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Sample records for making therapeutic plan

  1. Making a Quit Plan

    Science.gov (United States)

    ... 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 ...

  2. Making Planning Work

    DEFF Research Database (Denmark)

    Eibe Sørensen, Hans

    2018-01-01

    Planning for a growth opportunity's success remains a challenge. Under which conditions does planning work, then? This exploratory study investigates the business development tasks and processes that span a growth opportunity's planning phase and its implementation phase and their unique performa...

  3. THERAPEUTIC DECISION-MAKING OF PHYSICIANS

    NARCIS (Netherlands)

    DENIG, P; HAAIJER-RUSKAMP, FM

    1992-01-01

    In this review the therapeutic decision-making process of physicians is described. This process is divided into two steps: the generation of a limited set of possible options (the 'evoked set') and the selection from this evoked set of a treatment for a specific patient. Factors that are important

  4. Therapeutic radionuclides: Making the right choice

    International Nuclear Information System (INIS)

    Srivastava, S.C.

    1996-01-01

    Recently, there has been a resurgence of interest in nuclear medicine therapeutic procedures. Using unsealed sources for therapy is not a new concept; it has been around since the beginnings of nuclear medicine. Treatment of thyroid disorders with radioiodine is a classic example. The availability of radionuclides with suitable therapeutic properties for specific applications, as well as methods for their selective targeting to diseased tissue have, however, remained the main obstacles for therapy to assume a more widespread role in nuclear medicine. Nonetheless, a number of new techniques that have recently emerged, (e.g., tumor therapy with radiolabeled monoclonal antibodies, treatment of metastatic bone pain, etc.) appear to have provided a substantial impetus to research on production of new therapeutic radionuclides. Although there are a number of new therapeutic approaches requiring specific radionuclides, only selected broad areas will be used as examples in this article

  5. Therapeutic Doll Making in Art Psychotherapy for Complex Trauma

    Science.gov (United States)

    Stace, Sonia M.

    2014-01-01

    Therapeutic doll making can hold diverse functions for clients in therapy, particularly for those clients who are working through complex trauma histories. Recent literature pertaining to the treatment of complex trauma suggests that talking treatments have their limits; supplementary therapeutic approaches that focus on sensory, physical,…

  6. Clinical Significance: a Therapeutic Approach Topsychological Assessment in Treatment Planning

    Directory of Open Access Journals (Sweden)

    Afolabi Olusegun Emmanuel

    2015-06-01

    Full Text Available Psychological assessment has long been reported as a key component of clinical psychology. This paper examines the complexities surrounding the clinical significance of therapeutic approach to treatment planning. To achieve this objective, the paper searched and used the PsycINFO and PubMed databases and the reference sections of chapters and journal articles to analysed, 1 a strong basis for the usage of therapeutic approach to psychological assessment in treatment plans, 2 explained the conceptual meaning of clinical significant change in therapeutic assessment, 3 answered some of the questions regarding practicability and the clinical significance of therapeutic approach to treatment plans, particularly during or before treatment, 4 linked therapeutic assessment to change in clients’ clinical impression, functioning and therapeutic needs 5 analysed the empirically documenting clinically significant change in therapeutic assessment. Finally, the study suggested that though therapeutic assessment is not sufficient for the systematic study of psychotherapy outcome and process, it is still consistent with both the layman and professional expectations regarding treatment outcome and also provides a precise method for classifying clients as ‘changed’ or ‘unchanged’ on the basis of clinical significance criteria.

  7. Therapeutic risk management of the suicidal patient: safety planning.

    Science.gov (United States)

    Matarazzo, Bridget B; Homaifar, Beeta Y; Wortzel, Hal S

    2014-05-01

    This column is the fourth in a series describing a model for therapeutic risk management of the suicidal patient. Previous columns presented an overview of the therapeutic risk management model, provided recommendations for how to augment risk assessment using structured assessments, and discussed the importance of risk stratification in terms of both severity and temporality. This final column in the series discusses the safety planning intervention as a critical component of therapeutic risk management of suicide risk. We first present concerns related to the relatively common practice of using no-suicide contracts to manage risk. We then present the safety planning intervention as an alternative approach and provide recommendations for how to use this innovative strategy to therapeutically mitigate risk in the suicidal patient.

  8. [Parapneumonic pleural effusion: difficulties in making therapeutic decisions].

    Science.gov (United States)

    Chudzicka, Aleksandra; Chciałowski, Andrzej

    2007-01-01

    Pneumonia is the second most common cause of pleural effusion. The presence of pleural fluid makes the prognosis in patients with pneumonia worse and causes a higher mortality rate. This is why it is very important to undertake suitable treatment as soon as possible. Most parapneumonic pleural effusions resolve with antibiotic alone, but sometimes more invasive treatment is necessary. Therapeutic decisions are based on different criteria. For many years determining biochemical fluid characteristics has been used for this purpose. Presentlythe usefullness of new parameters is being evaluated. Their application in diagnostics was possible thanks to better knowledge of mechanisms that participate in the development of parapneumonic pleural effusion.

  9. Planning and decision making for aerial robots

    CERN Document Server

    Bestaoui Sebbane, Yasmina

    2014-01-01

    This book provides an introduction to the emerging field of planning and decision making for aerial robots. An aerial robot is the ultimate form of Unmanned Aerial Vehicle, an aircraft endowed with built-in intelligence, requiring no direct human control and able to perform a specific task. It must be able to fly within a partially structured environment, to react and adapt to changing environmental conditions and to accommodate for the uncertainty that exists in the physical world. An aerial robot can be termed as a physical agent that exists and flies in the real 3D world, can sense its environment and act on it to achieve specific goals. So throughout this book, an aerial robot will also be termed as an agent.   Fundamental problems in aerial robotics include the tasks of spatial motion, spatial sensing and spatial reasoning. Reasoning in complex environments represents a difficult problem. The issues specific to spatial reasoning are planning and decision making. Planning deals with the trajectory algori...

  10. Formulary decision-making about cephalosporins with similar therapeutic uses.

    Science.gov (United States)

    Mabe, Don M

    2003-05-15

    The various costs and intangible factors that enter into formulary decisions in an era of increasingly frequent drug product shortages that can adversely affect patient care and increase treatment costs are described. Pharmacy administration at Carolinas HealthCare System analyzed the costs associated with making a formulary switch from the third-generation cephalosporin ceftriaxone to cefotaxime, which recently became available in generic form and has a similar spectrum of antimicrobial activity and therapeutic uses. Hard dollar costs for purchasing drugs and the supplies needed to administer them; soft dollar costs for staff time spent acquiring, preparing, and administering doses; and intangible factors were considered. A reliable supply of drug product from the manufacturer was an important intangible factor because of frequent drug shortages in the past few years and the adverse effect on patient care and the increased soft dollar costs associated with these shortages. Administrators at Carolinas HealthCare System decided not to make the proposed formulary change after weighing the many factors and costs.

  11. Goals and plans in decision making

    Directory of Open Access Journals (Sweden)

    David H. Krantz

    2007-06-01

    Full Text Available We propose a constructed-choice model for general decision making. The model departs from utility theory and prospect theory in its treatment of multiple goals and it suggests several different ways in which context can affect choice. It is particularly instructive to apply this model to protective decisions, which are often puzzling. Among other anomalies, people insure against non-catastrophic events, underinsure against catastrophic risks, and allow extraneous factors to influence insurance purchases and other protective decisions. Neither expected-utility theory nor prospect theory can explain these anomalies satisfactorily. To apply this model to the above anomalies, we consider many different insurance-related goals, organized in a taxonomy, and we consider the effects of context on goals, resources, plans and decision rules. The paper concludes by suggesting some prescriptions for improving individual decision making with respect to protective measures.

  12. Remote monitoring of heart failure: benefits for therapeutic decision making.

    Science.gov (United States)

    Martirosyan, Mihran; Caliskan, Kadir; Theuns, Dominic A M J; Szili-Torok, Tamas

    2017-07-01

    Chronic heart failure is a cardiovascular disorder with high prevalence and incidence worldwide. The course of heart failure is characterized by periods of stability and instability. Decompensation of heart failure is associated with frequent and prolonged hospitalizations and it worsens the prognosis for the disease and increases cardiovascular mortality among affected patients. It is therefore important to monitor these patients carefully to reveal changes in their condition. Remote monitoring has been designed to facilitate an early detection of adverse events and to minimize regular follow-up visits for heart failure patients. Several new devices have been developed and introduced to the daily practice of cardiology departments worldwide. Areas covered: Currently, special tools and techniques are available to perform remote monitoring. Concurrently there are a number of modern cardiac implantable electronic devices that incorporate a remote monitoring function. All the techniques that have a remote monitoring function are discussed in this paper in detail. All the major studies on this subject have been selected for review of the recent data on remote monitoring of HF patients and demonstrate the role of remote monitoring in the therapeutic decision making for heart failure patients. Expert commentary: Remote monitoring represents a novel intensified follow-up strategy of heart failure management. Overall, theoretically, remote monitoring may play a crucial role in the early detection of heart failure progression and may improve the outcome of patients.

  13. Strategic facility planning improves capital decision making.

    Science.gov (United States)

    Reeve, J R

    2001-03-01

    A large, Midwestern IDS undertook a strategic facility-planning process to evaluate its facility portfolio and determine how best to allocate future investments in facility development. The IDS assembled a facility-planning team, which initiated the planning process with a market analysis to determine future market demands and identify service areas that warranted facility expansion. The team then analyzed each of the IDS's facilities from the perspective of uniform capacity measurements, highest and best use compared with needs, building condition and investment-worthiness, and facility growth and site development opportunities. Based on results of the analysis, the strategy adopted entailed, in part, shifting some space from inpatient care to ambulatory care services and demolishing and replacing the 11 percent of facilities deemed to be in the worst condition.

  14. Antimicrobials and therapeutic decision making: an historical perspective.

    Science.gov (United States)

    Quintiliani, R; Nightingale, C H

    1991-01-01

    In an effort to remedy inappropriate and excessive use of antimicrobials and to control costs, most hospitals have developed some type of antimicrobial management program. At Hartford Hospital, our most effective approaches have been those that reduce the chances for physician error, decrease the burden on ancillary services, and encourage short hospital stays. These include automatic correction of dose and dosing intervals of antimicrobials and, if possible, their conversion by pharmacy to cost-effective alternative agents; daily review of patients who are taking the drugs by an antimicrobial team; and replacement of parenteral with oral agents as soon as possible. Physician acceptance of these approaches will require significant changes in traditional prescribing styles and willingness to allow pharmacists to implement the recommendations of therapeutic and medical staff committees.

  15. Clinical decision-making and therapeutic approaches in osteopathy - a qualitative grounded theory study.

    Science.gov (United States)

    Thomson, Oliver P; Petty, Nicola J; Moore, Ann P

    2014-02-01

    There is limited understanding of how osteopaths make decisions in relation to clinical practice. The aim of this research was to construct an explanatory theory of the clinical decision-making and therapeutic approaches of experienced osteopaths in the UK. Twelve UK registered osteopaths participated in this constructivist grounded theory qualitative study. Purposive and theoretical sampling was used to select participants. Data was collected using semi-structured interviews which were audio-recorded and transcribed. As the study approached theoretical sufficiency, participants were observed and video-recorded during a patient appointment, which was followed by a video-prompted interview. Constant comparative analysis was used to analyse and code data. Data analysis resulted in the construction of three qualitatively different therapeutic approaches which characterised participants and their clinical practice, termed; Treater, Communicator and Educator. Participants' therapeutic approach influenced their approach to clinical decision-making, the level of patient involvement, their interaction with patients, and therapeutic goals. Participants' overall conception of practice lay on a continuum ranging from technical rationality to professional artistry, and contributed to their therapeutic approach. A range of factors were identified which influenced participants' conception of practice. The findings indicate that there is variation in osteopaths' therapeutic approaches to practice and clinical decision-making, which are influenced by their overall conception of practice. This study provides the first explanatory theory of the clinical decision-making and therapeutic approaches of osteopaths. Copyright © 2013 Elsevier Ltd. All rights reserved.

  16. Plan A: Off the shelf; Plan B: Make it yourself

    International Nuclear Information System (INIS)

    Westbrook, J.L.

    1996-01-01

    When there is radiological work to be done, you hope to be able to purchase, readily and cheaply, items for use in doing the work. But if there is no vendor who sells a product for your need, then you have to improvise. Similarly, particular kinds of services may not be available and sometimes even if a product or service is available, the lead time is such that you have to find some way to make do in the meantime. At Oak Ridge National Laboratory, we have had to devise a number of open-quotes make-it-yourselfclose quotes items and methods because of our specialized current facilities, several one-of-a-kind retired facilities, and the odd unusual situation that pops up-and because we have had practically every isotope from A to Z here. Several of these items and methods will be described, including the special shields and timesaving devices used for transuranic work, a cask for moving very hot pins, and ad hoc check sources

  17. The Impact of Forecasting on Strategic Planning and Decision Making

    African Journals Online (AJOL)

    The Impact of Forecasting on Strategic Planning and Decision Making: An Exploratory ... lead to the failure to achieve projected performance. ... the use of multiple regression analysis model to forecast the stock market activities of each sector ... making, and that these decisions must be congruent with the company strategy.

  18. 78 FR 63481 - Therapeutic Area Standards Initiative Project Plan; Availability

    Science.gov (United States)

    2013-10-24

    ... disadvantages of current and emerging alternatives for the exchange of regulated study data, and (2) issuing a... primary document for guiding all major aspects of FDA's multi-year initiative to develop and implement TA... is announcing the availability of the TA Project Plan. This TA Project Plan will be the primary...

  19. 49 Stories That Make an Ultimate STEM Lesson Plan

    Science.gov (United States)

    Mehta, Swati; Mehta, Rohit; Berzina-Pitcher, Inese; Seals, Christopher; Mishra, Punya

    2016-01-01

    In this paper we reviewed what 49 large urban public school district STEM teachers enrolled in a year-long graduate certificate and fellowship program at a large Midwestern university considered as their amazing teaching moments. They were asked to share their amazing teaching moments that would make an Ultimate Lesson Plan in STEM. In smaller…

  20. Improving Therapeutic Relationships: Joint Crisis Planning for Individuals With Psychotic Disorders.

    Science.gov (United States)

    Farrelly, Simone; Lester, Helen; Rose, Diana; Birchwood, Max; Marshall, Max; Waheed, Waquas; Henderson, R Claire; Szmukler, George; Thornicroft, Graham

    2015-12-01

    Outcomes for individuals with psychosis remain far from acceptable. Recently, prominent psychiatrists have called for an improved understanding of the impact of social contexts, and how social contexts might influence the development and maintenance of mental health problems. A key social context for individuals with psychosis is the therapeutic relationship. As part of a trial of joint crisis planning in England, this qualitative study aimed to determine the mechanism through which joint crisis planning might affect the therapeutic relationship. Results suggest that routine processes in mental health care are affected by policy and organizational requirements for risk mitigation-aspects that undermine person-centered approaches. In contrast, strong therapeutic relationships are characterized by individualized care and reliable and respectful treatment. The Joint Crisis Plan intervention partially succeeded in reducing contextual influences on routine role enactments, facilitating the demonstration of respect and improving the therapeutic relationship. © The Author(s) 2015.

  1. Effect of shared decision-making on therapeutic alliance in addiction health care

    Directory of Open Access Journals (Sweden)

    EAG Joosten

    2008-10-01

    Full Text Available EAG Joosten1,2, GH de Weert3, T Sensky4, CPF van der Staak5, CAJ de Jong1,21Novadic-Kentron, Network for Addiction Treatment Services, Vught, the Netherlands; 2Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA, Nijmegen, the Netherlands; 3Julius Center for Health Sciences and Primary Health Care, UMC Utrecht, Utrecht, the Netherlands; 4Department of Psychological Medicine, Imperial College London, London, United Kingdom; 5Academic Centre for Social Sciences, Radboud University Nijmegen, Nijmegen, the NetherlandsBackground: In recent decades, shared decision-making (SDM models have been developed to increase patient involvement in treatment decisions. The purpose of this study was to examine the effect of a shared decision-making intervention (SDMI for substance-dependent patients on patients’ and clinicians’ perceptions of therapeutic alliance.Methods: Clinicians were randomly assigned to SDMI or usual procedures to reach a treatment agreement. SDMI is a structured, manualized, 5-session procedure to facilitate treatment agreement and consists of five standardized sessions.Results: Patients’ perceptions of the therapeutic alliance were very favorable at start of treatment, and no differences were found between intervention groups. Clinicians’ scores on perceived helpfulness and on the overall therapeutic alliance were higher in the SDMI group than in the controls, after 8 weeks of treatment and at the end of treatment.Conclusion: The present study has shown that a specific intervention to enhance shared decision-making results in favorable changes in clinicians’ perceptions of the therapeutic alliance.Keywords: therapeutic alliance, helping alliance, shared decision-making, addiction, substance-dependence

  2. Planning horizon affects prophylactic decision-making and epidemic dynamics.

    Science.gov (United States)

    Nardin, Luis G; Miller, Craig R; Ridenhour, Benjamin J; Krone, Stephen M; Joyce, Paul; Baumgaertner, Bert O

    2016-01-01

    The spread of infectious diseases can be impacted by human behavior, and behavioral decisions often depend implicitly on a planning horizon-the time in the future over which options are weighed. We investigate the effects of planning horizons on epidemic dynamics. We developed an epidemiological agent-based model (along with an ODE analog) to explore the decision-making of self-interested individuals on adopting prophylactic behavior. The decision-making process incorporates prophylaxis efficacy and disease prevalence with the individuals' payoffs and planning horizon. Our results show that for short and long planning horizons individuals do not consider engaging in prophylactic behavior. In contrast, individuals adopt prophylactic behavior when considering intermediate planning horizons. Such adoption, however, is not always monotonically associated with the prevalence of the disease, depending on the perceived protection efficacy and the disease parameters. Adoption of prophylactic behavior reduces the epidemic peak size while prolonging the epidemic and potentially generates secondary waves of infection. These effects can be made stronger by increasing the behavioral decision frequency or distorting an individual's perceived risk of infection.

  3. The effect of cone beam CT (CBCT) on therapeutic decision-making in endodontics.

    Science.gov (United States)

    Mota de Almeida, F J; Knutsson, K; Flygare, L

    2014-01-01

    The aim was to assess to what extent cone beam CT (CBCT) used in accordance with current European Commission guidelines in a normal clinical setting has an impact on therapeutic decisions in a population referred for endodontic problems. The study includes data of consecutively examined patients collected from October 2011 to December 2012. From 2 different endodontic specialist clinics, 57 patients were referred for a CBCT examination using criteria in accordance with current European guidelines. The CBCT examinations were performed using similar equipment and standardized among clinics. After a thorough clinical examination, but before CBCT, the examiner made a preliminary therapy plan which was recorded. After the CBCT examination, the same examiner made a new therapy plan. Therapy plans both before and after the CBCT examination were plotted for 53 patients and 81 teeth. As four patients had incomplete protocols, they were not included in the final analysis. 4% of the patients referred to endodontic clinics during the study period were examined with CBCT. The most frequent reason for referral to CBCT examination was to differentiate pathology from normal anatomy, this was the case in 24 patients (45% of the cases). The primary outcome was therapy plan changes that could be attributed to CBCT examination. There were changes in 28 patients (53%). CBCT has a significant impact on therapeutic decision efficacy in endodontics when used in concordance with the current European Commission guidelines.

  4. Complex Strategic Choices Applying Systemic Planning for Strategic Decision Making

    CERN Document Server

    Leleur, Steen

    2012-01-01

    Effective decision making requires a clear methodology, particularly in a complex world of globalisation. Institutions and companies in all disciplines and sectors are faced with increasingly multi-faceted areas of uncertainty which cannot always be effectively handled by traditional strategies. Complex Strategic Choices provides clear principles and methods which can guide and support strategic decision making to face the many current challenges. By considering ways in which planning practices can be renewed and exploring the possibilities for acquiring awareness and tools to add value to strategic decision making, Complex Strategic Choices presents a methodology which is further illustrated by a number of case studies and example applications. Dr. Techn. Steen Leleur has adapted previously established research based on feedback and input from various conferences, journals and students resulting in new material stemming from and focusing on practical application of a systemic approach. The outcome is a coher...

  5. Consumer satisfaction with psychiatric services: The role of shared decision making and the therapeutic relationship.

    Science.gov (United States)

    Klingaman, Elizabeth A; Medoff, Deborah R; Park, Stephanie G; Brown, Clayton H; Fang, Lijuan; Dixon, Lisa B; Hack, Samantha M; Tapscott, Stephanie L; Walsh, Mary Brighid; Kreyenbuhl, Julie A

    2015-09-01

    Although dissatisfaction is a primary reason for disengagement from outpatient psychiatric care among consumers with serious mental illnesses, little is known about predictors of their satisfaction with medication management visits. The primary purpose of this study was to explore how dimensions of consumer preferences for shared decision making (i.e., preferences for obtaining knowledge about one's mental illness, being offered and asked one's opinion about treatment options, and involvement in treatment decisions) and the therapeutic relationship (i.e., positive collaboration and type of clinician input) were related to visit satisfaction. Participants were 228 Veterans with serious mental illnesses who completed a 19-item self-report questionnaire assessing satisfaction with visits to prescribers (524 assessments) immediately after visits. In this correlational design, a 3-level mixed model with the restricted maximum likelihood estimation procedure was used to examine shared decision-making preferences and therapeutic alliance as predictors of visit satisfaction. Preferences for involvement in treatment decisions was the unique component of shared decision making associated with satisfaction, such that the more consumers desired involvement, the less satisfied they were. Positive collaboration and prescriber input were associated with greater visit satisfaction. When consumers with serious mental illnesses express preferences to be involved in shared decision making, it may not be sufficient to only provide information and treatment options; prescribers should attend to consumers' interest in involvement in actual treatment decisions. Assessment and tailoring of treatment approaches to consumer preferences for shared decision making should occur within the context of a strong therapeutic relationship. (c) 2015 APA, all rights reserved).

  6. Consumer Satisfaction with Psychiatric Services: The Role of Shared Decision-Making and the Therapeutic Relationship

    Science.gov (United States)

    Klingaman, Elizabeth A.; Medoff, Deborah R.; Park, Stephanie G.; Brown, Clayton H.; Fang, Lijuan; Dixon, Lisa B.; Hack, Samantha M.; Tapscott, Stephanie L.; Walsh, Mary Brighid; Kreyenbuhl, Julie A.

    2017-01-01

    Objective Although dissatisfaction is a primary reason for disengagement from outpatient psychiatric care among consumers with serious mental illnesses, little is known about predictors of their satisfaction with medication management visits. The primary purpose of the present study was to explore how dimensions of consumer preferences for shared decision-making (i.e., preferences for obtaining knowledge about one’s mental illness, being offered and asked one’s opinion about treatment options, and involvement in treatment decisions) and the therapeutic relationship (i.e., positive collaboration and type of clinician input) were related to visit satisfaction. Methods Participants were 228 Veterans with serious mental illnesses who completed a 19-item self-report questionnaire assessing satisfaction with visits to prescribers (n=524 assessments) immediately after visits. In this correlational design, a 3-level mixed model with the restricted maximum likelihood estimation procedure was used to examine shared decision-making preferences and therapeutic alliance as predictors of visit satisfaction. Results Preferences for involvement in treatment decisions was the unique component of shared decision-making associated with satisfaction, such that the more consumers desired involvement, the less satisfied they were. Positive collaboration and prescriber input were associated with greater visit satisfaction. Conclusions and Implications for Practice When consumers with serious mental illnesses express preferences to be involved in shared decision-making, it may not be sufficient to only provide information and treatment options; prescribers should attend to consumers’ interest in involvement in actual treatment decisions. Assessment and tailoring of treatment approaches to consumer preferences for shared decision-making should occur within the context of a strong therapeutic relationship. PMID:25664755

  7. Neoliberal reform and health dilemmas: social hierarchy and therapeutic decision making in Senegal.

    Science.gov (United States)

    Foley, Ellen E

    2008-09-01

    In this article, I trace the links among neoliberalism, regional ecological decline, and the dynamics of therapeutic processes in rural Senegal. By focusing on illness management in a small rural community, the article explores how economic reform is mediated by existing social structures, and how household social organization in turn influences therapeutic decision making. The illness episodes relayed here demonstrate how the acute economic and social crisis facing the Ganjool region becomes written on the bodies of young men, and how the fault lines of gender and generation shape illness experiences. These narratives also illuminate the tremendous discrepancy between the lived realities of sickness and death, and the idealized models of health participation and empowerment envisioned by the state. Rather than "neoliberal subjects" who behave as rational economic actors, men and women coping with illness are social beings embedded in fields of power characterized by highly stratified household social relations.

  8. Using storyboards to make your performance improvement plan come alive.

    Science.gov (United States)

    Pfaadt, M

    1998-01-01

    The key to successfully using storyboarding within the PI plan is to create a storyboard for each activity as it is completed. Our agency waited until JCAHO was almost upon us. The historical preservation of activities as they occur will create an archive of activities for your PI committee and staff as well as for surveyors. The storyboard's second purpose is the communication of activities to the staff. Take the opportunity to use the boards as educational activities for the staff. Performance Improvement can many times be a frightening, or at best frustrating and uncomfortable activity for staff personnel. Bringing the PI plan alive through the use of storyboards accomplishes many goals as well as helps all staff see how Performance Improvement really makes a difference.

  9. Risky Group Decision-Making Method for Distribution Grid Planning

    Science.gov (United States)

    Li, Cunbin; Yuan, Jiahang; Qi, Zhiqiang

    2015-12-01

    With rapid speed on electricity using and increasing in renewable energy, more and more research pay attention on distribution grid planning. For the drawbacks of existing research, this paper proposes a new risky group decision-making method for distribution grid planning. Firstly, a mixing index system with qualitative and quantitative indices is built. On the basis of considering the fuzziness of language evaluation, choose cloud model to realize "quantitative to qualitative" transformation and construct interval numbers decision matrices according to the "3En" principle. An m-dimensional interval numbers decision vector is regarded as super cuboids in m-dimensional attributes space, using two-level orthogonal experiment to arrange points uniformly and dispersedly. The numbers of points are assured by testing numbers of two-level orthogonal arrays and these points compose of distribution points set to stand for decision-making project. In order to eliminate the influence of correlation among indices, Mahalanobis distance is used to calculate the distance from each solutions to others which means that dynamic solutions are viewed as the reference. Secondly, due to the decision-maker's attitude can affect the results, this paper defines the prospect value function based on SNR which is from Mahalanobis-Taguchi system and attains the comprehensive prospect value of each program as well as the order. At last, the validity and reliability of this method is illustrated by examples which prove the method is more valuable and superiority than the other.

  10. Making it personal: Diversity and deliberation in climate adaptation planning

    Directory of Open Access Journals (Sweden)

    Roopali Phadke

    2015-01-01

    Full Text Available The vulnerabilities and health burdens of climate change fall disproportionately upon lower income communities and communities of color. Yet the very groups who are most affected by climate change impacts are least likely to be involved in climate adaptation discussions. These communities face critical barriers to involvement including historical disenfranchisement, as well as a sense that climate change is distant and not personally relevant. Boundary organizations are increasingly playing an important role in bringing science to bear on policy decision-making with respect to climate change adaptation, an issue fraught with political and ideological tensions. Our project aimed to engage underrepresented communities in climate change adaptation decision-making using a neighborhood consensus conference model developed and tested in several diverse districts of Saint Paul, Minnesota. Our partnership, a “linked chain” of boundary organizations, devised a neighborhood consensus conference model to present best-available climate data as tangible, place-based scenarios. In so doing, we made climate change “personal” for those who remain outside of climate change planning discourses and opened an opportunity for them to assess their community’s vulnerabilities and communicate their priorities for public investment. Our neighborhood-based model built trust and social capital with local residents and allowed us to bring new voices into conversations around climate change adaptation concerns and priorities. We believe this work will have a long term impact on local climate adaptation planning decisions.

  11. Transport policy-making and planning Javanese cities

    Energy Technology Data Exchange (ETDEWEB)

    Dimitriou, H.

    1995-12-31

    Based on findings of field studies in five Javanese cities in Indonesia, this paper looks at a hierarchy of settlements and investigates what aspects of urban development and the transport sector most influences transport policy-making and planning in the country. The paper highlights the presence of a community hierarchy within these settlements with consonant trip-making patterns and the widespread mis-use of certain transport modes. The paper cross-relates observed transport problems and policy issues diagnosed from the five Javanese cities with an earlier prepared national agenda of urban transport policy issues and problems. This is done with a view to arriving at more sensitive policy and planning responses nationwide for cities of different kinds in Indonesia. The paper commences with an explanation of the settlement hierarchy and community structure employed by Indonesian government planners. An attempt is then made to relate this hierarchy and structure to the five cities studied. Within this context, factors affecting urban transport are discussed and tabulated against the above cities settlement hierarchy. These include aspects of: settlement size, structure and area; settlement development policy, urban for, density and topography; and travel and transport characteristics. An attempt is made to match this settlement hierarchy (and its constituent community structure) with a conceptualized hierarchy of transport modes, simultaneously investigating: the relationship between urban communities and assigned road hierarchies; community-based travel demand and trip-making characteristics; and the relationship between travel, speed and distance. From this an assessment is made of the performance and current use and mis-use of such transport modes.

  12. Coronary Computed Tomographic Angiography-Derived Fractional Flow Reserve for Therapeutic Decision Making.

    Science.gov (United States)

    Tesche, Christian; Vliegenthart, Rozemarijn; Duguay, Taylor M; De Cecco, Carlo N; Albrecht, Moritz H; De Santis, Domenico; Langenbach, Marcel C; Varga-Szemes, Akos; Jacobs, Brian E; Jochheim, David; Baquet, Moritz; Bayer, Richard R; Litwin, Sheldon E; Hoffmann, Ellen; Steinberg, Daniel H; Schoepf, U Joseph

    2017-12-15

    This study investigated the performance of coronary computed tomography angiography (cCTA) with cCTA-derived fractional flow reserve (CT-FFR) compared with invasive coronary angiography (ICA) with fractional flow reserve (FFR) for therapeutic decision making in patients with suspected coronary artery disease (CAD). Seventy-four patients (62 ± 11 years, 62% men) with at least 1 coronary stenosis of ≥50% on clinically indicated dual-source cCTA, who had subsequently undergone ICA with FFR measurement, were retrospectively evaluated. CT-FFR values were computed using an on-site machine-learning algorithm to assess the functional significance of CAD. The therapeutic strategy (optimal medical therapy alone vs revascularization) and the appropriate revascularization procedure (percutaneous coronary intervention vs coronary artery bypass grafting) were selected using cCTA-CT-FFR. Thirty-six patients (49%) had a functionally significant CAD based on ICA-FFR. cCTA-CT-FFR correctly identified a functionally significant CAD and the need of revascularization in 35 of 36 patients (97%). When revascularization was deemed indicated, the same revascularization procedure (32 percutaneous coronary interventions and 3 coronary artery bypass grafting) was chosen in 35 of 35 patients (100%). Overall, identical management strategies were selected in 73 of the 74 patients (99%). cCTA-CT-FFR shows excellent performance to identify patients with and without the need for revascularization and to select the appropriate revascularization strategy. cCTA-CT-FFR as a noninvasive "one-stop shop" has the potential to change diagnostic workflows and to directly inform therapeutic decision making in patients with suspected CAD. Copyright © 2017 Elsevier Inc. All rights reserved.

  13. A Methodology to Support Decision Making in Flood Plan Mitigation

    Science.gov (United States)

    Biscarini, C.; di Francesco, S.; Manciola, P.

    2009-04-01

    The focus of the present document is on specific decision-making aspects of flood risk analysis. A flood is the result of runoff from rainfall in quantities too great to be confined in the low-water channels of streams. Little can be done to prevent a major flood, but we may be able to minimize damage within the flood plain of the river. This broad definition encompasses many possible mitigation measures. Floodplain management considers the integrated view of all engineering, nonstructural, and administrative measures for managing (minimizing) losses due to flooding on a comprehensive scale. The structural measures are the flood-control facilities designed according to flood characteristics and they include reservoirs, diversions, levees or dikes, and channel modifications. Flood-control measures that modify the damage susceptibility of floodplains are usually referred to as nonstructural measures and may require minor engineering works. On the other hand, those measures designed to modify the damage potential of permanent facilities are called non-structural and allow reducing potential damage during a flood event. Technical information is required to support the tasks of problem definition, plan formulation, and plan evaluation. The specific information needed and the related level of detail are dependent on the nature of the problem, the potential solutions, and the sensitivity of the findings to the basic information. Actions performed to set up and lay out the study are preliminary to the detailed analysis. They include: defining the study scope and detail, the field data collection, a review of previous studies and reports, and the assembly of needed maps and surveys. Risk analysis can be viewed as having many components: risk assessment, risk communication and risk management. Risk assessment comprises an analysis of the technical aspects of the problem, risk communication deals with conveying the information and risk management involves the decision process

  14. Green Decision Making: How Systemic Planning can support Strategic Decision Making for Sustainable Transport Development

    DEFF Research Database (Denmark)

    Leleur, Steen

    for Strategic Management. The book was published in 2012 by Springer-Verlag, London, as a research monograph in the publisher’s series about Decision Engineering. The intention behind this new book – with its focus upon ‘greening’ of strategic decisions – is to provide a general and less technical description......The book is based on my participation in the SUSTAIN research project 2012-2017 about National Sustainable Transport Planning funded by the Danish Research Council (Innovationsfonden). Many of the issues treated here have a backdrop in my book Complex Strategic Choices – Applying Systemic Planning...... to this application area. In fact a company relocation decision case has been used to introduce the potential of SP as regards providing decision support for strategic decision making. A main concern in this presentation of SP, which deviates from the Springer book referred to above, is to highlight that ‘greening...

  15. Influence of perfusion and ventilation scans on therapeutic decision making and outcome in cases of possible embolism

    International Nuclear Information System (INIS)

    Mercandetti, A.J.; Kipper, M.S.; Moser, K.M.

    1985-01-01

    The authors examined the influence of perfusion (Q) and ventilation (V) scans on therapeutic decision making and outcome among 229 patients referred for lung scans because embolism was suggested and found that specific V/Q scan patterns strongly influenced postscan decisions regarding initiation, maintenance or cessation of heparin therapy. These therapeutic decisions bore a relationship to outcome (recurrences and death) and disclosed decision-making deficits that need remedy by future investigational and educational efforts. 25 references, 5 tables

  16. Whole-body MR imaging in psoriatic arthritis: Additional value for therapeutic decision making

    International Nuclear Information System (INIS)

    Weckbach, Sabine; Schewe, Stefan; Michaely, Henrik J.; Steffinger, Denise; Reiser, Maximilian F.; Glaser, Christian

    2011-01-01

    Purpose: In psoriatic arthritis (PsA) multiple locations may show inflammatory changes not always readily accessible to clinical exam. Often, clinical exam is inconclusive and the decision to initiate or adapt therapy is difficult. Whole body (WB)-MRI may help in this situation by providing a comprehensive overview of affected areas/joints. The purpose of this study was to make a proof of concept whether WB-MRI in psoriatic arthritis is feasible and can provide additional information compared to clinical examination alone with regard to therapeutic decision making in patients with PsA and inconclusive clinical situation. Materials and Methods: 30 patients with PsA and diffuse musculoskeletal pain were examined. A WB-MRI protocol was implemented on a 1.5 Tesla scanner using coronal and sagittal STIR- (TR: 5800, TE: 54, matrix 384 2 pixels, FOV 400 mm) and pre- and steady-state-post-Gadolinium-VIBE sequences (TR: 9.82, TE: 4.53, matrix 384 x 307 pixels, FOV: 400 mm). MRI was evaluated for image quality and inflammatory findings by two readers in consensus and compared to clinical exam. Results: The WB-MR-exam was well tolerated by all patients. Image quality was rated good to excellent in 26 of 30 patients (86.6%). WB-MRI detected significantly (p < 0.001) more areas of synovitis/enthesitis than clinical exam except for the hands and feet. MRI was able to detect unknown destructive bony changes in 10 patients (53%). In 22 patients (73.3%) the therapy regimen was modified, in 18 patients (62%) TNF-alpha-inhibitors were started. Conclusion: Whole-body MRI (WB-MRI) may be integrated in the diagnostic work-up of patients with psoriatic arthropathy facilitating individual adaptation of therapeutic strategy.

  17. Optimizing perioperative decision making: improved information for clinical workflow planning.

    Science.gov (United States)

    Doebbeling, Bradley N; Burton, Matthew M; Wiebke, Eric A; Miller, Spencer; Baxter, Laurence; Miller, Donald; Alvarez, Jorge; Pekny, Joseph

    2012-01-01

    Perioperative care is complex and involves multiple interconnected subsystems. Delayed starts, prolonged cases and overtime are common. Surgical procedures account for 40-70% of hospital revenues and 30-40% of total costs. Most planning and scheduling in healthcare is done without modern planning tools, which have potential for improving access by assisting in operations planning support. We identified key planning scenarios of interest to perioperative leaders, in order to examine the feasibility of applying combinatorial optimization software solving some of those planning issues in the operative setting. Perioperative leaders desire a broad range of tools for planning and assessing alternate solutions. Our modeled solutions generated feasible solutions that varied as expected, based on resource and policy assumptions and found better utilization of scarce resources. Combinatorial optimization modeling can effectively evaluate alternatives to support key decisions for planning clinical workflow and improving care efficiency and satisfaction.

  18. Reliability of the MDi Psoriasis® Application to Aid Therapeutic Decision-Making in Psoriasis.

    Science.gov (United States)

    Moreno-Ramírez, D; Herrerías-Esteban, J M; Ojeda-Vila, T; Carrascosa, J M; Carretero, G; de la Cueva, P; Ferrándiz, C; Galán, M; Rivera, R; Rodríguez-Fernández, L; Ruiz-Villaverde, R; Ferrándiz, L

    2017-09-01

    Therapeutic decisions in psoriasis are influenced by disease factors (e.g., severity or location), comorbidity, and demographic and clinical features. We aimed to assess the reliability of a mobile telephone application (MDi-Psoriasis) designed to help the dermatologist make decisions on how to treat patients with moderate to severe psoriasis. We analyzed interobserver agreement between the advice given by an expert panel and the recommendations of the MDi-Psoriasis application in 10 complex cases of moderate to severe psoriasis. The experts were asked their opinion on which treatments were most appropriate, possible, or inappropriate. Data from the same 10 cases were entered into the MDi-Psoriasis application. Agreement was analyzed in 3 ways: paired interobserver concordance (Cohen's κ), multiple interobserver concordance (Fleiss's κ), and percent agreement between recommendations. The mean percent agreement between the total of 1210 observations was 51.3% (95% CI, 48.5-54.1%). Cohen's κ statistic was 0.29 and Fleiss's κ was 0.28. Mean agreement between pairs of human observers only, excluding the MDi-Psoriasis recommendations, was 50.5% (95% CI, 47.6-53.5%). Paired agreement between the recommendations of the MDi-Psoriasis tool and the majority opinion of the expert panel (Cohen's κ) was 0.44 (68.2% agreement). The MDi-Psoriasis tool can generate recommendations that are comparable to those of experts in psoriasis. Copyright © 2017 AEDV. Publicado por Elsevier España, S.L.U. All rights reserved.

  19. Between Policy-Making and Planning SEA and Strategic Decision-Making in the Danish Energy Sector

    DEFF Research Database (Denmark)

    Lyhne, Ivar

    2011-01-01

    This article deals with the challenge of approaching decision-making processes through strategic environmental assessment (SEA). It is argued that the interaction between policy-making and planning in strategic decision-making processes is a neglected reason for problems with applying SEA......, as legislation and guidance on SEA primarily approach either the policy or plan level. To substantiate the argument, the extent of interaction is empirically investigated. Four contemporary decision-making processes in the Danish energy sector are mapped as a series of choices. Fundamental changes...... with considerable environmental impacts are decided these years, often without preceding SEA processes. The mapping shows a profound interaction between policy-making and planning. In this interaction, public consultation, systematic environmental analyses, and transparency on alternatives are primarily related...

  20. Narrative Financial Therapy: Integrating a Financial Planning Approach with Therapeutic Theory

    Directory of Open Access Journals (Sweden)

    Megan A. McCoy

    2014-03-01

    Full Text Available The article serves as one of the first attempts to develop an integrated theoretical approach to financial therapy that can be used by practitioners from multiple disciplines. The presented approach integrates the components of the six-step financial planning process with components of empirically-supported therapeutic methods. This integration provides the foundation for a manualized approach to financial therapy, shaped by the writings of narrative theorists and select cognitive-behavioral interventions that can be used both by mental health and financial professionals.

  1. Flexible lot sizing in hybrid make-to-order/make-to-stock production planning

    NARCIS (Netherlands)

    Beemsterboer, Bart; Land, Martin; Teunter, Ruud

    2017-01-01

    Hybrid make-to-order/make-to-stock production systems are difficult to control. Batch production of make-to-stock products allows for efficient capacity usage, but fixed batch sizes can make the system less responsive to make-to-order customers. Using Markov Decision Process modeling, we show that

  2. Soviet civil defense plans make nuclear war winnable

    International Nuclear Information System (INIS)

    Goure, L.

    1985-01-01

    In this paper, the author expresses his opinion that the U.S. is naive and suicidal in its lack of civil defense preparation for nuclear war. The Soviets' extensive civil defense planning is evidence that they plan to use their nuclear weapons and survive a counterattack by the U.S. The author compares the two systems and explains why the Soviets' system is superior

  3. Lexical Complexity of Decision-Making Writing Tasks: Form-focused Guided Strategic Planning

    OpenAIRE

    Mahdavirad, Fatemeh

    2016-01-01

    The present study is an attempt to investigate the effect of form-focused guided strategic planning on lexical complexity of learners’ performance in writing tasks. The twenty intermediate level participants of the study performed an unplanned and then a planned decision-making task. In the planned task condition, the participants were provided with form-focused guided strategic planning which contained detailed instructions about how to plan, by being instructed to focus on form. The guidanc...

  4. Reserves reporting for decision-making planning and control

    International Nuclear Information System (INIS)

    Higgins, G.

    1992-01-01

    This paper shows how the established Monte Carlo simulation approach to estimating hydrocarbon reserves can be expanded to provide the basis of a comprehensive valuation, planning and control system meeting all the reserve reporting requirements of an oil exploration and production company. The approach presented is also appropriate for other mining and extractive industries. The paper demonstrates how individual expectation curves can be modified to reflect both technically and commercially recoverable reserves and how these are in turn combined into the economic valuation, planning and control processes of an enterprise. Estimates across the full range of risk and reserves can be aggregated to provide a powerful planning tool that can be used to set corporate, divisional and individual objectives

  5. Green Decision Making: Sustainable Transport and Systemic Planning (SP)

    DEFF Research Database (Denmark)

    Leleur, Steen

    and infrastructure assessment and on the methodology and process of systemic planning (SP). SP theory development has interchanged with practical application and testing of the SP approach in a large number of cases. The word systemic in SP indicates that complex planning problems and provision of decision support...... in today’s strategic planning needs a focus on what may be addressed as systemic insights in balance with more conventional, systematically-based findings where causal linkages can be modelled and made use of. In practice this means that SP is based on a study-specific combination of hard (quantitative......) and soft (qualitative) operations research (OR) methods; especially the latter have a function as regards knowledge generation that relates to obtaining systemic insights. Furthermore, SP applies a process that drives group-based learning forward. The group should be formed with the different stakeholder...

  6. The Impact of Forecasting on Strategic Planning and Decision Making

    African Journals Online (AJOL)

    Nekky Umera

    strategies for the investment manager in relations to Nigeria stock market ... Forecasting generally involves using information from the past to make decision ..... that both number of share in unit and number of deal in share cannot account.

  7. South Korea: Language Policy and Planning in the Making

    Science.gov (United States)

    Song, Jae Jung

    2012-01-01

    This monograph discusses South Korea's language situation in a language policy and planning context. This monograph consists of four parts. Part 1 presents a genetic, typological and sociolinguistic description of South Korea's national language, and an overview of minority languages, including English as well as other languages, recently…

  8. Landscape generator : method to generate plausible landscape configurations for participatory spatial plan-making

    NARCIS (Netherlands)

    Slager, C.T.J.

    2011-01-01

    Contemporary regional spatial plan-making in the Netherlands is characterized as a complex process wherein multiple actors, with different levels of interests and demands, try to commonly develop a coherent and comprehensive set of future plan scenarios. The construction of the set of spatial plan

  9. Improvements to Strategic Planning and Implementation through Enhanced Correlation with Decision-Making Frameworks

    Science.gov (United States)

    McCready, John W.

    2010-01-01

    The purpose of this study was to examine use of decision-making tools and feedback in strategic planning in order to develop a rigorous process that would promote the efficiency of strategic planning for acquisitions in the United States Coast Guard (USCG). Strategic planning is critical to agencies such as the USCG in order to be effective…

  10. Plan now to make your retirement active, productive.

    Science.gov (United States)

    Schlepp, S

    1989-12-01

    In his book Planning to the Years Ahead, Lester I. Tenney, PhD, professor emeritus at Arizona State University, Tempe, links Abraham Maslow's hierarchy of needs to retirement planning. According to Maslow, economic and security needs can be achieved through a family environment (eg, food clothing, shelter), and social acceptance, self-worth, and self-satisfaction can be achieved from social interaction, work, or leisure activities. After the basic needs of food, clothing, and shelter have been achieved, people are able to move to the next level of achieving safety and security. The level of dependency that people have on satisfying these needs through work will determine how well they are at adapting to retirement. The more people depend on work alone, the harder will be the adjustment; people who are less dependent on work will find retirement easier to accept.

  11. Soft system methodology and decision making in community planning system

    OpenAIRE

    Křupka, Jiří; Kašparová, Miloslava; Jirava, Pavel; Mandys, Jan; Ferynová, Lenka; Duplinský, Josef

    2013-01-01

    A model of community planning was defined in this paper. The model was designed for the city of Pardubice and works with real questionnaire research data sets in its evaluation phase. Questionnaires were submitted to fill users, providers and sponsors of social services. When creating the model was used Checkland’s soft system methodology. Also soft computing methods and decision trees were used to create the model. The model was implemented in the data mining tool IBM SPSS Modeler 14.

  12. Virtual reality system for diagnosis and therapeutic planning of cerebral aneurysms.

    Science.gov (United States)

    Mo, Da-peng; Bao, Sheng-de; Li, Liang; Yi, Zhi-qiang; Zhang, Jia-yong; Zhang, Yang

    2010-08-01

    The virtual reality (VR) system can provide the neurosurgeon to intuitively interact with and manipulate the three dimensional (3-D) image similarly to manipulate a real object. It was seldom reported that the system was used in diagnosis and treatment of cerebral aneurysms. This study aimed to investigate the application of VR system in diagnosis and therapeutic planning of cerebral aneurysms. A total of 24 cases of cerebral aneurysms were enrolled in this study from 2006 to 2008, which diagnosed by 3-D digital subtraction angiography (3D-DSA) or VR-based computed tomography angiographies (CTA). The VR system and 3D-DSA system were used to observe and measure aneurysms and the adjacent vessels. The data of observation and measurements were compared between VR image and 3D-DSA image. All the patients underwent surgical plan and simulated neurosurgical procedures in the VR system. There were 28 aneurysms detected in VR system and 3D-DSA system. The VR system generated clear and vivid 3-D virtual images which clearly displayed the location and size of the aneurysms and their precise anatomical spatial relations to the parent arteries and skull. The location, size and shape of the aneurysms and their anatomical relationship with the adjacent vessels were similar between 3-D virtual image and 3D-DSA, but the spatial relationship between aneurysms and skull only been displayed by VR system. This VR system also could simulate simple surgical procedures and surgical environments. The VR system can provide a highly effective way to provide precise imaging details as same as 3D-DSA system and assist the diagnosis of cerebral aneurysms with virtual 3-D data based on CTA. It significantly enhances the chosen therapeutic strategy of cerebral aneurysms.

  13. Planning for Desperate Climate Intervention: can it Make Sense?

    Science.gov (United States)

    Duncan, Robert

    2014-07-01

    The three National Academies of the United States, working together, authored a comprehensive report in 1992 titled: Policy Implications of Greenhouse Warming: Mitigation, Adaptation, and the Science Base. The authors discussed various possible methods of geoengineering to mitigate the adverse climate effects of the slow, steady buildup of greenhouse gasses in the Earth's atmosphere. Subsequently far less expensive, clever designs were developed by inventors such as Bill Gates and his collaborators, and these have been patented. Many of the techniques in this geoengineering proposition were commonly considered as methods of selectively polluting the upper atmosphere to block the solar luminosity, and hence they met with staunch resistance from the international scientific community. At the time, these geoengineering approaches were proposed as a method of countering the slow steady increase of the earth's temperature that was assumed to be a consequence of the increase in concentration of atmospheric molecules that contain carbon, such as CO2 and CH4. Such intentional intervention in a system as complex as the earth's atmosphere was considered by most scientists, including the authors, as reckless. Within this paper, we propose that the less expensive of these geoengineering plans be reconsidered, but that such a system never be deployed or tested at scale unless a genuine climate runaway condition arises in the future. The more economically compelling approaches should be further tested at the `lab bench' level, and in small laboratory-scale tests, and simulations. A comprehensive plan should be developed to manufacture the required materials at scale and to finalize the design of the necessary system, but no such deployment should be entered into at this time. The many risks of an intense, sudden release of greenhouse gasses, mainly methane and carbon dioxide from geologic sources, are reviewed briefly herein. We consider it only prudent to develop an economical

  14. Ethical Decision Making, Therapeutic Boundaries, and Communicating Using Online Technology and Cellular Phones

    Science.gov (United States)

    Yonan, Jesay; Bardick, Angela D.; Willment, Jo-Anne H.

    2011-01-01

    Cellular telephones and social networking sites pose new challenges to the maintenance of therapeutic boundaries. One such difficulty is the possible development of dual relationships between clients and counselling professionals as a result of communicating by these means. Most regulatory bodies advise professional counsellors and psychologists…

  15. Fire and evacuation drills make the CERN safety plans work

    CERN Multimedia

    Antonella Del Rosso

    2013-01-01

    Regular drills are a way of making sure that we are ready and able to react in the event of a fire or other adverse event. They are also a demanding test of all the technical and organisational measures in place to allow the quick and safe evacuation of buildings. Recently, large-scale drills took place in Building 40 and at Point 5 underground.   Group photo at Point 5, after the common evacuation drill. The ability to react to unexpected, adverse events relies in particular on training. This is why CERN’s safety teams organise regular drills. One of the most recent exercises took place on 26 March in Building 40. “Building 40 is a modern building fully equipped against fire, with two emergency exits in the central atrium. We also have 29 emergency guides distributed on each floor to guide people out of their offices,” says Kate Richardson, Territorial Safety Officer of the building. “The drills are very useful for testing the building's insta...

  16. Planning for outdoor play: Government and family decision-making.

    Science.gov (United States)

    Sterman, Julia J; Naughton, Geraldine A; Bundy, Anita C; Froude, Elspeth; Villeneuve, Michelle A

    2018-03-08

    Despite indisputable developmental benefits of outdoor play, children with disabilities can experience play inequity. Play decisions are multifactorial; influenced by children's skills and their familial and community environments. Government agencies have responsibilities for equity and inclusion of people with disabilities; including in play. This multiple-perspective case study aimed to understand outdoor play decision-making for children with disabilities from the perspectives and interactions of: local government and families of primary school-aged children with disabilities. Five mothers, four local government employees, and two not-for-profit organization representatives participated in semi-structured interviews. Inductive and iterative analyzes involved first understanding perspectives of individuals, then stakeholders (local government and families), and finally similarities and differences through cross-case analysis. Local government focused more on physical access, than social inclusion. Local government met only minimal requirements and had little engagement with families. This resulted in poor understanding and action around family needs and preferences when designing public outdoor play spaces. To increase meaningful choice and participation in outdoor play, government understanding of family values and agency around engagement with local government needs to improve. Supporting familial collective capabilities requires understanding interactions between individuals, play, disability, and outdoor play environments.

  17. A simple tool to help decision making in infrastructure planning and ...

    African Journals Online (AJOL)

    2006-10-04

    Oct 4, 2006 ... a tool to help decision making for planning and management of phytotreatment ... mental studies aimed at the quantitative estimation of biologi- cal processes .... water has been simulated with a logistic model assuming an.

  18. Male Involvement in Family Planning Decision Making in Ile-Ife ...

    African Journals Online (AJOL)

    Erah

    spousal communication, and investigated the correlates of men's opinion in family planning decision making in ... questionnaire to collect information from 402 male study participants. ..... who attained post-secondary education were more.

  19. Making cities energy efficient. Urban and regional planning adopting RES

    Energy Technology Data Exchange (ETDEWEB)

    Ahonen, A.-M.; David, T.; Dorfner, J. [and others

    2013-06-01

    This report summarises the outcomes of a 30 months duration continuing education project entitled 'Urban Planners with Renewable Energy Skills' (UP-RES). The project was carried out by a multi-disciplinary international consortium with the aim of informing planners and related professionals about energy-efficient and CO{sub 2} reducing technologies, practices and systems that can be developed across urban areas to serve whole communities. This report provides an overview of the key issues: The overall project approach to devising a training program based on preceding training needs analysis The key tasks involved in creating the training materials The marketing of the training as well as evaluation results Best practise examples of RES in urban planning. The UP-RES project has focused on several major target groups. These include those groups directly involved in taking forward renewable energy projects for whom the UP-RES training was principally focused; those who wish to deliver such training programmes; and policy makers who are ultimately responsible for the decisions that govern how widely such technologies will be implemented. Each of these groups has its own perspective concerning renewable energy technologies so the report is structured accordingly: For professionals involved in implementation: Among those professions that are likely to become involved with renewable energy initiatives in urban areas are urban planners, architects, energy suppliers, developers, building owners, and consulting engineers. For these professionals chapters 3.2 (summary of training need analysis) and 4 (best practise examples) are most likely to appeal. For training experts and organisations: Training programmes that address the relevance of renewable energies in urban areas require a comprehensive set of materials. As an example of how to organise training courses and lessons learnt, chapter 3 might be interesting. For the generally interested: Renewable energies are

  20. Intelligent Aircraft Damage Assessment, Trajectory Planning, and Decision-Making under Uncertainty

    Science.gov (United States)

    Lopez, Israel; Sarigul-Klijn, Nesrin

    Situational awareness and learning are necessary to identify and select the optimal set of mutually non-exclusive hypothesis in order to maximize mission performance and adapt system behavior accordingly. This paper presents a hierarchical and decentralized approach for integrated damage assessment and trajectory planning in aircraft with uncertain navigational decision-making. Aircraft navigation can be safely accomplished by properly addressing the following: decision-making, obstacle perception, aircraft state estimation, and aircraft control. When in-flight failures or damage occur, rapid and precise decision-making under imprecise information is required in order to regain and maintain control of the aircraft. To achieve planned aircraft trajectory and complete safe landing, the uncertainties in system dynamics of the damaged aircraft need to be learned and incorporated at the level of motion planning. The damaged aircraft is simulated via a simplified kinematic model. The different sources and perspectives of uncertainties in the damage assessment process and post-failure trajectory planning are presented and classified. The decision-making process for an emergency motion planning and landing is developed via the Dempster-Shafer evidence theory. The objective of the trajectory planning is to arrive at a target position while maximizing the safety of the aircraft given uncertain conditions. Simulations are presented for an emergency motion planning and landing that takes into account aircraft dynamics, path complexity, distance to landing site, runway characteristics, and subjective human decision.

  1. [Test your decision-making. When to do endodontic retreatment? Some therapeutic alternatives].

    Science.gov (United States)

    Aryanpour, S; D'Hoore, W; Van Nieuwenhuysen, J P

    2000-01-01

    The aim of the present article was to propose examples of treatment alternatives for the management of 14 clinical cases. All these cases involved endodontically treated teeth and have been managed by the same practitioner. In this paper, the authors tried to show the variety of treatment alternatives as well as the complexity of the decision-making process and, not to consider that proposed alternatives were the most adequate.

  2. Making planned paths look more human-like in humanoid robot manipulation planning

    DEFF Research Database (Denmark)

    Zacharias, F.; Schlette, C.; Schmidt, F.

    2011-01-01

    It contradicts the human's expectations when humanoid robots move awkwardly during manipulation tasks. The unnatural motion may be caused by awkward start or goal configurations or by probabilistic path planning processes that are often used. This paper shows that the choice of an arm's target...... for the robot arm....

