1989) and includes copies of letters, Notices, and Orders sent by the Nuclear Regulatory Commission to licensees with respect to these enforcement actions. It is anticipated that the information in this publication will be widely disseminated to managers and employees engaged in activities licensed by the NRC, so that actions can be taken to improve safety by avoiding future violations similar to those described in this publication

  3. Cash Advance Accounting: Accounting Regulations and Practices

    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.

  4. Moral significance of phenomenal consciousness.

    Levy, Neil; Savulescu, Julian

    2009-01-01

    Recent work in neuroimaging suggests that some patients diagnosed as being in the persistent vegetative state are actually conscious. In this paper, we critically examine this new evidence. We argue that though it remains open to alternative interpretations, it strongly suggests the presence of consciousness in some patients. However, we argue that its ethical significance is less than many people seem to think. There are several different kinds of consciousness, and though all kinds of consciousness have some ethical significance, different kinds underwrite different kinds of moral value. Demonstrating that patients have phenomenal consciousness--conscious states with some kind of qualitative feel to them--shows that they are moral patients, whose welfare must be taken into consideration. But only if they are subjects of a sophisticated kind of access consciousness--where access consciousness entails global availability of information to cognitive systems--are they persons, in the technical sense of the word employed by philosophers. In this sense, being a person is having the full moral status of ordinary human beings. We call for further research which might settle whether patients who manifest signs of consciousness possess the sophisticated kind of access consciousness required for personhood.

  5. Clinical significance of the fabella

    Dodevski, A.; Lazarova-Tosovska, D.; Zhivadinovik, J.; Lazareska, M.

    2012-01-01

    Full text: Introduction: There is variable number of sesamoid bones in the human body; one of them is fabella, located in the tendon of the gastrocnemius muscle. Aim of this study was to investigate the frequency of occurrence of fabella in the Macedonian population and to discuss about clinical importance of this bone. Materials and methods: We retrospectively examined radiographs of 53 patients who had knee exams undertaken for a variety of clinical reasons, performed as a part of their medical treatment. Over a time span of six months, 53 patients (38 males and 15 females, age range 19-60 years, mean age of 36.7±12.3 years) were examined. Results: In seven (13.2%) patients of 53 analyzed reports, fabella was found in the lateral tendon of gastrocnemius muscle. We did not find a significant gender or side difference in the appearance of fabella. Conclusion: Although anatomic studies emphasized a lack of significance of the fabella, this bone has been associated with a spectrum of pathology affecting the knee as fabellar syndrome, perineal nerve injury and fracture. We should think of this sesamoid bone while performing diagnostic and surgical procedures

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

    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.

  7. Fire science application and integration in support of decision making

    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...

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

    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…

  9. No significant fuel failures (NSFF)

    Domaratzki, Z.

    1979-01-01

    It has long been recognized that no emergency core cooling system (ECCS) could be absolutely guaranteed to prevent fuel failures. In 1976 the Atomic Energy Control Board decided that the objective for an ECCS should be to prevent fuel failures, but if the objective could not be met it should be shown that the consequences are acceptable for dual failures comprising any LOCA combined with an assumed impairment of containment. Out of the review of the Bruce A plant came the definition of 'no significant fuel failures': for any postulated LOCA combined with any one mode of containment impairment the resultant dose to a person at the edge of the exclusion zone is less than the reference dose limits for dual failures

  10. Ritual Significance in Mycenaean Hairstyles

    Hsu, Florence Sheng-chieh

    2012-04-01

    Full Text Available Although the frescoes excavated from Bronze Age sites on the Greek mainland provide evidence for female figures in the Mycenaean society, the hairstyles of these figures have not been studied in detail. As in many other ancient cultures, hairstyles were not only an exhibition of beauty and fashion, but they also represented certain age groups or a person’s social status. The Mycenaeans inherited many of their hairstyles from their Minoan predecessors, although differences existed as well. It is also possible there may have been a shift in meaning for seemingly similar looking hairstyles from the Minoan to the Mycenaean periods. Female figures, which compose most of the Mycenaean figures in frescoes known to date, are fine examples for discussing the artistic representation and potential significance of Mycenaean hairstyles. By comparing with Minoan hairstyles, discussions of Mycenaean examples lead to conclusions in the relationship between hairstyles and ritual activities in the Mycenaean society.

  11. Advances in Schoolwide Inclusive School Reform

    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…

  12. The energetic significance of cooking.

    Carmody, Rachel N; Wrangham, Richard W

    2009-10-01

    While cooking has long been argued to improve the diet, the nature of the improvement has not been well defined. As a result, the evolutionary significance of cooking has variously been proposed as being substantial or relatively trivial. In this paper, we evaluate the hypothesis that an important and consistent effect of cooking food is a rise in its net energy value. The pathways by which cooking influences net energy value differ for starch, protein, and lipid, and we therefore consider plant and animal foods separately. Evidence of compromised physiological performance among individuals on raw diets supports the hypothesis that cooked diets tend to provide energy. Mechanisms contributing to energy being gained from cooking include increased digestibility of starch and protein, reduced costs of digestion for cooked versus raw meat, and reduced energetic costs of detoxification and defence against pathogens. If cooking consistently improves the energetic value of foods through such mechanisms, its evolutionary impact depends partly on the relative energetic benefits of non-thermal processing methods used prior to cooking. We suggest that if non-thermal processing methods such as pounding were used by Lower Palaeolithic Homo, they likely provided an important increase in energy gain over unprocessed raw diets. However, cooking has critical effects not easily achievable by non-thermal processing, including the relatively complete gelatinisation of starch, efficient denaturing of proteins, and killing of food borne pathogens. This means that however sophisticated the non-thermal processing methods were, cooking would have conferred incremental energetic benefits. While much remains to be discovered, we conclude that the adoption of cooking would have led to an important rise in energy availability. For this reason, we predict that cooking had substantial evolutionary significance.

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

    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.

  14. What Makes Your Writing Style Unique? Significant Differences Between Two Famous Romanian Orators

    Dascalu, Mihai; Gifu, Daniela; Trausan-Matu, Stefan

    2016-01-01

    This paper introduces a novel, in-depth approach of analyzing the differences in writing style between two famous Romanian orators, based on automated textual complexity indices for Romanian language. The considered authors are: (a) Mihai Eminescu, Romania’s national poet and a

  15. Do Age and Sex of School Students Make Significant Difference in Their Multiple Intelligences?

    Ravi, R.; Vedapriya, S. Gethsi

    2009-01-01

    Multiple Intelligences are a new educational theory proposed by Howard Gardner in 1983. Multiple intelligences describe an array of different kinds of intelligences exhibited by human beings. This theory consists of verbal-linguistic, logical and mathematics, visual and spatial, bodily kinesthetic, musical-rhythmic, intrapersonal, interpersonal,…

  16. F 35 JOINT STRIKE FIGHTER DOD Needs to Complete Developmental Testing Before Making Significant New Investments

    2017-04-01

    aircraft currently in production , 82 are United States aircraft and 60 are for international partners or foreign military sales . Aircraft Manufacturing... review team. As a result, development funds increased, test aircraft were added, the schedule was extended, and the early production rate decreased...the Navy’s initial operational capability, and delay the program’s full rate production decision, currently planned for April 2019. Assumptions

  17. Effect of Plasma Membrane Semipermeability in Making the Membrane Electric Double Layer Capacitances Significant.

    Sinha, Shayandev; Sachar, Harnoor Singh; Das, Siddhartha

    2018-01-30

    Electric double layers (or EDLs) formed at the membrane-electrolyte interface (MEI) and membrane-cytosol interface (MCI) of a charged lipid bilayer plasma membrane develop finitely large capacitances. However, these EDL capacitances are often much larger than the intrinsic capacitance of the membrane, and all of these capacitances are in series. Consequently, the effect of these EDL capacitances in dictating the overall membrane-EDL effective capacitance C eff becomes negligible. In this paper, we challenge this conventional notion pertaining to the membrane-EDL capacitances. We demonstrate that, on the basis of the system parameters, the EDL capacitance for both the permeable and semipermeable membranes can be small enough to influence C eff . For the semipermeable membranes, however, this lowering of the EDL capacitance can be much larger, ensuring a reduction of C eff by more than 20-25%. Furthermore, for the semipermeable membranes, the reduction in C eff is witnessed over a much larger range of system parameters. We attribute such an occurrence to the highly nonintuitive electrostatic potential distribution associated with the recently discovered phenomena of charge-inversion-like electrostatics and the attainment of a positive zeta potential at the MCI for charged semipermeable membranes. We anticipate that our findings will impact the quantification and the identification of a large number of biophysical phenomena that are probed by measuring the plasma membrane capacitance.