  3. Therapeutic Decision-Making in Endoscopically Unmanageable Nonvariceal Upper Gastrointestinal Hemorrhage

    International Nuclear Information System (INIS)

    Defreyne, Luc; Schrijver, Ignace De; Decruyenaere, Johan; Maele, Georges Van; Ceelen, Wim; Looze, Danny De; Vanlangenhove, Peter

    2008-01-01

    The purpose of this study was to identify endoscopic and clinical parameters influencing the decision-making in salvage of endoscopically unmanageable, nonvariceal upper gastrointestinal hemorrhage (UGIH) and to report the outcome of selected therapy. We retrospectively retrieved all cases of surgery and arteriography for arrest of endoscopically unmanageable UGIH. Only patients with overt bleeding on endoscopy within the previous 24 h were included. Patients with preceding nonendoscopic hemostatic interventions, portal hypertension, malignancy, and transpapillar bleeding were excluded. Potential clinical and endoscopic predictors of allocation to either surgery or arteriography were tested using statistical models. Outcome and survival were regressed on the choice of rescue and clinical variables. Forty-six arteriographed and 51 operated patients met the inclusion criteria. Univariate analysis revealed a higher number of patients with a coagulation disorder in the catheterization group (41.4%, versus 20.4% in the laparotomy group; p = 0.044). With multivariate analysis, the identification of a bleeding peptic ulcer at endoscopy significantly steered decision-making toward surgical rescue (OR = 5.2; p = 0.021). Taking into account reinterventions, hemostasis was achieved in nearly 90% of cases in both groups. Overall therapy failure (no survivors), rebleeding within 3 days (OR = 3.7; p = 0.042), and corticosteroid use (OR = 5.2; p = 0.017) had a significant negative impact on survival. The odds of dying were not different for embolotherapy or surgery. In conclusion, decision-making was endoscopy-based, with bleeding peptic ulcer significantly directing the choice of rescue toward surgery. Unsuccessful hemostasis and corticosteroid use, but not the choice of rescue, negatively affected outcome.

  4. Clinical holistic medicine: factors influencing the therapeutic decision-making. From academic knowledge to emotional intelligence and spiritual "crazy" wisdom.

    Science.gov (United States)

    Ventegodt, Søren; Kandel, Isack; Merrick, Joav

    2007-12-10

    Scientific holistic medicine is built on holistic medical theory, on therapeutic and ethical principles. The rationale is that the therapist can take the patient into a state of salutogenesis, or existential healing, using his skills and knowledge. But how ever much we want to make therapy a science it remains partly an art, and the more developed the therapist becomes, the more of his/her decisions will be based on intuition, feeling and even inspiration that is more based on love and human concern and other spiritual motivations than on mental reason and rationality in a simple sense of the word. The provocative and paradoxal medieval western concept of the "truth telling clown", or the eastern concepts of "crazy wisdom" and "holy madness" seems highly relevant here. The problem is how we can ethically justify this kind of highly "irrational" therapeutic behavior in the rational setting of a medical institution. We argue here that holistic therapy has a very high success rate and is doing no harm to the patient, and encourage therapists, psychiatrists, psychologist and other academically trained "helpers" to constantly measure their own success-rate. This paper discusses many of the important factors that influence clinical holistic decision-making. Sexuality could, as many psychoanalysts from Freud to Reich and Searles have believed, be the most healing power that exists and also the most difficult for the mind to comprehend, and thus the most "crazy-wise" tool of therapy.

  5. Considerations of net present value in policy making regarding diagnostic and therapeutic technologies.

    Science.gov (United States)

    Califf, Robert M; Rasiel, Emma B; Schulman, Kevin A

    2008-11-01

    The pharmaceutical and medical device industries function in a business environment in which shareholders expect companies to optimize profit within legal and ethical standards. A fundamental tool used to optimize decision making is the net present value calculation, which estimates the current value of cash flows relating to an investment. We examined 3 prototypical research investment decisions that have been the source of public scrutiny to illustrate how policy decisions can be better understood when their impact on societally desirable investments by industry are viewed from the standpoint of their impact on net present value. In the case of direct, comparative clinical trials, a simple net present value calculation provides insight into why companies eschew such investments. In the case of pediatric clinical trials, the Pediatric Extension Rule changed the net present value calculation from unattractive to potentially very attractive by allowing patent extensions; thus, the dramatic increase in pediatric clinical trials can be explained by the financial return on investment. In the case of products for small markets, the fixed costs of development make this option financially unattractive. Policy decisions can be better understood when their impact on societally desirable investments by the pharmaceutical and medical device industries are viewed from the standpoint of their impact on net present value.

  6. Planning a Stigmatized Nonvisible Illness Disclosure: Applying the Disclosure Decision-Making Model

    Science.gov (United States)

    Choi, Soe Yoon; Venetis, Maria K.; Greene, Kathryn; Magsamen-Conrad, Kate; Checton, Maria G.; Banerjee, Smita C.

    2016-01-01

    This study applied the disclosure decision-making model (DD-MM) to explore how individuals plan to disclose nonvisible illness (Study 1), compared to planning to disclose personal information (Study 2). Study 1 showed that perceived stigma from the illness negatively predicted disclosure efficacy; closeness predicted anticipated response (i.e., provision of support) although it did not influence disclosure efficacy; disclosure efficacy led to reduced planning, with planning leading to scheduling. Study 2 demonstrated that when information was considered to be intimate, it negatively influenced disclosure efficacy. Unlike the model with stigma (Study 1), closeness positively predicted both anticipated response and disclosure efficacy. The rest of the hypothesized relationships showed a similar pattern to Study 1: disclosure efficacy reduced planning, which then positively influenced scheduling. Implications of understanding stages of planning for stigmatized information are discussed. PMID:27662447

  7. Making parks make a difference: poor alignment of policy, planning and management with protected-area impact, and ways forward.

    Science.gov (United States)

    Pressey, Robert L; Visconti, Piero; Ferraro, Paul J

    2015-11-05

    Policy and practice around protected areas are poorly aligned with the basic purpose of protection, which is to make a difference. The difference made by protected areas is their impact, defined in program evaluation as the outcomes arising from protection relative to the counterfactual of no protection or a different form of protection. Although impact evaluation of programs is well established in fields such as medicine, education and development aid, it is rare in nature conservation. We show that the present weak alignment with impact of policy targets and operational objectives for protected areas involves a great risk: targets and objectives can be achieved while making little difference to the conservation of biodiversity. We also review potential ways of increasing the difference made by protected areas, finding a poor evidence base for the use of planning and management 'levers' to better achieve impact. We propose a dual strategy for making protected areas more effective in their basic role of saving nature, outlining ways of developing targets and objectives focused on impact while also improving the evidence for effective planning and management. © 2015 The Authors.

  8. Assessment of therapeutic response and treatment planning for brain tumors using metabolic and physiological MRI.

    Science.gov (United States)

    Nelson, Sarah J

    2011-07-01

    MRI is routinely used for diagnosis, treatment planning and assessment of response to therapy for patients with glioma. Gliomas are spatially heterogeneous and infiltrative lesions that are quite variable in terms of their response to therapy. Patients classified as having low-grade histology have a median overall survival of 7 years or more, but need to be monitored carefully to make sure that their tumor does not upgrade to a more malignant phenotype. Patients with the most aggressive grade IV histology have a median overall survival of 12-15 months and often undergo multiple surgeries and adjuvant therapies in an attempt to control their disease. Despite improvements in the spatial resolution and sensitivity of anatomic images, there remain considerable ambiguities in the interpretation of changes in the size of the gadolinium-enhancing lesion on T(1) -weighted images as a measure of treatment response, and in differentiating between treatment effects and infiltrating tumor within the larger T(2) lesion. The planning of focal therapies, such as surgery, radiation and targeted drug delivery, as well as a more reliable assessment of the response to therapy, would benefit considerably from the integration of metabolic and physiological imaging techniques into routine clinical MR examinations. Advanced methods that have been shown to provide valuable data for patients with glioma are diffusion, perfusion and spectroscopic imaging. Multiparametric examinations that include the acquisition of such data are able to assess tumor cellularity, hypoxia, disruption of normal tissue architecture, changes in vascular density and vessel permeability, in addition to the standard measures of changes in the volume of enhancing and nonenhancing anatomic lesions. This is particularly critical for the interpretation of the results of Phase I and Phase II clinical trials of novel therapies, which are increasingly including agents that are designed to have anti-angiogenic and anti

  9. Heart Team therapeutic decision-making and treatment in severe aortic valve stenosis

    DEFF Research Database (Denmark)

    Thyregod, Hans Gustav Hørsted; Holmberg, Fredrik; Gerds, Thomas Alexander

    2016-01-01

    Objectives: After transcatheter aortic valve implantation (TAVI) has been available for high-risk patients with severe aortic valve stenosis (AVS), the decision-making of the Heart Team (HT) has not been examined. Design: All adult patients with severe AVS referred to a large tertiary medical......%), and surgical aortic valve replacement (SAVR) in 392 (81%) of patients. In patients referred to intervention, TAVI compared with SAVR patients were older (OR = 1.17 per year, 95% CI 1.09-1.26; p obesity (OR = 4.69, 1.......51-13.77; p disease (COPD) (OR = 3.66, 1.21-10.75; p = 0.02). MT patients compared with patients referred to any intervention were older, had a higher prevalence of COPD, peripheral arterial disease, previous myocardial infarction, and cerebrovascular disease...

  10. Being safe: making the decision to have a planned home birth in the United States.

    Science.gov (United States)

    Lothian, Judith A

    2013-01-01

    Although there is evidence that supports the safety of planned home birth for healthy women, less than 1 percent of women in the United States choose to have their baby at home. An ethnographic study of the experience of planned home birth provided rich descriptions of women's experiences planning, preparing for, and having a home birth.This article describes findings related to how women make the decision to have a planned home birth. For these women, being safe emerged as central in making the decision. For them, being safe included four factors: avoiding technological birth interventions, knowing the midwife and the midwife knowing them, feeling comfortable and protected at home, and knowing that backup hospital medical care was accessible if needed.

  11. Making the End as Good as the Beginning: Financial Planning and Retirement for Women Plastic Surgeons.

    Science.gov (United States)

    Johnson, Debra J; Shenaq, Deana; Thakor, Manisha

    2016-10-01

    Financial planning is critically important to ensure financial security both during a plastic surgical career and in retirement. Unfortunately, plastic surgery training includes very little in the way of financial planning. The information that is available in the literature is mostly geared toward men. Women, with longer lifespans and more family care responsibilities, have unique needs when it comes to financial planning. Adequate attention must also be paid to life after retirement. A plastic surgical career can be all-encompassing, and thus women need to carefully plan volunteer activities, new hobbies, and even a second career to make their retirement years fulfilling and enjoyable. Key points regarding financial planning during the various phases of a woman plastic surgeon's career are discussed. Options for retirement are presented.

  12. Lexical Complexity of Decision-Making Writing Tasks: Form-focused Guided Strategic Planning

    Directory of Open Access Journals (Sweden)

    Fatemeh Mahdavirad

    2016-06-01

    Full Text Available The present study is an attempt to investigate the effect of form-focused guided strategic planning on lexical complexity of learners’ performance in writing tasks. The twenty intermediate level participants of the study performed an unplanned and then a planned decision-making task. In the planned task condition, the participants were provided with form-focused guided strategic planning which contained detailed instructions about how to plan, by being instructed to focus on form. The guidance included an explanation of the necessary structural and lexical patterns employed to express the learners’ views while developing a comparison-and-contrast paragraph in each task. The results of the statistical analysis indicated that the participants produced a written product with a greater lexical complexity in their performance of the task in the form-focused strategic planning condition. The findings emphasize the importance of guided strategic planning as a task condition in syllabus design for task-based language teaching and the necessity of incorporating this task feature for accomplishing lexical complexity in decision-making writing tasks.

  13. Maintenance planning support method for nuclear power plants based on collective decision making

    International Nuclear Information System (INIS)

    Shimizu, Shunichi; Sakurai, Shoji; Takaoka, Kazushi; Kanemoto, Shigeru; Fukutomi, Shigeki

    1992-01-01

    Inspection and maintenance planning in nuclear power plants is conducted by decision making based on experts' collective consensus. However, since a great deal of time and effort is required to reach a consensus among expert judgments, the establishment of effective decision making methods is necessary. Therefore, the authors developed a method for supporting collective decision making, based on a combination of three types of decision making methods; the Characteristic Diagram method, Interpretative Structural Modeling method, and the Analytic Hierarchy Process method. The proposed method enables us to determine the evaluation criteria systematically for collective decision making, and also allows extracting collective decisions using simplified questionnaires. The proposed method can support reaching a consensus of groups effectively through the evaluation of collective decision structural models and their characteristics. In this paper, the effectiveness of the proposed method was demonstrated through its application to the decision making problem concerning whether or not the improved ultrasonic testing equipment should be adopted at nuclear power plants. (author)

  14. Decision-making of selectable process plans based on petri net with manufacturing constraints

    DEFF Research Database (Denmark)

    Xiao, Weiyue; Jones, Richard William; Yu, Fei

    2016-01-01

    Intelligent Computer-Aided process planning and decision making for manufacturing systems is a critical subject, that some might argue, has not received the attention it should have from the research community. Despite the progress made in the area of artificial intelligence, there has not been a...

  15. Career Development Strivings: Assessing Goals and Motivation in Career Decision-Making and Planning

    Science.gov (United States)

    Dik, Bryan J.; Sargent, Adam M.; Steger, Michael F.

    2008-01-01

    This article describes and demonstrates a novel approach to assessing goals and motives among individuals engaged in the career decision-making and planning process. Participants generated five career development strivings, rated each striving along several dimensions (self-efficacy, outcome expectations, sense of calling, spiritual significance,…

  16. Male Involvement in Family Planning Decision Making in Ile-Ife ...

    African Journals Online (AJOL)

    This study assessed men's awareness, attitude, and practice of modern contraceptive methods, determined the level of spousal communication, and investigated the correlates of men's opinion in family planning decision making in Ile-Ife, Nigeria. Quantitative methodology was employed in this cross-sectional descriptive ...

  17. The Effects of Scenario Planning on Participant Decision-Making Style

    Science.gov (United States)

    Chermack, Thomas J.; Nimon, Kim

    2008-01-01

    This research examines changes in decision-making styles as a result of participation in scenario planning. A quasi-experimental pretest-posttest design and several nonparametric tests were used to analyze data gathered from research participants in a technology firm in the Northeastern United States. Results show that participants tend to…

  18. Decision-making and planning in full recovery of anorexia nervosa.

    Science.gov (United States)

    Lindner, Susanne E; Fichter, Manfred M; Quadflieg, Norbert

    2012-11-01

    Based on findings of persisting neuropsychological impairments in women recovered from anorexia nervosa (rec AN), this study examined decision-making and planning, for achieving a desired goal, as central executive functions in a large sample of rec AN. The definition of recovery included physiological, behavioral, and psychological variables. A total of 100 rec AN women were compared to 100 healthy women, 1:1 matched for age and educational level. Decision-making was assessed with the Iowa Gambling Task and planning with the Tower of London. Expert interviews and self-ratings were used for assessing the inclusion/exclusion criteria and control variables. Compared to healthy controls, rec AN women were better in decision-making and worse in planning even after considering control variables. This study does not support results from other studies showing that rec AN participants perform better in decision-making. Results from this study show that planning is impaired even after full recovery from AN. Copyright © 2012 Wiley Periodicals, Inc.

  19. Client Satisfaction And Decision Making Amongst Females Visiting Family Planning Clinics In Hyderabad, Pakistan.

    Science.gov (United States)

    Memon, Arbia; Hamid, Saima; Kumar, Ramesh

    2017-01-01

    Family Planning is the basic right of the human being. It involves decision regarding the number of children and desired space between children by the couple themselves. Quality services involving multiple dimensions build the confidence of the clients and lack of quality is one of the constraints behind incomplete coverage of family planning. Objectives of the current study were to determine the client satisfaction, decision-making process and various influences on clients in adopting family planning methods. This cross-sectional study was conducted at Family Planning Centre of Liaquat University Hospital, Hyderabad in 2016. Quality of the family planning services and satisfaction with the services were assessed through responses obtained from women selected purposively and visiting family planning centre through exit interviews with structured pretested and reliable questionnaire after taking the written consent. Access to Family Planning Centre was not an issue in 92% cases but only 31% respondents were appropriately greeted, 77% faced blank expression and 13% received sufficient privacy. Health problems and socioeconomic conditions were inquired by 41% and18% providers respectively, while motivating force for service use was mother in law in most 35% cases. Health workers were successful in clarifying misinformation (86%) and explaining side effects (71%) but only 21% respondents were satisfied with services. Respondents are influenced by family and health care providers while making decision and type of influence was considered positive by 83% respondents. Training and monitoring system be strengthened at family planning centres to improve quality of services while important influencing relations be focused for family planning education to improve utilization of services.

  20. Decision-making and evacuation planning for flood risk management in the Netherlands.

    Science.gov (United States)

    Kolen, Bas; Helsloot, Ira

    2014-07-01

    A traditional view of decision-making for evacuation planning is that, given an uncertain threat, there is a deterministic way of defining the best decision. In other words, there is a linear relation between threat, decision, and execution consequences. Alternatives and the impact of uncertainties are not taken into account. This study considers the 'top strategic decision-making' for mass evacuation owing to flooding in the Netherlands. It reveals that the top strategic decision-making process itself is probabilistic because of the decision-makers involved and their crisis managers (as advisers). The paper concludes that deterministic planning is not sufficient, and it recommends probabilistic planning that considers uncertainties in the decision-making process itself as well as other uncertainties, such as forecasts, citizens responses, and the capacity of infrastructure. This results in less optimistic, but more realistic, strategies and a need to pay attention to alternative strategies. © 2014 The Author(s). Disasters © Overseas Development Institute, 2014.

  1. Male involvement in family planning decision making in sub-Saharan Africa- what the evidence suggests

    Science.gov (United States)

    Vouking, Marius Zambou; Evina, Christine Danielle; Tadenfok, Carine Nouboudem

    2014-01-01

    The World Health Organization (WHO) estimated in 2012 that 287,000 maternal deaths occurred in 2010; sub-Saharan Africa (56%) and Southern Asia (29%) accounted for the global burden of maternal deaths. Men are also recognized to be responsible for the large proportion of ill reproductive health suffered by their female partners. Male involvement helps not only in accepting a contraceptive but also in its effective use and continuation. The objectives were to assess men's knowledge, attitude, and practice of modern contraceptive methods; determine the level of spousal communication about family planning decision making; and investigate the correlates of men's opinion about their roles in family planning decision making. We searched the following electronic databases from January 1995 to December 2013: Medline, Embase, CINAHL, LILAS, International Bibliography of Social Sciences, Social Services Abstracts, and Sociological Abstracts. Along with MeSH terms and relevant keywords, we used the Cochrane Highly Sensitive Search Strategy for identifying reports of articles in PubMed. There were no restrictions to language or publication status. Of 137 hits, 7 papers met the inclusion criteria. The concept of family planning was well known to men. In the Nigerian study, almost (99%) men were aware of the existence of modern contraceptives, and most of them were aware of at least two modern methods. Awareness of the condom was highest (98%). In the Malawi study, all of the participants reported that they were not using contraception before the intervention. In Ethiopia, above 90% of male respondents have supported and approved using and choosing family planning methods, but none of them practiced terminal methods. Generally, more male respondents disagreed than agreed that men should make decisions about selected family planning issues in the family. Decision-making dynamics around method choice followed a slightly different pattern. According to female participants

  2. The role of policy-making and planning cultures for sustainable transport?

    DEFF Research Database (Denmark)

    Hansen, Carsten Jahn

    2011-01-01

    for underlying sets of values and norms to enter the policy process more freely and explicitly. However, do we then have the cultures and moral force to build effective sustainable transport policies and plans? The article therefore also looks into a range of overlapping approaches that may potentially aid...... in rethinking and rebuilding transport policy-making and planning processes in terms of cultural learning processes. Finally, the role of the planner as a ‘cultural entrepreneur’ and ‘cultural story-teller’ is presented as potential tool to push through new agendas or ideas, such as more sustainable transport...

  3. Fleet Planning Decision-Making: Two-Stage Optimization with Slot Purchase

    Directory of Open Access Journals (Sweden)

    Lay Eng Teoh

    2016-01-01

    Full Text Available Essentially, strategic fleet planning is vital for airlines to yield a higher profit margin while providing a desired service frequency to meet stochastic demand. In contrast to most studies that did not consider slot purchase which would affect the service frequency determination of airlines, this paper proposes a novel approach to solve the fleet planning problem subject to various operational constraints. A two-stage fleet planning model is formulated in which the first stage selects the individual operating route that requires slot purchase for network expansions while the second stage, in the form of probabilistic dynamic programming model, determines the quantity and type of aircraft (with the corresponding service frequency to meet the demand profitably. By analyzing an illustrative case study (with 38 international routes, the results show that the incorporation of slot purchase in fleet planning is beneficial to airlines in achieving economic and social sustainability. The developed model is practically viable for airlines not only to provide a better service quality (via a higher service frequency to meet more demand but also to obtain a higher revenue and profit margin, by making an optimal slot purchase and fleet planning decision throughout the long-term planning horizon.

  4. Integrating climate change adaptation in energy planning and decision-making - Key challenges and opportunities

    DEFF Research Database (Denmark)

    Olhoff, Anne; Olsen, Karen Holm

    2011-01-01

    management framework is used as the basis for identifying key challenges and opportunities to enhance the integration of climate change adaptation in energy planning and decision-making. Given its importance for raising awareness and for stimulating action by planners and decision-makers, emphasis is placed......Energy systems are significantly vulnerable to current climate variability and extreme events. As climate change becomes more pronounced, the risks and vulnerabilities will be exacerbated. To date, energy sector adaptation issues have received very limited attention. In this paper, a climate risk...... barriers to integration of climate risks and adaptive responses in energy planning and decision making. Both detailed assessments of the costs and benefits of integrating adaptation measures and rougher ‘order of magnitude’ estimates would enhance awareness raising and momentum for action....

  5. Deviant Peer Behavior and Adolescent Delinquency: Protective Effects of Inhibitory Control, Planning, or Decision Making?

    Science.gov (United States)

    Hinnant, J Benjamin; Forman-Alberti, Alissa B

    2018-05-09

    We examined relations between adolescent perceptions of deviant peer behavior and delinquency as moderated by inhibitory control, planning, and decision making in the National Institute of Child Health and Human Development (NICHD) Study of Early Child Care and Youth Development at age 15 (N = 991). Adolescents reported perceptions of deviant peer behavior. Inhibitory control, planning, and decision making were assessed behaviorally. Delinquency was evaluated with a latent variable comprised of parent-guardian perceptions of adolescent delinquency and adolescent self-reports. Only inhibitory control moderated the relationship between deviant peer behavior and delinquency, showing that better inhibition protected against delinquency in contexts of high levels of adolescent perceptions of deviant peer behavior. Findings are discussed in the context of theories of adolescent delinquency and risk taking. © 2018 Society for Research on Adolescence.

  6. Business plans in bank decision-making when financing new ventures in South Africa

    Directory of Open Access Journals (Sweden)

    M Pretorius

    2004-04-01

    Full Text Available This article focuses on the position that South African commercial banks adopt when evaluating an application for finance of new business ventures. The role and importance of the business plan in the decision-making process is highlighted and investigated. This article begins to qualitatively describe the decision-making processes, criteria and processes instituted by the four major South African commercial banks that between them serve 96 per cent of the banking services for small business. It then questions the barriers placed on applicants applying for finance and recommends how these barriers can be removed. The article concludes that banks finance business ventures with poor potential for success if the applicant is creditworthy or has the necessary security rather than assist applicants with good plans and ventures with potential, but lacking sufficient security.

  7. Shared Decision-Making in Youth Mental Health Care: Using the Evidence to Plan Treatments Collaboratively.

    Science.gov (United States)

    Langer, David A; Jensen-Doss, Amanda

    2016-12-02

    The shared decision-making (SDM) model is one in which providers and consumers of health care come together as collaborators in determining the course of care. The model is especially relevant to youth mental health care, when planning a treatment frequently entails coordinating both youth and parent perspectives, preferences, and goals. The present article first provides the historical context of the SDM model and the rationale for increasing our field's use of SDM when planning psychosocial treatments for youth and families. Having established the potential utility of SDM, the article then discusses how to apply the SDM model to treatment planning for youth psychotherapy, proposing a set of steps consistent with the model and considerations when conducting SDM with youth and families.

  8. A complex systems approach to planning, optimization and decision making for energy networks

    International Nuclear Information System (INIS)

    Beck, Jessica; Kempener, Ruud; Cohen, Brett; Petrie, Jim

    2008-01-01

    This paper explores a new approach to planning and optimization of energy networks, using a mix of global optimization and agent-based modeling tools. This approach takes account of techno-economic, environmental and social criteria, and engages explicitly with inherent network complexity in terms of the autonomous decision-making capability of individual agents within the network, who may choose not to act as economic rationalists. This is an important consideration from the standpoint of meeting sustainable development goals. The approach attempts to set targets for energy planning, by determining preferred network development pathways through multi-objective optimization. The viability of such plans is then explored through agent-based models. The combined approach is demonstrated for a case study of regional electricity generation in South Africa, with biomass as feedstock

  9. Technology decision making. A constructive approach to planning and acquisition will require a paradigm shift.

    Science.gov (United States)

    Berkowitz, D A; Swan, M M

    1993-01-01

    Technology should be viewed as an integrating rather than a divisive element in hospital planning. In the past, technology decision-making responsibility has often been diffused throughout hospitals, but providers are beginning to take a more considered and coherent approach. The process of making decisions about technology has four key elements: assessment, planning, acquisition, and management. The most important aspect of the assessment phase is the formation of a technology advisory committee to review and evaluate requests for new and emerging technology; review capital budget requests for new and replacement technology; and set mission-based and strategic priorities for new, emerging, and replacement technologies. Technology planning allows hospitals to set long-term goals for technology acquisition. The process involves an audit of existing technologies, evaluation of other hospitals' technologies, and review of technology trends. A well-defined technology plan will, in turn, facilitate the acquisition and management process, allowing hospitals greater flexibility in negotiating costs and budgeting for training, spare parts, service, upgrades, and support. By pooling resources with other providers in their region, hospitals can further enhance the effectiveness of their use and acquisition of technology. Collaboration allows providers to share the risks of technologically volatile and intensive services and avoid costly duplication of equipment and facilities.

  10. The WIPP decision plan: Charting the course for openness in the decision making process

    International Nuclear Information System (INIS)

    Hagers, J.

    1992-01-01

    In June of 1989, the Secretary of Energy requested that a plan be developed that would clearly outline the prerequisites to opening the Waste Isolation Pilot Plant (WIPP). It was to provide the basis for a decision making process that was not only visible to the public, but one which included public participation. It must also be dynamic enough to effectively deal with the changing legislative, regulatory, and technical environments. Based on a recognized need for openness, the Secretary's Draft Decision Plan was developed. The plan charted the course for ultimately making the decision to declare WIPP ready to receive waste for the start of test phase operations. It outlined to critics and supporters alike the rigorous and thorough process by which the internal decisions were made. The plan identified all internal prerequisites to the decision; charted the review cycles, and targeted the completion dates. It also outlined the processes outside the control of the Department, institutional issues, such as legislative land withdrawal, issuance of permits, and designation of transportation routes

  11. Feasible sampling plan for Bemisia tabaci control decision-making in watermelon fields.

    Science.gov (United States)

    Lima, Carlos Ho; Sarmento, Renato A; Pereira, Poliana S; Galdino, Tarcísio Vs; Santos, Fábio A; Silva, Joedna; Picanço, Marcelo C

    2017-11-01

    The silverleaf whitefly Bemisia tabaci is one of the most important pests of watermelon fields worldwide. Conventional sampling plans are the starting point for the generation of decision-making systems of integrated pest management programs. The aim of this study was to determine a conventional sampling plan for B. tabaci in watermelon fields. The optimal leaf for B. tabaci adult sampling was the 6 th most apical leaf. Direct counting was the best pest sampling technique. Crop pest densities fitted the negative binomial distribution and had a common aggregation parameter (K common ). The sampling plan consisted of evaluating 103 samples per plot. This sampling plan was conducted for 56 min, costing US$ 2.22 per sampling and with a 10% maximum evaluation error. The sampling plan determined in this study can be adopted by farmers because it enables the adequate evaluation of B. tabaci populations in watermelon fields (10% maximum evaluation error) and is a low-cost (US$ 2.22 per sampling), fast (56 min per sampling) and feasible (because it may be used in a standardized way throughout the crop cycle) technique. © 2017 Society of Chemical Industry. © 2017 Society of Chemical Industry.

  12. The role of linguists in planning and making dictionaries in modern information society

    DEFF Research Database (Denmark)

    Bergenholtz, Henning

    2013-01-01

    , but not necessarily for all, e.g. not for meaning items, collocations or synonym items. This will be discussed outgoing from the description of a database and the concept for one polyfunctional and five monofunctional monolingual general dictionaries. The first monofunctional dictionary is a reception dictionary...... type of expert is best suited to make modern dictionaries in the information age? This question is quite complex. We have different kinds of dictionaries, e.g. general language and special language dictionaries. And we have different kinds of lexicographers, e.g. 1. metalexicographer, 2. practical...... lexicographer making the concept for a planned dictionary, 3. lexicographer making the concrete dictionary articles or parts of them. For (2) a linguist is of course not the natural choice. For (3) we need linguists for certain kind of dictionaries and certain data types in general languages...

  13. Dosimetric verification of a software for planning of radio therapeutical treatments

    International Nuclear Information System (INIS)

    Alfonso, R.; Huerta, U.; Alfonso, J.L.; Torres, M.

    1995-01-01

    A software for radiation treatment planning was recently developed by medical physicists at the Hermanos Ameijeiras Hospital in Havana. Selected locations in head and neck region were used to evaluate the reliability of calculated dose distributions in patients, taking as a reference the results of dosimetric measurements with TLD-700 powder in a RANDO type phantom. The different options is shown. Causes of discrepancies are analyzed and recommendations are made for the use of data acquisitions options

  14. Therapeutic treatment plan optimization with probability density-based dose prescription

    International Nuclear Information System (INIS)

    Lian Jun; Cotrutz, Cristian; Xing Lei

    2003-01-01

    The dose optimization in inverse planning is realized under the guidance of an objective function. The prescription doses in a conventional approach are usually rigid values, defining in most instances an ill-conditioned optimization problem. In this work, we propose a more general dose optimization scheme based on a statistical formalism [Xing et al., Med. Phys. 21, 2348-2358 (1999)]. Instead of a rigid dose, the prescription to a structure is specified by a preference function, which describes the user's preference over other doses in case the most desired dose is not attainable. The variation range of the prescription dose and the shape of the preference function are predesigned by the user based on prior clinical experience. Consequently, during the iterative optimization process, the prescription dose is allowed to deviate, with a certain preference level, from the most desired dose. By not restricting the prescription dose to a fixed value, the optimization problem becomes less ill-defined. The conventional inverse planning algorithm represents a special case of the new formalism. An iterative dose optimization algorithm is used to optimize the system. The performance of the proposed technique is systematically studied using a hypothetical C-shaped tumor with an abutting circular critical structure and a prostate case. It is shown that the final dose distribution can be manipulated flexibly by tuning the shape of the preference function and that using a preference function can lead to optimized dose distributions in accordance with the planner's specification. The proposed framework offers an effective mechanism to formalize the planner's priorities over different possible clinical scenarios and incorporate them into dose optimization. The enhanced control over the final plan may greatly facilitate the IMRT treatment planning process

  15. Pre-planned versus unplanned decision making in the case of environmental decontamination

    International Nuclear Information System (INIS)

    Paschoa, A.S.; Tranjan Filho, A.

    2000-01-01

    Until a few years ago it was not usual to pre-plan realistic countermeasures directly related to a radiological emergency or a nuclear accident (RENA), mostly because the probability of occurrence of such events was considered to be too low for real concern. The Three Mile Island, Chernobyl and Goiania accidents, however, changed long accepted views of the decision making community throughout the world. Today, meetings are being held just to discuss how one can go about making decisions to face the problems that may occur in a number of RENAs. The present work will examine several well established scientifically based radiological criteria to be used in decision making processes concerning either radioactive decontamination following a severe RENA, or decommissioning procedures. Such criteria can certainly be used to select pre-planned countermeasures, but can also be helpful as guidance to decision makers when facing a choice of untested and unplanned options. Selected advantages and disadvantages of each criterion based option will be presented and briefly discussed, as, for example, the amount of radioactive waste produced vis-B-vis the risk (concentration or projected dose) level adopted in the decontamination procedures. In addition, non-scientific aspects will be brought into the discussion, because their social, economical, and political implications cannot be ignored by responsible decision makers. Uncertainties associated with both non-scientific aspects and scientifically based environmental and dosimetric models will also be examined for specific cases. (author)

  16. Strategic planning decision making using fuzzy SWOT-TOPSIS with reliability factor

    Science.gov (United States)

    Mohamad, Daud; Afandi, Nur Syamimi; Kamis, Nor Hanimah

    2015-10-01

    Strategic planning is a process of decision making and action for long-term activities in an organization. The Strengths, Weaknesses, Opportunities and Threats (SWOT) analysis has been commonly used to help organizations in strategizing their future direction by analyzing internal and external environment. However, SWOT analysis has some limitations as it is unable to prioritize appropriately the multiple alternative strategic decisions. Some efforts have been made to solve this problem by incorporating Multi Criteria Decision Making (MCDM) methods. Nevertheless, another important aspect has raised concerns on obtaining the decision that is the reliability of the information. Decision makers evaluate differently depending on their level of confidence or sureness in the evaluation. This study proposes a decision making procedure for strategic planning using SWOT-TOPSIS method by incorporating the reliability factor of the evaluation based on Z-number. An example using a local authority in the east coast of Malaysia is illustrated to determine the strategic options ranking and to prioritize factors in each SWOT category.

  17. Data for Participation and Participation as Data: Supporting Incremental Participatory Decision-Making in Urban Planning

    DEFF Research Database (Denmark)

    Ddamba, Joshua; Dittrich, Yvonne

    2015-01-01

    Current literature on urban planning explores how to use ICT to support citizen participation. Advances in open data and its possibility to easily represent data on maps, opens up new opportunities to support participation and decision making in urban projects. This article investigates how spatial...... process and the decisions that are part of it. The paper concludes with design implications for decision support for urban planning. In future research, the intention is to explore these implications in a Participatory Design process....... of an urban renewal project, the article investigates the use of structured and unstructured data for participation. The fieldwork is conducted using ethnographically inspired methods, based on participatory observations, interviews and document analysis. As a result, the incremental decisions, the resulting...

  18. Effective strategy making: Co-designing scenarios as a tool for effective strategic planning

    Directory of Open Access Journals (Sweden)

    Jan Vogelij

    2015-08-01

    Full Text Available Subject of this study For establishing main lines of their future development, governments on several levels of government prepare spatial development visions, for assessing individual plans and initiatives against the background of a desired direction of development. Such strategic visions help to avoid the necessity to start considering again and again the question which direction long-term development should take. The European Commission promotes making such development strategies, hoping this leads to innovation in the regions and increased competitiveness of Europe. More particularly, the Commission expects a substantial contribution to prosperity of the rich diversity of local characteristics as assets for the development and innovation of the European territory. This study aims to explore the factors for success of strategic spatial planning. Strategy making happens in the different circumstances in European countries, legally regulated or informally, using terms like: Structure plans, structural visions, master plans, development visions and spatial development strategies. Here the term (spatial development vision is used. The central question is: Which aspects of planning processes and place-related conditions support the effectiveness of strategy making? The processes of strategy making and the place related circumstances are intensively interrelated. The diversity of circumstances in the European countries is expressed in the different national and regional planning cultures. That includes the set of procedures, competencies, education of planners and other experts and their resulting attitudes towards strategy making. In a development strategy all interests of society come together. Therefore the constructive working together of representatives of different sectors and interest is key to the success. Because of this crucial issue, we distinguished between co-operation, as just contributing to someone else’s activity, co

  19. Integrated catchment modelling within a strategic planning and decision making process: Werra case study

    Science.gov (United States)

    Dietrich, Jörg; Funke, Markus

    Integrated water resources management (IWRM) redefines conventional water management approaches through a closer cross-linkage between environment and society. The role of public participation and socio-economic considerations becomes more important within the planning and decision making process. In this paper we address aspects of the integration of catchment models into such a process taking the implementation of the European Water Framework Directive (WFD) as an example. Within a case study situated in the Werra river basin (Central Germany), a systems analytic decision process model was developed. This model uses the semantics of the Unified Modeling Language (UML) activity model. As an example application, the catchment model SWAT and the water quality model RWQM1 were applied to simulate the effect of phosphorus emissions from non-point and point sources on water quality. The decision process model was able to guide the participants of the case study through the interdisciplinary planning and negotiation of actions. Further improvements of the integration framework include tools for quantitative uncertainty analyses, which are crucial for real life application of models within an IWRM decision making toolbox. For the case study, the multi-criteria assessment of actions indicates that the polluter pays principle can be met at larger scales (sub-catchment or river basin) without significantly compromising cost efficiency for the local situation.

  20. The use of condition monitoring information for maintenance planning and decision-making

    Energy Technology Data Exchange (ETDEWEB)

    Laakso, K.; Rosqvist, T. [VTT Industrial Systems (Finland); Paulsen, J.L. [Risoe National Lab., Roskilde (Denmark)

    2002-12-01

    A survey is presented outlining the use of condition monitoring information in three Nordic nuclear power plants. The questions of the survey relate to the role of condition monitoring in strategic, as well as operative, maintenance planning and decision-making. The survey indicates that condition monitoring is increasingly implemented at nuclear power plants, but very selectively and in a rather slow pace for predictive maintenance. A combined strategy of condition based maintenance and predetermined preventive maintenance is applied for important equipment such as main circulation pumps and steam turbines. A realistic aim is to reduce the number of costly or error prone maintenance and disassembling inspection activities by condition monitoring given that the approach enables a good diagnosis and prediction. Systematic follow-up and analysis of such condition monitoring information followed by a case-specific planning and decision making of timely and rightly directed maintenance actions can justify an extension of the intervals of a number of predetermined inspection, maintenance or periodic testing tasks. (au)

  1. An investigation of the effects of therapeutic touch plan on acute chemotherapy-induced nausea in women with breast cancer in Isfahan, Iran, 2012-2013.

    Science.gov (United States)

    Matourypour, Pegah; Zare, Zahra; Mehrzad, Valiolah; Musarezaie, Amir; Dehghan, Mojtaba; Vanaki, Zohre

    2015-01-01

    Nausea is the worst and most prevalent chemotherapy-induced complication experienced by 70-80% of patients despite mediation therapy. Reduction of nausea is one of the most important roles of oncologist nurses. Today, complementary therapies in addition to classic medicine, because of their lower costs, receive much attention. Nonetheless, their safety and effectiveness are not yet proven. The purpose of this research was to investigate the effect of therapeutic touch plan as a complementary therapy on acute nausea in women with breast cancer in 2012-2013 in Isfahan, Iran. A quasi-experimental, single-blind, randomized control trial with three groups (control, placebo and intervention) was performed at the Isfahan Seyedolshohada (AS) Teaching Hospital, Isfahan, in 2012-2013. The intervention was therapeutic touch plan on women with breast cancer, with the three groups receiving the same medicine regimen. Information was recorded by a checklist after infusion of chemotherapy drugs. Data analysis was performed by SPSS, ANOVA and Kruskal-Wallis tests. The ANOVA test showed that the therapeutic touch plan was significantly effective in reducing the duration of nausea compared with the control and placebo groups (P touch plan was significantly effective in delaying the onset of nausea compared with the control and placebo groups (P touch plan is effective in reducing acute chemotherapy-induced nausea; thus, education and implementation of the therapeutic touch plan is proposed for clinical nurses.

  2. An investigation of the effects of therapeutic touch plan on acute chemotherapy-induced nausea in women with breast cancer in Isfahan, Iran, 2012–2013

    Science.gov (United States)

    Matourypour, Pegah; Zare, Zahra; Mehrzad, Valiolah; Musarezaie, Amir; Dehghan, Mojtaba; Vanaki, Zohre

    2015-01-01

    Introduction: Nausea is the worst and most prevalent chemotherapy-induced complication experienced by 70–80% of patients despite mediation therapy. Reduction of nausea is one of the most important roles of oncologist nurses. Today, complementary therapies in addition to classic medicine, because of their lower costs, receive much attention. Nonetheless, their safety and effectiveness are not yet proven. The purpose of this research was to investigate the effect of therapeutic touch plan as a complementary therapy on acute nausea in women with breast cancer in 2012–2013 in Isfahan, Iran. Materials and Methods: A quasi-experimental, single-blind, randomized control trial with three groups (control, placebo and intervention) was performed at the Isfahan Seyedolshohada (AS) Teaching Hospital, Isfahan, in 2012–2013. The intervention was therapeutic touch plan on women with breast cancer, with the three groups receiving the same medicine regimen. Information was recorded by a checklist after infusion of chemotherapy drugs. Data analysis was performed by SPSS, ANOVA and Kruskal–Wallis tests. Results: The ANOVA test showed that the therapeutic touch plan was significantly effective in reducing the duration of nausea compared with the control and placebo groups (P touch plan was significantly effective in delaying the onset of nausea compared with the control and placebo groups (P touch plan is effective in reducing acute chemotherapy-induced nausea; thus, education and implementation of the therapeutic touch plan is proposed for clinical nurses. PMID:26430688

  3. Making Less Vulnerable Cities: Resilience as a New Paradigm of Smart Planning

    Directory of Open Access Journals (Sweden)

    Francesca Moraci

    2018-03-01

    Full Text Available Previous studies have investigated how resilience can play a pivotal role in strategic urban design in the Netherlands and in some regional and municipal planning laws in Italy. Here, we have analysed several European projects that utilised the resilience approach successfully. Dutch policies already include resilience and climate adaptation in urban strategies. Moreover, they share those strategies with urban communities, making the innovation of the city real and cutting-edge. In Italy, on the other hand, the concept of resilience is present only in some regional laws and is still not used as an urban tool. In this paper, we aim to demonstrate how resilience can become the new paradigm of smart planning. Furthermore, we demonstrate how resilience is fundamental at all levels of urban intervention, involving municipal authorities, architects and urban planners, firms and enterprises, citizens and communities. The urban governance must establish specific goals and objectives to create a smart and sustainable city. Resilience should be one of these main aims, in order to achieve an innovative city design. A climate strategy should also be part of urban smart planning, enabling the implementation of a safer and resilient city.

  4. A Production Planning Model for Make-to-Order Foundry Flow Shop with Capacity Constraint

    Directory of Open Access Journals (Sweden)

    Xixing Li

    2017-01-01

    Full Text Available The mode of production in the modern manufacturing enterprise mainly prefers to MTO (Make-to-Order; how to reasonably arrange the production plan has become a very common and urgent problem for enterprises’ managers to improve inner production reformation in the competitive market environment. In this paper, a mathematical model of production planning is proposed to maximize the profit with capacity constraint. Four kinds of cost factors (material cost, process cost, delay cost, and facility occupy cost are considered in the proposed model. Different factors not only result in different profit but also result in different satisfaction degrees of customers. Particularly, the delay cost and facility occupy cost cannot reach the minimum at the same time; the two objectives are interactional. This paper presents a mathematical model based on the actual production process of a foundry flow shop. An improved genetic algorithm (IGA is proposed to solve the biobjective problem of the model. Also, the gene encoding and decoding, the definition of fitness function, and genetic operators have been illustrated. In addition, the proposed algorithm is used to solve the production planning problem of a foundry flow shop in a casting enterprise. And comparisons with other recently published algorithms show the efficiency and effectiveness of the proposed algorithm.

  5. Combining ecosystem services assessment with structured decision making to support ecological restoration planning.

    Science.gov (United States)

    Martin, David M; Mazzotta, Marisa; Bousquin, Justin

    2018-04-10

    Accounting for ecosystem services in environmental decision making is an emerging research topic. Modern frameworks for ecosystem services assessment emphasize evaluating the social benefits of ecosystems, in terms of who benefits and by how much, to aid in comparing multiple courses of action. Structured methods that use decision analytic-approaches are emerging for the practice of ecological restoration. In this article, we combine ecosystem services assessment with structured decision making to estimate and evaluate measures of the potential benefits of ecological restoration with a case study in the Woonasquatucket River watershed, Rhode Island, USA. We partnered with a local watershed management organization to analyze dozens of candidate wetland restoration sites for their abilities to supply five ecosystem services-flood water retention, scenic landscapes, learning opportunities, recreational opportunities, and birds. We developed 22 benefit indicators related to the ecosystem services as well as indicators for social equity and reliability that benefits will sustain in the future. We applied conceptual modeling and spatial analysis to estimate indicator values for each candidate restoration site. Lastly, we developed a decision support tool to score and aggregate the values for the organization to screen the restoration sites. Results show that restoration sites in urban areas can provide greater social benefits than sites in less urban areas. Our research approach is general and can be used to investigate other restoration planning studies that perform ecosystem services assessment and fit into a decision-making process.

  6. Strategic Decision-making,Action Planning,Flexible Creation:A Philosophic Thinking on Chinese City Development

    Institute of Scientific and Technical Information of China (English)

    2010-01-01

    Based on the rich experience in urban construction in China for decades,the author argues that urban planning is a process of flexible creation under the guidance of strategic decision-making and action planning and in accordance with local conditions in hope of creating better human settlements and a harmonious society at the same time.Efforts should be made to strengthen the general knowledge and universal truth on urban planning and transform them into public consensus.

  7. Application of multi-criteria decision making to sustainable energy planning - a review

    Energy Technology Data Exchange (ETDEWEB)

    Pohekar, S.D.; Ramachandram, M. [Birla Inst. of Technology and Science, Pilani (India)

    2004-08-01

    Multi-Criteria Decision Making (MCDM) techniques are gaining popularity in sustainable energy management. The techniques provide solutions to the problems involving conflicting and multiple objectives. Several methods based on weighted averages, priority setting, outranking, fuzzy principles and their combinations are employed for energy planning decisions. A review of more than 90 published papers is presented here to analyze the applicability of various methods discussed. A classification on application areas and the year of application is presented to highlight the trends. It is observed that Analytical Hierarchy Process is the most popular technique followed by outranking techniques PROMETHEE and ELECTRE. Validation of results with multiple methods, development of interactive decision support systems and application of fuzzy methods to tackle uncertainties in the data is observed in the published literature. (author)

  8. A study of decision-making behavior of aircraft pilots deviating from a planned flight

    Science.gov (United States)

    Flather, G. W., II; Giffin, W. C.; Rockwell, T. H.

    1981-01-01

    This paper outlines an investigation into the worth structures of pilots facing a deviation from a planned flight. A 'paper and pencil' simulation was used to frame the situation into which pilots interjected their own decision making skills in a simple ranking of candidate diversion airports with varying locational, navigational aid, radar and weather attributes. Using the conjoint measurement technique, attribute worth functions of 30 pilots were constructed. It was discovered that systematic differences in the worth functions of the pilots did not occur as a result of dividing the pilot sample according to any measure of flight hour experience. However, differences were found when the pilot sample was grouped according to grade of pilot certificate, type of pilot training, and type of flying most commonly done.

  9. Hybrid production planning system in make-to-order company - case study

    Directory of Open Access Journals (Sweden)

    2010-12-01

    Full Text Available This paper presents hybrid production planning and shop floor control system in make-to-order manufacturing of complex products. It presents the general idea of multi-hybrid system and selected practical aspects of its creation and its implementation. The construction of this system is based on the planning and executive levels and main aspects of its integration and its support tools. The research was carried out in HCP S.A. Poznan (Diesel Engines and Generating Sets Factory. HCP S.A. Poznan is the producer of high-power marine engines. The lead-time of the final product manufacturing is between 9 months and 1 year, and takes about 40.000 hours per one engine. The main problems of this production system are high share of the work in progress and long lead-time, which, as a result, causes many expenses. The flow of material streams is extremely complex and represents "A-plant" class, according to V-A-T classification, including significant internal constraints ("bottlenecks".

  10. Analyzing and sense making of human factors in the Malaysian radiation and nuclear emergency planning framework

    Science.gov (United States)

    Hamid, A. H. A.; Rozan, M. Z. A.; Deris, S.; Ibrahim, R.; Abdullah, W. S. W.; Rahman, A. A.; Yunus, M. N. M.

    2016-01-01

    The evolution of current Radiation and Nuclear Emergency Planning Framework (RANEPF) simulator emphasizes on the human factors to be analyzed and interpreted according to the stakeholder's tacit and explicit knowledge. These human factor criteria are analyzed and interpreted according to the "sense making theory" and Disaster Emergency Response Management Information System (DERMIS) design premises. These criteria are corroborated by the statistical criteria. In recent findings, there were no differences of distributions among the stakeholders according to gender and organizational expertise. These criteria are incrementally accepted and agreed the research elements indicated in the respective emergency planning frameworks and simulator (i.e. 78.18 to 84.32, p-value <0.05). This paper suggested these human factors criteria in the associated analyses and theoretical perspectives to be further acomodated in the future simulator development. This development is in conjunction with the proposed hypothesis building of the process factors and responses diagram. We proposed that future work which implies the additional functionality of the simulator, as strategized, condensed and concise, comprehensive public disaster preparedness and intervention guidelines, to be a useful and efficient computer simulation.

  11. Analyzing and sense making of human factors in the Malaysian radiation and nuclear emergency planning framework

    International Nuclear Information System (INIS)

    Hamid, A. H. A.; Rozan, M. Z. A.; Ibrahim, R.; Deris, S.; Abdullah, W. S. W.; Yunus, M. N. M.; Rahman, A. A.

    2016-01-01

    The evolution of current Radiation and Nuclear Emergency Planning Framework (RANEPF) simulator emphasizes on the human factors to be analyzed and interpreted according to the stakeholder’s tacit and explicit knowledge. These human factor criteria are analyzed and interpreted according to the “sense making theory” and Disaster Emergency Response Management Information System (DERMIS) design premises. These criteria are corroborated by the statistical criteria. In recent findings, there were no differences of distributions among the stakeholders according to gender and organizational expertise. These criteria are incrementally accepted and agreed the research elements indicated in the respective emergency planning frameworks and simulator (i.e. 78.18 to 84.32, p-value <0.05). This paper suggested these human factors criteria in the associated analyses and theoretical perspectives to be further acomodated in the future simulator development. This development is in conjunction with the proposed hypothesis building of the process factors and responses diagram. We proposed that future work which implies the additional functionality of the simulator, as strategized, condensed and concise, comprehensive public disaster preparedness and intervention guidelines, to be a useful and efficient computer simulation

  12. Analyzing and sense making of human factors in the Malaysian radiation and nuclear emergency planning framework

    Energy Technology Data Exchange (ETDEWEB)

    Hamid, A. H. A., E-mail: amyhamijah@gmail.com, E-mail: amyhamijah@nm.gov.my [Faculty of Computing, Universiti Teknologi Malaysia (UTM), Skudai, 81310 Johor Bahru, Johor (Malaysia); Universiti Malaysia Kelantan (UMK), Pengkalan Chepa, 16100 Kota Bharu, Kelantan (Malaysia); Rozan, M. Z. A., E-mail: drmohdzaidi@gmail.com; Ibrahim, R. [Faculty of Computing, Universiti Teknologi Malaysia (UTM), Skudai, 81310 Johor Bahru, Johor (Malaysia); Deris, S. [Universiti Malaysia Kelantan (UMK), Pengkalan Chepa, 16100 Kota Bharu, Kelantan (Malaysia); Abdullah, W. S. W.; Yunus, M. N. M. [Malaysian Nuclear Agency (NM), Bangi, 43000 Kajang, Selangor (Malaysia); Rahman, A. A. [Faculty of Medicine and Health Sciences, Universiti Putra Malaysia (UPM), 43400 Serdang, Selangor (Malaysia)

    2016-01-22

    The evolution of current Radiation and Nuclear Emergency Planning Framework (RANEPF) simulator emphasizes on the human factors to be analyzed and interpreted according to the stakeholder’s tacit and explicit knowledge. These human factor criteria are analyzed and interpreted according to the “sense making theory” and Disaster Emergency Response Management Information System (DERMIS) design premises. These criteria are corroborated by the statistical criteria. In recent findings, there were no differences of distributions among the stakeholders according to gender and organizational expertise. These criteria are incrementally accepted and agreed the research elements indicated in the respective emergency planning frameworks and simulator (i.e. 78.18 to 84.32, p-value <0.05). This paper suggested these human factors criteria in the associated analyses and theoretical perspectives to be further acomodated in the future simulator development. This development is in conjunction with the proposed hypothesis building of the process factors and responses diagram. We proposed that future work which implies the additional functionality of the simulator, as strategized, condensed and concise, comprehensive public disaster preparedness and intervention guidelines, to be a useful and efficient computer simulation.

  13. Adapting EVIAVE methodology as a planning and decision-making tool in Venezuela

    International Nuclear Information System (INIS)

    Zamorano, M.; Paolini, A.; Ramos, A.; Rodriguez, M.L.

    2009-01-01

    Landfills in Venezuela have serious problems regarding their location, design and operation. In fact, basic waste disposal is one of the main weaknesses of the municipal waste management in this country. The Venezuelan Ministry of Environment and Renewable Resources has studied and identified the negative impacts of operating landfills, but no program has been implemented to determine the cause-effect relation of these impacts or to design strategies to counteract with the serious environmental and health risks generated. This paper describes how EVIAVE methodology can be successfully used for landfill diagnosis, and shows how this type of landfill diagnosis was applied in Venezuela. For our research study, we carried out both a quantitative and qualitative evaluation of the environmental problems generated by 22 landfills in Venezuela. Our study was based on the following environmental indexes: Landfill Environment, Environmental Risk, Environmental Value, and Probability of Contamination. For the purposes of our study, it was first necessary to adapt EVIAVE to the legal system and social context in Venezuela. The results obtained confirmed the applicability of this methodology to Venezuelan landfills. EVIAVE was found to be an effective planning tool that provided crucial information for the development of action plans, which would improve landfill operation, and help make decisions pertaining to their closure, sealing and eventual recovery.

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

    Science.gov (United States)

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

    2016-01-01

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

  15. City-Level Energy Decision Making. Data Use in Energy Planning, Implementation, and Evaluation in U.S. Cities

    Energy Technology Data Exchange (ETDEWEB)

    Aznar, Alexandra [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Day, Megan [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Doris, Elizabeth [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Mathur, Shivani [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Donohoo-Vallett, Paul [U.S. Department of Energy, Washington, DC (United States)

    2015-07-08

    The Cities-LEAP technical report, City-Level Energy Decision Making: Data Use in Energy Planning, Implementation, and Evaluation in U.S. Cities, explores how a sample of cities incorporates data into making energy-related decisions. This report provides the foundation for forthcoming components of the Cities-LEAP project that will help cities improve energy decision making by mapping specific city energy or climate policies and actions to measurable impacts and results.

  16. Make

    CERN Document Server

    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.

  17. Feasibility of preference-driven radiotherapy dose treatment planning to support shared decision making in anal cancer

    DEFF Research Database (Denmark)

    Rønde, Heidi S; Wee, Leonard; Pløen, John

    2017-01-01

    PURPOSE/OBJECTIVE: Chemo-radiotherapy is an established primary curative treatment for anal cancer, but clinically equal rationale for different target doses exists. If joint preferences (physician and patient) are used to determine acceptable tradeoffs in radiotherapy treatment planning, multipl...... that preference-informed dose planning is feasible for clinical studies utilizing shared decision making....... dose plans must be simultaneously explored. We quantified the degree to which different toxicity priorities might be incorporated into treatment plan selection, to elucidate the feasible decision space for shared decision making in anal cancer radiotherapy. MATERIAL AND METHODS: Retrospective plans.......7%-points; (0.3; 30.6); p decision space available in anal cancer radiotherapy to incorporate preferences, although tradeoffs are highly patient-dependent. This study demonstrates...

  18. Home health nurse decision-making regarding visit intensity planning for newly admitted patients: a qualitative descriptive study.

    Science.gov (United States)

    Irani, Elliane; Hirschman, Karen B; Cacchione, Pamela Z; Bowles, Kathryn H

    2018-04-13

    Despite patients referred to home health having diverse and complex needs, it is unknown how nurses develop personalized visit plans. In this qualitative descriptive study, we interviewed 26 nurses from three agencies about their decision-making process to determine visit intensity and analyzed data using directed content analysis. Following a multifactorial assessment of the patient, nurses relied on their experience and their agency's protocols to develop the personalized visit plan. They revised the plan based on changes in the patient's clinical condition, engagement, and caregiver availability. Findings suggest strategies to improve visit planning and positively influence outcomes of home health patients.

  19. Summary and Recommendations from the National Cancer Institute's Clinical Trials Planning Meeting on Novel Therapeutics for Non-Muscle Invasive Bladder Cancer

    NARCIS (Netherlands)

    Lerner, S.P.; Bajorin, D.F.; Dinney, C.P.; Efstathiou, J.A.; Groshen, S.; Hahn, N.M.; Hansel, D.; Kwiatkowski, D.; O'Donnell, M.; Rosenberg, J.; Svatek, R.; Abrams, J.S.; Al-Ahmadie, H.; Apolo, A.B.; Bellmunt, J.; Callahan, M.; Cha, E.K.; Drake, C.; Jarow, J.; Kamat, A.; Kim, W.; Knowles, M.; Mann, B.; Marchionni, L.; McConkey, D.; McShane, L.; Ramirez, N.; Sharabi, A.; Sharpe, A.H.; Solit, D.; Tangen, C.M.; Amiri, A.T.; Allen, E. Van; West, P.J.; Witjes, J.A.; Quale, D.Z.

    2016-01-01

    The NCI Bladder Cancer Task Force convened a Clinical Trials Planning Meeting (CTPM) Workshop focused on Novel Therapeutics for Non-Muscle Invasive Bladder Cancer (NMIBC). Meeting attendees included a broad and multi-disciplinary group of clinical and research stakeholders and included leaders from

  20. The Planning Task for Teams (PLATT): An environment for research on planning and decision making in teams

    NARCIS (Netherlands)

    Kamphuis, W.; Houttuin, K.

    2007-01-01

    In this report, we introduce a newly developed task environment for experimental team research: the Planning Task for Teams (PLATT). PLATT is a scenario based, computerized, complex planning task for three-person teams. PLATT has been designed to be able to do experimental laboratory research on

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

    Directory of Open Access Journals (Sweden)

    Tetiana Kniazieva

    2017-12-01

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

  2. Decision making under uncertainty, therapeutic inertia, and physicians' risk preferences in the management of multiple sclerosis (DIScUTIR MS).

    Science.gov (United States)

    Saposnik, Gustavo; Sempere, Angel Perez; Raptis, Roula; Prefasi, Daniel; Selchen, Daniel; Maurino, Jorge

    2016-05-04

    The management of multiple sclerosis (MS) is rapidly changing by the introduction of new and more effective disease-modifying agents. The importance of risk stratification was confirmed by results on disease progression predicted by different risk score systems. Despite these advances, we know very little about medical decisions under uncertainty in the management of MS. The goal of this study is to i) identify whether overconfidence, tolerance to risk/uncertainty, herding influence medical decisions, and ii) to evaluate the frequency of therapeutic inertia (defined as lack of treatment initiation or intensification in patients not at goals of care) and its predisposing factors in the management of MS. This is a prospective study comprising a combination of case-vignettes and surveys and experiments from Neuroeconomics/behavioral economics to identify cognitive distortions associated with medical decisions and therapeutic inertia. Participants include MS fellows and MS experts from across Spain. Each participant will receive an individual link using Qualtrics platform(©) that includes 20 case-vignettes, 3 surveys, and 4 behavioral experiments. The total time for completing the study is approximately 30-35 min. Case vignettes were selected to be representative of common clinical encounters in MS practice. Surveys and experiments include standardized test to measure overconfidence, aversion to risk and ambiguity, herding (following colleague's suggestions even when not supported by the evidence), physicians' reactions to uncertainty, and questions from the Socio-Economic Panel Study (SOEP) related to risk preferences in different domains. By applying three different MS score criteria (modified Rio, EMA, Prosperini's scheme) we take into account physicians' differences in escalating therapy when evaluating medical decisions across case-vignettes. The present study applies an innovative approach by combining tools to assess medical decisions with experiments from

  3. Thinking about the patient's wishes: practical wisdom of discharge planning nurses in assisting surrogate decision-making.

    Science.gov (United States)

    Kageyama, Yoko; Asano, Midori

    2017-12-01

    The accelerating trend towards shorter hospital stays in Japan has made modes of decision-making essential for effective patient transition from the hospital to recuperation in the regional community, and the ageing of the population has brought a rise in surrogate decision-making by the families of patients lacking decision-making ('self-decision') capacity. To verbalise and elucidate the practical wisdom of discharge planning nurses by focusing on the perceptions and judgements, they apply in practice and describing their methodology in concrete terms. Participants were six discharge planning nurses and one person with previous experience as a discharge planning nurse, all working at discharge planning departments of acute care hospitals. Separate, semi-structured, interactive interviews were conducted with each participant. The study design was qualitative descriptive in form with qualitative content analysis. All participants provided written informed consent to participate in the study, which was approved by the study institution. Three concepts were extracted as the basis for discharge planning nurses' perception and judgement at acute care hospitals: working for mutual envisionment of the available postdischarge options; helping the family act as spokesperson(s) for the patient's wishes; and understanding the family inclusive of the patient as a relationship of strongly interaffecting interests. The practical wisdom of the nurse, working in mutual envisionment with the family, and collaborative decision-making through discussion with those who know the patient, leads to rational discharge assistance. © 2017 Nordic College of Caring Science.

  4. Male Involvement in Family Planning Decision Making in Ile-Ife ...

    African Journals Online (AJOL)

    Erah

    ORIGINAL RESEARCH ARTICLE. Male Involvement ... However, fertility and family planning research and .... design, employing both quantitative and qualitative research .... Table 2: Types of family planning methods known to male residents ...

  5. Application of System Dynamics model as decision making tool in urban planning process toward stabilizing carbon dioxide emissions from cities

    International Nuclear Information System (INIS)

    Fong, Wee-Kean; Matsumoto, Hiroshi; Lun, Yu-Fat

    2009-01-01

    In spite of the fact that cities are the main sources of CO 2 emissions, presently there are still no specific measures directly addressing the global warming issue in the urban planning process in Malaysia. The present study thus aims to shed new light in the urban planning sector in Malaysia by adopting System Dynamics Model as one of the decision making tools in the urban planning process, with specific considerations on the future CO 2 emission trends. This paper presented projections of future CO 2 emission trends based on the case of Iskandar Development Region of Malaysia, under various options of urban policies, using the System Dynamics Model. The projections demonstrated the capability of the said model in serving as a decision making tool in the urban planning process, with specific reference to CO 2 emissions from cities. Recommendations have been made on the possible approach of adopting the model in the process of Structure Plan study. If the current model was successfully adopted in the urban planning process in Malaysia, it will mark the first step for Malaysia in taking specific considerations on the issues of CO 2 emissions and global warming in the urban planning process. (author)

  6. Indigenous Perspectives and Knowledge Informing Freshwater Management, Planning and Decision Making in Aotearoa-New Zealand

    Science.gov (United States)

    Harmsworth, G.

    2017-12-01

    Indigenous Māori have distinct cultural values and perspectives that establish their identity, responsibilities, and rights to manage and use freshwater in New Zealand. Recognition of the 1840 Treaty of Waitangi and its principles has culminated in an array of modern legislation, obligations, national policy statements, statutory requirements, holistic frameworks, and approaches that strengthens Māori participation and authority in resource management and environmental decision-making. We briefly explain indigenous Māori frameworks, knowledge, values, and perspectives used to grow indigenous research and capability, enrich western scientific research, and inform freshwater planning, policy, and management. We will discuss some important methods, indicators, and tools that Māori have developed, or are developing, to support environmental assessment and the monitoring and reporting of freshwater ecosystems, particularly to help sustain and enhance customary values and practice. These tools include, for example, the Cultural Health Index, the Wai Ora Wai Māori assessment tool, the mauri compass, the mauri model, Māori wetlands assessment, kaitiaki tools, taonga assessment, which are being used to build Māori capability and capacity in freshwater sciences and management and to provide innovative approaches based on integrative knowledge systems. Many of these indigenous-led initiatives are now being used next to science and technical approaches at local, regional, and national scale in New Zealand to guide policy and help understand complex and dynamic human-environmental interactions. Māori epistemologies provide a holistic worldview well aligned with current international thinking and approaches that stress the importance of systems thinking and understanding interconnections between sub-component parts; exploring the world and universe within holistic, integrative frameworks; taking into account different perspectives, values, and worldviews, measuring

  7. Planning versus action: Different decision-making processes predict plans to change one's diet versus actual dietary behavior.

    Science.gov (United States)

    Kiviniemi, Marc T; Brown-Kramer, Carolyn R

    2015-05-01

    Most health decision-making models posit that deciding to engage in a health behavior involves forming a behavioral intention which then leads to actual behavior. However, behavioral intentions and actual behavior may not be functionally equivalent. Two studies examined whether decision-making factors predicting dietary behaviors were the same as or distinct from those predicting intentions. Actual dietary behavior was proximally predicted by affective associations with the behavior. By contrast, behavioral intentions were predicted by cognitive beliefs about behaviors, with no contribution of affective associations. This dissociation has implications for understanding individual regulation of health behaviors and for behavior change interventions. © The Author(s) 2015.

  8. Enhancing Transportation Equity Analysis for Long Range Planning and Decision Making

    OpenAIRE

    Bills, Tierra Suzan

    2013-01-01

    Metropolitan Planning Organizations (MPOs) regularly perform equity analyses for their long-range transportation plans, as this is required by Environmental Justice regulations. These regional-level plans may propose hundreds of transportation infrastructure and policy changes (e.g. highway and transit extensions, fare changes, pricing schemes, etc.) as well as land-use policy changes. The challenge is to assess the distribution of impacts from all the proposed changes across different popula...

  9. Geospatial Analysis Platform and tools: supporting planning and decision making across scales, borders, sectors and disciplines

    CSIR Research Space (South Africa)

    Naude, AH

    2008-04-01

    Full Text Available observation and geospatial analysis technologies, as well as the associated need for spatially explicit and sectorally integrated growth and development plans (including plans that deal with multi-scale or cross-border issues), the required statistical... planning. This requires planning and analysis that can (1) facilitate the sharing of spatial and other data, (2) deal with multi-scale or cross-border issues, as well as can (3) support the understanding of patterns and inter-regional dynamics at regional...

  10. Business owner and manager’s attitudes towards financial decision-making and strategic planning: Evidence from Croatian SMEs

    Directory of Open Access Journals (Sweden)

    Marina Klačmer Čalopa

    2017-01-01

    Full Text Available The main goal of the paper was to explore the attitude of business owners and managers in the small and medium sized companies (SMEs in Croatia toward financial decision-making and strategic planning. In addition, it is attempted to identify managers’ styles and entrepreneurial skills, as well as the level of their financial knowledge. Data was gathered using online questionnaire method and analyzed with standard tools of descriptive statistics. The research sample consisted of 106 respondents from SMEs in Croatia (14% response rate. Research results reveal that business owners and managers are concerned about financial results but, unfortunately, do not influence the financial decision-making in all of its stages. The study could contribute to a better understanding of attitudes of Croatian SMEs business owners and managers toward financial decision-making and strategic planning.

  11. Realizing block planning concepts in make-and-pack production using MILP modelling and SAP APO

    DEFF Research Database (Denmark)

    Günther, H.O.; Grunow, M.; Neuhaus, U.

    2006-01-01

    of a major producer of hair dyes as a case study. We present two different implementations of the block planning concept. One utilizes the Production Planning/Detailed Scheduling module of the SAP APO© software. The other approach is based on a mixed-integer linear programming formulation. In contrast...

  12. Ethical Decision Making in Academic Dishonesty with Application of Modified Theory of Planned Behavior: A Review

    Science.gov (United States)

    Meng, Chan Ling; Othman, Jamilah; D'Silva, Jeffrey Lawrence; Omar, Zoharah

    2014-01-01

    This conceptual paper studies the application of the Theory of Planned Behavior (TBP) in academic dishonesty with the mediating variable of ethical ideologies. The study reviews literature on the Theory of Planned Behavior and past studies pertaining to academic dishonesty. The paper analyses the relationship of the variables of TPB on academic…

  13. Making the Most of What We Have Got: Enhancing the RADAR Repository to Support Research Planning

    Science.gov (United States)

    Pike, Dawn; Siminson, Nicola Jane

    2017-01-01

    This article discusses how RADAR, the institutional repository (IR) at the Glasgow School of Art (GSA), has been modified to house an Annual Research Planning (ARP) template. A case study on the implementation of this research planning tool will outline the role that a repository and its staff can play in supporting individuals, enhancing…

  14. Innovations in emergency response plans : making the useful application of the 2007 CDA guidelines for emergency response plans

    Energy Technology Data Exchange (ETDEWEB)

    Stevenson, A.J. [Columbia Power Corp., Castlegar, BC (Canada)

    2008-07-01

    Columbia Power Corporation (CPC) changed its perspective and approach to emergency response plans (ERP) between 2002 and 2007 from one of administrative necessity to one of important functional reference. The new 2007 Canadian Dam Association Guidelines helped facilitate that transition for both CPC and all dam owners. As part of the licensing requirements for its new facility, CPC had an ERP commissioned and developed in 2002. A potential dam safety event occurred in 2004, which necessitated the need for the ERP to be put to use. However, at the time, it was found to be lacking in functionality for field personnel. As a result, CPC recognized the significance of having a functional ERP for field staff and undertook a substantial redraft between 2005 and 2007. This paper discussed the development of the ERP with particular reference to assessing the top potential emergency scenarios for the facility; development of response plans for the identified scenarios; a flow chart to guide personnel through the required actions; response checklist; detailed inspection checklists and any required forms, photos or specific information. It was concluded that the new ERP has been well received and has improved facility awareness and emergency preparedness. 1 ref., 2 figs.

  15. MULTIPLE CRITERIA DECISION MAKING IN STRATEGIC PLANNING OF TABLE EGG PRODUCTION

    Directory of Open Access Journals (Sweden)

    Ana Crnčan

    2016-06-01

    Full Text Available The main research objective was to analyze and evaluate different systems of table egg production by using the multiple criteria analysis, the method of Analytic Hierarchy Process (AHP in decision making within strategic planning of production. The survey involved 79 producers of table eggs registered in the Records on laying hens’ farms in the Republic of Croatia. In the first stage, the research defined the criteria and sub-criteria for system evaluation which were compared in pairs in order to determine the weight or importance for each of them. Alternatives were evaluation based on definition of priorities of examinees and the extent to which they meet each of the defined criteria and sub-criteria. Intensity of examinees’ preferences were entered into the Expert Choice software in order to evaluate ranking results of egg production systems. Defined model consisted of a quantitative criterion of economic indicators, and the other two referred to qualitative criteria, market indicators and technical-technological factors. Each criterion had its corresponding sub-criteria that were evenly distributed in numerical order. Based on individual assessments of the examinees, overall cumulative evaluation was obtained for the table egg production systems. Accordingly, the most acceptable alternative to egg production is the indoor keeping system (priority 0.301. It is followed by the free-range system of keeping laying hens (priority 0.253. The third-ranked alternative is egg production by hens kept in conventional cages (priority 0.226, while the fourth-ranked least acceptable alternative, as of the total evaluation, is the ecological system of egg production (priority 0.220. Taking into account the obtained results of multiple criteria evaluation as well as EU and world trends in changing consumers’ habits including food safety and quality as well as customers’ preferences towards local market and local products, it is recommended that eggs

  16. The anaemia control model: Does it help nephrologists in therapeutic decision-making in the management of anaemia?

    Science.gov (United States)

    Bucalo, María Laura; Barbieri, Carlo; Roca, Susana; Ion Titapiccolo, Jasmine; Ros Romero, Maria Soledad; Ramos, Rosa; Albaladejo, Mercedes; Manzano, Diana; Mari, Flavio; Molina, Manuel

    2018-06-03

    Anaemia is common in haemodialysis patients and treating it with erythropoiesis-stimulating agents (ESAs) is complex due to many factors. To assess the usefulness of the Anaemia Control Model (ACM) in the treatment of anaemia in haemodialysis. ACM is a software that predicts the optimal dose of darbepoetin and iron sucrose to achieve target haemoglobin (Hb) and ferritin levels, and makes prescription suggestions. Study conducted in dialysis clinics lasting 18months with two intervention phases (IPs) with ACM (IP1, n:213; IP2, n:218) separated by a control phase (CP, n:219). The primary outcome was the percentage of Hb in range and the median dose of ESAs, and the secondary outcomes were transfusion, hospitalisation and cardiovascular events. Clinical and patient analyses were performed. Hb variability was assessed by the standard deviation (SD) of the Hb. We also analysed the patients with most of the suggestions confirmed (ACM compliant group). ACM increased the percentage of Hb in range: 80.9% in IP2, compared with 72.7% in the CP and reduced the intake of darbepoetin (IP1: 20 [70]; CP 30 [80] μg P=0.032) with less Hb fluctuation (0.91±0.49 in the CP to 0.82±0.37g/dl in IP2, P<0.05), improving in the ACM compliant group. The secondary outcomes decreased with the use of ACM. ACM helps to obtain better anaemia results in haemodialysis patients, minimising the risks of treatment with ESAs and reducing costs. Copyright © 2018 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All rights reserved.

  17. An Interactive Strategy for Solving Multi-Criteria Decision Making of Sustainable Land Revitalization Planning Problem

    Science.gov (United States)

    Mayasari, Ruth; Mawengkang, Herman; Gomar Purba, Ronal

    2018-02-01

    Land revitalization refers to comprehensive renovation of farmland, waterways, roads, forest or villages to improve the quality of plantation, raise the productivity of the plantation area and improve agricultural production conditions and the environment. The objective of sustainable land revitalization planning is to facilitate environmentally, socially, and economically viable land use. Therefore it is reasonable to use participatory approach to fullfil the plan. This paper addresses a multicriteria decision aid to model such planning problem, then we develop an interactive approach for solving the problem.

  18. Cognitive Biases and Structural Failures in United States Foreign Policy: Explaining Decision-Making Dissonance in Phase IV Policy and Plans for Iraq

    National Research Council Canada - National Science Library

    Hafner, Ferinand

    2007-01-01

    .... This thesis applies four decision-making perspectives the rational actor, organizational process, bureaucratic politics, and individual level approaches to the Phase IV planning process to analyze...

  19. Strategic Aspects of Nuclear and Radiological Emergency Management. Planning for Effective Decision Making; Consequence Management and Transition to Recovery

    International Nuclear Information System (INIS)

    2010-01-01

    The collective experience of the NEA Working Party on Nuclear Emergency Matters (WPNEM), and in particular, the experience from the International Nuclear Emergency Exercise (INEX) series, has shown that it is important to plan and to implement emergency response actions based on a guiding strategic vision. Within this context, Strategic Aspects of Nuclear and Radiological Emergency Management presents a framework of strategic planning elements to be considered by national emergency management authorities when establishing or enhancing processes for decision making, and when developing or implementing protection strategies. The focus is on nuclear or radiological emergency situations leading to complex preparedness and response conditions, involving multiple jurisdictions and significant international interfaces. The report is aimed at national emergency management authorities, international organisations and those who are seeking to improve the effectiveness of emergency management. Its goal is to provide insights into decision-making processes within existing emergency planning arrangements. It also highlights common areas of good practice in decision making. Specific areas for improvement, identified during the INEX-3 consequence management exercise, are included, particularly in support of decision making for countermeasures for consequence management and the transition to recovery. (authors)

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

    Directory of Open Access Journals (Sweden)

    Dagmar Elfriede Rinnenburger

    2012-01-01

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

  1. Stakeholder Attitudes, Knowledge and Engagement in Local Road Systems Planning and Decision Making

    Science.gov (United States)

    2017-10-01

    Political and policy dynamics associated with local road systems planning, management, and financing merit special attention. This study: 1) analyzes stakeholder attitudes, knowledge, and engagement about financing for local road system management, t...

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

    Science.gov (United States)

    2013-07-01

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

  3. Making ITS/CVO happen : Pennsylvania's ITS/CVO business plan

    Science.gov (United States)

    1998-12-31

    This business plan will be used to coordinate the deployment of CVO technologies in Pennsylvania. It provides a 'roadmap' for Pennsylvania's ITS/CVO program by defining broad goals and objectives, as well as specific projects, milestones, responsibil...

  4. Does natural gas make sense for freight? Environmental and resource implications of the "Pickens Plan".

    Science.gov (United States)

    2013-04-01

    The Pickens Plan is a highly promoted U.S. energy strategy, proposing to use natural gas as a transportation fuel to : displace imported oil and, simultaneously, to increase renewable contributions to national electricity production. While the ...

  5. Business plan as a source of information for making business decisions

    Directory of Open Access Journals (Sweden)

    Boškov Veronika

    2016-01-01

    Full Text Available For the successful development and business support, it is necessary to inform all interested parties about the structure of the transaction, future development plans, the resources needed for the realization, the effects which we plan to achieve and of course financial outcomes that will follow from that job. The business plan is important precondition for starting any business venture, as well as for realisation of that business. Modern business conditions are characterized by intensive changes in the market, strong competition and increasingly demanding customers. Modern business involves meticulous market research and the possibility of profitable use of capital, which is achieved through the simulation of a business plan. It could be said that a business plan is a map of activities for developing business ideas, with all the necessary activities and resources - a map that has been tested and tested/checked first on paper. The business plan does not guarantee the company success, but is definitely a secure way to increase the likelihood of success and present a set of projected activities through the relevant, understandable and accurate information. The results of these activities are appeling to all stakeholders and motivate them to achieve set goals.

  6. Planning bridges the intention-behaviour gap: age makes a difference and strategy use explains why.

    Science.gov (United States)

    Reuter, Tabea; Ziegelmann, Jochen P; Wiedemann, Amelie U; Lippke, Sonia; Schuz, Benjamin; Aiken, Leona S

    2010-09-01

    This study examines age-differential association patterns between intentions, planning and physical activity in young and middle-aged individuals. The effectiveness of planning to bridge the intention-behaviour gap is assumed to increase with advancing age. We explore the use of behaviour change strategies that include selection, optimisation and compensation (SOC) as underlying mechanisms for age differences. In N = 265 employees of a national railway company (aged 19-64 years), intentions, planning, SOC strategy use and physical activity were assessed at baseline (Time 1) and again 1 month later (Time 2). Hypotheses were tested in two different path models. Age moderates the extent to which planning mediates the intention-behaviour relation due to an increasing strength of the planning-behaviour link. As a possible psychological mechanism for these age differences, we identified SOC strategy use as a mediator of the age by planning interaction effect on physical activity. These findings suggest differential mechanisms in behaviour regulation in young and middle-aged individuals.

  7. Metabolic Diseases Downregulate the Majority of Histone Modification Enzymes, Making a Few Upregulated Enzymes Novel Therapeutic Targets--"Sand Out and Gold Stays".

    Science.gov (United States)

    Shao, Ying; Chernaya, Valeria; Johnson, Candice; Yang, William Y; Cueto, Ramon; Sha, Xiaojin; Zhang, Yi; Qin, Xuebin; Sun, Jianxin; Choi, Eric T; Wang, Hong; Yang, Xiao-feng

    2016-02-01

    To determine whether the expression of histone modification enzymes is regulated in physiological and pathological conditions, we took an experimental database mining approach pioneered in our labs to determine a panoramic expression profile of 164 enzymes in 19 human and 17 murine tissues. We have made the following significant findings: (1) Histone enzymes are differentially expressed in cardiovascular, immune, and other tissues; (2) our new pyramid model showed that heart and T cells are among a few tissues in which histone acetylation/deacetylation, and histone methylation/demethylation are in the highest varieties; and (3) histone enzymes are more downregulated than upregulated in metabolic diseases and regulatory T cell (Treg) polarization/ differentiation, but not in tumors. These results have demonstrated a new working model of "Sand out and Gold stays," where more downregulation than upregulation of histone enzymes in metabolic diseases makes a few upregulated enzymes the potential novel therapeutic targets in metabolic diseases and Treg activity.

  8. Metabolic Diseases Downregulate the Majority of Histone Modification Enzymes, Making a Few Upregulated Enzymes Novel Therapeutic Targets – “Sand out and Gold Stays”

    Science.gov (United States)

    Shao, Ying; Chernaya, Valeria; Johnson, Candice; Yang, William Y.; Cueto, Ramon; Sha, Xiaojin; Zhang, Yi; Qin, Xuebin; Sun, Jianxin; Choi, Eric T.; Wang, Hong; Yang, Xiao-feng

    2016-01-01

    To determine whether the expression of histone modification enzymes is regulated in physiological and pathological conditions, we took an experimental database mining approach pioneered in our labs to determine a panoramic expression profile of 164 enzymes in 19 human and 17 murine tissues. We have made the following significant findings: 1) Histone enzymes are differentially expressed in cardiovascular, immune and other tissues; 2) Our new pyramid model showed that heart and T cells are among a few tissues in which histone acetylation/deacetylation, histone methylation/demethylation are in the highest varieties; and 3) Histone enzymes are more downregulated than upregulated in metabolic diseases and Treg polarization/differentiation, but not in tumors. These results have demonstrated a new working model of “sand out and gold stays,” where more downregulation than upregulation of histone enzymes in metabolic diseases makes a few upregulated enzymes the potential novel therapeutic targets in metabolic diseases and Treg activity. PMID:26746407

  9. Clinical Holistic Medicine: Factors Influencing The Therapeutic Decision-Making. From Academic Knowledge to Emotional Intelligence and Spiritual “Crazy” Wisdom

    Directory of Open Access Journals (Sweden)

    Søren Ventegodt

    2007-01-01

    Full Text Available Scientific holistic medicine is built on holistic medical theory, on therapeutic and ethical principles. The rationale is that the therapist can take the patient into a state of salutogenesis, or existential healing, using his skills and knowledge. But how ever much we want to make therapy a science it remains partly an art, and the more developed the therapist becomes, the more of his/her decisions will be based on intuition, feeling and even inspiration that is more based on love and human concern and other spiritual motivations than on mental reason and rationality in a simple sense of the word. The provocative and paradoxal medieval western concept of the “truth telling clown”, or the eastern concepts of “crazy wisdom” and “holy madness” seems highly relevant here. The problem is how we can ethically justify this kind of highly “irrational” therapeutic behavior in the rational setting of a medical institution. We argue here that holistic therapy has a very high success rate and is doing no harm to the patient, and encourage therapists, psychiatrists, psychologist and other academically trained “helpers” to constantly measure their own success-rate. This paper discusses many of the important factors that influence clinical holistic decision-making. Sexuality could, as many psychoanalysts from Freud to Reich and Searles have believed, be the most healing power that exists and also the most difficult for the mind to comprehend, and thus the most “crazy-wise” tool of therapy.

  10. The Role of Heuristic Methods as a Decision-Making Tool in Aggregate Production Planning

    OpenAIRE

    Mahmood B. Ridha

    2015-01-01

    This study aims to explain the role of heuristic methods in the decision making process and as a tool for knowledge capture. As a result, we conclude that heuristic methods give better support to the decision maker than mathematical models in many cases especially when time and cost are critical factors in decision making.

  11. Marine Spatial Planning Makes Room for Offshore Aquaculture in a Crowded Coastal Zone

    Science.gov (United States)

    Stevens, J.

    2016-12-01

    Offshore aquaculture is an emerging industry predicted to contribute significantly to global seafood production and food security. However, aquaculture farms can generate conflicts by displacing existing ocean user groups and impacting ecosystems. Further, there are multiple farm types with different seafood species, productivity levels and impacts. Thus, it is important to strategically and simultaneously plan farm type and location in relation to the seascape in order to most effectively maximize aquaculture value while also minimizing conflicts and environmental impacts. We address this problem and demonstrate the value of multi-objective planning with a case study that integrates bioeconomic modeling with ecosystem service tradeoff analysis to inform the marine spatial planning (MSP) of mussel, finfish and kelp aquaculture farms in the already-crowded Southern California Bight (SCB) ecosystem. We considered four user groups predicted to conflict with or be impacted by the three types of aquaculture: wild-capture fisheries, ocean viewshed from coastal properties, marine benthic habitat protection, and risk of disease outbreak between farms. Results indicate that significant conflicts and impacts, expected under conventional planning, can be reduced by strategic planning. For example, 28% of potential mussel farm sites overlap with wild-capture halibut fishery grounds, yet MSP can enable mussel aquaculture to generate up to a third of its total potential industry value without impacting halibut fishery yield. Results also highlight hotspot areas in the SCB most appropriate for each type of aquaculture under MSP, as well as particular mussel, finfish and kelp aquaculture spatial plans that align with legislative regulations on allowable impacts from future aquaculture farms in California. This study comprehensively informs aquaculture farm design in the SCB, and demonstrates the value of multi-objective simultaneous planning as a key component in MSP.

  12. Planning ahead in public health? A qualitative study of the time horizons used in public health decision-making.

    Science.gov (United States)

    Taylor-Robinson, David C; Milton, Beth; Lloyd-Williams, Ffion; O'Flaherty, Martin; Capewell, Simon

    2008-12-18

    In order to better understand factors that influence decisions for public health, we undertook a qualitative study to explore issues relating to the time horizons used in decision-making. Qualitative study using semi-structured interviews. 33 individuals involved in the decision making process around coronary heart disease were purposively sampled from the UK National Health Service (national, regional and local levels), academia and voluntary organizations. Analysis was based on the framework method using N-VIVO software. Interviews were transcribed, coded and emergent themes identified. Many participants suggested that the timescales for public health decision-making are too short. Commissioners and some practitioners working at the national level particularly felt constrained in terms of planning for the long-term. Furthermore respondents felt that longer term planning was needed to address the wider determinants of health and to achieve societal level changes. Three prominent 'systems' issues were identified as important drivers of short term thinking: the need to demonstrate impact within the 4 year political cycle; the requirement to 'balance the books' within the annual commissioning cycle and the disruption caused by frequent re-organisations within the health service. In addition respondents suggested that the tools and evidence base for longer term planning were not well established. Many public health decision and policy makers feel that the timescales for decision-making are too short. Substantial systemic barriers to longer-term planning exist. Policy makers need to look beyond short-term targets and budget cycles to secure investment for long-term improvement in public health.

  13. Improving rural electricity system planning: An agent-based model for stakeholder engagement and decision making

    International Nuclear Information System (INIS)

    Alfaro, Jose F.; Miller, Shelie; Johnson, Jeremiah X.; Riolo, Rick R.

    2017-01-01

    Energy planners in regions with low rates of electrification face complex and high-risk challenges in selecting appropriate generating technologies and grid centralization. To better inform such processes, we present an Agent-Based Model (ABM) that facilitates engagement with stakeholders. This approach evaluates long-term plans using the cost of delivered electricity, resource mix, jobs and economic stimulus created within communities, and decentralized generation mix of the system, with results provided in a spatially-resolved format. This approach complements existing electricity planning methods (e.g., Integrated Resource Planning) by offering novel evaluation criteria based on typical stakeholder preferences. We demonstrate the utility of this approach with a case study based on a “blank-slate” scenario, which begins without generation or transmission infrastructure, for the long-term rural renewable energy plans of Liberia, West Africa. We consider five electrification strategies: prioritizing larger populations, deploying large resources, creating jobs, providing economic stimulus, and step-wise cost minimization. Through the case study we demonstrate how this approach can be used to engage stakeholders, supplement more established energy planning tools, and illustrate the effects of stakeholder decisions and preferences on the performance of the system. - Highlights: • An Agent Based Model, BABSTER, for electrification planning is presented. • BABSTER provides a highly engaging spatially resolved interface. • Allows flexible investigation of decision strategies with real-world incentives. • We show that decision strategies directly impact centralization and resource choice. • It is illustrated through the case study of Liberia, West Africa.

  14. Making Strategic Planning Work in Local Government: An Empirical Study of Success And Failure

    Directory of Open Access Journals (Sweden)

    Ángel IGLESIAS

    2015-10-01

    Full Text Available Since the 1990s, local governments all over Europe have launched reforms to improve local democracy, public management and efficiency in the provision of local services. Some of these reforms are inspired by what previously has worked in private management and some of them have also a macro-level approach, whose main aim is to introduce institutional reforms and reorganizations to ensure contextual problem solving by strengthening governance within the local public sector. In this context, Strategic Planning in public organizations has attracted interest among academic researchers and practitioners as an instrument for dealing with a complex environment and for the achievement of higher performance and the attainment of greater democracy. But the decision on how to introduce Strategic Planning might follow a different rationale. The hypothesis maintained in this paper is that those that are based in an endogenous rationale are more likely to succeed. To test our hypothesis this paper draws on a comparative empirical analysis concerning the design and implementation of a Strategic Planning process within two Spanish city governments: one considered to have been a failure and the other a success. Focusing on the way in which the use of Strategic Planning has to face the trade-offs between urban and economic development and democracy, the paper explores how this formal mechanism of citizen´s and business’ participation serves to establish relational processes to reinvigorate local economic development, democracy and administrative modernization only when a strong political and administrative leadership is put into motion. Overall, the study yields evidence consistent with the notion that a successful Strategic Planning at the local level has to take into account not only institutional issues, but also the communal, social and political resources that frame the deliberations propelled by the Strategic Planning process.

  15. Graves' disease. Manifestations and therapeutic options

    International Nuclear Information System (INIS)

    McFarland, K.F.; Saleeby, G.

    1988-01-01

    Graves' disease is the most common cause of hyperthyroidism. Clinical features include thyroid enlargement, eye signs, tachycardia, heat intolerance, emotional lability, weight loss, and hyperkinesis. Three modes of therapy are available. The preferences of the patient and physician are usually prime considerations in devising the therapeutic plan. Radioactive iodine is the most frequently used and safest method of treatment for adults. Antithyroid drugs are preferred for children and pregnant women. Surgery is usually reserved for patients in whom the other forms of treatment are not acceptable. Considerable patient education during the decision-making process enhances the success of the therapeutic plan

  16. Solving complex maintenance planning optimization problems using stochastic simulation and multi-criteria fuzzy decision making

    International Nuclear Information System (INIS)

    Tahvili, Sahar; Österberg, Jonas; Silvestrov, Sergei; Biteus, Jonas

    2014-01-01

    One of the most important factors in the operations of many cooperations today is to maximize profit and one important tool to that effect is the optimization of maintenance activities. Maintenance activities is at the largest level divided into two major areas, corrective maintenance (CM) and preventive maintenance (PM). When optimizing maintenance activities, by a maintenance plan or policy, we seek to find the best activities to perform at each point in time, be it PM or CM. We explore the use of stochastic simulation, genetic algorithms and other tools for solving complex maintenance planning optimization problems in terms of a suggested framework model based on discrete event simulation

  17. Making Dreams, Not Babies: The Power of Hope in a Teen Family Planning Clinic.

    Science.gov (United States)

    Raines, Kimberly

    2018-04-01

    Teenage pregnancy is a signifi cant social issue in the United States, resulting in increased levels of poverty. Most public health family planning efforts have traditionally focused on teaching teens the how-to of contraception, with little focus on teaching the why-to. During my time as a nurse practitioner in a public health department family planning clinic, I developed a method to open discussions with patients about the possibilities of a future that includes delayed childbearing. My experience with this strategy taught me that hope may indeed be the most powerful contraceptive of all.

  18. Making dreams, not babies: the power of hope in a teen family planning clinic.

    Science.gov (United States)

    Raines, Kimberly

    2009-01-01

    Teenage pregnancy is a significant social issue in the United States, resulting in increased levels of poverty. Most public health family planning efforts have traditionally focused on teaching teens the how-to of contraception, with little focus on teaching the why-to. During my time as a nurse practitioner in a public health department family planning clinic, I developed a method to open discussions with patients about the possibilities of a future that includes delayed childbearing. My experience with this strategy taught me that hope may indeed be the most powerful contraceptive of all.

  19. Solving complex maintenance planning optimization problems using stochastic simulation and multi-criteria fuzzy decision making

    Energy Technology Data Exchange (ETDEWEB)

    Tahvili, Sahar [Mälardalen University (Sweden); Österberg, Jonas; Silvestrov, Sergei [Division of Applied Mathematics, Mälardalen University (Sweden); Biteus, Jonas [Scania CV (Sweden)

    2014-12-10

    One of the most important factors in the operations of many cooperations today is to maximize profit and one important tool to that effect is the optimization of maintenance activities. Maintenance activities is at the largest level divided into two major areas, corrective maintenance (CM) and preventive maintenance (PM). When optimizing maintenance activities, by a maintenance plan or policy, we seek to find the best activities to perform at each point in time, be it PM or CM. We explore the use of stochastic simulation, genetic algorithms and other tools for solving complex maintenance planning optimization problems in terms of a suggested framework model based on discrete event simulation.

  20. Developing Optimized Treatment Plans for Patients with Dyslipidemia in the Era of Proprotein Convertase Subtilisin/Kexin Type 9 Inhibitor Therapeutics.

    Science.gov (United States)

    Underberg, James A; Blaha, Michael J; Jackson, Elizabeth J; Jones, Peter H

    2017-10-01

    This educational content was derived from a live satellite symposium at the American College of Physicians Internal Medicine Meeting 2017 in San Diego, California (online at http://courses.elseviercme.com/acp/702e). This activity will focus on optimized treatment plans for patients with dyslipidemia in the era of proprotein convertase subtilisin/kexin type 9 inhibitor therapeutics. Low-density lipoprotein cholesterol has been identified as an important therapeutic target to prevent the progression of atherosclerotic disease; however, only 1 of every 3 adults with high low-density lipoprotein cholesterol has the condition under control. Expert faculty on this panel will discuss the science of proprotein convertase subtilisin/kexin type 9 inhibitors and aid physicians in the best practices to achieve low-density lipoprotein cholesterol target in their patients. Copyright © 2017. Published by Elsevier Inc.

  1. How are people with dementia involved in care-planning and decision-making? An Irish social work perspective.

    Science.gov (United States)

    Donnelly, Sarah; Begley, Emer; O'Brien, Marita

    2018-01-01

    In recent years, there have been national and international policy advances around capacity and decision-making and an apparent burgeoning rights-based approach to the issue, all of which have the potential to impact on the experience for people with dementia in Ireland. There is little evidence however on whether these policies and principles are being translated into practice and whether traditional paternalistic approaches to decision-making are being challenged. To gain insight into current practice, research was undertaken with social workers working with older people in Ireland; reporting on the involvement of people living with dementia in care-planning processes. Data collection included a mixed method approach; an on-line survey of social workers from across the country who reported on their open caseload during the month of June 2015 (N = 38 social workers reporting on the experiences of 788 older people, of which 39% of older people had a formal diagnosis of dementia). In addition, semi-structured telephone interviews were conducted with social workers working in the nine Community Health Organisation areas (N = 21). Findings show that people with dementia were high users of social work services, accounting for 44.5% of the client group. Social workers reported that there were no standardised approaches to how Health and Social Care Professionals involved people with dementia in care planning and decision-making. Overall, people with dementia were more likely to be excluded from decision-making processes due to (i) assumptions that they lacked capacity, (ii) family members preferences that the person was not involved, (iii) communication difficulties, (iv) time constraints, (v) little or no opportunity given or (vi) the person delegated decision-making to others. Good practices were identified through multidisciplinary team approaches and formal care planning meetings. This research highlights variability in how people with dementia participate

  2. A Modeling Framework for Prognostic Decision Making and its Application to UAV Mission Planning

    Data.gov (United States)

    National Aeronautics and Space Administration — The goal of prognostic decision making (PDM) is to utilize information on anticipated system health changes in selecting future actions. One of the key challenges in...

  3. Making Plans against All Odds : LED in Small Towns of the Free ...

    African Journals Online (AJOL)

    Since the transition to democracy, there has been an increasing emphasis on local economic development (LED) in South Africa. The LED efforts in three small municipalities of the Free State Province are examined against the international framework for. LED planning and implementation. Often, LED is limited to ...

  4. "It was an Emotional Baby": Previvors' Family Planning Decision-Making Styles about Hereditary Breast and Ovarian Cancer Risk.

    Science.gov (United States)

    Dean, Marleah; Rauscher, Emily A

    2017-12-01

    Women who test positive for a BRCA genetic mutation are at an increased risk for developing hereditary breast and ovarian cancer and have a 50% chance of passing on their genetic mutation to their children. The purpose of this study was to investigate how women who test positive for a BRCA mutation but have not been diagnosed with cancer make decisions regarding family planning. Analysis of interviews with 20 women revealed they engage in logical and emotional decision-making styles. Although women want to be logical to reduce their hereditary cancer risk, emotions often complicate their decision-making. Women experience fear and worry about a future cancer diagnosis, yet also desire to create a family, particularly having children through natural conception. That is, women negotiate having preventative surgeries in a logical doctor-recommended timeframe but also organize those decisions around emotional desires of motherhood. Overall, this study demonstrates the complex decisions women who test positive for a BRCA mutation must make in regards to genetic testing timing, family planning, and overall quality of life.

  5. Tool path planning of hole-making operations in ejector plate of injection mould using modified shuffled frog leaping algorithm

    Directory of Open Access Journals (Sweden)

    Amol M. Dalavi

    2016-07-01

    Full Text Available Optimization of hole-making operations in manufacturing industry plays a vital role. Tool travel and tool switch planning are the two major issues in hole-making operations. Many industrial applications such as moulds, dies, engine block, automotive parts etc. requires machining of large number of holes. Large number of machining operations like drilling, enlargement or tapping/reaming are required to achieve the final size of individual hole, which gives rise to number of possible sequences to complete hole-making operations on the part depending upon the location of hole and tool sequence to be followed. It is necessary to find the optimal sequence of operations which minimizes the total processing cost of hole-making operations. In this work, therefore an attempt is made to reduce the total processing cost of hole-making operations by applying relatively new optimization algorithms known as shuffled frog leaping algorithm and proposed modified shuffled frog leaping algorithm for the determination of optimal sequence of hole-making operations. An industrial application example of ejector plate of injection mould is considered in this work to demonstrate the proposed approach. The obtained results by the shuffled frog leaping algorithm and proposed modified shuffled frog leaping algorithm are compared with each other. It is seen from the obtained results that the results of proposed modified shuffled frog leaping algorithm are superior to those obtained using shuffled frog leaping algorithm.

  6. Decision making, procedural compliance, and outcomes definition in U.S. forest service planning processes

    International Nuclear Information System (INIS)

    Stern, Marc J.; Predmore, S. Andrew

    2011-01-01

    The National Environmental Policy Act (NEPA) dictates a process of analyzing and disclosing the likely impacts of proposed agency actions on the human environment. This study addresses two key questions related to NEPA implementation in the U.S. Forest Service: 1) how do Interdisciplinary (ID) team leaders and decision makers conceptualize the outcomes of NEPA processes? And 2), how does NEPA relate to agency decision making? We address these questions through two separate online surveys that posed questions about recently completed NEPA processes - the first with the ID team leaders tasked with carrying out the processes, and the second with the line officers responsible for making the processes' final decisions. Outcomes of NEPA processes include impacts on public relations, on employee morale and team functioning, on the achievement of agency goals, and on the achievement of NEPA's procedural requirements (disclosure) and substantive intent (minimizing negative environmental impacts). Although both tended to view public relations outcomes as important, decision makers' perceptions of favorable outcomes were more closely linked to the achievement of agency goals and process efficiency than was the case for ID team leaders. While ID team leaders' responses suggest that they see decision making closely integrated with the NEPA process, decision makers more commonly decoupled decision making from the NEPA process. These findings suggest a philosophical difference between ID team leaders and decision makers that may pose challenges for both the implementation and the evaluation of agency NEPA. We discuss the pros and cons of integrating NEPA with decision making or separating the two. We conclude that detaching NEPA from decision making poses greater risks than integrating them.

  7. Decision making and planning of children in the reproductive process of males

    Directory of Open Access Journals (Sweden)

    Alejandra Salguero

    2009-10-01

    Full Text Available Reproduction is not restricted to the biological; it is also a complex and dynamic social process. The objective of this paper is to analyze the decision and planning of children as part of the reproductive process in men. Methodologically, a qualitative research was made. The analysis includes in-depth interviews with 30 parents between 20 and 45 years, of medium socio-economic level in México. The results show that the reproductive process incorporates family formation negotiated with their couple the marriage until they had economic potential. In some cases, their decision hastened because the couple was pregnant. The planning was not contemplated but when getting the news, they accept it and get involved in the process, while others see it as a conflict.

  8. Strategic foresight: how planning for the unpredictable can improve environmental decision-making.

    Science.gov (United States)

    Cook, Carly N; Inayatullah, Sohail; Burgman, Mark A; Sutherland, William J; Wintle, Brendan A

    2014-09-01

    Advanced warning of potential new opportunities and threats related to biodiversity allows decision-makers to act strategically to maximize benefits or minimize costs. Strategic foresight explores possible futures, their consequences for decisions, and the actions that promote more desirable futures. Foresight tools, such as horizon scanning and scenario planning, are increasingly used by governments and business for long-term strategic planning and capacity building. These tools are now being applied in ecology, although generally not as part of a comprehensive foresight strategy. We highlight several ways foresight could play a more significant role in environmental decisions by: monitoring existing problems, highlighting emerging threats, identifying promising new opportunities, testing the resilience of policies, and defining a research agenda. Copyright © 2014 Elsevier Ltd. All rights reserved.

  9. An Extension of Neutrosophic AHP–SWOT Analysis for Strategic Planning and Decision-Making

    OpenAIRE

    Mohamed Abdel-Basset; Mai Mohamed; Florentin Smarandache

    2018-01-01

    Every organization seeks to set strategies for its development and growth and to do this, it must take into account the factors that affect its success or failure. The most widely used technique in strategic planning is SWOT analysis. SWOT examines strengths (S), weaknesses (W), opportunities (O) and threats (T), to select and implement the best strategy to achieve organizational goals. The chosen strategy should harness the advantages of strengths and opportunities, handle weaknesses, and av...

  10. Probabilistic scenario-based decision making for water resources planning and management

    NARCIS (Netherlands)

    Dong, C.

    2014-01-01

    Uncertainty is an unavoidable part of decision making. Decisions always have to be made before perfect knowledge on their consequences is known. However, there is no ‘perfect knowledge’ in hindsight. To research uncertainty and take actions proactively becomes the challenge to scientists and

  11. Students' Ethical Decision-Making in an Information Technology Context: A Theory of Planned Behavior Approach

    Science.gov (United States)

    Riemenschneider, Cynthia K.; Leonard, Lori N. K.; Manly, Tracy S.

    2011-01-01

    Business educators have increased the focus on ethics in the classroom. In order for students to become ethical professionals, they must first be held to an ethical standard as students. As information technology continues to permeate every aspect of students' lives, it becomes increasingly important to understand student decision-making in this…

  12. Strategic enterprise resource planning in a health-care system using a multicriteria decision-making model.

    Science.gov (United States)

    Lee, Chang Won; Kwak, N K

    2011-04-01

    This paper deals with strategic enterprise resource planning (ERP) in a health-care system using a multicriteria decision-making (MCDM) model. The model is developed and analyzed on the basis of the data obtained from a leading patient-oriented provider of health-care services in Korea. Goal criteria and priorities are identified and established via the analytic hierarchy process (AHP). Goal programming (GP) is utilized to derive satisfying solutions for designing, evaluating, and implementing an ERP. The model results are evaluated and sensitivity analyses are conducted in an effort to enhance the model applicability. The case study provides management with valuable insights for planning and controlling health-care activities and services.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2006-07-01

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

  14. A Multi-Criteria Methodology to Support Public Administration Decision Making Concerning Sustainable Energy Action Plans

    Directory of Open Access Journals (Sweden)

    Chiara Novello

    2013-08-01

    Full Text Available For municipalities that have joined the Covenant of Mayors promoted by the European Commission, the Sustainable Energy Action Plan (SEAP represents a strategic tool for achieving the greenhouse gas reductions required by 2020. So far as the energy retrofit actions in their residential building stock are concerned, which in the small-to-medium municipalities are responsible for more than 60% of CO2 emissions, the scenarios for intervening are normally decided on the basis of an economic (cost/performance analysis. This type of analysis, however, does not take into account important aspects for small and medium-sized communities such as social aspects, environmental impacts, local economic development and employment. A more comprehensive and effective tool to support the choices of public administrators is the multi-criteria analysis. This study proposes a methodology that integrates multi-criteria analysis in order to support Public Administration/Local Authorities in programming Sustainable Energy Action Plans with a more targeted approach to sustainability. The methodology, based on the ELECTRE III method, was applied to a medium-size municipality in the Lombardy region of Italy. The results obtained with this approach are discussed in this paper.

  15. Adaptive management and environmental decision making. A case study application to water use planning

    International Nuclear Information System (INIS)

    Gregory, Robin; Failing, Lee; Higgins, Paul

    2006-01-01

    Adaptive management (AM) techniques are one of the principal tools proposed by environmental decision makers to provide flexible and responsive management approaches over time. However, the record of successful applications is surprisingly small. We believe that this in part reflects the lack of an intuitively plausible framework for evaluating AM initiatives. This paper outlines such a framework, based on the insights of decision analysis, for evaluating the use of AM as a technique to improve environmental management decisions. British Columbia's Water Use Plan (WUP) process, which has developed operating plans for more than 20 major hydroelectric facilities, is introduced as a case-study example. The discussion emphasizes that decisions to adopt adaptive management strategies involve judgments concerning tradeoffs across a variety of economic, environmental, and social objectives. As a result, adaptive management initiatives need to be carefully evaluated based on their merits relative to other alternatives. Within an AM framework, alternative experimental designs should be evaluated because the design of a preferred experiment involves choices among different levels of investment, the quality of available and desired future information, and different ecological, economic, and social risks. (author)

  16. Family planning and contraceptive decision-making by economically disadvantaged, African-American women

    Science.gov (United States)

    Hodgson, Eric J.; Collier, Charlene; Hayes, Laura; Curry, Leslie; Fraenkel, Liana

    2013-01-01

    Background Significant racial disparities exist in the US unplanned pregnancy rate. We conducted a qualitative study using the theory of planned behavior as a framework to describe how low-income, African-American women approach family planning. Study Design Structured focus groups were held with adult, low-income, non-pregnant, African-American women in Connecticut. Data were collected using a standardized discussion guide, and audio-taped and transcribed. Four, independent researchers coded the transcripts using the constant comparative method. Codes were organized into over-arching themes. Results Contraceptive knowledge was limited with formal education often occurring after sexual debut. Attitudes about contraception were overtly negative with method effectiveness being judged by the experience of side effects. Family and friends strongly influence contraceptive decisions while male partners are primarily seen as a barrier. Contraceptive pills are perceived as readily accessible although compliance is considered a barrier. Conclusions Contraception education should occur before sexual debut, should involve trusted family and community members, and should positively frame issues in terms of achieving life goals. PMID:23177266

  17. Effect on therapeutic ratio of planning a boosted radiotherapy dose to the dominant intraprostatic tumour lesion within the prostate based on multifunctional MR parameters

    Science.gov (United States)

    Payne, G S; deSouza, N M; Dearnaley, D; Morgan, V A; Morgan, S C; Partridge, M

    2014-01-01

    Objective: To demonstrate the feasibility of an 8-Gy focal radiation boost to a dominant intraprostatic lesion (DIL), identified using multiparametric MRI (mpMRI), and to assess the potential outcome compared with a uniform 74-Gy prostate dose. Methods: The DIL location was predicted in 23 patients using a histopathologically verified model combining diffusion-weighted imaging, dynamic contrast-enhanced imaging, T2 maps and three-dimensional MR spectroscopic imaging. The DIL defined prior to neoadjuvant hormone downregulation was firstly registered to MRI-acquired post-hormone therapy and subsequently to CT radiotherapy scans. Intensity-modulated radiotherapy (IMRT) treatment was planned for an 8-Gy focal boost with 74-Gy dose to the remaining prostate. Areas under the dose–volume histograms (DVHs) for prostate, bladder and rectum, the tumour control probability (TCP) and normal tissue complication probabilities (NTCPs) were compared with those of the uniform 74-Gy IMRT plan. Results: Deliverable IMRT plans were feasible for all patients with identifiable DILs (20/23). Areas under the DVHs were increased for the prostate (75.1 ± 0.6 vs 72.7 ± 0.3 Gy; p < 0.001) and decreased for the rectum (38.2 ± 2.5 vs 43.5 ± 2.5 Gy; p < 0.001) and the bladder (29.1 ± 9.0 vs 36.9 ± 9.3 Gy; p < 0.001) for the boosted plan. The prostate TCP was increased (80.1 ± 1.3 vs 75.3 ± 0.9 Gy; p < 0.001) and rectal NTCP lowered (3.84 ± 3.65 vs 9.70 ± 5.68 Gy; p = 0.04) in the boosted plan. The bladder NTCP was negligible for both plans. Conclusion: Delivery of a focal boost to an mpMRI-defined DIL is feasible, and significant increases in TCP and therapeutic ratio were found. Advances in knowledge: The delivery of a focal boost to an mpMRI-defined DIL demonstrates statistically significant increases in TCP and therapeutic ratio. PMID:24601648

  18. Interdisciplinary expert consultation via a teleradiology platform. Influence on therapeutic decision-making and patient referral rates to an academic tertiary care center

    International Nuclear Information System (INIS)

    Helck, Andreas; Matzko, M.; Trumm, C.G.; Grosse, C.; Reiser, M.; Ertl-Wagner, B.; Piltz, S.

    2009-01-01

    In addition to teleradiological reporting as a nighthawking or a regular service, teleradiological communication can be used for interdisciplinary expert consultation. We intended to evaluate an interdisciplinary consultation system based on a teleradiology platform with regard to its impact on therapeutic decision-making, directed patient referrals to an academic tertiary care center and the economic benefit for the hospital providing the service. Therefore, consultations from five secondary care centers and consecutive admissions to an academic tertiary care center were prospectively evaluated over a time period of six months. A total of 69 interdisciplinary expert consultations were performed. In 54% of the cases the patients were consecutively referred to the university hospital for further treatment. In all acutely life-threatening emergencies (n=9), fast and focused treatment by referral to the academic tertiary care center was achieved (average time to treat 130 min). The admissions to the academic tertiary care center led to improved utilization of its facilities with additional revenue of more than 1 000 000 Euro p.a. An interdisciplinary expert consultation via a teleradiology platform enables fast and efficient expert care with improved and accelerated patient management and improved utilization of the service providing hospital. (orig.)

  19. Recurrent anterior shoulder instability: accuracy of estimations of glenoid bone loss with computed tomography is insufficient for therapeutic decision-making

    Energy Technology Data Exchange (ETDEWEB)

    Huijsmans, Polydoor Emile [Haga Hospital, Department of Orthopedic Surgery, The Hague (Netherlands); Witte, Pieter Bas de [Leiden University Medical Center, Department of Orthopedic Surgery, Leiden (Netherlands); Villiers, Richard V.P. de; Kruger, Niel Ruben [Van Wageningen and Partners, Radiology Department, Somerset West (South Africa); Wolterbeek, Derk Willem; Warmerdam, Piet [Haga Hospital, Department of Radiology, The Hague (Netherlands); Beer, Joe F. de [Cape Shoulder Institute, Department of Orthopedic Surgery, Cape Town (South Africa)

    2011-10-15

    To evaluate the reliability of glenoid bone loss estimations based on either axial computed tomography (CT) series or single sagittal (''en face'' to glenoid) CT reconstructions, and to assess their accuracy by comparing with actual CT-based bone loss measurements, in patients with anterior glenohumeral instability. In two separate series of patients diagnosed with recurrent anterior glenohumeral instability, glenoid bone loss was estimated on axial CT series and on the most lateral sagittal (en face) glenoid view by two blinded radiologists. Additionally, in the second series of patients, glenoid defects were measured on sagittal CT reconstructions by an independent observer. In both series, larger defects were estimated when based on sagittal CT images compared to axial views. In the second series, mean measured bone loss was 11.5% (SD = 6.0) of the total original glenoid area, with estimations of 9.6% (SD = 7.2) and 7.8% (SD = 4.2) for sagittal and axial views, respectively. Correlations of defect estimations with actual measurements were fair to poor; glenoid defects tended to be underestimated, especially when based on axial views. CT-based estimations of glenoid bone defects are inaccurate. Especially for axial views, there is a high chance of glenoid defect underestimation. When using glenoid bone loss quantification in therapeutic decision-making, measuring the defect instead of estimating is strongly advised. (orig.)

  20. The application of financial options theory to electric utility decision making in integrated resource planning and maintenance shutdowns

    International Nuclear Information System (INIS)

    Felder, F.