  18. The Significance of Self-Portraits: Making Connections through Monotype Prints in "Letras y Arte"

    Armon, Joan; Uhrmacher, P. Bruce; Ortega, Tony

    2009-01-01

    "Letras y Arte: Literacy and Art" is a 3-week summer course at Regis University in Denver, Colorado, offering a social justice approach to art education. In this article, the authors outline the background of "Letras y Arte," contextualize the program in art education, and explain three strategies for engaging students: (1)…

  19. Making Team Differences Work

    Strathman, Beth

    2015-01-01

    Most district and school leaders understand that recruiting group members who have differing backgrounds, perspectives, talents, and personalities makes for good decision-making. Unfortunately, simply assembling a variety of top-notch individuals does not necessarily mean their talents and perspectives will be fully considered. Beth Strathman…

  20. Making Smart Food Choices

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

  1. It Makes You Think

    Harden, Helen

    2009-01-01

    This article provides an overview of the "It Makes You Think" resource. The lessons provided by this resource show how students can learn about the global dimension through science. The "It Makes You Think" resource contains ten topics: (1) Metals in jewellery worldwide; (2) Global food market; (3) The worldwide travels of…

  2. Making Healthy Choices Easier

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

    2016-01-01

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

  3. [Decision making in cariology

    Verdonschot, E.H.A.M.; Liem, S.L.; Palenstein Helderman, W.H. van

    2003-01-01

    By conducting an oral examination, during radiographic examination and in treatment planning procedures dentists make numerous decisions. A dentist will be required to make his decisions explicit. Decision trees and decision analyses may play an important role. In a decision analysis, the

  4. Culinary Decision Making.

    Curtis, Rob

    1987-01-01

    Advises directors of ways to include day care workers in the decision-making process. Enumerates benefits of using staff to help focus and direct changes in the day care center and discusses possible pitfalls in implementation of a collective decision-making approach to management. (NH)

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

    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

  6. Decision-making: Theory and practice

    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.

  7. Neuroanatomical basis for recognition primed decision making.

    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.

  8. Origin and significance of defects in welds

    Lundin, C.D.

    1984-01-01

    In the past 10 to 15 years significant advances have taken place in the understanding of the origin and nature of weld discontinuities. The furthering of the knowledge of hot cracking, cold cracking, lamellar tearing and porosity formation is due to the development and utilization of sophisticated techniques for microscopy and microanalysis and the concerted efforts of many researchers in the U.S. and abroad. Concurrent with the progress toward better definition of the metallurgical mechanisms for discontinuity formation, the development of the fracture mechanics approach for the assessment of the significance of the discontinuities was brought into focus. It is the marriage of the metallurgical understanding of formation and the mechanics assessment of relevance that permits discontinuities to be treated with a new degree of sophistication. The many types of cracking and porosity formation were the subjects of numerous studies in the intervening years. This presentation will treat the various types of weld discontinuities which have their origin closely related to a metallurgical mechanism. Emphasis will be placed on hot cracking, and porosity formation with information presented on cold cracking, reheat cracking and lamellar tearing. The employment of the newer metallurgical tools will be discussed in terms of their utilization in determining the cause of discontinuity formation

  9. Prognostic significance of lymphovascular invasion in radical prostatectomy specimens.

    Yee, David S; Shariat, Shahrokh F; Lowrance, William T; Maschino, Alexandra C; Savage, Caroline J; Cronin, Angel M; Scardino, Peter T; Eastham, James A

    2011-08-01

    Study Type - Prognosis (case series). 4. What's known on the subject? and What does the study add? The reported incidence of lymphovascular invasion (LVI) in radical prostatectomy specimens ranges from 5% to 53%. Although LVI has a strong and significant association with adverse clinicopathologic features, it has almost uniformly not been found to be a predictor of biochemical recurrence (BR) on multivariate analysis. This study confirms that LVI is associated with features of aggressive disease and is an independent predictor of BCR. Given that LVI may play a role in the metastatic process, it may be useful in clinical decision-making regarding adjuvant therapy for patients treated with RP. To determine whether lymphovascular invasion (LVI) in radical prostatectomy (RP) specimens has prognostic significance. The study examined whether LVI is associated with clinicopathological characteristics and biochemical recurrence (BCR). LVI was evaluated based on routine pathology reports on 1298 patients treated with RP for clinically localized prostate cancer between 2004 and 2007. LVI was defined as the unequivocal presence of tumour cells within an endothelium-lined space. The association between LVI and clinicopathological features was assessed with univariate logistic regression. Cox regression was used to test the association between LVI and BCR. LVI was identified in 10% (129/1298) of patients. The presence of LVI increased with advancing pathological stage: 2% (20/820) in pT2N0 patients, 16% (58/363) in pT3N0 patients and 17% (2/12) in pT4N0 patients; and was highest in patients with pN1 disease (52%; 49/94). Univariate analysis showed an association between LVI and higher preoperative prostate-specific antigen levels and Gleason scores, and a greater likelihood of extraprostatic extension, seminal vesicle invasion, lymph node metastasis and positive surgical margins (all P < 0.001). With a median follow-up of 27 months, LVI was significantly associated with an

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

    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.

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

    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.

  12. Significant biases affecting abundance determinations

    Wesson, Roger

    2015-08-01

    I have developed two highly efficient codes to automate analyses of emission line nebulae. The tools place particular emphasis on the propagation of uncertainties. The first tool, ALFA, uses a genetic algorithm to rapidly optimise the parameters of gaussian fits to line profiles. It can fit emission line spectra of arbitrary resolution, wavelength range and depth, with no user input at all. It is well suited to highly multiplexed spectroscopy such as that now being carried out with instruments such as MUSE at the VLT. The second tool, NEAT, carries out a full analysis of emission line fluxes, robustly propagating uncertainties using a Monte Carlo technique.Using these tools, I have found that considerable biases can be introduced into abundance determinations if the uncertainty distribution of emission lines is not well characterised. For weak lines, normally distributed uncertainties are generally assumed, though it is incorrect to do so, and significant biases can result. I discuss observational evidence of these biases. The two new codes contain routines to correctly characterise the probability distributions, giving more reliable results in analyses of emission line nebulae.

  13. Astrobiological significance of chemolithoautotrophic acidophiles

    Pikuta, Elena V.; Hoover, Richard B.

    2004-02-01

    For more than a century (since Winogradsky discovered lithautotrophic bacteria) there has been a dilemma in microbiology about life that first inhabited the Earth. Which types of life forms first appeared in the primordial oceans during the earliest geological period on Earth as the primary ancestors of modern biological diversity? How did a metabolism of ancestors evolve: from lithoautotrophic to lithoheterotrophic and organoheterotrophic or from organoheterotrophic to organautotrophic and lithomixotrophic types? At the present time, it is known that chemolithoheterotrophic and chemolithoautotrophic metabolizing bacteria are wide spread in different ecosystems. On Earth the acidic ecosystems are associated with geysers, volcanic fumaroles, hot springs, deep sea hydrothermal vents, caves, acid mine drainage and other technogenic ecosystems. Bioleaching played a significant roel on a global geological scale during the Earth's formation. This important feature of bacteria has been successfully applied in industry. The lithoautotrophs include Bacteria and Archaea belonging to diverse genera containing thermophilic and mesophilic species. In this paper we discuss the lithotrophic microbial acidophiles and present some data with a description of new acidophilic iron- and sulfur-oxidizing bacterium isolated from the Chena Hot Springs in Alaska. We also consider the possible relevance of microbial acidophiles to Venus, Io, and acidic inclusions in glaciers and icy moons.

  14. Determining Semantically Related Significant Genes.

    Taha, Kamal

    2014-01-01

    GO relation embodies some aspects of existence dependency. If GO term xis existence-dependent on GO term y, the presence of y implies the presence of x. Therefore, the genes annotated with the function of the GO term y are usually functionally and semantically related to the genes annotated with the function of the GO term x. A large number of gene set enrichment analysis methods have been developed in recent years for analyzing gene sets enrichment. However, most of these methods overlook the structural dependencies between GO terms in GO graph by not considering the concept of existence dependency. We propose in this paper a biological search engine called RSGSearch that identifies enriched sets of genes annotated with different functions using the concept of existence dependency. We observe that GO term xcannot be existence-dependent on GO term y, if x- and y- have the same specificity (biological characteristics). After encoding into a numeric format the contributions of GO terms annotating target genes to the semantics of their lowest common ancestors (LCAs), RSGSearch uses microarray experiment to identify the most significant LCA that annotates the result genes. We evaluated RSGSearch experimentally and compared it with five gene set enrichment systems. Results showed marked improvement.

  15. Statistically significant relational data mining :

    Berry, Jonathan W.; Leung, Vitus Joseph; Phillips, Cynthia Ann; Pinar, Ali; Robinson, David Gerald; Berger-Wolf, Tanya; Bhowmick, Sanjukta; Casleton, Emily; Kaiser, Mark; Nordman, Daniel J.; Wilson, Alyson G.