    1995-01-01

    Increased competition in wholesale power generation will allow electric utilities to use financial models to improve their decision making. This competition will result in the creation of electricity spot, futures, and forward markets, which will provide necessary information for utility executives to used advance financial tools, such as random walk models and options theory. These models will allow executives to place a value on risk. Once this value is known, executives can determine how best to manage that risk, whether by entering into financial transactions, adjusting their operational and planning decisions, or both

  1. Detailed Sponge City Planning Based on Hierarchical Fuzzy Decision-Making: A Case Study on Yangchen Lake

    Directory of Open Access Journals (Sweden)

    Junyu Zhang

    2017-11-01

    Full Text Available We proposed a Hierarchical Fuzzy Inference System (HFIS framework to offer better decision supports with fewer user-defined data (uncertainty. The framework consists two parts: a fuzzified Geographic Information System (GIS and a HFIS system. The former provides comprehensive information on the criterion unit and the latter helps in making more robust decisions. The HFIS and the traditional Multi-Criteria Decision Making (MCDM method were applied to a case study and compared. The fuzzified GIS maps maintained a majority of the dominant characteristics of the criterion unit but also revealed some non-significant information according to the surrounding environment. The urban planning map generated by the two methods shares similar strategy choices (6% difference, while the spatial distribution of strategies shares 69.7% in common. The HFIS required fewer subjective decisions than the MCDM (34 user-defined decision rules vs. 141 manual evaluations.

  2. Women planning to major in computer science: Who are they and what makes them unique?

    Science.gov (United States)

    Lehman, Kathleen J.; Sax, Linda J.; Zimmerman, Hilary B.

    2016-12-01

    Despite the current growing popularity of the computer science (CS) major, women remain sorely underrepresented in the field, continuing to earn only 18% of bachelor's degrees. Understanding women's low rates of participation in CS is important given that the demand for individuals with CS training has grown sharply in recent years. Attracting and retaining more women to high-paying fields like CS may also help narrow the gender pay gap. Further, it is important that women participate in developing new technology so that technology advances serve the needs of both women and men. This paper explores the background characteristics, career aspirations, and self-perceptions of 1636 female first-year college students in the United States who intend to major in CS and compares them with 4402 male CS aspirants as well as with 26,642 women planning to major in other STEM sub-fields. The findings reveal a unique profile of women who pursue the CS major and notes many significant differences between men and women in CS and between women in CS and those in other STEM fields. For instance, women in CS tend to earn lower high school grades than women in other STEM fields, but earn higher SAT verbal scores. They also rate themselves higher than men in CS and women in other STEM fields on measures of their artistic ability, but rate themselves lower on other self-ratings, including academic and leadership ability. Further, women in CS are more likely to be undecided in their career plans than men in CS and women in other STEM fields. Understanding the unique characteristics of women in CS will help inform policies and recruitment programs designed to address the gender gap in computing.

  3. Characterization of the interaction between therapeutical carbon ions and bone-like materials and related impact on treatment planning

    Energy Technology Data Exchange (ETDEWEB)

    Eichhorn, Anna; Durante, Marco [GSI Helmholtzzentrum fuer Schwereionen, Darmstadt (Germany); TU Darmstadt (Germany); Carlino, Antonio [University of Palermo (Italy); Kaderka, Robert; Kraemer, Michael; La Tessa, Chiara; Scifoni, Emanuele [GSI Helmholtzzentrum fuer Schwereionen, Darmstadt (Germany)

    2013-07-01

    Radiotherapy is one of the most common and effective therapies for cancer. The treatment planning system for ions TRiP98 was developed at GSI, Darmstadt. In TRiP98, the interaction between primary radiation and tissue is modeled from experimental data measured in water and rescaled to other tissue. This approximation is not accurate enough for biological materials whose elemental composition besides density deviates significantly from water. The nuclear attenuation of carbon beams in bone-like materials was measured and an estimation of the fragmentation cross section was done. In parallel, the dose profile inhomogeneity predicted by TRiP98 at the interface between water and bones was investigated and measured at HIT (Heidelberg). A 3D treatment plan was delivered in a water phantom equipped with bone targets. Pin-point ionization chambers and X-ray dosimetric films were used for measuring the dose at different positions. As a further step, the measured cross sections of carbon ions in bone have been implemented in TRiP98. The comparison of the dose profiles calculated with the standard and benchmarked versions of the treatment planning will give an estimate of the improvement.

  4. Evaluation of Pharmacy and Therapeutic (P&T) Committee member knowledge, attitudes and ability regarding the use of comparative effectiveness research (CER) in health care decision-making.

    Science.gov (United States)

    Tang, D H; Warholak, T L; Hines, L E; Hurwitz, J; Brown, M; Taylor, A M; Brixner, D; Malone, D C

    2014-01-01

    Comparative effectiveness research (CER) is a constellation of research methods designed to improve health care decision making. Educational programs that improve health care decision makers' CER knowledge and awareness may ultimately lead to more cost-effective use of health care resources. This study was conducted to evaluate changes in CER knowledge, attitudes, and ability among Pharmacy and Therapeutics (P&T) Committee members and support staff after attending a tailored educational program. Physicians and pharmacists from two professional societies and the Indian Health Service who participated in the P&T process were invited via email to participate in this study. Participants completed a questionnaire, designed specifically for this study, prior to and following the 4-hour live, educational program on CER to determine the impact on their related knowledge, attitudes, and ability to use CER in decision-making. Rasch analysis was used to assess validity and reliability of subsections of the questionnaire and regression analysis was used to assess programmatic impact on CER knowledge, attitude, and ability. One hundred and forty of the 199 participants completed both the pre- and post-CER session questionnaires (response rate = 70.4%). Most participants (>75%) correctly answered eight of the ten knowledge items after attending the educational session. More than 60% of the respondents had a positive attitude toward CER both before and after the program. Compared to baseline (pretest), participants reported significant improvements in their perceived ability to use CER after attending the session in these areas: using CER reviews, knowledge of CER methods, identifying problems with randomized controlled trials, identifying threats to validity, understanding of evidence synthesis approaches, and evaluating the quality of CER (all P values CER educational program was effective in increasing participants' CER knowledge and self-perceived ability to evaluate

  5. 68Ga-PSMA 11 ligand PET imaging in patients with biochemical recurrence after radical prostatectomy - diagnostic performance and impact on therapeutic decision-making

    International Nuclear Information System (INIS)

    Grubmueller, B.; D'Andrea, D.; Korn, S.; Seitz, C.; Fajkovic, H.; Kramer, G.; Baltzer, P.; Haug, A.R.; Hacker, M.; Pfaff, S.; Hartenbach, Markus; Grubmueller, K.H.; Goldner, G.M.; Wadsak, W.; Babich, J.; Susani, M.; Mazal, P.; Shariat, S.F.

    2018-01-01

    To evaluate the diagnostic performance of [ 68 Ga]Ga-PSMA HBED-CC conjugate 11 positron emission tomography (PSMA-PET) in the early detection of metastases in patients with biochemical recurrence (BCR) after radical prostatectomy (RP) for clinically non-metastatic prostate cancer, to compare it to CT/MRI alone and to assess its impact on further therapeutic decisions. We retrospectively assessed 117 consecutive hormone-naive BCR patients who had 68 Ga-PSMA 11 PET/CT (n = 46) or PET/MRI (n = 71) between May 2014 and January 2017. BCR was defined as two PSA rises above 0.2 ng/ml. Two dedicated uro-oncological imaging experts (radiology/nuclear medicine) reviewed separately all images. All results were presented in a blinded sequential fashion to a multidisciplinary tumorboard in order to assess the influence of PSMA-PET imaging on decision-making. The median time from RP to BCR was 36 months (IQR 16-72). Overall, 69 (59%) patients received postoperative radiotherapy. Median PSA level at the time of imaging was 1.04 ng/ml (IQR 0.58-1.87). PSMA-positive lesions were detected in 100 (85.5%) patients. Detection rates were 65% for a PSA value of 0.2 to <0.5 ng/ml, 85.7% for 0.5 to <1, 85.7% for 1 to <2 and 100% for ≥2. PSMA-positive lesions could be confirmed by either histology (16%), PSA decrease in metastasis-directed radiotherapy (45%) or additional information in diffusion-weighted imaging when PET/MRI was performed (18%) in 79% of patients. PSMA-PET detected lesions in 67 patients (57.3%) who had no suspicious correlates according to the RECIST 1.1 criteria on MRI or CT. PSMA-PET changed therapeutic decisions in 74.6% of these 67 patients (p < 0.001), with 86% of them being considered for metastases-directed therapies. We confirm the high performance of PSMA-PET imaging for the detection of disease recurrence sites in patients with BCR after RP, even at relatively low PSA levels. Moreover, it adds significant information to standard CT/MRI, changing treatment

  6. {sup 68}Ga-PSMA 11 ligand PET imaging in patients with biochemical recurrence after radical prostatectomy - diagnostic performance and impact on therapeutic decision-making

    Energy Technology Data Exchange (ETDEWEB)

    Grubmueller, B.; D' Andrea, D.; Korn, S.; Seitz, C.; Fajkovic, H.; Kramer, G. [Medical University of Vienna, Department of Urology, Vienna (Austria); Baltzer, P. [Medical University of Vienna, Division of General and Pediatric Radiology, Department of Biomedical Imaging and Image-guided Therapy, Vienna (Austria); Haug, A.R.; Hacker, M.; Pfaff, S.; Hartenbach, Markus [Medical University of Vienna, Division of Nuclear Medicine, Department of Biomedical Imaging and Image-guided Therapy, Vienna (Austria); Grubmueller, K.H. [University Hospital Krems, Karl Landsteiner University of Health Sciences, Department of Urology and Andrology, Krems (Austria); Goldner, G.M. [Medical University of Vienna, Department of Radiation Oncology, Vienna (Austria); Wadsak, W. [Medical University of Vienna, Division of Nuclear Medicine, Department of Biomedical Imaging and Image-guided Therapy, Vienna (Austria); Center for Biomarker Research in Medicine, CBmed GmbH, Graz (Austria); Babich, J. [Weill Medical College of Cornell University, Division of Radiopharmaceutical Sciences, Department of Radiology, New York, NY (United States); Susani, M.; Mazal, P. [Medical University of Vienna, Clinical Institute of Pathology, Vienna (Austria); Shariat, S.F. [Medical University of Vienna, Department of Urology, Vienna (Austria); University of Texas Southwestern, Department of Urology, Dallas, TX (United States); Weill Medical College of Cornell University, Department of Urology and Division of Medical Oncology, New York, NY (United States)

    2018-02-15

    To evaluate the diagnostic performance of [{sup 68}Ga]Ga-PSMA{sup HBED-CC} conjugate 11 positron emission tomography (PSMA-PET) in the early detection of metastases in patients with biochemical recurrence (BCR) after radical prostatectomy (RP) for clinically non-metastatic prostate cancer, to compare it to CT/MRI alone and to assess its impact on further therapeutic decisions. We retrospectively assessed 117 consecutive hormone-naive BCR patients who had {sup 68}Ga-PSMA 11 PET/CT (n = 46) or PET/MRI (n = 71) between May 2014 and January 2017. BCR was defined as two PSA rises above 0.2 ng/ml. Two dedicated uro-oncological imaging experts (radiology/nuclear medicine) reviewed separately all images. All results were presented in a blinded sequential fashion to a multidisciplinary tumorboard in order to assess the influence of PSMA-PET imaging on decision-making. The median time from RP to BCR was 36 months (IQR 16-72). Overall, 69 (59%) patients received postoperative radiotherapy. Median PSA level at the time of imaging was 1.04 ng/ml (IQR 0.58-1.87). PSMA-positive lesions were detected in 100 (85.5%) patients. Detection rates were 65% for a PSA value of 0.2 to <0.5 ng/ml, 85.7% for 0.5 to <1, 85.7% for 1 to <2 and 100% for ≥2. PSMA-positive lesions could be confirmed by either histology (16%), PSA decrease in metastasis-directed radiotherapy (45%) or additional information in diffusion-weighted imaging when PET/MRI was performed (18%) in 79% of patients. PSMA-PET detected lesions in 67 patients (57.3%) who had no suspicious correlates according to the RECIST 1.1 criteria on MRI or CT. PSMA-PET changed therapeutic decisions in 74.6% of these 67 patients (p < 0.001), with 86% of them being considered for metastases-directed therapies. We confirm the high performance of PSMA-PET imaging for the detection of disease recurrence sites in patients with BCR after RP, even at relatively low PSA levels. Moreover, it adds significant information to standard CT/MRI, changing

  7. The Wipp Disposal Decision Plan: the Successful Road Map for Transparent and Credible Decision-Making

    International Nuclear Information System (INIS)

    Eriksson, Leif G.

    2001-01-01

    The Waste Isolation Pilot Plant (WIPP) deep geological repository for long-lived, transuranic radioactive waste (TRUW) opened on the 26th of March 1999. Beginning on the 4th of April 1994, the United States Department of Energy (DOE), implemented the WIPP Disposal Decision Plan (DDP), which embodied the five-year vision and intents of the then DOE Manager of the Carlsbad Area Office (CAO), presently the Carlsbad Field Office (CBFO). The successful design and implementation of the DDP ensured good science, enhanced regulator and stake holder (affected and interested parties) interactions and acceptance of programmatic decisions, which resulted in the certification of the WIPP TRUW repository by the U.S. Environmental Protection Agency (EPA) on the 18th of May 1998, almost three years earlier than projected in November 1993. The present paper contains three sections: A concise background information on the CBFO's TRUW disposal program, incl. the legal framework, current status, and author-envisioned challenges and solutions; A description of the main components and attributes of the WIPP DDP. A summary of the lessons learned during and after the 1994 through 1998 implementation of the WIPP DDP

  8. Evaluation of Croatian model of polycentric health planning and decision making.

    Science.gov (United States)

    Sogorić, Selma; Dzakula, Aleksandar; Rukavina, Tea Vukusić; Grozić-Zivolić, Sonja; Lazarić-Zec, Danijela; Dzono-Boban, Ankica; Brborović, Ognjen; Lang, Slobodan; Vuletić, Silvije

    2009-03-01

    To determine the progress in the development and implementation of health policies on a county level resulting from the learning-by-doing training provided through the County Public Health Capacity Building Program started in 2001 in Croatia. Modular training using management tools, public health theory and practice, and SMDP's Healthy Plan-it tool, followed by the self-evaluation of the progress made by county teams in health needs assessment and health policy development, implementation, and assurance. Fifteen county teams consisting of politicians, executive officers, public health professionals, and community members. Twelve of 15 county teams completed the program. The teams made progress in the evaluated areas, although to a different extent, which did not depend on the amount of time they had or the governance experience. The differences in improvement depended on the differences in the strength of political, executive, and professional components of the teams. Teams with a strong political and/or executive component, but weak public health professional and community components made major improvements in policy development and/or assurance function, but performed less well in the health needs assessment and constituency building. The reversed was also true. Learning-by-doing training program improved public health practices on a county level in Croatia.

  9. An Extension of Neutrosophic AHP–SWOT Analysis for Strategic Planning and Decision-Making

    Directory of Open Access Journals (Sweden)

    Mohamed Abdel-Basset

    2018-04-01

    Full Text Available Every organization seeks to set strategies for its development and growth and to do this, it must take into account the factors that affect its success or failure. The most widely used technique in strategic planning is SWOT analysis. SWOT examines strengths (S, weaknesses (W, opportunities (O and threats (T, to select and implement the best strategy to achieve organizational goals. The chosen strategy should harness the advantages of strengths and opportunities, handle weaknesses, and avoid or mitigate threats. SWOT analysis does not quantify factors (i.e., strengths, weaknesses, opportunities and threats and it fails to rank available alternatives. To overcome this drawback, we integrated it with the analytic hierarchy process (AHP. The AHP is able to determine both quantitative and the qualitative elements by weighting and ranking them via comparison matrices. Due to the vague and inconsistent information that exists in the real world, we applied the proposed model in a neutrosophic environment. A real case study of Starbucks Company was presented to validate our model.

  10. The Wipp Disposal Decision Plan: the Successful Road Map for Transparent and Credible Decision-Making

    Energy Technology Data Exchange (ETDEWEB)

    Eriksson, Leif G. [GRAM, Inc., Albuquerque, NM (United States)

    2001-07-01

    The Waste Isolation Pilot Plant (WIPP) deep geological repository for long-lived, transuranic radioactive waste (TRUW) opened on the 26th of March 1999. Beginning on the 4th of April 1994, the United States Department of Energy (DOE), implemented the WIPP Disposal Decision Plan (DDP), which embodied the five-year vision and intents of the then DOE Manager of the Carlsbad Area Office (CAO), presently the Carlsbad Field Office (CBFO). The successful design and implementation of the DDP ensured good science, enhanced regulator and stake holder (affected and interested parties) interactions and acceptance of programmatic decisions, which resulted in the certification of the WIPP TRUW repository by the U.S. Environmental Protection Agency (EPA) on the 18th of May 1998, almost three years earlier than projected in November 1993. The present paper contains three sections: A concise background information on the CBFO's TRUW disposal program, incl. the legal framework, current status, and author-envisioned challenges and solutions; A description of the main components and attributes of the WIPP DDP. A summary of the lessons learned during and after the 1994 through 1998 implementation of the WIPP DDP.

  11. Personality Makes a Difference: Attachment Orientation Moderates Theory of Planned Behavior Prediction of Cardiac Medication Adherence.

    Science.gov (United States)

    Peleg, Shira; Vilchinsky, Noa; Fisher, William A; Khaskia, Abed; Mosseri, Morris

    2017-12-01

    To achieve a comprehensive understanding of patients' adherence to medication following acute coronary syndrome (ACS), we assessed the possible moderating role played by attachment orientation on the effects of attitudes, subjective norms, and perceived behavioral control (PBC), as derived from the Theory of Planned Behavior (TPB; Ajzen, 1991), on intention and reported adherence. A prospective longitudinal design was employed. During hospitalization, ACS male patients (N = 106) completed a set of self-report questionnaires including sociodemographic variables, attachment orientation, and measures of TPB constructs. Six months post-discharge, 90 participants completed a questionnaire measuring adherence to medication. Attachment orientations moderated some of the predictions of the TPB model. PBC predicted intention and reported adherence, but these associations were found to be significant only among individuals with lower, as opposed to higher, attachment anxiety. The association between attitudes and intention was stronger among individuals with higher, as opposed to lower, attachment anxiety. Only among individuals with higher attachment avoidance, subjective norms were negatively associated with intention to take medication. Cognitive variables appear to explain both adherence intention and behavior, but differently, depending on individuals' attachment orientations. Integrating personality and cognitive models may prove effective in understanding patients' health behaviors. © 2016 Wiley Periodicals, Inc.

  12. Multiple methods for multiple futures: Integrating qualitative scenario planning and quantitative simulation modeling for natural resource decision making

    Science.gov (United States)

    Symstad, Amy J.; Fisichelli, Nicholas A.; Miller, Brian W.; Rowland, Erika; Schuurman, Gregor W.

    2017-01-01

    Scenario planning helps managers incorporate climate change into their natural resource decision making through a structured “what-if” process of identifying key uncertainties and potential impacts and responses. Although qualitative scenarios, in which ecosystem responses to climate change are derived via expert opinion, often suffice for managers to begin addressing climate change in their planning, this approach may face limits in resolving the responses of complex systems to altered climate conditions. In addition, this approach may fall short of the scientific credibility managers often require to take actions that differ from current practice. Quantitative simulation modeling of ecosystem response to climate conditions and management actions can provide this credibility, but its utility is limited unless the modeling addresses the most impactful and management-relevant uncertainties and incorporates realistic management actions. We use a case study to compare and contrast management implications derived from qualitative scenario narratives and from scenarios supported by quantitative simulations. We then describe an analytical framework that refines the case study’s integrated approach in order to improve applicability of results to management decisions. The case study illustrates the value of an integrated approach for identifying counterintuitive system dynamics, refining understanding of complex relationships, clarifying the magnitude and timing of changes, identifying and checking the validity of assumptions about resource responses to climate, and refining management directions. Our proposed analytical framework retains qualitative scenario planning as a core element because its participatory approach builds understanding for both managers and scientists, lays the groundwork to focus quantitative simulations on key system dynamics, and clarifies the challenges that subsequent decision making must address.

  13. Applying Portfolio Theory to EU Electricity Planning and Policy-Making

    Energy Technology Data Exchange (ETDEWEB)

    Awerbuch, Shimon; Berger, Martin

    2003-02-01

    This study introduces mean-variance portfolio theory and evaluates its potential application to the development of efficient (optimal) European Union (EU-15) generating portfolios that enhance energy security and diversification objectives. The analysis extends to European countries the previous work done by Awerbuch in the US, and applies a significantly more detailed portfolio model that reflects the risk of the relevant generating cost streams: fuel, operation and maintenance and construction period costs. It illustrates the portfolio effects of different generating mixes. The study offers preliminary findings on the effects of including more renewable energy sources in the typical EU portfolio mix and suggests interesting directions for further study. The study arises from the perception that these standard, finance-oriented analyses may offer valuable enhancements to energy planning, and concepts of energy security and diversity. Clearly the combination of better portfolio construction and more accurate pricing should lead to more optimal decisions in the round. This study, therefore, represents an effort to complement traditional approaches and point researchers and planners into new territory. The results generally indicate that the existing and projected EU generating mixes are sub optimal - though slightly - from a risk-return perspective, which implies that feasible portfolios with lower cost and risk exist. These can be developed by adjusting the conventional mix and by including larger shares of wind or similar renewable technologies. The results of the portfolio analysis suggest that fixed cost technologies such as renewables must be a part of any efficient generating portfolio. Our assessment of all technologies is limited to risk and cost measures, although other benefits, including low externality costs and sustainability, are often cited for renewables.

  14. Impact of the World Health Organization's Decision-Making Tool for Family Planning Clients and Providers on the quality of family planning services in Iran.

    Science.gov (United States)

    Farrokh-Eslamlou, Hamidreza; Aghlmand, Siamak; Eslami, Mohammad; Homer, Caroline S E

    2014-04-01

    We investigated whether use of the World Health Organization's (WHO's) Decision-Making Tool (DMT) for Family Planning Clients and Providers would improve the process and outcome quality indicators of family planning (FP) services in Iran. The DMT was adapted for the Iranian setting. The study evaluated 24 FP quality key indicators grouped into two main areas, namely process and outcome. The tool was implemented in 52 urban and rural public health facilities in four selected and representative provinces of Iran. A pre-post methodology was undertaken to examine whether use of the tool improved the quality of FP services and client satisfaction with the services. Quantitative data were collected through observations of counselling and exit interviews with clients using structured questionnaires. Different numbers of FP clients were recruited during the baseline and the post-intervention rounds (n=448 vs 547, respectively). The DMT improved many client-provider interaction indicators, including verbal and non-verbal communication (p<0.05). The tool also impacted positively on the client's choice of contraceptive method, providers' technical competence, and quality of information provided to clients (p<0.05). Use of the tool improved the clients' satisfaction with FP services (from 72% to 99%; p<0.05). The adapted WHO's DMT has the potential to improve the quality of FP services.

  15. Climate Resiliency Planning: Making Extreme Event Science Useful for Managers and Planners in Northern Nevada

    Science.gov (United States)

    McCarthy, M.; Kenneston, A.; Wall, T. U.; Brown, T. J.; Redmond, K. T.

    2014-12-01

    Effective climate resiliency planning at the regional level requires extensive interactive dialogue among climate scientists, emergency managers, public health officials, urban planners, social scientists, and policy makers. Engaging federal, tribal, state, local governments and private sector business and infrastructure owners/operators in defining, assessing and characterizing the impacts of extreme events allows communities to understand how different events "break the system" forcing local communities to seek support and resources from state/federal governments and/or the private sector and what actions can be taken proactively to mitigate consequences and accelerate recovery. The Washoe County Regional Resiliency Study was prepared in response to potential climate variability related impacts specific to the Northern Nevada Region. The last several decades have seen dramatic growth in the region, coupled with increased resource demands that have forced local governments to consider how those impacts will affect the region and may, in turn, impact the region's ability to provide essential services. The Western Regional Climate Center of the Desert Research Institute provided a synthesis of climate studies with predictions regarding plausible changes in the local climate of Northern California and Nevada for the next 50 years. In general, these predictions indicate that the region's climate is undergoing a gradual shift, which will primarily affect the frequency, amount, and form of precipitation in the Sierra Nevada and Great Basin. Changes in water availability and other extreme events may have serious and long lasting effects in the Northern Nevada Region, and create a variety of social, environmental and economic concerns. A range of extreme events were considered including Adverse Air Quality, Droughts, Floods, Heat Waves, High Wind, Structure Fires, Wildland Fires, and Major Winter Storms. Due to the complexity of our climate systems, and the difficulty in

  16. Development of a district information system for water management planning and strategic decision making

    Science.gov (United States)

    Loukas, A.; Tzabiras, J.; Spiliotopoulos, M.; Kokkinos, K.; Fafoutis, C.; Mylopoulos, N.

    2015-06-01

    The overall objective of this work is the development of a District Information System (DIS) which could be used by stakeholders for the purposes of a district day-to-day water management as well as for planning and strategic decisionmaking. The DIS was developed from a GIS-based modeling approach, which integrates a generic crop model and a hydraulic model of the transport/distribution system, using land use maps generated by Landsat TM imagery. The main sub-objectives are: (i) the development of an operational algorithm to retrieve crop evapotranspiration from remote sensing data, (ii) the development of an information system with friendly user interface for the data base, the crop module and the hydraulic module and (iii) the analysis and validation of management scenarios from model simulations predicting the respective behavior. The Lake Karla watershed is used in this study, but the overall methodology could be used as a basis for future analysis elsewhere. Surface Energy Balance Algorithm for Land (SEBAL) was used to derive monthly actual evapotranspiration (ET) values from Landsat TM imagery. Meteorological data from the archives of the Institute for Research and Technology, Thessaly (I.RE.TE.TH) has also been used. The methodology was developed using high quality Landsat TM images during 2007 growing season. Monthly ET values are used as an input to CROPWAT model. Outputs of CROPWAT model are then used as input for WEAP model. The developed scenario is based on the actual situation of the surface irrigation network of the Local Administration of Land Reclamation (LALR) of Pinios for the year of 2007. The DIS is calibrated with observed data of this year and the district parameterization is conducted based on the actual operation of the network. The operation of the surface irrigation network of Pinios LALR is simulated using Technologismiki Works, while the operation of closed pipe irrigation network of Lake Karla LALR is simulated using Watercad. Four

  17. Reserving Charging Decision-Making Model and Route Plan for Electric Vehicles Considering Information of Traffic and Charging Station

    Directory of Open Access Journals (Sweden)

    Haoming Liu

    2018-04-01

    Full Text Available With the advance of battery energy technology, electric vehicles (EV are catching more and more attention. One of the influencing factors of electric vehicles large-scale application is the availability of charging stations and convenience of charging. It is important to investigate how to make reserving charging strategies and ensure electric vehicles are charged with shorter time and lower charging expense whenever charging request is proposed. This paper proposes a reserving charging decision-making model for electric vehicles that move to certain destinations and need charging services in consideration of traffic conditions and available charging resources at the charging stations. Besides, the interactive mechanism is described to show how the reserving charging system works, as well as the rolling records-based credit mechanism where extra charges from EV is considered to hedge default behavior. With the objectives of minimizing driving time and minimizing charging expenses, an optimization model with two objective functions is formulated. Then the optimizations are solved by a K shortest paths algorithm based on a weighted directed graph, where the time and distance factors are respectively treated as weights of corresponding edges of transportation networks. Case studies show the effectiveness and validity of the proposed route plan and reserving charging decision-making model.

  18. Reward-dependent learning in neuronal networks for planning and decision making.

    Science.gov (United States)

    Dehaene, S; Changeux, J P

    2000-01-01

    gives access to enhanced rates of learning via an elementary process of internal or covert mental simulation. We have recently applied these ideas to a new model, developed with M. Kerszberg, which hypothesizes that prefrontal cortex and its reward-related connections contribute crucially to conscious effortful tasks. This model distinguishes two main computational spaces within the human brain: a unique global workspace composed of distributed and heavily interconnected neurons with long-range axons, and a set of specialized and modular perceptual, motor, memory, evaluative and attentional processors. We postulate that workspace neurons are mobilized in effortful tasks for which the specialized processors do not suffice; they selectively mobilize or suppress, through descending connections, the contribution of specific processor neurons. In the course of task performance, workspace neurons become spontaneously co-activated, forming discrete though variable spatio-temporal patterns subject to modulation by vigilance signals and to selection by reward signals. A computer simulation of the Stroop task shows workspace activation to increase during acquisition of a novel task, effortful execution, and after errors. This model makes predictions concerning the spatio-temporal activation patterns during brain imaging of cognitive tasks, particularly concerning the conditions of activation of dorsolateral prefrontal cortex and anterior cingulate, their relation to reward mechanisms, and their specific reaction during error processing.

  19. Effect of a therapeutic maximum allowable cost (MAC) program on the cost and utilization of proton pump inhibitors in an employer-sponsored drug plan in Canada.

    Science.gov (United States)

    Mabasa, Vincent H; Ma, Johnny

    2006-06-01

    Therapeutic maximum allowable cost (MAC) is a managed care intervention that uses reference pricing in a therapeutic class or category of drugs or an indication (e.g., heartburn). Therapeutic MAC has not been studied in Canada or the United States. The proton pump inhibitor (PPI) rabeprazole was used as the reference drug in this therapeutic MAC program based on prices for PPIs in the province of Ontario. No PPI is available over the counter in Canada. To evaluate the utilization and anticipated drug cost savings for PPIs in an employer-sponsored drug plan in Canada that implemented a therapeutic MAC program for PPIs. An employer group with an average of 6,300 covered members, which adopted the MAC program for PPIs in June 2003, was compared with a comparison group comprising the book of business throughout Canada (approximately 5 million lives) without a PPI MAC program (non-MAC group). Pharmacy claims for PPIs were identified using the first 6 characters of the generic product identifier (GPI 492700) for a 36-month period from June 1, 2002, through May 31, 2005. The primary comparison was the year prior to the intervention (from June 1, 2002, through May 31, 2003) and the first full year following the intervention (June 1, 2004, through May 31, 2005). Drug utilization was evaluated by comparing the market share of each of the PPIs for the 2 time periods and by the days of PPI therapy per patient per year (PPPY) and days of therapy per prescription (Rx). Drug cost was defined as the cost of the drug (ingredient cost), including allowable provincial pharmacy markup but excluding pharmacy dispense fee. Cost savings were calculated from the allowed drug cost per claim, allowed cost per day, and allowed cost PPPY. (All amounts are in Canadian dollars.) The MAC intervention group experienced an 11.7% reduction in the average cost per day of PPI drug therapy, from 2.14 US dollars in the preperiod to 1.89 US dollars in the postperiod, compared with a 3.7% reduction in

  20. SU-F-T-225: Is It Time to Have Pre-Configured Therapeutic Beams Available in Commercial Treatment Planning Systems?

    International Nuclear Information System (INIS)

    Ding, G

    2016-01-01

    Purpose: Commissioning radiation beams requires considerable effort to obtain the beam data for beam configuration in a commercial treatment planning system. With the advances in technology, the manufacturer of accelerators now has the ability to adjust radiation beam parameters to meet pre-determined specifications with high precision. This study aims to illustrate the feasibility of making pre-configured radiation beams available in commercial treatment planning systems. Methods: In recent years, Varian has made a set of measured beam data from the TrueBeam accelerator available to users. Although the beam data are provided as “suggestive data” without warranty, the commissioned data measured by users have been shown to be in excellent agreement with the data set provided when the beams from the installed Linacs were adjusted to meet the beam specifications. An unofficial survey among Varian Linac TrueBeam users shows that the suggestive data set has been used with validation by users in some clinics. This indicates that radiation beams from a specified Linac can be standardized and pre-configured in a treatment planning system. Results: Two newly installed Varian TrueBeam accelerators at two different centers were examined in which one set of commissioned beam data was obtained from measurements performed by an independent physics consulting company and the other was measured by local physicists in the department. All beams from both accelerators were tuned to meet the manufacturer’s specifications. Discrepancies of less than 1% were found between the commissioned beam data from both accelerators and the suggestive data set provided by Varian. Conclusion: It may be feasible that radiation beams can be pre-configured in commercial treatment planning systems. The radiation beam users will perform the beam validation and end-to-end tests instead of configuring beams. This framework can increase both the efficiency and the accuracy in commercial radiation

  1. [How I treat: from specialized pharmacology to drug therapy: a plea for an optimal educational program for rational therapeutics, from decision making to drug prescription].

    Science.gov (United States)

    Scheen, A J

    2000-09-01

    Clinical pharmacology and therapeutics are two complementary disciplines which should lead the medical student, through an optimized training, to a rational prescription of drugs, ultimate and important step of the medical approach. Such a learning should occur progressively throughout the medical education, focusing, first, on the therapeutic reasoning ("why?") and, second, on the practical application leading to the prescription ("how?"). The medical student should learn the difficult task of integrating disease, drug and patient, in order to optimize the benefit/risk ratio, while being informed about new concepts such as "Evidence-Based Medicine" and pharmacoeconomics.

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

    Science.gov (United States)

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

    2016-01-01

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

  3. Environmental planning and categorical exclusions: Making the categorical exclusion an integral part of your NEPA tool kit

    International Nuclear Information System (INIS)

    Holthoff, M.G.; Hanrahan, T.P.

    1994-06-01

    As contained in the Regulations for Implementing the Procedural Provisions of the National Environmental Policy Act, 40 CFR 1500--1508, the Council on Environmental Quality (CEQ) directs federal agencies to adopt their own procedures for implementing the Act. The US Department of Energy (DOE) and the US Department of Agriculture Forest Service (USFS) are two examples of federal agencies with dissimilar but functionally equivalent CX processes. The DOE and USFS were selected as subjects for this study because of their distinctly different missions and as a results of the author's familiarity with the policies of both agencies. The objectives of this study are to: (1) describe the CX policies and processes of the two agencies, (2) identify the similarities and differences between the two processes, and (3) suggest ways for improving these processes. In performing this evaluation, the authors will identify the components of each agency's CX process that clearly contributes qualitative information for the purpose of making environmental planning decisions. Drawing from the best elements of each process, the authors will provide some general recommendations that should enable the agencies to fulfill their various obligations to the CX process while concurrently performing early, thorough, and expeditious environmental reviews under NEPA

  4. Geo-portal as a planning instrument: supporting decision making and fostering market potential of Energy efficiency in buildings

    Science.gov (United States)

    Cuca, Branka; Brumana, Raffaella; Oreni, Daniela; Iannaccone, Giuliana; Sesana, Marta Maria

    2014-03-01

    Steady technological progress has led to a noticeable advancement in disciplines associated with Earth observation. This has enabled information transition regarding changing scenarios, both natural and urban, to occur in (almost) real time. In particular, the need for integration on a local scale with the wider territorial framework has occurred in analysis and monitoring of built environments over the last few decades. The progress of Geographic Information (GI) science has provided significant advancements when it comes to spatial analysis, while the almost free availability of the internet has ensured a fast and constant exchange of geo-information, even for everyday users' requirements. Due to its descriptive and semantic nature, geo-spatial information is capable of providing a complete overview of a certain phenomenon and of predicting the implications within the natural, social and economic context. However, in order to integrate geospatial data into decision making processes, it is necessary to provide a specific context, which is well supported by verified data. This paper investigates the potentials of geo-portals as planning instruments developed to share multi-temporal/multi-scale spatial data, responding to specific end-users' demands in the case of Energy efficiency in Buildings (EeB) across European countries. The case study regards the GeoCluster geo-portal and mapping tool (Project GE2O, FP7), built upon a GeoClustering methodology for mapping of indicators relevant for energy efficiency technologies in the construction sector.

  5. Graves' disease. Manifestations and therapeutic options

    Energy Technology Data Exchange (ETDEWEB)

    McFarland, K.F.; Saleeby, G.

    1988-03-01

    Graves' disease is the most common cause of hyperthyroidism. Clinical features include thyroid enlargement, eye signs, tachycardia, heat intolerance, emotional lability, weight loss, and hyperkinesis. Three modes of therapy are available. The preferences of the patient and physician are usually prime considerations in devising the therapeutic plan. Radioactive iodine is the most frequently used and safest method of treatment for adults. Antithyroid drugs are preferred for children and pregnant women. Surgery is usually reserved for patients in whom the other forms of treatment are not acceptable. Considerable patient education during the decision-making process enhances the success of the therapeutic plan.

  6. 76 FR 58807 - An Assessment of Decision-Making Processes: Evaluation of Where Land Protection Planning Can...

    Science.gov (United States)

    2011-09-22

    ...: Evaluation of Where Land Protection Planning Can Incorporate Climate Change Information-- Release of Final... Protection Planning can Incorporate Climate Change Information, (EPA/600/R-09/142F). The document was... goal of this report is to evaluate where land protection planning can incorporate climate change...

  7. Better sorry than safe : Making a Plan B reduces effectiveness of implementation intentions in healthy eating goals

    NARCIS (Netherlands)

    Vinkers, Charlotte D W; Adriaanse, Marieke A.; Kroese, Floor M.; de Ridder, Denise T D

    2015-01-01

    Objective: Implementation intentions (if–then plans) are helpful to health behaviour change. As these plans specify only one goal-directed behaviour for one specific situation, however, their effectiveness may be limited when a planned behaviour is impossible to execute in situ. The present research

  8. Non-technical factors impacting on the decision making processes in environmental remediation. Influences on the decision making process such as cost, planned land use and public perception

    International Nuclear Information System (INIS)

    2002-04-01

    The IAEA attaches great importance to the dissemination of information that can assist Member States with the development, implementation, maintenance and continuous improvement of systems, programmes and activities that support the nuclear fuel cycle and nuclear applications, including the legacy of past practices and accidents. In response to this, the IAEA has initiated a comprehensive programme of work covering all aspects of environmental remediation: factors important for formulating a strategy for environmental remediation; site characterisation techniques and strategies; assessment of remediation technologies; assessment of technical options for cleanup of contaminated media; post-restoration compliance monitoring; assessment of the costs of remediation measures; remediation of low-level disperse radioactive contaminations in the environment. While this project mainly focus on technological aspects, non-technical factors will be influencing the decision making process in remediation decisively. Often their influence is only tacitly accepted and not explicitly acknowledged by the responsible decision makers. This makes it difficult to trace the decision making process in the event that it has to be revisited. The present publication attempts to make these factors explicit and to present methods to include them consciously into the decision making process

  9. Guidelines for radiation oncology centres in AFRA Member States intending to make a transition from 2-D to 3-D treatment planning and delivery

    International Nuclear Information System (INIS)

    Meghzifene, A.

    2007-01-01

    The IAEA Regional Technical Cooperation Project RAF/6/031 on Medical Physics in Support of Cancer Management aims to strengthen national and regional medical physics capabilities to sustain radiotherapy treatments in the AFRA1 Member States. In particular, it aims at increasing the number of qualified medical physicists in the region as well as improving the level of medical physics by establishing regional training and continuous development programmes. Eighteen National Project Coordinators (NPCs) nominated by participating AFRA Member States are engaged in the project. RAF/6/031 was approved by the IAEA in 2005 for an initial five year duration. A coordination meeting is held every two years where the NPCs and IAEA Technical and Project Management Officers establish the project's training and development programmes. During the first coordination meeting at Cape Town in November 2005, it was decided to convene a Task Force Meeting to review the status of treatment planning in radiotherapy in AFRA Member States and prepare a guidance document on the transition from 2-D to 3-D treatment planning. This Task Force Meeting took place at the IAEA's Headquarters in Vienna on 23-26 April 2007. The resulting guidance document highlights the milestones that have to be achieved by radiotherapy centres routinely implementing 2-D computerized treatment planning before making a transition to 3-D treatment planning and delivery. The implementation of 3-D planning by radiotherapy centres that have not yet met these milestones could lead to serious mistakes in treatments. A self-assessment questionnaire was also prepared during the Task Force Meeting. Member States that are planning to make a transition to 3-D planning are advised to assess their existing capabilities through this questionnaire. The same questionnaire could also be useful for the IAEA staff and external experts when assessing the readiness of a radiotherapy centre to make a safe and effective transition to 3-D

  10. Shared decision-making behaviours in health professionals: a systematic review of studies based on the Theory of Planned Behaviour.

    Science.gov (United States)

    Thompson-Leduc, Philippe; Clayman, Marla L; Turcotte, Stéphane; Légaré, France

    2015-10-01

    Shared decision making (SDM) requires health professionals to change their practice. Socio-cognitive theories, such as the Theory of Planned Behaviour (TPB), provide the needed theoretical underpinnings for designing behaviour change interventions. We systematically reviewed studies that used the TPB to assess SDM behaviours in health professionals to explore how theory is being used to explain influences on SDM intentions and/or behaviours, and which construct is identified as most influential. We searched PsycINFO, MEDLINE, EMBASE, CINAHL, Index to theses, Proquest dissertations and Current Contents for all years up to April 2012. We included all studies in French or English that used the TPB and related socio-cognitive theories to assess SDM behavioural intentions or behaviours in health professionals. We used Makoul & Clayman's integrative SDM model to identify SDM behaviours. We extracted study characteristics, nature of the socio-cognitive theory, SDM behaviour, and theory-based determinants of the SDM behavioural intention or behaviour. We computed simple frequency counts. Of 12,388 titles, we assessed 136 full-text articles for eligibility. We kept 20 eligible studies, all published in English between 1996 and 2012. Studies were conducted in Canada (n = 8), the USA (n = 6), the Netherlands (n = 3), the United Kingdom (n = 2) and Australia (n = 1). The determinant most frequently and significantly associated with intention was the subjective norm (n = 15/21 analyses). There was great variance in the way socio-cognitive theories predicted SDM intention and/or behaviour, but frequency of significance indicated that subjective norm was most influential. © 2014 The Authors Health Expectations Published by John Wiley & Sons Ltd.

  11. The influence of specialty training, experience, discussion and reflection on decision making in modern restorative treatment planning.

    Science.gov (United States)

    Alani, A; Bishop, K; Djemal, S

    2011-02-26

    This study was designed to determine the effect of reflection and discussion of a group of dentists with differing backgrounds and qualifications in the management of failed endodontic treatment. During the Dental Pan-Society plenary session (16-17 November 2007) delegates (n = 393) were asked a series of questions on the management of a case with failed endodontic treatment of four maxillary incisors restored with linked crowns in a patient with a high smile line. The case had been previously posted on the conference website in addition to being presented on the day of the forum. Responses of delegates to predetermined questions and options on the management of the case were recorded using closed-circuit devices for each individual delegate. The questions were repeated after the case was opened up for discussion by the delegates in conjunction with a panel of leading experts. The discussion topics included the factors affecting the outcome of secondary root canal treatment, post-extraction changes and the options for prosthetic replacement including the provision of implants in the aesthetic zone. The initial response of the majority (58%) of delegates favoured extraction and prosthetic rehabilitation over endodontic retreatment of the affected teeth. Following the discussion this figure reduced to 50%. In respect to those individuals who were specialists, extraction was again the preferred option before the discussion for periodontists (74%), prosthodontists (64%) and restorative dentists (65%). This was in contrast to endodontists who preferred endodontic retreatment, with only 30% identifying extraction as the treatment of choice. Following the discussion, the number of periodontists and endodontists who favoured extraction reduced by 3% and 5% respectively, whereas the number of prosthodontists and restorative dentistry specialists who preferred extraction increased by 2% and 4% respectively. Reflection and discussion can make individuals reconsider their

  12. 20 CFR 1002.262 - When is the employer required to make the plan contribution that is attributable to the employee...

    Science.gov (United States)

    2010-04-01

    ... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false When is the employer required to make the plan contribution that is attributable to the employee's period of uniformed service? 1002.262 Section 1002.262 Employees' Benefits OFFICE OF THE ASSISTANT SECRETARY FOR VETERANS' EMPLOYMENT AND TRAINING SERVICE, DEPARTMENT OF LABOR REGULATIONS UNDER...

  13. Married women's decision making power on family planning use and associated factors in Mizan-Aman, South Ethiopia: a cross sectional study.

    Science.gov (United States)

    Belay, Abeba Daniel; Mengesha, Zelalem Birhanu; Woldegebriel, Manay Kifle; Gelaw, Yalemzewod Assefa

    2016-03-08

    Women's use of family planning service is influenced by many factors, especially by their decision making power. A woman's decision-making power, be it individual or decision made in collaboration with a partner, is the most important factor in the use of family planning in a household. The purpose of this study was to assess the impact of women's decision making power on family planning use and its associated factors. A community-based cross-sectional study was conducted on married women in the child bearing age. The women who were living in Mizan city were selected using the simple random sampling method. Trained nurses collected the data by interview, using a structured and pre-tested questioner. Bivariable and multivariable binary logistic regression analysis was used to identify the associated factors, and the odds ratio with a 95% CI was computed to assess the strength of the association. Collinearity was also assessed by looking at standard errors in the final fitted model. Overall, more than two-thirds [67.2%: 95% CI (63-71%)] of the married women were found to be more autonomous to decide family planning use. Secondary education [AOR: 9.04, 95% CI: (4.50, 18.16)], government employment [AOR: 4.84, 95% CI: (2.03, 11.52)], being wives of government employed spouses [AOR 2.71, 95% CI: (1.24, 7.97)], having husbands with college or university education [AOR: 11.29, 95% CI: (4.66, 27.35)], and being in the younger age [AOR: 0.27, 95% CI :(0.09, 0.75)] were significantly associated with women's decision-making power on family planning. In this study, women had a high decision making power in family planning use. Age category (34-44-years), formal education, and occupational status had effects on women's decision making power. Promoting parental adult education and engaging women in out of house employment is essential to improve their decision making power in using family planning.

  14. Making accessibility analyses accessible: A tool to facilitate the public review of the effects of regional transportation plans on accessibility

    OpenAIRE

    Golub, Aaron; Robinson, Glenn; Brendan Nee, Brendan Nee

    2013-01-01

    The regional transportation planning process in the United States has not been easily opened to public oversight even after strengthened requirements for public participation and civil rights considerations. In the effort to improve the public review of regional transportation plans, this paper describes the construction of a proof-of concept web-based tool designed to analyze the effects of regional transportation plans on accessibility to jobs and other essential destinations. The tool allo...

  15. "Putting Music On": Everyday Leisure Activities, Choice-Making and Person-Centred Planning in a Supported Living Scheme

    Science.gov (United States)

    Hassan, Nedim

    2017-01-01

    Background: Person-centred planning, which commonly becomes formalised within services for people with learning disabilities through an Essential Lifestyle Plan (ELP), was intended to help place the choices of individuals at the forefront of service provision. However, beyond UK government policy rhetoric, scholars have raised issues regarding the…

  16. Use of information systems in Air Force medical treatment facilities in strategic planning and decision-making.

    Science.gov (United States)

    Yap, Glenn A; Platonova, Elena A; Musa, Philip F

    2006-02-01

    An exploratory study used Ansoff's strategic planning model as a framework to assess perceived effectiveness of information systems in supporting strategic business plan development at Air Force medical treatment facilities (MTFs). Results showed information systems were most effective in supporting historical trend analysis, strategic business plans appeared to be a balance of operational and strategic plans, and facilities perceived a greater need for new clinical, vice administrative, information systems to support strategic planning processes. Administrators believed information systems should not be developed at the local level and perceived information systems have the greatest impact on improving clinical quality outcomes, followed by ability to deliver cost effective care and finally, ability to increase market share.

  17. Marketing therapeutic recreation services.

    Science.gov (United States)

    Thorn, B E

    1984-01-01

    The use of marketing strategies can enhance the delivery of therapeutic recreation services. This article discusses how agencies can adapt marketing techniques and use them to identify potential markets, improve image, evaluate external pressures, and maximize internal strengths. Four variables that can be controlled and manipulated in a proposed marketing plan are product, price, place and promotion.

  18. Effects of Information Visualization on Older Adults' Decision-Making Performance in a Medicare Plan Selection Task: A Comparative Usability Study.

    Science.gov (United States)

    Price, Margaux M; Crumley-Branyon, Jessica J; Leidheiser, William R; Pak, Richard

    2016-06-01

    Technology gains have improved tools for evaluating complex tasks by providing environmental supports (ES) that increase ease of use and improve performance outcomes through the use of information visualizations (info-vis). Complex info-vis emphasize the need to understand individual differences in abilities of target users, the key cognitive abilities needed to execute a decision task, and the graphical elements that can serve as the most effective ES. Older adults may be one such target user group that would benefit from increased ES to mitigate specific declines in cognitive abilities. For example, choosing a prescription drug plan is a necessary and complex task that can impact quality of life if the wrong choice is made. The decision to enroll in one plan over another can involve comparing over 15 plans across many categories. Within this context, the large amount of complex information and reduced working memory capacity puts older adults' decision making at a disadvantage. An intentionally designed ES, such as an info-vis that reduces working memory demand, may assist older adults in making the most effective decision among many options. The objective of this study is to examine whether the use of an info-vis can lower working memory demands and positively affect complex decision-making performance of older adults in the context of choosing a Medicare prescription drug plan. Participants performed a computerized decision-making task in the context of finding the best health care plan. Data included quantitative decision-making performance indicators and surveys examining previous history with purchasing insurance. Participants used a colored info-vis ES or a table (no ES) to perform the decision task. Task difficulty was manipulated by increasing the number of selection criteria used to make an accurate decision. A repeated measures analysis was performed to examine differences between the two table designs. Twenty-three older adults between the ages of 66

  19. SU-E-J-04: Integration of Interstitial High Intensity Therapeutic Ultrasound Applicators On a Clinical MRI-Guided High Intensity Focused Ultrasound Treatment Planning Software Platform

    Energy Technology Data Exchange (ETDEWEB)

    Ellens, N [Johns Hopkins University, Baltimore, Maryland (United States); Partanen, A [Philips Healthcare, Andover, Massachusetts (United States); Ghoshal, G; Burdette, E [Acoustic MedSystems Inc., Savoy, IL (United States); Farahani, K [National Cancer Institute, Bethesda, MD (United States)

    2015-06-15

    Purpose: Interstitial high intensity therapeutic ultrasound (HITU) applicators can be used to ablate tissue percutaneously, allowing for minimally-invasive treatment without ionizing radiation [1,2]. The purpose of this study was to evaluate the feasibility and usability of combining multielement interstitial HITU applicators with a clinical magnetic resonance imaging (MRI)-guided focused ultrasound software platform. Methods: The Sonalleve software platform (Philips Healthcare, Vantaa, Finland) combines anatomical MRI for target selection and multi-planar MRI thermometry to provide real-time temperature information. The MRI-compatible interstitial US applicators (Acoustic MedSystems, Savoy, IL, USA) had 1–4 cylindrical US elements, each 1 cm long with either 180° or 360° of active surface. Each applicator (4 Fr diameter, enclosed within a 13 Fr flexible catheter) was inserted into a tissue-mimicking agar-silica phantom. Degassed water was circulated around the transducers for cooling and coupling. Based on the location of the applicator, a virtual transducer overlay was added to the software to assist targeting and to allow automatic thermometry slice placement. The phantom was sonicated at 7 MHz for 5 minutes with 6–8 W of acoustic power for each element. MR thermometry data were collected during and after sonication. Results: Preliminary testing indicated that the applicator location could be identified in the planning images and the transducer locations predicted within 1 mm accuracy using the overlay. Ablation zones (thermal dose ≥ 240 CEM43) for 2 active, adjacent US elements ranged from 18 mm × 24 mm (width × length) to 25 mm × 25 mm for the 6 W and 8 W sonications, respectively. Conclusion: The combination of interstitial HITU applicators and this software platform holds promise for novel approaches in minimally-invasive MRI-guided therapy, especially when bony structures or air-filled cavities may preclude extracorporeal HIFU.[1] Diederich et al

  20. Impact of geriatric assessment for the therapeutic decision-making of breast cancer: results of a French survey. AFSOS and SOFOG collaborative work.

    Science.gov (United States)

    Falandry, Claire; Krakowski, Ivan; Curé, Hervé; Carola, Elisabeth; Soubeyran, Pierre; Guérin, Olivier; Gaudin, Hélène; Freyer, Gilles

    2018-04-01

    Cancer management in the elderly is often considered as suboptimal, highly variable, and rarely evidence-based. Data are needed to understand decision-making processes in this population. A survey was performed in France to describe decision-making in gynaecologic patients over 70. It followed a three-step method: (1) 101 representative physicians questioned about treatment decision criteria; (2) simplified individual data were collected; (3) as well as detailed data patients receiving chemotherapy. This analysis refers to breast cancer subgroup of patients. Main decision criteria were performance status, comorbidities, and renal function. In adjuvant setting, the main concern was life expectancy, whereas it was quality of life in metastatic setting. Of the 631 patients entered in the simplified analysis, 41% had been evaluated by a geriatrician, 67% received chemotherapy. In the detailed analysis, patients older than 75 were more likely to receive a monochemotherapy and to be treated with weekly/divided dose. In adjuvant setting, respectively, 19, 55, and 26% of the patients were treated with regimen validated in the elderly, validated in a younger population, and not validated. A G-CSF was prescribed in 48% of the patients, as primary prophylaxis in 78 and in 41% of patients with a risk of febrile neutropenia < 10%. Geriatric covariates become an increasing concern in the decision-making process. This survey also suggests an insufficient use of validated chemotherapy regimens. To date, age remains a risk factor for heterogeneity in oncologic practice justifying a persistent effort for elaborating and disclosing specific recommendations.

  1. The influence of interdisciplinary collaboration on decision making: a framework to analyse stakeholder coalitions, evolution and learning in strategic delta planning

    Science.gov (United States)

    Vermoolen, Myrthe; Hermans, Leon

    2015-04-01

    The sustained development of urbanizing deltas requires that conflicting interests are reconciled, in an environment characterized by technical complexity and knowledge limitations. However, integrating ideas and establishing cooperation between actors with different backgrounds and roles still proves a challenge. Agreeing on strategic choices is difficult and implementation of agreed plans may lead to unanticipated and unintended outcomes. How can individual disciplinary perspectives come together and establish a broadly-supported and well-informed plan, the implementation of which contributes to sustainable delta development? The growing recognition of this need to bring together different stakeholders and different disciplinary perspectives runs parallel to a paradigm shift from 'hard' hydrological engineering to multi-functional and more 'soft' hydrological engineering in water management. As a result, there is now more attention for interdisciplinary collaboration that not only takes the physical characteristics of water systems into account, but also the interaction between physical and societal components of these systems. Thus, it is important to study interdisciplinary collaboration and how this influences decision-making. Our research looks into this connection, using a case in delta planning in the Netherlands, where there have been several (attempts for) integration of spatial planning and flood risk/ water management, e.g. in the case of the Dutch Delta Programme. This means that spatial designers and their designs play an important role in the strategic delta planning process as well, next to civil engineers, etc. This study explores the roles of stakeholders, experts and policy makers in interdisciplinary decision-making in dynamic delta planning processes, using theories and methods that focus on coalitions, learning and changes over time in policy and planning processes. This requires an expansion of the existing frameworks to study

  2. The importance of decision-making aids in the energy area: from planning to the management of disorder and climate change

    International Nuclear Information System (INIS)

    Taverdet-Popiolek, N.

    2011-01-01

    The purpose of this article is to situate decision-making aids in the energy area in France and show how the tools have changed over time as a function of the changing economic and political context. The challenges faced, already important in the post-war era due to reconstruction, are now huge due to supply constraints and global warming. While it is the State's responsibility to address these issues, as the players in the energy area currently are mainly in the private sphere, we look at decisions taken both by the State and by companies. Schematically, we compare two major periods: that of post-war planning through the eighties, and that of risk management, which has been current practice since market deregulation. From the methodological standpoint, we show that decision-making aids borrow tools from varied disciplines ranging from economics through management to futurology and long range planning. (author)

  3. A study on making a long-term improvement in the national energy efficiency and GHG control plans by the AHP approach

    International Nuclear Information System (INIS)

    Lee, Seong Kon; Yoon, Yong Jin; Kim, Jong Wook

    2007-01-01

    Owing to the expiration of the national 10-year period plan and the establishment of an efficient energy and resource technology R and D system, the Korean government needs to make a strategic long-term national energy and resource technology R and D plan (NERP) to cope with forthcoming 10-year period. A new NERP aims to improve the energy intensity, reduce the emissions of greenhouse gas within the United Nations framework convention on climate change (UNFCCC), and contribute to the construction of an advanced economic system. We determine the priorities in technology development for the energy efficiency and greenhouse gas control plans (EGCP), which are parts of a new NERP, by using the AHP approach for the first time. We suggest a scientific procedure to determine the priorities in technology development by using AHP

  4. Multi-criteria decision making with linguistic labels: a comparison of two methodologies applied to energy planning

    OpenAIRE

    Afsordegan, Arayeh; Sánchez Soler, Monica; Agell Jané, Núria; Cremades Oliver, Lázaro Vicente; Zahedi, Siamak

    2014-01-01

    This paper compares two multi-criteria decision making (MCDM) approaches based on linguistic label assessment. The first approach consists of a modified fuzzy TOPSIS methodology introduced by Kaya and Kahraman in 2011. The second approach, introduced by Agell et al. in 2012, is based on qualitative reasoning techniques for ranking multi-attribute alternatives in group decision-making with linguistic labels. Both approaches are applied to a case of assessment and selection of the most suita...