    2014-02-01

    This report summarizes the work performed under the project (3z(BStatitically significant relational data mining.(3y (BThe goal of the project was to add more statistical rigor to the fairly ad hoc area of data mining on graphs. Our goal was to develop better algorithms and better ways to evaluate algorithm quality. We concetrated on algorithms for community detection, approximate pattern matching, and graph similarity measures. Approximate pattern matching involves finding an instance of a relatively small pattern, expressed with tolerance, in a large graph of data observed with uncertainty. This report gathers the abstracts and references for the eight refereed publications that have appeared as part of this work. We then archive three pieces of research that have not yet been published. The first is theoretical and experimental evidence that a popular statistical measure for comparison of community assignments favors over-resolved communities over approximations to a ground truth. The second are statistically motivated methods for measuring the quality of an approximate match of a small pattern in a large graph. The third is a new probabilistic random graph model. Statisticians favor these models for graph analysis. The new local structure graph model overcomes some of the issues with popular models such as exponential random graph models and latent variable models.

  16. Statistical Significance for Hierarchical Clustering

    Kimes, Patrick K.; Liu, Yufeng; Hayes, D. Neil; Marron, J. S.

    2017-01-01

    Summary Cluster analysis has proved to be an invaluable tool for the exploratory and unsupervised analysis of high dimensional datasets. Among methods for clustering, hierarchical approaches have enjoyed substantial popularity in genomics and other fields for their ability to simultaneously uncover multiple layers of clustering structure. A critical and challenging question in cluster analysis is whether the identified clusters represent important underlying structure or are artifacts of natural sampling variation. Few approaches have been proposed for addressing this problem in the context of hierarchical clustering, for which the problem is further complicated by the natural tree structure of the partition, and the multiplicity of tests required to parse the layers of nested clusters. In this paper, we propose a Monte Carlo based approach for testing statistical significance in hierarchical clustering which addresses these issues. The approach is implemented as a sequential testing procedure guaranteeing control of the family-wise error rate. Theoretical justification is provided for our approach, and its power to detect true clustering structure is illustrated through several simulation studies and applications to two cancer gene expression datasets. PMID:28099990

  17. Accessing patient-centered care using the advanced access model.

    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."

  18. The significance of music in teaching Turkish

    Feyzan Göher Vural

    2018-03-01

    Full Text Available The whole history of teaching foreign languages is, in a way, a search for the best methodologies of doing so. Methods of teaching can be seen as systems providing the optimal ways of getting basic knowledge of a foreign language for students. The existing wide variety of methods suggests the choice of those most efficient for particular individuals. Each of the methodologies used relies on a number of theoretical underpinnings. This article advances proposals on using music in teaching Turkish as a foreign language, based on the principles of suggestopedia — the psychology of positive teaching developed by G. Lozanov. It is claimed that suggestopedia helps students learn a foreign language 3 to 5 times faster than those who rely on traditional methods of study. Suggestopedia makes colloquial dialogues in a foreign language be pronounced and/or listened to in the same way as music, and music is used as a facilitating and motivating factor, without lyrics. However, teaching based on suggestopedia alone will not suffice, since in the classical form it is limited by adult audiences and small ones to boot. Other peculiarities of students and groups also have to be accounted for, such as their linguistic background: if their first language is a Turkic one, they can be expected to learn Turkish faster, since they are already familiar with the melodic mode of the language. It can nevertheless be postulated that the use of songs in language learning helps develop such skills as vocabulary, rules of grammar and correct pronunciation. Songs facilitate teaching new words, grammatical rules, learning direction, layout, numbers and demonstrative adjectives. This is both useful and interesting for all categories of learners, children as well as adults.

  19. An autonomous control framework for advanced reactors

    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.

  20. An autonomous control framework for advanced reactors

    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

  1. An autonomous control framework for advanced reactors

    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.

  2. Detection of significant protein coevolution.

    Ochoa, David; Juan, David; Valencia, Alfonso; Pazos, Florencio

    2015-07-01

    The evolution of proteins cannot be fully understood without taking into account the coevolutionary linkages entangling them. From a practical point of view, coevolution between protein families has been used as a way of detecting protein interactions and functional relationships from genomic information. The most common approach to inferring protein coevolution involves the quantification of phylogenetic tree similarity using a family of methodologies termed mirrortree. In spite of their success, a fundamental problem of these approaches is the lack of an adequate statistical framework to assess the significance of a given coevolutionary score (tree similarity). As a consequence, a number of ad hoc filters and arbitrary thresholds are required in an attempt to obtain a final set of confident coevolutionary signals. In this work, we developed a method for associating confidence estimators (P values) to the tree-similarity scores, using a null model specifically designed for the tree comparison problem. We show how this approach largely improves the quality and coverage (number of pairs that can be evaluated) of the detected coevolution in all the stages of the mirrortree workflow, independently of the starting genomic information. This not only leads to a better understanding of protein coevolution and its biological implications, but also to obtain a highly reliable and comprehensive network of predicted interactions, as well as information on the substructure of macromolecular complexes using only genomic information. The software and datasets used in this work are freely available at: http://csbg.cnb.csic.es/pMT/. pazos@cnb.csic.es Supplementary data are available at Bioinformatics online. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

  3. Safety issues on advanced fuel

    Gross, H.; Krebs, W.D. [Siemens AG, Bereich Energieerzeugug (KWU), Erlangen (Germany). Geschaeftsgebiet Nukleare Energieerzeugung

    1998-05-01

    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.) [Deutsch] In den letzten Jahren hat eine allgemeine Diskussion begonnen, ob mit fortgeschrittenen Brennelementen (BE) ungeklaerte Sicherheitsprobleme verbunden sind. Dabei ist `Fortgeschrittene Brennelemente` ein Sammelbegriff fuer hohe Abbraende, verbesserte Huellrohrmaterialien, Low-leakage-Einsatzplanungen mit hohen Heissstellenfaktoren usw. Die Auslegungsstoerfaelle RIA und Loca sind in dieser Diskussion von besonderer Bedeutung. Aus der Sicht von Siemens ist der RIA kein Sicherheitsproblem. Zwischen den mit modernen 3D-Methoden berechneten Enthalpieerhoehungen und den in RIA-Experimenten aufgetretenen Brennstabdefekten bestehen ausreichende Abstaende, wenn der Einfluss der Pulsbreite beruecksichtigt wird. Die Untersuchung eventueller Unsicherheiten bei hohen

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

    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.

  5. Decision making and cancer.

    Reyna, Valerie F; Nelson, Wendy L; Han, Paul K; Pignone, Michael P

    2015-01-01

    We review decision making along the cancer continuum in the contemporary context of informed and shared decision making in which patients are encouraged to take a more active role in their health care. We discuss challenges to achieving informed and shared decision making, including cognitive limitations and emotional factors, but argue that understanding the mechanisms of decision making offers hope for improving decision support. Theoretical approaches to decision making that explain cognition, emotion, and their interaction are described, including classical psychophysical approaches, dual-process approaches that focus on conflicts between emotion versus cognition (or reason), and modern integrative approaches such as fuzzy-trace theory. In contrast to the earlier emphasis on rote use of numerical detail, modern approaches emphasize understanding the bottom-line gist of options (which encompasses emotion and other influences on meaning) and retrieving relevant social and moral values to apply to those gist representations. Finally, research on interventions to support better decision making in clinical settings is reviewed, drawing out implications for future research on decision making and cancer. PsycINFO Database Record (c) 2015 APA, all rights reserved.

  6. Prognostic significance of aortic pulse wave velocity

    Hansen, T.W.; Jeppesen, J.; Torp-Pedersen, Christian Tobias

    2008-01-01

    Om bogen Vascular Hemodynamics This is the only complete work on vascular hemodynamics. Recently, vascular hemodynamics has undergone major advances, resulting from increasingly sophisticated imaging, computational, and clinical research methodologies. The effects of these advances are likely...... to be profound at both the scientific and clinical levels. Now, "Vascular Hemodynamics" provides a self-contained treatment of this rapidly advancing topic as it relates to vascular disease and related pathologies in the human body. Utilizing a multidisciplinary approach encompassing engineering, vascular...

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

    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.

  8. Making molecular machines work

    Browne, Wesley R.; Feringa, Ben L.

    2006-01-01

    In this review we chart recent advances in what is at once an old and very new field of endeavour the achievement of control of motion at the molecular level including solid-state and surface-mounted rotors, and its natural progression to the development of synthetic molecular machines. Besides a

  9. MAKE UP MARCH 2007

    Winnie

    2007-03-02

    Mar 2, 2007 ... patients with cancer apply to various malignant conditions. Treatment of ... study to study.3,4 Although evidence suggests that HD might be associated ... and more advanced disease, stage III or IV (75 - 89%), at presentation. .... patients, including testicular cancer, lung cancer and basal cell carcinoma of ...

  10. Molecular neuroimaging of emotional decision-making.

    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.

  11. Making people be healthy.

    Wilkinson, Timothy Martin

    2009-09-01

    How are we supposed to decide the rights and wrongs of banning smoking in bars, restricting adverts for junk food, nagging people into being screened for cancers, or banning the sale of party pills? The aim of this paper is to think through the political ethics of trying to make people healthier through influencing or restricting their choices. This paper covers: (1) Paternalism. What it is, what it assumes. (2) The place of health in well-being, and how this makes paternalism problematic. (3) The mistakes people make in acting in their own interests, and the implications for pro-health paternalism. (4) Autonomy objections to paternalism. The paper (5) finishes on a note of hope, by commending the currently fashionable libertarian paternalism: trying to have one's carrot cake and eat it too. A persistent theme is that thinking sensibly about making people healthier needs subtlety, not broad, ringing declarations.

  12. Making Ceramic Cameras

    Squibb, Matt

    2009-01-01

    This article describes how to make a clay camera. This idea of creating functional cameras from clay allows students to experience ceramics, photography, and painting all in one unit. (Contains 1 resource and 3 online resources.)

  13. Interactive Strategy-Making

    Andersen, Torben Juul

    2015-01-01

    This article outlines an interactive strategy-making model that combines central reasoning with ongoing learning from decentralised responses. The management literature often presents strategy as implementing an optimal plan identified through rational analysis and ascribes potential shortcomings...... to failed communication and execution of the planned actions. However, effective strategy-making comprises both central reasoning from forward-looking planning considerations and decentralised responses to emerging events as interacting elements in a dynamic adaptive system. The interaction between...

  14. Organizational decision making

    Grandori, Anna

    2015-01-01

    Approved for public release; distribution is unlimited This thesis develops a heuristic approach to organizational decision-making by synthesizing the classical, neo-classical and contingency approaches to organization theory. The conceptual framework developed also integrates the rational and cybernetic approaches with cognitive processes underlying the decision-making process. The components of the approach address the role of environment in organizational decision-maki...

  15. Making PMT halftone prints

    Corey, J.D.

    1977-05-01

    In the printing process for technical reports presently used at Bendix Kansas City Division, photographs are reproduced by pasting up PMT halftone prints on the artwork originals. These originals are used to make positive-working plastic plates for offset lithography. Instructions for making good-quality halftone prints using Eastman Kodak's PMT materials and processes are given in this report. 14 figures.

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

    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.

  17. Advanced Microelectronics Technologies for Future Small Satellite Systems

    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.

  18. Advanced technologies available for future solid propellant grains

    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)

  19. Testing the Difference of Correlated Agreement Coefficients for Statistical Significance

    Gwet, Kilem L.

    2016-01-01

    This article addresses the problem of testing the difference between two correlated agreement coefficients for statistical significance. A number of authors have proposed methods for testing the difference between two correlated kappa coefficients, which require either the use of resampling methods or the use of advanced statistical modeling…

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

    Bullock, Karen

    2006-02-01

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

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

    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.

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

    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.

  3. Decision Making in Action

    Orasanu, Judith; Statler, Irving C. (Technical Monitor)

    1994-01-01

    The importance of decision-making to safety in complex, dynamic environments like mission control centers and offshore installations has been well established. NASA-ARC has a program of research dedicated to fostering safe and effective decision-making in the manned spaceflight environment. Because access to spaceflight is limited, environments with similar characteristics, including aviation and nuclear power plants, serve as analogs from which space-relevant data can be gathered and theories developed. Analyses of aviation accidents cite crew judgement and decision making as causes or contributing factors in over half of all accidents. A similar observation has been made in nuclear power plants. Yet laboratory research on decision making has not proven especially helpful in improving the quality of decisions in these kinds of environments. One reason is that the traditional, analytic decision models are inappropriate to multidimensional, high-risk environments, and do not accurately describe what expert human decision makers do when they make decisions that have consequences. A new model of dynamic, naturalistic decision making is offered that may prove useful for improving decision making in complex, isolated, confined and high-risk environments. Based on analyses of crew performance in full-mission simulators and accident reports, features that define effective decision strategies in abnormal or emergency situations have been identified. These include accurate situation assessment (including time and risk assessment), appreciation of the complexity of the problem, sensitivity to constraints on the decision, timeliness of the response, and use of adequate information. More effective crews also manage their workload to provide themselves with time and resources to make good decisions. In brief, good decisions are appropriate to the demands of the situation. Effective crew decision making and overall performance are mediated by crew communication. Communication

  4. Cash Advance Accounting: Accounting Regulations and Practices

    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...

  5. Advanced Stirling Convertor Update

    Wood, J. Gary; Carroll, Cliff; Matejczyk, Dan; Penswick, L. B.; Soendker, E.

    2006-01-01

    This paper reports on the 88 We Advanced Stirling Convertor (ASC) currently being developed under Phase II of a NASA NRA program for possible use in advanced high specific power radioisotope space power systems. An early developmental unit, the Frequency Test Bed (FTB) which was built and tested in Phase I demonstrated 36% efficiency. The ASC-1 currently being developed under Phase II, uses a high temperature heater head to allow for operation at 850 °C and is expected to have an efficiency approaching 40% (based on AC electrical out) at a temperature ratio of 3.1. The final lightweight ASC-2 convertor to be developed in Phase III is expected to have a mass of approximately 1 kg. The implementation of the ASC would allow for much higher specific power radioisotope power systems, requiring significantly less radioisotope fuel than current systems. The first run of the ASC-1 occurred in September 2005, and full temperature operation was achieved in early October 2005. Presented is an update on progress on the ASC program as well as the plans for future development. Also presented are efforts being performed to ensure the ASC has the required long life already demonstrated in free-piston Stirling cryocoolers.

  6. A brief history of decision making.

    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?

  7. On acquiring decision making skills for endovascular interventions.

    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.

  8. Distributed Sensor Coordination for Advanced Energy Systems

    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

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

    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.

  10. Integrated assessment and environmental policy making. In pursuit of usefulness

    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)

  11. Advances in stereomicroscopy

    Schnitzler, H.; Zimmer, Klaus-Peter

    2008-09-01

    Similar to human's binocular vision, stereomicroscopes are comprised of two optical paths under a convergence angle providing a full perspective insight into the world's microstructure. The numerical aperture of stereomicroscopes has continuously increased over the years, reaching the point where the lenses of left and right perspective paths touched each other. This constraint appeared as an upper limit for the resolution of stereomicroscopes, as the resolution of a stereomicroscope was deduced from the numerical apertures of the two equally sized perspective channels. We present the optical design and advances in resolution of the world's first asymmetrical stereomicroscope, which is a technological breakthrough in many aspects of stereomicroscopes. This unique approach uses a large numerical aperture and thus an, so far, unachievable high lateral resolution in the one path, and a small aperture in the other path, which provides a high depth of field ("Fusion Optics"). This new concept is a technical challenge for the optical design of the zoom system as well as for the common main objectives. Furthermore, the new concept makes use of the particular way in which perspective information by binocular vision is formed in the human's brain. In conjunction with a research project at the University of Zurich, Leica Microsystems consolidated the functionality of this concept in to a new generation of stereomicroscopes.

  12. Switzerland advances payments to CERN

    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.

  13. Advances in fusion reactor design

    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

  14. Ethical Decision Making

    Lauesen, Linne Marie

    2012-01-01

    of the interaction between a corporation and its stakeholders. Methodology/approach: This paper offers a theoretical 'Organic Stakeholder Model' based on decision making theory, risk assessment and adaption to a rapidly changing world combined with appropriate stakeholder theory for ethical purposes in decision...... applicable): The Model is based on case studies, but the limited scope of the length of the paper did not leave room to show the empirical evidence, but only the theoretical study. Originality / value of a paper: The model offers a new way of combining risk management with ethical decision-making processes...... by the inclusion of multiple stakeholders. The conceptualization of the model enhances business ethics in decision making by managing and balancing stakeholder concerns with the same concerns as the traditional risk management models does – for the sake of the wider social responsibilities of the businesses...

  15. Making fictions sound real

    Langkjær, Birger

    2010-01-01

    This article examines the role that sound plays in making fictions perceptually real to film audiences, whether these fictions are realist or non-realist in content and narrative form. I will argue that some aspects of film sound practices and the kind of experiences they trigger are related...... to basic rules of human perception, whereas others are more properly explained in relation to how aesthetic devices, including sound, are used to characterise the fiction and thereby make it perceptually real to its audience. Finally, I will argue that not all genres can be defined by a simple taxonomy...... of sounds. Apart from an account of the kinds of sounds that typically appear in a specific genre, a genre analysis of sound may also benefit from a functionalist approach that focuses on how sounds can make both realist and non-realist aspects of genres sound real to audiences....

  16. Advances in facial reanimation.

    Tate, James R; Tollefson, Travis T

    2006-08-01

    Facial paralysis often has a significant emotional impact on patients. Along with the myriad of new surgical techniques in managing facial paralysis comes the challenge of selecting the most effective procedure for the patient. This review delineates common surgical techniques and reviews state-of-the-art techniques. The options for dynamic reanimation of the paralyzed face must be examined in the context of several patient factors, including age, overall health, and patient desires. The best functional results are obtained with direct facial nerve anastomosis and interpositional nerve grafts. In long-standing facial paralysis, temporalis muscle transfer gives a dependable and quick result. Microvascular free tissue transfer is a reliable technique with reanimation potential whose results continue to improve as microsurgical expertise increases. Postoperative results can be improved with ancillary soft tissue procedures, as well as botulinum toxin. The paper provides an overview of recent advances in facial reanimation, including preoperative assessment, surgical reconstruction options, and postoperative management.