  5. Virtual Netherlands : Geo-visualizations for interactive spatial planning and decision-making: From Wow to impact. Definition study.

    NARCIS (Netherlands)

    Riedijk, van A.; Velde, van de R.J.; Pleizier, I.D.; Hoogerwerf, T.C.; Lammeren, van R.J.A.; Baltussen, W.H.M.; Jansen, J.; Wynia, P.; Uum, van J.H.; Wilgenburg, van R.

    2006-01-01

    Dit onderzoekt maakt deel uit van het project virtueel Nederland. Het uitgangspunt van deze studie is: de ruimtelijke planning van Nederland levert betere resultaten op, als gebruik gemaakt wordt van ruimtelijke verbeelding, zoals google earth die biedt, waarin samenwerken: Vrije Universiteit,

  6. Using analytical tools for decision-making and program planning in natural resources: breaking the fear barrier

    Science.gov (United States)

    David L. Peterson; Daniel L. Schmoldt

    1999-01-01

    The National Park Service and other public agencies are increasing their emphasis on inventory and monitoring (I&M) programs to obtain the information needed to infer changes in resource conditions and trigger management responses.A few individuals on a planning team can develop I&M programs, although a focused workshop is more effective.Workshops are...

  7. Challenges in integrating the concept of ecosystem services and values in landscape planning, management and decision making

    NARCIS (Netherlands)

    Groot, de R.S.; Alkemade, J.R.M.; Braat, L.; Hein, L.G.; Willemen, L.L.J.M.

    2010-01-01

    Despite the growing body of literature on ecosystem services, still many challenges remain to structurally integrate ecosystem services in landscape planning, management and design. This paper therefore aims to provide an overview of the challenges involved in applying ecosystem service assessment

  8. Where spatial capacity building and spatial decision making meet. Publically debating participatory spatial planning via a newspaper.

    OpenAIRE

    Huybrechts, Liesbeth; Martens, Sarah; Devisch, Oswald

    2015-01-01

    This article reports on the in-between results of a Participatory Design research process in spatial planning in Godsheide, a small village in the Belgian Region of Limburg. The research explores how the language of newspapers enables citizens, policy makers, property developers and local organisations to build capacities (cfr. spatial capacity building) in ‘scripting’ their reflections on, but also actions in spatial change. In the heads of our participants, there existed a duality between -...

  9. Planned Home VBAC in the United States, 2004-2009: Outcomes, Maternity Care Practices, and Implications for Shared Decision Making.

    Science.gov (United States)

    Cox, Kim J; Bovbjerg, Marit L; Cheyney, Melissa; Leeman, Lawrence M

    2015-12-01

    In the United States, the number of planned home vaginal births after cesarean (VBACs) has increased. This study describes the maternal and neonatal outcomes for women who planned a VBAC at home with midwives who were contributing data to the Midwives Alliance of North America Statistics Project 2.0 cohort during the years 2004-2009. Two subsamples were created from the parent cohort: 12,092 multiparous women without a prior cesarean and 1,052 women with a prior cesarean. Descriptive statistics were calculated for maternal and neonatal outcomes for both groups. Sensitivity analyses comparing women with a prior vaginal birth and those who were at the lowest risk with various subgroups in the parent cohort were also conducted. Women with a prior cesarean had a VBAC rate of 87 percent, although transfer rates were higher compared with women without a prior cesarean (18% vs 7%, p history of cesarean (p = 0.015). Although there is a high likelihood of a vaginal birth at home, women planning a home VBAC should be counseled regarding maternal transfer rates and potential for increased risk to the newborn, particularly if uterine rupture occurs in the home setting. © 2015 Wiley Periodicals, Inc.

  10. Values, beliefs, and attitudes technical guide for Forest Service land and resource management, planning, and decision-making

    Science.gov (United States)

    Stewart D. Allen; Denise A. Wickwar; Fred P. Clark; Robert R. Dow; Robert Potts; Stephanie A. Snyder

    2009-01-01

    In recent years, the Forest Service and the public have placed increasing priority on making sure that management of public lands takes into account the needs of nearby communities, regional residents, national residents, and even members of the public who may not currently visit public lands. As awareness and commitment to this wide range of stakeholders grows, so...

  11. Macromolecular therapeutics.

    Science.gov (United States)

    Yang, Jiyuan; Kopeček, Jindřich

    2014-09-28

    This review covers water-soluble polymer-drug conjugates and macromolecules that possess biological activity without attached low molecular weight drugs. The main design principles of traditional and backbone degradable polymer-drug conjugates as well as the development of a new paradigm in nanomedicines - (low molecular weight) drug-free macromolecular therapeutics are discussed. To address the biological features of cancer, macromolecular therapeutics directed to stem/progenitor cells and the tumor microenvironment are deliberated. Finally, the future perspectives of the field are briefly debated. Copyright © 2014 Elsevier B.V. All rights reserved.

  12. Incorporating ecosystem function concept in environmental planning and decision making by means of multi-criteria evaluation: the case-study of Kalloni, Lesbos, Greece.

    Science.gov (United States)

    Oikonomou, Vera; Dimitrakopoulos, Panayiotis G; Troumbis, Andreas Y

    2011-01-01

    Nature provides life-support services which do not merely constitute the basis for ecosystem integrity but also benefit human societies. The importance of such multiple outputs is often ignored or underestimated in environmental planning and decision making. The economic valuation of ecosystem functions or services has been widely used to make these benefits economically visible and thus address this deficiency. Alternatively, the relative importance of the components of ecosystem value can be identified and compared by means of multi-criteria evaluation. Hereupon, this article proposes a conceptual framework that couples ecosystem function analysis, multi criteria evaluation and social research methodologies for introducing an ecosystem function-based planning and management approach. The framework consists of five steps providing the structure of a participative decision making process which is then tested and ratified, by applying the discrete multi-criteria method NAIADE, in the Kalloni Natura 2000 site, on Lesbos, Greece. Three scenarios were developed and evaluated with regard to their impacts on the different types of ecosystem functions and the social actors' value judgements. A conflict analysis permitted the better elaboration of the different views, outlining the coalitions formed in the local community and shaping the way towards reaching a consensus.

  13. Architecture and Patterns for IT Service Management, Resource Planning, and Governance Making Shoes for the Cobbler's Children

    CERN Document Server

    Betz, Charles T

    2011-01-01

    Information technology supports efficient operations, enterprise integration, and seamless value delivery, yet itself is too often inefficient, un-integrated, and of unclear value. This completely rewritten version of the bestselling Architecture and Patterns for IT Service Management, Resource Planning and Governance retains the original (and still unique) approach: apply the discipline of enterprise architecture to the business of large scale IT management itself. Author Charles Betz applies his deep practitioner experience to a critical reading of ITIL 2011, COBIT version 4, the CMMI suite

  14. City-Level Energy Decision Making: Data Use in Energy Planning, Implementation, and Evaluation in U.S. Cities

    Energy Technology Data Exchange (ETDEWEB)

    Aznar, Alexandra [National Renewable Energy Lab. (NREL), Golden, CO (United States); Day, Megan [National Renewable Energy Lab. (NREL), Golden, CO (United States); Doris, Elizabeth [National Renewable Energy Lab. (NREL), Golden, CO (United States); Mathur, Shivani [National Renewable Energy Lab. (NREL), Golden, CO (United States); Donohoo-Vallett, Paul [US Dept. of Energy, Washington, DC (United States)

    2015-07-01

    The report analyzes and presents information learned from a sample of 20 cities across the United States, from New York City to Park City, Utah, including a diverse sample of population size, utility type, region, annual greenhouse gas reduction targets, vehicle use, and median household income. The report compares climate, sustainability, and energy plans to better understand where cities are taking energy-related actions and how they are measuring impacts. Some common energy-related goals focus on reducing city-wide carbon emissions, improving energy efficiency across sectors, increasing renewable energy, and increasing biking and walking.

  15. Patient Decision-Making About Emergency and Planned Stoma Surgery for IBD: A Qualitative Exploration of Patient and Clinician Perspectives.

    Science.gov (United States)

    Dibley, Lesley; Czuber-Dochan, Wladyslawa; Wade, Tiffany; Duncan, Julie; Burch, Jennie; Warusavitarne, Janindra; Norton, Christine; Artom, Micol; O'Sullivan, Liam; Verjee, Azmina; Cann, Denise

    2018-01-18

    Many inflammatory bowel disease (IBD) patients worry about stoma-forming surgery (SFS), sometimes enduring poor bowel-related quality of life to avoid it. Anticipation of SFS and whether expectations match experience is underreported. This qualitative study explored influences on patients' SFS decision-making and compared preoperative concerns with postoperative outcomes. We purposively recruited participants with IBD from UK hospital outpatient and community sources, and IBD clinicians from public hospitals. Four focus groups, 29 semistructured patient participant interviews, and 18 clinician interviews were audio recorded, transcribed, and analysed thematically. Participants had a current temporary, recently-reversed, or permanent stoma, or were stoma naive. Four themes emerged: Preoperative concerns and expectations, Patient decision-making, Surgery and recovery, and Long-term outcomes. Participants and clinicians agreed about most preoperative concerns, that outcomes were often better than expected, and support from others with a stoma is beneficial. Patient decision-making involves multiple factors, including disease status. Some clinicians avoid discussing SFS, and the phrase 'last resort' can bias patient perceptions; others recommend early discussion, increasing dialogue when medical management becomes ineffective. The postoperative period is particularly challenging for patients. Stoma acceptance is influenced by personal perceptions and pre- and postoperative clinical and social support. Patients need balanced information on all treatment options, including surgery, from an early stage. Early multidisciplinary team dialogue about SFS, and contact with others living well with a stoma, could enable informed decision-making. Life with a stoma is often better than anticipated, improving quality of life and control. Ongoing specialist nursing support aids recovery and adjustment. © 2018 Crohn’s & Colitis Foundation of America. Published by Oxford University

  16. Therapeutic Nanodevices

    Science.gov (United States)

    Lee, Stephen; Ruegsegger, Mark; Barnes, Philip; Smith, Bryan; Ferrari, Mauro

    Therapeutic nanotechnology offers minimally invasive therapies with high densities of function concentrated in small volumes, features that may reduce patient morbidity and mortality. Unlike other areas of nanotechnology, novel physical properties associated with nanoscale dimensionality are not the raison d'être of therapeutic nanotechnology, whereas the aggregation of multiple biochemical (or comparably precise) functions into controlled nanoarchitectures is. Multifunctionality is a hallmark of emerging nanotherapeutic devices, and multifunctionality can allow nanotherapeutic devices to perform multistep work processes, with each functional component contributing to one or more nanodevice subroutine such that, in aggregate, subroutines sum to a cogent work process. Cannonical nanotherapeutic subroutines include tethering (targeting) to sites of disease, dispensing measured doses of drug (or bioactive compound), detection of residual disease after therapy and communication with an external clinician/operator. Emerging nanotherapeutics thus blur the boundaries between medical devices and traditional pharmaceuticals. Assembly of therapeutic nanodevices generally exploits either (bio)material self-assembly properties or chemoselective bioconjugation techniques, or both. Given the complexity, composition, and the necessity for their tight chemical and structural definition inherent in the nature of nanotherapeutics, their cost of goods (COGs) might exceed that of (already expensive) biologics. Early therapeutic nanodevices will likely be applied to disease states which exhibit significant unmet patient need (cancer and cardiovascular disease), while application to other disease states well-served by conventional therapy may await perfection of nanotherapeutic design and assembly protocols.

  17. Planning of renewables schemes: Deliberative and fair decision-making on landscape issues instead of reproachful accusations of non-cooperation

    International Nuclear Information System (INIS)

    Wolsink, Maarten

    2007-01-01

    The main issues related to successful implementation policies concern the socio-economic institutions that are conditional to planning in the energy policy domain, but also in the domain of spatial planning. Successful investments and the siting of renewable power plants eventually determine the success rate of national efforts in establishing renewable capacity. Central planning usually has several objectives and these often have a detrimental effect on the goal of renewable energy application. Current problems related to implementation decisions concerning wind power schemes are an example to those who will be faced by other renewable power plants, notably biomass. Regarding community acceptance of wind power schemes, the visual evaluation of the impact of wind power on the values of the landscape is by far the most dominant factor in explaining opposition or support. Type of landscape fully overshadows other attitudinal attributes, as well as other visual and scenic factors such as the design of wind turbines and wind farms, and the number and the size of turbines. Planning regimes and decision-making practices that really enhance the implementation processes of renewable energy require 'strong' ecological modernization. This means institutional changes that create involvement and trust of actors at the actual implementation level. Local opposition cannot be explained by the egotistical motives of local residents. When the inclination to behave according to (supposed) backyard motives is investigated, the scale to measure this phenomenon appears to indicate commitment to equity issues and fairness of decision-making. Hence, for wind power, local involvement to represent the local values of site-specific landscapes is crucial. For other renewables the source-specific features are different, but conflicts can be expected as well because the fairness of implementation decisions will be equally significant

  18. Insights into water managers' perception and handling of uncertainties - a study of the role of uncertainty in practitioners' planning and decision-making

    Science.gov (United States)

    Höllermann, Britta; Evers, Mariele

    2017-04-01

    Planning and decision-making under uncertainty is common in water management due to climate variability, simplified models, societal developments, planning restrictions just to name a few. Dealing with uncertainty can be approached from two sites, hereby affecting the process and form of communication: Either improve the knowledge base by reducing uncertainties or apply risk-based approaches to acknowledge uncertainties throughout the management process. Current understanding is that science more strongly focusses on the former approach, while policy and practice are more actively applying a risk-based approach to handle incomplete and/or ambiguous information. The focus of this study is on how water managers perceive and handle uncertainties at the knowledge/decision interface in their daily planning and decision-making routines. How they evaluate the role of uncertainties for their decisions and how they integrate this information into the decision-making process. Expert interviews and questionnaires among practitioners and scientists provided an insight into their perspectives on uncertainty handling allowing a comparison of diverse strategies between science and practice as well as between different types of practitioners. Our results confirmed the practitioners' bottom up approach from potential measures upwards instead of impact assessment downwards common in science-based approaches. This science-practice gap may hinder effective uncertainty integration and acknowledgement in final decisions. Additionally, the implementation of an adaptive and flexible management approach acknowledging uncertainties is often stalled by rigid regulations favouring a predict-and-control attitude. However, the study showed that practitioners' level of uncertainty recognition varies with respect to his or her affiliation to type of employer and business unit, hence, affecting the degree of the science-practice-gap with respect to uncertainty recognition. The level of working

  19. Methodology of environmental diagnosis for construction and demolition waste landfills: a tool for planning and making decisions.

    Science.gov (United States)

    Garrido, E; Calvo, F; Ramos, A F; Zamorano, M

    2005-11-01

    Current legislation in the European Union regarding landfills provides measures, procedures and guidance to prevent or reduce, insofar as possible, negative effects on the environment. This means that Member States must take measures so that landfills cannot operate unless the operator first presents a plan for the site, which includes the implementation of improvements considered necessary by the engineer for compliance with regulations. Researchers at the University of Granada have developed a method to ascertain the degree of environmental impact that a construction and demolition waste landfill may produce on its immediate surroundings. This methodology is based on environmental indexes; its objective is to give crucial information concerning possible environmental problems produced by a landfill. The data thus obtained will permit the elaboration of guidelines for improvements in the location, design, and operation of landfills, or in extreme cases, their dosing, sealing, and rehabilitation.

  20. Use of Bayesian Networks to Analyze Port Variables in Order to Make Sustainable Planning and Management Decision

    Directory of Open Access Journals (Sweden)

    Beatriz Molina Serrano

    2018-01-01

    Full Text Available In the current economic, social and political environment, society demands a greater variety of outcomes from the public logistics sector, such as efficiency, efficiency of managed resources, greater transparency and business performance. All of them are an indispensable counterpart for its recognition and support. In case of port planning and management, many variables are included. Use of Bayesian Networks allows to classify, predict and diagnose these variables and even to estimate the subsequent probability of unknown variables, basing on the known ones. Research includes a data base with more than 40 variables, which have been classified as smart port studies in Spain. Then a network was generated using a non-cyclic conducted grafo, which shows port variable relationships. As conclusion, economic variables are cause of the rest of categories and they represent a parent role in the most of cases. Furthermore, if environmental variables are known, subsequent probability of social variables can be estimated.

  1. Patients who make terrible therapeutic choices.

    Science.gov (United States)

    Curzer, Howard J

    2014-01-01

    The traditional approaches to dental ethics include appeals to principles, duties (deontology), and consequences (utilitarianism). These approaches are often inadequate when faced with the case of a patient who refuses reasonable treatment and does not share the same ethical framework the dentist is using. An approach based on virtue ethics may be helpful in this and other cases. Virtue ethics is a tradition going back to Plato and Aristotle. It depends on forming a holistic character supporting general appropriate behavior. By correctly diagnosing the real issues at stake in a patient's inappropriate oral health choices and working to build effective habits, dentists can sometimes respond to ethical challenges that remain intractable given rule-based methods.

  2. Make It Intuitive: An Evaluation Practice Emergent From The Plans And Scripted Behavior Of The Computer-community Of Practice

    Directory of Open Access Journals (Sweden)

    Pat Lehane

    2012-01-01

    Full Text Available The catch phrase today for system designers is to “make it intuitive,” which begs the question, what is intuitive? The action research discussed in this article was the final stage of the application of grounded theory to user data that provided survey categories (criteria for system acceptance. A theoretical rationale from the discipline of human–computer interaction was proposed to provide a consistent and repeatable interpretation of the users’ responses to the survey and directly align the responses to software design considerations. To put this work into context, I discuss in this article a case study on the use of the survey to monitor the user experience during the upgrade of an enterprise system and the subsequent implications and outcomes of applying the theoretical paradigm in practice. As such it may provide food for thought on survey design for elicitation of user requirements for information and communication technology systems.

  3. Differences in eighth grade science student and teacher perceptions of students' level of input into academic planning and decision making

    Science.gov (United States)

    Chapman, Jarrett Michael

    Teachers are expected to improve their planning, instruction, and assessment as they progress through their career. An important component to teachers knowing what to modify in their teaching style is being able to solicit meaningful feedback from students. This mixed-methods study was conducted to provide teachers with a quantitative method to collect data about their teaching using the Constructivist Learning Environment Survey (CLES). Phase 1 allowed students to provide anonymous feedback to their teachers that the teachers could later reflect upon in conjunction with the students' other feedback. Using measures of central tendencies, it was determined that of the five categories of the CLES the area of student negotiation was statistically different from the other categories. While eight teachers had sufficient (n>10) student data to be invited to participate in Phase 2, only five of the teachers choose to participate in a semi-structured interview to further examine the potential differences between teacher and student perception of student negotiation with the curriculum, instruction and assessment that occurs in the classroom. Coding the interview transcripts led to three categories: 1) teaching style (with themes including curriculum, instruction, and assessment, and sub themes of teacher centered and student centered); 2) external pressures (with themes of standards , standardized tests, and socioeconomic conditions); 3) effectiveness of student negotiation (with themes of positive effect or no effect on motivation). The five teachers who participated in Phase 2 had varying levels of awareness and willingness to adjust their classroom curriculum, instruction, and assessment to include student negotiation. All but one teacher, however, saw the value in increasing student negotiation in the classroom and desired to continue to change their teaching to include more student negotiation.

  4. Strategic planning to reduce the burden of stroke among veterans: using simulation modeling to inform decision making.

    Science.gov (United States)

    Lich, Kristen Hassmiller; Tian, Yuan; Beadles, Christopher A; Williams, Linda S; Bravata, Dawn M; Cheng, Eric M; Bosworth, Hayden B; Homer, Jack B; Matchar, David B

    2014-07-01

    Reducing the burden of stroke is a priority for the Veterans Affairs Health System, reflected by the creation of the Veterans Affairs Stroke Quality Enhancement Research Initiative. To inform the initiative's strategic planning, we estimated the relative population-level impact and efficiency of distinct approaches to improving stroke care in the US Veteran population to inform policy and practice. A System Dynamics stroke model of the Veteran population was constructed to evaluate the relative impact of 15 intervention scenarios including both broad and targeted primary and secondary prevention and acute care/rehabilitation on cumulative (20 years) outcomes including quality-adjusted life years (QALYs) gained, strokes prevented, stroke fatalities prevented, and the number-needed-to-treat per QALY gained. At the population level, a broad hypertension control effort yielded the largest increase in QALYs (35,517), followed by targeted prevention addressing hypertension and anticoagulation among Veterans with prior cardiovascular disease (27,856) and hypertension control among diabetics (23,100). Adjusting QALYs gained by the number of Veterans needed to treat, thrombolytic therapy with tissue-type plasminogen activator was most efficient, needing 3.1 Veterans to be treated per QALY gained. This was followed by rehabilitation (3.9) and targeted prevention addressing hypertension and anticoagulation among those with prior cardiovascular disease (5.1). Probabilistic sensitivity analysis showed that the ranking of interventions was robust to uncertainty in input parameter values. Prevention strategies tend to have larger population impacts, though interventions targeting specific high-risk groups tend to be more efficient in terms of number-needed-to-treat per QALY gained. © 2014 American Heart Association, Inc.

  5. Structurally Based Therapeutic Evaluation: A Therapeutic and Practical Approach to Teaching Medicinal Chemistry.

    Science.gov (United States)

    Alsharif, Naser Z.; And Others

    1997-01-01

    Explains structurally based therapeutic evaluation of drugs, which uses seven therapeutic criteria in translating chemical and structural knowledge into therapeutic decision making in pharmaceutical care. In a Creighton University (Nebraska) medicinal chemistry course, students apply the approach to solve patient-related therapeutic problems in…

  6. Equity monitoring for social marketing: use of wealth quintiles and the concentration index for decision making in HIV prevention, family planning, and malaria programs

    Science.gov (United States)

    2013-01-01

    Background The majority of social marketing programs are intended to reach the poor. It is therefore essential that social marketing organizations monitor the health equity of their programs and improve targeting when the poor are not being reached. Current measurement approaches are often insufficient for decision making because they fail to show a program's ability to reach the poor and demonstrate progress over time. Further, effective program equity metrics should be benchmarked against a national reference population and consider exposure, not just health outcomes, to measure direct results of implementation. This study compares two measures of health equity, concentration indices and wealth quintiles, using a defined reference population, and considers benefits of both measures together to inform programmatic decision making. Methods Three datasets from recent cross-sectional behavioral surveys on malaria, HIV, and family planning from Nepal and Burkina Faso were used to calculate concentration indices and wealth quintiles. Each sample was standardized to national wealth distributions based on recent Demographic and Health Surveys. Wealth quintiles were generated and concentration indices calculated for health outcomes and program exposure in each sample. Chi-square and t-tests were used to assess statistical significance of results. Results Reporting wealth quintiles showed that recipients of Population Services International (PSI) interventions were wealthier than national populations. Both measures indicated that desirable health outcomes were usually concentrated among wealthier populations. Positive and significant concentration indices in all three surveys indicated that wealth and program exposure were correlated; however this relationship was not necessarily linear. In analyzing the equity of modern contraceptive use stratified by exposure to family planning messages in Nepal, the outcome was equitable (concentration index = 0.006, p = 0.68) among the

  7. Equity monitoring for social marketing: use of wealth quintiles and the concentration index for decision making in HIV prevention, family planning, and malaria programs.

    Science.gov (United States)

    Chakraborty, Nirali M; Firestone, Rebecca; Bellows, Nicole

    2013-01-01

    The majority of social marketing programs are intended to reach the poor. It is therefore essential that social marketing organizations monitor the health equity of their programs and improve targeting when the poor are not being reached. Current measurement approaches are often insufficient for decision making because they fail to show a program's ability to reach the poor and demonstrate progress over time. Further, effective program equity metrics should be benchmarked against a national reference population and consider exposure, not just health outcomes, to measure direct results of implementation. This study compares two measures of health equity, concentration indices and wealth quintiles, using a defined reference population, and considers benefits of both measures together to inform programmatic decision making. Three datasets from recent cross-sectional behavioral surveys on malaria, HIV, and family planning from Nepal and Burkina Faso were used to calculate concentration indices and wealth quintiles. Each sample was standardized to national wealth distributions based on recent Demographic and Health Surveys. Wealth quintiles were generated and concentration indices calculated for health outcomes and program exposure in each sample. Chi-square and t-tests were used to assess statistical significance of results. Reporting wealth quintiles showed that recipients of Population Services International (PSI) interventions were wealthier than national populations. Both measures indicated that desirable health outcomes were usually concentrated among wealthier populations. Positive and significant concentration indices in all three surveys indicated that wealth and program exposure were correlated; however this relationship was not necessarily linear. In analyzing the equity of modern contraceptive use stratified by exposure to family planning messages in Nepal, the outcome was equitable (concentration index = 0.006, p = 0.68) among the exposed, while the wealthy

  8. Three-dimensional-printed cardiac prototypes aid surgical decision-making and preoperative planning in selected cases of complex congenital heart diseases: Early experience and proof of concept in a resource-limited environment

    Directory of Open Access Journals (Sweden)

    Mahesh Kappanayil

    2017-01-01

    Conclusions: 3D-printed cardiac prototypes can radically assist decision-making, planning, and safe execution of complex congenital heart surgery by improving understanding of 3D anatomy and allowing anticipation of technical challenges.

  9. Incorporating palaeoclimate data into water security planning and decision making - a case study from southeast Queensland, Australia

    Science.gov (United States)

    Kiem, Anthony; Vance, Tessa; Tozer, Carly; Roberts, Jason

    2017-04-01

    Regional Stochastic Model (SEQRSM) of catchment hydrology to (a) demonstrate the utility of a palaeoclimate proxy approach in producing more robust estimates of hydroclimatic risk under climate variability and change; (b) gain improved insights into the characteristics (e.g. location, duration, frequency, magnitude, spatial extent, sequencing) of hydroclimate extremes for water security planning and (c) deliver optimised solutions for hydroclimatic risk adaptation strategies to water managers (e.g. optimal and sustainable supply of water to meet current and future urban requirements and also to nearby catchments to support irrigation for dairy, vegetable and forage crops).

  10. Tourism climatology: evaluating environmental information for decision making and business planning in the recreation and tourism sector.

    Science.gov (United States)

    de Freitas, C R

    2003-09-01

    This work grew from initiatives of the International Society of Biometeorology's Commission on Climate, Tourism and Recreation (ISBCCTR). The ISBCCTR was formed during the 15th Congress of the ISB held in November 1999 in Sydney, Australia. The aim of ISBCCTR is to promote research in tourism climatology. The first formal meeting of the Commission took place at the Meliton Resort, Halkidiki, Greece, 5-10 October 2001. The aims were to (1) bring together a selection of scientists and tourism experts to review the current state of knowledge of tourism climatology and (2) explore areas and priorities for future work and the role of the Commission in this. The Workshop highlighted the fact that, although climate is widely recognised as vitally important to tourism, relatively little is known about its effects. Even less is known about the economic impact or significance of climate on commercial prospects for tourism. Important research themes that warrant attention were identified. Among these was the need for a tourism climate index (or indices) that integrates all facets of climate, uses standard data and is objectively tested and verified. Work is also required on developing a better understanding of what climate-related information is required by both tourists and the tourism industry, exploring the distinction between the impact of climate on tourists and the impact on the tourism industry, setting a standard approach to tourism climate assessment, assessing the role of weather forecasts and long-term expectations of climate on choices made by tourists, the risks to tourism caused by extreme atmospheric events, what climate-related criteria people use to make decisions about tourism and recreational choices, how products giving information about weather and climate are currently used by the recreation and tourism industry and what are the existing and future requirements for this climate information.

  11. Integration of IAM and GIS technologies to support decision making in the planning and procurement of physical infrastructure for the treatment of drug-resistant tuberculosis in South Africa

    CSIR Research Space (South Africa)

    Abbott, GR

    2008-10-01

    Full Text Available approach to strategic planning and the provision of accommodation be developed. This paper provides an overview of new processes and a toolkit being developed in South Africa to support decision making in the planning, procurement, management and operation...

  12. Therapeutic ultrasound

    International Nuclear Information System (INIS)

    Crum, Lawrence A

    2004-01-01

    The use of ultrasound in medicine is now quite commonplace, especially with the recent introduction of small, portable and relatively inexpensive, hand-held diagnostic imaging devices. Moreover, ultrasound has expanded beyond the imaging realm, with methods and applications extending to novel therapeutic and surgical uses. These applications broadly include: tissue ablation, acoustocautery, lipoplasty, site-specific and ultrasound mediated drug activity, extracorporeal lithotripsy, and the enhancement of natural physiological functions such as wound healing and tissue regeneration. A particularly attractive aspect of this technology is that diagnostic and therapeutic systems can be combined to produce totally non-invasive, imageguided therapy. This general lecture will review a number of these exciting new applications of ultrasound and address some of the basic scientific questions and future challenges in developing these methods and technologies for general use in our society. We shall particularly emphasize the use of High Intensity Focused Ultrasound (HIFU) in the treatment of benign and malignant tumors as well as the introduction of acoustic hemostasis, especially in organs which are difficult to treat using conventional medical and surgical techniques. (amum lecture)

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

    Science.gov (United States)

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

    2015-11-01

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

  14. Exubera. Inhale therapeutic systems.

    Science.gov (United States)

    Bindra, Sanjit; Cefalu, William T

    2002-05-01

    Inhale, in colaboration with Pfizer and Aventis Pharma (formerly Hoechst Marion Roussel; HMR), is developing an insulin formulation utilizing its pulmonary delivery technology for macromolecules for the potential treatment of type I and II diabetes. By July 2001, the phase III program had been completed and the companies had begun to assemble data for MAA and NDA filings; however, it was already clear at this time that additional data might be required for filing. By December 2001, it had been decided that the NDA should include an increased level of controlled, long-term pulmonary safety data in diabetic patients and a major study was planned to be completed in 2002, with the NDA filed thereafter (during 2002). US-05997848 was issued to Inhale Therapeutic Systems in December 1999, and corresponds to WO-09524183, filed in February 1995. Equivalent applications have appeared to date in Australia, Brazil, Canada, China, Czech Republic, Europe, Finland, Hungary, Japan, Norway, New Zealand, Poland and South Africa. This family of applications is specific to pulmonary delivery of insulin. In February 1999, Lehman Brothers gave this inhaled insulin a 60% probability of reaching market, with a possible launch date of 2001. The analysts estimated peak sales at $3 billion in 2011. In May 2000, Aventis predicted that estimated peak sales would be in excess of $1 billion. In February 2000, Merrill Lynch expected product launch in 2002 and predicted that it would be a multibillion-dollar product. Analysts Merril Lynch predicted, in September and November 2000, that the product would be launched by 2002, with sales in that year of e75 million, rising to euro 500 million in 2004. In April 2001, Merrill Lynch predicted that filing for this drug would occur in 2001. Following the report of the potential delay in regulatory filing, issued in July 2001, Deutsche Banc Alex Brown predicted a filing would take place in the fourth quarter of 2002 and launch would take place in the first

  15. Meticulous plans make plant sail

    International Nuclear Information System (INIS)

    Anon.

    1984-01-01

    It takes about five years for a top nuclear builder in the US to bring in a new plant. In Japan, they'd already be working on the second unit. The reasons why the Japanese can construct a nuclear power plant 2-7 years ahead of their US counterparts is discussed

  16. Communications, Immunization, and Polio Vaccines: Lessons From a Global Perspective on Generating Political Will, Informing Decision-Making and Planning, and Engaging Local Support.

    Science.gov (United States)

    Menning, Lisa; Garg, Gaurav; Pokharel, Deepa; Thrush, Elizabeth; Farrell, Margaret; Kodio, Frederic Kunjbe; Veira, Chantal Laroche; Wanyoike, Sarah; Malik, Suleman; Patel, Manish; Rosenbauer, Oliver

    2017-07-01

    The requirements under objective 2 of the Polio Eradication and Endgame Strategic Plan 2013-2018-to introduce at least 1 dose of inactivated poliomyelitis vaccine (IPV); withdraw oral poliomyelitis vaccine (OPV), starting with the type 2 component; and strengthen routine immunization programs-set an ambitious series of targets for countries. Effective implementation of IPV introduction and the switch from trivalent OPV (containing types 1, 2, and 3 poliovirus) to bivalent OPV (containing types 1 and 3 poliovirus) called for intense global communications and coordination on an unprecedented scale from 2014 to 2016, involving global public health technical agencies and donors, vaccine manufacturers, World Health Organization and United Nations Children's Fund regional offices, and national governments. At the outset, the new program requirements were perceived as challenging to communicate, difficult to understand, unrealistic in terms of timelines, and potentially infeasible for logistical implementation. In this context, a number of core areas of work for communications were established: (1) generating awareness and political commitment via global communications and advocacy; (2) informing national decision-making, planning, and implementation; and (3) in-country program communications and capacity building, to ensure acceptance of IPV and continued uptake of OPV. Central to the communications function in driving progress for objective 2 was its ability to generate a meaningful policy dialogue about polio vaccines and routine immunization at multiple levels. This included efforts to facilitate stakeholder engagement and ownership, strengthen coordination at all levels, and ensure an iterative process of feedback and learning. This article provides an overview of the global efforts and challenges in successfully implementing the communications activities to support objective 2. Lessons from the achievements by countries and partners will likely be drawn upon when

  17. Malignant mesothelioma: biology, diagnosis and therapeutic approaches

    Czech Academy of Sciences Publication Activity Database

    Tomasetti, M.; Amati, M.; Santarelli, L.; Alleva, R.; Neužil, Jiří

    2009-01-01

    Roč. 2, č. 2 (2009), s. 190-206 ISSN 1874-4672 Institutional research plan: CEZ:AV0Z50520514 Keywords : malignant mesothelioma * biology * diagnosis and therapeutic approaches Subject RIV: EB - Genetics ; Molecular Biology

  18. Cognitive Biases and Structural Failures in United States Foreign Policy: Explaining Decision-Making Dissonance in Phase IV Policy and Plans for Iraq

    National Research Council Canada - National Science Library

    Hafner, Ferinand

    2007-01-01

    After planning from September 2001 to May 2003, the George W. Bush administration failed to implement a coherent national plan at the transition to Stability, Security, Transition, and Reconstruction (SSTR) operations in Iraq...

  19. A Unified Electronic Tool for CPR and Emergency Treatment Escalation Plans Improves Communication and Early Collaborative Decision Making for Acute Hospital Admissions.

    Science.gov (United States)

    Johnson, Mae; Whyte, Martin; Loveridge, Robert; Yorke, Richard; Naleem, Shairana

    2017-01-01

    The National Confidential Enquiry into Patient Outcomes and Death (NCEPOD) report 'Time to Intervene' (2012) stated that in a substantial number of cases, resuscitation is attempted when it was thought a 'do not attempt cardiopulmonary resuscitation' (DNACPR) decision should have been in place. Early decisions about CPR status and advance planning about limits of care now form part of national recommendations by the UK Resuscitation Council (2016). Treatment escalation plans (TEP) document what level of treatment intervention would be appropriate if a patient were to become acutely unwell and were not previously formally in place at King's College Hospital. A unifying paper based form was successfully piloted in the Acute Medical Unit, introducing the TEP and bringing together decision making around both treatment escalation and CPR status. Subsequently an electronic order-set for CPR status and treatment escalation was launched in April 2015 which led to a highly visible CPR and escalation status banner on the main screen at the top of the patient's electronic record. Ultimately due to further iterations in the electronic process by December 2016, all escalation decisions for acutely admitted patients now have high quality supporting, explanatory documentation with 100% having TEPs in place. There is now widespread multidisciplinary engagement in the process of defining limits of care for acutely admitted medical patients within the first 14 hours of admission and a strategy for rolling this process out across all the divisions of the hospital through our Deteriorating Patient Group (DPG). The collaborative design with acute medical, palliative and intensive care teams and the high visibility provided by the electronic process in the Electronic Patient Record (EPR) has enhanced communication with these teams, patients, nursing staff and the multidisciplinary team by ensuring clarity through a universally understood process about escalation and CPR. Clarity and

  20. Interactive Strategy-Making

    DEFF Research Database (Denmark)

    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...

  1. Planning Meals

    Science.gov (United States)

    ... Take the guess work out of what to eat using our tips, recipes and sample meals. Featured Book: Ultimate Diabetes Meal Planner includes weekly plans for breakfast, lunch, dinner, and snacks, along with detailed recipes that make ...

  2. [Regional protocol for adjusting the therapeutic intensity. Southern Metropolitan Area of Barcelona].

    Science.gov (United States)

    Fontecha-Gómez, Benito Jesús; Amblàs-Novellas, Jordi; Betancor-Santana, Évora; Rexach-Cano, Lourdes; Ugarte, Marina Isabel; López-Pérez, Araceli; Planas, Kenneth; Gutiérrez Jiménez, Nuria; Casas Floriano, Rosario; García-Fortea, Cristina; Serrano Bermúdez, Gala; Rotllàn-Terradellas, María; Fernández-Ponce, Daniel

    2018-02-20

    The identification of patients with advanced and complex chronic diseases, and the fragmentation of care towards the end of life, requires the drawing up a long-term therapeutic plan. This should take into account the values and preferences of the patients, as well as the vital and functional prognosis. Having an adjustment tool for determining the diagnostic and therapeutic effort is helpful in the continuity of care, as well as in decision-making in the transitions and dynamic changes of patients as they approach the end of life process. Copyright © 2018 SEGG. Publicado por Elsevier España, S.L.U. All rights reserved.

  3. PlanYourLifeSpan.org - an intervention to help seniors make choices for their fourth quarter of life: Results from the randomized clinical trial.

    Science.gov (United States)

    Lindquist, Lee A; Ramirez-Zohfeld, Vanessa; Sunkara, Priya D; Forcucci, Chris; Campbell, Dianne S; Mitzen, Phyllis; Ciolino, Jody D; Gregory, Dyanna; Kricke, Gayle; Cameron, Kenzie A

    2017-11-01

    Few older adults contemplate their home support and health needs that may be required for aging-in-place. We sought to assess the efficacy of PlanYourLifespan.org (PYL), in influencing seniors' planning behaviors, perception of the importance of planning, and confidence accessing services. Randomized controlled trial, of adults, age ≥65 years in urban, suburban, rural areas of Texas, Illinois, Indiana. Among 385 participants, mean age was 71.9 years, 79.5% female. Between baseline and one-month follow-up, average planning behavior score increased 0.22 points in the PYL arm when compared to the attention control (AC) arm. After controlling for baseline, mean one-month planning behavior score was significantly higher in the PYL arm than in the AC arm (1.25 points, CI 0.37-2.12, p=0.005). Secondary analyses via longitudinal linear mixed modelling suggested a study arm-by-time interaction effect for both planning behavior (p=0.047 and perception of importance (p=0.05). Significant baseline covariates included self-efficacy, education, perceived social support, power of attorney, and history of stroke. PlanYourLifespan.org demonstrated efficacy in helping seniors plan for and communicate their health support needs. This free, nationally available tool may help individuals understand, plan, and communicate their options for their future support needs. Copyright © 2017 Elsevier B.V. All rights reserved.

  4. Making a Difference in Research and Practice: A Commentary on "Consulting to Facilitate Planned Organizational Change in Schools," an Article by Joseph E. Zins and Robert J. Illback

    Science.gov (United States)

    Flaspohler, Paul D.

    2007-01-01

    Zins and Illback observed in 1995 that planned organizational change processes were neglected in practice, training, and research. In the decade following publication of their article, implementation of processes and structures of planned organizational change increased dramatically. Schools and school districts continue to face increased…

  5. Assessing the health equity impacts of regional land-use plan making: An equity focussed health impact assessment of alternative patterns of development of the Whitsunday Hinterland and Mackay Regional Plan, Australia (Short report)

    International Nuclear Information System (INIS)

    Gunning, Colleen; Harris, Patrick; Mallett, John

    2011-01-01

    Health service and partners completed an equity focussed health impact assessment to influence the consideration of health and equity within regional land-use planning in Queensland, Australia. This project demonstrated how an equity oriented assessment matrix can assist in testing regional planning scenarios. It is hoped that this HIA will contribute to the emerging interest in ensuring that potential differential health impacts continue to be considered as part of land-use planning processes.

  6. A user perspective on the gap between science and decision-making. Local administrators’ views on expert knowledge in urban planning

    NARCIS (Netherlands)

    Stigt, van Rien; Driessen, P.J.; Spit, Tejo

    2015-01-01

    The role of expert knowledge of the environment in decision-making about urban development has been intensively debated. Most contributions to this debate have studied the use of knowledge in the decision-making process from the knowledge providers’ point of view. In this paper, we reverse the

  7. Three-dimensional-printed cardiac prototypes aid surgical decision-making and preoperative planning in selected cases of complex congenital heart diseases: Early experience and proof of concept in a resource-limited environment.

    Science.gov (United States)

    Kappanayil, Mahesh; Koneti, Nageshwara Rao; Kannan, Rajesh R; Kottayil, Brijesh P; Kumar, Krishna

    2017-01-01

    Three-dimensional. (3D) printing is an innovative manufacturing process that allows computer-assisted conversion of 3D imaging data into physical "printouts" Healthcare applications are currently in evolution. The objective of this study was to explore the feasibility and impact of using patient-specific 3D-printed cardiac prototypes derived from high-resolution medical imaging data (cardiac magnetic resonance imaging/computed tomography [MRI/CT]) on surgical decision-making and preoperative planning in selected cases of complex congenital heart diseases (CHDs). Five patients with complex CHD with previously unresolved management decisions were chosen. These included two patients with complex double-outlet right ventricle, two patients with criss-cross atrioventricular connections, and one patient with congenitally corrected transposition of great arteries with pulmonary atresia. Cardiac MRI was done for all patients, cardiac CT for one; specific surgical challenges were identified. Volumetric data were used to generate patient-specific 3D models. All cases were reviewed along with their 3D models, and the impact on surgical decision-making and preoperative planning was assessed. Accurate life-sized 3D cardiac prototypes were successfully created for all patients. The models enabled radically improved 3D understanding of anatomy, identification of specific technical challenges, and precise surgical planning. Augmentation of existing clinical and imaging data by 3D prototypes allowed successful execution of complex surgeries for all five patients, in accordance with the preoperative planning. 3D-printed cardiac prototypes can radically assist decision-making, planning, and safe execution of complex congenital heart surgery by improving understanding of 3D anatomy and allowing anticipation of technical challenges.

  8. Promoting the Involvement of Students with Emotional and Behavioral Disorders in Career and Vocational Planning and Decision-Making: The Self-Determined Career Development Model

    Science.gov (United States)

    Benitez, Debra T.; Lattimore, Jennifer; Wehmeyer, Michael L.

    2005-01-01

    The authors examined the effectiveness of a support model to instruct five youth with EBD to self-direct the problem-solving processes and promote self-determination skills by enabling them to: (a) set employment/career related goals, (b) develop and implement a plan toward goal attainment; and (c) adjust and evaluate progress toward meeting their…

  9. Making High Schools Work through Blended Instruction. A Vision and Plan for the Integration of Academic and Career and Technology Education in Maryland.

    Science.gov (United States)

    Maryland State Dept. of Education, Baltimore.

    A team consisting of Maryland State Department of Education (MSDE) staff, local educators, and other representatives developed an action plan to assist in advancing the blending of academic, career, and technology education. The team prepared a vision statement, set strategic directions, analyzed barriers, and developed recommendations and actions…

  10. Mitigating Evidentiary Bias in Planning and Policy-Making; Comment on “Reflective Practice: How the World Bank Explored Its Own Biases?”

    Directory of Open Access Journals (Sweden)

    Justin Parkhurst

    2017-02-01

    Full Text Available The field of cognitive psychology has increasingly provided scientific insights to explore how humans are subject to unconscious sources of evidentiary bias, leading to errors that can affect judgement and decision-making. Increasingly these insights are being applied outside the realm of individual decision-making to the collective arena of policy-making as well. A recent editorial in this journal has particularly lauded the work of the World Bank for undertaking an open and critical reflection on sources of unconscious bias in its own expert staff that could undermine achievement of its key goals. The World Bank case indeed serves as a remarkable case of a global policy-making agency making its own critical reflections transparent for all to see. Yet the recognition that humans are prone to cognitive errors has been known for centuries, and the scientific exploration of such biases provided by cognitive psychology is now well-established. What still remains to be developed, however, is a widespread body of work that can inform efforts to institutionalise strategies to mitigate the multiple sources and forms of evidentiary bias arising within administrative and policy-making environments. Addressing this gap will require a programme of conceptual and empirical work that supports robust development and evaluation of institutional bias mitigation strategies. The cognitive sciences provides a scientific basis on which to proceed, but a critical priority will now be the application of that science to improve policy-making within those agencies taking responsibility for social welfare and development programmes.

  11. Energetic sustainability of the electric sector: towards a model of support for planning and decision making; Sustentabilidade energetica do setor eletrico: em direcao a um modelo de apoio ao planejamento e a tomada de decisao

    Energy Technology Data Exchange (ETDEWEB)

    Machado, Fernando Vieira; Jannuzzi, Gilberto de Martino; Guimaraes, Roberto [Universidade Estadual de campinas (UNICAMP), SP (Brazil)

    2008-07-01

    The objective of this article is to present in the form still preliminary a proposal of a computational model of support to the planning and decision-making process to investors, planners and regulators of the electric sector so that be possible to make sure the supply of electricity with sustainability and low economics and social impacts. The support to the decision-making process depends of interactions of economical, social, technological and environmental aspects that here are exposed by the use of dynamics models for ecosystems services: MIMES (Multi-scale Integrated Model of the Earth's System) and Simile. The quantitative models are important so that the planners can adopt effectively the concept of sustainability in public politics. The activity of modeling of sustainability for the electrical sector requires an interdisciplinary vision to adapt the different involved concepts and, so, to structure the model in the better way. (author)

  12. Energetic sustainability of the electric sector: towards a model of support for planning and decision making; Sustentabilidade energetica do setor eletrico: em direcao a um modelo de apoio ao planejamento e a tomada de decisao

    Energy Technology Data Exchange (ETDEWEB)

    Machado, Fernando Vieira; Jannuzzi, Gilberto de Martino; Guimaraes, Roberto [Universidade Estadual de campinas (UNICAMP), SP (Brazil)

    2008-07-01

    The objective of this article is to present in the form still preliminary a proposal of a computational model of support to the planning and decision-making process to investors, planners and regulators of the electric sector so that be possible to make sure the supply of electricity with sustainability and low economics and social impacts. The support to the decision-making process depends of interactions of economical, social, technological and environmental aspects that here are exposed by the use of dynamics models for ecosystems services: MIMES (Multi-scale Integrated Model of the Earth's System) and Simile. The quantitative models are important so that the planners can adopt effectively the concept of sustainability in public politics. The activity of modeling of sustainability for the electrical sector requires an interdisciplinary vision to adapt the different involved concepts and, so, to structure the model in the better way. (author)

  13. Broad Scale Monitoring in the US Forest Service: Institutional Challenges and Collaborative Opportunites for Improving Planning and Decision-Making in an Era of Climate Change

    Science.gov (United States)

    Wurtzebach, Z.

    2016-12-01

    In 2012, the United States Forest Service promulgated new rules to guide Forest planning efforts in accordance with the National Forest Management Act (NFMA). One important component of the 2012 rule is a requirement for Regionally coordinated cross-boundary "broad scale" monitoring strategies that are designed to inform and facilitate Forest-level adaptive management and planning. This presentation will examine institutional challenges and opportunites for developing effective broad scale monitoring strategies identified in 90 interviews with USFS staff and partner organizations, and collaborative workshops held in Colorado, Wyoming, Arizona, and New Mexico. Internal barriers to development include funding and human resource constraints, organizational culture, problematic incentives and accountability structures, data management issues, and administrative barriers to collaboration. However, we also identify several opportunities for leveraging interagency collaboration, facilitating multi-level coordination, generating efficiencies in data collection and analysis, and improving strategies for reporting and communication to Forest level decision-makers and relevant stakeholders.

  14. [Decision making in cariology

    NARCIS (Netherlands)

    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

  15. Construction of a technique plan repository and evaluation system based on AHP group decision-making for emergency treatment and disposal in chemical pollution accidents

    International Nuclear Information System (INIS)

    Shi, Shenggang; Cao, Jingcan; Feng, Li; Liang, Wenyan; Zhang, Liqiu

    2014-01-01

    Highlights: • Different chemical pollution accidents were simplified using the event tree analysis. • Emergency disposal technique plan repository of chemicals accidents was constructed. • The technique evaluation index system of chemicals accidents disposal was developed. • A combination of group decision and analytical hierarchy process (AHP) was employed. • Group decision introducing similarity and diversity factor was used for data analysis. - Abstract: The environmental pollution resulting from chemical accidents has caused increasingly serious concerns. Therefore, it is very important to be able to determine in advance the appropriate emergency treatment and disposal technology for different types of chemical accidents. However, the formulation of an emergency plan for chemical pollution accidents is considerably difficult due to the substantial uncertainty and complexity of such accidents. This paper explains how the event tree method was used to create 54 different scenarios for chemical pollution accidents, based on the polluted medium, dangerous characteristics and properties of chemicals involved. For each type of chemical accident, feasible emergency treatment and disposal technology schemes were established, considering the areas of pollution source control, pollutant non-proliferation, contaminant elimination and waste disposal. Meanwhile, in order to obtain the optimum emergency disposal technology schemes as soon as the chemical pollution accident occurs from the plan repository, the technique evaluation index system was developed based on group decision-improved analytical hierarchy process (AHP), and has been tested by using a sudden aniline pollution accident that occurred in a river in December 2012

  16. Construction of a technique plan repository and evaluation system based on AHP group decision-making for emergency treatment and disposal in chemical pollution accidents

    Energy Technology Data Exchange (ETDEWEB)

    Shi, Shenggang [College of Environmental Science and Engineering, Beijing Forestry University, Beijing 100083 (China); College of Chemistry, Baotou Teachers’ College, Baotou 014030 (China); Cao, Jingcan; Feng, Li; Liang, Wenyan [College of Environmental Science and Engineering, Beijing Forestry University, Beijing 100083 (China); Zhang, Liqiu, E-mail: zhangliqiu@163.com [College of Environmental Science and Engineering, Beijing Forestry University, Beijing 100083 (China)

    2014-07-15

    Highlights: • Different chemical pollution accidents were simplified using the event tree analysis. • Emergency disposal technique plan repository of chemicals accidents was constructed. • The technique evaluation index system of chemicals accidents disposal was developed. • A combination of group decision and analytical hierarchy process (AHP) was employed. • Group decision introducing similarity and diversity factor was used for data analysis. - Abstract: The environmental pollution resulting from chemical accidents has caused increasingly serious concerns. Therefore, it is very important to be able to determine in advance the appropriate emergency treatment and disposal technology for different types of chemical accidents. However, the formulation of an emergency plan for chemical pollution accidents is considerably difficult due to the substantial uncertainty and complexity of such accidents. This paper explains how the event tree method was used to create 54 different scenarios for chemical pollution accidents, based on the polluted medium, dangerous characteristics and properties of chemicals involved. For each type of chemical accident, feasible emergency treatment and disposal technology schemes were established, considering the areas of pollution source control, pollutant non-proliferation, contaminant elimination and waste disposal. Meanwhile, in order to obtain the optimum emergency disposal technology schemes as soon as the chemical pollution accident occurs from the plan repository, the technique evaluation index system was developed based on group decision-improved analytical hierarchy process (AHP), and has been tested by using a sudden aniline pollution accident that occurred in a river in December 2012.

  17. An Assessment of Decision-Making Processes: The Feasibility of Incorporating Climate Change Information into Land Protection Planning (External Review Draft)

    Science.gov (United States)

    This report was prepared by the Global Change Research Program (GCRP) in the National Center for Environmental Assessment (NCEA) of the Office of Research and Development (ORD) at the U.S. Environmental Protection Agency (EPA). This draft report is a review of decision-making pro...

  18. Addressing Climate Change Adaptation in Regional Transportation Plans in California: A Guide and Online Visualization Tool for Planners to Incorporate Risks of Climate Change Impacts in Policy and Decision-Making

    Science.gov (United States)

    Tao, W.; Tucker, K.; DeFlorio, J.

    2012-12-01

    The reality of a changing climate means that transportation and planning agencies need to understand the potential effects of changes in storm activity, sea levels, temperature, and precipitation patterns; and develop strategies to ensure the continuing robustness and resilience of transportation infrastructure and services. This is a relatively new challenge for California's regional planning agencies - adding yet one more consideration to an already complex and multifaceted planning process. In that light, the California Department of Transportation (Caltrans) is developing a strategy framework using a module-based process that planning agencies can undertake to incorporating the risks of climate change impacts into their decision-making and long-range transportation plans. The module-based approach was developed using a best practices survey of existing work nationally, along with a set of structured interviews with metropolitan planning organizations (MPOs) and regional transportation planning agencies (RTPAs) within California. Findings led to the development of a process, as well as a package of foundational geospatial layers (i.e. the Statewide Transportation Asset Geodatabase - STAG), primarily comprising state and Federal transportation assets. These assets are intersected with a set of geospatial layers for the climate stressors of relevance in the state which are placed in the same reference layers as the STAG; thus providing a full set of GIS layers that can be a starting point for MPOs/RTPAs that want to follow the step-by-step module-based approach in its entirety. The fast-paced changes in science and climate change knowledge requires a flexible platform to display continuously evolving information. To this end, the development of the modules are accompanied by a set of geospatial analysis disseminated using an online web portal. In this way, the information can be relayed to MPO/RTPAs in a easy-to-use fashion that can help them follow the modules

  19. [Limitation of the therapeutic effort].

    Science.gov (United States)

    Herreros, B; Palacios, G; Pacho, E

    2012-03-01

    The limitation of the therapeutic effort (LTE) consists in not applying extraordinary or disproportionate measures for therapeutic purposes that are proposed for a patient with poor life prognosis and/or poor quality of life. There are two types. The first is to not initiate certain measures or to withdraw them when they are established. A decision of the LTE should be based on some rigorous criteria, so that we make the following proposal. First, it is necessary to know the most relevant details of the case to make a decision: the preferences of the patient, the preferences of the family when pertinent, the prognosis (severity), the quality of life and distribution of the limited resources. After, the decision should be made. In this phase, participatory deliberation should be established to clarify the end of the intervention. Finally, if it is decided to perform an LTE, it should be decided how to do it. Special procedures, disproportionate measures, that are useless and vain should not be initiated for the therapeutic objective designed (withdraw them if they have been established). When it has been decided to treat a condition (interim measures), the treatment should be maintained. This complex phase may need stratification of he measures. Finally, the necessary palliative measures should be established. Copyright © 2011 Elsevier España, S.L. All rights reserved.

  20. Use of representative models in the decision making process of an offshore field development plan; Utilizacao de modelos representativos na tomada de decisao do desenvolvimento complementar em campo offshore

    Energy Technology Data Exchange (ETDEWEB)

    Silva, Fabio Rodrigo C. da; Costa, Ana Paula de Araujo [PETROBRAS S.A., Rio de Janeiro, RJ (Brazil)

    2008-07-01

    The purpose of this study was to evaluate the risk and value of information on the complementary development project of an offshore field, which consists of drilling a well in a region that has not been drained by existing wells. It was applied a methodology that involves quantification of uncertainty and risk analysis (Costa, 2003) to obtain the probabilistic production curves of oil and value of information from the project. The work consists of applying a methodology that proposes the use of the concept of models that represents the geological uncertainties, called Representative Geological Models (RM) to improve the decision making process of the project. It was used a numerical simulator (IMEX) and a tool for parallel processing (UNIPAR). The RM represents the universe of all models combined, making up the risk curve of the study. The selection of RM consists of plotting a main objective function (NPV) with a secondary of production (FR%, NP, etc.). The adoption of this premise, which includes aspects of the amount recovered and the speed of recovery, is useful in sizing the later production facilities as well as in detailing the development plans and evaluating the flexibility of these plans. The adoption of the methodology of measuring uncertainties as well as an automated tool made the study possible and also provided detailed information, contributing to the decision making process. (author)

  1. [The planned home care transfer by a local medical support hospital and the introduction to home intravenous hyper alimentation--the making of a home care patient's instruction plan document].