  17. Advanced engineering mathematics

    Jeffrey, Alan

    2001-01-01

    Advanced Engineering Mathematics provides comprehensive and contemporary coverage of key mathematical ideas, techniques, and their widespread applications, for students majoring in engineering, computer science, mathematics and physics. Using a wide range of examples throughout the book, Jeffrey illustrates how to construct simple mathematical models, how to apply mathematical reasoning to select a particular solution from a range of possible alternatives, and how to determine which solution has physical significance. Jeffrey includes material that is not found in works of a similar nature, such as the use of the matrix exponential when solving systems of ordinary differential equations. The text provides many detailed, worked examples following the introduction of each new idea, and large problem sets provide both routine practice, and, in many cases, greater challenge and insight for students. Most chapters end with a set of computer projects that require the use of any CAS (such as Maple or Mathematica) th...

  18. Advanced biomaterials and biodevices

    Tiwari, Ashutosh

    2014-01-01

    Biomaterials are the fastest-growing emerging field of  biodevices. Design and development of biomaterials play a significant role in the diagnosis, treatment, and prevention of diseases. Recently, a variety of scaffolds/carriers have been evaluated for tissue regeneration, drug delivery, sensing and imaging.  Liposomes and microspheres have been developed for sustained delivery. Several anti-cancer drugs have been successfully formulated using biomaterial. The targeting of drugs to certain physiological sites has emerged as a promising tool in the treatment with improved drug bioavailability and reduction of dosing frequency. Biodevices-based targeting of drugs may improve the therapeutic success by limiting the adverse drug effects and resulting in more patient compliance and attaining a higher adherence level. Advanced biodevices hold merit as a drug carrier with high carrier capacity, feasibility of incorporation of both hydrophilic and hydrophobic substances, high stability, as well as the feasibility...

  19. Advanced Chemical Propulsion

    Bai, S. Don

    2000-01-01

    Design, propellant selection, and launch assistance for advanced chemical propulsion system is discussed. Topics discussed include: rocket design, advance fuel and high energy density materials, launch assist, and criteria for fuel selection.

  20. Mixed Frames and Risky Decision-Making.

    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.

  1. How We Make DNA Origami.

    Wagenbauer, Klaus F; Engelhardt, Floris A S; Stahl, Evi; Hechtl, Vera K; Stömmer, Pierre; Seebacher, Fabian; Meregalli, Letizia; Ketterer, Philip; Gerling, Thomas; Dietz, Hendrik

    2017-10-05

    DNA origami has attracted substantial attention since its invention ten years ago, due to the seemingly infinite possibilities that it affords for creating customized nanoscale objects. Although the basic concept of DNA origami is easy to understand, using custom DNA origami in practical applications requires detailed know-how for designing and producing the particles with sufficient quality and for preparing them at appropriate concentrations with the necessary degree of purity in custom environments. Such know-how is not readily available for newcomers to the field, thus slowing down the rate at which new applications outside the field of DNA nanotechnology may emerge. To foster faster progress, we share in this article the experience in making and preparing DNA origami that we have accumulated over recent years. We discuss design solutions for creating advanced structural motifs including corners and various types of hinges that expand the design space for the more rigid multilayer DNA origami and provide guidelines for preventing undesired aggregation and on how to induce specific oligomerization of multiple DNA origami building blocks. In addition, we provide detailed protocols and discuss the expected results for five key methods that allow efficient and damage-free preparation of DNA origami. These methods are agarose-gel purification, filtration through molecular cut-off membranes, PEG precipitation, size-exclusion chromatography, and ultracentrifugation-based sedimentation. The guide for creating advanced design motifs and the detailed protocols with their experimental characterization that we describe here should lower the barrier for researchers to accomplish the full DNA origami production workflow. © 2017 Wiley-VCH Verlag GmbH & Co. KGaA, Weinheim.

  2. Intersubjective meaning making

    Davidsen, Jacob

    of single-touch screen interaction among 8-9 year-old children presented here, shows that while the constraints of single-touch screens does not support equality of interaction at the verbal and the physical level, there seems to be an intersubjective learning outcome. More precisely, the constraints...... of single-touch screens offer support for intersubjective meaning making in its ability of constraining the interaction. By presenting a short embodied interaction analysis of 22 seconds of collaboration, I illustrate how an embodied interaction perspective on intersubjective meaning making can tell...... a different story about touch-screen supported collaborative learning....

  3. Emotion and decision making.

    Lerner, Jennifer S; Li, Ye; Valdesolo, Piercarlo; Kassam, Karim S

    2015-01-03

    A revolution in the science of emotion has emerged in recent decades, with the potential to create a paradigm shift in decision theories. The research reveals that emotions constitute potent, pervasive, predictable, sometimes harmful and sometimes beneficial drivers of decision making. Across different domains, important regularities appear in the mechanisms through which emotions influence judgments and choices. We organize and analyze what has been learned from the past 35 years of work on emotion and decision making. In so doing, we propose the emotion-imbued choice model, which accounts for inputs from traditional rational choice theory and from newer emotion research, synthesizing scientific models.

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

    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

  5. Advancing Water Science through Data Visualization

    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

  6. Advanced SOA tools and applications

    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.

  7. Advances in cervical screening technology.

    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.

  8. Advanced fuel technologies at General Atomics

    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

  9. Advanced High-Level Waste Glass Research and Development Plan

    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.

  10. Making Invisible Histories Visible

    Hanssen, Ana Maria

    2012-01-01

    This article features Omaha Public Schools' "Making Invisible Histories Visible" program, or MIHV. Omaha's schools have a low failure rate among 8th graders but a high one among high school freshmen. MIHV was created to help at-risk students "adjust to the increased demands of high school." By working alongside teachers and…

  11. In the making

    2005-01-01

    disciplines and includes other research areas with common interest in how people shape and make sense of things in an increasingly man-made world. The conference directs its interest towards the diversity, challenges, emerging practices and understanding of design. Rather than searching for common definitions...

  12. Strategic decision making

    Stokman, Frans N.; Assen, Marcel A.L.M. van; Knoop, Jelle van der; Oosten, Reinier C.H. van

    2000-01-01

    This paper introduces a methodology for strategic intervention in collective decision making.The methodology is based on (1) a decomposition of the problem into a few main controversial issues, (2) systematic interviews of subject area specialists to obtain a specification of the decision

  13. Making Room for Ethics

    Douglas-Jones, Rachel

    2017-01-01

    This article examines the work that goes in to ‘making room’ for ethics, literally and figuratively. It follows the activities of a capacity building Asia-Pacific NGO in training and recognising ethics review committees, using multi-sited field materials collected over 12 months between 2009...

  14. Making Deferred Taxes Relevant

    Brouwer, Arjan; Naarding, Ewout

    2018-01-01

    We analyse the conceptual problems in current accounting for deferred taxes and provide solutions derived from the literature in order to make International Financial Reporting Standards (IFRS) deferred tax numbers value-relevant. In our view, the empirical results concerning the value relevance of

  15. Time in the Making

    Dirckinck-Holmfeld, Katrine Remmen

    ? These are research questions Katrine Dirckinck - Holmfeld explores in the artistic research project Time in the Making: Rehearsing Reparative Critical Practices. Through the development of video installations Leap into Colour (20 12 - 2015) and movement (2012) and in dialogue with the work of artists Rania & Raed...

  16. Repeated Causal Decision Making

    Hagmayer, York; Meder, Bjorn

    2013-01-01

    Many of our decisions refer to actions that have a causal impact on the external environment. Such actions may not only allow for the mere learning of expected values or utilities but also for acquiring knowledge about the causal structure of our world. We used a repeated decision-making paradigm to examine what kind of knowledge people acquire in…

  17. What Makes Organization?

    Boll, Karen

    This article investigates a segmentation model used by the Danish Tax and Customs Administration to classify businesses’ motivational postures. The article uses two different conceptualizations of performativity to analyze what the model’s segmentations do; Hacking’s idea of making up people...

  18. Making Choices, Setting Goals

    Skinner, Timothy

    2013-01-01

    Diabetes management and education is very important. The way information is provided influences people's behaviours and thus outcomes. The way information is presented can increase or reduce the individual's ability to make informed decisions about their treatment and influences whether they acti...

  19. What Makes Clusters Decline?

    Østergaard, Christian Richter; Park, Eun Kyung

    2015-01-01

    Most studies on regional clusters focus on identifying factors and processes that make clusters grow. However, sometimes technologies and market conditions suddenly shift, and clusters decline. This paper analyses the process of decline of the wireless communication cluster in Denmark. The longit...... but being quick to withdraw in times of crisis....

  20. Making cocoa origin traceable

    Acierno, Valentina; Alewijn, Martin; Zomer, Paul; Ruth, van Saskia M.

    2018-01-01

    More and more attention is paid to sustainability in the cocoa production. Tools that assist in making sustainable cocoa traceable are therefore welcome. In the present study, the applicability of Flow Infusion-Electrospray Ionization- Mass Spectrometry (FI-ESI-MS) to assess the geographical origin

  1. Judgment and decision making.

    Fischhoff, Baruch

    2010-09-01

    The study of judgment and decision making entails three interrelated forms of research: (1) normative analysis, identifying the best courses of action, given decision makers' values; (2) descriptive studies, examining actual behavior in terms comparable to the normative analyses; and (3) prescriptive interventions, helping individuals to make better choices, bridging the gap between the normative ideal and the descriptive reality. The research is grounded in analytical foundations shared by economics, psychology, philosophy, and management science. Those foundations provide a framework for accommodating affective and social factors that shape and complement the cognitive processes of decision making. The decision sciences have grown through applications requiring collaboration with subject matter experts, familiar with the substance of the choices and the opportunities for interventions. Over the past half century, the field has shifted its emphasis from predicting choices, which can be successful without theoretical insight, to understanding the processes shaping them. Those processes are often revealed through biases that suggest non-normative processes. The practical importance of these biases depends on the sensitivity of specific decisions and the support that individuals have in making them. As a result, the field offers no simple summary of individuals' competence as decision makers, but a suite of theories and methods suited to capturing these sensitivities. Copyright © 2010 John Wiley & Sons, Ltd. For further resources related to this article, please visit the WIREs website. Copyright © 2010 John Wiley & Sons, Ltd.

  2. Making a Quit Plan

    ... BACK CLOSE SMOKEFREE.GOV HOME Create My Quit Plan Quitting starts now. Make a plan . Step 1 of 7 mark Step 2 of ... boosts your chances of success. Build a quit plan to get ready and find out what to ...

  3. Making media public

    Mollerup, Nina Grønlykke; Gaber, Sherief

    2015-01-01

    This article focuses on two related street screening initiatives, Tahrir Cinema and Kazeboon, which took place in Egypt mainly between 2011 and 2013. Based on long-term ethnographic studies and activist work, we explore street screenings as place-making and describe how participants at street scr...

  4. What makes workers happy?

    van der Meer, P.H.; Wielers, R.J.J.

    2013-01-01

    This article answers the question what makes workers happy? It does so by combining insights from micro-economics, sociology and psychology. Basis is the standard utility function of a worker that includes income and hours of work and is elaborated with job characteristics. In this way it is

  5. MULTICRITERIA DECISION-MAKING

    HENDRIKS, MMWB; DEBOER, JH; SMILDE, AK; DOORNBOS, DA

    1992-01-01

    Interest is growing in multicriteria decision making (MCDM) techniques and a large number of these techniques are now available. The purpose of this tutorial is to give a theoretical description of some of the MCDM techniques. Besides this we will give an overview of the differences and similarities

  6. Making students' frames explicit

    Nielsen, Louise Møller; Hansen, Poul Henrik Kyvsgaard

    2016-01-01

    Framing is a vital part of the design and innovation process. Frames are cognitive shortcuts (i.e. metaphors) that enable designers to connect insights about i.e. market opportunities and users needs with a set of solution principles and to test if this connection makes sense. Until now, framing...

  7. Making the Connection

    Perna, Mark C.

    2006-01-01

    Enrollment marketing is not just about enrollment; it is about creating relationships and serving one's community or target audience for many years. In this article, the author states that the first step in building such relationships is making a connection, and that is what effective marketing is all about. Administrators, teachers and critical…

  8. Designing for Decision Making

    Jonassen, David H.

    2012-01-01

    Decision making is the most common kind of problem solving. It is also an important component skill in other more ill-structured and complex kinds of problem solving, including policy problems and design problems. There are different kinds of decisions, including choices, acceptances, evaluations, and constructions. After describing the centrality…

  9. Making Cities Green.

    Goldstein, Neil B.; Engel, Jane

    1981-01-01

    Describes several examples of urban parks and the renewal of city open spaces. Community groups interested in getting funding from government or private sources must cope with budget restrictions by making effective, innovative use of available money. Government agencies with funds allocated for urban improvements are mentioned. (AM)

  10. Make time to move

    ... or after work. Schedule your exercise. Make getting exercise just as important as your other appointments. Set aside time in ... update 04-02-18. Related MedlinePlus Health Topics ... among the first to achieve this important distinction for online health information and services. Learn ...

  11. Making Lists, Enlisting Scientists

    Jensen, Casper Bruun

    2011-01-01

    was the indicator conceptualised? How were notions of scientific knowledge and collaboration inscribed and challenged in the process? The analysis shows a two-sided process in which scientists become engaged in making lists but which is simultaneously a way for research policy to enlist scientists. In conclusion...

  12. Making Images That Move

    Rennie, Richard

    2015-01-01

    The history of the moving image (the cinema) is well documented in books and on the Internet. This article offers a number of activities that can easily be carried out in a science class. They make use of the phenomenon of "Persistence of Vision." The activities presented herein demonstrate the functionality of the phenakistoscope, the…

  13. WHAT MAKES THINGS GO.

    Mobilization for Youth, Inc., New York, NY.

    THE INITIAL QUESTION IN THE TITLE IS ANSWERED THROUGH SIMPLE EXPERIMENTS FOR CULTURALLY DISADVANTAGED CHILDREN IN ELEMENTARY SCHOOL. MUSCLES, RUNNING, WATER, WIND, STEAM, FAST BURNING AND ELECTRICITY ARE FOUND TO "MAKE THINGS GO." USING THESE BASIC DISCOVERIES, VOCABULARY IS BUILT UP BY WORKING WITH DIFFERENT WORDS RELATING TO THE…

  14. Handbook of advanced lighting technology

    Sun, Ching-Cherng; Zissis, Georges; Ma, Ruiqing

    2017-01-01

    The Handbook of Advanced Lighting Technology is a major reference work on the subject of light source science and technology, with particular focus on solid-state light sources – LEDs and OLEDs – and the development of 'smart' or 'intelligent' lighting systems; and the integration of advanced light sources, sensors, and adaptive control architectures to provide tailored illumination which is 'fit to purpose.' The concept of smart lighting goes hand-in-hand with the development of solid-state light sources, which offer levels of control not previously available with conventional lighting systems. This has impact not only at the scale of the individual user, but also at an environmental and wider economic level. These advances have enabled and motivated significant research activity on the human factors of lighting, particularly related to the impact of lighting on healthcare and education, and the Handbook provides detailed reviews of work in these areas. The potential applications for smart lighting span ...

  15. Advanced CANDU reactors

    Dunn, J.T.; Finlay, R.B.; Olmstead, R.A.

    1988-12-01

    AECL has undertaken the design and development of a series of advanced CANDU reactors in the 700-1150 MW(e) size range. These advanced reactor designs are the product of ongoing generic research and development programs on CANDU technology and design studies for advanced CANDU reactors. The prime objective is to create a series of advanced CANDU reactors which are cost competitive with coal-fired plants in the market for large electricity generating stations. Specific plant designs in the advanced CANDU series will be ready for project commitment in the early 1990s and will be capable of further development to remain competitive well into the next century

  16. Advances in chemical Physics

    Rice, Stuart A

    2011-01-01

    The Advances in Chemical Physics series-the cutting edge of research in chemical physics The Advances in Chemical Physics series provides the chemical physics and physical chemistry fields with a forum for critical, authoritative evaluations of advances in every area of the discipline. Filled with cutting-edge research reported in a cohesive manner not found elsewhere in the literature, each volume of the Advances in Chemical Physics series offers contributions from internationally renowned chemists and serves as the perfect supplement to any advanced graduate class devoted to the study of che

  17. Advances in chemical physics

    Rice, Stuart A

    2012-01-01

    The Advances in Chemical Physics series-the cutting edge of research in chemical physics The Advances in Chemical Physics series provides the chemical physics field with a forum for critical, authoritative evaluations of advances in every area of the discipline. Filled with cutting-edge research reported in a cohesive manner not found elsewhere in the literature, each volume of the Advances in Chemical Physics series serves as the perfect supplement to any advanced graduate class devoted to the study of chemical physics. This volume explores: Quantum Dynamical Resonances in Ch

  18. Advances in chemical physics

    Rice, Stuart A

    2011-01-01

    The Advances in Chemical Physics series-the cutting edge of research in chemical physics The Advances in Chemical Physics series provides the chemical physics and physical chemistry fields with a forum for critical, authoritative evaluations of advances in every area of the discipline. Filled with cutting-edge research reported in a cohesive manner not found elsewhere in the literature, each volume of the Advances in Chemical Physics series offers contributions from internationally renowned chemists and serves as the perfect supplement to any advanced graduate class devoted to the study of che

  19. ACR-700 advanced technologies

    Tapping, R.L.; Turner, C.W.; Yu, S.K.W.; Olmstead, R.; Speranzini, R.A.

    2004-01-01

    A successful advanced reactor plant will have optimized economics including reduced operating and maintenance costs, improved performance, and enhanced safety. Incorporating improvements based on advanced technologies ensures cost, safety and operational competitiveness of the ACR-700. These advanced technologies include modern configuration management; construction technologies; operational technology for the control centre and information systems for plant monitoring and analysis. This paper summarizes the advanced technologies used to achieve construction and operational improvements to enhance plant economic competitiveness, advances in the operational technology used for reactor control, and presents the development of the Smart CANDU suite of tools and its application to existing operating reactors and to the ACR-700. (author)

  20. Recent BWR fuel management reactor physics advances

    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

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

    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.