    Science.gov (United States)

    Shinobu, Akiko; Ohtsu, Yoko

    2004-12-01

    It is important to offer continuous medical service without interrupting everyone's various job functions at the Tama Numbu-Chiiki Hospitals in order to secure the quality and safety of home medical care to patients and their families. From 1998 up to the present, home intravenous hyper alimentation (home IVH) has been introduced by individually exchanging information that was based on items such as clinical case, doctor and caregiver in charge of the day, and introductory information. Five years have passed since we started an introduction of home IVH, and it appears that the medical cooperation of home IVH between the Minami-tama medical region and its neighboring area has been established. Then, we arranged an examination of the past 2 years based on the 57 patients who elected to choose home IVH instruction. Consequently, we created "home IVH introduction plan document" in standardizing a flow from home IVH introduction to post-hospital intervention. Since November of 2003, the plan document has been utilized and carried out to 5 patients by the end of February in 2004. This home IVH introduction plan document was able to clarify the role of medical person in connection with the patient. Therefore, we could not only share the information, but also could transfer medical care smoothly from the hospital to the patient's home.

  2. Towards more eclectic understandings of energy demand and change—A tale of sense-making in the messiness of transformative planning

    DEFF Research Database (Denmark)

    Jensen, Charlotte Louise; Quitzau, Maj-Britt

    2017-01-01

    the strategic work carried out in a particular case of energy renovation seems to have involved: 1) acknowledgment of the need for reconfiguring bundles of practices, 2) actively enrolling different actors in the reconfiguring of bundles of practices, and 3) basing new practice arrangements......, we explore theoretical understandings of practices and translations as a means to illustrate how certain engagements with strategic work aimed at reconfiguring bundles of practices enable a different approach to establishing momentum for change through planning interventions. We illustrate how......’ performance....

  3. Unconscious emotional reasoning and the therapeutic misconception.

    Science.gov (United States)

    Charuvastra, A; Marder, S R

    2008-03-01

    The "therapeutic misconception" describes a process whereby research volunteers misinterpret the intentions of researchers and the nature of clinical research. This misinterpretation leads research volunteers to falsely attribute a therapeutic potential to clinical research, and compromises informed decision making, therefore compromising the ethical integrity of a clinical experiment. We review recent evidence from the neurobiology of social cognition to provide a novel framework for thinking about the therapeutic misconception. We argue that the neurobiology of social cognition should be considered in any ethical analysis of how people make decisions about participating in clinical trials. The neurobiology of social cognition also suggests how the complicated dynamics of the doctor-patient relationship may unavoidably interfere with the process of obtaining informed consent. Following this argument we suggest new ways to prevent or at least mitigate the therapeutic misconception.

  4. Construction of a technique plan repository and evaluation system based on AHP group decision-making for emergency treatment and disposal in chemical pollution accidents.

    Science.gov (United States)

    Shi, Shenggang; Cao, Jingcan; Feng, Li; Liang, Wenyan; Zhang, Liqiu

    2014-07-15

    The environmental pollution resulting from chemical accidents has caused increasingly serious concerns. Therefore, it is very important to be able to determine in advance the appropriate emergency treatment and disposal technology for different types of chemical accidents. However, the formulation of an emergency plan for chemical pollution accidents is considerably difficult due to the substantial uncertainty and complexity of such accidents. This paper explains how the event tree method was used to create 54 different scenarios for chemical pollution accidents, based on the polluted medium, dangerous characteristics and properties of chemicals involved. For each type of chemical accident, feasible emergency treatment and disposal technology schemes were established, considering the areas of pollution source control, pollutant non-proliferation, contaminant elimination and waste disposal. Meanwhile, in order to obtain the optimum emergency disposal technology schemes as soon as the chemical pollution accident occurs from the plan repository, the technique evaluation index system was developed based on group decision-improved analytical hierarchy process (AHP), and has been tested by using a sudden aniline pollution accident that occurred in a river in December 2012. Copyright © 2014 Elsevier B.V. All rights reserved.

  5. INDOT Technical Training Plan

    Science.gov (United States)

    2012-04-01

    The study provides the background documents necessary for the development of a Technical Training Plan and makes recommendations : for the content and structure of such a plan for the District Operations, Operations, Capital Program Management, and E...

  6. Breastfeeding: Planning Ahead

    Medline Plus

    Full Text Available ... and jobs View all pages in this section Home It's Only Natural Planning ahead It's Only Natural Planning ahead Breastfeeding and baby basics Making breastfeeding work for you Addressing breastfeeding myths Overcoming challenges Finding ...

  7. [Therapeutic use of cannabis derivatives].

    Science.gov (United States)

    Benyamina, Amine; Reynaud, Michel

    2014-02-01

    The therapeutic use of cannabis has generated a lot of interest in the past years, leading to a better understanding of its mechanisms of action. Countries like the United States and Canada have modified their laws in order to make cannabinoid use legal in the medical context. It's also the case in France now, where a recent decree was issued, authorizing the prescription of medication containing "therapeutic cannabis" (decree no. 2013-473, June 5, 2013). Cannabinoids such as dronabinol, Sativex and nabilone have been tested for the treatment of acute and chronic pain. These agents are most promising to relieve chronic pain associated with cancer, with human immunodeficiency virus infection and with multiple sclerosis. However, longer-term studies are required to determine potential long-term adverse effects and risks of misuse and addiction.

  8. An evaluation of the participation of the social movements on the decision making process and planning of the electric sector; Uma avaliacao da participacao dos movimentos sociais no planejamento e no processo decisorio do setor eletrico

    Energy Technology Data Exchange (ETDEWEB)

    Moral Hernandez, Francisco del; Bermann, Celio [Universidade de Sao Paulo (USP), SP (Brazil). Inst. de Eletrotecnica e Energia. Programa Interunidades de Pos-graduacao em Energia]. E-mail: delmoral@hotmail.com; cbermann@iee.usp.br

    2006-07-01

    This work presents some reflexions on the possibility of a public sphere in the decision making process in the energetic sector. By using the conceptual mark of Juergen HABERMAS, some reflexions on the political participation specificities at Latin America, mainly those ones suggested by AVRITZER (2002) and the theoretical reflexions of HONNETH (2003) recognition fight and construction in the social movements, the work tries the verification of how far the requirements of social organizations identified in this work are from a desirable situation, or else a more effective participation of the social movements on the decisions and planning spaces and the deliberative character of the public discussion space in the area of energy.

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

    Directory of Open Access Journals (Sweden)

    Russell N James III

    2016-12-01

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

  10. Making and Changing Wills

    Directory of Open Access Journals (Sweden)

    Cheryl Tilse

    2016-02-01

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

  11. Internet plan and planning

    Directory of Open Access Journals (Sweden)

    Kahriman Emina

    2008-01-01

    Full Text Available Paper discuss specific features of internet plan as well as planning as management process in general in the contemporary environment. No need to stress out that marketing plan and marketing planning is core activity in approaching to market. At the same time, there are a lot specific c request in preparing marketing plan comparing to business planning due to marketing plan is an essential part. The importance of internet plan and planning rely on specific features of the internet network but as a part of general corporate as well as marketing strategy.

  12. Japanese government makes the first step of the nuclear energy policy. The 'Nuclear Power Nation Plan' that shows the future of the nuclear energy policy of Japan

    International Nuclear Information System (INIS)

    Yanase, Tadao

    2006-01-01

    The Nuclear Energy Subcommittee of the METI Advisory Committee deliberated concrete actions for achieving the basic goals of the framework for nuclear energy policy, namely 1) continuing to meet at least 30 to 40% of electricity supply even after 2030 by nuclear power generation, 2) future promoting the nuclear fuel cycle, and 3) aiming at commercializing practical FBR cycle. In August 2006, the subcommittee recommendations were drawn up as a 'Nuclear Energy National Plan'. This report includes 1) building new nuclear power plants in liberalized electricity market, 2) appropriate use of existing nuclear power plants with assuring safety as a key prerequisite, 3) promoting nuclear fuel cycle and strategically reinforcing of nuclear industries, 4) early commercialization of FBR cycle, 5) assuming ample technical and human resources to support the next generation, 6) supporting for international development of Japan's nuclear industry, 7) positive involvement in creating an international framework to uphold both non-proliferation and the expansion of nuclear power generation, 8) building trust between government and local communities through detailed communication and 9) reinforcement of measures for radioactive waste disposal. (S.Y.)

  13. The role of responsible gambling strategy and gambling passion in the online gamblers' decision-making process: revising the theory of planned behavior.

    Science.gov (United States)

    Lee, Jaeseok; Chen, Chih-Chien; Song, Hak-Jun; Lee, Choong-Ki

    2014-06-01

    This study revised the theory of planned behavior (TPB) by incorporating the new concepts of gambling passion and responsible gambling strategy (RGS) to predict gamblers' intention to gamble in online sports betting. The data were collected at the end of March in 2012 through an online gambling website. The findings indicated that the inclusion of two types of gambling passion and two types of RGS explains online gambling intention well. Specifically, out of the original antecedent predictors of TPB, attitude toward online gambling was positively related to harmonious passion. Subjective norm had a positive relationship with both harmonious and obsessive passion. The results also showed that perceived behavioral control does not have a significant effect on the two gambling passions but has a direct and significant influence on behavioral intention. Additionally, the compulsory RGS had a negative effect on obsessive passion, whereas supplementary RGS had concurrent positive impacts on harmonious and obsessive passion. Lastly, the two gambling passions were notable predictors of behavioral intention toward online sports betting.

  14. [How to make regional medicine revive from the medical crisis or collapse due to the severe paucity of medical doctors: a plan with "the magnet hospital"].

    Science.gov (United States)

    Itoh, Tsunetoshi

    2009-01-01

    In 2002-2003, the practice of doctors lending their names to appear as "staff" of hospitals became known. Problems regarding funds from public hospitals were also revealed. Tohoku University asked regional societies how to improve the medical situation, and redefined its responsibilities. The Educational Development Center for Local Medicine and Department of Local Medical Service System were set up (2005-2008). A severe shortage of medical doctors prevails in Japan: the number of doctors per population is at the 4th lowest among OECD countries, and the number per hospital bed is the lowest. We have no nursing homes whose beds are not counted as hospital beds. The number of faculty staff in Japanese medical schools is 1/3 to those of Western countries. The reported number of doctors working in hospitals and offices surpasses that by census for medical doctors by >40,000. Japanese doctors work for >60 hours per week. I propose essential plans to improve Japanese situation for medical service: 1. Immediately increase the number of doctors by at least 50%. Based on our calculation, we need 450,000 doctors. 2. When the shortage of doctors is severe, establish a magnet hospital with c.a. 500 beds for every 200,000 population, capable of treating highly emergency patients and attracting doctors who need medical training. Hospitals should not belong to each city or town. 3. Establish a comprehensive organization to nurture doctors on a long-term basis. It should consist of a medical school, hospitals, and the prefectural government. It should help doctors to move between hospitals, and be responsible both for designing doctors' career paths and for allocating them appropriately.

  15. What to include in your birth plan

    Science.gov (United States)

    Pregnancy - birth plan ... Birth plans are guides that parents-to-be make to help their health care providers best support them during ... things to consider before you make a birth plan. This is a great time to learn about ...

  16. Conotoxins that confer therapeutic possibilities

    KAUST Repository

    Essack, Magbubah

    2012-06-04

    Cone snails produce a distinctive repertoire of venom peptides that are used both as a defense mechanism and also to facilitate the immobilization and digestion of prey. These peptides target a wide variety of voltage- and ligand-gated ion channels, which make them an invaluable resource for studying the properties of these ion channels in normal and diseased states, as well as being a collection of compounds of potential pharmacological use in their own right. Examples include the United States Food and Drug Administration (FDA) approved pharmaceutical drug, Ziconotide (Prialt; Elan Pharmaceuticals, Inc.) that is the synthetic equivalent of the naturally occurring ?-conotoxin MVIIA, whilst several other conotoxins are currently being used as standard research tools and screened as potential therapeutic drugs in pre-clinical or clinical trials. These developments highlight the importance of driving conotoxin-related research. A PubMed query from 1 January 2007 to 31 August 2011 combined with hand-curation of the retrieved articles allowed for the collation of 98 recently identified conotoxins with therapeutic potential which are selectively discussed in this review. Protein sequence similarity analysis tentatively assigned uncharacterized conotoxins to predicted functional classes. Furthermore, conotoxin therapeutic potential for neurodegenerative disorders (NDD) was also inferred. 2012 by the authors; licensee MDPI.

  17. Conotoxins that confer therapeutic possibilities

    KAUST Repository

    Essack, Magbubah; Bajic, Vladimir B.; Archer, John A.C.

    2012-01-01

    Cone snails produce a distinctive repertoire of venom peptides that are used both as a defense mechanism and also to facilitate the immobilization and digestion of prey. These peptides target a wide variety of voltage- and ligand-gated ion channels, which make them an invaluable resource for studying the properties of these ion channels in normal and diseased states, as well as being a collection of compounds of potential pharmacological use in their own right. Examples include the United States Food and Drug Administration (FDA) approved pharmaceutical drug, Ziconotide (Prialt; Elan Pharmaceuticals, Inc.) that is the synthetic equivalent of the naturally occurring ?-conotoxin MVIIA, whilst several other conotoxins are currently being used as standard research tools and screened as potential therapeutic drugs in pre-clinical or clinical trials. These developments highlight the importance of driving conotoxin-related research. A PubMed query from 1 January 2007 to 31 August 2011 combined with hand-curation of the retrieved articles allowed for the collation of 98 recently identified conotoxins with therapeutic potential which are selectively discussed in this review. Protein sequence similarity analysis tentatively assigned uncharacterized conotoxins to predicted functional classes. Furthermore, conotoxin therapeutic potential for neurodegenerative disorders (NDD) was also inferred. 2012 by the authors; licensee MDPI.

  18. Understanding Perceptions of Climate Change, Priorities, and Decision-Making among Municipalities in Lima, Peru to Better Inform Adaptation and Mitigation Planning.

    Science.gov (United States)

    Siña, Mariella; Wood, Rachel C; Saldarriaga, Enrique; Lawler, Joshua; Zunt, Joseph; Garcia, Patricia; Cárcamo, César

    2016-01-01

    Climate change poses multiple risks to the population of Lima, the largest city and capital of Peru, located on the Pacific coast in a desert ecosystem. These risks include increased water scarcity, increased heat, and the introduction and emergence of vector-borne and other climate sensitive diseases. To respond to these threats, it is necessary for the government, at every level, to adopt more mitigation and adaptation strategies. Here, focus groups were conducted with representatives from five Lima municipalities to determine priorities, perception of climate change, and decision-making processes for implementing projects within each municipality. These factors can affect the ability and desire of a community to implement climate change adaptation and mitigation strategies. The results show that climate change and other environmental factors are of relatively low priority, whereas public safety and water and sanitation services are of highest concern. Perhaps most importantly, climate change is not well understood among the municipalities. Participants had trouble distinguishing climate change from other environmental issues and did not fully understand its causes and effects. Greater understanding of what climate change is and why it is important is necessary for it to become a priority for the municipalities. Different aspects of increased climate change awareness seem to be connected to having experienced extreme weather events, whether related or not to climate change, and to higher socioeconomic status.

  19. Coastal Adaptation Planning for Sea Level Rise and Extremes: A Global Model for Adaptation Decision-making at the Local Level Given Uncertain Climate Projections

    Science.gov (United States)

    Turner, D.

    2014-12-01

    Understanding the potential economic and physical impacts of climate change on coastal resources involves evaluating a number of distinct adaptive responses. This paper presents a tool for such analysis, a spatially-disaggregated optimization model for adaptation to sea level rise (SLR) and storm surge, the Coastal Impact and Adaptation Model (CIAM). This decision-making framework fills a gap between very detailed studies of specific locations and overly aggregate global analyses. While CIAM is global in scope, the optimal adaptation strategy is determined at the local level, evaluating over 12,000 coastal segments as described in the DIVA database (Vafeidis et al. 2006). The decision to pursue a given adaptation measure depends on local socioeconomic factors like income, population, and land values and how they develop over time, relative to the magnitude of potential coastal impacts, based on geophysical attributes like inundation zones and storm surge. For example, the model's decision to protect or retreat considers the costs of constructing and maintaining coastal defenses versus those of relocating people and capital to minimize damages from land inundation and coastal storms. Uncertain storm surge events are modeled with a generalized extreme value distribution calibrated to data on local surge extremes. Adaptation is optimized for the near-term outlook, in an "act then learn then act" framework that is repeated over the model time horizon. This framework allows the adaptation strategy to be flexibly updated, reflecting the process of iterative risk management. CIAM provides new estimates of the economic costs of SLR; moreover, these detailed results can be compactly represented in a set of adaptation and damage functions for use in integrated assessment models. Alongside the optimal result, CIAM evaluates suboptimal cases and finds that global costs could increase by an order of magnitude, illustrating the importance of adaptive capacity and coastal policy.

  20. Decision Making

    Directory of Open Access Journals (Sweden)

    Pier Luigi Baldi

    2006-06-01

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

  1. A fuzzy set decision making model applied to electric power systems operation planning; Um modelo de decisao baseado em conjuntos nebulosos aplicado ao planejamento da operacao de sistemas de energia eletrica

    Energy Technology Data Exchange (ETDEWEB)

    Valenca, Mauricio Mendonca

    1993-05-01

    The power system static operation planning has a main objective the determination of performance strategies which satisfy operational criteria. A fuzzy set decision model which takes the load attainment and the compromise between optimality and critical operational constraints into account is presented. The prime characteristic of this methodology is the incorporation of the planner`s preferences structure in a decision process modeled by fuzzy sets. A routine of optimal power flow calculation is used as a computational tool for solving the nonlinear model of the electric power system and for defining the universe of discourse of the decision-making problem. tests were carried on a 30-bus IEEE system in order to find a compromise solution of electric operational goal versus reactive power generation limits. Results and conclusions are presented. (author) 28 refs., 32 figs.

  2. [Therapeutic Aggressiveness and Liquid Oncology].

    Science.gov (United States)

    Barón Duarte, F J; Rodríguez Calvo, M S; Amor Pan, J R

    2017-01-01

    Aggressiveness criteria proposed in the scientific literature a decade ago provide a quality judgment and are a reference in the care of patients with advanced cancer, but their use is not generalized in the evaluation of Oncology Services. In this paper we analyze the therapeutic aggressiveness, according to standard criteria, in 1.001 patients with advanced cancer who died in our Institution between 2010 and 2013. The results seem to show that aggressiveness at the end of life is present more frequently than experts recommend. About 25% of patients fulfill at least one criterion of aggressiveness. This result could be explained by a liquid Oncology which does not prioritize the patient as a moral subject in the clinical appointment. Medical care is oriented to necessities and must be articulated in a model focused on dignity and communication. Its implementation through Advanced Care Planning, consideration of patient's values and preferences, and Limitation of therapeutic effort are ways to reduce aggressiveness and improve clinical practice at the end of life. We need to encourage synergic and proactive attitudes, adding the best of cancer research with the best clinical care for the benefit of human being, moral subject and main goal of Medicine.

  3. Stem cells: The making of a therapeutic modality | Maduako | Abia ...

    African Journals Online (AJOL)

    Abia State University Medical Students' Association Journal. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 4, No 1 (2007) >. Log in or Register to get access to full text downloads. Username, Password, Remember me, or Register. DOWNLOAD FULL TEXT ...

  4. Therapeutic HIV Peptide Vaccine

    DEFF Research Database (Denmark)

    Fomsgaard, Anders

    2015-01-01

    Therapeutic vaccines aim to control chronic HIV infection and eliminate the need for lifelong antiretroviral therapy (ART). Therapeutic HIV vaccine is being pursued as part of a functional cure for HIV/AIDS. We have outlined a basic protocol for inducing new T cell immunity during chronic HIV-1...... infection directed to subdominant conserved HIV-1 epitopes restricted to frequent HLA supertypes. The rationale for selecting HIV peptides and adjuvants are provided. Peptide subunit vaccines are regarded as safe due to the simplicity, quality, purity, and low toxicity. The caveat is reduced immunogenicity...

  5. Model : making

    OpenAIRE

    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 ...

  6. Observational therapeutics: Scope, challenges, and organization.

    Science.gov (United States)

    Vaidya, Rama

    2011-10-01

    The importance of Observational Therapeutics in the progress of medicine has been neglected in the current era of the hierarchal position imparted to Randomized Controlled Trials (RCTs) for new drug discovery and practice of evidence-based medicine. There is a need to reflect on the reason for many new drugs being withdrawn during post marketing surveillance. There are several examples in literature where drug-discovery has originated initially from keen clinical and / or laboratory observations. The roots of these discoveries have often been from observations made by practitioners of traditional medicine including Ayurveda. The present article draws attention to the scope and challenges for observational therapeutics. There is an urgent need for the meticulous planning for a systematic organization of developing observational therapeutics, with a full understanding of its strengths and limitations.

  7. Observational therapeutics: Scope, challenges, and organization

    Directory of Open Access Journals (Sweden)

    Rama Vaidya

    2011-01-01

    Full Text Available The importance of Observational Therapeutics in the progress of medicine has been neglected in the current era of the hierarchal position imparted to Randomized Controlled Trials (RCTs for new drug discovery and practice of evidence-based medicine. There is a need to reflect on the reason for many new drugs being withdrawn during post marketing surveillance. There are several examples in literature where drug-discovery has originated initially from keen clinical and / or laboratory observations. The roots of these discoveries have often been from observations made by practitioners of traditional medicine including Ayurveda. The present article draws attention to the scope and challenges for observational therapeutics. There is an urgent need for the meticulous planning for a systematic organization of developing observational therapeutics, with a full understanding of its strengths and limitations.

  8. Developing patient rapport, trust and therapeutic relationships.

    Science.gov (United States)

    Price, Bob

    2017-08-09

    Rapport is established at the first meeting between the patient and nurse, and is developed throughout the therapeutic relationship. However, challenges can arise during this process. Initially, nurses can establish trust with the patient through the questions they ask, however, as care progresses, the nurse will be required to demonstrate a commitment to maintaining the patient's psychological well-being. When the therapeutic relationship ends, the nurse should assist the patient to assess progress and plan the next stage of recovery. This article provides three reflective exercises using case study examples to demonstrate how rapport is developed and sustained. Evidence is provided to identify why challenges arise in the therapeutic relationship and how the nurse can ensure they provide care that the patient regards as genuine.

  9. Therapeutic Recombinant Monoclonal Antibodies

    Science.gov (United States)

    Bakhtiar, Ray

    2012-01-01

    During the last two decades, the rapid growth of biotechnology-derived techniques has led to a myriad of therapeutic recombinant monoclonal antibodies with significant clinical benefits. Recombinant monoclonal antibodies can be obtained from a number of natural sources such as animal cell cultures using recombinant DNA engineering. In contrast to…

  10. Therapeutic applications of radiopharmaceuticals

    International Nuclear Information System (INIS)

    Baker, W.J.; Datz, F.L.; Beightol, R.W.

    1987-01-01

    Whether a radiopharmaceutical has diagnostic or therapeutic application depends on both the isotope and pharmaceutical used. For diagnostic applications, the isotope should undergo only γ-decay, since usually only γ-radiation is detected by nuclear medicine cameras. The half-life should be just long enough to allow the procedure to be performed. In contrast, the isotope needed for therapeutic purposes should have particulate radiation, such as a β-particle (electron), since these are locally absorbed an increase the local radiation dose. γ-Radiation, which penetrates the tissues, produces less radiation dose than do Β-particles. Several references dealing with radioactive decay, particulate interactions, and diagnostic and therapeutic applications of radiopharmaceuticals are available. Radiopharmaceuticals can legally be used only by physicians who are qualified by specific training in the safe handling of radionuclides. The experience and training of these physicians must be approved by the Nuclear Regulatory Commission or Agreement State Agency authorized to license the use of radiopharmaceuticals. A list of all byproduct material and procedures is available in the Code of Federal Regulations. Of the many radiopharmaceuticals available for diagnostic and therapeutic use, only those commonly used are discussed in this chapter

  11. Novel therapeutic approaches in chondrosarcoma.

    Science.gov (United States)

    Polychronidou, Genovefa; Karavasilis, Vasilios; Pollack, Seth M; Huang, Paul H; Lee, Alex; Jones, Robin L

    2017-03-01

    Chondrosarcoma is a malignant tumor of bones, characterized by the production of cartilage matrix. Due to lack of effective treatment for advanced disease, the clinical management of chondrosarcomas is exceptionally challenging. Current research focuses on elucidating the molecular events underlying the pathogenesis of this rare bone malignancy, with the goal of developing new molecularly targeted therapies. Signaling pathways suggested to have a role in chondrosarcoma include Hedgehog, Src, PI3k-Akt-mTOR and angiogenesis. Mutations in IDH1/2, present in more than 50% of primary conventional chondrosarcomas, make the development of IDH inhibitors a promising treatment option. The present review discusses the preclinical and early clinical data on novel targeted therapeutic approaches in chondrosarcoma.

  12. Steel making

    CERN Document Server

    Chakrabarti, A K

    2014-01-01

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

  13. Make Sense?

    DEFF Research Database (Denmark)

    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...

  14. PYTHIOSIS: A THERAPEUTIC APPROACH

    Directory of Open Access Journals (Sweden)

    C. M. C. Falcão

    2015-10-01

    Full Text Available Pythiosis, a disease caused by the oomycete Pythium insidiosum, often presents inefficient response to chemotherapy. It is a consensus that, in spite the several therapeutic protocols, a combination of surgery, chemotherapy and immunotherapy should be used. Surgical excision requires the removal of the entire affected area, with a wide margin of safety. The use of antifungal drugs has resulted in variable results, both in vitro and in vivo, and presents low therapeutic efficiency due to differences in the agent characteristics, which differ from true fungi. Immunotherapy is a non-invasive alternative for the treatment of pythiosis, which aims at modifying the immune response of the host, thereby producing an effective response to the agent. Photodynamic therapy has emerged as a promising technique, with good activity against P. insidiosum in vitro and in vivo. However, more studies are necessary to increase the efficiency of the current treatment protocols and consequently improve the cure rates. This paper aims to conduct a review covering the conventional and recent therapeutic methods against P. insidiosum infections

  15. Methodical development of a modular planning and decision-making model for local energy supply concepts with regard to the special conditions which prevail in the new Lands of unified Germany. Methodische Entwicklung eines strukturierten Planungs- und Entscheidungsmodells fuer die Gestaltung integrierter oertlicher Energieversorgungskonzepte unter Beruecksichtigung der besonderen Rahmenbedingungen in den neuen Bundeslaendern

    Energy Technology Data Exchange (ETDEWEB)

    Puestow, H.D.

    1992-05-27

    An action-oriented planning and decision-making model considering individual local conditions and general aspects of energy economy is presented for the development of feasible municipal energy supply concepts. The decision-making model was given a modular structure for future knowledge-based energy-economy planning by use of personal computers. The formalized methodology and a corresponding expert system development environment help to implement the developed phase model and give better and more rapid access to the expert knowledge which is relevant to energy economy. (orig.).

  16. Tax Planning for Enterprises

    Institute of Scientific and Technical Information of China (English)

    Fan Weiqing

    2011-01-01

    @@ Tax planning is legal planning activities for tax savings, meaning tax payers make operation plans within the national policy framework and choose operation programs favorable to tax savings.Along with a maturing socialist market economy system in China, tax planning is becoming an integral part of enterprise management and operation.For a better tax planning, enterprises have to fully understand the meaning, get proficient at relevant strategies, and apply these methods to save taxes and realize the maximization of enterprise value while considering the actual situation.

  17. Decision making.

    Science.gov (United States)

    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.

  18. Breastfeeding: Planning Ahead

    Medline Plus

    Full Text Available ... menu It's Only Natural Planning ahead Breastfeeding and baby basics Making breastfeeding work for you Addressing breastfeeding ... in the African-American community Incredible facts about babies, breastmilk, and breastfeeding Overcoming challenges Common questions about ...

  19. Breastfeeding: Planning Ahead

    Medline Plus

    Full Text Available ... Planning ahead Breastfeeding and baby basics Making breastfeeding work for you Addressing ... decisions. But if you haven’t already thought about breastfeeding, now is a great time. Before your baby is here is the ...

  20. Breastfeeding: Planning Ahead

    Medline Plus

    Full Text Available ... Planning ahead Breastfeeding and baby basics Making breastfeeding work for you Addressing breastfeeding myths Overcoming challenges Finding support Fitting breastfeeding into your life Partner resources Subscribe To receive Breastfeeding email updates ...

  1. Breastfeeding: Planning Ahead

    Medline Plus

    Full Text Available ... we are What we do Programs and activities Work with us Contact Us Blog Popular topics Vision ... Planning ahead Breastfeeding and baby basics Making breastfeeding work for you Addressing breastfeeding myths Breastfeeding myths in ...

  2. Breastfeeding: Planning Ahead

    Medline Plus

    Full Text Available ... It's Only Natural Planning ahead Breastfeeding and baby basics Making breastfeeding work for you Addressing breastfeeding myths Overcoming challenges Finding support Fitting breastfeeding into your life Partner resources Subscribe To receive Breastfeeding email updates ...

  3. Stroke and Therapeutic Hypothermia

    Directory of Open Access Journals (Sweden)

    Ozlem Ozkan Kuscu

    2016-09-01

    Full Text Available Stroke is significant cause of morbidity and mortality caused by disruption of blood flow. Neural injury occurs with two stage; while primary neural injury occurs with disruption of blood flow, after days and hours with metabolic processes secondary injury develops in tissues which is non injured in the first stage. Therefore it is important to prevent and treat the secondary injury as much as preventing and treating the primary neural injury. In this article developing pathophysiological changes after stroke, mechanisms of therapeutic hypothermia, application methods, the factors that determine the effectiveness, side effects and complications were reviewed. [Archives Medical Review Journal 2016; 25(3.000: 351-368

  4. Making Connections

    Science.gov (United States)

    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…

  5. Managerial Decision Making in Traffic

    Directory of Open Access Journals (Sweden)

    Teodor Perić

    2003-11-01

    Full Text Available Decision-making is defined as a selection of a certain actionamong several alternatives. It is the essence of planning, asin the managerial sense there is no plan until a decision of engagementof resources, reputation and direction of activities ismade. Decision-making is, in fact, only a step in planning, evenwhen it is performed quickly and without special consideration.It is what we all experience every day. It is one of the most fascinatingbiological activities and the subject of frightening implicationsfor the whole human race. Since various techniques improvethe system and the quality of managerial decision-making,they are classified into three assumptions: risk analysis, decision-making trees, and the theory of revealed preference. Allof these are based on the interaction of a certain number of importantvariables out of which many contain the elements ofuncertainty, but maybe also high level of probability.

  6. Utility planning for decommissioning

    International Nuclear Information System (INIS)

    Williams, D.H.

    1982-01-01

    Though the biggest impact on a utility of nuclear power plant decommissioning may occur many years from now, procrastination of efforts to be prepared for that time is unwarranted. Foresight put into action through planning can significantly affect that impact. Financial planning can assure the recovery of decommissioning costs in a manner equitable to customers. Decision-making planning can minimize adverse affects of current decisions on later decommissioning impacts and prepare a utility to be equipped to make later decommissioning decisions. Technological knowledge base planning can support all other planning aspects for decommissioning and prepare a utility for decommissioning decisions. Informed project planning can ward off potentially significant pitfalls during decommissioning and optimize the effectiveness of the actual decommissioning efforts

  7. Pharmacogenetics approach to therapeutics.

    Science.gov (United States)

    Koo, Seok Hwee; Lee, Edmund Jon Deoon

    2006-01-01

    1. Pharmacogenetics refers to the study of genetically controlled variations in drug response. Functional variants caused by single nucleotide polymorphisms (SNPs) in genes encoding drug-metabolising enzymes, transporters, ion channels and drug receptors have been known to be associated with interindividual and interethnic variation in drug response. Genetic variations in these genes play a role in influencing the efficacy and toxicity of medications. 2. Rapid, precise and cost-effective high-throughput technological platforms are essential for performing large-scale mutational analysis of genetic markers involved in the aetiology of variable responses to drug therapy. 3. The application of a pharmacogenetics approach to therapeutics in general clinical practice is still far from being achieved today owing to various constraints, such as limited accessibility of technology, inadequate knowledge, ambiguity of the role of variants and ethical concerns. 4. Drug actions are determined by the interplay of several genes encoding different proteins involved in various biochemical pathways. With rapidly emerging SNP discovery technological platforms and widespread knowledge on the role of SNPs in disease susceptibility and variability in drug response, the pharmacogenetics approach to therapeutics is anticipated to take off in the not-too-distant future. This will present profound clinical, economic and social implications for health care.

  8. Therapeutic nuclear medicine

    International Nuclear Information System (INIS)

    Baum, Richard P.

    2014-01-01

    Discusses all aspects of radionuclide therapy, including basic principles, newly available treatments, regulatory requirements, and future trends. Provides the knowledge required to administer radionuclide therapy safely and effectively in the individual patient. Explains the role of the therapeutic nuclear physician in effectively coordinating a diverse multidisciplinary team. Written by leading experts. The recent revolution in molecular biology offers exciting new opportunities for targeted radionuclide therapy. The selective irradiation of tumor cells through molecular biological mechanisms is now permitting the radiopharmaceutical control of tumors that are unresectable and unresponsive to either chemotherapy or conventional radiotherapy. In this up-to-date, comprehensive book, world-renowned experts discuss the basic principles of radionuclide therapy, explore in detail the available treatments, explain the regulatory requirements, and examine likely future developments. The full range of clinical applications is considered, including thyroid cancer, hematological malignancies, brain tumors, liver cancer, bone and joint disease, and neuroendocrine tumors. The combination of theoretical background and practical information will provide the reader with all the knowledge required to administer radionuclide therapy safely and effectively in the individual patient. Careful attention is also paid to the important role of the therapeutic nuclear physician in delivering the effective coordination of a diverse multidisciplinary team that is essential to the safe provision of treatment.

  9. Mechanisms of Plasma Therapeutics

    Science.gov (United States)

    Graves, David

    2015-09-01

    In this talk, I address research directed towards biomedical applications of atmospheric pressure plasma such as sterilization, surgery, wound healing and anti-cancer therapy. The field has seen remarkable growth in the last 3-5 years, but the mechanisms responsible for the biomedical effects have remained mysterious. It is known that plasmas readily create reactive oxygen species (ROS) and reactive nitrogen species (RNS). ROS and RNS (or RONS), in addition to a suite of other radical and non-radical reactive species, are essential actors in an important sub-field of aerobic biology termed ``redox'' (or oxidation-reduction) biology. It is postulated that cold atmospheric plasma (CAP) can trigger a therapeutic shielding response in tissue in part by creating a time- and space-localized, burst-like form of oxy-nitrosative stress on near-surface exposed cells through the flux of plasma-generated RONS. RONS-exposed surface layers of cells communicate to the deeper levels of tissue via a form of the ``bystander effect,'' similar to responses to other forms of cell stress. In this proposed model of CAP therapeutics, the plasma stimulates a cellular survival mechanism through which aerobic organisms shield themselves from infection and other challenges.

  10. Therapeutic nuclear medicine

    Energy Technology Data Exchange (ETDEWEB)

    Baum, Richard P. (ed.) [ENETS Center of Excellence, Bad Berka (Germany). THERANOSTICS Center for Molecular Radiotherapy and Molecular Imaging

    2014-07-01

    Discusses all aspects of radionuclide therapy, including basic principles, newly available treatments, regulatory requirements, and future trends. Provides the knowledge required to administer radionuclide therapy safely and effectively in the individual patient. Explains the role of the therapeutic nuclear physician in effectively coordinating a diverse multidisciplinary team. Written by leading experts. The recent revolution in molecular biology offers exciting new opportunities for targeted radionuclide therapy. The selective irradiation of tumor cells through molecular biological mechanisms is now permitting the radiopharmaceutical control of tumors that are unresectable and unresponsive to either chemotherapy or conventional radiotherapy. In this up-to-date, comprehensive book, world-renowned experts discuss the basic principles of radionuclide therapy, explore in detail the available treatments, explain the regulatory requirements, and examine likely future developments. The full range of clinical applications is considered, including thyroid cancer, hematological malignancies, brain tumors, liver cancer, bone and joint disease, and neuroendocrine tumors. The combination of theoretical background and practical information will provide the reader with all the knowledge required to administer radionuclide therapy safely and effectively in the individual patient. Careful attention is also paid to the important role of the therapeutic nuclear physician in delivering the effective coordination of a diverse multidisciplinary team that is essential to the safe provision of treatment.

  11. Cancer Survivorship Care Plan Utilization and Impact on Clinical Decision-Making at Point-of-Care Visits with Primary Care: Results from an Engineering, Primary Care, and Oncology Collaborative for Survivorship Health.

    Science.gov (United States)

    Donohue, SarahMaria; Haine, James E; Li, Zhanhai; Feldstein, David A; Micek, Mark; Trowbridge, Elizabeth R; Kamnetz, Sandra A; Sosman, James M; Wilke, Lee G; Sesto, Mary E; Tevaarwerk, Amye J

    2017-11-02

    Every cancer survivor and his/her primary care provider should receive an individualized survivorship care plan (SCP) following curative treatment. Little is known regarding point-of-care utilization at primary care visits. We assessed SCP utilization in the clinical context of primary care visits. Primary care physicians and advanced practice providers (APPs) who had seen survivors following provision of an SCP were identified. Eligible primary care physicians and APPs were sent an online survey, evaluating SCP utilization and influence on decision-making at the point-of-care, accompanied by copies of the survivor's SCP and the clinic note. Eighty-eight primary care physicians and APPs were surveyed November 2016, with 40 (45%) responding. Most respondents (60%) reported discussing cancer or related issues during the visit. Information needed included treatment (66%) and follow-up visits, and the cancer team was responsible for (58%) vs primary care (58%). Respondents acquired this information by asking the patient (79%), checking oncology notes (75%), the SCP (17%), or online resources (8%). Barriers to SCP use included being unaware of the SCP (73%), difficulty locating it (30%), and finding needed information faster via another mechanism (15%). Despite largely not using the SCP for the visit (90%), most respondents (61%) believed one would be quite or very helpful for future visits. Most primary care visits included discussion of cancer or cancer-related issues. SCPs may provide the information necessary to deliver optimal survivor care but efforts are needed to reduce barriers and design SCPs for primary care use.

  12. Antibody Engineering and Therapeutics

    Science.gov (United States)

    Almagro, Juan Carlos; Gilliland, Gary L; Breden, Felix; Scott, Jamie K; Sok, Devin; Pauthner, Matthias; Reichert, Janice M; Helguera, Gustavo; Andrabi, Raiees; Mabry, Robert; Bléry, Mathieu; Voss, James E; Laurén, Juha; Abuqayyas, Lubna; Barghorn, Stefan; Ben-Jacob, Eshel; Crowe, James E; Huston, James S; Johnston, Stephen Albert; Krauland, Eric; Lund-Johansen, Fridtjof; Marasco, Wayne A; Parren, Paul WHI; Xu, Kai Y

    2014-01-01

    The 24th Antibody Engineering & Therapeutics meeting brought together a broad range of participants who were updated on the latest advances in antibody research and development. Organized by IBC Life Sciences, the gathering is the annual meeting of The Antibody Society, which serves as the scientific sponsor. Preconference workshops on 3D modeling and delineation of clonal lineages were featured, and the conference included sessions on a wide variety of topics relevant to researchers, including systems biology; antibody deep sequencing and repertoires; the effects of antibody gene variation and usage on antibody response; directed evolution; knowledge-based design; antibodies in a complex environment; polyreactive antibodies and polyspecificity; the interface between antibody therapy and cellular immunity in cancer; antibodies in cardiometabolic medicine; antibody pharmacokinetics, distribution and off-target toxicity; optimizing antibody formats for immunotherapy; polyclonals, oligoclonals and bispecifics; antibody discovery platforms; and antibody-drug conjugates. PMID:24589717

  13. Therapeutic and diagnostic nanomaterials

    CERN Document Server

    Devasena T

    2017-01-01

    This brief highlights nanoparticles used in the diagnosis and treatment of prominent diseases and toxic conditions. Ecofriendly methods which are ideal for the synthesis of medicinally valued nanoparticles are explained and the characteristic features of these particles projected. The role of these particles in the therapeutic field, and the induced biological changes in some diseases are discussed. The main focus is on inflammation, oxidative stress and cellular membrane integrity alterations. The effect of nanoparticles on these changes produced by various agents are highlighted using in vitro and in vivo models. The mechanism of nanoparticles in ameliorating the biological changes is supported by relevant images and data. Finally, the brief demonstrates recent developments on the use of nanoparticles in diagnosis or sensing of some biological materials and biologically hazardous environmental materials.

  14. [Therapeutic education didactic techniques].

    Science.gov (United States)

    Valverde, Maite; Vidal, Mercè; Jansa, Margarida

    2012-10-01

    This article includes an introduction to the role of Therapeutic Education for Diabetes treatment according to the recommendations of the American Diabetes Association (ADA), the Diabetes Education Study Group (DESG) of the "European Association for Study of Diabetes (EASD) and the clinical Practice Guidelines (CPG) of the Spanish Ministry of Health. We analyze theoretical models and the differences between teaching vs. learning as well as current trends (including Internet), that can facilitate meaningful learning of people with diabetes and their families and relatives. We analyze the differences, similarities, advantages and disadvantages of individual and group education. Finally, we describe different educational techniques (metaplan, case method, brainstorming, role playing, games, seminars, autobiography, forums, chats,..) applicable to individual, group or virtual education and its application depending on the learning objective.

  15. Making Yugoslavs

    DEFF Research Database (Denmark)

    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...

  16. THE MAKING OF DECISION MAKING

    Directory of Open Access Journals (Sweden)

    Leonardo Yuji Tamura

    2016-04-01

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

  17. Therapeutic communities, old and new.

    Science.gov (United States)

    Jones, M

    1979-01-01

    The author attempts to clarify two largely different uses of term, Therapeutic Community (TC). By "old" TC he describes a movement which originated in psychiatry in the United Kingdom at the end of World War II. This was an attempt to establish a democratic system in hospitals where the domination of the doctors was replaced by open communication of content and feeling, information sharing, shared decision making, and problem solving shared as far as possible with all patients and staff. Daily meetings of all patients and staff formed the nucleus of this process. In recent years developments in the areas of systems theory, learning theory, and organization development have contributed to a better understanding of social organization and change. The "new" TCs derive from the more recent developments in the treatment of substance abuse. Central to this movement is Synanon and its many modification which use the clients' peer group to solve their own problems, largely eliminating mental health professionals. Linked with these "new" TCs is the development of Asklepieion units in prisons, which use Synanon "games" along with transactional analysis. An attempt is made to distinguish the methodologies used in TCs, "old" and "new".

  18. Inpatient Therapeutic Assessment With Narcissistic Personality Disorder.

    Science.gov (United States)

    Hinrichs, Jon

    2016-01-01

    Growing evidence supporting the effectiveness of Collaborative/Therapeutic Assessment (C/TA) has led clinicians and researchers to apply C/TA to a variety of clinical populations and treatment settings. This case example presents a C/TA inpatient adaptation illustrated with narcissistic personality disorder. After a brief overview of salient concepts, I provide a detailed account of the clinical interview, test interpretation paired with diagnostic considerations specific to narcissism, planned intervention, and discussion of assessment results. Throughout the case study, I attempt to demonstrate defining features of C/TA, inpatient adaptations, and clinical techniques that encourage meaningful engagement with a "hard to reach" personality.

  19. New concepts in therapeutic photomedicine: photochemistry, optical targeting and the therapeutic window

    International Nuclear Information System (INIS)

    Parrish, J.A.

    1981-01-01

    Advances in optics technology, synthetic photochemistry, and the science of photobiology make it possible to think beyond phototherapy and photochemotherapy which is dependent on direct photochemical alteration of metabolites or direct phototoxic insult to cells. This report discusses another gender of photomedicine therapy which includes in vivo photoactivation of medicines, photon-dependent drug delivery, and manipulation of host and exposure source to maximize therapeutic index. These therapeutic manipulations are made possible because the skin is highly overperfused and because non-ionizing electromagnetic radiation that enters skin and blood has adequate photon energy to cause electronic excitation. Radiation of 320-800 nm is not very directly phototoxic, is absorbed by a variety of relatively nontoxic photolabile molecules and has an internal dosimetric depth profile. This radiation can therefore be used to activate, deactivate, bind, release or biotransform medications in vivo in skin or other organs. The photochemist, synthetic chemist and photobiologist can collaborate to significantly increase therapeutic possibilities

  20. [Beat therapeutic inertia in dyslipidemic patient management: A challenge in daily clinical practice] [corrected].

    Science.gov (United States)

    Morales, Clotilde; Mauri, Marta; Vila, Lluís

    2014-01-01

    Beat therapeutic inertia in dyslipidemic patient management: a challenge in daily clinical practice. In patients with dyslipidemia, there is the need to reach the therapeutic goals in order to get the maximum benefit in the cardiovascular events risk reduction, especially myocardial infarction. Even having guidelines and some powerful hypolipidemic drugs, the goals of low-density lipoprotein-cholesterol (LDL-c) are often not reached, being of special in patients with a high cardiovascular risk. One of the causes is the therapeutic inertia. There are tools to plan the treatment and make the decisions easier. One of the challenges in everyday clinical practice is to know the needed percentage of reduction in LDL-c. Moreover: it is hard to know which one is the treatment we should use in the beginning of the treatment but also when the desired objective is not reached. This article proposes a practical method that can help solving these questions. Copyright © 2013 Sociedad Española de Arteriosclerosis. Published by Elsevier España. All rights reserved.

  1. Making Daily Mobility

    DEFF Research Database (Denmark)

    Jensen, Ole B.; Wind, Simon

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

  2. Public Participation Plan

    International Nuclear Information System (INIS)

    1993-07-01

    The purpose of this Public Participation Plan is to describe the US Department of Energy's (DOE) plan for involving the public in the decision-making process for the Uranium Mill Tailings Remedial Action (UMTRA) Project. The plan describes how the DOE will meet the public participation requirements of the Uranium Mill Tailings Radiation Control Act (UMTRCA) of 1978, as amended, and of the National Environmental Policy Act (NEPA) of 1969. It includes the UMTRA Project Office plans for complying with DOE Order 5440.1D and for implementing the DOE's Public Participation Policy for Environmental Restoration and Waste Management (1992) and Public Participation Guidance for Environmental Restoration and Waste Management (1993)

  3. [Nuclear transfer and therapeutic cloning].

    Science.gov (United States)

    Xu, Xiao-Ming; Lei, An-Min; Hua, Jin-Lian; Dou, Zhong-Ying

    2005-03-01

    Nuclear transfer and therapeutic cloning have widespread and attractive prospects in animal agriculture and biomedical applications. We reviewed that the quality of oocytes and nuclear reprogramming of somatic donor cells were the main reasons of the common abnormalities in cloned animals and the low efficiency of cloning and showed the problems and outlets in therapeutic cloning, such as some basic problems in nuclear transfer affected clinical applications of therapeutic cloning. Study on isolation and culture of nuclear transfer embryonic stem (ntES) cells and specific differentiation of ntES cells into important functional cells should be emphasized and could enhance the efficiency. Adult stem cells could help to cure some great diseases, but could not replace therapeutic cloning. Ethics also impeded the development of therapeutic cloning. It is necessary to improve many techniques and reinforce the research of some basic theories, then somatic nuclear transfer and therapeutic cloning may apply to agriculture reproduction and benefit to human life better.

  4. Pharmacokinetic and pharmacodynamic considerations for the next generation protein therapeutics.

    Science.gov (United States)

    Shah, Dhaval K

    2015-10-01

    Increasingly sophisticated protein engineering efforts have been undertaken lately to generate protein therapeutics with desired properties. This has resulted in the discovery of the next generation of protein therapeutics, which include: engineered antibodies, immunoconjugates, bi/multi-specific proteins, antibody mimetic novel scaffolds, and engineered ligands/receptors. These novel protein therapeutics possess unique physicochemical properties and act via a unique mechanism-of-action, which collectively makes their pharmacokinetics (PK) and pharmacodynamics (PD) different than other established biological molecules. Consequently, in order to support the discovery and development of these next generation molecules, it becomes important to understand the determinants controlling their PK/PD. This review discusses the determinants that a PK/PD scientist should consider during the design and development of next generation protein therapeutics. In addition, the role of systems PK/PD models in enabling rational development of the next generation protein therapeutics is emphasized.

  5. Therapeutic strategies in the treatment of periodontitis

    Directory of Open Access Journals (Sweden)

    Liljana Bogdanovska

    2012-04-01

    Full Text Available Periodontitis is a chronic inflammatory process which affects the tooth - supporting structures of the teeth. The disease is initiated by subgingival periopathogenic bacteria in susceptible periodontal sites. The host immune response towards periodontal pathogens helps to sustain periodontal disease and eventual alveolar bone loss. Although scaling and root planing is the standard treatment modality for periodontitis, it suffers from several drawbacks such as the inability to reach the base of deep pockets and doesn’t arrest migration of periodontal pathogens from other sites in the oral cavity. In order to overcome the limitations of scaling and root planning, adjunctive chemotherapeutics and host modulatory agents to the treatment are used. These therapeutic agents show substantial beneficial effects when compared to scaling and root planning alone. This review will cover an update on chemotherapeutic and past and future host immune modulatory agents used adjunctively to treat and manage periodontal diseases.

  6. Molecularly targeted therapeutic radiopharmaceuticals

    International Nuclear Information System (INIS)

    Saw, M.M.

    2007-01-01

    Full text: It is generally agreed that current focus of nuclear medicine development should be on molecular imaging and therapy. Though, the widespread use of the terminology 'molecular imaging' is quite recent, nuclear medicine has used molecular imaging techniques for more than 20 years ago. A variety of radiopharmaceuticals have been introduced for the internal therapy of malignant and inflammatory lesions in nuclear medicine. In the field of bio/medical imaging, nuclear medicine is one of the disciplines which has the privilege of organized and well developed chemistry/ pharmacy section; radio-chemistry/radiopharmacy. Fundamental principles have been developed more than 40 years ago and advanced research is going well into postgenomic era. The genomic revolution and dramatically increased insight in the molecular mechanisms underlying pathology have led to paradigm shift in drug development. Likewise does in the nuclear medicine. Here, the author will present current clinical and pre-clinical therapeutic radiopharmaceuticals based on molecular targets such as membrane-bound receptors, enzymes, nucleic acids, sodium iodide symporter, etc, in correlation with fundamentals of radiopharmacy. (author)

  7. Rethinking Therapeutic Misconception in Biobanking

    DEFF Research Database (Denmark)

    Tupasela, Aaro; Snell, Karoliina; Cañada, Jose

    2017-01-01

    Some authors have noted that in biobank research participants may be guided by what is called therapeutic misconception, whereby participants attribute therapeutic intent to research procedures.This article argues that the notion of therapeutic misconception is increasingly less justified when...... underpinnings for the need to separate research and treatment, and thus the notion of therapeutic misconception in the fi rst place. We call this tension between research and treatment ambivalent research advancement to highlight the difficulties that various actors have in managing such shifts within...

  8. Therapeutic cloning: The ethical limits

    International Nuclear Information System (INIS)

    Whittaker, Peter A.

    2005-01-01

    A brief outline of stem cells, stem cell therapy and therapeutic cloning is given. The position of therapeutic cloning with regard to other embryonic manipulations - IVF-based reproduction, embryonic stem formation from IVF embryos and reproductive cloning - is indicated. The main ethically challenging stages in therapeutic cloning are considered to be the nuclear transfer process including the source of eggs for this and the destruction of an embryo to provide stem cells for therapeutic use. The extremely polarised nature of the debate regarding the status of an early human embryo is noted, and some potential alternative strategies for preparing immunocompatible pluripotent stem cells are indicated

  9. Therapeutic cloning in the mouse

    Science.gov (United States)

    Mombaerts, Peter

    2003-01-01

    Nuclear transfer technology can be applied to produce autologous differentiated cells for therapeutic purposes, a concept termed therapeutic cloning. Countless articles have been published on the ethics and politics of human therapeutic cloning, reflecting the high expectations from this new opportunity for rejuvenation of the aging or diseased body. Yet the research literature on therapeutic cloning, strictly speaking, is comprised of only four articles, all in the mouse. The efficiency of derivation of embryonic stem cell lines via nuclear transfer is remarkably consistent among these reports. However, the efficiency is so low that, in its present form, the concept is unlikely to become widespread in clinical practice. PMID:12949262

  10. Plan well, plan often

    Science.gov (United States)

    Bill Block

    2013-01-01

    This issue includes an invited paper by Courtney Schultz and her colleagues commenting on the application of the newly adopted U.S. Forest Service Planning Rule (hereafter, the rule) for wildlife. The rule is basically implementing language to interpret the spirit and intent of the National Forest Management Act (NFMA) of 1976. Laws such as NFMA require additional...

  11. Language Planning: Corpus Planning.

    Science.gov (United States)

    Baldauf, Richard B., Jr.

    1989-01-01

    Focuses on the historical and sociolinguistic studies that illuminate corpus planning processes. These processes are broken down and discussed under two categories: those related to the establishment of norms, referred to as codification, and those related to the extension of the linguistic functions of language, referred to as elaboration. (60…

  12. Achieving the Promise of Therapeutic Extracellular Vesicles: The Devil is in Details of Therapeutic Loading.

    Science.gov (United States)

    Sutaria, Dhruvitkumar S; Badawi, Mohamed; Phelps, Mitch A; Schmittgen, Thomas D

    2017-05-01

    Extracellular vesicles (EVs) represent a class of cell secreted organelles which naturally contain biomolecular cargo such as miRNA, mRNA and proteins. EVs mediate intercellular communication, enabling the transfer of functional nucleic acids from the cell of origin to the recipient cells. In addition, EVs make an attractive delivery vehicle for therapeutics owing to their increased stability in circulation, biocompatibility, low immunogenicity and toxicity profiles. EVs can also be engineered to display targeting moieties on their surfaces which enables targeting to desired tissues, organs or cells. While much has been learned on the role of EVs as cell communicators, the field of therapeutic EV application is currently under development. Critical to the future success of EV delivery system is the description of methods by which therapeutics can be successfully and efficiently loaded within the EVs. Two methods of loading of EVs with therapeutic cargo exist, endogenous and exogenous loading. We have therefore focused this review on describing the various published approaches for loading EVs with therapeutics.

  13. Rough multiple objective decision making

    CERN Document Server

    Xu, Jiuping

    2011-01-01

    Rough Set TheoryBasic concepts and properties of rough sets Rough Membership Rough Intervals Rough FunctionApplications of Rough SetsMultiple Objective Rough Decision Making Reverse Logistics Problem with Rough Interval Parameters MODM based Rough Approximation for Feasible RegionEVRMCCRMDCRM Reverse Logistics Network Design Problem of Suji Renewable Resource MarketBilevel Multiple Objective Rough Decision Making Hierarchical Supply Chain Planning Problem with Rough Interval Parameters Bilevel Decision Making ModelBL-EVRM BL-CCRMBL-DCRMApplication to Supply Chain Planning of Mianyang Co., LtdStochastic Multiple Objective Rough Decision Multi-Objective Resource-Constrained Project Scheduling UnderRough Random EnvironmentRandom Variable Stochastic EVRM Stochastic CCRM Stochastic DCRM Multi-Objective rc-PSP/mM/Ro-Ra for Longtan Hydropower StationFuzzy Multiple Objective Rough Decision Making Allocation Problem under Fuzzy Environment Fuzzy Variable Fu-EVRM Fu-CCRM Fu-DCRM Earth-Rock Work Allocation Problem.

  14. Beyond the 'therapeutic misconception'

    DEFF Research Database (Denmark)

    Wadmann, Sarah; Hoeyer, Klaus

    2014-01-01

    -participants and trial sponsors, and a survey of the participants. We found an organisation of clinical drug trials allowing extraordinary care relationships to form which makes trial participation attractive and allows information to flow more freely. However, the research-care intermingling generates moral concerns...... for those involved. We conceptualize these concerns as a productive moral friction resulting from research staff caring too much for patients. We identify three situations in which friction arises: when care-giving comes to replace specialist contact, when caring for individuals appears unfair...

  15. Purinergic Signalling: Therapeutic Developments

    Directory of Open Access Journals (Sweden)

    Geoffrey Burnstock

    2017-09-01

    Full Text Available Purinergic signalling, i.e., the role of nucleotides as extracellular signalling molecules, was proposed in 1972. However, this concept was not well accepted until the early 1990’s when receptor subtypes for purines and pyrimidines were cloned and characterised, which includes four subtypes of the P1 (adenosine receptor, seven subtypes of P2X ion channel receptors and 8 subtypes of the P2Y G protein-coupled receptor. Early studies were largely concerned with the physiology, pharmacology and biochemistry of purinergic signalling. More recently, the focus has been on the pathophysiology and therapeutic potential. There was early recognition of the use of P1 receptor agonists for the treatment of supraventricular tachycardia and A2A receptor antagonists are promising for the treatment of Parkinson’s disease. Clopidogrel, a P2Y12 antagonist, is widely used for the treatment of thrombosis and stroke, blocking P2Y12 receptor-mediated platelet aggregation. Diquafosol, a long acting P2Y2 receptor agonist, is being used for the treatment of dry eye. P2X3 receptor antagonists have been developed that are orally bioavailable and stable in vivo and are currently in clinical trials for the treatment of chronic cough, bladder incontinence, visceral pain and hypertension. Antagonists to P2X7 receptors are being investigated for the treatment of inflammatory disorders, including neurodegenerative diseases. Other investigations are in progress for the use of purinergic agents for the treatment of osteoporosis, myocardial infarction, irritable bowel syndrome, epilepsy, atherosclerosis, depression, autism, diabetes, and cancer.

  16. Dental therapeutic systems.

    Science.gov (United States)

    Iqbal, Zeenat; Jain, Nilu; Jain, Gaurav K; Talegaonkar, Sushama; Ahuja, Alka; Khar, Roop K; Ahmad, Farhan J

    2008-01-01

    The recognition of periodontal diseases as amenable to local antibiotherapy has resulted in a paradigmatic shift in treatment modalities of dental afflictions. Moreover the presence of antimicrobial resistance, surfacing of untoward reactions owing to systemic consumption of antibiotics has further advocated the use of local delivery of physiologically active substances into the periodontal pocket. While antimicrobials polymerized into acrylic strips, incorporated into biodegradable collagen and hollow permeable cellulose acetate fibers, multiparticulate systems, bio-absorbable dental materials, biodegradable gels/ointments, injectables, mucoadhesive microcapsules and nanospheres will be more amenable for direct placement into the periodontal pockets the lozenges, buccoadhesive tablets, discs or gels could be effectively used to mitigate the overall gingival inflammation. Whilst effecting controlled local delivery of a few milligram of an antibacterial agent within the gingival crevicular fluid for a longer period of time, maintaining therapeutic concentrations such delivery devices will circumvent all adverse effects to non- oral sites. Since the pioneering efforts of Goodson and Lindhe in 1989, delivery at gingival and subgingival sites has witnessed a considerable progress. The interest in locally active systems is evident from the patents being filed and granted. The present article shall dwell in reviewing the recent approaches being proffered in the field. Patents as by Shefer, et al. US patent, 6589562 dealing with multicomponent biodegradable bioadhesive controlled release system for oral care products, Lee, et al. 2001, US patent 6193994, encompassing a locally administrable, biodegradable and sustained-release pharmaceutical composition for periodontitis and process for preparation thereof and method of treating periodontal disease as suggested by Basara in 2004via US patent 6830757, shall be the types of intellectual property reviewed and presented in

  17. Making the Connection between Environmental Science and Decision Making

    Science.gov (United States)

    Woodhouse, C. A.; Crimmins, M.; Ferguson, D. B.; Garfin, G. M.; Scott, C. A.

    2011-12-01

    As society is confronted with population growth, limited resources, and the impacts of climate variability and change, it is vital that institutions of higher education promote the development of professionals who can work with decision-makers to incorporate scientific information into environmental planning and management. Skills for the communication of science are essential, but equally important is the ability to understand decision-making contexts and engage with resource managers and policy makers. It is increasingly being recognized that people who understand the linkages between science and decision making are crucial if science is to better support planning and policy. A new graduate-level seminar, "Making the Connection between Environmental Science and Decision Making," is a core course for a new post-baccalaureate certificate program, Connecting Environmental Science and Decision Making at the University of Arizona. The goal of the course is to provide students with a basic understanding of the dynamics between scientists and decision makers that result in scientific information being incorporated into environmental planning, policy, and management decisions. Through readings from the environmental and social sciences, policy, and planning literature, the course explores concepts including scientific information supply and demand, boundary organizations, co-production of knowledge, platforms for engagement, and knowledge networks. Visiting speakers help students understand some of the challenges of incorporating scientific information into planning and decision making within institutional and political contexts. The course also includes practical aspects of two-way communication via written, oral, and graphical presentations as well as through the interview process to facilitate the transfer of scientific information to decision makers as well as to broader audiences. We aspire to help students develop techniques that improve communication and

  18. Therapeutical aspect of trichomoniasis

    Directory of Open Access Journals (Sweden)

    Vukićević Jelica

    2003-01-01

    Full Text Available Trichomoniasis is frequent, parasitic and sexually transmitted infection of genitourinary tract. It is treated by metronidazole (5-nitroimidazole according to protocol recommended by Center for Disease Control (CDC formerly called: Communicable Disease Center [19]. The resistance of Trichomonas vaginalis (TV strains to metronidazole (MND was described in USA in 1960, and later on in many European countries [8, 9, 10, 11, 12, 13]. In these cases, due to persistent trichomonas infection, it is necessary to repeat MND treatment with moderate modification of dose and/or length of its application. Nevertheless, oncogenic and toxic effects of MND have to be taken into consideration. OBJECT The aim of this study was to investigate and analyze the incidence of TV in STD and lower susceptibility of certain TV strains to MND were analyzed. MATERIAL AND METHODS In three-year period (1999-2001 612 patients (244 females and 368 males suspected of STD were examined clinically and microbiologically at the Institute of Dermatovenereology in Belgrade. The patients detected for TV were treated according to CDC protocol. The affected were considered cured if there was no manifest clinical infection, and no TV verified by microbiological test. Results TV was isolated in 216 patients (35.29 % of all subjects. Trichomonas infection was found in 90 (36.88 % out of 244 tested females and in 126 (32.34 % of 368 males. Clinically manifested infection, with extensive urethral and vaginal secretion, was recorded in 161 patients, while the asymptomatic form was found in 55 subjects. This result indicates the predominance of manifested trichomonas infections (75.54 % of cases. The difference of distribution of clinical forms of trichomoniasis, in relation to sex, was not statistically significant (c2=0.854; p>0.05. The patients with verified trichomonas infection were treated by metronidazole according to CDC protocol. The recommended therapeutical scheme consisted of three

  19. Management Planning In Transport

    Directory of Open Access Journals (Sweden)

    Teodor Perić

    2004-07-01

    Full Text Available Management planning in traffic and other activities includesa choice of missions and goals, as well as actions undertakenfor their realisation. It requires decision-making, that is,a choice among alternative trends of future actions. Therefore,planning and control are closely related.There are several types of plans: purposes or missions,goals, strategies, policies, procedures, rules, programs and calculations.Once managers become aware of the opportunities, they rationallyplan the setting of the goals and assumptions about thecurrent and future environment, finding and evaluating alternativetrends, and selecting the one that is to be followed.Therefore, planning means looking ahead and controlmeans looking backwards. The concept of overall planning,thus including traffic planning, illustrates the approach to managementwhich is based on the achieved goals.

  20. Science communication in policy making

    DEFF Research Database (Denmark)

    Coumou, Hilde; van der Werf Kulichova, Z.; Wehrmann, C.

    2014-01-01

    Policy making regarding application of agricultural biotechnology has been controversial. This study investigates what determines the motivation of European biotech scientists to actively participate in policy making. To do this, a conceptual framework was developed based on the Theory of Planned...... Behavior. The framework was operationalized in semi-structured interviews with 17 European biotech scientists to collect data about their motivation to involve in GMO policy making. The results of this qualitative study suggest that the attitude of the scientists towards active participation in policy...... making is dependent on their view of the way science and decision making relate to each other. The respondents who are currently active in policy making seem to be driven by commitment to the public good. However, many respondents feel social pressure from environmental NGOs to withdraw from engagement...

  1. Supply chain planning classification

    Science.gov (United States)

    Hvolby, Hans-Henrik; Trienekens, Jacques; Bonde, Hans

    2001-10-01

    Industry experience a need to shift in focus from internal production planning towards planning in the supply network. In this respect customer oriented thinking becomes almost a common good amongst companies in the supply network. An increase in the use of information technology is needed to enable companies to better tune their production planning with customers and suppliers. Information technology opportunities and supply chain planning systems facilitate companies to monitor and control their supplier network. In spite if these developments, most links in today's supply chains make individual plans, because the real demand information is not available throughout the chain. The current systems and processes of the supply chains are not designed to meet the requirements now placed upon them. For long term relationships with suppliers and customers, an integrated decision-making process is needed in order to obtain a satisfactory result for all parties. Especially when customized production and short lead-time is in focus. An effective value chain makes inventory available and visible among the value chain members, minimizes response time and optimizes total inventory value held throughout the chain. In this paper a supply chain planning classification grid is presented based current manufacturing classifications and supply chain planning initiatives.

  2. Therapeutic Inertia and Treatment Intensification.

    Science.gov (United States)

    Josiah Willock, Robina; Miller, Joseph B; Mohyi, Michelle; Abuzaanona, Ahmed; Muminovic, Meri; Levy, Phillip D

    2018-01-29

    This review aims to emphasize how therapeutic inertia, the failure of clinicians to intensify treatment when blood pressure rises or remains above therapeutic goals, contributes to suboptimal blood pressure control in hypertensive populations. Studies reveal that the therapeutic inertia is quite common and contributes to suboptimal blood pressure control. Quality improvement programs and standardized approaches to support antihypertensive treatment intensification are ways to combat therapeutic inertia. Furthermore, programs that utilize non-physician medical professionals such as pharmacists and nurses demonstrate promise in mitigating the effects of this important problem. Therapeutic inertia impedes antihypertensive management and requires a broad effort to reduce its effects. There is an ongoing need for renewed focus and research in this area to improve hypertension control.

  3. Elective course planning

    DEFF Research Database (Denmark)

    Kristiansen, Simon; Sørensen, Matias; Stidsen, Thomas Riis

    2011-01-01

    Efficient planning increasingly becomes an indispensable tool for management of both companies and public organizations. This is also the case for high school management in Denmark, because the growing individual freedom of the students to choose courses makes planning much more complex. Due...... to reforms, elective courses are today an important part of the curriculum, and elective courses are a good way to make high school education more attractive for the students. In this article, the problem of planning the elective courses is modeled using integer programming and three different solution...... for the Elective Course Planning Problem has been described in the literature before. The proposed algorithms are tested on data sets from 98 of the 150 high schools in Denmark. The tests show that for the majority of the problems, the optimal solution can be obtained within the one hour time bound. Furthermore...

  4. Human Factor in Therapeutic Relationship

    Directory of Open Access Journals (Sweden)

    Ramazan Akdogan

    2011-03-01

    Full Text Available herapeutic relationship is a professional relationship that has been structured based on theoretical props. This relationship is a complicated, wide and unique relationship which develops between two people, where both sides' personality and attitudes inevitably interfere. Therapist-client relationship experienced through transference and counter transference, especially in psychodynamic approaches, is accepted as the main aspect of therapeutic process. However, the approaches without dynamic/deterministic tendency also take therapist-client relationship into account seriously and stress uniqueness of interaction between two people. Being a person and a human naturally sometimes may negatively influence the relationship between the therapist and client and result in a relationship going out of the theoretical frame at times. As effective components of a therapeutic process, the factors that stem from being human include the unique personalities of the therapist and the client, their values and their attitude either made consciously or subconsciously. Literature has shown that the human-related factors are too effective to be denied in therapeutic relationship process. Ethical and theoretical knowledge can be inefficient to prevent the negative effects of these factors in therapeutic process at which point a deep insight and supervision would have a critical role in continuing an acceptable therapeutic relationship. This review is focused on the reflection of some therapeutic factors resulting from being human and development of counter transference onto the therapeutic process.

  5. The therapeutic alliance: a psychoanalytic perspective.

    Science.gov (United States)

    Freebury, D R

    1989-11-01

    Psychoanalysis has long distinguished between the transference neurosis and that part of the communication between therapist and patient which depends upon a relatively intact part of the patient's ego. It has been proposed that it is this capacity of the patient that sustains the difficult work of dealing with communications which are the consequence of transference, and which often threaten the viability of the treatment. This quality has been referred to variously as the unobjectionable positive transference, rational transference, mature transference, therapeutic alliance and working alliance. The ever broadening scope of Psychoanalysis, along with our greater knowledge of early childhood development, has enhanced our understanding of the many influences affecting the treatment alliances. Newer views of the transference, which stress the significance of the therapists' contributions to the therapeutic dyad, make it clear that the therapeutic alliance can no longer be explained as some simple, reality based, conflict free, motivating force. It involves, rather, a complex interaction of several factors, to each of which one must add the therapists' reciprocal reactions. Psychotherapy outcome research will need to take all of these factors into consideration.

  6. [End therapeutic nihilism towards COPD].

    Science.gov (United States)

    Juergens, Uwe R

    2007-03-15

    Prevention of COPD requires appropriate patient education, especially of adolescents, as well as the establishment of an effective national health policy. The new GOLD guidelines represent the current standard of knowledge on the management of chronic, progressive, obstructive pulmonary diseases. It points out that COPD is avoidable and treatable,and hence, there is no reason for therapeutic nihilism. Chronic bronchitis preceding a progressive respiratory obstruction cannot be improved with the presently available respiratory therapeutics. For this reason, therapeutic measures concentrate on the avoidance of exacerbations, which are primarily responsible for the severity of the course of COPD.

  7. Frontiers in nano-therapeutics

    CERN Document Server

    Tasnim, Nishat; Sai Krishna, Katla; Kalagara, Sudhakar; Narayan, Mahesh; Noveron, Juan C; Joddar, Binata

    2017-01-01

    This brief highlights recent research advances in the area of nano-therapeutics. Nanotechnology holds immense potential for application in a wide range of biological and engineering applications such as molecular sensors for disease diagnosis, therapeutic agents for the treatment of diseases, a vehicle for delivering therapeutics and imaging agents for theranostic applications, both in-vitro and in-vivo. The brief is grouped into the following sections namely, A) Discrete Nanosystems ; B) Anisotropic Nanoparticles; C) Nano-films/coated/layered and D) Nano-composites.

  8. Therapeutic hypothermia for acute stroke

    DEFF Research Database (Denmark)

    Olsen, Tom Skyhøj; Weber, Uno Jakob; Kammersgaard, Lars Peter

    2003-01-01

    Experimental evidence and clinical experience show that hypothermia protects the brain from damage during ischaemia. There is a growing hope that the prevention of fever in stroke will improve outcome and that hypothermia may be a therapeutic option for the treatment of stroke. Body temperature...... obvious therapeutic potential, hypothermia as a form of neuroprotection for stroke has been investigated in only a few very small studies. Therapeutic hypothermia is feasible in acute stroke but owing to serious side-effects--such as hypotension, cardiac arrhythmia, and pneumonia--it is still thought...

  9. Marketing Plan: Tukkanuotta Rauma

    OpenAIRE

    Hyrsky, Antti

    2012-01-01

    The purpose of this thesis was to make a marketing plan and a brand new website for a hair saloon. The marketing plan is based on the 7p’s of the extended or service marketing mix. The emphasis is on the parts of promotion and price. The thesis outlines the theory of marketing mix and applies it to the case. The second part of the thesis is a new website. The website was done using Joomla! 1.7 content management system. This platform was selected in order to make future updating and m...

  10. Stationary fuel cell systems. Danish strategy for maturing micro- combined power and heat generation for the market. To make the house owners environmentally conscious prosumers; Stationaere braendselscellesystemer. Dansk plan for markedsmodning af mikrokraftvarme. Goer boligejerne til miljoevenlige prosumenter

    Energy Technology Data Exchange (ETDEWEB)

    2011-04-15

    The aim of this new market maturing plan is to show how innovative technologies for micro stationary fuel cell cogeneration systems can enter both the Danish and the international markets. The report first presents a general description of all types of stationary plants. Not all of them are yet ready for commercialization - some are still in the research and development phase. The plan documents that there is a need for incentives for maturing the technologies for the market after the demonstration phase, and it presents methods for market introduction in Denmark and internationally. (ln)

  11. Implementation of nanoparticles in therapeutic radiation oncology

    Science.gov (United States)

    Beeler, Erik; Gabani, Prashant; Singh, Om V.

    2017-05-01

    Development and progress of cancer is a very complex disease process to comprehend because of the multiple changes in cellular physiology, pathology, and pathophysiology resulting from the numerous genetic changes from which cancer originates. As a result, most common treatments are not directed at the molecular level but rather at the tissue level. While personalized care is becoming an increasingly aim, the most common cancer treatments are restricted to chemotherapy, radiation, and surgery, each of which has a high likelihood of resulting in rather severe adverse side effects. For example, currently used radiation therapy does not discriminate between normal and cancerous cells and greatly relies on the external targeting of the radiation beams to specific cells and organs. Because of this, there is an immediate need for the development of new and innovative technologies that help to differentiate tumor cells and micrometastases from normal cells and facilitate the complete destruction of those cells. Recent advancements in nanoscience and nanotechnology have paved a way for the development of nanoparticles (NPs) as multifunctional carriers to deliver therapeutic radioisotopes for tumor targeted radiation therapy, to monitor their delivery, and improve the therapeutic index of radiation and tumor response to the treatment. The application of NPs in radiation therapy has aimed to improve outcomes in radiation therapy by increasing therapeutic effect in tumors and reducing toxicity on normal tissues. Because NPs possess unique properties, such as preferential accumulation in tumors and minimal uptake in normal tissues, it makes them ideal for the delivery of radiotherapy. This review provides an overview of the recent development of NPs for carrying and delivering therapeutic radioisotopes for systemic radiation treatment for a variety of cancers in radiation oncology.

  12. The 1986 action plan

    International Nuclear Information System (INIS)

    Anon.

    1988-01-01

    Discussion covers the actions that must be taken and the standards to be met to achieve the goals of the 20 year plan. Bonneville Power Administration (BPA) has agreed to develop detailed work plans for achieving the objects of the plan, through a public process in consultation with the Council and interested parties. BPA work plans and activities are outlined. The Council's plan emphasizes the following priorities: (1) a stronger regional role for BPA; (2) development of the capability to acquire conservation on a regional basis; (3) strategies to make better use of the hydropower system; (4) building conservation capability in all sectors; (5) demonstrating the cost effectiveness of renewable resources so they are available before the region has to build new generating resources; (6) allocation of costs for two unfinished nuclear power plants and elimination of barriers to their completion; and (7) a study of electric power sales and purchases between regions

  13. Design Considerations in Therapeutic Exergaming

    OpenAIRE

    Doyle, Julie; Kelly, Daniel; Caulfield, B.

    2011-01-01

    In this paper we discuss the importance of feedback in therapeutic exergaming. It is widely believed that exergaming benefits the patient in terms of encouraging adherence and boosting the patient’s confidence of correct execution and feedback is essential in achieving these. However, feedback and in particular visual feedback, may also have potential negative effects on the quality of the exercise. We describe in this paper a prototype single-sensor therapeutic exergame that we have develope...

  14. Evaluation of therapeutic patient education

    OpenAIRE

    D'Ivernois , Jean-François; Gagnayre , Rémi; Assal , Jean-Philippe; Golay , Alain; Libion , France; Deccache , Alain

    2006-01-01

    9 pages; These guidelines mainly focus on the principles of evaluating Therapeutic Patient Education; Over the past thirty years, therapeutic patient education (TPE) has become an essential part of the treatment of long-term diseases. Evaluations of this new practice are expected, and are sometimes imposed according to protocols and criteria that do not always reflect the complexity of changes taking place within patients and healthcare providers. Sometimes, expected results are not achieved ...

  15. Profiling Prostate Cancer Therapeutic Resistance

    OpenAIRE

    Cameron A. Wade; Natasha Kyprianou

    2018-01-01

    The major challenge in the treatment of patients with advanced lethal prostate cancer is therapeutic resistance to androgen-deprivation therapy (ADT) and chemotherapy. Overriding this resistance requires understanding of the driving mechanisms of the tumor microenvironment, not just the androgen receptor (AR)-signaling cascade, that facilitate therapeutic resistance in order to identify new drug targets. The tumor microenvironment enables key signaling pathways promoting cancer cell survival ...

  16. Mild Epicureanism: notes toward the definition of a therapeutic attitude.

    Science.gov (United States)

    Strenger, Carlo

    2008-01-01

    Psychotherapists generally feel uncomfortable addressing patients' beliefs, particularly religious beliefs, because of the desire to respect client subjectivity and to avoid the abuse of therapeutic authority. This paper's first contention is that at some junctures, investigation of the client's belief structure can be an important catalyst for change, as exemplified by an extended case example. This stance assumes that much of the individual and collective damage rigid belief systems inflict derives from their function as a defense against death awareness, as described by terror management theory. The paper develops the concept of a therapeutic meta-attitude towards belief mild Epicureanism, related to the classical Greek philosopher Epicurus (341-270 BC). Mild Epicureanism means to soften attachments to all belief systems, even therapeutic theories, to lower their potential inhibition of personal growth. The paper presents the argument that mild Epicureanism is consistent with most therapeutic approaches, and allows addressing clients' belief without interfering with their right to make up their own minds.

  17. Engaging therapeutic citizenship and clientship: Untangling the reasons for therapeutic pacifism among people living with HIV in urban Zambia.

    Science.gov (United States)

    Patterson, Amy S

    2016-10-01

    This article explores the reasons for therapeutic pacifism among people living with HIV (PLHIVs) in urban Zambia. It contributes to a growing ethnography on global health, biosociality, and patient-provider dynamics. Therapeutic citizenship is a biopolitical citizenship that includes claims and ethical projects that emerge from techniques to control and manage bodies. In some contexts, therapeutic citizenship has included activism and claims-making against local, national, and international power brokers. This article investigates therapeutic citizenship in the specific context of impoverished urban Zambian compounds, sites of food insecurity, unemployment, and political exclusion, as well as targets for donor, NGO, and faith-based organisation projects and PLHIV support group proliferation. The article utilises data from participant observations at two Lusaka AIDS clinics, interviews, and focused discussions with support groups of PLHIVs. It argues that PLHIVs continuously negotiate subjectivities related to kinship, clientship, religious belief, and political citizenship in processes that complicate therapeutic citizenship. Rather than fostering participation in PLHIV support groups or challenging 'politics as usual' through activist claims-making to institutions of biopower, these processes lead to therapeutic pacifism.

  18. A Business Plan of Teahouse in Helsinki, Finland

    OpenAIRE

    Xu, Zelu

    2013-01-01

    By studying what is a business plan, this paper introduces how to make a business plan with a real life case, starting a teashop business in Helsinki, Finland. It was started by studying how to make a business plan, which includes the structure of a business plan, such as operational planning, marketing planning and financial planning. It is the internal and external analysis that determines the corporate strategy, corporate strategy determines marketing strategy and operational strategy, ope...

  19. Multiobjective programming and planning

    CERN Document Server

    Cohon, Jared L

    2004-01-01

    This text takes a broad view of multiobjective programming, emphasizing the methods most useful for continuous problems. It reviews multiobjective programming methods in the context of public decision-making problems, developing each problem within a context that addresses practical aspects of planning issues. Topics include a review of linear programming, the formulation of the general multiobjective programming problem, classification of multiobjective programming methods, techniques for generating noninferior solutions, multiple-decision-making methods, multiobjective analysis of water reso

  20. Participation in decision making

    Directory of Open Access Journals (Sweden)

    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.

  1. THERAPEUTIC SUPPORT OF REALIZATION OF THE COMPETENCE APPROACH IN EDUCATION

    Directory of Open Access Journals (Sweden)

    Viktoriia A. Lykova

    2010-08-01

    Full Text Available The article analyses mechanisms of realization of the competence approach in education. Its therapeutic support actualizes factors of nonlinearity, processuality, subjectivity, conformity with nature, feedback in the educational environment. Behind each person there is a variety of tendencies, therefore to foresee or plan, «limit by standards» what exactly will be personally significant for a particular student in pedagogical interaction, is impossible. Therapeutic competence of teachers allows to realize individual learning pathways with support on a «fan of indicators» within a circle of competences.

  2. Classroom Management and Lesson Planning(4)

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    Lesson PlanningTask 1As teachers,we all need to plan our lessons before we teach.Make a list of things that you think need tobe included in a lesson plan.Then compare and discuss your list with another teacher.Also think about reasonswhy we need to plan our lessons.

  3. Classroom Management and Lesson Planning(4)

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    @@ Lesson Planning Task 1 As teachers,we all need to plan our lessons before we teach.Make a list of things that you think need to be included in a lesson plan.Then compare and discuss your list with another teacher.Also think about reasons why we need to plan our lessons.

  4. INDOT Technical Training Plan : Appendix H

    Science.gov (United States)

    2012-04-01

    The study provides the background documents necessary for the development of a Technical Training Plan and makes recommendations for the content and structure of such a plan for the District Operations, Operations, Capital Program Management, and Eng...

  5. INDOT Technical Training Plan : Appendix L

    Science.gov (United States)

    2012-04-01

    The study provides the background documents necessary for the development of a Technical Training Plan and makes recommendations for the content and structure of such a plan for the District Operations, Operations, Capital Program Management, and Eng...

  6. INDOT Technical Training Plan : Appendix D

    Science.gov (United States)

    2012-04-01

    The study provides the background documents necessary for the development of a Technical Training Plan and makes recommendations for the content and structure of such a plan for the District Operations, Operations, Capital Program Management, and Eng...

  7. INDOT Technical Training Plan : Appendix A

    Science.gov (United States)

    2012-04-01

    The study provides the background documents necessary for the development of a Technical Training Plan and makes recommendations for the content and structure of such a plan for the District Operations, Operations, Capital Program Management, and Eng...

  8. INDOT Technical Training Plan : Appendix G

    Science.gov (United States)

    2012-04-01

    The study provides the background documents necessary for the development of a Technical Training Plan and makes recommendations for the content and structure of such a plan for the District Operations, Operations, Capital Program Management, and Eng...

  9. INDOT Technical Training Plan : Appendix P

    Science.gov (United States)

    2012-04-01

    The study provides the background documents necessary for the development of a Technical Training Plan and makes recommendations for the content and structure of such a plan for the District Operations, Operations, Capital Program Management, and Eng...

  10. INDOT Technical Training Plan : Appendix I

    Science.gov (United States)

    2012-04-01

    The study provides the background documents necessary for the development of a Technical Training Plan and makes recommendations for the content and structure of such a plan for the District Operations, Operations, Capital Program Management, and Eng...

  11. INDOT Technical Training Plan : Appendix M

    Science.gov (United States)

    2012-04-01

    The study provides the background documents necessary for the development of a Technical Training Plan and makes recommendations for the content and structure of such a plan for the District Operations, Operations, Capital Program Management, and Eng...

  12. INDOT Technical Training Plan : Appendix F

    Science.gov (United States)

    2012-04-01

    The study provides the background documents necessary for the development of a Technical Training Plan and makes recommendations for the content and structure of such a plan for the District Operations, Operations, Capital Program Management, and Eng...

  13. INDOT Technical Training Plan : Appendix E

    Science.gov (United States)

    2012-04-01

    The study provides the background documents necessary for the development of a Technical Training Plan and makes recommendations for the content and structure of such a plan for the District Operations, Operations, Capital Program Management, and Eng...

  14. INDOT Technical Training Plan : Appendix O

    Science.gov (United States)

    2012-04-01

    The study provides the background documents necessary for the development of a Technical Training Plan and makes recommendations for the content and structure of such a plan for the District Operations, Operations, Capital Program Management, and Eng...

  15. INDOT Technical Training Plan : Appendix J

    Science.gov (United States)

    2012-04-01

    The study provides the background documents necessary for the development of a Technical Training Plan and makes recommendations for the content and structure of such a plan for the District Operations, Operations, Capital Program Management, and Eng...

  16. INDOT Technical Training Plan : Appendix K

    Science.gov (United States)

    2012-04-01

    The study provides the background documents necessary for the development of a Technical Training Plan and makes recommendations for the content and structure of such a plan for the District Operations, Operations, Capital Program Management, and Eng...

  17. INDOT Technical Training Plan : Appendix B

    Science.gov (United States)

    2012-04-01

    The study provides the background documents necessary for the development of a Technical Training Plan and makes recommendations for the content and structure of such a plan for the District Operations, Operations, Capital Program Management, and Eng...

  18. INDOT Technical Training Plan : Appendix N

    Science.gov (United States)

    2012-04-01

    The study provides the background documents necessary for the development of a Technical Training Plan and makes recommendations for the content and structure of such a plan for the District Operations, Operations, Capital Program Management, and Eng...

  19. INDOT Technical Training Plan : Appendix C

    Science.gov (United States)

    2012-04-01

    The study provides the background documents necessary for the development of a Technical Training Plan and makes recommendations for the content and structure of such a plan for the District Operations, Operations, Capital Program Management, and Eng...

  20. Epistemic Planning

    DEFF Research Database (Denmark)

    Baral, Chitta; Bolander, Thomas; van Ditmarsch, Hans

    The seminar Epistemic Planning brought together the research communities of Dynamic Epistemic Logic, Knowledge Representation and Reasoning, and Automated Planning to address fundamental problems on the topic of epistemic planning. In the context of this seminar, dynamic epistemic logic...... investigates the formal semantics of communication and communicative actions, knowledge representation and reasoning focuses on theories of action and change, and automated planning investigates computational techniques and tools to generate plans. The original goals of the seminar were to develop benchmarks...... for epistemic planning, to explore the relationship between knowledge and belief in multi-agent epistemic planning, to develop models of agency and capability in epistemic planning and to explore action types and their representations (these originally separate goals were merged during the seminar), and finally...

  1. Breastfeeding: Planning Ahead

    Medline Plus

    Full Text Available ... is the best time to learn about the benefits of breastfeeding and make plans to give your baby a healthy start in life. Expand the sections below to watch videos about breastfeeding and ... href="https://www.youtube-nocookie.com/embed/ge-2Cn-LRAE">https://www.youtube- ...

  2. PNNL Campus Master Plan

    Energy Technology Data Exchange (ETDEWEB)

    Mosey, Whitney LC

    2012-09-07

    The Plan is used as a guide for PNNL in making facility and infrastructure decisions essential to supporting the PNNL vision: to establish a modern, collaborative, flexible, and sustainable campus while optimizing the efficiency of operations in support of courageous discovery and innovation.

  3. Magnetic Fusion Program Plan

    International Nuclear Information System (INIS)

    1985-02-01

    This Plan reflects the present conditions of the energy situation and is consistent with national priorities for the support of basic and applied research. It is realistic in taking advantage of the technical position that the United States has already established in fusion research to make cost-effective progress toward the development of fusion power as a future energy option

  4. Planning for Accessibility.

    Science.gov (United States)

    Spoor, Dana L.

    1997-01-01

    Argues that barrier-free designs should be incorporated in the first steps of school facility planning to avoid the difficulties in meeting Americans with Disabilities Act (ADA) guidelines during renovations. Explains why not all barriers need be removed to make a facility accessible to everyone. Discusses issues involving ADA guidelines and child…

  5. Breastfeeding: Planning Ahead

    Medline Plus

    Full Text Available ... activities In your community Funding opportunities Internships and jobs View all pages in this section Back to section menu It's Only Natural Planning ahead Breastfeeding and baby basics Making breastfeeding work for you Addressing breastfeeding myths Breastfeeding myths in ...

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

    Science.gov (United States)

    Harolds, Jay

    2011-12-01

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

  7. SCENARIO PLANNING AS LEARNING

    Directory of Open Access Journals (Sweden)

    Antonio Lourenço Junior

    2010-10-01

    Full Text Available Scenario Planning has been increasingly used, from its introduction to the decision process as effective tools to test decisions, and improve performance in a dynamic environment (Chermack, 2005. The purpose of this article is to demonstrate the potential of an experimental Scenario Planning Model to mobilize, encourage and add more content to the organization’s decision making process – mainly with respect to Strategic Plans of two governmental institutions, a pharmaceutical company and a technology education foundation.  This study describes the application stages of a hybrid scenario-planning model – herein referred to as Planning as Learning – via action-research, showing the scenarios resulting from the experiment and describes the main results of an assessment of such practice. In order to do that, two well-established Scenario Planning models (Prospective school and Shell’s model were analyzed. They were used as a reference for the proposition and application of an experimental model in the two study objects. A questionnaire was used to assess the technique impact. It was possible to obtain high levels of reliability. In-depth interviews were also conducted with the participants. At the end, the results confirmed the model efficiency as a basis for decision making in the competitive environment in which the two institutions are inserted, also to encourage the learning process as a group, as observed throughout the work.

  8. Effectiveness of Family Planning Methods

    Science.gov (United States)

    ... women in a year Effectiveness of Family Planning Methods Implant Reversible Intrauterine Device (IUD) Permanent Male Sterilization ... 0.5 % Diaphragm 12 % How to make your method most effective After procedure, little or nothing to ...

  9. Potential therapeutic applications of biosurfactants.

    Science.gov (United States)

    Gudiña, Eduardo J; Rangarajan, Vivek; Sen, Ramkrishna; Rodrigues, Lígia R

    2013-12-01

    Biosurfactants have recently emerged as promising molecules for their structural novelty, versatility, and diverse properties that are potentially useful for many therapeutic applications. Mainly due to their surface activity, these molecules interact with cell membranes of several organisms and/or with the surrounding environments, and thus can be viewed as potential cancer therapeutics or as constituents of drug delivery systems. Some types of microbial surfactants, such as lipopeptides and glycolipids, have been shown to selectively inhibit the proliferation of cancer cells and to disrupt cell membranes causing their lysis through apoptosis pathways. Moreover, biosurfactants as drug delivery vehicles offer commercially attractive and scientifically novel applications. This review covers the current state-of-the-art in biosurfactant research for therapeutic purposes, providing new directions towards the discovery and development of molecules with novel structures and diverse functions for advanced applications. Copyright © 2013 Elsevier Ltd. All rights reserved.

  10. RNAi Therapeutics in Autoimmune Disease

    Directory of Open Access Journals (Sweden)

    Seunghee Cha

    2013-03-01

    Full Text Available Since the discovery of RNA interference (RNAi, excitement has grown over its potential therapeutic uses. Targeting RNAi pathways provides a powerful tool to change biological processes post-transcriptionally in various health conditions such as cancer or autoimmune diseases. Optimum design of shRNA, siRNA, and miRNA enhances stability and specificity of RNAi-based approaches whereas it has to reduce or prevent undesirable immune responses or off-target effects. Recent advances in understanding pathogenesis of autoimmune diseases have allowed application of these tools in vitro as well as in vivo with some degree of success. Further research on the design and delivery of effectors of RNAi pathway and underlying molecular basis of RNAi would warrant practical use of RNAi-based therapeutics in human applications. This review will focus on the approaches used for current therapeutics and their applications in autoimmune diseases, including rheumatoid arthritis and Sjögren’s syndrome.

  11. Conflicts in the therapeutic field

    Directory of Open Access Journals (Sweden)

    Antonino Aprea

    2012-06-01

    Full Text Available How the analytical knowledge that compare human consciousness with that, even more disturbing, moving behind his fifth can be said to be “for peace”? It can be - and this will be the contribution of the proposal - the same tortuous and enigmatic of therapeutic practice, with its hesitations and his impulses, to outline a path crossing and overcoming the conflict? May, finally, peace, in the sense of feasibility of intra-and interpersonal dialectic instead of tearing and hostileconfrontation with oneself and with the other, to be a reference in some crucial pivot of ethical therapeutic work? To these questions the intervention seeks to answer retracing some of the highlights of almost three years of therapeutic work with a young woman and her family.

  12. Reactor-produced therapeutic radioisotopes

    International Nuclear Information System (INIS)

    Knapp, F.F. Jr.

    2002-01-01

    The significant worldwide increase in therapeutic radioisotope applications in nuclear medicine, oncology and interventional cardiology requires the dependable production of sufficient levels of radioisotopes for these applications (Reba, 2000; J. Nucl. Med., 1998; Nuclear News, 1999; Adelstein and Manning, 1994). The issues associated with both accelerator- and reactor-production of therapeutic radioisotopes is important. Clinical applications of therapeutic radioisotopes include the use of both sealed sources and unsealed radiopharmaceutical sources. Targeted radiopharmaceutical agents include those for cancer therapy and palliation of bone pain from metastatic disease, ablation of bone marrow prior to stem cell transplantation, treatment modalities for mono and oligo- and polyarthritis, for cancer therapy (including brachytherapy) and for the inhibition of the hyperplastic response following coronary angioplasty and other interventional procedures (For example, see Volkert and Hoffman, 1999). Sealed sources involve the use of radiolabeled devices for cancer therapy (brachytherapy) and also for the inhibition of the hyperplasia which is often encountered after angioplasty, especially with the exponential increase in the use of coronary stents and stents for the peripheral vasculature and other anatomical applications. Since neutron-rich radioisotopes often decay by beta decay or decay to beta-emitting daughter radioisotopes which serve as the basis for radionuclide generator systems, reactors are expected to play an increasingly important role for the production of a large variety of therapeutic radioisotopes required for these and other developing therapeutic applications. Because of the importance of the availability of reactor-produced radioisotopes for these applications, an understanding of the contribution of neutron spectra for radioisotope production and determination of those cross sections which have not yet been established is important. This

  13. Data-Driven Planning: Using Assessment in Strategic Planning

    Science.gov (United States)

    Bresciani, Marilee J.

    2010-01-01

    Data-driven planning or evidence-based decision making represents nothing new in its concept. For years, business leaders have claimed they have implemented planning informed by data that have been strategically and systematically gathered. Within higher education and student affairs, there may be less evidence of the actual practice of…

  14. [Therapeutic touch and anorexia nervosa].

    Science.gov (United States)

    Satori, Nadine

    2016-01-01

    An innovative practice, therapeutic touch has been used for around ten years in the treatment of eating disorders. Delivered by nurse clinicians having received specific training, this approach is based on nursing diagnoses which identify the major symptoms of this pathology. The support is built around the body and its perceptions. Through the helping relationship, it mobilises the patient's resources to favour a relationship of trust, a letting-go, physical, psychological and emotional relaxation, and improves the therapeutic alliance. Copyright © 2016. Published by Elsevier Masson SAS.

  15. Understanding music’s therapeutic efficacy: Implications for music education

    Directory of Open Access Journals (Sweden)

    Diane Thram

    2014-11-01

    Full Text Available In the current era of electronic domination of human experience, be it via cell phone and/or computer addiction, or the ubiquitous television, actual participation in music- making is less and less common for the average person, child or adult. Passive participation through listening is most often cited by people as their major experience with music in their lives. When asked if listening has therapeutic effects, it is rare for anyone to respond in the negative. Likewise, for performers/active participants in music- making, be it solitary or as part of a group, invariably an enhanced sense of well-being from the act of making music is reported. This paper addresses therapeutic aspects of musical participation (singing, clapping, playing an instrument, dancing, listening by providing a historical overview (12th c to present of attitudes toward music’s therapeutic effects. It argues that music exists through the interaction of our biological capacity to make music with our cultural circumstances. How individuals benefit in all aspects their being – physical, mental and emotional – from engaging in the act of making music is illustrated with examples from field research in southern Africa. Finally implications for Music Education are explored which emphasize how more comprehensive integration of music into the curriculum can serve as an antidote to the increasing isolation and alienation of modern life.

  16. 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.

    Science.gov (United States)

    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.

  17. Forward planning

    International Nuclear Information System (INIS)

    Fontenla, D.P.

    2008-01-01

    By definition, forward planning is a process where input consists of conditions on beam configurations and parameters and output consists of dose distributions on target and critical structures, in contrast to inverse planning, where the opposite is true. For forward planning IMRT, criteria are as follows: (i) Plans created as an extension of standard 3D conformational planning; (ii) No significant increase in the complexity of the treatment planning or treatment delivery process; (3) Treatment verification using standard QA procedures; and process consists of the following steps: (i) Create a standard 3D conformational treatment plan; (ii) Copy one of the existing beams; (iii) Create control points: design new beam segments, blocking high dose areas; (iv) Repeat for all beams; (v) Re-compute dose; and (vi) Adjust control points weights to achieve desired dose distribution. A detailed exposition, with many clinical examples, is given for the breast, lung, and brain (P.A.)

  18. Multinational Corporate Strategy-making

    DEFF Research Database (Denmark)

    Andersen, Torben Juul; Andersson, Ulf

    2017-01-01

    from corporate headquarters. The model considers local subsidiary actions of both operational and strategic nature and we argue that it may be futile to distinguish between these effects as incremental operational responses can cumulate into more substantial changes over time with dimensions...... the complementary effects of central planning and decentralized decision-making. We present and synthesize these rather field specific perspectives and try to synthesize insights from both fields in an adaptive strategy-making model including the effects of autonomous subsidiary initiatives and intended mandates...

  19. Therapeutic Applications of Monte Carlo Calculations in Nuclear Medicine

    CERN Document Server

    Sgouros, George

    2003-01-01

    This book examines the applications of Monte Carlo (MC) calculations in therapeutic nuclear medicine, from basic principles to computer implementations of software packages and their applications in radiation dosimetry and treatment planning. It is written for nuclear medicine physicists and physicians as well as radiation oncologists, and can serve as a supplementary text for medical imaging, radiation dosimetry and nuclear engineering graduate courses in science, medical and engineering faculties. With chapters is written by recognised authorities in that particular field, the book covers the entire range of MC applications in therapeutic medical and health physics, from its use in imaging prior to therapy to dose distribution modelling targeted radiotherapy. The contributions discuss the fundamental concepts of radiation dosimetry, radiobiological aspects of targeted radionuclide therapy and the various components and steps required for implementing a dose calculation and treatment planning methodology in ...

  20. Environmental Implementation Plan

    International Nuclear Information System (INIS)

    1993-01-01

    The purpose of the Environmental Implementation Plan (EIP) is to show the current and future (five years) environmental plans from individual site organizations and divisions, as well as site environmental programs and initiatives which are designed to protect the environment and meet or exceed changing environmental/regulatory requirements. Communicating with site organizations, departments, and committees is essential in making the site's environmental-planning process work. The EIP gives the site the what, when, how, and why for environmental requirements. Through teamwork and proactive planning, a partnership for environmental excellence is formed to achieve the site vision for SRS to become the recognized model for Environmental Excellence in the Department of Energy's Nuclear Weapons Complex

  1. Environmental Implementation Plan

    Energy Technology Data Exchange (ETDEWEB)

    1993-03-15

    The purpose of the Environmental Implementation Plan (EIP) is to show the current and future (five years) environmental plans from individual site organizations and divisions, as well as site environmental programs and initiatives which are designed to protect the environment and meet or exceed changing environmental/regulatory requirements. Communicating with site organizations, departments, and committees is essential in making the site's environmental-planning process work. The EIP gives the site the what, when, how, and why for environmental requirements. Through teamwork and proactive planning, a partnership for environmental excellence is formed to achieve the site vision for SRS to become the recognized model for Environmental Excellence in the Department of Energy's Nuclear Weapons Complex.

  2. Environmental Implementation Plan

    Energy Technology Data Exchange (ETDEWEB)

    1993-03-15

    The purpose of the Environmental Implementation Plan (EIP) is to show the current and future (five years) environmental plans from individual site organizations and divisions, as well as site environmental programs and initiatives which are designed to protect the environment and meet or exceed changing environmental/regulatory requirements. Communicating with site organizations, departments, and committees is essential in making the site`s environmental-planning process work. The EIP gives the site the what, when, how, and why for environmental requirements. Through teamwork and proactive planning, a partnership for environmental excellence is formed to achieve the site vision for SRS to become the recognized model for Environmental Excellence in the Department of Energy`s Nuclear Weapons Complex.

  3. Review of the FAA 1982 National Airspace System plan

    Science.gov (United States)

    1982-08-01

    The National Airspace (NAS) Plan outlines the Federal Aviation Administration's most recent proposals for modernizing the facilities and equipment that make up the air traffic control (ATC) system. This review of the NAS Plan examines the Plan at two...

  4. Safeguards Technology Strategic Planning Pentachart

    International Nuclear Information System (INIS)

    Carroll, C. J.

    2017-01-01

    Builds on earlier strategic planning workshops conducted for SGIT, SGTS, and SGCP. Many of recommendations from these workshops have been successfully implemented at the IAEA. Provide a context for evaluating new approaches for anticipated safeguards challenges of the future. Approach used by government and military to plan for an uncertain future. Uses consensus decision-making.

  5. [Eye contact effects: A therapeutic issue?

    Science.gov (United States)

    Baltazar, M; Conty, L

    2016-12-01

    following the view that people with autism are not interested in processing social signals such as gaze but could do so efficiently if properly motivated. For each pathology we emphasize that eye contact could be used, for example, to enhance sensitivity to bodily states, thus improving emotional decision making (in autism); to lead to more positive appraisal of the self and others (in depression); to improve memory performances (in Alzheimer disease) and, more generally, to motivate the recipient to engage in the therapeutic process. (3) Finally we propose two concrete ways to employ eye contact effects as a therapeutic tool. The first is to develop cognitive-behavioral tools to learn and/or motivate the recipient to create frequent and prolonged eye contact periods. The second is to raise awareness among caregivers of the beneficial effects of eye contact and to teach them the way to use eye contact to reach its optimum effects. Future investigations are however needed to explore the ways in which eye contact effects can be efficiently integrated in therapeutic strategies, as well as to identify the clinical populations that can benefit from such therapeutic interventions. Copyright © 2016 L’Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.

  6. Therapy Talk: Analyzing Therapeutic Discourse

    Science.gov (United States)

    Leahy, Margaret M.

    2004-01-01

    Therapeutic discourse is the talk-in-interaction that represents the social practice between clinician and client. This article invites speech-language pathologists to apply their knowledge of language to analyzing therapy talk and to learn how talking practices shape clinical roles and identities. A range of qualitative research approaches,…

  7. Therapeutic approaches to genetic disorders

    African Journals Online (AJOL)

    salah

    Although prevention is the ideal goal for genetic disorders, various types of therapeutic ... The patient being ... pirical or aimed at controlling or mediating signs and symptoms without care. ... plications and gene therapy approaches .... genes family, have opened a wide and .... cancer where nanoparticles are used to.

  8. Medical therapeutic effect of hyperthyroidism

    International Nuclear Information System (INIS)

    Lee, K.B.

    1980-01-01

    In order to compare the therapeutic effect as well as side effects between antithyroid therapy and radioiodine therapy in hyperthyroidism, the author evaluated 111 cases of hyperthyroidism which were composed of 57 patients with antithyroid treatment, 23 patients with combined treatment comprising of antithyroid and radioactive iodine ( 131 I) and 31 patients with treatment of 131 I alone. (author)

  9. Cyclic peptide therapeutics: past, present and future.

    Science.gov (United States)

    Zorzi, Alessandro; Deyle, Kaycie; Heinis, Christian

    2017-06-01

    Cyclic peptides combine several favorable properties such as good binding affinity, target selectivity and low toxicity that make them an attractive modality for the development of therapeutics. Over 40 cyclic peptide drugs are currently in clinical use and around one new cyclic peptide drug enters the market every year on average. The vast majority of clinically approved cyclic peptides are derived from natural products, such as antimicrobials or human peptide hormones. New powerful techniques based on rational design and in vitro evolution have enabled the de novo development of cyclic peptide ligands to targets for which nature does not offer solutions. A look at the cyclic peptides currently under clinical evaluation shows that several have been developed using such techniques. This new source for cyclic peptide ligands introduces a freshness to the field, and it is likely that de novo developed cyclic peptides will be in clinical use in the near future. Copyright © 2017 Elsevier Ltd. All rights reserved.

  10. Ethical considerations of therapeutic hypnosis and children.

    Science.gov (United States)

    Etzrodt, Christine M

    2013-04-01

    Historically, therapeutic hypnosis has been met with skepticism within some fields, although acceptance has expanded in recent decades. Development and application of ethical standards and principles has contributed to increased acceptance of hypnosis with children. The Ethics Code of the American Psychological Association (APA, 2002) and the Code of Conduct of the American Society of Clinical Hypnosis (ASCH, 2000) serve as guides to ethical considerations when treating children. From a developmental and practical perspective, children have limited decision-making capacities, therefore special attention should be paid to their rights and welfare. Important ethical considerations relevant to children and hypnosis have emerged, including competence, supervision, informed consent, confidentiality, and boundaries. Considerations are reviewed from a normal and abnormal child development perspective.

  11. Therapeutic potential of adult stem cells

    DEFF Research Database (Denmark)

    Serakinci, Nedime; Keith, W. Nicol

    2006-01-01

    is the necessity to be able to identify, select, expand and manipulate cells outside the body. Recent advances in adult stem cell technologies and basic biology have accelerated therapeutic opportunities aimed at eventual clinical applications. Adult stem cells with the ability to differentiate down multiple...... lineages are an attractive alternative to human embryonic stem cells (hES) in regenerative medicine. In many countries, present legislation surrounding hES cells makes their use problematic, and indeed the origin of hES cells may represent a controversial issue for many communities. However, adult stem...... cells are not subject to these issues. This review will therefore focus on adult stem cells. Based on their extensive differentiation potential and, in some cases, the relative ease of their isolation, adult stem cells are appropriate for clinical development. Recently, several observations suggest...

  12. Organoid technology for brain and therapeutics research.

    Science.gov (United States)

    Wang, Zhi; Wang, Shu-Na; Xu, Tian-Ying; Miao, Zhu-Wei; Su, Ding-Feng; Miao, Chao-Yu

    2017-10-01

    Brain is one of the most complex organs in human. The current brain research is mainly based on the animal models and traditional cell culture. However, the inherent species differences between humans and animals as well as the gap between organ level and cell level make it difficult to study human brain development and associated disorders through traditional technologies. Recently, the brain organoids derived from pluripotent stem cells have been reported to recapitulate many key features of human brain in vivo, for example recapitulating the zone of putative outer radial glia cells. Brain organoids offer a new platform for scientists to study brain development, neurological diseases, drug discovery and personalized medicine, regenerative medicine, and so on. Here, we discuss the progress, applications, advantages, limitations, and prospects of brain organoid technology in neurosciences and related therapeutics. © 2017 John Wiley & Sons Ltd.

  13. Public affairs plan

    Energy Technology Data Exchange (ETDEWEB)

    1994-09-01

    The purpose of the Uranium Mill Tailings Remedial Action (UMTRA) Project Public Affairs Plan is to establish goals for the Fiscal Year 1995 UMTRA public affairs program and identify specific activities to be conducted during the year. It also describes the roles of various agencies involved in the conduct of the public affairs program and defines the functions of the Technical Assistance Contractor (TAC) Public Affairs Department. It integrates and replaces the Public Participation Plan (DOE/AL/62350-47D) and Public Information Plan (DOE/AL/623590-71). The plan describes the US Department of Energy`s (DOE) plans to keep stakeholders and other members of the public informed about project policies, plans, and activities, and provide opportunities for stakeholders and interested segments of the public to participate in project decision-making processes. The plan applies to the UMTRA Project Office; the DOE Albuquerque Operations Office, Office of Intergovernmental and External Affairs (OIEA); the UMTRA TAC; the UMTRA Remedial Action Contractor (RAC); and other cooperating agencies.

  14. Public affairs plan

    International Nuclear Information System (INIS)

    1994-09-01

    The purpose of the Uranium Mill Tailings Remedial Action (UMTRA) Project Public Affairs Plan is to establish goals for the Fiscal Year 1995 UMTRA public affairs program and identify specific activities to be conducted during the year. It also describes the roles of various agencies involved in the conduct of the public affairs program and defines the functions of the Technical Assistance Contractor (TAC) Public Affairs Department. It integrates and replaces the Public Participation Plan (DOE/AL/62350-47D) and Public Information Plan (DOE/AL/623590-71). The plan describes the US Department of Energy's (DOE) plans to keep stakeholders and other members of the public informed about project policies, plans, and activities, and provide opportunities for stakeholders and interested segments of the public to participate in project decision-making processes. The plan applies to the UMTRA Project Office; the DOE Albuquerque Operations Office, Office of Intergovernmental and External Affairs (OIEA); the UMTRA TAC; the UMTRA Remedial Action Contractor (RAC); and other cooperating agencies

  15. Tough Times: Strategic Planning as a War Canoe

    Science.gov (United States)

    Seymour, Daniel

    2011-01-01

    In this article, the author discusses how to make strategic planning a more valuable tool for higher education in today's tough times. Strategic planning is really the answer to five straightforward questions. The first three represent the plan itself, while the last two are what makes the plan vital and dynamic: (1) Why do we exist?; (2) What do…

  16. Integration of strategic environmental assessment in spatial planning

    DEFF Research Database (Denmark)

    Kørnøv, Lone

    The paper explores the similarities between the content of the EU directive, SEA practice and the existing spatial planning in Denmark, and how SEA can be integrated into plan making and plan implementation.......The paper explores the similarities between the content of the EU directive, SEA practice and the existing spatial planning in Denmark, and how SEA can be integrated into plan making and plan implementation....

  17. BUDGET PLANNING IN FINANCIAL MANAGEMENT

    Directory of Open Access Journals (Sweden)

    Nataliya Melnichuk

    2015-11-01

    Full Text Available The purpose of the paper is to determine the nature, targets, functions, principles and methods of budget planning and development of classifications due to its types. The essence of budget planning presented by various authors, is own interpretation (the process of developing a plan of formation, distribution and redistribution of financial funds according to budget system units during the reporting period based on budgetary purposes and targets defined by socio-economic development strategy is proposed. Methodology. The following methods such as cognition, induction, deduction, analysis and synthesis have been used in the process of survey. Results of the survey proves that budget planning plays an essential role in the financial management. On condition business environment changing even the best management system can become obsolete. The immediate reaction to the new trends in the financial system as a whole, in the industry is possible with budget planning as well. It also allows to make appropriate adjustments to the plans. Adjustment of long-term, medium-term and short-term plans makes it possible, without changing goals, to change ways of their achievement and thus to raise the level of efficiency of budget funds formation and use. It is necessary to revise the whole system plans, including their mission and goals in the case of global changes in the external and internal environment. Practical implications. The proposed approach to the classification of budget planning types allows to cope with the shortcomings of modern planning in the public sector (the development of the targets according to the state budget expenditures in Ukraine remains a formality and it rarely complies with realities. Value/originality is specified in the proposed interpretation which differs from existing ones that provides clarification of budget planning purpose in financial management; classification of budget planning principles, which differs from previous

  18. Inspection planning

    International Nuclear Information System (INIS)

    Korosec, D.; Levstek, M.F.

    2001-01-01

    Slovenian Nuclear Safety Administration (SNSA) division of nuclear and radiological safety inspection has developed systematic approach to their inspections. To be efficient in their efforts regarding regular and other types of inspections, in past years, the inspection plan has been developed. It is yearly based and organized on a such systematic way, that all areas of nuclear safety important activities of the licensee are covered. The inspection plan assures appropriate preparation for conducting the inspections, allows the overview of the progress regarding the areas to be covered during the year. Depending on the licensee activities and nature of facility (nuclear power plant, research reactor, radioactive waste storage, others), the plan has different levels of intensity of inspections and also their frequency. One of the basic approaches of the plan is to cover all nuclear and radiological important activities on such way, that all regulatory requests are fulfilled. In addition, the inspection plan is a good tool to improve inspection effectiveness based on previous experience and allows to have the oversight of the current status of fulfillment of planned inspections. Future improvement of the plan is necessary in the light of newest achievements on this field in the nuclear world, that means, new types of inspections are planned and will be incorporated into plan in next year.(author)

  19. Planning for land use and conservation: Assessing GIS-based conservation software for land use planning

    Science.gov (United States)

    Rob Baldwin; Ryan Scherzinger; Don Lipscomb; Miranda Mockrin; Susan Stein

    2014-01-01

    Recent advances in planning and ecological software make it possible to conduct highly technical analyses to prioritize conservation investments and inform local land use planning. We review these tools, termed conservation planning tools, and assess the knowledge of a key set of potential users: the land use planning community. We grouped several conservation software...

  20. Non-cooperative planning theory

    CERN Document Server

    Bogetoft, Peter

    1994-01-01

    Planning in a general sense is concerned with the design of communication and decision making mechanisms in organizations where information and choice are decentralized. Non-cooperative planning theory as it is developed in this book treats the incentive aspects hereof. It stresses how strategic behavior and opportunism may impede planning, and how this can be coped with via the organization of communication and decision making, the design of information and control systems, and the development of incentive schemes. In particular, the book contains a thorough investigation of incentive provision in information production.

  1. Environmental protection implementation plan

    International Nuclear Information System (INIS)

    Holland, R.C.