  2. Making Interaction Matter

    Machacek, Erika

    an understanding of the specific industrial peculiarities and to inform on prevailing, dynamic forms of interfirm governance. First, the GVC is mapped. Second, the filaments of rare earth-based phosphor powders for energy-efficient lamps and adjacent segments for recycling, and of rare-earth based magnets...... are investigated. Third, the REE-product potential from Southern Greenlandic rare earth-bearing deposits is compared with the potential from REE-bearing mineral occurrences of similarly advanced projects in Australia, Canada and South Africa. Findings unfold a highly complex industry with segment...

  3. Identification of distinct phenotypes of locally advanced pancreatic adenocarcinoma.

    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.

  4. Using imperfect advance demand information in forecasting

    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).

  5. Advancing Research on Undergraduate Science Learning

    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…

  6. Advancing lean manufacturing, the role of IT

    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

  7. Device for making liquid drops

    Yamada, Masao; Fukuda, Fumito; Nishikawa, Masana; Ishii, Takeshi.

    1976-01-01

    Object: To provide a device for producing liquid drops in the form of liquefied gases indispensable to make deuterium and tritium ice pellets used as a fusion fuel in a tokamak type fusion reactor. Structure: First, pressure P 1 at the upper surface of liquefied gas in a container and outlet pressure P 2 of a nozzle disposed at the lower part of the container are adjusted into the state of P 1 >= P 2 , and it is preset so that even under such conditions, the liquefied gas from the nozzle is not naturally flown out. Next, a vibration plate disposed within the container is rapidly downwardly advanced toward the nozzle through a predetermined distance. As a result, pressure of the liquefied gas within a depression under the vibration plate rises instantaneously or in a pulse fashion to dissatisfy the aforesaid set condition whereby the liquefied gas may be flown out from the nozzle in the form of liquid drops. In accordance with the present device, it is possible to produce a suitable number of drops at a suitable point. (Yoshihara, H.)

  8. Advanced quantum mechanics materials and photons

    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�...

  9. Advanced quantum mechanics materials and photons

    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...

  10. Judgment and decision making.

    Mellers, B A; Schwartz, A; Cooke, A D

    1998-01-01

    For many decades, research in judgment and decision making has examined behavioral violations of rational choice theory. In that framework, rationality is expressed as a single correct decision shared by experimenters and subjects that satisfies internal coherence within a set of preferences and beliefs. Outside of psychology, social scientists are now debating the need to modify rational choice theory with behavioral assumptions. Within psychology, researchers are debating assumptions about errors for many different definitions of rationality. Alternative frameworks are being proposed. These frameworks view decisions as more reasonable and adaptive that previously thought. For example, "rule following." Rule following, which occurs when a rule or norm is applied to a situation, often minimizes effort and provides satisfying solutions that are "good enough," though not necessarily the best. When rules are ambiguous, people look for reasons to guide their decisions. They may also let their emotions take charge. This chapter presents recent research on judgment and decision making from traditional and alternative frameworks.

  11. Making Heat Visible

    Goodhew, Julie; Pahl, Sabine; Auburn, Tim; Goodhew, Steve

    2015-01-01

    Householders play a role in energy conservation through the decisions they make about purchases and installations such as insulation, and through their habitual behavior. The present U.K. study investigated the effect of thermal imaging technology on energy conservation, by measuring the behavioral effect after householders viewed images of heat escaping from or cold air entering their homes. In Study 1 (n = 43), householders who received a thermal image reduced their energy use at a 1-year follow-up, whereas householders who received a carbon footprint audit and a non-intervention control demonstrated no change. In Study 2 (n = 87), householders were nearly 5 times more likely to install draught proofing measures after seeing a thermal image. The effect was especially pronounced for actions that addressed an issue visible in the images. Findings indicate that using thermal imaging to make heat loss visible can promote energy conservation. PMID:26635418

  12. Ethical decision making

    Zsolnai, László

    2011-01-01

    The self-centeredness of modern organizations leads to environmental destruction and human deprivation. The principle of responsibility developed by Hans Jonas requires caring for the beings affected by our decisions and actions. Ethical decision-making creates a synthesis of reverence for ethical norms, rationality in goal achievement, and respect for the stakeholders. The maximin rule selects the "least worst alternative" in the multidimensional decision space of deontologica...

  13. Strategic decision making

    Stokman, Frans N.; Assen, Marcel A.L.M. van; Knoop, Jelle van der; Oosten, Reinier C.H. van

    2000-01-01

    This paper introduces a methodology for strategic intervention in collective decision making.The methodology is based on (1) a decomposition of the problem into a few main controversial issues, (2) systematic interviews of subject area specialists to obtain a specification of the decision setting,consisting of a list of stakeholders with their capabilities, positions, and salience on each of the issues; (3) computer simulation. The computer simulation models incorporate only the main processe...

  14. Handbook on Decision Making

    Jain, Lakhmi C

    2010-01-01

    The present "Volume 1: Techniques and Applications" of the "Handbook on Decision Making" presents a useful collection of AI techniques, as well as other complementary methodologies, that are useful for the design and development of intelligent decision support systems. Application examples of how these intelligent decision support systems can be utilized to help tackle a variety of real-world problems in different domains, such as business, management, manufacturing, transportation and food industries, and biomedicine, are presented. The handbook includes twenty condensed c

  15. Classroom Games: Making Money

    Susan K. Laury; Charles A. Holt

    2000-01-01

    Economics is often taught at a level of abstraction that can hinder some students from gaining basic intuition. However, lecture and textbook presentations can be complemented with classroom exercises in which students make decisions and interact. The approach can increase interest in and decrease skepticism about economic theory. This feature offers short descriptions of classroom exercises for a variety of economics courses, with something of an emphasis on the more popular undergraduate co...

  16. Technology makes life better

    李红

    2015-01-01

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

  17. Making time to talk.

    2016-09-01

    NHS Employers has updated its people performance management toolkit, which now includes links to new guidance and resources. The toolkit encourages managers to 'make time to talk' about performance with staff, provides practical support, increases managers' knowledge about what good performance management is, and aims to increase their confidence in dealing with associated challenges, such as what to do if a team member is underperforming and how to give constructive feedback.

  18. Participation in decision making

    EG Valoyi

    2000-06-01

    Full Text Available The aim of the present study was to determine the extent to which employees would like to participate in decision making concerning various organisational issues, especially those concerning: the work itself, working conditions, human resources issues, and corporate policy and planning. The sample consisted of 146 participants, including managers, middle managers, and junior officials from a South African development corporation. A questionnaire to measure employees' desire to participate in decision making was specially constructed for this investigation. It has found that employees with higher academic qualifications were more desirous to participate in decision-making at all levels than employees with lower academic qualifications. This was also true for employees in higher job grades than in lower job grades. Men were more desirous to participate in decision making than women. The implications of the findings are discussed. Opsomming Die doel van die huidige studie was om vas te stel in watter mate werknemers sal wil deelneem aan die besluit- nameproses van organisasies, veral rakende die volgende sake: die werk self, werksomstandighede, menslike hulpbronaangeleenthede en korporatiewe beleid en beplanning. Die steekproef het uit 146 deelnemers, insluitende bestuurders, middelvlakbestuurders en junior amptenare van'n Suid Afrikaanse ontwikkelingskorporasie, bestaan. nVraelys wat die begeerte van werknemers meet om aan die besluitnameproses deel te neem, is spesiaal vir die doel van hierdie ondersoek, ontwerp. Dit is bevind dat werknemers met hoer akademiese kwalifikasies meer begerig is om aan die besluitnameproses op alle vlakke deel te neem as werknemers met laer akademiese kwalifikasies. Dit was ook waar vir werknemers in hoervlakposte vergeleke met werknemers in laervlakposte. Mans was ook meer begerig om aan die besluitnameproses deel te neem as vroue. Die implikasies van die studie word bespreek.

  19. Making Sense of Austerity

    Seabrooke, Leonard; Riisbjerg Thomsen, Rune

    2016-01-01

    such as ‘scroungers’ and ‘corporate criminals’ are identified, as are scenes such as the decline of the welfare state and the rise of technocracy. We link the storysets, story-lines, and plots together to understand how Brits and Danes are making sense of austerity. Their explanations and frustrations improve our...... understanding of who acts in everyday politics, and how everyday narratives are formed and maintained....

  20. Crisis decision making

    Holsti, O.R.

    1989-01-01

    This article presents evidence that the potential loss of control of events by officials who must operate under conditions that generate substantial stress is one of the central problems of crisis decision making. Examples of U.S. crises management and alliance management are reviewed, and possible tools for improving crisis management decisions are discussed. This article particularly focuses on crises which may lead to nuclear war

  1. Method for making nanomaterials

    Fan, Hongyou; Wu, Huimeng

    2013-06-04

    A method of making a nanostructure by preparing a face centered cubic-ordered metal nanoparticle film from metal nanoparticles, such as gold and silver nanoparticles, exerting a hydrostatic pressure upon the film at pressures of several gigapascals, followed by applying a non-hydrostatic stress perpendicularly at a pressure greater than approximately 10 GPA to form an array of nanowires with individual nanowires having a relatively uniform length, average diameter and density.

  2. Making the cut

    Mcshannon, G. [Hydra Mining Tools International Ltd. (United Kingdom)

    2006-04-15

    The paper explains how coal mines around the world can benefit from the use of cowless, radial shearer drums. Hydra Mining has designed and manufactured a range of shearer drums to combat problems ranging from dust, frictional ignitions, geological problems or low production rates. This allows the mine operator to maximise production efficiency. The company tailor-makes shearer drums for each longwall face to optimise the cutting performance of every installation. 8 figs.

  3. Making biofuels sustainable

    Gallagher, Ed

    2008-01-01

    Full text: As the twentieth century drew to a close, there was considerable support for the use of biofuels as a source of renewable energy. To many people, they offered significant savings in greenhouse gas emissions compared to fossil fuels, an opportunity for reduced dependency on oil for transport, and potential as a counter weight to increasing oil prices. They also promised an opportunity for rural economies to benefit from a new market for their products and a chance of narrowing the gap between rich and poor nations. Biofuel development was encouraged by government subsidies, and rapid growth occurred in many parts of the world. Forty per cent of Brazilian sugar cane is used for biofuel production, for example, as is almost a quarter of maize grown in the United States. Although only around 1 per cent of arable land is cultivated to grow feedstock for biofuels, there has been increasing concern over the way a largely unchecked market has developed, and about its social and environmental consequences. Recent research has confirmed that food prices have been driven significantly higher by competition for prime agricultural land and that savings in greenhouse gas emissions are much smaller - and in some cases entirely eliminated - when environmentally important land, such as rainforest, is destroyed to grow biofuels. As a result, many now believe that the economic benefits of biofuels have been obtained at too high a social and environmental price, and they question whether they can be a truly sustainable source of energy. The United Kingdom has always had sustainability at the heart of its biofuel policies and set up the Renewable Fuels Agency to ensure that this goal was met. The direct effects of biofuel production are already being assessed through five measures of environmental performance and two measures of social performance, as well as measures of the energy efficiency of the production processes used and of the greenhouse gas savings achieved

  4. International Conference on Computers and Advanced Technology in Education

    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...

  5. Making yourself indispensable.

    Zenger, John H; Folkman, Joseph R; Edinger, Scott K

    2011-10-01

    Peter Drucker and other leadership thinkers have long argued that leaders should focus on strengthening their strengths. How should they do that? Improving on a weakness is pretty easy and straight forward: You can make measurable progress by honing and practicing basic techniques. But developing a strength is a different matter, because simply doing more of what you're good at will yield only incremental improvements. If you are strong technically, becoming even more of a technical expert won't make you a dramatically better leader. If, however, you use what the authors call "nonlinear development"--similar to an athlete's cross-training--you can achieve exponential results. Your technical expertise will become more powerful if, for instance, you build on your communication skills, enabling you to explain technical problems both more broadly and more effectively. The authors, all from the leadership development consultancy Zenger Folkman, present a step-by-step process by which developing leaders can identify their strengths (through either a formal or an informal 360-degree evaluation), select appropriate complementary skills (the article identifies up to a dozen for each core strength), and develop those skills to dramatically improve their strengths--making themselves uniquely valuable to their companies.

  6. Nuclear regulatory decision making

    2005-01-01

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

  7. Advanced materials processing

    Giamei, A.F.

    1993-01-01

    Advanced materials will require improved processing methods due to high melting points, low toughness or ductility values, high reactivity with air or ceramics and typically complex crystal structures with significant anisotropy in flow and/or fracture stress. Materials for structural applications at elevated temperature in critical systems will require processing with a high degree of control. This requires an improved understanding of the relationship between process variables and microstructure to enable control systems to achieve consistently high quality. One avenue to the required level of understanding is computer simulation. Past attempts to do process modeling have been hampered by incomplete data regarding thermophysical or mechanical material behavior. Some of the required data can be calculated. Due to the advances in software and hardware, accuracy and costs are in the realm of acquiring experimental data. Such calculations can, for example, be done at an atomic level to compute lattice energy, fault energies, density of states and charge densities. These can lead to fundamental information about the competition between slip and fracture, anisotropy of bond strength (and therefore cleavage strength), cohesive strength, adhesive strength, elastic modulus, thermal expansion and possibly other quantities which are difficult (and therefore expensive to measure). Some of these quantities can be fed into a process model. It is probable that temperature dependencies can be derived numerically as well. Examples are given of the beginnings of such an approach for Ni 3 Al and MoSi 2 . Solidification problems are examples of the state-of-the-art process modeling and adequately demonstrate the need for extensive input data. Such processes can be monitored in terms of interfacial position vs. time, cooling rate and thermal gradient

  8. Telehealth on advanced networks.

    Wilson, Laurence S; Stevenson, Duncan R; Cregan, Patrick

    2010-01-01

    We address advanced Internet for complex telehealth applications by reviewing four hospital-based broadband telehealth projects and identifying common threads. These projects were conducted in Australia under a 6-year research project on broadband Internet applications. Each project addressed specific clinical needs and its development was guided by the clinicians involved. Each project was trialed in the field and evaluated against the initial requirements. The four projects covered remote management of a resuscitation team in a district hospital, remote guidance and interpretation of echocardiography, virtual-reality-based instructor-student surgical training, and postoperative outpatient consultations following pediatric surgery. Each was characterized by a high level of interpersonal communication, a high level of clinical expertise, and multiple participants. Each made use of multiple high-quality video and audio links and shared real-time access to clinical data. Four common threads were observed. Each application provided a high level of usability and task focus because the design and use of broadband capability was aimed directly to meet the clinicians' needs. Each used the media quality available over broadband to convey words, gestures, body movements, and facial expressions to support communication and a sense of presence among the participants. Each required a complex information space shared among the participants, including real-time access to stored patient data and real-time interactive access to the patients themselves. Finally, each application supported the social and organizational aspects of their healthcare focus, creating and maintaining relationships between the various participants, and this was done by placing the telehealth application into a wider functioning clinical context. These findings provide evidence for a significantly enhanced role for appropriate telemedicine systems running on advanced networks, in a wider range of clinical

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

    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.

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

    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.

  11. SEG Advances in Rotational Seismic Measurements

    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.

  12. ADVANCED PROTEOMICS AND BIOINFORMATICS TOOLS IN TOXICOLOGY RESEARCH: OVERCOMING CHALLENGES TO PROVIDE SIGNIFICANT RESULTS

    This presentation specifically addresses the advantages and limitations of state of the art gel, protein arrays and peptide-based labeling proteomic approaches to assess the effects of a suite of model T4 inhibitors on the thyroid axis of Xenopus laevis.

  13. Fumagillin: an overview of recent scientific advances and their significance for apiculture.

    van den Heever, Johan P; Thompson, Thomas S; Curtis, Jonathan M; Ibrahim, Abdullah; Pernal, Stephen F

    2014-04-02

    Fumagillin is a potent fungal metabolite first isolated from Aspergillus fumigatus. It is widely used in apiculture and human medicine against a variety of microsporidian fungal infections. It has been the subject of research in cancer treatments by employing its angiogenesis inhibitory properties. The toxicity of fumagillin has limited its use for human applications and spurred the development of analogues using structure-activity relationships relating to its angiogenesis properties. These discoveries may hold the key to the development of alternative chemical treatments for use in apiculture. The toxicity of fumagillin to humans is important for beekeeping, because any residues remaining in hive products pose a direct risk to the consumer. The analytical methods published to date measure fumagillin and its decomposition products but overlook the dicyclohexylamine counterion of the salt form widely used in apiculture.

  14. Advances in understanding phosphorus cycling in inland waters - Their significance for South African limnology

    Twinch, AJ

    1980-02-01

    Full Text Available The definitions of the different phosphorus compound fractions present in inland waters are reviewed and the limitations of the definitions discussed. The development of models of phosphorus cycling is summarized. Attempts to establish...

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

    Van Velde, AA. de; Burtak, F.

    2000-01-01

    In this paper authors deals with nuclear fuel cycle and their economic aspects. At Siemens, the developments focusing on the reduction of fuel cycle costs are currently directed on .further batch average burnup increase, .improvement of fuel reliability, .enlargement of fuel operation margins, .improvement of methods for fuel design and core analysis. These items will be presented in detail in the full paper and illustrated by the global operating experience of Siemens fuel for both PWRs and BWRs. (authors)

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

    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...

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

    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.

  18. Nutrition for Advanced Chronic Kidney Disease in Adults

    ... 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 ...

  19. Advancing Evaluation Theory and Practice in South Asia ...

    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, ...

  20. Some advances in pairing theory

    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)