    1998-03-01

    This Environmental Protection Implementation Plan is intended to ensure that the environmental program objectives of Department of Energy Order 5400.1 are achieved at SNL/California. This document states SNL/California's commitment to conduct its operations in an environmentally safe and responsible manner. The Environmental Protection Implementation Plan helps management and staff comply with applicable environmental responsibilities. SNL is committed to operating in full compliance with the letter and spirit of applicable environmental laws, regulations, and standards. Furthermore, SNL/California strives to go beyond compliance with legal requirements by making every effort practical to reduce impacts to the environment to levels as low as reasonably achievable

  2. PrEFiNe Plan: Strategic plan for Fabry's diseases in Nephrology

    Directory of Open Access Journals (Sweden)

    M.D. del Pino

    2016-07-01

    Discussion: PrEfiNE project will evaluate an action plan focused on improving FD knowledge to make necessary recommendations for an early recognition of the disease. In addition will generate a plan to improve previously undetected needs.

  3. Androgen Receptor: A Complex Therapeutic Target for Breast Cancer

    Science.gov (United States)

    Narayanan, Ramesh; Dalton, James T.

    2016-01-01

    Molecular and histopathological profiling have classified breast cancer into multiple sub-types empowering precision treatment. Although estrogen receptor (ER) and human epidermal growth factor receptor (HER2) are the mainstay therapeutic targets in breast cancer, the androgen receptor (AR) is evolving as a molecular target for cancers that have developed resistance to conventional treatments. The high expression of AR in breast cancer and recent discovery and development of new nonsteroidal drugs targeting the AR provide a strong rationale for exploring it again as a therapeutic target in this disease. Ironically, both nonsteroidal agonists and antagonists for the AR are undergoing clinical trials, making AR a complicated target to understand in breast cancer. This review provides a detailed account of AR’s therapeutic role in breast cancer. PMID:27918430

  4. Manufacturing of recombinant therapeutic proteins in microbial systems.

    Science.gov (United States)

    Graumann, Klaus; Premstaller, Andreas

    2006-02-01

    Recombinant therapeutic proteins have gained enormous importance for clinical applications. The first recombinant products have been produced in E. coli more than 20 years ago. Although with the advent of antibody-based therapeutics mammalian expression systems have experienced a major boost, microbial expression systems continue to be widely used in industry. Their intrinsic advantages, such as rapid growth, high yields and ease of manipulation, make them the premier choice for expression of non-glycosylated peptides and proteins. Innovative product classes such as antibody fragments or alternative binding molecules will further expand the use of microbial systems. Even more, novel, engineered production hosts and integrated technology platforms hold enormous potential for future applications. This review summarizes current applications and trends for development, production and analytical characterization of recombinant therapeutic proteins in microbial systems.

  5. Androgen Receptor: A Complex Therapeutic Target for Breast Cancer

    Directory of Open Access Journals (Sweden)

    Ramesh Narayanan

    2016-12-01

    Full Text Available Molecular and histopathological profiling have classified breast cancer into multiple sub-types empowering precision treatment. Although estrogen receptor (ER and human epidermal growth factor receptor (HER2 are the mainstay therapeutic targets in breast cancer, the androgen receptor (AR is evolving as a molecular target for cancers that have developed resistance to conventional treatments. The high expression of AR in breast cancer and recent discovery and development of new nonsteroidal drugs targeting the AR provide a strong rationale for exploring it again as a therapeutic target in this disease. Ironically, both nonsteroidal agonists and antagonists for the AR are undergoing clinical trials, making AR a complicated target to understand in breast cancer. This review provides a detailed account of AR’s therapeutic role in breast cancer.

  6. National Energy Plan II

    Energy Technology Data Exchange (ETDEWEB)

    None

    1979-01-01

    This volume contains the Administration's second National Energy Plan, as required by section 801 of the Department of Energy Organization Act (Public Law 95-91). A second volume will contain an assessment of the environmental trends associated with the energy futures reported here. Detailed appendices to the Plan will be published separately. The eight chapters and their subtitles are: Crisis and Uncertainty in the World Energy Future (The Immediate Crisis and the Continuing Problem, The Emergence of the Energy Problem, The Uncertainties of the World Energy Future, World Oil Prices, Consequences for the U.S.); The U.S. Energy Future: The Implications for Policy (The Near-, Mid-, and Long-Term, The Strategy in Perspective); Conservation (Historical Changes in Energy Use, Post-Embargo Changes - In Detail, Conservation Policies and Programs, The Role of Conservation); Oil and Gas (Oil, Natural Gas); Coal and Nuclear (Coal, Nuclear, Policy for Coal and Nuclear Power); Solar and Other Inexhaustible Energy Sources (Solar Energy, Geothermal, Fusion, A Strategy for Inexhaustible Resources); Making Decisions Promptly and Fairly (Managing Future Energy Crises: Emergency Planning, Managing the Current Shortfall: The Iranian Response Plan, Managing the Long-Term Energy Problem: The Institutional Framework, Fairness in Energy Policy, Public Participation in the Development of Energy Policy); and NEP-II and the Future (The Second National Energy Plan and the Nation's Energy Future, The Second National Energy Plan and the Economy, Employment and Energy Policy, The Second National Energy Plan and Individuals, The Second National Energy Plan and Capital Markets, and The Second National Energy Plan and the Environment). (ERA citation 04:041097)

  7. Therapeutic Applications of Monte Carlo Calculations in Nuclear Medicine

    International Nuclear Information System (INIS)

    Coulot, J

    2003-01-01

    Monte Carlo techniques are involved in many applications in medical physics, and the field of nuclear medicine has seen a great development in the past ten years due to their wider use. Thus, it is of great interest to look at the state of the art in this domain, when improving computer performances allow one to obtain improved results in a dramatically reduced time. The goal of this book is to make, in 15 chapters, an exhaustive review of the use of Monte Carlo techniques in nuclear medicine, also giving key features which are not necessary directly related to the Monte Carlo method, but mandatory for its practical application. As the book deals with therapeutic' nuclear medicine, it focuses on internal dosimetry. After a general introduction on Monte Carlo techniques and their applications in nuclear medicine (dosimetry, imaging and radiation protection), the authors give an overview of internal dosimetry methods (formalism, mathematical phantoms, quantities of interest). Then, some of the more widely used Monte Carlo codes are described, as well as some treatment planning softwares. Some original techniques are also mentioned, such as dosimetry for boron neutron capture synovectomy. It is generally well written, clearly presented, and very well documented. Each chapter gives an overview of each subject, and it is up to the reader to investigate it further using the extensive bibliography provided. Each topic is discussed from a practical point of view, which is of great help for non-experienced readers. For instance, the chapter about mathematical aspects of Monte Carlo particle transport is very clear and helps one to apprehend the philosophy of the method, which is often a difficulty with a more theoretical approach. Each chapter is put in the general (clinical) context, and this allows the reader to keep in mind the intrinsic limitation of each technique involved in dosimetry (for instance activity quantitation). Nevertheless, there are some minor remarks to

  8. Conversational evidence in therapeutic dialogue.

    Science.gov (United States)

    Strong, Tom; Busch, Robbie; Couture, Shari

    2008-07-01

    Family therapists' participation in therapeutic dialogue with clients is typically informed by evidence of how such dialogue is developing. In this article, we propose that conversational evidence, the kind that can be empirically analyzed using discourse analyses, be considered a contribution to widening psychotherapy's evidence base. After some preliminaries about what we mean by conversational evidence, we provide a genealogy of evaluative practice in psychotherapy, and examine qualitative evaluation methods for their theoretical compatibilities with social constructionist approaches to family therapy. We then move on to examine the notion of accomplishment in therapeutic dialogue given how such accomplishments can be evaluated using conversation analysis. We conclude by considering a number of research and pedagogical implications we associate with conversational evidence.

  9. Therapeutic Dancing for Parkinson's Disease

    Directory of Open Access Journals (Sweden)

    Lorenna Pryscia Carvalho Aguiar

    2016-06-01

    Full Text Available Therapeutic dancing has been advocated as an effective adjunct to conventional physical therapies for people living with Parkinson's disease (PD. This systematic review evaluates studies on the outcomes of different dance genres on mobility and quality of life in PD. We searched databases including CINHAL (1982–2015, Medline (1922–2015, Scopus (1996–2015, Web of Science (2002–2015, Embase (2007–2015, PEDro (1999–2015 and the Cochrane Library (1996–2015. The key words were: Parkinson's disease, Parkinson*, Parkinsonism, dance, dance therapy, dance genres, safety, feasibility, and quality of life. Two independent investigators reviewed the texts. Only randomized controlled trials, quasirandomized controlled trials, and case series studies were included. There was emerging evidence that therapeutic dance can be safe and feasible for people with mild to moderately severe PD, with beneficial effects on walking, freezing of gait, and health related quality of life.

  10. Therapeutic approaches for celiac disease

    Science.gov (United States)

    Plugis, Nicholas M.; Khosla, Chaitan

    2015-01-01

    Celiac disease is a common, lifelong autoimmune disorder for which dietary control is the only accepted form of therapy. A strict gluten-free diet is burdensome to patients and can be limited in efficacy, indicating there is an unmet need for novel therapeutic approaches to supplement or supplant dietary therapy. Many molecular events required for disease pathogenesis have been recently characterized and inspire most current and emerging drug-discovery efforts. Genome-wide association studies (GWAS) confirm the importance of human leukocyte antigen genes in our pathogenic model and identify a number of new risk loci in this complex disease. Here, we review the status of both emerging and potential therapeutic strategies in the context of disease pathophysiology. We conclude with a discussion of how genes identified during GWAS and follow-up studies that enhance susceptibility may offer insight into developing novel therapies. PMID:26060114

  11. Sinigrin and Its Therapeutic Benefits

    Directory of Open Access Journals (Sweden)

    Anisha Mazumder

    2016-03-01

    Full Text Available Sinigrin (allyl-glucosinolate or 2-propenyl-glucosinolate is a natural aliphatic glucosinolate present in plants of the Brassicaceae family, such as broccoli and brussels sprouts, and the seeds of Brassica nigra (mustard seeds which contain high amounts of sinigrin. Since ancient times, mustard has been used by mankind for its culinary, as well as medicinal, properties. It has been systematically described and evaluated in the classical Ayurvedic texts. Studies conducted on the pharmacological activities of sinigrin have revealed anti-cancer, antibacterial, antifungal, antioxidant, anti-inflammatory, wound healing properties and biofumigation. This current review will bring concise information about the known therapeutic activities of sinigrin. However, the information on known biological activities is very limited and, hence, further studies still need to be conducted and its molecular mechanisms also need to be explored. This review on the therapeutic benefits of sinigrin can summarize current knowledge about this unique phytocompounds.

  12. Communication Planning.

    Science.gov (United States)

    Development Communication Report, 1978

    1978-01-01

    Communication planning in developing countries is discussed in individual articles on theory, knowledge production and utilization, planning at the regional level, software, and rural development. A nutrition education project and three experiments in developing educational materials with feedback from villagers in Africa are described in the…

  13. Conference Planning.

    Science.gov (United States)

    Carter, Richard

    1982-01-01

    Presents an overview of the management planning technique known as Break Even Analysis and outlines its use as a tool in financial planning for organizations intending to conduct or sponsor a conference, seminar, or workshop. Three figures illustrating Break Even Analysis concepts and a Break Even Analysis worksheet are included. (JL)

  14. Systemic Planning

    DEFF Research Database (Denmark)

    Leleur, Steen

    This book presents principles and methodology for planning in a complex world. It sets out a so-called systemic approach to planning, among other things, by applying “hard” and “soft” methodologies and methods in combination. The book is written for Ph.D and graduate students in engineering...

  15. Potential Therapeutic Effects of Psilocybin.

    Science.gov (United States)

    Johnson, Matthew W; Griffiths, Roland R

    2017-07-01

    Psilocybin and other 5-hydroxytryptamine 2A agonist classic psychedelics have been used for centuries as sacraments within indigenous cultures. In the mid-twentieth century they were a focus within psychiatry as both probes of brain function and experimental therapeutics. By the late 1960s and early 1970s these scientific inquires fell out of favor because classic psychedelics were being used outside of medical research and in association with the emerging counter culture. However, in the twenty-first century, scientific interest in classic psychedelics has returned and grown as a result of several promising studies, validating earlier research. Here, we review therapeutic research on psilocybin, the classic psychedelic that has been the focus of most recent research. For mood and anxiety disorders, three controlled trials have suggested that psilocybin may decrease symptoms of depression and anxiety in the context of cancer-related psychiatric distress for at least 6 months following a single acute administration. A small, open-label study in patients with treatment-resistant depression showed reductions in depression and anxiety symptoms 3 months after two acute doses. For addiction, small, open-label pilot studies have shown promising success rates for both tobacco and alcohol addiction. Safety data from these various trials, which involve careful screening, preparation, monitoring, and follow-up, indicate the absence of severe drug-related adverse reactions. Modest drug-related adverse effects at the time of medication administration are readily managed. US federal funding has yet to support therapeutic psilocybin research, although such support will be important to thoroughly investigate efficacy, safety, and therapeutic mechanisms.

  16. Yessotoxin, a Promising Therapeutic Tool

    Directory of Open Access Journals (Sweden)

    Amparo Alfonso

    2016-01-01

    Full Text Available Yessotoxin (YTX is a polyether compound produced by dinoflagellates and accumulated in filter feeding shellfish. No records about human intoxications induced by this compound have been published, however it is considered a toxin. Modifications in second messenger levels, protein levels, immune cells, cytoskeleton or activation of different cellular death types have been published as consequence of YTX exposure. This review summarizes the main intracellular pathways modulated by YTX and their pharmacological and therapeutic implications.

  17. Cell kinetics and therapeutic efficiency

    International Nuclear Information System (INIS)

    Andreeff, M.; Abenhardt, W.; Gruner, B.; Stoffner, D.; Mainz Univ.

    1976-01-01

    The study shows that cell kinetics effects correlate with the effects of cytostatic drugs in the tumour model investigated here. It should, however, be noted that even genetically related tumour cell types may react differently to the same cytostatic drug, and that the cell kinetics effects, due to the changes in the cell cycle, cannot be predicted but should be followed with a very fast method, e.g. sequential flan fluorescence cytophotometry, for optimal therapeutic results. (orig./GSE) [de

  18. Cognition As a Therapeutic Target in the Suicidal Patient Approach

    Science.gov (United States)

    da Silva, Antônio Geraldo; Malloy-Diniz, Leandro Fernandes; Garcia, Marina Saraiva; Figueiredo, Carlos Guilherme Silva; Figueiredo, Renata Nayara; Diaz, Alexandre Paim; Palha, António Pacheco

    2018-01-01

    The current considerations about completed suicides and suicide attempts in different cultures call the attention of professionals to this serious public health problem. Integrative approaches have shown that the confluence of multiple biological and social factors modulate various psychopathologies and dysfunctional behaviors, such as suicidal behavior. Considering the level of intermediate analysis, personality traits and cognitive functioning are also of great importance for understanding the suicide phenomenon. About cognitive factors, we can group them into cognitive schemas of reality interpretation and underlying cognitive processes. On the other hand, different types of primary cognitive alterations are related to suicidal behavior, especially those resulting from changes in frontostriatal circuits. Among such cognitive mechanisms can be highlighted the attentional bias for environmental cues related to suicide, impulsive behavior, verbal fluency deficits, non-adaptive decision-making, and reduced planning skills. Attentional bias consists in the effect of thoughts and emotions, frequently not conscious, about the perception of environmental stimuli. Suicidal ideation and hopelessness can make the patient unable to find alternative solutions to their problems other than suicide, biasing their attention to environmental cues related to such behavior. Recent research efforts are directed to assess the possible use of attention bias as a therapeutic target in patients presenting suicide behavior. The relationship between impulsivity and suicide has been largely investigated over the last decades, and there is still controversy about the theme. Although there is strong evidence linking impulsivity to suicide attempts. Effective interventions address to reduce impulsivity in clinical populations at higher risk for suicide could help in the prevention. Deficits in problem-solving ability also seem to be distorted in patients who attempt suicide. Understanding

  19. Cognition As a Therapeutic Target in the Suicidal Patient Approach

    Directory of Open Access Journals (Sweden)

    Antônio Geraldo da Silva

    2018-02-01

    Full Text Available The current considerations about completed suicides and suicide attempts in different cultures call the attention of professionals to this serious public health problem. Integrative approaches have shown that the confluence of multiple biological and social factors modulate various psychopathologies and dysfunctional behaviors, such as suicidal behavior. Considering the level of intermediate analysis, personality traits and cognitive functioning are also of great importance for understanding the suicide phenomenon. About cognitive factors, we can group them into cognitive schemas of reality interpretation and underlying cognitive processes. On the other hand, different types of primary cognitive alterations are related to suicidal behavior, especially those resulting from changes in frontostriatal circuits. Among such cognitive mechanisms can be highlighted the attentional bias for environmental cues related to suicide, impulsive behavior, verbal fluency deficits, non-adaptive decision-making, and reduced planning skills. Attentional bias consists in the effect of thoughts and emotions, frequently not conscious, about the perception of environmental stimuli. Suicidal ideation and hopelessness can make the patient unable to find alternative solutions to their problems other than suicide, biasing their attention to environmental cues related to such behavior. Recent research efforts are directed to assess the possible use of attention bias as a therapeutic target in patients presenting suicide behavior. The relationship between impulsivity and suicide has been largely investigated over the last decades, and there is still controversy about the theme. Although there is strong evidence linking impulsivity to suicide attempts. Effective interventions address to reduce impulsivity in clinical populations at higher risk for suicide could help in the prevention. Deficits in problem-solving ability also seem to be distorted in patients who attempt

  20. Diagnostic and therapeutic peroral cholangioscopy

    Directory of Open Access Journals (Sweden)

    Jong Ho Moon

    2012-01-01

    Full Text Available Peroral cholangioscopy (POC provides direct visualization of the bile duct and facilitates diagnostic or therapeutic intervention. The currently available single-operator POC systems are "Mother-baby" scope system, SpyGlass direct visualization system, and direct POC using a regular ultra-slim upper endoscope. Direct POC using an ultra-slim upper endoscope having a larger 2-mm working channel can provide a valuable and economic solution for evaluating bile-duct lesions. Main diagnostic procedures under direct POC are visual characterization and optically guided target biopsy for the indeterminate bile duct lesion. Image-enhanced endoscopy such as narrow-band imaging has shown promise for more detailed evaluation of mucosal abnormality and can be performed under direct POC. Intracorporeal lithotripsy such as electrohydraulic lithotripsy or laser lithotripsy is a main therapeutic intervention of direct POC for patients with bile duct stones that are resistant to conventional endoscopic stone-removal procedures. Besides, tumor ablation therapy, such as photodynamic therapy and argon plasma coagulation may be also performed using direct POC. Further developments of the endoscope and specialized accessories or devices are expected to facilitate diagnostic and therapeutic role of this cholangioscopic procedure.

  1. Avian Diagnostic and Therapeutic Antibodies

    Energy Technology Data Exchange (ETDEWEB)

    Bradley, David Sherman [UND SMHS

    2012-12-31

    A number of infectious agents have the potential of causing significant clinical symptomology and even death, but dispite this, the number of incidence remain below the level that supports producing a vaccine. Therapeutic antibodies provide a viable treatment option for many of these diseases. We proposed that antibodies derived from West Nile Virus (WNV) immunized geese would be able to treat WNV infection in mammals and potential humans. We demonstrated that WNV specific goose antibodies are indeed successful in treating WNV infection both prophylactically and therapeutically in a golden hamster model. We demonstrated that the goose derived antibodies are non-reactogenic, i.e. do not cause an inflammatory response with multiple exposures in mammals. We also developed both a specific pathogen free facility to house the geese during the antibody production phase and a patent-pending purification process to purify the antibodies to greater than 99% purity. Therefore, the success of these study will allow a cost effective rapidly producible therapeutic toward clinical testing with the necessary infrastructure and processes developed and in place.

  2. Public affairs plan

    International Nuclear Information System (INIS)

    1995-09-01

    The purpose of the Uranium Mill Tailings Remedial Action (UMTRA) Project Public Affairs Plan is to establish goals for the fiscal year (FY) 1996 UMTRA Project public affairs program and to identify specific activities to be conducted during the year. It describes the roles of various agencies involved in the public affairs program and defines the functions of the UMTRA Project Technical Assistance Contractor (TAC) Public Affairs Department. It replaces the FY 1995 Public Affairs Plan (DOE/AL/62350-154). The plan also describes the US Department of Energy's (DOE) plans to keep stakeholders and other members of the public informed about UMTRA Project policies, plans, and activities, and provide opportunities for stakeholders and interested segments of the public to participate in UMTRA Project decision-making processes. The plan applies to the UMTRA Project Team; the DOE Grand Junction Projects Office (GJPO); the DOE Albuquerque Operations Office, Office of Public Affairs (OPA); the TAC; the UMTRA Project Remedial Action Contractor (RAC); and other cooperating agencies

  3. Making training decisions proactively

    International Nuclear Information System (INIS)

    Hartman, R.F.

    1988-01-01

    The challenge of making training decisions with a high degree of confidence as to the results of those decisions face every DOD, Federal, State, and City agency. Training has historically been a very labor and paper intensive system with limited automation support. This paper outlines how one DOD component, the Air Force, is approaching that challenge. The Training Decision System (TDS) will provide the Air Force with an automated decision aid to help plan and estimate the consequences of various mixes of resident training, On-The-Job Training (OJT), and field training within a specialty such as security. The system described provides training from enlistment to separation and responds to hundreds of related security task needs. This system identifies what the tasks are, who should provide the training, what training setting should be used, what proficiency should be achieved, and through computer modeling provides an assessment of training effectiveness options and estimate the impact of implementing those options. With current budgetary constraints and with the possibility of further reductions in the future, the most cost effective training mix must be found to sustain required capabilities

  4. Planning for seven generations: Energy planning of American Indian tribes

    International Nuclear Information System (INIS)

    Brookshire, Daniel; Kaza, Nikhil

    2013-01-01

    The prevalence of energy resources on American Indian lands, the links between energy management and tribal sovereignty, and recent federal government incentives make tribal energy planning an interesting case study for community energy planning in the US. This paper studies the strategic energy planning efforts, energy resource development, and energy efficiency policies established by tribes within the continental US. The paper analyzes the results of a survey of various tribes′ energy resource development and planning efforts and supplements the responses with publicly available information on resources, economics, and demographics. We find that incentives and advisory services from the federal government are key to developing the capacity of the tribes to pursue energy planning and energy resource development. These incentives largely avoid the misdeeds of past federal policy by promoting tribal control over energy planning and energy resource development efforts. Tribes with formal energy plans or visions are more likely to develop energy resources than tribes without them and are engaged in a more comprehensive and sustainable approach to energy resource development and energy efficiency. - Highlights: • American Indian tribal energy planning is an understudied topic. • Tribal energy planning is interconnected with tribal sovereignty and sustainability. • We report the results of a survey of energy planning and development efforts. • Federal Government assistance is critical to the efforts of the tribes. • Tribes with energy plans take a more comprehensive approach to energy resource development

  5. Acute Organophosphate Poisonings: Therapeutic Dilemmas and New Potential Therapeutic Agents

    International Nuclear Information System (INIS)

    Vucinic, S.; Jovanovic, D.; Vucinic, Z.; Todorovic, V.; Segrt, Z.

    2007-01-01

    It has been six decades since synthesis of organophosphates, but this chapter has not yet come to a closure. Toxic effects of organophosphates are well known and the current therapeutic scheme includes supportive therapy and antidotes. There is a dilemma on whether and when to apply gastric lavage and activated charcoal. According to Position Statement (by EAPCCT) it should be applied only if the patient presents within one hour of ingestion, with potentially lethal ingested dose. Atropine, a competitive antagonist of acetylcholine at m-receptors, which antagonizes bronchosecretion and bronchoconstriction, is the corner stone of acute organophosphate poisoning therapy. There were many attempts to find a more efficient drug, including glycopyrrolate which has been used even in clinical trials, but it still can not replace atropine. The only dilemma about atropine usage which still exists, concerns usage of high atropine dose and scheme of application. The most efficient atropinization is achieved with bolus doses of 1-2mg of atropine i.v push, with repeating the dose on each 5 minutes until signs of atropinization are registered. Diazepam, with its GABA stabilizing effect, reduces central nervous system damage and central respiratory weakness. Oximes reactivate phosphorylated acetylcholinesterase, which still has not gone ageing, reducing acetylcholine concentration and cholinergic crisis. These effects are clearly demonstrated in experimental conditions, but the clinical significance of oximes is still unclear and there are still those who question oxime therapy. For those who approve it, oxime dosage, duration of therapy, the choice of oxime for certain OP is still an open issue. We need new, more efficient antidotes, and those that are in use are only the small part of the therapy which could be used. Experimental studies show favorable therapeutic effect of many agents, but none of them has been introduced in standard treatment of OPI poisoning in the last 30

  6. Shared decision making

    Science.gov (United States)

    ... 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 ...

  7. Marketing plan

    OpenAIRE

    Jantunen, Essi; Hellman, Annika

    2012-01-01

    The aim of this bachelor’s thesis was to draw up an efficient marketing plan for Pohjolan Vihreä Polku Oy, which offers meeting and nature activity services. The company was in a process of conversion and needed a structured marketing plan. The objectives of the company were perceived through severe research. The main purposes of the marketing plan were to raise the visibility of the company and increase its clientele. The proposed marketing actions are also to be used to improve the company’...

  8. Ontological Planning

    Directory of Open Access Journals (Sweden)

    Ahmet Alkan

    2017-12-01

    • Is it possible to redefine ontology within the hierarchical structure of planning? We are going to seek answers to some of these questions within the limited scope of this paper and we are going to offer the rest for discussion by just asking them. In light of these assessments, drawing attention, based on ontological knowledge relying on the wholeness of universe, to the question, on macro level planning, of whether or not the ontological realities of man, energy and movements of thinking can provide macro data for planning on a universal level as important factors affecting mankind will be one of the limited objectives of the paper.

  9. Planning ahead

    Energy Technology Data Exchange (ETDEWEB)

    Davies, J. [Mintec Inc. (US)

    2004-09-01

    The paper presents a state-of-the-art mine planning program that facilitates data storage and provides easy access to essential mine information. MineSight from Mintec, Inc., and the addition MineSight 3D provide a powerful tool used by major coal companies worldwide, offering modelling of different deposit types and complete planning tools including advanced surface/surface and solid/surface intersection routines. The new MineSight Operations addition helps to streamline the planning process and store raw blasthole data (in acQuire) and essential cut attribute information. 12 figs.

  10. 1994 Site Development Plan: A plan with vision

    Energy Technology Data Exchange (ETDEWEB)

    1994-07-01

    The 1994 Lawrence Livermore National Laboratory Site Development Plan has been developed during a period of great change and uncertainty. Our goal is to make possible the best use of the Laboratory`s resources to meet shifting national priorities in the post-Cold War world. Site Planning is an important component of the overall Laboratory strategic planning process. This plan focuses on opportunities for the Laboratory as well as on key site development issues including facility construction, redevelopment and reuse, site accessibility, and security. A major challenge is to achieve sufficient stability in the site planning and execution so that the processes of construction can occur efficiently while at the same time providing sufficient flexibility in site facilities so that a range of changing national needs can be accommodated. We are closely coupled to the DOE strategic planning process to meet this challenge.

  11. Strategic Human Resource Planning in Academia

    Science.gov (United States)

    Ulferts, Gregory; Wirtz, Patrick; Peterson, Evan

    2009-01-01

    A strategic plan guides a college in successfully meeting its mission. Based on the strategic plan, a college can develop a human resource plan that will allow it to make management decisions in the present to support the future direction of the college. The overall purpose of human resource management is to: (1) ensure the organization has…

  12. Solid Waste Management Planning--A Methodology

    Science.gov (United States)

    Theisen, Hilary M.; And Others

    1975-01-01

    This article presents a twofold solid waste management plan consisting of a basic design methodology and a decision-making methodology. The former provides a framework for the developing plan while the latter builds flexibility into the design so that there is a model for use during the planning process. (MA)

  13. Recertification Project Plan

    International Nuclear Information System (INIS)

    2001-01-01

    The Waste Isolation Pilot Plant's (WIPP) Recertification Project was established to meet the requirement placed in the WIPP Land Withdrawal Act (LWA) to demonstrate WIPP's continued compliance with the Environmental Protection Agency's (EPA) disposal regulations at five-year intervals. This plan delineates the end goal of the effort, sets out interim goals, and offers up guiding assumptions. In general, it sets the overall direction for a highly complex and interdependent set of tasks leading to recertification of the repository in the spring of 2004. In addition, this plan establishes the institutional roles and responsibilities of WIPP project participants in the recertification effort and lays out a high-level schedule for producing the Compliance Recertification Application (CRA). Detailed plans from each organization supporting this project have been included with this document as attachments. Each participant plan provides significantly more detail with descriptions of activities that are designed to ensure a successful outcome. Woven throughout this plan are the elements of guidance and direction gained from technical exchanges with EPA managers and staff. An important principle on which this plan is built is that the process of recertification will not involve modification to the certification baseline, nor will it involve rule making of any kind. Only changes previously approved by the EPA will be detailed in the CRA. EPA-approved changes to the WIPP certification will be accepted through modification or will be approved through the annual change reporting process. For any compliance areas that have not changed since the submission of the Compliance Certification Application(CCA), these will merely be incorporated in the CRA by reference. The CRA will cover all information since the October 1996 submittal of the CCA. A second major principle on which this plan is built stems from the EPA WIPP Recertification Guidance. That guidance makes it clear that, if

  14. Statistical sampling plans

    International Nuclear Information System (INIS)

    Jaech, J.L.

    1984-01-01

    In auditing and in inspection, one selects a number of items by some set of procedures and performs measurements which are compared with the operator's values. This session considers the problem of how to select the samples to be measured, and what kinds of measurements to make. In the inspection situation, the ultimate aim is to independently verify the operator's material balance. The effectiveness of the sample plan in achieving this objective is briefly considered. The discussion focuses on the model plant

  15. Factor 4 planning

    International Nuclear Information System (INIS)

    Bariol-Mathais, Brigitte; Lavoillotte, Philippine; Gall-Sorrentino, Florence; Malez, Marianne; Sanna, Daniela; Marsauche, Maud; Marquet, Sarah; Debergue, Sophie; Aminu, Olufunmi; Bernard, Helene; Marchand, Jean-Michel; Blin, Frederic; Grange, Jerome; Caillierez, Sophie; Muller, Dania; Clement, Bob; Desire, Jean-Charles; Metais, Benedicte; Lannuzel, Philippe; Pezet-Kuhn, Murielle; Pons, Anne; Rivoire-Meley, Benedicte; Tissot, Heloise

    2015-07-01

    Factor 4 is the goal of cutting our greenhouse gas emissions by 75% by 2050. Achieving this objective will necessitate radical changes in our practices, in particular concerning transport and housing; the measures currently implemented, such as positive-energy buildings, low-impact mobility and eco-neighbourhoods, will not be enough to meet this goal. These measures must be conceived in the framework of broad territorial planning that integrates environmental and energy objectives far upstream. To this end, the French Environment and Energy Management Agency (ADEME) and the French network of Urban Planning Agencies (FNAU), pursuing their missions in their respective areas of competence, have joined forces to make infrastructure and land use planning an integral part of the environmental and energy transition process. In 2013, the two organisations signed a partnership agreement and compiled an inventory of practices that are relevant to Factor 4 planning. This work was led by Epures, Saint-etienne urban planning agency, along with FNAU, drawing upon the expertise of a dozen urban planning agencies in precursor territories. This inventory describes the stakes, resources and strengths for each territory, which have led to cross-sectoral territorial planning exercises with ambitious environmental and energy objectives; the importance of evaluation in attaining these goals is emphasised. Current experience, questions and available methodological tools are summarised in this document, to encourage territories and help them design their planning policies along a trajectory to achieve Factor 4 goals. The compilation also aims to be a contribution to the COP21 climate conference

  16. Individualised cancer therapeutics: dream or reality? Therapeutics construction.

    Science.gov (United States)

    Shen, Yuqiao; Senzer, Neil; Nemunaitis, John

    2005-11-01

    The analysis of DNA microarray and proteomic data, and the subsequent integration into functional expression sets, provides a circuit map of the hierarchical cellular networks responsible for sustaining the viability and environmental competitiveness of cancer cells, that is, their robust systematics. These technologies can be used to 'snapshot' the unique patterns of molecular derangements and modified interactions in cancer, and allow for strategic selection of therapeutics that best match the individual profile of the tumour. This review highlights technology that can be used to selectively disrupt critical molecular targets and describes possible vehicles to deliver the synthesised molecular therapeutics to the relevant cellular compartments of the malignant cells. RNA interference (RNAi) involves a group of evolutionarily conserved gene silencing mechanisms in which small sequences of double-stranded RNA or intrinsic antisense RNA trigger mRNA cleavage or translational repression, respectively. Although RNAi molecules can be synthesised to 'silence' virtually any gene, even if upregulated, a mechanism for selective delivery of RNAi effectors to sites of malignant disease remains challenging. The authors will discuss gene-modified conditionally replicating viruses as candidate vehicles for the delivery of RNAi.

  17. Report on the 2nd Research Coordination Meeting on The Development of Therapeutic Radiopharmaceuticals Based on 188Re and 90Y for Radionuclide. Working Document

    International Nuclear Information System (INIS)

    2010-01-01

    Radionuclide therapy is practiced for the treatment of malignant disorders of various organs and tissues as well as for treating certain other diseases such as rheumatoid arthritis. Advances in understanding tumor biology as well as developments in peptide chemistry and monoclonal antibody technology are opening new opportunities for the development of therapeutic radiopharmaceuticals, thereby widening the scope of radionuclide therapy. In addition, particulate based radiopharmaceuticals are useful for treating hepatocarcinoma as well as in radiation synovectomy. With the establishment of new products the demand and application of therapeutic nuclear medicine is expected to grow rapidly. While there are a large number of radioisotopes proposed for targeted therapy, practical considerations had been limiting the number of usable isotopes. Generator-produced radionuclides are an attractive option for the large scale on-site availability of therapeutic isotopes. The IAEA’s CRP on the ‘Development of generator technologies for therapeutic radionuclides’ (2004-2007) was successful in developing technologies for the preparation of 188 W/ 188 Re and 90 Sr/ 90 Y generators for eluting 188 Re and 90 Y of high radionuclidic and chemical purity usable for research applications in the development of therapeutic radiopharmaceuticals. The IAEA’s CRP on ‘The development of therapeutic radiopharmaceuticals based on 188 Re and 90 Y for radionuclide therapy’ was formulated to focus on enhancing the capacity of the 90 Sr/ 90 Y generator; to develop and validate quality control methods for the generator eluate; and to develop therapeutic radiopharmaceuticals based on 188 Re and 90 Y. The first RCM of the CRP was held in Polatom, Warsaw, Poland from 30 June to 4 July 2008. The meeting reviewed the work going on in the different participating laboratories, and the facilities, expertise and capabilities of the different participating groups, and formulated the work plan of

  18. Report on the 2{sup nd} Research Coordination Meeting on The Development of Therapeutic Radiopharmaceuticals Based on {sup 188}Re and {sup 90}Y for Radionuclide. Working Document

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2010-07-01

    participating groups, and formulated the work plan of the CRP. The work plan for the first 18 months of the CRP had three main components, which were split into several subprojects. The meeting report which was prepared post RCM and circulated among the participants gives details about the projects identified to be implemented during the CRP, the rationale for identification of the projects and a detailed work plan. During the RCM, subproject coordinators were identified with responsibility to liaise among the participating groups and monitor the progress of each sub project. An overall coordinator of the CRP was designated, whose responsibility was to liaise with the subproject coordinators. The overall coordinator was also to make six monthly reports on the progress of the CRP. The two six monthly reports thus prepared were circulated among all the CRP participants in order to disseminate the details of the work done in each laboratory. The second RCM of the CRP was held from 22 to 26 March 2010 at IAEA Head Quarters in Vienna. The purpose of the meeting was to review the progress of the work done in the first 18 months; to make necessary mid term corrections on the CRP’s implementation and to formulate the work plan for the second half of the CRP. This report gives the summary of the work done in each participating laboratory, the overall achievements in the first 18 months of the CRP, the work plan for the second part of the CRP as well as recommendations to the IAEA, detailing the participants’ inputs, for the implementation of the CRP.

  19. Therapeutic irradiation and brain injury

    International Nuclear Information System (INIS)

    Sheline, G.E.; Wara, W.M.; Smith, V.

    1980-01-01

    This is a review and reanalysis of the literature on adverse effects of therapeutic irradiation on the brain. Reactions have been grouped and considered according to time of appearance. The emphasis of the analysis is on delayed reactions, especially those that occur from a few months to several years after irradiation. All dose specifications were converted into equivalent megavoltage rads. The data were analyzed in terms of total dose, overall treatment time and number of treatment fractions. Also discussed were acute radiation reactions, early delayed radiation reactions, somnolence and leukoencephalopathy post-irradiation/chemotherapy and combined effects of radiation and chemotherapy

  20. Enactments in Psychoanalysis: Therapeutic Benefits.

    Science.gov (United States)

    Stern, Stanley

    The therapeutic benefits of enactments are addressed. Relevant literature reveals disparate conceptions about the nature and use of enactments. Clarification of the term is discussed. This analyst's theoretical and technical evolution is addressed; it is inextricably related to using enactments. How can it not be? A taxonomy of enactments is presented. The article considers that enactments may be fundamental in the evolution from orthodox to contemporary analytic technique. Assumptions underlying enactments are explored, as are guidelines for using enactments. Finally, the article posits that enactments have widened the scope of analysis and contributed to its vitality.

  1. Education plan

    International Nuclear Information System (INIS)

    Baur, J.

    1987-01-01

    There is pressing need for education of fusion people and those in the radiation effects community on the role of radiation hardening in radiation diagnostic. There is no plan at present to do this. The plan is to be proposed and developed. The education methods should include distribution of a primer, the proceedings of this workshop, and updated data compilations and talks by experts at the fusion labs, universities, and meetings

  2. business plan

    OpenAIRE

    Luzan, Dmitrij

    2009-01-01

    My thesis is dedicated to the business plan of the gastronomic facility. The thesis describes foundation of the company, analyses demand for the gastronomic services. The financial plan is being presented as well. The thesis includes the analysis of the company's environment, suppliers and customers. SWOT analysis, net present value analysis, index of the net present value and other ratio indexes are the parts of this thesis.

  3. Introduction of making of Micom robot

    International Nuclear Information System (INIS)

    Park, Sang Beom

    1991-01-01

    This book introduces micro robot like what is micro robot? mouse and cat, writing of plan of making, and tools for making, micom cat and mechanical cat, making of mechanical cat, sensor of CAT-3, software of CAT-3, motor and drive circuit of CAT-3, computer mouse of general system,, world of micro mouse, introduction of MICHI, sensor of MICHI, development of software like monitor function and communication program, related things of MICHI, advice for making of MICHI and arrangement of parts and program.

  4. Therapeutic conflicts in emergency department patients with multimorbidity: a cross-sectional study.

    Directory of Open Access Journals (Sweden)

    Stefan Markun

    Full Text Available Patients with multimorbidity are an increasing concern in healthcare. Clinical practice guidelines, however, do not take into account potential therapeutic conflicts caused by co-occurring medical conditions. This makes therapeutic decisions complex, especially in emergency situations.The aim of this study was to identify and quantify therapeutic conflicts in emergency department patients with multimorbidity.We reviewed electronic records of all patients ≥18 years with two or more concurrent active medical conditions, admitted from the emergency department to the hospital ward of the University Hospital Zurich in January 2009. We cross-tabulated all active diagnoses with treatments recommended by guidelines for each diagnosis. Then, we identified potential therapeutic conflicts and classified them as either major or minor conflicts according to their clinical significance.166 emergency inpatients with multimorbidity were included. The mean number of active diagnoses per patient was 6.6 (SD±3.4. We identified a total of 239 therapeutic conflicts in 49% of the of the study population. In 29% of the study population major therapeutic conflicts, in 41% of the patients minor therapeutic conflicts occurred.Therapeutic conflicts are common among multimorbid patients, with one out of two experiencing minor, and one out of three experiencing major therapeutic conflicts. Clinical practice guidelines need to address frequent therapeutic conflicts in patients with co-morbid medical conditions.

  5. Therapeutic conflicts in emergency department patients with multimorbidity: a cross-sectional study.

    Science.gov (United States)

    Markun, Stefan; Holzer, Barbara M; Rodak, Roksana; Kaplan, Vladimir; Wagner, Claudia C; Battegay, Edouard; Zimmerli, Lukas

    2014-01-01

    Patients with multimorbidity are an increasing concern in healthcare. Clinical practice guidelines, however, do not take into account potential therapeutic conflicts caused by co-occurring medical conditions. This makes therapeutic decisions complex, especially in emergency situations. The aim of this study was to identify and quantify therapeutic conflicts in emergency department patients with multimorbidity. We reviewed electronic records of all patients ≥18 years with two or more concurrent active medical conditions, admitted from the emergency department to the hospital ward of the University Hospital Zurich in January 2009. We cross-tabulated all active diagnoses with treatments recommended by guidelines for each diagnosis. Then, we identified potential therapeutic conflicts and classified them as either major or minor conflicts according to their clinical significance. 166 emergency inpatients with multimorbidity were included. The mean number of active diagnoses per patient was 6.6 (SD±3.4). We identified a total of 239 therapeutic conflicts in 49% of the of the study population. In 29% of the study population major therapeutic conflicts, in 41% of the patients minor therapeutic conflicts occurred. Therapeutic conflicts are common among multimorbid patients, with one out of two experiencing minor, and one out of three experiencing major therapeutic conflicts. Clinical practice guidelines need to address frequent therapeutic conflicts in patients with co-morbid medical conditions.

  6. EXETRA Perspectives: Concepts in Therapeutic Recreation.

    Science.gov (United States)

    Neal, Larry L.; Edginton, Christopher R.

    Fifteen papers address issues in therapeutic recreation for disabled persons from the perspectives of practitioners, educators, and students. The following papers are presented. "Therapeutic Recreation Service: The Past and Challenging Present" (H. Sessoms); "Therapeutic Recreatiion in an Era of Limits: A Crisis...A Challenge... An Opportunity"…

  7. Mycotic aneurysms : radiological diagnosis and therapeutic alternatives

    International Nuclear Information System (INIS)

    Urbano, J.; Arjonilla, M. A.

    2002-01-01

    To review mycotic aneurysms, their radiological diagnosis and therapeutic alternatives. Five men and a woman between 69 and 84 years old were diagnosed during the last 4 years with mycotic aneurysms. Three were in the aorta, one in the thoracic and two in the abdominal region; one was affecting the left primitive iliac artery, another the left popliteal artery and, in the last case, the medial cerebral artery. Hemo cultures were done on all patients. The surgical specimen was cultivated in 4. CAT was done on 5 patients, angiography on another five and Doppler ultrasound scan on two. Five patients showed positive hemo cultures and in two the surgical specimen culture was positive. The findings of the CAT were decisive in being able to suspect that the lesions were mycotic in nature. Three patients had to undergo emergency, expiring either in surgery or in postoperative care. One case was treated by means of aortic endo prosthesis, and one year later the patient remains asymptomatic. The cerebral aneurysm was embolized with metal coils and the patient remains asymptomatic three years later. The popliteal aneurysm underwent surgical intervention using an established protocol with good results. CAT is decisive in the diagnosis of mycotic aneurysms. Once detected, they must be treated without delay as their natural evolution is one of rapid expansion and rupture. Angiographies help in planning the treatment. Radiological intervention plays an important role in the treatment. (Author) 13 refs

  8. Scenario planning.

    Science.gov (United States)

    Enzmann, Dieter R; Beauchamp, Norman J; Norbash, Alexander

    2011-03-01

    In facing future developments in health care, scenario planning offers a complementary approach to traditional strategic planning. Whereas traditional strategic planning typically consists of predicting the future at a single point on a chosen time horizon and mapping the preferred plans to address such a future, scenario planning creates stories about multiple likely potential futures on a given time horizon and maps the preferred plans to address the multiple described potential futures. Each scenario is purposefully different and specifically not a consensus worst-case, average, or best-case forecast; nor is scenario planning a process in probabilistic prediction. Scenario planning focuses on high-impact, uncertain driving forces that in the authors' example affect the field of radiology. Uncertainty is the key concept as these forces are mapped onto axes of uncertainty, the poles of which have opposed effects on radiology. One chosen axis was "market focus," with poles of centralized health care (government control) vs a decentralized private market. Another axis was "radiology's business model," with one pole being a unified, single specialty vs a splintered, disaggregated subspecialty. The third axis was "technology and science," with one pole representing technology enabling to radiology vs technology threatening to radiology. Selected poles of these axes were then combined to create 3 scenarios. One scenario, termed "entrepreneurialism," consisted of a decentralized private market, a disaggregated business model, and threatening technology and science. A second scenario, termed "socialized medicine," had a centralized market focus, a unified specialty business model, and enabling technology and science. A third scenario, termed "freefall," had a centralized market focus, a disaggregated business model, and threatening technology and science. These scenarios provide a range of futures that ultimately allow the identification of defined "signposts" that can

  9. Medical decision making

    NARCIS (Netherlands)

    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,

  10. Diagnostic and therapeutic radiation exposure

    Energy Technology Data Exchange (ETDEWEB)

    Russell, W J [Radiation Effects Research Foundation, Hiroshima (Japan)

    1975-09-01

    Diagnostic and therapeutic radiology were studied as possible contaminants in the evaluations of A-bomb survivors in the ABCC-JNIH Adult Health Study for radiation effects. Hiroshima and Nagasaki subjects received X-ray examinations elsewhere within three months of their ABCC visits at rates of 23 and 12%, respectively. Medical X-ray examinations were more frequent among survivors than comparison subjects. Hiroshima and Nagasaki radiologic practice steadily increased since 1948, and differed markedly by city. From 1946-70 the Hiroshima and Nagasaki X-ray bone marrow doses were 2,300 and 1,000 g-rads, respectively. By 1970, cumulated medical X-ray doses approximated A-bomb doses at distances from the hypocenters of 2,000 m in Hiroshima and 2,800 m in Nagasaki. ABCC X-ray examination doses per subject are routinely updated for comparison with A-bomb doses. Each subject's reported fluoroscopy, photofluorography and radiation therapy exposure elsewhere are for future reference. Dental radiography, though increasing, was not currently an important contributor to survivors' overall exposure. Radiation therapy exposures of 137 subjects were confirmed, and doses estimated for most. Two-thirds the treatments were for malignancies; therapy differed markedly by city; and five cancers possibly arose from earlier radiation therapy. This underscores the importance of considering diagnostic and therapeutic radiology when attributing diseases to the atomic bombs.

  11. Therapeutic drug monitoring in pregnancy.

    Science.gov (United States)

    Matsui, Doreen M

    2012-10-01

    Therapeutic drug monitoring (TDM) is commonly recommended to optimize drug dosing regimens of various medications. It has been proposed to guide therapy in pregnant women, in whom physiological changes may lead to altered pharmacokinetics resulting in difficulty in predicting the appropriate drug dosage. Ideally, TDM may play a role in enhancing the effectiveness of treatment while minimizing toxicity of both the mother and fetus. Monitoring of drug levels may also be helpful in assessing adherence to prescribed therapy in selected cases. Limitations exist as therapeutic ranges have only been defined for a limited number of drugs and are based on data obtained in nonpregnant patients. TDM has been suggested for anticonvulsants, antidepressants, and antiretroviral drugs, based on pharmacokinetic studies that have shown reduced drug concentrations. However, there is only relatively limited (and sometimes inconsistent) information regarding the clinical impact of these pharmacokinetic changes during pregnancy and the effect of subsequent dose adjustments. Further studies are required to determine whether implementation of TDM during pregnancy improves outcome and is associated with any benefit beyond that achieved by clinical judgment alone. The cost effectiveness of TDM programs during pregnancy also remains to be examined.

  12. A Method for Automated Planning of FTTH Access Network Infrastructures

    DEFF Research Database (Denmark)

    Riaz, Muhammad Tahir; Pedersen, Jens Myrup; Madsen, Ole Brun

    2005-01-01

    In this paper a method for automated planning of Fiber to the Home (FTTH) access networks is proposed. We introduced a systematic approach for planning access network infrastructure. The GIS data and a set of algorithms were employed to make the planning process more automatic. The method explains...... method. The method, however, does not fully automate the planning but make the planning process significantly fast. The results and discussion are presented and conclusion is given in the end....

  13. Contrast-Enhanced Ultrasound Guided Biopsy of Undetermined Abdominal Lesions: A Multidisciplinary Decision-Making Approach

    Directory of Open Access Journals (Sweden)

    Feng Mao

    2017-01-01

    Full Text Available Aim. To investigate the value of contrast-enhanced ultrasound (CEUS guided biopsy of undetermined abdominal lesions in multidisciplinary treatment (MDT decision-making approach. Methods. Between Jan 2012 and Dec 2015, 60 consecutive patients (male, 37; female, 23; mean age, 51.3 years ± 14.6 who presented with undetermined abdominal lesions were included. CEUS and core needle percutaneous biopsy was performed under real-time CEUS guidance in all lesions. Data were recorded and compared with conventional ultrasound (US guidance group (n=75. All CEUS findings and clinical data were evaluated in MDT. Results. CEUS enabled the delimitation of more (88.3% versus 41.3% and larger (14.1 ± 10.7 mm versus 32.3 ± 18.5 mm nonenhanced necrotic areas. More inner (20.0% versus 6.7% and surrounding (18.3% versus 2.7% major vessels were visualized and avoided during biopsies. CEUS-guided biopsy increased the diagnostic accuracy from 93.3% to 98.3%, with correct diagnosis in 57 of 60 lesions (95.0%. The therapeutic plan was influenced by CEUS guided biopsies findings in the majority of patients (98.3%. Conclusion. The combination of CEUS guided biopsy and MDT decision-making approach is useful in the diagnostic work-up and therapeutic management.

  14. Contrast-Enhanced Ultrasound Guided Biopsy of Undetermined Abdominal Lesions: A Multidisciplinary Decision-Making Approach.

    Science.gov (United States)

    Mao, Feng; Dong, Yi; Ji, Zhengbiao; Cao, Jiaying; Wang, Wen-Ping

    2017-01-01

    Aim. To investigate the value of contrast-enhanced ultrasound (CEUS) guided biopsy of undetermined abdominal lesions in multidisciplinary treatment (MDT) decision-making approach. Methods. Between Jan 2012 and Dec 2015, 60 consecutive patients (male, 37; female, 23; mean age, 51.3 years ± 14.6) who presented with undetermined abdominal lesions were included. CEUS and core needle percutaneous biopsy was performed under real-time CEUS guidance in all lesions. Data were recorded and compared with conventional ultrasound (US) guidance group ( n = 75). All CEUS findings and clinical data were evaluated in MDT. Results. CEUS enabled the delimitation of more (88.3% versus 41.3%) and larger (14.1 ± 10.7 mm versus 32.3 ± 18.5 mm) nonenhanced necrotic areas. More inner (20.0% versus 6.7%) and surrounding (18.3% versus 2.7%) major vessels were visualized and avoided during biopsies. CEUS-guided biopsy increased the diagnostic accuracy from 93.3% to 98.3%, with correct diagnosis in 57 of 60 lesions (95.0%). The therapeutic plan was influenced by CEUS guided biopsies findings in the majority of patients (98.3%). Conclusion. The combination of CEUS guided biopsy and MDT decision-making approach is useful in the diagnostic work-up and therapeutic management.

  15. Is Real-World Evidence Used in P&T Monographs and Therapeutic Class Reviews?

    Science.gov (United States)

    Hurwitz, Jason T; Brown, Mary; Graff, Jennifer S; Peters, Loretta; Malone, Daniel C

    2017-06-01

    Payers are faced with making coverage and reimbursement decisions based on the best available evidence. Often these decisions apply to patient populations, provider networks, and care settings not typically studied in clinical trials. Treatment effectiveness evidence is increasingly available from electronic health records, registries, and administrative claims. However, little is known about when and what types of real-world evidence (RWE) studies inform pharmacy and therapeutic (P&T) committee decisions. To evaluate evidence sources cited in P&T committee monographs and therapeutic class reviews and assess the design features and quality of cited RWE studies. A convenience sample of representatives from pharmacy benefit management, health system, and health plan organizations provided recent P&T monographs and therapeutic class reviews (or references from such documents). Two investigators examined and grouped references into major categories (published studies, unpublished studies, and other/unknown) and multiple subcategories (e.g., product label, clinical trials, RWE, systematic reviews). Cited comparative RWE was reviewed to assess design features (e.g., population, data source, comparators) and quality using the Good ReseArch for Comparative Effectiveness (GRACE) Checklist. Investigators evaluated 565 references cited in 27 monographs/therapeutic class reviews from 6 managed care organizations. Therapeutic class reviews mostly cited published clinical trials (35.3%, 155/439), while single-product monographs relied most on manufacturer-supplied information (42.1%, 53/126). Published RWE comprised 4.8% (21/439) of therapeutic class review references, and none (0/126) of the monograph references. Of the 21 RWE studies, 12 were comparative and assessed patient care settings and outcomes typically not included in clinical trials (community ambulatory settings [10], long-term safety [8]). RWE studies most frequently were based on registry data (6), conducted in

  16. Energy planning and management plan

    International Nuclear Information System (INIS)

    1996-01-01

    This paper contains printed copies of 60FR 53181, October 12, 1995 and 60 FR 54151. This is a record of decision concerning the Western Area Power Administration's final draft and environmental impact statement, and Energy Planning and Management Program

  17. Environmental Implementation Plan

    International Nuclear Information System (INIS)

    1994-02-01

    The Environmental Implementation Plan (EIP) is a dynamic long-range environmental-protection plan for SRS. The EIP communicates the current and future (five year) environmental plans from individual organizations and divisions as well as site environmental initiatives which are designed to protect the environment and meet or exceed compliance with changing environmental/ regulatory requirements. Communication with all site organizations is essential for making the site environmental planning process work. Demonstrating environmental excellence is a high priority embodied in DOE and WSRC policy. Because of your support and participation in the three EIP initiatives; Reflections, Sectional Revision, and Integrated Planning, improvements are being made to the EIP and SRS environmental protection programs. I appreciate the ''Partnership in Environmental Excellence'' formed by the environmental coordinators and professionals who work daily toward our goal of compliance and environmental excellence. I look forward to seeing continued success and improvement in our environmental protection programs through combined efforts of all site organizations to protect our employees, the public health, and the environment. Together, we will achieve our site vision for SRS to be the recognized model for Environmental Excellence in the DOE Nuclear Weapons Complex

  18. Environmental Implementation Plan

    Energy Technology Data Exchange (ETDEWEB)

    1994-02-01

    The Environmental Implementation Plan (EIP) is a dynamic long-range environmental-protection plan for SRS. The EIP communicates the current and future (five year) environmental plans from individual organizations and divisions as well as site environmental initiatives which are designed to protect the environment and meet or exceed compliance with changing environmental/ regulatory requirements. Communication with all site organizations is essential for making the site environmental planning process work. Demonstrating environmental excellence is a high priority embodied in DOE and WSRC policy. Because of your support and participation in the three EIP initiatives; Reflections, Sectional Revision, and Integrated Planning, improvements are being made to the EIP and SRS environmental protection programs. I appreciate the ``Partnership in Environmental Excellence`` formed by the environmental coordinators and professionals who work daily toward our goal of compliance and environmental excellence. I look forward to seeing continued success and improvement in our environmental protection programs through combined efforts of all site organizations to protect our employees, the public health, and the environment. Together, we will achieve our site vision for SRS to be the recognized model for Environmental Excellence in the DOE Nuclear Weapons Complex.

  19. Public Information Plan

    International Nuclear Information System (INIS)

    1984-06-01

    The Public Information Plan is intended to be used in conjunction with the DOE-UMTRA Project ''Public Participation Plan'' to describe the Department of Energy's plan for involving the public in the decision-making process related to the Uranium Mill Tailings Remedial Action (UMTRA) Project. This project was authorized by Congress in the Uranium Mill Tailings Radiation Control of Act of 1978, PL95-604. The Act provides for a cooperative effort with affected states and Indian tribes for the cleanup of designated abandoned or inactive uranium mill tailings sites. The objective of the Public Information Plan of the UMTRA Project is timely and sufficient dissemination of factual information to promote understanding of the project by federal, state, and local officials, the media, special interest groups, and the general public; and thereby to encourage informed participation in the project by the public and government officials. The Uranium Mill Tailings Radiation Control Act provides for public involvement in remedial action planning, with special consideration given to landowners, Indian tribes, and the states. According to the Act, the Secretary of Energy shall hold public hearings in the states where processing sites, vicinity properties, and disposal sites are located. Public participation in the UMTRA Project will not, however, be limited to those mechanisms formally required by law. The public may also be involved informally through informational meetings, workshops, and local citizens' task forces. 12 refs., 2 figs., 1 tab

  20. Decision Making and Cancer

    OpenAIRE

    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...